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SAT0636 Ultrasonography definitions for synovitis grading in children: the omeract pediatric ultrasound task force
  1. J Vojinovic1,
  2. S Magni-Manzoni2,
  3. P Collado3,
  4. D Windschall4,
  5. V Ravagnani5,
  6. C Hernandez-Diaz6,
  7. JC Nieto Gonzales7,
  8. C Malattia8,
  9. N Tzaribachev9,
  10. G Susic10,
  11. N Damjanov11,
  12. S Guillaume Czitrom12,
  13. T Herlin13,
  14. S Lanni8,
  15. G Bruyn14,
  16. A Iagnocco15,
  17. L Terslev16,
  18. M-A D'Agostino17,
  19. E Naredo7
  1. 1Clinical Centre, Medical Faculty, University of Nis, Nis, Serbia
  2. 2Ospedale Pediatrico Bambino Gesu, Rome, Italy
  3. 3Hospital Universitario Severo Ochoa, Madrid, Spain
  4. 4Department of Pediatrics, Asklepios Hospital Weissenfels, Weissenfels, Germany
  5. 5Department of Medicine, University of Verona, Verona, Italy
  6. 6Instituto Nacional de Rehabilitaciόn, Mexico City, Mexico
  7. 7Department of Rheumatology, Hospital General Universitario Gregorio Marañόn and Complutense University, Madrid, Spain
  8. 8IRCCS Istituto Giannina Gaslini, Genova, Italy
  9. 9PRI - Pediatric Rheumatology Research Institute, Bad Bramstedt, Germany
  10. 10Institute for Rheumatology
  11. 11Institute for Rheumatology, University of Belgrade, Belgrade, Serbia
  12. 12Rhumatologie Pédiatrique, CHU Bicêtre, le Kremlin-Bicêtre, France
  13. 13Department of Pediatrics, Aarhus University Hospital Skejby, Aarhus N, Denmark
  14. 14Department of Rheumatology, MC Group, Lelystad, Netherlands
  15. 15Università degli Studi di Torino, Turin, Italy
  16. 16Department of Rheumatology, University of Copenhagen, Copenhagen, Denmark
  17. 17APHP, Hôpital Ambroise Paré, Rheumatology Department, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France


Background Ultrasound (US) was found to have face and content validity for detecting synovitis in juvenile idiopathic arthritis (JIA) with higher sensitivity than clinical examination. In order to test validity and improve the applicability of US in JIA, the OMERACT US pediatric subtask force recently published preliminary definitions for the sonographic features of synovitis in children.

Objectives Aim of this study was to confirm and improve B-mode and color power/Doppler (PD) US definitions for synovial components and grading in children, by using an image and patient based exercise.

Methods The definitions were confirmed and modified in a multi-step process. In the 1st step, definitions were developed in multi-round Delphi web based consensus process were ≥80% of participants would need to reach ≥80% of agreement on a Likert scale from 1–5 (1 strongly disagree, 2 disagree, 3 neutral, 4 agree, 5 strongly agree). In the 2nd step, in a face to face meeting, a subgroup of these experts revised the definitions for final wording and performed intra- and inter-observer reliability exercise study in JIA patients as the final 3rd phase of the process. The definitions were tested in four joints (wrist, 2nd MCP, knee and ankle) of JIA patients divided in four age groups following standardized image acquisition and machine setting protocol. Statistics program R (version 3.3.0) was used for the statistical analyses. For intra-rater agreement Cohen kappa and for inter-rater agreement prevalence and bias adjusted kappa (PABAK) were calculated if needed.

Results Reliability exercise included 20 JIA patients (distributed in equal numbers by age groups), 14 observers, 4 joints/observer, 3 observers/joint, 360 intra- and 360 inter-observer tests. A 0–3 semi-quantitative B-mode and color power/Doppler US definitions for synovial components and grading, were agreed (presented in Figure 1).

Figure 1.

Synovitis grading definitions in children and inter- and intra-observer reliability in B-mode (GS) and color power/Doppler (PD).

Conclusions The proposed synovitis grading for children showed to be reliable why the next step should be to test sensitivity to change in order to possibly be used as an outcome tool in JIA.

Disclosure of Interest None declared

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