The Pattern of Bone Erosion in the Hand and Wrist in Rheumatoid Arthritis

Martel, William; Hayes, John T.; Duff, Ivan F.

doi:10.1148/84.2.204

Cited by 122 publications

(35 citation statements)

References 9 publications

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“…These erosions differ markedly from the periarticular osteopenia and pericapsular bone loss commonly observed in rheumatoid joints (34). While these radiographic features suggest a different mechanism of bone loss in PsA, understanding of the basis of this difference has been impeded because the events that lead to psoriatic bone resorption have not been well defined.…”

Section: Discussionmentioning

confidence: 93%

Mechanisms of TNF-α– and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis

Ritchlin¹,

Haas-Smith²,

Li³

et al. 2003

J. Clin. Invest.

495

137

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Psoriatic arthritis (PsA) is an inflammatory joint disease characterized by extensive bone resorption. The mechanisms underlying this matrix loss have not been elucidated. We report here that blood samples from PsA patients, particularly those with bone erosions visible on plain radiographs, exhibit a marked increase in osteoclast precursors (OCPs) compared with those from healthy controls. Moreover, PsA PBMCs readily formed osteoclasts in vitro without exogenous receptor activator of NF-κB ligand (RANKL) or MCSF. Both osteoprotegerin (OPG) and anti-TNF antibodies inhibited osteoclast formation. Additionally, cultured PsA PBMCs spontaneously secreted higher levels of TNF-α than did healthy controls. In vivo, OCP frequency declined substantially in PsA patients following treatment with anti-TNF agents. Immunohistochemical analysis of subchondral bone and synovium revealed RANK-positive perivascular mononuclear cells and osteoclasts in PsA specimens. RANKL expression was dramatically upregulated in the synovial lining layer, while OPG immunostaining was restricted to the endothelium. These results suggest a model for understanding the pathogenesis of aggressive bone erosions in PsA. OCPs arise from TNF-α–activated PBMCs that migrate to the inflamed synovium and subchondral bone, where they are exposed to unopposed RANKL and TNF-α. This leads to osteoclastogenesis at the erosion front and in subchondral bone, resulting in a bidirectional assault on psoriatic bone

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Section: Discussionmentioning

confidence: 93%

Mechanisms of TNF-α– and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis

Ritchlin¹,

Haas-Smith²,

Li³

et al. 2003

J. Clin. Invest.

495

137

View full text Add to dashboard Cite

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“…This common biomechanical and functional thread also likely underscores the propensity for periarticular erosions in seronegative arthritis and even OA (15,16). Indeed, it was recognized more than 40 years ago that radiographic erosions tended to occur adjacent to the capsule, but this important anatomic observation went largely unnoticed (17).…”

Section: Discussionmentioning

confidence: 94%

Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis

McGonagle¹,

Tan²,

Døhn³

et al. 2009

Arthritis & Rheumatism

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Objective. The microanatomic basis for formation of erosions in inflammatory arthritis is incompletely understood but is thought to be related to bare areas and the associated cartilage-synovium junction. The purpose of this study was to test the hypothesis that erosion-prone sites are associated with microdamage in macroscopically normal joints.Methods. Histologic evaluation of erosion-prone sites was performed on 20 collateral ligaments (CLs) from the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints of 5 normal cadavers. In addition, the MCP joints (n ‫؍‬ 17) and PIP joints (n ‫؍‬ 3) of 20 patients with rheumatoid arthritis (RA) were assessed by computed tomography (CT) to ascertain whether the topography of erosion formation in patients with RA corresponded to the cadaveric findings.Results. Absence of a bare area was noted in cadaveric tissue at the periligamentous erosion-prone regions, especially in the distal MCP joints and both distal and proximal PIP joints. Nevertheless, these sites exhibited soft-tissue pathologic features and bony microdamage/cyst formation. Other significant findings included the presence of pannus without inflammatory changes in the regions in which a bare area was absent, and the replacement of bare area regions with fibrovascular synovial tissue in joints without inflammatory changes. The sites of cadaveric tissue microdamage corresponded to CT-determined erosion formation in the MCP and PIP joints of patients with RA, in whom erosions adjacent to the CLs were more common than dorsal or volar erosions.Conclusion. Periarticular erosion formation may not necessarily depend on the presence of a bare area and has a propensity to occur adjacent to ligaments in which bone microdamage is common. These findings suggest that periligamentous locations prone to microdamage may critically influence the topography of erosion formation in inflammatory arthritis.

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“…[1,15] Previous studies have revealed that the earliest erosions occur in the second and third MCPJs followed by the wrist joint. [16,17] It has also been reported that finger joint involvement was observed less often than other joint involvements. To our knowledge, no similar study exists in the literature that has evaluated ROM limitation.…”

Section: Discussionmentioning

confidence: 99%

“…As reported in the literature, MCPJ involvement occurs in the early stages; therfore, since the patients in this study had an average disease duration of 15 years, our results were expected. [16,17] In addition, it has been hypothesized that involvement of joints like the wrist and PIPJs is due to longer disease duration.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of Hand Dominancy and its Relationship with Hand involvement and hand Dexterity in Patients with Rheumatoid Arthritis

2013

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Amaç: Çalışmamızda sağ elini dominant olarak kullanan romatoid artritli (RA) hastalarda el dominansisi ile klinik ve radyolojik olarak el tutulumu ve el becerisi arasında ilişki olup olmadığının değerlendirilmesi amaçlandı. Hastalar ve yöntemler:Çalışmaya sağ elini dominant olarak kullanan 249 hasta (238 kadın, 11 erkek; ort. yaş 53.0±11.8 yıl; dağılım 25-78 yıl) alındı. Hastaların el ve el bileği tutulumunun değerlendirilmesinde, el ve el bileği eklem hareket açıklığı (EHA), metakarpofalangeal eklemler (MKFE) ve proksimal interfalangeal eklemler (PIFE) ölçüldü ve deformitelerin ve tenosinovitin varlığı kaydedildi. El becerisi nine hole peg testi, el kavrama kapasitesi (altı tip) ve kaba kavrama kuvveti ile değerlendirildi. Larsen skoru hesaplandı ve sonuçlar iki el arasında kıyaslandı.Bulgular: El bilek fleksiyon, ekstansiyon ve total PIFE EHA kısıtlılığı, piyano tuşu belirtisi ve düğme iliği deformitesi varlığı dominant (sağ) elde daha fazla idi. Sağ el sol ele göre daha kuvvetli bulundu, fakat iki el arasında kavrama tipleri açısından farklılık saptanmadı. Sağ elin radyolojik bulguları sol ele göre daha destrüktif idi.Sonuç: Çalışma bulgularımıza göre, RA'lı hastaların dominant eli daha fazla eklem kısıtlılığı ve radyolojik hasar içermekte idi, ayrıca bazı deformiteler dominant elde daha fazla gözlenebilmekte idi. Ancak, bu sonuçlara rağmen, dominant el halen dominant olmayan elden daha kuvvetlidir.Anahtar sözcükler: Dominansi; el kavrama kuvveti; el; eklem tutulumu; romatoid artrit.Objectives: This study aims to evaluate whether hand dominancy in patients with rheumatoid arthritis (RA) using their right hand dominantly is associated with clinical and radiological involvement of the hand and hand dexterity. Patients and methods:Two hundred and forty-nine patients (238 females, 11 males; mean age 53.0±11.8 years; range 25 to 78 years) with right-hand dominance were included in this study. In the evaluation of hand and wrist involvement in the patients, the range of motion (ROM) of the wrist, metacarpophalangeal joints (MCPJs) and proximal interphalangeal joints (PIPJs) were measured and the presence of deformities and tenosynovitis was recorded. Hand dexterity was assessed using the nine hole peg test, hand grip capacity (six types), and grip strength. The Larsen score was calculated, the results were compared between two hands.Results: Range of motion limitation in wrist flexion, extension and total number of PIPJs, piano key sign, and boutonniere deformity were more common in the dominant (right) hand. The right hand was stronger than the left; however, there was no difference between the hands in terms of their grip types. The radiological findings of the right hand were more destructive than those of the left hand. Conclusion:Our study results suggest that patients with RA have a higher incidence of joint limitation and radiological damage in the dominant hand and some deformities can be observed more frequently in the dominant hand. However, the dominant hand is still stronger than the non-dominant hand.

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The Pattern of Bone Erosion in the Hand and Wrist in Rheumatoid Arthritis

Cited by 122 publications

References 9 publications

Mechanisms of TNF-α– and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis

Mechanisms of TNF-α– and RANKL-mediated osteoclastogenesis and bone resorption in psoriatic arthritis

Microanatomic studies to define predictive factors for the topography of periarticular erosion formation in inflammatory arthritis

An Evaluation of Hand Dominancy and its Relationship with Hand involvement and hand Dexterity in Patients with Rheumatoid Arthritis

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