Ability of Oblique Foot Radiographs to Detect Erosions in Early Arthritis: Results in the ESPOIR Cohort

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To assess the usefulness of using oblique foot radiographs in addition to posteroanterior radiographs of the hands and feet for detecting erosions in patients with recent-onset arthritis.


We included 813 patients from the prospective French ESPOIR cohort with arthritis of <6 months' duration and ≥2 swollen joints. Baseline standardized posteroanterior radiographs of the hands and feet and oblique radiographs of the feet were assessed by 2 blinded readers for erosions typical for rheumatoid arthritis (ETRA) and the Sharp score as modified by van der Heijde.


A total of 715 complete sets were available. Mean ± SD total Sharp scores were 3.6 ± 6.6, 2.5 ± 6.3, and 1.8 ± 5 for the hand and wrist, foot, and oblique foot, respectively. ETRA were visible in 160 (22.4%) of 715 patients (95% confidence interval [95% CI] 19.4–25.6). They were seen on hand radiographs in 86 (53.7%) of 160 patients (95% CI 45.7–61.6), on posteroanterior foot radiographs in 91 (56.9%) of 160 patients (95% CI 48.8–64.6), and on oblique foot radiographs in 84 (52.5%) of 160 patients (95% CI 44.5–60.4). ETRA were visible at the feet, but not at the hands, in 74 (46%) of 160 patients (95% CI 38.4–54.3), among whom 22 (30%) had erosions only on the posteroanterior view, 16 (21%) only on the oblique view, and 36 (48.6%) on both.


ETRA were found in 22.4% of patients. Adding an oblique foot radiograph identified 16 (10%) of 160 additional patients (95% CI 6–16), compared with 27.5% and 13.8% identified by adding posteroanterior radiographs of the hands and feet, respectively.

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