PT  - JOURNAL ARTICLE
AU  - FLORENCE MILLOT
AU  - GAËLLE CLAVEL
AU  - FABIEN ETCHEPARE
AU  - FRÉDÉRIQUE GANDJBAKHCH
AU  - FRANCK GRADOS
AU  - ALAIN SARAUX
AU  - ANNE-CHRISTINE RAT
AU  - BRUNO FAUTREL
AU  - PIERRE BOURGEOIS
AU  - PATRICE FARDELLONE
TI  - Musculoskeletal Ultrasonography in Healthy Subjects and Ultrasound Criteria for Early Arthritis (The ESPOIR Cohort)
AID  - 10.3899/jrheum.100379
DP  - 2011 Apr 01
TA  - The Journal of Rheumatology
PG  - 613--620
VI  - 38
IP  - 4
4099  - http://www.jrheum.org/content/38/4/613.short
4100  - http://www.jrheum.org/content/38/4/613.full
SO  - J Rheumatol2011 Apr 01; 38
AB  - Objective. To confirm the occurrence of bone erosions and synovitis in healthy subjects detectable by ultrasound (US) and to establish US criteria for early arthritis. Methods. Our study involved 127 healthy subjects matched with a cohort of patients with early arthritis (the ESPOIR cohort). The second and fifth metacarpophalangeal (MCP) joints and the fifth metatarsophalangeal (MTP) joint of both hands and feet were assessed with US to detect bone erosion; and the second, third, fourth, and fifth MCP and the fifth MTP were evaluated for synovial thickening in B-mode US and synovial vascularity in power Doppler. Bone erosion and synovitis were defined according to the Outcome Measures in Rheumatology Clinical Trials consensus. Results. Bone erosion and grade 2–3 synovial thickening in B-mode were detected in 11% and 9% of healthy subjects. To consider the diagnosis of early arthritis, a cutoff at 1 case of synovial thickening in B-mode enabled discrimination between patients with early arthritis and healthy subjects, with a good sensitivity of 74.8% (95% CI 67.2%–82.3%) and a high specificity of 90.5% (95% CI 85.4%–95.6%). If higher specificity is required to confirm the diagnosis of early arthritis, cutoff at 2 cases of synovial thickening in B-mode or at 2 cases of bone erosion gave optimal results, with specificity of 98.4% (95% CI 96.2%–100%) and 100%, respectively, and lower sensitivity of 59.8% (95% CI 51.2%–68.3%) and 17% (95% CI 10.5%–23.5%) (area under the curve = 0.85 for synovitis and 0.63 for bone erosion). Neither the combination of power Doppler signal plus bone erosion, nor bone erosions plus synovial thickening on the same joint, were seen in healthy subjects. Conclusion. A single case of bone erosion or synovial thickening in B-mode is common in healthy subjects. However, more than 1 case of synovial thickening in B-mode or bone erosion is a strong argument for the diagnosis of early inflammatory arthritis.