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Performance of Hand Radiographs in Predicting the Diagnosis in Patients with Early Arthritis
VALERIE DEVAUCHELLE-PENSEC, JEAN M. BERTHELOT, SANDRINE JOUSSE, ISABELLE SAMJEE, THIERRY JOSSEAUME, DANIELLE COLIN, GERARD CHALÉS, CATHERINE Le HENAFF, JEAN B. THOREL, SYLVIE HOANG, ANTOINE MARTIN, PIERRE YOUINOU, PAUL Le GOFF, and ALAIN SARAUX ABSTRACT. Objective. To evaluate the ability of baseline hand radiographs to predict the diagnosis 2 years later in a cohort of patients with early arthritis. Methods. A total of 258 patients with arthritis onset within the previous year were evaluated. At baseline, all patients underwent a standardized evaluation including laboratory tests and radiographs. Hand radiographs were read by a blinded observer who used a standardized procedure for detecting features of crystal deposition diseases and rheumatoid arthritis (RA). After 30 ± 11.3 months, the final diagnosis was established by a panel of rheumatologists. All radiographs were evaluated. Results. Significant associations were found between radiographic features and a clinical diagnosis of RA, calcium pyrophosphate dihydrate (CPPD) arthritis, and hydroxyapatite arthritis. No radiographic abnormalities suggesting psoriatic arthritis or gout were seen. The sensitivities of hand radiographs for diagnosing CPPD or hydroxyapatite arthritis ranged from 80% to 100%. Baseline hand radiographs suggested the final diagnosis in 31/258 patients, including 21 (22.5%) of the 93 patients with RA, 10 of the 11 (91%) patients with CPPD or hydroxyapatite deposition disease, and none of the patients with other disorders. Sensitivity was 29%, specificity 86.5%, positive predictive value 61%, and negative predictive value 63%. Conclusion. In our cohort of patients with recent arthritis, the overall performance of hand radiographs in predicting a diagnosis 2 years later was modest. However, they had an excellent diagnostic value for calcium deposition diseases. (First Release June 15, 2006; J Rheumatol 2006;33:1511–5) Key Indexing Terms:
RECENT ARTHRITIS From the Unit of Rheumatology, Cavale Blanche Hospital, CHU Brest, Brest, France. Supported by Brest Hospital Center and the 1995 Clinical Research Hospital Program (PHRC 1995). V. Devauchelle-Pensec, MD, Unit of Rheumatology, Hôpital de la Cavale Blanche, CHU Brest, and Unit of Immunology, Morvan Hospital, Brest; S. Jousse, MD; I. Samjee, Fellow; P. Le Goff, MD, PhD; A. Saraux, MD, PhD, Unit of Rheumatology, Hôpital de la Cavale Blanche, CHU Brest; J.M. Berthelot, MD, Department of Rheumatology, Hôtel-Dieu, CHU Nantes; T. Josseaume, Fellow; D. Colin, MD, Department of Radiology, Hôpital de la Cavale Blanche; G. Chales, MD, PhD, Department of Rheumatology, Rennes; C. Le Henaff, MD, Department of Internal Medicine, Morlaix; J.B. Thorel, MD, Department of Rheumatology, Lorient; S. Hoang, MD, Department of Rheumatology, Vannes; A. Martin, MD, Department of Rheumatology, St Brieuc; P. Youinou, MD, PhD, Unit of Immunology, Morvan Hospital, CHU Brest. Address reprint requests to Dr. V. Devauchelle-Pensec, Unit of Rheumatology, Hôpital de la Cavale Blanche, BP 824, F29609 Brest cedex, France. E-mail: valerie.devauchelle-pensec@chu-brest.fr Accepted for publication March 2, 2006.
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