Session Information
Date: Sunday, November 8, 2015
Title: Osteoarthritis - Clinical Aspects Poster I: Treatments and Metabolic Risk Factors
Session Type: ACR Poster Session A
Session Time: 9:00AM-11:00AM
Background/Purpose: Hand osteoarthritis (HOA) causes considerable pain and disability. Radiographic HOA features show only a modest association with symptoms in HOA. Ultrasound is an easy non-invasive procedure, which is able to visualize synovial inflammation and joint effusion. HOA is a heterogeneous group of disorders with two main subsets including non-erosive disease and erosive, sometimes referred to as inflammatory, HOA. Few studies demonstrated inflammatory ultrasound changes and more severe clinical symptoms in patients with erosive compared with non-erosive disease, however the results are inconclusive.
Methods: The aim of the study was to compare pain, stiffness, physical impairment and ultrasound features between patients with erosive and non-erosive HOA in a cross-sectional study. Consecutive patients with symptomatic HOA fulfilling the American College of Rheumatology (ACR) criteria were included in this study. Joint pain and swelling were assessed. Patients reported joint pain on 100 mm visual analogue scale (VAS). Pain, joint stiffness and disability were assessed by the Australian/Canadian OA hand index (AUSCAN). Radiographs of both hands were examined and erosive disease was defined by at least one erosive interphalangeal joint. Synovial hypertrophy and power Doppler signal (PDS) were scored with ultrasound. Synovitis was graded on a scale of 0–3 and osteophytes were defined as cortical protrusions seen in two planes.
Results: Altogether, 134 patients (13 male) with symptomatic nodal HOA were included in this study between April 2012 and January 2015. Out of these patients, 72 had erosive disease. Patient’s characteristics are given in table 1. The disease duration (p<0.01), duration of morning stiffness (p<0.01) and number of clinically swollen joints (p<0.05) were significantly higher in patients with erosive compared with non-erosive disease. According to the AUSCAN, patients with erosive compared with non-erosive disease had more pain (p<0.05) and stiffness (p<0.01). US-detected pathologies such as gray-scale synovitis total score (p<0.001), intensity of PDS (p<0.01) and number of osteophytes (p<0.01) were significantly higher in patients with erosive compared with non-erosive disease (table 1). There were no significant differences in consumption of non-steroidal anti-inflammatory drugs (NSAIDs), analgesics and symptomatic slow-acting drugs (SYSADOA) for OA between both groups.
Table 1.
|
|
All patients |
Non-erosive HOA |
Erosive HOA |
P |
|
Age, years (mean ± SD) |
65.98 ± 8.16 |
64.25 ± 7.61 |
67.48 ± 8.33 |
NS |
|
Female, no. (%) |
121 (90.29%) |
55 (88.70%) |
66 (91.66%) |
NS |
|
Disease duration (years) |
8.54 ± 7.14 |
7.52 ± 7.02 |
9.42 ± 7.13 |
<0.01 * |
|
BMI, kg/m2 |
27.53 ± 4.33 |
27.50 ± 4.12 |
27.55 ± 4.49 |
NS |
|
AUSCAN, total |
21.60 ± 10.44 |
20.05 ± 9.98 |
22.93 ± 10.65 |
<0.05 * |
|
AUSCAN A, pain |
8.16 ± 4.26 |
7.73 ± 4.18 |
8.53 ± 4.29 |
<0.05 * |
|
AUSCAN B, function |
1.96 ± 0.87 |
2.02 ± 0.98 |
1.90 ± 0.77 |
NS |
|
AUSCAN C, stiffness |
11.34 ± 6.27 |
10.16 ± 5.78 |
12.36 ± 6.48 |
<0.01 * |
|
VAS, pain (mm) |
43.91 ± 21.42 |
41.85 ± 21.49 |
45.69 ± 21.19 |
NS |
|
Morning stiffness (min) |
21.12± 37.84 |
18.55± 29.06 |
23.34± 43.89 |
<0.01 * |
|
Tender joints, no. |
7.66 ± 3.34 |
7.32 ± 3.41 |
7.96 ± 3.25 |
NS |
|
Swollen joints, no. |
3.69 ± 4.42 |
3.45 ± 3.86 |
3.89 ± 4.78 |
<0.05 * |
|
Ultrasound |
|
|
|
|
|
Synovial hypertrophy |
6.72 ± 8.06 |
4.47 ± 6.09 |
8.67 ± 8.99 |
<0.001* |
|
Power Doppler signal |
1.99 ± 2.72 |
1.61 ± 2.07 |
2.31 ± 3.14 |
<0.01* |
|
Osteophytes, no. |
11.95 ± 5.31 |
10.6 ± 5.59 |
13.11 ± 4.76 |
<0.01* |
* Significantly higher in patients with erosive HOA
Conclusion: In general, this study shows that patients with erosive HOA have more severe pain and stiffness associated with US-detected synovial hypertrophy, inflammatory signs and osteophyte formation than patients with non-erosive disease.
To cite this abstract in AMA style:
Sleglova O, Ruzickova O, Pavelka K, Senolt L. More Inflammatory Signs on Ultrasound, Severe Pain and Stiffness Are Associated with Erosive Than Non-Erosive Hand Osteoarthritis [abstract]. Arthritis Rheumatol. 2015; 67 (suppl 10). https://acrabstracts.org/abstract/more-inflammatory-signs-on-ultrasound-severe-pain-and-stiffness-are-associated-with-erosive-than-non-erosive-hand-osteoarthritis/. Accessed .« Back to ACR/ARHP Annual Meeting 2015
ACR Meeting Abstracts - https://acrabstracts.org/abstract/more-inflammatory-signs-on-ultrasound-severe-pain-and-stiffness-are-associated-with-erosive-than-non-erosive-hand-osteoarthritis/