van der Heijde modification of Sharp score of joint involvement by rheumatoid arthritis on plain radiographs
A) Erosion score
The van der Heijde modification of the Sharp erosion score includes 16 areas from each hand and wrist, 10 metatarsophalangeal joints on both sides and two interphalageal joints of the big joints. The maximum erosion score is 160 for hands:
- 5 metacarpophalangeal joints (MCP)
- 4 proximal interphalangeal joints (PIP)
- interphalangeal joint of the thumb (IP)
- radius
- ulna
- trapezium and trapezoideum as one unit (multangular)
- scaphoid
- lunate
and 120 for feet:
- 5 metatarsophalangeal joints
- interphalangeal joint of the big toe (IP)
| Score | Description |
|---|---|
| 0 | Normal |
| 1 | Discrete erosions |
| 2 | Larger erosions |
| 3 | Larger erosions |
| 4 | Erosions extending over middle of the bone |
| 5 | Complete collapse |
B) Joint space narrowing score
Joint space is assessed in 15 regions in each hand:
- 5 metacarpal joints (MCP)
- 4 proximal interphalangeal joints (PIP)
- 3rd to 5th carpometacarpal joints (CMC)
- multangular bone
- radiocarpal
and 6 regions in each foot:
- 5 metatarsophalangeal joints (MTP)
- interphalangeal joint of the big toe (IP)
giving a maximum score of 120 in the hands and 48 in the feet.
| Score | Description |
|---|---|
| 0 | Normal |
| 1 | focal or doubtful |
| 2 | generalised, <50% of the original joint space |
| 3 | generalised, >50% of the original joint space or subluxation |
| 4 | bony ankylosis or complete luxation |
References:
1. Boini S, Guillemin F. Radiographic scoring methods as outcome measures in rheumatoid arthritis: properties and advantages. Ann Rheum Dis. 2001 Sep 1;60(9):817–27.
2. Van der Heijde DM, van Riel PL, Nuver-Zwart IH, Gribnau FW, vad de Putte LB. Effects of hydroxychloroquine and sulphasalazine on progression of joint damage in rheumatoid arthritis. Lancet. 1989 May 13;1(8646):1036–8.