OP0054 Pain in hand osteoarthritis and the associations with radiographic osteoarthritis severity and psychological factors
Authors: E. Mulrooney, K. Magnusson, H.B. Hammer, T.L. Gaarden, K. Engedal, T.K. Kvien, I.K. Haugen
Journal: Annals of the Rheumatic Diseases (2018)

<h3>Background</h3> Pain is the most preferred area of improvement for patients with hand osteoarthritis (OA). Whereas only weak associations have been found between radiographic OA severity and pain, few studies have explored whether psychological factors are associated with pain. <h3>Objectives</h3> To examine whether radiographic severity, depression, anxiety and pain catastrophizing are associated with self-reported pain in patients with hand OA, and to explore possible interactions between psychological factors and radiographic severity. <h3>Methods</h3> The Nor-Hand study is an observational cohort study of 300 (89% women) hand OA patients with median (IQR) age of 61 [57–66] years. Participants completed questionnaires, including Numeric Rating Scale (NRS, 0–10 scale) about hand pain, Australian/Canadian (AUSCAN) hand pain subscale (0–20 scale), Hospital Depression and Anxiety Scale (HADS, 0–42 scale) and Pain Catastrophizing Scale (PCS, 0–52 scale) at the baseline examination in 2016–2017. Bilateral interphalangeal, metacarpophalangeal, first carpometacarpal and the scaphotrapeziotrapezoidal joint were scored for radiographic OA according to the Kellgren-Lawrence (KL) index (sum score: 0–132 scale). Using linear regression analyses, we analysed whether KL sum score, HADS sum score and PCS sum score (independent variables) were associated with AUSCAN pain (dependent variable). Separate models were applied for each independent variable with adjustment for age, sex and body mass index (BMI). Thereafter, all independent variables were included in the same model. Analyses were repeated using NRS hand pain as the dependent variable. Interactions between KL sum score and HADS/PCS were explored. <h3>Results</h3> Patients reported wide range of pain severity with mean (SD) AUSCAN pain of 8.2 (4.0) and mean (SD) NRS hand pain of 3.8 (2.3). Their radiographic severity ranged from minimal to severe with a median (IQR) KL sum score of 28 (15–44). Most patients reported low levels of anxiety, depression and pain catastrophizing with median (IQR) HADS sum score of 6 (3–10) and PCS sum score of 9 (5–15). The HADS and PCS sum scores were associated with hand pain, both when analysed separately and in the same model together with KL sum score (table 1). Increasing radiographic severity was not associated with hand pain in the age, sex and BMI-adjusted models. When including HADS and PCS in the models, the associations between radiographic severity and pain became stronger for both pain outcomes and statistically significant for AUSCAN pain (table 1). We found interactions between KL sum score and HADS. In the 61 persons with HADS depression and anxiety subscale scores below 8, the KL sum score was significantly associated with AUSCAN pain (B=0.03, 95% CI: 0.003 to 0.06, p=0.03) and NRS pain (B=0.02, 95% CI: 0.002 to 0.03, p=0.03) (adjusted for age, sex, BMI and PCS), whereas no associations between radiographic severity and pain was found in persons with HAD depression and/or anxiety subscale scores of 8 or more. <h3>Conclusions</h3> Depression, anxiety and pain catastrophizing were associated with pain in hand OA, emphasising that pain in hand OA should be treated in a biopsychosocial framework. Importantly, radiographic severity was associated with pain only in persons with no or low levels of depression and anxiety. <h3>Disclosure of Interest</h3> None declared