Rheumatoid Arthritis Metacarpophalangeal Joints Research Articles

Erosion Identification in Metacarpophalangeal Joints in Rheumatoid Arthritis using High-Resolution Peripheral Quantitative Computed Tomography.

Bone erosions are a pathological feature of several forms of inflammatory arthritis including rheumatoid arthritis (RA). The increased presence and size of erosions are associated with poor outcomes, joint function, and disease progression. High-resolution peripheral quantitative computed tomography (HR-pQCT) provides unparalleled in vivo visualization of bone erosions. However, at this resolution, discontinuities in the cortical shell (cortical breaks) that are associated with normal physiological processes and pathology are also visible. The Study grouP for xtrEme Computed Tomography in Rheumatoid Arthritis previously used a consensus process to develop a definition of pathological erosion in HR-pQCT: a cortical break detected in at least two consecutive slices, in at least two perpendicular planes, non-linear in shape, with underlying trabecular bone loss. However, despite the availability of a consensus definition, erosion identification is a demanding task with challenges in inter-rater variability. The purpose of this work is to introduce a training tool to provide users with guidance on identifying pathological cortical breaks on HR-pQCT images for erosion analysis. The protocol presented here uses a custom-built module (Bone Analysis Module (BAM) - Training), implemented as an extension to an open-source image processing software (3D Slicer). Using this module, users can practice identifying erosions and compare their results to erosions annotated by expert rheumatologists.

Acceptance and image quality of high-resolution peripheral quantitative computed tomography of the metacarpophalangeal joints in rheumatoid arthritis.

High-resolution peripheral quantitative computed tomography (HR-pQCT) requires longer immobilization time than conventional radiography, which challenges patient acceptance and image quality. Therefore, the aim was to investigate the acceptance of HR-pQCT in patients with rheumatoid arthritis (RA), and secondly the effect of an inflatable hand immobilization device on motion artefacts of the metacarpophalangeal (MCP) joints. Fifty patients with established RA and a median (interquartile range) age of 64.3 (55.0-71.2) years had their MCP joints scanned by HR-pQCT with the hand positioned with and without an inflatable immobilization device followed by a full radiographic examination and a questionnaire on the imaging experience. The comparability of the erosion measures was investigated with and without the immobilization device using Bland-Altman plot and intrareader repeatability by intraclass correlation coefficient. The motion artefacts were graded for each acquisition, and intrareader repeatability was investigated by Cohen's kappa coefficient. Forty percent of the patients preferred HR-pQCT imaging, only 6% preferred conventional X-ray. Seventy-four percent reported it was not difficult to keep their fingers steady during the scan. Sixty percent of the patients reported the immobilization device helped keep their fingers steady. However, as motion artefacts were sparse, no clinically relevant difference was observed concerning the effect of the immobilization device on readability. The intrareader repeatability and comparability for the erosion measures were excellent. The high patient acceptance adds to the feasibility of HR-pQCT imaging of MCP joints in RA. The inflatable immobilization device did not reduce motion-induced image degradation.

Research on Application of Improved Random Forest in Medical Ultrasound Image Classification

Gray-scale ultrasound imaging methods are commonly used to assess synovitis in Rheumatoid Arthritis (RA) in clinical practice. This paper proposed an improved classification algorithm for ultrasound image of metacarpophalangeal joint in Rheumatoid Arthritis(RA). Using several features of gray scale co-occurrence matrix and improved Random Forest method to achieve automatic classification of Rheumatoid Arthritis(RA). Three grading experiments were carried out in the experiment: the first one is for the binary classification of grade 0 (normal) and grade 3 (lesion) ultrasound images of 80 × 50 pixels, 130 × 70 pixels, and 185 × 90 pixels. The second is for the binary classification of grade 0 (normal) and grade 1/2/3 (lesion) ultrasound images of 80 × 50 pixels, 130 × 70 pixels, and 185 × 90 pixels. The third is for four-grade classification of ultrasound images at grade 0(normal), grade 1(mild), grade 2(moderate), and grade 3(severe). Conclusion shows that use the method of combing gray scale co-occurrence matrix and improved Random Forest algorithm can achieve automatic classification of Rheumatoid Arthritis(RA), which has a high Classification Accuracy.

Die Arthroskopie der Fingergrundgelenke

With the advancements in arthroscopic technique, arthroscopy has become feasible in most human joints, even those as small as the finger joints. The metacarpophalangeal joints are very well suited for arthroscopy and arthroscopic therapy. Good results have been reported on arthroscopic synovectomy of the metacarpophalangeal joints in rheumatoid arthritis. Osteochondral lesions in degenerative arthritis, loose bodies and foreign bodies can well be treated. Arthroscopic arthrolysis for capsular contracture and treatment of post-traumatic lesions have been performed successfully. The arthroscopic assistance in the treatment of intraarticular fractures and the capsular shrinkage for instability have been described. However, metacarpophalangeal joint arthroscopy has not been popularised up to now and its role in clinical practice remains to be established. Existing indications will be discussed with respect to our own experience.

AB1302 Evaluation of physiological and abnormal cortical breaks in healthy individuals (HI) and rheumatoid arthritis (RA) patients by ultrasound in B-and PD-mode (PDUS) in comparison with micro computed tomography scan (μCT)

BackgroundAccurate detection of bone erosions in RA patients is important both for clinical studies and practice. US has been demonstrated to be more sensitive than x rays for detecting erosions.(1)Yet...

Metacarpophalangeal Joints in Rheumatoid Arthritis: Delayed Gadolinium-enhanced MR Imaging of Cartilage—A Feasibility Study

To evaluate the feasibility of delayed gadolinium-enhanced magnetic resonance (MR) imaging of the cartilage of metacarpophalangeal (MCP) joints in patients with rheumatoid arthritis (RA) compared with that in control subjects. Institutional review board approval and informed consent were obtained. Thirty-one MCP joints in 10 patients with RA (mean age, 59 years; range, 35-77 years) and six healthy volunteers (mean age, 51 years; range, 30-71 years) were examined with delayed gadolinium-enhanced MR imaging of cartilage. Sagittal images of the second and third MCP joints (hereafter, MCP II and MCP III) were acquired with a three-dimensional dual-flip-angle gradient-echo sequence at 3.0 T. B(1) field inhomogeneity-corrected T1 maps were calculated, and delayed gadolinium-enhanced MR imaging of cartilage values for phalangeal and metacarpal cartilage were determined. In addition, cartilage thickness was measured. A nonparametric Mann-Whitney U test was used to assess differences between groups. Phalangeal and metacarpal delayed gadolinium-enhanced MR imaging of cartilage values in patients with RA (MCP II: 388 msec ± 105 [standard deviation] and 342 msec ± 79, respectively; MCP III: 409 msec ± 96 and 371 msec ± 89, respectively) were significantly lower than in control subjects (MCP II: 598 msec ± 62 and 560 msec ± 51, respectively; MCP III: 586 msec ± 57 and 561 msec ± 80, respectively). Cartilage thickness of both joints was comparable in patients with RA (MCP II: 1.28 mm ± 0.50, MCP III: 1.17 mm ± 0.24) and control subjects (MCP II: 1.42 mm ± 0.33, MCP III: 1.18 mm ± 0.26). Delayed gadolinium-enhanced MR imaging of cartilage of the MCP joints is feasible at 3.0 T. Delayed gadolinium-enhanced MR imaging of cartilage may help to assess cartilage degeneration in morphologically normal-appearing MCP II and III cartilage in patients with RA.

The Unstable Metacarpophalangeal Joint in Rheumatoid Arthritis: Anatomy, Pathomechanics, and Physical Rehabilitation Considerations

The Unstable Metacarpophalangeal Joint in Rheumatoid Arthritis: Anatomy, Pathomechanics, and Physical Rehabilitation Considerations

Fashioning A New Radial Collateral Ligament During Arthroplasty of the Finger Metacarpophalangeal Joints in Rheumatoid Arthritis

We describe a technique for reconstructing the radial collateral ligament of the finger metacarpophalangeal joints in patients with rheumatoid arthritis during arthroplasty. This technique is used in cases where the original collateral ligament is unfit for imbrication. In this method, a new collateral ligament is created using the volar plate of the concerned metacarpophalangeal joint. The technique is surgically simple, has the advantage of using locally available tissue, and has produced results that are both clinically and radiologically satisfactory. These advantages make this procedure a useful tool to have in one's surgical armamentarium.

Surgery of the MCP joints in rheumatoid arthritis

Two million people in Europe suffer with rheumatoid arthritis (RA). Among them 75% are women and the disease typically occurs around 45years of age. Hand and wrist are almost always involved (over 80% of patients) and 70% of them will be obliged to stop their job. The ulnar drift of the metacarpophalangeal (MCP) joints is present in more than 36.5% of the cases in women.

Are bone erosions detected by magnetic resonance imaging and ultrasonography true erosions? A comparison with computed tomography in rheumatoid arthritis metacarpophalangeal joints

The objective of the study was, with multidetector computed tomography (CT) as the reference method, to determine whether bone erosions in rheumatoid arthritis (RA) metacarpophalangeal (MCP) joints detected with magnetic resonance imaging (MRI) and ultrasonography (US), but not with radiography, represent true erosive changes. We included 17 RA patients with at least one, previously detected, radiographically invisible MCP joint MRI erosion, and four healthy control individuals. They all underwent CT, MRI, US and radiography of the 2nd to 5th MCP joints of one hand on the same day. Each imaging modality was evaluated for the presence of bone erosions in each MCP joint quadrant. In total, 336 quadrants were examined. The sensitivity, specificity and accuracy, respectively, for detecting bone erosions (with CT as the reference method) were 19%, 100% and 81% for radiography; 68%, 96% and 89% for MRI; and 42%, 91% and 80% for US. When the 16 quadrants with radiographic erosions were excluded from the analysis, similar values for MRI (65%, 96% and 90%) and US (30%, 92% and 80%) were obtained. CT and MRI detected at least one erosion in all patients but none in control individuals. US detected at least one erosion in 15 patients, however, erosion-like changes were seen on US in all control individuals. Nine patients had no erosions on radiography. In conclusion, with CT as the reference method, MRI and US exhibited high specificities (96% and 91%, respectively) in detecting bone erosions in RA MCP joints, even in the radiographically non-erosive joints (96% and 92%). The moderate sensitivities indicate that even more erosions than are seen on MRI and, particularly, US are present. Radiography exhibited high specificity (100%) but low sensitivity (19%). The present study strongly indicates that bone erosions, detected with MRI and US in RA patients, represent a loss of calcified tissue with cortical destruction, and therefore can be considered true bone erosions.

Conventional radiography requires a MRI-estimated bone volume loss of 20% to 30% to allow certain detection of bone erosions in rheumatoid arthritis metacarpophalangeal joints

The aim of this study was to demonstrate the ability of conventional radiography to detect bone erosions of different sizes in metacarpophalangeal (MCP) joints of rheumatoid arthritis (RA) patients using magnetic resonance imaging (MRI) as the standard reference. A 0.2 T Esaote dedicated extremity MRI unit was used to obtain axial and coronal T1-weighted gradient echo images of the dominant 2nd to 5th MCP joints of 69 RA patients. MR images were obtained and evaluated for bone erosions according to the OMERACT recommendations. Conventional radiographs of the 2nd to 5th MCP joints were obtained in posterior-anterior projection and evaluated for bone erosions. The MRI and radiography readers were blinded to each other's assessments. Grade 1 MRI erosions (1% to 10% of bone volume eroded) were detected by radiography in 20%, 4%, 7% and 13% in the 2nd, 3rd, 4th and 5th MCP joint, respectively. Corresponding results for grade 2 erosions (11% to 20% of bone volume eroded) were 42%, 10%, 60% and 24%, and for grade 3 erosions (21% to 30% of bone volume eroded) 75%, 67%, 75% and 100%. All grade 4 (and above) erosions were detected on radiographs. Conventional radiography required a MRI-estimated bone erosion volume of 20% to 30% to allow a certain detection, indicating that MRI is a better method for detection and grading of minor erosive changes in RA MCP joints.

The Unstable Metacarpophalangeal Joint in Rheumatoid Arthritis: Anatomy, Pathomechanics, and Physical Rehabilitation Considerations

The Unstable Metacarpophalangeal Joint in Rheumatoid Arthritis: Anatomy, Pathomechanics, and Physical Rehabilitation Considerations

The Unstable Metacarpophalangeal Joint in Rheumatoid Arthritis: Anatomy, Pathomechanics, and Physical Rehabilitation Considerations

The metacarpophalangeal (MCP) joints bestow important strength to the longitudinal and transverse arch systems of the hand. In addition, these joints guide active movements of the fingers in 2 degrees of freedom, while allowing sufficient laxity for passive accessory motions. Both stability and mobility functions are attained in the healthy hand by a complex interaction among the muscles and the joints' periarticular connective tissues. Rheumatoid arthritis (RA) often causes destruction of the MCP joints' connective tissues, which leads to weakness of the tissues and an imbalance of active and passive forces, and subsequently, instability, pain, and deformity. The 2 most common deformities of the MCP joints associated with RA and instability are palmar subluxation and ulnar "drift." Therapists and physicians often collaborate to treat these conditions through a combination of surgical and nonsurgical interventions. Two of the more conservative nonsurgical interventions typically involve a combination of splinting and education on joint protection. Additional nonsurgical treatment may include the judicious use of exercise and methods for relieving pain and reducing inflammation. Surgical intervention is often indicated when the more conservative treatments fail to arrest the progression of the pain or deformity. Regardless of the specific approach, effective intervention for instability of the MCP joint requires that the clinician possess a sound knowledge of the anatomy and the pathomechanical influences that predispose or cause the instability. This clinical commentary is intended to provide this information, as well as offer treatment guidelines based on our clinical experience. Whenever possible, research will be cited to support clinical interventions. This paper is especially geared to the therapist who may not currently specialize in the treatment of instability of the MCP joint but may require basic information on this important topic.

Die WEKO-Fingergrundgelenkprothese

The WEKO prosthesis was developed between 1989 and 1993 in order to restore stability and function of destroyed metacarpophalangeal joints in rheumatoid arthritis. The prosthesis is a hinged one and is fixed to the bone cementlessly by special osseointegrated sleeves in which the stem of the implant is fastened by a cone. Forty-eight patients with 74 prosthesis have been operated on in 1993. In a follow-up study in 2003, 43 of them (89.5 %) with 65 prostheses (87.8 %) could be re-examined clinically and radiographically. In seven patients (16.2 %) implant arthroplasty failed comprising loosening of the prosthesis within their sleeves, loosening of the sleeves in the bone and implant breakage. Twelve implants (16.2 %) had to be removed. The range of motion at follow-up was 0/10/70 degrees in comparison to 0/0/90 degrees postoperatively. Patients satisfaction over the first three to four years was higher than later due to deterioration of the rheumatoid disease. Thus, classical handscores to assess the outcome could not be applied. A second generation of the WEKO prosthesis was developed to improve rotational stability and osseointegration paying attention to reports concerning failures which were seen also by other authors. The stem of the implant was changed to a cylindrical one with star shaped cross-section which allows some pistoning in order to reduce the stressload of the sleeves.

Langzeitergebnisse der Resektionsarthroplastik der Fingergrundgelenke

The metacarpophalangeal arthroplasty in rheumatoid arthritis reported is a modification of the Vainio-Arthroplasty. The main difference of the technique is the fixation of the proximal extensor tendon to the palmar plate, better to the ligamentum metacarpeum transversum profundum. The more flexion of the metacarpophalangeal joint the more reposition of the joint is achieved. The long-term results of 30 arthroplasties of the metacarpophalangeal joint are presented in a prospective study. The cases were followed for 10.5 to 14.5 years (average 11.6 years). Marked release of pain was found in all patients. 75 per cent of the patients reported functional improvement of their hand at a score of "good" or "very good". The postoperative movement was 70 degrees on an average. In summary, the resection arthroplasty of the metacarpophalangeal joints produces very good function and correction of the ulnar deviation and palmar luxation of the MCP-joints. The arthroplasty is a real alternative to the total endoprosthetic replacement of metacarpophalangeal joints in rheumatoid arthritis.

Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls

Objective. To introduce dynamic magnetic resonance imaging (MRI) as an indicator of inflammatory activity in the metacarpophalangeal (MCP) joints of patients with rheumatoid arthritis (RA) or early unclassified polyarthritis, and to compare the results with a healthy control group. Materials and Methods. We examined 42 RA and 23 early unclassified polyarthritis patients, and 12 healthy controls in a cross-sectional study. Dynamic MRI (repeated FLASH-MR images after injection of a contrast agent) was performed through the 2nd to the 5th MCP joint. Two methods for identification of the enhancing synovial membrane were compared: 1) outlining of enhancing synovial membrane on subtraction images and 2) automated recognition by principal component analysis (PCA). The early enhancement (EE) rate was calculated on the basis of the first method. Results. Method 1) and 2) were closely associated (P<0.00001). From the healthy control group, an upper limit (mean+2SD) of normal enhancement was established for the 2nd to 5th MCP joints, which served to identify abnormal EE rates in the corresponding joints of patients. The patients had higher EE rates in the 2nd to 5th MCP joints than had the healthy controls (P<0.01). There were no significant differences between the two patient groups (P>0.09). Conclusion. PCA seems to be a promising method for automated identification of enhancing tissue. EE rates of the finger joints may be useful in the assessment of the inflammatory activity in the joints of patients with RA and early unclassified polyarthritis and may reflect other aspects of disease activity than clinical evaluation.

Resection arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis: Results after more than 15 years

In a retrospective study of resection arthroplasty of the MP joints in rheumatoid arthritis, 23 patients (32 hands, 128 joints) have been followed for 15 to 22 years. Patient satisfaction was high, and all patients had significant pain relief. Active motion of the joints averaged 35 degrees, ranging from full extension to 35 degrees of flexion. Ankyloses developed in five hands (13 joints, 10%). Ulnar deviation of more than 15 degrees occurred in six patients (ten hands, 30%). Over the course of several years a significant remodelling of the joints was to be observed. In six hands (19%) the metacarpal heads became spontaneously restored to ball-shaped geometry. Gross metacarpal resorption was observed in nine hands (30%), causing significant shortening of the metacarpals. In one-third of patients the final result was rated as good, fair and poor, respectively. Careful patient selection is mandatory. Patients with mutilating arthritis should be excluded from the procedure; rheumatoid destruction of the wrist joint definitely influences the final result.

Long-term follow-up of Swanson's silastic arthroplasty of the metacarpophalangeal joints in rheumatoid arthritis

77 patients with rheumatoid arthritis, 62 female and 15 male, underwent metacarpophalangeal joint arthroplasty on 375 joints using the Swanson design silicone rubber spacer between 1976 and 1985. Retrospectively, 48 of these patients were evaluated by postal questionnaire and 35 of them also underwent objective assessment at intervals ranging from five to 14 years post-operatively. Objective variables recorded included range of active motion, recurrence of ulnar drift and radiographic appearances. Both in the early and late stages, the vast majority of patients were satisfied with the outcome, with abolition of pain, correction of deformity and improved range of motion. There was some loss of mobility with time. However, functional improvement was maintained in the majority. Complication rates compare favourably with other reported series and no case of silicone synovitis was diagnosed. We agree with previous studies that the procedure is useful for lasting relief of pain and enhancement of a patient's sense of well-being and is associated with few complications.

Ultrasound examination of metacarpophalangeal joints in rheumatoid arthritis.

To evaluate the ability of ultrasonography with high frequency transducer (13-MHz) in detecting metacarpophalangeal (MCP) joint abnormalities, 20 patients with rheumatoid arthritis (RA) and a symptomatic involvement of MCP joints were studied. Twenty healthy subjects served as controls. In all RA patients, ultrasonography clearly demonstrated one or more soft tissue and/or bone abnormalities. Sixteen patients (80%) had joint cavity widening because of effusion (1 case), synovial thickening (7 cases), and joint effusion with synovial thickening (8 cases). Loss of definition of the metacarpal articular cartilage was observed in 17 cases (85%). Sixteen (80%) had bone erosions and 9 (45%) showed a definite widening of the flexor tendons sheath. Margin irregularities of the extensor and flexor tendons were respectively visualized in 7 (35%) and in 8 (40%) cases. An extensor tendon rupture was observed in 2 cases (10%). Ultrasound examination by 13-MHz transducer appears to increase the accuracy of MCP joints evaluation in RA with respect to conventional radiography. It can be recommended as the first investigation in the assessment of soft tissue involvement in RA patients.

Surgical Synovectomy of the Metacarpophalangeal Joints in Rheumatoid Arthritis

Surgical Synovectomy of the Metacarpophalangeal Joints in Rheumatoid Arthritis Get access J. Calnan J. Calnan Search for other works by this author on: Oxford Academic PubMed Google Scholar Rheumatology, Volume XVIII, Issue suppl, January 1979, Pages 59–67, https://doi.org/10.1093/rheumatology/XVIII.suppl.59 Published: 01 January 1979