Doctoral defence: Annika Valner "Changes in structure and function of extremities in early rheumatoid arthritis"

On March 28th Annika Valner will defend her thesis "Changes in structure and function of extremities in early rheumatoid arthritis".

Supervisors:
Professor Margus Lember, University of Tartu
Associate professor Riina Kallikorm, University of Tartu

Opponent:
Professor Daina Andersone, University of Latvia

Summary:
Rheumatoid arthritis (RA) is a chronic disease that mainly causes inflammation in the small joints of the hands and feet. It is estimated to affect up to 1% of the population. Although treatments have become more effective and accessible, a total of 25% of patients have RA disease specific joint damage already within three months of developing RA. In addition, RA can cause bone, muscle and fat structure changes of the body, that can substantially affect the patient’s quality of life,

The aim of this study is to evaluate the factors that associate with arthritis related hand and leg structural and functional changes in early RA, as the data are lacking. The study included 83 patients with early RA and 321 population-based controls.Venous blood samples were collected for analysis of inflammatory markers. A 24-hour nutritional intake analysis was conducted, muscle function, bone mineral density and body composition were assessed. In the early RA group was done a face-to-face medical interview in order to receive information about the medical history, also was evaluated arthritis activity and done X-ray of hands.

The results showed that there are structural and functional changes both in hands and legs already present in the early stage of RA due to the systemic effect of inflammation. RA patients had lower hand bone mineral density, reduced lean mass of hands and legs, and accordingly worse muscle function, as well as higher fat mass of arms. The changes related to higher inflammatory activity, nutritional and smoking habits.

As arthritis involvement may vary, it is important in early RA to evaluate hands and legs in parallel. In addition to usual X-ray of hands, hand BMD and muscle mass assessment together with the evaluation of interleukin-6 could be done in early RA. The diagnostical method could be advantageous for rheumatologists in preventing arthritis related limb structural changes and possibly affect treatment strategies.