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Automated Measurement of Joint Space Width in Small Joints of Patients with Rheumatoid Arthritis CÉDRIC LUKAS, JOHN T. SHARP, JANE ANGWIN, MAARTEN BOERS, JEFF DURYEA, JAMES R. HALL, JOOST A. KAUFFMAN, ROBERT LANDEWÉ, GEORG LANGS, HEIN J. BERNELOT MOENS, PHILIPP PELOSCHEK, and DÉSIRÉE van der HEIJDE
ABSTRACT. Methods. Change in JSW was determined by 5 measurement methods on 4 radiographs per patient from 107 patients included in the COBRA trial (comparing sulfasalazine alone or in combination with methotrexate and corticosteroids). For each method the number of patients with sufficient available results was assessed (efficiency). An independent repeated measurement was carried out on a random sample of 30 patients' baseline and 1-year radiographs, to evaluate within-method reliability of change scores. Discriminatory ability (DA) of the measurement methods (between the 2 treatment arms) was compared with the DA of the Sharp-van der Heijde score (SHS) and its 2 components (erosion and JSW scores). Results. The overall success rate varied widely between methods. Applying the chosen threshold of a minimum of 50% available joints with a change score per patient resulted in a success rate > 92% in 4/5 methods. Repeatability of measurements was good for most methods (intraclass correlation coefficient ≥ 0.80 in 4/5 methods). Almost all measurement methods in 3 followup periods (12/14) showed a lower mean loss of JSW in patients from the intensive treatment group, although this was rarely statistically significant, confirming the known difference in structural damage. JSW as measured by the (semi)automated systems often showed higher DA than the JSW score of the SHS, but was lower than the total SHS and erosion scores. Conclusion. Although efficiency of the methods should be improved further, results already show good reliability and encouraging DA of most methods. Optimal information may be obtained with a combination of scoring of erosions and (semi)automated measurement of JSW. (First Release June 15 2008; J Rheumatol 2008;35:1288-93) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From the University of Maastricht, Maastricht, The Netherlands; University of Washington School of Medicine, Seattle, Washington, USA; GlaxoSmithKline, Stevenage, Hertfordshire, UK; Free University of Amsterdam, Amsterdam, The Netherlands; Brigham and Women's Hospital, Harvard University, Boston, Massachusetts, USA; University of Twente, Enschede, The Netherlands; Institute for Computer Graphics and Vision, Graz University of Technology, and Pattern Recognition and Image Processing Group, Vienna University of Technology, Vienna, Austria; Hospital Group Twente, Hengelo, The Netherlands; Vienna Medical University, Vienna, Austria; and Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. C. Lukas, MD, Rheumatologist, Universiteit Maastricht; J.T. Sharp, MD, Affiliate Professor of Medicine, University of Washington; J. Angwin, MA, Research Associate, Biology, Respiratory and Inflammation Centre of Excellence in Drug Discovery, GlaxoSmithKline; M. Boers, MD, Professor of Medicine, Department of Clinical Epidemiology, VU University Medical Center, Amsterdam, The Netherlands; D.M.F.M. van der Heijde, MD, PhD, Professor of Rheumatology, Leiden University Medical Center; J. Duryea, PhD, Assistant Professor, Brigham and Women's Hospital, Harvard University; J.R. Hall, Software Engineer, Snoqualmie, WA, USA; J.A. Kauffman, MSc, Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente; R.B. Landewé, MD, PhD, Universiteit Maastricht; H.J. Bernelot Moens, MD, Rheumatologist, Ziekenhuis Groep Twente; P. Peloschek, MD, Department of Radiology, Vienna Medical University; G. Langs, MSc, PhD, Institute for Computer Graphics and Vision, Graz University of Technology, and Pattern Recognition and Image Processing Group, Vienna University of Technology. Address reprint requests to Dr. R. Landewé, Department of Internal Medicine, Division of Rheumatology, PO Box 5800, 6202 AZ Maastricht, The Netherlands. Accepted for publication February 16, 2008. |
