Hand OA Atlas Moves Scoring System Forward

Major Finding: Osteophytosis was the dominant pathology in more than 3,700 hand joints examined by ultrasound in patients with hand OA.

Data Source: A descriptive imaging study of 127 patients with hand OA.

Disclosures: Dr. Hammer was supported by an unrestricted grant from Abbott Laboratories; this grant was given after the study was completed, however, according to Mr. Mathiessen. Mr. Mathiessen said they have no disclosures or conflicts of interest to report related to this study.

Investigators who are developing an ultrasound “atlas” of hand osteoarthritis hope that their collection of images will aid in the development of a standardized ultrasonographic scoring system for the disease.

The investigators' descriptive study of ultrasonographic findings in 127 patients builds upon the development several years ago of a preliminary ultrasonographic scoring system for the features of hand osteoarthritis.

In the prior effort, reported in 2008 in the Annals of the Rheumatic Diseases, experts led by Dr. Helen Keen of the University of Leeds (England) reached consensus on which ultrasound-detectable abnormalities—synovitis (gray scale and power Doppler) and osteophytes—are important and feasible for inclusion in a scoring system.

The new atlas of characteristic images of osteoarthritis in finger joints takes the effort a step further, “so that we can realize the full potential of ultrasound” as an imaging tool for hand OA, and “move toward validating the preliminary semiquantitative scoring system” for use in epidemiologic and outcome studies, said Alexander Mathiessen, a medical student at the University of Oslo.

The 127 patients who were examined with ultrasound had a mean age of 69 years and symptom duration of approximately 18 years. Two sonographers performed the assessments together and, using a 0-3 scale, achieved consensus in the scoring of osteophytes, gray-scale synovitis, and power Doppler in 30 joints: the first carpometacarpal (CMC), first through fifth metacarpophalangeal (MCP), first through fifth proximal interphalangeal (PIP), second through fifth distal interphalangeal (DIP), dorsal view, from radial to ulnar side bilaterally.

Osteophytosis has been the dominant pathology in the approximately 3,700 joints examined thus far, with a prevalence of 53%. All patients had osteophytes in at least four joints. In joints with osteophyte pathology, the mean scores were 1.8 for CMC, 1.2 for MCP, 1.8 for PIP, and 2.1 for DIP joints.

The imaging study, which Mr. Mathiessen performed with Dr. Hilde B. Hammer at the Diakonhjemmet Hospital in Oslo, revealed a large degree of symmetry between hands—a finding that confirms what other studies have shown, he noted.

“Hand osteoarthritis is remarkably symmetric,” said Mr. Mathiessen. “The odds ratio of having an osteophyte in one joint if you have it in the same opposite joint was 35.1, indicating significant concordance.”

And in another finding that “needs further evaluation,” the investigators found that in 84% of the patients, the sum osteophyte score was similar or greater in the dominant hand than in the nondominant hand. “It [may be] enough to scan only the dominant hand,” he observed.

Gray-scale synovitis and power Doppler activity were found in approximately 16% and 2% of the joints, respectively.

“We found synovitis in one-third of the CMC joints, though, and in about 20% of the small PIP and DIP joints,” Mr. Mathiessen said. “Power Doppler was frequent only in the CMC joint, with a prevalence of 14%.”

The findings might indicate “that the focus should be on osteophytes and synovitis,” he added. “Based on our findings, I'm not sure about the role of power Doppler in a final scoring system…. On the other hand, though, this feature is important for differentiating osteoarthritis against other joint diseases.”

Ultrasound images of hands affected by osteoarthritis, such as the Doppler image above, compose the OMERACT atlas.

Source Courtesy Alexander Mathiessen

Major Finding: Osteophytosis was the dominant pathology in more than 3,700 hand joints examined by ultrasound in patients with hand OA.

Data Source: A descriptive imaging study of 127 patients with hand OA.

Disclosures: Dr. Hammer was supported by an unrestricted grant from Abbott Laboratories; this grant was given after the study was completed, however, according to Mr. Mathiessen. Mr. Mathiessen said they have no disclosures or conflicts of interest to report related to this study.

Investigators who are developing an ultrasound “atlas” of hand osteoarthritis hope that their collection of images will aid in the development of a standardized ultrasonographic scoring system for the disease.

The investigators' descriptive study of ultrasonographic findings in 127 patients builds upon the development several years ago of a preliminary ultrasonographic scoring system for the features of hand osteoarthritis.

In the prior effort, reported in 2008 in the Annals of the Rheumatic Diseases, experts led by Dr. Helen Keen of the University of Leeds (England) reached consensus on which ultrasound-detectable abnormalities—synovitis (gray scale and power Doppler) and osteophytes—are important and feasible for inclusion in a scoring system.

The new atlas of characteristic images of osteoarthritis in finger joints takes the effort a step further, “so that we can realize the full potential of ultrasound” as an imaging tool for hand OA, and “move toward validating the preliminary semiquantitative scoring system” for use in epidemiologic and outcome studies, said Alexander Mathiessen, a medical student at the University of Oslo.

The 127 patients who were examined with ultrasound had a mean age of 69 years and symptom duration of approximately 18 years. Two sonographers performed the assessments together and, using a 0-3 scale, achieved consensus in the scoring of osteophytes, gray-scale synovitis, and power Doppler in 30 joints: the first carpometacarpal (CMC), first through fifth metacarpophalangeal (MCP), first through fifth proximal interphalangeal (PIP), second through fifth distal interphalangeal (DIP), dorsal view, from radial to ulnar side bilaterally.

Osteophytosis has been the dominant pathology in the approximately 3,700 joints examined thus far, with a prevalence of 53%. All patients had osteophytes in at least four joints. In joints with osteophyte pathology, the mean scores were 1.8 for CMC, 1.2 for MCP, 1.8 for PIP, and 2.1 for DIP joints.

The imaging study, which Mr. Mathiessen performed with Dr. Hilde B. Hammer at the Diakonhjemmet Hospital in Oslo, revealed a large degree of symmetry between hands—a finding that confirms what other studies have shown, he noted.

“Hand osteoarthritis is remarkably symmetric,” said Mr. Mathiessen. “The odds ratio of having an osteophyte in one joint if you have it in the same opposite joint was 35.1, indicating significant concordance.”

And in another finding that “needs further evaluation,” the investigators found that in 84% of the patients, the sum osteophyte score was similar or greater in the dominant hand than in the nondominant hand. “It [may be] enough to scan only the dominant hand,” he observed.

Gray-scale synovitis and power Doppler activity were found in approximately 16% and 2% of the joints, respectively.

“We found synovitis in one-third of the CMC joints, though, and in about 20% of the small PIP and DIP joints,” Mr. Mathiessen said. “Power Doppler was frequent only in the CMC joint, with a prevalence of 14%.”

The findings might indicate “that the focus should be on osteophytes and synovitis,” he added. “Based on our findings, I'm not sure about the role of power Doppler in a final scoring system…. On the other hand, though, this feature is important for differentiating osteoarthritis against other joint diseases.”

Ultrasound images of hands affected by osteoarthritis, such as the Doppler image above, compose the OMERACT atlas.

Source Courtesy Alexander Mathiessen

Major Finding: Osteophytosis was the dominant pathology in more than 3,700 hand joints examined by ultrasound in patients with hand OA.

Data Source: A descriptive imaging study of 127 patients with hand OA.

Disclosures: Dr. Hammer was supported by an unrestricted grant from Abbott Laboratories; this grant was given after the study was completed, however, according to Mr. Mathiessen. Mr. Mathiessen said they have no disclosures or conflicts of interest to report related to this study.

Investigators who are developing an ultrasound “atlas” of hand osteoarthritis hope that their collection of images will aid in the development of a standardized ultrasonographic scoring system for the disease.

The investigators' descriptive study of ultrasonographic findings in 127 patients builds upon the development several years ago of a preliminary ultrasonographic scoring system for the features of hand osteoarthritis.

In the prior effort, reported in 2008 in the Annals of the Rheumatic Diseases, experts led by Dr. Helen Keen of the University of Leeds (England) reached consensus on which ultrasound-detectable abnormalities—synovitis (gray scale and power Doppler) and osteophytes—are important and feasible for inclusion in a scoring system.

The new atlas of characteristic images of osteoarthritis in finger joints takes the effort a step further, “so that we can realize the full potential of ultrasound” as an imaging tool for hand OA, and “move toward validating the preliminary semiquantitative scoring system” for use in epidemiologic and outcome studies, said Alexander Mathiessen, a medical student at the University of Oslo.

The 127 patients who were examined with ultrasound had a mean age of 69 years and symptom duration of approximately 18 years. Two sonographers performed the assessments together and, using a 0-3 scale, achieved consensus in the scoring of osteophytes, gray-scale synovitis, and power Doppler in 30 joints: the first carpometacarpal (CMC), first through fifth metacarpophalangeal (MCP), first through fifth proximal interphalangeal (PIP), second through fifth distal interphalangeal (DIP), dorsal view, from radial to ulnar side bilaterally.

Osteophytosis has been the dominant pathology in the approximately 3,700 joints examined thus far, with a prevalence of 53%. All patients had osteophytes in at least four joints. In joints with osteophyte pathology, the mean scores were 1.8 for CMC, 1.2 for MCP, 1.8 for PIP, and 2.1 for DIP joints.

The imaging study, which Mr. Mathiessen performed with Dr. Hilde B. Hammer at the Diakonhjemmet Hospital in Oslo, revealed a large degree of symmetry between hands—a finding that confirms what other studies have shown, he noted.

“Hand osteoarthritis is remarkably symmetric,” said Mr. Mathiessen. “The odds ratio of having an osteophyte in one joint if you have it in the same opposite joint was 35.1, indicating significant concordance.”

And in another finding that “needs further evaluation,” the investigators found that in 84% of the patients, the sum osteophyte score was similar or greater in the dominant hand than in the nondominant hand. “It [may be] enough to scan only the dominant hand,” he observed.

Gray-scale synovitis and power Doppler activity were found in approximately 16% and 2% of the joints, respectively.

“We found synovitis in one-third of the CMC joints, though, and in about 20% of the small PIP and DIP joints,” Mr. Mathiessen said. “Power Doppler was frequent only in the CMC joint, with a prevalence of 14%.”

The findings might indicate “that the focus should be on osteophytes and synovitis,” he added. “Based on our findings, I'm not sure about the role of power Doppler in a final scoring system…. On the other hand, though, this feature is important for differentiating osteoarthritis against other joint diseases.”

Ultrasound images of hands affected by osteoarthritis, such as the Doppler image above, compose the OMERACT atlas.

Source Courtesy Alexander Mathiessen