Small joint involvement: a systematic roentgenographic study in rheumatoid arthritis

Area of Science:

• Rheumatology
• Radiology
• Orthopedics

Background:

• Rheumatoid arthritis (RA) is a chronic autoimmune disease characterized by joint inflammation.
• Radiographic assessment of erosions is crucial for monitoring RA progression.
• Understanding the pattern of joint involvement, including symmetry, aids in diagnosis and management.

Purpose of the Study:

• To analyze the symmetry and distribution of marginal erosions in rheumatoid arthritis (RA) using standard hand and foot roentgenograms.
• To determine the correlation between erosion patterns, disease duration, and seropositivity in RA patients.

Main Methods:

• Standard hand and foot roentgenograms from 200 hospitalized RA patients were reviewed by three independent observers.
• Marginal erosions were identified, and the degree of symmetry (absolute, unilateral, partial) was assessed for each joint.
• Statistical analysis was performed to correlate erosion patterns with disease duration and seropositivity.

Main Results:

• Metatarsophalangeal (70%) and metacarpophalangeal (68%) joints showed the highest prevalence of erosions, often with partial symmetry.
• Proximal interphalangeal joints (42%) frequently exhibited unilateral involvement.
• The wrist was the only site where symmetry was usual (90%); overall, roentgenographic asymmetry and unilateral involvement are common in RA.

Conclusions:

• Roentgenographic asymmetry and unilateral joint involvement are characteristic findings in rheumatoid arthritis.
• Disease duration is a significant factor influencing the extent of joint erosions in RA.
• Symmetry patterns of erosions are not influenced by seropositivity in RA patients.