International Consensus for ultrasound lesions in gout: results of Delphi process and web-reliability exercise

Abstract

This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies.

Ultrasound as an Outcome Measure in Gout. A Validation Process by the OMERACT Ultrasound Working Group

“…The unweighted κ values for all 4 lesions when reading the static images ranged from moderate to almost perfect for interobserver reliability (0.54-0.98), and similar results were found for the intrareader reliability (0.65-0.93). The US lesion with a higher level of reliability among the participants was the DC (intrareader: 0.98 and inter-reader: 0.93) whereas the lowest level of agreement was seen for the soft tissue aggregates (intrareader: 0.54 and inter-reader: 0.65) 14 .…”

“…The first step was to obtain consensus-based definitions for the US elementary lesion as indicated by the literature review. This was accomplished by performing a Delphi exercise 14 . Thirty-five rheumatologists performing US and with an interest in gout were invited to participate, and 32 responded positively.…”

“…Agreement could not be obtained to include synovitis (including Doppler activity) as an elementary lesion indicative of gout, because the presence of synovitis alone was not considered specific enough to define gout disease because it is a key component in other inflammatory arthropathies as well 14 . On the other hand, even if erosions may also be seen in other arthropathy conditions, since they may also be found extraarticularly in gout and may possibly have a slightly different appearance, it was decided to test, as part of the Delphi exercise, whether the existing definition worked also in gout.…”

Identifying Patient Candidates for IL-1 Inhibition: Lessons From Real-World Cases

“…Ultrasound of the knees and the first toes showed typical features of gout, ie, tophi, aggregates, double contour sign, and erosions ( Fig. 2) [2,3]. Double contour was detected in both first MTP joints and at the inter-condylar femoral region of both knees.…”

The OMERACT Ultrasound Working Group 10 Years On: Update at OMERACT 12

“…By using a previous systematic literature review, 4 elementary US components were identified, i.e., double contour sign, aggregates, tophi, and erosion 17 . The US definitions of these 4 identified lesions were agreed upon by the group using a Delphi exercise 18 . Subsequently, the metric properties of these components were …”