Background/Purpose:

Hand OA is a frequent polyarticular disease. Few is known with respect to its radiological progression over time, which in addition is difficult to assess, considering that no radiographic scoring method has, today, proved being superior to another. The goal of this study was to assess hand OA radiological progression over 3 years using three validated scoring methods.

Methods:

Data came from an international 3-year, randomized, placebo-controlled phase III trial designed to assess the effect of strontium ranelate compared to placebo on the radiographic progression of knee OA which included symptomatic primary knee OA patients (ACR criteria) at a Kellgren-Lawrence (KL) grade II or III, with a minimal joint space width (JSW) between 2.5-5 mm. During this trial, baseline and final postero-anterior radiographs of each hand were performed. Symptoms were assessed using the functional index for Hand OA (FIHOA; range 0-30) and the AUSCAN (0-300). Two independent readers scored half of the pairs of radiographs obtained each, blinded to treatment and time sequence, using the KL (range 0-128), Kallman (0-204) and Verbruggen anatomical phase (0-218) scoring methods with a good inter-rater reproducibility. Hand OA radiographic progression was studied in the placebo group by looking at 1/ baseline-end changes in global scores, 2/ the numbers of progressors (progression was defined for each global score by a change over each reader’s smallest detectable difference (SDD)), and 3/ the number of patients in whom at least 1 joint showed a deterioration (from KL0-1 to KL≥2; progression of ≥1 phase for Verbruggen score).

Results:

Of 1669 patients included in the SEKOIA trial, 999 had radiologic hand OA: 73%. 297 patients in the placebo group had baseline and post-baseline radiographs. 72% were female, mean age 64±7 years, body mass index 29.5±5 kg/m², and initial knee JSW 3.5±0.8 mm. Baseline hand OA radiologic severity was mild: KL score 21±13, Kallman score 24±21 and Verbruggen score 13±14. FIHOA score was 4±5, Auscan global score was 96+80. Mean time interval between baseline and final radiographs was 31.5 months.

 Hand OA radiographic progression over 2.6 years was modest with a mean change of 2.4±3.3 for KL score, 3.7±5.3 for Kallman score and 2.0±4.0 for Verbruggen score.

The numbers (%) of progressors (change≥SDD) were 7 (2%), 17 (6%), and 21 (7%) respectively.

The numbers (%) of patients with at least 1 worsened joint were 169 (57%) for KL and 139 (47%) for Verbruggen score, with respective means of 2.0±1.3 and 1.7±1.1 worsening joint.

Conclusion:

Whatever the radiological scoring method used, and the kind of analysis performed, mild radiographic hand OA patients showed a very weak global radiological progression over 2.6 years.       In future structure-modification trials in hand OA, analysing the number of patients with at least one joint worsening could be the most sensitive method.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/radiologic-progression-in-hand-osteoarthritis-oa-over-2-6-years-data-from-the-sekoia-trial/