In hand OA patients severe synovitis is associated with joint pain, which is worsened when BMLs co-occur, suggesting synovitis as primary target of treatment.

Objective: To investigate determinants of decrease and increase in joint pain in symptomatic finger osteoarthritis (OA) on magnetic resonance (MR) imaging over 2 years. Design: Eighty-five patients (81.2% women, mean age 59.2 years) with primary hand OA (89.4% fulfilling American College of Rheumatology (ACR) classification criteria) from a rheumatology outpatient clinic received contrast-enhanced MR imaging (1.5T) and physical examination of the right interphalangeal finger joints 2e5 at baseline and at follow-up 2 years later. MR images were scored paired in unknown time order, following the Hand OA MRI scoring system (HOAMRIS). Joint pain upon palpation was assessed by research nurses. Odds ratios (ORs; 95% confidence intervals) were estimated on joint level (n ¼ 680), using generalized estimating equations (GEE) to account for the within patient effects. Additional adjustments were made for change in MR-defined osteophytes, synovitis, and bone marrow lesions (BMLs). Results: Of 116 painful joints at baseline, at follow-up: 76 had less pain, 21 less synovitis, and 13 less BMLs. A decrease in synovitis (OR ¼ 5.9; 1.12e31.0), but not in BMLs (OR ¼ 0.39; 0.10e1.50), was associated with less pain. Of 678 joints without maximum baseline pain, at follow-up: 115 had increased pain, 132 increased synovitis, 96 increased BMLs, and 44 increased osteophytes. Increased synovitis (OR ¼ 1.81; 1.11e2.94), osteophytes (OR ¼ 2.75; 1.59e4.8), but not BMLs (OR ¼ 1.14; 0.81e1.60), was associated with increased pain. Through stratification it became apparent that BMLs were mainly acting as effect modifier of the synovitisepain association. Conclusion: Decrease in MR-defined synovitis is associated with reduced joint pain, identifying synovitis as a possible target for treatment of finger OA.

Objective: To investigate the construct validity of the new thumb base OA magnetic resonance imaging (MRI) scoring system (TOMS) by comparing TOMS scores with radiographic scores in patients with primary hand OA. Design: In 200 patients (83.5% women, mean (SD) age 61.0 (8.4) years), postero-anterior radiographs and MR scans (1.5 T) of the right first carpometacarpal (CMC-1) and scaphotrapeziotrapezoid (STT) joints, were scored using the OARSI atlas and TOMS, respectively. The distributions of the TOMS scores (specified in results section) were stratified for the OARSI scores of corresponding radiographic features and investigated using boxplots and non-parametric tests. Furthermore, Spearman's rank or Phi correlation coefficients (r/4) were calculated. Results: For all features, especially for erosions and osteophytes, the prevalence found with MRI was higher than with radiography. TOMS osteophyte and cartilage loss scores differed statistically significant between corresponding OARSI scores in CMC-1 (0 vs 1; 1 vs 2). TOMS scores were positively correlated with radiographic scores in CMC-1 for osteophytes (coefficient [95% confidence interval], r ¼ 0.75 [0.69; 0.81]), cartilage loss/joint space narrowing (r ¼ 0.70 [0.62; 0.76]), subchondral bone defects (SBDs)/ erosion-cyst (r ¼ 0.41 [0.29; 0.52]), bone marrow lesions (BMLs)/subchondral sclerosis (r ¼ 0.65 [0.56; 0.73]) and subluxation (4 ¼ 0.65 [0.57; 0.73]); and in STT for osteophytes (r ¼ 0.30 [0.17; 0.42]) and cartilage loss/joint space narrowing (r ¼ 0.53 [0.42; 0.62]). Conclusions: In patients with hand OA, TOMS scores positively correlated with radiographic scores, indicating good construct validity. However, the prevalence of features on MR images was higher compared to radiographs, suggesting that TOMS might be more sensitive than radiography. The clinical meaning of these extra MR detected cases is currently still unknown.

An exploratory study to determine the role of effusion, i.e., fluid in the joint, in pain, and radiographic progression in patients with hand osteoarthritis. Distal and proximal interphalangeal joints (87 patients, 82% women, mean age 59 years) were assessed for pain. T2-weighted and Gd-chelate contrast-enhanced T1-weighted magnetic resonance images were scored for enhanced synovial thickening (EST, i.e., synovitis), effusion (EST and T2-high signal intensity [hsi]) and bone marrow lesions (BMLs). Effusion was defined as follows: (1) T2-hsi > 0 and EST = 0; or 2) T2-hsi = EST but in different joint locations. Baseline and 2-year follow-up radiographs were scored following Kellgren-Lawrence, increase ≥ 1 defined progression. Associations between the presence of effusion and pain and radiographic progression, taking into account EST and BML presence, were explored on the joint level. Effusion was present in 17% (120/691) of joints, with (63/120) and without (57/120) EST. Effusion on itself was not associated with pain or progression. The association with pain and progression, taking in account other known risk factors, was stronger in the absence of effusion (OR [95%

Background The association between osteoarthritis (OA) and mortality has been a subject of interest, as this may lead us to a better understanding of the pathogenesis of OA. Unfortunately, study results have been controversial. Objectives To conduct a systematic review to determine the true association between OA and mortality. Methods A systematic search was performed in the databases MEDLINE, EMBASE, COCHRANE, Web of Science, ScienceDirect, CINAHL and Academic Search Premier up to October 2011. Two independent reviewers identified studies that reported mortality for OA patients, compared with a non-OA population. Study quality was also assessed Information on study design, patient characteristics, OA status, duration of follow-up, mortality assessment and outcomes were extracted for each study. Results The electronic databases yielded 1598 individual articles of which 1387 articles were excluded on the basis of title and 116 articles on the basis of abstracts. Ninety-five articles were screened full-text and only 27 articles met the inclusion criteria. Five articles were additionally excluded due to multiple publications for the same population, the lack of OA specific information or short follow-up time. Finally, 22 studies, investigating 23 patient populations, were included in the present review. Most studies involved knee or hip OA (n=17). Comparisons were mostly made with the general population using information from the country’s bureau of statistics. The quality of these studies varied widely. Thirteen studies reported mortality in 14 study populations, receiving either total knee or hip arthroplasty; the majority of these studies found lower mortality rates for OA patients. Four studies, generally of low quality, of which three hospital based found increased mortality rates, whereas one study, in OA patients consulting their general practitioners, did not. Five studies were based in the general population; two high quality studies reported higher mortality rates, while the other studies (of a varying quality) reported lower and equal mortality rates for OA cases. Conclusions The heterogeneous quality of the studies has unfortunately resulted in important limitations to our interpretation of the evidence. The association between OA and mortality appears to be complex, depending on the phenotype. Factors, such as selection bias, care seeking behavior, OA subtype, etc could account for the observed differences. Further studies are warranted. Disclosure of Interest None Declared