Hand OA Pain Increased in Comorbid Diabetes

Erosive hand osteoarthritis (OA) patients are more likely to experience more severe pain if they have comorbid diabetes, according to research presented at the European League Against Rheumatism Annual Meeting held in June 2014, in Paris, France.

Researchers from Diakonhjemmet Hospital in Oslo, Norway used a subscale of the Australian-Canadian Osteoarthritis Hand Index (AUSCAN) to measure hand pain in 530 individuals. Most of the individuals included in the study were women (77.4 percent) and the median age was 63.4 years. The study participants self-reported OA and afterward were diagnosed with OA using American College of Rheumatology guidelines in 2010. Most of the patients (399 patients) were found to have non-erosive OA.

“Having diabetes was associated with increased hand pain in erosive OA, but not in non-erosive hand OA,” researcher Karin Magnusson, PhD, said at the meeting. “Inflammatory and structural features were [also] associated with hand pain in erosive hand OA. Only factors outside the joint explained the variance in non-erosive hand OA.”

The investigators began their research because of the lack of information linking pain patients with hand OA. They noted that previous studies did not explore the socioeconomic factors associated with pain, on top of structural and inflammatory damages associated with OA. Other factors examined 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, overall widespread pain, number of joints with synovitis, and the number of joints with radiographic evidence of disease.

The researchers determined that a Kellgren-Lawrence scale of 2 or above was associated with pain in erosive — but not non-erosive – osteoarthritis.

An increased number of joints with synovitis, as well as diabetes, was associated with AUSCAN pain in erosive osteoarthritis. However, the researchers noted, poor mental health indicated hand pain experienced in patients with non-erosive OA. To assess mental health, the researchers used the Short-Form 36 mental health score.

The investigators also noted that a low level of education and a high number of pain sites were related to self-reported pain only.

“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,” the authors wrote.