Abstract
The shoulder may be affected in a large portion of patients with rheumatoid arthritis
(RA) worldwide. However, this joint does not receive the attention required during
follow-up. Indeed, although numerous clinical tests for diagnosis of a painful shoulder
are available, differentiating articular from peri-articular lesions may be difficult
in daily practice. Fortunately, the precise diagnosis of shoulder pain in RA has benefited
from a reliable imaging modality used to detect its exact origin—ultrasonography (US).
This study was aimed at assessing the intra- and inter-observer reliability of ultrasonographic
findings for patients with established RA with shoulder pain in a patient-based exercise
as a clinical challenge among Maghrebian rheumatologist experts in US. A total of
7 operators examined 10 patients in two rounds independently and blindly of each other.
Before beginning the session, all of the rheumatologists reached a consensus on sites
and US settings by performing a brief exercise on a normal shoulder. Outcome Measures
in Rheumatology Clinical Trials (OMERACT) definitions of US-detected pathologies were
used. Each patient underwent US scanning of the painful shoulder in predefined sites
based on US technical guidelines of the European Society of Musculoskeletal Radiology:
long head of biceps (LHB), subscapularis recess, posterior recess and axillary recess.
The presence of subdeltoid or subcoracoid bursitis or full rupture of the suprasupinatus
was identified if present. Intra- and inter-observer reliability measures were calculated
using the κ coefficient. Intra-observer reliability was good for gray-scale (GS) synovitis
in subscapularis and posterior recesses (κ = 0.77 and 0.73, respectively). It was
moderate in the presence of GS synovitis and effusion in LHB (κ =0.53 and 0.40, respectively),
posterior and subscapularis recess effusion (κ = 0.56 and 0.60, respectively) and
GS and power Doppler (PD) synovitis in axillary recesses (κ = 0.58 and 0.49, respectively).
Inter-observer reliability was good for PD for LHB signals (κ = 0.78). It was moderate
for GS for LHB synovitis (κ = 0.54). Inter-observer agreement was poor for effusion
and GS synovitis for subscapularis, posterior and axillary recesses, and very poor
for PD signals in these recesses. US was a reliable imaging tool for detecting tenosynovitis
in the LHB. However, reliability was moderate to poor in detecting synovitis in subscapularis,
posterior and axillary recesses. These findings could be optimized by standardization
of sites to assess.
Key Words
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Article info
Publication history
Published online: September 29, 2021
Accepted:
August 10,
2021
Received in revised form:
August 9,
2021
Received:
September 16,
2020
Identification
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