Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 Oct 21;9(10):3374.
doi: 10.3390/jcm9103374.

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

Qiuke Wang  1 , Jos Runhaar  1 , Margreet Kloppenburg  2 , Maarten Boers  3 , Johannes W J Bijlsma  4 , Sita M A Bierma-Zeinstra  1   5 ; The CREDO Expert Group
Collaborators, Affiliations

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

Qiuke Wang et al. J Clin Med. .

Abstract

Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs).

Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was "certainly no OA" and 100 was "certainly OA"). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically "certain" and "uncertain" knees, respectively. Student paired t-tests compared certainty scores.

Results: Most diagnoses of GPs (86%) and SPs (82%) were "consistent" after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically "uncertain" knees. Radiographs added some certainty to "consistent" OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04).

Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.

Keywords: diagnosis; general practitioner; knee osteoarthritis; radiography; secondary care physician.

PubMed Disclaimer

Conflict of interest statement

Q.W., J.R., M.K., J.W.J.B., S.M.A.B.-Z. report grant from the Dutch Arthritis Association. MK reports fee for consultancy (Abbvie, Pfizer, Levicept, GlaxoSmithKline, Merck-Serono, Kiniksa, Flexion), CHDR and local investigator of industry-driven trial (Abbvie), a grant from Pfizer, royalty for Wolters Kluwer (UptoDate), Springer Verlag (Reumatologie en klinische immunologie). S.M.A.B.-Z. reports consulting for Phizer, as an invited speaker in Osteoarthritis Research Society International (OARSI).

Figures

Figure 1
Figure 1
Diagnostic process. OA, osteoarthritis; GP, general practitioner; SP, secondary care physician; Clin diagnosis, diagnoses based on clinical data only; clin + rad, diagnoses based on clinical and radiographic data.
Figure 2
Figure 2
General practitioner (GP) and secondary care physician (SP) diagnoses based on clinical data (clin), clinical combined with radiographic data (clin + rad); OA, osteoarthriti.
Figure 3
Figure 3
Certainty scores of four subgroups before and after viewing radiographic data (means and standard deviations).
See this image and copyright information in PMC

References

    1. Brand C.A., Harrison C., Tropea J., Hinman R.S., Britt H., Bennell K. Management of osteoarthritis in general practice in australia. Arthritis Care Res. 2014;66:551–558. doi: 10.1002/acr.22197. - DOI - PubMed
    1. Demehri S., Guermazi A., Kwoh C.K. Diagnosis and longitudinal assessment of osteoarthritis: Review of available imaging techniques. Rheum. Dis. Clin. N. Am. 2016;42:607–620. doi: 10.1016/j.rdc.2016.07.004. - DOI - PubMed
    1. Zhang W., Doherty M., Peat G., Bierma-Zeinstra M.A., Arden N.K., Bresnihan B., Herrero-Beaumont G., Kirschner S., Leeb B.F., Lohmander L.S., et al. Eular evidence-based recommendations for the diagnosis of knee osteoarthritis. Ann. Rheum. Dis. 2010;69:483–489. doi: 10.1136/ard.2009.113100. - DOI - PubMed
    1. Parsons C., Fuggle N.R., Edwards M.H., Goulston L., Litwic A.E., Jagannath D., van der Pas S., Cooper C., Dennison E.M., Group E.R. Concordance between clinical and radiographic evaluations of knee osteoarthritis. Aging Clin. Exp. Res. 2018;30:17–25. doi: 10.1007/s40520-017-0847-z. - DOI - PMC - PubMed
    1. Decary S., Ouellet P., Vendittoli P.A., Roy J.S., Desmeules F. Diagnostic validity of physical examination tests for common knee disorders: An overview of systematic reviews and meta-analysis. Phys. Ther. Sport. 2017;23:143–155. doi: 10.1016/j.ptsp.2016.08.002. - DOI - PubMed

LinkOut - more resources