1295: Having More Tender Than Swollen Joints Is Associated with Worse Functional Outcomes in Patients with Early RA in a Prospective Real-World Cohort

Charis Meng¹, Yvonne Lee², Orit Schieir³, Marie-France Valois⁴, Margaret Butler¹, Gilles Boire⁵, Glen Hazelwood⁶, Carol Hitchon⁷, Edward Keystone⁸, Diane Tin⁹, Carter Thorne¹⁰, Louis Bessette¹¹, Janet Pope¹², Susan Bartlett¹³ and Vivian Bykerk¹, ¹Hospital for Special Surgery, New York, NY, ²Northwestern University, Chicago, IL, ³McGill University, Montréal, QC, Canada, ⁴McGill University, Pointe-Claire, QC, Canada, ⁵Université de Sherbrooke, Sherbrooke, QC, Canada, ⁶University of Calgary, Calgary, AB, Canada, ⁷University of Manitoba, Manitoba, MB, Canada, ⁸Keystone Consulting Enterprises Inc., Toronto, ON, Canada, ⁹Centre of Arthritis Excellence, Newmarket, ON, Canada, ¹⁰Southlake Regional Health Centre, Newmarket, ON, Canada, ¹¹Centre de l'Ostéoporose et de Rhumatologie de Québec, Quebec City, QC, Canada, ¹²University of Western Ontario, London, ON, Canada, ¹³McGill University, Montreal, QC, Canada

Background/Purpose: Early RA patients may present with more tender than swollen joints, which can persist during DMARD therapy. Elevated TSJD (tender-swollen joint difference) is often challenging for rheumatologists, as there may be multiple causes, and in some, it may contribute to overestimating disease activity scores and ineffective treatment decisions.Little is known about the phenotype and impact of TSJD on patient function. Our objective was to evaluate the distribution and impact of TSJD on functional outcomes in the first year following RA diagnosis, and to determine whether associations vary by joint size. A better understanding of pain patterns relating to TSJD may help identify patients who could benefit from adjunctive treatments targeted at different pain pathways.

Methods: Data were from patients with active, early RA enrolled in the Canadian Early Arthritis Cohort (CATCH), who completed assessments of general function (MDHAQ, range 0-10), upper extremity (UE) function of small and large joints (Neuro-QoL UE index, T-scores 0-100) over 1-year. 28 tender and swollen joint counts including 6 large joints (shoulders, elbows, knees) and 22 small joints (wrists, MCPs, PIPs) were performed. TSJDs were calculated by subtracting SJC from TJC at each visit. Adjusted associations between TSJD and functional outcomes (MD-HAQ and Neuro-QoL UE function T-score) were estimated in separate multivariable mixed effects models adjusted for age, sex, education, smoking, comorbidities, osteoarthritis/back pain and RA treatment. Separate analyses were performed for large versus small joint TSJD to examine potential differential impacts by joint size.

Results: Patients (n=549) were 70% female, mean (SD) age 56 (15) years, disease duration 5.3 (2.9) months. At baseline, 287 (52%) had TSJD >0, persisting in 32% at 12-months. 43% involved small joints and 34% had large joints, persisting at 12 months in 25% and 15% respectively. Higher TSJD was significantly associated with worse function [adjusted mean-changes (95%CI): MD-HAQ increase of 0.10 (0.08, 0.13) and decrease in Neuro-QoL UE function T-scores by -0.59 (-0.76, -0.43)] for every 1-point increase in TSJD (Table, Figure). Higher large joint TSJDs in particular were associated with the worst functional outcomes.

Conclusion: Having more tender than swollen joints is common in early RA. Higher TSJD score is associated with progressive worsening of functional outcomes, particularly when large joints are affected. Early identification and targeted intervention of predominantly tender joints may be needed to prevent long-term dysfunction.






C. Meng: None; Y. Lee: Cigna-Express Scripts, 8, Eli Lilly, 12, Medical Writer, Pfizer, 5, Sanofi, 12, Medical Writer; O. Schieir: None; M. Valois: None; M. Butler: None; G. Boire: Eli Lilly, 1, Janssen, 6, Organon, 1, Orimed Pharma, 1, 6, Otsuka, 1, Pfizer, 1, 5, Sandoz, 1, Teva, 1, Viatris, 1, 6; G. Hazelwood: None; C. Hitchon: Astra Zeneca, 1, Pfizer Canada, 5; E. Keystone: AbbVie/Abbott, 2, 6, Amgen, 2, 6, celltrion, 2, 6, Eli Lilly, 2, 6, Fresenius Kabi, 2, 6, Pfizer, 2, 6, Samsung Bioepsis, 2, sandoz, 2, 6; D. Tin: None; C. Thorne: Abbvie, 1, Biogen, 2, Nordic Pharma, 1, Pfizer, 1, 5, Roche, 1, Sandoz, 1, 2; L. Bessette: AbbVie, 2, 5, 6, Amgen, 2, 5, 6, Bristol Myers Squibb, 2, 5, 6, Eli Lilly, 2, 5, 6, Fresenius Kabi, 2, 6, Gilead, 2, 5, 6, JAMP Pharma, 2, 5, 6, Janssen, 2, 5, 6, Novartis, 2, 5, 6, Organon, 2, 6, Pfizer, 2, 5, 6, Sandoz, 2, 6, Sanofi, 2, 5, 6, Teva, 2, 6, UCB, 2, 5, 6, UCBA, 5; J. Pope: AbbVie, 1, 2; S. Bartlett: Janssen, 6, Merck/MSD, 2, 6, Novartis, 2, Organon, 1, 6, PROMIS Health Organization, 4, Sandoz, 2, 6; V. Bykerk: Abbvie, 2, BMS, 2, Pfizer, 2.