Can Swindon foot and ankle questionnaire (SFAQ) be used to screen ultrasound requests?
Roopa Tekkatte, Hyeladzira Thahal, Lyn Williamson, Great Western NHS Foundation Trust, Swindon
Background:
Pressures on radiology ultrasound services include increasing requests from Rheumatologists to confirm early rheumatoid arthritis (RA). Feet pose particular problems. They are often affected in RA, but are excluded from the current standard clinical score DAS28CRP. We developed a simple scoring system for feet and ankles in inflammatory arthritis (SFAQ), validated against clinical measures¹, but not ultrasound (US). We compared US findings in early RA with SFAQ and looked at changes in early disease.
Method:
Early inflammatory arthritis patients completed the SFAQ, and DAS28CRP. Ultrasound (US) assessment of the feet and ankles was performed by consultant musculoskeletal (MSK) radiologist, blinded to the clinical score. These tests were repeated at 6 months. SFAQ scores >6 were considered high. DAS28CRP scores were stratified: high >5.1, moderate 5.1-3.2, low <3.2.
Results:
15 patients took part. On US scan, 5/15 (33%) had active synovitis (Images 1 & 2). Of these 3/5 had high SFAQ (p-0.064) and 4/5 had high DAS28CRP. Of 10 patients with no synovitis, 6/10 had high SFAQ and 3/10 had high DAS28CRP.
5 of 15 patients attended at 6 months. 2/5 had initial US synovitis and high SFAQ in the first assessment. At second assessment: none had active synovitis; SFAQ and DAS28CRP scores were all normal.
Conclusion:
We showed correlation between active synovitis on US and high SFAQ score. With increasing demand and pressure on the MSK US service, SFAQ could be used for stratification of active synovitis in foot and ankle, thus reducing the need for ultrasound scanning. Statistical significance is not achieved due to small numbers. Larger studies are needed.
Reference
1. The Swindon foot and ankle questionnaire: Is a picture worth a thousand words? Rosemary Waller, Peter Manuel, Lyn Williamson ISRN Rheumatology 2012, 2012: 105479