Tenderness and radiographic progression in rheumatoid arthritis and psoriatic arthritis

Abstract

ObjectiveThe aim of this study was to assess the predictive value of tenderness in the absence of swelling with consideration of other potential risk factors for subsequent radiographic progression in rheumatoid arthritis (RA) and psoriatic arthritis (PsA).MethodsClinical and sonographic (grey scale and power Doppler (PD)) examination of 22 joints of the hand were performed in patients with RA and PsA. The impact of tenderness on progression after 2 years was analysed in non-swollen joints for RA and PsA separately with multilevel mixed logistic regression analysis.ResultsWe included 1207 joints in 55 patients with RA and 352 joints in 18 patients with PsA. In RA, tenderness was associated with radiographic progression after 2 years (model 2: OR 1.85 (95% CI 1.01 to 3.27), p=0.047), although the association of PD (OR 2.92 (95% CI 1.71 to 5.00), p<0.001) and erosions (OR 4.74 (95% CI 2.44 to 9.23), p<0.001) with subsequent structural damage was stronger. In PsA, we found a positive but not significant association between tenderness and radiographic progression (OR 1.72 (95% CI 0.71 to 4.17), p=0.23). In contrast, similarly to RA, erosions (OR 4.62 (95% CI 1.29 to 16.54), p=0.019) and PD (OR 3.30 (95% CI 1.13 to 9.53), p=0.029) had a marked effect on subsequent structural damage.ConclusionOur findings imply that tenderness in non-swollen joints in RA is associated with subsequent damage. In both diseases, additional risk factors, such as sonographic signs for synovitis and baseline radiographic damage are associated with radiographic progression.

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

“…Of note, having tender but not swollen joints may reflect noninflammatory pain in some, but for others it may be a milder manifestation of their inflammatory arthritis. One study of 55 patients with RA and 18 patients with psoriatic arthritis found that tender but not swollen joints were associated with subsequent radiographic progression 31 . We performed a sensitivity analysis adjusting for CRP that did not change our results.…”

“…One study of 55 patients with RA and 18 patients with psoriatic arthritis found that tender but not swollen joints were associated with subsequent radiographic progression. 31 We performed a sensitivity analysis adjusting for CRP that did not change our results. Further study is needed to determine how to better identify noninflammatory pain in our patients with RA, because management would differ from that of RA.…”

Determinants of radiographic progression in early psoriatic arthritis: insights from a real-world cohort

“… 15 In another study investigating the impact of tenderness on PsA, baseline radiographic damage was the only variable significantly associated with radiographic progression, despite many factors not having a marked influence, including joint tenderness. 31 …”

Advanced Glycation End Products and Psoriasis

“…The severity of PsA is independent from the severity of psoriasis PsA, which has in most cases mild to moderate disease with a fluctuating course. However, bone erosions can occur early in the disease’s course and lead to disability and impaired function of affected joints and bones [ 18 ]. The Group for Research and Assessment of Psoriasis and Psoriatic Arthritis (GRAPPA) has recognized different domains of PsA including synovitis, enthesitis/dactylitis, nail, skin, and axial involvement [ 19 ].…”