Carpal predominance in rheumatoid arthritis

Radiographic and clinical evaluation of the relative severity of wrist versus hand involvement in 101 patients with rheumatoid arthritis revealed more severe changes in the wrists in 60%, equal involvement in wrists and hands in 37%, and more severe changes in the hands in 3%. There were severe changes in the wrists but little or no bone or joint change in the metacarpophalangeal and proximal interphalangeal joints in 43 (21%) of the 202 extremities studied. Serial examinations showed that, in time, the hand changes tended to overtake those in the wrist. Appreciation of this progression of wrist and hand changes can help the physician avoid diagnostic difficulties in a significant percentage of patients.