Three groups in the 28 joints for rheumatoid arthritis synovitis--analysis using more than 17,000 assessments in the KURAMA database

PLoS One. 2013;8(3):e59341. doi: 10.1371/journal.pone.0059341. Epub 2013 Mar 12.

Abstract

Rheumatoid arthritis (RA) is a joint-destructive autoimmune disease. Three composite indices evaluating the same 28 joints are commonly used for the evaluation of RA activity. However, the relationship between, and the frequency of, the joint involvements are still not fully understood. Here, we obtained and analyzed 17,311 assessments for 28 joints in 1,314 patients with RA from 2005 to 2011 from electronic clinical chart templates stored in the KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance) database. Affected rates for swelling and tenderness were assessed for each of the 28 joints and compared between two different sets of RA patients. Correlations of joint symptoms were analyzed for swellings and tenderness using kappa coefficient and eigen vectors by principal component analysis. As a result, we found that joint affected rates greatly varied from joint to joint both for tenderness and swelling for the two sets. Right wrist joint is the most affected joint of the 28 joints. Tenderness and swellings are well correlated in the same joints except for the shoulder joints. Patients with RA tended to demonstrate right-dominant joint involvement and joint destruction. We also found that RA synovitis could be classified into three categories of joints in the correlation analyses: large joints with wrist joints, PIP joints, and MCP joints. Clustering analysis based on distribution of synovitis revealed that patients with RA could be classified into six subgroups. We confirmed the symmetric joint involvement in RA. Our results suggested that RA synovitis can be classified into subgroups and that several different mechanisms may underlie the pathophysiology in RA synovitis.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Arthritis, Rheumatoid / classification
  • Arthritis, Rheumatoid / complications
  • Arthritis, Rheumatoid / diagnosis*
  • Arthritis, Rheumatoid / pathology
  • Cluster Analysis
  • Databases, Factual
  • Female
  • Finger Joint / pathology*
  • Humans
  • Male
  • Middle Aged
  • Principal Component Analysis
  • Shoulder Joint / pathology*
  • Synovitis / classification
  • Synovitis / complications
  • Synovitis / diagnosis*
  • Synovitis / pathology
  • Wrist Joint / pathology*

Grants and funding

This study was supported by research grants from Mitsubishi Tanabe Pharma Corporation (http://www.mt-pharma.co.jp/e/), Eisai Co., Ltd. (http://www.eisai.co.jp/index.html), Abbott Japan Co., Ltd. (http://www.abbott.co.jp/), Chugai Pharmaceutical Co., Ltd. (http://www.chugai-pharm.co.jp/hc/ss/english/index.html), Pfizer Japan Inc. (http://www.pfizer.co.jp/pfizer/english/company/), and Bristol-Myyers K.K. (http://www.bms.co.jp/). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. No additional external funding was received for this study.