{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,14]],"date-time":"2025-11-14T21:33:00Z","timestamp":1763155980368},"reference-count":34,"publisher":"The Journal of Rheumatology","issue":"3","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Rheumatol"],"published-print":{"date-parts":[[2018,3]]},"abstract":"<jats:sec><jats:title>Objective.<\/jats:title><jats:p>To describe the dorsal 4-finger technique (DFFT) in examining metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) and compare it to the traditional 2-finger technique (TFT) using ultrasound (US) as a gold standard.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods.<\/jats:title><jats:p>Four rheumatologists evaluated 180 MCP joints of 18 patients with RA. All patients underwent US for greyscale (GSUS) and power Doppler US (PDUS). Agreements between rheumatologists, the 2 techniques, and US were evaluated using Cohen \u03ba and the first-order agreement coefficient (AC1) \u03ba methods.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results.<\/jats:title><jats:p>The population comprised 17 females (94.4%) with a mean (SD) age and disease duration of 56.8 (14.4) and 21.8 (12.9) years, respectively. Eight patients (44.4%) were taking methotrexate monotherapy, while 10 patients (55.6%) were receiving biologics. US evaluation revealed 69 (38.3%) and 30 (16.7%) joints exhibited synovitis grade 2\u20133 by GSUS and PDUS, respectively. Effusion was documented in 30 joints (16.7%). The mean intraobserver agreement using the DFFT and TFT were 80.5% and 86%, respectively. The mean interobserver agreements using the DFFT and TFT were 84% and 74%, respectively. \u03ba agreement with US findings was similar for both techniques in tender joints but was higher for the DFFT in nontender joints (0.33 vs 0.07, p = 0.015 for GSUS) and (0.48 vs 0.11, p = 0.002 for PDUS). The DFFT had a higher sensitivity in detecting ballottement by GSUS (0.47 vs 0.2, p &lt; 0.001) and PDUS (0.60 vs 0.27, p &lt; 0.001).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion.<\/jats:title><jats:p>The DFFT is a novel, reproducible, and reliable method to examine MCP joints, and it has a better correlation with US than the traditional TFT.<\/jats:p><\/jats:sec>","DOI":"10.3899\/jrheum.161507","type":"journal-article","created":{"date-parts":[[2018,1,15]],"date-time":"2018-01-15T20:10:14Z","timestamp":1516047014000},"page":"329-334","source":"Crossref","is-referenced-by-count":2,"title":["The Dorsal 4-finger Technique: A Novel Method to Examine Metacarpophalangeal Joints in Patients with Rheumatoid Arthritis"],"prefix":"10.3899","volume":"45","author":[{"given":"Mohammed A.","family":"Omair","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pooneh","family":"Akhavan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ali","family":"Naraghi","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shikha","family":"Mittoo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Juan","family":"Xiong","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Deborah","family":"Weber","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daming","family":"Lin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Melissa","family":"Weber","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":[[2018,1,15]]},"reference":[{"key":"2018112909375683000_45.3.329.1","first-page":"579","article-title":"Development of a disease activity score based on judgment in clinical practice by rheumatologists","volume":"20","author":"van der Heijde","year":"1993","journal-title":"J Rheumatol"},{"key":"2018112909375683000_45.3.329.2","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780390105"},{"key":"2018112909375683000_45.3.329.3","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keg072"},{"key":"2018112909375683000_45.3.329.4","doi-asserted-by":"publisher","DOI":"10.1186\/ar1740"},{"key":"2018112909375683000_45.3.329.5","doi-asserted-by":"publisher","DOI":"10.1002\/art.1780380602"},{"key":"2018112909375683000_45.3.329.6","doi-asserted-by":"publisher","DOI":"10.1002\/art.30129"},{"key":"2018112909375683000_45.3.329.7","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/keu413"},{"key":"2018112909375683000_45.3.329.8","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2011.153734"},{"key":"2018112909375683000_45.3.329.9","first-page":"425","article-title":"Interrelationship of outcome measures and process variables in early rheumatoid arthritis. 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