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Radiographic Hand Joint Space Width Assessed by Computer Is a Sensitive Measure of Change in Early Rheumatoid Arthritis
JANE ANGWIN, ANDREW LLOYD, GEOFF HEALD, GERALD NEPOM, MICHAEL BINKS, and MICHAEL F. JAMES
ABSTRACT.
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. (J Rheumatol 2004;31:1050-61) Key Indexing Terms:
RHEUMATOID ARTHRITIS
From GlaxoSmithKline Research and Development, Stevenage, Hertfordshire, UK. J. Angwin, MA; M. Binks, MD, RA Biology, Respiratory and Inflammation Centre of Excellence in Drug Discovery; A.P. Lloyd, BSc, Biostatistics and Data Sciences; G. Heald, Information Technology Research and Development; M.F. James, PhD, MRI Group, Neurology & GI Centre of Excellence for Drug Discovery, GSK Research & Development, UK; G.T. Nepom, MD, PhD, Virginia Mason Research Center, Seattle, Washington, USA. Address reprint requests to J. Angwin, GlaxoSmithKline R&D, Medicines Research Centre, Gunnels Wood Road, Stevenage, Hertfordshire SG1 2NY, UK. E-mail: jane.s.angwin@gsk.com Submitted April 23, 2003; revision accepted November 3, 2003.
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