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Abstract Number: 1345

Tender Joints Have Low Associations with Patient’s Evaluation of Joint Pain and Ultrasound Findings Explored at Joint Level in Patients with Rheumatoid Arthritis

Hilde B Hammer1, Joseph Sexton1, Sella A. Provan2, Brigitte Michelsen3,4 and Tore Kvien5, 1Dept. of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 2Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 3Rheumatology, Hospital of Southern Norway trust, Kristiansand, Norway, 4Rheumatology, Diakonhjemmet Hospital, Oslo, Norway, 5Diakonhjemmet Hospital, Oslo, Norway

Meeting: 2017 ACR/ARHP Annual Meeting

Date of first publication: September 18, 2017

Keywords: pain, rheumatoid arthritis (RA) and ultrasound

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Session Information

Date: Monday, November 6, 2017

Session Title: Rheumatoid Arthritis – Clinical Aspects Poster II: Pathophysiology, Autoantibodies, and Disease Activity Measures

Session Type: ACR Poster Session B

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

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.

Spearman correlations for sum scores

Sum score PRJP

Sum tender joints

Sum swollen joints

Sum US GS

Sum tender joints

0.54**

Sum swollen joints

0.32**

0.21*

Sum US GS

0.26**

0.03

0.69**

Sum US PD

0.26**

-0.1

0.64**

0.88**

Cohens kappa values on joint level (Standard error) (all joints, n=5568)

Swollen

Tender

PRJP

US GS

Tender

0.32 (0.02)

PRJP

0.25 (0.02)

0.34 (0.02)

US GS

0.57 (0.02)

0.21 (0.02)

0.23 (0.02)

US PD

0.56 (0.01)

0.20 (0.02)

0.25 (0.02)

0.74 (0.01)


Disclosure: H. B. Hammer, AbbVie Norway, 2,Abbvie, 8,Novartis Pharmaceutical Corporation, 5,Pfizer Inc, 8,Roche Pharmaceuticals, 8; J. Sexton, None; S. A. Provan, None; B. Michelsen, None; T. Kvien, AbbVie, Biogen, BMS, Celltrion, Eli Lilly and Company, Janssen, Merck-Serono, MSD, NOvartis, Oktal, Orion Pharma, Hospira/Pfizer, Riche, Samsung, Sandoz, UCB, 5.

To cite this abstract in AMA style:

Hammer HB, Sexton J, Provan SA, Michelsen B, Kvien T. Tender Joints Have Low Associations with Patient’s Evaluation of Joint Pain and Ultrasound Findings Explored at Joint Level in Patients with Rheumatoid Arthritis [abstract]. Arthritis Rheumatol. 2017; 69 (suppl 10). 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/. Accessed March 23, 2023.
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