TY - JOUR

T1 - Development and validation of an OMERACT ultrasound scoring system for the extent of calcium pyrophosphate crystal deposition at the joint level and patient level

AU - Sirotti, Silvia

AU - Terslev, Lene

AU - Filippucci, Emilio

AU - Iagnocco, Annamaria

AU - Moller, Ingrid

AU - Naredo, Esperanza

AU - Vreju, Florentin A.

AU - Adinolfi, Antonella

AU - Becce, Fabio

AU - Hammer, Hilde Berner

AU - Cazenave, Tomas

AU - Cipolletta, Edoardo

AU - Christiansen, Sara Nysom

AU - Delle Sedie, Andrea

AU - Diaz, Mario

AU - Figus, Fabiana

AU - Mandl, Peter

AU - MacCarter, Daryl

AU - Mortada, Mohamed A.

AU - Mouterde, Gael

AU - Porta, Francesco

AU - Reginato, Anthony M.

AU - Schmidt, Wolfgang A

AU - Serban, Teodora

AU - Wakefield, Richard J

AU - Zufferey, Pascal

AU - Sarzi-Puttini, Piercarlo

AU - Zanetti, Anna

AU - Damiani, Arianna

AU - Pineda, Carlos

AU - Keen, Helen I

AU - D'Agostino, Maria Antonieta

AU - Filippou, Georgios

AU - OMERACT Ultrasound working group-CPPD subgroup

N1 - Publisher Copyright: © 2023 Elsevier Ltd

PY - 2023

Y1 - 2023

N2 - Background: The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. Methods: In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. Findings: The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image—ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79–1·00] and κ 0·84 [0·79–0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). Interpretation: This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. Funding: The Italian Ministry of Health - Ricerca Corrente.

AB - Background: The Calcium Pyrophosphate Deposition (CPPD) subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound working group was established to validate ultrasound as an outcome measure instrument for CPPD, and in 2017 has developed and validated standardised definitions for elementary lesions for the detection of calcium pyrophosphate crystals in joints. The aim of this study was to develop and evaluate the reliability of a consensus-based ultrasound scoring system for CPPD extent, representing the next phase in the OMERACT methodology. Methods: In this study the novel scoring system for CPPD was developed through a stepwise process, following an established OMERACT ultrasound methodology. Following a previous systematic review to gather available evidence on existing scoring systems for CPPD, the novel scoring system was developed through a Delphi survey based on the expert opinion of the members of the OMERACT Ultrasound working group-CPPD subgroup. The reliability of the scoring system was then tested on a web-based and patient-based exercise. Intra-reader and inter-reader reliability of the new scoring system was assessed using weighted Light's κ coefficients. Findings: The four-grade semiquantitative scoring system consisted of: grade 0 (no findings consistent with CPPD), grade 1 (≤3 single spots or 1 small deposit), grade 2 (>3 single spots or >1 small deposit or ≥1 larger deposit occupying ≤50% of the structure under examination in the reference image—ie, the scanning view with the highest grade of depositions), and grade 3 (deposits that occupy more than 50% of the structure under examination in the reference image). The score should be applied to the knee (menisci and hyaline cartilage) and the triangular fibrocartilage complex of the wrist. The intra-reader and inter-reader reliabilities on static images were almost perfect (κ 0·90 [95% CI 0·79–1·00] and κ 0·84 [0·79–0·88]), and on the eight patients recruited (four [50%] female and four [50%] male) were substantial (κ 0·72 [95% CI 0·47 to 0·96] and 0·66 [0·61 to 0·71]). Interpretation: This OMERACT ultrasound scoring system for CPPD was reliable on both static images and patients. The scoring system might be a valuable tool for ensuring valid and comparable results in clinical trials and could help monitor the extent of crystal deposition in patients with CPPD in clinical practice. Funding: The Italian Ministry of Health - Ricerca Corrente.

U2 - 10.1016/S2665-9913(23)00136-4

DO - 10.1016/S2665-9913(23)00136-4

M3 - Journal article

C2 - 38251579

AN - SCOPUS:85165712092

VL - 5

SP - e474-e482

JO - The Lancet Rheumatology

JF - The Lancet Rheumatology

SN - 2665-9913

IS - 8

ER -