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AB1075 From a Formal Training Program in Musculoskeletal Ultrasound (MSKUS) to a High Reproducibility for Doppler Ultrasound in Rheumatoid Arthritis: The Lucky Experience
  1. M. Diaz1,
  2. O. Villota2,
  3. C. Ceron3,
  4. I. Moller4,
  5. E. Naredo5,
  6. D. Saabi6
  1. 1Rheumatology, University Hospital Fundacion Santa Fe de Bogota, Bogota
  2. 2Clinica Las Americas, Pasto
  3. 3Medicarte, Medellin, Colombia
  4. 4Instituto Poal de Reumatologia, Barcelona
  5. 5Rheumatology, Hospital General Universitario Gregorio Marañon, Madrid, Spain
  6. 6Universidad Autonoma de Bucaramanga, Bucaramanga, Colombia

Abstract

Background The MSKUS has shown higher sensitivity in detecting synovitis than clinical examination in RA patients. However this imaging modality is considered as examiner – dependent.Since 2004 OMERACT ultrasound task force has standardized the acquisition and interpretation of US images including a scoring system for synovitis.

Objectives To assess the intra- and inter-observer reliability of ultrasound (US) in scoring B-mode, Doppler synovitis and combined B-mode and Doppler synovitis in different peripheral joints of RA patients.

Methods Four rheumatologists, who had received a formal MSKUS postgraduate training program with particular focus on definitions and scoring synovitis on B-mode and Doppler mode, participated in a patient-based reliability exercise. Sixteen active RA patients (ACR criteria 1987) were studied (14 female/2 male)/(DAS 28>3.2), mean age 46.4±14.8 years, mean disease duration 9.8±4.2 years. The rheumatologists group independently and consecutively performed a B-mode and power Doppler (PD) US assessment of 7 joints (i.e. elbow, radiocarpal, midcarpal, knee, ankle, and second and third metacarpophalangeal joints) of each patient in two rounds in a blinded fashion. Each joint was semiquantitatively scored from 0 to 3 for B-mode synovitis (BS), Doppler synovitis (DS), and combined B-mode/Doppler synovitis (CS).The US assessment was performed using four commercially available real-time scanners (i.e. two MyLab Class C, one MyLab alpha, one MyLab one; Esaote, Genoa, Italy) equipped with multifrequency linear transducers (6-13 MHz). Intra-observer reliability was assessed by Cohen's κ. Inter-observer reliability was assessed by unweight Light's κ.

Results The main prevalence on synovitis on B-mode was 83%,the distribution of the assigned scores were the following: grade 1 in 18%, grade 2 in 32%,grade 3 in 33%.In 55% of joint synovial PD signal was detected and the distribution of scores was 15% of joint for grade 1,26% for grade 2, and 14% for grade 3. In general the intra-observer and inter-observer reliability for BS, DS, and CS in all joints and each joint was good to excellent (κ values 0.6-1).

Conclusions Formal,structured and continuous training in musculoskeletal ultrasound brought a good to excellent reproducibility.We have also been able to show that a MKUS has a high reliability in real - time acquisition BS,DS and CS modalities for scoring synovitis in patients with active rheumatoid arthritis.

References

  1. Naredo E, Rodriguez M, Campos C, et al. Validity, reproducibility,and responsiveness of twelve-joint simplified power doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum 2008;59:515-522.

Acknowledgements Clinica las Americas, Pasto, Colombia. AbbVie. Universidad de la Sabana, Bogota, Colombia. Asociacion Colombiana de Reumatologia.

Disclosure of Interest None declared

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