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Tenderness and radiographic progression in rheumatoid arthritis and psoriatic arthritis
  1. Irina Gessl1,
  2. Claudia A Hana1,
  3. Thomas Deimel1,
  4. Martina Durechova1,
  5. Miriam Hucke2,
  6. Victoria Konzett1,
  7. Mihaela Popescu3,
  8. Paul Studenic1,4,
  9. Gabriela Supp1,
  10. Michael Zauner1,
  11. Josef S Smolen1,
  12. Daniel Aletaha1,
  13. Peter Mandl1
  1. 1Departement of Rheumatology, Medical University of Vienna, Vienna, Austria
  2. 2Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Austria
  3. 3Department of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
  4. 4Department of Medicine (Solna), Division of Rheumatology, Karolinska Institute, Stockholm, Sweden
  1. Correspondence to Dr Peter Mandl, Internal Medicine 3; Division of Rheumatology, Medical University of Vienna, Wien, 1090, Austria; peter.mandl{at}meduniwien.ac.at

Abstract

Objective The aim of this study was to assess the predictive value of tenderness in the absence of swelling with consideration of other potential risk factors for subsequent radiographic progression in rheumatoid arthritis (RA) and psoriatic arthritis (PsA).

Methods Clinical and sonographic (grey scale and power Doppler (PD)) examination of 22 joints of the hand were performed in patients with RA and PsA. The impact of tenderness on progression after 2 years was analysed in non-swollen joints for RA and PsA separately with multilevel mixed logistic regression analysis.

Results We included 1207 joints in 55 patients with RA and 352 joints in 18 patients with PsA. In RA, tenderness was associated with radiographic progression after 2 years (model 2: OR 1.85 (95% CI 1.01 to 3.27), p=0.047), although the association of PD (OR 2.92 (95% CI 1.71 to 5.00), p<0.001) and erosions (OR 4.74 (95% CI 2.44 to 9.23), p<0.001) with subsequent structural damage was stronger. In PsA, we found a positive but not significant association between tenderness and radiographic progression (OR 1.72 (95% CI 0.71 to 4.17), p=0.23). In contrast, similarly to RA, erosions (OR 4.62 (95% CI 1.29 to 16.54), p=0.019) and PD (OR 3.30 (95% CI 1.13 to 9.53), p=0.029) had a marked effect on subsequent structural damage.

Conclusion Our findings imply that tenderness in non-swollen joints in RA is associated with subsequent damage. In both diseases, additional risk factors, such as sonographic signs for synovitis and baseline radiographic damage are associated with radiographic progression.

  • Arthritis, Psoriatic
  • Arthritis, Rheumatoid
  • Ultrasonography

Data availability statement

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

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  • Handling editor Kimme L Hyrich

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  • Contributors IG: 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. CH: Substantial contributions to the analysis or interpretation of data. Drafting the work or revising it critically for important intellectual content. TD: 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. 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. VK: Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. MP: 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. GS: Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. MZ: Substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. JSS: Drafting the work or revising it critically for important intellectual content. DA: Drafting the work or revising it critically for important intellectual content. PM: Drafting the work or revising it critically for important intellectual content and final approval of the version published. PM is guarantor for the study.

  • 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 JSS is Editorial Board Member (Editor-in-Chief), the other authors have no competing interests to declare.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

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

  • 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.