Can erosion severity be predictor of functional status in patients with rheumatoid arthritis?

Abstract

Aim: Rheumatoid arthritis (RA) is a systemic disease that primarily characterized by chronic inflammation of the diarthrodial joints. Synovitis, joint erosions and functional disorders are the main findings of the disease. In this study, we aimed to investigate whether functional impairment is related to radiological erosions in RA

Methods:Sixty-eight patients who diagnosed to have RA according toAmerican College of Rheumatology (ACR) criteria were included in the study. The demographic characteristics of patients, the duration and severity of morning stiffness imprisonment, and the severity of pain were recorded. Erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) were evaluated. Disease activity was assessed by Ritch index and DAS28 score, and functional status by Health Assessment Questionnaire (HAQ) and Duruöz Hand Index (DHI). The severity of the erosions was graded according to the Larsen score from radiographs of hand and foot

Results: Patients had the mean age 54.30±11.27  and an average disease duration of 8,4±6,4 years.  There was no correlation between HAQ and DHI and Larsen score (p> 0.05). However, statistically significant correlation was found between HAQ and DHI with duration and severity of morning stiffness, verbal pain score, Ritch index and DAS 28(p<0.05).

Conclusion: The radiological erosisons in patients with RA may not be indicator of functional status. Therefore, we think that not only radiological evaluation but also functional status must be followed by regularly in  the planning and follow-up of RA.

Keywords

• Rheumatoid arthritis,severity of erosion,Larsen score,functional status,HAQ

Romatoid Artritli Hastalarda Erozyon Şiddeti Fonksiyonel Durumun Belirleyicisi Olabilir Mi?

Öz

Amaç: Romatoid artrit (RA) başlıca diartrodial eklemlerin kronik inflamasyonu ile karakterize sistemik bir hastalıktır. Sinovit, eklem erozyonları ve fonksiyonel bozukluk hastalığın temel bulgularıdır. Bu çalışmada RA’da fonksiyonel bozukluğun radyolojik erozyonlarla ilişkisi olup olmadığını araştırmayı amaçladık.

Materyal-metod: Amerika Romatoloji Birliği (ACR) kriterlerine göre RA tanısı konan 68 (59 kadın, 9 erkek) hasta çalışmaya alındı. Hastaların demografik özellikleri, sabah tutukluğunun süresi ve şiddeti, ağrının şiddeti sorgulandı. Laboratuar parametrelerinden eritrosit sedimantasyon hızı (ESR) ve C-reaktif protein (CRP) düzeyleri değerlendirildi. Hastalık aktivitesi Ritch indeksi ve DAS28 skoru ile, fonksiyonel durum ise Sağlık Değerlendirme Anketi (HAQ) ve Duruöz El Skalası (DHI) ile değerlendirildi. Erozyonların şiddeti el ve ayak grafilerinden Larsen skoruna göre derecelendirildi. 

Bulgular: Çalışmaya alınan hastaların ortalama yaşı 54.30±11.27 ve ortalama hastalık süresi 8,4±6,4 yıldı. HAQ ve DHI ile Larsen skoru arasında herhangi bir korelasyon saptanmadı (p>0.05).  Ancak gerek HAQ, gerekse DHI ile sabah tutukluğunun süresi ve şiddeti, verbal ağrı skoru, ritch indeksi ve DAS 28 skorları arasında istatistiksel olarak anlamlı korelasyon saptandı (p<0.05).

Sonuç: RA’lı hastalarda radyolojik olarak saptanan erozyonlar fonksiyonel durumun bir göstergesi olmayabilir. Bu nedenle RA’da tedavinin planlanmasında ve takibinde sadece radyolojik değerlendirmelerle sınırlı kalınmayarak hastaların fonksiyonel durumlarının da mutlaka düzenli takip edilmesi gerektiğini düşünmekteyiz

Anahtar Kelimeler

• Romatoid artrit,erozyon şiddeti,Larsen skoru,Fonksiyonel durum,HAQ

Kaynakça

1. 1) Navarro-Compan V, Landewe R, Provan SA, Odegard S, Uhlig T, Kvien TK, et al. Relationship between types of radiographic damage and disability in patients with rheumatoid arthritis in the EURIDISS cohort: a longitudinal study. Rheumatology 2015;54:83-90
2. 2) Aletaha D, Funovits J, Smolen JS. Physical disability in rheumatoid arthritis is associated with cartilage damage rather than bone destruction. Ann Rheum Dis 2011;70:733-9.
3. 3) Radner H, Smolen JS, Aletaha D. Comorbidity affects all domains of physical function and quality of life in patients with rheumatoid arthritis. Rheumatology 2011;50:381-8.
4. 4) Kaya T, Karatepe AG, Günaydın R, Türkmen G, Özbek G. Romatoid artritli hastalarda yaşam kalitesi: hastalık aktivitesi, fonksiyonel durum ve sağlık durumu ile ilişkisi. Romatizma 2007;2:119-22.
5. 5) Zvaifler NJ, Etiology and Pathogenesis of Rheumatoid arthritis. In Arthritis & Allied Conditions. McCarty DJ, Kopman WJ (eds) 12th ed. Philadelphia, Lea&Febiger, 1993. 723-36
6. 6) Favalli EG, Becciolini A, Biggioggero M. Structural integrity versus radiographic progression in rheumatoid arthritis. Rheum&Musculoskeletal Diss 2015;1(Suppl 1):e000064
7. 7) Plant M. Radiological progression and outcome in early rheumatoid arthritis. MD Thesin. University of London,1996
8. 8) Şahin-Akyar G. Romatoid Artrit: Görüntüleme Yöntemleri:İn: Immunoloji-romatoloji.Romatoid Artrit özel sayısı. 2001.Sayfa 14-25

9. 9) MacGregor JA, Silman JA. Classification and epidemiology. In:Rheumatology. Ed’s; Hochberg CM, Silman JA, Weinblatt EM, Weisman HM, Smolen SJ. Mosby, Fourth Edition, 2008, pp;755-61.
10. 10) Van Gestel AM, Haagsma CJ, van Riel PLCM. Validation of rheumatoid arthritis improvement criteria that include simplified joint counts. Arthritis Rheum. 1998; 41(10):1845-50.
11. 11) Başaran S, Güzel R, Sarpel T. Yaşam kalitesi ve sağlık sonuçlarını değerlendirme ölçütleri. Romatizma 2005;20(1):55-63.
12. 12) Küçükdeveci A, Şahin H, Ataman S, Griffiths B, Tennant A Issues in cross-cultural validity: example from adaptation, reliability and validity of a Turkish version of the Stanford Health Assessment Questionnaire. Arthritis Rheum 2004;51(1):14-9.
13. 13) Poole JL, Measures of adult hand function. Arthritis Rheum 2003;49:59-66
14. 14) Duruöz MT, Poiraudeau S, Fermanian J, Menkes C, Amor B, Dougados M, et al, Development and validation of a rheumatoid hand functional disability scale that assesses functional handicap. J Rheumatol 1996;23:1167-72.
15. 15) Larsen A. How to apply Larsen score in evaluating radiographs of rheumatoid arthritis in longterm studies?, J Rheumatol, 1995:22:1974-5.
16. 16) Paimela L, Laasonen Li Helve T. Comparision of the original and the modified Larsen methods an the Sharp method in scoring radiographic progression in early rheumatoid arthritis. J Rheumatol 1998;25:1063-6.
17. 17) Tuulikki S, Annalhsa K, Pekka h. Scores for functional disability in patients with rheumatoid arthritis are correlated at higher levels with pain scores than with radiographic scores, Arthritis Rheum 2000;43:386-9.
18. 18) Yaşa E, Öz B, Ölmez N, Memiş Asuman. Romatoid Artrit Hastalarında El Deformiteleri ile Disabilite Arasındaki ilişki. J PMR Sci 2011;14:16-22
19. 19) Salaffi F, Stancati A. Disability and quality of life of patients with rheumatoid arthritis: assessment and perspectives. Reumatismo 2004;56:87-106.
20. 20) Aletaha D, Smolen J, Ward MM. Measuring function in rheumatoid arthritis: identifying reversible and irreversible components. Arthritis Rheum 2006;54:2784-92.
21. 21) Aletaha D, Strand V, Smolen JS, Ward MM. Treatment-related improvement in physical function varies with duration of rheumatoid arthritis: a pooled analysis of clinical trial results. Ann Rheum Dis 2008;67:238-43 .
22. 22) Plant M. Radiological progression and outcome in early rheumatoid arthritis. MD Thesin. University of London,1996
23. 23) Özsoy MH, Altınel L, Başarır K, Çavuşoğlu AT, Dinçel E. Romatoid artritte eklem hastalığının patogenezi. TOTBİD Derg 2006;5:3-4
24. 24) Geuskens GA, Burdorf A, Hazes JM. Consequences of rheumatoid arthritis for performance of social roles-a literature review. The Journal of rheumatology. 2007;34(6):1248-60
25. 25) Eberhardt KB, Fex E. Functional inpairment and disability in early rheumatoid arthritis. Development over 5 years, J Rheumatol 1995;22:1037-42
26. 26) Arvidson NG, Larsson A, Larsen A. Simple function tests, but not modified HAQ, correlate with radiological joint damage in rheumatoid arthritis. Scand J Rheumato 2002;31:146-50.
27. 27) Houssein DA, Choy EHS. Berry H. Scott DL. Differences between the clinical and radiological progression of rheumatoid arthritis. Br J Rheumatol 1996:35(suppl. 1 ):199
28. 28) Paco MJ, Welsing AM, Gestel V. The relationship between disease activity, joint destruction, and functional capasity over thr course of rheumatoid arthritis. 2001:44(9);2009-17.
29. 29) Firestein GE: Etiology and pathogenesis of rheumatoid arthritis. Kelley WN, Harris ED, Ruddy S, Sledge CB (Ed.). Textbook of Rheumatology, 3. Ed. WB Saunders Company, Philadelphia 1997, 851-97.
30. 30) Regansmith M, Gerald TO,Kwoh CK. Lack of correlation between the steinbrocker staging of hand radiographs and the functional health status of individuals with rheumatoid arthritis. Arthritis&rheumatism 1989;32:126-33
31. 31) McEntegart A, Morrison E, Capell HA, Duncan MR, Porter D, Madhok R et al. Effect of social deprivation on disease severity and outcome in patients with rheumatoid arthritis. Ann Rheum Dis 1997;56:410-3.