Background/Purpose: Hand osteoarthritis (HOA) leads to aesthetic damage and is rarely studied. We aim to investigate in HOA patients the prevalence of dissatisfaction with the appearance of their hands, the impact and its risk factors.

Methods: Cross-sectional data were used of the ongoing HOSTAS (Hand OSTeoArthritis in Secondary care) study, in which consecutive patients are included, that are diagnosed by the treating rheumatologist with primary HOA. Participants underwent physical examination to assess number of joints with bony joint enlargements (0-30), deformities (0-22) and limitation in mobility (0-22).  

The Michigan Hand Outcomes (MHQ) questionnaire involves a pain (range 0-100, higher scores=more pain) and an aesthetic scale, which measures satisfaction (range 1-5, lower scores=more dissatisfaction) with the appearance of the hands and its impact, namely discomfort in public, depression and/or the interference with normal social activities (range 3-12, lower scores = more impact). A score of <3 was considered as dissatisfaction and a score of <9 as experiencing impact. Scores for right and left hand were averaged.       

Disability was assessed by the functional index for HOA (FIHOA)(0-30). Anxiety (0-21), depression (0-21) and illness perceptions were assessed with the Hospital Anxiety and Depression scales (HADS) and Illness Perception Questionnaire (IPQ), respectively.

Odds Ratio (OR) with 95% confidence intervals (CI) were calculated using multivariate logistic regression as measures of relative risk for reporting dissatisfaction with appearance or impact due to dissatisfaction of the appearance, adjusted for age, sex and BMI.

Results: Of 226 patients (87% women, mean age 61.5 yrs, median symptom duration 5.2(range 0.1- 58.7) yrs) 93% met ACR criteria for HOA. 25% were aesthetically dissatisfied and only 4% reported impact due to dissatisfaction. Mean pain score was 44 (SD 19) and median FIHOA score was 8 (range 0-24). Median depression and anxiety scores were 4 (range 0-18) and 2 (range 0-17), respectively.

Pain (OR 1.02 (1.00-1.04)), disability (OR 1.07 (1.01-1.12)), deformities (OR 1.24 (1.11-1.37)), number of joints with limitation in mobility (OR 1.05 (1.01-1.08) and the illness perception scale which involves negative feelings towards OA (OR 1.08 (1.02 -1.15)) were associated with dissatisfaction, as well as with impact.

Bony joint enlargements (OR 1.09 (1.01-1.17)) and illness perception (belief in OA as a chronic disease) (OR 1.12 (1.01 -1.23)) were associated with dissatisfaction, but not with impact.     

Depression (OR 1.32 (1.13 -1.55)), anxiety levels (OR 1.37 (1.14 -1.64)) and illness perceptions (the belief in more severe consequences as a result of OA, less understanding of OA and attributing more psychological factors to their disease) were associated with impact.

Conclusion: HOA patients who consult secondary care report regularly aesthetic dissatisfaction with their hands. However, this dissatisfaction has negative impact only in a small group of patients, who also experiences more pain, depression and anxiety and negative illness perceptions. These results have implications for management strategies in patients with HOA.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/aesthetic-dissatisfaction-in-hand-osteoarthritis-patients-its-impact-and-risk-factors/