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Haugen IK, Felson D, Abhishek A, Berenbaum F, Edwards JJ, Herrero Beaumont G, Hermann-Eriksen M, Hill CL, Ishimori M, Jonsson H, Karjalainen T, Leung YY, Maheu E, Mallen CD, Moe RH, Ramonda R, Ritschl V, Stamm TA, Szekanecz Z, van der Giesen FJ, Ritt MJPF, Wittoek R, Kjeken I, Osteras N, van de Stadt LA, Englund M, Dziedzic KS, Marshall M, Bierma-Zeinstra S, Hansen P, Greibrokk E, Smeets W, Kloppenburg M. Development of radiographic classification criteria for hand osteoarthritis: a methodological report (Phase 2). RMD Open 2022; 8:e002024. [PMID: 35121640 PMCID: PMC8819785 DOI: 10.1136/rmdopen-2021-002024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2021] [Accepted: 01/05/2022] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVES In Phase 1 of developing new hand osteoarthritis (OA) classification criteria, features associated with hand OA were identified in a population with hand complaints. Radiographic findings could better discriminate patients with hand OA and controls than clinical examination findings. The objective of Phase 2 was to achieve consensus on the features and their weights to be included in three radiographic criteria sets of overall hand OA, interphalangeal OA and thumb base OA. METHODS Multidisciplinary, international expert panels were convened. Patient vignettes were used to identify important features consistent with hand OA. A consensus-based decision analysis approach implemented using 1000minds software was applied to identify the most important features and their relative importance influencing the likelihood of symptoms being due to hand OA. Analyses were repeated for interphalangeal and thumb base OA. The reliability and validity of the proposed criteria sets were tested. RESULTS The experts agreed that the criteria sets should be applied in a population with pain, aching or stiffness in hand joint(s) not explained by another disease or acute injury. In this setting, five additional criteria were considered important: age, morning stiffness, radiographic osteophytes, radiographic joint space narrowing and concordance between symptoms and radiographic findings. The reliability and validity were very good. CONCLUSION Radiographic features were considered critical when determining whether a patient had symptoms due to hand OA. The consensus-based decision analysis approach in Phase 2 complemented the data-driven results from Phase 1, which will form the basis of the final classification criteria sets.
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Affiliation(s)
- Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - David Felson
- Rheumatology section, Boston University School of Medicine, Boston, Massachusetts, USA
- Arthritis Research UK Epidemiology Unit, National Institute for Health Research Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Francis Berenbaum
- INSERM CRSA, Sorbonne University, Paris, France
- Department of Rheumatology, Hopital Saint-Antoine, Paris, France
| | - John James Edwards
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Gabriel Herrero Beaumont
- Department of Rheumatology, Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Universidad Autonoma de Madrid, Madrid, Spain
| | | | - Catherine L Hill
- Rheumatology Department, Queen Elizabeth Hospital, Woodville, South Australia, Australia
- Faculty of Health and Medical Sciences, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia, Australia
| | - Mariko Ishimori
- Department of Medicine, Division of Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Helgi Jonsson
- Department of Rheumatology, Landspitali, Reykjavik, Iceland
| | - Teemu Karjalainen
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Ying Ying Leung
- Department of Rheumatology and Immunology, Singapore General Hospital, Singapore
| | - Emmanuel Maheu
- Department of Rheumatology, Hopital Saint-Antoine, Paris, France
| | - Christian D Mallen
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Rikke Helene Moe
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine, University of Padua, Padova, Italy
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Wien, Austria
- Institute for Arthritis and Rehabilitation, Ludwig Boltzmann Gesellschaft, Wien, Austria
| | - Zoltan Szekanecz
- Division of Rheumatology, University of Debrecen, Debrecen, Hungary
| | | | - Marco J P F Ritt
- Department of Plastic, Reconstructive and Hand Surgery, Amsterdam UMC, Amsterdam, The Netherlands
| | - Ruth Wittoek
- Department of Rheumatology, Ghent University, Ghent, Belgium
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Nina Osteras
- National Advisory Unit on Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Lotte A van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Krysia S Dziedzic
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - M Marshall
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, UK
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Elsie Greibrokk
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Wilma Smeets
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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Haugen IK, Felson DT, Abhishek A, Berenbaum F, Bierma-Zeinstra S, Borgen T, Herrero Beaumont G, Ishimori M, Jonsson H, Kroon FP, Maheu E, Ramonda R, Ritschl V, Stamm TA, van der Heijde D, Wittoek R, Greibrokk E, Smeets W, Kloppenburg M. Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis. RMD Open 2020; 6:e001265. [PMID: 32584781 PMCID: PMC7425183 DOI: 10.1136/rmdopen-2020-001265] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/26/2020] [Accepted: 05/31/2020] [Indexed: 02/07/2023] Open
Abstract
OBJECTIVES Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA. METHODS In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC). RESULTS Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in the first carpometacarpal joints (AUC = 0.67 and 0.63, respectively). Painful DIP joints were associated with hand OA, but were less able to discriminate between groups (AUC = 0.67). Age and family history of OA were positively associated with hand OA, whereas negative associations were found for pain, stiffness and soft tissue swelling in metacarpophalangeal joints, pain and marginal erosions in wrists, longer morning stiffness, inflammatory biomarkers and autoantibodies. CONCLUSIONS Differences in symptoms, clinical findings, radiographic changes and laboratory tests were found in patients with hand OA versus controls. Radiographic OA features, especially in DIP joints, were best suited to discriminate between groups.
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Affiliation(s)
- Ida K Haugen
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - David T Felson
- Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
- Arthritis Research UK Epidemiology Unit and National Institute for Health Research Biomedical Research Centre, The University of Manchester, Manchester, UK
| | - Abhishek Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
- Nottingham NIHR-BRC,Nottingham, UK
| | | | - Sita Bierma-Zeinstra
- Department of General Practice, Department of Orthopedics, Erasmus Medical Center, Rotterdam, Netherlands
| | - Tove Borgen
- Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
- Frysja Medical Practice, Oslo, Norway
| | | | - Mariko Ishimori
- Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | | | - Féline Pb Kroon
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
| | - Emmanuel Maheu
- Faculty of Medicine Pierre & Marie Curie Paris VI, Hopital Saint-Antoine,Paris, France
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Valentin Ritschl
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
| | | | - Ruth Wittoek
- Rheumatology, University Hospital Ghent, Gent, Belgium
| | | | - Wilma Smeets
- Rheumatology, Leiden University Medical Center, Leiden, Netherlands
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Kloppenburg M, Kroon FP, Blanco FJ, Doherty M, Dziedzic KS, Greibrokk E, Haugen IK, Herrero-Beaumont G, Jonsson H, Kjeken I, Maheu E, Ramonda R, Ritt MJ, Smeets W, Smolen JS, Stamm TA, Szekanecz Z, Wittoek R, Carmona L. 2018 update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis 2019; 78:16-24. [PMID: 30154087 DOI: 10.1136/annrheumdis-2018-213826] [Citation(s) in RCA: 211] [Impact Index Per Article: 42.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Revised: 06/28/2018] [Accepted: 08/01/2018] [Indexed: 01/08/2023]
Abstract
Since publication of the European League Against Rheumatism (EULAR) recommendations for management of hand osteoarthritis (OA) in 2007 new evidence has emerged. The aim was to update these recommendations. EULAR standardised operating procedures were followed. A systematic literature review was performed, collecting the evidence regarding all non-pharmacological, pharmacological and surgical treatment options for hand OA published to date. Based on the evidence and expert opinion from an international task force of 19 physicians, healthcare professionals and patients from 10 European countries formulated overarching principles and recommendations. Level of evidence, grade of recommendation and level of agreement were allocated to each statement. Five overarching principles and 10 recommendations were agreed on. The overarching principles cover treatment goals, information provision, individualisation of treatment, shared decision-making and the need to consider multidisciplinary and multimodal (non-pharmacological, pharmacological, surgical) treatment approaches. Recommendations 1-3 cover different non-pharmacological treatment options (education, assistive devices, exercises and orthoses). Recommendations 4-8 describe the role of different pharmacological treatments, including topical treatments (preferred over systemic treatments, topical non-steroidal anti-inflammatory drugs (NSAIDs) being first-line choice), oral analgesics (particularly NSAIDs to be considered for symptom relief for a limited duration), chondroitin sulfate (for symptom relief), intra-articular glucocorticoids (generally not recommended, consider for painful interphalangeal OA) and conventional/biological disease-modifying antirheumatic drugs (discouraged). Considerations for surgery are described in recommendation 9. The last recommendation relates to follow-up. The presented EULAR recommendations provide up-to-date guidance on the management of hand OA, based on expert opinion and research evidence.
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Affiliation(s)
- Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Féline Pb Kroon
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Francisco J Blanco
- Department of Rheumatology, INIBIC-Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Krysia S Dziedzic
- Institute for Primary Care and Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Keele, UK
| | - Elsie Greibrokk
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Ida K Haugen
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology, Instituto de Investigación Sanitaria Fundación Jimenez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Helgi Jonsson
- Department of Rheumatology, Landspitalinn University Hospital, University of Iceland, Reykjavik, Iceland
| | - Ingvild Kjeken
- National Advisory Unit on Rehabilitation in Rheumatology, Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Emmanuel Maheu
- Department of Rheumatology, AP-HP, St Antoine Hospital, Paris, France
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine DIMED, University of Padova, Padova, Italy
| | - Marco Jpf Ritt
- Department of Plastic Surgery, VU University Medical Center, Amsterdam, The Netherlands
| | - Wilma Smeets
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Rheumatology, INIBIC-Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain
| | - Josef S Smolen
- Division of Rheumatology, Department of Medicine 3, Medical University of Vienna, Vienna, Austria
| | - Tanja A Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics and Intelligent Systems, Medical University of Vienna, Vienna, Austria
| | - Zoltan Szekanecz
- Department of Rheumatology, University of Debrecen, Faculty of Medicine, Debrecen, Hungary
| | - Ruth Wittoek
- Department of Rheumatology, University Hospital Ghent, Ghent, Belgium
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4
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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] [What about the content of this article? (0)] [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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