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Rheumatoid Arthritis of Wrist and Hand
Eva M. Escobedo, MD; B. J. Manaster, MD, PhD, FACR
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KEY FACTS

  • Imaging

    • Clinical Issues

      • Diagnostic Checklist

        TERMINOLOGY

        • Abbreviations

          • Rheumatoid arthritis (RA)
        • Definitions

          • Chronic progressive systemic inflammatory disease in which joints are primary target

        IMAGING

        • General Features

          • Radiographic Findings

            • CT Findings

              • MR Findings

                • Ultrasonographic Findings

                  • Imaging Recommendations

                    DIFFERENTIAL DIAGNOSIS

                      PATHOLOGY

                      • General Features

                        • Staging, Grading, & Classification

                          • Gross Pathologic & Surgical Features

                            • Microscopic Features

                              CLINICAL ISSUES

                              • Presentation

                                • Demographics

                                  • Natural History & Prognosis

                                    • Treatment

                                      DIAGNOSTIC CHECKLIST

                                      • Consider

                                        • Image Interpretation Pearls

                                          Selected References

                                          1. Andersson ML et al: Distribution of erosions in hands and feet at the time for the diagnosis of RA and during 8-year follow-up. Clin Rheumatol. 40(5):1799-810, 2021
                                          2. Kaeley GS et al: The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther. 22(1):1, 2020
                                          3. Malla S et al: Ultrasonography in early rheumatoid arthritis of hand and wrist joints: comparison with magnetic resonance imaging. Indian J Orthop. 54(5):695-703, 2020
                                          4. Conaghan PG et al: Very early MRI responses to therapy as a predictor of later radiographic progression in early rheumatoid arthritis. Arthritis Res Ther. 21(1):214, 2019
                                          5. Lee KA et al: Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients. Korean J Intern Med. 34(3):651-9, 2019
                                          6. O'Shaughnessy MA et al: Team approach: role of medical and surgical management in rheumatoid arthritis of the hand and wrist. JBJS Rev. 7(8):e10, 2019
                                          7. Niemantsverdriet E et al: Imaging detected tenosynovitis of metacarpophalangeal and wrist joints: an increasingly recognised characteristic of rheumatoid arthritis. Clin Exp Rheumatol. 36 Suppl 114(5):131-8, 2018
                                          8. Ten Brinck RM et al: Sequence of joint tissue inflammation during rheumatoid arthritis development. Arthritis Res Ther. 20(1):260, 2018
                                          9. Llopis E et al: Conventional radiology in rheumatoid arthritis. Radiol Clin North Am. 55(5):917-41, 2017
                                          10. Chang EY et al: Adult inflammatory arthritides: what the radiologist should know. Radiographics. 36(6):1849-70, 2016
                                          11. Nieuwenhuis WP et al: Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 67(4):869-76, 2015
                                          12. Prasad K et al: Arthritis robustus: review of a case of an "abnormal" rheumatoid. Springerplus. 3:606, 2014
                                          13. Schueller-Weidekamm C et al: Contrast-enhanced MR imaging of hand and finger joints in patients with early rheumatoid arthritis: do we really need a full dose of gadobenate dimeglumine for assessing synovial enhancement at 3 T? Radiology. 268(1):161-9, 2013
                                          14. Navalho M et al: Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology. 264(3):823-33, 2012
                                          15. Bøyesen P et al: Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients. Ann Rheum Dis. 70(1):176-9, 2011
                                          16. Finzel S et al: Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis. 70(9):1587-93, 2011
                                          17. Rowbotham EL et al: Rheumatoid arthritis: ultrasound versus MRI. AJR Am J Roentgenol. 197(3):541-6, 2011
                                          18. Aletaha D et al: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 62(9):2569-81, 2010
                                          19. Narváez JA et al: MR imaging of early rheumatoid arthritis. Radiographics. 30(1):143-63; discussion 163-5, 2010
                                          20. Schwenzer NF et al: The role of dynamic contrast-enhanced MRI in the differential diagnosis of psoriatic and rheumatoid arthritis. AJR Am J Roentgenol. 194(3):715-20, 2010
                                          21. Eshed I et al: Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology (Oxford). 48(8):887-91, 2009
                                          22. Møller Døhn U et al: Erosive progression is minimal, but erosion healing rare, in rheumatoid arthritis patients treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure. Ann Rheum Dis. 68(10):1585-90, 2009
                                          23. Cavaliere CM et al: Total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis: a decision analysis from the hand surgeons' perspective. J Hand Surg [Am]. 33(10):1744-55, 1755.e1-2, 2008
                                          24. Herzberg G: Management of bilateral advanced rheumatoid wrist destruction. J Hand Surg [Am]. 33(7):1192-5, 2008
                                          25. Kaiser GL et al: Functional outcomes after arthroplasty of the distal radioulnar joint and hand therapy: a case series. J Hand Ther. 21(4):398-409, 2008
                                          26. Lisbona MP et al: Etanercept reduces synovitis as measured by magnetic resonance imaging in patients with active rheumatoid arthritis after only 6 weeks. J Rheumatol. 35(3):394-7, 2008
                                          27. Ozgocmen S et al: Clinical evaluation and power Doppler sonography in rheumatoid arthritis: evidence for ongoing synovial inflammation in clinical remission. South Med J. 101(3):240-5, 2008
                                          28. Terslev L et al: Diagnostic sensitivity and specificity of Doppler ultrasound in rheumatoid arthritis. J Rheumatol. 35(1):49-53, 2008
                                          29. Trieb K: Treatment of the wrist in rheumatoid arthritis. J Hand Surg [Am]. 33(1):113-23, 2008
                                          30. Xie X et al: Quantitative, small bore, 1 Tesla, magnetic resonance imaging of the hands of patients with rheumatoid arthritis. Clin Exp Rheumatol. 26(5):860-5, 2008
                                          31. Hodgson RJ et al: Pharmacokinetic modeling of dynamic contrast-enhanced MRI of the hand and wrist in rheumatoid arthritis and the response to anti-tumor necrosis factor-alpha therapy. Magn Reson Med. 58(3):482-9, 2007
                                          32. Luukkainen R et al: Prognosis of 5-year radiographic erosions of the wrist according to early, late, and persistent wrist swelling or tenderness in patients with early rheumatoid arthritis. J Rheumatol. 34(1):50-3, 2007
                                          33. Wieners G et al: High-resolution MRI of the wrist and finger joints in patients with rheumatoid arthritis: comparison of 1.5 Tesla and 3.0 Tesla. Eur Radiol. 17(8):2176-82, 2007
                                          34. Voulgari PV et al: Persistent clinical response of infliximab therapy in patients with refractory rheumatoid arthritis, over a 3-year period. Curr Clin Pharmacol. 1(1):103-8, 2006
                                          35. de Haas WH et al: Rheumatoid arthritis, typus robustus. Ann Rheum Dis. 32(1):91-2, 1973
                                          Related Anatomy
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                                          Related Differential Diagnoses
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                                          References
                                          Tables

                                          Tables

                                          KEY FACTS

                                          • Imaging

                                            • Clinical Issues

                                              • Diagnostic Checklist

                                                TERMINOLOGY

                                                • Abbreviations

                                                  • Rheumatoid arthritis (RA)
                                                • Definitions

                                                  • Chronic progressive systemic inflammatory disease in which joints are primary target

                                                IMAGING

                                                • General Features

                                                  • Radiographic Findings

                                                    • CT Findings

                                                      • MR Findings

                                                        • Ultrasonographic Findings

                                                          • Imaging Recommendations

                                                            DIFFERENTIAL DIAGNOSIS

                                                              PATHOLOGY

                                                              • General Features

                                                                • Staging, Grading, & Classification

                                                                  • Gross Pathologic & Surgical Features

                                                                    • Microscopic Features

                                                                      CLINICAL ISSUES

                                                                      • Presentation

                                                                        • Demographics

                                                                          • Natural History & Prognosis

                                                                            • Treatment

                                                                              DIAGNOSTIC CHECKLIST

                                                                              • Consider

                                                                                • Image Interpretation Pearls

                                                                                  Selected References

                                                                                  1. Andersson ML et al: Distribution of erosions in hands and feet at the time for the diagnosis of RA and during 8-year follow-up. Clin Rheumatol. 40(5):1799-810, 2021
                                                                                  2. Kaeley GS et al: The importance of ultrasound in identifying and differentiating patients with early inflammatory arthritis: a narrative review. Arthritis Res Ther. 22(1):1, 2020
                                                                                  3. Malla S et al: Ultrasonography in early rheumatoid arthritis of hand and wrist joints: comparison with magnetic resonance imaging. Indian J Orthop. 54(5):695-703, 2020
                                                                                  4. Conaghan PG et al: Very early MRI responses to therapy as a predictor of later radiographic progression in early rheumatoid arthritis. Arthritis Res Ther. 21(1):214, 2019
                                                                                  5. Lee KA et al: Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients. Korean J Intern Med. 34(3):651-9, 2019
                                                                                  6. O'Shaughnessy MA et al: Team approach: role of medical and surgical management in rheumatoid arthritis of the hand and wrist. JBJS Rev. 7(8):e10, 2019
                                                                                  7. Niemantsverdriet E et al: Imaging detected tenosynovitis of metacarpophalangeal and wrist joints: an increasingly recognised characteristic of rheumatoid arthritis. Clin Exp Rheumatol. 36 Suppl 114(5):131-8, 2018
                                                                                  8. Ten Brinck RM et al: Sequence of joint tissue inflammation during rheumatoid arthritis development. Arthritis Res Ther. 20(1):260, 2018
                                                                                  9. Llopis E et al: Conventional radiology in rheumatoid arthritis. Radiol Clin North Am. 55(5):917-41, 2017
                                                                                  10. Chang EY et al: Adult inflammatory arthritides: what the radiologist should know. Radiographics. 36(6):1849-70, 2016
                                                                                  11. Nieuwenhuis WP et al: Evaluation of magnetic resonance imaging-detected tenosynovitis in the hand and wrist in early arthritis. Arthritis Rheumatol. 67(4):869-76, 2015
                                                                                  12. Prasad K et al: Arthritis robustus: review of a case of an "abnormal" rheumatoid. Springerplus. 3:606, 2014
                                                                                  13. Schueller-Weidekamm C et al: Contrast-enhanced MR imaging of hand and finger joints in patients with early rheumatoid arthritis: do we really need a full dose of gadobenate dimeglumine for assessing synovial enhancement at 3 T? Radiology. 268(1):161-9, 2013
                                                                                  14. Navalho M et al: Bilateral MR imaging of the hand and wrist in early and very early inflammatory arthritis: tenosynovitis is associated with progression to rheumatoid arthritis. Radiology. 264(3):823-33, 2012
                                                                                  15. Bøyesen P et al: Prediction of MRI erosive progression: a comparison of modern imaging modalities in early rheumatoid arthritis patients. Ann Rheum Dis. 70(1):176-9, 2011
                                                                                  16. Finzel S et al: Repair of bone erosions in rheumatoid arthritis treated with tumour necrosis factor inhibitors is based on bone apposition at the base of the erosion. Ann Rheum Dis. 70(9):1587-93, 2011
                                                                                  17. Rowbotham EL et al: Rheumatoid arthritis: ultrasound versus MRI. AJR Am J Roentgenol. 197(3):541-6, 2011
                                                                                  18. Aletaha D et al: 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum. 62(9):2569-81, 2010
                                                                                  19. Narváez JA et al: MR imaging of early rheumatoid arthritis. Radiographics. 30(1):143-63; discussion 163-5, 2010
                                                                                  20. Schwenzer NF et al: The role of dynamic contrast-enhanced MRI in the differential diagnosis of psoriatic and rheumatoid arthritis. AJR Am J Roentgenol. 194(3):715-20, 2010
                                                                                  21. Eshed I et al: Tenosynovitis of the flexor tendons of the hand detected by MRI: an early indicator of rheumatoid arthritis. Rheumatology (Oxford). 48(8):887-91, 2009
                                                                                  22. Møller Døhn U et al: Erosive progression is minimal, but erosion healing rare, in rheumatoid arthritis patients treated with adalimumab. A 1 year investigator-initiated follow-up study using high-resolution computed tomography as the primary outcome measure. Ann Rheum Dis. 68(10):1585-90, 2009
                                                                                  23. Cavaliere CM et al: Total wrist arthroplasty and total wrist arthrodesis in rheumatoid arthritis: a decision analysis from the hand surgeons' perspective. J Hand Surg [Am]. 33(10):1744-55, 1755.e1-2, 2008
                                                                                  24. Herzberg G: Management of bilateral advanced rheumatoid wrist destruction. J Hand Surg [Am]. 33(7):1192-5, 2008
                                                                                  25. Kaiser GL et al: Functional outcomes after arthroplasty of the distal radioulnar joint and hand therapy: a case series. J Hand Ther. 21(4):398-409, 2008
                                                                                  26. Lisbona MP et al: Etanercept reduces synovitis as measured by magnetic resonance imaging in patients with active rheumatoid arthritis after only 6 weeks. J Rheumatol. 35(3):394-7, 2008
                                                                                  27. Ozgocmen S et al: Clinical evaluation and power Doppler sonography in rheumatoid arthritis: evidence for ongoing synovial inflammation in clinical remission. South Med J. 101(3):240-5, 2008
                                                                                  28. Terslev L et al: Diagnostic sensitivity and specificity of Doppler ultrasound in rheumatoid arthritis. J Rheumatol. 35(1):49-53, 2008
                                                                                  29. Trieb K: Treatment of the wrist in rheumatoid arthritis. J Hand Surg [Am]. 33(1):113-23, 2008
                                                                                  30. Xie X et al: Quantitative, small bore, 1 Tesla, magnetic resonance imaging of the hands of patients with rheumatoid arthritis. Clin Exp Rheumatol. 26(5):860-5, 2008
                                                                                  31. Hodgson RJ et al: Pharmacokinetic modeling of dynamic contrast-enhanced MRI of the hand and wrist in rheumatoid arthritis and the response to anti-tumor necrosis factor-alpha therapy. Magn Reson Med. 58(3):482-9, 2007
                                                                                  32. Luukkainen R et al: Prognosis of 5-year radiographic erosions of the wrist according to early, late, and persistent wrist swelling or tenderness in patients with early rheumatoid arthritis. J Rheumatol. 34(1):50-3, 2007
                                                                                  33. Wieners G et al: High-resolution MRI of the wrist and finger joints in patients with rheumatoid arthritis: comparison of 1.5 Tesla and 3.0 Tesla. Eur Radiol. 17(8):2176-82, 2007
                                                                                  34. Voulgari PV et al: Persistent clinical response of infliximab therapy in patients with refractory rheumatoid arthritis, over a 3-year period. Curr Clin Pharmacol. 1(1):103-8, 2006
                                                                                  35. de Haas WH et al: Rheumatoid arthritis, typus robustus. Ann Rheum Dis. 32(1):91-2, 1973