Dr. Herrick has received consulting fees, speaking fees, and/or honoraria from Actelion (less than $10,000).
Lack of agreement between rheumatologists in defining digital ulceration in systemic sclerosis
Version of Record online: 26 FEB 2009
Copyright © 2009 by the American College of Rheumatology
Arthritis & Rheumatism
Volume 60, Issue 3, pages 878–882, March 2009
How to Cite
Herrick, A. L., Roberts, C., Tracey, A., Silman, A., Anderson, M., Goodfield, M., McHugh, N., Muir, L. and Denton, C. P. (2009), Lack of agreement between rheumatologists in defining digital ulceration in systemic sclerosis. Arthritis & Rheumatism, 60: 878–882. doi: 10.1002/art.24333
- Issue online: 26 FEB 2009
- Version of Record online: 26 FEB 2009
- Manuscript Accepted: 18 NOV 2008
- Manuscript Received: 23 DEC 2007
To test the intra- and interobserver variability, among clinicians with an interest in systemic sclerosis (SSc), in defining digital ulcers.
Thirty-five images of finger lesions, incorporating a wide range of abnormalities at different sites, were duplicated, yielding a data set of 70 images. Physicians with an interest in SSc were invited to take part in the Web-based study, which involved looking through the images in a random sequence. The sequence differed for individual participants and prevented cross-checking with previous images. Participants were asked to grade each image as depicting “ulcer” or “no ulcer,” and if “ulcer,” then either “inactive” or “active.” Images of a range of exemplar lesions were available for reference purposes while participants viewed the test images. Intrarater reliability was assessed using a weighted kappa coefficient with quadratic weights. Interrater reliability was estimated using a multirater weighted kappa coefficient.
Fifty individuals (most of them rheumatologists) from 15 countries participated in the study. There was a high level of intrarater reliability, with a mean weighted kappa value of 0.81 (95% confidence interval [95% CI] 0.77, 0.84). Interrater reliability was poorer (weighted κ = 0.46 [95% CI 0.35, 0.57]).
The poor interrater reliability suggests that if digital ulceration is to be used as an end point in multicenter clinical trials of SSc, then strict definitions must be developed. The present investigation also demonstrates the feasibility of Web-based studies, for which large numbers of participants can be recruited over a short time frame.