Rheumatoid Arthritis Deformity Research Articles

Tree-Based Reinforcement Learning for Identifying Optimal Personalized Treatment Decisions for Hand Deformity in Rheumatoid Arthritis.

Silicone metacarpophalangeal joint arthroplasty (SMPA) can reconstruct metacarpophalangeal (MCP) joint deformities in the rheumatoid hand, but patient selection criteria for the procedure remains unclear. We used statistical learning to elucidate patient selection criteria that will enhance long-term patient-reported and functional outcomes in patients with severe hand rheumatoid arthritis (RA). This is a secondary analysis of a prospective study of 169 adults with severe hand RA (average combined ulnar deviation (UD) and extensor lag (EL) at the MCP joint ≥ 50 degrees, per finger) with one-year follow-up, conducted at three centers in the United States and England from January 1, 2004, to December 31, 2011. Primary outcomes were Michigan Hand Outcomes Questionnaire (MHQ) pain sub-score, changes in EL, UD, and Arthritis Impact Measurement Scale (AIMS2) score. A tree-based reinforcement learning (T-RL) model was used to estimate clinical decision rules for treatment. 132 patients (mean[SD], 61[9] years; 108[72%] female) were included in the SMPA (n=50) and non-SMPA (n=82) cohorts. To minimize EL and UD, patients should undergo SMPA. To minimize pain, patients older than 55 should undergo SMPA. To increase hand-related quality-of-life (QOL), patients with grip strength <12 kg should undergo SMPA. Estimations with imputed missing data were similar, aside from a lower grip strength (<8 kg) threshold for hand-related QOL. Unless there is significant comorbidity that precludes surgery, most patients older than 55 with severe hand RA will have improved QOL, pain, and function after SMPA. Patients with preserved grip strength may benefit from continued medical management.

The association between Disease Activity Score and rheumatoid arthritis-associated cervical deformity: radiological evaluation of the BeSt trial.

The authors' objective was to evaluate the association of the Disease Activity Score (DAS) with cervical spine deformity in rheumatoid arthritis (RA) patients during 10-year optimal treatment of systemic disease. The authors evaluated radiological and 10-year follow-up (FU) data of the BeSt (BehandelStrategien) trial. In 272 RA patients, atlantoaxial subluxation (AAS), presence of vertical translocation (VT), and subaxial subluxation (SAS) were evaluated. The associations of these deformities with DAS, self-assessed health (determined with the Health Assessment Questionnaire [HAQ]), and erosions of the hands and feet (Sharp-Van der Heijde score) were studied. After 10 years of FU, AAS (> 2 mm neutral position) was observed in 62 patients (23%), AAS (≥ 3 mm in flexion) in 24%, AAS (≥ 5 mm in flexion) in 7%, VT did not occur, and SAS was present in 60 patients (22%). In total, 135 patients (50%) were in remission (DAS < 1.6) at 10 years of FU. No association could be established between AAS and DAS. Patients with cervical spine deformity (AAS > 2 mm and/or SAS) at 10 years had a higher HAQ score at 10 years than patients without cervical spine deformity (HAQ scores of 0.65 and 0.51, respectively, p = 0.04; 95% CI -0.29 to 0.00). Even though 50% of patients were in remission after 10 years and the BeSt trial was designed to optimize treatment, 40% of patients developed at least mild RA-associated cervical spine deformity and 7% developed significant AAS. This indicates that even in this era of disease-modifying antirheumatic drugs and biologicals, cervical deformity is prevalent among patients with RA and should not be neglected in patient treatment plans and information.

The Influence of Reducing Disease Activity Score on Cervical Spine Deformity in Rheumatoid Arthritis: A Systematic Review

Background Rheumatoid arthritis (RA) can cause deformity in particularly the craniocervical but also in the lower cervical region. Objectives The aim of this study is to give an overview of current literature on the association of disease activity score (DAS) and the prevalence and progression of rheumatoid arthritis-associated cervical spine deformities. Methods A literature search was done in PubMed, Embase, and Web of Science using a sensitive search string combination (Supplemental File). Studies describing the association between DAS and the incidence and progression of atlantoaxial subluxation, vertical subluxation, and subaxial subluxation were selected by predefined selection criteria, and risk of bias was assessed using a Cochrane checklist adjusted for this purpose. Results Twelve articles were retrieved, and risk of bias on study level was low to moderate. In the eight longitudinal studies, patients demonstrated high DAS at baseline, which decreased upon treatment with medication: cervical deformity at the end of follow-up was associated with higher DAS values. The four cross-sectional studies did not demonstrate a straightforward correlation between DAS and cervical deformity. Deformity progression was evaluated in three studies, but no convincing association with DAS was established. Conclusion A positive association between prevalence of cervical spine deformities and high disease activity was demonstrated, but quality of evidence was low. Progression of cervical deformity in association with DAS control over time is only scarcely studied, and future investigations should focus on halting of deformity progression.

Classical hand and foot deformities in rheumatoid arthritis.

Classical hand and foot deformities in rheumatoid arthritis.

Outcomes of Scarf and Akin Osteotomy with Intra-Articular Stepwise Lateral Soft Tissue Release for Correcting Hallux Valgus Deformity in Rheumatoid Arthritis.

Background. The effectiveness of scarf and Akin osteotomy with intra-articular lateral soft tissue release for the correction of hallux valgus (HV) in patients with rheumatoid arthritis (RA) has not been elucidated. Methods. A total of 36 feet in 28 patients with RA who had scarf and Akin osteotomy with intra-articular stepwise lateral soft tissue release between 2015 and 2020 at a single institute were investigated retrospectively, with a mean follow-up period of 32.0 ± 16.9 months. Radiographic evaluations including the HV angle, intermetatarsal angle, and sesamoid position were performed preoperatively and postoperatively. Clinical outcomes were assessed using the Japanese Society of Surgery of the Foot (JSSF) hallux scale and self-administered foot evaluation questionnaire (SAFE-Q). Results. The procedure resulted in significant HV correction, with a recurrence rate of 13.9%. The JSSF scale and all five SAFE-Q subscale scores significantly improved (p < 0.05), with no major complications. More than 90% of cases achieved adequate lateral soft tissue release without sacrificing the adductor tendon of the hallux. Conclusions. Intra-articular stepwise lateral soft tissue release in combination with scarf and Akin osteotomy provided satisfactory radiographic and patient-reported outcomes for the correction of HV in patients with RA with minimum lateral soft tissue release.

Special Issue No. – 10, June, 2020 Journal &gt; Special Issue &gt; Special Issue No. – 10, June, 2020 &gt; Page 5 “Quantative Methods in Modern Science” organized by Academic Paper Ltd, Russia MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE GENUS GAGEA SALISB., GROWING IN THE EAST KAZAKHSTAN REGION Authors: Zhamal T. Igissinova,Almash A. Kitapbayeva,Anargul S. Sharipkhanova,Alexander L. Vorobyev,Svetlana F. Kolosova,Zhanat

Special Issue No. – 10, June, 2020 Journal &gt; Special Issue &gt; Special Issue No. – 10, June, 2020 &gt; Page 5 “Quantative Methods in Modern Science” organized by Academic Paper Ltd, Russia MORPHOLOGICAL AND ANATOMICAL FEATURES OF THE GENUS GAGEA SALISB., GROWING IN THE EAST KAZAKHSTAN REGION Authors: Zhamal T. Igissinova,Almash A. Kitapbayeva,Anargul S. Sharipkhanova,Alexander L. Vorobyev,Svetlana F. Kolosova,Zhanat

Clinical Results of Total Knee Arthroplasty for the Knee with Severe Valgus Deformity in Rheumatoid Arthritis

Clinical Results of Total Knee Arthroplasty for the Knee with Severe Valgus Deformity in Rheumatoid Arthritis

A modified Terrono classification for Type 1 thumb deformity in rheumatoid arthritis: a cross-sectional analysis

The most common thumb deformity in rheumatoid arthritis is Nalebuff Type 1 deformity (boutonniere deformity). Type 1 deformity severely impairs hand function, and this impairment is evaluated by the Terrono classification. In some cases, the Terrono classification incorrectly categorizes advanced thumb deformity into earlier stages. We modified the Terrono classification by assessing the active range of motion of the interphalangeal joint prior to assessing the passive range of movement of the metacarpophalangeal joint. An active range of movement of the interphalangeal joint was strongly correlated with hand function. In 55 hands that we treated between 2004 and 2015, we compared the modified classification with the original Terrono classification. Our modified classification could detect advanced deformity earlier, and was more strongly correlated with hand function. Additionally, correlation analysis showed that advanced Type 1 deformity should be treated first, even in cases with severe ulnar drift. Our results suggest that the modified classification may benefit the treatment of Type 1 deformity, including joint-preserving surgery. Level of evidence: III.

A high incidence of extensor pollicis brevis insertion into the distal phalanx in rheumatoid arthritis patients who required the surgical reconstruction for thumb boutonnière deformity

Objectives: The aim of the current study was to investigate the pattern of extensor pollicis brevis (EPB) insertion macroscopically and histologically using cadaveric thumbs, and to compare the incidence of different insertions with that of thumb boutonnière deformity in rheumatoid arthritis (RA) patients who required surgical reconstruction.Methods: We examined 103 thumbs of 58 adult cadavers with no evidence of RA, and reviewed the surgical records of 28 thumbs of 23 RA patients who underwent surgical reconstruction for thumb boutonnière deformity. The incidence of different insertion patterns of the cadaveric thumbs and the RA thumbs were compared using the Fisher’s exact test.Results: Macroscopic and histologic examination revealed that the insertion patterns of EPB could be divided into three groups: insertion into the base of the proximal phalanx (Type P1), integration of EPB into the dorsal fibrocartilage of the MCP joint (Type P2), and insertion into the distal phalanx (Type D). The incidence of Type D was significantly higher in RA patients with thumb boutonnière deformity (64%) than that in the non-RA cadavers (29%; P < .05).Conclusion: EPB is inserted into the distal phalanx more frequently in RA patients who require surgery for thumb boutonnière deformity than non-RA cadavers, suggesting an additional possible mechanism of this deformity.

Modified Scarf osteotomy for hallux valgus deformity in rheumatoid arthritis

Category: Midfoot/Forefoot Introduction/Purpose: For severe hallux valgus (HV) deformity in rheumatoid arthritis (RA) cases, arthrodesis of the 1st metatarsophalangeal (MTP) joint has been recommended. However, with the progress of medical treatment of RA, joint preservation surgery has recently been performed. This study aimed to investigate the clinical and radiographic outcomes of modified Scarf osteotomy with medial capsule interposition for RA cases, including severe 1st MTP joint destruction, and to evaluate risk factors for recurrence. Methods: A retrospective observational study of 76 cases (60 patients) [mean follow-up period: 35.3 months (24-56 months)] that underwent the modified Scarf osteotomy was performed. Japanese Society for Surgery of the Foot (JSSF) RA foot ankle scale scores, hallux scale scores, and a self-administered foot evaluation questionnaire (SAFE-Q) were evaluated, along with preoperative and postoperative radiographic parameters. Results: The mean JSSF RA foot and ankle and hallux score improved significantly (RA: preoperative: 52.2, final follow-up: 76.9, hallux: preoperative: 38.2, final follow-up: 74.5). Recurrence (hallux valgus angle (HVA) &gt;20°) occurred in 12 feet (15.8%). Preoperative DAS28-CRP (Disease activity score evaluated on 28 joints-C-reactive protein), intermetatarsal angle between the first and second metatarsal bone (M1M2A), and M1M5A, as well as HVA, M1M2A, M1M5A, and Hardy grade at 3 months after surgery, were significantly greater in the recurrence group. There was a significant negative correlation between preoperative DAS28-CRP and JSSF RA foot and ankle scores at final follow-up (ß = -0.39: p=0.02), while there was a significantly positive correlation between preoperative DAS28-CRP and HVA at the final follow-up (ß = 0.44: p=0.001). Conclusion: The modified Scarf osteotomy with medial capsule interposition for HV deformity improved clinical and radiographic outcomes in RA cases with severe 1st MTP joint destruction. Increased preoperative M1M2A and M1M5A, incomplete reduction of the sesamoid bone, HVA, M1M2A, and M1M5A at 3 months after surgery should be kept in mind for recurrence. The preoperative DAS28-CRP score was associated with clinical and radiographic outcomes after surgery.

Scleromalacia perforans: a case report

BackgroundScleromalacia perforans is a rare ocular manifestation of rheumatoid arthritis which can potentially lead to blindness and is a late consequence in the course of the disease. It is an unusual finding for it to be present in a patient with joint pain without any rheumatologic progression of disease.Case presentationWe describe a rare case of scleromalacia perforans and orbital inflammatory disease in a 40-year-old Pakistani woman with apparently no associated rheumatologic deformity. It is rare in the sense that we usually see scleromalacia perforans with fixed deformities of rheumatoid arthritis in the hands or progressed systemic complications but not as a starting landmark of disease. She presented to us with pronounced eye manifestation which on further inquiry and investigation was found to be associated with rheumatoid arthritis. There was perforation of left globe on presentation and the right one was preserved. She visited various physicians and ophthalmologists and was treated with topical and systemic antibiotics but ended up losing sight in her left eye.ConclusionWe conclude that ocular manifestations, however rare they are, should be foreseen, investigated, and treated in patients with suspected arthritis as the complication is grave and sight threatening.

Indicación y resultados de la prótesis con estabilidad aumentada en la artroplastia primaria de rodilla [Constrained prosthesis in primary total knee arthroplasty

Introducción:&#x0D; Presentamos los resultados funcionales y criterios de indicación para artroplastía de rodilla con estabilización superior al estabilizado posterior, en la artroplastia de rodilla primaria (ATR).&#x0D; Materiales y métodos:&#x0D; Análisis retrospectivo de 43 ATR en 40 pacientes, con seguimiento promedio de 6,2 años. 38 casos presentaban genu valgo artrósico y 5 genu varo artrósico. La suficiencia de los ligamentos colaterales se definió como suficiente, atenuado o incompetente. Se desarrollo un sistema de clasificación para los genu valgo que relacionara el tipo de rodilla con el implante elegido.&#x0D; Resultados&#x0D; Se utilizaron 28 prótesis con estabilización posterior plus en pacientes con un deseje coronal promedio de 15.9°, de los cuales 21 presentaron ligamentos suficientes y 5 atenuados.&#x0D; Se utilizo una prótesis constreñida en 7 pacientes con deseje en valgo promedio de 21.6°, 2 con ligamentos suficientes y 5 con ligamentos atenuados.&#x0D; Se utilizaron 8 prótesis abisagradas rotatorias, 5 en pacientes con un genu valgo promedio de 24.6° (3 de ellas asociadas a recurvatum), 4 con ligamentos incompetentes y una con ligamentos atenuados, y tres con genu varo de 16° promedio.&#x0D; Conclusiones:&#x0D; Recomendamos utilizar las prótesis estabilizadas plus en desejes &lt; 20°, con ligamentos colaterales suficientes en ausencia de defectos óseos. Las prótesis constreñidas en pacientes con grandes desejes con ligamentos colaterales que presenten algún grado de suficiencia (a lo sumo atenuados). Las prótesis abisagradas rotatorias las reservamos para rodillas con incompetencia ligamentaria colateral o multidireccional, grandes defectos óseos o deformidades severas en artritis reumatoide o de origen neuropático.&#x0D; &#x0D; Abstract&#x0D; Introduction: The objective of this retrospective study was to show the functional results and indication criteria for prostheses for primary TKA with more constraint than posterior stabilization.&#x0D; Methods: Forty-three TKA were analyzed in 40 patients, with an average follow-up of 6.2 years. Preoperative diagnoses were valgus osteoarthritis (38 cases) and varus osteoarthritis (5 cases). Sufficiency of the collateral ligaments was classified as sufficient, attenuated or incompetent, through physical examination and X-rays with varus-valgus stress. Functional results were evaluated using the KSS.&#x0D; Results: Posterior-stabilized plus implants were used in 28 cases, with an average alignment of 15.9°: 26 were valgus knees, 21 of which presented sufficient and 5 attenuated ligaments. Constrained prostheses were used in 7 patients with an average valgus alignment of 21.6° (2 with sufficient and 5 with attenuated ligaments). Rotating-hinge prostheses were used in 8 patients, 5 with an average valgus alignment of 24.6° (3 of them associated with recurvatum), 4 with incompetent ligaments and one with attenuated ligaments. The average post-operative KSS was 84 (range 73-94) points. Noinstabilities were detected and prosthetic survival was 100% at the end of the follow-up.&#x0D; Conclusions: We recommend using posterior-stabilized plus implants in deformities &lt;20°, with sufficient collateral ligaments and no bone defects; constrained prosthesis in patients with greater deformity (&gt;20°) and collateral ligaments with some degree of sufficiency (attenuated at the most); and rotating-hinge implants in knees with collateral or multidirectional ligament insufficiency, associated with recurvatum, significant bone defects or severe deformities in rheumatoid arthritis or with neuropathic origin.

Ultrasonographic assessment of synovitis with lessor toe deformity in rheumatoid arthritis

Ultrasonographic assessment of synovitis with lessor toe deformity in rheumatoid arthritis

Design and Characterization of a Soft Robotic Therapeutic Glove for Rheumatoid Arthritis

ABSTRACTThe modeling and experimentation of a pneumatic actuation system for the development of a soft robotic therapeutic glove is proposed in this article for the prevention of finger deformities in rheumatoid arthritis (RA) patients. The Rehabilitative Arthritis Glove (RA-Glove) is a soft robotic glove fitted with two internal inflatable actuators for lateral compression and massage of the fingers and their joints. Two mechanical models to predict the indentation and bending characteristics of the inflatable actuators based on their geometrical parameters will be presented and validated with experimental results. Experimental validation shows that the model was within a standard deviation of the experimental mean for input pressure range of 0 to 2 bars. Evaluation of the RA-Glove was also performed on six healthy human subjects. The stress distribution along the fingers of the subjects using the RA-Glove was also shown to be even and specific to the finger sizes. This article demonstrates the modeling of soft pneumatic actuators and highlights the potential of the RA-Glove as a therapeutic device for the prevention of arthritic deformities of the fingers.

To Study The Serum Vitamin –D And Oxidative Stress Status In Rheumatoid Arthritis

Aim and objectives: Rheumatoid arthritis (RA) is a chronic autoimmune systemic disease characterized predominantly by synovial inflammation, leading to joint destruction. The study was undertaken to analyze the vitamin –D and oxidative stress status in Rheumatoid arthritis&#x0D; &#x0D; Materials and methods: The Study includes Patients diagnosed as RA by using RA factor within the age group of30 to 60 years and comprised of 20 age matched control group. To assess oxidative stress, serum Malonyldialdehyde (MDA) was by thiobarbituric acid method and antioxidant level was assessed by estimation of serum vitamin C by dinitrophenyl hydrazine method. And vitamin D total is estimated by chemiluminescent immunoassay.&#x0D; Results: There is a significant decreased level of vitamin -D in the RA patients (37.58±5.7ng/ml) as compared to healthy controls (58.5±5.6ngl/ml). There is a a significant increased levels of MDA in the RA patients (7.6±1.09) as compared to healthy controls (8.4±2.8). There is a significant decreased level of vitamin -c in the RA patients (0.6±0.3mg/dl) as compared to healthy controls (1.0±0.31mg/dl).&#x0D; &#x0D; Conclusion: Low levels of Vitamin D deficiency in RA patients is associated with inflammation which leads to Increased oxidative stress status , which may lead to connective tissue degradation leading to joint and periarticular deformities in rheumatoid arthritis.

Treatment of Severe Hallux Valgus Deformity in Rheumatoid Arthritis With 1st MTP Joint Fusion Combined With Proximal Chevron Metatarsal Osteotomy

Category: Bunion Introduction/Purpose: A severe hallux valgus deformity in rheumatoid patient is usually treated with the 1st MTP fusion, since the high success rate with low percentage of recurrence leads to higher patient satisfaction. However the large 1st inter- metatarsal angle, sometimes, is not decreased after the fusion, and the patient may suffer the persistent bunion pain. We tried to solve this problem by performing the 1st MTP fusion and the 1st proximal metatarsal osteotomy in one stage. We report our surgical technique with the outcome analysis of the patients. Methods: Six patients with the severe rheumatoid hallux valgus deformity were followed for more than 12 months after the combined 1st MTP fusion and 1st proximal metatarsal osteotomy. All were women. The mean age of patients was 51.3 years, and the mean follow up period was 2 years and 1 month. Inclusion criterion was a rheumatoid hallux valgus deformity of more than 18 degrees of the 1st intermetatarsal angle. The MTP fusion was fixed with threaded Steinmann pins and the proximal metatarsal osteotomy was fixed with Kirschner wires through the single curvilinear skin incision. Clinically American Orthopaedic Foot and Ankle Society (AOFAS) hallux MP-IP scale, and patient’s satisfaction after the surgery were analyzed. Radiographically the union of the fusion and the osteotomy was investigated. Results: Clinically the AOFAS scale improved from the preoperative 51.2 points to the postoperative 84.3 points. All patients were satisfied with the results. There were no wound problem or nonunion of fusion/osteotomy. Conclusion: The combined 1st MTP fusion and 1st proximal metatarsal osteotomy was an effective and safe procedure for the severe rheumatoid hallux valgus deformity with the large 1st inter-metatarsal angle.

Radiologic Patterning of Hallux Deformity in Rheumatoid Arthritis and Its Relationship to Flatfoot

Hallux deformities other than hallux valgus, especially those in the sagittal plane, have not yet been elucidated in the feet of patients with rheumatoid arthritis. The objectives of the present study were to classify rheumatoid arthritis hallux deformity in both the horizontal and the sagittal planes and investigate its relationship with flatfoot. Using a cross-sectional study design, we assessed patients with rheumatoid arthritis (527 feet in 274 patients) using radiographs and classified the deformity patterns of the great toes using cluster analysis. Of the 274 patients, the range of motion in the metatarsophalangeal joint was clinically investigated in 44 (16.1%) patients. The great toes could be divided into 5 clusters according to the characteristic configuration as follows: cluster I (normal type), cluster II (hallux valgus type), cluster III (boutonniere type), cluster IV (boutonniere with hallux valgus type), and cluster V (swan-neck type). Radiographic measurements revealed the characteristic deformities of each cluster, including splayed foot for cluster II; flat foot, metatarsal primus elevatus, and plantar displacement of the proximal phalanx for cluster III; and a mixture of these characteristics for cluster IV. Plantar displacement of the proximal phalanx, which was a specific characteristic of the boutonniere deformity, correlated significantly with the decreased dorsiflexion in the metatarsophalangeal joint. Our classification method revealed the relationship of hallux deformity in the sagittal plane to flatfoot and also demonstrated the usefulness of measuring basal phalanx displacement in predicting the range of motion of the metatarsophalangeal joint.

Association of NKG2D immunoreceptor polymorphisms with development of deformities in rheumatoid arthritis

Association of NKG2D immunoreceptor polymorphisms with development of deformities in rheumatoid arthritis

AB0298 Relationship between foot deformity and disease stage in patients with rheumatoid arthritis

BackgroundFoot deformities frequently arise in patients with rheumatoid arthritis (RA). Conditions such as hallux valgus or flat feet might cause gait dysfunction and lead to disability. However, the progression of...

SAT0056 Radiographic Relationship between Hallux Valgus Deformity and Fore-Mid-Hindfoot Deformity in Rheumatoid Arthritis: Evaluation Grouped by the Existence of 2ND MTP Joint Dorsal Dislocation

BackgroundSeveral midfoot deformities are described to progress hallux valgus (HV) deformity [1]. Involvement of hindfoot deformity in the 1st ray deformity is also suggested [2]. In rheumatoid foot, complicated deformity...