Having More Tender Than Swollen Joints Is Associated With Worse Patient-Reported Outcomes in Patients With Early RA

Charis F Meng; Yvonne C Lee; Orit Schieir; Marie-France Valois; Margaret A Butler; Gilles Boire; Glen Hazlewood; Carol Hitchon; Edward Keystone; Diane Tin; Carter Thorne; Louis Bessette; Janet Pope; Susan J Bartlett; Vivian P Bykerk; Canadian Early Arthritis Cohort Investigators

doi:10.1097/RHU.0000000000002091

Having More Tender Than Swollen Joints Is Associated With Worse Patient-Reported Outcomes in Patients With Early RA

J Clin Rheumatol. 2024 May 1. doi: 10.1097/RHU.0000000000002091. Online ahead of print.

Authors

Affiliations

¹ From the Hospital for Special Surgery, Division of Rheumatology, Weill Cornell Medical College, New York, NY.
² Northwestern University Feinberg School of Medicine, Medicine/Rheumatology, Chicago, Illinois.
³ University of Toronto, Dalla Lana School of Public Health.
⁴ McGill University, Montreal, Quebec, Canada.
⁵ Hospital for Special Surgery, Division of Rheumatology, New York, NY.
⁶ Université de Sherbrooke, Medicine, Quebec, Canada.
⁷ University of Calgary, Department of Medicine, Alberta, Canada.
⁸ University of Manitoba, Department of Internal Medicine, Winnipeg, Canada.
⁹ University of Toronto, Ontario, Canada.
¹⁰ Southlake Regional Health Centre, Centre of Arthritis Excellence, TAP Research Group, Ontario, Canada.
¹¹ Université Laval, Quebec City, Quebec, Canada.
¹² University of Western Ontario, London, Ontario, Canada.
¹³ Hospital for Special Surgery and Mount Sinai Hospital, Weill Cornell Medical College, New York, NY.

PMID: 38689390
DOI: 10.1097/RHU.0000000000002091

Abstract

Background/objective: In patients with rheumatoid arthritis (RA), high tender-swollen joint differences (TSJDs) have been associated with worse outcomes. A better understanding of the phenotype and impact of high TSJD on patient-reported outcomes (PROs) in early RA may lead to earlier personalized treatment targeting domains that are important to patients today. Our objectives were to evaluate the impact of TSJD on updated PROs in patients with early RA over 1 year and to determine differences in associations by joint size.

Methods: This longitudinal cohort study followed patients with active, early RA enrolled in the Canadian Early Arthritis Cohort between 2016 and 2022, who completed clinical assessments and PROMIS-29 measures over 1 year. Twenty-eight joint counts were performed and TSJDs calculated. Adjusted associations between TSJD and PROMIS-29 scores were estimated using separate linear-mixed models. Separate analyses of large versus small-joint TJSDs were performed.

Results: Patients with early RA (n = 547; 70% female; mean [SD] age, 56 [15] years; mean [SD] symptom duration, 5.3 [2.9] months) were evaluated. A 1-point increase in TSJD was significantly associated with worse PROMIS T-scores in all domains: physical function (adjusted regression coefficient, -0.27; 95% confidence interval [CI], -0.39, -0.15), social participation (adjusted regression coefficient, -0.34; 95% CI, -0.50, -0.19), pain interference (adjusted regression coefficient, 0.49; 95% CI, 0.35, 0.64), sleep problems (adjusted regression coefficient, 0.29; 95% CI, 0.16, 0.43), fatigue (adjusted regression coefficient, 0.34; 95% CI, 0.18, 0.50), anxiety (adjusted regression coefficient, 0.23; 95% CI, 0.08, 0.38), and depression (adjusted regression coefficient, 0.20; 95% CI, 0.06, 0.35). Large-joint TSJD was associated with markedly worse PROs compared with small-joint TSJD.

Conclusions: Elevated TSJD is associated with worse PROs particularly pain interference, social participation, and fatigue. Patients with more tender than swollen joints, especially large joints, may benefit from earlier, targeted therapeutic interventions.