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Burmester GR, Kalden JR, Rose T. [80 milestones in rheumatology from 80 years- III. 1980-2000]. Z Rheumatol 2021; 80:515-527. [PMID: 34236494 DOI: 10.1007/s00393-021-01037-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/21/2021] [Indexed: 11/27/2022]
Affiliation(s)
- Gerd-Rüdiger Burmester
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland.
| | - Joachim R Kalden
- Medizinische Klinik 3, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Deutschland
| | - Thomas Rose
- Medizinische Klinik mit Schwerpunkt Rheumatologie und Klinische Immunologie, Charité - Universitätsmedizin Berlin, Freie Universität Berlin und Humboldt Universität zu Berlin, Charitéplatz 1, 10117, Berlin, Deutschland
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Joint-Preserving Surgery for Forefoot Deformities in Patients with Rheumatoid Arthritis: A Literature Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084093. [PMID: 33924481 PMCID: PMC8068870 DOI: 10.3390/ijerph18084093] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 03/23/2021] [Accepted: 04/08/2021] [Indexed: 11/17/2022]
Abstract
The combination of first metatarsophalangeal joint arthrodesis and resection arthroplasty of all lesser metatarsal heads has been historically considered the golden standard treatment for rheumatoid forefoot deformities. However, as recent improved management of rheumatoid arthritis have reduced progression of joint destruction, the surgical treatments for rheumatoid forefoot deformities have gradually changed from joint-sacrificing surgery, such as arthrodesis and resection arthroplasty, to joint-preserving surgery. The aim of this literature review was to provide current evidence for joint-preserving surgery for rheumatoid forefoot deformities. We focused on the indications, specific outcomes, and postsurgical complications of joint-preserving surgery in this review.
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Hirano T, Nishide M, Nonaka N, Seita J, Ebina K, Sakurada K, Kumanogoh A. Development and validation of a deep-learning model for scoring of radiographic finger joint destruction in rheumatoid arthritis. Rheumatol Adv Pract 2019; 3:rkz047. [PMID: 31872173 PMCID: PMC6921374 DOI: 10.1093/rap/rkz047] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 11/04/2019] [Indexed: 12/15/2022] Open
Abstract
Objective The purpose of this research was to develop a deep-learning model to assess radiographic finger joint destruction in RA. Methods The model comprises two steps: a joint-detection step and a joint-evaluation step. Among 216 radiographs of 108 patients with RA, 186 radiographs were assigned to the training/validation dataset and 30 to the test dataset. In the training/validation dataset, images of PIP joints, the IP joint of the thumb or MCP joints were manually clipped and scored for joint space narrowing (JSN) and bone erosion by clinicians, and then these images were augmented. As a result, 11 160 images were used to train and validate a deep convolutional neural network for joint evaluation. Three thousand seven hundred and twenty selected images were used to train machine learning for joint detection. These steps were combined as the assessment model for radiographic finger joint destruction. Performance of the model was examined using the test dataset, which was not included in the training/validation process, by comparing the scores assigned by the model and clinicians. Results The model detected PIP joints, the IP joint of the thumb and MCP joints with a sensitivity of 95.3% and assigned scores for JSN and erosion. Accuracy (percentage of exact agreement) reached 49.3–65.4% for JSN and 70.6–74.1% for erosion. The correlation coefficient between scores by the model and clinicians per image was 0.72–0.88 for JSN and 0.54–0.75 for erosion. Conclusion Image processing with the trained convolutional neural network model is promising to assess radiographs in RA.
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Affiliation(s)
- Toru Hirano
- Department of Respiratory Medicine and Clinical Immunology, Internal Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - Masayuki Nishide
- Department of Respiratory Medicine and Clinical Immunology, Internal Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka
| | - Naoki Nonaka
- Medical Sciences Innovation Hub Program, RIKEN, Yokohama, Kanagawa
| | - Jun Seita
- Medical Sciences Innovation Hub Program, RIKEN, Yokohama, Kanagawa
| | - Kosuke Ebina
- Department of Musculoskeletal Regenerative Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka, Japan
| | | | - Atsushi Kumanogoh
- Department of Respiratory Medicine and Clinical Immunology, Internal Medicine, Graduate School of Medicine, Osaka University, Suita, Osaka
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Vanier A, Smolen JS, Allaart CF, Van Vollenhoven R, Verschueren P, Vastesaeger N, Saevarsdottir S, Visser K, Aletaha D, Combe B, Fautrel B. An updated matrix to predict rapid radiographic progression of early rheumatoid arthritis patients: pooled analyses from several databases. Rheumatology (Oxford) 2019; 59:1842-1852. [DOI: 10.1093/rheumatology/kez542] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Revised: 09/19/2019] [Indexed: 01/23/2023] Open
Abstract
Abstract
Objective
In early RA, some patients exhibit rapid radiographic progression (RRP) after one year, associated with poor functional prognosis. Matrices predicting this risk have been proposed, lacking precision or inadequately calibrated. We developed a matrix to predict RRP with high precision and adequate calibration.
Methods
Post-hoc analysis by pooling individual data from cohorts (ESPOIR and Leuven cohorts) and clinical trials (ASPIRE, BeSt and SWEFOT trials). Adult DMARD-naïve patients with active early RA for which the first therapeutic strategy after inclusion was to prescribe methotrexate or leflunomide were included. A logistic regression model to predict RRP was built. The best model was selected by 10-fold stratified cross-validation by maximizing the Area Under the Curve. Calibration and discriminatory power of the model were checked. The probabilities of RRP for each combination of levels of baseline characteristics were estimated.
Results
1306 patients were pooled. 20.6% exhibited RRP. Four predictors were retained: rheumatoid factor positivity, presence of at least one RA erosion on X-rays, CRP > 30mg/l, number of swollen joints. The matrix estimates RRP probability for 36 combinations of level of baseline characteristics with a greatly enhanced precision compared with previously published matrices (95% CI: from ± 0.02 minimum to ± 0.08 maximum) and model calibration is excellent (P = 0.79).
Conclusion
A matrix proposing RRP probability with high precision and excellent calibration in early RA was built. Although the matrix has moderate sensitivity and specificity, it is easily usable and may help physicians and patients to make treatment decisions in daily clinical practice.
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Affiliation(s)
- Antoine Vanier
- Department of Biostatistics Public Health and Medical Informatics, Sorbonne University, APHP, University Hospitals Pitié-Salpêtrière Charles-Foix, Paris
- University Bretagne-Loire, University of Nantes, University of Tours, Inserm UMR U1246 SPHERE ‘Methods in patient-centered outcomes and health research’, Nantes
| | - Josef S Smolen
- Division of Rheumatology and Department of Medicine 3, University of Vienna, Vienna, Austria
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Ronald Van Vollenhoven
- Rheumatology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | | | | | - Saedis Saevarsdottir
- Rheumatology Unit, Department of Medicine, Karolinska Institute and Karolinska University Hospital, Solna, Stockholm, Sweden
| | - Karen Visser
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Daniel Aletaha
- Division of Rheumatology and Department of Medicine 3, University of Vienna, Vienna, Austria
| | - Bernard Combe
- Department of Rheumatology, Montpellier 1 University, Montpellier University Hospital
| | - Bruno Fautrel
- Department of Rheumatology, Sorbonne University, GRC-08 (EEMOIS), APHP, University Hospitals Pitié-Salpêtrière Charles-Foix, Paris, France
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Preliminary validation of the Simplified Psoriatic Arthritis Radiographic Score (SPARS). Skeletal Radiol 2019; 48:1033-1041. [PMID: 30535825 DOI: 10.1007/s00256-018-3124-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2018] [Revised: 10/30/2018] [Accepted: 11/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop and validate in a preliminary way a novel radiographic scoring system for psoriatic arthritis (PsA), called Simplified Psoriatic Arthritis Radiographic Score (SPARS). MATERIALS AND METHODS Radiographs of hands and feet were obtained from consecutive PsA patients and assessed by two readers. For each joint (30 joints in the hands, ten joints in the feet), the combination of the erosions, joint narrowing space (JNS) and bony proliferation (BP) has been assessed, giving a value of 1 for erosions presence, 1 for JNS presence, and 1 for BP presence (SPARS score range, 0-120). Reliability was assessed by calculating the intraclass correlation coefficient (ICC) and smallest detectable difference (SDD) of the readings. To determine the convergent validity, SPARS was compared to the modified Sharp/van der Heijde Score (mSvdHS) and to the Ratingen scoring system (PARS). RESULTS One-hundred and five hands and feet radiographs have been assessed. The inter- and intra-rater reliability were excellent (inter-rater reliability 0.934, and intra-rater reliability for both readers 0.845 and 0.876). The SDD for the average SPARS scores of the two readers was 8.0. SPARS correlated strongly with mSvdHS (r = 0.926; p < 0.0001), and PARS (r = 0.904; p < 0.0001). The mean time to score each of the mSvdHS, PARS, and SPARS was 14.4, 10.1, and 4.5 min, respectively. CONCLUSIONS The SPARS properties are close to those of the mSvdHS and PARS and is quicker to calculate.
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Imagama T, Tokushige A, Seki K, Seki T, Ogasa H, Taguchi T. Risk Factors Associated With Short-term Clinical Results After Total Hip Arthroplasty for Patients With Rheumatoid Arthritis. Orthopedics 2018; 41:e772-e776. [PMID: 30168834 DOI: 10.3928/01477447-20180828-06] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 05/21/2018] [Indexed: 02/03/2023]
Abstract
Clinical outcomes of total hip arthroplasty for rheumatoid arthritis are reportedly worse than those of total hip arthroplasty for osteoarthritis of the hip. The authors examined pre- and postoperative factors associated with the modified Harris hip score (mHHS). Fifty-one joints of 48 rheumatoid arthritis patients who underwent total hip arthroplasty were studied retrospectively. The authors examined the correlation between preoperative rheumatoid arthritis disease activity (Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein) and mHHS at 1 year after total hip arthroplasty. Furthermore, pre- and postoperative mHHS values were compared between patients with other affected joints and patients with no affected joints in the lower limbs. The mean mHHS improved to 73.5 points postoperatively from 36.4 points preoperatively. Preoperative Disease Activity Score in 28 joints-C-reactive protein and C-reactive protein values were negatively correlated with pre- and postoperative mHHS values. Preoperative mHHS was not significantly different between the affected and not affected groups; however, postoperative mHHS was significantly lower in the affected group than in the not affected group. Total hip arthroplasty showed good clinical results for rheumatoid arthritis at short-term follow-up. However, pre- and postoperative mHHS values were influenced by preoperative rheumatoid arthritis disease activity. Moreover, the presence of additional affected joints in the lower limbs preoperatively resulted in a lower postoperative mHHS. Unlike patients with osteoarthritis, patients with rheumatoid arthritis often have multiple affected joints, which may contribute to a lower mHHS. Comprehensive treatment, including surgery for the other affected joints in the lower limbs, may improve a patient's postoperative mHHS. [Orthopedics. 2018; 41(6):e772-e776.].
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Kono M, Kamishima T, Yasuda S, Sakamoto K, Abe S, Noguchi A, Watanabe T, Shimizu Y, Oku K, Bohgaki T, Amengual O, Horita T, Atsumi T. Effectiveness of whole-body magnetic resonance imaging for the efficacy of biologic anti-rheumatic drugs in patients with rheumatoid arthritis: A retrospective pilot study. Mod Rheumatol 2017; 27:953-960. [PMID: 28121200 DOI: 10.1080/14397595.2016.1276425] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
OBJECTIVES To evaluate the scoring of whole-body magnetic resonance imaging (WBMRI) for efficacy assessment in rheumatoid arthritis (RA) patients receiving biological disease-modifying anti-rheumatic drugs (bDMARDs). METHODS Thirty consecutive RA patients receiving bDMARDs were included in this retrospective study. Contrast WBMRI was performed before and 1 year after bDMARDs initiation. RESULTS At baseline, mean age was 57.1 years and mean disease duration was 3.0 years. Median disease activity score in 28 joints improved from 5.1 to 2.1. Treatment with bDMARDs improved mean whole-body synovitis score from 31.2 to 23.2 and median whole-body bone-edema score from 11 to 3. Whole-body bone-erosion score improved in seven patients and deteriorated in 17 patients. Logistic regression analysis identified whole-body synovitis score as a poor prognostic factor for whole-body bone-erosion progression. Bone-edema score in individual bones was identified as a poor prognostic factor for the progression of bone-erosion. Changes in hand synovitis score correlated with those of other joints, but neither changes in bone-edema nor erosion score of hands correlated with those of other joints in WBMRI. CONCLUSIONS WBMRI scoring may be a novel useful tool to evaluate the efficacy of anti-rheumatic drugs, as well as a potential predictor of joint prognosis, in patients with RA.
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Affiliation(s)
- Michihito Kono
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tamotsu Kamishima
- b Faculty of Health Sciences , Hokkaido University , Sapporo , Japan
| | - Shinsuke Yasuda
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Keita Sakamoto
- c Department of Radiation Medicine , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Sawako Abe
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Atsushi Noguchi
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Toshiyuki Watanabe
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Yuka Shimizu
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Kenji Oku
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Toshiyuki Bohgaki
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Olga Amengual
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tetsuya Horita
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
| | - Tatsuya Atsumi
- a Division of Rheumatology, Endocrinology and Nephrology , Hokkaido University Graduate School of Medicine , Sapporo , Japan
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Gandjbakhch F, Granger B, Freund R, Foltz V, Jousse-Joulin S, Devauchelle V, Afshar M, Albert JD, Bailly F, Constant E, Biale L, Milin M, Couderc M, Denarie D, Fradin A, Martaille V, Pierreisnard A, Poursac N, Saraux A, Fautrel B. Multireader assessment as an alternative to reference assessment to improve the detection of radiographic progression in a large longitudinal cohort of rheumatoid arthritis (ESPOIR). RMD Open 2017; 3:e000343. [PMID: 28123779 PMCID: PMC5237761 DOI: 10.1136/rmdopen-2016-000343] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Revised: 11/29/2016] [Accepted: 11/30/2016] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION Structural damage progression is a major outcome in rheumatoid arthritis (RA). Its evaluation and follow-up in trials should involve radiographic scoring by 1 or 2 readers (reference assessment), which is challenging in large longitudinal cohorts with multiple assessments. OBJECTIVES To compare the reproducibility of multireader and reference assessment to improve the feasibility of detecting radiographic progression in a large cohort of patients with early arthritis (ESPOIR). METHODS We used 3 sessions to train 12 rheumatologists in radiographic scoring by the van der Heijde-modified Sharp score (SHS). Multireader scoring was based on 10 trained-reader assessments, each reader scoring a random sample of 1/5 of all available radiographs (for double scoring for each X-ray set) for patients included in the ESPOIR cohort with complete radiographic data at M0 and M60. Reference scoring was performed by 2 experienced readers. Scoring was performed blindly to clinical data, with radiographs in chronological order. We compared multireader and reference assessments by intraclass correlation coefficients (ICCs) for SHS and significant radiographic progression (SRP). RESULTS The intrareader and inter-reader reproducibility for trained assessors increased during the training sessions (ICC 0.79 to 0.94 and 0.76 to 0.92), respectively. For the 524 patients included, agreement between multireader and reference assessment of SHS progression between M0 and M60 and SRP assessment were almost perfect, ICC (0.88 (95% CI 0.82 to 0.93)) and (0.99 (95% CI 0.99 to 0.99)), respectively. CONCLUSIONS Multireader assessment of radiographic structural damage progression is comparable to reference assessment and could be used to improve the feasibility of radiographic scoring in large longitudinal cohort with numerous X-ray evaluations.
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Affiliation(s)
- Frederique Gandjbakhch
- Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Benjamin Granger
- Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Department of Statistics, CHU Pitie Salpetriere, APHP, Paris, France
| | - Romain Freund
- Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Violaine Foltz
- Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | | | | | - Mona Afshar
- Department of Rheumatology , Hopital Jean Verdier , Bondy , France
| | | | - Florian Bailly
- Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Elodie Constant
- Department of Rheumatology , CHU Saint Etienne , Saint Etienne , France
| | - Lisa Biale
- Department of Rheumatology , Hopital Begin , Saint Mande , France
| | - Morgane Milin
- Department of Rheumatology , CHU la Cavale Blanche , Brest , France
| | - Marion Couderc
- Department of Rheumatology , CHU Clermont Ferrand , Clermont Ferrand , France
| | - Delphine Denarie
- Department of Rheumatology , CHU Saint Etienne , Saint Etienne , France
| | - Anne Fradin
- Department of Rheumatology , CHU Poitiers , Poitiers , France
| | | | - Audrey Pierreisnard
- Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
| | - Nicolas Poursac
- Department of Rheumatology , CHU Bordeaux , Bordeaux , France
| | - Alain Saraux
- Department of Rheumatology , CHU la Cavale Blanche , Brest , France
| | - Bruno Fautrel
- Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France
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Terao C, Yamakawa N, Yano K, Markusse IM, Ikari K, Yoshida S, Furu M, Hashimoto M, Ito H, Fujii T, Ohmura K, Murakami K, Takahashi M, Hamaguchi M, Tabara Y, Taniguchi A, Momohara S, Raychaudhuri S, Allaart CF, Yamanaka H, Mimori T, Matsuda F. Rheumatoid Factor Is Associated With the Distribution of Hand Joint Destruction in Rheumatoid Arthritis. Arthritis Rheumatol 2016; 67:3113-23. [PMID: 26245322 DOI: 10.1002/art.39306] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2015] [Accepted: 07/23/2015] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Rheumatoid arthritis (RA) is a chronic disease leading to joint destruction. Although many studies have addressed factors potentially correlated with the speed of joint destruction, less attention has been paid to the distribution of joint destruction in patients with RA. In this study, destruction of the hand bones in patients with RA was classified into 2 anatomic subgroups, the fingers and the non-fingers, with the aim of analyzing which factors are associated with destruction of the finger joints. METHODS A total of 1,215 Japanese patients with RA were recruited from 2 different populations. The degree of joint destruction was assessed using the total modified Sharp/van der Heijde score (SHS) of radiographic joint damage. The SHS score of joint damage in the finger joints was used as the dependent variable, and the SHS score in the non-finger joints was used as a covariate. Age, sex, disease duration, smoking, C-reactive protein level, treatment for RA, and positivity for and levels of anti-citrullinated protein antibodies and rheumatoid factor (RF) were evaluated as candidate correlates. Overall effect sizes were assessed in a meta-analysis. In addition, associations observed in the Japanese patients were compared to those in a cohort of 157 Dutch RA patients in the BeSt study (a randomized, controlled trial involving 4 different strictly specified treatment strategies for early RA). RESULTS Not surprisingly, disease duration in Japanese patients with RA was associated with the finger SHS score (P ≤ 0.00037). Both positivity for and levels of RF showed significant associations with the finger SHS score after adjustment for covariates (P = 0.0022 and P = 8.1 × 10(-7) , respectively). These associations were also true in relation to the time-averaged finger SHS score. An association between RF positivity and the finger SHS score was also observed in Dutch patients with RA in the BeSt study (P = 0.049). CONCLUSION Positivity for and levels of RF are associated with finger joint destruction independent of non-finger joint destruction and other covariates. Our findings suggest that there are different mechanisms of joint destruction operating in the finger joints of patients with RA.
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Affiliation(s)
- Chikashi Terao
- Kyoto University Graduate School of Medicine, Kyoto, Japan, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, and Broad Institute, Cambridge, Massachusetts
| | | | | | | | - Katsunori Ikari
- Tokyo Women's Medical University and CREST Program, Japan Science and Technology Agency, Tokyo, Japan
| | | | - Moritoshi Furu
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | - Hiromu Ito
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Takao Fujii
- Kyoto University Graduate School of Medicine, Kyoto, Japan
| | | | | | | | - Masahide Hamaguchi
- Kyoto Prefectural University of Medicine, Graduate School of Medical Science, Kyoto, Japan
| | | | | | | | - Soumya Raychaudhuri
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, Broad Institute, Cambridge, Massachusetts, and University of Manchester and Manchester Academic Health Sciences Centre, Manchester, UK
| | | | | | - Tsuneyo Mimori
- Kyoto University Graduate School of Medicine, Kyoto, Japan
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10
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Tillett W, Shaddick G, Jadon D, Robinson G, Korendowych E, McHugh N. Novel Composite Radiographic Score for Longitudinal Observational Studies of Psoriatic Arthritis: A Proof-of-concept Study. J Rheumatol 2016; 43:367-70. [DOI: 10.3899/jrheum.150114] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2015] [Indexed: 11/22/2022]
Abstract
Objective.To devise a feasible composite radiographic score for use in observational studies of psoriatic arthritis (PsA).Methods.Radiographs from 50 patients with PsA were evaluated with the PsA-modified Sharp, Sharp/van der Heijde (SvdH), and Ratingen scores. Data reductions were made to devise a concise score.Results.The Reductive X-ray Score for Psoriatic Arthritis (ReXSPA) required the assessment of only 22 joints (234 points), including erosion, joint space narrowing, and osteoproliferation in the hands and feet. The ReXSPA accounted for 80% of change detected with the SvdH score.Conclusion.We report a proof-of-concept radiographic score for observational studies derived though data reduction.
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11
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Arya R, Del Rincon I, Farook VS, Restrepo JF, Winnier DA, Fourcaudot MJ, Battafarano DF, de Almeida M, Kumar S, Curran JE, Jenkinson CP, Blangero J, Duggirala R, Escalante A. Genetic Variants Influencing Joint Damage in Mexican Americans and European Americans With Rheumatoid Arthritis. Genet Epidemiol 2015; 39:678-88. [PMID: 26498133 DOI: 10.1002/gepi.21938] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2015] [Revised: 07/26/2015] [Accepted: 09/09/2015] [Indexed: 12/18/2022]
Abstract
Joint destruction in rheumatoid arthritis (RA) is heritable, but knowledge on specific genetic determinants of joint damage in RA is limited. We have used the Immunochip array to examine whether genetic variants influence variation in joint damage in a cohort of Mexican Americans (MA) and European Americans (EA) with RA. We studied 720 MA and 424 EA patients with RA. Joint damage was quantified using a radiograph of both hands and wrists, scored using Sharp's technique. We conducted association analyses with the transformed Sharp score and the Immunochip single nucleotide polymorphism (SNP) data using PLINK. In MAs, 15 SNPs from chromosomes 1, 5, 9, 17 and 22 associated with joint damage yielded strong p-values (p < 1 × 10(-4) ). The strongest association with joint damage was observed with rs7216796, an intronic SNP located in the MAP3K14 gene, on chromosome 17 (β ± SE = -0.25 ± 0.05, p = 6.23 × 10(-6) ). In EAs, 28 SNPs from chromosomes 1, 4, 6, 9, and 21 showed associations with joint damage (p-value < 1 × 10(-4) ). The best association was observed on chromosome 9 with rs59902911 (β ± SE = 0.86 ± 0.17, p = 1.01 × 10(-6) ), a synonymous SNP within the CARD9 gene. We also observed suggestive evidence for some loci influencing joint damage in MAs and EAs. We identified two novel independent loci (MAP3K14 and CARD9) strongly associated with joint damage in MAs and EAs and a few shared loci showing suggestive evidence for association.
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Affiliation(s)
- Rector Arya
- South Texas Diabetes and Obesity Institute and Regional Academic Health Center, the University of Texas Health Science Center, Edinburg, Texas, United States of America
| | - Inmaculada Del Rincon
- Division of Rheumatology and Clinical Immunology, Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Vidya S Farook
- South Texas Diabetes and Obesity Institute and Regional Academic Health Center, the University of Texas Health Science Center, Edinburg, Texas, United States of America
| | - Jose F Restrepo
- Division of Rheumatology and Clinical Immunology, Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | - Diedre A Winnier
- Research and Information Management, University Health System, San Antonio, Texas, United States of America
| | - Marcel J Fourcaudot
- Division of Diabetes, Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
| | | | - Marcio de Almeida
- South Texas Diabetes and Obesity Institute and UT Brownsville, Brownsville, Texas, United States of America
| | - Satish Kumar
- South Texas Diabetes and Obesity Institute and Regional Academic Health Center, the University of Texas Health Science Center, Edinburg, Texas, United States of America
| | - Joanne E Curran
- South Texas Diabetes and Obesity Institute and UT Brownsville, Brownsville, Texas, United States of America
| | - Christopher P Jenkinson
- South Texas Diabetes and Obesity Institute and Regional Academic Health Center, the University of Texas Health Science Center, Edinburg, Texas, United States of America
| | - John Blangero
- South Texas Diabetes and Obesity Institute and UT Brownsville, Brownsville, Texas, United States of America
| | - Ravindranath Duggirala
- South Texas Diabetes and Obesity Institute and Regional Academic Health Center, the University of Texas Health Science Center, Edinburg, Texas, United States of America
| | - Agustin Escalante
- Division of Rheumatology and Clinical Immunology, Department of Medicine, the University of Texas Health Science Center, San Antonio, Texas, United States of America
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Jadon DR, Shaddick G, Tillett W, Korendowych E, Robinson G, Waldron N, Cavill C, McHugh NJ. Psoriatic Arthritis Mutilans: Characteristics and Natural Radiographic History. J Rheumatol 2015; 42:1169-76. [DOI: 10.3899/jrheum.150083] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/16/2015] [Indexed: 02/08/2023]
Abstract
Objective.(1) To compare clinical characteristics of patients with psoriatic arthritis (PsA) with PsA mutilans (PAM) and without PAM, and (2) to determine the rate of PAM radiographic progression.Methods.A retrospective cohort study was conducted of all patients with PsA attending a teaching hospital. The most recent hand and feet radiographs were screened for PAM. Serial radiographs (earliest to most recent) were quantitatively scored for osteolysis, erosion, joint space narrowing, and osteoproliferation.Results.Out of the 610 cases, 36 PsA cases had PAM (5.9%). PAM cases were younger at diagnosis of PsA than non-PAM cases (p = 0.04), had more prevalent psoriatic nail dystrophy (OR 5.43, p < 0.001), and worse health assessment questionnaire score (1.25 vs 0.63, p < 0.04). Radiographic axial disease (OR 2.31, adjusted p = 0.03) and especially radiographic sacroiliitis (OR 2.99, adjusted p = 0.01) were more prevalent in PAM. PAM were more likely than non-PAM cases to have used a disease-modifying antirheumatic drug (DMARD; OR 16.36, p < 0.001). Out of 33 cases, 29 PAM cases had initiated a synthetic DMARD and 4/13 had initiated anti-tumor necrosis factor (anti-TNF) prior to first demonstration of PAM. A median 5 radiographs were scored for each PAM case (interquartile range 3–7). PAM progressed from monoarticular (60%) to polyarticular (80%) involvement. Osteolysis was initially rapid and progressive in the hands and feet, tapering later during disease course. Nail dystrophy predicted more severe osteolysis (p = 0.03).Conclusion.Compared with non-PAM cases, PAM cases have earlier age at PsA diagnosis, poorer function, more prevalent nail dystrophy, and more radiographic axial disease/sacroiliitis. The rate of osteolysis is higher in earlier disease, and more severe in those with nail dystrophy. DMARD and anti-TNF therapy appear not to prevent PAM occurrence.
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13
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Snekhalatha U, Anburajan M. Computer-based measurements of joint space analysis using metacarpal morphometry in hand radiograph for evaluation of rheumatoid arthritis. Int J Rheum Dis 2015; 20:1120-1131. [PMID: 25865479 DOI: 10.1111/1756-185x.12559] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM AND OBJECTIVES The aim and objectives are as follows: (i) to perform an automated segmentation of the hand from radiographs using a dual tree complex wavelet-based watershed algorithm; ii) to compare the measured statistical features of the joint space of the hand using gray level co-occurrence matrix (GLCM) method with standard diagnostic parameters of rheumatoid arthritis (RA). METHODS Fifty-three patients with RA and 17 age- and sex-matched healthy controls were included in the study. The erythrocyte sedimentation rate (ESR), C-reactive protein, rheumatoid factor, health assessment questionnaire score (HAQ), disease activity score (DAS) and hand radiographs of all the subjects were obtained. Joint space width and cortical thickness were measured in metacarpophalangeal joints (MCP) and metacarpal bone semi-automatically using MIMICS software. Dual tree complex wavelet transform-based watershed algorithm was applied for automated segmentation, and feature extraction was performed using the GLCM method in hand radiographs of the total population. RESULTS In the RA group (n = 53), the joint space width measured in the MCP1, MCP3, MCP5 of the hand were reduced significantly (P < 0.01) by 16.4%, 15.6%, and 17.5%, respectively compared to the normal group (n = 17). The measured combined cortical thickness at the second, third and fourth metacarpal bones of the hand were reduced significantly (P < 0.01) by 9.5%, 12% and 8%, respectively in the RA group compared to the normal group. CONCLUSION The dual tree complex wavelet transform-based watershed algorithm provided effective segmentation in the digitized hand radiographs. The standard diagnostic parameters for RA were highly correlated with measured statistical features at MCP3 hand joint in the total population studied.
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Affiliation(s)
- U Snekhalatha
- Department of Biomedical Engineering, SRM University, Kattankulathur, Chennai, Tamilnadu, India
| | - M Anburajan
- Department of Biomedical Engineering, SRM University, Kattankulathur, Chennai, Tamilnadu, India
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Huang M, Schweitzer ME. The role of radiology in the evolution of the understanding of articular disease. Radiology 2015; 273:S1-22. [PMID: 25340431 DOI: 10.1148/radiol.14140270] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Both the clinical practice of radiology and the journal Radiology have had an enormous effect on our understanding of articular disease. Early descriptions of osteoarthritis (OA) appeared in Radiology. More recently, advanced physiologic magnetic resonance (MR) techniques have furthered our understanding of the early prestructural changes in patients with OA. Sodium imaging, delayed gadolinium-enhanced MR imaging of cartilage, and spin-lattice relaxation in the rotating frame (or T1ρ) sequences have advanced understanding of the pathophysiology and pathoanatomy of OA. Many pioneering articles on rheumatoid arthritis (RA) also have been published in Radiology. In the intervening decades, our understanding of the natural history of RA has been altered by these articles. Many of the first descriptions of crystalline arthropathies, including gout, calcium pyrophosphate deposition, and hydroxyapatite deposition disease, appeared in Radiology.
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Affiliation(s)
- Mingqian Huang
- From the Department of Radiology, University of Stony Brook, HSC Level 4, Room 120, Stony Brook, NY 11746
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15
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van der Heijde D. Use of imaging as an outcome measure in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis in clinical trials. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00045-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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16
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The performance of matrices in daily clinical practice to predict rapid radiologic progression in patients with early RA. Semin Arthritis Rheum 2014; 43:627-31. [DOI: 10.1016/j.semarthrit.2013.09.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Revised: 09/12/2013] [Accepted: 09/29/2013] [Indexed: 01/04/2023]
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Tillett W, Jadon D, Shaddick G, Robinson G, Sengupta R, Korendowych E, de Vries CS, McHugh NJ. Feasibility, Reliability, and Sensitivity to Change of Four Radiographic Scoring Methods in Patients With Psoriatic Arthritis. Arthritis Care Res (Hoboken) 2014; 66:311-7. [DOI: 10.1002/acr.22104] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2013] [Accepted: 07/31/2013] [Indexed: 11/08/2022]
Affiliation(s)
- W. Tillett
- Royal National Hospital for Rheumatic Diseases; Bath UK
| | - D. Jadon
- Royal National Hospital for Rheumatic Diseases; Bath UK
| | | | | | - R. Sengupta
- Royal National Hospital for Rheumatic Diseases; Bath UK
| | | | | | - N. J. McHugh
- University of Bath and Royal United Hospital; Bath UK
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Asanuma YF, Shimada Y, Kouzu N, Yokota K, Nakajima K, Sato K, Akiyama Y, Isozaki M, Mikami AS, Kobayashi H, Mimura T. Serum osteoprotegerin concentration is associated with carotid atherosclerotic plaque in patients with rheumatoid arthritis. Mod Rheumatol 2014. [DOI: 10.3109/s10165-012-0654-5] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Upchurch KS, Kay J. Evolution of treatment for rheumatoid arthritis. Rheumatology (Oxford) 2013; 51 Suppl 6:vi28-36. [PMID: 23221584 DOI: 10.1093/rheumatology/kes278] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Treatment for RA has changed profoundly over the past 25 years, evolving from a strategy of providing symptomatic relief, to implementation of therapeutic regimens that impact disease activity and ultimately have been shown to slow or arrest structural joint damage. Drug therapy for RA has evolved from salicylates, to NSAIDs, CSs, DMARDs, MTX, and finally to biologic response modifiers. MTX has become the initial drug of choice in most patients with RA, and some do well on MTX monotherapy without the addition of other agents. Combination regimens including MTX and other conventional DMARDs may be an effective early approach to treatment of RA. The biologic response modifiers (biologics) became available in the late 1990s, based on our understanding of the molecular mediators of synovial inflammation in RA. The first biologics inhibited TNF-α, a cytokine active in host defences against some infections and malignancies, but which also promotes inflammation and bone erosion. Inhibitors of TNF-α are mostly given with MTX, although some can be given as monotherapy. Studies consistently show that combination MTX + TNF-α inhibitor therapy leads to better outcomes than with either agent alone. Tight control strategies, employing objective measures, also lead to improved outcomes. When patients fail treatment with one or more TNF-α inhibitor + MTX, a number of other possible alternatives may be tried, including treatment with biologics having other mechanisms, such as antibodies to certain ILs, other cytokines and inflammatory mediators. Current therapy for RA is such that progression from symptom onset to significant disability is now no longer inevitable, and RA patients can anticipate comfortable and productive lives on medical therapy.
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Affiliation(s)
- Katherine S Upchurch
- Division of Rheumatology, Department of Medicine, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA 01605, USA.
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Fautrel B, Granger B, Combe B, Saraux A, Guillemin F, Le Loet X. Matrix to predict rapid radiographic progression of early rheumatoid arthritis patients from the community treated with methotrexate or leflunomide: results from the ESPOIR cohort. Arthritis Res Ther 2012; 14:R249. [PMID: 23164197 PMCID: PMC3674616 DOI: 10.1186/ar4092] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Accepted: 11/06/2012] [Indexed: 12/11/2022] Open
Abstract
Introduction Early rheumatoid arthritis (RA) patients may show rapid radiographic progression (RRP) despite rapid initiation of synthetic disease-modifying anti-rheumatic drugs (DMARDs). The present study aimed to develop a matrix to predict risk of RRP despite early DMARD initiation in real life settings. Methods The ESPOIR cohort included 813 patients from the community with early arthritis for < 6 months; 370 patients had early RA and had received methotrexate or leflunomide during the first year of follow-up. RRP was defined as an increase in the van der Heijde-modified Sharp score (vSHS) ≥ 5 points at 1 year. Determinants of RRP were examined first by bivariate analysis, then multivariate stepwise logistic regression analysis. A visual matrix model was then developed to predict RRP in terms of patient baseline characteristics. Results We analyzed data for 370 patients. The mean Disease Activity Score in 28 joints was 5.4 ± 1.2, 18.1% of patients had typical RA erosion on radiographs and 86.4% satisfied the 2010 criteria of the American College of Rheumatology/European League Against Rheumatism. During the first year, mean change in vSHS was 1.6 ± 5.5, and 41 patients (11.1%) showed RRP. A multivariate logistic regression model enabled the development of a matrix predicting RRP in terms of baseline swollen joint count, C-reactive protein level, anti-citrullinated peptide antibodies status, and erosions seen on radiography for patients with early RA who received DMARDs. Conclusions The ESPOIR matrix may be a useful clinical practice tool to identify patients with early RA at high risk of RRP despite early DMARD initiation.
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21
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Serum osteoprotegerin concentration is associated with carotid atherosclerotic plaque in patients with rheumatoid arthritis. Mod Rheumatol 2012; 23:269-75. [PMID: 22584471 DOI: 10.1007/s10165-012-0654-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2012] [Accepted: 04/13/2012] [Indexed: 10/28/2022]
Abstract
OBJECTIVE Osteoprotegerin (OPG), a regulator of bone resorption, is involved in the pathogenesis of rheumatoid arthritis (RA) and atherosclerosis. OPG is elevated in patients with coronary artery disease, and high OPG levels are associated with cardiac disease severity and mortality in the general population. The purpose of this study was to investigate the relationship of serum OPG levels, traditional coronary risk factors, and RA-related factors to carotid atherosclerosis in RA patients. METHODS Ninety-one RA patients were studied (85 % women, age 60 ± 10 years). Serum OPG levels were measured by an enzyme-linked immunosorbent assay. The prevalence of carotid plaque was assessed by ultrasonographic imaging in all patients. The relationship between various clinical characteristics, OPG, and carotid plaque was examined. RESULTS Serum OPG levels were significantly higher in patients with carotid plaque than in those without plaque (median level 1,397 vs. 887 pg/mL, respectively; P = 0.006). There were no significant differences between RA patients with and without carotid plaque with respect to sex, duration of RA, blood pressure, body mass index, smoking, low-density lipoprotein cholesterol, Disease Activity Score-28, van der Heijde-modified Sharp score, and prednisolone dose. After adjusting for age, sex, and C-reactive protein, elevated levels of OPG were still associated with a higher prevalence of carotid plaque in patients with RA (P = 0.038). CONCLUSION RA patients suffer from accelerated atherosclerosis and also have increased levels of OPG. The serum OPG level is independently associated with carotid plaque.
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Horton SC, Walsh CAE, Emery P. Established rheumatoid arthritis: rationale for best practice: physicians' perspective of how to realise tight control in clinical practice. Best Pract Res Clin Rheumatol 2012; 25:509-21. [PMID: 22137921 DOI: 10.1016/j.berh.2011.10.012] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2011] [Accepted: 10/11/2011] [Indexed: 02/01/2023]
Abstract
Developments in the understanding of the pathogenesis of rheumatoid arthritis (RA) and the introduction of targeted biologic therapies have greatly advanced the management of RA in clinical practice. The management of RA is now aimed at achieving remission, to prevent joint damage and disability. In particular, a critical period early in disease is recognised, in which early aggressive treatment with disease-modifying therapy is advocated. Although a state of remission is the ideal, this chapter discusses the difficulties which may arise in achieving this goal in patients with established disease. The evidence for best management, aimed at achieving clinical remission in established disease, is reviewed. The consequences of incomplete control of chronic inflammation in established disease, including pain, disability and co-morbidities (such as cardiovascular disease and osteoporosis), also pose a significant clinical challenge. The rationale for a multidisciplinary team approach in reducing the associated morbidity and mortality of the disease are examined.
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Affiliation(s)
- S C Horton
- Section of Musculoskeletal Disease, Leeds Institute of Molecular Medicine, University of Leeds, UK
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23
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Kerensky TA, Gottlieb AB, Yaniv S, Au SC. Etanercept: efficacy and safety for approved indications. Expert Opin Drug Saf 2011; 11:121-39. [DOI: 10.1517/14740338.2012.633509] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Pariente B, Cosnes J, Danese S, Sandborn WJ, Lewin M, Fletcher JG, Chowers Y, D'Haens G, Feagan BG, Hibi T, Hommes DW, Irvine EJ, Kamm MA, Loftus EV, Louis E, Michetti P, Munkholm P, Oresland T, Panés J, Peyrin-Biroulet L, Reinisch W, Sands BE, Schoelmerich J, Schreiber S, Tilg H, Travis S, van Assche G, Vecchi M, Mary JY, Colombel JF, Lémann M. Development of the Crohn's disease digestive damage score, the Lémann score. Inflamm Bowel Dis 2011; 17:1415-22. [PMID: 21560202 PMCID: PMC3116198 DOI: 10.1002/ibd.21506] [Citation(s) in RCA: 434] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2010] [Accepted: 08/30/2010] [Indexed: 12/12/2022]
Abstract
Crohn's disease (CD) is a chronic progressive destructive disease. Currently available instruments measure disease activity at a specific point in time. An instrument to measure cumulative structural damage to the bowel, which may predict long-term disability, is needed. The aim of this article is to outline the methods to develop an instrument that can measure cumulative bowel damage. The project is being conducted by the International Program to develop New Indexes in Crohn's disease (IPNIC) group. This instrument, called the Crohn's Disease Digestive Damage Score (the Lémann score), should take into account damage location, severity, extent, progression, and reversibility, as measured by diagnostic imaging modalities and the history of surgical resection. It should not be "diagnostic modality driven": for each lesion and location, a modality appropriate for the anatomic site (for example: computed tomography or magnetic resonance imaging enterography, and colonoscopy) will be used. A total of 24 centers from 15 countries will be involved in a cross-sectional study, which will include up to 240 patients with stratification according to disease location and duration. At least 120 additional patients will be included in the study to validate the score. The Lémann score is expected to be able to portray a patient's disease course on a double-axis graph, with time as the x-axis, bowel damage severity as the y-axis, and the slope of the line connecting data points as a measure of disease progression. This instrument could be used to assess the effect of various medical therapies on the progression of bowel damage.
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Affiliation(s)
- Benjamin Pariente
- Department of Hepatogastroenterology, Hôpital Saint-LouisParis, France
| | - Jacques Cosnes
- Department of Gastroenterology and Nutrition, Hôpital Saint-AntoineParis, France
| | - Silvio Danese
- Department of Gastroenterology, Instituto Clinico HumanitasRozzano, Milan, Italy
| | - William J Sandborn
- Division of Gastroenterology, University of California San DiegoLa Jolla, California
| | - Maïté Lewin
- Department of Radiology, Hôpital Saint-AntoineParis, France
| | - Joel G Fletcher
- Department of Radiology, Mayo ClinicRochester, Minnesota, USA
| | - Yehuda Chowers
- Department of Gastroenterology, Rambam Health Care CampusBat Galim, Haifa, Israel
| | - Geert D'Haens
- Imelda GI Clinical Research CenterBonheiden, Belgium
| | - Brian G Feagan
- Robarts Research Institute, University of Western OntarioLondon, Ontario, Canada
| | - Toshifumi Hibi
- Division of Gastroenterology and Hepatology, Department of Internal Medicine, Keio University School of MedicineTokyo, Japan
| | - Daniel W Hommes
- Department of Gastroenterology and Hepatology, Leiden University Medical CenterLeiden, The Netherlands
| | - E Jan Irvine
- University of Toronto and Division of Gastroenterology, St. Michael's HospitalToronto, Ontario, Canada
| | - Michael A Kamm
- StVincent's Hospital & University of MelbourneMelbourne, Australia
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo ClinicRochester, Minnesota, USA
| | - Edouard Louis
- Department of Hepatogastroenterology, Centre Hospitalier Universitaire de Liège, Liège UniversityLiège, Belgium
| | - Pierre Michetti
- Department of Gastroenterology and Hepatology, Centre Hospitalier Universitaire Vaudois and University of LausanneLausanne, Switzerland
| | - Pia Munkholm
- Department of Medical Gastroenterology C, Herlev Hospital, University of CopenhagenDenmark
| | - Tom Oresland
- Akershus University Hospital, Dept of GI Surgery, University in OsloNorway
| | - Julian Panés
- Gastroenterology Eepartment, Hospital Clinic of BarcelonaBarcelona, Spain
| | - Laurent Peyrin-Biroulet
- Department of Hepatogastroenterology, Centre Hospitalier Universitaire de NancyVandoeuvre-Lès-Nancy, France
| | | | - Bruce E Sands
- MGH Crohn's and Colitis Center and Gastrointestinal Unit, Massachusetts General Hospital, Harvard Medical SchoolBoston, Massachusetts, USA
| | | | - Stefan Schreiber
- Institute of Clinical Molecular Biology, Christian-Albrechts UniversityKiel, Germany
| | - Herbert Tilg
- Christian Doppler Research Laboratory for Gut Inflammation, Medical University InnsbruckAustria
| | - Simon Travis
- Translational Gastroenterology Unit, John Radcliffe HospitalOxford, UK
| | - Gert van Assche
- Division of Gastroenterology, University of Leuven HospitalsLeuven, Belgium
| | - Maurizio Vecchi
- Gastroenterology and Gastrointestinal Endoscopy Unit, IRCCS Policlinico San Donato & University of MilanSan Donato Milanese, Italy
| | - Jean-Yves Mary
- INSERM U717, Biostatistics and Clinical Epidemiology, Hôpital Saint-LouisParis, France
| | - Jean-Frédéric Colombel
- Department of Hepatogastroenterology, Hôpital Huriez, Centre Hospitalier UniversitaireLille, France
| | - Marc Lémann
- Department of Hepatogastroenterology, Hôpital Saint-LouisParis, France
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Bird P, Joshua F. New applications of imaging techniques for monitoring progression of rheumatoid arthritis and predicting outcome. ACTA ACUST UNITED AC 2011. [DOI: 10.2217/iim.10.69] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Van Der Heijde D. Use of imaging as an outcome measure in rheumatoid arthritis, psoriatic arthritis, and ankylosing spondylitis in clinical trials. Rheumatology (Oxford) 2011. [DOI: 10.1016/b978-0-323-06551-1.00043-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Radiographic study on the pattern of wrist joint destruction in rheumatoid arthritis. Clin Rheumatol 2010; 30:353-9. [PMID: 20857155 DOI: 10.1007/s10067-010-1575-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2010] [Revised: 08/30/2010] [Accepted: 09/08/2010] [Indexed: 10/19/2022]
Abstract
When planning therapy for rheumatoid arthritis (RA) in the wrist joint, knowing the pattern of joint destruction is important. There were a few studies using the Larsen and modified Larsen method to evaluate RA wrist joint destruction. However, these methods are inadequate for thoroughly assessing the severity of joint destruction because joint bone erosion and joint space narrowing could not be evaluated individually in these methods. To clarify the pattern of RA wrist joint destruction in the different zones of the wrist, we conducted a large-scale radiographic study. We modified the van der Heijde/Sharp method to assess radiographic images. Subjects were 191 RA patients (22 men and 169 women; mean age 57.0 years) who were examined at our center between 2001 and 2003 and underwent plain X-ray of both wrist joints (n = 382). Using X-ray images of the wrist joint, classification was performed based on the severity of wrist joint surface bone erosion and joint space narrowing at different zones, and the results were statistically analyzed. The results showed that joint space narrowing in the midcarpal joint (MCJ) advanced faster than in the radiocarpal joint (RCJ). Conversely, bone erosion in the RCJ advanced faster than in the MCJ. In X-ray diagnosis of RA wrist joint disorders, knowing the pattern of destruction is useful for assessing the presence or absence of early joint destruction and in planning therapy.
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Laws P, Barton A, Warren RB. Psoriatic arthritis - what the dermatologist needs to know. J Eur Acad Dermatol Venereol 2010; 24:1270-7. [DOI: 10.1111/j.1468-3083.2010.03654.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
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Vastesaeger N, Xu S, Aletaha D, St Clair EW, Smolen JS. A pilot risk model for the prediction of rapid radiographic progression in rheumatoid arthritis. Rheumatology (Oxford) 2009; 48:1114-21. [PMID: 19589891 DOI: 10.1093/rheumatology/kep155] [Citation(s) in RCA: 171] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Identifying patients with RA at high risk of rapid radiographic progression (RRP) is critical for making appropriate treatment decisions. We developed an exploratory prediction model for the risk of RRP using an RA study population undergoing either conservative or aggressive disease management. METHODS Using data from the active-controlled study of patients receiving infliximab for the treatment of rheumatoid arthritis of early onset (ASPIRE) early RA study, RRP was defined as a threshold change in modified Sharp/van der Heijde score (SHS) of > or =5 U/year. Spearman's rank analysis was used to identify baseline risk factors for RRP. Logistic regression was used to calculate the probability of RRP in 1 year. The results were combined into a matrix model that consisted of risk factors and initiated treatment arranged in increasing risk of RRP. Data from the anti-TNF trial in rheumatoid arthritis with concomitant therapy (ATTRACT) established RA study were applied to the model to test its generalizability in another population. RESULTS The 28 swollen joint count, RF, CRP and ESR are included as trichotomous variables and initiated treatment (monotherapy or combination therapy) as a dichotomous variable. Two models, one incorporating all risk factors except CRP and another incorporating all risk factors except ESR, were developed to adjust for collinearity. These models identify subpopulations of RA patients at higher predicted risk for RRP. CONCLUSIONS These preliminary matrix models predict the risk of RRP using initiated treatment and easily accessible clinical and laboratory variables. Further testing in other populations and with other therapies is needed to obtain a definitive risk model that will guide rheumatologists in making treatment decisions for individual RA patients.
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Peloschek P, Nemec S, Widhalm P, Donner R, Birngruber E, Thodberg HH, Kainberger F, Langs G. Computational radiology in skeletal radiography. Eur J Radiol 2009; 72:252-7. [PMID: 19581060 DOI: 10.1016/j.ejrad.2009.05.053] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2009] [Accepted: 05/07/2009] [Indexed: 11/25/2022]
Abstract
Recent years have brought rapid developments in computational image analysis in musculo-skeletal radiology. Meanwhile the algorithms have reached a maturity that makes initial clinical use feasible. Applications range from joint space measurement to erosion quantification, and from fracture detection to the assessment of alignment angles. Current results of computational image analysis in radiography are very promising, but some fundamental issues remain to be clarified, among which the definition of the optimal trade off between automatization and operator-dependency, the integration of these tools into clinical work flow and last not least the proof of incremental clinical benefit of these methods.
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Affiliation(s)
- Ph Peloschek
- Computational Image Analysis and Radiology Lab, Department of Radiology, Medical University Vienna, Waehringer Guertel 18-20, Vienna, Austria
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Peloschek P, Boesen M, Donner R, Kubassova O, Birngruber E, Patsch J, Mayerhöfer M, Langs G. Assessement of rheumatic diseases with computational radiology: current status and future potential. Eur J Radiol 2009; 71:211-6. [PMID: 19457632 DOI: 10.1016/j.ejrad.2009.04.046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 04/16/2009] [Indexed: 01/08/2023]
Abstract
In recent years, several computational image analysis methods to assess disease progression in rheumatic diseases were presented. This review article explains the basics of these methods as well as their potential application in rheumatic disease monitoring, it covers radiography, sonography as well as magnetic resonance imaging in quantitative analysis frameworks.
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Affiliation(s)
- Philipp Peloschek
- Computational Imaging and Radiology Lab-CIR, Department of Radiology, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
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Hamburger MI, Hamburger FH, Bergman JM, Epstein A, Brown A. Influence of an educational seminar on use of disease activity measurements by rheumatologists in treatment of rheumatoid arthritis. J Rheumatol 2009; 36:532-538. [PMID: 19208595 DOI: 10.3899/jrheum.080291] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
OBJECTIVE To determine the variables underlying clinical decisions made by rheumatologists when treating patients with rheumatoid arthritis (RA), and to determine the effect of an educational seminar on the use of quantitative disease activity measurements in clinical practice in this population of physicians. METHODS Practicing rheumatologists were surveyed on the variables affecting their clinical management of patients with RA by questionnaire. Physicians were divided into 2 groups: the first comprised attenders (Group A) to an educational seminar in the use of the quantitative disease activity measurements in patient management, while the second group comprised nonattenders (Group NA). Both groups were surveyed on their practice behavior before (Survey 1) and 2 to 3 months after (Survey 2) the seminar. RESULTS Fifty-two rheumatologists in clinical practice from across the US completed and returned 364 surveys. A significantly greater number of rheumatologists in Group A reported use of disease activity measures following the training seminar (Survey 2), compared to their use pre-meeting and compared to Group NA (p < 0.0001). CONCLUSION Our results support employment of an educational seminar on the use of disease activity measurements to increase the use of these quantitative measures in rheumatologic practice.
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Affiliation(s)
- Max I Hamburger
- State University of New York Stony Brook, Stony Brook, NY, USA
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Kubassova O, Boesen M, Peloschek P, Langs G, Cimmino MA, Bliddal H, Torp-Pedersen S. Quantifying Disease Activity and Damage by Imaging in Rheumatoid Arthritis and Osteoarthritis. Ann N Y Acad Sci 2009; 1154:207-38. [DOI: 10.1111/j.1749-6632.2009.04392.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Nieto-Colonia AM, Santos WS, Keusseyan SP, Caldana W, Fernandes ARC, Andrade LEC. Antibodies to citrullinated peptides are not associated with the rate of joint destruction in patients with a well-established diagnosis of rheumatoid arthritis. ACTA ACUST UNITED AC 2008; 41:188-92. [PMID: 18235966 DOI: 10.1590/s0100-879x2008005000005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2007] [Accepted: 12/03/2007] [Indexed: 11/22/2022]
Abstract
Antibodies to citrullinated peptides are highly specific for rheumatoid arthritis (RA) and represent a significant risk factor for undifferentiated polyarthritis. This prognostic ability may be related to the very diagnostic performance of these autoantibodies, since RA is a more erosive disease than other forms of arthritis. The present study evaluated an association of antibodies to citrullinated peptides and the rate of joint destruction in patients with a well-established diagnosis of RA. Seventy-one patients with RA were evaluated in 1994 and again in 2002 (functional class, joint count, Health Assessment Questionnaire score, hands X-ray). Autoantibodies (rheumatoid factor (RF), anti-perinuclear factor, anti-cyclic citrullinated peptide (CCP) antibodies) and Sharp's index were analyzed blindly. Delta Sharp was calculated as the difference in Sharp's index obtained in 1994 and 2002. During the follow-up the Health Assessment Questionnaire score increased from 0.91 +/- 0.74 to 1.39 +/- 0.72 (P < 0.001). Similarly, the number of swollen joints increased from 4.6 +/- 5.71 to 6.4 +/- 4.1 (P = 0.002). The frequency of autoantibodies and anti-CCP titer remained stable; however, serum RF concentration increased from 202.8 +/- 357.6 to 416.6 +/- 636.5 IU/mL (P = 0.003). Sharp's index increased from 56.7 +/- 62.1 to 92.4 +/- 80.9 (P < 0.001). No correlation was observed between Delta Sharp and the presence of RF, anti-perinuclear factor, and anti-CCP antibodies at baseline. Antibodies to citrullinated epitopes are specific and early markers for the diagnosis of RA but do not seem to be associated with the rate of joint destruction in patients with a well-established diagnosis of RA.
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Affiliation(s)
- A M Nieto-Colonia
- Disciplina de Reumatologia, Escola Paulista de Medicina, Universidade Federal de São Paulo, Brasil
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Peloschek P, Langs G, Weber M, Sailer J, Reisegger M, Imhof H, Bischof H, Kainberger F. An Automatic Model-based System for Joint Space Measurements on Hand Radiographs: Initial Experience. Radiology 2007; 245:855-62. [DOI: 10.1148/radiol.2452061281] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Doria AS, Babyn PS, Feldman B. A critical appraisal of radiographic scoring systems for assessment of juvenile idiopathic arthritis. Pediatr Radiol 2006; 36:759-72. [PMID: 16552589 DOI: 10.1007/s00247-005-0073-2] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2005] [Revised: 10/04/2005] [Accepted: 11/14/2005] [Indexed: 12/26/2022]
Abstract
Assessing structural damage to joints over time is essential for evaluating the effectiveness of therapeutic interventions for patients with inflammatory arthritis. Although radiography is able to quantify joint damage, the changes found with conventional radiography early in the disease course are nonspecific, and late radiographic changes are often irreversible. Although many clinical trials on drug development for children still use radiographic scales as endpoints for the study, more specific therapies have been developed for juvenile idiopathic arthritis (JIA) that would enable imaging to "fine-tune" patients to placement into specific treatment algorithms. As a result, new imaging scales to identify early abnormalities are clearly needed. Many pediatric rheumatology centers around the world persistently apply adult-designed radiographic scoring systems to evaluate the progression of JIA. Few pediatric-targeted radiographic scales are available for assessment of progression of JIA in growing joints, and the clinimetric and psychometric properties of such scales have been poorly investigated. We present a critique to the evaluative, discriminative, and predictive roles of the van der Heijde modification of Sharp's radiographic method, a scale originally designed to assess damage to joints of adults with rheumatoid arthritis, when it is applied to a pediatric population. We discuss the advantages and drawbacks of this radiographic scoring system for assessing growing joints and the ability of MRI to overcome inadequacies of conventional radiography.
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Affiliation(s)
- Andrea S Doria
- Department of Diagnostic Imaging, The Hospital for Sick Children, 555 University Ave., University of Toronto, Ontario, M5G 1X8, Canada.
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Aletaha D, Smolen JS. The Definition and Measurement of Disease Modification in Inflammatory Rheumatic Diseases. Rheum Dis Clin North Am 2006; 32:9-44, vii. [PMID: 16504819 DOI: 10.1016/j.rdc.2005.09.005] [Citation(s) in RCA: 95] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
This article focuses on measures that are used to evaluate disease activity, damage, and function in three major inflammatory musculoskeletal disorders. The instruments used in rheumatoid arthritis, where most of the methodologic work has been done, are extensively discussed and instruments for the respective domains in psoriatic arthritis and ankylosing spondylitis are likewise presented.
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Affiliation(s)
- Daniel Aletaha
- Department of Rheumatology, Internal Medicine III, Medical University of Vienna, Vienna, Austria.
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Finckh A, de Pablo P, Katz JN, Neumann G, Lu Y, Wolfe F, Duryea J. Performance of an automated computer-based scoring method to assess joint space narrowing in rheumatoid arthritis: A longitudinal study. ACTA ACUST UNITED AC 2006; 54:1444-50. [PMID: 16645974 DOI: 10.1002/art.21802] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To compare the diagnostic performance of a computer-based method for measuring joint space width with the Sharp joint space narrowing (JSN) scoring method in patients with rheumatoid arthritis (RA). METHODS A random sample of patients with early RA, for whom sequential hand radiographs and Sharp scores were available, was selected from the National Data Bank for Rheumatic Diseases. Hand joint space width was measured using an automated, computer-based method in random order and with blinding for clinical information. We constructed a receiver operating characteristic curve and compared the diagnostic performance of the computer-based and Sharp methods based on the areas under the curve. RESULTS One hundred twenty-nine patients with early RA who underwent serial radiography were included. Changes in the computer-based and Sharp methods were highly correlated (r = 0.75, P < 0.001). The computer-based method was significantly more discriminant than the Sharp JSN subscale. The area under the curve of the computer-based method was 0.96 (95% confidence interval [95% CI] 0.94, 0.99) compared with 0.93 (95% CI 0.89, 0.96) for the Sharp subscale (P = 0.024). At the most discriminant cutoff, specificity of the computer-based method was 88.4% compared with 81.4% for the Sharp subscale (P = 0.11); sensitivity was 87.6% for the computer-based method compared with 82.2% for Sharp subscale (P = 0.19). The signal-to-noise ratio for the computer-based method was 83% compared with 70% for the Sharp subscale (P = 0.013). CONCLUSION The computer-based method for measuring joint space width is more discriminant than the semiquantitative Sharp JSN subscale.
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Affiliation(s)
- Axel Finckh
- Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
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Jawaid WB, Crosbie D, Shotton J, Reid DM, Stewart A. Use of digital x ray radiogrammetry in the assessment of joint damage in rheumatoid arthritis. Ann Rheum Dis 2005; 65:459-64. [PMID: 16126795 PMCID: PMC1798109 DOI: 10.1136/ard.2005.039792] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To compare digital x ray radiogrammetry (DXR) with manual radiography for assessing bone loss in RA and examine the relationship of the scores obtained with other disease indices. METHODS 225 consecutive consenting subjects attending the RA clinic were enrolled. An x ray examination was carried out; demographic details recorded; a self assessment questionnaire completed; blood taken for ESR measurement; and an assessment made by a trained nurse. All x ray films were scored manually using the modified Sharp technique by a single observer; 20 films were rescored by three readers. Films were assessed with the Pronosco X-Posure system, version 2.0. Analysis included chi2 tests, independent t tests, multiple linear regression, and partial correlations, as appropriate. The smallest detectable difference (SDD), coefficient of variation (CV), and coefficient of repeatability (CR) were determined from Bland and Altman plots. RESULTS The DXR precision varied: SDD = 0.002-0.9; CV = 0.09-5.9%; CR = 0.002-0.792, but was better than that of the intra- and interobserver Sharp scores: SDD = 73.9; CV = 27.8%; CR = 33.0-47.6. The DXR measurements, bone mineral density (R2 = 0.210), metacarpal index (R2 = 0.222), and cortical thickness (R2 = 0.215), significantly predicted Sharp scores. In women, DXR measurements significantly correlated with modified HAQ scores but with no other disease indices. Sharp scores significantly correlated with assessor's global assessment, swollen and tender joint counts, pain, HAQ, and DAS28. CONCLUSION DXR measurements are more precise than Sharp scores; both are related to long term disease activity in RA. DXR is simple to use, does not require intensive training, and may identify subjects not responding to standard treatment.
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Affiliation(s)
- W B Jawaid
- Department of Rheumatology, Aberdeen Royal Infirmary, UK
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Argyropoulou MI, Glatzouni A, Voulgari PV, Xydis VG, Nikas SN, Efremidis SC, Drosos AA. Magnetic resonance imaging quantification of hand synovitis in patients with rheumatoid arthritis treated with infliximab. Joint Bone Spine 2005; 72:557-61. [PMID: 16376805 DOI: 10.1016/j.jbspin.2004.08.014] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2004] [Accepted: 08/18/2004] [Indexed: 10/25/2022]
Abstract
AIM To investigate the clinical response and to evaluate by magnetic resonance imaging the inflammatory tissue changes in refractory rheumatoid arthritis patients treated with infliximab. METHODS Sixteen refractory rheumatoid arthritis patients who were treated with intravenous infliximab (3 mg/kg) at weeks 0, 2, 6 and every 8 weeks thereafter were examined with magnetic resonance imaging of the dominant affected wrist and hand before treatment and 1 year after therapy. The volume of the enhancing inflammatory tissue was evaluated in fat suppressed contrast enhanced T1-weighted images by using the Analyse 4.0 software. Disease activity was evaluated by assessing the disease activity score for 28 joint indices. The clinical improvement was evaluated according to the American College of Rheumatology 20% response criteria. RESULTS There were 13 females and 3 males with mean age 49.5 (17.0) years and mean disease duration 10.5 (8.0) years. Ten patients had positive IgM rheumatoid factor. One year after treatment, a significant reduction of the erythrocyte sedimentation rate, the C-reactive protein, the disease activity score for 28 joint indices and the volume of the enhancing inflammatory tissue was observed. All but two of the rheumatoid arthritis patients achieved the American College of Rheumatology 20% response criteria, while 9 (56.25%) and 5 (31.25%) patients achieved the 50% and 70% American College of Rheumatology response criteria, respectively. A positive correlation among the volume of the enhancing inflammatory tissue, swollen joint count, tender joint count, as well as disease activity score for 28 joint indices (r=0.66, r=0.79, r=0.57 respectively) was found before treatment. CONCLUSIONS In refractory rheumatoid arthritis patients, the addition of infliximab therapy may result in clinical, laboratory and magnetic resonance imaging improvement. Magnetic resonance imaging assessment of the volume of the enhancing inflammatory tissue may represent an additional tool for the investigation of joint disease activity and responsiveness to treatment.
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Affiliation(s)
- Maria I Argyropoulou
- Department of Radiology Medical School, University of Ioannina, Ioannina, Greece
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van der Heijde D, Sharp J, Wassenberg S, Gladman DD. Psoriatic arthritis imaging: a review of scoring methods. Ann Rheum Dis 2005; 64 Suppl 2:ii61-4. [PMID: 15708940 PMCID: PMC1766859 DOI: 10.1136/ard.2004.030809] [Citation(s) in RCA: 75] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Structural damage assessed on conventional radiographs is an important outcome measure in psoriatic arthritis. This article reviews the available scoring methods. A full description of the methods is given as well as information on various aspects of validity.
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Affiliation(s)
- D van der Heijde
- Department of Rheumatology, University Hospital Maastricht, PO Box 5800, 6202 AZ Maastricht, the Netherlands.
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Zangger P, Kachura JR, Bombardier C, Redelmeier DA, Badley EM, Bogoch ER. Assessing damage in individual joints in rheumatoid arthritis: a new method based on the Larsen system. Joint Bone Spine 2004; 71:389-96. [PMID: 15474390 DOI: 10.1016/j.jbspin.2003.07.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2003] [Accepted: 07/29/2003] [Indexed: 10/26/2022]
Abstract
OBJECTIVES To evaluate observer agreement using the Larsen system (LS) and a Modified Larsen system (ML) when assessing individual joints of the hands and wrists in rheumatoid arthritis, and to compare the two systems. To determine the minimally important difference (MID) for the ML. METHODS Thirty radiographs of hands and wrists from 10 patients who presented with RA were graded by two blinded observers, using the LS and then the ML. Patients were followed for a mean of 7.2 years (range: 4-10 years). Inter- and intra-observer agreement were calculated using the kappa statistic with linear incremental weights. Inter-observer agreement was also computed for the summed score, using an intraclass correlation coefficient. Inter-observer error was estimated by calculating the mean and standard deviation of the grading differences between the two observers. Prevalence of damage was calculated as a ratio of damage: no damage and expressed as a percentage. Pairs of radiographs were comparatively graded using a seven-point Likert scale. RESULTS The kappa statistic for inter-observer agreement was 0.38 (marginal reproducibility) for the LS and 0.52 (good reproducibility) for the ML (P = 0.004). Using a difference of one grade as perfect agreement, it was 0.56 (good reproducibility) for the LS and 0.87 (excellent reproducibility) for the ML (P = 0.001). Intra-observer agreement was high in both systems. The distribution of ML-grade differences varied according to the level of the Likert scale: for "a little bit worse", representing the smallest amount of detectable damage progression, the distribution differences peaked around two grades. This value represented a MID 87% of the time. CONCLUSIONS The LS lacks precision for individual joints. The ML, it is proposed, has more detailed definitions of grades, and is more reliable. When pairs of radiographs were compared, a two-grade difference on the ML was the MID.
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Affiliation(s)
- P Zangger
- Hôpital Orthopédique de la Suisse Romande and Centre Hospitalier Universitaire Vaudois, University of Lausanne, Switzerland.
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Graudal N. The natural history and prognosis of rheumatoid arthritis: association of radiographic outcome with process variables, joint motion and immune proteins. Scand J Rheumatol 2004; 118:1-38. [PMID: 15180092 DOI: 10.1080/03009740310004847] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The purposes of the present study were: 1) to investigate how the long-term course of outcome and inflammatory variables could be described in individual patients and suitably summarized in groups of patients; 2) to investigate the associations between outcome and inflammatory variables on the basis of the defined summary measures; and 3) to investigate new prognostic aspects of RA by means of frozen sera and DNA specimens. PATIENTS AND METHODS During the period 1966-78, 685 Danish Caucasian patients with RA, classified according to the 1958 American Rheumatism Association (ARA) criteria, were admitted to the Department of Rheumatology of Aarhus University Hospital. For scientific purposes all patients went through the same examination programme, including biochemical variables, clinical evaluation of 68 diarthrodial joints, and radiographic evaluation of 46 diarthrodial joints. Since 1987, data from these patients have been organized in a database. The data are arranged according to onset of disease. This thesis is based on about 600,000 data-points from 257 patients. RESULTS The thesis is based on six studies. The first study shows that early symptomatic improvement of RA during gold treatment was stable over several years, but when evaluated radiographically, the condition continued to deteriorate. In the second study, six main types of radiographic progression were identified: (a) a rare type with no radiographic progression at all (<1%); (b) a type with a slow or moderate onset, but an increasing progression rate (exponential growth type) (9%); (c) a linear type (30%); (d) a type with a moderate to fast onset, and a stable progression rate (the square root type) (11%); (e) a type with a fast onset, but a later decreasing progression rate (the first order kinetics type) (30%) and (f) a type characterized by slow onset, then acceleration and later deceleration (the sigmoid type) (20%). The fact that there was a systematic progression was used to define a system of radiographic events, which could be used as outcome measures in prediction models of the long-term course of RA. The third study shows that low serum levels of the complement-activating serum lectin, mannan (mannose) binding protein (lectin) (MBP = MBL), are associated with a higher erythrocyte sedimentation rate (ESR) (p=0.006), joint swelling score (JS score) (p=0.019), limitation of joint motion score (LM score) (p=0.027), and annual increase in radiographic destruction score (R score) (p=0.053). The fourth study demonstrated a highly significant association between summary measures of inflammatory variables and radiographic outcome, as defined in the second study, indicating that the degree of inflammation is important for the development of destructive joint damage in RA. The fifth study showed that MBL-insufficient patients (two defective structural MBL alleles, or one defective allele combined with a low-expression variant of the normal allele) had a relative risk of a severe radiographic event of 3.1 compared with the MBL competent group (p<0.0001). The sixth study showed that the relative risk (RR) of early interleukin (IL)-1alpha auto-antibodies (aAb) positive patients developing serious radiographic joint destruction was significantly lower than for IL-1alpha aAb-negative patients, RR=0.29 (p=0.04). In rheumatoid factor (RF) positive patients RR was only 0.18 (p=0.02). Patients who seroconverted >2 years after the onset of RA showed the most aggressive development of joint erosion, with RR of serious radiographic joint destruction of 2.56 (p=0.048). Other factors investigated in subgroups of the patients were HLA-DR4, chemokine receptor 5 (CCR 5) genotypes. IL-6 aAb, vascular endothelial growth factor (VEGF) aAb, and interferon (IFN)-gamma aAb. About 80% of the patients were HLA-DR4 positive, indicating the importance of HLA-DR4 as a predisposing factor for RA. There was no association between IL-6 aAb and radiographic outcome, or CCR5 genotypes and radiographic outcome. VEGF aAb and IFN-gamma aAb were quantitatively unimportant. CONCLUSION In spite of a general improvement in single measures of inflammatory variables, and a general deterioration in radiographic outcome of RA, there is a highly significant association between summary measures of inflammatory variables and radiographic outcome. The progression of radiographic damage in RA follows mathematical patterns. A new method of evaluating the long-term radiographic outcome by means of Kaplan-Meier plots is demonstrated. It is shown that MBL and IL-1alpha aAb are predictors of the prognosis of RA and may play important roles in the pathogenesis of RA.
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Affiliation(s)
- Niels Graudal
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.
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Bruynesteyn K, van der Heijde D, Boers M, van der Linden S, Lassere M, van der Vleuten C. The Sharp/van der Heijde method out-performed the Larsen/Scott method on the individual patient level in assessing radiographs in early rheumatoid arthritis. J Clin Epidemiol 2004; 57:502-12. [PMID: 15196621 DOI: 10.1016/j.jclinepi.2003.10.014] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2003] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To test the reliability of two radiologic scoring methods in rheumatoid arthritis (RA)--the Sharp/van der Heijde (SvH) and the Larsen/Scott (LS)--with generalizability analyses. STUDY DESIGN AND SETTING Films of 51 patients representing the spectrum of early RA were read by two raters for each method. The discriminative ability and responsiveness were expressed as: intraclass correlation coefficients (ICCs), two types of smallest detectable difference (SDD), and two types of smallest detectable change (SDC); reflecting measurement error when discriminating between or detecting changes within (1) individuals or (2) groups. They were calculated for (average) scores of one to three raters. RESULTS The discriminative capacity (0.85-0.97) and responsiveness (0.91-0.97) were good when expressed by ICC. On the group level the SDDs and SDCs ranged between 0.6-3.3% of the max. obtainable score. On the individual level, the scores showed better reliability measured with the SvH (SDDs 2.0-3.4%) than with the LS (SDDs 5.3-9.2%). The SvH also assessed changes in scores in individuals with less measurement error (SDCs 1.3-2.2%) than the LS (SDCs 2.3-3.9%). CONCLUSION For early RA patients, the SvH seems preferable if analyses on individual level are included.
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Affiliation(s)
- Karin Bruynesteyn
- Department of Internal Medicine, Division of Rheumatology, University of Maastricht, P.O. Box 5800, 6202 AZ, Maastricht, The Netherlands
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Abstract
Randomized, double-blind trials on new treatments, including anakinra, etanercept, infliximab, and leflunomide, show convincing reduction in radiographic progression. The relative efficacy of these new treatments is unknown. Head-to-head comparisons have not been performed and comparing treatment arms across trials has several pitfalls. These possible pitfalls are discussed.
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Affiliation(s)
- D M F M van der Heijde
- Division of Rheumatology, Department of Internal Medicine, University Hospital Maastricht, P.O. Box 5800, 6202 AZ Maastricht, The Netherlands.
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Taouli B, Zaim S, Peterfy CG, Lynch JA, Stork A, Guermazi A, Fan B, Fye KH, Genant HK. Rheumatoid Arthritis of the Hand and Wrist:Comparison of Three Imaging Techniques. AJR Am J Roentgenol 2004; 182:937-43. [PMID: 15039167 DOI: 10.2214/ajr.182.4.1820937] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE The purpose of this study was to compare the relative results from conventional high-field-strength 1.5-T MRI, 0.2-T low-field-strength dedicated extremity MRI, and radiography to detect and grade bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis. SUBJECTS AND METHODS Eighteen patients with rheumatoid arthritis underwent conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and conventional radiography of both hands and wrists. Two independent reviewers searched for the presence and extent of bone erosions, joint-space narrowing, and synovitis. Bone erosions (E scores) and joint-space narrowing (J scores) were evaluated at 14 and 13 sites, respectively, on conventional high-field-strength MRI, low-field-strength dedicated extremity MRI, and radiography, using the Sharp-Genant scoring system. Synovitis (S scores) were evaluated at 13 sites on conventional high-field-strength MRI and low-field-strength dedicated extremity MRI. RESULTS For the detection of bone erosions, we found no significant difference (p = 0.71) between conventional high-field-strength MRI (mean +/- SD E score, 27.5 +/- 9.8) and low-field-strength dedicated extremity MRI (28.8 +/- 10.0), but a significant difference (p < 0.001) appeared between MRI and radiography (13.1 +/- 8.3). J scores derived from MRI (conventional high-field-strength MRI, 15.2 +/- 8.3; low-field-strength dedicated extremity MRI, 14.5 +/- 10.4) were higher than those derived from radiography (12.7 +/- 9.6), although the difference was not significant (p = 0.70). Conventional high-field-strength MRI (S score, 35.1 +/- 8.6) and low-field-strength dedicated extremity MRI (30.8 +/- 10.2) were equivalent (p = 0.14) for the evaluation of synovitis. The interobserver agreement for MRI scores was good to excellent (intraclass correlation coefficients, 0.83-0.94). CONCLUSION Conventional high-field-strength MRI and low-field-strength dedicated extremity MRI showed similar results in terms of cross-sectional grading of bone erosions, joint-space narrowing, and synovitis in the hands and wrists of patients with rheumatoid arthritis.
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Affiliation(s)
- Bachir Taouli
- Department of Radiology, University of California, San Francisco, 505 Parnassus Ave., Box 0628, San Francisco, CA 94143-0628, USA
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Affiliation(s)
- B Taouli
- Department of Radiology, University of California San Francisco, CA 94143, USA.
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Arbillaga HO, Montgomery GP, Cabarrus LP, Watson MM, Martin L, Edworthy SM. Internet hand x-rays: A comparison of joint space narrowing and erosion scores (Sharp/Genant) of plain versus digitized x-rays in rheumatoid arthritis patients. BMC Musculoskelet Disord 2002; 3:13. [PMID: 11980582 PMCID: PMC113251 DOI: 10.1186/1471-2474-3-13] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2001] [Accepted: 04/30/2002] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The objective of the study is to examine the reliability of erosion and joint space narrowing scores derived from hand x-rays posted on the Internet compared to scores derived from original plain x-rays. METHODS Left and right x-rays of the hands of 36 patients were first digitized and then posted in standard fashion to a secure Internet website. Both the plain and Internet x-rays were scored for erosions and joint space narrowing using the Sharp/Genant method. All scoring was completed in a blind and randomized manner. Agreement between plain and Internet x-ray scores was calculated using Lin's concordance correlations and Bland-Altman graphical representation. RESULTS Erosion scores for plain x-rays showed almost perfect concordance with x-rays read on the Internet (concordance 0.887). However, joint space narrowing scores were only "fair" (concordance 0.365). Global scores demonstrated substantial concordance between plain and Internet readings (concordance 0.769). Hand x-rays with less disease involvement showed a tendency to be scored higher on the Internet versions than those with greater disease involvement. This was primarily evident in the joint space narrowing scores. CONCLUSIONS The Internet represents a valid medium for displaying and scoring hand x-rays of patients with RA. Higher scores from the Internet version may be related to better viewing conditions on the computer screen relative to the plain x-ray viewing, which did not include magnifying lens or bright light. The capability to view high quality x-rays on the Internet has the potential to facilitate information sharing, education, and encourage collaborative studies.
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Affiliation(s)
| | | | - Luis P Cabarrus
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Margaret M Watson
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Liam Martin
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Steven M Edworthy
- Department of Medicine, University of Calgary, Calgary, Alberta, Canada
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Swinkels HL, Laan RF, van 't Hof MA, van der Heijde DM, de Vries N, van Riel PL. Modified sharp method: factors influencing reproducibility and variability. Semin Arthritis Rheum 2001; 31:176-90. [PMID: 11740798 DOI: 10.1053/sarh.2001.28304] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND AND OBJECTIVES In rheumatoid arthritis, joint radiography is still the most frequently used instrument to assess the progression of joint damage. Unfortunately, the poor quality of the radiographic scoring methods available has a negative impact on the power in clinical trials. This study focuses on the influence of the following 4 factors on radiographic scores according to van der Heijde's modification of the Sharp method: intraobserver variation, interobserver variation, follow-up time, and number of measurement occasions within a patient series. METHODS One hundred and seventy-two patients in the early stages of rheumatoid arthritis were followed up. During the first 3 years, radiographs of the hands and feet were taken twice yearly and scored by 3 observers. The scoring process was repeated after an additional 3-year period. Correlation coefficients and differences between observers were calculated to define variability. The influence of the 4 factors on variability was studied. RESULTS One observer assigned a significantly higher score than the other 2, who had been trained together. Interobserver variability decreased as follow-up time increased. Interobserver correlation coefficients became higher, with smaller differences between observers for progression scores than for absolute scores. Increasing the number of measurements within a patient series led to higher scores. Intraobserver correlation coefficients were high, and a training effect occurred when the time between measurements was 1 year, resulting in lower scores. CONCLUSIONS This study demonstrates that, and shows how, the investigated factors influence the variability of the modified Sharp method. It is extremely important to take interobserver variation into account when designing protocols for multicenter clinical trials. A progression scoring method is recommended for studies assessing radiographic damage or clinical trials.
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Affiliation(s)
- H L Swinkels
- Department of Rheumatology, University Medical Centre Nijmegen, The Netherlands
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