Scoring Method Successfully Identifies Joint Damage in Rheumatoid Arthritis Patients

The study’s findings were presented at EULAR 2013, the annual congress of the European League Against Rheumatism, held June 12-15, 2013, in Madrid, Spain, and confirmed the use of ARASHI to evaluate joint damage in RA, and clarified the pattern of progression of damage during two-year tumor necrosis factor (TNF)-blocking therapies. In addition to validating the effectiveness of the scoring method, the data also showed that hip and knee joints with preexisting damage were predisposed to continue destruction, even during two-year treatment with TNF-blocking therapies.

RA is a chronic, inflammatory, autoimmune disease that affects approximately 1 in 100 worldwide. It can cause pain, stiffness, joint destruction, and deformity, and reduce quality of life, life expectancy, and physical function. “Radiographic damage is directly correlated to functional disability, overall severity, and pain in patients with RA. At present, radiographic damage of large joints is commonly evaluated by Larsen grade, which has severe limitations, including a ceiling effect within the grade,” commented the study’s lead author Dr. Isao Matsushita, department of orthopedic surgery, Faculty of Medicine, University of Toyama (Japan). “These data highlight the need for better scoring and evaluation, without which, progression of damage and patient needs cannot be accurately assessed.”

Fifty-one patients with a mean age of 59.9 years old were enrolled in the study; each fulfilled the ACR 1987 revised criteria. Those with a history of surgical intervention were excluded from analysis. Radiographic findings were evaluated at baseline using the ARASHI status score, and at one and two years after TNF-blocking therapies (infliximab, etanercept, or adalimumab) using the ARASHI change score.

ARASHI status score consists of four categories: joint space narrowing (0–3 points), erosion (0–3 points), joint surface (0–6 points), and stability (0–4 points), (total score range 0–16). ARASHI change score consists of five categories; porosis (-1–1 point), joint space narrowing (-1–2 points), erosion (-2–2 points), joint surface (-6–6 points), and stability (-1–1 point), (total score range -11–12). An increase in more than 1 point of change score was considered as progression of joint damage. 　

“Patients with preexisting damage demonstrated significant increases in the ARASHI change score during two-years of TNF-blocking therapy; highlighting progressive destruction even under drug therapy. These data show that joints are best protected with early and accurate evaluation, to ensure they do not exceed an ARASHI score of two, prior to the start of drug treatment,” concluded Dr. Isao Matsushita.

ACR 1987 revised criteria: For a diagnosis of RA patients must satisfy at least four of seven criteria (morning stiffness, arthritis of three or more joint areas, arthritis of hand joints, symmetric arthritis, rheumatoid nodules, serum rheumatoid factor, and radiographic changes). Criteria one through four must have been present for at least six weeks. Patients with two clinical diagnoses are not excluded. Designation as classic, definite, or likely rheumatoid arthritis is not to be made.

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