Esperanza Naredo

Publications (44)176.46 Total impact

• Article: EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis.

  Alexandra N Colebatch, Christopher John Edwards, Mikkel Ostergaard, Désirée van der Heijde, Peter V Balint, Maria-Antonietta D'Agostino, Kristina Forslind, Walter Grassi, Espen A Haavardsholm, Glenn Haugeberg, [......], Robert Bm Landewé, Esperanza Naredo, Philip J O'Connor, Ben Ostendorf, Kristina Potocki, Wolfgang A Schmidt, Josef S Smolen, Sekib Sokolovic, Iain Watt, Philip G Conaghan
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  ABSTRACT: OBJECTIVE: To develop evidence-based recommendations on the use of imaging of the joints in the clinical management of rheumatoid arthritis (RA). METHODS: The task force comprised an expert group of rheumatologists, radiologists, methodologists and experienced rheumatology practitioners from 13 countries. Thirteen key questions on the role of imaging in RA were generated using a process of discussion and consensus. Imaging modalities included were conventional radiography, ultrasound, MRI, CT, dual-emission x-ray absorptiometry, digital x-ray radiogrammetry, scintigraphy and positron emission tomography. Research evidence was searched systematically for each question using MEDLINE, EMBASE and Cochrane CENTRAL. The experts used the evidence obtained from the relevant studies to develop a set of 10 recommendations. The strength of recommendation was assessed using a visual analogue scale. RESULTS: A total of 6888 references was identified from the search process, from which 199 studies were included in the systematic review. Ten recommendations were produced encompassing the role of imaging in making a diagnosis of RA, detecting inflammation and damage, predicting outcome and response to treatment, monitoring disease activity, progression and remission. The strength of recommendation for each proposition varied according to both the research evidence and expert opinion. CONCLUSIONS: Ten key recommendations for the role of imaging in the management of RA were developed using research-based evidence and expert opinion.
  Annals of the rheumatic diseases 03/2013; · 8.11 Impact Factor
• Article: Three-dimensional Volumetric Ultrasound: A Valid Method for Blinded Assessment of Response to Therapy in Rheumatoid Arthritis.

  Esperanza Naredo, Carlos Acebes, Elia Brito, Juan José de Agustín, Eugenio de Miguel, Lucía Mayordomo, Ingrid Möller, Carmen Moragues, Eduardo Rejón, Ana Rodriguez, Jacqueline Uson, Jesús Garrido, David Martínez-Hernández
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  ABSTRACT: OBJECTIVE: To assess the responsiveness and repeatability of volumetric power Doppler ultrasound (PDUS) evaluation of synovitis and bone erosions in rheumatoid arthritis (RA). METHODS: Twenty-three patients with RA (19 women, mean age 52.7 ± 12.6 yrs, mean disease duration 10.1 ± 8.6 yrs) were prospectively enrolled. All patients were beginning therapy with rituximab because of disease activity despite therapy with synthetic disease-modifying antirheumatic drugs and tumor necrosis factor-blocking agents. Patients underwent clinical, laboratory, and volumetric PDUS examination at baseline, 6 months, and 12 months. Ten centers participated in the study. Four centers recruited the patients and performed the volumetric acquisitions of PDUS images, while the remaining 6 centers assessed the PDUS volumes, blinded to the identity of patients and date of the visits. The most symptomatic hand and foot were scored for B-mode synovitis, synovial PD signal, and bone erosions. The repeatability of the volumetric PDUS assessment was investigated. RESULTS: An overall improvement in clinical and PDUS measurements was found at the followup assessments. The mean indexes for synovial PD signal and bone erosions and the number of sites with abnormalities decreased significantly throughout the followup (p < 0.05). The intraacquisition, intrareader reliability was excellent for all PDUS measurements (intraclass correlation coefficients > 0.9). CONCLUSION: The results of our pilot study suggest that volumetric PDUS can be responsive and repeatable in multicenter cohort studies of RA. This technique may minimize assessment biases and reduce acquisition variability in open-label and observational studies.
  The Journal of Rheumatology 01/2013; · 3.69 Impact Factor
• Source

  Available from: José Luis Andreu

  Article: Situation of Spanish echography in Spanish rheumatology 2012.

  Eugenio de Miguel, Jose Luis Andreu, Esperanza Naredo, Ingrid Möller
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  ABSTRACT: OBJECTIVE: To know the situation of ultrasound in Spanish rheumatology. METHODS: A National survey addressed to all rheumatology units in hospitals with at least 200 beds. The questionnaire studied: a) the availability and the model of the ultrasound equipment, b) the degree of training, c) the purpose and areas of ultrasound examination, d) the usefulness, and e) the relevance of ultrasound in the training of residents. RESULTS: 169 units of the 234 surveyed physicians answered the questionnaire. The availability of ultrasound equipment was high (90%), 38.7% of rheumatologists use ultrasound, although half of the units had a rheumatologist especially dedicated to performing them. Training plans have enabled the incorporation of ultrasound, but there are areas that could be improved. The utility in routine clinical practice was scored at 7.8 (0-10), and ultrasound was integrated in the diagnostic and therapeutic decisions. There is a broad consensus on the need to include ultrasound in the training of residents. Administration is adding ultrasound to the portfolio of specialty services. CONCLUSIONS: In just 15 years, ultrasound has become available in 90% of rheumatology units from being previously inexistent. Its use is extensive, integrated into clinical practice and linked to the decision making processes. Training plans have been effective, but areas for improvement were identified, and there is a broad consensus on the need to integrate ultrasound in residents' training.
  Reumatologia clinica. 10/2012;
• Article: Automated radiofrequency-based US measurement of common carotid intima-media thickness in RA patients treated with synthetic vs synthetic and biologic DMARDs.

  Esperanza Naredo, Ingrid Möller, Alfonso Corrales, David A Bong, Tatiana Cobo-Ibáñez, Hector Corominas, Ma Luz Garcia-Vivar, Pilar Macarrón, Teresa Navio, Patricia Richi, Annamaria Iagnocco, Jesús Garrido, David Martínez-Hernández
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  ABSTRACT: Objective. To compare the carotid intima-media thickness (IMT) assessed with automated radiofrequency-based US in RA patients treated with synthetic vs synthetic and biologic DMARDs and controls.Methods. Ninety-four RA patients and 94 sex- and age-matched controls were prospectively recruited at seven centres. Cardiovascular (CV) risk factors and co-morbidities, RA characteristics and therapy were recorded. Common carotid artery (CCA)-IMT was assessed in RA patients and controls with automated radiofrequency-based US by the same investigator at each centre.Results. Forty-five (47.9%) RA patients had been treated with synthetic DMARDs and 49 (52.1%) with synthetic and biologic DMARDs. There were no significant differences between the RA patients and controls in demographics, CV co-morbidities and CV disease. There were significantly more smokers among RA patients treated with synthetic and biologic DMARDs (P = 0.036). Disease duration and duration of CS and synthetic DMARD therapy was significantly longer in RA patients treated with synthetic and biologic DMARDs (P < 0.0005). The mean CCA-IMT was significantly greater in RA patients treated only with synthetic DMARDs than in controls [591.4 (98.6) vs 562.1 (85.8); P = 0.035] and in RA patients treated with synthetic and biologic DMARDs [591.4 (98.6) vs 558.8 (95.3); P = 0.040). There was no significant difference between the mean CCA-IMT in RA patients treated with synthetic and biologic DMARDs and controls (P = 0.997).Conclusion. Our results suggest that radiofrequency-based measurement of CCA-IMT can discriminate between RA patients treated with synthetic DMARDs vs RA patients treated with synthetic and biologic DMARDs.
  Rheumatology (Oxford, England) 10/2012; · 4.24 Impact Factor
• Article: A multicentre study on high-frequency ultrasound evaluation of the skin and joints in patients with psoriatic arthritis treated with infliximab.

  Juan José De Agustin, Carmen Moragues, Eugenio de Miguel, Ingrid Möller, Carlos Acebes, Esperanza Naredo, Jacqueline Uson, Eduardo Rejon, Lucia Mayordomo, Jesus Garrido
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  ABSTRACT: OBJECTIVES: Our objective was to describe the ultrasound features of patients with PsA in joints and skin and their changes after treatment with infliximab. METHODS: Eight hospitals recruited PsA active patients. Clinical (joint count for pain, TJC, and swelling, SJC, pain VAS, ESR, C-reactive protein and PASI) and US variables (plaque thickness, PD signal of dermal lesions, synovitis, erosions, and PD signal, assessed by 4-category ordinal scales) were independently recorded at baseline and 4, 12 and 24-week after starting treatment with infliximab. The results were analysed with paired T, Wilcoxon test, ANOVA and marginal homogeneity test. RESULTS: Changes in 24 patients from baseline to last available data were significant for clinical variables, pain VAS, TJC and SJC as well as for ESR, CRP (all p<0.0005). Dermatological PASI changed from 14.6±14.9 to 2.1±4.1 and plaque thickness from 3.34±1.75 mm to 1.74±0.96 mm (both p<0.0005); synovitis and PD signal improved (both p<0.0005). Psoriatic plaque PD improved across the study (p<0.0005) with no signal increasing from 36.4% to 88.9% and positive PD signal decreasing from 63.6% to 11.1% of the plaques. CONCLUSIONS: Treatment with anti-TNF-α infliximab improves the symptoms of patients with PsA at joint and psoriatic skin levels from a clinical and ultrasonographic perspective.
  Clinical and experimental rheumatology 09/2012; · 2.15 Impact Factor
• Article: Reliability of a consensus-based ultrasound score for tenosynovitis in rheumatoid arthritis.

  Esperanza Naredo, Maria Antonietta D'Agostino, Richard J Wakefield, Ingrid Möller, Peter V Balint, Emilio Filippucci, Annamaria Iagnocco, Zunaid Karim, Lene Terslev, David A Bong, Jesús Garrido, David Martínez-Hernández, George A W Bruyn
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  ABSTRACT: OBJECTIVE: To produce consensus-based scoring systems for ultrasound (US) tenosynovitis and to assess the intraobserver and interobserver reliability of these scoring systems in rheumatoid arthritis (RA). METHODS: We undertook a Delphi process on US-defined tenosynovitis and US scoring system of tenosynovitis in RA among 35 rheumatologists, experts in musculoskeletal US (MSUS), from 16 countries. Then, we assessed the intraobserver and interobserver reliability of US in scoring tenosynovitis on B-mode and with a power Doppler (PD) technique. Ten patients with RA with symptoms in the hands or feet were recruited. Ten rheumatologists expert in MSUS blindly, independently and consecutively scored for tenosynovitis in B-mode and PD mode three wrist extensor compartments, two finger flexor tendons and two ankle tendons of each patient in two rounds in a blinded fashion. Intraobserver reliability was assessed by Cohen's κ. Interobserver reliability was assessed by Light's κ. Weighted κ coefficients with absolute weighting were computed for B-mode and PD signal. RESULTS: Four-grade semiquantitative scoring systems were agreed upon for scoring tenosynovitis in B-mode and for scoring pathological peritendinous Doppler signal within the synovial sheath. The intraobserver reliability for tenosynovitis scoring on B-mode and PD mode was good (κ value 0.72 for B-mode; κ value 0.78 for PD mode). Interobserver reliability assessment showed good κ values for PD tenosynovitis scoring (first round, 0.64; second round, 0.65) and moderate κ values for B-mode tenosynovitis scoring (first round, 0.47; second round, 0.45). CONCLUSIONS: US appears to be a reproducible tool for evaluating and monitoring tenosynovitis in RA.
  Annals of the rheumatic diseases 09/2012; · 8.11 Impact Factor
• Article: Impact of musculoskeletal ultrasound in an outpatient rheumatology clinic.

  Mihaela C Micu, María Alcalde, José Ignacio Sáenz, Manuel Crespo, Paz Collado, Sorana D Bolboacă, Esperanza Naredo
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  ABSTRACT: OBJECTIVE: To evaluate the impact of musculoskeletal ultrasound (MSUS), as a complementary method to clinical assessment, on rapid diagnosis and therapeutic decisions in a busy outpatient rheumatology clinic. METHODS: Sixty patients with different musculoskeletal complaints were included. Three expert rheumatologists made the clinical examination (CE) and filled a standardized clinical report sheet with the following parameters: general and /or local diagnoses planned systemic and /or local treatment and their decision concerning the use of MSUS evaluation complementary to CE. Another rheumatologist, blinded to clinical data, performed the MSUS assessment of the anatomic areas selected by the clinicians. The impact of the new information obtained by MSUS on the initial diagnosis and therapeutic strategy was estimated by the degree of change in the initial clinical diagnosis and therapy decisions. RESULTS: Out of 60 patients (67 anatomical areas), MSUS was considered as necessary after CE in 39 (65%) patients totaling 43 (64.17%) anatomical areas. An overall change of the initial clinical diagnosis was present in 60% of the areas (p = 0.0175). In all (100%) areas the new diagnosis was more objective and detailed. An overall change of the initial systemic therapy was present in 25% (p = 0.0014) and in 36% (p = 0.095) for local therapy. A guided diagnostic aspiration was decided to be performed in 15% areas and a guided therapeutic injection in 22%. CONCLUSION: Enhanced information obtained by MSUS evaluation leads to changes with significant impact on the initial diagnosis and treatment strategy designed after CE. © 2012 by the American College of Rheumatology.
  Arthritis care & research. 09/2012;
• Article: After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?

  Richard J Wakefield, Maria Antonietta D'Agostino, Esperanza Naredo, Maya H Buch, Annamaria Iagnocco, Lene Terslev, Mikkel Ostergaard, Marina Backhaus, Walter Grassi, Maxime Dougados, Gerd R Burmester, Benazir Saleem, Eugenio de Miguel, Cristina Estrach, Kei Ikeda, Marwin Gutierrez, Robert Thompson, Peter Balint, Paul Emery
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  ABSTRACT: For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network - the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.
  Postgraduate medical journal 08/2012; 88(1042):482-6. · 1.38 Impact Factor
• Article: The reliability of musculoskeletal ultrasound in the detection of cartilage abnormalities at the metacarpo-phalangeal joints.

  A Iagnocco, P G Conaghan, P Aegerter, I Möller, G A W Bruyn, I Chary-Valckenaere, E Filippucci, F Gandjbakhch, D Loeuille, E Naredo, M A D'Agostino
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  ABSTRACT: To assess the reliability of ultrasound (US) in detecting cartilage abnormalities at the metacarpo-phalangeal (MCP) joints in people with cartilage pathology. Nine expert ultrasonographers initially achieved consensus on definitions and scanning protocols. They then examined the second to fifth MCP joints of the dominant hand of eight people with hand osteoarthritis (OA). US examinations were conducted in two rounds, with independent blinded evaluations of cartilage lesions. Global cartilage abnormalities were assessed by applying a dichotomous (presence/absence) score; in addition, the following lesions were evaluated using the same scoring system: loss of anechoic structure and/or thinning of the cartilage layer, and irregularities and/or loss of sharpness of at least one cartilage margin. Reliability was assessed using kappa (k) coefficients. Thirty-two joints were examined. Intra-observer k values ranged from 0.52 to 1 for global cartilage abnormalities; k values ranged from 0.54 to 0.94 for loss of anechoic structure and/or thinning of cartilage layer and from 0.59 to 1 for irregularities and/or loss of sharpness of at least one cartilage margin. Values of k for inter-observer reliability were 0.80 for global cartilage abnormalities, 0.62 for loss of anechoic structure and/or thinning of cartilage layer, and 0.39 for irregularities and/or loss of sharpness of at least one cartilage margin. US is a reliable imaging modality for the detection of cartilage abnormalities in patients with cartilage pathology in the MCP joints. The analysis of specific cartilage measures showed more variable results that may be improved by modifying definitions and further standardization of US techniques.
  Osteoarthritis and Cartilage 07/2012; 20(10):1142-6. · 3.90 Impact Factor
• Article: The ability of synovitis to predict structural damage in rheumatoid arthritis: a comparative study between clinical examination and ultrasound.

  Maxime Dougados, Valérie Devauchelle-Pensec, Jean François Ferlet, Sandrine Jousse-Joulin, Maria-Antonietta D'Agostino, Marina Backhaus, Jacques Bentin, Gérard Chalès, Isabelle Chary-Valckenaere, Philip Conaghan, Richard J Wakefield, Frédéric Etcheparre, Philippe Gaudin, Walter Grassi, Désirée van der Heijde, Xavier Mariette, Esperanza Naredo, Marcin Szkudlarek
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  ABSTRACT: OBJECTIVES: To evaluate synovitis (clinical vs ultrasound (US)) to predict structural progression in rheumatoid arthritis (RA). METHODS: Patients with RA. STUDY DESIGN: Prospective, 2-year follow-up. DATA COLLECTED: Synovitis (32 joints (2 wrists, 10 metacarpophalangeal, 10 proximal interphalangeal, 10 metatarsophalangeal)) at baseline and after 4 months of therapy by clinical, US grey scale (GS-US) and power doppler (PD-US); x-rays at baseline and at year 2. ANALYSIS: Measures of association (OR) were tested between structural deterioration and the presence of baseline synovitis, or its persistence, after 4 months of therapy using generalised estimating equation analysis. RESULTS: Structural deterioration was observed in 9% of the 1888 evaluated joints in 59 patients. Baseline synovitis increased the risk of structural progression: OR=2.01 (1.36-2.98) p<0.001 versus 1.61 (1.06-2.45) p=0.026 versus 1.75 (1.18-2.58) p=0.005 for the clinical versus US-GS versus US-PD evaluation, respectively. In the joints with normal baseline examination (clinical or US), an increased probability for structural progression in the presence of synovitis for the other modality was also observed (OR=2.16 (1.16-4.02) p=0.015 and 3.50 (1.77-6.95) p<0.001 for US-GS and US-PD and 2.79 (1.35-5.76) p=0.002) for clinical examination. Persistent (vs disappearance) synovitis after 4 months of therapy was also predictive of subsequent structural progression. CONCLUSIONS: This study confirms the validity of synovitis for predicting subsequent structural deterioration irrespective of the modality of examination of joints, but also suggests that both clinical and ultrasonographic examinations may be relevant to optimally evaluate the risk of subsequent structural deterioration.
  Annals of the rheumatic diseases 06/2012; · 8.11 Impact Factor
• Article: After treat-to-target: can a targeted ultrasound initiative improve RA outcomes?

  Richard J Wakefield, Maria Antonietta D'Agostino, Esperanza Naredo, Maya H Buch, Annamaria Iagnocco, Lene Terslev, Mikkel Ostergaard, Marina Backhaus, Walter Grassi, Maxime Dougados, Gerd R Burmester, Benazir Saleem, Eugenio de Miguel, Cristina Estrach, Kei Ikeda, Marwin Gutierrez, Robert Thompson, Peter Balint, Paul Emery
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  ABSTRACT: For patients with rheumatoid arthritis (RA), remission can be achieved with tight control of inflammation and early use of disease modifying agents. The importance of remission as an outcome has been recently highlighted by European League Against Rheumatism recommendations. However, remission when defined by clinical remission criteria (disease activity score, simplified disease activity index, etc) does not always equate to the complete absence of inflammation as measured by new sensitive imaging techniques such as ultrasound (US) . There is evidence that imaging synovitis is frequently found in these patients and associated with adverse clinical and functional outcomes. This article reviews the data regarding remission, ultrasound imaging and outcomes in patients with RA to provide the background to a consensus statement from an international collaboration of ultrasonographers and rheumatologists who have recently formed a research network--the Targeted Ultrasound Initiative (TUI) group. The statement proposes that targeting therapy to PD activity provides superior outcomes compared with treating to clinical targets alone and introduces the rationale for a new randomised trial using targeted ultrasound in RA.
  Annals of the rheumatic diseases 06/2012; 71(6):799-803. · 8.11 Impact Factor
• Article: Reliability testing of tendon disease using two different scanning methods in patients with rheumatoid arthritis.

  George A W Bruyn, Ingrid Möller, Jesus Garrido, David Bong, Maria-Antonietta d'Agostino, Annamaria Iagnocco, Zunaid Karim, Lene Terslev, Nanno Swen, Peter Balint, Paul Baudoin, Dick Siewertsz van Reesema, Carlos Pineda, Richard J Wakefield, Esperanza Naredo
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  ABSTRACT: To assess the intra- and interobserver reliability of musculoskeletal ultrasonography (US) in detecting inflammatory and destructive tendon abnormalities in patients with RA using two different scanning methods. Thirteen observers examined nine patients with RA and one healthy individual in two rounds independently and blindly of each other. Each round consisted of two consecutive examinations, an anatomy-based examination and a free examination according to personal preferences. The following tendons were evaluated: wrist extensor compartments 2, 4 and 6, finger flexor tendons 3 and 4 at MCP level, tibialis posterior tendon and both peronei tendons. Overall, positive and negative agreements and κ-values for greyscale (GS) tenosynovitis, peritendinous power Doppler (PPD) signal, intratendinous power Doppler (IPD) signal and GS tendon damage were calculated. Intraobserver κ-value ranges were 0.53-0.55 (P < 0.0005) for GS tenosynovitis, 0.61-0.64 (P < 0.0005) for PPD signal, 0.65-0.66 (P < 0.0005) for IPD signal and 0.44-0.53 (P < 0.0005) for GS tendon damage. For interobserver reliability, substantial overall agreement ranged from 80 to 89% for GS tenosynovitis, 97 to 100% for PPD signal, 97 to 100% for IPD signal and 97 to 100% for GS tendon damage. Results were independent of scanning technique. Intraobserver reliability for tenosynovitis and tendon damage varied from moderate for GS to good for PD. Overall interobserver reliability for tenosynovitis and tendon damage was excellent both for GS and PD. This qualitative scoring system may serve as the first step to a semi-quantitative score for tendon pathology.
  Rheumatology (Oxford, England) 05/2012; 51(9):1655-61. · 4.24 Impact Factor
• Article: A systematic literature review of US definitions, scoring systems and validity according to the OMERACT filter for tendon lesion in RA and other inflammatory joint diseases.

  María Alcalde, Maria Antonietta D'Agostino, George A W Bruyn, Ingrid Möller, Annamaria Iagnocco, Richard J Wakefield, Esperanza Naredo
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  ABSTRACT: To present the published data concerning the US assessment of tendon lesions as well as the US metric properties investigated in inflammatory arthritis. A systematic literature search of PubMed, Embase and the Cochrane Library was performed. Selection criteria were original articles in the English language reporting US, Doppler, tenosynovitis and other tendon lesions in patients with RA and other inflammatory arthritis. Data extraction focused on the definition and quantification of US-detected tenosynovitis and other tendon abnormalities and the metric properties of US according to the OMERACT filter for evaluating the above tendon lesions. Thirty-three of 192 identified articles were included in the review. Most articles were case series (42%) or case-control (33%) studies describing hand and/or foot tenosynovitis in RA patients. The majority of older articles used only B-mode, whereas the most recent studies have incorporated Doppler mode. Definition of tenosynovitis or other tendon lesion was provided in 70% of the evaluated studies. Most of the studies (61%) used a binary score for evaluating tendon abnormalities. Concerning the OMERACT filter, 24 (73%) articles dealt with construct validity. The comparator most commonly used was clinical assessment and MRI. There were few studies assessing criterion validity. Some studies evaluated reliability (36%), responsiveness (21%) and feasibility (12%). US seems a promising tool for evaluating inflammatory tendon lesions. However, further validation is necessary for implementation in clinical practice and trials.
  Rheumatology (Oxford, England) 02/2012; 51(7):1246-60. · 4.24 Impact Factor
• Article: Is ultrasound a validated imaging tool for the diagnosis and management of synovitis in juvenile idiopathic arthritis? A systematic literature review.

  Paz Collado, Sandrine Jousse-Joulin, María Alcalde, Esperanza Naredo, Maria Antonietta D'Agostino
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  ABSTRACT: Ultrasound (US) has been shown to be a sensitive tool for evaluating synovitis in rheumatoid arthritis. However, the validity of US has not yet been established in juvenile idiopathic arthritis (JIA). The purpose of this study was to assess the validity of US for detecting synovitis for both diagnosis and followup in JIA. A systematic literature search in Embase and PubMed was performed before February 25, 2011. Selection criteria included original articles on children, JIA, US, Doppler, synovitis, and management published in the English language. Data were extracted from the articles meeting the inclusion criteria, particularly those focused on the US definition of synovitis, scoring systems used, and metric properties studied. The type and number of joints tested, study design, and quality of the studies were assessed. Twenty studies were identified using US to assess synovitis in JIA. The knee was the joint most commonly studied in these articles. There was heterogeneity regarding the US definition and quantification of synovitis. Synovitis was commonly assessed by using gray scale and only a few studies included the Doppler technique. Construct validity was reported in 80% of articles, including the clinical examination as the main comparator. US demonstrated higher sensitivity in detecting synovitis as compared to clinical examination. Few studies reported US reliability and responsiveness in JIA. US is a valuable tool for detecting synovitis in JIA, and demonstrated higher sensitivity in assessing synovitis as compared to clinical examination. However, further studies are needed for evaluating the reliability and responsiveness to assess synovitis changes over time.
  Arthritis care & research. 02/2012; 64(7):1011-9.
• Article: Inter- and intra-observer agreement of high-resolution ultrasonography and power Doppler in assessment of joint inflammation and bone erosions in patients with rheumatoid arthritis.

  Mario Alfredo Chávez-López, Cristina Hernández-Díaz, Carlos Moya, Carlos Pineda, Lucio Ventura-Ríos, Ingrid Möller, Esperanza Naredo, Rolando Espinosa, Angélica Peña, Alejandro Rosas-Cabral, Emilio Filippucci
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  ABSTRACT: To assess the inter- and intra-observer reproducibility of musculoskeletal ultrasonography among rheumatologist in detecting inflammatory and morphostructural changes in small joints of the hands in patients with rheumatoid arthritis (RA). Five members of the "Escuela de Ecografía del Colegio Mexicano de Reumatología" tested their inter- and intra-observer reliabilities in the assessment of basic sonographic findings of joint inflammation and bone erosion. Their results were compared to those obtained by a group of international experts from European League Against Rheumatism. A clinical rheumatologist evaluated eight RA patients. Five Siemens Acuson Antares ultrasound machines (7-13 MHz linear probes) were used. The OMERACT preliminary definitions of joint effusion, synovial hypertrophy, bone erosions and tenosynovitis were adopted. Inter-observer and intra-observer agreement was calculated by overall agreement and kappa statistics. Mean kappa value for joint effusion was good, 0.654 (85%); synovial hypertrophy, 0.550 (77.2%); power Doppler signal, 0.550 (82.5%); bone erosions, 0.549 (81%); and tenosynovitis, 0.500 (91.5%). Mean and overall intra-observer agreement for semiquantitative score was good for joint effusion, 0.630 (77.2%) and bone erosions, 0.605 (56.25%); and moderate to synovial hypertrophy, 0.476 (65%) and power Doppler signal, 0.471 (80%). Mean kappa value for joint effusion was 0.381 (95%), synovial hypertrophy, 0.447 (72%); power Doppler signal, 0.496 (81%); bone erosions, 0.294 (81%); and tenosynovitis, 0.030 (66%). Mean and overall inter-observer agreement for semiquantitative score was poor for joint effusion, 0.325 (57%) and bone erosions, 0.360 (43%); and moderate to synovial hypertrophy, 0.431 (55%) and power Doppler signal, 0.496 (81%). Intra-observer variability reached the highest levels of agreement. Factors related to the experience of the rheumatologist, the time spent in each examination and knowledge of the software ultrasound equipment could influence the lower level of inter-observer agreement in this study.
  Rheumatology International 01/2012; · 1.88 Impact Factor
• Article: Practice of ultrasound-guided arthrocentesis and joint injection, including training and implementation, in Europe: results of a survey of experts and scientific societies.

  Peter Mandl, Esperanza Naredo, Philip G Conaghan, Maria-Antonietta D'Agostino, Richard J Wakefield, Artur Bachta, Marina Backhaus, Hilde B Hammer, George A W Bruyn, Nemanja Damjanov, [......], Juhani M Koski, Ingrid Möller, Eugenio De Miguel, Wolfgang A Schmidt, Wijnand A A Swen, Marcin Szkudlarek, Lene Terslev, Hans-Rudolf Ziswiler, Mikkel Ostergaard, Peter V Balint
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  ABSTRACT: To document the practice and training opportunities of US-guided arthrocentesis and joint injection (UGAJ) among rheumatologists in the member countries of the European League Against Rheumatism (EULAR). An English-language questionnaire, containing questions on demographics, clinical and practical aspects of UGAJ, training options in UGAJ for rheumatologists, UGAJ education in the rheumatology training curriculum and other structured education programmes in UGAJ was sent to three different groups: (i) all national rheumatology societies of EULAR; (ii) all national societies of the European Federation of Societies for Ultrasound in Medicine and Biology (EFSUMB); and (iii) 22 senior rheumatologists involved in EULAR musculoskeletal US training from 14 European countries, who were also asked to circulate the questionnaire among relevant colleagues. Thirty-three (75%) of 44 countries responded to the questionnaire (61.3% of national rheumatology societies, 25% of the national US societies and 100% of expert ultrasonographers). In the majority of countries (85%) <10% of rheumatologists routinely perform UGAJ in clinical practice, while the remaining countries (15%) reported a rate of 10-50%. The percentage of rheumatologists receiving training in UGAJ was <10% in the majority (72.7%) of countries. The study highlights the relatively low prevalence of UGAJ as compared with the high (>80%) rate of rheumatologists performing conventional joint injection in most of the surveyed countries. The reported variations in practice and the lack of available structured training programmes for trainees in most countries indicates the need for standardization in areas including training guidelines.
  Rheumatology (Oxford, England) 12/2011; 51(1):184-90. · 4.24 Impact Factor
• Source

  Available from: Lene Terslev

  Article: Ultrasound in the evaluation of enthesitis: status and perspectives.

  Frédérique Gandjbakhch, Lene Terslev, Fredrick Joshua, Richard J Wakefield, Esperanza Naredo, Maria Antonietta D'Agostino
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  ABSTRACT: An increasing number of studies have applied ultrasound to the evaluation of entheses in spondyloarthritis patients. However, no clear agreement exists on the definition of enthesitis, on the number and choice of entheses to examine and on ultrasound technique, which may all affect the results of the examination. The objectives of this study were to first determine the level of homogeneity in the ultrasound definitions for the principal lesions of enthesitis in the published literature and second, to evaluate the metric properties of ultrasound for detecting enthesitis according to the OMERACT filter. Search was performed in PUBMED and EMBASE. Both grey-scale and Doppler definitions of enthesitis, including describing features of enthesitis, were collected and metrological qualities of studies were assessed. After selection, 48 articles were analyzed. The definition of ultrasound enthesitis and elementary features varied among authors. Grey-scale enthesitis was characterized by increasing thickness (94% of studies), hypoechogenicity (83%), enthesophytes (69%), erosions (67%), calcifications (52%), associated bursitis (46%) and cortical irregularities (29%). Only 46% of studies reported the use of Doppler. High discrepancies were observed on frequency, type of probe and Doppler mode used. Face and content validity were the most frequently evaluated criteria (43%) followed by reliability (29%) and responsiveness (19%). Ultrasound has evidence to support face, content validity and reliability for the evaluation of enthesitis, though there is a lack of well-reported methodology in most of the studies. Consensus on elementary lesions and standardization of exam is needed to determine the ultrasound definition of enthesitis in grey-scale and in Doppler for future applications.
  Arthritis research & therapy 11/2011; 13(6):R188. · 4.27 Impact Factor
• Article: [Teaching ultrasonography to Spanish rheumatologists: 15 years of experience].

  Esperanza Naredo, Jacqueline Uson
  Reumatología clinica. 11/2011; 7(6):354-6.
• Article: The OMERACT ultrasound task force--status and perspectives.

  Esperanza Naredo, Richard J Wakefield, Annamaria Iagnocco, Lene Terslev, Emilio Filippucci, Frederique Gandjbakhch, Philippe Aegerter, Sibel Aydin, Marina Backhaus, Peter V Balint, [......], David Kane, Helen I Keen, Ingrid Moller, Peter Mandl, Sarah Ohrndorf, Carlos Pineda, Wolfgang A Schmidt, Marcin Szkudlarek, Philip G Conaghan, Maria-Antonietta D'Agostino
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  ABSTRACT: This article reports the most recent work of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Task Force, and highlights the future research priorities discussed at the OMERACT 10 meeting. Results of the following studies were presented: (1) intra- and interobserver reliability of ultrasound detecting and scoring synovitis in different joints of patients with rheumatoid arthritis (RA); (2) systematic review of previous ultrasound scoring systems of synovitis in RA; (3) enthesitis systematic review and Delphi definition exercise in spondyloarthritis enthesitis; (4) enthesitis intra- and interobserver reliability exercise; and (5) Delphi definition exercise in hand osteoarthritis, and reliability exercises. Study conclusions were discussed, and a future research agenda was approved, notably further validation of an OMERACT ultrasound global synovitis score (GLOSS) in RA, emphasizing the importance of testing feasibility, predictive value, and added value over standard clinical variables. Future research areas will include validating scoring systems for enthesitis and osteoarthritis, and testing the metric qualities of ultrasound for evaluating tenosynovitis and structural damage in RA.
  The Journal of Rheumatology 09/2011; 38(9):2063-7. · 3.69 Impact Factor
• Article: A systematic literature review analysis of ultrasound joint count and scoring systems to assess synovitis in rheumatoid arthritis according to the OMERACT filter.

  Peter Mandl, Esperanza Naredo, Richard J Wakefield, Philip G Conaghan, Maria Antonietta D'Agostino
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  ABSTRACT: The OMERACT Ultrasound Task Force is currently developing a global synovitis score (GLOSS) with the objective of feasibly measuring global disease activity in patients with rheumatoid arthritis (RA). In order to determine the minimal number of joints to be included in such a scoring system, and to analyze the metric properties of proposed global (i.e., patient level) ultrasound (US) scoring systems of synovitis in RA, a systematic analysis of the literature was performed. A systematic literature search of Pubmed and Embase was performed (January 1, 1984, to March 31, 2010). Original research reports written in English including RA, ultrasound, Doppler, and scoring systems were included. The design, subjects, methods, imaging protocols, and performance characteristics studied were analyzed, as well as the ultrasound definition of synovitis. Of 3004 reports identified, 14 articles were included in the review. We found a lack of clear definition of synovitis as well as varying validity data with respect to the proposed scores. Scoring systems included a wide range and number of joints. All analyzed studies assessed construct validity and responsiveness by using clinical examination, laboratory findings, and other imaging modalities as comparators. Both construct validity and responsiveness varied according to the number and size of joints examined and according to the component of synovitis measured [i.e., gray-scale (GS) or power Doppler (PD) alone or in combination]. With regard to feasibility, time of evaluation varied from 15 to 60 min and increased with the number of joints involved in the examination. Ultrasound can be regarded as a valuable tool for globally examining the extent of synovitis in RA. However, it is presently difficult to determine a minimal number of joints to be included in a global ultrasound score. Further validation of proposed scores is needed.
  The Journal of Rheumatology 09/2011; 38(9):2055-62. · 3.69 Impact Factor