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Margreet Kloppenburg - One of the best experts on this subject based on the ideXlab platform.
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Performance of the Michigan Hand Outcomes Questionnaire in Hand Osteoarthritis.
Osteoarthritis and cartilage, 2018Co-Authors: Féline P B Kroon, A. Boersma, Annelies Boonen, S. Van Beest, W. Damman, D. Van Der Heijde, Frits R. Rosendaal, Margreet KloppenburgAbstract:Summary Objective To investigate the performance of the Michigan Hand Outcomes Questionnaire (MHQ) in Hand Osteoarthritis (OA) by evaluating truth, discrimination and feasibility. Design Symptomatic 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 (n = 383), 1- and 2-year follow-up (n = 312, n = 293). 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. Results MHQ 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. Conclusions MHQ 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.
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SP0161 2018 eular recommendations for the management of Hand Osteoarthritis
SATURDAY 16 JUNE 2018, 2018Co-Authors: Margreet KloppenburgAbstract:Hand Osteoarthritis is a prevalent Osteoarthritis phenotype, with high disease burden. With regard to the management of patients with Hand Osteoarthritis European League Against Rheumatism (EULAR) recommendations have been formulated in 2007. However, new evidence has emerged and therefore the recommendations have been updated by an international task force of experts, including rheumatologists, health professionals, plastic surgeon and patient representatives. First, a systematic literature review was performed, collecting evidence regarding non-pharmacological, pharmacological and surgical treatment options. Second, based on the evidence and expert opinion, five overarching principles were formulated, referring to treatment goal, information provision, individualised treatment, shared-decision making and need to consider multidisciplinary and multimodal treatment approaches. In addition ten recommendations were formulated, describing non-pharmacological, pharmacological and surgical options, and considerations about follow-up. Finally, a level of evidence, grade of recommendation and level of agreement were allocated by all experts to each statement. With the updated EULAR recommendations evidence-based up-to-date guidance can be provided on the management of Hand OA. Disclosure of Interest M. Kloppenburg Grant/research support from: Pfizer, IMI-APPROACH, Consultant for: GlaxoSmithKline, Abbvie
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Aesthetic dissatisfaction in patients with Hand Osteoarthritis and its impact on daily life.
Scandinavian journal of rheumatology, 2015Co-Authors: R. Liu, W. Damman, Frits R. Rosendaal, Ljj Beaart-van De Voorde, Ad A. Kaptein, Twj Huizinga, Margreet KloppenburgAbstract: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...
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Hand Osteoarthritis-nonpharmacological and pharmacological treatments.
Nature reviews. Rheumatology, 2014Co-Authors: Margreet KloppenburgAbstract:Hand Osteoarthritis (OA) is a common disease and the prevalence is expected to increase further with ageing of the general population. In this comprehensive Review, Margreet Kloppenburg describes the nonpharmacological and pharmacological management strategies currently available to alleviate the symptoms of Hand OA.
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Adiposity and Hand Osteoarthritis: the Netherlands Epidemiology of Obesity study
Arthritis research & therapy, 2014Co-Authors: A. Willemien Visser, Frits R. Rosendaal, Andreea Ioan-facsinay, Renée De Mutsert, Ralph L. Widya, Marieke Loef, Albert De Roos, Saskia Le Cessie, Martin Den Heijer, Margreet KloppenburgAbstract:Introduction Obesity, usually characterized by the body mass index (BMI), is a risk factor for Hand Osteoarthritis (OA). We investigated whether adipose tissue and abdominal fat distribution are associated with Hand OA.
M Kloppenburg - One of the best experts on this subject based on the ideXlab platform.
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Do Comorbidities Play a Role in Hand Osteoarthritis Disease Burden? Data from the Hand Osteoarthritis in Secondary Care Cohort
The Journal of rheumatology, 2017Co-Authors: W. Damman, Tom W J Huizinga, Féline P B Kroon, F.r. Rosendaal, Monique Reijnierse, R. Liu, M KloppenburgAbstract: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.
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Intra-Articular Therapies in the Treatment of Hand Osteoarthritis: A Systematic Literature Review
Drugs & aging, 2015Co-Authors: Féline P B Kroon, Roxana Rubio, Jan W. Schoones, M KloppenburgAbstract:Background Local treatments to alleviate symptoms in Hand Osteoarthritis (OA) are preferred, especially in elderly patients with comorbidities. Therefore, we have summarized the benefits and harms of intra-articular (IA) therapies.
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Hand Osteoarthritis a heterogeneous disorder
Nature Reviews Rheumatology, 2012Co-Authors: M Kloppenburg, W.y. KwokAbstract:Hand Osteoarthritis (OA) is a prevalent disorder. Hand OA is not one single disease, but a heterogeneous group of disorders. Radiographic signs of Hand OA, such as osteophytes or joint space narrowing, can be found in up to 81% of the elderly population. Several Hand OA subsets--such as nodal interphalangeal OA, thumb base OA and erosive OA--can be discriminated. Furthermore, the experience of symptoms and the course of the disease differ between patients. Studies that used well-defined study populations with longitudinal follow-up have shown that similarities and differences can be observed in the pathogenesis, epidemiology and risk factors of the various Hand OA subsets. Erosive OA in particular, characterized by erosive lesions on radiographical images, has a higher clinical burden and worse outcome than nonerosive Hand OA. Imaging modalities (such as ultrasonography) have increased our knowledge of the role of inflammation of the disease. Our understanding of the heterogeneous nature of Hand OA can eventually lead to increased knowledge of the pathogenesis of, and ultimately new treatment modalities for, this complex disease.
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association between weight or body mass index and Hand Osteoarthritis a systematic review
Annals of the Rheumatic Diseases, 2010Co-Authors: Erlangga Yusuf, Rob G H H Nelissen, A Ioanfacsinay, Vedrana Stojanovicsusulic, J Degroot, Gerjo J V M Van Osch, S Middeldorp, Tom W J Huizinga, M KloppenburgAbstract:Objective: To investigate the association between weight or body mass index (BMI) and the development of Hand Osteoarthritis. Methods: Systematic review of observational studies. Medical databases were searched up to April 2008. Articles that presented data on the association between weight and Hand Osteoarthritis were selected. The qualities of these studies were then assessed by two independent reviewers using a 19 criteria scoring system. Using the mean scores of all studies as a cut-off value, the studies were deemed as high or low quality. Study quality and study designs were combined to determine the level of evidence using best-evidence synthesis, which consisted of fi ve levels of evidence. Results: From the 25 studies included, two had cohort, three case-control and 20 cross-sectional study designs. Fifteen studies were considered high-quality studies. Of these high-quality studies, one cohort, two case-control and seven cross-sectional studies showed a positive association between weight or BMI and Hand Osteoarthritis. Based on three high-quality studies with preferred study designs (one cohort and two case-control) with a positive association, the level of evidence of the association between overweight and developing Hand Osteoarthritis is moderate. The approximate risk ratio of this association is 1.9. Conclusion: Weight or BMI is associated with the development of Hand Osteoarthritis. The level of evidence of published studies is moderate according to best-evidence synthesis. Further high-quality cohort or case-control studies are needed to elucidate the role of weight in Hand Osteoarthritis.
Tom W J Huizinga - One of the best experts on this subject based on the ideXlab platform.
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Do Comorbidities Play a Role in Hand Osteoarthritis Disease Burden? Data from the Hand Osteoarthritis in Secondary Care Cohort
The Journal of rheumatology, 2017Co-Authors: W. Damman, Tom W J Huizinga, Féline P B Kroon, F.r. Rosendaal, Monique Reijnierse, R. Liu, M KloppenburgAbstract: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.
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In erosive Hand Osteoarthritis more inflammatory signs on ultrasound are found than in the rest of Hand Osteoarthritis
Annals of the rheumatic diseases, 2012Co-Authors: Marion C Kortekaas, W.y. Kwok, Tom W J Huizinga, Monique Reijnierse, Margreet KloppenburgAbstract:Objective To compare inflammation as assessed by ultrasound between patients with the subset erosive Hand Osteoarthritis (EOA) versus non-EOA. Methods Consecutive Hand Osteoarthritis (HOA) patients (fulfilling ACR criteria) were included. Eighteen interphalangeal joints were scored on radiographs using the Verbruggen–Veys anatomical phase score; E and R phases were defined as erosive. Patients were assigned to EOA when at least one joint was erosive. Effusion, synovial thickening and power Doppler signal (PDS) were scored with ultrasound on a 4-point scale. Generalised estimated equation analyses were used to compare ultrasound features between EOA and HOA, and to associate ultrasound features with.anatomical phases; OR with 95% CI were calculated with adjustments for patient effects and confounders. Results Of 55 HOA patients (mean age 61 years, 86% women) 51% had EOA. In 94 erosive joints, synovial thickening, effusion and PDS were found in 13%, 50% and 15%, respectively; in 896 non-erosive joints in 10%, 26% and 8%, respectively. In summated scores of PDS, effusion was higher in EOA than in non-EOA. Effusion and synovial thickening were more frequent in S, J, E and R phases compared to N phase. PDS was only associated with E phase (OR 5.3, 95% CI 1.3 to 20.5) not with other phases. Non-erosive joints in EOA demonstrated more PDS (OR 3.2, 95% CI 1.6 to 6.4) and effusion (OR 2.2, 95% CI 1.2 to 3.8) in comparison to joints in non-EOA. Conclusions Inflammatory signs are more frequent in EOA than in non-EOA, not only in erosive joints but also in non-erosive joints, suggesting an underlying systemic cause for erosive evolution.
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Role of rheumatology clinical nurse specialists in optimizing management of Hand Osteoarthritis during daily practice in secondary care: an observational study
Journal of multidisciplinary healthcare, 2011Co-Authors: W.y. Kwok, Margreet Kloppenburg, Tom W J Huizinga, Liesbeth J J Beaart-van De Voorde, Thea P. M. Vliet VlielandAbstract:BACKGROUND The purpose of this study was to describe the effectiveness of a single one-hour consultation by a clinical nurse specialist in patients with Hand Osteoarthritis during daily rheumatology practice in secondary care. METHODS Consecutive patients diagnosed by rheumatologists to have primary Hand Osteoarthritis and referred to the clinical nurse specialist were eligible for entry into this study. The standardized 1-hour consultation consisted of assessments and education on Hand Osteoarthritis by a clinical nurse specialist. Before and 3 months after the consultation, assessments were done to evaluate treatment (use of assistive devices, acetaminophen), health-related quality of life (physical component summary [PCS] score of Short-Form 36), and Hand pain/function (Australian/ Canadian Osteoarthritis Hand Index [AUSCAN]). Paired t-tests and McNemar tests were used to analyze differences between baseline and follow-up. Satisfaction was measured after consultation at follow-up using a multidimensional questionnaire comprising 13 items (rated on a four-point scale). RESULTS A total of 439 patients were referred, with follow-up data available for 195 patients, comprising 177 (87%) females, and of mean age 59 ± 9.0 years. After consultation, the proportions of patients using assistive devices and/or acetaminophen increased significantly from 30% to 39% and from 35% to 49%, respectively. PCS improved significantly (P = 0.03) whereas AUSCAN Hand pain/function showed no significant differences compared with baseline (P values 0.52 and 0.92, respectively). The proportions of patients reporting to be satisfied or fully satisfied ranged from 78% to 99% per item. CONCLUSION A single, comprehensive, standardized assessment and education by a clinical nurse specialist improved the physical dimension of health-related quality of life in Hand Osteoarthritis. Most patients were satisfied with the consultation. Further controlled trials are needed to determine the added value of the clinical nurse specialist in care for Hand Osteoarthritis.
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association between weight or body mass index and Hand Osteoarthritis a systematic review
Annals of the Rheumatic Diseases, 2010Co-Authors: Erlangga Yusuf, Rob G H H Nelissen, A Ioanfacsinay, Vedrana Stojanovicsusulic, J Degroot, Gerjo J V M Van Osch, S Middeldorp, Tom W J Huizinga, M KloppenburgAbstract:Objective: To investigate the association between weight or body mass index (BMI) and the development of Hand Osteoarthritis. Methods: Systematic review of observational studies. Medical databases were searched up to April 2008. Articles that presented data on the association between weight and Hand Osteoarthritis were selected. The qualities of these studies were then assessed by two independent reviewers using a 19 criteria scoring system. Using the mean scores of all studies as a cut-off value, the studies were deemed as high or low quality. Study quality and study designs were combined to determine the level of evidence using best-evidence synthesis, which consisted of fi ve levels of evidence. Results: From the 25 studies included, two had cohort, three case-control and 20 cross-sectional study designs. Fifteen studies were considered high-quality studies. Of these high-quality studies, one cohort, two case-control and seven cross-sectional studies showed a positive association between weight or BMI and Hand Osteoarthritis. Based on three high-quality studies with preferred study designs (one cohort and two case-control) with a positive association, the level of evidence of the association between overweight and developing Hand Osteoarthritis is moderate. The approximate risk ratio of this association is 1.9. Conclusion: Weight or BMI is associated with the development of Hand Osteoarthritis. The level of evidence of published studies is moderate according to best-evidence synthesis. Further high-quality cohort or case-control studies are needed to elucidate the role of weight in Hand Osteoarthritis.
Krysia Dziedzic - One of the best experts on this subject based on the ideXlab platform.
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SP0044 Functional Consequences of Hand Osteoarthritis
Annals of the Rheumatic Diseases, 2016Co-Authors: Krysia DziedzicAbstract:Hand Osteoarthritis (OA) is not a single disease but a group of complex conditions ranging from a syndrome of joint pain accompanied by functional limitation to highly characterised subsets of radiographic Hand OA. Whilst Hand OA is one of the commonest forms of Osteoarthritis there is a “knowledge-to-practice” gap in recognising and addressing functional consequences of Hand OA across the clinical pathway. This presentation will consider functional consequences of Hand OA at four levels: societal (population level); health care delivery (organisational level); health care professional level; and the impact on the person living with Hand OA (individual level). It will draw on findings from three large cohorts of adults 50 years and over studied in North West Midlands, UK (n=30,000) (1–3) to describe the functional consequences of Hand OA at a population level. Findings from a randomised controlled trial (3), an implementation study (4) and qualitative data (5) will be used to illustrate health care (e.g. primary care; occupational therapy) for the functional consequences of Hand OA. The impact on the individual will be described using qualitative data of participant experiences of living with Hand OA (6). Proposals for closing the “knowledge-to-practice” gap for the functional consequences of Hand OA will be discussed. References Dziedzic K, Thomas E, Hill S, et al. The impact of musculoskeletal Hand problems in older adults: findings from the North Staffordshire Osteoarthritis Project (NorStOP). Rheumatology (Oxford). 2007Jun;46(6):963–7. Myers H, Nicholls E, Handy J, et al. The Clinical Assessment Study of the Hand (CAS-HA): a prospective study of musculoskeletal Hand problems in the general population. BMC Musculoskelet Disord. 2007 Aug 30;8:85. Dziedzic K, Nicholls E, Hill S, et al. Self-management approaches for Osteoarthritis in the Hand: a 2×2 factorial randomised trial. Ann Rheum Dis. 2015 Jan;74(1):108–18. Dziedzic KS, Healey EL, Porcheret M, et al. Implementing the NICE Osteoarthritis guidelines: a mixed methods study and cluster randomised trial of a model Osteoarthritis consultation in primary care – the Management of Osteoarthritis In Consultations (MOSAICS) study protocol. Implement Sci. 2014 Aug 27;9:95. Hill S, Dziedzic KS, Nio Ong B. Patients9 perceptions of the treatment and management of Hand Osteoarthritis: a focus group enquiry. Disabil Rehabil. 2011;33(19–20):1866–72. Hill S, Dziedzic KS, Ong BN. The functional and psychological impact of Hand Osteoarthritis. Chronic Illn. 2010 Jun;6(2):101–10. Disclosure of Interest None declared
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Recent advances in the diagnosis and management of Hand Osteoarthritis
International Journal of Clinical Rheumatology, 2013Co-Authors: Krysia DziedzicAbstract:Hand Osteoarthritis is a prevalent and heterogeneous condition and is one of the most common musculoskeletal conditions in adults aged 50 years and over. Hand Osteoarthritis frequently causes pain and functional limitation with subsequent reduction in health-related quality of life. The diagnosis and treatment of Hand Osteoarthritis can be challenging and a range of factors, including different clinical phenotypes, the numbers of joints affected and the impact on the individual, require a biopsychosocial approach to assessment and management. There are a number of international recommendations for the diagnosis and management of Hand Osteoarthritis and this review considers new evidence from July 2012 to December 2012 to report advances in the field. This review identifies new advances that may contribute to evidence-based practice.
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Osteoarthritis: best evidence for best therapies in Hand Osteoarthritis.
Nature reviews. Rheumatology, 2011Co-Authors: Krysia DziedzicAbstract:Nonpharmacological therapies are important in the management of Hand Osteoarthritis, but high quality evidence upon which to base guidelines for their clinical use has been lacking. A systematic review confined to such studies highlights the strengths and gaps in research in this field.
W.y. Kwok - One of the best experts on this subject based on the ideXlab platform.
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In erosive Hand Osteoarthritis more inflammatory signs on ultrasound are found than in the rest of Hand Osteoarthritis
Annals of the rheumatic diseases, 2012Co-Authors: Marion C Kortekaas, W.y. Kwok, Tom W J Huizinga, Monique Reijnierse, Margreet KloppenburgAbstract:Objective To compare inflammation as assessed by ultrasound between patients with the subset erosive Hand Osteoarthritis (EOA) versus non-EOA. Methods Consecutive Hand Osteoarthritis (HOA) patients (fulfilling ACR criteria) were included. Eighteen interphalangeal joints were scored on radiographs using the Verbruggen–Veys anatomical phase score; E and R phases were defined as erosive. Patients were assigned to EOA when at least one joint was erosive. Effusion, synovial thickening and power Doppler signal (PDS) were scored with ultrasound on a 4-point scale. Generalised estimated equation analyses were used to compare ultrasound features between EOA and HOA, and to associate ultrasound features with.anatomical phases; OR with 95% CI were calculated with adjustments for patient effects and confounders. Results Of 55 HOA patients (mean age 61 years, 86% women) 51% had EOA. In 94 erosive joints, synovial thickening, effusion and PDS were found in 13%, 50% and 15%, respectively; in 896 non-erosive joints in 10%, 26% and 8%, respectively. In summated scores of PDS, effusion was higher in EOA than in non-EOA. Effusion and synovial thickening were more frequent in S, J, E and R phases compared to N phase. PDS was only associated with E phase (OR 5.3, 95% CI 1.3 to 20.5) not with other phases. Non-erosive joints in EOA demonstrated more PDS (OR 3.2, 95% CI 1.6 to 6.4) and effusion (OR 2.2, 95% CI 1.2 to 3.8) in comparison to joints in non-EOA. Conclusions Inflammatory signs are more frequent in EOA than in non-EOA, not only in erosive joints but also in non-erosive joints, suggesting an underlying systemic cause for erosive evolution.
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Hand Osteoarthritis a heterogeneous disorder
Nature Reviews Rheumatology, 2012Co-Authors: M Kloppenburg, W.y. KwokAbstract:Hand Osteoarthritis (OA) is a prevalent disorder. Hand OA is not one single disease, but a heterogeneous group of disorders. Radiographic signs of Hand OA, such as osteophytes or joint space narrowing, can be found in up to 81% of the elderly population. Several Hand OA subsets--such as nodal interphalangeal OA, thumb base OA and erosive OA--can be discriminated. Furthermore, the experience of symptoms and the course of the disease differ between patients. Studies that used well-defined study populations with longitudinal follow-up have shown that similarities and differences can be observed in the pathogenesis, epidemiology and risk factors of the various Hand OA subsets. Erosive OA in particular, characterized by erosive lesions on radiographical images, has a higher clinical burden and worse outcome than nonerosive Hand OA. Imaging modalities (such as ultrasonography) have increased our knowledge of the role of inflammation of the disease. Our understanding of the heterogeneous nature of Hand OA can eventually lead to increased knowledge of the pathogenesis of, and ultimately new treatment modalities for, this complex disease.
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Hand Osteoarthritis—a heterogeneous disorder
Nature reviews. Rheumatology, 2011Co-Authors: Margreet Kloppenburg, W.y. KwokAbstract:Hand Osteoarthritis (OA) is a prevalent disorder. Hand OA is not one single disease, but a heterogeneous group of disorders. Radiographic signs of Hand OA, such as osteophytes or joint space narrowing, can be found in up to 81% of the elderly population. Several Hand OA subsets--such as nodal interphalangeal OA, thumb base OA and erosive OA--can be discriminated. Furthermore, the experience of symptoms and the course of the disease differ between patients. Studies that used well-defined study populations with longitudinal follow-up have shown that similarities and differences can be observed in the pathogenesis, epidemiology and risk factors of the various Hand OA subsets. Erosive OA in particular, characterized by erosive lesions on radiographical images, has a higher clinical burden and worse outcome than nonerosive Hand OA. Imaging modalities (such as ultrasonography) have increased our knowledge of the role of inflammation of the disease. Our understanding of the heterogeneous nature of Hand OA can eventually lead to increased knowledge of the pathogenesis of, and ultimately new treatment modalities for, this complex disease.
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Role of rheumatology clinical nurse specialists in optimizing management of Hand Osteoarthritis during daily practice in secondary care: an observational study
Journal of multidisciplinary healthcare, 2011Co-Authors: W.y. Kwok, Margreet Kloppenburg, Tom W J Huizinga, Liesbeth J J Beaart-van De Voorde, Thea P. M. Vliet VlielandAbstract:BACKGROUND The purpose of this study was to describe the effectiveness of a single one-hour consultation by a clinical nurse specialist in patients with Hand Osteoarthritis during daily rheumatology practice in secondary care. METHODS Consecutive patients diagnosed by rheumatologists to have primary Hand Osteoarthritis and referred to the clinical nurse specialist were eligible for entry into this study. The standardized 1-hour consultation consisted of assessments and education on Hand Osteoarthritis by a clinical nurse specialist. Before and 3 months after the consultation, assessments were done to evaluate treatment (use of assistive devices, acetaminophen), health-related quality of life (physical component summary [PCS] score of Short-Form 36), and Hand pain/function (Australian/ Canadian Osteoarthritis Hand Index [AUSCAN]). Paired t-tests and McNemar tests were used to analyze differences between baseline and follow-up. Satisfaction was measured after consultation at follow-up using a multidimensional questionnaire comprising 13 items (rated on a four-point scale). RESULTS A total of 439 patients were referred, with follow-up data available for 195 patients, comprising 177 (87%) females, and of mean age 59 ± 9.0 years. After consultation, the proportions of patients using assistive devices and/or acetaminophen increased significantly from 30% to 39% and from 35% to 49%, respectively. PCS improved significantly (P = 0.03) whereas AUSCAN Hand pain/function showed no significant differences compared with baseline (P values 0.52 and 0.92, respectively). The proportions of patients reporting to be satisfied or fully satisfied ranged from 78% to 99% per item. CONCLUSION A single, comprehensive, standardized assessment and education by a clinical nurse specialist improved the physical dimension of health-related quality of life in Hand Osteoarthritis. Most patients were satisfied with the consultation. Further controlled trials are needed to determine the added value of the clinical nurse specialist in care for Hand Osteoarthritis.
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Erosive Hand Osteoarthritis: its prevalence and clinical impact in the general population and symptomatic Hand Osteoarthritis
Annals of the rheumatic diseases, 2011Co-Authors: W.y. Kwok, Margreet Kloppenburg, F.r. Rosendaal, J.b. Van Meurs, A. Hofman, S.m.a. Bierma-zeinstraAbstract:Objective To estimate the prevalence of erosive Hand Osteoarthritis (EOA) in the general population and its relation to symptomatic Hand Osteoarthritis (HOA), Hand pain and disability. Methods Baseline data of participants from a population-based study (age ≥55 years) were used. Symptomatic HOA was defined as Hand pain and in addition to radiographic HOA (at least one interphalangeal (IP) joint or 1st carpometacarpal joint with Kellgren–Lawrence grade ≥2). EOA was defined as having at least one IP joint with erosions according to the Verbruggen–Veys scoring method. Hand pain and disability were self-reported. Multivariate logistic regression analyses were used to estimate the effect of EOA on pain and disability. Results were presented as OR with a 95% CI, adjusted for age and sex. Results Of 3430 participants, radiographic HOA was seen in 56% (n=1916) and symptomatic HOA in 11% (n=371). Erosions were seen in 96 subjects. The prevalence of EOA in the general, radiographic and symptomatic HOA population was 2.8%, 5.0% and 10.2%, respectively. Presence of EOA led to adjusted ORs for pain of 3.6 (95% CI 2.4 to 5.6) and for disability 2.4 (95% CI 1.1 to 5.4). In radiographic HOA, people with erosion(s) had more Hand pain (adjusted OR=3.1, 95% CI 2.0 to 4.8) or disability (adjusted OR=2.5, 95% CI 1.1 to 5.8) than people without erosion(s). Conclusion The prevalence of EOA is 2.8% in the general population and 10.2% in individuals with symptomatic HOA. It has a substantial impact on Hand pain and disability.
