Ann Rheum Dis doi:10.1136/annrheumdis-2014-207202
Clinical and epidemiological research
Concise reportThe diagnostic accuracy of the squeeze test to identify arthritis: a cross-sectional cohort study
W B van den Bosch1, L Mangnus1, M Reijnierse2, T W J Huizinga1, A H M van der Helm-van Mil1
+ Author Affiliations
1Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
2Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
W B van den Bosch, Department of Rheumatology, Leiden University Medical Center, P.O. Box 9600, Leiden 2300 RC, The Netherlands; W.B.van_den_Bosch@lumc.nl
Published Online First 24 April 2015Abstract
Objectives In daily practice, the squeeze test is used to screen for arthritis in metacarpophalangeal (MCP) and metatarsophalangeal (MTP) joints. This cross-sectional cohort study determined the diagnostic accuracy of this test.
Methods Patients referred with arthralgia of recent onset that had either a clinical suspicion for progression to arthritis or clinically apparent arthritis were studied. The main outcome was swelling at physical examination of ≥1 MCP or MTP joint. Joint inflammation detected at extremity MRI was the secondary outcome.
Results Both at MCP and MTP joints, a positive squeeze test associated with swollen joints (p<0.005). The sensitivity of the test at the MCP joints was 53%, specificity 82%, positive likelihood ratio (LR+) 3.0, negative likelihood ratio (LR−) 0.6 and area under the receiver operator characteristic curve (AUC) 0.68. At the MTP joints, the sensitivity was 54%, specificity 74%, LR+ 2.1, LR− 0.6 and AUC 0.64. With MRI-detected inflammation as outcome, the sensitivity and specificity were 39% and 86% and 31% and 69% for the test at the MCP and MTP joints, respectively.
Conclusions A positive squeeze test is associated with local joint inflammation but the sensitivity is low
, indicating a high percentage of swollen joints with a negative squeeze test. When the test is used on its own, it is insufficient to detect early arthritis.
Love it. Good finding - now, print it off to show to those who *need educating !
Shakes head... Been there and been told "Ah, no arthritis in hands and feet." Oh yes ? Incorrect. So, had MRI of of feet done, lots of arthritis in me feet. Already had X-Rays of hands showing arthritis. But so called 'doctor' was having none of it. Not that the fella mattered a twopence, as I have a rheumy who actually 'knows' the time of day and had it all Dx anyways - problem being I am in France and she is in UK. Sigh. Can't odds that, but do have the diagnostics clear and positive for arthritis - as my rheumy and also another UK rheumy said, and in their reports : "Riddled with arthritis".
Be prepared guys !