Destruction and arthroplasties of the metatarsophalangeal (MTP) joints and interphalangeal (IP) joint of the big toe were evaluated in 103 seropositive rheumatoid arthritis (RA) patients in a prospective follow-up study at onset and at 1,3,8,15, and 20 years from entry.
A total of 83 patients attended the 15-year follow-up and 68 attended the 20-year follow-up.
Data on the forefoot synovectomies and reconstructions performed were obtained from patient documents and radiographs.
The radiographs were assigned by the Larsen method ; in the end point analysis the last or preoperative radiograph was used.
Erosions of Larsen grade = 2 were present in 6% of the investigated 1236 joints at onset and after 20 years in 62%, respectively.
At the end point, 24% of the joints were severely damaged (Larsen grade 4-5).
The MTP I and IP joints showed the lowest grade of destruction during follow-up, and MTP V the worst destruction.
Synovectomies were performed in 24 MTP joints ; a total of 75% of these joints were later resected.
MTP II-V head resections were performed in 21% and the Keller procedure in 12% of the MTP I joints.
Erosive changes occur early in the MTP joints, and their grade of destruction is high ; therefore they should be included in radiographic criteria and scores.
MTP synovectomies are insufficient treatments for RA without concomitant immunosuppression of the disease.
Mots-clés Pascal : Polyarthrite rhumatoïde, Facteur rhumatoïde, Homme, Synovite, Articulation métatarsophalangienne, Exploration, Radiographie, Symptomatologie, Evolutivité, Prothèse, Total, Traitement, Epidémiologie, Pronostic, Long terme, Etude longitudinale, Chronique, Membre inférieur, Système ostéoarticulaire pathologie, Rhumatisme inflammatoire, Immunopathologie, Maladie autoimmune, Arthropathie, Pied pathologie, Radiodiagnostic, Chirurgie orthopédique
Mots-clés Pascal anglais : Rheumatoid arthritis, Rheumatoid factor, Human, Synovitis, Metatarsophalangeal joint, Exploration, Radiography, Symptomatology, Evolutivity, Prosthesis, Total, Treatment, Epidemiology, Prognosis, Long term, Follow up study, Chronic, Lower limb, Diseases of the osteoarticular system, Inflammatory joint disease, Immunopathology, Autoimmune disease, Arthropathy, Disease of the foot, Radiodiagnosis, Orthopedic surgery
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 98-0296373
Code Inist : 002B15D. Création : 27/11/1998.