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Experience of musculoskeletal ultrasound scanning improves physicians’ physical examination skills in assessment of synovitis

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Abstract

Objective

Musculoskeletal ultrasound (US) is more sensitive than physical examination in detecting synovitis and helps physicians to understand its pathophysiology. In this study, we aimed to determine if the experience in musculoskeletal US scanning is independently associated with improved physical examination skills to detect synovitis.

Method

Seventy patients with rheumatoid arthritis and twenty-three physicians were enrolled. Patients were first assessed by multiple physicians with a range of clinical/sonographic experience for the swelling of the wrist, metacarpophalangeal and proximal interphalangeal (PIP) joints and next underwent US assessment performed by another physician experienced in musculoskeletal US. We then calculated the positive/negative predictive values (PPV/NPV) of joint swelling to identify US-detected synovial hypertrophy. Finally, the factors independently associated with the accuracy of clinical assessment were identified by using multivariate analyses.

Results

One thousand five hundred forty joints were assessed 6116 times in total for swelling. Overall, PPV and NPV of joint swelling were 51.7% and 88.3%, respectively. Multivariate analyses identified wrist joint, tenderness, male and greater patients’ age as the factors significantly associated with higher PPV. In addition, there was a trend that longer experience in rheumatology clinical practice was associated with higher PPV (p = 0.058). On the other hand, longer experience in musculoskeletal US, PIP joint and positive rheumatoid factor were identified as the significant factors for higher NPV, while wrist joint, tenderness, presence of osteophyte and obesity as those for lower NPV.

Conclusion

Our data suggest that the experience in musculoskeletal US improves physical examination skills particularly to avoid overestimation.

Key Points

• Physicians with longer US experience are less likely to overestimate synovitis by physical examination.

• Musculoskeletal US is a useful tool for rheumatologists to improve their physical examination skill.

• Presence of osteophytes, joint tenderness and obesity influence the accuracy of physical examination of joints.

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Acknowledgements

We thank all staffs in our department for the care and management of patients enrolled in this study and for their support in data collection.

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Authors and Affiliations

  1. Department of Allergy and Clinical Immunology, Chiba University Hospital, 1-8-1 Inohana, Chuo-ku, Chiba-shi, Chiba, 260-8670, Japan

    Aiko Saku, Shunsuke Furuta, Manami Kato, Hiroki Furuya, Kazumasa Suzuki, Masashi Fukuta, Kenichi Suehiro, Sohei Makita, Tomohiro Tamachi, Kei Ikeda, Hiroaki Takatori, Yuko Maezawa, Akira Suto, Kotaro Suzuki, Koichi Hirose & Hiroshi Nakajima

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  1. Aiko Saku
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  2. Shunsuke Furuta
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  3. Manami Kato
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  4. Hiroki Furuya
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  5. Kazumasa Suzuki
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  13. Akira Suto
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  14. Kotaro Suzuki
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  16. Hiroshi Nakajima
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Corresponding author

Correspondence to Shunsuke Furuta.

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Ethical approval

This study was approved by the ethics committee of Chiba University School of Medicine (reference number: 2214). All procedures in this study were in accordance with the 1964 Helsinki declaration and its later amendments.

Informed consent

Written informed consent was obtained from all patients and physicians who participated in this study.

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Saku, A., Furuta, S., Kato, M. et al. Experience of musculoskeletal ultrasound scanning improves physicians’ physical examination skills in assessment of synovitis. Clin Rheumatol 39, 1091–1099 (2020). https://doi.org/10.1007/s10067-020-04960-5

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  • DOI: https://doi.org/10.1007/s10067-020-04960-5

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