CMC1 Joints Research Articles

Associations Between Ultrasound-Detected Synovitis, Pain, and Function in Interphalangeal and Thumb Base Osteoarthritis: Data From the Nor-Hand Cohort.

To explore whether ultrasound-detected gray-scale synovitis and power Doppler activity in the interphalangeal and first carpometacarpal (CMC1) joints are associated with pain and physical function in patients with hand osteoarthritis (OA). A total of 290 patients with hand OA underwent an ultrasound examination of the bilateral interphalangeal and CMC1 joints. Using logistic regression analyses with generalized estimating equations, we examined whether grade 0-3 gray-scale synovitis and power Doppler activity were associated with pain in the same joint. Using linear regression analyses, we examined whether the degree of inflammation was associated with numeric rating scale and Australian/Canadian (AUSCAN) Osteoarthritis Hand Index hand pain, AUSCAN physical function, and grip strength scores. Analyses were made separately for interphalangeal and CMC1 joints, and adjusted for age, sex, body mass index, psychosocial factors, use of analgesics, and presence of osteophytes. At joint level, increasing gray-scale synovitis severity was associated with higher odds of pain upon palpation in both the interphalangeal (grade 2-3; odds ratio [OR] 3.17 [95% confidence interval (95% CI) 2.35, 4.28]) and CMC1 joints (grade 2-3; OR 4.40 [95% CI 2.10, 9.24]). Similar associations were found for power Doppler activity and joint pain in the previous 24 hours and 6 weeks. Power Doppler activity in CMC1 was also related to overall hand pain/physical function and lower grip strength. Inflammation in both the interphalangeal and CMC1 joints was associated with pain in the same joint. However, associations with hand pain, reduced physical function, and lower grip strength were only present for inflammation in the CMC1 joints, suggesting that lowering CMC1 inflammation is an important treatment target.

In thumb base osteoarthritis structural damage is more strongly associated with pain than synovitis

Osteoarthritis in thumb base joints (first carpometacarpal (CMC-1), scaphotrapeziotrapezoid (STT)) is prevalent and disabling, yet focussed studies are scarce. Our aim was to investigate associations between ultrasonographic and magnetic resonance imaging (MRI) inflammatory features, radiographic osteophytes, and thumb base pain in hand osteoarthritis patients. Cross-sectional analyses were performed in cohorts with MRI (n=202) and ultrasound measurements (n=87). Pain upon thumb base palpation was assessed. Radiographs were scored for CMC-1/STT osteophytes. Synovial thickening, effusion and power Doppler signal in CMC-1 joints were assessed with ultrasound. MRIs were scored for synovitis and bone marrow lesions (BMLs) in CMC-1 and STT joints using OMERACT-TOMS. Associations between ultrasound/MRI features, osteophytes, and thumb base pain were assessed. Interaction between MRI features and osteophytes was explored. In 289 patients (mean age 60.2, 83% women) 139/376 thumb bases were painful. Osteophyte presence was associated with pain (MRI cohort: odds ratio (OR) 5.1 (2.7-9.8)). Ultrasound features were present in 25-33% of CMC-1 joints, though no associations were seen with pain. MRI-synovitis and BMLs grade ≥2 were scored in 25% and 43% of thumb bases, and positively associated with pain (OR 3.6 (95% CI 1.7-7.6) and 3.0 (1.6-5.5)). Associations attenuated after adjustment for osteophyte presence. Combined presence of osteophytes and MRI-synovitis had an additive effect. Ultrasonographic and MRI inflammatory features were often present in the thumb base. Osteophytes were more strongly associated with thumb base pain than inflammatory features, in contrast to findings in finger OA studies, supporting thumb base osteoarthritis as a distinct phenotype.

Associations between ultrasoundfeatures and pain across hand osteoarthritis phenotypes

Purpose: Previous hand osteoarthritis (OA) studies have shown associations between synovitis and pain, whereas few studies have explored whether these associations are present in both the interphalangeal joints and the first carpometacarpal (CMC-1) joints. Due to limited effect of steroid injections in the CMC-1 joint, it has been speculated whether pain in the CMC-1 joints is more related to subluxation and deformity rather than synovitis. Hence, the aim of this study was to explore the association between ultrasound-detected synovitis and pain in both the interphalangeal and CMC-1 joints in patients with hand OA. Methods: The Nor-Hand study is an observational study including 301 patients with hand OA (89% women, median (IQR) age of 61 (57−66) years). All participants underwent ultrasound and clinical examination of the bilateral finger joints and completed pain questionnaires. The proximal and distal interphalangeal joints and the CMC-1 joint were examined using a GE Logic S8 ultrasound machine. A trained medical student scored the joints for osteophytes, grey scale synovitis (effusion and/or synovial hypertrophy) and power Doppler activity on a 0–3 scale. A rheumatologist examined the same joints for tenderness upon palpation/movement, and patient self-reported joint pain during the last 24 h and last 6 weeks on two separate homunculi. We explored joint level associations between grey scale synovitis/power Doppler activity and pain in the same joints using logistic regression analyses with generalized estimating equations with adjustment for age, sex and body mass index (BMI). Analyses were repeated with adjustment for ultrasound-detected osteophytes. Separate models were performed for the ultrasound features as well as for the different pain outcomes. Results: The majority of patients had finger joints with presence of grey scale synovitis with a median (interquartile range, IQR) of 2 (0–5) and 0 (0–1) for the interphalangeal and CMC-1 joints, respectively. Power Doppler activity was less frequent with a median (IQR) of 0 (0–2) and 0 (0–1) for the interphalangeal and CMC-1 joints, respectively. The median (IQR) of tender joints upon palpation was 5 (2–10) and 1 (0–2) for the interphalangeal and CMC-1 joints, respectively, whereas the number of joints with self-reported pain was lower (median (IQR) of 2 (0–6) and 0 (0–2) for pain the previous 6 weeks for the interphalangeal and CMC-1 joints, respectively) Increasing severity of ultrasound-detected grey scale synovitis and power Doppler activity was associated with higher odds of tenderness upon palpation in the interphalangeal joints as well as the CMC-1 joints (Table). For self-reported pain, the strength of associations was similar (data not shown). The associations attenuated, but remained statistically significant when osteophytes were added to the models (except borderline significant for power Doppler activity and pain last 24 h in the CMC-1 joints). Conclusions: Ultrasound-detected synovitis was associated with pain in both interphalangeal joints and CMC-1 joints, and the association was independent of the severity of osteophytes. These results suggest that lowering inflammation could be a treatment target in patients with both interphalangeal OA as well as CMC-1 OA.Tabled 1Associations between ultrasound-detected synovitis and tenderness upon palpationOR (95% CI) of tenderness upon palpation (adjusted for age, sex and BMI)Bilateral DIP 2–5 and PIP 1–5 jointsBilateral CMC-1 jointsGrey scale synovitisGrade 01.00 (Ref.)1.00 (Ref.)Grade 13.10 (2.54–3.78)3.39 (1.85–6.17)Grade 2–35.74 (4.44–7.43)7.48 (3.93–14.21)Power-Doppler activityGrade 01.00 (Ref.)1.00 (Ref.)Grade 14.10 (3.14–5.35)4.46 (2.56–7.75)Grade 2–34.24 (3.24–5.53)6.40 (2.29–17.83) Open table in a new tab

Comparison between Several Ultrasound Hand Joint Scores and Conventional Radiography in Diagnosing Hand Osteoarthritis

This is the first study to investigate the usefulness of a standardized ultrasound (US) examination protocol in diagnosing hand osteoarthritis (OA). We conducted a cross-sectional study including 62 patients, ultimately diagnosed with hand OA based on imaging evidence of osteoarthritic changes with the particular distribution required for fulfilment of American College of Radiology diagnosis criteria. We compared a 32-joint US score (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP] or distal interphalangeal [DIP] and carpometacarpal [CMC]-1 joints), with smaller, predefined joint scores, assessing 22 joints (wrists, MCPs and PIPs or PIPs, DIPs and CMC-1), 10 joints (MCP 2–3, PIP 2–3 and CMC-1 or PIP 2–3, DIP 2–3 and CMC-1) and 6 joints (DIP 2–3, CMC-1), respectively. The US findings were correlated with radiographic scores for erosions and osteophytes. Radiographic osteophyte scores correlated well with all the US scores mentioned earlier (R = 0.381 to 0.645, p < 0.05), despite low sensitivity for detection of osteophytes (43.5%) and erosions (28.9%), compared with the 32 joint US score. Both 10 joint US protocols (assessing MCP 2–3, PIP 2–3 and CMC-1 or PIP 2–3, DIP 2–3 and CMC-1 joints) performed better than conventional radiography, by identifying osteophytes in an additional 25.6% and 23.9% of patients, respectively. The conclusion of this study is that the US examination of 10 preselected hand joints is more sensitive than conventional radiography in diagnosing hand OA in patients who do not fulfill American College of Radiology clinical criteria, a finding likely to have practical implications for facilitating diagnosis of hand OA.

Development and Reliability of the OMERACT Thumb Base Osteoarthritis Magnetic Resonance Imaging Scoring System.

To develop the Outcome Measures in Rheumatology (OMERACT) thumb base osteoarthritis (OA) magnetic resonance imaging (MRI) scoring system (TOMS) for the assessment of inflammatory and structural abnormalities in this hand OA subset, and test its cross-sectional reliability. Included features and their scaling were agreed upon by members of the OMERACT MRI Task Force using the Hand OA MRI scoring system as a template. A reliability exercise was performed in which 3 readers participated, using a preliminary atlas with examples to facilitate reading. Each reader independently scored a set of 20 MRI (coronal and axial T1- and T2-weighted fat-suppressed images, of which 5 included T1-weighted fat-suppressed post-Gadolinium images). Intra- and inter-reader reliability were assessed using ICC, percentage exact agreement (PEA), and percentage close agreement (PCA). The TOMS assessed the first carpometacarpal (CMC-1) and scaphotrapeziotrapezoid (STT) joints for synovitis, subchondral bone defects (including erosions, cysts, and bone attrition), osteophytes, cartilage, and bone marrow lesions on a 0-3 scale (normal to severe). Subluxation was evaluated only in the CMC-1 joint (absent/present). Reliability of scoring for both joints was comparable. Interreader ICC were good for all features (0.77-0.99 and 0.74-0.96 for CMC-1 and STT joints, respectively). Intrareader reliability analyses gave similar results. PCA was ≥ 65% for all features. PEA was low to moderate, with better performance for subchondral bone defects, subluxation, and bone marrow lesions. A thumb base OA MRI scoring system has been developed. The OMERACT TOMS demonstrated good intrareader and interreader reliability. Longitudinal studies are warranted to investigate reliability of change scores and responsiveness.

Computed tomography for the detection of thumb base osteoarthritis: comparison with digital radiography

To compare computed tomography (CT) with digital radiography for the detection of osteoarthritis (OA) of the first carpometacarpal (CMC1) and scaphotrapeziotrapezoid (STT) joint. We retrospectively identified patients who were assessed for CMC1 OA or STT OA at our hand surgery outpatient clinic between January 2008 and March 2011, and who had both a digital radiograph and a CT scan of the hand within a 3-month period. CT and radiographic images were scored independently by two musculoskeletal radiologists for joint space narrowing (JSN), osteophytes, subchondral sclerosis, bone cysts, and erosions in the CMC1 and STT joints. Thirty patients were identified. The inter-reader reliability of CT for the detection of CMC1 OA (ICC 1.00) and STT OA (ICC 0.80) was higher than radiography (ICC's 0.15 and 0.45). In comparison with their own radiographical scoring, both readers detected with CT 3 more patients with CMC1 OA, and 13 and 5 more patients with STT OA. Computed tomography had a higher inter-reader reliability and detection rate for both CMC1 and STT OA, compared with radiography. As surgical treatment selection of thumb base OA depends on the presence of pathology in the CMC1 and STT joints, CT may improve treatment selection and surgical planning.

The use of digital photographs for the diagnosis of hand osteoarthritis: the AGES-Reykjavik study

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.

Natural history of radiographic features of hand osteoarthritis over 10 years

To evaluate the natural history of radiographic hand osteoarthritis (OA) over 10 years. We assessed 118 subjects (30 women) twice (X-ray A and B) with mean (SD) follow-up time of 9.6 (0.4) years. Subjects were of mean (SD) age 52 (10) years at X-ray A and had undergone prior knee meniscectomy. Radiographs of the distal interphalangeal (DIP) and proximal interphalangeal (PIP) joints, and the first interphalangeal (IP1) and first carpometacarpal (CMC1) joints of both hands were read for joint space narrowing (JSN) and osteophytes according to the OARSI atlas. Radiographic progression was evaluated both at joint and subject level. At the time of X-ray A, we found radiographic OA (approximating Kellgren and Lawrence grade 2 or worse) in at least one hand joint in 42 (36%) subjects, and in 62 (53%) at X-ray B (P<0.001). At X-ray A, 21 subjects (18%) were classified as having primary hand OA vs 35 (30%) at X-ray B (P<0.001). Increase in JSN and osteophyte grade occurred most frequently in the DIP joints. OA at X-ray B was most frequently found in subjects' CMC1 (29%), DIP (14-27%), and IP1 joints (19%). Fifty-nine percent of subjects progressed radiographically (increase in total radiographic score by at least 2). However, the progression of the radiographic changes was mostly minor. In subjects with prior meniscectomy, CMC1, DIP, and IP1 joint OA is common. However, further hand OA progression over 10 years, as detected by plain radiography, is relatively modest. More sensitive imaging techniques may be preferable for clinical trials to evaluate structural hand OA progression.

Low-Field Magnetic Resonance Imaging of the Thumb Base in Severe Symptomatic Osteoarthritis: A Comparison with Radiographs and Clinical Symptoms

The objectives of this pilot study were to assess the findings of low-field MRI in symptomatic thumb base os- teoarthritis (OA), to identify suitable MRI sequences with or without Gadolinium contrast, and to compare these findings with conventional radiographs scored by the Altman atlas and patient reported pain. Twelve patients with symptomatic thumb base osteoarthritis participated. We used a 0,2T MRI system, before and after i.v. Gadolinium. The MRI images were scored on a 0-3 scale for synovitis (SYN), bone marrow edema (BME), cysts/erosions (CE) and osteophytes (OP). Interreader agreement on MRI scores was best for BME and CE but less for SYN and OP. Difficulties were in determin- ing the soft tissue involvement of the CMC1 joint, especially in demarcating the joint capsule and ligament pathology. The most informative MRI sequences were the High Resolution Gradient Echo, the STIR and the 3D volume.Gadolinium contrast provided little additional information. Cumulative MRI and radiographic scores for the 24 CMC1 joints studied were strongly correlated (Rs 0.81, p<0.001). Both BME in adjacent bones and SYN in the CMC1 joint correlated with rest pain (Rs 0.54, p<0.01 and Rs 0.45, p<0.05) respectively). BME was also associated with pain intensity on a 0-10 scale (R 0.44, p<0.05). Other radiographic and MRI variables showed no association with pain. Low-field MRI reflects CMC1 joint osteoarthritis damage and gives additional information regarding bone marrow edema and synovitis, both of which are strongly related to clinical symptoms. This study encourages further research to identify the most suitable equipment and sequences and to standardize the reading of MRI images.

High hand joint mobility is associated with radiological CMC1 osteoarthritis: the AGES-Reykjavik study

Previous studies have indicated that joint hypermobility may affect the development of clinical and radiological hand osteoarthritis (OA), but this question has not been addressed in epidemiological studies. Our objective was to investigate this relationship in a population-based study. The study group consisted of 384 unselected older participants in the Age, Gene/Environment Susceptibility-Reykjavik Study (161 males, median age 76, range 69-90, and 223 females median age 75, range 69-92). The criterion used for joint mobility was the single maximal degree of hyperextension of digits 2 and 5 on both hands (HYP degrees). HYP degrees was more prevalent in females and on the left hand in both men and women. Both genders had a positive association between the degree of mobility measured by HYP degrees and radiological scores for the first carpometacarpal joint (CMC1) OA. Thus, those with HYP degrees >or=70 had an odds ratio of 3.05 (1.69-5.5, P<0.001) of having a Kellgren-Lawrence score of >or=3 in a CMC1 joint. There was also a trend towards a negative association between HYP degrees and proximal interphalangeal joint scores. Hand joint mobility, defined as hyperextension in the metacarpophalangeal joints (HYP degrees ) is more prevalent in females and on the left side. It was associated with more severe radiographic OA in the CMC1 joints in this population. The reasons for this relationship are not known, but likely explanations involve ligament laxity and CMC1 joint stability. These findings may relate to the left-sided predominance of radiographic OA in the CMC1 joints observed in many prevalence studies.

Hand radiology characteristics of patients carrying the T303M mutation in the gene for matrilin‐3

Objective: To determine whether the recently described hand osteoarthritis (HOA)‐associated T303M mutation in the gene for matrilin‐3 (MATN3) is associated with specific radiological changes on hand radiographs.Method: Standard hand radiographs from 26 HOA patients carrying the T303M missense mutation in the MATN3 gene (T303M patients) were compared with those from 52 HOA controls matched for sex, age, and clinical disease severity. Two blinded readers scored the radiographs, using the Verbruggen–Veys anatomical scoring system for the interphalangeal and metacarpophalangeal joints and the OARSI atlas scoring system for the first carpometacarpal (CMC1) joints. A scoring system based on the latter was used for the scaphoid–trapezoid–trapezoideum (STT) joints.Results: No particular distinguishing features were found in the T303M patients and the prevalence of erosive and cystic changes was similar to the control group. As a group, however, the T303M patients had more severe thumb‐base affection, particularly in the STT joint. Thus, definite radiological OA in both CMC1 and STT joints and higher STT scores compared with CMC1 were significantly more common in patients carrying the T303M mutation. Radiological scores for joint‐space narrowing (CMC1 and STT) and osteophytes (STT) were also significantly higher in the T303M patients.Conclusion: Patients carrying the T303M mutation in the gene for matrilin‐3 express a form of HOA that is radiologically indistinguishable from idiopathic HOA in individual patients but they have more severe thumb‐base involvement, particularly in the STT joint. This is the first described genetic mutation that is associated with a common form of osteoarthritis.

Genomewide Scan for Hand Osteoarthritis: A Novel Mutation in Matrilin-3

Osteoarthritis (OA) is the most common human joint disease, characterized by loss and/or remodeling of joint synovium, cartilage, and bone. Here, we describe a genomewide linkage analysis of patients with idiopathic hand OA who were carefully phenotyped for involvement of either or both the distal interphalangeal (DIP) joints and the first carpometacarpal (CMC1) joints. The best linkage peaks were on chromosomes 4q and 3p and on the short arm of chromosome 2. Genomewide significance was reached for a locus on chromosome 2 for patients with affected CMC1 joints (LOD = 4.97); this locus was also significant for patients with OA in both CMC1 and DIP joints (LOD = 4.44). The peak LOD score at this locus coincides with a gene, MATN3, encoding the noncollagenous cartilage extracellular matrix protein, matrilin-3. Subsequent screening of the genomic sequence revealed a missense mutation, of a conserved amino acid codon, changing threonine to methionine in the epidermal growth factor-like domain in matrilin-3. The missense mutation cosegregates with hand OA in several families. The mutation frequency is slightly more than 2% in patients with hand OA in the Icelandic population and has a relative risk of 2.1.