Hand function is already reduced before RA development and reflects subclinical tenosynovitis

RMD Open, vol. 9, pp. e002885

Abstract

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.

Authors 9

1. Doortje I Krijbolder corresponding Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

2. Sarah J H Khidir Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

3. X. Matthijssen Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

4. Robin M. ten Brinck Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

5. Jill van Aken

   Spaarne Gasthuis

   Affiliation as printed

   Department of Rheumatology, Spaarne Gasthuis, Haarlem, Netherlands

6. Irene Speyer

   Medisch Centrum Haaglanden · Stichting Haaglanden Medisch Centrum

   Affiliation as printed

   Department of Rheumatology, Haaglanden Medical Center, Westeinde The Hague, Netherlands

7. Florus J van der Giesen Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center

   Affiliation as printed

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

8. Elise van Mulligen Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center · Erasmus MC

   Affiliation as printed

   Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands

9. Annette H M van der Helm–van Mil Aachen Department of Rheumatology, Leiden University Medical Center

   Leiden University Medical Center · Erasmus MC

   Affiliation as printed

   Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands

   Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands