How many joints in the hands and wrists should be included in a score of radiologic abnormalities used to assess rheumatoid arthritis?

Abstract

Numerous methods for reading abnormalities of rheumatoid arthritis in hand and wrist radiographs have been proposed over the past several decades. There are many differences among these methods, one of the more striking of which is the variation in the number of joints that are scored. In this study, we tested the number of joints that need to be read in order to represent abnormalities accurately and reproducibly, using the scores of multiple observers. Thirteen rheumatologists and radiologists each read a set of 41Presented at a workshop sponsored by the Joe and Betty Alpert Arthritis Center, Rose Medical Center, Denver, CO, November [28][29] 1983.Supported by a grant from the Eli LiHy Company, Indianapolis, IN.John T. Sharp hand and wrist films from patients with rheumatoid arthritis. Ten of 13 readers scored 27 joints in each hand and wrist; the other 3 readers scored fewer areas. Fourteen combinations of joints were selected based on the frequency of involvement and the technical adequacy of routine films in assessing a given area. After testing these 14 different combinations, 1 scheme, which included 17 areas read for erosions and 18 areas read for joint space narrowing, was tested further. The correlation coefficients for 10 intraobserver scores derived from this modified scheme compared with the original scores were between 0.981 and 0.997. Seventy-one of 78 interobserver comparisons were better using the new scheme than using the original scheme. These data indicate that the simplified scheme, using a combination of 17 joints to score erosions and 18 to score joint space narrowing, more accurately reflects the extent of abnormalities perceived by a panel of experts than does the original scheme. This abbreviated number of joints shortens the amount of time required to read a set of films and simplifies the scoring of films, since a number of areas that are difficult to read are eliminated from radiographic assessment.Destruction of bone and cartilage is a regular consequence of persistent, active synovitis in patients with rheumatoid arthritis (RA). Because finger and wrist joints are frequently involved in this disease, a number of investigators over the past several decades have proposed that an assessment of the severity of erosions and cartilage loss in hand and wrist joints, logically, would represent an index of the outcome of this disease process (1-6). More recently, it has been proposed that individual joints should be scored separately and the scores summed in order to accurately

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“…The original Sharp scoring method (34), however, did include erosions outside the joint space in the total score, and later modifications continued to incorporate these erosions in the score (23). In our study, we separately evaluated new bone formation, and we separately and specifically measured PsA-specific radiographic features, including joint space widening, ankylosis, pencil-and-cup deformity, gross osteolysis, shaft periostitis, and phalangeal tuft resorption.…”

“…Radiographic disease progression in the hands and wrists at 6 and 12 months was compared between the study groups using the annualized rate of change in the modified total Sharp score (TSS; joint erosion plus joint space narrowing [JSN] scores) (23). Features specific to PsA, including digital tuft resorption, juxtaarticular and shaft periostitis, gross osteolysis, pencil-in-cup deformity, joint space widening, and ankylosis, were also compared.…”

How to diagnose rheumatoid arthritis early: A prediction model for persistent (erosive) arthritis

“…The presence of HLA class II regions with RA predisposition, i.e., the shared epitope and DQ RA , were determined as described previously (14,15). The radiographs of the hands and feet were scored for the presence of erosions using the modified Sharp score (16,17) by an experienced rheumatologist who was blinded to the patient's other data.…”

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“…Two experienced readers (JTS and RHG) scored all available radiographs for erosions (scale of 0-5) and joint space narrowing (JSN; scale 0-4); the erosion and JSN scores were summed to give a total score. After a brief training session in which the readers discussed the scoring scale and reviewed a small group of radiographs to be sure they agreed on the features to be scored, the radiographs were scored independently using the method described by Sharp et al (48,49). A total of 17 joints in each hand and wrist were scored for erosions and 16 were scored for JSN.…”