Symptomatic Hand Osteoarthritis Research Articles

Colchicine is not effective for reducing osteoarthritic hand pain compared to placebo: a randomised, placebo-controlled trial (COLAH)

BackgroundColchicine may offer relief in osteoarthritis. This has never been investigated for hand osteoarthritis. ObjectivesTo investigate the effect of 1 mg daily colchicine vs placebo on hand pain and function over 12 weeks in older adults with hand osteoarthritis. MethodsCommunity-dwelling adults with diagnosed osteoarthritis of the hand aged 40–80 years were randomised to receive colchicine (0.5 mg twice daily) or matching placebo. Primary outcome measure was VAS hand pain score (0–100 mm). Secondary outcome measures included tender and swollen joint count, grip strength, C-reactive protein, and Michigan Hand Questionnaire total, function and pain scores. In an exploratory assessment, we compared synovial grade and power Doppler. All outcome measures were obtained at baseline and week 12. Stata v16 was used to perform constrained longitudinal data analysis models. Results64 adults (54 females, 10 males) aged 48–79 years of age were enrolled. 59 participants completed the study (N = 28 colchicine, N = 31 placebo) (withdrawal rate 8%). Adverse reactions to the study medication occurred in nine patients. VAS score was not significantly different at baseline (61 ± 17 mm in the colchicine, 64 ± 17 mm in the placebo group). Between-group difference for VAS score at week 12 was 7.6 mm (95% CI -3.5-18.7, p-value 0.18). There were no significant differences between groups for any secondary outcomes at baseline or week 12. Conclusions1 mg colchicine daily for 12 weeks was not effective for reducing pain, tender and swollen joint count or increasing grip strength in symptomatic hand osteoarthritis. Our results do not support the use of colchicine in hand osteoarthritis.

Efficacy of tocilizumab in patients with hand osteoarthritis: double blind, randomised, placebo-controlled, multicentre trial

ObjectiveTo evaluate the efficacy of tocilizumab, an antibody against IL-6 receptor, in patients with hand osteoarthritis.MethodsThis was a multicentre, 12-week, randomised, double-blind, placebo-controlled study from November 2015 to October 2018....

Efficacy of conservative treatments for hand osteoarthritis : An umbrella review of interventional studies.

Hand osteoarthritis (OA) is common, but the efficacy/safety of treatment interventions aimed to improve health outcomes in this population are not well understood. Therefore, the aim of this study was to map and grade the effect of interventions for health outcomes in hand OA. Umbrella review of systematic reviews with meta-analyses of randomized controlled trials (RCTs) using placebo/no intervention as control group. For outcomes with ap-value <0.05, the certainty of the evidence was evaluated using the grading of recommendations assessment, development and evaluation (GRADE) assessment. From 189 abstracts, 9meta-analyses (24outcomes) were included, with 8 reporting significant summary results. The use of splints was associated with reduced pain at medium term in thumb carpometacarpal OA (standardized mean difference [SMD] = -0.70; 95% confidence intervals [95% CI]: -1.05 to -0.35; low certainty), reduced pain in long follow-up RCTs in symptomatic hand OA (SMD = -0.80; 95% CI: -1.16; -0.45; moderate certainty), and better function (SMD = 0.42; 95% CI: 0.08; 0.70; low certainty). The use of resistance training (SMD = -0.27; 95% CI: -0.47; -0.07) or physical exercise (SMD = -0.23; 95% CI: -0.42; -0.04) in improving hand pain and in improving finger joint stiffness (SMD = -0.36; 95%CI: -0.58; -0.15) was supported by amoderate certainty of evidence. The use of intra-articular hyaluronic acid in improving function (MD = 1.12; 95% CI: 0.61; 1.64; moderate certainty of evidence) was the only statistically significant pharmacological intervention. Only some non-pharmacological interventions are effective in improving health outcomes in hand OA and this evidence is supported by amoderate/low certainty, indicating the necessity of further interventional research.

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.

Association between race and hand osteoarthritis, a propensity score-matched study using osteoarthritis initiative data

Purpose: Although black subjects have higher odds of knee and hip osteoarthritis (OA) and more severe disease, there has been controversy regarding the associations between race and hand osteoarthritis. Findings of few studies suggest that the prevalence of hand OA varies across groups with different races, while others highlight the roles of environmental factors in hand OA development. To determine the associations between race (black versus nonblack) and the presence of radiographic, symptomatic, and clinical hand OA.

Hand osteoarthritis is associated with mortality among men: the Johnston county osteoarthritis project

Purpose: Prior studies have suggested a role for symptomatic hand osteoarthritis (OA) in mortality. We therefore sought to explore whether hand OA measures are associated with death before subsequent follow-up, independent of lifestyle factors and comorbidities associated with premature death, and whether these associations differed by sex.

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.

Relative prevalence and distribution of knee, hand and foot symptomatic osteoarthritis subtypes in an English population.

In this brief report, we used data from a series of three related cohorts on pain and osteoarthritis (OA) of the knee, hand and foot, which were conducted in North Staffordshire, England. We used a common approach for sampling, data collection and coding, to estimate the relative prevalence of 10 different symptomatic radiographic OA subtypes in the knee, hand and foot and to compare their association with age, sex, socioeconomic position and body mass index. Overall, symptomatic hand OA was more common than knee or foot OA (22.4% vs 17.4% vs 16.5%), due mainly to the high prevalence of nodal interphalangeal joint OA among women. The first carpometacarpal joint OA was the most frequent subtype, with patellofemoral, tibiofemoral, (nodal) interphalangeal and midfoot OA also common. Of the risk factors examined, the greatest differences between subtypes appeared to be their associations with sex and obesity: sex differences were noticeably greater for all forms of hand OA except non-nodal interphalangeal joint OA, while obesity appeared most strongly associated with forms of knee OA. The prevalence of all subtypes was higher among older ages, and among those with lower educational attainment.

Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial

Hand osteoarthritis is a prevalent joint condition that has a high burden of disease and an unmet medical need for effective therapeutic options. Since local inflammation is recognised as contributing to osteoarthritic complaints, the Hand Osteoarthritis Prednisolone Efficacy (HOPE) study aimed to investigate the efficacy and safety of short-term prednisolone in patients with painful hand osteoarthritis and synovial inflammation. The HOPE study is a double-blind, randomised, placebo-controlled trial. We recruited eligible adults from rheumatology outpatient clinics at two sites in the Netherlands. Patients were considered eligible if they had symptomatic hand osteoarthritis and signs of inflammation in their distal and proximal interphalangeal (DIP/PIP) joints. For inclusion, patients were required to have four or more DIP/PIP joints with osteoarthritic nodes; at least one DIP/PIP joint with soft swelling or erythema; at least one DIP/PIP joint with a positive power Doppler signal or synovial thickening of at least grade 2 on ultrasound; and finger pain of at least 30 mm on a 100-mm visual analogue scale (VAS) that flared up during a 48-h non-steroidal anti-inflammatory drug (NSAID) washout (defined as worsening of finger pain by at least 20 mm on the VAS). Eligible patients were randomly assigned (1:1) to receive 10 mg prednisolone or placebo orally once daily for 6 weeks, followed by a 2-week tapering scheme, and a 6-week follow-up without study medication. The patients and study team were masked to treatment assignment. The primary endpoint was finger pain, assessed on a VAS, at 6 weeks in participants who had been randomly assigned to groups and attended the baseline visit. This study is registered with the Netherlands Trial Registry, number NTR5263. We screened patients for enrolment between Dec 3, 2015, and May 31, 2018. Patients completed baseline visits and started treatment between Dec 14, 2015, and July 2, 2018, and the last study visit of the last patient was Oct 4, 2018. Of 149 patients assessed for eligibility, 57 (38%) patients were excluded (predominantly because they did not meet one or several inclusion criteria, most often because of an absence of synovial inflammation or of flare-ups after NSAID washout) and 92 (62%) patients were eligible for inclusion. We randomly assigned 46 (50%) patients to receive prednisolone and 46 (50%) patients to receive placebo, all of whom were included in the modified intention-to-treat analysis of the primary endpoint. 42 (91%) patients in the prednisolone group and 42 (91%) in the placebo group completed the 14-week study. The mean change between baseline and week 6 on VAS-reported finger pain was -21·5 (SD 21·7) in the prednisolone group and -5·2 (24·3) in the placebo group, with a mean between-group difference (of prednisolone vs placebo) of -16·5 (95% CI -26·1 to -6·9; p=0·0007). The number of non-serious adverse events was similar between the groups. Five serious adverse events were reported during our study: one serious adverse event in the prednisolone group (a myocardial infarction) and four serious adverse events in the placebo group (an infected traumatic leg haematoma that required surgery, bowel surgery, atrial fibrillation that required a pacemaker implantation, and symptomatic uterine myomas that required a hysterectomy). Four (4%) patients discontinued the study because of an adverse event: one (2%) patient receiving prednisolone (for a myocardial infarction) and three (7%) patients receiving placebo (for surgery of the bowel and for an infected leg haematoma and for Lyme disease arthritis of the knee). Treatment with 10 mg prednisolone for 6 weeks is efficacious and safe for the treatment of patients with painful hand osteoarthritis and signs of inflammation. The results of our study provide clinicians with a new short-term treatment option for patients with hand osteoarthritis who report a flare-up of their disease. Dutch Arthritis Society.

Domains rated as important by patients with hand osteoarthritis.

No data exist on patient participation in the selection of core domains for clinical trials of hand osteoarthritis (HOA). We aim to explore HOA patients' perspectives in the relative importance of domains. Seven domains affecting patients' lives were derived from a prior qualitative study. We recruited consecutive patients with symptomatic HOA to rate on 11-point numeric rating scales for each domain, from 0 representing "not important at all" to 10 representing "most important", with consideration in two scenarios: (a) how important the domains are in affecting their current lives; and (b) how important the domains are when there are treatments for HOA (eg exercise or drugs). Forty-five patients (91% female; mean age±standard deviation 64.3±7.5years) with mild HOA symptoms were included. Of these, 31%-42% rated current impact of HOA in various domains as highly important. Seven domains with rated scores of ≥7/10 in importance were endorsed for clinical trials in the following order: pain and HOA symptoms (endorsed by 77.8% of patients), physical function (66.7%), ability to participate in social roles (64.4%), ability to participate in social activities (62.2%), work productivity (62.2%), emotional health (60%), and appearance of fingers (55.6%). The preliminary important domains as endorsed by patients with HOA for inclusion into clinical trials were explored. Apart from pain and physical function, further research is needed to refine other domains of impact, such as participation, emotional health and aesthetic concerns, as core domain sets for HOA.

Non-pharmacological treatment gap preceding surgical consultation in thumb carpometacarpal osteoarthritis - a cross-sectional study

BackgroundOsteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations. Evidence-based treatment recommendations state that all patients with hand OA should be offered non-pharmacological treatment. Surgery should be considered only when other treatment has proven insufficient in relieving pain. The purpose of this study was to investigate prior treatment and characteristics of patients referred to specialist health care surgical consultation due to CMCJ OA. The study includes exploring differences in pain and function between referred and non-referred hand, between men and women, and between patients with and without OA affection of other finger joints than CMCJ.MethodsPatients in this cross-sectional study reported prior non-pharmacological treatment for CMCJ OA. Patient demographics, disease and functional variables were assessed based on hand radiographs, patient-reported and observer-based outcome measures. Differences in pain and function between referred and non-referred hand, men and women, and between patients with and without additional affection of finger joints other than CMCJ, were analysed using Paired-samples T-tests, Wilcoxon Signed Rank, or Chi-Square tests.ResultsOne hundred and eighty patients were included. The mean age was 63 years and 79% were women. Only 21% reported having received non-pharmacological treatment before referral to surgical consultation. The results show a statistically significant worse function for referred hands, women and involvement of additional interphalangeal joints. Most patients reported no pain or mild pain in their referred hand.ConclusionsThe results of this study show a non-pharmacological treatment gap in OA care. Most patients report no pain or mild pain, and that they had not received non-pharmacological treatment prior to being referred to CMCJ OA surgical consultation. The results furthermore show that CMCJ OA negatively affects all aspects of function. Strategies need to be developed to improve OA care, including educating general practitioners in evidence-based treatment recommendations and in the assessment of hand pain, and encourage the routine referral of patients with symptomatic hand OA to occupational therapy before considering surgery.

Incidence and progression of hand osteoarthritis in the Johnston county osteoarthritis project

Purpose: Although hand osteoarthritis (HOA) is common and frequently leads to pain, stiffness and disability, studies of HOA are limited - particularly with regard to incidence and progression of disease. In this analysis, we sought to describe the incidence and progression of radiographic and symptomatic HOA in a large community-based cohort, including African American and white men and women. Methods: Data were obtained from adult participants (age ≥ 45 years) in the Johnston County Osteoarthritis (JoCo OA) Project, an ongoing population-based prospective observational cohort study monitoring the occurrence and natural history of OA in Johnston County, North Carolina. After exclusion of 109 participants due to missing radiographs or data regarding HOA status, 800 individuals were included for analysis. Radiographic HOA (rHOA) was defined as Kellgren-Lawrence grade (KLG) of 2 or more in at least 1 of 30 hand joints. We defined symptomatic HOA (sxHOA) as the presence of symptoms (either self-reported pain, aching, or stiffness or tenderness on palpation) and rHOA within the same hand. Two groups were defined: those with baseline rHOA and those without. Among those without baseline HOA, various incidence definitions were assessed, with incidence typically involving new HOA during follow-up (specific definitions in Table 1). Similarly, among those with baseline HOA, various progression definitions were assessed, with progression typically involving worsening HOA during follow-up (specific definitions in Table 2). Incidence and progression were assessed over an average of 12 years involving a baseline (T1: 1999-2004) and two follow-up time-points (T2: 2006-2010 and T3: 2013-2015). Proportions were computed for dichotomous variables and medians (interquartile range) for continuous variables. Differences between sex and race were assessed using the Chi-square test for dichotomous variables and the non-parametric Wilcoxon rank sum test for continuous variables (all showing skewed distributions). P-values associated with each test are shown in Table 1 and 2 and are unadjusted for covariates or multiple comparisons. Results: Of the 800 included participants, 2/3 were women and 1/3 African American, with mean ± SD age 60 ± 8 years, and mean ± SD BMI of 31 ± 6 kg/m2. Those with baseline HOA (n=327) tended to be older and were more often white and women than those without baseline HOA (n=473). Incidence of rHOA (Table 1) was generally comparable between women and men, although the incidence of sxHOA was more than twice as high in women (16% in women vs. 7% in men). Most rHOA and sxHOA incidence definitions were statistically significantly higher among whites than African Americans with exception of PIP, thumb IP and MCP rHOA, which were similar. Progression of rHOA and sxHOA (Table 2) was similar between sexes aside from thumb base OA (50% in women vs. 36% in men), MCP OA (58% in men vs. 39% in women) and change in total KLG (median 16 points in women vs. 14.5 in men). Whites were more likely to have progression of sxHOA compared with African Americans (44% vs. 28%). Whites also had greater change in number of rHOA joints and total KLG sums. Conclusions: In this large, community-based cohort, the incidence of rHOA was similar between men and women, although the incidence of sxHOA was higher in women. The progression of rHOA and sxHOA was similar between sexes aside from a small difference in pattern of radiographic joint involvement. In general, incidence and progression of radiographic and symptomatic HOA was higher in whites than in African Americans, supportive of our findings in prior work of more large joint involvement, and less hand OA, among African American participants.

Cross-cultural translation, adaptation and validation of a Japanese version of the functional index for hand osteoarthritis (J-FIHOA)

Purpose: Hand osteoarthritis (hand OA) is a highly prevalent and heterogeneous disorder. Although well-designed clinical trials and guidelines have been published, there are comparatively few hand OA studies concerning Asian countries. To both pursue appropriate clinical courses for patients and engage in future research, physicians need to discriminate between symptomatic and non-symptomatic hand OA. The Functional Index for Hand OsteoArthritis (FIHOA) has been well-studied and is accepted as the gold standard instrument with excellent reliability and responsiveness. Approximately twenty linguistic versions are currently available. Our objective was to make a Japanese version of the FIHOA (J-FIHOA) and to validate it among Japanese hand OA patients. Methods: Translation and cultural adaptation process: The FIHOA was translated following a process distilled from the established guidelines. An expert committee consisting of 6 members (two language professionals, three health professionals and an American native English speaker) was convened. Forward translation was performed independently by one professional translator who had no prior knowledge of this study and two language professionals serving on the expert committee. The committee assessed all results and synthesized them into a preliminary version of the J-FIHOA. It was translated back into English independently by two English native professional translators, one with a medical background and one without. Most of the FIHOA items were deemed equivalent, but discrepancies between the original and retranslation revealed several problems. Additional forward/backward translations were undertaken for specific linguistic points in need of revision. To resolve a few major issues, the committee consulted with the FIHOA developers. After all this process the J-FIHOA was finalized. Validation process: Our university and 16 other hospitals recruited hand OA patients at the outpatient departments from September 2017 to September 2018. New or follow-up patients who met the ACR classification criteria were eligible for inclusion. Patients with other rheumatic diseases or post-traumatic OA were excluded. A medical record review, X-rays of both hands and J-FIHOA in addition to the following patient-rated questionnaires were collected at an enrollment visit: the Japanese version of the Stanford Health Assessment Questionnaire (J-HAQ), numerical rating scale for pain (NRS pain) and the Japanese version of the Short Form 36 Health Survey (J-SF-36). The J-FIHOA scores at the enrollment visit were used to assess Cronbach’s alpha coefficient/item-total correlation and compared with the J-HAQ, NRS pain and J-SF-36 yielding respective Spearman’s rank correlation coefficients. Correlation was categorized as weak (r = 0.30-0.49), moderate (r = 0.50-0.69) or strong (r = 0.70-1.00). As item 7 is a gender-role question, an item total correlation needed to be calculated independently for women and men. We used test-retest methods for the patients whose treatment and symptoms were unchanged within the previous 3 months. The interval was 1-2 weeks. The reliability of the J-FIHOA was assessed with the intraclass correlation coefficient (ICC). Those who started new pharmacological treatments (oral acetaminophen, NSAIDs and/or tramadol) required answering the patient-rated questionnaires and a 1-month follow-up visit. Differences between pre- and post- pharmacological treatments were assessed to evaluate effect size. Results: Twenty-nine male and 145 female hand OA patients participated. Mean age at the enrollment visit was 65 years (42 to 88). One hundred fifty-seven longitudinal data sets were pooled and used to evaluate reliability (137 for test-retest) and responsiveness (20 for effect size). Cronbach’s alpha was 0.91, which showed high internal consistency. Item-total correlation ranged from 0.46 (item 5) to 0.89 (item 7) among men, and from 0.57 (item 10) to 0.79 (item 6) among women. Construct validity between the J-FIHOA and other scales was: 0.73 (J-HAQ), 0.56 (NRS pain), -0.31 (J-SF-36 physical component) and -0.21 (J-SF-36 mental component). There were stronger correlations between the J-FIHOA and J-HAQ than we expected. Although the FIHOA was designed as an instrument for hand functional impairment and has no pain-related questions, previous reports have shown moderate correlations between the FIHOA and pain. Our result was concordant with these reports. It was reasonable that the J-SF-36 was moderately correlated on the physical but not the mental component. Test-retest data showed that the intraclass correlation coefficient was 0.83 (95% confidence interval, 0.77 to 0.88) and in line with other linguistic versions. The effect size of the J-FIHOA was 0.56 while the J-HAQ was 0.44. We assumed that the higher effect size was because the J-FIHOA was a more disease-specific scale for hand OA. Conclusions: The J-FIHOA has good reliability and responsiveness. Current limitations are a small number of male participants (n=29) and the data sets for responsiveness (n=20). Patient recruitment and data collection will continue through December 2018.

Etanercept in patients with inflammatory hand osteoarthritis (EHOA): a multicentre, randomised, double-blind, placebo-controlled trial.

Hand osteoarthritis is a prevalent disease with limited treatment options. Since joint inflammation is often present, we investigated tumour necrosis factor (TNF) as treatment target in patients with proven joint inflammation in a proof-of-concept study. This 1-year, double-blind, randomised, multicentre trial (NTR1192) enrolled patients with symptomatic erosive inflammatory hand osteoarthritis. Patients flaring after non-steroidal anti-inflammatory drug washout were randomised to etanercept (24 weeks 50 mg/week, thereafter 25 mg/week) or placebo. The primary outcome was Visual Analogue Scale (VAS) pain at 24 weeks. Secondary outcomes included clinical and imaging outcomes (radiographs scored using Ghent University Scoring System (GUSS, n=54) and MRIs (n=20)). Of 90 patients randomised to etanercept (n=45) or placebo (n=45), respectively, 12 and 10 discontinued prematurely. More patients on placebo discontinued due to inefficacy (6 vs 3), but fewer due to adverse effects (1 vs 6). The mean between-group difference (MD) in VAS pain was not statistically significantly different (-5.7 (95% CI -15.9 to 4.5), p=0.27 at 24 weeks; - 8.5 (95% CI -18.6 to 1.6), p=0.10 at 1 year; favouring etanercept). In prespecified per-protocol analyses of completers with pain and inflammation at baseline (n=61), MD was -11.8 (95% CI -23.0 to -0.5) (p=0.04) at 1 year. Etanercept-treated joints showed more radiographic remodelling (delta GUSS: MD 2.9 (95% CI 0.5 to 5.4), p=0.02) and less MRI bone marrow lesions (MD -0.22 (95% CI -0.35 to -0.09), p = 0.001); this was more pronounced in joints with baseline inflammation. Anti-TNF did not relieve pain effectively after 24 weeks in erosive osteoarthritis. Small subgroup analyses showed a signal for effects on subchondral bone in actively inflamed joints, but future studies to confirm this are warranted.

Efficacy of Hydroxychloroquine in Hand Osteoarthritis: A Randomized, Double-Blind, Placebo-Controlled Trial.

To determine the symptom-modifying effect of hydroxychloroquine (HCQ) in hand osteoarthritis (OA). In this randomized, double-blind, multicenter trial, patients with symptomatic hand OA received either HCQ 400 mg once a day or placebo during 24 weeks. The primary outcome was change of pain measured on a 100-mm visual analog scale (VAS) at 24 weeks. Secondary outcomes included decrease of pain at weeks 6 and 12 and change in Australian Canadian Hand Osteoarthritis Index (AUSCAN) and Arthritis Impact Measurement Scale 2 short form (AIMS2-SF) total scores. A total of 196 patients was included (placebo n = 98, HCQ n = 98). Mean ± SD age was 58.0 ± 7.6 years, and 86% were female. Baseline mean ± SD pain VAS was 44.9 ± 22.9 mm in the placebo group and 43.2 ± 22.3 mm in the HCQ group. At 24 weeks, change in pain VAS was not significantly different between both groups (imputed mean VAS 42.7 in the HCQ group versus 45.3 in the placebo group after 24 weeks), as was the case in pain VAS at weeks 6 and 12. Changes in AUSCAN total score and AIMS2-SF total score in both groups were similar between the groups. In total, 24 patients in the placebo group and 21 patients in the HCQ group reported ≥1 adverse event. In the HCQ group, 3 patients reported a severe allergic reaction. Fifteen patients withdrew from the study (5 placebo, 10 HCQ group) due to adverse events. Treatment with HCQ at 24 weeks is not effective in reducing the symptoms of hand OA compared to placebo.

Performance of the Michigan Hand Outcomes Questionnaire in hand osteoarthritis

To investigate the performance of the Michigan Hand Outcomes Questionnaire (MHQ) in hand osteoarthritis (OA) by evaluating truth, discrimination and feasibility. Symptomatic hand OA patients from the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort completed questionnaires (demographics, MHQ, Australian/Canadian Hand Osteoarthritis Index [AUSCAN], Functional Index for Hand Osteoarthritis [FIHOA] and visual analogue scale [VAS] pain) at baseline (n=383), 1- and 2-year follow-up (n=312, n=293). Anchor questions at follow-up assessed whether pain/function levels were (un)acceptable and had changed compared to baseline. Correlations between MHQ and other pain/function questionnaires were calculated. Validity of unique MHQ domains (work performance, aesthetics, satisfaction), discrimination across disease stages, and responsiveness were assessed by categorizing patients by external anchors (employment, joint deformities, erosions, and anchor questions). Between-group differences were assessed with linear regression, probability plots and comparison of medians. MHQ pain and function subscales correlated moderately-to-good with other instruments (rs 0.63-0.81). Work performance scores were worse in patients with reduced working capacity than in employed patients. Aesthetics scores were worse in patients with more deformities. Patients with unacceptable complaints had worse satisfaction scores. All pain/function instruments discriminated between patients with acceptable vs unacceptable pain/function, while only MHQ activities of daily living (ADL), FIHOA, and MHQ aesthetics could discriminate between erosive and non-erosive disease. MHQ and AUSCAN were most responsive. MHQ has several unique aspects and advantages justifying its use in hand OA, including the unique assessment of work performance, aesthetics, and satisfaction. However, MHQ, AUSCAN and FIHOA appear to measure different aspects of pain and function.

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.

Short-term efficacy of paraffin therapy and home-based exercise programs in the treatment of symptomatic hand osteoarthritis.

This study aims to investigate the effects of a home-based exercise program in combination with paraffin therapy on pain, functional status, grip strength, and quality of life (QoL) and to compare the outcomes of these two treatment modalities. This prospective, single-blind, randomized-controlled study included a total of 61 patients (8 males, 53 females, mean age 59.22 years; range, 35 to 78 years) who were diagnosed with hand osteoarthritis (HOA) according to the American College of Rheumatology criteria between November 2016 and February 2017. The first group (group 1) (n=31) received paraffin therapy + home-based exercise program and the second group (group 2) (n=30) received home-based exercise program alone. All patients were assessed using the Visual Analog Scale (VAS), Australian/Canadian (AUSCAN) Osteoarthritis Hand Index, Health Assessment Questionnaire (HAQ), Hand Grip Strength (HGS), and Finger Pinch Strength (FPS) at baseline and at two and six weeks after the intervention. In group 1, there were statistically significant improvements in all parameters at two and six weeks (p<0.05). Statistically significant differences were observed in the HGS and AUSCAN Osteoarthritis Hand Index scores in group 2 at two and six weeks (p<0.05). Inter-group analysis showed statistically significant differences in favor of group 1 in the VAS, HAQ, AUSCAN Osteoarthritis Hand Index, HGS, and FPS scores at two and six weeks compared to baseline scores (p<0.05). Paraffin therapy combined with home-based exercise program in patients with symptomatic HOA provides effective pain control and is effective in improving functional status, HGS, FPS, and QoL in short term.

Hydroxychloroquine Effectiveness in Reducing Symptoms of Hand Osteoarthritis: A Randomized Trial.

Synovitis is believed to play a role in producing symptoms in persons with hand osteoarthritis, but data on slow-acting anti-inflammatory treatments are sparse. To determine the effectiveness of hydroxychloroquine versus placebo as an analgesic treatment of hand osteoarthritis. Randomized, double-blind, placebo-controlled clinical trial with 12-month follow-up. (ISRCTN registry number: ISRCTN91859104). 13 primary and secondary care centers in England. Of 316 patients screened, 248 participants (82% women; mean age, 62.7 years) with symptomatic (pain ≥4 on a 0- to 10-point visual analogue scale) and radiographic hand osteoarthritis were randomly assigned and 210 (84.7%) completed the 6-month primary end point. Hydroxychloroquine (200 to 400 mg) or placebo (1:1) for 12 months with ongoing usual care. The primary end point was average hand pain during the previous 2 weeks (on a 0- to 10-point numerical rating scale [NRS]) at 6 months. Secondary end points included self-reported pain and function, grip strength, quality of life, radiographic structural change, and adverse events. Baseline ultrasonography was done. At 6 months, mean hand pain was 5.49 points in the placebo group and 5.66 points in the hydroxychloroquine group, with a treatment difference of -0.16 point (95% CI, -0.73 to 0.40 point) (P= 0.57). Results were robust to adjustments for adherence, missing data, and use of rescue medication. No significant treatment differences existed at 3, 6, or 12 months for any secondary outcomes. The percentage of participants with at least 1 joint with synovitis was 94% (134 of 143) on grayscale ultrasonography and 59% on power Doppler. Baseline structural damage or synovitis did not affect treatment response. Fifteen serious adverse events were reported (7 in the hydroxychloroquine group [3 defined as possibly related] and 8 in the placebo group). Hydroxychloroquine dosage restrictions may have reduced efficacy. Hydroxychloroquine was no more effective than placebo for pain relief in patients with moderate to severe hand pain and radiographic osteoarthritis. Arthritis Research UK.

Sensorimotor performance and function in people with osteoarthritis of the hand: A case-control comparison.

To determine whether hand left/right judgements, tactile acuity, and body perception are impaired in people with hand OA. To examine the relationships between left right judgements, tactile acuity and hand pain. To explore the relationships between sensorimotor measures (left/right judgements and tactile acuity) and measures of hand function in people with hand OA. Twenty patients with symptomatic hand OA and 19 healthy pain-free controls undertook a hand left/right judgment task, a control left/right judgement task, two-point discrimination (TPD) threshold testing (assessing tactile acuity), a neglect-like symptoms questionnaire (assessing body perception) and several established measures of hand function. Neglect-like symptoms were experienced more frequently in the hand OA group (P < 0.05). People with hand OA were slower (P < 0.05) and less accurate (P < 0.05) in the hand left/right judgement task when compared to healthy controls, with no significant difference in the control task. Significant associations were found between hand left/right judgement reaction time and pain intensity (P < 0.05) and accuracy and pain intensity (P < 0.05). TPD was not different between groups, and no correlation was found between TPD and left/right judgement performance. No association was found between left/right judgement performance and measures of hand function (all P > 0.05). However, TPD (tactile acuity) was related to several measures of hand function (all P < 0.05). People with hand OA had more frequent neglect-like symptoms and were slower and less accurate compared to healthy controls at hand left/right judgments, which was indicative of disrupted working body schema. Future studies may wish to examine whether interventions targeting sensorimotor dysfunction are effective at reducing pain and improving hand function and dexterity in people with hand OA.