AB0598 44% OF SWOLLEN JOINTS IN RHEUMATOID ARTHRITIS PATIENTS WITH A MEDIAN OF 10 YEARS OF DISEASE ALSO HAVE JOINT DEFORMITY OR LIMITED MOTION, PRECLUDING RESOLUTION TO A NORMAL JOINT
Authors: T. Pincus, R. Hunter, N. Rodwell
Journal: Annals of the Rheumatic Diseases (2024)

<h3>Background:</h3> The initial report of a 28-joint count in rheumatoid arthritis (RA) indicated assessment of 3 abnormalities, swelling (SWL), tenderness or pain on motion (TEN), and deformity or limited motion (DEF) in 10 proximal interphalangeal (PIP) joints, 10 metacarpophalangeal (MCP) proximal interphalangeal (PIP) joints, 10 metacarpophalangeal (MCP) joints, 2 wrists, 2 elbows, 2 shoulders, and 2 knees, 2 provide total swollen (SJC), tender/pain on motion (TJC) and deformity/limited motion scores (Arth Rheum 1989;32:531). Only SJC and TJC are included in the RA core dataset or in clinical trials to assess reduction of inflammation by therapeutic agents in groups, appropriately, as DJC is unlikely to change over 6-12 months. However, omission of DJC has been extended to most long-term routine care and longitudinal databases, in which it may be inappropriate, as SJC and TJC appear stable over 5 years while DJC and radiographs indicate progression (Arth Care Res 1997;10:381). The proportion of swollen joints which also are positive for deformity and/or limited motion in patients who are monitored over long periods in routine care has not been reported. <h3>Objectives:</h3> To analyze 28 joint counts in patients with RA monitored over long periods in routine care, to recognize the proportion of swollen joints which also were positive for deformity/limited motion, precluding resolution to a normal joint. <h3>Methods:</h3> A standard 28 joint count was performed at a routine care visit of RA patients with median disease duration of 10 years. Each of 3 abnormalities, SWL, TEN, and DEF, were recorded for each of the 28 joints, as well as total SJC, TJC, and DJC. Each specific joint with SWL was classified into 6 groups: a. all SWL+,TND+or-,DEF+or-; b. swelling only:SWL+,TND-,DEF-; c. SWL+,TND-,DEF+; d. SWL+,TND+,DEF+; e. SWL+,TND+,DEF-; f. SWL+,TND+or-,DEF+ (c+d). Right (R) and left (L) wrist, elbow, and knee joints were added (total=2) for each individual joint (shoulder swelling is not assessed in a 28 joint count), and all 10 left and right proximal interphalangeal (PIP) joints and right and left metacarpophalangeal joints (MCP) were added together (total=10) to represent these joints. <h3>Results:</h3> The study included 173 patients with mean and median age of 59.9 and 61.3, and mean and median disease duration of 11.6 and 10.0 years, respectively. Mean and median SJC were 1.7 and 0, TJC 3.9 and 2, and DJC 5.5 and 4, respectively. Overall, 286 joints with SWL were identified in 173 patients (Group a) (Table 1); 37 (13%) with only SWL+,TND-,DEF- (Group b); 44 (16%) with SWL+,TND-,DEF+ (Group c); 80 (28%) with SWL+,TND+,DEF+ (Group d); 125 (44%[sic]) with SWL+,TND+,DEF- (Group e); and 124 (43%) with SWL+,DEF+,TEN+or- (Group f). Overall, 43% of all SWL+ joints were DEF+ (and/or TEN+or-), with similar patterns for all joints or groups, including 34% of PIP joints, 42% of MCP joints and knees, 44% of elbows, and 56% of wrists (Table 1). The highest number with SWL were wrists (17%), followed by MCP joints (7%). The highest number with SWL only was knees (21%), with SWL+,TEN+or–,DEF+ was wrists (56%), with SWL+,TEN+,DEF+ was knees (42%) (Table 1), although differences were not large. <h3>Conclusion:</h3> Patients with median disease duration of 10 years treated in the biological era have low total SJC scores, indicating strong control of inflammation. However, swelling with joint deformity is seen in 43% of joints, &gt;3 times swelling only, precluding resolution to a normal joint. Assessment only of SJC and TJC without DJC may give inappropriately favorable impressions of patient status and long-term RA outcomes at this time. DJC might be included in all formal joint counts in routine clinical care and long-term databases. <b>Table 1.</b> <h3>REFERENCES:</h3> <b>NIL.</b> <h3>Acknowledgements:</h3> <b>NIL.</b> <h3>Disclosure of Interests:</h3> <b>None declared.</b>