Abstract
We investigated the relationship between distal interphalangeal (DIP) joint involvement and disease activity in 10,038 patients with adult-onset rheumatoid arthritis (RA). The affected joint distribution was investigated using the joint indices (JI) x, y, and z, corresponding to the upper and lower joints, and the predominance of large-joint involvement, respectively. DIP joint involvement (defined by the presence of tenderness and/or swelling in DIP joints) was present in 206 (2.1%) of 10,038 patients with RA. Patients with RA exhibiting DIP joint involvement were significantly younger, and more frequently women. DIP joint involvement was positively associated with Disease Activity Score-28 using C-reactive protein, and clinical variables related to high RA disease activity, including JIs x and y, and was negatively associated with JI z. JI x was significantly higher than JI y in RA patients with DIP joint involvement. An odds ratio analysis revealed that small-to-medium sized and upper-extremity joints ranked first, second, and fourth among the eight variables significantly associated with DIP joint involvement. The correlation coefficients revealed that small-sized and upper-extremity joints ranked first and second among the five significant variables. DIP joint involvement, albeit rare, is significantly associated with high RA disease activity with predominance of small-sized and upper-extremity joints.
Highlights
Introduction iationsRheumatoid arthritis (RA) is a systemic autoimmune disease characterized by persistent erosive synovitis that results in cartilage and bone destruction, leading to joint deformities and functional impairment [1]
The present study aimed to examine the frequency of distal interphalangeal (DIP) joint involvement in patients with rheumatoid arthritis (RA), and to determine its relationship with RA disease activity and affected joint distribution, based on data obtained from the National Database of Rheumatic Diseases in Japan (NinJa) [18]
Our findings showed that joint indices (JI) x was significantly higher than JI y in patients with DIP joint involvement, indicating that articular symptoms in these patients were more prominent in the upper extremities than in the lower extremities
Summary
Rheumatoid arthritis (RA) is a systemic autoimmune disease characterized by persistent erosive synovitis that results in cartilage and bone destruction, leading to joint deformities and functional impairment [1]. Bone erosions in RA typically occur at the edge of the joint (marginal erosions) (i.e., the bare area), where the bone is not covered either by the cartilage or the synovial joint capsule. Rheumatoid synovitis usually begins in the small joints of the hands and feet before spreading to larger joints [2]. Research has suggested that the distal interphalangeal (DIP) joints are spared from the swelling and pain that typically affects the small joints of the hands in patients with. When a patient presents with DIP symptoms, such as tenderness and/or swelling at disease onset, some rheumatologists would argue that the differential diagnosis should place an emphasis on osteoarthritis (OA) and psoriatic arthritis (PsA).
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