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MR Vol.12 No.2 indexに戻る
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MODERN RHEUMATOLOGY
Vol.12 No.2 |
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The definition and clinical features of the mutilans
type of rheumatoid arthritis |
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| O. Namiki1 |
| (1)Department of Orthopaedic Surgery, Showa
University School of Medicine, 1-5-8 Hatanodai, Shinagawa-ku, Tokyo
142-8666, Japan |
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| Abstract |
| Abstract The mutilans type of rheumatoid arthritis
(RA) is refractory to several treatments and involves many types
of surgical application. It is difficult to prevent its progress,
and it has a poor functional prognosis. However, the definition
is not always distinct. In this report, I attempt to clarify the
clinical features of the mutilans type of RA and establish an accurate
definition of the disease. Previous definitions have been divided
into three groups: (1) the mutilans group (Mu-G), which has more
than three joints showing severe resorptive bone destruction and
joint instability; (2) the suspected mutilans group (sMu-G) which
has one to two joints with joint instability or showing no instability
but with highly resorptive bone destruction; (3) the Larsen V group
(LV-G), which has radiological findings indicating Larsen grade
V disease. Patients suffering from rheumatoid arthritis for over
10 years and who do not fall into any of the above groups are referred
to as the control group. Among 337 patients who suffered from RA
for more than 10 years, 58 were classified as being in the mutilans
group, 59 in the suspected Mu-G, 47 in the LV-G, and 173 in the
control group. The mutilans group had distinctive features which
were different from those of the other groups, which had a radiological
finding of Larsen grade V disease or severe resorptive bone destruction
without instability. From these data, the definition of the mutilans
type of RA should be specified as the Mu-G. Thus, the Mu-G shows
a distinctive clinical picture which is unlike that in the other
groups. It is important to define the mutilans type of RA clearly
because it has a poor prognosis. Early identification will help
in the establishment of a treatment plan. |
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| Key words |
| Key words Arthritis mutilans ・ Larsen grade
V ・ Mutilans type ・ Mutilating disease (MUD) ・ Rheumatoid arthritis
(RA) |
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