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Defining Enthesitis in Spondyloarthritis by Ultrasound: Results of a Delphi Process and of a Reliability Reading Exercise

2013; Wiley; Volume: 66; Issue: 5 Linguagem: Inglês

10.1002/acr.22191

2151-4658

Lene Terslev, Esperanza Naredo, Annamaria Iagnocco, P Bálint, Richard J. Wakefield, Philippe Aegerter, Sibel Zehra Aydın, Artur Bachta, Hilde Berner Hammer, George A. W. Bruyn, Emilio Filippucci, Frédérique Gandjbakhch, Péter Mandl, Carlos Pineda, Wolfgang Schmidt, Maria Antonietta D’Agostino,

Rheumatoid Arthritis Research and Therapies

To standardize ultrasound (US) in enthesitis.An initial Delphi exercise was undertaken to define US-detected enthesitis and its core components. These definitions were subsequently tested on static images taken from spondyloarthritis patients in order to evaluate their reliability.Excellent agreement (>80%) was obtained for including hypoechogenicity, increased thickness of the tendon insertion, calcifications, enthesophytes, erosions, and Doppler activity as core elementary lesions of US-detected enthesitis. US definitions were subsequently obtained for each elementary component. On static images, the intraobserver reliability showed a high degree of variability for the detection of elementary lesions, with kappa coefficients ranging from 0.13-1. The interobserver kappa values were variable, with the lowest kappa coefficient for enthesophytes (0.24) and the highest coefficient for Doppler activity at the enthesis (0.63).This is the first consensus-based US definition of enthesitis and its elementary components and the first step performed to ensure a higher degree of homogeneity and comparability of results between studies and in daily clinical work.