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J Rheumatol. 2017 Jan;44(1):70-77. doi: 10.3899/jrheum.160079. Epub 2016 Oct 15.

Limited Reliability of Radiographic Assessment of Sacroiliac Joints in Patients with Suspected Early Spondyloarthritis.

Author information

1
From the King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Hospital of Southern Jutland, Aabenraa; Institute of Regional Health Research, University of Southern Denmark, Odense; Department of Radiology, and Department of Rheumatology, Aarhus University Hospital, Aarhus; Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart, Middelfart; Department of Internal Medicine, Hospital Lillebaelt Vejle, Vejle; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rufibach rePROstat, Biostatistical Consulting and Training, Basel, Switzerland. achristiansen@gigtforeningen.dk.
2
A.A. Christiansen, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; O. Hendricks, MD, PhD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; D. Kuettel, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; K. Hørslev-Petersen, MD, DMSc, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; A.G. Jurik, MD, DMSc, Institute of Regional Health Research, University of Southern Denmark, and Department of Radiology, Aarhus University Hospital, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; S. Nielsen, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; K. Rufibach, PhD, Rufibach rePROstat, Biostatistical Consulting and Training; A.G. Loft, MD, DMSc, Department of Internal Medicine, Hospital Lillebaelt Vejle, and Department of Rheumatology, Aarhus University Hospital; S.J. Pedersen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, and Department of Clinical Medicine, University of Copenhagen; L.T. Hermansen, MSc, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; M. Østergaard, MD, PhD, DMSc, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, and Department of Clinical Medicine, University of Copenhagen; B. Arnbak, MSc, PhD, Institute of Regional Health Research, University of Southern Denmark, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; C. Manniche, MD, DMSc, Institute of Regional Health Research, University of Southern Denmark, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark. achristiansen@gigtforeningen.dk.
3
From the King Christian 10th Hospital for Rheumatic Diseases, Gråsten; Hospital of Southern Jutland, Aabenraa; Institute of Regional Health Research, University of Southern Denmark, Odense; Department of Radiology, and Department of Rheumatology, Aarhus University Hospital, Aarhus; Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart, Middelfart; Department of Internal Medicine, Hospital Lillebaelt Vejle, Vejle; Copenhagen Center for Arthritis Research (COPECARE), Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, Glostrup; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark; Rufibach rePROstat, Biostatistical Consulting and Training, Basel, Switzerland.
4
A.A. Christiansen, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; O. Hendricks, MD, PhD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; D. Kuettel, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; K. Hørslev-Petersen, MD, DMSc, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark; A.G. Jurik, MD, DMSc, Institute of Regional Health Research, University of Southern Denmark, and Department of Radiology, Aarhus University Hospital, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; S. Nielsen, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; K. Rufibach, PhD, Rufibach rePROstat, Biostatistical Consulting and Training; A.G. Loft, MD, DMSc, Department of Internal Medicine, Hospital Lillebaelt Vejle, and Department of Rheumatology, Aarhus University Hospital; S.J. Pedersen, MD, PhD, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, and Department of Clinical Medicine, University of Copenhagen; L.T. Hermansen, MSc, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland; M. Østergaard, MD, PhD, DMSc, COPECARE, Center for Rheumatology and Spine Diseases, Rigshospitalet - Glostrup, and Department of Clinical Medicine, University of Copenhagen; B. Arnbak, MSc, PhD, Institute of Regional Health Research, University of Southern Denmark, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; C. Manniche, MD, DMSc, Institute of Regional Health Research, University of Southern Denmark, and Research Department, Spine Centre of Southern Denmark, Hospital Lillebaelt Middelfart; U. Weber, MD, King Christian 10th Hospital for Rheumatic Diseases, and Hospital of Southern Jutland, and Institute of Regional Health Research, University of Southern Denmark.

Abstract

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.

KEYWORDS:

INTERREADER AGREEMENT; MODIFIED NEW YORK CRITERIA; RADIOGRAPHIC SACROILIITIS; SPONDYLOARTHRITIS

PMID:
27744397
DOI:
10.3899/jrheum.160079
[Indexed for MEDLINE]

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