Clinical Rheumatology

, Volume 16, Issue 1, pp 80–86

The rheumatoid wrist: Bilateral MR analysis of the distribution of rheumatoid lesions in axial plan in a female population

  • C. Pierre-Jerome
  • S. I. Bekkelund
  • S. I. Mellgren
  • T. Torbergsen
  • G. Husby
  • R. Nordstrøm
Originals

Summary

In this case-control study, we analyzed 146 wrists: a) to search for the distribution pattern of the rheumatoid lesions and, b) to correlate the distribution pattern of these lesions with the clinical parameters. Thirty-one patients with rheumatoid arthritis (RA) and 42 controls — all women — were examined by means of a bilateral MR fast field echo (FFE) sequence, in axial plan. The wrist was divided into three regions: metacarpal (level I), carpal (level II) and radioulnar (level III). Erosions were present in thirty (97%) patients and in six (14%) controls. They were asymmetrically distributed at all levels, mainly at level II. Marrow infiltration and bone destruction were seen in 35% of the patients in an asymmetrical pattern at level I and II, respectively. These lesions were absent in the control group. Subchondral cysts were assymmetrically present in both groups — in 48% of the patients at levels II and III, and in 11% of the controls at level II. In the patient group, this asymmetrical pattern of the lesions correlated with the disease duration at levels I and II (p=0.011 and p=0.013, respectively). Most lesions were found at the radial force-bearing column of the wrist, more in the right side. Synovial hypertrophy and hyperintense median nerve were evident in 96% and 70% of the patients, respectively. We concluded that contrary to common belief rheumatoid damages to the carpal bones become rather asymmetrical as the disease progresses. The line of force along the radial side of the wrist possibly influences the distribution pattern of the rheumatoid lesions.

Key words

MRI Wrist Rheumatoid Arthritis Erosions 

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References

  1. 1.
    Resnick D, Niwayama G. Diagnosis of bone and joint disorders (3. ed.). Philadelphia PA, W.B. Saunders Co. 1995: 866–96.Google Scholar
  2. 2.
    Resnick D. Gout-like lesions in rheumatoid arthritis. Letter to the editor. Am J Roentgenol 1976; 127: 1062.Google Scholar
  3. 3.
    Foley-Nolan D, Stack J P, Ryan M. Magnetic resonance imaging in the assessment of rheumatoid arthritis. A comparison with plain film radiographs. Br J Rheumatol 1991; 30: 101–106.Google Scholar
  4. 4.
    Ostergaard P, Gideon K, Sorenson M. Scoring of synovial membrane hypertrophy and bone lesions by MR imaging in clincally active and inactive rheumatoid arthritis of the wrist. Scand J Rheumatol 1995; 24: 212–18.Google Scholar
  5. 5.
    Gilkeson G, Polisson R, Sinclair H. Early detection of carpal erosions in patients with rheumatoid arthritis: A pilot study of magnetic resonance imaging. J Rheumatol 1988; 15: 1361–6.Google Scholar
  6. 6.
    Rundback J H, Rosenberg ZS, Solomon G. The radiographic features of rheumatoid arthritis in HLA-B27-positive patients. Skeletal Radiol 1993; 22: 263–7.Google Scholar
  7. 7.
    Jorgensen C, Cyteval C, Anaya JM. Sensitivity of magnetic resonance imaging of the wrist in very early rheumatoid arthritis. Clin Exp Rheumatol 1993; 11: 163–8.Google Scholar
  8. 8.
    Arnett FC, Edworthy SM, Bloch DA. The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 1988; 31: 315–24.Google Scholar
  9. 9.
    Ritchie D, Boyle J, Mc Innes J. Clinical studies with an articular index for the assessment of joint tenderness in patients with rheumatoid arthritis. Q J Med 1968; 147: 393–406.Google Scholar
  10. 10.
    Lichtman D. The wrist and its disorders. W.B. Saunders Co, 1988 pp. 41–52.Google Scholar
  11. 11.
    Soila P. A roentgenological study of asymmetry in rheumatoid arthritis. A preliminary communication. Acta Rheumatol Scand 1963; 9: 264.Google Scholar
  12. 12.
    Owsianik WDJ; Kundi A, Whitehead JN. Radiological articular involvement in the dominant hand in rheumatoid arthritis. Ann Rheum Dis 1980; 39: 508.Google Scholar
  13. 13.
    Youm Y, Flatt A. Kinematics of the wrist. Clin Orthop 1980; 149: 21–32.Google Scholar
  14. 14.
    Buckland-Wright JC. Microfocal radiographic examination of erosions in the wrist and hand of patients with rheumatoid arthritis. Ann Rheum. Dis 1984; 43: 160–71.Google Scholar
  15. 15.
    Rominger MB, Bernreuter WK, Kenney PJ. MR Imaging of the hands in early rheumatoid arthritis: Preliminary results. Radiographics 1993; 13: 37–46.Google Scholar
  16. 16.
    Meske S, Friedburg H, Henning J et al. Rheumatoid arthritis lesions of the wrist examined by rapid gradient-echo magnetic resonance imaging. Scan J Rheumatol 1990; 19: 235–8.Google Scholar
  17. 17.
    Corvetta A, Giovagnoni A, Baldelli S et al.. MR imaging of rheumatoid hand lesions: Comparison with conventional radiology in 31 patients. Clin Exp Rheumatol 1992; 10: 217–22.Google Scholar
  18. 18.
    Gubler FM, Algra PR, Maas M et al. Gadolinium-DTPA enhanced magnetic resonance imaging of bone cysts in patients with rheumatoid arthritis. Ann Rheum Dis 1993; 52: 716–19.Google Scholar
  19. 19.
    Yanagawa A, Takano K, Nishioka K et al. Clinical staging and gadolinium-DTPA enhanced images of the wrist in rheumatoid arthritis. J Rheumatol 1993; 20: 781–4.Google Scholar
  20. 20.
    Larsen A, Dale K, Eek M. Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference film. Acta Radiol 1977; 18: 481–91.Google Scholar
  21. 21.
    Pierre-Jerome C, Bekkelund SI, Mellgren SI, Torbergsen T. Quantitative magnetic resonance imaging and the electrophysiology of the carpal tunnel region in floor cleaners. Scand J Work Environ Health 1996; 22: 53–7.Google Scholar
  22. 22.
    Gross A, Louis DS, Carr KA, Weiss SA. Carpal tunnel syndrome: A clinicopathologic study. JOEM 1995; 37: 437–41.Google Scholar
  23. 23.
    Fry HJH. Overuse syndrome, alias tenosynovitis/tendinitis, the terminological hoax. Plast Reconstr Surg. 1986; 78:414–7.Google Scholar
  24. 24.
    Polisson RP, Schoenberg OL, Fischman A et al. Use of magnetic resonance imaging and positron emission tomography in the assessment of synovial volume and glucose metabolism in patients with rheumatoid arthritis. Arthritis Rheum 1995; 38: 819–25.Google Scholar
  25. 25.
    Recht MP, Resnick D MR Imaging of articular cartilage: Current status and future directions; AJR 1994; 163: 283–90.Google Scholar
  26. 26.
    Pierre-Jerome C, Bekkelund SI, Husby G et al. Bilateral fast MR imaging of the rheumatoid wrist. Clin Rheumatol 1996; 15: 42–6.Google Scholar
  27. 27.
    Vliet Vlieland TPM, Van der Wijk T, Jolie IMM et al. Determinants of hand function in patients with rheumatoid arthritis. J Rheumatol 1996; 23: 835–40.Google Scholar
  28. 28.
    Winalski CS, Palmer WE, Rosenthal DI et al. Magnetic resonance imaging of rheumatoid arthritis. Radiol Clin North Am 1996; 34: 243–58.Google Scholar

Copyright information

© Clinical Rheumatology 1997

Authors and Affiliations

  • C. Pierre-Jerome
    • 4
  • S. I. Bekkelund
    • 1
  • S. I. Mellgren
    • 1
  • T. Torbergsen
    • 4
  • G. Husby
    • 2
  • R. Nordstrøm
    • 3
  1. 1.Department of NeurologyTromsø University HospitalNorway
  2. 2.Department of RheumatologyTromsø University HospitalNorway
  3. 3.Department of Plastic SurgeryTromsø University HospitalNorway
  4. 4.Radiology Dpt. MRI sectionTromsø University HospitalTromsøNorway

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