THE PATTERN OF RHEUMATOID INVOLVEMENT OF THE HAND AND WRIST IN BLACK PATIENTS – A RADIOLOGICAL STUDY

Abstract

Introduction and Aims: There is a clinical impression that rheumatoid involvement of the hand and wrist in black patients differs from white patients. The aim of this study was to look at the hand and wrist involvement in black patients and to compare it with the available series in white patients.

Method: The wrist and hand x-rays of 75 black patients with proven rheumatoid arthritis were used. The x-rays were classified according to the Larsen criteria. We also classified the wrist involvement according to the Stanley and Simmen classifications. We also looked at the extent of wrist involvement and the stability of the wrist.

Results: The Larsen score for the fingers was counted out of 100 – where each MP-joint and each PIP-joint, including the IP-joint of the thumb, counts five (5 x 20). The Larsen score for the left hand was 9,65 and for the right hand 10,32. The Larsen score for the wrist was counted out of five. It was 2,48 for the left wrist and 2,73 for the right wrist. According to the Stanley classification on the right side, 18 fell into the conservative group, 16 into the reconstructive group, 28 into the salvage group and 13 into the irretrievable group. In the Simmen classification on the right side, 23 were classified as normal, 14 as ankylosed, nine as osteo-arthritic and 29 as disintegrated. On the left side, 22 were classified as normal, 12 as ankylosed, 12 as osteo-arthritic and 29 as disintegrated.

Conclusion: Our conclusion is that rheumatoid arthritis involvement was more or less the same as reported in other series, but finger joint involvement was considerably less. This finding must influence surgical decision-making and also the results of drug trials, whenever black patients are involved.