DESTRUCTION AND ARTHROPLASTIES OF THE METATARSOPHALANGEAL JOINTS IN SEROPOSITIVE RHEUMATOID-ARTHRITIS - A 20-YEAR FOLLOW-UP-STUDY

Destruction and arthroplasties of the metatarsophalangeal (MTP) joints and interphalangeal (IP) joint of the big toe were evaluated in 103 s eropositive rheumatoid arthritis (RA) patients in a prospective follow -up study at onset and at 1, 3, 8, 15, and 20 years from entry. A tota l of 83 patients attended the 15-year follow-up and 68 attended the 20 -year follow-up. Data on the forefoot synovectomies and reconstruction s performed were obtained from patient documents and radiographs. The radiographs were assigned by the Larsen method; in the end point analy sis the last or preoperative radiograph was used. Erosions of Larsen g rade greater than or equal to 2 were present in 6% of the investigated 1236 joints at onset and after 20 years in 62%, respectively. At the end point, 24% of the joints were severely damaged (Larsen grade 4-5). The MTP I and IP joints showed the lowest grade of destruction during follow-up, and MTP V the worst destruction. Synovectomies were perfor med in 24 MTP joints; a total of 75% of these joints were later resect ed. MTP II-V head resections were performed in 21% and the Keller proc edure in 12% of the MTP I joints. Erosive changes occur early in the M TP joints, and their grade of destruction is high; therefore they shou ld be included in radiographic criteria and scores. MTP synovectomies are insufficient treatments for RA without concomitant immunosuppressi on of the disease.