Three Groups in the 28 Joints for Rheumatoid Arthritis Synovitis – Analysis Using More than 17,000 Assessments in the KURAMA Database

Abstract

Rheumatoid arthritis (RA) is a joint-destructive autoimmune disease. Three composite indices evaluating the same 28 joints are commonly used for the evaluation of RA activity. However, the relationship between, and the frequency of, the joint involvements are still not fully understood. Here, we obtained and analyzed 17,311 assessments for 28 joints in 1,314 patients with RA from 2005 to 2011 from electronic clinical chart templates stored in the KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance) database. Affected rates for swelling and tenderness were assessed for each of the 28 joints and compared between two different sets of RA patients. Correlations of joint symptoms were analyzed for swellings and tenderness using kappa coefficient and eigen vectors by principal component analysis. As a result, we found that joint affected rates greatly varied from joint to joint both for tenderness and swelling for the two sets. Right wrist joint is the most affected joint of the 28 joints. Tenderness and swellings are well correlated in the same joints except for the shoulder joints. Patients with RA tended to demonstrate right-dominant joint involvement and joint destruction. We also found that RA synovitis could be classified into three categories of joints in the correlation analyses: large joints with wrist joints, PIP joints, and MCP joints. Clustering analysis based on distribution of synovitis revealed that patients with RA could be classified into six subgroups. We confirmed the symmetric joint involvement in RA. Our results suggested that RA synovitis can be classified into subgroups and that several different mechanisms may underlie the pathophysiology in RA synovitis.

Discordance and accordance between patient’s and physician’s assessments in rheumatoid arthritis

“…We enrolled our patients from the Kyoto University Rheumatoid Arthritis Management Alliance (KURAMA) cohort (6). Clinical and laboratory variables that are characteristic of RA are assessed and documented every year for an RA survey, which includes a patient-based questionnaire.…”

Evaluation of antigen-induced synovitis in a porcine model: Immunological, arthroscopic and kinetic studies

“…This inflammation is painful and usually linked to osteoarthritis, rheumatoid arthritis or infections [3, 4, 6]. To alleviate pain and discomfort, the synovitis can be successfully treated with anti-inflammatory medications such as non-steroidal anti-inflammatory drugs [9] or biological therapies [10, 11, 14, 20].…”

“…This renewal is also facilitated by physical exercise and joint flexion [2]. The synovitis is an inflammation-related disease usually linked to rheumatoid arthritis [3], osteoarthritis [4, 5] and viral infections [6]. The inflammation of synovial tissue is accompanied to immune cells infiltration (mainly composed by macrophages and T and B lymphocytes) which initiates an inflammatory response causing pain and discomfort [7] and affecting the normal joint function [8].…”

Relationship between handedness and joint involvement in rheumatoid arthritis

“…We enrolled a total of 334 RA patients from the KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance) cohort31. The KURAMA cohort was established in 2011 at the Center for Rheumatic Diseases in Kyoto University Hospital for tight control of RA and to utilize their sequential clinical and laboratory data for clinical investigations31.…”

“…The KURAMA cohort was established in 2011 at the Center for Rheumatic Diseases in Kyoto University Hospital for tight control of RA and to utilize their sequential clinical and laboratory data for clinical investigations31. All of the patients with written informed consent fulfilled the revised 1987 ACR criteria for RA32 or the 2010 ACR/EULAR classification criteria for RA33.…”