The hand osteoarthritis of New York university (honey) registry: the impact of obesity and menopausal status

Abstract

Purpose: Hand osteoarthritis (OA) data in the literature emanates mainly from cohorts of knee or hip OA. Targeted populations of hand OA could better define the clinical spectrum, address etiologies, and discern pathophysiology. While prevalence increases with age, other factors impacting onset and severity are unclear. Many studies suggest adiposity plays a metabolic role in OA beyond the increased mechanical load - as evidenced by a greater prevalence of hand OA in obese patients. Other reports link hormonal status to OA pain. We aimed to study factors contributing to hand OA in a dedicated cohort. Methods: We enrolled patients with interphalangeal (IP) and/or 1st carpometacarpal (CMC) OA by physical exam, excluding those with rheumatoid arthritis, psoriatic arthritis, and lupus. During a one-time visit, participants completed adapted versions of the Michigan Hand Outcomes and QuickDash questionnaires, provided blood and urine samples for future biomarker testing, and were asked about comorbidities, other sites of musculoskeletal disease, prior hand trauma, and current or prior treatments for hand pain. Hand radiographs were scored for involvement of 20 joints (18 IPs, 2 first CMCs), and specifically for presence of erosions. Results: Of 337 patients screened, 171 were eligible and willing to participate. The average age was 66.3±9.5 years (42 to 90) and BMI was 26.2±5.0 kg/m2 (16.4 to 42.1) with 88.5% Caucasian and 78.8% female. Plain radiographs (available for 149 patients) revealed an average of 10.5±5.1 affected joints, with concurrent CMC and IP OA involvement in most patients (69.1%) The average length of time between onset of hand pain and enrollment was 11.7 years. Most patients were diagnosed with OA after their symptoms began (6.6 years after, n=79) though many were diagnosed concurrently with initial occurrence of symptoms (n=53). Radiographs showed erosive changes in at least one joint in 36.5% of the patients. This subset with central erosions had a significantly higher number of joints affected overall (12.5 vs. 9.1, p=<0.001). Patients with BMI > 30 kg/m2 had significantly more hand pain (p=0.022), stiffness (p=0.047), and disability (p=0.025) compared to those with normal weight BMI < 25, despite similarities in age and number of joints affected. Patients reporting OA in additional sites also reported more hand pain (p=0.018) and disability (p=0.003), though they were older (67.7 vs. 62.3 years, p=0.010). Women reported significantly more pain (p=0.035), disability (p=0.004), and a higher average number of joints affected (p=0.020) than males with similar mean ages and BMI (Table 1). Within the female subset, those aged 48 to 54 years (likely to be perimenopausal, +/- 3 years of age 51) reported more pain and disability than younger or older patients, even though females > 54 years of age had more affected joints (Figure 1). This finding raises the possibility that perimenopausal women with hand OA may experience increased hand pain at onset of menopause with improvement upon its conclusion. Conclusions: We have established the only prospective registry and biorepository in North America focused primarily on hand OA. Our findings support literature that hand OA pain and disability may be due in part to an inflammatory-driven process exacerbated by adiposity, and reflect a higher OA burden. Estrogen-mediated mechanisms altered during menopause may also have a role in OA symptoms. We expect the HONEY registry will be useful for elucidating etiologies and pathophysiology, and facilitating clinical trials for emerging therapeutic options.View Large Image Figure ViewerDownload Hi-res image Download (PPT)