Radiographic Structural Damage Is Worse in the Dominant than the Non-Dominant Hand in Individuals with Early Rheumatoid Arthritis

Abstract

ObjectiveThe relationship between mechanical stress and radiographic progression in rheumatoid arthritis (RA) is unclear. The assumption is that mechanical stress is greater in the dominant hand. Therefore, the aim of the present study was to compare the presence and progression of erosions and joint space narrowing (JSN) in the dominant and non-dominant hand.MethodsData from 194 patients recently diagnosed with seropositive RA, and with hand radiographs taken at the time of diagnosis and at 2-year follow-up, were analyzed retrospectively. Radiographs were scored using the van der Heijde-modified Sharp Score (HSS) method. Each joint group within each hand was rated separately by two independent examiners in a double-blinded manner.ResultsOne hundred and ninety-four patients were enrolled (80% female, 88% positive rheumatoid factor, 92% positive anti-citrullinated protein antibody, and 95.4% right-handed). The baseline, follow-up erosion and JSN HSS were significantly higher in the dominant hand than in the non-dominant hand. The annual rate of radiographic progression was also higher in the dominant hand. The erosive progression in the wrist joints varied significantly according to handedness, but the erosion in the proximal interphalangeal joints and metacarpophalangeal joints was similar in both hands. The radiographic progression was associated with the dominant hand, an abnormal baseline C-reactive protein level, and joint damage at baseline. There was no significant difference in bone mineral density between the right and left hands.ConclusionRadiological damage was worse and progressed faster in the dominant hand, suggesting that mechanical stress is associated with radiographic joint damage in early and active RA.

Relationship between handedness and joint involvement in rheumatoid arthritis

“…We chose six reports141516172021 and an additional three reports referred to in the six reports (for detail, see Materials and Methods)181922. Thus, a total of nine previous reports were identified (Table 1).…”

“…The maximum number of patients was 292 in the previous reports22. Six reports listed the information of handedness141516171819 but four reports only examined the right-handed paients14151819. Two reports examined the right-handed and left-handed patients although they did not evaluate them separately1617.…”

“…Six reports listed the information of handedness141516171819 but four reports only examined the right-handed paients14151819. Two reports examined the right-handed and left-handed patients although they did not evaluate them separately1617. The joint symptoms were used as a measurement in one report17 and X-rays were used in eight reports1415161718192022.…”

“…Two reports examined the right-handed and left-handed patients although they did not evaluate them separately1617. The joint symptoms were used as a measurement in one report17 and X-rays were used in eight reports1415161718192022. Only two out of the eight reports used mTSS as evaluation of X-rays1618.…”

“…There are multiple previous studies which tried to address this issue141516171819202122. However, they analyzed a relatively small number of patients with RA and evaluated only the right-handedness or did not evaluate the joint involvement differently in right-handed and left-handed patients.…”