A comparison of ultrasound and clinical examination in the detection of flexor tenosynovitis in early arthritis.

Hmamouchi I, Bahiri R, Srifi N, Aktaou S, Abouqal R, Hajjaj-Hassouni N.

Source

Laboratory of Information and Research on Bone Diseases, Department of Rheumatology, University Mohammed V Souissi, Faculty of Medicine and Pharmacy, El Ayachi hospital, University Hospital of Rabat-Sale, Morocco. i.hmamouchi@yahoo.fr

Abstract

BACKGROUND:

Tenosynovitis is widely accepted to be common in rheumatoid arthritis (RA) and postulated to be the first manifestation of RA, but its true prevalence in early disease and in particular the hand has not been firmly established. The aims of this study were first to investigate the frequency and distribution of finger flexor tenosynovitis using ultrasound in early arthritis, second to compare clinical examination with ultrasound (US) using the latter as the gold standard.

METHODS:

33 consecutive patients who had who were initially diagnosed with polyarthritis and suspected of polyarthritis and clinical suspicion of inflammatory arthritis of the hands and wrists were assessed during consecutive, routine presentations to the rheumatology outpatient clinic. We scanned a total of 165 finger tendons and subsequent comparisons were made using clinical examination.

RESULTS:

Flexor tenosynovitis was found in 17 patients (51.5%) on ultrasound compared with 16 (48.4%) of all patients on clinical examination. Most commonly damaged joint involved on US was the second finger followed by the third, fifth, and fourth. Both modalities demonstrated more pathology on the second and third metacarpophalangeal (MCP) compared with the fourth and fifth MCP. A joint-by-joint comparison of US and clinical examination demonstrated that although the sensitivity, specificities and positive predictive values of clinical examination were relatively high, negative predictive value of clinical examination was low (0.23).

CONCLUSIONS:

Our study suggest that clinical examination can be a valuable tool for detecting flexor disease in view of its high specificity and positive predictive values, but a negative clinical examination does not exclude inflammation and an US should be considered. Further work is recommended to standardize definitions and image acquisition for peritendinous inflammation for ultrasound.

PMID: 21549008

比较超声与临床体检检查早期关节炎患者手部屈肌腱腱鞘炎

Hmamouchi I, et al. BMC Musculoskelet Disord. 2011;12:91.

背景: 目前普遍认为腱鞘炎在RA病人中是常见的，并推测它是RA的首个临床表现，但是在早期病程中尤其是手部腱鞘炎的真实受累率尚未确凿。

目的: 本研究的目的有二，首先是探究手指屈肌腱腱鞘炎发生频率和分布情况，利用超声检测早期关节炎病人的腱鞘炎。其次是将临床体检与超声(US)相比较，并以后者作为金标准。

方法: 共有33例顺序诊治的病人，他们起初被诊断为手和腕的多发性关节炎，或多发性关节炎疑诊，或临床可疑炎性关节炎，并常规转诊至风湿病门诊。我们共检查了165个手指肌腱，随后与临床体检进行比较。

结果: 超声发现17例病人(51.5%)有屈肌腱腱鞘炎，临床体检发现16例(48.4%)病人。超声发现最常受累的是食指，其次是第三、第五和第四手指。两种检查手段也都证明第二和第三个掌指关节(MCP)的病理损伤重于第五和第四MCP。逐个关节地比较超声和临床体检，结果证明尽管临床体检的敏感性、特异性和阳性预测值相对较高，但是阴性预测值较低(0.23)。

结论: 本研究提示，就较高特异性和阳性预测值而言，临床体检是检测屈肌腱病变的有价值工具，但是临床体检阴性并不能排除炎症，这时应考虑加用超声检查。推荐进一步需完善相关标准化定义以及规范超声检查腱鞘周围炎症的图像获取。