Study: Rheumatologists, patients disagree about digital ulcer grading

Added clinical context did not significantly improve overall intrarater and interrater reliability of digital ulcer grading, according to the results of a recently published study.

Patients with systemic sclerosis (SSc) often develop digital ulcers, which cause much of the pain and disability linked to the disease, the authors wrote. Furthermore, digital ulcers are typically the primary outcome measure in SSc clinical trials.

The researchers prospectively collected 80 clinical images of a range of digital ulcers from 36 patients with SSc-related disorders. They selected images that represented a range of lesions in patients with SSc. In addition, they collected clinical context information, such as pain (severity and temporal relationship), lesion duration and discharge (patient reported and clinician observed).

Fifty-one rheumatologists agreed to rate the images, 26 rheumatologists without context and 25 with context. Using a custom-built, secure web-based interface, the raters graded the images on an ordinal scale of severity: no ulcer, inactive ulcer or active ulcer. Patients used the same scale to grade their lesions.

Clinical context had no significant effect on reliability, the authors wrote. Overall, intrarater reliability was high, but there was no significant difference with or without context. For raters with context, the overall weighted kappa coefficient was 0.71; for those without it was 0.64.

Analysis showed that pain and discharge were linked to greater lesion severity, whereas lesion duration was linked to reduced severity. Regardless of context, patients and rheumatologists frequently disagreed on digital ulcer grading. - by Colleen Owens

Disclosure: The researchers report no relevant financial disclosures.

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Source:

Hughes M, et al. Arthritis Care Res (Hoboken). 2016;doi:10.1002/acr.22833.