Radiological scoring in Radiological scoring in Psoriatic ArthritisPsoriatic Arthritis

Radiological scoring in Radiological scoring in Psoriatic ArthritisPsoriatic Arthritis

Application of the OMERACT filter Application of the OMERACT filter to four scoring methodsto four scoring methods

Radiological scoring methods for PsARadiological scoring methods for PsARadiological scoring methods for PsARadiological scoring methods for PsA

• Four methods describedFour methods described– Modified SteinbrockerModified Steinbrocker– Ratingen method for PsARatingen method for PsA– Sharp method for PsASharp method for PsA– Sharp/van der Heijde method for PsASharp/van der Heijde method for PsA

• All originally developed and tested for RAAll originally developed and tested for RA

• Addition of DIPs of the hands as a scoring siteAddition of DIPs of the hands as a scoring site

Specific features in radiographs of PsASpecific features in radiographs of PsASpecific features in radiographs of PsASpecific features in radiographs of PsA

• Joint patternJoint pattern– DIPs and PIPs, asymmetric and frequently DIPs and PIPs, asymmetric and frequently

in a ray-patternin a ray-pattern– Wrist and isolated rayWrist and isolated ray– Symmetrical as in RASymmetrical as in RA

• FeaturesFeatures– Destruction (widening, osteolysis, pencil-in-Destruction (widening, osteolysis, pencil-in-

cup)cup)– Proliferation (shaft metacarpal/tarsal, Proliferation (shaft metacarpal/tarsal,

adjacent to joints, ankylosis)adjacent to joints, ankylosis)

Comparison of sites/features included in scoringComparison of sites/features included in scoringComparison of sites/features included in scoringComparison of sites/features included in scoring

modified modified

SteinbrockerSteinbrockerRatingenRatingen SharpSharp Sharp/van Sharp/van

der Heijdeder Heijde

FilmsFilms hands/feethands/feet hands/feethands/feet hands/feethands/feet hands/feethands/feet

ErosionsErosions

JSNJSN

MalalignmentMalalignment

ProliferationProliferation

GlobalGlobal

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XX

XX

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XX

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XX

XX

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XX

XX

XX

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RangeRange 0-1600-160 0-3600-360 0-4700-470 0-5280-528

Methods: OMERACT filterMethods: OMERACT filterMethods: OMERACT filterMethods: OMERACT filter

• TruthTruth : does the method measure what it : does the method measure what it should measure?should measure?

• DiscriminationDiscrimination: Reliability, discrimination : Reliability, discrimination between patients, and sensitivity to change between patients, and sensitivity to change over timeover time

• FeasibilityFeasibility

Boers J Rheumatol 1998;25:198-9

Modified SteinbrockerModified SteinbrockerModified SteinbrockerModified Steinbrocker

• 68 patients; 2 readers; blinded for sequence68 patients; 2 readers; blinded for sequence

• Interobserver ICC status scores 0.86Interobserver ICC status scores 0.86

• Intraobserver ICC status scores 0.80 and 0.81Intraobserver ICC status scores 0.80 and 0.81

• No formal sensitivity to change testingNo formal sensitivity to change testing

• Predictor of mortalityPredictor of mortality

Ratingen score for PsARatingen score for PsARatingen score for PsARatingen score for PsA

• 20 patients; 2 readers; 3-year interval; chronological 20 patients; 2 readers; 3-year interval; chronological scoring; intrapatient SD/intra(inter)reader SDscoring; intrapatient SD/intra(inter)reader SD

• Weak correlation between destruction score and Weak correlation between destruction score and proliferation scoreproliferation score

Destruction Destruction scorescore

Proliferation Proliferation scorescore

Total scoreTotal score

Reader 1Reader 1 3.33.3 2.22.2 3.63.6

Reader 2Reader 2 2.02.0 4.24.2 2.72.7

Reader 1,2Reader 1,2

SDDSDD

3.83.8

5.8%5.8%

2.72.7

5.0%5.0%

3.93.9

4.6%4.6%

Sharp method for PsASharp method for PsASharp method for PsASharp method for PsA

• 4 readers; sequence blinded; <1-year interval4 readers; sequence blinded; <1-year interval

• Interreader ICCs status scores 0.81-0.88 Interreader ICCs status scores 0.81-0.88

• Interreader ICCs change scores 0.63Interreader ICCs change scores 0.63

• Statistically significant difference between two Statistically significant difference between two treatment armstreatment arms– In/exclusion DIPs did not change resultIn/exclusion DIPs did not change result– Scoring additional did not change result (shaft Scoring additional did not change result (shaft

periostitis, juxta-articular periostitis, periostitis in periostitis, juxta-articular periostitis, periostitis in the wrist, tuft resorption, widening, osteolysis, the wrist, tuft resorption, widening, osteolysis, pencil-in-cup)pencil-in-cup)

Sharp/van der Heijde method for PsASharp/van der Heijde method for PsASharp/van der Heijde method for PsASharp/van der Heijde method for PsA

• Applied in clinical trial; analyses interreader Applied in clinical trial; analyses interreader reliability and sensitivity to change underwayreliability and sensitivity to change underway

• 100 patients; high correlation between total 100 patients; high correlation between total score and score and – clinically damaged jointsclinically damaged joints– juxta-articular new bone formationjuxta-articular new bone formation– osteolysis scoreosteolysis score

SummarySummarySummarySummary

• TruthTruth

– Very little informationVery little information

• DiscriminationDiscrimination

– Little information on reliability of change scores Little information on reliability of change scores

and sensitivity to changeand sensitivity to change

• FeasibilityFeasibility

– Good for all methodsGood for all methods