A Patient Based Reliability Exercise of Omeract Ultrasound Definitions in Giant Cell Arteritis

Valentin S. Schäfer¹, Stavros Chrysidis², Christian Dejaco³, Christina Duftner⁴, Annamaria Iagnocco⁵, George A. W. Bruyn⁶, Greta Carrara⁷, MA D'Agostino⁸, Eugenio De Miguel⁹, Andreas P Diamantopoulos¹⁰, Ulrich Fredberg¹¹, Wolfgang Hartung¹², Alojzija Hočevar¹³, Tanaz A. Kermani¹⁴, Matthew J. Koster¹⁵, Tove Lorenzen¹⁶, Pierluigi Macchioni¹⁷, Marcin Milchert¹⁸, Uffe Møller Døhn¹⁹, Chetan Mukhtyar²⁰, Cristina Ponte²¹, Sofia Ramiro²², Carlo Alberto Scirè²³, Lene Terslev²⁴, Kenneth J. Warrington¹⁵, Bhaskar Dasgupta²⁵ and Wolfgang A. Schmidt²⁶, ¹Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany, ²Department of Rheumatology, Hospital of Southwest Denmark, Esbjerg, Denmark, ³Rheumatology and Immunology, Medical University Graz, Graz, Austria, ⁴Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria, ⁵Academic Rheumatology Unit, Università degli Studi di Torino, Torino, Italy, ⁶Rheumatology, MC Groep, Loenga, Netherlands, ⁷Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, ⁸Rheumatology, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France, ⁹Medicine, Universidad Autonoma Madrid, MADRID, Spain, ¹⁰Martina Hansens Hospital, Bærum, Oslo, Norway, ¹¹Diagnostic Centre, Silkeborg Regional Hospital, 8600 Silkeborg, Denmark, ¹²Department of Rheumatology/Clinical Immunology, Asklepios Medical Center, 93077 Bad Abbach, Germany, ¹³Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia, ¹⁴Rheumatology, University of California Los Angeles, Los Angeles, CA, ¹⁵Rheumatology, Mayo Clinic, Rochester, MN, ¹⁶Diagnostic Centre, Region Hospital Silkeborg, Silkeborg, Denmark, ¹⁷Arcispedale Santa Maria Nuova, Reggio Emilia, Italy, ¹⁸Pomeranian Medical University, Szczecin,, Szczecin, Poland, ¹⁹Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark, ²⁰Norfolk and Norwich University Hospital, Norwich, United Kingdom, ²¹Rheumatology Department, Hospital de Santa Maria - Centro Hospital Lisboa Norte, Lisbon, Portugal, ²²Rheumatology, Department of Rheumatology, LUMC, Leiden, Netherlands, Leiden, Netherlands, ²³Italian Society for Rheumatology, Milan, Italy, ²⁴Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark, Copenhagen, Denmark, ²⁵Rheumatology, Southend University Hospital NHS Foundation Trust, Southend, UK, Westcliff-on-Sea, United Kingdom, ²⁶Medical Center for Rheumatology and Clinical Immunology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: giant cell arteritis, outcomes, patient health, ultrasonography and vasculitis

Session Information

Date: Sunday, November 5, 2017

Title: Vasculitis Poster I: Large Vessel Vasculitis

Session Type: ACR Poster Session A

Session Time: 9:00AM-11:00AM

Background/Purpose: To test the reliability of recently established consensus-based ultrasound definitions for normal and vasculitic temporal and axillary arteries in patients with giant cell arteritis (GCA) and in controls.

Methods: A preliminary one-day meeting was held in Southend, United Kingdom. One year later, a full three-day meeting according to OMERACT ultrasound group guidelines for patient based reliability testing was conducted in Berlin, Germany. This meeting included a 6-hour training session for standardization of examination technique and ultrasound machine settings. In both exercises 6-18 MHz linear ultrasound transducers of high quality ultrasound machines were used. Bilateral common superficial temporal arteries with frontal and parietal branches as well as axillary arteries were examined at two time points by 12 sonographers for normal findings, halo sign and compression sign using consensus-based definitions. In the preliminary meeting, 4 patients had longstanding established GCA, 1 patient had severe arteriosclerosis; and 1 normal control was included. In the second meeting, 4 GCA patients with more recent diagnosis and 2 healthy controls were examined. Inter- and intra-observer reliability was calculated.

Results: In the preliminary exercise, inter-reader reliabilities were fair to moderate for the overall diagnosis of GCA (Light’s kappa, 0.29-0.51) and poor to fair for identifying vasculitis in the respective anatomical segments (Light’s kappa, 0.02-0.46). Intra-reader reliabilities were moderate (Cohen’s kappa, 0.32-0.64). In the main exercise, inter-reader reliability was good to excellent (Light’s kappa, 0.76-0.86) for the overall diagnosis of GCA and moderate to good (Light’s kappa, 0.46-0.71) for identifying vasculitis in the respective anatomical segments. Intra-reader reliability was excellent for diagnosis of GCA (Cohen’s kappa, 0.91) and good (Cohen’s kappa, 0.71-0.80) for the anatomical segments.

Conclusion: The patient based reliability for ultrasound definitions of halo and compression sign of temporal and for halo sign of axillary artery is good to excellent in recent onset GCA. Training of a standardized examination protocol is crucial for achieving specific results and good inter- and intra-observer reliabilities. The reliability in established disease requires further study.

Disclosure: V. S. Schäfer, None; S. Chrysidis, None; C. Dejaco, Merck Sharp and Dohme GmbH, 5,Merck Sharp and Dohme GmbH, 7,Merck Sharp and Dohme GmbH, 8; C. Duftner, None; A. Iagnocco, None; G. A. W. Bruyn, None; G. Carrara, None; M. D'Agostino, BMS, AbbVie, Novartis, 8; E. De Miguel, None; A. P. Diamantopoulos, Roche Pharmaceuticals, 8,BMS, 8; U. Fredberg, None; W. Hartung, None; A. Hočevar, None; T. A. Kermani, None; M. J. Koster, None; T. Lorenzen, None; P. Macchioni, None; M. Milchert, None; U. M. Døhn, None; C. Mukhtyar, None; C. Ponte, None; S. Ramiro, None; C. A. Scirè, None; L. Terslev, None; K. J. Warrington, None; B. Dasgupta, None; W. A. Schmidt, None.

To cite this abstract in AMA style:

Schäfer VS, Chrysidis S, Dejaco C, Duftner C, Iagnocco A, Bruyn GAW, Carrara G, D'Agostino M, De Miguel E, Diamantopoulos AP, Fredberg U, Hartung W, Hočevar A, Kermani TA, Koster MJ, Lorenzen T, Macchioni P, Milchert M, Døhn UM, Mukhtyar C, Ponte C, Ramiro S, Scirè CA, Terslev L, Warrington KJ, Dasgupta B, Schmidt WA. A Patient Based Reliability Exercise of Omeract Ultrasound Definitions in Giant Cell Arteritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/a-patient-based-reliability-exercise-of-omeract-ultrasound-definitions-in-giant-cell-arteritis/. Accessed .

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