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Assessment of mutilans-like hand deformities in chronic
inflammatory joint diseases. A radiographic study of 52 patients
a Rheumatism
Foundation Hospital, FIN-18120 Heinola, Finland, b Tampere University Hospital, Tampere,
Finland
Correspondence to: Dr E Belt.
Accepted for publication 31 December 1998
OBJECTIVES
To evaluate
patients with mutilans-like hand deformities in chronic inflammatory
joint diseases and to determine radiographic scoring systems for
arthritis mutilans (AM).
METHODSA total of 52 patients with severe hand deformities were collected during 1997. A
Larsen hand score of 0-110 was formed to describe destruction of the
hand joints. Secondly, each ray of the hand was assessed individually
by summing the Larsen grade of the wrist and the grades of the MCP and
PIP joints. When the sum of these grades was 
13, the finger was
considered to be mutilated. A mutilans hand score of 0-10 was formed
according to the number of mutilans fingers. Surgical treatment and
spontaneous fusions were recorded.
RESULTSThe study
consisted of 22 patients with juvenile rheumatoid arthritis (JRA), nine
with rheumatoid factor (RF) positive and 13 with RF negative arthritis,
27 patients with RF positive RA, and three adult patients with other
diagnoses. The mean age of patients with adult rheumatic diseases was
27 years at the onset of arthritis. The mean disease duration in all
patients was 30 years. The mean Larsen hand score was 93. Four patients
had no mutilans fingers and in 15 patients all 10 fingers were
mutilated. The Larsen hand score of 0-110 and the mutilans hand score
of 0-10 correlated well (rs = 0.90). Fourteen patients showed spontaneous fusions in the peripheral
joints. A total of 457 operations were performed on 48 patients.
CONCLUSIONBoth the
Larsen hand score of 0-110 and the mutilans hand score of 0-10
improve accuracy in evaluating mutilans-like hand deformities, but in
unevenly distributed hand deformities the mutilans hand score is better
in describing deformation of individual fingers.
© 1999 by Annals of the Rheumatic Diseases
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