RESEARCH - Utility of power Doppler ultrasound: a diagnostic algorithm for persistence of very early inflammatory arthritis

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Ann Rheum Dis 2010;69:417-419 doi:10.1136/ard.2008.106658

Clinical and epidemiological research

Concise report

A diagnostic algorithm for persistence of very early inflammatory

arthritis: the utility of power Doppler ultrasound when added to

conventional assessment tools

J E Freeston, R J Wakefield, P G Conaghan, E M A Hensor, S P , P Emery

+ Author Affiliations

Academic Section of Musculoskeletal Disease, University of Leeds,

Chapel Allerton Hospital, Leeds, UK

Abstract

Objectives: The aim of this study was to assess the value of power

Doppler ultrasound (PDUS) in combination with routine management in a

cohort of patients with very early inflammatory arthritis (IA).

Methods: 50 patients with ≤12 weeks of inflammatory symptoms with or

without signs had clinical, laboratory and imaging assessments.

Diagnosis was recorded at 12 months. Assuming a 15% pre-test

probability of IA, post-test probabilities for various assessments

were calculated and used to develop a diagnostic algorithm.

Results: All patients positive for rheumatoid factor (RF) and/or

cyclic citrullinated peptide (CCP) developed persistent IA, so the

added value of PDUS was assessed in the seronegative (RF and CCP

negative) group. The probability of IA in a seronegative patient was

6%. The addition of clinical and radiographic features raised the

probability of IA to 30% and, with certain ultrasound features, this

rose to 94%.

Conclusions: In seronegative patients with early IA, combining PDUS

with routine assessment can have a major impact on the certainty of

diagnosis.

http://ard.bmj.com/content/69/2/417.abstract?etoc

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