Progression of RA on radiographs judged differently by radiologists and rheumatologists

[Guest guest]

J Rheumatol. 2004 Jun;31(6):1088-94.

Progression of rheumatoid arthritis on plain radiographs judged

differently by expert radiologists and rheumatologists.

Bruynesteyn K, Van Der Linden S, Landewe R, Gubler F, Weijers R, Van Der

Heijde D.

Department of Internal Medicine, Division of Rheumatology and the

Department of Radiology, University Hospital Maastricht, Maastricht, The

Netherlands.

OBJECTIVE: In a former study a panel of rheumatologists was used to

assess which progression in radiological joint damage due to rheumatoid

arthritis (RA) on hand and foot radiographs taken at one-year intervals

was considered the minimally clinically important difference (MCID). We

compare the judgments of the panel of rheumatologists with the judgments

of 2 musculoskeletal radiologists. METHODS: Two experienced

musculoskeletal radiologists evaluated independently the same hand and

foot radiographs as assessed by the panel of rheumatologists.

Progression was defined as important if the radiologist would state it

as substantial progression in their report. Two readers, different from

the radiologists and rheumatologists, independently obtained the

Sharp/van der Heijde scores. Receiver operating characteristic curve

analyses were performed to quantify the minimally important progression

defined by the radiologists expressed in Sharp/van der Heijde

change-scores. The change-score with the highest accuracy represented

the minimally important progression and was compared with the MCID

defined by the panel of rheumatologists for 4 different settings (early

versus advanced RA and mild versus high disease activity). RESULTS: The

minimally important progression defined by the radiologists was

estimated at 6.5 Sharp/van der Heijde units. This was larger than the

MCID defined by the panel of rheumatologists in 3 of the 4 clinical

settings (3.0-4.5 units) and similar to the setting " advanced RA, mild

disease activity. " The panel of rheumatologists was inclined to change

therapy in cases not reported as substantially progressive by the

radiologists. The Sharp/van der Heijde progression scores of the

radiographs on which the radiologists and rheumatologists disagreed

related better with the rheumatologists' opinions.

CONCLUSION: Changes that were not regarded as substantial by the

radiologists were judged clinically important by the rheumatologists in

3 of the 4 clinical settings. Thus, the radiologists appeared to be

reserved in judging changes as important.

PMID: 15170919

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org