Arthritis & Rheumatism, Volume 63,
November 2011 Abstract Supplement

Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Chicago, Illinois November 4-9, 2011.

Are Training Sessions Useful for Ultrasound Scan Evaluation of Synovitis In Rheumatoid Arthritis?

Ponce1,  Andrés, Alegre2,  Juan J., Castano3,  Manuel, Gutierrez-Polo4,  Ricardo, Jimenez-Nunez5,  Francisco G., Macarron6,  María P., Garrido7,  Jesús

Hospital General de Granollers, Granollers, Spain
Hospital Universitario Dr Peset, Valencia, Spain
Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
C.H. de Navarra, Pamplona, Spain
Hospital Regional Universitario Carlos Haya., Malaga, Spain
Hospital Clínico San Carlos, Madrid, Spain
Facultad de Psicología.Universidad Autónoma de Madrid, Madrid, Spain


US is becoming a realistic tool for synovitis assessment in rheumatoid arthritis (RA), although reliability remains as a challenging issue. Therefore, training sessions (TS) are needed to improve the intra and inter-observer reliability. However, the improvement in reliability due to TS has not been quantified. The aim of this study is to measure the reliability of the US evaluation for different joints, both before and after TS.


6 rheumatologists expert in US evaluated the presence of synovitis and PD signal in 173 static images of joints from RA patients (45 wrists, 27 metacarpophalangeals, 25 ankles, 36 metatarsophanlangeals, 20 knees, and 20 elbows) recorded in a regular clinical setting by 65 different rheumatologists, with evaluation time limited to 1 minute per image. Fifteen to thirty days later they took a second evaluation of the images of a joint assigned to each researcher (Pre-TS). One month later a 3-hour standardization and training session (TS) took place. Fifteen days after that the rheumatologists evaluated the images following the same procedure, first all the images and, 15–30 days apart, images of assigned joint (Post-TS). Intra and inter-observer kappa were calculated, both pre-TS and post-TS.


The intra- and inter-observer kappa values for each joint, pre-TS and post-TS, are shown in the following table:

 Intra-observer kappaInter-observer kappa
 Power DopplerGrey scalePower DopplerGrey scale

After TS the magnitude of the reliability statistic kappa increased mainly for those joints that showed the lowest kappa values at the pre-TS evaluation.


The intra an inter-observer reliability in the evaluation of the static images, taken in regular clinical settings, improve clearly after a training session.

To cite this abstract, please use the following information:
Ponce, Andrés, Alegre, Juan J., Castano, Manuel, Gutierrez-Polo, Ricardo, Jimenez-Nunez, Francisco G., Macarron, María P., et al; Are Training Sessions Useful for Ultrasound Scan Evaluation of Synovitis In Rheumatoid Arthritis? [abstract]. Arthritis Rheum 2011;63 Suppl 10 :191

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