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Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis
  1. G A W Bruyn1,
  2. E Naredo2,
  3. I Möller3,
  4. C Moragues4,
  5. J Garrido5,
  6. G H de Bock6,
  7. M-A d’Agostino7,
  8. E Filippucci8,
  9. A Iagnocco9,
  10. M Backhaus10,
  11. W A A Swen11,
  12. P Balint12,
  13. C Pineda13,
  14. S Milutinovic14,
  15. D Kane15,
  16. G Kaeley16,
  17. F J Narvaez4,
  18. R J Wakefield17,
  19. J A Narvaez18,
  20. J de Augustin19,
  21. W A Schmidt20
  1. 1
    Department of Rheumatology, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
  2. 2
    Department of Rheumatology, Hospital Severo Ochoa, Madrid, Spain
  3. 3
    Department of Rheumatology, Instituto Poal de Reumatologia, Barcelona, Spain
  4. 4
    Department of Rheumatology, Hospital de Bellvitge, Barcelona, Spain
  5. 5
    Department of Methodology of Psychology, Universidad Autonoma de Madrid, Madrid, Spain
  6. 6
    Department of Epidemiology, University of Groningen, Groningen, The Netherlands
  7. 7
    Department of Rheumatology, Hopital Ambroise Pare, Paris, France
  8. 8
    Department of Rheumatology, Universita della Politechnica della Marche, Ancona, Italy
  9. 9
    Department of Rheumatology, University de la Sapienza, Rome, Italy
  10. 10
    Charite University Hospital, Berlin, Germany
  11. 11
    Department of Rheumatology, Medisch Centrum Alkmaar, Alkmaar, The Netherlands
  12. 12
    Department of Rheumatology, National Institute of Rheumatology and Rehabilatation, Budapest, Hungary
  13. 13
    National Institute of Rehabilitation, Mexico City, Mexico
  14. 14
    Institute for Rheumatology and Rehabilitation, Belgrade, Serbia
  15. 15
    Department of Rheumatology, Adelainde and Meath Hospital, Dublin, Ireland
  16. 16
    ROAD Clinic, Lakewood, Washington, USA
  17. 17
    Department of Rheumatology, Chapel Allerton Hospital, Leeds, UK
  18. 18
    Department of Radiology, Hospital de Bellvitge, Barcelona, Spain
  19. 19
    Department of Rheumatology, Hospital Val d’Hebron, Barcelona, Spain
  20. 20
    Department of Rheumatology, Hospital Berlin-Buch, Berlin, Germany
  1. G A W Bruyn, Department of Rheumatology, Medisch Centrum Leeuwarden, 8934 AD Leeuwarden, Leeuwarden, The Netherlands; gawbruyn{at}


Objective: To assess the intra and interobserver reproducibility of musculoskeletal ultrasonography (US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis (RA) and to determine the overall agreement between US and MRI.

Methods: A total of 14 observers examined 5 patients in 2 rounds independently and blindly of each other. US results were compared with MRI. Overall agreement of all findings, of positive findings on MRI, as well as intra and interobserver reliabilities, were calculated.

Results: Overall agreement between US and MRI was seen in 79% with regard to humeral head erosions (HHE), in 64% with regard to posterior recess synovitis (PRS), in 31% with regard to axillary recess synovitis (ARS), in 64% with regard to bursitis, in 50% with regard to biceps tenosynovitis (BT), and in 84% for complete cuff tear (CCT). Intraobserver and interobserver κ was 0.69 and 0.43 for HHE, 0.29 and 0.49 for PRS, 0.57 and 1.00 for ARS, −0.17 and 0.51 for bursitis, 0.17 and 0.46 for BT and 0.52 and 0.6 for CCT, respectively. The intraobserver and interobserver κ for power Doppler (PD) was 0.90 and 0.70 for glenohumeral signals and 0.60 and 0.51 for bursal signals, respectively.

Conclusions: US is a reliable imaging technique for most shoulder pathology in RA especially with regard to PD. Standardisation of scanning technique and definitions of particular lesions may further enhance the reliability of US investigation of the shoulder.

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  • Competing interests: None declared.

  • Funding: Roche Pharmaceuticals Espana funded this study.

  • Ethics approval: Ethics approval was obtained.