Numerous methods for reading abnormalities of rheumatoid arthritis in hand and wrist radiographs have been proposed over the past several decades. There are many differences among these methods, one of the more striking of which is the variation in the number of joints that are scored. In this study, we tested the number of joints that need to be read in order to represent abnormalities accurately and reproducibly, using the scores of multiple observers. Thirteen rheumatologists and radiologists each read a set of 41Presented at a workshop sponsored by the Joe and Betty Alpert Arthritis Center, Rose Medical Center, Denver, CO, November [28][29] 1983.Supported by a grant from the Eli LiHy Company, Indianapolis, IN.John T. Sharp hand and wrist films from patients with rheumatoid arthritis. Ten of 13 readers scored 27 joints in each hand and wrist; the other 3 readers scored fewer areas. Fourteen combinations of joints were selected based on the frequency of involvement and the technical adequacy of routine films in assessing a given area. After testing these 14 different combinations, 1 scheme, which included 17 areas read for erosions and 18 areas read for joint space narrowing, was tested further. The correlation coefficients for 10 intraobserver scores derived from this modified scheme compared with the original scores were between 0.981 and 0.997. Seventy-one of 78 interobserver comparisons were better using the new scheme than using the original scheme. These data indicate that the simplified scheme, using a combination of 17 joints to score erosions and 18 to score joint space narrowing, more accurately reflects the extent of abnormalities perceived by a panel of experts than does the original scheme. This abbreviated number of joints shortens the amount of time required to read a set of films and simplifies the scoring of films, since a number of areas that are difficult to read are eliminated from radiographic assessment.Destruction of bone and cartilage is a regular consequence of persistent, active synovitis in patients with rheumatoid arthritis (RA). Because finger and wrist joints are frequently involved in this disease, a number of investigators over the past several decades have proposed that an assessment of the severity of erosions and cartilage loss in hand and wrist joints, logically, would represent an index of the outcome of this disease process (1-6). More recently, it has been proposed that individual joints should be scored separately and the scores summed in order to accurately

Methods of scoring osseous defects and joint space narrowing in the hands and wrists of patients with definite or classical rheumatoid arthritis were devised. The usefulness of the scores was tested i n a group o f 90 patients who had one or more sets of X-ray films of the hands and wrists 36 months or more after onset of illness. Correlations were found between the extent of radiographic abnormalities or the rate of progression of radiographic changes and the age at onset, hand and wrist deformities, preceding physical signs of inflammation in the joints of the hands and wrists, hand function as measured by fist formation, the early appearance of subcutaneous nodules, and the titer of anti-lgG. Among black patients the extent of elevation of ,,-globulins was associated with roentgenographic changes. The correlations between the scores of radiologic abnormalities and the clinical and laboratory manifestations of rheumatoid arthritis establish the value of the described methods of assessing the roentgenographic changes and indicate the usefulness of these methods in evaluating the effect of therapy in this disease.

Forty-one coded radiographic films from 16 patients with rheumatoid arthritis were read by 13 observers, using 4 different methods for scoring abnormalities. Although absolute scores differed widely among individual observers, correlation coefficients were greater than 0.850 for approximately 2 of 3 comparisons. When films were ranked, using the median rank of all readers, 72% of individual ranks were within 10% of the median ranks. Among serial films on individual patients, 92% of comparisons between early and late films were interpreted as demonstrating progression of abnormalities when mean standardized scores showed an increase in scores of 15 units or greater. Films with lesser changes were interpreted inconsistently. This study shows good general agreement among readers in scoring radiologic abnormalities of hands and wrists, when applied to a film set showing a broad spectrum of severity, and defines the sensitivity of radiologic detection of disease progression.

The presence of lymphocyte cytotoxic antibodies in sera from patients with SLE was related to the presence of fever and dermatologic, central nervous system and hematologic symptoms. Cytotoxic antibodies correlated inversely with the white blood count and serum complement C3. Possibly, the action of lymphocytotoxic antibodies on cell membranes may lead to complement-mediated cell injury which, in turn, results in release of intracellular contents and nuclear antigens.In systemic lupus erythematosus (SLE) the pathogenesis of the disease is not entirely clear, serum contains antibodies directed against although antibodies which have antinuclear nuclear and cytoplasmic constituents of cells. specificities have been eluted from kidneys (2) Tissues, particularly the kidney and skin, may and spleen vessels (3) of patients with SLE. It is contain deposits of immunoglobulins (1). The thought that perhaps these antibodies are deprecise role that these antibodies play in the posited within tissues as a complex with hoFrom the

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