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Prevention or Retardation of Joint Damage in Rheumatoid Arthritis

Issues of Definition, Evaluation and Interpretation of Plain Radiographs

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Abstract

This article discusses methodological concepts and challenges underlying the interpretation of changes in plain radiographs of the joints of patients with rheumatoid arthritis. A series of consensus conferences (OMERACT [Outcome Measures in Rheumatology]) has resulted in the formulation and execution of a research agenda to harmonise reading and interpretation of films. This is important in the light of the increasing evidence that drugs can impact on the progression of joint damage.

In these conferences, methodological issues have been divided according to applicability tenets summarised in the OMERACT Filter of Truth, Discrimination, and Feasibility. To pass the Filter, a measure must measure what it is supposed to measure (Truth), must discriminate between clinically relevant states (Discrimination) and be feasible in terms of costs and interpretability. ‘Truth’ issues include the choice of joints, the view and other technical specifications of the radiograph, such as which abnormalities to score, the level of aggregation of the information, culminating in the choice of the scoring system. ‘Discrimination’ issues include reproducibility and sensitivity to change. The current research agenda includes items such as defining a criterion for ‘no relevant progression’, comparison between time ordered and randomly ordered reading, further comparison of methods and subscores, and methodology around missing values.

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References

  1. Fries JF, Spitz P, Kraines RG, et al. Measurement of patient outcome in arthritis. Arthritis Rheum 1980; 23: 137–45

    Article  PubMed  CAS  Google Scholar 

  2. Fries JF. The hierarchy of outcome assessment. J Rheumatol 1993; 20: 546–7

    PubMed  CAS  Google Scholar 

  3. Boers M. Validity of radiography as outcome measure in rheumatoid arthritis. J Rheumatol 1995; 22: 1783–6

    PubMed  CAS  Google Scholar 

  4. Kirwan JR. Conceptual issues in scoring radiographic progression in rheumatoid arthritis. J Rheumatol 1999; 26: 720–5

    PubMed  CAS  Google Scholar 

  5. Boers M. Value of magnetic resonance imaging in rheumatoid arthritis? Lancet 2000; 356: 1458–9

    Article  PubMed  CAS  Google Scholar 

  6. Lassere M, Bird P. Measurement of RA disease activity & damage using MRI. Truth and discrimination: Does MRI make the grade? J Rheumatol 2001; 28: 1151–7

    CAS  Google Scholar 

  7. Boers M, Brooks P, Strand V, et al. The OMERACT Filter for outcome measures in rheumatology. J Rheumatol 1998; 25: 198–9

    PubMed  CAS  Google Scholar 

  8. Boers M, Tugwell P, Felson DT, et al. World Health Organization and International League of Associations for Rheumatology core endpoints for symptom modifying antirheumatic drugs in rheumatoid arthritis clinical trials. J Rheumatol Suppl. 1994; 41: 86–9

    PubMed  CAS  Google Scholar 

  9. Molenaar ET, Boers M, van der Heijde DM, et al. Imaging in rheumatoid arthritis: results of group discussions. J Rheumatol 1999; 26: 749–51

    PubMed  CAS  Google Scholar 

  10. Van der Heijde DM. How to report radiographic data in randomized clinical trials in rheumatoid arthritis?. Guidelines from a roundtable discussion. Arthritis Rheum 2002. In press

  11. Van der Heijde D, Lassere M, Edmonds J, et al. Minimal clinically important difference in plain films in RA: group discussions, conclusions, and recommendations. OMERACT Imaging Task Force. J Rheumatol 2001; 28: 914–7

    Google Scholar 

  12. Van der Heijde D, Boers M, Lassere M. Methodological issues in radiographic scoring methods in rheumatoid arthritis. J Rheumatol 1999; 26: 726–30

    PubMed  Google Scholar 

  13. Van der Heijde DM. Plain X-rays in rheumatoid arthritis: overview of scoring methods, their reliability and applicability. Ballieres Clin Rheumatol 1996; 10: 435–53

    Article  Google Scholar 

  14. Drossaers-Bakker KW, Kroon HM, Zwinderman AH, et al. Radiographic damage of large joints in long-term rheumatoid arthritis and its relation to function. Rheumatology 2000; 39: 998–1003

    Article  PubMed  CAS  Google Scholar 

  15. Sharp JT, Lidsky MD, Collins LC, et al. Methods of scoring the progression of radiologic changes in rheumatoid arthritis: correlation of radiologic, clinical and laboratory abnormalities. Arthritis Rheum 1971; 14: 706–20

    Article  PubMed  CAS  Google Scholar 

  16. Sharp JT, Young DY, Bluhm GB, et al. How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis? Arthritis Rheum 1985; 28: 1326–35

    Article  PubMed  CAS  Google Scholar 

  17. van der Heijde DM, van Riel PL, Nuver-Zwart IH, et al. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet 1989; 1: 1036–8

    Article  PubMed  Google Scholar 

  18. Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn 1977; 18: 481–91

    CAS  Google Scholar 

  19. Scott DL, Houssien DA, Laasonen L. Proposed modification to Larsen’s scoring methods for hand and wrist radiographs. Br J Rheumatol 1995; 34: 56

    Article  PubMed  CAS  Google Scholar 

  20. Rau R, Herborn G. A modified version of Larsen’s scoring method to assess radiologic changes in rheumatoid arthritis. J Rheumatol 1995; 22: 1976–82

    PubMed  CAS  Google Scholar 

  21. Bland JM, Altman DG. Statistical methods for assessing agreement between two methods of clinical measurement. Lancet 1986; 1: 307–10

    Article  PubMed  CAS  Google Scholar 

  22. Lassere M, Boers M, van der Heijde D, et al. Smallest detectable difference in radiological progression. J Rheumatol 1999; 26: 731–9

    PubMed  CAS  Google Scholar 

  23. Fries JF, Bloch DA, Sharp JT, et al. Assessment of radiologic progression in rheumatoid arthritis: a randomized, controlled trial. Arthritis Rheum 1986; 29: 1–9

    Article  PubMed  CAS  Google Scholar 

  24. Ferrara R, Priolo F, Cammisa M, et al. Clinical trials in rheumatoid arthritis: methodological suggestions for assessing radiographs arising from the GRISAR Study. Gruppo Reumatologi Italiani Studio Artrite Reumatoide. Ann Rheum Dis 1997; 56: 608–12

    CAS  Google Scholar 

  25. Salaffi F, Carotti M. Interobserver variation in quantitative analysis of hand radiographs in rheumatoid arthritis: comparison of 3 different reading procedures. J Rheumatol 1997; 24: 2055–6

    PubMed  CAS  Google Scholar 

  26. Bruynesteyn K, van der Heijde D, Boers M, et al. Minimal clinically important difference in radiological progression of joint damage over 1 year in rheumatoid arthritis: preliminary results of a validation study with clinical experts. J Rheumatol 2001; 28: 904–10

    PubMed  CAS  Google Scholar 

  27. Felson DT, Anderson J, Boers M, et al. American College of Rheumatology preliminary criteria for improvement in rheumatoid arthritis patients. Arthritis Rheum 1995; 38: 727–35

    Article  PubMed  CAS  Google Scholar 

  28. Boers M, Verhoeven AC, Markusse HM, et al. Randomised comparison of combined step-down prednisolone, methotrexate and sulphasalazine with sulphasalazine alone in early rheumatoid arthritis. Lancet 1997; 350: 309–18

    Article  PubMed  CAS  Google Scholar 

  29. Lipsky PE, van der Heijde DM, St Clair EW, et al. Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 2000; 343: 1594–602

    Article  PubMed  CAS  Google Scholar 

  30. Strand V, Lassere M, van der Heijde D, et al. Recent rheumatoid arthritis clinical trials using radiographic endpoints—updated research agenda. J Rheumatol 2001; 28: 887–9

    PubMed  CAS  Google Scholar 

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Acknowledgements

No sources of funding were used to assist in the preparation of this manuscript; and the authors have no potential conflicts of interest that are directly relevant to the contents of this manuscript.

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Authors and Affiliations

  1. Department of Clinical Epidemiology & Biostatistics, VU University Medical Center, PO Box 7057, Amsterdam, 1007MB, The Netherlands

    Maarten Boers

  2. University of Maastricht, Maastricht, The Netherlands

    Désirée M. F. M. van der Heijde

  3. Limburg University Centre, Diepenbeek, Belgium

    Désirée M. F. M. van der Heijde

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  1. Maarten Boers
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  2. Désirée M. F. M. van der Heijde
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Correspondence to Maarten Boers.

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Boers, M., van der Heijde, D.M.F.M. Prevention or Retardation of Joint Damage in Rheumatoid Arthritis. Drugs 62, 1717–1724 (2002). https://doi.org/10.2165/00003495-200262120-00002

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