title: Aesthetic dissatisfaction in patients with hand osteoarthritis and its impact on daily life.
abstract: OBJECTIVE
  To evaluate the nature and extent of aesthetic dissatisfaction in patients with hand osteoarthritis (OA), and to investigate its impact on daily life and its determinants.
  
  
  METHODS
  Patients with primary hand OA, consulting secondary care, underwent physical examination for the number of joints with bony joint enlargements, soft tissue swelling and deformities, and radiographs. Questionnaires were filled in to measure pain and function (Functional Index for Hand Osteoarthritis, FIHOA), dissatisfaction with the appearance of the hands and its impact (aesthetic scales from the Michigan Hand Outcomes Questionnaire, MHQ), anxiety and depression (the Hospital Anxiety and Depression Scale, HADS), and illness perceptions (the revised Illness Perception Questionnaire, IPQ-R). Odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using multivariate logistic regression as measures of relative risk for dissatisfaction with appearance or its impact, adjusted for age, sex, body mass index (BMI), and joint-specific abnormalities (bony joint enlargements, deformities, or radiographic severity), self-reported pain and function.
  
  
  RESULTS
  Of 247 patients (mean age 61.6 years, 88% women), 63 (26%) were aesthetically dissatisfied and 33 (13%) reported impact on daily life due to dissatisfaction. Patients with joint-specific abnormalities were at higher risk for reporting dissatisfaction. Patients who reported impact also reported more depression and negative illness perceptions, independently from joint-specific abnormalities.
  
  
  CONCLUSIONS
  Hand OA patients report aesthetic dissatisfaction with their hands regularly, especially in those with joint abnormalities. This dissatisfaction has a negative impact in a small group of patients who also reported more depression and negative illness perceptions. These results indicate the influence of psychosocial factors on outcome measures in patients with hand OA.
authors.affiliation: a Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: R
authors.initials: R
authors.lastname: Liu
authors.affiliation: a Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: W
authors.initials: W
authors.lastname: Damman
authors.affiliation: a Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: Ljj
authors.initials: L
authors.lastname: Beaart-van de Voorde
authors.affiliation: b Department of Medical Psychology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: A A
authors.initials: AA
authors.lastname: Kaptein
authors.affiliation: c Department of Clinical Epidemiology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: F R
authors.initials: FR
authors.lastname: Rosendaal
authors.affiliation: a Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: Twj
authors.initials: T
authors.lastname: Huizinga
authors.affiliation: a Department of Rheumatology , Leiden University Medical Centre , Leiden , The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: Kloppenburg
mesh_terms: D000203:Activities of Daily Living; D000368:Aged; D001007:Anxiety / Q000523:psychology*; D001294:Attitude to Health; D003430:Cross-Sectional Studies; D003863:Depression / Q000523:psychology*; D004954:Esthetics / Q000523:psychology*; D005260:Female; D006227:Hand Deformities, Acquired / Q000000981:diagnostic imaging / Q000209:etiology / Q000523:psychology*; D050823:Hand Joints / Q000000981:diagnostic imaging; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010003:Osteoarthritis / Q000150:complications / Q000000981:diagnostic imaging / Q000523:psychology*; D010147:Pain Measurement; D017060:Patient Satisfaction; D011788:Quality of Life; D011859:Radiography; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires