Hand function is already reduced before RA development and reflects subclinical tenosynovitis
© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ..
BACKGROUND: Clinically suspect arthralgia (CSA) is characterised by arthralgia of small joints and considered a risk stage for development of rheumatoid arthritis (RA). However, it remains unknown if the function of the hands is already affected and what mechanisms underlie impaired hand-function in CSA.
METHODS: We studied various measures of hand function in two CSA populations. CSA patients in the TREAT EARLIER-trial (n=236) were evaluated at baseline for: grip strength on a dynamometer (GS), patient-reported difficulties in the grip domain of the Health Assessment Questionnaire (HAQ) questionnaire and incomplete fist closure at physical examination. Findings were validated in an independent CSA cohort (n=600) where hand function was measured as: GS evaluated by squeezing the examiner's fingers, grip domain of the HAQ questionnaire and fist closure. Contrast-enhanced MRI of the hands measured synovitis, tenosynovitis and bone marrow oedema (summed as subclinical inflammation) in both cohorts.
RESULTS: GS (on a dynamometer) was reduced in 75% compared with reference values in healthy controls, 60% reported grip difficulties and 13% had incomplete fist closure. Reduced GS was associated with subclinical inflammation (-0.38 kg/point inflammation, 95% CI -0.68 to -0.08). Studying separate MRI features, GS reduction was independently associated with tenosynovitis, decreasing with -2.63 kg (95% CI -2.26 to -0.33)/point tenosynovitis (range observed tenosynovitis scores: 0-20). Similar relations with tenosynovitis were seen for patient-reported grip difficulties (OR 1.12/point, 95% CI 1.07 to 1.42) and incomplete fist closure (OR 1.36/point, 95% CI 1.03 to 1.79). In the validation cohort, 36% had decreased examiner-assessed GS, 51% reported grip difficulties and 14% incomplete fist closure: all were associated with tenosynovitis. Decreased dynamometer-measured GS was most sensitive for detecting tenosynovitis (75%), while incomplete fist closure was most specific (88%-90%).
CONCLUSION: Hand function is already often affected before RA development. These limitations are related to subclinical inflammation and tenosynovitis in particular.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2023 |
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| Erschienen: |
2023 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:9 |
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| Enthalten in: |
RMD open - 9(2023), 1 vom: 09. Feb. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Krijbolder, Doortje Isabelle [VerfasserIn] |
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| Links: |
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| Themen: |
Arthritis, Rheumatoid |
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| Anmerkungen: |
Date Completed 13.02.2023 Date Revised 19.04.2024 published: Print NTR: NTR4853-trial-NL4599 Citation Status MEDLINE |
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| doi: |
10.1136/rmdopen-2022-002885 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM352687894 |
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| 041 | |a eng | ||
| 100 | 1 | |a Krijbolder, Doortje Isabelle |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Hand function is already reduced before RA development and reflects subclinical tenosynovitis |
| 264 | 1 | |c 2023 | |
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| 500 | |a Date Completed 13.02.2023 | ||
| 500 | |a Date Revised 19.04.2024 | ||
| 500 | |a published: Print | ||
| 500 | |a NTR: NTR4853-trial-NL4599 | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. | ||
| 520 | |a BACKGROUND: Clinically suspect arthralgia (CSA) is characterised by arthralgia of small joints and considered a risk stage for development of rheumatoid arthritis (RA). However, it remains unknown if the function of the hands is already affected and what mechanisms underlie impaired hand-function in CSA | ||
| 520 | |a METHODS: We studied various measures of hand function in two CSA populations. CSA patients in the TREAT EARLIER-trial (n=236) were evaluated at baseline for: grip strength on a dynamometer (GS), patient-reported difficulties in the grip domain of the Health Assessment Questionnaire (HAQ) questionnaire and incomplete fist closure at physical examination. Findings were validated in an independent CSA cohort (n=600) where hand function was measured as: GS evaluated by squeezing the examiner's fingers, grip domain of the HAQ questionnaire and fist closure. Contrast-enhanced MRI of the hands measured synovitis, tenosynovitis and bone marrow oedema (summed as subclinical inflammation) in both cohorts | ||
| 520 | |a RESULTS: GS (on a dynamometer) was reduced in 75% compared with reference values in healthy controls, 60% reported grip difficulties and 13% had incomplete fist closure. Reduced GS was associated with subclinical inflammation (-0.38 kg/point inflammation, 95% CI -0.68 to -0.08). Studying separate MRI features, GS reduction was independently associated with tenosynovitis, decreasing with -2.63 kg (95% CI -2.26 to -0.33)/point tenosynovitis (range observed tenosynovitis scores: 0-20). Similar relations with tenosynovitis were seen for patient-reported grip difficulties (OR 1.12/point, 95% CI 1.07 to 1.42) and incomplete fist closure (OR 1.36/point, 95% CI 1.03 to 1.79). In the validation cohort, 36% had decreased examiner-assessed GS, 51% reported grip difficulties and 14% incomplete fist closure: all were associated with tenosynovitis. Decreased dynamometer-measured GS was most sensitive for detecting tenosynovitis (75%), while incomplete fist closure was most specific (88%-90%) | ||
| 520 | |a CONCLUSION: Hand function is already often affected before RA development. These limitations are related to subclinical inflammation and tenosynovitis in particular | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Arthritis, Rheumatoid | |
| 650 | 4 | |a Magnetic Resonance Imaging | |
| 650 | 4 | |a Patient Reported Outcome Measures | |
| 650 | 4 | |a Synovitis | |
| 700 | 1 | |a Khidir, Sarah J H |e verfasserin |4 aut | |
| 700 | 1 | |a Matthijssen, Xanthe M E |e verfasserin |4 aut | |
| 700 | 1 | |a Ten Brinck, Robin M |e verfasserin |4 aut | |
| 700 | 1 | |a van Aken, Jill |e verfasserin |4 aut | |
| 700 | 1 | |a Speyer, Irene |e verfasserin |4 aut | |
| 700 | 1 | |a van der Giesen, Florus J |e verfasserin |4 aut | |
| 700 | 1 | |a van Mulligen, Elise |e verfasserin |4 aut | |
| 700 | 1 | |a van der Helm-van Mil, Annette H M |e verfasserin |4 aut | |
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