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Extended report
Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis
  1. Esperanza Naredo1,
  2. Maria Antonietta D'Agostino2,
  3. Richard J Wakefield3,
  4. Ingrid Möller4,
  5. Peter V Balint5,
  6. Emilio Filippucci6,
  7. Annamaria Iagnocco7,
  8. Zunaid Karim8,
  9. Lene Terslev9,
  10. David A Bong10,
  11. Jesús Garrido11,
  12. David Martínez-Hernández12,
  13. George A W Bruyn13,
  14. on behalf of the OMERACT Ultrasound Task Force*
  1. 1Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Complutense University, and Hospital Universitario Severo Ochoa, Madrid, Spain
  2. 2Department of Rheumatology, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
  3. 3Department of Rheumatology, Section of Musculoskeletal Disease, University of Leeds, Leeds, UK
  4. 4Department of Rheumatology, Instituto Poal de Reumatologia, Barcelona, Spain
  5. 53rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  6. 6Department of Rheumatology, Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy
  7. 7Department of Rheumatology, Sapienza Università di Roma, Rome, Italy
  8. 8Department of Rheumatology, Mid Yorkshire NHS trust, Wakefield, UK
  9. 9Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
  10. 10Department of Rheumatology, Instituto Poal, Barcelona, Spain
  11. 11Department of Social Psychology and Methodology, Autonoma University, Madrid, Spain
  12. 12Department of Preventive Medicine and Public Health, Complutense University, Madrid, Spain
  13. 13Department of Rheumatology, MC Groep, Lelystad, The Netherlands
  1. Correspondence to Dr Esperanza Naredo, Department of Rheumatology, General Universitario Gregorio Marañón, Doctor Alvarez Sierra 4, 4° A, Madrid 28033, Spain; enaredo{at}


Objective To produce consensus-based scoring systems for ultrasound (US) tenosynovitis and to assess the intraobserver and interobserver reliability of these scoring systems in rheumatoid arthritis (RA).

Methods We undertook a Delphi process on US-defined tenosynovitis and US scoring system of tenosynovitis in RA among 35 rheumatologists, experts in musculoskeletal US (MSUS), from 16 countries. Then, we assessed the intraobserver and interobserver reliability of US in scoring tenosynovitis on B-mode and with a power Doppler (PD) technique. Ten patients with RA with symptoms in the hands or feet were recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.

Results Four-grade semiquantitative scoring systems were agreed upon for scoring tenosynovitis in B-mode and for scoring pathological peritendinous Doppler signal within the synovial sheath. The intraobserver reliability for tenosynovitis scoring on B-mode and PD mode was good (κ value 0.72 for B-mode; κ value 0.78 for PD mode). Interobserver reliability assessment showed good κ values for PD tenosynovitis scoring (first round, 0.64; second round, 0.65) and moderate κ values for B-mode tenosynovitis scoring (first round, 0.47; second round, 0.45).

Conclusions US appears to be a reproducible tool for evaluating and monitoring tenosynovitis in RA.

  • Ultrasonography
  • Rheumatoid Arthritis
  • Inflammation

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