Turkish Journal of Physical Medicine and Rehabilitation 2001 , Vol 47 , Num 3

The Evaluation of Radiographic Damage by 4 Different Methods in Hand X-Rays and the Correlation of Radiologic Changes with Clinical and Laboratory Abnormalities in Patients with Rheumatoid Arthritis

Pınar Borman 1 ,Deniz Cılız 2 ,Ümit Seçkin 3 ,Bülent Sakman 2 ,Işıl Maral 4
1 Hacettepe Üniversitesi Tıp Fakültesi, Fiziksel Tıp ve Rehabilitasyon Anabilim Dalı, Ankara
2 Ankara Numune Eğitim ve Araştırma Hastanesi, Radyodiyagnostik Kliniği, Ankara
3 Ankara Numune Eğitim ve Araştırma Hastanesi, 2. Fiziksel Tıp ve Rehabilitasyon Kliniği, Ankara
4 Gazi Üniversitesi Tıp Fakültesi, Halk Sağlığı Anabilim Dalı, Ankara

The aim of this study was to evaluate the radiographic damage in hand x-rays by 4 different quantitative radiological methods and to compare the radiologic scores of different methods by each other and by measures of functional status, clinical and laboratory variables in patients with rheumatoid arthritis (RA). Thirty-three patients with a mean age of 47.5+10.3 years were included in the study. Demographic data, laboratory and clinical activity parameters including pain by VAS, tenderness by Ritchie Articular Index (RAI), erythrocyte sedimentation rate (ESR), C-Reactive protein (CRP), rheumatoid factor (RF) were recorded. Health assessment questionnaire (HAQ) was used to assess functional disability. The degree of destruction in hand x-rays was analysed according to Sharp, modified Larsen, Kaye and Rau methods. There was a significant correlation between the mean score of each radiographic method. All the radiographic scores were highly correlated with duration of disease (p<0.01). The scores were also correlated with age and ESR at lower levels. None of the radiographic scores were correlated with clinical parameters including VAS, CRP, RAI and HAQ scores. The highest correlation coefficients were observed between ESR and the radiographic scores of modified Larsen method. The patients with short disease duration had also high scores according to the joint space narrowing and erosion. All the radiological total scores were higher in sero-positive than in sero-negative patients, but the differences were not statistically significant. In conclusion 4 different radiological scoring methods provided similar data, although various clinial parameters of RA patients correlated only at low levels with radiographic damage. The radiographic damage was found to be more common in early RA than is generally expected. Further longitidunal studies are needed to develop a scoring system that estimate minimally detectable changes to assess severity and predict functional disability.

Keywords : Romatoid artrit, radyolojik hasar, el grafileri.