CORRELATION OF CLINICAL ASSESSMENT WITH ULTRA SOUND ASSESSMENT OF DISEASE ACTIVITY IN RHEUMATOID ARTHRITIS PATIENTS.

Abstract

BACKGROUND: Rheumatoid arthritis disease activity is graded based on clinical examination and laboratory work up, using various scales. Although these scales are regularly used in clinical practice there are some important pitfalls which include; subjectivity, very high tender joint count and small changes in ESR, variations in clinical assessment of synovitis between different observers. Therefore, ultrasound is being increasingly used to grade disease activity and detect joint inflammation which may be missed on clinical examination.

OBJECTIVE: To correlate clinical assessment with ultra sound assessment of disease activity in rheumatoid arthritis patients.

STUDY-DESIGN: Prospective Observational hospital based study. 

MATERIAL AND METHODS: The swollen joint count, tender joint count, patient global assessment, ESR and CRP were used to calculate disease activity score. All patients underwent blinded power doppler and grey scale ultrasound examination within 48 hours of clinical assessment and ultrasound disease activity score was calculated. Correlation was sought between clinical assessment and ultrasound assessment.

RESULTS: Forty-eight patients were included in the study with a mean age of 46.31 years and mean duration of illness being 98.3 months. In our RA patients who were inactive on clinical examination 31.6% had active disease on ultrasound, whereas 7 % of patients with clinically active disease had inactive disease on ultrasound examination.

CONCLUSIONS: Our study showed that RA patients who were inactive on clinical assessment, as defined by clinical criteria, had signs of activity on ultrasound (subclinical synovitis), as defined by ultrasound disease activity score.