Clinical aspects of hand osteoarthritis : are erosions of importance?

Kwok, W.Y.

This thesis focuses on epidemiological studies of hand OA in secondary care, erosive OA as a subset of hand OA and the added value of imaging in hand OA to understand better the pathophysiology of hand OA and seek for opportunities to define progression in an earlier stage. Chapter 2 gives an overview about the current knowledge on hand OA and it is clear that hand OA is a prevalent, heterogeneous disorder (including several hand OA subsets) that can cause considerable pain and disability. Much less is known about the risk factors of progression in hand OA. Moderate evidence for an abnormal scintigram at baseline was found as a risk factor for radiographic progression in a systematic review as described in chapter 3. In rheumatology practice, the most prevalent phenotype of OA is hand OA as depicted in chapter 4. This symptomatic population experience a substantial lower health-related quality of life compared to the general population. The collaborations with the Rotterdam Study...Show moreThis thesis focuses on epidemiological studies of hand OA in secondary care, erosive OA as a subset of hand OA and the added value of imaging in hand OA to understand better the pathophysiology of hand OA and seek for opportunities to define progression in an earlier stage. Chapter 2 gives an overview about the current knowledge on hand OA and it is clear that hand OA is a prevalent, heterogeneous disorder (including several hand OA subsets) that can cause considerable pain and disability. Much less is known about the risk factors of progression in hand OA. Moderate evidence for an abnormal scintigram at baseline was found as a risk factor for radiographic progression in a systematic review as described in chapter 3. In rheumatology practice, the most prevalent phenotype of OA is hand OA as depicted in chapter 4. This symptomatic population experience a substantial lower health-related quality of life compared to the general population. The collaborations with the Rotterdam Study and NorStOP Study (chapter 5, 6, 7) revealed that 2.8% of the general population rising to 10.2% in the symptomatic population is affected by erosive disease in the interphalangeal joints (IPJs). Furthermore, erosions are not present in IPJs only and prevalence of erosive disease in 1st carpometacarpal joints (CMCJs) is also given. Persons with erosive OA in the interphalangeal joints report more pain and functional limitations, however to a lesser extent than persons with other rheumatic inflammatory diseases. Inflammation does play a role in OA joints with erosions, as assessed with Power Doppler Signal, greyscale synovitis and effusion on ultrasound (chapter 8). Also in OA joints without erosions, inflammatory signs are visible on ultrasound (chapter 9). Regarding other imaging modalities used in hand OA research, quantitative joint space width (JSW) measurements in hand OA joints have been shown to be associated with self-reported pain, functional ability and structural abnormalities (chapter 10), whereas features on Magnetic Resonance Imaging (MRI, such as abnormal collateral ligaments and bone marrow lesions) are also associated with pain upon palpation in individual joints (chapter 11). Finally, the health-related quality of life in hand OA patients in rheumatology practice can be improved with a protocol-led consultation about increasing the use of helping aids and acetaminophen given by a clinical nurse specialist (chapter 12).Show less

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Clinical aspects of hand osteoarthritis : are erosions of importance?

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