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Mazza DF, Boonsri PS, Arora A, Bayne CO, Szabo RM, Chaudhari AJ, Boutin RD. Relationships between diagnostic imaging of first carpometacarpal osteoarthritis and pain, functional status, and disease progression: A systematic review. Osteoarthritis Cartilage 2024; 32:476-492. [PMID: 38141842 DOI: 10.1016/j.joca.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To systematically review the association of pain, function, and progression in first carpometacarpal (CMC) osteoarthritis (OA) with imaging biomarkers and radiography-based staging. DESIGN Database searches in PubMed, Embase, and the Cochrane Library, along with citation searching were conducted in accordance with published guidance. Data on the association of imaging with pain, functional status, and disease progression were extracted and synthesized, along with key information on study methodology such as sample sizes, use of control subjects, study design, number of image raters, and blinding. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. RESULTS After duplicate removal, a total of 1969 records were screened. Forty-six articles are included in this review, covering a total of 28,202 study participants, 7263 with first CMC OA. Osteophytes were found to be one of the strongest biomarkers for pain across imaging modalities. Radiographic findings alone showed conflicting relationships with pain. However, Kellgren-Lawrence staging showed consistent associations with pain in various studies. Radiographic, sonographic, and MRI findings and staging showed little association to tools evaluating functional status across imaging modalities. The same imaging methods showed limited ability to predict progression of first CMC OA. A major limitation was the heterogeneity in the study base, limiting synthesis of results. CONCLUSION Imaging findings and radiography-based staging systems generally showed strong associations with pain, but not with functional status or disease progression. More research and improved imaging techniques are needed to help physicians better manage patients with first CMC OA.
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Affiliation(s)
- Dario F Mazza
- Department of Radiology, University of California, Davis, CA, USA.
| | | | - Aman Arora
- Department of Radiology, University of California, Davis, CA, USA.
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | | | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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van Beest S, van de Stadt LA, Rosendaal FR, Kloppenburg M. Patients with clinically diagnosed hand OA not fulfilling the ACR classification criteria are in an earlier disease phase and more often have thumb base OA. Osteoarthr Cartil Open 2023; 5:100347. [PMID: 36942210 PMCID: PMC10023912 DOI: 10.1016/j.ocarto.2023.100347] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Accepted: 02/14/2023] [Indexed: 02/22/2023] Open
Abstract
Objective To investigate the performance of the American College of Rheumatology (ACR) classification criteria for hand osteoarthritis. Design Longitudinal data up to four years from a cohort of consecutive patients with primary hand osteoarthritis diagnosed by their rheumatologist (Hostas study) were used to classify presence or absence of hand osteoarthritis according to the 1990 ACR criteria (traditional format: one major and 4 minor ACR criteria) (ACR+/ACR-). Demographics, Australian/Canadian osteoarthritis hand index (AUSCAN) pain and function were obtained. Hand radiographs were scored according to Kellgren-Lawrence; radiographic osteoarthritis was defined as Kellgren-Lawrence ≥2 in ≥1 CMC1 joint or ≥2 DIP/PIP/MCP joints. Results Of 538 patients (mean age 61 years, 86.1% women) 485 (90.1%) fulfilled ACR criteria at baseline. Except for the minor criterion swelling of <3 MCP joints, all criteria differed between the groups. ACR- patients were younger, with higher BMI, a shorter time since diagnosis, and less bony enlargements, joint deformities and radiographic osteoarthritis, except for radiographic CMC1 osteoarthritis which was seen more often in ACR- patients. No difference in AUSCAN pain or function was seen between ACR- versus ACR+ patients. After follow-up 37/53 (69.8%) converted to ACR+, 2/53 (3.8%) did not, and 14/53 (26.4%) were lost to follow-up. Conclusions In clinical practice the majority of patients fulfill the ACR classification criteria, but those in an earlier disease phase, with less signs of hand osteoarthritis or with primarily thumb base osteoarthritis are less likely to fulfill them. New classification criteria also including earlier disease stages and with attention for hand osteoarthritis subtypes are required.
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Affiliation(s)
- Sjoerd van Beest
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
- Corresponding author. Department of Rheumatology Leiden University Medical Center, C1-R PO Box, 9600 2300, RC Leiden the Netherlands
| | - Lotte A. van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Frits R. Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Pezeshk P, Soldatos T, Ezzati F, Bhatnagar N, Chhabra A. Spectrum of Hand Arthritis. Magn Reson Imaging Clin N Am 2023; 31:239-253. [PMID: 37019548 DOI: 10.1016/j.mric.2023.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2023]
Abstract
Early diagnosis of arthritis is of paramount importance to slow the progression of disease and joint destruction. Because of temporal dissemination of the clinical and laboratory manifestations of the inflammatory arthritis and overlap of the findings, diagnosis can be challenging in early stages of the disease. This article highlights the utility of advanced cross-sectional imaging, including color-Doppler ultrasound, diffusion-weighted MR imaging, and perfusion MR imaging in the domain of arthropathy so that the reader can apply these principles and techniques in their practices for timely and accurate diagnosis and improved multidisciplinary communications for better management of such conditions.
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Molendijk E, Schiphof D, Oei EHG, de Vos RJ, Bos PK, van Meurs JBJ, Lubberts E, Zillikens MC, van der Eerden BCJ, Kavousi M, Schouten BWV, de Rooij-Duran MIB, Bierma-Zeinstra SMA. Accelerated menopausal changes as human disease model 'FOCUM' for the development of osteoarthritis and other degenerative disorders: protocol for a prospective cohort study. BMJ Open 2022; 12:e064779. [PMID: 36375984 PMCID: PMC9664313 DOI: 10.1136/bmjopen-2022-064779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
INTRODUCTION The incidence of degenerative disorders, including osteoarthritis (OA), increases rapidly in women after menopause. However, the influence of the menopause is still insufficiently investigated due to the slowness of menopausal transition. In this study, a novel human model is used in which it is expected that menopausal-related changes will occur faster. This is the Females discontinuing Oral Contraceptives Use at Menopausal age model. The ultimate aim is to link these changes to OA and other degenerative disorders, including cardiovascular diseases, diabetes, osteoporosis and tendinopathies. METHODS AND ANALYSIS This is a pilot observational prospective cohort study with 2 years of follow-up. Fifty women aged 50-60 who use oral contraceptive (OC) and have the intention to stop are included. Measurements are performed once before stopping OC, and four times thereafter at 6 weeks, 6 months, 1 year and 2 years. At every time point, a questionnaire is filled in and a sample of blood is drawn. At the first and final time points, a physical examination, hand radiographs and a MRI scan of one knee are performed. The primary OA outcome is progression of the MRI Osteoarthritis Knee Score. Secondary OA outcomes are the development of clinical knee and hand OA, development of knee OA according to the MRI definition, and progression of radiographic features for hand OA. Principal component analysis will be used to assess which changes occur after stopping OC. Univariate and multivariate generalised estimating equation models will be used to test for associations between these components and OA. ETHICS AND DISSEMINATION The study has been approved by the Medical Ethics Committee of the Erasmus MC University Medical Center Rotterdam (MEC-2019-0592). All participants must give informed consent before data collection. Results will be disseminated in national and international journals. TRIAL REGISTRATION NUMBER NL70796.078.19.
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Affiliation(s)
- Eveline Molendijk
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology and Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert-Jan de Vos
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - P Koen Bos
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Erik Lubberts
- Department of Rheumatology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - M Carola Zillikens
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Maryam Kavousi
- Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Boris W V Schouten
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | | | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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Garcia-Lopez E, Moore DC, Kenney DE, Ladd AL, Weiss APC, Crisco JJ. Evaluation of the PROMIS Upper Extremity Against Validated Patient-Reported Outcomes in Patients With Early Carpometacarpal Osteoarthritis. J Hand Surg Am 2022; 47:621-628. [PMID: 35527094 PMCID: PMC9271544 DOI: 10.1016/j.jhsa.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Internal consistency, construct, and criterion validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) v1.2 were evaluated in patients with early-stage carpometacarpal (CMC) osteoarthritis (OA). We hypothesized that in patients with early CMC OA, PROMIS UE scores would: (1) be lower than those in asymptomatic controls; (2) correlate with established patient-reported outcomes; (3) correlate with pinch and grip strengths; and (4) not correlate with radiographic disease progression. METHODS Patients with early CMC OA (modified Eaton stage 0 or 1) and matched asymptomatic control patients completed the PROMIS UE, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation at 2 time points. The PROMIS UE's internal consistency was evaluated by Cronbach's alpha, construct validity by Spearman correlation coefficients among the patient-reported outcome measures, and criterion validity using measures of strength. A floor or ceiling effect was indicated if more than 15% of patients achieved the lowest or highest possible score. RESULTS The PROMIS UE had high internal consistency. Patients with early CMC OA had a lower score than healthy controls (average, 42 vs 54, respectively). We observed moderate to high correlations between the PROMIS UEv1.2, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation and good criterion validity when compared to key pinch and grip strengths. The PROMIS UE did not correlate to radiographic disease severity. CONCLUSIONS The PROMIS UE had a high correlation with Australian and Canadian Osteoarthritis Hand Index and a moderate correlation with Patient-Rated Wrist-Hand Evaluation. The PROMIS UE had high internal consistency and good criterion validity. CLINICAL RELEVANCE The PROMIS UE is a valid assessment for disability in patients with early CMC OA and can serve as a clinical adjunct to an outcome assessment.
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Affiliation(s)
- Edgar Garcia-Lopez
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Douglas C. Moore
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Deborah E. Kenney
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Amy L. Ladd
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA, USA
| | - Arnold-Peter C. Weiss
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
| | - Joseph J. Crisco
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI, USA
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Suwannaphisit S, Tangtrakulwanich B, Suwanno P, Sinnathakorn N, Maheu E. Cross-cultural adaptation and validation of the Thai version of the functional index for hand osteoarthritis (FIHOA). BMC Musculoskelet Disord 2022; 23:582. [PMID: 35705932 PMCID: PMC9202204 DOI: 10.1186/s12891-022-05528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background The Functional Index for Hand Osteoarthritis (FIHOA) is a simple tool to assess functional impairment for hand OA patients. The purpose of this study was to translate the FIHOA into the Thai language, and validate it in Thai hand OA patients. Methods The FIHOA was translated into Thai (T-FIHOA) according to the principles of
cross-cultural adaptation and administered to 102 hand OA patients recruited between September 2020 and July 2021 together with the modified Health Assessment Questionnaire (mHAQ), Disabilities of the Arm, Shoulder and Hand (DASH), and visual analogue scale (VAS) for hand pain. Spearman’s correlation coefficient and intraclass correlation coefficient (ICC) were used to check the test-retest reliability of each item and the total scores in the translated questionnaire. The internal consistency reliability was evaluated using Cronbach’s alpha. The external construct validity was assessed using correlations between the T-FIHOA, mHAQ, DASH and hand pain VAS. Results The T-FIHOA had a unidimensional structure. The ICC was > 0.9 and the Cronbach’s alpha of 0.92 indicated excellent reliability and internal consistency, respectively. The external validity tests indicated moderate correlation with the hand pain VAS (r = 0.37, P < 0.01) and moderate to strong correlations with the mHAQ (r = 0.63, P < 0.01), and DASH score (r = 0.52, P < 0.01). The T-FIHOA had the highest effect size (ES) and standardized response mean (SRM) (− 0.37 and − 0.58 respectively) among all questionnaires except for the VAS when assessing changes between baseline and week 4. Conclusions The T-FIHOA is a good and reliable assessment tool freely available for practitioners/researchers to evaluate functional impairment in Thai hand OA patients.
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Affiliation(s)
- Sitthiphong Suwannaphisit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Porames Suwanno
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Nitiphoom Sinnathakorn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Emmanuel Maheu
- Department of Rheumatology, APHP, Saint-Antoine Hospital, 283, Boulevard Voltaire, Paris, France
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Gil JA, Kleiner J, McQuillan TJ, Kenney D, Ladd AL, Weiss APC, Crisco JJ. The Association of AUSCAN and PRWHE Patient-reported Outcome Measures With Radiographic Progression of Early Thumb Carpometacarpal Arthritis at 36-Month Follow-up Is Limited to Subtle Changes in the Pain Subscale. Hand (N Y) 2022; 17:354-360. [PMID: 32935579 PMCID: PMC8984720 DOI: 10.1177/1558944720928489] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a paucity of literature that examines how patient-reported outcomes correspond to early radiographic progression of thumb carpometacarpal (CMC) osteoarthritis (OA). This study examines how Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Patient-Rated Hand and Wrist Evaluation (PRWHE) scores change over 36 months in subjects with early CMC OA. METHODS Ninety-one subjects with symptomatic early thumb CMC OA were enrolled. Differences in AUSCAN and PRWHE scores were measured between subjects at baseline and at 18-month follow-up, and between the subjects at baseline and at 36-month follow-up. Radiographic progression was defined as an increase in modified Eaton Stage. Differences in AUSCAN and PRWHE scores were compared between these 2 groups in order to determine if radiographic progression was associated with a greater change in AUSCAN and PRWHE at 18- and 36-month follow-up. RESULTS At 18- and 36-month follow-up visits, there were no significant differences in AUSCAN or PRWHE compared to baseline. Multivariable logistic regression analysis did not reveal any significant differences between subjects with radiographic progression to subjects without radiographic progression at 18-month follow-up. At 36-month follow-up, this analysis did demonstrate that subjects with evidence of radiographic progression had a significant increase in the PRWHE pain subscale. CONCLUSION AUSCAN and PRWHE scores were not found to significantly progress at 18-month and 36-month follow-up. However, when comparing the subset of subjects with and without radiographic OA, subjects with early CMC OA who had 1 stage of radiographic progression were found to have a significantly higher intensity of pain on the PRWHE pain subscale at 36-month follow-up.
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Affiliation(s)
- Joseph A. Gil
- Warren Alpert Medical School of Brown
University, Providence, RI, USA,Joseph A. Gil, Department of Orthopaedic
Surgery, Rhode Island Hospital, Warren Alpert Medical School of Brown
University, 593 Eddy Street, Providence, RI 02903, USA.
| | - Justin Kleiner
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
| | | | | | - Amy L. Ladd
- Stanford School of Medicine, Redwood
City, CA, USA
| | | | - Joseph J. Crisco
- Warren Alpert Medical School of Brown
University, Providence, RI, USA
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O'Neil J, McEwen D, Kang BK, Dorion M, Brosseau L, Imoto AM, Álvarez Gallardo IC, Westby MD. Intervention reporting and dissemination of information for the management of hand osteoarthritis. J Hand Ther 2021; 34:362-368. [PMID: 32565101 DOI: 10.1016/j.jht.2020.03.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Accepted: 03/21/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION A variety of exercise programs are recognized to be effective for the management of hand osteoarthritis (HOA). It is important to report the essential elements of these exercise programs for clinicians to replicate properly and facilitate their implementation with individuals who suffers from HOA, especially if they are found to be effective programs. PURPOSE OF THE STUDY The objective of this article was to assess content reporting using three exercise reporting standardized assessment tools among exercise interventions randomized controlled trials (RCTs) involving individuals with HOA. STUDY DESIGN A descriptive study was used. METHODS Two pairs of trained assessors independently identified, selected, and scored the reporting quality of the exercise programs of RCTs on the management of HOA using three standardized assessment tools: the Consensus on Exercise Reporting Template (CERT) checklist, Consensus on Therapeutic Exercise Training (CONTENT) scale, and Template for Intervention Description and Replication (TIDieR) checklist to review the quality of reporting of 11 RCTs included in a recent Ottawa Panel guideline. RESULTS Based on consensus reached by two different pairs of reviewers and an arbitrator, the mean total scores for the 11 included exercise programs were reported as follows: the mean total score for the CERT, CONTENT, and TIDieR was 10.58/19 ± 4.34, 3.27/9 ± 1.90, and 5.92/12 ± 2.54, respectively. The overall Pearson's Correlation (r) between the methodological quality and intervention reporting was 0.86, 0.71, and 0.54 for moderate-to-high RCTs and 0.47, 0.79, and 0.42 for fair-to-poor methodological quality for the CERT checklist, CONTENT scale, and TIDieR checklist, respectively. CONCLUSIONS The intervention reporting in the management of HOA is poor among low-, moderate-, and high-quality clinical trials. The least reported information was intervention parameters related to behavior change. Improving reporting is recommended to ensure replication of effective exercise programs to enhance quality of life of individuals with HOA.
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Affiliation(s)
- Jennifer O'Neil
- School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada; Bruyère Research Institute, Ottawa, Ontario, Canada.
| | - Daniel McEwen
- School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Bhavjot K Kang
- Centre for Hip Health and Mobility Robert H.N. Ho Research Centre, School of Kinesiology, University of British Columbia, Vancouver, Canada
| | - Michelle Dorion
- School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Lucie Brosseau
- School of Rehabilitation, University of Ottawa, Ottawa, Ontario, Canada
| | - Aline Mizusaki Imoto
- Evidence-Based Health Department, Federal University of Sao Paulo, Sao Paulo, Brazil
| | | | - Marie Deanna Westby
- Centre for Hip Health and Mobility Robert H.N. Ho Research Centre, School of Kinesiology, University of British Columbia, Vancouver, Canada; Mary Pack Arthritis Program, Vancouver Coastal Health and Centre for Hip Health and Mobility and Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Shi Y, Fu K, Oo WM, Deveza LA, Wang X, Duong V, Robbins SR, Hunter DJ. Associations between radiographic features, clinical features and ultrasound of thumb-base osteoarthritis: A secondary analysis of the COMBO study. Int J Rheum Dis 2021; 25:38-46. [PMID: 34821056 PMCID: PMC9298930 DOI: 10.1111/1756-185x.14248] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 10/28/2021] [Accepted: 11/01/2021] [Indexed: 11/28/2022]
Abstract
Aim To investigate the associations of ultrasound and radiographic features of thumb‐base osteoarthritis (OA) with thumb‐base pain and hand function at baseline and 12 weeks. Method Data from a randomized controlled trial conducted in participants with symptomatic radiographic thumb‐base OA were analyzed. Participants who finished follow up were included in this secondary analysis. Pain and hand function were assessed using self‐reported measures. All participants underwent ultrasound examinations for synovitis, power Doppler signal (PDS), and osteophytes, and underwent radiography for osteophytes, joint space narrowing (JSN), and subchondral bone sclerosis at baseline. Hand pain and function were reassessed after the 12‐week follow up. The associations of ultrasound and radiographic findings with clinical features were further evaluated, using linear regression analyses, after adjustment for relevant confounding factors. Results A total of 166 participants (average age 66.2 years; 76.5% female) were included. At baseline, radiographic JSN and subchondral bone sclerosis were associated with hand function. There was a significant association between ultrasound‐detected PDS and patient's global assessment (PGA) at baseline. Baseline radiographic JSN was significantly associated with the changes in stiffness and PGA from baseline to 12 weeks. There was no association between ultrasound features and changes in the clinical outcomes over 12 weeks. Conclusion This study indicates that radiographic features significantly correlate with hand function, and ultrasound PDS is closely related to the PGA at baseline in thumb‐base OA. Radiographic JSN may be a predictor for stiffness and PGA in thumb‐base OA.
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Affiliation(s)
- Ying Shi
- Ultrasound Department, Shenzhen Longhua District Central Hospital, Shenzhen, China.,Ultrasound Department, The Second Hospital of Shanxi Medical University, Taiyuan, China
| | - Kai Fu
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Win Min Oo
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Leticia A Deveza
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Xia Wang
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Vicky Duong
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Sarah R Robbins
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
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van Beest S, Kroon HM, Reijnierse M, Rosendaal FR, Kloppenburg M, Kroon FPB. Two-Year Changes in Magnetic Resonance Imaging Features and Pain in Thumb Base Osteoarthritis. Arthritis Care Res (Hoboken) 2021; 73:1628-1637. [PMID: 32558377 PMCID: PMC8596842 DOI: 10.1002/acr.24355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 04/28/2020] [Accepted: 06/09/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To investigate the two-year course of pain and osteoarthritic features on magnetic resonance imaging (MRI) in the thumb base. METHODS Patients in the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort who had received radiographic examination, MRI, and clinical examination of the right thumb base at baseline and who had a 2-year follow-up period were studied. Pain on palpation of the thumb base was assessed on a 0-3 scale. MRIs were analyzed with the Outcome Measures in Rheumatology (OMERACT) thumb base osteoarthritis MRI scoring system for synovitis, bone marrow lesions (BMLs), subchondral bone defects, cartilage space loss, osteophytes, and subluxation. Radiographs were assessed for osteophytes and joint space narrowing. We studied the associations of changes in synovitis and BMLs with changes in pain using a logistic regression model adjusted for radiographic damage, with values expressed as odds ratios (ORs) and 95% confidence intervals (95% CIs). RESULTS Of 165 patients, 83% were women and the mean age was 60.7 years. At baseline, 65 patients had thumb base pain. At 2-year follow-up, pain had decreased in 32 patients and increased in 33 patients. MRI features remained stable in most patients. Structural MRI features generally deteriorated, while synovitis and BMLs improved in some individuals and deteriorated in others. Change in radiographic osteophytes rarely occurred (n = 10). Increased synovitis (odds ratio [OR] 3.4 [95% CI 1.3-9.3]) and increased BMLs (OR 5.1 [95% CI 2.1-12.6]) were associated with increased pain. Decreased BMLs appeared to be associated with decreased pain (OR 2.7 [95% CI 0.8-8.9]), and reductions in synovitis occurred too infrequently to calculate associations. CONCLUSION Over 2 years, thumb base pain fluctuated, while MRI features changed in a minority of patients with hand osteoarthritis. Changes in synovitis and BMLs were associated with changes in pain on palpation, even after adjustment for radiographic damage.
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Kroon FPB, van der Heijde D, Maxwell LJ, Beaton DE, Abishek A, Berenbaum F, Blanco FJ, Conaghan PG, Dziedzic K, Hill CL, Haugen IK, Ishimori M, Ritschl V, Stamm TA, Wittoek R, Kloppenburg M. Core outcome measurement instrument selection for physical function in hand osteoarthritis using the OMERACT Filter 2.1 process. Semin Arthritis Rheum 2021; 51:1311-1319. [PMID: 34538514 DOI: 10.1016/j.semarthrit.2021.08.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 08/04/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Physical function is one of the Outcome Measures in Rheumatology (OMERACT) core outcome domains for hand osteoarthritis studies. Our aim was to select appropriate instrument(s) to measure this domain, as part of the development of a core outcome measurement set. METHODS Following the OMERACT Filter 2.1 instrument selection process, the (function subscale of) the Australian/Canadian Hand Osteoarthritis Index (AUSCAN), Functional Index for Hand Osteoarthritis (FIHOA) and Michigan Hand Outcomes Questionnaire (MHQ) were assessed for domain match, feasibility, truth and discrimination. Data gathered from available literature, working group and patient surveys, and additional analyses in two hand osteoarthritis cohorts were used to inform a consensus process. Results were summarized in Summary of Measurements Properties tables and reviewed by the OMERACT technical advisory group. RESULTS MHQ passed the assessment of domain match and feasibility by the working group and patient research partners. For AUSCAN important limitations in feasibility were noted, but domain match was good. FIHOA did not pass the assessment and was not taken through the follow-up assessment. Based on published literature, reliability and construct/longitudinal validity of both MHQ and AUSCAN fulfilled OMERACT standards. While clinical trial discrimination and thresholds of meaning were good for AUSCAN, results for MHQ were ambiguous. CONCLUSION MHQ was provisionally endorsed as OMERACT core outcome measure for the core domain physical function. While AUSCAN may have better metric properties than MHQ, it received provisional endorsement as a second measure of function due to important feasibility issues. A research agenda to merit full endorsement was set.
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Affiliation(s)
- Féline P B Kroon
- Department of Rheumatology, and Department of Rheumatology, Zuyderland Medical Center, Leiden University Medical Center, Leiden, Heerlen, the Netherlands.
| | | | - Lara J Maxwell
- University of Ottawa, and Centre for Practice-Changing Research, Ottawa Hospital Research Institute, Ottawa, Canada
| | - Dorcas E Beaton
- Musculoskeletal Health and Outcomes Research, and Department of Occupational Science and Occupational Therapy, St. Michael's Hospital and Institute for Work and Health, Rehabilitation Sciences Institute, and the Institute for Health Policy Management and Evaluation, University of Toronto, Toronto, Canada
| | - Abishek Abishek
- Academic Rheumatology, University of Nottingham, and National Institute for Health Research, Nottingham Biomedical Research Centre, Nottingham, United Kingdom
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM, Saint-Antoine hospital AP-HP, Paris, France
| | - Francisco J Blanco
- Grupo de investigación en Reumatología. Instituto de Investigación Biomédica de A Coruña (INIBIC). Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas. Universidade da Coruña (UDC). As Xubias, 15006. A Coruña, España
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, and National Institute for Health Research, Leeds Biomedical Research Centre, Leeds, United Kingdom
| | - Krysia Dziedzic
- Impact Accelerator Unit, School of Medicine, Keele University, Keele, United Kingdom
| | - Catherine L Hill
- Discipline of Medicine, Adelaide, and Rheumatology Department, Queen Elizabeth Hospital, University of Adelaide, Woodville South, South Australia
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Mariko Ishimori
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, United States of America
| | - Valentin Ritschl
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Tanja A Stamm
- Institute of Outcomes Research, Centre for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, and Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Margreet Kloppenburg
- Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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Sellam J, Maheu E, Crema MD, Touati A, Courties A, Tuffet S, Rousseau A, Chevalier X, Combe B, Dougados M, Fautrel B, Kloppenburg M, Laredo JD, Loeuille D, Miquel A, Rannou F, Richette P, Simon T, Berenbaum F. The DIGICOD cohort: A hospital-based observational prospective cohort of patients with hand osteoarthritis - methodology and baseline characteristics of the population. Joint Bone Spine 2021; 88:105171. [PMID: 33689840 DOI: 10.1016/j.jbspin.2021.105171] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite its prevalence, there are few worldwide hand osteoarthritis (HOA) cohorts. The main objective of DIGItal COhort Design (DIGICOD) cohort is to investigate prognostic clinical, biological, genetic and imaging factors of clinical worsening after 6years follow-up. METHODS DIGICOD is a hospital-based prospective cohort including patients>35years-old with symptomatic HOA fulfilling: (i) ACR criteria for HOA with≥2 symptomatic joints among proximal/distal interphalangeal joints or 1st interphalangeal joint with Kellgren-Lawrence (KL)≥2; or (ii) symptomatic thumb base OA with KL≥2. Main exclusion criteria were inflammatory arthritis and crystal arthropathies. Annual clinical evaluations were scheduled with imaging (X-rays of the hands and of other OA symptomatic joints) and biological sampling every 3years. Hand radiographs are scored using KL and anatomical Verbruggen-Veys scores. Follow-up visits are ongoing. Cohort methodology and baseline characteristics are presented. RESULTS Between April 2013 and June 2017, from the 436 HOA included patients, 426 have been analysed of whom 357 (84%) are women. Mean age±standard deviation was 66.7±7.3years and mean disease duration was 12.6±9.6years. Metabolic syndrome affected 151 (36.5%) patients. Mean Visual Analog Scale (VAS) hand pain (0-100mm) was 44.4±26.7mm at activity. Mean FIHOA (0-100) was 19.9±18.6. Elevated serum CRP level (≥5mg/L) involved 10% patients. Mean KL score (0-128) was 46.7±18 and the mean number of joint with KL≥2 was 15.1±6.3. Erosive HOA (defined as≥1 Erosive or Remodeling phase joint according to Verbruggen-Veys score) involved 195/426 (45.8%) patients and the median number (interquartile range) of erosive joints in erosive patients was 3.0 (1.0-5.0). CONCLUSION DIGICOD is a unique prospective HOA cohort with a long-term 6years standardized assessment and has included severe radiologically HOA patients with a high prevalence of erosive disease.
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Affiliation(s)
- Jérémie Sellam
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France; Centre de Recherche Saint-Antoine, Inserm URMS_938, Paris, France
| | - Emmanuel Maheu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France
| | - Michel D Crema
- Institut d'Imagerie du Sport, Institut National du Sport, de l'Expertise et de la Performance (INSEP), Paris, France
| | - Amel Touati
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Alice Courties
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France; Centre de Recherche Saint-Antoine, Inserm URMS_938, Paris, France
| | - Sophie Tuffet
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Alexandra Rousseau
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Xavier Chevalier
- AP-HP, UPEC, Service de rhumatologie, Hôpital Henri-Mondor, Paris, France
| | - Bernard Combe
- Département de rhumatologie, CHU, Université de Montpellier, Montpellier, France
| | - Maxime Dougados
- AP-HP, Service de rhumatologie, Université de Paris, Service de rhumatologie, Hôpital Cochin, Paris, France
| | - Bruno Fautrel
- AP-HP, Sorbonne Université, Service de rhumatologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Margreet Kloppenburg
- Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jean-Denis Laredo
- Service de radiologie, Université de Paris, Hôpital Lariboisière, Paris, France
| | | | - Anne Miquel
- AP-HP, Sorbonne Université, Service de radiologie, Hôpital Saint-Antoine, Paris, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, AP-HP, Centre-Université de Paris, Hôpital Cochin, Paris, France; Université de Paris, Faculté de Santé, UFR de Médecine, Université de Paris, 75006 Paris, France; INSERM UMRS-1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
| | - Pascal Richette
- AP-HP, Université de Paris, Service de rhumatologie, Hôpital Lariboisière, Paris, France
| | - Tabassome Simon
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Francis Berenbaum
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France; Centre de Recherche Saint-Antoine, Inserm URMS_938, Paris, France.
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Kjeken I, Bergsmark K, Haugen IK, Hennig T, Hermann-Eriksen M, Hornburg VT, Hove Å, Prøven A, Sjøvold TA, Slatkowsky-Christensen B. Task shifting in the care for patients with hand osteoarthritis. Protocol for a randomized controlled non-inferiority trial. BMC Musculoskelet Disord 2021; 22:194. [PMID: 33593307 PMCID: PMC7888184 DOI: 10.1186/s12891-021-04019-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 01/26/2021] [Indexed: 12/02/2022] Open
Abstract
Background Current health policy states that patients with osteoarthritis (OA) should mainly be managed in primary health care. Still, research shows that patients with hand OA have poor access to recommended treatment in primary care, and in Norway, they are increasingly referred to rheumatologist consultations in specialist care. In this randomized controlled non-inferiority trial, we will test if a new model, where patients referred to consultation in specialist health care receive their first consultation by an occupational therapy (OT) specialist, is as safe and effective as the traditional model, where they receive their first consultation by a rheumatologist. More specifically, we will answer the following questions:
What are the characteristics of patients with hand OA referred to specialist health care with regards to joint affection, disease activity, symptoms and function? Is OT-led hand OA care as effective and safe as rheumatologist-led care with respect to treatment response, disease activity, symptoms, function and patient satisfaction? Is OT-led hand OA care equal to, or more cost effective than rheumatologist-led care? Which factors, regardless of hand OA care, predict improvement 6 and 12 months after baseline?
Methods Participants will be patients with hand OA diagnosed by a general practitioner and referred for consultation at one of two Norwegian departments of rheumatology. Those who agree will attend a clinical assessment and report their symptoms and function in validated outcome measures, before they are randomly selected to receive their first consultation by an OT specialist (n = 200) or by a rheumatologist (n = 200). OTs may refer patients to a rheumatologist consultation and vice versa. The primary outcome will be the number of patients classified as OMERACT/OARSI-responders after six months. Secondary outcomes are pain, function and satisfaction with care over the twelve-month trial period. The analysis of the primary outcome will be done by logistic regression. A two-sided 95% confidence interval for the difference in response probability will be formed, and non-inferiority of OT-led care will be claimed if the upper endpoint of this interval does not exceed 15%. Discussion The findings will improve access to evidence-based management of people with hand OA. Trial registration ClinicalTrials.gov, NCT03102788. Registered April 6th, 2017, https://clinicaltrials.gov/ct2/show/NCT03102788?term=Kjeken&draw=2&rank=1 Date and version identifier: December 17th, 2020. First version.
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Affiliation(s)
- Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | - Kjetil Bergsmark
- Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, N-0319, Vinderen, Oslo, Norway
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, PO Box 23, N-0319, Vinderen, Oslo, Norway
| | | | | | | | - Åshild Hove
- Division of Clinical Service, Diakonhjemmet Hospital, Oslo, Norway
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Neuprez A, Kaux JF, Locquet M, Beaudart C, Reginster JY. The presence of erosive joints is a strong predictor of radiological progression in hand osteoarthritis: results of a 2-year prospective follow-up of the Liège Hand Osteoarthritis Cohort (LIHOC). Arthritis Res Ther 2021; 23:12. [PMID: 33407767 PMCID: PMC7788934 DOI: 10.1186/s13075-020-02390-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course. Methods Two hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression. Results After 2 years, all radiographic scores deteriorated significantly in the study population (p < 0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p < 0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p < 0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p < 0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p < 0.01). Conclusions Evidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-020-02390-x.
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Affiliation(s)
- Audrey Neuprez
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium. .,Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium.
| | - Jean-François Kaux
- Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
| | - Médéa Locquet
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium.,Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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15
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Shapiro LM, McQuillan TJ, Kerkhof FD, Ladd A. Radiographic Progression of Thumb CMC Osteoarthritis: A Systematic Review. Journal of Hand Surgery Global Online 2020; 2:343-348. [PMID: 35415524 PMCID: PMC8991744 DOI: 10.1016/j.jhsg.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
- Corresponding author: Lauren M. Shapiro, MD, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94603.
| | | | - Faes D. Kerkhof
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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van de Stadt LA, Kroon FPB, Kloppenburg M. Measures of Hand Function. Arthritis Care Res (Hoboken) 2020; 72 Suppl 10:321-341. [PMID: 33091260 DOI: 10.1002/acr.24352] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 06/05/2020] [Indexed: 01/12/2023]
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Güven N, Dinçer F, Çetin A, Güven SC. Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations. Adv Rheumatol 2020; 60:41. [PMID: 32831136 DOI: 10.1186/s42358-020-00143-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. METHODS Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. RESULTS Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. CONCLUSIONS No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.
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Affiliation(s)
- Nurhan Güven
- Department of Physical and Rehabilitation Medicine, Division of Rheumatology, Ankara University Medical School, Ankara, Turkey.
| | - Fitnat Dinçer
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Alp Çetin
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Serdar Can Güven
- Department of Rheumatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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Scherzer ZA, Alvarez C, Renner JB, Murphy LB, Schwartz TA, Jordan JM, Golightly YM, Nelson AE. Effects of Comorbid Cardiovascular Disease and Diabetes on Hand Osteoarthritis, Pain, and Functional State Transitions: The Johnston County Osteoarthritis Project. J Rheumatol 2020; 47:1541-1549. [PMID: 32062598 DOI: 10.3899/jrheum.191075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study is to examine the course of hand osteoarthritis (HOA) and its relationship with cardiovascular disease (CVD) and diabetes (DM). METHODS Data were collected at 3 timepoints from 845 Johnston County Osteoarthritis Project participants (two-thirds women, one-third African Americans, mean age 60 yrs) with and without HOA, CVD, or DM. A diagnosis of radiographic HOA (rHOA) required a Kellgren-Lawrence severity grade of ≥ 2 in at least 3 joints in each hand. A 4-state progressive model included transitions based on rHOA and pain or function as defined using the Australian/Canadian HOA Index (AUSCAN). Markov multistate models estimated HR (aHR) and 95% CI for associations between DM or CVD and specific state transitions, adjusting for baseline and time-varying covariates. RESULTS Participants with DM (vs those without DM) were more likely to experience worsening pain with rHOA. Individuals who had or developed CVD (vs those who did not) were significantly less likely to experience symptomatic improvement, regardless of rHOA status. Those with DM or CVD (vs those without these comorbidities) were less likely to experience improvement in function, although this was statistically significant only for those with DM and no rHOA. CONCLUSION Overall, having or developing DM and/or CVD reduced the likelihood of symptomatic and functional improvement over time, suggesting an effect of comorbid CVD and DM on the clinical and radiographic course of HOA. Additional studies are needed to confirm these findings.
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Affiliation(s)
- Zachary A Scherzer
- Z.A. Scherzer, BS, Medical Student, Oakland University William Beaumont School of Medicine, Rochester, Missouri, and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carolina Alvarez
- C. Alvarez, MS, Statistician, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jordan B Renner
- J.B. Renner, MD, Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise B Murphy
- L.B. Murphy, PhD, Senior Service Fellow/Epidemiologist, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Todd A Schwartz
- T.A. Schwartz, DrPH, Associate Professor of Biostatistics, Thurston Arthritis Research Center, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joanne M Jordan
- J.M. Jordan, MD, MPH, Joseph P. Archie, Jr. Eminent Professor of Medicine and Vice Dean for Faculty Affairs and Leadership Development, Thurston Arthritis Research Center, and Department of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne M Golightly
- Y.M. Golightly, PT, PhD, Assistant Professor of Epidemiology, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda E Nelson
- A.E. Nelson, MD, MSCR, Associate Professor of Medicine, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Abstract
STUDY DESIGN Literature review. INTRODUCTION Pain is a subjective experience that results from the modulation of nociception conveyed to the brain via the nervous system. Perception of pain takes place when potential or actual noxious stimuli are appraised as threats of injury. This appraisal is influenced by one's cognitions and emotions based on her/his pain-related experiences, which are processed in the forebrain and limbic areas of the brain. Unarguably, patients' psychological factors such as cognitions (eg, pain catastrophizing), emotions (eg, depression), and pain-related behaviors (eg, avoidance) can influence perceived pain intensity, disability, and treatment outcomes. Therefore, hand therapists should address the patient pain experience using a biopsychosocial approach. However, in hand therapy, a biomedical perspective predominates in pain management by focusing solely on tissue healing. PURPOSE OF THE STUDY This review aims to raise awareness among hand therapists of the impact of pain-related psychological factors. METHODS AND RESULTS This literature review allowed to describe (1) how the neurophysiological mechanisms of pain can be influenced by various psychological factors, (2) several evidence-based interventions that can be integrated into hand therapy to address these psychological issues, and (3) some approaches of psychotherapy for patients with maladaptive pain experiences. DISCUSSION AND CONCLUSION Restoration of sensory and motor functions as well as alleviating pain is at the core of hand therapy. Numerous psychological factors including patients' beliefs, cognitions, and emotions alter their pain experience and may impact on their outcomes. Decoding the biopsychosocial components of the patients' pain is thus essential for hand therapists.
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Affiliation(s)
- Tokiko Hamasaki
- Research Center of the CHUM, Montreal, Québec, Canada; School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Hand Center, CHUM, Montreal, Québec, Canada
| | - René Pelletier
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Daniel Bourbonnais
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada; Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal, Montreal, Québec, Canada
| | - Patrick Harris
- Hand Center, CHUM, Montreal, Québec, Canada; Department of Surgery, Plastic Surgery Service, CHUM, Montreal, Québec, Canada; Department of Surgery, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada
| | - Manon Choinière
- Research Center of the CHUM, Montreal, Québec, Canada; Department of Anesthesiology and Pain Medicine, Faculty of Medicine, Université de Montréal, Montreal, Québec, Canada.
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Bender A, Kaesser U, Eichner G, Bachmann G, Steinmeyer J. Biomarkers of Hand Osteoarthritis Are Detectable after Mechanical Exercise. J Clin Med 2019; 8:jcm8101545. [PMID: 31561460 PMCID: PMC6832610 DOI: 10.3390/jcm8101545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022] Open
Abstract
Background: Hand osteoarthritis (OA) is one of the most common joint diseases, but studies on biomarkers are rare. The aim of this explorative study was (a) to evaluate potential biomarkers of hand OA, (b) to identify an optimal time point to sample venous blood, and (c) to correlate biomarker levels with radiological and clinical scores. Methods: Four female cohorts were investigated. One with a more Heberden-accentuated OA and one with a more Bouchard-accentuated hand OA, and two symptom-free control groups aged 20–30 or 50–75 years. The venous blood was sampled before and at eight time points after mechanical exercise of the OA hand. X-rays of OA hands were assessed using the Kellgren and Lawrence as well as Kallman scores. Participants were evaluated clinically using the AUSCAN™ Index, visual analog scale (VAS), and Health Assessment Questionnaire (HAQ). Serum levels of seven biomarkers were measured by ELISA. Results. The concentrations of CPII, COMP, IL-15, sVCAM-1, NGAL, and PIIANP were significantly increased within 15 min after exercise. PIIANP was markedly elevated in the Heberden-accentuated OA group as compared to both control groups, but did not correlate with any radiological or clinical score. Analysis of the probabilistic index further revealed that CPII can distinguish between Bouchard’s OA and premenopausal controls whereas COMP can discriminate between Bouchard’s and Heberden’s OA. Conclusions: This study demonstrates that even previously undetectable biomarkers can be quantified in serum after mechanical exercise. Future larger studies are needed to determine specificity and sensitivity of these markers and their ability to diagnose even pre-radiological OA.
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Affiliation(s)
- Anna Bender
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus Liebig University Giessen, Paul-Meimberg-Str. 3, 35392 Giessen, Germany.
| | | | - Gerrit Eichner
- Mathematical Institute, Justus Liebig University Giessen, 35392 Giessen, Germany.
| | - Georg Bachmann
- Georg Bachmann, Department of Diagnostic Radiology, Kerckhoff-Klinik GmbH, 61231 Bad Nauheim, Germany.
| | - Juergen Steinmeyer
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus Liebig University Giessen, Paul-Meimberg-Str. 3, 35392 Giessen, Germany.
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Marshall M, Watt FE, Vincent TL, Dziedzic K. Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management. Nat Rev Rheumatol 2018; 14:641-56. [PMID: 30305701 DOI: 10.1038/s41584-018-0095-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Osteoarthritis (OA) is a highly prevalent condition, and the hand is the most commonly affected site. Patients with hand OA frequently report symptoms of pain, functional limitations and frustration in undertaking everyday activities. The condition presents clinically with changes to the bone, ligaments, cartilage and synovial tissue, which can be observed using radiography, ultrasonography or MRI. Hand OA is a heterogeneous disorder and is considered to be multifactorial in aetiology. This Review provides an overview of the epidemiology, presentation and burden of hand OA, including an update on hand OA imaging (including the development of novel techniques), disease mechanisms and management. In particular, areas for which new evidence has substantially changed the way we understand, consider and treat hand OA are highlighted. For example, genetic studies, clinical trials and careful prospective imaging studies from the past 5 years are beginning to provide insights into the pathogenesis of hand OA that might uncover new therapeutic targets in the disease.
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Damman W, Liu R, Kaptein AA, Evers AWM, van Middendorp H, Rosendaal FR, Kloppenburg M. Illness perceptions and their association with 2 year functional status and change in patients with hand osteoarthritis. Rheumatology (Oxford) 2019; 57:2190-2199. [PMID: 30107461 DOI: 10.1093/rheumatology/key231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the association between illness perceptions and disability both cross-sectionally and over 2 years in patients with hand OA. Methods Illness perceptions and self-reported disability were assessed at baseline and after 2 years in 384 patients with primary hand OA (mean age 61 years, 84% women, n = 312 with follow-up) with the Illness Perception Questionnaire - Revised (IPQ-R), Functional Index for Hand OA, Australian/Canadian Hand OA Index and HAQ. Risk ratios for high disability (highest quartile) at both time points were estimated for tertiles of IPQ-R dimensions, using Poisson regression. The mean IPQ dimension change difference between patients with and without disability progression (change Functional Index for Hand OA ⩾ 1, Australian/Canadian Hand OA Index > 1.4, HAQ > 0.22) was estimated with linear regression. Analyses were adjusted for age, Doyle index and baseline score. Results At baseline, stronger negative illness perceptions were associated with high disability. Baseline illness perceptions were also associated with high disability after 2 years, although adjustment made apparent that these associations were confounded by baseline disability status. Most illness perceptions changed over 2 years; understanding increased, OA was regarded as more chronic and fewer emotions and consequences and less personal and treatment control were experienced. The 2 year change in disability was different between patients with and without progression for the illness perceptions of more perceived consequences, symptoms, treatment control and emotions. Conclusion Illness perceptions seemed to be implicated in disability and its progression. Our results suggest that interventions could focus on improving baseline disability, potentially using illness perceptions to accomplish this goal.
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Affiliation(s)
- Wendy Damman
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Rani Liu
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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van Beest S, Damman W, Liu R, Reijnierse M, Rosendaal FR, Kloppenburg M. In finger osteoarthritis, change in synovitis is associated with change in pain on a joint-level; a longitudinal magnetic resonance imaging study. Osteoarthritis Cartilage 2019; 27:1048-1056. [PMID: 30978394 DOI: 10.1016/j.joca.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate determinants of decrease and increase in joint pain in symptomatic finger osteoarthritis (OA) on magnetic resonance (MR) imaging over 2 years. DESIGN Eighty-five patients (81.2% women, mean age 59.2 years) with primary hand OA (89.4% fulfilling American College of Rheumatology (ACR) classification criteria) from a rheumatology outpatient clinic received contrast-enhanced MR imaging (1.5T) and physical examination of the right interphalangeal finger joints 2-5 at baseline and at follow-up 2 years later. MR images were scored paired in unknown time order, following the Hand OA MRI scoring system (HOAMRIS). Joint pain upon palpation was assessed by research nurses. Odds ratios (ORs; 95% confidence intervals) were estimated on joint level (n = 680), using generalized estimating equations (GEE) to account for the within patient effects. Additional adjustments were made for change in MR-defined osteophytes, synovitis, and bone marrow lesions (BMLs). RESULTS Of 116 painful joints at baseline, at follow-up: 76 had less pain, 21 less synovitis, and 13 less BMLs. A decrease in synovitis (OR = 5.9; 1.12─31.0), but not in BMLs (OR = 0.39; 0.10─1.50), was associated with less pain. Of 678 joints without maximum baseline pain, at follow-up: 115 had increased pain, 132 increased synovitis, 96 increased BMLs, and 44 increased osteophytes. Increased synovitis (OR = 1.81; 1.11─2.94), osteophytes (OR = 2.75; 1.59─4.8), but not BMLs (OR = 1.14; 0.81─1.60), was associated with increased pain. Through stratification it became apparent that BMLs were mainly acting as effect modifier of the synovitis-pain association. CONCLUSION Decrease in MR-defined synovitis is associated with reduced joint pain, identifying synovitis as a possible target for treatment of finger OA.
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Affiliation(s)
- S van Beest
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - W Damman
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - R Liu
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - M Reijnierse
- Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - F R Rosendaal
- Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - M Kloppenburg
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
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Abstract
BACKGROUND Hand conditions are common in elderly persons. PURPOSE To assess the prevalence of common hand conditions in elderly persons in a community setting, specifically osteoarthritis of the hand, trigger finger, and carpal tunnel syndrome. METHODS The elderly persons were recruited from community groups for elderly persons. Data collection included participants' demographic and clinical data; quick disability, arm, shoulder, and hand (QuickDASH) questionnaire; and presence of hand conditions. RESULTS Of the 55 elderly persons recruited, almost a third of them presented with a hand condition (n = 17, 30.8%). Hand conditions were more common in females (39% in females, 7% in males; χ = 4.97, p = .04). Quick-DASH scores were higher in those with hand conditions, indicating lower levels of function (greater disability) (t =-4.61, p = .002). CONCLUSIONS Most elderly persons did not seek medical attention for their hand condition until the late stages. Nurses can play an important role in providing community hand assessment, education on hand symptoms, information about available treatment, and adaptive approaches to maximize functioning.
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Kroon FP, van Beest S, Gandjbakhch F, Peterfy CG, Chen S, Conaghan PG, Eshed I, Foltz V, Genant HK, Haugen IK, Medema JK, Østergaard M, Zhang L, Levesque MC, Kloppenburg M. Longitudinal Reliability of the OMERACT Thumb Base Osteoarthritis Magnetic Resonance Imaging Scoring System (TOMS). J Rheumatol 2018; 46:1228-1231. [DOI: 10.3899/jrheum.180949] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/07/2018] [Indexed: 11/22/2022]
Abstract
Objective.To assess the longitudinal reliability of the Outcome Measures in Rheumatology (OMERACT) Thumb base Osteoarthritis Magnetic resonance imaging (MRI) Scoring system (TOMS).Methods.Paired MRI of patients with hand osteoarthritis were scored in 2 exercises (6-mo and 2-yr followup) for synovitis, subchondral bone defects (SBD), osteophytes, cartilage assessment, bone marrow lesions (BML), and subluxation. Interreader reliability of delta scores was assessed.Results.Little change occurred. Average-measure intraclass correlation coefficients were good-excellent (≥ 0.71), except synovitis (0.55–0.83) and carpometacarpal-1 osteophytes/cartilage assessment (0.47/0.39). Percentage exact/close agreement was 52–92%/68–100%, except BML in 2 years (28%/64–76%). Smallest detectable change was below the scoring increment, except in SBD and BML.Conclusion.TOMS longitudinal reliability was moderate-good. Limited change hampered assessment.
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Marshall M, Peat G, Nicholls E, Myers HL, Mamas MA, van der Windt DA. Metabolic risk factors and the incidence and progression of radiographic hand osteoarthritis: a population-based cohort study. Scand J Rheumatol 2018; 48:52-63. [PMID: 29952684 PMCID: PMC6319183 DOI: 10.1080/03009742.2018.1459831] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To determine whether selected metabolic factors are associated with greater amounts of radiographic hand osteoarthritis (OA) incidence and progression. METHODS The study identified 706 adults, aged 50-69 years, with hand pain and hand radiographs at baseline, from two population-based cohorts. Metabolic factors (body mass index, hypertension, dyslipidaemia, and diabetes) were ascertained at baseline by direct measurement and medical records. Analyses were undertaken following multiple imputation of missing data, and in complete cases (sensitivity analyses). Multivariable regression models estimated associations between metabolic factors and two measures of radiographic change at 7 years for all participants, individuals free of baseline radiographic OA, and in baseline hand OA subsets. Estimates were adjusted for baseline values and other covariates. RESULTS The most consistent and strong associations observed were between the presence of diabetes and the amount of radiographic progression in individuals with nodal OA [adjusted mean differences in Kellgren-Lawrence summed score of 4.50 (-0.26, 9.25)], generalized OA [3.27 (-2.89, 9.42)], and erosive OA [3.05 (-13.56, 19.67)]. The remaining associations were generally weak or inconsistent, although numbers were limited for analyses of incident radiographic OA and erosive OA in particular. CONCLUSION Overall metabolic risk factors were not independently or collectively associated with greater amounts of radiographic hand OA incidence or progression over 7 years, but diabetes was associated with radiographic progression in nodal, and possibly generalized and erosive OA. Diabetes has previously been associated with prevalent but not incident hand OA. Further investigation in hand OA subsets using objective measures accounting for disease duration and control is warranted.
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Affiliation(s)
- M Marshall
- a Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences , Keele University , Staffordshire , UK
| | - G Peat
- a Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences , Keele University , Staffordshire , UK
| | - E Nicholls
- b Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit , Keele University , Staffordshire , UK
| | - H L Myers
- b Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit , Keele University , Staffordshire , UK
| | - M A Mamas
- c Keele Cardiovascular Research Group, Guy Hilton Research Centre , Keele University , Stoke-on-Trent , UK
| | - D A van der Windt
- a Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences , Keele University , Staffordshire , UK
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27
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Brosseau L, Thevenot O, MacKiddie O, Taki J, Wells GA, Guitard P, Léonard G, Paquet N, Aydin SZ, Toupin-April K, Cavallo S, Moe RH, Shaikh K, Gifford W, Loew L, De Angelis G, Shallwani SM, Aburub AS, Mizusaki Imoto A, Rahman P, Álvarez Gallardo IC, Cosic MB, Østerås N, Lue S, Hamasaki T, Gaudreault N, Towheed TE, Koppikar S, Kjeken I, Mahendira D, Kenny GP, Paterson G, Westby M, Laferrière L, Longchamp G. The Ottawa Panel guidelines on programmes involving therapeutic exercise for the management of hand osteoarthritis. Clin Rehabil 2018; 32:1449-1471. [PMID: 29911409 DOI: 10.1177/0269215518780973] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
OBJECTIVE: To identify programmes involving therapeutic exercise that are effective for the management of hand osteoarthritis and to provide stakeholders with updated, moderate to high-quality recommendations supporting exercises for hand osteoarthritis. METHODS: A systematic search and adapted selection criteria included comparable trials with exercise programmes for managing hand osteoarthritis. Based on the evaluated evidence, a panel of experts reached consensus through a Delphi approach endorsing the recommendations. A hierarchical alphabetical grading system (A, B, C+, C, C-, D-, D, D+, E, F) was based on clinical importance (≥15%) and statistical significance ( P < 0.05). RESULTS: Ten moderate- to high-quality studies were included. Eight studies with programmes involving therapeutic exercise (e.g. range of motion (ROM) + isotonic + isometric + functional exercise) seemed to be effective. Forty-six positive grade recommendations (i.e. A, B, C+) were obtained during short-term (<12 weeks) trials for pain, stiffness, physical function, grip strength, pinch strength, range of motion, global assessment, pressure pain threshold, fatigue and abductor pollicis longus moment and during long-term (>12 weeks) trials for physical function and pinch strength. CONCLUSION: Despite that many programmes involving exercise with positive recommendations for clinical outcomes are available to healthcare professionals and hand osteoarthritis patients that aid in the management of hand osteoarthritis, there is a need for further research to isolate the specific effect of exercise components.
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Affiliation(s)
- Lucie Brosseau
- 1 Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Odette Thevenot
- 2 School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Olivia MacKiddie
- 2 School of Human Kinetics, University of Ottawa, Ottawa, ON, Canada
| | - Jade Taki
- 3 Interdisciplinary School of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - George A Wells
- 4 School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Paulette Guitard
- 5 Occupational Therapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Guillaume Léonard
- 6 Research Center on Aging, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Nicole Paquet
- 1 Physiotherapy Program, School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Karine Toupin-April
- 8 Children's Hospital of Eastern Ontario Research Institute, Department of Pediatrics, Faculty of Medicine and School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Sabrina Cavallo
- 9 School of Rehabilitation, University of Montréal, Montréal, QC, Canada
| | - Rikke Helene Moe
- 10 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kamran Shaikh
- 11 Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Wendy Gifford
- 12 School of Nursing, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Laurianne Loew
- 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Gino De Angelis
- 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Ala' S Aburub
- 13 School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON, Canada
| | - Aline Mizusaki Imoto
- 14 Evidence-based Health Department, Federal University of Sao Paulo, Sao Paulo, Brazil
| | - Prinon Rahman
- 15 Department of Community Health and Epidemiology, Dalhousie University, Halifax, NS, Canada
| | | | - Milkana Borges Cosic
- 16 Department of Physical Education and Sport, University of Cadiz, Cadiz, Spain
| | - Nina Østerås
- 17 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Sabrina Lue
- 18 Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Tokiko Hamasaki
- 19 Hand Center, Centre Hospitalier de l'Université de Montréal and School of Rehabilitation, Faculty of Medicine, Université de Montréal, QC, Canada
| | - Nathaly Gaudreault
- 20 Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, QC, Canada
| | | | - Sahil Koppikar
- 21 Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Ingvild Kjeken
- 17 National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dharini Mahendira
- 21 Division of Rheumatology, University of Toronto, Toronto, ON, Canada
| | - Glen P Kenny
- 22 School of Human Kinetics, Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada
| | | | - Marie Westby
- 24 Mary Pack Arthritis Program, Vancouver Coastal Health and Centre for Hip Health and Mobility and Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Lucie Laferrière
- 25 Canadian Forces Health Services Group, National Defense, Ottawa, ON, Canada
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Karl Spies C, Langer M, Hahn P, Peter Müller L, Unglaub F. The Treatment of Primary Arthritis of the Finger and Thumb Joint. Dtsch Arztebl Int 2018; 115:269-275. [PMID: 29739493 PMCID: PMC5954171 DOI: 10.3238/arztebl.2018.0269] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/15/2017] [Revised: 08/15/2017] [Accepted: 01/31/2018] [Indexed: 02/05/2023]
Abstract
BACKGROUND Primary finger and thumb joint arthritis is common, with a markedly rising prevalence from age 50 onward. As the population as a whole ages, the need for effective, stage-appropriate treatment of this condition is increasing. METHODS This review is based on pertinent publications retrieved by a selective search in the PubMed and Cochrane Library databases. RESULTS Pain on movement and morning stiffness are commonly reported symptoms. Thorough physical examination and plain x-rays are mandatory. In the early stages of primary finger and thumb joint arthritis, a conservative, multimodal treatment approach involving the use of splints, physiotherapy, and non-steroidal anti-inflammatory drugs can be helpful. The intraarticular injection of hyaluronic acid or cortisone seems to relieve pain in the short term, but its long-term efficacy in primary finger and thumb joint arthritis is questionable. Arthrodesis (joint fusion) is a reliable surgical treatment option for arthritis of the metacarpophalangeal and interphalangeal joints of the thumb. For mobility-preserving surgery of the metacarpophalangeal joints of the second through fifth fingers, silicone implant arthroplasty remains the gold standard. Symptomatic, advanced arthritis of the distal interphalangeal joint is most effectively treated with arthrodesis. CONCLUSION The efficacy of conservative treatment has been documented in high-quality clinical trials, while that of surgical treatment has not. The various surgical methods have yielded benefits in routine clinical use, but these remain to be assessed in randomized and controlled trials.
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Affiliation(s)
| | - Martin Langer
- Department of Trauma, Hand, and Plastic Surgery, Münster University Hospital, Münster
| | - Peter Hahn
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
| | - Lars Peter Müller
- Department of Orthopedics and Trauma Surgery, Cologne University Hospital, Cologne
| | - Frank Unglaub
- Department of Hand Surgery, Vulpius Hospital, Bad Rappenau
- Medical Faculty Mannheim, University of Heidelberg, Mannheim
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Metin Ökmen B, Ökmen K, Altan L. Effectiveness of Superficial Radial Nerve Block on Pain, Function and Quality of Life in Patients With Hand Osteoarthritis: A Prospective, Randomized and Controlled Single-Blind Study. Arch Rheumatol 2018; 33:464-72. [PMID: 30874237 DOI: 10.5606/ArchRheumatol.2018.6754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2017] [Accepted: 02/01/2018] [Indexed: 11/21/2022] Open
Abstract
Objectives This study aims to investigate the effects of ultrasound-guided superficial branch of the radial nerve block on pain, function and quality of life in patients with hand osteoarthritis. Patients and methods In this prospective, randomized and controlled single-blind study, 50 female patients (mean age 59.0±5.1 years; range, 46 to 64 years) diagnosed with hand osteoarthritis were randomized into two groups. Group 1 (n=25) was administered an ultrasound-guided superficial branch of the radial nerve injection (with a combination of 2 mL 0.25% bupivacaine and 1 mL methylprednisolone acetate) + exercise, while group 2 (n=25) only exercised. Patients were assessed with a visual analog scale for pain, hand grip strength, finger grip strength, Quick Disability of the Arm, Shoulder and Hand questionnaire, Duruöz Hand Index and Short-form 12. Data were obtained before treatment (W0), in the second week after treatment (W2) and in the fourth week after treatment (W4). Results In group 1, a statistically significant improvement was obtained in all parameters at both W2 and W4 compared to the values recorded at W0 (p<0.05). In group 2, a statistically significant improvement was observed only in the parameters of hand grip strength and finger grip strength at W2 and W4 (p<0.05). A comparison of the scores of the two groups showed statistically significant superior improvement in group 1 in all parameters at both W2 and W4 (p<0.05). Conclusion The findings of our study showed that an ultrasound-guided superficial branch of the radial nerve block combined with exercise is a significantly superior treatment to exercise-only regarding the improvements in the parameters of pain, function and quality of life in hand osteoarthritis patients.
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Sakellariou G, Conaghan PG, Zhang W, Bijlsma JWJ, Boyesen P, D'Agostino MA, Doherty M, Fodor D, Kloppenburg M, Miese F, Naredo E, Porcheret M, Iagnocco A. EULAR recommendations for the use of imaging in the clinical management of peripheral joint osteoarthritis. Ann Rheum Dis 2017; 76:1484-1494. [DOI: 10.1136/annrheumdis-2016-210815] [Citation(s) in RCA: 114] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Revised: 02/25/2017] [Accepted: 03/05/2017] [Indexed: 11/04/2022]
Abstract
The increased information provided by modern imaging has led to its more extensive use. Our aim was to develop evidence-based recommendations for the use of imaging in the clinical management of the most common arthropathy, osteoarthritis (OA). A task force (including rheumatologists, radiologists, methodologists, primary care doctors and patients) from nine countries defined 10 questions on the role of imaging in OA to support a systematic literature review (SLR). Joints of interest were the knee, hip, hand and foot; imaging modalities included conventional radiography (CR), MRI, ultrasonography, CT and nuclear medicine. PubMed and EMBASE were searched. The evidence was presented to the task force who subsequently developed the recommendations. The strength of agreement for each recommendation was assessed. 17 011 references were identified from which 390 studies were included in the SLR. Seven recommendations were produced, covering the lack of need for diagnostic imaging in patients with typical symptoms; the role of imaging in differential diagnosis; the lack of benefit in monitoring when no therapeutic modification is related, though consideration is required when unexpected clinical deterioration occurs; CR as the first-choice imaging modality; consideration of how to correctly acquire images and the role of imaging in guiding local injections. Recommendations for future research were also developed based on gaps in evidence, such as the use of imaging in identifying therapeutic targets, and demonstrating the added value of imaging. These evidence-based recommendations and related research agenda provide the basis for sensible use of imaging in routine clinical assessment of people with OA.
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Courties A, Sellam J, Maheu E, Cadet C, Barthe Y, Carrat F, Berenbaum F. Coronary heart disease is associated with a worse clinical outcome of hand osteoarthritis: a cross-sectional and longitudinal study. RMD Open 2017; 3:e000344. [PMID: 28243467 PMCID: PMC5318565 DOI: 10.1136/rmdopen-2016-000344] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Revised: 12/08/2016] [Accepted: 12/09/2016] [Indexed: 01/27/2023] Open
Abstract
Objective To determine whether cardiometabolic factors are associated with hand osteoarthritis (HOA) symptoms, radiographic severity and progression in a post hoc analysis of the phase III Strontium ranelate Efficacy in Knee OsteoarthrItis triAl (SEKOIA) trial, designed to determine the effect of strontium ranelate on knee osteoarthritis (OA). Methods Among the 1683 patients randomised in the SEKOIA study, 869 with radiographic HOA at baseline (rHOA≥2 joints with Kellgren-Lawrence grade ≥2) were included in a cross-sectional analysis. For longitudinal study, we included only the 307 patients with rHOA at baseline from the placebo group. We evaluated whether baseline symptomatic HOA, radiographic severity and clinical and rHOA progression were associated with coronary heart disease and/or metabolic diseases (obesity, diabetes and hypertension, dyslipidaemia) by multivariate regression analysis. Results At baseline, 869 patients (72% women) were included in the cross-sectional analysis; 26% were symptomatic. On multivariate analysis, symptomatic HOA was associated with coronary heart disease (OR 3.59, 95% CI (1.78 to 7.26)) but not metabolic diseases. After a mean follow-up of 2.6 years, for the 307 participants in the placebo group, on multivariate analysis, worse clinical HOA outcome was associated with coronary heart disease (OR 2.91, 95% CI (1.02 to 8.26)). The slow radiographic progression did not allow for revealing any associated factors. Conclusions Symptomatic HOA and worse HOA clinical course are associated with coronary heart disease. These results strengthen the systemic component of HOA and the association between OA pain and cardiac events. Trial registration number ISRCTN41323372.
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Affiliation(s)
- Alice Courties
- Rheumatology Department , Saint-Antoine Hospital, Inserm UMR S_938, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris (AP-HP), DHU i2B , Paris , France
| | - Jérémie Sellam
- Rheumatology Department , Saint-Antoine Hospital, Inserm UMR S_938, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris (AP-HP), DHU i2B , Paris , France
| | - Emmanuel Maheu
- Rheumatology Department, Saint-Antoine Hospital, Inserm UMR S_938, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris (AP-HP), DHU i2B, Paris, France; Department of Rheumatology, Private Office, Paris, France
| | - Christian Cadet
- Department of Rheumatology , Private Office , Paris , France
| | - Yoann Barthe
- Public Health Department , Saint-Antoine Hospital, Inserm UMRS_1136, UPMC Univ Paris 06, AP-HP , Paris , France
| | - Fabrice Carrat
- Public Health Department , Saint-Antoine Hospital, Inserm UMRS_1136, UPMC Univ Paris 06, AP-HP , Paris , France
| | - Francis Berenbaum
- Rheumatology Department , Saint-Antoine Hospital, Inserm UMR S_938, UPMC Univ Paris 06, Assistance Publique-Hôpitaux de Paris (AP-HP), DHU i2B , Paris , France
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Kjeken I, Eide REM, Klokkeide Å, Matre KH, Olsen M, Mowinckel P, Andreassen Ø, Darre S, Nossum R. Does occupational therapy reduce the need for surgery in carpometacarpal osteoarthritis? Protocol for a randomized controlled trial. BMC Musculoskelet Disord 2016; 17:473. [PMID: 27842579 PMCID: PMC5109819 DOI: 10.1186/s12891-016-1321-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2016] [Accepted: 11/01/2016] [Indexed: 05/16/2023] Open
Abstract
BACKGROUND In the absence of disease-modifying interventions for hand osteoarthritis (OA), occupational therapy (OT) comprising patient education, hand exercises, assistive devices and orthoses are considered as core treatments, whereas surgery are recommended for those with severe carpometacarpal (CMC1) OA. However, even though CMC1 surgery may reduce pain and improve function, the risk of adverse effects is high, and randomized controlled trials comparing surgery with non-surgical interventions are warranted. This multicentre randomized controlled trial aims to address the following questions: Does OT in the period before surgical consultation reduce the need for surgery in CMC1-OA? What are patients' motivation and reasons for wanting CMC1-surgery? Are there differences between departments of rheumatology concerning the degree of CMC1-OA, pain and functional limitations in patients who are referred for surgical consultation for CMC1 surgery? Is the Measure of Activity Performance of the Hand a reliable measure in patients with CMC1-OA? Do patients with CMC1-OA with and without affection of the distal and proximal interphalangeal finger joints differ with regard to symptoms and function? Do the degree of CMC1-OA, symptoms and functional limitations significantly predict improvement after 2 years following OT or CMC1-surgery? Is OT more cost-effective than surgery in the management of CMC1-OA? METHODS/DESIGN All persons referred for surgical consultation due to their CMC1-OA at one of three Norwegian departments of rheumatology are invited to participate. Those who agree attend a clinical assessment and report their symptoms, function and motivation for surgery in validated outcome measures, before they are randomly selected to receive OT in the period before surgical consultation (estimated n = 180). The primary outcome will be the number of participants in each group who have received surgical treatment after 2 years. Secondary and tertiary outcomes are pain, function and satisfaction with care over the 2-year trial period. Outcomes will be collected at baseline, 4, 18 and 24 months. The main analysis will be on an intention-to-treat basis, using logistic regression, comparing the number of participants in each group who have received surgical treatment after 2 years. DISCUSSION The findings will improve the evidence-based management of HOA. TRIAL REGISTRATION IDENTIFIER NCT01794754 . First registrated February 15th 2013.
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Affiliation(s)
- Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway.
| | | | | | - Karin Hoegh Matre
- Department of Rheumatology, Haukeland University Hospital, Bergen, Norway
| | - Monika Olsen
- Haugesund Rheumatism Hospital, Haugesund, Norway
| | - Petter Mowinckel
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23, Vinderen, N-0319, Oslo, Norway
| | - Øyvor Andreassen
- Patient research panel, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Siri Darre
- Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
| | - Randi Nossum
- Department of Clinical Services, St. Olav's Hospital, Trondheim University Hospital, Trondheim, Norway
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Damman W, Kortekaas MC, Stoel BC, van 't Klooster R, Wolterbeek R, Rosendaal FR, Kloppenburg M. Sensitivity-to-change and validity of semi-automatic joint space width measurements in hand osteoarthritis: a follow-up study. Osteoarthritis Cartilage 2016; 24:1172-9. [PMID: 26876778 DOI: 10.1016/j.joca.2016.02.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Revised: 01/11/2016] [Accepted: 02/07/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess sensitivity-to-change and validity of longitudinal quantitative semi-automatic joint space width (JSW) measurements and to compare this method with semi-quantitative joint space narrowing (JSN) scoring in hand osteoarthritis (OA) patients. DESIGN Baseline and 2-year follow-up radiographs of 56 hand OA patients (mean age 62 years, 86% women) were used. JSN was scored 0-3 using the Osteoarthritis Research Society International atlas and JSW was quantified in millimetres (mm) in the second to fifth distal, proximal interphalangeal and metacarpal joints (DIPJs, PIPJs, MCPJs). Sensitivity-to-change was evaluated by calculating Standardized Response Means (SRMs). Change in JSW or JSN above the Smallest Detectable Difference (SDD) defined progression on joint level. To assess construct validity, progressed joints were compared by cross-tabulation and by associating baseline ultrasound variables with progression (using generalized estimating equations, adjusting for age and sex). RESULTS The JSW method detected statistically significant mean changes over 2.6 years (-0.027 mm (95%CI -0.01; -0.04), -0.024 mm (-0.01; -0.03), -0.021 mm (-0.01; -0.03) for DIPJs, PIPJs, MCPJs, respectively). Sensitivity-to-change was low (SRMs: 0.174, 0.168, 0.211, respectively). 9.1% (121/1336) of joints progressed in JSW, but 3.6% (48/1336) widened. 83 (6.2%) joints progressed in JSW only, 36 (2.7%) in JSN only and 37 (2.8%) in both methods. Progression in JSW showed weaker associations with baseline inflammatory ultrasound features than progression in JSN. CONCLUSIONS Assessment of progression in hand OA defined by JSW measurements is possible, but performs less well than progression defined by JSN scoring. Therefore, the value of JSW measurements in hand OA clinical trials remains questionable.
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Affiliation(s)
- W Damman
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands.
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
| | - B C Stoel
- Division of Image Processing, Department of Radiology, LUMC, Leiden, The Netherlands
| | - R van 't Klooster
- Division of Image Processing, Department of Radiology, LUMC, Leiden, The Netherlands
| | - R Wolterbeek
- Department of Medical Statistics, LUMC, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
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Mancarella L, Addimanda O, Pelotti P, Pignotti E, Pulsatelli L, Meliconi R. Ultrasound detected inflammation is associated with the development of new bone erosions in hand osteoarthritis: a longitudinal study over 3.9 years. Osteoarthritis Cartilage 2015; 23:1925-32. [PMID: 26521738 DOI: 10.1016/j.joca.2015.06.004] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2014] [Revised: 05/15/2015] [Accepted: 06/02/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the association between ultrasound (US) detected inflammation at baseline and the subsequent development of new bone erosions at follow-up in patients with hand osteoarthritis (HOA). METHOD 32 of the 35 (10 controls, 12 patients with non erosive HOA (non-EHOA), 13 with EHOA subjects originally studied were re-evaluated 3.9 years after the initial study, by means of standard radiography and US examination. Kellgren-Lawrence (K-L) and Kallman scores were utilized to evaluate 576 interphalangeal (IP) joints. US detected synovial inflammation features were scored as present/absent. US detected bone erosions were also investigated. The association between synovial inflammation features at baseline and the development of new bone erosions was evaluated using the generalized linear mixed model (GLMM) after adjustment for patient effect, age, gender, body mass index. RESULTS In HOA patients, radiographic scores worsened and bone erosions progressed. In HOA patients similar percentages of joints with Power Doppler Signal (PDS) and gray scale (GS) synovitis were found comparing baseline and follow-up examinations, whilst a significant increase was found in the joints with effusions. Only a minority of joints were positive on both occasions (between 2 and 6 %), the majority fluctuated between positive and negative and vice versa. PDS positivity was associated with new radiographic central erosions and US-detected bone erosions, whereas GS synovitis and effusion were not. CONCLUSIONS Radiographic scores and bone erosions increased over a period of about 4 years. Synovial inflammation as detected by PDS was associated with the appearance of new bone erosions.
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Affiliation(s)
- L Mancarella
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - O Addimanda
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - P Pelotti
- Ultrasound Unit, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - E Pignotti
- Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - L Pulsatelli
- Laboratory of Immunorheumatology and Tissue Regeneration, Rizzoli Orthopaedic Institute, Bologna, Italy.
| | - R Meliconi
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, Bologna, Italy; Dept of Biomedical & Neuromotor Sciences, University of Bologna, Italy.
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Visser AW, Bøyesen P, Haugen IK, Schoones JW, van der Heijde DM, Rosendaal FR, Kloppenburg M. Instruments Measuring Pain, Physical Function, or Patient’s Global Assessment in Hand Osteoarthritis: A Systematic Literature Search. J Rheumatol 2015; 42:2118-34. [DOI: 10.3899/jrheum.141228] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/22/2022]
Abstract
Objective.Description of use and metric properties of instruments measuring pain, physical function, or patient’s global assessment (PtGA) in hand osteoarthritis (OA).Methods.Medical literature databases up to January 2014 were systematically reviewed for studies reporting on instruments measuring pain, physical function, or PtGA in hand OA. The frequency of the use of these instruments were described, as well as their metric properties, including discrimination (reliability, sensitivity to change), feasibility, and validity.Results.In 66 included studies, various questionnaires and performance- or assessor-based instruments were applied for evaluation of pain, physical function, or PtGA. No major differences regarding metric properties were observed between the instruments, although the amount of supporting evidence varied. The most frequently evaluated questionnaires were the Australian/Canadian Hand OA Index (AUSCAN) pain subscale and visual analog scale (VAS) pain for pain assessment, and the AUSCAN function subscale and Functional Index for Hand OA (FIHOA) for physical function assessment. Excellent reliability was shown for the AUSCAN and FIHOA, and good sensitivity to change for all mentioned instruments; additionally, the FIHOA had good feasibility. Good construct validity was suggested for all mentioned questionnaires. The most commonly applied performance- or assessor-based instruments were the grip and pinch strength for the assessment of physical function, and the assessment of pain by palpation. For these measures, good sensitivity to change and construct validity were established.Conclusion.The AUSCAN, FIHOA, VAS pain, grip and pinch strength, and pain on palpation were most frequently used and provided most supporting evidence for good metric properties. More research has to be performed to compare the different instruments with each other.
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Hamasaki T, Lalonde L, Harris P, Bureau NJ, Gaudreault N, Ziegler D, Choinière M. Efficacy of treatments and pain management for trapeziometacarpal (thumb base) osteoarthritis: protocol for a systematic review. BMJ Open 2015; 5:e008904. [PMID: 26463223 PMCID: PMC4606390 DOI: 10.1136/bmjopen-2015-008904] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
INTRODUCTION The thumb is essential for daily activities. Unfortunately, this digit is commonly affected by trapeziometacarpal osteoarthritis (TMO), handicapping a large number of individuals. TMO constitutes an increasing human and economic burden for our society whose population is ageing. Limited access to adequate treatment is among the most important obstacles to optimal TMO management. Poor understanding of TMO characteristics, lack of knowledge about evidence-based treatments, simplistic pain management plans based solely on the patient's physical condition, absence of interprofessional communication and lack of multidisciplinary treatment guidelines contribute to inadequate TMO management. On the long term, our research project aims at improving the quality of care and services offered to patients with TMO by developing a patient-centred, evidence-based multidisciplinary management clinical pathway coordinated across the healthcare system. This proposed systematic review is a prerequisite to ensuring evidence-based practices and aims to document the efficacy of all the existing modalities for TMO management. METHODS AND ANALYSIS The protocol of the systematic review is registered with PROSPERO and will be conducted using the guidelines Cochrane Handbook for Systematic Reviews of Interventions. We will identify studies in English and French concerning TMO treatments through searches in Cochrane Central, EMBASE, MEDLINE, PsychINFO, CINHAL, PubMed, OT Seekers, PEDRO and the grey literature. 2 reviewers will independently screen study eligibility, extract data and appraise studies using published assessment tools. Meta-analyses will be undertaken where feasible; otherwise, narrative syntheses will be carried out. The robustness of evidence will be assessed using the GRADE system. ETHICS AND DISSEMINATION Ethics approval is not required for this study. A comprehensive knowledge exchange and transfer plan incorporating effective strategies will be used to disseminate the findings of this review and utilise them to optimise TMO management. TRIAL REGISTRATION NUMBER PROSPERO CRD42015015623.
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Affiliation(s)
- Tokiko Hamasaki
- CHUM Research Center, Montreal, Quebec, Canada
- Faculty of Medicine, School of Rehabilitation, Université de Montréal, Montreal, Quebec, Canada
- Hand Clinic, CHUM, Montreal, Quebec, Canada
| | - Lyne Lalonde
- CHUM Research Center, Montreal, Quebec, Canada
- Faculty of Pharmacy, Université de Montréal, Montreal, Quebec, Canada
| | - Patrick Harris
- Hand Clinic, CHUM, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Surgery, Université de Montréal, Montreal, Quebec, Canada
| | - Nathalie J Bureau
- CHUM Research Center, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Radiology, Radio-Oncology and Nuclear Medicine, Université de Montréal, Montreal, Quebec, Canada
- Department of Radiology, CHUM, Montreal, Quebec, Canada
| | - Nathaly Gaudreault
- Faculty of Medicine and Health Sciences, School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Charles-LeMoyne Hospital Research Center, Longueuil, Quebec, Canada
| | | | - Manon Choinière
- CHUM Research Center, Montreal, Quebec, Canada
- Faculty of Medicine, Department of Anesthesiology, Universite de Montreal, Montreal, Quebec, Canada
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Visser AW, Bøyesen P, Haugen IK, Schoones JW, van der Heijde DM, Rosendaal FR, Kloppenburg M. Radiographic scoring methods in hand osteoarthritis--a systematic literature search and descriptive review. Osteoarthritis Cartilage 2014; 22:1710-23. [PMID: 25278080 DOI: 10.1016/j.joca.2014.05.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/18/2014] [Accepted: 05/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This systematic literature review aimed to evaluate the use of conventional radiography (CR) in hand osteoarthritis (OA) and to assess the metric properties of the different radiographic scoring methods. DESIGN Medical literature databases up to November 2013 were systematically reviewed for studies reporting on radiographic scoring of structural damage in hand OA. The use and metric properties of the scoring methods, including discrimination (reliability, sensitivity to change), feasibility and validity, were evaluated. RESULTS Of the 48 included studies, 10 provided data on reliability, 11 on sensitivity to change, four on feasibility and 36 on validity of radiographic scoring methods. Thirteen different scoring methods have been used in studies evaluating radiographic hand OA. The number of examined joints differed extensively and the obtained scores were analyzed in various ways. The reliability of the assessed radiographic scoring methods was good for all evaluated scoring methods, for both cross-sectional and longitudinal radiographic scoring. The responsiveness to change was similar for all evaluated scoring methods. There were no major differences in feasibility between the evaluated scoring methods, although the evidence was limited. There was limited knowledge about the validity of radiographic OA findings compared with clinical nodules and deformities, whereas there was better evidence for an association between radiographic findings and symptoms and hand function. CONCLUSIONS Several radiographic scoring methods are used in hand OA literature. To enhance comparability across studies in hand OA, consensus has to be reached on a preferred scoring method, the examined joints and the used presentation of data.
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Affiliation(s)
- A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - P Bøyesen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - D M van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Kjeken I, Grotle M, Hagen KB, Østerås N. Development of an evidence-based exercise programme for people with hand osteoarthritis. Scand J Occup Ther 2014; 22:103-16. [DOI: 10.3109/11038128.2014.941394] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Soto-Hermida A, Fernández-Moreno M, Pértega-Díaz S, Oreiro N, Fernández-López C, Blanco FJ, Rego-Pérez I. Mitochondrial DNA haplogroups modulate the radiographic progression of Spanish patients with osteoarthritis. Rheumatol Int 2015; 35:337-44. [PMID: 25086630 DOI: 10.1007/s00296-014-3104-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2014] [Accepted: 07/21/2014] [Indexed: 12/21/2022]
Abstract
Not all patients with osteoarthritis (OA) show the same disease progression, as some of them remain relatively stable over time, while others progress to severe structural deterioration of the joint. In this sense, the main goal of both genetic and protein biomarkers in OA is to predict not only the risk of OA at an earlier stage of the disease but also which OA patients are more likely to progress to severe disease. Taking into account the incidence of the mitochondria and the mtDNA haplogroups in the pathogenesis of OA, the main objective of this work was to evaluate the incidence of the mtDNA haplogroups in the radiographic progression of the OA disease in a well-characterized follow-up cohort of Spanish patients. DNA from 281 OA patients from Hospital Universitario A Coruña was isolated to determine the European mtDNA haplogroups. Knee or hip radiographs from all affected joints were obtained at two time points with at least 36 months apart. Radiographs were evaluated using the Kellgren/Lawrence (K/L) scale; radiographic OA progression was defined as any radiographic worsening of the K/L joint score. Statistical analyses included Kaplan-Meier survival curves and Cox regression models. Patients belonging to the cluster TJ showed a slower radiographic OA progression than patients in the cluster KU (p = 0.036). Moreover, patients carrying the most common mtDNA haplogroup H are more apt to require total joint replacement surgery than non-H patients (p = 0.049). The inherited mitochondrial variants influence the radiographic progression of OA and could be considered among the genetic variants taken into account when the radiographic progression of OA is analyzed.
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Hennig T, Hæhre L, Hornburg VT, Mowinckel P, Norli ES, Kjeken I. Effect of home-based hand exercises in women with hand osteoarthritis: a randomised controlled trial. Ann Rheum Dis 2014; 74:1501-8. [PMID: 24667900 DOI: 10.1136/annrheumdis-2013-204808] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Accepted: 03/06/2014] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hand exercises are recommended for patients with hand osteoarthritis (HOA), though evidence for their effect is conflicting. OBJECTIVE To evaluate, in a randomised controlled trial, the effect of HOA information plus home-based hand exercises (exercise group) compared with information only (control group) in women with HOA. METHODS Interventions were delivered by two occupational therapists. Exercise group participants received eight follow-up calls over the 3-month study and recorded adherence, pain after exercises and adverse events in a diary. Primary outcome was activity performance measured after 3 months by the Patient-Specific Functional Scale (PSFS), with a range of 0-10. Secondary outcomes were measurements of hand function, disease activity, symptoms and number of responders to treatment according to the OMERACT-OARSI criteria. RESULTS Of 80 women randomised (40 : 40) (mean age (SD) 60.8 years (7.0)), follow-up was 89% (n=71). An intention-to-treat analysis was performed. The adjusted mean difference for the exercise versus control group was 1.4 points (95% CI 0.6 to 2.2, effect size 1.0) for the PSFS score. Thirteen patients in the exercise group versus three participants in the control group reached a positive minimal clinical important difference of 2.2 points in the PSFS total score, while none versus two, respectively, had a negative change (p=0.007). For secondary outcomes, significant mean differences were found in grip strength and thumb web space, in fatigue, joint pain and the Functional Index for HOA activity performance scores. Sixteen exercise-group participants fulfilled the OMERACT-OARSI response criteria versus two control-group participants (p<0.001). CONCLUSIONS Hand exercises were well tolerated and significantly improved activity performance, grip strength, pain and fatigue in women with HOA. TRIAL REGISTRATION NUMBER ISRTCN79019063.
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Affiliation(s)
| | - Liv Hæhre
- Martina Hansens Hospital, Sandvika, Norway
| | | | - Petter Mowinckel
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Claessen KMJA, Ramautar SR, Pereira AM, Romijn JA, Kroon HM, Kloppenburg M, Biermasz NR. Increased clinical symptoms of acromegalic arthropathy in patients with long-term disease control: a prospective follow-up study. Pituitary 2014; 17:44-52. [PMID: 23344976 DOI: 10.1007/s11102-013-0464-6] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Arthropathy is an invalidating complication of acromegaly. This arthropathy deteriorates radiographically despite long-term disease control. However, the clinical course and its relationship to the radiographic course are currently unknown. We aimed to investigate the clinical course of arthropathy during follow-up and its relationship to radiographic progression in long-term controlled acromegaly patients. Prospective follow-up study. We studied 58 patients (mean age 62 years, women 41 %) with controlled acromegaly for a mean of 17.6 years. Clinical progression of joint disease was defined at baseline and after 2.6 years, by the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and Australian/Canadian Osteoarthritis Index (AUSCAN) questionnaires for lower limb and hand OA, respectively, and performance tests. Potential risk factors for progression were assessed. The clinical course of arthropathy was related to the radiographic course. On average, hand and lower limb function deteriorated during follow-up, despite large interindividual variations. Joint pain was stable over time. High levels of pain and functional impairment at baseline were related to clinical progression of hand pain and functional limitations. High baseline BMI was a risk factor for functional deterioration in the lower limb. The changes in symptoms and radiographic progression during follow-up were not related. In treated acromegaly patients, joint function deteriorates during prolonged follow-up, despite biochemical disease control, although there was interindividual variation. Clinical and radiographic course of arthropathy were not related. Therefore, in clinical practice, a combination of clinical and radiographic assessment is necessary to evaluate the course of acromegalic arthropathy.
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Affiliation(s)
- K M J A Claessen
- Department of Endocrinology and Metabolic Diseases C4-R and Center for Endocrine Tumors Leiden, Leiden University Medical Center, P.O. Box 9600, 2300 RC, Leiden, The Netherlands,
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Li X, Liu X, Du X, Ye Z. Diffusion-weighted MR imaging for assessing synovitis of wrist and hand in patients with rheumatoid arthritis: a feasibility study. Magn Reson Imaging 2014; 32:350-3. [PMID: 24512797 DOI: 10.1016/j.mri.2013.12.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2013] [Revised: 10/14/2013] [Accepted: 12/01/2013] [Indexed: 12/31/2022]
Abstract
The purpose of this study was to investigate the feasibility of diffusion-weighted imaging (DWI) in detecting synovitis of wrist and hand in patients with rheumatoid arthritis (RA) and evaluate its sensitivity, specificity and accuracy as compared to T2-weighted imaging (T2WI) with short tau inversion recovery (STIR) with the reference standard contrast-enhanced magnetic resonance imaging (CE-MRI). Twenty-five patients with RA underwent MR examinations including DWI, T2WI with STIR and CE-MRI. MR images were reviewed for the presence and location of synovitis of wrist and hand. The sensitivity, specificity and accuracy of DWI and T2WI with STIR were calculated respectively and then compared. All patients included in this study completed MR examinations and yielded diagnostic image quality of DWI. For individual joint, there was good to excellent inter-observer agreement (k=0.62-0.83) using DWI images, T2WI with STIR images and CE-MR images, respectively. There was a significance between DWI and T2WI with STIR in analyzing proximal interphalangeal joints II-V, respectively (P<0.05). The k-values for the detection of synovitis indicated excellent overall inter-observer agreements using DWI images (k=0.86), T2WI with STIR images (k=0.85) and CE-MR images (k=0.91), respectively. Overall, DWI demonstrated a sensitivity, specificity and accuracy of 75.6%, 89.3% and 84.6%, respectively, for detection of synovitis, while 43.0%, 95.7% and 77.6% for T2WI with STIR, respectively. DWI showed positive lesions much better and more than T2WI with STIR. Our results indicate that DWI presents a novel non-invasive approach to contrast-free imaging of synovitis. It may play a role as an addition to standard protocols.
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Affiliation(s)
- Xubin Li
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China.
| | - Xia Liu
- Department of Radiology, Peking University People's Hospital, Beijing 100044, China
| | - Xiangke Du
- Department of Radiology, Peking University People's Hospital, Beijing 100044, China
| | - Zhaoxiang Ye
- Department of Radiology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Tianjin 300060, China; Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, China
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Hermann M, Nilsen T, Eriksen CS, Slatkowsky-Christensen B, Haugen IK, Kjeken I. Effects of a soft prefabricated thumb orthosis in carpometacarpal osteoarthritis. Scand J Occup Ther 2013; 21:31-9. [PMID: 24215554 DOI: 10.3109/11038128.2013.851735] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023]
Abstract
AIMS To explore the feasibility and assess the effect of a prefabricated soft thumb-base orthosis on pain, hand strength, and activity performance in persons with osteoarthritis of the CMC joint. METHODS In this randomized controlled trial, 29 patients received hand exercises only (control group) and 30 patients received hand exercises and an orthosis (orthosis group). The primary outcome was pain, while secondary outcomes included grip and pinch strength, and self-reported symptoms and activity performance. Outcome assessments, and measures of grip strength and pain with and without orthosis in the orthosis group, were made after two months. RESULTS 55 participants (mean age 70.5 years) completed all assessments. There were no significant differences between the groups in primary or secondary outcomes after two months. However, in the orthosis group, pain was significantly less when wearing the orthosis than when not wearing it. Participants reported that the orthosis felt uncomfortable during activities involving water and one-third wanted more support of the CMC joint. CONCLUSIONS A soft prefabricated orthosis seems to have an immediate pain-relieving effect during use, but no effects in terms of less hand pain, or improved strength or activity performance when not worn.
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Affiliation(s)
- Merete Hermann
- Department of Rheumatology, Diakonhjemmet Hospital , Oslo , Norway
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Marshall M, Peat G, Nicholls E, van der Windt D, Myers H, Dziedzic K. Subsets of symptomatic hand osteoarthritis in community-dwelling older adults in the United Kingdom: prevalence, inter-relationships, risk factor profiles and clinical characteristics at baseline and 3-years. Osteoarthritis Cartilage 2013; 21:1674-84. [PMID: 23954700 PMCID: PMC3819994 DOI: 10.1016/j.joca.2013.08.004] [Citation(s) in RCA: 64] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2013] [Revised: 07/04/2013] [Accepted: 08/03/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare the population prevalence, inter-relationships, risk factor profiles and clinical characteristics of subsets of symptomatic hand osteoarthritis (OA) with a view to understanding their relative frequency and distinctiveness. METHOD 1076 community-dwelling adults with hand symptoms (60% women, mean age 64.7 years) were recruited and classified into pre-defined subsets using physical examination and standardised hand radiographs, scored with the Kellgren & Lawrence (K&L) and Verbruggen-Veys grading systems. Detailed information on selected risk factors was obtained from direct measurement (Body Mass Index (BMI)), self-complete questionnaires (excessive use of hands, previous hand injury) and medical record review (hypertension, dyslipidaemia, type 2 diabetes). Hand pain and disability were self-reported at baseline and 3-year follow-up using Australian/Canadian Osteoarthritis Hand Index (AUSCAN). RESULTS Crude population prevalence estimates for symptomatic hand OA subsets in the adult population aged 50 years and over were: thumb base OA (22.4%), nodal interphalangeal joint (IPJ) OA (15.5%), generalised hand OA (10.4%), non-nodal IPJ OA (4.9%), erosive OA (1.0%). Apart from thumb base OA, there was considerable overlap between the subsets. Erosive OA appeared the most distinctive with the highest female: male ratio, and the most disability at baseline and 3-years. A higher frequency of obesity, hypertension, dyslipidaemia, and metabolic syndrome was observed in this subset. CONCLUSION Overlap in the occurrence of hand OA subsets poses conceptual and practical challenges to the pursuit of distinct phenotypes. Erosive OA may nevertheless provide particular insight into the role of metabolic and cardiovascular risk factors in the pathogenesis of OA.
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Affiliation(s)
- M. Marshall
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - G. Peat
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - E. Nicholls
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - D. van der Windt
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - H. Myers
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
| | - K. Dziedzic
- Arthritis Research UK Primary Care Centre, Primary Care Sciences, Keele University, Keele, Staffordshire ST5 5BG, United Kingdom
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Haugen IK, Slatkowsky-Christensen B, Bøyesen P, van der Heijde D, Kvien TK. Cross-sectional and longitudinal associations between radiographic features and measures of pain and physical function in hand osteoarthritis. Osteoarthritis Cartilage 2013; 21:1191-8. [PMID: 23973130 DOI: 10.1016/j.joca.2013.04.004] [Citation(s) in RCA: 59] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/11/2013] [Accepted: 04/09/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Previous longitudinal studies have shown no associations between increasing amount of radiographic hand osteoarthritis (OA) and levels of hand pain/disability. In this longitudinal study, we aimed to study whether radiographic hand OA was related to pain/disability in cross-sectional and longitudinal settings focusing on joint-specific analyses. METHODS We included 190 patients (173 women, mean (standard deviation, SD) age 61.5 (5.7) years) from the Oslo hand OA cohort, of whom 112 had 7-year follow-up data. Finger joints were scored for radiographic OA according to the Kellgren-Lawrence scale and Osteoarthritis Research Society International (OARSI) atlas. Pain and function were assessed by clinical examination (joint tenderness), grip strength and the Australian/Canadian (AUSCAN) questionnaire. Associations between radiographic hand OA and tenderness in the same joint were examined by logistic regression analyses with Generalized Estimating Equations, whereas associations between overall amount of radiographic OA and hand pain/disability were assessed by linear regression (adjusted for age and sex). RESULTS A dose-dependent association was found between the severity of radiographic OA and tenderness in the same joint. Joints that progressed into severe radiographic OA during follow-up had the highest odds of developing tenderness (OR = 11, 95% confidence interval (CI) 4.0-33). Incident erosions seemed to be the most important individual feature associated with incident tenderness (OR = 6.2, 95% CI 3.2-12). Weak associations were found between the amount of radiographic hand OA and overall hand pain/disability. CONCLUSION Radiographic hand OA is associated with tenderness in the same joint, and erosive development strongly predicts future joint tenderness independent of other radiographic features.
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Affiliation(s)
- I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Paradowski PT, Lohmander LS, Englund M. The association between metacarpal ratio, radiographic hand and knee osteoarthritis and its progression after meniscectomy. Osteoarthritis Cartilage 2013; 21:1053-7. [PMID: 23672791 DOI: 10.1016/j.joca.2013.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2013] [Revised: 04/07/2013] [Accepted: 05/01/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine whether the ratio of the second and fourth metacarpal bone length (MC2:MC4) in subjects with prior meniscectomy of the knee is associated with radiographic hand and knee osteoarthritis (OA) and its progression. DESIGN We assessed 219 subjects (175 men and 44 women) twice with a follow-up time ranging from 4 to 10 years. Participants had all undergone prior meniscectomy. The subjects were of mean (SD) 53 (11) years of age at the first radiographic examination. One observer measured the metacarpal lengths of both hands. We used the average MC2:MC4 from left and right hand divided into tertiles as the exposure variable, using the highest tertile, i.e., "female" pattern as reference category. Radiographic OA of both hands and knees and its progression were evaluated on subject level as our outcomes. We used logistic regression to evaluate the possible association of MC2:MC4 with hand and knee OA and its progression with adjustment for age, sex, body mass index, and follow-up time. RESULTS We found no statistically significant association between the lower MC2:MC4 tertile "male" pattern and prevalent hand OA (odds ratio [OR] 0.70; 95% confidence interval [CI] 0.24-1.99) and prevalent knee OA (OR 1.08; 95% CI 0.56-2.07). Neither did we find any corresponding significant association for the progression of hand OA (OR 0.89; 95% CI 0.34-2.32), nor knee OA (OR 0.69; 95% CI 0.33-1.46). CONCLUSIONS We did not detect any association between MC2:MC4 and radiographic hand and knee OA and its progression in subjects with prior meniscectomy.
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Affiliation(s)
- P T Paradowski
- Department of Orthopedics, Sunderby Central Hospital of Norrbotten, Sjukhusvägen 10, Luleå, Sweden.
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Sunk IG, Amoyo-Minar L, Stamm T, Haider S, Niederreiter B, Supp G, Soleiman A, Kainberger F, Smolen JS, Bobacz K. Interphalangeal Osteoarthritis Radiographic Simplified (iOARS) score: a radiographic method to detect osteoarthritis of the interphalangeal finger joints based on its histopathological alterations. Ann Rheum Dis 2013; 73:1983-9. [DOI: 10.1136/annrheumdis-2012-203117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Bijsterbosch J, Kloppenburg M, Reijnierse M, Rosendaal FR, Huizinga TWJ, Slagboom PE, Meulenbelt I. Association study of candidate genes for the progression of hand osteoarthritis. Osteoarthritis Cartilage 2013; 21:565-9. [PMID: 23357225 DOI: 10.1016/j.joca.2013.01.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2012] [Revised: 12/31/2012] [Accepted: 01/18/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although a few consistent osteoarthritis (OA) susceptibility genes have been identified, little is known on OA progression. Since OA progression is clinically the most relevant phenotype, we investigate the association between asporin (ASPN), bone morphogenetic protein 5 (BMP5) and growth differentiation factor 5 (GDF5) polymorphisms and progression of hand OA. METHODS Single-nucleotide polymorphisms (SNPs) ASPN rs13301537, BMP5 rs373444 and GDF5 rs143383 were genotyped in 251 hand OA patients from the Genetics osteoARthritis and Progression (GARP) study and 725 controls. In a case-control comparison we assessed the association between these SNPs and radiographic progression of hand OA over 6 years, which was based on change in osteophytes or joint space narrowing (JSN), above the smallest detectable change. SNPs with suggestive evidence for association were further analysed for their effect on progression over 2 years, and for the mean change in osteophytes and JSN. RESULTS The minor allele of ASPN SNP rs13301537 was associated with hand OA progression over 6 years (odds ratio (OR) (95% CI) 1.49 (1.06-2.07); P = 0.020). The mean change in osteophytes and JSN was higher in carriers of the minor allele compared to homozygous carriers of the common allele with mean difference of 0.73 (95% CI - 0.07-1.56; P = 0.073) and 0.82 (95% CI 0.12-1.52; P = 0.022), respectively. An association with similar effect size was found between ASPN SNP rs13301537 and 2-year progression, and the mean change in osteophytes and JSN was significantly higher in homozygotes. CONCLUSION ASPN is associated with hand OA progression. This gives insight in the pathogenesis of hand OA progression and identified a potential target for therapeutic approaches.
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Affiliation(s)
- J Bijsterbosch
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.
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Kwok WY, Plevier JWM, Rosendaal FR, Huizinga TWJ, Kloppenburg M. Risk Factors for Progression in Hand Osteoarthritis: A Systematic Review. Arthritis Care Res (Hoboken) 2013; 65:552-62. [DOI: 10.1002/acr.21851] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 09/04/2012] [Indexed: 11/06/2022]
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Jonsson H, Helgadottir GP, Aspelund T, Sverrisdottir JE, Eiriksdottir G, Sigurdsson S, Eliasson GJ, Jonsson A, Ingvarsson T, Harris TB, Launer L, Gudnason V. The use of digital photographs for the diagnosis of hand osteoarthritis: the AGES-Reykjavik study. BMC Musculoskelet Disord 2012; 13:20. [PMID: 22340303 PMCID: PMC3293753 DOI: 10.1186/1471-2474-13-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/16/2012] [Indexed: 11/29/2022] Open
Abstract
Background The objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and finally to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable. Methods High quality photographs with standard distance and hand positioning were analysed for the presence of HOA and subsequently compared with standard radiographs and clinical examination in 381 random participants in the AGES-Reykjavik Study, a large population study. The mean age of the participants was 76 years. Results Using the photographic method, the most commonly affected joints were the second DIP joints followed by the third DIP joints and second and third PIP joints. Both interobserver (ICC = 0.83) and intraobserver reading agreements (ICC = 0.89) were acceptable. On comparison with radiography and clinical examination, aggregate scores were significantly correlated (Rs 0.35-0.69), more so in females (Rs 0.53-0.72) than males. Hand pain in males showed very little association with HOA findings by the three methods but all methods showed a comparable moderate association with hand pain in females. The performance of photography in predicting pain on most days for at least a month in females was comparable to that of radiography and clinical examination (AUC 0.63 p = 0.004). Analysis of intermittent pain yielded similar results for in the DIP and PIP joints (OR 3.2-3.3, p < 0.01), but for the CMC1 joints, both radiography (OR 9.0, p < 0.0001), and clinical examination (OR 9.8, p < 0.0001), had higher predictive odds ratios for pain than photography (OR 3.6, p < 0.0001)., A shortened, rapidly performed form of reading photographs also showed a high degree of correlation with the other methods (Rs 0.56-0.82). Conclusion High quality hand photographs can be used to diagnose and grade hand osteoarthritis. The method has the advantage of being inexpensive and easy to perform. By using a slightly simplified method of reading, it appears to be highly suitable for use in large studies.
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Affiliation(s)
- Helgi Jonsson
- Landspitalinn University Hospital, University of Iceland, IS-108 Fossvogur, Reykjavik, ICELAND.
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