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

Autor:	Krijbolder DI; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands d.i.krijbolder@lumc.nl., Khidir SJH; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands., Matthijssen XME; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands., Ten Brinck RM; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands., van Aken J; Department of Rheumatology, Spaarne Gasthuis, Haarlem, Netherlands., Speyer I; Department of Rheumatology, Haaglanden Medical Center, Westeinde The Hague, Netherlands., van der Giesen FJ; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands., van Mulligen E; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands., van der Helm-van Mil AHM; Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.; Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands.
Jazyk:	angličtina
Zdroj:	RMD open [RMD Open] 2023 Feb; Vol. 9 (1).
DOI:	10.1136/rmdopen-2022-002885
Abstrakt:	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. Competing Interests: Competing interests: None declared. (© 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.)
Databáze:	MEDLINE
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