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Objective: To study the association of magnetic resonance (MR) features with radiographic progression of hand osteoarthritis over 2 years.Methods: Of 87 primary patients with hand osteoarthritis (82% women, mean age 59 years), 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 2 years 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 2 years, graded associations with radiographic progression, suggesting that both joint tissues could be important targets for therapy. [ABSTRACT FROM AUTHOR]

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 selfreported. 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. [ABSTRACT FROM AUTHOR]

Objective In order to gain insight in the pathogenesis of erosive hand osteoarthritis (OA), the evolution of erosions in hand OA and risk factors involved were investigated. Methods The 6-year evolution in radiographic Verbruggen–Veys anatomical phase was assessed in interphalangeal joints of 236 patients with hand OA (mean age 59 years, 83% women) from the GARP (for ‘Genetics ARthrosis and Progression’) sibling pair study. Erosive evolution comprised phase transitions from non-erosive to erosive phases and from active erosions to remodelling. Clustering of erosive evolution within patients was assessed using the χ test. Familial aggregation was evaluated in sibling pairs by estimating ORs for siblings and probands sharing erosive evolution. Local baseline determinants and the effect of high sensitivity C reactive protein were assessed using generalised estimating equations. Results Erosive evolution took place in 181 of 4120 interphalangeal joints at risk (4.4%), corresponding to 60 patients (25.4% of study sample). Erosive evolution was found more often in multiple interphalangeal joints in one patient than would be expected by chance (χ 373.0, p<0.001). The adjusted OR (95% CI) for a sibling having erosive evolution if the proband had erosive evolution was 4.7 (1.4 to 15.8). Systemic inflammation was not associated with erosive activity. Independent local determinants were joint space narrowing (OR (95% CI) 8.9 (4.8 to 16.4)) and self-reported pain (OR (95%CI) 2.3 (1.1 to 4.7)). Conclusions Erosive evolution was clustered within patients and families. Local factors were also involved in the evolution. This increase in insight in the pathogenesis of erosive hand OA will contribute to the development of new treatments. [ABSTRACT FROM PUBLISHER]

Objective To investigate the long-term clinical and radiographic disease course of hand osteoarthritis (OA) and determinants of outcome. Methods Clinical and radiographic measures were obtained at baseline and after 6 years in 289 patients with hand OA (mean age 59.5 years, 83.0% women). Clinical outcomes were self-reported pain and functional limitations assessed with the Australian/Canadian Osteoarthritis Hand Index (AUSCAN). Poor clinical outcome was defined as a follow-up score not fulfilling the Patient Acceptable Symptom State. Radiographic outcome was assessed by osteophytes and joint space narrowing (JSN) on standardised hand radiographs using the Osteoarthritis Research Society International (OARSI) atlas. Radiographic progression was defined as a change in osteophytes or JSN, above the smallest detectable change. Change in outcome measures was calculated and baseline determinants for poor clinical outcome and radiographic progression were assessed using logistic regression analysis. Results Clinical change showed great variation, with half of the population reporting deterioration. Poor outcome in pain was related to high levels of functional limitations and a high number of painful joints at baseline. Poor outcome on functional limitations was related to high baseline pain levels. Radiographic progression was present in 52.5% of patients and associated with high baseline levels of pain, nodes, osteophytes and the presence of erosive OA and nodal OA. Clinical change and radiographic progression were not related. Conclusions This study gives insight in the clinical and radiographic course of hand OA as well as determinants of outcome. These findings enable better patient information on prognosis. The relationship between clinical and radiographic outcome needs further investigation. [ABSTRACT FROM PUBLISHER]

Objective To describe the clinical burden of erosive osteoarthritis (EOA) of the hand in terms of pain, functioning and health-related quality of life (HRQL) and its relationship to nodal osteoarthritis (OA). Methods Patients with EOA (n=42) and non-EOA (n=194) of the hand were compared. Pain was assessed with the Australian/Canadian Osteoarthritis Hand Index (AUSCAN), the Michigan Hand Outcome Questionnaire (MHQ) and pain intensity upon pressure. Functioning was evaluated with AUSCAN, MHQ, grip strength, pinch grip and hand mobility tests. HRQL was measured with the Short Form-36. Patient satisfaction with hand function and aesthetics were also evaluated. The presence of nodal OA as well as its extent (reflected by the number of nodes) was assessed. Mean differences between patient groups were estimated with linear mixed models. To determine whether differences were independent of the nodal character of the disease, adjustments were made for the number of nodes. Results Patients with EOA experienced more pain, more functional limitation, less satisfaction with hand function and aesthetics and worse hand mobility than patients with non-EOA. HRQL was similar for the two groups. Patients with EOA had more nodes. A higher number of nodes was associated with worse outcome. After correction for the number of nodes, only hand mobility and patient satisfaction remained different between the groups. Conclusion Patients with EOA have a higher clinical burden than those with non-erosive disease. This higher burden is only partly attributed to the erosive disease itself, but mainly to the nodal character of the disease. [ABSTRACT FROM PUBLISHER]

Objectives: To investigate the course of hand osteoarthritis over 2 years by currently available outcome measures. Methods: 189 participants of the Genetics, Arthrosis and Progression (GARP) study with hand osteoarthritis were followed for 2 years. Self-reported hand pain and functional limitations were assessed with the Australian/Canadian osteoarthritis hand index (AUSCAN LK 3.0). Pain intensity upon lateral pressure in the interphalangeal and thumb base joints was graded on a four-point scale. Osteophytes (0–3) and joint space narrowing (JSN) (0–3) was scored at baseline and after 2 years in interphalangeal and thumb base joints. Standardised response means (SRM) were calculated. Results: 172 (91%) patients completed the 2-year follow-up (mean age 60.5 years, 78.5% women). Statistically significant increases in self-reported pain and function scores, in pain intensity scores as well as in osteophyte and JSN total scores were seen over 2 years. SRM were 0.25, 0.23, 0.67, 0.34 and 0.35, respectively, for self-reported pain and function scores, pain intensity scores, osteophyte and JSN total scores. Radiological progression was not associated with changes in self-reported pain and function. Women in an early post-menopausal stage were especially at risk of progressing radiologically. Conclusions: Currently available outcome measures were able to assess progression over the relatively short time period of 2 years. Radiographic outcomes were more responsive than self-reported outcomes. Pain intensity upon lateral pressure seems to be a responsive measure but needs validation. [ABSTRACT FROM PUBLISHER]

Coagulation and RFLP data from 41 families with an isolated haemophilia A patient were used to estimate the sex ratio of mutation frequencies (nu/mu). Based on the results of coagulation assays in all the female relatives investigated, nu/mu was estimated to be 12.1 by the maximum likelihood method (95% confidence interval 3.8 to 62.5). In order to avoid the possible influence of germline mosaicism, an additional analysis was performed in which only the results in the mothers and grandmothers of an isolated patient were included. The nu/mu ratio was then estimated to be 5.2 (95% confidence interval 1.8 to 15.1). Because an estimate of nu/mu based on all available RFLP data can easily be biased in favour of males, we set up a model in which only information on the grandparental derivation of the patient's X chromosome was used, irrespective of the generation in which the mutation actually occurred. In this way nu/mu was estimated to be minimally 4. The probability of carriership for mothers of an isolated haemophilia A patient amounts to 86% with a sex ratio of 5.2. Although this would imply that 14% of the mothers are not carriers of the disease in the classical sense, they may be mosaic for the mutation and, therefore, also at risk of transmitting the mutation more than once. [ABSTRACT FROM PUBLISHER]

Objective To compare the reliability, sensitivity to change and feasibility of three radiographic scoring methods for hand osteoarthritis (OA). Methods Baseline, 2-year and 6-year hand radiographs of 90 patients with hand OA were read in triplicate in chronological order by three readers from different European centres using the OARSI atlas (OARSI), Kellgren-Lawrence grading scale (KL) and Verbruggen- Veys anatomical phase score (VV). Reliability was determined using intraclass correlation coefficients and smallest detectable change (SDC). Sensitivity to change was assessed by the proportion of progression above the SDC. Feasibility was reflected by the mean performance time. Results Intra- and inter-reader reliability was similar across methods. Inter-reader SDCs (% maximum score) for KL, OARSI and VV were 2.9 (3.2), 4.1 (2.9) and 2.7 (1.8) over 2 years and 3.8 (4\.1), 4.6 (3.3) and 4.0 (2.5) over 6 years, respectively. KL detected a slightly higher proportion of progression. There were differences between readers, despite methods to enhance consistency. The mean performance time (SD, minutes) for KL, OARSI and VV was 4.3 (2.5), 9.3 (6.0) and 2.8 (1.5), respectively. Conclusion Methods had comparable reliability and sensitivity to change. Global methods were fastest to perform. For multicentre trials use of a central reading centre and multiple readers may minimise inter-reader variation. [ABSTRACT FROM AUTHOR]

Objective To determine the impact of limitations in daily activities and pain on quality of life (QoL) in patients with osteoarthritis (OA) visiting a rheumatologist. Methods Patients diagnosed by the rheumatologist with primary hand, knee or hip OA were consecutively included from August 2005 to April 2009. QoL was assessed by Short Form-36, with the physical component summary score (PCS), calculated using data from a norm-based population. Self-reported pain and function in patients with hand OA was assessed by the Australian/Canadian OA hand index (AUSCAN) pain (range 0–20) and AUSCAN function (range 0–36). Linear regression analyses were performed to investigate associations between PCS and demographic characteristics, and between PCS and pain and function in patients with OA. Results Hand OA was diagnosed in 95% of 460 included patients (89% women, mean age 61 years). PCS was lowered in patients with OA. Patients with hand OA reported a considerable amount of pain (mean 9.5 (SD 4.3)) and disability (mean 16.5 (SD 8.6)). AUSCAN function was associated with PCS (adjusted β=−0.3, 95% CI –0.4 to –0.2), but AUSCAN pain was not. Conclusions Hand OA was the most common OA subtype in secondary care. Health-related QoL is decreased in patients with OA and is associated with limitations in daily activities. [ABSTRACT FROM PUBLISHER]

The article discusses a study which examined the risk of venous thrombosis associated with oral contraceptives. The study included 1,524 premenopausal women more than 50 years of age and who are not using hormonal uterine device or depot contraceptive and 1,760 controls. It found that oral contraceptive administration increased risk of venous thrombosis or pulmonary embolism by fivefold. It also discovered that the risk of thrombosis was higher for deep venous thrombosis of the leg compared to pulmonary embolism.

Objectives: Data on work participation impairment and related societal costs for patients with hand osteoarthritis (OA) are scarce. Therefore, we aimed to investigate the association of hand OA with work limitations and costs of productivity loss in paid and unpaid work., Methods: We used data from the Hand Osteoarthritis in Secondary Care cohort, including patients with hand OA diagnosed by their treating rheumatologist. Using the validated Health and Labour Questionnaire, we assessed experienced unpaid and paid work restrictions, unpaid work replacement by others and inefficiency and absence during paid work related to hand OA over the last 2 weeks. Societal costs (€) per hour of paid and unpaid work were estimated using Dutch salary data in 2019., Results: 381 patients were included (mean age 61 years, 84% women, 26% high education level, 55% having any comorbidity). Replacement of unpaid work by others due to hand OA was necessary for 171 out of 381 patients (45%). Paid work was reported by 181/381 patients (47%), of whom 13/181 (7%) reported absenteeism, 28/181 (15%) unproductive hours at work and 120/181 (66%) paid work restrictions due to hand OA.Total estimated work-related societal costs per patient with hand OA (381 patients) were €94 (95% CI 59 to 130) per 2 weeks (€2452, 95% CI 1528 to 3377 per year)., Conclusions: Hand OA is associated with impairment in paid and unpaid work participation, which translates into substantial societal costs of lost productivity. These results highlight the importance of adequate hand OA treatment., Competing Interests: Competing interests: AB received a research grant from Abbvie and consultancy fees to her department from Novartis, Lilly, Galapagos and Abbvie. MK received grants/research support for the submitted work, all paid to the institution., (© Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)