{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:31:19Z","timestamp":1791412279831,"version":"4.3.3"},"reference-count":17,"publisher":"BMJ","issue":"1","license":[{"start":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T00:00:00Z","timestamp":1675900800000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000780","name":"European Union","doi-asserted-by":"crossref","award":["714312"],"award-info":[{"award-number":["714312"]}],"id":[{"id":"10.13039\/501100000780","id-type":"DOI","asserted-by":"crossref"}]},{"DOI":"10.13039\/501100000142","name":"Arthritis Society","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000142","id-type":"DOI","asserted-by":"publisher"}]},{"name":"European Research Council"},{"DOI":"10.13039\/501100001826","name":"ZonMw","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001826","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["RMD Open"],"accepted":{"date-parts":[[2023,1,23]]},"published-print":{"date-parts":[[2023,2]]},"abstract":"<jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Clinically suspect arthralgia (CSA) is characterised by arthralgia of small joints and considered a risk stage for development of rheumatoid arthritis (RA). However, it remains unknown if the function of the hands is already affected and what mechanisms underlie impaired hand-function in CSA.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We studied various measures of hand function in two CSA populations. CSA patients in the TREAT EARLIER-trial (n=236) were evaluated at baseline for: grip strength on a dynamometer (GS), patient-reported difficulties in the grip domain of the Health Assessment Questionnaire (HAQ) questionnaire and incomplete fist closure at physical examination. Findings were validated in an independent CSA cohort (n=600) where hand function was measured as: GS evaluated by squeezing the examiner\u2019s fingers, grip domain of the HAQ questionnaire and fist closure. Contrast-enhanced MRI of the hands measured synovitis, tenosynovitis and bone marrow oedema (summed as subclinical inflammation) in both cohorts.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>GS (on a dynamometer) was reduced in 75% compared with reference values in healthy controls, 60% reported grip difficulties and 13% had incomplete fist closure. Reduced GS was associated with subclinical inflammation (\u22120.38\u2009kg\/point inflammation, 95%\u2009CI \u22120.68 to \u22120.08). Studying separate MRI features, GS reduction was independently associated with tenosynovitis, decreasing with \u22122.63\u2009kg (95% CI \u22122.26 to \u22120.33)\/point tenosynovitis (range observed tenosynovitis scores: 0\u201320). Similar relations with tenosynovitis were seen for patient-reported grip difficulties (OR 1.12\/point, 95% CI 1.07 to 1.42) and incomplete fist closure (OR 1.36\/point, 95% CI 1.03 to 1.79). In the validation cohort, 36% had decreased examiner-assessed GS, 51% reported grip difficulties and 14% incomplete fist closure: all were associated with tenosynovitis. Decreased dynamometer-measured GS was most sensitive for detecting tenosynovitis (75%), while incomplete fist closure was most specific (88%\u201390%).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>Hand function is already often affected before RA development. These limitations are related to subclinical inflammation and tenosynovitis in particular.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1136\/rmdopen-2022-002885","type":"journal-article","created":{"date-parts":[[2023,2,9]],"date-time":"2023-02-09T10:00:51Z","timestamp":1675936851000},"page":"e002885","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Hand function is already reduced before RA development and reflects subclinical tenosynovitis"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1654-1031","authenticated-orcid":false,"given":"Doortje Isabelle","family":"Krijbolder","sequence":"first","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5953-6844","authenticated-orcid":false,"given":"Sarah J H","family":"Khidir","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7332-8072","authenticated-orcid":false,"given":"Xanthe M E","family":"Matthijssen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robin M","family":"ten Brinck","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jill","family":"van Aken","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Spaarne Gasthuis, Haarlem, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Irene","family":"Speyer","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Haaglanden Medical Center, Westeinde The Hague, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4261-7979","authenticated-orcid":false,"given":"Florus J","family":"van der Giesen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1900-790X","authenticated-orcid":false,"given":"Elise","family":"van Mulligen","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"},{"name":"Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8572-1437","authenticated-orcid":false,"given":"Annette H M","family":"van der Helm-van Mil","sequence":"additional","affiliation":[{"name":"Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands"},{"name":"Department of Rheumatology, Erasmus Medical Centre, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2023,2,9]]},"reference":[{"key":"2025090312434066000_9.1.e002885.1","doi-asserted-by":"crossref","DOI":"10.1136\/rmdopen-2016-000419","article-title":"Functional limitations in the phase of clinically suspect arthralgia are as serious as in early clinical arthritis; a longitudinal study","volume":"3","author":"Ten Brinck","year":"2017","journal-title":"RMD Open"},{"key":"2025090312434066000_9.1.e002885.2","doi-asserted-by":"crossref","first-page":"2583","DOI":"10.1093\/rheumatology\/keab793","article-title":"Work participation is reduced during the development of RA, months before clinical arthritis manifests","volume":"61","author":"Rogier","year":"2022","journal-title":"Rheumatology (Oxford)"},{"key":"2025090312434066000_9.1.e002885.3","doi-asserted-by":"publisher","DOI":"10.1093\/rheumatology\/34.3.296"},{"key":"2025090312434066000_9.1.e002885.4","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2015-208138"},{"key":"2025090312434066000_9.1.e002885.5","doi-asserted-by":"crossref","first-page":"553","DOI":"10.1016\/j.apmr.2019.10.183","article-title":"Measurement properties of the hand grip strength assessment: a systematic review with meta-analysis","volume":"101","author":"Bobos","year":"2020","journal-title":"Arch Phys Med Rehabil"},{"key":"2025090312434066000_9.1.e002885.6","doi-asserted-by":"publisher","DOI":"10.1016\/j.jhsa.2008.01.008"},{"key":"2025090312434066000_9.1.e002885.7","doi-asserted-by":"publisher","DOI":"10.1002\/acr.20631"},{"key":"2025090312434066000_9.1.e002885.8","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1016\/S0140-6736(22)01193-X","article-title":"Intervention with methotrexate in patients with arthralgia at risk of rheumatoid arthritis to reduce the development of persistent arthritis and its disease burden (TREAT EARLIER): a randomised, double-blind, placebo-controlled, proof-of-concept trial","volume":"400","author":"Krijbolder","year":"2022","journal-title":"Lancet"},{"key":"2025090312434066000_9.1.e002885.9","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2014-205522"},{"key":"2025090312434066000_9.1.e002885.10","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/afr051"},{"key":"2025090312434066000_9.1.e002885.11","doi-asserted-by":"publisher","DOI":"10.1136\/ard.2003.019935"},{"key":"2025090312434066000_9.1.e002885.12","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2019-216350"},{"key":"2025090312434066000_9.1.e002885.13","doi-asserted-by":"publisher","DOI":"10.1136\/annrheumdis-2016-209835"},{"key":"2025090312434066000_9.1.e002885.14","doi-asserted-by":"crossref","first-page":"301","DOI":"10.1002\/acr.24452","article-title":"Walking disabilities in association with tenosynovitis at the metatarsophalangeal joints: a longitudinal magnetic resonance imaging study in early arthritis","volume":"74","author":"Dakkak","year":"2022","journal-title":"Arthritis Care Res (Hoboken)"},{"key":"2025090312434066000_9.1.e002885.15","doi-asserted-by":"crossref","first-page":"86","DOI":"10.1093\/rheumatology\/key220","article-title":"Is joint pain in patients with arthralgia suspicious for progression to rheumatoid arthritis explained by subclinical inflammation? 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