PubMed · 2018909
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P Arnstein, S Fleming. Bag packers' hand.. https://doi.org/10.1016/0007-1226(91)90059-s
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BACKGROUND: Although very common, hand osteoarthritis (OA) is rarely the focus of clinical trials aimed at determining whether a drug is effective on its symptoms and/or anatomical progression. Besides the common difficulties met in trials in OA in general, the highly unpredictable course of hand OA presents specific challenges. However, hand OA is beginning to be considered as a potential model for the study of drugs in OA, since researchers now have at their disposal new clinical tools and radiological methods to assess with better accuracy and sensitivity either its symptomatic activity or its anatomical course. METHOD: The now well-known consensual recommendations for the design and conduct of clinical trials in OA are reviewed, and the specific clinical tools and radiological methods available for the assessment of hand OA detailed. Some specific recommendations for the design of clinical trials in hand OA and the selection of patients for such trials are proposed, taking into account the particularities of this location of OA.
The aim of the session was to discuss the current definitions of and criteria for hand osteoarthritis (OA) and to review the tools proposed for the clinical assessment of hand OA in research and trials. The American College of Rheumatology criteria for the classification and reporting of hand OA were discussed and their limitations noted; specifically, they are designed for symptomatic OA and based on physical examination. The differences between erosive and non-erosive hand OA were discussed as was the relationship between hand OA and generalized OA, since hand OA represents a generalized OA of hand joints and can be considered as a marker for developing generalized OA (i.e. OA at other sites). Different clinical tools to assess patients were presented and discussed, such as pain assessment, Dreiser's functional index or Bellamy's AUSCAN for function assessment, assessment of the mobility, stiffness, inflammation and aesthetic damages. The agreements, disagreements and further studies to be performed to answer questions still debated are presented.