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.
Highlights
Simultaneous and symmetrical joint involvement is a hallmark of rheumatoid arthritis (RA) and was included as a diagnostic criterion defined by the American College of Rheumatology in 1987 [1]
The annual rate of radiographic progression was higher in the dominant hand
The radiographic progression was associated with the dominant hand, an abnormal baseline C-reactive protein level, and joint damage at baseline
Summary
Simultaneous and symmetrical joint involvement is a hallmark of rheumatoid arthritis (RA) and was included as a diagnostic criterion defined by the American College of Rheumatology in 1987 [1]. The levels of radiographic damage in the dominant and non-dominant hand both at a specific time point and at follow-up are highly correlated [2]. The cartilage degeneration in OA can be correlated with abnormal or excessive articular contact stress [5]. Studies show that RA patients with hemiplegia or paralysis tend to suffer asymmetrical joint damage [8,9,10], suggesting that intra-articular mechanical stress is an important factor contributing to radiographic progression of RA. Few studies have examined the severity and progression of joint damage in the right and left hands simultaneously
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