Background/Purpose: The estimated prevalence of hand osteoarthritis (HOA) varies severely according to the selection of different diagnostic modalities, items of interest and subject samples. In most studies conventional radiography (CR) was used in this matter. Recently ultrasound (US) was considered reliable and reproducible, and even more sensitive in detecting HOA signs such as osteophytes. We assumed that the prevalence of HOA detected by US was higher as described in previous studies. The objectives of this study were to investigate the prevalence and precise pattern of HOA in a working population by US.

Methods: The study included 427 participants (15.7% women, 84.3% men, mean age 53.5 years). A total of 11,840 images were scored for synovitis 0-3, synovitis mm, erosions 0-3, osteophytes 0-3, joint space mm and cartilage thickness mm. US assessment was provided for both hands, scanning 26 finger joints of each participant (CMC 1, MCP 2-5, PIP 2-5 and DIP 2-5) using an Esaote Mylab 25Gold unit with an 18 MHz linear transducer. Gray-scale US was performed on the palmar side with all joints in neutral position. Static images were stored and evaluated afterwards using Esaote Mylab-Desk software. HOA was defined as present if one or more joints of the participant showed osteophytes.

Results: The overall prevalence for HOA was nearly 100%. Only one participant had no osteophytes. There is strong evidence to suggest that the number of osteophytes increase with age (p<0.001). With every additional year, a mean increase of 0.18 (standard error 0.03) osteophytes has been observed. We found no evidence for an association of the number of osteophytes with sex (p = 0.4, after adjustment of age p = 0.9). The prevalence rates of osteophytes in the following joints of the right hand were: 8.5% MCP 5, 38.2% PIP 5, 56.8% DIP 5, 18.1% MCP 4, 51.4% PIP 4, 65.6% DIP 4, 28.3% MCP 3, 58.7% PIP 3, 67.4% DIP 3, 19.8% MCP 2, 48.5% PIP 2, 66.7% DIP 2 and 37.5% CMC 1. The prevalence rates of osteophytes in the following joints of the left hand were: 7.3% MCP 5, 34% PIP 5, 47.5% DIP 5, 12.3% MCP 4, 51.5% PIP 4, 56.2% DIP 4, 19.7% MCP 3, 53.2% PIP 3, 67.3% DIP 3, 14.6% MCP 2, 45.8% PIP 2, 59.6% DIP 2 and 40.1% CMC 1. Overall, DIP 3 on the right-hand side was the most frequently affected joint, followed by DIP 3 on the left-hand side, then right-hand DIP 2 and DIP 4, then left-hand DIP 2.

Conclusion: US detected HOA shows a higher prevalence when compared to studies using CR. This supports prior studies emphasizing that US is more sensitive than CR in detecting HOA signs such as osteophytes. Nearly all participants showed HOA signs and on average more than 15% of the MCP joints were affected which could possibly be misinterpreted in the context of accompanying inflammatory joint diseases. Regarding that, HOA is an underestimated problem in sonographic assessments and has to be more carefully respected when interpreting US images of hand and finger joints.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/prevalence-and-pattern-of-hand-osteoarthritis-in-a-working-population-using-ultrasound/