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Hand Pain| Osteoarthritis

Posted Feb 18 2009 11:53am

February 15, 2009 

This study performed upper-extremity physical examinations on a sample of United States adults age 60+ yrs. Data for demographics, pain history, analgesic use, and activity limitations were obtained by interview to determine the prevalence of symptomatic hand osteoarthritis using American College of Rheumatology (ACR) physical examination criteria.   

Among United States adults, 58% had Heberden' s nodes, 29.9% had Bouchard' s nodes, and 18.2% had first carpal-metacarpal deformities. Women had significantly more first carpal-metacarpal deformities (24.3%) than men (10.3%). Symptomatic osteoarthritis prevalence at these sites was 5.4, 4.7, and 1.9%, respectively. Overall, symptomatic hand osteoarthritis prevalence by ACR criteria was 8% (95% CI 6.5-9.5%), or 2.9 million persons.

Symptomatic hand osteoarthritis significantly increased with age and was decreased among non-Hispanic blacks, but there were no gender differences. Symptomatic hand osteoarthritis was associated with self-reported difficulty lifting 10 lbs (OR 2.31; 95% CI 1.23-4.33), dressing (OR 3.77; 95% CI 1.99-7.13), and eating (OR 3.44; 95% CI 1.76-6.73). Frequent monthly use was significantly increased for analgesics, especially acetaminophen, but not nonsteroidal antiinflammatory drugs.  S ymptomatic hand osteoarthritis affects 1 in 12 older United States adults. (Dillon CF, Hirsch R, Rasch EK, Gu Q: Symptomatic hand osteoarthritis in the United States: prevalence and functional impairment estimates from the third U.S. National Health and Nutrition Examination Survey, 1991-1994).  

This following study on 522 subjects from 101 Tasmanian families (males N=174, females N=348) described the associations between hand osteoarthritis (OA), pain and disability in males and females and to further validate the Australian/Canadian OA hand index (AUSCAN LK3.0).   

Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal and first carpometacarpal joints as well as a score for Heberden' s nodes based on hand photography. Hand pain and function were assessed by grip strength by dynamometry in both hands on two occasions.

Theprevalence of hand OA was high in this sample at 44-71% (depending on site). Pain and dysfunction increased with age while grip strength decreased. All three measures were markedly worse in women, even after taking the severity of arthritis into account. Hand OA explained 5.7-10% of the variation in function, grip strength and pain scores, even after adjustment for age and sex. Further adjustment suggested that the osteoarthritic associations with function and grip strength were largely mediated by pain. Severity of disease was more strongly associated with these scores than presence or absence.  

The conclusions were that hand OA at these two sites makes substantial contributions to hand function, strength and pain. The associations with function and strength measures appear mediated by pain. Gender differences in all three measures persist after adjustment for variation in age and OA severity indicating that factors apart from radiographic disease are responsible. (Jones G, Cooley HM, Bellamy N: A cross-sectional study of the association between Heberden' s nodes, radiographic osteoarthritis of the hands, grip strength, disability and pain. Osteoarthritis & Cartilage. 9(7):606-11, 2001).

hand pain, osteoarthritis, pain, upper body topics
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