An ultrasound negative for subclinical synovitis in arthralgia patients: is it helpful in identifying those not developing arthritis?

Cleo Rogier*, Giulia Frazzei, Marion C. Kortekaas, Marloes Verstappen, Sarah Ohrndorf, Elise van Mulligen, Ronald F. van Vollenhoven, Dirkjan van Schaardenburg, Pascal H.P. de Jong, Annette H.M. van der Helm-van Mil

*Corresponding author for this work

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OBJECTIVE: To investigate the negative predictive value (NPV) of musculoskeletal US (MSUS) in arthralgia patients at risk for developing inflammatory arthritis. METHODS: An MSUS examination of hands and feet was performed in arthralgia patients at risk for inflammatory arthritis in four independent cohorts. Patients were followed for one-year on the development of inflammatory arthritis. Subclinical synovitis was defined as greyscale ≥2 and/or power Doppler ≥1. NPVs were determined and compared with the prior risks of not developing inflammatory arthritis. Outcomes were pooled using meta-analyses and meta-regression analyses. In sensitivity analyses, MSUS imaging of tender joints only (rather than the full US protocol) was analysed and ACPA stratification applied. RESULTS: After 1 year 78, 82, 77 and 72% of patients in the four cohorts did not develop inflammatory arthritis. The NPV of a negative US was 86, 85, 82 and 90%, respectively. The meta-analysis showed a pooled non-inflammatory arthritis prevalence of 79% (95% CI 75%, 83%) and a pooled NPV of 86% (95% CI 81, 89%). Imaging tender joints only (as generally done in clinical practice) and ACPA stratification showed similar results. CONCLUSION: A negative US result in arthralgia has a high NPV for not developing inflammatory arthritis, which is mainly due to the high a priori risk of not developing inflammatory arthritis. The added value of a negative US (<10% increase) was limited.

Original languageEnglish
Pages (from-to)4892-4897
Number of pages6
JournalRheumatology (Oxford, England)
Issue number12
Early online date13 Apr 2022
Publication statusPublished - Dec 2022

Bibliographical note

The research leading to these results has
received funding from: Dutch Arthritis Foundation
(SONAR cohort, clinically suspect arthralgia Leiden cohort, Amsterdam cohort, clinically suspect arthralgia
Rotterdam), The European Research Council (ERC)
under the European Union’s Horizon 2020 research and
innovation programme (starting grant, agreement no.
714312) (clinically suspect arthralgia Leiden cohort).

Publisher Copyright:
© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology.


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