van der Heijde D, Dankert T, Nieman F, Rau R, Boers M
University Hospital Maastricht, Maastricht, The Netherlands, Evangelisches Fachkrankenhaus, Ratingen, Germany.
Rheumatology (Oxford). 1999 Oct;38(10):941-7. doi: 10.1093/rheumatology/38.10.941.
To determine the reliability and sensitivity to change of a simplified radiological scoring method [simple erosion narrowing score (SENS)] for rheumatoid arthritis (RA). SENS was compared to the Sharp/van der Heijde score (SHS) as a gold standard.
Sets of seven radiographs of hands and feet were taken of 20 RA patients with a wide spectrum of radiological damage. For 14 patients, these seven radiographs were taken during a follow-up period of 5 yr, and for six patients during a follow-up of 10 yr. Each set of radiographs was scored twice by the same observer (DvdH). Erosions and joint space narrowing were scored with SHS (range 0-448) in 32 and 30 joints in the hands, respectively, and both in 12 joints in the feet. SENS gives a score of 1 if there is any erosion in a joint and also 1 if there is any narrowing in the joint (range 0-86). In each case, SENS was derived from SHS. To analyse data, generalizability theory and repeated measurements ANOVA were used.
The overall reliability coefficient was 0.81 for SHS and 0.80 for SENS. Intra-observer reliability [intraclass correlation coefficient (ICC)] was 0.99 and 0.98 for SHS and SENS, respectively. The ICC for the sensitivity to change was 0.84 for SHS and 0.88 for SENS. The smallest detectable difference (SDD) could be determined for both methods. The presence of progression based on this SDD was very comparable between the two methods.
The measurement properties of SENS are good and comparable to SHS. This makes SENS suitable for use in clinical practice and in large (epidemiological) studies, especially in the first years of disease.
确定一种用于类风湿关节炎（RA）的简化放射学评分方法[简单侵蚀狭窄评分（SENS）]的可靠性及对变化的敏感性。将SENS与作为金标准的Sharp/van der Heijde评分（SHS）进行比较。
对20例具有广泛放射学损伤的RA患者拍摄了手部和足部的七组X线片。对于14例患者，这七组X线片是在5年的随访期内拍摄的，对于6例患者是在10年的随访期内拍摄的。每组X线片由同一名观察者（DvdH）进行两次评分。分别在手部的32个关节和30个关节以及足部的12个关节中用SHS（范围0 - 448）对侵蚀和关节间隙狭窄进行评分。如果关节有任何侵蚀，SENS得分为1；如果关节有任何狭窄，SENS也得分为1（范围0 - 86）。在每种情况下，SENS均由SHS得出。为分析数据，使用了概化理论和重复测量方差分析。
SHS的总体可靠性系数为0.81，SENS为0.80。观察者内可靠性[组内相关系数（ICC）]，SHS为0.99，SENS为0.98。变化敏感性的ICC，SHS为0.84，SENS为0.88。两种方法均可确定最小可检测差异（SDD）。基于此SDD的进展情况在两种方法之间非常可比。
SENS的测量特性良好，与SHS相当。这使得SENS适用于临床实践和大型（流行病学）研究，尤其是在疾病的最初几年。
