Simple Erosion Narrowing Score Research Articles

Serum Collagen Triple Helix Repeat Containing-1 Levels are Related to Radiological Affection and Disease Activity in Rheumatoid Arthritis.

Rheumatoid arthritis (RA) is a common systemic inflammatory disease. Collagen triple helix repeat containing-1 (CTHRC1) is a unique gene product able to reduce collagen deposition. The present study aimed to assess CTHRC1 level in RA patients and to uncover its relation to clinical, laboratory and radiological findings. The study included 60 adult RA patients. In addition, there were 60 control subjects who included patients with osteoarthritis (n = 20) and reactive arthritis (n = 20) and healthy controls (n = 20). Serum CTHRC1 levels were assessed by Enzyme-Linked Immunosorbent Assay (ELISA). Disease activity was calculated using the Disease Activity Score (DAS28-CRP). Radiological damage was evaluated using the Simple Erosion Narrowing Score (SENS). There was significantly higher serum CTHRC1 levels in RA patients when compared to OA, ReA and control groups [median (IQR): 4.66 (1.68-11.7) versus 1.88 (1.14-2.94), 1.55 (0.98-3.15) and 1.14 (0.85-1.3) mg/dL, respectively, p < 0.001]. There was significantly higher CTHRC1 levels in patients with higher disease activity [median (IQR): 2.23 (1.4-4.73) versus 6.55 (4.66-12.0) mg/dL, p = 0.004]. Patients with higher SENS had significantly higher CTHRC1 [median (IQR): 1.99 (1.4-4.66) versus 9.75 (4.39-12.63) mg/dL, p < 0.001] and DAS28 [median (IQR): 4.25 (2.9-5.2) versus 5.4 (4.65-5.8), p = 0.01]. Serum CTHRC1 levels are related to disease severity and radiological affection in RA patients.

Clinical utility of anti-carbamylated antibody in rheumatoid arthritis female patients: Emerging predictive value compared to anti-cyclic citrullinated peptide and rheumatoid factor

Aim of the workTo evaluate the frequency of anti-carbamylated protein (anti-CarP) antibodies positivity in female rheumatoid arthritis (RA) patients; to study their association with different disease aspects clinically and radiologically and to assess their potential predictive role of RA disease compared to other autoantibodies. Patients and methodsFifty-one RA female patients and 44 age-matched controls were studied. Duration of morning stiffness, disease activity score (DAS28) and health assessment questionnaire (HAQ) were assessed. Laboratory investigations included acute phase reactants, rheumatoid factor (RF), anti-cyclic citrullinated peptide (anti-CCP) and anti-CarP antibodies. Conventional radiography of both hands and feet was performed and assessed by a simple erosion narrowing score (SENS). All patients were evaluated by ultrasound 7 (US7) score. ResultsThe mean age of patients was 46.9 ± 8.6 years with disease duration of 6.2 ± 5.3 years. Anti-CarP antibody was positive in 52% and 54.5% of patients seronegative for anti-CCP and RF respectively. RF was positive in 40 (78.4), anti-CCP was positive in 26(51%), and anti-CarP in 21 (41.2%) patients. Anti-CarP antibodies were significantly associated with radiological damage, DAS28, HAQ and acute phase reactants. The sensitivity and specificity were 41.2% and 88.6%, respectively for anti-CarP, 51% and 93.2% for anti-CCP and 78.4% and 90.9% for RF to diagnose RA. ConclusionsAn association between anti-CarP antibody positivity and the disease activity, severity, structural damage and hence poor disease outcome has been demonstrated. Testing anti-CarP antibodies could be a useful marker for the assessment of disease activity as well as the expectation of prognosis in RA patients.

Risk of cervical myelopathy in rheumatoid arthritis patients with neck pain

BackgroundCervical spine (CS) evaluation in rheumatoid arthritis (RA) is challenging since subtle neurological insult is usually masked by the severe peripheral joint affection or muscle atrophy. Neglected CS lesions could end up with cervical myelopathy. Magnetic resonance imaging (MRI) has been the modality of choice in assessing CS in RA. Aim of the workTo evaluate CS in RA using MRI and detect the risk factors for its involvement. Patients and methodsForty RA patients with neck pain were assessed using disease activity score (DAS28), Ranawat classification of rheumatoid myelopathy, simple erosion narrowing score (SENS), bilateral hand and wrist musculoskeletal ultrasound (MSKUS) for early erosion detection and CS MRI. ResultsThe mean age of patients was 44.3 ± 10.1 years, disease duration 7.9 ± 6.6 years and the DAS28 was 4.8 ± 1.6. 70% of patients were in Ranawat class I, 30% in class II, and none in class III. 70% of patients had CS lesions where synovitis occurred in 67.5% of patients, odontoid erosions in 15%, atlanto-axial marrow edema in 5%, atlanto-occipital marrow edema in 5% and none had atlanto-axial subluxation (AAS), subaxial subluxation (SAS), spinal cord/brain stem compression. CS involvement was significantly related to peripheral joint erosion, high SENS and positive RF (p = 0.01, p < 0.0001, p < 0.0001 respectively). ConclusionCS involvement is remarkable in RA especially in those with peripheral joint erosions, high SENS and positive RF. RA patients with persistent neck pain, even in absence of objective neurological deficit should be evaluated early for detection and management of CS lesions before irreversible neurological damage takes place.

Sonographic assessment of cartilage damage at the metacarpal head in rheumatoid arthritis: qualitative versus quantitative methods.

To test the validity of the OMERACT semi-quantitative score by comparing with a quantitative method in the US assessment of hyaline cartilage at the metacarpal head (MH) in patients with RA and healthy controls (HCs). The hyaline cartilage from the second to fifth MHs of both hands was scanned. Hyaline cartilage was scored semi-quantitatively and quantitatively by measuring cartilage thickness and comparing with reference values. In RA patients, radiographic joint space narrowing (JSN) was scored on the same joints using the Simple Erosion Narrowing Score (SENS). A total of 408 MHs in 51 RA patients and 320 MHs in 40 HSs were evaluated. The OMERACT semi-quantitative score was quicker to perform than the quantitative method [6.0 min (s.d. 0.5) vs 8.0 (1.5); P < 0.01]. A significant correlation between the US scores (R = 0.68) and between the US scores and the JSN-SENS (R = 0.61 and R = 0.63 for the semi-quantitative and quantitative method, respectively) was found. The frequency of cartilage abnormalities was similar between the two US methods in RA patients (58.8% and 51.0% of RA patients for the semi-quantitative and quantitative method, respectively; P = 0.46), while the former revealed more abnormalities in HCs (27.5% and 7.5% of HCs; P = 0.02). The higher feasibility of the OMERACT semi-quantitative score suggests its use as a first-choice method in the evaluation of cartilage damage. However, despite its limits, the quantitative assessment of HCs, providing patient-tailored information with age- and sex-corrected cut-off values, may represent a valid supplement for optimizing the evaluation of cartilage damage in selected cases.

Simple Erosion Narrowing Score of the hands as a predictor of cervical spine subluxation in rheumatoid arthritis.

BackgroundInvolvement of the cervical spine is common in patients with rheumatoid arthritis and can lead to devastating or even fatal consequences. Currently no guidelines exist as to whether radiographs of the cervical spine should be included in follow-up visits.ObjectivesTo determine whether the Simple Erosion Narrowing Score (SENS) of the hands correlate with the presence of cervical spine subluxation in patients with rheumatoid arthritis.MethodThis was a retrospective, observational, cross-sectional study. A total of 56 rheumatoid arthritis patients with hand radiographs and lateral radiographs of the cervical spine were evaluated. The SENS of the hands and the presence of cervical spine subluxation were compared. The SENS of the hands was correlated with the prevalence of cervical spine subluxation, as was the erosion and joint space narrowing scores of the hands.ResultsA correlation between the SENS of the hands and the prevalence of cervical spine subluxation was confirmed. A higher prevalence of cervical spine subluxation correlated with an increase in the SENS of the hands (p = 0.0002). The erosion and joint space narrowing scores of the hands also correlated with the prevalence of cervical spine subluxation (p = 0.0001).ConclusionThis study confirmed that a correlation exists between cervical spine subluxation, peripheral joint space erosions and joint space narrowing in patients with rheumatoid arthritis and SENS may therefore be used as a predictor of cervical spine disease.

Association of Dickkopf-1 Polymorphisms With Radiological Damage and Periodontal Disease in Patients With Early Rheumatoid Arthritis: A Cross-Sectional Study.

Rheumatoid arthritis (RA) is a systemic autoimmune disease that increased bone resorption. Periodontal disease (PD) is an associated risk factor of RA. Studies suggest an association between bone markers such as the dickkopf-related protein 1 (DKK-1) and progression of radiological damage. We aimed to evaluate the marker DKK-1, its polymorphisms in patients with early rheumatoid arthritis (eRA), and its association with rheumatic, radiological, and periodontal variables. This is a cross-sectional study. Samples were obtained from 63 patients with eRA. Radiographs of hands and feet were evaluated by Sharp-van der Heijde score (SHS) and Simple Erosion Narrowing Score (SENS). Serum DKK-1 levels and high-resolution fusion analysis was used for polymorphisms (rs1896368, rs1896367, rs1528873). Bivariate analyses were performed. Individuals heterozygous for rs1896367 had more frequent erosions (p = 0.026) and joint space narrowing (p = 0.005) in the feet, higher SHS (p = 0.016), and higher SENS (p ≤ 0.001). Patients homozygous for rs1896368 had less frequent joint space narrowing in hands and feet as assessed by SHS and less presence of erosions by SENS (odds ratio, 0.04; 95% confidence interval, 0.00-0.93; p < 0.05). The presence of PD was associated with the homozygous of rs1896367 (p = 0.009) and the heterozygous of rs1896368 (p = 0.033). Polymorphism rs1896367 seems to be associated with greater radiological compromise; rs1896368 confers protection against bone damage in Colombian eRA patients.

Magnetic resonance imaging of the craniovertebral junction in early rheumatoid arthritis.

To assess the involvement of the atlantoaxial joint in patients with early rheumatoid arthritis (ERA) and to elucidate the risk profile for the individual patient. Consecutive ERA patients (disease duration < 12months) were included in our study. A cervical spine magnetic resonance imaging (MRI) and X-rays (cervical spine, hands, wrists, and feet) were performed in all patients. The MRI features were correlated with clinical, radiological, and biochemical variables. Fifty patients (13 men and 37 women) with a mean age of 58.2years (range, 36-79years) were included in the study. In 12 (24%) patients were detectable MRI findings suggestive of the craniovertebral junction involvement. Compared with patients without cervical involvement, the patients with atlantoaxial synovitis showed a significantly higher anti-citrullinated protein antibodies (ACPA) titer [mean 200.25 UI (SD 262.44) vs. mean 22.05 (SD 40.21) (p < 0.001)]; a worse Disease Activity Score 44 joints (DAS44) [mean 5.72 (SD 0.44) vs. mean 4.52 (SD 0.53) (p < 0.001)]; a worse Health Assessment Questionnaire Disability Index (HAQ-DI) [mean 1.55 (SD 0.37) vs. mean 1.09 (SD 0.33) (p < 0.001)], and a higher Simple Erosion Narrowing Score (SENS) [mean 15.83 (SD 4.52) vs. mean 7.71 (SD 3.43) (p < 0.001)]. The multivariate analysis revealed a meaningful relationship between atlantoaxial synovitis and ACPA, DAS44, and the presence of an erosive disease. The craniovertebral junction is frequently involved in ERA patients. ACPA, high disease activity, and erosive disease at baseline are predictors of atlantoaxial involvement.

Role of ultrasound disease activity score in assessing inflammatory disease activity in rheumatoid arthritis patients

Aim of the workTo evaluate role of ultrasound disease activity score (DAS) in assessing joint inflammation in rheumatoid arthritis (RA), and its correlation with disease parameters. Patients and methodsFifty RA were included. All patients were assessed for DAS-28, health assessment questionnaire disability index (HAQ-DI) and X-ray simple erosion narrowing score (SENS). Power Doppler (PD) and grey-scale (GS) US examination were done for all patients. PDUS score for synovitis in 22 joints and GS score for effusion/hypertrophy in 28 joints were included in US DAS calculation. ResultsThe mean age of the patients was 43.9±10.8years; 46 females and 4 males and the mean disease duration was 8.7±6.1years. The mean DAS28 was 5.04±1.2 and HAQ-DI was 1.2±0.7. The mean US DAS was 5.2±1.3 (2.11–7.21). According to the US DAS, patients with high activity had significantly prolonged morning stiffness, higher swollen and tender joint counts, patient and physician global assessment, DAS-28, HAQ-DI, and SENS compared to those with moderate activity or low activity/remission. The mean US erosion count (USEC) was 8.9±6.6 (0–18) and it was higher in patients with high disease activity (p=0.04). A significant correlation was found between USDAS with DAS28 and HAQ-DI. US DAS showed moderate correlation (r=0.5, p=0.001), while USEC showed a strong correlation (r=0.8, p<0.001) with SENS. ConclusionUS DAS is a feasible scoring system for use in daily rheumatologic practice. US DAS may reflect disease activity and disability. The association between US DAS and USEC with radiologic scoring reflects their ability to detect structural joint damage.

Further Simplification of the Simple Erosion Narrowing Score With Item Response Theory Methodology.

To further simplify the simple erosion narrowing score (SENS) by removing scored areas that contribute the least to its measurement precision according to analysis based on item response theory (IRT) and to compare the measurement performance of the simplified version to the original. Baseline and 18-month data of the Combinatietherapie Bij Reumatoide Artritis (COBRA) trial were modeled using longitudinal IRT methodology. Measurement precision was evaluated across different levels of structural damage. SENS was further simplified by omitting the least reliably scored areas. Discriminant validity of SENS and its simplification were studied by comparing their ability to differentiate between the COBRA and sulfasalazine arms. Responsiveness was studied by comparing standardized change scores between versions. SENS data showed good fit to the IRT model. Carpal and feet joints contributed the least statistical information to both erosion and joint space narrowing scores. Omitting the joints of the foot reduced measurement precision for the erosion score in cases with below-average levels of structural damage (relative efficiency compared with the original version ranged 35-59%). Omitting the carpal joints had minimal effect on precision (relative efficiency range 77-88%). Responsiveness of a simplified SENS without carpal joints closely approximated the original version (i.e., all Δ standardized change scores were ≤0.06). Discriminant validity was also similar between versions for both the erosion score (relative efficiency = 97%) and the SENS total score (relative efficiency = 84%). Our results show that the carpal joints may be omitted from the SENS without notable repercussion for its measurement performance.

HLA-DRB1 alleles in Egyptian rheumatoid arthritis patients: Relations to anti-cyclic citrullinated peptide antibodies, disease activity and severity

BackgroundHuman leukocyte antigen HLA-DRB1 alleles encoding a common amino acid sequence called shared epitope in the third hypervariable region of DRB1 molecule have been identified as risk alleles for rheumatoid arthritis (RA). Aim of the workThe aim was to study HLA-DRB1 01, 04 and 10 alleles in Egyptian RA patients and determine their relation with anticyclic citrullinated peptide (anti-CCP) antibody level, disease activity, clinical and radiological severity. Patients and methodsThe study involved 40 RA patients and 20 control. Simplified disease activity index (SDAI) was calculated, clinical severity was assessed using the mechanical joint score (MJS) and radiological severity evaluated using the simple erosion narrowing score (SENS). HLA-DRB1 genotyping and anti-CCP antibodies were detected. ResultsThe mean patients’ age was 41.6±12.7years and disease duration 8.9±7.7years. The frequency of HLA DRB1 01, 04 and 10 in patients was 42.5%, 60% and 25% respectively. Of them 04 was significantly higher than in controls (p=0.013) and was associated with anti-CCP positive cases (p=0.0008) while the absence of HLA-DRB1 alleles was significantly associated with negative anti-CCP negative RA (p=0.0008). There were significant associations between HLA-DRB1 01 and 04 with SDAI (p=0.0002 and p=0.005, respectively); between HLA-DRB1 04 and 10 with SENS (p=0.002 and p=0.001 respectively) and between HLA-DRB1 01, 04 and 10 with MJS (p=0.02, p=0.03 and p=0.02, respectively). ConclusionHLA-DRB1 04 is associated with RA in Egyptian patients and is strongly associated in the production of elevated titers of anti-CCP antibodies which contribute to the development, severity and activity of the disease.

Comparation Aspect of Scoring Indexes betweens Osteoarticular Scores, Sharp’s Radiographic Indexes in Patients with Rheumathoid Arthritis Patients

Introduction: There are numerous radiographic scoring methods in Rheumathoid Arthritis (RA). The scoring method Sharp/van der Heijde (SHS) is considered “a gold standard” for the assessment of the disease progression in RA. It is reliable but complex scoring method, which is time consuming and is used by well trained readers. The simple erosion narrowing score (SENS) was derived from the SHS method as an easier, quicker and reliable method for joint lesions scoring. Aim: The aim of the present work was to use and evaluate the SENS method, for the first time in Macedonia, in comparison with SHS, and to test the agreement between the readers for the two scoring methods, in a group of patients with established RA. Materials and methods: Evaluation of the patients included collection of demographic and clinical data, physical examination and calculation of the 28-joint disease activity score, (DAS-28). Laboratory tests and bilateral radiographs of the hands, wrists and feet were done in each of the patients. The radiographs were scored in pairs by two independent readers: rheumatologist and experienced radiologist. Results: The study group consisted of 54 RA patients. The mean age of the patients was 54.4 years. The average duration of the disease was 4.74 years with the mean DAS 28 score 5.0.The average radiography scores read by the rheumatologist and radiologist were 43.7 vs.38.4 with the total SENS and 70 vs. 72 for the total SHS method. The interobserver reliability, calculated by the intraclass correlation coefficient (ICC) was 0.77 for SENS and 0.88 for SHS score. Conclusion: The performances of SENS method were good and the reading was very fast and easy. The agreement between the readers was higher for the more detailed SHS score.

A Comparison of Two Radiography Scoring Methods Used by Rheumatologists and Radiologists in Patients with Established Rheumatoid Arthritis

Background : There are numerous radiographic scoring methods in rheumatoid arthritis (RA). The scoring method Sharp/van der Heijde (SHS) is considered “a gold standard” for the assessment of the disease progression in RA. It is reliable but complex scoring method, which is time consuming and is used by well trained readers. The Simple Erosion Narrowing Score (SENS) was derived from the SHS method as an easier, quicker and reliable method for joint lesions scoring. Aim : The aim of the present work is to use and to evaluate the SENS method, for the first time in Macedonia, in comparison with SHS, and to test the agreement between the readers for the two scoring methods, in a group of patients with established RA. Materials and Methods : Evaluation of the patients included collection of demographic and clinical data, physical examination and calculation of the 28-joint Disease Activity Score (DAS-28). Laboratory tests and bilateral radiographs of the hands, wrists and feet were done in each of the patients. The radiographs were scored in pairs by two independent readers: rheumatologist and experienced radiologist. Results : The study group consisted of 54 RA patients. The mean age of the patients was 54,4 years. The average duration of the disease was 4,74 years with the mean DAS 28 score 5,0. The average radiography scores read by the rheumatologist and radiologist were 43,7 vs. 38,6 for the total SENS and 70 vs. 72 for the total SHS score. The interobserver reliability was calculated by the intraclass correlation coefficient (ICC) which was 0,77 for SENS and 0,88 for the SHS score. The intraobserver reliability was 0,76 vs 0,74 for the rheumatologist and radiologist, respectively. Conclusion : The performances of SENS method were good and the reading was very fast and easy. The agreement between the readers was higher for the more detailed SHS score.

FRI0073 Predictive factors for unfavorable outcomes in early rheumatoid arthritis: a prospective multicenter cohort study in argentina.

BackgroundRheumatoid arthritis (RA) is known to have a variable course resulting in a wide range of outcomes, varying from a mild disease causing hardly any impairment to severe disease leading...

AB0414 Predisposing factors in the development of lesions of the cervical spine in patients with rheumatoid arthritis

BackgroundInvolment of the cervical spine in patients with RA is particulary important for the injury of the neurogical structures.ObjectivesThe main aim of the present study was to determine the predisposing...

Comparison of radiographic scoring methods in a cohort of RA patients treated with anti-TNF therapy

To compare the ability of the simple erosion narrowing score (SENS) to classify radiographic progression relative to the Sharp/van der Heijde score (SHS) in a prospective cohort of anti-TNF-treated RA patients. Radiographs of the hands, wrists and feet of patients enrolled in a pharmacovigilance programme are performed every 2 years. These radiographs were read in chronological order by three rheumatologists and scored using the SHS. SENS scores were derived from the SHS. Additionally, one rheumatologist scored the radiographs using the SENS method only. Patients with radiographic progression in excess of the smallest detectable change were classified as progressors. The probability of agreement and κ-value between the SHS and SENS methods for determining progression was calculated. A sample of 25 patients was selected from the database. The annualized mean (s.d.) change in SHS score was 6.61 U (7.48 U) and in SENS score was 2.27 U (2.17 U). Five patients were classified as progressors using SHS and seven using SENS, with a probability of agreement of 84% (κ = 0.565). The SENS method captures radiographic progression reliably compared with the more detailed SHS method. SENS is suitable for application in clinical practice or in observational cohorts.

Bone Mineral Density Changes in Patients with Recent-Onset Rheumatoid Arthritis

Background:Osteoporosis and related fragility fractures are one of the most common complications seen in patients with rheumatoid arthritis (RA) and dramatically affect quality of life.Objective:To evaluate changes in bone mineral density in patients with recent onset rheumatoid arthritis (<1 year) and its correlation if any with a modified DAS-28 score and simple erosion narrowing score (SENS).Methods:This study included 30 patients with recent-onset rheumatoid arthritis fulfilling the new American College of Rheumatology/European League Against Rheumatism diagnostic criteria for rheumatoid arthritis and 20 healthy volunteers as controls. All were subjected to a complete blood count, erythrocyte sedimentation rate, C-reactive protein, liver function tests, renal function tests, rheumatoid factor, and plain x-rays of the hands and feet. Dual-energy x-ray absorptiometry DEXA was used to measure bone mineral density (BMD) of the left proximal femur, lumbar spine (L1–L4), and lower distal radius at the time of recruitment.Results:In the RA patients, 13.3% had osteoporosis, 50% had osteopenia, and 36.7% had normal BMD. The most common site of osteoporosis was the lumbar spine (four patients, 13.3%) followed by the femur (two patients, 6.6%), and forearm (only one patient, 3.3%). There was a significantly higher percentage of osteoporosis among RA males than females and the difference was statistically significant (P = 0.009). Osteoporosis was more common in patients treated with corticosteroids and disease modifying antirheumatic drugs (DMARDs) than in patients treated with only nonsteroidal anti-inflammatory drugs (P = 0.004). Higher disease activity (DAS-28) was found in RA patients with osteoporosis compared to RA patients with normal BMD or osteopenia, but the difference was not statistically significant. Osteoporotic RA patients were found to have a higher SENS score for radiological damage than nonosteoporotic ones.Conclusion:BMD changes do occur in patients with early RA, and are not necessarily correlated with disease activity (DAS-28). However, a significant negative correlation was found between BMD and the score of radiological damage (SENS). Dual energy x-ray absorptiometry is an important investigation to assess BMD in early RA patients.

Antibodies to Mutated Citrullinated Vimentin in Rheumatoid Arthritis: Diagnostic Value, Association with Radiological Damage and Axial Skeleton Affection

Early definitive diagnosis and effective treatment are mandatory in rheumatoid arthritis (RA) as it can halt the disease progression and subsequent joints destruction. To investigate the diagnostic and prognostic value of anti-mutated citrullinated vimentin (anti-MCV) and its correlation with disease activity, peripheral and axial skeleton affection in RA patients. A total of 123 patients with different rheumatic diseases were enrolled in a prospective-two year study at Ain Shams University hospital: 64 patients with RA and 59 patients with other rheumatic diseases as controls. RA patients were fulfilling the traditional and the new ACR/EULAR diagnostic criteria for RA. They have been followed up for two years. At baseline, all RA patients were subjected to: Clinical assessment of disease activity by taking full histories, general and local examination, measurement of 28 joint count of tender and swollen joints with calculation of disease activity score (DAS-28) for each patient. Complete blood count, erythrocytes sedimentation rate, C-reactive protein and rheumatoid factor titers were performed. Anti-MCV IgG immunoglobulins' assay was performed at the study endpoint by ELISA. RA patients were then classified into; anti-MCV positive and anti-MCV negative groups for statistical comparison. Plain X-ray was performed on the peripheral joints and scored by the Simple Erosion Narrowing score (SEN-score). Magnetic Resonance Imaging (MRI) scans were carried out to 22 RA patients on cervical and lumbosacral regions. Anti-MCV antibodies were found to be of high sensitivity (79.6%) and specificity (96.6%) in diagnosing RA. The area under the curve was 0.893 at 95% confidence interval (CI), confers an odds ratio of 23.5. Anti-MCV positive RA patients had significantly higher DAS-28 and SEN-scores than anti-MCV negative patients; who were found to have more benign disease with lower incidence of erosions (P < 0.05). MRI scans revealed that; 17/22 (77%) had cervical joints involvement while, 8 (36%) had lumbo-sacral joint lesions (P < 0.05), both were correlated significantly with aggressive peripheral joint disease. Anti-MCV antibodies are promising diagnostic and prognostic marker in RA, with high sensitivity and specificity. They may identify a subset of RA patients with aggressive early erosive disease. The axial skeleton-especially the cervical spine-could be affected in RA and this was correlated with aggressive peripheral joints' disease. MRI scanning is a sensitive method for detecting axial skeleton involvement in RA, in attempt for better disease control and outcomes.

Relationship between bone mineral density and radiologic scores of hands in rheumatoid arthritis.

This study proposed to assess the relationship between hand bone mineral density (BMD) and radiographic scoring methods, important measures to assess the course of rheumatoid arthritis. Hand, spine, and femur BMD of 49 patients with rheumatoid arthritis and 34 age- and sex-matched healthy control subjects were measured using dual X-ray absorptiometry and the results were compared. Standard hand films of patients were scored according to five different scoring methods--Larsen method, modified Larsen method, Sharp/van der Heijde modified method, carpo:metacarpal ratio, and simple erosion narrowing score (SENS)--and were correlated with hand BMD. There was a moderate relationship between hand BMD measurements and radiologic scores. SENS was the method that correlated significantly with the highest correlation coefficient. Hand BMD correlated significantly with disease duration and c-reactive protein levels. Hand BMD in patients with rheumatoid arthritis was significantly lower than in control subjects, whereas there was no significant difference in axial BMD measurements. The advantages and disadvantages of hand BMD and radiographic scoring methods were determined. Our results indicate that hand BMD measurements may be as useful is assessing the course of rheumatoid arthritis as radiologic scoring methods. However to prove this, a well-designed reference population for hand BMD and longitudinal studies are required.

Reliability and sensitivity to change of a simplification of the Sharp/van der Heijde radiological assessment in rheumatoid arthritis.

To determine the reliability and sensitivity to change of a simplified radiological scoring method [simple erosion narrowing score (SENS)] for rheumatoid arthritis (RA). SENS was compared to the Sharp/van der Heijde score (SHS) as a gold standard. Sets of seven radiographs of hands and feet were taken of 20 RA patients with a wide spectrum of radiological damage. For 14 patients, these seven radiographs were taken during a follow-up period of 5 yr, and for six patients during a follow-up of 10 yr. Each set of radiographs was scored twice by the same observer (DvdH). Erosions and joint space narrowing were scored with SHS (range 0-448) in 32 and 30 joints in the hands, respectively, and both in 12 joints in the feet. SENS gives a score of 1 if there is any erosion in a joint and also 1 if there is any narrowing in the joint (range 0-86). In each case, SENS was derived from SHS. To analyse data, generalizability theory and repeated measurements ANOVA were used. The overall reliability coefficient was 0.81 for SHS and 0.80 for SENS. Intra-observer reliability [intraclass correlation coefficient (ICC)] was 0.99 and 0.98 for SHS and SENS, respectively. The ICC for the sensitivity to change was 0.84 for SHS and 0.88 for SENS. The smallest detectable difference (SDD) could be determined for both methods. The presence of progression based on this SDD was very comparable between the two methods. The measurement properties of SENS are good and comparable to SHS. This makes SENS suitable for use in clinical practice and in large (epidemiological) studies, especially in the first years of disease.