Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

Andrea Di Matteo; Edoardo Cipolletta; Giulia Maria Destro Castaniti; Gianluca Smerilli; Carla Airoldi; Sibel Zehra Aydin; Andrea Becciolini; Karina Bonfiglioli; Alessandra Bruns; Greta Carrara; Tomas Cazenave; Alessandro Ciapetti; Micaela Ana Cosatti; Juan José de Agustín; Marco Di Carlo; Eleonora Di Donato; Luca Di Geso; Emine Duran; Ashley Elliott; Cristina Estrach; Bayram Farisogulları; Alessia Fiorenza; Daniela Fodor; Alessandra Gabba; Cristina Hernández-Díaz; Feng Huang; Jana Hurnakova; Ling Li; Diogo Jesus; Omer Karadag; Maria Victoria Martire; Marco Massarotti; Xabier Michelena; Alice Andreea Musca; Jagdish Nair; Tadashi Okano; Ioannis Papalopoulos; Marcos Rosemffet; João Rovisco; Davide Rozza; Fausto Salaffi; Iulia Satulu; Crescenzio Scioscia; Carlo Alberto Scirè; Fei Sun; Maria Magdalena Tamas; Shun Tanimura; Lucio Ventura-Rios; Paraksevi V. Voulgari; Florentin Ananu Vreju; Gentiana Vukatana; Ernest Wong; Jinshui Yang; Johana Zacariaz Hereter; Anna Zanetti; Walter Grassi; Emilio Filippucci

doi:10.1093/rheumatology/keac162

Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

Andrea Di Matteo^*, Edoardo Cipolletta, Giulia Maria Destro Castaniti, Gianluca Smerilli, Carla Airoldi, Sibel Zehra Aydin, Andrea Becciolini, Karina Bonfiglioli, Alessandra Bruns, Greta Carrara, Tomas Cazenave, Alessandro Ciapetti, Micaela Ana Cosatti, Juan José de Agustín, Marco Di Carlo, Eleonora Di Donato, Luca Di Geso, Emine Duran, Ashley Elliott, Cristina EstrachBayram Farisogulları, Alessia Fiorenza, Daniela Fodor, Alessandra Gabba, Cristina Hernández-Díaz, Feng Huang, Jana Hurnakova, Ling Li, Diogo Jesus, Omer Karadag, Maria Victoria Martire, Marco Massarotti, Xabier Michelena, Alice Andreea Musca, Jagdish Nair, Tadashi Okano, Ioannis Papalopoulos, Marcos Rosemffet, João Rovisco, Davide Rozza, Fausto Salaffi, Iulia Satulu, Crescenzio Scioscia, Carlo Alberto Scirè, Fei Sun, Maria Magdalena Tamas, Shun Tanimura, Lucio Ventura-Rios, Paraksevi V. Voulgari, Florentin Ananu Vreju, Gentiana Vukatana, Ernest Wong, Jinshui Yang, Johana Zacariaz Hereter, Anna Zanetti, Walter Grassi, Emilio Filippucci

^*Corresponding author for this work

School of Medicine, Dentistry and Biomedical Sciences

Research output: Contribution to journal › Article › peer-review

16 Citations (Scopus)

Abstract

Objectives
To investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA.

Methods
In this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs.

Results
Bone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation.

Conclusions
The results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

Original language	English
Pages (from-to)	4863-4874
Number of pages	12
Journal	Rheumatology
Volume	61
Issue number	12
Early online date	16 Mar 2022
DOIs	https://doi.org/10.1093/rheumatology/keac162
Publication status	Published - Dec 2022

Keywords

enthesitis
multicenter international study
power Doppler signal
PsA
reliability
seronegative spondyloarthritis
ultrasound

ASJC Scopus subject areas

Rheumatology
Pharmacology (medical)

Access to Document

10.1093/rheumatology/keac162Licence: Unspecified

Evaluating ultrasound confirmed enthesitis as a predictive marker for response to biologic therapy in psoriatic arthritis
Elliott, A. (Author), Wright, G. (Supervisor) & Rooney, M. (Supervisor), Jul 2024
Student thesis: Doctoral Thesis › Doctor of Philosophy

File

Cite this

Di Matteo, A., Cipolletta, E., Castaniti, G. M. D., Smerilli, G., Airoldi, C., Aydin, S. Z., Becciolini, A., Bonfiglioli, K., Bruns, A., Carrara, G., Cazenave, T., Ciapetti, A., Cosatti, M. A., de Agustín, J. J., Di Carlo, M., Di Donato, E., Di Geso, L., Duran, E., Elliott, A., ... Filippucci, E. (2022). Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study. Rheumatology, 61(12), 4863-4874. https://doi.org/10.1093/rheumatology/keac162

@article{a8589c42878449568bb534b45116cd94,

title = "Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study",

abstract = "ObjectivesTo investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA.MethodsIn this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light{\textquoteright}s kappa, Cohen{\textquoteright}s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs.ResultsBone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light{\textquoteright}s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light{\textquoteright}s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light{\textquoteright}s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light{\textquoteright}s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation.ConclusionsThe results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.",

keywords = "enthesitis, multicenter international study, power Doppler signal, PsA, reliability, seronegative spondyloarthritis, ultrasound",

author = "{Di Matteo}, Andrea and Edoardo Cipolletta and Castaniti, {Giulia Maria Destro} and Gianluca Smerilli and Carla Airoldi and Aydin, {Sibel Zehra} and Andrea Becciolini and Karina Bonfiglioli and Alessandra Bruns and Greta Carrara and Tomas Cazenave and Alessandro Ciapetti and Cosatti, {Micaela Ana} and {de Agust{\'i}n}, {Juan Jos{\'e}} and {Di Carlo}, Marco and {Di Donato}, Eleonora and {Di Geso}, Luca and Emine Duran and Ashley Elliott and Cristina Estrach and Bayram Farisogulları and Alessia Fiorenza and Daniela Fodor and Alessandra Gabba and Cristina Hern{\'a}ndez-D{\'i}az and Feng Huang and Jana Hurnakova and Ling Li and Diogo Jesus and Omer Karadag and Martire, {Maria Victoria} and Marco Massarotti and Xabier Michelena and Musca, {Alice Andreea} and Jagdish Nair and Tadashi Okano and Ioannis Papalopoulos and Marcos Rosemffet and Jo{\~a}o Rovisco and Davide Rozza and Fausto Salaffi and Iulia Satulu and Crescenzio Scioscia and Scir{\`e}, {Carlo Alberto} and Fei Sun and Tamas, {Maria Magdalena} and Shun Tanimura and Lucio Ventura-Rios and Voulgari, {Paraksevi V.} and Vreju, {Florentin Ananu} and Gentiana Vukatana and Ernest Wong and Jinshui Yang and Hereter, {Johana Zacariaz} and Anna Zanetti and Walter Grassi and Emilio Filippucci",

year = "2022",

month = dec,

doi = "10.1093/rheumatology/keac162",

language = "English",

volume = "61",

pages = "4863--4874",

journal = "Rheumatology",

issn = "1462-0324",

publisher = "Oxford University Press",

number = "12",

}

Di Matteo, A, Cipolletta, E, Castaniti, GMD, Smerilli, G, Airoldi, C, Aydin, SZ, Becciolini, A, Bonfiglioli, K, Bruns, A, Carrara, G, Cazenave, T, Ciapetti, A, Cosatti, MA, de Agustín, JJ, Di Carlo, M, Di Donato, E, Di Geso, L, Duran, E, Elliott, A, Estrach, C, Farisogulları, B, Fiorenza, A, Fodor, D, Gabba, A, Hernández-Díaz, C, Huang, F, Hurnakova, J, Li, L, Jesus, D, Karadag, O, Martire, MV, Massarotti, M, Michelena, X, Musca, AA, Nair, J, Okano, T, Papalopoulos, I, Rosemffet, M, Rovisco, J, Rozza, D, Salaffi, F, Satulu, I, Scioscia, C, Scirè, CA, Sun, F, Tamas, MM, Tanimura, S, Ventura-Rios, L, Voulgari, PV, Vreju, FA, Vukatana, G, Wong, E, Yang, J, Hereter, JZ, Zanetti, A, Grassi, W & Filippucci, E 2022, 'Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study', Rheumatology, vol. 61, no. 12, pp. 4863-4874. https://doi.org/10.1093/rheumatology/keac162

TY - JOUR

T1 - Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

AU - Di Matteo, Andrea

AU - Cipolletta, Edoardo

AU - Castaniti, Giulia Maria Destro

AU - Smerilli, Gianluca

AU - Airoldi, Carla

AU - Aydin, Sibel Zehra

AU - Becciolini, Andrea

AU - Bonfiglioli, Karina

AU - Bruns, Alessandra

AU - Carrara, Greta

AU - Cazenave, Tomas

AU - Ciapetti, Alessandro

AU - Cosatti, Micaela Ana

AU - de Agustín, Juan José

AU - Di Carlo, Marco

AU - Di Donato, Eleonora

AU - Di Geso, Luca

AU - Duran, Emine

AU - Elliott, Ashley

AU - Estrach, Cristina

AU - Farisogulları, Bayram

AU - Fiorenza, Alessia

AU - Fodor, Daniela

AU - Gabba, Alessandra

AU - Hernández-Díaz, Cristina

AU - Huang, Feng

AU - Hurnakova, Jana

AU - Li, Ling

AU - Jesus, Diogo

AU - Karadag, Omer

AU - Martire, Maria Victoria

AU - Massarotti, Marco

AU - Michelena, Xabier

AU - Musca, Alice Andreea

AU - Nair, Jagdish

AU - Okano, Tadashi

AU - Papalopoulos, Ioannis

AU - Rosemffet, Marcos

AU - Rovisco, João

AU - Rozza, Davide

AU - Salaffi, Fausto

AU - Satulu, Iulia

AU - Scioscia, Crescenzio

AU - Scirè, Carlo Alberto

AU - Sun, Fei

AU - Tamas, Maria Magdalena

AU - Tanimura, Shun

AU - Ventura-Rios, Lucio

AU - Voulgari, Paraksevi V.

AU - Vreju, Florentin Ananu

AU - Vukatana, Gentiana

AU - Wong, Ernest

AU - Yang, Jinshui

AU - Hereter, Johana Zacariaz

AU - Zanetti, Anna

AU - Grassi, Walter

AU - Filippucci, Emilio

PY - 2022/12

Y1 - 2022/12

N2 - ObjectivesTo investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA.MethodsIn this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs.ResultsBone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation.ConclusionsThe results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

AB - ObjectivesTo investigate the reliability of the OMERACT US Task Force definition of US enthesitis in SpA.MethodsIn this web exercise, based on the evaluation of 101 images and 39 clips of the main entheses of the lower limbs, the elementary components included in the OMERACT definition of US enthesitis in SpA (hypoechoic areas, entheseal thickening, power Doppler signal at the enthesis, enthesophytes/calcifications, bone erosions) were assessed by 47 rheumatologists from 37 rheumatology centres in 15 countries. Inter- and intra-observer reliability of the US components of enthesitis was calculated using Light’s kappa, Cohen’s kappa, Prevalence And Bias Adjusted Kappa (PABAK) and their 95% CIs.ResultsBone erosions and power Doppler signal at the enthesis showed the highest overall inter-reliability [Light’s kappa: 0.77 (0.76–0.78), 0.72 (0.71–0.73), respectively; PABAK: 0.86 (0.86–0.87), 0.73 (0.73–0.74), respectively], followed by enthesophytes/calcifications [Light’s kappa: 0.65 (0.64–0.65), PABAK: 0.67 (0.67–0.68)]. This was moderate for entheseal thickening [Light’s kappa: 0.41 (0.41–0.42), PABAK: 0.41 (0.40–0.42)], and fair for hypoechoic areas [Light’s kappa: 0.37 (0.36–0.38); PABAK: 0.37 (0.37–0.38)]. A similar trend was observed in the intra-reliability exercise, although this was characterized by an overall higher degree of reliability for all US elementary components compared with the inter-observer evaluation.ConclusionsThe results of this multicentre, international, web-based study show a good reliability of the OMERACT US definition of bone erosions, power Doppler signal at the enthesis and enthesophytes/calcifications. The low reliability of entheseal thickening and hypoechoic areas raises questions about the opportunity to revise the definition of these two major components for the US diagnosis of enthesitis.

KW - enthesitis

KW - multicenter international study

KW - power Doppler signal

KW - PsA

KW - reliability

KW - seronegative spondyloarthritis

KW - ultrasound

U2 - 10.1093/rheumatology/keac162

DO - 10.1093/rheumatology/keac162

M3 - Article

C2 - 35293988

AN - SCOPUS:85137382209

SN - 1462-0324

VL - 61

SP - 4863

EP - 4874

JO - Rheumatology

JF - Rheumatology

IS - 12

ER -

Reliability assessment of the definition of ultrasound enthesitis in SpA: results of a large, multicentre, international, web-based study

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Fingerprint

Student theses

Evaluating ultrasound confirmed enthesitis as a predictive marker for response to biologic therapy in psoriatic arthritis

Cite this