Department of Pediatric Rheumatology, National Reference Centre for Auto-Inflammatory Diseases and Amyloidosis of Inflammatory origin (CEREMAIA), Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Le Kremlin Bicêtre, France.
Service de Radiologie Pédiatrique, Hôpital Necker Enfants Malades, AP-HP, Paris, France.
Rheumatology (Oxford). 2021 Aug 2;60(8):3579-3587. doi: 10.1093/rheumatology/keaa804.
To evaluate the reliability of the OMERACT paediatric ultrasound (US) synovitis definitions and scoring system in JIA.
Thirteen sonographers analysed 75 images for the presence/absence of elementary lesions (binary scoring) and for grading synovitis, synovial hypertrophy, effusion and Doppler signals. Static US images of the second metacarpophalangeal joint (MCP-II), wrist, elbow, knee and ankle in JIA patients at different ages and different disease stages were collected with standardized scanning by two experienced sonographers. Intra- and inter-reader reliability were analysed with kappa coefficients.
Intra-reader reliability was good for binary scoring (Cohen's kappa 0.62, range 0.47-0.75), synovitis and synovial hypertrophy; excellent for Doppler signals (quadratic weighted kappa 0.77, 0.66-0.86; 0.76, 0.61-0.84; and 0.87, 0.77-0.94, respectively); and moderate for effusion (0.55, 0.24-0.76). Inter-reader reliability was good for synovitis and synovial hypertrophy (Light's kappa 0.68, 95% CI: 0.61, 0.75 and 0.63, 0.54-0.71, respectively), excellent for Doppler signals (0.85, 95% CI: 0.77, 0.90), and moderate for binary scoring and effusion (0.48, 95% CI: 0.36, 0.64 and 0.49, 0.40-0.60, respectively). We obtained the best scores for the knee (0.71, 0.54-0.85) except for Doppler signals, with reliability higher for MCP-II. We found a trend toward better results in older children.
This is the first study establishing the reliability of the OMERACT paediatric US synovitis definitions and scoring system in the five most commonly affected joints in JIA. The reliability was good among a large group of sonographers. These results support the applicability of these definitions and scoring system in clinical practice and multicentre studies.
评估 OMERACT 儿科超声（US）滑膜炎定义和评分系统在 JIA 中的可靠性。
13 名超声医师对 75 张图像进行了存在/不存在基本病变（二进制评分）以及滑膜炎、滑膜肥厚、积液和多普勒信号分级的分析。使用两位经验丰富的超声医师进行标准化扫描，收集 JIA 患者不同年龄和不同疾病阶段的第二掌指关节（MCP-II）、腕、肘、膝和踝关节的静态 US 图像。采用 Kappa 系数分析内部和外部读者的可靠性。
对于二进制评分（Cohen's kappa 0.62，范围 0.47-0.75）、滑膜炎和滑膜肥厚，内部读者的可靠性良好；对于多普勒信号，可靠性极好（二次加权 Kappa 0.77、0.66-0.86；0.76、0.61-0.84；0.87、0.77-0.94）；对于积液，可靠性中等（0.55、0.24-0.76）。对于滑膜炎和滑膜肥厚，外部读者的可靠性良好（Light's kappa 0.68、95%置信区间：0.61、0.75 和 0.63、0.54-0.71），对于多普勒信号，可靠性极好（0.85、95%置信区间：0.77、0.90），对于二进制评分和积液，可靠性中等（0.48、95%置信区间：0.36、0.64 和 0.49、0.40-0.60）。除了多普勒信号外，我们在膝关节（0.71、0.54-0.85）获得了最佳评分，其可靠性高于 MCP-II。我们发现年龄较大的儿童结果更好。
这是第一项在 JIA 中五个最常受影响的关节中建立 OMERACT 儿科 US 滑膜炎定义和评分系统可靠性的研究。在一大群超声医师中，可靠性良好。这些结果支持这些定义和评分系统在临床实践和多中心研究中的适用性。
