The Sharp/van der Heijde method out-performed the Larsen/Scott method on the individual patient level in assessing radiographs in early rheumatoid arthritis

J Clin Epidemiol. 2004 May;57(5):502-12. doi: 10.1016/j.jclinepi.2003.10.014.


Objective: To test the reliability of two radiologic scoring methods in rheumatoid arthritis (RA)--the Sharp/van der Heijde (SvH) and the Larsen/Scott (LS)--with generalizability analyses.

Study design and setting: Films of 51 patients representing the spectrum of early RA were read by two raters for each method. The discriminative ability and responsiveness were expressed as: intraclass correlation coefficients (ICCs), two types of smallest detectable difference (SDD), and two types of smallest detectable change (SDC); reflecting measurement error when discriminating between or detecting changes within (1) individuals or (2) groups. They were calculated for (average) scores of one to three raters.

Results: The discriminative capacity (0.85-0.97) and responsiveness (0.91-0.97) were good when expressed by ICC. On the group level the SDDs and SDCs ranged between 0.6-3.3% of the max. obtainable score. On the individual level, the scores showed better reliability measured with the SvH (SDDs 2.0-3.4%) than with the LS (SDDs 5.3-9.2%). The SvH also assessed changes in scores in individuals with less measurement error (SDCs 1.3-2.2%) than the LS (SDCs 2.3-3.9%).

Conclusion: For early RA patients, the SvH seems preferable if analyses on individual level are included.

Publication types

  • Comparative Study
  • Validation Study

MeSH terms

  • Analysis of Variance
  • Arthritis, Rheumatoid / diagnostic imaging*
  • Arthritis, Rheumatoid / drug therapy
  • Arthritis, Rheumatoid / pathology
  • Arthrography
  • Data Interpretation, Statistical
  • Disease Progression
  • Humans
  • Randomized Controlled Trials as Topic / methods
  • Reproducibility of Results
  • Severity of Illness Index*
  • Treatment Outcome