Concomitant diabetes associated with osteoarthritic hand pain

By Sara Freeman, medwireNews Reporter

People with erosive osteoarthritis (OA) of the hand are more likely to experience pain if they have also diabetes, suggests research presented at the recent annual meeting of the European League Against Rheumatism in Paris, France.

“Having diabetes was associated with increased hand pain in erosive OA, but not in non-erosive hand OA”, Karin Magnusson and colleagues, from Diakonhjemmet Hospital in Oslo, Norway, reported in a poster presentation at the meeting.

Hand pain was measured using a subscale of the AUStralian-CANadian Osteoarthritis Hand Index (AUSCAN) subscale and, in multivariate regression analysis, the beta coefficient (B) for AUSCAN pain was 3.81 for patients with both erosive OA and diabetes, and –0.42 in those with non-erosive OA and diabetes.

“Inflammatory and structural features were [also] associated with hand pain in erosive hand OA”, the researchers said. “Only factors outside the joint explained the variance in non-erosive hand OA.”

Magnusson and team performed a cross sectional study of 530 individuals who had self-reported OA and were subsequently diagnosed with clinical hand OA according to American College of Rheumatology criteria at a clinical examination in 2010. The majority (n=399) of patients had non-erosive OA.

The rationale for the study was that structural findings and the amount of pain patients with hand OA experience are frequently discordant, and that previous studies had not tended to look at the sociodemographic factors that might be involved, along with structural and inflammatory changes.

The team looked at several possible explanatory factors that may be associated with hand pain and the number of tender joints upon palpation (0–30). These factors included patient age, gender, educational status, family history of OA, smoking status, alcohol intake, physical activity, body mass index, the presence of comorbid diabetes, hypertension, mental health, widespread pain, number of joints with synovitis and the number of joints with radiographic evidence of disease (Kellgren-Lawrence grade ≥2).

In addition to diabetes, an increased number of joints with synovitis was associated with AUSCAN pain in erosive disease (B=0.45 and 0.24 for non-erosive OA). A Kellgren-Lawrence grade of 2 or above was also associated with pain in erosive but not in non-erosive disease (B=0.17 vs 0.00).

Conversely, poor mental health, as assessed using the Short-Form 26 mental health score, was associated with hand pain in patients with non-erosive OA (B=–0.06).

“Although our study included a broad range of possible predictors of pain, only a small part of the variation in hand OA can be explained”, Magnusson and colleagues concluded.

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