Background/Purpose:  Previous studies have shown no association between increased amount of radiographic hand osteoarthritis (OA) resulting in more hand pain/disabilities. In this longitudinal study, our aim was to study whether radiographic hand OA was related to joint tenderness in cross-sectional and longitudinal settings focusing on joint-specific analyses, and whether presence of MRI-defined synovitis and bone marrow lesions (BMLs) at follow-up had an effect on the observed longitudinal associations.

Methods: We included 190 patients (173 women, mean (SD) age 61.5 (5.7) years) from the Oslo hand OA cohort with hand radiographs at baseline, of which 112 (102 women) had 7-years follow-up data. Of those, 89 had pre-/post-Gd T1w fs MRIs of the distal (DIP) and proximal interphalangeal (PIP) joints in the right hand, whereas 101 had STIR images. The bilateral DIP, PIP and carpometacarpal joints were scored for radiographic OA according to Kellgren-Lawrence scale and OARSI atlas, whereas the right hand’s DIP and PIP joints were scored for synovitis and BMLs according to Oslo hand OA MRI score. Joint tenderness on palpation (absent/present) was assessed by a rheumatologist. To explore the associations between radiographic hand OA and tenderness in the same joint, we performed uni-/multivariate logistic regression analyses with Generalized Estimating Equations. In the longitudinal analyses only joints with potential for radiographic progression and without tenderness at baseline were included. Features that were associated with tenderness in univariate analyses (p<0.20) were included in a multivariate model and excluded by backward selection. All analyses were adjusted for age and sex. Using the final multivariate model from the longitudinal analyses, we did additional adjustment for presence of MRI-defined synovitis (grade 2-3) and BMLs (grade 1-3) at follow-up (only DIP and PIP joints in right hand included in these analyses).

Results: Incident erosions seemed to be the most important predictor for incident tenderness, but also progression of osteophytes and JSN remained in the final model. Sclerosis and cysts were not associated with tenderness in the multivariate models, and malalignment remained in the final multivariate model for cross-sectional data only (table). Associations between radiographic progression of osteophytes, JSN and erosions and incident joint tenderness were similar after adjustment for BMLs and synovitis at follow-up (data not shown).

Table: Associations between OA severity and joint tenderness in cross-sectional analyses and between radiographic progression and incident tenderness in longitudinal analyses (no progression as reference).

		Cross-sectional analyses (OR, 95% CI) *	Longitudinal analyses (OR, 95% CI) *
Model 1: Global score:
Kellgren/ Lawrence	Grade 0 Grade 1 Grade 2 Grade 3 Grade 4	1.0 (ref.) 1.4 (1.2-1.7) 3.0 (2.4-3.7) 6.8 (4.5-10) 5.3 (3.3-8.6)	1.0  (ref.) 1.2 (0.7-2.0) 1.5 (0.9-2.5) 5.7 (3.0-11) 11 (4.0-33)
Model 2: Individual radiographic features (one multivariate model):
Osteophyte	Grade 0 Grade 1 Grade 2 Grade 3	1.0 (ref.) 2.4 (1.9-3.0) 2.7 (1.9-4.0) 2.8 (1.7-4.5)	1.0 (ref.) 1.6 (1.0-2.4)
Joint space narrowing	Grade 0 Grade 1 Grade 2 Grade 3	1.0 (ref.) 0.9 (0.7-1.1) 1.4 (1.0-1.8) 1.1 (0.7-1.6)	1.0 (ref.) 2.1 (1.2-3.7)
Erosions	Grade 0 Grade 1	1.0 (ref.) 1.6 (1.0-2.4)	1.0 (ref.) 6.2 (3.2-12)
Malalignment	Grade 0 Grade 1	1.0 (ref.) 1.6 (1.1-2.2)	–

Conclusion: Erosive development can strongly predict future joint tenderness, and the association to tenderness seemed to be independent of MRI-defined BMLs and synovitis. However, future longitudinal MRI studies are warranted.

---

« Back to 2012 ACR/ARHP Annual Meeting

ACR Meeting Abstracts - https://acrabstracts.org/abstract/erosive-evolution-in-hand-osteoarthritis-is-associated-with-incident-joint-tenderness-independent-of-mri-defined-bone-marrow-lesions-and-synovitis/