Korean J Health Promot.  2023 Dec;23(4):209-216. 10.15384/kjhp.2023.23.4.209.

Determination of Distributional Characteristics and Efficacy of Hand Radiographic Damage in Patients with Rheumatoid Arthritis Using a Novel Damage Assessment Method

• Cheong MJ
• Chung CH

• KMID: 2549691
• DOI: http://doi.org/10.15384/kjhp.2023.23.4.209

Abstract

Background
The purpose of this study was to identify the distribution characteristics of radiological damage to the hand of rheumatoid arthritis patients and evaluate its effectiveness using a new damage assessment method.
Methods
Hand radiographs of a total of 127 rheumatoid arthritis patients were evaluated. We simplified the pre-existing van der Heijde modified total sharp score to assess the extent of bone damage. We selected 36 joints in both hands as regions of interest in our own way, and the erosion and joint space narrowing were scored.
Results
When the erosion and joint space narrowing score values of each joint of the hand were added together, the joint space narrowing score was higher than the overall erosion score. We can see that the scaphoid,lunate,radius and ulnar joints have higher erosion scores, and the 4th proximal interphalangeal (PIP), Scaphoid, Lunate, and Radius joints have higher joint space narrowing scores than other joints. These damage assessment results were similar to the results from the previous damage assessment model.
Conclusions
The joint space narrowing score is higher than the erosion score, suggesting that joint space narrowing precedes erosion. When checking the hand X-ray of rheumatoid arthritis patients, it is necessary to carefully check the scaphoid,lunate,radius and ulnar and 4th PIP joints, which relatively high radiographic damage scores. Also, the damage assessment model used in this study is relatively simple and does not show difference in analysis results from existing assessment models, so it can be considered for application in follow-up research.

Keyword

Rheumatoid arthritis, Hand X-ray, Radiographic damage; 류마티스 관절염, 수부 X-선 검사, 방사선학적 손상

Figure

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  Figure 1. (A-C) Region of interest (mTSS and SENS vs. our method). PIP, proximal inter-phalageal; MCP, meta-carpo-phalangeal; IP, inter-phalangeal; PMC, proximal metacarpal; CMC, carpometacarpal; CSL, capitate-scaphoid-lunate; RC, radiocarpal; mTSS, modified total sharp score; SENS, simple erosion narrowing score.

• 

  Figure 2. (A) Total sum of each joint erosion score. (B) Total sum of each joint space narrowing score. PIP, proximal inter-phalangeal; MCP, meta-carop-phalangeal; IP, inter-phalangeal; CMC, carpo-meta-carpal; JSN_R, joint space narrowing_right; JSN_L, joint space narrowing_left.

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  Figure 3. Heatmap of radiographic damage (darker color means more damage).

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  Figure 4. (A-C) Pearson’s coefficient of correlation (r) between the values of mTSS and our method score. (A) Erosion score r=0.986 (P<0.01). (B) Joint space narrowing score r=0.978 (P<0.01). (C) Total score r=0.984 (P<0.01). TSSE, total sharp score erosion; TSSJSN, total sharp score joint space narrowing; TSS, total sharp score; mTSS, modified total sharp score by van der Heijde.

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