title: Pain in hand osteoarthritis is associated with inflammation: the value of ultrasound.
abstract: OBJECTIVE
  To investigate the association of ultrasound (US) features-grey scale (GS) synovitis, synovial thickening, effusion and power Doppler signal (PDS)-with symptoms in hand osteoarthritis (HOA).
  
  
  METHODS
  Fifty-five consecutive patients (mean age 62 years, 87% women) with HOA, fulfilling the American College of Rheumatology criteria, were assessed for pain upon palpation and filled in Australian/Canadian Osteoarthritis Index (AUSCAN) scores, visual analogue scale pain and Short Form-36 (SF-36). US was performed in all metacarpophalangeal, proximal interphalangeal, distal interphalangeal, first interphalangeal and first carpometacarpal joints, and features were semiquantitatively scored (0-3). Generalised estimating equations were used to calculate OR (95% CI) for the association between US features and pain per joint adjusted for relevant confounders. The association between US features summated scores and self-reported outcomes was studied by linear regression analysis.
  
  
  RESULTS
  GS synovitis, effusion, synovial thickening and PDS were shown in 96%, 91%, 73% and 86% of patients, respectively. US features were dose-dependently associated with pain upon palpation (OR 4.5 (95% CI 2.2 to 9.0), 4.4 (2.0 to 9.4), 4.9 (2.2 to 11.0) and 4.1 (2.2 to 7.9)). GS synovitis was associated with AUSCAN pain, stiffness and SF-36, and effusion with AUSCAN pain.
  
  
  CONCLUSIONS
  GS synovitis, effusion, synovial thickening and PDS are associated with pain in HOA, suggesting a role for inflammation. Further follow-up studies are warranted.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, The Netherlands. m.c.kortekaas@lumc.nl
authors.forename: Marion C
authors.initials: MC
authors.lastname: Kortekaas
authors.forename: Wing-Yee
authors.initials: WY
authors.lastname: Kwok
authors.forename: Monique
authors.initials: M
authors.lastname: Reijnierse
authors.forename: Iain
authors.initials: I
authors.lastname: Watt
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Margreet
authors.initials: M
authors.lastname: Kloppenburg
mesh_terms: D000368:Aged; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications* / Q000000981:diagnostic imaging / Q000503:physiopathology; D010146:Pain / Q000000981:diagnostic imaging / Q000209:etiology*; D010147:Pain Measurement / Q000379:methods; D010173:Palpation; D011788:Quality of Life; D013583:Synovial Membrane / Q000000981:diagnostic imaging / Q000473:pathology; D013585:Synovitis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D018608:Ultrasonography, Doppler / Q000379:methods