A comparison of common radiographic scoring systems used in rheumatoid arthritis (RA)
| Year | Author | Description of scoring system | Advantages/disadvantages |
|---|---|---|---|
| Table adapted from van der Heijde,5 Scott,16 and Lassere69 with permission. | |||
| 1949 | Steinbrocker et al | Global, ordinal scale (range 1–4) | Simple, initial standard limited by a short scale and partiality for severely damaged joints |
| 1963 | Kellgren and Lawrence | Global, ordinal score for joint groups including hands, wrists, and feet (range 0–4), standard reference films | Simple, semiquantitative. Lacks sensitivity in detecting progressive damage |
| 1971 | Sharp et al | Detailed, assigns 2 individual ordinal scores, one for erosions (range 0–5) and one for joint space narrowing (range 0–4), for various joints of the hands and wrists | Sensitive, but requires training and is time consuming to apply. Later modified |
| 1977 | Larsen et al | Global, ordinal score (range 0–5) for limb joints, standard reference films | Semiquantitative, easier to learn, less sensitive to changes than the Sharp method |
| 1983 | Genant | Detailed, scores erosions and joint space narrowing in the hands, wrists, and feet, ordinal scale (range 0–4) | Semiquantitative, presents difficulties in assessing progression of structural damage |
| 1987 | Kaye et al | Erosions and joint space narrowing scored together for multiple joints of the hands and wrists, ordinal scale (range 0, 2–5) | Simple, quantitative, requires training to apply efficiently |
| 1989 | van der Heijde et al | Modified Sharp scoring system for hands, wrists, and feet, uses a wider range (0–10) of ordinal scores for the feet | Sensitive for detection of structural changes, requires training to be used efficiently, time consuming |
| 1995 | Scott et al | Modified Larsen scoring system, redefines grades of score, adds new reference films | Modifications enhance sensitivity and increase reliability, still less sensitive to changes in structural damage than the Sharp method |
| 1995 | Rau and Herborn | Modified Larsen scoring system which adds a semiquantitative description of the loss of joint surface area and provides standardised reference films for all stages at different anatomical sites | Modifications improve ease of use and reliability, but non-structural (eg, swelling) and early erosive changes disproportionately affect the score |
| 1998 | Genant | Modified Sharp scoring system in which typically only hands are scored, with a range of 0 to 3 for the erosion score of each site and 0 to 4 for joint space narrowing | Good intra- and interreader agreement. Omission of feet may compromise ability to detect signs of early RA |