Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
Rheumatology Unit, Sapienza Università di Roma, Rome, Italy.
Ann Rheum Dis. 2016 Feb;75(2):402-7. doi: 10.1136/annrheumdis-2014-206289. Epub 2014 Dec 17.
Ultrasonography is sensitive for the evaluation of cartilage pathology and degree of osteophytes in patients with hand osteoarthritis (OA). High consistency of assessments is essential, and the OMERACT (Outcome Measures in Rheumatology) ultrasonography group took the initiative to explore the reliability of a global ultrasonography score in patients with hand OA using semiquantitative ultrasonography score of cartilage and osteophytes in finger joints.
Ten patients with hand OA were examined by 10 experienced sonographers over the course of two days. Semiquantitative scoring (0-3) was performed on osteophytes (carpo-metacarpal 1, metacarpo-phalangeal (MCP) 1-5, proximal interphalangeal 1-5 and distal interphalangeal 2-5 joints bilaterally with an ultrasonography atlas as reference) and cartilage pathology (MCP 2-5 bilaterally). A web-based exercise on static cartilage images was performed a month later. Reliability was assessed by use of weighted κ analyses.
Osteophyte scores were evenly distributed, and the intraobserver and interobserver reliabilities were substantial to excellent (κ range 0.68-0.89 and mean κ 0.65 (day 1) and 0.67 (day 2), respectively). Cartilage scores were unevenly distributed, and the intraobserver and interobserver reliability was fair to moderate (κ range 0.46-0.66 and mean κ 0.39 (day 1) and 0.33 (day 2), respectively). The web-based exercise showed acceptable agreement for cartilage being normal (κ 0.47) or with complete loss (κ 0.68), but poor for the intermediate scores (κ 0.22-0.30).
Use of the present semiquantitative ultrasonography scoring system for cartilage pathology in hand OA is not recommended (while normal or total loss of cartilage may be assessed). However, the OMERACT ultrasonography group will endorse the use of semiquantitative scoring of osteophytes with the ultrasonography atlas as reference.
超声检查对于评估手部骨关节炎（OA）患者的软骨病变和骨赘程度具有较高的敏感性。评估的高度一致性至关重要，OMERACT（风湿病结局测量）超声组主动探索了一种使用手指关节软骨和骨赘半定量超声评分的手部 OA 患者的整体超声评分的可靠性。
10 名手部 OA 患者在两天内由 10 名经验丰富的超声医师进行检查。采用超声图谱作为参考，对骨赘（腕掌关节 1 个，掌指关节 1-5 个，近指间关节 1-5 个和远侧指间关节 2-5 个双侧）和软骨病变（双侧掌指关节 2-5 个）进行半定量评分（0-3 分）。一个月后进行静态软骨图像的网络练习。使用加权κ分析评估可靠性。
骨赘评分分布均匀，观察者内和观察者间的可靠性为高至极好（κ范围 0.68-0.89，平均κ值分别为 0.65（第 1 天）和 0.67（第 2 天））。软骨评分分布不均匀，观察者内和观察者间的可靠性为中至高（κ范围 0.46-0.66，平均κ值分别为 0.39（第 1 天）和 0.33（第 2 天））。网络练习对于软骨正常（κ 0.47）或完全丧失（κ 0.68）的评估具有可接受的一致性，但对于中间评分（κ 0.22-0.30）则较差。
不建议使用目前的手部 OA 软骨病变半定量超声评分系统（虽然可以评估正常或完全丧失的软骨）。然而，OMERACT 超声组将支持使用超声图谱参考的骨赘半定量评分。
