Early changes of rheumatoid arthritis in the hand and wrist

The radiographic diagnosis of rheumatoid arthritis can be suggested long before bone and joint destruction. Soft tissue swelling at the ulnar styloid is classical, but soft tissue swelling also occurs at the PIP and MCP joints. Joint space widening, loss of the lateral fat planes of the wrist, and radial carpal narrowing can all be seen prior to bony change. The earliest bony change is loss of the cortical white line on the radial aspect of the fourth and fifth metacarpal heads.