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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Kvien TK, Magnusson K, Haugen IK. Hand osteoarthritis phenotypes based on a biopsychosocial approach, and their associations with cross-sectional and longitudinal pain. Osteoarthritis Cartilage 2024; 32:963-971. [PMID: 38697510 PMCID: PMC11254542 DOI: 10.1016/j.joca.2024.04.011] [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: 11/05/2023] [Revised: 04/23/2024] [Accepted: 04/24/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVE Hand osteoarthritis (OA) pain is characterized as heterogeneous and multifactorial. Differences in pain may be explained by underlying phenotypes, which have not been previously explored DESIGN: Latent class analysis determined classes of participants with hand OA from the Nor-Hand study baseline examination (2016-17) based on a biopsychosocial framework. Outcomes were hand and overall bodily pain intensity (Numeric Rating Scale, 0-10) at baseline and follow-up (2019-21), The relations of the classes to pain outcomes at baseline, follow-up, and change over time were analysed in separate models by linear regression, using the overall healthiest class as reference. RESULTS Five classes differing in radiographic hand OA burden and OA burden in the lower extremities by ultrasound, demographic factors, psychosocial burden and pain sensitization was identified. Persons with the least severe OA but higher burden of biopsychosocial factors reported the most hand pain (beta 3.65, 95% CI 2.53, 4.75). Pain was less pronounced in persons with the most severe hand OA but low burden of biopsychosocial factors (beta 1.03, 95% CI 0.41, 1.65). Results were similar for overall bodily pain and at follow-up. Changes in pain were small, but the association between a separate class defined by higher levels of biopsychosocial burden and pain changes was significant. CONCLUSION The five hand OA phenotypes were associated with pain at baseline and 3.5 years later. The phenotype with the least OA severity, but higher burden of biopsychosocial factors reported more pain than the phenotype with the most severe OA, reflecting the symptom-structure discordance of the hand OA pain experience.
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Affiliation(s)
- Elisabeth Mulrooney
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway.
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, United States
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde B Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille S Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway; Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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Mazza DF, Boonsri PS, Arora A, Bayne CO, Szabo RM, Chaudhari AJ, Boutin RD. Relationships between diagnostic imaging of first carpometacarpal osteoarthritis and pain, functional status, and disease progression: A systematic review. Osteoarthritis Cartilage 2024; 32:476-492. [PMID: 38141842 DOI: 10.1016/j.joca.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 10/20/2023] [Accepted: 11/29/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVE To systematically review the association of pain, function, and progression in first carpometacarpal (CMC) osteoarthritis (OA) with imaging biomarkers and radiography-based staging. DESIGN Database searches in PubMed, Embase, and the Cochrane Library, along with citation searching were conducted in accordance with published guidance. Data on the association of imaging with pain, functional status, and disease progression were extracted and synthesized, along with key information on study methodology such as sample sizes, use of control subjects, study design, number of image raters, and blinding. Methodological quality was assessed using National Heart, Lung, and Blood Institute tools. RESULTS After duplicate removal, a total of 1969 records were screened. Forty-six articles are included in this review, covering a total of 28,202 study participants, 7263 with first CMC OA. Osteophytes were found to be one of the strongest biomarkers for pain across imaging modalities. Radiographic findings alone showed conflicting relationships with pain. However, Kellgren-Lawrence staging showed consistent associations with pain in various studies. Radiographic, sonographic, and MRI findings and staging showed little association to tools evaluating functional status across imaging modalities. The same imaging methods showed limited ability to predict progression of first CMC OA. A major limitation was the heterogeneity in the study base, limiting synthesis of results. CONCLUSION Imaging findings and radiography-based staging systems generally showed strong associations with pain, but not with functional status or disease progression. More research and improved imaging techniques are needed to help physicians better manage patients with first CMC OA.
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Affiliation(s)
- Dario F Mazza
- Department of Radiology, University of California, Davis, CA, USA.
| | | | - Aman Arora
- Department of Radiology, University of California, Davis, CA, USA.
| | - Christopher O Bayne
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | - Robert M Szabo
- Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
| | | | - Robert D Boutin
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA.
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du Toit C, Dima R, Papernick S, Jonnalagadda M, Tessier D, Fenster A, Lalone E. Three-dimensional ultrasound to investigate synovitis in first carpometacarpal osteoarthritis: A feasibility study. Med Phys 2024; 51:1092-1104. [PMID: 37493097 DOI: 10.1002/mp.16640] [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: 10/28/2022] [Revised: 07/03/2023] [Accepted: 07/03/2023] [Indexed: 07/27/2023] Open
Abstract
BACKGROUND Synovitis is one of the defining characteristics of osteoarthritis (OA) in the carpometacarpal (CMC1) joint of the thumb. Quantitative characterization of synovial volume is important for furthering our understanding of CMC1 OA disease progression, treatment response, and monitoring strategies. In previous studies, three-dimensional ultrasound (3-D US) has demonstrated the feasibility of being a point-of-care system for monitoring knee OA. However, 3-D US has not been tested on the smaller joints of the hand, which presents unique physiological and imaging challenges. PURPOSE To develop and validate a novel application of 3-D US to monitor soft-tissue characteristics of OA in a CMC1 OA patient population compared to the current gold standard, magnetic resonance imaging (MRI). METHODS A motorized submerged transducer moving assembly was designed for this device specifically for imaging the joints of the hands and wrist. The device used a linear 3-D scanning approach, where a 14L5 2-D transducer was translated over the region of interest. Two imaging phantoms were used to test the linear and volumetric measurement accuracy of the 3-D US device. To evaluate the accuracy of the reconstructed 3-D US geometry, a multilayer monofilament string-grid phantom (10 mm square grid) was scanned. To validate the volumetric measurement capabilities of the system, a simulated synovial tissue phantom with an embedded synovial effusion was fabricated and imaged. Ten CMC1 OA patients were imaged by our 3-D US and a 3.0 T MRI system to compare synovial volumes. The synovial volumes were manually segmented by two raters on the 2D slices of the 3D US reconstruction and MR images, to assess the accuracy and precision of the device for determining synovial tissue volumes. The Standard Error of Measurement and Minimal Detectable Change was used to assess the precision and sensitivity of the volume measurements. Paired sample t-tests were used to assess statistical significance. Additionally, rater reliability was assessed using Intra-Class Correlation (ICC) coefficients. RESULTS The largest percent difference observed between the known physical volume of synovial extrusion in the phantom and the volume measured by our 3D US was 1.1% (p-value = 0.03). The mean volume difference between the 3-D US and the gold standard MRI was 1.78% (p-value = 0.48). The 3-D US synovial tissue volume measurements had a Standard Error Measurement (SEm ) of 11.21 mm3 and a Minimal Detectible Change (MDC) of 31.06 mm3 , while the MRI synovial tissue volume measurements had an SEM of 16.82 mm3 and an MDC of 46.63 mm3 . Excellent inter- and intra-rater reliability (ICCs = 0.94-0.99) observed across all imaging modalities and raters. CONCLUSION Our results indicate the feasibility of applying 3-D US technology to provide accurate and precise CMC1 synovial tissue volume measurements, similar to MRI volume measurements. Lower MDC and SEm values for 3-D US volume measurements indicate that it is a precise measurement tool to assess synovial volume and that it is sensitive to variation between volume segmentations. The application of this imaging technique to monitor OA pathogenesis and treatment response over time at the patient's bedside should be thoroughly investigated in future studies.
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Affiliation(s)
- Carla du Toit
- Department of Kinesiology, Western University, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Robert Dima
- Department of Health Sciences, Western University, London, Ontario, Canada
| | - Samuel Papernick
- Department of Medical Biophysics, Western University, London, Ontario, Canada
| | | | - David Tessier
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Western University, London, Ontario, Canada
- Robarts Research Institute, Western University, London, Ontario, Canada
| | - Emily Lalone
- Department of Kinesiology, Western University, London, Ontario, Canada
- Department of Health Sciences, Western University, London, Ontario, Canada
- Department of Mechanical and Materials Engineering, Western University, London, Ontario, Canada
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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gløersen M, Kvien TK, Magnusson K, Haugen IK. Comorbidities in people with hand OA and their associations with pain severity and sensitization: Data from the longitudinal Nor-Hand study. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100367. [PMID: 37234862 PMCID: PMC10206186 DOI: 10.1016/j.ocarto.2023.100367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 04/24/2023] [Indexed: 05/28/2023] Open
Abstract
Objective To determine whether the comorbidity burden and co-existing comorbidities are cross-sectionally and/or longitudinally associated with pain and pain sensitization in a cohort study of people with hand OA. Design We examined whether comorbidity burden and individual comorbidities based on the self-administered Comorbidity Index (range: 0-42) at baseline were associated with pain outcomes at baseline and 3 years follow-up. Pain outcomes included hand and overall bodily pain (range: 0-10) as well as pressure pain thresholds at the tibialis anterior muscle (kg/cm2) and temporal summation (distal radioulnar joint) as measures of central pain sensitization. We performed linear regression analyses adjusted for age, sex, body mass index, physical exercise and education. Results We included 300 and 196 participants in cross-sectional and longitudinal analyses, respectively. Using baseline data, the burden of comorbidities was associated with greater pain in hands (beta = 0.61, 95% CI 0.37, 0.85) and overall body (beta = 0.60, 95% CI 0.37, 0.87). Similar strength of associations was found between comorbidity burden (baseline) and follow-up pain. Among the individual comorbidities, back pain and depression were associated with nearly one unit higher pain score in hands and overall body at both baseline and follow-up. Only back pain was related to lower pressure pain thresholds at follow up (beta = -0.24, 95% CI -0.50, -0.001). Conclusion People with hand OA and greater comorbidity burden, co-existing back pain or depression reported greater pain severity than their counterparts, also 3 years later. These results acknowledge the relevance of accounting for comorbidities in the pain experience in people with hand OA.
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Affiliation(s)
- Elisabeth Mulrooney
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, United States
| | - Hanne Dagfinrud
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Berner Hammer
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Pernille Steen Pettersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Marthe Gløersen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tore K. Kvien
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Karin Magnusson
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ida K. Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
- Faculty of Medicine, University of Oslo, Oslo, Norway
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Garcia-Lopez E, Moore DC, Kenney DE, Ladd AL, Weiss APC, Crisco JJ. Evaluation of the PROMIS Upper Extremity Against Validated Patient-Reported Outcomes in Patients With Early Carpometacarpal Osteoarthritis. J Hand Surg Am 2022; 47:621-628. [PMID: 35527094 PMCID: PMC9271544 DOI: 10.1016/j.jhsa.2022.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 01/24/2022] [Accepted: 03/02/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Internal consistency, construct, and criterion validity of the Patient-Reported Outcomes Measurement Information System (PROMIS) upper extremity (UE) v1.2 were evaluated in patients with early-stage carpometacarpal (CMC) osteoarthritis (OA). We hypothesized that in patients with early CMC OA, PROMIS UE scores would: (1) be lower than those in asymptomatic controls; (2) correlate with established patient-reported outcomes; (3) correlate with pinch and grip strengths; and (4) not correlate with radiographic disease progression. METHODS Patients with early CMC OA (modified Eaton stage 0 or 1) and matched asymptomatic control patients completed the PROMIS UE, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation at 2 time points. The PROMIS UE's internal consistency was evaluated by Cronbach's alpha, construct validity by Spearman correlation coefficients among the patient-reported outcome measures, and criterion validity using measures of strength. A floor or ceiling effect was indicated if more than 15% of patients achieved the lowest or highest possible score. RESULTS The PROMIS UE had high internal consistency. Patients with early CMC OA had a lower score than healthy controls (average, 42 vs 54, respectively). We observed moderate to high correlations between the PROMIS UEv1.2, Australian and Canadian Osteoarthritis Hand Index, and Patient-Rated Wrist-Hand Evaluation and good criterion validity when compared to key pinch and grip strengths. The PROMIS UE did not correlate to radiographic disease severity. CONCLUSIONS The PROMIS UE had a high correlation with Australian and Canadian Osteoarthritis Hand Index and a moderate correlation with Patient-Rated Wrist-Hand Evaluation. The PROMIS UE had high internal consistency and good criterion validity. CLINICAL RELEVANCE The PROMIS UE is a valid assessment for disability in patients with early CMC OA and can serve as a clinical adjunct to an outcome assessment.
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Affiliation(s)
- Edgar Garcia-Lopez
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
| | - Douglas C Moore
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
| | - Deborah E Kenney
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Amy L Ladd
- Robert A. Chase Hand & Upper Limb Center, Department of Orthopaedic Surgery, Stanford University School of Medicine, Stanford, CA
| | - Arnold-Peter C Weiss
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI
| | - Joseph J Crisco
- Department of Orthopaedics, The Warren Alpert Medical School of Brown University and Rhode Island Hospital, Providence, RI.
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Duruöz MT, Erdem Gürsoy D, Tuncer T, Altan L, Ayhan F, Bal A, Bilgilisoy M, Cerrahoğlu L, Çapkın E, Çay HF, Çevik R, Durmaz B, Dülgeroğlu D, Gürer G, Gürsoy S, Hepgüler S, Hizmetli S, Kaçar C, Kaptanoğlu E, Kaya T, Ecesoy H, Alkan Melikoğlu M, Nas K, Nur H, Özçakır Ş, Sarıdoğan M, Sarıkaya S, Sezer İ, Sindel D, Şahin N, Şahin Ö, Faruk Şendur Ö, Taşçı Bozbaş G, Tıkız C, Uğurlu H. The clinical, functional, and radiological features of hand osteoarthritis: TLAR-osteoarthritis multi-center cohort study. Arch Rheumatol 2022; 37:375-382. [PMID: 36589604 PMCID: PMC9791555 DOI: 10.46497/archrheumatol.2022.9234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2021] [Accepted: 10/24/2021] [Indexed: 01/03/2023] Open
Abstract
Objectives This study aims to evaluate the clinical, functional, and radiological features of hand osteoarthritis (OA) and to examine their relationships in different geographic samples of the Turkish population. Patients and methods Between April 2017 and January 2019, a total of 520 patients (49 males, 471 females; mean age: 63.6±9.8 years) with hand OA were included in the study from 26 centers across Turkey by the Turkish League Against Rheumatism (TLAR). The demographic characteristics, grip strengths with Jamar dynamometer, duration of hand pain (month), the severity of hand pain (Visual Analog Scale [VAS]), and morning stiffness were evaluated. The functional disability was evaluated with Duruöz Hand Index (DHI). The Kellgren-Lawrence (KL) OA scoring system was used to assess the radiological stage of hand OA. Results The DHI had significant correlations with VAS-pain (r=0.367, p<0.001), duration of pain (r=0.143, p=0.001) and bilateral handgrip strengths (r=-0.228, p=0.001; r=-0.303, p<0.001). Although DHI scores were similar between the groups in terms of the presence of hand deformity (p=0.125) or Heberden's nodes (p=0.640), the mean DHI scores were significantly higher in patients with Bouchard's nodes (p=0.015). The total number of nodes had no significant correlations with the VAS-pain and DHI score (p>0.05). The differences between the groups of radiological hand OA grades in terms of age (p=0.007), VAS-pain (p<0.001), duration of pain (p<0.001), and DHI (p<0.001) were significant. There were no significant differences between radiological hand OA grades according to the duration of the stiffness, grip strength, and BMI (p>0.05 for all). Conclusion In our population, the patients with hand OA had pain, functional disability, and weak grip strength. The functional impairment was significantly correlated with the severity of the pain, and the functional status was worse in high radiological hand OA grades.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Marmara University School of Medicine, Istanbul, Turkey
| | - Didem Erdem Gürsoy
- Department of Physical Medicine and Rehabilitation, Rheumatology Clinic, Prof. Dr. Cemil Taşcoğlu City Hospital, Istanbul, Turkey
| | - Tiraje Tuncer
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Lale Altan
- Department of Physical Medicine and Rehabilitation, Uludağ University School of Medicine, Bursa, Turkey
| | - Figen Ayhan
- Department of Physical Medicine and Rehabilitation, Atılım University School of Medicine, Ankara, Turkey
| | - Ajda Bal
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Meral Bilgilisoy
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Lale Cerrahoğlu
- Department of Physical Medicine and Rehabilitation, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Erhan Çapkın
- Department of Physical Medicine and Rehabilitation, Karadeniz Technical University School of Medicine, Trabzon, Turkey
| | - Hasan Fatih Çay
- Department of Physical Medicine and Rehabilitation, Antalya Training and Research Hospital, Antalya, Turkey
| | - Remzi Çevik
- Department of Physical Medicine and Rehabilitation, Dicle University School of Medicine, Diyarbakır, Turkey
| | - Berrin Durmaz
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Deniz Dülgeroğlu
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Dışkapı Yıldırım Beyazıt Training and Research Hospital, Ankara, Turkey
| | - Gülcan Gürer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Savaş Gürsoy
- Department of Physical Medicine and Rehabilitation, Gaziantep University School of Medicine, Gaziantep, Turkey
| | - Simin Hepgüler
- Department of Physical Medicine and Rehabilitation, Ege University School of Medicine, Izmir, Turkey
| | - Sami Hizmetli
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Cahit Kaçar
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Ece Kaptanoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Başkent University Zübeyde Hanım Application and Research Center, Izmir, Turkey
| | - Taciser Kaya
- Department of Physical Medicine and Rehabilitation, University of Health Sciences, Izmir Faculty of Medicine, Izmir, Turkey
| | - Hilal Ecesoy
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Karamanoğlu Mehmetbey University School of Medicine, Karaman, Turkey
| | - Meltem Alkan Melikoğlu
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Atatürk University School of Medicine, Erzurum, Turkey
| | - Kemal Nas
- Department of Physical Medicine and Rehabilitation, Sakarya University School of Medicine, Sakarya, Turkey
| | - Hakan Nur
- Department of Physical Medicine and Rehabilitation, Akdeniz University School of Medicine, Antalya, Turkey
| | - Şüheda Özçakır
- Department of Physical Medicine and Rehabilitation, Uludağ University School of Medicine, Bursa, Turkey
| | - Merih Sarıdoğan
- Department of Physical Medicine and Rehabilitation, Istanbul University Cerrahpaşa School of Medicine, Istanbul, Turkey
| | - Selda Sarıkaya
- Department of Physical Medicine and Rehabilitation, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - İlhan Sezer
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Akdeniz University School of Medicine, Antalya, Turkey
| | - Dilşad Sindel
- Department of Physical Medicine and Rehabilitation, Istanbul University Istanbul School of Medicine, Istanbul, Turkey
| | - Nilay Şahin
- Department of Physical Medicine and Rehabilitation, Balıkesir University, Balıkesir, Turkey
| | - Özlem Şahin
- Department of Physical Medicine and Rehabilitation, Cumhuriyet University School of Medicine, Sivas, Turkey
| | - Ömer Faruk Şendur
- Department of Physical Medicine and Rehabilitation, Adnan Menderes University School of Medicine, Aydın, Turkey
| | - Gülnur Taşçı Bozbaş
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University School of Medicine, Konya, Turkey
| | - Canan Tıkız
- Department of Physical Medicine and Rehabilitation, Celal Bayar University School of Medicine, Manisa, Turkey
| | - Hatice Uğurlu
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University School of Medicine, Konya, Turkey
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7
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Gasperi N, Schreiber N, Bosch P, Adinolfi A, Kleyer A, Hagen M, Gasperi C, Weger M, Kiechl S, Willeit J, Schett G, Iagnocco A, Gasperi A, Mayr A, Dejaco C. Ultrasound-detected inflammation is more common in clinically manifest hand osteoarthritis than in painless bony enlarged finger joints: subanalysis of the population-based Bruneck study. Ther Adv Musculoskelet Dis 2022; 14:1759720X221096382. [PMID: 35586515 PMCID: PMC9109483 DOI: 10.1177/1759720x221096382] [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: 05/26/2021] [Accepted: 03/28/2022] [Indexed: 11/30/2022] Open
Abstract
Purpose: The aim of this article is to examine the extent of structural and
inflammatory lesions by ultrasound in elderly subjects with hand
osteoarthritis (HOA) fulfilling the ACR classification criteria (Group A),
in subjects with painless enlarged finger joints (Group B), and in
individuals without clinical abnormalities at hands (Group C). Methods: This study was nested within the population-based, prospective Bruneck study;
293 subjects of ⩾65 years of age were assessed. Clinical and ultrasound
assessment was conducted at wrists and finger joints. Gray scale synovitis
(GSS), Power Doppler (PD), osteophytes, and erosions were scored
semiquantitatively (0–3). The Short Form Score for the Assessment and
Quantification of Chronic Rheumatic Affections of the Hands (SF-SACRAH), the
Health Assessment Questionnaire (HAQ), and the Functional Index for Hand
Osteoarthritis (FIHOA) were retrieved. Results: Most subjects had ⩾1 ultrasound abnormality, of which osteophytes were the
most prevalent finding in all groups (Group A: 100%, Group B: 99.4%, and
Group C: 93.9%). GSS and PD-signals were more common in Group A than in
Group B (94% versus 67% and 33% versus
13%, respectively). In Group C, GSS was observed in 39.4% of subjects. In
subjects with HOA, the SF-SACRAH correlated with osteophyte scores
(corrcoeff = 0.48), and the FIHOA correlated with the
osteophyte (corrcoeff = 0.42) and PD scores
(corrcoeff = 0.33). Conclusion: GSS and PD were more frequent in patients with symptomatic HOA than in cases
with painless bony enlargements and subjects without clinical joint
abnormalities. Functional restriction in HOA is associated with structural
and inflammatory ultrasound changes.
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Affiliation(s)
- Nina Gasperi
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Nikolaus Schreiber
- Intensive Care Unit, Department of Internal Medicine, Medical University of Graz, Graz, Austria
| | - Philipp Bosch
- Division of Rheumatology and Immunology, Medical University of Graz, Graz, Austria
| | - Antonella Adinolfi
- Rheumatology Unit, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - Arnd Kleyer
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Melanie Hagen
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | - Christiane Gasperi
- Department of Neurology, Klinikum Rechts der Isar, Technical University of Munich, Munich, Germany
| | - Martin Weger
- Department of Internal Medicine, Bruneck Hospital, Bruneck, Italy
| | - Stefan Kiechl
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Johann Willeit
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
| | - Georg Schett
- Department of Internal Medicine 3-Rheumatology and Immunology, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Universitätsklinikum Erlangen, Erlangen, Germany
| | | | - Arno Gasperi
- Department of Neurology, Bruneck Hospital, Bruneck, Italy
| | - Agnes Mayr
- Department of Laboratory Medicine, Bruneck Hospital, Bruneck, Italy
| | - Christian Dejaco
- Rheumatology Service, South Tyrolean Health Trust, Hospital of Bruneck, Spitalstraße 11, Bruneck 39031, Italy
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8
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Mulrooney E, Neogi T, Dagfinrud H, Hammer HB, Pettersen PS, Gaarden TL, Engedal K, Kvien TK, Magnusson K, Haugen IK. The associations of psychological symptoms and cognitive patterns with pain and pain sensitization in people with hand osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100267. [DOI: 10.1016/j.ocarto.2022.100267] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 04/28/2022] [Indexed: 11/16/2022] Open
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9
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Shah K, Cai H, Lane JCE, Collins GS, Arden NK, Furniss D, Filbay SR. Prognostic factors for finger interphalangeal joint osteoarthritis: a systematic review. Rheumatology (Oxford) 2021; 60:1080-1090. [PMID: 33253392 DOI: 10.1093/rheumatology/keaa735] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 10/16/2020] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE Radiographic hand OA affects one in five adults. Symptomatic hand OA can result in functional impairment, pain and reduced quality of life. A prevalent form of hand OA is IP joint OA, however prognostic factors for IP joint OA remain poorly understood. This systematic review aimed to identify prognostic factors for IP joint OA, and to summarize the diagnostic criteria for IP joint OA in prognostic studies. METHODS EMBASE, MEDLINE, Scopus and The Cochrane Library were searched from inception until 19 February 2020 (PROSPERO CRD42019116782). Eligible studies described diagnostic criteria defining IP joint OA, and assessed potential prognostic factors for IP joint OA. Risk of bias was assessed using a modified Quality in Prognosis Studies (QUIPS) tool and a best evidence synthesis was used. RESULTS Eighteen studies were included (risk of bias: eight high, three moderate, seven low). All defined OA radiographically, and three studies incorporated clinical symptoms into their definition of OA. Forty-nine potential prognostic factors were assessed. Eight were prognostic: older age in women, female gender (both moderate evidence); family history of Heberden's nodes, Kashin-Beck disease, older age in men, dental occupation in men, finger fracture, parity (all limited evidence). Higher BMI in women (limited evidence) was prognostic for symptomatic radiographic OA. No prognostic factors for symptomatic OA were identified. CONCLUSION IP joint OA is most commonly defined radiographically, yet criteria were heterogeneous. Eight prognostic factors for radiographic IP joint OA and one for symptomatic radiographic IP joint OA were identified, all with limited or moderate evidence. Further studies on causality and on prognostic pathways are needed.
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Affiliation(s)
- Karishma Shah
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - He Cai
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,West China Hospital of Stomatology, State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Sichuan University, Chengdu, China
| | - Jennifer C E Lane
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Gary S Collins
- Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel K Arden
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Dominic Furniss
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Department of Plastic and Reconstructive Surgery, Nuffield Orthopaedic Centre, Oxford, Oxford, UK
| | - Stephanie R Filbay
- Botnar Research Centre, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.,Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, Melbourne University, Melbourne, Victoria, Australia
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10
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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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11
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Fjellstad CM, Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Associations Between Ultrasound‐Detected Synovitis, Pain, and Function in Interphalangeal and Thumb Base Osteoarthritis: Data From the Nor‐Hand Cohort. Arthritis Care Res (Hoboken) 2020; 72:1530-1535. [DOI: 10.1002/acr.24047] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 08/13/2019] [Indexed: 11/06/2022]
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12
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Shah K, Yang X, Lane JCE, Collins GS, Arden NK, Furniss D, Filbay SR. Risk factors for the progression of finger interphalangeal joint osteoarthritis: a systematic review. Rheumatol Int 2020; 40:1781-1792. [PMID: 32839851 PMCID: PMC7519919 DOI: 10.1007/s00296-020-04687-1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Accepted: 08/13/2020] [Indexed: 02/08/2023]
Abstract
Progressive hand interphalangeal joint (IPJ) osteoarthritis is associated with pain, reduced function and impaired quality of life. However, the evidence surrounding risk factors for IPJ osteoarthritis progression is unclear. Identifying risk factors for IPJ osteoarthritis progression may inform preventative strategies and early interventions to improve long-term outcomes for individuals at risk of IPJ osteoarthritis progression. The objectives of the study were to describe methods used to measure the progression of IPJ osteoarthritis and identify risk factors for IPJ osteoarthritis progression. MEDLINE, EMBASE, Scopus, and The Cochrane Library were searched from inception to 19th February 2020 (PROSPERO CRD42019121034). Eligible studies assessed potential risk factor/s associated with IPJ osteoarthritis progression. Risk of bias was assessed using a modified QUIPS Tool, and a best evidence synthesis was performed. Of eight eligible studies, all measured osteoarthritis progression radiographically, and none considered symptoms. Eighteen potential risk factors were assessed. Diabetes (adjusted mean difference between 2.06 and 7.78), and larger finger epiphyseal index in males (regression coefficient β = 0.202) and females (β = 0.325) were identified as risk factors (limited evidence). Older age in men and women showed mixed results; 13 variables were not risk factors (all limited evidence). Patients with diabetes and larger finger epiphyseal index might be at higher risk of radiographic IPJ osteoarthritis progression, though evidence is limited and studies are biased. Studies assessing symptomatic IPJ osteoarthritis progression are lacking.
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Affiliation(s)
- Karishma Shah
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.
| | - Xiaotian Yang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Jennifer C E Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK
| | - Gary S Collins
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Nigel K Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK
| | - Dominic Furniss
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, UK.,National Institute for Health Research Oxford Biomedical Research Centre, John Radcliffe Hospital, Oxford, UK
| | - Stephanie R Filbay
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, UK.,Department of Physiotherapy, Centre for Health Exercise and Sports Medicine, University of Melbourne, Melbourne, Australia
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13
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Güven N, Dinçer F, Çetin A, Güven SC. Hand strenght and dexterity in interphalangeal hand osteoarthritis and effects of osteophyte formations. Adv Rheumatol 2020; 60:41. [PMID: 32831136 DOI: 10.1186/s42358-020-00143-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Accepted: 08/06/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand osteoarthritis (HOA) is a complex disorder with various subtypes characterized with predominance of different features. It is challenging to estimate the severity of hand disability in HOA, since contribution of different disease components to clinical burden is yet to be clarified. The aim of the study is to investigate hand functions in nonerosive interphalangeal hand osteoarthritis (HOA) without inflammatory features, and search for effects of osteophyte formations detected by radiography and ultrasound on functionality. METHODS Thirty one HOA patients and 20 healthy subjects with similar age, gender, body mass index were included. Hand functions were evaluated by self-reported questionnaires and objective strength and dexterity measurements. A total of 459 interphalangeal joints were evaluated and scored by radiography and ultrasound for ostephyte formations. RESULTS Strength and dexterity measurements were similar between groups. Self-reported functionality was hampered in HOA group but not statistically significant. Osteophyte scores obtained by ultrasound and radiography were significantly higher in HOA group. Osteophyte scores obtained by ultrasound were higher than the scores obtained by radiography. Ultrasound scores showed no correlation with any of the parameters while osteophytes scores obtained by radiography partially showed a significant negative correlation with assembly part of dexterity testing. CONCLUSIONS No significant difference observed in hand strength and dexterity in nonerosive interphalangeal HOA patients withouth signs of inflammation when compared to healthy subjects. Osteophyte formations prominent enough to be deteceted by radiography may have a negative effect on hand dexterity.
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Affiliation(s)
- Nurhan Güven
- Department of Physical and Rehabilitation Medicine, Division of Rheumatology, Ankara University Medical School, Ankara, Turkey.
| | - Fitnat Dinçer
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Alp Çetin
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Serdar Can Güven
- Department of Rheumatology, Ministry of Health, Ankara City Hospital, Ankara, Turkey
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14
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Damman W, Liu R, Kaptein AA, Evers AWM, van Middendorp H, Rosendaal FR, Kloppenburg M. Illness perceptions and their association with 2 year functional status and change in patients with hand osteoarthritis. Rheumatology (Oxford) 2019; 57:2190-2199. [PMID: 30107461 DOI: 10.1093/rheumatology/key231] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 11/13/2022] Open
Abstract
Objective To investigate the association between illness perceptions and disability both cross-sectionally and over 2 years in patients with hand OA. Methods Illness perceptions and self-reported disability were assessed at baseline and after 2 years in 384 patients with primary hand OA (mean age 61 years, 84% women, n = 312 with follow-up) with the Illness Perception Questionnaire - Revised (IPQ-R), Functional Index for Hand OA, Australian/Canadian Hand OA Index and HAQ. Risk ratios for high disability (highest quartile) at both time points were estimated for tertiles of IPQ-R dimensions, using Poisson regression. The mean IPQ dimension change difference between patients with and without disability progression (change Functional Index for Hand OA ⩾ 1, Australian/Canadian Hand OA Index > 1.4, HAQ > 0.22) was estimated with linear regression. Analyses were adjusted for age, Doyle index and baseline score. Results At baseline, stronger negative illness perceptions were associated with high disability. Baseline illness perceptions were also associated with high disability after 2 years, although adjustment made apparent that these associations were confounded by baseline disability status. Most illness perceptions changed over 2 years; understanding increased, OA was regarded as more chronic and fewer emotions and consequences and less personal and treatment control were experienced. The 2 year change in disability was different between patients with and without progression for the illness perceptions of more perceived consequences, symptoms, treatment control and emotions. Conclusion Illness perceptions seemed to be implicated in disability and its progression. Our results suggest that interventions could focus on improving baseline disability, potentially using illness perceptions to accomplish this goal.
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Affiliation(s)
- Wendy Damman
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Rani Liu
- Department of Rheumatology, Leiden University Medical Center, The Netherlands
| | - Ad A Kaptein
- Department of Medical Psychology, Leiden University Medical Center, The Netherlands
| | - Andrea W M Evers
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
| | - Henriët van Middendorp
- Health, Medical and Neuropsychology Unit, Institute of Psychology, Leiden University, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, The Netherlands.,Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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15
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Pettersen PS, Neogi T, Magnusson K, Hammer HB, Uhlig T, Kvien TK, Haugen IK. Peripheral and Central Sensitization of Pain in Individuals With Hand Osteoarthritis and Associations With Self-Reported Pain Severity. Arthritis Rheumatol 2019; 71:1070-1077. [PMID: 30741501 PMCID: PMC6594897 DOI: 10.1002/art.40850] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 02/05/2019] [Indexed: 01/13/2023]
Abstract
OBJECTIVE Pain sensitization, an important osteoarthritis (OA) pain mechanism, has not been substantially investigated in patients with hand OA. It is unknown how peripheral and central sensitization are related to self-reported hand pain. METHODS Individuals with verified hand OA in the Nor-Hand study underwent quantitative sensory testing of pressure pain thresholds (PPTs) locally (painful and nonpainful finger joints) and remotely (wrist, trapezius, and tibialis anterior muscles), and testing of temporal summation (TS), a manifestation of central sensitization. We examined cross-sectional associations of PPT tertiles and TS with hand pain using the Numerical Rating Scale (NRS) (range 0-10) and the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subscale (range 0-20). Linear regression models were adjusted for demographics, psychosocial factors, and radiographic severity. RESULTS This study included 282 participants (88% female) with a median age of 61 years (interquartile range [IQR] 57-66). Participants with the lowest PPTs in their finger joints and in most remote locations reported higher NRS pain values, compared to patients with the highest PPTs, with adjusted β values ranging from 0.6 (95% confidence interval [95% CI] 0.0, 1.2) to 0.9 (95% CI 0.3, 1.5). The 118 participants (42%) with TS reported higher mean ± SD NRS pain values compared to those without TS (4.1 ± 2.4 versus 3.1 ± 1.7; adjusted β = 0.6 [95% CI 0.2, 1.1]). Neither PPTs nor the presence of TS were associated with AUSCAN pain. CONCLUSION Central sensitization was common in patients with hand OA. Lower local and widespread PPTs and the presence of TS were associated with higher hand pain intensity, even after adjustment for demographics, psychosocial factors, and radiographic severity. Sensitization may therefore represent a possible treatment target.
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Affiliation(s)
- Pernille Steen Pettersen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Department of Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, United States
| | - Karin Magnusson
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Department of Clinical Sciences Lund, Lund University, Faculty of Medicine, Orthopedics, Clinical Epidemiology Unit, Lund, Sweden
| | | | - Till Uhlig
- Department of Rheumatology, National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Faculty of medicine, University of Oslo, Oslo, Norway
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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16
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Kroon FPB, van Beest S, Ermurat S, Kortekaas MC, Bloem JL, Reijnierse M, Rosendaal FR, Kloppenburg M. In thumb base osteoarthritis structural damage is more strongly associated with pain than synovitis. Osteoarthritis Cartilage 2018; 26:1196-1202. [PMID: 29709499 DOI: 10.1016/j.joca.2018.04.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Revised: 03/15/2018] [Accepted: 04/11/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis in thumb base joints (first carpometacarpal (CMC-1), scaphotrapeziotrapezoid (STT)) is prevalent and disabling, yet focussed studies are scarce. Our aim was to investigate associations between ultrasonographic and magnetic resonance imaging (MRI) inflammatory features, radiographic osteophytes, and thumb base pain in hand osteoarthritis patients. DESIGN Cross-sectional analyses were performed in cohorts with MRI (n = 202) and ultrasound measurements (n = 87). Pain upon thumb base palpation was assessed. Radiographs were scored for CMC-1/STT osteophytes. Synovial thickening, effusion and power Doppler signal in CMC-1 joints were assessed with ultrasound. MRIs were scored for synovitis and bone marrow lesions (BMLs) in CMC-1 and STT joints using OMERACT-TOMS. Associations between ultrasound/MRI features, osteophytes, and thumb base pain were assessed. Interaction between MRI features and osteophytes was explored. RESULTS In 289 patients (mean age 60.2, 83% women) 139/376 thumb bases were painful. Osteophyte presence was associated with pain (MRI cohort: odds ratio (OR) 5.1 (2.7-9.8)). Ultrasound features were present in 25-33% of CMC-1 joints, though no associations were seen with pain. MRI-synovitis and BMLs grade ≥2 were scored in 25% and 43% of thumb bases, and positively associated with pain (OR 3.6 (95% CI 1.7-7.6) and 3.0 (1.6-5.5)). Associations attenuated after adjustment for osteophyte presence. Combined presence of osteophytes and MRI-synovitis had an additive effect. CONCLUSIONS Ultrasonographic and MRI inflammatory features were often present in the thumb base. Osteophytes were more strongly associated with thumb base pain than inflammatory features, in contrast to findings in finger OA studies, supporting thumb base osteoarthritis as a distinct phenotype.
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Affiliation(s)
- F P B Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - S van Beest
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - S Ermurat
- Department of Rheumatology, Uludag University Medical Faculty, Bursa, Turkey
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - J L Bloem
- Department of Radiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Reijnierse
- Department of Radiology, 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 Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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17
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Vansteenkiste S, Reneman MF, van der Eerden PJM, Soer R, Dijkstra PU, van der Sluis CK. Upper limb functional capacity of working patients with osteoarthritis of the hands: A cross-sectional study. J Hand Ther 2018; 30:507-515. [PMID: 28279625 DOI: 10.1016/j.jht.2017.01.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Revised: 12/30/2016] [Accepted: 01/04/2017] [Indexed: 02/09/2023]
Abstract
STUDY DESIGN A cross-sectional design was used. INTRODUCTION Little is known about the effects of osteoarthritis of the hands (OAH) on work ability in working patients with OAH. PURPOSE OF THE STUDY The study aimed to analyze the differences in upper limb functional capacity (ULFC) between working patients with OAH and healthy workers and to evaluate variables associated with ULFC and with self-reported disability (SRD) in working patients with OAH. METHODS Forty-one patients performed the ULFC Evaluation (ULFCE) and also completed 2 SRD measures. The patients' results were compared with the ULFCE results of 82 matched healthy workers from a reference database. Three sets of multivariate regression analyses were used to reveal the predictors of ULFC and SRD. RESULTS Patients scored 12%-45% lower on all ULFCE tests (P values ranging from P P Discussion Working patients with OAH had a considerably lower ULFC compared with healthy workers. Female gender and the presence of OAH predicted lower ULFC. Pain and lower finger strength predicted worse scores on SRD. CONCLUSION(S) In the case of professionals advising working patients with OAH, our results suggest that a careful evaluation of the ULFC and SRD is warranted. Subsequently, advice regarding exercises or adjustments at work can be given. LEVEL OF EVIDENCE 3b.
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Affiliation(s)
- Stefaan Vansteenkiste
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands.
| | - Michiel F Reneman
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Pepijn J M van der Eerden
- Department of Radiology, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Remko Soer
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Expertise Center of Health and Wellbeing, Saxion University of Applied Sciences, Enschede, The Netherlands
| | - Pieter U Dijkstra
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands; Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Corry K van der Sluis
- Department of Rehabilitation Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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18
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Moon DK, Park YJ, Song SY, Kim MJ, Park JS, Nam DC, Kim DH, Na JB, Lee SI, Hwang SC, Park KS. Common Upper Extremity Disorders and Function Affect Upper Extremity-Related Quality of Life: A Community-Based Sample from Rural Areas. Yonsei Med J 2018; 59:669-676. [PMID: 29869465 PMCID: PMC5990682 DOI: 10.3349/ymj.2018.59.5.669] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Revised: 05/03/2018] [Accepted: 05/03/2018] [Indexed: 11/27/2022] Open
Abstract
PURPOSE Upper extremity musculoskeletal disorders (UEMDs), such as rotator cuff tear, epicondylitis, and hand osteoarthritis, have a negative impact on quality of life (QOL). In this study, we evaluated the prevalence of rotator cuff tear, lateral and medial epicondylitis, and hand osteoarthritis in the dominant side and the impact of these UEMDs on the disabilities of the arm, shoulder, and hand (DASH) outcome measure, which assesses upper extremity-related QOL. MATERIALS AND METHODS In 2013-2015, 987 participants from rural areas completed a questionnaire and underwent physical examinations, laboratory tests, simple radiographic evaluations of bilateral upper extremities, and magnetic resonance imaging studies of bilateral shoulders. Based on data from these participants, researchers evaluated DASH and performed a functional assessment of each region of the dominant side and related UEMDs. RESULTS The prevalences of epicondylitis, rotator cuff tear, and hand osteoarthritis were 33.7%, 53.4%, and 44.6%, respectively. Univariate regression analysis results revealed that epicondylitis, epicondylitis+rotator cuff tear, epicondylitis+hand osteoarthritis, and epicondylitis+rotator cuff tear+hand osteoarthritis were significantly associated with DASH score. Multiple regression analysis, including DASH, UEMD, and regional functional assessments, showed that only epicondylitis and epicondylitis+rotator cuff tear were associated with DASH score. CONCLUSION Epicondylitis significantly affected QOL, while other UEMDs, such as hand osteoarthritis and rotator cuff tear, had no significant impact. When a patient's QOL is affected by a UEMD, there is an increased possibility of the simultaneous presence of other UEMDs.
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Affiliation(s)
- Dong Kyu Moon
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Young Jin Park
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Youn Song
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Mi Ji Kim
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea
| | - Jin Sung Park
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dae Cheol Nam
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Dong Hee Kim
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Jae Boem Na
- Department of Radiology, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sang Il Lee
- Department of Internal Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea
| | - Sun Chul Hwang
- Department of Orthopedic Surgery, Institute of Health Sciences, Gyeongsang National University School of Medicine, Gyeongsang National University Hospital, Jinju, Korea.
| | - Ki Soo Park
- Department of Preventive Medicine, Institute of Health Sciences, Gyeongsang National University School of Medicine, Jinju, Korea.
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19
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Schaefer LF, McAlindon TE, Eaton CB, Roberts MB, Haugen IK, Smith SE, Duryea J, Driban JB. The associations between radiographic hand osteoarthritis definitions and hand pain: data from the osteoarthritis initiative. Rheumatol Int 2017; 38:403-413. [PMID: 29270642 DOI: 10.1007/s00296-017-3913-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Accepted: 12/12/2017] [Indexed: 11/30/2022]
Abstract
The goal of our study was to evaluate the associations between various definitions of radiographic hand osteoarthritis (OA) and self-reported hand pain. We conducted a cross-sectional study with 3604 participants from the Osteoarthritis Initiative (OAI). Posteroanterior radiographs of the dominant hand were read using a modified Kellgren-Lawrence (KL) scale. For our primary analysis, hand OA at person level was defined as two or more finger joints with KL grade 2 or higher. In addition, for the purpose of exploratory analyses, we explored more conservative definitions of hand OA as well as different sum scores and digit- and row-based scores. The majority of definitions of radiographic hand OA were statistically significantly associated with self-reported hand pain. In our main analysis, persons with two or more finger joints with KL grade > 2 were approximately two times more likely to self-report hand pain than persons without radiographic hand OA. Increasing KL grades and increasing number of joints affected lead to stronger associations. Almost all definitions of hand OA were related to pain. Individuals with more severely affected joints or with higher number of affected joints are more likely to report hand pain than their peers. Specifically, individuals with hand joints with KL 3 or 4 have the greatest likelihood of hand pain.
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Affiliation(s)
- Lena F Schaefer
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
| | | | - Charles B Eaton
- Center for Primary Care, Prevention, Alpert Medical School of Brown University, Providence, USA
| | - Mary B Roberts
- Center for Primary Care, Prevention, Alpert Medical School of Brown University, Providence, USA
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Stacy E Smith
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
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Haugen IK, Slatkowsky Christensen B, Bøyesen P, Sesseng S, van der Heijde D, Kvien TK. Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritis. Ann Rheum Dis 2015; 75:702-8. [DOI: 10.1136/annrheumdis-2014-206829] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/19/2015] [Indexed: 11/04/2022]
Abstract
ObjectivesTo explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort.MethodsWe included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0–3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA.ResultsAmong joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant.ConclusionsThe Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs.
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Menz H, Roddy E, Marshall M, Thomas M, Rathod T, Myers H, Thomas E, Peat G. Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Osteoarthritis Cartilage 2015; 23:77-82. [PMID: 25450852 PMCID: PMC4291455 DOI: 10.1016/j.joca.2014.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/30/2014] [Accepted: 10/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). DESIGN Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. RESULTS Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. CONCLUSIONS This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice.
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Affiliation(s)
- H.B. Menz
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom,Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia,Address correspondence and reprint requests to: H.B. Menz, Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia. Tel: 61-(3)-9479-5801; Fax: 61-(3)-9479-5415.
| | - E. Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - M. Marshall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - M.J. Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - T. Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - H. Myers
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - E. Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - G.M. Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
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Kloppenburg M, Bøyesen P, Smeets W, Haugen IK, Haugen I, Liu R, Visser W, van der Heijde DM. Report from the OMERACT Hand Osteoarthritis Special Interest Group: advances and future research priorities. J Rheumatol 2014; 41:810-8. [PMID: 24429165 DOI: 10.3899/jrheum.131253] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Osteoarthritis (OA) is one of the most common musculoskeletal disorders, frequently affecting the hands. In the last decade there has been increased awareness concerning this disorder because of its clinical burden. Unfortunately, only limited treatments for symptom alleviation are available, and no effective treatment for disease modification exists. The lack of treatment is due not only to a lack of understanding of the disease process, but also to poor outcome measures to assess the condition. The OMERACT Hand OA Special Interest Group (SIG) has started to develop a core set of outcome measures for hand OA clinical trials, observational studies, and clinical record keeping. At OMERACT 11, results from a Delphi exercise were presented, and a preliminary set of core domains was discussed. The group attempted to adopt the new OMERACT Filter 2.0 in the process, and literature overviews of conventional radiographs, ultrasonography, and magnetic resonance imaging as outcome measures in hand OA were presented. Discussions that followed highlighted further suggestions for core domains, the heterogeneity of hand OA, and future research priorities.
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Affiliation(s)
- Margreet Kloppenburg
- From the Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Role of Modern Imaging Techniques in Hand Osteoarthritis Research and Clinical Practice. Curr Rheumatol Rep 2013; 16:399. [DOI: 10.1007/s11926-013-0399-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Haugen IK, Slatkowsky-Christensen B, Bøyesen P, van der Heijde D, Kvien TK. Cross-sectional and longitudinal associations between radiographic features and measures of pain and physical function in hand osteoarthritis. Osteoarthritis Cartilage 2013; 21:1191-8. [PMID: 23973130 DOI: 10.1016/j.joca.2013.04.004] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2012] [Revised: 03/11/2013] [Accepted: 04/09/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Previous longitudinal studies have shown no associations between increasing amount of radiographic hand osteoarthritis (OA) and levels of hand pain/disability. In this longitudinal study, we aimed to study whether radiographic hand OA was related to pain/disability in cross-sectional and longitudinal settings focusing on joint-specific analyses. METHODS We included 190 patients (173 women, mean (standard deviation, SD) age 61.5 (5.7) years) from the Oslo hand OA cohort, of whom 112 had 7-year follow-up data. Finger joints were scored for radiographic OA according to the Kellgren-Lawrence scale and Osteoarthritis Research Society International (OARSI) atlas. Pain and function were assessed by clinical examination (joint tenderness), grip strength and the Australian/Canadian (AUSCAN) questionnaire. Associations between radiographic hand OA and tenderness in the same joint were examined by logistic regression analyses with Generalized Estimating Equations, whereas associations between overall amount of radiographic OA and hand pain/disability were assessed by linear regression (adjusted for age and sex). RESULTS A dose-dependent association was found between the severity of radiographic OA and tenderness in the same joint. Joints that progressed into severe radiographic OA during follow-up had the highest odds of developing tenderness (OR = 11, 95% confidence interval (CI) 4.0-33). Incident erosions seemed to be the most important individual feature associated with incident tenderness (OR = 6.2, 95% CI 3.2-12). Weak associations were found between the amount of radiographic hand OA and overall hand pain/disability. CONCLUSION Radiographic hand OA is associated with tenderness in the same joint, and erosive development strongly predicts future joint tenderness independent of other radiographic features.
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Affiliation(s)
- I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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25
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Nelson AE, Elstad E, DeVellis RF, Schwartz TA, Golightly YM, Renner JB, Conaghan PG, Kraus VB, Jordan JM. Composite measures of multi-joint symptoms, but not of radiographic osteoarthritis, are associated with functional outcomes: the Johnston County Osteoarthritis Project. Disabil Rehabil 2013; 36:300-6. [PMID: 23639066 DOI: 10.3109/09638288.2013.790490] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
PURPOSE To determine associations between multiple joint symptoms and radiographic osteoarthritis (rOA) and functional outcomes. METHOD Complete cross-sectional data for multi-joint symptoms and radiographs, Health Assessment Questionnaire (HAQ) scores, and gait speed were available for 1307 Johnston County Osteoarthritis Project participants (34% men, 32% African American, mean age 66 years). Factor analysis of symptom scores and radiographic grades for the lumbosacral spine, bilateral hands, knees, and hips provided composite scores. Regression models were used to determine associations between composite scores, HAQ, and gait speed, adjusting for age, body mass index, gender, and race. RESULTS Five rOA factors were identified: (1) IP/CMC factor (carpometacarpal [CMC] and all interphalangeal [IP] joints); (2) MCP factor (metacarpophalangeal joints 2-5); (3) Knee factor (tibiofemoral and patellofemoral joints); (4) Spine factor (L1/2 to L5/S1); and (5) Symptom factor. After adjustment, only the Symptom composite was significantly associated with HAQ and gait speed; a 1-standard deviation increase in Symptom score was associated with 9 times higher odds of having poorer function on the HAQ (odds ratio 9.32, 95% confidence interval [CI] 6.80, 12.77), and a clinically significant decline in gait speed (0.06 m/s, 95% CI -0.07, -0.05). CONCLUSIONS A novel Symptom composite score was associated with poorer functional outcomes. IMPLICATIONS FOR REHABILITATION Osteoarthritis (OA) commonly affects multiple joints and is the most common form of arthritis. Symptomatic assessments, which can be easily executed by rehabilitation practitioners, are more closely related to self-reported and performance-based functional status than are less accessible and more costly radiographs. Symptomatic assessments are likely to be more informative for understanding, treating, and potentially preventing functional limitations than radiographic assessments.
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Mallinson P, Tun J, Farnell R, Campbell D, Robinson P. Osteoarthritis of the thumb carpometacarpal joint: Correlation of ultrasound appearances to disability and treatment response. Clin Radiol 2013; 68:461-5. [DOI: 10.1016/j.crad.2012.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Revised: 10/02/2012] [Accepted: 10/10/2012] [Indexed: 10/27/2022]
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Wittoek R, Cruyssen BV, Verbruggen G. Predictors of functional impairment and pain in erosive osteoarthritis of the interphalangeal joints: comparison with controlled inflammatory arthritis. ACTA ACUST UNITED AC 2012; 64:1430-6. [PMID: 22139828 DOI: 10.1002/art.33502] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To compare levels of pain and functional limitation in patients with erosive osteoarthritis (OA) of the interphalangeal finger joints with those in patients with nonerosive OA and patients with controlled inflammatory arthritis affecting the hands, and to explore predictors of functional impairment in erosive OA. METHODS A cross-sectional study including 270 patients with OA of the hands who were referred to rheumatology clinics was performed. A group of patients with inflammatory arthritis (rheumatoid arthritis or psoriatic arthritis) with a low Disease Activity Score in 28 joints (<3.2; n = 79) was examined. Levels of functional impairment (measured by the Functional Index for Hand OA [FIHOA] and Australian/Canadian OA Hand Index [AUSCAN]) and pain were compared between the groups. Predictors of functional impairment in erosive OA were evaluated by generalized linear models. RESULTS Of 270 patients with hand OA, 167 (61.9%) were classified as having erosive OA. Despite a higher percentage of patients taking analgesics (almost 60%), patients with erosive OA had worse functional outcome and pain scores than patients with controlled inflammatory arthritis or nonerosive OA. Pain scores remained significantly higher in patients with erosive OA after correction for potential confounders. FIHOA and AUSCAN function scores showed a trend toward more disability in patients with erosive OA. Female sex and the number of radiographic affected joints (consisting of joints in the erosive and remodeled radiographic phases) were the strongest predictors of functional impairment in erosive OA. Whether the carpometacarpal joints were affected did not influence functional status in patients with erosive OA. CONCLUSION Our findings indicate that patients with erosive OA have more functional impairment and significantly more pain compared to patients with controlled inflammatory arthritis affecting the hands. This highlights the significant clinical burden of erosive OA and warrants the search for new treatment strategies.
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Jonsson H, Helgadottir GP, Aspelund T, Sverrisdottir JE, Eiriksdottir G, Sigurdsson S, Eliasson GJ, Jonsson A, Ingvarsson T, Harris TB, Launer L, Gudnason V. The use of digital photographs for the diagnosis of hand osteoarthritis: the AGES-Reykjavik study. BMC Musculoskelet Disord 2012; 13:20. [PMID: 22340303 PMCID: PMC3293753 DOI: 10.1186/1471-2474-13-20] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2011] [Accepted: 02/16/2012] [Indexed: 11/29/2022] Open
Abstract
Background The objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and finally to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable. Methods High quality photographs with standard distance and hand positioning were analysed for the presence of HOA and subsequently compared with standard radiographs and clinical examination in 381 random participants in the AGES-Reykjavik Study, a large population study. The mean age of the participants was 76 years. Results Using the photographic method, the most commonly affected joints were the second DIP joints followed by the third DIP joints and second and third PIP joints. Both interobserver (ICC = 0.83) and intraobserver reading agreements (ICC = 0.89) were acceptable. On comparison with radiography and clinical examination, aggregate scores were significantly correlated (Rs 0.35-0.69), more so in females (Rs 0.53-0.72) than males. Hand pain in males showed very little association with HOA findings by the three methods but all methods showed a comparable moderate association with hand pain in females. The performance of photography in predicting pain on most days for at least a month in females was comparable to that of radiography and clinical examination (AUC 0.63 p = 0.004). Analysis of intermittent pain yielded similar results for in the DIP and PIP joints (OR 3.2-3.3, p < 0.01), but for the CMC1 joints, both radiography (OR 9.0, p < 0.0001), and clinical examination (OR 9.8, p < 0.0001), had higher predictive odds ratios for pain than photography (OR 3.6, p < 0.0001)., A shortened, rapidly performed form of reading photographs also showed a high degree of correlation with the other methods (Rs 0.56-0.82). Conclusion High quality hand photographs can be used to diagnose and grade hand osteoarthritis. The method has the advantage of being inexpensive and easy to perform. By using a slightly simplified method of reading, it appears to be highly suitable for use in large studies.
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Affiliation(s)
- Helgi Jonsson
- Landspitalinn University Hospital, University of Iceland, IS-108 Fossvogur, Reykjavik, ICELAND.
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Haugen IK, Bøyesen P. Imaging modalities in hand osteoarthritis--and perspectives of conventional radiography, magnetic resonance imaging, and ultrasonography. Arthritis Res Ther 2011; 13:248. [PMID: 22189142 PMCID: PMC3334630 DOI: 10.1186/ar3509] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Hand osteoarthritis (OA) is very frequent in middle-aged and older women and men in the general population. Currently, owing to high feasibility and low costs, conventional radiography (CR) is the method of choice for evaluation of hand OA. CR provides a two-dimensional picture of bony changes, such as osteophytes, erosions, cysts, and sclerosis, and joint space narrowing as an indirect measure of cartilage loss. There are several standardized scoring methods for evaluation of radiographic hand OA. The scales have shown similar reliability, validity, and sensitivity to change, and no conclusion about the preferred instrument has been drawn. Patients with hand OA may experience pain, stiffness, and physical disability, but the associations between radiographic findings and clinical symptoms are weak to moderate and vary across studies. OA is, indeed, recognized to involve the whole joint, and modern imaging techniques such as ultrasound (US) and magnetic resonance imaging (MRI) could be valuable tools for better evaluation of hand OA. Standardized scoring methods have been proposed for both modalities. Several studies have examined the validity of US features in hand OA, whereas knowledge of the validity of MRI is more limited. However, both synovitis (detected by either US or MRI) and MRI-defined bone marrow lesions have been associated with pain, indicating that treatment of inflammation is important for pain management in hand OA. Both US and MRI have shown better sensitivity than CR in detection of erosions, and this may indicate that erosive hand OA may be more common than previously thought.
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Affiliation(s)
- Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, P,O, Box 23, Vinderen, 0319 Oslo, Norway.
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Abstract
Hand osteoarthritis (OA) is a prevalent disorder. Hand OA is not one single disease, but a heterogeneous group of disorders. Radiographic signs of hand OA, such as osteophytes or joint space narrowing, can be found in up to 81% of the elderly population. Several hand OA subsets--such as nodal interphalangeal OA, thumb base OA and erosive OA--can be discriminated. Furthermore, the experience of symptoms and the course of the disease differ between patients. Studies that used well-defined study populations with longitudinal follow-up have shown that similarities and differences can be observed in the pathogenesis, epidemiology and risk factors of the various hand OA subsets. Erosive OA in particular, characterized by erosive lesions on radiographical images, has a higher clinical burden and worse outcome than nonerosive hand OA. Imaging modalities (such as ultrasonography) have increased our knowledge of the role of inflammation of the disease. Our understanding of the heterogeneous nature of hand OA can eventually lead to increased knowledge of the pathogenesis of, and ultimately new treatment modalities for, this complex disease.
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Affiliation(s)
- Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, 2300 RC Leiden, The Netherlands.
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Gorniak GC, Conrad W, Conrad E, Decker B. Patterns of radiocarpal joint articular cartilage wear in cadavers. Clin Anat 2011; 25:468-77. [PMID: 22095798 DOI: 10.1002/ca.21258] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2011] [Revised: 07/15/2011] [Accepted: 07/22/2011] [Indexed: 11/12/2022]
Abstract
The radiocarpal joint transmits about 80% of the compression forces crossing the wrist. However, primary osteoarthritis of this joint is surprisingly uncommon, suggesting that articular cartilage wear is not sufficient to produce arthritic symptoms. By examining the distal radius, scaphoid, and lunate in aged cadavers, wear patterns were charted and measured, allowing assessment of radiocarpal joint wear and mechanics. Bilateral radiocarpal joints of 16 females and 14 males (age 77.7 ± 14.4, N = 30) were exposed and measurements of the wear recorded microscopically. Wear locations were mapped, and X-Y loci and wear areas calculated. Gender right and sides compared. Over 95% of distal radius wear showed distinct radial-scaphoid and radial-lunate wear areas. These bilateral areas were in the palmar half of the distal radius. One main central wear area was seen in 95% of the scaphoid, and 97% of the lunate articular surfaces that were examined. Articular wear showed a circular pattern and was minimal in 95.7% of the surfaces, and the lunate showed the largest wear area. Wear patterns in males and females support the literature that for most ADLs the wrist is in slight extension and ulnar deviation. There are gender differences, but wear areas between sides were similar. Female wear indicates their wrist is positioned more often in a more extended and ulnarly deviated position than males. The wear patterns suggest rotational movements of the scaphoid and lunate during wrist motion and that the wrist is most often used in neutral flexion/extension to slight extension.
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Affiliation(s)
- Gerard C Gorniak
- University of St Augustine for Health Sciences, Institute of Physical Therapy, St Augustine, Florida 32086-5783, USA.
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Ding H, Solovieva S, Leino-Arjas P. Determinants of incident and persistent finger joint pain during a five-year followup among female dentists and teachers. Arthritis Care Res (Hoboken) 2011; 63:702-10. [PMID: 21309003 DOI: 10.1002/acr.20437] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
OBJECTIVE To investigate the association of radiographic finger osteoarthritis (OA), hand use, and lifestyle factors with incident and persistent finger joint pain among female dentists and teachers. METHODS Random samples of female dentists (n = 295) and teachers (n = 248) ages 45-63 years were examined by radiography for the presence of finger joint OA. Body weight was measured. Information on finger joint pain during the past 30 days, height, smoking, and leisure-time hand activity was collected by questionnaire. Five years later, 482 women (89%; 65% still active occupationally) responded to a survey on finger joint pain. RESULTS The incidence and persistence of finger joint pain were higher among the subjects with OA compared to those without OA. The relative risk (RR) of incident pain in the first through the third fingers was 1.8 (95% confidence interval [95% CI] 1.2-2.7) in the right hand and the RR in the left hand was 3.0 (95% CI 2.0-4.6), allowing for age, occupation, and lifestyle factors. The corresponding figures for the fourth and fifth fingers were RR 2.3 (95% CI 1.4-3.8) in the right and RR 1.9 (95% CI 1.1-3.5) in the left hand. Regarding persistent pain, the RRs varied between 2.4 and 5.4. Body mass index, smoking, or leisure-time hand activity were not associated with pain. The dentists tended to have a higher incidence of pain in the first through the third fingers of the right hand compared with the teachers. CONCLUSION Radiographic finger joint OA was a significant determinant of both persistent and incident finger joint pain in a 5-year followup among middle-aged women. Hand use may modify the association between radiographic OA and finger joint pain.
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Affiliation(s)
- Hebo Ding
- Finnish Institute of Occupational Health, Helsinki, Finland
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Markkula R, Kalso E, Huunan-Seppälä A, Koskenvuo M, Koskenvuo K, Leino-Arjas P, Kaprio J. The burden of symptoms predicts early retirement: a twin cohort study on fibromyalgia-associated symptoms. Eur J Pain 2011; 15:741-7. [PMID: 21316271 DOI: 10.1016/j.ejpain.2011.01.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 12/16/2010] [Accepted: 01/15/2011] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To assess whether symptoms of fibromyalgia (FM) predict disability retirement or mortality. METHODS All Finnish Twin Cohort members and diagnosed FM-patients who had answered the same health questionnaire in 1990-1992 were studied. A sample of 10,608 working aged individuals of the cohort was classified in homogenous groups based on symptom profile with latent class analysis, using a battery of questions addressing FM-associated symptoms validated between FM-patients and twins. This resulted in three classes: no or few symptoms (LC1), some symptoms (LC2), and high load of FM-symptoms (LC3). In a 14-year follow-up, 1990-2004, information on disability retirement was obtained from official pension registers. Further linkage with Population Register Centre data for 1990-2009 yielded information on the vital status of the cohort subjects. Those with malignancies or inflammatory rheumatic diseases were excluded. RESULTS Cumulative incidence of early disability retirement was 9.5% among all 8448 individuals (after exclusions), and 26% in LC3. Adjusted hrs for early retirement were 1.0 (reference class) in LC1, 1.5 (95%CI 1.2-1.7) in LC2, and 2.9 (2.4-3.6) in LC3 for all causes and 1.8 (1.4-2.5) in LC2 and 5.0 (3.6-6.9) in LC3 for musculoskeletal disorders. In 173,675 person-years, the high symptom class (LC3) had a 43% (95% CI 17-75%) increased overall mortality risk, which was fully accounted for by adjustment for lifestyle factors, mainly smoking. CONCLUSION Symptoms associated with FM strongly correlate with early disability retirement. Lifestyle problems associated with high symptom load need prompt management to avoid increased risk of mortality.
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Affiliation(s)
- Ritva Markkula
- Helsinki University Central Hospital, Pain Clinic, Department of Anaesthesiology and Intensive Care Medicine, Finland.
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Kjeken I. Occupational therapy-based and evidence-supported recommendations for assessment and exercises in hand osteoarthritis. Scand J Occup Ther 2010; 18:265-81. [PMID: 21091120 DOI: 10.3109/11038128.2010.514942] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS The aims of this study were to develop recommendations for occupational therapy assessment and design of hand exercise programmes in patients with hand osteoarthritis. METHODS An expert group followed a Delphi procedure to reach consensus for up to 10 recommendations for assessment and exercises, respectively. Thereafter, an evidence-based approach was used to identify and appraise research evidence supporting each recommendation, before the recommendations were validated by the expert group. RESULTS The process resulted in 10 recommendations for assessment and eight for design of exercise programmes. The literature search revealed that there is a paucity of clinical trials to guide recommendations for hand osteoarthritis, and the evidence for the majority of the recommendations was based on expert opinions. Also, even if a systematic review demonstrates some evidence for the efficacy of strength training exercises in hand OA, the evidence for any specific exercise is limited to expert opinions. CONCLUSIONS A first set of recommendations for assessment and exercise in hand osteoarthritis has been developed. For many of the recommendations there is a paucity of research evidence. High-quality studies are therefore needed to establish a high level of evidence concerning functional assessment and the effect of hand exercises in hand osteoarthritis.
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Affiliation(s)
- Ingvild Kjeken
- National Resource Center for Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
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Pantsulaia I, Kalichman L, Kobyliansky E. Association between radiographic hand osteoarthritis and RANKL, OPG and inflammatory markers. Osteoarthritis Cartilage 2010; 18:1448-53. [PMID: 20633673 DOI: 10.1016/j.joca.2010.06.009] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2010] [Revised: 06/12/2010] [Accepted: 06/15/2010] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to evaluate the association between prevalence and severity of radiographic hand osteoarthritis (OA) and serum levels of systemic inflammatory markers in a community-based population sample. DESIGN A cross-sectional observational study was conducted on a population comprised 1452 Chuvashians (763 males, aged 49.23 ± 17.43; and 689 females, aged 50.37 ± 17.47 years). OA was evaluated in 14 joints of each hand using Kellgren and Lawrence (K-L), joint space narrowing (JSN) and osteophyte (OS) scores. Serum levels of systemic inflammatory and osteoclastogenic cytokines were measured by an enzyme-linked immunosorbent assay (ELISA). Statistical analyses included descriptive statistics, correlation analysis and multiple linear regressions. RESULTS Monocyte chemotactic protein-1 (MCP-1) and osteoprotegerin (OPG) levels were associated with OA traits, but the statistically significant correlations were weak and/or moderate. In particular, the MCP-1 inflammation marker showed a statistically significant association with JSN (β=0.077, P=0.022) and OS (β=0.067, P=0.024) scores, but not with the number of affected joints (K-L ≥ 2). OPG was significantly correlated with the scores as to the number of affected joints (β=0.063, P=0.035) and OS (β=0.077, P=0.028). No significant associations were found between levels of other inflammatory [interleukin (IL)-6, tumor necrosis factor (TNF)-α, IL-17] and osteoclastogenic [receptor activator for nuclear factor κ B ligand (RANKL), macrophage colony-stimulating factor (M-CSF)] cytokines and OA characteristics. CONCLUSIONS This study strengthens the premise that OPG might be a valid biomarker of hand OA. Confirmation of these results in larger cohorts of patients will reinforce our theory that the RANKL/OPG pathway is a suitable target for developing novel agents against OA.
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Affiliation(s)
- I Pantsulaia
- Department of Biomedicine, Institute of Medical Biotechnology, Ministry of Education and Sciences, Tbilisi, Georgia
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Kalichman L, Hernández-Molina G. Hand Osteoarthritis: An Epidemiological Perspective. Semin Arthritis Rheum 2010; 39:465-76. [DOI: 10.1016/j.semarthrit.2009.03.001] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2008] [Revised: 02/19/2009] [Accepted: 03/16/2009] [Indexed: 10/20/2022]
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Ding H, Solovieva S, Vehmas T, Takala EP, Leino-Arjas P. Hand osteoarthritis and pinch grip strength among middle-aged female dentists and teachers. Scand J Rheumatol 2010; 39:84-7. [PMID: 20132076 DOI: 10.3109/03009740903201834] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES Among female dentists and teachers, we investigated the relationship of pinch grip strength with radiographic hand osteoarthritis (OA) and hand joint pain. MATERIALS AND METHODS We studied 295 female dentists and 248 female teachers aged 45-63 years for pinch grip strength using the Martin Vigorimeter. Hand radiographs were examined for the presence of OA in the wrist and each joint of the first, second, and third fingers. Joint pain and tasks with high hand loading during leisure were assessed by questionnaire. Glove size was used as proxy for hand size. RESULTS Symptomatic hand OA (jointwise co-occurrence of radiological findings and pain) increased the risk of low pinch grip strength in both hands, with an odds ratio (OR) of 3.3 (95% CI 1.8-6.2) for the right and 2.0 (95% CI 1.1-3.8) for the left hand, allowing for age, occupation, body mass index (BMI), hand size, and hand-loading leisure-time activity. The occurrence of findings and pain in non-corresponding joints was also associated with pinch grip strength in the right hand, but not in the left. Having only radiographic findings or pain was not associated with pinch grip strength. CONCLUSIONS Our findings support the view that hand function is related to the severity of hand OA.
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Affiliation(s)
- H Ding
- Finnish Institute of Occupational Health, Centre of Expertise for Health and Work Ability, Helsinki, Finland
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Slatkowsky-Christensen B, Mowinckel P, Loge JH, Kvien TK. Health-related quality of life in women with symptomatic hand osteoarthritis: a comparison with rheumatoid arthritis patients, healthy controls, and normative data. ACTA ACUST UNITED AC 2008; 57:1404-9. [PMID: 18050180 DOI: 10.1002/art.23079] [Citation(s) in RCA: 129] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Data on the burden of disease and impact on health-related quality of life (HRQOL) in hand osteoarthritis (OA) are limited. The goal of this study was to compare HRQOL in patients with hand OA with HRQOL in patients with rheumatoid arthritis (RA), healthy controls, and normative data from the general population. METHODS A total of 190 women with hand OA were compared with 194 women with RA and 144 healthy women of the same age. Health status was measured using the Short Form 36 (SF-36), Short Form 6D (SF-6D), modified Health Assessment Questionnaire (M-HAQ), pain and fatigue visual analog scales, and grip strength. Scores were compared by analysis of variance and a multivariate analysis of covariance, adjusting for age, number of comorbidities, and years of education. Gaps between patients and population subjects were assessed by calculating S scores on all dimensions of the SF-36. RESULTS Hand OA and RA patients had worse scores on all assessed dimensions of subjective health compared with healthy controls. RA patients showed poorest general health (SF-36), poorest physical function (M-HAQ, SF-36 physical, grip strength), and highest level of fatigue compared with hand OA patients. Hand OA patients reported poorer mental health. Mean utility scores (SF-6D) in hand OA and RA were 0.64 and 0.63, respectively, with a mean difference compared with healthy controls of 0.13 in hand OA and 0.14 in RA patients. S scores confirmed a marked disparity between individuals with a rheumatic diagnosis (hand OA, RA) and population subjects. CONCLUSION This study illustrates that patients with hand OA experience a broad impact on HRQOL compared with healthy controls. Fatigue and physical function are worse in RA than hand OA.
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Marshall M, Dziedzic KS, van der Windt DA, Hay EM. A systematic search and narrative review of radiographic definitions of hand osteoarthritis in population-based studies. Osteoarthritis Cartilage 2008; 16:219-26. [PMID: 17646114 DOI: 10.1016/j.joca.2007.06.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2007] [Accepted: 06/05/2007] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Currently there is no agreed "gold standard" definition of radiographic hand osteoarthritis (RHOA) for use in epidemiological studies. We therefore undertook a systematic search and narrative review of community-based epidemiological studies of hand osteoarthritis (OA) to identify (1) grading systems used, (2) definitions of radiographic OA for individual joints and (3) definitions of overall RHOA. METHODS The following electronic databases were searched: Medline, Embase, Science Citation Index and Ageline (inception to Dec 2006). The search strategy combined terms for "hand" and specific joint sites, OA and radiography. Inclusion and exclusion criteria were applied. Data were extracted from each paper covering: hand joints studied, grading system used, definitions applied for OA at individual joints and overall RHOA. RESULTS Titles and abstracts of 829 publications were reviewed and the full texts of 399 papers were obtained. One hundred fifty-two met the inclusion criteria and 24 additional papers identified from screening references. Kellgren and Lawrence (K&L) was the most frequently applied grading system used in 80% (n=141) of studies. In 71 studies defining OA at the individual joint level 69 (97%) used a definition of K&L grade > or = 2. Only 53 publications defined overall RHOA, using 21 different definitions based on five grading systems. CONCLUSION The K&L scheme remains the most frequently used grading system. There is a consistency in defining OA in a single hand joint as K&L grade > or = 2. However, there are substantial variations in the definitions of overall RHOA in epidemiological studies.
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Affiliation(s)
- M Marshall
- Primary Care Musculoskeletal Research Centre, Keele University, Keele, Staffordshire ST5 5BG, UK.
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Abstract
PURPOSE OF REVIEW This review describes advances in our knowledge on the clinical burden of hand osteoarthritis, its relation to radiographic signs of osteoarthritis and potential targets for therapy. Treatments and trial methodology for hand osteoarthritis are critically reviewed. RECENT FINDINGS Recent studies have shown that there is an association between radiographic hand osteoarthritis and hand pain, and that symptomatic hand osteoarthritis leads to substantial disability. Some risk factors for hand osteoarthritis have been described but the development of hand osteoarthritis is still unclear. Unfortunately, pharmacological therapies for hand osteoarthritis are lacking and have been investigated little. Only a few studies on other treatment modalities are available. Surgical treatments are not covered in this review. SUMMARY Advances have been made in our understanding of symptomatic hand osteoarthritis. Potential targets for therapy are recognized. The challenge for the coming years is to conduct clinical trials of high quality in hand osteoarthritis.
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Affiliation(s)
- Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Centre, Leiden, The Netherlands.
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