Rheumatology Medical News about persistence of very early inflammatory arthritis;diagnostic algorithm

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A diagnostic algorithm for persistence of very early inflammatory arthritis: The utility of power Doppler ultrasound when added to conventional assessment tools
Annals of Rheumatic Diseases, 05/11/09

Freeston JE et al. – Study reports that in sero-negative early inflammatory arthritis (IA) patients, combining power doppler ultrasound (PDUS) with routine assessment can have a major impact on the certainty of diagnosis.

Methods

An assessment of the value of PDUS in combination with routine management in a very early IA cohort:
- 50 pts with ≤12 wks of inflammatory symptoms +/- signs had clinical, laboratory and imaging assessments
- Diagnosis was recorded at 12 mo
- 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 RF and/or CCP positive pts developed persistent IA so the added value of PDUS was assessed in the sero-negative (RF and CCP negative) group
Probability of IA in a sero-negative patient was 6%
Addition of clinical and radiographic features raised the probability of IA to 30%
With certain US features this rose to 94%

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