Rheumatology, LUMC, Leiden, The Netherlands.
Rheumatology, LUMC, Leiden, The Netherlands
RMD Open. 2024 Apr 9;10(2):e003895. doi: 10.1136/rmdopen-2023-003895.
Rheumatoid arthritis (RA) mainly affects small joints. Despite the mechanical function of joints, the role of mechanical stress in the development of arthritis is insufficiently understood. We hypothesised that mechanical stress/physical strain is a risk factor for joint inflammation in RA. Therefore, we studied work-related physical strain in subjects with clinically suspected arthralgia (CSA) as a risk factor for the presence of imaging-detected subclinical joint inflammation and the development of clinical arthritis/RA.
In 501 CSA patients and 155 symptom-free persons' occupation-related physical strain was quantified using the International Standard Classification of Occupations. Contrast-enhanced hand-MRIs were made and evaluated for joint inflammation (sum of synovitis/tenosynovitis/osteitis). CSA patients were followed on RA development. Age relationship was studied using an interaction term of physical strain with age.
The degree of physical strain in CSA is associated with the severity of joint inflammation, independent of educational-level/BMI/smoking (interaction physical strain-age p=0.007; indicating a stronger association with increasing age). Physical strain is associated with higher tenosynovitis scores, in particular. In symptom-free persons, physical strain was not associated with imaging-detected joint inflammation. Higher degrees of physical strain also associated with higher risks for RA development in an age-dependent manner (HR=1.20 (1.06-1.37)/10-year increase in age), independent of educational-level/BMI/smoking. This association was partly mediated by an effect via subclinical joint inflammation.
Work-related physical strain increases the risk of subclinical joint inflammation and of developing RA. The age relationship suggests an effect of long-term stress or that tenosynovium is more sensitive to stress at older age. Together, the data indicate that mechanical stress contributes to the development of arthritis in RA.
类风湿关节炎（RA）主要影响小关节。尽管关节具有机械功能，但机械应激在关节炎发展中的作用尚未得到充分理解。我们假设机械应激/物理应变是 RA 关节炎症的危险因素。因此，我们研究了临床疑似关节炎（CSA）患者的与工作相关的物理应变，作为影像学检测到的亚临床关节炎症存在和临床关节炎/RA 发展的危险因素。
在 501 例 CSA 患者和 155 例无症状者中，使用国际职业分类标准量化职业相关的物理应变。进行对比增强手部 MRI 并评估关节炎症（滑膜炎/腱鞘炎/骨炎总和）。对 CSA 患者进行 RA 发展的随访。使用物理应变与年龄的交互项研究年龄关系。
CSA 患者的物理应变程度与关节炎症的严重程度相关，与教育程度/体重指数/吸烟无关（物理应变-年龄交互项 p=0.007；表明与年龄增加的关联更强）。物理应变与更高的腱鞘炎评分相关，尤其是在无症状者中，物理应变与影像学检测到的关节炎症无关。更高程度的物理应变也与 RA 发展的风险呈年龄依赖性增加相关（HR=1.20（1.06-1.37）/每增加 10 岁），与教育程度/体重指数/吸烟无关。这种关联部分通过亚临床关节炎症的影响而介导。
与工作相关的物理应变增加了亚临床关节炎症和发展为 RA 的风险。年龄关系表明，长期应激或腱膜在老年时对应激更敏感的影响。总的来说，这些数据表明机械应激有助于 RA 关节炎的发展。
