Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an Omeract Reliability Exercise Using Consensual Definitions

George A. W. Bruyn¹, Heidi Siddle², Petra Hanova³, Felicie Costantino⁴, Annamaria Iagnocco⁵, Andrea Delle Sedie⁶, Marwin Gutierrez⁷, Hilde B. Hammer⁸, Elizabeth Jernberg⁹, Damien Loeuille¹⁰, Carlos Pineda¹¹, Mihaela Cosmina Micu¹², Ingrid Moller¹³, bethan richards¹⁴, Maria S. Stoenoiu¹⁵, Takeshi Suzuki¹⁶, Lene Terslev¹⁷, Violeta Vlad¹⁸, Robert Wonink¹⁹, MA D'Agostino²⁰ and Richard J. Wakefield²¹, ¹Dept of Rheumatology, MC Groep hospitals, Lelystad, Netherlands, ²University of Leeds, Leeds, United Kingdom, ³Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University in Prague, Prague, Czech Republic, ⁴Hôpital Universitaire Ambroise Pare, Paris, France, ⁵Academic Rheumatology Unit, Università degli Studi di Torino, Torino, Italy, ⁶Department Rheumatology, University of Pisa, Pisa, Italy, ⁷Rheumatology, Instituto Nacional de Rehabilitación, Mexico City, Mexico, ⁸Dept. of Rheumtology, Diakonhjemmet Hospital, Oslo, Norway, ⁹University of Washington, Seattle, WA, ¹⁰Rheumatology, CHRU Vandoeuvre les Nancy, Nancy, France, ¹¹Instituto Nacional de Rehabilitation, Mexico, Mexico, ¹²Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Cluj Napoca, Romania, ¹³Instituto de Poal, Barcelona, Spain, ¹⁴University of New South Wales, Sydney, Australia, ¹⁵Service de Rhumatologie, Cliniques Universitaires Saint-Luc,Institut de Recherche Expérimentale et Clinique (IREC), Université catholique de Louvain,, Brussels, Belgium, ¹⁶Division of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo, Japan, ¹⁷Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark, Copenhagen, Denmark, ¹⁸RCRD Research Center, Bucharest, Romania, ¹⁹Bergman Clinics, Naarden, Netherlands, ²⁰Rheumatology, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France, ²¹University of Leeds, Leeds Institute of Rheumatic and Musculoskeletal Medicine, Leeds, United Kingdom

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: synovitis and ultrasonography

Session Information

Date: Monday, November 6, 2017

Title: Rheumatoid Arthritis – Clinical Aspects Poster II: Pathophysiology, Autoantibodies, and Disease Activity Measures

Session Type: ACR Poster Session B

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

Background/Purpose: To evaluate the intra- and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).

Methods: Following a 2-round Delphi consensus process on US-defined STJ synovitis in patients with RA, twelve sonographers conducted an US reliability exercise on 10 RA patients with ankle/rearfoot pain using a 16-8 MHz linear probe. The anteromedial, posteromedial, and posterolateral STJ was assessed ultrasonographically using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis (synovial hyeprtrophy (SH) and power Doppler (PD) signal) and a dichotomous score for the presence of joint effusion (JE). Intraobserver reliability was calculated by Cohen’s kappa. Interobserver reliability was computed by Light’s kappa. Weighted k coefficients with absolute weighting were computed for B-mode and PD signal.

Results: Overall intra- and interobserver agreement for the STJ was 83% and 69%; overall intra- and interobserver agreement for SH, PD signal and JE, was 81(51-100)%, 88 (67-100) %, and 80 (72-88)%, respectively, and 69 (60-74)%, 76 (66-83)%, and 60 (54-65)% respectively. Mean weighted Cohen’s kappa for SH, PD, and JE, was 0.80 (0.62-0.98), 0.61 (0.48-0.73), and 0.52 (0.36-0.67), respectively. Weighted Cohen’s kappa for SH, PD, and JE in the anteromedial, posteromedial and posterolateral STJ was -0.04-0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05-0.65, and -0.2-0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weigthed Light kappa for SH was 0.67 (95%CI 0.58-0.74), 0.46 (0.35-0.59) for PD, and 0.16 (0.08-0.27) for JE. Weighted Light kappa for SH, PD, and JE was 0.63 (0.45-0.82),0.33 (0.19-0.42) and 0.09 (-0.01-0.19), for the anteromedial STJ; 0.49 (0.27-0.64), 0.35 (0.27-0.4), and 0.04 (-0.06-0.1) for posteromedial STJ, and 0.82 (0.75-0.89), 0.66 (0.56-0.8), and 0.18 (0.04-0.34) for posterolateral STJ, respectively.

Conclusion: Ultrasound is a reliable imaging technique for assessing synovitis of the STJ in patients with RA. The most reliable site to assess STJ synovitis in patients with RA is the posterolateral probe position.

Disclosure: G. A. W. Bruyn, None; H. Siddle, None; P. Hanova, None; F. Costantino, None; A. Iagnocco, None; A. Delle Sedie, None; M. Gutierrez, None; H. B. Hammer, None; E. Jernberg, None; D. Loeuille, None; C. Pineda, None; M. C. Micu, None; I. Moller, None; B. richards, None; M. S. Stoenoiu, None; T. Suzuki, None; L. Terslev, None; V. Vlad, None; R. Wonink, None; M. D'Agostino, BMS, AbbVie, Novartis, 8; R. J. Wakefield, None.

To cite this abstract in AMA style:

Bruyn GAW, Siddle H, Hanova P, Costantino F, Iagnocco A, Delle Sedie A, Gutierrez M, Hammer HB, Jernberg E, Loeuille D, Pineda C, Micu MC, Moller I, richards B, Stoenoiu MS, Suzuki T, Terslev L, Vlad V, Wonink R, D'Agostino M, Wakefield RJ. Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an Omeract Reliability Exercise Using Consensual Definitions [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/ultrasound-of-subtalar-joint-synovitis-in-patients-with-rheumatoid-arthritis-results-of-an-omeract-reliability-exercise-using-consensual-definitions/. Accessed .

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