Abstract
BackgroundThe objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and finally to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable.MethodsHigh quality photographs with standard distance and hand positioning were analysed for the presence of HOA and subsequently compared with standard radiographs and clinical examination in 381 random participants in the AGES-Reykjavik Study, a large population study. The mean age of the participants was 76 years.ResultsUsing the photographic method, the most commonly affected joints were the second DIP joints followed by the third DIP joints and second and third PIP joints. Both interobserver (ICC = 0.83) and intraobserver reading agreements (ICC = 0.89) were acceptable. On comparison with radiography and clinical examination, aggregate scores were significantly correlated (Rs 0.35-0.69), more so in females (Rs 0.53-0.72) than males. Hand pain in males showed very little association with HOA findings by the three methods but all methods showed a comparable moderate association with hand pain in females. The performance of photography in predicting pain on most days for at least a month in females was comparable to that of radiography and clinical examination (AUC 0.63 p = 0.004). Analysis of intermittent pain yielded similar results for in the DIP and PIP joints (OR 3.2-3.3, p < 0.01), but for the CMC1 joints, both radiography (OR 9.0, p < 0.0001), and clinical examination (OR 9.8, p < 0.0001), had higher predictive odds ratios for pain than photography (OR 3.6, p < 0.0001)., A shortened, rapidly performed form of reading photographs also showed a high degree of correlation with the other methods (Rs 0.56-0.82).ConclusionHigh quality hand photographs can be used to diagnose and grade hand osteoarthritis. The method has the advantage of being inexpensive and easy to perform. By using a slightly simplified method of reading, it appears to be highly suitable for use in large studies.
Highlights
The objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable
In addition to symptoms directly related to the hand itself, it is related to osteoarthritis at other sites and there is evidence that the presence of HOA increases the propensity for the development and progression of
The use of hand photographs as a screening method for HOA has been investigated in a few studies but found to be less sensitive than radiography [9,10,11]
Summary
The objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable. In addition to symptoms directly related to the hand itself, it is related to osteoarthritis at other sites and there is evidence that the presence of HOA increases the propensity for the development and progression of little information about prognosis [7,8]. Other imaging modalities such as scintigraphy, ultrasound and magnetic resonance imaging (MRI) have the advantage of being more dynamic and give a better indication of disease activity in the various tissues of the joints. OA is increasingly viewed as a dynamic process, one that is metabolically active, with the process of the disease involving both destruction and repair that may be triggered by a variety of biochemical as well as mechanical insults [12]
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