Background/Purpose:

Osteoarthritis (OA) is a highly prevalent disease, affecting more than 400 millions individuals around the world. Hand osteoarthritis (HOA) is the most frequent form of OA. The prevalence is variable depending on the definition used and the population studied. It has been suggested in a few studies that disability may be comparable to that seen in rheumatoid arthritis (RA). As HOA is more frequent than RA, the burden of disease is greater. The aim of this study was to systematically assess the disability associated with HOA, along with its correlates, in a cohort of post-menopausal women, the QUALYOR study (QUalité Osseuse Lyon Orléans).

Methods:

At the 72 months follow-up visit of the study, we performed, radiographs using a High-resolution direct digital X-ray device (BMA®, D3A Medical Imaging), clinical examination assessing pain, nodes and deformations, grip strength, AUSCAN and COCHIN questionnaires and a bone densitometry (DXA Hologic Discovery A). At baseline, a HRpQCT (XtremeCT, Scanco Medical), a DXA and a blood sample to assess bone turnover markers (CTX, PINP) were performed. Radiographic hand OA (RHOA) was defined as at least 2 over 30 articulations grading 2 or more using the Kellgren Lawrence score. Moderate to severe symptomatic HOA was defined as radiographic hand OA and AUSCAN total score > 43/100 (threshold previously identified as the level of non acceptable disability in HOA(1)). T-tests were used to compare continuous variables, Spearman correlations were performed to explore the association of these parameters with HOA and a multivariate analysis including age using logistic regression models was made.

Results:

We included 1189 patients, aged at least 55. The mean age was 71.7 years. Inter-reader reliability was good (ICC = 0.86) and intra-reader reliability was excellent (ICC = 0.97). RHOA was rare before age 60. Among 1189 women, 815 (68.5%) had RHOA. They were older than those without RHOA and grip strength was significantly lower in this group. No significant difference was noted on bone microarchitecture, bone turnover markers and clinical characteristics especially BMI. Figure 1 presents RHOA prevalence by joint in the total population and in the RHOA population. Of note, 194 patients with RHOA had erosions on radiographs (23.8%). 86 patients over 815 (10.5%) had moderate to severe symptomatic HOA. BMI at the time of osteoarthritis evaluation was significantly higher in this group. Grip strength was significantly lower in those with symptomatic RHOA. No significant difference was seen in bone microarchitecture, bone mineral density and bone turnover markers in RHOA.

Conclusion:

In our cohort of post-menopausal women aged at least 55, 68.5% had RHOA and 10.5% of them had a moderate to severe HOA related disability. BMI was associated with symptomatic RHOA.

References:

1. Bellamy N, Hochberg M, Tubach F, Martin-Mola E, Awada H, Bombardier C, et al. Development of multinational definitions of minimal clinically important improvement and patient acceptable symptomatic state in osteoarthritis. Arthritis Care Res (Hoboken). juill 2015;67(7):972‑80.

Figure 1

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/the-disability-associated-with-hand-osteoarthritis-is-substantial-in-a-cohort-of-post-menopausal-women-the-qualyor-study/