Autofeedback from Ultrasound Images Provides Rapid Improvement in Palpation Skills for Identifying Joint Swelling in Rheumatoid Arthritis

作者：Ogasawara Michihiro^*; Murayama Go; Yamada Yusuke; Nemoto Takuya; Kageyama Michiaki; Toyama Shoko; Kusaoi Maki; Onuma Shin; Kon Takayuki; Sekiya Fumio; Sugimoto Kaoru; Matsudaira Ran; Matsushita Masakazu; Tada Kurisu; Kempe Kazuo; Yamaji Ken; Tamura Naoto; Takasaki Yoshinari

来源：Journal of Rheumatology, 2012, 39(6): 1207-1214.

DOI：10.3899/jrheum.111433

• RHEUMATOID ARTHRITIS
• ULTRASOUND
• JOINT SWELLING
• JOINT PALPATION

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. %26lt;br%26gt;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. %26lt;br%26gt;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 kappa 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 kappa coefficients %26gt; 0.8 increased from 8.8% to 17% for joint swelling and from 8.3% to 14% for PD-positive sites. %26lt;br%26gt;Conclusion. Our results suggest that autofeedback from US assessment provides quick improvement in palpation skills for identifying joint swelling in patients with RA. (J Rheumatol First Release May 15 2012; doi:10.3899/jrheum.111433)

• 出版日期2012-6