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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

Evaluation of the extent of the pathological changes in subchondral bone architecture (SCBO), the presence/absence of subchondral bone plate (SCPL) and of synovial joint space (JTSP). The changes in these three variables were recorded on an 11-point rating scale (range 0–100 with 10 unit increases). Top series: IP joint going through ‘E’ phase. Bottom series: remodelling IP joint.
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Figure 3: Evaluation of the extent of the pathological changes in subchondral bone architecture (SCBO), the presence/absence of subchondral bone plate (SCPL) and of synovial joint space (JTSP). The changes in these three variables were recorded on an 11-point rating scale (range 0–100 with 10 unit increases). Top series: IP joint going through ‘E’ phase. Bottom series: remodelling IP joint.

Mentions: The 90 images were read in a single order to evaluate the extent of the pathological changes in the three selected areas of the IP finger joint. Proportional amounts of normal tissue still present during a ‘J’ or ‘E’ phase or that reappeared during remodelling (‘E/R’ and ‘R’ phase) were recorded on an 11-point rating scale (range 0–100 with 10 unit increases) (figure 3). The sum of the three separate scores constitutes the total IP joint score. Equal weight was attributed to each of the subdomains. In addition, a longitudinal analysis was done after arranging the results of the readings in the correct sequence.12


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)

Evaluation of the extent of the pathological changes in subchondral bone architecture (SCBO), the presence/absence of subchondral bone plate (SCPL) and of synovial joint space (JTSP). The changes in these three variables were recorded on an 11-point rating scale (range 0–100 with 10 unit increases). Top series: IP joint going through ‘E’ phase. Bottom series: remodelling IP joint.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

Figure 3: Evaluation of the extent of the pathological changes in subchondral bone architecture (SCBO), the presence/absence of subchondral bone plate (SCPL) and of synovial joint space (JTSP). The changes in these three variables were recorded on an 11-point rating scale (range 0–100 with 10 unit increases). Top series: IP joint going through ‘E’ phase. Bottom series: remodelling IP joint.
Mentions: The 90 images were read in a single order to evaluate the extent of the pathological changes in the three selected areas of the IP finger joint. Proportional amounts of normal tissue still present during a ‘J’ or ‘E’ phase or that reappeared during remodelling (‘E/R’ and ‘R’ phase) were recorded on an 11-point rating scale (range 0–100 with 10 unit increases) (figure 3). The sum of the three separate scores constitutes the total IP joint score. Equal weight was attributed to each of the subdomains. In addition, a longitudinal analysis was done after arranging the results of the readings in the correct sequence.12

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