Ultrasound More Accurate Diagnosis of Hand Osteoarthritis Than Radiography

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Clinicians face difficulty differentiating between osteoarthritis and other hand arthropathies, particularly when the clinical examination is equivocal.
Clinicians face difficulty differentiating between osteoarthritis and other hand arthropathies, particularly when the clinical examination is equivocal.

Researchers have found that ultrasound examination of the hands can identify osteoarthritis in patients who do not fulfill American College of Rheumatology (ACR) criteria by identifying osteophytes in the distribution and number required for diagnosis. These findings were presented at the 2017 Annual European Congress of Rheumatology Meeting (EULAR) held June 14-17 in Madrid, Spain.

Coziana Ciurtin, PhD, from University College London Hospitals NHS Foundation Trust in London, United Kingdom and colleagues conducted a cross-sectional study that included 62 patients who were ultimately diagnosed with osteoarthritis according to ACR criteria. The researchers compared the 34 joint score of the hand with smaller, pre-defined joint scores, which included 2 scores of 22 and 12 joints each, as well as other scores that included 10 and 6 joints. They also correlated the ultrasound findings with the radiographic scores (2108 joints).

The researchers found that the radiographic osteophyte scores correlated well with the predefined ultrasound scores (R=0.381 to 0.645, P <.05), despite having a low sensitivity for detecting osteophytes (58.6%) and an even lower sensitivity for detecting erosions (38.4%) when compared with the 34-joint ultrasound scores.

The different ultrasound scores correlated well (R = 0.53 to 0.97, P <.05), other than the 6-joint score that excluded the proximal interphalangeal joints (R= -0181 to 0.207, P >.05).

“In a real-life context, clinicians face difficulty in differentiating between [osteoarthritis] and other hand arthropathies, particularly when the clinical examination is equivocal (eg, no obvious bony enlargement with the characteristic distribution for hand OA).”

“[Ultrasound] examination of the hands can facilitate the diagnosis of hand [osteoarthritis] in patients who do not fulfill the ACR criteria, by identifying the presence of osteophytes with the particular distribution and number required for diagnosis in a proportion of patients that was 3 times higher than that of patients diagnosed based on clinical examination and hand radiography alone,” the researchers concluded.

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Reference

Hussain S, Sivakumaran P, Ciurtin C. Ultrasound hand examination is more sensitive in diagnosing hand osteoarthritis than conventional radiography: comparison between different ultrasonographic scores. Presented at: The Annual European Congress of Rheumatology Meeting (EULAR). June 14-17, 2017; Madrid, Spain. Abstract FRI0627. doi:10.1136/annrheumdis-2017-eular.2713 

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