Patterns of disease progression in the rheumatoid wrist: A longterm followup

0Objective, To identify different patterns of disease manifestation and cha nges in the rate of progression of rheumatoid arthritis (RA) in the wrist. Methods. Forty wrists, with normal baseline radiographs, of 20 patients wit h RA were evaluated by means of a retrospective radiographic review for a p eriod of at least 15 years. Results. Radiographical scores for damage (Larsen method) and malalignment (carpal collapse and ulnar translocation index; radial deviation of the wri st and ulnar shift of the fingers) showed progression with increasing disea se duration for all patients. Women had higher Larsen scores than men (p < 0.05) and rheumatoid factor positive patients had higher Larsen scores than rheumatoid factor negative patients. For all 3 left-handed patients the do minant scores were somewhat higher than the right-handed scores, but the di fference was not significant. For the 17 right-handed patients no differenc es were found between the dominant and the left hand. Early in the course o f the disease 4 types of wrist involvement can be identified on the basis o f the first localization of damage in the wrist (central, radial, ulnar, an d diffuse type). Radial deviation of the wrist was increased in wrists with "central" involvement compared to wrists with "diffuse" involvement (p < 0 .05). Furthermore, radial deviation of the wrist was positively correlated with ulnar drift of the fingers (p < 0.01). Conclusion. Wrist involvement was found to play an important role in the ty pical rheumatoid deformity of the hand. Early treatment of the wrist is pro posed to prevent this deformity.