Rheumatoid arthritis of the wrist - Classification related to the natural course

The authors introduce a new functional classification of rheumatoid arthrit is of the wrist. Unlike the classifications used today, it includes the asp ect of the natural course of rheumatoid arthritis. The goal of this paper i s to identify radiologic indicators that will classify rheumatoid arthritis into stable forms of the disease (Types I and II) and unstable forms of th e disease (Type III). of 144 wrists examined, the first available radiograp h and the radiograph obtained at the time of the first surgery were assesse d. The indicators measured were: carpal height ratio, ulnar translocation, radial rotation, and scapholunate dissociation. Noting the changes that occ urred each year in these indicators, it was possible to identify a signific ant difference between stable forms (Types I and II) and unstable forms (Ty pe III) for the parameters carpal height ratio, ulnar translocation, and sc apholunate dissociation. The distribution of the indicators allowed the def inition of three values: the 100% value, the cut off point, and the lower t hreshold value. Combining the three radiologic parameters at those values m arkedly enhanced the possibility to classify rheumatoid arthritis of the wr ist. With the help of the three radiologic indicators carpal height ratio, ulnar translocation, and scapholunate dissociation, it is possible to class ify wrists with an early stage of rheumatoid arthritis according to the Sch ulthess classification. The early identification of destabilizing forms of rheumatoid arthritis becomes possible, malting the choice and timing of the surgical intervention easier. Wrists with a progressive unstable form of r heumatoid arthritis may be stabilized earlier.