W. Damman

Bone marrow lesions and synovitis on MRI associate with radiographic progression after 2 years in hand osteoarthritis

Objective To study the association of magnetic resonance (MR) features with radiographic progression of hand osteoarthritis over 2u2005years. Methods Of 87 primary patients with hand osteoarthritis (82% women, mean age 59u2005years), baseline distal and proximal interphalangeal joint contrast-enhanced MR images were scored 0–3 for bone marrow lesions (BMLs) and synovitis following the Oslo score. Baseline and 2-year follow-up radiographs were scored following Kellgren-Lawrence (KL) (0–4) and OsteoArthritis Research Society International (OARSI) scoring methods (0–3 osteophytes, joint space narrowing (JSN)). Increase ≥1 defined progression. Associations between MR features and radiographic progression were explored on joint and on patient level, adjusting for age, sex, body mass index, synovitis and BML. Joints in end-stage were excluded. Results Of 696 analysed joints, 324 had baseline KL=0, 28 KL=4 and after 2u2005years 78 joints progressed. BML grade 2/3 was associated with KL progression (2/3 vs 0: adjusted risk ratio (RR) (95% CI) 3.3 (2.1 to 5.3)) and with osteophyte or JSN progression, as was synovitis. Summated scores were associated with radiographic progression on patient level (RR crude BML 1.08 (1.01 to 1.2), synovitis 1.09 (1.04 to 1.1), adjusted synovitis 1.08 (1.03 to 1.1)). Conclusions BMLs, next to synovitis, show, already after 2u2005years, graded associations with radiographic progression, suggesting that both joint tissues could be important targets for therapy.

Bone marrow lesions on magnetic resonance imaging in hand osteoarthritis are associated with pain and interact with synovitis

OBJECTIVEnTo determine the association between bone marrow lesions (BMLs) and (teno)synovitis as assessed on magnetic resonance (MR) imaging in patients with pain in hand osteoarthritis (OA).nnnMETHODSnIn 105 consecutive primary hand OA patients (83% women, mean age 59 years), who were diagnosed by rheumatologists and included in the HOSTAS (Hand OSTeoArthritis in Secondary care) cohort, contrast enhanced MR imaging of right distal and proximal interphalangeal joints were obtained. In 92 patients joint site specific pain upon palpation was assessed within 3 weeks of magnetic resonance imaging (MRI) examination. MR features were scored (0-3) following the Oslo hand OA score: BMLs, synovitis, cysts, flexor tenosynovitis (FTS). Additionally, extensor tendon inflammation (ETI) (0-3) was scored. Odds ratios (OR, 95% confidence interval (CI)) were calculated using generalized estimating equations for MR features with joint pain, adjusted for putative confounders. Stratified analyses were performed to investigate interaction.nnnRESULTSnBMLs, synovitis, cysts, FTS and ETI were demonstrated in 56%, 90%, 22%, 16% and 30% of patients, respectively. BMLs (grade 2/3 vs 0: 3.5 (1.6-7.7)) and synovitis (3 vs 0: OR 3.6 (95% CI 1.9-6.6)) were severity-dependent associated with joint pain, but FTS and ETI were not. Stratified analyses showed that BMLs did not associate with pain in the absence of synovitis, whereas synovitis was associated with pain in the absence of BMLs. Interaction was seen between BMLs and synovitis grade 2 or 3.nnnCONCLUSIONnIn hand OA patients severe synovitis is associated with joint pain, which is worsened when BMLs co-occur, suggesting synovitis as primary target of treatment.

Do Comorbidities Play a Role in Hand Osteoarthritis Disease Burden? Data from the Hand Osteoarthritis in Secondary Care Cohort

Objective. Because the association and its clinical relevance between comorbidities and primary hand osteoarthritis (OA) disease burden is unclear, we studied this in patients with hand OA from our Hand OSTeoArthritis in Secondary care (HOSTAS) cohort. Methods. Cross-sectional data from the HOSTAS study were used, including consecutive patients with primary hand OA. Nineteen comorbidities were assessed: 18 self-reported (modified Charlson index and osteoporosis) and obesity (body mass index ≥ 30 kg/m2). Mean differences were estimated between patients with versus without comorbidities, adjusted for age and sex: for general disease burden [health-related quality of life (HRQOL), Medical Outcomes Study Short Form-36 physical component scale (0–100)] and disease-specific burden [self-reported hand function (0–36), pain (0–20; Australian/Canadian Hand OA Index), and tender joint count (TJC, 0–30)]. Differences above a minimal clinically important improvement/difference were considered clinically relevant. Results. The study included 538 patients (mean age 61 yrs, 86% women, 88% fulfilled American College of Rheumatology classification criteria). Mean (SD) HRQOL, function, pain, and TJC were 44.7 (8), 15.6 (9), 9.3 (4), and 4.8 (5), respectively. Any comorbidity was present in 54% (287/531) of patients and this was unfavorable [adjusted mean difference presence/absence any comorbidity (95% CI): HRQOL −4.4 (−5.8 to −3.0), function 1.9 (0.4–3.3), pain 1.4 (0.6–2.1), TJC 1.3 (0.4–2.2)]. Number of comorbidities and both musculoskeletal (e.g., connective tissue disease) and nonmusculoskeletal comorbidities (e.g., pulmonary and cardiovascular disease) were associated with disease burden. Associations with HRQOL and function were clinically relevant. Conclusion. Comorbidities showed clinically relevant associations with disease burden. Therefore, the role of comorbidities in hand OA should be considered when interpreting disease outcomes and in patient management.

Coping styles and disability in patients with hand osteoarthritis

OBJECTIVEnCoping responses have been shown to determine health outcomes in chronic diseases. The aim of the study was to examine the role of joint-specific factors and coping styles on disability in patients with hand OA.nnnMETHODSnPrimary hand OA patients who consulted secondary care, underwent physical examination to assess the number of joints with bony joint enlargements, pain upon palpation, soft tissue swelling, deformities and limitations in motion. Coping styles were assessed with Coping with Rheumatic Stressors. Disability (score ≥5) was assessed by the Functional Index for Hand OA (possible score 0-30) cross-sectionally and after 1 year. With multivariate logistic regression, joint-specific variables and coping styles were associated with disability cross-sectionally and after 1 year, adjusted for age, sex and BMI.nnnRESULTSnA total of 314 patients (88% women, mean age 61.4 years) were included in the cross-sectional analyses; 68% were considered as disabled. Longitudinal data after 1 year were available in 173 patients (71% disabled). In multivariate analysis including all joint-specific factors, only painful joints and joints with limitations in motion were associated with disability. Disadvantageous scores for the coping scales (comforting cognitions, decreasing activity and pacing) were positively associated with disability cross-sectionally. Disability after 1 year was only associated with the coping scales decreasing activity and pacing. Joint-specific factors were also associated with disability, independent of coping styles.nnnCONCLUSIONnIn patients with hand OA, joint-specific factors and coping styles decreasing activity and pacing were both associated with disability. Our results suggest that interventions should aim at joint-specific complaints as well as changing coping styles to improve functional outcome.

Validity, reliability, responsiveness and feasibility of four hand mobility measures in hand osteoarthritis

ObjectivesnTo investigate metric properties of four hand mobility tests in hand OA patients, using the OMERACT filter.nnnMethodsnTrained assessors examined the Hand Mobility in Scleroderma test (HAMIS), fingertip-to-palm distance (FPD), modified Kapandji index (MKI) and number of hand joints with limited mobility in participants from two cohorts [Genetics ARthrosis and Progression (n = 207) and Hand OSTeoArthritis in Secondary care (n = 174)]. Validity was appraised by assessment of correlations with other outcome measures, and ability to measure thumb vs finger mobility specifically, using cumulative probability plots. The proportion of participants changing in hand mobility based on the smallest detectable difference was calculated for responsiveness. Intraclass correlation coefficients (ICCs) for intra- and interobserver reliability, and feasibility (time to perform tests) were studied in a random sample (n = 20).nnnResultsnParticipants displayed large variation in mobility scores. Strongest correlations were observed with structural damage (rs = 0.43-0.52) and bony swelling (rs = 0.46-0.58); correlation patterns were similar among tests. HAMIS, FPD and MKI could all measure finger mobility specifically, but only HAMIS measured thumb mobility particularly. Interobserver reliability was best for HAMIS, ICC 0.90 (95% CI: 0.76, 0.96); intraobserver reliability was excellent for all (ICCs 0.94-0.97). In 2 years, little change was observed; HAMIS was the most sensitive-to-change (smallest detectable difference 3.7% of maximum score). The mean performance time ranged from 0.7 (s.d. 0.5, for FPD) to 5.7 (s.d. 1.3, for HAMIS) min.nnnConclusionnHAMIS, FPD, MKI and number of joints with limited mobility are all valid, reliable and feasible measures for assessing hand mobility in hand OA, although HAMIS had slightly more favourable properties. Studies assessing sensitivity-to-change in a clinical trial setting are warranted.

Illness perceptions and their association with 2 year functional status and change in patients with hand osteoarthritis

ObjectivenTo investigate the association between illness perceptions and disability both cross-sectionally and over 2 years in patients with hand OA.nnnMethodsnIllness perceptions and self-reported disability were assessed at baseline and after 2 years in 384 patients with primary hand OA (mean age 61 years, 84% women, n = 312 with follow-up) with the Illness Perception Questionnaire - Revised (IPQ-R), Functional Index for Hand OA, Australian/Canadian Hand OA Index and HAQ. Risk ratios for high disability (highest quartile) at both time points were estimated for tertiles of IPQ-R dimensions, using Poisson regression. The mean IPQ dimension change difference between patients with and without disability progression (change Functional Index for Hand OA ⩾ 1, Australian/Canadian Hand OA Index > 1.4, HAQ > 0.22) was estimated with linear regression. Analyses were adjusted for age, Doyle index and baseline score.nnnResultsnAt baseline, stronger negative illness perceptions were associated with high disability. Baseline illness perceptions were also associated with high disability after 2 years, although adjustment made apparent that these associations were confounded by baseline disability status. Most illness perceptions changed over 2 years; understanding increased, OA was regarded as more chronic and fewer emotions and consequences and less personal and treatment control were experienced. The 2 year change in disability was different between patients with and without progression for the illness perceptions of more perceived consequences, symptoms, treatment control and emotions.nnnConclusionnIllness perceptions seemed to be implicated in disability and its progression. Our results suggest that interventions could focus on improving baseline disability, potentially using illness perceptions to accomplish this goal.

Performance of the Michigan Hand Outcomes Questionnaire in hand osteoarthritis

OBJECTIVEnTo investigate the performance of the Michigan Hand Outcomes Questionnaire (MHQ) in hand osteoarthritis (OA) by evaluating truth, discrimination and feasibility.nnnDESIGNnSymptomatic hand OA patients from the Hand Osteoarthritis in Secondary Care (HOSTAS) cohort completed questionnaires (demographics, MHQ, Australian/Canadian Hand Osteoarthritis Index [AUSCAN], Functional Index for Hand Osteoarthritis [FIHOA] and visual analogue scale [VAS] pain) at baseline (nxa0=xa0383), 1- and 2-year follow-up (nxa0=xa0312, nxa0=xa0293). Anchor questions at follow-up assessed whether pain/function levels were (un)acceptable and had changed compared to baseline. Correlations between MHQ and other pain/function questionnaires were calculated. Validity of unique MHQ domains (work performance, aesthetics, satisfaction), discrimination across disease stages, and responsiveness were assessed by categorizing patients by external anchors (employment, joint deformities, erosions, and anchor questions). Between-group differences were assessed with linear regression, probability plots and comparison of medians.nnnRESULTSnMHQ pain and function subscales correlated moderately-to-good with other instruments (rs 0.63-0.81). Work performance scores were worse in patients with reduced working capacity than in employed patients. Aesthetics scores were worse in patients with more deformities. Patients with unacceptable complaints had worse satisfaction scores. All pain/function instruments discriminated between patients with acceptable vs unacceptable pain/function, while only MHQ activities of daily living (ADL), FIHOA, and MHQ aesthetics could discriminate between erosive and non-erosive disease. MHQ and AUSCAN were most responsive.nnnCONCLUSIONSnMHQ has several unique aspects and advantages justifying its use in hand OA, including the unique assessment of work performance, aesthetics, and satisfaction. However, MHQ, AUSCAN and FIHOA appear to measure different aspects of pain and function.

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

SAT0478 Comorbidity in Hand Osteoarthritis: Its Impact on Hand Pain and Function

Background Although hand pain and function are important complaints in patients with hand osteoarthritis (OA), their determinants are unclear. Comorbidity is shown to be associated with complaints in knee and hip OA. Objectives Therefore, we studied the association of comorbidities with hand pain and function in hand OA patients. Methods Cross-sectional data were used of the HOSTAS (Hand OSTeoArthritis in Secondary care) study, which included consecutive patients diagnosed by their treating rheumatologist with primary hand OA from 2009 to 2015. Self-reported comorbidity was assessed by a 17-item list (modified Charlson index). Additionally, presence of knee and/or hip OA (poly OA) was determined by fulfilling the ACR criteria and presence of obesity by body mass index (BMI) ≥30 kg/m2. Number of comorbidities (max 19) and groups of comorbidities (figure) were studied. Self-reported hand pain (0–20) and hand function (0–36) were assessed by Australian/Canadian Hand OA Index (AUSCAN, Likert scale), where higher scores mean worse health. Multivariable linear regression analysis was used to associate comorbidities with hand pain and function, adjusting for age, sex and education (3 categories, as proxy for socioeconomic status). To assess clinical relevance, we compared mean differences between absence and presence of specific comorbidities, with the minimal clinically important improvement (MCII, published by Bellamy et al.), which was 1.6 (95%CI 1.0 to 2.0) for pain and 1.4 (0.1 to 2.2) for function. Results 538 patients were included with a mean (SD) age of 61 (9) years, mean BMI of 27 (5) kg/m2, 86% women and 91% fulfilling the ACR hand OA criteria. 27% had a low education level. 38% of patients reported ≥1 comorbidity (of 17), 24% had poly OA (mainly knee) and 23% had obesity. Mean (SD) pain and function were 9.3 (4.3) and 15.6 (8.5), where women had worse scores than men. Presence of any comorbidity was associated with worse pain and function; mean difference (95%CI) pain 1.1 (0.3 to 1.9) and function 1.8 (0.2 to 3.3). Also the number of comorbidities resulted in worse complaints (regression coefficient (95%CI) pain 0.8 (0.4 to 1.1) and function 1.4 (0.8 to 2.1)). Presence of poly OA or lung disease was associated with both pain and function, while presence of cardiovascular disease was associated with pain only and osteoporosis with function only. Other comorbidities, like obesity, were not associated (figure). For pain, only the presence of cardiovascular disease was similar to the MCII, while all associations (i.e. presence of any comorbidity, poly OA, osteoporosis and lung disease) were clinically relevant for function. For example, presence of lung disease resulted in 3.4 points higher (worse) score for function (figure), while MCII was 1.4, so this difference could be considered clinically relevant. Conclusions Presence as well as number of comorbidities showed a clinically relevant association with self-reported hand pain and function in patients with hand OA. Remarkably, as in knee OA, not only musculoskeletal comorbidity was associated with hand symptoms, but also non-musculoskeletal comorbidities (lung and cardiovascular disease). Further studies should investigate the role of comorbidities in clinical burden in hand OA and how these can be modified. Disclosure of Interest None declared