[The wrist joint in chronic polyarthritis--a new classification based on the type of destruction in relation to the natural course and the consequences for surgical therapy].

Existing classifications of rheumatoid wrist involvement are based on the degree or stage of destruction of the wrist. We suggest to classify rheumatoid wrist involvement according to the type rather than the extent of destruction. In order to recognize the nature of wrist destruction at an early stage of the disease as well as in late stages, a continuous series of 63 patients with definitive rheumatoid arthritis for over 20 years and wrist involvement of more than ten years were analysed both clinically and radiologically. Based on radiological appearance of the late stage, three different types of wrist involvement can be recognized: Group I--Type I: rheumatoid arthritis--ankylosis Group II--Type II: rheumatoid arthritis--(secondary) osteoarthrosis Group III--Type III: rheumatoid arthritis--destabilization Spontaneous ankylosis is characteristic for patients with a juvenile onset of rheumatoid arthritis, however, it also occurs in patients with a later consent of the disease. Patients in group II (type II) demonstrate a tendency to develop secondary arthrosis. Articular surface cartilage loss progresses at a rate which remains in relative equilibrium with processes typical of arthrosis, stabilizing the carpal architecture. In group III (type III), all wrists develop an unstable radiocarpal joint as evidenced by ulnar and palmar subluxation of the carpus relative to the radius and progressive loss of carpal height. When early surgical treatment is considered, it is crucial to recognize patients with type III wrist destruction. For these patients, an osseous stabilizing procedure is essential for long-term stabilization of the wrist. It is important that any evidence of progressive loss of carpal height or of ulnar radiocarpal translocation not be ignored.(ABSTRACT TRUNCATED AT 250 WORDS)