Creation of an Ultrasonographic Scoring System for CPPD Extent: Results from a Delphi Process by the OMERACT US Working Group

Silvia Sirotti¹, Antonella Adinolfi², Fabio Becce³, Tomas Cazenave⁴, Sara Nysom Christiansen⁵, Edoardo Cipolletta⁶, Andrea Delle Sedie⁷, Mario Enrique Diaz Cortes⁸, Fabiana Figus⁹, Emilio Filippucci¹⁰, Peter Mandl¹¹, Daryl MacCarter¹², Ingrid Moller¹³, Mohamed Mortada¹⁴, Gael Mouterde¹⁵, Maria Esperanza Naredo Sanchez¹⁶, Carlos Pineda¹⁷, Francesco Porta¹⁸, Wolfgang Schmidt¹⁹, Teodora Serban²⁰, Lene Terslev²¹, Florentin Vreju²², Richard Wakefield²³, Pascal Zufferey²⁴, Piercarlo Sarzi-Puttini²⁵, Maria-Antonietta D'Agostino²⁶, Nemanja Damjanov²⁷, Annamaria Iagnocco²⁸, Helen Keen²⁹ and Georgios Filippou³⁰, ¹Department of Clinical Sciences and Community Health, Università degli Studi di Milano, Milan, Italy, ²Rheumatology Unit, Grande Ospedale Metropolitano Niguarda, Milan, Italy, ³Lausanne University Hospital, Lausanne, Switzerland, ⁴Instituto de Rehabilitación Psicofisica, Buenos Aires, Argentina, Buenos Aires, Argentina, ⁵Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark, ⁶Polytechnic University of Marche, Jesi, Italy, ⁷University of Pisa, Pisa, Italy, ⁸Rheumatology Unit, University Hospital Fundación Santa Fe de Bogota, Bogotà, Colombia, ⁹University of Torino, Torino, Italy, ¹⁰Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy, ¹¹Medical University of Vienna, Vienna, Austria, ¹²Rheumatology Department, North Valley Hospital, Whitefish, MT, ¹³University of Barcelona, Barcelona, Spain, ¹⁴Zagazig University, Zagazig, Egypt, ¹⁵Rheumatology department, CHU Montpellier, Montpellier, France, ¹⁶Department of rheumatology, Joint and Bone research Unit, Hospital Universitario Fundación Jiménez díaz and Autónoma University, Madrid, Spain, ¹⁷Instituto Nacional de Rehabilitacion, Mexico City, Federal District, Mexico, ¹⁸INS, Institute of Neurosciences, Florence, Italy, ¹⁹Immanuel Krankenhaus Berlin, Berlin, Germany, ²⁰ASL 3 Genovese, Genova, Italy, ²¹Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Glostrup, Denmark, ²²Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania, ²³Rheumatology, Leeds University, Leeds, United Kingdom, ²⁴Rheumatology Department, University of Lausanne, CHUV, Lausanne, Switzerland, ²⁵L.Sacco University Hospital, Milano, Italy, ²⁶Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy, ²⁷University of Belgrade School of Medicine, Institute of Rheumatology, Belgrade, Serbia, ²⁸University of Turin, Roma, Italy, ²⁹University of Western Australia, Daglish, Australia, ³⁰Rheumatology Department, Luigi Sacco University Hospital, Siena, Italy

Meeting: ACR Convergence 2021

Keywords: CPPD, OMERACT, Ultrasound

Session Information

Date: Tuesday, November 9, 2021

Title: Metabolic & Crystal Arthropathies – Basic & Clinical Science Poster II (1565–1583)

Session Type: Poster Session D

Session Time: 8:30AM-10:30AM

Background/Purpose: Ultrasound (US) has proven to be an excellent technique for detecting Calcium Pyrophosphate (CPP) deposits, however there are no grading systems that allow for a quantification and extent of deposition in patients. The only attempt was made on 2013 by Filippou et al. (Filippou G et al. Ann Rheum Dis 2013) but that score was never validated. The aim of this study is to create a scoring system for the quantification of CPP deposition at patient level according to the OMERACT framework.

Methods: According to the OMERACT methodology we performed a systematic literature review (SLR) aimed to estimate the prevalence of CPP deposition in peripheral joints by imaging in order to establish relevant joints for Calcium Pyrophosphate Deposition Disease (CPPD) monitoring [abstract submitted separately]. At the same time, a preliminary survey was circulated among the members of the OMERACT US – CPPD subgroup to collect their suggestions on the items to be included in the scoring system according to their personal experience. Subsequently, a Delphi survey was prepared and circulated between members of the OMERACT US – CPPD subgroup, including statements that reflected both the results of the SLR and of the preliminary survey. In total, 32 statements were created regarding the kind of scoring for single structures, the sites to be included, the final scoring at patient level, and the scanning technique. Participants were asked to reply on a Likert Scale and agreement was achieved when 4 and 5 grades reached 75% or more of concordance. In case of disagreement, new statements were proposed according to the members suggestions and proposed for voting in a consequent round.

Results: 3 Delphi rounds were needed in order to reach agreement on all items. 32 participants out of 41 members replied at the first round, 26/32 at the second and 25/26 at the third round. 20 statements were approved in the first round, 3 at the second and 3 at the third. Statements in some cases were grouped together (for example the scale to use for the scoring) so once agreement was reached for one scoring the others were not proposed anymore. The experts decided to include only the knees (menisci and hyaline cartilage) and the triangular fibrocartilage of the wrists in the final score, using a four-grade scoring system (0-3). The final scoring with the definitions and the relative technical notes is represented in Figure 1.

Conclusion: This is the first attempt to create a scoring system for CPP crystals extent in patients affected by CPPD. In the next future the scoring will be assessed for reliability and hopefully released for use in clinical practice and research.

Disclosures: S. Sirotti, None; A. Adinolfi, None; F. Becce, Horizon, 2, Siemens Healthineers, 5; T. Cazenave, None; S. Christiansen, Novartis, 5, BMS, 6, GE, 6; E. Cipolletta, None; A. Delle Sedie, None; M. Diaz Cortes, None; F. Figus, None; E. Filippucci, None; P. Mandl, MSD, 5, 6, Celgene, 5, 6, Lilly, 5, 6, BMS, 5, 6, AbbVie, 5, 6, Janssen, 5, 6, Novartis, 5, 6, Roche, 5, 6, UCB, 5, 6; D. MacCarter, None; I. Moller, None; M. Mortada, None; G. Mouterde, AbbVie, 2, 5, 6, BMS, 2, 5, 6, Celgene, 2, 5, 6, Lilly, 2, 5, 6, Novartis, 2, 5, 6, Pfizer, 2, 5, 6; M. Naredo Sanchez, None; C. Pineda, None; F. Porta, None; W. Schmidt, None; T. Serban, None; L. Terslev, None; F. Vreju, None; R. Wakefield, None; P. Zufferey, None; P. Sarzi-Puttini, None; M. D'Agostino, None; N. Damjanov, AbbVie, 2, 5, 6, Pfizer, 2, 5, 6, Roche, 2, 5, 6, Gideon Richter, 2, 6, Merck, 2, 6, Novartis, 2, 6; A. Iagnocco, None; H. Keen, Roche, 6, Abbvie, 6, Roche, 12, education/travel; G. Filippou, None.

To cite this abstract in AMA style:

Sirotti S, Adinolfi A, Becce F, Cazenave T, Christiansen S, Cipolletta E, Delle Sedie A, Diaz Cortes M, Figus F, Filippucci E, Mandl P, MacCarter D, Moller I, Mortada M, Mouterde G, Naredo Sanchez M, Pineda C, Porta F, Schmidt W, Serban T, Terslev L, Vreju F, Wakefield R, Zufferey P, Sarzi-Puttini P, D'Agostino M, Damjanov N, Iagnocco A, Keen H, Filippou G. Creation of an Ultrasonographic Scoring System for CPPD Extent: Results from a Delphi Process by the OMERACT US Working Group – CPPD Subgroup [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/creation-of-an-ultrasonographic-scoring-system-for-cppd-extent-results-from-a-delphi-process-by-the-omeract-us-working-group-cppd-subgroup/. Accessed .

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