Skip to main content

Advertisement

Log in

Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis

  • Original Article
  • Published:
Rheumatology International Aims and scope Submit manuscript

Abstract

To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the “Escuela de Ecografía del Colegio Mexicano de Reumatología” tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7–13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Hau M, Kneitz C, Tony HP, Keberle M, Jahns R, Jenett M (2002) High resolution ultrasound detects a decrease in pannus vascularization of small finger joints in patients with rheumatoid arthritis receiving treatment with soluble tumour necrosis factor a receptor (etanercept). Ann Rheum Dis 61:55–58

    Article  PubMed  CAS  Google Scholar 

  2. Taylor PC, Steuer A, Gruber J, Cosgrove DO, Blomley MJK, Marsters PA et al (2004) Comparison of ultrasonographic assessment of synovitis and joint vascularity with radiographic evaluation in a randomized, placebo-controlled study of infliximab therapy in early rheumatoid arthritis. Arthritis Rheum 50:1107–1116

    Article  PubMed  CAS  Google Scholar 

  3. Ribbens C, Andre B, Marcelis S, Kaye O, Mathy L, Bonnet V et al (2003) Rheumatoid hand joint synovitis: gray-scale and power Doppler US quantifications following anti-tumor necrosis factor-alpha treatment: pilot study. Radiology 229:562–569

    Article  PubMed  Google Scholar 

  4. Naredo E, Bonilla G, Gamero F, Uson J, Carmona L, Laffon A (2005) Assessment of inflammatory activity in rheumatoid arthritis: a comparative study of clinical evaluation with grey scale and power Doppler ultrasonography. Ann Rheum Dis 64:375–381

    Article  PubMed  CAS  Google Scholar 

  5. Naredo E, Collado P, Cruz A, Palop MJ, Cabero F, Richi P, Carmona L, Crespo M (2007) Longitudinal power Doppler ultrasonographic assessment of joint inflammatory activity in early rheumatoid arthritis: predictive value in disease activity and radiologic progression. Arthritis Rheum 57:116–124

    Article  PubMed  Google Scholar 

  6. Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M (2003) Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 48:955–962

    Article  PubMed  Google Scholar 

  7. Van Riel PLCM, Schumacher HR (2001) How does one assess early rheumatoid arthritis in daily clinical practice? Best Pract Res Clin Rheumatol 151:67–76

    Google Scholar 

  8. Jousse-Joulin S, D′Agostino MA, Marhadour T, Albert JD, Bentin J, Chary Valckenaere I et al (2010) Reproducibility of joint swelling assessment by sonography in patients with long lasting rheumatoid arthritis (SEA-repro study part II). J Rheumatol 37(5):938–945

    Article  PubMed  Google Scholar 

  9. Wakefield RJ, Balint PV, Szkudlarek M, Filippucci E, Backhaus M, D’Agostino MA et al (2005) Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 32:2485–2487

    PubMed  Google Scholar 

  10. Bruyn GAW, Naredo E, Möller I, Moragues C, Garrido J, de Bock GH et al (2009) Reliability of ultrasonography in detecting shoulder disease in patients with rheumatoid arthritis. Ann Rheum Dis 68(3):357–361

    Article  PubMed  CAS  Google Scholar 

  11. Pineda C, Filippucci E, Chávez-López M, Hernández-Díaz C, Moya C, Ventura L et al (2008) Ultrasound in rheumatology. The Mexican experience. Clin Exp Rheumatol 26:929–932

    PubMed  CAS  Google Scholar 

  12. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American rheumatism association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31:315–324

    Article  PubMed  CAS  Google Scholar 

  13. Rubin JM, Adler RS, Fowlkes JB, Spratt S, Pallister JE, Chen JF et al (1995) Fractional moving blood volume: estimation with power Doppler US. Radiology 197:183–190

    PubMed  CAS  Google Scholar 

  14. Kane D, Grassi W, Sturrock R, Balint PV (2004) Musculoskeletal ultrasound—a state of the art review in rheumatology. Part 2: clinical indications for musculoskeletal ultrasound in rheumatology. Rheumatology (Oxford) 43:829–838

    Article  CAS  Google Scholar 

  15. Landis JR, Koch GG (1977) The measurement of observer agreement for categorical data. Biometrics 33:159–174

    Article  PubMed  CAS  Google Scholar 

  16. Scheel AK, Schmidt WA, Hermann KGA, Bruyn GA, D’Agostino MA, Grassi W et al (2005) Interobserver reliability of rheumatologists performing musculoskeletal ultrasonography: results from a EULAR “train the trainers” course. Ann Rheum Dis 64:1043–1049

    Article  PubMed  CAS  Google Scholar 

  17. Naredo E, Rodríguez M, Campos C, Rodriguez-Heredia JM, Medina J, Giner E et al (2008) Validity, reproducibility, and responsiveness of a twelve-joint simplified power Doppler ultrasonographic assessment of joint inflammation in rheumatoid arthritis. Arthritis Rheum (Arthritis Care & Research) 59:515–522

    Article  Google Scholar 

  18. Brown AK, Roberts TE, Wakefield RJ, Karim Z, Hensor E, O’Connor PJ et al (2007) The challenges of integrating ultrasonography into routine rheumatology practice: addressing the needs of clinical rheumatologists. Rheumatology (Oxford) 46:821–829

    Article  CAS  Google Scholar 

  19. Wakefield RJ, Gibbon WW, Conaghan PG, O’Connor P, McGonagle D, Pease C et al (2000) The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 43:2762–2770

    Article  PubMed  CAS  Google Scholar 

  20. Szkudlarek M, Narvestad E, Klarlund M, Court-Payen M, Thomsen HS, Østergaard M (2004) Ultrasonography of the metatarsophalangeal joints in rheumatoid arthritis. Comparison with magnetic resonance imaging, conventional radiography, and clinical examination. Arthritis Rheum 50:2103–2112

    Article  PubMed  Google Scholar 

  21. Terslev L, Torp-Pedersen S, Qvistgaard E, Kristoffersen H, Rogind H, Danneskiold-Samsoe B et al (2003) Effects of treatment with etanercept (Enbrel, TNRF:Fc) on rheumatoid arthritis evaluated by Doppler ultrasonography. Ann Rheum Dis 62:178–181

    Article  PubMed  CAS  Google Scholar 

  22. Ostergaard M, Wiell C (2004) Ultrasonography in rheumatoid arthritis: a very promising method still needing more validation. Curr Opin Rheumatol 16:223–230

    Article  PubMed  Google Scholar 

  23. Feinstein AR, Cicchetti DV (1990) High agreement but low kappa: I the problems of two paradoxes. J Clin Epidemiol 43:543–549

    Article  PubMed  CAS  Google Scholar 

Download references

Acknowledgment

The authors would like to thank the Mexican College of Rheumatology for an unrestricted research grant.

Author information

Authors and Affiliations

Authors

Corresponding author

Correspondence to Mario Alfredo Chávez-López.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Chávez-López, M.A., Hernández-Díaz, C., Moya, C. et al. Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis. Rheumatol Int 33, 173–177 (2013). https://doi.org/10.1007/s00296-011-2297-9

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00296-011-2297-9

Keywords

Navigation