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Hand function is already reduced before RA development and reflects subclinical tenosynovitis
Doortje Isabelle Krijbolder1, Sarah J H Khidir2, Xanthe M E Matthijssen2
1Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands d.i.krijbolder@lumc.nl.
RMD Open
|February 9, 2023
Summary
Hand function is often impaired in clinically suspect arthralgia (CSA) before rheumatoid arthritis (RA) develops. This is linked to underlying subclinical inflammation, particularly tenosynovitis.
Area of Science:
- Rheumatology
- Musculoskeletal Health
- Medical Imaging
Background:
- Clinically suspect arthralgia (CSA) is a precursor to rheumatoid arthritis (RA).
- The impact of CSA on hand function and its underlying mechanisms remain unclear.
- Investigating early functional changes in CSA is crucial for timely intervention.
Purpose of the Study:
- To assess hand function in patients with CSA.
- To identify the relationship between hand function deficits and subclinical inflammation in CSA.
- To validate findings in an independent cohort.
Main Methods:
- Evaluated grip strength (GS), patient-reported grip difficulties (Health Assessment Questionnaire), and fist closure in two CSA cohorts.
- Utilized contrast-enhanced MRI to quantify synovitis, tenosynovitis, and bone marrow edema (subclinical inflammation).
- Correlated hand function measures with MRI-detected inflammation.
Main Results:
- Reduced grip strength (75%), grip difficulties (60%), and incomplete fist closure (13%) were prevalent in CSA patients.
- Reduced GS was significantly associated with subclinical inflammation, especially tenosynovitis.
- Tenosynovitis correlated with grip difficulties and incomplete fist closure in both cohorts.
- Dynamometer-measured GS was most sensitive (75%) and incomplete fist closure most specific (88-90%) for detecting tenosynovitis.
Conclusions:
- Hand function deficits are common in CSA patients prior to RA diagnosis.
- Subclinical inflammation, particularly tenosynovitis, is a key factor contributing to impaired hand function in CSA.
- Early detection of hand dysfunction in CSA may help identify individuals at higher risk for RA.
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