Abstract
PurposeNon-operative management of trapeziometacarpal osteoarthritis (TMOA) demonstrates only short-term symptomatic alleviation, and no approved disease modifying drugs exist to treat this condition. A key issue in these patients is that radiographic disease severity can be discordant with patient reported pain, illustrating the need to identify molecular mediators of disease. This study characterizes the biochemical profile of TMOA patients to elucidate molecular mechanisms driving TMOA progression.MethodsPlasma from patients with symptomatic TMOA undergoing surgical (n=39) or non-surgical management (n=44) with 1-year post-surgical follow-up were compared using a targeted panel of 27 cytokines. Radiographic (Eaton-Littler), anthropometric, longitudinal pain (VAS, TASD, quick DASH) and functional (key pinch, grip strength) data were used to evaluate relationships between structure, pain, and systemic cytokine expression. Principal Component Analysis was used to identify clusters of patients.ResultsPatients undergoing surgery had greater BMI as well as higher baseline quick DASH, TASD scores. Systemically, these patients could only be distinguished by differing levels of Interleukin-7 (IL-7), with an adjusted odds ratio of 0.22 for surgery for those with increased levels of this cytokine. Interestingly, PCA analysis of all patients (regardless of surgical status) identified a subset of patients with an “inflammatory” phenotype, as defined by a unique molecular signature consisting of thirteen cytokines.ConclusionOverall, this study demonstrated that circulating cytokines are capable of distinguishing TMOA disease severity, and identified IL-7 as a target capable of differentiating disease severity with higher levels associated with a decreased likelihood of TMOA needing surgical intervention. It also identified a cluster of patients who segregate based on a molecular signature of select cytokines.
Highlights
Osteoarthritis at the base of the thumb (Trapeziometacarpal Osteoarthritis [TMOA]), is a prevalent and painful condition [1]
We evaluated whether circulating cytokines can distinguish symptomatic disease severity by comparing patients undergoing non-surgical management to those undergoing surgery, and provide a basis for communicating active processes occurring within the joint
We show that the cytokine IL-7 is capable of discriminating disease severity between these two groups
Summary
Osteoarthritis at the base of the thumb (Trapeziometacarpal Osteoarthritis [TMOA]), is a prevalent and painful condition [1]. The etiology of TMOA is unknown, and pain is the main reason individuals seek medical attention [2]. Though studies examining the occurrence of this specific condition are lacking, it is estimated that TMOA has a lifetime prevalence of approximately 10% [3, 4]. This is highly variable between radiographic TMOA which has an estimated prevalence of 1250%, and symptomatic TMOA which affects 1-16% of individuals [5]. The TM joint has been grouped together with other hand joints in OA studies despite evidence supporting it as distinctly affected [6]
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