ObjectivesTo 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) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04).ConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.
BackgroundIn inflammatory joint diseases, joint swelling is regarded as a sign of inflammation, which is associated with structural progression [1-3]. However, the significance of tenderness without swelling is unclear.ObjectivesTo 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)Methods36/24/30 patients respectively with RA, OA and PsA were included in the study. Each patient underwent clinical examination, followed by an ultrasound examination of bilateral MCP 1-5 (metacarpophalangeal), PIP 1-5 (proximal interphalangeal) joint and wrists; the sonographer was blinded to clinical data. On clinical examination synovial swelling and tenderness were evaluated using a binary scoring method, and tender, non-swollen joints (TNS) were identified. Grey-scale signs of synovitis (GS) and Power Doppler signal (PD) were evaluated using a semiquantitative grading system.Differences of PD signals between groups (RA vs. OA, RA vs. PsA, TNS vs. non-tender non-swollen joints) were calculated by Chi-Square test. Furthermore, joints of RA and PsA patients were tracked back for up to 6 years to identify the time point of the last swelling of that respective joint. Kaplan-Meier estimates for the occurrence of the last time point of swelling were compared between PD positive and PD negative TNS joints.ResultsTNS joints more often showed PD signal in RA patients as compared to those with OA and PsA (18.7% vs. 11.5% vs. 9.2%, respectively, p=0.135 for RA vs. OA; p<0.01 for RA vs. PSA). TNS joints were significantly more often PD positive as compared to non-tender non-swollen joints (18.7% vs. 10.3% respectively, p<0.01) in RA, but not in PsA (9.2% vs. 7.6%, p=0.54) or OA (11.5% vs. 10.2%, p=0.72) (fig. 1). Kaplan-Meier analysis revealed a significantly shorter time period to last observed swelling in PD positive as opposed to PD negative TNS joints in both RA (45.2 vs. 65.5 months, p=0.017) and PsA (20.6 months vs. 107.7 months, p<0.001), however we found no difference in GS positive vs. negative TNS joints.ConclusionThe results of this study confirm the current practice of considering tenderness a sign of active inflammation in RA, but imply that this may not be the case in PsA or OA. The fact that shorter time to last swelling was associated with positive PD in TNS joints suggests that, at least in RA, tenderness might reside after prior clinical swelling has resolved.References[1] Conaghan PG, et al., Arthritis Rheum2003; 48: 64-71.[2] Aletaha D, et al. Ann Rheum Dis2011; 70: 1975-1980.[3] Aletaha D, et al. Arthritis Rheum2011; 63: 3702-3711.Abstract THU0133 – Figure 1 Power Doppler signals of tender non-swollen joints compared to non-tender non-swollen joints in rheumatoid arthritis (RA), psoriatic arthritis (PsA) and osteoarthrosis (OA).Disclosure of InterestsIrina Gessl Grant/research support from: Travel Grant, Mihaela Popescu: None declared, Victoria Schimpl: None declared, Gabriela Supp: None ...
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