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

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

Abstract

Background: In 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.

Methods: From 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.

Results: Patients 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.

Conclusions: Disease 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.

Keywords: Disease activity; Musculoskeletal physiological processes; Rheumatoid arthritis.

Figures

Fig. 1
Fig. 1
Position for grip strength and pinch measures
Fig. 2
Fig. 2
ROC curves: cut-off for DAS 28 to predict the MHQ-NR and DASH-NR scores, pinch and grip strength values within normal ranges
Fig. 3
Fig. 3
Correlation between changes in the DAS28 and MHQ (baseline to one year follow-up)

References

    1. Fleming A, Benn RT, Corbett M, Wood PH. Early rheumatoid arthritis disease. II. Patterns of joint involvement. Ann Rheum Dis. 1976;35:361–4. doi: 10.1136/ard.35.4.361.
    1. De la Mata LJ, Palacios CJ. Rheumatoid arthritis: are outcomes better with medical or surgical management? Orthopedics. 1998;21:1085–6.
    1. TRIEB K. Treatment of the wrist in rheumatoid arthritis. J Hand Surg [Am] 2008;33:113–23. doi: 10.1016/j.jhsa.2007.09.011.
    1. Rehim SA, Chung KC. Applying evidence in the care of patients with rheumatoid hand and wrist deformities. Plast Reconstr Surg. 2013;132:885–97. doi: 10.1097/PRS.0b013e31829fe5e1.
    1. Ghattas L, Mascella F, Pomponio G. Hand surgery in rheumatoid arthritis: state of the art and suggestions for research. Rheumatology (Oxford) 2005;44:834–45. doi: 10.1093/rheumatology/keh608.
    1. Pincus T, Callahan LF. Rheumatology function tests: grip strength, walking time, button tests and questionnaires document and predict long-term morbidity and mortality in rheumatoid arthritis. J Rheumatol. 1992;19:1051–7.
    1. Wolfe F, Michaud K, Gellefer O, Choi HK. Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum. 2003;48:1530–42. doi: 10.1002/art.11024.
    1. Verhoeven AC, Boers M, Van Der Linden S. Responsiveness of the core set, response criteria, and utilities in early rheumatoid arthritis. Ann Rheum Dis. 2000;59:966–74. doi: 10.1136/ard.59.12.966.
    1. Bellamy N, Boers M, Felson D, Fries J, Furst D, Henry D, et al. Health status instruments/utilities. J Rheumatol. 1995;22:1203–7.
    1. Whole F. A reappraisal of HAQ disability in rheumatoid arthritis. Arthritis Rheum. 2000;43:2751–42. doi: 10.1002/1529-0131(200012)43:12<2751::AID-ANR15>;2-6.
    1. Yelin E, Trupin L, Wong B, Rush S. The impact of functional status and change in functional status on mortality over 18 years among persons with rheumatoid arthritis. J Rheumatol. 2002;29:1851–7.
    1. Burton W, Morrison A, Maclean R, Ruderman E. Systematic review of studies of productivity loss due to rheumatoid arthritis. Occup Med (Lond) 2006;56:18–27. doi: 10.1093/occmed/kqi171.
    1. Marra CA, Woolcott JC, Kopec JA, Shojania K, Offer R, Brazier JE, et al. A comparison of generic, indirect utility measures (the HUI2, HUI3, SF-6D and the EQ-5D) and disease-specific instruments (the RAQoL, and the HAQ) in rheumatoid arthritis. Soc Sci Med. 2005;60:1571–82. doi: 10.1016/j.socscimed.2004.08.034.
    1. Waljee JF, Chung KC, Kim HM, Burns PB, Burke FD, Wilgis EF, et al. Validity and responsiveness of the Michigan Hand Questionnaire in patients with Rheumatoid Arthritis: a multicenter, international study. Arthritis Care Res. 2010;62:1569–77. doi: 10.1002/acr.20274.
    1. Shauver MJ, Chung KC. The Michigan Hand Outcomes Questionnaire (MHQ) after 15 years of field trial. Plast Reconstr Surg. 2013;131(5):779e–87. doi: 10.1097/PRS.0b013e3182865d83.
    1. Hudak PL, Amadio PC, Bombardier C. Development of an upper extremity outcome measure: the DASH (Disabilities of the Arm, Shoulder and Hand). The Upper Extremity Collaborative Group (UECG) Am J Ind Med. 1996;29:602–8. doi: 10.1002/(SICI)1097-0274(199606)29:6<602::AID-AJIM4>;2-L.
    1. Bilberg A, Bremell T, Mannerkorpi K. Disability of the Arm, Shoulder and Hand questionnaire in Swedish patients with rheumatoid arthritis: a validity study. J Rehabil Med. 2012;44:7–11. doi: 10.2340/16501977-0887.
    1. Raven EE, Haverkamp D, Sierevelt IN, van Montfoort DO, Pöll RG, Blankevoort L, et al. Construct validity and reliability of the disability of arm, shoulder and hand questionnaire for upper extremity complaints in rheumatoid arthritis. J Rheumatol. 2008;35:2334–8. doi: 10.3899/jrheum.080067.
    1. Hunsaker FG, Cioffi DA, Amadio PC, Wright JG, Caughlin B. The American academy of orthopaedic surgeons outcomes instruments: normative values from the general population. J Bone Joint Surg Am. 2002;84-A(2):208–15.
    1. Johnsson PM, Eberhardt K. Hand deformities are important sings of disease severity in patients with early rheumatoid arthritis. Rheumatology (Oxford) 2009;48:1398–401. doi: 10.1093/rheumatology/kep253.
    1. Eberhardt K, Johnson PM, Rydgren L. The occurrence and significance of hand deformities in early rheumatoid arthritis. Br J Rheumatol. 1991;30:211–3. doi: 10.1093/rheumatology/30.3.211.
    1. Aktekin LA, Eser F, Baskan BM, Sivas F, Malhan S, Öksüz E, et al. Disability of Arm Shoulder and Hand Questionnaire in rheumatoid arthritis patients: relationship with disease activity, HAQ, SF-36. Rheumatol Int. 2011;31:823–6. doi: 10.1007/s00296-010-1568-1.
    1. Bodur H, Yilmaz Ö, Keskin D. Hand disability and related variables in patients with rheumatoid arthritis. Rheumatol Int. 2006;26:541–4. doi: 10.1007/s00296-005-0023-1.
    1. Vliet Vlieland TP, Van Der Wijk TP, Jolie IM, Zwinderman AH, Hazes JM. Determinants of hand function in patients with rheumatoid arthritis. J Rheumatol. 1996;23:835–40.
    1. Singh H, Kumar S, Talapatra P, Gupta V, Ray S, Kumar H. Assessment of hand functions in rheumatoid arthritis using SF-SACRAH (short form score for the assessment and quantification of chronic rheumatoid affections of the hands) and its correlation to disease activity. Rheumatol Int. 2012;32:3413–9. doi: 10.1007/s00296-011-2201-7.
    1. Eberhardt K, Sandqvist G, Geborek P. Hand function tests are important and sensitive tools for assessment of treatment response in patients with rheumatoid arthritis. Scand J Rheumatol. 2008;37:109–12. doi: 10.1080/03009740701747129.
    1. Parra-Salcedo F, Contreras-Yáñez I, Elías-López D, Aguilar-Salinas CA, Pascual-Ramos V. Prevalence, incidence, and characteristics of the metabolic syndrome (MetS) in a cohort of Mexican Mestizo early rheumatoid arthritis patients treated with conventional disease modifying anti-rheumatic drugs: the complex relationship between MetS and disease activity. Arthritis Res Ther. 2015;17:34. doi: 10.1186/s13075-015-0549-x.
    1. Mäkinen H, Kautiainen H, Hannonen P, Sokka T. Is DAS28 an appropriate tool to assess remission in rheumatoid arthritis? Ann Rheum Dis. 2005;64:1410–3. doi: 10.1136/ard.2005.037333.
    1. Mathiowetz V, Kashman N, Volland G, Weber K, Dowe M, Rogers S. Grip and pinch strength: normative data for adults. Arch Phys Med Rehabil. 1985;66:69–74.
    1. Welsing PM, Van Gestel AM, Swinkels HL, Kiemeney LA, Van Riel PL. The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum. 2001;44:2009–17. doi: 10.1002/1529-0131(200109)44:9<2009::AID-ART349>;2-L.
    1. Häkkinen A, Kautiainen H, Hannonen P, Ylinen J, Mäkinen H, Sokka T. Muscle strength, pain, and disease activity explain individual subdimensions of the Health Assessment Questionnaire disability index, especially in women with rheumatoid arthritis. Ann Rheum Dis. 2006;65:30–4. doi: 10.1136/ard.2004.034769.
    1. Sheehy C, Evans V, Hasthorpe H, Mukhtyar C. Revising DAS28 scores for remission in rheumatoid arthritis. Clin Rheumatol. 2014;33:269–72. doi: 10.1007/s10067-013-2468-z.
    1. Kuiper S, Van Gestel AM, Swinkels HL, De Boo TM, Da Silva JA, Van Riel PL. Influence of sex, age, and menopausal state on the course of early rheumatoid arthritis. J Rheumatol. 2001;28:1809–16.
    1. Young A, Dixey J, Cox N, Davies P, Devlin J, Emery P, et al. How does functional disability in early rheumatoid arthritis (RA) affect patients and their lives? Results of 5 years of follow-up in 732 patients from the Early RA Study (ERAS) Rheumatology (Oxford) 2000;39:603–11. doi: 10.1093/rheumatology/39.6.603.
    1. Dougados M. Comorbidities in rheumatoid arthritis. Curr Opin Rheumatol. 2016;28:282–8. doi: 10.1097/BOR.0000000000000267.
    1. Geryk LL, Carpenter DM, Blalock SJ, DeVellis RF, Jordan JM. The impact of comorbidity on health-related quality of life in rheumatoid arthritis and osteoarthritis patients. Clin Exp Rheumatol. 2015;33(3):366–74.
    1. Ellerby N, Mattey DL, Packham J, Dawes P, Hider SL. Obesity and comorbidity are independently associated with a failure to achieve remission in patients with established rheumatoid arthritis. Ann Rheum Dis. 2014;73:e74. doi: 10.1136/annrheumdis-2014-206254.
    1. London DA, Stepan JG, Boyer MI, Calfee RP. The impact of depression and pain catastrophization on initial presentation and treatment outcomes of atraumatic hand conditions. J Bone Joint Surg Am. 2014;96(10):806–14. doi: 10.2106/JBJS.M.00755.
    1. Calfee R, Chu J, Sorensen A, Martens E, Elfar J. What is the impact of comorbidities on self-reported hand function in patients with symptomatic trapeziometacarpal arthritis. Clin Orthop Relat Res. 2015;473:3477–83. doi: 10.1007/s11999-015-4507-3.
    1. Chung KC, Burns PB, Reichert HA, Fox DA, Burke FD, Wilgis EF, et al. Properties of the International Classification for Functioning, Disability and Health in assessing hand outcomes in patients with rheumatoid arthritis. J Rehabil Med. 2011;43:292–8. doi: 10.2340/16501977-0671.

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