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Abstract Number: 1549

Joint Damage and Malalignment Determine Articular Tenderness More Than Inflammation in Rheumatoid Arthritis, Psoriatic Arthritis or Osteoarthritis in Established Disease

Mihaela Popescu1, Victoria Schimpl2, Gabriela Supp3, Martina Durechova3, Paul Studenic3, Michael Zauner3, Josef Smolen3, Daniel Aletaha4, Peter Mandl3 and Irina Gessl3, 1Hôpital Maisonneuve-Rosemont, Montreal, Canada, 2Medical University of Vienna, Vienna, Austria, 3Division of Rheumatology, Department of Medicine III, Medical University of Vienna, Vienna, Austria, 4Division of Rheumatology, Department of Medicine III, Medical University of Vienna,, Vienna, Austria

Meeting: ACR Convergence 2020

Keywords: Disease Activity, Osteoarthritis, Psoriatic arthritis, rheumatoid arthritis, Ultrasound

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Session Information

Date: Monday, November 9, 2020

Session Title: Imaging of Rheumatic Diseases Poster

Session Type: Poster Session D

Session Time: 9:00AM-11:00AM

Background/Purpose: 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).

Methods: Patients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Gray scale signs of synovitis (GS) and Power Doppler signal (PD) were evaluated using a semiquantitative grading system. Radiographs of the hands were scored for erosions, joint space narrowing, osteophytes and malalignment and a binary damage score was calculated. Differences in PD and GS between tender non-swollen (TNS) vs. non-tender non-swollen joints (NTNS) were calculated by Chi-Square test and prediction of tenderness was assessed by sex- and age-adjusted binary logistic regression analysis.

Results: There was no difference in the frequency of PD positivity between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96) (Fig. 1). However, PD had a significant impact on tenderness in non-swollen joints in patients with a disease duration of less than 2 years, both in RA (OR 2.22, 95%CI 1.12-4.43, p=0.02) and in PsA (OR 3.26, 95%CI 1.21-8.81, p=0.02). The radiographic damage score had a significant impact on tenderness in non-swollen joints in RA (OR 1.8, 95%CI 1.17-2.86, p< 0.01), PsA (OR 1.84, 95%CI 1.18-2.86; p< 0.01) and OA (OR 1.89, 95%CI 1.03-3.46; p=0.04) (Fig. 2).

Conclusion: Tenderness might not always be a sign of active inflammation in RA, PsA and OA. While inflammation may play a role in early disease, tenderness in established disease may be better explained by joint damage and malalignment.

Figure 1. Difference of damage score (0 vs. ≥1) in patients with rheumatoid arthritis (RA), psoriatic arthritis (PsA) and osteoarthritis (OA).

Figure 2. Difference of detected erosions (0 vs. ≥1), joint space narrowing (0 vs. ≥1), malalignment (presence/ absence), osteophytes (presence/ absence) and damage score (0 vs. ≥1) in patients with rheumatoid arthritis (A), psoriatic arthritis (B) and osteoarthritis (C). Impact of erosions (semiquantitatively), joint space narrowing (semiquantitatively), malalignment, osteophytes and damage score on tenderness in non-swollen joints was calculated by age- and sex-adjusted binary logistic regression.


Disclosure: M. Popescu, None; V. Schimpl, None; G. Supp, None; M. Durechova, None; P. Studenic, None; M. Zauner, None; J. Smolen, AbbVie, 2, 5, 8, AstraZeneca, 2, 5, 8, Eli Lilly, 2, 5, 8, Celgene, 5, 8, Celltrion, 5, 8, Chugai, 5, 8, Gilead, 5, 8, ILTOO, 5, 8, Janssen, 5, 8, Kabi, 5, 8, Novartis-Sandoz, 5, 8, Pfizer Inc, 5, 8, Samsung, 5, 8, Sanofi, 5, 8; D. Aletaha, UCB, 5, 8, Eli Lilly, 5, 8, Gilead Sciences, Inc., 2, 5, Janssen, 5, Sanofi/Genzyme, 5, 8, AbbVie, 2, 5, 8, Amgen, 5, 8, Novartis, 2, 5, 8, Pfizer, 5, 8, Roche, 2, 5, 8, Merck Sharp & Dohme, 2, 5, 8, Bristol-Myers Squibb, 8, Celgene, 5, 8, Medac, 5, 8, Sandoz, 5, 8; P. Mandl, AbbVie, 9, BMS, 9, Chugai, 9, MSD, 9, Janssen, 9, Lilly, 9, Novartis, 9, Pfizer, 9, Roche, 9; I. Gessl, Sobi, 9.

To cite this abstract in AMA style:

Popescu M, Schimpl V, Supp G, Durechova M, Studenic P, Zauner M, Smolen J, Aletaha D, Mandl P, Gessl I. Joint Damage and Malalignment Determine Articular Tenderness More Than Inflammation in Rheumatoid Arthritis, Psoriatic Arthritis or Osteoarthritis in Established Disease [abstract]. Arthritis Rheumatol. 2020; 72 (suppl 10). https://acrabstracts.org/abstract/joint-damage-and-malalignment-determine-articular-tenderness-more-than-inflammation-in-rheumatoid-arthritis-psoriatic-arthritis-or-osteoarthritis-in-established-disease/. Accessed May 17, 2022.
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