EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT

Abstract

Objectives: To develop evidence-based recommendations for the diagnosis of hand osteoarthritis (OA). Methods: The multidisciplinary guideline development group, representing 15 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. For each recommendation, research evidence was searched for systematically. Whenever possible, the sensitivity, specificity and likelihood ratio (LR) were calculated; relative risk and odds ratios were estimated for risk factors for hand OA. Quality of evidence was categorised using the European League Against Rheumatism (EULAR) hierarchy, and strength of recommendation was assessed by the EULAR visual analogue scale. Results: Diagnostic topics included clinical manifestations, radiographic features, subgroups, differential diagnosis, laboratory tests, risk factors and comorbidities. The sensitivity, specificity and LR varied between tests depending upon the cut-off level, gold standard and controls. Overall, no single test could be used to define hand OA on its own (LR ,10) but a composite of the tests greatly increased the chance of the diagnosis. The probability of a subject having hand OA was 20% when Heberden nodes alone were present, but this increased to 88% when in addition the subject was over 40 years old, had a family history of nodes and had joint space narrowing in any finger joint. Conclusion: Ten key recommendations for diagnosis of hand OA were developed using research evidence and expert consensus. Diagnosis of hand OA should be based on assessment of a composite of features.

Risk Factors of Symptomatic Knee, Hand and Hip Osteoarthritis in a Suburban Area of İzmir City

“…On the other hand, the increment of risk rates with obesity for hip OA was not as much as knee OA (38,39). In the EULAR recommendations, obesity takes place among major risk factors for hand OA (evidence level 2a) (26). In line with existing literature, we report that obesity and morbid obesity increase the risk of developing SKO up to 5.8 times in men and women (95% CI 2.1-16.2).…”

“…EULAR reported that SHaO was found to be rare under 40 years of age, whereas it had a dramatic increase in rate in women after their 40s. Therefore, being over 40 years old was reported (evidence level 2a ) as a major risk factor for developing SHaO in numerous studies (26). In a recent study about hip OA, it was shown that between 40-44 years of age, primary radiographical hip OA prevalence was 0.7% and increased to 14% at 85 years of age (27).…”

“…In the EULAR recommendations, female gender was reported as a risk factor for hand OA (evidence level 1b). Also, Yeşil et (26). It was also revealed that women with developmental hip dysplasia had high risk for hip OA than the male population (30).…”

Widespread Pressure Pain Hypersensitivity in Elderly Subjects with Unilateral Thumb Carpometacarpal Osteoarthritis

“…In addition, patients had also to report pain at the thumb as their main symptom. The combination of radiological and clinical findings has been recommended for making a more accurate diagnosis of thumb CMC OA [47]. Exclusion criteria were as follows: previous treatment intervention with surgery in the hand or the forearm; corticosteroid injection or any physical therapy intervention within 6 months before the study; multiple pain diagnoses of the upper extremity, e.g., carpal tunnel syndrome, de Quervain's tenosynovitis, shoulder pathology, and cervical radiculopathy; evidence of systemic illness (rheumatoid arthritis, psoriatic arthritis, systemic lupus erythematosus); fibromyalgia syndrome; complex regional pain syndrome; any degenerative or non-degenerative neurological conditions where pain perception can be altered; presence of any symptom in the non-dominant hand; evidence of radiographic alterations at the first CMC joint in the nondominant hand; presence of a score greater than 6 points in the Beck Depression Inventory (BDI-II); or presence of a score >30 points on the State Trait Anxiety Inventory (STAI).…”

Oxidative stress and related factors in patients with ankylosing spondylitis

“…Diabetes mellitus (DM): Current use of medications prescribed to treat DM or fasting serum glucose levels ≥126 mg/dL (15).…”