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• W3153371941 abstract "Purpose: Ultrasonography is used in rheumatic musculoskeletal diseases (RMDs) as outcome measure in clinical trials. In hand osteoarthritis (OA) it is a suitable imaging modality because multiple joints can be scanned with high sensitivity for subtle pathology. Traditionally, ultrasonography is scored dynamic and real-time. Dynamic ultrasonography is investigator dependent, which can lead to suboptimal inter-rater reliability. Central reading of static US images could avoid issues of inter-rater reliability. However, agreement between real-time and static assessment has not been studied in hand OA or other RMDs. Therefore, we studied this agreement in inflammatory hand OA. Methods: Ninety-two patients fulfilling the American College of Rheumatology hand OA criteria and showing clinical and ultrasonographic signs of inflammation were randomised to receive 10mg prednisolone or placebo for six weeks in a clinical trial. Of 75 patients static images of ultrasonography were available. These were included in the present study. Hand joints were assessed for synovial thickening, effusion, Doppler signal and osteophytes by ultrasound (score 0-3 per joint, 30 joints per patient; DIP/PIP 2-5, IP-1, MCP 1-5 and CMC-1 joints) at baseline and after treatment. Two ultrasonographers scored the live images together (simultaneously) in real-time. A consensus score for each joint was recorded. Representative images were stored during scanning. These static images were scored by one ultrasonographer with a minimum of 6 months between real-time and static scoring. For each patient, images of each visit were scored paired, with known chronological order. The ultrasonographers were blinded to patients’ clinical data and treatment. Agreement between scoring methods was studied at joint level with quadratic weighted kappa. At patient level, intra-class correlations (ICC; mixed effect model, absolute agreement, with and without clustering taken into acount) were calculated at both timepoints. ICCs were also calculated for the delta of sum scores. Responsiveness of scoring methods was analyzed with generalized estimating equations (GEE) with treatment as independent and ultrasonography findings as dependent variable. Results: Thirty-nine patients (52%) were treated with prednisolone and 36 (48%) were treated with placebo. Patient characteristics were well-balanced between treatment groups. All patients had signs of osteophytes as assessed by real-time ultrasonography, almost all a positive Doppler signal or synovial thickening, while three quarters had effusion in at least one of 30 assessed joints. Total ultrasonography sum score for osteophytes was high (mean 45 ±SD 12), whereas sum score was low for positive Doppler signal (mean 5.9 ±SD 4.4), with intermediate sum scores for synovial thickening and effusion (mean 16 ±SD 6.3 and 11 ±SD 6.0 respectively). Static sum scores were overall slightly higher (osteophytes mean 48 ±SD 10; Doppler mean 6.9 S±D 5.0; synovial thickening mean 20 ±SD 7.0 and effusion 13 ±SD 6.5) Agreement at baseline was good to excellent at joint level (kappa 0.72-0.88) and moderate to excellent at patient level (ICC 0.59-0.86). Agreement for delta sum scores was poor to fair for synovial thickening and effusion (ICC 0.18 and 0.34 respectively), but excellent for Doppler signal (ICC 0.80) (Table 1). Real-time ultrasonography showed responsiveness to prednisolone with a mean between-group difference of synovial thickening sum score of -2.5 (CI:-4.7 to-0.3). Static ultrasonography did not show a decrease in synovial thickening (Figure 1). No difference in ultrasonography scores was seen for the other ultrasonography features, neither with real-time nor static scoring. Conclusions: While cross-sectional agreement between real-time and static ultrasonography was good, agreement of delta sum scores was not and paired static ultrasonography measurement of synovial thickening did not show responsiveness to prednisone therapy where real-time ultrasonography did. Therefore, when using ultrasonography in clinical trials, real-time dynamic scoring should remain the standard.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
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• W3153371941 date "2021-04-01" @default.
• W3153371941 modified "2023-10-16" @default.
• W3153371941 title "Real-time versus static scoring in musculoskeletal ultrasonography in patients with inflammatory hand osteoarthritis" @default.
• W3153371941 doi "https://doi.org/10.1016/j.joca.2021.02.434" @default.
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