Article Text

Download PDFPDF

OP0288 Reliability of a eular-omeract semiquantitative scoring system for the assessment of cartilage in rheumatoid arthritis
  1. P Mandl1,
  2. E Filippucci2,
  3. P Studenic1,
  4. A Bachta3,
  5. D Bong4,
  6. GA Bruyn5,
  7. C Dejaco6,
  8. A Delle Sedie7,
  9. C Duftner8,
  10. I Gessl1,
  11. HB Hammer9,
  12. C Hernandez Diaz10,
  13. A Iagnocco11,
  14. K Ikeda12,
  15. D Kane13,
  16. H Keen14,
  17. E Kővári15,
  18. U Moeller-Doehn16,
  19. E Naredo17,
  20. J-C Nieto18,
  21. C Pineda10,
  22. A Rodriguez19,
  23. WA Schmidt20,
  24. G Supp1,
  25. L Terslev16,
  26. R Thiele21,
  27. D Windschall22,
  28. M-A D'Agostino23,
  29. PV Balint24
  1. 1Medical University of Vienna, Vienna, Austria
  2. 2Università Politecnica delle Marche, Jesi, Italy
  3. 3Military Institute of Medicine, Warsaw, Poland
  4. 4Instituto Poal de Reumatologia, Barcelona, Spain
  5. 5MC Groep, Lelystad, Netherlands
  6. 6Medical University of Graz, Graz, Austria
  7. 7University of Pisa, Pisa, Italy
  8. 8Medical University of Innsbruck, Innsbruck, Austria
  9. 9Diakonhjemmet Hospital, Oslo, Norway
  10. 10Instituto Nacional de Rehabilitaciόn, Mexico City, Mexico
  11. 11Universitá degli Studi di Torino, Turin, Italy
  12. 12Chiba University Hospital, Chiba, Japan
  13. 13Trinity College Dublin, Dublin, Ireland
  14. 14University of Western Australia, Perth, Australia
  15. 15Semmelweis University, Budapest, Hungary
  16. 16Copenhagen University Hospital Glostrup, Copenhagen, Denmark
  17. 17Hospital Universitario Fundaciόn Jiménez Díaz and Autόnoma University
  18. 18Hospital General Universitario Gregorio Marañόn and Complutense University
  19. 19Hospital Ramόn y Cajal, Madrid, Spain
  20. 20Immanuel Krankenhaus, Berlin, Germany
  21. 21University of Rochester, Rochester, United States
  22. 22Asklepios Hospital, Weissenfels, Germany
  23. 23Université VSQY, Inserm U1173, APHP Ambroise Paré, Boulogne-Billancourt, France
  24. 24National Institute of Rheumatology and Physiotherapy, Budapest, Hungary


Background Joint destruction in rheumatoid arthritis (RA) is comprised of hyaline cartilage and bone damage, with the former more clearly associated with irreversible physical disability than bony damage.

Objectives To test the reliability of a semiquantitative scoring system for the assessment of cartilage by musculoskeletal ultrasound (US) in a web-based exercise as well as a patient-based reliability study of patients with RA.

Methods Static images of metacarpophalangeal (MCP) joints 2–5 in RA patients and healthy controls were acquired and a dataset of 123 anonymized images including 25 duplicate images was circulated among an international EULAR-OMERACT taskforce of 25 rheumatologist experts in US who independently scored the images using a semiquantitative scoring system. Subsequently 12 taskforce members participated in a patient-based reliability study. During this meeting MCP joints 2–5 of 6 patients with RA were assessed twice on the same day by all experts using US machines (GE) equipped with high-frequency transducers (18–22MHz) with presets calibrated for the appropriate assessment of cartilage. Participants assessed metacarpal cartilage both in the standardized longitudinal midline scan as well as by freehand technique utilizing multiple planes and scored by the semiquantitative scoring system. Intraobserver reliability was assessed by Cohen's kappa and interobserver reliability by Fleiss' kappa.

Results The three-grade semiquantitative (Grade 0, normal cartilage; Grade 1, minimal change; Grade 2, severe change) scoring system demonstrated excellent (kappa: 0.87) to good (kappa: 0.73) intraobserver reliability in the web-based exercise and the patient-based reliability study respectively. Interobserver reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.49) in the patient-based reliability study. The dynamic technique performed slightly better than the longitudinal midline scan alone.

Conclusions A semiquantitative scoring system demonstrated good intra- and moderate to good inter-observer reliability in a web-based exercise and patient-based reliability study. Our study demonstrates that US is a reliable tool for evaluating cartilage and supports the use of a new semiquantitative US scoring system for evaluating cartilage change in RA.

Acknowledgements The patient-based reliability study was supported by a research grant from UCB.

Disclosure of Interest None declared

Statistics from

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.