Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis

Abstract

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.

Inflammation and biologic therapy in patients with rheumatoid arthritis achieving versus not achieving ACR/EULAR Boolean remission in a treat-to-target study

“…Not achieving remission solely due to PGA often presents a challenge in interpretation of the composite scores as non-inflammatory factors (eg, joint damage, fibromyalgia, fatigue and depression) could strongly impact its elevation 6 7. It has also been discussed if tender joint count potentially overestimates disease activity as it might represent erosive damage and pain sensitisation,6 8 although in early disease tender joints might be more related to inflammation 9 10…”

Prognostic Factors for Open-Wedge High Tibial Osteotomy with Spacer Implantation in Patients with Medial Compartmental Knee Osteoarthritis

“…Similarly, previous studies have reported that patients with K-L grade IV OA achieve unsatisfactory results after conventional HTO. Studies have shown that in ammatory factors in the joints play a more important role than dynamics in the late clinical manifestations of knee OA [33][34][35].…”

Correspondence on ‘Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis’

“…Interestingly, the findings in rheumatoid arthritis (RA) were dependent on the disease stage: tenderness in longstanding RA (mean disease duration 7.2 years) was not associated with subclinical inflammation, while in early RA (disease duration <2 years) tenderness of hand joints was associated with subclinical inflammation (54.5% of tender joints vs 48.4% of non-tender joints showed inflammation; OR 2.22). 1 Since validation of research findings is of utmost importance, we hypothesised that the findings observed in early clinical RA would correspond to similar findings in the symptomatic phase that precedes clinical inflammatory arthritis and RA. 2 It is important to understand whether joint tenderness in patients with clinically suspect arthralgia (CSA) is related to subclinical inflammation, since joint swelling is per definition absent in this phase.…”