Disability induced by hand osteoarthritis: are patients with more symptoms at digits 2-5 interphalangeal joints different from those with more symptoms at the base of the thumb?
BACKGROUND
The contribution of osteoarthritis (OA) at the base of the thumb (BT) and digits 2-5 interphalangeal joints (IP) to disability in the hand has never been assessed.


OBJECTIVE
To evaluate and compare disability in patients with clinical hand OA and more severe symptoms at BT or IP.


METHODS
Observational, prospective, correlational.


METHODS
Rheumatology and rehabilitation departments in two tertiary care teaching hospitals.


METHODS
One hundred and sixteen patients (107 women, mean age 62+/-7 years) fulfilling the American College of Rheumatology criteria for OA in the hand, with more symptomatic BT (67 patients) or IP (49 patients).


METHODS
Disability assessment with Cochin hand functional scale (CHFS) was the primary outcome. Assessment of impairment by the visual analog scale of pain (VAS pain), Ritchie articular index (RAI), modified Kapandji index (mKI), Kallman radiological classification and handicap assessment with visual analog scale (VASHd) was the secondary outcome. Group comparisons were assessed by use of Student's t-test for quantitative variables and Chi-square test for categorical variables. Results of the CHFS analysis were assessed by factorial analysis followed by Varimax rotation. Correlation between scores of disability, impairment, and handicap measures were calculated with use of Spearman rank correlation coefficient.


RESULTS
Demographic data, disease duration, and level of global pain were similar between the BT and IP groups. The BT and IP groups did not differ significantly according to disability and handicap level (P=0.42 and P=0.94 for CHFS total score and VASHd, respectively). Factor analysis of the CHFS revealed similar results for the two groups of patients, especially for the first extracted factor. Disability scores correlated best with global hand pain (r=0.65) in the BT group and with RAI scores (r=0.71) in the IP group.


CONCLUSIONS
Disability and perceived handicap levels are comparable in clinical hand OA patients with more symptomatic BT or IP. These two groups should not be considered different during trials assessing treatments for hand OA when the primary outcome measure assesses disability.
Spacek
Elena
E
Hôpital Cochin, Service de rééduction et de réadaptation de l'appareil locomoteur et des pathologies du rachis, Assistance Publique-Hôpitaux de Paris, Université René Descartes, 27 rue du Faubourg Saint Jacques, 75014 Paris, France.
Poiraudeau
Serge
S
Fayad
Fouad
F
Lefèvre-Colau
Marie-Martine
MM
Beaudreuil
Johann
J
Rannou
François
F
Fermanian
Jacques
J
Revel
Michel
M
D000368:Aged; D004185:Disability Evaluation; D005260:Female; D005384:Finger Joint; D018737:Hand Strength; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000175:diagnosis* / Q000503:physiopathology; D010147:Pain Measurement; D013933:Thumb