类风湿关节炎患者跗骨下关节滑膜炎的超声表现：应用一致性定义的 OMERACT 可靠性研究结果。
Ultrasound of Subtalar Joint Synovitis in Patients with Rheumatoid Arthritis: Results of an OMERACT Reliability Exercise Using Consensual Definitions.
机构信息
From MC Groep Hospitals, Lelystad, the Netherlands; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Charles University, Prague, Czech Republic; Hôpital Ambroise Paré, Boulogne-Billancourt, France; Università degli Studi di Torino, Turin; Azienda Ospedaliero Universitaria Pisana, Pisa, Italy; Instituto Nacional de Rehabilitación, Mexico City, Mexico; Diakonhjemmet Hospital, Oslo, Norway; Virginia Mason Medical Center/University of Washington, Seattle, Washington, USA; Hôpital Brabois, Centre Hospitalier Universitaire (CHU) de Nancy, Nancy, France; Rehabilitation Clinical Hospital, Cluj Napoca, Romania; Instituto Poal de Reumatología, Barcelona, Spain; Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital, Sydney, Australia; Cliniques Universitaires Saint-Luc Institut de Recherche Expérimentale et Clinique (IREC), Brussels, Belgium; Japanese Red Cross Medical Center, Tokyo, Japan; Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark; Clinical Hospital Sf. Maria, Bucharest, Romania; Bergman Clinics, Naarden, the Netherlands.
G.A. Bruyn, MD, PhD, MC Groep Hospitals; H.J. Siddle, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; P. Hanova, MD, PhD, Charles University; F. Costantino, PhD, Hôpital Ambroise Paré; A. Iagnocco, MD, PhD, Università degli Studi di Torino; A. Delle Sedie, MD, Azienda Ospedaliero Universitaria Pisana; M. Gutierrez, MD, Instituto Nacional de Rehabilitación; H.B. Hammer, MD, PhD, Diakonhjemmet Hospital; E. Jernberg, MD, Virginia Mason Medical Center/University of Washington; D. Loeille, MD, PhD, Hôpital Brabois, CHU de Nancy; M.C. Micu, MD, Rehabilitation Clinical Hospital; I. Moller, MD, PhD, Instituto Poal de Reumatología; C. Pineda, MD, Instituto Nacional de Rehabilitación; B. Richards, MD, Institute of Rheumatology and Orthopaedics, Royal Prince Alfred Hospital; M.S. Stoenoiu, MD, PhD, Cliniques Universitaires Saint-Luc IREC; T. Suzuki, MD, Japanese Red Cross Medical Center; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup; V. Vlad, MD, Clinical Hospital Sf. Maria; R. Wonink, Bergman Clinics; M.A. d'Agostino, MD, PhD, Hôpital Ambroise Paré; R.J. Wakefield, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds. Drs. Bruyn and Siddle equally contributed to this work.
出版信息
J Rheumatol. 2019 Apr;46(4):351-359. doi: 10.3899/jrheum.171490. Epub 2018 Nov 1.
OBJECTIVE
To evaluate the intraobserver and interobserver reliability of the ultrasonographic (US) assessment of subtalar joint (STJ) synovitis in patients with rheumatoid arthritis (RA).
METHODS
Following a Delphi process, 12 sonographers conducted an US reliability exercise on 10 RA patients with hindfoot pain. The anteromedial, posteromedial, and posterolateral STJ was assessed using B-mode and power Doppler (PD) techniques according to an agreed US protocol and using a 4-grade semiquantitative grading score for synovitis [synovial hypertrophy (SH) and signal] and a dichotomous score for the presence of joint effusion (JE). Intraobserver and interobserver reliability were computed by Cohen's and Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.
RESULTS
Mean weighted Cohen's κ for SH, PD, and JE were 0.80 (95% CI 0.62-0.98), 0.61 (95% CI 0.48-0.73), and 0.52 (95% CI 0.36-0.67), respectively. Weighted Cohen's κ for SH, PD, and JE in the anteromedial, posteromedial, and posterolateral STJ were -0.04 to 0.79, 0.42-0.95, and 0.28-0.77; 0.31-1, -0.05 to 0.65, and -0.2 to 0.69; 0.66-1, 0.52-1, and 0.42-0.88, respectively. Weighted Light's κ for SH was 0.67 (95% CI 0.58-0.74), 0.46 (95% CI 0.35-0.59) for PD, and 0.16 (95% CI 0.08-0.27) for JE. Weighted Light's κ for SH, PD, and JE were 0.63 (95% CI 0.45-0.82), 0.33 (95% CI 0.19-0.42), and 0.09 (95% CI -0.01 to 0.19), for the anteromedial; 0.49 (95% CI 0.27-0.64), 0.35 (95% CI 0.27-0.4), and 0.04 (95% CI -0.06 to 0.1) for posteromedial; and 0.82 (95% CI 0.75-0.89), 0.66 (95% CI 0.56-0.8), and 0.18 (95% CI 0.04-0.34) for posterolateral STJ, respectively.
CONCLUSION
Using a multisite assessment, US appears to be a reliable tool for assessing synovitis of STJ in RA.
目的
评估类风湿关节炎（RA）患者跗骨关节（STJ）滑膜炎的超声（US）评估的观察者内和观察者间可靠性。
方法
在德尔菲（Delphi）过程之后，12 名超声医师对 10 名患有后足疼痛的 RA 患者进行了 US 可靠性检查。根据商定的 US 协议，使用 B 模式和功率多普勒（PD）技术对前内侧、后内侧和后外侧 STJ 进行评估，并使用滑膜炎的 4 级半定量分级评分[滑膜肥厚（SH）和信号]和关节积液（JE）存在的二分评分。观察者内和观察者间可靠性通过 Cohen's 和 Light's κ 计算。B 模式和 PD 信号的加权 κ 系数采用绝对加权。
结果
SH、PD 和 JE 的平均加权 Cohen's κ 分别为 0.80（95%CI 0.62-0.98）、0.61（95%CI 0.48-0.73）和 0.52（95%CI 0.36-0.67）。前内侧、后内侧和后外侧 STJ 的 SH、PD 和 JE 的加权 Cohen's κ 分别为-0.04 至 0.79、0.42-0.95 和 0.28-0.77；0.31-1、-0.05 至 0.65 和-0.2 至 0.69；0.66-1、0.52-1 和 0.42-0.88。SH 的加权 Light's κ 为 0.67（95%CI 0.58-0.74），PD 为 0.46（95%CI 0.35-0.59），JE 为 0.16（95%CI 0.08-0.27）。SH、PD 和 JE 的加权 Light's κ 分别为 0.63（95%CI 0.45-0.82）、0.33（95%CI 0.19-0.42）和 0.09（95%CI -0.01 至 0.19），用于前内侧；0.49（95%CI 0.27-0.64）、0.35（95%CI 0.27-0.4）和 0.04（95%CI -0.06 至 0.1），用于后内侧；和 0.82（95%CI 0.75-0.89）、0.66（95%CI 0.56-0.8）和 0.18（95%CI 0.04-0.34），用于后外侧 STJ。
结论
使用多站点评估，US 似乎是评估 RA 患者 STJ 滑膜炎的可靠工具。
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