Inflammation Is Associated with Erosive Progression in Patients with Hand Osteoarthritis: A Prospective Ultrasonography Study

Marion C. Kortekaas^1,2, Wing Yee Kwok³, Monique Reijnierse⁴, Theo Stijnen⁵ and Margreet Kloppenburg⁶, ¹Rheumatology, Leiden University Medical Center, Leiden, Netherlands, ²Department of Rheumatology, Flevoziekenhuis, Almere-Stad, Netherlands, ³Leiden University Medical Center, Leiden, Netherlands, ⁴Radiology, Leiden University Medical Center, Leiden, Netherlands, ⁵Medical Statistics, Leiden University Medical Center, Leiden, Netherlands, ⁶Rheumatology and Clinical Epidemiology, Leiden University Medical Center, Leiden, Netherlands

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Inflammation, longitudinal studies and ultrasound, OA

Session Information

Title: Osteoarthritis - Clinical Aspects I: Imaging in Osteoarthritis

Session Type: Abstract Submissions (ACR)

Background/Purpose

Erosive hand osteoarthritis (OA) is a subset that shows inflammatory features with ultrasound or MRI much more frequent than non-erosive hand OA, and can progress relatively fast. Whether inflammatory features are associated with erosive progression is unknown. Therefore, we investigated relationships between inflammatory ultrasound features and erosive progression over 2.3 years follow-up in hand OA patients.

Methods

In 56 consecutive hand OA patients (mean age 61 years, 86% female), recruited from the rheumatology outpatient clinic and all fulfilling ACR criteria, effusion, synovial thickening and Power Doppler signal (PDS) were assessed in all interphalangeal joints (IPJs) with ultrasound using standardized methods at baseline and after 2.3 years. Radiographs were scored at both time-points for osteophytes and joint space narrowing using the OARSI method and for erosive disease, defined as E(rosive)- and R(emodelled)-phase, using the Verbruggen-Veys method. Progression was defined as a non-erosive joint becoming erosive, or E-phase becoming R-phase. R-phases at baseline were excluded. Associations were analysed using GEE logistic regression, adjusting for age, gender, BMI and baseline structural abnormalities.

Results

At baseline 51 IPJs (18 patients) and at follow-up 100 IPJs (26 patients) were erosive, hence 49 IPJs showed erosive progression. Moderate/severe synovial thickening and PDS at baseline were associated with erosive progression: adjusted odds ratio (95% confidence interval) 6.3 (2.3-17.5) and 6.9 (2.0-23.3), respectively. Effusion showed a trend: 2.7 (0.94-7.7). Persistent inflammation, defined as inflammation present both at baseline and follow-up, showed stronger associations with erosive progression compared to inflammation present either at baseline or follow-up.

Conclusion

Inflammatory ultrasound features, especially when persistent, are associated with erosive progression in hand OA, implicating that inflammation plays a role in its pathogenesis and could be a therapeutic target.

Disclosure:

M. C. Kortekaas,
None;

W. Y. Kwok,
None;

M. Reijnierse,
None;

T. Stijnen,
None;

M. Kloppenburg,
None.

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