TY - JOUR
T1 - Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis
AU - Christiansen, Alice Ashouri
AU - Hendricks, Oliver
AU - Küttel, Dorota Paulina
AU - Hørslev-Petersen, Kim
AU - Jurik, Anne Grethe
AU - Nielsen, Steen
AU - Rufibach, Kaspar
AU - Loft, Anne Gitte
AU - Pedersen, Susanne Juhl
AU - Hermansen, Louise Thuesen
AU - Østergaard, Mikkel
AU - Arnbak, Bodil
AU - Manniche, Claus
AU - Weber, Ulrich
PY - 2017
Y1 - 2017
N2 - Objective. To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.Methods. The study sample consisted of 104 consecutive patients aged 18–40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27–positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.Results. Mean κ values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.Conclusion. Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA and low back pain.
AB - Objective. To determine the reproducibility of evaluation of sacroiliac joint (SIJ) radiographs among readers with varying levels of experience, and to identify potential drivers of disagreement in classification among 5 predefined radiographic lesion types.Methods. The study sample consisted of 104 consecutive patients aged 18–40 with low back pain ≥ 3 months of duration who met the Assessment of SpondyloArthritis international Society (ASAS) definition for a positive SIJ magnetic resonance image, or were HLA-B27–positive and had ≥ 1 spondyloarthritis (SpA)-related clinical/laboratory feature according to the ASAS classification criteria for axial SpA. Seven blinded readers (2 musculoskeletal radiologists, 5 rheumatologists) classified pelvic radiographs according to the modified New York criteria (mNY) and recorded presence/absence of 5 lesion types in both SIJ: erosion, sclerosis, ankylosis, joint space widening, and joint space narrowing. Reproducibility of mNY classification among 21 reader pairs was assessed and potential drivers of disagreement were identified among 5 lesion types. A generalized linear mixed logistic regression model served to analyze to what extent discordance in lesion type was associated with discrepant mNY classification.Results. Mean κ values (percent concordance) were 0.39 (84.1%) for mNY classification over 21 reader pairs, 0.46 (79.8%) between 2 musculoskeletal radiologists, and 0.55 (86.5%) and 0.36 (77.9%) between the most experienced rheumatologist and the 2 radiologists. Erosion showed the lowest agreement (25%) among patients with discordant classification and gave the highest OR of 13.5 for disagreement.Conclusion. Reproducibility of radiographic SIJ classification in an SpA inception cohort was only fair to at best moderate among 7 readers with varying levels of experience, questioning the applicability of mNY in early SpA and low back pain.
KW - SPONDYLOARTHRITISRADIOGRAPHIC SACROILIITISINTERREADER AGREEMENTMODIFIED NEW YORK CRITERIA LOW BACK PAIN
KW - Reproducibility of Results
KW - Sacroiliac Joint/diagnostic imaging
KW - Spondylarthritis/diagnostic imaging
KW - Humans
KW - Male
KW - Back Pain/diagnostic imaging
KW - Sacroiliitis/diagnostic imaging
KW - Disease Progression
KW - Young Adult
KW - Magnetic Resonance Imaging
KW - Adolescent
KW - Adult
KW - Female
U2 - 10.3899/jrheum.160079
DO - 10.3899/jrheum.160079
M3 - Journal article
C2 - 27744397
SN - 0315-162X
VL - 44
SP - 70
EP - 77
JO - The Journal of Rheumatology
JF - The Journal of Rheumatology
IS - 1
ER -