Diagnostic Utility of Musculoskeletal Ultrasound in Detecting Early Synovitis Compared with Clinical Examination
DOI:
https://doi.org/10.53350/Annalspakmed.1.9.18Keywords:
musculoskeletal ultrasound, early synovitis, Power Doppler, rheumatoid arthritis, diagnostic accuracy, inflammatory arthritis.Abstract
Background: Early synovitis is an essential predictor of progressive inflammatory arthritis and it is a very important factor that defines the long-term joint performance. Clinical examination is the first diagnostic mechanism that might not be effective in identifying subtle synovial inflammation particularly at the early disease stage. The high-resolution visualization of muscle synovial hypertrophy, effusion, and microvascular activity is subject to musculoskeletal ultrasound (MSK-US) which can potentially benefit over routine physical examination.
Objectives: To assess the diagnostic value of musculoskeletal ultrasound versus standard clinical examination in the detection of early synovitis in adults with symptoms of inflammatory joints that have recently come about.
Methods: An interventional cross-sectional data analysis of diagnostic accuracy was done at tertiary care hospitals in Punjab, Pakistan, between June 2023 and May 2025. One hundred and twenty adults (120) with ≤ 6 months of joint symptoms were subjected to standard clinical evaluation and then MSK- US of wrists, metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. The results of ultrasound were reported and interpreted in regards to OMERACT criteria. Sensitivity, specificity, predictive values and intermodal agreement were evaluated.
Results: Clinical testing identified synovitis in 52 out of 119 (43.3%), but MSK-US identified synovitis in 82 out of 119 (68.3%), identifying 30 more cases of subclinical inflammation. The ultrasound was found to be more sensitive (88.5) with a reasonable specificity (79.4) over clinical examination. Seventy percent nine out of ten ultrasound-positive joints had power Doppler activity, which is an indicator of active inflammation. The two methods showed moderate agreement ( 0.54).
Conclusion: Musculoskeletal ultrasound has better diagnostic performance than clinical examination in the early detection of synovitis. Its capability to expose subclinical synovial alteration indicates its necessity to be incorporated in the regular diagnostic courses to make timely therapeutic choices.
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