DESTRUCTION AND RECONSTRUCTION OF HAND JOINTS IN RHEUMATOID-ARTHRITIS- A 20 YEAR FOLLOW-UP-STUDY

Objective. To examine the radiographic endpoint changes and performed joint fusions and arthroplasties in hand joints in rheumatoid arthriti s (RA) occurring over a 20 year period. Methods. In 83 patients with r ecent (< 6 months) rheumatoid factor positive RA, radiographs were tak en at 15 and 20 years from entry, The Larsen grades for 12 hand joints were evaluated, as well as the preoperative grades for reconstructed joints. Data of the performed hand joint fusions and arthroplasties we re obtained. Results. At 15 year followup the mean Larsen grade of wri st joints was 2.5, metacarpophalangeal (MCP) I-V 1.0-1.8, and interpha langeal I and proximal interphalangeal (PIP) II-V 0.7-0.9. At the endp oint the mean grades were: wrist joint 2.7, MCP I 1.1, MCP II 2.2, MCP III 1.9, MCP IV 1.3, MCP V 1.5, IP I and PIP II-V 0.7-1.0. Modified L arsen grade for carpometacarpal I was 1.6 and 2.0 at 15 year followup and endpoint, respectively. Reconstructive surgery was performed in 33 /83 patients. The number of operations was 83, and 38 of them were wri st fusions. Conclusion. In this inception cohort, wrist joints had the highest destruction and the need for reconstructive surgery; the grad e of destruction was lower in MCP and PIP joints, in this order. Possi bilities of reconstructive surgery are discussed.