Inter-Reader and Intra-Reader Reliability of the New Omeract Ultrasonographic Criteria for the Diagnosis of Calcium Pyrophosphate Deposition Disease

Georgios Filippou¹, Carlo Alberto Scirè², Nemanja Damjanov³, Antonella Adinolfi⁴, Greta Carrara⁵, Valentina Picerno¹, Carmela Toscano¹, George A. W. Bruyn⁶, Maria Antonietta D'Agostino⁷, Andrea Delle Sedie⁸, Emilio Filippucci⁹, Marwin Gutierrez¹⁰, Mihaela Cosmina Micu¹¹, Ingrid Moller¹², Esperanza Naredo¹³, Pascal Zufferey¹⁴, Carlos Pineda¹⁵, francesco Porta¹⁶, Wolfgang A. Schmidt¹⁷, Lene Terslev¹⁸, Violeta Vlad¹⁹, Bruno Frediani¹, Annamaria Iagnocco²⁰ and OMERACT working group "US in CPPD", ¹University of Siena, Siena, Italy, ²Epidemiology Unit – Italian Society for Rheumatology (SIR), Milano, Italy, ³Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia, ⁴Policlinico le Scotte, Siena, Italy, ⁵Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, ⁶Rheumatology, MC Groep, Loenga, Netherlands, ⁷University of Paris, Paris, France, ⁸Department Rheumatology, University of Pisa, Pisa, Italy, ⁹Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Italy, ¹⁰Instituto Nacional de Rehabilitación, Mexico, Mexico, ¹¹Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Cluj Napoca, Romania, ¹²Direction, Poal Institute of Rheumatology, Corbera de Llobregat, Spain, ¹³Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain, ¹⁴Department of Rheumatology, University Hospital Lausanne, Lausanne, Switzerland, ¹⁵Instituto Nacional de Rehabilitation, Mexico, Mexico, ¹⁶Hospital of Pistoia, Pistoia, Italy, ¹⁷Immanuel Krankenhaus Berlin, Med Ctr for Rheumatology Berlin-Buch, Berlin, Germany, ¹⁸Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Copenhagen, Denmark, ¹⁹RCRD Research Center, Bucharest, Romania, ²⁰Sapienza Università di Roma, Roma, Italy

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: Calcium pyrophosphate dihydrate (CPPD), crystal-induced arthritis and ultrasound

Session Information

Date: Wednesday, November 16, 2016

Title: Imaging of Rheumatic Diseases III: Crystal Arthritis, Osteoarthritis, Connective Tissue Disease and Vasculitis

Session Type: ACR Concurrent Abstract Session

Session Time: 11:00AM-12:30PM

Background/Purpose: ultrasonography (US) has been implemented recently as a possible diagnostic method for CPPD[1]. However, data on the reliability of US in CPPD diagnosis are lacking. Aim of the study was to assess the inter-reader and intra-reader reliability of US on detecting CPP deposition in fibrocartilage(FC), hyaline cartilage (HC), tendons (T) and synovial fluid (SF)

Methods: the OMERACT “US in CPPD” group defined firstly the US CPPD identification criteria following the methods adopted by OMERACT and described at the OMERACT handbook (http://www.omeract.org/omeract_publications.html). After a systematic literature review and a Delphi survey the set of US criteria for identification of CPPD by were defined (table 1).

Subsequently, a two steps procedure for the assessment of the reliability has been followed. Firstly, the panel gave a dichotomous score on the presence absence of CPPD in 150 photos of FC, HC, T and SF equally distributed, on a web based platform. The assessment has been carried out twice in order to calculate both inter and intra-reader reliability. In the second step, the experts met for a real life-patient based assessment of CPPD in a workshop organised in Siena-Italy. In that occasion, FC/HC/T/SF of the right knee and FC and SF of the right wrist of 8 patients were assessed twice in a day by all experts giving again a dichotomous score for CPPD. 8 US scanners (ESAOTE mylab seven) equipped with the same probe and the same preset (made ad hoc before the meeting), have been used for the workshop.

Results: Reliability values of the web based exercise and of the workshop are presented in table 2. Tendons and synovial fluid analysis did not reach sufficient strength of agreement neither on the web based nor in the patient based exercise regarding the inter-reader kappa and independently of the site. However, in the static exercise, both tendons and SF reached a good intra-reader reliability meaning that scanning technique of these structures is very important for CPPD identification. On the other hand, menisci (but not triangular FC of the wrist) and HC reached good kappa values for inter-reader and intra-reader agreement both on static and web-based exercise.

Conclusion: Knee cartilage and fibrocartilage structures resulted to be reliable enough for identification of CPPD. On the other hand, CPPD identification in tendons and synovial fluid is challenging and the actual OMERACT criteria for these sites do not ensure a safe classification of patients. OMERACT US criteria for CPPD identification in knee menisci and HC allow a reliable classification of patients and should be used when CPPD is suspected. References:

1 Zhang W, Doherty M, Bardin T, et al. European League Against Rheumatism recommendations for calcium pyrophosphate deposition. Part I: terminology and diagnosis. Ann Rheum Dis 2011;70:563–70. doi:10.1136/ard.2010.139105

Disclosure: G. Filippou, None; C. A. Scirè, None; N. Damjanov, None; A. Adinolfi, None; G. Carrara, None; V. Picerno, None; C. Toscano, None; G. A. W. Bruyn, None; M. A. D'Agostino, None; A. Delle Sedie, None; E. Filippucci, None; M. Gutierrez, None; M. C. Micu, None; I. Moller, None; E. Naredo, None; P. Zufferey, None; C. Pineda, None; F. Porta, None; W. A. Schmidt, None; L. Terslev, None; V. Vlad, None; B. Frediani, None; A. Iagnocco, None.

To cite this abstract in AMA style:

Filippou G, Scirè CA, Damjanov N, Adinolfi A, Carrara G, Picerno V, Toscano C, Bruyn GAW, D'Agostino MA, Delle Sedie A, Filippucci E, Gutierrez M, Micu MC, Moller I, Naredo E, Zufferey P, Pineda C, Porta F, Schmidt WA, Terslev L, Vlad V, Frediani B, Iagnocco A. Inter-Reader and Intra-Reader Reliability of the New Omeract Ultrasonographic Criteria for the Diagnosis of Calcium Pyrophosphate Deposition Disease [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/inter-reader-and-intra-reader-reliability-of-the-new-omeract-ultrasonographic-criteria-for-the-diagnosis-of-calcium-pyrophosphate-deposition-disease/. Accessed .

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