The relationship between joint damage and functional disability in rheumatoid arthritis: a systematic review

Objective.Magnetic resonance imaging (MRI) has been increasingly recognized as a critical tool for the assessment of patients with rheumatoid arthritis (RA) and is able to reliably identify synovitis, bone marrow edema, bone erosion, and joint space narrowing (JSN)/cartilage loss. Understanding the exact relationship between each MRI feature and local synovial pathobiology is critical to dissect disease pathogenesis as well as develop future predictive models.Methods.A systematic review was performed of the current published literature examining the relationship between MRI abnormalities and synovial pathobiology in patients with RA.Results.Eighteen studies were identified; most focused on validation of MRI as a tool to detect and quantify synovitis, with a significant relationship demonstrated. Additionally, from the limited data available, a critical role seems likely for synovial pathways, at least in driving joint damage. However, there was a lack of data examining the relationship between synovial pathobiology and bone marrow abnormalities and JSN.Conclusion.Although understanding the interrelationship of these disease biomarkers offers the potential to enhance the predictive validity of modern imaging with concomitant synovial pathobiological analysis, further studies integrating MRI with synovial tissue analysis in well-controlled cohorts at distinct disease stages before and after therapeutic intervention are required to achieve this.

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Do Radiographic Joint Damage and Disease Activity Influence Functional Disability Through Different Mechanisms? Direct and Indirect Effects of Disease Activity in Established Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.121346 ◽

2013 ◽

Vol 40 (9) ◽

pp. 1505-1512 ◽

Cited By ~ 5

Author(s):

Sandhya C. Nair ◽

Johannes W.J. Bijlsma ◽

Jacobien H. van der Werf ◽

Maaike J. van der Veen ◽

Suzanne P. Linn-Rasker ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Functional Disability ◽

Functional Decline ◽

Joint Damage ◽

Treatment Strategies ◽

Joint Disease ◽

Influence Functional ◽

Over Time ◽

Predictive Effect

Objective.To explore the relationship between rheumatoid arthritis (RA) disease activity and functional disability over time, considering indirect (predictive) and direct (concurrent) associations as well as the influence of radiographic joint damage and treatment strategy.Methods.Functional disability [Health Assessment Questionnaire (HAQ)], disease activity [28-joint Disease Activity Score (DAS28)], and radiographic joint damage [Sharp/van der Heijde score (SHS)] were measured in 4 consecutive randomized controlled trials with increasingly intensive (tight control) treatment strategies. Average followup time for the 3 cohorts was 97, 53, and 50 months, respectively. Next to current DAS28, the previous DAS28 was used to study the predictive effect of a change in DAS28 on progression of functional disability (HAQ). Finally, it was investigated whether SHS mediated the predictive effect of DAS28.Results.In patients treated with intensive treatment strategies, the progression of HAQ over time was statistically significantly less (p < 0.0001). The predictive influence of DAS28 on HAQ progression increased over the duration of the disease. SHS was not found to influence HAQ progression and did not mediate the predictive effect of DAS28. In the less intensively treated patients, the direct effect of disease activity decreased with disease duration, and contrarily, SHS did influence HAQ progression, but was not found to (fully) mediate the predictive effect of DAS28.Conclusion.In patients with RA treated with modern treatment strategies, there is less functional decline over time. Further, disease activity does predict functional decline but joint damage does not. This might indicate that factors associated with cumulative disease activity but not visible on radiographs can influence functional decline in patients with RA. This further underlines the importance of disease activity as a treatment target in early RA and in established RA.

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SAT0119 The relationship between inflammation and joint damage in rheumatoid arthritis is dependent on anti-CCP status

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2012-eular.3066 ◽

2013 ◽

Vol 71 (Suppl 3) ◽

pp. 510.2-511

Author(s):

Y. De Punder ◽

J. Hendrikx ◽

E. Valls Pascual ◽

P. van Riel ◽

J. Fransen

Keyword(s):

Rheumatoid Arthritis ◽

Joint Damage ◽

The Relationship

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SAT0090 EFFECTS OF ADHERENCE TO MEDITERRANEAN DIET ON RHEUMATOID ARTHRITIS IMPACT OF DISEASE (RAID) SCORE

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2020-eular.2338 ◽

2020 ◽

Vol 79 (Suppl 1) ◽

pp. 979.1-979

Author(s):

F. Ingegnoli ◽

I. Scotti ◽

T. Schioppo ◽

T. Ubiali ◽

G. Marano ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Mediterranean Diet ◽

Functional Disability ◽

Regression Coefficient ◽

Well Being ◽

P Value ◽

Food Groups ◽

Single Item ◽

And Coping ◽

The Relationship

Background:Mediterranean diet (MD) is a well-balanced, nutritionally adequate and potentially anti-inflammatory diet that encompasses all food groups. Presently, there are conflicting data about the benefits of MD in rheumatoid arthritis (RA). Not enough evidence support a role of MD in the prevention and treatment of RA, and a modest impact of MD on laboratory parameters has been described. Greater effect on subjective aspects of the disease such as joint pain, morning stiffness, and fatigue was reported.Objectives:To investigate whether the adherence to MD affects RA perception as measured by Rheumatoid Arthritis Impact of Disease (RAID) score.Methods:Consecutive patients <65 years with RA attending our outpatient clinic were enrolled in this cross-sectional study. For each patient we collected: 1) RAID that consists of 7 single-item domains (pain, functional disability, fatigue, sleep, physical well-being, emotional well-being and coping), each rated by patients on an 11-point numerical rating scale from 0 (best) to 10 (worst) [1], and 2) MD score, a self-reported questionnaire that evaluates the adherence to MD through the consumption of 11 food groups, ranging from 0 (no adherence) to 55 (high adherence) [2]. Univariate analysis was performed using MD score as independent variable. Moreover, to evaluate the adjusted relationship between the single item of RAID and MD score, a multiple regression model was used.Results:205 RA patients were enrolled: median age at visit 53 (q1-q3: 44-59) years, female 80.5 %. The median MD and RAID score were 35 (q1-q3: 32-39) and 2.42 (q1-q3: 0.63-4.51) respectively.RAID total score had a statistically significant negative relationship with MD score (regression coefficient -0.08; p-value=0.016). Concerning the single RAID items, a statistically significant negative association was found for pain (regression coefficient -0.08; p-value=0.025), functional disability (regression coefficient -0.13; p-value<0.001), sleep (regression coefficient -0.08; p-value=0.041), physical well-being (regression coefficient -0.08; p-value=0.027) and coping (regression coefficient -0.11; p-value=0.008).Multiple regression analysis to evaluate the relationship between significant RAID items and MD score did not show any statistical significance as all items are strongly related to each other.Conclusion:To our knowledge, this is the first study addressing the relationship between the adherence to MD and the perception of RA impact. A better MD adherence was associated with lower self-reported composite total RAID score as well as lower pain, functional disability, sleep, physical well-being and coping. The effect of MD adherence on overall RAID is relevant but, at the same time, a prominent effect of one single item on the others could not be documented. This study confirmed the importance of non-pharmacological interventions, such as diet, in RA management.References:[1] Gossec L, et al. Ann Rheum Dis 2011;70(6):935-42.[2] Panagiotakos DB, et al. Nutr Metab Cardiovasc Dis 2006;16(8):559-68.Disclosure of Interests:Francesca Ingegnoli: None declared, Isabella Scotti: None declared, Tommaso Schioppo: None declared, Tania Ubiali: None declared, Giuseppe Marano: None declared, Patrizia Boracchi: None declared, Orazio De Lucia: None declared, Antonella Murgo: None declared, Roberto Caporali Consultant of: AbbVie; Gilead Sciences, Inc.; Lilly; Merck Sharp & Dohme; Celgene; Bristol-Myers Squibb; Pfizer; UCB, Speakers bureau: Abbvie; Bristol-Myers Squibb; Celgene; Lilly; Gilead Sciences, Inc; MSD; Pfizer; Roche; UCB

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The Influence of Individual Joint Impairment on Functional Disability in Rheumatoid Arthritis Using a Large Observational Database of Japanese Patients

The Journal of Rheumatology ◽

10.3899/jrheum.110770 ◽

2012 ◽

Vol 39 (3) ◽

pp. 476-480 ◽

Cited By ~ 8

Author(s):

KUMI SHIDARA ◽

EISUKE INOUE ◽

DAISUKE HOSHI ◽

EIICHI TANAKA ◽

YOHEI SETO ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Functional Capacity ◽

Functional Disability ◽

Health Assessment ◽

Japanese Patients ◽

Score Change ◽

Observational Cohort ◽

The Difference ◽

The Relationship ◽

Assessment Questionnaire

Objective.To clarify the influence of individual joint impairment on functional capacity through a retrospective study with a 3-year interval, using a large cohort of Japanese patients with rheumatoid arthritis (RA).Methods.Subjects included 3457 patients with RA who participated in a large observational cohort study in both April 2004 and April 2007; 43 joints were assessed and classified into 10 joint areas. Impairment of each joint area was scored based on the presence of swelling or tenderness: score 0 (no swelling or tenderness in either joint), score 1 (swelling or tenderness in a unilateral joint), and score 2 (swelling or tenderness in bilateral joints). Score change was defined as the difference between scores from 2004 and 2007. The Japanese validated version of the Health Assessment Questionnaire is the J-HAQ; ΔJ-HAQ score was determined by subtracting J-HAQ score in 2007 from that in 2004. The relationship between score change and ΔJ-HAQ score, and the effect of joint impairment on ΔJ-HAQ score were assessed.Results.Major joint areas that contributed to ΔJ-HAQ score included the wrist (31%), shoulder (21%), knee (13%), and ankle (10%). The shoulder, wrist, knee, and ankle in the worsening group were associated with a J-HAQ score increase of 0.13 to 0.18 compared to the improvement group.Conclusion.Our study demonstrated that impairment of the shoulder, wrist, knee, and ankle significantly affects functional capacity in patients with RA. Care of these joints is suggested to be especially important for better functional outcomes.

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Linkage and Association Studies of Joint Morbidity from Rheumatoid Arthritis

The Journal of Rheumatology ◽

10.3899/jrheum.090526 ◽

2009 ◽

Vol 37 (2) ◽

pp. 291-295 ◽

Cited By ~ 2

Author(s):

JIN-YOUNG MIN ◽

KYOUNG-BOK MIN ◽

JOOHON SUNG ◽

SUNG-IL CHO

Keyword(s):

Rheumatoid Arthritis ◽

Association Studies ◽

Clinical Signs ◽

Joint Damage ◽

Genetic Variations ◽

Nucleotide Polymorphisms ◽

Sibling Pairs ◽

Rf Values ◽

Family Based ◽

The Relationship

Objective. To investigate the relationship between genetic variations of rheumatoid arthritis (RA) susceptibility in terms of joint morbidity.Methods. We used data from Genetic Analysis Workshop 15. The Illumina linkage panel IV included 5858 single-nucleotide polymorphisms (SNP), with 5744 SNP passing quality control filters. The phenotypic variables analyzed were the level of rheumatoid factor (RF) and score on the Joint Alignment and Motion (JAM) scale. We modified the scale, dividing by RF values relevant to disease severity. Linkage analysis for affected sibling pairs was done using the MERLIN program, and family-based association tests were carried out using PLINK and FBAT software.Results. We found a high peak (LOD = 3.29; NPL Z = 4.07) near the HLA-DRB1 region on chromosome 6. The linkage at 6p24 at rs1410766 [LOD = 2.66; nonparametric linkage (NPL) Z = 3.23] was statistically significant. Two other regions also showed possible linkage peaks: chromosome 7q30 at rs322812 (LOD = 2.47; NPL Z = 3.39) and chromosome 15p34 at rs347117 (LOD = 1.95; NPL Z = 2.80). For the family-based association study, 7 SNP related to clinical RA severity were detected.Conclusion. Genetic variations may lead to an enhanced risk of joint damage and increased levels of RF. Further studies are needed to elucidate the roles of other genes involved in RA and to explore whether the clinical signs of RA are associated with particular genetic variations.

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Association of Body Mass Index Categories with Disease Activity and Radiographic Joint Damage in Rheumatoid Arthritis: A Systematic Review and Metaanalysis

The Journal of Rheumatology ◽

10.3899/jrheum.150224 ◽

2015 ◽

Vol 42 (12) ◽

pp. 2261-2269 ◽

Cited By ~ 34

Author(s):

Celine Vidal ◽

Thomas Barnetche ◽

Jacques Morel ◽

Bernard Combe ◽

Claire Daïen

Keyword(s):

Rheumatoid Arthritis ◽

Systematic Review ◽

Body Mass Index ◽

Disease Activity ◽

Body Mass ◽

Health Assessment ◽

Joint Damage ◽

Overweight And Obesity ◽

Mean Difference ◽

Obese Patients

Objective.Obesity and overweight are increasing conditions. Adipose tissue with proinflammatory properties could be involved in rheumatoid arthritis (RA) activity and radiographic progression. This study aims to investigate the influence of overweight and obesity on RA activity and severity.Methods.We conducted a systematic review and metaanalysis to assess the association of body mass index (BMI) categories with the Disease Activity Score in 28 joints (DAS28), functional disability [Health Assessment Questionnaire (HAQ)], and radiographic joint damage in patients with RA. We searched Medline through PubMed, EMBASE, and the Cochrane Database of Systematic Reviews for all studies assessing DAS28, HAQ, or/and radiographic damage according to predefined BMI groups.Results.Among the 737 citations retrieved, 58 articles met the inclusion criteria and 7 were included in the metaanalysis. DAS28 was higher in obese (BMI > 30 kg/m2) than non-obese (BMI ≤ 30 kg/m2) patients (mean difference 0.14, 95% CI 0.01–0.27, p = 0.04, I2 = 0%). HAQ score was also higher among obese patients (mean difference 0.10, 95% CI 0.01–0.19, p = 0.03, I2 = 0%). Radiographic joint damage was negatively associated with obesity (standardized mean difference −0.15, 95% CI −0.29 to −0.02, p = 0.03, I2 = 38%).Conclusion.Obesity in RA is associated with increased DAS28 and HAQ score and with lower radiographic joint damage. These associations mainly result from an increase of subjective components of the DAS28 (total joint count and global health assessment) in obese patients. Conflicting results were reported concerning inflammation markers (C-reactive protein and erythrocyte sedimentation rate).

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Contribution of Multiplex Immunoassays to Rheumatoid Arthritis Management: From Biomarker Discovery to Personalized Medicine

Journal of Personalized Medicine ◽

10.3390/jpm10040202 ◽

2020 ◽

Vol 10 (4) ◽

pp. 202

Author(s):

Carlos M. Laborde ◽

Patricia Castro-Santos ◽

Roberto Díaz-Peña

Keyword(s):

Rheumatoid Arthritis ◽

Personalized Medicine ◽

Physical Disability ◽

Functional Disability ◽

Biomarker Discovery ◽

Joint Damage ◽

Cartilage Destruction ◽

Local Inflammation ◽

Protein Biomarkers ◽

Low Sensitivity

Rheumatoid arthritis (RA) is a multifactorial, inflammatory and progressive autoimmune disease that affects approximately 1% of the population worldwide. RA primarily involves the joints and causes local inflammation and cartilage destruction. Immediate and effective therapies are crucial to control inflammation and prevent deterioration, functional disability and unfavourable progression in RA patients. Thus, early diagnosis is critical to prevent joint damage and physical disability, increasing the chance of achieving remission. A large number of biomarkers have been investigated in RA, although only a few have made it through the discovery and validation phases and reached the clinic. The single biomarker approach mostly used in clinical laboratories is not sufficiently accurate due to its low sensitivity and specificity. Multiplex immunoassays could provide a more complete picture of the disease and the pathways involved. In this review, we discuss the latest proposed protein biomarkers and the advantages of using protein panels for the clinical management of RA. Simultaneous analysis of multiple proteins could yield biomarker signatures of RA subtypes to enable patients to benefit from personalized medicine.

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AB0864-HPR INFLUENCE OF THE TYPE OF PAIN SYNDROME ON THE SEVERITY OF ANXIETY-DEPRESSIVE DISORDERS IN PATIENTS WITH RHEUMATOID ARTHRITIS

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.2795 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 1455.2-1456

Author(s):

E. Egorova ◽

N. Nikitina ◽

A. Rebrov

Keyword(s):

Rheumatoid Arthritis ◽

Severe Pain ◽

Depressive Disorders ◽

Functional Limitations ◽

Joint Damage ◽

Statistical Processing ◽

Pain Syndrome ◽

Anxiety And Depression ◽

Moderate Pain ◽

The Relationship

Background:Rheumatoid arthritis (RA) is a chronic autoimmune disease that leads to joint damage and deformation. Pain syndrome, along with functional limitations, causes the emergence of anxiety-depressive disorders. The patient’s psycho-emotional characteristics affect the patient’s quality of life and the effectiveness of the therapy. The aim: to assess the severity of anxiety and depression in women with rheumatoid arthritis, depending on the type of the pain syndrome.Objectives:The study included 163 women with RA according to the EULAR / ACR 2010 criteria (age 53,9 ± 10,15 years, RA duration - 10 [4; 14] years, DAS28 – 5,03 [4,35; 5,8]).Methods:We used the Hospital Depression and Anxiety Scale (HADS) questionnaire: 0-7 points were assessed as the absence of significant symptoms of anxiety and depression, 8-10 points - subclinically expressed anxiety and depression, more than 11 points - clinically expressed anxiety and depression. The severity of pain was determined by the VAS: no pain (0-4 mm), mild pain (5-44 mm), moderate pain (45-74 mm), severe pain (75-100 mm). Assessment of the type of pain (identification of the neuropathic component of pain) was carried out using the DN4 questionnaire: a sum of 4 or more points indicated the presence of a neuropathic component of pain (NCP). Statistical processing was performed using the STATISTICA 10,0 program.Results:The frequency of occurrence of anxiety-depressive disorders in RA patients was determined: clinically pronounced anxiety was detected in 35 (21,4%) patients, depression - in 34 (20,9%); subclinically expressed anxiety - in 42 (25,8%), depression - in 44 (27%) patients; absence of reliably pronounced symptoms of anxiety - in 86 (52,8%) patients, depression - in 85 (52,1%) patients.Severe pain according to VAS was noted in 57 (35%) patients, moderate pain - in 75 (46%), in 31 (19%) patients the pain syndrome was mild. In 81 (49,7%) patients a neuropathic component of pain was revealed.The relationship was established between the presence of NCP and the severity of anxiety (r = 0,27, p < 0,05), depression (r = 0,31, p <0,05). The relationship was revealed between the presence of NCP and the severity of pain according to the VAS (r = 0.32, p <0.05).To explain the relationship between the presence of NCP and anxiety-depressive disorders, the patients were divided into two groups depending on the presence of NCP, comparable in age, the main clinical characteristics of RA, and basic therapy. The level of anxiety in women with NCP (9,5 [7; 13]) was significantly higher than in patients without NCP (6.1 [4; 9]) (p = 0.01). The severity of depression in women with NCP was 8,55 [6; 11], in patients without NCP – 5,15 [3; 6] (p = 0.005).Conclusion:Thus, every fifth patient with RA had clinically significance anxiety and depression, subclinical anxiety and depression were found in 26% of RA patients. Most of the patients (81%) had moderate or severe pain, half of the patients had signs of neuropathic pain. The relationship between the severity of anxiety and depression with the intensity of pain and the presence of a neuropathic component was revealed.Disclosure of Interests:None declared

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Comparative Analyses of Serological Biomarkers and Disease Characteristics between Elderly-onset and Younger-onset Rheumatoid Arthritis

Medicine & Health ◽

10.17576/mh.2021.1601.19 ◽

2021 ◽

Vol 16 (1) ◽

pp. 237-245

Author(s):

Rajalingham Sakthiswary ◽

Keyword(s):

Rheumatoid Arthritis ◽

Disease Activity ◽

Functional Disability ◽

Disease Duration ◽

Severe Disease ◽

Age At Onset ◽

Health Assessment ◽

Joint Damage ◽

Study Data ◽

Elderly Onset

The onset of rheumatoid arthritis (RA) may occur any time after the age of 16 years. The purpose of this study was to compare the clinical and serological differences between elderly onset RA (EORA); which is begins at the age of 60 and above, with younger onset RA (YORA). A total of 69 EORA and 82 YORA female patients were enrolled in this study. Data on medications, disease duration, age at onset, disease activity at onset and laboratory parameters were collected by reviewing the medical records. All patients had their blood samples taken for serum anticyclic citrulinated peptide (anti-CCP), IgA rheumatoid factor (RF), IgM RF and IgG RF. Besides, the subjects were assessed for their radiographic joint damage based on Modified Sharp Score (MSS) and functional disability based on the Health Assessment Questionnaire-disability Index (HAQ-DI) scores. Despite comparable disease duration and frequency of seropositivity, the YORA group had significantly higher disease activity at onset of the disease (p=0.009). In keeping with this finding, the YORA group had more severe joint damage based on radiographic assessment (MSS scores of 17.49+19.04 versus 10.04+12.79). The YORA group had significantly higher levels of IgA RF and anti-CCP with p-values of 0.035 and 0.002, respectively. Our findings suggest that YORA is associated with more severe disease, worse radiographic joint damage and higher levels of anti-CCP and IgA RF.

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