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Roux C, Gandjbakhch F, Pierreisnard A, Couderc M, Lukas C, Masri R, Sommier JP, Clerc-Urmes I, Baumann C, Chary-Valckenaere I, Loeuille D. Ultrasonographic criteria for the diagnosis of erosive rheumatoid arthritis using osteoarthritic patients as controls compared to validated radiographic criteria. Joint Bone Spine 2019; 86:467-474. [PMID: 30711693 DOI: 10.1016/j.jbspin.2019.01.011] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 12/12/2018] [Accepted: 01/23/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVES The aims of this study were to compare characteristics of radiography (RX) and ultrasound (US) erosive lesions in rheumatoid arthritis (RA) and osteoarthritis (OA) patients (prevalence, topography and severity), to determine thresholds for the diagnosis of erosive RA based on US and to evaluate the performance of US and RX to establish a diagnosis of erosive RA differentiated from hand OA. METHODS Patients fulfilling ACR 1987 and/or ACR/EULAR 2010 criteria for RA or ACR hand OA criteria were prospectively included. A modified Sharp erosion score was assessed by two blinded readers and one adjudicator for discordant cases (number of eroded joints ≤ three). Erosions in US were scored on six bilateral joints (MCP2-3, 5; MTP2-3, 5) with a four-grade scale to calculate total US score for erosions (USSe). RESULTS A total of 168 patients were included: 122 RA (32 early RA < 2 years; 90 late RA ≥ 2 years); 46 OA patients. On RX: 42 RA patients (6 early; 36 late) and 5 OA patients were eroded according to EULAR 2013 definition criteria with sensitivity at 34.4% and specificity at 89.1%. On US, 95 RA patients (21 early; 74 late) and 12 OA patients were eroded. Considering at least two joint facets eroded or at least one joint facet eroded at grade 2 on US, sensitivities were good (68-72.1%) and specificities excellent (89.1-100%). Agreement between RX and US was excellent (90-92%). The positive and negative likehood ratios were respectively 3.16 and 0.73 for radiography and 6.64 and 0.31 for US (for two facets eroded). CONCLUSION USSe can differentiate RA from OA in erosive disease and detect two times more patients with erosive RA than RX with excellent specificity and agreement.
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Affiliation(s)
- Camille Roux
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France.
| | | | - Audrey Pierreisnard
- Department of rheumatology, academic hospital Pitié Salpêtrière, 75013 Paris, France
| | - Marion Couderc
- Department of rheumatology, university hospital of Clermont- Ferrand, 63000 Clermont- Ferrand, France
| | - Cédric Lukas
- Department of rheumatology, university hospital of Lapeyronie, 34000 Montpellier, France
| | - Racha Masri
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Jean-Philippe Sommier
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Isabelle Clerc-Urmes
- Platform of clinical research support PARC (MDS unity), university Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Cédric Baumann
- Platform of clinical research support PARC (MDS unity), university Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Isabelle Chary-Valckenaere
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; Inserm, CIC-EC CIE6, university hospital of Nancy, epidemiology and clinical evaluation, 54500 Vandoeuvre-lès-Nancy, France
| | - Damien Loeuille
- Department of rheumatology, university hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France; Inserm, CIC-EC CIE6, university hospital of Nancy, epidemiology and clinical evaluation, 54500 Vandoeuvre-lès-Nancy, France
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202
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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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203
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Kloppenburg M, Peterfy C, Haugen IK, Kroon F, Chen S, Wang L, Liu W, Levy G, Fleischmann RM, Berenbaum F, van der Heijde D, Bansal P, Wittoek R, Feng S, Fang Y, Saltarelli M, Medema JK, Levesque MC. Phase IIa, placebo-controlled, randomised study of lutikizumab, an anti-interleukin-1α and anti-interleukin-1β dual variable domain immunoglobulin, in patients with erosive hand osteoarthritis. Ann Rheum Dis 2018; 78:413-420. [PMID: 30552176 PMCID: PMC6390132 DOI: 10.1136/annrheumdis-2018-213336] [Citation(s) in RCA: 98] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the efficacy, safety, pharmacokinetics and pharmacodynamics of the anti-interleukin (IL)-1α/β dual variable domain immunoglobulin lutikizumab (ABT-981) in erosive hand osteoarthritis (HOA). METHODS Patients with ≥1 erosive and ≥3 tender and/or swollen hand joints were randomised to placebo or lutikizumab 200 mg subcutaneously every 2 weeks for 24 weeks. The primary endpoint was change in Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain score from baseline to 16 weeks. At baseline and week 26, subjects had bilateral hand radiographs and MRI of the hand with the greatest number of baseline tender and/or swollen joints. Continuous endpoints were assessed using analysis of covariance models, with treatment and country as main factors and baseline measurements as covariates. RESULTS Of 132 randomised subjects, 1 received no study drug and 110 completed the study (placebo, 61/67 (91%); lutikizumab, 49/64 (77%)). AUSCAN pain was not different among subjects treated with lutikizumab versus placebo at week 16 (least squares mean difference, 1.5 (95% CI -1.9 to 5.0)). Other clinical and imaging endpoints were not different between lutikizumab and placebo. Lutikizumab significantly decreased serum high-sensitivity C reactive protein levels, IL-1α and IL-1β levels, and blood neutrophils. Lutikizumab pharmacokinetics were consistent with phase I studies and not affected by antidrug antibodies. Injection site reactions and neutropaenia were more common in the lutikizumab group; discontinuations because of adverse events occurred more frequently with lutikizumab (4/64) versus placebo (1/67). CONCLUSION Despite adequate blockade of IL-1, lutikizumab did not improve pain or imaging outcomes in erosive HOA compared with placebo.
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Affiliation(s)
- Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Féline Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Su Chen
- Data and Statistical Sciences, AbbVie, North Chicago, Illinois, USA
| | - Li Wang
- Development Design Center, AbbVie, North Chicago, Illinois, USA
| | - Wei Liu
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, Illinois, USA
| | - Gwen Levy
- Pharmacovigilance and Patient Safety, AbbVie, North Chicago, Illinois, USA
| | - Roy M Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Metroplex Clinical Research Center, Dallas, Texas, USA
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne Universités and Inserm, DHU i2B, APHP, Hospital Saint-Antoine, Paris, France
| | | | - Prashant Bansal
- Scientific and Medical Services, PAREXEL, Waltham, Massachusetts, USA
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Sheng Feng
- Exploratory Statistics, Data Science and Statistics, AbbVie, North Chicago, Illinois, USA
| | - Yuni Fang
- Drug Metabolism, Pharmacokinetics and Bioanalysis, AbbVie, North Chicago, Illinois, USA
| | - Mary Saltarelli
- Drug Metabolism, Pharmacokinetics and Bioanalysis, AbbVie, North Chicago, Illinois, USA
| | - Jeroen K Medema
- Immunology Development, AbbVie, North Chicago, Illinois, USA
| | - Marc C Levesque
- Immunology Development, AbbVie, North Chicago, Illinois, USA
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204
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Wouters RM, Tsehaie J, Slijper HP, Hovius SER, Feitz R, Selles RW. Exercise Therapy in Addition to an Orthosis Reduces Pain More Than an Orthosis Alone in Patients With Thumb Base Osteoarthritis: A Propensity Score Matching Study. Arch Phys Med Rehabil 2018; 100:1050-1060. [PMID: 30543802 DOI: 10.1016/j.apmr.2018.11.010] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Revised: 09/04/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
Abstract
OBJECTIVE To compare the effect of exercises and orthotics with orthotics alone on pain and hand function in patients with first carpometacarpal joint (CMC-1) osteoarthritis (OA) and to predict outcomes on pain and hand function of exercises and orthotics. DESIGN Prospective cohort study with propensity score matching. SETTING Data collection took place in 13 outpatient clinics for hand surgery and hand therapy in The Netherlands. PARTICIPANTS A consecutive, population-based sample of patients with CMC-1 OA (N=173) was included in this study, of which 84 were matched on baseline demographics and baseline primary outcomes. INTERVENTIONS Exercises and orthotics versus orthotics alone. MAIN OUTCOME MEASURES Primary outcomes included pain and hand function at 3 months, measured using visual analog scale (VAS, 0-100) and the Michigan Hand Outcomes Questionnaire (MHQ, 0-100). RESULTS A larger decrease in VAS pain at rest (11.1 points difference; 95% confidence interval, 1.9-20.3; P=.002) and during physical load (22.7 points difference; 95% confidence interval, 13.6-31.0; P<.001) was found in the exercise + orthotic group compared to the orthotic group. In addition, larger improvement was found for the MHQ subscales pain, work performance, aesthetics, and satisfaction in the exercise + orthotic group. No differences were found on other outcomes. Baseline scores of metacarpophalangeal flexion, presence of scaphotrapeziotrapezoid OA, VAS pain at rest, heavy physical labor, and MHQ total predicted primary outcomes for the total exercise + orthotic group (N=131). CONCLUSIONS Non-surgical treatment of patients with CMC-1 OA should include exercises, since there is a relatively large treatment effect compared to using an orthosis alone. Future research should study exercises and predictors in a more standardized setting to confirm this finding.
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Affiliation(s)
- Robbert M Wouters
- Center for Hand Therapy, Handtherapie Nederland, Utrecht, The Netherlands; Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands.
| | - Jonathan Tsehaie
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | - Steven E R Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | - Reinier Feitz
- Hand and Wrist Center, Xpert Clinic, Hilversum, The Netherlands
| | | | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, The Netherlands; Department of Rehabilitation Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
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205
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McAlindon T, Roberts M, Driban J, Schaefer L, Haugen IK, Smith SE, Duryea J, Cunha D, Blanco F, Fernández-Garcia JL, Eaton C. Incident hand OA is strongly associated with reduced peripheral blood leukocyte telomere length. Osteoarthritis Cartilage 2018; 26:1651-1657. [PMID: 30172836 PMCID: PMC6345164 DOI: 10.1016/j.joca.2018.08.010] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2018] [Revised: 07/23/2018] [Accepted: 08/10/2018] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To evaluate the relationship of telomere length to the prevalence and incidence of hand osteoarthritis in a longitudinal cohort. DESIGN We conducted a cross-sectional and longitudinal analysis of data from a subset of participants in the Osteoarthritis Initiative (OAI) recruited between February 2004 and May 2006. 274 individuals were eligible for the study based on availability of both baseline and 48-month hand radiographs and peripheral blood leucocyte telomere length data. Mean telomere length of peripheral blood leukocytes (PBL)s from the DNA samples was determined using a validated quantitative polymerase chain reaction (PCR)-based assay, and hand radiographs were analyzed and graded using the Kellgren-Lawrence scale. RESULTS In joint -level analyses, prevalent Interphalangeal Joint Osteoarthritis (IPJOA) was significantly associated with PBL telomere length in the baseline sample in unadjusted analyses (RR = 2.84; 95% CI:0.87-9.29) or in models adjusted for age, sex, and body mass index (aRR = 1.10; 95% CI: 0.96-1.27). The association in crude and adjusted analyses appeared slightly stronger with incident IPJOA, especially in the subset with normal hands at baseline (aRR = 1.62; 95% CI: 1.02-2.57). PBL telomere length was also associated with prevalent HOA at baseline (significant in unadjusted analysis: RR = 1.22; 95% CI 1.06-1.42), but not after adjusting for covariates: aRR = 1.12; 95% CI: 0.96-1.30). The magnitude of association was stronger for incident HOA, especially incident symptomatic HOA (aRR = 1.53; 95% CI: 1.09-2.15). CONCLUSIONS In summary, the results of this exploratory analysis are confirmatory of previous work showing a cross-sectional relationship between telomere length and HOA and add to the field by demonstrating an even stronger association with incident IPJOA, both radiographic and symptomatic.
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Affiliation(s)
- T McAlindon
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| | - M Roberts
- Center for Primary Care & Prevention, Alpert Medical School of Brown University, Pawtucket, RI, USA.
| | - J Driban
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| | - L Schaefer
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
| | - S E Smith
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - J Duryea
- Department of Radiology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - D Cunha
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA.
| | - F Blanco
- INIBIC - Complexo Hospitalario Universitario A Coruña, Rheumatology Division, As Xubias 84, 15006, A Coruña, Spain.
| | - J-L Fernández-Garcia
- INIBIC - Complexo Hospitalario Universitario A Coruña, Genetics Unit, As Xubias 84, 15006, A Coruña, Spain.
| | - C Eaton
- Center for Primary Care & Prevention, Alpert Medical School of Brown University, Pawtucket, RI, USA.
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206
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Davis JE, Schaefer LF, McAlindon TE, Eaton CB, Roberts MB, Haugen IK, Smith SE, Duryea J, Lu B, Driban JB. Characteristics of Accelerated Hand Osteoarthritis: Data from the Osteoarthritis Initiative. J Rheumatol 2018; 46:422-428. [PMID: 30504506 DOI: 10.3899/jrheum.180240] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/15/2018] [Indexed: 01/30/2023]
Abstract
OBJECTIVE We aimed to determine whether hand joints develop an accelerated form of osteoarthritis (OA) and to characterize individuals who develop accelerated hand osteoarthritis (AHOA). METHODS We evaluated 3519 participants in the Osteoarthritis Initiative with complete data for baseline and 48-month radiographic hand osteoarthritis (HOA). One reader scored posteroanterior radiographs of the dominant hand using a modified Kellgren-Lawrence (KL) scale and another reader scored the presence of central or marginal erosions. A third reader read images flagged for signs of diseases other than OA. We defined AHOA as ≥ 1 joints that progressed from a KL grade of 0 or 1 at baseline to KL grade 3 or 4 at 48 months. RESULTS The definition of AHOA was met by 1% over 4 years: 37 hands had 1 joint affected and 1 hand had 2 joints affected. At baseline, adults who developed AHOA were more likely to have hand pain (37% vs 22%), radiographic HOA (71% vs 36%), as well as central (22% vs 7%) and marginal erosions (11% vs 2%) in other joints compared to those without AHOA. Adults with AHOA were more likely to develop new erosions over 48 months (central 35%, marginal 5%) than those without AHOA (central 5%, marginal 1%). The most common locations of accelerated OA were the second metacarpophalangeal and first carpometacarpal joint. CONCLUSION Accelerated OA can occur in the hand, especially among digits commonly used for pinching and fine motor skills.
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Affiliation(s)
- Julie E Davis
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Lena F Schaefer
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Timothy E McAlindon
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Charles B Eaton
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Mary B Roberts
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Ida K Haugen
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Stacy E Smith
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Jeffrey Duryea
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Bing Lu
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center
| | - Jeffrey B Driban
- From the Division of Rheumatology, Tufts Medical Center; Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, USA; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. .,J.E. Davis, BS, Research Assistant II, Division of Rheumatology, Tufts Medical Center; L.F. Schaefer, MD, Radiology Fellow, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; T.E. McAlindon, MD, MPH, Chief of Rheumatology, Division of Rheumatology, Tufts Medical Center; C.B. Eaton, MD, MS, Professor of Family Medicine and Epidemiology, Director of Center for Primary Care and Prevention, Alpert Medical School of Brown University; M.B. Roberts, MSc, Statistical Programmer, Center for Primary Care and Prevention, Alpert Medical School of Brown University; I.K. Haugen, MD, PhD, Rheumatology Fellow, Department of Rheumatology, Diakonhjemmet Hospital; S.E. Smith, MD, Section Head and Weissman Distinguished Chair of Musculoskeletal Radiology, Associate Radiology Residency Program Director, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; J. Duryea, PhD, Associate Research Associate, Associate Professor of Radiology, Department of Radiology, Brigham and Women's Hospital and Harvard Medical School; B. Lu, DrPH, MD, Assistant Professor of Medicine, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital and Harvard Medical School; J.B. Driban, PhD, ATC, CSCS, Associate Professor, Division of Rheumatology, Tufts Medical Center.
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207
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O'Neill TW, McCabe PS, McBeth J. Update on the epidemiology, risk factors and disease outcomes of osteoarthritis. Best Pract Res Clin Rheumatol 2018; 32:312-326. [PMID: 30527434 DOI: 10.1016/j.berh.2018.10.007] [Citation(s) in RCA: 220] [Impact Index Per Article: 36.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Revised: 10/12/2018] [Accepted: 10/12/2018] [Indexed: 12/20/2022]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis and a leading cause of pain and disability worldwide. OA can affect any synovial joint, although the hip, knee, hand, foot and spine are the most commonly affected sites. Knowledge about the occurrence and risk factors for OA is important to define the clinical and public health burden of the disease to understand mechanisms of disease occurrence and may also help to inform the development of population-wide prevention strategies. In this article, we review the occurrence and risk factors for OA and also consider patient-reported outcome measures that have been used for the assessment of the disease.
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Affiliation(s)
- Terence W O'Neill
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
| | - Paul S McCabe
- Royal Oldham Hospital, Pennine Acute NHS Trust, Rochdale Rd, Oldham OL1 2JH, UK
| | - John McBeth
- Arthritis Research UK Centre for Epidemiology, The University of Manchester, Manchester, UK & NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK.
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208
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Sankah BEA, Stokes M, Adams J. Exercise programs for the management of people with hand osteoarthritis: a scoping review protocol. ACTA ACUST UNITED AC 2018; 17:461-469. [PMID: 30451710 DOI: 10.11124/jbisrir-2017-003806] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTIONS The review questions for this scoping review are.
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Affiliation(s)
- Beatrice E A Sankah
- Centre for Innovation and Leadership in Health Sciences, School of Health Sciences, University of Southampton, Southampton, United Kingdom.,Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, Nottingham, United Kingdom
| | - Maria Stokes
- Centre for Innovation and Leadership in Health Sciences, School of Health Sciences, University of Southampton, Southampton, United Kingdom.,Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, Nottingham, United Kingdom
| | - Jo Adams
- Centre for Innovation and Leadership in Health Sciences, School of Health Sciences, University of Southampton, Southampton, United Kingdom.,Arthritis Research UK Centre of Excellence for Sport, Exercise and Osteoarthritis, Nottingham, United Kingdom
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209
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Kim MJ, Park KS, Seo AR, Lee SI, Ha YC, Yoo JI. Determining functional activity profiles in patients with upper extremity disorders: is there effect modification by hand-grip strength? Clin Interv Aging 2018; 13:2351-2358. [PMID: 30532525 PMCID: PMC6241862 DOI: 10.2147/cia.s187066] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Purpose The purposes of this study were to investigate the effect of hand-grip strength (HGS) on the Disabilities of the Arm, Shoulder, and Hand (DASH) score in women with upper extremity musculoskeletal disorders (UEMDs) living in rural communities and examine whether upper extremity diseases affected upper extremity functional activity in each group (normal/low HGS) and whether grip strength (GS) was an effect modifier in upper extremity functional activity. Methods A total of 239 women older than 60 years who had completed a medical workup for epicondylitis, rotator cuff tears, and/or hand osteoarthritis were included in the final study. Functional activity was assessed by DASH, and muscle strength was measured by GS. Low HGS was defined according to the Asian Working Group for Sarcopenia (HGS <18 kg in women). Pearson correlation analysis was performed to evaluate the relationship between HGS and the DASH score. A multiple regression analysis was performed after defining DASH as a dependent variable and dividing subjects into two groups (low HGS and normal HGS). Statistical analyses were performed using SPSS Statistics V.24. Results HGS in the participants correlated with the DASH score (r=−0.320, P<0.001). In the low HGS group, waist circumference (B=−0.526, P=0.010) and the DASH score were significantly correlated. In addition, DASH scores were statistically significantly increased as the number of upper extremity diseases increased to 2 (B=11.592, P=0.016) and 3 (B=15.716, P=0.001). The DASH score in the normal HGS group was correlated with the Patient Health Questionnaire-2 score (β=2.680, P<0.001) after adjusting covariates. Conclusion We found that HGS in UEMD patients affected health-related quality of life as measured by the DASH. Maintaining hand muscle strength may improve patient functional activity in age-related UEMDs.
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Affiliation(s)
- Mi-Ji Kim
- Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, .,Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, , .,Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, ,
| | - Ki Soo Park
- Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, .,Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, , .,Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, ,
| | - Ae-Rim Seo
- Department of Preventive Medicine, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, .,Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, ,
| | - Sang-Il Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Republic of Korea
| | - Yong-Chan Ha
- Department of Orthopedic Surgery, Chung-Ang University Hospital, Seoul, Republic of Korea
| | - Jun-Il Yoo
- Institute of Health Sciences, Gyeongsang National University College of Medicine, Jinju, Republic of Korea, , .,Center for Farmer's Safety and Health, Gyeongsang National University Hospital, Jinju, Republic of Korea, , .,Department of Orthopedic Surgery, Gyeongsang National University Hospital, Jinju, Republic of Korea,
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210
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The Effect of Periarticular Injection of Methylprednisolone Acetate in Patients with Primary Osteoarthritis of the Proximal Interphalangeal Joints: A Case Controlled Study. PAIN RESEARCH AND TREATMENT 2018; 2018:7561209. [PMID: 30538864 PMCID: PMC6261070 DOI: 10.1155/2018/7561209] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 08/12/2018] [Accepted: 08/28/2018] [Indexed: 11/17/2022]
Abstract
Backgrounds Primary osteoarthritis of the proximal interphalangeal joints (PIPJ) is a common entity. It could be associated with local pain that has no effective treatment. Local subcutaneous periarticular injection of methylprednisolone acetate (MPA) was evaluated in a prospective case-control study. Methods Patients with painful osteoarthritis of the PIPJ for more than 1 month not responding to nonsteroidal meds were prospectively recruited. Radiographic, demographic, clinical, and lab parameters were documented. Visual analogue scale (VAS) was documented regarding the level of PIPJ pain prior to the injection. Patients had local subcutaneous periarticular injection at the medial and lateral sides of each painful PIPJ of one hand, of 8 mg (0.2 ml) of MPA mixed with 0.1 ml of lidocaine 1% (group 1) at each side. Age- and sex-matched control group were given 0.3 ml of normal saline using the same approach (group 2) at each side. VAS was evaluated 1, 4, and 10 weeks following the injection and compared to baseline levels using Wilcoxon's ranks signed test. Results Eighteen and sixteen patients were recruited in group 1 and group 2, respectively. There were 11 females in group 1 with mean age of 52.7 ± 9.2 years. Mean VAS in group 1 at baseline was 67 and at weeks 1, 4, and 10 was 23 (p=0.001), 29 (p=0.001), and 55 (p=0.043), respectively. Mean VAS in group 2 at baseline was 65 and at weeks 1, 4, and 10 was 43 (p=0.005), 64 (p=0.534), and 69 (0.698), respectively. Conclusions Subcutaneous periarticular injection of MPA + lidocaine at the PIP joints resulted in a small but significant improvement that gradually diminished with time across the week 10, among patients with primary OA of hands.
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211
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Kang TW, Lee JH, Park DH, Cynn HS. Effects of a finger exercise program on hand function in automobile workers with hand osteoarthritis: A randomized controlled trial. HAND SURGERY & REHABILITATION 2018; 38:59-66. [PMID: 30401613 DOI: 10.1016/j.hansur.2018.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2018] [Revised: 08/27/2018] [Accepted: 09/27/2018] [Indexed: 11/19/2022]
Abstract
Hand osteoarthritis reduces a person's ability to perform work activities and return to their occupation. We investigated the effects of a finger exercise program on hand grip strength, pain, physical function, and stiffness in automobile manufacturing workers with hand osteoarthritis. This randomized controlled trial was conducted on 29 subjects. Fifteen experimental subjects received a finger exercise program with paraffin baths, while 14 control subjects received only paraffin baths. Hand grip strength, pain, physical function, and stiffness were assessed at baseline and 8 weeks later. In the experimental group, hand grip strength (P < 0.001) and Australian/Canadian osteoarthritis hand index (AUSCAN) scores (pain, P < 0.001; stiffness, P < 0.001; physical function, P < 0.001) were significantly improved by 3.52 ± 2.03, 21.6 ± 8.3 (pain), 16.8 ± 10.21 (stiffness), and 13.86 ± 4.54 (physical function) compared with preintervention values. In the control group, hand grip strength (P = 0.004) and AUSCAN scores (pain, P < 0.001; stiffness, P = 0.019; physical function, P < 0.001) were significantly improved by 0.57 ± 0.62, 7.85 ± 5.46 (pain) 11.42 ± 7.18 (stiffness), and 10.28 ± 14.41 (physical function) compared with preintervention values. Significant differences between groups were found for postintervention hand grip strength (P = 0.015) and AUSCAN index subscale scores (pain, P < 0.001; physical function, P = 0.020). A combined finger exercise and paraffin bath program is effective in reducing pain, improving physical function, and increasing hand grip strength in workers with hand osteoarthritis.
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Affiliation(s)
- T-W Kang
- Department of Physical Therapy, Wonkwang University School of Medicine & Hospital, Iksan, Jeollabuk-do, South Korea
| | - J-H Lee
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, 220-710, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea
| | - D-H Park
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, 220-710, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea
| | - H-S Cynn
- Applied Kinesiology and Ergonomic Technology Laboratory, Department of Physical Therapy, The Graduate School, Yonsei University, 220-710, Baekwoon-kwan, 1 Yonseidae-gil, Wonju, Kangwon-do, South Korea.
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212
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Radial subluxation in relation to hand strength and radiographic severity in trapeziometacarpal osteoarthritis. Osteoarthritis Cartilage 2018; 26:1506-1510. [PMID: 30009974 DOI: 10.1016/j.joca.2018.06.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 06/02/2018] [Accepted: 06/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Greater joint laxity and radial subluxation of the thumb metacarpal base have been shown to be risk factors for the development of trapeziometacarpal osteoarthritis in an asymptomatic and radiographically normal joint. Despite this, it is unknown whether joint laxity changes with disease progression from mild to severe osteoarthritis. This study aimed to investigate the relationship between joint laxity and osteoarthritis severity, using the trapeziometacarpal subluxation ratio as an indicator of joint laxity. METHOD Baseline data were used from the first 100 participants included in the COMBO (Efficacy of combined conservative therapies on clinical outcomes in base of thumb OA) trial. All participants had bilateral posteroanterior (PA) and Eaton stress view hand radiographs, as well as grip and tip-pinch strength measurements. The PA view was used to assess Kellgren-Lawrence and Eaton grades, and the Eaton stress view was used to assess the trapeziometacarpal joint subluxation ratios. Generalised estimating equations were utilized to account for the fact that hand data are paired, and within-person measurements are therefore not independent. RESULTS Lower radial subluxation ratios were associated with higher Kellgren-Lawrence grades (B-coefficient -0.302; p-value 0.027), and lower grip strength scores (B-coefficient 2.06; p-value 0.006). CONCLUSIONS Radial subluxation ratios decreased with increasing disease severity, contrary to the progression from a normal joint to one with mild osteoarthritis, wherein higher joint laxity is a risk factor for disease. This may be explained by the mechanical stabilization provided by osteophytes and capsular changes in worsening osteoarthritis, as has been shown to be the case in the knee. TRIAL REGISTRATION NUMBER ACTRN 12616000353493. LEVEL OF EVIDENCE III.
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213
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Thumb base osteoarthritis: A hand osteoarthritis subset requiring a distinct approach. Best Pract Res Clin Rheumatol 2018; 31:649-660. [PMID: 30509411 DOI: 10.1016/j.berh.2018.08.007] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Hand osteoarthritis (OA) is usually a polyarticular disease, preferentially affecting the thumb base (TB) and interphalangeal joints. TB OA alone is generally not addressed separately, but as a part of hand OA. Studies have shown that OA in the TB joints clusters together, as does OA in the interphalangeal joints, supporting it as a distinct subset. Further support for this view comes from a specific risk profile, influence on clinical burden, impact of synovial inflammation on local joint pain, and specific treatment interventions. Therefore, clinical care and future hand OA research should not only address hand OA in general but also should focus on the different subsets separately, including TB OA.
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214
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Dean B, Henari S, Thurley N, Little C, McNab I, Riley N. Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis. F1000Res 2018; 7:1484. [PMID: 30631440 PMCID: PMC6281017 DOI: 10.12688/f1000research.16218.2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/06/2018] [Indexed: 12/21/2022] Open
Abstract
Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25 th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.
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Affiliation(s)
- Benjamin Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxon, OX3 7LD, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Shwan Henari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Neal Thurley
- Bodleian Health Care Libraries, University of Oxford, Oxford, Oxon, OX3 9DU, UK
| | - Chris Little
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Ian McNab
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Nicholas Riley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
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215
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Dean B, Henari S, Thurley N, Little C, McNab I, Riley N. Therapeutic interventions for osteoarthritis of the wrist: a systematic review and meta-analysis. F1000Res 2018; 7:1484. [PMID: 30631440 PMCID: PMC6281017 DOI: 10.12688/f1000research.16218.1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2018] [Indexed: 10/05/2023] Open
Abstract
Background: In order to evaluate the effectiveness of interventions for osteoarthritis of the wrist in adults we performed a systematic review and meta-analysis. Methods: The MEDLINE and EMBASE via OVID, CINAHL and SPORTDiscus via EBSCO databases were searched from inception to 25 th April 2018.All randomised controlled clinical trials (RCTs) and any prospective studies of adults with wrist osteoarthritis investigating any intervention with a comparator were included. Data were extracted and checked for accuracy and completeness by pairs of reviewers. Primary outcomes were pain and function. Comparative treatment effects were analysed by random effects at all time points. Results: Three RCTs were identified for inclusion after screening and all had a high risk of bias. Two compared proximal row carpectomy (PRC) with four corner fusion (4CF) for post-traumatic osteoarthritis, while the other compared leather with commercial wrist splints in patients with chronic wrist pain, of which a small group had wrist osteoarthritis. Conclusion: There is no prospective study comparing operative to non-operative treatment for wrist osteoarthritis, while there is a paucity of prospective studies assessing the effectiveness of both non-operative and operative interventions. Further research is necessary in order to better define which patients benefit from which specific interventions. Registration: The review protocol was registered with PROSPERO under the registration number CRD42018094799.
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Affiliation(s)
- Benjamin Dean
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, Oxon, OX3 7LD, UK
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Shwan Henari
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Neal Thurley
- Bodleian Health Care Libraries, University of Oxford, Oxford, Oxon, OX3 9DU, UK
| | - Chris Little
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Ian McNab
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
| | - Nicholas Riley
- Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, Oxon, OX3 7LD, UK
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216
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Lu SC, Vereecke EE, Synek A, Pahr DH, Kivell TL. A novel experimental design for the measurement of metacarpal bone loading and deformation and fingertip force. PeerJ 2018; 6:e5480. [PMID: 30221084 PMCID: PMC6138040 DOI: 10.7717/peerj.5480] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Accepted: 07/30/2018] [Indexed: 12/15/2022] Open
Abstract
Background Musculoskeletal and finite element modelling are often used to predict joint loading and bone strength within the human hand, but there is a lack of in vitro evidence of the force and strain experienced by hand bones. Methods This study presents a novel experimental setup that allows the positioning of a cadaveric digit in a variety of postures with the measurement of force and strain experienced by the third metacarpal. The setup allows for the measurement of fingertip force as well. We tested this experimental setup using three cadaveric human third digits in which the flexor tendons were loaded in two tendon pathways: (1) parallel to the metacarpal bone shaft, with bowstringing; (2) a semi-physiological condition in which the tendons were positioned closer to the bone shaft. Results There is substantial variation in metacarpal net force, metacarpal strain and fingertip force between the two tendon pathways. The net force acting on the metacarpal bone is oriented palmarly in the parallel tendon condition, causing tension along the dorsum of the metacarpal shaft, while the force increases and is oriented dorsally in the semi-physiological condition, causing compression of the dorsal metacarpal shaft. Fingertip force is also greater in the semi-physiological condition, implying a more efficient grip function. Inter-individual variation is observed in the radioulnar orientation of the force experienced by the metacarpal bone, the fingertip force, and the strain patterns on the metacarpal shaft. Conclusion This study demonstrates a new method for measuring force and strain experienced by the metacarpal, and fingertip force in cadaveric digits that can, in turn, inform computation models. Inter-individual variation in loads experienced by the third digit suggest that there are differences in joint contact and/or internal bone structure across individuals that are important to consider in clinical and evolutionary contexts.
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Affiliation(s)
- Szu-Ching Lu
- Animal Postcranial Evolution Lab, Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury, UK
| | - Evie E Vereecke
- Department of Development and Regeneration, University of Leuven, Kortrijk, Belgium
| | - Alexander Synek
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria
| | - Dieter H Pahr
- Institute of Lightweight Design and Structural Biomechanics, Vienna University of Technology, Vienna, Austria.,Department of Anatomy and Biomechanics, Karl Landsteiner Private University of Health Sciences, Krems an der Donau, Austria
| | - Tracy L Kivell
- Animal Postcranial Evolution Lab, Skeletal Biology Research Centre, School of Anthropology and Conservation, University of Kent, Canterbury, UK.,Department of Human Evolution, Max Planck Institute for Evolutionary Anthropology, Leipzig, Germany
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Kabalyk MA. PREVALENCE OF OSTEOARTHRITIS IN RUSSIA: REGIONAL ASPECTS OF TRENDS IN STATISTICAL PARAMETERS DURING 2011–2016. ACTA ACUST UNITED AC 2018. [DOI: 10.14412/1995-4484-2018-416-422] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Recent demographic changes caused by labor migration and by the larger number of retirement-aged people, as well as unstable economic conditions are the reason for analyzing the incidence of osteoarthritis (OA) in the adult population of the Russian Federation in the light of changing socioeconomic factors. Objective: to analyze the incidence of OA in the regions of the Russian Federation in terms of key socioeconomic factors. Material and methods. Trends in OA prevalence and incidence were retrospectively analyzed using the data of annual statistical reports of the Ministry of Health of Russia (Form No. 12) in the period 2011–2016. The above parameters were studied among three population cohorts: adult, able-bodied, and retirement-aged (pensioners) people. Data on the execution of consolidated budgets of the regions of the Russian Federation, territorial compulsory health insurance funds (TCHIFs) were analyzed to identify substantial socioeconomic factors influencing the trends in statistical parameters. The findings were subjected to a comparative analysis of these parameters for Russia as a whole, 85 regions, and 8 federal districts. Results and discussion. During the period from 2011 to 2016, the prevalence of OA in Russia increased from 32.2 per 1,000 population in 2011 to 35.7 in 2016. The highest prevalence of OA is observed among the retirement-aged population and averages 33.2% of the number of registered patients per the total population in this age group during 6-year follow-ups. The maximum prevalence is seen in the retirement-aged population (70.4 per 1,000 corresponding age population; which is more than 3.8 times greater than that in the able-bodied one). There is a steady increase in the prevalence and incidence of OA in the population of Russia as a whole. According to official statistics, patients with OA make up one quarter of all patients with musculoskeletal system diseases and OA is detected in 4% of the entire adult population. Over 20 years, the number of patients with OA increased by 260%. The investigation has shown that the population’s income growth is associated with lower incidence and prevalence rates among pensioners. During 6 years, there is a decline in budget funding for health care in 30 regions of Russia. The share of expenditures in the consolidated regional budgets has been established to be directly associated with the incidence and morbidity of OA. There was an average 183% increase in the expenditures of TCHIFs in Russia. The expenditures of TCHIFs in the regions were directly related to the higher incidence of OA among adults and pensioners, but were unassociated with those among the able-bodied population.
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Lechtenboehmer CA, Jaeger VK, Kyburz D, Walker UA, Hügle T. Brief Report: Influence of Disease Activity in Rheumatoid Arthritis on Radiographic Progression of Concomitant Interphalangeal Joint Osteoarthritis. Arthritis Rheumatol 2018; 71:43-49. [PMID: 30073800 DOI: 10.1002/art.40684] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Accepted: 07/31/2018] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Distal interphalangeal (DIP) joints are commonly considered to be unaffected by rheumatoid arthritis (RA). Despite synovitis and bone marrow edema being associated with radiographic progression in hand osteoarthritis (OA) and hand RA, radiographic courses differ substantially. This study was undertaken to analyze incidence and progression of radiographically evident DIP joint OA in RA patients, in relation to RA activity and patient characteristics. METHODS In sequential radiographs of 1,988 RA patients in the Swiss Clinical Quality Management in Rheumatic Diseases registry, we evaluated and scored 15,904 DIP joints. Scoring was based on the presence of central erosions and subchondral sclerosis and on the severity of osteophytes and joint space narrowing, according to the modified Kellgren/Lawrence (K/L) grade. The presence of DIP joint OA was defined as ≥1 joint with a K/L grade of ≥2, and progression was defined as an increase in a summed K/L grade. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. RESULTS The median follow-up time was 4.5 years (interquartile range 3.1-7.0), and the mean ± SD age was 56.1 ± 11.1 years. DIP joint OA was present in 60% of patients at baseline. Higher mean age (OR 1.09 [95% CI 1.08-1.10]), female sex (OR 1.37 [95% CI 1.08-1.74]), and higher mean body mass index (OR 1.03 [95% CI 1.00-1.06]) were associated with the presence of DIP joint OA, but neither the presence of anti-citrullinated protein antibodies (ACPAs) (OR 0.72 [95% CI 0.50-1.03]) nor the presence of rheumatoid factor (OR 1.01 [95% CI 0.74-1.38]) were associated with it. Disease Activity Score using the erythrocyte sedimentation rate and metacarpophalangeal (MCP) joint erosions were not associated with DIP joint OA progression. RA disease duration had no relevant effect size associated with DIP joint OA progression (OR 0.97 [95% CI 0.96-0.99]). CONCLUSION Known risk factors for DIP joint OA were replicated in patients with RA. The observation that RA activity, the presence of ACPA, and MCP joint erosions were not associated with the prevalence or progression of DIP joint OA indicates that there are distinct roles of inflammation in the pathogenesis of RA and DIP joint OA.
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Affiliation(s)
| | | | - Diego Kyburz
- University Hospital of Basel, Basel, Switzerland
| | | | - Thomas Hügle
- Lausanne University Hospital (CHUV), Lausanne, Switzerland
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Relationship of the Patient-Specific Functional Scale to commonly used clinical measures in hand osteoarthritis. J Hand Ther 2018; 30:538-545. [PMID: 28807599 DOI: 10.1016/j.jht.2017.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 02/27/2017] [Accepted: 04/22/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort correlation study. INTRODUCTION There is no known published research on correlations between the Patient-Specific Functional Scale (PSFS), hand grip strength, and the Disability of the Arm, Shoulder and Hand (DASH) in a population with hand osteoarthritis (OA). PURPOSE The purpose of this study is to establish reliability of the PSFS and to evaluate the relationship between the PSFS, hand grip strength, and the DASH for a population with hand OA. METHODS Thirty-five participants in 4 hand clinics completed the PSFS, hand grip strength testing, and the DASH at the onset of therapy and at discharge. Eighteen participants enrolled at the primary investigator's site completed a baseline PSFS one week before the pretreatment collection with data used to establish relative and absolute reliability. Data were analyzed separately at pretreatment and posttreatment with Spearman's rho correlation (P < .05). Intraclass correlation (2, 1), standard error of the measurement, and minimum detectable change (MDC90 and MDC95) were calculated from the repeated baseline and pretreatment PSFS. RESULTS Intraclass correlation for PSFS was (r = 0.80) with the standard error of the measurement = 0.56, MDC90 = 1.30, and MDC95 = 1.56. Small correlation between the PSFS and DASH scores was found pretreatment (ρ = -0.10) and change scores (ρ = 0.13). CONCLUSION Excellent reliability with small measurement error has established clinical utility of the PSFS for the population with hand OA. These outcome measures were shown to measure different constructs and therefore should not be used interchangeably. LEVEL OF EVIDENCE 3.
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Moon DK, Park YJ, Song SY, Kim MJ, Park JS, Nam DC, Kim DH, Na JB, Lee SI, Hwang SC, Park KS. Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas. Yonsei Med J 2018; 59:669-676. [PMID: 29869465 PMCID: PMC5990682 DOI: 10.3349/ymj.2018.59.5.669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS In 2013-2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Jin Park
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Youn Song
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Mi Ji Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Sung Park
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dae Cheol Nam
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Hee Kim
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Boem Na
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Il Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea.
| | - Ki Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
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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] [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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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] [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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Oya N, Tajika T, Ichinose T, Sasaki T, Yamamoto A, Kuboi T, Endo F, Takagishi K, Chikuda H. The prevalence of elbow osteoarthritis in Japanese middle-aged and elderly populations: the relationship between risk factors and function. J Shoulder Elbow Surg 2018; 27:1086-1091. [PMID: 29680492 DOI: 10.1016/j.jse.2018.02.049] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2017] [Revised: 02/02/2018] [Accepted: 02/13/2018] [Indexed: 02/01/2023]
Abstract
BACKGROUND The aim was to investigate the prevalence of elbow osteoarthritis (OA) in populations aged 40 years or older and to clarify the risk factors and their relationship with elbow function. METHODS The respondents were 354 residents of a single village who underwent general medical examinations in April 2016. The mean age was 67.2 years (range, 40-93 years), and 222 respondents (62.7%) were women. Anteroposterior radiographs of the bilateral elbow joints were obtained, and the subjects were classified into 4 groups (non-OA, mild OA, moderate OA, and severe OA) according to the modified Kellgren-Lawrence scale. With respect to risk factors for elbow OA, a logistic regression analysis was performed. RESULTS Elbow OA was detected in 55.0% of the elbows. The prevalence of symptomatic elbow OA was 22.6%, and no correlation between elbow OA and daily function was observed. The risk of elbow OA increased according to age, with odds ratios for those in their 50s, 60s, 70s, and 80s or older against those in their 40s of 12.99, 11.26, 14.45, and 26.85, respectively. In addition, male sex and a history of elbow trauma were significant risk factors, with odds ratios of 2.57 and 9.26, respectively. CONCLUSIONS The prevalence of elbow OA was 55.0%; the prevalence of symptomatic elbow OA was 22.6%; and the risk factors for elbow OA were older age, male sex, and a history of elbow trauma.
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Affiliation(s)
- Noboru Oya
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan.
| | - Tsuyoshi Tajika
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Ichinose
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Tsuyoshi Sasaki
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Atsushi Yamamoto
- Department of Orthopaedic Surgery, Keiyu Orthopaedic Hospital, Gunma, Japan
| | - Takuro Kuboi
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Fumitaka Endo
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
| | - Kenji Takagishi
- Department of Orthopaedic Surgery, Saint Pierre Hospital, Gunma, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, Gunma, Japan
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Wouters RM, Tsehaie J, Hovius SE, Dilek B, Selles RW. Postoperative Rehabilitation Following Thumb Base Surgery: A Systematic Review of the Literature. Arch Phys Med Rehabil 2018; 99:1177-1212.e2. [DOI: 10.1016/j.apmr.2017.09.114] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 09/06/2017] [Indexed: 11/26/2022]
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Abstract
This review analyzes various surgical exposures and implant designs for proximal interphalangeal (PIP) joint pathology. Our literature review found that silicone implants using a volar approach had the best arc of motion, least extension lag, and lowest complication rates compared with all the other implant designs and approaches. Surface replacement arthroplasties had more frequent surgical revisions compared with silicone implants. Continued efforts toward the development of improved PIP joint implants are necessary.
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Affiliation(s)
- Michiro Yamamoto
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA; Department of Hand Surgery, Nagoya University Graduate School of Medicine, 65 Tsurumai-cho, Showa-ku, Nagoya, Aichi 466-8550, Japan.
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan, 2130 Taubman Center, SPC 5340, 1500 E. Medical Center Drive, Ann Arbor, MI 48109, USA
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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; 33:464-472. [PMID: 30874237 DOI: 10.5606/archrheumatol.2018.6754] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [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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Sivakumaran P, Hussain S, Ciurtin C. Comparison between Several Ultrasound Hand Joint Scores and Conventional Radiography in Diagnosing Hand Osteoarthritis. ULTRASOUND IN MEDICINE & BIOLOGY 2018; 44:544-550. [PMID: 29289433 DOI: 10.1016/j.ultrasmedbio.2017.11.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Revised: 11/13/2017] [Accepted: 11/17/2017] [Indexed: 06/07/2023]
Abstract
This is the first study to investigate the usefulness of a standardized ultrasound (US) examination protocol in diagnosing hand osteoarthritis (OA). We conducted a cross-sectional study including 62 patients, ultimately diagnosed with hand OA based on imaging evidence of osteoarthritic changes with the particular distribution required for fulfilment of American College of Radiology diagnosis criteria. We compared a 32-joint US score (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP] or distal interphalangeal [DIP] and carpometacarpal [CMC]-1 joints), with smaller, predefined joint scores, assessing 22 joints (wrists, MCPs and PIPs or PIPs, DIPs and CMC-1), 10 joints (MCP 2-3, PIP 2-3 and CMC-1 or PIP 2-3, DIP 2-3 and CMC-1) and 6 joints (DIP 2-3, CMC-1), respectively. The US findings were correlated with radiographic scores for erosions and osteophytes. Radiographic osteophyte scores correlated well with all the US scores mentioned earlier (R = 0.381 to 0.645, p < 0.05), despite low sensitivity for detection of osteophytes (43.5%) and erosions (28.9%), compared with the 32 joint US score. Both 10 joint US protocols (assessing MCP 2-3, PIP 2-3 and CMC-1 or PIP 2-3, DIP 2-3 and CMC-1 joints) performed better than conventional radiography, by identifying osteophytes in an additional 25.6% and 23.9% of patients, respectively. The conclusion of this study is that the US examination of 10 preselected hand joints is more sensitive than conventional radiography in diagnosing hand OA in patients who do not fulfill American College of Radiology clinical criteria, a finding likely to have practical implications for facilitating diagnosis of hand OA.
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Affiliation(s)
- Priyanka Sivakumaran
- University College London Medical School, London, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Sidra Hussain
- University College London Medical School, London, UK; Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK.
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228
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Hussain S, Sivakumaran P, Gill A, Dhas D, Ciurtin C. Ultrasonography-detected subclinical inflammation in patients with hand osteoarthritis and established rheumatoid arthritis: a comparison between two different pathologies using the same ultrasound examination protocol. Musculoskeletal Care 2018; 16:26-31. [PMID: 28471034 DOI: 10.1002/msc.1197] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVES A recent review of ultrasound (US) studies in osteoarthritis (OA) showed very limited data about hand OA. Previous US studies in patients with OA described a degree of overlap between the US appearance of rheumatoid arthritis (RA) and OA joints. The present study aimed to assess the US features of subclinical inflammation in RA and hand OA, using the same US examination protocol. METHODS A retrospective, cohort study compared patients with established RA (n = 224) and hand OA (n = 73), with respect to several demographic, clinical, laboratory and US parameters. We used a 22-hand joint US examination protocol (wrists, metacarpophalangeal and proximal interphalangeal joints bilaterally - Outcome Measures in Rheumatology Clinical Trials [OMERACT] scoring system) for all patients. RESULTS Subclinical joint inflammation in the context of equivocal clinical examination was found in 9.6% of OA patients compared with 46.4% of RA patients (p = 0.0001), despite the fact that there was no significant difference between the degree of chronic joint swelling (synovial hypertrophy grades 2 and 3; p = 0.75 and p = 0.11, respectively). The presence of osteophytes was more common in patients with hand OA, as expected (p = 0.0001). CONCLUSIONS Our study findings reflected differences between the incidence and characteristics of subclinical inflammation in patients with RA and OA, which could be helpful in patients with an equivocal clinical examination or history of both diseases. Almost one in 10 patients with hand OA had active synovitis, while almost one in two patients with RA had uncontrolled inflammation in at least one joint.
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Affiliation(s)
- Sidra Hussain
- University College London Medical School, London, UK
| | | | - Anna Gill
- Department of Rheumatology, North Middlesex University Hospital NHS Trust, London, UK
| | - Delfin Dhas
- Department of Biomedical Sciences, Royal Holloway University, London, UK
| | - Coziana Ciurtin
- Department of Rheumatology, University College London Hospitals NHS Foundation Trust, London, UK
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229
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Guitard P, Brosseau L, Wells GA, Paquet N, Paterson G, Toupin-April K, Cavallo S, Aydin SZ, Léonard G, De Angelis G. The knitting community-based trial for older women with osteoarthritis of the hands: design and rationale of a randomized controlled trial. BMC Musculoskelet Disord 2018; 19:56. [PMID: 29444664 PMCID: PMC5813366 DOI: 10.1186/s12891-018-1965-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 02/06/2018] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The prevalence of hand osteoarthritis (HOA) has been reported to be higher amongst women over 50 years old (66%) compared to men of the same age (34%). Although exercise therapy has been shown effective in reducing symptoms and disability associated with HOA, adherence to treatment programs remains low. The primary objective of this RCT is to examine the effectiveness of a 12-week knitting program for morning stiffness (primary outcome) and pain relief (secondary outcome) 2 h post-wakening in females (aged 50 to 85 years old) with mild to moderate hand osteoarthritis (HOA). METHODS/DESIGN A single-blind, two-arm randomized controlled trial (RCT) with a parallel group design will be used to reach this objective and compare results to a control group receiving an educational pamphlet on osteoarththritis (OA) designed by the Arthritis Society. The premise behind the knitting program is to use a meaningful occupation as the main component of an exercise program. The knitting program will include two components: 1) bi-weekly 20-min knitting sessions at a senior's club and 2) 20-min home daily knitting sessions for the five remaining weekdays. Participants assigned to the control group will be encouraged to read the educational pamphlet and continue with usual routine. Pain, morning stiffness, hand function, self-efficacy and quality of life will be measured at baseline, six weeks, 12 weeks (end of program) with standardized tools. We hypothesize that participants in the knitting program will have significant improvements in all clinical outcomes compared to the control group. A published case study as well as the preliminary results of a feasibility study as examined through a 6-week pre-post study (n = 5 women with HOA) involving 20-min daily knitting morning sessions led to this proposed randomized controlled trial research protocol. This article describes the intervention, the empirical evidence to support it. DISCUSSION This knitting RCT has the potential to enhance our understanding of the daily HOA symptoms control and exercise adherence, refine functional exercise recommendations in this prevalent disease, and reduce the burden of disability in older women. TRIAL REGISTRATION (ACTRN12617000843358) registered on 7/06/2017.
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Affiliation(s)
- Paulette Guitard
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Lucie Brosseau
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - George A. Wells
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, ON Canada
| | - Nicole Paquet
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
| | - Gail Paterson
- The Arthritis Society, Ottawa Office, Ontario Division, Ottawa, ON Canada
| | - Karine Toupin-April
- 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
- School of Rehabilitation Sciences, University of Ottawa, Ottawa, ON Canada
| | | | - Guillaume Léonard
- Val-des-Monts, University of Sherbrooke; and researcher, Research Center on Aging, Sherbrooke, QC Canada
| | - Gino De Angelis
- School of Rehabilitation Sciences, Faculty of Health Sciences, University of Ottawa, 451 Smyth Road, Ottawa, ON K1H 8M5 Canada
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Completo A, Nascimento A, Girão AF, Fonseca F. Biomechanical evaluation of pyrocarbon proximal interphalangeal joint arthroplasty: An in-vitro analysis. Clin Biomech (Bristol, Avon) 2018; 52:72-78. [PMID: 29407860 DOI: 10.1016/j.clinbiomech.2018.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2017] [Revised: 12/20/2017] [Accepted: 01/14/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pyrocarbon proximal interphalangeal joint arthroplasty provided patients with excellent pain relief and joint motion, however, overall implant complications have been very variable, with some good outcomes at short-medium-term follow-up and some bad outcomes at longer-term follow-up. Implant loosening with migration, dislocation and implant fracture were the main reported clinical complications. The aim of the present work was to test the hypothesis that the magnitude proximal interphalangeal joint cyclic loads in daily hand functions generates stress-strain behaviour which may be associated with a risk of pyrocarbon component loosening in the long-term. METHODS This study was performed using synthetic proximal and middle phalanges to experimentally predict the cortex strain behaviour and implant stability considering different load conditions for both intact and implanted states. Finite element models were developed to assess the structural behaviour of cancellous-bone and pyrocarbon components, these models were validated against experimentally measured cortex strains. FINDINGS Cortex strains showed a significant increase at dorsal side and reduction at palmar side between intact and implanted states. Cancellous-bone adjacent to the condylar implant base components suffers a two to threefold strain increase, comparing with the intact condition. INTERPRETATION The use of pyrocarbon implant changes the biomechanical behaviour of the joint phalanges and is associated with a potential risk of support cancellous-bone suffer fatigue failure in mid to long term due to the strain increase for cyclic loads in the range of daily hand activities, this risk is more prominent than the risk of bone resorption due to strain-shielding effect.
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Affiliation(s)
- A Completo
- Mechanical Engineering Department, University of Aveiro, Portugal.
| | - A Nascimento
- Orthopaedics Department, Coimbra University Hospital, Portugal
| | - A F Girão
- Mechanical Engineering Department, University of Aveiro, Portugal
| | - F Fonseca
- Orthopaedics Department, Coimbra University Hospital, Portugal
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231
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Schaefer LF, McAlindon TE, Eaton CB, Roberts MB, Haugen IK, Smith SE, Duryea J, Driban JB. The associations between radiographic hand osteoarthritis definitions and hand pain: data from the osteoarthritis initiative. Rheumatol Int 2017; 38:403-413. [PMID: 29270642 DOI: 10.1007/s00296-017-3913-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
The goal of our study was to evaluate the associations between various definitions of radiographic hand osteoarthritis (OA) and self-reported hand pain. We conducted a cross-sectional study with 3604 participants from the Osteoarthritis Initiative (OAI). Posteroanterior radiographs of the dominant hand were read using a modified Kellgren-Lawrence (KL) scale. For our primary analysis, hand OA at person level was defined as two or more finger joints with KL grade 2 or higher. In addition, for the purpose of exploratory analyses, we explored more conservative definitions of hand OA as well as different sum scores and digit- and row-based scores. The majority of definitions of radiographic hand OA were statistically significantly associated with self-reported hand pain. In our main analysis, persons with two or more finger joints with KL grade > 2 were approximately two times more likely to self-report hand pain than persons without radiographic hand OA. Increasing KL grades and increasing number of joints affected lead to stronger associations. Almost all definitions of hand OA were related to pain. Individuals with more severely affected joints or with higher number of affected joints are more likely to report hand pain than their peers. Specifically, individuals with hand joints with KL 3 or 4 have the greatest likelihood of hand pain.
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Affiliation(s)
- Lena F Schaefer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Charles B Eaton
- Center for Primary Care, Prevention, Alpert Medical School of Brown University, Providence, USA
| | - Mary B Roberts
- Center for Primary Care, Prevention, Alpert Medical School of Brown University, Providence, USA
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Stacy E Smith
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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232
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Reginster JYL, Arden NK, Haugen IK, Rannou F, Cavalier E, Bruyère O, Branco J, Chapurlat R, Collaud Basset S, Al-Daghri NM, Dennison EM, Herrero-Beaumont G, Laslop A, Leeb BF, Maggi S, Mkinsi O, Povzun AS, Prieto-Alhambra D, Thomas T, Uebelhart D, Veronese N, Cooper C. Guidelines for the conduct of pharmacological clinical trials in hand osteoarthritis: Consensus of a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum 2017; 48:1-8. [PMID: 29287769 DOI: 10.1016/j.semarthrit.2017.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/09/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To gather expert opinion on the conduct of clinical trials that will facilitate regulatory review and approval of appropriate efficacious pharmacological treatments for hand osteoarthritis (OA), an area of high unmet clinical need. METHODS The European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) organized a working group under the auspices of the International Osteoporosis Foundation (IOF) and the World Health Organization (WHO). RESULTS This consensus guideline is intended to provide a reference tool for practice, and should allow for better standardization of the conduct of clinical trials in hand OA. Hand OA is a heterogeneous disease affecting different, and often multiple, joints of the thumb and fingers. It was recognized that the various phenotypes and limitations of diagnostic criteria may make the results of hand OA trials difficult to interpret. Nonetheless, practical recommendations for the conduct of clinical trials of both symptom and structure modifying drugs are outlined in this consensus statement, including guidance on study design, execution, and analysis. CONCLUSIONS While the working group acknowledges that the methodology for performing clinical trials in hand OA will evolve as knowledge of the disease increases, it is hoped that this guidance will support the development of new pharmacological treatments targeting hand OA.
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Affiliation(s)
- Jean-Yves L Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Nigel K Arden
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Francois Rannou
- Division of Physical Medicine and Rehabilitation, AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Route 52, Porte 53, Domaine du Sart-Tilman, Liège, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jaime Branco
- Department of Rheumatology, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | - Roland Chapurlat
- Division of Rheumatology, INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, Lyon, France
| | | | - Nasser M Al-Daghri
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology, Bone and Joint Research Unit, Fundación Jiménez Diaz, Universidad Autonoma, Madrid, Spain
| | - Andrea Laslop
- Scientific Office, Austrian Medicines and Medical Devices Agency, AGES, Vienna, Austria
| | - Burkhard F Leeb
- Second Department of Medicine, Centre for Rheumatology Lower Austria, State Hospital Stockerau, Stockerau, Austria
| | | | - Ouafa Mkinsi
- Rheumatology Department, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Anton S Povzun
- Scientific Research Institute of Emergency Care n.a. l.l. Dzhanelidze, Saint-Petersburg, Russia
| | - Daniel Prieto-Alhambra
- Musculoskeletal Pharmaco and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Thierry Thomas
- Department of Rheumatology, Hôpital Nord, CHU de St-Etienne & INSERM 1059, Université de Lyon, Saint-Etienne, France
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Department of Orthopaedics and Traumatology, Hôpital du Valais (HVS), Centre Hospitalier du Valais Romand (CHVR), CVP, Crans-Montana, Switzerland
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
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233
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Wen L, Shin MH, Kang JH, Yim YR, Kim JE, Lee JW, Lee KE, Park DJ, Kim TJ, Kweon SS, Lee YH, Yun YW, Lee SS. Association between grip strength and hand and knee radiographic osteoarthritis in Korean adults: Data from the Dong-gu study. PLoS One 2017; 12:e0185343. [PMID: 29190722 PMCID: PMC5708816 DOI: 10.1371/journal.pone.0185343] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2016] [Accepted: 11/12/2017] [Indexed: 11/25/2022] Open
Abstract
Objectives We assessed whether grip strength was related to various types of radiographic damage in Korean adults with osteoarthritis (OA). Methods Data from 2,251 subjects enrolled in the Dong-gu study, who had no hand joint pain, were analyzed to investigate the relationship between grip strength and OA. Hand grip strength was measured using a hand-held dynamometer, and radiographs of the hand and knee were scored according to a semi-quantitative grading system. Multiple linear regressions were used to explore associations between grip strength and radiographic features of OA. Results Grip strength in men and women was negatively related to hand (both p < 0.001) and knee (men, p < 0.001; women, p = 0.010) OA after adjusting for confounders. Hand (men, p < 0.001; women, p = 0.001) and knee (both p < 0.001) joint space narrowing (JSN) showed the strongest associations with low grip strength, regardless of gender. Moreover, the severity of hand osteophytes in women (p = 0.001), and subchondral cysts (men, p < 0.001) was correlated with low grip strength in both genders. Conclusions Among subjects without hand joint pain, low grip strength was associated significantly with hand and knee radiographic OA, regardless of gender. Among all types of OA radiographic damage, low grip strength showed the strongest association with JSN.
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Affiliation(s)
- Lihui Wen
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
- Department of Biomedical Sciences, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Min-Ho Shin
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
| | - Ji-Hyoun Kang
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Yi-Rang Yim
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Ji-Eun Kim
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Jeong-Won Lee
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Kyung-Eun Lee
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Dong-Jin Park
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Tae-Jong Kim
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
| | - Sun-Seog Kweon
- Department of Preventive Medicine, Chonnam National University Medical School, Gwangju, Republic of Korea
- Jeonnam Regional Cancer Center, Chonnam National University Hwasun Hospital, Hwasun, Republic of Korea
| | - Young-Hoon Lee
- Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Republic of Korea
| | - Yong-Woon Yun
- Department of Preventive Medicine, Bitgoeul Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Shin-Seok Lee
- Department of Rheumatology, Chonnam National University Medical School & Hospital, Gwangju, Republic of Korea
- Department of Biomedical Sciences, Chonnam National University Medical School, Gwangju, Republic of Korea
- * E-mail:
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234
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Abstract
The thumb carpometacarpal joint (CMCJ1) is born to have good freedom of motion. However, the excellent mobility at this joint also predisposes attenuation of capsuloligamentous structures, joint incongruity, instability, and osteoarthritis. The prevalence of radiographic CMCJ1 arthritis is high. There is no single ideal surgery for all stages of CMCJ1 arthritis, and for all kinds of patients. The arthroscopic approach seems to provide a better alternative with rewarding preliminary results. It includes arthroscopic synovectomy/debridement/thermal shrinkage, arthroscopic partial trapeziectomy and suture button suspensionplasty, and arthroscopic CMCJ1 excision/suture button suspensionplasty/K-wire fixation.
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Affiliation(s)
- Clara Wing-Yee Wong
- Division of Hand and Microsurgery, Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 16/F, The Club Lusitano, 16 Ice House Street, Central, Hong Kong SAR.
| | - Pak-Cheong Ho
- Division of Hand and Microsurgery, Department of Orthopaedic and Traumatology, Prince of Wales Hospital, Chinese University of Hong Kong, 5F, Lui Che Woo Clinical Sciences Building, 30-32 Ngan Shing Street, Shatin, NT, Hong Kong SAR
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Gløersen M, Mulrooney E, Mathiessen A, Hammer HB, Slatkowsky-Christensen B, Faraj K, Isaksen T, Neogi T, Kvien TK, Magnusson K, Haugen IK. A hospital-based observational cohort study exploring pain and biomarkers in patients with hand osteoarthritis in Norway: The Nor-Hand protocol. BMJ Open 2017; 7:e016938. [PMID: 28947452 PMCID: PMC5623515 DOI: 10.1136/bmjopen-2017-016938] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
INTRODUCTION We have limited knowledge about the underlying disease mechanisms and causes of pain in hand osteoarthritis (OA). Consequently, no disease-modifying drug exists, and more knowledge about the pathogenesis of hand OA is needed, as well as a validation of different outcome measures. Our first aim of this study is to explore the validity of various imaging modalities for the assessment of hand OA. Second, we want to gain a better understanding of the disease processes, with a special focus on pain mechanisms. METHODS AND ANALYSIS The Nor-Hand study is a hospital-based observational study including 300 patients with evidence of hand OA by ultrasound and/or clinical examination. The baseline examination consists of functional tests and joint assessment of the hands, medical assessment, pain sensitisation tests, ultrasound (hands, acromioclavicular joint, hips, knees and feet), CT and MRI of the dominant hand, conventional radiographs of the hands and feet, fluorescence optical imaging of the hands, collection of blood and urine samples as well as self-reported demographic factors and OA-related questionnaires. Two follow-up examinations are planned. Cross-sectional analyses will be used to investigate agreements and associations between different relevant measures at the baseline examination, whereas the longitudinal data will be used for evaluation of predictors for clinical outcomes. ETHICS AND DISSEMINATION The protocol is approved by the Norwegian Regional Committee for Medical and Health Research Ethics (Ref. no: 2014/2057). The participants receive oral and written information about the project and sign a consent form before participation. They can, whenever they want, withdraw from the study, and all de-identified data will be safely stored on the research server at Diakonhjemmet Hospital. Results will be presented at international and national congresses and in peer-reviewed rheumatology journals. TRIAL REGISTRATION NUMBER NCT03083548; Pre-results.
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Affiliation(s)
- Marthe Gløersen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | | | | | | | - Karwan Faraj
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - Thore Isaksen
- Department of Radiology, Volvat Medical Center, Oslo, Norway
| | - Tuhina Neogi
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, USA
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- The Medical Faculty, Institute for Clinical Medicine, University of Oslo, Olso, Norway
| | - Karin Magnusson
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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A Systematic Review of Different Implants and Approaches for Proximal Interphalangeal Joint Arthroplasty. Plast Reconstr Surg 2017; 139:1139e-1151e. [PMID: 28445369 DOI: 10.1097/prs.0000000000003260] [Citation(s) in RCA: 49] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Outcomes after implant arthroplasty for primary degenerative and posttraumatic osteoarthritis of the proximal interphalangeal joint were different according to the implant design and surgical approach. The purpose of this systematic review was to evaluate outcomes of various types of implant arthroplasty for proximal interphalangeal joint osteoarthritis, with an emphasis on different surgical approaches. METHODS The authors searched all available literature in the PubMed and EMBASE databases for articles reporting on outcomes of implant arthroplasty for proximal interphalangeal joint osteoarthritis. Data collection included active arc of motion, extension lag, and complications. The authors combined the data of various types of surface replacement arthroplasty into one group for comparison with silicone arthroplasty. RESULTS A total of 849 articles were screened, yielding 40 studies for final review. The mean postoperative arc of motion and the mean gain in arc of motion of silicone implant with the volar approach were 58 and 17 degrees, respectively, which was greater than surface replacement implant with the dorsal approach at 51 and 8 degrees, respectively. The mean postoperative extension lag of silicone implant with the volar approach and surface replacement with the dorsal approach was 5 and 14 degrees, respectively. The revision rate of silicone implant with the volar approach and surface replacement with the dorsal approach was 6 percent and 18 percent at a mean follow-up of 41.2 and 51 months, respectively. CONCLUSION Silicone implant with the volar approach showed the best arc of motion, with less extension lag and fewer complications after surgery among all the implant designs and surgical approaches.
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237
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Haugen IK, Magnusson K, Turkiewicz A, Englund M. The Prevalence, Incidence, and Progression of Hand Osteoarthritis in Relation to Body Mass Index, Smoking, and Alcohol Consumption. J Rheumatol 2017; 44:1402-1409. [PMID: 28711879 DOI: 10.3899/jrheum.170026] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/31/2017] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To estimate the extent that overweight/obesity, smoking, and alcohol are associated with prevalence and longitudinal changes of radiographic hand osteoarthritis (OA). METHODS Participants from the Osteoarthritis Initiative (n = 1232) were included, of whom 994 had 4-year followup data. In analyses on incident hand OA, only persons without hand OA at baseline were included (n = 406). Our exposure variables were overweight/obesity [body mass index (BMI), waist circumference], smoking (current/former, smoking pack-yrs), and alcohol consumption (drinks/week). Using linear and logistic regression analyses, we analyzed possible associations between baseline exposure variables and radiographic hand OA severity, erosive hand OA, incidence of hand OA, and radiographic changes. Analyses were adjusted for age, sex, and education. RESULTS Neither overweight nor obesity were associated with hand OA. Current smoking was associated with less hand OA in cross-sectional analyses, whereas longitudinal analyses suggested higher odds of incident hand OA in current smokers (OR 2.20, 95% CI 1.02-4.77). Moderate alcohol consumption was associated with higher Kellgren-Lawrence sum score at baseline (1-3 drinks: 1.55, 95% CI 0.43-2.67) and increasing sum score during 4-year followup (4-7 drinks: 0.33, 95% CI 0.01-0.64). Moderate alcohol consumption (1-7 drinks/week) was associated with 2-fold higher odds of erosive hand OA, which was statistically significant. Additional adjustment for BMI gave similar strengths of associations. CONCLUSION Overweight/obesity were not associated with hand OA. Contrasting results were observed for smoking and hand OA, suggesting lack of association. Moderate alcohol consumption was associated with hand OA severity, radiographic changes, and erosive hand OA, warranting further investigation.
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Affiliation(s)
- Ida K Haugen
- From the Department of Rheumatology, Diakonhjemmet Hospital; National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA. .,I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K. Magnusson, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; A. Turkiewicz, PhD, CStat, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit; M. Englund, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine.
| | - Karin Magnusson
- From the Department of Rheumatology, Diakonhjemmet Hospital; National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K. Magnusson, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; A. Turkiewicz, PhD, CStat, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit; M. Englund, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Aleksandra Turkiewicz
- From the Department of Rheumatology, Diakonhjemmet Hospital; National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K. Magnusson, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; A. Turkiewicz, PhD, CStat, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit; M. Englund, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Martin Englund
- From the Department of Rheumatology, Diakonhjemmet Hospital; National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway; Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital; K. Magnusson, PT, PhD, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital; A. Turkiewicz, PhD, CStat, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit; M. Englund, MD, PhD, Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, and Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
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Haugen IK, Slatkowsky-Christensen B, Faraj K, van der Heijde D, Kvien TK. The comparison of magnetic resonance imaging and radiographs to assess structural progression over 5 years in hand osteoarthritis. Rheumatology (Oxford) 2017; 56:371-377. [PMID: 27940594 DOI: 10.1093/rheumatology/kew419] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Indexed: 11/14/2022] Open
Abstract
Objective . The aim was to explore the agreement between 1.0 T MRI and conventional radiography (CR) to detect progression of hand OA over 5 years and the associations between structural progression and incident joint tenderness. Methods Paired radiographs and paired MRIs of the second-fifth IP joints of the dominant hand from 69 hand OA patients were read for osteophytes, joint space narrowing and erosions. Patients with two or more joints demonstrating progression of any structural feature(s) were classified as progressors per imaging modality. Agreement between methods to detect progressors was evaluated with κ and intraclass correlation coefficients. At the joint level, the associations between methods to detect progression were explored with generalized estimating equations. Likewise, we analysed the associations between progression per imaging modality and incident pain. Results MRI (58.0%) and CR (62.3%) detected similar numbers of progressors. The agreement between methods to detect progressors was good (κ = 0.61). We found good agreement between methods regarding the number of progressive joints (intraclass correlation coefficient = 0.61, 95% CI: 0.43, 0.76). At the joint level, MRI progression was associated with radiographic progression (P < 0.001). Incident joint tenderness was more common in joints with progression by MRI and CR, but statistically significance was not reached. Conclusion Both 1.0 T MRI and CR detect a similar amount of progression over 5 years in patients with hand OA, although not in exactly the same joints. As CR assesses more joints for a lower cost, CR should be the imaging modality of choice rather than 1.0 T MRI in observational studies with a long period of follow-up.
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Affiliation(s)
| | | | - Karwan Faraj
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - Désirée van der Heijde
- Department of Rheumatology.,Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Radiographic Patterns of Radiocarpal and Midcarpal Arthritis. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2017; 1:e017. [PMID: 30211351 PMCID: PMC6132295 DOI: 10.5435/jaaosglobal-d-17-00017] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Introduction: The purpose of this study was to determine the specific locations of radiocarpal and/or midcarpal joint osteoarthritis (RC/MC OA). Methods: A total of 1,007 wrist radiographs were screened for the presence of RC/MC OA. The locations of the degenerative changes were identified. In addition, the observers then determined whether the observed patterns fell under the scapholunate advanced collapse (SLAC) pattern. Results: The SLAC pattern did not represent the majority of observed degenerative changes. Almost one-third of the patients had degenerative changes present at the radiolunate or scaphocapitate articulations in the absence of radioscaphoid changes. Women have a lower risk of arthritis compared with men (odds ratio, 0.306; P < 0.05). Increasing age correlated with the presence of arthritis (odds ratio, 1.05; P < 0.05). Conclusion: Contrary to the previous reports in the literature, our cohort demonstrated that <50% of wrist OA fell into the category of SLAC arthritis.
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Abstract
LEARNING OBJECTIVES After studying this article, the participant should be able to: 1. Assess the patient's history, clinical examination, and radiographic findings to diagnose and stage basilar joint arthritis. 2. Recall the cause and epidemiology of the condition. 3. Formulate a management plan including nonoperative management, and evaluate the candidacy for surgical treatment. 4. Understand the rationale for the various surgical options available (including rehabilitation), their potential complications, and the evidence related to outcomes. SUMMARY This article has been prepared to accompany practice-based assessment with ongoing surgical education for the Maintenance of Certification for the American Board of Plastic Surgery. It is designed for clinicians to analyze and structure their care of a patient with arthritis of the trapeziometacarpal joint.
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241
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The Algerian study of osteoarthritis. A very low frequency of hip osteoarthritis. Presse Med 2017; 46:636-637. [DOI: 10.1016/j.lpm.2017.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/31/2017] [Accepted: 04/05/2017] [Indexed: 11/17/2022] Open
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Magnusson K, Bech Holte K, Juel NG, Brox JI, Hagen KB, Haugen IK, Berg TJ. Long term type 1 diabetes is associated with hand pain, disability and stiffness but not with structural hand osteoarthritis features - The Dialong hand study. PLoS One 2017; 12:e0177118. [PMID: 28510594 PMCID: PMC5433713 DOI: 10.1371/journal.pone.0177118] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 04/21/2017] [Indexed: 01/06/2023] Open
Abstract
OBJECTIVE To explore whether having long-term type 1 diabetes (>45 years) is associated with a higher prevalence of radiographic hand OA, erosive hand OA and increased hand pain, disability and stiffness. METHODS In total N = 96 persons with type 1 diabetes diagnosed before 1970 were included (mean [SD] age: 62.2 [7.4], mean [SD] HbA1c: 7.43 [0.80] and N = 49 [51%] men). Regular measurements of their HbA1c were obtained till 2015. We included N = 69 healthy controls without any diabetes (mean [SD] age: 63.0 [7.0], mean [SD] HbA1c: 5.41 [0.32], N = 29 [42%] men). The groups were compared for radiographic hand OA (Kellgren-Lawrence grade ≥2 in ≥1 joint) and erosive hand OA (central erosions in ≥1 joint), Australian/Canadian index (AUSCAN) for hand pain, disability and stiffness using regression analyses adjusted for age, sex, educational level and waist circumference. RESULTS We found no associations between having long term type 1 diabetes and more prevalent radiographic hand OA (OR = 0.83, 95% CI = 0.38-1.81). We found a trend towards higher prevalence of erosive hand OA in diabetes patients (OR = 2.96, 95% CI = 0.82-10.64). Strong and consistent associations were observed between long term type 1 diabetes and increased hand pain (B = 2.78, 95% CI = 1.65-3.91), disability (B = 5.30, 95% CI = 3.48-7.12) and stiffness (B = 2.00, 95% CI = 1.33-2.67). These associations were particularly strong for women and participants below the median age of 61 years. CONCLUSION Long-term type 1 diabetes was not associated with radiographic hand OA, but was strongly associated with hand pain, disability and stiffness. The association between diabetes and erosive hand OA warrants further investigation.
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Affiliation(s)
- Karin Magnusson
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- * E-mail:
| | | | - Niels Gunnar Juel
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
| | - Jens Ivar Brox
- Department of Physical Medicine and Rehabilitation, Oslo University Hospital, Oslo, Norway
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Kåre Birger Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Tore Julsrud Berg
- Department of Endocrinology, Oslo University Hospital, Oslo, Norway
- The Norwegian Diabetics’ Centre, Oslo, Norway
- Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
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Qin J, Barbour KE, Murphy LB, Nelson AE, Schwartz TA, Helmick CG, Allen KD, Renner JB, Baker NA, Jordan JM. Lifetime Risk of Symptomatic Hand Osteoarthritis: The Johnston County Osteoarthritis Project. Arthritis Rheumatol 2017; 69:1204-1212. [PMID: 28470947 DOI: 10.1002/art.40097] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/09/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Symptomatic hand osteoarthritis (OA) is a common condition that affects hand strength and function, and causes disability in activities of daily living. Prior studies have estimated that the lifetime risk of symptomatic knee OA is 45% and that of hip OA is 25%. The objective of the present study was to estimate the overall lifetime risk of symptomatic hand OA, and the stratified lifetime risk according to potential risk factors. METHODS Data were obtained from 2,218 adult subjects (ages ≥45 years) in the Johnston County Osteoarthritis Project, a population-based prospective cohort study among residents of Johnston County, North Carolina. Data for the present study were collected from 2 of the follow-up cycles (1999-2004 and 2005-2010). Symptomatic hand OA was defined as the presence of both self-reported symptoms and radiographic OA in the same hand. Lifetime risk, defined as the proportion of the population who will develop symptomatic hand OA in at least 1 hand by age 85 years, was estimated from models using generalized estimating equations. RESULTS Overall, the lifetime risk of symptomatic hand OA was 39.8% (95% confidence interval [95% CI] 34.4-45.3%). In this population, nearly 1 in 2 women (47.2%, 95% CI 40.6-53.9%) had an estimated lifetime risk of developing symptomatic hand OA by age 85 years, compared with 1 in 4 men (24.6%, 95% CI 19.5-30.5%). Race-specific symptomatic hand OA risk estimates were 41.4% (95% CI 35.5-47.6%) among whites and 29.2% (95% CI 20.5-39.7%) among African Americans. The lifetime risk of symptomatic hand OA among individuals with obesity (47.1%, 95% CI 37.8-56.7%) was 11 percentage points higher than that in individuals without obesity (36.1%, 95% CI 29.7-42.9%). CONCLUSION These findings demonstrate the substantial burden of symptomatic hand OA overall and in sociodemographic and clinical subgroups. Increased use of public health and clinical interventions is needed to address its impact.
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Affiliation(s)
- Jin Qin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Distribution of osteoarthritis in a Norwegian population-based cohort: associations to risk factor profiles and health-related quality of life. Rheumatol Int 2017; 37:1541-1550. [DOI: 10.1007/s00296-017-3721-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2016] [Accepted: 04/17/2017] [Indexed: 01/16/2023]
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Medicare Spending and Evidence-Based Approach in Surgical Treatment of Thumb Carpometacarpal Joint Arthritis: 2001 to 2010. Plast Reconstr Surg 2017; 137:980e-989e. [PMID: 27219267 DOI: 10.1097/prs.0000000000002156] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
BACKGROUND Despite equivalent outcomes among surgical treatments of thumb carpometacarpal arthritis, little is known about the variation in spending. Because of its complexities, the authors hypothesized that trapeziectomy with ligament reconstruction and tendon interposition incurs the greatest cost to Medicare compared with other surgical procedures. METHODS Using a random 5 percent sample of Medicare beneficiaries diagnosed with thumb carpometacarpal joint arthritis, the authors examined total and out-of-pocket spending for 3530 patients who underwent a surgical treatment between 2001 and 2010. The authors used generalized linear regression models, controlling for patient characteristics and place of surgery, to examine variations in spending. RESULTS Eighty-nine percent of patients who underwent surgery received trapeziectomy with ligament reconstruction and tendon interposition, with total and out-of-pocket spending of $2576 (95 percent CI, $2333 to $2843; p < 0.001) and $436 (95 percent CI, $429 to $531; p < 0.001), respectively. Simple complete trapeziectomy was the least expensive procedure, performed in 5 percent of patients, with total and out-of-pocket spending of $1268 (95 percent CI, $1089 to $1476; p < 0.001) and $236 (95 percent CI, $180 to $258; p < 0.001), respectively. Because of increasingly higher facility costs, performing the same procedure in a hospital outpatient setting compared with an ambulatory center would increase Medicare spending by more than two-fold (p < 0.001). CONCLUSIONS With a consistent rise in health care spending, adherence to an evidence-based approach in medicine is more important than ever. Most surgeons continue to perform trapeziectomy with ligament reconstruction and tendon interposition, the most expensive surgical option. Medicare could potentially save $7.4 million annually if simple complete trapeziectomy was the procedure of choice.
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Addimanda O, Cavallari C, Pignotti E, Pulsatelli L, Mancarella L, Ramonda R, Fioravanti A, Meliconi R. Radiographic involvement of metacarpophalangeal and radiocarpal joints in hand osteoarthritis. Clin Rheumatol 2017; 36:1077-1082. [PMID: 28161769 DOI: 10.1007/s10067-017-3565-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/24/2017] [Accepted: 01/29/2017] [Indexed: 02/02/2023]
Abstract
To evaluate, by means of a longitudinal study, radiographic involvement of metacarpophalangeal and radio-carpal joints in hand osteoarthritis, its relationship with erosive disease and its progression, 368 patients with hand osteoarthritis were enrolled. All patients underwent hand X-rays. On the basis of the presence of central erosions in interphalangeal joints, patients were divided into three groups: 0-no central erosions, 1-one joint with central erosion, and 2-two or more joints with central erosions. A longitudinal study on 44 patients and nine normal controls, whose X-rays were available after 3.9 years, was performed. The radiological involvement of metacarpophalangeal and radio-carpal joints was evaluated using Kellgren-Lawrence and OARSI scores. Low number of joints showed Kellgren-Lawrence values ≥2 group 0, 42/1290 (3.3%); group 1, 10/410 (2.4%); and group 2, 36/1980 (1.8%). Low score values were obtained for all radiographic items. Only metacarpophalangeal joint space narrowing score showed significant increase from groups 0 to 2. Subsequent adjustment for age, gender, and BMI did not confirm the statistical significance. Marginal erosions were rarely found (6.7% of joints). Metacarpophalangeal and radio-carpal radiographic per patient scores significantly worsened at follow-up, but no significant increase in joints with Kellgren-Lawrence score ≥2 was found. In normal controls, no significant radiographic worsening was found. Only a minority of metacarpophalangeal joints shows a Kellgren-Lawrence value ≥2. Metacarpophalangeal and to lesser extent radiocarpal joints had significant worsening at follow-up. Metacarpophalangeal joint involvement in hand osteoarthritis is mild but progressive. Radiocarpal involvement is negligible.
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Affiliation(s)
- Olga Addimanda
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy. .,Dept of Biomedical & Neuromotor Sciences, University of Bologna, Bologna, Italy.
| | - Carlotta Cavallari
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy
| | | | - Lia Pulsatelli
- Immunorheumatology and Tissue regeneration, Rizzoli Orthopaedic Institute, Bologna, Italy
| | - Luana Mancarella
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy
| | | | - Antonella Fioravanti
- Rheumatology Unit, Department of Clinical Medicine and Immunological Science, University of Siena, Siena, Italy
| | - Riccardo Meliconi
- Medicine & Rheumatology Unit, Rizzoli Orthopaedic Institute, 40136, Bologna, Italy.,Dept of Biomedical & Neuromotor Sciences, University of Bologna, Bologna, Italy
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Yuan F, Aliu O, Chung KC, Mahmoudi E. Evidence-Based Practice in the Surgical Treatment of Thumb Carpometacarpal Joint Arthritis. J Hand Surg Am 2017; 42:104-112.e1. [PMID: 28160900 PMCID: PMC5302845 DOI: 10.1016/j.jhsa.2016.11.029] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 11/18/2016] [Accepted: 11/21/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE Thumb carpometacarpal (CMC) arthritis contributes considerably to functional disability in the aging adult United States (US) population. Owing to the increasing growth in this segment of our population, its burden on health care resources will increase in the future. Variations exist in the degree of complexity and cost among different surgical treatments. We examined the national trends of the surgical treatment of thumb CMC arthritis and hypothesized that current practice patterns are not supported by evidence favoring the simpler trapeziectomy-only procedure. METHODS Using a random 5%, nationally representative, sample of Medicare fee-for-service beneficiaries diagnosed with thumb CMC arthritis between 2001 and 2010, we used a multinomial logistic regression model to assess the association between patients' characteristics and the surgical treatment. Furthermore, we used surgeons' unique identifiers to examine how their practice preferences have changed over time. RESULTS Our findings demonstrated an increasing trend in the utilization of trapeziectomy with ligament reconstruction and tendon interposition (LRTI) from 84% in 2001 to 90% in 2010. Ninety-five percent of surgeons performed only 1 type of surgical procedure, and among those, 93% of surgeons performed only trapeziectomy with LRTI. Compared with 2001, the odds of a patient undergoing thumb CMC arthrodesis or prosthetic arthroplasty slightly increased between 2007 and 2010. CONCLUSIONS The majority of hand surgeons in the US use trapeziectomy with LRTI as the surgical treatment of choice for thumb CMC arthritis. Although clinical trials from the United Kingdom support the use of the less complex trapeziectomy-only procedure, US surgeons are still reticent to change their practice, which favors LRTI. National comparative studies are still needed to examine the effectiveness of various surgical options for the treatment of thumb CMC joint arthritis. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Frank Yuan
- Research Fellow, Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School
| | - Oluseyi Aliu
- Resident, Department of Surgery, Section of Plastic Surgery, University of Michigan Health System
| | - Kevin C. Chung
- Professor of Surgery, Department of Surgery, Section of Plastic Surgery, Assistant Dean for Faculty Affairs, University of Michigan Medical School
| | - Elham Mahmoudi
- Assistant Research Professor of Surgery, Department of Surgery, Section of Plastic Surgery, University of Michigan Medical School
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Magnusson K, Mathiessen A, Hammer HB, Kvien TK, Slatkowsky-Christensen B, Natvig B, Hagen KB, Østerås N, Haugen IK. Smoking and alcohol use are associated with structural and inflammatory hand osteoarthritis features. Scand J Rheumatol 2017; 46:388-395. [PMID: 28145147 DOI: 10.1080/03009742.2016.1257736] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
OBJECTIVES To explore whether smoking and alcohol use are associated with hand osteoarthritis (OA) features in two different OA cohorts. METHOD We studied 530 people with radiographic hand OA from the Musculoskeletal pain in Ullensaker STudy (MUST) and 187 people from the Oslo hand OA cohort [mean (sd) age 65 (8.0) and 62 (5.7) years, 71% and 91% women, respectively]. Smoking, alcohol use and hand pain were self-reported. Participants underwent conventional hand radiographs and ultrasound examination of 30 hand joints. The Kellgren-Lawrence sum score for radiographic OA severity (0-120 scale) and the proportion of participants having at least one joint with grey-scale synovitis (grade ≥1) were calculated. We studied whether smoking and alcohol use were cross-sectionally associated with radiographic OA, synovitis, and pain using adjusted linear and logistic regression analyses. RESULTS Smoking was associated with less radiographic OA in both cohorts [β = -4.71, 95% confidence interval (CI) -8.36 to -1.06 for current smoking in MUST and β = -0.15, 95% CI -0.29 to -0.02 for smoking pack-years in the Oslo hand OA cohort]. Stratified analyses indicated that the association was present in men only. Being a monthly drinker (examined in MUST only) was significantly associated with present synovitis compared to never drinkers (odds ratio = 2.35, 95% CI 1.27 to 4.34) (no gender differences). Neither smoking nor alcohol was associated with hand pain. CONCLUSIONS Smoking was associated with less radiographic hand OA whereas alcohol consumption was associated with present joint inflammation in hand OA. Future longitudinal studies are needed to explore the causal associations and explanatory mechanisms behind gender differences.
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Affiliation(s)
- K Magnusson
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - A Mathiessen
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - H B Hammer
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - T K Kvien
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | | | - B Natvig
- c Department of General Practice, Institute of Health and Society , University of Oslo , Oslo , Norway
| | - K B Hagen
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - N Østerås
- a National Advisory Unit on Rehabilitation in Rheumatology , Diakonhjemmet Hospital , Oslo , Norway.,b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
| | - I K Haugen
- b Department of Rheumatology , Diakonhjemmet Hospital , Oslo , Norway
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Østerås N, Kjeken I, Smedslund G, Moe RH, Slatkowsky‐Christensen B, Uhlig T, Hagen KB. Exercise for hand osteoarthritis. Cochrane Database Syst Rev 2017; 1:CD010388. [PMID: 28141914 PMCID: PMC6464796 DOI: 10.1002/14651858.cd010388.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hand osteoarthritis (OA) is a prevalent joint disease that may lead to pain, stiffness and problems in performing hand-related activities of daily living. Currently, no cure for OA is known, and non-pharmacological modalities are recommended as first-line care. A positive effect of exercise in hip and knee OA has been documented, but the effect of exercise on hand OA remains uncertain. OBJECTIVES To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand OA. Main outcomes are hand pain and hand function. SEARCH METHODS We searched six electronic databases up until September 2015. SELECTION CRITERIA All randomised and controlled clinical trials comparing therapeutic exercise versus no exercise or comparing different exercise programmes. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, assessed risk of bias and assessed the quality of the body of evidence using the GRADE approach. Outcomes consisted of both continuous (hand pain, physical function, finger joint stiffness and quality of life) and dichotomous outcomes (proportions of adverse events and withdrawals). MAIN RESULTS We included seven studies in the review. Most studies were free from selection and reporting bias, but one study was available only as a congress abstract. It was not possible to blind participants to treatment allocation, and although most studies reported blinded outcome assessors, some outcomes (pain, function, stiffness and quality of life) were self-reported. The results may be vulnerable to performance and detection bias owing to unblinded participants and self-reported outcomes. Two studies with high drop-out rates may be vulnerable to attrition bias. We downgraded the overall quality of the body of evidence to low owing to potential detection bias (lack of blinding of participants on self-reported outcomes) and imprecision (studies were few, the number of participants was limited and confidence intervals were wide for the outcomes pain, function and joint stiffness). For quality of life, adverse events and withdrawals due to adverse events, we further downgraded the overall quality of the body of evidence to very low because studies were very few and confidence intervals were very wide.Low-quality evidence from five trials (381 participants) indicated that exercise reduced hand pain (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.07) post intervention. The absolute reduction in pain for the exercise group, compared with the control group, was 5% (1% to 9%) on a 0 to 10 point scale. Pain was estimated to be 3.9 points on this scale (0 = no pain) in the control group, and exercise reduced pain by 0.5 points (95% CI 0.1 to 0.9; number needed to treat for an additional beneficial outcome (NNTB) 9).Four studies (369 participants) indicated that exercise improved hand function (SMD -0.28, 95% CI -0.58 to 0.02) post intervention. The absolute improvement in function noted in the exercise group, compared with the control group, was 6% (0.4% worsening to 13% improvement). Function was estimated at 14.5 points on a 0 to 36 point scale (0 = no physical disability) in the control group, and exercise improved function by 2.2 points (95% CI -0.2 to 4.6; NNTB 9).One study (113 participants) evaluated quality of life, and the effect of exercise on quality of life is currently uncertain (mean difference (MD) 0.30, 95% CI -3.72 to 4.32). The absolute improvement in quality of life for the exercise group, compared with the control group, was 0.3% (4% worsening to 4% improvement). Quality of life was 50.4 points on a 0 to 100 point scale (100 = maximum quality of life) in the control group, and the mean score in the exercise group was 0.3 points higher (3.5 points lower to 4.1 points higher).Four studies (369 participants) indicated that exercise reduced finger joint stiffness (SMD -0.36, 95% CI -0.58 to -0.15) post intervention. The absolute reduction in finger joint stiffness for the exercise group, compared with the control group, was 7% (3% to 10%). Finger joint stiffness was estimated at 4.5 points on a 0 to 10 point scale (0 = no stiffness) in the control group, and exercise improved stiffness by 0.7 points (95% CI 0.3 to 1.0; NNTB 7).Three studies reported intervention-related adverse events and withdrawals due to adverse events. The few reported adverse events consisted of increased finger joint inflammation and hand pain. Low-quality evidence from the three studies showed an increased likelihood of adverse events (risk ratio (RR) 4.55, 95% CI 0.53 to 39.31) and of withdrawals due to adverse events in the exercise group compared with the control group (RR 2.88, 95% CI 0.30 to 27.18), but the effect is uncertain and further research may change the estimates.Included studies did not measure radiographic joint structure changes. Two studies provided six-month follow-up data (220 participants), and one (102 participants) provided 12-month follow-up data. The positive effect of exercise on pain, function and joint stiffness was not sustained at medium- and long-term follow-up.The exercise intervention varied largely in terms of dosage, content and number of supervised sessions. Participants were instructed to exercise two to three times a week in four studies, daily in two studies and three to four times daily in another study. Exercise interventions in all seven studies aimed to improve muscle strength and joint stability or function, but the numbers and types of exercises varied largely across studies. Four studies reported adherence to the exercise programme; in three studies, this was self-reported. Self-reported adherence to the recommended frequency of exercise sessions ranged between 78% and 94%. In the fourth study, 67% fulfilled at least 16 of the 18 scheduled exercise sessions. AUTHORS' CONCLUSIONS When we pooled results from five studies, we found low-quality evidence showing small beneficial effects of exercise on hand pain, function and finger joint stiffness. Estimated effect sizes were small, and whether they represent a clinically important change may be debated. One study reported quality of life, and the effect is uncertain. Three studies reported on adverse events, which were very few and were not severe.
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Affiliation(s)
- Nina Østerås
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Ingvild Kjeken
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Geir Smedslund
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
- Norwegian Institute of Public HealthPO BOX 4404 NydalenOsloN‐0403Norway
| | - Rikke H Moe
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | | | - Till Uhlig
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Kåre Birger Hagen
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
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Wolski M, Englund M, Stachowiak G, Podsiadlo P. Automated selection of bone texture regions on hand radiographs: Data from the Osteoarthritis Initiative. Proc Inst Mech Eng H 2016. [DOI: 10.1177/0954411916676219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Manual selection of finger trabecular bone texture regions on hand X-ray images is time-consuming, tedious, and observer-dependent. Therefore, we developed an automated method for the region selection. The method selects square trabecular bone regions of interest above and below the second to fifth distal and proximal interphalangeal joints. Two regions are selected per joint (16 regions per hand). The method consists of four integral parts: (1) segmentation of a radiograph into hand and background, (2) identification of finger regions, (3) localization of center points of heads of distal phalanges and the distal interphalangeal, proximal interphalangeal, and metacarpophalangeal joints, and (4) placement of the regions of interest under and above the distal and proximal interphalangeal joints. A gold standard was constructed from regions selected by two observers on 40 hand X-ray images taken from Osteoarthritis Initiative cohort. Datasets of 520 images were generated from the 40 images to study the effects of hand and finger positioning. The accuracy in regions selection and the agreement in calculating five directional fractal parameters were evaluated against the gold standard. The accuracy, agreement, and effects of hand and finger positioning were measured using similarity index (0 for no overlap and 1 for entire overlap) and interclass correlation coefficient as appropriate. A high accuracy in selecting regions (similarity index ≥ 0.79) and a good agreement in fractal parameters (interclass correlation coefficient ≥ 0.58) were achieved. Hand and finger positioning did not affect considerably the region selection (similarity index ≥ 0.70). These results indicate that the method developed selects bone regions on hand X-ray images with accuracy sufficient for fractal analyses of bone texture.
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Affiliation(s)
- Marcin Wolski
- Tribology Laboratory, Department of Mechanical Engineering, School of Civil and Mechanical Engineering, Curtin University, Bentley, WA, Australia
| | - Martin Englund
- Orthopaedics, Department of Clinical Sciences – Lund, Lund University, Lund, Sweden
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
| | - Gwidon Stachowiak
- Tribology Laboratory, Department of Mechanical Engineering, School of Civil and Mechanical Engineering, Curtin University, Bentley, WA, Australia
| | - Pawel Podsiadlo
- Tribology Laboratory, Department of Mechanical Engineering, School of Civil and Mechanical Engineering, Curtin University, Bentley, WA, Australia
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