Foot Radiographs May Aid Prediction of Rheumatoid Arthritis

[Guest guest]

Foot Radiographs May Aid Prediction of Rheumatoid Arthritis

A DGReview of : " Ability of foot radiographs to predict rheumatoid arthritis

in patients with early arthritis "

Journal of Rheumatology

01/27/2004

By Deanna M Green, PhD

Erosion observed in foot radiographs during early arthritis is significantly

associated with diagnosis of rheumatoid arthritis later on, according to a

French multicentre, blinded study. Furthermore, combining foot and hand

radiographs further improves diagnostic performance.

Early detection of rheumatoid arthritis enhances disease management,

offering more treatment options to prevent joint destruction and long-term

disability. Previous studies have found that more foot joints are affected

than hand joints in the early stages of rheumatoid arthritis.

D. Pensec, MD, and colleagues at the Hopital de la Cavale Blanche,

Brest, France, evaluated the ability of foot radiographs to predict

diagnosis of rheumatoid arthritis in patients with early arthritis.

The study included 30 patients who had symptoms of arthritis for less than 1

year. Multiple hand and foot radiographs were taken at study entry and

evaluated for erosion and joint space narrowing. Incidence of RA diagnosis

was assessed during a mean follow-up of 30 months.

The best diagnostic performance was seen for erosions detected on foot

radiograph during early arthritis. Foot erosion was significantly associated

with later rheumatoid arthritis.

Specifically, Sharp's erosion score and the erosion component of item 7 of

the 1987 American College of Rheumatology (ACR) criteria for RA both showed

a specificity of 97.5% in the prediction of rheumatoid arthritis. However,

the sensitivity was only 18%.

Use of hand radiographs improved the sensitivity of these methods. When both

hand and foot radiographs were included in the evaluation, the item 7

erosion component had a sensitivity of 32.5% and a specificity of 94.5%.

The study also indicated that the erosion component of item 7 had

significantly greater predictive value than the complete item 7, which had a

specificity of 94%.

These data suggest that foot radiographs taken during the early stages of

arthritis may be helpful in predicting later diagnosis of rheumatoid

arthritis.

J Rheumatol. 2004 Jan; 31:1:66-70