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A comparison between the simplified erosion and narrowing score and the Sharp–van der Heijde score: post hoc analysis from the BeSt study
  1. N B Klarenbeek1,
  2. M Güler-Yüksel1,
  3. D M F M van der Heijde1,
  4. P J S M Kerstens2,
  5. C Mallée3,
  6. M L Westedt4,
  7. T W J Huizinga1,
  8. B A C Dijkmans2,5,
  9. C F Allaart1
  1. 1Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2Department of Rheumatology, Jan van Breemen Institute, Amsterdam, The Netherlands
  3. 3Department of Rheumatology, Hospital, Haarlem, The Netherlands
  4. 4Department of Rheumatology, Hospital, the Hague, The Netherlands
  5. 5Department of Rheumatology, VU Medical Center, Amsterdam, The Netherlands
  1. Correspondence to Dr N B Klarenbeek, Department of Rheumatology, C-01-R, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands; n.b.klarenbeek{at}

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The Sharp–van der Heijde method (SHS; range 0–448)1 is an often used and well-validated method to assess joint damage on x-rays in rheumatoid arthritis (RA). It is a comprehensive method that requires training, making it less feasible for clinical practice. The simplified erosion and narrowing score (SENS; range 0–86)2 scores the same joints as SHS, but without grading of damage per joint, making it quicker and easier to learn. Using SENS takes 7 min for seven sets of radiographs, compared with 25 min for seven sets using SHS.2

In earlier studies, SENS showed good reliability and responsiveness, but these studies either had no restrictions in disease duration or limited patient numbers.24 We aimed to compare the properties of SENS and SHS in a large group of early, intensively treated RA patients with limited joint damage during 5 years of follow-up in the BeSt (Behandel Strategieen [Treatment Strategies]) study. Details of the study have been described earlier.5

Annual radiographs of hands and feet …

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  • Funding This study was funded by a grant of the Dutch College of Health Insurances (College Voor Zorgverzekeringen) with additional funding provided by Schering-Plough, B V and Centocor. The authors, not the sponsors, were responsible for the study design, the collection, analyses and interpretation of all data, the writing of this article and the decision to publish.

  • Patient consent Obtained.

  • Ethics approval The BeSt study was approved by the medical ethical committees of all participating centres.

  • Provenance and peer review Not commissioned; externally peer reviewed.