Ultrasound definition of tendon damage in patients with rheumatoid arthritis. Results of a OMERACT consensus-based ultrasound score focussing on the diagnostic reliability.
OBJECTIVE
To develop the first ultrasound scoring system of tendon damage in rheumatoid arthritis (RA) and assess its intraobserver and interobserver reliability.


METHODS
We conducted a Delphi study on ultrasound-defined tendon damage and ultrasound scoring system of tendon damage in RA among 35 international rheumatologists with experience in musculoskeletal ultrasound. Twelve patients with RA were included and assessed twice by 12 rheumatologists-sonographers. Ultrasound examination for tendon damage in B mode of five wrist extensor compartments (extensor carpi radialis brevis and longus; extensor pollicis longus; extensor digitorum communis; extensor digiti minimi; extensor carpi ulnaris) and one ankle tendon (tibialis posterior) was performed blindly, independently and bilaterally in each patient. Intraobserver and interobserver reliability were calculated by κ coefficients.


RESULTS
A three-grade semiquantitative scoring system was agreed for scoring tendon damage in B mode. The mean intraobserver reliability for tendon damage scoring was excellent (κ value 0.91). The mean interobserver reliability assessment showed good κ values (κ value 0.75). The most reliable were the extensor digiti minimi, the extensor carpi ulnaris, and the tibialis posterior tendons. An ultrasound reference image atlas of tenosynovitis and tendon damage was also developed.


CONCLUSIONS
Ultrasound is a reproducible tool for evaluating tendon damage in RA. This study strongly supports a new reliable ultrasound scoring system for tendon damage.
Rheumatology Department, MC Groep Hospitals, Lelystad, The Netherlands.
George A W
GA
Bruyn
Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic.
Petra
P
Hanova
Department of Rheumatology, Sapienza Università di Roma, Rome, Italy.
Annamaria
A
Iagnocco
Department of Rheumatology, Université Paris Ouest-Versailles-Saint Quentin en Yvelines, Hôpital Ambroise Paré, APHP, Boulogne-Billancourt, France.
Maria-Antonietta
MA
d'Agostino
Department of Rheumatology, Instituto Poal, Barcelona, Spain.
Ingrid
I
Möller
Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark.
Lene
L
Terslev
Department of Rheumatology, Charite University Hospital, Berlin, Germany.
Marina
M
Backhaus
Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary.
Peter V
PV
Balint
Department of Rheumatology, Clinica Reumatologica, Universitá Politecnica delle Marche, Jesi, Ancona, Italy.
Emilio
E
Filippucci
Rheumatology Department, MC Groep Hospitals, Lelystad, The Netherlands.
Paul
P
Baudoin
Department of Rheumatology, VU Medisch Centrum, Amsterdam, The Netherlands.
Richard
R
van Vugt
Department of Rheumatology, National Institute of Rehabilitation, Mexico City, Mexico.
Carlos
C
Pineda
Academic Unit of Musculoskeletal Disease, University of Leeds, Leeds, UK.
Richard
R
Wakefield
Department of Social Psychology and Methodology, Faculty of Psychology, Autonoma University, Madrid, Spain.
Jesus
J
Garrido
Technology Centre ASCR, Prague, Czech Republic.
Ondrej
O
Pecha
Department of Rheumatology, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Esperanza
E
Naredo
D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000150:complications* / Q000000981:diagnostic imaging; D003697:Delphi Technique; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D015203:Reproducibility of Results; D012421:Rupture / Q000000981:diagnostic imaging / Q000209:etiology; D012720:Severity of Illness Index; D013708:Tendon Injuries / Q000000981:diagnostic imaging / Q000209:etiology; D013710:Tendons / Q000000981:diagnostic imaging; D013717:Tenosynovitis / Q000000981:diagnostic imaging* / Q000209:etiology*; D014463:Ultrasonography
Rheumatoid Arthritis; Tendinitis; Ultrasonography