{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2023,9,23]],"date-time":"2023-09-23T14:22:44Z","timestamp":1695478964810},"reference-count":16,"publisher":"The Journal of Rheumatology","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2009,12]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>Rheumatologists base many clinical decisions regarding the management of inflammatory joint diseases on joint counts performed at clinic. We investigated the reliability and accuracy of physically examining the metacarpophalangeal (MCP) joints to detect inflammatory synovitis using magnetic resonance imaging (MRI) as the gold standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>MCP joints 2 to 5 in both hands of 5 patients with rheumatoid arthritis (RA) and 5 with psoriatic arthritis (PsA) were assessed by 5 independent examiners for joint-line swelling (visually and by palpation); joint-line tenderness by palpation (tender joint count, TJC) and stress pain; and by MRI (1.5 Tesla superconducting magnet). Interrater reliability was assessed using kappa statistics, and agreement between examination and corresponding MRI assessment was assessed by Fisher\u2019s exact tests (p &lt; 0.05 considered statistically significant).<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>Interrater agreement was highest for visual assessment of swelling (\u03ba = 0.55\u20130.63), slight-fair for assessment of swelling by palpation (\u03ba = 0.19\u20130.41), and moderate (\u03ba = 0.41\u20130.58) for assessment of joint tenderness. In patients with RA, TJC, stress pain, and visual swelling assessment were strongly associated with MRI evaluation of synovitis. Visual swelling assessment demonstrated high specificity (&gt; 0.8) and positive predictive value (= 0.8). For PsA, significant associations exist between TJC and MRI synovitis scores (p &lt; 0.01) and stress pain and MRI edema scores (p &lt; 0.04). Assessment of swelling by palpation was not significantly associated with synovitis or edema as determined by MRI in RA or PsA (p = 0.54\u20131.0).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>In inflammatory arthritis, disease activity in MCP joints can be reliably assessed at the bedside by examining for joint-line tenderness (TJC) and visual inspection for swelling. Clinical assessment may have to be complemented by other methods for evaluating disease activity in the joint, such as MRI, particularly in patients with PsA.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.080205","type":"journal-article","created":{"date-parts":[[2009,11,17]],"date-time":"2009-11-17T03:20:20Z","timestamp":1258428020000},"page":"2751-2757","source":"Crossref","is-referenced-by-count":17,"title":["Significance of Clinical Evaluation of the Metacarpophalangeal Joint in Relation to Synovial\/Bone Pathology in Rheumatoid and Psoriatic Arthritis Detected by Magnetic Resonance Imaging"],"prefix":"10.3899","volume":"36","author":[{"given":"MILLICENT A.","family":"STONE","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"LAWRENCE M.","family":"WHITE","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DAFNA D.","family":"GLADMAN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"ROBERT D.","family":"INMAN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"SAM","family":"CHAYA","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"MATTHEW","family":"LAX","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DAVID","family":"SALONEN","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DEBORAH A.","family":"WEBER","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"JUDY A.","family":"GUTHRIE","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EMMA","family":"POMEROY","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"DOMINIK","family":"PODBIELSKI","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"EDWARD C.","family":"KEYSTONE","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2262","published-online":{"date-parts":[[2009,11,16]]},"reference":[{"key":"2018112909213646000_36.12.2751.1","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200111)44:11<2703::AID-ART451>3.0.CO;2-E"},{"key":"2018112909213646000_36.12.2751.2","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200110)44:10<2242::AID-ART386>3.0.CO;2-F"},{"issue":"Suppl","key":"2018112909213646000_36.12.2751.3","first-page":"S65","article-title":"Number of active joints, not diagnosis, is the primary determinant of function and performance in early synovitis","volume":"21","author":"Gerber","year":"2003","journal-title":"Clin Exp Rheumatol"},{"key":"2018112909213646000_36.12.2751.4","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2006.056457"},{"key":"2018112909213646000_36.12.2751.5","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2004.035196"},{"key":"2018112909213646000_36.12.2751.6","first-page":"1115","article-title":"Patients with rheumatoid arthritis are more tender than those with psoriatic arthritis","volume":"19","author":"Buskila","year":"1992","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.7","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(199908)42:8<1706::AID-ANR20>3.0.CO;2-Z"},{"key":"2018112909213646000_36.12.2751.8","first-page":"661","article-title":"Comparison of four articular indices for use in clinical trials in rheumatoid arthritis: patient, order and observer variation","volume":"18","author":"Thompson","year":"1991","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.9","first-page":"1385","article-title":"OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Core set of MRI acquisitions, joint pathology definitions, and the OMERACT RA-MRI scoring system","volume":"30","author":"Ostergaard","year":"2003","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.10","first-page":"1366","article-title":"OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging Studies. Exercise 3: an international multicenter reliability study using the RA-MRI Score","volume":"30","author":"Lassere","year":"2003","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.11","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.pu.09.050188.001011"},{"key":"2018112909213646000_36.12.2751.12","first-page":"1126","article-title":"The clinical assessment of patients with psoriatic arthritis: results of a reliability study of the Spondyloarthritis Research Consortium of Canada","volume":"31","author":"Gladman","year":"2004","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.13","first-page":"1740","article-title":"INternational SPondyloarthritis Inter-Observer Reliability Exercise \u00e2\u0080\u0094 The INSPIRE Study: II. Assessment of peripheral joints, enthesitis and dactylitis","volume":"34","author":"Gladman","year":"2007","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.14","doi-asserted-by":"publisher","DOI":"10.1002\/art.20333"},{"key":"2018112909213646000_36.12.2751.15","first-page":"492","article-title":"An experiment in reducing interobserver variability of the examination for joint tenderness","volume":"15","author":"Klinkhoff","year":"1988","journal-title":"J Rheumatol"},{"key":"2018112909213646000_36.12.2751.16","doi-asserted-by":"publisher","DOI":"10.1002\/1529-0131(200111)44:11<2492::AID-ART429>3.0.CO;2-X"}],"container-title":["The Journal of Rheumatology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.3899\/jrheum.080205","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2018,11,29]],"date-time":"2018-11-29T17:36:00Z","timestamp":1543512960000},"score":1,"resource":{"primary":{"URL":"http:\/\/www.jrheum.org\/lookup\/doi\/10.3899\/jrheum.080205"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2009,11,16]]},"references-count":16,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2009,12,4]]},"published-print":{"date-parts":[[2009,12]]}},"alternative-id":["10.3899\/jrheum.080205"],"URL":"https:\/\/doi.org\/10.3899\/jrheum.080205","relation":{},"ISSN":["0315-162X","1499-2752"],"issn-type":[{"value":"0315-162X","type":"print"},{"value":"1499-2752","type":"electronic"}],"subject":[],"published":{"date-parts":[[2009,11,16]]}}}