CLINICAL RADIOOGRAPHIC REPORT – LONGITUDINAL

1. HEADER

• Patient: Hispanic female
• Clinical context: Rheumatoid arthritis, currently well controlled on hydroxychloroquine
• Index studies:
• 2026: Bilateral feet and ankles
• Comparison studies:
• 2024: Bilateral hands/wrists, feet and ankles
• 2023: Bilateral hands/wrists, feet and ankles
• 2020: Bilateral feet and ankles
• Approximate inter-study intervals: ~3 years, then ~14 months, then ~19 months (total span ~6 years).

• Region set:
• Hands and wrists (bilateral)
• Feet and ankles (bilateral)

• Projection set (representative, per region):
• Hands/wrists: PA and oblique views, both sides
• Feet: AP (dorsoplantar), oblique, lateral views, both sides
• Ankles: AP/mortise-style and lateral views, both sides

2. TECHNICAL / ALIGNMENT OVERVIEW

• Overall image quality adequate on all dates; no major motion or positioning artifact obscuring joint margins.
• Bone mineralization appropriate for age; no diffuse demineralization or osteopenic pattern dominating interpretation.

3. REGION-BY-REGION FINDINGS – INDEX + LONGITUDINAL COMPARISON

3.1 Hands and wrists (2024 vs 2023)

Right hand/wrist – PA & oblique

• Radiocarpal and intercarpal joint spaces preserved; carpal rows well aligned, no carpal collapse.
• MCP, PIP, DIP and thumb IP joint spaces preserved without focal, clearly erosive-type narrowing.
• No definite marginal erosions at distal radius/ulna, carpal bones, MCP heads or phalangeal bases.
• No periostitis, no bony ankylosis, no subluxations or dislocations.
• No visible chondrocalcinosis or soft-tissue calcifications.

Left hand/wrist – PA & oblique

• Radiocarpal and intercarpal joint spaces preserved; normal carpal alignment.
• MCP, PIP, DIP and thumb IP joint spaces preserved; no focal inflammatory-type narrowing.
• No definite marginal erosions at distal radius/ulna, carpal bones, MCP heads or phalangeal bases.
• No periostitis, ankylosis or subluxation/dislocation.
• No chondrocalcinosis or soft-tissue calcifications.

Longitudinal hand/wrist comparison (2024 vs 2023)

• No new erosions and no progression of joint-space loss in any carpal, MCP, PIP or DIP joint.
• Overall configuration of carpal rows and small joints unchanged.
• Pattern remains non-erosive over this interval.

3.2 Feet and ankles – RIGHT side (2026 vs 2024 vs 2023 vs 2020)

Right foot – AP/oblique/lateral

• Mild hallux valgus with mild joint-space narrowing and small dorsal osteophytes at the first MTP joint; present on 2020 study and similar on all subsequent exams.
• Mild midfoot/tarsometatarsal osteophytes with preserved joint spaces; appearance stable to minimally more conspicuous but still mild across the series.
• Plantar calcaneal enthesophyte (spur) present on earliest study with gradual, slight enlargement by 2026; tiny posterior calcaneal spur also present. No erosions or destructive change of the calcaneus.
• Mild pes planus alignment (talo–first-metatarsal relationship), unchanged over time.
• Remaining MTP and IP joints with preserved joint spaces; no definite marginal erosions at metatarsal heads or phalangeal bases.
• No periostitis, ankylosis, or stress fracture identified.

Right ankle – AP/mortise & lateral

• Tibiotalar joint space preserved without focal narrowing.
• Medial and lateral malleoli intact; no marginal erosions or cortical destructive changes.
• Subtalar joint preserved.
• No osteochondral defect of the talar dome seen.

Longitudinal comparison – right foot/ankle

• Over 6-year interval, degenerative/enthesopathic changes (first-MTP OA, midfoot spurs, calcaneal spur) show at most mild progression.
• No development of erosions, subluxations or clear inflammatory-type joint-space loss.

3.3 Feet and ankles – LEFT side (2026 vs 2024 vs 2023 vs 2020)

Left foot – AP/oblique/lateral

• Mild hallux valgus with mild joint-space narrowing and small dorsal osteophytes at the first MTP joint, present in 2020 and similar on later studies.
• Mild midfoot/tarsometatarsal osteophytes with preserved joint spaces; appearance stable to minimally more conspicuous but mild.
• Plantar calcaneal spur present on 2020 images with minimal interval increase by 2026; no adjacent erosions.
• Mild pes planus alignment, unchanged.
• Remaining MTP and IP joints show preserved joint spaces without definite marginal erosions.
• No periostitis, ankylosis, or fracture identified.

Left ankle – AP/mortise & lateral

• Tibiotalar joint space preserved; no focal narrowing.
• Medial and lateral malleoli intact; no erosive change.
• Subtalar joint preserved; no collapse or gross OA.
• No talar dome osteochondral defect.

Longitudinal comparison – left foot/ankle

• Mild degenerative/enthesopathic features (first-MTP OA, midfoot osteophytes, plantar spur) show at most very slow, mild progression.
• No erosions, subluxations, or characteristic inflammatory joint-space loss at MTPs, midfoot joints, ankles or subtalar joints over 6 years.

4. SYNTHESIS / LONGITUDINAL TRAJECTORY

• Hands/wrists: Non-erosive on both available dates, with stable joint spaces and carpal alignment and no radiographic transformation into erosive RA.
• Feet/ankles: Mild bilateral first-MTP and midfoot osteoarthritis plus chronic plantar calcaneal enthesopathy and mild pes planus, all present on earliest available studies and evolving only minimally.
• Across 6 years of serial imaging, there is no radiographic trajectory toward erosive rheumatoid arthritis in either hands or feet/ankles.
• Observed structural changes are small-burden, predominantly mechanical/degenerative and enthesopathic rather than erosive/inflammatory.

5. IMPRESSION

1. Hands and wrists (2024 vs 2023)
   • Non-erosive study of both hands and wrists.
   • No new erosions, no progressive joint-space loss and no deformity to suggest active, structurally aggressive RA over the comparison interval.
2. Feet and ankles (2026 vs 2024 vs 2023 vs 2020)
   • Mild, bilateral first-MTP and midfoot osteoarthritis with mild hallux valgus and chronic plantar calcaneal enthesophytes; pattern and tempo consistent with degenerative/enthesopathic change.
   • No definite erosions or inflammatory-type joint-space loss in MTPs, midfoot joints, ankles or subtalar joints on any study.
3. Overall longitudinal conclusion
   • Over approximately 6 years of follow-up, radiographs of hands, wrists, feet and ankles are concordant with well-controlled, non-erosive rheumatoid arthritis, with only mild, largely mechanical/degenerative and enthesopathic findings and no structural progression to erosive disease.

6. EMR SUMMARY

• Serial X-rays of your hands, wrists, feet and ankles over the last 6 years do not show joint damage from rheumatoid arthritis.
• There is only mild wear-and-tear arthritis at the big-toe joints and some chronic heel-spur changes, which have changed very slowly and remain mild.
• Overall, the imaging pattern fits well-controlled, non-erosive RA without radiographic progression.

Structured Radiographic Report – Longitudinal Study

Patient: Hispanic female

Current study date: 2026

Comparison studies: 2024, 2023, 2020

Inter-study intervals: ~3 years → ~14 months → ~19 months (total span ~6 years).

Indication: Rheumatoid arthritis on hydroxychloroquine; assess structural damage and progression in hands and feet.

FINDINGS

Hands and wrists (bilateral)

• Bone mineralization within normal limits.
• Radiocarpal, intercarpal, and carpometacarpal joint spaces preserved without carpal collapse or joint space narrowing typical of RA.
• MCP and PIP joints with maintained joint spaces and smooth, well-defined cortices; no definite marginal erosions or periarticular osteopenia.
• DIP joints show mild osteoarthritic change with small osteophytes and minimal joint space narrowing, most notably in the index and middle fingers.
• No subluxation, dislocation, or acute fracture.

Feet and ankles (bilateral)

• Hindfoot and midfoot alignment preserved with pes planus configuration of both feet.
• Tibiotalar joint spaces maintained and symmetric.
• Midfoot joints with mild osteoarthritic change, including small osteophytes and minimal joint space narrowing.
• First MTP joints with mild osteoarthritis (small osteophytes and mild narrowing), more conspicuous on the right.
• Lesser MTP and IP joints with preserved joint spaces and smooth cortices; no definite erosions.
• Small plantar calcaneal spurs bilaterally; no large Achilles insertion enthesophytes.
• No acute fracture, dislocation, or aggressive bone lesion.

Longitudinal comparison (2020 → 2023 → 2024 → 2026)

• No new marginal erosions, no interval joint space loss at MCP, PIP, or MTP joints, and no development of characteristic deformities of erosive RA.
• Mild midfoot and first MTP osteoarthritic changes and plantar calcaneal spurs have shown slow, modest progression over the comparison interval, consistent with chronic mechanical/degenerative change rather than inflammatory erosive disease.

IMPRESSION

1. Non-erosive pattern of rheumatoid arthritis in hands and feet, with no radiographic progression of classic RA-type damage over approximately six years.
2. Mild, slowly progressive osteoarthritis involving distal interphalangeal finger joints, first MTP joints, and midfoot joints.
3. Bilateral pes planus and small plantar calcaneal spurs, compatible with chronic mechanical/enthesopathic change.
4. No acute osseous abnormality identified.

HEADER

Patient: Hispanic female

Current study date: 2026

Prior comparison studies: 2024, 2023, 2020

Approximate inter-study intervals: ~3 years, then ~14 months, then ~19 months (total span ~6 years).

Indication: Rheumatoid arthritis, clinically well controlled on hydroxychloroquine. Longitudinal assessment for structural damage and progression.

FINDINGS

Hands and wrists (bilateral)

• Bone density mildly decreased but without focal demineralization.
• Carpal, radiocarpal, and distal radioulnar joints: joint spaces preserved, normal alignment, no erosions.
• MCP, PIP, DIP joints: joint spaces largely preserved, no definite marginal erosions or subluxations. Low-grade osteoarthritic changes at some distal interphalangeal joints.
• Soft tissues unremarkable; no calcified tophi or masses.

Feet (bilateral)

• Metatarsophalangeal joints: preserved joint spaces and smooth cortical margins, no erosions or rheumatoid-type deformities.
• Midfoot: small osteophytes and mild joint-space narrowing at tarsometatarsal/naviculocuneiform joints, compatible with mild osteoarthritis.
• Hindfoot/ankle: small plantar calcaneal enthesophytes; ankle and subtalar joint spaces preserved, no erosions or collapse.
• Mild pes planus configuration bilaterally.
• No acute fracture, dislocation, or destructive lesion.

COMPARISON

Across studies from 2020 to 2026 there is:

• No interval development of classic rheumatoid erosions, deformities, or carpal collapse in the hands or feet.
• Slow, low-grade progression of midfoot osteoarthritic changes and plantar calcaneal enthesophytes.
• Overall preservation of joints typically targeted by rheumatoid arthritis.

IMPRESSION

1. Non-erosive rheumatoid arthritis pattern in hands, wrists, and forefeet: no radiographic evidence of progressive erosive or deforming disease over approximately six years.
2. Mild osteoarthritis of the distal interphalangeal joints of the hands and of the first metatarsophalangeal and midfoot joints, with slow, low-grade progression most evident in the dorsal midfoot.
3. Chronic bilateral pes planus and small plantar calcaneal enthesophytes, consistent with mechanical/enthesopathic changes rather than primary inflammatory bone destruction.
4. No acute fracture, dislocation, Charcot arthropathy, or aggressive bone lesion identified.