A modified Sharp/van der Heijde score can be used to evaluate X-rays of the hands and feet in patients with gout.
Joints examined:
(1) proximal interphalangeal joints of both hands (5 per hand)
(2) metacarpophalangeal joints (5 per hand)
(3) carpal and wrist (5 per side)
(4) metatarsophalangeal joints of both feet (5 per foot)
(5) first interphalangeal joint of toes (1 per foot)
Areas for erosion in each hand: 16
Areas for joint space narrowing in each hand: 15
Areas for erosion in each foot: 6
Areas for joint space narrowing in each foot: 6
Analysis:
(1) Sharp/van der Heijde joint space narrowing score
(2) Sharp/van der Heijde erosion score
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Joint Space Narrowing, Subluxation, Luxation
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Points
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normal joint space
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0
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focal narrowing
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1
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generalized narrowing <= 50% (>= 50% left)
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2
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generalized narrowing > 50% (< 50% space left)
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3
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subluxation
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3
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bony ankylosis or complete luxation
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4
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Erosion Score for Hands
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Points
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none
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0
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discrete
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1
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intermediate
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2
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large and > 50% of joint surface
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3
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intermediate
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4
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complete collapse of the joint or full surface affected
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5
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For the feet both joint surfaces of the examined joint are scored for erosions, giving a range from 0 to 10.
composite score =
= (joint space narrowing score) + (erosion score)
Interpretation:
• minimum composite score for each site: 0
• maximum composite score for each site of hand: 9
• maximum composite score for each site of foot: 14
Additional features (extra-articular erosions, joint space widening, ankylosis) were infrequent and scoring these findings did not increase the reliability of the final score.
