Hand X-ray examination in two planes is not required for radiographic assessment of hand osteoarthritis

Abstract

<jats:sec><jats:title>Aims:</jats:title><jats:p> Radiographic imaging is essential in the diagnosis of hand osteoarthritis (HOA); however, it is unknown whether a multiplanar examination would add essential information to dorso-palmar (dp) views alone. This study evaluated whether an additional radiographic view would aid clinicians in the diagnostic process of HOA. </jats:p></jats:sec><jats:sec><jats:title>Methods:</jats:title><jats:p> The dp radiographs of both hands from 159 HOA patients were assessed according to the scores described by Kellgren and Lawrence (K/L). In oblique view images, structures similar to classic ostophytes (OPs) were found, namely bony proliferations on the dorsal and/or ventral margins of joints, and were documented as dorsal/ventral OPs (dvOPs). Function and pain were assessed by applying standardised read-out systems. Logistic regression analysis and Mann–Whitney tests were implemented. </jats:p></jats:sec><jats:sec><jats:title>Results:</jats:title><jats:p> The presence of dvOPs was associated with the degree of joint damage; however, dp views were sufficient to estimate radiographic changes. Only a few joints showed dvOPs as the only structural alteration; nevertheless, in almost all cases, classical radiographic OA changes were found in dp views of other joints of the same or the contralateral hand. The presence of dvOPs did not affect joint function or pain according to established scores, but was associated with radiographic progression in distal interphalangeal joints. </jats:p></jats:sec><jats:sec><jats:title>Conclusion:</jats:title><jats:p> This is the first study to confirm that additional radiographic planes, oblique/lateral views, are not necessary in the diagnostic process in HOA in daily clinical practice. Nevertheless, the presence of dvOPs reflect more severe joint damage and is associated with radiographic progression in HOA; hence, oblique/lateral views could be a useful tool for academic purposes. </jats:p></jats:sec>

Dorso-ventral osteophytes of interphalangeal joints correlate with cartilage damage and synovial inflammation in hand osteoarthritis: a histological/radiographical study

“…Naturally, since this study was performed using a limited number of finger specimens, our findings might not accurately reflect HOA changes in the general population. Yet, our previous study on a HOA patient cohort with a comparable age range (40–85 years) supports our data, although prevalence of dvOPs in this cohort was lower [ 12 ]. Nonetheless, future longitudinal analyses could observe the evolution of dvOPs to determine the timepoint of initiation, as well as the speed of their development.…”

“…So far, however, almost no effort has been made to evaluate dorsally located OPs in HOA; this may be due to the fact that international societies do not regard additional radiographic views (besides standard dp images) as necessary in HOA diagnosis [ 7 , 8 ] or that no radiographic score in HOA comprises the evaluation of oblique/lateral view images [ 15 , 18 , 28 – 33 ]. Nevertheless, especially in DIP and PIP joints, a predilection for dorsally based OP formation exists [ 21 – 23 , 26 ], and its prevalence, as demonstrated in our previous study, is considerable [ 12 ].…”

“…Thus, the implementation of dvOPs evaluation could fill this gap, thereby improving the diagnostic value of plain radiographs in HOA. Nevertheless, for a quick evaluation regarding HOA in daily clinical practice, applying a standardized radiographic score on dp views is sufficient [ 12 ]; however, in some intricate cases, the inclusion of dvOPs could make a difference. Naturally, since this study was performed using a limited number of finger specimens, our findings might not accurately reflect HOA changes in the general population.…”

“…Nevertheless, concerning HOA the question arises which structures would be importantly enhanced or exclusively displayed on oblique or lateral views compared with the dp view. This question was already partly addressed by investigating oblique radiographic views in patients with HOA [ 12 ]. The most frequent structural changes seen in oblique views that were not detectable by dp views were dorsally and/or ventrally located osteophytes (OP).…”