ACR Meeting Abstracts

ACR Meeting Abstracts

Abstract Number: 1943

Results of a Reliability Exercise for the Grading of Tendon Rupture in Patients With Rheumatoid Arthritis, using  a Consensus-Based Ultrasound Score

George A. W. Bruyn1, Petra Hanova2, Annamaria Iagnocco3, Maria-Antonietta d'Agostino4, Lene Terslev5, I. Moller6, Peter V. Balint7, E. Filippucci8, Carlos Pineda9, Marina Backhaus10, Richard van Vugt11, Richard J. Wakefield12, Paul Baudoin13, Kei Ikeda14, Artur Bachta15, Helen I. Keen16, Levent Oczakar17, Sibel Z. Aydin18, Marwin Gutierrez19, Peter Mandl20 and Esperanza Naredo21, 1Dept of Rheumatology, MC Groep hospitals, Lelystad, Netherlands, 2Institute of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Prague, Czech Republic, 3Sapienza University of Rome, Rome, Italy, 4Rheumatology, Versailles-Saint Quentin en Yvelines University- APHP, Ambroise-Paré Hospital, Boulogne-Billancourt, France, 5The Parker Institute, Copenhagen, Denmark, 6Instituto Poal, Barcelona, Spain, 7Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary, 8University Politecnica delle Marche, Ancona, Italy, 9Biomedical Research, Instituto Nacional de Rehabilitacion, Mexico City, Mexico, 10Rheumatology/Immunology, Charite University Hospital, Berlin, Germany, 11VU Medisch Centrum, Amsterdam, Netherlands, 12Division of Rheumatic and Musculoskeletal Disease, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, United Kingdom, 13MC Groep hospitals, Lelystad, Netherlands, 14Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan, 15Military Medical Institute, Warsaw, Poland, 16School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia, 17Hacettepe University Medical School, Ankara, Turkey, 18Unit of Rheumatology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey, 19Università Politecnica delle Marche, Jesi, Italy, 20Medical University of Vienna, Vienna, Austria, 21Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: ,

Session Information

Title: Imaging in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose:  To develop the first ultrasound (US) scoring system of tendon rupture in rheumatoid arthritis (RA) and assess its intra- and inter-observer reliability.

Methods: We undertook a Delphi consensus process on US defined tendon damage and US scoring system of tendon damage in RA among 35 rheumatologists expert in musculoskeletal US from 16 countries. Then, we assessed the intra- and interobserver reliability of US in scoring tendon damage on B-mode. Twelve patients with RA with symptoms of hands or feet were recruited. Twelve rheumatologists expert in musculoskeletal US consecutively performed a blind and independent US examination for tendon damage in B mode of five wrist extensor compartments and one ankle tendon of each patient bilaterally in two rounds. Intra- and inter-observer reliability were assessed by kappa coefficients. Reliability of tendon compartments was assessed by ICC.

Results: Five men and seven women were included. Median age was 66.5 years, range 36-74. Rheumatoid factor positivity was present in 8 patients (67%), anti-CCP+ in five (42%). Median DAS28 was 3.79, range 2.41-5.6. A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B-mode, where grade 0 stands for normal tendon, grade 1 for partial rupture, and grade 2 for complete tendon rupture, respectively.  Overall, 3456 investigations of tendon compartments were carried out. US scoring showed the following prevalences: grade 0 (N=2652, 76.7%); grade 1 (N=727, 21%), and grade 2 (N=77,  2.3%). The mean intra-observer reliability for tendon damage scoring was excellent (kappa value 0.91). The mean interobserver reliability assessment showed good kappa values (kappa value 0.75). The most reliable tendons were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior.

Conclusion: US is a reproducible tool for evaluating tendon damage in RA. In addition, this study supports a novel reliable US scoring system for tendon rupture. The scoring system should at least include the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons.

Disclosure:

G. A. W. Bruyn,

Vertex,

7;

P. Hanova,
None;

A. Iagnocco,
None;

M. A. d’Agostino,

BMS, Abbvie, Pfizer, Roche,

8,

BMS,

5,

Elsevier ,

7;

L. Terslev,
None;

I. Moller,
None;

P. V. Balint,
None;

E. Filippucci,
None;

C. Pineda,
None;

M. Backhaus,
None;

R. van Vugt,
None;

R. J. Wakefield,
None;

P. Baudoin,
None;

K. Ikeda,
None;

A. Bachta,
None;

H. I. Keen,
None;

L. Oczakar,
None;

S. Z. Aydin,
None;

M. Gutierrez,
None;

P. Mandl,
None;

E. Naredo,
None.

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