Progression Of Hand Osteoarthritis Research Articles

Association of Weight Loss and Weight Gain With Structural Defects and Pain in Hand Osteoarthritis: Data From the Osteoarthritis Initiative.

Our aim was to define the association of weight change (weight loss or weight gain) with the incidence and progression of hand osteoarthritis (OA), assessed either by radiography or by pain, using data from the Osteoarthritis Initiative. Among the 4,796 participants, we selected 4,598 participants, excluding those with cancer or rheumatoid arthritis or a body mass index under 18.5 kg/m2. We investigated the association of weight change with incidence and progression of radiographic hand OA and the development and resolution of hand pain. Using multivariable logistic regression, we investigated the association of weight change from baseline to the 4-year follow-up with the incidence and progression of radiographic hand OA at the 4-year follow-up. Additionally, multivariable repeated-measure mixed-effects logistic regression analyzed the association of weight change with the development and resolution of hand pain across 2-year, 4-year, 6-year, and 8-year follow-ups. No statistically significant associations were observed between weight change and the investigated outcomes. Specifically, for each 5% weight loss, the odds ratios for the incidence and progression of radiographic hand OA were 0.90 (95% confidence interval [95% CI] 0.67-1.23) and 0.92 (95% CI 0.84-1.00), respectively. Similarly, for each 5% weight loss, the odds ratios for the development and resolution of hand pain at the 8-year follow-up were 1.00 (95% CI 0.92-1.09) and 1.07 (95% CI 0.91-1.25), respectively. Our study found no evidence of an association between weight change and the odds of incidence or progression of radiographic hand OA over 4 years, nor the development or resolution of hand pain over 8 years.

IDENTIFYING PATIENTS WITH DIFFERENT PAIN TRAJECTORIES IN HAND OSTEOARTHRITIS

Purpose: Hand pain is a common symptom in hand osteoarthritis (OA). Pain is not clearly associated with structural joint damage. Joint damage shows progression in hand OA, but previous cohort studies did not report an increase in mean pain levels on the short to midterm. This does not preclude the existence of groups of hand OA patients with different pain trajectories. Such groups have previously been found in knee OA patients. Knowledge of similar patient populations in hand OA may help guide pain treatment decisions.

METHODS - A randomised controlled trial of METhotrexate to treat Hand Osteoarthritis with Synovitis: study protocol for a randomised controlled trial

BackgroundHand osteoarthritis is a common and disabling problem without effective therapies. Accumulating evidence suggests the role of local inflammation in causing pain and structural progression in hand osteoarthritis, and hand osteoarthritis with synovitis is a commonly encountered clinical phenotype. Methotrexate is a well-established, low-cost, and effective treatment for inflammatory arthritis with a well-described safety profile. The aim of this multicentre, randomised, double-blind, placebo-controlled trial is to determine whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis.MethodsNinety-six participants with hand osteoarthritis and synovitis will be recruited through the Osteoarthritis Clinical Trial Network (Melbourne, Hobart, Adelaide, and Perth), and randomly allocated in a 1:1 ratio to receive either methotrexate 20 mg or identical placebo once weekly for 6 months. The primary outcome is pain reduction (assessed by 100 mm visual analogue scale) at 6 months. The secondary outcomes include changes in physical function and quality of life assessed using Functional Index for Hand Osteoarthritis, Australian Canadian Osteoarthritis Hand Index, Health Assessment Questionnaire, Michigan Hand Outcomes Questionnaire, Short-Form-36, tender and swollen joint count, and grip strength, and structural progression assessed using progression of synovitis and bone marrow lesions from magnetic resonance imaging and radiographic progression at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups.DiscussionThis study will provide high-quality evidence to address whether methotrexate has an effect on reducing pain over 6 months in patients with hand osteoarthritis and synovitis, with major clinical and public health importance. While a positive trial will inform international clinical practice guidelines for the management of hand osteoarthritis, a negative trial would be highly topical and change current trends in clinical practice.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000877381. Registered 15 June 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373124

The Leptin Concentration Level in Progression of Hand Osteoarthritis Disease

Subject :Hand Osteoarthritis (HOA) is know as degenerative cartilage cell disease in joint association withgeneration various inflammatory responses . This disease is more common in geriatric and effected bymany factors such as obesity . Leptin is hormones secreted of fatty tissue involve as mediators in manypathophysiology process , and support inflammation at cartilage of hand joint .Objective of the Study: Role of leptin concentration level in progression of hand Osteoarthritis .Materials and Methods: This study was done on 60 patients with HOA disease and 60 healthy persons(control ), the all subjects age within this study were more than 60 years of both genders .After obtainedserum , immediately used quantity method (immunoassay) for measured level of leptin concentration .Results: This study shows elevation of serum leptin concentration level in HOA group compare with healthycontrol group .Conclusion: This study confirms that serum leptin concentration level can act as support HOA diseaseprogression .

Current Epidemiology and Risk Factors for the Development of Hand Osteoarthritis.

Hand osteoarthritis (hand OA), the most common peripheral arthritis in the world, is less studied than osteoarthritis (OA) of the knee and hip. However, it is uniquely situated to offer novel insight into OA as a disease process by removing weight-bearing as a confounder of systemic disease mechanisms. Here we review the epidemiology of hand OA and key risk factors for its development. Mounting evidence points to obesity as an important risk factor for hand OA development, with new evidence implicating a role for leptin and serum fatty acids. Disease progression in hand OA and specifically the erosive OA subtype may be associated with diabetes. New evidence supports an association between cardiovascular disease progression and symptomatic hand OA. Alcohol use may be associated with increased synovitis and erosive hand OA. Differences in ethnical distributions of hand OA have become more apparent, with a lower prevalence in Black patients compared to White patients. Novel genetic insights implicating the WNT gene pathway and IL-1β have led to novel potential targets in hand OA pathogenesis. Hand OA is a heterogeneous disease with many modifiable and non-modifiable risk factors that can determine disease severity and shed light on disease pathogenesis.

PROCOAC (PROspective COhort of A Coruña) description: Spanish prospective cohort to study osteoarthritis

Introduction and objectiveThe use of well characterized osteoarthritis (OA) cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). MethodsThe Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: I) Patients older than 55 years who underwent an abdominal x-ray to study both hips II) Patients diagnosed with radiographic hand OA according to ACR criteria III) Patients diagnosed with radiographic knee or hip OA according to ACR criteria. Follow-up was performed every two years collecting clinical, analytical, genetic and radiographic information. ResultsThe cohort consists of 937 patients, 873 have radiographic knee OA, 783 hip OA and 679 hand OA. The mean age of the population is 63.9±8.9 years and the average BMI is 29.6±5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Twenty-one point four percent and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7% respectively. Of the population, 44.1% has only 1 joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR=1.11; p<.001), BMI (OR=1.11; p=.002) and total WOMAC (OR=1.03; p=.005) are the only risk factors if we compare the involvement of a single location versus three. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL≤2 grade, and therefore a significantly higher percentage of patients with knee OA experienced pain (66.1%) compared to patients with OA hip (21.1%) (p<.001). ConclusionsThe PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip OA; as well as determining factors that are associated with the different OA phenotypes.

Usefulness of serum hyaluronic acid levels as a predictor of incidence of hand osteoarthritis analyzed by longitudinal analysis from the Iwaki cohort

The factors predicting hand osteoarthritis (HOA) in patients remain unknown. We aimed to investigate the usefulness of serum hyaluronic acid (sHA) levels in predicting HOA progression from a 6-year longitudinal epidemiological study. A total of 417 participants in the Iwaki cohort were followed-up over 6 years. Hand and knee radiographs taken at baseline and follow-up were scored according to Kellgren–Lawrence grades and Kallman score. Participants were classified into the HOA group and the non-HOA group. sHA levels at baseline were determined by ELISA. Correlations between sHA levels, the number of involved joints, and Kallman score were estimated. Factors related to the incidence or progression of HOA over 6 years were analyzed. The prevalence of HOA was 19.9% at baseline, and 3.6 ± 2.1 joints were involved. sHA levels in the HOA group at baseline were significantly higher than in the non-HOA group (p < 0.001) and correlated with the number of involved joints (r = 0.399, p < 0.001) and Kallman score (r = 0.540, p < 0.001). The incidence rate was 14.5%, and the progression rate was 46.1% over 6 years. Higher sHA levels at baseline were the risk factor of HOA incidence. Thus, sHA levels predicted the incidence of HOA over 6 years.

Familial Clustering of Erosive Hand Osteoarthritis in a Large Statewide Cohort.

Erosive hand osteoarthritis (OA) is a severe and rapidly progressing subset of hand OA. Its etiology remains largely unknown, which has hindered development of successful treatments. This study was undertaken to test the hypothesis that erosive hand OA demonstrates familial clustering in a large statewide population linked to genealogical records, and to determine the association of potential risk factors with erosive hand OA. Patients diagnosed as having erosive hand OA were identified by searching 4,741,840 unique medical records from a comprehensive statewide database, the Utah Population Database (UPDB). Affected individuals were mapped to pedigrees to identify high-risk families with excess clustering of erosive hand OA as defined by a familial standardized incidence ratio (FSIR) of ≥2.0. The magnitude of familial risk of erosive hand OA in related individuals was calculated using Cox regression models. Association of potential erosive hand OA risk factors was analyzed using multivariate conditional logistic regression and logistic regression models. We identified 703 affected individuals linked to 240 unrelated high-risk pedigrees with excess clustering of erosive hand OA (FSIR ≥2.0, P < 0.05). The relative risk of developing erosive hand OA was significantly elevated in first-degree relatives (P < 0.001). There were significant associations between a diagnosis of erosive hand OA and age, sex, diabetes, and obesity (all P < 0.05). Familial clustering of erosive hand OA observed in a statewide database indicates a potential genetic contribution to the etiology of the disease. Age, sex, diabetes, and obesity are risk factors for erosive hand OA. Identification of causal gene variants in these high-risk families may provide insight into the genes and pathways that contribute to erosive hand OA onset and progression.

The presence of erosive joints is a strong predictor of radiological progression in hand osteoarthritis: results of a 2-year prospective follow-up of the Li\xe8ge Hand Osteoarthritis Cohort (LIHOC)

BackgroundThis study measured the magnitude and determinants of clinical and radiological progression in patients with hand osteoarthritis (HOA) over a 2-year prospective follow-up to gain a greater understanding of the disease time course.MethodsTwo hundred three consecutive outpatients diagnosed with HOA were followed for 2 years (183 women, median age 69 years). Pain and function were evaluated using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), and clinical examination recorded the number of painful/swollen joints and nodes. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Clinical progression was defined as deterioration in AUSCAN ≥ the minimal clinically important difference. Radiographic progression was defined as (a) one new erosive/remodeled joint, (b) progression of ≥ one anatomical stage in one joint, or (c) change in KL total score above the smallest detectable difference. Logistic regression was performed to determine whether patient characteristics influenced clinical and radiological progression.ResultsAfter 2 years, all radiographic scores deteriorated significantly in the study population (p < 0.05), and the number of proximal and distal interphalangeal nodes was significantly higher (p < 0.01). The AUSCAN, number of painful joints at rest or at pressure, number of swollen joints, and pain measure on a visual analog scale remained unchanged. At the individual level, the number of patients with clinically meaningful progression ranged from 25 to 42% (clinical progression) and from 22 to 76% (radiological progression). The only significant predictor of worsening of total AUSCAN was AUSCAN pain subscale < 74.5 (odds ratio [OR] 1.02 [1.01, 1.03]; p < 0.01). The presence of ≥ four swollen joints (OR 2.78 [1.21, 6.39]; p = 0.02) and erosive osteoarthritis (OR 13.23 [5.07, 34.56]; p < 0.01) at baseline predicted a new erosive joint. A meaningful change in KL was more frequent with painful joints at baseline (OR 3.43 [1.68, 7.01]; p < 0.01).ConclusionsEvidence of radiological progression over 2 years was observed in patients with HOA in the LIHOC population even without clinical worsening of disease. For individual patients, baseline pain level is predictive for clinical progression and the presence of erosive or swollen joints are significant predictors of radiological progression.

Cross-Talk between Diet-Associated Dysbiosis and Hand Osteoarthritis.

Hand osteoarthritis (OA) is a degenerative joint disease which leads to pain and disability. Recent studies focus on the role of obesity and metabolic syndrome in inducing or worsening joint damage in hand OA patients, suggesting that chronic low-grade systemic inflammation may represent a possible linking factor. The gut microbiome has a crucial metabolic role which is fundamental for immune system development, among other important functions. Intestinal microbiota dysbiosis may favour metabolic syndrome and low-grade inflammation—two important components of hand OA onset and evolution. The aim of this narrative is to review the recent literature concerning the possible contribution of dysbiosis to hand OA onset and progression, and to discuss the importance of gut dysbiosis on general health and disease.

Natural disease progression in finger osteoarthritis: results from a 10 year follow-up cohort

Objective: Limited evidence is available about long-term natural disease progression in hand osteoarthritis (HOA). The objective is to study natural radiographic and clinical disease progression in HOA after longer follow-up (i.e. 10 years) and to identify predictors for progression. Method: At baseline (T0), 270 patients with HOA were included in the Belgian HOA register. The majority (84.8%) was female and the mean age was 62.9 years. In total, 154 (57%) and 106 (39.3%) patients consented to follow-up after approximately 5 (T1) and 10 years (T2), respectively. Clinical and functional outcome measures were collected. Hand radiographs were taken and scored according to the anatomical phase scoring system. Results: At T2, most of the patients (73.3%) showed any radiographic progression compared to T0. Remodelling was most frequently seen and new erosive joints rather rarely. Functional Index for Hand Osteoarthritis (0–30) and Australian/Canadian Osteoarthritis Hand Index function (0–90) increased over time, from 8.8 to 9.9 (p = 0.017) and 39.3 to 41.9 (p = 0.035), respectively, after T2. Visual analogue scale pain (0–100) did not change (40.2 to 38.6 from T0 to T2, p = 0.656). Univariate and multivariate logistic regression retained baseline soft-tissue swelling [odds ratio (OR) 8.20 and 8.76, respectively], higher levels of pain (OR 4.08 and 4.30), and number of baseline erosive joints (OR 31.82 and 30.02) as significant predictors for radiographic progression. Conclusions: Significant radiographic progression is seen over time in HOA. While pain remains similar after 10 years, functional status declines. Patients with soft-tissue swelling, high levels of pain, and already erosive disease at baseline are prone to progression over time.

Carpal tunnel syndrome as a co-factor in the joint pain and pathogenesis of hand osteoarthritis

Purpose: We conducted this study to evaluate the impact of carpal tunnel syndrome (CTS) treatment on symptoms related to hand osteoarthritis (HOA) and show a possible role of neuropathic factors in the development of HOA. Methods: We include patients with the coexistence of HOA and CTS treated between June 2016 and June 2019. Their information was obtained from their clinical records. The diagnosis of OA was based on the American College of Rheumatology criteria. Diagnosis of CTS was based on their symptoms and positivity for Tinel’s and Phalen’s signs, and the results of an electrodiagnostic test (prolonged motor or sensory latencies across the carpal canal of the median nerve). The impact of the treatment (surgical or medical: splint-infiltration) for CTS on the pain associated with symptomatic HOA was evaluated using a Visual Analogue Scale for Pain Intensity (VASPI) (1 to 10), before and three months after the treatment for CTS. A positive response was considered when the reported pain was reduced by at least three points (33%) on the scale as this is the best recommended cut-off point for an acceptable response regarding pain treatment. The results are described as percentage values. Results: Eighteen patients with both HOA and CTS were included. Fourteen patients had bilateral CTS and four had unilateral CTS. A total of 32 hands were therefore treated and assessed. The average age was 52 years. 14 were women. A significant improvement (33% of VASPI score) in pain due to HOA was obtained in 21/28 hands for 14 patients treated for bilateral CTS. All four patients with unilateral TCS show improvement in pain related to HOA. 28 hands received non-surgical treatment (wrist splinting and injection of corticosteroids), and four hands were treated with a surgical approach (two of these had axonal damage and surgical treatment was not successful). Figure 1 shows the four patients with unilateral TCS and the development of more severe ipsilateral HOA. Conclusions: This study indicates that CTS is associated with more painful and progressive HOA and that the treatment of CTS can improve the pain associated with HOA and can probably help to slow its evolution. More studies are needed in order to replicate these findings and to further explore the possible role of CTS in the development of joint damage in HOA.

A systematic review of risk factors and diagnostic methods for hand interphalangeal joint osteoarthritis progression

Purpose: The economic burden from osteoarthritis (OA) has been estimated at $10 billion annually in the USA alone. With an aging population globally, more patients with OA are likely to progress in their disease, and it is anticipated that this year OA will be the fourth leading cause of disability worldwide. Hand OA is the most prevalent type of radiographic OA. However, it is not yet well-known which factors put patients at risk of hand OA progression. There is also no established consensus on how hand interphalangeal joint (IPJ) OA progression should be measured.

Incidence and progression of hand osteoarthritis in a large community-based cohort: the Johnston County Osteoarthritis Project

To describe the incidence and progression of radiographic and symptomatic hand osteoarthritis (rHOA and sxHOA) in a large community-based cohort. Data were from the Johnston County OA Project (1999-2015, 12±1.2 years follow-up, age 45+). Participants had bilateral hand radiographs each visit, read for Kellgren-Lawrence grade (KLG) at 30 joints. We defined rHOA as KLG ≥2 in ≥1 joint. SxHOA was defined in a hand/joint with rHOA and self-reported symptoms or tenderness on exam. Incidence was assessed in those without, while progression was assessed in those with, baseline rHOA. Proportions or medians are reported; differences by sex and race were assessed using models appropriate for dichotomous or continuous definitions, additionally adjusted for age, education, body mass index (BMI), and weight change. Of 800 participants (68% women, 32% African American, mean age 60 years), 327 had baseline rHOA and were older, more often white and female, than those without rHOA (n=473). The incidence of HOA was high, for rHOA (60%) and for sxHOA (13%). Women were more likely than men to have incident HOA, particularly for distal interphalangeal joint radiographic osteoarthritis (DIP rOA) (adjusted odds ratios (aOR) 1.60 95% confidence intervals (95% CI) [1.03, 2.49]) and sxHOA (aOR 2.98 [1.50, 5.91]). Progressive HOA was more similar by sex, although thumb base rOA progressed more frequently in women than in men (aOR 2.56 [1.44, 4.55]). Particularly HOA incidence, but also progression, was more frequent among whites compared with African Americans. This study provides much needed information about the natural history of HOA, a common and frequently debilitating condition, in the general population.

Hand X-ray examination in two planes is not required for radiographic assessment of hand osteoarthritis.

Aims:Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA.Methods:The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann–Whitney tests were implemented.Results:The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints.Conclusion:This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes.

Metabolic syndrome, diabetes and osteoarthritis progression: the Rotterdam study

Purpose: Osteoarthritis (OA) is a degenerative musculoskeletal disorder, characterized by cartilage degradation, synovitis and sclerosis of subchondral bone. Results from observational studies have suggested the existence of a distinct form of OA linked to obesity related factors such as type 2 diabetes (T2D) and dyslipidaemia, also known as metabolic OA. However, conclusive evidence for the existence of such a separate form of OA is still lacking. Recently there has been an increase of interest in the relation between metabolic factors and OA, in particular the metabolic syndrome and its components. In this study, we aimed to investigate the relation between several metabolic factors and conditions (diabetes mellitus, metabolic syndrome, and its components) and progression of radiographic osteoarthritis (OA) in knee, hip and hand joints. Methods: We used data from the Rotterdam Study, a large population-based longitudinal cohort aimed at identifying risk factors for cardiovascular, neurological, endocrine and musculoskeletal diseases in the elderly. The present study included 6,191 individuals with up to 12 years of follow-up data for OA (knee, hip and hand) and data on metabolic factors. Progression of radiographic OA in knee and hip joints was defined as a combination of incident OA (i.e. Kellgren/Lawrence (KL) grade <2 at baseline and ≥2 at follow-up) and progression (increase in KL grade starting from 2 or above). An increase of ≥2 in KL sum score in distal Interphalangeal (DIP)/proximal interphalangeal (PIP) joints was defined as progression in hand OA. We analysed the associations of (components of) the metabolic syndrome with progression of radiographic knee and hip OA stratified for sex using multivariate regression models with generalised estimating equations. In the first model we adjusted for age, smoking, alcohol use, education, subcohort, baseline K/L grade and months between radiographs, while in model 2 we additionally adjusted for BMI. In addition, quartiles of each metabolic factor were analysed for risk of OA progression. Results: Metabolic syndrome and two of its components, abdominal obesity and elevated blood pressure, were associated with higher odds of knee OA progression. However, after additional adjustment for BMI (models 2), the association with metabolic syndrome showed a protective and significant association only in women and the ORs for the elevated blood pressure were attenuated and no longer significant (see Table 1), while the association of abdominal obesity disappeared suggesting that it can be explained by BMI. Diabetes and high fasting glucose, another metabolic component, showed significant protective associations only after adjusting for BMI as shown in Table 1. In additional analyses, the upper 3 quartiles of systolic blood pressure had an increased odds of radiographic knee OA progression before (OR 1.44, 95% CI 1.20 - 1.73) and after BMI adjustment (OR 1.27, 95% CI 1.06 - 1.53) when women and men were analysed together. Figure 1 shows the sex stratified analysis, where the effect sizes attenuated slightly after adjustment for BMI and results did not reach significance level anymore. No associations with hip and hand OA progression were found for the metabolic syndrome components that were tested. Furthermore, secondary survival analyses suggested that the protective effects seen for the metabolic syndrome and diabetes were due to competing risks. Conclusions: Metabolic syndrome and its component were not associated with higher risk of progression in hip, knee or hand OA independently from BMI, suggesting that the associations are mainly driven by obesity and high BMI. For diabetes, high fasting glucose and metabolic syndrome (only in women) an apparent protection against knee OA progression was observed in both non-stratified and stratified analysis. However, the apparent protective effect of diabetes and metabolic syndrome against knee OA progression is most probably due to competing risks. The only factor that seems associated with an increased risk for knee OA progression is higher systolic blood pressure.View Large Image Figure ViewerDownload Hi-res image Download (PPT)

Brief Report: Influence of Disease Activity in Rheumatoid Arthritis on Radiographic Progression of Concomitant Interphalangeal Joint Osteoarthritis.

Distal interphalangeal (DIP) joints are commonly considered to be unaffected by rheumatoid arthritis (RA). Despite synovitis and bone marrow edema being associated with radiographic progression in hand osteoarthritis (OA) and hand RA, radiographic courses differ substantially. This study was undertaken to analyze incidence and progression of radiographically evident DIP joint OA in RA patients, in relation to RA activity and patient characteristics. In sequential radiographs of 1,988 RA patients in the Swiss Clinical Quality Management in Rheumatic Diseases registry, we evaluated and scored 15,904 DIP joints. Scoring was based on the presence of central erosions and subchondral sclerosis and on the severity of osteophytes and joint space narrowing, according to the modified Kellgren/Lawrence (K/L) grade. The presence of DIP joint OA was defined as ≥1 joint with a K/L grade of ≥2, and progression was defined as an increase in a summed K/L grade. Adjusted odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated. The median follow-up time was 4.5 years (interquartile range 3.1-7.0), and the mean ± SD age was 56.1 ± 11.1 years. DIP joint OA was present in 60% of patients at baseline. Higher mean age (OR 1.09 [95% CI 1.08-1.10]), female sex (OR 1.37 [95% CI 1.08-1.74]), and higher mean body mass index (OR 1.03 [95% CI 1.00-1.06]) were associated with the presence of DIP joint OA, but neither the presence of anti-citrullinated protein antibodies (ACPAs) (OR 0.72 [95% CI 0.50-1.03]) nor the presence of rheumatoid factor (OR 1.01 [95% CI 0.74-1.38]) were associated with it. Disease Activity Score using the erythrocyte sedimentation rate and metacarpophalangeal (MCP) joint erosions were not associated with DIP joint OA progression. RA disease duration had no relevant effect size associated with DIP joint OA progression (OR 0.97 [95% CI 0.96-0.99]). Known risk factors for DIP joint OA were replicated in patients with RA. The observation that RA activity, the presence of ACPA, and MCP joint erosions were not associated with the prevalence or progression of DIP joint OA indicates that there are distinct roles of inflammation in the pathogenesis of RA and DIP joint OA.

Correction: Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study

Correction: Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study

Current Treatment Options for Osteoarthritis

Osteoarthritis (OA) is the most common joint disease and a leading cause for impaired function and disability with significant treatment costs and socio-economic burden. Despite recent achievements in the knowledge on disease pathogenesis, the treatment is still a challenge and contrary to the inflammatory joint diseases, no disease-modifying drugs are currently available for OA. Different response in different localizations of the disease further complicates the therapeutic choice. The standard pharmacological treatment includes agents for control of pain and inflammation (non-steroidal anti-inflammatory drugs, analgesics including opioids, intraarticular corticosteroids) and the group of the symptomatic slow acting drugs for OA such as glucosamine sulfate, chondroitin sulfate, diacerein, unsaponifiables extract of soybean and avocado administered orally and intrarticular hyaluronic acid. In addition, a number of studies investigate the efficacy of classic disease-modifying drugs used in inflammatory arthritides and antiresoptive agents as potential future therapies that could prevent structural progression of the disease. In a number of small studies, therapeutic efficacy of hydroxychloroquine (HCT) in OA has been suggested, but the results are contradictory. The first results from a multicenter, randomized, double-blind, placebo-controlled trial focused on symptomatic hand OA were recently reported (British HERO study). It has been concluded that HCQ was not superior than placebo as analgesic treatment or for reduction of the radiographic progression in hand OA. Placebo-controlled trial evaluating the efficacy of HCT in inflammatory and erosive hand OA is under way (OA TREAT study). Another field of recent research is the efficacy of TNF-alpha blockers based on the knowledge of their high efficacy in the inflammatory joint diseases and the significant role of TNF-alpha in the pathogenesis of OA. However, current evidence from the available studies does not support the use of TNF-alpha blockers in OA. The benefit of TNF-alpha blockers in specific sub-groups of patients with higher level of inflammation, objective criteria for the expected responders as well as cost-effectiveness of such treatment is a matter of further research and discussion. New biologic agents that target the nerve growth factor-β are other currently investigated drugs as a potential symptomatic therapeutic option in OA. Significant research has been also focused on revealing potential symptomatic or eventually disease-modifying efficacy of drugs that target bone metabolism due to contemporary notion for the crucial role of the subchondral bone in OA pathology and the positive association between the increased subchondral bone turnover and the progressive cartilage loss. A significant delay of joint width narrowing vs. placebo has been observed in patients with symptomatic knee OA after treatment with strontium renelate. The intraarticular administration of platelet-rich plasma is evaluated as potential future therapy and has been tried in knee and hip OA with beneficial effect. Based on the current knowledge about the OA pathogenesis and the undergoing studies, new therapies for OA are awaited both as a safe symptomatic treatment - alternative to the conventional treatment options and as a disease-modifying therapy that would revolutionize the contemporary approach to OA.

Metabolic risk factors and the incidence and progression of radiographic hand osteoarthritis: a population-based cohort study

Objective: To determine whether selected metabolic factors are associated with greater amounts of radiographic hand osteoarthritis (OA) incidence and progression.Methods: The study identified 706 adults, aged 50–69 years, with hand pain and hand radiographs at baseline, from two population-based cohorts. Metabolic factors (body mass index, hypertension, dyslipidaemia, and diabetes) were ascertained at baseline by direct measurement and medical records. Analyses were undertaken following multiple imputation of missing data, and in complete cases (sensitivity analyses). Multivariable regression models estimated associations between metabolic factors and two measures of radiographic change at 7 years for all participants, individuals free of baseline radiographic OA, and in baseline hand OA subsets. Estimates were adjusted for baseline values and other covariates.Results: The most consistent and strong associations observed were between the presence of diabetes and the amount of radiographic progression in individuals with nodal OA [adjusted mean differences in Kellgren–Lawrence summed score of 4.50 (−0.26, 9.25)], generalized OA [3.27 (−2.89, 9.42)], and erosive OA [3.05 (−13.56, 19.67)]. The remaining associations were generally weak or inconsistent, although numbers were limited for analyses of incident radiographic OA and erosive OA in particular.Conclusion: Overall metabolic risk factors were not independently or collectively associated with greater amounts of radiographic hand OA incidence or progression over 7 years, but diabetes was associated with radiographic progression in nodal, and possibly generalized and erosive OA. Diabetes has previously been associated with prevalent but not incident hand OA. Further investigation in hand OA subsets using objective measures accounting for disease duration and control is warranted.