Prevalence and distribution of ultrasound-detected hand synovial abnormalities in a middle-aged and older population

Abstract

Objective Synovial abnormalities are modifiable targets for hand pain and osteoarthritis. We examined the prevalence and distribution of ultrasound-detected hand synovial abnormalities in a community-derived sample of older people in China.

Methods Within the Xiangya Osteoarthritis Study, a community-based study, we assessed synovial hypertrophy (SH), joint effusion, and Power Doppler signal (PDS) on all fingers and thumbs of both hands using standardized ultrasound examinations (score: 0–3). We assessed distribution patterns of SH and effusion using χ2-test and interrelationships of SH and effusion in different joints and hands by generalized estimating equations.

Results Among 3,623 participants (mean age: 64.4 years; women: 58.1%), prevalence of SH, effusion and PDS were 85.5%, 87.3% and 1.5%, respectively. Prevalence of SH, effusion and PDS increased with age, was higher in the right hand than in the left hand and was more common in proximal than in distal hand joints. SH and effusion often occurred in multiple joints (P < 0.001). SH in one joint was strongly associated with presence of SH in the same joint of the opposite hand (odds ratio [OR]= 6.60, 95% confidence interval [CI]: 6.19–7.03) followed by SH in other joints in the same row, (OR=5.70, 95%CI: 5.32–6.11), and then other joints in the same ray of the same hand (OR=1.49, 95%CI: 1.39–1.60). Similar patterns were observed for effusion.

Conclusion Hand synovial abnormalities are common among older people, often affect multiple hand joints and present a unique pattern. These findings suggest both systemic and mechanical factors play roles in their occurrence.

Zusammenfassung

Ziel Synoviale Anomalien sind modifizierbare Ursachen für Handschmerzen und Osteoarthritis. Wir untersuchten die Prävalenz und die Verteilung der sonografisch nachgewiesenen synovialen Anomalien der Hand aus der Bevölkerung stammenden Stichprobe älterer Menschen in China.

Methoden In einer community-basierten Studie haben wir synoviale Hypertrophie (SH), Gelenkerguss und Power-Doppler-Signal (PDS) für alle Fingern und Daumen beider Hände mit standardisierten Ultraschalluntersuchungen (Score: 0–3) untersucht. Wir bewerteten die Verteilungsmuster von SH und Erguss mit dem χ2-Test und die Relationen von SH und Erguss in unterschiedlichen Gelenken und Händen mittels generalisierter Schätzgleichungen.

Ergebnisse Unter 3.623 Teilnehmern (Durchschnittsalter: 64,4 Jahre; Frauen: 58,1%) betrug die Prävalenz von SH 85,5 %, von Erguss 87,3 % und von PDS 1,5 %. Die Prävalenz von SH, Erguss und PDS nahm mit dem Alter zu, war in der rechten Hand höher als in der linken Hand und trat häufiger in proximalen als distalen Handgelenken auf. SH und Erguss traten häufig in mehreren Gelenken auf (p < 0,001). SH in einem Gelenk war stark assoziiert mit dem Vorhandensein von SH im gleichen Gelenk der anderen Hand (Odds Ratio [OR]= 6,60; 95% Konfidenzintervall [CI]: 6,19–7,03), gefolgt von SH in anderen Gelenken derselben Reihe (OR=5,70; 95% CI: 5,32–6,11) sowie in anderen Gelenken im selben Strahl derselben Hand (OR=1,49; 95% CI: 1,39–1,60). Ähnliche Muster wurden für Ergüsse beobachtet.

Schlussfolgerung Synoviale Anomalien der Hand sind bei älteren Menschen häufig, betreffen oft mehrere Handgelenke und weisen ein einzigartiges Muster auf. Diese Ergebnisse deuten darauf hin, dass sowohl systemische als auch mechanische Faktoren bei ihrem Auftreten eine Rolle spielen.

Keywords

Synovial abnormalities - Hand - Prevalence - Distribution - Ultrasonography

Publication History

Received: 29 June 2022

Accepted after revision: 07 March 2023

Accepted Manuscript online:
07 March 2023

Article published online:
03 May 2023

• References

• 1 Dahaghin S, Bierma-Zeinstra SM, Reijman M. et al. Prevalence and determinants of one month hand pain and hand related disability in the elderly (Rotterdam study). Ann Rheum Dis 2005; 64: 99-104 DOI: 10.1136/ard.2003.017087. (PMID: 15608306)
• 2 Dziedzic K, Thomas E, Hill S. et al. The impact of musculoskeletal hand problems in older adults: findings from the North Staffordshire Osteoarthritis Project (NorStOP). Rheumatology (Oxford) 2007; 46: 963-967 DOI: 10.1093/rheumatology/kem005.
• 3 Cole A, Gill TK, Taylor AW. et al. Prevalence and associations of hand pain in the community: results from a population-based study. Scand J Rheumatol 2011; 40: 145-149 DOI: 10.3109/03009742.2010.508467.
• 4 Mattap SM, Laslett LL, Squibb K. et al. Hand examination, ultrasound and its association with hand pain and function in community-based older adults. Arthritis Care Res (Hoboken) 2019; DOI: 10.1002/acr.24128.
• 5 Thomas E, Croft PR, Dziedzic KS. Hand problems in community-dwelling older adults: onset and effect on global physical function over a 3-year period. Rheumatology (Oxford) 2009; 48: 183-187 DOI: 10.1093/rheumatology/ken452. (PMID: 19141575)
• 6 Zhang Y, Niu J, Kelly-Hayes M. et al. Prevalence of symptomatic hand osteoarthritis and its impact on functional status among the elderly: The Framingham Study. Am J Epidemiol 2002; 156: 1021-1027 DOI: 10.1093/aje/kwf141.
• 7 Kroon FPB, Kortekaas MC, Boonen A. et al. Results of a 6-week treatment with 10 mg prednisolone in patients with hand osteoarthritis (HOPE): a double-blind, randomised, placebo-controlled trial. Lancet 2019; 394: 1993-2001 DOI: 10.1016/S0140-6736(19)32489-4.
• 8 Conaghan PG, Cook AD, Hamilton JA. et al. Therapeutic options for targeting inflammatory osteoarthritis pain. Nat Rev Rheumatol 2019; 15: 355-363 DOI: 10.1038/s41584-019-0221-y. (PMID: 31068673)
• 9 Visser AW, de Mutsert R, le Cessie S. et al. The relative contribution of mechanical stress and systemic processes in different types of osteoarthritis: the NEO study. Ann Rheum Dis 2015; 74: 1842-1847 DOI: 10.1136/annrheumdis-2013-205012. (PMID: 24845389)
• 10 Spector TD, Cicuttini F, Baker J. et al. Genetic influences on osteoarthritis in women: a twin study. BMJ 1996; 312: 940-943 DOI: 10.1136/bmj.312.7036.940. (PMID: 8616305)
• 11 Kidd BL, Mapp PI, Gibson SJ. et al. A neurogenic mechanism for symmetrical arthritis. Lancet 1989; 2: 1128-1130 DOI: 10.1016/s0140-6736(89)91491-8. (PMID: 2572850)
• 12 Niu J, Zhang Y, LaValley M. et al. Symmetry and clustering of symptomatic hand osteoarthritis in elderly men and women: the Framingham Study. Rheumatology (Oxford) 2003; 42: 343-348 DOI: 10.1093/rheumatology/keg110. (PMID: 12595633)
• 13 Wei J, Zhang C, Zhang Y. et al. Association between gut microbiota and symptomatic hand osteoarthritis: data from the Xiangya Osteoarthritis Study. Arthritis Rheumatol 2021; DOI: 10.1002/art.41729.
• 14 Hammer HB, Iagnocco A, Mathiessen A. et al. Global ultrasound assessment of structural lesions in osteoarthritis: a reliability study by the OMERACT ultrasonography group on scoring cartilage and osteophytes in finger joints. Ann Rheum Dis 2016; 75: 402-407 DOI: 10.1136/annrheumdis-2014-206289. (PMID: 25520476)
• 15 Mathiessen A, Hammer HB, Terslev L. et al. Ultrasonography of Inflammatory and Structural Lesions in Hand Osteoarthritis: An Outcome Measures in Rheumatology Agreement and Reliability Study. Arthritis Care Res (Hoboken) 2022; 74: 2005-2012 DOI: 10.1002/acr.24734. (PMID: 34137211)
• 16 Wakefield RJ, Balint PV, Szkudlarek M. et al. Musculoskeletal ultrasound including definitions for ultrasonographic pathology. J Rheumatol 2005; 32: 2485-2487 (PMID: 16331793)
• 17 Koski JM, Saarakkala S, Helle M. et al. Power Doppler ultrasonography and synovitis: correlating ultrasound imaging with histopathological findings and evaluating the performance of ultrasound equipments. Ann Rheum Dis 2006; 65: 1590-1595 DOI: 10.1136/ard.2005.051235.
• 18 D’Agostino MA, Terslev L, Aegerter P. et al. Scoring ultrasound synovitis in rheumatoid arthritis: a EULAR-OMERACT ultrasound taskforce-Part 1: definition and development of a standardised, consensus-based scoring system. RMD Open 2017; 3: e000428 DOI: 10.1136/rmdopen-2016-000428. (PMID: 28948983)
• 19 Szkudlarek M, Court-Payen M, Jacobsen S. et al. Interobserver agreement in ultrasonography of the finger and toe joints in rheumatoid arthritis. Arthritis Rheum 2003; 48: 955-962 DOI: 10.1002/art.10877. (PMID: 12687537)
• 20 Yokose C, Dalbeth N, Wei J. et al. Radiologic evidence of symmetric and polyarticular monosodium urate crystal deposition in gout – A cluster pattern analysis of dual-energy CT. Semin Arthritis Rheum 2020; 50: 54-58 DOI: 10.1016/j.semarthrit.2019.07.002. (PMID: 31371194)
• 21 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: 1097-1106 DOI: 10.1002/art.20135.
• 22 Parodi M, Silvestri E, Garlaschi G. et al. How normal are the hands of normal controls? A study with dedicated magnetic resonance imaging. Clin Exp Rheumatol 2006; 24: 134-141
• 23 Saboury B, Parsons MA, Moghbel M. et al. Quantification of aging effects upon global knee inflammation by 18F-FDG-PET. Nucl Med Commun 2016; 37: 254-258 DOI: 10.1097/MNM.0000000000000430.
• 24 Lefevre S, Knedla A, Tennie C. et al. Synovial fibroblasts spread rheumatoid arthritis to unaffected joints. Nat Med 2009; 15: 1414-1420 DOI: 10.1038/nm.2050. (PMID: 19898488)
• 25 Schett G, Tohidast-Akrad M, Steiner G. et al. The stressed synovium. Arthritis Res 2001; 3: 80-86 DOI: 10.1186/ar144. (PMID: 11178114)
• 26 Jamal J, Roebuck MM, Lee SY. et al. Modulation of the mechanical responses of synovial fibroblasts by osteoarthritis-associated inflammatory stressors. Int J Biochem Cell Biol 2020; 126: 105800 DOI: 10.1016/j.biocel.2020.105800. (PMID: 32673644)
• 27 Wood MJ, Leckenby A, Reynolds G. et al. Macrophage proliferation distinguishes 2 subgroups of knee osteoarthritis patients. JCI Insight 2019; 4 DOI: 10.1172/jci.insight.125325. (PMID: 30674730)
• 28 Pratt AG, Siebert S, Cole M. et al. Targeting synovial fibroblast proliferation in rheumatoid arthritis (TRAFIC): an open-label, dose-finding, phase 1b trial. Lancet Rheumatol 2021; 3: e337-e346 DOI: 10.1016/S2665-9913(21)00061-8. (PMID: 33928262)
• 29 Padovano I, Costantino F, Breban M. et al. Prevalence of ultrasound synovial inflammatory findings in healthy subjects. Ann Rheum Dis 2016; 75: 1819-1823 DOI: 10.1136/annrheumdis-2015-208103. (PMID: 26613767)