BACKGROUND: Physical examination is the cornerstone of diagnosing and monitoring inflammatory arthritis, with the detection of joint effusions being one of the most crucial components of the exam. Rheumatologists largely rely on palpation, supported by other examination techniques, such as evaluating range of motion and visual inspection, to assess for signs of joint swelling. However, remote care is on the rise in rheumatology and aside from visual inspection, physical examination of joints is limited during telehealth visits. The ability of rheumatologists to accurately detect hand synovitis through photos or videos of the hands, without the benefit of direct tactile examination, is currently unknown. OBJECTIVE: To assess the accuracy of detecting joint effusions of the hands by remote visual evaluation alone. METHODS: We conducted a prospective cohort study of rheumatology patients in Edmonton, Canada. Participants were assessed clinically by rheumatologists for the presence of effusions of the metacarpal phalangeal (MCP) and proximal interphalangeal (PIP) joints between June 13, 2024 to October 29, 2024. Participants had photos and videos of their hands taken by study staff on the same day. Photos and videos were remotely assessed separately by four rheumatologists not involved in the initial clinic assessments for the presence of MCP and PIP joint effusions, and compared against the clinical assessments. RESULTS: The study cohort included 156 patients (mean age 53, 67% women, 33% had rheumatoid arthritis), for a total of 3120 MCP and PIP joints. 20/156 (12.8%) patients, and 69/3120 (2.2%) joints had effusions per clinical assessment. The average visual assessment joint-level sensitivity and specificity of photos were 0.14 (95% CI 0.07-0.19) and 0.97 (95% CI 0.96-0.98), respectively. The average visual assessment joint-level sensitivity and specificity of videos were 0.24 (95% CI 0.13-0.33) and 0.98 (95% CI 0.97-0.99), respectively. The average person-level visual assessment sensitivity and specificity of photos were 0.44 (95% CI 0.30-0.60) and 0.82 (95% CI 0.76-0.87), respectively. The average person-level visual assessment sensitivity and specificity of videos were 0.48 (95% CI 0.35-0.60) and 0.84 (95% CI 0.79-0.89), respectively. Assessor agreement was poor (Kappa 0.12-0.17). CONCLUSIONS: Visual inspection of photos and videos to detect joint effusions of the MCP and PIP joints is poor at both the joint- and person-level. Patients and rheumatologists should be aware of these limitations when conducting remote telehealth assessments.
Ye et al. (Wed,) studied this question.