Determination of the minimal clinically important difference in rheumatoid arthritis joint damage of the Sharp/van der Heijde and Larsen/Scott scoring methods by clinical experts and comparison with the smallest detectable difference
Determination of the minimal clinically important difference in rheumatoid arthritis joint damage of the Sharp/van der Heijde and Larsen/Scott scoring methods by clinical experts and comparison with the smallest detectable difference
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DOI：
10.1002/art.10190
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发表时间：
2002-04-01
影响因子：
--
通讯作者：
van der Linden, S
中科院分区：
文献类型：
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作者：
Bruynesteyn, K;van der Heijde, D;van der Linden, S
Objective.评估早期类风湿性关节炎（RA）患者手足X线片关节损伤的最小临床重要差异（MCID），采用Sharp/货车der Heijde和Larsen/Scott方法评估，并研究每种方法的最小可检测差异（SDD）与MCID的关系。国际专家小组对关节损伤进展的临床相关性的判断，如在4种临床环境（早期与晚期RA和轻度与高度疾病活动性）中以1年间隔获得的X线片集上所见，被用作外部标准，并与通过2种评分方法确定的进展评分进行比较。具有最高检测临床相关进展的联合灵敏度和特异性的进展评分代表MCID。以SDD作为相关进展的阈值，比较各评分方法的敏感性和特异性，并与MCID的敏感性和特异性进行比较。专家组将Sharp/货车der Heijde方法的SDD水平（5.0）附近的关节损伤变化判定为最小临床重要性，当使用SDD作为阈值时，在4种临床环境中检测临床重要进展的灵敏度（平均79%）和特异性（平均84%）令人满意。Larsen/Scott法的MCID（平均2.3）远小于SDD（平均5.8），因此以SDD为阈值检测临床重要进展的敏感性较低（平均51%），特异性较高（平均99%）。本研究表明，Sharp/货车der Heijde方法的SDD可用作MCID，即，作为个体响应标准的阈值水平。然而，Larsen/Scott方法的SDD被证明太不敏感，不能用作个体临床相关变化的阈值。
Objective. To assess the minimal clinically important difference (MCID) in joint damage on hand and foot radiographs of patients with early rheumatoid arthritis (RA) as assessed with the Sharp/van der Heijde and Larsen/Scott methods, and to study how the smallest detectable difference (SDD) relates to the MCID for each method.Methods. The judgments of an international panel of experts on the clinical relevance of progression of joint damage as seen on sets of radiographs obtained at 1-year intervals in 4 clinical settings (early versus late RA and mild versus high disease activity) were used as the external criterion, which was compared with the progression scores as determined by the 2 scoring methods. Progression scores with the highest combined sensitivity and specificity for detecting clinically relevant progression represented the MCID. Subsequently, the sensitivity and specificity of the scoring methods were determined when using the SDD as the threshold for relevant progression, and these were compared with the sensitivity and specificity of the MCID.Results. The panel judged changes in joint damage around the level of the SDD (5.0) of the Sharp/van der Heijde method as minimal clinically important, resulting in satisfactory sensitivity (mean 79%) and specificity (mean 84%) for detecting clinically important progression in the 4 clinical settings when using the SDD as the threshold value. The MCID (mean 2.3) of the Larsen/Scott method was much smaller than its SDD (5.8), and the sensitivity for detecting clinically important progression by applying the SDD as threshold was consequently low (mean 51%), accompanied by high specificity (mean 99%).Conclusion. This study suggests that the SDD of the Sharp/van der Heijde method can be used as the MCID, i.e., as the threshold level for individual response criteria. The SDD of the Larsen/Scott method, however, turned out to be too insensitive to use as the threshold for individual clinically relevant change.