Concise report Bijsterbosch J, Haugen IK, Malines C, et al. Ann Rheum Dis (2011). doi:10.1136/ard.2010.143479 1 of 3 Accepted 30 March 2011 ABSTRACT Objective To compare the reliability, sensitivity to change and feasibility of three radiographic scoring methods for hand osteoarthritis (OA). Methods Baseline, 2-year and 6-year hand radiographs of 90 patients with hand OA were read in triplicate in chronological order by three readers from different European centres using the OARSI atlas (OARSI), Kellgren–Lawrence grading scale (KL) and Verbruggen– Veys anatomical phase score (VV). Reliability was determined using intraclass correlation coefficients and smallest detectable change (SDC). Sensitivity to change was assessed by the proportion of progression above the SDC. Feasibility was reflected by the mean performance time. Results Intra- and inter-reader reliability was similar across methods. Inter-reader SDCs (% maximum score) for KL, OARSI and VV were 2.9 (3.2), 4.1 (2.9) and 2.7 (1.8) over 2 years and 3.8 (4.1), 4.6 (3.3) and 4.0 (2.5) over 6 years, respectively. KL detected a slightly higher proportion of progression. There were differences between readers, despite methods to enhance consistency. The mean performance time (SD, minutes) for KL, OARSI and VV was 4.3 (2.5), 9.3 (6.0) and 2.8 (1.5), respectively. Conclusion Methods had comparable reliability and sensitivity to change. Global methods were fastest to perform. For multicentre trials use of a central reading centre and multiple readers may minimise inter-reader variation. INTRODUCTION Despite the high prevalence and health impact of hand osteoarthritis (OA), no structure-modifying treatments exist. 1 2 The development of these treatments implies the need for reliable and sensi- tive outcome measures. 3 Structural damage is con- sidered a primary outcome, with serial radiographs as recommended outcome measure. Various radio- graphic scoring methods exist to assess severity and progression of structural damage. 4–10 They differ with respect to the number of hand joints scored, the use of a global score as opposed to grading of individual radiographic features, the radiographic features scored and the grading of features. There is no consensus on the preferred method, but owing to these differences the choice of method may depend on the study objective. Only one previous study has compared scor- ing methods for hand OA, which was over a relatively short period of 1 year. 11 In order to gain further insight into the clinimetric properties of available scoring methods, we assessed the reliability, sensitivity to change and feasibility of three radiographic scoring methods for the assess- ment of hand OA over a period of 2 and 6 years. PATIENTS AND METHODS Study design and patient population Patients were participants of the Genetics ARthrosis and Progression study comprising 192 Caucasian sib pairs with symptomatic OA at multiple sites in the hand or in at least two of the following sites: hand, knee, hip or spine. Patients were evaluated at baseline and some of them after 2 and 6 years. Details on the recruitment and selection have been published elsewhere. 12 The study was approved by the medical ethics committee. Patients were eligible for this study if they had hand OA defined by the American College of Rheumatology criteria for clinical hand OA 13 or if structural abnormalities were present and if base- line, 2-year and 6-year radiographs were avail- able. From this group a sample of 90 patients was included to ensure variability in baseline and pro- gression scores based on a previous study. 14 See supplementary online appendix 1 for more infor- mation on inclusion and sampling. Radiographs and scoring methods Standardised hand radiographs (dorsal-volar) were obtained at baseline and follow-up by a single radiographer. With the Kellgren–Lawrence grading scale (KL), 6 10 a global score, the distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints, interphalan- geal thumb (IP-1) joints, metacarpal (MCP) joints and first carpometacarpal (CMC-1) were graded 0–4 as described in the atlas (0=no OA; 1=doubtful OA; 2=definite minimal OA; 3=moderate OA; 4=severe OA). Total scores range from 0 to 120. Using the OARSI atlas (OARSI) 4 individual radiographic features were graded. Osteophytes (0–3), joint space narrowing (JSN) (0–3), subchon- dral erosions (0–1), sclerosis (0–1) and malalign- ment (0–1) were assessed in the DIP, PIP, IP-1 and CMC-1 joints. Pseudowidening (0–1) was assessed in the DIP joints and cysts (0–1) were assessed in the PIP and CMC-1 joints. Total scores range from 0 to 198. The Verbruggen–Veys anatomical phase score (VV) 9 comprises five phases with a numeri- cal value representing the evolution of hand Additional data are ▶ published online only. To view these files please visit the journal online at (http://ard.bmj. com). 1 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands 2 Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway 3 Department of Rheumatology, Pierre & Marie Curie University, AP-HP Hospital Saint-Antoine, Paris, France 4 Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands 5 Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands Correspondence to Jessica Bijsterbosch, Department of Rheumatology, Leiden University Medical Center, C1-R, PO Box 9600, 2300 RC Leiden, The Netherlands; J.Bijsterbosch@lumc.nl Reliability, sensitivity to change and feasibility of three radiographic scoring methods for hand osteoarthritis J Bijsterbosch, 1 I K Haugen, 2 C Malines, 3 E Maheu, 3 F R Rosendaal, 4 I Watt, 5 F Berenbaum, 3 T K Kvien, 2 D M van der Heijde, 1,2 T W J Huizinga, 1 M Kloppenburg 1 ARD Online First, published on May 10, 2011 as 10.1136/ard.2010.143479 Copyright Article author (or their employer) 2011. 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