Central nervous system involvement in perceived joint stiffness

P. S. Helliwell

University of Leeds, Rheumatology and Rehabilitation, Leeds, West Yorkshire, UK.

E-mail: p.helliwell{at}leeds.ac.uk

SIR, Haigh et al. [1] state that measurement of objective joint stiffness does not relate to that experienced by the patient in rheumatoid arthritis (RA). This premise underlies their paper on phantom limb stiffness in amputees who have RA. However, more recent studies by our group have shown that objective joint stiffness does correlate with subjective stiffness providing appropriate correction for muscle wasting is made [2]. Furthermore, the changes observed can reflect local joint inflammation and the response to intra-articular steroids [3]. People may also use a variety of descriptors to relate the deterioration they experience after a night in bed and may, in some cases, find it difficult to distinguish between stiffness and pain [4]. I agree that cortical plasticity may explain some of the symptoms experienced in the presence of chronically inflamed joints, but the physical evidence suggests that joint stiffness is a real phenomenon and that distal sensory function in large fibre afferents is normal in this group of patients [5].

The author has declared no conflict of interest.

References

  1. Haigh RC, McCabe CS, Halligan PW, Blake DR. Joint stiffness in a phantom limb: evidence of central nervous system involvement in rheumatoid arthritis. Rheumatology 2003;42:888–92.[Abstract/Free Full Text]
  2. Helliwell PS, Smeathers JE, Wright V. The contribution of different tissues to stiffness in the joint. Proc Inst Mech Eng Part H Eng Med 1995;208:223–8.
  3. Helliwell PS. Use of an objective measure of articular stiffness to record changes in finger joints after intra-articular injection of corticosteroid. Ann Rheum Dis 1997;56:71–3.[Abstract/Free Full Text]
  4. Helliwell PS. The semiology of arthritis—discriminating between patients on the basis of their symptoms. Ann Rheum Dis 1995;54:924–6.[Abstract]
  5. Helliwell PS. Normal vibration perception thresholds in rheumatoid arthritis—evidence against the neurogenic theory of articular stiffness. Clin Rheumatol 1994;13:51–3.[ISI][Medline]
Accepted 18 July 2003





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