Radiographic hand joint space width assessed by computer is a sensitive measure of change in early RA

June 7, 2004

J Rheumatol. 2004 Jun;31(6):1050-61.

Radiographic hand joint space width assessed by computer is a sensitive

measure of change in early rheumatoid arthritis.

Angwin J, Lloyd A, Heald G, Nepom G, Binks M, MF.

GlaxoKline Research and Development, age, Hertfordshire, UK.

OBJECTIVE: To compare changes in the computerized measurement of

radiographic hand joint space width (JSW) to changes in modified Sharp

scores in a retrospective 2-year study of early rheumatoid arthritis

(RA). METHODS: First and last standard clinical hand radiographs of 245

patients with RA were analyzed blind using purpose-written computer

software to measure changes in JSW for proximal interphalangeal (PIP)

and metacarpophalangeal (MCP) joints in the 3 middle fingers of each

hand. Before measurement, the radiographs were scored independently by 2

radiologists using a modification of Sharp scoring. RESULTS: The paired

changes in JSW (-0.051 +/- 0.005 mm) and Sharp score (+3.81 +/- 0.50)

were both significant over the study duration. In measured joints

showing an increase in joint space narrowing (JSN) score, 92% had a

corresponding reduction in JSW. In patients with an increase in total

score, including JSN and erosion scores in fingers and wrists, 84% had a

corresponding reduction in mean (PIP + MCP) JSW. Patients with no change

in Sharp score (47%) still experienced a significant reduction in

measured JSW (-0.027 +/- 0.006 mm). HLA-DR genetic markers of severe

disease progression were associated with significantly greater

reductions in JSW but not increases in Sharp score. (Values: mean +/-

standard error of mean).

CONCLUSION: Measured JSW averaged over 6 PIP and 6 MCP joints was a

valid and more sensitive measure of change than total Sharp score in

this study of early RA.

PMID: 15170915

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Mayo Clinic in Rochester

s Hopkins Medicine

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