Abstract
Hand osteoarthritis (HOA) is a prevalent condition for which treatments are based on analgesia and physical therapies. Our primary objective was to evaluate pain perception in participants with HOA by assessing the characteristics of nodal involvement, pain threshold in each hand joint, and radiological severity. We hypothesised that inflammation in hand osteoarthritis joints enhances sensitivity and firing of peripheral nociceptors, thereby causing chronic pain. Participants with proximal and distal interphalangeal (PIP and DIP) joint HOA and non-OA controls were recruited. Clinical parameters of joint involvement were measured including clinical nodes, VAS (visual analogue score) for pain (0–100 mm scale), HAQ (health assessment questionnaire), and Kellgren-Lawrence scores for radiological severity and pain threshold measurement were performed. The mean VAS in HOA participants was 59.3 mm ± 8.19 compared with 4.0 mm ± 1.89 in the control group (P < 0.0001). Quantitative sensory testing (QST) demonstrated lower pain thresholds in DIP/PIP joints and other subgroups in the OA group including the thumb, metacarpophalangeal (MCPs), joints, and wrists (P < 0.008) but not in controls (P = 0.348). Our data demonstrate that HOA subjects are sensitised to pain due to increased firing of peripheral nociceptors. Future work to evaluate mechanisms of peripheral sensitisation warrants further investigation.
Highlights
Osteoarthritis (OA) is the commonest form of arthritis worldwide, affecting increasing numbers of people in an ageing population [1]
Our study is the first to demonstrate that subjects with nodal hand OA (HOA) have reduced pain thresholds in their finger and wrist joints compared with non-HOA controls, suggesting that in chronic HOA people are sensitised to pain
Since nonDIP/PIP finger and wrist joints with low Kellgren-Lawrence scores (K-L) scores for radiological severity demonstrated reduced pain thresholds in our HOA group, our work suggests that participants with HOA have evidence of peripheral sensitisation
Summary
Osteoarthritis (OA) is the commonest form of arthritis worldwide, affecting increasing numbers of people in an ageing population [1]. Among US adults, nearly 27 million people have osteoarthritis [2]. The US Framingham study found that 27% of adults aged over 26 have hand OA (HOA) [2]. In a European study of 7983 people, 25% of participants with hand pain showed significant hand disability [3]. In the functional context of the hand, causes significant emotional and financial burden to those affected, impacting on carers and on society as a whole. Treatment of HOA currently comprises analgesia with paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs), opioid analgesics, and rehabilitative hand physiotherapy [4]. Large numbers of people continue to experience impaired hand function and pain. There is a pressing unmet need to improve management of HOA
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