R. Liu

Mortality in osteoarthritis patients

Objectives: To investigate whether all-cause mortality and deaths due to cardiovascular disease are increased in patients who have consulted primary or secondary health care with symptoms and signs of osteoarthritis (OA). Method: This study included 383 patients with symptomatic OA at multiple sites from the Genetics ARthrosis and Progression (GARP) study (mean age 60 years, 82% women, 3693 person-years of follow-up) and 459 patients with primary hand, knee, or hip OA from the Osteoarthritis Care Clinic (OCC) study (mean age 61 years, 88% women, 1890 person-years of follow-up). Standardized mortality ratios (SMRs) with 95% confidence intervals (CIs) were calculated for all-cause mortality and causes of deaths in comparison to the general population. Cox proportional hazard ratios (HRs) with 95% CIs were used to associate baseline characteristics with all-cause mortality. Results: In the GARP study, 26 patients died whereas 48 deaths were expected (SMR 0.54, 95% CI 0.37–0.79). The SMR was 0.47 (95% CI 0.29–0.76) in women and 0.73 (95% CI 0.39–1.35) in men. Similar results were found in the OCC study (SMR 0.45, 95% CI 0.25–0.82). Malignancy and cardiovascular disease were the main causes of deaths in GARP. Male sex (HR 3.04, 95% CI 1.38–6.69), increasing age (HR 1.10, 95% CI 1.05–1.16), and self-reported cancer (HR 8.29, 95% CI 3.12–22.03) were associated with increased mortality in GARP. Conclusions: Patients consulting health care for their OA are not at higher risk of death than the general population. These results suggest that the management of OA patients may not need to focus specifically on the treatment of cardiovascular risk factors and comorbidities.

Aesthetic dissatisfaction in patients with hand osteoarthritis and its impact on daily life.

Objectives: To evaluate the nature and extent of aesthetic dissatisfaction in patients with hand osteoarthritis (OA), and to investigate its impact on daily life and its determinants. Method: Patients with primary hand OA, consulting secondary care, underwent physical examination for the number of joints with bony joint enlargements, soft tissue swelling and deformities, and radiographs. Questionnaires were filled in to measure pain and function (Functional Index for Hand Osteoarthritis, FIHOA), dissatisfaction with the appearance of the hands and its impact (aesthetic scales from the Michigan Hand Outcomes Questionnaire, MHQ), anxiety and depression (the Hospital Anxiety and Depression Scale, HADS), and illness perceptions (the revised Illness Perception Questionnaire, IPQ-R). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate logistic regression as measures of relative risk for dissatisfaction with appearance or its impact, adjusted for age, sex, body mass index (BMI), and joint-specific abnormalities (bony joint enlargements, deformities, or radiographic severity), self-reported pain and function. Results: Of 247 patients (mean age 61.6 years, 88% women), 63 (26%) were aesthetically dissatisfied and 33 (13%) reported impact on daily life due to dissatisfaction. Patients with joint-specific abnormalities were at higher risk for reporting dissatisfaction. Patients who reported impact also reported more depression and negative illness perceptions, independently from joint-specific abnormalities. Conclusions: Hand OA patients report aesthetic dissatisfaction with their hands regularly, especially in those with joint abnormalities. This dissatisfaction has a negative impact in a small group of patients who also reported more depression and negative illness perceptions. These results indicate the influence of psychosocial factors on outcome measures in patients with hand OA.

OP0342 Assessment of structural damage of the thumb base in patients with hand osteoarthritis: comparing the newly developed omeract magnetic resonance imaging scoring system with standard radiography

Background The thumb base is frequently involved in patients with hand osteoarthritis (OA), resulting in osteophytes and cartilage loss. Radiography is the most commonly used imaging modality to evaluate structural OA signs, however it is insensitive especially due to overprojection. Magnetic resonance imaging (MRI) could be a valuable alternative, however a standardized scoring method for thumb base MR images did not exist until recently OMERACT developed the thumb base OA MRI scoring system (TOMS)1. Objectives Our aim was to investigate the validity of the new TOMS by comparing TOMS scores with radiographic scores. Methods Two hundred consecutively included patients (83.5% women, median age 60.5 years) diagnosed with primary hand OA in secondary care, who had both a dorsopalmar radiograph of the right hand and a MRI scan of the right thumb base taken at baseline, were studied. T1- and fat suppressed T2-turbo spin weighted sequences were performed in axial and coronal planes on a 1.5 Tesla extremity MRI unit. Radiographs of the first carpometacarpal (CMC1) and scaphotrapeziotrapezoid (STT) joints were scored using the OARSI atlas (osteophytes and joint space narrowing [JSN] in CMC1: 0–3 and STT: absent/present) by one reader with good intra-reader reliability, blinded for clinical and MRI data. MR images were scored using TOMS (osteophytes in CMC1: 0–6 and STT: 0–9; cartilage space loss [CSL] for both joints: 0–3) by two readers, blinded for clinical and radiographic data, with good intra- and inter-reader reliability. For further analysis we used the average of both readers, rounded down to the nearest integer. To study validity, the distribution of the TOMS scores for osteophytes and CSL were compared for the different radiographic stages for osteophytes and JSN, respectively. Results On MR images osteophytes were detected in the vast majority of thumb bases (CMC1 n=172; STT n=102). The score of TOMS increased with more severe radiographic stages (see figures). However, the number of patients without any osteophytes in both CMC1 and STT was considerably lower for TOMS (n=19) than for the OARSI (n=106) scoring. A similar difference was apparent for absence of CSL (n=82) versus JSN (n=108) in both CMC1 and STT. Patients with isolated STT osteophytes were quite rare for both TOMS (n=9) and the OARSI (n=5) scoring. The most prominent discrepancy between TOMS and OARSI sensitivity was found for osteophytes: an additional 168 joints (CMC1 n=84; STT n=84) were found positive with TOMS, while only 1 OARSI-positive CMC1 scored negative with TOMS. Conclusions Scores of osteophytes and cartilage loss assessed on MR images by TOMS were correlated with radiographic scores, indicating good validity of the TOMS. Furthermore, the frequencies of joints with osteophytes and cartilage loss assessed on MR images were higher compared to those on radiographs, suggesting high sensitivity for the TOMS. References Kroon FPB, Conaghan P, Foltz V, et al. Development and reliability of the OMERACT thumb base osteoarthritis MRI scoring system. J Rheumatol. 2017; in press. Disclosure of Interest None declared

SAT0512 MRI providing insights in association of synovitis and bone marrow lesions (BMLS) with pain in thumb base osteoarthritis (OA)

Background Hand OA affects the interphalangeal (IP) and thumb base joints (first carpometacarpal [CMC1] and scaphotrapeziotrapezoid [STT]). Much is still unknown about the pathophysiology of thumb base OA. Magnetic resonance imaging (MRI) studies have led to new insights in IP OA, but in absence of a scoring system thumb base MRI studies are lacking. Objectives Investigate the prevalence of MRI synovitis and BMLs in the thumb base, and their association with pain, using the novel OMERACT thumb base OA MRI scoring system (TOMS)1. Methods Cross-sectional data of the Hand OSTeoArthritis in Secondary care (HOSTAS) study, including consecutive patients diagnosed by their treating rheumatologist with primary hand OA, were used. Patients with an MRI of the right thumb base at baseline were included in the analysis. MRIs were scored by two readers using the TOMS for synovitis and bone marrow lesions (BMLs) in the CMC1 and STT joints (grade 0–3). BMLs were evaluated in the proximal and distal joint parts separately, resulting in a 0–6 and 0–9 sum score for CMC1 and STT, respectively. Pain on palpation of the thumb base was assessed by trained research nurses. Hand radiographs were assessed for presence of osteophytes in the CMC1 and STT joints. Associations between MRI lesions and thumb base tenderness were analysed using logistic regression, presented as odds ratios (ORs) with 95% confidence intervals (CIs), stratified for absence or presence of radiographic osteophytes. For the analyses synovitis and BML scores were aggregated into a dichotomous total thumb base involvement score (0–1 in both joints vs ≥2 in at least one joint). Results 85 out of 202 patients (84% women, mean age 60.1 years) reported pain on palpation in the thumb base. Synovitis was seen in both thumb base joints (CMC1 42%, STT 37%), although prevalence of grade 2–3 synovitis was low in both the CMC1 (16%) and STT (14%). BMLs were present in CMC1 and STT in 54 and 53%, respectively, with 18 and 21% having a sum score of 2–3, and 16 and 7% a sum score ≥4. In absence of radiographic osteophytes, presence of synovitis or BMLs in either thumb base joint was not statistically significantly associated with thumb base tenderness (ORs 1.9 [95% CI 0.6–6.4] and 1.5 [0.5–4.3], respectively). However, in absence of synovitis or BMLs, radiographic osteophytes and pain were associated, with increasing ORs when MRI lesions were additionally present (Table). Similar results were found for self-reported thumb base pain (not shown). Conclusions Synovitis and BMLs are present in the thumb base, although severe MRI lesions were uncommon. Prevalence of synovitis was similar in the CMC1 and STT joints, although higher BML scores were more frequently seen in CMC1. Radiographic osteophytes seemed more important in predicting thumb base tenderness than MRI inflammation alone. Combined presence of radiographic osteophytes and MRI lesions had a small additive effect. These findings are in contrast to results from IP OA studies, supporting thumb base OA as a distinct hand OA subset. It might also explain why trials investigating intra-articular corticosteroids in thumb base OA have led to equivocal results. References Kroon F, Conaghan P, Foltz V, et al. J Rheumatol 2017 (in press). Disclosure of Interest None declared