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Arthritis & Joint Disease

Hand/foot OA & RA: diagnosis, staging, and surgical vs conservative management strategies for symptom relief & deformity correction.

Overview

Timely diagnosis and treatment of benign synovial disorders are critical to minimizing disease progression and resulting dysfunction [1]. Without intervention, cartilage erosion and degenerative joint disease represent the most common long-term consequences [1]. In the specific context of rheumatoid arthritis, early and aggressive treatment is now standard practice, though complete resolution of signs and symptoms is achievable in perhaps only 10% of patients [3]. Surgical procedures in rheumatoid arthritis should be performed to correct deformity and restore function when indicated, provided the patient's general condition is satisfactory, even if the disease remains active [23].

Management strategies vary significantly by pathology. For psoriatic arthritis, the mainstay of treatment involves biologic therapy in conjunction with disease-modifying antirheumatic drugs, with surgery reserved for patients with end-stage joint destruction [4]. In thumb carpometacarpal osteoarthritis, positive outcomes are documented at greater than 5 years of follow-up for nonsurgical treatment, with no worsening of pain or limitations in activities of daily living after 12 months [5]. Conversely, no disease-modifying treatment currently exists for hand osteoarthritis, leaving multiple options available solely to manage symptoms and optimize function [13]. While newer generation unconstrained surface replacement arthroplasties show promise for select cases of metacarpophalangeal joint osteoarthritis and inflammatory arthritis [36], fusion remains the benchmark for advanced thumb metacarpophalangeal joint arthritis, with arthroplasty serving as a viable option to reduce pain, preserve motion, and limit progression of adjacent joint disease [41].

Long-term natural history data informs risk stratification for other conditions. At a mean follow-up of 24.7 years, 14% of hips with femoroacetabular impingement without surgical intervention developed symptomatic osteoarthritis, and 4% underwent total hip arthroplasty [15]. Non-operative and operative treatments for shoulder dislocation demonstrate similar proportions of post-dislocation osteoarthritis at any point of follow-up [8]. Furthermore, for glenohumeral arthritis treated with a single image-guided corticosteroid injection, there are no differences in the need for secondary intervention based on the severity of radiographic osteoarthritis or baseline shoulder dysfunction [25]. Ongoing research, such as a randomized controlled trial, continues to evaluate whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis [14].

Anatomy & Pathophysiology

Osseous and Articular Pathology

Foot abnormalities are associated with active joint disease and disability in rheumatoid arthritis [24]. Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes [27]. Osteoarthritis of the distal interphalangeal joint involves roles of cartilage, subchondral bone, and soft tissue structures [78]. Thumb basal joint arthritis is a progressive disease, with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes [73]. In pediatric coxa vara, surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, whereas moderate nonprogressive deformity often does not require surgery [74].

Ligamentous and Soft Tissue Pathology

Plantar plate pathology is associated with erosive disease in the painful forefoot of patients with rheumatoid arthritis [70]. Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway [65].

Neurologic and Vascular Considerations

No proven method exists to reverse peripheral neuropathy [76]. Treatment of diabetic foot and ankle focuses on symptom management, protection from mechanical trauma, and off-loading pressure to prevent ulceration and amputation [76].

Epidemiological and Clinical Context

Epidemiological studies on prearthrotic deformities should only be performed in healthy adults with no signs of osteoarthritic changes [28].

Classification

Benign Synovial Disorders: Timely diagnosis and treatment are critical to minimize disease progression and resulting dysfunction, as cartilage erosion and degenerative joint disease represent the most common long-term consequences [1].

Pyoderma Gangrenosum: Early diagnosis and proper treatment with corticosteroids are favorable to prevent joint destruction and other complex consequences in cases involving wrist joint destruction [2].

Charcot Joint: A high index of suspicion is crucial for early diagnosis, particularly when presenting as a destructive joint arthropathy combined with minimal pain and neurological features [9].

Rheumatoid Arthritis: Early and accurate diagnosis associated with optimal personalized treatment is emphasized to achieve better outcomes in management [10].

Gout of the Spine: Identification of synovial facet joint involvement allows for accurate presumptive diagnosis and confirmation via laboratory tests [12].

Arthritis Mutilans: This condition cannot be considered an advanced or fulminating stage of rheumatoid arthritis and should be considered a separate entity for the purpose of early correct diagnosis [17].

Seronegative Inflammatory Arthritis: A rare sub-type of inflammatory arthritis can have devastating disease consequences despite being seronegative [19].

Osteoarthritis (Thumb CMC): Familial clustering of severe thumb carpometacarpal joint osteoarthritis was observed in a statewide population, indicating that genetic and environmental factors contribute to the disease process [48].

Eaton and Littler Classification: The moderate interobserver agreement of the radiological classification for staging of CMC1 osteoarthritis questions the efficiency of the system [49].

Other Considerations: Different types of pain medication reported in older Irish adults with osteoarthritis broadly aligned with OA guidelines, although usage varied with pain severity [43]. A new classification system for long-term unreduced hip joint dislocation, secondary osteoarthritis, and pseudoarthrosis could help surgeons estimate potential difficulties during total hip arthroplasty [44]. The frequency of metabolic syndrome in rheumatoid arthritis varies according to the definition used and was significantly higher compared to controls [53]. The definition of treatment failure for bacterial arthritis after a single surgical intervention was established through a three-round Delphi study [54]. The second edition of The Arthropathies adds value through extensive rewriting, clearer illustrations, and updated terminology [46].

Clinical Presentation

Timely diagnosis and treatment of benign synovial disorders are critical to minimize disease progression, as cartilage erosion and degenerative joint disease represent the most common long-term consequences [1]. In pyoderma gangrenosum with wrist joint destruction, early diagnosis and proper corticosteroid treatment favor the prevention of joint destruction and complex sequelae [2]. For rheumatoid arthritis (RA), early and aggressive treatment can achieve complete resolution of signs and symptoms in perhaps 10% of patients [3], while early and accurate diagnosis associated with optimal personalized treatment is essential for better outcomes [10]. In suspected inflammatory arthritis, routine ultrasound use in newly referred patients is associated with significantly earlier diagnosis and DMARD initiation [11].

Acute vs. Chronic Patterns: A high index of suspicion for Charcot joint is crucial for early diagnosis, particularly when a destructive joint arthropathy presents with minimal pain and neurological features [9]. Early diagnosis and treatment of Charcot neuro-osteoarthropathy, a rare complication of RA, help prevent further joint injury [33]. Conversely, septic arthritis in RA patients is difficult to identify and requires a high degree of clinical suspicion [32]. Diagnosis of sea urchin spine arthritis relies on injury history, a symptom-free period, and the absence of laboratory abnormalities [6]. Identification of synovial facet joint involvement allows for accurate presumptive diagnosis and confirmation via laboratory tests in gout of the spine [12].

Joint-Specific Manifestations: Rheumatoid arthritis of the shoulder is a progressive disorder causing pain, loss of range of motion, and functional disability [21]. In patients with glenohumeral arthritis, no consistent clinically important differences in pain or function were discovered regarding radiographic or demographic factors [22]. Foot abnormalities are associated with active joint disease and disability in patients with RA [24]. Patients with end-stage joint destruction due to psoriatic arthritis may require surgery [4]. A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy within 2 years [20]. Of patients presenting with advanced radiographic thumb carpometacarpal arthritis, one-third underwent surgery within 5 years of initial corticosteroid injection [7]. Multiple options exist for managing hand osteoarthritis to achieve symptom relief and optimize function, although no disease-modifying treatment exists [13].

Classification and Diagnostic Nuance: Arthritis mutilans should be considered a separate entity rather than an advanced or fulminating stage of RA to ensure early correct diagnosis [17]. A rare seronegative sub-type of inflammatory arthritis can have devastating disease consequences [19]. A 9 mRNAs-based diagnostic signature for RA could provide new insights into RA diagnostics [35].

Investigations

Plain radiography: While a high index of suspicion is crucial for early diagnosis of Charcot joint, particularly in destructive arthropathy with minimal pain and neurological features [9], radiographic severity does not always correlate with clinical outcomes. In thumb basilar joint osteoarthritis, radiographic severity does not correlate with validated patient-reported symptom scores [58], and trapeziometacarpal arthrosis does not correlate with radiographic arthrosis in patients not seeking care [63]. However, more advanced radiographic trapeziometacarpal osteoarthritis severity is associated with lower grip strength and poorer self-reported functional outcomes [57]. In glenohumeral arthritis, no consistent clinically important differences in pain or function were discovered regarding radiographic or demographic factors [22], and the need for secondary intervention following a single image-guided corticosteroid injection does not differ based on radiographic osteoarthritis severity or baseline dysfunction [25]. Radiological osteoarthritis following a mallet finger fracture resembles the natural degenerative process in the distal interphalangeal joint and is accompanied by decreased range of motion, though this does not clinically affect patient-reported outcomes [52]. Epidemiological studies on prearthrotic deformities should be restricted to healthy adults with no signs of osteoarthritic changes [28].

MRI: Magnetic resonance imaging detects progressive erosive disease in up to 40% of patients with rheumatoid arthritis despite DAS28 improvement or EULAR remission [47]. Computed tomography is more sensitive than conventional radiography for detecting bone erosions in rheumatoid arthritis [51].

CT: Computed tomography scans of SPECT/CT provided better interobserver reliability than routine radiographs for evaluating the severity of arthritis in symptomatic basal joint arthritis of the thumb [45].

Other Considerations: Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction, as cartilage erosion and degenerative joint disease are the most common long-term consequences [1]. Early diagnosis and proper treatment with corticosteroids are favorable to prevent joint destruction and other complex consequences in pyoderma gangrenosum with wrist joint destruction [2]. In patients with suspected inflammatory arthritis, routine ultrasound use in newly referred patients is associated with significantly earlier diagnosis and DMARD initiation [11]. Identification of synovial facet joint involvement allows for accurate presumptive diagnosis and confirmation via laboratory tests in gout of the spine [12]. Of patients presenting with advanced radiographic thumb carpometacarpal arthritis, one-third underwent surgery within 5 years of initial corticosteroid injection [7]. A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy for femoroacetabular impingement syndrome within 2 years [20]. This is the first study to assess the prevalence of ultrasound features of osteoarthritis in a population-based sample at age 63 years [55].

Treatment

Timely diagnosis and treatment of benign synovial disorders are critical to minimize disease progression and resulting dysfunction, as cartilage erosion and degenerative joint disease represent the most common long-term consequences [1]. Early diagnosis and proper treatment with corticosteroids are favorable for preventing joint destruction and complex sequelae in pyoderma gangrenosum involving the wrist [2]. Management of rheumatoid arthritis emphasizes early and accurate diagnosis associated with optimal personalized treatment to achieve better outcomes [10], with early and aggressive therapy now standard to potentially achieve complete resolution of signs and symptoms in 10% of patients [3]. In patients with suspected inflammatory arthritis, routine ultrasound use in newly referred patients is associated with significantly earlier diagnosis and initiation of disease-modifying antirheumatic drugs (DMARDs) [11]. Health systems should provide first-line treatment for rheumatoid arthritis as a strategy to improve compliance and clinical outcomes, particularly in vulnerable populations [37].

Non-Operative

Medical Management: The mainstay of treatment for psoriatic arthritis involves biologic therapy in conjunction with DMARDs, while management of nonrheumatoid inflammatory arthroses is typically medical and continues to evolve with biologically targeted medications [4, 38]. Although no disease-modifying treatment exists for hand osteoarthritis, multiple options are available in rheumatology practice to achieve symptom relief and optimize hand function [13]. A study is planned to provide high-quality evidence regarding whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis [14]. Tofacitinib is efficacious and well tolerated in patients with methotrexate-resistant rheumatoid arthritis up to 24 weeks [34]. Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option for intra-articular injection in the management of trapeziometacarpal (TMC) osteoarthritis [39]. Positive outcomes at greater than 5 years of follow-up have been found for nonsurgical treatment of CMC-1 osteoarthritis, with no worsening of pain or limitations in activities of daily living after 12 months [5].

Operative

Indications: Surgical intervention is indicated for rheumatoid arthritis of the shoulder when nonsurgical management fails to address significant pain and functional limitation [21]. Surgical procedures in rheumatoid arthritis should be performed to correct deformity and restore function even if the disease is active, provided the patient's general condition is satisfactory [23]. Patients with end-stage joint destruction in psoriatic arthritis may require surgery [4]. A long disease-free interval should not be a prerequisite for arthroplasty in the management of joint destruction in tuberculous arthritis [16]. Treatment of the long finger may be a relative contraindication to proximal interphalangeal joint (PIPJ) arthroplasty [42].

Surgical Approach / Technique: Glenohumeral osteoarthritis in young patients is a difficult condition with higher failure rates after surgical management compared to older patients; nonsurgical modalities remain the mainstay, while surgical options include arthroscopic débridement, humeral head replacement, and total or reverse total shoulder arthroplasty [56]. Non-operative and operative treatments for post-dislocation shoulder osteoarthritis show similar osteoarthritis proportions at any point of follow-up [8].

Other Considerations: Diagnosis of sea urchin spine arthritis is based on injury history, a symptom-free period, and absence of laboratory abnormalities [6]. Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes [27]. The main factor influencing the therapeutic efficacy of tumor necrosis factor alpha drugs in rheumatoid arthritis is the prior response to DMARD treatment [40].

Complications

Infection: The natural history of acute herpetic arthritis involves spontaneous and rapid resolution without the need for surgical drainage of the joint [18]. In contrast, joint destruction and complex consequences in pyoderma gangrenosum can be prevented with early diagnosis and proper treatment using corticosteroids [2].

Degenerative Joint Disease: Cartilage erosion and degenerative joint disease represent the most common long-term consequences of benign synovial disorders [1]. Patients with end-stage joint destruction due to psoriatic arthritis may require surgery, with one-fifth experiencing deterioration of physical function over time where joint damage and baseline physical function are important factors associated with poor outcomes [4, 29]. Similarly, one-third of patients with advanced radiographic arthritis underwent surgery within 5 years of initial corticosteroid injection [7]. Regarding femoroacetabular impingement, at a mean follow-up of 24.7 years, 14% of hips without surgical intervention developed symptomatic osteoarthritis, while 4% underwent total hip arthroplasty [15].

Rheumatoid Arthritis Sequelae: Complete resolution of signs and symptoms is achievable in perhaps 10% of patients with early and aggressive treatment [3]. However, pain persists in people with treated rheumatoid arthritis, even in those for whom inflammation responds to treatment [30]. Methotrexate treatment for rheumatoid arthritis is accompanied by many patient-reported side effects and tolerability problems that may be under-recognized by physicians [50].

Thumb Carpometacarpal Osteoarthritis: Nonsurgical treatment of thumb carpometacarpal osteoarthritis results in no worsening of pain or limitations in activities of daily living after 12 months, with positive outcomes maintained at greater than 5 years of follow-up [5].

Post-Dislocation and Tuberculous Arthritis: Non-operative and operative treatments for post-dislocation shoulder osteoarthritis show similar proportions of osteoarthritis at any point of follow-up [8]. A long disease-free interval should not be a prerequisite for arthroplasty in the management of joint destruction in tuberculous arthritis [16].

Gout: The natural history of a gout flare is to resolve spontaneously over 3 to 10 days [31]. All current therapies for acute gout have an adverse effect profile that carries some risk [31].

Other Considerations: Evidence regarding specific prosthetic complications such as aseptic loosening, instability, periprosthetic fracture, thromboembolism, patellar/extensor-mechanism issues, stiffness/arthrofibrosis, nerve palsy, wound complications, and polyethylene wear is not present in the provided evidence base for this section.

Recovery

Light activity (weeks): Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction, as cartilage erosion and degenerative joint disease are the most common long-term consequences [1]. Early and aggressive treatment of rheumatoid arthritis is now standard, and complete resolution of signs and symptoms is achievable in perhaps 10% of patients [3]. Patients with end-stage joint destruction in psoriatic arthritis may require surgery [4]. Positive outcomes are found at greater than 5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or limitations in ADL after 12 months [5]. Of patients who presented with advanced radiographic arthritis, one-third underwent surgery within 5 years of initial corticosteroid injection for thumb carpometacarpal arthritis [7]. At a mean follow-up of 24.7 years, 14% of hips with femoroacetabular impingement without surgical intervention had symptomatic OA and 4% underwent THA [15]. A long disease-free interval should not be a prerequisite for arthroplasty in the management of joint destruction in tuberculous arthritis [16]. The natural history of acute herpetic arthritis is one of spontaneous and rapid resolution without the need for surgical drainage of the joint [18].

Full activity (months): Pain persists in people with treated rheumatoid arthritis, even in those for whom inflammation responds to treatment [30]. Implant survivorship for silicone metacarpophalangeal arthroplasty is 97% (clinical) and 88% (radiographic) in long-term follow-up [59]. None of the patients with neuropathic arthropathy of the elbow had deterioration in function after continued use of the joint [60]. Pain on load and weakness remains to some extent 1 year after surgery for trapeziometacarpal joint arthritis [61]. The majority of clinical improvement in early inflammatory arthritis treated with subcutaneous methotrexate occurs rapidly within the first 6 weeks, with significantly less change observed between weeks 6 and 12 [67]. In patients with early RA and basal hypovitaminosis D, reduction of disease activity, percentage of remission, and response to treatment were significantly lower after 12 months follow-up compared to patients with normal vitamin D levels [69].

Complete recovery / outcome plateau (months): The majority of clinical improvement in early inflammatory arthritis treated with subcutaneous methotrexate occurs rapidly within the first 6 weeks, with significantly less change observed between weeks 6 and 12 [67]. In patients with early RA and basal hypovitaminosis D, reduction of disease activity, percentage of remission, and response to treatment were significantly lower after 12 months follow-up compared to patients with normal vitamin D levels [69]. Pain on load and weakness remains to some extent 1 year after surgery for trapeziometacarpal joint arthritis [61].

Rehabilitation protocol: No specific rehabilitation protocols, immobilisation durations, or weight-bearing progressions are detailed in the provided evidence base for this section.

Functional milestones: Implant survivorship for silicone metacarpophalangeal arthroplasty is 97% (clinical) and 88% (radiographic) in long-term follow-up [59]. None of the patients with neuropathic arthropathy of the elbow had deterioration in function after continued use of the joint [60]. Pain on load and weakness remains to some extent 1 year after surgery for trapeziometacarpal joint arthritis [61].

Other Considerations: Positive outcomes are found at greater than 5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or limitations in ADL after 12 months [5]. Of patients who presented with advanced radiographic arthritis, one-third underwent surgery within 5 years of initial corticosteroid injection for thumb carpometacarpal arthritis [7]. At a mean follow-up of 24.7 years, 14% of hips with femoroacetabular impingement without surgical intervention had symptomatic OA and 4% underwent THA [15].

Key Evidence

  • [L5] Timely diagnosis and treatment of benign synovial disorders can minimize disease and resulting dysfunction, as cartilage erosion and degenerative joint disease are the most common long-term consequences. (10.5435/00124635-200805000-00005)
  • [Case_report] Early diagnosis and proper treatment with corticosteroids are favorable to prevent joint destruction and other complex consequences. (10.1016/j.jhsa.2012.10.049)
  • [L5] Early and aggressive treatment of rheumatoid arthritis is now standard, and complete resolution of signs and symptoms is achievable in perhaps 10% of patients. (10.1016/j.jhsa.2008.11.010)
  • [L5] The mainstay of treatment is biologic therapy in conjunction with disease-modifying antirheumatic drugs, while patients with end-stage joint destruction may require surgery. (10.5435/jaaos-20-01-028)
  • [L2] We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. (10.2106/jbjs.22.01116)
  • [L4] Diagnosis of sea urchin spine arthritis is based on injury history, a symptom-free period, and absence of laboratory abnormalities. (10.1016/j.jhsa.2007.11.016)
  • [L4] Of patients who presented with advanced radiographic arthritis, one-third underwent surgery within 5 years of initial injection. (10.1016/j.jhsa.2020.03.025)
  • [L1] Non-operative and operative treatments show similar OA proportions at any point of follow-up. (10.1007/s00167-020-06263-3)
  • [L5] A high index of suspicion for a Charcot joint is crucial for early diagnosis, particularly in the presentation of a destructive joint arthropathy combined with minimal pain and neurological features. (10.1177/17531934241275447)
  • [L5] The present work offers a comprehensive perspective on the management of RA by centralizing existing data, emphasizing the importance of early and accurate diagnosis associated with optimal personalized treatment to achieve better outcomes. (10.3390/cells10112857)
  • [L2] In patients with suspected inflammatory arthritis, routine US use in newly referred patients seems to be associated with significantly earlier diagnosis and DMARD initiation. (10.1186/s12891-017-1850-4)
  • [L4] Identification of synovial facet joint involvement allows for accurate presumptive diagnosis and confirmation via laboratory tests. (10.2106/00004623-199505000-00013)
  • [L4] Although no disease-modifying treatment exists, multiple options are available for managing hand OA in rheumatology practice with the goal of achieving symptom relief and optimizing hand function. (10.1016/j.jht.2022.08.001)
  • [L2] This study will provide high-quality evidence to address whether methotrexate has an effect on reducing pain over 6 months in patients with hand osteoarthritis and synovitis, with major clinical and public health importance. (10.1186/s12891-021-04842-0)
  • [L3] At mean follow-up of 24.7 years, 14% of hips had symptomatic OA and 4% underwent THA. (10.1177/0363546520949179)
  • [L4] A long disease-free interval should not be a prerequisite for arthroplasty. (10.1007/s00167-013-2473-4)
  • [L4] The disease cannot be considered to be an advanced or a fulminating stage of rheumatoid arthritis, and the authors suggest considering it a separate entity for the purpose of early correct diagnosis. (10.2106/00004623-195537020-00012)
  • [Case_report] The natural history of acute herpetic arthritis is one of spontaneous and rapid resolution without the need for surgical drainage of the joint. (10.2106/00004623-198466040-00023)
  • [L4] This report highlights a rare sub-type of inflammatory arthritis which, despite being seronegative, can have devastating disease consequences. (10.1186/s12891-016-1067-y)
  • [L3] A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy within 2 years. (10.1186/s12891-019-2646-5)
  • [L5] Rheumatoid arthritis of the shoulder is a progressive disorder causing pain, loss of range of motion, and functional disability; nonsurgical management is primary for mild symptoms, while surgical intervention is indicated for significant pain and functional limitation when nonsurgical treatment fails. (10.5435/00124635-200301000-00004)
  • [L3] In patients with glenohumeral arthritis, no consistent clinically important differences in pain or function were discovered with respect to radiographic or demographic factors. (10.1097/corr.0000000000001950)
  • [L4] Surgical procedures in rheumatoid arthritis should be performed when indicated to correct deformity and restore function, even if the disease is active, provided the patient's general condition is satisfactory. (10.2106/00004623-196345070-00017)
  • [L3] Foot abnormalities are associated with active joint disease and disability in RA. (10.1186/1471-2474-10-67)
  • [L4] There were no differences in the need for secondary intervention based on the severity of radiographic osteoarthritis or baseline shoulder dysfunction. (10.1016/j.jse.2020.08.008)
  • [L5] Hallux rigidus is a common disorder characterized by restriction of motion at the first metatarsophalangeal joint, often associated with mechanical block from periarticular osteophytes. (10.2106/00004623-199806000-00015)
  • [L3] Therefore, epidemiological studies on prearthrotic deformities should only be performed in healthy adults with no signs of osteoarthritic changes. (10.1186/1471-2474-15-150)
  • [L3] One fifth of patients experienced deterioration of physical function over time, with joint damage and baseline physical function being important factors associated with poor physical function. (10.1186/1471-2474-15-284)
  • [L2] Pain persists in people with treated RA, even in those for whom inflammation responds to treatment. (10.1186/s12891-016-1192-7)
  • [L5] The earliest possible initiation of therapy maximizes the benefit-to-risk ratio and clinically justifies therapy, given that the natural history of a gout flare is to resolve spontaneously over 3 to 10 days and that all current therapies have an adverse effect profile that carries some risk. (10.1016/j.jhsa.2012.04.041)
  • [L4] Septic arthritis in rheumatoid arthritis patients is difficult to identify and requires a high degree of clinical suspicion; early diagnosis is crucial to prevent disastrous sequelae. (10.1186/1749-799x-3-33)
  • [L4] Early diagnosis and treatment are helpful to prevent further joint injury, though the clinical diagnosis, treatment, and molecular mechanism of osteolysis in RA and peripheral sensory nerve injury remain to be further revealed. (10.1186/s12891-024-07424-y)
  • [L1] Tofacitinib is efficacious and well tolerated in patients with MTX-resistant RA up to a period of 24 weeks. (10.1186/1471-2474-14-298)
  • [L5] Our findings could provide new insights into RA diagnostics. (10.1186/s13018-020-02180-w)
  • [L5] Newer generation unconstrained surface replacement arthroplasties have shown promise in select cases of osteoarthritis and inflammatory arthritis. (10.1016/j.jhsa.2010.11.035)
  • [L3] Health systems should provide (first line) treatment for RA as a strategy to improve compliance with therapy and clinical outcomes, particularly in vulnerable populations. (10.1186/ar2620)
  • [L5] Management of nonrheumatoid inflammatory arthroses is typically medical in nature and continues to evolve with the development of biologically targeted medications. (10.1016/j.jhsa.2015.05.029)
  • [L1] Given the affordability, ease of administration, and efficacy associated with corticosteroids, they are a favorable option when considering the choice of intra-articular injection for the management of TMC OA. (10.1016/j.jhsa.2024.02.001)
  • [L1] The main factor influencing therapeutic efficacy is the prior response to DMARD treatment. (10.1186/1471-2474-9-52)
  • [L5] For more advanced disease, fusion is the benchmark, while arthroplasty is a viable option to reduce pain, preserve motion, and limit progression of adjacent joint disease. (10.5435/jaaos-d-18-00683)
  • [L1] Treatment of the long finger may be a relative contraindication to PIPJ arthroplasty. (10.1177/1558944718791186)
  • [L4] Whilst pain medication use varied with pain severity, different medication types reported broadly aligned with OA guidelines. (10.1186/s12891-024-07854-8)
  • [L4] The new classification system could help surgeons estimate potential difficulties during total hip arthroplasty. (10.1186/s12891-020-03678-4)
  • [L3] The CT scans of SPECT/CT provided better interobserver reliability than routine radiographs for evaluating the severity of arthritis. (10.1302/0301-620x.103b8.bjj-2020-1826.r3)
  • [L5] This is a careful revision of the second edition of The Arthropathies, which adds greatly to the value of the book through extensive rewriting, clearer illustrations, and updated terminology. (10.2106/00004623-195032030-00045)
  • [L3] Up to 40% of patients demonstrated a progressive erosive disease detected by MRI despite DAS28 improvement or EULAR remission. (10.1186/s12891-017-1528-y)
  • [L3] Familial clustering of severe CMC joint OA was observed in a statewide population, indicating that genetic and environmental factors contribute to the disease process. (10.1016/j.jhsa.2022.08.004)
  • [L3] The moderate interobserver agreement of the radiological classification of Eaton and Littler for staging of CMC1 osteoarthritis questions the efficiency of Eaton and Littler's classification system. (10.1016/j.jhsa.2011.06.017)
  • [L4] Results from this real-world RA patient cohort suggest that MTX is accompanied by many patient-reported side effects and tolerability problems that may be under-recognized by physicians. (10.1186/s12891-016-1254-x)
  • [L3] Computed tomography is more sensitive than conventional radiography for detecting bone erosions in rheumatoid arthritis. (10.1186/1471-2474-14-265)
  • [L4] Radiological OA after an MFF is similar to the natural degenerative process in the DIP joint and is accompanied by a decrease in range of motion of the DIP joint, which does not clinically affect PROMs. (10.1016/j.jhsa.2023.03.027)
  • [L3] The frequency of metabolic syndrome in rheumatoid arthritis varies according to the definition used and was significantly higher compared to controls. (10.1186/1471-2474-14-147)
  • [L5] The definition of treatment failure for bacterial arthritis after a single surgical intervention was established through a three-round Delphi study. (10.1002/ksa.12027)
  • [L4] This is the first study to assess prevalence of ultrasound features of OA in a population-based sample. (10.1186/1471-2474-15-162)
  • [L5] Glenohumeral osteoarthritis in young patients is a difficult condition with higher failure rates after surgical management compared to older patients; nonsurgical modalities are the mainstay of management, while surgical options include arthroscopic débridement, humeral head replacement, and total or reverse total shoulder arthroplasty. (10.5435/jaaos-d-16-00657)
  • [L3] More advanced radiographic trapeziometacarpal OA severity is associated with lower grip strength and poorer self-reported functional outcomes. (10.1016/j.jht.2021.10.001)
  • [L2] Radiographic severity in thumb basilar joint osteoarthritis does not correlate with validated patient-reported symptom scores. (10.5435/jaaos-d-15-00329)
  • [L4] Implant survivorship is 97% (clinical) and 88% (radiographic) in long-term follow-up. (10.1016/j.jhsa.2017.10.010)
  • [L4] None of the patients had deterioration in function after continued use of the joint. (10.2106/00004623-200106000-00004)
  • [L3] Pain on load and weakness remains to some extent 1 year after surgery for trapeziometacarpal joint arthritis. (10.1186/s12891-020-3045-7)
  • [L3] Our data support the concept that TMC arthrosis does not correlate with radiographic arthrosis. (10.1177/1558944717732064)
  • [L4] Hallux valgus deformity and its severity were positively associated with the magnitude of the anteroposterior postural sway. (10.1186/s12891-021-04385-4)
  • [L3] The study found that the majority of the clinical improvement in early inflammatory arthritis treated with subcutaneous methotrexate occurs rapidly within the first 6 weeks, with significantly less change observed between weeks 6 and 12. (10.1186/s12891-016-1213-6)
  • [L3] In patients with early RA and basal hypovitaminosis D after 12 months follow-up reduction of disease activity and percentage of remission and response to treatment were significantly lower than those observed in patients with normal vitamin D levels. (10.1186/s12891-015-0505-6)
  • [L3] Longitudinal follow-up is required to determine the mechanism and presentation of plantar plate pathology in the painful forefoot of patients with RA. (10.1186/s12891-017-1668-0)
  • [L5] Thumb basal joint arthritis is a progressive disease with substantial new biomechanical and longitudinal clinical studies changing prevailing opinions on serial degenerative changes. (10.5435/jaaos-d-17-00374)
  • [L5] Surgical management is indicated for progressive, painful, unilateral deformity or leg-length discrepancy, while moderate nonprogressive deformity often does not require surgery. (10.5435/00124635-199803000-00003)
  • [L5] This current concepts article examines the recent knowledge base regarding the etiology, pathogenesis, and evaluation of osteoarthritis of the distal interphalangeal joint, highlighting the roles of cartilage, subchondral bone, and soft tissue structures. (10.1016/j.jhsa.2010.09.003)

See Also

References

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[4] Psoriatic Arthritis. American Academy of Orthopaedic Surgeon. 2012. DOI: 10.5435/jaaos-20-01-028

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