E071 Which clinical, ultrasound and OT hand assessments are most useful in predicting hand disability in early rheumatoid arthritis?
Authors: Harkness Cathryn , Ball Elisabeth , Wright Stephen , Crone Emma , Henry Emma , Foster Leanne , Farmer Helen , Bell Aubrey 
Published: April 2023

Background/Aims

Developing a clear understanding of the features of hand involvement that are associated with future disability will assist in designing future OT clinical intervention studies and will aid in selecting RA patients for intensive hand therapy and early aggressive medical treatment. This study aimed to determine which hand assessments best predicted hand disability in patients with early Rheumatoid arthritis (RA).

Methods

63 early RA patients with hand symptoms were identified from Rheumatology clinics in the Belfast Health and Social Care Trust. Assessments were undertaken at baseline and at 1 year. Hand disability outcome was measured using the Sequential Occupational Dexterity Assessment (SODA). Grip Strength (GS), Total Pain Score (PS), Modified Kapandji index (MK), Stanford Health Assessment Questionnaire (HAQ) and Moberg pick up test (MoV) were assessed by trained occupational therapists (OTs); Ultrasound assessments of hand and wrist were undertaken by trained rheumatologists. Summated (Global) hand and wrist Ultrasound activity score (G-UAS), hand and wrist Power Doppler score (G-PD), and ultrasound erosion score were calculated. Hand deformity score (DS), standardised hand X-ray, Das-28, RF and anti-CCP antibody were undertaken at each assessment.

Results

There was no significant change in the median SODA score after one year. The main static predictor for baseline SODA was HAQ (25% of the variability). DAS28, MK and Grip Average were statistically significant on their own accounting for between 6-10% variability in the model but when all significant explanatory variables were included HAQ was the only significant variable (23%). Regression for year 1 SODA showed that the main static predictor was MK (adjusted R-squared 59%). PS, DAS28 and GS were statistically significant on their own accounting for between 7-23% variability, but when all significant explanatory variables were included, the MK was the only one of significance (58%). Regressing all explanatory variables against SODA resulted in an adjusted R-squared of 61%: MK and G-UAS (although not significant on its own) were the only ones that were significant. When baseline data was used to predict year 1 SODA, HAQ, MK, PS, DAS28 and GS were statistically significant on their own, but when all significant explanatory variables were included only HAQ and MK were significant explaining 57% of the variability. When HAQ was excluded, PS, DAS28 and GS were statistically significant on their own accounting for between 10-19% variability. When all significant explanatory variables were included, MK was the only one that was significant (adjusted R-squared was 50%).

Conclusion

Amongst the variables assessed, the HAQ showed good overall prediction for SODA as expected. MK was the most reliable time-lag predictor of hand disability at one year in early RA. X-ray, MoV, GS and ultrasound assessments were much less associated but longer follow-up studies would be useful.

Disclosure

C. Harkness: None. E. Ball: None. S. Wright: None. E. Crone: None. E. Henry: None. L. Foster: None. H. Farmer: None. A. Bell: None.