OBJECTIVES: To define chronic ultrasound lesions of the axillary artery (AA) in long-standing giant cell arteritis (GCA) and to evaluate the reliability of the new ultrasound definition in a web-based exercise. METHODS: A structured Delphi, involving an expert panel of the Large Vessel Vasculitis subgroup of the Outcome Measures in Rheumatology (OMERACT) Ultrasound Working Group was carried out. The reliability of the new definition was tested in a 2-round web-based exercise involving 23 experts and using 50 still images each from AA of long-standing and acute GCA patients, as well as 50 images from healthy individuals. RESULTS: The final OMERACT ultrasound definition of chronic changes was based on measurement and appearance of the intima-media complex. The overall reliability of the new definition for chronic ultrasound changes in longstanding GCA of the AA was good to excellent with Light's kappa values of 0.79-0.80 for inter-reader reliability and mean Light's-kappa of 0.88 for intra-reader reliability. The mean inter-rater and intra-rater agreements were 86-87% and 92%, respectively. Good reliabilities were observed comparing the vessels with longstanding versus acute GCA with a mean agreement and kappa values of 81% and 0.63, respectively. CONCLUSION: The new OMERACT ultrasound definition for chronic vasculitis of the AA in GCA revealed a good to excellent inter- and intra-reader reliability in a web-based exercise of experts.

Academic Rheumatology Centre Università degli Studi di Torino Turin Italy

Clinic for Internal Medicine 3 Department of Oncology Hematology Rheumatology and Clinical Immunology University Hospital Bonn Germany

Copenhagen University Hospital at Hvidovre Hvidovre Denmark

Department of Clinical Medicine University of Copenhagen Copenhagen Denmark; Copenhagen Center for Arthritis Research Center for Rheumatology and Spine Diseases Rigshospitalet Glostrup Glostrup Denmark

Department of Internal Medicine 6 Medical University Innsbruck Innsbruck Austria

Department of Rheumatology Aarhus University Hospital Aarhus Denmark

Department of Rheumatology and Clinical Immunology Asklepios Medical Center 93077 Bad Abbach Germany

Department of Rheumatology and Immunology University of Bern Inselspital Switzerland

Department of Rheumatology Esbjerg Hospital Esbjerg Denmark

Department of Rheumatology Institute of Rheumatology Prague Czech Republic

Department of Rheumatology Internal Medicine Geriatrics and Clinical Immunology of Pomeranian Medical University in Szczecin Poland

Department of Rheumatology Martina Hansens Hospital Bïrum Oslo Norway

Department of Rheumatology MC Hospital Group Lelystad The Netherlands

Department of Rheumatology Medical University of Graz Graz; Austria and Department of Rheumatology Hospital of Bruneck Bruneck Italy

Department of Rheumatology Norfolk and Norwich University Hospital Norwich UK

Department of Rheumatology Silkeborg Hospital Silkeborg Denmark

Department of Rheumatology University Medical Centre Ljubljana; Slovenian Faculty of Medicine University of Ljubljana Ljubljana Slovenia

Diagnostic Centre Silkeborg Regional Hospital Silkeborg Denmark; Department of Rheumatology Odense University Hospital Odense Denmark

Division of Musculoskeletal and Rheumatic Diseases Instituto Nacional de Rehabilitacion Mexico City Mexico

Division of Rheumatology University of California Los Angeles; David Geffen School of Medicine California USA

Epidemiology Research Unit Italian Society for Rheumatology Milano Italy

Hospital de Santa Maria Centro Hospitalar Universitário de Lisboa Norte Centro Académico de Medicina de Lisboa

Immanuel Krankenhaus Berlin Medical Centre for Rheumatology Berlin Buch Berlin Germany

Rheumatology Fondazione IRCCS Policlinico San Matteo University of Pavia Pavia Italy

Rheumatology La Paz University Hospital Madrid Spain

Rheumatology Southend University Hospital NHS Foundation Trust Essex UK

Rheumatology Unit Department of Specialistic Medicine Azienda USL IRCCS di Reggio Emilia Reggio Emilia Italy

University of Western Australia Australia

UOC e Sezione di Reumatologia Dipartimento di Scienze Mediche Università degli Studi di Ferrara Ferrara Italy; Società Italiana di Reumatologia Unità Epidemiologica Milan Italy

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