Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Doppler ultrasound plays an increasing role for monitoring disease activity in rheumatoid arthritis (RA). This study aimed to evaluate the association between two semi-quantitative color Doppler ultrasound scoring systems (SQS) currently in use, and the novel quantitative scoring (QS) of color Doppler pixel count.
Methods: Adult patients with RA and inadequate clinical response to anti-rheumatic therapy were examined with musculoskeletal ultrasound (MSUS) upon entering a prospective study with add-on therapy. Dorsal MSUS of the wrists, metacarpophalangeal joint (MCP) 2-5 and metatarsophalangeal joint (MTP) 2-5 in both sides were performed. All MSUS images with sign of synovitis were collected and the QS was measured. Five assessors blinded to the QS evaluated all the images independently from each other, according to either SQS method. Association between QS and SQS was studied using correlations and multilevel models taking into account the clustering of ratings at the rater, patient and joint levels.
Results: Analysis of the 1190 ratings collected revealed a strong correlation (ρ=0.89, p<0.0001) and significant associations (p<0.0001, for all multilevel models) between QS and SQS. Correlations between QS and SQS according to Szkudlarek et al. (ρ=0.87, p<0.0001) or Hammer et al. (ρ=0.91, p<0.0001) were similar. A total of 239 (20.1%) images were given a SQS grade that did not match that expected based on initial QS, using predefined cutoffs. Main explanations for discrepancies were different perceived region of interest (ROI) (40.7%) and Doppler pixel count near cutoffs between SQS grades (32.3%).
Conclusion: We showed that both SQS methods correlated well with QS to assess synovial activity in RA. This suggests that any of these methods can be used to assess synovial activity in RA, but also that SQS methods are intrinsically limited when the Doppler pixel count is close to the cutoffs between the SQS grades. Another main reason for discrepancy was different perceived ROI that might underline the need for further consensus on how to define the ROI at the joint level. Analysis discrepancies between these methods may help guide further revision of criteria used to assess disease activity with MSUS in RA.
To cite this abstract in AMA style:Rezaei H, af Klint E, Hammer HB, Terslev L, d'Agostino M, Kisten Y, Arnaud L. Analysis of Correlation and Causes for Discrepancy Between Quantitative and Semi Quantitative Doppler Scores in Synovitis in Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/analysis-of-correlation-and-causes-for-discrepancy-between-quantitative-and-semi-quantitative-doppler-scores-in-synovitis-in-rheumatoid-arthritis/. Accessed July 5, 2020.
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