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Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis
  1. G AW Bruyn (gawbruyn{at}
  1. Medisch Centrum Leeuwarden, Netherlands
    1. E Naredo (enaredo{at}
    1. Severo Ochoa Hospital, Spain
      1. I Moller (ingrid.moller{at}
      1. Instituo Poal, Spain
        1. C Moragues (cmoragues{at}
        1. Bellvitge Hospital, Spain
          1. J Garrido
          1. Universidad Autonoma de Madrid, Spain
            1. G H de Bock
            1. Universitair Medisch Centrum Groningen, Netherlands
              1. M-A D'Agostino (maria-antonietta.dagostino{at}
              1. Ambroise Paré Hospital, UVSQ University, France
                1. E Filippucci (emilio_filippucci{at}
                1. Universita Politecnica delle Marche, Italy
                  1. A Iagnocco (annamaria.iagnocco{at}
                  1. Sapienza University, Italy
                    1. M Backhaus (marina.backhaus{at}
                    1. Universital Hospital Charité, Germany
                      1. N Swen (n.swen{at}
                      1. Medisch Centrum Alkmaar, Netherlands
                        1. P V Balint (balint.peter{at}
                        1. National Institute of Rheumatology and Physiotherapy, Hungary
                          1. C Pineda (carpineda{at}
                          1. Instituto Nacional de Rehabilitacion, Mexico
                            1. S Milutinovic (sanja.milutinovic{at}
                            1. Institute of Rheumatology, Serbia and Montenegro
                              1. D J Kane (david.kane{at}
                              1. Adelaide and Meath Hospital, Eire
                                1. G Kaeley (gurj{at}
                                1. ROAD Clinic Lakewood, United States
                                  1. J A Narvaez (jose_a_narvaez{at}
                                  1. Hospital Universitari de Bellvitge, Spain
                                    1. J de Agustin (28073jao{at}
                                    1. Hospital de la Santa Creu i Sant Pau, Spain
                                      1. R J Wakefield (r.j.wakefield{at}
                                      1. Leeds University Hospitals, United Kingdom
                                        1. J Narvaez (gaw.bruyn{at}
                                        1. Hospital Universitario de Bellvitge, Spain
                                          1. W A Schmidt (schmidt.wa{at}
                                          1. Berlin-Buch Hospital, Germany


                                            Objective: To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) among rheumatologists in detecting destructive and inflammatory shoulder abnormalities in patients with rheumatoid arthritis (RA) and to determine the overall agreement between the US and magnetic resonance imaging (MRI).

                                            Methods: Fourteen observers examined 5 patients in 2 rounds independently and blindly of each other. US results were compared with MRI. Overall agreements of all findings, of positive findings on MRI, as well as intra- and interobserver reliabilities were calculated.

                                            Results: Overall agreement between US and MRI was seen in 79 % with regard to humeral head erosions (HHE), in 64 % with regard to posterior recess synovitis (PRS), in 31 % with regard to axillary recess synovitis (ARS), in 64 % with regard to bursitis, in 50% with regard to biceps tenosynovitis (BT), and in 84 % for complete cuff tear (CCT). Intra-observer and interobserver kappa was 0.69 and 0.43 for HHE, 0.29 and 0.49 for PRS, 0.57 and 1.00 for ARS, -0.17 and 0.51 for bursitis, 0.17 and 0.46 for BT and 0.52 and 0.6 for CCT, respectively. The intra-observer and interobserver kappa for power Doppler (PD) was 0.90 and 0.70 for glenohumeral signals and 0.60 and 0.51 for bursal signals, respectively.

                                            Conclusion: US is a reliable imaging technique for most shoulder pathology in RA especially with regard to PD. Standardization of scanning technique and definitions of particular lesions may further enhance the reliability of US investigation of the shoulder.

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