Distribution of erosions in hands and feet at the time for the diagnosis of RA and during 8-year follow-up

Abstract

Background Joint destruction in rheumatoid arthritis (RA) is usually evaluated by radiographs of both hands and feet, while the inflammatory status mostly is evaluated by DAS28 which, however, does not include the feet. Objectives To investigate the distribution of erosions in hands and feet in early RA over 8 years and its potential clinical implications. Furthermore, the group of patients never showing erosions has been addressed. Methods This study comprises 1041 patients from the BARFOT study of patients with early RA. Radiographs of hands and feet were performed at baseline, 1, 2, 5, and 8 years and evaluated by the Sharp van der Heijde scoring (SHS) method (32 joints in the hands and 12 in the feet). Disease activity was measured by DAS28, SR, CRP, and function with HAQ. Results In the feet, there were significantly more eroded joints in percent of examined joints than in the hands at all time points. Patients with erosions only in the feet were younger, more often seropositive and smokers. They had significantly lower baseline DAS28, than the patients with erosions only in the hands. The patients without erosions over time were, at diagnosis, significantly younger and less frequently seropositive compared with patients having erosions. Conclusions This study highlights the importance of evaluating the feet in patients with RA, both with clinical examinations and with imaging and lends support to the notion that seropositivity and smoking are risk factors for erosive disease. Further studies of patients with nonerosive disease are needed. Key Points:• Foot problems are common in RA• This study emphasizes the limitations of DAS28 and Sharp van der Heijde score as regards evaluating disease activity and radiographic damage• This study highlights the importance of evaluating the feet in patients with RA with clinical examinations and imaging• This study also points out the need of further studies of patients with non-erosive RA.

High‐resolution peripheral quantitative computed tomography for the evaluation of bone erosions of metatarsophalangeal joints in patients with rheumatoid arthritis

“…Furthermore, our finding differs from our previous study, which showed that HR‐pQCT of the 2nd and 3rd MCP joints had equal but not superior sensitivity for classifying patients with erosive RA compared with CR of 44 joints 17 . This difference may be explained by the higher number of erosions present in the feet compared with the hands on CR in our cohort and agrees with previous CR studies reporting more erosions in the feet than in the hands 25–27 . Similar to HR‐pQCT studies assessing erosions in the MCP joints, the present study showed that a large proportion of non‐erosive patients by CR were determined as erosive by HR‐pQCT 17,28 .…”

Clinical Presentation of Connective Tissue Disease Patients with and without Interstitial Lung Disease: A Retrospective Study

“…In our opinion, a possible explanation is that respiratory disease in these patients was perceived as clinically prevalent, potentially associated with a not particularly painful, though potentially erosive, case of inflammatory arthritis. Actually, RA-PU patients showed a higher proportion of typical erosions and deformities of the hands, compared with RA-RU patients, and in general higher than reported in the literature [34, 35]. Therefore, the disease must have started in the joints, but patients likely underestimated this clinical sign and did not consult a rheumatologist promptly.…”

Erosion-free rheumatoid arthritis: clinical and conceptional implications—a BARFOT study

“…In a recent study on the distribution of erosions in hands and feet in RA we noticed that a number of patients did not seem to develop any erosion [5]. However, that this may occur has already been reported in the latter part of the twentieth century.…”