Consensus-based semi-quantitative ultrasound scoring system for gout lesions: Results of an OMERACT Delphi process and web-reliability exercise

• Published in: Seminars in arthritis and rheumatism Vol. 51; no. 3; pp. 644 - 649
• Main Authors: Christiansen, Sara Nysom, Filippou, Georgios, Scirè, Carlo Alberto, Balint, Peter V, Bruyn, George AW, Dalbeth, Nicola, Dejaco, Christian, Sedie, Andrea Delle, Filippucci, Emilio, Hammer, Hilde B, Iagnocco, Annamaria, Keen, Helen I, Kissin, Eugene Y, Koski, Juhani, Mandl, Peter, Martin, Julia, Miguel, Eugenio De, Möller, Ingrid, Naredo, Esperanza, Pineda, Carlos, Schmidt, Wolfgang A, Stewart, Sarah, Antonietta D'Agostino, Maria, Terslev, Lene
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.06.2021; WB Saunders
• Subjects: Delphi exercise; Gout; Life Sciences; OMERACT; Outcome measure; Reliability; Scoring system; Ultrasound; OMERACT; Gout; Scoring system; Outcome measure; Delphi exercise; Reliability; Ultrasound
• ISSN: 0049-0172; 1532-866X; 1532-866X
• DOI: 10.1016/j.semarthrit.2020.11.011

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. 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. 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). 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.