Results of a Reliability Exercise for the Grading of Tendon Rupture in Patients With Rheumatoid Arthritis, using a Consensus-Based Ultrasound Score

George A. W. Bruyn¹, Petra Hanova², Annamaria Iagnocco³, Maria-Antonietta d'Agostino⁴, Lene Terslev⁵, I. Moller⁶, Peter V. Balint⁷, E. Filippucci⁸, Carlos Pineda⁹, Marina Backhaus¹⁰, Richard van Vugt¹¹, Richard J. Wakefield¹², Paul Baudoin¹³, Kei Ikeda¹⁴, Artur Bachta¹⁵, Helen I. Keen¹⁶, Levent Oczakar¹⁷, Sibel Z. Aydin¹⁸, Marwin Gutierrez¹⁹, Peter Mandl²⁰ and Esperanza Naredo²¹, ¹Dept of Rheumatology, MC Groep hospitals, Lelystad, Netherlands, ²Institute of Rheumatology, 1st Faculty of Medicine, Charles University, Prague, Prague, Czech Republic, ³Sapienza University of Rome, Rome, Italy, ⁴Rheumatology, Versailles-Saint Quentin en Yvelines University- APHP, Ambroise-Paré Hospital, Boulogne-Billancourt, France, ⁵The Parker Institute, Copenhagen, Denmark, ⁶Instituto Poal, Barcelona, Spain, ⁷Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary, ⁸University Politecnica delle Marche, Ancona, Italy, ⁹Biomedical Research, Instituto Nacional de Rehabilitacion, Mexico City, Mexico, ¹⁰Rheumatology/Immunology, Charite University Hospital, Berlin, Germany, ¹¹VU Medisch Centrum, Amsterdam, Netherlands, ¹²Division of Rheumatic and Musculoskeletal Disease, University of Leeds and NIHR Leeds Musculoskeletal Biomedical Research Unit, Leeds, United Kingdom, ¹³MC Groep hospitals, Lelystad, Netherlands, ¹⁴Department of Allergy and Clinical Immunology, Chiba University Hospital, Chiba, Japan, ¹⁵Military Medical Institute, Warsaw, Poland, ¹⁶School of Medicine and Pharmacology, The University of Western Australia, Crawley, Australia, ¹⁷Hacettepe University Medical School, Ankara, Turkey, ¹⁸Unit of Rheumatology, Medeniyet University, Goztepe Training and Research Hospital, Istanbul, Turkey, ¹⁹Università Politecnica delle Marche, Jesi, Italy, ²⁰Medical University of Vienna, Vienna, Austria, ²¹Rheumatology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain

Meeting: 2013 ACR/ARHP Annual Meeting

Keywords: Rheumatoid arthritis (RA), tendonitis/bursitis and ultrasonography

Session Information

Title: Imaging in Rheumatoid Arthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose: To develop the first ultrasound (US) scoring system of tendon rupture in rheumatoid arthritis (RA) and assess its intra- and inter-observer reliability.

Methods: We undertook a Delphi consensus process on US defined tendon damage and US scoring system of tendon damage in RA among 35 rheumatologists expert in musculoskeletal US from 16 countries. Then, we assessed the intra- and interobserver reliability of US in scoring tendon damage on B-mode. Twelve patients with RA with symptoms of hands or feet were recruited. Twelve rheumatologists expert in musculoskeletal US consecutively performed a blind and independent US examination for tendon damage in B mode of five wrist extensor compartments and one ankle tendon of each patient bilaterally in two rounds. Intra- and inter-observer reliability were assessed by kappa coefficients. Reliability of tendon compartments was assessed by ICC.

Results: Five men and seven women were included. Median age was 66.5 years, range 36-74. Rheumatoid factor positivity was present in 8 patients (67%), anti-CCP+ in five (42%). Median DAS28 was 3.79, range 2.41-5.6. A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B-mode, where grade 0 stands for normal tendon, grade 1 for partial rupture, and grade 2 for complete tendon rupture, respectively. Overall, 3456 investigations of tendon compartments were carried out. US scoring showed the following prevalences: grade 0 (N=2652, 76.7%); grade 1 (N=727, 21%), and grade 2 (N=77, 2.3%). The mean intra-observer reliability for tendon damage scoring was excellent (kappa value 0.91). The mean interobserver reliability assessment showed good kappa values (kappa value 0.75). The most reliable tendons were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior.

Conclusion: US is a reproducible tool for evaluating tendon damage in RA. In addition, this study supports a novel reliable US scoring system for tendon rupture. The scoring system should at least include the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons.

Disclosure:

G. A. W. Bruyn,

Vertex,

P. Hanova,
None;

A. Iagnocco,
None;

M. A. d’Agostino,

BMS, Abbvie, Pfizer, Roche,

BMS,

Elsevier ,

L. Terslev,
None;

I. Moller,
None;

P. V. Balint,
None;

E. Filippucci,
None;

C. Pineda,
None;

M. Backhaus,
None;

R. van Vugt,
None;

R. J. Wakefield,
None;

P. Baudoin,
None;

K. Ikeda,
None;

A. Bachta,
None;

H. I. Keen,
None;

L. Oczakar,
None;

S. Z. Aydin,
None;

M. Gutierrez,
None;

P. Mandl,
None;

E. Naredo,
None.

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