Tender Joint Count and Inflammatory Activity in Patients With Established Rheumatoid Arthritis: Results From a Longitudinal Study

Abstract

ObjectiveThe tender joint count (TJC) is included in composite disease activity scores (CDAS) (the Disease Activity Score in 28 joints, the Clinical Disease Activity Index, and the Simplified Disease Activity Index). The impact of having predominantly tender joints was explored by use of the Tender‐Swollen Joint Count Difference (TSJD), and ultrasound (US) provided a measure of joint inflammation. The current study aimed to explore the cross‐sectional and longitudinal associations between the TSJD and a spectrum of outcome measures, including US scores in patients with established rheumatoid arthritis (RA) during follow‐up and while receiving treatment with biologic disease‐modifying antirheumatic drugs (bDMARDs).MethodsThis was an observational study of 209 patients with established RA consecutively included upon initiation of bDMARD treatment and followed‐up with clinical, laboratory, and comprehensive US examinations at 0, 1, 2, 3, 6, and 12 months. Patients were categorized into 2 groups: those with predominantly tender joints (TSJD >0) and those with predominantly swollen joints (TSJD ≤0). Statistical analyses included Pearson's correlation coefficient, an independent samples t‐test, and regression analyses.ResultsThe TJC had high correlations only with patient‐reported outcomes (PROMs) (P < 0.001). Levels from CDAS and PROMs were significantly higher (P < 0.001) at all visits in patients with TSJD >0 compared to those with TSJD <0. Laboratory markers and assessor's global visual analog scale scores were similar, and US sum scores were significantly lower (P < 0.001–0.03). The baseline TSJD positively predicted levels of all CDAS at 6 months (P < 0.001–0.019) but was a negative predictor of US sum scores (gray‐scale and power Doppler) at 6 and 12 months (P < 0.001).ConclusionPatients with predominantly tender joints had higher CDAS but lower levels of inflammation as defined by US. These findings indicate that inclusion of the TJC in the CDAS may contribute to misleading information about inflammatory activity.

Swollen, but not tender joints, are independently associated with ultrasound synovitis: results from a longitudinal observational study of patients with established rheumatoid arthritis

“…Examinations at patient level of the present cohort have shown patients with pain catastrophising to have higher levels of all the patient-reported outcomes including tender joint count but no differences in ultrasound scores,23 and patients with higher number of tender than swollen joints were found to have higher levels of composite scores but lower levels of ultrasound sum scores 33…”

Predictors of sustained remission in patients with early rheumatoid arthritis treated according to an aggressive treat-to-target protocol

“…On the other hand, tenderness might reflect structural damage and fibromyalgia with central sensitization potentially influencing the composite disease activity score in some patients. (84,(194)(195)(196)(197). In a review by Navarro-Compan, all composite disease activity scores that included swollen joints were related to radiographic progression, as were the single components directly reflecting inflammation (such as SJC and ESR/CRP).…”

Pain appraisal and quality of life in 108 outpatients with rheumatoid arthritis

“…Moreover, many studies have reported that pain is a crucial and distressing symptom of RA (Jia & Jackson, 2016;Sturgeon et al, 2016). However, most of these studies have failed to show a strong relationship between pain in RA and objective measures of inflammation (Egsmose & Madsen, 2015;Hammer, Michelsen, Provan et al, 2018). In the past few years, more studies have discovered the influence of several pain appraisal variables, including cognitive beliefs, and behavioral and social responses, to explain the impact of RA on HRQoL (Morgan, 2013;Santos, Duarte, Ferreira, Pinto, Geenen & da Silva, 2018;Sturgeon et al, 2016).…”