title: Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis.
abstract: OBJECTIVE
  To produce consensus-based scoring systems for ultrasound (US) tenosynovitis and to assess the intraobserver and interobserver reliability of these scoring systems in rheumatoid arthritis (RA).
  
  
  METHODS
  We undertook a Delphi process on US-defined tenosynovitis and US scoring system of tenosynovitis in RA among 35 rheumatologists, experts in musculoskeletal US (MSUS), from 16 countries. Then, we assessed the intraobserver and interobserver reliability of US in scoring tenosynovitis on B-mode and with a power Doppler (PD) technique. Ten patients with RA with symptoms in the hands or feet were recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal.
  
  
  RESULTS
  Four-grade semiquantitative scoring systems were agreed upon for scoring tenosynovitis in B-mode and for scoring pathological peritendinous Doppler signal within the synovial sheath. The intraobserver reliability for tenosynovitis scoring on B-mode and PD mode was good (κ value 0.72 for B-mode; κ value 0.78 for PD mode). Interobserver reliability assessment showed good κ values for PD tenosynovitis scoring (first round, 0.64; second round, 0.65) and moderate κ values for B-mode tenosynovitis scoring (first round, 0.47; second round, 0.45).
  
  
  CONCLUSIONS
  US appears to be a reproducible tool for evaluating and monitoring tenosynovitis in RA.
authors.affiliation: Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Complutense University, and Hospital Universitario Severo Ochoa, Madrid, Spain. enaredo@ser.es
authors.forename: Esperanza
authors.initials: E
authors.lastname: Naredo
authors.forename: Maria Antonietta
authors.initials: MA
authors.lastname: D'Agostino
authors.forename: Richard J
authors.initials: RJ
authors.lastname: Wakefield
authors.forename: Ingrid
authors.initials: I
authors.lastname: Möller
authors.forename: Peter V
authors.initials: PV
authors.lastname: Balint
authors.forename: Emilio
authors.initials: E
authors.lastname: Filippucci
authors.forename: Annamaria
authors.initials: A
authors.lastname: Iagnocco
authors.forename: Zunaid
authors.initials: Z
authors.lastname: Karim
authors.forename: Lene
authors.initials: L
authors.lastname: Terslev
authors.forename: David A
authors.initials: DA
authors.lastname: Bong
authors.forename: Jesús
authors.initials: J
authors.lastname: Garrido
authors.forename: David
authors.initials: D
authors.lastname: Martínez-Hernández
authors.forename: George A W
authors.initials: GA
authors.lastname: Bruyn
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications / Q000000981:diagnostic imaging* / Q000473:pathology; D003697:Delphi Technique; D005260:Female; D006801:Humans; D007391:International Cooperation; D007596:Joints / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D011795:Surveys and Questionnaires; D013717:Tenosynovitis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000473:pathology; D014463:Ultrasonography