Objectives The main objective was to generate a GLobal OMERACT Ultrasound DActylitis Score (GLOUDAS) in psoriatic arthritis and to test its reliability. To this end, we assessed the validity, feasibility and applicability of ultrasound assessment of finger entheses to incorporate them into the scoring system. Methods The study consisted of a stepwise process. First, in cadaveric specimens, we identified enthesis sites of the fingers by ultrasound and gross anatomy, and then verified presence of entheseal tissue in histological samples. We then selected the entheses to be incorporated into a dactylitis scoring system through a Delphi consensus process among international experts. Next, we established and defined the ultrasound components of dactylitis and their scoring systems using Delphi methodology. Finally, we tested the interobserver and intraobserver reliability of the consensus- based scoring systemin patients with psoriatic dactylitis. Results 32 entheses were identified in cadaveric fingers. The presence of entheseal tissues was confirmed in all cadaveric samples. Of these, following the consensus process, 12 entheses were selected for inclusion in GLOUDAS. Ultrasound components of GLOUDAS agreed on through the Delphi process were synovitis, tenosynovitis, enthesitis, subcutaneous tissue inflammation and periextensor tendon inflammation. The scoring system for each component was also agreed on. Interobserver reliability was fair to good (κ 0.39–0.71) and intraobserver reliability good to excellent (κ 0.80–0.88) for dactylitis components. Interobserver and intraobserver agreement for the total B-mode and Doppler mode scores (sum of the scores of the individual abnormalities) were excellent (interobserver intraclass correlation coefficient (ICC) 0.98 for B-mode and 0.99 for Doppler mode; intraobserver ICC 0.98 for both modes). Conclusions We have produced a consensus-driven ultrasound dactylitis scoring system that has shown acceptable interobserver reliability and excellent intraobserver reliability. Through anatomical knowledge, small entheses of the fingers were identified and histologically validated. All data relevant to the study are included in the article or uploaded as online supplemental information.

中文翻译：

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验证数字附着点并将其纳入银屑病关节炎初步全球 OMERACT 超声 DActyitis 评分 (GLOUDAS)

目标 主要目标是生成银屑病关节炎的全球 OMERACT 超声 Dactylitis 评分 (GLOUDAS) 并测试其可靠性。为此，我们评估了手指附着点超声评估的有效性、可行性和适用性，并将其纳入评分系统。方法 该研究由一个逐步的过程组成。首先，在尸体标本中，我们通过超声和​​大体解剖来识别手指的附着部位，然后验证组织学样本中是否存在附着组织。然后，我们通过国际专家之间的德尔菲共识流程选择要纳入指炎评分系统的附着点。接下来，我们使用德尔菲法建立并定义了指炎的超声成分及其评分系统。最后，我们测试了银屑病指炎患者基于共识的评分系统的观察者间和观察者内的可靠性。结果在尸体手指中鉴定出 32 个附着点。在所有尸体样本中都证实了附着点组织的存在。其中，按照共识流程，选择了 12 个观点纳入 GLOUDAS。通过德尔菲过程达成一致的 GLOUDAS 超声成分是滑膜炎、腱鞘炎、附着点炎、皮下组织炎症和伸肌腱周围炎症。每个部分的评分系统也达成了一致。指炎成分的观察者间可靠性为一般至良好（κ 0.39-0.71），观察者内可靠性为良好至优秀（κ 0.80-0.88）。 B 型和多普勒模式总得分（个体异常得分的总和）的观察者间和观察者内一致性非常好（B 型观察者组内相关系数 (ICC) 为 0.98，多普勒模式为 0.99；观察者内 ICC 两者均为 0.98）模式）。结论 我们已经建立了一个共识驱动的超声指炎评分系统，该系统显示出可接受的观察者间可靠性和出色的观察者内可靠性。通过解剖学知识，识别了手指的小附着点并进行了组织学验证。与研究相关的所有数据都包含在文章中或作为在线补充信息上传。