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DAFNA D. GLADMAN, ROBERT D. INMAN, RICHARD J. COOK, DESIRÉE van der HEIJDE, ROBERT B.M. LANDEWÉ, JURGEN BRAUN, JOHN C. DAVIS, PHILIP MEASE, JOACHIM BRANDT, RUBEN BURGOS VARGAS, VINOD CHANDRAN, PHILIP HELLIWELL, ARTHUR KAVANAUGH, FINBAR D. O'SHEA, MUHAMMAD A. KHAN, NICOLO PIPITONE, PROTON RAHMAN, JOHN D. REVEILLE, MILLICENT A. STONE, WILLIAM TAYLOR, DOUGLAS J. VEALE, and WALTER P. MAKSYMOWYCH

ABSTRACT.

Objective. To determine whether the axial measures used in primary ankylosing spondylitis (AS) were reproducible for both AS and psoriatic arthritis (PsA) with axial disease.

Methods. A group of 20 rheumatologists from 11 countries with expertise in spondyloarthritis (SpA) met for a combined physical examination exercise to assess 10 patients with PsA with axial involvement (9 men, 1 woman, mean age 52 yrs, mean disease duration 17 yrs) and 9 AS patients (7 men, 2 women, mean age 38 yrs, mean disease duration 16 yrs). A modified Latin-square design was used. Measures included were occiput to wall, tragus to wall, cervical rotation, chest expansion, lateral spinal bending, modified Schober, and hip mobility. Data were analyzed using intraclass correlation coefficients (ICC) adjusted for order of measurements.

Results. The majority of the variance was contributed by the patients. There was no order effect. Observer effect was noted especially for chest expansion for both AS and PsA patients, and for the modified Schober in PsA. The ICC demonstrated very good to excellent agreement for most measures for both AS and PsA. Chest expansion provided only moderate agreement for AS and PsA.

Conclusion. Overall, measures of spinal mobility used in primary AS perform well with respect to interobserver reliability, and are equally reproducible when applied to PsA patients with axial involvement. Thus, these measures should now be evaluated in therapeutic trials of patients with PsA to determine sensitivity to change and concordance with other measures of structural damage. (First Release July 1 2007; J Rheumatol 2007;34:1733-9)

Key Indexing Terms:

SPONDYLOARTHRITIS
ASSESSMENT
RELIABILITY
SPINAL

From the Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada.

Supported by the SPARCC NRI grant from The Arthritis Society, Canada, the Krembil Foundation, and unrestricted funds from Abbott Canada, Amgen/Wyeth Canada, Schering Canada, Pfizer Canada, and Wyeth Global. R.J. Cook is Canada Research Chair in Statistical Methods for Health Research. W.P. Maksymowych is a Senior Scholar of the Alberta Heritage Foundation for Medical Research. V. Chandran is an Ogryzlo Fellow of The Arthritis Society, Canada, and Arthritis Centre of Excellence Fellow, University Health Network, Toronto. F.D. O'Shea is supported by an Irish Society for Rheumatology Traveling Fellowship. M.A. Stone is supported by the Cumming AS Visiting Professorship Award.

D.D. Gladman, MD, FRCPC; R.D. Inman, MD; V. Chandran, MD; F.D. O'Shea, MD, Division of Rheumatology, University of Toronto, Toronto, Ontario, Canada; R.J. Cook, MD, Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; R.B.M. Landewé, MD, PhD, Department of Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands; J. Braun, MD, Rheumazentrum, Ruhrgebiet, Herne, Germany; J.C. Davis, MD, Department of Rheumatology, Allergy and Immunology, University of California, San Francisco, California, USA; P. Mease, MD, Swedish Medical Center, Seattle, Washington, USA; J. Brandt, MD, Rheumatologische, Praxisgemeinschaft, Berlin, Germany; R. Burgos Vargas, MD, Rheumatology Unit, Hospital General de Mexico, Mexico City, Mexico; P. Helliwell, MD, PhD, University of Leeds, Leeds, United Kingdom; A. Kavanaugh, MD, Department of Rheumatology, Allergy and Immunology, University of California, San Diego, California, USA; M.A. Khan, MD, Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA; N. Pipitone, MD, U.O. di Reumatologia, Arcispedale S. Maria Nuova, Reggio Emilia, Italy; P. Rahman, MD, Department of Rheumatology, Memorial University, St. Johns, Newfoundland, Canada; J.D. Reveille, MD, University of Texas Health Sciences Centre, Houston, Texas, USA; M.A. Stone, MD, Department of Rheumatology, University of Toronto, Toronto, Royal National Hospital for Rheumatic Diseases, Bath, United Kingdom; W. Taylor, MBChB, FRACP, FAFRM, Rehabilitation Teaching and Research Unit, Wellington School of Medicine and Health Sciences, University of Otago, Wellington, New Zealand; D.J. Veale, MD, Rheumatology, St. Vincent's University Hospital, Dublin, Ireland; W.P. Maksymowych, FRCPC, Department of Rheumatology, University of Alberta, Edmonton, Alberta, Canada.

Address reprint requests to Dr. D.D. Gladman, Toronto Western Hospital, University Health Network, 399 Bathurst Street, 1E410B, Toronto, Ontario M5T 2S8, Canada. E-mail: dafna.gladman@utoronto.ca

Accepted for publication April 20, 2007.