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1. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

Author

Di Matteo, A, Cipolletta, E, Castaniti, G, Smerilli, G, Airoldi, C, Aydin, S, Becciolini, A, Bonfiglioli, K, Bruns, A, Carrara, G, Cazenave, T, Ciapetti, A, Cosatti, M, de Agustin, J, Di Carlo, M, Di Donato, E, Di Geso, L, Duran, E, Elliott, A, Estrach, C, Farisogullari, B, Fiorenza, A, Fodor, D, Gabba, A, Hernandez-Diaz, C, Huang, F, Hurnakova, J, Li, L, Jesus, D, Karadag, O, Martire, M, Massarotti, M, Michelena, X, Musca, A, Nair, J, Okano, T, Papalopoulos, I, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Satulu, I, Scioscia, C, Scire, C, Sun, F, Tamas, M, Tanimura, S, Ventura-Rios, L, Voulgari, P, Vreju, F, Vukatana, G, Wong, E, Yang, J, Hereter, J, Zanetti, A, Grassi, W, Filippucci, E, Di Matteo A., Cipolletta E., Castaniti G. M. D., Smerilli G., Airoldi C., Aydin S. Z., Becciolini A., Bonfiglioli K., Bruns A., Carrara G., Cazenave T., Ciapetti A., Cosatti M. A., de Agustin J. J., Di Carlo M., Di Donato E., Di Geso L., Duran E., Elliott A., Estrach C., Farisogullari B., Fiorenza A., Fodor D., Gabba A., Hernandez-Diaz C., Huang F., Hurnakova J., Li L., Jesus D., Karadag O., Martire M. V., Massarotti M., Michelena X., Musca A. A., Nair J., Okano T., Papalopoulos I., Rosemffet M., Rovisco J., Rozza D., Salaffi F., Satulu I., Scioscia C., Scire C. A., Sun F., Tamas M. -M., Tanimura S., Ventura-Rios L., Voulgari P. V., Vreju F. A., Vukatana G., Wong E., Yang J., Hereter J. Z., Zanetti A., Grassi W., Filippucci E., Di Matteo, A, Cipolletta, E, Castaniti, G, Smerilli, G, Airoldi, C, Aydin, S, Becciolini, A, Bonfiglioli, K, Bruns, A, Carrara, G, Cazenave, T, Ciapetti, A, Cosatti, M, de Agustin, J, Di Carlo, M, Di Donato, E, Di Geso, L, Duran, E, Elliott, A, Estrach, C, Farisogullari, B, Fiorenza, A, Fodor, D, Gabba, A, Hernandez-Diaz, C, Huang, F, Hurnakova, J, Li, L, Jesus, D, Karadag, O, Martire, M, Massarotti, M, Michelena, X, Musca, A, Nair, J, Okano, T, Papalopoulos, I, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Satulu, I, Scioscia, C, Scire, C, Sun, F, Tamas, M, Tanimura, S, Ventura-Rios, L, Voulgari, P, Vreju, F, Vukatana, G, Wong, E, Yang, J, Hereter, J, Zanetti, A, Grassi, W, Filippucci, E, Di Matteo A., Cipolletta E., Castaniti G. M. D., Smerilli G., Airoldi C., Aydin S. Z., Becciolini A., Bonfiglioli K., Bruns A., Carrara G., Cazenave T., Ciapetti A., Cosatti M. A., de Agustin J. J., Di Carlo M., Di Donato E., Di Geso L., Duran E., Elliott A., Estrach C., Farisogullari B., Fiorenza A., Fodor D., Gabba A., Hernandez-Diaz C., Huang F., Hurnakova J., Li L., Jesus D., Karadag O., Martire M. V., Massarotti M., Michelena X., Musca A. A., Nair J., Okano T., Papalopoulos I., Rosemffet M., Rovisco J., Rozza D., Salaffi F., Satulu I., Scioscia C., Scire C. A., Sun F., Tamas M. -M., Tanimura S., Ventura-Rios L., Voulgari P. V., Vreju F. A., Vukatana G., Wong E., Yang J., Hereter J. Z., Zanetti A., Grassi W., and Filippucci E.

Abstract

Objectives. To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. Methods. In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. Results. Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. Conclusions. The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

Published
2022

2. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: Reliability of the OMERACT definitions in an extended set of joints - An international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

Author

Filippou, G, Scire, C, Adinolfi, A, Damjanov, N, Carrara, G, Bruyn, G, Cazenave, T, D'Agostino, M, Delle Sedie, A, Di Sabatino, V, Diaz Cortes, M, Filippucci, E, Gandjbakhch, F, Gutierrez, M, Maccarter, D, Micu, M, Moller Parera, I, Mouterde, G, Mortada, M, Naredo, E, Pineda, C, Porta, F, Reginato, A, Satulu, I, Schmidt, W, Serban, T, Terslev, L, Vlad, V, Vreju, F, Zufferey, P, Bozios, P, Toscano, C, Picerno, V, Iagnocco, A, Filippou G., Scire C. A., Adinolfi A., Damjanov N. S., Carrara G., Bruyn G. A. W., Cazenave T., D'Agostino M. A., Delle Sedie A., Di Sabatino V., Diaz Cortes M. E., Filippucci E., Gandjbakhch F., Gutierrez M., Maccarter D. K., Micu M., Moller Parera I., Mouterde G., Mortada M. A., Naredo E., Pineda C., Porta F., Reginato A. M., Satulu I., Schmidt W. A., Serban T., Terslev L., Vlad V., Vreju F. A., Zufferey P., Bozios P., Toscano C., Picerno V., Iagnocco A., Filippou, G, Scire, C, Adinolfi, A, Damjanov, N, Carrara, G, Bruyn, G, Cazenave, T, D'Agostino, M, Delle Sedie, A, Di Sabatino, V, Diaz Cortes, M, Filippucci, E, Gandjbakhch, F, Gutierrez, M, Maccarter, D, Micu, M, Moller Parera, I, Mouterde, G, Mortada, M, Naredo, E, Pineda, C, Porta, F, Reginato, A, Satulu, I, Schmidt, W, Serban, T, Terslev, L, Vlad, V, Vreju, F, Zufferey, P, Bozios, P, Toscano, C, Picerno, V, Iagnocco, A, Filippou G., Scire C. A., Adinolfi A., Damjanov N. S., Carrara G., Bruyn G. A. W., Cazenave T., D'Agostino M. A., Delle Sedie A., Di Sabatino V., Diaz Cortes M. E., Filippucci E., Gandjbakhch F., Gutierrez M., Maccarter D. K., Micu M., Moller Parera I., Mouterde G., Mortada M. A., Naredo E., Pineda C., Porta F., Reginato A. M., Satulu I., Schmidt W. A., Serban T., Terslev L., Vlad V., Vreju F. A., Zufferey P., Bozios P., Toscano C., Picerno V., and Iagnocco A.

Abstract

Objectives: To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. Methods: A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. Results: The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification. Conclusions: Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.

Published
2018

4. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: Reliability of the OMERACT definitions in an extended set of joints - An international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

Author

Filippou, G., Scire, C. A., Adinolfi, A., Damjanov, N. S., Carrara, G., Bruyn, G. A. W., Cazenave, T., D'Agostino, Maria Antonietta, Delle Sedie, A., Di Sabatino, V., Diaz Cortes, M. E., Filippucci, E., Gandjbakhch, F., Gutierrez, M., Maccarter, D. K., Micu, M., Moller Parera, I., Mouterde, G., Mortada, M. A., Naredo, E., Pineda, C., Porta, F., Reginato, A. M., Satulu, I., Schmidt, W. A., Serban, T., Terslev, L., Vlad, V., Vreju, F. A., Zufferey, P., Bozios, P., Toscano, C., Picerno, V., Iagnocco, A., D'Agostino M. A. (ORCID:0000-0002-5347-0060), Filippou, G., Scire, C. A., Adinolfi, A., Damjanov, N. S., Carrara, G., Bruyn, G. A. W., Cazenave, T., D'Agostino, Maria Antonietta, Delle Sedie, A., Di Sabatino, V., Diaz Cortes, M. E., Filippucci, E., Gandjbakhch, F., Gutierrez, M., Maccarter, D. K., Micu, M., Moller Parera, I., Mouterde, G., Mortada, M. A., Naredo, E., Pineda, C., Porta, F., Reginato, A. M., Satulu, I., Schmidt, W. A., Serban, T., Terslev, L., Vlad, V., Vreju, F. A., Zufferey, P., Bozios, P., Toscano, C., Picerno, V., Iagnocco, A., and D'Agostino M. A. (ORCID:0000-0002-5347-0060)

Abstract

Objectives: To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. Methods: A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. Results: The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification. Conclusions: Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.

Published
2018

12. Entheseal involvement in systemic lupus erythematosus: are we missing something?

Author

Di Matteo, A., Satulu, I., Di Carlo, M., Lato, V., Filippucci, E., and Grassi, W.

Subjects
*SYSTEMIC lupus erythematosus treatment, *SYSTEMIC lupus erythematosus diagnosis, *PREDNISONE, *DISEASE prevalence, *DIAGNOSTIC ultrasonic imaging
Abstract

Background: Musculoskeletal involvement is extremely common in patients with systemic lupus erythematosus (SLE). Continuing the research initiated in patients with inflammatory arthritis, recent studies have shown the potential role of musculoskeletal ultrasound (MSUS) in the evaluation of clinical and subclinical lupus synovitis. The inflammatory process in SLE is traditionally considered to be localized at synovial tissue areas while enthesis is not included among the possible targets of the disease. Patients and methods: Entheses included in the Glasgow Ultrasound Enthesitis Scoring System were scanned in a cohort of 20 SLE patients serving as disease controls in an MSUS study aimed at assessing enthesitis in patients with psoriatic arthritis. We describe in detail four cases with unexpected and unequivocal expressions of MSUS enthesitis according to the OMERACT definition. Three out of four patients had no predisposing factors for enthesopathy. Case no. 2 was treated with a variable-dose prednisone regimen. Results: In the four cases MSUS examination revealed relevant greyscale and power Doppler abnormalities at the entheseal level, most commonly at the distal insertion of the patellar tendon. Signs of clinical enthesitis were detected in only one patient. Conclusions: This case series shows for the first time the presence of clearly evident MSUS findings indicative of enthesitis in four out of 20 SLE patients (20%), raising the hypothesis that enthesis could be a missing target in the clinical evaluation of SLE patients. Our case series justifies further investigations for a better evaluation of the prevalence, characteristics and clinical relevance of entheseal involvement in SLE. [ABSTRACT FROM AUTHOR]

Published
2017
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13. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

Author

Andrea Di Matteo, Edoardo Cipolletta, Giulia Maria Destro Castaniti, Gianluca Smerilli, Carla Airoldi, Sibel Zehra Aydin, Andrea Becciolini, Karina Bonfiglioli, Alessandra Bruns, Greta Carrara, Tomas Cazenave, Alessandro Ciapetti, Micaela Ana Cosatti, Juan José de Agustín, Marco Di Carlo, Eleonora Di Donato, Luca Di Geso, Emine Duran, Ashley Elliott, Cristina Estrach, Bayram Farisogulları, Alessia Fiorenza, Daniela Fodor, Alessandra Gabba, Cristina Hernández-Díaz, Feng Huang, Jana Hurnakova, Ling Li, Diogo Jesus, Omer Karadag, Maria Victoria Martire, Marco Massarotti, Xabier Michelena, Alice Andreea Musca, Jagdish Nair, Tadashi Okano, Ioannis Papalopoulos, Marcos Rosemffet, João Rovisco, Davide Rozza, Fausto Salaffi, Iulia Satulu, Crescenzio Scioscia, Carlo Alberto Scirè, Fei Sun, Maria-Magdalena Tamas, Shun Tanimura, Lucio Ventura-Rios, Paraksevi V Voulgari, Florentin Ananu Vreju, Gentiana Vukatana, Ernest Wong, Jinshui Yang, Johana Zacariaz Hereter, Anna Zanetti, Walter Grassi, Emilio Filippucci, Di Matteo, A, Cipolletta, E, Castaniti, G, Smerilli, G, Airoldi, C, Aydin, S, Becciolini, A, Bonfiglioli, K, Bruns, A, Carrara, G, Cazenave, T, Ciapetti, A, Cosatti, M, de Agustin, J, Di Carlo, M, Di Donato, E, Di Geso, L, Duran, E, Elliott, A, Estrach, C, Farisogullari, B, Fiorenza, A, Fodor, D, Gabba, A, Hernandez-Diaz, C, Huang, F, Hurnakova, J, Li, L, Jesus, D, Karadag, O, Martire, M, Massarotti, M, Michelena, X, Musca, A, Nair, J, Okano, T, Papalopoulos, I, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Satulu, I, Scioscia, C, Scire, C, Sun, F, Tamas, M, Tanimura, S, Ventura-Rios, L, Voulgari, P, Vreju, F, Vukatana, G, Wong, E, Yang, J, Hereter, J, Zanetti, A, Grassi, W, and Filippucci, E

Subjects
power Doppler signal, Internet, reliability, ultrasound, Reproducibility of Results, seronegative spondyloarthriti, Ultrasonography, Doppler, Enthesopathy, enthesiti, PsA, Rheumatology, Humans, Pharmacology (medical), multicenter international study, Ultrasonography
Abstract

Objectives To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. Methods In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. Results Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. Conclusions The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

Published
2022

14. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force

Author

Emilio Filippucci, V. Picerno, Ingrid Möller Parera, Pascal Zufferey, Nemanja Damjanov, Greta Carrara, Esperanza Naredo, Georgios Filippou, Anthony M. Reginato, Lene Terslev, Wolfgang A. Schmidt, C. Toscano, Teodora Serban, Violeta Vlad, Annamaria Iagnocco, Antonella Adinolfi, Maria Antonietta D'Agostino, I. Satulu, Tomas Cazenave, Carlos Pineda, Daryl K. MacCarter, Andrea Delle Sedie, Gaël Mouterde, Panagiotis Bozios, Mihaela C. Micu, Valentina Di Sabatino, Mohamed Mortada, George A W Bruyn, Marwin Gutierrez, Florentin Ananu Vreju, Carlo Alberto Scirè, Mario Enrique Diaz Cortes, Francesco Porta, Frédérique Gandjbakhch, Service de rhumatologie [CHU Cochin], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Cochin [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Service de Rhumatologie, Assistance Publique - Hôpitaux de Marseille (APHM)-Institut du Mouvement et de l'appareil Locomoteur (IML), Gènes HLA-DR, Autoanticorps et Microchimérisme dans la Polyarthrite Rhumatoïde et la Sclérodermie (HLA-DR), Aix Marseille Université (AMU)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Centre National de la Recherche Scientifique (CNRS), Service de rhumatologie [Rennes] = Rheumatology [Rennes], CHU Pontchaillou [Rennes], Foie, métabolismes et cancer, Université de Rennes 1 (UR1), Université de Rennes (UNIV-RENNES)-Université de Rennes (UNIV-RENNES)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Structure Fédérative de Recherche en Biologie et Santé de Rennes ( Biosit : Biologie - Santé - Innovation Technologique ), Ingénierie Moléculaire et Physiopathologie Articulaire (IMoPA), Université de Lorraine (UL)-Centre National de la Recherche Scientifique (CNRS), Service de Rhumatologie [CHRU Nancy], Centre Hospitalier Régional Universitaire de Nancy (CHRU Nancy), Les Hôpitaux Universitaires de Strasbourg (HUS)-Centre National de Référence pour les Maladies Systémiques Autoimmunes Rares, Centre Hospitalier du Mans, CHU Grenoble, Université Joseph Fourier - Grenoble 1 (UJF)-CHU Grenoble, Hôpital Sainte-Marguerite [CHU - APHM] (Hôpitaux Sud ), Centre de résonance magnétique biologique et médicale (CRMBM), Aix Marseille Université (AMU)-Assistance Publique - Hôpitaux de Marseille (APHM)-Centre National de la Recherche Scientifique (CNRS), Hôpital Lapeyronie [Montpellier] (CHU), Institut Desbrest de santé publique (IDESP), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Montpellier (UM), Service de rhumatologie, AP-HP Hôpital Bicêtre (Le Kremlin-Bicêtre), Hôpital Roger Salengro [Lille], CHRU Brest - Service de Rhumatologie (CHU - BREST - Rhumato), Centre Hospitalier Régional Universitaire de Brest (CHRU Brest), Hôpital Lariboisière-Fernand-Widal [APHP], Biologie de l'Os et du Cartilage : Régulations et Ciblages Thérapeutiques (BIOSCAR (UMR_S_1132 / U1132)), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris Cité (UPC), CHU Toulouse [Toulouse], Service de Rhumatologie [CHU Gabriel-Montpied], CHU Gabriel Montpied [Clermont-Ferrand], CHU Clermont-Ferrand-CHU Clermont-Ferrand, Service de Rhumatologie [CHU Pitié Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Filippou, G, Scire, C, Adinolfi, A, Damjanov, N, Carrara, G, Bruyn, G, Cazenave, T, D'Agostino, M, Delle Sedie, A, Di Sabatino, V, Diaz Cortes, M, Filippucci, E, Gandjbakhch, F, Gutierrez, M, Maccarter, D, Micu, M, Moller Parera, I, Mouterde, G, Mortada, M, Naredo, E, Pineda, C, Porta, F, Reginato, A, Satulu, I, Schmidt, W, Serban, T, Terslev, L, Vlad, V, Vreju, F, Zufferey, P, Bozios, P, Toscano, C, Picerno, V, Iagnocco, A, Università degli Studi di Ferrara (UniFE), Università degli Studi di Siena = University of Siena (UNISI), University of Belgrade [Belgrade], MC Groep Hospitals, Lelystad, Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), University of Pisa - Università di Pisa, Università Politecnica delle Marche [Ancona] (UNIVPM), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Universidad Autonoma Metropolitana - Iztapalapa, Instituto Nacional de Rehabilitacion, Rheumatology, North Valley Hospital, Whitefish, Montana, Facultat de Medicina [Barcelona], Aide à la Décision pour une Médecine Personnalisé - Laboratoire de Biostatistique, Epidémiologie et Recherche Clinique - EA 2415 (AIDMP), Université Montpellier 1 (UM1)-Université de Montpellier (UM), Zagazig University, and Universidad Autónoma de Madrid (UAM)

Subjects
Male, Wrist Joint, Genetics and Molecular Biology (all), Settore MED/16 - REUMATOLOGIA, Gout, chondrocalcinosis, osteoarthritis, ultrasonography, [SDV.IB.IMA]Life Sciences [q-bio]/Bioengineering/Imaging, International Cooperation, Triangular fibrocartilage, MESH: Wrist Joint, Urate lowering therapy, Osteoarthritis, MESH: Observer Variation, Biochemistry, MESH: Uric Acid, Metacarpophalangeal Joint, chemistry.chemical_compound, 0302 clinical medicine, Medicine, Acromioclavicular joint, Immunology and Allergy, 030212 general & internal medicine, skin and connective tissue diseases, Observer Variation, MESH: Aged, MESH: Middle Aged, Ultrasound, Calcium pyrophosphate, MESH: Follow-Up Studies, Middle Aged, Management, MESH: Reproducibility of Results, MESH: Internet, medicine.anatomical_structure, Radiology Information Systems, Acromioclavicular Joint, [SDV.MHEP.RSOA]Life Sciences [q-bio]/Human health and pathology/Rhumatology and musculoskeletal system, Rheumatology, Immunology, Biochemistry, Genetics and Molecular Biology (all), MESH: Radiology Information Systems, osteoarthriti, Female, Hip Joint, Flare, MESH: Hip Joint, musculoskeletal diseases, General Biochemistry, Genetics and Molecular Biology, NO, 03 medical and health sciences, chondrocalcinosi, Humans, MESH: Metacarpophalangeal Joint, MESH: Chondrocalcinosis, Aged, 030203 arthritis & rheumatology, Reproducibility, Internet, MESH: Symptom Flare Up, MESH: Gout Suppressants, MESH: Humans, business.industry, Prophylaxis, MESH: Gout, Reproducibility of Results, MESH: Acromioclavicular Joint, medicine.disease, MESH: Male, MESH: Prospective Studies, MESH: International Cooperation, chemistry, sense organs, business, Nuclear medicine, MESH: Female, Chondrocalcinosis, Kappa, MESH: Ultrasonography
Abstract

Objectives To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints. Methods A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises. Results The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification. Conclusions Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined.

Published
2018

15. Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study.

Author

Di Matteo A, Cipolletta E, Destro Castaniti GM, Smerilli G, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Bruns A, Carrara G, Cazenave T, Ciapetti A, Cosatti MA, de Agustín JJ, Di Carlo M, Di Donato E, Di Geso L, Duran E, Elliott A, Estrach C, Farisogulları B, Fiorenza A, Fodor D, Gabba A, Hernández-Díaz C, Huang F, Hurnakova J, Li L, Jesus D, Karadag O, Martire MV, Massarotti M, Michelena X, Musca AA, Nair J, Okano T, Papalopoulos I, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Satulu I, Scioscia C, Scirè CA, Sun F, Tamas MM, Tanimura S, Ventura-Rios L, Voulgari PV, Vreju FA, Vukatana G, Wong E, Yang J, Zacariaz Hereter J, Zanetti A, Grassi W, and Filippucci E

Subjects
Humans, Reproducibility of Results, Ultrasonography methods, Ultrasonography, Doppler methods, Internet, Enthesopathy diagnostic imaging
Abstract

Objectives: To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA., Methods: In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light's kappa, Cohen's kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs., Results: Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light's kappa: 0.77 (0.76-0.78), 0.72 (0.71-0.73), respectively; PABAK: 0.86 (0.86-0.87), 0.73 (0.73-0.74), respectively], followed by enthesophytes/calcifications [Light's kappa: 0.65 (0.64-0.65), PABAK: 0.67 (0.67-0.68)]. This was moderate for entheseal thickening [Light's kappa: 0.41 (0.41-0.42), PABAK: 0.41 (0.40-0.42)], and fair for hypoechoic areas [Light's kappa: 0.37 (0.36-0.38); PABAK: 0.37 (0.37-0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation., Conclusions: The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis., (© The Author(s) 2022. Published by Oxford University Press on behalf of the British Society for Rheumatology. All rights reserved. For permissions, please email: journals.permissions@oup.com.)

Published
2022
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16. Entheseal involvement in patients with systemic lupus erythematosus: an ultrasound study.

Author

Di Matteo A, Filippucci E, Cipolletta E, Satulu I, Hurnakova J, Lato V, De Angelis R, Horvath R, Pavelka K, Salaffi F, and Grassi W

Subjects
Achilles Tendon diagnostic imaging, Adult, Arthritis, Psoriatic complications, Arthritis, Psoriatic diagnostic imaging, Case-Control Studies, Enthesopathy etiology, Female, Foot diagnostic imaging, Humans, Lupus Erythematosus, Systemic complications, Male, Middle Aged, Patellar Ligament diagnostic imaging, Quadriceps Muscle diagnostic imaging, Severity of Illness Index, Enthesopathy diagnostic imaging, Lupus Erythematosus, Systemic diagnostic imaging, Ultrasonography, Doppler methods
Abstract

Objectives: The main objective of this study is to explore the prevalence and distribution of entheseal US changes in a cohort of SLE patients, taking as controls a group including both PsA patients and healthy subjects. The secondary objective is to investigate the correlation between the US findings and the clinical and serological data in SLE patients., Methods: Clinical and US assessment of quadriceps, patellar and Achilles tendons, and plantar fascia entheses were performed by independent rheumatologists on 65 patients with SLE, 50 patients with PsA and 50 healthy subjects. US findings were identified according to the OMERACT definitions. In SLE patients, the correlation between the US changes and the clinical and laboratory findings was evaluated., Results: US revealed one or more abnormalities in at least one enthesis in 44 out of 65 SLE patients (67.7%), 47 out of 50 PsA patients (94.0%) and 22 out of 50 healthy subjects (44.0%). In SLE patients, US findings indicating active inflammation were significantly more frequently detected than in healthy subjects (P < 0.001). The distal enthesis of the patellar tendon was the most commonly involved. The presence of power Doppler signal at the enthesis was an independent predictor of SLE disease activity (SLEDAI-2k P < 0.001, β = 0.52; musculoskeletal-BILAG P < 0.001, β = 0.56)., Conclusion: The burden of entheseal sonographic changes was significantly higher in SLE patients than in healthy subjects, especially as regards active inflammation. The presence of power Doppler signal at the enthesis may represent a potential biomarker of SLE disease activity.

Published
2018
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17. Identification of calcium pyrophosphate deposition disease (CPPD) by ultrasound: reliability of the OMERACT definitions in an extended set of joints-an international multiobserver study by the OMERACT Calcium Pyrophosphate Deposition Disease Ultrasound Subtask Force.

Author

Filippou G, Scirè CA, Adinolfi A, Damjanov NS, Carrara G, Bruyn GAW, Cazenave T, D'Agostino MA, Delle Sedie A, Di Sabatino V, Diaz Cortes ME, Filippucci E, Gandjbakhch F, Gutierrez M, Maccarter DK, Micu M, Möller Parera I, Mouterde G, Mortada MA, Naredo E, Pineda C, Porta F, Reginato AM, Satulu I, Schmidt WA, Serban T, Terslev L, Vlad V, Vreju FA, Zufferey P, Bozios P, Toscano C, Picerno V, and Iagnocco A

Subjects
Acromioclavicular Joint diagnostic imaging, Aged, Female, Hip Joint diagnostic imaging, Humans, International Cooperation, Internet, Male, Metacarpophalangeal Joint diagnostic imaging, Middle Aged, Observer Variation, Radiology Information Systems, Reproducibility of Results, Ultrasonography methods, Wrist Joint diagnostic imaging, Chondrocalcinosis diagnostic imaging, Ultrasonography standards
Abstract

Objectives: To assess the reliability of the OMERACT ultrasound (US) definitions for the identification of calcium pyrophosphate deposition disease (CPPD) at the metacarpal-phalangeal, triangular fibrocartilage of the wrist (TFC), acromioclavicular (AC) and hip joints., Methods: A web-based exercise and subsequent patient-based exercise were carried out. A panel of 30 OMERACT members, participated at the web-based exercise by evaluating twice a set of US images for the presence/absence of CPPD. Afterwards, 19 members of the panel met in Siena, Italy, for the patient-based exercise. During the exercise, all sonographers examined twice eight patients for the presence/absence of CPPD at the same joints. Intraoberserver and interobserver kappa values were calculated for both exercises., Results: The web-based exercise yielded high kappa values both in intraobserver and interobserver evaluation for all sites, while in the patient-based exercise, inter-reader agreement was acceptable for the TFC and the AC. TFC reached high interobserver and intraobserver k values in both exercises, ranging from 0.75 to 0.87 (good to excellent agreement). AC reached moderate kappa values, from 0.51 to 0.85 (moderate to excellent agreement) and can readily be used for US CPPD identification., Conclusions: Based on the results of our exercise, the OMERACT US definitions for the identification of CPPD demonstrated to be reliable when applied to the TFC and AC. Other sites reached good kappa values in the web-based exercise but failed to achieve good reproducibility at the patient-based exercise, meaning the scanning method must be further refined., Competing Interests: Competing interests: None declared., (© Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2018. All rights reserved. No commercial use is permitted unless otherwise expressly granted.)

Published
2018
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