Precision of the larsen and the sharp methods of assessing radiologic change in patients with rheumatoid arthritis

Abstract

Objective. To compare the sensitivity of Sharp's and Larsen's radiographic scoring methods for detecting change in rheumatoid arthritis (RA) over time.Methods. Radiographs of the hands and wrists were taken at the beginning and at the end of a 2-year followup period, in 42 patients with active RA. Films were scored blindly using both scoring methods. Patients were under treatment with methotrexate (intramuscular injections).Results. Radiographic evidence of progression or amelioration was detected in 25 patients by Larsen's method and in 35 patients by Sharp's method. The relative sensitivity to change over time was greater for Sharp's method (0.01 < P < 0.025).Conclusion. Sharp's radiographic scaring method seems to be more sensitive to change over time than is Larsen's method. The clinical importance af the change needs to be definitively established.Although it is a multisystem disorder, rheumatoid arthritis (RA) is characterized by protracted syn-

The Sharp/van der Heijde method out-performed the Larsen/Scott method on the individual patient level in assessing radiographs in early rheumatoid arthritis

“…They are used to detect changes over time within patients or groups of patients (as an evaluative instrument) as well as to detect differences between individual patients or groups of patients (as a discriminative instrument) [8]. The sensitivity to detect changes over time ( ϭ responsiveness) and the ability to discriminate between patients are both part of the reliability of these scoring methods and have been evaluated several times within the last decades by various statistics [4,[9][10][11][12][13][14][15][16][17][18][19][20][21]. This variability in methods does not allow an unequivocal comparative evaluation of radiologic scoring methods.…”

Multireader assessment as an alternative to reference assessment to improve the detection of radiographic progression in a large longitudinal cohort of rheumatoid arthritis (ESPOIR)

“…These results highlight that reproducibility is never poor (<0.6) but can range from correct16 17 and good18 19 to excellent 27 9 20–26 Of note, the reference statistic used to evaluate the reproducibility is the ICC. Only a few studies evaluated inter-rater reliability in radiographic evaluation in RA with >2 readers 16…”

“…This reproducibility depends on reader experience, number of readers, joint training of the readers, use of progression score or absolute score, and time of reproducibility evaluation during the follow-up of the patient 9. The results of different studies evaluating inter-rater reliability in RA scoring are shown in the online supplementary table S1.…”

Interpreting radiographic data in rheumatoid arthritis

“…30 Nevertheless, some studies have found that compared with the Larsen method and its modifications, the Sharp method and its variations are more sensitive, particularly with respect to change over time. [31][32][33] The original Sharp method assessed 27 joints in each hand and wrist, with each joint being given a separate score for joint space narrowing and erosions. 34 Sharp and colleagues subsequently identified 17 areas for erosions and 18 areas for joint space narrowing that resulted in a high degree of intraand interobserver accuracy.…”