Reachout Orthopedics - Issue 2

and the number of joints with bony prolifera- tion. Similar simplifications have been already applied for the radiographic scoring systems in RA [54]. In SPARS, a joint is defined as eroded (score 1) if one or more erosions with an interruption of the cortical plate>1 mm (PARS grade 1 of DS) can be observed (Fig. 8). Comparison of The Scoring Methods in PsA All radiographic scoring methods have been proven to capture radiographic change with reasonable precision in PsA. There was consensus that MSS and mSvdHS were the optimal tool to use in randomized controlled trials (where sensitivity to change is often the most important attribute of the outcome measure), but the most appropriate tool for use in longitudinal observational studies has yet to be established [62]. Tillett et al . [68] reported the first comparison of feasibility of four radiographic scoring methods for PsA in an observational cohort. The smallest detectable change (SDC) of thePARS is similar to that of the mSvdHS and MSS, but it can be scored faster. Furthermore, the PARS is the only one that focuses on bony proliferation. Proliferative lesions are pathognomonic for PsA and are considered the most specific PsA radiographic features [7]. The feasibility of each method was estimated based on the mean time taken to score each film as well. The method which took the least time to score was the Steinbrocker method followed by the PARS, the mSvdHS, and the MSS at 6.2 min, 10.5 min, 14.4 min, and 14.6 min, respectively. Recently, the SPARS, a new and faster method, has been developed. The SPARS has properties which are close to the ones of the mSvdHS and PARS allowing a quicker calculation [67]. Conclusion Plain radiography remains the gold standard for the assessment of structural joint damage in RA and PsA. Characteristic radiographic findings are part of the ACR classification criteria for RA [69] and CASPAR criteria for PsA [7, 70]. Plain radiography can be helpful in the differentiation of RA from PsA and other joint conditions, including osteoar- thritis, calcium pyrophosphate deposition disease, gout, and neoplasms [71]. Early bone erosions are correlated with poor long-term radiographic and functional outcome, and Fig. 5: Modified Steinbrocker global scoring method represented with figure and grading. a Joints evaluated in each hand: 4 DIP, 4 PIP, 5 MCP, the IP of the thumb, the wrist is evaluated as one joint. The maximum score for both hands is 120. b Joints selected in each foot: all the MTP joints and the IP joint of the big toe. The maximum score considering both feet is 48. DIP distal interphalangeal joint, IP interphalangeal joint, MCP metacarpophalangeal joint, MTP metatarsophalangeal joint, PIP proximal interphalangeal joint Fig. 6: van der Heijde-modified Sharp scoring method (mSvdHS) representation with figure and grading. 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 (5 points) and for JSN (4 points). 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 200. b Joints selected in each foot for erosions: the proximal and distal articular components of the MTP joints and IP are evaluated separately resulting in a 0–10 score for each joint. The maximum score considering both feet is 120. c Joints selected in the hand in the mSvdHS: 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 160. d Joints selected for JSN in each foot. The maximum score for both feet is 48. CMC carpometacarpal, CS capitate–scaphoid, DIP distal interphalangeal, IP interphalangeal joint, Lun lunate, MCP metacarpophalangeal joint, MTP metatarsophalangeal joint, PIP proximal interphalangeal joint, PMC proximal metacarpal, Rad radius, RS radio-scaphoid, Sc scaphoid, ST scaphoid–trapezium, T–T trapezium–trapezoid, Ul ulna 8 reachOut Orthopedics