Objective: Physical function is one of the Outcome Measures in Rheumatology (OMERACT) core outcome domains for hand osteoarthritis studies. Our aim was to select appropriate instrument(s) to... Show moreObjective: Physical function is one of the Outcome Measures in Rheumatology (OMERACT) core outcome domains for hand osteoarthritis studies. Our aim was to select appropriate instrument(s) to measure this domain, as part of the development of a core outcome measurement set.Methods: Following the OMERACT Filter 2.1 instrument selection process, the (function subscale of) the Australian/Canadian Hand Osteoarthritis Index (AUSCAN), Functional Index for Hand Osteoarthritis (FIHOA) and Michigan Hand Outcomes Questionnaire (MHQ) were assessed for domain match, feasibility, truth and discrimination. Data gathered from available literature, working group and patient surveys, and additional analyses in two hand osteoarthritis cohorts were used to inform a consensus process.Results were summarized in Summary of Measurements Properties tables and reviewed by the OMERACT technical advisory group. Results: MHQ passed the assessment of domain match and feasibility by the working group and patient research partners. For AUSCAN important limitations in feasibility were noted, but domain match was good. FIHOA did not pass the assessment and was not taken through the follow-up assessment. Based on published literature, reliability and construct/longitudinal validity of both MHQ and AUSCAN fulfilled OMERACT standards. While clinical trial discrimination and thresholds of meaning were good for AUSCAN, results for MHQ were ambiguous.Conclusion: MHQ was provisionally endorsed as OMERACT core outcome measure for the core domain physical function. While AUSCAN may have better metric properties than MHQ, it received provisional endorsement as a second measure of function due to important feasibility issues. A research agenda to merit full endorsement was set. (c) 2021 The Author(s). Published by Elsevier Inc. Show less
Background: Hand osteoarthritis (HOA) is a highly prevalent rheumatic disease that predominates in females and causes pain and loss of functional capacity. Obesity and metabolic syndrome have been... Show moreBackground: Hand osteoarthritis (HOA) is a highly prevalent rheumatic disease that predominates in females and causes pain and loss of functional capacity. Obesity and metabolic syndrome have been previously suggested to associate with the severity of HOA, but clarity on these associations is yet to be achieved.Objective: Test the association between obesity and other components of the metabolic syndrome and disability in women with hand osteoarthritis (HOA).Design: Individuals from EpiReumaPt epidemiological community-based study (2011-2013) are representative of the Portuguese population. Women with diagnosis of primary HOA were included.Primary outcome: hand functional status, assessed by Cochin questionnaire.Secondary outcomes: hand pain, assessed by visual analogue scale and tender hand joint count (THJ).Explanatory variables: obesity, diabetes mellitus, arterial hypertension and hypercholesterolemia. Possible associations between obesity and the other components of metabolic syndrome with Cochin score, hand pain and THJ were tested in a multivariable linear regression model.Potential confounders considered: age, education level and countrywide distribution.Results: 473 women with primary HOA were included. Forty percent were overweight and 29% obese. Ninety-three (19.8%) participants had diabetes, 261 (55.8%) reported hypertension and 261 (55.9%) hypercholesterolemia. Mean Cochin score was 15.5 +/- 14.8, mean pain VAS was 4.7 +/- 2.6 and mean THJ 1.4 +/- 3. In the multivariable analysis, obesity (beta 4.6 CI 0.7;8.5) and diabetes (beta 4.0 CI 0.4;7.6) were found to significantly associate with HOA functional disability. In addition, diabetes, but not obesity, associated with hand pain. There was no association between obesity or diabetes with THJ.Conclusion: In a Portuguese female population with primary HOA, obesity and diabetes mellitus independently associated with a worse hand functional status. These data add to evidence suggesting a role of metabolic factors in the severity of HOA. Show less
This thesis describes research done in the field of hand osteoarthritis, and had the following three aims:1) To evaluate the current state of treatment options in hand osteoarthritis;2) To... Show moreThis thesis describes research done in the field of hand osteoarthritis, and had the following three aims:1) To evaluate the current state of treatment options in hand osteoarthritis;2) To investigate the role of inflammation as a treatment target in hand osteoarthritis; and3) To facilitate development of new treatment options by improving outcome measurement in hand osteoarthritis. Show less
Beest, S. van; Kroon, F.P.B.; Kroon, H.M.; Damman, W.; Liu, R.; Bloem, J.L.; ... ; Kloppenburg, M. 2019
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... 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
Obesity is a major risk factor of osteoarthritis development and progression. Theoretically, obesity is a factor that can be modified. While obesity epidemic is difficult to reverse because we live... Show moreObesity is a major risk factor of osteoarthritis development and progression. Theoretically, obesity is a factor that can be modified. While obesity epidemic is difficult to reverse because we live in lipogenic environment, personal approach in modify obesity may avail. Therefore, understanding how obesity leads to osteoarthritis is needed. The first three chapters of this thesis investigate several aspects of osteoarthritis: what structures are damaged, what factors are associated with worsening of osteoarthritis and how to measure worsening of osteoarthritis. The other four chapters investigate the link between obesity and osteoarthritis. We show that obesity is associated with hand osteoarthritis. Since we do not walk on our hand, there must be another factor than mechanical that cause joint damage in osteoarthritis. One of the factors is adipokines, protein produced mainly by fat tissue. We showed that adiponectin, one of the adipokines, prevents worsening of hand osteoarthritis. We concluded that obesity plays role in osteoarthritis not only due to added mechanical force but also due to added metabolic force (adipokines). These adipokines might be used as target in modifying the effect of obesity on osteoarthritis. However, we still need more studies on how obesity links with osteoarthritis Show less
