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Original research
Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis
  1. Ida K Haugen1,
  2. David T Felson2,3,
  3. Abhishek Abhishek4,5,
  4. Francis Berenbaum6,
  5. Sita Bierma-Zeinstra7,
  6. Tove Borgen1,8,
  7. Gabriel Herrero Beaumont9,
  8. Mariko Ishimori10,
  9. Helgi Jonsson11,
  10. Féline PB Kroon12,
  11. Emmanuel Maheu13,
  12. Roberta Ramonda14,
  13. Valentin Ritschl15,
  14. Tanja A Stamm15,
  15. Desirée van der Heijde12,
  16. Ruth Wittoek16,
  17. Elsie Greibrokk1,
  18. Wilma Smeets12 and
  19. Margreet Kloppenburg12
  1. 1 Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
  2. 2 Rheumatology Section, Boston University School of Medicine, Boston, Massachusetts, USA
  3. 3 Arthritis Research UK Epidemiology Unit and National Institute for Health Research Biomedical Research Centre, The University of Manchester, Manchester, UK
  4. 4 Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
  5. 5 Nottingham NIHR-BRC,Nottingham, UK
  6. 6 Department of Rheumatology, Hopital Saint-Antoine,Paris, France
  7. 7 Department of General Practice, Department of Orthopedics, Erasmus Medical Center, Rotterdam, Netherlands
  8. 8 Frysja Medical Practice, Oslo, Norway
  9. 9 Rheumatology, Universidad Autonoma De Madrid, Madrid, Spain
  10. 10 Rheumatology, Cedars-Sinai Medical Center, Los Angeles, California, USA
  11. 11 Rheumatology, Landspitali, Reykjavik, Iceland
  12. 12 Rheumatology, Leiden University Medical Center, Leiden, Netherlands
  13. 13 Faculty of Medicine Pierre & Marie Curie Paris VI, Hopital Saint-Antoine,Paris, France
  14. 14 Rheumatology Unit, Department of Medicine—DIMED, University of Padova School of Medicine and Surgery, Padova, Italy
  15. 15 Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Wien, Austria
  16. 16 Rheumatology, University Hospital Ghent, Gent, Belgium
  1. Correspondence to Ida K Haugen; ida.haugen{at}


Objectives Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA.

Methods In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC).

Results Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in the first carpometacarpal joints (AUC = 0.67 and 0.63, respectively). Painful DIP joints were associated with hand OA, but were less able to discriminate between groups (AUC = 0.67). Age and family history of OA were positively associated with hand OA, whereas negative associations were found for pain, stiffness and soft tissue swelling in metacarpophalangeal joints, pain and marginal erosions in wrists, longer morning stiffness, inflammatory biomarkers and autoantibodies.

Conclusions Differences in symptoms, clinical findings, radiographic changes and laboratory tests were found in patients with hand OA versus controls. Radiographic OA features, especially in DIP joints, were best suited to discriminate between groups.

  • Epidemiology
  • MRI
  • Osteoarthritis
  • Outcomes research
  • Ultrasonography
  • Chondrocytes
  • Hand Osteoarthritis
  • Knee Osteoarthritis
  • Chondrocalcinosis
  • Gene Polymorphism
  • Ankylosing Spondylitis
  • Anti-TNF
  • Patient perspective
  • Qualitative research
  • Rehabilitation
  • Spondyloarthritis

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  • Contributors All coauthors had substantial contributions to the conception or design of the work, or the acquisition, analysis or interpretation of data. IKH drafted the paper, and all coauthors revised it critically for important intellectual content and gave their final approval of the version published.

  • Funding The project on the development of new classification criteria for hand OA is funded by EULAR. The EULAR executive committee has not been involved in the study design, analyses or interpretation of results.

  • Competing interests Ida K. Haugen reports a research grant from Pfizer, outside the submitted work. Francis Berenbaum reports personal fees from Boehringer, Bone Therapeutics, Expanscience, Galapagos, Gilead, GSK, Merck Sereno, MSD, Nordic, Novartis, Pfizer, Regulaxis, Roche, Sandoz, Sanofi, Servier, UCB, Peptinov, TRB Chemedica, 4P Pharma, outside the submitted work. Sita Bierma-Zeinstra reports grants from The Netherlands Organisation for Health Research and Development, CZ, European Union, Foreum, Dutch Arthritis Association, personal fees from Infirst healthcare, Pfizer and Osteoarthritis and Cartilage, outside the submitted work. Emmanuel Maheu reports personal fees from Expanscience, Mylan-Meda, TRB Chemedica, Pierre Fabre, Celgène and Fidia, and non-financial support from Pfizer, outside the submitted work. Roberta Ramonda reports honoraria for speaking engagements and for Advisory Board from Abbvie, Celgene, Novartis, Pfizer and Lilly. Tanja Stamm received speaker fees from Sanofi, AbbVie and Roche. Désirée van der Heijde reports personal fees from AbbVie, personal fees from Amgen, personal fees from Astellas, personal fees from AstraZeneca, personal fees from BMS, personal fees from Boehringer Ingelheim, personal fees from Celgene, personal fees from Cyxone, personal fees from Daichii, personal fees from Eisai, personal fees from Elly-Lilly, personal fees from Galapagos, personal fees from Gilead, personal fees from GSK, personal fees from Janssen, personal fees from Merck, personal fees from Novartis, personal fees from Pfizer, personal fees from Regeneron, personal fees from Roche, personal fees from Sanofi, personal fees from Takeda, personal fees from UCB Pharma, outside the submitted work; and Director Imaging Rheumatology BV. Ruth Wittoek reports personal fees from Abbvie, personal fees from Galapagos, personal fees from UCB, personal fees from Bristol Myers Squib, personal fees from Tilman, grants from Amgen, outside the submitted work. Margreet Kloppenburg reports grants from European League Against Rheumatism during the conduct of the study, fee for consultancy (Abbvie, Pfizer, Levicept, GlaxoSmithKline, Merck-Serono, Kiniksa, Flexion) and local investigator of industry-driven trial (Abbvie), other from Dutch Society of Rheumatology, Wolters Kluwer (UptoDate) and Springer Verlag (Reumatologie en klinische immunologie), grants from Pfizer, outside the submitted work. David Felson, Abhishek Abhishek, Tove Borgen, Gabriel Herrero-Beaumont, Mariko L. Ishimori, Helgi Jonsson, Féline P.B. Kroon, Valentin Ritschl, Elsie Greibrokk and Wilma Smeets have no conflicts of interest.

  • Patient consent for publication Consent obtained directly from patient(s).

  • Data sharing statement Data are available upon reasonable request.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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