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Spondyloarthritis Research Consortium of Canada sacroiliac joint inflammation and structural scores: change score reliability and recalibration utility in children

  • Weiss, Pamela F.1, 2
  • Maksymowych, Walter P.3
  • Xiao, Rui1
  • Biko, David M.1
  • Francavilla, Michael L.1
  • Lambert, Robert G.4
  • Jaremko, Jacob L.4
  • Heshin-Bekenstein, Merav5
  • Brandon, Timothy G.6
  • Chauvin, Nancy A.7
  • 1 Perelman School of Medicine at the University of Pennsylvania, Philadelphia, USA , Philadelphia (United States)
  • 2 The Children’s Hospital of Philadelphia, Roberts Center for Pediatric Research, 2716 South Street, Room 11121, Philadelphia, PA, 19104, USA , Philadelphia (United States)
  • 3 Department of Medicine at the University of Alberta and CaRE Arthritis, Edmonton, Canada , Edmonton (Canada)
  • 4 Department of Radiology and Diagnostic Imaging at the University of Alberta, Edmonton, Canada , Edmonton (Canada)
  • 5 Tel Aviv University, Tel Aviv, Israel , Tel Aviv (Israel)
  • 6 Division of Rheumatology and Center for Pediatric Clinical Effectiveness at the Children’s Hospital of Philadelphia, Department of Pediatrics, Philadelphia, USA , Philadelphia (United States)
  • 7 Department of Radiology at Penn State Health Milton S. Hershey Children’s Hospital, Hershey, PA, USA , Hershey (United States)
Published Article
Arthritis Research & Therapy
BioMed Central
Publication Date
Mar 24, 2020
DOI: 10.1186/s13075-020-02157-4
Springer Nature


BackgroundThe SPARCC sacroiliac joint inflammation (SIS) and structural (SSS) scores are reliable measures to quantify abnormalities in the pediatric sacroiliac joint. We aimed to evaluate the utility of online calibration modules for the SIS and SSS and the reliability of their component change scores.MethodsChange score reliability of 6 raters was assessed by overall and pairwise intraclass correlation coefficients (ICCs) before and after the use of real-time iterative calibration (RETIC) modules for both the SIS and SSS comprised of 20 adult cases. Acceptable ICC for change scores was > 0.7 for SIS and > 0.5 for all SSS components. Sensitivity to change was assessed by the standardized response mean (SRM).ResultsIn scoring exercise 1, the SIS had acceptable reliability with a change score ICC of 0.80 and sclerosis was the only SSS lesion that met the acceptability threshold with a change score ICC of 0.52. After RETIC calibration, the SIS overall (ICC = 0.83) and mean pairwise (ICC = 0.83) change scores remained reliable with a large SRM (0.90). All SSS components except sclerosis met the overall and mean pairwise change score ICC acceptability thresholds—backfill: overall = 0.54, mean pairwise = 0.50; fat metaplasia: overall = 0.65, mean pairwise = 0.57; erosion: overall = 0.60, mean pairwise = 0.58; and ankylosis: overall = 0.96, mean pairwise = 0.96. The SSS RETIC module augmented the number of SSS components surpassing the acceptability threshold from 1 to 4. Sensitivity to change, as measured by the SRM, was large for erosion (0.96), moderate for backfill (0.55) and sclerosis (0.70), and small for fat metaplasia (0.36) and ankylosis (0.28).ConclusionRETIC modules improved the overall reliability of SPARCC SIS and SSS change scores for previously calibrated raters. SIS recalibration was not as helpful to the most experienced raters who achieved high levels of agreement before recalibration. The SPARCC SIS and all SSS components except sclerosis are reliable measures to quantify change over time in children. A pediatric-specific RETIC tool should be developed to enhance the calibration of readers.

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