Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria.
Department of Pathology, Medical University of Vienna, Vienna, Austria.
Ann Rheum Dis. 2014 Nov;73(11):1983-9. doi: 10.1136/annrheumdis-2012-203117. Epub 2013 Jul 29.
To develop a radiographic score for assessment of hand osteoarthritis (OA) that is based on histopathological alterations of the distal (DIP) and proximal (PIP) interphalangeal joints.
DIP and PIP joints were obtained from corpses (n=40). Plain radiographies of these joints were taken. Joint samples were prepared for histological analysis; cartilage damage was graded according to the Mankin scoring system. A 2×2 Fisher's exact test was applied to define those radiographic features most likely to be associated with histological alterations. Receiver operating characteristic curves were analysed to determine radiographic thresholds. Intraclass correlation coefficients (ICC) estimated intra- and inter-reader variability. Spearman's correlation was applied to examine the relationship between our score and histopathological changes. Differences between groups were determined by a Student's t test.
The Interphalangeal Osteoarthritis Radiographic Simplified (iOARS) score is presented. The score is based on histopathological changes of DIP and PIP joints and follows a simple dichotomy whether OA is present or not. The iOARS score relies on three equally ranked radiographic features (osteophytes, joint space narrowing and subchondral sclerosis). For both DIP and PIP joints, the presence of one x-ray features reflects interphalangeal OA. Sensitivity and specificity for DIP joints were 92.3% and 90.9%, respectively, and 75% and 100% for PIP joints. All readers were able to reproduce their own readings in DIP and PIP joints after 4 weeks. The overall agreement between the three readers was good; ICCs ranged from 0.945 to 0.586. Additionally, outcomes of the iOARS score in a hand OA cohort revealed a higher prevalence of interphalangeal joint OA compared with the Kellgren and Lawrence score.
The iOARS score is uniquely based on histopathological alterations of the interphalangeal joints in order to reliably determine OA of the DIP and PIP joints radiographically. Its high specificity and sensitivity together with the dichotomous approach renders the iOARS score reliable, fast to perform and easy to apply. This tool may not only be valuable in daily clinical practice but also in clinical and epidemiological trials.
开发一种基于远端指间关节（DIP）和近端指间关节（PIP）的组织病理学改变的手部骨关节炎（OA）放射学评分方法。
从尸体中获取 DIP 和 PIP 关节（n=40）。对这些关节进行普通 X 射线摄影。对关节样本进行组织学分析；根据 Mankin 评分系统对软骨损伤进行分级。应用 2×2 Fisher 确切概率法确定最有可能与组织学改变相关的放射学特征。分析受试者工作特征曲线以确定放射学阈值。计算组内相关系数（ICC）以评估内、外读者间的可重复性。应用 Spearman 相关分析评估我们的评分与组织病理学变化之间的关系。通过学生 t 检验确定组间差异。
提出了指间关节炎放射学简化评分（iOARS）。该评分基于 DIP 和 PIP 关节的组织病理学变化，并采用简单的二分法来判断是否存在 OA。iOARS 评分依赖于三个同等重要的放射学特征（骨赘、关节间隙变窄和软骨下硬化）。对于 DIP 和 PIP 关节，一个 X 射线特征的存在反映了指间关节炎 OA。DIP 关节的敏感性和特异性分别为 92.3%和 90.9%，PIP 关节的敏感性和特异性分别为 75%和 100%。所有读者在 4 周后都能够重现自己在 DIP 和 PIP 关节的读数。三位读者之间的总体一致性良好；ICC 范围为 0.945 至 0.586。此外，手部 OA 队列的 iOARS 评分结果显示，指间关节 OA 的患病率高于 Kellgren 和 Lawrence 评分。
iOARS 评分独特地基于指间关节的组织病理学改变，以可靠地确定 DIP 和 PIP 关节的 OA 放射学表现。其高特异性和敏感性以及二分法使得 iOARS 评分可靠、快速且易于应用。该工具不仅在日常临床实践中具有价值，而且在临床和流行病学研究中也具有价值。
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