title: The use of digital photographs for the diagnosis of hand osteoarthritis: the AGES-Reykjavik study.
abstract: BACKGROUND
  The objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and finally to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable.
  
  
  METHODS
  High quality photographs with standard distance and hand positioning were analysed for the presence of HOA and subsequently compared with standard radiographs and clinical examination in 381 random participants in the AGES-Reykjavik Study, a large population study. The mean age of the participants was 76 years.
  
  
  RESULTS
  Using the photographic method, the most commonly affected joints were the second DIP joints followed by the third DIP joints and second and third PIP joints. Both interobserver (ICC = 0.83) and intraobserver reading agreements (ICC = 0.89) were acceptable. On comparison with radiography and clinical examination, aggregate scores were significantly correlated (R(s) 0.35-0.69), more so in females (R(s) 0.53-0.72) than males. Hand pain in males showed very little association with HOA findings by the three methods but all methods showed a comparable moderate association with hand pain in females. The performance of photography in predicting pain on most days for at least a month in females was comparable to that of radiography and clinical examination (AUC 0.63 p = 0.004). Analysis of intermittent pain yielded similar results for in the DIP and PIP joints (OR 3.2-3.3, p < 0.01), but for the CMC1 joints, both radiography (OR 9.0, p < 0.0001), and clinical examination (OR 9.8, p < 0.0001), had higher predictive odds ratios for pain than photography (OR 3.6, p < 0.0001)., A shortened, rapidly performed form of reading photographs also showed a high degree of correlation with the other methods (R(s) 0.56-0.82).
  
  
  CONCLUSIONS
  High quality hand photographs can be used to diagnose and grade hand osteoarthritis. The method has the advantage of being inexpensive and easy to perform. By using a slightly simplified method of reading, it appears to be highly suitable for use in large studies.
authors.affiliation: Landspitalinn University Hospital, University of Iceland, IS-108 Fossvogur, Reykjavik, ICELAND. helgi@hi.is
authors.forename: Helgi
authors.initials: H
authors.lastname: Jonsson
authors.forename: Gudrun P
authors.initials: GP
authors.lastname: Helgadottir
authors.forename: Thor
authors.initials: T
authors.lastname: Aspelund
authors.forename: Johanna E
authors.initials: JE
authors.lastname: Sverrisdottir
authors.forename: Gudny
authors.initials: G
authors.lastname: Eiriksdottir
authors.forename: Sigurdur
authors.initials: S
authors.lastname: Sigurdsson
authors.forename: Gudmundur J
authors.initials: GJ
authors.lastname: Eliasson
authors.forename: Asbjorn
authors.initials: A
authors.lastname: Jonsson
authors.forename: Thorvaldur
authors.initials: T
authors.lastname: Ingvarsson
authors.forename: Tamara B
authors.initials: TB
authors.lastname: Harris
authors.forename: Lenore
authors.initials: L
authors.lastname: Launer
authors.forename: Vilmundur
authors.initials: V
authors.lastname: Gudnason
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D005260:Female; D006225:Hand / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D050823:Hand Joints / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D006801:Humans; D007055:Iceland; D008297:Male; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology; D010781:Photography / Q000191:economics / Q000379:methods* / Q000592:standards*; D011859:Radiography / Q000379:methods