Abstract
Most severity indices of osteoarthritis (OA) include measures of physical function which render them unsuitable for assessing the impact of OA on disability. Data from 1002 moderate to severely disabled community-dwelling women ≥65 years were used to develop hand OA severity indices which are independent of functional status. Baseline exams and strength tests were conducted by trained nurse examiners. Each distal and proximal interphalangeal joint, and first carpo-metacarpal joint (20 joints in all) was scored for the presence of a) bony enlargement or deformity, and b) pain on motion or tenderness on palpation. Severity indices were then created: Deformity index (DEF) = sum of joints with bony changes (0–20); Pain/Tenderness index (PT) = sum of joints with pain or tenderness (0–20); and Combined Deformity/Pain index = sum of DEF and PT (0–40). These indices were then validated against grip and pinch strength. All three indices showed a significant trend for weaker grip strength as severity index scores increased. When the 25th, 50th and 75th percentiles were used to divide each severity index into levels of involvement, a threshold effect was observed with significantly poorer grip strength performance above the 75th percentile for each index. Similar results were seen for pinch strength. In conclusion, these hand OA severity indices, based on examination findings alone, help distinguish disease status, and may provide a valuable research tool for investigating the role of hand OA in impairment and disability.
Similar content being viewed by others
References
Stein R.K., Gortmaker S.L., Perrin E.C., Perrin J.M., Pless I.B., Walker D.K., Weitzman M.: Severity of illness: Concepts and measurements. Lancet 2: 1506–1509, 1987.
Ettinger W.H., Fried L.P., Harris T., Shemanski L., Schulz R., Robbins J.: Self-reported causes of physical disability in older people: The Cardiovascular Health Study. J. Am. Geriatr. Soc. 42: 1035–1044, 1994.
Fried L.P., Guralnik J.M.: Disability in older adults: Evidence regarding significance, etiology, and risk. J. Am. Geriatr. Soc. 45: 92–100, 1997.
Acheson R.M., Ginsburg G.N.: New Haven survey of joint diseases XVI: Impairment, disability and arthritis. Br. J. Prev. Soc. Med. 27: 168–176, 1973.
Baron M., Dutil E., Berkson L., Lander P., Becker R.: Hand function in the elderly: relation to osteoarthritis. J. Rheumatol. 14: 815–819, 1987.
Pattrick M., Aldridge S., Hamilton E., Manhaire A., Doherty M.: A controlled study of hand function in nodal and erosive arthritis. Ann. Rheum. Dis. 48: 978–982, 1989.
Doyle D.V., Dieppe P.A., Scott J., Huskisson E.C.: An articular index for the assessment of osteoarthritis. Ann. Rheum. Dis. 40: 75–78, 1981.
Dreiser R-L., Maheu E., Guillou G.B., Caspard H., Grouin J-M.: Validation of an algofunctional index for osteoarthritis of the hand. Rev. Rheum. (Engl Ed) 62: 43S–53S, 1995.
Bellamy N., Campbell J., Haraoui B., Buchbinder R., Hall S., Muirden K., Gerecz-Simon E., Kean W., Hobby K., MacDermid J., Roth J.: Development of the Australian/Canadian (AUSCAN) osteoarthritis (OA) hand index. Arthritis Rheum. 40 (Suppl.): S110, 1997 (Abstract).
Hughes S.L., Gibbs J., Edelman P., Singer R., Chang R.W.: Joint impairment and hand function in the elderly. J. Am. Geriatr. Soc. 40: 871–877, 1992.
Fried L.P., Kasper J.D., Guralnik J.M., Simonsick E.M.: The Women’s Health and Aging Study: An introduction. In: Guralnik J.M., Fried L.P., Simonsick E.M., Kasper J.D., Lafferty M.E. (Eds.), The Women’s Health and Aging Study: Health and Social Characteristics of Older Women with Disability. National Institute on Aging, Bethesda, MD, 1995; NIH Pub. No. 95-4009. Full text available on http://www.nih.gov/nia/edb/whasbook/title.htm
Fried L.P., Ettinger W.H., Hermanson B., Linda B., Newman A.B., Gardin J.: Physical disability in older adults: A physiological approach. J. Clin. Epidemiol. 47: 747–760, 1994.
Kasper J.D., Shapiro S., Guralnik J.M., Bandeen-Roche K., Fried L.P.: Designing a community study of moderately to severely disabled older women: The Women’s Health and Aging Study. Ann. Epidemiol. (in press), 1999.
Folstein M.F., Folstein S.E., McHugh P.R.: “Mini-Mental State”: A practical method for grading the cognitive state of patients for the clinician. J. Psychiatr. Res. 12: 189–198, 1975.
Fried L.P., Kasper J.D., Williamson J.D., Skinner E.A., Morris C.D., Hochberg M.C.: Disease ascertainment algorithms. In: Guralnik J.M., Fried L.P., Simonsick E.M., Kasper J.D., Lafferty M.E. (Eds.), The Women’s Health and Aging Study: Health and Social Characteristics of Older Women with Disability. National Institute on Aging, Bethesda, MD, 1995; NIH Pub. No. 95-4009. Full text available on WWW site: http://www.nih.gov/nia/edb/whasbook/title.htm
Altman R., Alarcon G., Appelrouth D., Bloch D., Borenstein D., Brandt K., Brown C., Cooke T.D., Daniel W., Gray R., Greenwald R., Hochberg M., Howell D., Ike R., Kapila P., Kaplan D., Koopman W., Longley S., McShane D.J., Medsger T., Michele B., Murphy W., Osial T., Ramsey-Goldman R., Rothschild B., Stark K., Wolfe F.: The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand. Arthritis Rheum. 33: 1601–1610, 1990.
Rantanen T., Guralnik J., Leveille S., Izmirlian G., Hirsch R., Simonsick E.M., Ling S., Fried L.P.: Racial differences in muscle strength in disabled older women. J. Gerontol. A. Biol. Med. Sci. 53: B355–361, 1998.
Desrosiers J., Bravo G., Hébert R., Dutil E.: Normative data for grip strength of elderly men and women. Am. J. Occup. Ther. 49: 637–644, 1995.
Hughes S.L., Gibbs J., Dunlop D., Singer R.: Predictors of hand function in older persons: A two-year longitudinal analysis. J. Am. Geriatr. Soc. 43: 122–129, 1995.
Bagge E., Bjelle A., Edén S., Svanborg A.: A longitudinal study of the occurrence of joint complaints in elderly people. Age Aging 21: 160–167, 1992.
Guralnik J.M., Fried L.P., Salive M.E.: Disability as a public health outcome in the aging population. Ann. Rev. Public Health 17: 25–46, 1996.
Slemenda C., Mazzuca S., Brandt K.D., Katz B.P.: Lower extremity strength, lean tissue mass and bone density in progression of knee osteoarthritis. Arthritis Rheum. 39(Suppl.): S169, 1996 (Abstract).
Slemenda C., Brandt K.D., Heilman D.K., Mazzuca S., Braunstein E.M., Katz B.P., Wolinsky F.D.: Quadriceps weakness and osteoarthritis of the knee. Ann. Intern. Med. 127: 97–104, 1997.
McAlindon T.E., Cooper C., Kirwan J.R., Dieppe P.A.: Determinants of disability in osteoarthritis of the knee. Ann. Rheum. Dis. 52: 258–262, 1993.
van Baar M.E., Dekker J., Lemmens J.A.M., Oostendorp R.A.B., Bijlsma J.W.J.: Pain and disability in patients with osteoarthritis of hip or knee: The relationship with articular, kinesiological, and psychological characteristics. J. Rheumatol. 25: 125–133, 1998.
Slemenda C., Mazzuca S., Brandt K.D., Katz B.P.: Lower extremity lean tissue mass and strength predict increases in pain and in functional impairment in knee osteoarthritis. Arthritis Rheum. 39(Suppl.): S212, 1996 (Abstract).
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Hirsch, R., Guralnik, J.M., Leveille, S.G. et al. Severity of hand osteoarthritis and its association with upper extremity impairment in a population of disabled older women: The Women’s Health and Aging Study. Aging Clin Exp Res 11, 253–261 (1999). https://doi.org/10.1007/BF03339666
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/BF03339666