Medicine faculty, Paris-Descartes university, Cochin hospital, UPRES-EA 4058, AP-HP, Rheumatology B, Paris, France.
Joint Bone Spine. 2013 Mar;80(2):155-9. doi: 10.1016/j.jbspin.2012.07.014. Epub 2012 Sep 19.
Synovitis assessment through evaluation of swollen joints is integral in steering treatment decisions in rheumatoid arthritis (RA). However, there is high inter-observer variation. The objective was to assess if a short collegiate consensus would improve swollen joint agreement between rheumatologists and whether this was affected by experience.
Eighteen rheumatologists from French university rheumatology units participated in three 30 minutes rounds over a half day meeting evaluating joint counts of RA patients in small groups, followed by short consensus discussions. Agreement was evaluated at the end of each round as follows: (i) global agreement of swollen joints (ii) swollen joint agreement according to level of experience of the rheumatologist (iii) swollen joint count and (iv) agreement of disease activity state according to the Disease Activity Score (DAS28). Agreement was calculated using percentage agreement and kappa.
Global agreement of swollen joints failed to improve (kappa 0.50 to 0.52) at the joint level. Agreement between seniors did not improve but agreement between newly qualified rheumatologists and their senior peer, which was initially poor (kappa 0.28), improved significantly (to 0.54) at the end of the consensus exercises. Concordance of DAS28 activity states improved from 71% to 87%.
Consensus exercises for swollen joint assessment is worthwhile and may potentially improve agreement between clinicians in clinical synovitis and disease activity state, benefit was mostly observed in newly qualified rheumatologists.
通过评估肿胀关节来评估滑膜炎是类风湿关节炎（RA）治疗决策的重要组成部分。然而，观察者之间存在高度的变异性。本研究旨在评估短期同行共识是否能提高风湿病学家对肿胀关节的一致性，并评估经验是否对此有影响。
18 名来自法国大学风湿病科的风湿病学家参加了为期半天的会议，在会上，他们分小组评估了 RA 患者的关节计数，在三次 30 分钟的会议中进行了评估，随后进行了简短的共识讨论。在每轮结束时评估一致性如下：（i）肿胀关节的总体一致性；（ii）根据风湿病学家经验水平的肿胀关节一致性；（iii）肿胀关节计数；（iv）根据疾病活动评分（DAS28）确定的疾病活动状态的一致性。使用百分比一致性和 Kappa 来计算一致性。
在关节水平上，肿胀关节的总体一致性没有提高（Kappa 值为 0.50 至 0.52）。资深医生的一致性没有提高，但新获得资格的风湿病医生与他们的资深同事的一致性最初很差（Kappa 值为 0.28），在共识练习结束时显著提高（达到 0.54）。DAS28 活动状态的一致性从 71%提高到 87%。
肿胀关节评估的共识练习是值得的，可能会潜在地改善临床滑膜炎和疾病活动状态的临床医生之间的一致性，新获得资格的风湿病医生受益最大。
