title: Three groups in the 28 joints for rheumatoid arthritis synovitis--analysis using more than 17,000 assessments in the KURAMA database.
abstract: 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.
authors.affiliation: Center for Genomic Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan. a0001101@kuhp.kyoto-u.ac.jp
authors.forename: Chikashi
authors.initials: C
authors.lastname: Terao
authors.forename: Motomu
authors.initials: M
authors.lastname: Hashimoto
authors.forename: Keiichi
authors.initials: K
authors.lastname: Yamamoto
authors.forename: Kosaku
authors.initials: K
authors.lastname: Murakami
authors.forename: Koichiro
authors.initials: K
authors.lastname: Ohmura
authors.forename: Ran
authors.initials: R
authors.lastname: Nakashima
authors.forename: Noriyuki
authors.initials: N
authors.lastname: Yamakawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Yoshifuji
authors.forename: Naoichiro
authors.initials: N
authors.lastname: Yukawa
authors.forename: Daisuke
authors.initials: D
authors.lastname: Kawabata
authors.forename: Takashi
authors.initials: T
authors.lastname: Usui
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yoshitomi
authors.forename: Moritoshi
authors.initials: M
authors.lastname: Furu
authors.forename: Ryo
authors.initials: R
authors.lastname: Yamada
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Matsuda
authors.forename: Hiromu
authors.initials: H
authors.lastname: Ito
authors.forename: Takao
authors.initials: T
authors.lastname: Fujii
authors.forename: Tsuneyo
authors.initials: T
authors.lastname: Mimori
mesh_terms: D000328:Adult; D000368:Aged; D001172:Arthritis, Rheumatoid / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D016000:Cluster Analysis; D016208:Databases, Factual; D005260:Female; D005384:Finger Joint / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D025341:Principal Component Analysis; D012785:Shoulder Joint / Q000473:pathology*; D013585:Synovitis / Q000145:classification / Q000150:complications / Q000175:diagnosis* / Q000473:pathology; D014955:Wrist Joint / Q000473:pathology*
references.citation: Arthritis Rheum. 1999 Sep;42(9):1854-60
references.pmid: 10513799
references.citation: Clin Trials. 2012 Aug;9(4):408-17
references.pmid: 22605791
references.citation: Nature. 2003 May 15;423(6937):356-61
references.pmid: 12748655
references.citation: Ann Rheum Dis. 1990 Nov;49(11):916-20
references.pmid: 2256738
references.citation: Ann Rheum Dis. 1992 Feb;51(2):177-81
references.pmid: 1550400
references.citation: Clin Exp Rheumatol. 2009 Jul-Aug;27(4):552-9
references.pmid: 19772784
references.citation: Arthritis Rheum. 2005 Mar;52(3):733-43
references.pmid: 15751062
references.citation: J Rheumatol. 2000 Jan;27(1):261-3
references.pmid: 10648051
references.citation: Rheumatology (Oxford). 2003 Feb;42(2):244-57
references.pmid: 12595618
references.citation: J Rheumatol. 2002 Nov;29(11):2278-87
references.pmid: 12415582
references.citation: Arthritis Rheum. 2006 Mar;54(3):702-10
references.pmid: 16508926
references.citation: Arthritis Rheum. 1988 Mar;31(3):315-24
references.pmid: 3358796
references.citation: Arthritis Rheum. 1993 Jun;36(6):729-40
references.pmid: 8507213
references.citation: Best Pract Res Clin Rheumatol. 2007 Aug;21(4):663-75
references.pmid: 17678828
references.citation: Arthritis Rheum. 2009 Sep 15;61(9):1194-201
references.pmid: 19714611
references.citation: Ann Rheum Dis. 2010 Sep;69(9):1580-8
references.pmid: 20699241
references.citation: Arthritis Rheum. 2010 Sep;62(9):2569-81
references.pmid: 20872595