Figure 1 - uploaded by Sytske Anne Bergstra
Content may be subject to copyright.
Distribution of swollen (fig. 1-A) and tender (fig. 1-B) joint involvement in Mexico, the Netherlands, India and South-Africa. Coloured circles indicate the percentage of patients with swelling or tenderness in the specific joint per country. White circles indicate that the joint is not included in the joint count.
Source publication
Background
Genetic and environmental risk factors for rheumatoid arthritis (RA) are population dependent and may affect disease expression. Therefore, we studied tender and swollen joint involvement in patients newly diagnosed with RA in four countries and performed a subanalysis within countries to assess whether the influence of autoantibody posi...
Similar publications
In time, osteoarthritis (OA) generates the misalignment of the affected joint structures. However, due to the nature of bipedal gait, OA in the lower limb can also cause pathological gait patterns, which can generate instability and falls, with great consequence, especially in the aged population. With goniometry used to evaluate the range of motio...
Zusammenfassung
Die Osteoarthrose ist die häufigste Ursache für den Hüftschmerz des Erwachsenen. Daher wird anderen Ursachen wie z. B. Entzündungen weniger Beachtung für den Gelenkschmerz in der Erstdiagnose geschenkt. Dieser Artikel gibt eine Übersicht von unterschiedlichen rheumatologischen Erkrankungen der Hüfte und deren Interpretation in der B...
Ultrasound is a uniquely valuable tool for evaluating musculoskeletal problems in the pediatric hand. Acute and chronic injuries involving tendons and ligaments of the hand can be quickly assessed and can guide surgical decision-making. Using ultrasound, palpable lesions and masses can be evaluated for cystic and solid components aiding in differen...
Introduction
Standardised scoring systems for rheumatoid arthritis (RA) joint disease activity include Larsen score for radiographs, rheumatoid arthritis magnetic resonance imaging score (RAMRIS) for MRI and using the European League Against Rheumatisms-Outcome Measures in Rheumatology (EULAR-OMERACT) score for ultrasound (US) images. The aim of th...
The rheumatoid arthritis is chronic disease with progressive course and deteriorations of joints as well as other organs. The pathogenesis of rheumatoid arthritis is characterized with chronic synovitis and inflammation. The main roles in development of rheumatoid arthritis have auto-reactive T cells and inflammatory cytokines, especially tumor nec...
Citations
... The elbow was the least frequently reported joint. The IAA group had somewhat higher proportions for the hand, shoulder, foot and wrist, consistent with the expected pattern of joint involvement for RA [32], the most frequently reported diagnosis in this group. Bringing the above data together, Table 2 provides odds ratios for the probability of OA and IAA vs DK. ...
Objective:
To understand differences between people with arthritis who do not know their type (DK) compared to those reporting osteoarthritis (OA) or inflammatory and autoimmune types of arthritis (IAA), including the receipt of appropriate health care, information, and services.
Methods:
Analysis of the Survey on Living with Chronic Disease in Canada-Arthritis Component. Respondents aged ≥20 years with health professional-diagnosed arthritis (n = 4,385) were characterized as reporting DK, OA or IAA. Variables: arthritis characteristics (duration, number and site of joints affected), arthritis impact (current pain and fatigue, difficulty in sleeping and daily activities, impact on life), health (self-rated general and mental health, life stress), arthritis management strategies (seeing health professionals, medication use, assistive devices, receipt of arthritis information, self-management activities). Multinomial logistic and log-Poisson regressions were used, as appropriate, to compare the DK to the OA and IAA groups.
Results:
In this arthritis sample, 44.2% were in the DK group, 38.3% reported OA and 17.5% reported IAA. Those in the DK group were more likely to be younger, have low income, low education, and be of non-white cultural background compared to those with OA. There were no significant differences in arthritis impact, but the DK group was less likely to have received information on, or have used, arthritis management strategies.
Conclusions:
The sociodemographic characteristics of the DK group suggest they likely have lower health literacy. They were less likely to have accessed health care and other support services, indicating this is an important group for health education, both for individuals with arthritis and health care providers.
... Several studies have reported the prevalence rates of affected joints throughout the body, including the small joints such as the metacarpophalangeal (MCP) and proximal interphalangeal (PIP) joints. Additionally, the large joints such as the knee, shoulder, elbow, or even ankle joints are also often affected (3)(4)(5). Therefore, treat-to-target strategy aims to evaluate disease status to make decisions regarding the treatment, and the disease status assessment tools consider joints throughout the body with scores of 28, 44, or 58 joints in Disease Activity Score (DAS), ACR core set, Simpli ed Disease Activity Index (SDAI), and Clinical Disease Activity Index (CDAI). ...
Background: Established assessment tools for patients with rheumatoid arthritis (RA), including disease activity scores (DASs), disease activity indices (DAIs), visual analog scales (VASs), and health assessment questionnaires (HAQs), are widely used. However, comparative associations between joint involvement and disease status assessment tools have rarely been investigated.
Methods: We included a dataset of 4016 patients from a large RA cohort from 2012 to 2019. The tenderness and swelling of each joint were counted as a symptom, with 70 and 68 affected joints throughout the body, respectively. The relative contribution of various joints to the disease status assessment tools, VAS scores, and functional disability indexes was analyzed using multiple regression analysis.
Results: Upper extremity joints contributed more than the lower extremity joints, except the knee, toward disease assessment. Additionally, larger joints contributed more than the smaller joints overall, but the metacarpophalangeal and proximal interphalangeal joints made significant contributions to DASs and DAIs. Further, the ankle played a minor but important role in most assessment tools, especially in HAQs.
Conclusions: Larger joints and the joints in the upper extremity contribute more to disease status, VAS score, and functional disability. However, each joint makes a unique contribution to these assessment tools.
... This was particularly evident for the wrist, but not for the TMJ, which could be due to the low number of patients for whom the TMJ was assessed or to the difficulties in the assessment of the swelling of this latter joint by the physician. Moreover, large geographical differences in joint assessments have previously been reported in the Measurement of Efficacy of Treatment in the Era of Outcome in Rheumatology (METEOR) study [50]. ...
Abstract Background Rheumatoid arthritis (RA) is a heterogeneous disease with established poor prognostic factors such as seropositivity, joint damage, and high disease activity at an early, treatment-naïve stage of disease. However, few studies have examined if specific joint locations are correlated with these factors in such a population. This analysis explored the potential correlation of individual swollen and erosive joints with other disease characteristics at baseline and with remission rates in a post-hoc analysis of the Phase III randomized AGREE study. Methods Methotrexate (MTX)-naïve, erosive, RF- and/or ACPA-positive early RA patients (N = 509) were retrospectively evaluated. Baseline joint swelling was analyzed for large and small joints. Baseline erosions were analyzed for wrist, MCP1–5, IP1, PIP2–5 and MTP1–5. Remission rates were assessed after 6 months of treatment with abatacept (ABA) + MTX (N = 256) or MTX (N = 253). The following statistical tests were used: Chi-Square or Fisher’s exact test (categorical variables); Student’s t-test or Wilcoxon rank-sum test (continuous variables); continuity-corrected Chi-square test (efficacy remission endpoints). Results Baseline swelling was most frequent in wrist (91.9%) and MCP2 joint (89.1%), while baseline erosion was most frequent in MTP5 joint (43.5%). Swollen shoulder was significantly correlated (p
... The distribution and prevalence of large joint disease assessed by clinical criteria at fixed time points has been provided by data from inception cohorts of early RA [1,5,6] and cross-sectional studies in established disease [3,7]. There is a paucity of information concerning the onset and time course of damage in large joints, such as shoulder, elbow, hip, knee and ankle, from early to established RA, or of the influence of rheumatoid factor (RF) status. ...
This study aimed to examine the progression of large joint involvement from early to established RA in terms of range of movement (ROM) and time to joint surgery, according to the presence of rheumatoid factor (RF). We used a historical longitudinal cohort of early RA patients. Patients were deemed RF negative if all repeated assessments were negative. The rate of progression from normal to any loss of range of movement (ROM) from years 3 to 14 were modelled using generalized estimating equations, for elbows, wrists, hips, knees and ankle, adjusting for confounders. Time to joint surgery was analysed using multivariable Cox models. A total of 1458 patients were included (66% female, mean age 55 years) and 74% were RF-positive. The prevalence of any loss of ROM, from year 3 through to 14 was highest in the wrist followed by ankle, knee, elbow and hip. Odds of loss of ROM increased over time in all joint regions assessed, at around 7-13% per year from year 3 to 14. Time to surgery was similar according to RF-status for the wrist and ankle, but RF-positive cases had a lower hazard of surgery at the elbow (HR 0.37, 0.15-0.90), hip (HR 0.69, 0.48-0.99) and after 10 years at the knee (HR 0.41, 0.25-0.68). Large joints become progressively involved in RA, most frequently affecting the wrist followed by ankle, which is overlooked in composite disease activity indices. RF-negative and positive cases progressed similarly. Treat-to-target approaches should be followed irrespective of RF status.
... Evaluation of joint distribution at RA presentation in two early arthritis cohorts from the Netherlands (n ¼ 947) and India (n ¼ 947) revealed the ankle to be recorded as swollen in 5-15% of cases, slightly more so in autoantibody negative cases in the Netherlands [25]. In a large series of 1000 RA patients from Sweden with established RA, median duration 10 years, 17% recalled involvement of the hindfoot/ankle at presentation [26]. ...
Ankle arthritis is a useful clinical signpost to differential diagnosis in rheumatic disease. Biomechanical features and differences in cartilage physiology compared with the knee may confer protection of the ankle joint from factors predisposing to certain arthritides. The prevalence of ankle OA is low, and usually secondary to trauma. Primary OA of the ankle should be investigated for underlying causes, especially haemochromatosis. New presentations of inflammatory mono/oligo arthritis involving the ankle are more likely due to undifferentiated arthritis or spondyloarthritis than RA, and gout over CPPD. The ankle is often involved in bacterial and viral causes of septic arthritis, especially bacterial, chikungunya and HIV infection, but rarely tuberculosis. Periarticular hind foot swelling can be confused with ankle arthritis, exemplified by Lofgren's syndrome and hypertrophic osteoarthropathy where swelling is due to subcutaneous oedema and osteitis respectively, and the ankle joint is rarely involved.
... Though effusion is unspecific and does not have to be a sign of arthritis, the prevalence found is certainly unexpectedly high. There is little evidence on the prevalence of elbow arthritis in RA [21]. Porter BB et al. [22] reported in 1974, an incidence of severe elbow joint disability by clinical examination in 225 RA patients of 25% in one or both upper limbs. ...
Objectives:
The prevalence of elbow joint arthritis in rheumatoid arthritis (RA) assessed by ultrasound has not yet been investigated.
Methods:
We investigated 102 patients with RA and 50 patients without rheumatological disease. Both elbow joints were examined by ultrasound for effusion, hypervascularization, and enthesitis. A clinical examination was performed, and Disease Activity Score in 28 joints (DAS28), and visual analog scale for pain (VASp) were recorded. Arthritis was defined as joint effusion (≥grade II) and synovial hyperperfusion.
Results:
The RA cohort versus the control group displayed a joint effusion in 54.9% vs. 6.9%, a hypervascularization in 6.8% vs. 0%. Arthritis was detected in 36 RA patients (35.29%) and no one in the control group. Four (3.8%) RA patients and one (1%) control displayed enthesitis. The RA cohort showed a significant correlation between movement restriction and joint effusion (p-value = 0.001) as well as DAS28 (p-value = 0.02) and between DAS28 and ultrasound detected arthritis (p-value = 0.022). In an overall analysis, a highly significant correlation of VASp with movement restriction (MR) (p-value ≤ 0.001), the presence of joint effusion (p-value ≤ 0.001), and the diagnosis of RA (p-value ≤ 0.001) were observed. Interrater analysis of ultrasound imaging showed good agreement with Cohen's kappa of 0.896.
Conclusion:
The prevalence of elbow arthritis in RA seems to be high, with 35.29%. Movement restriction is a good indicator, but not in all RA patients (32 vs. 70 patients without MR) compared to the control group (5 vs. 45 patients without MR). Reported pain correlates with joint effusion and MR (p-value ≤ 0.001).
Rheumatoid arthritis (RA) is a systemic autoimmune disease that predominantly affects the joints. The prevalence of RA varies globally, with generally a higher prevalence in industrialized countries, which may be explained by exposures to environmental risk factors, but also by genetic factors, differing demographics and under-reporting in other parts of the world. Over the past three decades, strong trends of the declining severity of RA probably reflect changes in treatment paradigms and overall better management of the disease. Other trends include increasing RA prevalence. Common risk factors for RA include both modifiable lifestyle-associated variables and non-modifiable features, such as genetics and sex. A better understanding of the natural history of RA, and of the factors that contribute to the development of RA in specific populations, might lead to the introduction of specific prevention strategies for this debilitating disease.
Rheumatoid arthritis (RA) is a chronic autoimmune disease characterised by symmetric inflammatory polyarthritis. However, RA limited to a single joint is extremely rare. Here, we report a middle-aged woman who presented with insidious right elbow arthritis. She had no other peripheral joint pain, tenderness or swelling. She had high-positive anti-cyclic citrullinated peptide antibodies. An MRI of the right elbow showed capsular distension, joint effusion and bone marrow oedema. Synovial biopsy revealed hyperplasia with lymphoplasmacytic infiltrate consistent with RA. Therapy with methotrexate 7.5 mg orally weekly was effective to control her inflammatory arthritis. This case highlights the relevance of synovial tissue analysis for patients presenting with chronic inflammatory monarthritis when the cause is not clinically evident, and the importance of considering RA even in the absence of polyarticular involvement. Delayed diagnosis and treatment of inflammatory monarthritis can lead to joint destruction and disability.
ZUSAMMENFASSUNG
In der Vergangenheit wurde der endoprothetische Ersatz des Handgelenkes nahezu ausschließlich bei älteren, „low-demand“ Patienten und bestehender rheumatoider Arthritis durchgeführt. Ein jüngeres Lebensalter, insbesondere im Zusammenhang mit einer posttraumatischen Arthrose gilt z. T. immer noch als Kontraindikation. Dieses Dogma hat sich inzwischen mit den guten mittelfristigen Erfahrungen im Umgang mit der 4. Prothesengeneration deutlich geändert. Für die derzeit verfügbaren Implantate werden Standzeiten von 86 % nach 10 Jahren (Motec) 1, 78 % über 15 Jahre (Universal 2) 2, oder 94 % für 8 Jahre (ReMotion) berichtet 3. Hierbei ließen sich auch für die vermeintlich schwierigere Klientel der Jüngeren ein zuverlässiger Erhalt eines für die täglichen Dinge ausreichenden Bewegungsumfanges, eine zuverlässige Schmerzbefreiung und ein Zugewinn für die Griffstärke darstellen. Alternativ garantiert auch die Arthrodese des Handgelenkes keineswegs immer eine hohe Patientenzufriedenheit und niedrige Komplikationsrate. Dennoch reichen die bisherigen Publikationen, insbesondere aufgrund ihrer geringen Fallstärke, weiterhin nicht aus, um den künstlichen Handgelenkersatz über die Anwendung in wenigen Spezialzentren hinaus generell empfehlen zu können. Weiterhin lässt sich nicht beantworten, warum diesbezüglich die OP-Frequenz im Widerspruch zu den deutlich verbesserten Ergebnissen eher wieder abzunehmen scheint 4.
First-degree relatives (FDR) of patients with rheumatoid arthritis (RA) have a higher risk for the development of RA. In the stages prior to the development of arthritis, nonspecific musculoskeletal (MSK) manifestations may occur. The aim of the study is to describe the frequency of rheumatic regional pain syndromes (RRPS) in FDR of RA patients. A cross-sectional study was carried out from July 2016 to September 2018. Parents, offspring, and siblings of RA patients completed the Community Oriented Program in the Rheumatic Diseases (COPCORD) questionnaire. Rheumatoid factor (RF) IgG, IgM, and IgA; anticitrullinated peptide antibodies (ACPAs); C-reactive protein (CRP); and erythrocyte sedimentation rate (ESR) were determined. All subjects with a positive COPCORD (defined by the presence of musculoskeletal pain) were evaluated and classified. Three hundred thirty-five FDRs participated, 75.8% were female, mean age of 44.15 years; 138 (41.2%) were diagnosed with at least one RRPS; 72 (21.5%) had rotator cuff tendinitis, 51 (15.2%) pes anserine bursitis, and 39 (11.6) lateral epicondylitis; RA was diagnosed in 24 (7.16%) subjects, undifferentiated arthritis (UA) in 30 (8.9%) and inflammatory arthralgia (AI) in 104 (31%). We found anti-CCP positivity in 6.8%, RF IgA in 22.3%, RF IgM in 48.6%, and RF IgG in 8.9%. The presence of RRPS was higher in this RA-FDR group compared to general population. Clinical evaluation of this risk group should include screening for RRPS.
Key Points
• The frequency of rheumatic regional pain syndromes in first-degree relatives of patients with rheumatoid arthritis was 41%.
• Rotator cuff tendinitis was detected in 21.5%, higher than reported in the Mexican population.
• The presence of RRPS in this risk group could be considered as one of the first manifestations of RA.
