Clinical study of hand osteoarthritis in a series of 116 patients

Objectives: To study clinical joint lesions in hand osteoarthritis and their relationships with age, sex, heredity and functionnal disability. Methods: A prospective study of 116 patientes (13 males, 103 females), mean age 64.5 ± 9.4 years, having a symptomatic osteoarthritis and selected for a therapeutic spa trial. Were included patients having A.C.R. criteria for osteoarthritis of the hand or an osteoarthritis of the first carpometacarpal joint (CM1) and a Dreiser's Index ≤ 5. A new index, the Topographic Scoring index of a rheumatic hand (T.S.I.R.H.) was used (cotation 0 to 8 for each joint). No X-ray was performed. The same observer examined all the patients. Results: Both hands were involved in 90% of cases and 25% of all joints were affected by osteoarthritis. The right hand was more frequently affected than the left (p<0.0001). The frequency with which the joints were affected was: CM1 (70%), DIP (37%), PIP (20%), MCP (9%). The MCP joint was rarely affected alone. CM1 and DIP2, 3 were the most frequently symetricly concerned and the most severely injured with the highest grade at the T.S.I.R.H. Heredity induced earlier lesions but was not associated with an increase number or severity of the lesions. The number and the severity of osteoarthritis increased with duration of disease (p<0.01 and p<0.001 respectivly). No sex differences was found except for a disease onset at a later age in man (p< 0.05), but the number of patients was small. There was no correlation between fonctionnal disability (right hand) and clinical examniation (T.S.I.R.H.).