Articular ultrasonography: Interobserver reliability in rheumatoid arthritis

• Published in: Revista brasileira de reumatologia (English Ed.). 2014-05, Vol.54 (3), p.250-254
• Main Authors: Bisi, Melissa Cláudia, Prado, Aline Defaveri do, Rabelo, Cristina, Brollo, Flávia, Silveira, Inês Guimarães da, Mendonça, José Alexandre de, Staub, Henrique Luiz
• Format: Article
• Language: English
• Subjects: Artrite reumatoide (AR); Reproducibility, kappa; Reprodutibilidade Kappa; Rheumatoid arthritis; Ultrasonography; Ultrassonografia (US)
• ISSN: 2255-5021; 2255-5021
• DOI: 10.1016/j.rbre.2013.09.002

Ultrasonography (US) has a recent use in Rheumatology, and the reliability of the method in rheumatoid arthritis (RA) patients has yet to be clarified. To test, in a RA survey, the reproducibility of musculoskeletal US performed by rheumatologists with one-year training through re-analysis by a Rheumatologist experien- ced in the method. This cross-sectional study included consecutive RA patients from our tertiary center. US exam was performed in metacarpophalangeal joints, proximal interpha- langeal joints, and wrists. Presence of synovitis, power Doppler (PD) signal, bone erosions, and cartilage changes comprised the US parameters evaluated. A kappa value in-between 0.20 and 0.40 was considered fair; in-between 0.41 and 0.60 was moderate; in-between 0.61 and 0.80 was good; and above 0.81 was excellent. We analyzed 1,380 joints of 60 RA patients (78% females, 78% caucasoids). Mean age was 58 ± 11.56 years, mean disease duration was 9.98 ± 7.79 years, mean DAS28 was 3.82 ± 1.53, and mean HAQ was 0.91 ± 0.67. Kappa agreement for synovitis ranged from 0.30 to 0.70; for PD signal, from 0.53 to absolute agreement; for erosions, from 0.70 to 0.97; for cartilage changes, from 0.28 to 0.63. Although good, moderate and excellent interobserver agreement were obtained for erosions and PD, concordance for synovitis and cartilage changes were less impressive in our patients with active RA. Further studies on standardization of scanning technique are necessary to improve musculoskeletal US reproducibility. A ultrassonografia (US) tem uso recente na reumatologia, e a confiabilidade do método em pacientes com artrite reumatoide (AR) ainda está por ser definida. Testar, em uma pesquisa de AR, a reprodutibilidade da US musculosquelética re- alizada por reumatologistas com treinamento de um ano por meio da reanálise por um reumatologista com experiência no método. Esse estudo transversal incluiu pacientes de AR consecutivos de nosso centro terciário. O exame US foi realizado nas articulações metacarpofalângicas, articula- ções interfalângicas proximais e pulsos. Os parâmetros avaliados foram: presença de si- novite, sinal de power Doppler (PD), erosões ósseas e alterações cartilaginosas. Um valor Kappa entre 0,20 e 0,40 foi considerado razoável; entre 0,41 e 0,60, moderado; entre 0,61 e 0,80, bom; e acima de 0,81, excelente. Analisamos 1380 articulações de pacientes com AR (78% mulheres, 78% cau- casoides). Média de idade = 58 ± 11,56 anos, duração média da doença = 9,98 ±