Background The radiographic joint damage in rheumatoid arthritis (RA) is commonly evaluated by van der Heijde total Sharp score, however only small joints of hands and feet are assessed in this method. We developed and demonstrated a new radiographic scoring method for Large joint of rheumatoid arthritis (Assessment of Rheumatoid Arthritis by Scoring of Large Joint Destruction and Healing in Radiographic Imaging: ARASHI) in EULAR 20111).
Objectives The purpose of this study is to evaluate the radiographic damage of hip and knee joints in rheumatoid arthritis (RA) during TNF-blocking therapies by this new radiographic scoring method, and to clarify the pattern of the progression of hip and knee joints during 2 years of TNF-blocking therapies.
Methods “ARASHI status score” consists of 4 categories; joint space narrowing (0∼3 points), erosion (0∼3 points), joint surface (0∼6 points), and stability (0∼4 points), (total 0-16 points). “ARASHI change score” consists of 5 categories; porosis (-1∼1 point), joint space narrowing (-1∼2 points), erosion (-2∼2 points), joint surface (-6∼6 points), and stability (-1∼1 point), (total -11∼12 points). Increase in more than 1 point of change score was considered as progression of joint damage. hirty seven consecutive patients (4 male, 33 women, mean age of 58.7 years old) were enrolled in this study. All patients fulfilled the ACR 1987 revised criteria. The joints with history of surgical intervention were excluded from this analysis, and the radiographic findings of 65 hip joints and 53 knee joints were evaluated at baseline using the ARASHI status score, and at 1 and 2 years after TNF-blocking therapies (infliximab or etanercept) using the ARASHI change score.
Results There were 2 hip and 8 knee joints with 3 and more points of the status score at baseline. All of these joints showed significant increase in the change score at 1 or 2 years after TNF-blocking therapies. On the other hand, in hip and knee joints with pre-existing status score of 0-2 points, only 5.6% of the joints showed progression of joint damage during follow-up.
Conclusions ARASHI scoring method was useful for radiographic assessment of the status and progression of the large weight-bearing joints. In this study, we demonstrated that hip and knee joints with pre-existing damage greater than 2 points of status score were highly predisposed to progressive destruction even under TNF-blocking therapies. Therefore, it is essential that there is less status score in hip and knee joints at the start of TNF-blocking therapies.
Nasu Y, Nishida K, Hashizume K et al. The verification of a new radiographic scoring method for large joint damage of rheumatoid arthritis (ARASHI status score) relevant to clinical and radiographic parameters. Ann Rheum Dis 2011;70(Suppl3):727
Disclosure of Interest None Declared