Rheumatology and Clinical Immunology Subspecialty, Internal Medicine Department, Kasr Alainy School of Medicine, Cairo University, Cairo University Hospitals, Al-Saray St., El-Maniel, Cairo, 11562, Egypt.
Rheumatology and Clinical Immunology Subspecialty, Internal Medicine Department, Fayoum University, Fayoum, Egypt.
Clin Rheumatol. 2024 Dec;43(12):3913-3923. doi: 10.1007/s10067-024-07171-4. Epub 2024 Oct 18.
Ultrasound (US) can evaluate all joint components affected by knee osteoarthritis (KOA); however, standardized scoring of US-detected pathology is needed to improve its diagnostic and monitoring capabilities.
To examine the validity, reliability, and feasibility of the Outcome Measures in Rheumatology (OMERACT) ultrasound scoring for KOA, comparing with clinical and radiography measures, using predefined cutoff values.
This cross-sectional study included 75 Egyptian patients with primary KOA. All patients had Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score, bilateral knee radiography, and ultrasonography. Inter-observer reliability of ultrasound was evaluated in 30 knees by another newly trained operator.
Most of the OMERACT-US KOA scores showed significant associations with WOMAC clinical scores, except for femoral cartilage damage and effusion. The synovitis score was significantly associated with WOMAC-pain score (p-value 0.046), while medial meniscus extrusion (MME) and medial osteophytes were significantly associated with WOMAC-stiffness score (p-value 0.009 and 0.023, respectively). MME and synovitis were significantly associated with WOMAC-physical score (p-value 0.035 and 0.020, respectively). The ultrasound scores also showed a strong correlation with radiographic scoring. Inter-observer reliability ranged from moderate to excellent agreement (k = 0.58 to k = 0.83); it was highest for lateral osteophytes (k = 0.83), good agreement for synovitis (k = 0.72), any osteophytes (k = 0.71), damage of femoral cartilage (k = 0.70), and moderate agreement for medial osteophytes (k = 0.58) and MME (k = 0.59).
OMERACT-US scoring system for KOA demonstrated validity, reliability, and feasibility for evaluating both structural and inflammatory components. Using cutoff values improved the scoring reliability for osteophytes and MME. Key Points • OMERACT-US scores provide a valid assessment of inflammatory and structural components of knee osteoarthritis. • The following changes may improve the performance of the OMERACT-US scores. a. The binary score for effusion and synovial hypertrophy can be omitted, as they have no added value. b. A semi-quantitative grading for effusion may capture the impact of effusion on clinical outcomes. c. Added cutoff values to score medial meniscal extrusion, osteophytes, and pathological effusion improved the respective scores' reliability. d. Applying the updated OMERACT definition of synovitis. • OMERACT-US scores are reliable to be used with a newly trained operator, particularly when cutoff values are included, and proper training time is provided. • The OMERACT-US score is feasible to be used in clinical practice, as the time taken to perform was short, even for a newly trained operator.
超声（US）可评估受膝骨关节炎（KOA）影响的所有关节成分；然而，需要标准化的 US 检测病理学评分，以提高其诊断和监测能力。
使用预设的截断值，检查关节成像和代谢物测定在骨关节炎中的临床应用（OMERACT）超声评分对 KOA 的有效性、可靠性和可行性，并与临床和放射学测量进行比较。
本横断面研究纳入了 75 例埃及原发性 KOA 患者。所有患者均进行了西部安大略省和麦克马斯特大学骨关节炎指数（WOMAC）评分、双侧膝关节放射摄影和超声检查。另一位新培训的操作员评估了 30 个膝关节的超声检查者间可靠性。
除股骨软骨损伤和关节积液外，大多数 OMERACT-US KOA 评分与 WOMAC 临床评分均具有显著相关性。滑膜炎评分与 WOMAC 疼痛评分显著相关（p 值 0.046），而内侧半月板突出（MME）和内侧骨赘与 WOMAC 僵硬评分显著相关（p 值分别为 0.009 和 0.023）。MME 和滑膜炎与 WOMAC 躯体评分显著相关（p 值分别为 0.035 和 0.020）。超声评分也与放射学评分有很强的相关性。检查者间的可靠性范围为中度至极好的一致性（k 值为 0.58 至 0.83）；外侧骨赘的一致性最高（k 值为 0.83），滑膜炎（k 值为 0.72）、任何骨赘（k 值为 0.71）、股骨软骨损伤（k 值为 0.70）的一致性良好，内侧骨赘（k 值为 0.58）和 MME（k 值为 0.59）的一致性为中度。
KOA 的 OMERACT-US 评分系统可有效评估结构和炎症成分。使用截断值可提高骨赘和 MME 的评分可靠性。
关键点
• OMERACT-US 评分可有效评估膝骨关节炎的炎症和结构成分。
• 以下变化可能会提高 OMERACT-US 评分的性能：
可以省略积液和滑膜肥厚的二分评分，因为它们没有额外的价值。
积液的半定量分级可能会捕捉积液对临床结果的影响。
添加 MME、内侧骨赘和病理性积液的评分截断值可提高相应评分的可靠性。
应用 OMERACT 滑膜炎的更新定义。
• 经过适当的培训时间和使用包含截断值的评分，新培训的操作员可以可靠地使用 OMERACT-US 评分，尤其是当使用截断值时。
• 即使对于新培训的操作员，OMERACT-US 评分也可在临床实践中快速且可靠地执行。
