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.