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DAFNA D. GLADMAN, ROBERT D. INMAN, RICHARD J. COOK, WALTER P. MAKSYMOWYCH, JURGEN BRAUN, JOHN C. DAVIS, ROBERT B.M. LANDEWÉ, 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 DESIRÉE van der HEIJDE

ABSTRACT.

Objective. To determine whether the assessments of peripheral joints and enthesitis were reproducible for both AS and PsA with axial disease, and whether dactylitis assessment is reproducible in patients with PsA.

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, disease duration 17 yrs) and 9 patients with AS (7 men, 2 women, mean age 38 yrs, disease duration 16 yrs). A modified Latin-square design that enabled assessment of patient, assessor, and order effect was used. Measures included were number of tender and swollen joints, presence of enthesitis using 6 different indices, and dactylitis score. Data were analyzed using intraclass correlation (ICC) adjusted for order of measurements.

Results. The majority of the variance was contributed by the patients. There was no order effect. The assessment of tender joints (ICC 0.69) was more reliable than the assessment of swollen joints (ICC 0.54). Moreover, there was better agreement in patients with PsA (ICC 0.78) than in patients with AS (ICC 0.62). There was excellent agreement on the number of active enthesitis sites (ICC 0.86). All the enthesitis indices provided substantial to excellent agreement among observers. Agreement for the dactylitis score was substantial (ICC 0.70).

Conclusion. The assessment of peripheral joints is more reliable in patients with PsA. Enthesitis instruments can be used reliably in patients with AS and patients with PsA with spinal involvement. The Leeds dactylitis instrument functions well in PsA. (First Release July 15 2007; J Rheumatol 2007;34:1740-5)

Key Indexing Terms:

SPONDYLOARTHRITIS
RELIABILITY
ASSESSMENT
PERIPHERAL JOINTS
ENTHESITIS
DACTYLITIS

From the Centre for Prognosis Studies in the Rheumatic Diseases, 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, 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, University of Toronto, Toronto, Ontario, Canada; R.J. Cook, MD, Department of Statistics and Actuarial Science, University of Waterloo, Waterloo, Ontario, Canada; W.P. Maksymowych, FRCPC, Department of Rheumatology, University of Alberta, Edmonton, Alberta, Canada; J. Braun, MD, Rheumazentrum, Ruhrgebiet, Herne, Germany; J.C. Davis, MD, Department of Rheumatology, Allergy and Immunology, University of California, San Francisco, California, USA; R.B.M. Landewé, MD, PhD, Department of Rheumatology, University Hospital Maastricht, Maastricht, The Netherlands; 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. John's, 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; D. van der Heijde, MD, PhD, Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.

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 6, 2007.