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Abstract
Objectives To determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.
Methods Patients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis.
Results In total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04).
Conclusion Tenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.
- arthritis
- rheumatoid
- ultrasonography
- arthritis
- psoriatic
- osteoarthritis
- outcome assessment
- health care
Data availability statement
Data are available upon reasonable request. Deidentified, coded data will be made available from the corresponding author upon reasonable request.
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Data availability statement
Data are available upon reasonable request. Deidentified, coded data will be made available from the corresponding author upon reasonable request.
Footnotes
Handling editor David S Pisetsky
Twitter @Stiddyo
Deceased 27.07.2019
Correction notice This article has been corrected since it published Online First. The provenance and peer review statement has been included.
Contributors GI: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data, drafting the work or revising it critically for important intellectual content. MP: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. VS: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. GS: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. TD: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. MD: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. MH: drafting the work or revising it critically for important intellectual content. ML: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. PS: drafting the work or revising it critically for important intellectual content. MZ, JSS: drafting the work or revising it critically for important intellectual content. DA: substantial contributions to the conception or design of the work, drafting the work or revising it critically for important intellectual content. PM: substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data, drafting the work or revising it critically for important intellectual content, final approval of the version published, agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.
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