Predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis

Abstract

Objectives: To identify early predictors of stenosing tenosynovitis in the hand and hand-related activity limitations in patients with rheumatoid arthritis (RA).

Design: A longitudinal study of an inception cohort.

Setting: A large outpatient clinic.

Participants: Consecutive patients who attended the Early Arthritis Clinic for at least 2 years and fulfilled the American College of Rheumatology criteria for RA at baseline and/or at the 1-year follow-up were invited to participate until 200 patients were included.

Interventions: Not applicable.

Main outcome measures: Stenosing tenosynovitis, assessed by means of a standardized physical examination. Hand-related activity limitations, assessed with the Disabilities of Arm, Shoulder and Hand questionnaire (DASH). A DASH score above the upper limit of the 95% range of the normative score was defined as abnormal. Prognostic factors: demographic and disease activity-related variables, radiographic damage, the Health Assessment Questionnaire (HAQ) total score and category scores at the 2-year follow-up.

Results: The mean age ± SD of the patients was 59.7±10.7 years (75% female). The mean time ± SD between the 2-year follow-up and the assessment of the dependent variables was 3.9±2.7 years. Stenosing tenosynovitis was present in 33%. The median (interquartile range) DASH score was 26.7 (10.8-42.5); 30% were abnormal. Stenosing tenosynovitis was predicted by the HAQ subscale regarding the use of hands (HAQ-hand) at the 2-year follow-up (odds ratio [OR], 2.3; 95% confidence interval [CI], 1.2-4.2). Hand-related activity limitations were predicted by the Disease Activity Score in 28 joints (OR, 1.8; 95% CI, 1.3-2.4) and HAQ-hand (OR, 2.4; 95% CI, 1.3-5.8) at the 2-year follow-up.

Conclusions: Stenosing tenosynovitis in patients with RA was predicted by HAQ-hand at the 2-year follow-up, and hand-related activity limitations were predicted by disease activity and HAQ-hand at the 2-year follow-up.