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Severely destructive unilateral wrist arthritis as a rare variant of rheumatoid arthritis: analysis of clinical and imaging features


1, 2, 3, 4, 5, 6, 7

 

  1. Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
  2. Department of Diagnostic and Interventional Radiology, University Medical Centre Göttingen, Germany.
  3. Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
  4. Centre for Rheumatic Diseases, Department of Inflammation Biology, School of Immunology and Microbial Sciences, Faculty of Life Sciences & Medicine, King's College London, UK.
  5. Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
  6. Department of Nephrology and Rheumatology, University Medical Centre Göttingen, Germany.
  7. 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
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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.

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