Measurement of structural abnormalities in arthritis using radiographic images.

This article reviewed the current methods for scoring radiographic abnormalities in RA with emphasis on reliability. There is disagreement on the expected course of RA with usual treatment and there is no clear resolution of this disagreement although several factors that contribute to this disagreement have been identified. Scoring joint damage has been effective in establishing benefit from drug treatment for nine agents, five within the last 3 years. Scoring will continue to be used to examine the benefit of new agents in the immediate years to come. A panel of experienced readers agreed that some repair of erosion damage was seen with available treatment. The extent of damage that is reversible has not been established and the frequency of any degree of repair remains unknown. Several methods of true measurement of erosions and joint space width have been reported. They have not found a place in daily practice or in research studies, probably because experience is too limited to know whether they are more powerful in detecting real progression of disease than scoring methods. Several problems that are related to standardizing methods of measuring joint space width were identified.