The rheumatoid wrist: patterns of disease progression. A review of 50 wrists.

50 wrists in 28 patients have been followed in a retrospective radiographic review for a mean period of 9.56 years. Patterns of disease and the rates of change in the severity of the disease have been determined, with particular reference to the changing relationship in time between involvement of the wrist and hand. In the wrist, there was relative sparing of the mid-carpal joint, with a significant correlation between a high incidence of triquetro-lunate disease and changes in the ulnar styloid. Wrist disease was found to "protect" the hand for the first five years but not after this time. On the basis of these results, earlier surgical intervention is proposed, with the intention of shifting the emphasis of surgery from salvage to prophylactive or reconstructive procedures.