Skip to main content
SpringerLink
Log in

Contribution of the bone and cartilage/soft tissue components of the joint damage to the level of disability in rheumatoid arthritis patients: a longitudinal study

Clinical Rheumatology Aims and scope Submit manuscript

Abstract

The study aims to analyze the association between the bone and cartilage/periarticular components of the radiographic joint damage and disability over the course of disease, in a cohort of rheumatoid arthritis (RA) patients from a day-to-day clinical practice. The secondary aim is to study the role of demographic and disease-related variables in this association. We performed a retrospective longitudinal study including 736 RA patients. Disability was assessed with the health assessment questionnaire (HAQ), and radiographic joint damage of hands and wrists with the Sharp van-der-Heijde score (total (SHS), erosion (ES), and narrowing/(sub)luxation (NSLS) components]. Generalized estimating equations models, adjusted by disease activity, demographic and disease-related variables, were used to test the relationship between SHS and medium-term (median value of the HAQs performed in the following year after each radiograph) and long-term (set of HAQ measures performed during follow-up, at least 1 year apart from the first x-ray) disability. Interaction terms between the SHS and demographic and disease-related variables were introduced in the models. To account for multiple testing, Bonferroni correction was applied. NSLS was independently associated with medium-term disability, even after Bonferroni correction. We observed significant and positive interactions between NSLS and age at x-ray, and with the ES. SHS showed no association with long-term disability. The cartilage/soft tissue component of the radiographic joint damage seems to exert a much more important role in medium-term disability than the erosive component. This association could be modulated by the age at the x-ray and by the magnitude of the erosive damage.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price includes VAT (France)

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

References

  1. Pincus T (1995) Long-term outcomes in rheumatoid arthritis. Br J Rheumatol 34(Suppl 2):59–73

    Article  PubMed  Google Scholar 

  2. Morel J, Combe B (2005) How to predict prognosis in early rheumatoid arthritis. Best Pract Res Clin Rheumatol 19:137–146. https://doi.org/10.1016/j.berh.2004.08.008

    Article  PubMed  CAS  Google Scholar 

  3. Bombardier C, Barbieri M, Parthan A, Zack DJ, Walker V, Macarios D, Smolen JS (2012) The relationship between joint damage and functional disability in rheumatoid arthritis: a systematic review. Ann Rheum Dis 71:836–844. https://doi.org/10.1136/annrheumdis-2011-200343

    Article  PubMed  Google Scholar 

  4. Boers M, Kostense PJ, Verhoeven AC, van der Linden S (2001) Inflammation and damage in an individual joint predict further damage in that joint in patients with early rheumatoid arthritis. Arthritis Rheum 44:2242–2246

    Article  PubMed  CAS  Google Scholar 

  5. van der Heijde D (2011) Erosions versus joint space narrowing in rheumatoid arthritis: what do we know? Ann Rheum Dis 70(Suppl 1):i116–i118. https://doi.org/10.1136/ard.2010.140525

    Article  PubMed  Google Scholar 

  6. Knevel R, Gröndal G, Huizinga TWJ, Visser AW, Jónsson H, Víkingsson A, Geirsson ÁJ, Steinsson K, van der Helm-van Mil AHM (2012) Genetic predisposition of the severity of joint destruction in rheumatoid arthritis: a population-based study. Ann Rheum Dis 71:707–709. https://doi.org/10.1136/annrheumdis-2011-200627

    Article  PubMed  Google Scholar 

  7. van der Heijde D (1999) How to read radiographs according to the Sharp/van der Heijde method. J Rheumatol 26:743–745

    PubMed  Google Scholar 

  8. Welsing PM, van Gestel AM, Swinkels HL et al (2001) The relationship between disease activity, joint destruction, and functional capacity over the course of rheumatoid arthritis. Arthritis Rheum 44:2009–2017. https://doi.org/10.1002/1529-0131(200109)44:9<2009::AID-ART349>3.0.CO;2-L

    Article  PubMed  CAS  Google Scholar 

  9. Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, Hazes JMW (1999) Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis Rheum 42:1854–1860. https://doi.org/10.1002/1529-0131(199909)42:9<1854::AID-ANR9>3.0.CO;2-F

    Article  PubMed  CAS  Google Scholar 

  10. Guillemin F, Briançon S, Pourel J (1992) Functional disability in rheumatoid arthritis: two different models in early and established disease. J Rheumatol 19:366–369

    PubMed  CAS  Google Scholar 

  11. Molenaar ETH, Voskuyl AE, Dijkmans BAC (2002) Functional disability in relation to radiological damage and disease activity in patients with rheumatoid arthritis in remission. J Rheumatol 29:267–270

    PubMed  Google Scholar 

  12. Scott DL, Smith C, Kingsley G (2003) Joint damage and disability in rheumatoid arthritis: an updated systematic review. Clin Exp Rheumatol 21:S20–S27

    PubMed  CAS  Google Scholar 

  13. Krishnan E, Fries JF (2003) Reduction in long-term functional disability in rheumatoid arthritis from 1977 to 1998: a longitudinal study of 3035 patients. Am J Med 115:371–376

    Article  PubMed  Google Scholar 

  14. Aletaha D, Smolen J, Ward MM (2006) Measuring function in rheumatoid arthritis: identifying reversible and irreversible components. Arthritis Rheum 54:2784–2792. https://doi.org/10.1002/art.22052

    Article  PubMed  Google Scholar 

  15. Abasolo L, Ivorra-Cortes J, Leon L, Jover JA, Fernandez-Gutierrez B, Rodriguez-Rodriguez L (2016) Influence of demographic and clinical factors on the mortality rate of a rheumatoid arthritis cohort: a 20-year survival study. Semin Arthritis Rheum 45:533–538. https://doi.org/10.1016/j.semarthrit.2015.10.016

    Article  PubMed  Google Scholar 

  16. Leon L, Jover JA, Loza E, Zunzunegui MV, Lajas C, Vadillo C, Fontsere O, Rodriguez–Rodriguez L, Martinez C, Fernandez-Gutierrez B, Abasolo L (2013) Health-related quality of life as a main determinant of access to rheumatologic care. Rheumatol Int 33:1797–1804. https://doi.org/10.1007/s00296-012-2599-6

    Article  PubMed  Google Scholar 

  17. Ramey DR, Raynauld JP, Fries JF (1992) The health assessment questionnaire 1992: status and review. Arthritis Care Res 5:119–129

    Article  PubMed  CAS  Google Scholar 

  18. Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, Eberl G, van Riel PL, Tugwell P (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology (Oxford) 42:244–257

    Article  CAS  Google Scholar 

  19. Martínez C, Ortiz AM, Juarranz Y, Lamana A, Seoane IV, Leceta J, García-Vicuña R, Gomariz RP, González-Álvaro I (2014) Serum levels of vasoactive intestinal peptide as a prognostic marker in early arthritis. PLoS One 9:e85248. https://doi.org/10.1371/journal.pone.0085248

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  20. Armstrong RA (2014) When to use the Bonferroni correction. Ophthalmic Physiol Opt 34:502–508. https://doi.org/10.1111/opo.12131

    Article  PubMed  Google Scholar 

  21. van der Heijde D, Landewé R, van Vollenhoven R et al (2008) Level of radiographic damage and radiographic progression are determinants of physical function: a longitudinal analysis of the TEMPO trial. Ann Rheum Dis 67:1267–1270. https://doi.org/10.1136/ard.2007.081331

    Article  PubMed  PubMed Central  Google Scholar 

  22. Breedveld FC, Han C, Bala M, van der Heijde D, Baker D, Kavanaugh AF, Maini RN, Lipsky PE (2005) Association between baseline radiographic damage and improvement in physical function after treatment of patients with rheumatoid arthritis. Ann Rheum Dis 64:52–55. https://doi.org/10.1136/ard.2003.017160

    Article  PubMed  CAS  Google Scholar 

  23. Landewé RBM, Boers M, Verhoeven AC, Westhovens R, van de Laar MAFJ, Markusse HM, van Denderen JC, Westedt ML, Peeters AJ, Dijkmans BAC, Jacobs P, Boonen A, van der Heijde DMFM, van der Linden S (2002) COBRA combination therapy in patients with early rheumatoid arthritis: long-term structural benefits of a brief intervention. Arthritis Rheum 46:347–356

    Article  PubMed  CAS  Google Scholar 

  24. Plant MJ, O’Sullivan MM, Lewis PA et al (2005) What factors influence functional ability in patients with rheumatoid arthritis. Do they alter over time? Rheumatology (Oxford) 44:1181–1185. https://doi.org/10.1093/rheumatology/keh707

    Article  CAS  Google Scholar 

  25. Nair SC, Bijlsma JWJ, van der Werf JH, van der Veen MJ, Linn-Rasker SP, Vreugdenhil S, Lafeber FPJG, Welsing PMJ (2013) Do radiographic joint damage and disease activity influence functional disability through different mechanisms? Direct and indirect effects of disease activity in established rheumatoid arthritis. J Rheumatol 40:1505–1512. https://doi.org/10.3899/jrheum.121346

    Article  PubMed  Google Scholar 

  26. Koevoets R, Dirven L, Klarenbeek NB, van Krugten MV, Ronday HK, van der Heijde DMFM, Huizinga TWJ, Kerstens PSJM, Lems WF, Allaart CF (2013) Insights in the relationship of joint space narrowing versus erosive joint damage and physical functioning of patients with RA. Ann Rheum Dis 72:870–874. https://doi.org/10.1136/annrheumdis-2011-201191

    Article  PubMed  CAS  Google Scholar 

  27. Smolen JS, van der Heijde DM, Keystone EC, van Vollenhoven RF, Goldring MB, Guérette B, Cifaldi MA, Chen N, Liu S, Landewé RBM (2013) Association of joint space narrowing with impairment of physical function and work ability in patients with early rheumatoid arthritis: protection beyond disease control by adalimumab plus methotrexate. Ann Rheum Dis 72:1156–1162. https://doi.org/10.1136/annrheumdis-2012-201620

    Article  PubMed  CAS  Google Scholar 

  28. Aletaha D, Funovits J, Smolen JS (2011) Physical disability in rheumatoid arthritis is associated with cartilage damage rather than bone destruction. Ann Rheum Dis 70:733–739. https://doi.org/10.1136/ard.2010.138693

    Article  PubMed  Google Scholar 

  29. Black N (1996) Why we need observational studies to evaluate the effectiveness of health care. BMJ 312:1215–1218

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  30. McKee M, Britton A, Black N, McPherson K, Sanderson C, Bain C (1999) Methods in health services research. Interpreting the evidence: choosing between randomised and non-randomised studies. BMJ 319:312–315

    Article  PubMed  PubMed Central  CAS  Google Scholar 

  31. Ødegård S, Landewé R, van der Heijde D, Kvien TK, Mowinckel P, Uhlig T (2006) Association of early radiographic damage with impaired physical function in rheumatoid arthritis: a ten-year, longitudinal observational study in 238 patients. Arthritis Rheum 54:68–75. https://doi.org/10.1002/art.21548

    Article  PubMed  Google Scholar 

  32. Scott DL, Pugner K, Kaarela K, Doyle DV, Woolf A, Holmes J, Hieke K (2000) The links between joint damage and disability in rheumatoid arthritis. Rheumatology (Oxford) 39:122–132

    Article  CAS  Google Scholar 

  33. Buchner DM, Wagner EH (1992) Preventing frail health. Clin Geriatr Med 8:1–17

    Article  PubMed  CAS  Google Scholar 

  34. Kwok WY, Bijsterbosch J, Malm SH, Biermasz NR, Huetink K, Nelissen RG, Meulenbelt I, Huizinga TWJ, van ’t Klooster R, Stoel BC, Kloppenburg M (2011) Validity of joint space width measurements in hand osteoarthritis. Osteoarthr Cartil 19:1349–1355. https://doi.org/10.1016/j.joca.2011.08.011

    Article  PubMed  CAS  Google Scholar 

  35. Maillefert JF, Combe B, Goupille P et al (2004) The 5-yr HAQ-disability is related to the first year’s changes in the narrowing, rather than erosion score in patients with recent-onset rheumatoid arthritis. Rheumatology (Oxford) 43:79–84. https://doi.org/10.1093/rheumatology/keg465

    Article  Google Scholar 

  36. van der Heijde DM, van Riel PL, van Leeuwen MA et al (1992) Prognostic factors for radiographic damage and physical disability in early rheumatoid arthritis. A prospective follow-up study of 147 patients. Br J Rheumatol 31:519–525

    Article  PubMed  Google Scholar 

  37. Bansback N, Young A, Brennan A, Dixey J (2006) A prognostic model for functional outcome in early rheumatoid arthritis. J Rheumatol 33:1503–1510

    PubMed  Google Scholar 

  38. Fries JF, Spitz PW, Young DY (1982) The dimensions of health outcomes: the health assessment questionnaire, disability and pain scales. J Rheumatol 9:789–793

    PubMed  CAS  Google Scholar 

  39. Scott DL, Garrood T (2000) Quality of life measures: use and abuse. Baillieres Best Pract Res Clin Rheumatol 14:663–687. https://doi.org/10.1053/berh.2000.0106

    Article  PubMed  CAS  Google Scholar 

  40. Young A, Koduri G, Batley M, Kulinskaya E, Gough A, Norton S, Dixey J, on behalf of the Early Rheumatoid Arthritis Study (ERAS) group (2007) Mortality in rheumatoid arthritis. Increased in the early course of disease, in ischaemic heart disease and in pulmonary fibrosis. Rheumatology (Oxford) 46:350–357. https://doi.org/10.1093/rheumatology/kel253

    Article  CAS  Google Scholar 

  41. Wolfe F, Michaud K, Gefeller O, Choi HK (2003) Predicting mortality in patients with rheumatoid arthritis. Arthritis Rheum 48:1530–1542. https://doi.org/10.1002/art.11024

    Article  PubMed  Google Scholar 

  42. World Health Organisation WB (2011) World report on disability. WHO Library Cataloguing-in-Publication Data.http://www.who.int/disabilities/world_report/2011/report.pdf. Accessed 15 May 2018

Download references

Acknowledgements

LRR is recipient of a Miguel Servet type 1 research contract from the Instituto de Salud Carlos III (ISCIII), Ministry of Health [CP12/03129]. This study was partially supported by a grant from “Fondo de Investigaciones Sanitarias” [PI11/ 02413] (ISCIII) and Red de Investigación en Inflamación y Enfermedades Reumáticas [RD12/0009/0011] (ISCIII).

Author information

Author notes

  1. Fernández-Gutiérrez and Luis Rodriguez-Rodriguez share senior authorship.

Authors and Affiliations

  1. Rheumatology Department and Health Research Institute (IDISSC), Hospital Clínico San Carlos, c\ Prof. Martin Lagos s/n, 28040, Madrid, Spain

    Lydia Abasolo, Leticia Leon, Juan A. Jover, Benjamín Fernández-Gutiérrez & Luis Rodriguez-Rodriguez

  2. Rheumatology Department, Hospital Universitario y Politécnico La Fe, Valencia, Spain

    Jose Ivorra-Cortes

Authors
  1. Lydia Abasolo
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose Ivorra-Cortes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Leticia Leon
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Juan A. Jover
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Benjamín Fernández-Gutiérrez
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Luis Rodriguez-Rodriguez
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis Rodriguez-Rodriguez.

Ethics declarations

Ethics statement

The authors confirm that all human and animal studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments.

Disclosures

None.

Electronic supplementary material

ESM 1

(PDF 349 kb)

ESM 2

(PDF 21 kb)

ESM 3

(PDF 182 kb)

ESM 4

(PDF 93 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Abasolo, L., Ivorra-Cortes, J., Leon, L. et al. Contribution of the bone and cartilage/soft tissue components of the joint damage to the level of disability in rheumatoid arthritis patients: a longitudinal study. Clin Rheumatol 38, 691–700 (2019). https://doi.org/10.1007/s10067-018-4335-4

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10067-018-4335-4

Keywords

search

Navigation