Reliability and Availability of the 2017 EULAR-OMERACT Scoring System for Ultrasound Synovitis Assessment: Results From a Training and Reading Exercise

Overview

Journal J Ultrasound Med

Date 2024 Oct 18

PMID 39422331

Authors

Chenyang Zhao

Nan Zhuang

Yusen Zhang

Heng Lv

Weiwei Zhang

YuZhou Shen

Wangjie Wu

Yun Tian

Lu Xie

Gengmin Zhou

Haiyu Luo

Li Qiu

Desheng Sun

Haiqin Xie

Affiliations

Soon will be listed here.

Abstract

Objective: To evaluate the availability and reliability of the European League Against Rheumatisms Outcome Measures in Rheumatology Synovitis (EULAR-OMERACT) scoring system among radiologists with different levels of musculoskeletal ultrasound (US) experience in assessing synovitis in patients with rheumatoid arthritis (RA).

Method: The patients with RA were retrospectively recruited from January 2020 to March 2022. Five radiologists with different levels of US experience were recruited for the reader study (R1-5), which included two parts. The participating radiologists first read 120 gray-scale (GS) and 120 Doppler US images twice, before and after a standard training program. In the first part, they semi-quantitatively scored the images from 0 to 3 based on the EULAR-OMERACT scoring system. In the second part, they read and scored 165 paired GS and Doppler images two times in 1 month using the EULAR-OMERACT scoring system. The correlation between the sum of the GSUS and power Doppler US (PDUS) image scores and the clinical scores was assessed.

Result: The intra-rater agreement of the five radiologists was good for the EULAR-OMERACT scoring system, with κ ranging from 0.72 to 0.94 for GSUS and from 0.81 to 0.97 for PDUS. The inter-rater agreement among the experts was good to very good in the EULAR-OMERACT scoring system (κ: 0.76-0.94 for GSUS and 0.80-0.96 for PDUS). The sum of the GSUS and PDUS scores in the EULAR-OMERACT scoring system was moderate to highly positively correlated with the clinical scores (ρ of GSUS: 0.58-0.79, ρ of PDUS: 0.57-0.70 for disease activity score in 28 joints C-reactive protein) after training.

Conclusion: The EULAR-OMERACT scoring system is a reliable method for evaluating synovitis in RA and shows potential for disease assessment and follow-up in patients with RA.

References

Naredo E, Valor L, de la Torre I, Montoro M, Bello N, Martinez-Barrio J . Predictive value of Doppler ultrasound-detected synovitis in relation to failed tapering of biologic therapy in patients with rheumatoid arthritis. Rheumatology (Oxford). 2015; 54(8):1408-14. DOI: 10.1093/rheumatology/kev006. View

Safiri S, Kolahi A, Hoy D, Smith E, Bettampadi D, Mansournia M . Global, regional and national burden of rheumatoid arthritis 1990-2017: a systematic analysis of the Global Burden of Disease study 2017. Ann Rheum Dis. 2019; 78(11):1463-1471. DOI: 10.1136/annrheumdis-2019-215920. View

Simpson E, Hock E, Stevenson M, Wong R, Dracup N, Wailoo A . What is the added value of ultrasound joint examination for monitoring synovitis in rheumatoid arthritis and can it be used to guide treatment decisions? A systematic review and cost-effectiveness analysis. Health Technol Assess. 2018; 22(20):1-258. PMC: 5949573. DOI: 10.3310/hta22200. View

Bruyn G, Iagnocco A, Naredo E, Balint P, Gutierrez M, Hammer H . OMERACT Definitions for Ultrasonographic Pathologies and Elementary Lesions of Rheumatic Disorders 15 Years On. J Rheumatol. 2019; 46(10):1388-1393. DOI: 10.3899/jrheum.181095. View

Brulhart L, Ziswiler H, Tamborrini G, Zufferey P . The importance of sonographer experience and machine quality with regards to the role of musculoskeletal ultrasound in routine care of rheumatoid arthritis patients. Clin Exp Rheumatol. 2015; 33(1):98-101. View

Zufferey P, Moller B, Brulhart L, Tamborrini G, Scherer A, Finckh A . Persistence of ultrasound synovitis in patients with rheumatoid arthritis fulfilling the DAS28 and/or the new ACR/EULAR RA remission definitions: results of an observational cohort study. Joint Bone Spine. 2014; 81(5):426-32. DOI: 10.1016/j.jbspin.2014.04.014. View

Takase-Minegishi K, Horita N, Kobayashi K, Yoshimi R, Kirino Y, Ohno S . Diagnostic test accuracy of ultrasound for synovitis in rheumatoid arthritis: systematic review and meta-analysis. Rheumatology (Oxford). 2017; 57(1):49-58. DOI: 10.1093/rheumatology/kex036. View

Ohrndorf S, Boer A, Boeters D, Ten Brinck R, Burmester G, Kortekaas M . Do musculoskeletal ultrasound and magnetic resonance imaging identify synovitis and tenosynovitis at the same joints and tendons? A comparative study in early inflammatory arthritis and clinically suspect arthralgia. Arthritis Res Ther. 2019; 21(1):59. PMC: 6376767. DOI: 10.1186/s13075-019-1824-z. View

Vanbelle S . Comparing dependent kappa coefficients obtained on multilevel data. Biom J. 2017; 59(5):1016-1034. PMC: 5600130. DOI: 10.1002/bimj.201600093. View

10.

Vlad V, Berghea F, Libianu S, Balanescu A, Bojinca V, Constantinescu C . Ultrasound in rheumatoid arthritis: volar versus dorsal synovitis evaluation and scoring. BMC Musculoskelet Disord. 2011; 12:124. PMC: 3118155. DOI: 10.1186/1471-2474-12-124. View

11.

Yokota K, Tsuzuki Wada T, Akiyama Y, Mimura T . Detection of synovial inflammation in rheumatic diseases using superb microvascular imaging: Comparison with conventional power Doppler imaging. Mod Rheumatol. 2017; 28(2):327-333. DOI: 10.1080/14397595.2017.1337288. View

12.

Schmidt W, Schonau V, Reiche B, Oberdorfer P, Ohrndorf S, Backhaus M . Grading of ultrasound Doppler signals in synovitis: does it need an update?. Rheumatology (Oxford). 2015; 54(10):1897-903. DOI: 10.1093/rheumatology/kev205. View

13.

Dale J, Stirling A, Zhang R, Purves D, Foley J, Sambrook M . Targeting ultrasound remission in early rheumatoid arthritis: the results of the TaSER study, a randomised clinical trial. Ann Rheum Dis. 2016; 75(6):1043-50. DOI: 10.1136/annrheumdis-2015-208941. View

14.

Colebatch A, Edwards C, Ostergaard M, van der Heijde D, Balint P, DAgostino M . EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013; 72(6):804-14. DOI: 10.1136/annrheumdis-2012-203158. View

15.

Cheung P, Dougados M, Gossec L . Reliability of ultrasonography to detect synovitis in rheumatoid arthritis: a systematic literature review of 35 studies (1,415 patients). Arthritis Care Res (Hoboken). 2010; 62(3):323-34. DOI: 10.1002/acr.20102. View

16.

Haavardsholm E, Aga A, Olsen I, Lillegraven S, Hammer H, Uhlig T . Ultrasound in management of rheumatoid arthritis: ARCTIC randomised controlled strategy trial. BMJ. 2016; 354:i4205. PMC: 4986519. DOI: 10.1136/bmj.i4205. View

17.

Ventura-Rios L, Hernandez-Diaz C, Ferrusquia-Toriz D, Cruz-Arenas E, Rodriguez-Henriquez P, Alvarez Del Castillo A . Reliability of ultrasound grading traditional score and new global OMERACT-EULAR score system (GLOESS): results from an inter- and intra-reading exercise by rheumatologists. Clin Rheumatol. 2017; 36(12):2799-2804. DOI: 10.1007/s10067-017-3662-1. View

18.

Mandl P, Baranauskaite A, Damjanov N, Hojnik M, Kurucz R, Nagy O . Musculoskeletal ultrasonography in routine rheumatology practice: data from Central and Eastern European countries. Rheumatol Int. 2016; 36(6):845-54. PMC: 4873522. DOI: 10.1007/s00296-016-3442-2. View

19.

Terslev L, Naredo E, Aegerter P, Wakefield R, Backhaus M, Balint P . Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 2: reliability and application to multiple joints of a standardised consensus-based scoring system. RMD Open. 2017; 3(1):e000427. PMC: 5597800. DOI: 10.1136/rmdopen-2016-000427. View

20.

Yamada Y, Ogasawara M, Gorai M, Matsuki Y, Murayama G, Sugisaki N . The synovial grade corresponding to clinically involved joints and a feasible ultrasound-adjusted simple disease activity index for monitoring rheumatoid arthritis. Mod Rheumatol. 2016; 26(6):844-849. DOI: 10.3109/14397595.2016.1158385. View