Matsuno Hiroaki, Yudoh Kazuo, Hanyu Tadamasa, Kano Syogo, Komatsubara Yoshio, Matsubara Tsukasa, Murata Norikazu, Nakai Hideki, Nakamura Hiroshi, Ozaki Syoichi, Shimizu Masatoshi, Shiozawa Shunichi, Takasugi Kiyoshi, Goto Makoto
Department of Biomedical Engineering, Toin University of Yokohama, 1614 Kurogane, Aoba, Yokohama, 225-8502, Japan.
J Orthop Sci. 2003;8(4):467-73. doi: 10.1007/s00776-003-0676-0.
We investigated interobserver variations in the Larsen radiographic scoring method on hand radiographs of rheumatoid arthritis (RA) patients in a multicenter trial and developed a new radiographic scoring method. Thirteen experienced rheumatologists scored 10 representative RA hand radiograms with the Larsen scoring method and clarified the precipitating factors of interobserver variation. Based on this study, it was proved that the ankylotic joint, overlapping joint, and more precise erosive joint are needed for optimal radiographic evaluation. Therefore, we modified the Larsen scoring method on the basis of these precipitating factors and developed a novel radiographic scoring method. Finally, to determine which scoring system was most reliable, the interobserver variation using three methods (original Larsen method, revised Larsen method, our scoring method) were compared by 13 experienced rheumatologists and 13 residents. Our scoring method proved to have simplicity, reliability, and ease of learning. These results suggest that our novel radiological quantitative assessment method has useful applications for clinical studies in patients with RA.
在一项多中心试验中，我们研究了类风湿关节炎（RA）患者手部X线片采用Larsen放射学评分方法时观察者间的差异，并开发了一种新的放射学评分方法。13名经验丰富的风湿病学家用Larsen评分方法对10张具有代表性的RA手部X线片进行评分，并明确了观察者间差异的促成因素。基于这项研究，证实了为进行最佳放射学评估，需要强直关节、重叠关节以及更精确的侵蚀性关节。因此，我们基于这些促成因素对Larsen评分方法进行了修改，开发了一种新的放射学评分方法。最后，为确定哪种评分系统最可靠，13名经验丰富的风湿病学家和13名住院医师采用三种方法（原始Larsen方法、修订后的Larsen方法、我们的评分方法）比较了观察者间的差异。我们的评分方法被证明具有简单性、可靠性和易于学习的特点。这些结果表明，我们新的放射学定量评估方法在RA患者的临床研究中具有实用价值。
