Sara Kamp Felbo1,2,3, Charlotte Wiell2, Mikkel Østergaard1,2,3, René Panduro Poggenborg1, Pernille Bøyesen4, Hilde Berner Hammer5,6, Annelies Boonen7,8, Susanne Juhl Pedersen9, Inge Juul Sørensen2, Ole Rintek Madsen3,9, Ole Slot2, Jakob Møllenbach Møller10, Marcin Szkudlarek11, Lene Terslev1,2,3. 1. Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup. 2. Center for Rheumatology and Spine Diseases, Rigshospitalet. 3. Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark. 4. Department of Rheumatology, Oslo University Hospital, Rikshospitalet. 5. Department of Rheumatology, Diakonhjemmet Hospital. 6. Faculty of Medicine, University of Oslo, Oslo, Norway. 7. Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center. 8. Care and Public Health Research Institute (CAPHRI), Maastricht University, The Netherlands. 9. Center for Rheumatology and Spine Diseases, Gentofte Hospital, Gentofte. 10. Department of Radiology, Herlev-Gentofte Hospital, Herlev. 11. Department of Rheumatology, Zealand's University Hospital Køge, Køge, Denmark.
Abstract
OBJECTIVE: To investigate the association between clinical joint tenderness and intra- and periarticular inflammation as assessed by ultrasound and MRI in patients with active PsA and to explore if the associations differ according to patient-reported outcomes (PROs) and structural damage. METHODS: Forty-one patients with active PsA and hand involvement had 76/78 joints examined for swelling/tenderness and ultrasound and MRI of 24 and 12 finger joints, respectively. Synovitis, tenosynovitis, periarticular inflammation and erosions were assessed using OMERACT definitions and scoring systems. Correlation between imaging inflammation sum-scores (intra-and periarticular) and tender/swollen joint counts were calculated using Spearman's rho, agreement at joint level was examined using prevalence and bias adjusted kappa (PABAK). Subgroup analyses explored the influence of PROs and radiographic erosive disease on these associations. RESULTS: No significant correlations were found between tender or swollen joint counts and imaging inflammation sum-scores (rho = -0.31-0.38). In patients with higher level of overall pain, disability and lower self-reported mental health, a tendency towards negative correlations were found. At joint level, intra- and periarticular imaging inflammatory lesions had slight agreement with joint tenderness (PABAK = 0.02-0.19) and slight to moderate with swelling (PABAK = 0.16-0.54). For tender joints, agreement with imaging inflammation was even weaker in patients with either high overall pain scores, high disability scores, and/or non-erosive disease. CONCLUSION: Joint tenderness had low association with imaging signs of inflammation in PsA patients, particularly in patients with high self-reported pain, disability and low mental health, indicating that tenderness is influenced by other parameters than local inflammation.
OBJECTIVE: To investigate the association between clinical joint tenderness and intra- and periarticular inflammation as assessed by ultrasound and MRI in patients with active PsA and to explore if the associations differ according to patient-reported outcomes (PROs) and structural damage. METHODS: Forty-one patients with active PsA and hand involvement had 76/78 joints examined for swelling/tenderness and ultrasound and MRI of 24 and 12 finger joints, respectively. Synovitis, tenosynovitis, periarticular inflammation and erosions were assessed using OMERACT definitions and scoring systems. Correlation between imaging inflammation sum-scores (intra-and periarticular) and tender/swollen joint counts were calculated using Spearman's rho, agreement at joint level was examined using prevalence and bias adjusted kappa (PABAK). Subgroup analyses explored the influence of PROs and radiographic erosive disease on these associations. RESULTS: No significant correlations were found between tender or swollen joint counts and imaging inflammation sum-scores (rho = -0.31-0.38). In patients with higher level of overall pain, disability and lower self-reported mental health, a tendency towards negative correlations were found. At joint level, intra- and periarticular imaging inflammatory lesions had slight agreement with joint tenderness (PABAK = 0.02-0.19) and slight to moderate with swelling (PABAK = 0.16-0.54). For tender joints, agreement with imaging inflammation was even weaker in patients with either high overall pain scores, high disability scores, and/or non-erosive disease. CONCLUSION: Joint tenderness had low association with imaging signs of inflammation in PsA patients, particularly in patients with high self-reported pain, disability and low mental health, indicating that tenderness is influenced by other parameters than local inflammation.
Authors: Philip S Helliwell; Phillip J Mease; Arthur Kavanaugh; Laura C Coates; Alexis Ogdie; Atul Deodhar; Vibeke Strand; Gregory Kricorian; Lyrica X H Liu; David Collier; Dafna D Gladman Journal: RMD Open Date: 2022-07