Reachout Orthopedics - Issue 2

Fig. 7: Psoriatic arthritis Ratingen score (PARS) representation with figure and grading. a Joints evaluated in each hand for destruction and proliferation: 4 DIP, 4 PIP, 5 MCP, the IP of the thumb and the wrist (evaluated as one joint). The maximum score for both hands is 270. b Joints selected in each foot for destruction and proliferation: the IP of the big toe and second to fifth MTP joints. The maximum score considering both feet is 90. DIP distal interphalangeal joint, IP interphalangeal joint, MCP metacarpophalangeal joint, MTP metatarsophalangeal joint, PIP proximal interphalangeal joint Fig. 8: Simplified psoriatic arthritis score (SPARS) representation with figure and grading. The grading in SPARS is a dichotomic scale. a Joints evaluated in each hand for erosion, joint space narrowing and bone proliferation: 4 DIP, 4 PIP, 5 MCP, the IP of the thumb, and wrist is evaluated as one joint. b Joints selected in each foot for erosion, joint space narrowing, and bone proliferation: the IP of the big toe and second to fifth MTP joints. The maximum score is considered. DIP distal interphalangeal joint, IP interphalangeal joint, MCP metacarpophalangeal joint, MTP metatarsophalangeal joint, PIP proximal interphalangeal joint early progression in radiographic erosions is related to future impairment in physical function [72]. Radiographic measurement has been of major importance in the develop- ment of concepts concerning the severity of RA and PsA and the need for tight control to prevent anatomic damage. It will have, also, a crucial role in many aspects of treatment in the rheumatic diseases, including identifying patients who are suitable for use of disease- modifying antirheumatic drugs (DMARDs) and biological agents (bDMARDs), predicting patient response and relapse, and identifying true disease remission [17, 19, 71, 73, 74]. A deeper insight into the mechanism of struc- tural changes triggered by these chronic joint diseases is essential for developing therapies that can arrest, prevent, and even reverse bone and cartilage changes. Even thoughmagnetic resonance imaging (MRI) and ultrasound (US) demonstrated to be more sensitive than radiographs in detect- ing early structural changes in joints and sur- rounding structures [75, 76], availability and costs may limit the use of these techniques in daily clinical practice. Further research in the use of MRI and US will lead to their proper integration with conventional radiography. Therefore, it remains important for a rheumatologist to understand the scoring of plain radiographs and the history of the scoring methods. The introduction of easier scoring system in time allows the rheumatologist to use it in clinical trials but also in clinical practice. Funding: This work has not been supported by any funding. Compliance with ethical standards Conflict of interest: The authors declare that they have no conflict of interest. Ethical approval: This article does not contain any studies with human participants performed by any of the authors. Publisher’s Note: Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. References available on request Healthcare.India@springer.com Source: Salaffi, F., Carotti, M., Beci, G. et al . Radiol med (2019). https://doi.org/10.1007/s11547-019-01001-3. © Italian Society of Medical Radiology 2019. 9 reachOut Orthopedics