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.
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 March 22, 2019.
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ACR Meeting Abstracts - https://acrabstracts.org/abstract/reliability-of-ultrasound-in-detecting-cartilage-change-in-patients-with-rheumatoid-arthritis-a-study-by-omeract-ultrasound-task-force/