RESEARCH - Asymmetry of small joint involvement in RA: prevalence and tendency towards symmetry over time

[Guest guest]

Joint Bone Spine. 2005 May;72(3):241-7.

Asymmetry of small joint involvement in rheumatoid arthritis: prevalence and

tendency towards symmetry over time.

Zangger P, Keystone EC, Bogoch ER.

Hopital Orthopedique de la Suisse Romande, and Centre Hospitalier

Universitaire Vaudois, University of Lausanne, Lausanne, Switzerland.

zangger@...

OBJECTIVES: To quantify asymmetry of radiological joint damage in rheumatoid

arthritis (RA), to determine whether asymmetrical damage to joints in RA

becomes symmetrical over time, and to identify factors predictive of

symmetrization. METHODS: In phase 1, initial, mid-term (mean follow-up: 3

years) and late (mean follow-up: 8 years) radiographs of 48 patients with

definite RA (English population) were graded by the Modified Larsen (ML)

system. In phase 2, 27 subjects (Canadian population) with at least one

asymmetrical pair of joints in the hands or feet were identified. Two

successive radiographs of 77 asymmetrical joints, separated by at least 2

years, were compared. Clinical and biological factors were assessed for

their ability to predict symmetrization, defined as a reduction in

side-to-side difference over time of two or more ML grades. RESULTS: In

phase 1, the overall rate of asymmetry was 12.9% (95% CI: 11.2-14.5%),

increasing from 9.7% (first visit) to 13.8% (mid-term) and 14.4% (last

visit). Metacarpophalangeal (MCP) joints were more frequently asymmetrical

than thumb (MCP and interphalangeal) joints (P = 0.0064) and proximal

interphalangeal (PIP) joints (P < 0.0001); wrist quadrants were more

frequently asymmetrical than PIP joints (P < 0.0001). In phase 2, two groups

were identified and compared: symmetrizers (22 joints) and non-symmetrizers

(55 joints). The overall probability of small joints in the hand and foot

symmetrizing was 28.5%. Rheumatoid factor (RF) was predictive of

symmetrization. The risk of symmetrization was significantly increased in

RF-positive patients with asymmetric joints (P = 0.01). The prevalence of

asymmetry did not decrease with disease duration, despite symmetrization.

CONCLUSIONS: Prevalence of asymmetry in joint damage in RA was 13-16%.

Symmetry was more evident in PIP joints than in MCP and wrist joints.

Seropositive patients are more than twice as likely to symmetrize than

seronegative patients. Data regarding the tendency for symmetrization may

have value in the clinical management of RA patients with asymmetrical joint

damage.

PMID: 15850996

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

5850996 & dopt=Citation

Not an MD

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org

[Guest guest]

I seem to get inflamation in symmetrical joints, just not at exactly

the same time. What has happened so far is that I'll get it, for

instance, in one wrist. Then that will just be starting to calm down

when the other wrist flares up. Sometimes they overlap, sometimes

not. But if I get it in one joint, I know it's coming in the other

one soon.

The only exception to this pattern so far was when my left hand

totally seized up. That DIDN'T happen to my right hand, but then

again, that was the point when the Rheumatologist put me on

prednisone, so maybe that kept it from happening in the other hand.

>

> Joint Bone Spine. 2005 May;72(3):241-7.

>

>

> Asymmetry of small joint involvement in rheumatoid arthritis:

prevalence and

> tendency towards symmetry over time.

>

>

> Zangger P, Keystone EC, Bogoch ER.

>

> Hopital Orthopedique de la Suisse Romande, and Centre Hospitalier

> Universitaire Vaudois, University of Lausanne, Lausanne,

Switzerland.

> zangger@...

>

> OBJECTIVES: To quantify asymmetry of radiological joint damage in

rheumatoid

> arthritis (RA), to determine whether asymmetrical damage to joints

in RA

> becomes symmetrical over time, and to identify factors predictive

of

> symmetrization. METHODS: In phase 1, initial, mid-term (mean

follow-up: 3

> years) and late (mean follow-up: 8 years) radiographs of 48

patients with

> definite RA (English population) were graded by the Modified

Larsen (ML)

> system. In phase 2, 27 subjects (Canadian population) with at

least one

> asymmetrical pair of joints in the hands or feet were identified.

Two

> successive radiographs of 77 asymmetrical joints, separated by at

least 2

> years, were compared. Clinical and biological factors were

assessed for

> their ability to predict symmetrization, defined as a reduction in

> side-to-side difference over time of two or more ML grades.

RESULTS: In

> phase 1, the overall rate of asymmetry was 12.9% (95% CI: 11.2-

14.5%),

> increasing from 9.7% (first visit) to 13.8% (mid-term) and 14.4%

(last

> visit). Metacarpophalangeal (MCP) joints were more frequently

asymmetrical

> than thumb (MCP and interphalangeal) joints (P = 0.0064) and

proximal

> interphalangeal (PIP) joints (P < 0.0001); wrist quadrants were

more

> frequently asymmetrical than PIP joints (P < 0.0001). In phase 2,

two groups

> were identified and compared: symmetrizers (22 joints) and non-

symmetrizers

> (55 joints). The overall probability of small joints in the hand

and foot

> symmetrizing was 28.5%. Rheumatoid factor (RF) was predictive of

> symmetrization. The risk of symmetrization was significantly

increased in

> RF-positive patients with asymmetric joints (P = 0.01). The

prevalence of

> asymmetry did not decrease with disease duration, despite

symmetrization.

> CONCLUSIONS: Prevalence of asymmetry in joint damage in RA was 13-

16%.

> Symmetry was more evident in PIP joints than in MCP and wrist

joints.

> Seropositive patients are more than twice as likely to symmetrize

than

> seronegative patients. Data regarding the tendency for

symmetrization may

> have value in the clinical management of RA patients with

asymmetrical joint

> damage.

>

> PMID: 15850996

>

> http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?

cmd=Retrieve & db=PubMed & list_uids=15850996 & dopt=Citation

>

>

>

>

> Not an MD

>

> I'll tell you where to go!

>

> Mayo Clinic in Rochester

> http://www.mayoclinic.org/rochester

>

> s Hopkins Medicine

> http://www.hopkinsmedicine.org

>