Plant M J, Saklatvala J, Borg A A, Jones P W, Dawes P T
Staffordshire Rheumatology Centre, Haywood Hospital, Stoke-on-Trent, England.
J Rheumatol. 1994 Oct;21(10):1808-13.
To compare radiological scoring systems in early RA, and then to determine if the rate of radiological progression in the first year of disease (RRP01) predicts the subsequent rate of progression up to 8 years (RRP1-8).
Hand and feet radiographs were performed at 0, 1, 2 and 8 years in 65 patients presenting with nonerosive RA and symptoms for less than 3 years. All films were scored by Sharp's method; Sharp, Larsen and carpometacarpal (CMC) ratio methods were compared in 23 patients.
Significant change in score was detected over the first year using Sharp (median of 15.5 vs 7.5, p < 0.00002) and Larsen (30.5 vs 22.5, p < 0.0002), but not CMC ratio (1.13 vs 1.14, p = 0.07). Sharp had greater range and sensitivity of change, and had better inter and intraobserver reproducibility. RRP01 showed a skewed distribution (median 0.7 units/month; range -0.3 to +6.1). Spearman correlation between RRP01 and RRP1-8 was r = 0.57, p < 0.001.
Both Sharp and Larsen indices are sensitive to change in the first year of RA, but Sharp has advantages of greater sensitivity and reproducibility: CMC ratio is not useful. Radiological progression rate in the first year correlates only moderately with subsequent rate of progression up to 8 years. This suggests that radiological progression is nonuniform and that different patterns of progression over time may exist.
比较早期类风湿关节炎（RA）的放射学评分系统，然后确定疾病第一年的放射学进展率（RRP01）是否能预测随后长达8年的进展率（RRP1 - 8）。
对65例非侵蚀性RA且症状持续时间少于3年的患者在0、1、2和8年时进行手和足部X线片检查。所有片子均采用夏普（Sharp）方法评分；对23例患者的片子采用夏普、拉森（Larsen）和腕掌关节（CMC）比值法进行比较。
使用夏普方法（中位数15.5对7.5，p < 0.00002）和拉森方法（30.5对22.5，p < 0.0002）在第一年时检测到评分有显著变化，但CMC比值法（1.13对1.14，p = 0.07）未检测到。夏普方法的变化范围和敏感性更大，且观察者间和观察者内的可重复性更好。RRP01呈偏态分布（中位数0.7单位/月；范围 - 0.3至 + 6.1）。RRP01与RRP1 - 8之间的斯皮尔曼相关性为r = 0.57，p < 0.001。
夏普和拉森指数对RA第一年的变化均敏感，但夏普具有更高的敏感性和可重复性优势：CMC比值法无用。第一年的放射学进展率与随后长达8年的进展率仅呈中度相关。这表明放射学进展是不均匀的，且可能存在不同的随时间进展模式。
