title: Clinical and radiographic disease course of hand osteoarthritis and determinants of outcome after 6 years.
abstract: OBJECTIVE
  To investigate the long-term clinical and radiographic disease course of hand osteoarthritis (OA) and determinants of outcome.
  
  
  METHODS
  Clinical and radiographic measures were obtained at baseline and after 6 years in 289 patients with hand OA (mean age 59.5 years, 83.0% women). Clinical outcomes were self-reported pain and functional limitations assessed with the Australian/Canadian Osteoarthritis Hand Index (AUSCAN). Poor clinical outcome was defined as a follow-up score not fulfilling the Patient Acceptable Symptom State. Radiographic outcome was assessed by osteophytes and joint space narrowing (JSN) on standardised hand radiographs using the Osteoarthritis Research Society International (OARSI) atlas. Radiographic progression was defined as a change in osteophytes or JSN, above the smallest detectable change. Change in outcome measures was calculated and baseline determinants for poor clinical outcome and radiographic progression were assessed using logistic regression analysis.
  
  
  RESULTS
  Clinical change showed great variation, with half of the population reporting deterioration. Poor outcome in pain was related to high levels of functional limitations and a high number of painful joints at baseline. Poor outcome on functional limitations was related to high baseline pain levels. Radiographic progression was present in 52.5% of patients and associated with high baseline levels of pain, nodes, osteophytes and the presence of erosive OA and nodal OA. Clinical change and radiographic progression were not related.
  
  
  CONCLUSIONS
  This study gives insight in the clinical and radiographic course of hand OA as well as determinants of outcome. These findings enable better patient information on prognosis. The relationship between clinical and radiographic outcome needs further investigation.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. J.Bijsterbosch@lumc.nl
authors.forename: J
authors.initials: J
authors.lastname: Bijsterbosch
authors.forename: I
authors.initials: I
authors.lastname: Watt
authors.forename: I
authors.initials: I
authors.lastname: Meulenbelt
authors.forename: F R
authors.initials: FR
authors.lastname: Rosendaal
authors.forename: T W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: M
authors.initials: M
authors.lastname: Kloppenburg
mesh_terms: D000368:Aged; D015331:Cohort Studies; D004185:Disability Evaluation; D018450:Disease Progression; D005260:Female; D005500:Follow-Up Studies; D050823:Hand Joints / Q000000981:diagnostic imaging* / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000150:complications / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000503:physiopathology; D054850:Osteophyte / Q000000981:diagnostic imaging / Q000473:pathology; D010146:Pain / Q000209:etiology; D011379:Prognosis; D011859:Radiography