Medina Yimy F, Rondón Martin A
PhD Program in Clinical Epidemiology, Department of Clinical Epidemiology and Biostatistics, Pontificia Universidad Javeriana, Bogotá 110311, Colombia.
Rheumatology Unit, Internal Medicine, Universidad Nacional de Colombia, Bogotá 111321, Colombia.
J Clin Med. 2025 Jul 29;14(15):5334. doi: 10.3390/jcm14155334.
Physical joint examination is fundamental in rheumatoid arthritis (RA) assessment. This study evaluated the diagnostic accuracy and agreement between standardized and non-standardized physical joint examinations in RA patients using musculoskeletal ultrasound as the reference standard. We assessed the joints for tenderness and swelling, calculating sensitivity, specificity, and predictive values. Musculoskeletal ultrasound was used as the reference standard, with adjustment for imperfect reference bias. Agreement between the methods was evaluated using the average kappa coefficient. A total of 1496 joints were evaluated. Without adjustment for imperfect reference bias, standardized examination showed higher sensitivity for detecting pain and swelling than non-standardized examination. Specificity was similar for pain but higher for swelling in standardized examination. After bias adjustment, standardized examination sensitivity improved for pain (93.8% vs. 77.3%; 95% CI: 0.14-0.19) and swelling (91.9% vs. 60.0%; 95% CI: 0.29-0.34). Tenderness specificity remained comparable (standardized examination: 75.4%, non-standardized examination: 76.3%), while the non-standardized examination maintained superior swelling specificity (85.7% vs. 77.1%). Standardized joint examination demonstrated significantly higher concordance than non-standardized assessment in evaluating joint tenderness; standardized assessment yielded significantly greater average kappa coefficients under both false-positive-prioritized (0.44 vs. 0.37; = 0.01) and false-negative-prioritized scenarios (0.59 vs. 0.45; < 0.0001). For joint swelling, standardized evaluation showed significantly higher concordance when false negatives were considered more critical (0.59 vs. 0.37; < 0.0001), whereas differences under false-positive prioritization were not statistically significant. Standardization of the physical joint examination significantly improves diagnostic accuracy and agreement in detecting joint tenderness and swelling in patients with rheumatoid arthritis. Implementing a standardized physical examination protocol may enhance disease activity diagnosis and optimize clinical management of RA.
体格关节检查是类风湿关节炎（RA）评估的基础。本研究以肌肉骨骼超声作为参考标准，评估了RA患者中标准化和非标准化体格关节检查之间的诊断准确性及一致性。我们评估关节的压痛和肿胀情况，计算敏感性、特异性和预测值。肌肉骨骼超声用作参考标准，并对不完善参考偏倚进行了校正。使用平均kappa系数评估两种方法之间的一致性。共评估了1496个关节。在未校正不完善参考偏倚的情况下，标准化检查在检测疼痛和肿胀方面比非标准化检查具有更高的敏感性。疼痛的特异性相似，但标准化检查中肿胀的特异性更高。校正偏倚后，标准化检查对疼痛的敏感性提高（93.8%对77.3%；95%CI：0.14 - 0.19），对肿胀的敏感性也提高（91.9%对60.0%；95%CI：0.29 - 0.34）。压痛特异性仍相当（标准化检查：75.4%，非标准化检查：76.3%），而非标准化检查在肿胀特异性方面保持优势（85.7%对77.1%）。在评估关节压痛时，标准化关节检查显示出比非标准化评估更高的一致性；在优先考虑假阳性（0.44对0.37；P = 0.01）和优先考虑假阴性的情况下（0.59对0.45；P < 0.0001），标准化评估产生的平均kappa系数显著更高。对于关节肿胀，当认为假阴性更关键时，标准化评估显示出显著更高的一致性（0.59对0.37；P < 0.0001），而在优先考虑假阳性时差异无统计学意义。体格关节检查的标准化显著提高了类风湿关节炎患者关节压痛和肿胀检测的诊断准确性及一致性。实施标准化体格检查方案可能会增强疾病活动度诊断并优化RA的临床管理。
