Interpretable Rheumatoid Arthritis Scoring via Anatomy-aware Multiple Instance Learning

The Sharp/van der Heijde (SvdH) score has been widely used in clinical trials to quantify radiographic damage in Rheumatoid Arthritis (RA), but its complexity has limited its adoption in routine clinical practice. To address the inefficiency of manual scoring, this work proposes a two-stage pipeline for interpretable image-level SvdH score prediction using dual-hand radiographs. Our approach extracts disease-relevant image regions and integrates them using attention-based multiple instance learning to generate image-level features for prediction. We propose two region extraction schemes: 1) sampling image tiles most likely to contain abnormalities, and 2) cropping patches containing disease-relevant joints. With Scheme 2, our best individual score prediction model achieved a Pearson's correlation coefficient (PCC) of 0.943 and a root mean squared error (RMSE) of 15.73. Ensemble learning further boosted prediction accuracy, yielding a PCC of 0.945 and RMSE of 15.57, achieving state-of-the-art performance that is comparable to that of experienced radiologists (PCC = 0.97, RMSE = 18.75). Finally, our pipeline effectively identified and made decisions based on anatomical structures which clinicians consider relevant to RA progression.

Deep Learning Models to Automate the Scoring of Hand Radiographs for Rheumatoid Arthritis

The van der Heijde modification of the Sharp (SvdH) score is a widely used radiographic scoring method to quantify damage in Rheumatoid Arthritis (RA) in clinical trials. However, its complexity with a necessity to score each individual joint, and the expertise required limit its application in clinical practice, especially in disease progression measurement. In this work, we addressed this limitation by developing a bespoke, automated pipeline that is capable of predicting the SvdH score and RA severity from hand radiographs without the need to localise the joints first. Using hand radiographs from RA and suspected RA patients, we first investigated the performance of the state-of-the-art architectures in predicting the total SvdH score for hands and wrists and its corresponding severity class. Secondly, we leveraged publicly available data sets to perform transfer learning with different finetuning schemes and ensemble learning, which resulted in substantial improvement in model performance being on par with an experienced human reader. The best model for RA scoring achieved a Pearson's correlation coefficient (PCC) of 0.925 and root mean squared error (RMSE) of 18.02, while the best model for RA severity classification achieved an accuracy of 0.358 and PCC of 0.859. Our score prediction model attained almost comparable accuracy with experienced radiologists (PCC = 0.97, RMSE = 18.75). Finally, using Grad-CAM, we showed that our models could focus on the anatomical structures in hands and wrists which clinicians deemed as relevant to RA progression in the majority of cases.