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Destruction and reconstruction of hand joints in rheumatoid arthritis. A 20 year followup study
Objective:
To examine the radiographic endpoint changes and performed joint fusions and arthroplasties in hand joints in rheumatoid arthritis (RA) occurring over a 20 year period.
Methods:
In 83 patients with recent (< 6 months) rheumatoid factor positive RA, radiographs were taken at 15 and 20 years from entry. The Larsen grades for 12 hand joints were evaluated, as well as the preoperative grades for reconstructed joints. Data of the performed hand joint fusions and arthroplasties were obtained.
Results:
At 15 year followup the mean Larsen grade of wrist joints was 2.5, metacarpophalangeal (MCP) I-V 1.0-1.8, and interphalangeal I and proximal interphalangeal (PIP) II-V 0.7-0.9. At the endpoint the mean grades were: wrist joint 2.7, MCP I 1.1, MCP II 2.2, MCP III 1.9, MCP IV 1.3, MCP V 1.5, IP I and PIP II-V 0.7-1.0. Modified Larsen grade for carpometacarpal I was 1.6 and 2.0 at 15 year followup and endpoint, respectively. Reconstructive surgery was performed in 33/83 patients. The number of operations was 83, and 38 of them were wrist fusions.
Conclusion:
In this inception cohort, wrist joints had the highest destruction and the need for reconstructive surgery; the grade of destruction was lower in MCP and PIP joints, in this order. Possibilities of reconstructive surgery are discussed.