RESEARCH - Hand deformities are important signs of disease severity in patients with early RA

October 17, 2009

Rheumatology Advance Access originally published online on August 31, 2009

Rheumatology 2009 48(11):1398-1401; doi:10.1093/rheumatology/kep253

Hand deformities are important signs of disease severity in patients

with early rheumatoid arthritis

Pia M. sson1 and Kerstin Eberhardt1

1Department of Rheumatology, Lund University Hospital, Lund, Sweden.

Abstract

Objectives. The aim of this study was to investigate the occurrence

and significance of hand deformities during the first 10 years of RA.

Methods. One hundred and eighty-three early RA patients were included

in the study during 1985–89. Mean ± S.D. of age at onset was 51.4 ±

12.4 years, and mean duration of symptoms before inclusion 12 ± 7

months; 64% were women. The patients were followed annually.

Assessment of hand deformities was standardized. Hand mobility was

measured by signals of functional impairment (SOFI), disability by HAQ

and hand HAQ, disease activity by ESR and radiographic changes by the

Larsen method.

Results. One hundred and eight (59%) patients developed at least one

hand deformity during the study time. The majority occurred during the

first years. After 10 years, the rate of ulnar deviation, button hole

deformity and swan neck deformity was 44, 24 and 23.5%, respectively.

The deformity group showed significantly higher disease activity

during the first 5 years, and significantly more hand impairment, more

disability and more severe radiographic changes throughout the study.

Presence of a deformity after 1 year increased the risk of developing

a Larsen score above median after 5 years. Odds ratio (95% CI) was 2.1

(1.023, 4.385).

Conclusions. More than half of the patients in this early RA cohort

had developed hand deformities after 10 years. Most deformities

occurred during the first year of the disease. Presence of hand

deformities had an impact on daily life function and added useful

prognostic information, being an early sign of a more severe disease.

Not an MD

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