Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis

Esperanza Naredo^{1

2}, Maria Antonietta D'Agostino³, Lene Terslev^{4

5}, Carlos Pineda⁶, M Isabel Miguel⁷, Joan Blasi⁸, George A Bruyn^{9

10}, Marion C Kortekaas^{11

12}, Peter Mandl¹³, Rodina Nestorova¹⁴, Marcin Szkudlarek^{5

15}, Plamen Todorov¹⁶, Violeta Vlad¹⁷, Priscilla Wong¹⁸, Catherine Bakewell¹⁹, Emilio Filippucci²⁰, Alen Zabotti²¹, Mihaela Micu²², Florentin Vreju²³, Mohamed Mortada²⁴, José Alexandre Mendonça²⁵, Carlos A Guillen-Astete²⁶, Otto Olivas-Vergara²⁷, Annamaria Iagnocco²⁸, Petra Hanova²⁹, Ilaria Tinazzi³⁰, Peter V Balint^{31

32}, Sibel Zehra Aydin³³, David Kane³⁴, Helen Keen³⁵, Gurjit S Kaeley³⁶, Ingrid Möller^{7

37}

Affiliations

¹ Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain enaredo@ser.es.
² Autonomous University of Madrid, Madrid, Spain.
³ Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.
⁴ Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
⁵ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁶ Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
⁷ 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.
⁸ Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain.
⁹ Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands.
¹⁰ Reumakliniek Flevoland, Lelystad, Netherlands.
¹¹ Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
¹² Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands.
¹³ Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria.
¹⁴ Rheumatology Center "St. Irina", Sofia, Bulgaria.
¹⁵ Department of Rheumatology, Zealand's University Hospital, Køge, Denmark.
¹⁶ Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital "Kaspela", Plovdiv, Bulgaria.
¹⁷ Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania.
¹⁸ Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong.
¹⁹ Intermountain Health Care Inc, Salt Lake City, Utah, USA.
²⁰ Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy.
²¹ Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
²² Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania.
²³ Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania.
²⁴ Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
²⁵ Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil.
²⁶ Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
²⁷ Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain.
²⁸ Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy.
²⁹ Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic.
³⁰ Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy.
³¹ 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary.
³² Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary.
³³ Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³⁴ Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland.
³⁵ School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
³⁶ University of Florida College of Medicine, Jacksonville, Florida, USA.
³⁷ Instituto Poal de Reumatología, Barcelona, Spain.

PMID: 38531611
DOI: 10.1136/ard-2023-225278

Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis

Esperanza Naredo et al. Ann Rheum Dis. 2024.

. 2024 Jul 15;83(8):1060-1071.

doi: 10.1136/ard-2023-225278.

Authors

Affiliations

¹ Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Madrid, Spain enaredo@ser.es.
² Autonomous University of Madrid, Madrid, Spain.
³ Department of Rheumatology, Università Cattolica del Sacro Cuore, Policlinico Universitario Agostino Gemelli IRCSS, Rome, Italy.
⁴ Center for Rheumatology and Spine Diseases, Rigshospitalet, Copenhagen, Denmark.
⁵ Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
⁶ Division of Musculoskeletal and Rheumatic Disorders, Instituto Nacional de Rehabilitacion Luis Guillermo Ibarra Ibarra, Mexico City, Mexico.
⁷ 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.
⁸ Histology Unit, Faculty of Medicine and Health Sciences (Campus de Bellvitge), University of Barcelona, Barcelona, Spain.
⁹ Tergooi MC Hospital, Hilversum and Reumakliniek Lelystad, Lelystad, Netherlands.
¹⁰ Reumakliniek Flevoland, Lelystad, Netherlands.
¹¹ Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
¹² Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands.
¹³ Department of Internal Medicine III, Division of Rheumatology, Medical University Vienna, Wien, Austria.
¹⁴ Rheumatology Center "St. Irina", Sofia, Bulgaria.
¹⁵ Department of Rheumatology, Zealand's University Hospital, Køge, Denmark.
¹⁶ Department of Internal Disease Propaedeutics and Rheumatology, Medical University of Plovdiv, Clinic of Rheumatology, University Hospital "Kaspela", Plovdiv, Bulgaria.
¹⁷ Rheumatology, Clinical Hospital Sf Maria, Bucharest, Romania.
¹⁸ Virtus Medical Group, Hong Kong SAR, Hong Kong, Hong Kong.
¹⁹ Intermountain Health Care Inc, Salt Lake City, Utah, USA.
²⁰ Rheumatology Unit, Department of Clinical and Molecular Sciences, Polytechnic University of Marche, Jesi, Italy.
²¹ Rheumatology Clinic, Department of Medicine, University of Udine, c/o Azienda Sanitaria Universitaria Friuli Centrale, Udine, Italy.
²² Rheumatology Division, 2nd Rehabilitation Department, Spitalul Clinic de Recuperare Cluj-Napoca, Cluj-Napăoca, Romania.
²³ Rheumatology Department, University of Medicine and Pharmacy Craiova, Craiova, Romania.
²⁴ Rheumatology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt.
²⁵ Postgraduate Program in Health Sciences/Rheumatology/Ultrasonography Service, Pontifical Catholic University of Campinas, Sao Paulo, Brazil.
²⁶ Department of Rheumatology, Hospital Universitario Ramón y Cajal, Madrid, Spain.
²⁷ Department of Rheumatology and Joint and Bone Research Unit, Hospital Universitario Fundación Jiménez Díaz, IIS-FJD, Autonomous University, Madrid, Spain.
²⁸ Academic Rheumatology Centre, Department of Clinical and Biological Sciences, Università degli Studi di Torino, Turin, Italy.
²⁹ Department of Rheumatology, Institute of Rheumatology, Prague, Czech Republic.
³⁰ Rheumatology Unit, IRCCS Sacro Cuore Don Calabria, Negrar, Italy.
³¹ 3rd Rheumatology Department, National Institute of Musculoskeletal Diseases, Budapest, Hungary.
³² Musculoskeletal Radiology Group, Medical Imaging Clinic, Semmelweis University, Budapest, Hungary.
³³ Division of Rheumatology, University of Ottawa, the Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
³⁴ Department of Rheumatology, Tallaght University Hospital, Dublin, Ireland.
³⁵ School of Medicine, University of Western Australia, Perth, Western Australia, Australia.
³⁶ University of Florida College of Medicine, Jacksonville, Florida, USA.
³⁷ Instituto Poal de Reumatología, Barcelona, Spain.

PMID: 38531611
DOI: 10.1136/ard-2023-225278

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.

Keywords: Arthritis, Psoriatic; Inflammation; Synovitis; Ultrasonography.

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Conflict of interest statement

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.

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Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis

Affiliations

Validation and incorporation of digital entheses into a preliminary GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis

Authors

Affiliations

Abstract

Conflict of interest statement

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LinkOut - more resources

Full Text Sources

Medical