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Larsen grades in evaluating the first carpometacarpal joint.
E A Belt1, J I Lehtivuori, K Kaarela
1Rheumatism Foundation Hospital, Heinola, Finland.
Scandinavian Journal of Rheumatology
|November 24, 1999
Summary
This study illustrates Larsen grades for the carpometacarpal joint (CMC I) in rheumatoid arthritis (RA) progression. Separate CMC I monitoring is crucial for understanding RA
Area of Science:
- Rheumatology
- Radiology
- Orthopedics
Background:
- Rheumatoid arthritis (RA) commonly affects the carpometacarpal joint (CMC I).
- Assessing CMC I joint destruction is vital for RA management.
- Larsen grading is a standard method for evaluating joint damage in RA.
Purpose of the Study:
- To visually demonstrate the different Larsen grades of CMC I involvement in rheumatoid arthritis.
- To highlight the progression of CMC I destruction over a 20-year period.
- To assess the reliability of CMC I grading in RA.
Main Methods:
- Prospective follow-up of 103 seropositive RA patients over 20 years (Heinola Follow-up Survey of Arthritis).
- Serial hand radiography at multiple time points (onset, 1, 3, 8, 15, 20 years).
- Selection of one patient with all Larsen grades for CMC I to illustrate disease progression; inter- and intraobserver variability assessed using Weighted Kappa test.
Main Results:
- Illustrations and schematic presentations of various Larsen grades for CMC I destruction are provided.
- Interobserver agreement for CMC I grading was 0.75 (Weighted Kappa).
- Intraobserver agreement for CMC I grading was 0.82 (Weighted Kappa).
Conclusions:
- The study emphasizes the importance of evaluating CMC I joint destruction independently from the entire wrist (carpus) in RA.
- Consistent and reliable grading of CMC I is achievable.
- Monitoring CMC I progression aids in a more comprehensive understanding of RA's impact on hand function.