Summary
Radiography of hands and feet is a standard measure of outcome in rheumatoid arthritis. We hypothesised that this radiological information can be reproduced by clinical evaluation.
A rheumatologist examined 78 patients with rheumatoid arthritis and tried to predict the radiological Larsen score, for the proximal interphalangeal (PIP), metacarpophalangeal (MCP), wrist, ankle, and metatarsophalangeal (MTP) joints.
Spearman correlation between clinical Larsen and X-ray Larsen was 0.79 for hands and 0.66 for feet. There was no significant difference in scores for PIP, MCP, wrists, or ankles, but MTP joints were underscored by clinical Larsen relative to X-ray Larsen (median of 20 vs 22 respectively, p=0.04). Categorical data for index finger MCP joints showed significant proportional agreement of 37% (Kappa 0.24, p<0.0001).
In conclusion, the Larsen X-ray score can be predicted by clinical examination with surprising accuracy in the small hand joints but less so in the feet. Although the favourable agreement shown in this study does not make X-rays redundant, we suggest that clinical examination of the hands should be further refined and standardised as a measure of outcome.
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Fries, J.F., Bloch, D.A., Sharp, J.T., McShane, D.J., Spitz, P., Bluhm, G.B., Forrester, D., Genant, H., Gofton, P., Richman, S., Wiessman, B., Wolfe, F. Assessment of radiological progression in rheumatoid arthritis: a randomised, controlled trial. Arthritis Rheum 1986, 29, 1–9.
Brook, A., Corbett, M. Radiographic changes in early rheumatoid disease. Ann Rheum Dis 1977, 36, 71–73.
Paimela, L. The radiographic criterion in the 1987 revised criteria for rheumatoid arthritis — reassessment in a prospective study of early disease. Arthritis Rheum, 1992, 35(3), 255–258.
Turner, R.A., Flint, K.P., Semble, E.L., Agudelo, C.A. Clinical evaluation of radiographic progression in rheumatoid arthritis. Clin Exp Rheum, 1990, 8, 583–586.
Scott, D.L., Coulton, B.L., Popert, A.J. Long-term progression of joint damage in rheumatoid arthritis. Ann Rheum Dis, 1986, 45, 373–378.
Larsen, A., Dale, K., Eek, M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiologica Diagnosis 1977, 18, 481–491.
Sharp, J.T. Radiologic assessment as an outcome measure in rheumatoid arthritis. Arthritis Rheum 1989, 32 (2), 221–229.
Brower, A.C. Use of the radiograph to measure the course of rheumatoid arthritis: the gold standard versus fool's gold. Arthritis Rheum 1990, 33 (3), 316–324.
Gofton, J.P., O'Brien, Wm. Effects of auranofin on the radiological progression of joint erosion in rheumatoid arthritis. J Rheumatol 1988, suppl. 8, 169–172.
van der Heijde, D.M.F.M., van Riel, P.L.C.M., Nuver-Zwart, I.H., Gribnau, F.W., van de Putte, L.B.A. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet, 1989, 1036–1038.
Cuchacovich, M., Couret, M., Peray, P., Gatica, H., Sany, J. Precision of the Larsen and the Sharp methods of assessing radiologic change in patients with rheumatoid arthritis. Arthritis Rheum 1992, 35, 736–739.
Grindulis, K.A., Scott, D.L., Struthers, G.R. The assessment of radiological change in the hands and wrists in rheumatoid arthritis. Rheumatol Int 1983, 3, 39–42.
Mewa, A.A.M., Pui, M., Cockshot, W.P., Buchanan, W.W. Observer differences in detecting erosions in radiographs of rheumatoid arthritis. J Rheumatol, 1983, 10(2), 216–221.
De Carvalho, A., Graudal, H. Relationship between radiologic and clinical findings in rheumatoid arthritis. Acta Radiol (Diagn) 1980, 21, 797–802.
Fuchs, H.A., Callahan, L.F., Kaye, J.J., Brooks, R.H., Nance, E.P., Pincus, T. Radiographic and joint count findings of the hand in rheumatoid arthritis: related and unrelated findings. Arthritis Rheum 1988, 31, 44–51.
Pincus, T., Callahan, L.F., Brooks, R.H., Fuchs, H.A., Olsen, N.J., Kaye, J.J. Self-report questionnaire scores in rheumatoid arthritis compared with traditional physical, radiographic, and laboratory measures. Ann Int Med 1989, 110, 259–266.
Isomäki, H., Martio, J., Sarna, S., Kiviniemi, P., Akimova, T., Ievleva, L., Mylov, N., Trifimova, T. Predicting the outcome of rheumatoid arthritis — a Soviet-Finnish Cooperative Study. Scand J Rheumatol 1984, 13, 33–38.
Scott, D.L., Coulton, B.L., Bacon, P.J. Methods of X-ray assessment in rheumatoid arthritis: a re-evaluation. Br J Rheumatol 1985, 24, 31–39.
Ritchie, D.M., Boyle, J.A., Mc Innes, J.M. et al. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968, 147, 393–406.
van der Heijde, D.M.F.M., van't Hof, M.A., van Riel, P.L.C.M., Theunisse, L.A.M., Lubberts, E.W., van Leeuwen, M.A., van Rijswijk, M.H., van de Putte, L.B.A. Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Ann Rheum Dis 1990, 49, 916–920.
Davis, M.J., Dawes, P.T., Fowler, P.D., Sheeran, T.P., Shadforth, M.F., Ziade, F., Collins, M., Jones, P. Comparison and evaluation of a disease activity index for use in patients with rheumatoid arthritis. Brit J Rheum 1990, 29, 111–115.
Altman, D.G., Bland, J.M. Measurement in medicine: the analysis of method comparison studies. Statistician 1983, 32, 307–317.
Brennan, P., Silman, A. Statistical methods for assessing observer variability in clinical measures. BMJ 1992, 304, 1491–1494.
Esdaile, J.M., Danoff, D., Rosenthall, L., Gutowski, A. Deforming arthritis in SLE. Ann Rheum Dis 1981, 40, 124.
Zvaifler, N.J. Chronic postrheumatic fever (Jaccoud's) arthritis. N Engl J Med 1962, 267, 10.
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Plant, M.J., Saklatvala, J., Jones, P.W. et al. Prediction of radiographic damage in hands and feet in rheumatoid arthritis by clinical evaluation. Clin Rheumatol 13, 487–491 (1994). https://doi.org/10.1007/BF02242948
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DOI: https://doi.org/10.1007/BF02242948