Background/Purpose:

In patients with rheumatoid arthritis (RA) the pain experience in joints with different degrees of joint inflammation is highly individual and dependent upon the pain threshold. The composite scores all include tender joints as an approximation of disease activity. Ultrasonography (US) is sensitive for assessment of joint inflammation (synovitis (grey scale, GS) and vascularization (power Doppler, PD)). The present objective was to cross-sectionally explore the associations at joint level between joint pain experienced by the patient, presence of pain by external pressure (tender joint), presence of joint swelling and the degree of US pathology.

Methods:
174 patients with established RA (mean (SD) age 52 (13) years, disease duration 10 (8) years, 82% women, 79% anti-CCP positive, 80% on DMARDs (MTX in 74%) and 55.2% on prednisolone (mean (SD) dosage of 4.5 (5.8) mg) were assessed before initiating bDMARD treatment. The presence of patient reported joint pain (PRJP) was assessed at joint level by use of a manikin including 32 joints (bilateral wrist, MCP1-5, PIP2-3, elbow, knee, ankle, MTP1-5). Each joint was scored 0-3 reflecting the level of spontaneous joint pain the last day. The same 32 joints were scored 0-3 for US pathology (GS and PD). An experienced study nurse assessed the presence of tenderness and swelling (MTP1-5 scored as one joint). Correlations of sum scores (PRJP, GS, PD and tender/swollen joints) were assessed by use of Spearman. Associations at joint level was explored using Cohens kappa, with transforming semi-quantitative scores to categorical (PRJP: 0=0, 1-3=1; US GS 0-1=0 (as score 1 may also be seen in healthy joints), 2-3=1; US PD 0=0, 1-3=1).

Results:

Correlations between sum scores showed moderate to high correlations between PRJP and tender joints as well as between swollen joints and US GS/PD (table1, *=p<0.05, **=p<0.001). At joint level, the associations between PRJP, tender and swollen joints were low, while US (GS/PD) had strong associations with swollen joints (table 2).

Conclusion:

Sum scores of tender joints and PRJP were correlated, but they had low or none associations with sum scores of swollen joints and GS/PD. On the other hand, there were high correlations between sum scores of swollen joints and US. At joint level, there were surprisingly low association between tender joints and PRJP. In addition, tender joints had low associations with swollen joints and GS/PD US findings. However, also at joint level, swollen joints and US findings were associated. The present findings raise questions regarding the prominent role of tender joints in composite disease activity measures for RA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/tender-joints-have-low-associations-with-patients-evaluation-of-joint-pain-and-ultrasound-findings-explored-at-joint-level-in-patients-with-rheumatoid-arthritis/