Assessment of mutilans-like hand deformities in chronic inflammatory joint diseases. A radiographic study of 52 patients

Belt, Eero A.; Kaarela, K.; Kauppi, Markku; Savolainen, H. A.; Kautiainen, Hannu; Lehto, Matti

doi:10.1136/ard.58.4.250

Cited by 22 publications

(7 citation statements)

References 12 publications

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“…Mutilating changes were defined in patients with three or more “mutilans fingers [34]” as previously established [35]. Patients with the development of stages I–IV into mutilating changes during the follow-up period were separately categorized.…”

Section: Methodsmentioning

confidence: 99%

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

et al. 2014

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ObjectiveTo clarify the incidence and predictive risk factors of cervical spine instabilities which may induce compression myelopathy in patients with rheumatoid arthritis (RA).MethodsThree types of cervical spine instability were radiographically categorized into “moderate” and “severe” based on atlantoaxial subluxation (AAS: atlantodental interval >3 mm versus ≥10 mm), vertical subluxation (VS: Ranawat value <13 mm versus ≤10 mm), and subaxial subluxation (SAS: irreducible translation ≥2 mm versus ≥4 mm or at multiple). 228 “definite” or “classical” RA patients (140 without instability and 88 with “moderate” instability) were prospectively followed for >5 years. The endpoint incidence of “severe” instabilities and predictors for “severe” instability were determined.ResultsPatients with baseline “moderate” instability, including all sub-groups (AAS+ [VS− SAS−], VS+ [SAS− AAS±], and SAS+ [AAS± VS±]), developed “severe” instabilities more frequently (33.3% with AAS+, 75.0% with VS+, and 42.9% with SAS+) than those initially without instability (12.9%; p<0.003, p<0.003, and p = 0.061, respectively). The incidence of cervical canal stenosis and/or basilar invagination was also higher in patients with initial instability (17.5% with AAS+, 37.5% with VS+, and 14.3% with SAS+) than in those without instability (7.1%; p = 0.028, p<0.003, and p = 0.427, respectively). Multivariable logistic regression analysis identified corticosteroid administration, Steinbrocker stage III or IV at baseline, mutilating changes at baseline, and the development of mutilans during the follow-up period correlated with the progression to “severe” instability (p<0.05).ConclusionsThis prospective cohort study demonstrates accelerated development of cervical spine involvement in RA patients with pre-existing instability—especially VS. Advanced peripheral erosiveness and concomitant corticosteroid treatment are indicators for poor prognosis of the cervical spine in RA.

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Section: Methodsmentioning

confidence: 99%

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

et al. 2014

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“…30 Bilateral hand radiographs were used for classifying the severity of peripheral joint destruction into 5 categories: stages I to IV by the Steinbrocker classifi cation 31 and mutilating changes. 32 Mutilating changes were defi ned in patients with 3 or more "mutilans fi ngers" as established by Belt et al . 32 Patients with the development of stages I to IV into mutilating changes during the follow-up period were separately categorized.…”

Section: Radiographical Evaluationmentioning

confidence: 99%

Incidence and Aggravation of Cervical Spine Instabilities in Rheumatoid Arthritis

Yurube

Sumi

Nishida

et al. 2012

Spine

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A minimum 5-year follow-up reveals the occurrence of cervical instabilities in 43.6%, "severe" aggravation in 12.9%, and decreased SAC in 4.3% of patients with RA. Characteristics of severe disease activity-established mutilating changes, progressive development into mutilating changes, and potentially concomitant corticosteroid treatment-are indicators for poor prognosis of the cervical spine in RA.

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“…The basic series consisted of 52 cases with mutilans-like hand deformities collected among patients treated at the Rheumatism Foundation Hospital in Heinola, Finland during 1997 [9]. Study inclusion was based on clinical judgement and the presence of severe ®nger deformity and instability or telescoping.…”

Section: Methodsmentioning

confidence: 99%

“…The designation``mutilans ®nger'' was established when the sum of these grades in one ray was ³13 (maximum 15). A mutilans hand score of 0±10 was reached according to the number of mutilans ®ngers [9].…”

Section: Methodsmentioning

confidence: 99%

The cervical spine in mutilant rheumatoid arthritis

Laiho¹,

Belt²,

Kauppi³

2001

Rheumatol Int

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The purpose of this study was to detect the frequency of inflammatory cervical spine changes and characteristic features such as resorption in rheumatoid arthritis (RA) with arthritis mutilans (AM) hand deformity. The series included 23 patients with AM hand deformity who fulfilled the 1987 American Rheumatism Association criteria for RA. Cervical spine radiographs were evaluated for subluxations, atlantoaxial impaction (AAI), and apophyseal joint ankylosis. Assessment of the severity of inflammatory changes in the cervical spine was based on former radiographic criteria for operation. Twenty patients (87%) showed subluxations, AAI, or apophyseal joint ankylosis in the cervical spine. Anterior atlantoaxial subluxation (aAAS) was observed in nine (39%), AAI in 13 (57%), and apophyseal joint ankylosis in 12 (52%). Six (26%) had been operated on the cervical spine. Patients with AM hand deformity evinced frequent and severe inflammatory cervical spine changes often requiring operation. Resorptive change (AAI) in the upper cervical spine and ankylosis of apophyseal joints were the most characteristic abnormalities in these patients.

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Assessment of mutilans-like hand deformities in chronic inflammatory joint diseases. A radiographic study of 52 patients

Cited by 22 publications

References 12 publications

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

Accelerated Development of Cervical Spine Instabilities in Rheumatoid Arthritis: A Prospective Minimum 5-Year Cohort Study

Incidence and Aggravation of Cervical Spine Instabilities in Rheumatoid Arthritis

The cervical spine in mutilant rheumatoid arthritis

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