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Semin Musculoskelet Radiol 2021; 25(02): 232-245
DOI: 10.1055/s-0041-1729150
Review Article

Rheumatoid Hand and Other Hand-deforming Rheumatic Conditions

Iwona Sudoł-Szopińska 
1   Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
,
James Teh
2   Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
,
Anne Cotten
3   Service de Radiologie et Imagerie Musculosquelettique, Centre de Consultation et d'Imagerie de l'Appareil Locomoteur, CHU, France
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Abstract

The hand and wrist are commonly involved in rheumatic conditions, particularly rheumatoid arthritis and other systemic connective tissue diseases. With spondyloarthritis, hand and wrist involvement frequently occurs in psoriatic arthritis but generally does not occur in the remaining subtypes. The hand and wrist may also be affected in various metabolic and endocrine diseases, but these lie beyond the scope of this review.

Radiographs may demonstrate the presence of joint space narrowing, bone loss, cysts and erosions, malalignments, and osteolysis. They may also show regions of soft tissue swelling or thinning, and detect calcifications. Ultrasonography and magnetic resonance imaging (MRI) enable evaluation of the soft tissues, particularly the synovium, tenosynovium, and tendons. Furthermore, erosions are better demonstrated than on radiographs. MRI allows evaluation of periarticular bone marrow edema.

This article discusses typical imaging features of the hand and wrist in rheumatologic conditions including the advantages and limitations of the various methods.

Keywords

rheumatoid arthritis - rheumatoid hand - ultrasound - magnetic resonance imaging - imaging


Publication History

Article published online:
03 June 2021

© 2021. Thieme. All rights reserved.

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  • References

  • 1 Avenarius DFM, Nusman C, Malattia C. et al. Current status of wrist imaging in juvenile idiopathic arthritis. Pediatr Radiol 2018; 48 (06) 801-810
    CrossrefPubMedGoogle Scholar
  • 2 Ben Achour W, Bouaziz M, Mechri M. et al. A cross sectional study of bone and cartilage biomarkers: correlation with structural damage in rheumatoid arthritis. Libyan J Med 2018; 13 (01) 1512330
    CrossrefPubMedGoogle Scholar
  • 3 Taylor-Gjevre RM, Mitchell A, Street M, Leswick DA, Stewart SA, Obaid H. The role of radiology in the quantification of digital ulnar deviation in rheumatoid arthritis patients. J Med Imaging Radiat Oncol 2016; 60 (03) 323-328
    CrossrefPubMedGoogle Scholar
  • 4 Fujimori M, Nakamura S, Hasegawa K. et al. Cartilage quantification using contrast-enhanced MRI in the wrist of rheumatoid arthritis: cartilage loss is associated with bone marrow edema. Br J Radiol 2017; 90 (1077): 20170167
    CrossrefPubMedGoogle Scholar
  • 5 Cyteval C. Doppler ultrasonography and dynamic magnetic resonance imaging for assessment of synovitis in the hand and wrist of patients with rheumatoid arthritis. Semin Musculoskelet Radiol 2009; 13 (01) 66-73
    Article in Thieme ConnectPubMedGoogle Scholar
  • 6 Geusens P, van den Bergh J. Bone erosions in rheumatoid arthritis. Rheumatology (Oxford) 2014; 53 (01) 4-5
    CrossrefPubMedGoogle Scholar
  • 7 Ilan DI, Rettig ME. Rheumatoid arthritis of the wrist. Bull Hosp Jt Dis 2003; 61 (3-4): 179-185
    PubMedGoogle Scholar
  • 8 Sudoł-Szopińska I, Matuszewska G, Kwiatkowska B, Pracoń G. Diagnostic imaging of psoriatic arthritis. Part I: etiopathogenesis, classifications and radiographic features. J Ultrason 2016; 16 (64) 65-77
    CrossrefPubMedGoogle Scholar
  • 9 Efthimiou P, Paik PK, Bielory L. Diagnosis and management of adult onset Still's disease. Ann Rheum Dis 2006; 65 (05) 564-572
    CrossrefPubMedGoogle Scholar
  • 10 Dray GJ. The hand in systemic lupus erythematosus. Hand Clin 1989; 5 (02) 145-155
    CrossrefPubMedGoogle Scholar
  • 11 van Vugt RM, Derksen RH, Kater L, Bijlsma JW. Deforming arthropathy or lupus and rhupus hands in systemic lupus erythematosus. Ann Rheum Dis 1998; 57 (09) 540-544
    CrossrefPubMedGoogle Scholar
  • 12 Boutry N, Hachulla E, Zanetti-Musielak C, Morel M, Demondion X, Cotten A. Imaging features of musculoskeletal involvement in systemic sclerosis. Eur Radiol 2007; 17 (05) 1172-1180
    CrossrefPubMedGoogle Scholar
  • 13 Sudoł-Szopińska I, Jacques T, Gietka P, Cotten A. Imaging in dermatomyositis in adults and children. J Ultrason 2020; 20 (80) e36-e42
    CrossrefPubMedGoogle Scholar
  • 14 Brown AK. How to interpret plain radiographs in clinical practice. Best Pract Res Clin Rheumatol 2013; 27 (02) 249-269
    CrossrefPubMedGoogle Scholar
  • 15 Wakefield RJ, Green MJ, Marzo-Ortega H. et al. Should oligoarthritis be reclassified? Ultrasound reveals a high prevalence of subclinical disease. Ann Rheum Dis 2004; 63 (04) 382-385
    CrossrefPubMedGoogle Scholar
  • 16 Ory PA. Radiography in the assessment of musculoskeletal conditions. Best Pract Res Clin Rheumatol 2003; 17 (03) 495-512
    CrossrefPubMedGoogle Scholar
  • 17 Sudoł-Szopińska I, Matuszewska G, Gietka P, Płaza M, Walentowska-Janowicz M. Imaging of juvenile idiopathic arthritis. Part I: Clinical classifications and radiographs. J Ultrason 2016; 16 (66) 225-236
    CrossrefPubMedGoogle Scholar
  • 18 Ravelli A, Ioseliani M, Norambuena X. et al. Adapted versions of the Sharp/van der Heijde score are reliable and valid for assessment of radiographic progression in juvenile idiopathic arthritis. Arthritis Rheum 2007; 56 (09) 3087-3095
    CrossrefPubMedGoogle Scholar
  • 19 Beals C, Baumgartner R, Peterfy C. et al. Magnetic resonance imaging of the hand and wrist in a randomized, double-blind, multicenter, placebo-controlled trial of infliximab for rheumatoid arthritis: comparison of dynamic contrast enhanced assessments with semi-quantitative scoring. PLoS One 2017; 12 (12) e0187397
    CrossrefPubMedGoogle Scholar
  • 20 Kosta PE, Voulgari PV, Zikou AK, Drosos AA, Argyropoulou MI. The usefulness of magnetic resonance imaging of the hand and wrist in very early rheumatoid arthritis. Arthritis Res Ther 2011; 13 (03) R84
    CrossrefPubMedGoogle Scholar
  • 21 Ji L, Deng X, Geng Y, Song Z, Zhang Z. The additional benefit of ultrasonography to 2010 ACR/EULAR classification criteria when diagnosing rheumatoid arthritis in the absence of anti-cyclic citrullinated peptide antibodies. Clin Rheumatol 2017; 36 (02) 261-267
    CrossrefPubMedGoogle Scholar
  • 22 Lee K-A, Min S-H, Kim T-H, Lee S-H, Kim H-R. Magnetic resonance imaging-assessed synovial and bone changes in hand and wrist joints of rheumatoid arthritis patients. Korean J Intern Med (Korean Assoc Intern Med) 2019; 34 (03) 651-659
    CrossrefPubMedGoogle Scholar
  • 23 Sun X, Deng X, Geng Y. et al. A simplified and validated ultrasound scoring system to evaluate synovitis of bilateral wrists and hands in patients with rheumatoid arthritis. Clin Rheumatol 2018; 37 (01) 185-191
    CrossrefPubMedGoogle Scholar
  • 24 Magni-Manzoni S, Collado P, Jousse-Joulin S. et al; Paediatric Ultrasound Group of the OMERACT Ultrasound Task Force. Current state of musculoskeletal ultrasound in paediatric rheumatology: results of an international survey. Rheumatology (Oxford) 2014; 53 (03) 491-496
    CrossrefPubMedGoogle Scholar
  • 25 Sudoł-Szopińska I, Jurik AG, Eshed I. et al. Recommendations of the ESSR Arthritis Subcommittee for the Use of Magnetic Resonance Imaging in Musculoskeletal Rheumatic Diseases. Semin Musculoskelet Radiol 2015; 19 (04) 396-411
    Article in Thieme ConnectPubMedGoogle Scholar
  • 26 Plagou A, Teh J, Grainger AJ. et al. Recommendations of the ESSR Arthritis Subcommittee on Ultrasonography in Inflammatory Joint Disease. Semin Musculoskelet Radiol 2016; 20 (05) 496-506
    Article in Thieme ConnectPubMedGoogle Scholar
  • 27 Narváez JA, Narváez J, De Lama E, De Albert M. MR imaging of early rheumatoid arthritis. Radiographics 2010; 30 (01) 143-163 ; discussion 163–165
    CrossrefPubMedGoogle Scholar
  • 28 Sudoł-Szopińska I, Kontny E, Maśliński W. et al. The pathogenesis of rheumatoid arthritis in radiological studies. Part I: Formation of inflammatory infiltrates within the synovial membrane. J Ultrason 2012; 12 (49) 202-213
    CrossrefPubMedGoogle Scholar
  • 29 Smith MD. The normal synovium. Open Rheumatol J 2011; 5: 100-106
    CrossrefPubMedGoogle Scholar
  • 30 Buchbender C, Ostendorf B, Mattes-György K. et al. Synovitis and bone inflammation in early rheumatoid arthritis: high-resolution multi-pinhole SPECT versus MRI. Diagn Interv Radiol 2013; 19 (01) 20-24
    PubMedGoogle Scholar
  • 31 Hodgson RJ, O'Connor P, Moots R. MRI of rheumatoid arthritis image quantitation for the assessment of disease activity, progression and response to therapy. Rheumatology (Oxford) 2008; 47 (01) 13-21
    CrossrefPubMedGoogle Scholar
  • 32 Stomp W, Krabben A, van der Heijde D. et al. Aiming for a shorter rheumatoid arthritis MRI protocol: can contrast-enhanced MRI replace T2 for the detection of bone marrow oedema?. Eur Radiol 2014; 24 (10) 2614-2622
    CrossrefPubMedGoogle Scholar
  • 33 Boesen M, Kubassova O, Sudoł-Szopińska I. et al. MR imaging of joint infection and inflammation with emphasis on dynamic contrast-enhanced MR imaging. PET Clin 2018; 13 (04) 523-550
    CrossrefPubMedGoogle Scholar
  • 34 Sudoł-Szopińska I, Kontny E, Maśliński W, Prochorec-Sobieszek M, Warczyńska A, Kwiatkowska B. Significance of bone marrow edema in pathogenesis of rheumatoid arthritis. Pol J Radiol 2013; 78 (01) 57-63
    CrossrefPubMedGoogle Scholar
  • 35 Ostrowska M, Maśliński W, Prochorec-Sobieszek M, Nieciecki M, Sudoł-Szopińska I. Cartilage and bone damage in rheumatoid arthritis. Reumatologia 2018; 56 (02) 111-120
    CrossrefPubMedGoogle Scholar
  • 36 Boutry N, Morel M, Flipo RM, Demondion X, Cotten A. Early rheumatoid arthritis: a review of MRI and sonographic findings. AJR Am J Roentgenol 2007; 189 (06) 1502-1509
    CrossrefPubMedGoogle Scholar
  • 37 Ji L, Li G, Xu Y, Zhou W, Zhang Z. Early prediction of rheumatoid arthritis by magnetic resonance imaging in the absence of anti-cyclic citrullinated peptide antibodies and radiographic erosions in undifferentiated inflammatory arthritis patients: a prospective study. Int J Rheum Dis 2015; 18 (08) 859-865
    CrossrefPubMedGoogle Scholar
  • 38 Tamai M, Kawakami A, Uetani M. et al. A prediction rule for disease outcome in patients with undifferentiated arthritis using magnetic resonance imaging of the wrists and finger joints and serologic autoantibodies. Arthritis Rheum 2009; 61 (06) 772-778
    CrossrefPubMedGoogle Scholar
  • 39 Duer-Jensen A, Hørslev-Petersen K, Hetland ML. et al. Bone edema on magnetic resonance imaging is an independent predictor of rheumatoid arthritis development in patients with early undifferentiated arthritis. Arthritis Rheum 2011; 63 (08) 2192-2202
    CrossrefPubMedGoogle Scholar
  • 40 Töpfer D, Finzel S, Museyko O, Schett G, Engelke K. Segmentation and quantification of bone erosions in high-resolution peripheral quantitative computed tomography datasets of the metacarpophalangeal joints of patients with rheumatoid arthritis. Rheumatology (Oxford) 2014; 53 (01) 65-71
    CrossrefPubMedGoogle Scholar
  • 41 Canella C, Philippe P, Pansini V, Salleron J, Flipo RM, Cotten A. Use of tomosynthesis for erosion evaluation in rheumatoid arthritic hands and wrists. Radiology 2011; 258 (01) 199-205
    CrossrefPubMedGoogle Scholar
  • 42 Stoenoiu MS, Houssiau FA, Lecouvet FE. Tendon friction rubs in systemic sclerosis: a possible explanation—an ultrasound and magnetic resonance imaging study. Rheumatology (Oxford) 2013; 52 (03) 529-533
    CrossrefPubMedGoogle Scholar
  • 43 Hubac J, Gilson M, Gaudin P, Clay M, Imbert B, Carpentier P. Ultrasound prevalence of wrist, hand, ankle and foot synovitis and tenosynovitis in systemic sclerosis, and relationship with disease features and hand disability. Joint Bone Spine 2020; 87 (03) 229-233
    CrossrefPubMedGoogle Scholar
  • 44 Pracoń G, Płaza M, Walentowska-Janowicz M, Sudoł-Szopińska I. The value of ultrasound in the diagnosis of limited scleroderma—a case report. J Ultrason 2015; 15 (62) 326-331
    CrossrefPubMedGoogle Scholar
  • 45 Freire V, Bazeli R, Elhai M. et al. Hand and wrist involvement in systemic sclerosis: US features. Radiology 2013; 269 (03) 824-830
    CrossrefPubMedGoogle Scholar
  • 46 Zhou AY, Muir L, Harris J, Herrick AL. The impact of magnetic resonance imaging in early diagnosis of hand osteomyelitis in patients with systemic sclerosis. Clin Exp Rheumatol 2014; 32 (06, Suppl 86): S-232
    PubMedGoogle Scholar
  • 47 Abdel-Magied RA, Lotfi A, AbdelGawad EA. Magnetic resonance imaging versus musculoskeletal ultrasonography in detecting inflammatory arthropathy in systemic sclerosis patients with hand arthralgia. Rheumatol Int 2013; 33 (08) 1961-1966
    CrossrefPubMedGoogle Scholar
  • 48 Ćwikła JB, Żbikowski P, Kwiatkowska B, Buscombe JR, Sudoł-Szopińska I. Radiosynovectomy in rheumatic diseases. J Ultrason 2014; 14 (58) 241-251
    CrossrefPubMedGoogle Scholar
  • 49 Wakefield RJ, Gibbon WW, Conaghan PG. et al. The value of sonography in the detection of bone erosions in patients with rheumatoid arthritis: a comparison with conventional radiography. Arthritis Rheum 2000; 43 (12) 2762-2770
    CrossrefPubMedGoogle Scholar
  • 50 Szkudlarek M, Court-Payen M, Jacobsen S, Klarlund M, Thomsen HS, Østergaard M. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003; 48 (04) 955-962
    CrossrefPubMedGoogle Scholar
  • 51 Teh J, Stevens K, Williamson L, Leung J, McNally EG. Power Doppler ultrasound of rheumatoid synovitis: quantification of therapeutic response. Br J Radiol 2003; 76 (912) 875-879
    CrossrefPubMedGoogle Scholar
  • 52 Østergaard M, Peterfy CG, Bird P. et al. The OMERACT Rheumatoid Arthritis Magnetic Resonance Imaging (MRI) Scoring System: updated recommendations by the OMERACT MRI in Arthritis Working Group. J Rheumatol 2017; 44 (11) 1706-1712
    CrossrefPubMedGoogle Scholar
  • 53 Haavardsholm EA, Østergaard M, Ejbjerg BJ, Kvan NP, Kvien TK. Introduction of a novel magnetic resonance imaging tenosynovitis score for rheumatoid arthritis: reliability in a multireader longitudinal study. Ann Rheum Dis 2007; 66 (09) 1216-1220
    CrossrefPubMedGoogle Scholar
  • 54 Peterfy CG, DiCarlo JC, Olech E, Bagnard MA, Gabriele A, Gaylis N. Evaluating joint-space narrowing and cartilage loss in rheumatoid arthritis by using MRI. Arthritis Res Ther 2012; 14 (03) R131
    CrossrefPubMedGoogle Scholar
  • 55 Miese F, Buchbender C, Scherer A. et al. Molecular imaging of cartilage damage of finger joints in early rheumatoid arthritis with delayed gadolinium-enhanced magnetic resonance imaging. Arthritis Rheum 2012; 64 (02) 394-399
    CrossrefPubMedGoogle Scholar
  • 56 Aletaha D, Neogi T, Silman AJ. et al. 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis Rheum 2010; 62 (09) 2569-2581
    CrossrefPubMedGoogle Scholar
  • 57 Berger AJ, Meals RA. Management of osteoarthrosis of the thumb joints. J Hand Surg Am 2015; 40 (04) 843-850
    CrossrefPubMedGoogle Scholar
  • 58 Bellis E, Scirè CA, Carrara G. et al. Ultrasound-detected tenosynovitis independently associates with patient-reported flare in patients with rheumatoid arthritis in clinical remission: results from the observational study STARTER of the Italian Society for Rheumatology. Rheumatology (Oxford) 2016; 55 (10) 1826-1836
    CrossrefPubMedGoogle Scholar
  • 59 Yu X, Li Z, Ren M, Xi J, Wu J, Ji Y. Superb microvascular imaging (SMI) for evaluating hand joint lesions in patients with rheumatoid arthritis in clinical remission. Rheumatol Int 2018; 38 (10) 1885-1890
    CrossrefPubMedGoogle Scholar