FRI0424 PROGRESSION OF PAIN, STIFFNESS, FUNCTION CHANGES AND ULTRASOUND DETECTED CHANGES IN THE GROUP OF 151 PATIENTS WITH HAND OSTEOARTHRITIS OVER THREE YEARS

Abstract

Background:Hand osteoarthritis (HOA) is a common and frequent cause of pain. HOA is a heterogeneous group of disorders with two main subsets including non-erosive and erosive disease. Few studies demonstrated inflammatory ultrasound changes and more severe clinical symptoms in patients with erosive compared with non-erosive disease, however the results are inconsistent.Objectives:The aim of this study was to evaluate progression of pain, stiffness, physical impairment and ultrasound features in patients with erosive and non-erosive HOA in a three years longitudinal study.Methods:Consecutive patients with symptomatic HOA fulfilling the American College of Rheumatology (ACR) criteria were included in this study. Joint pain and swelling were assessed. Patients reported joint pain on 100 mm visual analogue scale (VAS). Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). Erosive disease was defined by at least one erosive interphalangeal joint. Synovial hypertrophy and power Doppler signal (PDS) were scored with ultrasound. Synovitis was graded on a scale of 0–3 and osteophytes were defined as cortical protrusions seen in two planes. Patients were examined at baseline and at the first, second and third year of follow-up.Results:Altogether, 151 patients (16 male) with symptomatic nodal HOA were included in this study and followed between April 2012 and January 2020. Out of these patients, 84 (4 male) had erosive disease. The disease duration (p<0.05) was higher in patients with erosive compared with non-erosive disease.Pain reported on VAS was significantly higher (p<0.01) in patients with erosive compared with non-erosive disease at baseline. Progression of pain after the third year of follow up was significantly higher in patients with erosive disease (p<0.01). The number of painful and clinically swollen joints (p<0.05) was significantly higher in patients with erosive compared with non-erosive disease at baseline. It fluctuated over the second and third year of follow up, but it still remained statistically higher (p<0.01) at the third year of follow up in patients with erosive disease.According to the AUSCAN, patients with erosive compared with non-erosive disease had more pain (p<0.01) and stiffness (p<0.01) at baseline. Pain (p<0.05), stiffness and also function (p<0.05) worsened in patients with erosive compared with non-erosive disease at the third year of follow up.US-detected pathologies such as gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) and number of osteophytes (p<0.01) were significantly higher in patients with erosive compared with non-erosive disease at baseline. There were improvements in gray-scale synovitis total score and intensity of PDS in patients with non-erosive disease while patients with erosive disease worsened after the second and third year of follow up. US-detected gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) remained significantly higher in patients with erosive compared with non-erosive disease after the third year of follow up. On the other hand, the progression of US-determined osteophyte formation was observed in both groups but was significantly higher (p<0.05) in patients with erosive compared with non-erosive disease after the third year of follow up. .Conclusion:The findings of this study show that pain and number of painful and clinically swollen joints associated with US-detected synovial changes and osteophyte formation is more severe in patients with erosive HOA than in patients with non-erosive disease. In addition, osteophyte formation is more likely to progress independent of synovial inflammation.