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Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

  • Andrea Di Matteo
  • , Edoardo Cipolletta
  • , Giulia Maria Destro Castaniti
  • , Gianluca Smerilli
  • , Carla Airoldi
  • , Sibel Zehra Aydin
  • , Andrea Becciolini
  • , Karina Bonfiglioli
  • , Alessandra Bruns
  • , Greta Carrara
  • , Tomas Cazenave
  • , Alessandro Ciapetti
  • , Micaela Ana Cosatti
  • , Juan José de Agustín
  • , Marco Di Carlo
  • , Eleonora Di Donato
  • , Luca Di Geso
  • , Emine Duran
  • , Ashley Elliott
  • , Cristina Estrach
  • Bayram Farisogulları, Alessia Fiorenza, Daniela Fodor, Alessandra Gabba, Cristina Hernández-Díaz, Feng Huang, Jana Hurnakova, Ling Li, Diogo Jesus, Omer Karadag, Maria Victoria Martire, Marco Massarotti, Xabier Michelena, Alice Andreea Musca, Jagdish Nair, Tadashi Okano, Ioannis Papalopoulos, Marcos Rosemffet, João Rovisco, Davide Rozza, Fausto Salaffi, Iulia Satulu, Crescenzio Scioscia, Carlo Alberto Scirè, Fei Sun, Maria Magdalena Tamas, Shun Tanimura, Lucio Ventura-Rios, Paraksevi V. Voulgari, Florentin Ananu Vreju, Gentiana Vukatana, Ernest Wong, Jinshui Yang, Johana Zacariaz Hereter, Anna Zanetti, Walter Grassi, Emilio Filippucci
  • Marche Polytechnic University
  • University of Palermo
  • Hospital Provincial de Rosario
  • University of Ottawa
  • University of Parma
  • Universidade de São Paulo
  • Université de Sherbrooke
  • Italian Society of Rheumatology
  • Instituto de Rehabilitación Psicofísica
  • Betsi Cadwaladr University Health Board
  • Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno
  • Vall d’Hebron Hospital Universitari
  • Ospedale Madonna del Soccorso
  • Hacettepe University
  • Queen's University Belfast
  • University of Liverpool
  • ASL VC Sant’ Andrea Hospital
  • Iuliu Hatieganu University of Medicine and Pharmacy
  • ATS Sardegna
  • Instituto Nacional de Rehabilitación
  • General Hospital of People's Liberation Army
  • Charles University
  • Guangdong Academy of Medical Sciences
  • Centro Hospitalar de Leiria
  • University of Beira Interior
  • San Roque Hospital
  • University Hospitals Dorset NHS Foundation Trust
  • Dr. I. Cantacuzino Institute
  • Osaka Metropolitan University
  • Heraklion University Hospital
  • University of Coimbra
  • Kalmar County Hospital
  • Rheumatology Unit
  • National Hospital Organization Hokkaido Medical Center
  • University of Ioannina
  • Craiova University of Medicine and Pharmacy
  • St. Orsola Hospital-University of Bologna
  • Portsmouth Hospitals University NHS Trust
  • Hospital Italiano de Buenos Aires
  • University of Milan - Bicocca

Research output: Contribution to journalArticlepeer-review

30 Citations (Scopus)

Abstract

Objectives. To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA. Methods. In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs. Results. Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation. Conclusions. The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

Original languageEnglish
Pages (from-to)4863-4874
Number of pages12
JournalRheumatology
Volume61
Issue number12
DOIs
Publication statusPublished - 1 Dec 2022

Keywords

  • PsA
  • enthesitis
  • multicenter international study
  • power Doppler signal
  • reliability
  • seronegative spondyloarthritis
  • ultrasound

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