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Reproducibility and Sensitivity to Change of 5 Methods for Scoring Hand Radiographic Damage in Patients with Rheumatoid Arthritis
FRANCIS GUILLEMIN, LAURENT BILLOT, STEPHANIE BOINI, NATHALIE GERARD, SIGRID ØDEGAARD, and TORE K. KVIEN
ABSTRACT.
Methods. Radiographs of 22 patients from Norway and France with average 2 years' disease duration at baseline and mean 30 months' followup were assessed by 2 readers according to Larsen, Larsen/Rau, Sharp, Sharp/van der Heijde, and Simple Erosion Narrowing Score (SENS) methods. Reproducibility at baseline and on progression was assessed using intraclass correlation coefficients (ICC) and Bland-Altman graphs. Sensitivity to change was compared across methods by computing the country-adjusted standardized response means (SRM) ratio. Results. Intrarater reproducibility varied with the reader (ICC ranging from 0.90 to 0.97), with Larsen and Larsen/Rau ranking highest. Interrater reproducibility was highest with Sharp and Sharp/van der Heijde (ICC 0.76 to 0.93). Bland-Altman graphs showed a decrease of concordance in cases of more severe damage. Sensitivity to change was higher with Sharp and Sharp/van der Heijde modified for erosions (SRM ratio 1.44 and 1.70), than with Larsen/Rau and SENS. The differences between Sharp, Sharp/van der Heijde, and Larsen were less for joint space narrowing. There was a significant reader effect (p < 0.05) in all but the Sharp method. Expressed as percentage of the maximum score, the smallest detectable difference varied between 3.5% (Sharp/van der Heijde) and 14.2% (SENS erosion). Conclusion. All methods have high intraobserver and interobserver reliability. The interrater reproducibility decreases with disease severity. Recent modified methods perform best to detect changes, but the advantages of SENS seemed to be lost when applied on hand radiographs alone. Training the readers appears to be essential. (J Rheumatol 2005;32:778-86) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the School of Public Health, Nancy, France; and the Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. Supported by a grant from Programme Hospitalier de Recherche Clinique of the French Ministry of Health, 1995, and from EC-COMAC. The EURIDISS study was supported in France by a grant from the Programme Hospitalier de Recherche Clinique, 1995, from the Ministry of Health. Internationally, the study was supported by the COMAC-Health Services Research, contract MR4*0344-NL, and DG contract BMH4-CT96-1580, from the European Community. F. Guillemin, MD, PhD, Professor of Epidemiology and Public Health; L. Billot, MSc, Statistician; S. Boini, MSc, Fellow; N. Gerard, MD, Rheumatologist, EA 3444, School of Public Health, Nancy; S. Ødegaard, MD, Rheumatologist; T.K. Kvien, MD, Professor of Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo. Address reprint requests to Prof. F. Guillemin, Ecole de santé publique, Faculté de médecine BP 184, 54505 Vandoeuvre-les-Nancy, France. E-mail: francis.guillemin@sante-pub.u-nancy.fr Accepted for publication November 22, 2004. |