Development of radiographic classification criteria for hand osteoarthritis: a methodological report (Phase 2)

Abstract

ObjectivesIn Phase 1 of developing new hand osteoarthritis (OA) classification criteria, features associated with hand OA were identified in a population with hand complaints. Radiographic findings could better discriminate patients with hand OA and controls than clinical examination findings. The objective of Phase 2 was to achieve consensus on the features and their weights to be included in three radiographic criteria sets of overall hand OA, interphalangeal OA and thumb base OA.MethodsMultidisciplinary, international expert panels were convened. Patient vignettes were used to identify important features consistent with hand OA. A consensus-based decision analysis approach implemented using 1000minds software was applied to identify the most important features and their relative importance influencing the likelihood of symptoms being due to hand OA. Analyses were repeated for interphalangeal and thumb base OA. The reliability and validity of the proposed criteria sets were tested.ResultsThe experts agreed that the criteria sets should be applied in a population with pain, aching or stiffness in hand joint(s) not explained by another disease or acute injury. In this setting, five additional criteria were considered important: age, morning stiffness, radiographic osteophytes, radiographic joint space narrowing and concordance between symptoms and radiographic findings. The reliability and validity were very good.ConclusionRadiographic features were considered critical when determining whether a patient had symptoms due to hand OA. The consensus-based decision analysis approach in Phase 2 complemented the data-driven results from Phase 1, which will form the basis of the final classification criteria sets.

2023 EULAR classification criteria for hand osteoarthritis

“…In addition to the 21 experts, 1 person developed all surveys and performed the analyses (IKH) and 8 experts were involved in the discussion about the results in phase 2 and/or a reliability exercise. 10 Groups of case vignettes were created, presenting positive or negative findings from the diagnostic tests identified in phase 1. The experts ranked the cases according to their likelihood of having hand OA as cause of the complaints, both individually and in consensus.…”

“…Sets of criteria and categories were drafted and tested in a series of surveys using the 1000minds software to determine the relative weights of the criteria and their categories. 10…”

“…We used 3 sets of patient vignettes for overall hand OA, interphalangeal OA and thumb base OA, each with 30 patients with pain, aching and/or stiffness in at least 1 target joint on most days of the prior 6 weeks and without psoriasis (sets 2A-C). 10…”

“…Inflammatory biomarkers were excluded during phase 2 due to concerns about feasibility and limited impact on the validity of the proposed scoring system. 10 Analyses yielded a score for each patient (range: 0-100), representing the likelihood that the complaints were due to overall hand OA, interphalangeal OA and thumb base OA, respectively. 10 Rescaling of the criteria Different scales were tested manually.…”

Osteoarthritis, part of life or a curable disease? A bird's‐eye view

“…These criteria are intended to enable clinical observational studies of natural history as well as randomized clinical trials enrolling patients at an earlier stage of their disease [6]. New criteria to classify hand OA have also just recently been developed by the European Alliance of Associations for Rheumatology (EULAR), aimed at defining the disease for overall hand OA, interphalangeal OA, and OA in the base of the thumb [7].…”