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Imaging
Original article
OMERACT agreement and reliability study of ultrasonographic elementary lesions in osteoarthritis of the foot
  1. Alen Zabotti1,
  2. Georgios Filippou2,
  3. Marco Canzoni3,
  4. Antonella Adinolfi4,
  5. Valentina Picerno5,
  6. Greta Carrara6,
  7. Peter Balint7,
  8. George A Bruyn8,
  9. Maria Antonietta D'Agostino9,
  10. Nemanja Damjanov10,
  11. Andrea Delle Sedie11,
  12. Emilio Filippucci12,
  13. Maria Luz Gonzalez Fernandez13,
  14. Hilde Berner Hammer14,
  15. Zunaid Karim15,
  16. Peter Mandl16,
  17. Ingrid Moller17,
  18. Maria Rosario Morales Lozano18,
  19. Esperanza Naredo19,
  20. Francesco Porta20,
  21. Garifallia Sakellariou21,
  22. Lene Terslev22,
  23. Carlo Alberto Scirè2,6 and
  24. Annamaria Iagnocco23
  25. The OMERACT Ultrasound Task Force members
    1. 1Department of Medical and Biological Sciences, Rheumatology Clinic, University Hospital Santa Maria della Misericordia, Udine, Italy
    2. 2Dipartimento di Scienze Mediche, Università degli studi di Ferrara, Clinica di Reumatologia, Ferrara, Italy
    3. 3Agenzia Sanitaria Locale Viterbo, Viterbo, Italy
    4. 4Department of Clinical Medicine and Immunology, Rheumatology Section, University of Siena, Siena, Italy
    5. 5Rheumatology Department of Lucania, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
    6. 6Epidemiology Unit, Italian Society for Rheumatology (SIR), Milan, Italy
    7. 73rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
    8. 8Rheumatology, Medisch Centrum Leeuwarden, Sneek, Netherlands
    9. 9Rheumatology, Ambroise Paré Hospital, APHP, Université Versailles-Saint-Quentin en Yvelines, Boulogne-Billancourt, France
    10. 10Institute of Rheumatology, University of Belgrade Medical School, Belgrade, Serbia
    11. 11Rheumatology Unit, University of Pisa, Pisa, Italy
    12. 12Rheumatology, Universita Politecnica delle Marche, Jesi, Italy
    13. 13University Podiatry Clinic, Universidad Complutense de Madrid, Madrid, Spain
    14. 14Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
    15. 15Department of Rheumatology, Midyorkshire NHS Trust, Midyorkshire, UK
    16. 16Internal Medicine III, Department of Rheumatology, Medical University Vienna, Vienna, Austria
    17. 17Reumatologia, Instituto Poal de Reumatologia, Barcelona, Spain
    18. 18Clinic of Podiatry, Faculty of E.F. and Podiatry, Universidad Complutense, Madrid, Spain
    19. 19Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
    20. 20Azienda Sanitaria Locale 3, ASL 3, Pistoia, Italy
    21. 21Chair and Division of Rheumatology, Universityof Pavia, IRCCS Policlinico San Matteo Foundation, Pavia, Italy
    22. 22Center for Rheumatology and Spine Disease, Rigshospitalet-Glostrup, Copenaghen, Denmark
    23. 23Scienze Cliniche e Biologiche, Università degli Studi di Torino, Rome, Italy
    1. Correspondence to Professor Annamaria Iagnocco; annamaria.iagnocco1{at}gmail.com

    Abstract

    Objective To evaluate the level of agreement on ultrasonographic (US) lesions among highly experienced sonographers as well as the intraobserver and interobserver reliability of inflammatory and structural US lesions in patients with osteoarthritis (OA) of the foot.

    Methods After a systematic literature review, a Delphi survey was performed to test definitions of US lesions in OA of the foot, including inflammatory lesions (ie, synovial hypertrophy [SH], joint effusion [JE], power Doppler signal [PD]), and structural abnormalities (ie, cartilage damage [CD] and osteophytes). Subsequently, the reliability of US in assessing the aforementioned lesions was tested on static images as well as during a live exercise. Reliability was assessed by kappa analyses and prevalence-adjusted bias-adjusted kappa (PABAK) on a dichotomous and an ordinal scale.

    Results Intraobserver and interobserver reliability for SH and JE evaluated by binary scoring was good for both components, while the intraobserver reliability for semiquantitative scoring of SH ranged from moderate in the web-based exercise (PABAK 0.49) to good (PABAK 0.8) in the live exercise. Reliability for CD and PD assessments were respectively good and excellent in all exercises (ranged from PABAK 0.61 to 0.79 for CD and 0.88 to 0.95 for PD). The interobserver reliability for the semiquantitative scoring of osteophytes was fair in the live exercise (PABAK 0.36) and moderate in the static exercise (PABAK 0.60).

    Conclusions Consensual US definitions were found to be reliable for assessing inflammatory lesions in OA of the foot, while the use of US to assess structural damage requires further studies.

    • osteoarthritis
    • ultrasonography
    • outcomes research
    http://creativecommons.org/licenses/by-nc/4.0/

    This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

    https://doi.org/10.1136/rmdopen-2018-000795

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      Footnotes

      • AZ, GF and MC contributed equally.

      • Collaborators Fabiana Figus, Iolanda Rutigliano, Chiara Scirocco.

      • Contributors Reported in the manuscript.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.

      • Data sharing statement No additional data are available.