Reproducibility of multiple‐observer scoring of radiologic abnormalities in the hands and wrists of patients with rheumatoid arthritis

Sharp, John T.; Bluhm, Gilbert B.; Brook, Andrew; Brower, Anne C.; Corbett, Mary; Decker, John L.; Genant, Harry K.; Gofton, J. P.; Goodman, Neal; Larsen, Arvi; Lidsky, Martin D.; Pussila, Pekka; Weinstein, Aaron S.; Weissman, Barbara N.; Young, David M.

doi:10.1002/art.1780280104

Cited by 122 publications

(58 citation statements)

References 22 publications

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“…Reader variability increased with radiographs that demonstrated less severe involvement. The authors commented that "there are no guidelines determining what is an appropriate level when correlation coefficients are used to measure precision of reproducibility" (27). In our study, the data were also analyzed using a model that examined whether the group differences could be attributed to reader variability.…”

Section: Discussionmentioning

confidence: 97%

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The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Weinblatt

Polisson

Blotner

et al. 1993

Arthritis & Rheumatism

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Objective. To determine the effects of drug therapy (methotrexate [MTX] versus auranofin [AUR]) onradiographic progression in patients with active rheumatoid arthritis (RA).Methods. We conducted a 9-month randomized, multicenter, double-blind trial comparing MTX and AUR. Standardized radiographs of the hands and wrists were obtained at baseline and at completion of the study. Four experienced bone radiologists graded the radiographs for erosions, joint space narrowing, erosion healing, and reparative bone formation. Conclusion. The rate of radiographic progression in patients with RA, as measured by erosion score and joint space narrowing score, was demonstrated to be lower in those treated with MTX, as compared with AUR, over a 36-week period.The rate of radiographic progression is considered to be an important parameter of the efficacy of second-line therapy in rheumatoid arthritis (RA). Whether any second-line therapy in current use, including methotrexate (MTX), slows radiographic progression is uncertain (1,2). The clinical efficacy profile of MTX is, however, favorable, based on data from short-term randomized placebo-controlled trials (3-3, comparative studies with other second-line therapies ( 6 4 , and long-term prospective studies (9,lO). In a previously published report we described the clinical results of a 36-week multicenter study comparing MTX and auranofin (AUR) (11). The effect of treatment on radiographic activity has now been evaluated PATIENTS AND METHODSPatients. Two hundred eighty-one patients with active RA were enrolled in a multicenter double-blind trial comparing MTX and AUR (1 1). All patients had had inadequate disease response to at least 2 nonsteroidal antiinflammatory drugs (NSAIDs). Patients who had received prior treatment, of any duration, with gold salts, MTX, D-penicillamine, or cytotoxic agents were excluded from the study.Patients were randomized to receive either AUR (n = 143) or MTX (n = 138) for 9 months. (At 1 of the sites, only 1 patient was enrolled in the AUR group, and that patient was excluded from the efficacy analysis.) The initial dosage of AUR was 6 mg/day; this could be increased to 9 mg/day after 24 weeks of treatment, if there was a lack of a beneficial response with the lower dosage. The initial dosage of MTX was 7.5 mg/week, which could be increased to 15 mg/week between weeks 6 and 12 in patients who had not shown a clinical response. Patients were allowed to continue taking stable maintenance doses of background NSAIDs and/or prednisone (at a maximum dosage of 10 mg/day). Standard clinical assessments of arthritis activity were performed during the trial.Radiographic evaluation. Radiographs of the hands and wrists were obtained at baseline and at completion of the 9-month trial. A standardized protocol was used for obtaining these radiographs. All radiographs were taken on a single 30 X 35-cm cassette, with the patient in a posteroanterior position with the fingers slightly separated and the forearms flat. Each study center was provided with a Kodak (Ea...

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Section: Discussionmentioning

confidence: 97%

“…All 4 radiologists were experienced bone radiologists, and a high degree of interobserver reliability was demonstrated. Sharp et a1 evaluated the effects of multiple observers on radiographic scoring (27). Reader variability increased with radiographs that demonstrated less severe involvement.…”

Section: Discussionmentioning

confidence: 99%

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

Weinblatt

Polisson

Blotner

et al. 1993

Arthritis & Rheumatism

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“…Using the raw scores, the numbers of patients classified as having LIS and HIS with Larsen's and Sharp's methods were statistically significantly different (0.025 C P < 0.05). Sharp's method showed 9 patients with a HIS that Larsen's classified as a LIS. Only 1 patient was classified as HIS with Larsen's method that Sharp's classified as LIS.…”

Section: Resultsmentioning

confidence: 99%

“…The efficacy of MTX therapy on radiographic evidence of RA progression has not been demonstrated in randomized controlled trials, but its potential for preventing radiographic progression has been suggested (1 [3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Whether the rate of progression was slowed during the period of observation of our patients remains uncertain, since there was no control group.…”

Section: Discussionmentioning

confidence: 99%

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

Cuchacovich

Couret

Peray

et al. 1992

Arthritis & Rheumatism

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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-

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“…Progresja radiologiczna była oceniana za pomocą indeksu Sharpa w modyfikacji van der Heijde'a (SHS) [10,11]. Biorąc pod uwagę fakt, że całkowita destrukcja jednego stawu w ciągu roku to wzrost o 5 jednostek w skali SHS, jako definicję RRP przyjęto wzrost wskaźnika SHS o 5 jednostek/rok [12,13].…”

Section: S U M M a R Yunclassified

Matrix risk models for the prediction of rapid radiographic progression in patients with rheumatoid arthritis

Przepiera-Będzak¹,

Brzosko²

2012

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Matryce modeli przewidywania ryzyka szybkiej progresji radiologicznej u chorych na reumatoidalne zapalenie stawów Matrix risk models for the prediction of rapid radiographic progression in patients with rheumatoid arthritis H Ha an nn na a P Pr rz ze ep pi ie er ra a--B Bę ęd dz za ak k, , M Ma ar re ek k B Br rz zo os sk ko o Klinika Reumatologii i Chorób Wewnętrznych Pomorskiego Uniwersytetu Medycznego w Szczecinie S Sł ło ow wa a k kl lu uc cz zo ow we e: : szybka progresja radiologiczna, reumatoidalne zapalenie stawów.K Ke ey y w wo or rd ds s: : rapid radiographic progression, rheumatoid arthritis. S t r e s z c z e n i eSzybka progresja radiologiczna (rapid radiographic progression -RRP) w przebiegu reumatoidalnego zapalenia stawów (RZS) występuje u niewielkiego odsetka chorych. Zastosowanie efektywnej terapii pozwoli zwolnić postęp zmian radiologicznych w tej grupie chorych. Szybka identyfikacja czynników ryzyka RRP ma zatem istotne znaczenie w leczeniu RZS. Korzystanie z pojedynczych zmiennych mających wpływ na RRP może mieć ograniczone znaczenie, skuteczniejsze jest zastosowanie kombinacji wielu zmiennych. W tym celu opracowano matryce modeli przewidywania RRP u chorych na RZS. W tworzeniu tych modeli wykorzystano wyniki badań klinicznych ASPIRE, ATTRACT oraz badania BEST. Stworzone matryce modeli ryzyka wystąpienia RRP mogą być przydatne reumatologom w ich codziennej praktyce w podejmowaniu decyzji o zastosowaniu leczenia u chorych na RZS. Pozwalają one na ocenę ryzyka wystąpienia RRP u każdego chorego, z uwzględnieniem kombinacji specyficznych czynników ryzyka. Wymagają zastosowania kilku prostych do oceny zmiennych, uwzględniają różne opcje leczenia i są łatwe w zastosowaniu.

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Reproducibility of multiple‐observer scoring of radiologic abnormalities in the hands and wrists of patients with rheumatoid arthritis

Cited by 122 publications

References 22 publications

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

The effects of drug therapy on radiographic progression of rheumatoid arthritis. results of a 36‐week randomized trial comparing methotrexate and auranofin

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

Matrix risk models for the prediction of rapid radiographic progression in patients with rheumatoid arthritis

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