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

Pfeil A, Oelzner P, Bornholdt K, Hansch A, Lehmann G, Renz DM, Wolf G, Böttcher J - Arthritis Res. Ther. (2013)

Bottom Line: 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.The Z-Scores of finger articulations in patients with RA were generally decreased.The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96±0.31 standard deviations).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The 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.

Methods: A 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.

Results: The 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.

Conclusion: The 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.

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Joint space width reduction based on computer-aided joint space analysis-specific Z-Scores. Reduction of joint space widths based on the computer-aided joint space analysis-specific Z-Score differentiated for each finger and for all articulations between Sharp-van der Heijde score 0 and 3.
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Figure 2: Joint space width reduction based on computer-aided joint space analysis-specific Z-Scores. Reduction of joint space widths based on the computer-aided joint space analysis-specific Z-Score differentiated for each finger and for all articulations between Sharp-van der Heijde score 0 and 3.

Mentions: For MCP articulation (see Table 1 and Figure 2), the Z-Score (MCP total) showed a continuous significant decline (-1.65 ± 0.30 SDs) from 0.24 ± 0.33 SDs (score 0) to -1.41 ± 1.01 SDs (score 3). The index finger showed the strongest decrease in the Z-Score (-2.37 ± 0.43 SDs) from 0.46 ± 0.62 SDs (score 0) to -1.91 ± 1.57 SDs (score 3). The thumb and middle finger also presented a decrease of -1.74 ± 0.42 SDs (thumb) from 0.27 ± 0.62 SDs (score 0) to -1.46 ± 1.54 SDs (score 3) versus -1.77 ± 0.46 SDs (middle finger) from 0.32 ± 0.61 SDs (score 0) to -1.45 ± 1.69 SDs (score 3). The Z-Score also decreased for the ring finger by -1.39 ± 0.36 SDs and for the little finger by -1.56 ± 0.43 SDs.


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

Pfeil A, Oelzner P, Bornholdt K, Hansch A, Lehmann G, Renz DM, Wolf G, Böttcher J - Arthritis Res. Ther. (2013)

Joint space width reduction based on computer-aided joint space analysis-specific Z-Scores. Reduction of joint space widths based on the computer-aided joint space analysis-specific Z-Score differentiated for each finger and for all articulations between Sharp-van der Heijde score 0 and 3.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3672701&req=5

Figure 2: Joint space width reduction based on computer-aided joint space analysis-specific Z-Scores. Reduction of joint space widths based on the computer-aided joint space analysis-specific Z-Score differentiated for each finger and for all articulations between Sharp-van der Heijde score 0 and 3.
Mentions: For MCP articulation (see Table 1 and Figure 2), the Z-Score (MCP total) showed a continuous significant decline (-1.65 ± 0.30 SDs) from 0.24 ± 0.33 SDs (score 0) to -1.41 ± 1.01 SDs (score 3). The index finger showed the strongest decrease in the Z-Score (-2.37 ± 0.43 SDs) from 0.46 ± 0.62 SDs (score 0) to -1.91 ± 1.57 SDs (score 3). The thumb and middle finger also presented a decrease of -1.74 ± 0.42 SDs (thumb) from 0.27 ± 0.62 SDs (score 0) to -1.46 ± 1.54 SDs (score 3) versus -1.77 ± 0.46 SDs (middle finger) from 0.32 ± 0.61 SDs (score 0) to -1.45 ± 1.69 SDs (score 3). The Z-Score also decreased for the ring finger by -1.39 ± 0.36 SDs and for the little finger by -1.56 ± 0.43 SDs.

Bottom Line: 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.The Z-Scores of finger articulations in patients with RA were generally decreased.The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96±0.31 standard deviations).

View Article: PubMed Central - HTML - PubMed

ABSTRACT

Introduction: The 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.

Methods: A 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.

Results: The 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.

Conclusion: The 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.

Show MeSH
Related in: MedlinePlus