[Radiographic study of the rheumatoid hand and etiopathogenic mechanisms of deformities. Apropos of 100 cases]. / Etude radiographic de la main rhumatoïde et des mécanismes étiopathogéniques des déformations. A propos de 100 cas.

X-rays of the hands and wrists of 100 patients suffering from rheumatoid arthritis (RA) were compared to those of 65 control subjects matched for age and sex. Osteoarticular destruction was assessed using Larsen's index and by carpal bone deformities; ulnar deviation of the fingers (UDF) and radial deviation of carpal bones (RDC). No significant asymmetry of lesions in the right or left hands can be demonstrated, whatever the subsets of patients and osteoarticular manifestations studied. After a one year course, there is no significant difference between patients and control subjects. Only the index of carpal deformity is significantly high and the clinical course progresses between 1 and 5 years (p = 0.02). The difference becomes significant for UDF (p less than 0.01) after the disease evolves for 5 to 10 yrs. UDF is correlated with carpal osteoarticular lesions (p = 0.01) and metacarpophalangeal lesions (MCP). Different osteoarticular lesions of the hand are correlated with each other. The close correlation between UDF and RDC and MCP involvement has been confirmed by various statistical tests. Comparison of seropositive and seronegative patients with RA only reveals a more marked disturbance of MCP in the seropositive patients. Various methods of assessing osteoarticular deformities and joint destruction are discussed. Finally, the etiopathogenic mechanisms causing deformities of the hand in RA were studied, and the authors reviewed the importance of the initial involvement of soft tissues and therapeutic implications whereby prevention of disease extension using prompt local therapy is recommended.