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Assessing rheumatologists and radiologists agreement rate regarding the diagnosis of focal bone erosions and osteopenic changes using hand X-rays radiography in patients with rheumatoid arthritis

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Abstract

In rheumatoid arthritis, diagnosis of bone erosions and osteopenic changes in earlier stages is extremely important to the initiation of specific and more aggressive treatment to subsidize the disease, decrease morbidities, and increase patients’ quality of life. In the present study, we assessed consensus rate of rheumatologists and radiologists regarding the detection of radiographic changes of hand in rheumatoid arthritis. Ninety-six adult patients with documented rheumatoid arthritis referring to our outpatient rheumatology clinic during March 2009–2010, enrolled into this cross-sectional study. Hands and wrists X-ray obtained for all patients. The films were observed by a rheumatologist and a radiologist separately, to detect focal bone erosions, periarticular osteopenic changes, and joint space losses. Agreement rates between the two specialists were assessed using the kappa test ratio. A total of 96 patients comprising 86 (89.5 %) female and 10 (10.41 %) male with a mean age of 48.5 ± 1.2 years (range 22–76 years old) were studied. The proportion agreement between the radiologist and rheumatologist regarding bone erosions and juxta-articular osteopenic changes was 69.7 and 84.3 %, respectively. The kappa agreement coefficient for the diagnosis of bone erosions was 36 % which showed significant poor agreement between two specialist (p < 0.001, proportion agreement = 69.7 %). As well, the kappa of 20 % for the detection of juxta-articular osteopenic changes revealed significant poor agreement between the two specialist (p < 0.047, proportion agreement = 84.3 %). The results of the present study demonstrate that there is a minimal agreement between the two radiology and rheumatology specialists regarding simultaneous diagnosis of bone erosions and periarticular osteopenic changes in rheumatoid arthritis patients that emphasis requiring both specialists’ X-ray report at the time of diagnosis.

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References

  1. Weyand CM (2000) New insights into the pathogenesis of rheumatoid arthritis. Rheumatology 39(supp 1):3–8

    Article  PubMed  Google Scholar 

  2. Scott DL (2000) Prognostic factors in early rheumatoid arthritis. Rheumatology (Oxford) 39(Suppl 1):24–29

    Article  Google Scholar 

  3. van der Heijde DM (2000) Radiographic imaging: the ‘gold standard’ for assessment of disease progression in rheumatoid arthritis. Rheumatology (Oxford) 39(Suppl 1):9–16

    Article  Google Scholar 

  4. Sommer OJ, Kladosek A, Weiler V et al (2005) Rheumatoid arthritis: a practical guide to state-of-the-art imaging, image interpretation, and clinical implications. Radiographics 25(2):381–398

    Article  PubMed  Google Scholar 

  5. Firestein GS, Budd RC, Harris Jr ED, McInnes IB, Rhuddy S, Sergent JS (2008) Textbook of rheumatology (Kelley). Saunders 1035–1143

  6. Berglin E, Lorentzon R, Nordmark L et al (2003) Predictors of radiological progression and changes in hand bone density in early rheumatoid arthritis. Rheumatology (Oxford) 42(2):268–275

    Article  CAS  Google Scholar 

  7. Bottcher J, Pfeil A (2008) Diagnosis of periarticular osteoporosis in rheumatoid arthritis using digital X-ray radiogrammetry. Arthritis Res Ther 10(1):103

    Article  PubMed  Google Scholar 

  8. Hoff M, Haugeberg G, Kvien TK (2007) Hand bone loss as an outcome measure in established rheumatoid arthritis: 2-year observational study comparing cortical and total bone loss. Arthritis Res Ther 9:R81

    Article  PubMed  Google Scholar 

  9. Deodhar AA, Brabyn J, Pande I et al (2003) Hand bone densitometry in rheumatoid arthritis, a 5 year longitudinal study: an outcome measure and a prognostic marker. Ann Rheum Dis 62:767–770

    Article  PubMed  CAS  Google Scholar 

  10. Klipple JH, Stone JH, Crofford LJ, White PH (2008) Primer on the rheumatic diseases. Springer, Berlin, pp 114–142

    Book  Google Scholar 

  11. Haugeberg G, Orstavik RE, Uhlig T et al (2002) Bone loss in patients with rheumatoid arthritis: results from a population-based cohort of 366 patients followed up for 2 years. Arthritis Rheum 46:1720–1728

    Article  PubMed  Google Scholar 

  12. Prevoo MLL, van’t Hof MA, Kuper HH et al (1995) Modified disease activity scores that include twenty-eight-joint counts. Arthritis Rheum 38:44–48

    Article  PubMed  CAS  Google Scholar 

  13. Calabrese LH (1993) Human immunodeficiency virus infection and arthritis. Rheum Dis Clin N Am 19:477–488

    CAS  Google Scholar 

  14. Solomon G, Brancato L, Winchester R (1991) An approach to the human immunodeficiency virus-positive patient with a spondyloarthropathic disease. Rheum Dis Clin N Am 17:43–58

    CAS  Google Scholar 

  15. Schumacher HR, Gall EP (1974) Arthritis in acute hepatitis and chronic active hepatitis: pathology of the synovial membrane with evidence for the presence of Australia antigen in synovial membranes. Am J Med 57:655–664

    Article  PubMed  CAS  Google Scholar 

  16. Lee YH, Ji JD, Yeon JE et al (1998) Cryoglobulinaemia and rheumatic manifestations in patients with hepatitis C virus infection. Ann Rheum Dis 57:728–731

    Article  PubMed  CAS  Google Scholar 

  17. Bukhari M, Lunt M, Harrison BJ et al (2002) Rheumatoid factor is the major predictor of increasing severity of radiographic erosions in rheumatoid arthritis. Arthritis Rheum 46:906–912

    Article  PubMed  CAS  Google Scholar 

  18. Vencovsky J, Machacek S, Sedova L et al (2003) Autoantibodies can be prognostic markers of an erosive disease in early rheumatoid arthritis. Ann Rheum Dis 62:427–430

    Article  PubMed  CAS  Google Scholar 

  19. Berglin E, Johansson T, Sundin U et al (2006) Radiological outcome in rheumatoid arthritis is predicted by presence of antibodies against cyclic citrullinated peptide before and at disease onset, and by IgA-RF at disease onset. Ann Rheum Dis 65:453–458

    Article  PubMed  CAS  Google Scholar 

  20. Kaarela K, Kautiainen H (1997) Continuous progression of radiological destruction in seropositive rheumatoid arthritis. J Rheumatol 24:1285–1287

    PubMed  CAS  Google Scholar 

  21. Fries JF (2000) Current treatment paradigms in rheumatoid arthritis. Rheumatology (Oxford) 39(Suppl 1):30–35

    Article  Google Scholar 

  22. Wassenberg S, Rau R (1995) Problems in evaluating radiographic findings in rheumatoid arthritis using different methods of radiographic scoring: examples of difficult cases and a study design to develop an improved scoring method. J Rheumatol 22:1990–1997

    PubMed  CAS  Google Scholar 

  23. Wolfe AM (1968) The epidemiology of rheumatoid arthritis: a review, I: surveys. Bull Rheum Dis 19:518–523

    PubMed  CAS  Google Scholar 

  24. Lindqvist E, Jonsson K, Saxne T et al (2003) Course of radiographic damage over 10 years in a cohort with early rheumatoid arthritis. Ann Rheum Dis 62:611–616

    Article  PubMed  CAS  Google Scholar 

  25. Scott DL (2004) Radiological progression in established rheumatoid arthritis. J Rheumatol Suppl 69:55–65

    PubMed  Google Scholar 

  26. Bird P, Kirkham B, Portek I et al (2004) Documenting damage progression in a two-year longitudinal study of rheumatoid arthritis patients with established disease (the DAMAGE study cohort): is there an advantage in the use of magnetic resonance imaging as compared with plain radiography? Arthritis Rheum 50:1383–1389

    Article  PubMed  Google Scholar 

  27. Ideguchi H, Ohno S, Hattori H et al (2006) Bone erosions in rheumatoid arthritis can be repaired through reduction in disease activity with conventional disease-modifying antirheumatic drugs. Arthritis Res Ther 8:R76

    Article  PubMed  Google Scholar 

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The authors declare that they have no conflict of interest.

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Authors and Affiliations

  1. Rheumatology Research Department, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences (SBUMC), South Kargar Street, 13336-31151, Tehran, Iran

    Arman Ahmadzadeh, Alireza Rajaee, Mohammadmehdi Emam & Katayoun Enteshari

  2. Radiology Department, Taleghani Hospital, Shaheed Beheshti University of Medical Sciences (SBMUC), Tehran, Iran

    Pooneh Dehghan

  3. Infection Disease Department, Loghman Hakim Hospital, Shaheed Beheshti University of Medical Sciences (SBUMC), Tehran, Iran

    Latif Gachkar

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  1. Arman Ahmadzadeh
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  2. Pooneh Dehghan
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  3. Alireza Rajaee
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  4. Mohammadmehdi Emam
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  5. Katayoun Enteshari
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  6. Latif Gachkar
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Correspondence to Arman Ahmadzadeh.

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Ahmadzadeh, A., Dehghan, P., Rajaee, A. et al. Assessing rheumatologists and radiologists agreement rate regarding the diagnosis of focal bone erosions and osteopenic changes using hand X-rays radiography in patients with rheumatoid arthritis. Rheumatol Int 33, 2019–2023 (2013). https://doi.org/10.1007/s00296-012-2645-4

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  • DOI: https://doi.org/10.1007/s00296-012-2645-4

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