Abstract
Introduction
Erosive Hand OsteoArthritis (EHOA) is a common rheumatological problem. We aim to determine characteristics of EHOA patients: comorbidities, radiographic erosivity and pain experienced after being diagnosed, in order to find which of these are potentially relevant in upcoming interventional trials.
Method
Retrospective analysis of EHOA patients within the electronic database in one centre, with a telephone interview on pain as experienced even exceeding 12 months after being diagnosed.
Results
Eighty-four non-academic EHOA patients were found: 89% females (median age 69 years), 11% males (similar age distribution). Kellgren-Lawrence (KL) erosivity scores in both sexes were comparable; DIPs scored higher than PIP’s. Comorbid conditions were crystal-induced arthritis, rheumatoid arthritis (RA) and psoriatic arthritis (PsA) in 8%, 5% and 1%, respectively; seropositivity for rheumatoid factor and anti-citrullinated protein antibodies in 8% and 1% respectively. Pain worst experienced often exceeded a visual analogue score of 5.0, but was unrelated to the total KL score. Some pain reduction was reached with non-steroidals (perorally/transcutaneously) as deduced from continued use in 1 in 3.
Conclusions
In many EHOA patients, there is an unmet need regarding the treatment of pain, which per se was not directly correlated with erosivity score. Future studies may be designed considering the aforementioned characteristics, acting on the inflammatory process resulting in PIP/DIP erosions, with the exclusion of RA and PsA in order to get a clean study on EHOA. Several studies with monoclonal antibodies have been performed but demonstrated ineffectivity on the outcome of pain. Hope glooms with the arrival of innovative small molecules that may reach EHOA target cells.
Key Points • Erosive handOA is a common problem in non-academic rheumatology; it is often associated with significant pain in both sexes exceeding a VASpain of 5.0 even years after being diagnosed; 1 in 3 found some relief in non-steroidals perorally/transcutaneously. • Future studies will have to focus on (episodic) inflammatory hand OA resulting in proven erosivity (EHOA) located in PIP plus DIP joints and may have to exclude comorbid active crystal-induced arthritis as well as rheumatoid/psoriatic arthritis and possibly even RF/ACPA seropositivity in order to get a clean study on EHOA. • As several big monoclonals have failed in EHOA, we may have to search for promising new drugs within the group of small molecules. These will have to show a significant pain-reducing effect and preferably also a disease-modifying osteoarthritis drug (DMOAD) effect. |
Similar content being viewed by others
References
Dahaghin S, Bierma-Zeinstra SM, Ginai AZ et al (2006) Prevalence and patterns of radiographic hand osteoarthritis and association with pain and disability (the Rotterdam study). Ann Rheum Dis 64:682–687
Zhang Y, Xu L, Nevitt MC et al (2001) Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States; the Beijing Osteoarthritis study. Arthritis Rheum 44:2065–2071
Haugen IK, Felson DT, Englund M et al (2012) The association between erosive hand osteoarthritis and subchondral bone attrition of the knee: the Framingham Osteoarthritis Study. Ann Rheum Dis 71:1698–1701. https://doi.org/10.1136/annrheumdis-2012-201659
Kwok WY, Kloppenburg M, Marshall M et al (2013) Comparison of clinical burden between patients with erosive hand osteoarthritis and inflammatory arthritis in symptomatic community-dwelling adults: the Keele clinical assessment studies. B J Rheumatol 52:2260–2267. https://doi.org/10.1093/rheumatology/ket267
Haugen IK, Felson DT, Abhishek A et al (2020) Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis. RMD Open 5:e001265. https://doi.org/10.1136/rmdopen-2020-001265
Poletto E, Tinazzi I, Marchetta A et al (2021) Hand erosive osteoarthritis and distal interphalangeal involvement in psoriatic arthritis: the place of conservative therapy. J Clin Med 10:2630. https://doi.org/10.3390/jcm10122630
Allen KD, DeVellis RF, Renner JB et al (2007) Validity and factor structure of the AUSCAN Osteoarthritis hand index in a community-based sample. Osteoarthritis Cartilage 15:830–836. https://doi.org/10.1016/j.joca.2007.01.012
Kingsbury SR, Tharmanathan P, Adamson J et al (2021) Hydroxychloroquine effectiveness in reducing symptoms of hand osteoarthritis (HERO): study protocol for a randomized controlled trial.
Kedor C et al (2020) Hydroxychloroquine in patients with inflammatory and erosive osteoarthritis of the hands: results of a randomized, double-blind, placebo-controlled, multicentre, investigator-initiated trial (OA TREAT). EULAR abstract OP0186
Cohen SB, Proudman S, Kivitz AJ et al (2011) A randomized, double-blind study of AMG 108 (a fully human monoclonal antibody to IL-1R1) in patients with osteoarthritis of the knee. Arthritis Res Ther 13:R125. https://doi.org/10.1186/ar3430
Chevalier X, Ravaud P, Maheu E et al (2015) Adalimumab in patients with hand osteoarthritis refractory to analgesics and NSAIDs: a randomised, multicentre, double-blind, placebo-controlled trial. Ann Rheum Dis 74(9):1697–1705. https://doi.org/10.1136/annrheumdis-2014-205348
Kloppenburg M, Ramonda R, Bobacz K et al (2018) Etanercept in patients with inflammatory hand osteoarthritis (EHOA): a multicentre, randomised, double-blind, placebo-controlled trial. Ann Rheum Dis 77(12):1757–1764. https://doi.org/10.1136/annrheumdis-2018-213202
Kloppenburg M, Peterfy Ch, Haugen I et al (2019) Phase II1, placebo-controlled, randomised study of lutikizumab, an anti-interleukin-1alpha and anti-interleukin-1beta dual variable domain immunoglobulin, in patients with erosive hand osteoarthritis. Ann Rheum Dis 78:413–420
Richette P, Latourte A, Sellam J et al (2020) Efficacy of tocilizumab in patients with hand osteoarthritis: double-blind, randomised, placebo-controlled, multicentre trial. Ann Rheum Dis. https://doi.org/10.1136/annrheumdis-2020-218547
Kroon FPB, Kortekaas MC, Boonen A et al (2019) Results of a 6-week treatment with 10mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial. Lancet 394(10213):1993–2001. https://doi.org/10.1016/S0140-6736(19)32489-4
Graessel S, Zaucke F, Madry H (2021) Osteoarthritis: novel molecular mechanisms increase our understanding of disease pathology. J Clin Med 10(9):1938. https://doi.org/10.3390/jcm10091938
Klück V, Jansen TL, Janssen M et al (2020) Dapansutrile, an oral selective NLRP3 inflammasome inhibitor for treatment of gout flares: an open-label, dose-adaptive, proof-of-concept, phase 2 a trial. Lancet Rheumatol. https://doi.org/10.1016/S2665-9913(20)30087-4
Kellgren J, Lawrence J (1957) Radiological Assessment of Osteo-Arthrosis. Ann Rheum Dis 16(4):494–502. https://doi.org/10.1136/ard.16.4.494
Panter C, Berry P, Chauhan D et al (2021) A qualitative exploration of the patient experience of erosive and non-erosive hand osteoarthritis. JPRO. https://doi.org/10.1186/s41687-021-00286-1
Stern AG, De Carvalho MR, Buck GA et al (2003) Association of erosive hand osteoarthritis with a single nucleotide polymorphism on the gene encoding interleukin-1 beta. Osteoarthritis Cartilage 11:394–402
Bacconnier L, Jorgensen C, Fabre S (2009) Erosive osteoarthritis of the hand: clinical experience with anakinra. Ann Rheum Dis 68:1078–1079
Varan O, Babaoglu H, Atas N et al (2018) Response to anakinra in 3 patients with erosive osteoarthritis. J Clin Rheumatol 1–2
Starobova H, Nadar EI, Vetter I (2020) The NLRP3 inflammasome: role and therapeutic potential in pain treatment. Front Physiol. https://doi.org/10.3389/fphys.2020.01016
Vincent T (2020) Peripheral pain mechanisms in osteoarthritis. Pain 161:S138–S146
Schieker M, Conaghan PG, Mindeholm L et al (2020) Effects of interleukin-1β inhibition on incident hip and knee replacement. Ann Int Med 173:509–515. https://doi.org/10.7326/M20-0527
Fioravanti A, Tenti S, McAllister M et al (2019) Exploring the involvement of NLRP3 and IL-1beta in osteoarthritis of the hand: results of a pilot study. Mediators of Inflamm. https://doi.org/10.1155/2019/2363460
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Disclosures
None.
Additional information
Publisher's note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Giesen, T., Sanduleanu, S. & Jansen, T.L.T.A. Erosive Hand OsteoArthritis (EHOA): analysis of consecutive patients presenting with EHOA in a hospital-based rheumatology practice and its implications for an upcoming interventional study. Clin Rheumatol 41, 1833–1841 (2022). https://doi.org/10.1007/s10067-022-06073-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10067-022-06073-7