Radiological progression persists in hand osteoarthritis without clinical worsening
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Researchers studying a Belgian cohort of patients with hand osteoarthritis observed evidence of radiological progression over 2 years even without clinical worsening, according to data published in Arthritis Research & Therapy.
“There is a disparity between the radiological and clinical evolution of HOA,” Audrey Neuprez, MD, MPH, of the University of Liège, in Belgium, and colleagues wrote. “Symptomatic disease is considerably less frequent than radiological disease, and HOA patients often present varying degrees of symptoms including asymptomatic disease. Presumably, a more severe subset is characterized by radiographic evidence of erosions.”
“Previously, we assessed the magnitude and the determinants of the esthetic discomfort generated by HOA using the baseline data of a cohort of 203 patients diagnosed with HOA, the Liège Hand Osteoarthritis Cohort (LIHOC),” they added. “These patients were subsequently followed in an observational study over a 2-year period.”
To gain a greater understanding of hand OA disease course over time, Neuprez and colleagues continued to analyze the magnitude and detriments of clinical and radiological progression among patients enrolled in LIHOC during a prospective, 2-year follow-up. The 203 participants were initially enrolled between February 2013 and August 2014, from the specialized unit for musculoskeletal health at the University Hospital, in Liège, Belgium. Diagnoses of hand OA were made according to the American College of Rheumatology X-ray clinical criteria.
The researchers assessed pain and function using the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), while the number of painful or swollen joints and nodes were counted during clinical examination. X-rays were scored using Kellgren-Lawrence (KL) and Verbruggen-Veys scales. Neuprez and colleagues defined clinical progression as an AUSCAN deterioration greater than or equal to the minimal clinically important difference. Radiographic progression was defined as follows: One new erosive or remodeled joint, progression of at least one anatomical stage in one joint, or change in KL total score above the smallest detectable difference.
The researchers used logistic regression to analyze whether patient characteristics influenced clinical and radiological progression.
According to the researchers, all radiographic scores deteriorated significantly in the study population (P < .05), and the number of proximal and distal interphalangeal nodes was significantly higher (P < .01), after 2 years. Meanwhile, AUSCAN, the number of painful joints at rest or at pressure, the number of swollen joints and the pain measure on a visual analog scale all remained unchanged.
At the individual level, the number of patients with clinically meaningful progression ranged from 25% to 42%, for clinical progression, and from 22% to 76%, for radiological progression. The only significant predictor of worsening of total AUSCAN was an AUSCAN pain subscale of less than74.5 (OR = 1.02; 95% CI, 1.01-1.03). The presence of at least four swollen joints (OR = 2.78; 95% CI, 1.21-6.39) and erosive osteoarthritis (OR = 13.23; 95% CI, 5.07-34.56) at baseline predicted a new erosive joint. In addition, meaningful changes in KL were more frequent with painful joints at baseline (OR = 3.43; 95% CI, 1.68-7.01).
“We observed radiological progression of HOA in our cohort over 2years, whichever assessment scale was used, and without evidence for clinical worsening of the AUSCAN composite measure of pain, function, and stiffness, suggesting an absence of correlation between the two measures of disease progression,” Neuprez and colleagues wrote. “However, at the individual level, we identified a subset of our population who experienced a relevant clinical and/or radiological worsening of HOA.”
“The proportion of progressors varied between 25% and 75% of the entire sample based on the tool selected to define progression,” they added. “Some baseline features were identified as significant predictors of greater HOA progression including pain level for clinical progression and the presence of erosive or swollen joints for radiological progression. These results support previous publications and may aid the early identification of HOA patients who may benefit most from early intervention.”
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