Session Information
Session Type: ACR Poster Session C
Session Time: 9:00AM-11:00AM
Background/Purpose:
Patient-reported outcome has been considered as an important aspect in the evaluation of patients with rheumatoid arthritis (RA). Recently, ultrasonography (US) has been used as a valid and objective tool for joint assessment for both joint synovitis and tenosynovitis. Therefore, the objective of this study was to elucidate the clinical significance of self-reported joint pain and stiffness of each joint by examining the association of those subjective findings with US joint synovitis and tenosynovitis.
Methods:
A total of 40 patients with RA were enrolled in this study between October 2014 and June 2015. All the patients reported the presence of pain and/or stiffness in each joint of hands including bilateral interphalangeal (IP) joints of the thumb, proximal interphalangeal (PIP) joints, metacarpophalangeal (MCP) joints and wrist joints. They also received joint examination by rheumatologists for the presence of tenderness and swelling, and US joint examination for the presence of joint synovitis and tenosynovitis. The medical records were reviewed for the patient characteristics and laboratory data.
Results: The median age was 66.5 years and the median disease duration was 3.7 years. The median DAS28-ESR was 2.7. Thirty-two patients (80%) were seropositive for either rheumatoid factor or anti-cyclic citrullinated peptide antibody. Although joint pain and stiffness were similarly observed among IP/PIP, MCP and wrist joints (pain in 9-11% of joints and stiffness in 5-6% of joints), US joint synovitis was detected in 6% of IP/PIP joints, 16% of MCP joints and 38% of wrist joints, and US tenosynovitis in 2% of IP/PIP joints, 8% of MCP joints and 18% of wrist joints, respectively (Table 1). The concordance defined by κ value indicated poor correlation of subjective joint pain with US synovitis (κ=0.19) and tenosynovitis (κ=0.03), as well as joint stiffness with US synovitis (κ=0.13) and tenosynovitis (κ=-0.04), respectively, although joint swelling showed a moderate correlation with US synovitis (κ=0.43).
Conclusion:
Patient-reported joint symptoms, especially joint stiffness, were not sensitive enough, and they did not correlate well with US joint findings.
Table 1. The presence rate of clinical findings at each joint level.
|
|
Pain |
Stiffness |
Swelling |
US joint synovitis |
US tenosynovitis |
|
IP/PIP |
9% |
5% |
5% |
6% |
2% |
|
MCP |
10% |
6% |
7% |
16% |
8% |
|
Wrist |
11% |
5% |
20% |
38% |
18% |
|
Total |
9% |
5% |
7% |
13% |
6% |
To cite this abstract in AMA style:
Hirata A, Ogura T, Hayashi N, Takenaka S, Ito H, Mizushina K, Fujisawa Y, Imamura M, Yamashita N, Kameda H. Clinical Significance of Patient-Reported Pain and Stiffness at Each Joint Level in the Evaluation of Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/clinical-significance-of-patient-reported-pain-and-stiffness-at-each-joint-level-in-the-evaluation-of-patients-with-rheumatoid-arthritis/. Accessed .« Back to 2015 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/clinical-significance-of-patient-reported-pain-and-stiffness-at-each-joint-level-in-the-evaluation-of-patients-with-rheumatoid-arthritis/