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. 2002 Apr;61(4):330–334. doi: 10.1136/ard.61.4.330

Development of a radiographic index to assess the tarsal involvement in patients with spondyloarthropathies

C Pacheco-Tena 1, J Londono 1, J Cazarin-Barriento 1, A Martinez 1, J Vazquez-Mellado 1, J Moctezuma 1, M Gonzalez 1, C Pineda 1, M Cardiel 1, R Burgos-Vargas 1
PMCID: PMC1754046  PMID: 11874836

Abstract

Objective: To develop and test an index to evaluate the radiographic changes that occur in the tarsus and adjacent areas of the foot in patients with spondyloarthropathies (SpA).

Methods: The spondyloarthropathy tarsal radiographic index (SpA-TRI) was developed in three consecutive steps: (a) detection of descriptors after reviewing 70 radiographic files; (b) descriptor gradation and subsequent modifications performed by a consensus committee, and (c) interobserver variability assessed by three blinded and independent observers on 272 radiographs: anteroposterior 118, lateral 90, oblique 64 from 121 patients with SpA, and intraobserver variability on 75 radiographs from 25 patients with SpA. Statistical analysis included percentage of agreement and κ test. SpA-TRI score ranges from 0 to 4 (0=normal; 1=osteopenia or suspicious findings; 2=definite joint space narrowing, bony erosion(s), periosteal whiskering, or enthesophyte(s) in the plantar fascia or Achilleal tendon attachments; 3=para-articular enthesophyte(s); 4=bony ankylosis (joint space fusion or complete bridging)).

Results: Complete agreement for every evaluation was >40%, and discordance >1 grade was <15%. The κ scores among the three observers were acceptable for all the single projections: oblique (0.52, 0.36, 0.35), lateral (0.50, 0.42, 0.56), and anteroposterior (0.40, 0.41, 0.21) views. The combination of lateral and oblique views achieved the highest concordance rates (0.72, 0.33, 0.66), surpassing that of the three projections altogether (0.34, 0.58, 0.37). In every case the concordance was comparable with that of sacroiliac joints (0.47, 0.41, 0.34); intraobserver concordance showed a similar trend.

Conclusion: The SpA-TRI is an index that includes the most prominent features of tarsal disease and adjacent areas of the foot in SpA and grades them accordingly, it has an adequate reproducibility, and is suitable for use with two or more projections, preferably the combination of oblique and lateral.

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Figure 1 .

Figure 1

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Lateral view of the right foot of a 33 year old, B27+ male patient with diagnosis of AS and ankylosing tarsitis. As can be noted, there is complete obliteration of spaces between the joints, forming a single tarsal mass, which includes metatarsal joints (grade 4); in addition, bone proliferation tracts are detectable extending over the surface of several bones (arrows), suggesting a role for periosteal proliferation and remodelling.

Figure 2 .

Figure 2

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Radiographic and MRI lateral aspect of the left foot of an 18 year old, HLA-B27+ male patient, showing joint space narrowing and particularly enthesophyte (grade 3) extending from the astragalus to the navicular bone. The MRI was obtained on the same day as the radiograph, and demonstrates the actual extension of the enthesophyte, showing the formation of a complete bridge.

Figure 3 .

Figure 3

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Oblique view of the right foot of a 35 year old, B27+ female patient, with diagnosis of undifferentiated SpA and severe recurrent tarsitis (grade 3) that shows (A) a complete view of the proximal and mid-tarsal structures, displaying some descriptors of SpA-TRI; (B) joint space narrowing (1), and erosions (2); (C) para-articular enthesophyte (3) and periosteal whiskering (4).

Figure 4 .

Figure 4

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Proposed joints and structures to be evaluated in the different tarsal radiographic projections. (A) Anteroposterior; (B) oblique; (C) lateral.

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Burgos-Vargas R., Madariaga-Ceceña M. A., Katona-Salgo G. Espondilitis anquilosante juvenil: características clínicas en 41 enfermos. Bol Med Hosp Infant Mex. 1985 Sep;42(9):523–530. [PubMed] [Google Scholar]
  2. Burgos-Vargas R., Naranjo A., Castillo J., Katona G. Ankylosing spondylitis in the Mexican mestizo: patterns of disease according to age at onset. J Rheumatol. 1989 Feb;16(2):186–191. [PubMed] [Google Scholar]
  3. Burgos-Vargas R., Pacheco-Tena C., Vázquez-Mellado J. Juvenile-onset spondyloarthropathies. Rheum Dis Clin North Am. 1997 Aug;23(3):569–598. doi: 10.1016/s0889-857x(05)70348-3. [DOI] [PubMed] [Google Scholar]
  4. Burgos-Vargas R., Vázquez-Mellado J. The early clinical recognition of juvenile-onset ankylosing spondylitis and its differentiation from juvenile rheumatoid arthritis. Arthritis Rheum. 1995 Jun;38(6):835–844. doi: 10.1002/art.1780380618. [DOI] [PubMed] [Google Scholar]
  5. Dougados M., van der Linden S., Juhlin R., Huitfeldt B., Amor B., Calin A., Cats A., Dijkmans B., Olivieri I., Pasero G. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 1991 Oct;34(10):1218–1227. doi: 10.1002/art.1780341003. [DOI] [PubMed] [Google Scholar]
  6. Lau C. S., Burgos-Vargas R., Louthrenoo W., Mok M. Y., Wordsworth P., Zeng Q. Y. Features of spondyloarthritis around the world. Rheum Dis Clin North Am. 1998 Nov;24(4):753–770. doi: 10.1016/s0889-857x(05)70040-5. [DOI] [PubMed] [Google Scholar]
  7. MacKay K., Brophy S., Mack C., Doran M., Calin A. The development and validation of a radiographic grading system for the hip in ankylosing spondylitis: the bath ankylosing spondylitis radiology hip index. J Rheumatol. 2000 Dec;27(12):2866–2872. [PubMed] [Google Scholar]
  8. MacKay K., Mack C., Brophy S., Calin A. The Bath Ankylosing Spondylitis Radiology Index (BASRI): a new, validated approach to disease assessment. Arthritis Rheum. 1998 Dec;41(12):2263–2270. doi: 10.1002/1529-0131(199812)41:12<2263::AID-ART23>3.0.CO;2-I. [DOI] [PubMed] [Google Scholar]
  9. Pacheco-Tena C., Burgos-Vargas R., Vázquez-Mellado J., Cazarín J., Pérez-Díaz J. A. A proposal for the classification of patients for clinical and experimental studies on reactive arthritis. J Rheumatol. 1999 Jun;26(6):1338–1346. [PubMed] [Google Scholar]
  10. Spoorenberg A., de Vlam K., van der Heijde D., de Klerk E., Dougados M., Mielants H., van der Tempel H., Boers M., van der Linden S. Radiological scoring methods in ankylosing spondylitis: reliability and sensitivity to change over one year. J Rheumatol. 1999 Apr;26(4):997–1002. [PubMed] [Google Scholar]
  11. Viitanen J. V., Kokko M. L., Lehtinen K., Suni J., Kautiainen H. Correlation between mobility restrictions and radiologic changes in ankylosing spondylitis. Spine (Phila Pa 1976) 1995 Feb 15;20(4):492–496. doi: 10.1097/00007632-199502001-00015. [DOI] [PubMed] [Google Scholar]
  12. van der Linden S., Valkenburg H. A., Cats A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria. Arthritis Rheum. 1984 Apr;27(4):361–368. doi: 10.1002/art.1780270401. [DOI] [PubMed] [Google Scholar]

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