OUTCOME OF RHEUMATOID WRIST INVOLVEMENT - A RADIOGRAPHIC 20-YEAR FOLLOW-UP

Based on Sharp's findings in 1971 that rheumatoid arthritis (RA) does not run its full course for 20 or more years, a radiographic classific ation was performed in 73 patients of 146 wrist joints after 20 years of disease duration to explore the radiographic outcome of rheumatoid wrist involvement. Disease duration at follow up ranged from 20 to 45 years (average, 26.4 years). Radiographic classification was made acco rding to the condition of the radiocarpal joint in terms of erosive ch anges, bony ankylosis, dislocation and bone resorption. Radiographs of 146 wrists were classified into one of the following four types. Narr owing type (72/146, 49%): radiocarpal joint showed narrowing but the j oint space did not disappear, whereas erosive changes of the carpal bo nes occurred followed by bony ankylosis of the intercarpal joints. Par tial fusion type (18/146, 12%): partial bony ankylosis between the dis tal radius and the proximal carpal row occurred. The intercarpal joint was preserved radiographically. Bony ankylosis type (30/146, 21%): th e whole wrist joint was ankylosed. Collapsing type (26/146, 18%). Seve re malalignment of the radiocarpal joint occurred because of bone reso rption of the distal radius and/or carpal bones. This classification i s not designed to chart the severity of the disease but to define the radiographic outcome of rheumatoid wrist involvement.