Document Server@UHasselt >
Research >
Research publications >

Please use this identifier to cite or link to this item: http://hdl.handle.net/1942/2641

Title: Detecting radiological changes in rheumatoid arthritis that are considered important by clinical experts: Influence of reading with or without known sequence
Authors: Bruynesteyn, K
Boers, M
Saudan, A
Peloso, P
Paulus, H
Houben, H
Griffiths, B
Edmonds, J
Bresnihan, B
Boonen, A
van der Linden, S
Issue Date: 2002
Citation: JOURNAL OF RHEUMATOLOGY, 29(11). p. 2306-2312
Abstract: Objective. To evaluate whether knowledge of the chronological sequence influences the sensitivity and specificity of the Sharp/van der Heijde (SvH) and Larsen/Scott (LS) scoring method to detect clinically important progression of joint damage caused by rheumatoid arthritis (RA) in the individual patient and assess whether Scoring in chronological order leads to better sensitivity at the cost of lower specificity. Methods. For both scoring methods, progression scores obtained with (chronological) and without knowledge of the sequence of the films (paired) were compared with the judgment of an international expert panel. This panel assessed whether progression of joint damage seen on films with I year intervals was clinically relevant (defined as progression of joint damage that would make clinicians change therapy). The applied thresholds for clinical relevance Were (1) the progression scores with the highest accuracy by receiver operating characteristics analyses for the expert opinion, and (2) the smallest progression score that can be detected apart from interobserver measurement error by the scoring method, i.e., the smallest detectable difference (SDD). Results. Progression scores that detected clinically relevant progression most accurately (chronological: 3.0 SvH units and 2.0 LS units; paired: 2.5 SvH units and 1.5 LS units) were smaller than the SDD (chronological 5.0 SvH units and 5.8 LS units; paired 13.8 SvH units and 9.7 LS units). With the SDD as threshold, the sensitivity to detect clinically relevant progression increased significantly from 20 to 60% for the SvH method and from 23 to 33%, for the LS method if the sequence of the films was known. The specificity remained good when scoring chronologically: 88% for the SvH and 100% for the LS. Conclusion. Our results suggest that knowing the chronological sequence leads to an increase in detecting clinically relevant changes in the patient without serious overestimation of nonrelevant differences. Analyzing a clinical trial should be done preferably by reading films in chronological order.
Notes: Maastricht Univ, Dept Internal Med, Div Rheumatol, Maastricht, Netherlands. Atrium Med Ctr, Dept Rheumatol, Heerlen, Netherlands. Vrije Univ Amsterdam, Med Ctr, Dept Clin Epidemiol & Biostat, Amsterdam, Netherlands. Limburgs Univ Ctr, Diepenbeek, Belgium. Ctr Med Aeroport, Geneva, Switzerland. Univ Iowa, Dept Rheumatol, Hlth Care, Iowa City, IA USA. Univ Calif Los Angeles, Sch Med, Dept Rheumatol, Los Angeles, CA USA. Freeman Rd Hosp, Muskuloskeletal Unit, Newcastle Upon Tyne NE7 7DN, Tyne & Wear, England. St George Hosp, Dept Rheumatol, Sydney, NSW, Australia. St Vincents Hosp, Dept Rheumatol, Dublin 4, Ireland.Bruynesteyn, K, Univ Hosp Maastricht, Dept Internal Med, Div Rheumatol, POB 5800, NL-6202 AZ Maastricht, Netherlands.
URI: http://hdl.handle.net/1942/2641
Link to publication: http://jrheum.com/abstracts/abstracts02/2306.html
ISI #: 000179043100011
ISSN: 0315-162X
Category: A1
Type: Journal Contribution
Validation: ecoom, 2003
Appears in Collections: Research publications

Files in This Item:

There are no files associated with this item.

Items in DSpace are protected by copyright, with all rights reserved, unless otherwise indicated.