Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise

Rossi‐Semerano, Linda; Breton, Sylvain; Semerano, Luca; Boubaya, Marouane; Ohanyan, Haykanush; Bossert, Marie; Boiu, S; Chatelus, Emmanuel; Durand, G.; Jean, Sylvie; Goumy, Laurence; Mathiot, Anne; Mouterde, Gaël; Nugues, F.; Hennia, Ahmed Ould; Rey, Bénédicte; Scheven, Annette Von; Sparsa, L.; Devauchelle‐Pensec, Valérie; Jousse‐Joulin, Sandrine

doi:10.1093/rheumatology/keaa804

Cited by 17 publications

(16 citation statements)

References 23 publications

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“…This exercise demonstrated good to excellent reliability for B-mode and PDmode views 22 . Most recently, Rossi-Semerano et al 23 reported the reliability of the OMERACT pediatric US synovitis scoring system among 13 pediatric ultrasonographers of diverse subspecialty backgrounds: nine rheumatologists, two pediatricians, and two radiologists with varying degrees of experience. This group used a total of 75 images to evaluate the reliability of feedback following the first and second training exercises noted that careful review of the normal spectrum of sonographic findings related to the degree of skeletal maturation was most helpful.…”

Section: Discussionmentioning

confidence: 99%

“…For the scoring systems of the MCP II, wrist, and elbow, they found fair to good reliability for the B-mode and excellent reliability for PD-mode. However, the scoring system used was not joint-specific, which the authors acknowledged 23 . Our study used a larger sample of normal and pathologic images (n=300), including all views recommended in the evaluation of JIA and involved 17 pediatric rheumatology sonographers with different levels of expertise.…”

Section: Accepted Article Accepted Articlementioning

confidence: 99%

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Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints

et al. 2022

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Objective Musculoskeletal ultrasound (MSUS) is increasingly being utilized in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aims to assess reliability of these scoring systems when used by sonographers with different levels of expertise. Methods Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist and finger. Subsequently, scoring exercises of B-mode and Power Doppler (PD)-mode still-images for each joint were performed. Inter-reader reliability was determined using two-way single score intra-class correlation coefficients (ICC) for synovitis and Cohen's kappa for tenosynovitis. Results Seventeen pediatric rheumatologists with different levels of MSUS expertise (1 – 15 years) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC>0.75) was found after the first scoring exercise for all of the finger and elbow views evaluated on B-mode and PD-mode, and for all of the wrist views on B-mode. After a second training session and a scoring exercise the wrist PD-mode views reached excellent reliability as well. Conclusion The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. This reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure with further validation.

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Section: Discussionmentioning

confidence: 99%

Section: Accepted Article Accepted Articlementioning

confidence: 99%

Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints

et al. 2022

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“…Enthesis sites evaluated were: Achilles' tendon, plantar fascia, tibial tuberosity, and superior and inferior pole of the patella femoris. The US examination technique and the standard scans were based on published Outcome Measures in Rheumatology (OMERACT) guidelines and on the studies on paediatric musculoskeletal ultrasound (MSUS) available at study entry The findings obtained were reported according to the semiquantitative gray scale for synovitis in children (PedSynS) and semiquantitative scale for power Doppler [13][14][15][16]. Subclinical synovitis was defined in the presence of joint physical examination without arthritis and ultrasonographic examination with grade 2 or 3 synovitis with or without positive PD signal.…”

Section: Ultrasonographymentioning

confidence: 99%

“…The total number of joints with subclinical activity was 22 / 1260 (1.7%). The most affected were knees (13); wrist (6), talus navicular (1), ankle (1) and 2nd MCP (1). Details in Figures 2 -8.…”

Section: Volume 2 | Issue 2 | 77 J Clin Rheum Res 2022mentioning

confidence: 99%

Prevalence of Subclinical Activity by Ultrasound Examination in Mexican Children with Juvenile Idiopathic Arthritis in Remission

2022

JCRR

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Background: Juvenile Idiopathic Arthritis (JIA) is a chronic disease that affects 0.6 - 1.9 /1,000 children. Persistent joint inflammation conditions cartilage damage and erosions. Recent studies have shown that clinical examination significantly underestimates joint inflammation, with ultrasound having a higher sensitivity. The aim of this study was determined the prevalence of subclinical synovitis by musculoskeletal ultrasound in Mexican children with JIA in remission. Methods: Cross-sectional study, patients with JIA in clinical remission based on the Wallace criteria were included, with and without pharmacological treatment, we also included a control group of healthy children. The evaluation was performed by a certified Rheumatologist in Pediatric Musculoskeletal Ultrasound by EULAR. Joints clinically examined were also evaluated following the standard guidelines. Results: A total of 37 JIA patients with clinical remission and 33 healthy children were evaluated (1260 joints scanned), subclinical activity was detected in 15/37 (40.5%) patients and none of healthy children; 14 patients were still on treatment (93.3%). The subclinical activity was detected by gray scale in 22/1260 (1.7%) or by power Doppler (PD) in 15/1260 (1.1%) joints, the knee was involved in 13/22 (59%) joints. The subtype mainly affected was the rheumatoid factor-positive (FR) polyarticular (33.3%), erosions were detected in three patients (8%). In the knee, we observed slight distention of the supra patellar recess, evidenced in 19/33 healthy children (57.5%), predominantly among children aged 4 to 8 years. When comparing the groups with or without subclinical synovitis, no statistically significant differences were found with regard to age, evolution time or acute phase reactants. Conclusions: Subclinical synovitis was detected in 40.5% of the patients in clinical remission using gray scale or by power Doppler, mainly on those who were still on treatment. The most affected subtype was the rheumatoid factor-positive polyarticular, the knees were the most frequent involved. In the healthy children, a slight distention of the supra patellar recess was observed in almost half of cases.

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“…Inflammation of tissues and/or vessels of different location and size is a major component of common rheumatological pathologies such as synovitis, enthesitis and vasculitis (1)(2)(3)(4). Metacarpophalangeal (MCP) joints are frequently involved in inflammatory arthritides especially in rheumatoid arthritis (RA), psoriatic arthritis (PsA), and juvenile idiopathic arthritis (5)(6)(7). Additionally, finger arteries are often affected in various types of vasculitides (3).…”

Section: Introductionmentioning

confidence: 99%

Vascular supply of the metacarpophalangeal joint

et al. 2022

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ObjectiveTo describe in detail the arterial vasculature of metacarpophalangeal joints 2–5 on cadaver specimens and to compare it to ultrasound imaging of healthy subjects.MethodsEighteen hands of donated human cadavers were arterially injected and investigated with either corrosion casting or cryosectioning. Each layer of cryosectioned specimens was photographed in high-resolution. Images were then segmented for arterial vessels of the metacarpophalangeal (MCP) joints 2–5. The arterial pattern of the joints was reconstructed from the segmented images and from the corrosion cast specimens. Both hands of ten adult healthy volunteers were scanned focusing on the vasculature of the same joints with high-end ultrasound imaging, including color Doppler. Measurements were made on both cryosectioned arteries and Doppler images.ResultsThe arterial supply of MCP joints 2–5 divides into a metacarpal and a phalangeal territory, respectively. The metacarpal half receives arteries from the palmar metacarpal arteries or proper palmar digital arteries, while the phalangeal half is supplied by both proper and common palmar digital arteries. Comparing anatomical and ultrasonographic results, we determined the exact anatomic location of normal vessels using Doppler images acquired of healthy joints. All, except three branches, were found with less than 50% frequency using ultrasound. Doppler signals were identified significantly more frequently in MCP joints 2–3 than on 4–5 (p < 0.0001). Similarly, Doppler signals differed in the number of detectable small, intraarticular vessels (p < 0.009), but not that of the large extraarticular ones (p < 0.1373). When comparing measurements acquired by ultrasound and on cadaver vessels, measurements using the former technique were found to be larger in all joints (p < 0.0001).ConclusionUsing morphological and ultrasonographic techniques, our study provides a high-resolution anatomical maps and an essential reference data set on the entire arterial vasculature of healthy human MCP 2–5 joints. We found that Doppler signal could be detected in less than 50% of the vessels of healthy volunteers except three locations. Intraarticular branches were detected with ultrasound imaging significantly more frequently on healthy MCP 2–3 joints, which should be taken into account when inflammatory and normal Doppler signals are evaluated. Our study also provides reference data for future, higher-resolution imaging techniques.

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Application of the OMERACT synovitis ultrasound scoring system in juvenile idiopathic arthritis: a multicenter reliability exercise

Cited by 17 publications

References 23 publications

Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints

Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger Joints

Prevalence of Subclinical Activity by Ultrasound Examination in Mexican Children with Juvenile Idiopathic Arthritis in Remission

Vascular supply of the metacarpophalangeal joint

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