Course of Grip Force Impairment in Patients With Early Rheumatoid Arthritis Over the First Five Years After Diagnosis.

OBJECTIVE: Objective measures of function are important in rheumatoid arthritis (RA). The objective of this study was to investigate grip strength in patients with early RA. METHODS: An inception cohort of 225 patients with early RA was followed in accordance with a structured protocol. Average and peak grip force values of the dominant hand (measured using a Grippit device [AB Detektor]) were evaluated and compared to expected age- and sex-specific reference values from the literature. Separate analyses were performed for those with limited self-reported disability (Health Assessment Questionnaire disability index [HAQ DI] score ≤0.5) and clinical remission (Disease Activity Score in 28 joints <2.6). RESULTS: Baseline average grip force among RA patients was significantly lower than the corresponding expected value (mean 105N versus 266N; P < 0.001). Observed average and peak grip force values were significantly reduced compared to those expected in women as well as in men over time and at all time points. The average grip force improved significantly from inclusion to the 12-month visit (age-corrected mean change 34N [95% confidence interval 26-43]). At 5 years, the average grip force was still lower than that expected overall (mean 139N versus 244N; P < 0.001), and also among those with HAQ DI scores ≤0.5 and those in clinical remission. CONCLUSION: Grip strength improved in early RA patients, particularly during the first year. However, it was still significantly impaired 5 years after diagnosis, even among those with limited self-reported disability and those in clinical remission. This suggests that further efforts to improve hand function are important in early RA.

Early rheumatoid arthritis and body composition.

OBJECTIVES: RA is associated with joint destruction and cardiovascular diseases (CVDs). Possible predictors for CVD are early changes in body composition. We therefore evaluated whether lean mass of arms and legs (LMAL), total body fat mass (BFM) or truncal fat distribution (TFD) are altered early in RA, and if so, which factors are associated. METHODS: We included 132 RA patients (95 women) with disease duration of < or =12 months. Disease activity score (DAS28), HAQ, BMI, comorbidity, smoking and medications were recorded. Total and regional lean mass and fat mass were measured with DXA. Data were compared with 132 age- and gender-matched controls, and possibly associated factors were analysed in linear regression models. RESULTS: LMAL was low in patients for both women and men (P = 0.007 and <0.001, respectively). BMI (P = 0.012), BFM (P = 0.014) and TFD (P < 0.001) were higher than expected in RA women. In bivariate analyses, all adjusted for age and current smoking, disease duration was independently associated with low LMAL in women (P = 0.021). High BFM was associated with HAQ x disease duration in men (P = 0.033) and DAS28 in women (P = 0.011). High TFD was associated with a history of diabetes or CVD in men with RA (P = 0.005). CONCLUSIONS: Low LMAL, high BFM and high TFD are present in early RA patients. The long-term significant consequences of these abnormalities need to be determined.

Bone mineral density in the hand as a predictor for mortality in patients with rheumatoid arthritis.

OBJECTIVES: BMD in the hand, as evaluated by digital X-ray radiogrammetry (DXR), has been suggested to be a predictor for joint damage in RA. A predictor for long-term prognosis might also predict increased mortality in RA. The aim of the present study was to evaluate BMD in the hand as a predictor for all-cause mortality. METHODS: In 1978, 152 consecutive patients (78% women, mean disease duration: 14.2 years) were enrolled. X-rays of the hands at inclusion were available in 108 patients. Reasons for not evaluating DXR in 24 patients were placement of joint prostheses or severe malalignment. BMD was evaluated by DXR on the same digitized hand X-rays used for scoring radiographic joint damage. Measures of disease activity and damage were used to predict mortality by Cox regression models. RESULTS: From February 1978 through March 2008, 62 of the 82 patients died, corresponding to a standardized mortality ratio of 2.92 (95% CI 2.19, 3.65) for both sexes combined. In age- and sex-adjusted proportional hazards models, BMD [hazard ratio (HR) = 0.58/1 s.d.; 95% CI 0.37, 0.91], Steinbrocker functional class 3-4 (HR = 4.74/1 step; 95% CI 1.93, 11.64), the physician's global assessment (HR = 1.38/1 s.d.; 95% CI 1.03, 1.84) and ESR (HR = 1.92/1 s.d.; 95% CI 1.42, 2.58) were significant predictors of mortality, but RF, disease duration, Larsen index, Ritchie articular index and the patient's global assessment were not. CONCLUSION: Low DXR-BMD predicted overall mortality in age- and sex-adjusted analyses, which further supports it as a valid measurement of disease activity or damage and as having prognostic value.

Prediction of mortality in rheumatoid arthritis based on disease activity markers.

OBJECTIVE: The risks and predictors for mortality in patients with rheumatoid arthritis (RA) were examined in a cohort of 152 consecutive outpatients (119 women, 33 men) seen in a 2 month period. METHODS: We evaluated 4 measures of disease activity: erythrocyte sedimentation rate (ESR), physician and patient global assessment of disease activity, and the Ritchie Articular Index (RAI) as mortality predictors, adjusting for disease severity, treatment, and cardiovascular disease (CVD) comorbidity. RESULTS: During followup from 1978 through 1998, 111 patients (86 women, 25 men) died, and only one was lost to followup. The standardized mortality ratio for women was 161 (95% confidence interval 129-199), for men 152 (95% CI 99-223), and for both sexes combined 156 (95% CI 128-188). In a proportional hazards model adjusted for age and sex, at the beginning of the period and for the whole group, significant predictors of mortality were Steinbrocker functional class, Larsen index, CVD comorbidity, use of corticosteroids ever, ESR, and the physician and patient global assessment of disease activity; but the rheumatoid factor (RF), RAI, and use of disease modifying antirheumatic drugs were not significant predictors. When evaluating the 4 assessments of disease activity adjusting for confounders, only physician global assessment hazard ratio (HR) = 1.32 per 1 SD (95% CI 1.00-1.74) and ESR HR = 1.47 per 1 SD (95% CI 1.11-1.93) were significant predictors. CONCLUSION: This longterm followup study of a single clinical patient cohort showed a significant increase in mortality among patients with RA compared to the general population in Malmö. In addition to disease damage and CVD comorbidity, measures of disease activity independently predicted mortality, which supports the hypothesis that improving these variables may also improve longterm outcome.