Ogasawara Michihiro, Murayama Go, Yamada Yusuke, Nemoto Takuya, Kageyama Michiaki, Toyama Shoko, Kusaoi Makio, Onuma Shin, Kon Takayuki, Sekiya Fumio, Sugimoto Kaoru, Matsudaira Ran, Matsushita Masakazu, Tada Kurisu, Kempe Kazuo, Yamaji Ken, Tamura Naoto, Takasaki Yoshinari
Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan.
J Rheumatol. 2012 Jun;39(6):1207-14. doi: 10.3899/jrheum.111433. Epub 2012 May 15.
Joint swelling, an important factor in the classification criteria and disease activity assessment in rheumatoid arthritis (RA), renders joint palpation a necessary skill for physicians. Ultrasound (US) examination that visualizes soft tissue abnormalities is now used to assess musculoskeletal disease. We assessed the usefulness of US assessments in enhancing physical joint examination skills.
We examined 1944 joints (bilateral shoulder, elbow, wrist, metacarpophalangeal joints 1-5, and knee joints) in 108 patients with RA during April-July 2011. We first physically examined and confirmed joint swelling; subsequently, the same rheumatologist conducted US examinations and multiple assessors graded the joint swelling. When the 2 results differed, we received autofeedback from the US results to improve the physical examination skills.
The sensitivities and specificities of physical examination for US-detected swollen joint, the correlation coefficient (CC) of the swollen joint counts, and the concordance rate in each patient for joint swelling sites and power Doppler (PD)-positive sites with the κ coefficients between the physical and US examinations were compared over time. We found that the sensitivity of physical examination increased by 42 percentage points (pp), while the specificity decreased by 18 pp. The average CC in June-July was greater than that in April-May. The percentage of κ coefficients > 0.8 increased from 8.8% to 17% for joint swelling and from 8.3% to 14% for PD-positive sites.
Our results suggest that autofeedback from US assessment provides quick improvement in palpation skills for identifying joint swelling in patients with RA.
关节肿胀是类风湿关节炎（RA）分类标准和疾病活动度评估中的一个重要因素，这使得关节触诊成为医生必备的技能。能可视化软组织异常的超声（US）检查现被用于评估肌肉骨骼疾病。我们评估了超声评估在提高物理关节检查技能方面的实用性。
2011年4月至7月期间，我们对108例类风湿关节炎患者的1944个关节（双侧肩部、肘部、腕部、第1 - 5掌指关节和膝关节）进行了检查。我们首先进行体格检查并确认关节肿胀；随后，同一位风湿病学家进行超声检查，多名评估人员对关节肿胀进行分级。当两种结果不同时，我们从超声结果中获得自动反馈以提高体格检查技能。
比较了体格检查对超声检测到的肿胀关节的敏感性和特异性、肿胀关节计数的相关系数（CC）、每位患者关节肿胀部位和能量多普勒（PD）阳性部位的一致性率以及体格检查和超声检查之间的κ系数。我们发现体格检查的敏感性提高了42个百分点（pp），而特异性降低了18个百分点。6 - 7月的平均CC大于4 - 5月。关节肿胀的κ系数> 0.8的百分比从8.8%增加到17%，PD阳性部位从8.3%增加到14%。
我们的结果表明，超声评估的自动反馈能快速提高类风湿关节炎患者关节肿胀触诊技能。
