Full Papers
Severely destructive unilateral wrist arthritis as a rare variant of rheumatoid arthritis: analysis of clinical and imaging features
V. Korendovych1, J. Fleischhammer2, B. Tampe3, E. Nikiphorou4, R. Vasko5, G.A. Müller6, P. Korsten7
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Department of Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, UK.
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
- Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany. peter.korsten@med.uni-goettingen.de
CER13248
2021 Vol.39, N°2
PI 0372, PF 0377
Full Papers
PMID: 32573416 [PubMed]
Received: 24/02/2020
Accepted : 27/04/2020
In Press: 23/06/2020
Published: 09/04/2021
Abstract
OBJECTIVES:
Rheumatoid arthritis (RA) is a common autoimmune disease typically affecting joints symmetrically. A small number of patients develop unilateral and severely destructive wrist arthritis (DWA). The objective of our study was to characterise patients with this type of affection.
METHODS:
This was a retrospective cohort study of RA patients with positive RF/anti-CCP antibodies. Clinical characteristics, including, age, gender, disease duration, dexterity, occupational history, smoking status, and the number of prescribed DMARDs were recorded. Conventional radiographs were evaluated using the modified Sharp/van der Heijde scoring (mSS) method.
RESULTS:
We analysed our laboratory database of 1247 patients and identified 559 patients with a clinical diagnosis of RA. For 395 of the patients, radiographs of the hands were available for evaluation. 25 patients had extensive unilateral DWA, corresponding to a prevalence of 6.3% (25 of 395 patients). 11 patients were excluded due to incomplete data. Of the remaining 14 patients, 13 were female with a median age of 61 (33–83) years, and median disease duration of 18 (1–33) years. 8 of 11 (72.7%) patients were smokers; in three, smoking status was not known. 80% with known dexterity developed unilateral DWA in the dominant hand. Total mSS was significantly higher on the affected side (39, interquartile range 35.25–46.25) versus non-affected (13, IQR 3–23). MSS were not different if the carpal bones were excluded from scoring. Side of involvement (left vs. right), or dominant versus non-dominant hand, did not result in a different mSS.
CONCLUSIONS:
Unilateral DWA is a rare variant of RA which predominantly affects women who smoke.
