Gerardo Quintana-López1,2,3, Kevin Maldonado-Cañón4, Jorge Bruce Flórez-Suárez4, Paul Méndez-Patarroyo4,5, Paola Coral-Alvarado4,5, Enrique Calvo6. 1. Reumavance Group, Rheumatology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá University Hospital, Carrera 7 No. 117-15, 110111, Bogota, Colombia. gquintanal@unal.edu.co. 2. Department of Internal Medicine, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia. gquintanal@unal.edu.co. 3. Department of Internal Medicine, School of Medicine, Universidad de Los Andes, Bogota, Colombia. gquintanal@unal.edu.co. 4. Reumavance Group, Rheumatology Section, Department of Internal Medicine, Fundación Santa Fe de Bogotá University Hospital, Carrera 7 No. 117-15, 110111, Bogota, Colombia. 5. Department of Internal Medicine, School of Medicine, Universidad de Los Andes, Bogota, Colombia. 6. Department of Radiology, School of Medicine, Universidad Nacional de Colombia, Bogota, Colombia.
Abstract
OBJECTIVES: Assessing disease activity in rheumatoid arthritis (RA) patients requires comprehensive quantification of tender and swollen joints. We aimed to evaluate the correlation and agreement between rheumatologists after a training session dedicated to the standardization of synovitis assessment and compare its performance with a reference imaging modality such as musculoskeletal ultrasonography (MSUS). METHODS: In this cross-sectional study, a total of 28 and 10 joints in RA patients were evaluated by physical examination and ultrasound (US), respectively. After participating in a training session, individual joint assessment for tenderness and swelling was performed by three rheumatologists. MSUS examination was performed separately by an experimented radiologist in a standardized manner, evaluating findings according to the Outcome Measures in Rheumatology Clinical Trial (OMERACT) guidelines. RESULTS: A total of 80 RA patients were included, with a mean Disease Activity Score based on 28 joints (DAS28)-ESR of 4.02. The interobserver overall agreement and concordance rate in a total of 2240 joints assessed was 81.7% (k = 0.449, p < 0.0001) for tender joints and 66% (k = 0.227, p < 0.0001) for swollen joints. The overall concordance rate was fair (Fleiss' kappa = 0.21, p = 0.027) with an overall agreement of 67.18% yet, more joints were found to be swollen by the US assessment, compared to the physical examination (43% vs 39%). CONCLUSION: In our study population, joint tenderness showed better interobserver agreement, correlation, and concordance rate than joint swelling. When comparing the US assessment to the physical examination, a fair overall concordance rate supports the need for the implementation of training sessions dedicated to standardization in rheumatology clinics.
OBJECTIVES: Assessing disease activity in rheumatoid arthritis (RA) patients requires comprehensive quantification of tender and swollen joints. We aimed to evaluate the correlation and agreement between rheumatologists after a training session dedicated to the standardization of synovitis assessment and compare its performance with a reference imaging modality such as musculoskeletal ultrasonography (MSUS). METHODS: In this cross-sectional study, a total of 28 and 10 joints in RA patients were evaluated by physical examination and ultrasound (US), respectively. After participating in a training session, individual joint assessment for tenderness and swelling was performed by three rheumatologists. MSUS examination was performed separately by an experimented radiologist in a standardized manner, evaluating findings according to the Outcome Measures in Rheumatology Clinical Trial (OMERACT) guidelines. RESULTS: A total of 80 RA patients were included, with a mean Disease Activity Score based on 28 joints (DAS28)-ESR of 4.02. The interobserver overall agreement and concordance rate in a total of 2240 joints assessed was 81.7% (k = 0.449, p < 0.0001) for tender joints and 66% (k = 0.227, p < 0.0001) for swollen joints. The overall concordance rate was fair (Fleiss' kappa = 0.21, p = 0.027) with an overall agreement of 67.18% yet, more joints were found to be swollen by the US assessment, compared to the physical examination (43% vs 39%). CONCLUSION: In our study population, joint tenderness showed better interobserver agreement, correlation, and concordance rate than joint swelling. When comparing the US assessment to the physical examination, a fair overall concordance rate supports the need for the implementation of training sessions dedicated to standardization in rheumatology clinics.
Authors: Richard J Wakefield; Peter V Balint; Marcin Szkudlarek; Emilio Filippucci; Marina Backhaus; Maria-Antonietta D'Agostino; Esperanza Naredo Sanchez; Annamaria Iagnocco; Wolfgang A Schmidt; George A W Bruyn; George Bruyn; David Kane; Philip J O'Connor; Bernhard Manger; Fred Joshua; Juhani Koski; Walter Grassi; Marissa N D Lassere; Nanno Swen; Franz Kainberger; Andrea Klauser; Mikkel Ostergaard; Andrew K Brown; Klaus P Machold; Philip G Conaghan Journal: J Rheumatol Date: 2005-12 Impact factor: 4.666
Authors: George A Bruyn; Annamaria Iagnocco; Esperanza Naredo; Peter V Balint; Marwin Gutierrez; Hilde B Hammer; Paz Collado; Georgios Filippou; Wolfgang A Schmidt; Sandrine Jousse-Joulin; Peter Mandl; Philip G Conaghan; Richard J Wakefield; Helen I Keen; Lene Terslev; Maria Antonietta D'Agostino Journal: J Rheumatol Date: 2019-02-01 Impact factor: 4.666
Authors: Lene Terslev; Esperanza Naredo; Philippe Aegerter; Richard J Wakefield; Marina Backhaus; Peter Balint; George A W Bruyn; Annamaria Iagnocco; Sandrine Jousse-Joulin; Wolfgang A Schmidt; Marcin Szkudlarek; Philip G Conaghan; Emilio Filippucci; Maria Antonietta D'Agostino Journal: RMD Open Date: 2017-07-11