Letters: Standardize Squeeze Test for Inflammatory Arthritis?

Squeeze Test in Inflammatory Arthritis, Need for Standardization?

The first use of the squeeze test as a clinical maneuver to detect inflammatory arthritis in patients with hand problems was described by Recth in 1988, and Morton described its use for patients with foot problems.^1,2 In 1991, Eberhardt and Rigby proposed the clinical maneuver be used in the hands and feet to classify patients with rheumatoid arthritis.^3-5 Also in the late 1980s, the American Rheumatism Association proposed the Rheumatoid Arthritis Classification Criteria.⁶ These efforts to diagnose early arthritis in a simpler manner had no echoes.

It was not until 2002 that Visser et al developed a prediction rule to identify patients with persistent erosive arthritis, again evoking the use of the squeeze test, but the ACPA positivity test surpassed the predictor force of the clinical maneuver.⁷

Also in 2002, Emery et al proposed, in addition to other clinical features, the use of the squeeze test for screening and early referral of patients with inflammatory arthritis to a rheumatologist.⁸

In 2007, van der Helm-van Mil et al developed a prediction rule to develop rheumatoid arthritis in an undifferentiated arthritis cohort, but the ACPA positivity and other clinical features surpassed the squeeze test as a predictor of RA.⁹ In 2008, El Mediany et al, in Egypt, also recognized the use of the squeeze test for hands and feet, but ACPA won again.

The squeeze test—aka compression test, Morton test or Gaenslen’s squeeze test—is being used today in busy clinical settings for RA activity evaluation in patients with established RA, as de Jong and Wiesinger proposed.^2,10-13

Despite all the investigation that has been done on the squeeze test, the method and force to use are not well described. We suggest before the use of the squeeze test grows, it be standardized and validated by rheumatologists and musculoskeletal health professionals.

Regards,
Dr. David Vega Morales Centro de Especialistas en Artritis y Reumatismo CEAR Monterrey, Nuevo León

References

1. Recht L, Lithman T, Rasmussen JO, et al. A test to detect hand dysfunction. Practitioner. 1988 Nov 8;232(1458):1236–1239.
2. Wu KK. Morton neuroma and metatarsalgia. Curr Opin Rheumatol. 2000 Mar;12(2):131–142.
3. Rigby AS, Wood PH. The lateral metacarpophalangeal/metatarsophalangeal squeeze: An alternative assignment criterion for rheumatoid arthritis. Scand J Rheumatol. 1991;20(2):115–120.
4. Rigby A, Wood N. The lateral metacarpophalangeal/metatarsophalangeal squeeze: A useful discriminator for rheumatoid arthritis. Br J Rheumatol. 1989 Nov:28(suppl):18–19.
5. Rigby AS. Development of a scoring system to assist in the diagnosis of rheumatoid arthritis. Methods Inf Med. 1991;30(1):23–29.
6. Arnett FC, Edworthy SM, Bloch DA, et al. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum. 1988 Mar;31(3):315–324.
7. Visser H, le Cessie S, Vos K, et al. How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis. Arthritis Rheum. 2002 Feb;46(2):357–365.
8. Emery P, Breedveld FC, Dougados M, et al. Early referral recommendation for newly diagnosed rheumatoid arthritis: Evidence based development of a clinical guide. Ann Rheum Dis. 2002 Apr;61(4):290–297.
9. van der Helm-van Mil AH, le Cessie S, van Dongen H, et al. A prediction rule for disease outcome in patients with recent-onset undifferentiated arthritis: How to guide individual treatment decisions. Arthritis Rheum. 2007 Feb;56(2):433–440.
10. Hochberg MC, Silman AJ, Smolen JS, et al (eds). Rheumatology. Philadelphia: Mosby/Elsevier; 2011.
11. Firestein GS, Budd RC, Harris Jr. ED, et al. Part 5 Evaluation of Generalized and Localized Symptoms. In Kelley’s Textbook of Rheumatology. Philadelphia: Elsevier; 2009.
12. Wiesinger T, Smolen JS, Aletaha D, et al. Compression test (Gaenslen’s squeeze test) positivity, joint tenderness, and disease activity in patients with rheumatoid arthritis. Arthritis Care Res (Hoboken). 2013 Apr;65(4):653–657.
13. de Jong PH, Weel AE, de Man YA, et al. Brief report: To squeeze or not to squeeze, that is the question! Optimizing the disease activity score in 28 joints by adding the squeeze test of metatarsophalangeal joints in early rheumatoid arthritis. Arthritis Rheum. 2012 Oct;64(10):3095–3101.