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Detecting Radiological Changes in Rheumatoid Arthritis That Are Considered Important by Clinical Experts: Influence of Reading With or Without Known Sequence KARIN BRUYNESTEYN, DÉSIRÉE VAN DER HEIJDE, MAARTEN BOERS, ARIANE SAUDAN, PAUL PELOSO, HAROLD PAULUS, HARRY HOUBEN, BRIDGET GRIFFITHS, JOHN EDMONDS, BARRY BRESNIHAN, ANNELIES BOONEN, and SJEF VAN DER LINDEN
ABSTRACT.
Methods. For both scoring methods, progression scores obtained with (chronological) and without knowledge of the sequence of the films (paired) were compared with the judgment of an international expert panel. This panel assessed whether progression of joint damage seen on films with 1 year intervals was clinically relevant (defined as progression of joint damage that would make clinicians change therapy). The applied thresholds for clinical relevance were (1) the progression scores with the highest accuracy by receiver operating characteristics analyses for the expert opinion, and (2) the smallest progression score that can be detected apart from interobserver measurement error by the scoring method, i.e., the smallest detectable difference (SDD). Results. Progression scores that detected clinically relevant progression most accurately (chronological: 3.0 SvH units and 2.0 LS units; paired: 2.5 SvH units and 1.5 LS units) were smaller than the SDD (chronological 5.0 SvH units and 5.8 LS units; paired 13.8 SvH units and 9.7 LS units). With the SDD as threshold, the sensitivity to detect clinically relevant progression increased significantly from 20 to 60% for the SvH method and from 23 to 33% for the LS method if the sequence of the films was known. The specificity remained good when scoring chronologically: 88% for the SvH and 100% for the LS. Conclusion. Our results suggest that knowing the chronological sequence leads to an increase in detecting clinically relevant changes in the patient without serious overestimation of nonrelevant differences. Analyzing a clinical trial should be done preferably by reading films in chronological order. (J Rheumatol 2002;29:2306-12) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the Department of Internal Medicine, Division of Rheumatology, Maastricht University, Maastricht, the Department of Rheumatology, Atrium Medical Center, Heerlen, and the Department of Clinical Epidemiology and Biostatistics, VU Medical Center, Amsterdam, The Netherlands; Limburg University Center, Diepenbeek, Belgium; Centre Médical De L'Aeroport, Geneva, Switzerland; the Department of Rheumatology, University of Iowa Health Care, Iowa City, and the Department of Rheumatology, UCLA School of Medicine, Los Angeles, USA; the Muskuloskeletal Unit, Freeman Hospital, Newcastle Upon Tyne, United Kingdom; the Department of Rheumatology, St. George Hospital, Sydney, Australia; and the Department of Rheumatology, St. Vincent's Hospital, Dublin, Ireland. Supported by the Dutch Arthritis Association. K. Bruynesteyn, MD, Division of Rheumatology, Maastricht University; D. van der Heijde, MD, PhD, Professor of Rheumatology, Maastricht University and Limburg University Center; M. Boers, MSc, MD, PhD, Rheumatologist, Professor of Clinical Epidemiology, VU Medical Center; A. Saudan, MD, Rheumatologist, Centre Médical De L'Aeroport; P. Peloso, MSc, MD, FRCPC, Rheumatologist, University of Iowa Health Care; H. Paulus, MD, Professor of Medicine, UCLA School of Medicine; H. Houben, MD, PhD, Rheumatologist, Atrium Medical Center; B. Griffiths, MD, MRCP, Rheumatologist, Freeman Hospital; J. Edmonds, MBBS, FRACP, Professor of Rheumatology, St. George Hospital; B. Bresnihan, MD, FRCP, FRCPI, Professor of Rheumatology, St. Vincent's Hospital; A. Boonen, MD, Rheumatologist; S. van der Linden, MD, PhD, Professor of Rheumatology, Maastricht University. Address reprint requests to Dr. K. Bruynesteyn, Department of Internal Medicine, Division of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, The Netherlands. E-mail: kbru@sint.azm.nl Submitted February 5, 2002; revision accepted April 18, 2002.
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