Omeract Ultrasonographic Criteria for the Diagnosis of Calcium Pyrophosphate Deposition Disease at the Metacarpal-Phalangeal, Wrist, Acromion-Clavicular and Hip Joints: An Inter-Observer and Intra-Observer Reliability Study

Pascal Zufferey¹, Georgios Filippou², Carlo Alberto Scirè³, Nemanja Damjanov⁴, MA D'Agostino⁵, George A. W. Bruyn⁶, Antonella Adinolfi², Greta Carrara⁷, Valentina Di Sabatino⁸, Andrea Delle Sedie⁹, Tomas Cazenave¹⁰, Carlos Pineda¹¹, Francesco Porta¹², Daryl K. MacCarter¹³, Emilio Filippucci¹⁴, Frédérique Gandjbakhch¹⁵, Ingrid Moller¹⁶, Anthony Reginato¹⁷, Mihaela Cosmina Micu¹⁸, Mohamed Mortada¹⁹, Gaël Mouterde²⁰, Lene Terslev²¹, Esperanza Naredo²², Valentina Picerno², Wolfgang A. Schmidt²³, Violeta Vlad²⁴, Florentin Ananu Vreju²⁵ and Annamaria Iagnocco²⁶, ¹Department of Rheumatology, University Hospital Lausanne, Lausanne, Switzerland, ²University of Siena, Siena, Italy, ³Epidemiology Unit -Italian Society for Rheumatology, Milano, Italy, ⁴Institute of Rheumatology, Belgrade University School of Medicine, Belgrade, Serbia, ⁵Rheumatology, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France, ⁶Rheumatology, MC Groep, Loenga, Netherlands, ⁷Epidemiology Unit, Italian Society for Rheumatology, Milano, Italy, ⁸CMV, Grosseto, Italy, ⁹University of Pisa, Rheumatology Unit, Pisa, Italy, ¹⁰Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina, ¹¹Biomedical Research, Instituto Nacional de Rehabilitacion, Mexico City, Mexico, ¹²Hospital of Pistoia, Pistoia, Italy, ¹³Coeur d'Alene Arthritis Clinic, Coeur d'Alene, ID, ¹⁴Clinical Reumatologica, Universita Politecnica delle Marche, Ancona, Italy, ¹⁵Service de Rhumatologie, GH Pitié-Salpétrière, MD, Paris, France, ¹⁶Instituto de Poal, Barcelona, Spain, ¹⁷Rheumatology, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, RI, ¹⁸Division of Rheumatology, Department of Rehabilitation II, Clinical Rehabilitation Hospital, Cluj Napoca, Romania, ¹⁹zagazig university, Zagazig, Egypt, ²⁰Rheumatology Department, Hopital Lapeyronie, Montpellier, France, ²¹Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark, Copenhagen, Denmark, ²²Rheumatology Department, Hospital Gregorio Marañón, Madrid, Spain, ²³Med Ctr Rheumatology Berlin Buch, Immanuel Krankenhaus Berlin, Berlin, Germany, ²⁴RCRD Research Center, Bucharest, Romania, ²⁵University of Medicine and Pharmacy, Department of Rheumatology, Craiova, Romania, ²⁶Academic Rheumatology Unit, Università degli Studi di Torino, Torino, Italy

Meeting: ACR/ARHP Annual Meeting 2017

Date of first publication: September 18, 2017

Keywords: Crystal-induced arthritis, diagnosis and ultrasound

Session Information

Date: Tuesday, November 7, 2017

Title: Metabolic and Crystal Arthropathies Poster II

Session Type: ACR Poster Session C

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

Background/Purpose:

The OMERACT US subtask force “US in CPPD” has recently created the definitions for US identification of crystal deposits in joints and tested the reliability between different observers[1]. Those cirteria were however validated only at the knee.The Objectives were to assess the inter- and intra-observer reliability of US on detecting CPPD in the triangular fibrocartilage complex (TFCC) of the wrists, fibrocartilage of the acromio-clavicular (AC) joint and hip labrum (HL) and hyaline cartilage (HC) of the metacarpal heads (MC) and femoral head.

Methods: The OMERACT US criteria for identification of CPPD have been used for this exercise[2] using a two steps approach. First, a panel of US experts gave a dichotomous score (presence/absence of CPPD) of 120 images of sites under investigation using a web based platform. The assessment was carried out twice in order to calculate both the inter and intra-observer reliability. In the second step, the experts met for a patient based assessment of CPPD in a workshop. Bilateral evaluation of TFCC, AC joints, HL and HC of the hip and HC of the II and III MC of 8 patients was carried out twice in the same day by 18 US experts. Eight US machines (3 GE, 1 Samsung and 4 Esaote) equipped with high resolution linear probes were used for the workshop

Results:

Reliability values of the web based exercise (both intra and inter) were high demonstrating that definitions were clear for all participants for all sites. The results of the patient based exercise are presented in table 1. The TFCC of the wrist demonstrated to be the most reliable site for the assessment of CPPD followed by the AC joint. Other sites demonstrated lower kappa values and thus are not considered reliable for assessment of CPPD

Section	Mean prevalence	Mean observed agreement	Mean kappa	PabaK*
Inter-Reader Agreement
1) ALL	48,2	0,71	0,43	0,42
2) Fibrocartilage	72,7	0,75	0,39	0,51
3) Hyaline cartilage	23,7	0,67	0,09	0,34
4) Hand	22,6	0,69	0,12	0,38
5) Wrist Fibrocartilage	95,1	0,91	0,01	0,82
6) Acromion-Clavicular Joint	61,1	0,75	0,51	0,51
7) Hip	43,7	0,61	0,23	0,23
7a) Hip Labrum	61,8	0,6	0,16	0,19
7b) Hip Cartilage	25,7	0,63	0,04	0,26
Intra-Reader Agreement
1) ALL	48,3	0,85	0,69	0,71
2) Fibrocartilage	73,1	0,85	0,57	0,71
3) Hyaline cartilage	23,4	0,86	0,53	0,73
4) Hand	23	0,84	0,48	0,69
5) Wrist Fibrocartilage	95,1	0,93	0,66	0,87
6) Acromion-Clavicular Joint	62,5	0,88	0,68	0,76
7) Hip	42,9	0,82	0,58	0,66
7a) Hip Labrum	61,7	0,73	0,32	0,47
7b) Hip Cartilage	23,9	0,91	0,67	0,83
Strength of agreement: < 0.20 Poor. 0.21 – 0.40 Fair. 0.41 – 0.60 Moderate. 0.61 – 0.80 Substantial. 0.81 – 1.00 Excellent *Pabak: Prevalence-Adjusted Bias-Adjusted Kappa

Conclusion:

the TFCC of the wrist is the most reliable site for assessing CPPD. By adding these results to the previous exercise[2], we can confirm that the new OMERACT US definitions for assessing CPPD can be applied reliably at the knee (meniscus and HC), TFCC of the wrist and AC joints. These peripheral sites are the most frequently involved in CPPD. The next step of the OMERACT “US in CPPD” subtask force, will be to test the value of these findings in a longitudinal observational study.

Disclosure: P. Zufferey, None; G. Filippou, None; C. A. Scirè, None; N. Damjanov, None; M. D'Agostino, BMS, AbbVie, Novartis, 8; G. A. W. Bruyn, None; A. Adinolfi, None; G. Carrara, None; V. Di Sabatino, None; A. Delle Sedie, None; T. Cazenave, None; C. Pineda, None; F. Porta, None; D. K. MacCarter, None; E. Filippucci, None; F. Gandjbakhch, None; I. Moller, None; A. Reginato, None; M. C. Micu, None; M. Mortada, None; G. Mouterde, None; L. Terslev, None; E. Naredo, Abbvie, Roche, BMS, Pfizer, UCB, Novartis, Lilly, Janssen, 5; V. Picerno, None; W. A. Schmidt, Roche Pharmaceuticals, 8,Roche Pharmaceuticals, 5,Roche Pharmaceuticals, 2,GlaxoSmithKline, 2,GlaxoSmithKline, 5,Bristol-Myers Squibb, 5,Bristol-Myers Squibb, 8; V. Vlad, None; F. Ananu Vreju, None; A. Iagnocco, None.

To cite this abstract in AMA style:

Zufferey P, Filippou G, Scirè CA, Damjanov N, D'Agostino M, Bruyn GAW, Adinolfi A, Carrara G, Di Sabatino V, Delle Sedie A, Cazenave T, Pineda C, Porta F, MacCarter DK, Filippucci E, Gandjbakhch F, Moller I, Reginato A, Micu MC, Mortada M, Mouterde G, Terslev L, Naredo E, Picerno V, Schmidt WA, Vlad V, Ananu Vreju F, Iagnocco A. Omeract Ultrasonographic Criteria for the Diagnosis of Calcium Pyrophosphate Deposition Disease at the Metacarpal-Phalangeal, Wrist, Acromion-Clavicular and Hip Joints: An Inter-Observer and Intra-Observer Reliability Study [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/omeract-ultrasonographic-criteria-for-the-diagnosis-of-calcium-pyrophosphate-deposition-disease-at-the-metacarpal-phalangeal-wrist-acromion-clavicular-and-hip-joints-an-inter-observer-and-intra-obs/. Accessed .

ACR Meeting Abstracts - https://acrabstracts.org/abstract/omeract-ultrasonographic-criteria-for-the-diagnosis-of-calcium-pyrophosphate-deposition-disease-at-the-metacarpal-phalangeal-wrist-acromion-clavicular-and-hip-joints-an-inter-observer-and-intra-obs/