‘Insights in the relationship of joint space narrowing versus erosive joint damage and physical functioning of patients with RA’

Koevoets, Rosanne; Dirven, Linda; Klarenbeek, Naomi B; Krugten, M V van; Ronday, H.K.; Heijde, D.M.F.M. van der; Huizinga, Tom W J; Kerstens, P.; Lems, Willem F.; Allaart, Cornelia F

doi:10.1136/annrheumdis-2011-201191

Cited by 25 publications

(18 citation statements)

References 19 publications

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“…Structural joint damage can be visualized and quantified by using radiography and the Sharp scoring system or its modified versions, where the assessment of joint space narrowing (JSN), as a marker for the extent of cartilage damage, and the presence of bone erosion sites (ERO score) can be scored separately (van der Heijde, 1999). So far, studies in RA individuals that correlate functional impairment with JSN or ERO scores have demonstrated that cartilage damage could be more strongly associated than bone erosion with irreversible physical disability (Aletaha et al, 2011; Koevoets et al, 2013; Lillegraven et al, 2012; Navarro-Compan et al, 2015; Smolen et al, 2013; van der Heijde, 2011). However, those studies are limited by the fact that not all joints are affected by JSN and ERO, and that differential diagnosis of bone and cartilage erosion is sometimes difficult and might overlap.…”

Section: Introductionmentioning

confidence: 99%

Cartilage damage and bone erosion are more prominent determinants of functional impairment in longstanding experimental arthritis than synovial inflammation

Hayer

Bauer

Willburger

et al. 2016

Disease Models &Amp; Mechanisms

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Chronic inflammation of articular joints causing bone and cartilage destruction consequently leads to functional impairment or loss of mobility in affected joints from individuals affected by rheumatoid arthritis (RA). Even successful treatment with complete resolution of synovial inflammatory processes does not lead to full reversal of joint functionality, pointing to the crucial contribution of irreversibly damaged structural components, such as bone and cartilage, to restricted joint mobility. In this context, we investigated the impact of the distinct components, including synovial inflammation, bone erosion or cartilage damage, as well as the effect of blocking tumor necrosis factor (TNF) on functional impairment in human-TNF transgenic (hTNFtg) mice, a chronic inflammatory erosive animal model of RA. We determined CatWalk-assisted gait profiles as objective quantitative measurements of functional impairment. We first determined body-weight-independent gait parameters, including maximum intensity, print length, print width and print area in wild-type mice. We observed early changes in those gait parameters in hTNFtg mice at week 5 – the first clinical signs of arthritis. Moreover, we found further gait changes during chronic disease development, indicating progressive functional impairment in hTNFtg mice. By investigating the association of gait parameters with inflammation-mediated joint pathologies at different time points of the disease course, we found a relationship between gait parameters and the extent of cartilage damage and bone erosions, but not with the extent of synovitis in this chronic model. Next, we observed a significant improvement of functional impairment upon blocking TNF, even at progressed stages of disease. However, blocking TNF did not restore full functionality owing to remaining subclinical inflammation and structural microdamage. In conclusion, CatWalk gait analysis provides a useful tool for quantitative assessment of functional impairment in inflammatory destructive arthritis. Our findings indicate that cartilage damage and bone erosion, but not synovial inflammation, are the most important determinants for progressive functional impairment in this chronic erosive arthritis model.

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Section: Introductionmentioning

confidence: 99%

Cartilage damage and bone erosion are more prominent determinants of functional impairment in longstanding experimental arthritis than synovial inflammation

Hayer

Bauer

Willburger

et al. 2016

Disease Models &Amp; Mechanisms

View full text Add to dashboard Cite

show abstract

“…However, if one looks to the rheumatology experience for guidance, it should be kept in mind that treatment concepts designed for joint inflammation probably have to be adapted to suit the gastrointestinal tract. Intestinal damage may not necessarily cause a functional disability in the way a destroyed joint will . In our study, several of the patients with CD who had significant fibrotic tissue transformation (strictures) also had relatively mild symptoms during the following years and did not require intra‐abdominal surgery .…”

Section: Prognosismentioning

confidence: 62%

The emerging global epidemic of paediatric inflammatory bowel disease – causes and consequences

Malmborg

Hildebrand

2015

J Intern Med

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“…However, a SHS ≥ 1 (and thus more radiographic erosions) is associated with improved worker productivity. It is known that having erosions is associated with impaired physical functioning (32), and therefore one might expect lower worker productivity. But as these patients had a short disease duration before inclusion, resulting in minimal radiological damage to the joints at baseline and even during follow-up, the chosen cut-off point used for these analyses may have resulted in poor discrimination of the patients with and without damage, as most patients had no damage.…”

Section: Discussionmentioning

confidence: 99%

Predictors of sick leave and improved worker productivity after 52 weeks of intensive treatment in patients with early rheumatoid arthritis

Blomjous

Boers

Uyl

et al. 2019

Scandinavian Journal of Rheumatology

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Objective: To identify predictors of sick leave and improved worker productivity in patients with early rheumatoid arthritis (RA) treated for 52 weeks with intensive combination strategies. Methods: Patients with early RA were included in the COmbinatietherapie Bij Reumatoïde Artritis (COBRA)-light trial and followed for 52 weeks. As the COBRA-light strategy proved to be non-inferior to the COBRA strategy, all patients were pooled. Predictors for sick leave and improved worker productivity were assessed through a 3 month time-lag multivariable logistic generalized estimating equations model. Results: At baseline, 97 patients had a paid job, 59 had no job, and for six patients the work status was unknown. During the trial, 13 patients stopped working (8%) and six started working (4%). Only sick leave in the past 3 months predicted sick leave. By excluding this variable, patient global assessment and actual hours of sick leave became predictors. Increased worker productivity was predicted by higher patient global assessment levels, Sharp van der Heijde score ≥ 1, actual hours on sick leave, and higher worker productivity in the past 3 months. Conclusion: Sick leave and improved worker productivity were mainly predicted by non-disease-specific variables. Both outcomes can be predicted on a 3 month basis, using the outcome over the past 3 months for the next 3 months. By applying this model in daily practice, decisions for therapy change could be based not solely on disease activity but also taking into account a possible high risk for sick leave in the upcoming 3 months.

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‘Insights in the relationship of joint space narrowing versus erosive joint damage and physical functioning of patients with RA’

Abstract: Joint damage in the wrist, erosions more than JSN, is associated with impaired physical functioning even in patients with early RA with limited overall damage after 5 years tightly controlled treatment.

Cited by 25 publications

References 19 publications

Cartilage damage and bone erosion are more prominent determinants of functional impairment in longstanding experimental arthritis than synovial inflammation

Cartilage damage and bone erosion are more prominent determinants of functional impairment in longstanding experimental arthritis than synovial inflammation

The emerging global epidemic of paediatric inflammatory bowel disease – causes and consequences

Predictors of sick leave and improved worker productivity after 52 weeks of intensive treatment in patients with early rheumatoid arthritis

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