scholarly journals Eleven-year alterations in hand deformities in rheumatoid arthritis by comprehensive assessment using cluster analysis and analysis of covariance

2020 ◽  
Author(s):  
Shogo Toyama ◽  
Daisaku Tokunaga ◽  
Shinji Tsuchida ◽  
Rie Kushida ◽  
Ryo Oda ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Onset ◽  
Learning Curves ◽  
Comprehensive Assessment ◽  
Analysis Of Covariance ◽  
Cross Sectional ◽  
Boutonniere Deformity ◽  
Evaluation Point ◽  
Boutonnière Deformity ◽  
Swan Neck Deformity

Abstract BackgroundAlthough drug therapy in rheumatoid arthritis has recently improved, treating established rheumatoid hand, consisting of three major deformities—thumb deformity, finger deformities, and ulnar drift— remains a challenge. Underlying complex pathophysiology makes it difficult to comprehensively understand these deformities, and comprehensive assessment methods require accumulated skill and long learning curves. We aimed to establish an easier composite method of understanding the pathophysiology and to elucidate alterations in deformities.MethodsWe established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 (100 hands in 52 patients) and 2015 (63 hands in 37 patients) after case exclusion. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantified and entered as parameters into a two-step cluster (cross-sectional) analysis for the data in 2004. The parameters in each cluster were plotted at each evaluation point. Two-way analysis of covariance was performed to examine whether differences existed between evaluation points and clusters for the deformity parameters.ResultsFive clusters were most appropriate to clarify each deformity: cluster 1: minimal deformity; cluster 2: type 1 thumb deformity; cluster 3: thumb deformity and severe boutonnière deformity; cluster 4: type 2 or 3 thumb deformity and severe ulnar drift; cluster 5: thumb deformity and severe swan-neck deformity. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. Clusters 1–4 had similar disease duration, and showed different paths of deformity progression from disease onset. We considered clusters 1 and 2 as a conservative subset and clusters 3, 4, and 5 as a progressive subset. Over time, thumb deformity type altered to other types, and swan-neck deformity worsened significantly.ConclusionsOur comprehensive assessment indicated five deformity patterns and a progressive course in rheumatoid hand. Knowledge of the characteristics of the progressive subset may allow rheumatologists to more easily determine practical interventions and functional prognosis.

scholarly journals Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance

2021 ◽  
Author(s):  
Shogo Toyama ◽  
Daisaku Tokunaga ◽  
Shinji Tsuchida ◽  
Rie Kushida ◽  
Ryo Oda ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cluster Analysis ◽  
Learning Curves ◽  
Comprehensive Assessment ◽  
Analysis Of Covariance ◽  
Boutonniere Deformity ◽  
Hand Deformities ◽  
Evaluation Point ◽  
Boutonnière Deformity ◽  
Swan Neck Deformity

Abstract BackgroundAlthough drug therapy for rheumatoid arthritis (RA) has recently improved, treating patients with established disease, whose hands have three major deformities (thumb deformity, finger deformities, and ulnar drift), remains a challenge. The underlying complex pathophysiology makes understanding these deformities difficult, and comprehensive assessment methods require accumulated skill with long learning curves. We aimed to establish a simpler composite method to understand the pathophysiology of and alterations in the hand deformities of patients with RA.MethodsWe established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 (100 hands of 52 patients) and 2015 (63 hands of 37 patients) after case exclusion. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantitated and entered as parameters into a two-step cross-sectional cluster analysis for the data in 2004. The parameters in each cluster were plotted at each evaluation point. Two-way analysis of covariance was used to examine whether differences existed between evaluation points and clusters of deformity parameters.ResultsFive clusters most appropriately described hand deformity: (i) cluster 1, minimal deformity; (ii) cluster 2, type 1 thumb deformity; (iii) cluster 3, thumb deformity and severe boutonnière deformity; (iv) cluster 4, type 2 or 3 thumb deformity and severe ulnar drift; and (v) cluster 5, thumb deformity and severe swan-neck deformity. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. Clusters 1–4 had similar disease duration but showed different paths of deformity progression from disease onset. Clusters 1 and 2 represented conservative deformity parameters and clusters 3, 4, and 5 represented progressive deformity parameters. Over time, thumb deformity evolved into other types of deformities and swan-neck deformity worsened significantly.ConclusionsOur comprehensive analysis identified five deformity patterns and a progressive course in the rheumatoid hand. Knowledge of the characteristics of progressive deformity parameters may allow rheumatologists to more easily implement practical interventions and determine functional prognosis.

scholarly journals Comprehensive assessment of alterations in hand deformities over 11 years in patients with rheumatoid arthritis using cluster analysis and analysis of covariance

2021 ◽  
Vol 23 (1) ◽  
Author(s):  
Shogo Toyama ◽  
Daisaku Tokunaga ◽  
Shinji Tsuchida ◽  
Rie Kushida ◽  
Ryo Oda ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cluster Analysis ◽  
Learning Curves ◽  
Comprehensive Assessment ◽  
Analysis Of Covariance ◽  
Boutonniere Deformity ◽  
Hand Deformities ◽  
Evaluation Point ◽  
Boutonnière Deformity ◽  
Swan Neck Deformity

Abstract Background Although drug therapy for rheumatoid arthritis (RA) has recently improved, treating patients with established disease, whose hands have three major deformities (thumb deformity, finger deformities, and ulnar drift), remains a challenge. The underlying complex pathophysiology makes understanding these deformities difficult, and comprehensive assessment methods require accumulated skill with long learning curves. We aimed to establish a simpler composite method to understand the pathophysiology of and alterations in the hand deformities of patients with RA. Methods We established a rheumatoid hand cohort in 2004 and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 (100 hands of 52 patients) and 2015 (63 hands of 37 patients) after case exclusion. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantitated and entered as parameters into a two-step cross-sectional cluster analysis for the data in 2004. The parameters in each cluster were plotted at each evaluation point. Two-way analysis of covariance was used to examine whether differences existed between evaluation points and clusters of deformity parameters. Results Five clusters most appropriately described hand deformity: (i) cluster 1, minimal deformity; (ii) cluster 2, type 1 thumb deformity; (iii) cluster 3, thumb deformity and severe boutonnière deformity; (iv) cluster 4, type 2 or 3 thumb deformity and severe ulnar drift; and (v) cluster 5, thumb deformity and severe swan-neck deformity. Clusters 1 and 2 had higher function than cluster 5, and cluster 3 had moderate function. Clusters 1–4 had similar disease duration but showed different paths of deformity progression from disease onset. Clusters 1 and 2 represented conservative deformity parameters and clusters 3, 4, and 5 represented progressive deformity parameters. Over time, thumb deformity evolved into other types of deformities and swan-neck deformity worsened significantly. Conclusions Our comprehensive analysis identified five deformity patterns and a progressive course in the rheumatoid hand. Knowledge of the characteristics of progressive deformity parameters may allow rheumatologists to more easily implement practical interventions and determine functional prognosis.

scholarly journals Comprehensive assessment of rheumatoid hand using cluster analysis involving parameter analysis of three major hand deformities: a cross-sectional and longitudinal study

2020 ◽  
Author(s):  
Shogo Toyama ◽  
Ryo Oda ◽  
Daisaku Tokunaga ◽  
Shinji Tsuchida ◽  
Rie Kushida ◽  
...  
Keyword(s):  
Cluster Analysis ◽  
Learning Curves ◽  
Comprehensive Assessment ◽  
Cross Sectional ◽  
Boutonniere Deformity ◽  
Deformity Progression ◽  
Boutonnière Deformity ◽  
Cluster 2 ◽  
Swan Neck Deformity

Abstract Background Although drug therapy in rheumatoid arthritis has recently improved, treating established rheumatoid hand consisting of three major deformities—thumb deformity, finger deformities, and ulnar drift—remains a challenge. Underlying complex pathophysiology makes it difficult to comprehensively understand these deformities, and comprehensive assessment methods require accumulated skill and long learning curves. We aimed to establish an easier composite method of understanding the pathophysiology using data from our cohort and cluster analysis. Methods We established a rheumatoid hand cohort in 2004, and clinically evaluated 134 hands (67 patients). We repeated the evaluations in 2009 and 2015, which provided data for 297 hands and 43 hands for cross-sectional and longitudinal analyses, respectively. Thumb deformities, finger deformities (swan-neck and boutonnière deformity), and ulnar drift were semi-quantified and entered as parameters into a two-step cluster (cross-sectional) analysis. Parameter distributions were considered to clarify each cluster’s characteristics. Next, hands with cluster change over the study period were reviewed to clarify deformity progression (longitudinal analysis). We also performed a stratified analysis between the clusters and the affected period to clarify whether long affected period plays an important role in deformity progression. Results We identified seven clusters: cluster 1: mild finger deformities; cluster 2: type 1 thumb deformity; cluster 3: type 2 thumb deformity and severe ulnar drift; cluster 4: type 3 or 4 thumb deformity and low or moderate swan-neck deformity; cluster 5: various thumb deformities and severe boutonnière deformity; cluster 6: type 1 thumb deformity and severe swan-neck deformity; and cluster 7: type 6 thumb deformity. The ulnar drift parameters were equally distributed among the clusters except for cluster 3. Larger cluster numbers generally indicated lower function. At the study endpoint, cluster 1 had changed mainly to cluster 2 or 4, cluster 2 changed to cluster 3, and cluster 7 was considered the final morphology with the lowest hand function. Patients affected for > 30 years had increased risk of rapid disability progression. Conclusions Our comprehensive assessment indicated seven deformity patterns and a progressive course in rheumatoid hand. Using patterns may provide rheumatologists with easier information for practical interventions and to determine functional prognosis.

scholarly journals Psychological Distress in Out-Patients Assessed for Chronic Pain Compared to Those with Rheumatoid Arthritis

2016 ◽  
Vol 2016 ◽  
pp. 1-7 ◽  
Author(s):  
D. Rice ◽  
S. Mehta ◽  
A. Shapiro ◽  
J. Pope ◽  
M. Harth ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Chronic Pain ◽  
Psychological Distress ◽  
Cross Sectional Study ◽  
Anxiety Symptoms ◽  
Analysis Of Covariance ◽  
Pain Clinic ◽  
Cross Sectional ◽  
Rheumatology Clinic ◽  
Two Samples

Background. Patients diagnosed with chronic pain (CP) and rheumatoid arthritis (RA) represent two samples with overlapping symptoms, such as experiencing significant pain.Objectives. To compare the level of psychological distress among patients diagnosed CP attending a specialist pain clinic with those attending a specialist RA clinic.Measures. A cross-sectional study was conducted at an academic specialist chronic pain and rheumatology clinic.Participants. 330 participants included a CP group (n=167) and a RA group (n=163) completed a booklet of questionnaires regarding demographic characteristics, duration, and severity of their pain. Psychological and personality variables were compared between the CP and RA participants using a Multivariate Analysis of Covariance (MANCOVA).Results. Level of psychological distress based on the subscales of the DASS (depression, anxiety, and stress), PASS (escape avoidance, cognitive anxiety, fear of pain, and physiological anxiety), and PCS (rumination, magnification, and helplessness) was significantly higher in the CP group compared to the RA group. Categorization of individuals based on DASS severity resulted in significant differences in rates of depression and anxiety symptoms between groups, with a greater number of CP participants displaying more severe depressive and anxiety symptoms.Discussion and Conclusions. This study found greater levels of psychological distress among CP individuals referred to an academic pain clinic when compared to RA patients referred to an academic rheumatology clinic.

scholarly journals Journey of rheumatoid arthritis patients in Tunisia: From symptoms to treatment

2021 ◽  
Author(s):  
Alia Fazaa ◽  
Hiba Bettaieb ◽  
Meriem Sellami ◽  
Saoussen Miladi ◽  
Kmar Ouenniche ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Social Insurance ◽  
Disease Onset ◽  
Healthcare Providers ◽  
Healthcare Services ◽  
Wait Times ◽  
Diagnosis Delay ◽  
Cross Sectional ◽  
Study Results ◽  
The Mean

Objectives: This study aims to assess the different delays of rheumatoid arthritis (RA) patients’ journey from disease onset to treatment initiation and to identify possible influencing factors. Patients and methods: This cross-sectional study included a total of 100 patients (14 males, 86 females; mean age: 56.5±12.4 years; range, 26 to 82 years) who met the 2010 American College of Rheumatology (ACR)/European League Against Rheumatism (EULAR) criteria for RA between January 2019 and January 2020. Demographic and clinical data and disease characteristics were collected from the patient interviews and medical files. Five different intervals were defined from symptom onset until the initiation of conventional synthetic disease-modifying anti- rheumatic drugs (csDMARDs). Results: The mean age at RA onset was 46.6±12.4 years. Median delays from onset of symptoms until general practitioner (GP) and rheumatologist consultations were six (range, 0.25 to 240) months and 12 (range, 0 to 242) months, respectively. Median delays from onset of symptoms to RA diagnosis and treatment with csDMARDs were 15.7 (range, 2 to 252) months and 18 (range, 2 to 270) months, respectively. The mean number of consultations was 7.3±4.2 and the median number of physicians visited before the diagnosis was three (range, 1 to 8). The RA diagnosis delay was associated with rural geographic environment (p=0.02), lack of social insurance (p=0.027), progressive symptoms onset (p=0.006), morning stiffness (p=0.023), being initially examined by a GP (p=0.02), number of consultations (p<0.001; r=0.49), and number of physicians consulted before diagnosis (p=0.001; r=0.33) respectively. Based on the patients’ self-perception, the main causes of this long delay were lack of financial means (33%), wait times until exploration results (31%), wait times until the first GP or rheumatologist visit (26%), and geographical difficulty in accessing healthcare services (18%). Conclusion: Our study results suggest that patients with RA experience a significant delay until diagnosis and initiation of treatment. Healthcare providers should urgently consider factors related to diagnosis delay to shorten RA patients’ journey.

scholarly journals ACPA-IgG variable domain glycosylation increases before the onset of rheumatoid arthritis and stabilizes thereafter; a cross-sectional study encompassing over 1500 samples

2021 ◽  
Author(s):  
Theresa Kissel ◽  
Lise Hafkenscheid ◽  
Tineke J van Wesemael ◽  
Mami Tamai ◽  
Shin-ya Kawashiri ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Onset ◽  
Cross Sectional Study ◽  
Response To Therapy ◽  
Variable Domain ◽  
Autoimmune Response ◽  
Cross Sectional ◽  
Remarkable Feature ◽  
Established Disease ◽  
Disease Stages

Objective: The autoimmune response in rheumatoid arthritis (RA) is marked by anti-citrullinated protein antibodies (ACPA). A remarkable feature of ACPA-IgG is the abundant expression of N-linked glycans in the variable domain. Nonetheless, the presence of ACPA variable domain glycans (VDG) across disease stages and its response to therapy is poorly described. To understand its dynamics, we investigated the abundance of ACPA-IgG VDG in 1574 samples from individuals in different clinical disease stages. Methods: Using liquid chromatography, we analyzed ACPA-IgG VDG profiles of 7 different cohorts from Japan, Canada, the Netherlands and Sweden. We assessed 184 healthy, 228 pre-symptomatic, 277 arthralgia, 305 patients at RA-onset and 117 RA-patients 4, 8 and 12 months after disease onset. Additionally, we measured VDG of 234 samples from RA-patients that did or did not achieve long-term drug-free remission (DFR) during up to 16 years follow-up. Results: Our data show that ACPA-IgG VDG significantly increases (p<0.0001) towards disease-onset and associates with ACPA-levels and epitope spreading pre-diagnosis. A slight increase in VDG was observed in established RA and a moderate influence of treatment. Individuals who later achieved DFR displayed reduced ACPA-IgG VDG already at RA-onset. Conclusion: The abundance of ACPA-IgG VDG rises towards RA-onset and correlates with maturation of the ACPA-response. Although, ACPA-IgG VDG levels are rather stable in established disease, a lower degree at RA-onset correlates with DFR. Even though the underlying biological mechanisms are still elusive, our data support the concept that VDG relates to an expansion of the ACPA-response pre-disease and contributes to disease-development.

scholarly journals Is It the Age at Disease Onset or the Disease Radiological Severity That Affects Cervical Spine Involvement in Patients With Rheumatoid Arthritis?

2018 ◽  
Vol 11 ◽  
pp. 117954411875968 ◽  
Author(s):  
Hanan Sayed M Abozaid ◽  
Reham Alaa El-din Hassan ◽  
Waleed A Elmadany ◽  
Mohamed Aly Ismail ◽  
Dalia S Elgendy ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Cervical Spine ◽  
Disease Onset ◽  
Neck Disability Index ◽  
Scoring Method ◽  
Cross Sectional ◽  
X Ray ◽  
Larsen Score ◽  
Hands And Feet ◽  
Cervical Involvement

Background: Cervical spine involvement in patients with rheumatoid arthritis (RA) can cause pain and disability, with a variety of neurologic signs and symptoms. Objectives: To investigate the relationship between structural cervical spine involvement in patients with RA with the age at disease onset and the degree of radiologic severity of RA measured by Larsen scoring. Patients and methods: This cross-sectional study included 50 adult patients with RA. Patients who complained or not complained from symptoms of cervical spine involvement in RA were included; we did X-ray of the cervical spine, hands, and feet; Larsen scoring method; disease activity score (DAS28); and Neck Disability Index. Results: The results revealed that patients with cervical involvement tend to be younger at their disease onset than those with no cervical involvement, as detected by cervical X-ray. The relation was significant P < .05 regarding all cervical involvements except for basilar invagination. Disease radiological severity (measured by Larsen score) significantly increases the risk for subaxial subluxation, P = .040. All other cervical complications of RA tend to have nonsignificant relation with disease severity. Using univariate binary regression analysis for risk factors for cervical involvement showed that the only probable risk factor for cervical involvement (detected by X-ray) in patients with RA is age at disease onset. Conclusions: The early age at disease onset tends to affect cervical spine involvement in patients with RA more than the disease radiological severity.

scholarly journals AB0148 CHARACTERISTICS OF RHEUMATOID ARTHRITIS PATIENTS WITH HIP INVOLVEMENT

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1101.2-1101
Author(s):  
H. Hajji ◽  
K. Maatallah ◽  
H. Ferjani ◽  
W. Triki ◽  
D. Ben Nessib ◽  
...  
Keyword(s):  
Rheumatoid Arthritis ◽  
Disease Activity ◽  
Disease Onset ◽  
Joint Space ◽  
Cross Sectional Study ◽  
Cross Sectional ◽  
Reactive Protein ◽  
Sharp Score ◽  
Significant Difference ◽  
Standard Radiographs

Background:Rheumatoid arthritis (RA) is an autoimmune inflammatory disease that affects both small and large joints. Hip involvement is an evolutionary turning point in RA and significantly alters the patient’s quality of life.Objectives:This study aimed to assess characteristics of RA patients with hip involvement.Methods:It was a cross-sectional study, including patients with RA (according to 2010 ACR/European League Against Rheumatism (EULAR) criteria).We divided patients into two groups: G0 patients without hip involvement, G1 patients with hip involvement. Hip involvement was defined with a limited movement during examination with abnormalities on standard radiographs. We collected the following data: age, the disease activity score (DAS28), the inflammatory biomarkers C-reactive protein (CRP) and Erythrocyte sedimentation rate (ESR), Rheumatoid Factor (RF), and Anti Citrullinated Peptides Antibodies (ACPA), and SHARP score (A scoring system used to assess the radiological changes in patients with RA. It describes erosions and narrowing of the joint space of 27 small joints of the hands, including the carpal bones and feet).Results:Among the 224 patients included, 25had hip involvement (11%). The male / female sex-ratio was higher in G1 (0.66 vs 0.22, p=0.017).Patients in G1 were younger at disease onset (44,16±16,11 years vs 51.9±13.9 years, p= 0.022) and had a longer disease duration (12,28 ± 11,49 years vs 6,2010 ± 6,45 years, p=0.02). They had also higher HAQ(1,7692 vs 1,3054, p=0.05).SHARP score was higher in G1 (176.32 vs. 106.88, p=0.011). Atlantoaxial subluxation was more common in G1 (32% vs 14%,p=0.035).When comparing the groups we did not find any significant difference regarding age (56.12 ± 11.88 years vs 58,24±12,26 years, p=0.341), disease activity (DAS28-ESR:5.41 vs. 5.65, p=0.380; DAS28-CRP: 5.19 vs. 5.51, p=0.290), ESR (53.88 vs. 46.95, p=0.237), CRP:23,8894 vs 22,89, p=0.975), and in the serological profile (RF; G1:68% vs G0: 70.8%, p=0.817, ACPA; G1: 60% vs G0:69%, p=0.366).Conclusion:Patients with hip involvement were commonly male, were younger at disease onset and had more functional impairment based on the HAQ score. C1-C2 dislocation wasalso more common in this group.The SHARP score was also significantly higher in G1, which shows a severe and destructive disease.Disclosure of Interests:None declared

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