Rydholm Maria, Wikström Ingegerd, Hagel Sofia, Jacobsson Lennart T H, Turesson Carl
Lund University and Skåne University Hospital, Malmö, Sweden.
Lund University and Skåne University Hospital, Lund, Sweden.
ACR Open Rheumatol. 2019 Aug 19;1(8):507-515. doi: 10.1002/acr2.11062. eCollection 2019 Oct.
The objective of this study is to identify early predictors of future reduced grip force in patients with rheumatoid arthritis (RA) and to identify early predictors of grip force over time.
In a structured follow-up of an inception cohort of patients with early RA, average grip force values of the dominant hand were evaluated and compared with the expected based on age- and sex-specific reference values. Potential predictors of reduced grip force (less than 50% of expected) at 5 years were examined using logistic regression. Differences in percentage of expected grip force values over the study period and differences in change over time, by baseline disease parameters, were estimated using mixed linear-effects models.
Among 200 patients with early RA, 44% had reduced grip force 5 years after diagnosis. Baseline characteristics that predicted reduced grip force at 5 years included high scores for the Health Assessment Questionnaire Disability Index (odds ratio 1.54 per SD; 95% confidence interval 1.13-2.11), high scores for pain and patient global assessment, and low grip force. C-reactive protein levels, the erythrocyte sedimentation rate, the 28-joint Disease Activity Score (DAS28), rheumatoid factor, anti-cyclic citrullinated peptide antibodies, joint counts, and synovitis of individual joints in the dominant upper extremity did not predict reduced grip force. Patients with baseline synovitis of the wrist or metacarpophalangeal joints or patients with a high DAS28 had lower estimated grip force at inclusion but also greater improvement of grip force over time.
Patient-reported outcomes predicted reduced grip strength 5 years after diagnosis. This underlines the prognostic importance of disability in early RA. Joint counts and synovitis in individual joints may change rapidly in early RA and appear to be less predictive of long-term hand function.
本研究的目的是确定类风湿关节炎（RA）患者未来握力降低的早期预测因素，并确定握力随时间变化的早期预测因素。
在对早期RA患者起始队列进行的结构化随访中，评估优势手的平均握力值，并与基于年龄和性别特异性参考值的预期值进行比较。使用逻辑回归分析5年时握力降低（低于预期的50%）的潜在预测因素。使用混合线性效应模型估计研究期间预期握力值百分比的差异以及按基线疾病参数随时间变化的差异。
在200例早期RA患者中，44%在诊断后5年握力降低。预测5年时握力降低的基线特征包括健康评估问卷残疾指数高分（每标准差优势比1.54；95%置信区间1.13 - 2.11）、疼痛和患者整体评估高分以及握力低。C反应蛋白水平、红细胞沉降率、28关节疾病活动评分（DAS28）、类风湿因子、抗环瓜氨酸肽抗体、关节计数以及优势上肢单个关节的滑膜炎均不能预测握力降低。腕关节或掌指关节有基线滑膜炎的患者或DAS28高的患者在纳入时握力估计值较低，但随着时间推移握力改善也更大。
患者报告的结局可预测诊断后5年握力降低。这突出了早期RA中残疾的预后重要性。早期RA中单个关节的关节计数和滑膜炎可能迅速变化，似乎对长期手部功能的预测性较小。
