Patient and physician perspectives of hand function in a cohort of rheumatoid arthritis patients: the impact of disease activity.

Irazú Contreras-Yáñez,Ana K Romero-Guzmán,Víctor M Menchaca-Tapia,Virginia Pascual-Ramos

doi:10.1186/s12891-016-1246-x

Abstract

BackgroundIn 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA). Hand function was incorporated into evaluations from 2014 onward. The objectives were to examine hand function in our cohort, compare hand function with function in healthy controls and determine the factors associated with impaired function.MethodsFrom February 2014 to June 2015, 139 patients (97.2 % of the cohort) had disease activity scored (28 joints, [DAS28]); the Michigan Hand Outcome Questionnaire (MHQ) and Disabilities of the Arm, Shoulder and Hand Outcome Measure (DASH) were completed, and the tip-, key- and palmar-pinch and grip strengths were measured. Sixty-nine healthy controls underwent the same evaluations. Ninety-nine patients underwent a second evaluation one year after their baseline. Descriptive statistics and linear regression models were used. Patients and controls signed informed consent.ResultsPatients were primarily middle-aged females with a median disease duration of 7 years; 91 patients had DAS28-remission, and 16, 23, and 9 patients had low, moderate and high disease activity, respectively. Controls scored better than did patients with (any) disease activity level; remission patients had similar DASH and key pinch function as did controls with poorer MHQ and both tip and palmar pinch and grip strength. DAS28 was consistently associated with impaired hand function. Among the patients with a one-year re-assessment, changes in DAS28 correlated (rho = 0.34 to 0.63) with changes in hand function (p ≤ 0.01 for all comparisons), but there was no correlation with palmar pinch strength.ConclusionsDisease activity was associated with hand function impairment in RA patients with variable follow-up. MHQ discriminated poorer hand function in remission patients who otherwise had similar DASH scores as the controls did.

Highlights

In 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA)
hand function (HF) may be compromised at follow-up in the vast majority of RA patients, the current recommendations for disease assessment are limited to counts of swollen and tender joints, and these assessments do not include a comprehensive assessment of HF
The present study was performed within an ongoing cohort of early-onset RA patients, who were highly represented by middle-age women with a median of seven years of disease duration and different disease activity levels

Summary

Introduction

In 2004, we initiated an inception cohort of patients with recent-onset rheumatoid arthritis (RA). Reports in the literature indicate that 70 % of all RA patients may present with some form of hand disability at follow-up [2, 3]. Such patients will be referred for prophylactic or reconstructive. Questionnaires included in routine evaluations examine how RA affects a patient’s physical function and ‘participation’ in daily activities, and the questionnaires include several questions pertaining to HF. These questions are usually limited to a few items [7, 10,11,12,13]. DASH has demonstrated validity and reliability as a measure of physical disability in the upper extremities of RA patients [17, 18], and valid, reliable normative data are available for use in clinical and research settings [19]

Methods

Results

Discussion

Conclusion