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Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints
  1. H B Hammer1,
  2. A Iagnocco2,
  3. A Mathiessen1,
  4. E Filippucci3,
  5. F Gandjbakhch4,5,
  6. M C Kortekaas6,7,
  7. I Möller8,
  8. E Naredo9,
  9. R J Wakefield10,
  10. P Aegerter11,12,
  11. M-A D'Agostino13,14
  1. 1Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2Rheumatology Unit, Sapienza Università di Roma, Rome, Italy
  3. 3Clinica Reumatologica, Università Politecnica delle Marche, Jesi (Ancona), Italy
  4. 4Department of Rheumatology, AP-HP, Pitie-Salpetriere Hospital, Paris, France
  5. 5UPMC Université Paris 06, Paris, France
  6. 6Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  7. 7Department of Rheumatology, Flevoziekenhuis, The Netherlands
  8. 8Instituto Poal de Reumatologia, Barcelona, Spain
  9. 9Department of Rheumatology, Hospital GU Gregorio Marañón, Madrid, Spain
  10. 10Leeds Institute of Rheumatic and Rehabilitation Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
  11. 11Université Versailles-Saint Quentin En Yvelines, Paris, France
  12. 12Department of Public Health, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
  13. 13Université Versailles-Saint Quentin En Yvelines, Inserm U987, Boulogne-Billancourt, France
  14. 14Department of Rheumatology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
  1. Correspondence to Dr Hilde Berner Hammer, Department of Rheumatology, Diakonhjemmet Hospital, Box 23 Vinderen, Oslo 0319, Norway; h-hammer{at}


Objective Ultrasonography is sensitive for the evaluation of cartilage pathology and degree of osteophytes in patients with hand osteoarthritis (OA). High consistency of assessments is essential, and the OMERACT (Outcome Measures in Rheumatology) ultrasonography group took the initiative to explore the reliability of a global ultrasonography score in patients with hand OA using semiquantitative ultrasonography score of cartilage and osteophytes in finger joints.

Methods Ten patients with hand OA were examined by 10 experienced sonographers over the course of two days. Semiquantitative scoring (0–3) was performed on osteophytes (carpo-metacarpal 1, metacarpo-phalangeal (MCP) 1–5, proximal interphalangeal 1–5 and distal interphalangeal 2–5 joints bilaterally with an ultrasonography atlas as reference) and cartilage pathology (MCP 2–5 bilaterally). A web-based exercise on static cartilage images was performed a month later. Reliability was assessed by use of weighted κ analyses.

Results Osteophyte scores were evenly distributed, and the intraobserver and interobserver reliabilities were substantial to excellent (κ range 0.68–0.89 and mean κ 0.65 (day 1) and 0.67 (day 2), respectively). Cartilage scores were unevenly distributed, and the intraobserver and interobserver reliability was fair to moderate (κ range 0.46–0.66 and mean κ 0.39 (day 1) and 0.33 (day 2), respectively). The web-based exercise showed acceptable agreement for cartilage being normal (κ 0.47) or with complete loss (κ 0.68), but poor for the intermediate scores (κ 0.22–0.30).

Conclusions Use of the present semiquantitative ultrasonography scoring system for cartilage pathology in hand OA is not recommended (while normal or total loss of cartilage may be assessed). However, the OMERACT ultrasonography group will endorse the use of semiquantitative scoring of osteophytes with the ultrasonography atlas as reference.

  • Ultrasonography
  • Osteoarthritis
  • Hand Osteoarthritis

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