Rhythmic variations in pain, stiffness, and manual dexterity in hand osteoarthritis

Abstract

Objective: To explore circadian variation in pain, stiffness, and manual dexterity in patients with hand osteoarthritis (OA). Methods: Twenty one patients with hand OA, as defined by ACR criteria (17 women, four men, mean age 62.2 years, range 52-74 years) self rated pain and stiffness on separate 10 cm horizontal visual analogue scales and performed bead intubation coordinometry (BIC) six times each day (on waking up, at bedtime, and every four hours in between) for 10 consecutive days. Each series (using data with the trend removed if there was a significant trend) was analysed for circadian rhythmicity by a cosine vector technique (single cosinor). With individual data expressed as the percentage of the mean, group rhythm characteristics at period 24 hours were summarised for each variable by population mean cosinor analysis. Results: Individual analyses identified significant circadian rhythms at p<0.05 for pain (n=15/21), stiffness (n=16/20), and dexterity (n=18/21), and a significant circadian rhythm on a group basis was identified for pain (p=0.013), stiffness (p<0.001), and dexterity (p<0.001). Pain was least at 1610 and stiffness at 1618. Peak dexterity occurred in mid-afternoon at 1548 and occurred within the 95% confidence interval of least pain (1312-1800) and stiffness (1520-1732). Conclusions: Dexterity was influenced by the patient's level of pain or stiffness, which changed systematically throughout the day. Similar results have been previously reported in 14 patients with rheumatoid arthritis where peak dexterity occurred at 1544 and at 1528 in 14 age and sex matched healthy controls. The predictability of rhythmic variation in pain, stiffness, and dexterity has implications for scheduling activities of daily living and for timing antirheumatic drug treatment.

Effects of Chronic Osteoarthritis Pain on Neuroendocrine Function in Men

“…Moreover, the presence of normal and similar concentrations of ACTH and cortisol (mean and integrated ACTH) in the OA and control groups suggests that resistance to the actions of glucocorticoids was unlikely in our OA patients. Third, because OA pain intensity is known to fluctuate through the day with lower pain levels reported at 1500 -1600 h (44) and because an average of 7-14 pain scores gives a more accurate estimate of true mean pain than a single measurement or additional scores in the setting of chronic pain (45), patients were asked to keep a log of their pain average once at bedtime for 14 d at the time of study entry (45). Fourth, we studied only men with moderate to severe pain, thus minimizing the likelihood of false-negative results.…”

The chondrocyte clock gene Bmal1 controls cartilage homeostasis and integrity

“…It is well known that there is a daily rhythm to pain and stiffness in arthritic diseases, and the concept of time-dependent pain treatment (chronotherapy) for joint problems was first introduced in the 1980s (38,39). Our previous work identified autonomous clocks in cartilage tissue and chondrocytes (11,14).…”

“…Age, mechanical injuries, and chronic inflammation are known risk factors, disrupting the function and viability of chondrocytes and leading to an imbalance between the catabolic and anabolic pathways (1-3). As a weight-bearing tissue, articular cartilage is exposed to the daily loading and unloading cycles associated with the circadian (24-hour) rhythms of rest and activity, and sufferers of OA experience time-of-day dependence in their symptoms (4)(5)(6).…”

Effects of a soft prefabricated thumb orthosis in carpometacarpal osteoarthritis

“…Common consequences of HOA are pain related to hand use, reduced hand strength and mobility, and restrictions in activity and participation (4)(5)(6)(7). Studies further indicate that the degree of pain and functional limitations are higher in persons with CMC osteoarthritis (CMC-OA) compared with those without involvement of this joint (8,9).…”