Capillaroscopic Findings in Erosive and Nodal Osteoarthritis of the Hands

Osteoarthritis of the hands is a very common disease that can present a large number of different clinic pictures, such as nodal (NOA) and erosive (EOA) forms. EOA in particular is a rare subset of hand osteoarthritis characterised by faster destructive changes involving the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints. In the early stages of the disease the differential diagnosis from other arthritides, such as rheumatoid or seronegative arthritis, may pose a challenge. Nailfold capillaroscopy is a non-invasive technique that allows the in vivo study of the microvascular environment. In this study the authors have compared the capillaroscopic microvascular patterns in 56 patients with EOA, in 46 patients with NOA, and in 50 normal controls. The abnormalities that could be found in EOA patients were similar to those described by some authors in patients with psoriatic arthritis. The authors discuss the significance of these abnormalities and the possible relationship between EOA and psoriatic arthritis. Received: 17 April 2000 / Accepted: 18 September 2000     

High-resolution ultrasonography and 3.0 T magnetic resonance imaging in erosive and nodal hand osteoarthritis: high frequency of erosions in nodal osteoarthritis

Erosive osteoarthritis (EOA) is defined as hand osteoarthritis (OA) with interphalangeal joint erosions on plain radiographs. We sought to find ultrasound (US) and magnetic resonance imaging (MRI) features that could distinguish EOA from nodal hand OA (NOA). Symptomatic consecutive patients with hand OA as defined by the American College of Rheumatology criteria (13 EOA patients as defined by erosion in ≥1 interphalangeal joint and seven nodal OA patients) and five normal individuals were examined by plain radiography, US, and MRI. Patients and controls underwent evaluation of metacarpophalangeal and interphalangeal joints by US, and all fingers from second to fifth digit by MRI. A total of 240 joints in symptomatic patients were examined by both imaging modalities. Synovitis, osteophytes, cartilage loss, and erosions were frequently detected in the joints of patients with EOA and NOA. Six of seven patients with NOA had joint erosions that were seen on MRI or US scan but seen on plain radiographs. The overall concordance between MRI and US findings was substantial for osteophytes (κ?=?0.79) and excellent for cysts (κ?=?0.85), erosions (κ?=?0.84), synovitis (κ?=?0.82), and tenosynovitis (κ?=?0.83) in both groups. Inflammatory changes, such as effusions and synovitis, and structural changes, such as erosions, were frequently detected by US and MRI in EOA and nodal OA. These findings may support the hypothesis that EOA could not be a separate entity but may represent the severe end of the spectrum of hand OA.     

Relation between Heberden's nodes and distal interphalangeal joint osteophytes and their role as markers of generalised disease

OBJECTIVE—Heberden's nodes are often used as a marker for osteoarthritis (OA). This study examined how often Heberden's nodes and radiological distal interphalangeal (DIP) osteophytes coexist in the same digit and the sensitivity, specificity, and positive predicative value of each for OA at different sites or generalised disease.
METHODS—This was a population-based study of 660 middle aged women taking part in a twin study of OA. Distal interphalangeal osteophytes were defined radiologically and graded on a four point scale (0-3) using a published atlas of individual features. Heberden's nodes were defined by standardised clinical examination. OA in other joints (knees, proximal interphalangeal (PIP) joints and carpometacarpal (CMC) joints) was defined radiologically using a published atlas.
RESULTS—Poor agreement was observed between a Heberden's node (HN) and a radiological distal interphalangeal osteophyte in the same finger of the same hand (κ statistic (95% CI) = 0.36 (0.33, 0.39)). Although HN and radiological DIP osteophytes had similar sensitivity, the specificity and positive predicative value of DIP osteophytes was considerably higher for detecting knee, CMC, PIP OA, and OA in more than two groups of joints (knee, CMC, and DIP joints).
CONCLUSION—HN are not synonymous with DIP osteophytes. Radiological DIP osteophytes are a better marker of knee and multiple joint OA than HN. HN may still be an imperfect surrogate for hand OA when radiology is impractical, but are not an accurate marker of generalised disease.

Keywords: Heberden's nodes; osteoarthritis; distal interphalangeal joint osteophytes     

Impact of sex, age, body mass index and handedness on finger joint space width in patients with prolonged rheumatoid arthritis using computer-aided joint space analysis

To evaluate the associations between sex, age, body mass index (BMI) and handedness regarding the radiogeometric detectable joint space distances of the finger articulations in patients suffering from a prolonged course of rheumatoid arthritis (RA). The joint space widths were measured by a new available Computer-aided joint space analysis (CAJSA); 128 patients with RA underwent computerized semi-automated joint space analysis of joint space distances at the metacarpal–phalangeal articulation (JSD–MCP II–V), proximal–interphalangeal joint (JSD–PIP II–V) and distal–interphalangeal joint (JSD–DIP II–V) based on digitally performed radiographs of the hand (Radiogrammetry Kit, Version 1.3.6; Sectra; Sweden). The joint space distance (JSD) of each articulation was expressed as JSD total in millimeter. The patient cohort was differentiated for gender, age, handedness and BMI (BMI < 20; BMI 20–25, BMI > 25). JSD revealed a significant age-related narrowing of 24.8% (JSD–MCP), 22.6% (JSD–PIP) and 28.7% (JSD–DIP) between the ages of 20 and 79. Additionally, males showed a significantly wider JSD compared to the female cohort for all age groups. All JSD-distances were varied between the right and left hand. The JSD–MCP demonstrated significant differences regarding the BMI groups. In contrast to JSD–MCP an effect of the BMI on measurements of JSD–PIP and JSD–DIP could not be observed. These influences must be differentiated from disease-related alterations caused by RA.     

Incidence and size of erosions in the wrist and hand of rheumatoid patients: a quantitative microfocal radiographic study.

Quantitative macroradiographic examination of a group of early to moderately advanced rheumatoid patients showed the wrist and hand to have an average of 75 (SD 26) erosions out of 142 possible sites. Joint involvement was greatest in the wrist followed by the metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints respectively. In the wrist erosion distribution was concentrated in the radiocarpal and medial carpometacarpal complex, in the hand it tended to be located at the second and third MCP and third PIP joints. No difference was observed in erosion number and area between the right and left extremities. The distribution of the lesions is discussed in relation to the intra-articular pressures on normal hand function. The similarity of erosion development, across the joints at the different regions of the hand, suggests the presence of factors other than mechanical pressure. In general, erosions were widespread, and the largest erosions occurred in the larger bones of the wrist and hand.     

Assessing the prevalence of hand osteoarthritis in epidemiological studies. The reliability of a radiological hand scale

OBJECTIVE: The hands are often involved in the osteoarthritic disease process. A radiological grading scale is presented, derived from a published atlas, to assess the prevalence of hand osteoarthritis (OA) involvement in clinical and epidemiological studies and its reproducibility is studied. METHODS: This hand scale is based on the radiological feature "joint space narrowing", which represents the macromorphological process of cartilage loss. Osteophytes and sclerosis are less important unless seen in conjuction with joint space narrowing. Nine individual joints per hand (four proximal interphalangeal joints (PIP), four distal interphalangeal joints (DIP), first carpometacarpal joint (CMC-1)) are scored dichotomously for the presence of OA. To save time and to increase reliability a severity grading of radiological features is not performed. To determine inter-rater and intra-rater reliability of the individual joints and the presence of OA in two separate joint groups (>/= 2 PIP or DIP and at least one CMC-1, used to define "generalised OA" in the ongoing Ulm Osteoarthritis Study) 50 pairs of anteroposterior hand radiographs were read by two investigators twice within one month. The kappa coefficient was calculated to quantify the strength of associations. RESULTS: On average five minutes were needed to score one hand radiograph. Both raters were able to reproduce their own readings in all individual joints and for the presence of OA in two separate joint groups after one month. Reliability was highest for the PIP joints (kappa: 0.56-1. 00) it was slightly lower for the DIP joints (0.38-0.87), for the CMC-1 joints (0.58-0.69) and for OA in two separate joint groups (0. 54). The values for inter-rater agreement were good as well, kappa coefficients ranged from 0.52 to 0.92. CONCLUSION: This grading scale was shown to be reliable within and between readers for all the individual joints as well as for the presence of OA in two separate joint groups. Scoring a limited number of joints dichotomously makes this scale efficient and therefore useful for clinical and epidemiological trials, when dealing with large patient samples.     

Clinical and radiographic distribution of structural damage in erosive and nonerosive hand osteoarthritis

Objective

To characterize the clinical and radiographic joint phenotype in erosive hand osteoarthritis (EHOA) and non‐EHOA.

Methods

A total of 446 patients with HOA (233 with EHOA and 213 with non‐EHOA) were evaluated. Demographic (sex and age at disease onset), clinical (body mass index and distribution of nodes), and radiographic features (Kellgren/Lawrence and Kallman's scores obtained from radiographs of both hands) from all patients were recorded.

Results

Patients with EHOA had a significantly earlier disease onset. Clinical and radiographic distribution of structural damage in the distal interphalangeal (DIP), proximal interphalangeal (PIP), and first carpometacarpal joints was similar in EHOA and non‐EHOA. EHOA patients showed higher percentages of nodes and more severe radiographic scores; the more severe radiographic score of joints with nodes was due to both osteophytes and joint space narrowing (JSN). A direct correlation between osteophytes and JSN scores was observed. Central erosions (CE) were more prevalent in the DIP joints than in the PIP joints. Gull‐wing pattern of CE was prevalent in the DIP joints, whereas saw‐tooth pattern was prevalent in the PIP joints. Marginal erosions (ME) were present in 100% of EHOA patients and in 80% of non‐EHOA patients. An ordinal correlation between the presence of ME and osteophyte score was found.

Conclusion

We found quantitative, but not topographic, differences in structural damage between EHOA and non‐EHOA. Heberden's nodes, severe radiologic scores, and CE were concentrated in the second, third, and fifth DIP joints of both hands. ME were also present in the majority of non‐EHOA patients.     

Chopstick arthropathy: the Beijing Osteoarthritis Study

OBJECTIVE: Several investigators have speculated that mechanical stress might play an important role in the development of hand osteoarthritis (OA). Chopsticks, used universally as eating utensils in China, increase joint loading in the first through third fingers. We conducted a population-based survey among elderly Chinese individuals living in Beijing, to explore whether chopsticks use is associated with prevalent hand OA. METHODS: We recruited a sample of persons ages 60 years and older, using door-to-door enumeration in randomly selected neighborhoods in Beijing. Subjects answered questions about the hand with which they use chopsticks, handedness, and pincer grip activities. Bilateral posteroanterior hand radiographs were obtained, and each joint was graded according to the Kellgren/Lawrence (K/L) scale. We defined a subject as having radiographic OA if at least 1 of his or her hand joints had radiographic OA (K/L score of > or =2). We defined a particular hand group (i.e., distal interphalangeal [DIP] joints, proximal interphalangeal [PIP] joints, or metacarpophalangeal [MCP] joints) as having OA if at least 1 joint of the group had radiographic OA. We calculated the prevalence of OA for each hand joint and, according to the status of chopsticks use, performed a matched analysis to examine the relationship between chopsticks use and the prevalence of hand OA. In the analysis, we excluded persons who reported a previous hand injury. Because most subjects used chopsticks with their dominant hand (a hand they would be expected to use more for all manual tasks), we also performed the analysis among subjects who reported that they had no hand preference when performing other activities and subjects who denied other pincer grip activities. RESULTS: A total of 1,008 men and 1,499 women were assessed. The prevalence ratio for OA of the thumb IP joint in the chopsticks hand was 1.2 (range 1.1-1.4) in men and 1.6 (range 1.4-1.7) in women; the prevalence ratio for OA of the second and third PIP joints was 1.5 (range 1.1-2.2) in men and 1.4 (range 1.2-1.7) in women; and the prevalence ratio for OA of the second and third MCP joints was 1.4 (range 1.2-1.6) in men and 1.4 (range 1.2-1.6) in women. The prevalence ratios in these joints were greater than the ratios in other MCP, PIP, or DIP joints from the same hand that were unlikely to be involved by chopsticks use, especially among women. Similar results were observed when the analyses were limited to ambidextrous subjects and subjects who did not engage in any other pincer grip activities. Thumb IP joint OA affected 26% of the entire population studied, and chopsticks use accounted for 19% of the risk of OA developing in this joint in men and 36% of the risk in women. CONCLUSION: This epidemiologic study investigated the relationship of chopsticks use to hand arthropathy. The results suggest that chopsticks use is associated with an increased prevalence of OA in the IP joint of the thumb, and in the second and third PIP and MCP joints.     

Magnetic resonance imaging of the wrist and finger joints in patients with inflammatory joint diseases.

OBJECTIVE: To study magnetic resonance imaging (MRI) features in the wrist and metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints in 4 patient groups: early rheumatoid arthritis (RA) (< 3 yrs); established RA (> 3 yrs); other arthritis; arthralgia. METHODS: MRI was obtained before and after contrast (gadodiamide) injection of the wrist and finger joints in 103 patients and 7 controls. The study included: (1) 28 patients with disease duration < 3 yrs who fulfilled the American College of Rheumatology (ACR) criteria for RA; (2) 25 patients with RA disease duration > 3 yrs who fulfilled the ACR criteria. (3) 25 patients with reactive arthritis, psoriatic arthritis, or mixed connective tissue disease; and (4) 25 patients with arthralgia. The following MRI variables were assessed: number of joints with enhancement after contrast injection, number of joints with joint fluid, and number of bones with edema in the wrist and fingers. The volume of the enhancing synovial membrane after contrast injection in the MCP, PIP, and DIP joints was manually outlined. MR images were scored independently under blinded conditions. RESULTS: Bone marrow edema was found in 68% of the patients with established RA, and the number of bones with edema was significantly higher in patients with established RA compared to patients with early RA, other arthritis, and arthralgia (Mann-Whitney p < 0.04). Bone edema was not found in patients with arthralgia. There was marked overlap within and between the patient groups. No differences in MRI features were found between patients with early RA and patients with other arthritis. The volumes of the synovial membrane in the MCP, PIP, and DIP joints were significantly higher in patients with arthritis compared to patients with arthralgia. CONCLUSION: Although there was marked overlap between the arthritis patient groups, MRI determined bone marrow edema and synovial membrane volumes provided additional information about disease activity and may be used as a marker of it. Bone marrow edema appeared with the highest percentage in patients with long duration of RA (> 3 yrs) and is probably secondary to changes in inflammatory activity.     

Artrosis interfalángica sintomática y asintomática: un estudio ecográfico

ObjectiveTo date few studies have examined whether ultrasonography can depict morphologic differences in painful and painless osteoarthritis (OA). This study describes and compares the clinical, radiographic and ultrasonographic findings of patients with both painful and painless proximal interphalgeal (PIP) and/or distal interphalgeal (DIP) OA.MethodsPatients with PIP and/or DIP OA (ACR criteria) were prospectively recruited. The clinical rheumatologist chose up to 3 painful joints and up to 3 painless symmetric joints in each patient to define 2 cohorts of OA: symptomatic (SG) and asymptomatic (ASG). A conventional postero-anterior hand x ray was performed and read by one rheumatologist following the OARSI atlas, blinded to clinical and sonographic data. Ultrasound (US) was performed by an experienced rheumatologist, blinded to both clinical and radiographic data in joints previously selected by the clinical rheumatologist. US-pathology was assessed as present or absent as defined in previous reports: osteophytes, joint space narrowing, synovitis, intra-articular power doppler signal, intra-articular bony erosion, and visualization of cartilage. Radiographic and ultrasonographic intrareader reliability test was performed.ResultsA total of 50 joints in the SG and ASG were included from 20 right handed women aged 61.85 (46-73) years with PIP and DIP OA diagnosed 6.8 (1-17) years ago. 70% SG joints and ASG were right and left sided respectively. The SG showed significantly more osteophytes, synovitis and non-visualization of joint cartilage. Intrareader radiographic and ultrasonographic agreement was excellent.ConclusionThis study demonstrates that painful PIP and/or DIP OA have more ultrasonographic structural changes and synovitis.     

Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis

BACKGROUND: The pathogenesis of the early stages of hand osteoarthritis is poorly understood, but recent high-resolution magnetic resonance imaging (hrMRI) studies suggest that the joint ligaments have a major role in the phenotypic expression of the disease. OBJECTIVE: To combine hrMRI and cadaveric histological studies to better understand the mechanisms of damage, and especially the role of joint ligaments and tendons in disease expression. METHODS: hrMRI was carried out in the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints in 20 patients with osteoarthritis, with a disease duration < or = 12 months. Histological sections of the DIP and PIP joints were obtained from three dissecting-room specimens for comparative analysis. RESULTS: The collateral ligaments influenced the location of both hrMRI-determined bone oedema and bone erosion in early osteoarthritis. These changes were best understood in relation to the enthesis organ concept, whereby the interaction between ligament fibrocartilages leads to bone disease. Normal ligaments were commonly associated with microdamage at insertions corresponding to ligament thickening noted in early osteoarthritis. The ligaments also influenced the location of node formation in early osteoarthritis. The DIP extensor tendon insertions were associated with the development of a neoarticular surface. CONCLUSIONS: Small-joint collateral ligaments and tendons have a central role in the early stages of hand osteoarthritis, and determine the early expression of both the soft tissue and bony changes in disease.     

Pseudogout attack induced during etidronate disodium therapy

We report the first case of pseudogout attack in the distal interphalangeal (DIP) joints during etidronate disodium therapy. A 64-year-old woman had intermittent administration of etidronate disodium (Didronel; Sumitomo, Osaka, Japan) alone because of osteoporosis. Each cycle consisted of a daily dose of 200 mg for 2 weeks, repeating every 12 weeks. Two weeks after completing the third cycle, severe pain and swelling occurred in the DIP joints of the right middle, ring, and left ring finger; and skin ulcer formation was observed on the dorsal side of the DIP joints of the right middle and ring fingers as well as the left ring finger. Because monoclinic calcium pyrophosphate crystals were detected in the synovial fluid from the DIP joints of the right middle finger, we diagnosed these symptoms as induced by pseudogout attack. Oral loxoprofen sodium at a daily dose of 180 mg resulted in rapid symptom resolution. A decrease in function of calcium metabolism in elderly persons has been reported to be a cause of pseudogout attack. On the other hand, distal interphalangeal joint arthritis presenting as Heberden's nodes is a common condition in elderly patients. Therefore, pseudogout attack should be considered as an adverse drug reaction when administering bisphosphonate in elderly patients with Heberden's nodes.     

Articular hypermobility is a protective factor for hand osteoarthritis

OBJECTIVE: Very few studies have evaluated the association of articular hypermobility and radiographic osteoarthritis (OA) in humans. We assessed hypermobility and its relationship to radiographic hand OA in a family-based study. METHODS: A total of 1,043 individuals were enrolled in the multicenter Genetics of Generalized Osteoarthritis study, in which families were required to have 2 siblings with radiographic OA involving >/=3 joints (distributed bilaterally) of the distal interphalangeal (DIP), proximal interphalangeal (PIP), or carpometacarpal (CMC) joint groups, and OA in at least one DIP joint. Radiographic OA was defined as a score of >/=2 on the Kellgren/Lawrence scale in one or more joints within the group. The Beighton criteria for assessment of hypermobility were recorded on a 0-9-point scale. Hypermobility was defined as a Beighton score of >/=4, a threshold generally used to establish a clinical diagnosis of joint laxity. A threshold of >/=2 was also evaluated to assess lesser degrees of hypermobility. The Beighton score for the present was calculated based on clinical examination, and that for the past was based on recall of childhood hypermobility in the first 2 decades of life. The association of hypermobility and radiographic OA of the PIP, CMC, and metacarpophalangeal joints was evaluated in all participants and in men and women separately. Multiple logistic regression was used to examine the relationship of hypermobility with radiographic OA in each joint group, after adjusting for age and sex. The association of hypermobility and DIP OA was not evaluated, because evidence of DIP OA was required for study inclusion. RESULTS: Using a threshold Beighton score of 4, 3.7% of individuals were classified as hypermobile based on the present examination, and 7.4% were classified as hypermobile based on the past assessment. A significant negative association between present hypermobility and age was observed. In persons with hypermobility, the odds of OA in PIP joints was lower (for present, odds ratio [OR] 0.34, 95% confidence interval [95% CI] 0.16-0.71; for past, OR 0.43, 95% CI 0.24-0.78). Similar results were obtained using a threshold Beighton score of 2. The lower odds of PIP OA with hypermobility were significant after adjusting for sex and age (for present, OR 0.44, 95% CI 0.20-0.94; for past, OR 0.48, 95% CI 0.26-0.87). CONCLUSION: This study demonstrated a joint-protective effect of hypermobility for radiographic OA of PIP joints. In contrast to previous studies showing an association of hypermobility and CMC OA, in this cohort there was no evidence for increased odds of OA in any joint group of the hand in association with articular hypermobility.     

Assessment of hand osteoarthritis: correlation between thermographic and radiographic methods

OBJECTIVE: Anatomical stages of digital osteoarthritis (OA) have been characterized radiographically as progressing through sequential phases from normal to osteophyte formation, progressive loss of joint space, joint erosion and joint remodelling. Our study was designed to evaluate a physiological parameter, joint surface temperature, measured with computerized digital infrared thermal imaging, and its association with sequential stages of radiographic OA (rOA). METHODS: Thermograms, radiographs and digital photographs were taken of both hands of 91 subjects with nodal hand OA. Temperature measurements were made on digits 2-5 at distal interphalangeal (DIP) joints, proximal interphalangeal (PIP) joints and metacarpophalangeal (MCP) joints (2184 joints in total). We fitted a repeated measures ANCOVA model to analyse the effects of rOA on temperature, with handedness, joint group, digit and NSAID use as covariates. RESULTS: The reliability of the thermoscanning procedure was high (generalizability coefficient 0.899 for two scans performed 3 h apart). The mean joint temperature decreased with increasing rOA severity, defined by the Kellgren-Lawrence (KL) scale. The mean temperature of KL0 joints was significantly different from that of each of the other KL grades (P 相似文献   

高频超声对手骨关节炎患者骨赘评估的临床价值

目的:总结手OA患者双手骨赘的好发部位,分析骨赘严重程度与临床因素的相关性。方法:选取明确诊断的手OA患者104例,根据病程分为3组:<1年组,1~5年组,>5年组。应用高频超声对手OA患者的第一腕掌关节(CMC1)、掌指关节(MCP)、近端指间关节(PIP)、远端指间关节(DIP)进行探查,记录骨赘部位并进行半定量分级(OSGS),同时记录入组者年龄、病程、ESR、CRP,填写视觉模拟评分(VAS)和澳大利亚/加拿大手骨关节炎指数(AUSCAN)疼痛量表,比较不同病程组的各项指标,统计骨赘好发部位及发生率,分析骨赘与临床因素的相关性。采用Wilcoxon秩和检验,Kruskal-Wallis检验,χ^2检验以及Spearman相关性分析进行统计分析。结果:①共检查双手3120个关节,骨赘占33.56%(1047/3120)。不同病程组OSGS和AUSCAN差异有统计学意义(H=13.485,P<0.01;H=51.491,P<0.01),VAS、ESR、CRP差异无统计学意义(H=5.808,P=0.055;H=2.878,P=0.237;H=2.319,P=0.314)。②双手不同关节区中,PIP所占比重最大(46.54%,484/1040),其次为DIP(46.51%,387/832)、CMC1(30.77%,64/208),MCP所占比重最小(10.77%,112/1040),不同关节区骨赘发生率差异有统计学意义(χ^2=384.194,P<0.01)。③双手指间关节区中,骨赘构成比最大的分别是MCP3(46.43%,52/112)、PIP3(30.58%,148/484)和DIP2(31.01%,120/387)。④OSGS与年龄、病程、VAS、AUSCAN评分呈正相关(r=0.370,P<0.01;r=0.382,P<0.01;r=0.215,P=0.029;r=0.390,P<0.01),与ESR、CRP无相关性(r=0.173,P=0.079;r=0.162,P=0.101)。结论:手OA骨赘多见于PIP,其次为DIP,高频超声对骨赘的探查有助于手OA诊断和评估疾病严重程度。     

The distribution of radiological joint damage in the rheumatoid hand.

We report a detailed study of the relative distribution of joint damage, as assessed by erosion and joint space scores, in the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints of the rheumatoid hand. Hand radiographs of 30 patients with erosive rheumatoid arthritis were studied. There was significantly more damage in the dominant hand. The little-finger PIP joints were more damaged and the thumb interphalangeal (IP) joints less damaged than the other PIP joints. The index and middle finger MCP joints were more damaged than the other MCP joints. There was a significant negative correlation between the erosion scores of the PIP and MCP joints of each individual digit, when digits with only minimal damage were excluded. These findings support the concept that joint damage in the rheumatoid hand is greater in those joints that are subjected to greater mechanical stresses, and that in any digital ray the damage is concentrated at either the IPI or MCP joint.     

Magnetic resonance imaging in early rheumatoid arthritis: a multicenter,prospective study

To identify the magnetic resonance imaging (MRI) features of hands and wrists in early rheumatoid arthritis (RA). A total of 129 early arthritis patients (≤1 year) were enrolled in the study. At presentation, MRI of the hands was performed, with clinical and laboratory analyses. After a 1-year follow-up, clinical diagnosis of early RA or non-RA was confirmed by two rheumatologists. The characteristics of MRI variables at baseline in RA patients not fulfilling ACR 1987 criteria [RA-87(?)] were compared with those fulfilling ACR1987 criteria [RA-87(+)] and non-RA. In the 129 early arthritis patients, 90 were diagnosed with RA in a 1-year follow-up. There were 47.8 % (43/90) of the RA patients not fulfilling ACR 1987 criteria [RA-87(?)]. The scores of synovitis in RA-87(?) patients were similar with those in RA-87(+) [Synovitis score, 14.0 (IQR, 4.0–25.0) vs. 14.0 (IQR, 10.0–25.0), p?>?0.05]. Compared with those in non-RA, RA-87(?) patients had higher synovitis scores and occurrence of synovitis in proximal interphalangeal (PIP) joints [synovitis score, 14.0 (IQR, 4.0–25.0) vs. 6.0 (IQR, 2.0–14.5), p?=?0.046; occurrence of PIP synovitis: 53.5 vs. 27.3 %, p?=?0.02]. There was no significant difference of bone marrow edema, bone erosion, and tenosynovitis between RA-87(?) and non-RA. Synovitis in PIP joints was independent predictor for RA-87(?) [OR, 3.1 (95 %CI 1.2–8.1)]. High synovitis scores and synovitis in PIP joints on MRI were important in early RA, especially those not fulfilling ACR 1987 criteria.     

THE DISTRIBUTION OF RADIOLOGICAL JOINT DAMAGE IN THE RHEUMATOID HAND

We report a detailed study of the relative distribution of jointdamage, as assessed by erosion and joint space scores, in theproximal interphalangeal (PIP) and metacarpophalangeal (MCP)joints of the rheumatoid hand. Hand radiographs of 30 patientswith erosive rheumatoid arthritis were studied. There was significantly more damage in the dominant hand. Thelittle-finger PIP joints were more damaged and the thumb interphalangeal(IP) joints less damaged than the other PIP joints. The indexand middle finger MCP joints were more damaged than the otherMCP joints. There was a significant negative correlation betweenthe erosion scores of the PIP and MCP joints of each individualdigit, when digits with only minimal damage were excluded. These findings support the concept that joint damage in therheumatoid hand is greater in those joints that are subjectedto greater mechanical stresses, and that in any digital raythe damage is concentrated at either the PIP or MCP joint. ^*Paper read at the Annual Provincial Meeting of the BritishAssociation for Rheumatology and Rehabilitation, the Royal Societyof Medicine, Section of Rheumatology and Rehabilitation andthe Irish Society for Rheumatology and Rehabilitation, Portsmouth,12 and 13 October 1978.     

Association of hand and knee osteoarthritis: evidence for a polyarticular disease subset.

OBJECTIVE--To examine the association between hand and knee osteoarthritis (OA) in a community based population. METHODS--Radiographs of 695 participants aged > or = 40 years in the Baltimore Longitudinal Study of Aging were read for changes of OA, using Kellgren-Lawrence grade > or = 2 as the case definition. RESULTS--Logistic regression analyses, adjusting for age, gender and body mass index, revealed a significant association between OA in the knee and the following joint groups: distal and proximal interphalangeal (DIP, PIP) and Hand2 (OA in two or more hand joint groups) for grade 2-4 and grade 3-4 disease, and the first carpometacarpal (CMC1) joint for grade 3-4 disease. CONCLUSION--There is an association between OA in hand sites and the knee. The strength of the associations increases with increasing disease severity. For the PIP site, there is a trend toward increasing strength of association for increasing numbers of affected joints and bilateral disease.     

The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand

Clinical criteria for the classification of symptomatic idiopathic (primary) osteoarthritis (OA) of the hands were developed from data collected in a multicenter study. Patients with OA were compared with a group of patients who had hand symptoms from other causes, such as rheumatoid arthritis and the spondylarthropathies. Variables from the medical history, physical examination, laboratory tests, and radiographs were analyzed. All patients had pain, aching, or stiffness in the hands. Patients were classified as having clinical OA if on examination there was hard tissue enlargement involving at least 2 of 10 selected joints, swelling of fewer than 3 metacarpophalangeal joints, and hard tissue enlargement of at least 2 distal interphalangeal (DIP) joints. If the patient had fewer than 2 enlarged DIP joints, then deformity of at least 1 of the 10 selected joints was necessary in order to classify the symptoms as being due to OA. The 10 selected joints were the second and third DIP, the second and third proximal interphalangeal, and the trapeziometacarpal (base of the thumb) joints of both hands. Criteria derived using the "classification tree" method were 92% sensitive and 98% specific. The "traditional format" classification method required that at least 3 of these 4 criteria be present to classify a patient as having OA of the hand. The latter sensitivity was 94% and the specificity was 87%. Radiography was of less value than clinical examination in the classification of symptomatic OA of the hands.