학술논문
Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis.
Document Type
Academic Journal
Author
Naredo E; Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain enaredo@ser.es.; Autonomous University of Madrid, Madrid, Spain.; D'Agostino MA; Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.; Terslev L; Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Pineda C; Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.; Miguel MI; Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain.; Blasi J; Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain.; Bruyn GA; Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands.; Reumakliniek Flevoland, Lelystad, Netherlands.; Kortekaas MC; Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.; Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands.; Mandl P; Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria.; Nestorova R; Rheumatology Center 'St. Irina', Sofia, Bulgaria.; Szkudlarek M; Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.; Department of Rheumatology, Zealand's University Hospital, Køge, Denmark.; Todorov P; Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital 'Kaspela', Plovdiv, Bulgaria.; Vlad V; Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania.; Wong P; Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong.; Bakewell C; Intermountain Health Care Inc, Salt Lake City, Utah, USA.; Filippucci E; Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy.; Zabotti A; Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.; Micu M; Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania.; Vreju F; Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania.; Mortada M; Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.; Mendonça JA; Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil.; Guillen-Astete CA; Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.; Olivas-Vergara O; Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain.; Iagnocco A; Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy.; Hanova P; Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic.; Tinazzi I; Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy.; Balint PV; 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary.; Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary.; Aydin SZ; Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.; Kane D; Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland.; Keen H; School of Medicine, University of Western Australia, Perth, Western Australia, Australia.; Kaeley GS; University of Florida College of Medicine, Jacksonville, Florida, USA.; Möller I; Human Anatomy and Embryology Unit, Department of Pathology and Experimental Therapeutics, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain.; Instituto Poal de Reumatología, Barcelona, Spain.
Source
Publisher: BMJ Country of Publication: England NLM ID: 0372355 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1468-2060 (Electronic) Linking ISSN: 00034967 NLM ISO Abbreviation: Ann Rheum Dis Subsets: MEDLINE
Subject
Language
English
Abstract
Objectives: The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system.
Methods: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis.
Results: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes).
Conclusions: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
Competing Interests: Competing interests: EN: Speaker fees from Abbvie, Lilly, Novartis, Pfizer; research grant from Lilly and Abbvie; support for attending meetings from Novartis and Fresenius Kabi. MADA: Speaker fees from Abbvie, Amgen, BMS, Galapagos, Novartis, Lilly, Janssen, and UCB; consulting fees from Abbvie, Amgen, BMS, Galapagos, Novartis, Lilly, Janssen, UCB; research grant from Abbvie, Amgen, Pfizer; royalty from Elsevier; support for attending meetings from Novartis and Janssen. LT: Speaker fees from Janssen, Lilly, Novartis, Pfizer; advisory board for Janssen and UCB. CP: No competing interests. MM: No competing interests. JB: No competing interests. GAWB: No competing interests. MCK: No competing interests. PM: Speaker fees from Janssen, Lilly, Novartis, AbbVie; research grant from AbbVie and Novartis. RN: Speaker fees from Abbvie, Novartis, Pfizer, Marcin Szkudlarek: Speaker fees from Novartis; meeting support from Pfizer. PT: Speaker fees from AbbVie, Novartis, Sandoz; advisory board for Novartis. VV: No competing interests. PW: No competing interests. CB: Speaker and/or Consultancy fees from: Janssen, Lilly, Novartis, AbbVie, Pfizer, UCB, Sanofi. EF: Speaker fees from AbbVie, Amgen, Bristol-Myers Squibb, Janssen-Cilag, Lilly, Novartis, Pfizer, Union Chimique Belge Pharma. AZ: Speaker bureau from AbbVie, Novartis, Janssen, Lilly, UCB, and Amgen; paid instructor from AbbVie, Novartis, UCB. MM: Speaker fees from Eli Lilly, SC Angelini Pharmaceuticals Romania SRL, KRKA; consulting fees from Eli Lilly, Galapagos. FAV: Speaker fees from Abbvie, Ewopharma BMS, Novartis, Lilly, Janssen, Pfizer, Zentiva, UCB; advisory board Abbvie, Ewopharma, Lilly, Janssen, Pfizer. MAM: No competing interests. JAM: Speaker fees from Janssen, Novartis, UCB; advisory board for Novartis. CAG-A: Speaker fees from Janssen, Abbvie, Novartis, Pfizer; advisory fees from Novartis, Galápagos, UCB; support for attending meetings from Pfizer, Janssen, Novartis. OO-V: Speaker fees from GSK and Novartis; support for attending meetings from Pfizer, Janssen, Gebro Pharma. AI: Grants from Abbvie, Pfizer, Novartis; Honoraria from AbbVie, Alfa-sigma, BMS, Celgene, Celltrion, Eli-Lilly, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi Genzyme, SOBI; Consulting fees from Abbvie, BMS, Pfizer, Eli-Lilly; Leadership or fiduciary roles as EULAR Immediate Past President; EULAR Presidency member; EULAR Board member; EULAR Advocacy Committee Member; EULAR Advocacy Committee Advisor. PH: No competing interests. IT: No competing interests. PVB: Speaker fees from Abbvie, Eli Lilly, Jannsen, Novartis, Richter, Sandoz; support for attending meetings from Abbvie, Janssen, Novartis, Eli Lilly, Sandoz. SZA: Speaker fees from Abbvie, Novartis, Pfizer, Janssen, UCB; research grant from Abbvie, Novartis, Pfizer, Janssen, Lilly, Fresenius Kabi; support for attending meetings from Abbvie, Pfizer, UCB and Fresenius Kabi. DK: Speaker fees from Abbvie, Galapagos, Janssen, Novartis; support for attending meetings from Novartis, Abbvie, and Janssen. HIK: Clinical trials Roche, Abbvie, Sun, Emerald, Novartis, Biogen, Sanofi, and Suneos. GSK: Research grants from Abbvie, Bristol Myers Squibb, Galapagos, Novartis, JannsenIngrid Möller: No competing interests.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)
Methods: The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis.
Results: 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39-0.71) and intraobserver reliability good to excellent (κ 0.80-0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes).
Conclusions: We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated.
Competing Interests: Competing interests: EN: Speaker fees from Abbvie, Lilly, Novartis, Pfizer; research grant from Lilly and Abbvie; support for attending meetings from Novartis and Fresenius Kabi. MADA: Speaker fees from Abbvie, Amgen, BMS, Galapagos, Novartis, Lilly, Janssen, and UCB; consulting fees from Abbvie, Amgen, BMS, Galapagos, Novartis, Lilly, Janssen, UCB; research grant from Abbvie, Amgen, Pfizer; royalty from Elsevier; support for attending meetings from Novartis and Janssen. LT: Speaker fees from Janssen, Lilly, Novartis, Pfizer; advisory board for Janssen and UCB. CP: No competing interests. MM: No competing interests. JB: No competing interests. GAWB: No competing interests. MCK: No competing interests. PM: Speaker fees from Janssen, Lilly, Novartis, AbbVie; research grant from AbbVie and Novartis. RN: Speaker fees from Abbvie, Novartis, Pfizer, Marcin Szkudlarek: Speaker fees from Novartis; meeting support from Pfizer. PT: Speaker fees from AbbVie, Novartis, Sandoz; advisory board for Novartis. VV: No competing interests. PW: No competing interests. CB: Speaker and/or Consultancy fees from: Janssen, Lilly, Novartis, AbbVie, Pfizer, UCB, Sanofi. EF: Speaker fees from AbbVie, Amgen, Bristol-Myers Squibb, Janssen-Cilag, Lilly, Novartis, Pfizer, Union Chimique Belge Pharma. AZ: Speaker bureau from AbbVie, Novartis, Janssen, Lilly, UCB, and Amgen; paid instructor from AbbVie, Novartis, UCB. MM: Speaker fees from Eli Lilly, SC Angelini Pharmaceuticals Romania SRL, KRKA; consulting fees from Eli Lilly, Galapagos. FAV: Speaker fees from Abbvie, Ewopharma BMS, Novartis, Lilly, Janssen, Pfizer, Zentiva, UCB; advisory board Abbvie, Ewopharma, Lilly, Janssen, Pfizer. MAM: No competing interests. JAM: Speaker fees from Janssen, Novartis, UCB; advisory board for Novartis. CAG-A: Speaker fees from Janssen, Abbvie, Novartis, Pfizer; advisory fees from Novartis, Galápagos, UCB; support for attending meetings from Pfizer, Janssen, Novartis. OO-V: Speaker fees from GSK and Novartis; support for attending meetings from Pfizer, Janssen, Gebro Pharma. AI: Grants from Abbvie, Pfizer, Novartis; Honoraria from AbbVie, Alfa-sigma, BMS, Celgene, Celltrion, Eli-Lilly, Galapagos, Gilead, Janssen, MSD, Novartis, Pfizer, Sanofi Genzyme, SOBI; Consulting fees from Abbvie, BMS, Pfizer, Eli-Lilly; Leadership or fiduciary roles as EULAR Immediate Past President; EULAR Presidency member; EULAR Board member; EULAR Advocacy Committee Member; EULAR Advocacy Committee Advisor. PH: No competing interests. IT: No competing interests. PVB: Speaker fees from Abbvie, Eli Lilly, Jannsen, Novartis, Richter, Sandoz; support for attending meetings from Abbvie, Janssen, Novartis, Eli Lilly, Sandoz. SZA: Speaker fees from Abbvie, Novartis, Pfizer, Janssen, UCB; research grant from Abbvie, Novartis, Pfizer, Janssen, Lilly, Fresenius Kabi; support for attending meetings from Abbvie, Pfizer, UCB and Fresenius Kabi. DK: Speaker fees from Abbvie, Galapagos, Janssen, Novartis; support for attending meetings from Novartis, Abbvie, and Janssen. HIK: Clinical trials Roche, Abbvie, Sun, Emerald, Novartis, Biogen, Sanofi, and Suneos. GSK: Research grants from Abbvie, Bristol Myers Squibb, Galapagos, Novartis, JannsenIngrid Möller: No competing interests.
(© Author(s) (or their employer(s)) 2024. No commercial re-use. See rights and permissions. Published by BMJ on behalf of EULAR.)