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Hand osteoarthritis in the elderly. Application of clinical criteria
G Aspelund1, S Gunnarsdóttir, P Jónsson
1Department of Rheumatology, Landspítali University Hospital, Iceland.
Insights
The American College of Rheumatology (ACR) criteria for hand osteoarthritis (OA) may be too restrictive for population studies. Symptom criteria were found to be unstable over time, impacting prevalence estimates in elderly Icelanders.
Area of Science:
- Rheumatology
- Epidemiology
- Geriatrics
Background:
- Hand osteoarthritis (OA) is a prevalent condition in elderly populations.
- Accurate prevalence estimation is crucial for public health and resource allocation.
- The American College of Rheumatology (ACR) classification criteria are widely used for diagnosing OA.
Purpose of the Study:
- To determine the prevalence of clinical hand OA in an elderly Icelandic population.
- To evaluate the suitability of the ACR classification criteria for population surveys.
- To assess the stability of OA symptoms over time.
Main Methods:
- Cross-sectional study utilizing the ACR classification criteria.
- Prevalence assessment in an elderly Icelandic cohort.
- Evaluation of intra- and interobserver agreement and symptom stability over six months.
Main Results:
- Overall hand OA prevalence was 3.3% in men and 6.8% in women.
- A significant proportion met examination criteria but lacked symptoms (19.6% men, 32.0% women).
- Carpometacarpal joint OA was more common in women (31.3%) than men (1.0%).
- Symptom criterion stability was only 70% over six months.
Conclusions:
- The ACR symptom criterion for hand OA is insensitive and unstable for population surveys.
- Current ACR criteria may underestimate hand OA prevalence in epidemiological studies.
- Further refinement of diagnostic criteria is needed for accurate population-based OA assessment.
Abstract:
The American College of Rheumatology (ACR) classification criteria were used to define the prevalence of clinical hand osteoarthritis (OA) in an elderly population in Iceland. The prevalence of hand OA was 3.3% for men and 6.8% for women, however, 19.6% of the men and 32.0% of the women fulfilled the ACR examination but lacked required symptoms. The prevalence of clinical signs of OA in the interphalangeal joints were similar for both sexes but were much more common in the first carpometacarpal joint of women (31.3% vs. 1.0% in men, p < 0.0001). No differences were observed between former seamen (55% of the men) and nonseamen or between the right and left hand. Intra- and interobserver agreement in diagnosis ranged from 83% to 97%, but only 70% of subjects fulfilling the symptoms criterion fulfilled the same criterion six months later. Our results suggest that the present symptoms criterion of the ACR clinical criteria restricts their use in population surveys, being both insensitive and unstable over time.