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Towards a radiographic definition of nodal osteoarthritis (OA)
Osteoarthritis and Cartilage Vol. 1 No. 1 pheral joint OA who have been examined at two time pSints, 3 years apart, and from a further 100 patients ~ t h knee OA, studied over a 5-year time interval. i : ~ review of these data, in conjunction with recently ~ublished information from other centers, has improved Our understanding of the clinical manifestations and
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natural history of the disorder. The conclusion is that OA should be viewed as a dynamic disease process, which goes through temporary phases of activity which may be dominated by either destruction or repair. Clues to the determinants of progression, stabilization or improvement are being sought.
T o w a r d s a r a d i o g r a p h i c d e f i n i t i o n o f n o d a l o s t e o a r t h r i t i s (OA) A. C. JONES*, M. PATTRICKt,N. D. HOPKINSON$ AND M. DOHERTY* Rheumatology Units, *Nottingham, tNorth Manchester and $Derby, U.K. O~:;i::::::subsets, such as nodal osteoarthritis (NOA), e ~ a c t e r i z e d by Seberden's nodes, may demonstrate ~nces in epidemiological and biological character:We have re-examined data from four studies ing associations with NOA [IgG Rheumatoid ~ (IgG RNF), MZ ~-antitrypsin (s-AT) phenotype, :~lB8 and lack of a negative association with sn/~king (Br J Rheumtol 1987; 48: 470] to determine rd~ographic parameters that might define the NOA subset. ::::S~udy AP hand radiographs were reassessed by a S!r/gIe observer (AJ) and each joint graded for definite 6~t~ophyte, narrowing and sclerosis. These features W~re used to subdivide the cases and the data reana-
lyzed. Patients with osteophytes at < 2 finger distal interphalangeal joints (DIPs) had an Odds Ratio (OR) for smoking of 0.4 (95~/o CI 0.3-0.7) compared to 1.1 (CI 0.6-1.9) for those with > 3 DIPs involved (N = 193). Cases with osteophytes at the thumb interphalangeal (IP) and any DIP had an age-stratified OR for IgG RhF = 5.3 (CI 1.9-14.8, N = 116) compared to those without. No pattern of involvement associated with HLA-B1A8, or MZ ~-1 AT could be determined; no patient without DIP involvement had these phenotypes. These data suggest that definite osteophytes at the thumb IPs and finger DIPs may be useful in defining a distinct NOA subset of OA; involvement of even a small number of joints may be important.
P r o g r e s s i o n o f h a n d r a d i o g r a p h s in p a t i e n t s w i t h k n e e o s t e o a r t h r i t i s CONOR J. MCCARTHY, JANET CUSHNAGHAN AND PAUL A. DIEPPE
Rheumatology Unit, Bristol Royal Infirmary, Bristol, U.K. Little is known about the progression of hand disease in patients who present with knee osteoarthritis (OA). Hand OA is associated with knee OA, but does radiographic progression of hand OA parallel that of the knee? The aim of this study was to follow the progression of hand radiographs in a group of patients with symptomatic knee OA. Seventy-three patients (M 27:F 46, mean age 61.9 years) with radiographic knee OA and knee pain had hand and knee radiographs at entry and repeat radiographs at a mean of 67.3 months (60-72). Each hand joint and the three knee compartments were examined for the individual features of OA. Knee radiographs were scored blind to entry date and hand radiographs were scored at entry a n d progression noted at the follow-up film. At entry, 51 patients (70%) had evidence of hand OA.
Twenty had no evidence of hand OA, and two developed hand OA during the study. In the 51 patients, 88 individual hand joints showed radiographic progression (27 of these were at the thumb base). Progression of both hand and knee OA occurred in 26 patients (51~/o). There was no change in either joint site in seven patients (14~o). Discordant progression occurred in the remaining 18 patients (35~o), 10 with only knee progression and eight only hand progression. Ninety-four per cent (16[17) of patients with progression at the thumb base also had progression at the knee joint. In conclusion, progression of hand and knee OA are discordant, but progression of thumb base OA closely parallels knee joint progression. This suggests that thumb base and knee OA may have a similar etiology and progression and that interphalangeal OA is a different disease.
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natural history of the disorder. The conclusion is that OA should be viewed as a dynamic disease process, which goes through temporary phases of activity which may be dominated by either destruction or repair. Clues to the determinants of progression, stabilization or improvement are being sought.
T o w a r d s a r a d i o g r a p h i c d e f i n i t i o n o f n o d a l o s t e o a r t h r i t i s (OA) A. C. JONES*, M. PATTRICKt,N. D. HOPKINSON$ AND M. DOHERTY* Rheumatology Units, *Nottingham, tNorth Manchester and $Derby, U.K. O~:;i::::::subsets, such as nodal osteoarthritis (NOA), e ~ a c t e r i z e d by Seberden's nodes, may demonstrate ~nces in epidemiological and biological character:We have re-examined data from four studies ing associations with NOA [IgG Rheumatoid ~ (IgG RNF), MZ ~-antitrypsin (s-AT) phenotype, :~lB8 and lack of a negative association with sn/~king (Br J Rheumtol 1987; 48: 470] to determine rd~ographic parameters that might define the NOA subset. ::::S~udy AP hand radiographs were reassessed by a S!r/gIe observer (AJ) and each joint graded for definite 6~t~ophyte, narrowing and sclerosis. These features W~re used to subdivide the cases and the data reana-
lyzed. Patients with osteophytes at < 2 finger distal interphalangeal joints (DIPs) had an Odds Ratio (OR) for smoking of 0.4 (95~/o CI 0.3-0.7) compared to 1.1 (CI 0.6-1.9) for those with > 3 DIPs involved (N = 193). Cases with osteophytes at the thumb interphalangeal (IP) and any DIP had an age-stratified OR for IgG RhF = 5.3 (CI 1.9-14.8, N = 116) compared to those without. No pattern of involvement associated with HLA-B1A8, or MZ ~-1 AT could be determined; no patient without DIP involvement had these phenotypes. These data suggest that definite osteophytes at the thumb IPs and finger DIPs may be useful in defining a distinct NOA subset of OA; involvement of even a small number of joints may be important.
P r o g r e s s i o n o f h a n d r a d i o g r a p h s in p a t i e n t s w i t h k n e e o s t e o a r t h r i t i s CONOR J. MCCARTHY, JANET CUSHNAGHAN AND PAUL A. DIEPPE
Rheumatology Unit, Bristol Royal Infirmary, Bristol, U.K. Little is known about the progression of hand disease in patients who present with knee osteoarthritis (OA). Hand OA is associated with knee OA, but does radiographic progression of hand OA parallel that of the knee? The aim of this study was to follow the progression of hand radiographs in a group of patients with symptomatic knee OA. Seventy-three patients (M 27:F 46, mean age 61.9 years) with radiographic knee OA and knee pain had hand and knee radiographs at entry and repeat radiographs at a mean of 67.3 months (60-72). Each hand joint and the three knee compartments were examined for the individual features of OA. Knee radiographs were scored blind to entry date and hand radiographs were scored at entry a n d progression noted at the follow-up film. At entry, 51 patients (70%) had evidence of hand OA.
Twenty had no evidence of hand OA, and two developed hand OA during the study. In the 51 patients, 88 individual hand joints showed radiographic progression (27 of these were at the thumb base). Progression of both hand and knee OA occurred in 26 patients (51~/o). There was no change in either joint site in seven patients (14~o). Discordant progression occurred in the remaining 18 patients (35~o), 10 with only knee progression and eight only hand progression. Ninety-four per cent (16[17) of patients with progression at the thumb base also had progression at the knee joint. In conclusion, progression of hand and knee OA are discordant, but progression of thumb base OA closely parallels knee joint progression. This suggests that thumb base and knee OA may have a similar etiology and progression and that interphalangeal OA is a different disease.