Hand osteoarthritis: clinical phenotypes, molecular mechanisms and disease management

• Published in: Nature reviews. Rheumatology 2018-11, Vol.14 (11), p.641-656
• Main Authors: Marshall, Michelle, Watt, Fiona E., Vincent, Tonia L., Dziedzic, Krysia
• Format: Article
• Language: English
• Subjects: 692/4023/1670/407; 692/420; 692/700; 692/700/478/174; 692/700/565; Anti-Inflammatory Agents - therapeutic use; Arthritis; Care and treatment; Cartilage diseases; Clinical trials; Clinical Trials as Topic; Development and progression; Diagnosis; Disease Management; Epidemiology; Frustration; Genetic aspects; Genetic Predisposition to Disease; Hand; Hand - diagnostic imaging; Hand - pathology; Health aspects; Humans; Ligaments; Magnetic Resonance Imaging; Mechanical loading; Mechanical properties; Medical research; Medicine; Medicine & Public Health; Medicine, Experimental; Molecular modelling; Osteoarthritis; Osteoarthritis - drug therapy; Osteoarthritis - epidemiology; Osteoarthritis - genetics; Osteoarthritis - pathology; Pain; Pathogenesis; Phenotype; Phenotypes; Radiography; Review Article; Rheumatology; Therapeutic applications; Treatment Outcome; Ultrasonic imaging; Ultrasonography; Ultrasound
• ISSN: 1759-4790; 1759-4804
• DOI: 10.1038/s41584-018-0095-4

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. Hand osteoarthritis (OA) is a heterogeneous and prevalent condition involving multiple joints. In this Review, the authors provide an update on the epidemiology, presentation and burden of hand OA, as well as on advances in imaging techniques, disease management and pathogenesis. 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.