Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
Department of Rheumatology, Università Politecnica delle Marche, Jesi, Ancona, Italy.
Rheumatology (Oxford). 2019 Oct 1;58(10):1802-1811. doi: 10.1093/rheumatology/kez153.
To develop and test the reliability of a new semiquantitative scoring system for the assessment of cartilage changes by ultrasound in a web-based exercise as well as a patient exercise of patients with RA.
A taskforce of the Outcome Measures in Rheumatology Ultrasound Working Group performed a systematic literature review on the US assessment of cartilage in RA, followed by a Delphi survey on cartilage changes and a new semiquantitative US scoring system, and finally a web-based exercise as well as a patient exercise. For the web-based exercise, taskforce members scored a dataset of anonymized static images of MCP joints in RA patients and healthy controls, which also contained duplicate images. Subsequently, 12 taskforce members used the same US to score cartilage in MCP and proximal interphalangeal joints of six patients with RA in in a patient reliability exercise. Percentage agreement and prevalence of lesions were calculated, as intrareader reliability was assessed by weighted kappa and interreader reliability by Light's kappa.
The three-grade semiquantitative scoring system demonstrated excellent intrareader reliability (kappa: 0.87 and 0.83) in the web-based exercise and the patient exercise, respectively. Interreader reliability was good in the web-based exercise (kappa: 0.64) and moderate (kappa: 0.48) in the patient exercise.
Our study demonstrates that ultrasound is a reliable tool for evaluating cartilage changes in the MCP joints of patients with RA and supports further development of a new reliable semiquantitative ultrasound scoring system for evaluating cartilage involvement in RA.
开发和测试一种新的半定量评分系统，用于基于网络的锻炼和 RA 患者锻炼中评估超声下软骨变化的可靠性。
风湿病超声工作组的一个专门小组对 RA 患者超声评估软骨的文献进行了系统评价，随后进行了关于软骨变化和新的半定量超声评分系统的德尔菲调查，最后进行了基于网络的锻炼和患者锻炼。在基于网络的锻炼中，专门小组的成员对 RA 患者和健康对照者的 MCP 关节的匿名静态图像数据集进行了评分，其中还包含重复图像。随后，12 名专门小组成员在患者可靠性锻炼中使用相同的超声对 6 名 RA 患者的 MCP 和近端指间关节的软骨进行了评分。计算了病变的百分比一致性和患病率，并通过加权 kappa 评估了内部读者的可靠性，通过 Light's kappa 评估了读者间的可靠性。
在基于网络的锻炼和患者锻炼中，三级半定量评分系统分别显示出极好的内部读者可靠性（kappa：0.87 和 0.83）。在基于网络的锻炼中，读者间的可靠性良好（kappa：0.64），在患者锻炼中为中度（kappa：0.48）。
我们的研究表明，超声是评估 RA 患者 MCP 关节软骨变化的可靠工具，并支持进一步开发一种新的可靠的半定量超声评分系统来评估 RA 中的软骨受累。
