Open Access Open Badges Research article

Joint damage in rheumatoid arthritis: assessment of a new scoring method

Alexander Pfeil1*, Peter Oelzner1, Klaus Bornholdt2, Andreas Hansch3, Gabriele Lehmann1, Diane M Renz4, Gunter Wolf1 and Joachim Böttcher5

Author affiliations

1 Department of Internal Medicine III, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany

2 Sanofi-Aventis Deutschland GmbH, Potsdamer Straße 8, 10785 Berlin, Germany

3 Institute of Diagnostic and Interventional Radiology, Jena University Hospital - Friedrich Schiller University Jena, Erlanger Allee 101, 07747 Jena, Germany

4 Department of Diagnostic Radiology, Charité University Medicine Berlin, Campus Virchow Clinic, Augustenburger Platz 1, 13353 Berlin, Germany

5 Institute of Diagnostic and Interventional Radiology, SRH Wald-Klinikum Gera, Straße des Friedens 122, 07548 Gera, Germany

For all author emails, please log on.

Citation and License

Arthritis Research & Therapy 2013, 15:R27  doi:10.1186/ar4163

Published: 13 February 2013



The aim of this study was to assess a novel approach for the quantification of finger joint space narrowing and joint destruction in patients with rheumatoid arthritis (RA) focusing on the peripheral hand articulations.


A total of 280 patients with verified RA underwent computerized semi-automated measurements of joint space distance at the finger articulations based on radiographs. The Z-Score, which can differentiate between joint space alterations caused by RA versus age/gender-related changes, was calculated as a comparative parameter. The severity of joint space narrowing was also quantified by the Sharp Score. Sensitivity and specificity of the Z-Score (based on joint space widths differentiated for each peripheral finger joint) were evaluated to reveal the potential for the occurrence of erosions. Additionally, the potential of the Z-Score regarding the differentiation of therapeutic effects on joint space widths in patients under a therapy of methotrexate versus leflunomide was performed.


The Z-Scores of finger articulations in patients with RA were generally decreased. Metacarpal-phalangeal (MCP) joint articulations showed a continuous significant decline of -1.65 ± 0.30 standard deviations dependent on the Sharp Score. The proximal-interphalangeal joints also revealed a significant reduction of the Z-Score (-0.96 ± 0.31 standard deviations). The sensitivity and specificity of MCP joint space distance for the detection of erosions were 85.4% versus 55.2%. The Sharp Score for joint space narrowing was not able to detect different treatments, whereas an accentuated stabilization of joint space narrowing could be identified for the Z-Score of the MCP joints in patients treated with leflunomide and methotrexate.


The Z-Scoring method based on computer-aided analysis of joint space widths was able to reliably quantify severity-dependent joint space narrowing in RA patients. In the future, calculation of a Z-Score based on gender-specific and age-specific reference data shows the potential for a surrogate marker of RA progression that comprehends the early identification of patients with RA, and in particular those with erosive course of the disease, enabling a timely therapeutic strategy for cartilage protection.