A Comparison Between Methotrexate and Methotrexate with Biological Agents Treatment in Hand Deformities in Patients with Rheumatoid Arthritis

Objective: A comparison between the treatment used and hand deformities in patients with RA. The treatment includes conventional disease modifying drugs (DMARD) or DMARD and biological agents. Methods: This study involved 70 female patients admitted between February 2016 and August 2016 to The Central Clinical Hospital in Warsaw to the Rheumatology Department. The group was divided as follows: 35 patients treated with methotrexate (MTX) alone and 35 patients treated with MTX and biological agents. 35 additional healthy volunteers were used as a control group. Results: 35 hand deformities were noted in the group treated with MTX and biological agents and 42 hand deformities were noted in the group treated with MTX alone. The deformities and their frequencies were as follows: subluxation of the metacarpophalangeal joints (MCPJ) (20.0%) in both groups, ulnar deviation of the MCPJ (14.3 and 20.0%) respectively, radial deviation of the wrist (5.7 and 17.1%), boutonniere deformity of the fingers II V (20% and 25.7%), swan neck deformity (8.6% and 14.3%), Z deformity of the thumb (11.4 and 2.9%). According to the results, the average and maximum hand endurance, power grip strength, ability to rotate in the proximal and distal radio-ulnar joint were statistically significantly worse in both RA groups compared with the control group. Between both RA groups, the group treated with MTX and biological agents showed statistically significantly better results in number of rotations in radio-ulnar proximal and distal joints in the dominant hand. In the group treated with both MTX and biological agents, results showed a negative correlation in hand endurance, power grip strength and ability to rotate in the proximal and distal radio-ulnar joint, compared with DAS28 and HAQ. With disease progression, strength, ability and hand endurance decreases. It was observed that in the group treated with MTX alone, hand manipulation ability decreased over time with disease progression, but this correlation was not observed in the group treated with both MTX with biological agents. In the group treated with MTX alone, a negative correlation was noted in comparison to HAQ. Conclusion: Effective management of RA includes slowing down the disease progression. The mode of treatment has an important role as wrist, hands and finger joints are most commonly affected.