Upper extremity joint tenderness as a practical indicator for assessing presenteeism in rheumatoid arthritis patients: A cross-sectional observational study

Ryota Naito; Masashi Taniguchi; Hideo Onizawa; Tomoya Nakajima; Kayo McCracken; Masato Mori; Ryosuke Hiwa; Takuji Nakamura; Akira Onishi; Shuichi Matsuda; Akio Morinobu; Shinji Hirose; Yutaka Shinkawa; Hisanori Umehara; Masao Tanaka

doi:10.1371/journal.pone.0318047

Peer Review History

Original SubmissionJanuary 19, 2025
19 Jan 2025 Author Response https://doi.org/10.1371/journal.pone.0318047.r001
25 Mar 2025 Decision Letter - Sham Santhanam, Editor Dear Dr. Tanaka, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Kindly look into the editor's and reviewers comments and revise the manuscript accordingly. Please submit your revised manuscript by May 09 2025 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). 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Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Sham Santhanam Academic Editor PLOS ONE Journal Requirements: 1. When submitting your revision, we need you to address these additional requirements.-->--> -->-->Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at -->-->https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and -->-->https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf-->--> -->-->2. Thank you for stating in your Funding Statement: -->-->M.Tanaka and A.O. belong to the department financially supported by two local governments in Japan (Nagahama City, Shiga and Toyooka City, Hyogo) and two pharmaceutical companies (Ayumi Pharmaceutical Corp. and Asahi Kasei Pharma Corp.).-->-->M.Tanaka received research grants and/or speaker fees from AbbVie GK, Astellas Pharma Inc., Bristol-Myers Squibb Company, Chugai Pharmaceutical Co., Ltd., Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Nippon Zoki Pharmaceutical Co., Ltd., Pfizer Inc., Taisho Pharmaceutical Co., Ltd., Teijin Pharma, Ltd. and UCB Japan Co., Ltd. A.O. received grants from Pfizer Inc., Bristol-Myers Squibb Company, and Advantest, as well as personal fees from Asahi Kasei Pharma Corp., Chugai Pharmaceutical Co., Ltd., Eli Lilly Japan K.K., Ono Pharmaceutical Co., Ltd., Mitsubishi Tanabe Pharma Corp., Takeda Pharmaceutical Co., Ltd. and Daiichi Sankyo Co., Ltd. S.M. received speaking fees from Pfizer Inc., Chugai Pharmaceutical Co. Ltd., Asahi Kasei Pharma Corp., Eisai Co. Ltd., Mitsubishi Tanabe Pharma Corp., and Teijin Pharma Ltd.; A.M. received honoraria from AbbVie G.K., Chugai Pharmaceutical Co. Ltd., Eli Lilly Japan K.K., Eisai Co. Ltd., Pfizer Inc., Bristol–Myers Squibb, Mitsubishi Tanabe Pharma Co., Astellas Pharma Inc. and Gilead Sciences Japan, and received research grants from AbbVie G.K., Asahi Kasei Pharma Corp., Chugai Pharmaceutical Co. Ltd., and Mitsubishi Tanabe Pharma Corp.-->-->R.H. received research grants and/or speaker fees from AbbVie GK, Asahi Kasei Pharma Corp., Bristol Myers Squibb Company, Daiichi Sankyo Co., Ltd., Eisai Co., Ltd., Eli Lilly Japan K.K., GSK plc, Kissei, Pfizer Inc., Mitsubishi Tanabe Pharma Co., and UCB Japan. -->--> -->-->Please provide an amended statement that declares all the funding or sources of support (whether external or internal to your organization) received during this study, as detailed online in our guide for authors at http://journals.plos.org/plosone/s/submit-now.  Please also include the statement “There was no additional external funding received for this study.” in your updated Funding Statement. -->-->Please include your amended Funding Statement within your cover letter. We will change the online submission form on your behalf.-->?> 3. Please review your reference list to ensure that it is complete and correct. If you have cited papers that have been retracted, please include the rationale for doing so in the manuscript text, or remove these references and replace them with relevant current references. Any changes to the reference list should be mentioned in the rebuttal letter that accompanies your revised manuscript. If you need to cite a retracted article, indicate the article’s retracted status in the References list and also include a citation and full reference for the retraction notice. Additional Editor Comments: Congrats on the effort. 1. Mention the type of study - cross sectional/observational - in the title and in methods Please refer to standard reporting guidelines and the checklist (STROBE - if it's an observational study) 2. The methods section can be trimmed further - section on TJC evaluation and statistical analysis 3. In results, please mention the individual subheadings without inferences (not to mention if it has a positive or negative correlation) 4. Not to repeat the content in tables/figures extensively. Use figures only if really needed (figure 2) 5. Also look into the reviewers comments. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: I congratulate the authors for a well conducted study. The study carries a message that has clinical implications. I would like to suggest some minor changes Comment 1 The abstract does not reflect the study completely. Please include the following lines in abstract 1. Please mention in methods that presenteeism was ‘self-reported’ 2. Please mention in the results that a positive correlation was seen between upper extremity TJC and presenteeism but not with lower extremity TJC 3. Please change the last line in conclusion of abstract to ‘Minimizing TJC in the upper extremities, particularly in the shoulders and fingers, could be important treatment goal to reduce work disability in RA patients.’ Comment 2 Please summarise the study in conclusion in the manuscript in a better way Comment 3 Please mention the average interval between collecting WPAI data for 158 patients that were included in the temporal change comparison. Reviewer #2: This cross-sectional study provides valuable insights into work disability among patients with rheumatoid arthritis. The manuscript is well-written, and the title, abstract, and introduction are appropriate and adequately presented. However, the cross-sectional design limits the ability to establish causality. To strengthen the analysis, the authors may consider incorporating a multivariable model that adjusts for socioeconomic status, as this could be an important confounder in assessing work disability. Overall, this is an impressive manuscript that contributes to the existing literature on the subject. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: Yes: Vijaya Prasanna Parimi ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org https://doi.org/10.1371/journal.pone.0318047.r002
Revision 1
28 Apr 2025 Author Response Response to Editor’s comments We sincerely appreciate editor’s encouraging words and the opportunity to improve our manuscript. As outlined below, we have addressed the editor's comments with utmost sincerity and care. Comment 1 Mention the type of study - cross sectional/observational - in the title and in methods. Please refer to standard reporting guidelines and the checklist (STROBE - if it's an observational study). Response: We have revised the title (Page 1, Line 1) and the “Methods” section (Page 6, Lines 3-4) to specify the study type. Additionally, since our study includes certain longitudinal analyses, we have also mentioned this in the “Methods” section (Page 6, Lines 3–4). Furthermore, we have referred to the STROBE checklist and confirmed that our manuscript adheres to these reporting guidelines. Comment 2 The methods section can be trimmed further - section on TJC evaluation and statistical analysis. Response: We have trimmed the sections “TJC evaluation of upper and lower extremities” (Page 7-9) and “Statistical analysis” (Page 10, after the line, and Page 11) by reducing the number of words by changing the wording (465 words => 375 words, and 372 words => 305 words, respectively), while ensuring accuracy. Comment 3 In results, please mention the individual subheadings without inferences (not to mention if it has a positive or negative correlation). Response: We have revised the “Results” section to ensure that the subheadings do not include inferences (Pages 13-16). Comment 4 Not to repeat the content in tables/figures extensively. Use figures only if really needed (figure 2). Response: We have revised the “Results” section to retain the key points related to the tables and figures by not mentioning duplicate items (Pages 12-17, deleted items are in red, double lined text). Additionally, following the editor’s suggestion, we have determined that Figure 2 is not essential for the main text and have therefore moved it to the Supporting Information (S1 Fig). We have also updated the figure numbering throughout the manuscript accordingly (in the red letters after the “Results” section). Comment 4 Also look into the reviewer comments. Response: We have addressed Reviewer #1’s and Reviewer #2’s comments as well. Responses to their comments can be found in the next section. =========================================================================================== Response to reviewers’ comments Reviewer #1: We sincerely thank Reviewer #1 for the positive feedback and for recognizing the clinical implications of our study. We appreciate the constructive suggestions and have addressed them accordingly. Comment 1 The abstract does not reflect the study completely. Please include the following lines in abstract 1. Please mention in methods that presenteeism was ‘self-reported’ 2. Please mention in the results that a positive correlation was seen between upper extremity TJC and presenteeism but not with lower extremity TJC 3. Please change the last line in conclusion of abstract to ‘Minimizing TJC in the upper extremities, particularly in the shoulders and fingers, could be important treatment goal to reduce work disability in RA patients.’ Response: As suggested by Reviewer #1, we have revised the abstract as follows: 1. We have clarified that presenteeism was ‘self-reported’ in the “Methods” section of the “Abstract” (Page 2, Line 11). 2. We have revised the “Results” section of the “Abstract” to indicate that a positive correlation was seen between upper extremity TJC and presenteeism, but not with lower extremity TJC (Page 3, Lines 2–3). 3. We have modified the last sentence of the “Conclusion” of the “Abstract” to: ‘Minimizing TJC in the upper extremities, particularly in the shoulders and fingers, could be an important treatment goal to reduce work disability in RA patients.’ (Page 3, Lines 5 and 6). Comment 2 Please summarise the study in conclusion in the manuscript in a better way. Response: As suggested by Reviewer #1, we have revised the conclusion to provide a clearer and more concise summary of our findings. Specifically, we have emphasized the significance of upper extremity TJC, particularly in the shoulders and fingers, as a predictor of work disability in RA patients. Comment 3 Please mention the average interval between collecting WPAI data for 158 patients that were included in the temporal change comparison. Response: Reviewer #1 mentioned 158 patients; however, the temporal change analysis included 137 patients who continued working, after excluding 21 retirees. Therefore, we have reported the average interval for the 137 patients as 248 ± 121 days in the manuscript and have also made slight modifications to the surrounding text for clarity and coherence (Page 16, Lines 10 and 11). Reviewer #2: We sincerely thank Reviewer #2 for the positive feedback and for recognizing the value of our study. We greatly appreciate Reviewer #2’s kind words regarding the title, abstract, and introduction. Specific point However, the cross-sectional design limits the ability to establish causality. To strengthen the analysis, the authors may consider incorporating a multivariable model that adjusts for socioeconomic status, as this could be an important confounder in assessing work disability. Overall, this is an impressive manuscript that contributes to the existing literature on the subject. Response: We sincerely appreciate Reviewer #2’s valuable comments, particularly regarding the potential confounding effect of socioeconomic status (SES) on work disability. As we mentioned in the "Discussion" section (the first limitation comment on Page 20, Lines 13-17), we acknowledge this limitation and the need for cautious interpretation of our results. Unfortunately, our cohort data does not include indicators of SES which have been reported as relevant factors in the association with work disability. Additionally, due to the lack of ethical approval to collect SES data from the facility, we were unable to incorporate this information into our analysis. However, although adjustments for SES as a confounder are not included, we believe that our data still offer meaningful insights into the relationship between upper extremity TJC and work disability in RA patients, contributing to a broader understanding of this topic. Furthermore, as suggested by Reviewer #2 regarding the limitations of the cross-sectional study design, we have revised the manuscript to clearly acknowledge this issue. Specifically, we have noted that the cross-sectional nature of our study limits the ability to establish causality and requires careful interpretation (Page 22, Lines 9-11). We sincerely appreciate your insightful suggestions, and we hope that our responses adequately address your concerns. Attachments Attachment Submitted filename: Response to Reviewers R1.docx https://doi.org/10.1371/journal.pone.0318047.r003
12 May 2025 Decision Letter - Martin Feuchtenberger, Editor Upper extremity joint tenderness as a practical indicator for assessing presenteeism in rheumatoid arthritis patients: A cross-sectional observational study PONE-D-24-60059R1 Dear Dr. Tanaka, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Martin Feuchtenberger Academic Editor PLOS ONE Additional Editor Comments (optional): Congratulations to the authors and many thanks also to the reviewers of the manuscript! Kind regards, Martin Feuchtenberger Reviewers' comments: Reviewer's Responses to Questions Comments to the Author Reviewer #1: All comments have been addressed Reviewer #2: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions??> Reviewer #1: Yes Reviewer #2: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? -->?> Reviewer #1: Yes Reviewer #2: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available??> The PLOS Data policy Reviewer #1: Yes Reviewer #2: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English??> Reviewer #1: Yes Reviewer #2: Yes ****** Reviewer #1: Thank you for making the suggested corrections. Please find some minor comments 1. Please mention the units of the time interval between two WAPI surveys, whether it is days or weeks. 2. Please include this text in conclusion “Presenteeism due to RA tended to improve as upper extremity TJC improved” Reviewer #2: This is a revised manuscript addressing the reviewer comments. The queries were answered. No specific extra comments to the author or editor. ****** what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy Reviewer #1: No Reviewer #2: Yes: Vijaya Prasanna Parimi ******** https://doi.org/10.1371/journal.pone.0318047.r004
Formally Accepted
Acceptance Letter - Martin Feuchtenberger, Editor PONE-D-24-60059R1 PLOS ONE Dear Dr. Tanaka, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset You will receive further instructions from the production team, including instructions on how to review your proof when it is ready. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few days to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Dr. Martin Feuchtenberger Academic Editor PLOS ONE https://doi.org/10.1371/journal.pone.0318047.r005

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