Background/Purpose: The development of drug therapies for rheumatoid arthritis (RA), and control of synovitis has now become easier. However, once patients are relieved of pain, they become physically more active and sometimes overuse their joints. Such overuse can result in progression of joint deformity, joint destruction, and in some cases, tendon rupture. However, the actual situation of joint overuse in RA patients remains insufficiently recognized. Here we analyzed the clinical characteristics of such patients who had overused their joints.

Methods: In-depth history taking about joint overuse and physical examinations were performed prospectively for 3148 consecutive patients with RA who visited our outpatient department between August 2016 and October 2016. The patients who satisfied the following inclusion criteria were diagnosed as having joint overuse: (i) met the 2010 American College of Rheumatology/European League against Rheumatism criteria for RA, (ii) had experienced preceding events that exerted a strain on the joints, and (iii) had joint pain and/or swelling of the strained joints. Patients who were suspected of having other conditions such as infection, trauma, pseudogout, and gout were excluded. Among the patients, 41 (10 men and 31 women) were diagnosed as having joint overuse. The patients’ clinical features and laboratory data before they developed joint overuse were collected from their medical records. As comparative controls, we selected 123 age- and sex-matched contemporary patients with RA who had no joint overuse from among 3148 patients. Comparisons between the parameters at different time points were performed using the Friedman test, and a post hoc analysis was performed using the Wilcoxon signed-rank test with Holm correction. The data were expressed as median (interquartile range).

Results: Forty-one patients with a mean age of 62.0 years (range, 54.0–69.0 years) were diagnosed as having joint overuse. The different joints affected by overuse were the wrist (16), hand (thumb and fingers, n = 12), shoulder (4), knee (3), ankle (3), and forefoot (3). The reasons for overuse were occupational in 25 patients, housework in 10, hobbies in 5, and ceremonial occasions in 1. The clinical disease activity index at baseline was 5.00 (2.60–9.00), which increased to 9.00 (6.00–11.3) owing to overuse, and improved to 4.80 (2.20–9.00) at the next visit (p < 0.001 and p < 0.001, respectively). The 28-joint Disease Activity Score based on erythrocyte sedimentation rate, C-reactive protein, visual analog scale score for pain, and swollen joint count was also elevated transiently. Logistic regression analysis revealed that treatment with biological disease-modifying antirheumatic drugs (bDMARDs; odds ratio [OR], 3.28; 95% confidence interval [CI], 11.32–8.17), low health assessment questionnaire disability index (HAQ-DI; OR, 0.301; 95% CI, 0.11–0.85), and Steinbrocker stage III or IV (OR, 6.89; 95% CI, 2.57–18.5) were significantly associated with the development of joint overuse.

Conclusion: When patients with advanced RA have low HAQ-DI using bDMARDs, they are at risk of joint overuse. Appropriate education would be important for such patients to prevent the overuse.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/joint-overuse-in-patients-with-rheumatoid-arthritis/