Department of Orthopaedic Surgery and Rheumatology, National Hospital Organization Nagoya Medical Center, 4-1-1 Sannomaru, Naka-ku Nagoya City, 460-0001, Aichi, Japan,
Mod Rheumatol. 2013 Nov;23(6):1053-62. doi: 10.1007/s10165-012-0823-6. Epub 2013 Apr 27.
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).
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).
ARASHI Status score and Change score significantly correlated with Larsen's grade (r = 0.89, P < 0.0001) and follow-up-baseline differences in Larsen's grade (r = 0.83, P < 0.0001), respectively. Inter-reader ICCs were very high for both Status score (0.88, 95% confidence interval [CI], 0.83-0.92, P < 0.001) and Change score (0.92, 95% CI, 0.87-0.96, P < 0.001). Intra-reader ICCs were also very high for both Status score (0.92, 95% CI, 0.71-0.98, P < 0.001) and Change score (0.97, 95% CI, 0.91-0.99, P < 0.001). 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.
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.
评估一种新的评分方法在评估早期和已确诊类风湿关节炎（RA）患者大关节的影像学表现和包括关节重塑在内的纵向变化方面的可靠性和敏感性。
ARASHI 研究小组为评估 RA 患者的大关节设计了新的放射学评分系统（状态评分；范围 0-16 分，和变化评分；范围-11 至 12 分）。从 25 例已确诊 RA 患者（每个关节 5 例，共 50 张胶片）的两次时间点（平均间隔 2.3 年）采集显示大关节（肩、肘、髋、膝和踝关节）前后位的 X 线片，并从另外 5 例不同的 RA 患者的每个关节采集严重关节破坏的 5 张 X 线片。在对每个组成部分的定义达成共识并进行读者培训后，由 9 位独立的高级骨科医生使用 Larsen 分级系统和 ARASHI 状态和变化评分对图像进行评估。通过组内相关系数（ICC）和 95%置信区间最小可检测变化（MDC95）的测量误差来评估可靠性。
ARASHI 状态评分和变化评分与 Larsen 分级（r = 0.89，P < 0.0001）和 Larsen 分级随访-基线差异（r = 0.83，P < 0.0001）显著相关。状态评分（0.88，95%置信区间[CI]，0.83-0.92，P < 0.001）和变化评分（0.92，95% CI，0.87-0.96，P < 0.001）的读者间 ICC 均非常高。状态评分（0.92，95% CI，0.71-0.98，P < 0.001）和变化评分（0.97，95% CI，0.91-0.99，P < 0.001）的读者内 ICC 也非常高。读者间一致性的 MDC95 分别为 4.18（最大可获得评分的 25%，MOS）和 4.99（MOS 的 21%），用于状态评分和变化评分。读者内一致性的 MDC95 可接受，分别为 2.82（MOS 的 17%）和 3.02（MOS 的 13%），用于状态评分和变化评分。
ARASHI 评分方法在评估每个大关节及其状态和变化评分的组成部分时，具有良好的读者间/内可靠性，ICC 较高，MDC95 可接受。结果表明，ARASHI 评分方法可能有助于评估状态，以及监测 RA 患者大关节的破坏和重塑的纵向变化。
