Peter Mandl1, Paul Studenic1, Emilio Filippucci2, Artur Bachta3, Marina Backhaus4, David Bong5, George A W Bruyn6, Paz Collado7, Nemanja Damjanov8, Christian Dejaco9,10, Andrea Delle-Sedie11, Eugenio De Miguel12, Christina Duftner13, Irina Gessl1, Marwin Gutierrez14, Hilde B Hammer15, Cristina Hernandez-Diaz16, Annmaria Iagnocco17, Kei Ikeda18, David Kane19, Helen Keen20, Stephen Kelly21, Eszter Kővári22, Ingrid Möller5, Uffe Møller-Dohn23, Esperanza Naredo24, Juan C Nieto25, Carlos Pineda14, Alex Platzer1, Ana Rodriguez26, Wolfgang A Schmidt27, Gabriela Supp1, Marcin Szkudlarek28, Lene Terslev23, Ralf Thiele29, Richard J Wakefield30,31, Daniel Windschall32, Maria-Antonietta D'Agostino33,34, Peter V Balint35. 1. Division of Rheumatology, Medical University of Vienna, Vienna, Austria. 2. Department of Rheumatology, Università Politecnica delle Marche, Jesi, Ancona, Italy. 3. Department of Rheumatology, Military Institute of Medicine, Warsaw, Poland. 4. Department of Internal Medicine, Rheumatology and Clinical Immunology, Park-Klinik Weissensee Academic Hospital of the Charité, Berlin, Germany. 5. Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain. 6. Department of Rheumatology, MC Groep, Lelystad, the Netherlands. 7. Department of Rheumatology, Hospital Universitario Severo Ochoa, Madrid, Spain. 8. University of Belgrade School of Medicine, Institute for Rheumatology, Belgrade, Serbia. 9. Department of Rheumatology, Medical University of Graz, Graz, Austria. 10. Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy. 11. Rheumatology Unit, University of Pisa, Pisa, Italy. 12. Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain. 13. Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University of Innsbruck/Tirol Kliniken, Innsbruck, Austria. 14. Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación, Mexico City, Mexico. 15. Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. 16. Laboratorio de Ultrasonido Musculoesquelético y Articular, Instituto Nacional de Rehabilitación, Mexico City, Mexico. 17. Academic Rheumatology Center, Università degli Studi di Torino, Turin, Italy. 18. Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan. 19. Department of Rheumatology, School of Medicine, Trinity College Dublin, Ireland. 20. School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia. 21. Rheumatology Department, Mile End Hospital, Barts Health NHS Trust, London, UK. 22. School of PhD Studies, Semmelweis University, Budapest, Hungary. 23. Center for Rheumatology and Spine Diseases, Copenhagen University Hospital Glostrup, Copenhagen, Denmark. 24. Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz and Autónoma University. 25. Department of Rheumatology, Hospital General Universitario Gregorio Marañón and Complutense University. 26. Department of Rheumatology, Hospital Ramón y Cajal, Madrid, Spain. 27. Medical Center for Rheumatology, Immanuel Krankenhaus Berlin, Berlin, Germany. 28. Department of Rheumatology, Zealand's University Hospital at Køge, Denmark. 29. University of Rochester School of Medicine and Dentistry, Rochester, USA. 30. NIHR Leeds Biomedical Research Centre, Leeds Teaching Hospitals NHS Trust. 31. Leeds Institute of Rheumatic and Musculoskeletal Medicine, Chapel Allerton Hospital, University of Leeds, Leeds, UK. 32. Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany. 33. Department of Rheumatology, APHP, Hopital Ambroise Paré, Paris, France. 34. Department of Rheumatology, INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Versailles, France. 35. 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
Abstract
OBJECTIVES: To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA. METHODS: A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RA patients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light's kappa. RESULTS: The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise. CONCLUSION: Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.
OBJECTIVES: To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA. METHODS: A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RApatients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light's kappa. RESULTS: The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise. CONCLUSION: Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.
Authors: Edoardo Cipolletta; Maria Chiara Fiorentino; Sara Moccia; Irene Guidotti; Walter Grassi; Emilio Filippucci; Emanuele Frontoni Journal: Front Med (Lausanne) Date: 2021-03-01