A new method of scoring radiographic change in rheumatoid arthritis

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.