1
|
Naredo E, D'Agostino MA, Terslev L, Pineda C, Miguel MI, Blasi J, Bruyn GA, Kortekaas MC, Mandl P, Nestorova R, Szkudlarek M, Todorov P, Vlad V, Wong P, Bakewell C, Filippucci E, Zabotti A, Micu M, Vreju F, Mortada M, Mendonça JA, Guillen-Astete CA, Olivas-Vergara O, Iagnocco A, Hanova P, Tinazzi I, Balint PV, Aydin SZ, Kane D, Keen H, Kaeley GS, Möller I. Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis. Ann Rheum Dis 2024:ard-2023-225278. [PMID: 38531611 DOI: 10.1136/ard-2023-225278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 03/08/2024] [Indexed: 03/28/2024]
Abstract
OBJECTIVES The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. METHODS The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. RESULTS 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). CONCLUSIONS We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
Collapse
Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain
- Autonomous University of Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - M Isabel Miguel
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - Joan Blasi
- Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
| | - George A Bruyn
- Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands
- Reumakliniek Flevoland, Lelystad, Netherlands
| | - Marion C Kortekaas
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands
| | - Peter Mandl
- Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria
| | | | - Marcin Szkudlarek
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
- Department of Rheumatology, Zealand's University Hospital, Køge, Denmark
| | - Plamen Todorov
- Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Violeta Vlad
- Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania
| | - Priscilla Wong
- Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy
| | - Alen Zabotti
- Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania
| | - Florentin Vreju
- Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania
| | - Mohamed Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - José Alexandre Mendonça
- Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil
| | | | - Otto Olivas-Vergara
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Ilaria Tinazzi
- Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary
- Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary
| | - Sibel Zehra Aydin
- Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada
| | - David Kane
- Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland
| | - Helen Keen
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
| | - Gurjit S Kaeley
- University of Florida College of Medicine, Jacksonville, Florida, USA
| | - Ingrid Möller
- Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain
- Instituto Poal de Reumatología, Barcelona, Spain
| |
Collapse
|
2
|
Delle Sedie A, Terslev L, Bruyn GAW, Cazenave T, Chrysidis S, Diaz M, Di Carlo M, Frigato M, Gargani L, Gutierrez M, Hocevar A, Iagnocco A, Juche A, Keen H, Mandl P, Naredo E, Mortada M, Pineda C, Karalilova R, Porta F, Ravagnani V, Scirè C, Serban T, Smith K, Stoenoiu MS, Tardella M, Torralba K, Wakefield R, D'Agostino MA. Standardization of interstitial lung disease assessment by ultrasound: results from a Delphi process and web-reliability exercise by the OMERACT ultrasound working group. Semin Arthritis Rheum 2024; 65:152406. [PMID: 38401294 DOI: 10.1016/j.semarthrit.2024.152406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Revised: 01/25/2024] [Accepted: 01/29/2024] [Indexed: 02/26/2024]
Abstract
OBJECTIVES Over the last years ultrasound has shown to be an important tool for evaluating lung involvement, including interstitial lung disease (ILD) a potentially severe systemic involvement in many rheumatic and musculoskeletal diseases (RMD). Despite the potential sensitivity of the technique the actual use is hampered by the lack of consensual definitions of elementary lesions to be assessed and of the scanning protocol to apply. Within the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group we aimed at developing consensus-based definitions for ultrasound detected ILD findings in RMDs and assessing their reliability in dynamic images. METHODS Based on the results from a systematic literature review, several findings were identified for defining the presence of ILD by ultrasound (i.e., Am-lines, B-lines, pleural cysts and pleural line irregularity). Therefore, a Delphi survey was conducted among 23 experts in sonography to agree on which findings should be included and on their definitions. Subsequently, a web-reliability exercise was performed to test the reliability of the agreed definitions on video-clips, by using kappa statistics. RESULTS After three rounds of Delphi an agreement >75 % was obtained to include and define B-lines and pleural line irregularity as elementary lesions to assess. The reliability in the web-based exercise, consisting of 80 video-clips (30 for pleural line irregularity, 50 for B-lines), showed moderate inter-reader reliability for both B-lines (kappa = 0.51) and pleural line irregularity (kappa = 0.58), while intra-reader reliability was good for both B-lines (kappa = 0.72) and pleural line irregularity (kappa = 0.75). CONCLUSION Consensus-based ultrasound definitions for B-lines and pleural line irregularity were obtained, with moderate to good reliability to detect these lesions using video-clips. The next step will be testing the reliability in patients with ILD linked to RMDs and to propose a consensual and standardized protocol to scan such patients.
Collapse
Affiliation(s)
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet-Glostrup, Glostrup, Denmark
| | - George A W Bruyn
- Reumakliniek Lelystad, Lelystad, and Tergooi Hospital, Hilversum, the Netherlands
| | - Tomas Cazenave
- Instituto de Rehabiltacion Psicofisca, Buenos Aires, Argentina
| | - Stavros Chrysidis
- Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Esbjerg Hospital, Denmark
| | - Mario Diaz
- Fundacion Santa Fe de Bogotá, Bogotà, Colombia
| | - Marco Di Carlo
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | - Marilena Frigato
- S.C. Allergologia, Immunologia e Reumatologia, ASST "Carlo Poma" Mantova, Mantova, Italy
| | - Luna Gargani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, Pisa, Italy
| | | | | | - Annamaria Iagnocco
- Academic Rheumatology Centre, Dipartimento Scienze Cliniche e Biologiche - AO Mauriziano di Torino, Università di Torino, Turin, Italy
| | - Aaron Juche
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Helen Keen
- Department of Medicine and Pharmacology, University of Western Australia, Murdoch, Perth, WA, Australia
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Fundación Jiménez Díaz, Madrid, Spain
| | - Mohamed Mortada
- Department of Rheumatology Rehabilitation and Physical Medicine, Zagazig University, Zagazig, Egypt
| | - Carlos Pineda
- Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Rositsa Karalilova
- Medical University of Plovdiv, University Hospital "Kaspela", Plovdiv, Bulgaria
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Santa Maria Maddalena Hospital, Rovigo, Italy
| | | | - Carlo Scirè
- School of Medicine, University of Milano Bicocca, Milan, Italy
| | | | - Kate Smith
- NIHR Leeds Biomedical Research Centre and University of Leeds, UK
| | - Maria S Stoenoiu
- Rheumatology Department, Clinique Universitaires Saint Luc, Institut de Recherche Expérimentale et Clinique, Université Catholique de Louvain, Brussels, Belgium
| | - Marika Tardella
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Jesi, Italy
| | | | | | - Maria Antonietta D'Agostino
- Rheumatology division, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Università Cattolica del Sacro Cuore, Roma, Italy
| |
Collapse
|
3
|
Vega-Fernandez P, Rogers K, Sproles A, Thornton S, Huggins J, Lovell DJ, Cassedy A, Meyers AB, Ting TV. Diagnostic Accuracy Study of the Pediatric-Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2024; 76:251-258. [PMID: 37587869 PMCID: PMC10841426 DOI: 10.1002/acr.25218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA). METHODS Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode. In addition to MSUS, a subset of participants also received magnetic resonance imaging (MRI) of the knee, which was scored according to the combined Juvenile Arthritis MRI Scoring (JAMRIS) system. Spearman's correlations (rs ) were used to calculate associations between variables. Test characteristics of the PAUSS-knee were calculated with MRI as the reference standard. Inflammatory biomarkers were assessed in synovial fluid from involved knees. RESULTS Eighty children with JIA contributed 112 MSUSs and 25 MRIs of the knee. Of the knees, 41% (n = 46) had clinical evidence of arthritis. The B-mode PAUSS-knee score moderately correlated with clinically determined arthritis (rs = 0.54, P < 0.001) and strongly correlated with the JAMRIS score (rs = 0.75, P < 0.001). Compared with MRI, the area under the curve for the B-mode PAUSS-knee was 0.92. For a cutoff of >1, the B-mode PAUSS-knee had a sensitivity of 83% and specificity of 82%. Biomarker analysis indicates that interleukin-2R levels correlate with PAUSS score. CONCLUSION Our data indicate that the PAUSS-knee has excellent accuracy for the diagnosis of arthritis when compared with MRI. The PAUSS-knee has the potential to effectively inform JIA medical decision-making in real time.
Collapse
Affiliation(s)
- Patricia Vega-Fernandez
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly Rogers
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Alyssa Sproles
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sherry Thornton
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Huggins
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J. Lovell
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Cassedy
- Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, USA
| | - Arthur B Meyers
- Department of Radiology, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Division of Radiology, Cincinnati, OH, USA
| | - Tracy V Ting
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
4
|
Collado P, Naredo E, D'Agostino MA. Reply. Arthritis Care Res (Hoboken) 2023; 75:2545. [PMID: 37458137 DOI: 10.1002/acr.25198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 07/10/2023] [Indexed: 07/18/2023]
Affiliation(s)
- Paz Collado
- Hospital Universitario Severo Ochoa and Universidad Internacional Alfonso X El Sabio, Madrid, Spain
| | - Esperanza Naredo
- Hospital General Universitario Gregorio Marañón and Universidad Autónoma de Madrid, Madrid, Spain
| | - Maria Antonietta D'Agostino
- Fondazione Policlinico Universitario Agostino Gemelli IRCCS and Università Cattolica del Sacro Cuore, Rome, Italy
| |
Collapse
|
5
|
Sirotti S, Terslev L, Filippucci E, Iagnocco A, Moller I, Naredo E, Vreju FA, Adinolfi A, Becce F, Hammer HB, Cazenave T, Cipolletta E, Christiansen SN, Delle Sedie A, Diaz M, Figus F, Mandl P, MacCarter D, Mortada MA, Mouterde G, Porta F, Reginato AM, Schmidt WA, Serban T, Wakefield RJ, Zufferey P, Sarzi-Puttini P, Zanetti A, Damiani A, Pineda C, Keen HI, D'Agostino MA, Filippou G. Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level. THE LANCET. RHEUMATOLOGY 2023; 5:e474-e482. [PMID: 38251579 DOI: 10.1016/s2665-9913(23)00136-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 01/23/2024]
Abstract
BACKGROUND The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. METHODS In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. FINDINGS The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image-ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79-1·00] and κ 0·84 [0·79-0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). INTERPRETATION This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. FUNDING The Italian Ministry of Health - Ricerca Corrente.
Collapse
Affiliation(s)
- Silvia Sirotti
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | - Annamaria Iagnocco
- Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy
| | - Ingrid Moller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain; IIS-FJD, Universidad Autónoma of Madrid, Madrid, Spain
| | - Florentin A Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Antonella Adinolfi
- Rheumatology Division, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Fabio Becce
- Department of Diagnostic and Interventional Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases, Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tomas Cazenave
- Rheumatology Unit, Instituto de Rehabilitación Psicofísica, Buenos Aires, Argentina
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Ancona, Italy
| | | | - Andrea Delle Sedie
- Rheumatology Unit, Azienda Ospedaliero-Universitaria Pisana, Pisa, Italy
| | - Mario Diaz
- Rheumatology Unit, University Hospital Fundación Santa Fe de Bogota, Bogota, Colombia
| | - Fabiana Figus
- Rheumatology Service, ASL Torino 3, Collegno Pinerolo, Turin, Italy
| | - Peter Mandl
- Division of Rheumatology, Department of Internal Medicine III, Medical University Vienna, Vienna, Austria
| | - Daryl MacCarter
- Department of Rheumatology, North Valley Hospital, Whitefish, MT, USA
| | - Mohamed A Mortada
- Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Gael Mouterde
- Rheumatology Department & IDESP, CHU Montpellier, Montpellier University, Montpellier, France
| | - Francesco Porta
- Interdisciplinary Pain Medicine Unit, Rheumatology Section, Santa Maria Maddalena Hospital, Occhiobello, Italy
| | - Anthony M Reginato
- Division of Rheumatology, The Warren Alpert Medical School of Brown University, Providence, RI, USA
| | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Teodora Serban
- Rheumatology Department, Ospedale La Colletta, ASL3 Genovese, Genoa, Italy
| | - Richard J Wakefield
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK; Leeds Biomedical Research Centre, Leeds Teaching Hospitals Trust, Chapel Allerton Hospital, Leeds, UK
| | - Pascal Zufferey
- Rheumatology Department, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
| | - Piercarlo Sarzi-Puttini
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy; Department of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milan, Italy
| | - Anna Zanetti
- Società Italiana di Reumatologia, Epidemiology Research Unit, Milan, Italy
| | - Arianna Damiani
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Helen I Keen
- School of Medicine, The University of Western Australia, Murdoch, Perth, WA, Australia
| | - Maria Antonietta D'Agostino
- Rheumatology Department, Università Cattolica del Sacro Cuore, Fondazione Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy
| | - Georgios Filippou
- IRCCS Ospedale Galeazzi - Sant'Ambrogio, Rheumatology Department, Milan, Italy.
| |
Collapse
|
6
|
Agache M, Popescu CC, Enache L, Dumitrescu BM, Codreanu C. Nail Ultrasound in Psoriasis and Psoriatic Arthritis-A Narrative Review. Diagnostics (Basel) 2023; 13:2236. [PMID: 37443629 PMCID: PMC10341279 DOI: 10.3390/diagnostics13132236] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 06/22/2023] [Accepted: 06/28/2023] [Indexed: 07/15/2023] Open
Abstract
Ultrasonography has advantages for assessing psoriatic arthritis (PsA) due to its ability to evaluate several targets, including joints, entheses, and tendons, but also skin and nails. Although ultrasound is widely used in PsA, nail ultrasound, despite its potential as a non-invasive method for the early detection of inflammation in the nail apparatus, has low applicability in medical practice, as probes with a higher frequency are needed compared with the frequency of probes usually used. In the present article, we have narratively evaluated the studies published in the last 5 years (19 February 2018-18 February 2023) on nail ultrasound value in the diagnosis and monitoring of PsA. The studies published during this period share common measurement parameters, such as the OMERACT definition of enthesis published in 2018. We included original articles published in PubMed and Web of Science using the following search terms in all possible combinations: psoriatic arthritis, psoriasis, ultrasound, and nail. Articles were declared relevant if they presented data on nail morphology, power Doppler evaluation and nearby structure evaluation, while focusing on digitorum extensor enthesitis. In most of the studies, common morphological parameters were generally increased in patients with psoriasis or PsA and were demonstrated to change with medication. The thickness of the extensor tendon was greater in patients with PsA and psoriasis versus controls and it was correlated with nail clinical changes, especially the presence of onycholysis. The presence of PD showed large variability in healthy individuals. The link between enthesitis and nail involvement is still a subject of controversy, taking into account the latest histological findings. The use of ultrasound in the evaluation of nail and DIP enthesitis remains a challenge and an area of research in the coming years.
Collapse
Affiliation(s)
- Mihaela Agache
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Claudiu C. Popescu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Luminița Enache
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Bianca M. Dumitrescu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| | - Cătălin Codreanu
- Department of Internal Medicine and Rheumatology, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania (C.C.)
- Clinical Center of Rheumatic Diseases, 030167 Bucharest, Romania
| |
Collapse
|
7
|
Vega-Fernandez P, De Ranieri D, Oberle E, Clark M, Bukulmez H, Lin C, Shenoi S, Thatayatikom A, Woolnough L, Benham H, Brunner E, Henrickson M, Pratt LR, Proulx-Gauthier JP, Janow G, Cassedy A, Ting TV, Roth J. Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle. Rheumatology (Oxford) 2023; 62:2239-2246. [PMID: 36308429 PMCID: PMC10234197 DOI: 10.1093/rheumatology/keac622] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 08/30/2022] [Indexed: 11/30/2023] Open
Abstract
OBJECTIVE The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle. METHODS As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). RESULTS Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97). CONCLUSION A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.
Collapse
Affiliation(s)
- Patricia Vega-Fernandez
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Deirdre De Ranieri
- Division of Rheumatology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital, Chicago, IL, USA
| | - Edward Oberle
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, OH, USA
| | - Matthew Clark
- Department of Pediatrics, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Hulya Bukulmez
- Division of Pediatric Rheumatology, Department of Pediatrics, Metro Health Medical System, Case Western Reserve University, Cleveland, OH, USA
| | - Clara Lin
- Department of Pediatrics, Children’s Hospital Colorado, Aurora, CO, USA
| | - Susan Shenoi
- Seattle Children’s Hospital and Research Center University of Washington, Seattle, WA, USA
| | - Akaluck Thatayatikom
- AdventHealth Medical Group Pediatric Rheumatology and Immunology, Orlando, FL, USA
| | | | - Heather Benham
- Department of Pediatrics, Scottish Rite for Children, Frisco, TX, USA
| | - Emily Brunner
- Department of Pediatrics, Geisinger Medical Center, Danville, PA, USA
| | - Michael Henrickson
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Laura R Pratt
- Department of Pediatrics, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Ginger Janow
- Joseph M. Sanzari Children’s Hospital, Hackensack, NJ, USA
| | - Amy Cassedy
- Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Tracy V Ting
- Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | | |
Collapse
|
8
|
Dejaco C, Ponte C, Monti S, Rozza D, Scirè CA, Terslev L, Bruyn GAW, Boumans D, Hartung W, Hočevar A, Milchert M, Døhn UM, Mukhtyar CB, Aschwanden M, Bosch P, Camellino D, Chrysidis S, Ciancio G, D'Agostino MA, Daikeler T, Dasgupta B, De Miguel E, Diamantopoulos AP, Duftner C, Agueda A, Fredberg U, Hanova P, Hansen IT, Hauge EM, Iagnocco A, Inanc N, Juche A, Karalilova R, Kawamoto T, Keller KK, Keen HI, Kermani TA, Kohler MJ, Koster M, Luqmani RA, Macchioni P, Mackie SL, Naredo E, Nielsen BD, Ogasawara M, Pineda C, Schäfer VS, Seitz L, Tomelleri A, Torralba KD, van der Geest KSM, Warrington KJ, Schmidt WA. The provisional OMERACT ultrasonography score for giant cell arteritis. Ann Rheum Dis 2023; 82:556-564. [PMID: 36600183 DOI: 10.1136/ard-2022-223367] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Accepted: 11/26/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To develop an Outcome Measures in Rheumatology (OMERACT) ultrasonography score for monitoring disease activity in giant cell arteritis (GCA) and evaluate its metric properties. METHODS The OMERACT Instrument Selection Algorithm was followed. Forty-nine members of the OMERACT ultrasonography large vessel vasculitis working group were invited to seven Delphi rounds. An online reliability exercise was conducted using images of bilateral common temporal arteries, parietal and frontal branches as well as axillary arteries from 16 patients with GCA and 7 controls. Sensitivity to change and convergent construct validity were tested using data from a prospective cohort of patients with new GCA in which ultrasound-based intima-media thickness (IMT) measurements were conducted at weeks 1, 3, 6, 12 and 24. RESULTS Agreement was obtained (92.7%) for the OMERACT GCA Ultrasonography Score (OGUS), calculated as follows: sum of IMT measured in every segment divided by the rounded cut-off values of IMTs in each segment. The resulting value is then divided by the number of segments available. Thirty-five members conducted the reliability exercise, the interrater intraclass correlation coefficient (ICC) for the OGUS was 0.72-0.84 and the median intrareader ICC was 0.91. The prospective cohort consisted of 52 patients. Sensitivity to change between baseline and each follow-up visit up to week 24 yielded standardised mean differences from -1.19 to -2.16, corresponding to large and very large magnitudes of change, respectively. OGUS correlated moderately with erythrocyte sedimentation rate, C reactive protein and Birmingham Vasculitis Activity Score (corrcoeff 0.37-0.48). CONCLUSION We developed a provisional OGUS for potential use in clinical trials.
Collapse
Affiliation(s)
- Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Steiermark, Austria
- Department of Rheumatology, Brunico Hospital, Brunico, Trentino-Alto Adige, Italy
| | - Cristina Ponte
- Department of Rheumatology, Centro Hospitalar Universitário Lisboa Norte, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
- Rheumatology Research Unit, Instituto de Medicina Molecular, Faculdade de Medicina, Universidade de Lisboa, Centro Académico de Medicina de Lisboa, Lisbon, Portugal
| | - Sara Monti
- Department of Internal Medicine and Therapeutics, Università di Pavia, Pavia, Italy
- Division of Rheumatology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | | | | | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- Clinical Medicine, Copenhagen University, Copenhagen, Denmark
| | | | - Dennis Boumans
- Rheumatology and Clinical Immunology, Hospital Group Twente, Almelo, The Netherlands
| | | | - Alojzija Hočevar
- Department of Rheumatology, Universitiy Medical Centre Ljubljana, Ljubljana, Slovenia
- Medical Faculty, University of Ljubljana, Ljubljana, Slovenia
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology, Pomeranian Medical University in Szczecin, Szczecin, Poland
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark
| | - Chetan B Mukhtyar
- Vasculitis Service, Rheumatology Department, Norfolk and Norwich University Hospital NHS Trust, Norwich, UK
| | | | - Philipp Bosch
- Department of Rheumatology, Medical University of Graz, Graz, Steiermark, Austria
| | - Dario Camellino
- Division of Rheumatology, Department of Medical Specialties, Azienda Sanitaria Locale 3 Genovese, Arenzano, Genoa, Italy
| | | | - Giovanni Ciancio
- Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | | | - Thomas Daikeler
- Clinic for Rheumatology, University Hospital Basel, Basel, Switzerland
| | - Bhaskar Dasgupta
- Mid and South Essex University Hospitals NHS Foundation Trust, Southend University Hospital, Westcliff-on-Sea, UK
| | | | - Andreas P Diamantopoulos
- Section of Rheumatology, Division of Internal Medicine, Akershus University Hospital, Lorenskog, Norway
| | - Christina Duftner
- Department of Internal Medicine, Clinical Division of Internal Medicine II, Medical University Innsbruck, Innsbruck, Austria
| | - Ana Agueda
- Centro Hospitalar do Baixo Vouga E.P.E, Aveiro, Portugal
| | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark
- Rheumatology, Odense University Hospital, Odense, Denmark
| | - Petra Hanova
- Rheumatology, Institute of Rheumatology, Prague, Czech Republic
- Rheumatology, Hána CB spol. s r.o, Ceske Budejovice, Czech Republic
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus Copenhagen Hospital, Aarhus, Denmark
| | - Ellen-Margrethe Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Annamaria Iagnocco
- Academic Rheumatology Center, Dipartimento Scienze Cliniche e Biologiche, Università degli Studi di Torino, Turin, Italy
| | - Nevsun Inanc
- Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Aaron Juche
- Department of Rheumatology, Immanuel Hospital, Berlin, Germany
| | | | - Toshio Kawamoto
- Immunology, Juntendo University School of Medicine, Tokyo, Japan
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Kresten Krarup Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | | | - Tanaz A Kermani
- Rheumatology, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, California, USA
| | - Minna J Kohler
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Matthew Koster
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Raashid Ahmed Luqmani
- Nuffield Department of Orthopaedicx, Rheumatology and Musculoskeletal Science (NDORMs), University of Oxford, Oxford, UK
| | | | | | - Esperanza Naredo
- Department of Rheumatology and Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, Madrid, Spain
| | - Berit Dalsgaard Nielsen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
- Department of Medicine, Regional Hospital Horsens, Horsens, Denmark
| | - Michihiro Ogasawara
- Department of Internal Medicine and Rheumatology, Juntendo University School of Medicine, Tokyo, Japan
| | - Carlos Pineda
- Division of Rheumatology, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | | | - Luca Seitz
- Rheumatology and Immunology, Inselspital University Hospital Bern, Bern, Switzerland
| | - Alessandro Tomelleri
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, San Raffaele Scientific Institute, Milan, Italy
| | - Karina D Torralba
- Division of Rheumatology, Department of Medicine, Loma Linda University School of Medicine, Loma Linda, California, USA
| | - Kornelis S M van der Geest
- Rheumatology and Clinical Immunology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Kenneth J Warrington
- Division of Rheumatology, Allergy and Immunology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Wolfgang A Schmidt
- Rheumatology, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| |
Collapse
|
9
|
Schmidt WA. Vascular ultrasound in rheumatology practice. Best Pract Res Clin Rheumatol 2023; 37:101847. [PMID: 37419758 DOI: 10.1016/j.berh.2023.101847] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 06/19/2023] [Indexed: 07/09/2023]
Abstract
Rheumatologists are increasingly using vascular ultrasound. Several guidelines now recommend ultrasound as the first diagnostic modality in giant cell arteritis (GCA). The German curriculum for rheumatology training has recently included ultrasound for the acute diagnosis of vasculitis. Recent studies have shown that ultrasound of temporal, axillary, subclavian, and vertebral arteries has sensitivities and specificities of >90%. Vascular ultrasound detects subclinical GCA in approximately 20% of patients with "pure" polymyalgia rheumatica. GCA fast-track clinics might regularly include these patients. A new score based on the intima-media thickness of the temporal and axillary arteries allows the monitoring of structural changes with treatment. The score decreases faster for the temporal arteries than it does for the axillary arteries. Measuring the diameter of the ascending aorta and the aortic arch might become a fast and cost-effective tool for the long-term monitoring of aortic aneurysms in extracranial GCA. Vascular ultrasound also has a role for Takayasu arteritis, thrombosis, Behçet's syndrome, and Raynaud's phenomenon.
Collapse
Affiliation(s)
- Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Lindenberger Weg 19, 13125 Berlin, Germany.
| |
Collapse
|
10
|
Vega-Fernandez P, Ting TV, Oberle EJ, McCracken C, Figueroa J, Altaye M, Cassedy A, Kaeley GS, Roth J. Musculoskeletal Ultrasound in Childhood Arthritis Limited Examination: A Comprehensive, Reliable, Time-Efficient Assessment of Synovitis. Arthritis Care Res (Hoboken) 2023; 75:401-409. [PMID: 34328679 PMCID: PMC8800943 DOI: 10.1002/acr.24759] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 07/10/2021] [Accepted: 07/27/2021] [Indexed: 02/01/2023]
Abstract
OBJECTIVE To develop and initially validate a comprehensive pediatric musculoskeletal ultrasound (MSUS) joint-specific scoring system, and to determine the minimum number of joints needed to identify active disease. METHODS A semiquantitative scoring system was developed by consensus and initially validated by interrater reliability using intraclass correlation coefficients (ICCs). Subsequently, newly diagnosed juvenile idiopathic arthritis patients with an active joint count of >4 had a 42-joint MSUS performed at baseline and 3 months using this protocol. A minimum set of joints needed to identify all patients with synovitis on MSUS was obtained through a data reduction process. Spearman's correlation (rs ) was calculated to determine the association between MSUS findings and clinical Juvenile Arthritis Disease Activity Score in 10 joints (cJADAS10). Standardized response means (SMRs) were used to assess change over time. RESULTS The final joint-specific scoring system revealed an excellent interrater reliability (ICC 0.81-0.96) for all joints. Thirty patients were enrolled. Scanning 5 joints bilaterally (wrists, second and third metacarpophalangeal joints, knees and ankles) captured 100% of children with B-mode synovitis and had moderate correlation with the cJADAS10 at baseline (rs = 0.45). Mean ultrasound scores at baseline and follow-up were 28.3 and 22.3, with an SRM of 0.69 (P = 0.002) for 42 joints, and 36 and 27.7, with an SRM of 0.76 (P = 0.003) for the reduced joints, respectively. CONCLUSION A limited MSUS examination called musculoskeletal ultrasound in childhood arthritis limited examination (MUSICAL) captures all patients with active synovitis, and our new joint-specific scoring system is highly reliable and sensitive to change.
Collapse
Affiliation(s)
- Patricia Vega-Fernandez
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Tracy V Ting
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Edward J. Oberle
- Nationwide Children’s Hospital and The Ohio State University, Pediatric Rheumatology, 700 Children's Drive, Columbus, Ohio, USA
| | | | - Janet Figueroa
- Emory University School of Medicine, Pediatrics, Atlanta, Georgia, USA
| | - Mekibib Altaye
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Amy Cassedy
- Cincinnati Children’s Hospital Medical Center, 3333 Burnet Ave, MLC 4010, Cincinnati, OH, 45229, USA
| | - Gurjit S Kaeley
- University of Florida, Jacksonville, Rheumatology, Jacksonville, Florida, USA
| | - Johannes Roth
- Hebrew SeniorLife, IFAR, 1200 Centre St, Boston, Massachusetts, USA
| | | |
Collapse
|
11
|
Mathiessen A, Hammer HB, Terslev L, Kortekaas MC, D'Agostino MA, Haugen IK, Bruyn GA, Filippou G, Filippucci E, Kloppenburg M, Mancarella L, Mandl P, Möller I, Mortada MA, Naredo E, Sedie AD, Sexton J, Wittoek R, Iagnocco A, Ellegaard K. Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study. Arthritis Care Res (Hoboken) 2022; 74:2005-2012. [PMID: 34137211 DOI: 10.1002/acr.24734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). METHODS The Outcome Measures in Rheumatology Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores. A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with 6 sonographers testing inflammatory and structural features in 12 hand OA patients. We used Cohen's kappa for intrareader and Light's kappa for interreader reliability for all features except PD, in which prevalence-adjusted bias-adjusted kappa (PABAK) was applied. Percentage agreement was also assessed. RESULTS The web-based reliability exercise demonstrated substantial intra- and interreader reliability for all inflammatory features (κ > 0.64). In the patient-based exercise, intra- and interreader reliability, respectively, varied: SH κ = 0.73 and 0.45; JE κ = 0.70 and 0.55; PD PABAK = 0.90 and 0.88; PIP joint cartilage κ = 0.56 and 0.45; and STT osteophytes κ = 0.62 and 0.36. Percentage close agreement was high for all features (>85%). CONCLUSION With ultrasound, substantial to excellent intrareader reliability was found for inflammatory features of hand OA. Interreader reliability was moderate, but overall high close agreement between readers suggests that better reliability is achievable after further training. Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less reliability and the latter is not endorsed.
Collapse
Affiliation(s)
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | | | | | - Peter Mandl
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Ruth Wittoek
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Karen Ellegaard
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
| | | |
Collapse
|
12
|
Magni-Manzoni S, Muratore V, Vojinović J, Pires Marafon D, D'Agostino MA, Naredo E. Procedures for the content, conduct and format of EULAR/PReS paediatric musculoskeletal ultrasound courses. RMD Open 2022; 8:rmdopen-2022-002455. [PMID: 35798512 PMCID: PMC9263933 DOI: 10.1136/rmdopen-2022-002455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 06/13/2022] [Indexed: 12/02/2022] Open
Abstract
Background Despite the worldwide increasing request of education on paediatric musculoskeletal ultrasound (PedMSUS), content, conduct and format of PedMSUS courses have never been internationally agreed. Objectives To produce educational procedures for the conduct, content and format of EULAR/PReS PedMSUS courses. Methods After a systemic literature review and expert opinion collection, a panel of items for the development of procedures on PedMSUS courses was identified. Agreement on the items was assessed through Delphi surveys among a taskforce of 24 members, which included 18 experts in PedMSUS (8 rheumatologists, 1 radiologist, 9 paediatric rheumatologists), 1 methodologist and rheumatologist expert in MSUS, 2 patient research partners, 1 health professional in rheumatology and 2 EMEUNET/EMERGE members, from 8 different European countries. Each item was assessed through a 5-point Likert scale (0, full disagreement; 5, full agreement); agreement was reached for >75% of answers rating 4–5. All items with agreement were included in the preliminary core set of educational procedures, which underwent external assessment by a broader Consensus group (Faculty and Tutors of previous EULAR PedMSUS courses and PReS Imaging Working Party members), through Delphi survey. Results Two Delphi surveys produced the preliminary core set of procedures for basic, intermediate, advanced and teach-the-teachers (TTT) PedMSUS courses. A Delphi survey within the Consensus group produced agreement on the proposed procedures. Conclusions Shared EULAR/PReS procedures for the conduct, content and format of basic, intermediate, advanced and TTT PedMSUS courses were identified on international basis.
Collapse
Affiliation(s)
| | | | - Jelena Vojinović
- Faculty of Medicine, University of Niš, Niš, Serbia.,Department of Pediatric Rheumatology and Immunology, Nis, Nis, Serbia, Clinical Centre Niš, Niš, Serbia
| | | | - Maria Antonietta D'Agostino
- Rheumatology Department, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.,INSERM, Paris, France
| | - Esperanza Naredo
- Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,Universidad Autónoma de Madrid, Madrid, Spain
| | | |
Collapse
|
13
|
Izzetti R, Fulvio G, Nisi M, Gennai S, Graziani F. Reliability of OMERACT Scoring System in Ultra-High Frequency Ultrasonography of Minor Salivary Glands: Inter-Rater Agreement Study. J Imaging 2022; 8:jimaging8040111. [PMID: 35448238 PMCID: PMC9026431 DOI: 10.3390/jimaging8040111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2022] [Revised: 04/03/2022] [Accepted: 04/12/2022] [Indexed: 12/10/2022] Open
Abstract
Minor salivary gland ultra-high frequency ultrasonography (UHFUS) has recently been introduced for the evaluation of patients with suspected primary Sjögren’s Syndrome (pSS). At present, ultrasonographic assessment of major salivary glands is performed using the Outcome Measures in Rheumatology (OMERACT) scoring system. Previous reports have explored the possibility of applying the OMERACT scoring system to minor salivary glands UHFUS, with promising results. The aim of this study was to test the inter-reader concordance in the assignment of the OMERACT score to minor salivary gland UHFUS. The study was conducted on 170 minor salivary glands UHFUS scans of patients with suspected pSS. Three independent readers performed UHFUS image evaluation. Intraclass correlation coefficient (ICC) was employed to assess inter-reader reliability. Bland and Altman analysis was employed to test the agreement with a gold standard examiner. ICC values > 0.9 were found for scores 0 and 1, while score 2 and score 3 presented ICCs of 0.873 and 0.785, respectively. The measurements performed by the three examiners were in agreement with the gold standard examiner. According to these results, UHFUS interpretation showed good inter-observer reliability, suggesting that OMERACT score can be effectively used for the evaluation of glandular alterations, even for minor salivary glands.
Collapse
Affiliation(s)
- Rossana Izzetti
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
- Correspondence:
| | - Giovanni Fulvio
- Department of Clinical and Experimental Medicine, University of Pisa, 56126 Pisa, Italy;
- Unit of Rheumatology, University Hospital of Pisa, 56126 Pisa, Italy
| | - Marco Nisi
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Stefano Gennai
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| | - Filippo Graziani
- Department of Surgical, Medical and Molecular Pathology and Critical Care Medicine, University of Pisa, 56126 Pisa, Italy; (M.N.); (S.G.); (F.G.)
- Unit of Dentistry and Oral Surgery, University Hospital of Pisa, 56126 Pisa, Italy
| |
Collapse
|
14
|
Hočevar A, Bruyn GA, Terslev L, De Agustin JJ, MacCarter D, Chrysidis S, Collado P, Dejaco C, Fana V, Filippou G, Finzel S, Gandjbakhch F, Hanova P, Hammenfors D, Hernandez-Diaz C, Iagnocco A, Mortada MA, Inanc N, Naredo E, Ohrndorf S, Perko N, Schmidt WA, Tamborrini G, Tomšič M, Chary-Valckenaere I, Zabotti A, Keen HI, Pineda C, D'Agostino MA, Jousse-Joulin S. Development of a new ultrasound scoring system to evaluate glandular inflammation in Sjögren's syndrome: an OMERACT reliability exercise. Rheumatology (Oxford) 2021; 61:3341-3350. [PMID: 34849616 DOI: 10.1093/rheumatology/keab876] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Revised: 11/16/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE The aim of this exercise from the OMERACT ultrasound subgroup on Sjögren's syndrome (pSS) was to develop and assess the reliability of a consensus-based semiquantitative colour Doppler (CD) ultrasound scoring system for pathologic salivary gland vascularization in patients with pSS. METHODS Using the Delphi method a CD semiquantitative scoring system for vascularization of bilateral parotid and submandibular glands was developed and tested in static images and on patients (9 pSS patients and 9 sonographers). Intra-reader and inter-reader reliability of grading the salivary glands were computed by weighted Cohen and Light's kappa (κ) analysis, respectively. RESULTS The consensus-based semiquantitative score was: Grade 0, no visible vascular signals; Grade 1, focal, dispersed vascular signals; Grade 2, diffuse vascular signals detected in < 50% of the gland; Grade 3, diffuse vascular signals in > 50% of the gland. In static images, the intra- and inter-reader reliability showed excellent κ values (95% confidence interval) = 0.90 (0.87-0.93) and 0.80 (0.74-0.84), respectively) for all four salivary glands together. In patients, the intra- and inter-reader reliability for all four salivary glands together was κ = 0.84 (0.73-0.92) and 0.70 (0.64-0.76), respectively. CONCLUSION The consensus-based CD ultrasound scoring for the evaluation of salivary gland vascularization in pSS showed a good inter-reader reliability and excellent intra-reader reliability in static images and in patients. The clinical application of the developed scoring system should be tested in clinical settings.
Collapse
Affiliation(s)
- Alojzija Hočevar
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | - George A Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, The Netherlands
| | - Lene Terslev
- Centre for Rheumatology and Spinal Diseases, Rigshospitalet, Copenhagen, Denmark
| | - Juan Jose De Agustin
- Department of Rheumatology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Daryl MacCarter
- Rheumatology Department, North Valley Hospital, Whitefish, MT, USA
| | - Stavros Chrysidis
- Department of Rheumatology, Hospital of Southwest Jutland, Esbjerg, Denmark
| | | | - Christian Dejaco
- Department of Rheumatology, Medical University Graz, Graz, Austria
| | - Viktoria Fana
- Department of Rheumatology, Hospital of Bruneck (ASAA-SABES)
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Frederique Gandjbakhch
- Sorbonne Université
- Rheumatology Department, Pitié Salpêtrière Hospital, APHP, Paris, France
| | - Petra Hanova
- Institute of Rheumatology, Prague, Czech Republic
| | - Daniel Hammenfors
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Cristina Hernandez-Diaz
- Musculoskeletal Ultrasound Laboratory, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | | | - Nevsun Inanc
- Division of Rheumatology, Marmara University, School of Medicine, Istanbul, Turkey
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité - Universitätsmedizin Berlin, Campus Mitte, Humboldt-Universität zu Berlin, Freie Universität Berlin, Berlin, Germany
| | - Nejc Perko
- Faculty of Electrical Engineering, University of Ljubljana, Ljubljana, Slovenia
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | | | - Matija Tomšič
- Department of Rheumatology, University Medical Centre, Ljubljana, Slovenia
| | | | - Alen Zabotti
- Department of Medical and Biological Sciences, Rheumatology Institute, University Hospital Santa Maria della Misericordia, Udine, Italy
| | - Helen I Keen
- Rheumatology Department, Royal Perth Hospital, Perth, WA, Australia
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitación Luis Guillermo Ibarra Ibarra, Mexico City, Mexico
| | - Maria-Antonietta D'Agostino
- Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli, Rome, Italy
- Paris Saclay University of Versailles Saint Quentin en Yvelines, UMRII73
| | | |
Collapse
|
15
|
D'Agostino MA, Beaton DE, Maxwell LJ, Cembalo SM, Hoens AM, Hofstetter C, Zabalan C, Bird P, Christensen R, de Wit M, Doria AS, Maksymowych WP, Oo WM, Østergaard M, Serban T, Sloan VS, Terslev L, van Rossum MA, Conaghan PG, Boers M. Improving domain definition and outcome instrument selection: Lessons learned for OMERACT from imaging. Semin Arthritis Rheum 2021; 51:1125-1133. [PMID: 34452758 DOI: 10.1016/j.semarthrit.2021.08.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 08/02/2021] [Accepted: 08/17/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVES Imaging is one of the most rapidly evolving fields in medicine. Unfortunately, many imaging technologies have been applied as measurement instruments without rigorous evaluation of the evidence supporting their truth, discriminatory capability and feasibility for that context of use. The Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Instrument Selection Algorithm (OFISA) is used to evaluate such evidence for use of an instrument in a research setting. The objectives of this work are to: [1] define and describe the key conceptual aspects that are essential for the evaluation of imaging as an outcome measurement instrument and [2] describe how these aspects can be assessed through OFISA. METHODS Experts in imaging and/or methodology met to formalize concepts and define key steps. These concepts were discussed with a team of patient research partners with interest in imaging to refine technical and methodological aspects into comprehensible information. A workshop was held at OMERACT2020 and feedback was incorporated into existing OMERACT process for domain and instrument selection. RESULTS Three key lessons were identified: (1) a clear definition of the domain we want to measure is a necessary prerequisite to the selection of a good instrument, (2) the sources of variability that can directly influence the instrument should be clearly identified, (3) incorporating these first two lessons into OFISA improves the quality of every instrument selection process. CONCLUSIONS The incorporation of these lessons in the updated OMERACT Filter (now 2.2) will improve the quality of the selection process for all types of outcome measurement instruments.
Collapse
Affiliation(s)
- Maria Antonietta D'Agostino
- Università Cattolica del Sacro Cuore; Rheumatology UOC, Fondazione Policlinico Universitario Agostino Gemelli, IRCSS, Rome, Italy; UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France.
| | - Dorcas E Beaton
- Institute for Work & Health and Institute for Health Policy Management and Evaluation, University of Toronto, Toronto
| | - Lara J Maxwell
- Faculty of Medicine, University of Ottawa, Ottawa, Canada
| | | | - Alison Maria Hoens
- OMERACT Patient Research Partner; University of British Columbia Faculty of Medicine Department of Physical Therapy, Canada; Patient Partner, Arthritis Research Canada
| | | | - Codruta Zabalan
- OMERACT Patient Research Partner; Romanian League against Rheumatism
| | - Paul Bird
- University of New South Wales, Sydney, Australia
| | - Robin Christensen
- Section for Biostatistics and Evidence-Based Research, the Parker Institute, Bispebjerg, Frederiksberg Hospital, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | | | - Andrea S Doria
- The Hospital for Sick Children, Medical Imaging Department, University of Toronto, Toronto, Canada
| | | | - Win Min Oo
- Rheumatology Department, Institute of Bone and Joint Disease, Kolling Institute, Sydney University, Sydney, Australia; Department of Physical Medicine and Rehabilitation, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Teodora Serban
- La Colletta Hospital, Rheumatology Department, ASL3 Genovese, Genoa, Italy
| | - Victor S Sloan
- Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ, USA; The Peace Corps, USA
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Marion A van Rossum
- Amsterdam Rheumatology and Immunology Center
- Reade and Emma Children's Hospital Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre, UK
| | - Maarten Boers
- Department of Epidemiology and Data Science, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands; Amsterdam Rheumatology and Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| |
Collapse
|
16
|
Finzel S, Jousse-Joulin S, Costantino F, Hánová P, Hocevar A, Iagnocco A, Keen H, Naredo E, Ohrndorf S, Schmidt WA, D'Agostino MA, Terslev L, Bruyn GA. Patient-based reliability of the Outcome Measures in Rheumatology (OMERACT) ultrasound scoring system for salivary gland assessment in patients with Sjögren's syndrome. Rheumatology (Oxford) 2021; 60:2169-2176. [PMID: 33085747 DOI: 10.1093/rheumatology/keaa471] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Revised: 07/06/2020] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND To assess the reliability of the consensually agreed US definitions of major salivary gland lesions and the US scoring system for salivary gland assessment in patients with SS. METHODS Nine experienced sonographers scanned and read the US images of both parotid glands (PGs) and submandibular glands (SMGs) in eight patients with primary and secondary SS in two rounds. A consensually agreed four-grade semi-quantitative scoring was applied in B-mode for morphological lesions: grade 0, normal; grade 1, mild inhomogeneity without anechoic or hypoechoic areas; grade 2, moderate inhomogeneity with focal anechoic or hypoechoic areas; grade 3, severe inhomogeneity with diffuse an- or hypoechoic areas occupying the entire gland or fibrous gland. The presence or absence of typical SS lesions, i.e. the Sjögren's signature, was scored binary. Intra- and interreader reliabilities were computed using weighted and unweighted Cohen's and Light's κ coefficients. RESULTS The mean prevalence of grades 0-3 in PG were 43, 17, 23 and 31% and 28, 14, 33 and 32% for the SMGs, respectively. The weighted κ for intrareader reliability ranged from 0.44 to 1 for grading and 0.64 to 1 for the Sjögren's signature of PG and 0.59 to 1 and -0.09 to 0.6 for SMGs, respectively. The interreader reliability κ for grading in PG was 0.62 (95% CI 0.47, 0.74) and for Sjögren's signature it was 0.36 (95% CI 0, 0.43); in SMG it was 0.62 (95% CI 0.47, 0.72) and 0.03 (95% CI 0, 0.07) respectively. CONCLUSIONS The consensually agreed novel US scoring system for major salivary gland lesions showed substantial intra- and interreader reliability in patients with SS. The reliability of the Sjögren's signature was moderate.
Collapse
Affiliation(s)
- Stephanie Finzel
- Department of Rheumatology and Clinical Immunology, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | | | - Félicie Costantino
- Department of Rheumatology, AP-HP Ambroise Paré Hospital, University of Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Petra Hánová
- Institute of Rheumatology, Prague, Czech Republic
| | - Alojzija Hocevar
- Rheumatology Department, University Medical Centre, Ljubljana, Slovenia
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - Helen Keen
- Rheumatology Department, Royal Perth Hospital, Perth, WA, Australia
| | - Esperanza Naredo
- Rheumatology Department, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, Universidad Autónoma, Madrid, Spain
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Wolfgang A Schmidt
- Medical Centre for Rheumatology Berlin-Buch, Immanuel Krankenhaus Berlin, Berlin, Germany
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, AP-HP Ambroise Paré Hospital, University of Versailles Saint Quentin en Yvelines, Boulogne-Billancourt, France
| | - Lene Terslev
- Centre for Rheumatology and Spinal Diseases, Rigshospitalet, Copenhagen, Denmark
| | - George A Bruyn
- Department of Rheumatology, MC Groep Hospitals, Lelystad, The Netherlands
| |
Collapse
|
17
|
Paramalingam S, Needham M, Raymond W, Mastaglia F, Lightowler D, Morin N, Counsel P, Keen HI. Muscle shear wave elastography, conventional B mode and power doppler ultrasonography in healthy adults and patients with autoimmune inflammatory myopathies: a pilot cross-sectional study. BMC Musculoskelet Disord 2021; 22:537. [PMID: 34118902 PMCID: PMC8199828 DOI: 10.1186/s12891-021-04424-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Accepted: 05/18/2021] [Indexed: 12/05/2022] Open
Abstract
Background Before the role of shear wave elastography (SWE) and B mode ultrasound (US) in the diagnosis of different forms of idiopathic inflammatory myopathies (IIM) can be investigated, normative data is required. This study aimed to describe and then compare normative SWE and B mode ultrasound metrics of muscles in healthy controls and patients with IIM. Methods Twenty nine healthy adult controls and 10 IIM patients (5 with inclusion body myositis and 5 with necrotising autoimmune myopathy) underwent a full clinical examination, laboratory investigations, SWE and US measurements of selected proximal and distal limb muscles. Shear wave speed (SWS) and multiple US domains [echogenicity, fascial thickness, muscle bulk and power Doppler (PD)] were measured in both groups. Results In healthy controls (n = 29; mean age 46.60 ± 16.10; 44.8 % female), age was inversely correlated with SWS at the deltoid (stretch) (Rs. -0.40, p = 0.030) and PD score at the deltoid (rest) (Rs. -0.40, P = 0.032). Those ≥ 50 years old had a lower SWS at the deltoid (stretch) compared to the < 50 year group (2.92 m/s vs. 2.40 m/s, P = 0.032). Age correlated with increased echogenicity in the flexor digitorum profundus (Rs. 0.38, P = 0.045). Females had a smaller muscle bulk in the deltoid (P = 0.022). Body mass index (BMI) was inversely associated with SWS in the deltoid (stretch) (Rs – 0.45, P = 0.026), and positively correlated with echogenicity in the deltoid (Rs. 0.69, P = 0.026). In patients ≥50 years of age, patients with IIM (mean age 61.00 ± 8.18; females 20.0 %) had a higher proportion of abnormal echogenicity scores at the flexor digitorum profundus (FDP) (40.00 % vs. 14.30 %, P = 0.022) and tibialis anterior (TA) (80.00 % vs. 28.60 %, P = 0.004). Fascial thickness was lower in the FDP (0.63mm vs. 0.50mm, p = 0.012) and TA (0.58mm vs. 0.45mm, P = 0.001). Conclusions Our findings suggest there is scope for US techniques to be useful for diagnostic screening of affected muscles in patients with IIM, especially in those with suspected inclusion body myositis or necrotising autoimmune myopathy. We provide normative data for future studies into SWE and US techniques in skeletal muscle. The differences between IIM patients and controls warrant further study in a broader IIM patient cohort. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-021-04424-0.
Collapse
Affiliation(s)
- Shereen Paramalingam
- University of Notre Dame Australia, Fremantle, Western Australia, Australia. .,Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Western Australia, 6150, Murdoch, Australia.
| | - Merrilee Needham
- University of Notre Dame Australia, Fremantle, Western Australia, Australia.,Institute of Immunology and Infectious Diseases, Murdoch University, Murdoch, Western Australia, Australia.,Department of Neurology, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.,Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Warren Raymond
- University of Western Australia, Crawley, Western Australia, Australia
| | - Frank Mastaglia
- Perron Institute for Neurological and Translational Science, Nedlands, Western Australia, Australia
| | - Daniel Lightowler
- University of Western Australia, Crawley, Western Australia, Australia
| | - Narelle Morin
- Sonowest Healthcare, Siemens Healthineers, Bayswater, Australia
| | - Peter Counsel
- Department of Radiology, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Helen Isobel Keen
- Department of Rheumatology, Fiona Stanley Hospital, 11 Robin Warren Dr, Western Australia, 6150, Murdoch, Australia.,University of Western Australia, Crawley, Western Australia, Australia
| |
Collapse
|
18
|
Schäfer VS, Chrysidis S, Schmidt WA, Duftner C, Iagnocco A, Bruyn GA, Carrara G, De Miguel E, Diamantopoulos AP, Nielsen BD, Fredberg U, Hartung W, Hanova P, Hansen IT, Hocevar A, Juche A, Kermani TA, Lorenzen T, Macchioni P, Milchert M, Døhn UM, Mukhtyar C, Monti S, Ponte C, Seitz L, Scirè CA, Terslev L, Dasgupta B, Keen HI, Pineda C, Dejaco C. OMERACT definition and reliability assessment of chronic ultrasound lesions of the axillary artery in giant cell arteritis. Semin Arthritis Rheum 2021; 51:951-956. [PMID: 34140184 DOI: 10.1016/j.semarthrit.2021.04.014] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/16/2021] [Accepted: 04/22/2021] [Indexed: 11/20/2022]
Abstract
OBJECTIVES To define chronic ultrasound lesions of the axillary artery (AA) in long-standing giant cell arteritis (GCA) and to evaluate the reliability of the new ultrasound definition in a web-based exercise. METHODS A structured Delphi, involving an expert panel of the Large Vessel Vasculitis subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group was carried out. The reliability of the new definition was tested in a 2-round web-based exercise involving 23 experts and using 50 still images each from AA of long-standing and acute GCA patients, as well as 50 images from healthy individuals. RESULTS The final OMERACT ultrasound definition of chronic changes was based on measurement and appearance of the intima-media complex. The overall reliability of the new definition for chronic ultrasound changes in longstanding GCA of the AA was good to excellent with Light's kappa values of 0.79-0.80 for inter-reader reliability and mean Light's-kappa of 0.88 for intra-reader reliability. The mean inter-rater and intra-rater agreements were 86-87% and 92%, respectively. Good reliabilities were observed comparing the vessels with longstanding versus acute GCA with a mean agreement and kappa values of 81% and 0.63, respectively. CONCLUSION The new OMERACT ultrasound definition for chronic vasculitis of the AA in GCA revealed a good to excellent inter- and intra-reader reliability in a web-based exercise of experts.
Collapse
Affiliation(s)
- Valentin Sebastian Schäfer
- Clinic for Internal Medicine III, Department of Oncology, Hematology, Rheumatology and Clinical Immunology, University Hospital Bonn, Germany.
| | | | - Wolfgang A Schmidt
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Christina Duftner
- Department of Internal Medicine VI, Medical University Innsbruck, Innsbruck, Austria
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, Università degli Studi di Torino, Turin, Italy
| | - George A Bruyn
- Department of Rheumatology, MC Hospital Group, Lelystad, The Netherlands
| | - Greta Carrara
- Epidemiology Research Unit, Italian Society for Rheumatology, Milano, Italy
| | | | | | | | - Ulrich Fredberg
- Diagnostic Centre, Silkeborg Regional Hospital, Silkeborg, Denmark; Department of Rheumatology, Odense University Hospital, Odense, Denmark
| | - Wolfgang Hartung
- Department of Rheumatology and Clinical Immunology, Asklepios Medical Center, 93077 Bad Abbach, Germany
| | - Petra Hanova
- Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic
| | - Ib Tønder Hansen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana; Slovenian Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | - Aaron Juche
- Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology Berlin-Buch, Berlin, Germany
| | - Tanaz A Kermani
- Division of Rheumatology, University of California, Los Angeles; David Geffen School of Medicine, California, USA
| | - Tove Lorenzen
- Department of Rheumatology, Silkeborg Hospital, Silkeborg, Denmark
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Specialistic Medicine, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Marcin Milchert
- Department of Rheumatology, Internal Medicine, Geriatrics and Clinical Immunology of Pomeranian Medical University in Szczecin, Poland
| | | | - Chetan Mukhtyar
- Department of Rheumatology, Norfolk and Norwich University Hospital, Norwich, UK
| | - Sara Monti
- Rheumatology, Fondazione IRCCS Policlinico San Matteo, University of Pavia, Pavia, Italy
| | - Cristina Ponte
- Hospital de Santa Maria, Centro Hospitalar Universitário de Lisboa Norte, Centro Académico de Medicina de Lisboa
| | - Luca Seitz
- Department of Rheumatology and Immunology, University of Bern, Inselspital, Switzerland
| | - Carlo A Scirè
- UOC e Sezione di Reumatologia - Dipartimento di Scienze Mediche, Università degli Studi di Ferrara, Ferrara, Italy; Società Italiana di Reumatologia, Unità Epidemiologica, Milan, Italy
| | - Lene Terslev
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet Glostrup, Glostrup, Denmark
| | - Bhaskar Dasgupta
- Rheumatology, Southend University Hospital NHS Foundation Trust, Essex, UK
| | | | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz; Austria and Department of Rheumatology, Hospital of Bruneck, Bruneck, Italy
| |
Collapse
|
19
|
Christiansen SN, Østergaard M, Slot O, Fana V, Terslev L. Ultrasound for the diagnosis of gout-the value of gout lesions as defined by the Outcome Measures in Rheumatology ultrasound group. Rheumatology (Oxford) 2021; 60:239-249. [PMID: 32696059 DOI: 10.1093/rheumatology/keaa366] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Revised: 05/25/2020] [Indexed: 12/12/2022] Open
Abstract
OBJECTIVE To evaluate ultrasound for diagnosing gout using consensus-based Outcome Measures in Rheumatology ultrasound definitions of gout lesions. METHODS Ultrasound was performed in patients with clinically suspected gout. Joints (28) and tendons (26) were binarily evaluated for the Outcome Measures in Rheumatology gout lesions-double contour (DC), tophus, aggregates and erosions. Ultrasound assessment was compared with two reference standards: (i) presence of MSU crystals in joint/tophus aspirate (primary outcome) and (ii) ACR/EULAR 2015 gout classification criteria (secondary outcome). Both reference standards were evaluated by rheumatologists blinded to ultrasound findings. Sensitivity, specificity, accuracy, positive predictive value and negative predictive value of each ultrasound lesion against both reference standards were determined. RESULTS Eighty-two patients (70 men), mean age 62.4 (range 19-88) years, were included. Fifty-seven patients were MSU-positive whereas 25 patients were MSU-negative (no MSU crystals: 23; aspiration unsuccessful: 2). Of these 25 patients, three patients were classified as ACR/EULAR-positive (i.e. totally 60 ACR/EULAR-positive patients). All ultrasound lesions had high sensitivities for gout (0.77-0.95). DC and tophus showed high specificities (0.88-0.95), positive predictive values (0.94-0.98) and accuracies (0.82-0.84) when both reference standards were used. In contrast, low specificities were found for aggregates and erosions (0.32-0.59). Ultrasound of MTP joints for DC or tophus, knee joint for DC and peroneus tendons for tophus was sufficient to identify all MSU-positive patients with ultrasound signs of gout at any location. CONCLUSION Ultrasound-visualized DC and tophus, as defined by the Outcome Measures in Rheumatology ultrasound group, show high specificities, positive predictive values and accuracies for diagnosing gout and are therefore valid tools in clinical practice.
Collapse
Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Ole Slot
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
| | - Viktoria Fana
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
20
|
Antony A, Holland R, D'Agostino MA, Maksymowych WP, Bertheussen H, Schick L, Goel N, Ogdie A, Orbai AM, Højgaard P, Coates LC, Strand V, Gladman DD, Christensen R, Leung YY, Mease P, Tillett W. Measurement properties of radiographic outcome measures in Psoriatic Arthritis: A systematic review from the GRAPPA-OMERACT initiative. Semin Arthritis Rheum 2021; 51:367-386. [PMID: 33601193 DOI: 10.1016/j.semarthrit.2021.01.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2020] [Revised: 11/27/2020] [Accepted: 01/05/2021] [Indexed: 11/17/2022]
Abstract
BACKGROUND Structural damage is as an important outcome in the Psoriatic Arthritis (PsA) Core Domain Set and its assessment is recommended at least once in the development of a new drug. OBJECTIVES To conduct a systematic review (SR) to identify studies addressing the measurement properties of radiographic outcome instruments for structural damage in PsA and appraise the evidence through the Outcome Measures in Rheumatology (OMERACT) Filter 2.1 Framework Instrument Selection Algorithm (OFISA). METHODS A SR was conducted using search strategies in EMBASE and MEDLINE to identify full-text English studies which aimed to develop or assess the measurement properties of radiographic outcome instruments in PsA. Determination of eligibility and data extraction was performed independently by two reviewers with input from a third to achieve consensus. Two reviewers assessed the methodology and results of eligible studies and synthesized the evidence using OMERACT methodology. RESULTS Twelve articles evaluating radiographic instruments were included. The articles assessed nine peripheral (hands, wrists and/or feet) and six axial (spinal and/or sacroiliac joints) radiographic instruments. The peripheral radiographic instruments with some evidence for reliability, cross-sectional construct validity and longitudinal construct validity were the Ratingen and modified Sharp van der Heijde scores. No instruments had evidence for clinical trial discrimination or thresholds of meaning. There was limited evidence for the measurement properties of all identified axial instruments. CONCLUSION There are significant knowledge gaps in the responsiveness of peripheral radiographic instruments. Axial radiographic instruments require further validation, and the need to generate novel instruments and utilise other imaging modalities should be considered.
Collapse
Affiliation(s)
- Anna Antony
- School of Clinical Sciences, Department of Rheumatology, Monash Medical Centre, Monash University, 246 Clayton Road, Clayton 3168 VIC, Australia.
| | - Richard Holland
- Department of Rheumatology, Concord Repatriation General Hospital, New South Wales, Australia
| | | | | | | | | | - Niti Goel
- Patient Research Partner, Duke University School of Medicine, United States
| | - Alexis Ogdie
- Division of Rheumatology, University of Pennsylvania, Pennsylvania, United States
| | - Ana-Maria Orbai
- Division of Rheumatology, Johns Hopkins University School of Medicine, United States
| | - P Højgaard
- Centre for Rheumatology and Spine Diseases, Rigshospitalet, Denmark
| | - Laura C Coates
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, and Oxford Biomedical Research Centre, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Vibeke Strand
- Division of Immunology/Rheumatology, Stanford University School of Medicine, Palo Alto CA, United States
| | - Dafna D Gladman
- Krembil Research Institute, University of Toronto, Toronto Western Hospital, Canada
| | - Robin Christensen
- Musculoskeletal Statistics Unit, the Parker Institute, Bispebjerg and Frederiksberg Hospital, Copenhagen & Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Philip Mease
- Rheumatology, Swedish Medical Center, Seattle, Washington, USA
| | - William Tillett
- Department of Pharmacy and Pharmacology, University of Bath, Bath, United Kingdom
| |
Collapse
|
21
|
Costantino F, Carmona L, Boers M, Backhaus M, Balint PV, Bruyn GA, Christensen R, Conaghan PG, Ferreira RJO, Garrido-Castro JL, Guillemin F, Hammer HB, van der Heijde D, Iagnocco A, Kortekaas MC, Landewé RB, Mandl P, Naredo E, Schmidt WA, Terslev L, Terwee CB, Thiele R, D'Agostino MA. EULAR recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). Ann Rheum Dis 2021; 80:840-847. [PMID: 33483318 DOI: 10.1136/annrheumdis-2020-219816] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Revised: 01/11/2021] [Accepted: 01/12/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To produce European League Against Rheumatism (EULAR) recommendations for the reporting of ultrasound studies in rheumatic and musculoskeletal diseases (RMDs). METHODS Based on the literature reviews and expert opinion (through Delphi surveys), a taskforce of 23 members (12 experts in ultrasound in RMDs, 9 in methodology and biostatistics together with a patient research partner and a health professional in rheumatology) developed a checklist of items to be reported in every RMD study using ultrasound. This checklist was further refined by involving a panel of 79 external experts (musculoskeletal imaging experts, methodologists, journal editors), who evaluated its comprehensibility, feasibility and comprehensiveness. Agreement on each proposed item was assessed with an 11-point Likert scale, grading from 0 (total disagreement) to 10 (full agreement). RESULTS Two face-to-face meetings, as well as two Delphi rounds of voting, resulted in a final checklist of 23 items, including a glossary of terminology. Twenty-one of these were considered 'mandatory' items to be reported in every study (such as blinding, development of scoring systems, definition of target pathologies) and 2 'optional' to be reported only if applicable, such as possible confounding factors (ie, ambient conditions) or experience of the sonographers. CONCLUSION An EULAR taskforce developed a checklist to ensure transparent and comprehensive reporting of aspects concerning research and procedures that need to be presented in studies using ultrasound in RMDs. This checklist, if widely adopted by authors and editors, will greatly improve the interpretability of study development and results, including the assessment of validity, generalisability and applicability.
Collapse
Affiliation(s)
- Félicie Costantino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France.,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France
| | - Loreto Carmona
- Instituto de Salud Musculoesquelética (INMUSC), Madrid, Madrid, Spain
| | - Maarten Boers
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Marina Backhaus
- Department of Internal Medicine-Rheumatology and Clinical Immunology, Park-Klinik Weissensee, Berlin, Berlin, Germany
| | - Peter V Balint
- 3rd Department of Rheumatology, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George A Bruyn
- Rheumatology Department, MC Group Hospitals, Lelystad, The Netherlands.,Rheumatology Department, Reumakliniek Flevoland, Lelystad, The Netherlands
| | - Robin Christensen
- Department of Clinical Research, Odense University Hospital, Odense, Denmark
| | | | - Ricardo J O Ferreira
- Rheumatology, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.,Health Sciences Research Unit: Nursing (UICiSA:E), Coimbra, Portugal
| | | | | | | | | | - Annamaria Iagnocco
- Scienze Cliniche e Biologiche, Università degli Studi di Torino, Torino, Italy
| | | | - Robert Bm Landewé
- Rheumatology Department, Amsterdam Rheumatology Center, AMC, Amsterdam, The Netherlands.,Rheumatology, Zuyderland MC, Heerlen, The Netherlands
| | - Peter Mandl
- Internal Medicine 3, Division of Rheumatology, Medical University Vienna, Vienna, Austria
| | - Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain.,IIS Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Wolfgang A Schmidt
- Rheumatology Department, Medical Centre for Rheumatology Berlin Buch, Berlin, Germany
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Kobenhavn, Denmark
| | - Caroline B Terwee
- Epidemiology and Biostatistics, Vrije Universiteit Amsterdam, Amsterdam, Noord-Holland, The Netherlands
| | - Ralf Thiele
- Department of Medicine, Division of Allergy, Immunology and Rheumatology, University of Rochester School of Medicine and Dentistry, Rochester, New York, USA
| | - Maria-Antonietta D'Agostino
- UVSQ, Inserm U1173, Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-le-Bretonneux, France .,Rheumatology Department, Ambroise Paré Hospital, AP-HP, Boulogne-Billancourt, Île-de-France, France.,Rheumatology Department, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Roma, Italy
| |
Collapse
|
22
|
Christiansen SN, Filippou G, Scirè CA, Balint PV, Bruyn GA, Dalbeth N, Dejaco C, Sedie AD, Filippucci E, Hammer HB, Iagnocco A, Keen HI, Kissin EY, Koski J, Mandl P, Martin J, Miguel ED, Möller I, Naredo E, Pineda C, Schmidt WA, Stewart S, Antonietta D'Agostino M, Terslev L. Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise. Semin Arthritis Rheum 2021; 51:644-649. [PMID: 33468347 DOI: 10.1016/j.semarthrit.2020.11.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Revised: 10/27/2020] [Accepted: 11/05/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study aimed to develop (1) a new ultrasound definition for aggregates and (2) a semi-quantitative ultrasound scoring system (0-3) for tophus, double contour and aggregates. Furthermore, the intra- and inter-reader reliabilities of both the re-defined aggregates and the semi-quantitative scoring system were assessed using static image exercises. METHODS Thirty-seven rheumatologists were invited. A Delphi process was used for re-defining aggregates and for selecting a semi-quantitative scoring system with >75% agreement obligate for reaching consensus. Subsequently, a web-based exercise on static ultrasound images was conducted in order to assess the reliability of both the re-defined aggregates and the semi-quantitative scoring system. RESULTS Twenty rheumatologists contributed to all rounds of the Delphi and image exercises. A consensual re-definition of aggregates was obtained after three Delphi rounds but needed an overarching principle for scoring aggregates in patients. A consensus-based semi-quantitative ultrasound scoring system for gout lesions was developed after two Delphi rounds. The re-definition of aggregates showed good intra- and inter-reader reliability (κ-values 0.71 and 0.61). The reliabilities of the scoring system were good for all lesions with slightly higher intra-reader (κ-values 0.74-0.80) than inter-reader reliabilities (κ-values 0.61-0.67). CONCLUSION A re-definition of aggregates was obtained with a good reliability when assessing static images. The first consensus-based semi-quantitative ultrasound scoring system for gout-specific lesions was developed with good inter- and intra-reader reliability for all lesions when tested in static images. The next step is to assess the reliabilities when scoring lesions in patients.
Collapse
Affiliation(s)
- Sara Nysom Christiansen
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy; Rheumatology Unit, Luigi Sacco University Hospital of Milan, Milan, Italy
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Italy
| | - Peter V Balint
- 3rd Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
| | - George Aw Bruyn
- Department of Rheumatology, MC Groep, Lelystad, the Netherlands
| | - Nicola Dalbeth
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Christian Dejaco
- Department of Rheumatology, Medical University of Graz, Graz, Austria and Hospital of Brunico (SABES-ASDAA), Department of Rheumatology, Brunico, Italy
| | | | - Emilio Filippucci
- Rheumatology Department, Clinica Reumatologica, Università Politecnica delle Marche, Jesi, Ancona, Italy
| | - Hilde B Hammer
- Rheumatology Department, Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Annamaria Iagnocco
- Academic Rheumatology Centre, DSCB Università degli Studi di Torino, Turin, Italy
| | - Helen I Keen
- School of Medicine and Pharmacology Fiona Stanley Hospital Unit, University of Western Australia, Perth, Australia
| | | | - Juhani Koski
- Department of Internal Medicine, Mikkeli Central Hospital, Mikkeli, Finland
| | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Julia Martin
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Eugenio De Miguel
- Department of Rheumatology, Hospital Universitario La Paz, Madrid, Spain
| | - Ingrid Möller
- Instituto Poal de Reumatologia, University of Barcelona, Barcelona, Spain
| | - Esperanza Naredo
- Department of Rheumatology, Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz and Universidad Autónoma de Madrid. Madrid, Spain
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico
| | - Wolfgang A Schmidt
- Rheumatology Department, Immanuel Krankenhaus Berlin, Medical Centre for Rheumatology, Berlin-Buch, Berlin, Germany
| | - Sarah Stewart
- Bone & Joint Research Group, Faculty of Medicine, University of Auckland, Auckland, New Zealand
| | - Maria Antonietta D'Agostino
- Department of Rheumatology, Ambroise Pare´ Hospital, and Versailles Saint-Quentin-en-Yvelines University, Boulogne-Billancourt, France
| | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | | |
Collapse
|
23
|
Zabotti A, Zandonella Callegher S, Tullio A, Vukicevic A, Hocevar A, Milic V, Cafaro G, Carotti M, Delli K, De Lucia O, Ernst D, Ferro F, Gattamelata A, Germanò G, Giovannini I, Hammenfors D, Jonsson MV, Jousse-Joulin S, Macchioni P, Parisi S, Perricone C, Stradner MH, Filipovic N, Tzioufas AG, Valent F, De Vita S. Salivary Gland Ultrasonography in Sjögren's Syndrome: A European Multicenter Reliability Exercise for the HarmonicSS Project. Front Med (Lausanne) 2020; 7:581248. [PMID: 33330537 PMCID: PMC7719819 DOI: 10.3389/fmed.2020.581248] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 10/21/2020] [Indexed: 12/26/2022] Open
Abstract
Objectives: Salivary gland ultrasonography (SGUS) is increasingly applied for the management of primary Sjögren's syndrome (pSS). This study aims to: (i) compare the reliability between two SGUS scores; (ii) test the reliability among sonographers with different levels of experience. Methods: In the reliability exercise, two four-grade semi-quantitative SGUS scoring systems, namely De Vita et al. and OMERACT, were tested. The sonographers involved in work-package 7 of the HarmonicSS project from nine countries in Europe were invited to participate. Different levels of sonographers were identified on the basis of their SGUS experience and of the knowledge of the tested scores. A dedicated atlas was used as support for SGUS scoring. Results: Twenty sonographers participated in the two rounds of the reliability exercise. The intra-rater reliability for both scores was almost perfect, with a Light's kappa of 0.86 for the De Vita et al. score and 0.87 for the OMERACT score. The inter-rater reliability for the De Vita et al. and the OMERACT score was substantial with Light's Kappa of 0.75 and 0.77, respectively. Furthermore, no significant difference was noticed among sonographers with different levels of experience. Conclusion: The two tested SGUS scores are reliable for the evaluation of major salivary glands in pSS, and even less-expert sonographers could be reliable if adequately instructed.
Collapse
Affiliation(s)
- Alen Zabotti
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Sara Zandonella Callegher
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Annarita Tullio
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Arso Vukicevic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Alojzija Hocevar
- Department of Rheumatology, University Medical Centre Ljubljana, Ljubljana, Slovenia
| | - Vera Milic
- Institute of Rheumatology, Belgrade, Serbia
| | - Giacomo Cafaro
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | - Marina Carotti
- Department of Radiology, Ospedali Riuniti, Università Politecnica delle Marche, Ancona, Italy
| | - Konstantina Delli
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Orazio De Lucia
- Unit of Clinical Rheumatology, Department of Rheumatology and Medical Sciences, Aziende Socio Sanitarie Territoriali (ASST) Centro Traumatologico Ortopedico G. Pini-Centri Traumatologici Ortopedici (CTO), Milan, Italy
| | - Diana Ernst
- Clinic for Immunology and Rheumatology, Hannover Medical School, Hannover, Germany
| | - Francesco Ferro
- Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy
| | - Angelica Gattamelata
- Department of Internal Medicine and Medical Specialties, Rheumatology, Sapienza University of Rome, Rome, Italy
| | - Giuseppe Germanò
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Ivan Giovannini
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| | - Daniel Hammenfors
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Malin V Jonsson
- Broegelmann Research Laboratory, Department of Clinical Science, University of Bergen, Bergen, Norway.,Section for Oral and Maxillofacial Radiology, Department of Clinical Dentistry, University of Bergen, Bergen, Norway
| | - Sandrine Jousse-Joulin
- Rheumatology Department, Centre Hospitalier Universitaire (CHU) de Brest, Univ Brest, Brest, France.,UMR 1227, Lymphocytes B et Autoimmunité (LBAI), Inserm, Univ Brest, Brest, France
| | - Pierluigi Macchioni
- Rheumatology Unit, Department of Internal Medicine, Azienda Ospedaliera Arcispedale Santa Maria Nuova (ASMN), Istituto di Ricovero e Cura a Carattere Scientifico, Reggio Emilia, Italy
| | - Simone Parisi
- Unit of Rheumatology, Department of General and Specialty Medicine, Città della Salute e della Scienza, Turin, Italy
| | - Carlo Perricone
- Rheumatology Unit, Department of Medicine, University of Perugia, Perugia, Italy
| | | | - Nenad Filipovic
- Faculty of Engineering Science, University of Kragujevac, Kragujevac, Serbia.,Bioengineering Research and Development Center (BioIRC), Kragujevac, Serbia
| | - Athanasios G Tzioufas
- Department of Pathophysiology, School of Medicine, National and Kapodistrian University of Athens, Athens, Greece
| | - Francesca Valent
- Institute of Epidemiology, Academic Hospital 'Santa Maria della Misericordia', Udine, Italy
| | - Salvatore De Vita
- Rheumatology Clinic, Department of Medical Area, Academic Hospital S. Maria della Misericordia, University of Udine, Udine, Italy
| |
Collapse
|
24
|
Filippou G, Scanu A, Adinolfi A, Toscano C, Gambera D, Largo R, Naredo E, Calvo E, Herrero-Beaumont G, Zufferey P, Bonjour CM, MacCarter DK, Makman S, Weber Z, Figus F, Möller I, Gutierrez M, Pineda C, Clavijo Cornejo D, Garcia H, Ilizaliturri V, Mendoza Torres J, Pichardo R, Rodriguez Delgado LC, Filippucci E, Cipolletta E, Serban T, Cirstoiu C, Vreju FA, Grecu D, Mouterde G, Govoni M, Punzi L, Damjanov NS, Keen HI, Bruyn GA, Terslev L, D'Agostino MA, Scirè CA, Iagnocco A. Criterion validity of ultrasound in the identification of calcium pyrophosphate crystal deposits at the knee: an OMERACT ultrasound study. Ann Rheum Dis 2020; 80:261-267. [PMID: 32988839 DOI: 10.1136/annrheumdis-2020-217998] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 08/03/2020] [Accepted: 08/21/2020] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To evaluate the discriminatory ability of ultrasound in calcium pyrophosphate deposition disease (CPPD), using microscopic analysis of menisci and knee hyaline cartilage (HC) as reference standard. METHODS Consecutive patients scheduled for knee replacement surgery, due to osteoarthritis (OA), were enrolled. Each patient underwent ultrasound examination of the menisci and HC of the knee, scoring each site for presence/absence of CPPD. Ultrasound signs of inflammation (effusion, synovial proliferation and power Doppler) were assessed semiquantitatively (0-3). The menisci and condyles, retrieved during surgery, were examined microscopically by optical light microscopy and by compensated polarised microscopy. CPPs were scored as present/absent in six different samples from the surface and from the internal part of menisci and cartilage. Ultrasound and microscopic analysis were performed by different operators, blinded to each other's findings. RESULTS 11 researchers from seven countries participated in the study. Of 101 enrolled patients, 68 were included in the analysis. In 38 patients, the surgical specimens were insufficient. The overall diagnostic accuracy of ultrasound for CPPD was of 75%-sensitivity of 91% (range 71%-87% in single sites) and specificity of 59% (range 68%-92%). The best sensitivity and specificity were obtained by assessing in combination by ultrasound the medial meniscus and the medial condyle HC (88% and 76%, respectively). No differences were found between patients with and without CPPD regarding ultrasound signs of inflammation. CONCLUSION Ultrasound demonstrated to be an accurate tool for discriminating CPPD. No differences were found between patents with OA alone and CPPD plus OA regarding inflammation.
Collapse
Affiliation(s)
- Georgios Filippou
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy .,Rheumatology Department, Luigi Sacco University Hospital, Milano, Italy
| | - Anna Scanu
- Department of Medicine-DIMED, Rheumatology Unit, University of Padova, Padova, Italy
| | - Antonella Adinolfi
- Rheumatology Department, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy
| | - Carmela Toscano
- Rheumatology Department, Azienda Ospedaliera Regionale San Carlo, Potenza, Italy
| | - Dario Gambera
- Orthopedics Department, Rugani Hospital, Monteriggioni, Italy
| | - Raquel Largo
- Joint and Bone Research Unit, Rheumatology Department, IIS-Fundacion Jimenez Diaz, Madrid, Spain
| | - Esperanza Naredo
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Emilio Calvo
- Department of Orthopaedic Surgery, Hospital Universitario Fundación Jiménez Díaz, Madrid, Spain
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundacion Jimenez Diaz, Madrid, Spain
| | - Pascal Zufferey
- Rheumatology Department, University of Lausanne, CHUV, Lausanne, Switzerland
| | | | - Daryl K MacCarter
- Rheumatology Department, North Valley Hospital, Whitefish, Montana, USA
| | - Stanley Makman
- Rheumatology Department, North Valley Hospital, Whitefish, Montana, USA
| | - Zachary Weber
- Rheumatology Department, North Valley Hospital, Whitefish, Montana, USA
| | - Fabiana Figus
- Rheumatology Unit, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
| | - Ingrid Möller
- Rheumatology, Instituto Poal de Reumatologia, Barcelona, Spain
| | - Marwin Gutierrez
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | - Carlos Pineda
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | | | - Hector Garcia
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | - Victor Ilizaliturri
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | | | - Raul Pichardo
- Rheumatology Department, Instituto Nacional de Rehabilitacion, Mexico, Mexico
| | | | - Emilio Filippucci
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Edoardo Cipolletta
- Rheumatology Unit, Department of Clinical and Molecular Sciences, Università Politecnica delle Marche, Ancona, Italy
| | - Teodora Serban
- Rheumatology Department, Carol Davila University, Bucharest, Romania
| | - Catalin Cirstoiu
- Rheumatology Department, Carol Davila University, Bucharest, Romania
| | - Florentin Ananu Vreju
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Dan Grecu
- Rheumatology Department, University of Medicine and Pharmacy of Craiova, Craiova, Romania
| | - Gaël Mouterde
- Rheumatology, University of Montpellier, Montpellier, France
| | - Marcello Govoni
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Leonardo Punzi
- Department of Medicine, Ospedale SS Giovanni e Paolo Venezia, Venezia, Italy
| | - Nemanja S Damjanov
- Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia.,Institute of Rheumatology, University of Belgrade, Belgrade, Serbia
| | - Helen Isobel Keen
- Medicine and Pharmacology Department, The University of Western Australia, Murdoch, Perth, Australia
| | - George Aw Bruyn
- Department of Rheumatology, Reumakliniek Lelystad, Lelystad, The Netherlands
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen University, Copenhagen, Denmark
| | - Maria-Antonietta D'Agostino
- Infection et inflammation, Laboratory of Excellence INFLAMEX, Université Paris-Saclay, Montigny-Le-Bretonneux, France.,Rheumatology, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - Carlo Alberto Scirè
- Section of Rheumatology, Department of Medical Sciences, University of Ferrara, Ferrara, Italy
| | - Annamaria Iagnocco
- Rheumatology Unit, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Torino, Italy
| |
Collapse
|
25
|
Seven S, Pedersen SJ, Østergaard M, Felbo SK, Sørensen IJ, Døhn UM, Terslev L. Peripheral Enthesitis Detected by Ultrasonography in Patients With Axial Spondyloarthritis-Anatomical Distribution, Morphology, and Response to Tumor Necrosis Factor-Inhibitor Therapy. Front Med (Lausanne) 2020; 7:341. [PMID: 32766263 PMCID: PMC7381133 DOI: 10.3389/fmed.2020.00341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 06/08/2020] [Indexed: 01/04/2023] Open
Abstract
Objectives: To investigate the anatomical distribution, morphological abnormalities and response to adalimumab therapy of ultrasound(US)-detected peripheral enthesitis in patients with axial spondyloarthritis (SpA). Methods: In a randomized, placebo-controlled, double-blinded, investigator-initiated trial (NCT01029847), patients with axial SpA according to the Assessment of Spondyloarthritis International Society criteria were randomized to subcutaneous adalimumab 40 mg every other week or placebo from baseline to week 6. From week 6 to 24, all patients received adalimumab 40 mg every other week. Of 49 patients enrolled, 21 patients participated in our observational US sub-study. US assessment applying the OMERACT US definitions for enthesitis of 10 peripheral entheseal regions of the upper and lower extremities and clinical examination were performed at baseline, weeks 6 and 24. US was performed by one experienced investigator. Hypo-echogenicity, increased thickness and Doppler activity of the enthesis were considered signs of active inflammation, whereas insertional bone erosions, intratendinous calcifications, and enthesophytes were regarded as signs of structural lesions. Results: Enthesitis on US was mostly present in the lower limbs, especially in the Achilles tendon (81%), the quadriceps tendon (62%), and the greater femoral trochanter (52%). Structural lesions were predominant (38 vs. 12% of examined entheses with inflammatory changes), particularly in the entheses of the lower limbs, and exhibited no change during treatment. Conclusion: US-detected structural lesions were common while inflammatory lesions were relatively rare in patients initiating adalimumab due to axial SpA. Structural lesions did not appear to change during 24 weeks follow-up, suggesting that these lesions may not be helpful outcome measures in short-term clinical trials.
Collapse
Affiliation(s)
- Sengul Seven
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Susanne Juhl Pedersen
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Mikkel Østergaard
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Sara Kamp Felbo
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Inge Juul Sørensen
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Uffe Møller Døhn
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark
| | - Lene Terslev
- Copenhagen Center for Arthritis Research and Center for Rheumatology and Spine Diseases, Centre of Head and Orthopaedics, Rigshospitalet, Glostrup, Denmark.,Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| |
Collapse
|
26
|
Weiss PF, Roth J. Juvenile-Versus Adult-Onset Spondyloarthritis: Similar, but Different. Rheum Dis Clin North Am 2020; 46:241-257. [PMID: 32340699 DOI: 10.1016/j.rdc.2020.01.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
This article provides an overview of juvenile spondyloarthritis and important differences in the classification criteria, clinical presentation, outcomes, and pathology in juvenile versus adult-onset disease. Key differences in classification criteria between children and adults with spondyloarthritis are important to understand, as they can make transition from pediatric to adult care challenging. MRI and ultrasonography are increasingly relied on for the assessment of adult-onset disease activity and change over time in the pediatric population. The unique features of the maturing axial and peripheral skeleton are described for each modality, as they are key to understand for accurate interpretation of pathology in the pediatric population.
Collapse
Affiliation(s)
- Pamela F Weiss
- Perelman School of Medicine UPENN, Philadelphia, PA, USA; Division of Rheumatology, Children's Hospital of Philadelphia, Philadelphia, PA, USA.
| | - Johannes Roth
- Division of Pediatric Dermatology and Rheumatology, Children's Hospital of Eastern Ontario, University of Ottawa, 401 Smyth Road, Ottawa, Ontario K1H8L1, Canada
| |
Collapse
|
27
|
Wong PC, Lee G, Delle Sedie A, Hanova P, Inanc N, Jousse-Joulin S, Ohrndorf S, Stoenoiu MS, Keen HI, Terslev L, D'Agostino MA, Bruyn GA. Musculoskeletal Ultrasound in Systemic Lupus Erythematosus: Systematic Literature Review by the Lupus Task Force of the OMERACT Ultrasound Working Group. J Rheumatol 2019; 46:1379-1387. [PMID: 31203213 DOI: 10.3899/jrheum.181087] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/16/2019] [Indexed: 01/12/2023]
Abstract
OBJECTIVE To identify and synthesize the best available evidence on the application of musculoskeletal (MSK) ultrasound (US) in patients with systemic lupus erythematosus (SLE) and to present the measurement properties of US in different elementary lesions and pathologies. METHODS A systematic literature search of PubMed, Embase, and the Cochrane Library was performed. Original articles were included that were published in English between August 1, 2014, and December 31, 2018, reporting US, Doppler, synovitis, joint effusion, bone erosion, tenosynovitis, and enthesitis in patients with SLE. Data extraction focused on the definition and quantification of US-detected synovitis, joint effusion, bone erosion, tenosynovitis, enthesitis, and the measurement properties of US according to the OMERACT Filter 2.1 instruments selection. RESULTS Of the 143 identified articles, 15 were included. Most articles were cross-sectional studies (14/15, 93%). The majority of the studies used the OMERACT definitions for ultrasonographic pathology. Regarding the measurement properties of US in different elementary lesions and pathologies, all studies dealt with face validity, content validity, and feasibility. Most studies achieved construct validity. Concerning the reliability of image reading, 1 study (1/15, 7%) assessed both intraobserver and interobserver reliability. For image acquisition, 4 studies (4/15, 27%) evaluated interobserver reliability and none had evaluated intraobserver reliability. Criterion validity was assessed in 1 study (1/15, 7%). Responsiveness was not considered in any of the studies. CONCLUSION This literature review demonstrates the need for further research and validation work to define the involvement of US as an outcome measurement instrument for the MSK manifestations in patients with SLE.
Collapse
Affiliation(s)
- Priscilla C Wong
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands.
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep.
| | - Gavin Lee
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Andrea Delle Sedie
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Petra Hanova
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Nevsun Inanc
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Sandrine Jousse-Joulin
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Sarah Ohrndorf
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Maria S Stoenoiu
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Helen I Keen
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Lene Terslev
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - Maria-Antonietta D'Agostino
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| | - George A Bruyn
- From the Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; Department of Medicine, Hong Kong Sanatorium and Hospital, Hong Kong SAR, China; Rheumatology Unit, University of Pisa, Pisa, Italy; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic; Division of Rheumatology, School of Medicine, Marmara University, Istanbul, Turkey; Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University, Brest; Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, Boulogne-Billancourt; INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University, Saint-Quentin en Yvelines, France; Department of Rheumatology and Clinical Immunology, Charite University Hospital, Berlin, Germany; Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc, Brussels, Belgium; School of Medicine and Pharmacology, University of Western Australia, Perth, Australia; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark; Department of Rheumatology, MC Groep, Lelystad, the Netherlands
- P.C. Wong, MD, Division of Rheumatology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong; G. Lee, MD, Department of Medicine, Hong Kong Sanatorium and Hospital; A. Delle Sedie, MD, Rheumatology Unit, University of Pisa; P. Hanova, MD, PhD, Department of Rheumatology, Institute of Rheumatology; N. Inanc, MD, Division of Rheumatology, School of Medicine, Marmara University; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital and Brest Occidentale University; S. Ohrndorf, MD, Department of Rheumatology and Clinical Immunology, Charite University Hospital; M.S. Stoenoiu, MD, PhD, Department of Rheumatology, Université Catholique de Louvain, Institut de Recherche Expérimentale et Clinique, Cliniques Universitaires Saint Luc; H.I. Keen, MD, PhD, School of Medicine and Pharmacology, University of Western Australia; L. Terslev, MD, PhD, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Department of Rheumatology, AP-HP, Hôpital Ambroise Paré, Rheumatology Department, and INSERM U1173, Laboratoire d'Excellence INFLAMEX, UFR Simone Veil, Versailles-Saint-Quentin University; G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep
| |
Collapse
|
28
|
Bruyn GA, Iagnocco A, Naredo E, Balint PV, Gutierrez M, Hammer HB, Collado P, Filippou G, Schmidt WA, Jousse-Joulin S, Mandl P, Conaghan PG, Wakefield RJ, Keen HI, Terslev L, D'Agostino MA. OMERACT Definitions for Ultrasonographic Pathologies and Elementary Lesions of Rheumatic Disorders 15 Years On. J Rheumatol 2019; 46:1388-1393. [PMID: 30709946 DOI: 10.3899/jrheum.181095] [Citation(s) in RCA: 104] [Impact Index Per Article: 20.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE The Outcome Measures in Rheumatology (OMERACT) Ultrasound (US) Working Group (WG) operates research activities for the validation of US as an outcome measurement instrument according to the Filter 2.0 framework. METHODS Original publications on definitions and scoring systems for pathophysiological manifestations and elementary lesions of various rheumatic disorders were reviewed from the onset of the WG research in 2005. RESULTS Definitions and scoring systems according to new terminology are provided. CONCLUSION We have redefined OMERACT US pathology and elementary lesions as well as scoring systems, which are now proposed for OMERACT approval for application in clinical trials.
Collapse
Affiliation(s)
- George A Bruyn
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Annamaria Iagnocco
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Esperanza Naredo
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Peter V Balint
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Marwin Gutierrez
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Hilde B Hammer
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Paz Collado
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Georgios Filippou
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Wolfgang A Schmidt
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Sandrine Jousse-Joulin
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Peter Mandl
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Philip G Conaghan
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Richard J Wakefield
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Helen I Keen
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | - Lene Terslev
- From the Department of Rheumatology, MC Groep hospitals, Lelystad, the Netherlands; Academic Rheumatology Centre, Università degli Studi di Torino, Turin; Department of Medical Sciences, Section of Rheumatology, University of Ferrara; Azienda Ospedaliero-Universitaria Sant'Anna di Cona, Ferrara, Italy; Department of Rheumatology, Bone and Joint Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz; Universidad Autónoma de Madrid; Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa, Madrid, Spain; Rheumatology Department, National Institute of Rheumatology and Physiotherapy, Budapest, Hungary; Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion, Mexico City, Mexico; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch, Berlin, Germany; Rheumatology Department, Cavale Blanche Hospital; Brest Occidentale University, Brest; Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines, Boulogne-Billancourt, France; Department of Rheumatology, Medical University of Vienna, Vienna, Austria; Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds; UK National Institute for Health Research (NIHR) Leeds Biomedical Research Centre, Leeds, UK; Department of Rheumatology, University of Adelaide, Adelaide, Australia; Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark
- G.A. Bruyn, MD, PhD, Department of Rheumatology, MC Groep hospitals, Lelystad; A. Iagnocco, MD, Academic Rheumatology Centre, Università degli Studi di Torino; E. Naredo, MD, Department of Rheumatology, Bone and Joint Research Unit, and Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid; P.V. Balint, MD, PhD, Rheumatology Department, National Institute of Rheumatology and Physiotherapy; M. Gutierrez, MD, PhD, Division of Musculoskeletal and Rheumatic Diseases, Instituto Nacional de Rehabilitacion; H.B. Hammer, MD, Department of Rheumatology, Diakonhjemmet Hospital; P. Collado, MD, PhD, Rheumatology Department, Paediatric Rheumatology Unit, Hospital Universitario Severo Ochoa; G. Filippou, MD, PhD, Department of Medical Sciences, Section of Rheumatology, University of Ferrara, and Azienda Ospedaliero-Universitaria Sant'Anna di Cona; W.A. Schmidt, MD, Immanuel Krankenhaus Berlin, Medical Center for Rheumatology Berlin-Buch; S. Jousse-Joulin, MD, Rheumatology Department, Cavale Blanche Hospital, and Brest Occidentale University; P. Mandl, PhD, Department of Rheumatology, Medical University of Vienna; P.G. Conaghan, MD, PhD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; R.J. Wakefield, MD, Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and NIHR Leeds Biomedical Research Centre; H.I. Keen, MD, PhD, Department of Rheumatology, University of Adelaide; L. Terslev, MD, PhD, Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet; M.A. D'Agostino, MD, PhD, Rheumatology Department, AP-HP, Hôpital Ambroise Paré, INSERM U1173, Labex Inflamex, Université Versailles St-Quentin en Yvelines
| | | |
Collapse
|