Background: Rheumatoid Arthritis [RA] is a chronic systemic disease that affects the functional capacity of the hand due to inflammatory arthritis and joint destruction. RA patients have difficulties with everyday life activities and daily living activities. The prevalence of osteoporosis is estimated to be about twice that of the general population. Dual-energy X-ray absorptiometry (DEXA) is the most precise tool for detecting loss in bone mineral density in RA.
Aim of the study: This study aims to investigate the relation between generalized bone mineral density (BMD) and each of hand joint destruction and hand function in order to find out its possible role in assessment of rheumatoid hand disability.
Patients and Methods: Fifty patients diagnosed as RA based on the 2010 ACR Rheumatoid Arthritis Classification Criteria were included in this study. All patients were subjected to the following scores: Duruöz Hand Index (DHI), Grip Ability Test (GAT), Grip strength test, and Pinch strength tests for assessing the function of the dominant hand of each patient. The participants were also subjected to plain x-ray evaluated by van der Heijde-modified total Sharp score (vdH-S) to assess the damage of the joints of the dominant hand, and Dual-energy X-ray absorptiometry (DEXA) to assess the Bone Mineral Density.
Results: The current study showed that wrist BMD was correlated with grip strength, pinch strength, GAT, and van der Heijde modified sharp score of the dominant hand. Moreover, X-ray joint findings were significantly correlated with each of total grip ability test, grip strength, and pinch strength as the hand disability manifested more with joint damage.
Conclusion: In conclusion, Osteoporosis, hand function, and joint damage in RA are correlated suggesting related pathophysiological mechanisms. The Severity of RA could be related to osteoporosis as well as joint destruction and hand disability.
Van Nies JA, Krabben A, Schoones JW, Huizinga TW, Kloppenburg M, van derHelm-van Mil AH. “What is the evidence for the presence of a therapeutic win-dow of opportunity in rheumatoid arthritis? A systematic literature reviews” AnnRheum Dis. 2014; 73:861–70.2.
Akram M, Daniyal M, Sultana S, Owais A, Akhtar N, Zahid R, Said F, Bouyahya A, Ponomarev E, Ali Shariat M, Thiruvengadam M. “Traditional and modern management strategies for rheumatoid arthritis” Clinica Chimica Acta; International Journal of Clinical Chemistry. 2021 Jan; 512:142-155.
Smolen JS, Landewe R, Breedveld FC, et al. “EULAR recommendations for the management of rheumatoid arthritis with synthetic and biological disease- modifying antirheumatic drugs: 2013 update”. Ann Rheum Dis. 2014; 73:492– 509.
Stephanie Tom, Kelley and Firestein’s Textbook of Rheumatology, 2-volume Set, 10th Edition, The Journal of Rheumatology, 2017, 44 (6) 964.
Romero-Guzmán A.K., Menchaca-Tapia V.M., Contreras-Yáñez I., Pascual-Ramos V. “Patient and physician perspectives of hand function in a cohort of rheumatoid arthritis patients: the impact of disease activity”. BMC Musculoskelet Disord, 2016: 17, 392.
van Tuijl J., Janssen-Potten Y. & Seelen H. “Evaluation of upper extremity motor function tests in tetraplegics”. Spinal Cord, 2002, 40, 51–64.
Sferra da Silva G., de Almeida Lourenço M. & de Assis M.R. “Hand strength in patients with RA correlates strongly with function but not with activity of disease”. Adv Rheumatol, 2018; 58: 20.
Xu S, Wang Y, Lu J, Xu J. “Osteoprotegerin and RANKL in the pathogenesis of rheumatoid arthritis-induced osteoporosis”. Rheumatol Int. 2012; 32: 3397–3403.
Mochizuki T, Yano K, Ikari K, Hiroshima R, Sakuma Y, Momohara S. “Correlation between hand bone mineral density and joint destruction in established rheumatoid arthritis”. J Orthop. 2017, 14(4):461-465.
Kilic G and Ozgocmen S, “Hand bone mass in rheumatoid arthritis: A review of the literature”. World J Orthop. 2015; 6(1): 106–116.
Duruöz MT, Poiraudeau S, Fermanian J, et al. “Development and validation of a rheumatoid hand functional disability scale that assess functional handicap”. J Rheumatol. 1996; 23:1167–72.
Poole J., “Measures of Hand Function”. Arthritis Care & Research, Vol. 63, No. S11, 2011, pp S189–S199.
Higgins SC, Adams J, Hughes R. “Measuring hand grip strength in rheumatoid arthritis”. Rheumatol Int. 2018; 38(5):707-714.
Van der Heijde D. Radiographic progression in rheumatoid arthritis: dose it reflect outcome? Dose it reflect treatment? Ann Rheum Dis. 2001; 60:47–50.
Heidari B, Hassanjani Roushan MR. “Rheumatoid arthritis and osteoporosis”. Caspian J Intern Med. 2012; 3(3):445-446.
Tanaka S, Tanaka Y. “RANKL as a therapeutic target of rheumatoid arthritis”. J Bone Miner Metab. 2021 Jan; 39(1):106-112.
Hill CL, Schultz CG, Wu R, Chatterton BE, Cleland LG. “Measurement of hand bone mineral density in early rheumatoid arthritis using dual energy X-ray absorptiometry”. Int J Rheum Dis. 2010; 13(3):230-4.
Hafez EA, Mansour HE, Hamza SH, Moftah SG, Younes TB, Ismail MA. “Bone mineral density changes in patients with recent-onset rheumatoid arthritis”. Clin Med Insights Arthritis Musculoskelet Disord. 2011; 4:87-94.
Hafström I., Ajeganova S., Forslind K., Svensson B., “Anti-citrullinated protein antibodies are associated with osteopenia but not with pain at diagnosis of rheumatoid arthritis: data from the BARFOT cohort”. Arthritis Res Ther. 2019; 21-45.
Wysham KD, Shoback DM, Imboden JB Jr, Katz PP. “Association of High Anti-Cyclic Citrullinated Peptide Seropositivity and Lean Mass Index with Low Bone Mineral Density in Rheumatoid Arthritis”. Arthritis Care Res (Hoboken). 2018; 70(7):961-969.
Hoff M, Haugeberg G. “Using hand bone mass measurements to assess progression of rheumatoid arthritis”. Ther Adv Musculoskelet Dis. 2010; 2(2):79-87.
Luo Y, Jiang K, He M. “Association between grip strength and bone mineral density in general US population of NHANES 2013-2014”. Arch Osteoporos. 2020 Mar 16; 15(1):47.
Lee SH, Gong HS. “Measurement and Interpretation of Handgrip Strength for Research on Sarcopenia and Osteoporosis”. Journal of Bone Metabolism. 2020; 27(2):85-96.
Dogu B, Kuran B, Yilmaz F, Usen A, Sirzai H. “Is hand bone mineral density a marker for hand function in patients with established rheumatoid arthritis? The correlation among bone mineral density of the hand, radiological findings, and hand function”. Clin Rheumatol. 2013; 32(8):1177-83.
Deodhar AA, Brabyn J, Pande I, Scott DL, Woolf AD. “Hand bone densitometry in rheumatoid arthritis, a five-year longitudinal study: an outcome measure and a prognostic marker”. Ann Rheum Dis. 2003; 62(8):767-770.
Li YZ, Zhuang HF, Cai SQ, Lin CK, Wang PW, Yan LS, Lin JK, Yu HM. “Low Grip Strength is a Strong Risk Factor of Osteoporosis in Postmenopausal Women”. Orthop Surg. 2018; 10(1):17-22.
Yamamoto Y, Turkiewicz A, Wingstrand H, Englund M. “Fragility fractures in patients with rheumatoid arthritis and osteoarthritis compared with the general population [J]”. J Rheumatol. 2015; 42(11):2055–2058.
Lindner, L., Callhoff, J., Alten, R. et al. “Osteoporosis in patients with rheumatoid arthritis: trends in the German National Database 2007–2017”. Rheumatol Int, 2020; 40, 2005–2012.
Dedeoğlu M, Gafuroğlu Ü, Yilmaz Ö, Bodur H. “The relationship between hand grip and pinch strengths and disease activity, articular damage, pain, and disability in patients with rheumatoid arthritis”. Turk J Rheumatol 2013; 28(2):69-77.
Birtane M, Kabayel DD, Uzunca K, Unlu E, Tastekin N. “The relation of hand functions with radiological damage and disease activity in rheumatoid arthritis”. Rheumatol Int. 2008; 28(5):407-12.
Scott DL, Smith C, Kingsley G. “Joint damage and disability in rheumatoid arthritis: an updated systematic review”. Clin Exp Rheumatol. 2003; 21(5 Suppl 31): S20-7.