Arthritis & Rheumatism, Volume 62,
November 2010 Abstract Supplement
Abstracts of the American College of
Rheumatology/Association of Rheumatology Health Professionals
Annual Scientific Meeting
Atlanta, Georgia November 6-11, 2010.
Greater Burden of Disease in Erosive Hand Osteoarthritis.
Ishimori1, Mariko L., Altman4, Roy D., Cohen2, Myles J., Rotter2, Jerome I., Weisman3, Michael H.
The goal of our study was to evaluate relationships between patients with erosive vs. non-erosive hand osteoarthritis (OA) by radiography and features such as extent of joint involvement, body mass index (BMI), and pain, stiffness, and physical disability as assessed by the Australian/Canadian (AUSCAN) Hand Osteoarthritis Index.
Consecutive patients with clinical and radiographic hand OA were evaluated by examination, BMI, radiography, and AUSCAN as part of The Genetics of Hand Osteoarthritis Study (GHOST). Radiographs were scored by radiographic atlas and analyzed for relationship to degree of joint involvement, BMI and AUSCAN subscales. Subjects were grouped as 1) erosive involvement of distal interphalangeal (DIP), proximal interphalangeal (PIP) and interphalangeal (IP) joints with hand OA, 2) non erosive (nodal) involvement of DIP, PIP and IP joints with hand OA, and 3) non-erosive involvement of 1st carpo-metacarpal (CMC) joints only. Subjects with any one joint with erosive change were classified as having erosive hand OA. Two scores were generated: 1) Total Countnumber of selected joints with osteophytes and 2) Total ScoreSum of osteophytes scores from selected joints (DIP, PIP, IP, CMC).
A total of 279 subjects were enrolled with a mean age of 68.7 years. The majority of study subjects were women (90.7%) and Caucasian (91.0%). The breakdown of radiographic findings was as follows: 105 (37.6%) with erosive changes, 124 (44.4%) with non-erosive (nodal) involvement and 50 (17.9%) with non-erosive CMC involvement. The group of subjects with erosive hand OA had greater Total Score (p<0.0001) and Total Count (p=0.001) than subjects with non-erosive (nodal) hand OA or CMC involvement. The AUSCAN subscore of stiffness was significantly greater in erosive hand OA (p<0.0003) and nodal hand OA (p=0.027) than in subjects with CMC only involvement (Wilcoxon rank sum). Within the erosive hand OA group, increasing number of joints involved with HOA correlated with worsening Stiffness (p=0.0099) and Physical Function (p=0.0175) subscales of the AUSCAN index (Spearman's correlation).
In a cross-sectional analysis of clinical and radiographic hand OA, subjects with erosive hand OA generally had a greater burden of joints involved that the non-erosive (nodal) group. This may be related to erosive OA potentially being a more severe manifestation and a different group than traditional non-erosive (nodal) OA, suggesting genetic differences. Within the erosive hand OA group, greater Stiffness and worse Physical Function by AUSCAN index correlated with increasing numbers of joints involved with hand OA. This occurred even when there were very few or only one joint with erosive change. The concepts of nodal versus erosive IP arthritis may represent distinct clinical and etiologic groups, and not two sides of a spectrum, reflecting the heterogenity of hand OA which may have implications for genetic studies. Future studies need to include careful descriptions of disease phenotypes, particularly in relation to genetic investigations.
To cite this abstract, please use the following information:
Ishimori, Mariko L., Altman, Roy D., Cohen, Myles J., Rotter, Jerome I., Weisman, Michael H.; Greater Burden of Disease in Erosive Hand Osteoarthritis. [abstract]. Arthritis Rheum 2010;62 Suppl 10 :187