Long term type 1 diabetes is associated with hand pain but not with structural hand osteoarthritis features – The Dialong hand study

Abstract

s / Osteoarthritis and Cartilage 24 (2016) S63eS534 S209 started with an initial cohort of people with a diagnosis of OA (ICD 9 code 715) who were treated within the VHA system between January 1, 2000 and December 31, 2014. We further classified the cohort, focusing on OA of the knee and hip. For knee OA, we included people with a diagnosis of OA (ICD 9 code 715), who were at least 50 years old, and who had been treated at least once for knee pain (ICD 9 code 719.46). For hip OA, we included people with a diagnosis of OA (ICD 9 code 715), who never had an erythrocyte sedimentation rate of 20 or above, and who had been treated at least once for hip pain (ICD 9 code 719.45). We validated the cohort through a manual review of 40 charts, with half of the charts randomly selected from the identified OA cohort, and half of the charts randomly selected from among those excluded from the cohort. Results: A total of 12,064,025 clinical records were available for this research. The OA identified cohort included 1,147,535 patients, of which 1,073,169 (94%) were male. The median age was 56 (interquartile range 51e68). There were 755,010 (66%) Caucasian, 177,745 (16%) African American, 51,826 (4%) Hispanic, 4,822 (<1%) Asian, and 158,132 (14%) of unknown race/ethnicity. Within the cohort, 11,976 had a history of a lower joint replacement (1%). Our manual review of the cohort included 20 true positives, 13 true negatives, 7 false negatives, and no false positives, resulting in a sensitivity of 74% and specificity of 100%. Between the years 2000 and 2014, the cohort accounted for 5,980,233 primary care visits, 884,882 rheumatology clinic visits, and 4,649,522 emergency medical visits within the VHA system. The top five ICD 9 codes for all clinic and emergency medical visits were hypertension (719,558 visits), hyperlipidemia (372,900 visits), diabetes (348,787 visits), lower back pain (222,397 visits), and joint pain (211,739 visits). Most patients in the cohort received prescriptions for NSAIDs (919,469, 79%), acetaminophen (874,721, 76%), and opiates (829,063, 72%). Less than half of the cohort received prescriptions for neuropathic pain medication (478,462, 42%), tramadol (431,338, 38%), and muscle relaxants (355,325, 31%). Over-the-counter use of acetaminophen and NSAIDs was not ascertainable. Conclusions: This demonstration project illustrates the feasibility of using a big data approach to select a large cohort of OA patients. This approach could improve our understanding of OA and holds promise for understanding OA subphenotypes, development of personalized treatment strategies for OA and facilitation of OA clinical trials. The next steps include combining clinical analytics with available genomic data as well as further validating this work with other datasets that include more females and other demographic diversity. 354 LONG TERM TYPE 1 DIABETES IS ASSOCIATED WITH HAND PAIN BUT NOT WITH STRUCTURAL HAND OSTEOARTHRITIS FEATURES e THE DIALONG HAND STUDY K. Magnusson y, N.G. Juel z, J.I. Brox zx, K. Holte k, K.B. Hagen yx, I.K. Haugen ¶, T. Julsrud Berg xk. yDept. of Rheumatology, Diakonhjemmet Hosp., Natl. Advisory Unit on Rehabilitation in Rheumatology, Oslo, Norway; zDept. of Physical Med. and Rehabilitation, Oslo Univ. Hosp., Oslo, Norway; xUniv. of Oslo, Oslo, Norway; kDept. of Endocrinology, Oslo Univ. Hosp., Oslo, Norway; Dept. of Rheumatology, Diakonhjemmet Hosp., Oslo, Norway Purpose: Previous studies have shown an association between diabetes and hand osteoarthritis (OA). However, these studies have not Associations between type 1 diabetes and radiographic hand OA, hand pain, function