van der Meulen Coen, van de Stadt Lotte A, Buck Saskia J, Rosendaal Frits R, Terpstra Sietse E S, Kloppenburg Margreet
Leiden University Medical Center, Leiden, The Netherlands.
Amsterdam Rheumatology and Immunology Center, Reade, Amsterdam, The Netherlands.
Arthritis Care Res (Hoboken). 2025 May;77(5):614-622. doi: 10.1002/acr.25480. Epub 2025 Jan 27.
We aimed to characterize patients with hand osteoarthritis (OA) with deteriorating or improving hand pain and to investigate patients achieving good clinical outcome after four years.
We used four-year annual Australian/Canadian Hand Osteoarthritis Index (AUSCAN) pain subscale (range 0-20) measurements from the Hand OSTeoArthritis in Secondary Care cohort (patients with hand OA). Pain changes were categorized as deterioration, stable, and improvement using the Minimal Clinical Important Improvement. Good clinical outcome was categorized using the Patient Acceptable Symptom State (PASS). Associations between baseline characteristics (patient and disease characteristics, coping styles, and illness perceptions) and outcomes were investigated using multinomial or binary logistic regression, adjusted for baseline pain, age, sex, and body mass index (BMI).
A total of 356 patients (83% female, mean age 60.6 years, mean AUSCAN score 9.1) were analyzed. Pain improved for 38% of patients, deteriorated for 30% of patients, and remained stable for 32% of patients over four years. Four-year pain development followed annual trends. At baseline, 44% of patients reached PASS, and 49% of patients reached PASS at follow-up. Higher BMI, coping through comforting cognitions, and illness comprehension were positively associated with pain deterioration. Higher AUSCAN function score, mental well-being, and illness consequences were negatively associated with pain improvement. Employment (positive) and emotional representations (negative) were associated with both improvement and deterioration. Higher baseline AUSCAN function, tender joint count, and symptoms attributed to hand OA were associated negatively with PASS after four years.
The pain course of patients with hand OA is variable, not inevitably worsening, and various factors may play a role. Whether modification of these risk factors can influence pain outcomes requires further investigation.
我们旨在对手部骨关节炎（OA）患者进行特征描述，这些患者的手部疼痛有恶化或改善情况，并调查四年后取得良好临床结局的患者。
我们使用了来自二级医疗队列中手部骨关节炎患者（手部OA患者）的四年期澳大利亚/加拿大手部骨关节炎指数（AUSCAN）疼痛子量表（范围0 - 20）测量值。使用最小临床重要改善将疼痛变化分类为恶化、稳定和改善。使用患者可接受症状状态（PASS）对良好临床结局进行分类。使用多项或二元逻辑回归研究基线特征（患者和疾病特征、应对方式和疾病认知）与结局之间的关联，并对基线疼痛、年龄、性别和体重指数（BMI）进行调整。
共分析了356例患者（83%为女性，平均年龄60.6岁，平均AUSCAN评分9.1）。在四年期间，38%的患者疼痛改善，30%的患者疼痛恶化，32%的患者疼痛保持稳定。四年的疼痛发展遵循年度趋势。在基线时，44%的患者达到PASS，随访时49%的患者达到PASS。较高的BMI、通过安慰性认知应对以及疾病理解与疼痛恶化呈正相关。较高的AUSCAN功能评分、心理健康和疾病后果与疼痛改善呈负相关。就业（正相关）和情感表征（负相关）与改善和恶化均相关。较高的基线AUSCAN功能、压痛关节计数以及归因于手部OA的症状与四年后的PASS呈负相关。
手部OA患者的疼痛病程是可变的，并非必然恶化，多种因素可能起作用。这些风险因素的改变是否能影响疼痛结局需要进一步研究。
