Background/Purpose: Few studies of which joints most affect physical function in rheumatoid arthritis (RA) patients have been conducted. The present study investigated the effect of bilateral and unilateral disease in the shoulder, elbow, wrist, hip, knee, ankle, finger, and toe joints on Modified Health Assessment Questionnaire (MHAQ) scores using the National Database of Rheumatic Diseases by iR-net in Japan (NinJa), a multicenter, rheumatic disease database.

Methods: The subjects were the 9,212 patients (1,766 men, 7,466 women) with complete medical records among the 10,367 patients registered in NinJa in 2011. The presence or absence of disease in each joint (swelling and pain were considered as disease) and whether the disease was bilateral or unilateral were investigated. At least one metacarpophalangeal joint or proximal interphalangeal joint were considered as finger and toe joint’s disease. The correlations between bilateral and unilateral disease of each joint and MHAQ scores were investigated using logistic regression analysis.

Results:

Patients were aged 63.2±12.9 years and their duration of symptoms was 12.2±10.7　years. The majority of subjects had moderate disease activity (mean baseline 28-joint Disease Activity Score, 3.3±1.3). The MHAQ scores median were 0.25. The 2 most frequently affected joints were the finger joints (42.2%) and wrist (36.6%) joint, followed by the knee (21.2%), ankle (20.9%), toe joints (18.7%), elbow (17.8%), shoulder (11.5%). In contrast, the frequencies of hip joint involvements were small (2.0%). Significant correlations were observed between the MHAQ scores and bilateral and unilateral disease of all joints apart from bilateral disease of the hip and bilateral and unilateral disease of the toes. The odds ratio for each joint (95% confidence interval) bilaterally and unilaterally, respectively, were as follows: shoulder, 4.0 (2.9 to 5.6) and 1.8 (1.5 to 2.1) ; elbow, 2.6 (2.1 to 3.4) and 1.8 (1.5 to 2.1); wrist, 1.9 (1.7 to 2.2) and 1.5 (1.3 to 1.7); hip, 1.7 (0.7 to 4.7) and 3.0 (2.0 to 4.7) ; knee, 2.6 (2.2 to 3.2) and 1.9 (1.7 to 2.2) ; ankle, 2.3 (1.9 to 3.0) and 2.0 (1.8 to 2.4) ; finger, 1.4 (1.2 to 1.5) and 1.2 (1.0 to 1.3) ; and toe, 1.0 (0.8 to 1.3) and 1.1 (0.9 to1.3). Regarding the odds ratio, an integer score was assigned to each identified risk factor as follows: each joint (bilaterally/unilaterally) points, shoulder (4/2); elbow(3/2); wrist(2/2); finger(1/1); hip(0/3); knee(3/2); ankle(2/2). The total risk scores for each patient ranged from 0 to 18. The results of the ROC analysis were as follows: cut-off value, 3 points; area under the ROC curve, 0.709; sensitivity 58.6%; and specificity, 72.8%.

Conclusion: While MHAQ scores were significantly affected by disease in almost all joints, a greater effect was exerted by the major joints, in increasing order of ankle, knee, elbow and shoulder. Bilateral disease tended to have a greater effect than unilateral disease in these major joints and the wrist

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-effects-of-disease-of-the-joints-on-modified-health-assessment-questionnaire-scores-in-rheumatoid-arthritis-patients-a-retrospective-study-using-the-national-database-of-rheumatic-diseases-by-ir/