Association Between Hand Synovitis and All-Cause Mortality: A General Population-Based Study

Hand synovitis affects over 20% middle-aged and older adults. Although the roles of synovitis in hand pain and osteoarthritis are well established, its relationship with serious outcomes such as mortality remains uncertain. We investigated the association between hand synovitis and all-cause mortality.

In the population-based Xiangya Osteoarthritis Study (XO Study), participants underwent bilateral hand ultrasonography at baseline to assess synovitis (grades 0-3; ≥2 defined as positive). Mortality data were obtained from local registries. Cox proportional hazards models were employed to examine the association between hand synovitis and all-cause mortality, adjusting for age, age squared, sex, body mass index, educational level, alcohol consumption, smoking status, hand injury, physical activity level, radiographic hand osteoarthritis status, hypertension, hyperlipidemia, and the age-adjusted Charlson Comorbidity Index.

Among 3,552 participants (mean ± SD age 64.4 ± 9.3 years, 57.9% women), 393 deaths occurred over a mean follow-up of 5.72 years. Ultrasound-detected hand synovitis was significantly associated with higher all-cause mortality (adjusted hazard ratio [aHR] 1.26, 95% confidence interval [CI] 1.01-1.58). Compared with no synovitis, bilateral involvement conferred a higher mortality than unilateral involvement (aHR 1.42 [95% CI 1.03-1.96] versus 1.20 [95% CI 0.93-1.54]). Mortality risk also increased with the number of affected joints (aHRs: 1.19 [95% CI 0.91-1.57] for one joint; 1.35 [95% CI 1.02-1.80] for more than one joint; P for trend < 0.05). In the exploratory analyses, the strongest association was observed for distal interphalangeal joint synovitis (aHR 1.82 [95% CI 1.14-2.91]).

Hand synovitis, especially when bilateral or polyarticular, may serve as a marker of increased all-cause mortality risk, though future studies are needed to confirm and investigate this further. Ultrasound assessment offers a noninvasive and accessible approach to identify this potential biomarker for mortality risk.