Symmetry and clustering of symptomatic hand osteoarthritis in elderly men and women: the Framingham Study

Joint-specific prevalence and radiographic pattern of hand osteoarthritis in Korean

We investigated the prevalence and involvement patterns of radiographic osteoarthritis (OA) with hand symptoms among Korean people and compared the difference in prevalence of hand OA between racial groups. Hand radiographs in 299 Korean subjects (266 female, 33 male) ≥40 years of age were examined, who had hand arthralgia. The study population was comprised of 206 patients who had radiographic OA at least at one hand joint. Radiographic OA (Kellgren-Lawrence scale ≥2 grades) was evaluated for 16 joints of each hand. The most prevalent OA was in the interphalangeal joints (IP) of thumb, followed by the distal interphalangeal joints (DIP) of index finger, DIP of middle and fifth finger in the frequency of order. The involvement of metacarpophalangeal joints (MP) was relatively common in 1st-3rd MP. Hand OA in Korean was higher in the thumb IP and lower in the thumb carpometacarpal joints compared with Caucasian previously reported. Moreover, the higher OA frequency of 1st-3rd MP was not in accordance with other studies in Caucasian and other Asian populations. The patterns of radiographic hand OA were symmetric (OR 15.68), clustered by ray (OR 8.69) and row (OR 6.66). In conclusion, our study showed that thumb IP and 2nd/3rd/5th DIP should be included in the assessment of radiologic hand OA in Koreans.

Radiographic hand osteoarthritis: patterns and associations with hand pain and function in a community-dwelling sample

OBJECTIVE

Patterns of radiographic osteoarthritis (ROA) of the hand are often examined by row, with the four joints of the thumb studied inconsistently. The objectives of this study were to determine relationships of ROA at different hand joints, use the findings to define radiographic sub-groups and investigate their associations with pain and function.

METHODS

Sixteen joints in each hand were scored for the presence of ROA in a community-dwelling cohort of adults, 50-years-and-over, with self-reported hand pain or problems. Principal components analysis (PCA) with varimax rotation was used to study patterns of ROA in the hand joints and identify distinct sub-groups. Differences in pain and function between these sub-groups were assessed using Australian/Canadian Osteoarthritis Index (AUSCAN), Grip Ability Test (GAT) and grip and pinch strength.

RESULTS

PCA was undertaken on data from 592 participants and identified four components: distal interphalangeal joints (DIPs), proximal interphalangeal joints (PIPs), metacarpophalangeal joints (MCPs), thumb joints. However, the left thumb interphalangeal (IP) joint cross-loaded with the PIP and thumb groups. On this basis, participants were categorised into four radiographic sub-groups: no osteoarthritis (OA), finger only OA, thumb only OA and combined thumb and finger OA. Statistically significant differences were found between the sub-groups for AUSCAN function, and in women alone for grip and pinch strength. Participants with combined thumb and finger OA had the worst scores.

CONCLUSION

Individual thumb joints can be clustered together as a joint group in ROA. Four radiographic sub-groups of hand OA can be distinguished. Pain and functional difficulties were highest in participants with both thumb and finger OA.

EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT

OBJECTIVES

To develop evidence-based recommendations for the diagnosis of hand osteoarthritis (OA).

METHODS

The multidisciplinary guideline development group, representing 15 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched for systematically. Whenever possible, the sensitivity, specificity and likelihood ratio (LR) were calculated; relative risk and odds ratios were estimated for risk factors for hand OA. Quality of evidence was categorised using the European League Against Rheumatism (EULAR) hierarchy, and strength of recommendation was assessed by the EULAR visual analogue scale.

RESULTS

Diagnostic topics included clinical manifestations, radiographic features, subgroups, differential diagnosis, laboratory tests, risk factors and comorbidities. The sensitivity, specificity and LR varied between tests depending upon the cut-off level, gold standard and controls. Overall, no single test could be used to define hand OA on its own (LR <10) but a composite of the tests greatly increased the chance of the diagnosis. The probability of a subject having hand OA was 20% when Heberden nodes alone were present, but this increased to 88% when in addition the subject was over 40 years old, had a family history of nodes and had joint space narrowing in any finger joint.

CONCLUSION

Ten key recommendations for diagnosis of hand OA were developed using research evidence and expert consensus. Diagnosis of hand OA should be based on assessment of a composite of features.

Efficacy and safety of a novel synergistic drug candidate, CRx-102, in hand osteoarthritis

OBJECTIVE

The novel synergistic drug candidate CRx-102 comprises dipyridamole and low dose prednisolone and is in clinical development for the treatment of immunoinflammatory diseases. The purpose of this clinical study was to examine the efficacy and safety of CRx-102 in patients with hand osteoarthritis (HOA).

METHODS

The study was conducted as a blinded, randomised, placebo-controlled trial at four centres in Norway. Eligibility criteria included being of age 30-70 years, at least one swollen and tender joint, a Kellgren-Lawrence (K-L) score of 2 or higher on radiographs, and a score of at least 30 mm pain on the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) visual analogue pain scale (VAS). The primary endpoint was a reduction in pain from baseline to day 42 on the AUSCAN pain subscale. Two-sided p values for the differences in least squares (LS) means adjusted for baseline are presented.

RESULTS

The mean age of the 83 patients with HOA was 60 years and 93% were females. CRx-102 was statistically superior to placebo at 42 days for changes in AUSCAN pain (LS mean -14.2 vs -4.0) and for clinically relevant secondary endpoints (joint pain VAS (-18.6 vs -6.3), patient global VAS (-15.9 vs -4.2)) in the intention to treat population. The most frequently reported adverse event during the study was headache (52% in CRx-102 vs 15% in the placebo group).

CONCLUSIONS

The novel synergistic drug candidate CRx-102 demonstrated efficacy by statistically reducing pain compared to placebo in HOA and was generally well tolerated.

Heberden's nodes and what Heberden could not see: the pivotal role of ligaments in the pathogenesis of early nodal osteoarthritis and beyond

Despite its relatively high prevalence, polyarticular nature, limited treatment options and recognized genetic contribution, the study of generalized OA (GOA) has lagged behind that of isolated knee OA. Whilst the pathogenesis of OA has been viewed in relation to either articular cartilage or bone disease, this article offers a viewpoint on why GOA may, in fact, be primarily a disorder of ligaments, and to a lesser extent tendon and joint capsule dysfunction. A relatively fast presentation of GOA, typically in the perimenopausal period, and its recognition on clinical grounds alone makes this type of OA potentially useful for pathogenic studies in OA, in general. The recent high-resolution MRI studies, microanatomical studies and animal models, in addition to established clinical and radiographic data that support this ligament-centric perspective of disease, are reviewed. The earliest structural abnormalities in GOA may be evident in ligaments and the ligament-associated 'enthesis organ', where degenerative changes are evident. Ligaments also influence the expression of joint damage including Heberden's node and joint erosion formation. Joint inflammation in a 'periarthritis' pattern is well recognized in GOA, and histological studies have shown that the ligament and capsule could represent the epicentre of such inflammatory changes. A perspective is also offered on how ligaments could play a pivotal role in OA in general; for example, the loss of joint space in knee OA due to meniscal extrusion could ultimately be related to derangement of the medial collateral ligament to which the meniscus is anchored.

Health-related quality of life in women with symptomatic hand osteoarthritis: a comparison with rheumatoid arthritis patients, healthy controls, and normative data

OBJECTIVE

Data on the burden of disease and impact on health-related quality of life (HRQOL) in hand osteoarthritis (OA) are limited. The goal of this study was to compare HRQOL in patients with hand OA with HRQOL in patients with rheumatoid arthritis (RA), healthy controls, and normative data from the general population.

METHODS

A total of 190 women with hand OA were compared with 194 women with RA and 144 healthy women of the same age. Health status was measured using the Short Form 36 (SF-36), Short Form 6D (SF-6D), modified Health Assessment Questionnaire (M-HAQ), pain and fatigue visual analog scales, and grip strength. Scores were compared by analysis of variance and a multivariate analysis of covariance, adjusting for age, number of comorbidities, and years of education. Gaps between patients and population subjects were assessed by calculating S scores on all dimensions of the SF-36.

RESULTS

Hand OA and RA patients had worse scores on all assessed dimensions of subjective health compared with healthy controls. RA patients showed poorest general health (SF-36), poorest physical function (M-HAQ, SF-36 physical, grip strength), and highest level of fatigue compared with hand OA patients. Hand OA patients reported poorer mental health. Mean utility scores (SF-6D) in hand OA and RA were 0.64 and 0.63, respectively, with a mean difference compared with healthy controls of 0.13 in hand OA and 0.14 in RA patients. S scores confirmed a marked disparity between individuals with a rheumatic diagnosis (hand OA, RA) and population subjects.

CONCLUSION

This study illustrates that patients with hand OA experience a broad impact on HRQOL compared with healthy controls. Fatigue and physical function are worse in RA than hand OA.

A systematic search and narrative review of radiographic definitions of hand osteoarthritis in population-based studies

OBJECTIVE

Currently there is no agreed "gold standard" definition of radiographic hand osteoarthritis (RHOA) for use in epidemiological studies. We therefore undertook a systematic search and narrative review of community-based epidemiological studies of hand osteoarthritis (OA) to identify (1) grading systems used, (2) definitions of radiographic OA for individual joints and (3) definitions of overall RHOA.

METHODS

The following electronic databases were searched: Medline, Embase, Science Citation Index and Ageline (inception to Dec 2006). The search strategy combined terms for "hand" and specific joint sites, OA and radiography. Inclusion and exclusion criteria were applied. Data were extracted from each paper covering: hand joints studied, grading system used, definitions applied for OA at individual joints and overall RHOA.

RESULTS

Titles and abstracts of 829 publications were reviewed and the full texts of 399 papers were obtained. One hundred fifty-two met the inclusion criteria and 24 additional papers identified from screening references. Kellgren and Lawrence (K&L) was the most frequently applied grading system used in 80% (n=141) of studies. In 71 studies defining OA at the individual joint level 69 (97%) used a definition of K&L grade > or = 2. Only 53 publications defined overall RHOA, using 21 different definitions based on five grading systems.

CONCLUSION

The K&L scheme remains the most frequently used grading system. There is a consistency in defining OA in a single hand joint as K&L grade > or = 2. However, there are substantial variations in the definitions of overall RHOA in epidemiological studies.

Joint-specific hand symptoms and self-reported and performance-based functional status in African Americans and Caucasians: The Johnston County Osteoarthritis Project

OBJECTIVE

To assess associations between joint-specific hand symptoms and self-reported and performance-based functional status.

METHODS

Participants were from the population-based Johnston County Osteoarthritis Project. Symptoms in the distal interphalangeal (DIP), proximal interphalangeal (PIP), first carpometacarpal (CMC), and metacarpophalangeal (MCP) joints were assessed on a 30-joint diagram of both hands. Self-reported function was assessed by Health Assessment Questionnaire (HAQ) and performance-based function by timed repeated chair stands and 8-foot walk time. Separate multiple logistic regression models examined associations between symptoms in specific hand joint groups, symptoms in >/=2 hand joint groups and number of symptomatic hand joints, and functional status measures, controlling for age, race/ethnicity, sex, body mass index, radiographic knee and hip OA, knee and hip symptoms and depressive symptoms.

RESULTS

Those with symptomatic hand joint groups were more likely than those without these complaints to report more difficulty and require longer times for performance measures. Those with 2 or more symptomatic hand joint groups were more likely to have higher HAQ scores (OR = 1.97 (1.53 to 2.53)) and require more time to complete 5 chair stands (OR = 1.98 (1.23 to 3.18)) and the 8 foot walk test (OR = 1.49 (1.12 to 1.99)).

CONCLUSIONS

Joint-specific hand symptoms are associated with difficulty performing upper- or lower-extremity tasks, independent of knee and hip OA and symptoms, suggesting that studies examining functional status in OA should not ignore symptomatic joints beyond the joint site of interest, even when functional measures appear to be specific for the joint site under study.

Research in hand osteoarthritis: time for reappraisal and demand for new strategies. An opinion paper

BACKGROUND

Osteoarthritis of the hands is a prevalent musculoskeletal disease with a considerable effect on patients' lives, but knowledge and research results in the field of hand osteoarthritis are limited. Therefore, the Disease Characteristics in Hand OA (DICHOA) initiative was founded in early 2005 with the aim of addressing key issues and facilitating research into hand osteoarthritis.

OBJECTIVE

To review and discuss current knowledge on hand osteoarthritis with regard to aetiopathogenesis, diagnostic criteria, biomarkers and clinical outcome measures.

METHODS

Recommendations were made based on a literature review.

RESULTS

Outcomes of hand osteoarthritis should be explored, including patient perspective on the separate components of disease activity, damage and functioning. All imaging techniques should be cross-validated for hand osteoarthritis with clinical status, including disease activity, function and performance, biomarkers and long-term outcome. New imaging modalities are available and need scoring systems and validation. The role of biomarkers in hand osteoarthritis has to be defined.

CONCLUSION

Future research in hand osteoarthritis is warranted.

Vitamin D receptor gene polymorphisms and susceptibility of hand osteoarthritis in Finnish women

We examined whether polymorphisms of the vitamin D receptor (VDR) gene was associated with individual risk of hand osteoarthritis (OA). Radiographs of both hands of 295 dentists and of 248 teachers were examined and classified for the presence of OA using reference images. The VDR ApaI and TaqI genotypes were determined by PCR-based methods. No association was observed between the VDR polymorphisms and the odds of overall hand OA. However, the carriers of the VDR t allele or At haplotype were at almost half the odds of symmetrical hand OA (odds ratio [OR] = 0.60, 95% confidence interval [CI] = 0.38–0.94 and OR = 0.59, 95% CI = 0.38–0.93, respectively) compared with the carriers of the T allele and of the non-At haplotype, respectively. Increased odds of this disease, on the contrary, was observed for women with two copies of the VDR a allele (OR = 1.93, 95% CI = 1.99–3.70) compared with women with the AA genotype. Conversely, the VDR a allele carriage was associated with a tendency of lowered odds of osteophyte (OR = 0.51, 95% CI = 0.25–1.03). When the genotype data were used to construct haplotypes, the VDR AaTt joint genotype appeared to pose a remarkably lower odds (OR = 0.26, 95% CI = 0.08–0.91) of osteophyte compared with the AAtt joint genotype. As a novel finding we observed a joint effect of a low calcium intake and VDR polymorphisms on symmetrical OA; the OR was 2.64 (95% CI = 1.29–5.40) for carriers of the aT haplotype with low daily calcium intake compared with non-carriers of the haplotype with high daily calcium intake. Our results suggest that VDR gene polymorphisms play a role in the etiology of symmetrical hand OA. Moreover, the association between the VDR gene and OA may be modified by calcium intake.

How men and women are affected by osteoarthritis of the hand

Factors other than age and genetics may play a role in explaining the onset of osteoarthritis of the hand. Genetic, physiologic, and anatomic differences in men and women cause the variable expressions of osteoarthritis. These different factors affect women's ability to modify osteoarthritis of the hand before and after its onset, although it is genetic. By maintaining normal weight, good health, and nutrition, one can diminish the genetic and multifactorial effects of osteoarthritis of the hand. Future research in genetics, polymorphism, anatomy, hormonal influences, association with other disease processes, and multifactorial issues will clarify these relationships. Additional studies are needed to investigate the outcomes of gender-specific treatments, joint replacement surgery, and other interventions for osteoarthritis of the hand.

Prevalence and involvement patterns of radiographic hand osteoarthritis in Japanese women: the Hizen-Oshima Study

The prevalence and pattern of joint involvement in radiographic hand osteoarthritis (OA) have been reported in Western populations, but similar data are lacking for Japanese. We examined this issue in 551 Japanese women aged > or = 40 years. Radiographs were obtained of both hands and graded according to the Kellgren-Lawrence (K-L) criteria. OA was defined as K-L grade 2 or higher. The prevalence of radiographic OA in the IP, MCP, and CMC joints was distributed similarly in both hands. The most frequent locations of radiographic OA were the distal IP joints of the index finger, the IP joint of the thumb, and the distal IP joints of the middle finger, in this order. The prevalence of radiographic OA in each joint group increased significantly with age, and that in Japanese women was lower in the thumb CMC joint and higher in the thumb IP joint compared to those in Caucasian women reported previously. The strongest predictor for the presence of radiographic OA in a particular joint was the disease status in the same joint of the opposite hand (OR = 18.5; 95% CI; 15.2-22.7), followed by the joints in the same row of the same hand (OR = 15.5; 95% CI, 11.9-20.1), and then by the joints in the same ray of the same hand (OR = 1.3; 95% CI, 1.0-1.6). Although the prevalence of hand OA is likely to show site-specific differences between Japanese and Caucasian women, our results indicate that both groups show similar involvement pattern symmetrically and in the same row of the same hand.

Prevalence and pattern of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study)

OBJECTIVE

To investigate the prevalence and pattern of radiographic osteoarthritis (ROA) of the hand joints and its association with self reported hand pain and disability.

METHODS

Baseline data on a population based study (age >/=55 years) were used (n = 3906). Hand ROA was defined as the presence of Kellgren-Lawrence grade >/=2 radiological changes in two of three groups of hand joints in each hand. The presence of hand pain during the previous month was defined as hand pain. The health assessment questionnaire was used to measure hand disability.

RESULTS

67% of the women and 54.8% of the men had ROA in at least one hand joint. DIP joints were affected in 47.3% of participants, thumb base in 35.8%, PIP joints in 18.2%, and MCP joints in 8.2% (right or left hand). ROA of other joint groups (right hand) co-occurred in 56% of DIP involvement, 88% of PIP involvement, 86% of MCP involvement, and 65% of thumb base involvement. Hand pain showed an odds ratio of 1.9 (1.5 to 2.4) with the ROA of the hand (right). Hand disability showed an odds ratio of 1.5 (1.1 to 2.1) with ROA of the hand (right or left).

CONCLUSIONS

Hand ROA is common in the elderly, especially in women. Co-occurrence of ROA in different joint groups of the hand is more common than single joint disease. There is a modest to weak association between ROA of the hand and hand pain/disability, varying with the site of involvement.

High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis

OBJECTIVE

To investigate the use of a novel surface coil for clinically utilized magnetic resonance imaging (MRI) scanners, in order to describe the microanatomic basis for hand osteoarthritis (OA) at all stages of disease.

METHODS

MRI of proximal or distal interphalangeal joints was performed in 58 subjects: 16 patients with early OA (symptom duration < or =12 months), 14 patients with chronic OA, 10 patients with clinically normal asymptomatic joints adjacent to arthritic joints, and 18 normal controls. High-resolution images were obtained with displayed pixel dimensions of 80-100 mum using a 1.5T scanner and a 23-mm-diameter surface coil. All joint structures were evaluated.

RESULTS

The high-resolution images of every joint structure showed comparable abnormalities in both early and chronic OA, including cartilage loss, bone edema, synovial enhancement, osteophytosis, and erosions. Heberden's and Bouchard's node formation occurred at regions where soft tissue bulged through the capsule between the dorsal tendons and collateral ligaments (CLs). Prominent CL thickening or disruption (100% of OA patients) was evident even in joints where cartilage was partially preserved. Clinically normal joints adjacent to OA hand joints showed thickening and enhancement of CLs which was the most common abnormality seen (80% of OA patients). Older normal subjects showed subtle changes within the CLs.

CONCLUSION

Obtaining high-resolution MR images from clinically utilized scanners represents a novel way for exploring the microanatomic basis of hand arthritis and may have considerable potential in the clinical setting. In the present evaluation in nodal OA, previously unappreciated CL abnormalities were especially common.

Patterns of joint distribution in hand osteoarthritis: contribution of age, sex, and handedness

The most frequent site of osteoarthritis (OA) is the hands, but the pattern of hand OA development remains controversial. Understanding these patterns may assist in evaluating biological aging, determining etiology, and proposing ways of preventing hand OA. We investigated the pattern distribution of OA in hands and the influences of age, sex, and handedness on its development. The study population was comprised of Chuvashians (660 males age 18-89 years and 585 females age 18-90 years). OA development was evaluated for 15 joints of each hand according to the Kellgren and Lawrence grading scheme. Statistical analyses included Pearson correlation, cluster analysis, MANCOVA, and linear and polynomial regression. OA changes first appeared in subjects <30 years of age. Metacarpophalangeal (MP) joints underwent the first OA changes until the sixth decade, when the row of distal interphalangeal (DIP) joints became most affected. Cluster analysis showed that symmetry was the most common pattern of interrelationship between rows of joints. The best-fitting and most parsimonious model of age-related pattern of hand OA was the polynomial two-interval linear model. It showed a higher rate of OA development during the relatively young ages, 32-34 years than later on. We found statistically significant differences between sexes only for the DIP (P = 0.019) and PIP (P = 0.011) rows of joints. Handedness had no influence on hand OA development.

Epidemiology of osteoarthritis: prevalence, risk factors and functional impact

Osteoarthritis (OA), the most common form of arthritis, is a major contributor to functional impairment and reduced independence in older adults. OA of the hip and knee are two of the most important causes of pain and physical disability in community-dwelling adults. Symptomatic hand OA is a common disease among the elderly, and impairs hand function, this impairment being largely mediated by pain. Like other chronic diseases, the etiology of OA is multifactorial, and several local and systemic risk factors have been identified. Differences in the prevalence of OA may be attributable to both genetic and life-style factors. Disease definition may be based upon clinical or radiographic criteria, although case definition should rely on radiographic features for epidemiological studies. This review focuses on the functional impact of the disease, describes geographic differences in prevalence rates, discusses disease definition criteria, and summarizes the most common risk factors, including age, associated with the risk of OA.