Serological and Progression Differences of Joint Destruction in the Wrist and the Feet in Rheumatoid Arthritis - A Cross-Sectional Cohort Study

<div><p>Objective</p><p>To investigate clinical and radiological differences between joint destruction in the wrist and the feet in patients with RA.</p><p>Methods</p><p>A cross-sectional clinical study was conducted in an RA cohort at a single institution. Clinical data included age, sex and duration of disease. Laboratory data included sero-positivity for anti-cyclic citrullinated peptide (CCP) antibody and RF. Radiological measurements included Larsen grades and the modified Sharp/van der Heijde method (SHS) for the hands/wrists and the feet. Statistical analyses were performed using the Kruskal—Wallis H-test, a dummy variable linear regression model and multivariate logistic regression analysis with 95% confidence interval and odds ratios.</p><p>Results</p><p>A total of 405 patients were enrolled, and 314 patients were analysed in this study. The duration of disease in the foot-dominant group was significantly less than that in the wrist-dominant group. When patients were subdivided by duration of disease, the Larsen grade of the feet was significantly higher than that of the wrist in the first quadrant subgroup, but this was reversed with increasing duration of disease. Anti-CCP status was a significant predictive factor for joint destruction in the wrist but not in the feet, while RF status was not predictive in either the wrist or the feet.</p><p>Conclusions</p><p>Joint destruction in the feet started earlier than in the wrist, but the latter progresses faster with increasing duration of disease. Anti-CCP status predicts joint destruction in the wrist better than in the feet.</p></div

Serological and Progression Differences of Joint Destruction in the Wrist and the Feet in Rheumatoid Arthritis - A Cross-Sectional Cohort Study - Fig 2

<p>(A) Comparison of joint destruction of the wrist and the feet in the duration of the disease. Larsen grade of the feet was significantly higher than that of the wrist in the first subgroup (p<0.001). (B) Comparison of difference of the joint destruction between the wrist and the feet in Larsen grade. <i>P</i> < 0.001.</p

Demographic data.

<p><i>DAS28;</i> Disease Activity Score 28, <i>ESR;</i> erythrocyte sedimentation rate, <i>anti-CCP;</i> anti-cyclic citrullinated peptide antibody, <i>CRP;</i> C-reactive protein, <i>RF;</i> rheumatoid factor, <i>MMP-3;</i> matrix metalloprotenase-3, <i>HAQ;</i> health assessment questionnaire, <i>bDMARDs;</i> biological disease modifying anti-rheumatic drugs, <i>MTX;</i> methotrexate</p><p>Demographic data.</p

Prognostic factors of the joint destruction in Larsen grade and covariables (OR, 95%CI).

<p><i>OR;</i> odds ratio, <i>95%CI;</i> 95% confidence interval, <i>DAS28;</i> Disease Activity Score 28, <i>anti-CCP;</i> anti-cyclic citrulinated peptide antibody, <i>RF;</i> rheumatoid factor,</p><p>*: p<0.05</p><p>Prognostic factors of the joint destruction in Larsen grade and covariables (OR, 95%CI).</p

Flow chart of the study.

<p>Flow chart of the study.</p

Comparison of 4 subgroups based on wrist/foot differences of joint destruction in Larsen grade.

<p><i>DAS28;</i> Disease Activity Score 28, <i>ESR;</i> erythrocyte sedimentation rate, <i>HAQ;</i> health assessment questionnaire, <i>anti-CCP;</i> anti-cyclic citrulinated peptide antibody, <i>RF;</i> rheumatoid factor, <i>bDMARDs;</i> biological disease modifying anti-rheumatic drugs, <i>MTX;</i> methotrexate.</p><p>*: statistically significant against Wrist-Foot group (p<0.05),</p><p>^§; statistically significant against Wrist group,</p><p>^†; statistically significant against Foot group, n.s. denotes not significant.</p><p>Comparison of 4 subgroups based on wrist/foot differences of joint destruction in Larsen grade.</p