Radiological scoring in Psoriatic Arthritis Application of the OMERACT filter to four scoring...
-
Upload
byron-oconnor -
Category
Documents
-
view
215 -
download
3
Transcript of Radiological scoring in Psoriatic Arthritis Application of the OMERACT filter to four scoring...
Radiological scoring in Radiological scoring in Psoriatic ArthritisPsoriatic Arthritis
Radiological scoring in Radiological scoring in Psoriatic ArthritisPsoriatic Arthritis
Application of the OMERACT filter Application of the OMERACT filter to four scoring methodsto four scoring methods
Radiological scoring methods for PsARadiological scoring methods for PsARadiological scoring methods for PsARadiological scoring methods for PsA
• Four methods describedFour methods described– Modified SteinbrockerModified Steinbrocker– Ratingen method for PsARatingen method for PsA– Sharp method for PsASharp method for PsA– Sharp/van der Heijde method for PsASharp/van der Heijde method for PsA
• All originally developed and tested for RAAll originally developed and tested for RA
• Addition of DIPs of the hands as a scoring siteAddition of DIPs of the hands as a scoring site
Specific features in radiographs of PsASpecific features in radiographs of PsASpecific features in radiographs of PsASpecific features in radiographs of PsA
• Joint patternJoint pattern– DIPs and PIPs, asymmetric and frequently DIPs and PIPs, asymmetric and frequently
in a ray-patternin a ray-pattern– Wrist and isolated rayWrist and isolated ray– Symmetrical as in RASymmetrical as in RA
• FeaturesFeatures– Destruction (widening, osteolysis, pencil-in-Destruction (widening, osteolysis, pencil-in-
cup)cup)– Proliferation (shaft metacarpal/tarsal, Proliferation (shaft metacarpal/tarsal,
adjacent to joints, ankylosis)adjacent to joints, ankylosis)
Comparison of sites/features included in scoringComparison of sites/features included in scoringComparison of sites/features included in scoringComparison of sites/features included in scoring
modified modified
SteinbrockerSteinbrockerRatingenRatingen SharpSharp Sharp/van Sharp/van
der Heijdeder Heijde
FilmsFilms hands/feethands/feet hands/feethands/feet hands/feethands/feet hands/feethands/feet
ErosionsErosions
JSNJSN
MalalignmentMalalignment
ProliferationProliferation
GlobalGlobal
--
--
--
--
XX
XX
--
--
XX
--
XX
XX
--
--
--
XX
XX
XX
--
--
RangeRange 0-1600-160 0-3600-360 0-4700-470 0-5280-528
Methods: OMERACT filterMethods: OMERACT filterMethods: OMERACT filterMethods: OMERACT filter
• TruthTruth : does the method measure what it : does the method measure what it should measure?should measure?
• DiscriminationDiscrimination: Reliability, discrimination : Reliability, discrimination between patients, and sensitivity to change between patients, and sensitivity to change over timeover time
• FeasibilityFeasibility
Boers J Rheumatol 1998;25:198-9
Modified SteinbrockerModified SteinbrockerModified SteinbrockerModified Steinbrocker
• 68 patients; 2 readers; blinded for sequence68 patients; 2 readers; blinded for sequence
• Interobserver ICC status scores 0.86Interobserver ICC status scores 0.86
• Intraobserver ICC status scores 0.80 and 0.81Intraobserver ICC status scores 0.80 and 0.81
• No formal sensitivity to change testingNo formal sensitivity to change testing
• Predictor of mortalityPredictor of mortality
Ratingen score for PsARatingen score for PsARatingen score for PsARatingen score for PsA
• 20 patients; 2 readers; 3-year interval; chronological 20 patients; 2 readers; 3-year interval; chronological scoring; intrapatient SD/intra(inter)reader SDscoring; intrapatient SD/intra(inter)reader SD
• Weak correlation between destruction score and Weak correlation between destruction score and proliferation scoreproliferation score
Destruction Destruction scorescore
Proliferation Proliferation scorescore
Total scoreTotal score
Reader 1Reader 1 3.33.3 2.22.2 3.63.6
Reader 2Reader 2 2.02.0 4.24.2 2.72.7
Reader 1,2Reader 1,2
SDDSDD
3.83.8
5.8%5.8%
2.72.7
5.0%5.0%
3.93.9
4.6%4.6%
Sharp method for PsASharp method for PsASharp method for PsASharp method for PsA
• 4 readers; sequence blinded; <1-year interval4 readers; sequence blinded; <1-year interval
• Interreader ICCs status scores 0.81-0.88 Interreader ICCs status scores 0.81-0.88
• Interreader ICCs change scores 0.63Interreader ICCs change scores 0.63
• Statistically significant difference between two Statistically significant difference between two treatment armstreatment arms– In/exclusion DIPs did not change resultIn/exclusion DIPs did not change result– Scoring additional did not change result (shaft Scoring additional did not change result (shaft
periostitis, juxta-articular periostitis, periostitis in periostitis, juxta-articular periostitis, periostitis in the wrist, tuft resorption, widening, osteolysis, the wrist, tuft resorption, widening, osteolysis, pencil-in-cup)pencil-in-cup)
Sharp/van der Heijde method for PsASharp/van der Heijde method for PsASharp/van der Heijde method for PsASharp/van der Heijde method for PsA
• Applied in clinical trial; analyses interreader Applied in clinical trial; analyses interreader reliability and sensitivity to change underwayreliability and sensitivity to change underway
• 100 patients; high correlation between total 100 patients; high correlation between total score and score and – clinically damaged jointsclinically damaged joints– juxta-articular new bone formationjuxta-articular new bone formation– osteolysis scoreosteolysis score
SummarySummarySummarySummary
• TruthTruth
– Very little informationVery little information
• DiscriminationDiscrimination
– Little information on reliability of change scores Little information on reliability of change scores
and sensitivity to changeand sensitivity to change
• FeasibilityFeasibility
– Good for all methodsGood for all methods