Early radiographic joint space narrowing and erosion and later malalignment in rheumatoid arthritis: a longitudinal analysis

J Rheumatol. 1998 Apr;25(4):636-40.


Objective: To analyze the time course of development of radiographic erosion, joint space narrowing, and malalignment in a longitudinal study of radiographs of the hands and wrists of 58 patients with rheumatoid arthritis (RA) taken over 18 years.

Methods: Among 210 consecutive patients in a reported cohort, 58 had at least one prior available radiograph 2-18 years earlier. A total of 141 hand and wrist radiographs in the 58 patients were scored for joint space narrowing, erosion, and malalignment in individual joints.

Results: Of the 58 patients studied, all developed joint space narrowing, 56 (96.5%) developed erosions, while only 24 (41.4%) developed malalignment. In radiographs of 22 patient studied within the first 5 years of disease, joint space narrowing was seen in 17 (77.3%), erosion in 16 (72.7%), and malalignment in only 3 (13.6%). Radiographic progression was seen in all 36 patients in whom the interval between radiographs was longer than 2 years.

Conclusion: Joint space narrowing and erosion are seen in hand radiographs of most patients with RA seen in treatment centers within the first 5 years of disease. By contrast, malalignment develops in fewer patients, and generally only after 5 years of disease.

MeSH terms

  • Arthritis, Rheumatoid / diagnostic imaging
  • Arthritis, Rheumatoid / pathology*
  • Hand / diagnostic imaging
  • Hand / pathology*
  • Humans
  • Longitudinal Studies
  • Radiography
  • Wrist / diagnostic imaging
  • Wrist / pathology*