Hand Erosive Osteoarthritis and Distal Interphalangeal Involvement in Psoriatic Arthritis: The Place of Conservative Therapy

Osteoarthritis versus psoriasis arthritis: Physiopathology, cellular signaling, and therapeutic strategies

Osteoarthritis and psoriasis arthritis are two degenerative forms of arthritis that share similar yet also different manifestations at the histological, cellular, and clinical levels. Rheumatologists have marked them as two entirely distinct arthropathies. Given recent discoveries in disease initiation and progression, potential mechanisms, cellular signaling pathways, and ongoing clinical therapeutics, there are now more opportunities for discovering osteoarthritis drugs. This review summarized the osteoarthritis and psoriasis arthritis signaling pathways, crosstalk between BMP, WNT, TGF-β, VEGF, TLR, and FGF signaling pathways, biomarkers, and anatomical pathologies. Through bench research, we demonstrated that regenerative medicine is a promising alternative for treating osteoarthritis by highlighting significant scientific discoveries on entheses, multiple signaling blockers, and novel molecules such as immunoglobulin new antigen receptors targeted for potential drug evaluation. Furthermore, we offered valuable therapeutic approaches with a multidisciplinary strategy to treat patients with osteoarthritis or psoriasis arthritis in the coming future in the clinic.

Osteoarthritis of hand joints: prevalence, risk factors, phenotypes, diagnosis, treatment

Osteoarthritis is the most common rheumatic disease, accompanied by constant pain and dysfunction of the joints, the progression of which leads to a deterioration in the quality of life and often to disability of patients. The article presents the prevalence, predictors of development and progression of osteoarthritis of the hand joints (OHJ). Clinical classification of OHJ, clinical picture depending on the localization of the process, topical features of involvement of the hand joints in different types of OHJ are given. Clinical, laboratory and instrumental methods for diagnosing of the disease, classification and diagnostic criteria are described, much attention is paid to modern principles of OHJ therapy in accordance with Russian clinical guidelines, as well as EULAR and ACR recommendations.

Comparison of the effectiveness of peloid and paraffin treatment for symptomatic hand osteoarthritis in women: a single-blind randomized controlled study

Although peloid and paraffin treatments may have a positive effect in the short term on pain, functional status, hand grip strength, and quality of life in patients with hand osteoarthritis (HOA), there are no comprehensive and comparative studies of these therapies for HOA. The aim of our study was to evaluate the short-term effects of peloid and paraffin treatments in symptomatic HOA patients. Eighty female patients diagnosed with HOA were randomly divided into two equal groups: peloid group (peloid therapy and home exercise) and paraffin group (paraffin therapy and home exercise). Peloid and paraffin applications were performed over 3 weeks for a total of 15 sessions. Patients were evaluated with visual analog scale (VAS)-rest, -activity, and -handgrip for pain, Jamar hand dynamometer for grip strength, Australian/Canadian (AUSCAN) Osteoarthritis Hand Index for function, health assessment questionnaire (HAQ) for physical activity, Beck depression inventory (BDI) for depression, and short form-36 (SF-36) for quality of life. Evaluations were performed before treatment, in the 3rd week, and 1 month after treatment. For all parameters except SF-36, statistically significant improvements were observed in short-term evaluations compared to the baseline in both groups (p = .000). Reductions in HAQ scores in the 3rd week and 1st month (p = .001 and p = .003), and the decrease in BDI scores in the 3rd week (p = .005) was statistically significantly higher in the peloid group. Improvements in some subparameters of the SF-36 were statistically significant in favor of the peloid group. In female patients with HOA, both groups experienced similar positive effects on pain, functional status, and hand grip strength for up to one month, but the peloid group was found to be superior in the short term in terms of physical activity and some quality of life parameters. Peloid therapy can be preferred as a natural and reliable method for symptomatic HOA.

Prescription-grade crystalline glucosamine sulfate as an add-on therapy to conventional treatments in erosive osteoarthritis of the hand: results from a 6-month observational retrospective study

Objective

To evaluate the efficacy of prescription-grade Crystalline Glucosamine Sulfate (pCGS) as an add-on treatment to conventional therapy, compared to usual therapy alone, in patients with erosive osteoarthritis of the hand (EHOA).

Methods

This 6-month retrospective case–control study included patients with concomitant knee osteoarthritis and symptomatic EHOA. Participants were stratified into two groups based on whether or not pCGS (1500 mg/day) was added to the conventional therapy (education and training in ergonomic principles, exercise and use on-demand of symptomatic drugs) for hand osteoarthritis. Patients were evaluated at baseline, after 3 and 6 months. Primary outcomes were the change from baseline to month 6 in Visual Analogue Scale (VAS) hand pain and in Functional Index for Hand Osteoarthritis (FIHOA) score. A set of secondary parameters was also evaluated.

Results

123 patients were included as follows: 67 treated with pCGS in addition to conventional therapy (pCGS Group) and 56 with conventional therapy alone (Control Group). After 6 months a significant difference in VAS and in FIHOA score (p < 0.01 and p < 0.001, respectively) was observed in favor of pCGS Group. Similar results were found for morning stiffness duration (p < 0.05), health assessment questionnaire (p < 0.01) and physical and mental component score of 36-item short form (p < 0.05 and p < 0.001, respectively). A significant reduction of symptomatic drug consumption at 3 and 6 months was reported in the pCGS Group (p < 0.001). No serious adverse event was recorded in both groups.

Conclusions

Despite all the limitations inherent to an observational study, our results suggest the potential effectiveness of pCGS, when used in combination with conventional therapy in EHOA. Further randomized placebo-controlled trials are needed to confirm these positive findings.

Trial Registration

ClinicalTrials.gov, http://www.clinicaltrials.gov, date of registration: February 2, 2022, NCT05237596. The present trial was retrospectively registered.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40520-022-02151-7.

Erosive Hand OsteoArthritis (EHOA): analysis of consecutive patients presenting with EHOA in a hospital-based rheumatology practice and its implications for an upcoming interventional study

INTRODUCTION

Erosive Hand OsteoArthritis (EHOA) is a common rheumatological problem. We aim to determine characteristics of EHOA patients: comorbidities, radiographic erosivity and pain experienced after being diagnosed, in order to find which of these are potentially relevant in upcoming interventional trials.

METHOD

Retrospective analysis of EHOA patients within the electronic database in one centre, with a telephone interview on pain as experienced even exceeding 12 months after being diagnosed.

RESULTS

Eighty-four non-academic EHOA patients were found: 89% females (median age 69 years), 11% males (similar age distribution). Kellgren-Lawrence (KL) erosivity scores in both sexes were comparable; DIPs scored higher than PIP's. Comorbid conditions were crystal-induced arthritis, rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in 8%, 5% and 1%, respectively; seropositivity for rheumatoid factor and anti-citrullinated protein antibodies in 8% and 1% respectively. Pain worst experienced often exceeded a visual analogue score of 5.0, but was unrelated to the total KL score. Some pain reduction was reached with non-steroidals (perorally/transcutaneously) as deduced from continued use in 1 in 3.

CONCLUSIONS

In many EHOA patients, there is an unmet need regarding the treatment of pain, which per se was not directly correlated with erosivity score. Future studies may be designed considering the aforementioned characteristics, acting on the inflammatory process resulting in PIP/DIP erosions, with the exclusion of RA and PsA in order to get a clean study on EHOA. Several studies with monoclonal antibodies have been performed but demonstrated ineffectivity on the outcome of pain. Hope glooms with the arrival of innovative small molecules that may reach EHOA target cells. Key Points • Erosive handOA is a common problem in non-academic rheumatology; it is often associated with significant pain in both sexes exceeding a VASpain of 5.0 even years after being diagnosed; 1 in 3 found some relief in non-steroidals perorally/transcutaneously. • Future studies will have to focus on (episodic) inflammatory hand OA resulting in proven erosivity (EHOA) located in PIP plus DIP joints and may have to exclude comorbid active crystal-induced arthritis as well as rheumatoid/psoriatic arthritis and possibly even RF/ACPA seropositivity in order to get a clean study on EHOA. • As several big monoclonals have failed in EHOA, we may have to search for promising new drugs within the group of small molecules. These will have to show a significant pain-reducing effect and preferably also a disease-modifying osteoarthritis drug (DMOAD) effect.