Radiographic changes in the distal phalanx tuft of the hands in subjects with rheumatoid arthritis. Systematic review

Abstract

Abstract Objective To determine the abnormal findings in the distal phalanx tuft of the hands (DPTH) in plain radiographs associated with the presence of rheumatoid arthritis (RA) in adults subjects. Methods A systematic review was performed following the PRISMA guidelines using databases, such as, Medline, Embase, Bireme, Scielo, and Google Scholar. The main changes in the DPTH included erosion, resorption, sclerosis, and proliferation detected on plain radiographs in adults with RA. Prevalence of radiographic findings was analyzed using a Mantel–Haenszel fixed effects model. Statistical associations (according to study type) were expressed as relative risk (RR) or odds ratio (OR) with their respective confidence intervals (CI) and p values. Results A total of 9 studies were included, in which sclerosis prevalence in the DPTH was 28.3% (95% CI: 0.23–0.34; p I 2 value = 75%). Resorption prevalence in the DPTH was 1.8% (95% CI: 0.006–0.05; p I 2 value = 0%). No study reported proliferation or erosions in DPTH. Conclusion Sclerosis in the DPTH is the most frequent radiographic alteration in patients with RA. However, it cannot be considered a pathognomonic finding of that condition, therefore new studies with a more solid methodological structure are needed to clarify this association. Finally, proliferation, erosion or resorption on the DPTH are not typical radiographic findings in subjects with RA.