Objective: To investigate the characteristics of hand dysfunction and its associated factors in patients with rheumatoid arthritis (RA). Methods: A cross-sectional study. Patients with RA were recruited from January 2019 to April 2024 at the Department of Rheumatology and Immunology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University. Demographic and clinical data were collected, including age, gender, active smoking, disease duration, time of morning stiffness, rheumatoid factor and anti-cyclic citrullinated peptide antibody, disease activity, radiographic indicators, and hand function assessment. Hand function was assessed by grip strength measures and self-reported items related to hand function in the Stanford Health Assessment Questionnaire. Factors related to hand function were analyzed by logistic regression analyses. Results: A total of 1 079 RA patients were recruited [mean age: (53.0±12.6) years]. Overall, 72.6% (783/1 079) patients experienced a decrease in grip strength, 57.2% (617/1 079) patients experienced a decreased grip strength in both hands, with the average grip strength of the left and right hands decreasing by 16.3% and 14.1%, respectively, compared to normal values; 39.9% (430/1 079) patients had self-reported hand dysfunction. There were 185 (17.1%) older RA patients (age ≥65 years). The proportion of older RA patients with decreased grip strength [89.7% (166/185) vs. 69.0% (617/894)] and degree of decrease in grip strength compared to normal values (left hand:-35.3%±30.6% vs. -12.3%±38.6%; right hand:-32.6%±32.3% vs. -10.3%±42.1%) were significantly higher than that in young patients, and the proportion of older patients with self-reported hand dysfunction was also significantly higher [53.0% (98/185) vs. 37.1% (332/894), all P<0.001]. Multivariate logistic regression analysis showed that pain visual analogue scale (OR=1.375, 95%CI 1.020-1.854) was independently associated with grip strength decrease in older RA patients, while the 28-joint tender joint count (OR=1.151, 95%CI 1.063-1.246) and provider global assessment of disease activity (OR=1.381, 95%CI 1.171-1.628) were associated with self-reported hand dysfunction. Conclusions: Hand dysfunction is common in RA patients, especially among older RA patients, which is related to pain, joint tenderness and provider global assessment of disease activity. This result implies the importance of pain management in RA patients.
目的： 探讨类风湿关节炎（RA）患者手功能障碍的特征及其相关因素。 方法： 本研究为横断面研究，纳入2019年1月至2024年4月就诊于中山大学孙逸仙纪念医院风湿免疫科的RA患者。收集患者的临床资料，包括年龄、性别、吸烟史、病程、晨僵时间、类风湿因子、抗环瓜氨酸肽抗体、疾病活动指标、关节放射学评估指标和手功能评估指标，手功能评估包括握力和斯坦福健康评估问卷自我报告的手功能。采用logistic回归分析与手功能相关的因素。 结果： 共纳入1 079例RA患者，年龄（53.0±12.6）岁，72.6%（783/1 079）的患者有握力下降，57.2%（617/1 079）双手握力同时下降，左、右手的平均握力较正常值分别下降16.3%和14.1%；39.9%（430/1 079）的患者有自我报告手功能障碍。老年RA（年龄≥65岁）患者185例（17.1%），有握力下降的患者比例［89.7%（166/185）］及握力下降程度（左手：-35.3%±30.6%，右手：-32.6%±32.3%）均高于年轻RA患者［69.0%（617/894），左手：-12.3%± 38.6%；右手：-10.3%±42.1%］（均P<0.001），且有自我报告手功能障碍的患者比例也明显升高［53.0%（98/185）比37.1%（332/894），P<0.001］。多因素logistic回归分析显示，疼痛视觉模拟评分（OR=1.375，95%CI 1.020~1.854）是老年RA患者握力下降的独立相关因素，28个压痛关节数（OR=1.151，95%CI 1.063~1.246）和医生总体疾病活动度评估（OR=1.381，95%CI 1.171~1.628）是自我报告手功能障碍的独立相关因素。 结论： RA尤其是老年RA患者有明显的手功能障碍，并且与疼痛、关节压痛和医生总体疾病活动度评估相关，提示应重视RA患者疼痛的管理。.