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Jiang T, Yang T, Zhang W, Doherty M, Zhang Y, Zeng C, Sarmanova A, Yang Z, Li J, Wang Y, Wang Y, Obotiba AD, Lei G, Wei J. Prevalence and distribution of ultrasound-detected hand synovial abnormalities in a middle-aged and older population. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2024; 45:277-284. [PMID: 36882153 DOI: 10.1055/a-2048-8782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/05/2023]
Abstract
OBJECTIVE Synovial abnormalities are modifiable targets for hand pain and osteoarthritis. We examined the prevalence and distribution of ultrasound-detected hand synovial abnormalities in a community-derived sample of older people in China. METHODS Within the Xiangya Osteoarthritis Study, a community-based study, we assessed synovial hypertrophy (SH), joint effusion, and Power Doppler signal (PDS) on all fingers and thumbs of both hands using standardized ultrasound examinations (score: 0-3). We assessed distribution patterns of SH and effusion using χ2-test and interrelationships of SH and effusion in different joints and hands by generalized estimating equations. RESULTS Among 3,623 participants (mean age: 64.4 years; women: 58.1%), prevalence of SH, effusion and PDS were 85.5%, 87.3% and 1.5%, respectively. Prevalence of SH, effusion and PDS increased with age, was higher in the right hand than in the left hand and was more common in proximal than in distal hand joints. SH and effusion often occurred in multiple joints (P < 0.001). SH in one joint was strongly associated with presence of SH in the same joint of the opposite hand (odds ratio [OR]= 6.60, 95% confidence interval [CI]: 6.19-7.03) followed by SH in other joints in the same row, (OR=5.70, 95%CI: 5.32-6.11), and then other joints in the same ray of the same hand (OR=1.49, 95%CI: 1.39-1.60). Similar patterns were observed for effusion. CONCLUSION Hand synovial abnormalities are common among older people, often affect multiple hand joints and present a unique pattern. These findings suggest both systemic and mechanical factors play roles in their occurrence.
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Affiliation(s)
- Ting Jiang
- Department of Orthopaedics, Xiangya Hospital, Xiangya Hospital Central South University, Changsha, China
- Department of Ultrasonography, Xiangya Hospital Central South University, Changsha, China
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
- Pain Centre Versus Arthritis UK, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Tuo Yang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
- Pain Centre Versus Arthritis UK, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
- Health Management Center, Xiangya Hospital Central South University, Changsha, China
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
- Pain Centre Versus Arthritis UK, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
- Pain Centre Versus Arthritis UK, University of Nottingham, Nottingham, United Kingdom of Great Britain and Northern Ireland
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, United States
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, United States
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
| | - Aliya Sarmanova
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, United Kingdom of Great Britain and Northern Ireland
| | - Zidan Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital Central South University, Changsha, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China
| | - Yilun Wang
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital Central South University, Changsha, China
| | - Yuqing Wang
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China
| | - Abasiama D Obotiba
- Department of Health and Care Professions, Faculty of Health and Life Sciences, University of Exeter, Exeter, United Kingdom of Great Britain and Northern Ireland
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
| | - Jie Wei
- Health Management Center, Xiangya Hospital Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Central South University Xiangya School of Public Health, Changsha, China
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Jiang T, Weng Q, Zhang Y, Zhang W, Doherty M, Sarmanova A, Yang Z, Yang T, Li J, Liu K, Wang Y, Obotiba AD, Zeng C, Lei G, Wei J. Association Between Hyperuricemia and Ultrasound-Detected Hand Synovitis. Arthritis Care Res (Hoboken) 2024. [PMID: 38570913 DOI: 10.1002/acr.25342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Although hand synovitis is prevalent in the older population, the etiology remains unclear. Hyperuricemia, a modifiable metabolic disorder, may serve as an underlying mechanism of hand synovitis, but little is known about their relationship. We assessed the association between hyperuricemia and hand synovitis in a large population-based sample. METHODS We performed a cross-sectional study in Longshan County, Hunan Province, China. Hyperuricemia was defined as a serum urate level >420 μmol/L in men and >360 μmol/L in women. Ultrasound examinations were performed on both hands of 4,080 participants, and both gray-scale synovitis and the Power Doppler signal (PDS) were assessed using semiquantitative scores (grades 0-3). We evaluated the association of hyperuricemia with hand gray-scale synovitis (grade ≥2) and PDS (grade ≥1), respectively, adjusting for age, sex, and body mass index. RESULTS All required assessments for analysis were available for 3,286 participants. The prevalence of hand gray-scale synovitis was higher among participants with hyperuricemia (30.0%) than those with normouricemia (23.3%), with an adjusted odds ratio (aOR) of 1.28 (95% confidence interval [CI] 1.00-1.62). Participants with hyperuricemia also had a higher prevalence of PDS (aOR 2.36; 95% CI 1.15-4.81). Furthermore, hyperuricemia positively associated, both at the hand and joint levels, with the presence of gray-scale synovitis (aOR 1.27; 95% CI 1.00-1.60 and adjusted prevalence ratio [aPR] 1.26; 95% CI 1.10-1.44, respectively) and PDS (aOR 2.35; 95% CI 1.15-4.79 and aPR 2.34; 95% CI 1.28-4.30, respectively). CONCLUSION This population-based study provides more evidence for a positive association between hyperuricemia and prevalent hand synovitis.
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Affiliation(s)
- Ting Jiang
- Xiangya Hospital, Central South University, Changsha, China, the University of Nottingham, and Pain Centre Versus Arthritis UK, Nottingtham, United Kingdom
| | - Qianlin Weng
- Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Weiya Zhang
- University of Nottingham and Pain Centre Versus Arthritis UK, Nottingham, United Kingdom
| | - Michael Doherty
- University of Nottingham and Pain Centre Versus Arthritis UK, Nottingham, United Kingdom
| | | | - Zidan Yang
- Xiangya Hospital, Central South University, Changsha, China
| | - Tuo Yang
- Xiangya Hospital, Central South University, Changsha, China, the University of Nottingham, and Pain Centre Versus Arthritis UK, Nottingtham, United Kingdom
| | - Jiatian Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Ke Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Wang
- Xiangya Hospital, Central South University, Changsha, China
| | | | - Chao Zeng
- Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Xiangya Hospital, Central South University, and Xiangya School of Public Health, Central South University, Changsha, China
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Jiang T, Yang Z, Zhang Y, Zhang W, Doherty M, Li H, Yang T, Yang Y, Li J, Wang Y, Zeng C, Lei G, Wei J. Dysbiosis of gut microbiota, a potential mediator of bile acid compositions, and prevalence of hand synovitis: a community-based study. Rheumatology (Oxford) 2023; 62:3179-3187. [PMID: 36692134 DOI: 10.1093/rheumatology/kead042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/11/2023] [Accepted: 01/14/2023] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVES Hand synovitis, a potentially modifiable pathological lesion, is common and associated with pain and hand OA; nevertheless, its pathogenesis remains uncertain. This study investigated the relationship between gut microbiota dysbiosis and hand synovitis prevalence and evaluated whether bile acids mediate the association. METHODS Participants were derived from a community-based observational study. Synovitis in each hand joint was assessed using US. Gut microbiota was evaluated using 16S ribosomal RNA amplicon sequencing on faeces, and plasma bile acids were measured by HPLC mass spectrometry. We examined the relationship between gut microbiota dysbiosis and hand synovitis prevalence, as well as the extent to which bile acids were involved in the association. RESULTS Among 1336 participants (mean age: 63.2 years; women: 58.8%), 18.3% had prevalent hand synovitis (unilateral in 13.6% and bilateral in 4.7%). β-diversity, but not α-diversity, of gut microbiota was significantly associated with prevalent hand synovitis. Higher relative abundance of the genus Prevotella and lower relative abundance of the genus Blautia were significantly associated with the prevalence of hand synovitis. Similar associations were also observed for laterality and the number of joints affected by hand synovitis. The association between Prevotella and hand synovitis was partially mediated through its effect on tauroursodeoxycholic acid and glycoursodeoxycholic acid, the mediation proportions being 25.7% and 21.6%, respectively. CONCLUSION Our findings suggest that gut microbiota dysbiosis is associated with the prevalence of hand synovitis. Such an association appears to be partially mediated by plasma bile acids.
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Affiliation(s)
- Ting Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, China
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Zidan Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA
- The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Hui Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Tuo Yang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Pain Centre Versus Arthritis UK, Nottingham, UK
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Yuanheng Yang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Department of Plastic and Cosmetic Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Wang
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China
- National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China
- Department of Epidemiology and Health Statistics, Xiangya School of Public Health, Central South University, Changsha, China
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Salis Z, Gallego B, Sainsbury A. Researchers in rheumatology should avoid categorization of continuous predictor variables. BMC Med Res Methodol 2023; 23:104. [PMID: 37101144 PMCID: PMC10134601 DOI: 10.1186/s12874-023-01926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology. METHODS We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes. RESULTS For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association). CONCLUSIONS Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.
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Affiliation(s)
- Zubeyir Salis
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Blanca Gallego
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Perth, WA, 6009, Australia.
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Ma C, Aitken D, Wu F, Squibb K, Cicuttini F, Jones G. Association between radiographic hand osteoarthritis and bone microarchitecture in a population-based sample. Arthritis Res Ther 2022; 24:223. [PMID: 36115996 PMCID: PMC9482179 DOI: 10.1186/s13075-022-02907-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 08/30/2022] [Indexed: 12/01/2022] Open
Abstract
Background Subchondral bone plays an important role in the pathogenesis of radiographic osteoarthritis (OA). However, the bony changes that occur in hand OA (HOA) are much less understood. This study aimed to describe the association between radiographic HOA and high-resolution peripheral quantitative computed tomography (HRpQCT) measures of the hand and radius in a population-based sample. Methods A total of 201 participants (mean age 72, 46% female) from the Tasmanian Older Adult Cohort (TASOAC) study underwent HRpQCT assessment of the 2nd distal and proximal interphalangeal (DIP, PIP), 1st carpometacarpal (CMC) joint, and distal radius. Radiographic HOA was assessed at the 2nd DIP, PIP joints, and the 1st CMC joint using the OARSI atlas. Results Proximal osteophyte and joint space narrowing (JSN) scores were consistently more strongly associated with HRpQCT measures compared to the distal site with positive associations for indices of bone size (total and trabecular bone area and cortical perimeter but inconsistent for cortical area) and negative associations for volumetric bone mineral density (vBMD). There was a decrease in trabecular number and bone volume fraction with increasing osteophyte and JSN score as well as an increase in trabecular separation and inhomogeneity. Osteophyte and JSN scores in the hand were not associated with HRpQCT measures at the distal radius. Conclusions This hypothesis generating data suggests that bone size and trabecular disorganization increase with both osteophyte formation and JSN (proximal more than distal), while local vBMD decreases. This process appears to be primarily at the site of pathology rather than nearby unaffected bone. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02907-6.
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Obotiba AD, Swain S, Kaur J, Doherty M, Zhang W, Abhishek A. Reliability of detection of ultrasound and MRI features of hand osteoarthritis: a systematic review and meta-analysis. Rheumatology (Oxford) 2021; 61:542-553. [PMID: 34086885 PMCID: PMC8824416 DOI: 10.1093/rheumatology/keab470] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 05/06/2021] [Accepted: 05/25/2021] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES To systematically review the literature on inter- and intra-rater reliability of scoring ultrasound and MRI changes in hand osteoarthritis (OA). METHODS Medline, EMBASE, CINHAL, Web of Science and AMED were searched from inception to January 2020. Kappa (K), weighted Kappa (Kw) and intra-class correlation coefficients (ICC) for dichotomous, semi-quantitative and summated scores respectively, and their 95% confidence intervals (CI) were pooled using random-effects model. Heterogeneity between studies was assessed and reliability estimates were interpreted using Landis-Koch's classification. RESULTS Fifty studies met the inclusion criteria (33 ultrasound, 21 MRI). The pooled K(95% CI) for inter-rater reliability was substantial for ultrasound-detected osteophytes [0.66 (0.54, 0.79)], grey-scale synovitis (GSS) [0.64 (0.32, 0.97)], and power Doppler (PD) [0.76, (0.47, 1.05)]; whereas intra-rater reliability was almost perfect for osteophytes [0.82 (0.80, 0.84)], central bone erosions (CBEs) [0.83 (0.78, 0.89)], and effusion [0.83 (0.74, 0.91)]; and substantial for GSS [0.64 (0.49, 0.79)] and PD [0.70 (0.59, 0.80)].Inter-rater reliability for dichotomous assessment was substantial for MRI-detected CBEs [0.75 (0.67, 0.83)] and synovitis [0.69 (0.51, 0.87)]; slight for osteophytes [0.14 (0.04, 0.25)]; and almost perfect for sum score of osteophytes, CBEs, joint space narrowing (JSN), and bone marrow lesions (BMLs) (0.81-0.89). Intra-rater reliability was almost perfect for sum score of MRI synovitis [0.92 (0.87, 0.96)], BMLs [0.88 (0.78, 0.98)], osteophytes [0.86 (0.74, 0.98)], CBEs [0.83 (0.66, 1.00)] and JSN [0.91 (0.87, 0.91)]. CONCLUSION Ultrasound and MRI are reliable in detecting hand OA features. Ultrasound may be preferred due to low-cost and increasing availability.
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Affiliation(s)
- Abasiama D Obotiba
- Correspondence to: Abasiama D. Obotiba, A26, Academic Rheumatology, Clinical Sciences Building, Nottingham City Hospital, Nottingham, NG5 1PB, UK. E-mail:
| | - Subhashisa Swain
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
- Department of Primary Care, University of Oxford
| | - Jaspreet Kaur
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham
- NIHR Nottingham Biomedical Research Centre (BRC), Nottingham, UK
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