Rheumatoid Wrist

Koski JM, Hermunen H (2001) Intra-articular glucocorticoid treatment of the rheumatoid wrist. An ultrasonographic study. Scand J Rheumatol 30 268-270 Kuo MH, Leong CP, Cheng YF et al (2001) Static wrist position associated with least median nerve compression sonographic evaluation. Am J Phys Med Rehabil 80 256-260 Lanteri M, Ptasznik R, Constable L et al (1997) Ultrasound changes in the wrist and hand in hemodialysis patients. Clin Nephrol 48 375-380... 

A 50-year-old female with rheumatoid arthritis has developed erosions in her wrist bones. Which of the following agents should be administered7... 

Radiographic changes lypical of rheumatoid arthritis on posteroanterior hand and wrist x-rays, which must include erosions or unequivocal bony decalcification localized to or most marked adjacent to tire involved joints (osteoarthritis changes alone do not qualify). 

Rheumatoid arthritis is an autoimmune disease of the synovial lining of joints. Typically, the joints affected are those in the extremities fingers, wrists, toes, and ankles. It is a debilitating disease in which ligaments may be damaged and joints deformed. 

Arthritis Arthritis is the general term for chronic pain in the joints the fingers, wrists, elbows, shoulders, knees, ankles, and feet. There are two types of arthritis— rheumatoid arthritis, which results from an inflammation of the thin membranes that line the joints, and the more common osteoarthritis, which results from a... 

Rheumatoid arthritis (RA) is a progressive disease which mainly affects the joints of the body. It is an inflammatory condition which follows a relapsing, remitting course, which can be very variable. The hands and wrists are most commonly affected although other joints may be involved. It is usual that the disease is found in symmetrical joints, although this is not always the case. 

The joints affected most frequently by rheumatoid arthritis are the small joints of the hands, wrists, and feet (Fig. 89-3). In addition, elbows, shoulders, hips, knees, and ankles may be involved. Patients usually experience joint stiffness that typically is worse in the morning. The duration of stiffness tends to be correlated directly with disease activity, usually exceeds 30 minutes, and may persist all day. Chronic inflammation with lack of an adequate exercise program results in loss of range of motion, atrophy of muscles, weakness, and deformity. 

Involvement of the hands and wrists is common in rheumatoid arthritis. Hand involvement is manifested by pain, swelling, tenderness, and grip weakness during the acute phase, and by subluxation, instability, deformity, and muscle atrophy in the chronic phase of the disease. Functional difficulties with clasp, grasp, and pinch alter both strength and fine motor movement. 

MR enhancement in inflamed wrists of patients with rheumatoid arthritis. Joint Bone Spine 73 518-522... 

Rheumatoid arthritis and osteoarthritis may involve the joints of the wrist and hand. Psoriatic arthritis and gouty arthritis may also affect this area. Many of the findings and specific deformities were mentioned previously. In the arthriti-des, the small accessory motions of the joint are lost first. The osteopathic physician must articulate all joints once the acute inflammation has subsided. Placing traction on the joint as it is articulated decreases the discomfort for the patient. The patient should be encouraged to exercise the joints gently to maintain mobility. 

Keywords— Finite element analysis, wrist. Rheumatoid Arthritis, arthroplasty, stability. 

The wrist joint is involved in virtually every human functional activity and as such, are exposed to high number of traumatic injuries, primary osteoarthritis and secondary degenerative disease [1], One of the most common skeletal disease that is always associated with the wrist joint is Rheumatoid Arthritis [2], The disease affects mostly synovial joints, resulting in considerable pain, loss of function and eventual deformity. It is a life-long condition, and the disease activity might change over time. Even though other joints such as the hip and knee can also be affected with Rheumatoid Arthritis, the most commonly affected joint is the wrist [3]. 

In general, there are three main symptoms in which led to wrist deformation-cartilage destruction, synovial proliferation and ligamentous laxity [3-4]. The laxity of the ligaments due to stretching action caused by synovial expansion, resulting the instability of the wrist. As stated by Metz et al., wrist affected with Rheumatoid Arthritis was... 

Arthroplasty is one of the treatments for severe deformity case of Rheumatoid Arthritis, intended to preserve wrist joint motion while removing pain or any other problems associated with the wrist joint [6]. However, there are several problems associated with the wrist arthroplasty. Loosening effect was commonly occurred due to lack of bony support towards the implant [7-8]. Jay Menon et al. claimed that the wrist arthroplasty experienced with a earpal component fixed with three screws could successfiilly result a good bony support [8]. Bone graft was needed in order to enhance the fusion between bones and implant [9]. Hence, the aim of this project was to analyse the biomechanical effect of bone graft in enhancing distal component fixation of the wrist implant. 

B. The Modelling of the Wrist Affected with Rheumatoid Arthritis... 

The latest wrist implant, ReMotion produced by Small Bone Innovations was used in the simulation [9]. The model was constructed using a CAD software, Solidwork 2009. The 3D models were turned into surface triangular elements and positioned onto the Rheumatoid Arthritis model. Surgical preparation of the bone was carried out prior to insertion of the implant. The implants were then placed in their respective bone model and then converted into solid tetrahedral mesh. 

Fig. 1 3 Dimensional finite element model for (a) Rheumatoid Arthritis wrist, (b) the carpal side of the wrist arthroplasty, (c)the positioned implant into the Rheumatoid Arthritis model as well as the enhanced fixation of the carpal side of the wrist arthroplasty (d)...

Wrist affected with Rheumatoid Arthritis was commonly associated with carpal bones instability. In addition, stability of the wrist arthroplasty was still arguable due to some clinical reported the failure of the wrist arthroplasty due to weak fixation in which lead to instability. One of the suggested methods to enhance the fixation was to use bone graft. It was clearly observed in the results that the displacement of the bones as well as implants in the model fixed with bone graft is low. Since this study was established under semi-static condition, the low displacement significantly indicated the stability of the implant fixation. Thus, the fixation with bone graft found to be relatively... 

This presented paper was successfully illustrated the biomechanical behaviour of the two main fixation methods of the wrist arthroplasty, with and without bone graft. Based on the results and presented discussions, it can be concluded that wrist arthroplasty with carpal component fixed with bone graft successfully restore the stability of the carpal bones of the wrist with Rheumatoid Arthritis. This stability was interpreted with lower carpal displacement as well as considerably sufficient stresses value to provide fixation. 

Stegeman M et al. (2005) Biaxial total wrist arthroplasty in rheumatoid arthritis. Satisfactory functional results, Rheumatology International 25.191-194... 

Adams B D (2006) Total wrist arthroplasty for rheumatoid arthritis. International Congress Series 1295 83-93... 

McKee ABurge P (2010) (i) The principles of surgery in the rheumatoid hand and wrist, Orthopaedics and Trauma 24.T7T180... 

Brumfield Rjr., Kuschner SH, Gellman H et al (1990) Results of dorsal wrist synovectomies in the rheumatoid hand. J Hand Surg 15 733-735... 

A variety of arthritides can affect the wrist joints, the most important of which are rheumatoid arthritis and psoriatic arthritis. Rheumatoid arthritis, is characterized by bilateral and symmetric synovitis. The first manifestation of arthritis is serous syno-... 

In recent years, increasing attention has been directed to the role of US in the assessment of rheumatoid arthritis of the wrist and hand (Koski 1992 Koski and Hermunen 2001 Lund et al. 1995 van... 

Fig.l0.68a-d. Distinguishing joint synovitis versus extensor tenosynovitis with US. a,b Transverse 12-5 MHz US images obtained over the dorsal wrist in two patients with rheumatoid arthritis each presenting with tenderness and swelling over the dorsal right wrist. In a, the synovial effusion (asterisks) is closely apposed to the wrist bones because the inflammatory process involves the dorsal recesses of the wrist joints, whereas the overlying extensor tendons (T) are spared. In b, the effusion (asterisks) occurs all around the extensor tendons (T) as an expression of tenosynovitis, while the dorsal recesses of the wrist joints are normal. c,d Diagram correlations... 

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