Reachout Orthopedics - Issue 2

Fig. 4: Simplified erosion and narrowing score (SENS) representation with figure and grading. The grading in SENS is a dichotomic scale. a Joints selected in each hand for erosions: 4 PIP, 5 MCP, IP, scaphoid, lunate, distal ulna, distal radius, the two components of the CMC joints of the thumb are evaluated separately (PMC and trapezium–trapezoid). The maximum score for both hands is 32. b Joints selected in each foot for erosions. The maximum score considering both feet is 12. c Joints selected in the hand: the CMC 3, CMC 4, CMC 5 are scored separately, the IP is not included, only the radio-scaphoid part of the radiocarpal joint is evaluated. The maximum score for both hands is 30. d The joint selected for JSN in each foot. The maximum score for both feet is 12. CMC carpometacarpal, CS capitate–scaphoid, IP interphalangeal joint, Lun lunate, MCP metacarpophalangeal joint, MTP metatarsophalangeal joint, PIP proximal interphalangeal joint, PMC proximal metacarpal, Rad radius, RC radio-scaphoid, Sc scaphoid, ST scaphoid–trapezium, T–T trapezium–trapezoid, Ul ulna Table 4: Features of psoriatic arthritis included in the five radiographic scoring systems for psoriatic arthritis. Scoring method Erosion Joint space narrowing Bony proliferation Modified Steinbrocker global scoring method + – – Modified Sharp score (MSS) + + – Modified Sharp–van der Heijde method for psoriatic arthritis (mSvdHS) + + – Psoriatic arthritis Ratingen score (PARS) + – + Simplified psoriatic arthritis radiographic score (SPARS) + + + with the wrist as one joint, and all MTP and the IP of the big toe [65] (Fig. 5). Psoriatic Arthritis Scoring Method Based on the Sharp Scoring Method for Rheumatoid Arthritis (MSS) Radiographic evaluation was performed in the initial studies with biologic agents in PsA using a modification of the Sharp method for RA [66], which includes a separate evaluation of erosions and JSN. The same joints were scored as in the original method, with the ad- dition of the DIP from 2 to 5 joints of hands [36, 63]. Other radiographically detectable changes in PsA, such as periostitis and tuft resorption are recorded and scored separately, but not included in the score value. Sharp–van der Heijde-Modified Scoring Method for Psoriatic Arthritis (mSvdHS) The modification based on the Sharp–van der Heijde method for RA scores the same joints and definitions as seen in RA [41], with the addition of the eight DIP joints for erosions and the eight DIP and two IP joints of the thumb for JSN. The presence of gross osteolysis and “pencil in cup” is scored separately; if one of these abnormalities is present, the joint gets the maximum score assigned for erosion and for JSN (Fig. 6). Psoriatic Arthritis Ratingen Score (PARS) This method was developed based on the Rau and Herborn modification of the Larsen Score [53]. This method includes 40 joints of the hands and feet (DIP 2–5 of the hands, 2 IP of the thumbs, 8 PIP of the hands, 10 MCP of both wrists, 2 IP of the great toes, and MTP 2–5). Destruction and proliferation of all joints are scored separately [53] (Fig. 7). Simplified Psoriatic Arthritis Radiographic Score (SPARS) Recently, our group has developed the SPARS, obtaining its definition through a consensus analysis, involving three radiologists skilled in musculoskeletal imaging and five rheuma- tologists with clinical experience on PsA and radiographic scoring systems [67]. SPARS assess the same joints of the PARS in a simpler manner: the grade of the combination of erosion and bony proliferation of the PARS is replaced by the sum of joints with erosion 7 reachOut Orthopedics