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. 2024 Oct 21;83(11):1428-1435.
doi: 10.1136/ard-2023-225073.

2023 EULAR classification criteria for hand osteoarthritis

Ida K Haugen  1 , David T Felson  2 , Abhishek Abhishek  3 , Francis Berenbaum  4 , Sita Bierma-Zeinstra  5 , Krysia S Dziedzic  6 , John James Edwards  6 , Martin Englund  7 , Merete Hermann-Eriksen  8 , Gabriel Herrero-Beaumont  9 , Catherine Hill  10 , Mariko L Ishimori  11 , Helgi Jonsson  12 , Teemu Karjalainen  13 , Ying Ying Leung  14 , Emmanuel Maheu  15 , Christian D Mallen  6 , Michelle Marshall  6 , Rikke H Moe  16 , Roberta Ramonda  17 , Valentin Ritschl  18   19 , Marco Jpf Ritt  20 , Tanja A Stamm  18   19 , Zoltan Szekanecz  21 , Florus van der Giesen  22 , Lotte A van de Stadt  22   23 , Coen van der Meulen  24 , Ruth Wittoek  25 , Elsie Greibrokk  16 , Hellen Laheij  26 , Margreet Kloppenburg  26   27
Affiliations

2023 EULAR classification criteria for hand osteoarthritis

Ida K Haugen et al. Ann Rheum Dis. .

Abstract

Objectives: The objective of this study is to develop classification criteria for overall hand osteoarthritis (OA), interphalangeal OA and thumb base OA based on self-reported data and radiographic features.

Methods: The classification criteria sets were developed in three phases. In phase 1, we identified criteria that discriminated hand OA from controls. In phase 2, we used a consensus-based decision analysis approach to derive a clinician-based evaluation of the relative importance of the criteria. In phase 3, we refined the scoring system, determined the cut-offs for disease classification and compared the sensitivity and specificity of the European Alliance of Associations for Rheumatology (EULAR) criteria with the 1990 American College of Rheumatology (ACR) criteria.

Results: In persons with hand symptoms and no other disease (including psoriasis) or acute injury that can explain the hand symptoms (mandatory criteria), hand OA can be classified based on age, duration of morning stiffness, number of joints with osteophytes and joint space narrowing, and concordance between symptoms and radiographic findings. Using a sum of scores based on each diagnostic element, overall hand OA can be classified if a person achieves 9 or more points on a 0-15 scale. The cut-off for interphalangeal OA and thumb base OA is 8 points. While the EULAR criteria demonstrated better sensitivity than the ACR criteria in the phase 1 data set, the performance of the two criteria sets was similar in two external cohorts.

Conclusions: International experts developed the EULAR criteria to classify overall hand OA, interphalangeal OA and thumb base OA in clinical studies using a rigorous methodology.

Keywords: Epidemiology; Osteoarthritis; Patient Reported Outcome Measures.

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Conflict of interest statement

Competing interests: IKH reports personal fees from Novartis and GSK; research grants from Pfizer and IMI-APPROACH (both paid to the institution); and unpaid role as secretary general of OARSI, all outside of the submitted work. AA reports institutional research grants from AstraZeneca and Oxford Immunotech; and personal fees from UpToDate (royalty), Springer (royalty), Cadilla Pharmaceuticals (lecture fees), NGM Bio (consulting), Limbic (consulting) and Inflazome (consulting), all outside of the submitted work. FB reports shares of 4P Pharma and 4Moving Biotech; personal fees from Boehringer Ingelgeim, Galapagos, Gilead, GSK, Merck Sereno, MSD, Novartis, Pfizer, Roche, Sanofi, Servier and Viatris; and research grant from TRB Chemedica, all outside the submitted work.Sita Bierma-Zeinstra reports research grants from Dutch Arthritis Association, EU Horizon, EU ERC and ZonMW (paid to institution), personal fees from Pfizer, Infirst healthcare, and paid role as deputy editor of Osteoarthritis and Cartilage, all outside of the submitted work.Krysia Dziedzic reports research grants from National Institute for Health and Care Research (NIHR); royalty/licence for Textbook for Rheumatology Therapists; payment for lecture at Australian Rheumatology Association Conference in May 2022; Implementation Advisor Fellows and Scholars Programme National Institute for Health and Care Excellence (UK 2019-22), Steering group member of NICE Implementation subgroup and Steering group member of OARSI Joint Effort initiative, all paid to institution and outside of the submitted work.Martin Englund reports personal fees from Cellcolabs AB (Sweden) and Key2 Compliance (Sweden), outside of the submitted work. Ying Ying Leung reports grants from National Medical Research Council (NMRC/CSA-INV/0022/2017), and personal fees from AbbVie, DKSH, Janssen, Novartis and Pfizer, outside of the submitted work. EM reports personal fees from Expanscience, Keyrus Life Science, Pierre Fabre, Rottapharm, MEDA-Mylan, Sublimed, TRB Chemedica, outside the submitted work. RR reports personal fees from from Novartis, AbbVie, Pfizer, MSD, Janssen, Lilly; support for attending EULAR, ACR and SIR; advisory board for Janssen, Novartis and Abbvie, outside of the submitted work. TAS reports grants and personal fees from AbbVie and Roche, and personal fees from Sanofi, Takeda and Novartis, outside the submitted work. ZS reports personal fees from AbbVie, Pfizer, Roche, Novartis, Lilly, Gedeon Richter, Sobi/Galapagos, outside of the submitted work. RW reports institutional research grants from Pfizer and Amgen, unrelated to this work, and is a Senior Clinical Investigator of the Research Foundation Flanders (Belgium) (FWO) (1803023N). MK reports consulting fees from Abbvie, Pfizer, Kiniksa, Flexion, Galapagos, Jansen, CHDR, Novartis and UCB (all paid to institution), outside of the submitted work. DF, JJE, MH-E, GH-B, CH, MLI, HJ, TK, CDM, MM, RHM, VR, MJPFR, FVG, LAS, CM, EG and HL report no conflicts of interest.

Figures

Figure 1
Figure 1. Three phases in developing classification criteria for overall hand osteoarthritis (OA), interphalangeal OA and thumb base OA.
See this image and copyright information in PMC

References

    1. Haugen IK, Englund M, Aliabadi P, et al. Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham osteoarthritis study. Ann Rheum Dis. 2011;70:1581–6. doi: 10.1136/ard.2011.150078. - DOI - PMC - PubMed
    1. Pereira D, Peleteiro B, Araújo J, et al. The effect of osteoarthritis definition on prevalence and incidence estimates: a systematic review. Osteoarthritis and Cartilage. 2011;19:1270–85. doi: 10.1016/j.joca.2011.08.009. - DOI - PubMed
    1. Kloppenburg M, Kroon FP, Blanco FJ, et al. Update of the EULAR recommendations for the management of hand osteoarthritis. Ann Rheum Dis. 2019;78:16–24. doi: 10.1136/annrheumdis-2018-213826. - DOI - PubMed
    1. Kolasinski SL, Neogi T, Hochberg MC, et al. American college of rheumatology/arthritis foundation guideline for the management of osteoarthritis of the hand, hip, and knee. Arthritis & Rheumatology. 2020;72:220–33. doi: 10.1002/art.41142. - DOI - PMC - PubMed
    1. McAlindon TE, Bannuru RR, Sullivan MC, et al. OARSI guidelines for the non-surgical management of knee osteoarthritis. Osteoarthritis and Cartilage. 2014;22:363–88. doi: 10.1016/j.joca.2014.01.003. - DOI - PubMed

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