ABSTRACT
The aim of this study was to evaluate the reliability of the outcome measures in rheumatology (OMERACT) definitions for ultrasound (US) elementary lesions in gout through an image reading exercise. Images from patients with gout (static images and videos) were collected. As an initial step, we carried out a image reading exercise within the experts of the Pan-American League of Associations for Rheumatology (PANLAR) US Study Group (n = 16). The following step consisted in a web-based exercise with the participation of larger number of sonographers (n = 63) from different centers. Images were rated evaluating the presence/absence of any US elementary lesion. Inter- and intra-reader reliabilities were analyzed using kappa coefficients. Participants were stratified according to their level of experience. In the first exercise, inter-reader kappa values were 0.45 for aggregates, 0.57 for tophus, 0.69 for erosions, and 0.90 for double contour (DC). Intra-reader kappa values were 0.86, 0.76, 0.80, and 0.90, respectively. The web-based exercise showed inter-reader kappa values for aggregates, tophus, erosions, and DC of 0.42, 0.49, 0.69, and 0.79, respectively. The intra-reader kappa values were 0.62, 0.69, 0.77, and 0.85, respectively. Reliability was not influenced by the sonographer's level of experience. The reliability of the new OMERACT US definitions for elementary lesions in gout ranged from moderate to excellent, depending on the type of lesion.
Subject(s)
Gout/diagnostic imaging , Cross-Sectional Studies , Humans , Reproducibility of Results , UltrasonographyABSTRACT
El lupus eritematoso sistémico es una enfermedad inflamatoria crónica de naturaleza autoinmune, de etiología desconocida en la que hay daño celular y tisular por autoanticuerpos y que cursa con un amplio espectro de manifestaciones clínicas. La hemorragia alveolar difusa es una forma de presentación poco frecuente en pacientes con lupus eritematoso sistémico, raramente debuta como una manifestación inicial de la enfermedad. Aproximadamente 2 % de todos los pacientes con lupus eritematoso sistémico presentan este cuadro, siendo su asociación con otras enfermedades de origen inmune, entre ellas la tiroiditis autoinmune un caso excepcional con elevada mortalidad
Systemic lupus erythematosus is a chronic inflammatory disease of autoimmune nature of unknown etiology in which there is cell and tissue damage that causes autoantibodies and a broad spectrum of clinical manifestations. Diffuse alveolar hemorrhage is a rare presentation in patients with Systemic lupus erythematosus, rarely it debuts as an initial manifestation of the disease. Approximately 2 % of all patients with Systemic lupus erythematosus have this disease, and its association with other immune-mediated diseases including autoimmune thyroiditis an exceptional case with high mortality
ABSTRACT
El síndrome de Evans, es caracterizado por la presencia de anemia hemolítica autoinmune y púrpura trombocitopénica, presentándose con menor frecuencia en pacientes con diagnóstico de lupus eritematoso sistémico. La asociación de estas dos entidades con el síndrome de anticuerpos antifosfolípidos se torna inusual, constituyendo un desafío diagnóstico y a la vez terapéutico para el clínico. Presentamos un paciente con lupus eritematoso sistémico, que desarrollo síndrome de Evans y síndrome antifosfolípido, complicado con hemorragia intracerebral cisternal y trombosis venosa profunda de miembros superiores
Evans syndrome is characterized by the presence of autoimmune hemolytic anemia and thrombocytopenic purpura, appearing less frequently in patients with systemic lupus erythematosus. The association of these two entities with antiphospholipid antibody syndrome becomes unusual, constituting a diagnostic challenge and therapeutic. We present a patient with systemic lupus erythematosus who developed Evans syndrome and antiphospholipid syndrome, complicated with cerebral haemorrhage and deep venous thrombosis of upper limbs
