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Extended report
Validation of a radiographic scoring system for haemochromatosis arthropathy
  1. Tomáš Dallos1,2,
  2. Enijad Sahinbegovic1,
  3. Elmar Aigner3,
  4. Roland Axmann1,
  5. Maximilian Schöniger-Hekele4,
  6. Thomas Karonitsch5,
  7. Tanja Stamm5,
  8. Martin Farkas6,
  9. Thomas Karger7,
  10. Alexander Cavallaro8,
  11. Ulrich Stölzel9,
  12. Gernot Keyßer10,
  13. Christian Datz3,
  14. Georg Schett1,
  15. Bernhard Manger1,
  16. Jochen Zwerina1
  1. 1Department of Internal Medicine 3, University of Erlangen-Nuremberg, Erlangen, Germany
  2. 22nd Department of Paediatrics, Comenius University in Bratislava, Bratislava, Slovakia
  3. 3Department of Internal Medicine, Hospital Oberndorf, Oberndorf, Austria
  4. 4Division of Gastroenterology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
  5. 5Division of Rheumatology, Department of Internal Medicine 3, Medical University of Vienna, Vienna, Austria
  6. 6Department of Internal Medicine, Hospital Wiener Neustadt, Wiener Neustadt, Austria
  7. 7Rheumapraxis Cologne, Cologne, Germany
  8. 8Radiology Department, University of Erlangen-Nuremberg, Erlangen, Germany
  9. 9Department of Internal Medicine II, Chemnitz Hopital, Chemnitz, Germany
  10. 10Department of Internal Medicine I, University of Halle-Wittenberg, Halle/Saale, Germany
  1. Correspondence to Dr Tomáš Dallos, 2nd Department of Paediatrics, Comenius University in Bratislava, Limbová 1, 833 40 Bratislava, Slovak Republic; dallos{at}


Background Arthropathy is one of the earliest and most common manifestations of hereditary haemochromatosis with a significant impact on quality of life. Although its radiographic features are well known, there is no assessment tool for their evaluation.

Objective To develop and validate a novel scoring system for the evaluation of radiographic features of haemochromatosis arthropathy.

Methods A dichotomous scoring system assessing four radiographic features of haemochromatosis arthropathy and a 4-grade scale reflecting severity of radiographic change have been developed. Standard radiographs (hand, wrist, knee and ankle) of 170 subjects (116 male, 54 female) with genetically confirmed haemochromatosis and laboratory signs of iron overload were assessed by three readers and construct validity, feasibility and cross-sectional reliability (intrareader and inter-reader) were assessed.

Results Intrareader and inter-reader reliability as assessed by percentage pairwise agreement and Cohen's weighed κ were good to excellent for most features and locations evaluated. Radiographic scores correlated well with clinical parameters (bony swollen joint count, hand function and physician's global health assessment; Pearson's correlation, r2=0.18–0.62, p<0.0001). A complete set of radiographs took 3.4±1.2 (mean±SD) min to be assessed. An atlas of characteristic radiographic features was compiled.

Conclusion A feasible and reliable radiological assessment tool for the evaluation of haemochromatosis arthropathy has been validated and an atlas of characteristic radiographic features provided.

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  • Funding (1) Articulum Fellowship Vienna Medical Academy Articulum Fellowship Alser Strasse 4 1090 Vienna Austria to TD; (2) ANCYLOSS programme, Bundesministerium für Bildung und Forschung, Dienstsitz Bonn Heinemannstr 2 53175 Bonn Germany; (3) Deutsche Gesellschaft für Rheumatologie e.V Geschäftsstelle Luisenstrasse 41 10117 Berlin Germany (grant to JZ)

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of the ethics committees of the participating institutions: University Hospital Vienna, University Hospital Erlangen.

  • Provenance and peer review Not commissioned; externally peer reviewed.