title: Risk factors for progression in hand osteoarthritis: a systematic review.
abstract: OBJECTIVE
  To assess the risk factors for progression of hand osteoarthritis (OA).
  
  
  METHODS
  In a systematic review of cohort studies, medical literature databases were searched up to May 2012 for articles reporting data on the association between risk factors and hand OA progression. The quality of these studies was assessed by 2 independent reviewers using a criteria scoring system of 16 items, and studies were dichotomized into those with scores of 69% or over and those with scores under 69%. Best evidence synthesis was used to determine the level of evidence per risk factor.
  
  
  RESULTS
  In total, 14 articles that fulfilled the selection criteria were included, of which 8 were high quality. The most frequently investigated risk factors were age, sex, radiographic features (e.g., erosive OA), and scintigraphy. Progression was mostly defined by radiographic criteria, but also clinical progression as an outcome was described. Most of the investigated risk factors showed limited or inconclusive evidence for an association with hand OA progression. Limited evidence according to the best evidence synthesis with most available studies was present for the association between a positive scintigraphic scan and radiographic progression (up to 2.8 times more progression than negative joints).
  
  
  CONCLUSIONS
  Limited evidence is available for a positive association between an abnormal scintigraphic scan and radiographic hand OA progression. These data suggest that a positive scintigraphic scan as an inclusion criterion for studies that aim to show structural modification can increase the power of such studies. Future longitudinal studies with a well-defined baseline population are needed to search for risk factors of hand OA progression.
authors.affiliation: Leiden University Medical Center, Leiden, The Netherlands. w.y.kwok@lumc.nl
authors.forename: W Y
authors.initials: WY
authors.lastname: Kwok
authors.forename: J W M
authors.initials: JW
authors.lastname: Plevier
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: D018450:Disease Progression; D014943:Global Health; D006225:Hand; D006801:Humans; D015994:Incidence; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000209:etiology; D011788:Quality of Life; D011859:Radiography; D018570:Risk Assessment; D012307:Risk Factors