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Difficulties making a fist in clinically suspect arthralgia: an easy applicable phenomenon predictive for RA that is related to flexor tenosynovitis
  1. Fenne Wouters1,
  2. Florus J van der Giesen1,
  3. Xanthe M E Matthijssen1,
  4. Ellis Niemantsverdriet1,
  5. Annette H M van der Helm-van Mil1,2
  1. 1 Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
  2. 2 Department of Rheumatology, Erasmus University Medical Center, Rotterdam, The Netherlands
  1. Correspondence to Fenne Wouters, Department of Rheumatology, Leiden University Medical Center, Leiden 2300 RC, The Netherlands; f.wouters{at}

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Difficulties making a fist in patients presenting with recent-onset arthralgia of small joints without clinically detectable arthritis is considered a risk factor for progression to inflammatory arthritis (IA) and rheumatoid arthritis (RA). This is also reflected by this sign being incorporated in the European League Against Rheumatism (EULAR) definition of arthralgia suspicious for progression to RA.1 However, to date, there is barely scientific evidence for its predictive value and little comprehension on the underlying mechanism in recent-onset arthralgia. We studied if difficulties making a fist is indeed predictive for the development of IA and RA, and whether this sign is associated with subclinical inflammation.

Patients presenting with recent-onset (<1 year) arthralgia of the small joints were consecutively included in the Leiden clinically suspect arthralgia (CSA) cohort.2 At baseline, the ability to completely close the fist (actively close the fist with all fingertips touching the palm) and fist strength (measured by a patient squeezing the assessor’s fingers) were determined (figure 1). It was determined by trained research nurses in all patients, and for reliability purposes also by rheumatologists in a subset of patients. Contrast-enhanced 1.5T MRI of the wrist and second to fifth metacarpophalangeal (MCP) joints was performed and …

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  • EN and AHMvdH-vM are joint senior authors.

  • Handling editor Josef S Smolen

  • Contributors FW, FJvdG, EN and AHMvdH-vM developed the study concept and design. FW and XMEM contributed to the data acquisition. FW performed data analyses. FW, EN and AHMvdH-vM wrote the first version of the manuscript. All authors critically reviewed the paper and approved the final manuscript.

  • Funding This work was supported by the European Research Council (ERC) under the European Union’s Horizon 2020 research and innovation programme (Starting grant, agreement No. 714312) and the Dutch Arthritis Society.

  • Competing interests None declared.

  • Patient consent for publication Obtained.

  • Ethics approval Ethical approval is provided by a Local Medical Ethics Committee, named ‘Commissie Medische Ethiek’.

  • Provenance and peer review Not commissioned; externally peer reviewed.