Background/Purpose: Hand osteoarthritis (HOA) is a common and frequent cause of pain. 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. 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.

Methods: Consecutive patients with symptomatic HOA fulfilling the American College of Rheumatology (ACR) criteria were included in this study. Joint tenderness and swelling were assessed. Patients reported joint pain on 100 mm visual analogue scale (VAS) was completed. 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. Effusion, 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, 81 patients (five male) with symptomatic nodal HOA were included in this study between April 2012 and April 2013. Out of these patients, 46 had erosive disease. Patient’s characteristics are given in table 1. The intensity of pain assessment on VAS (p<0.05), duration of morning stiffness (p<0.05) and number of clinically swollen joints (p<0.05) were significantly higher in patients with erosive compared with non-erosive disease. Accordingly, functional impairments assessed by AUSCAN showed more disability in patients with erosive compared with non-erosive disease (p<0.05). US-detected pathologies (gray-scale synovitis, power Doppler signal and osteophytes) were common in both groups of patients. Although, synovial hypertrophy was higher in patients with erosive compared with non-erosive disease (total score: 7.7 vs. 3.8; p<0.05), the differences in intensity of power Doppler signal and number of osteophytes did not differ between both groups. 

Conclusion: This study shows that patients with erosive HOA have more hand pain, joint stiffness and functional limitation associated with US-detected synovial hypertrophy, but not with inflammatory signs or osteophyte formation.

Acknowledgement: This work was supported by the project (Ministry of Health, Czech Republic) for consensual development of research organization 023728.

Table 1

	All patients	Non-erosive HOA	Erosive HOA
Age, years (mean ± SD)	66.74 ± 8.87	64.49 ± 8.21	68.46 ± 8.97
Female, no. (%)	76 (96.30%)	33(94.29%)	43(93.48%)
Disease duration, years (mean ± SD)	8.78 ± 8.18	7.91 ± 8.57	9.43 ± 7.81
BMI, kg/m2 (mean ± SD)	28.36 ± 5.42	28.98 ± 6.06	27.88 ± 4.82
AUSCAN, total (mean ± SD)	22.94 ± 11.43	20.51 ± 10.51	24.78 ± 11.53
AUSCAN A, pain (mean ± SD)	8.47 ± 4.41	8.03 ± 4.45	8.80 ± 4.36
AUSCAN B, function (mean ± SD)	2.00 ± 0.89	1.83 ± 1.06	2.13 ± 0.71
AUSCAN C, stiffness (mean ± SD)	12.04 ± 6.52	10.37 ± 6.21	13.30 ± 6.46
VAS, pain (mm)	43.19 ± 24.20	39.71 ± 24.80	45.84 ± 23.40
Tender joints, no.	9.49 ± 6.58	9.26 ± 7.23	9.67 ± 6.04
Swollen joints, no.	3.49 ± 4.28	2.83 ± 3.52	4.00 ± 4.71
NSAIDs, no. (%)	37 (45.68%)	16 (45.71%)	21 (46.65%)
SYSADOA, no. (%)	55 (67.90%)	23 (65.71%)	32 (69.57%)

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/pain-functional-impairment-and-ultrasound-detected-changes-in-patients-with-erosive-and-non-erosive-hand-osteoarthritis/