Validation of a novel radiographic scoring system for calcinosis affecting the hands of patients with systemic sclerosis

Lorinda Chung, Antonia Valenzuela, David Fiorentino, Kathryn Stevens, Shufeng Li, Jonathan Harris, Charles Hutchinson, Shervin Assassi, Lorenzo Beretta, Santhanam Lakshminarayanan, Tatiana S. Rodriguez-Reyna, Christopher P. Denton, Rebecca G. Taillefer, Ariane L. Herrick, Murray Baron

Research output: Contribution to journalArticle

Abstract

Objective. There are currently no validated outcome measures to assess calcinosis severity in systemic sclerosis (SSc; scleroderma). We sought to develop and validate a novel radiographic scoring system for calcinosis affecting the hands of SSc patients for potential use in future clinical trials. Methods. Following a 1-hour teleconference training session, 12 investigators (8 rheumatologists, 1 dermatologist, and 3 radiologists) scored 12 hand radiographs in random order using 2 scoring systems (termed "simple" and "complex") and re-scored 2 randomly assigned radiographs after a minimum of 24 hours. Interrater and intrarater reliability were assessed using a weighted kappa coefficient for the simple system (κ), and an intraclass correlation coefficient (ICC) for the complex system (ICC 0.7 for excellent). Results. Mean time to complete the complex scoring system was significantly longer than the simple scoring system (4.0 versus 0.4 minutes; P <0.0001). Overall interrater reliability for the simple scoring system was poor (κ = 0.39, 95% confidence interval [95% CI] 0.1-0.52) but improved if dichotomized as mild/moderate versus severe (κ = 0.51, 95% CI 0.26-0.7). Interrater reliability was excellent for the complex scoring system (ICC 0.89, 95% CI 0.86-0.92). Intrarater reliability was moderate for the simple scoring system (κ = 0.67, 95% CI 0.37-0.96) but almost perfect for the complex scoring system (ICC 0.93, 95% CI 0.89-0.97). Conclusion. We developed a novel radiographic scoring system that accounts for the area coverage, density, and anatomic location of calcinosis affecting the hands in patients with SSc. This scoring system is feasible with excellent reliability and should undergo further validation testing for use in clinical trials.

Original languageEnglish
Pages (from-to)425-430
Number of pages6
JournalArthritis Care and Research
Volume67
Issue number3
DOIs
Publication statusPublished - Mar 1 2015

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Calcinosis
Systemic Scleroderma
Hand
Confidence Intervals
Clinical Trials
Telecommunications
Research Personnel
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Rheumatology
  • Medicine(all)

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Validation of a novel radiographic scoring system for calcinosis affecting the hands of patients with systemic sclerosis. / Chung, Lorinda; Valenzuela, Antonia; Fiorentino, David; Stevens, Kathryn; Li, Shufeng; Harris, Jonathan; Hutchinson, Charles; Assassi, Shervin; Beretta, Lorenzo; Lakshminarayanan, Santhanam; Rodriguez-Reyna, Tatiana S.; Denton, Christopher P.; Taillefer, Rebecca G.; Herrick, Ariane L.; Baron, Murray.

In: Arthritis Care and Research, Vol. 67, No. 3, 01.03.2015, p. 425-430.

Research output: Contribution to journalArticle

Chung, L, Valenzuela, A, Fiorentino, D, Stevens, K, Li, S, Harris, J, Hutchinson, C, Assassi, S, Beretta, L, Lakshminarayanan, S, Rodriguez-Reyna, TS, Denton, CP, Taillefer, RG, Herrick, AL & Baron, M 2015, 'Validation of a novel radiographic scoring system for calcinosis affecting the hands of patients with systemic sclerosis', Arthritis Care and Research, vol. 67, no. 3, pp. 425-430. https://doi.org/10.1002/acr.22434
Chung, Lorinda ; Valenzuela, Antonia ; Fiorentino, David ; Stevens, Kathryn ; Li, Shufeng ; Harris, Jonathan ; Hutchinson, Charles ; Assassi, Shervin ; Beretta, Lorenzo ; Lakshminarayanan, Santhanam ; Rodriguez-Reyna, Tatiana S. ; Denton, Christopher P. ; Taillefer, Rebecca G. ; Herrick, Ariane L. ; Baron, Murray. / Validation of a novel radiographic scoring system for calcinosis affecting the hands of patients with systemic sclerosis. In: Arthritis Care and Research. 2015 ; Vol. 67, No. 3. pp. 425-430.
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AU - Valenzuela, Antonia

AU - Fiorentino, David

AU - Stevens, Kathryn

AU - Li, Shufeng

AU - Harris, Jonathan

AU - Hutchinson, Charles

AU - Assassi, Shervin

AU - Beretta, Lorenzo

AU - Lakshminarayanan, Santhanam

AU - Rodriguez-Reyna, Tatiana S.

AU - Denton, Christopher P.

AU - Taillefer, Rebecca G.

AU - Herrick, Ariane L.

AU - Baron, Murray

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N2 - Objective. There are currently no validated outcome measures to assess calcinosis severity in systemic sclerosis (SSc; scleroderma). We sought to develop and validate a novel radiographic scoring system for calcinosis affecting the hands of SSc patients for potential use in future clinical trials. Methods. Following a 1-hour teleconference training session, 12 investigators (8 rheumatologists, 1 dermatologist, and 3 radiologists) scored 12 hand radiographs in random order using 2 scoring systems (termed "simple" and "complex") and re-scored 2 randomly assigned radiographs after a minimum of 24 hours. Interrater and intrarater reliability were assessed using a weighted kappa coefficient for the simple system (κ), and an intraclass correlation coefficient (ICC) for the complex system (ICC 0.7 for excellent). Results. Mean time to complete the complex scoring system was significantly longer than the simple scoring system (4.0 versus 0.4 minutes; P <0.0001). Overall interrater reliability for the simple scoring system was poor (κ = 0.39, 95% confidence interval [95% CI] 0.1-0.52) but improved if dichotomized as mild/moderate versus severe (κ = 0.51, 95% CI 0.26-0.7). Interrater reliability was excellent for the complex scoring system (ICC 0.89, 95% CI 0.86-0.92). Intrarater reliability was moderate for the simple scoring system (κ = 0.67, 95% CI 0.37-0.96) but almost perfect for the complex scoring system (ICC 0.93, 95% CI 0.89-0.97). Conclusion. We developed a novel radiographic scoring system that accounts for the area coverage, density, and anatomic location of calcinosis affecting the hands in patients with SSc. This scoring system is feasible with excellent reliability and should undergo further validation testing for use in clinical trials.

AB - Objective. There are currently no validated outcome measures to assess calcinosis severity in systemic sclerosis (SSc; scleroderma). We sought to develop and validate a novel radiographic scoring system for calcinosis affecting the hands of SSc patients for potential use in future clinical trials. Methods. Following a 1-hour teleconference training session, 12 investigators (8 rheumatologists, 1 dermatologist, and 3 radiologists) scored 12 hand radiographs in random order using 2 scoring systems (termed "simple" and "complex") and re-scored 2 randomly assigned radiographs after a minimum of 24 hours. Interrater and intrarater reliability were assessed using a weighted kappa coefficient for the simple system (κ), and an intraclass correlation coefficient (ICC) for the complex system (ICC 0.7 for excellent). Results. Mean time to complete the complex scoring system was significantly longer than the simple scoring system (4.0 versus 0.4 minutes; P <0.0001). Overall interrater reliability for the simple scoring system was poor (κ = 0.39, 95% confidence interval [95% CI] 0.1-0.52) but improved if dichotomized as mild/moderate versus severe (κ = 0.51, 95% CI 0.26-0.7). Interrater reliability was excellent for the complex scoring system (ICC 0.89, 95% CI 0.86-0.92). Intrarater reliability was moderate for the simple scoring system (κ = 0.67, 95% CI 0.37-0.96) but almost perfect for the complex scoring system (ICC 0.93, 95% CI 0.89-0.97). Conclusion. We developed a novel radiographic scoring system that accounts for the area coverage, density, and anatomic location of calcinosis affecting the hands in patients with SSc. This scoring system is feasible with excellent reliability and should undergo further validation testing for use in clinical trials.

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