title: Multireader assessment as an alternative to reference assessment to improve the detection of radiographic progression in a large longitudinal cohort of rheumatoid arthritis (ESPOIR).
abstract: BACKGROUND
  Structural damage progression is a major outcome in rheumatoid arthritis (RA). Its evaluation and follow-up in trials should involve radiographic scoring by 1 or 2 readers (reference assessment), which is challenging in large longitudinal cohorts with multiple assessments.
  
  
  OBJECTIVE
  To compare the reproducibility of multireader and reference assessment to improve the feasibility of detecting radiographic progression in a large cohort of patients with early arthritis (ESPOIR).
  
  
  METHODS
  We used 3 sessions to train 12 rheumatologists in radiographic scoring by the van der Heijde-modified Sharp score (SHS). Multireader scoring was based on 10 trained-reader assessments, each reader scoring a random sample of 1/5 of all available radiographs (for double scoring for each X-ray set) for patients included in the ESPOIR cohort with complete radiographic data at M0 and M60. Reference scoring was performed by 2 experienced readers. Scoring was performed blindly to clinical data, with radiographs in chronological order. We compared multireader and reference assessments by intraclass correlation coefficients (ICCs) for SHS and significant radiographic progression (SRP).
  
  
  RESULTS
  The intrareader and inter-reader reproducibility for trained assessors increased during the training sessions (ICC 0.79 to 0.94 and 0.76 to 0.92), respectively. For the 524 patients included, agreement between multireader and reference assessment of SHS progression between M0 and M60 and SRP assessment were almost perfect, ICC (0.88 (95% CI 0.82 to 0.93)) and (0.99 (95% CI 0.99 to 0.99)), respectively.
  
  
  CONCLUSIONS
  Multireader assessment of radiographic structural damage progression is comparable to reference assessment and could be used to improve the feasibility of radiographic scoring in large longitudinal cohort with numerous X-ray evaluations.
authors.affiliation: Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Frederique
authors.initials: F
authors.lastname: Gandjbakhch
authors.affiliation: Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France; Department of Statistics, CHU Pitie Salpetriere, APHP, Paris, France.
authors.forename: Benjamin
authors.initials: B
authors.lastname: Granger
authors.affiliation: Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Romain
authors.initials: R
authors.lastname: Freund
authors.affiliation: Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Violaine
authors.initials: V
authors.lastname: Foltz
authors.affiliation: Department of Rheumatology , CHU la Cavale Blanche , Brest , France.
authors.forename: Sandrine
authors.initials: S
authors.lastname: Jousse-Joulin
authors.affiliation: Department of Rheumatology , CHU la Cavale Blanche , Brest , France.
authors.forename: Valerie
authors.initials: V
authors.lastname: Devauchelle
authors.affiliation: Department of Rheumatology , Hopital Jean Verdier , Bondy , France.
authors.forename: Mona
authors.initials: M
authors.lastname: Afshar
authors.affiliation: Department of Rheumatology , CHU Rennes , Rennes , France.
authors.forename: Jean David
authors.initials: JD
authors.lastname: Albert
authors.affiliation: Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Florian
authors.initials: F
authors.lastname: Bailly
authors.affiliation: Department of Rheumatology , CHU Saint Etienne , Saint Etienne , France.
authors.forename: Elodie
authors.initials: E
authors.lastname: Constant
authors.affiliation: Department of Rheumatology , Hopital Begin , Saint Mande , France.
authors.forename: Lisa
authors.initials: L
authors.lastname: Biale
authors.affiliation: Department of Rheumatology , CHU la Cavale Blanche , Brest , France.
authors.forename: Morgane
authors.initials: M
authors.lastname: Milin
authors.affiliation: Department of Rheumatology , CHU Clermont Ferrand , Clermont Ferrand , France.
authors.forename: Marion
authors.initials: M
authors.lastname: Couderc
authors.affiliation: Department of Rheumatology , CHU Saint Etienne , Saint Etienne , France.
authors.forename: Delphine
authors.initials: D
authors.lastname: Denarie
authors.affiliation: Department of Rheumatology , CHU Poitiers , Poitiers , France.
authors.forename: Anne
authors.initials: A
authors.lastname: Fradin
authors.affiliation: Department of Rheumatology , Hopital d'Orleans , Orleans , France.
authors.forename: Virginie
authors.initials: V
authors.lastname: Martaille
authors.affiliation: Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Audrey
authors.initials: A
authors.lastname: Pierreisnard
authors.affiliation: Department of Rheumatology , CHU Bordeaux , Bordeaux , France.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Poursac
authors.affiliation: Department of Rheumatology , CHU la Cavale Blanche , Brest , France.
authors.forename: Alain
authors.initials: A
authors.lastname: Saraux
authors.affiliation: Department of Rheumatology, APHP, CHU Pitie-Salpetriere, Paris, France; Paris 6 University, GRC-UPMC 08, Pierre Louis Institute of Epidemiology and Public Health, Paris, France.
authors.forename: Bruno
authors.initials: B
authors.lastname: Fautrel
keywords: Disease Activity; Early Rheumatoid Arthritis; Outcomes research; Rheumatoid Arthritis