Hand Fingers

The early alteration of rheumatoid arthritis has been described to initiate from the second and third metacarpophalangeal joints and the third proximal interphalangeal joint (Fig. 10.10A). As shown in this case, however, the synchronous involvement of the wrist is common. Indeed, wrist involvement is as characteristic and heralding as digital involvement, or is even predominant during the early stages of the disease (Hendrix et al. 1987). Radiography reveals erosion, articular narrowing, and marked po-

Ankylosis Radiographs

Fig. 10.7A, B Advanced bony ankylosis. A Dorsopalmar radiograph of the right wrist in a 39-year-old female shows diffuse sealing of the radiocarpal, intercarpal, and carpometacarpal joints due to bony ankylosis (arrowheads). The radial styloid reveals osteopenia with inflamed adjacent tendon (arrow). B Dorsal pinhole scan demonstrates increased tracer uptake of various intensities in ankylosed wrist joints (arrowheads) with conspicuous uptake occurring in the radial styloid that is the site of active inflammation (arrow)

Fig. 10.7A, B Advanced bony ankylosis. A Dorsopalmar radiograph of the right wrist in a 39-year-old female shows diffuse sealing of the radiocarpal, intercarpal, and carpometacarpal joints due to bony ankylosis (arrowheads). The radial styloid reveals osteopenia with inflamed adjacent tendon (arrow). B Dorsal pinhole scan demonstrates increased tracer uptake of various intensities in ankylosed wrist joints (arrowheads) with conspicuous uptake occurring in the radial styloid that is the site of active inflammation (arrow)

Rheumatism Arthritis Static Bone Scan

Fig. 10.8A-C Nuclear angiography in rheumatoid arthritis. A Blood flow scan of both hands in a 53-year-old male with rheumatoid arthritis shows blotchy areas of increased vascularity in the intercarpal and first through third carpometacarpal joints (arrows). B Equilibrium scan also reveals increased blood pool (arrows). C Static bone scan demonstrates increased uptake in the intercar-pal and first and second metacarpophalangeal and inter-phalangeal joints (arrows)

Fig. 10.8A-C Nuclear angiography in rheumatoid arthritis. A Blood flow scan of both hands in a 53-year-old male with rheumatoid arthritis shows blotchy areas of increased vascularity in the intercarpal and first through third carpometacarpal joints (arrows). B Equilibrium scan also reveals increased blood pool (arrows). C Static bone scan demonstrates increased uptake in the intercar-pal and first and second metacarpophalangeal and inter-phalangeal joints (arrows)

Tracer Uptake Mycardial Blood Flow Pet

Fig. 10.9 18F-FDG PET for assessment of rheumatoid arthritis activity. Dorsal PET scans of both wrists and hands show prominent, symmetrical FDG uptake in the carpal and interphalangeal joints (Fig. 1D in Beckers et al. 2004)

rosis. Pinhole scanning shows intense tracer uptake characteristically in the juxta-articular bones, with the joint space being either widened or preserved (Fig. 10.5). The uptake tends to extend beyond the subchondral zones toward the phalangeal and metacarpal shafts, representing the watershed phenomenon. Radiographic correlation reveals that tracer is highly concentrated in the subchondral and periarticular bones, which are markedly os-teopenic (Figs. 10.1A and 10.5). When the disease is moderately advanced the joints become narrowed and tracer uptake coalesces across the joints (Fig. 10.7). It is logical that the smaller joints between the phalanges are more readily closed than the larger metacarpophalangeal joints. The intensity of tracer uptake appears roughly parallel with that of pathological

Fig. 10.9 18F-FDG PET for assessment of rheumatoid arthritis activity. Dorsal PET scans of both wrists and hands show prominent, symmetrical FDG uptake in the carpal and interphalangeal joints (Fig. 1D in Beckers et al. 2004)

changes such as local osteopenia and periar-ticular swelling. Interestingly, deformity such as subluxation, dislocation, or flexion accumulates tracer most conspicuously, distinguishing it from inactivated ankylosis (Fig. 10.11).

Dorsal Hand Swelling

Fig. 10.10A, B Early manifestations of hand rheumatoid arthritis. A Dorsopalmar radiographs of hands show classic involvement of the first through third metacarpophalangeal joints (1, 2, 3). B Dorsal bone scan reveals intense tracer uptake in the diseased metacarpophalangeal joints (1, 2, 3)

Fig. 10.10A, B Early manifestations of hand rheumatoid arthritis. A Dorsopalmar radiographs of hands show classic involvement of the first through third metacarpophalangeal joints (1, 2, 3). B Dorsal bone scan reveals intense tracer uptake in the diseased metacarpophalangeal joints (1, 2, 3)

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