Document Detail

Improving agreement in assessment of synovitis in rheumatoid arthritis.
MedLine Citation:
PMID:  22999909     Owner:  NLM     Status:  Publisher    
OBJECTIVE: Synovitis assessment through evaluation of swollen joints is integral in steering treatment decisions in rheumatoid arthritis (RA). However, there is high inter-observer variation. The objective was to assess if a short collegiate consensus would improve swollen joint agreement between rheumatologists and whether this was affected by experience. METHODS: Eighteen rheumatologists from French university rheumatology units participated in three 30minutes rounds over a half day meeting evaluating joint counts of RA patients in small groups, followed by short consensus discussions. Agreement was evaluated at the end of each round as follows: (i) global agreement of swollen joints (ii) swollen joint agreement according to level of experience of the rheumatologist (iii) swollen joint count and (iv) agreement of disease activity state according to the Disease Activity Score (DAS28). Agreement was calculated using percentage agreement and kappa. RESULTS: Global agreement of swollen joints failed to improve (kappa 0.50 to 0.52) at the joint level. Agreement between seniors did not improve but agreement between newly qualified rheumatologists and their senior peer, which was initially poor (kappa 0.28), improved significantly (to 0.54) at the end of the consensus exercises. Concordance of DAS28 activity states improved from 71% to 87%. CONCLUSION: Consensus exercises for swollen joint assessment is worthwhile and may potentially improve agreement between clinicians in clinical synovitis and disease activity state, benefit was mostly observed in newly qualified rheumatologists.
Peter P Cheung; Maxime Dougados; Vincent Andre; Nathalie Balandraud; Gérard Chales; Isabelle Chary-Valckenaere; Emmanuel Chatelus; Emmanuelle Dernis; Ghislaine Gill; Mélanie Gilson; Sandrine Guis; Gael Mouterde; Stephan Pavy; François Pouyol; Thierry Marhadour; Pascal Richette; Adeline Ruyssen-Witrand; Martin Soubrier; Laure Gossec
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-9-19
Journal Detail:
Title:  Joint, bone, spine : revue du rhumatisme     Volume:  -     ISSN:  1778-7254     ISO Abbreviation:  Joint Bone Spine     Publication Date:  2012 Sep 
Date Detail:
Created Date:  2012-9-24     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100938016     Medline TA:  Joint Bone Spine     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
Copyright © 2012 Société française de rhumatologie. Published by Elsevier SAS. All rights reserved.
Medicine faculty, Paris-Descartes university, Cochin hospital, UPRES-EA 4058, AP-HP, Rheumatology B, Paris, France; Division of Rheumatology, National University Health System, 1E, Kent-Ridge road, Tower Block Level 10, 119228, Singapore. Electronic address:
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