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Reliability and Sensitivity to change of the Simple Erosion Narrowing Score compared to the Sharp/van der Heijde method for scoring radiographs in rheumatoid arthritis
  1. E M Dias (esma.dias{at}
  1. University Hospital Maastricht, Netherlands
    1. C Lukas (cedriclukas{at}
    1. University Hospital Maastricht, Netherlands
      1. R B Landewé (rlan{at}
      1. University Hospital Maastricht, Netherlands
        1. D Fatenejad (fatenes{at}
        1. Wyeth Research, Collegeville, PA, United States
          1. D MFM van der Heijde (d.vanderheijde{at}
          1. Leiden University Medical Center, Netherlands


            Objective: To compare the performance of a simplified scoring method for structural damage on radiographs of patients with rheumatoid arthritis (RA) (the Simple Erosion Narrowing Score or SENS) with the Sharp-van der Heijde Score (SHS) as reference.

            Method: We used the radiographic data from the Trial of Etanercept and Methotrexate with Radiographic Patient Outcomes (TEMPO trial). The SENS was derived from the crude SHS data. Inter-observer reliability for status scores and change scores was determined by intra class correlation coefficients (ICC) and by the smallest detectable change (SDC) method. The ability to discriminate between treatment groups was assessed by the Mann-Whitney U test. Stratifying the sensitivity to change and discriminative ability for different levels of disease severity assessed a potential ceiling effect.

            Results: Inter-observer reliability was similar for both methods. ICCs were higher for status scores than for change scores. The SDC was 4.98 (1.1% of possible maximum score) for SHS and 2.28 (3.5%) for SENS. Sensitivity of SENS to detect progression above the SDC, with reference SHS, ranged from 45.0 to 88.7 %. Specificity ranged from 81.5 to 97.3 %, and the Kappa coefficient (between-method agreement) ranged from 0.58 to 0.66. Discriminative ability between treatment groups was good and similar for both methods. A ceiling effect could not be detected.

            Conclusions: With regard to most of the tested properties, the performance of SENS is as good as that of SHS. This confirms that SENS is a valuable method, which may be feasible in clinical practice.

            • radiographs
            • reliability
            • rheumatoid arthritis
            • scoring
            • simplification

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