RT Journal Article
SR Electronic
T1 Autofeedback from Ultrasound Images Provides Rapid Improvement in Palpation Skills for Identifying Joint Swelling in Rheumatoid Arthritis
JF The Journal of Rheumatology
JO J Rheumatol
FD The Journal of Rheumatology
SP jrheum.111433
DO 10.3899/jrheum.111433
A1 Michihiro Ogasawara
A1 Go Murayama
A1 Yusuke Yamada
A1 Takuya Nemoto
A1 Michiaki Kageyama
A1 Shoko Toyama
A1 Makio Kusaoi
A1 Shin Onuma
A1 Takayuki Kon
A1 Fumio Sekiya
A1 Kaoru Sugimoto
A1 Ran Matsudaira
A1 Masakazu Matsushita
A1 Kurisu Tada
A1 Kazuo Kempe
A1 Ken Yamaji
A1 Naoto Tamura
A1 Yoshinari Takasaki
YR 2012
UL http://www.jrheum.org/content/early/2012/05/14/jrheum.111433.abstract
AB Objective Joint swelling, an important factor in the classification criteria and disease activity assessment in rheumatoid arthritis (RA), renders joint palpation a necessary skill for physicians. Ultrasound (US) examination that visualizes soft tissue abnormalities is now used to assess musculoskeletal disease. We assessed the usefulness of US assessments in enhancing physical joint examination skills. Methods We examined 1944 joints (bilateral shoulder, elbow, wrist, metacarpophalangeal joints 1–5, and knee joints) in 108 patients with RA during April-July 2011. We first physically examined and confirmed joint swelling; subsequently, the same rheumatologist conducted US examinations and multiple assessors graded the joint swelling. When the 2 results differed, we received autofeedback from the US results to improve the physical examination skills. Results The sensitivities and specificities of physical examination for US-detected swollen joint, the correlation coefficient (CC) of the swollen joint counts, and the concordance rate in each patient for joint swelling sites and power Doppler (PD)-positive sites with the κ coefficients between the physical and US examinations were compared over time. We found that the sensitivity of physical examination increased by 42 percentage points (pp), while the specificity decreased by 18 pp. The average CC in June-July was greater than that in April-May. The percentage of κ coefficients > 0.8 increased from 8.8% to 17% for joint swelling and from 8.3% to 14% for PD-positive sites Conclusion Our results suggest that autofeedback from US assessment provides quick improvement in palpation skills for identifying joint swelling in patients with RA.