Structural damage

Working group OMERACT > Structural damage

Target domain: Structural manifestations (erosion, cartilage,malaligment)

MENTOR:

MARIA-ANTONIETTA D’AGOSTINO  

Convenors: PETER MANDL, PETER BALINT, EMILIO FILIPPUCI

Website responsible: P Mandl

fellow: Irina Gessl

Objective of the subgroup’s work: 

1. Development of a US scoring system for structural change in RA and other inflammatory arthritides

2. Investigation of reliability, truth and feasibility

3. Improve reliability and feasibility (which joints, which domains i.e. bone erosion, cartilage, joint deformity)

4. After obtaining steps 1-3, try endorsement of the instrument

What is the contribution of the subgroup work to the OMERACT work?

This group combines the work of the erosion group and the cartilage group and aims to develop an instrument to measure structural damage in RA (and eventually in PsA)

Short description of the previous work (including publications)

Development and reliability testing of a semiquantitative scoring system (0-2) for grading cartilage changes in RA. The scoring system was shown to be reliable in MCP joints but reliability in PIP joints needs to be improved. Results were published:

Mandl P, Studenic P, Filippucci E, Bachta A, Backhaus M, Bong D, Bruyn GAW, Collado P, Damjanov N, Dejaco C, Delle-Sedie A, De Miguel E, Duftner C, Gessl I, Gutierrez M, Hammer HB, Hernandez-Diaz C, Iagnocco A, Ikeda K, Kane D, Keen H, Kelly S, Kővári E, Möller I, Møller-Dohn U, Naredo E, Nieto JC, Pineda C, Platzer A, Rodriguez A, Schmidt WA, Supp G, Szkudlarek M, Terslev L, Thiele R, Wakefield RJ, Windschall D, D'Agostino MA, Balint PV. Development of semiquantitative ultrasound scoring system to assess cartilage in rheumatoid arthritis. Rheumatology (Oxford). 2019 Apr 26. pii: kez153. doi:10.1093/rheumatology/kez153.

The semiquantitative scoring system has now been validated in an independent clinical cohort:

Cipolletta E, Mandl P, Di Matteo A, Mashadi Mirza R, Passarini G, Grassi W, Filippucci E. Sonographic assessment of cartilage damage at the metacarpal head in rheumatoid arthritis: qualitative versus quantitative methods. Rheumatology (Oxford). 2022 Mar 2;61(3):1018-1025. 

An SLR on the use of US to assess structural damage has been recently performed and published:

Gessl I, Balint PV, Filippucci E, Keen HI, Pineda C, Terslev L, Wildner B, D'Agostino MA, Mandl P. Structural damage in rheumatoid arthritis assessed by musculoskeletal ultrasound: A systematic literature review by the Structural Joint Damage Task Force of the OMERACT Ultrasound Working Group. Semin Arthritis Rheum. 2021 Jun;51(3):627-639. 

A Delphi survey of statements was prepared based on a previously published systematic literature review and circulated between members of the group, including definitions on normal US appearance of joint components, scanning technique, definitions of elementary lesions and scoring systems for bone erosions and joint malalignment. Still images of metacarpophalangeal and proximal interphalangeal joints 2-5 in healthy controls and in RA patients with varying degrees of pathology were acquired by the USWG taskforce members. A dataset of 100 anonymized images, representing various grades of the 3 components of structural damage were created and utilized in two rounds of a web-based exercise. Results were reported in an abstract at EULAR 2022:

Mandl P, Gessl I, Filippou G et al. Scoring structural damage in rheumatoid arthritis by ultrasound: results from a delphi process and web-reliability exercise by the omeract us working group. Ann Rheum Dis. 2022 81(Supp 1):193.

In order to allow participants to perform actual measurements for the scoring of erosions, still images of metacarpophalangeal and proximal interphalangeal joints 2-5 in healthy controls and in RA patients with varying degrees of pathology were acquired in DICOM format by the USWG taskforce members. A dataset of 40 anonymized images, representing various grades of consensual scoring system for scoring bone erosions were created and utilized in two rounds of a web-based exercise using the CMRAD platform. Results were reported in an abstract at EULAR 2023:

Mandl P, Gessl I, Filippou G et al. An ultrasound scoring system based on the size and number of erosions is reliable in rheumatoid arthritis. Annals of the Rheumatic Diseases 2023;82:303.

Description of present work

 Next steps and discussion points structural damage

1. ·       Drafting of the manuscript about Delphi and web-based exercise

   ·       Organization of patient exercise on structural damage (2024 Q4)