Risk Factors and Prophylactic Tenosynovectomy for Extensor Tendon Ruptures in the Rheumatoid Hand

Ryu, Junnosuke; Saito, Shu; Honda, Toshio; Yamamoto, Kazuki

doi:10.1016/s0266-7681(98)80022-3

Cited by 58 publications

(30 citation statements)

References 10 publications

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“…The importance of ongoing tenosynovial inflammation in promoting tendon rupture has been confirmed by observations that prophylactic dorsal tenosynovectomy can prevent this complication in many patients (5). However, the decision to perform surgery is usually made in established cases of RA once clinical or radiologic features of joint damage have developed (6).…”

mentioning

confidence: 99%

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

McQueen¹,

Beckley²,

Crabbe³

et al. 2005

Arthritis & Rheumatism

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Objective. To determine whether magnetic resonance imaging (MRI) evidence of tendinopathy in early rheumatoid arthritis (RA) could be used to predict the course of tendon involvement in later disease and specifically the risk of tendon rupture.Methods. The occurrence, pattern, and progression of tendinopathy were studied prospectively over 6 years in a cohort of patients who had presented with RA. Of 42 patients enrolled, full MRI and clinical data were available for 31 at 6 years. MRI scans of the dominant wrist were scored for tendinopathy by 2 radiologists using a validated system. These data were compared with MRI synovitis, erosion scores, and disease activity measures. Prognostic factors for tendon inflammation and rupture were sought.Results. Thirty-four patients (81%) had MRI evidence of tendinopathy at baseline, falling to 59% at 1 year and 68% at 6 years. The most commonly affected site was the extensor carpi ulnaris. MRI tendinopathy and synovitis scores were correlated at baseline (r ‫؍‬ 0.37, P ‫؍‬ 0.01) and 1 year (r ‫؍‬ 0.45, P ‫؍‬ 0.003) but not at 6 years (r ‫؍‬ 0.11, P ‫؍‬ 0.5). The strongest predictor of the 6-year tendinopathy score was the 1-year tendinopathy score ( Conclusion. MRI can be used to quantify tendinopathy at the wrist in RA patients. High scores in early disease were predictive of tendon rupture in a small group of patients, but further studies are required to determine whether this has clinical relevance.Tendinopathy involving the extensor tendons of the wrist is observed in 50-64% of patients with rheumatoid arthritis (RA) (1). An important complication is tendon rupture, which has been related both to invasion of the tendon by tenosynovial pannus and fraying of the tendon against eroded bone margins (2,3). Studies of invasive tenosynovium have revealed high levels of matrix metalloproteinases, proinflammatory cytokines, and angiogenic factors, indicating a propensity for damage to neighboring tissues (4). The importance of ongoing tenosynovial inflammation in promoting tendon rupture has been confirmed by observations that prophylactic dorsal tenosynovectomy can prevent this complication in many patients (5). However, the decision to perform surgery is usually made in established cases of RA once

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mentioning

confidence: 99%

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

McQueen¹,

Beckley²,

Crabbe³

et al. 2005

Arthritis & Rheumatism

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“…13.7 ). Therefore, along with severe extensor tenosynovitis [ 14 ] and scallop sign (not signifi cant in this study) in the radiograph [ 15 ], early recognition of wrist deformity and palmar dislocation of ECU tendon may "potentially" decrease the rate of unsuspected extensor tendon ruptures in RA (Table 13.1 ).…”

Section: Wrist Deformity and Extensor Tendon Rupturementioning

confidence: 73%

Total Wrist Fusion and Limited Wrist Fusion Procedures in Rheumatoid Arthritis

Ishikawa

2016

Clinical Management of the Rheumatoid Hand, Wrist, and Elbow

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“…The aim of treatment is to relieve symptoms and prevent tendon rupture. Apart from the duration of symptoms, Ryu identifi ed two radiological prognostic factors for the risk of tendon rupture [ 11 ]: the scallop sign as described by Freiberg and dorsal dislocation of the distal ulna ( Fig. 11.7 ).…”

Section: Extensor Tenosynovectomymentioning

confidence: 99%

Soft Tissue Reconstructive Procedures in the Rheumatoid Wrist, Including Tendon Transfer Procedures

Bellemère

2016

Clinical Management of the Rheumatoid Hand, Wrist, and Elbow

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Risk Factors and Prophylactic Tenosynovectomy for Extensor Tendon Ruptures in the Rheumatoid Hand

Cited by 58 publications

References 10 publications

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

Magnetic resonance imaging evidence of tendinopathy in early rheumatoid arthritis predicts tendon rupture at six years

Total Wrist Fusion and Limited Wrist Fusion Procedures in Rheumatoid Arthritis

Soft Tissue Reconstructive Procedures in the Rheumatoid Wrist, Including Tendon Transfer Procedures

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