Having More Tender Than Swollen Joints is Associated With Worse Function and Work Impairment in Patients With Early Rheumatoid Arthritis

Abstract

ObjectivePatients with early rheumatoid arthritis (RA) may present with more tender than swollen joints, which can persist. Elevated tender‐swollen joint difference (TSJD) is often challenging, because there may be multiple causes and it may contribute to overestimating disease activity. Little is known about the phenotype and impact of TSJDs on patient function. Our objective was to evaluate the impact of TSJD on functional outcomes in early RA and to see whether associations vary by joint size.MethodsData were from patients with active, early RA (≤12 months) enrolled in the Canadian Early Arthritis Cohort, who completed assessments of general function (Multidimensional Health Assessment Questionnaire [MDHAQ]), upper extremity (UE) function (Quality of Life in Neurological Disorders [Neuro‐QoL] UE scale), and work/activity impairment (Work Productivity and Activity Impairment RA) over their first year of follow‐up. A total of 28 joint counts were performed. TSJDs were calculated. Adjusted associations between TSJDs and functional outcomes were estimated in separate multivariable linear mixed effects models. Separate analyses were performed for large‐ versus small‐joint TSJD.ResultsPatients (N = 547) were 70% female, mean age 56 (SD 15) years, mean disease duration 5.3 (SD 2.9) months. At baseline, 287 (52%) had TSJD >0 (43% involved large joints and 34% small joints), decreasing to 32% at 12 months. A one‐point increase in TSJD was significantly associated with worse function (MDHAQ: adjusted mean change 0.10, 95% confidence interval [CI] 0.08–0.13; Neuro‐QoL UE function T score: adjusted mean change −0.59, 95% CI −0.76 to −0.43; and greater work impairment: adjusted mean change 1.95%, 95% CI 0.85%–3.05%). Higher large‐joint TSJDs were associated with the worst functional outcomes.ConclusionHaving more tender than swollen joints is common in early RA and is associated with worse function, most notably when involving large joints. Early identification and targeted intervention strategies may be needed.

Having More Tender Than Swollen Joints Is Associated With Worse Patient-Reported Outcomes in Patients With Early RA

“…Also consistent with our previous study looking at functional outcomes and work impairment, 15 large-joint TSJD was associated with worse outcomes compared with small-joint TSJD. This is illustrated by the clinical scenarios of patients who develop any large-joint TSJD in comparison to small-joint TSJD.…”

“…Five hundred forty-seven patients with early RA were evaluated. The total cohort was mainly female (70%) and White (79%), with a mean (SD) age of 56 (15) years, symptom duration of 5.3 (2.9) months, and mean CDAI (SD) of 26.1 (13.6), as previously reported 15 (Table 1).…”

“…About one half of patients had a baseline TSJD >0, which decreased to 32% at 12-month follow-up, as previously reported. 15 Patients with TSJD >0 at baseline were more likely to report worse PROMIS function ( 1).…”

“…Our prior work in patients with early RA showed an overall group prevalence of elevated TSJD (>0) of 52% in an early RA cohort, which persisted in about a third of patients at 1 year, indicating TSJDs are common. 15 A linear increase of only 1 in TSJD was significantly associated with worse functional outcomes as measured by MDHAQ and Neuro-QoL upper extremity function T-scores. Elevated TSJD also was associated with greater work and activity impairment.…”

“…Worse functional outcomes were most notable with TSJDs in large joints. 15 Building on this work, we now focus on the impact of TSJD on newer, standardized PROs across multiple domains of health-related quality of life. The Patient Reported Outcome Measurement Information System (PROMIS)-29 measures covers 7 domains of health (physical function, social participation, pain interference, sleep problems, fatigue, anxiety, and depressive symptoms).…”