Radiographic Progression of Thumb CMC Osteoarthritis: A Systematic Review

Abstract

Thumb carpometacarpal (CMC) osteoarthritis (OA) is a prevalent disease that causes pain and disability. Determining the progression of CMC OA is problematic given the lack of consensus for classifications and scoring systems. We performed a systematic review to (1) determine which imaging modalities or scoring systems are used to evaluate CMC OA progression, and (2) describe the progression of CMC OA through available metrics. Methods: This review adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. An English language literature search was performed in July 2019 and included studies evaluating CMC OA progression with an imaging modality or radiographic scoring system, with a minimum 1-year follow-up. Studies were analyzed with respect to their methodology, scoring systems, and relevant findings. Results: The initial search yielded 4,097 articles, 10 of which met inclusion criteria. Study size varied from 32 to 289 subjects; many subjects were included in multiple cohorts. Eight studies used radiography whereas 2 used scintigraphy. Estimates of progression varied from 20% to 70% (with large variation in follow-up time); the magnitude of progression varied from 3% to 48% (joint space narrowing) and from 0.6 to 1 points (KellgreneLawrence scale). The percentage of subjects who progressed and the progression degree varied widely and depended on follow-up length and the scoring system used. Conclusions: A paucity of literature exists to measure CMC OA progression; there is a lack of uniformly accepted imaging modality, scoring system, or follow-up interval. This absence provides the opportunity to determine consensus techniques and metrics to assess the natural history of thumb CMC OA. Type of study/level of evidence: Diagnostic III.

The prevalence, incidence, and progression of radiographic thumb base osteoarthritis in a population-based cohort: the Rotterdam Study

“…Few studies assessed the longitudinal progression of CMC-1 ROA 12 . Previous studies demonstrated that females had slightly more progression of CMC-1 ROA than males 7,11 , while we did not observe a significant pattern on this.…”

“…A smaller study from Harris et al reported that 47-89% of the participants (included in a rheumatology outpatient clinic) with CMC-1 ROA at baseline showed progression after 10 years 24 . Shapiro et al hypothesize that variability in progression rates may stem from differences in study populations, follow-up durations, scoring systems, and definitions of progression 12 .…”

“…Only a few large cohort studies reported data on incident or progression of hand ROA 7,10,11 , though none were specifically focused on the CMC-1 joint. A recent systematic review from Shapiro et al found quite a few studies with large variability in progression scores ranging from 20-70% 12 , concluding that more studies in large cohorts are needed to understand the progression of CMC-1 ROA better.…”

Dorsal Subluxation of the First Metacarpal During Thumb Flexion is an Indicator of Carpometacarpal Osteoarthritis Progression

“…The severity of thumb CMC OA is typically staged using radiograph-based systems [11,12,20,38]. Osteophytes are a main feature of thumb CMC OA, and typically distribute around the joint circumference and increase in size as the disease progresses [1,4,31].…”

“…Pathophysiologic changes associated with thumb CMC OA include cartilage loss [32,34], osteophyte formation [8], altered motion patterns [10], joint malalignment (subluxation), and mechanical instability [1,22], although the course of the disease is variable across individuals. In some patients, the disease is indolent and the symptoms remain mild, while in others it progresses rapidly [19,21,38]. Individuals with advanced CMC OA can experience chronic pain with grasping and pinching, which can substantially impair function [2,25].…”