Skip to main content

Advertisement

SpringerLink
Log in

Radiographic measurements in the evaluation and classification of elbow joint destruction in patients with rheumatoid arthritis

  • Original Article
  • Published:
Clinical Rheumatology Aims and scope Submit manuscript

Abstract

We developed two new radiographic parameters—the humeral surface height ratio and ulnar surface height ratio—to precisely detect changes in the bony structure of rheumatoid elbows. Of the 59 patients with rheumatoid arthritis, 101 elbows were classified into four types (osteoarthritis, ankylosis, erosive, and resorptive) according to the radiographic appearance. Clinically, osteoarthritis type and ankylosis type were considered to be stable form, and erosive type and resorptive type were unstable form. Patients' clinical data and yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio were compared among the four types and between the two forms. There were significant differences between the two forms and among the three types except for the ankylosis type in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and ulnar surface height ratio. Stable and unstable forms were distinguished by a cut-off point of 0.65 and 2.58 in yearly radiographic changes in the bony structure evaluated by the humeral surface height ratio and the ulnar surface height ratio, respectively. These parameters might be useful for monitoring the structural changes of the elbow joint in rheumatoid arthritis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3

Similar content being viewed by others

References

  1. De Seze S, Debeyre N, Djian A, Manual R (1963) The elbow joint. In: Carter ME (ed) International Congress Series. Vol. 61. Excerpta Medica Foundation, Amsterdam, pp 115–123

    Google Scholar 

  2. Laine V, Vainio K (1969) Elbow in rheumatoid arthritis. In: Hijimans W, Paul W, Herschel H (eds) Early synovectomy in rheumatoid arthritis. Excerpta Medica Foundation, Amsterdam, pp 112–116

    Google Scholar 

  3. Porter BB, Richardson C, Vainio K (1974) Rheumatoid arthritis of the elbow: the results of synovectomy. J Bone Joint Surg Br 56:427–437

    Google Scholar 

  4. Flury MP, Herren DB, Simmen BR (1999) Rheumatoid arthritis of the wrist. Classification related to the natural course. Clin Orthop 366:72–77

    Article  PubMed  Google Scholar 

  5. Simmen BR, Huber H (1992) The rheumatoid wrist: a new classification related to the type of the natural course and its consequences for surgical therapy. In: Simmen BR, Hagena FW (eds) The wrist in rheumatoid arthritis. Karger, Basel, pp 13–25

    Google Scholar 

  6. Wakitani S, Imoto K, Saito M, Murata N, Hirooka A, Yoneda M et al (1999) Evaluation of surgeries for rheumatoid shoulder based on the destruction pattern. J Rheumatol 26(1):41–46

    PubMed  CAS  Google Scholar 

  7. Larsen A, Dale K, Eek M (1977) Radiographic evaluation of rheumatoid arthritis and related conditions by standard reference films. Acta Radiol Diagn (Stockh) 18(4):481–491

    CAS  Google Scholar 

  8. Larsen A (1995) How to apply Larsen score in evaluating radiographs of rheumatoid arthritis in long-term studies. J Rheumatol 22(10):1974–1975

    PubMed  CAS  Google Scholar 

  9. Steinbrocker O, Traeger CH, Batterman RC (1949) Therapeutic criteria in rheumatoid arthritis. J Am Med Assoc 140(8):659–662

    PubMed  CAS  Google Scholar 

  10. Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, Cooper NS et al (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31(3):315–324

    Article  PubMed  CAS  Google Scholar 

  11. Abe A, Ishikawa H, Murasawa A, Nakazono K (2008) Disease activity and the course of elbow joint deterioration over 10 years in the patients with early rheumatoid arthritis. Clin Rheumatol 27(7):867–872

    Article  PubMed  Google Scholar 

  12. Lehtinen J, Kaarela K, Kauppi MJ, Belt EA, Maenpaa HM, Lehto MU (2002) Bone destruction pattern in rheumatoid elbow: a radiographic assessment of 148 elbows at 15 years. J Shoulder Elbow Surg 11:253–258

    Article  PubMed  Google Scholar 

  13. Ljung P, Jonsson K, Rydholm U (1995) The natural course of rheumatoid elbow arthritis: a radiographic and clinical five-year follow up. J Orthop Rheumatol 8:32–36

    Google Scholar 

  14. Nemoto K, Arino H, Yoshihara Y, Fujikawa K (2004) Arthroscopic synovectomy for the rheumatoid elbow: a short-term outcome. J Shoulder Elbow Surg 13:652–655

    Article  PubMed  Google Scholar 

  15. Kitamura T, Hashimoto J, Murase T, Tomita T, Hattori T, Yoshikawa H et al (2007) Radiographic study of joint destruction patterns in the rheumatoid elbow. Clin Rheumatol 26:515–519

    Article  PubMed  Google Scholar 

  16. Alarcon GS, Lopez-Mendez A, Walter J, Boerbooms AM, Russell AS, Furst DE et al (1992) Radiographic evidence of disease progression in methotrexate treated and nonmethotrexate disease modifying antirheumatic drug treated rheumatoid arthritis patients: a meta-analysis. J Rheumatol 19(12):1868–1873

    PubMed  CAS  Google Scholar 

  17. Drosos AA, Tsifetaki N, Tsiakou EK, Timpanidou M, Tsampoulas C, Tatsis CK et al (1997) Influence of methotrexate on radiographic progression in rheumatoid arthritis: a sixty-month prospective study. Clin Exp Rheumatol 15(3):263–267

    PubMed  CAS  Google Scholar 

  18. Jeurissen ME, Boerbooms AM, van de Putte LB, Doesburg WH, Lemmens AM (1991) Influence of methotrexate and azathioprine on radiologic progression in rheumatoid arthritis. A randomized, double-blind study. Ann Intern Med 114(12):999–1004

    PubMed  CAS  Google Scholar 

  19. Lopez-Mendez A, Daniel WW, Reading JC, Ward JR, Alarcon GS (1993) Radiographic assessment of disease progression in rheumatoid arthritis patients enrolled in the cooperative systematic studies of the rheumatic diseases program randomized clinical trial of methotrexate, auranofin, or a combination of the two. Arthritis Rheum 36(10):1364–1369

    Article  PubMed  CAS  Google Scholar 

  20. Rau R, Herborn G, Karger T, Werdier D (1991) Retardation of radiologic progression in rheumatoid arthritis with methotrexate therapy. A controlled study. Arthritis Rheum 34(10):1236–1244

    Article  PubMed  CAS  Google Scholar 

  21. Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH, Keystone EC et al (2000) A comparison of etanercept and methotrexate in patients with early rheumatoid arthritis. N Engl J Med 343(22):1586–1593

    Article  PubMed  CAS  Google Scholar 

  22. Breedveld FC, Weisman MH, Kavanaugh AF, Cohen SB, Pavelka K, van Vollenhoven R et al (2006) The PREMIER study: a multicenter, randomized, double-blind clinical trial of combination therapy with adalimumab plus methotrexate versus methotrexate alone or adalimumab alone in patients with early, aggressive rheumatoid arthritis who had not had previous methotrexate treatment. Arthritis Rheum 54(1):26–37

    Article  PubMed  CAS  Google Scholar 

  23. Genovese MC, Bathon JM, Martin RW, Fleischmann RM, Tesser JR, Schiff MH et al (2002) Etanercept versus methotrexate in patients with early rheumatoid arthritis: two-year radiographic and clinical outcomes. Arthritis Rheum 46(6):1443–1450

    Article  PubMed  CAS  Google Scholar 

  24. Klareskog L, van der Heijde DM, de Jager JP, Gough A, Kalden J, Malaise M et al (2004) Therapeutic effect of the combination of etanercept and methotrexate compared with each treatment alone in patients with rheumatoid arthritis: double-blind randomised controlled trial. Lancet 363(9410):675–681

    Article  PubMed  CAS  Google Scholar 

  25. Lipsky PE, van der Heijde DM, St Clair EW, Furst DE, Breedveld FC, Kalden JR et al (2000) Infliximab and methotrexate in the treatment of rheumatoid arthritis. N Engl J Med 343(22):1594–1602

    Article  PubMed  CAS  Google Scholar 

  26. Nishimoto N, Hashimoto J, Miyasaka N, Yamamoto K, Kawai S, Takeuchi T et al (2007) Study of active controlled monotherapy used for rheumatoid arthritis, an IL-6 inhibitor (SAMURAI): evidence of clinical and radiographic benefit from an X ray reader-blinded randomised controlled trial of tocilizumab. Ann Rheum Dis 0:1–6

    Google Scholar 

  27. Smolen J, Han C, Bala M, Maini RN, Kalden JR, van der Heijde DM et al (2005) Evidence of radiographic benefit of treatment with infliximab plus methotrexate in rheumatoid arthritis patients who had no clinical improvement: a detailed subanalysis of data from the anti-tumor necrosis factor trial in rheumatoid arthritis with concomitant therapy study. Arthritis Rheum 52:1020–1030

    Article  PubMed  CAS  Google Scholar 

  28. van der Heijde DM, Klareskog L, Rodriguez-Valverde V, Codreanu C, Bolosiu H, Melo-Gomes J et al (2006) Comparison of etanercept and methotrexate, alone and combinated, in the treatment of rheumatoid arthritis: two-year clinical and radiographic results from the TEMPO study, a double blind, randomized trial. Arthitis Rheum 54:1063–1074

    Article  CAS  Google Scholar 

  29. Breedveld FC, Emery P, Keystone E, Patel K, Furst DE, Kalden JR et al (2004) Infliximab in active early rheumatoid arthritis. Ann Rheum Dis 63:149–155

    Article  PubMed  CAS  Google Scholar 

  30. van der Heijde DM (1996) Plain X-rays in rheumatoid arthritis: overview of scoring methods, their reliability and applicability. Bailliers Clin Rheumatol 10:435–453

    Article  Google Scholar 

Download references

Disclosures

None

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Kenzo Hashizume, Keiichiro Nishida, Kazuo Fujiwara, Yasutaka Kadota, Ryuichi Nakahara & Toshifumi Ozaki

  2. Department of Human Morphology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1 Shikata-cho, Okayama, 700-8558, Japan

    Keiichiro Nishida

  3. Department of Medical Materials for Musculoskeletal Reconstruction, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan

    Kazuo Fujiwara

  4. Kurashiki Kosai Hospital, Okayama, Japan

    Kazuhiko Ezawa

  5. Kagawa Rosai Hospital, Kagawa, Japan

    Hajime Inoue

Authors
  1. Kenzo Hashizume
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Keiichiro Nishida
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kazuo Fujiwara
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Yasutaka Kadota
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Ryuichi Nakahara
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Kazuhiko Ezawa
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Hajime Inoue
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Toshifumi Ozaki
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Keiichiro Nishida.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hashizume, K., Nishida, K., Fujiwara, K. et al. Radiographic measurements in the evaluation and classification of elbow joint destruction in patients with rheumatoid arthritis. Clin Rheumatol 29, 637–643 (2010). https://doi.org/10.1007/s10067-010-1381-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-010-1381-y

Keywords

Search

Navigation