Is Nørgaard's Radiological Sign for Early Rheumatoid Arthritis Reliable?: An Epidemological Approach

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Abstract
From two population surveys in Sweden and Iceland, hand X-rays of 170 persons between 34 and 70 years of age were read by three sets of observers. Special attention was paid to the features of N0rgaard's sign, namely small erosions at the base of the lateral ends of the phalanges, visible only in the oblique projection, attributable to early rheumatoid arthritis. The 1966 criteria for rheumatoid arthritis were applied and two rheumatoid factor tests were used (AFT and SSCT). Only 16% of the persons were graded identically for X-ray findings by the three sets of observers. In population contexts, Nørgaard's sign was shown to have poor reproducibility and low specificity and not to contribute significantly to the radiological diagnosis of rheumatoid arthritis. The “overdiagnosis” of radiological signs of rheumatoid arthritis made by the radiologists might be due to ethnical difference in the bone structure of the populations examined.

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