Reproducibility of Joint Swelling Assessment by Sonography in Patients with Long-lasting Rheumatoid Arthritis (SEA-Repro Study Part II)
Reproducibility of Joint Swelling Assessment by Sonography in Patients with Long-lasting Rheumatoid Arthritis (SEA-Repro Study Part II)
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DOI：
10.3899/jrheum.090881
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发表时间：
2010-05-01
影响因子：
3.9
通讯作者：
Saraux, Alain
中科院分区：
文献类型：
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作者：
Jousse-Joulin, Sandrine;d'Agostino, Maria Antonietta;Saraux, Alain
目标。与临床资料对照，评价B超和能量多普勒(PD)对活动期类风湿关节炎(RA)患者的观察者内和观察者间的可重复性。在考虑改变其RA治疗方案的7名患者中，7名医疗专业人员检查了疾病活动评分28关节计数(DAS28)中使用的28个关节。然后，7名超声医生使用之前发表的B型和PD分级系统，对7名患者进行了两次检查。临床参考标准是根据至少4/7的检查者是否存在滑膜炎。根据至少4/7的超声医师的说法，超声参考标准至少为1级(ALG1)或2级(ALG2)滑膜炎。对观察者间超声检查的重复性进行评估，并与观察者内重复性最好的超声诊断者进行比较。一致性由Cohen‘s kappa统计量来衡量。分别使用B超和PD的观察者内和观察者间的重复性一般到很好。所有使用B超、PD和两者的临床医生和超声医师之间的一致性为0.46。1级滑膜炎分别为0.37和0.36，2级滑膜炎分别为0.58、0.19和0.19。体格检查发现滑膜炎的关节数(36.7%)少于B超检查的关节数(58.6%；P<；0.001)。体检发现滑膜炎的关节数明显多于PD合并ALG1者(17.8%；P
Objective. To evaluate the intraobserver and interobserver reproducibility of B-mode and power Doppler (PD) sonography in patients with active long-standing rheumatoid arthritis (RA) comparatively with clinical data.Methods. In each of 7 patients being considered for a change in their RA treatment regimen, 7 healthcare professionals examined the 28 joints used in the Disease Activity Score 28-joint count (DAS28). Then 7 sonographers examined each of the 7 patients twice, using previously published B-mode and PD grading systems. The clinical reference standard was presence of synovitis according to at least 4/7 examiners. The sonographic reference standard was at least grade 1 (ALG1) or 2 (ALG2) synovitis according to at least 4/7 sonographers. Interobserver reproducibility of sonography was assessed versus the sonographer having the best intraobserver reproducibility. Agreement was measured by Cohen's kappa statistic.Results. Intraobserver and interobserver reproducibility of B-mode and PD used separately was fair to good. Agreement between clinicians and sonographers at all sites using B-mode, PD, and both was 0.46. 0.37, and 0.36, respectively, for grade 1 synovitis; and 0.58, 0.19, and 0.19 for grade 2 synovitis. The number of joints with synovitis was smaller by physical examination (36.7%) than by B-mode with ALG1 (58.6%; p < 0.001). The number of joints with synovitis was higher by physical examination than by PD with both ALG1 (17.8%; p