Reliability of ultrasound assessment of elementary lesions in psoriatic arthritis and development of a reference dactylitis atlas.
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Jousse-Joulin Sandrine, D'Agostino Maria A, Mouterde Gael, Naredo Esperanza, Gossec Laure, Gaujoux-Viala Cécile, Goupille Philippe, Wendling Daniel, Berenbaum Francis, Constantin Arnaud, Richette Pascal, Devauchelle-Pensec Valerie, Combe Bernard, Simon David, Villoutreix Caroline, Louati Karine, Fogel Olivier, Ottaviani Sebastien, Mammou Saloua, Amouzougan Adamah, Brault Rachel, Chary-Valckenaere Isabelle, Chatelus Emmanuel, Couderc Marion, Dawidowicz Karen, Delepine Camille, Denis Amélie, Ducoulombier Vincent, Frazier Aline, Ferrero Stéphanie, Gastaldi Romain, Hua Charlotte, Goff Benoit Le, Moyano Chantal, Padovano Ilarie, Philippe Peggy, Robin François, Ruyssen-Witrand Adeline, Salliot Carine, Verhoeven Frank, Wirth Theo, Audureau Etienne, Gandjbakhch Frédérique, Claudepierre Pascal
Аннотация
METHODS: A cross-sectional study was conducted to analyse the reliability of pPsA US lesions, as a first step in an ongoing predictive cohort (APACHE, NCT03768271) study. Three web-based reliability exercises were carried out between 2020 and 2024. Inter-rater and intra-rater reliability were assessed using Light's kappa (κ). During the third reliability exercise, a reference atlas of elementary US lesions in dactylitis was developed.
RESULTS: Experienced and trainee sonographers from 30 recruiting centres participated into the study. In step 1, intra-reader kappas were moderate-to-good for synovitis (0.50-0.80), tenosynovitis (0.51-0.63), enthesitis (0.62-0.73), and poor for dactylitis (0.31-0.47); inter-reader kappas were lower for synovitis (0.32-0.70), tenosynovitis (0.40-0.49), enthesitis (0.47-0.60) and dactylitis (0.13-0.24). In Step 2, reliability improved notably in expert and trainees except for dactylitis [intra-reader: synovitis (0.81-0.90), tenosynovitis (0.66-0.83), enthesitis (0.61-0.81), dactylitis (0.37-0.47); inter-reader: synovitis c(0.72-0.84), tenosynovitis (0.55-0.76), enthesitis (0.37-0.59), dactylitis (0.12-0.30)]. Step 3 achieved moderate-to-good reliability for dactylitis (intra 0.69-0.80, inter 0.46-0.68). An atlas was produced based on expert consensus and lesion identification rates among sonographers.
CONCLUSION: Standardized training was associated with a marked improvement in intra- and inter-reader reliability for the assessment of elementary pPsA lesions. The consensus-based US atlas provides practical guidance for identifying challenging dactylitis-related lesions in clinical and research settings.