![]() īased on these findings, we hypothesized that a semi-quantitative approach using type/stage and ulnar drift parameters would provide a comprehensive understanding of the rheumatoid hand. The authors evaluated thumb deformity using the Nalebuff classification system (type 1–6), finger swan-neck deformity using the Nalebuff classification (type 1–4), finger boutonnière deformity using the Nalebuff classification (stage 1–3), and ulnar drift using the authors’ own method, which quantitated drift by evaluating joint parameters in an extended cohort. Another study described deformity severity in patients with established RA over 5 years of observation and found that overall deformities worsened over time. Although the authors did not evaluate thumb deformity and did not assess severity of finger deformities, they demonstrated that deformities were present in regular patterns such as “ulnar drift combined with swan-neck deformity.” Thus, there may be specific developmental patterns of deformities in rheumatoid hands, including the thumb. However, deformity severity was not described. However, it remains difficult to understand patients’ overall pathophysiological condition (deformity presence or absence, location and severity, and alterations over time) to determine the most relevant treatment options.Ī study of early RA patients over a 10-year period showed that approximately 50% of hands exhibited combined deformity. Swan-neck deformity, either alone or in combination with other deformities, has been reported to affect hand function to a greater degree than other deformities. Several studies have attempted to quantitate hand function using hand space and force-time curves to evaluate hand deformity. Rheumatoid hand, the term used to describe the characteristic deformities in the hands of patients with rheumatoid arthritis (RA), typically includes varying degrees of thumb deformity, finger deformities, and ulnar drift. Knowledge of the characteristics of progressive deformity parameters may allow rheumatologists to more easily implement practical interventions and determine functional prognosis. Our comprehensive analysis identified five deformity patterns and a progressive course in the rheumatoid hand. Over time, thumb deformity evolved into other types of deformities and swan-neck deformity worsened significantly. Clusters 1 and 2 represented conservative deformity parameters and clusters 3, 4, and 5 represented progressive deformity parameters. Clusters 1–4 had similar disease duration but showed different paths of deformity progression from disease onset. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. ![]() Resultsįive clusters most appropriately described hand deformity: (i) cluster 1, minimal deformity (ii) cluster 2, type 1 thumb deformity (iii) cluster 3, thumb deformity and severe boutonnière deformity (iv) cluster 4, type 2 or 3 thumb deformity and severe ulnar drift and (v) cluster 5, thumb deformity and severe swan-neck deformity. Two-way analysis of covariance was used to examine whether differences existed between evaluation points and clusters of deformity parameters. The parameters in each cluster were plotted at each evaluation point. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantitated and entered as parameters into a two-step cross-sectional cluster analysis for the data in 2004. We repeated the evaluations in 2009 (100 hands of 52 patients) and 2015 (63 hands of 37 patients) after case exclusion. We established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We aimed to establish a simpler composite method to understand the pathophysiology of and alterations in the hand deformities of patients with RA. The underlying complex pathophysiology makes understanding these deformities difficult, and comprehensive assessment methods require accumulated skill with long learning curves. Although drug therapy for rheumatoid arthritis (RA) has recently improved, treating patients with established disease, whose hands have three major deformities (thumb deformity, finger deformities, and ulnar drift), remains a challenge.
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