Patient accrual for the study was slow, and in the meantime, Dr. Sharp left Ford for Baylor College of Medicine in Houston. Characteristically, he maintained good relationships with his former colleagues, and credits the efforts of Gilbert Bluhm, MD, a rheumatologist in Troy, Mich., in bringing the study to completion. The X-ray method was published in 1971 and the gold study in 1974.1,2 Modifications of the score followed almost immediately, explains Dr. Sharp, whose intent was to develop a method that was user-friendly for clinicians.
“At the time [that Dr. Sharp began his work], we were using improvement methodology that was archaic and mostly dependent upon patient report and very little that was validated,” notes Dr. Simon. “He was a lone voice out there suggesting that, in fact, we could do an objective measurement, that it could be done by a rheumatologist, and that it is reproducible, accurate, and can be monitored over the long term.”
Sharing the Wealth
Outcome measures in rheumatology have come a long way since the beginning of Dr. Sharp’s career, and much of that advancement, assert his colleagues, is due to his innovations. As a member of the steering committee of OMERACT, (Outcomes Measures in Rheumatoid Arthritis Clinical Trials), Dr. Simon has interacted often with Dr. Sharp, whose passion for standardized outcome measures continues to blossom.
“In 1999,” says Dr. Simon, “the work became legitimized when the FDA said that, for approval of a drug or a therapeutic for the treatment of structural progression in rheumatoid arthritis, the Sharp score was one of the acceptable methodologies. He stuck to his guns, and he then won—and he was correct. That’s a very important addition to the profiles of how evidence is accumulated in our field. And the work he’s doing now, which is to look at the question of measuring healing with this similar methodology, continues to be seminal.”
Since its initial development, the Sharp score has undergone many modifications, about which he is characteristically gracious. Desiree van der Heijde, MD, PhD, professor of rheumatology at University Hospital Maastricht in the Netherlands, first became aware of his work while doing her PhD thesis in 1986. Three years later, in 1989, she published her first modification of the Sharp Score, in which the erosion score for the MTP joints in the feet is doubled, to a total of 10.3 The hand erosion scores remain the same as in the original Sharp score, and joint subluxation is also included in the joint space narrowing score.
Great Man in the Field
Dr. van der Heijde recalls how excited she was, as a young researcher, to meet Dr. Sharp for the first time at the ACR. “Meeting him, as the great man in this field, was wonderful for me. He always wants to show his development of the score as just an ordinary thing which he has done,” she continues. “And he’s also very willing to share everything. He never keeps things for himself—he’s willing to share credits and new developments.”
