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August 2023 - Irina Gessl


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Dr. Irina Gessl


Inflammatory joint diseases such as rheumatoid arthritis (RA) and psoriatic arthritis (PsA) are characterized by joint swelling and tenderness. Without adequate treatment, they lead to irreversible structural damage. While joint swelling is widely regarded as a clear indicator of an active disease, joint tenderness, especially in the absence of swelling, might have other reasons besides inflammation such as pain memory or structural damage.(2)

The aim of this study was to assess whether joint tenderness without swelling is a risk factor for the progression of structural damage (radiographic progression). In total, we included 1.207 joints in 55 patients with RA and 352 joints in 18 patients with PsA. We found a positive association between tenderness and subsequent progression in both diseases, but it was only significant in RA. In both diseases, the association of baseline structural damage and baseline sonographic signs for synovitis with radiographic progression was higher and significant.

In patients with RA and PsA, a sonographic examination of the joints and current x-rays can be used to assess disease activity and to estimate the risk of radiographic progression. This may be particularly relevant in patients with many painful and only few or no swollen joints.

Selected Literature

  1. Gessl I, Hana CA, Deimel T, Durechova M, Hucke M, Konzett V, u. a. Tenderness and radiographic progression in rheumatoid arthritis and psoriatic arthritis. Ann Rheum Dis. März 2023;82(3):344–50.

  2. Gessl I, Popescu M, Schimpl V, Supp G, Deimel T, Durechova M, u. a. Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis. Ann Rheum Dis. Juli 2021;80(7):884–90.

  3. Gessl I, Waldmann E, Penz D, Majcher B, Dokladanska A, Hinterberger A, u. a. Resection rates and safety profile of cold vs. hot snare polypectomy in polyps sized 5-10 mm and 11-20 mm. Dig Liver Dis Off J Ital Soc Gastroenterol Ital Assoc Study Liver. April 2019;51(4):536–41.

  4. Gessl I, Waldmann E, Penz D, Majcher B, Dokladanska A, Hinterberger A, u. a. Evaluation of adenomas per colonoscopy and adenomas per positive participant as new quality parameters in screening colonoscopy. Gastrointest Endosc. März 2019;89(3):496–502.

  5. Gessl I, Waldmann E, Britto-Arias M, Penz D, Pablik E, Trauner M, u. a. Surveillance colonoscopy in Austria: Are we following the guidelines? Endoscopy. Februar 2018;50(2):119–27.

  6. Gessl I, Balint PV, Filippucci E, Keen HI, Pineda C, Terslev L, u. a. Structural damage in rheumatoid arthritis assessed by musculoskeletal ultrasound: A systematic literature review by the Structural Joint Damage Task Force of the OMERACT Ultrasound Working Group. Semin Arthritis Rheum. Juni 2021;51(3):627–39.

Dr. Irina Gessl

Medizinische Universität Wien
Universitätsklinik für Innere Medizin III
Klinische Abteilung für Rheumatologie
Währinger Gürtel 18-20
1090 Wien

T: +43 (0)1 40400-43000