Reliability of Ultrasound in Detecting Cartilage Change in Patients with Rheumatoid Arthritis: A Study By Omeract Ultrasound Task Force

Peter Mandl¹, Emilio Filippucci², Farideh Alasti¹, Artur Bachta³, Marina Backhaus⁴, David Bong⁵, George A. W. Bruyn⁶, Paz Collado⁷, Nemanja Damjanov⁸, Christian Dejaco⁹, Andrea Delle Sedie¹⁰, Christina Duftner¹¹, Marwin Gutierrez¹², Hilde B. Hammer¹³, Cristina Hernandez-Diaz¹⁴, Annamaria Iagnocco¹⁵, Kei Ikeda¹⁶, David Kane¹⁷, Helen I. Keen¹⁸, Stephen Kelly¹⁹, Eszter Kővári²⁰, Eugenio De Miguel²¹, Ingrid Möller²², Uffe Møller Døhn²³, Esperanza Naredo²⁴, Juan Carlos Nieto²⁵, Carlos Pineda²⁶, Ana Rodriguez²⁷, Wolfgang A. Schmidt²⁸, Marcin Szkudlarek²⁹, Ralf G. Thiele³⁰, Lene Terslev³¹, Richard J. Wakefield³², Daniel Windschall³³, Maria Antonietta D'Agostino³⁴ and Peter Balint³⁵, ¹Department of Internal Medicine III; Division of Rheumatology, Medical University Vienna, Vienna, Austria, ²Università Politecnica delle Marche, Jesi, Italy, ³Military Medical Institute, Warsaw, Poland, ⁴Rheumatology, Park-Klinik Weissensee, Berlin, Germany, ⁵Rheumatology, Instituto Poal de Reumatologia, Barcelona, Spain, ⁶Rheumatology, MC Groep, Loenga, Netherlands, ⁷Rheumatology, Pediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain, ⁸Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia, ⁹Rheumatology and Immunology, Medical University Graz, Graz, Austria, ¹⁰Department Rheumatology, University of Pisa, Pisa, Italy, ¹¹Medical University Innsbruck, Innsbruck, Austria, ¹²Instituto Nacional de Rehabilitación, Mexico, Mexico, ¹³Dept. of Rheumtology, Diakonhjemmet Hospital, Oslo, Norway, ¹⁴Instituto Nacional de Rehabilitación, Mexico City, Mexico, ¹⁵Sapienza Università Di Roma,, Roma, Italy, ¹⁶Chiba University Hospital, Chiba, Japan, ¹⁷Rheumatology, Adelaide, Meath hospital Dublin (incorporating the National Children's hospital), Dublin 24, Ireland, ¹⁸School of Medicine and Pharmacology, University of Western Australia, Perth, Australia, ¹⁹18Mile End Hospital, Barts Health NHS Trust, London, United Kingdom, ²⁰III Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary, ²¹Hospital Universitario La Paz, Madrid, Spain, ²²Instituto Poal de Reumatologia, Barcelona, Spain, ²³Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Glostrup, Denmark, ²⁴Rheumatology, Hospital General Universitario Gregorio Marañón and Universidad Complutense, Madrid, Spain, ²⁵Hospital General Universitario Gregorio Marañón and Complutense University, Madrid, Spain, ²⁶Instituto Nacional de Rehabilitation, Mexico, Mexico, ²⁷Rheumatology, Hospital Ramón y Cajal, Madrid, Spain, ²⁸Immanuel Krankenhaus Berlin, Med Ctr for Rheumatology Berlin-Buch, Berlin, Germany, ²⁹Copenhagen University Hospital at Køge, Køge, Denmark, ³⁰Medicine, University of Rochester Medical Center, Rochester, NY, ³¹Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Copenhagen Center for Arthritis Research (COPECARE), Copenhagen, Denmark, ³²University of Leeds, Leeds, United Kingdom, ³³Pediatric Clinic, Asklepios Hospital Weissenfels, Weissenfels, Germany, ³⁴Rheumatology, Versailles-Saint Quentin en Yvelines University, Boulogne-Billancourt, France, ³⁵Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary

Meeting: 2016 ACR/ARHP Annual Meeting

Date of first publication: September 28, 2016

Keywords: cartilage, rheumatoid arthritis (RA) and ultrasonography

Session Information

Date: Sunday, November 13, 2016

Title: Imaging of Rheumatic Diseases - Poster I: Ultrasound and Emerging Technologies

Session Type: ACR Poster Session A

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

Background/Purpose: The assessment of cartilage and bone damage in rheumatoid arthritis (RA) has traditionally relied on radiographical analyses in which joint space loss served as a surrogate marker of cartilage loss. Discernment of the relative contributions of damage to cartilage and other soft tissue structures within the joint space narrowing score however is not possible. Recently musculoskeletal ultrasonography (MSUS) was shown to be a reliable and reproducible tool for the assessment of cartilage in RA in the small joints of the hand. We aimed to produce MSUS consensus-based definitions of cartilage change in RA and assess its intraobserver and interobserver reliability.

Methods: We conducted a Delphi study on US defined cartilage change and a proposed semiquantitative (SQ) US scoring system for cartilage change in RA. A written Delphi questionnaire was developed based on a systematic literature review and expert international consensus and was distributed via consecutive written questionnaires by email to a group 35 rheumatologists from 17 countries with experience in musculoskeletal US. Taskforce members performed US B mode examination of the metacarpal cartilage in metacarpophalangeal joints 2-5 in RA patients and the images were collected in an electronic database. A reference image atlas of cartilage changes was developed for scoring 123 anonymized images including 25 duplicate images. These were sent to the participants who independently scored the images. Intraobserver reliability was assessed by CohenÕs kappa and interobserver reliability by FleissÕ kappa.

Results: Group agreement (76-100%) was reached for 6 statements concerning: i) MSUS definition and assessment of normal hyaline cartilage, ii) elementary cartilage lesions in MSUS and iii) grading of elementary cartilage lesions inpatients with RA in a two-round Delphi consensus process. A three-grade SQ (0-2) scoring system (grade 0, normal cartilage; grade 1, minimal change: blurring of outer and/or subchondral margin, focal thinning or incomplete loss of homogeneity of echostructure; grade 2, severe: diffuse thinning or complete loss of homogeneity of echostructure) was agreed for scoring cartilage damage in RA (Figure 1). Both intra- and inter-observer reliability were good (κ value of 0.87 and 0.64 respectively).

Conclusion: This study demonstrates that US is a reliable tool for evaluating cartilage in RA and strongly supports the use of a new reliable semiquantitative MSUS scoring system for cartilage change.

Figure 1. Three-grade semiquantitative scoring system (0-2) for scoring cartilage damage in RA.

Disclosure: P. Mandl, None; E. Filippucci, None; F. Alasti, None; A. Bachta, None; M. Backhaus, None; D. Bong, None; G. A. W. Bruyn, None; P. Collado, None; N. Damjanov, None; C. Dejaco, None; A. Delle Sedie, None; C. Duftner, None; M. Gutierrez, None; H. B. Hammer, None; C. Hernandez-Diaz, None; A. Iagnocco, None; K. Ikeda, None; D. Kane, None; H. I. Keen, None; S. Kelly, None; E. Kővári, None; E. De Miguel, None; I. Möller, None; U. M. Døhn, None; E. Naredo, None; J. C. Nieto, None; C. Pineda, None; A. Rodriguez, None; W. A. Schmidt, None; M. Szkudlarek, None; R. G. Thiele, Amgen, 8,AbbVie, 8,BioClinica, 5; L. Terslev, None; R. J. Wakefield, None; D. Windschall, Roche Pharmaceuticals, 2,Novartis Pharmaceutical Corporation, 2; M. A. D'Agostino, None; P. Balint, None.

To cite this abstract in AMA style:

Mandl P, Filippucci E, Alasti F, Bachta A, Backhaus M, Bong D, Bruyn GAW, Collado P, Damjanov N, Dejaco C, Delle Sedie A, Duftner C, Gutierrez M, Hammer HB, Hernandez-Diaz C, Iagnocco A, Ikeda K, Kane D, Keen HI, Kelly S, Kővári E, De Miguel E, Möller I, Døhn UM, Naredo E, Nieto JC, Pineda C, Rodriguez A, Schmidt WA, Szkudlarek M, Thiele RG, Terslev L, Wakefield RJ, Windschall D, D'Agostino MA, Balint P. Reliability of Ultrasound in Detecting Cartilage Change in Patients with Rheumatoid Arthritis: A Study By Omeract Ultrasound Task Force [abstract]. Arthritis Rheumatol. 2016; 68 (suppl 10). https://acrabstracts.org/abstract/reliability-of-ultrasound-in-detecting-cartilage-change-in-patients-with-rheumatoid-arthritis-a-study-by-omeract-ultrasound-task-force/. Accessed .

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