Definition and Standardization of Inflammatory Pathology in Hand Osteoarthritis Assessed By Ultrasound: Results from a Delphi Process and Reliability Testing in the Omeract Ultrasonographer Group in Hand Osteoarthritis

Alexander Mathiessen¹, Hilde B Hammer¹, Lene Terslev², George A. W. Bruyn³, Maria Antonietta D'Agostino⁴, Georgios Filippou⁵, Emilio Filippucci⁶, Ida Kristin Haugen⁷, Marion Kortekaas⁸, Luana Mancarella⁹, Peter Mandl¹⁰, Ingrid Moller¹¹, Mohamed Atia Mortada¹², Esperanza Naredo¹³, Andrea Delle Sedie¹⁴, Ruth Wittoek¹⁵, Annamaria Iagnocco¹⁶ and Karen Ellegaard¹⁷, ¹Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, ²Copenhagen University Hospital at Glostrup, Copenhagen, Denmark, ³Rheumatology, MC Groep, Loenga, Netherlands, ⁴Department of Rheumatology, Assistance publique-Hôpitaux de Paris Ambroise Paré Hospital, Boulogne-Billancourt , Université Versailles Saint Quentin en Yvelines, Paris, France, ⁵University of Siena, Siena, Italy, ⁶Rheumatology Unit, Università Politecnica delle Marche, Jesi, Italy, ⁷Diakonhjemmet Hospital, Oslo, Norway, ⁸Dept. of Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ⁹Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy, ¹⁰Department of Internal Medicine III; Division of Rheumatology, Medical University Vienna, Vienna, Austria, ¹¹Instituto Poal de Reumatologia, Barcelona, Spain, ¹²Dept. of Rheumatology, Zagazig University, Zagazig, Egypt, ¹³Rheumatology Department, Hospital Gregorio Marañón, Madrid, Spain, ¹⁴University of Pisa, Rheumatology Unit, Pisa, Italy, ¹⁵Rheumatology, Ghent University Hospital, Ghent, Belgium, ¹⁶Academic Rheumatology Unit, Università degli Studi di Torino, Torino, Italy, ¹⁷Dept. of Rheumatology, The Parker Institute, Copenhagen, Denmark

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: Imaging, osteoarthritis and ultrasonography

Session Information

Date: Tuesday, November 7, 2017

Title: Imaging of Rheumatic Diseases Poster II

Session Type: ACR Poster Session C

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

Background/Purpose:

The introduction of MRI and ultrasound (US) atlases has improved reliability in rheumatoid arthritis. With an increased interest in the role of inflammation in osteoarthritis (OA), a similar US reference atlas could be useful for hand OA. Recent US studies of hand OA either apply a preliminary hand OA scoring system without image examples or an US atlas developed for RA patients. Hence, our aim was to standardize and explore the reliability of US assessments of inflammatory pathologies in patients with hand OA.

Methods:

The OMERACT (Outcome Measures in Rheumatology) US group in hand OA performed a Delphi exercise to agree on US-detected inflammatory pathologies including synovitis, effusion and power Doppler signals in hand OA finger joints. Still-images of interphalangeal joints with different grades of pathology were acquired and a set of 99 images was distributed in a web-based reliability exercise, with re-reading of 40 images after a week. Finally, the definitions were tested in a patient-based reliability exercise, where 6 experienced sonographers examined 12 patients with hand OA using GE Logic E9 machines. The 2nd–5th proximal and distal interphalangeal joints of the right hand were scored 0-3 for synovial hypertrophy and effusion (dorsal and volar side) and for Doppler activity (dorsal side). An US atlas was available during the exercise. Intraclass correlation coefficient (ICC) values were calculated with average-measure for inter-reader and single-measure for intra-reader reliability, defined as poor (<0.5), moderate (0.5–0.75), good (0.75–0.9) and excellent (>0.90).

Results:

US atlases of elementary lesions were developed (figure). The web-based reliability exercise (completed by 12 sonographers) showed excellent inter-reader and good to excellent intra-reader reliability for all variables (table). The patient-based reliability exercise showed moderate to good inter-reader and intra-reader reliability for all pathologies (table), with slightly better agreement for dorsal assessment of hypertrophy and effusion.

Conclusion:

Following a Delphi process, a semiquantitative scoring system with a complementary US atlas showed moderate to excellent reliability for sonographic assessments of inflammatory features in finger joints of hand OA patients. Our study demonstrates that ultrasound is a reliable tool for evaluating inflammation in hand OA patients.

Figure

Table

	Web-based reliability exercise		Patient-based reliability exercise
	Inter-reader ICC (95% CI)*	Intra-reader ICC mean (range)	Inter-reader ICC (95% CI)*	Intra-reader ICC mean (range)
Hypertrophy dorsal	0.98 (0.95–0.99)	0.84 (0.55, 0.97)	0.76 (0.48–0.92)	0.73 (0.48, 0.87)
Hypertrophy palmar	0.96 (0.93–0.98)	0.69 (0.17, 0.93)	0.64 (0.28–0.87)	0.56 (0.16, 0.76)
Effusion dorsal	0.98 (0.95–0.99)	0.79 (0.35, 0.95)	0.88 (0.63–0.96)	0.83 (0.54, 0.97)
Effusion palmar	0.97 (0.93–0.99)	0.80 (0.54, 1.00)	0.74 (0.44–0.91)	0.59 (0.28, 0.81)
Doppler dorsal	0.99 (0.99–1.00)	0.98 (0.92, 1.00)	0.82 (0.60–0.94)	0.51 (0.29, 0.86)
* Highest result in round 1 and 2.

Disclosure: A. Mathiessen, None; H. B. Hammer, None; L. Terslev, None; G. A. W. Bruyn, None; M. A. D'Agostino, None; G. Filippou, None; E. Filippucci, None; I. K. Haugen, None; M. Kortekaas, None; L. Mancarella, None; P. Mandl, None; I. Moller, None; M. A. Mortada, None; E. Naredo, None; A. Delle Sedie, None; R. Wittoek, None; A. Iagnocco, None; K. Ellegaard, None.

To cite this abstract in AMA style:

Mathiessen A, Hammer HB, Terslev L, Bruyn GAW, D'Agostino MA, Filippou G, Filippucci E, Haugen IK, Kortekaas M, Mancarella L, Mandl P, Moller I, Mortada MA, Naredo E, Delle Sedie A, Wittoek R, Iagnocco A, Ellegaard K. Definition and Standardization of Inflammatory Pathology in Hand Osteoarthritis Assessed By Ultrasound: Results from a Delphi Process and Reliability Testing in the Omeract Ultrasonographer Group in Hand Osteoarthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/definition-and-standardization-of-inflammatory-pathology-in-hand-osteoarthritis-assessed-by-ultrasound-results-from-a-delphi-process-and-reliability-testing-in-the-omeract-ultrasonographer-group-in-h/. Accessed .

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