Department of Allergy and Clinical Immunology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan.
Clin Rheumatol. 2020 Apr;39(4):1091-1099. doi: 10.1007/s10067-020-04960-5. Epub 2020 Feb 1.
Musculoskeletal ultrasound (US) is more sensitive than physical examination in detecting synovitis and helps physicians to understand its pathophysiology. In this study, we aimed to determine if the experience in musculoskeletal US scanning is independently associated with improved physical examination skills to detect synovitis.
Seventy patients with rheumatoid arthritis and twenty-three physicians were enrolled. Patients were first assessed by multiple physicians with a range of clinical/sonographic experience for the swelling of the wrist, metacarpophalangeal and proximal interphalangeal (PIP) joints and next underwent US assessment performed by another physician experienced in musculoskeletal US. We then calculated the positive/negative predictive values (PPV/NPV) of joint swelling to identify US-detected synovial hypertrophy. Finally, the factors independently associated with the accuracy of clinical assessment were identified by using multivariate analyses.
One thousand five hundred forty joints were assessed 6116 times in total for swelling. Overall, PPV and NPV of joint swelling were 51.7% and 88.3%, respectively. Multivariate analyses identified wrist joint, tenderness, male and greater patients' age as the factors significantly associated with higher PPV. In addition, there was a trend that longer experience in rheumatology clinical practice was associated with higher PPV (p = 0.058). On the other hand, longer experience in musculoskeletal US, PIP joint and positive rheumatoid factor were identified as the significant factors for higher NPV, while wrist joint, tenderness, presence of osteophyte and obesity as those for lower NPV.
Our data suggest that the experience in musculoskeletal US improves physical examination skills particularly to avoid overestimation.Key Points• Physicians with longer US experience are less likely to overestimate synovitis by physical examination.• Musculoskeletal US is a useful tool for rheumatologists to improve their physical examination skill.• Presence of osteophytes, joint tenderness and obesity influence the accuracy of physical examination of joints.
肌肉骨骼超声（US）比体格检查更能敏感地检测滑膜炎，并帮助医生了解其病理生理学。本研究旨在确定肌肉骨骼 US 扫描经验是否与改善体格检查以检测滑膜炎的技能独立相关。
共纳入 70 例类风湿关节炎患者和 23 名医生。患者首先由具有不同临床/超声经验的多位医生进行肿胀评估，包括腕关节、掌指关节和近端指间关节（PIP）关节，然后由另一位精通肌肉骨骼 US 的医生进行 US 评估。然后，我们计算关节肿胀的阳性/阴性预测值（PPV/NPV），以识别 US 检测到的滑膜肥厚。最后，通过多变量分析确定与临床评估准确性独立相关的因素。
总共评估了 1544 个关节 6116 次肿胀。总体而言，关节肿胀的 PPV 和 NPV 分别为 51.7%和 88.3%。多变量分析确定腕关节、压痛、男性和患者年龄较大是与更高 PPV 显著相关的因素。此外，有趋势表明，在风湿病临床实践中经验更丰富与更高的 PPV 相关（p=0.058）。另一方面，肌肉骨骼 US 经验更长、PIP 关节和阳性类风湿因子被确定为更高 NPV 的显著因素，而腕关节、压痛、骨赘存在和肥胖则为更低 NPV 的因素。
我们的数据表明，肌肉骨骼 US 经验可改善体格检查技能，特别是避免过度估计滑膜炎。
具有更长 US 经验的医生通过体格检查不太可能高估滑膜炎。
肌肉骨骼超声是风湿病医生提高体格检查技能的有用工具。
骨赘、关节压痛和肥胖会影响关节体格检查的准确性。
