Serological and Progression Differences of Joint Destruction in the Wrist and the Feet in Rheumatoid Arthritis - A Cross-Sectional Cohort Study. 


                        Yosuke Hamamoto, 

                        Hiromu Ito, 

                        Moritoshi Furu, 

                        Motomu Hashimoto, 

                        Takao Fujii, 

                        Masahiro Ishikawa, 

                        Noriyuki Yamakawa, 

                        Chikashi Terao, 

                        Masayuki Azukizawa, 

                        Takahiro Iwata

Published: August 28, 2015

DOI: 10.1371/journal.pone.0136611

Joint destruction in the wrist and feet in rheumatoid arthritis-a comparison

In a nutshell

The authors evaluated the progression of joint destruction in wrist and feet rheumatoid arthritis (RA). 

Some background

In RA, high levels of immune system proteins are generated. This causes inflammation, leading to chronic pain and structural joint damage. In the early stage of the disease, joint inflammation can affect daily function. In the later stages, joint destruction can further worsen physical disabilities. Joint destruction in the wrist and feet in RA is a frequent occurrence that can affect daily function in the long term.

Comparison of the wrist and feet, in terms of the progression of joint destruction, needs to be investigated for the development of better RA treatment options. 

Methods & findings

The authors aimed to compare joint destruction between the wrist and feet in RA patients.

314 RA patients were analyzed in this study. The average duration of disease was 13 years. 4 groups were used in this study. 62 patients in group 1 had established joint destruction in both the right wrist and feet. 74 patients in group 2 had established joint destruction in the wrist only. 53 patients in group 3 had established joint destruction in the feet only. 125 patients in group 4 did not have any established joint destruction in either the wrist or the feet.

Initially, when patients were further divided based on the duration of RA disease, joint destruction in group 3 was highest. However over time, joint destruction in group 3 and group 4 was significantly lower than group 1 and group 2. The DAS28 score of group 3 and group 4 was significantly lower than that of group 1. DAS28 is an assessment used to measure the progress and improvement of RA by examining 28 joints.

When evaluated for the presence of anti-CCP (a protein present in RA patients used as a predictive factor), patients in group 2 were at a 4.48 times higher risk of joint destruction compared to the other three groups. Rheumatoid factor (RF – substance present in the blood of RA patients) was not predictive of joint destruction in either the feet or wrist.  

The bottom line

The authors concluded that joint destruction in the feet started earlier than in the wrist but that joint destruction in the wrist progressed more rapidly. They also indicated that anti-CCP status was a good predictor of joint destruction in RA in the wrist.