EULAR evidence based recommendations for the diagnosis of hand osteoarthritis - report of a task force of the EULAR Standing Committee for International Clinical Studies Including Therapeutics (ESCISIT)

W Zhang ^1*, M Doherty ¹, B F Leeb ², L Alekseeva ³, N K Arden ⁴, J W Bijlsma ⁵, F Dincer ⁶, K Dziedzic ⁷, H J Hauselmann ⁸, P Kaklamanis ⁹, M Kloppenburg ¹⁰, L S Lohmander ¹¹, E Maheu ¹², M Martín-Mola ¹³, K Pavelka ¹⁴, L Punzi ¹⁵, S Reiter ¹⁶, J Smolen ¹⁷, G Verbruggen ¹⁸, I Watt ¹⁹ and I Zimmermann-Górska ²⁰

¹ Nottingham University, United Kingdom
² 2nd Department of Medicine, Lower Austrian Centre for Rheumatology, Stockerau, Australia
³ State Institute of Rheumatology, Russian Academic Medical School, Moscow, Russian Federation
⁴ MRC Environmental Epidemiology Resource Centre, Southampton General Hospital, Southampton, United Kingdom
⁵ Rheumatology and Clinical Immunology Department, University Medical Center Utrecht, Utrecht, Netherlands
⁶ Hacettepe University, Faculty of Medicine, Department of Physical Medicine and Rehabilitation, Ankar, Turkey
⁷ Primary Care Musculoskeletal Research Centre, Keele University, Keele, United Kingdom
⁸ Clinic Im Park Hirslanden Group, Centre for Rheumatology and Bone Disease, Zurich, Switzerland
⁹ 16, Anaperon Polemou St, Athens, Greece
¹⁰ Department of Rheumatology, Leiden University Medical Centre, Leiden, Netherlands
¹¹ Department of Orthopaedics, Clinical Sciences Lund, Lund University, Lund, Sweden
¹² Rheumatology, Hospital Saint-Antoine, Paris, France
¹³ Servicio de Reumatologia, Hospital Universitario La Paz, Madrid, Spain
¹⁴ Institute of Rheumatology, Na Slupi 4, Prague, Czech Republic
¹⁵ Rheumatology Unit, Department of Clinical and Experimental Medicine, University of Padova, Italy
¹⁶ Rheumatology Unit, Federal Institute for Drugs and Medical Devices, Germany
¹⁷ 2nd Department of Medicine, Krankenhauz Lainz, Vienna, Australia
¹⁸ Department of Rheumatology, Ghent University Hospital, Gent, Belgium
¹⁹ Department of Radiology. Leiden University Medical Centre, Leiden, Netherlands
²⁰ Department of Rheumatology, Rehabilitation and Internal Medicine, University of Medical Sciences, Po, Poland

^* To whom correspondence should be addressed. E-mail: weiya.zhang{at}nottingham.ac.uk.

Accepted 28 January 2008

Abstract

Objectives: To develop evidence based recommendations for the diagnosis of hand osteoarthritis (OA).

Methods: The multidisciplinary guideline development group, representing 15 European countries, generated 10 key propositions regarding diagnosis using a Delphi consensus approach. Research evidence was searched systematically for each recommendation. Whenever possible, the sensitivity, specificity and likelihood ratio (LR) were calculated; relative risk and odds ratios were estimated for risk factors for hand OA. Quality of evidence was categorised using the EULAR hierarchy, and strength of recommendation was assessed by the EULAR visual analogue scale.

Results: Diagnostic topics included clinical manifestations, radiographic features, subgroups, differential diagnosis, laboratory tests, risk factors and co-morbidities. The sensitivity, specificity and LR varied between tests depending upon the cut-off level, gold standard and controls. Overall, no single test could be used to define hand OA on its own (LR <10) but a composite of the tests greatly increased the chance of the diagnosis. The probability of a subject having hand OA was 20% when Heberden’s nodes alone were present, but this increased to 88% when in addition the subject was over 40 years old, had a family history of nodes and had joint space narrowing in any finger joint.

Conclusion: 10 key recommendations for diagnosis of hand OA were developed using both research evidence and expert consensus. Diagnosis of hand OA should be based on assessment of a composite of features.

Keywords: EULAR, diagnosis, hand, osteoarthritis, recommendations

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