Reliability testing of tendon disease using two different scanning methods in patients with rheumatoid arthritis

• Published in: Rheumatology (Oxford, England) Vol. 51; no. 9; pp. 1655 - 1661
• Main Authors: BRUYN, George A. W, MÖLLER, Ingrid, BAUDOIN, Paul, REESEMA, Dick Siewertsz Van, PINEDA, Carlos, WAKEFIELD, Richard J, NAREDO, Esperanza, GARRIDO, Jesus, BONG, David, D'AGOSTINO, Maria-Antonietta, LAGNOCCO, Annamaria, KARIM, Zunaid, TERSLEV, Lene, SWEN, Nanno, BALINT, Peter
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01.09.2012
• Subjects: Adult; Antirheumatic Agents - therapeutic use; Arthritis, Rheumatoid - complications; Arthritis, Rheumatoid - diagnosis; Arthritis, Rheumatoid - physiopathology; Biological and medical sciences; Diseases of the osteoarticular system; Female; Humans; Inflammatory joint diseases; Juxtaarticular diseases. Extraarticular rhumatism; Male; Medical sciences; Middle Aged; Observer Variation; Patient Selection; Reproducibility of Results; Rupture; Tendon Injuries - complications; Tendon Injuries - diagnosis; Tendon Injuries - physiopathology; Tendons - diagnostic imaging; Tendons - pathology; Tenosynovitis - complications; Tenosynovitis - diagnosis; Tenosynovitis - physiopathology; Ultrasonography - methods; Sonography; Juxtaarticular disease; Human; Immunopathology; reliability testing; ultrasonography; Diseases of the osteoarticular system; Rheumatology; Autoimmune disease; Inflammatory joint disease; adult rheumatology; Chronic; Rheumatoid arthritis; Echography; Tenosynovitis; Adult; Reliability; Tendon
• ISSN: 1462-0324; 1462-0332
• DOI: 10.1093/rheumatology/kes103

To assess the intra- and interobserver reliability of musculoskeletal ultrasonography (US) in detecting inflammatory and destructive tendon abnormalities in patients with RA using two different scanning methods. Thirteen observers examined nine patients with RA and one healthy individual in two rounds independently and blindly of each other. Each round consisted of two consecutive examinations, an anatomy-based examination and a free examination according to personal preferences. The following tendons were evaluated: wrist extensor compartments 2, 4 and 6, finger flexor tendons 3 and 4 at MCP level, tibialis posterior tendon and both peronei tendons. Overall, positive and negative agreements and κ-values for greyscale (GS) tenosynovitis, peritendinous power Doppler (PPD) signal, intratendinous power Doppler (IPD) signal and GS tendon damage were calculated. Intraobserver κ-value ranges were 0.53-0.55 (P < 0.0005) for GS tenosynovitis, 0.61-0.64 (P < 0.0005) for PPD signal, 0.65-0.66 (P < 0.0005) for IPD signal and 0.44-0.53 (P < 0.0005) for GS tendon damage. For interobserver reliability, substantial overall agreement ranged from 80 to 89% for GS tenosynovitis, 97 to 100% for PPD signal, 97 to 100% for IPD signal and 97 to 100% for GS tendon damage. Results were independent of scanning technique. Intraobserver reliability for tenosynovitis and tendon damage varied from moderate for GS to good for PD. Overall interobserver reliability for tenosynovitis and tendon damage was excellent both for GS and PD. This qualitative scoring system may serve as the first step to a semi-quantitative score for tendon pathology.