Abstract
BackgroundMany patients with hand osteoarthritis (HOA) experience reduced health-related quality of life. This study sought to better understand the disease and treatment experience of individuals with HOA, explore any differences in experiences between erosive and non-erosive HOA sub-types, and evaluate content validity of the Michigan Hand Outcomes Questionnaire (MHQ) in HOA.MethodsThirty subjects from the United States (n = 15 erosive HOA; n = 15 non-erosive HOA) participated in semi-structured interviews: concept elicitation explored symptoms/impacts important to patients; cognitive interviews assessed understanding and relevance of the MHQ. A sub-sample participated in real-time data capture (RTDC) activities via a smartphone/tablet app over 7 days. Verbatim transcripts were coded using Atlas.ti software and thematically analyzed. Concept saturation and MHQ content validity were evaluated.ResultsMost participants reported experiencing pain, swelling and stiffness, symptoms that most commonly had a direct impact on physical functioning. Substantial impacts on activities of daily living, emotional functioning, sleep and work were also reported. RTDC findings corroborated concept elicitation findings. There were no notable differences between erosive and non-erosive HOA, except nodules were reported more frequently in erosive disease. Most participants used analgesic treatments, but effects were short-lived. Pain was the symptom most frequently reported as most bothersome and important to treat. Concept saturation was achieved. MHQ items and instructions were well understood and relevant to most participants; stiffness and swelling were reported as important symptoms not included in the MHQ.ConclusionsThis study characterizes key symptoms of HOA which are burdensome for patients and not well controlled by current therapies, highlighting an unmet treatment need. Although the study is limited by a small sample size that may not be representative of the broader erosive and non-erosive HOA population, concept saturation was achieved, and our findings suggest that disease experience is similar for patients with erosive and non-erosive HOA. Evaluation of stiffness and swelling items in conjunction with the MHQ may enhance relevance and improve measurement precision to assess important domains of HQRoL in an HOA population.
Highlights
Many patients with hand osteoarthritis (HOA) experience reduced health-related quality of life
All participants had received a diagnosis of HOA via X-ray, and for most a clinical examination was performed (n = 28/30, 93%)
This study provides evidence that the key symptoms of HOA have an impact on several domains of health-related quality of life (HRQoL), and are not well-controlled by currently available therapies in this targeted population of individuals erosive and non-erosive HOA, confirming an unmet treatment need for more effective, durable, and disease-modifying therapies
Summary
Many patients with hand osteoarthritis (HOA) experience reduced health-related quality of life. Hand osteoarthritis (HOA) is among the most common forms of OA, with an age-standardized (40–84 years) prevalence of approximately 40% in the US [1, 2]. Patients with HOA can experience reduced health-related quality of life (HRQoL) including impairments in physical functioning and mental/emotional well-being [5,6,7]. Erosive HOA is characterized by rapid onset and more inflammatory signs including stiffness, swelling and erythema, more synovitis, and a more aggressive disease course than non-erosive HOA [8,9,10,11]. There are limited data comparing the patient experience of erosive versus non-erosive forms of HOA. Smartphone/tablet apps offer the possibility to collect patient experience data in ‘real-time’, capturing disease symptoms and impacts as they are experienced
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