Background/Purpose:

Osteoarthritis (OA) affects 27 million adults in the United States. Symptomatic hand osteoarthritis (SHOA) is a common condition that affects hand strength and function. Lifetime risk, defined as the probability of developing a condition over the course of a lifetime, has been used to convey person-level risk of other chronic conditions including breast cancer, and more recently estimates of symptomatic knee and hip OA have been published. To better understand the overall burden of SHOA, as well as to guide targeted interventions, we estimated the lifetime risk of SHOA and whether the risk is different by potential risk factors.

Methods:

We analyzed data from the Johnston County Osteoarthritis Project, an on-going population-based prospective cohort study in residents of Johnston County, North Carolina. Data were collected among 2,218 adults ≥ 45 years at the first (1999-2004) and second (2005-2010) time period. The presence of SHOA at each time period was defined by self-reported symptoms (pain, aching, and stiffness) and radiographic OA (ROA) in the same hand. ROA was defined as a Kellgren-Lawrence grade ≥2 in at least 3 total joints out of the 15 joints in each hand, and at least one of them being the distal interphalangeal joint (361 participants met this criteria in at least one time period). Lifetime risk, defined as the proportion of the population who will develop SHOA in at least one hand by age 85, was estimated using the predicted marginal probability from generalized estimating equations logistic regression, accounting for clustered variance from the stratified random sampling design and multiple measurements within participant. Additionally, sampling weights were applied in analyses to make appropriate population-based statistical inferences. The overall and stratified lifetime risk by sex, race and obesity (BMI≥30 kg/m²) are presented.

Results:

The lifetime risk of SHOA was 39% (95% confidence intervals [CIs] 34-45%) overall. Nearly one of two women (48%; CIs 41-55%) developed SHOA by age 85 compared with one of four men (25%; CIs 19-31%). Lifetime risk of SHOA was 47% (CIs 38-57%) among the obese participants, higher than that among those who were not obese (36%; CIs 29-42%). Race-specific estimates were 40% (CIs 34-47%) among whites and 32% (CIs 21-44%) among African-American adults.

Conclusion:

Almost 40% of people will develop SHOA by age 85. The risk is particularly high among women and obese adults. SHOA has substantial public health implications considering its high lifetime risk, and its impact on functional impairment of the hands and quality of life.

These findings underscore the need for increased use of public health and clinical interventions to address the impact of SHOA on individuals and society. Earlier diagnosis can allow earlier use of the same standard interventions used for other types of OA. These include self-management education, losing weight if overweight/obese, physical/occupational therapy, thermal modalities, joint protection techniques, provision of assistive devices, and acetaminophen/NSAID use, which may contribute to maintaining better function and fewer symptoms.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/lifetime-risk-of-symptomatic-hand-osteoarthritis-the-johnston-county-osteoarthritis-project/