THE RHEUMATOID WRIST - BILATERAL MR ANALYSIS OF THE DISTRIBUTION OF RHEUMATOID LESIONS IN AXIAL PLAN IN A FEMALE-POPULATION

In this case-control study, we analyzed 146 wrists: a) to search for t he distribution pattern of the rheumatoid lesions and, b) to correlate the distribution pattern of these lesions with the clinical parameter s. Thirty-one patients with rheumatoid arthritis (RA) and 42 controls - all women - were examined by means of a bilateral MR fast field echo (FFE) sequence, in axial plan, The wrist was divided into three regio ns: metacarpal (level I), carpal (level II) and radiaulnar (level III) . Erosions were present in thirty (97%) patients and in six (14%) cont rols. They were asymmetrically distributed at all levels, mainly at le vel II. Marrow infiltration and bone destruction were seen in 35% of t he patients in an asymetrical pattern at level I and II, respectively. These lesions were absent in the control group, Subchondral cysts wer e asymmetrically present in both groups - in 48% of the patients at le vels II and III, and in 11% of the controls at level II. In the patien t group, this asymmetrical pattern of the lesions correlated with the disease duration at levels I and LI (p=0.011 and p=0.013, respectively ), Most lesions were found at the radial force-bearing column of the w rist, more in the right side. Synovial hypertrophy and hyperintense me dian nerve were evident in 96% and 70% of the patients, respectively, We concluded that contrary to common belief rheumatoid damages to the carpal bones become rather asymmetrical as the disease progresses. The line of force along the radial side of the wrist possibly influences the distribution pattern of the rheumatoid lesions.