Background Osteoarthritis (OA) is one of the most common causes of pain in the hands after 40-45 years resulting in poor health-related quality of life (HRQoL). This reduction caused not only moderate to severe pain and dysfunction but also the presence of aesthetic dissatisfaction. Nowadays there are no accurate measures of evaluating it.
Objectives To estimate the level of aesthetic discomfort in patients with hand osteoarthritis (HOA) and it's possible correlations with clinical manifestations and dependence of personal factors.
Methods 90 women 45-75 years with symptomatic HOA were examined in terms of number of painful and nodulus joints and evaluating functions using a questionnaire AUSCAN (Australian/Canadian Osteoarthritis Hand Index). Next, they filled a standard questionnaire about their level of dissatisfaction with the appearance of the hands. The questions try to estimate the level of trouble because of deforming hands, fear of future deformation and willingness of women to surgical correction. All responses were evaluated on a VAS scale. Later all patients completed Ellis's stress test.
Data were analyzed using Statistica 10.0 and are presented as mean (standard deviation).
Results The average age was 62.3 (8.0) years, duration of HOA – 8.3 (7.6) years, number of painful joints – 2.5 (3.3), number of nodulus joints – 7.5 (4.5). AUSCAN data were the following: pain – 225 (128), stiffness – 50 (32), functional impairment – 334 (190). Patients with HOA revealed a significant level of aesthetic discomfort – 47.3 (28.8), comparable with the level of pain in the joints – 43.5 (23.3). The most pronounced was the fear of deformation in the future – 68.9 (20.9) and external incommodity because of the hand deformity – 49.2 (32.3); less pronounced was the desire to surgical correction – 9.8 (19.9). Stress test results showed that women tend to make excessive demands on themselves and others and adapt poorly to stress. In analyzing the data the aesthetic discomfort was more pronounced in younger women. We haven't been identified significant relationship between the level of aesthetic discomfort and severity of pain and dysfunction, but we've found previously identified willingness of young women to surgery (r=-0.52) and strong association between level of aesthetic dissatisfaction and fear of future deformation (r=0.78). Active internet use and employment in women 45-65 years significantly reduced the aesthetic dissatisfaction (OR=11.1 and 7.5 respectively), whereas marriage and higher education haven't influenced.
Conclusions Aesthetic discomfort is a significant component of the reduced HRQoL in patients with HOA. Further study of this component of HOA is necessary, including the definition of the term “aesthetic discomfort” and the criteria for its diagnosis. This knowledge can help to develop methods of correction and prevention of aesthetic dissatisfaction. It's necessary to work not only rheumatologists, but also psychologists and rehabilitation specialists.
Disclosure of Interest None declared