Bony Ankylosis in Rheumatoid Arthritis

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Abstract
Hand and wrist radiographs of 203 patients with rheumatoid arthritis were examined for bony ankylosis. Forty-eight patients (23.6%) showed ankylosis, including 34 with more than one joint fused. The distribution of ankylosed joints was 32.4% midcarpal, 29.5% common carpometacarpal, 15.8% radiocarpal, 15.8% proximal interphalangeal, and 6.5% metacarpophalangeal. Patients with ankylosis had significantly higher radiographic erosion, joint space narrowing, and malalignment scores than those without ankylosis (all P < 0.001). Patients with ankylosis had significantly longer duration of disease (P < 0.001) and physical examinations showed more limited motion and deformity (both P < 0.001). More patients with ankylosis had subcutaneous nodules (P < 0.05). Functional testing with grip strength and the button test revealed poorer performance in patients with ankylosis (both P < 0.001). Questionnaires revealed patients with ankylosis had more difficulty with activities of daily living (P < 0.001) and had more limited activity (P < 0.01); physicians estimated more limited functional capacity (P < 0.001). Thus, radiographic bony ankylosis was a relatively common feature of rheumatoid arthritis, and a marker of patients whose disease was clinically, radiographically, and functionally more severe.