Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands
Department of Rheumatology, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
RMD Open. 2023 Jun;9(2). doi: 10.1136/rmdopen-2023-003107.
It is unknown whether rheumatoid arthritis (RA) starts in hands or feet. To investigate this, we performed functional, clinical and imaging studies during progression from clinically suspect arthralgia (CSA) to RA. Additionally, we studied whether functional disabilities of hands/feet at CSA onset contribute to predicting RA development.
600 patients with CSA were followed for clinical inflammatory arthritis (IA) during median follow-up of 25 months, during which 99 developed IA. Functional disabilities were measured at baseline/4/12/24 months with the Health Assessment Questionnaire Disability Index (HAQ); HAQ items assessing hand disabilities and foot disabilities were selected. The course of disabilities towards IA development (here considered as t=0) was depicted by increasing incidences and analysed using linear mixed models. To evaluate robustness of findings, tender hand/foot joints and subclinical joint inflammation (measured with CE-1.5TMRI) of hand/foot were additionally studied. Associations between disabilities at CSA presentation (here t=0) and future IA development were studied using Cox regression in the total CSA population.
During IA development, hand disabilities occurred earlier and more frequently than foot disabilities. Despite both hand disabilities and foot disabilities rose significantly towards IA development, hand disabilities were more severe during this course (mean difference over time: 0.41 units, 95% CI 0.28 to 0.55, p<0.001, on a range 0-3). Similar to functional disabilities, tender joints and subclinical joint inflammation occurred earlier in the hands than feet. In the total CSA population, a single HAQ question on difficulties with dressing (hand functioning) was independently predictive for IA development: HR=2.2, 95% CI 1.4 to 3.5, p=0.001.
Evaluation of functional disabilities, supported by clinical and imaging findings, revealed that joint involvement starts predominantly in the hands during RA development. Additionally, a single question on dressing difficulties adds value to risk stratification in patients with CSA.
类风湿关节炎（RA）是从手部还是足部开始的目前尚不清楚。为了对此进行研究，我们在从临床疑似关节炎（CSA）发展为 RA 的过程中进行了功能、临床和影像学研究。此外，我们还研究了 CSA 发病时手部/足部的功能障碍是否有助于预测 RA 的发展。
600 例 CSA 患者在中位随访 25 个月期间接受了临床炎症性关节炎（IA）的随访，在此期间有 99 例发生了 IA。在基线/4/12/24 个月时使用健康评估问卷残疾指数（HAQ）测量功能障碍；选择评估手部和足部残疾的 HAQ 项目。使用线性混合模型分析向 IA 发展（此处视为 t=0）的残疾过程中，发病率的增加情况。为了评估研究结果的稳健性，还研究了手部/足部的压痛关节和亚临床关节炎症（使用 CE-1.5TMRI 测量）。在整个 CSA 人群中，使用 Cox 回归分析 CSA 发病时（此处 t=0）的残疾与未来 IA 发展之间的关系。
在 IA 发展过程中，手部功能障碍比足部功能障碍更早且更频繁地发生。尽管手部和足部功能障碍在向 IA 发展的过程中均显著增加，但在此过程中手部功能障碍更严重（随时间的平均差异：0.41 个单位，95%CI 0.28 至 0.55，p<0.001，范围为 0 至 3）。与功能障碍类似，压痛关节和亚临床关节炎症在手部的发生也早于足部。在整个 CSA 人群中，一项关于穿衣困难（手部功能）的 HAQ 单一问题独立预测 IA 发展：HR=2.2，95%CI 1.4 至 3.5，p=0.001。
通过功能评估、临床和影像学发现，评估关节受累情况表明，在 RA 发展过程中，关节受累主要从手部开始。此外，关于穿衣困难的单一问题可增加 CSA 患者的风险分层价值。
