Background
Patients and methods
Patients
Clinical assessment
Assessment of grip force
Statistics
Results
Patients
Characteristics of the early RA cohort†
| Inclusiona
|
1 year
b
|
5 years
c
|
---|---|---|---|
Female sex n (%) | 152 (71) | 153 (71) | 124 (71) |
Age (years) | 59.9 (14.7) | 61 (14.6) | 64.7 (14.3) |
Symptom duration at inclusion (month); median (IQR) | 7 (5–10) | 7 (5‒10) | 7 (5‒10) |
RF positive % (n) | 61 (132) | 62 (135) | 65 (114) |
Anti-CCP positive % (n) | 56 (104/187) | 58 (108/186) | 59 (90/153) |
RF and/or anti-CCP positive % (n) | 72 (154) | 72 (155) | 75 (132) |
Swollen joints (0-28); median (IQR) | 7 (5–11) | 4 (2‒7) | 4 (4‒7) |
Tender joints (0-28); median (IQR) | 4 (1–9) | 2 (0‒5) | 1 (1‒3) |
DAS28 (0‒10) | 4.64 (1.38) | 3.65 (1.34) | 3.59 (1.38) |
HAQ (0‒3) | 0.85 (0.62) | 0.63 (0.59) | 0.75 (0.66) |
Patient’s global assessment (VAS 0‒100) | 43 (26) | 31 (24) | 35 (24) |
Pain (VAS 0‒100) | 41 (27) | 31 (24) | 30 (23) |
Average grip force right hand (N) | 102 (76) | 131 (85) | 137 (93) |
Average grip force right hand (% of expected) | 39 (25) | 51 (27) | 56 (30) |
Average grip force left hand (N) | 97 (70) | 120 (78) | 130 (88) |
Average grip force left hand (% of expected) | 39 (25) | 49 (27) | 55 (30) |
Methotrexate treatment % (n) | 55 (119) | 63 (137) | 61 (106) |
Other DMARD % (n) | 30 (64) | 31 (67) | 25 (43) |
Corticosteroid treatment % (n) | 39 (83) | 31 (66) | 29 (51) |
CRP (mg/l); median (IQR) | 9 (< 9‒24) | < 9 (< 9‒10) | < 9 < 9‒10) |
ESR (mm/h); median (IQR) | 20 (10–40) | 15 (7‒27) | 16 (10‒25) |
Frequency of synovitis and tenderness involvement in early RA — over time
Inclusiona
| 1-year follow-upb |
5-year follow-upc
| ||||
---|---|---|---|---|---|---|
Right
|
Left
|
Right
|
Left
|
Right
|
Left
| |
Synovitis;
n
(%)
| ||||||
MCP I | 130 (60) | 149 (69) | 100 (46) | 131 (61) | 83 (48) | 108 (62) |
MCP II | 135 (63) | 129 (60) | 102 (48) | 87 (40) | 98 (56) | 86 (49) |
MCP III | 102 (47) | 95 (44) | 62 (29) | 59 (27) | 59 (34) | 57 (33) |
MCP IV | 26 (12) | 27 (13) | 9 (4) | 3 (1) | 9 (5) | 9 (5) |
MCP V | 25 (12) | 25 (12) | 14 (6) | 10 (5) | 23 (13) | 14 (8) |
PIP I | 35 (16) | 42 (20) | 17 (8) | 20 (9) | 10 (6) | 10 (6) |
PIP II | 61 (28) | 54 (25) | 32 (15) | 26 (12) | 19 (11) | 24 (14) |
PIP III | 73 (34) | 70 (33) | 36 (17) | 36 (17) | 31 (18) | 26 (15) |
PIP IV | 44 (20) | 56 (26) | 22 (10) | 34 (16) | 16 (9) | 23 (13) |
PIP V | 30 (14) | 42 (20) | 17 (8) | 28 (13) | 13 (8) | 20 (11) |
Tenderness; n (%) | ||||||
MCP I | 73 (34) | 82 (38) | 46 (21) | 56 (26) | 34 (20) | 35 (20) |
MCP II | 68 (32) | 73 (34) | 40 (19) | 40 (18) | 31 (18) | 28 (16) |
MCP III | 60 (28) | 62 (29) | 29 (14) | 30 (14) | 23 (13) | 24 (14) |
MCP IV | 36 (17) | 32 (15) | 17 (8) | 14 (6) | 14 (8) | 11 (6) |
MCP V | 34 (16) | 33 (15) | 11 (5) | 13 (6) | 16 (9) | 13 (7) |
PIP I | 39 (18) | 35 (16) | 20 (9) | 19 (9) | 14 (8) | 14 (8) |
PIP II | 47 (22) | 49 (23) | 25 (12) | 19 (9) | 17 (10) | 15 (9) |
PIP III | 51 (24) | 55 (26) | 25 (12) | 32 (15) | 21 (12) | 14 (11) |
PIP IV | 53 (25) | 48 (22) | 15 (7) | 23 (12) | 14 (8) | 17 (10) |
PIP V | 36 (17) | 46 (21) | 15 (7) | 18 (8) | 17 (10) | 16 (9) |
Relation between synovitis and tenderness of individual MCP and PIP joints and grip force in analyses of both hands combined
Inclusion
a
|
1-year follow-up
a
|
5-year follow-up
a
| |
---|---|---|---|
Synovitis | |||
MCP I |
− 9.2 (− 13.6 to − 4.8)
|
− 7.5 (− 12.3 to − 2.7)
|
− 7.8 (− 13.6 to − 1.9)
|
MCP II |
− 7.4 (− 11.7 to − 3.1)
| − 2.9 (− 7.8 to 2.0) | − 4.2 (− 10.2 to 1.9) |
MCP III |
− 6.9 (− 11.0 to − 2.7)
| − 1.4 (− 6.9 to 4.2) | − 2.1 (− 8.5 to 4.2) |
MCP IV |
− 8.7 (− 15.1 to − 2.4)
| − 9.1 (− 23.4 to 5.2) | − 3.5 (− 16.5 to 9.6) |
MCP V | − 6.4 (− 13.0 to 0.3) | − 4.6 (− 14.9 to 5.7) | 4.1 (− 5 − 7 to 13.9) |
PIP I | 0.6 (− 5.1 to 6.3) | − 3.9 (− 12.3 to 4.5) | − 6.9 (− 19.5 to 5.7) |
PIP II | − 2.7 (− 7.5 to 2.0) | − 5.1 (− 12.1 to 1.8) | − 6.8 (− 15.6 to 2.1) |
PIP III |
− 4.9 (− 9.4 to − 0.5)
| − 2.9 (− 9.2 to 3.5) | 1.0 (− 6.9 to 9.0) |
PIP IV | − 3.5 (− 8.5 to 1.5) | − 3.3 (− 10.2 to 3.6) | 3.6 (− 5.6 to 12.8) |
PIP V | − 3.7 (− 9.3 to 2.0) | − 5.0 (− 12.8 to 2.7) | − 1.8 (− 11.8 to 8.3) |
Tender joints | |||
MCP I |
− 8.9 (− 13.4 to − 4.3)
|
− 5.9 (− 11.8 to − 0.1)
| − 7.2 (− 15.5 to 1.2) |
MCP II | − 8.5 (− 13.0 to 4.0) | − 3.2 (− 9.7 to 3.2) | − 6.5 (− 15.2 to 2.2) |
MCP III |
− 8.7 (− 13.9 to − 3.5)
| 0.8 (− 6.8 to 8.4) | − 5.8 (− 15.1 to 3.6) |
MCP IV |
− 12.1 (− 18.0 to − 6.3)
| − 7.5 (− 17.1 to 2.1) | − 6.7 (− 18.9 to 5.4) |
MCP V | − − 7.6 (− 13.6 to − 1.6)
| − 9.0 (− 19.6 to 1.6) | 5.8 (− 6.4 to 18.0) |
PIP I |
− 5.8 (− 11.5 to − 0)
| − 6.9 (− 15.4 to 1.6) | − 5.9 (− 17.2 to 5.4) |
PIP II |
− 8.0 (− 13.1 to − 2.9)
| − 5.4 (− 13.6 to 2.8) | − 7.6 (− 18.4 to 3.2) |
PIP III |
− 9.4 (− 14.3 to − 4.5)
|
− 8.4 (− 15.7 to − 1.1)
| − 4.0 (− 14.1 to 6.1) |
PIP IV |
− 5.4 (− 10.4 to − 0.3)
| − 4.0 (− 12.6 to 4.6) | − 2.3 (− 13.2 to 8.6) |
PIP V |
− 7.8 (− 13.2 to − 2.4)
| − 8.1 (− 17.3 to 1.1) | − 7.7 (− 18.1 to 2.8) |
Relation between synovitis and tenderness of individual MCP and PIP joints and grip force in separate, fully adjusted analyses of the right and left hand
Individual MCP/PIP involvement and grip force of the right and left hand — unadjusted analyses, and analyses adjusted for wrist involvement
MCP and PIP synovitis/tenderness and grip force over time
Right hand
b
|
Left hand
b
| |
---|---|---|
Synovitis
| ||
MCP I |
− 5.0 (− 8.3 to − 1.7)
|
− 3.7 (− 6.6 to − 0.8)
|
MCP II |
− 1.7 (− 4.9 to 1.5)
|
− 1.7 (− 4.8 to 1.4)
|
MCP III |
− 1.2 (− 4.4 to 2.0)
|
− 0.4 (− 3.3 to 2.4)
|
MCP IV |
− 4.7 (− 9.3 to − 0.2)
|
− 6.1 (− 10.9 to − 1.4)
|
MCP V |
− 3.0 (− 7.7 to 1.7)
|
− 6.0 (− 10.2 to − 1.8)
|
PIP I | 0.8 (− 4.5 to 6.1) |
− 2.4 (− 6.7 to 1.9)
|
PIP II | 0.3 (− 3.3 to 3.9) |
− 1.8 (− 5.6 to 1.9)
|
PIP III | 0.7 (− 2.6 to 4.0) |
− 0.6 (− 4.4 to 3.3)
|
PIP IV |
− 0.3 (− 4.4 to 3.9)
| 0.1 (− 4.2 to 4.3) |
PIP V |
− 3.0 (− 8.1 to 2.2)
| 1.1 (− 4.6 to 6.9) |
Tenderness
| ||
MCP I |
− 5.8 (− 9.4 to − 2.2)
|
− 1.5 (− 5.0 to 2.0)
|
MCP II |
− 4.0 (− 7.8 to − 0.2)
|
− 2.2 (− 5.4 to 1.0)
|
MCP III |
− 2.9 (− 7.1 to 1.2)
|
− 0.3 (− 3.8 to 3.2)
|
MCP IV |
− 9.0 (− 12.8 to − 5.2)
|
− 6.5 (− 10.8 to − 2.1)
|
MCP V |
− 4.4 (− 9.2 to 0.5)
|
− 2.6 (− 7.7 to 2.5)
|
PIP I |
− 1.7 (− 6.9 to 3.5)
|
− 4.9 (− 9.7 to − 0.2)
|
PIP II |
− 4.5 (− 8.8 to − 0.2)
|
− 3.2 (− 7.9 to 1.5)
|
PIP III |
− 4.3 (− 8.7 to 0.1)
|
− 3.9 (− 7.8 to − 0.1)
|
PIP IV |
− 0.9 (− 6.5 to 4.6)
|
− 0.5 (− 6.1 to 5.0)
|
PIP V |
− 4.0 (− 8.9 to 0.8)
|
− 1.9 (− 7.5 to 3.8)
|
Discussion
Conclusion
-
MCP synovitis of the thumb is common in patients with early RA, and a major contributor to reduced grip force over the first 5 years.
-
Although less frequent, the involvement of MCP IV and MCP V may also have a significant impact on hand function.
-
Despite improvement, grip force was still substantially reduced compared to the general population 5 years after RA diagnosis.
-
This underlines the importance of both efficient treatment of synovitis and structured hand training in early RA.