OBJECTIVE To investigate the course of disability related to the upper extremities (UEs) in early rheumatoid arthritis (RA), and to assess correlations between such disability and clinical variables, including grip force. METHODS In an inception cohort of patients with early RA (diagnosed 1995-2005, N = 222, follow-up 10 yrs), disability of the UEs was assessed using a subscore of the Health Assessment Questionnaire-Disability Index (HAQ-DI-UE), and average grip force of the dominant hand was measured. Changes between consecutive follow-up visits in the HAQ-DI-UE subscore, and correlations at each visit with key clinical variables, were assessed. The relation between joint involvement and HAQ-DI-UE was examined using multivariate linear regression analysis. RESULTS The HAQ-DI-UE decreased significantly from inclusion to the 6-month follow-up (mean change -0.26, 95% CI -0.18 to -0.34), and increased significantly after 2 years. There were fairly strong correlations for HAQ-DI-UE with grip force (r = -0.50 to -0.62), patient global assessment (r = 0.53 to 0.64), and patient-reported pain (r = 0.54 to 0.60) at all timepoints through 5 years, but only moderate to weak correlations with swollen joints, C-reactive protein, and erythrocyte sedimentation rate. At inclusion, wrist synovitis and tender proximal interphalangeal joints both had an independent effect on HAQ-DI-UE, whereas tenderness of the shoulder and the wrist had a greater importance at 6 months. CONCLUSION Disability related to the UEs decreased significantly during the first 6 months, and increased again after 2 years. The correlations with clinical variables underline the major effect of pain and impaired hand function in early RA.

中文翻译：

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早期类风湿性关节炎中与上肢相关的残疾 - 长期病程和疾病可变影响：一项队列研究。


目的 探讨早期类风湿性关节炎 （RA） 中与上肢 （UE） 相关的残疾病程，并评估此类残疾与临床变量（包括握力）之间的相关性。方法 在早期 RA 患者 （1995-2005 年诊断，N = 222，随访 10 年） 的初始队列中，使用健康评估问卷-残疾指数 （HAQ-DI-UE） 的子评分评估 UE 的残疾，并测量惯用手的平均握力。评估 HAQ-DI-UE 子评分连续随访之间的变化，以及每次就诊与关键临床变量的相关性。使用多变量线性回归分析检查关节参与与 HAQ-DI-UE 之间的关系。结果 从纳入到 6 个月随访，HAQ-DI-UE 显著降低 （平均变化 -0.26,95% CI -0.18 至 -0.34），2 年后显著升高。HAQ-DI-UE 与 5 年内所有时间点的握力 （r = -0.50 至 -0.62） 、患者整体评估 （r = 0.53 至 0.64） 和患者报告的疼痛 （r = 0.54 至 0.60） 都有相当强的相关性，但与关节肿胀、C 反应蛋白和红细胞沉降率仅存在中度至弱相关性。入组时，腕部滑膜炎和近端指间关节压痛均对 HAQ-DI-UE 有独立影响，而肩部和腕部压痛在 6 个月时更重要。结论 与 UE 相关的残疾在前 6 个月显著下降，2 年后再次增加。与临床变量的相关性强调了疼痛和手部功能受损对早期 RA 的主要影响。