Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis

Abstract

Objective. To evaluate the interobserver agreement of ultrasonographic assessment of finger and toe joints in patients with rheumatoid arthritis (RA) by 2 investigators with different medical backgrounds.Methods. Ultrasonography and clinical examination were performed on 150 small joints of 30 patients with active RA. A General Electric LOGIQ 500 ultrasound unit with a 7-13-MHz linear array transducer was used. In each patient, 5 preselected small joints (second and third metacarpophalangeal, second proximal interphalangeal, first and second metatarsophalangeal) were examined independently on the same day by 2 ultrasound investigators (an experienced musculoskeletal radiologist and a rheumatologist with limited ultrasound training). Joint effusion, synovial thickening, bone erosions, and power Doppler signal were evaluated in accordance with an introduced 4-grade semiquantitative scoring system, on which the investigators had reached consensus prior to the study.Results. Exact agreement between the 2 observers was seen in 91% of the examinations with regard to bone erosions, in 86% with regard to synovitis, in 79% with regard to joint effusions, and in 87% with regard to power Doppler signal assessments. Conclusion. An experienced radiologist and a rheumatologist with limited ultrasound training achieved high interobserver agreement rates for the identification of synovitis and bone erosions, using an introduced semiquantitative scoring system for ultrasonography of finger and toe joints in RA. Signs of inflammation were more frequently detected with ultrasound than with clinical examination. Ultrasonography may improve the assessment of RA patients by radiologists and rheumatologists.

A Systematic Literature Review Analysis of Ultrasound Joint Count and Scoring Systems to Assess Synovitis in Rheumatoid Arthritis According to the OMERACT Filter

“…Binary grading 11 as well as a semiquantitative scoring system 9 were also developed for evaluating vascularization of synovial hypertrophy by CD/PD. Quantitative approaches are also utilized, including the determination of the number of Doppler pixels by dedicated pixel-counting software 12,13,14,15 , measurement of pulsatility and resistive indices, and microbubble contrast material.…”

“…Of 3004 studies identified initially, 14 articles were selected to be included in the review 8,9,14,25,26,27,28,29,30,31,32,33,34,35 . Table 1 shows the study design characteristics of the studies.…”

“…All articles evaluated PD, rather than CD activity. The definition of PD activity proposed by Szkudlarek, et al was adopted by almost all articles 9 . The quantification of synovial activity at the single-joint level was also found to be variable.…”

“…At the single-joint level, synovitis and effusion in GS were initially evaluated by binary grading (presence/absence) 7 . This was followed by the creation of several semiquantitative scoring systems 8,9 , which rated individual synovial hyperthrophy and effusion as well as the combination thereof. Additional studies utilized quantitative measurements for evaluating synovitis in GS, based on the volume/depth of synovial tissue 8,10 .…”

Eular Report on the Use of Ultrasonography in Painful Knee Osteoarthritis Part 2: Exploring Decision Rules for Clinical Utility

“…Recently, increasing interest has been shown in ultrasonography (US) 10 11 as it provides a reliable, non-invasive tool that can be used in a clinic setting for detecting both synovial hypertrophy and effusions in small and large joints. 12 13 At the knee, US has been demonstrated to be more sensitive than clinical examination in detecting synovitis 13 14 and compares well with MRI in the detection of effusion and Baker's cyst. 15 We conducted a large cross sectional study using US to determine the presence of synovial inflammation in painful knee OA.…”