Vol.23 No.6

Original Article

Development and validation of a new radiographic scoring system to evaluate bone and cartilage destruction and healing of large joints with rheumatoid arthritis: ARASHI (Assessment of rheumatoid arthritis by scoring of large joint destruction and healing in radiographic imaging) study

Authors

Atsushi Kaneko 1 , Isao Matsushita2 , Katsuaki Kanbe3 , Katsumitsu Arai4 , Yoshiaki Kuga5 , Asami Abe6 , Takeshi Matsumoto7 , Natsuko Nakagawa8 , Keiichiro Nishida9

  • Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku Nagoya City 460-0001, Aichi, Japan
  • Department of Orthopaedic Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
  • Department of Orthopaedic Surgery, Tokyo Women’s Medical University, Medical Center East, Tokyo, Japan
  • Department of Orthopaedic Surgery, Niigata Prefectural Central Hospital, Niigata, Japan
  • Department of Orthopaedic Surgery, Center for Rheumatic Diseases, Wakaba Hospital, Saitama, Japan
  • Department of Rheumatology, Niigata Rheumatic Center, Niigata, Japan
  • Department of Orthopaedic Surgery, Yokohama Rosai Hospital, Kanagawa, Japan
  • Department of Orthopaedic Surgery, Kohnan Kakogawa Hospital, Hyogo, Japan
  • Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
Received:

3 July 2012

Accepted:

17 December 2012

Published online:

27 April 2013

Full Text

PDF　(member's only)

Abstract

Objective To assess the reliability and sensitivity of a novel scoring method to evaluate the radiographic appearance of and longitudinal changes including joint remodeling in large joints with early and established rheumatoid arthritis (RA).
Methods The ARASHI study group devised new radiographic scoring systems (Status score; range 0?16 points, and Change score; range -11 to 12 points) for evaluation of large joints with RA. Radiographs showing anterior/posterior views of large joints (shoulder, elbow, hip, knee, and ankle joints) taken at two time points (mean interval 2.3 years) were collected from 25 patients with established RA (5 patients for each of the 5 joints, 50 films in total), and an additional 5 films of each joint with severe joint destruction were collected from 5 different sets of RA patients. After consensus on the definition of each component and reader training, images were evaluated using the Larsen’s grading system and the ARASHI Status and Change score by 9 independent senior orthopedic surgeons.
The reliability was estimated by intra-class correlation coefficients (ICCs) and measurement error by 95 % confidence intervals of minimum detectable change (MDC95).
Results ARASHI Status score and Change score significantly correlated with Larsen’s grade (r = 0.89, P%ABST%.0001) and follow-up-baseline differences in Larsen’s grade (r = 0.83, P%ABST%.0001), respectively. Interreader ICCs were very high for both Status score (0.88, 95 % confidence interval [CI], 0.83?0.92, P%ABST%.001) and Change score (0.92, 95 % CI, 0.87?0.96, P%ABST%.001). Intrareader ICCs were also very high for both Status score (0.92, 95 % CI, 0.71?0.98, P%ABST%.001) and Change score (0.97, 95 % CI, 0.91?0.99, P%ABST%.001). The MDC95 for inter-reader agreement were 4.18 (25 % of maximum obtainable score, MOS) and 4.99 (21 % of MOS) for Status score and Change score, respectively. The MDC95 for intra-reader agreement was acceptable with 2.82 (17 % of MOS) and 3.02 (13 % of MOS) for Status score and Change score, respectively.
Conclusion The ARASHI scoring method showed good inter-/intra-reader reliability with high ICCs and acceptable MDC95 with respect to each large joint and the components of both Status and Change scores. The results suggest that the ARASHI scoring method might be useful for the assessment of status, as well as longitudinal monitoring of destruction and remodeling of large joints with RA.

Key words

Large joint, Radiographic scoring system, ARASHI study, Rheumatoid arthritis