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Summary Objective Inflammation worsens joint destruction in osteoarthritis (OA) and aggravates pain. Saturated and n-6 fatty acids (FAs) increase, whereas n-3 FAs reduce inflammation. We examined whether FA levels affected the development of OA. Design We studied participants from the Multicenter Osteoarthritis study (MOST) at risk of developing knee OA. After baseline, repeated knee x-rays and MRIs were obtained and knee symptoms queried through 60 month follow-up. Using baseline fasting samples, serum FAs were analyzed with standard assays. After excluding participants with baseline OA, we defined two sets of cases: those developing radiographic OA and those developing symptomatic OA (knee pain and radiographic OA). Controls did not develop these outcomes. Additionally, we examined worsening of MRI cartilage loss and synovitis and of knee pain using WOMAC and evaluated the number of hand joints affected by nodules. In regression models, we tested the association of each OA outcome with levels of saturated, n-3 and n-6 FAs adjusting for age, sex, BMI, education, race, baseline pain and depressive symptoms. Results We studied 260 cases with incident symptomatic and 259 with incident radiographic OA. Mean age was 61 years (61% women). We found no signficant nor suggestive associations of FA levels with incident OA (e.g., for incident symptomatic OA, OR per s.d. increase in n-3 FA 1.00 (0.85, 1.18) nor with any OA outcome in knee or hand. Conclusion Despite previously described effects on systemic inflammation, blood levels of FAs were not associated with risk of later knee OA or other OA outcomes.

We propose a novel approach for articulated hand pose estimation from a single depth image using a very deep convolutional network. For the first, a very deep network structure is designed to directly maps a single depth image to its corresponding 3D hand joint locations. This approach eliminates the necessity of hand-crafted intermediate features and sophisticated post-processing stages for robust and accurate hand pose estimation. We use Batch Normalization to accelerate training and prevent the objective function from getting stuck in poor local minima. We introduce a low-dimensional embedding forcing the network to learn the inherent constraints of hand joints, which helps to reduce the cost of reconstructing 3D hand poses from high-dimension feature space. We discuss the effect of the convolutional network depth on its accuracy under the hand pose regression setting. Quantitative assessments on two challenging datasets show that our proposed method gets competitive results to state-of-the-art approaches in terms of accuracy. Moreover, qualitative results also show that our proposed method is robust to some difficult hand poses.

Continuum mechanisms have recently been used in various manipulator designs, often for medical applications. Instead of forming manipulators, a multi-backbone continuum mechanism, in a composed configuration, can be alternatively used as a transmission unit to generate an arbitrary number of translating outputs that are linearly combined from two independent inputs. This CCM (Composed Continuum Mechanism), applicable in other design scenarios, is applied as mechanical postural synergies of an anthropomorphic robotic hand. In this hand, three actuators actuate the CCM in its coordinated motion mode to drive the eleven hand joints according to two synergy inputs to form synergy-based hand poses in a pre-grasp phase. Then, the CCM closes the fingers in its synchronized motion mode. Joint-level compliance was selectively introduced based on a statics analysis to help achieve the stable grasping and pinching of many daily life objects. The compliance calculation, postural synergy synthesis, system descriptions and experimental characterizations of this hand with Compliant Mechanical Postural Synergy (the CoMPS hand) are expounded. The efficacy of the hand, demonstrated by the experimental results, can inspire its use as a prosthesis, as a training device for synergy control, or in a humanoid robot, showing the potentials of the proposed CCM.

This is the first study to investigate the usefulness of a standardized ultrasound (US) examination protocol in diagnosing hand osteoarthritis (OA). We conducted a cross-sectional study including 62 patients, ultimately diagnosed with hand OA based on imaging evidence of osteoarthritic changes with the particular distribution required for fulfilment of American College of Radiology diagnosis criteria. We compared a 32-joint US score (wrists, metacarpophalangeal [MCP], proximal interphalangeal [PIP] or distal interphalangeal [DIP] and carpometacarpal [CMC]-1 joints), with smaller, predefined joint scores, assessing 22 joints (wrists, MCPs and PIPs or PIPs, DIPs and CMC-1), 10 joints (MCP 2-3, PIP 2-3 and CMC-1 or PIP 2-3, DIP 2-3 and CMC-1) and 6 joints (DIP 2-3, CMC-1), respectively. The US findings were correlated with radiographic scores for erosions and osteophytes. Radiographic osteophyte scores correlated well with all the US scores mentioned earlier (R = 0.381 to 0.645, p 0.05), despite low sensitivity for detection of osteophytes (43.5%) and erosions (28.9%), compared with the 32 joint US score. Both 10 joint US protocols (assessing MCP 2-3, PIP 2-3 and CMC-1 or PIP 2-3, DIP 2-3 and CMC-1 joints) performed better than conventional radiography, by identifying osteophytes in an additional 25.6% and 23.9% of patients, respectively. The conclusion of this study is that the US examination of 10 preselected hand joints is more sensitive than conventional radiography in diagnosing hand OA in patients who do not fulfill American College of Radiology clinical criteria, a finding likely to have practical implications for facilitating diagnosis of hand OA.

A patchable triboelectric nanogenerator (TENG) is highly promising for self-powered human-motion detection, but it may undergo repeated stretching/releasing cycles during daily activities of a human, which may lead to mechanical fracture of each component and degradation in electrical output performance of the TENG device. Here, we report a fully stretchable and durable triboelectric nanogenerator (TENG) with gold (Au) nanosheets (NSs) embedded into both PDMS matrix and micropyramid-patterned PDMS. It was found that a new design of the Au NS electrodes dramatically improves the mechanical flexibility and stretchability, enabling to achieve the outstanding output stability of the Au NS electrode-based TENG (Au NS-TENG) during 10,000 cycles of repeated pushing and stretching tests. Our fully stretchable and durable Au NS-TENGs were successfully applied to the hand joints that can be used in the self-powered human-motion detection processes for wearable applications.

To update our earlier systematic reviews which evaluated all published randomized controlled trials (RCTs) evaluating pharmacological and non-pharmacological therapies in patients with hand osteoarthritis (OA). Surgical therapies were not evaluated.RCTs published between March 2008 and December 2015 were added to the previous systematic reviews.A total of 95 RCTs evaluating various pharmacological and non-pharmacological therapies in hand OA were analyzed in this update. Generally, the methodological quality of these RCTs has improved since the last update, with more studies describing their methods for randomization, blinding, and allocation concealment. However, RCTs continue to be weakened by a lack of consistent case definition and a lack of standardized outcome assessments specific to hand OA. The number and location of evaluated hand joints continues to be underreported, and only 25% of RCTs adequately described the method used to ensure allocation concealment. These remain major weaknesses of published RCTs. A meta-analysis could not be performed because of marked study heterogeneity, insufficient statistical data available in the published RCTs, and a small number of identical comparators.Hand OA is a complex area in which to study the efficacy of therapies. There has been an improvement in the overall design and conduct of RCTs, however, additional large RCTs with a more robust methodological approach specific to hand OA are needed in order to make clinically relevant conclusions about the efficacy of the diverse treatment options available.

Current assessment of osteoarthritis (OA) is primary based on visual grading of joint space narrowing and osteophytes present on radiographs. The approach is observer-dependent, not sensitive enough for the detection of the early stages of OA and time consuming. A promising solution is through fractal analysis of trabecular bone (TB) textures on radiographs. The goal is to develop an automated decision support system for the detection and prediction of OA based on TB texture regions selected on knee and hand radiographs. In this review, we describe our progress towards this development which was conducted in five stages, i.e., (i) development of automated methods for the selection of TB texture regions on knee and hand radiographs (ii), development of fractal signature methods for TB texture analysis, (iii) applications of the methods in the analysis of x-ray images of knees and hands, (iv) development of TB texture classification system, and (v) development of ReadMyXray website for knee x-ray analysis. The results achieved so far are encouraging and it is hoped, that once the system is fully developed and evaluated, it will be used to aid medical practitioners in the decision-making, i.e., in designing OA preventative measures, treatments and monitoring the OA progression.

In this paper, a method is proposed to improve the accuracy of 3D hand pose estimation. The existing methods make poor use of the depth information of hand joints and have difficulties of estimating the 3D coordinates accurately. To solve this problem, a method that utilizing the information between adjacent joints of each finger is proposed to estimate the depth coordinates of joints. In order to make full use of 2D information for depth estimation, this paper divides hand pose estimation into two sub-tasks (2D hand joints estimation and depth estimation). In depth estimation, a multi-stage network is proposed. We first estimate the depth of a part of hand joints, and then with the help of it and 2D information, the depth coordinates of adjacent joints can be well estimated. The method proposed in this paper has been proved to be effective on three public hand pose datasets through Self-comparisons. Compared with the methods that based on 2D CNN, our method achieves state-of-the-art performance on ICVL and NYU datasets, and also has a good result on MSRA dataset.

Purpose To compare goniometric and visual assessments of angular hand joint and wrist joint positions measured by board-certified hand surgeons and certified hand therapists. We hypothesized that visual estimation would be similar to the goniometric measurement accuracy of digital and wrist joint positions. Methods The wrist, index finger metacarpophalangeal (MCP) joint, and index finger proximal interphalangeal (PIP) joint were evaluated in different positions by 40 observers: 20 board-certified hand surgeons and 20 certified hand therapists. Each observer estimated the position of the wrist, index MCP joint, and index PIP joint of the same volunteer, who was positioned in low-profile orthoses to reproduce predetermined positions. Following visual estimation, the participants measured the same joint positions using a goniometer. The control measurement was digitally determined by a radiologist who obtained radiographs of the hand and wrist positions in each orthosis. Observers were blinded to the results of control measurements. Results When considering all joints at all positions, neither visual assessments nor goniometer assessments were consistently within ± 5° of the measurements obtained on control radiographs. When considering individual joints, goniometer measurements were significantly closer to control radiograph measurements than the visual assessments for all 3 PIP joint positions. There was no difference for the measurements at the wrist or for 2 of the 3 MCP joint positions. Significant differences between surgeon and therapist joint angle measurements were not observed when comparing visual and goniometer assessments to radiograph controls. Conclusions Compared with radiograph measurements, neither visual nor goniometer assessment displayed high levels of accuracy. On average, visual assessment of the angular positions of the index MCP and wrist joint were as accurate as the goniometer assessment, whereas goniometer assessment of the angular position of the PIP joint was more accurate than visual assessment. There was a relatively high degree of between-observer variability in measurements, and therefore, no one person's measurements could be consistently relied upon to be accurate. Type of study/level of evidence Diagnostic II.

summary Objective: To understand the differences in prevalence and incidence estimates of osteoarthritis (OA), according to case definition, in knee, hip and hand joints. Method: A systematic review was carried out in PUBMED and SCOPUS databases comprising the date of publication period from January 1995 to February 2011. We attempted to summarise data on the incidence and prevalence of OA according to different methods of assessment: self-reported, radiographic and symptomatic OA (clinical plus radiographic). Prevalence estimates were combined through metaanalysis and between-study heterogeneity was quantified. Results: Seventy-two papers were reviewed (nine on incidence and 63 on prevalence). Higher OA prevalences are seen when radiographic OA definition was used for all age groups. Prevalence metaanalysis showed high heterogeneity between studies even in each specific joint and using the same OA definition. Although the knee is the most studied joint, the highest OA prevalence estimates were found in hand joints. OA of the knee tends to be more prevalent in women than in men independently of the OA definition used, but no gender differences were found in hip and hand OA. Insufficient data for incidence studies didn’t allow us to make any comparison according to joint site or OA definition. Conclusions: Radiographic case definition of OA presented the highest prevalences. Within each joint site, self-reported and symptomatic OA definitions appear to present similar estimates. The high heterogeneity found in the studies limited further conclusions.

Clinicians frequently use finger goniometers to measure joint range of motion (ROM) in the digits. Other methods of depicting finger ROM can be beneficial in situations where therapists may not have access to finger goniometers, patients want to self-assess ROM, or therapists want to visually and graphically see composite ROM in the digits. This author describes a technique to obtain diagrams of hand joint angles by using an improvised goniometer made from paper.—V ictoria P riganc , PhD, OTR, CHT, CLT, Practice Forum Editor

Granuloma annulare is a benign inflammatory dermatosis that is most common in children and young adults. The subcutaneous form of granuloma annulare, which occurs mainly on the extremities in children, is rare. Lesions usually occur as painless subcutaneous nodules without inflammation of the cutaneous surface; the most frequent sites are the legs, buttocks, and scalp. Nevertheless, we present a case of subcutaneous granuloma annulare confined to the dorsa of the hand joints and right knee in a 51-year-old woman.

The aim of the study was to evaluate the prevalence and pattern of radiographic hand osteoarthritis (OA) in an Abkhazian community-based sample and its association with age, sex, body mass index (BMI) and place of residence. The study sample was comprised of 542 males with a mean age of 43.9, sd 15.6 years and 463 females with a mean age of 44.9, sd 13.9 years. OA was evaluated for 14 joints of the left hand according to the Kellgren and Lawrence grading scheme. Statistical analyses included prevalence estimation, multiple regression analysis and chi(2) tests. In the entire Abkhazian sample the average prevalence of hand OA was 33.6% for males and 35.4% for females. After age 65, the prevalence of hand OA was 87.5% for males and 83.3% for females. No sex differences were found in the prevalence or number of affected hand joints. Statistically significant association was found between the number of affected joints and BMI, but not between the prevalence of hand OA and BMI. Different prevalences of radiographic hand OA were found in individuals from different villages, after adjustment for age, sex and BMI. Additional studies are needed to explore the possible reasons for such differences.

Resume Introduction Confrontes a une association inedite de luxations etagees de la colonne du pouce et d’une fracture de la base du deuxieme metacarpien, les auteurs presentent une etude cadaverique de l’articulation trapezosecond metacarpien. Materiels et methodes Trente dissections de pieces formolees (15 mains droites et 15 mains gauches) et 15 pieces fraiches (huit mains droites et sept mains gauches), soit au total 45 dissections, ont permis d’observer les liens articulaires, ligamentaires et tendineux entre le trapeze et la base du deuxieme metacarpien en se focalisant sur les structures palmaires. Resultats L’articulation entre le trapeze et le deuxieme metacarpien a ete constamment trouvee dans nos dissections sous la forme d’une petite articulation a fente synoviale en continuite avec l’interligne carpometacarpien. Elle etait renforcee en avant par un puissant ligament tendu entre la crete du trapeze et le base du deuxieme metacarpien et par la terminaison du tendon du muscle flechisseur radial du carpe sur la base des deuxieme et troisieme metacarpiens, jouant le role de ligament actif a distance par ses expansions courtes et resistantes vers la crete du trapeze et le ligament palmaire trapezosecond metacarpien. Conclusion Les liens etroits entre trapeze et base du deuxieme metacarpien ont une signification mecanique observee dans les traitements des instabilites du pouce et illustree dans cette association clinique originale.

The distal interphalangeal hand joints are rarely involved in rheumatic disease. The only exceptions are osteoarthritis and psoriatic arthritis. Osteoarthritis is the most common cause of joint disease involving these joints.

Resume Objectifs Les buts de cette etude ont ete : l'analyse des signes precoces de polyarthrite rhumatoide (PR) a l'imagerie par resonance magnetique (IRM) des articulations des mains et des pieds ; la recherche d'eventuelles discordances entre les signes IRM a la main et au pied. Methodes Nous avons etudie par IRM les mains et les pieds de 21 patients atteints d'une PR repondant aux criteres de l'ACR 1987. Resultats L'IRM a mis en evidence des signes evocateurs de PR chez tous les patients. Ils etaient presents a la fois aux mains et aux pieds chez 18 des 21 patients. Chez les trois autres patients, ils n'etaient presents qu'aux articulations des mains. A la main, l'IRM a montre des signes evocateurs de PR chez les 21 patients, avec des erosions osseuses chez 14 patients (67 %). Il a ete observe autant d'anomalies osseuses aux mains qu'aux pieds. L'IRM a mis en evidence une synovite active des mains chez 17 patients (81 %) et des pieds chez 15 patients (71 %). Il existait un œdeme osseux a l'IRM des mains chez 14 patients (63 %) et des pieds chez 11 patients (52 %). Nous n'avons pas trouve de difference significative concernant les anomalies IRM liees a la PR entre les articulations metacarpophalangiennes des mains et les metatarsophalangiennes des pieds (p > 0,05). Conclusion L'atteinte des pieds est frequemment mise en evidence dans les PR recentes.

Resume Objectifs La trapezectomie partielle avec tendinoplastie de suspension et d'interposition represente une alternative a la trapezectomie totale ou a la prothese trapezometacarpienne dans le traitement chirurgical de la rhizarthrose. Elle permet theoriquement d'eviter le collapsus du premier rayon et ainsi preserve la mobilite du pouce et la force pollicidigitale. Cette etude retrospective monocentrique a permis d'evaluer cette technique pour en preciser les indications, et les resultats a moyen terme. Methode Trente-trois patients (41 cas) de 57,4 ans d'âge moyen ont ete operes selon cette technique. Selon le stade de Dell, il s'agissait d'un stade II dans 23 cas, d'un stade III dans 15 cas, et d'un stade IV dans trois cas. Il n'existait aucun cas d'atteinte scaphotrapezienne associee. L'evaluation a ete clinique et radiographique. La mesure de la force pouce–index a ete effectuee a l'aide d'un dynamometre. Resultats Au recul moyen de 57 mois, l'indolence etait obtenue dans 71 % des cas. L'opposition moyenne selon Kapanji etait de 9,56 sur 10, la force pouce–index de 6,51 kg, et l'ouverture de la premiere commissure de 34°. L'espace trapezometacarpien moyen etait evalue a 2,52 mm. Les complications etaient limitees a trois cas d'algodystrophie. Conclusion La trapezectomie partielle avec tendinoplastie donne des resultats fonctionnels satisfaisants qui restent stables avec le temps. Elle restitue une pince pollicidigitale fonctionnelle en limitant le collapsus de la colonne du pouce. Il s'agit d'une intervention fiable, avec un taux limite de complications, reservee a la rhizarthrose isolee sans atteinte degenerative de l'articulation scaphotrapezienne.

Objectives. – to assess quantitatively the relative contribution of joint degeneration characteristics such as osteophytes (OS), joint space narrowing (JS), subchondral sclerosis (SS), subchondral cysts (SC), lateral deformity (LD) and cortical collapse (CC) to the Kellgren and Lawrence (K–L) score grade of hand osteoarthritis (OA). Methods. – Radiographs of both hands were taken from 1245 study participants, native Chuvasha, Russian Federation. K–L score and the six above-mentioned characteristics were assessed on 15 joints of each hand. Multiple regression and correlation analyses were performed: for rows of hand joints and groups of thumb joints, and for the aforementioned rows but assigned into six age groups. Results and Conclusions. – According to the K–L grading system the relative contribution of OS to joint degeneration was high in all stages of the process. JS and SS played an important role in determining the K–L score in persons younger than 40 but less so in older people. Conversely, influence of SC and LD is insignificant at the onset of OA (i.e., in young persons), yet in older people it was a leading determinant of the K–L score. CC exerts no influence on the K–L score of OA.

Summary Quadriceps strength may protect against knee osteoarthritis (OA), but muscle activity is a major determinant of forces at the hand joints. Gripping objects is a common task during which high muscular forces are sustained, particularly at the proximal hand joints (metacarpophalangeal (MCP) joints and thumb base). The association between maximal grip strength and incident OA at different hand joints was examined in a longitudinal study of radiographic hand OA. Subjects with higher maximal grip strength were at increased risk for development of OA in the proximal interphalangeal (PIP) joints, MCP and thumb base joints in men; and in the MCP in women. No association was found between maximal grip strength and incident distal interphalangeal (DIP) joints OA in men or women. The conclusion is that increased grip strength, which is the major force of loading across proximal hand joints, increases the risk of OA in those joints.

Objective High definition macroradiography permits the advancement in the zone of calcified cartilage (described as a ZCC step) to be detected in osteoarthritic (OA) hand joints of patients. The pattern of their incidence and distribution was determined and compared to the joint space width (JSW) measurement. Design Macroradiographs, ×5 magnification, were obtained of the OA hands of 44 patients at baseline and at 18 months. The incidence of ZCC steps, identified as an advancement in the mineralized cartilage front into articular cartilage, was assessed at each articular surface. JSW was measured and was used to determine the difference in JSW between hands and groups of joints with and without ZCC steps at both X-ray visits. Results ZCC steps were only found at the convex articular surfaces in 42 (48%) of hand joints in 28 (64%) patients. Here, ZCC steps were present in 36 joints in the non-dominant hand compared to 30 joints in the dominant hand. In the former, they were present in 22 DIP, six PIP and eight MCP joints and in 12 DIP, 8 PIP and 10 MCP joints in the dominant hand. By 18 months new ZCC steps had formed in 15 hands with and 17 hands without previous ZCC steps. At both X-ray visits no statistically significant difference in JSW was found between the hands and joint groups with and without ZCC steps. Conclusion Although ZCC steps and JSW loss were greater at the PIP joints, supporting a mechanical hypothesis for ZCC formation, their presence in joints, where JSW was larger, and their greater incidence in the non-dominant PIP joints, suggest that factors associated with vascular changes, related to subchondral bone remodeling, are responsible.{copy}

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. Methods We conducted a systematic literature review until May 2015, including all controlled trials investigating efficacy or safety of any IA therapy in carpometacarpal (CMC) and interphalangeal (IP) OA compared with placebo or other treatments. Two authors independently selected trials and assessed risk of bias using the Cochrane tool. The main efficacy outcome was pain. We performed meta-analysis where appropriate. Results A total of 13 trials (864 patients) studying CMC (n = 11) and IP OA (n = 2) were included, comparing corticosteroids or hyaluronic acid (HA) versus placebo (n = 4 and n = 3), and corticosteroids versus HA (n = 6). Single studies investigated infliximab, dextrose, and different HAs. The overall risk of bias was unclear or high in most trials. Meta-analysis of two trials comparing corticosteroids with placebo in CMC OA showed no improvement in pain [mean difference −3.56, 95 % confidence interval (CI) −13.87 to 6.75, scale 0–100). HA also appeared not efficacious compared with placebo in CMC OA. One trial comparing corticosteroids with placebo in IP OA demonstrated significantly improved pain during movement. No convincing evidence for efficacy of corticosteroids or HA over the other or alternative therapies was found. Only local adverse events were reported. No specific IA therapy appeared more harmful than another. Conclusion Despite a beneficial short-term safety profile, IA corticosteroids or HA do not appear more effective than placebo in CMC OA. The suggestion that IA corticosteroids might be efficacious in IP OA requires confirmation. Electronic supplementary material The online version of this article (doi:10.1007/s40266-015-0330-5) contains supplementary material, which is available to authorized users.

In an attempt to demonstrate whether clinically selected joints of the hand in active rheumatoid disease had consistent MRI findings, 45 patients were examined, in whom one joint in each was selected by both the referring clinician and patient as being active and symptomatic. Such joints, in order to be included in the study, were required to conform to ARA criteria of activity and usually mild to moderate X-ray changes. The joints were imaged using spin-echo sequences with T1W and T2W precontrast images, followed by T1W images after intravenous administration of Gd-DTPA. Different patterns of joint abnormalities were found. In 27 joints MRI findings suggested highly active synovitis and/or destructive pannus. In four, crescentic enhancement was thought to be compatible with simple synovitis, but in 23 rounded masses of synovial proliferation were characterized by marked, diffuse contrast enhancement on T1W postcontrast images, which corresponded well with high signal intensity on T2W images. Synovial proliferation in a further 12 joints was shown by only moderate stippled contrast enhancement and nonhomogeneous intermediate to high signal intensity on T2W images. These findings were thought to represent less active synovitis and pannus. MRI did not demonstrate inflammatory activity in six joints. In two of these pannus was of low signal intensity on T2W images, without contrast enhancement after Gd-DTPA infection presumed fibrotic and inert, and four were normal on all pulse sequences. These results suggest that clinical features of synovitis, even in carefully selected joints clinically, do not produce a homogeneous group when examined by MRI imaging. Indeed, a spectrum exists from presumed marked, active synovitis to total normality. If MRI is to be used as a clinical and research tool in the assessment of rheumatoid disease, and its therapeutic manipulation, these results are of some importance, since the variable findings indicate an appreciable heterogeneity of appearances in joints thought clinically to be of relatively uniform severity.

Summary The aim of the session was to discuss the current definitions of and criteria for hand osteoarthritis (OA) and to review the tools proposed for the clinical assessment of hand OA in research and trials. The American College of Rheumatology criteria for the classification and reporting of hand OA were discussed and their limitations noted; specifically, they are designed for symptomatic OA and based on physical examination. The differences between erosive and non-erosive hand OA were discussed as was the relationship between hand OA and generalized OA, since hand OA represents a generalized OA of hand joints and can be considered as a marker for developing generalized OA (i.e. OA at other sites). Different clinical tools to assess patients were presented and discussed, such as pain assessment, Dreiser's functional index or Bellamy's AUSCAN for function assessment, assessment of the mobility, stiffness, inflammation and aesthetic damages. The agreements, disagreements and further studies to be performed to answer questions still debated are presented.

Purpose: Previous studies that used semi-quantitative scoring of hand radiographs suggest that hand osteoarthritis (OA) puts a person at risk for knee OA. One possible mechanism to explain a relationship between hand and knee OA is a systemic cartilage loss. Therefore, we used a quantitative method to measure hand joint space width (JSW), an imaging marker of cartilage loss, to test whether individuals that develop incident knee OA have less finger joint cartilage. Methods: Participants of the OAI were included in this case-control study if they had knee radiographs at the baseline and 48-month visit as well as quantitative and semi-quantitative radiographic knee readings (as of October 2011). Cases were defined as individuals with an incident knee osteophyte (baseline OARSI osteophyte score < 2 and 48-month OARSI osteophyte score 2). Controls were individuals with no incident knee osteophyte (baseline and 48-month OARSI osteophyte scores < 2). If a participant had a case and control knee, then the control knee was excluded. If the participant had two case knees or two control knees, then the right knee was selected. 276 knee-, cohort-, age-, gender-, and body mass index-matched participants met this criteria. Two readers used a semi-automated, custom software to delineate the joint margins metacarpophalangeal (MCP), proximal interphalangeal (PIP), and distal interphalangeal (DIP) joints of digits 2 to 5 on the dominant hand. The software divided each joint into 5 regions to derive a region-specific JSW measurement (JSW1 to JSW5; inter-tester ICC [2,1 model] 1⁄4 0.82 to 0.92; see Figure). Due to anatomical considerations the outermost regions (JSW1 and JSW5) of the MCP joints could not be reliably replicated and were excluded from calculations. Mean MCP JSW, mean PIP JSW, and mean DIP JSW were calculated by averaging the joint JSW measurements across regions within joint and across fingers. Mean hand JSW was averaged across all regions, joints, and fingers to develop a composite hand measurement. Four paired sample t-tests (p < 0.05) were performed to compare the four mean JSW measurements between cases and controls. Results: Of the 276 participants, 121 matched case-control pairs had readable hand radiographs. Case participants were 62.5 8.6 years of age, had a body mass index of 29.7 4.1 kg/m, and 8 (6.67%) were left handed. Control participants were 62.5 8.4 years of age, had a body mass index of 29.4 5.0 kg/m, and 5 (4.13%) were left handed. Both groups were 68.6% female, included 65 (54%) right knees, and 63 (52%) participants from the Incidence cohort. Paired sample t-tests revealed no significant differences in all mean JSW measurements between the case and control groups (see Table). Conclusions: We found that baseline mean hand JSW is not significantly different among those who develop a definite knee osteophyte over 48 months and those who do not. Our results indicate that systemic loss of cartilage is not an explanation of the relationship of hand and knee OA. Ă