Assessment of mutilans-like hand deformities in chronic inflammatory jointdiseases. A radiographic study of 52 patients

Objectives-To evaluate patients with mutilans-like hand deformities in chro nic inflammatory joint diseases and to determine radiographic scoring syste ms for arthritis mutilans (AM). Methods-A total of 52 patients with severe hand deformities were collected during 1997. A Larsen hand score of 0-110 was formed to describe destructio n of the hand joints. Secondly, each ray of the hand was assessed individua lly by summing the Larsen grade of the wrist and the grades of the MCP and PIP joints. When the sum of these grades was greater than or equal to 13, t he finger was considered to be mutilated. A mutilans hand score of 0-10 was formed according to the number of mutilans fingers. Surgical treatment and spontaneous fusions were recorded. Results-The study consisted of 22 patients with juvenile rheumatoid arthrit is (JRA), nine with rheumatoid factor (RF) positive and 13 with RF negative arthritis, 27 patients with RF positive RA, and three adult patients with other diagnoses. The mean age of patients with adult rheumatic diseases was 27 years at the onset of arthritis. The mean disease duration in all patie nts was 30 years. The mean Larsen hand score was 93. Four patients had no m utilans fingers and in 15 patients all 10 fingers were mutilated. The Larse n hand score of 0-110 and the mutilans hand score of 0-10 correlated well ( r(s) = 0.90). Fourteen patients showed spontaneous fusions in the periphera l joints. A total of 457 operations were performed on 48 patients. Conclusion-Both the Larsen hand score of 0-110 and the mutilans hand score of 0-10 improve accuracy in evaluating mutilans-like hand deformities, but in unevenly distributed hand deformities the mutilans hand score is better in describing deformation of individual fingers.