Patterns of disease progression in the rheumatoid wrist: a long-term followup

To identify different patterns of disease manifestation and changes in the rate of progression of rheumatoid arthritis (RA) in the wrist.

Forty wrists, with normal baseline radiographs, of 20 patients with RA were evaluated by means of a retrospective radiographic review for a period of at least 15 years.

Radiographical scores for damage (Larsen method) and malalignment (carpal collapse and ulnar translocation index; radial deviation of the wrist and ulnar shift of the fingers) showed progression with increasing disease duration for all patients. Women had higher Larsen scores than men (p < 0.05) and rheumatoid factor positive patients had higher Larsen scores than rheumatoid factor negative patients. For all 3 left-handed patients the dominant scores were somewhat higher than the right-handed scores, but the difference was not significant. For the 17 right-handed patients no differences were found between the dominant and the left hand. Early in the course of the disease 4 types of wrist involvement can be identified on the basis of the first localization of damage in the wrist (central, radial, ulnar, and diffuse type). Radial deviation of the wrist was increased in wrists with "central" involvement compared to wrists with "diffuse" involvement (p < 0.05). Furthermore, radial deviation of the wrist was positively correlated with ulnar drift of the fingers (p < 0.01).

Wrist involvement was found to play an important role in the typical rheumatoid deformity of the hand. Early treatment of the wrist is proposed to prevent this deformity.