International consensus for ultrasound lesions in gout: Results of delphi process and web-reliability exercise

Marwin Gutierrez, Wolfgang A. Schmidt, Ralf G. Thiele, Helen I. Keen, Gurjit S. Kaeley, Esperanza Naredo, Annamaria Iagnocco, George A. Bruyn, Peter V. Balint, Emilio Filippucci, Peter Mandl, David Kane, Carlos Pineda, Andrea Delle Sedie, Hilde Berner Hammer, Robin Christensen, Maria Antonietta D'Agostino, Lene Terslev, David Bong, Eugenio De MiguelChristian Dejaco, Eugene Kissin, Frederique Gandjbakhch, Jane Freeston, Juhani Koski, Ingrid Moller, Marcin Szkudlarek, Nanno Swen, Anthony Reginato, Oscar Epis, Sibel Zehra Aydin, Viviana Ravagnani, Richard Wakefield, Petra Hanova, Ghada Mardenly, Veronica Sharp

Research output: Contribution to journalArticle

84 Citations (Scopus)


Objective. To produce consensus-based definitions of the US elementary lesions in gout and to test their reliability in a web-based exercise. Methods. The process consisted of two steps. In the first step a written Delphi questionnaire was developed from a systematic literature review and expert international consensus. This collated information resulted in four statements defining US elementary lesions: double contour (DC), tophus, aggregates and erosion. The Delphi questionnaire was sent to 35 rheumatology experts in US, asking them to rate their level of agreement or disagreement with each statement. The second step tested the reliability by a web-exercise. US images of both normal and gouty elementary lesions were collected by the participants. A facilitator then constructed an electronic database of 110 images. The database was sent to the participants, who evaluated the presence/absence of US elementary lesions. A group of 20 images was displayed twice to evaluate intra-reader reliability. Results. A total of 32 participants responded to the questionnaires. Good agreement (>80%) was obtained for US definitions on DC, tophus, aggregates and erosion in the Delphi exercise after three rounds. The reliability on images showed inter-reader κ values for DC, tophus, aggregates, erosion findings of 0.98, 0.71, 0.54 and 0.85, respectively. The mean intra-reader κ values were also acceptable: 0.93, 0.78, 0.65 and 0.78, respectively. Conclusion. This, the first consensus-based US definition of elementary lesions in gout, demonstrated good reliability overall. It constitutes an essential step in developing a core outcome measurement that permits a higher degree of homogeneity and comparability between multicentre studies.
Original languageEnglish
Pages (from-to)1797-1805
Number of pages9
Publication statusPublished - 2015


  • Delphi Technique
  • Delphi process
  • Diagnostic Imaging
  • Elementary lesions
  • Gout
  • Humans
  • Internet
  • Observer Variation
  • Reproducibility of Results
  • Surveys and Questionnaires
  • Terminology as Topic
  • Ultrasonography
  • Ultrasound
  • Web reliability


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