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Sharp Score — SCE Rheumatology MCQ

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ModerateMusculoskeletal ImagingSharp ScoreSCE Rheumatology

A 50-year-old woman with rheumatoid arthritis undergoes radiographs of both hands and feet to quantify structural progression using the Sharp/van der Heijde method. Which pair of abnormalities forms the principal radiographic subscores in this method?

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Correct answer: C — Bone erosions and joint-space narrowing at predefined joints

The Sharp/van der Heijde method quantifies structural damage from rheumatoid arthritis using separate scores for **bone erosions** and **joint-space narrowing** at predefined sites on hand, wrist and foot radiographs. These are summed to produce the total score; increasing scores indicate increasing radiographic damage. Periarticular osteopenia may occur in rheumatoid arthritis but is not a component of this score. Soft-tissue swelling, synovial thickening and tenosynovitis reflect inflammatory activity rather than the structural lesions quantified by the method; the latter two are better assessed with ultrasound or MRI. Osteophytes and subchondral sclerosis are primarily osteoarthritic radiographic features and are not Sharp/van der Heijde components.

Reference: Deimel T et al. autoscoRA: Deep Learning to Automate Sharp/van der Heijde Scoring of Radiographic Damage in Rheumatoid Arthritis. Arthritis & Rheumatology. 2026. https://pubmed.ncbi.nlm.nih.gov/42011795/