Positive Squeeze Test Supports the Diagnosis of Subclinical Synovitis

In patients with arthralgia suspicious for progression of rheumatoid arthritis (RA), a positive squeeze test doubles the probability of presence of subclinical synovitis, according to a letter to the editor published in Rheumatology.

Previous studies described an association between a positive squeeze test with the presence of local inflammation on magnetic resonance imaging (MRI) and swollen metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints in patients with early arthritis. The goal of the current study was to investigate the association between a positive squeeze test in patients with clinically suspect arthralgia with subclinical inflammation.

The study cohort included 315 subjects with recent-onset arthralgia of small joints and a clinical suspicion for progression to RA. All participants had a squeeze test performed at baseline with compression across the knuckles of MCP and MTP joints. In addition, MRI of MCP (2-5) and MTP (1-5) joints was performed at baseline and scored by 2 trained readers for synovitis and tenosynovitis.

A positive squeeze test in MCP or MTP joints was evident in approximately half (51%) of the study participants with clinically suspect arthralgia and was associated with almost a 2-fold increased probability for local subclinical synovitis (adjusted odds ratio 1.90; 95 CI, 1.16-3.13). The sensitivity of a positive squeeze test for subclinical synovitis was 44% (95% CI, 33-55%) and the specificity was 72% (95% CI, 68-76%).

There was no association between a positive squeeze test and subclinical synovitis with progression to inflammatory arthritis, in contrast to tenosynovitis.

“[T]he squeeze test is a simple test that, when positive in CSA [clinically suspect arthralgia], doubles the probability of presence of subclinical synovitis,” concluded the researchers.

Reference

Wouters F, Niemantsverdriet E, van der Helm-van Mil AHM. The value of the squeeze test for detection of subclinical synovitis in patients with arthralgia suspicious for progression to RA [published online Mar 16, 2020]. Rheumatology (Oxford). doi:10.1093/rheumatology/keaa082