A RECENT cohort study has explored the progression of disability in the upper extremities (UEs) in patients with early rheumatoid arthritis (RA) and its correlation with clinical variables, such as grip strength and pain. Over a 10-year follow-up period, the research highlights fluctuations in disability levels and emphasises the significant impact of pain and hand function on daily activities.
The study included 222 patients diagnosed with early RA between 1995 and 2005, assessing UE disability using a subscore of the Health Assessment Questionnaire–Disability Index (HAQ-DI-UE) and measuring average grip force of the dominant hand. Researchers tracked changes in disability at regular follow-ups and analysed correlations between disability and key disease variables.
Findings revealed that UE disability decreased significantly during the first six months after diagnosis, with an average reduction of 0.26 points on the HAQ-DI-UE scale. However, disability levels increased after two years, highlighting the chronic nature of RA-related impairments. Throughout the follow-up, disability was strongly correlated with grip force (r = –0.50 to –0.62), patient-reported pain (r = 0.54 to 0.60), and global health assessment scores (r = 0.53 to 0.64). By contrast, inflammatory markers such as swollen joints, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR) showed weaker correlations with disability.
Joint tenderness, particularly in the wrist and shoulder, was a key predictor of UE disability, with wrist synovitis being independently associated at diagnosis. This underscores the importance of addressing hand function and pain management early in the disease course to mitigate long-term disability.
The study highlights the fluctuating nature of UE disability in RA and underscores the need for targeted interventions to preserve hand strength and function, potentially improving patient outcomes over the long term.
Reference
Rydholm M et al. Disability Related to the Upper Extremities in Early Rheumatoid Arthritis—Long-Term Course and Disease Variable Impact: A Cohort Study. Ann Rheum Dis. 2024;DOI:10.3899/jrheum.2024-0608.
