Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

Abstract

Osteoarthritis (OA) is a highly prevalent condition, and the hand is the most commonly affected site. Patients with hand OA frequently report symptoms of pain, functional limitations and frustration in undertaking everyday activities. The condition presents clinically with changes to the bone, ligaments, cartilage and synovial tissue, which can be observed using radiography, ultrasonography or MRI. Hand OA is a heterogeneous disorder and is considered to be multifactorial in aetiology. This Review provides an overview of the epidemiology, presentation and burden of hand OA, including an update on hand OA imaging (including the development of novel techniques), disease mechanisms and management. In particular, areas for which new evidence has substantially changed the way we understand, consider and treat hand OA are highlighted. For example, genetic studies, clinical trials and careful prospective imaging studies from the past 5 years are beginning to provide insights into the pathogenesis of hand OA that might uncover new therapeutic targets in the disease.

Key points

  • Hand osteoarthritis (OA) is highly prevalent, and individuals with this condition frequently report symptoms of pain, functional limitations and frustration in undertaking everyday activities.

  • Clinical imaging is not recommended for the diagnosis or routine monitoring of patients with hand OA unless an alternative diagnosis is suspected.

  • MRI and ultrasonography findings have provided insight into hand OA pathology, but further prospective studies are required to inform on how features of the disease change over time.

  • Hand OA is multifactorial in aetiology with evidence for the involvement of abnormal mechanical loading and hereditary factors, whereas the contribution of inflammation to pathogenesis remains contentious.

  • Recommendations for core treatments in the management of hand OA should be integrated into clinical practice to improve the quality of care for patients.

  • A greater understanding of the presentation, pathogenesis and disease course is needed to help provide targeted therapy with existing and new treatments.

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Fig. 1: Features of hand osteoarthritis.
Fig. 2: Predicted molecular drivers of hand osteoarthritis by genetic association.

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Acknowledgements

The work of M.M. and K.D. is supported by the Arthritis Research UK Primary Care Centre (20202), and the work of K.D. is partially funded by a Knowledge Mobilisation Research Fellowship (KMRF-2014-03-002) from the UK National Institute for Health Research (NIHR). The work of T.L.V. and F.E.W. is supported by the Arthritis Research UK Centre for Osteoarthritis Pathogenesis (20205 and 21621) and in part by the NIHR Oxford Biomedical Research Centre (the work of F.E.W.). The views expressed are those of the authors and not necessarily those of the UK National Health Service (NHS), the NIHR or the UK Department of Health.

Review criteria

The aim of this Review is to update earlier reviews4,6 published in Nature Reviews Rheumatology with evidence from a search over the past 5 years for new original studies, Cochrane reviews and international guidelines. A search for original articles that examined hand osteoarthritis and were published between 1 January 2012 and 10 October 2017 was performed in MEDLINE. The title and abstracts were searched using the following terms: “osteoarthritis” or “OA” and “hand”, “finger”, “thumb”, “interphalangeal”, “inter phalangeal”, “IPJ”, “metacarpophalangeal”, “metacarpo phalangeal”, “MCP”, “carpometacarpal”, “carpo metacarpal”, “CMC”, “trapezioscaphoid”, “trapezio scaphoid”, “TS”, “erosive”, “nodal” or “node”. All full-text papers and articles in the English language were reviewed. The authors also searched the reference lists of identified articles for further relevant papers.

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The authors contributed equally to all aspects of the article.

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Correspondence to Krysia Dziedzic.

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M.M. declares she has no competing interests. F.E.W. declares that she has received clinical study research funding from Astellas and Pfizer. T.L.V. declares that she was a member of a hand osteoarthritis (OA) advisory board for GlaxoSmithKline in 2017. K.D. declares that she is a member of the 2018 EULAR Guidelines Committee for the management of hand OA.

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Marshall, M., Watt, F.E., Vincent, T.L. et al. Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management. Nat Rev Rheumatol 14, 641–656 (2018). https://doi.org/10.1038/s41584-018-0095-4

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