Date: Monday, November 6, 2017
Session Type: ACR Poster Session B
Session Time: 9:00AM-11:00AM
Background/Purpose: To evaluate the intra- and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).
Methods: Following a 2-round Delphi consensus process on US-defined STJ synovitis in patients with RA, twelve sonographers conducted an US reliability exercise on 10 RA patients with ankle/rearfoot pain using a 16-8 MHz linear probe. The anteromedial, posteromedial, and posterolateral STJ was assessed ultrasonographically using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis (synovial hyeprtrophy (SH) and power Doppler (PD) signal) and a dichotomous score for the presence of joint effusion (JE). Intraobserver reliability was calculated by Cohen’s kappa. Interobserver reliability was computed by Light’s kappa. Weighted k coefficients with absolute weighting were computed for B-mode and PD signal.
Results: Overall intra- and interobserver agreement for the STJ was 83% and 69%; overall intra- and interobserver agreement for SH, PD signal and JE, was 81(51-100)%, 88 (67-100) %, and 80 (72-88)%, respectively, and 69 (60-74)%, 76 (66-83)%, and 60 (54-65)% respectively. Mean weighted Cohen’s kappa for SH, PD, and JE, was 0.80 (0.62-0.98), 0.61 (0.48-0.73), and 0.52 (0.36-0.67), respectively. Weighted Cohen’s kappa for SH, PD, and JE in the anteromedial, posteromedial and posterolateral STJ was -0.04-0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05-0.65, and -0.2-0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weigthed Light kappa for SH was 0.67 (95%CI 0.58-0.74), 0.46 (0.35-0.59) for PD, and 0.16 (0.08-0.27) for JE. Weighted Light kappa for SH, PD, and JE was 0.63 (0.45-0.82),0.33 (0.19-0.42) and 0.09 (-0.01-0.19), for the anteromedial STJ; 0.49 (0.27-0.64), 0.35 (0.27-0.4), and 0.04 (-0.06-0.1) for posteromedial STJ, and 0.82 (0.75-0.89), 0.66 (0.56-0.8), and 0.18 (0.04-0.34) for posterolateral STJ, respectively.
Conclusion: Ultrasound is a reliable imaging technique for assessing synovitis of the STJ in patients with RA. The most reliable site to assess STJ synovitis in patients with RA is the posterolateral probe position.
To cite this abstract in AMA style:Bruyn GAW, Siddle H, Hanova P, Costantino F, Iagnocco A, Delle Sedie A, Gutierrez M, Hammer HB, Jernberg E, Loeuille D, Pineda C, Micu MC, Moller I, richards B, Stoenoiu MS, Suzuki T, Terslev L, Vlad V, Wonink R, D'Agostino M, Wakefield RJ. Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an Omeract Reliability Exercise Using Consensual Definitions [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). https://acrabstracts.org/abstract/ultrasound-of-subtalar-joint-synovitis-in-patients-with-rheumatoid-arthritis-results-of-an-omeract-reliability-exercise-using-consensual-definitions/. Accessed August 21, 2018.
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