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The morbid anatomy of "erosive osteoarthritis" of the interphalangeal finger joints. an optimized scoring system to monitor disease progression in affected joints
  1. Gust Verbruggen*,
  2. Ruth Wittoek,
  3. Bert Vander Cruyssen,
  4. Dirk Elewaut
  1. 1 University Hospital Ghent, Belgium
  1. Correspondence to: Gust Verbruggen, University Hospital Ghent, Department of Rheumatology, Ghent University Hospital, De Pintelaan, 185, Gent, B-9000, Belgium; gust.verbruggen{at}


Objectives: To develop and validate a quantitative radiographic scoring system, the Ghent University Scoring System, GUSS, with better ability to detect progression over a shorter period of time in erosive osteoarthritis (OA) of the interphalangeal (IP) finger joints compared to the existing anatomic phase scoring system.

Methods: Thirty IP finger joints showing erosive features at baseline or follow-up were selected from 18 patients with erosive hand osteoarthritis. Posteroanterior radiographs of these joints obtained at baseline, 6 and 12 months - totalling 90 images - were used for the study. All joints were first scored according to the original anatomic phase scoring system. Erosive progression and signs of repair or remodelling were then scored by indicating the proportion of normal subchondral bone, subchondral plate and joint space on 11-point rating scale (range 0-100 with 10 unit increases). Inter- and intra-reader reproducibilities were studied using intraclass coefficients of correlation (ICC). Based on the within-variance of two readers, the smallest detectable change (SDC) was calculated and allowed identifying joints with changes above the SDC as 'progressors'.

Results: Longitudinal interreader ICC scores rated very well for all variables and the total score (ICC 0.86 – 0.93). In order to identify 'real' change over background noise, a change of at least 40 units on the total score (range: 0-300) over 12 months (SDC 0-12: 36.0), and 50 units over 6 months (SDC 0-6: 47.6) had to be present. This allowed identifying 60% of the 30 joints as 'progressors' over 6 months compared to 33.3% with the classical anatomical scoring system, and 70% vs. 56.6% over 12 months.

Conclusion: The new radiographic scoring system, GUSS, is a reliable method to score radiographic change over time in erosive IP OA and detects more progression over a shorter period of time than the classical scoring system.

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