Rau R, Wassenberg S, Herborn G, Stucki G, Gebler A
Department of Rheumatology, Evangelisches Fachkrankenhaus Ratingen, Germany.
J Rheumatol. 1998 Nov;25(11):2094-107.
To test the reliability and to define the minimal detectable change of a new radiographic scoring method in rheumatoid arthritis (RA).
Following the recommendations of an expert panel a new radiographic scoring method was defined. It scores 38 joints [all proximal interphalangeal (PIP) and metacarpophalangeal joints, 4 sites in the wrists, IP of the great toes, and metatarsophalangeals 2 to 5], regarding only the amount of joint surface destruction on a 0 to 5 scale for each joint. Each grade represents 20% of joint surface destruction. The method was tested by 5 readers on a set of 7 serial radiographs of hands and forefeet of 20 patients with progressive and destructive RA. Analysis of variance was performed, as it provides the best information about the capability of a method to detect real change and to define its sensitivity according to the minimal detectable change.
Analysis of variance proved a high probability that the readers found real change with a ratio of intrapatient to intrareader standard deviation of 2.6. It also confirmed that one reader could detect a change of 3.5% of the total score with a probability of 95% and that different readers agreed upon a change of 4.6%. Inexperienced readers performed with comparable results to experienced readers. The time required for the reading averaged less than 10 minutes for the scoring of one set.
The new radiographic scoring method proved to be reliable, precise, and easy to learn, with reasonable cost. Compared to published data, it may provide better results than the widely used Larsen score. These features favor our new method for use in clinical trials and in longterm observational studies in RA.
测试一种用于类风湿关节炎（RA）的新放射学评分方法的可靠性，并确定其最小可检测变化。
根据专家小组的建议定义了一种新的放射学评分方法。该方法对38个关节进行评分[所有近端指间关节（PIP）和掌指关节、腕部4个部位、拇趾趾间关节以及第2至5跖趾关节]，仅根据每个关节表面破坏的程度在0至5分的范围内进行评分。每个等级代表关节表面破坏的20%。5名阅片者对20例患有进行性和破坏性RA患者的一组7张手部和前足的连续X线片进行了该方法的测试。进行方差分析，因为它能提供关于一种方法检测实际变化的能力以及根据最小可检测变化确定其敏感性的最佳信息。
方差分析证明阅片者发现实际变化的可能性很高，患者内标准差与阅片者内标准差之比为2.6。它还证实一名阅片者能够以95%的概率检测到总分3.5%的变化，不同阅片者对4.6%的变化达成一致。经验不足的阅片者与经验丰富的阅片者表现相当。对一组片子进行评分平均所需时间不到10分钟。
新的放射学评分方法被证明是可靠、精确且易于学习的，成本合理。与已发表的数据相比，它可能比广泛使用的Larsen评分提供更好的结果。这些特点有利于我们的新方法用于RA的临床试验和长期观察研究。
