Prognostic Evaluation Of Finger Joint Bony Lesions In Rheumatoid Arthritis

Abstract

This study is an attempt to solve the problem associated with the Indications for preventive synovectomy operations in finger joints. In order to avoid unnecessary surgery, patients in which regression without surgery is probable or possible should be separated from the remainder. The justification of a pessimistic view of the possibilities of regression when X-ray demonstrable erosions have already developed is illustrated. The X-ray demonstrable development of 292 metacarpophalangeal and proximal interphalangeal joints in 17 cases was studied. No evident regression of a bony lesion was found. The rate of progress of bony erosions was found to be 18% in the group as a whole. When the period between the first and second examination was 31/2 years or more, up to 8 years, this figure increased to 35%. The conclusion must be drawn that if a bony erosion exists in the finger joint of a patient aged between 30 and 60 years, the chances that this joint will heal without surgery are almost non-existent, and, as a consequence, if preventive synovectomy is to be of use in these patients, a competent synovectomy operation at the right stage is justified. It is not too early to perform the operation when the first small signs of bony lesions are seen roentgenologically.

Erik Moberg, M.D. Department of Orthopaedic Surgery Sahlgrenska sjukhuset Göteborg Sweden