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1. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Author

Di Matteo, A, Moscioni, E, Lommano, M, Cipolletta, E, Smerilli, G, Farah, S, Airoldi, C, Aydin, S, Becciolini, A, Bonfiglioli, K, Carotti, M, Carrara, G, Cazenave, T, Corradini, D, Cosatti, M, de Agustin, J, Destro Castaniti, G, Di Carlo, M, Di Donato, E, Di Geso, L, Elliott, A, Fodor, D, Francioso, F, Gabba, A, Hernandez-Diaz, C, Horvath, R, Hurnakova, J, Jesus, D, Marin, J, Martire, M, Mashadi Mirza, R, Massarotti, M, Musca, A, Nair, J, Okano, T, Papalopoulos, I, Rosa, J, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Scioscia, C, Scire, C, Tamas, M, Tanimura, S, Ventura-Rios, L, Villota-Eraso, C, Villota, O, Voulgari, P, Vreju, F, Vukatana, G, Hereter, J, Zanetti, A, Grassi, W, Filippucci, E, Di Matteo A., Moscioni E., Lommano M. G., Cipolletta E., Smerilli G., Farah S., Airoldi C., Aydin S. Z., Becciolini A., Bonfiglioli K., Carotti M., Carrara G., Cazenave T., Corradini D., Cosatti M. A., de Agustin J. J., Destro Castaniti G. M., Di Carlo M., Di Donato E., Di Geso L., Elliott A., Fodor D., Francioso F., Gabba A., Hernandez-Diaz C., Horvath R., Hurnakova J., Jesus D., Marin J., Martire M. V., Mashadi Mirza R., Massarotti M., Musca A. A., Nair J., Okano T., Papalopoulos I., Rosa J., Rosemffet M., Rovisco J., Rozza D., Salaffi F., Scioscia C., Scire C. A., Tamas M. -M., Tanimura S., Ventura-Rios L., Villota-Eraso C., Villota O., Voulgari P. V., Vreju F. A., Vukatana G., Hereter J. Z., Zanetti A., Grassi W., Filippucci E., Di Matteo, A, Moscioni, E, Lommano, M, Cipolletta, E, Smerilli, G, Farah, S, Airoldi, C, Aydin, S, Becciolini, A, Bonfiglioli, K, Carotti, M, Carrara, G, Cazenave, T, Corradini, D, Cosatti, M, de Agustin, J, Destro Castaniti, G, Di Carlo, M, Di Donato, E, Di Geso, L, Elliott, A, Fodor, D, Francioso, F, Gabba, A, Hernandez-Diaz, C, Horvath, R, Hurnakova, J, Jesus, D, Marin, J, Martire, M, Mashadi Mirza, R, Massarotti, M, Musca, A, Nair, J, Okano, T, Papalopoulos, I, Rosa, J, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Scioscia, C, Scire, C, Tamas, M, Tanimura, S, Ventura-Rios, L, Villota-Eraso, C, Villota, O, Voulgari, P, Vreju, F, Vukatana, G, Hereter, J, Zanetti, A, Grassi, W, Filippucci, E, Di Matteo A., Moscioni E., Lommano M. G., Cipolletta E., Smerilli G., Farah S., Airoldi C., Aydin S. Z., Becciolini A., Bonfiglioli K., Carotti M., Carrara G., Cazenave T., Corradini D., Cosatti M. A., de Agustin J. J., Destro Castaniti G. M., Di Carlo M., Di Donato E., Di Geso L., Elliott A., Fodor D., Francioso F., Gabba A., Hernandez-Diaz C., Horvath R., Hurnakova J., Jesus D., Marin J., Martire M. V., Mashadi Mirza R., Massarotti M., Musca A. A., Nair J., Okano T., Papalopoulos I., Rosa J., Rosemffet M., Rovisco J., Rozza D., Salaffi F., Scioscia C., Scire C. A., Tamas M. -M., Tanimura S., Ventura-Rios L., Villota-Eraso C., Villota O., Voulgari P. V., Vreju F. A., Vukatana G., Hereter J. Z., Zanetti A., Grassi W., and Filippucci E.

Abstract

Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0–3) and a continuous quantitative measurement (“VAS echogenicity,” 0–100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall’s Tau and Pearson’s Rho coefficients. Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57–0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68–0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. “VAS echogenicity” showed a high reliability both in the inter-observer [ICC = 0.80 (0.75–0.85)] and intra-observer [ICC = 0.88 (0.88–0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and “VAS echogenicity” [ICC = 0.52 (0.50–0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases.

Published
2023

2. 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

3. Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

Author

Bruyn, G. A. W., Pineda, C., Hernandez-Diaz, C., Ventura-Rios, L., Moya, C., Garrido, J., Groen, H., Pena, A., Espinosa, R., Moeller, I., Filippucci, E., Iagnocco, A., Balint, P. V., Kane, D., D'Agostino, M-A, Angulo, M., Ponte, R., Fernandez-Gallardo, J. M., Naredo, E., Moller, I., and Science in Healthy Ageing & healthcaRE (SHARE)

Subjects
Adult, Male, Shoulder, medicine.medical_specialty, Settore MED/16 - REUMATOLOGIA, ROTATOR CUFF TEARS, LARGE JOINTS, LOW KAPPA, Biceps, Arthritis, Rheumatoid, Rheumatology, Bursitis, REPRODUCIBILITY, Internal medicine, Positive predicative value, Synovitis, Dash, medicine, Humans, INTEROBSERVER RELIABILITY, ULTRASOUND, RADIOGRAPHIC DAMAGE, Tenosynovitis, medicine.diagnostic_test, business.industry, Reproducibility of Results, Ultrasonography, Doppler, Magnetic resonance imaging, Gold standard (test), Hand, medicine.disease, Magnetic Resonance Imaging, PHYSICAL-EXAMINATION, OBSERVER AGREEMENT, Arm, Physical therapy, Female, MUSCULOSKELETAL ULTRASONOGRAPHY, Nuclear medicine, business
Abstract

Objective. To assess the intra- and interobserver reproducibility of musculoskeletal ultrasonography (US) in detecting inflammatory shoulder changes in patients with rheumatoid arthritis, and to determine the agreement between US and the Shoulder Pain and Disability Index (SPADI) and the Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, using magnetic resonance imaging (MRI) as a gold standard.Methods. Eleven rheumatologists investigated 10 patients in 2 rounds independently and blindly of each other by US. US results were compared with shoulder function tests and MRI.Results. The positive and negative predictive values (NPVs) for axillary recess synovitis (ARS) were 0.88 and 0.43, respectively, for posterior recess synovitis (PRS) were 0.36 and 0.97, respectively, for subacromial/subdeltoid bursitis (SASB) were 0.85 and 0.28, respectively, and the NPV for biceps tenosynovitis (BT) was 1.00. The intraobserver kappa was 0.62 for ARS, 0.59 for PRS, 0.51 for BT, and 0.70 for SASB. The intraobserver kappa for power Doppler US (PDUS) signal was 0.91 for PRS, 0.77 for ARS, 0.94 for SASB, and 0.53 for BT. The interobserver maximum kappa was 0.46 for BT, 0.95 for ARS, 0.52 for PRS, and 0.61 for SASB. The interobserver reliability of PDUS was 1.0 for PRS, 0.1 for ARS, 0.5 for BT, and 1.0 for SASB. P values for the SPADI and DASH versus cuff tear on US were 0.02 and 0.01, respectively; all other relationships were not significant.Conclusion. Overall agreements between gray-scale US and MRI regarding synovitis of the shoulder varied considerably, but excellent results were seen for PDUS. Measures of shoulder function have a poor relationship with US and MRI. Improved standardization of US scanning technique could further reliability of shoulder US.

Published
2010

7. Erratum: Validity of ultrasonography and measures of adult shoulder function and reliability of ultrasonography in detecting shoulder synovitis in patients with rheumatoid arthritis using magnetic resonance imaging as a gold standard

Author

Bruyn, G. A. W., primary, Pineda, C., additional, Hernandez-Diaz, C., additional, Ventura-Rios, L., additional, Moya, C., additional, Garrido, J., additional, Groen, H., additional, Pena, A., additional, Espinosa, R., additional, Möller, I., additional, Filippucci, E., additional, Iagnocco, A., additional, Balint, P. V., additional, Kane, D., additional, D'Agostino, M.-A., additional, Angulo, M., additional, Ponte, R., additional, Fernandez-Gallardo, J. M., additional, and Naredo, E., additional

Published
2010
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8. 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

9. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study

Author

Andrea Di Matteo, Erica Moscioni, Maria Giovanna Lommano, Edoardo Cipolletta, Gianluca Smerilli, Sonia Farah, Carla Airoldi, Sibel Zehra Aydin, Andrea Becciolini, Karina Bonfiglioli, Marina Carotti, Greta Carrara, Tomas Cazenave, Davide Corradini, Micaela Ana Cosatti, Juan Josè de Agustin, Giulia Maria Destro Castaniti, Marco Di Carlo, Eleonora Di Donato, Luca Di Geso, Ashley Elliott, Daniela Fodor, Francesca Francioso, Alessandra Gabba, Cristina Hernández-Díaz, Rudolf Horvath, Jana Hurnakova, Diogo Jesus, Josefina Marin, Maria Victoria Martire, Riccardo Mashadi Mirza, Marco Massarotti, Alice Andreea Musca, Jagdish Nair, Tadashi Okano, Ioannis Papalopoulos, Javier Rosa, Marcos Rosemffet, João Rovisco, Davide Rozza, Fausto Salaffi, Crescenzio Scioscia, Carlo Alberto Scirè, Maria-Magdalena Tamas, Shun Tanimura, Lucio Ventura-Rios, Catalina Villota-Eraso, Orlando Villota, Paraskevi V. Voulgari, Florentin Ananu Vreju, Gentiana Vukatana, Johana Zacariaz Hereter, Anna Zanetti, Walter Grassi, Emilio Filippucci, Institut Català de la Salut, [Di Matteo A] Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy. Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, United Kingdom. [Moscioni E, Lommano MG, Cipolletta E, Smerilli G, Farah S] Rheumatology Unit, Department of Clinical and Molecular Sciences, 'Carlo Urbani' Hospital, Polytechnic University of Marche, Ancona, Italy. [de Agustin JJ] Servei de Reumatologia, Vall d’Hebron Hospital Universitari, Barcelona, Spain, Vall d'Hebron Barcelona Hospital Campus, Di Matteo, A, Moscioni, E, Lommano, M, Cipolletta, E, Smerilli, G, Farah, S, Airoldi, C, Aydin, S, Becciolini, A, Bonfiglioli, K, Carotti, M, Carrara, G, Cazenave, T, Corradini, D, Cosatti, M, de Agustin, J, Destro Castaniti, G, Di Carlo, M, Di Donato, E, Di Geso, L, Elliott, A, Fodor, D, Francioso, F, Gabba, A, Hernandez-Diaz, C, Horvath, R, Hurnakova, J, Jesus, D, Marin, J, Martire, M, Mashadi Mirza, R, Massarotti, M, Musca, A, Nair, J, Okano, T, Papalopoulos, I, Rosa, J, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Scioscia, C, Scire, C, Tamas, M, Tanimura, S, Ventura-Rios, L, Villota-Eraso, C, Villota, O, Voulgari, P, Vreju, F, Vukatana, G, Hereter, J, Zanetti, A, Grassi, W, and Filippucci, E

Subjects
reliability, Otros calificadores::Otros calificadores::/diagnóstico por imagen [Otros calificadores], General Medicine, muscle echogenicity, sarcopenia, enfermedades musculoesqueléticas::enfermedades reumáticas [ENFERMEDADES], Músculs - Ecografia, Musculoskeletal Diseases::Rheumatic Diseases [DISEASES], rheumatic diseases, diagnóstico::técnicas y procedimientos diagnósticos::diagnóstico por imagen::ecografía [TÉCNICAS Y EQUIPOS ANALÍTICOS, DIAGNÓSTICOS Y TERAPÉUTICOS], Diagnosis::Diagnostic Techniques and Procedures::Diagnostic Imaging::Ultrasonography [ANALYTICAL, DIAGNOSTIC AND THERAPEUTIC TECHNIQUES, AND EQUIPMENT], musculoskeletal ultrasound, rheumatic disease, Reumatisme - Ecografia, Other subheadings::Other subheadings::/diagnostic imaging [Other subheadings]
Abstract

Muscle echogenicity; Musculoskeletal ultrasound; Rheumatic diseases Ecogenicidad muscular; Ecografía musculoesquelética; Enfermedades reumáticas Ecogenicitat muscular; Ecografia musculoesquelètica; Malalties reumàtiques Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases. Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0–3) and a continuous quantitative measurement (“VAS echogenicity,” 0–100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall’s Tau and Pearson’s Rho coefficients. Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57–0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68–0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. “VAS echogenicity” showed a high reliability both in the inter-observer [ICC = 0.80 (0.75–0.85)] and intra-observer [ICC = 0.88 (0.88–0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and “VAS echogenicity” [ICC = 0.52 (0.50–0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively). Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases. RH and JH were supported by Ministry of Health, Czech Republic – conceptual development of research organization, Motol University Hospital, Prague, Czech Republic (00064203).

Published
2023

10. Relationship Between Ultrasound and Physical Examination in the Assessment of Enthesitis in Patients With Spondyloarthritis: Results From the DEUS Multicenter Study.

Author

Di Matteo A, Di Donato S, Smerilli G, Becciolini A, Camarda F, Cauli A, Cazenave T, Cipolletta E, Corradini D, de Agustin JJ, Destro Castaniti GM, Di Donato E, Duran E, Farisogullari B, Fornaro M, Francioso F, Giorgis P, Granados R, Granel A, Hernandez-Diaz C, Horvath R, Hurnakova J, Jesus D, Karadag O, Li L, Li Y, Lommano MG, Marin J, Martire MV, Michelena X, Muntean L, Piga M, Rosemffet M, Rovisco J, Salaffi F, Saraiva L, Scioscia C, Tamas MM, Tanimura S, Venetsanopoulou A, Ventura Rios L, Villota O, Villota-Eraso C, Voulgari PV, Vukatana G, Zacariaz Hereter J, Grassi W, and Filippucci E

Abstract

Objective: The study objectives were (i) to explore the agreement between the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and physical examination in assessing enthesitis in patients with spondyloarthritis (SpA) and (ii) to investigate the prevalence and clinical relevance of subclinical enthesitis in this population., Methods: Twenty rheumatology centers participated in this cross-sectional study. Patients with SpA, including axial spondyloarthritis (axSpA) and psoriatic arthritis (PsA), underwent both ultrasound scan and physical examination of large lower limb entheses. The OMERACT ultrasound lesions of enthesitis were considered, along with a recently proposed definition for "active enthesitis" by our group. Subclinical enthesitis was defined as the presence of "active enthesitis" in ≥1 enthesis in patients with SpA without clinical enthesitis (ie, number of positive entheses on physical examination and Leeds Enthesitis Index score = 0)., Results: A total of 4,130 entheses in 413 patients with SpA (224 with axSpA and 189 with PsA) were evaluated through ultrasound and physical examination. Agreement between ultrasound and physical examination ranged from moderate (ie, enthesophytes) to almost perfect (ie, power Doppler and "active enthesitis"). Patellar tendon entheses demonstrated the highest agreement, whereas Achilles tendon insertion showed the lowest. Among 158 (38.3%) of 413 patients with SpA with clinical enthesitis, 108 (68.4%) exhibited no "active enthesitis" on ultrasound. Conversely, of those 255 without clinical enthesitis, 39 (15.3%) showed subclinical enthesitis. Subclinical enthesitis was strongly associated with local structural damage. However, no differences were observed regarding the demographic and clinical profiles of patients with SpA with and without subclinical enthesitis., Conclusion: Our study underscores the need for a comprehensive tool integrating ultrasound and physical examination for assessing enthesitis in patients with SpA., (© 2024 American College of Rheumatology.)

Published
2024
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11. Power Doppler signal at the enthesis and bone erosions are the most discriminative OMERACT ultrasound lesions for SpA: results from the DEUS (Defining Enthesitis on Ultrasound in Spondyloarthritis) multicentre study.

Author

Di Matteo A, Smerilli G, Di Donato S, Liu AR, Becciolini A, Camarda F, Cazenave T, Cipolletta E, Corradini D, de Agustín JJ, Destro Castaniti GM, Di Donato E, Di Geso L, Duran E, Farisogullari B, Fornaro M, Francioso F, Giorgis P, Granel A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Karadag O, Li L, Marin J, Martire MV, Michelena X, Moscioni E, Muntean L, Piga M, Rosemffet M, Rovisco J, Sahin D, Salaffi F, Saraiva L, Scioscia C, Tamas MM, Tanimura S, Venetsanopoulou A, Ventura-Rios L, Villota O, Villota-Eraso C, Voulgari PV, Vukatana G, Zacariaz Hereter J, Marzo-Ortega H, Grassi W, and Filippucci E

Subjects
Humans, Female, Male, Adult, Middle Aged, Arthritis, Psoriatic diagnostic imaging, Arthritis, Psoriatic complications, Severity of Illness Index, Achilles Tendon diagnostic imaging, Achilles Tendon pathology, Case-Control Studies, Enthesopathy diagnostic imaging, Ultrasonography, Doppler methods, Spondylarthritis diagnostic imaging, Spondylarthritis complications
Abstract

Objectives: To assess, in spondyloarthritis (SpA), the discriminative value of the Outcome Measures in Rheumatology (OMERACT) ultrasound lesions of enthesitis and their associations with clinical features in this population., Methods: In this multicentre study involving 20 rheumatology centres, clinical and ultrasound examinations of the lower limb large entheses were performed in 413 patients with SpA (axial SpA and psoriatic arthritis) and 282 disease controls (osteoarthritis and fibromyalgia). 'Active enthesitis' was defined as (1) power Doppler (PD) at the enthesis grade ≥1 plus entheseal thickening and/or hypoechoic areas, or (2) PD grade >1 (independent of the presence of entheseal thickening and/or hypoechoic areas)., Results: In the univariate analysis, all OMERACT lesions except enthesophytes/calcifications showed a significant association with SpA. PD (OR=8.77, 95% CI 4.40 to 19.20, p<0.001) and bone erosions (OR=4.75, 95% CI 2.43 to 10.10, p<0.001) retained this association in the multivariate analysis. Among the lower limb entheses, only the Achilles tendon was significantly associated with SpA (OR=1.93, 95% CI 1.30 to 2.88, p<0.001) in the multivariate analyses. Active enthesitis showed a significant association with SpA (OR=9.20, 95% CI 4.21 to 23.20, p<0.001), and unlike the individual OMERACT ultrasound lesions it was consistently associated with most clinical measures of SpA disease activity and severity in the regression analyses., Conclusions: This large multicentre study assessed the value of different ultrasound findings of enthesitis in SpA, identifying the most discriminative ultrasound lesions and entheseal sites for SpA. Ultrasound could differentiate between SpA-related enthesitis and other forms of entheseal pathology (ie, mechanical enthesitis), thus improving the assessment of entheseal involvement in SpA., Competing Interests: Competing interests: ADM has received speaking fees from Janssen and has received support for attending meetings by Galapagos outside the submitted work. GS has received speaking fees and support for attending meetings by Novartis outside the submitted work. EC has received speaking fees from Novartis outside the submitted work. EDD has received speaking fees from Novartis and has received support for attending meetings by AbbVie outside the submitted work. MF has received speaking fees from Galapagos, AbbVie, Boehringer Ingelheim, Lilly and GSK and has received support for attending meetings by Pfizer outside the submitted work. XM has received speaking fees from AbbVie, Lilly Novartis, UCB and Janssen and has received support for attending meetings by UCB and Janssen outside the submitted work. MGR has received speaking fees from AbbVie, Raffo and Tecnofarma outside the submitted work. HM-O has received research grants from Janssen, Novartis, Pfizer and UCB and honoraria/speaker fees from AbbVie, Amgen, Eli Lilly, Janssen, Moonlake, Novartis, Pfizer, Takeda and UCB non-relevant to the submitted work. WG has received speaking fees from Accademia di Medicina, Janssen, Angelini Ethos, Galapagos, Biopharma and UVET outside the submitted work. EF has received speaking fees from AbbVie, Amgen, BMS, Janssen, Lilly, Novartis, Pfizer and Union Chimique Belge Pharma outside the submitted work., (© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)

Published
2024
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12. Reliability assessment of ultrasound muscle echogenicity in patients with rheumatic diseases: Results of a multicenter international web-based study.

Author

Di Matteo A, Moscioni E, Lommano MG, Cipolletta E, Smerilli G, Farah S, Airoldi C, Aydin SZ, Becciolini A, Bonfiglioli K, Carotti M, Carrara G, Cazenave T, Corradini D, Cosatti MA, de Agustin JJ, Destro Castaniti GM, Di Carlo M, Di Donato E, Di Geso L, Elliott A, Fodor D, Francioso F, Gabba A, Hernández-Díaz C, Horvath R, Hurnakova J, Jesus D, Marin J, Martire MV, Mashadi Mirza R, Massarotti M, Musca AA, Nair J, Okano T, Papalopoulos I, Rosa J, Rosemffet M, Rovisco J, Rozza D, Salaffi F, Scioscia C, Scirè CA, Tamas MM, Tanimura S, Ventura-Rios L, Villota-Eraso C, Villota O, Voulgari PV, Vreju FA, Vukatana G, Hereter JZ, Zanetti A, Grassi W, and Filippucci E

Abstract

Objectives: To investigate the inter/intra-reliability of ultrasound (US) muscle echogenicity in patients with rheumatic diseases., Methods: Forty-two rheumatologists and 2 radiologists from 13 countries were asked to assess US muscle echogenicity of quadriceps muscle in 80 static images and 20 clips from 64 patients with different rheumatic diseases and 8 healthy subjects. Two visual scales were evaluated, a visual semi-quantitative scale (0-3) and a continuous quantitative measurement ("VAS echogenicity," 0-100). The same assessment was repeated to calculate intra-observer reliability. US muscle echogenicity was also calculated by an independent research assistant using a software for the analysis of scientific images (ImageJ). Inter and intra reliabilities were assessed by means of prevalence-adjusted bias-adjusted Kappa (PABAK), intraclass correlation coefficient (ICC) and correlations through Kendall's Tau and Pearson's Rho coefficients., Results: The semi-quantitative scale showed a moderate inter-reliability [PABAK = 0.58 (0.57-0.59)] and a substantial intra-reliability [PABAK = 0.71 (0.68-0.73)]. The lowest inter and intra-reliability results were obtained for the intermediate grades (i.e., grade 1 and 2) of the semi-quantitative scale. "VAS echogenicity" showed a high reliability both in the inter-observer [ICC = 0.80 (0.75-0.85)] and intra-observer [ICC = 0.88 (0.88-0.89)] evaluations. A substantial association was found between the participants assessment of the semi-quantitative scale and "VAS echogenicity" [ICC = 0.52 (0.50-0.54)]. The correlation between these two visual scales and ImageJ analysis was high (tau = 0.76 and rho = 0.89, respectively)., Conclusion: The results of this large, multicenter study highlighted the overall good inter and intra-reliability of the US assessment of muscle echogenicity in patients with different rheumatic diseases., Competing Interests: SA received honoraria from AbbVie, Celgene, UCB, Novartis, Janssen, Pfizer, and Sanofi. AB served as a speaker for AbbVie, Amgen, Sanofi-Genzyme, and UCB, outside the submitted work. EF had received speaking fees from AbbVie, Amgen, BMS, Janssen, Lilly, Novartis, Roche, Pfizer, and UCB, outside the submitted work. WG had received speaking fees from Celltrion and Pfizer, outside the submitted work., (Copyright © 2023 Di Matteo, Moscioni, Lommano, Cipolletta, Smerilli, Farah, Airoldi, Aydin, Becciolini, Bonfiglioli, Carotti, Carrara, Cazenave, Corradini, Cosatti, de Agustin, Destro Castaniti, Di Carlo, Di Donato, Di Geso, Elliott, Fodor, Francioso, Gabba, Hernández-Díaz, Horvath, Hurnakova, Jesus, Marin, Martire, Mashadi Mirza, Massarotti, Musca, Nair, Okano, Papalopoulos, Rosa, Rosemffet, Rovisco, Rozza, Salaffi, Scioscia, Scirè, Tamas, Tanimura, Ventura-Rios, Villota-Eraso, Villota, Voulgari, Vreju, Vukatana, Hereter, Zanetti, Grassi and Filippucci.)

Published
2023
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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

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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14. Reliability of OMERACT ultrasound elementary lesions in gout: results from a multicenter exercise.

Author

Cazenave T, Martire V, Reginato AM, Gutierrez M, Waimann CA, Pineda C, Rosa JE, Ruta S, Sedano-Santiago O, Bertoli AM, Audisio M, Hernandez-Diaz C, Ventura-Rios L, Quintero M, De Miguel E, Alvarez-Del-Castillo-Araujo AL, Abril A, Ayala-Ledesma EN, Alarcon-Isidro E, Santiago ML, Pera MA, Urquiola C, Rodriguez Gil G, Saldarriaga Rivera LM, Cefferino C, Benegas M, Diaz Cortes ME, Bravo M, Peiteado D, Estrella NA, Micas RA, Saavedra Muñoz J, Arape Toyo RDC, Gálvez Elkin MS, Spindler WJ, Sandobal C, Marin J, Lima Gomes Ochtrop M, Pavao Ayala R, Catay ER, Py GE, Aguilar GH, Rengel Colina YY, Airoldi CA, Mora-Trujillo CS, Kohan MP, Urioste Eguez LE, Castillo-Gallego C, Diaz-Coto JF, Tate P, Saucedo CM, Vega-Hinojosa O, Troitiño CJ, Marengo MF, Marcaida PM, Monjo Henry I, Muñoz-Louis R, Solano C, Fernandez Castillo FR, Graf CE, Guinsburg M, Santa Cruz MJ, Navarta Ortiz DA, Alva Linares M, and Rosemffet MG

Subjects
Cross-Sectional Studies, Humans, Reproducibility of Results, Ultrasonography, Gout diagnostic imaging
Abstract

The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.

Published
2019
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15. How is the ultrasound in rheumatology used, implemented, and applied in Latin American centers? Results from a multicenter study.

Author

Gutierrez M, Hernandez-Diaz C, Ventura-Rios L, Saldarriaga-Rivera LM, Ruta S, Alva M, -Trujillo CM, Pérez W, Terrazas H, Del Carmen Arape Toyo R, Quintero M, Solano C, Santiago OS, Sotomayor JG, Cefferino C, Py GE, Audisio MJ, Spindler WJ, Berman H, Airoldi C, Wong R, Del Castillo Araujo AL, Díaz ME, Villaquiran CC, Mantilla RD, Mendonça JA, da Silveira IG, do Prado AD, Bisi MC, Rosario V, Medrano-Sánchez J, Muñoz-Louis R, Lozada-Navarro AC, Bernal A, Lozano M, and Pineda C

Subjects
Adolescent, Adult, Aged, Aged, 80 and over, Female, Humans, Latin America, Male, Middle Aged, Referral and Consultation, Retrospective Studies, Young Adult, Rheumatic Diseases diagnostic imaging, Rheumatology methods, Ultrasonography statistics & numerical data
Abstract

This study aimed to perform an overview of how ultrasound (US) is being used, implemented, and applied in rheumatologic centers in Latin America (LA). A retrospective, multicenter 1-year experience study was undertaken. Eighteen centers from eight countries were involved. The following information were collected: demographic data, indication to perform an US examination, physician that required the examination, and the anatomical region required for the examination. A total of 7167 patients underwent an US examination. The request for US examinations came most frequently from their own institution (5981 (83.45 %)) than from external referral (1186 (16.55 %)). The services that more frequently requested an US examination were rheumatology 5154 (71.91 %), followed by orthopedic 1016 (14.18 %), and rehabilitation 375 (5.23 %). The most frequently scanned area was the shoulder in 1908 cases (26.62 %), followed by hand 1754 (24.47 %), knee 1518 (21.18 %), ankle 574 (8.01 %), and wrist 394 (5.50 %). Osteoarthritis was the most common disease assessed (2279 patients (31.8 %)), followed by rheumatoid arthritis (2125 patients (29.65 %)), psoriatic arthritis (869 patients (12.1 %)), painful shoulder syndrome (545 (7.6 %)), connective tissue disorders (systemic sclerosis 339 (4.7 %), polymyositis/dermatomyositis 107 (1.4 %), Sjögren's syndrome 60 (0.8 %), and systemic lupus erythematosus 57 (0.8 %)). US evaluation was more frequently requested for diagnostic purposes (3981 (55.5 %)) compared to follow-up studies (2649 (36.9 %)), research protocols (339 (4.73 %)), and invasive guided procedures (198 (2.76 %)). US registered increasing applications in rheumatology and highlighted its positive impact in daily clinical practice. US increases the accuracy of the musculoskeletal clinical examination, influence the diagnosis, and the disease management.

Published
2016
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16. New Ultrasound Modalities in Rheumatology.

Author

Gutierrez M, Okano T, Reginato AM, Cazenave T, Ventura-Rios L, Bertolazzi C, and Pineda C

Subjects
Dimensional Measurement Accuracy, Humans, Imaging, Three-Dimensional methods, Inflammation diagnosis, Inventions, Reproducibility of Results, Rheumatic Diseases diagnosis, Rheumatic Diseases physiopathology, Rheumatology methods, Rheumatology trends, Ultrasonography methods
Abstract

Over the years, ultrasound (US) has accumulated important evidence supporting its relevant role for the assessment of inflammatory processes of different rheumatologic diseases, as well as in the follow-up in assessing the response to different therapeutic approaches. This has been possible because of the increase in training, competency, and knowledge, as well as the rapid progress in the US technologies.Currently, some US machines can be equipped by sophisticated software modalities (i.e., 3-dimensional US, elastosonography, automated cardiovascular software, and fusion imaging) that can augment US traditional role as a safe, fast, and easy-to-perform modality and giving it new life and increased relevance in rheumatology. In this article, we evaluated the US developments, from conventional B-mode to more sophisticated technologies, and their potential clinical impact in the field of rheumatology.Three-dimensional US can improve the accuracy of the assessment of bone erosions and the quantification of power Doppler because of its multiplanar view including coronal, axial and sagital view. Elastosonography is still looking for its role in rheumatology. Preliminary works induce us to consider it as a promise tool for the assessment of tendon pathology and skin of patients with connective tissue disorders. The automated method for the measurement of carotid intima-media thickness permits a rapid and accurate assessment. The preliminary published data showed that it is reliable, and valid compared to the traditional method; they also support the future of rheumatologists as the direct operators in evaluating the cardiovascular risk in daily practice. Fusion imaging increases the diagnostic power of US, displaying simultaneously in the monitor, the US image, and the corresponding computed tomography/magnetic resonance imaging image. However, there are no sufficient data supporting its application in daily rheumatologic practice.

Published
2015
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17. Hand function in rheumatic diseases: patient and physician evaluations.

Author

López López CO, Alvarez-Hernández E, Medrano Ramirez G, Montes Castillo ML, Hernández-Díaz C, Ventura Rios L, Arreguin Lopez R, and Vázquez-Mellado J

Subjects
Adult, Arthritis, Rheumatoid physiopathology, Disability Evaluation, Female, Gout physiopathology, Hand diagnostic imaging, Hand Joints physiopathology, Hand Strength, Humans, Male, Middle Aged, Neural Conduction, Osteoarthritis physiopathology, Quality of Life, Range of Motion, Articular physiology, Rheumatic Diseases diagnostic imaging, Scleroderma, Systemic physiopathology, Ultrasonography, Hand physiopathology, Rheumatic Diseases physiopathology
Abstract

Aim: Rheumatic diseases have repercussions in hand function. The m-SACRAH (modified Score for the Assessment and quantification of Chronic Rheumatoid Affections of the Hands) questionnaire evaluates hand function according to the patient's opinion. Our aim was to look for the clinical and para-clinical variables that correlate with m-SACRAH in rheumatic diseases., Methods: Consecutive patients with diagnoses of rheumatoid arthritis (RA), osteoarthritis (OA), gout, and systemic sclerosis (SS) with hand involvement and who agreed to participate, answered the m-SACRAH and Health Assessment Questionnaire Disability Index (HAQ-DI) and underwent blinded and independent rheumatologist and physiatrist evaluations. Nerve conduction studies (NCS) and hand ultrasonography (USG) were performed., Statistical Analysis: Spearman's correlation and the Mann-Whitney U-test., Results: Forty patients were included. There were 72% women and mean age of 49.25 ± 14.2 years. According to m-SACRAH patients were dived into two groups (mild vs. moderate-severe), only the number limited to motion joints were different among them (median 2 vs. 8 P = 0.036). Patients' perspective variables had a good correlation (HAQ-DI/mSACRAH: r = 0.43, P < 0.05), but only correlated with limited motion joints (r = 0.41, P < 0.05 for m-SACRAH and r = 0.31, P < 0.05 for HAQ-DI). Physician's evaluations had a good correlation. Visual analog scale of hand function with physiatrist evaluations: passive range of motion (r = -0.49, P = 0.001), sum of affected pinches (r = 0.66, P = 0.001), limited to motion joints (r = 0.34, P < 0.05) and palm-finger distance (r = 0.50, P = 0.05). Regarding para-clinical evaluations, only tenosynovitis by ultrasonography correlated with HAQ-Di (r = 0.357, P < 0.05)., Conclusions: Patients' perspectives correlated with the number of limited motion joints but with none of the other physicians' and para-clinical evaluations. The patients' opinion about their function should play a major role in their management., (© 2014 Asia Pacific League of Associations for Rheumatology and Wiley Publishing Asia Pty Ltd.)

Published
2014
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18. The diagnostic value of the proposal for clinical gout diagnosis (CGD).

Author

Vázquez-Mellado J, Hernández-Cuevas CB, Alvarez-Hernández E, Ventura-Rios L, Peláez-Ballestas I, Casasola-Vargas J, García-Méndez S, and Burgos-Vargas R

Subjects
Adult, Aged, Arthritis, Rheumatoid diagnosis, Female, Humans, Male, Middle Aged, Osteoarthritis diagnosis, Sensitivity and Specificity, Spondylarthritis diagnosis, Gout diagnosis, Hyperuricemia diagnosis
Abstract

The purpose of this study is to determine the diagnostic properties of the clinical gout diagnosis (CGD) proposal in patients with gout and other rheumatic diseases. We investigated the presence of current or past history of the previously published CGD criteria: (1) >1 attack of acute arthritis, (2) mono/oligoarthritis attacks, (3) rapid progression of pain and swelling (<24 h), (4) podagra, (5) erythema, (6) unilateral tarsitis, (7) probable tophi, and (8) hyperuricemia. CGD was established in patients with greater than or equal to four out of eight of these criteria. Demographic data and comorbidities were also considered. Statistical analysis included diagnostic test evaluation (sensitivity, specificity, likelihood ratios, positive predictive values and receiving operating characteristic curves). One hundred and sixty-seven patients with the following diagnoses were included: gout (most in intercritical period, n = 75), rheumatoid arthritis (RA, n = 30), osteoarthritis (OA, n = 31) and spondyloarthritis (SpA, n = 31). All gout patients had MSU crystal demonstration and constituted the gold standard for diagnostic test evaluation. There were significant differences across diagnostic groups in most demographic variables and comorbidity. The presence of greater than or equal to four out of eight of the CGD criteria were found in 97% patients with gout, in two patients with SpA, and one each with RA and OA. The sensitivity, specificity, and LR+ of greater than or equal to four out of eight of the CGD criteria were 97.3%, 95.6%, and 22.14, respectively. The presence of more than or equal to four out of eight items from the CGD proposal is highly suggestive of gout.

Published
2012
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