Rheumatoid arthritis (RA) is a joint-destructive autoimmune disease. Three composite indices evaluating the same 28 joints are commonly used for the evaluation of RA activity. However, the relationship between, and the frequency of, the joint involvements are still not fully understood. Here, we obtained and analyzed 17,311 assessments for 28 joints in 1,314 patients with RA from 2005 to 2011 from electronic clinical chart templates stored in the KURAMA (Kyoto University Rheumatoid Arthritis Management Alliance) database. Affected rates for swelling and tenderness were assessed for each of the 28 joints and compared between two different sets of RA patients. Correlations of joint symptoms were analyzed for swellings and tenderness using kappa coefficient and eigen vectors by principal component analysis. As a result, we found that joint affected rates greatly varied from joint to joint both for tenderness and swelling for the two sets. Right wrist joint is the most affected joint of the 28 joints. Tenderness and swellings are well correlated in the same joints except for the shoulder joints. Patients with RA tended to demonstrate right-dominant joint involvement and joint destruction. We also found that RA synovitis could be classified into three categories of joints in the correlation analyses: large joints with wrist joints, PIP joints, and MCP joints. Clustering analysis based on distribution of synovitis revealed that patients with RA could be classified into six subgroups. We confirmed the symmetric joint involvement in RA. Our results suggested that RA synovitis can be classified into subgroups and that several different mechanisms may underlie the pathophysiology in RA synovitis.
Drossaers-Bakker KW, de Buck M, van Zeben D, Zwinderman AH, Breedveld FC, et al. (1999) Long-term course and outcome of functional capacity in rheumatoid arthritis: the effect of disease activity and radiologic damage over time. Arthritis and Rheumatism 42: 1854–1860.
[3]
Smolen JS, Van Der Heijde DM, St Clair EW, Emery P, Bathon JM, et al. (2006) Predictors of joint damage in patients with early rheumatoid arthritis treated with high-dose methotrexate with or without concomitant infliximab: results from the ASPIRE trial. Arthritis and Rheumatism 54: 702–710.
[4]
Felson DT, Anderson JJ, Boers M, Bombardier C, Chernoff M, et al. (1993) The American College of Rheumatology preliminary core set of disease activity measures for rheumatoid arthritis clinical trials. The Committee on Outcome Measures in Rheumatoid Arthritis Clinical Trials. Arthritis and Rheumatism 36: 729–740.
[5]
van der Heijde DM, van 't Hof MA, van Riel PL, Theunisse LA, Lubberts EW, et al. (1990) Judging disease activity in clinical practice in rheumatoid arthritis: first step in the development of a disease activity score. Annals of the Rheumatic Diseases 49: 916–920.
[6]
van der Heijde DM, van't Hof MA, van Riel PL, van Leeuwen MA, van Rijswijk MH, et al. (1992) Validity of single variables and composite indices for measuring disease activity in rheumatoid arthritis. Annals of the Rheumatic Diseases 51: 177–181.
[7]
Smolen JS, Breedveld FC, Schiff MH, Kalden JR, Emery P, et al. (2003) A simplified disease activity index for rheumatoid arthritis for use in clinical practice. Rheumatology 42: 244–257.
[8]
Aletaha D, Smolen JS (2007) The Simplified Disease Activity Index (SDAI) and Clinical Disease Activity Index (CDAI) to monitor patients in standard clinical care. Best Pract Res Clin Rheumatol 21: 663–675.
[9]
Salaffi F, Cimmino MA, Leardini G, Gasparini S, Grassi W (2009) Disease activity assessment of rheumatoid arthritis in daily practice: validity, internal consistency, reliability and congruency of the Disease Activity Score including 28 joints (DAS28) compared with the Clinical Disease Activity Index (CDAI). Clinical and Experimental Rheumatology 27: 552–559.
[10]
Arnett FC, Edworthy SM, Bloch DA, McShane DJ, Fries JF, et al. (1988) The American Rheumatism Association 1987 revised criteria for the classification of rheumatoid arthritis. Arthritis Rheum 31: 315–324.
[11]
Scheel AK, Hermann KG, Kahler E, Pasewaldt D, Fritz J, et al. (2005) A novel ultrasonographic synovitis scoring system suitable for analyzing finger joint inflammation in rheumatoid arthritis. Arthritis and Rheumatism 52: 733–743.
[12]
Backhaus M, Ohrndorf S, Kellner H, Strunk J, Backhaus TM, et al. (2009) Evaluation of a novel 7-joint ultrasound score in daily rheumatologic practice: a pilot project. Arthritis and Rheumatism 61: 1194–1201.
[13]
van der Heijde D (2000) How to read radiographs according to the Sharp/van der Heijde method. Journal of Rheumatology 27: 261–263.
[14]
Machold KP, Stamm TA, Eberl GJ, Nell VK, Dunky A, et al. (2002) Very recent onset arthritis – clinical, laboratory, and radiological findings during the first year of disease. Journal of Rheumatology 29: 2278–2287.
[15]
Yamamoto K, Yamanaka K, Hatano E, Sumi E, Ishii T, et al. (2012) An eClinical trial system for cancer that integrates with clinical pathways and electronic medical records. Clin Trials 9: 408–417.
[16]
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, et al. (2010) 2010 Rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Arthritis and Rheumatism 62: 2569–2581.
[17]
Aletaha D, Neogi T, Silman AJ, Funovits J, Felson DT, et al. (2010) 2010 rheumatoid arthritis classification criteria: an American College of Rheumatology/European League Against Rheumatism collaborative initiative. Annals of the Rheumatic Diseases 69: 1580–1588.
