A Novel Radiographic Measurement Method for the Evaluation of Metatarsophalangeal Joint Dislocation of the Lesser Toe in Patients with Rheumatoid Arthritis.

Hideki Ohashi,Toshifumi Ozaki,Yoshihisa Nasu,Kenta Saiga,Shunji Okita,Masahiro Horita,Ryuichi Nakahara,Keiichiro Nishida

doi:10.3390/ijerph18147520

Abstract

Dorsal dislocation of metatarsophalangeal (MTP) joints of the lesser toe frequently occurs in patients with rheumatoid arthritis (RA), and may cause painful and uncomfortable plantar callosities and ulceration. The current study examined the reliability and clinical relevance of a novel radiographic parameter (the MTP overlap distance [MOD]) in evaluating the severity of MTP joint dislocation. The subjects of the current study were 147 RA patients (276 feet; 1104 toes). MOD, defined as the overlap distance of the metatarsal head and the proximal end of the phalanx, was measured on plain radiographs. The relationship between the MOD and clinical complaints (forefoot pain and/or callosity formation) was analyzed to create a severity grading system. As a result, toes with callosities had a significantly larger MOD. ROC analysis revealed that the MOD had a high AUC for predicting an asymptomatic foot (−0.70) and callosities (0.89). MOD grades were defined as follows: grade 1, 0 ≤ MOD < 5 mm; grade 2, 5 ≤ MOD < 10 mm; and grade 3, MOD ≥ 10 mm. The intra- and inter-observer reliability of the MOD grade had high reproducibility. Furthermore, the MOD and MOD grade improved significantly after joint-preserving surgeries for lesser toe deformities. Our results suggest that MOD and MOD grade might be useful tools for the evaluation of deformities of the lesser toe and the effect of surgical intervention for MTP joints in patients with RA.

Highlights

The treatment of rheumatoid arthritis (RA) has made great progress in recent years with the widespread use of effective drugs that inhibit joint destruction, such as methotrexate and biologic disease-modifying antirheumatic drugs
We retrospectively reviewed the medical records of 280 RA patients admitted to our department for surgical treatment from July 2014 to December 2017
We examined the correlation between the pre- and post-operative changes (∆) in clinical scores (JSSF-RA and SAFE-Q subscales) and the preand post-operative changes in the Mtp Overlap Distance (MOD)

Summary

Introduction

The treatment of rheumatoid arthritis (RA) has made great progress in recent years with the widespread use of effective drugs that inhibit joint destruction, such as methotrexate and biologic disease-modifying antirheumatic drugs (bDMARDs). Reported the prevalence of RA patients in the population who underwent joint replacement surgeries in the United States between 2002 and 2012 They showed that the prevalence among cases of elbow, shoulder, and ankle replacement surgeries decreased by 50%, 18%, and 38%, respectively. Cordtz et al [2] evaluated the incidence of joint replacement before (1996–2001) and after (2003–2012) the introduction of bDMARDs in patients diagnosed with RA in Denmark between 1996 and 2012. They reported that the incidence of joint replacement in RA patients was stable from 1996 to 2001 but started to decrease from 2003, Int. J.

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