Inter-observer reliability of high-resolution ultrasonography in the assessment of bone erosions in patients with rheumatoid arthritis: experience of an intensive dedicated training programme.
OBJECTIVE
The present study was aimed at testing the ability of a rheumatologist without experience in ultrasound (US) who attended an intensive 4-week training programme focused on US assessing bone erosions in the hands and feet in patients with RA.


METHODS
Twenty patients diagnosed with RA according to the ACR criteria were included in the study. All US examinations were performed bilaterally by two investigators (with different experience in the field of musculoskeletal US) at the following sites: the dorsal, lateral and volar aspect of the second metacarpal, ulnar and fifth metatarsal head; and the dorsal and volar aspect of the third metacarpal and second proximal heads. Each quadrant was scanning in longitudinal and transverse scans for assessing the qualitative, semiquantitative and quantitative US findings indicative of bone erosions according the OMERACT preliminary definition.


RESULTS
Both κ-values and overall agreement percentages of qualitative and semiquantitative assessments showed moderate to excellent agreement between the two investigators. Similar results were obtained for the quantitative assessment with the concordance correlation coefficient value always significant. The only exception was the volar aspects, in particular those of the fifth metatarsal head.


CONCLUSIONS
Our study suggests that after a 4-week dedicated training programme, a rheumatologist without experience in US is able to detect and score bone erosions in the hands and feet of patients with RA.
Clinica Reumatologica, Università Politecnica delle Marche, 60035 Jesi, Ancona, Italy. dr.gmarwin@gmail.com
Marwin
M
Gutierrez
Emilio
E
Filippucci
Santiago
S
Ruta
Fausto
F
Salaffi
Patrizia
P
Blasetti
Luca
L
Di Geso
Walter
W
Grassi
D000368:Aged; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000000981:diagnostic imaging*; D018488:Bone Demineralization, Pathologic / Q000175:diagnosis / Q000000981:diagnostic imaging*; D004502:Education, Medical, Continuing / Q000379:methods*; D005260:Female; D005528:Foot / Q000000981:diagnostic imaging*; D006225:Hand / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012219:Rheumatology / Q000193:education*; D012720:Severity of Illness Index; D014463:Ultrasonography / Q000379:methods / Q000592:standards