Cross-cultural adaptation of the Dutch version of the Functional Index for Hand Osteoarthritis (FIHOA) and a study on its construct validity

SummaryObjectiveTo validate a cross-culturally translated and adapted Dutch version of the Functional Index for Hand Osteoarthritis (FIHOA) in patients with osteoarthritis (OA) of the hands and to evaluate its construct validity by comparing with the Australian/Canadian Osteoarthritis Hand Index (AUSCAN).MethodsThe FIHOA was translated into Dutch and cross-culturally adapted. The questionnaire was administered to 72 patients with hand OA (female/male ratio: 64/8, handedness: right: 62/left: 7/both: 3). A visual analogue scale (VAS) pain scale (100mm) and the AUSCAN questionnaire were also recorded. An item–item analysis was performed. Test–retest reliability (time interval: 5 days) was assessed in 21 patients with intraclass correlation coefficient (ICC) and Bland and Altman graphical method. Construct validity was assessed by Spearman rank correlation coefficient between the FIHOA and AUSCAN.ResultsInternal consistency was high (Cronbach's alpha=0.89). All items, except for one (‘Are you able to clench the fist?’), and the mean total FIHOA scores were statistically different between the subgroups based on the VAS (mean total score=7.46 and 14.19, in a-/mild symptomatic and symptomatic group, respectively (P<0.001)).The Spearman's correlation between all subscales of the AUSCAN (pain, stiffness, functionality) and the FIHOA was good, especially with the subscale functionality (r=0.81, P<0.01). Test–retest reliability was excellent with an ICC of 0.96 for the total score and the Bland and Altman plot showing a homogeneous distribution of the differences.ConclusionThe psychometric properties of the Dutch version of the FIHOA are excellent. There is a good correlation between the FIHOA and all subscales of the AUSCAN, especially the subscale functionality

Translation of clinical problems in osteoarthritis into pathophysiological research goals

Osteoarthritis (OA) accounts for more disability among the elderly than any other disease and is associated with an increased mortality rate. The prevalence in Europe will rise in the future since this continent has a strongly ageing population and an obesity epidemic; obesity and age both being major risk factors for OA. No adequate therapeutic options, besides joint replacement, are available, although they are greatly needed and should be acquired by adequate research investments. However, the perspective on OA from a researcher's point of view is not always aligned with the perspective of a patient with OA. Researchers base their views on OA mainly on abnormalities in structure and function while patients consider OA as a collection of symptoms. In this viewpoint paper, we discuss the possibility of translating the most important clinical problems into pathophysiological research goals to facilitate the translation from bench to bedside and vice versa. This viewpoint is the outcome of a dialogue within the 'European League Against Rheumatism study group on OA' and People with Arthritis/Rheumatism across Europe (PARE) representatives

Development of classification criteria for hand osteoarthritis: comparative analyses of persons with and without hand osteoarthritis

Objectives Further knowledge about typical hand osteoarthritis (OA) characteristics is needed for the development of new classification criteria for hand OA.Methods In a cross-sectional multi-centre international study, a convenience sample of patients from primary and secondary/tertiary care with a physician-based hand OA diagnosis (n = 128) were compared with controls with hand complaints due to inflammatory or non-inflammatory conditions (n = 70). We examined whether self-reported, clinical, radiographic and laboratory findings were associated with hand OA using logistic regression analyses. Discrimination between groups was assessed by calculating the area under receiver operating curves (AUC).Results Strong associations with hand OA were observed for radiographic osteophytes (OR = 1.62, 95% CI 1.40 to 1.88) and joint space narrowing (JSN) (OR = 1.57, 95% CI 1.36 to 1.82) in the distal interphalangeal (DIP) joints with excellent discrimination (AUC = 0.82 for both). For osteophytes and JSN, we found acceptable discrimination between groups in the proximal interphalangeal joints (AUC = 0.77 and 0.78, respectively), but poorer discrimination in the first carpometacarpal joints (AUC = 0.67 and 0.63, respectively). Painful DIP joints were associated with hand OA, but were less able to discriminate between groups (AUC = 0.67). Age and family history of OA were positively associated with hand OA, whereas negative associations were found for pain, stiffness and soft tissue swelling in metacarpophalangeal joints, pain and marginal erosions in wrists, longer morning stiffness, inflammatory biomarkers and autoantibodies.Conclusions Differences in symptoms, clinical findings, radiographic changes and laboratory tests were found in patients with hand OA versus controls. Radiographic OA features, especially in DIP joints, were best suited to discriminate between groups.Clinical epidemiolog

Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

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 disease