Article Text

Download PDFPDF
Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis
  1. Irina Gessl1,
  2. Mihaela Popescu2,
  3. Victoria Schimpl3,
  4. Gabriela Supp1,
  5. Thomas Deimel1,
  6. Martina Durechova1,
  7. Miriam Hucke4,
  8. Michaela Loiskandl1,
  9. Paul Studenic1,
  10. Michael Zauner1,
  11. Josef S Smolen1,
  12. Daniel Aletaha1,
  13. Peter Mandl1
  1. 1 Department of Rheumatology, Medical University of Vienna, Vienna, Austria
  2. 2 Department of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  3. 3 Department of Pediatric and Adolescent Medicine, Klinik Donaustadt, Vienna, Austria
  4. 4 Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Kärnten, Austria
  1. Correspondence to Dr Peter Mandl, Department of Rheumatology, Medical University of Vienna, Vienna 1090, Austria; peter.mandl{at}meduniwien.ac.at

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.

Statistics from Altmetric.com

Data availability statement

Data are available upon reasonable request. Deidentified, coded data will be made available from the corresponding author upon reasonable request.

View Full Text

Footnotes

  • Handling editor David S Pisetsky

  • Twitter @Stiddyo

  • Deceased 27.07.2019

  • 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.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.