Radiological Signs of Rheumatoid Arthritis: A Study of Observer Differences in the Reading of Hand Films

Classifications in Brief: Kellgren-Lawrence Classification of Osteoarthritis

“…The first formalized attempts at establishing a radiographic classification scheme for OA were described by Kellgren and Lawrence (KL) in 1957 [19]. After studying rheumatism in coal miners at the Bedford Colliery in North West England [18], Kellgren investigated the inter-and intraobserver reliability of radiographic changes of rheumatism observed in the hand [17]. After concluding that there was wide disagreement among different observers, KL endeavored to establish a classification scheme with an associated set of standardized radiographs for OA of diarthrodial joints.…”

Radiological evaluation of erosions: a quantitative method for assessing long‐term remittive therapy in rheumatoid arthritis.

“…As Kellgren and his associates suggested in the mid-nineteen fifties and numerous other studies have also reported (Empire Rheumatism Council, 1955;Fletcher & Rowley, 1952;Kellgren & Bier, 1956;Larsen et al, 1979), it is considerably more difficult to make a reliable assessment of osteoporosis than of new erosions. Despite that fact, various alternative methods have been proposed which rely exclusively or chiefly on some measurement of osteoporosis.…”

“…The assessment is based chiefly on the 5-point ordinal scale (0-4) developed in the mid-fifties by J. H. Kellgren, first with Bier (Kellgren & Bier, 1956) and later with Lawrence (Kellgren & Lawrence, 1957) in a trial which involved readings by such eminent international rheumatologists as Bunim, McEwen, Ragan and Bywaters. These early studies found 'a satisfactory measure of agreement' among different readers (and between different readings by the same observer) in regard to the severity of RA and the presence or absence of erosions, but less interobserver consistency in evaluating the severity of erosions, especially in borderline cases.…”

Konventionelle Radiologie – Differenzialdiagnostik und Verlaufsbeurteilung der chronischen Polyarthritis

“…So kann eine relativ harte, ü berbelichtete Aufnahme eine Osteoporose vort ä uschen, wohingegen eine sehr weiche Aufnahme den gegenteiligen Effekt hat. So verwundert es nicht, dass der subjektive Eindruck des Beurteilers auch hier ganz wesentlich dar ü ber entscheidet, ob er eine gelenknahe Osteoporose erkennt oder nicht[5] , wodurch auch zu erkl ä ren ist, weshalb sie in verschiedenen Studien in sehr unterschiedlicher H ä ufi gkeit zwischen 5 % [6] und 28 %[7] bei fr ü her chronischer Polyarthritis gefunden wird. Die direkten Arthritiszeichen -subchondrale Signalzysten, kn ö -cherne Erosion und Gelenkspaltverschm ä lerung -entsprechen strukturellen Ver ä nderungen.…”