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  • Review Article
  • Published:

Hand osteoarthritis—a heterogeneous disorder

Nature Reviews Rheumatology volume 8, pages 22–31 (2012)Cite this article

Subjects

Abstract

Hand osteoarthritis (OA) is a prevalent disorder. Hand OA is not one single disease, but a heterogeneous group of disorders. Radiographic signs of hand OA, such as osteophytes or joint space narrowing, can be found in up to 81% of the elderly population. Several hand OA subsets—such as nodal interphalangeal OA, thumb base OA and erosive OA—can be discriminated. Furthermore, the experience of symptoms and the course of the disease differ between patients. Studies that used well-defined study populations with longitudinal follow-up have shown that similarities and differences can be observed in the pathogenesis, epidemiology and risk factors of the various hand OA subsets. Erosive OA in particular, characterized by erosive lesions on radiographical images, has a higher clinical burden and worse outcome than nonerosive hand OA. Imaging modalities (such as ultrasonography) have increased our knowledge of the role of inflammation of the disease. Our understanding of the heterogeneous nature of hand OA can eventually lead to increased knowledge of the pathogenesis of, and ultimately new treatment modalities for, this complex disease.

Key Points

  • Hand OA is a heterogeneous and prevalent disorder, comprising several subsets

  • Local and systemic risk factors are recognized for hand OA, although not all risk factors contribute in the same way in all subsets

  • The clinical burden of hand OA is heterogeneous and can vary from mild (in the general population) to considerable, especially in patients consulting secondary care

  • The disease course of hand OA is variable and further studies are warranted to investigate the association between changes in symptoms and structural damage over time

  • Further research into the underlying pathogenesis of erosive OA is needed, to clarify whether erosive OA is a separate disease entity or a severe stage of nodal interphalangeal OA

  • Use of ultrasonography has highlighted the role of inflammation in hand OA, which will hopefully be further elucidated by the use of MRI

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Figure 1: Classification criteria of the ACR for hand OA.
Figure 2: MRI scans showing typical features of hand OA.
Figure 3: Radiograph showing typical presentation of thumb base OA.
Figure 4: Detection of erosive OA.

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Authors and Affiliations

  1. Department of Rheumatology, Leiden University Medical Center, Albinusdreef 2, PO Box 9600, Leiden, 2300 RC, The Netherlands

    Margreet Kloppenburg & Wing-Yee Kwok

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  1. Margreet Kloppenburg
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  2. Wing-Yee Kwok
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M. Kloppenburg and W.-Y. Kwok contributed equally to researching data for the article, discussion of content, writing, reviewing and editing the manuscript.

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Correspondence to Margreet Kloppenburg.

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Competing interests

M. Kloppenberg has received grant or research support from the Dutch Arthritis Association, Pfizer and TI Pharma. W.-Y. Kwok has no competing interests.

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Kloppenburg, M., Kwok, WY. Hand osteoarthritis—a heterogeneous disorder. Nat Rev Rheumatol 8, 22–31 (2012). https://doi.org/10.1038/nrrheum.2011.170

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