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Saito S, Makino A, Morimoto N. Sustained increase of pinch strength after traction treatment for symptomatic distal interphalangeal joint osteoarthritis. Heliyon 2024; 10:e32830. [PMID: 38975115 PMCID: PMC11226916 DOI: 10.1016/j.heliyon.2024.e32830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2023] [Revised: 06/08/2024] [Accepted: 06/10/2024] [Indexed: 07/09/2024] Open
Abstract
Background Symptomatic distal interphalangeal joint osteoarthritis is a common joint disease that causes hand disability and reduces quality of life. There are few conservative treatment options for this condition. The purpose of this study was to investigate the effect of traction treatment on symptomatic distal interphalangeal joint osteoarthritis. Methods This prospective, longitudinal study involved multiple time-series observations and within-subject controls. The most painful distal interphalangeal joints in patients with hand osteoarthritis were treated by daily, 15-min joint traction at home using a finger trap orthosis. The corresponding contralateral digits were used as within-subject controls. The primary outcome measure was two-point pinch strength, and the secondary outcome measures were radiographic findings and treatment adherence. Longitudinal and pairwise comparison analyses of the treated and control digits examined improvements in two-point pinch strength at months 1, 3, and 6 from baseline. The durability of treatment effects after treatment discontinuation was investigated at month 12. Results Eighteen treated digits and 18 corresponding control digits were eligible for analysis. There was a significant increase in two-point pinch strength after 1-month traction, and this increase was maintained until month 6 despite the absence of radiographic changes. Compared to controls, significant improvement in two-point pinch strength relative to baseline was seen at every observation time point, with a moderate to large effect size. There was no time-treatment interaction. Treatment adherence was high. At months 3 and 6, around 60-80 % of digits were voluntarily treated. Pinch strength was comparable between months 6 and 12, with greater improvement than in the control group. Conclusion Joint traction treatment can improve pinch strength in symptomatic distal interphalangeal joint osteoarthritis. Larger, randomized studies on traction treatment and the effect on hand function are warranted.
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Affiliation(s)
- Susumu Saito
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Japan
| | - Aiko Makino
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Japan
| | - Naoki Morimoto
- Department of Plastic and Reconstructive Surgery, Graduate School of Medicine and Faculty of Medicine, Kyoto University, Japan
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McAlindon TE, Hunnicutt JL, Roberts MB, Haugen IK, Schaefer LF, Driban JB, Lu B, Duryea J, Smith SE, Booth SL, Petty GA, Mathiessen A, Zeng L, Eaton C. Associations of inflammatory and metabolic biomarkers with incident erosive hand osteoarthritis in the osteoarthritis initiative cohort. Osteoarthritis Cartilage 2024; 32:592-600. [PMID: 38311107 PMCID: PMC11031286 DOI: 10.1016/j.joca.2023.10.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 10/19/2023] [Accepted: 10/30/2023] [Indexed: 02/06/2024]
Abstract
OBJECTIVE Erosive hand osteoarthritis (eHOA) is a subtype of hand osteoarthritis (OA) that develops in finger joints with pre-existing OA and is differentiated by clinical characteristics (hand pain/disability, inflammation, and erosions) that suggest inflammatory or metabolic processes. METHOD This was a longitudinal nested case-cohort design among Osteoarthritis Initiative participants who had hand radiographs at baseline and 48-months, and biospecimens collected at baseline. We classified incident radiographic eHOA in individuals with ≥1 joint with Kellgren-Lawrence ≥2 and a central erosion present at 48-months but not at baseline. We used a random representative sample (n = 1282) for comparison. We measured serum biomarkers of inflammation, insulin resistance and dysglycemia, and adipokines using immunoassays and enzymatic colorimetric procedures, blinded to case status. RESULTS Eighty-six participants developed incident radiographic eHOA. In the multivariate analyses adjusted for age, gender, race, smoking, and body mass index, and after adjustment for multiple analyses, incident radiographic eHOA was associated with elevated levels of interleukin-7 (risk ratio (RR) per SD = 1.30 [95% confidence interval (CI) 1.09, 1.55] p trend 0.01). CONCLUSION This exploratory study suggests an association of elevated interleukin-7, an inflammatory cytokine, with incident eHOA, while other cytokines or biomarkers of metabolic inflammation were not associated. Interleukin-7 may mediate inflammation and tissue damage in susceptible osteoarthritic finger joints and participate in erosive progression.
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Affiliation(s)
- Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA.
| | | | - Mary B Roberts
- Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, RI, USA.
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway.
| | - Lena F Schaefer
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA.
| | - Bing Lu
- UConn Health, University of Connecticut, Farmington, CT, USA.
| | - Jeffrey Duryea
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Sarah L Booth
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
| | - Gayle A Petty
- Jean Mayer USDA Human Nutrition Research Center on Aging, Tufts University, Boston, MA, USA.
| | - Alexander Mathiessen
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
| | - Li Zeng
- Department of Integrative Physiology and Pathobiology, School of Medicine, Tufts University, Boston, MA, USA.
| | - Charles Eaton
- Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, RI, USA.
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Wittoek R, Verbruggen G, Vanhaverbeke T, Colman R, Elewaut D. RANKL blockade for erosive hand osteoarthritis: a randomized placebo-controlled phase 2a trial. Nat Med 2024; 30:829-836. [PMID: 38361122 PMCID: PMC10957468 DOI: 10.1038/s41591-024-02822-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/19/2024] [Indexed: 02/17/2024]
Abstract
Erosive hand osteoarthritis (OA) is a prevalent and disabling disease with limited treatment options. Here we present the results of a monocentric, placebo-controlled, double-blind, randomized phase 2a clinical trial with denosumab, a receptor activator of nuclear factor-κB ligand inhibitor, evaluating the effects on structure modification in erosive hand OA. Patients were randomized to 48 weeks treatment with denosumab 60 mg every 3 months (n = 51, 41 females) or placebo (n = 49, 37 females). The primary (radiographic) endpoint was the change in the total Ghent University Scoring System (GUSS) at week 24, where positive changes correspond to remodeling and negative changes to erosive progression. Secondary endpoints were the change in the GUSS at week 48 and the number of new erosive joints at week 48 by the anatomical phase scoring system. Baseline mean GUSS (standard deviation) of target joints was 155.9 (69.3) in the denosumab group and 158.7 (46.8) in the placebo group. The primary endpoint was met with an estimated difference between groups of 8.9 (95% confidence interval (CI) 1.0 to 16.9; P = 0.024) at week 24. This effect was confirmed at week 48 (baseline adjusted GUSS (standard error of the mean) denosumab and placebo were 163.5 (2.9) and 149.2 (3.9), respectively; with an estimated difference between groups of 14.3 (95% CI 4.6 to 24.0; P = 0.003)). At patient level, more new erosive joints were developed in the placebo group compared with denosumab at week 48 (odds ratio 0.24 (95% CI 0.08 to 0.72); P = 0.009). More adverse events occurred in the placebo group (125 events in 44 patients (90%)) compared with the denosumab group (97 events in 41 patients (80%)). These results demonstrate that denosumab has structure modifying effects in erosive hand OA by inducing remodeling and preventing new erosive joints. EU Clinical Trials Register identifier 2015-003223-53 .
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Affiliation(s)
- Ruth Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium.
| | - Gust Verbruggen
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Tine Vanhaverbeke
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
| | - Roos Colman
- Biostatistics Unit, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - Dirk Elewaut
- Department of Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
- VIB Center for Inflammation Research, Ghent University, Ghent, Belgium
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Estee MM, Cicuttini FM, Page MJ, Wluka AE, Wang Y. Efficacy of tumor necrosis factor inhibitors in hand osteoarthritis: A systematic review and meta-analysis of randomized controlled trials. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100404. [PMID: 37649531 PMCID: PMC10462838 DOI: 10.1016/j.ocarto.2023.100404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
Objectives This study aimed at systematically review the evidence for the efficacy of Tumor Necrosis Factor (TNF) inhibitors on symptoms and structural outcomes in hand osteoarthritis. Methods Three databases were searched for randomized controlled trials examining the efficacy of TNF inhibitors in hand osteoarthritis. Two authors extracted data and assessed the risk of bias. The mean difference (MD) was calculated, and a random-effects meta-analysis was performed. Results Four studies were identified involving 276 participants. Meta-analysis showed that TNF inhibitors had no effect on pain at 4-6 weeks (MD -0.93, 95%CI -7.41 to 5.55; 2 studies) and 24-26 weeks (MD -3.82, 95%CI -11.46 to 3.83; 2 studies) and no effect on grip strength at 12 months (MD -0.35, 95%CI -1.08 to 0.37; 2 studies). There was limited evidence for the effect of TNF inhibitors on structural outcomes at 12 months. Subgroup analysis from 2 studies showed beneficial effect of TNF inhibitors on reducing the progression of structural outcomes in hand OA patients with signs of inflammation but not in those without inflammation. The certainty of the evidence was low for the effect of TNF inhibitor on pain and moderate for the effect on grip strength. Conclusion This study found no effect of TNF inhibitors on clinical outcomes in hand osteoarthritis over the short term (<6 weeks) and within one year, with some evidence for beneficial effect on structural outcomes.
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Affiliation(s)
- Mahnuma Mahfuz Estee
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Flavia M. Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Matthew J. Page
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Anita E. Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
| | - Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria 3004, Australia
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van der Meulen C, van de Stadt LA, Rosendaal FR, Runhaar J, Kloppenburg M. Determination and characterization of patient subgroups based on pain trajectories in hand osteoarthritis. Rheumatology (Oxford) 2023; 62:3035-3042. [PMID: 36648311 PMCID: PMC10473188 DOI: 10.1093/rheumatology/kead017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/24/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To investigate pain, pain trajectories and their determinants in hand osteoarthritis (OA). METHODS Data from the HOSTAS (Hand OSTeoArthritis in Secondary care) consisting of consecutive hand OA patients were used. Australian Canadian Osteoarthritis Hand Index (AUSCAN) pain was measured yearly for four years. Patients with complete AUSCAN at ≥2 time points were eligible for longitudinal analysis. Associations between variables of interest and baseline AUSCAN pain were investigated with linear regression. Development of pain over time was modelled using latent class growth analysis (LCGA). Associations of LCGA classes with variables of interest were analysed using multinomial logistic regression adjusted for baseline pain. RESULTS A total of 484/538 patients [mean (s.d.) age 60.8 (8.5) years, 86% women, mean (s.d.) AUSCAN pain 9.3 (4.3)] were eligible for longitudinal analysis. Sex, marital and working status, education, disease duration and severity, anxiety and depression scores, lower health-related quality of life (HR-QoL), specific illness perceptions and coping styles were associated with baseline pain. LCGA yielded three classes, characterized by average pain levels at baseline; average pain remained stable over time within classes. Classes with more pain were positively associated with BMI, tender joint count, symptom duration, hand function scores and depression scores, negatively with physical HR-QoL, and education level. CONCLUSION Baseline pain was associated with patient and disease characteristics, and psychosocial factors. LCGA showed three pain trajectories in hand OA patients, with different baseline pain levels and stable pain over time. Classes were distinguished by BMI, education level, disease severity, depression and HR-QoL.
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Affiliation(s)
- Coen van der Meulen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte A van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Liang KW, Wang B, Huang HH, Tsao TF, Tyan YS, Wang PH. Effectiveness and Safety of Intra-arterial Imipenem/Cilastatin Sodium Infusion for Patients with Hand Osteoarthritis-Related Interphalangeal Joint Pain. J Vasc Interv Radiol 2023; 34:1485-1492.e1. [PMID: 37295555 DOI: 10.1016/j.jvir.2023.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Revised: 05/10/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
PURPOSE To evaluate the effectiveness and safety of intra-arterial imipenem/cilastatin sodium (IPM/CS) infusion for painful interphalangeal joint osteoarthritis (OA). MATERIALS AND METHODS Fifty-eight patients with interphalangeal joint OA who underwent intra-arterial IPM/CS infusion were retrospectively evaluated. Intra-arterial infusions were performed via percutaneous wrist arterial access. The Numerical Rating Scale (NRS), Functional Index for Hand Osteoarthritis (FIHOA), and Patient Global Impression of Change (PGIC) scale scores were assessed at intervals of 1, 3, 6, 12, and 18 months. Clinical success was evaluated based on PGIC. RESULTS All patients were followed up for at least 6 months after treatment. Of them, 30 and 6 patients were followed up for 12 and 18 months, respectively. No severe or life-threatening adverse events were encountered. The mean NRS score was 6.0 ± 1.4 at baseline, which significantly decreased to 2.8 ± 1.4, 2.2 ± 1.9, and 2.4 ± 1.9 at 1, 3, and 6 months after treatment, respectively (all P < .001). The mean NRS scores were 2.8 ± 1.7 and 2.9 ± 1.9 at 12 and 18 months, respectively, in the remaining patients. The mean FIHOA score significantly decreased from 9.8 ± 5.0 at the baseline to 4.1 ± 3.5 at 3 months (P < .001). The mean FIHOA score was 4.5 ± 3.3 at 12 months in the remaining 30 patients. The clinical success rates based on PGIC at 1, 3, 6, 12, and 18 months were 62.1%, 77.6%, 70.7%, 63.4%, and 50.0%, respectively. CONCLUSIONS Intra-arterial IPM/CS infusion is a potential treatment option for interphalangeal joint OA refractory to medical management.
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Affiliation(s)
- Keng-Wei Liang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Bow Wang
- Department of Medical Imaging, National Cheng Kung University, Tainan, Taiwan; College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Hsin-Hui Huang
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Teng-Fu Tsao
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yeu-Sheng Tyan
- Department of Medical Imaging, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Po-Hui Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan; School of Medicine, Chung Shan Medical University, Taichung, Taiwan; Department of Obstetrics and Gynecology, Chung Shan Medical University Hospital, Taichung, Taiwan.
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Binvignat M, Emond P, Mifsud F, Miao B, Courties A, Lefèvre A, Maheu E, Crema MD, Klatzmann D, Kloppenburg M, Richette P, Butte AJ, Mariotti-Ferrandiz E, Berenbaum F, Sokol H, Sellam J. Serum Tryptophan Metabolites are Associated with Erosive Hand Osteoarthritis and Pain: Results from the DIGICOD Cohort. Osteoarthritis Cartilage 2023:S1063-4584(23)00761-6. [PMID: 37105396 DOI: 10.1016/j.joca.2023.04.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2022] [Revised: 04/09/2023] [Accepted: 04/11/2023] [Indexed: 04/29/2023]
Abstract
OBJECTIVE To investigate host and gut-microbiota related Tryptophan metabolism in hand osteoarthritis (HOA). METHODS The baseline serum concentration of 20 Tryptophan metabolites was measured in 416 HOA patients in a cross-sectional analysis of the DIGICOD cohort. Tryptophan metabolites levels, metabolite-ratios and metabolism pathway activation were compared between erosive (N=141) and non-erosive HOA (N=275) by multiple logistic regressions adjusted on age, BMI and sex. The association between Tryptophan metabolite levels and HOA symptoms was investigated by a Spearman's rank correlation analysis. RESULTS Four serum Tryptophan metabolites, eight metabolite ratios and one metabolism pathway were associated with erosive HOA. Erosive HOA was negatively associated with Tryptophan (odds ratio (OR)=0.41, 95% confidence interval [0.24-0.70]), indole-3-aldehyde (OR=0.67 [0.51-0.90]) and 3-OH-anthranilic acid (OR=1.32 [1.13-1.54]) and positively with 5-OH-Tryptophan levels (OR=1.41 [1.13-1.77]). The pro-inflammatory kynurenine-indoleamine 2,3-dioxygenase pathway was upregulated in erosive HOA (OR=1.60 [1.11-2.29]). Eleven metabolites were correlated with HOA symptoms and were mostly pain-related. Serotonin and N-acetyl serotonin levels were negatively correlated with number of tender joints. Indole-3-aldehyde level was negatively correlated and 3-OH-anthranilic acid, 3-OH-kynurenine and 5-OH-Tryptophan levels were positively correlated with number of patients-reported painful joints. Quinolinic acid and 3-OH-kynurenine levels correlated positively with AUSCAN pain. CONCLUSIONS Tryptophan metabolites disturbance is associated with erosive HOA and pain and emphasize the role of low-grade inflammation and gut dysbiosis in HOA.
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Affiliation(s)
- Marie Binvignat
- Department of Rheumatology, Sorbonne Université, Saint-Antoine Hospital, INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France; Bakar Computational Health Science Institute, University of California, San Francisco, San Francisco,CA, USA; Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Patrick Emond
- IBrain Lab, Inserm UMR 1253 Université de Tours, Tours France; Department of Nuclear Medicine, Centre Hospitalo-Universitaire de Tours, Tours France
| | - Francois Mifsud
- Université de Paris, BFA, CNRS UMR 8251, 75013 Paris, France; Diabetes Center, University of California San Francisco, San Francisco, CA, USA
| | - Brenda Miao
- Bakar Computational Health Science Institute, University of California, San Francisco, San Francisco,CA, USA
| | - Alice Courties
- Department of Rheumatology, Sorbonne Université, Saint-Antoine Hospital, INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Antoine Lefèvre
- IBrain Lab, Inserm UMR 1253 Université de Tours, Tours France
| | - Emmanuel Maheu
- Department of Rheumatology, Sorbonne Université, Saint-Antoine Hospital, INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Michel D Crema
- Institute of Sports Imaging, French National Institute of Sports (INSEP), Paris, France
| | - David Klatzmann
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France; Biotherapy (CIC-BTi) and Inflammation-Immunopathology-Biotherapy Department (i2B), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Margreet Kloppenburg
- Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | - Pascal Richette
- Department of Rheumatology, Lariboisière Hospital, INSERM U1132, Université de Paris, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Atul J Butte
- Bakar Computational Health Science Institute, University of California, San Francisco, San Francisco,CA, USA
| | - Encarnita Mariotti-Ferrandiz
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Sorbonne Université, Paris, France
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne Université, Saint-Antoine Hospital, INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France
| | - Harry Sokol
- Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France; Department of Gastroenterology Sorbonne Université, Saint Antoine Hospital, Centre de Recherche Saint-Antoine (CRSA) INSERM UMRS-938, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Université Paris-Saclay, INRAE, AgroParisTech, Micalis Institute, Jouy-en-Josas, France
| | - Jérémie Sellam
- Department of Rheumatology, Sorbonne Université, Saint-Antoine Hospital, INSERM UMRS-938, Centre de Recherche Saint-Antoine (CRSA), Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France; Paris Center for Microbiome Medicine (PaCeMM) FHU, Paris, France.
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8
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Cambon-Binder A, Jaisson S, Tuffet S, Courties A, Eymard F, Okwieka A, Gillery P, Miquel A, Rousseau A, Crema MD, Berenbaum F, Sellam J. Serum carboxymethyllysine concentration is associated with erosive hand osteoarthritis. Osteoarthritis Cartilage 2023:S1063-4584(23)00727-6. [PMID: 36931384 DOI: 10.1016/j.joca.2023.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 01/30/2023] [Accepted: 03/03/2023] [Indexed: 03/19/2023]
Abstract
OBJECTIVE Carboxymethyllysine (CML) and homocitrulline (HCit) are the products of two non-enzymatic post-translational modifications of protein, a process related to age. We investigated whether serum CML and HCit concentrations were associated with hand osteoarthritis (HOA), especially erosive HOA. DESIGN Serum CML and HCit were measured by using liquid chromatography coupled with tandem mass spectrometry at inclusion in 386 patients included in the DIGICOD cohort. We investigated whether serum CML and/or HCit concentrations were associated with erosive HOA or with HOA clinical and radiological features. Moreover, we compared the tissular concentrations of CML and HCit in OA and non-OA cartilage from proximal interphalangeal and metacarpo-phalangeal (MCP) joints from human cadaveric donors. RESULTS Median (IQR) serum CML concentration was lower in patients with erosive HOA than those with non-erosive HOA (178.7 [157.1-208.8] vs 194.7 [168.9-217.1] μmol/mol Lys, p=0.002), but median HCit concentration did not differ between the groups (193.9 [162.9-232.0] vs 193.9 [155.9-224.6] μmol/mol Lys). Cartilage HCit and CML concentrations were not correlated with clinical features. Serum CML concentration was higher in OA than non-OA MCPs (7.0 vs 4.0 mmol/mol Lys, p=0.01). CONCLUSIONS Serum CML concentration was lower in erosive HOA than non-erosive HOA, and cartilage CML concentration was higher in OA than non-OA cartilage. These results encourage further studies to test whether serum CML could be a new prognostic biomarker in HOA.
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Affiliation(s)
- A Cambon-Binder
- Sorbonne University, Assistance Publique-Hôpitaux de Paris (AP-HP), Orthopaedic and Upper Limb Surgery Department, Saint-Antoine Hospital, Paris, France; Centre de Recherche Saint-Antoine, INSERM UMRS_938, Paris, France
| | - S Jaisson
- MEDyC Unit CNRS UMR n° 7369, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France; Biochemistry Department, University Hospital of Reims, Reims, France
| | - S Tuffet
- Sorbonne University, AP-HP, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Saint-Antoine Hospital, Paris, France
| | - A Courties
- Centre de Recherche Saint-Antoine, INSERM UMRS_938, Paris, France; Sorbonne University, AP-HP, Rheumatology department, Saint-Antoine Hospital, Paris, France
| | - F Eymard
- Department of Rheumatology, AP-HP, Henri Mondor Hospital, 94000 Créteil, France
| | - A Okwieka
- MEDyC Unit CNRS UMR n° 7369, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France; Biochemistry Department, University Hospital of Reims, Reims, France
| | - P Gillery
- MEDyC Unit CNRS UMR n° 7369, Faculty of Medicine, University of Reims Champagne-Ardenne, Reims, France; Biochemistry Department, University Hospital of Reims, Reims, France
| | - A Miquel
- Sorbonne University, AP-HP, Radiology Department, Saint-Antoine Hospital, Paris, France
| | - A Rousseau
- Sorbonne University, AP-HP, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Saint-Antoine Hospital, Paris, France
| | - M D Crema
- Institut d'Imagerie du Sport, Institut National du Sport, de l'Expertise et de la Performance (INSEP), Paris, France
| | - F Berenbaum
- Centre de Recherche Saint-Antoine, INSERM UMRS_938, Paris, France; Sorbonne University, AP-HP, Rheumatology department, Saint-Antoine Hospital, Paris, France
| | - J Sellam
- Centre de Recherche Saint-Antoine, INSERM UMRS_938, Paris, France; Sorbonne University, AP-HP, Rheumatology department, Saint-Antoine Hospital, Paris, France.
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9
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Oo WM, Hunter DJ. Efficacy, Safety, and Accuracy of Intra-articular Therapies for Hand Osteoarthritis: Current Evidence. Drugs Aging 2023; 40:1-20. [PMID: 36633823 DOI: 10.1007/s40266-022-00994-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 01/13/2023]
Abstract
The lifetime risk of symptomatic hand osteoarthritis (OA) is 39.8%, with one in two women and one in four men developing the disease by age 85 years and no disease-modifying drug (DMOAD) available so far. Intra-articular (IA) therapy is one of the options commonly used for symptomatic alleviation of OA disease as it can circumvent systemic exposure and potential side effects of oral medications. The current narrative review focuses on the efficacy and safety profiles of the currently available IA agents in hand OA (thumb-base OA or interphalangeal OA) such as corticosteroids and hyaluronic acid (HA), as well as the efficacy and safety of IA investigational injectates in phase 2/3 clinical trials such as prolotherapy, platelet-rich plasma, stem cells, infliximab, interferon-? and botulinum toxin, based on the published randomized controlled trials on PubMed database. The limited published literature revealed the short-term symptomatic benefits of corticosteroids in interphalangeal OA while long-term data are lacking. Most of the short-term studies showed no significant difference between corticosteroids and hyaluronic acid in thumb-base OA, usually with a faster onset of pain relief in the corticosteroid group and a slower but greater (statistically insignificant) pain improvement in the HA group. The majority of studies in investigational agents were limited by small sample size, short-term follow-up, and presence of serious side effects. In addition, we reported higher accuracy rates of drug administrations under imaging guidance than landmark guidance (blind method), and then briefly describe challenges for the long-term efficacy and prospects of IA therapeutics.
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Affiliation(s)
- Win Min Oo
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar.
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia.
| | - David J Hunter
- Rheumatology Department, Faculty of Medicine and Health, Royal North Shore Hospital, and Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Sydney, NSW, Australia
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10
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Tenti S, Bruyère O, Cheleschi S, Reginster JY, Veronese N, Fioravanti A. An update on the use of conventional and biological disease-modifying anti-rheumatic drugs in hand osteoarthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231158618. [PMID: 36937821 PMCID: PMC10017945 DOI: 10.1177/1759720x231158618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/02/2023] [Indexed: 03/15/2023] Open
Abstract
Osteoarthritis (OA) is a highly prevalent condition worldwide associated with pain, progressive disability, reduced participation in social activities, and impaired quality of life. Despite its growing burden, the therapeutic options are still limited and almost exclusively addressed to symptoms' management, while no disease-modifying OA drugs able to prevent or retard disease progression are actually available. For these reasons, in the last decades, relevant efforts to find new potential therapeutic targets in OA have been made and a number of existing conventional and biological disease-modifying anti-rheumatic drugs (DMARDs), including hydroxychloroquine (HCQ), methotrexate (MTX), tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 inhibitors, commonly used to treat inflammatory rheumatic diseases, have been repurposed for the treatment of OA and explored also in hand osteoarthritis (HOA). The current narrative review was aimed to provide a comprehensive and updated understanding of the possibilities and the criticisms related to the treatment of HOA with conventional and biological DMARDs. Unfortunately, therapy with conventional and biologic drugs in HOA has not achieved the expected success, despite a rationale for their use exists. Thus, our findings outline the urgent need to enhance the exploration of HOA basic molecular mechanisms to find new potential therapeutic targets, personalized for each patient, and appropriate for the different subsets of HOA and for the different phases of disease.
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Affiliation(s)
- Sara Tenti
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health, Aspects of Musculoskeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Sara Cheleschi
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health, Aspects of Musculoskeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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11
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Binvignat M, Pires G, Tchitchek N, Costantino F, Courties A, Klatzmann D, Butte AJ, Combe B, Dougados M, Richette P, Mariotti-Ferrandiz E, Berenbaum F, Sellam J. Identification of Symptom Phenotypes of Hand Osteoarthritis Using Hierarchical Clustering: Results From the DIGICOD Cohort. Arthritis Care Res (Hoboken) 2022. [PMID: 36263851 DOI: 10.1002/acr.25047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 09/20/2022] [Accepted: 10/18/2022] [Indexed: 01/27/2023]
Abstract
OBJECTIVE We aimed to delineate phenotypes in hand osteoarthritis (HOA) based on cardinal symptoms (pain, functional limitation, stiffness, and aesthetic discomfort). METHODS With data from the Digital Cohort Design (DIGICOD), we performed a hierarchical agglomerative clustering analysis based on Australian/Canadian Osteoarthritis Hand Index (AUSCAN) subscores for pain, physical function, stiffness, and visual analog scale for aesthetic discomfort. Kruskal-Wallis and post hoc analyses were used to assess differences between clusters. RESULTS Among 389 patients, we identified 5 clusters: cluster 1 (n = 88) and cluster 2 (n = 91) featured low and mild symptoms; cluster 3 (n = 80) featured isolated aesthetic discomfort; cluster 4 (n = 42) featured a high level of pain, stiffness, and functional limitation; and cluster 5 (n = 88) had the same features as cluster 4 but with high aesthetic discomfort. For clusters 4 and 5, AUSCAN pain score was >41 of 100, representing only one-third of our patients. Aesthetic discomfort (clusters 3 and 5) was significantly associated with erosive HOA and a higher number of nodes. The highly symptomatic cluster 5 was associated but not significantly with metabolic syndrome, and body mass index and C-reactive protein level did not differ among clusters. Symptom intensity was significantly associated with joint destruction as well as with physical and psychological burden. Patients' main expectations differed among clusters, and function improvement was the most frequent expectation overall. CONCLUSION The identification of distinct clinical clusters based on HOA cardinal symptoms suggests previously undescribed subtypes of this condition, warranting further study of biological characteristics of such clusters, and opening a path toward phenotype-based personalized medicine in HOA.
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Affiliation(s)
- Marie Binvignat
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France, Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Paris, France, and Bakar Computational Health Science Institute, University of California, San Francisco
| | - Gabriel Pires
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Paris, France
| | - Nicolas Tchitchek
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital, Paris, France
| | - Félicie Costantino
- Department of Rheumatology, Ambroise Paré Hospital, UMR 1173 INSERM, Université de Versailles Saint-Quentin, Assistance Publique-Hôpitaux de Paris, Boulogne, France
| | - Alice Courties
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - David Klatzmann
- Immunology, Immunopathology, Immunotherapy I3 Lab, Inserm URMS 959, Pitié-Salpêtrière Hospital and Biotherapy (CIC-BTi) and Inflammation Immunopathology-Biotherapy Department (i2B), Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Atul J Butte
- Bakar Computational Health Science Institute, University of California, San Francisco
| | - Bernard Combe
- Department of Rheumatology, Université de Montpellier, Montpellier, France
| | - Maxime Dougados
- Department of Rheumatology, Cochin Hospital, Inserm UMR 1153, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Pascal Richette
- Department of Rheumatology, Lariboisière Hospital, INSERM U1132, Université de Paris, Assistance Publique-Hôpitaux de Paris, Paris, France
| | | | - Francis Berenbaum
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, Saint-Antoine Hospital, Centre de Recherche Saint-Antoine, Paris Inserm UMRS 938, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Paris, France
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12
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Sunk IG, Amoyo-Minar L, Niederreiter B, Soleiman A, Kainberger F, Smolen JS, Aletaha D, Bobacz K. Dorso-ventral osteophytes of interphalangeal joints correlate with cartilage damage and synovial inflammation in hand osteoarthritis: a histological/radiographical study. Arthritis Res Ther 2022; 24:226. [PMID: 36175909 PMCID: PMC9520866 DOI: 10.1186/s13075-022-02911-w] [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: 02/17/2022] [Accepted: 09/07/2022] [Indexed: 11/20/2022] Open
Abstract
Objective To detect dorsally located osteophytes (OP) on lateral x-ray views and to correlate their presence with the extent of structural joint damage, determined by histologic grading (cartilage damage and synovial inflammation) and radiographic scoring in hand osteoarthritis (HOA). Methods Distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints were obtained from post mortem specimens (n = 40). Multiplanar plain x-rays were taken (dorso/palmar (dp) and lateral views). Radiographic OA was determined by the Kellgren and Lawrence classification. Joint samples were prepared for histological analysis and cartilage damage was graded according to the Mankin scoring system. Inflammatory changes of the synovial membrane were scored using the general synovitis score (GSS). Spearman’s correlation was applied to examine the relationship between histological and radiographical changes. Differences between groups were determined by Mann-Whitney test. Results Bony proliferations that were only detectable on lateral views but reminiscent of OPs on dp images were termed dorso-ventral osteophytes (dvOPs). All joints displaying dvOPs were classified as OA and the presence of dvOPs in DIP and PIP joints correlated with the extent of histological and radiographic joint damage, as well as with patient age. Joint damage in osteoarthritic DIP and PIP joints without any dvOPs was less severe compared to joints with dvOPs. Synovial inflammation was mainly present in joints displaying dvOPs and correlated with joint damage. Conclusion dvOPs are associated with increasing structural alterations in DIP and PIP joints and can be seen as markers of advanced joint damage. Detecting dvOPs can facilitate the diagnosis process and improve damage estimation in HOA.
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Affiliation(s)
- Ilse-Gerlinde Sunk
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Love Amoyo-Minar
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Birgit Niederreiter
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Afschin Soleiman
- Department of Pathology, Medical University of Vienna, Vienna, Austria
| | - Franz Kainberger
- Department of Radiology and Osteology, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Daniel Aletaha
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria
| | - Klaus Bobacz
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18-20, 1090, Vienna, Austria.
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13
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van de Stadt LA, Kroon FPB, Thudium CF, Bay-Jensen AC, Kloppenburg M. Serum biomarkers in prednisolone-treated hand osteoarthritis patients. Rheumatology (Oxford) 2022; 62:1350-1355. [PMID: 35946535 PMCID: PMC9977113 DOI: 10.1093/rheumatology/keac442] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 07/22/2022] [Accepted: 07/22/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To investigate whether biomarkers are modulated by prednisolone treatment in patients with hand OA and whether they can predict response to prednisolone. METHODS Biomarkers reflecting tissue turnover and inflammation [aggrecanase-derived neoepitope of arggecan (ARGS), MMP-derived neoepitope of type I collagen (C1M), MMP-derived neoepitope of type III collagen (C3M), marker of true type V collagen formation (PROC5), MMP-derived neoepitope of CRP (CRPM), citrullinated vimentin fragment (VICM), high-sensitivity (hsCRP)] were measured in sera from 78 patients with painful inflammatory hand OA, who were randomized between prednisolone or placebo treatment. Association of baseline biomarker levels with disease characteristics [visual analogue scale (VAS) pain, synovial thickening ultrasonography sum score and erosive OA] and OMERACT-Osteoarthritis Research Society International (OARSI) response after 6 weeks were analysed with linear or logistic regression and adjusted for age, BMI and sex. Change in biomarker levels after 6 weeks was assessed with linear regression adjusted for baseline biomarker levels, age, BMI and sex. RESULTS For all patients (mean age 64 years, 79% female), there were no associations between biomarker levels and VAS finger pain or synovial thickening score at baseline. Patients with erosive hand OA had higher levels of C1M and hsCRP [adjusted geometric mean ratio 1.24 (95% CI 1.03, 1.49) and 1.91 (1.19, 3.06), respectively]. Biomarker levels did not decrease over time. There was no association between baseline biomarkers levels and OARSI response, except for CRPM [geometric mean ratio of 0.88 (0.77, 1.00)]. CONCLUSION Erosive disease was associated with higher levels of C1M and hsCRP. Biomarker levels were not influenced by treatment with prednisolone. Current biomarkers were not associated with response to prednisolone in hand OA.
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Affiliation(s)
- Lotte A van de Stadt
- Correspondence to: Lotte A. van de Stadt, Department Rheumatology, Leiden University Medical Center, postal zone C1-R, Albinusdreef 2, 2333 ZA Leiden, The Netherlands. E-mail:
| | - Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden,Department of Rheumatology, Zuyderland Medical Center, Heerlen, The Netherlands
| | | | | | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden,Department of Clinical Epidemiology, LUMC, Leiden, The Netherlands
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14
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Terpstra SE, van de Stadt L, Boonen A, Damman W, Rosendaal F, Kloppenburg M. Hand osteoarthritis is associated with limitations in paid and unpaid work participation and related societal costs: the HOSTAS cohort. RMD Open 2022; 8:rmdopen-2022-002367. [PMID: 35906024 PMCID: PMC9345053 DOI: 10.1136/rmdopen-2022-002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Data on work participation impairment and related societal costs for patients with hand osteoarthritis (OA) are scarce. Therefore, we aimed to investigate the association of hand OA with work limitations and costs of productivity loss in paid and unpaid work. METHODS We used data from the Hand Osteoarthritis in Secondary Care cohort, including patients with hand OA diagnosed by their treating rheumatologist. Using the validated Health and Labour Questionnaire, we assessed experienced unpaid and paid work restrictions, unpaid work replacement by others and inefficiency and absence during paid work related to hand OA over the last 2 weeks. Societal costs (€) per hour of paid and unpaid work were estimated using Dutch salary data in 2019. RESULTS 381 patients were included (mean age 61 years, 84% women, 26% high education level, 55% having any comorbidity). Replacement of unpaid work by others due to hand OA was necessary for 171 out of 381 patients (45%). Paid work was reported by 181/381 patients (47%), of whom 13/181 (7%) reported absenteeism, 28/181 (15%) unproductive hours at work and 120/181 (66%) paid work restrictions due to hand OA.Total estimated work-related societal costs per patient with hand OA (381 patients) were €94 (95% CI 59 to 130) per 2 weeks (€2452, 95% CI 1528 to 3377 per year). CONCLUSIONS Hand OA is associated with impairment in paid and unpaid work participation, which translates into substantial societal costs of lost productivity. These results highlight the importance of adequate hand OA treatment.
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Affiliation(s)
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and the Caphri Research Institute Maastricht University, Maastricht, The Netherlands
| | - Wendy Damman
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Rosendaal
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Duarte-Salazar C, Marín-Arriaga N, Miranda-Duarte A. The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity. REUMATOLOGIA CLINICA 2022; 18:338-342. [PMID: 35680365 DOI: 10.1016/j.reumae.2021.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 03/04/2021] [Indexed: 06/15/2023]
Abstract
UNLABELLED Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. METHODS 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. RESULTS Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. CONCLUSION Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.
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Affiliation(s)
- Carolina Duarte-Salazar
- Departamento de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico.
| | - Norma Marín-Arriaga
- Departamento de Imagenología y Servicio de Resonancia Magnética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Antonio Miranda-Duarte
- Departamento de Genética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
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Effect of Transcutaneous Vagus Nerve Stimulation in Erosive Hand Osteoarthritis: Results from a Pilot Trial. J Clin Med 2022; 11:jcm11041087. [PMID: 35207369 PMCID: PMC8878516 DOI: 10.3390/jcm11041087] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2021] [Revised: 02/04/2022] [Accepted: 02/15/2022] [Indexed: 11/17/2022] Open
Abstract
Beyond its effect on vegetative functions, the activation of the vagus nerve inhibits inflammation and reduces pain signaling. The aim of this open-label pilot study was to determine the efficacy and tolerance of transcutaneous auricular VNS (taVNS) on erosive hand osteoarthritis (EHOA) symptoms. Symptomatic EHOA patients with hand pain VAS ≥ 40/100 mm and ≥1 interphalangeal swollen joint(s) were included. The taVNS was performed for 4 weeks using an auricular electrode applied one hour per day and connected to a TENS device with pre-established settings. Clinical efficacy was evaluated by changes between baseline and at 4 weeks with hand pain VAS and the functional index FIHOA score, using a Wilcoxon t-test. The treatment tolerance was also evaluated. Eighteen patients (median age 69 years old, 83% women) were analyzed. At baseline, hand pain VAS was 60 mm [IQR 50; 78.2] and FIHOA 15 [10.7; 20.2]. After 4 weeks, taVNS significantly reduced hand pain VAS, with a median decrease of 23.5 mm [7.7; 37.2] (p = 0.001), as well as FIHOA, with a median decrease of 2 points [0.75; 5.2] (p = 0.01). No serious adverse events were reported. One patient stopped taVNS because of auricular discomfort. This first proof-of-concept trial indicated that taVNS is feasible and may decrease joint inflammation and clinical symptoms in EHOA, arguing for a randomized controlled study versus sham stimulation.
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17
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Loef M, Faquih TO, von Hegedus JH, Ghorasaini M, Ioan-Facsinay A, Kroon FP, Giera M, Kloppenburg M. The lipid profile for the prediction of prednisolone treatment response in patients with inflammatory hand osteoarthritis: The HOPE study. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100167. [DOI: 10.1016/j.ocarto.2021.100167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 10/21/2022] Open
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18
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Gløersen M, Steen Pettersen P, Maugesten Ø, Mulrooney E, Mathiessen A, Gammelsrud H, Hammer HB, Neogi T, Ohrndorf S, Faraj K, Sjølie D, Slatkowsky-Christensen B, Kvien TK, Haugen IK. Study protocol for the follow-up examination of the Nor-Hand study: A hospital-based observational cohort study exploring pain and biomarkers in people with hand osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100198. [PMID: 36474811 PMCID: PMC9718069 DOI: 10.1016/j.ocarto.2021.100198] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 07/24/2021] [Accepted: 07/26/2021] [Indexed: 11/16/2022] Open
Abstract
Objective This study aims to increase the understanding of pain mechanisms in hand OA and explore potential risk factors for pain development or worsening in a biopsychosocial framework. Another important aim is to validate potential soluble and imaging OA biomarkers. Design The follow-up examination of the Nor-Hand hospital-based observational cohort study started in October 2019 and was completed in May 2021. In total, 212 of the 300 participants with hand OA who were examined at baseline attended the follow-up study. The participants underwent clinical joint examinations, medical and functional assessments, quantitative sensory testing, fluorescence optical imaging, ultrasound of the hands, acromioclavicular joints, feet, knees and hips, conventional radiographs of the hands and feet and magnetic resonance imaging of the dominant hand. Blood and urine samples were collected, and all participants answered questions about demographic factors and OA-related questionnaires. Associations between disease variables and symptoms will be examined in cross-sectional and longitudinal analyses. Longitudinal analyses will be performed to assess the predictive value of baseline variables on hand OA outcomes. Conclusion Current knowledge about predictors for disease progression in hand OA is limited, but with longitudinal data we will be able to explore the predictive value of baseline variables on hand OA outcomes, such as changes in patient-reported outcomes or changes in soluble and imaging biomarkers. This provides a unique opportunity to gain more knowledge about the natural disease course of hand OA.
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Affiliation(s)
- Marthe Gløersen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Pernille Steen Pettersen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Øystein Maugesten
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Elisabeth Mulrooney
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | | | - Heidi Gammelsrud
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Hilde Berner Hammer
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, United States
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Karwan Faraj
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | - Dag Sjølie
- Department of Radiology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Tore Kristian Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
- University of Oslo, Faculty of Medicine, Oslo, Norway
| | - Ida Kristin Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
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19
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Current Epidemiology and Risk Factors for the Development of Hand Osteoarthritis. Curr Rheumatol Rep 2021; 23:61. [PMID: 34216294 DOI: 10.1007/s11926-021-01025-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2021] [Indexed: 12/23/2022]
Abstract
PURPOSE OF REVIEW Hand osteoarthritis (hand OA), the most common peripheral arthritis in the world, is less studied than osteoarthritis (OA) of the knee and hip. However, it is uniquely situated to offer novel insight into OA as a disease process by removing weight-bearing as a confounder of systemic disease mechanisms. Here we review the epidemiology of hand OA and key risk factors for its development. RECENT FINDINGS Mounting evidence points to obesity as an important risk factor for hand OA development, with new evidence implicating a role for leptin and serum fatty acids. Disease progression in hand OA and specifically the erosive OA subtype may be associated with diabetes. New evidence supports an association between cardiovascular disease progression and symptomatic hand OA. Alcohol use may be associated with increased synovitis and erosive hand OA. Differences in ethnical distributions of hand OA have become more apparent, with a lower prevalence in Black patients compared to White patients. Novel genetic insights implicating the WNT gene pathway and IL-1β have led to novel potential targets in hand OA pathogenesis. Hand OA is a heterogeneous disease with many modifiable and non-modifiable risk factors that can determine disease severity and shed light on disease pathogenesis.
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Mohajer B, Kwee RM, Guermazi A, Berenbaum F, Wan M, Zhen G, Cao X, Haugen IK, Demehri S. Metabolic Syndrome and Osteoarthritis Distribution in the Hand Joints: A Propensity Score Matching Analysis From the Osteoarthritis Initiative. J Rheumatol 2021; 48:1608-1615. [PMID: 34329188 DOI: 10.3899/jrheum.210189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate the metabolic syndrome (MetS) association with radiographic and symptomatic hand osteoarthritis (HOA). METHODS Using 1:2 propensity score matching for relevant confounders, we included 2509 participants (896 MetS positive and 1613 MetS negative) from the Osteoarthritis Initiative dataset. MetS and its components, according to the International Diabetes Federation criteria, were extracted from baseline data, and included hypertension, abdominal obesity, dyslipidemia, and diabetes. We scored distinct hand joints based on the modified Kellgren-Lawrence (mKL) grade of baseline radiographs, with HOA defined as mKL ≥ 2. In the cross-sectional analysis, we investigated the association between MetS and its components with radiographic HOA and the presence of nodal and erosive HOA phenotypes using regression models. In the longitudinal analysis, we performed Cox regression analysis for hand pain incidence in follow-up visits. RESULTS MetS was associated with higher odds of radiographic HOA, including the number of joints with OA (OR 1.32, 95% CI 1.08-1.62), the sum of joints mKLs (OR 2.42, 95% CI 1.24-4.71), mainly in distal interphalangeal joints (DIPs) and proximal interphalangeal joints (PIPs; OR 1.52, 95% CI 1.08-2.14 and OR 1.38, 95% CI 1.09-1.75, respectively), but not metacarpophalangeal (MCP) and first carpometacarpal (CMC1) joints. Hand pain incidence during follow-up was higher with MetS presence (HR 1.25, 95% CI 1.07-1.47). The erosive HOA phenotype and joints' nodal involvement were more frequent with MetS (OR 1.40, 95% CI 1.01-1.97 and OR 1.28, 95% CI 1.02-1.60, respectively). CONCLUSION MetS, a potentially modifiable risk factor, is associated with radiographic DIP and PIP OA and longitudinal hand pain incidence while sparing MCPs and CMC1s. Nodal and erosive HOA phenotypes are associated with MetS, suggestive of possible distinct pathophysiology.
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Affiliation(s)
- Bahram Mohajer
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Robert M Kwee
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Ali Guermazi
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Francis Berenbaum
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Mei Wan
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Gehua Zhen
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Xu Cao
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Ida K Haugen
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
| | - Shadpour Demehri
- This research was supported by the National Institutes of Health (NIH) National Institute on Aging under award number P01AG066603. The Osteoarthritis Initiative (OAI), a collaborative project between public and private sectors, includes 5 contracts: N01-AR-2-2258, N01-AR-2-2259, N01-AR-2-2260, N01-AR-2-2261, and N01-AR-2-2262. The OAI is conducted by the OAI project investigators and is financially supported by the National Institutes of Health (NIH). Private funding partners are Merck Research Laboratories, Novartis Pharmaceuticals Corporation, GlaxoSmithKline, and Pfizer Inc. In preparing this manuscript, publicly available OAI project datasets were used. The results of this work do not necessarily reflect the opinions of the OAI project investigators, the NIH, or the private funding partners. B. Mohajer, MD, MPH, S. Demehri, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; R.M. Kwee, MD, Musculoskeletal Radiology, Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA, and Department of Radiology, Zuyderland Medical Center, Heerlen/Sittard/ Geleen, the Netherlands; A. Guermazi, MD, PhD, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; F. Berenbaum, MD, PhD, Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France; M. Wan, PhD, G. Zhen, MD, X. Cao, PhD, Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA; I.K. Haugen, MD, PhD, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway. AG has received funding from MerckSerono, AstraZeneca, Galapagos, Pfizer, Roche, TissueGene ( for consultation), and Boston Imaging Core Lab (as the president and stockholder). SD has received funding from Toshiba Medical Systems ( for consultation) and grants from the GE Radiology Research Academic Fellowship and Carestream Health ( for a clinical trial study). IH has received funding from the Southeastern Norway Health Authority. None of the authors have any conflicting personal or financial relationships that could have influenced the results of this study. The other authors have no competing interests to declare. Address correspondence to Dr. B. Mohajer, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD 21287, USA. . Accepted for publication June 2, 2021
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Kouki I, Tuffet S, Crema MD, Rousseau A, Richette P, Dougados M, Berenbaum F, Sellam J, Courties A. Metacarpophalangeal impairment in hand osteoarthritis is not rare and is associated with mechanical factors: Results from the DIGICOD hand osteoarthritis cohort. Arthritis Care Res (Hoboken) 2021; 74:1696-1703. [PMID: 33973396 DOI: 10.1002/acr.24642] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/29/2021] [Accepted: 04/29/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE To determine the prevalence, distribution and characteristics associated with radiographic metacarpophalangeal (MCP) osteoarthritis (OA). METHODS This is a cross-sectional study of baseline data from the DIGItal Cohort Osteoarthritis Design, a French monocentric cohort including patients with symptomatic hand OA (HOA). We evaluated the prevalence of radiographic MCP OA defined as ≥2 MCP joints with a Kellgren and Lawrence score ≥2. We compared the prevalence of MCP OA in the dominant and non-dominant hands. Associations between radiographic MCP OA and patient characteristics were studied using univariable and multivariable logistic regression. RESULTS Radiographic MCP OA was present in 138 of the 425 patients (32.5%) but was not severe. Patients with MCP OA had a mean age of 69.2±6.9 years, a BMI of 25±4.2 kg/m2 , and 86.2% were women. MCP OA was more frequent in the dominant hand and predominated at the 1st and 2nd MCP joints. In the multivariable analysis, MCP OA was associated with older age (OR 1.05, 95%CI [1.01,1.10] for each year), manual occupation (OR 3.74, 95%CI [1.21,11.54]), scaphotrapezial OA (OR 2.18, 95%CI [1.27,3.72]), and a high number of proximal interphalangeal joints with radiographic OA. MCP OA was not associated with metabolic syndrome or HOA symptoms. CONCLUSION In this cross-sectional study using a hospital-based HOA cohort, radiographic MCP OA was frequent and associated with structural HOA features rather than with symptom severity. Our results suggest that the involvement of MCP joints in HOA is predominantly related to mechanical rather than systemic factors in this population.
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Affiliation(s)
- Inès Kouki
- Sorbonne University, Department of Rheumatology, Saint-Antoine Hospital, CRSA Inserm UMRS_938, Paris, 75012, France
| | - Sophie Tuffet
- Sorbonne University, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Saint-Antoine Hospital, Paris, 75012, France
| | - Michel D Crema
- Institut d'Imagerie du Sport, Institut National du Sport, 'Expertise et de la Performance (INSEP), Paris, 75012, France
| | - Alexandra Rousseau
- Sorbonne University, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Saint-Antoine Hospital, Paris, 75012, France
| | - Pascal Richette
- University of Paris, Department of Rheumatology, Lariboisière Hospital, Paris, 75010, France
| | - Maxime Dougados
- University of Paris, Department of Rheumatology, Cochin Hospital, INSERM (U1153), Clinical epidemiology and biostatistics, PRES Sorbonne Paris-Cité, Paris, 75014, France
| | - Francis Berenbaum
- Sorbonne University, Department of Rheumatology, Saint-Antoine Hospital, CRSA Inserm UMRS_938, Paris, 75012, France
| | - Jérémie Sellam
- Sorbonne University, Department of Rheumatology, Saint-Antoine Hospital, CRSA Inserm UMRS_938, Paris, 75012, France
| | - Alice Courties
- Sorbonne University, Department of Rheumatology, Saint-Antoine Hospital, CRSA Inserm UMRS_938, Paris, 75012, France
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Ferrero S, Wittoek R, Allado E, Cruzel C, Fontas E, Breuil V, Ziegler L, Kremer J, Loeuille D, Roux CH. Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial. Semin Arthritis Rheum 2021; 51:831-838. [PMID: 34157578 DOI: 10.1016/j.semarthrit.2021.04.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2021] [Revised: 04/13/2021] [Accepted: 04/27/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To examine the effect of methotrexate (MTX) on pain and structural progression in symptomatic erosive hand osteoarthritis (HOA). METHODS This 1-year prospective, single-centre, randomised, double-blind, placebo-controlled study (www.ClinicalTrial.gov, NCT01068405) followed up patients with symptomatic erosive HOA. Patients were randomised into two groups based on the drug that was administered: 10 mg methotrexate (MTX) per week or a placebo. The primary endpoint was the change in pain (determined using a visual analogue scale [VAS]) from baseline to 3 months. The secondary endpoints were pain VAS score at 12 months, clinical features (pain VAS score and function), radiographic features (the anatomical radiographic Verbruggen-Veys [VV] score and Gent University Score System), and magnetic resonance imaging (MRI) at 12 months. RESULTS Sixty-four patients with HOA were randomised into either the placebo or MTX group. At 3 months, there was no significant difference in the mean decrease in the pain VAS score (mm) (MTX: 21.1 [standard deviation, 27.4], placebo: 11.7 [24.3]; p = 0.2). At 12 months, according to the VV score, erosive joints progressed significantly more to a remodelling phase in the MTX group than in the placebo group (27% vs 15%; p = 0.03). Joints with space loss appeared to be eroding less in the MTX group compared to the placebo group (8% vs 29%; p = 0.2). Synovitis on MRI at baseline could be associated with the erosive structural evolution of non-erosive joints (p = 0.02). CONCLUSIONS Weekly doses of 10-mg MTX showed no superiority over the placebo in terms of pain relief at 3 or 12 months. CLINICAL TRIAL REGISTRATION NUMBER This study was registered at www.ClinicalTrial.gov (NCT01068405).
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Affiliation(s)
- Stéphanie Ferrero
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Cote d'Azur University, Nice F-06000, France.
| | - Ruth Wittoek
- Department of Rheumatology, Faculty of Medicine and Health Sciences, Ghent University, Ghent University Hospital, C. Heymanslaan 10, 9000 Ghent, Belgium
| | - Edem Allado
- Center of Sports Medicine and Adapted Physical Activity, University, Hospital of Nancy, Nancy F-54000, France
| | - Coralie Cruzel
- Department of Clinical Research, Cimiez Hospital, Nice University Hospital, Nice F-06000, France
| | - Eric Fontas
- Department of Clinical Research, Cimiez Hospital, Nice University Hospital, Nice F-06000, France
| | - Veronique Breuil
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Cote d'Azur University, Nice F-06000, France
| | - Liana Ziegler
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Cote d'Azur University, Nice F-06000, France
| | - Joel Kremer
- Department of Rheumatology, Albany Medical Center, Albany, NY, USA
| | - Damien Loeuille
- Department of Rheumatology, University Hospital of Nancy, Nancy F-54000, France
| | - Christian H Roux
- Department of Rheumatology, Pasteur Hospital, Nice University Hospital, Cote d'Azur University, Nice F-06000, France; Department of Rheumatology, University of Cote d'Azur, Nice Hospital, Laboratory LAMHESS, EA6312, IBV CNRS IMR 7277 INSERM U1091 UNS, France
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Duarte-Salazar C, Marín-Arriaga N, Miranda-Duarte A. The High Clinical Burden of Erosive Hand Osteoarthritis is Associated with Clinical Findings, Pain, and Radiographic Severity. REUMATOLOGIA CLINICA 2021; 18:S1699-258X(21)00087-5. [PMID: 33875393 DOI: 10.1016/j.reuma.2021.03.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Revised: 02/17/2021] [Accepted: 03/04/2021] [Indexed: 11/18/2022]
Abstract
Varying reports exist on the clinical impact of erosive hand osteoarthritis (EHOA) in terms of pain and articular function. Few studies have assessed the association of a patient's clinical features with the presence of more severe radiographic disease. The aim was to evaluate clinical and radiographic characteristics in EHOA comparing with non-erosive (NEHOA); to examine pain and functional impairment between EHOA and NEHOA; and correlate functional impairment with clinical findings, pain, and radiographic severity. METHODS 62 patients with EHOA and 57 with NEHO were included. Pain was assessed through Visual Analogue Scale (VAS) and Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain. Functioning was evaluated with the Health Assessment Questionnaire (HAQ) concerning hand function and AUSCAN. Radiographs were scored with the Kallman scale and subchondral erosions with the Verbruggen-Veys method. Student t-tests were used for comparing quantitative data, chi-squared tests for categorical variables, and Pearson or Spearman tests for assessing correlation. RESULTS Patients with EHOA reported significantly higher levels of pain on the VAS and AUSCAN (p<0.01). In EHOA, VAS positively correlated with the HAQ and AUSCAN scales (rho=0.68 and 0.77). In NEHOA, Visual Analogue Scale (VAS) positively and strongly correlated with HAQ and AUSCAN (rho=0.84 and 0.89). Nodes, Kallman score and erosions showed a positive but weak correlation with HAQ and AUSCAN in both groups. CONCLUSION Both EHOA and NEHOA participants had functional impairment, but the erosive subtype had higher clinical burden and increased joint damage. This higher clinical burden is attributed mainly to pain.
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Affiliation(s)
- Carolina Duarte-Salazar
- Departamento de Reumatología, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico.
| | - Norma Marín-Arriaga
- Departamento de Imagenología y Servicio de Resonancia Magnética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
| | - Antonio Miranda-Duarte
- Departamento de Genética, Instituto Nacional de Rehabilitación "Luis Guillermo Ibarra Ibarra", Mexico City, Mexico
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McAlindon TE, Driban JB, Roberts MB, Duryea J, Haugen IK, Schaefer LF, Smith SE, Mathiessen A, Eaton C. Erosive Hand Osteoarthritis: Incidence and Predictive Characteristics among Participants in the Osteoarthritis Initiative. Arthritis Rheumatol 2021; 73:2015-2024. [PMID: 33844453 DOI: 10.1002/art.41757] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 04/01/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To evaluate age, sex, race, osteoarthritis severity, metabolic factors, and bone health as risk factors for incident erosive hand osteoarthritis (EHOA) at baseline and over 48-month period. METHODS This study was a longitudinal cohort design including participants from the Osteoarthritis Initiative with complete hand radiographs from baseline and 48-month visits who were eligible at baseline for incident EHOA. Individuals were classified as having EHOA if they had Kellgren-Lawrence (KL) grade≥2 in at least one interphalangeal joint on two different fingers and central erosion in at least one joint. RESULTS Of the 3365 individuals identified without prevalent EHOA at baseline, 86 (2.6%) developed EHOA during the 48-month period. Risk factors included being older [relative risk (RR) per standard deviation=0.76 (95% confidence interval 0.59, 0.98)], female [RR=1.73 (1.05, 2.85)], greater osteoarthritis severity (sum of KL grade 13.9 vs. 5.3, p<0.001) and less cortical width (1.38 vs 1.52 mm, p<0.001). After 48 months, people who developed EHOA were characterized by greater progressions of radiographic osteoarthritis (i.e., joint space narrowing, KL grade progression [RRs = 1.35 to 1.9] and loss of cortical thickness [RR = 1.23], adjusted for age, sex, race, body mass index, and baseline osteoarthritis severity (sum KL scores). CONCLUSION These findings present EHOA as a disorder of advanced age and female sex, strongly associated with severity of articular structural damage and its progression. Individuals who develop EHOA have thinner bones prior to EHOA development and as it progresses, suggesting EHOA as a disorder of skeletal frailty.
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Affiliation(s)
- Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA
| | - Mary B Roberts
- Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, RI, USA
| | - Jeffrey Duryea
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Lena F Schaefer
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Stacy E Smith
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alexander Mathiessen
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.,Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Charles Eaton
- Care New England Medical Group/Primary Care and Specialty Services, Pawtucket, RI, USA
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Sellam J, Maheu E, Crema MD, Touati A, Courties A, Tuffet S, Rousseau A, Chevalier X, Combe B, Dougados M, Fautrel B, Kloppenburg M, Laredo JD, Loeuille D, Miquel A, Rannou F, Richette P, Simon T, Berenbaum F. The DIGICOD cohort: A hospital-based observational prospective cohort of patients with hand osteoarthritis - methodology and baseline characteristics of the population. Joint Bone Spine 2021; 88:105171. [PMID: 33689840 DOI: 10.1016/j.jbspin.2021.105171] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 02/17/2021] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Despite its prevalence, there are few worldwide hand osteoarthritis (HOA) cohorts. The main objective of DIGItal COhort Design (DIGICOD) cohort is to investigate prognostic clinical, biological, genetic and imaging factors of clinical worsening after 6years follow-up. METHODS DIGICOD is a hospital-based prospective cohort including patients>35years-old with symptomatic HOA fulfilling: (i) ACR criteria for HOA with≥2 symptomatic joints among proximal/distal interphalangeal joints or 1st interphalangeal joint with Kellgren-Lawrence (KL)≥2; or (ii) symptomatic thumb base OA with KL≥2. Main exclusion criteria were inflammatory arthritis and crystal arthropathies. Annual clinical evaluations were scheduled with imaging (X-rays of the hands and of other OA symptomatic joints) and biological sampling every 3years. Hand radiographs are scored using KL and anatomical Verbruggen-Veys scores. Follow-up visits are ongoing. Cohort methodology and baseline characteristics are presented. RESULTS Between April 2013 and June 2017, from the 436 HOA included patients, 426 have been analysed of whom 357 (84%) are women. Mean age±standard deviation was 66.7±7.3years and mean disease duration was 12.6±9.6years. Metabolic syndrome affected 151 (36.5%) patients. Mean Visual Analog Scale (VAS) hand pain (0-100mm) was 44.4±26.7mm at activity. Mean FIHOA (0-100) was 19.9±18.6. Elevated serum CRP level (≥5mg/L) involved 10% patients. Mean KL score (0-128) was 46.7±18 and the mean number of joint with KL≥2 was 15.1±6.3. Erosive HOA (defined as≥1 Erosive or Remodeling phase joint according to Verbruggen-Veys score) involved 195/426 (45.8%) patients and the median number (interquartile range) of erosive joints in erosive patients was 3.0 (1.0-5.0). CONCLUSION DIGICOD is a unique prospective HOA cohort with a long-term 6years standardized assessment and has included severe radiologically HOA patients with a high prevalence of erosive disease.
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Affiliation(s)
- Jérémie Sellam
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France; Centre de Recherche Saint-Antoine, Inserm URMS_938, Paris, France
| | - Emmanuel Maheu
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France
| | - Michel D Crema
- Institut d'Imagerie du Sport, Institut National du Sport, de l'Expertise et de la Performance (INSEP), Paris, France
| | - Amel Touati
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Alice Courties
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France; Centre de Recherche Saint-Antoine, Inserm URMS_938, Paris, France
| | - Sophie Tuffet
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Alexandra Rousseau
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Xavier Chevalier
- AP-HP, UPEC, Service de rhumatologie, Hôpital Henri-Mondor, Paris, France
| | - Bernard Combe
- Département de rhumatologie, CHU, Université de Montpellier, Montpellier, France
| | - Maxime Dougados
- AP-HP, Service de rhumatologie, Université de Paris, Service de rhumatologie, Hôpital Cochin, Paris, France
| | - Bruno Fautrel
- AP-HP, Sorbonne Université, Service de rhumatologie, Hôpital Pitié-Salpêtrière, Paris, France
| | - Margreet Kloppenburg
- Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Jean-Denis Laredo
- Service de radiologie, Université de Paris, Hôpital Lariboisière, Paris, France
| | | | - Anne Miquel
- AP-HP, Sorbonne Université, Service de radiologie, Hôpital Saint-Antoine, Paris, France
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, AP-HP, Centre-Université de Paris, Hôpital Cochin, Paris, France; Université de Paris, Faculté de Santé, UFR de Médecine, Université de Paris, 75006 Paris, France; INSERM UMRS-1124, Toxicité Environnementale, Cibles Thérapeutiques, Signalisation Cellulaire et Biomarqueurs (T3S), Campus Saint-Germain-des-Prés, Paris, France
| | - Pascal Richette
- AP-HP, Université de Paris, Service de rhumatologie, Hôpital Lariboisière, Paris, France
| | - Tabassome Simon
- AP-HP, Sorbonne Université, Service de Pharmacologie Clinique et Plateforme de Recherche Clinique de l'Est Parisien (URCEST, CRB, CRC), Hôpital Saint-Antoine, Paris, France
| | - Francis Berenbaum
- Assistance Publique-Hôpitaux de Paris (AP-HP), Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Paris, France; Centre de Recherche Saint-Antoine, Inserm URMS_938, Paris, France.
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26
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Neuprez A, Kaux JF, Locquet M, Beaudart C, Reginster JY. The presence of erosive joints is a strong predictor of radiological progression in hand osteoarthritis: results of a 2-year prospective follow-up of the Liège Hand Osteoarthritis Cohort (LIHOC). Arthritis Res Ther 2021; 23:12. [PMID: 33407767 PMCID: PMC7788934 DOI: 10.1186/s13075-020-02390-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2020] [Accepted: 12/09/2020] [Indexed: 11/10/2022] Open
Abstract
Background This study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course. Methods Two hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression. Results After 2 years, all radiographic scores deteriorated significantly in the study population (p < 0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p < 0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p < 0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p < 0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p < 0.01). Conclusions Evidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-020-02390-x.
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Affiliation(s)
- Audrey Neuprez
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium. .,Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium.
| | - Jean-François Kaux
- Rehabilitation and Sports Traumatology Department, University and University Hospital of Liège, Liège, Belgium
| | - Médéa Locquet
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium
| | - Charlotte Beaudart
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics University of Liège, WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Agin, Liège, Belgium.,Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
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27
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Shapiro LM, McQuillan TJ, Kerkhof FD, Ladd A. Radiographic Progression of Thumb CMC Osteoarthritis: A Systematic Review. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:343-348. [PMID: 35415524 PMCID: PMC8991744 DOI: 10.1016/j.jhsg.2020.09.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2020] [Accepted: 09/02/2020] [Indexed: 11/19/2022] Open
Affiliation(s)
- Lauren M. Shapiro
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
- Corresponding author: Lauren M. Shapiro, MD, Department of Orthopaedic Surgery, Stanford University, 450 Broadway Street, Redwood City, CA 94603.
| | | | - Faes D. Kerkhof
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
| | - Amy Ladd
- Department of Orthopaedic Surgery, Stanford University, Redwood City, CA
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28
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Vanhaverbeke T, Pardaens L, Wittoek R. Natural disease progression in finger osteoarthritis: results from a 10 year follow-up cohort. Scand J Rheumatol 2020; 49:498-504. [DOI: 10.1080/03009742.2020.1771762] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- T Vanhaverbeke
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - L Pardaens
- Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium
| | - R Wittoek
- Department of Internal Medicine and Pediatrics, Ghent University, Ghent, Belgium
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
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Staats K, Sunk IG, Weidekamm C, Kerschbaumer A, Bécède M, Supp G, Stamm T, Windhager R, Smolen JS, Bobacz K. Hand X-ray examination in two planes is not required for radiographic assessment of hand osteoarthritis. Ther Adv Musculoskelet Dis 2020; 12:1759720X20934934. [PMID: 32655702 PMCID: PMC7333491 DOI: 10.1177/1759720x20934934] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 05/07/2020] [Indexed: 11/16/2022] Open
Abstract
AIMS Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA. METHODS The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann-Whitney tests were implemented. RESULTS The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints. CONCLUSION This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes.
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Affiliation(s)
- Kevin Staats
- Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Ilse-Gerlinde Sunk
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Claudia Weidekamm
- Department of Radiology and Nuclear medicine, Medical University of Vienna, Vienna, Austria
| | - Andreas Kerschbaumer
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Manuel Bécède
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Gabriela Supp
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Tanja Stamm
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Reinhard Windhager
- Department of Orthopedic Surgery, Medical University of Vienna, Vienna, Austria
| | - Josef S. Smolen
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Klaus Bobacz
- Department of Internal Medicine III, Division of Rheumatology, Medical University of Vienna, Waehringer Guertel 18–20, Vienna, 1090, Austria
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30
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Assessment of structural lesions, synovitis and bone marrow lesions in erosive hand osteoarthritis on MRI (0.3T) compared to the radiographic anatomical Verbruggen-Veys score. PLoS One 2020; 15:e0234972. [PMID: 32574222 PMCID: PMC7310719 DOI: 10.1371/journal.pone.0234972] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 06/05/2020] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE To evaluate prevalence of structural lesions, synovitis and bone marrow lesions (BMLs) on MRI performed with a 0.3T imaging system in patients with erosive hand osteoarthritis (EHOA) and to compare them to the anatomic radiographic Verbruggen-Veys score (VV). DESIGN For this Cross-sectional study, fifty-five EHOA patients were studied with 0.3T contrast-enhanced MRI and radiography (RX) of their dominant hand. Structural lesions were scored according to the OMERACT Hand Osteoarthritis MRI Scoring System as follows: osteophytes and erosions were graded from 0 to 3. On joint destruction lesion synovitis and BMLs were graded from 0 to 1. And on MRI, we evaluated the presence of several structural features: N: normal, O: osteophytic lesions, E: erosive lesions, E/O: osteophytic and erosive lesions and D: joint destruction. RX was scored according to the VV system. Relations between MRI features and VV stages were analysed. RESULTS MRI identified more structural lesions than RX (77.3% versus 74.8%) and particularly more erosive lesions (E or E/O) than VV Phase E (33.5% versus 20.2%). E/O and D were mostly found on MRI. Synovitis and BMLs were significantly associated with E/O and D with the following odds ratios (ORs): 8.4 (95% CI 1.8-13.6); OR: 13.7 (95% CI 2.9-21.0); OR: 15.7 (95% CI 3.2-23.5); OR: 38.5 (95% CI 9.5-57.0), respectively. CONCLUSION MRI 0.3T appears completely relevant for EHOA lesion analysis. First, MRI shows more erosive lesions than RX in EHOA; second, it allows for the analysis of synovitis and BMLs to be associated with more specific structural MRI features (E/O and D).
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Steen Pettersen P, Neogi T, Magnusson K, Hammer HB, Uhlig T, Kvien TK, Haugen IK. Associations Between Radiographic and Ultrasound-Detected Features in Hand Osteoarthritis and Local Pressure Pain Thresholds. Arthritis Rheumatol 2020; 72:966-971. [PMID: 31904188 PMCID: PMC10478785 DOI: 10.1002/art.41199] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2019] [Accepted: 12/31/2019] [Indexed: 01/01/2023]
Abstract
OBJECTIVE Pain sensitization contributes to the complex osteoarthritis (OA) pain experience. The relationship between imaging features of hand OA and clinically assessed pain sensitization is largely unexplored. This study was undertaken to examine the association of structural and inflammatory features of hand OA with local pressure pain thresholds (PPTs) in the Nor-Hand study. METHODS The cross-sectional relationship of severity of structural radiographic features of hand OA (measured according to the Kellgren/Lawrence scale [grade 0-4] and the absence or presence of erosive joint disease) as well as ultrasound-detected hand joint inflammation (assessed by gray-scale synovitis [grade 0-3] and the absence or presence of power Doppler activity) to the PPTs of 2 finger joints was examined by multilevel regression analyses adjusted for age, sex, and body mass index, using beta values with 95% confidence intervals (95% CIs). RESULTS A total of 570 joints in 285 participants included in the Nor-Hand study were assessed. Greater structural and inflammatory severity was associated with lower PPTs, with adjusted beta values of -0.5 (95% CI -0.6, -0.4) per Kellgren/Lawrence grade increase, -1.4 (95% CI -1.8, -0.9) for erosive versus non-erosive joints, -0.7 (95% CI -0.9, -0.6) per gray-scale synovitis grade increase, and -1.5 (95% CI -1.8, -1.1) for joints with power Doppler activity on ultrasound versus those without. CONCLUSION Greater severity of structural pathologic features and hand joint inflammation was associated with lower PPTs in the finger joints of patients with hand OA, indicating pain sensitization. Our results indicate that pain sensitization might be driven by structural and inflammatory pathology in hand OA.
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Affiliation(s)
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Karin Magnusson
- Diakonhjemmet Hospital, Oslo, Norway, and Lund University, Lund, Sweden
| | | | - Till Uhlig
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | - Ida K Haugen
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
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Roux CH, Pisani DF, Gillet P, Fontas E, Yahia HB, Djedaini M, Ambrosetti D, Michiels JF, Panaia-Ferrari P, Breuil V, Pinzano A, Amri EZ. Oxytocin Controls Chondrogenesis and Correlates with Osteoarthritis. Int J Mol Sci 2020; 21:ijms21113966. [PMID: 32486506 PMCID: PMC7312425 DOI: 10.3390/ijms21113966] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2020] [Revised: 05/22/2020] [Accepted: 05/26/2020] [Indexed: 12/12/2022] Open
Abstract
This study investigated the relationship of oxytocin (OT) to chondrogenesis and osteoarthritis (OA). Human bone marrow and multipotent adipose-derived stem cells were cultured in vitro in the absence or presence of OT and assayed for mRNA transcript expression along with histological and immunohistochemical analyses. To study the effects of OT in OA in vivo, a rat model and a human cohort of 63 men and 19 women with hand OA and healthy controls, respectively, were used. The baseline circulating OT, interleukin-6, leptin, and oestradiol levels were measured, and hand X-ray examinations were performed for each subject. OT induced increased aggrecan, collagen (Col) X, and cartilage oligomeric matrix protein mRNA transcript levels in vitro, and the immunolabelling experiments revealed a normalization of Sox9 and Col II protein expression levels. No histological differences in lesion severity were observed between rat OA groups. In the clinical study, a multivariate analysis adjusted for age, body mass index, and leptin levels revealed a significant association between OA and lower levels of OT (odds ratio = 0.77; p = 0.012). Serum OT levels are reduced in patients with hand OA, and OT showed a stimulatory effect on chondrogenesis. Thus, OT may contribute to the pathophysiology of OA.
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Affiliation(s)
- Christian H. Roux
- Université Côte d’Azur, French National Centre for Scientific Research (CNRS), Inserm, iBV, 06107 Nice, France; (H.B.Y.); (M.D.)
- Department of Rheumatology, Nice University Hospital, Pasteur Hospital, 06003 Nice, France;
- Correspondence: (C.H.R.); (E.-Z.A.); Tel.: +33-492-03-54-99 (C.H.R.); +33-493-37-7082 (E.-Z.A.)
| | | | - Pierre Gillet
- UMR 7365 French National Centre for Scientific Research (CNRS)–Université de Lorraine, ‘Ingénierie Moléculaire et Physiopathologie Articulaire’ (IMoPA), F54505 Vandoeuvre-lès-Nancy, France; (P.G.); (A.P.)
| | - Eric Fontas
- Department of Clinical Research, Nice University Hospital, Cimiez Hospital, F-06003 Nice, France;
| | - Hédi Ben Yahia
- Université Côte d’Azur, French National Centre for Scientific Research (CNRS), Inserm, iBV, 06107 Nice, France; (H.B.Y.); (M.D.)
| | - Mansour Djedaini
- Université Côte d’Azur, French National Centre for Scientific Research (CNRS), Inserm, iBV, 06107 Nice, France; (H.B.Y.); (M.D.)
| | - Damien Ambrosetti
- Université Côte d’Azur, UFR Médecine, F-06107 Nice, France; (D.A.); (J.-F.M.)
- Anatomopathology Service, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, F-06003 Nice, France
| | - Jean-François Michiels
- Université Côte d’Azur, UFR Médecine, F-06107 Nice, France; (D.A.); (J.-F.M.)
- Anatomopathology Service, Pasteur Hospital, Centre Hospitalier Universitaire de Nice, F-06003 Nice, France
| | | | - Véronique Breuil
- Department of Rheumatology, Nice University Hospital, Pasteur Hospital, 06003 Nice, France;
| | - Astrid Pinzano
- UMR 7365 French National Centre for Scientific Research (CNRS)–Université de Lorraine, ‘Ingénierie Moléculaire et Physiopathologie Articulaire’ (IMoPA), F54505 Vandoeuvre-lès-Nancy, France; (P.G.); (A.P.)
| | - Ez-Zoubir Amri
- Université Côte d’Azur, French National Centre for Scientific Research (CNRS), Inserm, iBV, 06107 Nice, France; (H.B.Y.); (M.D.)
- Correspondence: (C.H.R.); (E.-Z.A.); Tel.: +33-492-03-54-99 (C.H.R.); +33-493-37-7082 (E.-Z.A.)
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Silva PG, de Carvalho Silva F, da Rocha Corrêa Fernandes A, Natour J. Effectiveness of Nighttime Orthoses in Controlling Pain for Women With Hand Osteoarthritis: A Randomized Controlled Trial. Am J Occup Ther 2020; 74:7403205080p1-7403205080p10. [PMID: 32365314 DOI: 10.5014/ajot.2020.033621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
IMPORTANCE Hand osteoarthritis is a musculoskeletal problem that is associated with hand pain, stiffness, functional limitation, decreased grip strength, and reduced quality of life. OBJECTIVE To evaluate the effectiveness of nighttime orthoses on the second or third finger of the dominant hand in controlling pain in women with symptomatic osteoarthritis (OA) in the interphalangeal joint. DESIGN Randomized controlled trial. SETTING Outpatient clinic. PARTICIPANTS Fifty-two women with symptomatic OA and presence of Heberden's and Bouchard's nodes, allocated randomly to the intervention group or the control group. INTERVENTION The intervention group used a nighttime orthosis on the second or third finger of the dominant hand. Both groups participated in an educational session. OUTCOMES AND MEASURES The following parameters were measured: pain (numerical rating scale, Australian/Canadian Osteoarthritis Hand Index), grip and pinch strength, function (Cochin Hand Functional Scale), and manual performance (Moberg Pick Up Test). RESULTS The intervention group showed a statistically significant improvement in pain (p < .001) and hand function. The improvement in pain correlated with Cochin Hand Functional Scale scores and the absence of Bouchard's nodes in the third finger, which are predictors of the best prognosis for treatment with a nighttime orthosis. CONCLUSIONS AND RELEVANCE This study demonstrates that nighttime orthoses are effective in reducing pain and lead to improvement in hand function in women with hand OA. They are therefore specifically recommended for nonpharmacological treatment of hand OA. WHAT THIS ARTICLE ADDS Orthoses can be considered, together with manual exercises and joint protection, as an intervention to reduce symptoms and improve hand function in people with hand OA. This study is an important step in empowering occupational therapists to determine appropriate and effective intervention for clients with OA.
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Affiliation(s)
- Paula Gabriel Silva
- Paula Gabriel Silva, PhD, OT, is Occupational Therapist, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Fabiana de Carvalho Silva
- Fabiana de Carvalho Silva, MsC, PT, is Physical Therapist, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Artur da Rocha Corrêa Fernandes
- Artur da Rocha Corrêa Fernandes, MD, PhD, is Physician, Department of Diagnostic Imaging, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil
| | - Jamil Natour
- Jamil Natour, MD, PhD, is Physician, Rheumatology Division, Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil;
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Maugesten Ø, Mathiessen A, Hammer HB, Hestetun SV, Kvien TK, Uhlig T, Ohrndorf S, Haugen IK. Validity and diagnostic performance of fluorescence optical imaging measuring synovitis in hand osteoarthritis: baseline results from the Nor-Hand cohort. Arthritis Res Ther 2020; 22:98. [PMID: 32357904 PMCID: PMC7193370 DOI: 10.1186/s13075-020-02185-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 04/13/2020] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE Fluorescence optical imaging (FOI) demonstrates enhanced microcirculation in finger joints as a sign of inflammation. We wanted to assess the validity and diagnostic performance of FOI measuring synovitis in persons with hand OA, comparing it with magnetic resonance imaging (MRI)- and ultrasound-detected synovitis. METHODS Two hundred and twenty-one participants with hand OA underwent FOI and ultrasound (gray-scale synovitis and power Doppler activity) of the bilateral hands and contrast-enhanced MRI examination of the dominant hand. Fifteen joints in each hand were scored on semi-quantitative scales (grade 0-3) for all modalities. Four FOI images were evaluated: one composite image (Prima Vista Mode (PVM)) and three images representing phases of fluorescent dye distribution. Spearman's correlation coefficients were calculated between sum scores of FOI, MRI, and ultrasound. Sensitivity, specificity, and area under the curve (AUC) were calculated for FOI using MRI or ultrasound as reference. RESULTS FOI did not demonstrate enhancement in the thumb base, and the joint was excluded from further analyses. FOI sum scores showed poor to fair correlations with MRI (rho 0.01-0.24) and GS synovitis sum scores (rho 0.12-0.25). None of the FOI images demonstrated both good sensitivity and specificity, and the AUC ranged from 0.50-0.61 and 0.51-0.63 with MRI and GS synovitis as reference, respectively. FOI demonstrated similar diagnostic performance with PD activity and GS synovitis as reference. CONCLUSION FOI enhancement correlated poorly with synovitis assessed by more established imaging modalities, questioning the value of FOI for the evaluation of synovitis in hand OA.
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Affiliation(s)
- Øystein Maugesten
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway.
- Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Alexander Mathiessen
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
| | - Hilde Berner Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sigrid Valen Hestetun
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
| | - Tore Kristian Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Sarah Ohrndorf
- Department of Rheumatology and Clinical Immunology, Charite Universitatsmedizin Berlin, Berlin, Germany
| | - Ida Kristin Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Diakonveien 12, 0370, Oslo, Norway
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Xu QX, Wittoek R. Influence of non-steroidal anti-inflammatory drugs on the inflammatory sonographic features in erosive hand osteoarthritis: an intervention study. Rheumatol Adv Pract 2020; 4:rkaa002. [PMID: 32099954 PMCID: PMC7032542 DOI: 10.1093/rap/rkaa002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2019] [Revised: 12/26/2019] [Indexed: 11/14/2022] Open
Abstract
Objective The aim was to examine whether inflammatory US features in erosive hand OA patients change when discontinuing intake of NSAIDs before US examination in a non-randomized study. Methods Patients (n = 99) were allocated to the NSAIDs or control group according to their intake at baseline. US was performed at baseline (T0) and 2 weeks after discontinuation of NSAIDs (T1). Inflammatory features (i.e. synovial proliferation, effusion and power Doppler signal) were scored using a semi-quantitative scale (from zero to three). Pain levels were scored on a numerical rating scale. Binomial mixed models were fitted for US features, and odds ratios of having a US score of at least two vs at most one for synovial proliferation and effusion, and zero vs at least one for power Doppler were calculated. Results At baseline, both groups [NSAIDs group (n = 47) vs control group (n = 52)] were comparable for numerical rating scale pain, disease duration, number of radiographically affected joints, BMI and US baseline data, but not for age (P = 0.005). At T1, more synovial proliferation and power Doppler signal was seen compared with T0 in the NSAIDs group (P = 0.018 and 0.031, respectively). However, the interaction term time*NSAIDs was not found to be significant for any variable. The numerical rating scale pain at T1 was higher compared with baseline, although statistically non-significant. Conclusion No significant changes in inflammatory US features were seen in patients with erosive hand OA after withdrawal of NSAIDs for 2 weeks. This study suggests that an NSAID-free period is not necessary before assessing inflammatory disease activity in erosive hand OA.
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Affiliation(s)
- Qun Xia Xu
- Faculty of Health Sciences and Medicine, Ghent University
| | - Ruth Wittoek
- Department of Internal Medicine, Rheumatology, Ghent University Hospital, Ghent University, Ghent, Belgium
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Kroon FPB, Kortekaas MC, Boonen A, Böhringer S, Reijnierse M, Rosendaal FR, Riyazi N, Starmans M, Turkstra F, van Zeben J, Allaart CF, Kloppenburg M. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial. Lancet 2019; 394:1993-2001. [PMID: 31727410 DOI: 10.1016/s0140-6736(19)32489-4] [Citation(s) in RCA: 74] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 09/28/2019] [Accepted: 10/15/2019] [Indexed: 01/05/2023]
Abstract
BACKGROUND Hand osteoarthritis is a prevalent joint condition that has a high burden of disease and an unmet medical need for effective therapeutic options. Since local inflammation is recognised as contributing to osteoarthritic complaints, the Hand Osteoarthritis Prednisolone Efficacy (HOPE) study aimed to investigate the efficacy and safety of short-term prednisolone in patients with painful hand osteoarthritis and synovial inflammation. METHODS The HOPE study is a double-blind, randomised, placebo-controlled trial. We recruited eligible adults from rheumatology outpatient clinics at two sites in the Netherlands. Patients were considered eligible if they had symptomatic hand osteoarthritis and signs of inflammation in their distal and proximal interphalangeal (DIP/PIP) joints. For inclusion, patients were required to have four or more DIP/PIP joints with osteoarthritic nodes; at least one DIP/PIP joint with soft swelling or erythema; at least one DIP/PIP joint with a positive power Doppler signal or synovial thickening of at least grade 2 on ultrasound; and finger pain of at least 30 mm on a 100-mm visual analogue scale (VAS) that flared up during a 48-h non-steroidal anti-inflammatory drug (NSAID) washout (defined as worsening of finger pain by at least 20 mm on the VAS). Eligible patients were randomly assigned (1:1) to receive 10 mg prednisolone or placebo orally once daily for 6 weeks, followed by a 2-week tapering scheme, and a 6-week follow-up without study medication. The patients and study team were masked to treatment assignment. The primary endpoint was finger pain, assessed on a VAS, at 6 weeks in participants who had been randomly assigned to groups and attended the baseline visit. This study is registered with the Netherlands Trial Registry, number NTR5263. FINDINGS We screened patients for enrolment between Dec 3, 2015, and May 31, 2018. Patients completed baseline visits and started treatment between Dec 14, 2015, and July 2, 2018, and the last study visit of the last patient was Oct 4, 2018. Of 149 patients assessed for eligibility, 57 (38%) patients were excluded (predominantly because they did not meet one or several inclusion criteria, most often because of an absence of synovial inflammation or of flare-ups after NSAID washout) and 92 (62%) patients were eligible for inclusion. We randomly assigned 46 (50%) patients to receive prednisolone and 46 (50%) patients to receive placebo, all of whom were included in the modified intention-to-treat analysis of the primary endpoint. 42 (91%) patients in the prednisolone group and 42 (91%) in the placebo group completed the 14-week study. The mean change between baseline and week 6 on VAS-reported finger pain was -21·5 (SD 21·7) in the prednisolone group and -5·2 (24·3) in the placebo group, with a mean between-group difference (of prednisolone vs placebo) of -16·5 (95% CI -26·1 to -6·9; p=0·0007). The number of non-serious adverse events was similar between the groups. Five serious adverse events were reported during our study: one serious adverse event in the prednisolone group (a myocardial infarction) and four serious adverse events in the placebo group (an infected traumatic leg haematoma that required surgery, bowel surgery, atrial fibrillation that required a pacemaker implantation, and symptomatic uterine myomas that required a hysterectomy). Four (4%) patients discontinued the study because of an adverse event: one (2%) patient receiving prednisolone (for a myocardial infarction) and three (7%) patients receiving placebo (for surgery of the bowel and for an infected leg haematoma and for Lyme disease arthritis of the knee). INTERPRETATION Treatment with 10 mg prednisolone for 6 weeks is efficacious and safe for the treatment of patients with painful hand osteoarthritis and signs of inflammation. The results of our study provide clinicians with a new short-term treatment option for patients with hand osteoarthritis who report a flare-up of their disease. FUNDING Dutch Arthritis Society.
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Affiliation(s)
- Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands.
| | - Marion C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Annelies Boonen
- Department of Medicine, Division of Rheumatology, Maastricht University Medical Center and Care and Public Health Research Institute, Maastricht University, Maastricht, Netherlands
| | - Stefan Böhringer
- Department of Biomedical Data Sciences, Medical Statistics Section, Leiden University Medical Center, Leiden, Netherlands
| | - Monique Reijnierse
- Department of Radiology, Leiden University Medical Center, Leiden, Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
| | - Naghmeh Riyazi
- Department of Rheumatology, Haga Hospital, The Hague, Netherlands
| | - Mirian Starmans
- Department of Rheumatology, Zuyderland Medical Center, Heerlen, Netherlands
| | - Franktien Turkstra
- Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, Netherlands
| | - Jende van Zeben
- Department of Rheumatology, Sint Franciscus Vlietland Group, Rotterdam, Netherlands
| | - Cornelia F Allaart
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands
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Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management. Nat Rev Rheumatol 2019; 14:641-656. [PMID: 30305701 DOI: 10.1038/s41584-018-0095-4] [Citation(s) in RCA: 98] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Osteoarthritis (OA) is a highly prevalent condition, and the hand is the most commonly affected site. Patients with hand OA frequently report symptoms of pain, functional limitations and frustration in undertaking everyday activities. The condition presents clinically with changes to the bone, ligaments, cartilage and synovial tissue, which can be observed using radiography, ultrasonography or MRI. Hand OA is a heterogeneous disorder and is considered to be multifactorial in aetiology. This Review provides an overview of the epidemiology, presentation and burden of hand OA, including an update on hand OA imaging (including the development of novel techniques), disease mechanisms and management. In particular, areas for which new evidence has substantially changed the way we understand, consider and treat hand OA are highlighted. For example, genetic studies, clinical trials and careful prospective imaging studies from the past 5 years are beginning to provide insights into the pathogenesis of hand OA that might uncover new therapeutic targets in the disease.
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van Beest S, Damman W, Liu R, Reijnierse M, Rosendaal FR, Kloppenburg M. In finger osteoarthritis, change in synovitis is associated with change in pain on a joint-level; a longitudinal magnetic resonance imaging study. Osteoarthritis Cartilage 2019; 27:1048-1056. [PMID: 30978394 DOI: 10.1016/j.joca.2019.03.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 02/06/2019] [Accepted: 03/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate determinants of decrease and increase in joint pain in symptomatic finger osteoarthritis (OA) on magnetic resonance (MR) imaging over 2 years. DESIGN Eighty-five patients (81.2% women, mean age 59.2 years) with primary hand OA (89.4% fulfilling American College of Rheumatology (ACR) classification criteria) from a rheumatology outpatient clinic received contrast-enhanced MR imaging (1.5T) and physical examination of the right interphalangeal finger joints 2-5 at baseline and at follow-up 2 years later. MR images were scored paired in unknown time order, following the Hand OA MRI scoring system (HOAMRIS). Joint pain upon palpation was assessed by research nurses. Odds ratios (ORs; 95% confidence intervals) were estimated on joint level (n = 680), using generalized estimating equations (GEE) to account for the within patient effects. Additional adjustments were made for change in MR-defined osteophytes, synovitis, and bone marrow lesions (BMLs). RESULTS Of 116 painful joints at baseline, at follow-up: 76 had less pain, 21 less synovitis, and 13 less BMLs. A decrease in synovitis (OR = 5.9; 1.12─31.0), but not in BMLs (OR = 0.39; 0.10─1.50), was associated with less pain. Of 678 joints without maximum baseline pain, at follow-up: 115 had increased pain, 132 increased synovitis, 96 increased BMLs, and 44 increased osteophytes. Increased synovitis (OR = 1.81; 1.11─2.94), osteophytes (OR = 2.75; 1.59─4.8), but not BMLs (OR = 1.14; 0.81─1.60), was associated with increased pain. Through stratification it became apparent that BMLs were mainly acting as effect modifier of the synovitis-pain association. CONCLUSION Decrease in MR-defined synovitis is associated with reduced joint pain, identifying synovitis as a possible target for treatment of finger OA.
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Affiliation(s)
- S van Beest
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - W Damman
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - R Liu
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - M Reijnierse
- Radiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - F R Rosendaal
- Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
| | - M Kloppenburg
- Departments of Rheumatology, Leiden University Medical Center (LUMC), Leiden, the Netherlands; Clinical Epidemiology, Leiden University Medical Center (LUMC), Leiden, the Netherlands.
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An Assessment of Hand Erosive Osteoarthritis: Correlation of Radiographic Severity with Clinical, Functional and Laboratory Findings. Rheumatol Ther 2019; 6:125-133. [PMID: 30725363 PMCID: PMC6393271 DOI: 10.1007/s40744-019-0145-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2019] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The present study aimed (a) to evaluate the clinical and radiographic characteristics of hand erosive osteoarthritis (EOA) in a group of consecutive patients, (b) to correlate the severity of radiographic involvement with clinical and laboratory findings and (c) to associate the levels of pain and functional impairment with some radiographic findings. METHODS Patients with EOA were consecutively enrolled. Inclusion criteria required the American College of Rheumatology (ACR) criteria for hand osteoarthritis and the presence of at least one joint in "E" or "R" phase according to Verbruggen-Veys. For each patient, demographic and clinical data were collected including evaluation of pain and function with the Australian Canadian Osteoarthritis Hand Index (AUSCAN) scale and Health Assessment Questionnaire (HAQ). Laboratory parameters and plain radiography of both hands were also collected. Each radiograph was evaluated in accordance with the Verbruggen-Veys classification and scored with the Kallman score. RESULTS During the study period 60 patients (M/F 13:47) with EAO were enrolled. More severe radiographic disease ("E" or "R") was often found at II and III distal interphalangeal (IP) joints. In addition, Kallman score, presence of osteophytes, erosions and joint space narrowing correlated significantly with duration of symptoms, AUSCAN, pain and active joints. More severe radiographic involvement was associated with AUSCAN and with the presence of ankylosis only at proximal IP joints. CONCLUSION The present study showed that EOA is characterised by a significant correlation between radiographic involvement and some clinical characteristics of the disease. However, an impairment of joint function was mainly associated to radiological proximal IP joint involvement, but not with other symptoms such as pain.
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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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Kroon FPB, Boersma A, Boonen A, van Beest S, Damman W, van der Heijde D, Rosendaal FR, Kloppenburg M. Performance of the Michigan Hand Outcomes Questionnaire in hand osteoarthritis. Osteoarthritis Cartilage 2018; 26:1627-1635. [PMID: 30099114 DOI: 10.1016/j.joca.2018.07.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Revised: 06/27/2018] [Accepted: 07/26/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the performance of the Michigan Hand Outcomes Questionnaire (MHQ) in hand osteoarthritis (OA) by evaluating truth, discrimination and feasibility. DESIGN Symptomatic hand OA patients from the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort completed questionnaires (demographics, MHQ, Australian/Canadian Hand Osteoarthritis Index [AUSCAN], Functional Index for Hand Osteoarthritis [FIHOA] and visual analogue scale [VAS] pain) at baseline (n = 383), 1- and 2-year follow-up (n = 312, n = 293). Anchor questions at follow-up assessed whether pain/function levels were (un)acceptable and had changed compared to baseline. Correlations between MHQ and other pain/function questionnaires were calculated. Validity of unique MHQ domains (work performance, aesthetics, satisfaction), discrimination across disease stages, and responsiveness were assessed by categorizing patients by external anchors (employment, joint deformities, erosions, and anchor questions). Between-group differences were assessed with linear regression, probability plots and comparison of medians. RESULTS MHQ pain and function subscales correlated moderately-to-good with other instruments (rs 0.63-0.81). Work performance scores were worse in patients with reduced working capacity than in employed patients. Aesthetics scores were worse in patients with more deformities. Patients with unacceptable complaints had worse satisfaction scores. All pain/function instruments discriminated between patients with acceptable vs unacceptable pain/function, while only MHQ activities of daily living (ADL), FIHOA, and MHQ aesthetics could discriminate between erosive and non-erosive disease. MHQ and AUSCAN were most responsive. CONCLUSIONS MHQ has several unique aspects and advantages justifying its use in hand OA, including the unique assessment of work performance, aesthetics, and satisfaction. However, MHQ, AUSCAN and FIHOA appear to measure different aspects of pain and function.
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Affiliation(s)
- F P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - A Boersma
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - A Boonen
- Department of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - S van Beest
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - W Damman
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - D van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Kloppenburg M, Ramonda R, Bobacz K, Kwok WY, Elewaut D, Huizinga TWJ, Kroon FPB, Punzi L, Smolen JS, Vander Cruyssen B, Wolterbeek R, Verbruggen G, Wittoek R. Etanercept in patients with inflammatory hand osteoarthritis (EHOA): a multicentre, randomised, double-blind, placebo-controlled trial. Ann Rheum Dis 2018; 77:1757-1764. [DOI: 10.1136/annrheumdis-2018-213202] [Citation(s) in RCA: 74] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Revised: 08/15/2018] [Accepted: 08/31/2018] [Indexed: 01/27/2023]
Abstract
ObjectiveHand osteoarthritis is a prevalent disease with limited treatment options. Since joint inflammation is often present, we investigated tumour necrosis factor (TNF) as treatment target in patients with proven joint inflammation in a proof-of-concept study.MethodsThis 1-year, double-blind, randomised, multicentre trial (NTR1192) enrolled patients with symptomatic erosive inflammatory hand osteoarthritis. Patients flaring after non-steroidal anti-inflammatory drug washout were randomised to etanercept (24 weeks 50 mg/week, thereafter 25 mg/week) or placebo. The primary outcome was Visual Analogue Scale (VAS) pain at 24 weeks. Secondary outcomes included clinical and imaging outcomes (radiographs scored using Ghent University Scoring System (GUSS, n=54) and MRIs (n=20)).ResultsOf 90 patients randomised to etanercept (n=45) or placebo (n=45), respectively, 12 and 10 discontinued prematurely. More patients on placebo discontinued due to inefficacy (6 vs 3), but fewer due to adverse effects (1 vs 6). The mean between-group difference (MD) in VAS pain was not statistically significantly different (−5.7 (95% CI −15.9 to 4.5), p=0.27 at 24 weeks; − 8.5 (95% CI −18.6 to 1.6), p=0.10 at 1 year; favouring etanercept). In prespecified per-protocol analyses of completers with pain and inflammation at baseline (n=61), MD was −11.8 (95% CI −23.0 to −0.5) (p=0.04) at 1 year. Etanercept-treated joints showed more radiographic remodelling (delta GUSS: MD 2.9 (95% CI 0.5 to 5.4), p=0.02) and less MRI bone marrow lesions (MD −0.22 (95% CI −0.35 to −0.09), p = 0.001); this was more pronounced in joints with baseline inflammation.ConclusionAnti-TNF did not relieve pain effectively after 24 weeks in erosive osteoarthritis. Small subgroup analyses showed a signal for effects on subchondral bone in actively inflamed joints, but future studies to confirm this are warranted.
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Minten MJM, Leseman-Hoogenboom MM, Kloppenburg M, Kortekaas MC, Leer JW, Poortmans PMP, van den Hoogen FHJ, den Broeder AA, van den Ende CHM. Lack of beneficial effects of low-dose radiation therapy on hand osteoarthritis symptoms and inflammation: a randomised, blinded, sham-controlled trial. Osteoarthritis Cartilage 2018; 26:1283-1290. [PMID: 30231990 DOI: 10.1016/j.joca.2018.06.010] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 05/22/2018] [Accepted: 06/27/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Low-dose radiation therapy (LDRT) is widely used as treatment for osteoarthritis (OA) in some countries, while relatively unknown in others. Systematic literature review displayed a lack of high-level evidence for beneficial effects in clinical practice. The aim was to assess the efficacy of LDRT on symptoms and inflammation in hand OA patients in a randomised, blinded, sham-controlled trial, using validated outcome measures. DESIGN Hand OA patients, ≥50 years, with pain ≥5 (scale 0-10) and non-responding to conservative therapy were included and randomised 1:1 to receive LDRT (6 × 1 Gy in 2 weeks) or sham (6 × 0 Gy in 2 weeks). Primary outcome was the proportion of OMERACT-OARSI responders, 3 months post-intervention. Secondary outcomes were pain and functioning (Australian/Canadian Hand Osteoarthritis Index; AUSCAN), quality of life (Short Form Health Survey; SF36) and inflammatory outcomes: erythrocyte sedimentation rate and C-reactive protein serum levels, effusion, synovial thickening and power Doppler signal on ultrasound (range 0-3). RESULTS Fifty-six patients were included. After 3 months, no significant difference in responders was observed between groups (LDRT: 8 (29%); sham: 10 (36%); difference -7% (95%CI -31-17%)). Also, differences in clinical and inflammatory outcomes between groups were small and not significant. CONCLUSIONS We were unable to demonstrate a substantial beneficial effect of LDRT on symptoms and inflammation in patients with hand OA, compared to sham treatment. Although a small effect can not be excluded, a treatment effect exceeding 20% is very unlikely, given the confidence interval. Therefore, in the absence of other high-level evidence, we advise against the use LDRT as treatment for patients with hand OA. CLINICAL TRIAL REGISTRATION NUMBER NTR4574 (Dutch Trial Register).
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Affiliation(s)
- M J M Minten
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands.
| | - M M Leseman-Hoogenboom
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Flevoziekenhuis, Almere, The Netherlands.
| | - J W Leer
- Department of Radiation Oncology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - P M P Poortmans
- Department of Radiation Oncology, Institut Curie, Paris, France.
| | - F H J van den Hoogen
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - A A den Broeder
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - C H M van den Ende
- Department of Rheumatology, Sint Maartenskliniek, Nijmegen, The Netherlands; Department of Rheumatology, Radboud University Medical Center, Nijmegen, The Netherlands.
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Aitken D, Laslett LL, Pan F, Haugen IK, Otahal P, Bellamy N, Bird P, Jones G. A randomised double-blind placebo-controlled crossover trial of HUMira (adalimumab) for erosive hand OsteoaRthritis - the HUMOR trial. Osteoarthritis Cartilage 2018; 26:880-887. [PMID: 29499287 DOI: 10.1016/j.joca.2018.02.899] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 02/16/2018] [Accepted: 02/20/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To assess the efficacy of adalimumab in patients with erosive hand osteoarthritis (OA). METHOD Patients >50 years old, meeting the American College of Rheumatology (ACR) criteria for hand OA, with pain >50 on 100 mm visual analogue scale (VAS), morning stiffness >30 min and ≥1 erosive joint on X-ray with synovitis present on magnetic resonance imaging (MRI) were included in a randomised double-blind placebo-controlled crossover trial. Patients were randomised to adalimumab (40 mg subcutaneous injections every other week) or identical placebo injections for 12 weeks followed by an 8-week washout and then crossed over treatment groups for another 12 weeks. The primary outcome was change in VAS hand pain over 12 weeks. Secondary outcomes included change in Australian/Canadian Hand OA Index (AUSCAN) pain, function and stiffness subscales from baseline to 4, 8 and 12 weeks, change in MRI-detected synovitis and bone marrow lesions (BMLs) from baseline to 12 weeks and change in VAS from baseline to 4 and 8 weeks. RESULTS We recruited 51 patients and 43 were randomised to either Group 1 (N = 18, active then placebo) or Group 2 (N = 25, placebo then active). At 12 weeks there was no difference between the groups on the primary outcome measure (mean decrease in VAS pain of 3.2 mm standard deviation (SD 16.7) for adalimumab vs 0.8 mm (SD 29.6) for placebo). The adjusted treatment effect was -0.7 mm (95% confidence interval (CI) -9.3 to 8.0), P = 0.87. No statistically significant differences were found for any secondary outcomes. CONCLUSION Adalimumab did not show any effect on pain, synovitis or BMLs in patients with erosive hand OA with MRI-detected synovitis as compared to placebo after 12 weeks. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12612000791831.
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Affiliation(s)
- D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - F Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - P Otahal
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia
| | - N Bellamy
- University of Queensland School of Medicine, Brisbane, Queensland, Australia; Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - P Bird
- University of NSW, Sydney, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Australia.
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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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Kroon FPB, Damman W, Liu R, Bijsterbosch J, Meulenbelt I, van der Heijde D, Kloppenburg M. Validity, reliability, responsiveness and feasibility of four hand mobility measures in hand osteoarthritis. Rheumatology (Oxford) 2018; 57:525-532. [PMID: 29253246 DOI: 10.1093/rheumatology/kex438] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2017] [Indexed: 11/13/2022] Open
Abstract
Objectives To investigate metric properties of four hand mobility tests in hand OA patients, using the OMERACT filter. Methods Trained assessors examined the Hand Mobility in Scleroderma test (HAMIS), fingertip-to-palm distance (FPD), modified Kapandji index (MKI) and number of hand joints with limited mobility in participants from two cohorts [Genetics ARthrosis and Progression (n = 207) and Hand OSTeoArthritis in Secondary care (n = 174)]. Validity was appraised by assessment of correlations with other outcome measures, and ability to measure thumb vs finger mobility specifically, using cumulative probability plots. The proportion of participants changing in hand mobility based on the smallest detectable difference was calculated for responsiveness. Intraclass correlation coefficients (ICCs) for intra- and interobserver reliability, and feasibility (time to perform tests) were studied in a random sample (n = 20). Results Participants displayed large variation in mobility scores. Strongest correlations were observed with structural damage (rs = 0.43-0.52) and bony swelling (rs = 0.46-0.58); correlation patterns were similar among tests. HAMIS, FPD and MKI could all measure finger mobility specifically, but only HAMIS measured thumb mobility particularly. Interobserver reliability was best for HAMIS, ICC 0.90 (95% CI: 0.76, 0.96); intraobserver reliability was excellent for all (ICCs 0.94-0.97). In 2 years, little change was observed; HAMIS was the most sensitive-to-change (smallest detectable difference 3.7% of maximum score). The mean performance time ranged from 0.7 (s.d. 0.5, for FPD) to 5.7 (s.d. 1.3, for HAMIS) min. Conclusion HAMIS, FPD, MKI and number of joints with limited mobility are all valid, reliable and feasible measures for assessing hand mobility in hand OA, although HAMIS had slightly more favourable properties. Studies assessing sensitivity-to-change in a clinical trial setting are warranted.
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Affiliation(s)
- Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Wendy Damman
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Rani Liu
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Jessica Bijsterbosch
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands
| | - Ingrid Meulenbelt
- Department of Molecular Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
| | | | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
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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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Damman W, Liu R, Kroon FP, Reijnierse M, Huizinga TW, Rosendaal FR, Kloppenburg M. Do Comorbidities Play a Role in Hand Osteoarthritis Disease Burden? Data from the Hand Osteoarthritis in Secondary Care Cohort. J Rheumatol 2017; 44:1659-1666. [DOI: 10.3899/jrheum.170208] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/06/2017] [Indexed: 12/28/2022]
Abstract
Objective.Because the association and its clinical relevance between comorbidities and primary hand osteoarthritis (OA) disease burden is unclear, we studied this in patients with hand OA from our Hand OSTeoArthritis in Secondary care (HOSTAS) cohort.Methods.Cross-sectional data from the HOSTAS study were used, including consecutive patients with primary hand OA. Nineteen comorbidities were assessed: 18 self-reported (modified Charlson index and osteoporosis) and obesity (body mass index ≥ 30 kg/m2). Mean differences were estimated between patients with versus without comorbidities, adjusted for age and sex: for general disease burden [health-related quality of life (HRQOL), Medical Outcomes Study Short Form-36 physical component scale (0–100)] and disease-specific burden [self-reported hand function (0–36), pain (0–20; Australian/Canadian Hand OA Index), and tender joint count (TJC, 0–30)]. Differences above a minimal clinically important improvement/difference were considered clinically relevant.Results.The study included 538 patients (mean age 61 yrs, 86% women, 88% fulfilled American College of Rheumatology classification criteria). Mean (SD) HRQOL, function, pain, and TJC were 44.7 (8), 15.6 (9), 9.3 (4), and 4.8 (5), respectively. Any comorbidity was present in 54% (287/531) of patients and this was unfavorable [adjusted mean difference presence/absence any comorbidity (95% CI): HRQOL −4.4 (−5.8 to −3.0), function 1.9 (0.4–3.3), pain 1.4 (0.6–2.1), TJC 1.3 (0.4–2.2)]. Number of comorbidities and both musculoskeletal (e.g., connective tissue disease) and nonmusculoskeletal comorbidities (e.g., pulmonary and cardiovascular disease) were associated with disease burden. Associations with HRQOL and function were clinically relevant.Conclusion.Comorbidities showed clinically relevant associations with disease burden. Therefore, the role of comorbidities in hand OA should be considered when interpreting disease outcomes and in patient management.
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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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Barreto G, Sandelin J, Salem A, Nordström DC, Waris E. Toll-like receptors and their soluble forms differ in the knee and thumb basal osteoarthritic joints. Acta Orthop 2017; 88:326-333. [PMID: 28093922 PMCID: PMC5434604 DOI: 10.1080/17453674.2017.1281058] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Although the pathogenesis of osteoarthritis (OA) is not well understood, chondrocyte-mediated inflammatory responses (triggered by the activation of innate immune receptors by damage-associated molecules) are thought to be involved. We examined the relationship between Toll-like receptors (TLRs) and OA in cartilage from 2 joints differing in size and mechanical loading: the first carpometacarpal (CMC-I) and the knee. Patients and methods - Samples of human cartilage obtained from OA CMC-I and knee joints were immunostained for TLRs (1-9) and analyzed using histomorphometry and principal component analysis (PCA). mRNA expression levels were analyzed with RT-PCR. Collected synovial fluid (SF) samples were screened for the presence of soluble forms of TLR2 and TLR4 by enzyme-linked immunosorbent assay (ELISA). Results - In contrast to knee OA, TLR expression in CMC-I OA did not show grade-dependent overall profile changes, but PCA revealed that TLR expression profiles clustered according to their cellular compartment organization. Protein levels of TLR4 were substantially higher in knee OA than in CMC-I OA, while the opposite was the case at the mRNA level. ELISA assays confirmed the presence of soluble forms of TLR2 and TLR4 in SF, with sTLR4 being considerably higher in CMC-I OA than in knee OA. Interpretation - We observed that TLRs are differentially expressed in OA cartilage, depending on the joint. Soluble forms of TLR2 and TLR4 were detected for the first time in SF of osteoarthritic joints, with soluble TLR4 being differentially expressed. Together, our results suggest that negative regulatory mechanisms of innate immunity may be involved in the pathomolecular mechanisms of osteoarthritis.
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Affiliation(s)
- Goncalo Barreto
- Clinicum, Faculty of Medicine, University of Helsinki;,ORTON Orthopaedic Institute of the Invalid Foundation;,Correspondence:
| | | | - Abdelhakim Salem
- Clinicum, Faculty of Medicine, University of Helsinki;,Institute of Dentistry, Clinicum, University of Helsinki
| | - Dan C Nordström
- Department of Rheumatology, Helsinki University and Helsinki University Hospital
| | - Eero Waris
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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