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.


Less-Experienced Rheumatologists Can Improve Agreement in the Detection of Clinical Synovitis Through Consensus in Rheumatoid Arthritis (RA).

Cheung1,  Peter, Andre2,  Vincent, Balandraud3,  Natalie, Chales4,  Gerard H., Chary-Valckaneare5,  Isabelle, Chatelus6,  Emmanuel, Dernis2,  Emmanuelle

Hospital Cochin, Paris, France
Hopital Bicetre, Paris, France
Hopital de Roger Salengro, Lille, France
Lariboisière Hospital, Paris, France
Hopitaux de Toulouse, Toulouse, France
CHU Clermont-Ferrand, Clermont-Ferrand, France
Paris-Descartes University, Cochin Hospital, Paris, France
Cochin Hospital, Paris, France
Centre Hospitalier, Le Mans, France
Hopital de la Conception, Marseilles, France
CHR—Hopital Sud, Rennes, France
Hopital de Brabois, Nancy, France
Hopital Hautepierre, Strasbourg, France
CH Grenoble Hopital Sud, Grenoble, France
CHU La Cavale Blanche, Brest, France
Hopital Lapeyronie, Montpellier, France

Background/Purpose:

Synovitis assessment through evaluation of swollen joints (SJ) is integral in steering treatment decisions in RA, and in determining clinical remission. Studies indicate agreement in the assessment of SJ is low; there is limited data on practical methods of achieving consensus at the "joint level" among rheumatologists. The aim was to assess if a short collegiate consensus, would improve SJ agreement between rheumatologists, and whether this improvement was affected by experience.

Methods:

18 rheumatologists from French rheumatology University units participated in a half day national initiative. Clinicians were divided into groups of 4–5 and underwent two 30-minute rounds evaluating SJ in 9 RA patients with moderate disease activity, followed by short consensus discussions. Rheumatologists then assessed one additional patient as measurement of their final SJ agreement. Agreement was evaluated at the joint level, and according to level of experience of the rheumatologist; newly-qualified (<5 years), experienced (5–10 years) and very experienced (>10 years), expressed as kappa (k), proportion of positive agreement (synovitis) and negative agreement (no synovitis).

Results:

In all, 9 male and 9 female rheumatologists participated, with median 9.5 years (Q1:Q3, 2.8:14.3) of experience. As seen in Table 1, there was only moderate agreement globally, with initial k=0.50 (95%CI 0.41–0.59) and no improvement over the 3 rounds. Rheumatologists agreed on the presence of synovitis 60% of the time and on the absence of synovitis 90% of the time, also with no improvement over the 3 rounds. When agreement was analyzed according to level of experience, SJ agreement of the "recently qualified" rheumatologists improved with k=0.28 (95%CI 0.05–0.51) going up to k=0.54 (95%CI 0.38–0.70) when compared to "very experienced" rheumatologists; and k=0.33 (95%CI 0.15–0.51) to k=0.47 (95%CI 0.31–0.64) when compared with "experienced" rheumatologists. The proportion of positive agreement (synovitis) between "recently qualified" and "very experienced" rheumatologists also increased from 40% to 64%. On the other hand, agreement between an "experienced" versus a "very experienced" rheumatologist was good initially, with k=0.74 (95%CI 0.61–0.87), but decreased over the subsequent 2 rounds.

Table 1. Agreement of swollen joints among the 18 rheumatologists and categorized according to level of experience

 GlobalRecently qualified vs ExperiencedRecently qualified vs Very ExperiencedExperienced vs Very Experienced
Round 1    
Kappa (95%CI)0.50 (0.41, 0.59)0.33 (0.15, 0.51)0.28 (0.05, 0.51)0.74 (0.61,0.87)
Positive Agreement60%44%40%81%
Negative Agreement90%88%87%93%
Disagreement31%19%21%10%
Round 2    
Kappa (95%CI)0.53 (0.46, 0.60)0.49 (0.36, 0.63)0.53 (0.37, 0.68)0.42 (0.24,0.59)
Positive Agreement61%63%63%54%
Negative Agreement87%87%88%86%
Disagreement33%20%17%21%
Round 3    
Kappa (95%CI)0.52 (0.44, 0.60)0.47 (0.31, 0.64)0.54 (0.38, 0.70)0.42 (0.24,0.61)
Positive Agreement58%56%64%53%
Negative Agreement90%91%90%88%
Disagreement33%15%15%18%

Conclusion:

"Recently trained" rheumatologists appeared to have improved their level of SJ agreement with a more senior rheumatologist although global SJ agreement for the study group did not change.

To cite this abstract, please use the following information:
Cheung, Peter, Andre, Vincent, Balandraud, Natalie, Chales, Gerard H., Chary-Valckaneare, Isabelle, Chatelus, Emmanuel, et al; Less-Experienced Rheumatologists Can Improve Agreement in the Detection of Clinical Synovitis Through Consensus in Rheumatoid Arthritis (RA). [abstract]. Arthritis Rheum 2011;63 Suppl 10 :2050
DOI:

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