Patterns of Involvement of the Hand Joints in Classical Rheumatoid Arthritis.
Journal
Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
ISSN: 1536-7355
Titre abrégé: J Clin Rheumatol
Pays: United States
ID NLM: 9518034
Informations de publication
Date de publication:
01 Aug 2023
01 Aug 2023
Historique:
medline:
24
7
2023
pubmed:
9
5
2023
entrez:
9
5
2023
Statut:
ppublish
Résumé
Symmetrical involvement of the hand joints is described as characteristic of rheumatoid arthritis (RA). Quantitative data on specific patterns of involvement are lacking. The Brigham Rheumatoid Arthritis Sequential Study was created for observational studies of patients with RA and afforded a unique opportunity to answer these questions. Of 1598 subjects in the Brigham Rheumatoid Arthritis Sequential Study cohort, 535 met the following criteria: (1) disease duration of 7 years or greater, (2) seropositive, and (3) hand radiographs available. Patterns in specific hand joints based on physical examination and radiographic findings obtained at entry were identified. The level of symmetry of involvement of the metacarpophalangeal (MCP) and wrist joints was determined, as was the correlation between findings on physical examination and radiographic changes in the hand joints. The prevalence of joint space narrowing and/or erosions in each proximal interphalangeal (PIP) joints ranged between 11% and 18%. Joint space narrowing and/or erosions in the MCPs increased radially from the fifth to the second finger. Swelling and tenderness on physical examination of both the PIPs and MCPs also increased radially although the positive predictive value of physical examination as an indicator of joint damage decreased radially. The wrist was the most common joint involved both by physical examination (67%) and radiographically (70%). The right side was more involved radiographically. Analysis of radiographic changes in individual patients revealed that symmetrical findings in the wrists and MCPs occurred in only 67% of patients. The study describes the pattern of involvement of the hand joints in patients with long standing RA. Findings of interest include symmetrical involvement in only 67% of patients and a discordancy between physical findings and radiographic changes most marked in the more radial PIP joints.
Sections du résumé
BACKGROUND
BACKGROUND
Symmetrical involvement of the hand joints is described as characteristic of rheumatoid arthritis (RA). Quantitative data on specific patterns of involvement are lacking.
OBJECTIVE
OBJECTIVE
The Brigham Rheumatoid Arthritis Sequential Study was created for observational studies of patients with RA and afforded a unique opportunity to answer these questions.
METHODS
METHODS
Of 1598 subjects in the Brigham Rheumatoid Arthritis Sequential Study cohort, 535 met the following criteria: (1) disease duration of 7 years or greater, (2) seropositive, and (3) hand radiographs available. Patterns in specific hand joints based on physical examination and radiographic findings obtained at entry were identified. The level of symmetry of involvement of the metacarpophalangeal (MCP) and wrist joints was determined, as was the correlation between findings on physical examination and radiographic changes in the hand joints.
RESULTS
RESULTS
The prevalence of joint space narrowing and/or erosions in each proximal interphalangeal (PIP) joints ranged between 11% and 18%. Joint space narrowing and/or erosions in the MCPs increased radially from the fifth to the second finger. Swelling and tenderness on physical examination of both the PIPs and MCPs also increased radially although the positive predictive value of physical examination as an indicator of joint damage decreased radially. The wrist was the most common joint involved both by physical examination (67%) and radiographically (70%). The right side was more involved radiographically. Analysis of radiographic changes in individual patients revealed that symmetrical findings in the wrists and MCPs occurred in only 67% of patients.
CONCLUSIONS
CONCLUSIONS
The study describes the pattern of involvement of the hand joints in patients with long standing RA. Findings of interest include symmetrical involvement in only 67% of patients and a discordancy between physical findings and radiographic changes most marked in the more radial PIP joints.
Identifiants
pubmed: 37158761
doi: 10.1097/RHU.0000000000001971
pii: 00124743-990000000-00117
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
230-234Informations de copyright
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
D.H.S. receives salary support from P30 AR072577; D.H.S. receives salary support from research contracts with Brigham and Women's Hospital from Abbvie, Amgen, CorEvitas, Janssen, and Moderna. N.A.S. receives grant support from Mallinckrodt, AMGEN, Bristol Myers Squibb, and Aqtual. N.A.S. receives salary support from research contracts with Brigham and Women's Hospital from Abbvie, Amgen, Aqtual, Eli Lilly, Bristol Myers Squibb, and Jannsen. M.E.W. has the following potential conflicts of interest: research grants from Bristol Myers Squibb, Aqtual, Amgen, and Janssen; consultant for Abbvie, Aclaris, Amgen, Aqtual, Bayer, Bristol Myers Squibb, CorEvitas, Eli Lilly, EQRx, Genosco, GlaxoSmithKline, Gilead, Horizon, Johnson and Johnson, Kyvrena, Pfizer, Rani, Revolo, Scipher, Sci Rhom, Set Point, and Tremeau; and options for Canfite, Inmedix, and Scipher. The other authors declare no conflict of interest.
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