Wrist In Rheumatoid Arthritis Research Articles

Magnetic resonance imaging of the wrist in rheumatoid arthritis.

Despite the extraordinary advances made in medical imaging over the past two decades and the central role that magnetic resonance imaging (MRI) and other sophisticated technologies now play in routine clinical practice, rheumatology has benefited relatively little from these advances thus far. Over the past few years, however, evidence has accumulated to show that MRI can identify joint damage in patients with rheumatoid arthritis earlier and more sensitively than other techniques can, and that MRI can directly visualize and monitor changes in synovium and bone that precede actual bone erosion. Much of this development is being driven by the pharmaceutical and biotechnology industries as they search for novel therapies to combat this disease. Accordingly, the imaging tools that ultimately will be used to direct patients to specific therapies and then to monitor treatment effectiveness and safety are currently being refined and validated in rigorous multicenter and multinational clinical trials aimed at gaining regulatory approval of these new therapies. As these therapies become available for clinical use, radiologists can anticipate increased demand for expertise and experience in evaluating disease progression and treatment response with these techniques and the emergence of MRI systems specifically adapted for this application. The following discussion reviews the current status of this development, and points to areas where further advances are anticipated in the near future.

Magnetic resonance imaging of soft tissue changes in rheumatoid arthritis wrist joints.

An increasingly aggressive therapeutic strategy, improved treatment options, and encouraging preliminary results have attracted growing attention to the potential of magnetic resonance imaging (MRI) in the diagnosis, prognostication, and monitoring of rheumatoid arthritis (RA). MRI offers multiplanar imaging with unprecedented soft tissue contrast and high spatial resolution. Synovitis, the primary joint lesion in RA, can be detected and monitored. By contrast, conventional radiography shows only the late signs of preceding synovitis. Other soft tissue changes, such as tenosynovitis, tendonitis, enthesitis, joint effusions, and ligament and tendon tears, can be visualized. Unfortunately, the image resolution in most clinically available MR units is insufficient for evaluation of wrist joint cartilage. Preliminary data suggest that MRI is a valuable tool in the diagnosis and prognostication of RA. The superior sensitivity of MRI may be of major significance in both clinical trials and practice. In trials, MRI may allow reductions in the trial size and length because of its more sensitive separation of responders from nonresponders. Thus, although thorough validation is awaited, particularly concerning the reproducibility and prognostic value, MRI seems to be a very promising method for assessment of both established and early RA.

An appraisal of magnetic resonance imaging of the wrist in rheumatoid arthritis

Objectives: To evaluate the role of magnetic resonance imaging (MRI) in the diagnosis, staging, and follow-up of the rheumatoid wrist. Methods: A Medline search was performed to identify all publications from the years 1985 to 1999 concerning MRI of the wrist in patients with rheumatoid arthritis (RA). Additional papers were retrieved by scanning the references to the Medline-listed articles. Details of the MRI technique, as well as clinical data, were analyzed and compared. Results: A total of 55 papers were identified. There were considerable variations in imaging sequence, section type, and slice thickness. Erosions and synovitis were the conditions that mostly profited from the adoption of MRI. Although the visualization of erosions was better detailed with MRI than with conventional radiography, erosions were only rarely related to clinical and laboratory parameters. Another advantage was that synovitis imaging, which can be enhanced by contrast agents, was amenable to quantitation. The extent of the synovial surface and the rate of contrast enhancement in a series of consecutive, rapidly acquired images were the most common measures. Conclusions: MRI of the rheumatoid wrist is a useful technique to ascertain the criteria for diagnosis and progression of RA, and to monitor the effects of treatment. Implementation of a standardized protocol could further increase its value. Semin Arthritis Rheum 30:180-195. Copyright © 2000 by W.B. Saunders Company

Gadolinium-enhanced MR imaging of the wrist in rheumatoid arthritis: value of fat suppression pulse sequences.

To determine the usefulness of fat-suppressed gadolinium (Gd)-enhanced MR imaging of the wrist in patients with rheumatoid arthritis (RA). Fat-suppressed Gd-enhanced T1-weighted spin-echo (SE) images were obtained and compared with other standard techniques in 38 wrists of 27 patients (22-77 years) with RA. Scoring based on the degree of synovial enhancement of each joint was developed and the total scores (J-score) were correlated with radiographic stage, C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), and symptomatic change in the follow-up study. Synovial proliferations showed marked enhancement in all the wrists. In addition, contrast enhancement in the bone marrow and tenosynovium was seen in 36 and eight wrists respectively. Fat-suppressed Gd-enhanced T1-weighted images demonstrated these abnormalities better than other techniques. The J-scores correlated well with values of CRP (P = 0.0034), but not with radiographic stages and ESR. Fat-suppressed Gd-enhanced T1-weighted SE images can clearly demonstrate most of the essential lesions in RA including the proliferative synovium, bone erosion, bone marrow inflammatory change, and tenosynovitis. Scoring based on the extent of Gd-enhancement of synovium can be useful in the assessment of the inflammatory status.

Quantitative assessment of the synovial membrane in the rheumatoid wrist: an easily obtained MRI score reflects the synovial volume.

Determination of the synovial membrane volume in the rheumatoid arthritis (RA) wrist by gadolinium-DTPA-enhanced MRI is introduced. Moreover, dynamic imaging and an MRI score of synovial hypertrophy, based on gradings in six regions, are evaluated as substitutes of the time-consuming volume calculations. Twenty-six RA wrists were examined. Synovial membrane volumes ranged from 1 to 20 ml (median 9 ml). Synovial hypertrophy scores were highly correlated to synovial volumes (Spearman r = 0.88; P < 10(-8) for uncorrelated values). The volumes and scores were significantly higher in wrists with joint swelling and/or joint tenderness than in wrists without these signs (Mann-Whitney, both P < 0.05). Suboptimal slice selection made dynamic imaging uninformative. MRI allows quantification of the synovial volume in the rheumatoid wrist. The volume is related to clinical signs of inflammation, but may also give information about the cumulated synovial proliferation in the joint. An easily obtained score of synovial hypertrophy reflects the synovial volume and may thus be a useful marker of synovial involvement.

Radiolunäre Arthrodese - ein präventiver Eingriff bei der Handgelenksbeteiligung der chronischen Polyarthritis

Different operative procedures are used to stop the destruction of the wrist joint in rheumatoid arthritis. Between 1990 and 1993 we have performed 16 radiolunate arthrodesis according to Shapiro. They have been examined with a follow up of almost two years. The patients showed a postoperative reduction of pain and swelling. The stabilization of the wrist joint stopped the preoperative carpal instability. A radiological progress of the rheumatoid arthritis in the wrist joint could not be documented during the follow up. The postoperative mobility of the wrist joint (radiologically measured) was 10/0/30° in flexion and extension and 20/0/5° in radial and ulnar abduction. All the patients were satisfied with the postoperative result.

Clinical Significance of Dynamic Magnetic Resonance imaging in the Evaluation of Wrist Joint in RheumatoidArthritis

Clinical Significance of Dynamic Magnetic Resonance imaging in the Evaluation of Wrist Joint in RheumatoidArthritis

Fibrous stabilization of the rheumatoid wrist

19 patients (mean age 59.8 years) underwent fibrous stabilization of the wrist for rheumatoid arthritis. 17 patients were reviewed after a mean follow up of 24.5 months (range 13-40 months). There were four excellent, 11 good, and two poor results according to modified Koka and D'Arcy (1989) criteria. The poor results were due to deep infection in one patient and an unbalanced wrist due to ruptured radial extensors in another. The pre-operative range of wrist movement was an important determinant of the frequency of radio-carpal and/or mid-carpal fusion and the final post-operative range of movement.

The Wrist in Rheumatoid Arthritis

The Wrist in Rheumatoid Arthritis

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Swanson silicone arthroplasty of the wrist in rheumatoid arthritis: A long-term follow-up

Twenty-three Swanson silicone rubber implants in patients with stage III or stage IV rheumatoid arthritis were reviewed at an average of 72 months after surgery. Minimum follow-up in patients with unrevised implants was 44 months. Results were rated good or excellent in 48%, fair in 4%, and poor in 48%. Pain was the primary indication for surgery. Patient satisfaction and pain relief were achieved in 63%. Implant fracture occurred in 52%. Revision rate was 30%, including one recommended revision. Radiographic changes consistent with particulate synovitis were seen in 30%. Prosthesis settling and bony resorption were seen in more than 75% of the patients. Survivorship analysis demonstrated 42% survival at 77 months. Progressive clinical and radiologic deterioration was seen. Swanson silicone rubber implant is recommended only in the very low demand patient with stage III or stage IV rheumatoid arthritis and in those with insufficient bone stock to allow total wrist arthroplasty with a metal-on-plastic design.

Biodynamics of the Wrist in Rheumatoid Arthritis—The Enigma of Stiffness

The wrist has been moved rhythmically in the horizontal plane by sinusoidal torques provided by a printed motor. Measurements have been made on normal subjects and subjects with rheumatoid arthritis. Both groups exhibited a resonance, the oscillations being greatest when the applied torque was of certain frequency. In both groups the resonant frequency fell to approximately the same constant value when the torque was raised. While the main relationships were similar a somewhat lower torque resulted in the lowering of resonant frequency in the patients. The relationship between applied torque and peak velocity at resonance was also studied. For a given torque the motion was greater in the patients. No objective signs of increased viscous or elastic stiffness were demonstrable at the wrist in patients with rheumatoid arthritis.

Status and frequency of local juxta-articular demineralization and erosion in the wrist area in the early phase of chronic polyarthritis. Results based on 3-dimensional soft x-ray pictures

In early rheumatoid arthritis the location and incidence of localized juxta-articular demineralizations and erosions were investigated at 53 points of the wrist. On the level of the metacarpal bases, the distal and proximal row of the carpal bones more changes are seen in the oblique vd. and the lateral view than in the dv. view. At the distal bones of the forearm more changes are seen at the radius than at the ulnar styloid. The most often changes at all occur at the volar middle third of the triquetrum in the oblique view and at the distal volar articular facet of the scaphoid in the lateral view. Close relations between localized juxta-articular demineralizations and erosions do not exist. If the early bone changes at the wrist in rheumatoid arthritis are to be detected additional oblique and lateral view are prerequisite.

Productive osseous changes about the wrist in rheumatoid arthritis.

Radiographs of 225 consecutive patients with adult-form rheumatoid arthritis were examined for evidence of productive osseous changes about the wrist. The prevalence of new bone on the ulnar styloid was 10%.. This form of new bone is probably due to overlying chronic tenosynovitis. A collar of new bone around the ulnar head is a result of degenerative change in the distal radioulnar joint. In general, productive osseous changes in rheumatoid arthritis may represent inflammatory periosteal bone formation, osteophytosis, or contact remodeling. We found no evidence of an association between diffuse idiopathic skeletal hyperostosis and extensive productive osseous changes in patients with rheumatoid arthritis.

Synovectomy of the wrist in rheumatoid arthritis and related diseases. A follow-up study of 97 consecutive cases.

Synovectomy of the wrist was done on 77 patients (97 wrists) during 1968-1981. The age of the patients at the time of operation ranged from 18 to 77 years, mean 44.9 yrs. Clinical and radiological follow-up examinations (90 wrists) or follow-up evaluation by questionnaire (7 wrists) were made by the authors in 1982. The mean length of the follow-up period was 8.5 years. Clinical symptoms of pain, swelling, restricted motion, instability and deformity of the wrist joint were evaluated and graded according to a special score. Radiological changes due to rheumatoid arthritis and osteoarthrosis were graded and analysed. Eight wrists were arthrodesed during the follow-up. Among the remaining wrists (89 cases) pain was absent or almost absent in 39%, was less than before the operation in 49% and was unchanged or worse in 12% of cases. The respective percentages for the presence of swelling were 47%, 36%, and 17%. The range of dorsiflexion was between 0 and 70 degrees, with an average of 27.9 degrees. The range of volar flexion was between 0 and 75 degrees, the mean being 28.2 degrees. The average ulnar and radial side motions were 12.9 degrees and 5.4 degrees, respectively. The radiological grading of RA remained about the same in 10 wrists and did not improve in a single wrist. In the other wrists the X-ray changes progressed. The results (patient's opinion) were subjectively good in 53%, fair in 32%, and poor in 15%.(ABSTRACT TRUNCATED AT 250 WORDS)

Swanson Implant Arthroplasty of the Wrist in Rheumatoid Patients

Severe involvement of the wrist in rheumatoid arthritis poses great functional restrictions in eating, maintaining personal hygiene, and in performing general daily activities. Twenty-six Swanson radiocarpal implant arthroplasties were performed in 23 patients. Patients' average age was 57 years, with a preoperative diagnosis in all patients of rheumatoid arthritis. Follow-up averaged 33 months (range, 5-47 months). The principal indication for surgery was pain in 23 wrists and wrist deformity in three wrists. Particular attention was paid to postoperative functional status and to any changes in performance of routine activities of daily living pertinent to the wrist. Employing a pain rating scale of 1-4, preoperative scores averaged 3.71 on the operated side and postoperative scores, 1.75. Postoperative activities of daily living that benefited from the improved extension capability of the wrist showed significant improvement. No significant improvement resulted in those activities necessitating strength or fine motor control. Prosthesis fracture in one patient, and recurrence of ulnar deviation in two patients, were the major complications. Capsular reconstruction and tendon transfer to balance the wrist were integral components of the procedure.

Arthrodesis of the wrist joint in rheumatoid arthritis

Summary Fifty six fusions of the wrist joint were performed using a slight modification of the method described by Mannerfelt and Malmsten (1971) . All but one of the patients had rheumatoid arthritis. The patients were reviewed one to eight years after the operation. Ankylosis in useful position was achieved in nearly 100 per cent of the cases. The operation is simple and does not require any special instruments, but x-ray facilities in the operating room are necessary. Normally there is no need for any kind of external immobilisation.

Arthrodesis of the wrist joint in rheumatoid arthritis

Fifty six fusions of the wrist joint were performed using a slight modification of the method described by Mannerfelt and Malmsten (1971). All but one of the patients had rheumatoid arthritis. The patients were reviewed one to eight years after the operation. Ankylosis in useful position was achievedin nearly 100 percent of the cases. The operation is simple and does not require any special instruments, but x-ray facilities in the operating room are necessary. Normally there is no need for any kind of external immobilisation.

Surgery of the Wrist in Rheumatoid Arthritis

One hundred four patients with rheumatoid arthritis of the wrist were evaluated a minimum of 12 months post-operatively (average of 34 months). Seventy patients had 87 arthroplasties and 34 patients had 41 arthrodeses performed on the Arthritis Service of Rancho Los Amigos Hospital (Downey, California), from 1962 to 1975. Seventy-eight per cent of the arthrodeses fused, yet only 69% were painfree. Of the 22% that did not fuse, 67% were pain-free. Carpal and/or intercarpal synovitis recurred in 16% of the fused group and 33% of the nonfused group. Eighty-three per cent of the arthroplasties were pain-free, 91% were stable, and all lost motion which averaged 40 degrees (55%). Spontaneous fusion occurred in 16%). Synovitis recurred in 8.0%.

Interpositional arthroplasty of the wrist in rheumatoid arthritis

The procedure of interpositional arthroplasty of the wrist joint in rheumatoid arthritis, using silicone sheeting, is described. The results and complications of sixty arthroplasties are presented.