AB1112 THE DIAGNOSTIC OF THE OSTEOARTHRITIS OF THE HANDS BY CONVENTIONAL RADIOGRAPHY
Authors: D. Kudinsky, L. Alekseeva, A. Smirnov, A. Volkov, O. Alekseeva, E. Taskina, A. Sukhinina
Journal: Annals of the Rheumatic Diseases (2020)

Background: The most severe phenotype of osteoarthritis (OA) is currently considered to be an inflammatory or erosive phenotype (EOA). There is currently no reliable x-ray picture of this disease in the literature, and the question of whether it is an independent form of OA, a natural more pronounced stage of progression, or a separate nosology is debated in the literature. Objectives: To identify the localization, frequency, and severity of pain and radiological symptoms in patients with EOA and non-erosive (NOA) disease in the interphalangeal (DIP and PIP) and metacarpal (MCP) joints of the hands. Methods: 64 women with diagnosis of OA of the hand (HOA) joints according to the ACR criteria were included into study after signing the informed consent form. Mean age was 65.28 ± 6.82 years (48-77), mean BMI 27,7 ± 4,4 kg/m 2 , mean disease duration 12 ± 8,1 years. Individual patient’s medical record included relevant anthropometric data, records from case history and clinical examination, AUSCAN scores, patient’s articular status. Instrumental diagnostic methods included plain radiography of the hand joints in an anterior-posterior projection. The images were described in accordance with the Kellgren&amp;Lawrence (K&amp;L) system. When evaluating radiographs of 64 patients with HOA, the most common was stage II (49%) according to K&amp;L, and the most common symptoms in distal (DIP), proximal (PIP) interphalangeal and MCP were joint space narrowing (JSN) (100%, 100%, and 95%, respectively) and osteophytes (OP) (88%, 70%, and 45%, respectively). Subchondral osteosclerosis (SO) (5%), erosions (8%), and subluxations (3%) in MCP, as well as subluxation in PIP (6%) were less common. Statistica 10.0 was used for statistical analysis. 23 patients had EOA, 37 had NOA. Depending on the presence of erosions in interphalangeal joints patients were divided into 2 groups comparable in terms of age, age of OA onset and duration of disease (the average age of patients with EOA interphalangeal joints was 68 + 6.15 years, and mean disease duration 18,34 + 7.11 years; in the group without erosive changes in the average age amounted to 65,13±5.43 years, mean disease duration of 16.56±8.4 years). Results: EOA DIP and PIP was detected in 15 (23%) with radiological changes corresponding to stages III-IV of HOA and in 8 people (12%) with stage II on the K&amp;L scale. Patients with stage I according to standard radiography had no erosive process. In DMFs OP (100% and 78%, OR=1.28, 95%, CI [1.08-1.5], p=0.02), SO (74% and 11%, OR=6.8, 95%, CI [2.6-17.8], p&lt;0,0001), subchondral cysts (SC) (61% and 24%, OR=2.5, 95%, CI [1.3-4.82], p=0.005) and subluxations (43% and 14%, OR=3.2, 95%, CI [1.3-8.23], p=0.01) were significantly more often found in patients with EOA. In PIPs SO (43% AND 5%, OR=8.04, 95%, CI [1.93-33.5], p=0.0005), SC (52% and 27%, OR=1.93, 95%, CI [0.1-3.73], p=0.045) and subluxations (17% and 0%, p=0.01) were significantly more frequently detected in patients with EOA compared to the non-erosive group. According to the results of the AUSCAN questionnaire, a significantly greater severity of pain was found in patients with EOA (65%) in comparison with the non-erosive (30%) form of HOA (OR=2.19, 95%, CI [1.23-3.9], p=0.008). Conclusion: DIPs is most often affected in OA of interphalangeal joints, less often PIPs, the most common symptoms are JSN and OP. At EOA in addition to more frequent detection OP, cysts, SO, subluxations in DIPs, SO, cysts and subluxations in PIPs, there is also significantly more pronounced pain according to AUSCAN data, it can be concluded that EOA is more severe in comparison with the non-erosive form of HOA. Disclosure of Interests: Danil Kudinsky: None declared, Ludmila Alekseeva Grant/research support from: Bayer, Alexander Smirnov: None declared, Alexander Volkov: None declared, Olga Alekseeva: None declared, Elena Taskina: None declared, Anastasiia Sukhinina: None declared