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Omair MA, Akhavan P, Naraghi A, Mittoo S, Xiong J, Weber D, Lin D, Weber M, Keystone EC. The Dorsal 4-finger Technique: A Novel Method to Examine Metacarpophalangeal Joints in Patients with Rheumatoid Arthritis. J Rheumatol 2018; 45:329-334. [PMID: 29335348 DOI: 10.3899/jrheum.161507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/12/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To describe the dorsal 4-finger technique (DFFT) in examining metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) and compare it to the traditional 2-finger technique (TFT) using ultrasound (US) as a gold standard. METHODS Four rheumatologists evaluated 180 MCP joints of 18 patients with RA. All patients underwent US for greyscale (GSUS) and power Doppler US (PDUS). Agreements between rheumatologists, the 2 techniques, and US were evaluated using Cohen κ and the first-order agreement coefficient (AC1) κ methods. RESULTS The population comprised 17 females (94.4%) with a mean (SD) age and disease duration of 56.8 (14.4) and 21.8 (12.9) years, respectively. Eight patients (44.4%) were taking methotrexate monotherapy, while 10 patients (55.6%) were receiving biologics. US evaluation revealed 69 (38.3%) and 30 (16.7%) joints exhibited synovitis grade 2-3 by GSUS and PDUS, respectively. Effusion was documented in 30 joints (16.7%). The mean intraobserver agreement using the DFFT and TFT were 80.5% and 86%, respectively. The mean interobserver agreements using the DFFT and TFT were 84% and 74%, respectively. κ agreement with US findings was similar for both techniques in tender joints but was higher for the DFFT in nontender joints (0.33 vs 0.07, p = 0.015 for GSUS) and (0.48 vs 0.11, p = 0.002 for PDUS). The DFFT had a higher sensitivity in detecting ballottement by GSUS (0.47 vs 0.2, p < 0.001) and PDUS (0.60 vs 0.27, p < 0.001). CONCLUSION The DFFT is a novel, reproducible, and reliable method to examine MCP joints, and it has a better correlation with US than the traditional TFT.
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Affiliation(s)
- Mohammed A Omair
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Pooneh Akhavan
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Ali Naraghi
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Shikha Mittoo
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Juan Xiong
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Deborah Weber
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Daming Lin
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Melissa Weber
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada.,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors
| | - Edward C Keystone
- From the Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University, Riyadh, Saudi Arabia; Division of Rheumatology, Department of Medicine, and Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto, Toronto, Ontario, Canada. .,M.A. Omair, MD, SF Rheum, Division of Rheumatology, Department of Medicine, College of Medicine, King Saud University; P. Akhavan, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; A. Naraghi, FRCPC, Division of Musculoskeletal Imaging, Department of Medical Imaging, Mount Sinai Hospital, University of Toronto; S. Mittoo, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; J. Xiong, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; D. Lin, PhD, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; M. Weber, RN, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto; E.C. Keystone, FRCPC, Division of Rheumatology, Department of Medicine, Mount Sinai Hospital, University of Toronto. Dr. Omair and Dr. Akhavan are co-first authors.
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