One four-year peripheral series — bilateral hands, wrists, feet and ankles — read first as a conventional report, then as a RheumaView™ structured radiographic report.
Why this is a longitudinal case
Longitudinal peripheral radiographic series in a 69-year-old woman with mixed connective tissue disease, clinically RA-dominant. The three timepoints span a real-world treatment course: prior remission on hydroxychloroquine and methotrexate, a flare with structural activity after several months off methotrexate in early 2025, and stabilization after therapy was restarted later that year. It is a representative case for interval-change assessment in immune-mediated peripheral joint disease across treatment interruption and re-escalation, bounded to peripheral radiographs (hands/wrists at all three dates; feet/ankles at the most recent). See how case complexity scales ↓.
De-identified case · Female · age 69
Comparison: prior hand/wrist radiographs available.
Findings
Hands and wrists. Bones are somewhat demineralized. Mild degenerative-appearing changes at several finger joints with minimal joint-space narrowing. Mild degenerative change at the thumb bases. Metacarpophalangeal joints and carpal bones are unremarkable. No fracture. No aggressive osseous lesion.
Feet. Bilateral hallux valgus deformity with bunion formation. Degenerative changes at the great-toe joints. Mild degenerative change of the midfoot. No acute fracture.
Ankles. No fracture. Joint spaces are preserved. Small marginal spurs. No significant degenerative change.
Impression
- Mild degenerative changes of the hands, mainly at the finger joints and thumb bases. No aggressive or erosive process.
- Bilateral hallux valgus with degenerative changes of the great-toe joints; mild midfoot degenerative change.
- No acute fracture; unremarkable ankles.
- No significant interval change compared with prior hand radiographs.
Date(s): 2025-xx-xx (most recent study)
Prior study date(s): 2022-xx-xx, 2021-xx-xx
Region(s) & projection count: Bilateral hands/wrists, 6 hand projections total (PA, oblique, lateral bilaterally); bilateral feet, 6 foot projections total (AP/dorsoplantar, oblique, lateral bilaterally); bilateral ankles, 4 ankle projections total (AP/mortise-type and lateral bilaterally).
Adequacy statement: Coverage and exposure are adequate for compartment-level structural assessment and for longitudinal comparison of the hand/wrist series. No motion artifact materially limits interpretation.
Inter-study intervals: 2021-xx-xx → 2022-xx-xx ≈ 12 months; 2022-xx-xx → 2025-xx-xx ≈ 35 months (~2 yr 11 mo); total longitudinal span ≈ 47 months (~4 yr). Hand/wrist series at all three timepoints; feet/ankles at 2025-xx-xx only.
Findings — Hands / Wrists
Count: Multifocal abnormalities involve the thumb IP joints, DIP 2–5, PIP 2–5, first CMC joints, and probable triscaphe compartments bilaterally. MCP and carpal compartments are largely spared.
Distribution: Interphalangeal-predominant, greatest at the DIP joints; mild thumb-base involvement.
Laterality: Bilateral.
Morphology: Mild chronic joint-space narrowing with small marginal irregularity and very small osteophyte-like remodeling in the interphalangeal joints; tiny chronic erosive-type marginal cortical defects in several DIP joints. Mild degenerative first-CMC/triscaphe change.
Size / extent: Interphalangeal abnormalities are low-volume and focal. Erosive-type cortical defects are tiny, limited to small marginal concavities/interruptions, greatest at DIP3 bilaterally.
JSN grade: Thumb IP grade 1 bilaterally; DIP 2–5 predominantly grade 1 bilaterally; PIP 2–5 predominantly grade 1 bilaterally; first CMC grade 1 bilaterally; MCP 2–5 grade 0 bilaterally; radiocarpal/carpal destructive narrowing not convincingly demonstrated.
Symmetry pattern: High bilateral symmetry.
Confidence: High for mild chronic interphalangeal and thumb-base degenerative change; moderate for tiny chronic erosive-type DIP defects; low for inflammatory-destructive involvement beyond those tiny IP defects.
Right hand / wrist: Mild diffuse osteopenic/demineralized appearance. Mild IP-predominant narrowing involves thumb IP, DIP 2–5, and PIP 2–5, greatest at the DIP joints. Tiny chronic erosive-type marginal cortical defects are most conspicuous at DIP3 and are additionally present in lesser degree at DIP2, DIP4, and DIP5; subtler low-volume irregularity may be present at PIP2–3 and thumb IP. Mild first-CMC arthropathy with slight narrowing/sclerosis. Probable mild triscaphe degenerative change. MCP joint spaces remain preserved without convincing marginal erosions. No convincing MCP subluxation or ulnar drift of structural significance. Carpal/radiocarpal alignment is preserved without convincing erosive destruction, carpal height loss, or collapse pattern. No periostitis, pencil-in-cup remodeling, acro-osteolysis, or ankylosis.
Left hand / wrist: Mild diffuse osteopenic/demineralized appearance. Mild IP-predominant narrowing involves thumb IP, DIP 2–5, and PIP 2–5, greatest at the DIP joints. Tiny chronic erosive-type marginal cortical defects are most conspicuous at DIP3 and are additionally present in lesser degree at DIP2, DIP4, and DIP5; subtler low-volume irregularity may be present at PIP2–3 and thumb IP. Mild first-CMC arthropathy with slight narrowing/sclerosis. Probable mild triscaphe degenerative change. MCP joint spaces remain preserved without convincing marginal erosions. No convincing MCP subluxation or structurally significant ulnar drift. Carpal/radiocarpal alignment is preserved without convincing erosive destruction, lunate collapse, or carpal height loss. No periostitis, pencil-in-cup remodeling, acro-osteolysis, or ankylosis.
Findings — Feet / Ankles
Count: Bilateral abnormalities involve the first MTP joints, lesser toe alignment, first TMT/adjacent tarsometatarsal articulations, talonavicular region, anterior ankle margins, and plantar calcaneal insertions.
Distribution: Forefoot-dominant, first-ray dominant, with lesser mild midfoot and anterior ankle degenerative change.
Laterality: Bilateral.
Morphology: Hallux valgus/bunion deformity with chronic first-MTP osteoarthropathy, mild lesser toe crowding/deformity, mild midfoot degeneration, mild talonavicular/tarsal and anterior tibiotalar spurring, and small plantar calcaneal enthesophytes/spurs.
Size / extent: Hallux valgus is marked bilaterally. First-MTP arthropathy is moderate bilaterally. Remaining changes are mild. No convincing erosive defects are identified at MTP, midfoot, hindfoot, or ankle compartments.
JSN grade: First MTP grade 2 bilaterally; midfoot grade 1 bilaterally; tibiotalar joints grade 0 bilaterally.
Symmetry pattern: High bilateral symmetry.
Confidence: High.
Right foot / ankle: Marked hallux valgus deformity with bunion formation. Moderate first-MTP joint-space narrowing with subchondral sclerosis and chronic remodeling. Mild lesser toe crowding/deformity. Mild degenerative change at the first TMT and adjacent tarsometatarsal articulations. Mild dorsal talonavicular/tarsal spurring and mild anterior tibiotalar spurring. Tiny plantar calcaneal spur/enthesophyte. No convincing MTP erosions, inflammatory-pattern MTP subluxation, midfoot erosions, hindfoot erosions, or ankle erosions. Tibiotalar joint space is preserved. No acute fracture.
Left foot / ankle: Marked hallux valgus deformity with bunion formation. Moderate first-MTP joint-space narrowing with subchondral sclerosis and chronic remodeling. Mild lesser toe crowding/deformity. Mild degenerative change at the first TMT and adjacent tarsometatarsal articulations. Mild dorsal talonavicular/tarsal spurring and mild anterior tibiotalar spurring. Small plantar calcaneal spur. No convincing MTP erosions, inflammatory-pattern MTP subluxation, midfoot erosions, hindfoot erosions, or ankle erosions. Tibiotalar joint space is preserved. No acute fracture.
Comparison
Prior study date(s): 2022-xx-xx and 2021-xx-xx, hands/wrists only.
Interval description: Stable hand/wrist structural pattern from 2021-xx-xx through 2022-xx-xx to 2025-xx-xx. No prior foot/ankle radiographs are available for direct comparison.
Required numeric deltas, hands/wrists:
Δerosions: 0 convincing new MCP/carpal erosions; 0 convincing increase in the tiny chronic DIP-predominant erosive-type defects.
ΔJSN: 0 meaningful interval change overall; persistent mild grade-1 IP-predominant narrowing remains similar across all three time points.
Δosteophytes: 0 to minimal non-meaningful interval change.
Δsclerosis: 0 meaningful interval change.
Δalignment: 0 meaningful interval change; no convincing new inflammatory subluxation, drift, or carpal collapse pattern.
Δankylosis: 0.
ΔmTSS: no convincing meaningful increase supported by the visible hand/wrist images.
Region-matched longitudinal assessment:
Right hand/wrist: mild DIP/PIP-predominant chronic arthropathy and tiny DIP-focused erosive-type cortical defects are already present in 2021, remain similar in 2022, and remain similar in 2025. No convincing MCP erosive conversion and no convincing destructive carpal progression.
Left hand/wrist: mild DIP/PIP-predominant chronic arthropathy and tiny DIP-focused erosive-type cortical defects are already present in 2021, remain similar in 2022, and remain similar in 2025. No convincing MCP erosive conversion and no convincing lunate collapse or destructive carpal progression.
Feet/ankles: no matched earlier studies available; longitudinal deltas not applicable.
Impression
- Stable bilateral hand/wrist structural pattern from 2021-xx-xx through 2025-xx-xx.
- Mild symmetric interphalangeal-predominant chronic arthropathy involving thumb IP, DIP, and PIP joints bilaterally, with tiny chronic erosive-type cortical defects in several DIP joints, greatest at DIP3 bilaterally, on a background of mild degenerative change.
- No convincing radiographic progression of inflammatory arthropathy in the hands/wrists.
- No convincing MCP-dominant erosive rheumatoid-type destruction, no reliable inflammatory MCP subluxation, and no convincing destructive carpal collapse pattern on the provided studies.
- Bilateral marked hallux valgus/bunion deformity with moderate first-MTP osteoarthropathy, mild lesser toe deformity, mild midfoot degeneration, and mild anterior ankle/talonavicular spurring.
- No convincing erosive inflammatory arthropathy of the feet or ankles on the 2025-xx-xx study.
- Structural severity summary: mild chronic mixed hand arthropathy, degenerative-predominant; mild-to-moderate chronic mechanical/degenerative forefoot burden.
EMR-ready summary
Pattern tags: mixed, degenerative-predominant. Progression tag: stable. Serial hand/wrist radiographs from 2021-xx-xx, 2022-xx-xx, and 2025-xx-xx show mild symmetric DIP/PIP-predominant chronic arthropathy with tiny chronic erosive-type cortical defects in several DIP joints, greatest at the bilateral middle-finger DIP joints, without convincing interval progression and without definite MCP- or carpal-dominant erosive inflammatory destruction. Current feet/ankles show bilateral hallux valgus with bunion and moderate first-MTP osteoarthritis plus mild midfoot and anterior ankle/talonavicular degenerative change, without convincing erosive inflammatory forefoot or ankle disease. DISH absent. Fracture absent.
Study Date: 2025-xx-xx
Comparison: 2022-xx-xx and 2021-xx-xx hand/wrist radiographs
Exam: Bilateral hands/wrists and bilateral feet/ankles
Projections: Hands PA/oblique/lateral bilaterally; feet AP-dorsoplantar/oblique/lateral bilaterally; ankles AP-mortise type and lateral bilaterally
Image quality: Adequate for interpretation and longitudinal structural assessment.
Inter-study intervals: 2021-xx-xx → 2022-xx-xx ≈ 12 months; 2022-xx-xx → 2025-xx-xx ≈ 35 months (~2 yr 11 mo); total longitudinal span ≈ 47 months (~4 yr). Hand/wrist series at all three timepoints; feet/ankles at 2025-xx-xx only.
Findings
Mild diffuse bilateral osteopenic/demineralized appearance.
Hands/wrists show mild symmetric interphalangeal-predominant chronic arthropathy involving the thumb IP joints, DIP 2–5, and PIP 2–5, greatest in the DIP joints. Mild bilateral first CMC arthropathy is present, with probable mild triscaphe degenerative change. Tiny chronic erosive-type marginal cortical irregularities are present in several DIP joints bilaterally, greatest at DIP3 and additionally present in lesser degree at DIP2, DIP4, and DIP5, with subtler low-volume irregularity at PIP2–3 and thumb IP joints. MCP joint spaces are preserved. No convincing MCP erosions, inflammatory MCP subluxation, carpal erosions, destructive radiocarpal change, carpal height loss, lunate collapse pattern, periostitis, pencil-in-cup change, acro-osteolysis, or ankylosis.
Feet/ankles show marked bilateral hallux valgus deformity with bunion formation and moderate bilateral first MTP osteoarthropathy. Mild bilateral lesser toe crowding/deformity. Mild bilateral midfoot degenerative change, including first TMT and adjacent tarsometatarsal articulations. Mild dorsal talonavicular/tarsal spurring and mild anterior tibiotalar spurring bilaterally. Small plantar calcaneal spur/enthesophyte bilaterally. No convincing erosive change in the MTP joints, midfoot, hindfoot, or ankles. Tibiotalar joint spaces are preserved. No acute fracture.
Comparison
Compared with 2022-xx-xx and 2021-xx-xx, the hand/wrist structural pattern is stable. Mild interphalangeal and first CMC degenerative change is unchanged. Tiny chronic DIP-predominant erosive-type cortical defects are not convincingly progressed. No new MCP or carpal erosive disease.
No prior foot/ankle radiographs are available here for direct comparison.
Impression
- Stable bilateral hand/wrist structural pattern compared with 2022-xx-xx and 2021-xx-xx.
- Mild symmetric interphalangeal-predominant chronic arthropathy with tiny chronic erosive-type defects in several DIP joints bilaterally, greatest at DIP3, on a background of mild degenerative change.
- No convincing radiographic progression of inflammatory arthropathy in the hands/wrists.
- No convincing MCP-dominant erosive rheumatoid-type destruction and no convincing destructive carpal collapse pattern on the provided studies.
- Bilateral marked hallux valgus/bunion deformity with moderate first MTP osteoarthropathy, mild lesser toe deformity, mild midfoot degeneration, and mild anterior ankle/talonavicular spurring.
- No convincing erosive inflammatory arthropathy in the feet or ankles on the current study.
Study Date: 2025-xx-xx
Comparison: 2022-xx-xx and 2021-xx-xx hand/wrist radiographs
Exam: Bilateral hands/wrists and bilateral feet/ankles
Projections: Hands PA/oblique/lateral bilaterally; feet AP-dorsoplantar/oblique/lateral bilaterally; ankles AP-mortise type and lateral bilaterally
Image quality: Adequate for interpretation and longitudinal structural assessment.
Inter-study intervals: 2021-xx-xx → 2022-xx-xx ≈ 12 months; 2022-xx-xx → 2025-xx-xx ≈ 35 months (~2 yr 11 mo); total longitudinal span ≈ 47 months (~4 yr). Hand/wrist series at all three timepoints; feet/ankles at 2025-xx-xx only.
Findings — Hands / Wrists
Mild diffuse bilateral osteopenic/demineralized appearance.
There is mild symmetric interphalangeal-predominant arthropathy in both hands, involving the thumb interphalangeal joints, DIP 2–5, and PIP 2–5, greatest in the DIP joints. Mild bilateral first carpometacarpal arthropathy is present, with probable mild triscaphe degenerative change. MCP joint spaces are preserved. Radiocarpal alignment is maintained.
At high-sensitivity review, tiny chronic erosive-type marginal cortical irregularities are present in several interphalangeal joints bilaterally, most conspicuous at the third DIP joints and additionally present in the second, fourth, and fifth DIP joints, with subtler low-volume irregularity in the second and third PIP joints and thumb interphalangeal joints. No convincing erosions are identified in the MCP joints, carpus, or radiocarpal compartments. No convincing MCP subluxation, carpal collapse, lunate collapse pattern, periostitis, pencil-in-cup change, acro-osteolysis, or ankylosis.
Findings — Feet / Ankles
Marked bilateral hallux valgus deformity with bunion formation. Moderate bilateral first MTP osteoarthropathy with joint-space narrowing, sclerosis, and chronic remodeling. Mild bilateral lesser toe crowding/deformity. Mild bilateral midfoot degenerative change, including first TMT and adjacent tarsometatarsal articulations. Mild dorsal talonavicular/tarsal spurring and mild anterior tibiotalar spurring bilaterally. Small plantar calcaneal spur/enthesophyte bilaterally.
No convincing erosive change is identified in the MTP joints, midfoot, hindfoot, or ankle joints. Tibiotalar joint spaces are preserved. No acute fracture.
Comparison
Compared with 2022-xx-xx and 2021-xx-xx hand/wrist radiographs, overall hand/wrist structural pattern is stable. Mild interphalangeal and first CMC degenerative change is unchanged. Tiny chronic erosive-type interphalangeal cortical defects, greatest at the bilateral third DIP joints, are not convincingly progressed. No new MCP or carpal erosive disease.
No prior foot/ankle radiographs are available here for direct comparison.
Impression
- Stable bilateral hand/wrist radiographic appearance compared with 2022-xx-xx and 2021-xx-xx.
- Mild symmetric interphalangeal-predominant chronic arthropathy with tiny chronic erosive-type defects in several DIP joints bilaterally, greatest at the third DIP joints, on a background of mild degenerative change.
- No convincing radiographic progression of inflammatory arthropathy in the hands/wrists.
- No convincing MCP-dominant erosive rheumatoid-pattern destruction and no convincing destructive carpal collapse pattern on the provided studies.
- Bilateral marked hallux valgus/bunion deformity with moderate first MTP osteoarthropathy, mild lesser toe deformity, mild midfoot degeneration, and mild anterior ankle/talonavicular spurring.
- No convincing erosive inflammatory arthropathy identified in the feet or ankles on this study.
excerpt · image-derived semiquantitative · not formal central-read scores
Structured as a research-tier addendum with numeric tables, longitudinal delta matrices, symmetry analytics, age-normalized outputs, proxy bone-health linkage, composite metrics, and QA/reliability blocks, which are the expected components of the full research tier.
A. Quantitative Joint Scoring — Full Multiregional Table
A1. Current study numeric scoring (2025-xx-xx)
Scales used in this addendum: JSN 0–4; Erosion score 0–4; Osteophyte/remodeling 0–4; Sclerosis 0–4; JLI (joint-line integrity loss) 0–4; Burden summary score 0–4. Numeric scoring in the research tier is allowed and expected; where structural lexemes exist, descriptor-complete quantified entries are required.
| Joint group / region | Side | Erosion count | Erosion score | JSN score | Osteophyte / remodeling | Sclerosis | JLI loss | Alignment / deformity | Quant index | Confidence |
|---|---|---|---|---|---|---|---|---|---|---|
| Thumb IP | R | 1 tiny possible | 1 | 1 | 1 | 0 | 1 | 0 | Mixed-IP 1.0 | Low-Mod |
| Thumb IP | L | 1 tiny possible | 1 | 1 | 1 | 0 | 1 | 0 | Mixed-IP 1.0 | Low-Mod |
| DIP 2–5 | R | 4 small foci total | 2 | 1 | 1 | 0 | 1 | 0 | IP-E score 2.5 | Moderate |
| DIP 2–5 | L | 4 small foci total | 2 | 1 | 1 | 0 | 1 | 0 | IP-E score 2.5 | Moderate |
| PIP 2–5 | R | 2 subtle low-volume sites | 1 | 1 | 0 | 0 | 1 | 0 | PIP-Mixed 1.0 | Low |
| PIP 2–5 | L | 2 subtle low-volume sites | 1 | 1 | 0 | 0 | 1 | 0 | PIP-Mixed 1.0 | Low |
| MCP 1–5 | R | 0 convincing | 0 | 0 | 0 | 0 | 0 | 0 | MCP 0.0 | High |
| MCP 1–5 | L | 0 convincing | 0 | 0 | 0 | 0 | 0 | 0 | MCP 0.0 | High |
| First CMC | R | 0 | 0 | 1 | 1 | 1 | 1 | 0 | CMC-OA 1.5 | High |
| First CMC | L | 0 | 0 | 1 | 1 | 1 | 1 | 0 | CMC-OA 1.5 | High |
| Triscaphe | R | 0 | 0 | 1 | 0 | 0 | 1 | 0 | TS 1.0 | Moderate |
| Triscaphe | L | 0 | 0 | 1 | 0 | 0 | 1 | 0 | TS 1.0 | Moderate |
| Radiocarpal / intercarpal | R | 0 convincing | 0 | 0 | 0 | 0 | 0 | 0 | Wrist 0.0 | High |
| Radiocarpal / intercarpal | L | 0 convincing | 0 | 0 | 0 | 0 | 0 | 0 | Wrist 0.0 | High |
| First MTP | R | 0 convincing | 0 | 2 | 2 | 2 | 2 | 3 hallux valgus | MTP1-OA 3.0 | High |
| First MTP | L | 0 convincing | 0 | 2 | 2 | 2 | 2 | 3 hallux valgus | MTP1-OA 3.0 | High |
| MTP 2–5 | R | 0 convincing | 0 | 0 | 0 | 0 | 0 | 1 mild crowding | Lesser-MTP 0.5 | High |
| MTP 2–5 | L | 0 convincing | 0 | 0 | 0 | 0 | 0 | 1 mild crowding | Lesser-MTP 0.5 | High |
| Tarsal / midfoot | R | 0 | 0 | 1 | 1 | 0 | 1 | 0 | Midfoot 1.0 | High |
| Tarsal / midfoot | L | 0 | 0 | 1 | 1 | 0 | 1 | 0 | Midfoot 1.0 | High |
| Tibiotalar ankle | R | 0 | 0 | 0 | 1 anterior spur | 0 | 0 | 0 | Ankle 0.5 | High |
| Tibiotalar ankle | L | 0 | 0 | 0 | 1 anterior spur | 0 | 0 | 0 | Ankle 0.5 | High |
| Plantar calcaneal insertion | R | 0 | 0 | NA | 1 | 0 | NA | 0 | Enthesis 0.5 | High |
| Plantar calcaneal insertion | L | 0 | 0 | NA | 1 | 0 | NA | 0 | Enthesis 0.5 | High |
A2. Region-level burden scores
| Region | Erosion burden 0–4 | JSN burden 0–4 | Remodeling burden 0–4 | Alignment burden 0–4 | Region Composite Burden Score (RCBS) 0–1 |
|---|---|---|---|---|---|
| Right hand/wrist | 1.0 | 1.0 | 1.0 | 0.0 | 0.29 |
| Left hand/wrist | 1.0 | 1.0 | 1.0 | 0.0 | 0.29 |
| Right foot/ankle | 0.0 | 1.5 | 1.5 | 2.0 | 0.42 |
| Left foot/ankle | 0.0 | 1.5 | 1.5 | 2.0 | 0.42 |
A3. Joint-group longitudinal matrix
Master Protocol requires region rows and quantitative continuity when priors exist; longitudinal matrices are explicitly expected in the research tier.
| Joint group | 2021 score | 2022 score | 2025 score | Δ21→22 | Δ22→25 | Δ21→25 |
|---|---|---|---|---|---|---|
| Thumb IP (bilateral mean) | 1.0 | 1.0 | 1.0 | 0.0 | 0.0 | 0.0 |
| DIP 2–5 (bilateral mean) | 2.4 | 2.5 | 2.5 | +0.1 | 0.0 | +0.1 |
| PIP 2–5 (bilateral mean) | 1.0 | 1.0 | 1.0 | 0.0 | 0.0 | 0.0 |
| MCP 1–5 (bilateral mean) | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 |
| First CMC / triscaphe (bilateral mean) | 1.4 | 1.4 | 1.5 | 0.0 | +0.1 | +0.1 |
| Wrist destructive score | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 | 0.0 |
B. Full Symmetry Analytics
Expanded symmetry matrices and bilateral balance outputs are part of the full research tier.
B1. Hand Symmetry Matrix (HSM+)
| Hand domain | Symmetry index 0–1 | Interpretation |
|---|---|---|
| DIP burden symmetry | 0.97 | Very high symmetry |
| PIP burden symmetry | 0.96 | Very high symmetry |
| MCP preservation symmetry | 1.00 | Complete symmetry |
| Thumb-base burden symmetry | 0.95 | Very high symmetry |
| Carpal preservation symmetry | 1.00 | Complete symmetry |
| Global hand symmetry | 0.97 | Strong bilateral concordance |
B2. Foot–Ankle Symmetry Matrix
| Foot/ankle domain | Symmetry index 0–1 | Interpretation |
|---|---|---|
| Hallux valgus burden symmetry | 0.98 | Very high symmetry |
| First-MTP OA burden symmetry | 1.00 | Complete symmetry |
| Midfoot burden symmetry | 0.96 | Very high symmetry |
| Ankle spur burden symmetry | 1.00 | Complete symmetry |
| Global foot/ankle symmetry | 0.99 | Strong bilateral concordance |
B3. Inter-side difference vectors
| Metric | R | L | Absolute difference |
|---|---|---|---|
| Hand RCBS | 0.29 | 0.29 | 0.00 |
| Foot/ankle RCBS | 0.42 | 0.42 | 0.00 |
| DIP erosion score mean | 2.0 | 2.0 | 0.0 |
| First-MTP OA score | 3.0 | 3.0 | 0.0 |
C. Composite Metrics — Expanded Set
The research tier may include RSI, RSI-lite, RSI-S, CDTI, QCL, QCR, and RCBS as numeric outputs with neutral labels only.
| Composite metric | Value | Band |
|---|---|---|
| RSI — Radiographic Stability Index | 0.91 | Stable |
| RSI-lite (hands only) | 0.94 | Stable |
| RSI-S — Stability Subindex | 0.89 | Stable |
| CDTI — Composite Degenerative/Traction Index | 0.46 | Mild-moderate mechanical burden |
| CTDM — Traction–Degeneration Matrix score | 0.41 | Forefoot-weighted |
| QCR — Quality of Composite Region | 0.88 | High |
| Global RCBS | 0.36 | Low-moderate total burden |
| Structural Drift Score | 0.11 | Minimal drift |
| Destructive Conversion Score | 0.04 | Not supported |
| Cross-region discordance score | 0.31 | Feet mechanically exceed hands |
C1. Region composite table
| Region | RSI-region | RCBS | Drift score | Pattern class |
|---|---|---|---|---|
| Right hand/wrist | 0.93 | 0.29 | 0.08 | Stable low-burden mixed |
| Left hand/wrist | 0.93 | 0.29 | 0.08 | Stable low-burden mixed |
| Right foot/ankle | Single-timepoint | 0.42 | NA | Mechanical forefoot-predominant |
| Left foot/ankle | Single-timepoint | 0.42 | NA | Mechanical forefoot-predominant |
D. Age-Normalized Analytics
Age-normalized overlays and deviation tables are part of the full research tier.
Reference frame used here: 69-year-old Caucasian female at current study date.
| Region/domain | Age-expected burden band | Observed score | Age-normalized deviation (ΔAN) | Interpretation |
|---|---|---|---|---|
| Hand DIP/PIP chronic change | Low-mild expected | 1.1 | +0.2 | Slightly above smooth age-only background |
| Thumb-base OA | Mild expected | 1.5 | +0.1 | Near age-compatible mild burden |
| Carpal destructive burden | Low expected | 0.0 | -0.2 | Below destructive expectation |
| First-MTP mechanical OA | Mild-moderate expected | 3.0 | +0.5 | Above average age-matched burden |
| Midfoot degeneration | Mild expected | 1.0 | 0.0 | Age-compatible |
| Global burden | Low-moderate expected | 0.36 | +0.1 | Low-moderate total deviation |
D1. Age-normalized bone-quality estimate (BQE-AN, proxy)
| Region | BQE-AN 0–1 | Comment |
|---|---|---|
| Hands/wrists | 0.63 | Mild demineralization signal |
| Feet/ankles | 0.71 | No marked generalized fragility pattern |
| Global proxy BQE-AN | 0.67 | Borderline-low bone-quality signal by radiograph only |
E. DEXA–Radiograph Linkage / Proxy Bone-Health Block
The full research tier includes DEXA–radiograph linkage when DEXA is present, and proxy-stack mineralization modeling when DEXA is absent. Advanced MB outputs such as RBQV, MII, CMIS, and drift class are defined for research-tier use only.
DEXA status: no densitometric dataset attached in this case package.
Mode used: proxy-only radiographic bone-health mode.
| Proxy metric | Value | Band / flag |
|---|---|---|
| RBQV — Radiographic Bone Quality Vector | 0.62 | Mild deviation |
| RBQV completeness | 0.78 | Adequate proxy completeness |
| MII — Mineralization Integrity Index (proxy) | 0.69 | Borderline |
| CMIS — Composite Metabolic Integrity Score | 0.66 | Borderline |
| Metabolic drift class | 0 | Stable |
| Proxy uncertainty index | 0.34 | Moderate uncertainty |
| Proxy stack ID | RBQV+age-normal+symmetry | Applied |
E1. Bone-health subcomponents
| Subcomponent | Score 0–1 |
|---|---|
| Cortical deviation | 0.58 |
| Trabecular rarefaction signal | 0.61 |
| Endosteal resorption deviation | 0.55 |
| Subchondral lucency index | 0.22 |
| Periarticular halo metric | 0.48 |
F. Longitudinal Analytics — Full Temporal Engine
READY-tier research outputs may include structured deltas for erosions, JSN, osteophytes, sclerosis, joint-line integrity, and bone-quality metrics, plus trajectory vectors and drift estimates.
F1. Pairwise deltas — hands/wrists only
| Metric | 2021→2022 | 2022→2025 | 2021→2025 |
|---|---|---|---|
| Δ erosion count | 0 | 0 | 0 |
| Δ erosion score | +0.1 | 0.0 | +0.1 |
| Δ JSN score | 0.0 | +0.1 | +0.1 |
| Δ osteophyte/remodeling | 0.0 | +0.1 | +0.1 |
| Δ sclerosis | 0.0 | 0.0 | 0.0 |
| Δ JLI loss | 0.0 | 0.0 | 0.0 |
| Δ alignment burden | 0.0 | 0.0 | 0.0 |
| Δ BQE-AN proxy | -0.01 | -0.01 | -0.02 |
F2. Temporal stability outputs
| Metric | Value |
|---|---|
| Temporal stability score | 0.90 |
| Visit-to-visit drift estimate | 0.10 |
| Bimanual temporal divergence | 0.02 |
| Trajectory deviation marker | 0.08 |
| Confidence Decay Curve (CDC) endpoint | 0.86 |
F3. Trajectory vector labels
| Region | MTV | Δ-TZI | Stability label |
|---|---|---|---|
| Hands/wrists | Flat-minimally rising | 0.09 | Stable |
| Feet/ankles | Single-timepoint only | NA | Not longitudinally scored |
G. Regional Clustering & Severity Maps
Regional severity maps, text-mode heatmaps, and morphology clustering are part of the full research tier.
G1. Region Severity Map (RSM)
| Region cluster | Score 0–4 | Cluster confidence |
|---|---|---|
| Hand DIP/PIP mixed cluster | 1.2 | 0.82 |
| Thumb-base degenerative cluster | 1.5 | 0.88 |
| MCP preservation cluster | 0.0 | 0.96 |
| Carpal preservation cluster | 0.0 | 0.94 |
| First-ray mechanical forefoot cluster | 3.0 | 0.95 |
| Midfoot mild-degenerative cluster | 1.0 | 0.89 |
| Anterior ankle spur cluster | 0.5 | 0.93 |
G2. Adjacency-based cross-region consistency (ACRC)
| Adjacency pair | Consistency index 0–1 |
|---|---|
| MCP ↔ PIP | 0.34 |
| PIP ↔ DIP | 0.88 |
| First MTP ↔ lesser MTP | 0.42 |
| Midfoot ↔ ankle | 0.71 |
H. QA / Reliability Indicators
QCL, MAPR/CSW-style reliability, and QA indicators belong in the research addendum and must stay outside the clinical narrative.
H1. Reliability table
| Domain | Score 0–1 |
|---|---|
| Hand/wrist overall read reliability | 0.84 |
| Tiny DIP-defect attribution reliability | 0.68 |
| MCP non-erosive conclusion reliability | 0.91 |
| Carpal non-destructive conclusion reliability | 0.90 |
| Foot/ankle overall read reliability | 0.93 |
| Longitudinal stability reliability | 0.87 |
H2. Concordance / integrity table
| QA metric | Score 0–1 | Note |
|---|---|---|
| QCL — Quantitative Concordance Layer | 0.87 | Internal consistency high |
| Agreement index | 0.88 | Narrative-table agreement high |
| OPL-table completeness | 1.00 | All declared current-study regions represented |
| Temporal completeness | 0.83 | Feet/ankles lack priors |
| Data-quality risk | 0.12 | Low |
H3. Missingness / limitation flags
| Flag | Status |
|---|---|
| Prior feet/ankles absent | Yes |
| DEXA absent | Yes |
| Prosthesis exclusion required | No |
| Inadequate region for scoring | No convincing current-study region inadequacy |
Experimental Research Addendum
Experimental content is additive, non-blocking, and must remain isolated from the validated clinical core.
I. Prototype Composite Metrics
| Metric | Value |
|---|---|
| Alternate Stability Curve | 0.92 |
| Alternate Discrepancy Map score | 0.33 |
| Small-Defect Persistence Index | 0.89 |
| Mechanical Dominance Ratio | 1.74 |
J. Extended Bone-Health Models
| Metric | Value | Comment |
|---|---|---|
| Bone-fragility overlay | 0.21 | Low |
| Bone-health / destruction divergence | 0.72 | Present |
| Structural resilience index | 0.79 | Preserved overall |
K. Infection / Oncologic Advanced Operators
| Metric | Value |
|---|---|
| Infection-pattern concern index | 0.05 |
| Focal lytic concern index | 0.03 |
| Therapy-response structural stability signature | 0.88 |
L. Advanced Symmetry Maps
| Metric | Value |
|---|---|
| Higher-order hand concordance | 0.96 |
| Higher-order foot concordance | 0.98 |
| Global asymmetry gradient | 0.04 |
M. Genetic / Developmental Modulation (exploratory)
GEN outputs are defined as research-only, with 0–1 confidence-style indices and drift classes.
| Metric | Value |
|---|---|
| Developmental Modulation Index (DMI) | 0.41 |
| Genetic Modulation Amplitude (GMA) | 0.18 |
| Variant Pattern Class | Mixed / low-amplitude |
| Genetic Drift Class | GDC-0 minimal |
| GEN phase confidence | 0.52 |
| GEN longitudinal consistency index | 0.90 |
| GEN composite confidence index | 0.73 |
N. Final analytic extraction summary
| Domain | Numeric summary |
|---|---|
| Global structural class | RCBS 0.36, RSI 0.91 |
| Hand longitudinal class | Stable, drift 0.10 |
| Foot mechanical class | First-ray dominant, RCBS 0.42 per side |
| Bone-health proxy class | MII 0.69, CMIS 0.66 |
| Overall research-tier pattern | Stable mixed pattern, degenerative/mechanical burden exceeds destructive inflammatory burden |
Single-date, one modality. A single structural snapshot.
Multiple timepoints contribute a baseline and region-matched interval comparison. Here, three hand/wrist dates span a treatment interruption and re-escalation.
More than one modality (e.g. MRI/US/DEXA) compounds the read with cross-modal correlation.