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Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability
  1. George A W Bruyn1,
  2. Petra Hanova2,
  3. Annamaria Iagnocco3,
  4. Maria-Antonietta d'Agostino4,
  5. Ingrid Möller5,
  6. Lene Terslev6,
  7. Marina Backhaus7,
  8. Peter V Balint8,
  9. Emilio Filippucci9,
  10. Paul Baudoin1,
  11. Richard van Vugt10,
  12. Carlos Pineda11,
  13. Richard Wakefield12,
  14. Jesus Garrido13,
  15. Ondrej Pecha14,
  16. Esperanza Naredo15
  17. on behalf of the OMERACT Ultrasound Task Force
  1. 1Rheumatology Department, MC Groep Hospitals, Lelystad, The Netherlands
  2. 2Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
  3. 3Department of Rheumatology, Sapienza Università di Roma, Rome, Italy
  4. 4Department of Rheumatology, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France
  5. 5Department of Rheumatology, Instituto Poal, Barcelona, Spain
  6. 6Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark
  7. 7Department of Rheumatology, Charite University Hospital, Berlin, Germany
  8. 8Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  9. 9Department of Rheumatology, Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy
  10. 10Department of Rheumatology, VU Medisch Centrum, Amsterdam, The Netherlands
  11. 11Department of Rheumatology, National Institute of Rehabilitation, Mexico City, Mexico
  12. 12Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK
  13. 13Department of Social Psychology and Methodology, Faculty of Psychology, Autonoma University, Madrid, Spain
  14. 14Technology Centre ASCR, Prague, Czech Republic
  15. 15Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
  1. Correspondence to George A W Bruyn, Department of Rheumatology, MC Groep Hospitals, Lelystad 8333 AA, The Netherlands; gawbruyn{at}


Objective To develop the first ultrasound scoring system of tendon damage in rheumatoid arthritis (RA) and assess its intraobserver and interobserver reliability.

Methods We conducted a Delphi study on ultrasound-defined tendon damage and ultrasound scoring system of tendon damage in RA among 35 international rheumatologists with experience in musculoskeletal ultrasound. Twelve patients with RA were included and assessed twice by 12 rheumatologists-sonographers. Ultrasound examination for tendon damage in B mode of five wrist extensor compartments (extensor carpi radialis brevis and longus; extensor pollicis longus; extensor digitorum communis; extensor digiti minimi; extensor carpi ulnaris) and one ankle tendon (tibialis posterior) was performed blindly, independently and bilaterally in each patient. Intraobserver and interobserver reliability were calculated by κ coefficients.

Results A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B mode. The mean intraobserver reliability for tendon damage scoring was excellent (κ value 0.91). The mean interobserver reliability assessment showed good κ values (κ value 0.75). The most reliable were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons. An ultrasound reference image atlas of tenosynovitis and tendon damage was also developed.

Conclusions Ultrasound is a reproducible tool for evaluating tendon damage in RA. This study strongly supports a new reliable ultrasound scoring system for tendon damage.

  • Rheumatoid Arthritis
  • Tendinitis
  • Ultrasonography
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