The relation between upper extremity joint involvement and grip force in early rheumatoid arthritis: a retrospective study

Abstract

To investigate the relation between joint involvement in the upper extremities and grip force in patients with early rheumatoid arthritis (RA). An inception cohort of 225 patients with early RA was followed according to a structured protocol. The same rheumatologist assessed all patients for swollen joints and joint tenderness. Grip force was measured (Grippit; AB Detektor, Gothenburg, Sweden) at the same visit. Average grip force values for the dominant hand were expressed as % of expected, based on age-and sex-specific reference values from the literature. Associations between grip force and current synovitis or tenderness of individual joints, and other disease parameters measured at the same visit, were examined. Patients with current synovitis of the wrist joint or ≥ 1 metacarpophalangeal (MCP) joint of the dominant hand had a significantly lower grip force at inclusion, at 1 year and at 5 years. Proximal interphalangeal joint tenderness and MCP joint tenderness were consistently associated with reduced grip force. In multivariate analysis, extensive MCP joint synovitis was associated with lower grip force at inclusion (β − 2.8% per joint; 95% CI − 5.3 to − 0.4), and also at the 1-year follow-up. Patient reported pain scores and erythrocyte sedimentation rates had independent negative associations with grip force at all time points. In patients with early RA, extensive synovitis of the MCP joints was associated with reduced grip force, independently of other upper extremity joint involvement. Pain and inflammation have effects on hand function beyond those mediated by local synovitis. Keywords Early rheumatoid arthritis • Grip force • Joint tenderness • Synovitis Abbreviations ACR American College of Rheumatology ADL Activities of daily living CI Confidence intervals CRP C-reactive protein DAS28 Disease activity score for 28 joints DASH Disabilities of the Arm, Shoulder and Hand Questionnaire DMARDs Disease modifying anti rheumatic drugs ESR Erythrocyte sedimentation rate

Disability Related to Function of the Upper Extremities in Early Rheumatoid Arthritis – Course and Relation to Other Disease Parameters Over 10 Years: A Cohort Study

“…Together with shoulders and elbows, wrist joints accounted for the greatest contributions to disease activity, HAQ-DI and long term functional prognosis (41). Several other studies demonstrated a major impact of wrist involvement on grip force in RA (19,22,(43)(44)(45).…”

The relation between synovitis of individual finger joints and grip force over the first 5 years in early rheumatoid arthritis — a cohort study

“…In the main analysis, synovitis and joint tenderness of individual joints in both hands were combined. As wrist synovitis, high ESR, and severe patient-reported pain (measured by VAS) were independently associated with reduced grip force in a previous study of this patient sample [ 27 ], and as we were interested in assessing the contribution of individual joints to impaired grip, the main analyses were adjusted for these covariates. By adjusting for ESR and pain, we corrected for potential confounding by general effects of inflammation on strength and impaired performance due to fear of pain.…”

“…Information on the contribution of individual joints to impaired grip strength may be helpful for guiding individualized management. We have previously reported that wrist synovitis and extensive metacarpophalangeal (MCP) joint synovitis are associated with reduced grip force in early RA, but the impact of individual finger joints has not been assessed [ 27 ]. The objective of this study was to investigate the relation between swelling and tenderness of individual finger joints and grip force in patients with early RA.…”

Outcomes of Pyrocarbon Arthroplasty in Metacarpophalangeal Joints Affected by Rheumatoid Arthritis

“…1 Rheumatoid arthritis affecting the MCP joint often results in weakness, instability, pain, and deformity. 1,2 Surgical and nonsurgical techniques are used by physicians and therapists to treat pain and inflammation associated with this condition. 3 Surgery is indicated when less invasive techniques fail to prevent the progression of the patient’s pain and deformity.…”