Joint damage in rheumatoid arthritis: assessment of a new scoring method

Abstract

IntroductionThe aim of this study was to assess a novel approach for the quantification of finger joint space narrowing and joint destruction in patients with rheumatoid arthritis (RA) focusing on the peripheral hand articulations.MethodsA total of 280 patients with verified RA underwent computerized semi-automated measurements of joint space distance at the finger articulations based on radiographs. The Z-Score, which can differentiate between joint space alterations caused by RA versus age/gender-related changes, was calculated as a comparative parameter. The severity of joint space narrowing was also quantified by the Sharp Score. Sensitivity and specificity of the Z-Score (based on joint space widths differentiated for each peripheral finger joint) were evaluated to reveal the potential for the occurrence of erosions. Additionally, the potential of the Z-Score regarding the differentiation of therapeutic effects on joint space widths in patients under a therapy of methotrexate versus leflunomide was performed.ResultsThe Z-Scores of finger articulations in patients with RA were generally decreased. Metacarpal-phalangeal (MCP) joint articulations showed a continuous significant decline of -1.65 ± 0.30 standard deviations dependent on the Sharp Score. The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96 ± 0.31 standard deviations). The sensitivity and specificity of MCP joint space distance for the detection of erosions were 85.4% versus 55.2%. The Sharp Score for joint space narrowing was not able to detect different treatments, whereas an accentuated stabilization of joint space narrowing could be identified for the Z-Score of the MCP joints in patients treated with leflunomide and methotrexate.ConclusionThe Z-Scoring method based on computer-aided analysis of joint space widths was able to reliably quantify severity-dependent joint space narrowing in RA patients. In the future, calculation of a Z-Score based on gender-specific and age-specific reference data shows the potential for a surrogate marker of RA progression that comprehends the early identification of patients with RA, and in particular those with erosive course of the disease, enabling a timely therapeutic strategy for cartilage protection.

Die Knochenmasse der Hand als Indikator für die strukturelle Destruktion bei Patienten mit einer rheumatoiden Arthritis – welche Messmethoden sind geeignet?

“…Somit konnte anhand der periartikulären Knochenmineraldichtemessung durch die DXR ein Therapieeffekt verifiziert und eine Aussage über die strukturelle Integrität basierend auf der DXR thematisiert wurden. Im Vergleich zur DXA und zur HR-pQCT können für die DXR-Analyse die bereits vorliegenden Handröntgenaufnahmen ergän-zend einer zusätzlichen computer basierten Analyse der Fingergelenkspaltweite zugeführt werden [30], sodass ein weiterer wichtiger Parameter zur Beurteilung der strukturellen Destruktion im Rahmen eines Untersuchungsganges präzise und objektiv erfasst werden kann.…”

Tomosynthesis can facilitate accurate measurement of joint space width under the condition of the oblique incidence of X-rays in patients with rheumatoid arthritis

“…1,[22][23][24] Cartilage thinning caused by RA is revealed as JSN in radiographic images. 3,4 The degree of JSN is an indirect index that suggests the degree of cartilage thinning or the progression of RA. Therefore, the accurate detection of JSW is linked to the determination of appropriate treatment strategy in each patient and the improvement of therapy evaluation quality, which are important in minimizing the loss of quality of life in patients with RA.…”

“…JSW can therefore be an indirect index used to assess the degree of cartilage damage and hence the progression of RA. [3][4][5] The accurate detection of JSW is thus very important and is linked to an accurate evaluation of the progression of RA, which leads to correct diagnosis and proper treatment of RA in each patient.…”

Visualisation of structural damage as a surrogate marker of radiographic progression in patients with rheumatoid arthritis

“…Computer-based quantifications of metacarpal bone mineral density and joint space narrowing have demonstrated the ability to detect very small change 5 6. In a head-to-head comparison between the Sharp score and computer-assisted joint space analysis, the computer-based technique was able to verify smaller changes in joint space width independent of the severity of RA 7. Additionally, the computer-based quantification of metacarpal bone mineral density by digital x-ray radiogrammetry has been able to quantify therapeutic effects based on the PREMIER study and the BesT study 8 9.…”