title: Rheumatoid arthritis of the hand: a five-year longitudinal analysis of clinical and radiographic findings.
abstract: OBJECTIVE
  Treatments for rheumatoid arthritis (RA) have improved since methotrexate and biological agents were approved; however, few longitudinal analyses have tracked joint destruction, deformity progression, or functional impairments that directly affect the activities of daily living. Due to the consequences of functional impairments, we conducted this study to glean more information regarding deformity progression over time.
  
  
  METHODS
  This study enrolled 134 hands in 67 RA patients with hand deformities in 2004. After 5 years, 100 hands in 52 patients were eligible for the final assessment. Analyses consisted of morphological and radiographical evaluations of deformities, functional evaluations by questionnaires and the modified Kapandji index, and activity evaluations.
  
  
  RESULTS
  In this period, the type I deformity (Nalebuff and Millender, Orthop Clin North Am 6(3):753-63, 1975) was the most common thumb deformity. Swan-neck and boutonnière finger deformities also progressed. At the 5-year follow-up, questionnaire score worsened, when disease activity was high.
  
  
  CONCLUSIONS
  Our study showed that there was a marked progression in hand deformities in RA patients over a 5-year period. In order to assist RA patients in performing the activities of daily living, medical and rehabilitative interventions should target the restoration of functional loss through joint destruction as well as the prevention of disease progression.
authors.affiliation: Department of Orthopaedics, Graduate School of Medical Science, Kyoto Prefectural University of Medicine , Kajii-cho 465, Kamigyo-ku, Kyoto, Kyoto , Japan . e-mail: fjwr@koto.kpu-m.ac.jp , shogo.toyama@gmail.com.
authors.forename: Shogo
authors.initials: S
authors.lastname: Toyama
authors.forename: Daisaku
authors.initials: D
authors.lastname: Tokunaga
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Fujiwara
authors.forename: Ryo
authors.initials: R
authors.lastname: Oda
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Kobashi
authors.forename: Hisashi
authors.initials: H
authors.lastname: Okumura
authors.forename: Satoru
authors.initials: S
authors.lastname: Nakamura
authors.forename: Daigo
authors.initials: D
authors.lastname: Taniguchi
authors.forename: Toshikazu
authors.initials: T
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging / Q000503:physiopathology*; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018737:Hand Strength; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D011859:Radiography; D011795:Surveys and Questionnaires