Joint tenderness showed broader associations with concurrent ultrasound abnormalities than patient-reported pain among anti-cyclic citrullinated peptide–positive patients without clinical arthritis.
To analyze the association between joint tenderness and ultrasound abnormalities in anti-cyclic citrullinated peptide-positive patients with musculoskeletal symptoms but no clinical arthritis.
Approach:
Study Design: Cross-sectional analysis of baseline data from 323 participants in the CCP Study, focusing on those with physical examination, pain questionnaire, and ultrasound scan completed on the same day.
Participants: Eligible participants were aged 18 years or older, tested positive for anti-cyclic citrullinated peptide antibodies, and had new nonspecific musculoskeletal complaints without clinical arthritis or a history of inflammatory arthritis.
Assessment Methods: Joint tenderness assessed by a rheumatologist; ultrasound evaluated gray-scale synovitis, power Doppler activity, tenosynovitis, and erosions.
Statistical Analysis: Joint-level associations were evaluated using generalized estimating equation logistic models, adjusting for age and sex.
Key Findings:
Joint tenderness was more consistently associated with ultrasound abnormalities than patient-reported joint pain.
Significant associations were found between tenderness and gray-scale abnormalities, power Doppler activity, tenosynovitis, and erosions.
Absence of tenderness had high negative predictive values for power Doppler activity, tenosynovitis, and erosions.
Positive predictive values for tenderness indicating ultrasound abnormalities were generally limited.
Interpretation:
The findings suggest that joint tenderness may be a more reliable indicator of ultrasound abnormalities than patient-reported pain, but the study does not establish a clinical scanning strategy.
Limitations:
Adjustment was made only for age and sex.
Regional pain reporting rather than joint-specific.
Dichotomization of ultrasound scores.
Protocol and equipment changes during recruitment.
Low event counts at some joints.
Absence of formal reliability testing.
Conclusion:
The study highlights the need for further research to evaluate the role of physical examination findings in guiding ultrasound assessments in patients at risk for rheumatoid arthritis.
