Introduction
Materials and methods
Patients
Ultrasonography
Ultrasonography parameters
Magnetic resonance imaging
Magnetic resonance imaging parameters
Projection radiography
Clinical examination
Statistical analysis
Results
Ultrasonography observations in PsA and RA patients and CTRLs
All | Psoriasis-associated arthritis | Rheumatoid arthritis | Healthy control persons | |
---|---|---|---|---|
Bone erosions | ||||
MCP joint | 12% | 13% | 18% | 3% |
PIP joint | 12% | 14% | 3% | 13% |
DIP joint | 3% | 4% | 0% | 0% |
MTP joint | 15% | 15% | 24% | 6% |
Bone proliferations | ||||
MCP joint | 4% | 6% | 0% | 0% |
PIP joint | 8% | 12% | 3% | 0% |
DIP joint | 9% | 13% | 0% | 5% |
MTP joint | 5% | 5% | 4% | 6% |
Synovitis | ||||
MCP joint | 22% | 19% | 50% | 3% |
PIP joint | 13% | 13% | 23% | 3% |
DIP joint | 18% | 22% | 23% | 3% |
MTP joint | 44% | 43% | 56% | 34% |
Tenosynovitis | ||||
MCP joint | 7% | 4% | 23% | 0% |
PIP joint | 18% | 16% | 40% | 0% |
DIP joint | 6% | 2% | 20% | 3% |
Insertional changes | ||||
Extensor tendons | 8% | 12% | 3% | 3% |
Flexor tendons | 8% | 7% | 18% | 0% |
Capsular/extracapsular changes | 9% | 7% | 25% | 0% |
Observations by ultrasonography, MRI, and x-ray in the MRI-examined hand
Ultrasonography | MRI | X-ray | |
---|---|---|---|
Bone erosions | |||
MCP joint (total) | 15% | 16% | 7% |
PsA | 18% | 23% | 12% |
RA | 15% | 10% | 0% |
PIP joint (total) | 15% | 7% | 5% |
PsA | 20% | 8% | 7% |
RA | 0% | 10% | 5% |
DIP joint (total) | 1% | 3% | 5% |
PsA | 2% | 5% | 8% |
RA | 0% | 0% | 0% |
Bone proliferations | |||
MCP joint (total) | 4% | 3% | 0% |
PsA | 7% | 5% | 0% |
RA | 0% | 0% | 0% |
PIP joint (total) | 7% | 6% | 0% |
PsA | 12% | 10% | 0% |
RA | 0% | 0% | 0% |
DIP joint (total) | 7% | 2% | 4% |
PsA | 12% | 3% | 7% |
RA | 0% | 0% | 0% |
Synovitis | |||
MCP joint (total) | 28% | 27% | NA |
PsA | 28% | 35% | NA |
RA | 55% | 30% | NA |
PIP joint (total) | 22% | 20% | NA |
PsA | 27% | 23% | NA |
RA | 30% | 25% | NA |
DIP joint (total) | 12% | 5% | NA |
PsA | 18% | 7% | NA |
RA | 5 % | 5% | NA |
Tenosynovitis | |||
MCP joint (total) | 6% | 13% | NA |
PsA | 2% | 12% | NA |
RA | 25% | 30% | NA |
PIP joint (total) | 20% | 7% | NA |
PsA | 18% | 5% | NA |
RA | 45% | 20% | NA |
DIP joint (total) | 6% | 6% | NA |
PsA | 2% | 3% | NA |
RA | 25% | 20% | NA |
Insertional changes | |||
Extensor tendons (total) | 6% | 4% | NA |
PsA | 8% | 7% | NA |
RA | 5% | 0% | NA |
Flexor tendons (total) | 9% | 4% | NA |
PsA | 3% | 0% | NA |
RA | 35% | 20% | NA |
Capsular/extracapsular changes (total) | 18% | 7% | NA |
PsA | 22% | 7% | NA |
RA | 25% | 15% | NA |
Ultrasonography interobserver agreement
US1 versus US2 | US versus MRI | US versus x-ray | MRI versus x-ray | |
---|---|---|---|---|
Bone erosions | ||||
MCP joint (total) | 95%; κ = 0.795 | 87%; κ = 0.504 | 89%; κ = 0.268 | 89%; κ = 0.470 |
PsA | 95%; κ = 0.830 | 85%; κ = 0.547 | 88%; κ = 0.358 | 85%; κ = 0.492 |
RA | 88%; κ = 0.600 | 85%; κ = 0.318 | 83%; κ = NA | 90%; κ = NA |
CTRL | 100%; κ = NA | 95%; κ = NA | 95%; κ = NA | 100%; κ = NA |
PIP joint (total) | 86%; κ = 0.522 | 86%; κ = 0.296 | 87%; κ = 0.361 | 92%; κ = 0.292 |
PsA | 83%; κ = 0.526 | 85%; κ = 0.400 | 85%; κ = 0.411 | 88%; κ = 0.160 |
RA | 100%; κ = NA | 90%; κ = NA | 93%; κ = 0.375 | 95%; κ = 0.643 |
CTRL | 88%; κ = NA | 85%; κ = NA | 88%; κ = NA | 100%; κ = NA |
DIP joint (total) | 100%; κ = 1.000 | 96%; κ = -0.015 | 96%; κ = 0.506 | 96%; κ = 0.481 |
PsA | 100%; κ = 1.000 | 93%; κ = -0.026 | 93%; κ = 0.527 | 93%; κ = 0.467 |
RA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA |
CTRL | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA |
MTP joint (total) | 90%; κ = 0.702 | - | 89%; κ = 0.259 | - |
PsA | 90%; κ = 0.799 | - | 89%; κ = 0.378 | - |
RA | 100%; κ = 1.000 | - | 78%; κ = -0.084 | - |
CTRL | 90%; κ = 0.783 | - | 100%; κ = NA | - |
Bone proliferations | ||||
MCP joint (total) | 97%; κ = 0.783 | 93%; κ = -0.036 | 96%; κ = NA | 97%; κ = NA |
PsA | 95%; κ = 0.776 | 88%; κ = -0.061 | 94%; κ = NA | 95%; κ = NA |
RA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA |
CTRL | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA |
PIP joint (total) | 92%; κ = 0.665 | 93%; κ = 0.424 | 93%; κ = 0.117 | 94%; κ = NA |
PsA | 89%; κ = 0.648 | 88%; κ = 0.397 | 89%; κ = 0.120 | 90%; κ = NA |
RA | 100%; κ = NA | 100%; κ = NA | 98%; κ = NA | 100%; κ = NA |
CTRL | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA |
DIP joint (total) | 95%; κ = 0.851 | 95%; κ = 0.427 | 94%; κ = 0.472 | 98%; κ = 0.658 |
PsA | 94%; κ = 0.838 | 92%; κ = 0.414 | 91%; κ = 0.476 | 97%; κ = 0.651 |
RA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA | 100%; κ = NA |
CTRL | 100%; κ = NA | 100%; κ = NA | 95%; κ = NA | 100%; κ = NA |
MTP joint (total) | 93%; κ = 0.515 | - | 99%; κ = NA | - |
PsA | 92%; κ = 0.250 | - | 98%; κ = NA | - |
RA | 100%; κ = 1.000 | - | 100%; κ = NA | - |
CTRL | 100%; κ = NA | - | 100%; κ = NA | - |
US1 versus US2 | US versus MRI | USa versus clinical examinationb | MRIc versus clinical examinationb | |
---|---|---|---|---|
Synovitis | ||||
MCP joint (total) | 88%; κ = 0.305 | 83%; κ = 0.574 | 62%; κ = -0.033 | 63%; κ = 0.047 |
PsA | 84%; κ = 0.280 | 80%; κ = 0.540 | 62%; κ = 0.047 | 64%; κ = 0.131 |
RA | 100%; κ = NA | 75%; κ = 0.519 | 63%; κ = -0.007 | 60%; κ = 0.091 |
CTRL | 100%; κ = NA | 100%; κ = NA | 63%; κ = NA | 100%; κ = NA |
PIP joint (total) | 78%; κ = 0.361 | 78%; κ = 0.337 | 66%; κ = NA | 66%; κ = 0.012 |
PsA | 84%; κ = 0.367 | 73%; κ = 0.290 | 64%; κ = -0.053 | 68%; κ = 0.149 |
RA | 50%; κ = 0.059 | 75%; κ = 0.375 | 63%; κ = 0.162 | 50%; κ = -0.190 |
CTRL | 100%; κ = NA | 95%; κ = NA | 73%; κ = NA | 95%; κ = NA |
DIP joint (total) | 83%; κ = 0.129 | 87%; κ = 0.177 | 74%; κ = -0.020 | 79%; κ = -0.082 |
PsA | 84%; κ = 0.120 | 78%; κ = 0.039 | 72%; κ = 0.041 | 68%; κ = -0.098 |
RA | 100%; κ = NA | 100%; κ = 1.000 | 83%; κ = -0.077 | 90%; κ = -0.053 |
CTRL | 100%; κ = NA | 100%; κ = NA | 73%; κ = NA | 100%; κ = NA |
MTP joint (total) | 91%; κ = 0.825 | - | 51%; κ = -0.063 | - |
PsA | 90%; κ = 0.799 | - | 55%; κ = -0.038 | - |
RA | 100%; κ = 1.000 | - | 52%; κ = -0.034 | - |
CTRL | 90%; κ = 0.783 | - | 38%; κ = NA | - |
Tenosynovitis | ||||
MCP joint (total) | 93%; κ = -0.034 | 91%; κ = 0.484 | - | - |
PsA | 91%; κ = -0.048 | 90%; κ = 0.227 | - | - |
RA | 100%; κ = NA | 85%; κ = 0.625 | - | - |
CTRL | 100%; κ = NA | 100%; κ = NA | - | - |
PIP joint (total) | 87%; κ = -0.029 | 96%; κ = 0.645 | - | - |
PsA | 89%; κ = -0.035 | 87%; κ = 0.380 | - | - |
RA | 63%; κ = NA | 75%; κ = 0.468 | - | - |
CTRL | 100%; κ = NA | 100%; κ = NA | - | - |
DIP joint (total) | 97%; κ = NA | 96%; κ = 0.645 | - | - |
PsA | 98%; κ = NA | 98%; κ = 0.659 | - | - |
RA | 88%; κ = NA | 85%; κ = 0.571 | - | - |
CTRL | 100%; κ = NA | 100%; κ = NA | - | - |
Insertional changes | ||||
Extensor tendons (total) | 88%; κ = NA | 94%; κ = 0.370 | - | - |
PsA | 83%; κ = NA | 92%; κ = 0.400 | - | - |
RA | 100%; κ = NA | 95%; κ = NA | - | - |
CTRL | 100%; κ = NA | 100%; κ = NA | - | - |
Flexor tendons (total) | 98%; κ = NA | 95%; κ = 0.593 | - | - |
PsA | 98%; κ = NA | 97%; κ = NA | - | - |
RA | 100%; κ = NA | 85%; κ = 0.634 | - | - |
CTRL | 100%; κ = NA | 100%; κ = NA | - | - |
Capsular/extra-capsular changes | ||||
Total | 86%; κ = NA | 87%; κ = 0.511 | - | - |
PsA | 83%; κ = NA | 88%; κ = 0.410 | - | - |
RA | 88%; κ = NA | 90%; κ = 0.692 | - | - |
CTRL | 100%; κ = NA | 100%; κ = NA | - | - |
Agreement between ultrasonography, MRI, x-ray, and clinical examination
Sensitivities and specificities of ultrasonography, x-ray, and clinical examination, with MRI as standard reference method
US sensitivity | US specificity | X-ray sensitivity | X-ray specificity | Clinical examination sensitivity | Clinical examination specificity | |
---|---|---|---|---|---|---|
Bone erosions | ||||||
MCP joint | 0.56 | 0.93 | 0.38 | 0.99 | NA | NA |
PIP joint | 0.57 | 0.88 | 0.40 | 0.95 | NA | NA |
DIP joint | 0.00 | 0.99 | 0.67 | 0.97 | NA | NA |
Bone proliferations | ||||||
MCP joint | 0.00 | 0.97 | 0.00 | 0.96 | NA | NA |
PIP joint | 0.50 | 0.96 | 0.00 | 0.96 | NA | NA |
DIP joint | 1.00 | 0.95 | 1.00 | 0.98 | NA | NA |
Synovitis | ||||||
MCP joint | 0.70 | 0.88 | NA | NA | 0.31 | 0.74 |
PIP joint | 0.50 | 0.88 | NA | NA | 0.25 | 0.76 |
DIP joint | 0.40 | 0.87 | NA | NA | 0.00 | 0.83 |
Tenosynovitis | ||||||
MCP joint | 0.38 | 0.99 | NA | NA | NA | NA |
PIP joint | 1.00 | 0.86 | NA | NA | NA | NA |
DIP joint | 0.67 | 0.98 | NA | NA | NA | NA |
Insertional changes | ||||||
Extensor tendons | 0.50 | 0.96 | NA | NA | NA | NA |
Flexor tendons | 1.00 | 0.95 | NA | NA | NA | NA |
Capsular/extracapsular changes | 1.00 | 0.88 | NA | NA | NA | NA |