Background/Purpose: Hand osteoarthritis (HOA) is a common and frequent cause of pain. HOA is a heterogeneous group of disorders with two main subsets including non-erosive and erosive disease. Few studies demonstrated inflammatory ultrasound changes and more severe clinical symptoms in patients with erosive compared with non-erosive disease, however the results are inconsistent. The aim of this study was to evaluate progression of pain, stiffness, physical impairment and ultrasound features in patients with erosive and non-erosive HOA in a three years longitudinal study.

Methods: Patients with symptomatic HOA fulfilling the American College of Rheumatology (ACR) criteria were included in this study. Joint pain and swelling were assessed. Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). Radiographs of both hands were examined, and erosive disease was defined by at least one erosive interphalangeal joint. Synovial hypertrophy and power Doppler signal (PDS) were scored with ultrasound. Synovitis was graded on a scale of 0–3 and osteophytes were defined as cortical protrusions seen in two planes. Patients were examined at baseline and at the first, second and third year of follow up.

Results:

Altogether, 97 patients (7 male) with symptomatic nodal HOA were included in this study and followed between April 2012 and January 2018. Out of these patients, 57 had erosive disease. The number of painful and clinically swollen joints (p<0.05) was significantly higher in patients with erosive compared with non-erosive disease at baseline. The number of painful and clinically swollen joints fluctuate over the second and third year of follow up, but it still remains statistically higher (p<0.01) at the third year of follow up in patients with erosive disease.

According to the AUSCAN, patients with erosive disease had more pain (p<0.05) and stiffness (p<0.01) at baseline. Pain and stiffness, but not function, worsened in patients with erosive compared with non-erosive disease after second year (p<0.01). Pain (p<0.01), stiffness (p<0.05) and also function (p<0.01) worsened in patients with erosive disease at the third year of follow up.

US-detected pathologies such as gray-scale synovitis (p<0.001), intensity of PDS (p<0.01) and number of osteophytes (p<0.01) were significantly higher in patients with erosive disease at baseline. There were improvements in gray-scale synovitis total score and intensity of PDS in patients with non-erosive disease while patients with erosive disease worsened after the second and third year of follow up (p<0.01). The progression of US-determined osteophyte formation was observed in both groups after the second year of follow up but were significantly higher in patients with erosive than with non-erosive disease after the third year of follow up (p<0.05).

Conclusion: The findings of this study show that pain and number of clinically swollen joints associated with US-detected synovial changes and osteophyte formation is more severe in patients with erosive HOA than in patients with non-erosive disease. In addition, osteophyte formation is more likely to progress independent of synovial inflammation.

Supported by the project MH 023728 and AZV 18-00542.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/progression-of-pain-stiffness-function-changes-and-ultrasound-detected-synovitis-and-osteophyte-formation-in-patients-with-hand-osteoarthritis-over-three-years/