FRI0140 Midcarpal joint effusion is as common as radiocarpal joint effusion in swollen wrists of patients with rheumatoid arthritis
Authors: J. H. Lee, J. Lee, S.-M. Jung, C.-H. Yoon, S.-K. Kwok, S.-H. Park, H.-Y. Kim, K.-S. Park
Journal: Annals of the Rheumatic Diseases (2013)

<h3>Background</h3> Wrist joint is most commonly involved in rheumatoid arthritis (RA) and consists of multiple compartments; radiocarpal, midcarpal, and carpometacarpal joints. Intraarticular corticosteroid injection is usually done into radiocarpal joint for wrist joint swelling. However, it is hard to expect that drug injected into the radiocarpal joint spread to other compartments of wrist joint <h3>Objectives</h3> To identify the distribution of joint effusions in swollen wrist joints of patients with RA and examine the effect of intraarticular corticosteroid injection into multiple compartments of wrist joints <h3>Methods</h3> In RA patients with wrist joint swelling, we examined the distribution of joint effusion (radiocarpal, midcarpal, and carpometacarpal joints and extensor digitorum tendons) using musculoskeletal ultrasound <h3>Results</h3> Twenty-seven patients presented with wrist joint swelling including 3 patients with both wrists involved and total of 30 wrist joints were examined. Twenty patients were female (74%), mean age was 55.8 ± 11.8 years, and mean disease duration was 62.5 ± 61.22 months. Twenty-four patients (88.9%) were seropositive and 9 patients (33.3%) had been treated with anti-TNF agents. Radio-carpal joint effusion was present in all 30 swollen wrist joints. Of note, effusion was found in midcarpal joints of 28 swollen wrists (93.3%). Among midcarpal joints, lunate-capitate joint was most commonly involved (n=28), followed by lunate-hamate joint (n=26), scaphoid-trapezoid joint (n=25), and triquetrum-hamate joint (n=25). In 15 wrists, effusion was also found in carpometacarpal joints (CMC); 4th CMC joint (n=10), 5th CMC joint (n=9), 3rd CMC joint (n=6), and 2nd CMC joint (n=2). Extensor digitorum tendons were involved in 3 wrists. We injected corticosteroid into both radiocarpal and midcarpal joints in 7 wrists and 6 of them (85.7%) showed marked improvement in pain and swelling at the next visit. <h3>Conclusions</h3> Midcarpal joint effusion is as common as radiocarpal joint effusion in swollen wrists of patients with RA. This suggests that, in patients with wrist joint swelling, not only radicarpal joint but also midcarpal joint should be considered for intraarticular corticosteroid injection <h3>References</h3> Boesen M, Jensen KE, Torp-Pedersen S, Cimmino MA, Danneskiold-Samsøe B, Bliddal HIntra-articular distribution pattern after ultrasound-guided injections in wrist joints of patients with rheumatoid arthritis Eur J Radiol. 2009;69:331-8. <h3>Disclosure of Interest</h3> J. H. Lee Shareholder of: not applicable, Grant/research support from: not applicable, Consultant for: not applicable, Employee of: not applicable, Paid instructor for: not applicable, Speakers bureau: not applicable, J. Lee Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable, S.-M. Jung Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable, C.-H. Yoon Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable, S.-K. Kwok Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable, S.-H. Park Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable, H.-Y. Kim Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable, K.-S. Park Shareholder of: not appilicable, Grant/research support from: not appilicable, Consultant for: not appilicable, Employee of: not appilicable, Paid instructor for: not appilicable, Speakers bureau: not appilicable