Measuring hand grip strength in rheumatoid arthritis

Effect of traditional Chinese Yijinjing exercise on hand dysfunction in rheumatoid arthritis patients: a randomized controlled trial

Introduction

Rheumatoid arthritis (RA) patients often experience significant hand dysfunction. Yijinjing, a traditional Chinese exercise, has been recognized for its benefits to mind-body health. This study aimed to evaluate the efficacy and safety of Yijinjing in improving hand dysfunction among individuals with RA.

Methods

This research was conducted as a single-center, outcome-blinded, randomized controlled trial. A total of 66 eligible RA participants were randomly assigned in a 1:1 ratio to either the Yijinjing exercise group (YJJG) with sessions conducted three times per week over a 12-week period or the control group (CG), which maintained ordinary activities. Various outcomes were assessed, including the Michigan Hand Outcomes Questionnaire (MHQ), handgrip strength, active range of motion (AROM), RA disease activity, the Health Assessment Questionnaire Disability Index (HAQ-DI), levels of anxiety and depression, and wrist ultrasound, all of which were collected at baseline and the week 12.

Results

At the end of the 12 weeks, the YJJG demonstrated significant improvements in MHQ scores compared to the CG (p < 0.05), alongside enhancements in handgrip strength and AROM, specifically in wrist extension, radial deviation, and metacarpophalangeal flexion (p < 0.05). Wrist ultrasound scores did not exhibit a significant increase in the YJJG, meaning no inflammation aggravation (p > 0.05). Additionally, morning stiffness duration, Disease Activity Score 28-ESR (DAS28-ESR), erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels showed significant improvement in the YJJG (p < 0.05). Both groups reported enhancements in quality of life, as well as reductions in anxiety and depression scores, with the YJJG displaying greater improvements overall (p < 0.05). Importantly, no adverse events or significant abnormalities in vital signs were observed in either group.

Conclusion

Yijinjing exercise may effectively enhance hand function, handgrip strength, and flexibility in RA patients with low disease activity. Furthermore, it appears to improve quality of life and reduce anxiety and depression without exacerbating joint inflammation.

Clinical trial registration

https://clinicaltrials.gov/study/NCT05527158, Identifier NCT05527158.

An engineered glove to follow finger function in rheumatoid arthritis: an observational prospective study

The engineered Hand Test System (HTS) glove has shown high reliability in assessing the baseline functional status of rheumatoid arthritis (RA) hand. Starting from this achievement, the aim of the present observational prospective study was to assess the functionality of the single fingers of rheumatoid hand at follow-up. Eighty RA patients performed HTS glove tests at baseline and among these fifty-six patients were re-tested after 7 months. The HTS glove parameters [Touch Duration (TD), Movement Rate (MR), Inter Tapping Interval (ITI)] were correlated with disease activity and disability clinimetric indexes [Disease Activity Score 28 joint count-C-reactive protein (DAS28-CRP), Clinical Disease Activity Index (CDAI), Simplified Disease Activity Index (SDAI), Health Assessment Questionnaire-Disability Index (HAQ-DI), grip strength, visual analogue scale of pain (VAS), patient global assessment (PGA)], and with laboratory values. HTS glove parameters (TD, ITI, and MR) showed statistically significant correlations with clinimetric and clinical indexes at both time points (p < 0.05). During follow-up, a statistically significant variation of all HTS glove parameters for the fingers that have performed both the worst or best HTS test at baseline was detected (p < 0.05), while the mean HTS glove parameter values by considering all fingers did not show a statistically significant variation over time, as well as the traditional clinimetric indexes. Besides the objective role in assessing the RA hand function by integrating the traditional clinimetric indexes, the HTS glove seems a useful tool for evaluating worst or best finger function during time by measuring the movement speed.

Risk Factors and Clinical Outcomes Associated With Sarcopenia in Rheumatoid Arthritis: A Systematic Review and Meta-analysis

ABSTRACT

Sarcopenia is underrecognized in patients with rheumatoid arthritis (RA). Risk factors of sarcopenia and its impact on outcomes in RA patients are relatively unknown. We conducted a systematic review to identify factors and outcomes associated with sarcopenia in RA. We conducted this review according to PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) 2020 guidelines. We searched PubMed, Embase, CINAHL, and Web of Science databases by combining the following search concepts: (1) RA and (2) sarcopenia. Articles were included if they included RA patients, assessed for sarcopenia using a consensus working group definition, and assessed for clinical outcomes. Meta-analysis was performed using studies that shared the same sarcopenia definition and consistency in reporting patient or disease variables. Our search identified 3602 articles. After removal of duplicates, title and abstract screen, and full-text review, 16 articles were included for final analysis. All studies had observational study designs. The pooled prevalence of sarcopenia ranged from 24% to 30%, depending on the criteria for sarcopenia used. Factors associated with sarcopenia included higher 28-joint Disease Activity Scale scores (+0.39; 95% confidence interval, +0.02 to +0.77) and baseline methotrexate use (odds ratio, 0.70; 95% confidence interval, 0.51-0.97). Baseline glucocorticoid use had a positive correlation with sarcopenia in multiple studies. Several studies found lower bone mineral density and higher incidence of falls and fractures in patients with sarcopenia. Sarcopenia is prevalent in RA, and it may be associated with higher RA disease activity, lower bone mineral density, and increased falls and fractures. Therefore, early screening of sarcopenia in RA patients is important to incorporate into clinical rheumatology practice.

The relation between synovitis of individual finger joints and grip force over the first 5 years in early rheumatoid arthritis - a cohort study

OBJECTIVE

The objective of this study was to investigate the relation between swelling and tenderness of individual finger joints and grip force in patients with early rheumatoid arthritis (RA).

METHODS

In an inception cohort of patients with early RA (symptom duration < 12 months), all patients were examined by the same rheumatologist, and grip force was measured using the Grippit instrument at inclusion, 1 and 5 years. The average grip force values of each hand were evaluated and expressed as % of expected values, based on age- and sex-specific reference values. Linear regression analyses were used to assess the cross-sectional relation between the involvement of individual finger joints and grip force. In generalized estimating equations, the impact of time-varying synovitis/tenderness on grip force over time was estimated. Analyses were adjusted for wrist involvement, erythrocyte sedimentation rate, and patient-reported pain.

RESULTS

In 215 patients with early RA, grip force was 39% of expected at diagnosis, and increased to 56% after 5 years. Synovitis of the first metacarpophalangeal (MCP) joint (60% and 69% at baseline in the right and left hand) was associated with reduced grip force at inclusion (adjusted ß - 9.2 percentage unit of expected grip force; 95% CI - 13.6 to - 4.8 for both hands combined) and at all follow-up evaluations. Synovitis of MCP I and MCP IV (12% at baseline) was significantly associated with reduced grip force over time in both hands. Proximal interphalangeal (PIP) joint swelling, and tenderness of MCP or PIP joints, had less impact on grip force.

CONCLUSION

MCP I synovitis is the major contributor to reduced grip force in patients with early RA. This underlines the importance of the involvement of the thumb for impaired hand function in RA. MCP IV synovitis, but not PIP involvement or finger joint tenderness, also has a substantial impact on grip force.

Can Blood Biomarkers Be Used to Assess Oxidative Stress in COPD Patients After Pulmonary Rehabilitation

Purpose

To determine the level of oxidative stress in the body due to pulmonary rehabilitation (PR) with thiols and disulfide and to investigate their relationship with indirect markers such as creatine kinase (CK), creatine kinase - MB (CK-MB), and lactate dehydrogenase (LDH), which show cell destruction.

Patients and Methods

Patients with chronic obstructive pulmonary disease (COPD) are included in inpatient and outpatient care. They were evaluated before and after for PR, and an exercise program was prescribed. In addition, native thiol (NT), total thiol (TT), disulfide (DS), LDH, CK, and CK-MB values were tested.

Results

The mean age of 21 patients was 63±7.31 years. Eleven of them were outpatients and 10 of them were inpatients. Most of the patients were male (M/F=20/1, 95.2/4.8%). There was a significant difference in pulmonary function tests (PFT), St. George Respiratory Questionnaire (SGRQ), and 1 repetition maximum (1RM) before and after the treatment (p<0.001). There was a correlation between PFT and 1RM upper extremity. While there was no significant difference between thiols and disulfide, according to GOLD scores, there was a significant difference in patients with level 3-MMRC. No correlation was found between LDH, CK, CK-MB, and thiols, DS. ΔCK was found to be associated with ΔDS, and ΔCK-MB with ΔNT, and ΔTT.

Conclusion

PR contributes to the antioxidant process by improving respiration and reducing oxidative stress. The decrease in LDH, CK with PR, increase in CK-MB, and correlation of CK with thiols and DS gave a different interpretation. In this case, it should be considered that oxidative stress may also be increased in people with high CK values.

Lumbrical muscle enhancement on MRI and its association with rheumatoid arthritis

OBJECTIVE

To investigate the significance of lumbrical muscle enhancement (LME) on magnetic resonance imaging (MRI) in rheumatoid arthritis (RA).

MATERIALS AND METHODS

Blinded to the diagnoses, contrast-enhanced bilateral hand MRIs of patients with suspected early RA between 2014 and 2019 were reviewed by two observers for the presence and degree (weak/strong) of LME. The presence of other inflammatory findings was also noted. The patients were then stratified into RA (n = 41), control (n = 31), and other arthritides groups(n = 28) based on their final diagnoses in the hospital records within the following 12 months. Categorical variables were compared by chi-square test or Fisher's exact test. Differences among the groups were evaluated by one-way ANOVA or Kruskal-Wallis tests. When the p-value from the Kruskal-Wallis test was statistically significant, multiple comparison test was used to identify group differences. Correlations between LME and flexor tenosynovitis were evaluated by Spearman rank correlation test. The agreement between two observers was assessed by Cohen's Kappa (κ) statistic. P-value < 0.05 was considered as statistically significant.

RESULTS

There were 100 patients (88 females) with mean age of 47.2 ± 11.2. There were no significant differences for age or sex between groups (p = 0.17, p = 0.84, respectively). RA patients showed significantly more frequent (p < 0.001) and stronger LME (p = 0.001). There were no correlations between LME and flexor tenosynovitis (p > 0.05). Interrater agreement for the degree of LME on right and left sides was substantial (κ = 0.74, κ = 0.67, respectively).

CONCLUSION

RA patients demonstrated significantly more frequent and stronger LME with substantial interrater agreement. LME could constitute a subtle radiological clue for early RA.

Association between arthritis and hand grip strength indices combined with anthropometry in an older Korean population

BACKGROUND

Hand grip strength (HGS) is related to arthritis and all-cause mortality. Many studies have examined the association between HGS and arthritis, but these studies did not consider relative HGS indices. The objectives of this study were to examine the association between arthritis and HGS indices in an older Korean population and to compare an absolute HGS index and a relative HGS indices.

METHODS

In a large-scale cross-sectional study, a total of 16,860 subjects older than 50 years from the Korea National Health and Nutrition Survey from 2014 to 2019 were included for statistical analysis. A binary logistic regression model was used to examine the association between arthritis and HGS indices in crude and covariate-adjusted models.

RESULTS

In the crude analysis, all anthropometric and HGS indices were associated with arthritis except for weight in men. In adjusted models 1 and 2, among the anthropometric indices, waist circumference (WC) and waist-to-height ratio (WHtR) were associated with arthritis in men but not in women. Absolute HGS and all relative HGS indices showed a negative association with arthritis among both men and women, and the magnitude of the association of arthritis with the absolute HGS index and the relative HGS indices was similar. However, the magnitude of the association between all HGS indices and arthritis was higher for men than for women except in the crude analysis.

DISCUSSION

Absolute and relative HGS indices had negative associations with arthritis, and the magnitude of the association between the absolute HGS index and arthritis and between the relative HGS indices and arthritis was similar in all models. To our knowledge, this is the first report of an association between arthritis and relative HGS indices, which was not observed in previous studies.

Physical Function of RA patients Tapering Treatment-A Post Hoc Analysis of the Randomized Controlled RETRO Trial

Several studies have shown that tapering or stopping disease-modifying anti-rheumatic drugs (DMARDs) in rheumatoid arthritis (RA) patients in sustained remission is feasible. However, tapering/stopping bears the risk of decline in physical function as some patients may relapse and face increased disease activity. Here, we analyzed the impact of tapering or stopping DMARD treatment on the physical function of RA patients. The study was a post hoc analysis of physical functional worsening for 282 patients with RA in sustained remission tapering and stopping DMARD treatment in the prospective randomized RETRO study. HAQ and DAS-28 scores were determined in baseline samples of patients continuing DMARD (arm 1), tapering their dose by 50% (arm 2), or stopping after tapering (arm 3). Patients were followed over 1 year, and HAQ and DAS-28 scores were evaluated every 3 months. The effect of treatment reduction strategy on functional worsening was assessed in a recurrent-event Cox regression model with a study-group (control, taper, and taper/stop) as the predictor. Two-hundred and eighty-two patients were analyzed. In 58 patients, functional worsening was observed. The incidences suggest a higher probability of functional worsening in patients tapering and/or stopping DMARDs, which is likely due to higher relapse rates in these individuals. At the end of the study, however, functional worsening was similar among the groups. Point estimates and survival curves show that the decline in functionality according to HAQ after tapering or discontinuation of DMARDs in RA patients with stable remission is associated with recurrence, but not with an overall functional decline.

Understanding prescribed dose in hand strengthening exercise for rheumatoid arthritis: A secondary analysis of the SARAH trial

OBJECTIVE

1) To identify therapist or participant characteristics associated with prescribed dose of hand strengthening exercise in adults with rheumatoid arthritis and 2) To determine the impact of dose prescribed on outcome (hand function and grip strength).

METHODS

Overall dose was calculated using area under the curve (AUC). Analysis 1 assessed the association between therapist professional background, therapist grade, baseline participant physical and psychological characteristics and prescribed dose. Analyses 2 and 3 estimated the relationship between prescribed dose and overall hand function and grip strength. Generalised estimating equation linear regression analysis was used.

RESULTS

Analysis 1: Being treated by an occupational therapist (β = -297.0, 95% CI -398.6, -195.4), metacarpophalangeal joint deformity (β = -24.1, 95% CI -42.3, -5.9), a higher number of swollen wrist/hand joints (β = -11.4, 95% CI -21.6, -1.2) and the participant feeling downhearted and low all of the time (β = -293.6, 95% CI -436.1, -151.1) were associated with being prescribed a lower dose. Being treated by a grade 6 therapist (β = 159.1, 95% CI 65.7, 252.5), higher baseline grip strength (β = 0.15, 95% CI 0.02, 0.28) and greater participant confidence to exercise without fear of making symptoms worse (β = 18.9, 95% CI 1.5, 36.3) were associated with being prescribed a higher dose. Analyses 2 and 3: Higher dose was associated with greater overall hand function (β = 0.005, 95% CI 0.001, 0.010) and full-hand grip strength (β = 0.014, 95% CI 0.000, 0.025) at 4-month.

CONCLUSION

Higher dose was associated with better clinical outcomes. Prescription of hand strengthening exercise is associated with both therapist and participant characteristics.

Arthritis, physical function, and disability among older Mexican Americans over 23 years of follow-up

OBJECTIVE

Arthritis is a common chronic condition in the ageing population. Its impact on physical function varies according to sociodemographic and race/ethnic factors. The study objective was to examine the impact of arthritis on physical function and disability among non-disabled older Mexican Americans over time.

DESIGN

A 23-year prospective cohort study of 2230 Mexican Americans aged 65 years and older from the Hispanic Established Population for the Epidemiologic Study of the Elderly (1993/94-2016). The independent variable was self-reported physician-diagnosed arthritis, and the outcomes included Activities of Daily Living (ADL), Instrumental Activities of Daily Living (IADL), mobility, Short Physical Performance Battery (SPPB), and handgrip strength. Covariates were sociodemographic, medical conditions, body mass index, depressive symptoms, and cognitive function. General linear mixed models were performed to estimate the change in SPPB and muscle strength. General Equation Estimation models estimated the odds ratios (OR) of becoming ADL- or IADL- or mobility - disabled as a function of arthritis. All variables were used as time-varying except for sex, education, and nativity.

RESULTS

Overall, participants with arthritis had higher odds ratio (OR) of any ADL [OR = 1.35, 95% Confidence Interval (CI) = 1.09-1.68] and mobility (OR = 1.34, 95% CI = 1.18-1.52) disability over time than those without arthritis, after controlling for all covariates. Women, but not men, reporting arthritis had increased risk for ADL and mobility disability. The total SPPB score declined 0.18 points per year among those with arthritis than those without arthritis, after controlling for all covariates (p-value < .010).

CONCLUSIONS

Our study demonstrates the independent effect of arthritis in increasing ADL and mobility disability and decreased physical function in older Mexican Americans over 23-years of follow-up.

A chinese medicine formula (kunbixiao granule) for female rheumatoid arthritis: Study protocol for a double-blind, randomized, placebo-controlled trial

Introduction: Rheumatoid arthritis (RA) is a chronic autoimmune disease affecting females more than males. Clinical symptoms, disease activity and comorbidities are more severe in females. Moreover, the choice of treatment for females is limited during childbearing age due to the side effects of current drugs. Therefore, developing novel and safer drugs for females is urgently needed. Kunbixiao granules (KBXG), a Chinese medicine formula, has been applied to treat female RA patients in our center as a complementary therapy. However, there is insufficient evidence for its effect. Therefore, we aim to conduct a randomized, controlled, double-blind clinical trial to confirm the efficacy and safety of KBXG for the treatment of female RA.

Methods: This study is a single-center, double-blind, randomized, parallel group, placebo-controlled clinical trial. A total of 90 female RA patients with Disease Activity Score for 28 joints (DAS28) > 3.2 will be enrolled. They will be randomly assigned to receive either KBXG or placebo for 12 weeks. The change in DAS28 based on C-reactive protein (DAS28-CRP) and the Clinical Disease Activity Index (CDAI) are the primary outcomes. The secondary outcomes include a rate of achieving 20%, 50% and 70% improvement in the American College Rheumatology criteria (ACR20, ACR50, ACR70), TCM syndrome score, visual analogue scale (VAS), average hands grip strength, the consumption of concomitant medication, Hospital Anxiety and Depression Scale (HADS), lumbar spine bone mineral density (L-BMD) and 7-joint ultrasound score (US7). Any adverse events will also be recorded.

Discussion: This trial will provide evidence of KBXG in reducing disease activity, and improving clinical symptoms and quality of life of female RA patients. The long-term effects of KBXG on female RA patients still needs a further follow-up.

Lower hand grip in rheumatoid arthritis patients is associated with low finite element analysis using high resolution peripheral quantitative computed tomography scan of the 2nd metacarpophalangeal joint

AIM

To evaluate hand function by hand grip test in rheumatoid arthritis (RA) patients, and its association with bone erosions and the estimated bone strength (finite element - FE analysis) through the analysis of the 2nd metacarpal head of the dominant hand using high resolution peripheral quantitative computed tomography (HR-pQCT).

METHOD

Eighty-two female RA patients between 18-50 years old were selected. Demographic data, Health Questionnaire Assessment Disability Index (HAQ), Disease Activity Score of 28 joints (DAS)-28, simplified disease activity index (SDAI) and the hand grip test were set. The HR-pQCT scans of 2nd metacarpophalangeal joints of the dominant hand of all patients were performed according to SPECTRA group protocols. The images were used to assess bone erosions and FE analysis. The hand grip test was categorized in 2 groups and separately compared (< 18 vs ≥18 kgf). A logistic regression was performed using hand grip test <18 kgf as a dependent variable.

RESULTS

A significant difference was found between the 2 groups regarding HAQ, inflammatory markers (erythrocyte sedimentation rate, C-reactive protein), DAS-28, SDAI, total volume of erosion and bone strength parameter (FE analysis - Failure Load [F.Load]). The logistic regression analysis showed that the risk factors associated with hand grip test <18 kgf were higher SDAI (odds ratio [OR] 0.912; 95% CI 0.837-0.993) and lower values of bone strength parameter (F.Load) (OR 1.007; 95% CI 1.002-1.012).

CONCLUSION

Lower values of hand grip test were associated with higher disease activity score-SDAI and lower bone strength of 2nd metacarpal bone head of the dominant hand evaluated here through a FE analysis using HR-pQCT scan.

An Exercise and Educational and Self-management Program Delivered With a Smartphone App (CareHand) in Adults With Rheumatoid Arthritis of the Hands: Randomized Controlled Trial

BACKGROUND

Rheumatoid arthritis (RA) is a prevalent autoimmune disease that usually involves problems of the hand or wrist. Current evidence recommends a multimodal therapy including exercise, self-management, and educational strategies. To date, the efficacy of this approach, as delivered using a smartphone app, has been scarcely investigated.

OBJECTIVE

This study aims to assess the short- and medium-term efficacy of a digital app (CareHand) that includes a tailored home exercise program, together with educational and self-management recommendations, compared with usual care, for people with RA of the hands.

METHODS

A single-blinded randomized controlled trial was conducted between March 2020 and February 2021, including 36 participants with RA of the hands (women: 22/36, 61%) from 2 community health care centers. Participants were allocated to use the CareHand app, consisting of tailored exercise programs, and self-management and monitoring tools or to a control group that received a written home exercise routine and recommendations, as per the usual protocol provided at primary care settings. Both interventions lasted for 3 months (4 times a week). The primary outcome was hand function, assessed using the Michigan Hand Outcome Questionnaire (MHQ). Secondary measures included pain and stiffness intensity (visual analog scale), grip strength (dynamometer), pinch strength (pinch gauge), and upper limb function (shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire). All measures were collected at baseline and at a 3-month follow-up. Furthermore, the MHQ and self-reported stiffness were assessed 6 months after baseline, whereas pain intensity and scores on the shortened version of the Disabilities of the Arm, Shoulder, and Hand questionnaire were collected at the 1-, 3-, and 6-month follow-ups.

RESULTS

In total, 30 individuals, corresponding to 58 hands (CareHand group: 26/58, 45%; control group: 32/58, 55%), were included in the analysis; 53% (19/36) of the participants received disease-modifying antirheumatic drug treatment. The ANOVA demonstrated a significant time×group effect for the total score of the MHQ (F_1.62,85.67=9.163; P<.001; η²=0.15) and for several of its subscales: overall hand function, work performance, pain, and satisfaction (all P<.05), with mean differences between groups for the total score of 16.86 points (95% CI 8.70-25.03) at 3 months and 17.21 points (95% CI 4.78-29.63) at 6 months. No time×group interaction was observed for the secondary measures (all P>.05).

CONCLUSIONS

Adults with RA of the hands who used the CareHand app reported better results in the short and medium term for overall hand function, work performance, pain, and satisfaction, compared with usual care. The findings of this study suggest that the CareHand app is a promising tool for delivering exercise therapy and self-management recommendations to this population. Results must be interpreted with caution because of the lack of efficacy of the secondary outcomes.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04263974; https://clinicaltrials.gov/ct2/show/NCT04263974.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s13063-020-04713-4.

Functional exercise capacity in rheumatoid arthritis unrelated to lung injury: A comparison of women with and without rheumatoid disease

BACKGROUND

Rheumatoid arthritis (RA) mainly affects the joints of the upper and lower limbs, so evaluating functional exercise capacity in individuals with RA via dynamic tests of the locomotor system is essential.

OBJECTIVES

To compare functional exercise capacity using the Glittre-activities of daily living (ADL) test (G-AT) in women with and without RA in the absence of RA pulmonary disease (RA-PD) and to correlate the findings with hand functioning, physical functioning, handgrip strength (HGS), and quadriceps strength (QS).

METHODS

This cross-sectional pilot study evaluated 35 women with RA and 25 healthy controls by assessing hand functioning using the Cochin Hand Functional Scale (CHFS), physical functioning with the Health Assessment Questionnaire Disability Index (HAQ-DI), muscle functioning using HGS and QS, and G-AT results.

RESULTS

Compared to the women in the control group, the women with RA presented higher scores for the CHFS (p< 0.0001) and HAQ-DI (p< 0.0001) and lower HGS (p< 0.0001) and QS (p= 0.013) values. The median G-AT time was higher in the RA patients than in the healthy controls [300 (295-420) vs. 180 (155-203) s], p< 0.0001), and the greatest difficulty reported by patients after the G-AT was squatting to perform the shelving tasks. G-AT time was positively correlated with the HAQ-DI (rs= 0.668, p< 0.0001) and CHFS (rs= 0.586, p= 0.0007) and negatively correlated with QS (rs=-0.429, p= 0.037). There was no significant correlation between the G-AT time and HGS.

CONCLUSIONS

Women with RA take longer to perform G-AT tasks. Moreover, G-AT time was associated with hand functioning, physical functioning and QS, but not with HGS.

Assessment of Rheumatoid Hand Function as a Characteristic Feature of Rheumatoid Arthritis in Patients Treated with Methotrexate or Methotrexate with Biological Agents with and without Deformation of Hands

BACKGROUND

The hand is an excellent work tool that provides the functional ability to mechanical work. The hand is affected in rheumatoid arthritis (RA) patients, it is a significant problem in the functional sphere as a result of deformities, the grasping function limitation and muscle strength.

OBJECTIVES

The aim of the study was the assessment of grip strength, endurance and manipulation abilities of rheumatoid hands with or without deformities treated with methotrexate (MTX) or MTX plus biologics (MTX+BIO).

MATERIAL AND METHODS

The study involved 80 RA women, (40 received MTX+BIO, 40 MTX), treated at the Rheumatology Department of the Central Clinical Hospital of Interior Affairs in Warsaw. VAS-pain, DAS28, SDAI, HAQ, HAQ hands, estimation of hand grip strength, endurance, manipulation ability were analyzed.

RESULTS

In group MTX+BIO values of DAS28 (3.7±1.3 vs 4.3±1.2, p=0.019), HAQ (0.72 ± 0.57 vs 1.08± 0.87, p=0.011) and HAQ-hand (0.85±0.65 vs. 1.19±0.68, p=0.024) were statistically lower than in MTX group. Hand deformations recorded in 35 (43.7%) cases, 16 (40%) in MTX group, 19 (47.5%) in MTX+BIO. Comparison of grip strength, endurance, manipulation ability showed better results in MTX+BIO group with deformities (significance level from 0.013 to 0.046) than in MTX group. Relative differences in hand function in MTX + BIO group ranged from 10.8% (maximal power grip strength) to 127.6% (minimal hand endurance), after disease duration adjustment - from 28.2% (maximal power grip strength) to 148.4% (minimal hand endurance).

CONCLUSION

Measuring grip strength, hand endurance, manipulation abilities are useful in RA patients with hand deformities.

Comparison of the effectiveness of a structured exercise program on nonspecific neck pain in string and woodwind players

To investigate the effect of a structured exercise training program on pain, functional status, physical function and quality of life (QoL) in string and woodwind players with nonspecific cervical pain. This study had a prospective cohort design and conducted on 40 musicians (26 male, 14 female) aged between 18 and 65 years with persistent nonspecific neck pain in the previous 3 months. Forty musicians were assigned to either violin (n = 20, median age; 26.5 year, height; 1.67 m, body mass; 65 kg, BMI; 23.04 kg/m²) or ney group (n = 20, median age; 27.5 year, height; 1.81 m, body mass; 75 kg, BMI; 23.35 kg/m²) and followed the same structured exercise program (3 days/per week for 8 weeks). The primary outcome was neck pain intensity and assessed on a visual analog scale (VAS). Secondary outcomes; cervical range of motion (ROM) was measured using a goniometer, the jaw-to-sternum and jaw-to-wall distances were used for the assessment of cervical mobility, neck, shoulder and back muscles strength were assessed with a hand-held dynamometer, the Northwick Park Neck Pain and Short Form 36 (SF-36) questionnaires were also used. Normality of data distribution was checked using the Kolmogorov-Smirnov test. For evaluating the training effectiveness on outcome measures, Mann-Whitney U and Wilcoxon test were used compare pre-test and post-test values with/within groups, respectively. The primary outcome (pain intensity) was lowered %33 in both groups. However, the mean change was found similar (median mean changes; -2 for both groups) (p > 0.05). The secondary outcomes; cervical mobility, cervical flexion ROM, disability and muscle strength of the left middle trapezius, left hand grip, anterior and middle parts of the right deltoid, and cervical flexors also significantly improved in both groups (p < 0.05). Only the mean changes of right serratus anterior, middle trapezius and cervical flexor muscles were higher in violin group than ney group (p < 0.05). There was no significant difference in the cervical extension, right rotation, left rotation, right lateral flexion and left lateral flexion after the treatment in both groups (p > 0.05). There was no significant difference between the groups after the exercise program in terms of pain, mobility, range of motion and SF-36 subdomains (p > 0.05). Specific exercise program had similar positive effects on pain, cervical mobility, cervical fexion ROM and disability in string and woodwind players. Although several muscles showed similar improvements in strength, some muscle groups recovered differently. Physical needs specific to the instrument and performance should be taken into account when prescribing exercises to musicians having the same problem, but playing different instruments.

Engineered glove to evaluate hand disability in rheumatoid arthritis: A pilot-study

OBJECTIVE

The Hand Test System (HTS) is an engineered-sensorized glove that has been originally developed in the neuroscientific field for the evaluation of hand fingers' speed movement. This pilot-study aimed to evaluate the reproducibility of HTS analysis in rheumatoid arthritis (RA), correlating glove-derived parameters with clinical disease activity indexes, self-reported disability-related questionnaires and hand strength.

METHODS

Fifty-five RA patients and fifty age and sex matched healthy controls (HCs) performed HTS analysis. The glove recognized the touch speed between the finger tips during standard sequences of movements, providing three quantitative parameters: touch duration (TD), inter-tapping interval (ITI) and movement rate (MR). These variables were correlated with Health Assessment Questionnaire (HAQ), Health Assessment Questionnaire-Disease Index (HAQ-DI), Hand Disability Index (HDI), Hand Grip Strength (HGS), DAS28-CRP, CDAI and SDAI.

RESULTS

Intraclass correlation coefficient was 0.93 (CI: 0.92, 0.95). RA patients showed significantly slower TD, ITI and MR than HCs, for all classes of disease activity (P<0.001). All HTS parameters correlated significantly with HAQ, HAQ-DI, HDI, HGS, DAS28-CRP, SDAI, CDAI (between P<0.05 and P<0.001). Of note, also RA patients in clinical remission showed a significantly higher TD compared with HCs (P<0.001).

CONCLUSION

HTS seems a new safe and fast tool to evaluate rheumatoid hand's functionality, measuring the speed of finger movements. Furthermore, the HTS parameters significantly correlate with quality of life, disease activity, hand strength and perceived hand disability, evaluating also potential hand motor impairment in RA clinical remission.

Decrease in handgrip strength in rheumatoid arthritis (RA): is there a sex-related difference?

Rheumatoid arthritis occurs two to three times more often in women than in men and it has been less studied in men. The results of gender influence on clinical course of the disease are contradictory. The aim of this study is to determine the difference in handgrip strength between female and male RA patients in comparison to healthy individuals. The study included 100 RA patients and 100 healthy individuals (50% were male in both groups). Handgrip strength was measured in both hands using a dynamometer. A two-way ANCOVA was used to analyse the data and age was included in the study as covariate. The results show that both male and female RA patients have lower handgrip strength compared to healthy individuals. The analysis of gender and disease interaction has shown that male RA patients have lower handgrip strength than female RA patients in comparison with the healthy group, age adjusted. This interaction is evident and statistically significant in both right hand (F 1, 195) = 14.62; p < 0.01) and left hand (F 1, 195) = 20.54; p < 0.01). The common-language effect size has shown that there is 92% (right hand) and 93% (left hand) chance that male individual will have stronger handgrip than his female counterpart. In RA patients, there is 77% chance for both hands that male will have stronger handgrip. Men and women with RA have significantly lower handgrip strength compared to healthy individuals and the difference is more pronounced in men which was not previously observed in the literature.

Value of musculoskeletal ultrasound in assessment of rheumatoid hand function

Background

Musculoskeletal ultrasound can be now considered a complement to physical examination in rheumatoid arthritis. This study evaluates the role of musculoskeletal ultrasound in assessment of rheumatoid hand function and underlying functional defects and disabilities in order to find out a possibly better tool for assessment.

Results

Hand grip weakness was significantly associated with metacarpophalangeal joints synovitis of ulnar 4 fingers (p = 0.045), wrist joint synovitis (p = 0.009), flexor tendons tenosynovitis of the ulnar 4 fingers (p = 0.001), flexor pollicis longus tendon tenosynovitis (p = 0.013).

Hand function impairment by grip ability test was significantly associated with metacarpophalangeal joints synovitis of ulnar 4 fingers (p = 0.009), wrist joint synovitis (p = 0.004), and flexor tendons tenosynovitis of the ulnar 4 fingers (p = 0.042). Multiple linear regression analysis showed that the most influencing factor affecting grip ability test and hand grip strength was ulnar 4 Flexor tendons tenosynovitis (P = 0.023, P = 0.037) respectively.

Conclusions

Joint synovitis and tenosynovitis that are detected by musculoskeletal ultrasound can be used as an assessment tool for hand function in rheumatoid arthritis, since they are associated with reduced hand grip strength and impaired hand ability.

Evaluation of Nutritional Status and Methods to Identify Nutritional Risk in Rheumatoid Arthritis and Spondyloarthritis

Patients with rheumatoid arthritis (RA) and spondyloarthritis (SpA) experience several nutritional challenges and are prone to develop malnutrition. This observational study aimed to perform a comprehensive nutritional assessment of outpatients diagnosed with RA and SpA, as well as to evaluate methods to identify nutritional risk. Nutritional status was investigated by anthropometric measures, body composition (DXA, dual energy X-ray absorptiometry), and handgrip strength (HGS). Nutritional risk was classified by Nutritional Risk Screening 2002 (NRS2002) and malnutrition was defined by the Global Leadership Initiative on Malnutrition (GLIM) criteria and fat-free mass index (FFMI; kg/m², <16.7 (M), <14.6 (F)). Out of 71 included patients, 46 (66%) were abdominally obese, 28 (39%) were obese in terms of body mass index (BMI), and 33 (52%) were obese in terms of the fat mass index (FMI; kg/m², ≥8.3 (M), ≥11.8 (F)). Malnutrition was identified according to FFMI in 12 (19%) patients, according to GLIM criteria in 5 (8%) patients, and on the basis of BMI (<18.5 kg/m²) in 1 (1%) patient. None were identified by NRS2002 to be at nutritional risk. Our study revealed high prevalence of abdominal obesity and low FFMI. Waist circumference was a good indicator of FMI. BMI, NRS2002, and HGS did not capture patients with malnutrition identified by DXA.

A mobile app using therapeutic exercise and education for self-management in patients with hand rheumatoid arthritis: a randomized controlled trial protocol

Background

Therapeutic exercise is a safe and cost-effective approach to alleviate hand rheumatoid arthritis (RA)-related symptoms. This study aims to investigate the differences in self-management between a smartphone app (CareHand), using hand exercises and educational advices, compared with a standard approach, on hand overall function, pain intensity, stiffness, and grip and pinch strength in patients with hand RA.

Methods

The project is a prospective, longitudinal, superiority, randomized controlled trial. Fifty-eight participants with hand RA will be randomly assigned into an experimental group (CareHand app) or a control group (conventional treatment). Control intervention involves a paper sheet with exercises and recommendations, and the experimental group includes the use of a smartphone app, which provides individualized exercise programs, self-management, and educational strategies to promote adherence to treatment. Both intervention protocols will last for 3 months. The principal investigator will conduct an educational session at baseline for all participants. Primary outcome comprises the overall hand function, assessed with the Michigan Hand Outcome Questionnaire (MHQ). Secondary outcomes include self-reported functional ability with the Quick DASH questionnaire, self-reported pain intensity and morning stiffness using a Visual Analogue Scale (VAS), and hand grip and pinch strength (dynamometer). Outcome measures will be collected at baseline, and at 1 month and 3-month follow-up.

Discussion

This study will evaluate the effectiveness of a tele-rehabilitation tool, which uses exercise and self-management strategies, compared to a conventional approach, in patients with hand RA. The smartphone app will allow to monitor the patient’s status and to enhance patient-therapist communication. Some limitations may be related to the short follow-up duration and the lack of evaluation of psychosocial factors. Overall, this new way of promoting long-term effects in patients with a chronic rheumatic disease could be feasible and easy to implement in daily life clinical practice and current musculoskeletal care.

Trial registration

ClinicalTrials.gov NCT04263974. Registered on 7 March 2020. Date of last update 15 April 2020. Ethics committee code: PI_RH_2018.

Changes in hand grip strength and body weight after a dynamic exercise program and Mediterranean diet in women with rheumatoid arthritis: a randomized clinical trial

BACKGROUND

In patients with rheumatoid arthritis (RA) exercise improves muscle strength and decreases fat mass, whereas the consumption of a Mediterranean diet (MD) also has been associated with higher grip strength. Therefore, it is important to explore the combined effects of these interventions on hand grip strength and weight in RA.

OBJECTIVE

To determine the combined effect of an MD and a dynamic exercise program (DEP) on hand grip strength in women with RA.

METHOD

In a randomized clinical trial, 106 women with RA were included and assigned to the DEP-MD, DEP and MD groups. Weight, body circumferences, Disease Activity Score-28, Health Assessment Questionnaire Disability Index [HAQ-DI], and hand grip strength were measured at baseline and 24 weeks after the interventions.

RESULTS

After 24 weeks, hand grip strength showed a significant increase in the DEP group (median 2 kg) compared with DEP-MD (median 0.5 kg) and MD (median -0.5 kg) groups (p = 0.03). In the MD group weight and waist circumference showed a significant decrease (-2.2 kg and -4.3 cm) compared with DEP-MD (0.85 kg and 1.9 cm) and DEP (0.35 kg and 0.5 cm) groups (p < 0.01). Finally, a significant decrease was observed in the HAQ-DI after treatment in the DEP-MD group of -0.5 and the DEP group of -0.25 compared with the MD group with no change (p = 0.03).

CONCLUSION

In women with RA, in addition to pharmacological treatment, DEP increases hand grip strength and an MD decreases weight and waist circumferences, while the combination of DEP and MD improves disability.

Concurrent validity of handgrip strength between the jamar and bulb dynamometers in women with rheumatoid arthitis

Abstract Introduction: Rheumatoid arthritis (RA) is a progressive disease that causes deformation and constant joint damage. Handgrip strength (HGS) has been used by several health professionals in clinical practice as a mechanism for assessing muscle strength and overall performance. Objective: To perform the concordance analysis of handgrip strength measurements using a pneumatic dynamometer (Bulb) and a hydraulic dynamometer (Jamar) in women with rheumatoid arthritis. Method: The HGS measurements by the two dynamometers followed the norms of the American Society of Hand Therapists. The concordance between measurements was performed by the Bland-Altman method. Significance level was 5%. Results: In total, 41 women (60.63 ± 8.35 years) participated in the study. Analysis showed that the measures between the two dynamometers were not concordant (bias = 9.04, p < 0.01), there was a linear relationship between the difference of the measures and the mean (r = 0.73, p < 0.01), and the limits of agreement were very extensive (−2.74 to 20.81). Conclusion: Assuming that the rheumatoid arthritis compromises the hands, with a consequent decrease in HGS, further exploration of the subject is suggested in future studies to define the best measure for clinical practice at the different levels of health care. However, since there are many different dynamometers, we suggest to better explore the agreement between the measurements obtained by them in populations under different conditions.

Factors Associated With Low Lean Mass in Early Rheumatoid Arthritis: A Cross- Sectional Study

Background and Objectives: The aim of the study was to evaluate body composition (BC) of rheumatoid arthritis (RA) patients at disease onset compared to population controls focusing on the associations between low lean mass and disease specific parameters, nutritional factors and physical activity. Materials and Methods: 91 patients with early rheumatoid arthritis (ERA) (72% female) and 328 control subjects (54% female) were studied. BC- lean and fat mass parameters were measured with a Lunar Prodigy Dual Energy X-Ray Absorptiometry (DXA) machine. The prevalence, age and gender adjusted odds ratios of having low lean mass and overfat, associations between nutrition, physical activity, and ERA disease specific parameters and the presence of low lean mass were evaluated. Results: We found that the BC of patients with recent onset RA differs from control subjects-ERA patients had a higher mean body fat percentage (BFP) and lower appendicular lean mass (ALM). 41.8% of the ERA patients and 19.8% of the controls were classified as having low lean mass adjusted OR 3.3 (95% C.I. 1.9-5.5, p < 0.001). 68.1% of the ERA subjects and 47.3% of the controls were overfat (adjusted OR 1.9 (95% C.I. 1.1-3.3, p = 0.02)) and the adjusted odds of having both low lean mass and overfat were 4.4 times higher (26.4% vs. 7.0% 95% C.I. 2.3-8.4, p < 0.001) among the ERA group. Higher ESR (OR 1.03, C.I.1.002-1.051, p = 0.03), CRP (OR 1.03, C.I. 1.002-1.061, p = 0.04), lower protein intake (OR 0.98 C.I. 0.96-0.99, p = 0.04), corticosteroid usage (OR 3.71 C.I. 1.4-9.9, p < 0.01) and lower quality of life (higher HAQ score OR 2.41 C.I. 1.24-4.65, p < 0.01) were associated with having low lean mass in the ERA group (adjusted to age and gender). Conclusions: Patients with early RA have lower appendicular lean mass and higher body fat percentage compared to healthy controls. Loss of lean mass in early RA is associated with elevated inflammatory markers inducing catabolism, lower protein intake and also with GCS treatment.

Prevalence of frailty and its associated factors in patients with rheumatoid arthritis: a cross-sectional analysis

OBJECTIVES

The aims of the present research were to assess the prevalence of frailty and its potential associated factors in a cohort of adult patients with rheumatoid arthritis (RA).

METHODS

Consecutive RA patients and healthy controls were assessed according to the Survey of Health, Ageing and Retirement in Europe Frailty Instrument (SHARE-FI), and classified as frail, pre-frail, or non-frail. Chi-square, analysis of variance (ANOVA), and multinomial logistic regression analyses were used to test the prognostic value of frailty for the outcomes of interest.

RESULTS

Two hundred and ten consecutive RA patients (65.7% female, mean age 60.4 years) and 100 healthy controls (63% female, mean age 59.1 years) were included. According to SHARE-FI criteria, 35 RA patients (16.6%) were categorized as frail, 68 (32.4%) as pre-frail, and 107 (51%) as non-frail, while 8 control subjects were categorized as frail, (8%), 17 as pre-frail (17%), and 75 as non-frail (75%) (chi-squared 12.8; P = 0.0016). The results from logistic regression analysis revealed that age (odds ratio [OR] = 1.12, 95% confidence interval [CI] = 1.07-1.17; P < 0.0001), comorbidities (OR = 1.51, 95% CI = 1.01-2.27; P = 0.0446), and high disease activity (OR = 1.10, 95% CI = 1.04-1.16; P = 0.0006) were independently associated with frailty in RA.

CONCLUSIONS

Frailty or pre-frailty are common in RA. The SHARE-FI may be a useful tool for the screening of frailty in RA and may summarize the results of a comprehensive RA assessment providing a marker of deficits accumulation.

Hand grip endurance moderating the effect of grip force on functional ability and disease activity in rheumatoid arthritis patients: a cross-sectional study

To examine the effect of endurance on the relationship between grip force and measures of functional capacity and disease activity, we performed a cross-sectional study at the University Department of Rheumatology, Physical medicine and Rehabilitation from January 2017 to August 2018. Functional capacity of the hand was measured by ABILHAND-RA questionnaire and disease activity was assessed by the Disease Activity Score (DAS-28-CRP). All participants underwent dynamometric measurements of maximal grip force and hand grip endurance during repeated gripping. We analyzed the data from 34 RA patients at the median (IQR) age of 57 (51-61), 31 (91%) of them women, and 44 healthy participants at the age of 55 (50-59), 39 (89%) of them women. The moderating effect of endurance on the correlation between maximum grip force and the ABILHAND-RA score was not significant in healthy participants (b = 0.000, 95% CI - 0.005-0.004, p = 0.862), but it was in RA patients (b = 0.003, 95% CI 0.000-0.005, p = 0.027). In RA patients, the effect of maximum grip force on the ABILHAND-RA score increased with the increase in hand grip endurance. In RA patients, the interaction between endurance and grip force significantly explained the 15% more variance of the disease activity than main effects of these two measures, age, gender and body mass index alone. Hand grip endurance during repeated gripping affects the correlation between maximum grip force and the ABILHAND-RA score in a pattern that differs in RA patients and in the healthy population. In RA patients, hand grip endurance significantly moderates the correlation between maximum grip force and the DAS-28-CRP.