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Abstract
Osteoarthritis is the most common rheumatic disease, and is becoming a major problem of public health with the ageing of the population in developed countries. OA of the hand is very common. Its prevalence and Incidence vary with the definition used.
Many studies conclude that hip and knee OA causes severe functional limitations. However, the contribution of hand OA to impairment and activity limitations is less clear. The discordance between symptoms, signs, and functional impairment in hand OA is well recognized.
Plain radiographs are the initial method of choice to image the hands, as they are widely available, cheap and reproducible. The characteristic radiological features of OA include JSN, OST, sclerosis and deformity. It is not clear whether any or all these features are truly indicative for OA.
Musculoskeletal US has been increasingly utilized to aid the understanding and management of rheumatic conditions. Our study included 30 primary hand OA patients who were classified into two groups those with IP joint involvement only and those with IP and CMC joints with 15 healthy controls, aiming at studying the validity of US in assessing OA, the relationship between ultrasonographic findings and symptoms of OA and the clinical utility of ultrasonography in OA.
All studied groups were subjected to the following: Thorough clinical examination with stress on musculoskeletal examination; all hand joints were examined for tenderness, soft tissue swelling, hard tissue enlargement, and deformity, functional assessment by AUSCAN questionnaire, grip and pinch strength measurement and pain assessment by VAS.
Postero-anterior radiograph of both hands were taken. Each site was examined for the presence of JSN, OST, cartilage erosions and alignment and was then classified according to K-L grade. High resolution US of the hand joints was performed.
There was a positive correlation between the K-L grading, JSN and OST ultrasonographic findings. No significant correlation was detected between the K-L grading and cartilage thinning. There was a positive correlation between AUSCAN score, cartilage thinning, OST and JSN. There was only a positive correlation between stiffness and JSN. There was a negative correlation between grip strength, cartilage thinning and OST findings. No significant correlation between grip strength and JSN was detected.
Regarding clinical correlations, DIP hard swelling was correlated with underlying DIP cartilage thinning, OST and JSN, while DIP deformity was correlated with cartilage thinning and OST. In comparison between different groups of patients as regards functional affection; there was a statistically significant difference in AUSCAN and VAS, as patients with symptoms at both sites (IP & 1st CMC joints) experienced higher level of pain and disability and less pinch strength.
In conclusion, US demonstrates a large set of changes involving the hyaline cartilage from early to late, US demonstrated correlations between radiographic abnormalities and clinical findings such as bony swelling, pain, and decreased grip strength. The increased detection of OA structural pa