Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis

Alice Ashouri Christiansen; Oliver Hendricks; Dorota Kuettel; Kim Hørslev-Petersen; Anne Grethe Jurik; Steen Nielsen; Kaspar Rufibach; Anne Gitte Loft; Susanne Juhl Pedersen; Louise Thuesen Hermansen; Mikkel Østergaard; Bodil Arnbak; Claus Manniche; Ulrich Weber

doi:10.3899/jrheum.160079

Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis

Alice Ashouri Christiansen^*, Oliver Hendricks, Dorota Kuettel, Kim Hørslev-Petersen, Anne Grethe Jurik, Steen Nielsen, Kaspar Rufibach, Anne Gitte Loft, Susanne Juhl Pedersen, Louise Thuesen Hermansen, Mikkel Østergaard, Bodil Arnbak, Claus Manniche, Ulrich Weber

^*Corresponding author for this work

Department of Clinical Medicine

27 Citations (Scopus)

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 k 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.

Original language	English
Journal	Journal of Rheumatology
Volume	44
Issue number	1
Pages (from-to)	70-77
Number of pages	8
ISSN	0315-162X
DOIs	https://doi.org/10.3899/jrheum.160079
Publication status	Published - Jan 2017

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Christiansen, A. A., Hendricks, O., Kuettel, D., Hørslev-Petersen, K., Jurik, A. G., Nielsen, S., Rufibach, K., Loft, A. G., Pedersen, S. J., Hermansen, L. T., Østergaard, M., Arnbak, B., Manniche, C., & Weber, U. (2017). Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis. Journal of Rheumatology, 44(1), 70-77. https://doi.org/10.3899/jrheum.160079

Christiansen, AA, Hendricks, O, Kuettel, D, Hørslev-Petersen, K, Jurik, AG, Nielsen, S, Rufibach, K, Loft, AG, Pedersen, SJ, Hermansen, LT, Østergaard, M, Arnbak, B, Manniche, C & Weber, U 2017, 'Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis', Journal of Rheumatology, vol. 44, no. 1, pp. 70-77. https://doi.org/10.3899/jrheum.160079

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title = "Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis",

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 k 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.",

author = "Christiansen, {Alice Ashouri} and Oliver Hendricks and Dorota Kuettel and Kim H{\o}rslev-Petersen and Jurik, {Anne Grethe} and Steen Nielsen and Kaspar Rufibach and Loft, {Anne Gitte} and Pedersen, {Susanne Juhl} and Hermansen, {Louise Thuesen} and Mikkel {\O}stergaard and Bodil Arnbak and Claus Manniche and Ulrich Weber",

year = "2017",

month = jan,

doi = "10.3899/jrheum.160079",

language = "English",

volume = "44",

pages = "70--77",

journal = "Journal of Rheumatology",

issn = "0315-162X",

publisher = "Journal of Rheumatology Publishing Co. Ltd.",

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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 - Kuettel, Dorota

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 - 2017/1

Y1 - 2017/1

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 k 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.

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 k 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.

U2 - 10.3899/jrheum.160079

DO - 10.3899/jrheum.160079

M3 - Journal article

C2 - 27744397

AN - SCOPUS:85008234771

SN - 0315-162X

VL - 44

SP - 70

EP - 77

JO - Journal of Rheumatology

JF - Journal of Rheumatology

IS - 1

ER -

Limited reliability of radiographic assessment of sacroiliac joints in patients with suspected early spondyloarthritis

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