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Role of Modern Imaging Techniques in Hand Osteoarthritis Research and Clinical Practice

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Abstract

Hand osteoarthritis (OA) is a frequent disease, which may lead to considerable pain and physical limitations. However, limited research has been performed in hand OA. Lately, modern imaging techniques, such as ultrasonography (US) and magnetic resonance imaging (MRI), have gained increasing attention in hand OA clinical research. Both modalities may provide important knowledge about the natural history and pathogenesis of the disease, in addition to serving as potential outcome measures in clinical trials. In clinical practice, the diagnosis of hand OA should be based on clinical examination and conventional radiography, if necessary. However, US and MRI can provide information about the degree of inflammation and exclude potential differential diagnoses.

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References

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  1. Haugen IK, Englund M, Aliabadi P, et al. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study. Ann Rheum Dis. 2011;70:1581–6.

    Article  PubMed  Google Scholar 

  2. Slatkowsky-Christensen B, Mowinckel P, Loge JH, Kvien TK. Health-related quality of life in women with symptomatic hand osteoarthritis: a comparison with rheumatoid arthritis patients, healthy controls, and normative data. Arthritis Rheum. 2007;57:1404–9.

    Article  PubMed  Google Scholar 

  3. Zhang W, Doherty M, Leeb BF, et al. EULAR evidence based recommendations for the management of hand osteoarthritis: report of a Task Force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT). Ann Rheum Dis. 2007;66:377–88.

    Article  CAS  PubMed  Google Scholar 

  4. Colebatch AN, Edwards CJ, Østergaard M, et al. EULAR recommendations for the use of imaging of the joints in the clinical management of rheumatoid arthritis. Ann Rheum Dis. 2013;72:804–14.

    Article  PubMed  Google Scholar 

  5. McQueen FM, Ostergaard M. Imaging in rheumatology: new tools for use in clinical practice in 2012. Preface. Best Pract Res Clin Rheumatol. 2012;26:743–9.

    Article  PubMed  Google Scholar 

  6. Peterfy C, Østergaard M, Conaghan PG. MRI comes of age in RA clinical trials. Ann Rheum Dis. 2013;72:794–6.

    Article  PubMed  Google Scholar 

  7. •• Haugen IK, Bøyesen P, Slatkowsky-Christensen B, et al. Comparison of features by MRI and radiographs of the interphalangeal finger joints in patients with hand osteoarthritis. Ann Rheum Dis. 2012;71:345–50. This paper shows that MRI is more sensitive than conventional radiography to detect osteophytes and erosions in 106 hand OA patients.

    Article  PubMed  Google Scholar 

  8. •• Haugen IK, Bøyesen P, Slatkowsky-Christensen B, et al. Associations between MRI-defined synovitis, bone marrow lesions and structural features and measures of pain and physical function in hand osteoarthritis. Ann Rheum Dis. 2012;71:899–904. This paper shows that MRI features such as synovitis, bone marrow lesions, and bone damage is associated with pain in the same joint in 85 hand OA patients.

    Article  PubMed  Google Scholar 

  9. • Wittoek R, Jans L, Lambrecht V, et al. Reliability and construct validity of ultrasonography of soft tissue and destructive changes in erosive osteoarthritis of the interphalangeal finger joints: a comparison with MRI. Ann Rheum Dis. 2011;70:278–83. In this small study of 14 hand OA patients, there was good agreement between US and MRI in the detection of osteophytes, erosions, and synovitis. Both US and MRI were more sensitive than radiography to detect erosions.

    Article  PubMed  Google Scholar 

  10. • Vlychou M, Koutroumpas A, Alexiou I, Fezoulidis I, Sakkas LI. High-resolution ultrasonography and 3.0 T magnetic resonance imaging in erosive and nodal hand osteoarthritis: high frequency of erosions in nodal osteoarthritis. Clin Rheumatol. 2013;32:755–62. Good agreement between US and MRI was found in this small study of 20 hand OA patients.

    Article  PubMed  Google Scholar 

  11. Guermazi A, Roemer FW, Hayashi D. Imaging of osteoarthritis: update from a radiological perspective. Curr Opin Rheumatol. 2011;23:484–91.

    Article  PubMed  Google Scholar 

  12. Wildi LM, Raynauld J-P, Martel-Pelletier J, et al. Relationship between bone marrow lesions, cartilage loss and pain in knee osteoarthritis: results from a randomised controlled clinical trial using MRI. Ann Rheum Dis. 2010;69:2118–24.

    Article  PubMed  Google Scholar 

  13. Wildi LM, Raynauld J-P, Martel-Pelletier J, et al. Chondroitin sulphate reduces both cartilage volume loss and bone marrow lesions in knee osteoarthritis patients starting as early as 6 months after initiation of therapy: a randomised, double-blind, placebo-controlled pilot study using MRI. Ann Rheum Dis. 2011;70:982–9.

    Article  PubMed Central  PubMed  Google Scholar 

  14. Raynauld J-P, Martel-Pelletier J, Bias P, et al. Protective effects of licofelone, a 5-lipoxygenase and cyclo-oxygenase inhibitor, versus naproxen on cartilage loss in knee osteoarthritis: a first multicentre clinical trial using quantitative MRI. Ann Rheum Dis. 2009;68:938–47.

    Article  CAS  PubMed  Google Scholar 

  15. Conaghan PG, Hunter DJ, Maillefert JF, Reichmann WM, Losina E. Summary and recommendations of the OARSI FDA osteoarthritis Assessment of Structural Change Working Group. Osteoarthritis Cartilage. 2011;19:606–10.

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  16. Zhang W, Doherty M, Leeb BF, et al. EULAR evidence-based recommendations for the diagnosis of hand osteoarthritis: report of a task force of ESCISIT. Ann Rheum Dis. 2009;68:8–17.

    Article  CAS  PubMed  Google Scholar 

  17. Ohrndorf S, Werner SG, Finzel S, Backhaus M. Musculoskeletal ultrasound and other imaging modalities in rheumatoid arthritis. Curr Opin Rheumatol. 2013;25:367–74.

    Article  PubMed  Google Scholar 

  18. Coates LC, Hodgson R, Conaghan PG, Freeston JE. MRI and ultrasonography for diagnosis and monitoring of psoriatic arthritis. Best Pract Res Clin Rheumatol. 2012;26:805–22.

    Article  PubMed  Google Scholar 

  19. Keen HI, Lavie F, Wakefield RJ, et al. The development of a preliminary ultrasonographic scoring system for features of hand osteoarthritis. Ann Rheum Dis. 2008;67:651–5.

    Article  CAS  PubMed  Google Scholar 

  20. •• Mathiessen A, Haugen IK, Slatkowsky-Christensen B, Bøyesen P, Kvien TK, Hammer HB. Ultrasonographic assessment of osteophytes in 127 patients with hand osteoarthritis: exploring reliability and associations with MRI, radiographs and clinical joint findings. Ann Rheum Dis. 2013;72:51–6. A scoring atlas for US assessment of osteophytes was developed, and found good intra- and inter-reader agreement in a reliability exercise. In 127 hand OA patients, US and MRI detected more joints with osteophytes than conventional radiography and clinical examination.

    Article  PubMed  Google Scholar 

  21. Hammer HB, Bolton-King P, Bakkeheim V, et al. Examination of intra and interrater reliability with a new ultrasonographic reference atlas for scoring of synovitis in patients with rheumatoid arthritis. Ann Rheum Dis. 2011;70:1995–8.

    Article  PubMed  Google Scholar 

  22. • Iagnocco A, Conaghan PG, Aegerter P, et al. The reliability of musculoskeletal ultrasound in the detection of cartilage abnormalities at the metacarpo-phalangeal joints. Osteoarthritis Cartilage. 2012;20:1142–6. The first study examining the reliability of cartilage assessment in the metacarpophalangeal joints in hand OA patients.

    Article  CAS  PubMed  Google Scholar 

  23. Vlychou M, Koutroumpas A, Malizos K, Sakkas LI. Ultrasonographic evidence of inflammation is frequent in hands of patients with erosive osteoarthritis. Osteoarthritis Cartilage. 2009;17:1283–7.

    Article  CAS  PubMed  Google Scholar 

  24. Keen HI, Wakefield RJ, Grainger AJ, et al. An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms. Arthritis Rheum. 2008;59:1756–63.

    Article  PubMed  Google Scholar 

  25. Keen HI, Wakefield RJ, Hensor EMA, Emery P, Conaghan PG. Response of symptoms and synovitis to intra-muscular methylprednisolone in osteoarthritis of the hand: an ultrasonographic study. Rheumatology (Oxford). 2010;49:1093–100.

    Article  Google Scholar 

  26. Kortekaas MC, Kwok W-Y, Reijnierse M, Watt I, Huizinga TWJ, Kloppenburg M. Pain in hand osteoarthritis is associated with inflammation: the value of ultrasound. Ann Rheum Dis. 2010;69:1367–9.

    Article  PubMed  Google Scholar 

  27. Mancarella L, Magnani M, Addimanda O, et al. Ultrasound-detected synovitis with power_Doppler signal is associated with severe radiographic damage and reduced cartilage thickness in hand osteoarthritis. Osteoarthritis Cartilage. 2010;18:1263–8.

    Article  CAS  PubMed  Google Scholar 

  28. • Kortekaas MC, Kwok W-Y, Reijnierse M, Huizinga TWJ, Kloppenburg M. In erosive hand osteoarthritis more inflammatory signs on ultrasound are found than in the rest of hand osteoarthritis. Ann Rheum Dis. 2013;72:930–4. In 55 hand OA patients, inflammatory signs were more frequent in erosive OA than in non-erosive OA, not only in erosive joints but also in non-erosive joints.

    Article  PubMed  Google Scholar 

  29. Wittoek R, Carron P, Verbruggen G. Structural and inflammatory sonographic findings in erosive and non-erosive osteoarthritis of the interphalangeal finger joints. Ann Rheum Dis. 2010;69:2173–6.

    Article  PubMed  Google Scholar 

  30. Iagnocco A, Filippucci E, Ossandon A, et al. High resolution ultrasonography in detection of bone erosions in patients with hand osteoarthritis. J Rheumatol. 2005;32:2381–3.

    PubMed  Google Scholar 

  31. Keen HI, Wakefield RJ, Grainger AJ, et al. Can ultrasonography improve on radiographic assessment in osteoarthritis of the hands? A comparison between radiographic and ultrasonographic detected pathology. Ann Rheum Dis. 2008;67:1116–20.

    Article  CAS  PubMed  Google Scholar 

  32. Möller B, Bonel H, Rotzetter M, Villiger PM, Ziswiler H-R. Measuring finger joint cartilage by ultrasound as a promising alternative to conventional radiograph imaging. Arthritis Rheum. 2009;61:435–41.

    Article  PubMed  Google Scholar 

  33. Iagnocco A, Perella C, D'Agostino MA, et al. Magnetic resonance and ultrasonography real-time fusion imaging of the hand and wrist in osteoarthritis and rheumatoid arthritis. Rheumatology (Oxford). 2011;50:1409–13.

    Article  Google Scholar 

  34. Summers MN, Haley WE, Reveille JD, Alarcón GS. Radiographic assessment and psychologic variables as predictors of pain and functional impairment in osteoarthritis of the knee or hip. Arthritis Rheum. 1988;31:204–9.

    Article  CAS  PubMed  Google Scholar 

  35. • Kortekaas MC, Kwok W-Y, Reijnierse M, Huizinga TWJ, Kloppenburg M. Osteophytes and joint space narrowing are independently associated with pain in finger joints in hand osteoarthritis. Ann Rheum Dis. 2011;70:1835–7. In 55 hand OA patients, US-detected osteophytes were associated with pain in the same joint (adjusted for US-detected synovitis).

    Article  PubMed  Google Scholar 

  36. Koutroumpas AC, Alexiou IS, Vlychou M, Sakkas LI. Comparison between clinical and ultrasonographic assessment in patients with erosive osteoarthritis of the hands. Clin Rheumatol. 2010;29:511–6.

    Article  PubMed  Google Scholar 

  37. Mallinson PI, Tun JK, Farnell RD, Campbell DA, Robinson P. Osteoarthritis of the thumb carpometacarpal joint: correlation of ultrasound appearances to disability and treatment response. Clin Radiol. 2013;68:461–5.

    Article  CAS  PubMed  Google Scholar 

  38. Ingegnoli F, Soldi A, Meroni PL. Power_Doppler sonography and clinical monitoring for hyaluronic Acid treatment of rhizarthrosis: a pilot study. J Hand Microsurg. 2011;3:51–4.

    Article  PubMed Central  PubMed  Google Scholar 

  39. Klauser AS, Faschingbauer R, Kupferthaler K, et al. Sonographic criteria for therapy follow-up in the course of ultrasound-guided intra-articular injections of hyaluronic acid in hand osteoarthritis. Eur J Radiol. 2011;81:1607–11.

    Article  PubMed  Google Scholar 

  40. Möller I, Bong D, Naredo E, et al. Ultrasound in the study and monitoring of osteoarthritis. Osteoarthritis Cartilage. 2008;16 Suppl 3:S4–7.

    Article  PubMed  Google Scholar 

  41. Felson DT. Developments in the clinical understanding of osteoarthritis. Arthritis Res Ther. 2009;11:203.

    Article  PubMed Central  PubMed  Google Scholar 

  42. •• Haugen IK, Lillegraven S, Slatkowsky-Christensen B, et al. Hand osteoarthritis and MRI: development and first validation step of the proposed Oslo Hand Osteoarthritis MRI score. Ann Rheum Dis. 2011;70:1033–8. Presentation of the first MRI scoring system for hand OA.

    Article  PubMed  Google Scholar 

  43. Kwok WY, Kortekaas MC, Reijnierse M, et al. MRI in hand osteoarthritis: Validation of the Oslo hand osteoarthritis MRI-scoring method and association with pain. Osteoarthritis Cartilage. 2011;1(Suppl1):S26–7.

    Google Scholar 

  44. •• Haugen IK, Østergaard M, Eshed I, et al. Iterative development and reliability of the OMERACT hand osteoarthritis MRI scoring system. J Rheumatol 2013 [in press]. Presentation of the hand OA MRI scoring developed in OMERACT, which was based on the previous scoring system as presented by Haugen et al. (reference 42).

  45. Tan AL, Grainger AJ, Tanner SF, et al. High-resolution magnetic resonance imaging for the assessment of hand osteoarthritis. Arthritis Rheum. 2005;52:2355–65.

    Article  PubMed  Google Scholar 

  46. Peterfy CG, Janzen DL, Tirman PF, et al. "Magic-angle" phenomenon: a cause of increased signal in the normal lateral meniscus on short-TE MR images of the knee. AJR Am J Roentgenol. 1994;163:149–54.

    Article  CAS  PubMed  Google Scholar 

  47. Baker K, Grainger A, Niu J, et al. Relation of synovitis to knee pain using contrast-enhanced MRIs. Ann Rheum Dis. 2010;69:1779–83.

    Article  CAS  PubMed  Google Scholar 

  48. Ejbjerg B, Narvestad E, Rostrup E, et al. Magnetic resonance imaging of wrist and finger joints in healthy subjects occasionally shows changes resembling erosions and synovitis as seen in rheumatoid arthritis. Arthritis Rheum. 2004;50:1097–106.

    Article  PubMed  Google Scholar 

  49. McQueen F, Østergaard M, Peterfy C, et al. Pitfalls in scoring MR images of rheumatoid arthritis wrist and metacarpophalangeal joints. Ann Rheum Dis. 2005;64 Suppl 1:i48–55.

    Article  PubMed  Google Scholar 

  50. Marshall M, Peat G, Nicholls E, et al. Subsets of symptomatic hand osteoarthritis in community-dwelling older adults in the United Kingdom: prevalence, inter-relationships, risk factor profiles and clinical characteristics at baseline and 3-years. Osteoarthritis Cartilage. 2013 Aug 13 [Epub ahead of print].

  51. Lewis AR, Nolan MJ, Hodgson RJ, et al. High resolution magnetic resonance imaging of the proximal interphalangeal joints. Correlation with histology and production of a three-dimensional data set. J Hand Surg (Br). 1996;21:488–95.

    Article  CAS  Google Scholar 

  52. Tan AL, Toumi H, Benjamin M, et al. Combined high-resolution magnetic resonance imaging and histological examination to explore the role of ligaments and tendons in the phenotypic expression of early hand osteoarthritis. Ann Rheum Dis. 2006;65:1267–72.

    Article  CAS  PubMed  Google Scholar 

  53. Grainger AJ, Farrant JM, O'Connor PJ, et al. MR imaging of erosions in interphalangeal joint osteoarthritis: is all osteoarthritis erosive? Skelet Radiol. 2007;36:737–45.

    Article  CAS  Google Scholar 

  54. Dahaghin S, Bierma-Zeinstra SMA, Hazes JMW, Koes BW. Clinical burden of radiographic hand osteoarthritis: a systematic appraisal. Arthritis Rheum. 2006;55:636–47.

    Article  CAS  PubMed  Google Scholar 

  55. Yusuf E, Kortekaas MC, Watt I, Huizinga TWJ, Kloppenburg M. Do knee abnormalities visualised on MRI explain knee pain in knee osteoarthritis? A systematic review. Ann Rheum Dis. 2011;70:60–7.

    Article  PubMed  Google Scholar 

  56. Felson DT. Imaging abnormalities that correlate with joint pain. Br J Sports Med. 2011;45:289–91.

    Article  PubMed  Google Scholar 

  57. McQueen FM. A vital clue to deciphering bone pathology: MRI bone oedema in rheumatoid arthritis and osteoarthritis. Ann Rheum Dis. 2007;66:1549–52.

    Article  CAS  PubMed  Google Scholar 

  58. Hunter DJ, Gerstenfeld L, Bishop G, et al. Bone marrow lesions from osteoarthritis knees are characterized by sclerotic bone that is less well mineralized. Arthritis Res Ther. 2009;11:R11.

    Article  PubMed Central  PubMed  Google Scholar 

  59. Zanetti M, Bruder E, Romero J, Hodler J. Bone marrow edema pattern in osteoarthritic knees: correlation between MR imaging and histologic findings. Radiology. 2000;215:835–40.

    Article  CAS  PubMed  Google Scholar 

  60. Kirkhus E, Bjørnerud A, Thoen J, et al. Contrast-enhanced dynamic magnetic resonance imaging of finger joints in osteoarthritis and rheumatoid arthritis: an analysis based on pharmacokinetic modeling. Acta Radiol. 2006;47:845–51.

    Article  CAS  PubMed  Google Scholar 

  61. Hayashi D, Roemer FW, Katur A, et al. Imaging of Synovitis in Osteoarthritis: Current Status and Outlook. Semin Arthritis Rheum. 2011;41:116–30.

    Article  PubMed  Google Scholar 

  62. Kay J, Czirják L. Gadolinium and systemic fibrosis: guilt by association. Ann Rheum Dis. 2010;69:1895–7.

    Article  PubMed  Google Scholar 

  63. Ostergaard M, Conaghan PG, O'Connor P, et al. Reducing invasiveness, duration, and cost of magnetic resonance imaging in rheumatoid arthritis by omitting intravenous contrast injection – Does it change the assessment of inflammatory and destructive joint changes by the OMERACT RAMRIS? J Rheumatol. 2009;36:1806–10.

    Article  PubMed  Google Scholar 

  64. Braum LS, McGonagle D, Bruns A, et al. Characterisation of hand small joints arthropathy using high-resolution MRI –limited discrimination between osteoarthritis and psoriatic arthritis. Eur Radiol. 2013;23:1686–93.

    Article  PubMed  Google Scholar 

  65. Wenham CYJ, Hensor EMA, Grainger AJ, et al. A randomized, double-blind, placebo-controlled trial of low-dose oral prednisolone for treating painful hand osteoarthritis. Rheumatology (Oxford). 2012;51:2286–94.

    Article  CAS  Google Scholar 

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Ida Kristin Haugen and Hilde Berner Hammer declare that they have no conflict of interest.

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Haugen, I.K., Hammer, H.B. Role of Modern Imaging Techniques in Hand Osteoarthritis Research and Clinical Practice. Curr Rheumatol Rep 16, 399 (2014). https://doi.org/10.1007/s11926-013-0399-y

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