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J Rheumatol. 2019 Apr;46(4):351-359. doi: 10.3899/jrheum.171490. Epub 2018 Nov 1.

Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions.

Author information

1
From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands. g.bruijn@mcgroep.com.
2
G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work. g.bruijn@mcgroep.com.
3
From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands.
4
G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work.

Abstract

OBJECTIVE:

To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).

METHODS:

Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.

RESULTS:

Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively.

CONCLUSION:

Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.

KEYWORDS:

RHEUMATOID ARTHRITIS; SUBTALAR JOINT; ULTRASOUND

PMID:
30385707
DOI:
10.3899/jrheum.171490

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