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FRI0519 Ultrasound Definition of Cartilage Change in Patients with Rheumatoid Arthritis: A Reliability Study by The Omeract Ultrasonography
  1. P. Mandl1,
  2. E. Filippucci2,
  3. F. Alasti1,
  4. A. Bachta3,
  5. M. Backhaus4,
  6. D. Bong5,
  7. G.A. Bruyn6,
  8. P. Collado7,
  9. N. Damjanov8,
  10. C. Dejaco9,
  11. A. Delle-Sedie10,
  12. C. Duftner11,
  13. M. Gutierrez2,
  14. H.B. Hammer12,
  15. C. Hernandez Diaz13,
  16. A. Iagnocco14,
  17. K. Ikeda15,
  18. D. Kane16,
  19. H. Keen17,
  20. S. Kelly18,
  21. E. Kővári19,
  22. E. De Miguel20,
  23. I. Möller5,
  24. U. Moller-Dohn21,
  25. E. Naredo22,
  26. J.C. Nieto22,
  27. C. Pineda13,
  28. A. Rodriguez23,
  29. W.A. Schmidt24,
  30. M. Szkudlarek25,
  31. L. Terslev21,
  32. R. Thiele26,
  33. R. Wakefield27,
  34. D. Windschall28,
  35. M.-A. D'Agostino29,30,
  36. P.V. Balint19
  1. 1Medical University of Vienna, Vienna, Austria
  2. 2Università Politecnica delle Marche, Jesi, Italy
  3. 3Military Institute of Medicine, Warsaw, Poland
  4. 4Park-Klinik Weissensee Academic Hospital of the Charité, Berlin, Germany
  5. 5Instituto Poal de Reumatologia, Barcelona, Spain
  6. 6MC Groep, Lelystad, Netherlands
  7. 7Hospital Universitario Severo Ochoa, Madrid, Spain
  8. 8University of Belgrade School of Medicine, Belgrade, Serbia
  9. 9Medical University of Graz, Graz, Austria
  10. 10University of Pisa, Pisa, Italy
  11. 11Medical University of Innsbruck, Innsbruck, Austria
  12. 12Diakonhjemmet Hospital, Oslo, Norway
  13. 13Instituto Nacional de Rehabilitaciόn, Mexico City, Mexico
  14. 14Sapienza Università di Roma, Rome, Italy
  15. 15Chiba University Hospital, Chiba, Japan
  16. 16Trinity College, Dublin, Ireland
  17. 17University of Western Australia, Perth, Australia
  18. 18Mile End Hospital, Barts Health NHS Trust, London, United Kingdom
  19. 19National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
  20. 20Hospital Universitario La Paz, Madrid, Spain
  21. 21Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
  22. 22Hospital General Universitario Gregorio Marañόn and Complutense University
  23. 23Hospital Ramόn y Cajal, Madrid, Spain
  24. 24Medical Centre for Rheumatology, Berlin, Germany
  25. 25Copenhagen University Hospital at Køge, Køge, Denmark
  26. 26University of Rochester School of Medicine and Dentistry, Rochester, United States
  27. 27LIRRM, University of Leeds, Chapel Allerton Hospital, Leeds, United Kingdom
  28. 28Asklepios Hospital, Weissenfels, Germany
  29. 29LIRMM, University of Leeds, Leeds, United Kingdom
  30. 30INSERMU1173, Université Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France


Objectives To produce ultrasound (US) consensus-based definitions of cartilage change in rheumatoid arthritis (RA) and assess its intraobserver and interobserver reliability in a web-based exercise.

Methods We conducted a Delphi study on US defined cartilage change and a proposed semiquantitative (SQ) US scoring system for cartilage change in RA. A written Delphi questionnaire was developed based on a systematic literature review and expert international consensus and was distributed via consecutive written questionnaires by email to a group 35 rheumatologists from 17 countries with experience in musculoskeletal US. Taskforce members performed US B mode examination of the metacarpal cartilage in metacarpophalangeal joints 2–5 in RA patients and the images were collected in an electronic database. A reference image atlas of cartilage changes was developed for scoring 123 anonymized images including 25 duplicate images. These were sent to the participants who independently scored the images. Intraobserver reliability was assessed by Cohen's kappa and interobserver reliability by Fleiss' kappa.

Results Group agreement (76–100%) was reached for 6 statements concerning: i) MSUS definition and assessment of normal hyaline cartilage, ii) elementary cartilage lesions in MSUS and iii) grading of elementary cartilage lesions in patients with RA in a two-round Delphi consensus process. A three-grade SQ (0–2) scoring system (grade 0, normal cartilage; grade 1, minimal change: blurring of outer and/or subchondral margin, focal thinning or incomplete loss of homogeneity of echostructure; grade 2, severe: diffuse thinning or complete loss of homogeneity of echostructure) was agreed for scoring cartilage damage in RA. Both intra- and inter-observer reliability were good (κ value of 0.87 and 0.64 respectively).

Conclusions This study demonstrates that US is a reliable tool for evaluating cartilage in RA and strongly supports the use of a new reliable semiquantitative MSUS scoring system for cartilage change.

Disclosure of Interest None declared

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