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Morbid anatomy of 'erosive osteoarthritis' of the interphalangeal finger joints: an optimised scoring system to monitor disease progression in affected joints.

Verbruggen G, Wittoek R, Vander Cruyssen B, Elewaut D - Ann. Rheum. Dis. (2009)

Bottom Line: Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identification of joints with changes above the SDC as 'progressors'.Longitudinal inter-reader ICC scores rated well for all variables and the total score (ICC 0.86-0.93).To identify 'real' change over background noise, a change of at least 40 units on the total score (range 0-300) over 12 months (SDC 0-12:36.0), and 50 units over 6 months (SDC 0-6:47.6) had to be present. 60% of the 30 joints were identified as 'progressors' over 6 months compared with 33.3% with the classical anatomical scoring system, and 70% versus 56.6%, respectively, over 12 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, 0K12 IB - Ghent University Hospital, De Pintelaan, 185, B-9000 Gent, Belgium. gust.verbruggen@ugent.be

ABSTRACT

Objectives: To develop and validate a quantitative radiographic scoring system, the Ghent University Scoring System (GUSS), with better ability to detect progression over a shorter period of time in erosive osteoarthritis (OA) of the interphalangeal (IP) finger joints compared with the existing anatomic phase scoring system.

Methods: Thirty IP finger joints showing erosive features at baseline or follow-up were selected from 18 patients with erosive hand OA. Posteroanterior radiographs of these joints obtained at baseline, 6 and 12 months--totalling 90 images--were used for the study. All joints were first scored according to the original anatomic phase scoring system. Erosive progression and signs of repair or remodelling were then scored by indicating the proportion of normal subchondral bone, subchondral plate and joint space on an 11-point rating scale (range 0-100 with 10 unit increases). Inter- and intrareader reproducibility was studied using intraclass correlation coefficients (ICCs). Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identification of joints with changes above the SDC as 'progressors'.

Results: Longitudinal inter-reader ICC scores rated well for all variables and the total score (ICC 0.86-0.93). To identify 'real' change over background noise, a change of at least 40 units on the total score (range 0-300) over 12 months (SDC 0-12:36.0), and 50 units over 6 months (SDC 0-6:47.6) had to be present. 60% of the 30 joints were identified as 'progressors' over 6 months compared with 33.3% with the classical anatomical scoring system, and 70% versus 56.6%, respectively, over 12 months.

Conclusion: GUSS, is a reliable method to score radiographic change over time in erosive IP OA and detects more progression over a shorter period of time than the classical scoring system.

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Related in: MedlinePlus

(A) Erosive changes and (B) remodelling on radiographs of six different interphalangeal joints taken at 6-month intervals. (A) 1: Disappearance of the joint space. 2: Destruction of the subchondral bone plate; osteolytic events in and near the subchondral plate lead to a ruffled aspect of the subchondral plate. 3: Appearance of osteolytic areas in the subchondral bone. 4: Both the destruction of the subchondral plate and the osteolytic events in the subchondral bone area cause the generation of a widened pseudo-joint with irregular margins. (B) 5: Disappearance of the osteolytic areas in the subchondral bone area. 6: Reconstruction of the subchondral bone plate, which did not necessarily appear as a denser radio-opaque zone. 7: Reappearance of a radiotranslucent area recognised as the reconstructed joint space.
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Figure 1: (A) Erosive changes and (B) remodelling on radiographs of six different interphalangeal joints taken at 6-month intervals. (A) 1: Disappearance of the joint space. 2: Destruction of the subchondral bone plate; osteolytic events in and near the subchondral plate lead to a ruffled aspect of the subchondral plate. 3: Appearance of osteolytic areas in the subchondral bone. 4: Both the destruction of the subchondral plate and the osteolytic events in the subchondral bone area cause the generation of a widened pseudo-joint with irregular margins. (B) 5: Disappearance of the osteolytic areas in the subchondral bone area. 6: Reconstruction of the subchondral bone plate, which did not necessarily appear as a denser radio-opaque zone. 7: Reappearance of a radiotranslucent area recognised as the reconstructed joint space.

Mentions: Three variables were selected to grade the severity of the radiographic changes: the proportions of the subchondral bone showing osteolytic areas, the relative amount of the subchondral bony plate resorbed, and the disappearance of the normal joint space, either by an entire loss of the articular cartilage or by a complete destruction of the subchondral bone plate and the appearance of a pseudo-joint (figure 1A).


Morbid anatomy of 'erosive osteoarthritis' of the interphalangeal finger joints: an optimised scoring system to monitor disease progression in affected joints.

Verbruggen G, Wittoek R, Vander Cruyssen B, Elewaut D - Ann. Rheum. Dis. (2009)

(A) Erosive changes and (B) remodelling on radiographs of six different interphalangeal joints taken at 6-month intervals. (A) 1: Disappearance of the joint space. 2: Destruction of the subchondral bone plate; osteolytic events in and near the subchondral plate lead to a ruffled aspect of the subchondral plate. 3: Appearance of osteolytic areas in the subchondral bone. 4: Both the destruction of the subchondral plate and the osteolytic events in the subchondral bone area cause the generation of a widened pseudo-joint with irregular margins. (B) 5: Disappearance of the osteolytic areas in the subchondral bone area. 6: Reconstruction of the subchondral bone plate, which did not necessarily appear as a denser radio-opaque zone. 7: Reappearance of a radiotranslucent area recognised as the reconstructed joint space.
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC2925149&req=5

Figure 1: (A) Erosive changes and (B) remodelling on radiographs of six different interphalangeal joints taken at 6-month intervals. (A) 1: Disappearance of the joint space. 2: Destruction of the subchondral bone plate; osteolytic events in and near the subchondral plate lead to a ruffled aspect of the subchondral plate. 3: Appearance of osteolytic areas in the subchondral bone. 4: Both the destruction of the subchondral plate and the osteolytic events in the subchondral bone area cause the generation of a widened pseudo-joint with irregular margins. (B) 5: Disappearance of the osteolytic areas in the subchondral bone area. 6: Reconstruction of the subchondral bone plate, which did not necessarily appear as a denser radio-opaque zone. 7: Reappearance of a radiotranslucent area recognised as the reconstructed joint space.
Mentions: Three variables were selected to grade the severity of the radiographic changes: the proportions of the subchondral bone showing osteolytic areas, the relative amount of the subchondral bony plate resorbed, and the disappearance of the normal joint space, either by an entire loss of the articular cartilage or by a complete destruction of the subchondral bone plate and the appearance of a pseudo-joint (figure 1A).

Bottom Line: Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identification of joints with changes above the SDC as 'progressors'.Longitudinal inter-reader ICC scores rated well for all variables and the total score (ICC 0.86-0.93).To identify 'real' change over background noise, a change of at least 40 units on the total score (range 0-300) over 12 months (SDC 0-12:36.0), and 50 units over 6 months (SDC 0-6:47.6) had to be present. 60% of the 30 joints were identified as 'progressors' over 6 months compared with 33.3% with the classical anatomical scoring system, and 70% versus 56.6%, respectively, over 12 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Rheumatology, 0K12 IB - Ghent University Hospital, De Pintelaan, 185, B-9000 Gent, Belgium. gust.verbruggen@ugent.be

ABSTRACT

Objectives: To develop and validate a quantitative radiographic scoring system, the Ghent University Scoring System (GUSS), with better ability to detect progression over a shorter period of time in erosive osteoarthritis (OA) of the interphalangeal (IP) finger joints compared with the existing anatomic phase scoring system.

Methods: Thirty IP finger joints showing erosive features at baseline or follow-up were selected from 18 patients with erosive hand OA. Posteroanterior radiographs of these joints obtained at baseline, 6 and 12 months--totalling 90 images--were used for the study. All joints were first scored according to the original anatomic phase scoring system. Erosive progression and signs of repair or remodelling were then scored by indicating the proportion of normal subchondral bone, subchondral plate and joint space on an 11-point rating scale (range 0-100 with 10 unit increases). Inter- and intrareader reproducibility was studied using intraclass correlation coefficients (ICCs). Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identification of joints with changes above the SDC as 'progressors'.

Results: Longitudinal inter-reader ICC scores rated well for all variables and the total score (ICC 0.86-0.93). To identify 'real' change over background noise, a change of at least 40 units on the total score (range 0-300) over 12 months (SDC 0-12:36.0), and 50 units over 6 months (SDC 0-6:47.6) had to be present. 60% of the 30 joints were identified as 'progressors' over 6 months compared with 33.3% with the classical anatomical scoring system, and 70% versus 56.6%, respectively, over 12 months.

Conclusion: GUSS, is a reliable method to score radiographic change over time in erosive IP OA and detects more progression over a shorter period of time than the classical scoring system.

Show MeSH
Related in: MedlinePlus