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Huang L, Zhang ZY, Gao M, Wang XQ, Duan XQ, Liu ZL. The Effectiveness of Exercise-Based Rehabilitation in People With Hand Osteoarthritis: A Systematic Review With Meta-analysis. J Orthop Sports Phys Ther 2024; 54:457-467. [PMID: 38506711 DOI: 10.2519/jospt.2024.12241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
OBJECTIVE: To investigate the effectiveness of exercise-based rehabilitation programs compared with nonexercise intervention or no intervention for people with hand osteoarthritis (OA). DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: We searched 5 databases on July 23, 2023. STUDY SELECTION CRITERIA: We included randomized controlled trials that compared the effectiveness of rehabilitation programs that included an exercise component, with nonexercise intervention or no intervention for people with hand OA. DATA SYNTHESIS: Standardized mean differences (SMDs) were pooled using a random-effects model. The risk of bias was assessed using the Cochrane Risk of Bias 2.0 tool. The certainty of the evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) approach. RESULTS: Fourteen trials were included in the meta-analysis (n = 1341 participants). In the immediate term (<24 weeks), there was low-certainty evidence of an effect of exercise-based rehabilitation on improving pain (13 trials; SMD = -0.65; 95% CI: -1.06, -0.25), function (11 trials; SMD = -0.35; 95% CI: -0.54, -0.15), and grip strength (14 trials; SMD = 0.21; 95% CI: 0.03, 0.38). There was moderate-certainty evidence of an effect on reducing stiffness (7 trials; SMD = -0.33; 95% CI: -0.51, -0.16). There was low-certainty evidence of no effect on improving pinch strength and quality of life. For the long term (≥24 weeks), there was low-certainty evidence that exercise-based rehabilitation had no additional effect on improving pain, function, and stiffness. CONCLUSION: Exercise-based rehabilitation improved pain, function, stiffness, and grip strength in people with hand OA in the immediate term; the benefits were not maintained in the long term. J Orthop Sports Phys Ther 2024;54(7):1-11. Epub 20 March 2024. doi:10.2519/jospt.2024.12241.
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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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Chen SC, Tsai CF, Wang PH, Lee YT, Chen CC. Auricular acupressure approach for the early stage of knee osteoarthritis. QJM 2023; 116:811-812. [PMID: 37162482 DOI: 10.1093/qjmed/hcad086] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Indexed: 05/11/2023] Open
Affiliation(s)
- S-C Chen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - C-F Tsai
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - P-H Wang
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Medical Research, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Y-T Lee
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Internal Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - C-C Chen
- Department of Family and Community Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- Department of Occupational Medicine, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Mathiessen A, Hammer HB, Terslev L, Kortekaas MC, D'Agostino MA, Haugen IK, Bruyn GA, Filippou G, Filippucci E, Kloppenburg M, Mancarella L, Mandl P, Möller I, Mortada MA, Naredo E, Sedie AD, Sexton J, Wittoek R, Iagnocco A, Ellegaard K. Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study. Arthritis Care Res (Hoboken) 2022; 74:2005-2012. [PMID: 34137211 DOI: 10.1002/acr.24734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 05/15/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To standardize and assess the reliability of ultrasonographic assessment of inflammatory and structural lesions in patients with hand osteoarthritis (OA). METHODS The Outcome Measures in Rheumatology Ultrasound Working Group selected synovial hypertrophy (SH), joint effusion (JE), and power Doppler (PD) signals as the main inflammatory lesions in hand OA, and suggested osteophytes in the scapho-trapezio-trapezoid (STT) and cartilage defects in the proximal interphalangeal (PIP) joints as novel additions to previous structural scoring systems. A complementary imaging atlas provided detailed examples of the scores. A reliability exercise of static images was performed for the inflammatory features, followed by a patient-based exercise with 6 sonographers testing inflammatory and structural features in 12 hand OA patients. We used Cohen's kappa for intrareader and Light's kappa for interreader reliability for all features except PD, in which prevalence-adjusted bias-adjusted kappa (PABAK) was applied. Percentage agreement was also assessed. RESULTS The web-based reliability exercise demonstrated substantial intra- and interreader reliability for all inflammatory features (κ > 0.64). In the patient-based exercise, intra- and interreader reliability, respectively, varied: SH κ = 0.73 and 0.45; JE κ = 0.70 and 0.55; PD PABAK = 0.90 and 0.88; PIP joint cartilage κ = 0.56 and 0.45; and STT osteophytes κ = 0.62 and 0.36. Percentage close agreement was high for all features (>85%). CONCLUSION With ultrasound, substantial to excellent intrareader reliability was found for inflammatory features of hand OA. Interreader reliability was moderate, but overall high close agreement between readers suggests that better reliability is achievable after further training. Assessment of osteophytes in the STT joint and cartilage in the PIP joints achieved less reliability and the latter is not endorsed.
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Affiliation(s)
| | - Hilde B Hammer
- Diakonhjemmet Hospital and University of Oslo, Oslo, Norway
| | | | | | | | | | | | | | | | | | | | - Peter Mandl
- Medical University of Vienna, Vienna, Austria
| | | | | | | | | | | | - Ruth Wittoek
- Ghent University Hospital, Ghent University, Ghent, Belgium
| | | | - Karen Ellegaard
- Copenhagen University Hospital Bispebjerg-Frederiksberg, Frederiksberg, Denmark
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Suwannaphisit S, Tangtrakulwanich B, Suwanno P, Sinnathakorn N, Maheu E. Cross-cultural adaptation and validation of the Thai version of the functional index for hand osteoarthritis (FIHOA). BMC Musculoskelet Disord 2022; 23:582. [PMID: 35705932 PMCID: PMC9202204 DOI: 10.1186/s12891-022-05528-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/09/2022] [Indexed: 11/21/2022] Open
Abstract
Background The Functional Index for Hand Osteoarthritis (FIHOA) is a simple tool to assess functional impairment for hand OA patients. The purpose of this study was to translate the FIHOA into the Thai language, and validate it in Thai hand OA patients. Methods The FIHOA was translated into Thai (T-FIHOA) according to the principles of
cross-cultural adaptation and administered to 102 hand OA patients recruited between September 2020 and July 2021 together with the modified Health Assessment Questionnaire (mHAQ), Disabilities of the Arm, Shoulder and Hand (DASH), and visual analogue scale (VAS) for hand pain. Spearman’s correlation coefficient and intraclass correlation coefficient (ICC) were used to check the test-retest reliability of each item and the total scores in the translated questionnaire. The internal consistency reliability was evaluated using Cronbach’s alpha. The external construct validity was assessed using correlations between the T-FIHOA, mHAQ, DASH and hand pain VAS. Results The T-FIHOA had a unidimensional structure. The ICC was > 0.9 and the Cronbach’s alpha of 0.92 indicated excellent reliability and internal consistency, respectively. The external validity tests indicated moderate correlation with the hand pain VAS (r = 0.37, P < 0.01) and moderate to strong correlations with the mHAQ (r = 0.63, P < 0.01), and DASH score (r = 0.52, P < 0.01). The T-FIHOA had the highest effect size (ES) and standardized response mean (SRM) (− 0.37 and − 0.58 respectively) among all questionnaires except for the VAS when assessing changes between baseline and week 4. Conclusions The T-FIHOA is a good and reliable assessment tool freely available for practitioners/researchers to evaluate functional impairment in Thai hand OA patients.
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Affiliation(s)
- Sitthiphong Suwannaphisit
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand.
| | - Boonsin Tangtrakulwanich
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Porames Suwanno
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Nitiphoom Sinnathakorn
- Department of Orthopedics, Faculty of Medicine, Prince of Songkla University, 15 Karnjanavanich Road, Hat Yai, Songkhla, 90110, Thailand
| | - Emmanuel Maheu
- Department of Rheumatology, APHP, Saint-Antoine Hospital, 283, Boulevard Voltaire, Paris, France
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Öncel A, Küçükşen S, Ecesoy H, Sodali E, Yalçin Ş. Comparison of efficacy of fluidotherapy and paraffin bath in hand osteoarthritis: A randomized controlled trial. Arch Rheumatol 2021; 36:201-209. [PMID: 34527924 PMCID: PMC8418774 DOI: 10.46497/archrheumatol.2021.8123] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/09/2020] [Indexed: 01/01/2023] Open
Abstract
Objectives
This study aims to compare the efficacy of paraffin bath therapy and fluidotherapy on pain, hand muscle strength, functional status, and quality of life (QoL) in patients with hand osteoarthritis (OA). Patients and methods
This prospective randomized controlled study included 77 patients (8 males, 69 females; mean age: 63.1±10.3 years; range 39 to 88 years) with primary hand OA who applied between July 2017 and March 2018. The patients were randomized into two groups with the sealed envelope method: Paraffin bath therapy (20 min, one session per day, for two weeks) was applied for 36 patients whereas 41 patients received fluidotherapy for the same period. The pain severity of the patients, both at rest and during activities of daily living (ADL) within the last 48 hours was questioned and scored using Visual Analog Scale. Duruöz Hand Index (DHI) was used to evaluate hand functions. Gross grip strength was measured using Jamar dynamometer whereas fine grip strength was measured using pinch meter in three different positions (lateral pinch, tip pinch, and palmar pinch). The 36-Item Short Form (SF-36) was used to analyze the QoL. All measurements were performed before, immediately after, and three months after treatment. Results
Improvement was observed in pain score at rest and during ADL, DHI scores, gross and fine grip strengths, and SF-36 subscores in both groups after treatment. However, no significant difference was observed between the groups. Conclusion Both fluidotherapy and paraffin bath therapy have been found to have positive effects on pain, hand muscle strength, functional status, and QoL in the treatment of hand OA. However, no superiority was observed between the two treatment modalities.
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Affiliation(s)
- Adil Öncel
- Department of Physical Medicine and Rehabilitation, Sultanbeyli State Hospital, Istanbul, Turkey
| | - Sami Küçükşen
- Department of Physical Medicine and Rehabilitation, Necmettin Erbakan University Medical School, Konya, Turkey
| | - Hilal Ecesoy
- Department of Physical Medicine and Rehabilitation, Division of Rheumatology, Necmettin Erbakan University Medical School, Konya, Turkey
| | - Emre Sodali
- Department of Physical Medicine and Rehabilitation, Sabuncuoğlu Training and Research Hospital, Amasya, Turkey
| | - Şevket Yalçin
- Department of Physical Medicine and Rehabilitation, İpekyolu Hospital, Mardin, Turkey
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Translation, cultural adaptation and reproducibility of a Portuguese version of the Functional Index for Hand OsteoArthritis (FIHOA). Adv Rheumatol 2021; 61:30. [PMID: 34090513 DOI: 10.1186/s42358-021-00189-1] [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: 01/26/2021] [Accepted: 05/20/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Functional Index for Hand Osteoarthritis (FIHOA) is a simple, reliable, and reproducible specific instrument to evaluate hand OA that can be applied both in clinical practice and research protocols. In order to be used in Brazil, FIHOA has to be translated into Portuguese, culturally adapted and have the reliability of the translated FIHOA version tested, which is the purpose of this study. METHODS The FIHOA was translated into Brazilian Portuguese and administered to 68 patients with hand OA recruited between May 2019 and February 2020. The test-retest was applied to 32 patients and the reliability was assessed using Spearman's correlation coefficient and intraclass correlation coefficient (ICC). The internal consistency reliability was evaluated using Cronbach's alpha. External construction validity was assessed using the Spearman's correlation test between FIHOA and pain, assessed with a Visual Analogue Scale (VAS), the Cochin Hand Functional Scale (CHFS) and Health Assessment Questionnaire (HAQ). RESULTS The 30 participants that initially answered the translated version of the FiHOA did not report difficulties in understanding or interpreting the translated version. The test-retest reliability for the total score was strong (r = 0.86; ICC = 0.89). Mean differences (1.37 ± 0.68) using Bland Altman's analysis did not significantly differ from zero and no systematic bias was observed. Cronbach's alpha was also high (0.89) suggesting a strong internal coherence in the test items. There were also correlations between FIHOA and the CHFS (r = 0.88), HAQ (r = 0.64) and pain in the hands both at rest (r = 0.55) and in motion (r = 0.44). CONCLUSION The translation of the FIHOA into Brazilian Portuguese proved a valid instrument for measuring the functional capacity of patients with hand OA who understand Brazilian Portuguese.
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Kim SK, Jung UH, Choe JY. Functional index for hand osteoarthritis (FIHOA) is associated with pain, muscle strength, and EQ-5D in hand osteoarthritis. Adv Rheumatol 2021; 61:19. [PMID: 33741081 DOI: 10.1186/s42358-021-00177-5] [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: 10/05/2020] [Accepted: 03/08/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND This study identified whether Functional Index for Hand Osteoarthritis (FIHOA) is associated with pain, hand muscle strength, health-related quality of life, and radiographic severity in hand osteoarthritis (OA). METHODS We consecutively recruited 95 patients with hand OA. The FIHOA was used to assess questionnaire-based physical function in hand OA. Health-related quality of life was evaluated using EuroQol-5 dimension (EQ-5D). Radiographic changes of hand joints were measured by Kellgren-Lawrence (K-L) grade, which was determined based on total radiographic severity score and number of affected joints. Other measures included patient's visual analogue scale (VAS) score for pain and performance-based function indexes such as grip and pinch strength. Statistical analysis was performed using Mann-Whitney U test, Spearman's correlation analysis, and multivariate logistic regression analysis. RESULTS FIHOA score was negatively associated with grip and pinch hand strength and EQ-5D and positively correlated to VAS pain (p < 0.05 for all). There were significant differences of grip and pinch strength, VAS pain, EQ-5D index, and EQ-VAS between two FIHOA groups (≤ 4 vs. > 4) (p < 0.05 for all). Multivariate logistic regression analysis showed that higher FIHOA score (FIHOA > 4) was related with increased VAS pain and with lower EQ-5D index (p = 0.008 and p = 0.013, respectively). There was no association between FIHOA score and measures of total radiographic severity score and number of affected joints. CONCLUSION This study observes that FIHOA score is associated with patient-reported VAS pain, hand muscle strength indexes, and EQ-5D but not radiographic severity in hand OA.
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Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea.
| | - Ui Hong Jung
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Catholic University of Daegu School of Medicine, 33, Duryugongwon-ro 17-gil, Nam-gu, Daegu, 42472, Republic of Korea
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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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Kim SK, Jung UH, Kim JW, Choe JY. Ultrasound Findings were Associated With Radiographic Changes, But Not Clinical and Functional Outcomes in Hand Osteoarthritis. JOURNAL OF RHEUMATIC DISEASES 2021; 28:17-24. [PMID: 37476391 PMCID: PMC10324955 DOI: 10.4078/jrd.2021.28.1.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/18/2020] [Accepted: 09/18/2020] [Indexed: 07/22/2023]
Abstract
Objective There is a debate over the relevance of ultrasound abnormalities to the pain, functional impairment, and radiologic severity in hand osteoarthritis (OA) This study aims to determine the association between ultrasound abnormalities and clinical, functional, and radiographic measures in hand OA. Methods A total of 66 patients was consecutively enrolled All patients with gray-scale synovitis, joint effusion, and osteophytes were examined by ultrasound for 20 hand joints Radiographic changes in both hands were evaluated by the Kellgren-Lawrence (K-L) grading system and were described as total radiographic severity score and number of affected joints Other measures were also assessed, including each patient's visual analogue scale for pain, the Functional Index for Hand Osteoarthritis for functional disability, and grip and pinch strength for hand muscle strength. Results In total, 10 patients with gray-scale synovitis, 35 with joint effusion, and 66 with osteophytes were detected in hand OA scans on ultrasound Osteophytes on ultrasound were significantly associated with total radiographic severity score and number of affected joint (r=0293, p=0003 and r=0336, p<0001, respectively) In addition, there were weak associations of synovitis and joint effusion with radiographic changes Patients with higher total radiographic severity score showed larger number of ultrasound-detected abnormalities, such as synovitis, joint effusion, and osteophytes (p=0011, p=0002, and p<0001, respectively). Conclusion This study shows that ultrasound findings, especially osteophytes, were associated with radiographic changes based on K-L grade, but not clinical and functional status in hand OA.
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Affiliation(s)
- Seong-Kyu Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ui Hong Jung
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Ji-Won Kim
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
| | - Jung-Yoon Choe
- Division of Rheumatology, Department of Internal Medicine, Daegu Catholic University School of Medicine, Daegu, Korea
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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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12
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Leung YY, Li JCH, Thumboo J. Domains rated as important by patients with hand osteoarthritis. Int J Rheum Dis 2020; 22:2045-2051. [PMID: 31722448 DOI: 10.1111/1756-185x.13709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 03/10/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022]
Abstract
BACKGROUND No data exist on patient participation in the selection of core domains for clinical trials of hand osteoarthritis (HOA). We aim to explore HOA patients' perspectives in the relative importance of domains. METHODS Seven domains affecting patients' lives were derived from a prior qualitative study. We recruited consecutive patients with symptomatic HOA to rate on 11-point numeric rating scales for each domain, from 0 representing "not important at all" to 10 representing "most important", with consideration in two scenarios: (a) how important the domains are in affecting their current lives; and (b) how important the domains are when there are treatments for HOA (eg exercise or drugs). RESULTS Forty-five patients (91% female; mean age ± standard deviation 64.3 ± 7.5 years) with mild HOA symptoms were included. Of these, 31%-42% rated current impact of HOA in various domains as highly important. Seven domains with rated scores of ≥7/10 in importance were endorsed for clinical trials in the following order: pain and HOA symptoms (endorsed by 77.8% of patients), physical function (66.7%), ability to participate in social roles (64.4%), ability to participate in social activities (62.2%), work productivity (62.2%), emotional health (60%), and appearance of fingers (55.6%). CONCLUSION The preliminary important domains as endorsed by patients with HOA for inclusion into clinical trials were explored. Apart from pain and physical function, further research is needed to refine other domains of impact, such as participation, emotional health and aesthetic concerns, as core domain sets for HOA.
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Affiliation(s)
- Ying Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Justin Chung-Hin Li
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Li Ka Shing Faculty of Medicine, the University of Hong Kong, Hong Kong, Hong Kong
| | - Julian Thumboo
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
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13
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Bender A, Kaesser U, Eichner G, Bachmann G, Steinmeyer J. Biomarkers of Hand Osteoarthritis Are Detectable after Mechanical Exercise. J Clin Med 2019; 8:E1545. [PMID: 31561460 PMCID: PMC6832610 DOI: 10.3390/jcm8101545] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/18/2019] [Accepted: 09/24/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Hand osteoarthritis (OA) is one of the most common joint diseases, but studies on biomarkers are rare. The aim of this explorative study was (a) to evaluate potential biomarkers of hand OA, (b) to identify an optimal time point to sample venous blood, and (c) to correlate biomarker levels with radiological and clinical scores. METHODS Four female cohorts were investigated. One with a more Heberden-accentuated OA and one with a more Bouchard-accentuated hand OA, and two symptom-free control groups aged 20-30 or 50-75 years. The venous blood was sampled before and at eight time points after mechanical exercise of the OA hand. X-rays of OA hands were assessed using the Kellgren and Lawrence as well as Kallman scores. Participants were evaluated clinically using the AUSCAN™ Index, visual analog scale (VAS), and Health Assessment Questionnaire (HAQ). Serum levels of seven biomarkers were measured by ELISA. RESULTS The concentrations of CPII, COMP, IL-15, sVCAM-1, NGAL, and PIIANP were significantly increased within 15 min after exercise. PIIANP was markedly elevated in the Heberden-accentuated OA group as compared to both control groups, but did not correlate with any radiological or clinical score. Analysis of the probabilistic index further revealed that CPII can distinguish between Bouchard's OA and premenopausal controls whereas COMP can discriminate between Bouchard's and Heberden's OA. CONCLUSIONS This study demonstrates that even previously undetectable biomarkers can be quantified in serum after mechanical exercise. Future larger studies are needed to determine specificity and sensitivity of these markers and their ability to diagnose even pre-radiological OA.
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Affiliation(s)
- Anna Bender
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus Liebig University Giessen, Paul-Meimberg-Str. 3, 35392 Giessen, Germany.
| | | | - Gerrit Eichner
- Mathematical Institute, Justus Liebig University Giessen, 35392 Giessen, Germany.
| | - Georg Bachmann
- Georg Bachmann, Department of Diagnostic Radiology, Kerckhoff-Klinik GmbH, 61231 Bad Nauheim, Germany.
| | - Juergen Steinmeyer
- Laboratory for Experimental Orthopaedics, Department of Orthopaedics, Justus Liebig University Giessen, Paul-Meimberg-Str. 3, 35392 Giessen, Germany.
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14
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Siviero P, Limongi F, Gesmundo A, Zambon S, Cooper C, Dennison EM, Edwards MH, Timmermans EJ, van der Pas S, Schaap LA, van Schoor NM, Denkinger MD, Herbolsheimer F, Peter R, Castell MV, Otero Á, Queipo R, Pedersen NL, Deeg DJH, Maggi S. Minimal clinically important decline in physical function over one year: EPOSA study. BMC Musculoskelet Disord 2019; 20:227. [PMID: 31101033 PMCID: PMC6525447 DOI: 10.1186/s12891-019-2593-1] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Accepted: 04/26/2019] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND The Australian/Canadian hand Osteoarthritis Index (AUSCAN) and the Western Ontario and McMaster Universities knee and hip Osteoarthritis Index (WOMAC) are the most commonly used clinical tools to manage and monitor osteoarthritis (OA). Few studies have as yet reported longitudinal changes in the AUSCAN index regarding the hand. While there are published data regarding WOMAC assessments of the hip and the knee, the two sites have always evaluated separately. The current study therefore sought to determine the minimal clinically important difference (MCID) in decline in the AUSCAN hand and WOMAC hip/knee physical function scores over 1 year using anchor-based and distribution-based methods. METHODS The study analysed data collected by the European Project on Osteoarthritis, a prospective observational study investigating six adult cohorts with and without OA by evaluating changes in the AUSCAN and WOMAC physical function scores at baseline and 12-18 months later. Pain and stiffness scores, the performance-based grip strength and walking speed and health-related quality of life measures were used as the study's anchors. Receiver operating characteristic curves and distribution-based methods were used to estimate the MCID in the AUSCAN and WOMAC physical function scores; only the data of those participants who possessed paired (baseline and follow up-measures) AUSCAN and WOMAC scores were included in the analysis. RESULTS Out of the 1866 participants who were evaluated, 1842 had paired AUSCAN scores and 1845 had paired WOMAC scores. The changes in the AUSCAN physical function score correlated significantly with those in the AUSCAN pain score (r = 0.31). Anchor- and distribution-based approaches converged identifying 4 as the MCID for decline in the AUSCAN hand physical function. Changes in the WOMAC hip/knee physical function score were significantly correlated with changes in both the WOMAC pain score (r = 0.47) and the WOMAC stiffness score (r = 0.35). The different approaches converged identifying two as the MCID for decline in the WOMAC hip/knee physical function. CONCLUSIONS The most reliable MCID estimates of decline over 1 year in the AUSCAN hand and WOMAC hip/knee physical function scores were 4 and 2 points, respectively.
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Affiliation(s)
- Paola Siviero
- National Research Council, Neuroscience Institute - Aging Branch, Via Giustiniani 2, ,35128 Padova, Italy
| | - Federica Limongi
- National Research Council, Neuroscience Institute - Aging Branch, Via Giustiniani 2, ,35128 Padova, Italy
| | - Antonella Gesmundo
- Department of Medicine, University of Padova, Via 8 Febbraio 2, 35122 Padova, Italy
| | - Sabina Zambon
- Department of Medicine, University of Padova, Via 8 Febbraio 2, 35122 Padova, Italy
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Elaine M. Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
| | - Mark H. Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
- Portsmouth Hospitals NHS Trust, Portsmouth, PO6 3LY UK
| | - Erik J. Timmermans
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Suzan van der Pas
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Laura A. Schaap
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Natasja M. van Schoor
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Michael D. Denkinger
- Bethesda Geriatric Clinic, University of Ulm, Zollernring 26, 89073 Ulm, Germany
| | - Florian Herbolsheimer
- Institute of the History Philosophy and Ethics of Medicine, University of Ulm, Frauensteige 6, 89075 Ulm, Germany
| | - Richard Peter
- Institute of the History Philosophy and Ethics of Medicine, University of Ulm, Frauensteige 6, 89075 Ulm, Germany
| | - Maria Victoria Castell
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Ángel Otero
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Rocio Queipo
- Department of Preventive Medicine and Public Health, Unit of Primary Care and Family Medicine, Faculty of Medicine, Universidad Autonoma de Madrid, Arzobispo Morcillo 4, 28029 Madrid, Spain
| | - Nancy L. Pedersen
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, P.O.Box 281, Nobels väg 12A, SE-171 77 Stockholm, Sweden
| | - Dorly J. H. Deeg
- Department of Epidemiology and Biostatistics, Amsterdam UMC - location VU University medical center, Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - Stefania Maggi
- National Research Council, Neuroscience Institute - Aging Branch, Via Giustiniani 2, ,35128 Padova, Italy
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15
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Kloppenburg M, Peterfy C, Haugen IK, Kroon F, Chen S, Wang L, Liu W, Levy G, Fleischmann RM, Berenbaum F, van der Heijde D, Bansal P, Wittoek R, Feng S, Fang Y, Saltarelli M, Medema JK, Levesque MC. Phase IIa, placebo-controlled, randomised study of lutikizumab, an anti-interleukin-1α and anti-interleukin-1β dual variable domain immunoglobulin, in patients with erosive hand osteoarthritis. Ann Rheum Dis 2018; 78:413-420. [PMID: 30552176 PMCID: PMC6390132 DOI: 10.1136/annrheumdis-2018-213336] [Citation(s) in RCA: 106] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 10/26/2018] [Accepted: 10/28/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To assess the efficacy, safety, pharmacokinetics and pharmacodynamics of the anti-interleukin (IL)-1α/β dual variable domain immunoglobulin lutikizumab (ABT-981) in erosive hand osteoarthritis (HOA). METHODS Patients with ≥1 erosive and ≥3 tender and/or swollen hand joints were randomised to placebo or lutikizumab 200 mg subcutaneously every 2 weeks for 24 weeks. The primary endpoint was change in Australian/Canadian Osteoarthritis Hand Index (AUSCAN) pain subdomain score from baseline to 16 weeks. At baseline and week 26, subjects had bilateral hand radiographs and MRI of the hand with the greatest number of baseline tender and/or swollen joints. Continuous endpoints were assessed using analysis of covariance models, with treatment and country as main factors and baseline measurements as covariates. RESULTS Of 132 randomised subjects, 1 received no study drug and 110 completed the study (placebo, 61/67 (91%); lutikizumab, 49/64 (77%)). AUSCAN pain was not different among subjects treated with lutikizumab versus placebo at week 16 (least squares mean difference, 1.5 (95% CI -1.9 to 5.0)). Other clinical and imaging endpoints were not different between lutikizumab and placebo. Lutikizumab significantly decreased serum high-sensitivity C reactive protein levels, IL-1α and IL-1β levels, and blood neutrophils. Lutikizumab pharmacokinetics were consistent with phase I studies and not affected by antidrug antibodies. Injection site reactions and neutropaenia were more common in the lutikizumab group; discontinuations because of adverse events occurred more frequently with lutikizumab (4/64) versus placebo (1/67). CONCLUSION Despite adequate blockade of IL-1, lutikizumab did not improve pain or imaging outcomes in erosive HOA compared with placebo.
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Affiliation(s)
- Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | | | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Féline Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Su Chen
- Data and Statistical Sciences, AbbVie, North Chicago, Illinois, USA
| | - Li Wang
- Development Design Center, AbbVie, North Chicago, Illinois, USA
| | - Wei Liu
- Clinical Pharmacology and Pharmacometrics, AbbVie, North Chicago, Illinois, USA
| | - Gwen Levy
- Pharmacovigilance and Patient Safety, AbbVie, North Chicago, Illinois, USA
| | - Roy M Fleischmann
- Department of Internal Medicine, University of Texas Southwestern Medical Center at Dallas, Metroplex Clinical Research Center, Dallas, Texas, USA
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne Universités and Inserm, DHU i2B, APHP, Hospital Saint-Antoine, Paris, France
| | | | - Prashant Bansal
- Scientific and Medical Services, PAREXEL, Waltham, Massachusetts, USA
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University Hospital, Ghent, Belgium
| | - Sheng Feng
- Exploratory Statistics, Data Science and Statistics, AbbVie, North Chicago, Illinois, USA
| | - Yuni Fang
- Drug Metabolism, Pharmacokinetics and Bioanalysis, AbbVie, North Chicago, Illinois, USA
| | - Mary Saltarelli
- Drug Metabolism, Pharmacokinetics and Bioanalysis, AbbVie, North Chicago, Illinois, USA
| | - Jeroen K Medema
- Immunology Development, AbbVie, North Chicago, Illinois, USA
| | - Marc C Levesque
- Immunology Development, AbbVie, North Chicago, Illinois, USA
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16
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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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17
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Reginster JYL, Arden NK, Haugen IK, Rannou F, Cavalier E, Bruyère O, Branco J, Chapurlat R, Collaud Basset S, Al-Daghri NM, Dennison EM, Herrero-Beaumont G, Laslop A, Leeb BF, Maggi S, Mkinsi O, Povzun AS, Prieto-Alhambra D, Thomas T, Uebelhart D, Veronese N, Cooper C. Guidelines for the conduct of pharmacological clinical trials in hand osteoarthritis: Consensus of a Working Group of the European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal Diseases (ESCEO). Semin Arthritis Rheum 2017; 48:1-8. [PMID: 29287769 DOI: 10.1016/j.semarthrit.2017.12.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 11/09/2017] [Accepted: 12/05/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To gather expert opinion on the conduct of clinical trials that will facilitate regulatory review and approval of appropriate efficacious pharmacological treatments for hand osteoarthritis (OA), an area of high unmet clinical need. METHODS The European Society on Clinical and Economic Aspects of Osteoporosis, Osteoarthritis and Musculoskeletal diseases (ESCEO) organized a working group under the auspices of the International Osteoporosis Foundation (IOF) and the World Health Organization (WHO). RESULTS This consensus guideline is intended to provide a reference tool for practice, and should allow for better standardization of the conduct of clinical trials in hand OA. Hand OA is a heterogeneous disease affecting different, and often multiple, joints of the thumb and fingers. It was recognized that the various phenotypes and limitations of diagnostic criteria may make the results of hand OA trials difficult to interpret. Nonetheless, practical recommendations for the conduct of clinical trials of both symptom and structure modifying drugs are outlined in this consensus statement, including guidance on study design, execution, and analysis. CONCLUSIONS While the working group acknowledges that the methodology for performing clinical trials in hand OA will evolve as knowledge of the disease increases, it is hoped that this guidance will support the development of new pharmacological treatments targeting hand OA.
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Affiliation(s)
- Jean-Yves L Reginster
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Nigel K Arden
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Francois Rannou
- Division of Physical Medicine and Rehabilitation, AP-HP Cochin Hospital, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Etienne Cavalier
- Department of Clinical Chemistry, University of Liège, CHU Sart-Tilman, Route 52, Porte 53, Domaine du Sart-Tilman, Liège, Belgium
| | - Olivier Bruyère
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Jaime Branco
- Department of Rheumatology, CEDOC, NOVA Medical School, Universidade Nova de Lisboa, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | - Roland Chapurlat
- Division of Rheumatology, INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, Lyon, France
| | | | - Nasser M Al-Daghri
- Biochemistry Department, College of Science, King Saud University, Riyadh, Saudi Arabia
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology, Bone and Joint Research Unit, Fundación Jiménez Diaz, Universidad Autonoma, Madrid, Spain
| | - Andrea Laslop
- Scientific Office, Austrian Medicines and Medical Devices Agency, AGES, Vienna, Austria
| | - Burkhard F Leeb
- Second Department of Medicine, Centre for Rheumatology Lower Austria, State Hospital Stockerau, Stockerau, Austria
| | | | - Ouafa Mkinsi
- Rheumatology Department, IBN ROCHD University Hospital, Casablanca, Morocco
| | - Anton S Povzun
- Scientific Research Institute of Emergency Care n.a. l.l. Dzhanelidze, Saint-Petersburg, Russia
| | - Daniel Prieto-Alhambra
- Musculoskeletal Pharmaco and Device Epidemiology, Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Thierry Thomas
- Department of Rheumatology, Hôpital Nord, CHU de St-Etienne & INSERM 1059, Université de Lyon, Saint-Etienne, France
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Department of Orthopaedics and Traumatology, Hôpital du Valais (HVS), Centre Hospitalier du Valais Romand (CHVR), CVP, Crans-Montana, Switzerland
| | | | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
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18
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Lue S, Koppikar S, Shaikh K, Mahendira D, Towheed TE. Systematic review of non-surgical therapies for osteoarthritis of the hand: an update. Osteoarthritis Cartilage 2017; 25:1379-1389. [PMID: 28602781 DOI: 10.1016/j.joca.2017.05.016] [Citation(s) in RCA: 34] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 05/11/2017] [Accepted: 05/27/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated. DESIGN RCTs published between March 2008 and December 2015 were added to the previous systematic reviews. RESULTS A total of 95 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, the methodological quality of these RCTs has improved since the last update, with more studies describing their methods for randomization, blinding, and allocation concealment. However, RCTs continue to be weakened by a lack of consistent case definition and a lack of standardized outcome assessments specific to hand OA. The number and location of evaluated hand joints continues to be underreported, and only 25% of RCTs adequately described the method used to ensure allocation concealment. These remain major weaknesses of published RCTs. A meta-analysis could not be performed because of marked study heterogeneity, insufficient statistical data available in the published RCTs, and a small number of identical comparators. CONCLUSION Hand OA is a complex area in which to study the efficacy of therapies. There has been an improvement in the overall design and conduct of RCTs, however, additional large RCTs with a more robust methodological approach specific to hand OA are needed in order to make clinically relevant conclusions about the efficacy of the diverse treatment options available.
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Affiliation(s)
- S Lue
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - S Koppikar
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - K Shaikh
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
| | - D Mahendira
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - T E Towheed
- Department of Medicine, Queen's University, Kingston, Ontario, Canada.
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Saltzherr MS, Coert JH, Selles RW, van Neck JW, Jaquet JB, van Osch GJVM, Oei EHG, Luime JJ, Muradin GSR. Accuracy of magnetic resonance imaging to detect cartilage loss in severe osteoarthritis of the first carpometacarpal joint: comparison with histological evaluation. Arthritis Res Ther 2017; 19:55. [PMID: 28288684 PMCID: PMC5348904 DOI: 10.1186/s13075-017-1262-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2016] [Accepted: 02/14/2017] [Indexed: 11/21/2022] Open
Abstract
Background Magnetic resonance imaging (MRI) is increasingly used for research in hand osteoarthritis, but imaging the thin cartilage layers in the hand joints remains challenging. We therefore assessed the accuracy of MRI in detecting cartilage loss in patients with symptomatic osteoarthritis of the first carpometacarpal (CMC1) joint. Methods Twelve patients scheduled for trapeziectomy to treat severe symptomatic osteoarthritis of the CMC1 joint underwent a preoperative high resolution 3D spoiled gradient (SPGR) MRI scan. Subsequently, the resected trapezium was evaluated histologically. The sections were scored for cartilage damage severity (Osteoarthritis Research Society International (OARSI) score), and extent of damage (percentage surface area). Each MRI scan was scored for the area of normal cartilage, partial cartilage loss and full cartilage loss. The percentages of the total surface area with any cartilage loss and full-thickness cartilage loss were calculated using MRI and histological evaluation. Results MRI and histological evaluation both identified large areas of overall cartilage loss. The median (IQR) surface area of any cartilage loss on MRI was 98% (82–100%), and on histological assessment 96% (87–98%). However, MRI underestimated the extent of full-thickness cartilage loss. The median (IQR) surface area of full-thickness cartilage loss on MRI was 43% (22–70%), and on histological evaluation 79% (67–85%). The difference was caused by a thin layer of high signal on the articulating surface, which was interpreted as damaged cartilage on MRI but which was not identified on histological evaluation. Conclusions Three-dimensional SPGR MRI of the CMC1 joint demonstrates overall cartilage damage, but underestimates full-thickness cartilage loss in patients with advanced osteoarthritis.
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Affiliation(s)
- Michael S Saltzherr
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands. .,Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Johan W van Neck
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jean-Bart Jaquet
- Department of Plastic, Reconstructive and Hand surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Gerjo J V M van Osch
- Department of Orthopaedics and Department of Otorhinolaryngology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Edwin H G Oei
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jolanda J Luime
- Department of Rheumatology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Galied S R Muradin
- Department of Radiology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Østerås N, Kjeken I, Smedslund G, Moe RH, Slatkowsky‐Christensen B, Uhlig T, Hagen KB. Exercise for hand osteoarthritis. Cochrane Database Syst Rev 2017; 1:CD010388. [PMID: 28141914 PMCID: PMC6464796 DOI: 10.1002/14651858.cd010388.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Hand osteoarthritis (OA) is a prevalent joint disease that may lead to pain, stiffness and problems in performing hand-related activities of daily living. Currently, no cure for OA is known, and non-pharmacological modalities are recommended as first-line care. A positive effect of exercise in hip and knee OA has been documented, but the effect of exercise on hand OA remains uncertain. OBJECTIVES To assess the benefits and harms of exercise compared with other interventions, including placebo or no intervention, in people with hand OA. Main outcomes are hand pain and hand function. SEARCH METHODS We searched six electronic databases up until September 2015. SELECTION CRITERIA All randomised and controlled clinical trials comparing therapeutic exercise versus no exercise or comparing different exercise programmes. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data, assessed risk of bias and assessed the quality of the body of evidence using the GRADE approach. Outcomes consisted of both continuous (hand pain, physical function, finger joint stiffness and quality of life) and dichotomous outcomes (proportions of adverse events and withdrawals). MAIN RESULTS We included seven studies in the review. Most studies were free from selection and reporting bias, but one study was available only as a congress abstract. It was not possible to blind participants to treatment allocation, and although most studies reported blinded outcome assessors, some outcomes (pain, function, stiffness and quality of life) were self-reported. The results may be vulnerable to performance and detection bias owing to unblinded participants and self-reported outcomes. Two studies with high drop-out rates may be vulnerable to attrition bias. We downgraded the overall quality of the body of evidence to low owing to potential detection bias (lack of blinding of participants on self-reported outcomes) and imprecision (studies were few, the number of participants was limited and confidence intervals were wide for the outcomes pain, function and joint stiffness). For quality of life, adverse events and withdrawals due to adverse events, we further downgraded the overall quality of the body of evidence to very low because studies were very few and confidence intervals were very wide.Low-quality evidence from five trials (381 participants) indicated that exercise reduced hand pain (standardised mean difference (SMD) -0.27, 95% confidence interval (CI) -0.47 to -0.07) post intervention. The absolute reduction in pain for the exercise group, compared with the control group, was 5% (1% to 9%) on a 0 to 10 point scale. Pain was estimated to be 3.9 points on this scale (0 = no pain) in the control group, and exercise reduced pain by 0.5 points (95% CI 0.1 to 0.9; number needed to treat for an additional beneficial outcome (NNTB) 9).Four studies (369 participants) indicated that exercise improved hand function (SMD -0.28, 95% CI -0.58 to 0.02) post intervention. The absolute improvement in function noted in the exercise group, compared with the control group, was 6% (0.4% worsening to 13% improvement). Function was estimated at 14.5 points on a 0 to 36 point scale (0 = no physical disability) in the control group, and exercise improved function by 2.2 points (95% CI -0.2 to 4.6; NNTB 9).One study (113 participants) evaluated quality of life, and the effect of exercise on quality of life is currently uncertain (mean difference (MD) 0.30, 95% CI -3.72 to 4.32). The absolute improvement in quality of life for the exercise group, compared with the control group, was 0.3% (4% worsening to 4% improvement). Quality of life was 50.4 points on a 0 to 100 point scale (100 = maximum quality of life) in the control group, and the mean score in the exercise group was 0.3 points higher (3.5 points lower to 4.1 points higher).Four studies (369 participants) indicated that exercise reduced finger joint stiffness (SMD -0.36, 95% CI -0.58 to -0.15) post intervention. The absolute reduction in finger joint stiffness for the exercise group, compared with the control group, was 7% (3% to 10%). Finger joint stiffness was estimated at 4.5 points on a 0 to 10 point scale (0 = no stiffness) in the control group, and exercise improved stiffness by 0.7 points (95% CI 0.3 to 1.0; NNTB 7).Three studies reported intervention-related adverse events and withdrawals due to adverse events. The few reported adverse events consisted of increased finger joint inflammation and hand pain. Low-quality evidence from the three studies showed an increased likelihood of adverse events (risk ratio (RR) 4.55, 95% CI 0.53 to 39.31) and of withdrawals due to adverse events in the exercise group compared with the control group (RR 2.88, 95% CI 0.30 to 27.18), but the effect is uncertain and further research may change the estimates.Included studies did not measure radiographic joint structure changes. Two studies provided six-month follow-up data (220 participants), and one (102 participants) provided 12-month follow-up data. The positive effect of exercise on pain, function and joint stiffness was not sustained at medium- and long-term follow-up.The exercise intervention varied largely in terms of dosage, content and number of supervised sessions. Participants were instructed to exercise two to three times a week in four studies, daily in two studies and three to four times daily in another study. Exercise interventions in all seven studies aimed to improve muscle strength and joint stability or function, but the numbers and types of exercises varied largely across studies. Four studies reported adherence to the exercise programme; in three studies, this was self-reported. Self-reported adherence to the recommended frequency of exercise sessions ranged between 78% and 94%. In the fourth study, 67% fulfilled at least 16 of the 18 scheduled exercise sessions. AUTHORS' CONCLUSIONS When we pooled results from five studies, we found low-quality evidence showing small beneficial effects of exercise on hand pain, function and finger joint stiffness. Estimated effect sizes were small, and whether they represent a clinically important change may be debated. One study reported quality of life, and the effect is uncertain. Three studies reported on adverse events, which were very few and were not severe.
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Affiliation(s)
- Nina Østerås
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Ingvild Kjeken
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Geir Smedslund
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
- Norwegian Institute of Public HealthPO BOX 4404 NydalenOsloN‐0403Norway
| | - Rikke H Moe
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | | | - Till Uhlig
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
| | - Kåre Birger Hagen
- Diakonhjemmet HospitalNational Advisory Unit on Rehabilitation in RheumatologyBoks 23 VinderenOsloOsloNorway0319
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Kordi Yoosefinejad A, Motealleh A, Babakhani M. Evaluation of validity and reliability of the Persian version of the functional index of hand osteoarthritis. Rheumatol Int 2017; 37:719-725. [PMID: 28084532 DOI: 10.1007/s00296-016-3645-6] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2016] [Accepted: 12/21/2016] [Indexed: 11/28/2022]
Abstract
The Functional index of hand osteoarthritis (FIHOA) is a commonly used patient-reported outcome questionnaire designed to measure function in patients with hand osteoarthritis. The objective of this study was to evaluate the validity and reliability of the Persian version of the FIHOA. The Persian-translated version of FIHOA was administered to 72 native Persian-speaking patients in Iran with hand osteoarthritis. Thirty-six of the patients completed the questionnaire on two occasions 1 week apart. The physical component of the SF-36 and a numerical rating scale were used to evaluate the construct validity of the Persian version of FIHOA. Internal consistency was high (Cronbach's alpha = 0.89). Test-retest reliability for the total score was excellent (weighted kappa = 0.89, 95% CI 0.79-0.94). A significant positive correlation between total FIHOA score and numerical rating scale (r = 0.70) and a significant negative correlation between total FIHOA score and the physical component scale of the SF-36 (r = -0.76) were observed. The Persian version of the FIHOA showed adequate validity and reliability to evaluate functional disability in Persian-speaking patients with hand osteoarthritis.
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Affiliation(s)
- Amin Kordi Yoosefinejad
- School of Rehabilitation, Shiraz University of Medical Sciences, Abivardi 1, Chamran Blvd., Shiraz, Iran
| | - Alireza Motealleh
- School of Rehabilitation, Shiraz University of Medical Sciences, Abivardi 1, Chamran Blvd., Shiraz, Iran.
| | - Mohammad Babakhani
- School of Rehabilitation, Shiraz University of Medical Sciences, Abivardi 1, Chamran Blvd., Shiraz, Iran
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Prodinger B, Stamm T, Peterson D, Stucki G, Tennant A. Toward a Standardized Reporting of Outcomes in Hand Osteoarthritis: Developing a Common Metric of Outcome Measures Commonly Used to Assess Functioning. Arthritis Care Res (Hoboken) 2016; 68:1115-27. [DOI: 10.1002/acr.22816] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 12/01/2015] [Accepted: 12/08/2015] [Indexed: 11/10/2022]
Affiliation(s)
- Birgit Prodinger
- Swiss Paraplegic Research and International Classification of Functioning, Disability, and Health Research Branch, World Health Organization Collaborating Centre, Nottwil, Switzerland, and University of Lucerne; Lucerne Switzerland
| | - Tanja Stamm
- Medical University of Vienna; Vienna Austria
| | - Diana Peterson
- Swiss Paraplegic Research, Nottwil, Switzerland, and University of Lucerne; Lucerne Switzerland
| | - Gerold Stucki
- Swiss Paraplegic Research and International Classification of Functioning, Disability, and Health Research Branch, World Health Organization Collaborating Centre, Nottwil, Switzerland, and University of Lucerne; Lucerne Switzerland
| | - Alan Tennant
- Swiss Paraplegic Research and International Classification of Functioning, Disability, and Health Research Branch, World Health Organization Collaborating Centre, Nottwil, Switzerland, and University of Lucerne; Lucerne Switzerland
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Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC). Arthritis Res Ther 2015; 17:346. [PMID: 26620999 PMCID: PMC4666038 DOI: 10.1186/s13075-015-0807-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/28/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction The primary complaint of patients with hand osteoarthritis (OA) is frequently the inelegant appearance of their hands. Only one study has been conducted to assess the magnitude of and identify the determinants of aesthetic discomfort in hand OA. Methods The LIège Hand Osteoarthritis Cohort is a prospective cohort of 203 patients diagnosed with hand OA. At baseline, these patients rated their aesthetic discomfort on a 100-mm visual analogue scale (VAS) and used a Likert scale (range 0–7) to quantify the magnitude of their aesthetic damage. Results The median value of the aesthetic discomfort VAS was 35.0 [interquartile range (Q1–Q3) 6.0–59.0]. The median damage was rated 3.0 (Q1–Q3 1.0–4.0), corresponding to a moderate level. Both were significantly (p < 0.02) associated with the female gender, the duration of hand OA, the radiological severity of OA (Verbruggen–Veys and Kellgren–Lawrence scales) and pain, disability, or stiffness [Australian Canadian Osteoarthritis Hand Index (AUSCAN) and Functional Index for Hand Osteoarthritis ]. After a stepwise analysis, the parameters correlated to the aesthetic discomfort were the presence of erosive joints (p = 0.0048), the AUSCAN score (p < 0.0001), the number of joints with severe radiological damage (p = 0.023), and gender (p = 0.0009). For aesthetic damage, the parameters associated were AUSCAN score (p < 0.0001), duration of hand OA >10 years (p = 0.001), and presence of erosive joints (p < 0.0001). Compared with patients with low aesthetic discomfort (VAS ≤33 mm), those with the highest discomfort (VAS ≥66 mm) had more erosive OA (p = 0.014), a higher Verbruggen and Veys score (p = 0.0039), and a higher AUSCAN score (p < 0.001). Conclusions Aesthetic discomfort and damage are significant complaints in patients with hand OA. The determinants of the magnitude of these are gender, radiological severity, duration of hand OA, presence of erosive joints, and impact on pain, function, and stiffness as assessed with the AUSCAN. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0807-y) contains supplementary material, which is available to authorized users.
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Agreement of Physicians and Nurses Performing Tender and Swollen Joint Counts in Rheumatoid Arthritis. J Clin Rheumatol 2015; 22:30-4. [PMID: 26513306 DOI: 10.1097/rhu.0000000000000324] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of this study were to assess the agreement of physicians and nurses performing tender and swollen joint counts (TJCs/SJCs) in rheumatoid arthritis (RA) and identify factors that might influence their examinations including patient age, sex, race, RA disease duration, body mass index, RA disease activity level, comorbid fibromyalgia, comorbid osteoarthritis, and levels of acute-phase reactants. METHODS Seventy-two RA participants underwent TJCs/SJCs of 28 joints using a standardized protocol by 2 nurses and 2 rheumatologists. Demographic, laboratory, radiographic, and clinical data were obtained to assess the influence of these factors on TJCs/SJCs. Intraclass correlations (ICCs) among examiners were determined for TJCs/SJCs. Nurse-physician differences and agreement of individual joints were evaluated using Cohen κ. Analysis of variance was performed to detect differences in means between examiners for TJCs/SJCs. Intraclass correlation and Fisher Z tests were used to identify factors influencing TJCs/SJCs. RESULTS Agreement was strong among these nurses and physicians for total TJCs/SJCs (ICC = 0.84/ICC = 0.79, respectively). κ was best for hand joint tenderness and poorest for shoulder swelling. Some significant differences in mean TJCs/SJCs were found between examiners. Fibromyalgia significantly reduced agreement of both TJCs and SJCs. Agreement of TJC was significantly reduced when patients had lower disease activity, greater work impairment, lower mental health quality of life, and elevated erythrocyte sedimentation rate, whereas female sex, assessor's perception of but not radiographic hand osteoarthritis, and elevated C-reactive protein significantly reduced agreement for SJC. CONCLUSIONS Strong agreement was found among nurses and physicians for total 28-joint counts, with agreement at individual joints being stronger for tenderness than swelling. Fibromyalgia significantly reduced ICCs of TJCs/SJCs.
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Visser AW, Bøyesen P, Haugen IK, Schoones JW, van der Heijde DM, Rosendaal FR, Kloppenburg M. Instruments Measuring Pain, Physical Function, or Patient’s Global Assessment in Hand Osteoarthritis: A Systematic Literature Search. J Rheumatol 2015; 42:2118-34. [DOI: 10.3899/jrheum.141228] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2015] [Indexed: 11/22/2022]
Abstract
Objective.Description of use and metric properties of instruments measuring pain, physical function, or patient’s global assessment (PtGA) in hand osteoarthritis (OA).Methods.Medical literature databases up to January 2014 were systematically reviewed for studies reporting on instruments measuring pain, physical function, or PtGA in hand OA. The frequency of the use of these instruments were described, as well as their metric properties, including discrimination (reliability, sensitivity to change), feasibility, and validity.Results.In 66 included studies, various questionnaires and performance- or assessor-based instruments were applied for evaluation of pain, physical function, or PtGA. No major differences regarding metric properties were observed between the instruments, although the amount of supporting evidence varied. The most frequently evaluated questionnaires were the Australian/Canadian Hand OA Index (AUSCAN) pain subscale and visual analog scale (VAS) pain for pain assessment, and the AUSCAN function subscale and Functional Index for Hand OA (FIHOA) for physical function assessment. Excellent reliability was shown for the AUSCAN and FIHOA, and good sensitivity to change for all mentioned instruments; additionally, the FIHOA had good feasibility. Good construct validity was suggested for all mentioned questionnaires. The most commonly applied performance- or assessor-based instruments were the grip and pinch strength for the assessment of physical function, and the assessment of pain by palpation. For these measures, good sensitivity to change and construct validity were established.Conclusion.The AUSCAN, FIHOA, VAS pain, grip and pinch strength, and pain on palpation were most frequently used and provided most supporting evidence for good metric properties. More research has to be performed to compare the different instruments with each other.
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Liu R, Damman W, Kaptein AA, Rosendaal FR, Kloppenburg M. Coping styles and disability in patients with hand osteoarthritis. Rheumatology (Oxford) 2015; 55:411-8. [DOI: 10.1093/rheumatology/kev295] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2014] [Indexed: 11/13/2022] Open
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Bellamy N, Hochberg M, Tubach F, Martin-Mola E, Awada H, Bombardier C, Hajjaj-Hassouni N, Logeart I, Matucci-Cerinic M, van de Laar M, van der Heijde D, Dougados M. Development of multinational definitions of minimal clinically important improvement and patient acceptable symptomatic state in osteoarthritis. Arthritis Care Res (Hoboken) 2015; 67:972-80. [PMID: 25581339 DOI: 10.1002/acr.22538] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 11/03/2014] [Accepted: 12/16/2014] [Indexed: 01/22/2023]
Abstract
OBJECTIVE The ability to interpret scores from patient-reported outcome measures at the individual patient level depends on the availability of valid, clinically meaningful benchmarks of response and state attainment. The goal was to develop multinational estimates for minimal clinically important improvement (MCII) and patient acceptable symptomatic state (PASS). METHODS A multinational sample of patients with osteoarthritis (OA) was evaluated before and 4 weeks after treatment with nonsteroidal antiinflammatory drugs. Patients completed either the Western Ontario and McMaster Osteoarthritis Index (WOMAC) numerical rating scale 3.1 (hip and knee OA) or the Australian/Canadian Index (AUSCAN) numerical rating scale 3.1 (hand OA) before and after treatment. Patients rated the clinical importance of their response to treatment and their satisfaction with the health state achieved, from which multinational MCII and PASS estimates were calculated for both the WOMAC and AUSCAN indices. RESULTS A total of 609 patients from 7 countries participated in the study. MCII and PASS estimates varied slightly by instrument and subscale. Absolute (percentage) change for MCII ranged 6-9 (10% to 17%) for WOMAC and 4-9 (8% to 15%) for AUSCAN. PASS estimates ranged 39-48 for WOMAC and 38-45 for AUSCAN. Some between-country variation was observed in MCII and PASS. CONCLUSION Preliminary multinational estimates for MCII and PASS have been developed for several countries. Further research is required to evaluate the robustness, temporal consistency, and age- and sex-dependency of the preliminary estimates as well as their generalizability to other countries, languages, cultures, regions, and other condition-specific outcome measures.
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Affiliation(s)
- Nicholas Bellamy
- University of Queensland School of Medicine, Brisbane, Queensland, Australia, and Royal Brisbane and Women's Hospital, Herston, Queensland, Australia
| | - Marc Hochberg
- University of Maryland School of Medicine, Baltimore
| | - Florence Tubach
- Université Paris Diderot, Sorbonne Paris Cité, INSERM, UMR-S 1123, INSERM, CIC 1425-EC, UMR-S 1123, and AP-HP Hôpital Bichat, Paris, France
| | - Emilio Martin-Mola
- Hospital Universitario La Paz and Universidad Autónoma Madrid, Madrid, Spain
| | - Hassane Awada
- Saint Joseph University Hôtel-Dieu de France, Beirut, Lebanon
| | - Claire Bombardier
- University of Toronto, Toronto General Research Institute, Institute for Work and Health, and Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Najia Hajjaj-Hassouni
- Mohammed Vth Souissi University, CNRST, and Laboratory of Information and Research on Bone Diseases (LIRPOS-URAC 30), Rabat, Morocco, and El Ayachi Hospital and University Hospital, Salé, Morocco
| | | | | | - Mart van de Laar
- Arthritis Center Twente, Medisch Spectrum Twente, and University Twente, Enschede, The Netherlands
| | | | - Maxime Dougados
- Paris Descartes University, Cochin Hospital, AP-HP, INSERM (U1153), PRES Sorbonne Paris-Cité, Paris, France
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Kloppenburg M, Bøyesen P, Visser AW, Haugen IK, Boers M, Boonen A, Conaghan PG, Hawker GA, Kvien TK, Landewé R, Uhlig T, Smeets W, Greibrokk E, van der Heijde DM. Report from the OMERACT Hand Osteoarthritis Working Group: Set of Core Domains and Preliminary Set of Instruments for Use in Clinical Trials and Observational Studies. J Rheumatol 2015; 42:2190-7. [DOI: 10.3899/jrheum.141017] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.During OMERACT 12, a workshop was held with the aim to endorse a core set of domains for 3 settings: clinical trials of symptom and structure modification and observational studies. Additional goals were to endorse a core set of contextual factors for these settings, and to define preliminary instruments for each core domain. Finally, an agenda for future research in hand osteoarthritis (OA) was to be proposed.Methods.Literature reviews of preliminary instruments for each core domain of the proposed core set for hand OA in the settings described above. Literature review of radiographic scoring methods and modern imaging in hand OA were also performed. Proposed contextual factors for a core set were identified through 2 Delphi exercises with participation of hand OA experts, patient partners, and OMERACT participants.Results.Results from Delphi exercises and systematic literature reviews were presented and discussed. It was agreed that a preliminary core domain set for the setting clinical trials of symptom modification should contain at least “pain, physical function, patient global assessment, joint activity and hand strength.” The settings clinical trial of structure modification and observational studies would in addition include structural damage. Preliminary instruments for the proposed domains were agreed on. A list of prioritized contextual factors was defined and endorsed for further research. A research agenda was proposed for domain instrument validation according to the OMERACT Filter 2.0.Conclusion.Preliminary core sets for clinical trials of symptom and structure modification and observational studies in hand osteoarthritis, including preliminary instruments and contextual factors, were agreed upon during OMERACT 12.
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Peters SE, Jha B, Couzens GB, Walsh W, Lisle D, Ross M. The effectiveness of the Push Brace™ orthosis and corticosteroid injection for managing first carpometacarpal joint osteoarthritis: A factorial randomised controlled trial protocol. HAND THERAPY 2015. [DOI: 10.1177/1758998315584835] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Introduction Various conservative treatments for first carpometacarpal joint osteoarthritis have been reported. We aim to investigate the short-term effectiveness of conservative management interventions used to improve pain and function for adults with first carpometacarpal joint arthritis in a randomised controlled trial. Methods A pragmatic 2 × 2 factorial randomised controlled trial will be conducted. This randomised controlled trial will have one control group (hand therapy) and three intervention groups. Interventions will include Push Brace™ orthosis and hand therapy, ultrasound-guided intra-articular corticosteroid injection and hand therapy and a combination of all three interventions. A total of 276 participants will be recruited for the trial. The primary outcomes will be pain (reported using a Visual Analogue Scale) and function (using the Patient Rated Wrist/Hand Evaluation). Secondary outcomes will include osteoarthritis specific function, pinch strength, global change and quality of life. Adverse events and complications will be reported. Outcomes assessments will be completed prior to the intervention and at 3, 6, 12 and 24 months post-intervention. The trial will be conducted at a private hand surgery clinic in Queensland, Australia. Conclusions Results from this trial will contribute to the evidence on conservative management of first carpometacarpal osteoarthritis.
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Affiliation(s)
- Susan E Peters
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia
| | - Bhavana Jha
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia
| | - Gregory B Couzens
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Australia
| | | | - David Lisle
- Brisbane Private Imaging, Brisbane Private Hospital, Brisbane, Australia
| | - Mark Ross
- Brisbane Hand and Upper Limb Research Institute, Brisbane, Australia
- Orthopaedic Department, Princess Alexandra Hospital, Woolloongabba, Australia
- University of Queensland, St Lucia, Australia
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Jordan JM, Henrotin Y. Osteoarthritis research society international initiative on recommendations for conducting clinical trials in osteoarthritis: overview. Osteoarthritis Cartilage 2015; 23:671-3. [PMID: 25952339 DOI: 10.1016/j.joca.2015.03.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Affiliation(s)
- J M Jordan
- Department of Medicine, Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston, Jr. Bldg., CB# 7280, Chapel Hill, NC, 27599-7280, USA; Department of Orthopaedics, Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston, Jr. Bldg., CB# 7280, Chapel Hill, NC, 27599-7280, USA.
| | - Y Henrotin
- Institute of Pathology, University of Liège, (B23) +5, CHU Sart-Tilman, 4000 Liège, Belgium.
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Kloppenburg M, Maheu E, Kraus VB, Cicuttini F, Doherty M, Dreiser RL, Henrotin Y, Jiang GL, Mandl L, Martel-Pelletier J, Nelson AE, Neogi T, Pelletier JP, Punzi L, Ramonda R, Simon LS, Wang S. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for hand osteoarthritis. Osteoarthritis Cartilage 2015; 23:772-86. [PMID: 25952348 DOI: 10.1016/j.joca.2015.03.007] [Citation(s) in RCA: 79] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2015] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Hand osteoarthritis (OA) is a very frequent disease, but yet understudied. However, a lot of works have been published in the past 10 years, and much has been done to better understand its clinical course and structural progression. Despite this new knowledge, few therapeutic trials have been conducted in hand OA. The last OARSI recommendations for the conduct of clinical trials in hand OA dates back to 2006. The present recommendations aimed at updating previous recommendations, by incorporating new data. The purpose of this expert opinion, consensus driven exercise is to provide evidence-based guidance on the design, execution and analysis of clinical trials in hand OA, where published evidence is available, supplemented by expert opinion, where evidence is lacking, to perform clinical trials in hand OA, both for symptom and for structure-modification. They indicate core outcome measurement sets for studies in hand OA, and list the methods and instruments that should be used to measure symptoms or structure. For both symptom- and structure-modification, at least pain, physical function, patient global assessment, HR-QoL, joint activity and hand strength should be assessed. In addition, for structure-modification trials, structural progression should be measured by radiographic changes. We also provide a research agenda listing many unsolved issues that seem to most urgently need to be addressed from the perspective of performing "good" clinical trials in hand OA. These updated OARSI recommendations should allow for better standardizing the conduct of clinical trials in hand OA in the next future.
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Affiliation(s)
- M Kloppenburg
- Departments of Rheumatology, Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - E Maheu
- Department of Rheumatology, Saint-Antoine Hospital - AP-HP, and Private Office, Paris, France.
| | - V B Kraus
- Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, NC, USA
| | - F Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, 3004, Australia
| | - M Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - R-L Dreiser
- Department of Rheumatology, Bichat Hospital, AP-HP, Paris, France
| | - Y Henrotin
- Bone and Cartilage Research Unit, Arthropôle Liège, University of Liège, CHU Sart-Tilman, 4000 Liège and Department of Physical Therapy and Rehabilitation, Princess Paola Hospital, Marche-en-Famenne, Belgium
| | - G-L Jiang
- Neurology & Pain Clinical Development, Allergan, Inc., 2525 Dupont Dr., Irvine, CA, 92612, USA
| | - L Mandl
- Hospital for Special Surgery, Weil Cornell Medical School, Division of Rheumatology, New York City, USA
| | - J Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), University of Montreal, Montreal, Quebec, Canada.
| | - A E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - T Neogi
- Section of Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, USA; Section of Rheumatology, Boston University School of Medicine, Boston, USA
| | - J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), University of Montreal, Montreal, Quebec, Canada.
| | - L Punzi
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - R Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | | | - S Wang
- Immunology Development, Global Pharmaceutical R&D, Abbvie, North Chicago, USA
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OARSI Clinical Trials Recommendations: Hand imaging in clinical trials in osteoarthritis. Osteoarthritis Cartilage 2015; 23:732-46. [PMID: 25952345 DOI: 10.1016/j.joca.2015.03.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2014] [Revised: 03/04/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
Tremendous advances have occurred in our understanding of the pathogenesis of hand osteoarthritis (OA) and these are beginning to be applied to trials targeted at modification of the disease course. The purpose of this expert opinion, consensus driven exercise is to provide detail on how one might use and apply hand imaging assessments in disease modifying clinical trials. It includes information on acquisition methods/techniques (including guidance on positioning for radiography, sequence/protocol recommendations/hardware for MRI); commonly encountered problems (including positioning, hardware and coil failures, sequences artifacts); quality assurance/control procedures; measurement methods; measurement performance (reliability, responsiveness, validity); recommendations for trials; and research recommendations.
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Fitzgerald GK, Hinman RS, Zeni J, Risberg MA, Snyder-Mackler L, Bennell KL. OARSI Clinical Trials Recommendations: Design and conduct of clinical trials of rehabilitation interventions for osteoarthritis. Osteoarthritis Cartilage 2015; 23:803-14. [PMID: 25952351 DOI: 10.1016/j.joca.2015.03.013] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2014] [Revised: 03/06/2015] [Accepted: 03/09/2015] [Indexed: 02/02/2023]
Abstract
A Task Force of the Osteoarthritis Research Society International (OARSI) has previously published a set of guidelines for the conduct of clinical trials in osteoarthritis (OA) of the hip and knee. Limited material available on clinical trials of rehabilitation in people with OA has prompted OARSI to establish a separate Task Force to elaborate guidelines encompassing special issues relating to rehabilitation of OA. The Task Force identified three main categories of rehabilitation clinical trials. The categories included non-operative rehabilitation trials, post-operative rehabilitation trials, and trials examining the effectiveness of devices (e.g., assistive devices, bracing, physical agents, electrical stimulation, etc.) that are used in rehabilitation of people with OA. In addition, the Task Force identified two main categories of outcomes in rehabilitation clinical trials, which include outcomes related to symptoms and function, and outcomes related to disease modification. The guidelines for rehabilitation clinical trials provided in this report encompass these main categories. The report provides guidelines for conducting and reporting on randomized clinical trials. The topics include considerations for entering patients into trials, issues related to conducting trials, considerations for selecting outcome measures, and recommendations for statistical analyses and reporting of results. The focus of the report is on rehabilitation trials for hip, knee and hand OA, however, we believe the content is broad enough that it could be applied to rehabilitation trials for other regions as well.
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Affiliation(s)
- G K Fitzgerald
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, USA.
| | - R S Hinman
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
| | - J Zeni
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - M A Risberg
- Norwegian Research Center for Active Rehabilitation, Department of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway
| | - L Snyder-Mackler
- Department of Physical Therapy, University of Delaware, Newark, DE, USA
| | - K L Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia
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Mathiessen A, Slatkowsky-Christensen B, Kvien TK, Hammer HB, Haugen IK. Ultrasound-detected inflammation predicts radiographic progression in hand osteoarthritis after 5 years. Ann Rheum Dis 2015; 75:825-30. [PMID: 25834142 DOI: 10.1136/annrheumdis-2015-207241] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2015] [Accepted: 03/15/2015] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To examine whether ultrasound predicts radiographic hand osteoarthritis (OA) progression after 5 years. METHODS We included 78 participants (71 women, mean (SD) age 67.8 (5.2) years) from the Oslo Hand OA cohort with ultrasound examination (gray-scale (GS) synovitis and power Doppler (PD) signals) at baseline and conventional radiographs and clinical examination at baseline and 5-year follow-up. Radiographic progression was defined as an increase in global OA according to the Kellgren-Lawrence (KL) scale or progression of individual radiographic OA features. We examined whether baseline ultrasound features and clinical examination predicted radiographic progression using generalised estimating equations, adjusted for age, sex, body mass index and follow-up time. RESULTS Radiographic progression occurred in 17.9% joints for KL, 12.1% for joint space narrowing, 11.7% for osteophytes and 4.5% for erosions. Ultrasound-detected inflammation predicted KL progression, and dose-response associations were observed for GS synovitis grade 1 (OR=2.8, 95% CI 1.8 to 4.2), grade 2 (OR=3.6, 95% CI 2.2 to 5.8) and grade 3 (OR=15.2, 95% CI 6.9 to 33.6), and for PD signal grade 1 (OR=2.9, 95% CI 1.2 to 6.8) and grades 2-3 (OR=12.0, 95% CI 3.5 to 41.0). Significant associations were also observed between ultrasound inflammation and progression of all individual radiographic features, and between clinical soft tissue swelling at baseline and radiographic progression. CONCLUSIONS Ultrasound-detected GS synovitis and PD signals were significantly associated with radiographic progression after 5 years. This study supports the use of ultrasound as a tool to detect patients with hand OA who are likely to progress.
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Affiliation(s)
| | | | - Tore K Kvien
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | | | - Ida K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
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Dziedzic K, Nicholls E, Hill S, Hammond A, Handy J, Thomas E, Hay E. Self-management approaches for osteoarthritis in the hand: a 2×2 factorial randomised trial. Ann Rheum Dis 2015; 74:108-18. [PMID: 24107979 PMCID: PMC4283664 DOI: 10.1136/annrheumdis-2013-203938] [Citation(s) in RCA: 68] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2013] [Revised: 08/02/2013] [Accepted: 09/17/2013] [Indexed: 11/03/2022]
Abstract
BACKGROUND Osteoarthritis is the leading cause of disability in older adults. Evidence of effectiveness for self-management of hand osteoarthritis is lacking. METHODS In this randomised, factorial trial, we evaluated the effectiveness of joint protection versus no joint protection, and hand exercise versus no hand exercise in adults, 50 years of age or older, with hand osteoarthritis. Following a population survey (n=12 297), eligible individuals were randomly assigned (1:1:1:1) to: leaflet and advice; joint protection; hand exercise; joint protection plus hand exercise. Joint protection and hand exercises were delivered by nine occupational therapists, over four group sessions. The primary outcome was the OARSI/OMERACT responder criteria at 6 months. Outcomes were collected blind to allocation (3, 6, 12 m). Analysis was by intention to treat. RESULTS Of 257 participants randomised (65:62:65:65) (mean age (SD) 66 years (9.1); female 66%) follow-up was 85% at 6 m (n=212). Baseline characteristics and loss to follow-up were similar between groups. There were no reported treatment side effects. At 6 m 33% assigned joint protection were responders compared with 21% with no joint protection (p=0.03). Of those assigned hand exercises, 28% were responders compared with 25% with no exercises (n.s.). Differences in secondary outcomes were not statistically significant, except for improvement in pain self-efficacy with joint protection (3 m p=0.002; 6 m p=0.001; 12 m p=0.03). CONCLUSIONS These findings show that occupational therapists can support self-management in older adults with hand osteoarthritis, and that joint protection provides an effective intervention for medium term outcome. (Funded by the Arthritis Research UK ISRCTN 33870549).
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Affiliation(s)
- Krysia Dziedzic
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Elaine Nicholls
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Susan Hill
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Alison Hammond
- Centre for Health Sciences Research, University of Salford, Salford, UK
| | - June Handy
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Elaine Thomas
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Elaine Hay
- Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
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36
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Altman RD. Clinical features of osteoarthritis. Rheumatology (Oxford) 2015. [DOI: 10.1016/b978-0-323-09138-1.00173-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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37
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Hammer HB, Iagnocco A, Mathiessen A, Filippucci E, Gandjbakhch F, Kortekaas MC, Möller I, Naredo E, Wakefield RJ, Aegerter P, D'Agostino MA. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis 2014; 75:402-7. [PMID: 25520476 DOI: 10.1136/annrheumdis-2014-206289] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2014] [Accepted: 12/01/2014] [Indexed: 01/15/2023]
Abstract
OBJECTIVE Ultrasonography is sensitive for the evaluation of cartilage pathology and degree of osteophytes in patients with hand osteoarthritis (OA). High consistency of assessments is essential, and the OMERACT (Outcome Measures in Rheumatology) ultrasonography group took the initiative to explore the reliability of a global ultrasonography score in patients with hand OA using semiquantitative ultrasonography score of cartilage and osteophytes in finger joints. METHODS Ten patients with hand OA were examined by 10 experienced sonographers over the course of two days. Semiquantitative scoring (0-3) was performed on osteophytes (carpo-metacarpal 1, metacarpo-phalangeal (MCP) 1-5, proximal interphalangeal 1-5 and distal interphalangeal 2-5 joints bilaterally with an ultrasonography atlas as reference) and cartilage pathology (MCP 2-5 bilaterally). A web-based exercise on static cartilage images was performed a month later. Reliability was assessed by use of weighted κ analyses. RESULTS Osteophyte scores were evenly distributed, and the intraobserver and interobserver reliabilities were substantial to excellent (κ range 0.68-0.89 and mean κ 0.65 (day 1) and 0.67 (day 2), respectively). Cartilage scores were unevenly distributed, and the intraobserver and interobserver reliability was fair to moderate (κ range 0.46-0.66 and mean κ 0.39 (day 1) and 0.33 (day 2), respectively). The web-based exercise showed acceptable agreement for cartilage being normal (κ 0.47) or with complete loss (κ 0.68), but poor for the intermediate scores (κ 0.22-0.30). CONCLUSIONS Use of the present semiquantitative ultrasonography scoring system for cartilage pathology in hand OA is not recommended (while normal or total loss of cartilage may be assessed). However, the OMERACT ultrasonography group will endorse the use of semiquantitative scoring of osteophytes with the ultrasonography atlas as reference.
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Affiliation(s)
- H B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - A Iagnocco
- Rheumatology Unit, Sapienza Università di Roma, Rome, Italy
| | - A Mathiessen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - E Filippucci
- Clinica Reumatologica, Università Politecnica delle Marche, Jesi (Ancona), Italy
| | - F Gandjbakhch
- Department of Rheumatology, AP-HP, Pitie-Salpetriere Hospital, Paris, France UPMC Université Paris 06, Paris, France
| | - M C Kortekaas
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands Department of Rheumatology, Flevoziekenhuis, The Netherlands
| | - I Möller
- Instituto Poal de Reumatologia, Barcelona, Spain
| | - E Naredo
- Department of Rheumatology, Hospital GU Gregorio Marañón, Madrid, Spain
| | - R J Wakefield
- Leeds Institute of Rheumatic and Rehabilitation Medicine, University of Leeds, Chapel Allerton Hospital, Leeds, UK
| | - P Aegerter
- Université Versailles-Saint Quentin En Yvelines, Paris, France Department of Public Health, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
| | - M-A D'Agostino
- Université Versailles-Saint Quentin En Yvelines, Inserm U987, Boulogne-Billancourt, France Department of Rheumatology, AP-HP, Ambroise Paré Hospital, Boulogne-Billancourt, France
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Myers H, Thomas E, Dziedzic K. Musculoskeletal Hand Symptoms and Functional Limitation in Community-Dwelling Adults Aged 50 Years and Over: Results from a Cross-Sectional Study. Br J Occup Ther 2014. [DOI: 10.4276/030802214x14151078348431] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Introduction: Hand pain and problems are common in community-dwelling adults aged 50 years and over. As the population ages, the absolute number of people with these issues is likely to increase. Debilitating hand problems affect at least 12% of the older population in the United Kingdom, but fewer than 1 in 30 people with this degree of disability consult an occupational therapist. Method: This paper describes a new analysis of a population study using data from surveys and a nested clinical cohort. Demographic characteristics, and the nature, severity, and frequency of symptoms and functional limitation in 1,811 adults aged 50 years and over with disabling hand problems are described, and the potential need for healthcare estimated. Findings: Moderate or severe functional limitation within the previous week was commonly reported. Irrespective of age and gender, weakness was the most frequently reported severe symptom (n = 470, 27%). Most problems occurred in activities requiring strength (such as opening a jar: n = 945, 52%). More females reported difficulty with tasks requiring strength (such as opening a jar: f: 59%; m: 38%), and more males reported difficulty with dexterous activities (such as picking up coins: m: 24%; f: 17%). Conclusion: The results from this study have implications for current and future management of hand problems in the community, highlighting a potential role for occupational therapy.
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Affiliation(s)
- Helen Myers
- Clinical Studies Coordinator, Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire
| | - Elaine Thomas
- Reader in Biostatistics, Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire
| | - Krysia Dziedzic
- Arthritis Research UK Professor of Musculoskeletal Therapies, Arthritis Research UK Primary Care Centre, Keele University, Keele, Staffordshire
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McIntyre J, Joubert RWE, Ramklass SS. Functional limitations and coping mechanisms of women aged 60 years and older with self-reported hand osteoarthritis. S Afr Fam Pract (2004) 2014. [DOI: 10.1080/20786190.2014.975487] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
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40
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Detert J, Klaus P, Listing J, Höhne-Zimmer V, Braun T, Wassenberg S, Rau R, Buttgereit F, Burmester GR. Hydroxychloroquine in patients with inflammatory and erosive osteoarthritis of the hands (OA TREAT): study protocol for a randomized controlled trial. Trials 2014; 15:412. [PMID: 25348033 PMCID: PMC4219005 DOI: 10.1186/1745-6215-15-412] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2014] [Accepted: 09/24/2014] [Indexed: 11/12/2022] Open
Abstract
Background Osteoarthritis (OA) is a heterogeneous group of conditions with disturbed integrity of articular cartilage and changes in the underlying bone. The pathogenesis of OA is multifactorial and not just a disease of older people. Hydroxychloroquine (HCQ) is a disease-modifying anti-rheumatic drug (DMARD) typically used for the treatment of various rheumatic and dermatologic diseases. Three studies of HCQ in OA, including one abstract and one letter, are available and use a wide variety of outcome measures in small patient populations. Despite initial evidence for good efficacy of HCQ, there has been no randomized, double-blind, and placebo-controlled trial in a larger patient group. In the European League Against Rheumatism (EULAR), evidence-based recommendations for the management of hand OA, HCQ was not included as a therapeutic option because of the current lack of randomized clinical trials. Methods/Design OA TREAT is an investigator-initiated, multicenter, randomized, double-blind, placebo-controlled trial. A total of 510 subjects with inflammatory and erosive hand OA, according to the classification criteria of the American College of Rheumatology (ACR), with recent X-ray will be recruited across outpatient sites, hospitals and universities in Germany. Patients are randomized 1:1 to active treatment (HCQ 200 to 400 mg per day) or placebo for 52 weeks. Both groups receive standard therapy (non-steroidal anti-inflammatory drugs [NSAID], coxibs) for OA treatment, taken steadily two weeks before enrollment and continued further afterwards. If disease activity increases, the dose of NSAID/coxibs can be increased according to the drug recommendation. The co-primary clinical endpoints are the changes in Australian-Canadian OA Index (AUSCAN, German version) dimensions for pain and hand disability at week 52. The co-primary radiographic endpoint is the radiographic progression from baseline to week 52. A multiple endpoint test and analysis of covariance will be used to compare changes between groups. All analyses will be conducted on an intention-to-treat basis. Discussion The OA TREAT trial will examine the clinical and radiological efficacy and safety of HCQ as a treatment option for inflammatory and erosive OA over 12 months. OA TREAT focuses on erosive hand OA in contrast to other current studies on symptomatic hand OA, for example, HERO [Trials 14:64, 2013]. Trial registration ISRCTN46445413, date of registration: 05-10-2011.
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Affiliation(s)
- Jacqueline Detert
- Department of Rheumatology and Clinical Immunology, Charité-Universitätsmedizin Berlin, Charitéplatz 1, 10117 Berlin, Germany.
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41
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Visser AW, Bøyesen P, Haugen IK, Schoones JW, van der Heijde DM, Rosendaal FR, Kloppenburg M. Radiographic scoring methods in hand osteoarthritis--a systematic literature search and descriptive review. Osteoarthritis Cartilage 2014; 22:1710-23. [PMID: 25278080 DOI: 10.1016/j.joca.2014.05.026] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/18/2014] [Accepted: 05/30/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This systematic literature review aimed to evaluate the use of conventional radiography (CR) in hand osteoarthritis (OA) and to assess the metric properties of the different radiographic scoring methods. DESIGN Medical literature databases up to November 2013 were systematically reviewed for studies reporting on radiographic scoring of structural damage in hand OA. The use and metric properties of the scoring methods, including discrimination (reliability, sensitivity to change), feasibility and validity, were evaluated. RESULTS Of the 48 included studies, 10 provided data on reliability, 11 on sensitivity to change, four on feasibility and 36 on validity of radiographic scoring methods. Thirteen different scoring methods have been used in studies evaluating radiographic hand OA. The number of examined joints differed extensively and the obtained scores were analyzed in various ways. The reliability of the assessed radiographic scoring methods was good for all evaluated scoring methods, for both cross-sectional and longitudinal radiographic scoring. The responsiveness to change was similar for all evaluated scoring methods. There were no major differences in feasibility between the evaluated scoring methods, although the evidence was limited. There was limited knowledge about the validity of radiographic OA findings compared with clinical nodules and deformities, whereas there was better evidence for an association between radiographic findings and symptoms and hand function. CONCLUSIONS Several radiographic scoring methods are used in hand OA literature. To enhance comparability across studies in hand OA, consensus has to be reached on a preferred scoring method, the examined joints and the used presentation of data.
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Affiliation(s)
- A W Visser
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.
| | - P Bøyesen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - I K Haugen
- Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - J W Schoones
- Walaeus Library, Leiden University Medical Center, Leiden, The Netherlands
| | - D M van der Heijde
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - F R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - M Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands; Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Østerås N, Hagen KB, Grotle M, Sand-Svartrud AL, Mowinckel P, Kjeken I. Limited effects of exercises in people with hand osteoarthritis: results from a randomized controlled trial. Osteoarthritis Cartilage 2014; 22:1224-33. [PMID: 25008206 DOI: 10.1016/j.joca.2014.06.036] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/03/2014] [Accepted: 06/28/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the clinical effectiveness of an exercise programme on self-reported hand activity performance in people with hand osteoarthritis (OA). DESIGN In this randomized, controlled trial, participants with physician-confirmed hand OA were randomly allocated to a 12-week exercise intervention (group- and home-based) or usual care. The primary outcome was self-reported hand activity performance at 3 months measured by the Functional Index for Hand Osteoarthritis (FIHOA) and a patient-generated measure of disability, the Patient-Specific Functional Scale (PSFS). RESULTS Of 130 randomized participants (mean age 66 (standard deviation (SD) 9); female 90%), 120 (92%) and 119 (92%) completed the 3- and 6-month follow-ups. The adjusted mean difference for the exercise vs control group was -0.5 points (95% confidence interval (CI) -1.6, 0.6) for the FIHOA score (0-30 scale, 0 = best) and 0.9 points (95% CI 0.1, 1.7) for the PSFS score (0-10 scale, 10 = best). Small significant mean differences in favour of the intervention group were found for hand pain, hand stiffness and disease activity, whereas no mean differences were observed in hand dexterity or maximal grip strength. A significantly larger proportion in the intervention (46%) vs control group (16%) fulfilled the Outcome Measures in Rheumatological Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) responder criteria at 3 months (OR = 4.4, 95% CI 1.9, 10.2). At the 6-month follow-up, there were no significant group differences in any outcome. CONCLUSIONS The exercise programme was well tolerated among people with hand OA, but resulted only in small, beneficial short-term improvements on self-reported measures and not on most performance-based tests. Future studies should address optimal grip strength exercises and dosage. TRIAL REGISTRATION ClinicalTrials.gov registration number: NCT01245842.
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Affiliation(s)
- N Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway.
| | - K B Hagen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; Department of Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
| | - M Grotle
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; FORMI (Communication Unit for Musculoskeletal Disorders), Division for Surgery and Neurology, Oslo University Hospital, Ullevål, Oslo, Norway.
| | - A-L Sand-Svartrud
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway.
| | - P Mowinckel
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway.
| | - I Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, PO Box 23 Vinderen, N-0319 Oslo, Norway; Department of Health Sciences, Institute of Health and Society, Faculty of Medicine, University of Oslo, Norway.
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Jahangiri A, Moghaddam FR, Najafi S. Hypertonic dextrose versus corticosteroid local injection for the treatment of osteoarthritis in the first carpometacarpal joint: a double-blind randomized clinical trial. J Orthop Sci 2014; 19:737-43. [PMID: 25158896 DOI: 10.1007/s00776-014-0587-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Accepted: 05/03/2014] [Indexed: 02/09/2023]
Abstract
PURPOSE To compare the advantages of prolotherapy in the treatment of first carpometacarpal osteoarthritis (OA) with those of corticosteroid local injection in the short and long term. METHODS We performed a randomized controlled trial from March 2010 to March 2011 in an outpatient clinic at a university hospital. Sixty participants (60 hands) with OA of the first carpometacarpal joint were assigned equally to two groups. For the corticosteroid group, after 2 monthly saline placebo injections, a single dose of 40 mg methylprednisolone acetate (0.5 ml) mixed with 0.5 ml of 2% lidocaine was injected. For the dextrose (DX) group, 0.5 ml of 20% DX was mixed with 0.5 ml of 2% lidocaine and the injection was repeated monthly for 3 months. Pain intensity, hand function and the strength of lateral pinch grip were measured at the baseline and at 1, 2, and 6 months after the treatment. RESULTS Mean age (STD) was 63.6 (9.7) years, and mean (STD) visual analog scale (VAS) was 6 (2). The two groups were comparable at 2 months, but significantly different at 1 month, with better results for corticosteroid, and at 6 months with apparently more favorable outcome for DX [mean difference (95% CI) in VAS = 1.1 (0.2, 2.0), p = 0.02]. After 6 months of treatment, both DX and corticosteroid injection increased functional level, but DX seemed to be more effective [mean difference (95% CI) in total function score = 1.0 (0.2, 1.8), p = 0.01]. DISCUSSION For the long term, DX seems to be more advantageous, while the two treatments were comparable in the short term. Because of the satisfactory pain relief and restoring of function, we would prefer DX prolotherapy for the treatment of patients with OA. LEVEL OF EVIDENCE Therapeutic studies--investigating the results of treatment; level I.
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Affiliation(s)
- Azadeh Jahangiri
- Department of Physical Medicine and Rehabilitation, Islamic Republic of Iran Army University of Medical Sciences, Tehran, Iran,
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Østerås N, Hagen KB, Grotle M, Sand-Svartrud AL, Mowinckel P, Aas E, Kjeken I. Exercise programme with telephone follow-up for people with hand osteoarthritis - protocol for a randomised controlled trial. BMC Musculoskelet Disord 2014; 15:82. [PMID: 24629063 PMCID: PMC3995554 DOI: 10.1186/1471-2474-15-82] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2013] [Accepted: 03/05/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Hand osteoarthritis (OA) is one of the most prevalent musculoskeletal diseases in an adult population and may have a large influence on an individual's functioning, health-related quality of life and participation in society. Several studies have demonstrated that exercises may reduce pain and improve functioning in people with knee OA, with a similar effect suggested for hip OA. For hand OA, available research is very limited and shows conflicting results, and high-quality randomised controlled trials are warranted.This paper outlines the protocol for a randomised controlled trial that aims to determine the effect of an exercise intervention on self-reported hand activity performance in people with hand OA. METHODS Participants with physician-confirmed hand OA according to the ACR clinical criteria are being recruited from two Norwegian OA cohorts: the population-based "Musculoskeletal pain in Ullensaker Study" (MUST) OA cohort, and the hospital-based Oslo Hand OA cohort. Participants are randomised into an intervention- or control group. The control group receives "usual care", whereas the intervention group receives a 12-week exercise intervention. The intervention group attends four group sessions and is instructed to perform the exercise program three times a week at home. Adherence will be captured using self-report. During the eight weeks with no group sessions, the intervention group receives a weekly telephone call. The assessments and group sessions are being conducted locally in Ullensaker Municipality and at Diakonhjemmet Hospital, Oslo. Outcomes are collected at baseline, and at 3 and 6 months. The primary outcome measure is self-reported hand activity performance at 3 months post-randomisation, as measured by the Functional Index for Hand Osteoarthritis (FIHOA); and a patient-generated measure of disability, the Patient-Specific Functional Scale (PSFS). Secondary outcome measures are self-reported OA symptoms (e.g. pain, stiffness and fatigue), the Patient Global Assessment of disease activity, measured hand function (e.g. grip strength, thumb web space and hand dexterity) and health-related quality of life. Cost-utility and cost-effectiveness analyses will be conducted. DISCUSSION This study will contribute to the knowledge on both the effect and resource use of an exercise programme with telephone follow-up on self-reported hand activity performance among people with hand OA. TRIAL REGISTRATION The trial is registered at ClinicalTrials.gov with registration number: NCT01245842.
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Affiliation(s)
- Nina Østerås
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, PO Box 23 Vindern, N-0319 Oslo, Norway.
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Watt FE, Kennedy DL, Carlisle KE, Freidin AJ, Szydlo RM, Honeyfield L, Satchithananda K, Vincent TL. Night-time immobilization of the distal interphalangeal joint reduces pain and extension deformity in hand osteoarthritis. Rheumatology (Oxford) 2014; 53:1142-9. [PMID: 24509405 PMCID: PMC4023558 DOI: 10.1093/rheumatology/ket455] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Objective. DIP joint OA is common but has few cost-effective, evidence-based interventions. Pain and deformity [radial or ulnar deviation of the joint or loss of full extension (extension lag)] frequently lead to functional and cosmetic issues. We investigated whether splinting the DIP joint would improve pain, function and deformity. Methods. A prospective, radiologist-blinded, non-randomized, internally controlled trial of custom splinting of the DIP joint was carried out. Twenty-six subjects with painful, deforming DIP joint hand OA gave written, informed consent. One intervention joint and one control joint were nominated. A custom gutter splint was worn nightly for 3 months on the intervention joint, with clinical and radiological assessment at baseline, 3 and 6 months. Differences in the change were compared by the Wilcoxon signed rank test. Results. The median average pain at baseline was similar in the intervention (6/10) and control joints (5/10). Average pain (primary outcome measure) and worst pain in the intervention joint were significantly lower at 3 months compared with baseline (P = 0.002, P = 0.02). Differences between intervention and control joint average pain reached significance at 6 months (P = 0.049). Extension lag deformity was significantly improved in intervention joints at 3 months and in splinted joints compared with matched contralateral joints (P = 0.016). Conclusion. Short-term night-time DIP joint splinting is a safe, simple treatment modality that reduces DIP joint pain and improves extension of the digit, and does not appear to give rise to non-compliance, increased stiffness or joint restriction. Trial registration: clinical trials.gov, http://clinicaltrials.gov, NCT01249391.
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Affiliation(s)
- Fiona E Watt
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.
| | - Donna L Kennedy
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
| | - Katharine E Carlisle
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
| | - Andrew J Freidin
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
| | - Richard M Szydlo
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
| | - Lesley Honeyfield
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
| | - Keshthra Satchithananda
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
| | - Tonia L Vincent
- Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK.Arthritis Research UK Centre for OA Pathogenesis, Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, Rheumatology Department, Therapies Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Centre for Haematology, Hammersmith Hospital, Imperial College London, Imaging Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust and Department of Imaging, King's College Hospital, London, UK
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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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Gandini F, Giannitti C, Fattore G, Giordano N, Galeazzi M, Fioravanti A. Validation of an Italian version of the functional index for hand osteoarthritis (FIHOA). Mod Rheumatol 2014. [DOI: 10.3109/s10165-011-0579-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Marks M, Schoones JW, Kolling C, Herren DB, Goldhahn J, Vliet Vlieland TPM. Outcome measures and their measurement properties for trapeziometacarpal osteoarthritis: a systematic literature review. J Hand Surg Eur Vol 2013; 38:822-38. [PMID: 23649014 DOI: 10.1177/1753193413488301] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The objective was to identify all outcome measures used in studies on trapeziometacarpal osteoarthritis (TMC OA) and evaluate their measurement properties. In a two-step systematic literature review, we first identified studies including TMC OA patients and extracted all outcome measures. They were categorized according to the Outcome Measures in Rheumatology (OMERACT) core set for OA including five dimensions: pain, physical function, global assessment, imaging, and quality of life (QoL). Secondly, we retrieved articles on the measurement properties of the identified outcome measures for TMC OA patients. First, 316 articles including 101 different outcome measures were identified, addressing the OMERACT pain and function domains most frequently but under-representing QoL. Second, 12 articles investigating measurement properties of 12 outcome measures were identified. The methodological quality of these studies was poor to fair, implying that based on the literature no recommendations to use any of the outcome measures can yet be made.
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Affiliation(s)
- M Marks
- Department of Research and Development, Schulthess Klinik, Zurich, Switzerland
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Sunk IG, Amoyo-Minar L, Stamm T, Haider S, Niederreiter B, Supp G, Soleiman A, Kainberger F, Smolen JS, Bobacz K. Interphalangeal Osteoarthritis Radiographic Simplified (iOARS) score: a radiographic method to detect osteoarthritis of the interphalangeal finger joints based on its histopathological alterations. Ann Rheum Dis 2013; 73:1983-9. [DOI: 10.1136/annrheumdis-2012-203117] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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