J Korean Med Sci.  2016 Mar;31(3):435-442. 10.3346/jkms.2016.31.3.435.

Simplified Radiographic Damage Index for Affected Joints in Chronic Gouty Arthritis

• Son CN
• Kim TE
• Park K
• Hwang JH
• Kim SK

• KMID: 2363506
• DOI: http://doi.org/10.3346/jkms.2016.31.3.435

Abstract

The aim of this study was to develop and validate a new radiographic damage scoring method (DAmagE index of GoUt; DAEGU) in chronic gout using plain radiography. Two independent observers scored foot x-rays from 15 patients with chronic gout according to the DAEGU method and the modified Sharp/van der Heijde (SvdH) method. The 10 metatarsophalangeal (MTP) and 2 interphalangeal (IP) joints of the first toes of both feet were scored to assess the degrees of erosion and joint space narrowing (JSN). The intraobserver and interobserver reliabilities were analyzed by calculating the intraclass correlation coefficient (ICC) and minimal detectable change (MDC). The correlation between the DAEGU and SvdH methods was analyzed by calculating the Spearman's rho correlation coefficients and Kappa coefficients. The DAEGU method was found to be highly reproducible (0.945-0.987 for the intraobserver and 0.993-0.996 for the interobserver ICC values). The erosion, JSN, and total scores exhibited strong positive correlations between the DAEGU and SvdH methods and also within each method (r = 0.860-0.969, P < 0.001 for all parameters). The DAEGU and SvdH methods were in very good agreement as determined by Kappa coefficient analysis [0.732 (0.387-1.000) for erosion and 1.000 (1.000-1.000) for JSN]. In conclusion, this study revealed that DAEGU method was a reliable and feasible tool in the assessment of radiographic damage in chronic gout. The DAEGU method may provide a more easy assessment of structural damage in chronic gout in the real clinical practice.

Keyword

Gout; Radiography; Bone Erosion; Reliability

MeSH Terms

Adult
Arthritis, Gouty/*diagnostic imaging/pathology
Chronic Disease
Female
Humans
Joints/*diagnostic imaging/pathology
Male
Middle Aged
Severity of Illness Index
*Tomography, X-Ray Computed

Figure

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  Fig. 1 Radiographic scores for each joint change by DAEGU method. (A) Bone erosion, (B) joint space narrowing, (C) individual examples at affected joints in chronic gout patients. Black areas at periarticular and intraarticular structures indicate bone erosion.

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  Fig. 2 Spearman's correlation analysis for median values of bone erosion and joint space narrowing calculated by two radiologists within and between SvdH and DAEGU scoring methods.

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