An ultrasonographic study of osteoarthritis of the hand: synovitis and its relationship to structural pathology and symptoms.

OBJECTIVE Few studies have examined hand osteoarthritis (OA) pathology using sensitive imaging techniques. The aim of this study was to determine the extent of ultrasound (US)-detected pathology and investigate its relationship with symptoms in hand OA. METHODS Subjects with symptomatic hand OA and controls were recruited. All underwent clinical and US examination of the small joints of both hands and completed a range of measures of hand pain, stiffness, and function. RESULTS Thirty-six subjects with symptomatic OA and 19 control subjects with similar demographics were recruited. US-detected pathology (osteophytes, joint space narrowing, gray-scale synovitis, and power Doppler signal) occurred frequently in symptomatic hand OA (41%, 40%, 46%, and 7% of joints, respectively), and significantly less often in controls (P < 0.001 for all comparisons). Symptomatic joints were more likely to demonstrate US-detected changes of gray-scale synovitis, power Doppler signal, or osteophytes (P < 0.001, P = 0.002, and P < 0.001, respectively). Neither the number of affected joints per individual nor the summative semiquantitative scores for synovitis per individual correlated with symptoms (pain visual analog scale [VAS], global VAS, or Australian/Canadian Osteoarthritis Hand Index). CONCLUSION This study demonstrated extensive synovitis changes as well as the traditional structural radiographic findings of hand OA. Symptomatic joints were significantly more likely to demonstrate US-detected structural changes or inflammation in symptomatic hand OA; however, the extent of changes in individual joints or in individuals did not correlate with the degree of symptoms, which may relate to both the assessment tools and the complex nature of pain.