Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Ultrasonography (US) is an important tool in rheumatology practice. However, it highly depends on sonographer’s experience. The objective of our study was to evaluate intra and inter-reader reliability of ultrasound assessment in rheumatoid arthritis (RA) using a Score named REUMA (Rapid Evaluation by US to Monitor Arthritis) among observers across Latin American using a web tool.
Methods: We conducted a cross-sectional study. Fifty-one Latin American ultrasonographers with different experience took part in a web- based US reading exercise evaluating static images from 20 RA patients. The 4 – joints US scores was calculated for each patient including bilateral radiocarpal, midcarpal and second metacarpophalangeal joints. Power Doppler (PD) and gray scale (GS) were graded from 0 to 3. US scores comes as the result of the addition of PD and GS score, with a total score ranged from 0 – 36, being 36 the highest disease activity. Five patients were evaluated twice in order to address intra – rater reliability. The inter and intra-rater reliability was assessed using a two-way random, absolute, individual and average-measures intra-class correlation coefficient (ICC), with reliability being poor for ICC <0.40, fair for 0.40 to 0.59, good for 0.60 to 0.74, and excellent for values between 0.75 and 1.0. Furthermore, we stratified sonographers according to US experience (defining High experience as: at least 5 years of experience and 80 US assessments/month), evaluating differences in intra – reader reliability, inter-reader reliability, and variation of observers means between patients. Statistical significance was assessed at a type I error rate of 0.05.
Results: A total of 1020 US image assessments were performed. Mean 4-joints US score was 17 ± 8 (Doppler subscale 10 ± 4; Synovitis subscale 7 ± 4). The ICC was in the excellent range for intra [(individual ICC = 0.945 (IC95% 0.905 – 0.965); average ICC = 0.972 (IC95% 0.950 – 0.982)] and inter- reader reliability [(individual ICC = 0.867 (IC95% 0.786 – 0.934); average ICC = 0.997 (IC95% 0.995 – 0.999)]. When comparing high with low experience sonographers, there was no significant differences in intra-class correlation coefficient. However, there was a greater variation between the means among low experience readers, ranging from 13 to 22, in comparison with 14 to 18 in higher experience sonographers (Figure 1), which could introduce a bias to inter – reader reliability estimates.
Conclusion: Ultrasonography represents an excellent complementary tool to evaluate disease activity in patients with rheumatoid arthritis. However, its reliability is related to sonographer expertise and experience. Low – experience readers exhibit a higher variation on disease activity estimates. It is necessary to develope US training programs in order to improve reliability. Figure 1. Agreement with the mean between multiple observers in total score, gray and power doppler subscale.
To cite this abstract in AMA style:Cazenave T, Martire MV, Waimann CA, Alarcón E, Ventura L, Spindler WJ, Hernandez-Diaz C, Rosa J, Ruta S, Guinsburg M, Rodriguez Gil G, Urquiola C, Py G, Alva M, Tate P, Cerón C, Santiago L, Alvarez del Castillo Araujo AL, Haye Salinas MJ, Catay E, Bravo M, Zacariaz J, Sandobal C, Pacheco G, Benegas M, Navarta D, Arturi V, Bertoli A, Audisio M, Pineda C, Estrella N, Airoldi C, Kohan P, Santa Cruz MJ, Saldarriaga Rivera L, Wong R, Carrillo I, Najera H, García J, Pereira DF, Athayde Cardoso Linhares F, Mendonça JA, Quintero M, Reginato AM, Ayala Ledesma EN, Urioste L, De Miguel E, Gálvez Elkin MS, Saucedo C, Marin J, Arape R, Gutierrez M, Rosenffet M. Measuring Agreement in the Ultrasonographic Evaluation of Disease Activity in Rheumatoid Arthritis Patients. a Latin-American Multicenter Exercise Assessing the Influence of Sonographer Experience and Expertise [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/measuring-agreement-in-the-ultrasonographic-evaluation-of-disease-activity-in-rheumatoid-arthritis-patients-a-latin-american-multicenter-exercise-assessing-the-influence-of-sonographer-experience-and/. Accessed August 3, 2021.
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