Upper extremity-related disabilities in early RA increase after 2 years

Disability related to the upper extremities (UEs) in early rheumatoid arthritis (RA) is significantly decreased in the first 6 months, but this tends to significantly rise after 2 years, reports a study.

A total of 222 patients with early RA diagnosed from 1995 to 2005 were included in this cohort study, with follow-up of 10 years. The authors assessed disability of the UEs using a subscore of the Health Assessment Questionnaire–Disability Index (HAQ-DI-UE) and measured the average grip force of the dominant hand. 

Changes in the HAQ-DI-UE subscore between consecutive follow-up visits, as well as correlations at each visit with key clinical variables, were also examined. Multivariate linear regression analysis was used to explore the association between joint involvement and HAQ-DI-UE.

From inclusion to 6 months, the HAQ-DI-UE significantly decreased (mean change, –0.26, 95 percent confidence interval [CI], –0.18 to –0.34), but it increased significantly after 2 years.

The HAQ-DI-UE showed robust associations with grip force (r, –0.50 to –0.62), patient global assessment (r, 0.53–0.64), and patient-reported pain (r, 0.54–0.60) at all timepoints through year 5. However, it only showed moderate to weak associations with swollen joints, C-reactive protein, and erythrocyte sedimentation rate.

In addition, wrist synovitis and tender proximal interphalangeal joints independently influenced HAQ-DI-UE at inclusion, while tenderness of the shoulder and the wrist had greater importance at 6 months.

“The correlations with clinical variables underline the major effect of pain and impaired hand function in early RA,” the authors said.