Date: Sunday, October 21, 2018
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Distal interphalangeal (DIP) joint arthropathy is characteristic of both psoriatic arthritis and osteoarthritis, but it has long been pointed out that DIP joints can also be affected in rheumatoid arthritis (RA) since the report by McCarty et al. (Arthritis Rheum 9(2):325,1966). However, the clinical significance of DIP joint involvement in RA has yet to be elucidated in detail. The aim of this study was to examine the frequency of DIP joint involvement in RA, and its relationship with RA disease activity, using the National Database of Rheumatic Diseases in Japan (NinJa).
Methods: We used data of patients with adult-onset RA registered in NinJa in 2016 whose affected joint distribution data were available (n=12413). The relationship between DIP joint involvement and age, sex, age at RA onset, disease duration, stage, class, pain visual analog scale (VAS) score, tender joint count (TJC), swollen joint count (SJC), disease activity scorein 28 joints-C-reactive protein level (DAS28-CRP), modified Health Assessment Questionnaire (mHAQ), rheumatoid factor, and anti-cyclic citrullinated peptide (anti-CCP) antibody were analyzed.
Results: The number of RA patients who presented with DIP joint involvement (tenderness or swelling in the second to fourth DIP joints) was 257 (2.0%). The number (mean ±standard deviation) of affected DIP joints was 2.6 ±2.3 with median of 1. DIP involvement was not related to age, age at RA onset, disease duration, stage III-IV, class 3-4, mHAQ, presence of rheumatoid factor or that of anti-CCP antibody. On the other hand, DIP involvement was significantly more frequent in women than in men (91.0% versus 80.1%, p<0.01). Furthermore, pain VAS, TJC, SJC, and DAS28-CRP were significantly higher in RA patients with DIP involvement than in those without it, indicating the association of DIP involvement with high RA disease activity. Categorizing RA disease activity based on DAS28-CRP scores also revealed that DIP involvement was significantly associated with higher frequency of moderate and high disease activity and with lower frequency of remission status. Regarding the involvement of other joints in the hand, the number of affected DIP joints was significantly correlated with those of the proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints with correlation coefficients of 0.24 and 0.14, respectively (p<0.01).
Conclusion: We have demonstrated that DIP involvement was significantly associated with high disease activity in RA. It would thus be necessary to pay more attention to DIP joint involvement, albeit being observed infrequently, when evaluating disease activity in RA patients.
To cite this abstract in AMA style:Sawada T, Nishiyama S, Tago M, Tahara K, Kato E, Mori H, Hayashi H, Matsui T, Nishino J, Tohma S. Distal Interphalangeal Joint Involvement and Its Association with Disease Activity in Rheumatoid Arthritis (RA): Analysis Based on a Nationwide RA Database in Japan [abstract]. Arthritis Rheumatol. 2018; 70 (suppl 10). https://acrabstracts.org/abstract/distal-interphalangeal-joint-involvement-and-its-association-with-disease-activity-in-rheumatoid-arthritis-ra-analysis-based-on-a-nationwide-ra-database-in-japan/. Accessed July 18, 2019.
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