title: Destruction and arthroplasties of the metatarsophalangeal joints in seropositive rheumatoid arthritis. A 20-year follow-up study.
abstract: 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 > or =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.
authors.affiliation: Rheumatism Foundation Hospital, Heinola, Finland.
authors.forename: E A
authors.initials: EA
authors.lastname: Belt
authors.forename: K
authors.initials: K
authors.lastname: Kaarela
authors.forename: M U
authors.initials: MU
authors.lastname: Lehto
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000473:pathology* / Q000601:surgery; D001178:Arthroplasty; D018450:Disease Progression; D005260:Female; D005384:Finger Joint / Q000473:pathology / Q000601:surgery; D005385:Fingers / Q000473:pathology / Q000601:surgery; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008683:Metatarsophalangeal Joint / Q000473:pathology* / Q000601:surgery; D008875:Middle Aged; D011446:Prospective Studies; D019651:Plastic Surgery Procedures; D012217:Rheumatoid Factor / Q000097:blood; D000074402:Synovectomy; D014034:Toes / Q000473:pathology / Q000601:surgery
chemical_list: D012217:Rheumatoid Factor