title: Reproducibility of joint swelling assessments in long-lasting rheumatoid arthritis: influence on Disease Activity Score-28 values (SEA-Repro study part I).
abstract: OBJECTIVE
  To evaluate the reproducibility of clinical synovitis assessments in rheumatoid arthritis and the effect of variability on the Disease Activity Score-28 (DAS28).
  
  
  METHODS
  Seven healthcare professionals from different cities examined the same patients with active non-early rheumatoid arthritis (RA; duration > 4 yrs), for whom a treatment change was being considered. There was no training session and the examination was to be performed as quickly as possible. The healthcare professionals assessed the 28 joints of the DAS28 in 7 patients (196 joints), then reexamined the same 28 joints in 4 of these 7 patients (112 joints), who had been rendered unrecognizable. Then 7 sonographers examined each of the 7 patients twice, using B-mode and power Doppler ultrasound (PD). The reference standards were presence of synovitis according to at least 50% of clinical examiners and 50% of sonographers. Agreement was assessed by Cohen's kappa statistic.
  
  
  RESULTS
  Intraobserver reliability ranged from 0.31 (least experienced research technician) to 0.77 (most experienced physician). Interobserver reliability ranged from 0.18 to 0.62. The largest difference between the lowest and the highest swollen joint counts in the same patient was 15, and the greatest variation in the DAS28 score was 0.92. Agreement between clinical and sonographic reference standards was 0.46, 0.37, and 0.36 for B-mode, PD, and both, respectively.
  
  
  CONCLUSIONS
  Clinical inter- and intraobserver reliability is highly dependent on the examiner. Consequences on the DAS28 score can be substantial. Agreement with sonography is poor when both B-mode and PD are used but seems better, although low, when B-mode is used alone.
authors.affiliation: Rheumatology Unit, CHU, and University Hospital La Cavale Blanche, Brest, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Marhadour
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.forename: Gérard
authors.initials: G
authors.lastname: Chalès
authors.forename: Laurent
authors.initials: L
authors.lastname: Grange
authors.forename: Cécile
authors.initials: C
authors.lastname: Hacquard
authors.forename: Damien
authors.initials: D
authors.lastname: Loeuille
authors.forename: Jérémie
authors.initials: J
authors.lastname: Sellam
authors.forename: Jean-David
authors.initials: JD
authors.lastname: Albert
authors.forename: Jacques
authors.initials: J
authors.lastname: Bentin
authors.forename: Isabelle
authors.initials: I
authors.lastname: Chary Valckenaere
authors.forename: Maria-Antonietta
authors.initials: MA
authors.lastname: d'Agostino
authors.forename: Fabien
authors.initials: F
authors.lastname: Etchepare
authors.forename: Philippe
authors.initials: P
authors.lastname: Gaudin
authors.forename: Christophe
authors.initials: C
authors.lastname: Hudry
authors.forename: Maxime
authors.initials: M
authors.lastname: Dougados
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
mesh_terms: D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D005260:Female; D006801:Humans; D007596:Joints / Q000000981:diagnostic imaging* / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012015:Reference Standards; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013585:Synovitis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D014463:Ultrasonography