Abstract
The impact of primary hand osteoarthritis (HOA) on bone mass, microstructure, and biomechanics in the affected skeletal regions is largely unknown. HOA patients and healthy controls (HCs) underwent high-resolution peripheral quantitative computed tomography (HR-pQCT). We measured total, trabecular, and cortical volumetric bone mineral densities (vBMDs), microstructural attributes, and performed micro-finite element analysis for bone strength. Failure load and scaled multivariate outcome matrices from distal radius and second metacarpal (MCP2) head measurements were analyzed using multiple linear regression adjusting for age, sex, and functional status and reported as adjusted Z-score differences for total and direct effects. A total of 105 subjects were included (76 HC: 46 women, 30 men; 29 HOA: 23 women, six men). After adjustment, HOA was associated with significant changes in the multivariate outcome matrix from the MCP2 head (p < .001) (explained by an increase in cortical vBMD (Δz = 1.07, p = .02) and reduction in the trabecular vBMD (Δz = -0.07, p = .09). Distal radius analysis did not show an overall effect of HOA; however, there was a gender-study group interaction (p = .044) explained by reduced trabecular vBMD in males (Δz = -1.23, p = .02). HOA was associated with lower failure load (-514 N; 95%CI, -1018 to -9; p = 0.05) apparent in males after adjustment for functional status. HOA is associated with reduced trabecular and increased cortical vBMD in the MCP2 head and a reduction in radial trabecular vBMD and bone strength in males. Further investigations of gender-specific changes of bone architecture in HOA are warranted. © 2020 The Authors. Journal of Bone and Mineral Research published by American Society for Bone and Mineral Research.
Highlights
Osteoarthritis of the hand (HOA) is a highly prevalent rheumatic disorder, the burden of which increases with age.[1,2,3,4,5] Clinical manifestation of HOA can vary, ranging from a mild disease, characterized by Heberden’s node formation at the distal interphalangeal joints, to a severe disease with decline in function, especially if proximal hand joints become involved
The clinical burden of HOA comprises pain and joint deformity, which can lead to loss of grip strength and impairment in hand function subsequently influencing patients’ quality of life.[3,6,7] Despite increasing efforts to homogenize diagnostic criteria, define therapeutic and research targets, and formulate imaging recommendations for HOA,(8–12) no breakthrough has been made toward an effective treatment, often limiting HOA management to symptomatic treatment with nonsteroidal antiinflammatory drugs (NSAIDs)
HOA is defined by its clinical appearance by the 1990 American College of Rheumatology (ACR) classification criteria.[16,17] On the other hand, several imaging studies using magnetic resonance imaging (MRI) and ultrasound have shown that HOA can exhibit signs of inflammation such as synovitis and osteitis, which are considered predictors for disease progression.[18,19,20] Functional decline in the course of HOA together with inflammatory changes could progressively alter the bone architecture of the affected anatomical sites in HOA
Summary
Osteoarthritis of the hand (HOA) is a highly prevalent rheumatic disorder, the burden of which increases with age.[1,2,3,4,5] Clinical manifestation of HOA can vary, ranging from a mild disease, characterized by Heberden’s node formation at the distal interphalangeal joints, to a severe disease with decline in function, especially if proximal hand joints become involved. HOA is defined by its clinical appearance by the 1990 American College of Rheumatology (ACR) classification criteria.[16,17] On the other hand, several imaging studies using MRI and ultrasound have shown that HOA can exhibit signs of inflammation such as synovitis and osteitis, which are considered predictors for disease progression.[18,19,20] Functional decline in the course of HOA together with inflammatory changes could progressively alter the bone architecture of the affected anatomical sites in HOA. In order to define the impact of HOA on bone we performed a study comparing healthy individuals with HOA patients and analyzed bone mass, microstructure and function in the skeletal regions, which are functionally affected by the disease. HRpQCT analyses of the radius and the fingers were done in HOA patients and respective healthy controls (HCs)
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