Background/Purpose: Hand osteoarthritis (HOA) is considered as a less severe disease with a better functional prognosis and a lower global burden than rheumatoid arthritis (RA). This paradigm may no longer be true considering the efficacy of targeted therapies in RA compared to the weak efficacy of therapies in the most severe form of HOA, namely erosive HOA (EHOA) (1).

Methods: We aimed to compare the burdens of established EHOA and RA. The objectives were to compare pain, functional impairment and the prevalence of comorbidities and of cardiovascular diseases (CVD).

This study involved EOHA patients, defined by at least 1 erosive joint according to the Verbruggen score (3)from inclusion visit of DIGital Cohort Osteoarthritis Design (DIGICOD), a French cohort of symptomatic HOA. RA patients fulfilling ACR/EULAR 2010 criteria at the 10th year visit were selected from the ESPOIR cohort (Étude et Suivi des Polyarthrites Indifférenciées Récentes), a French cohort of early RA (4).

Pain intensity at rest or mobilization (0-100mm visual analogical scale (VAS)³40/100), fatigue (VAS fatigue³25/100), function (normalized (0-100) scores of Health assessment questionnaire for RA, and AUStralian CANadian Osteoarthritis Hand Index for EHOA > 16.7) were analyzed and compared between EHOA and RA using logistic regression models adjusted on age, gender, BMI, comorbidities and socio-educational level. The risk to have ³ 2 comorbidities (among CVD, cancer, hemopathy, fracture) or at least 1 CVD (among high blood pressure, diabetes, dyslipidemia, myocardial infarction, stroke) were compared and adjusted on age, gender, BMI and socio-educational level. Odds ratios (OR) and their 95% confidence intervals (CIs) were reported (EOHA vs RA).

Results: We selected 138 EHOA patients and 379 with RA. The median [interquartile] age for EHOA patients was 67.3 [64.3 ; 72.2] years vs 48.6[39.9 ; 55.6] years for RA patients (p< 0.001). The disease duration, at the evaluation time, was 13.5 [7.0; 20.0] for EHOA and 10.5 years [10.3 ; 10.7] for RA patients. RA was anti-CCP antibodies positive for 56% of patients and in remission for 61%. RA patients received methotrexate (82%), biologics (37%) and corticosteroids (25%) while 20% of EHOA patients received oral non-steroidal anti-inflammatory drugs.

The number of painful joints in the hands was higher for EHOA than RA patients (4.0 [2.0;8.8] vs 0.0 [0.0;3.0], p< 0.001).

In the adjusted analysis, EHOA was associated with more pain at mobilization (OR = 3.13 95% CI [1.74 to 5.68] p< 0.001) and functional impairment (OR = 2.27 CI 95% [1.26 to 4.17], p = 0.007) (Figure 1). There was no difference for pain at rest and for fatigue.

For comorbidities, the proportions of EHOA patients with ³ 2 comorbidities were higher than RA patients (37.7% vs 27.5%). However, in adjusted analysis, the risk to have ³ 2 comorbidities was lower in EHOA than in RA (OR = 0.25 CI 95% [0.13 to 0.48]; p< 0.001) while there was no difference for CVD risk

Conclusion: After more than 10 years of disease duration, EHOA is associated with more pain and functional impairment but less comorbidities than RA. This study highlights the significant need for effective therapies EHOA.

1. Kwok WY, Ann Rheum Dis, 2011
2. Sellam J, Joint Bone Spine, 2021
3. Combe B, Rheumatology (Oxford),2021

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/higher-pain-and-functional-impairment-in-erosive-hand-osteoarthritis-than-in-treated-rheumatoid-arthritis-a-comparative-study-between-digicod-and-espoir-cohorts/