Doyle Index is a valuable additional pain measure in osteoarthritis
ABSTRACT To determine reliability, feasibility, and validity of the Doyle Index (DI), a pain score proposed for osteoarthritis (OA).
The DI was performed in 260 patients with OA at multiple sites (mean age 64.9 years, 84% women) by grading pain (0-3) in 48 joints and joint groups by pressure or passive movement. Reliability and feasibility were determined in a random sample of 18 patients, by examining them twice using four raters. Intraclass correlation coefficients (ICCs) for intra- and interrater reliability were calculated, as well as the mean time to perform the DI. Validity was assessed in 260 patients, by correlating DI total scores and DI scores for the hand and knee/hip joints separately, to the pain and function subscales of the Australian/Canadian Osteoarthritis Hand Index (AUSCAN) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), using Spearman's rank coefficient (r).
In the total population the median (interquartile range) DI score was 11.0 (5.0-19.0). Intraobserver ICCs [95% confidence interval (CI)] ranged from 0.94 (0.84, 0.98) to 0.97 (0.93, 0.99). Interobserver ICC was 0.88 (0.77, 0.94). The mean time to perform the total DI was 5.1min (range 2.4-7.8). DI total scores as well as scores for the hand and knee/hip joints separately were related to AUSCAN (r range 0.61-0.65) and WOMAC (r range 0.43-0.51), although the level of correlation was moderate.
The DI is a reliable, easy to perform, and valid measure for OA pain during physical examination and therefore a promising additional outcome measure not only for OA research but also for clinical practice.
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ABSTRACT: To study the associations between structural abnormalities on ultrasound (US) or conventional x-rays (CR) and pain in hand osteoarthritis (HOA). In 55 consecutive patients with HOA (mean age 61 years, 86% women) fulfilling the American College of Rheumatology criteria, pain in 30 separate hand joints was assessed upon palpation; osteophytes were assessed by US and CR and joint space narrowing (JSN) by CR. Associations between structural abnormalities and pain per joint were analysed using generalised estimated equations to account for patient effects and adjusted for age, sex, body mass index, US inflammatory features and other remaining structural abnormalities. In 1649 joints, 69% and 46% had osteophytes on US and CR, respectively and 47% had JSN. Osteophytes and JSN showed independent associations with pain per joint adjusted: OR for osteophytes: 4.8 (95% CI 3.1 to 7.5) for US and 4.1 (95% CI 2.4 to 7.1) for CR; for JSN: 4.2 (95% CI 2.0 to 9.0). Osteophytes and JSN are independently associated with pain in individual HOA joints, taking into account patient effects.Annals of the rheumatic diseases 07/2011; 70(10):1835-7. DOI:10.1136/ard.2010.147553 · 10.38 Impact Factor
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ABSTRACT: To investigate the factors associated with clinical progression and good prognosis in patients with lower limb osteoarthritis (OA). Cohort study of 145 patients with OA in either knee, hip or both. Progression was defined as 1) new joint prosthesis or 2) increase in WOMAC pain or function score during 6-years follow-up above pre-defined thresholds. Patients without progression with decrease in WOMAC pain or function score lower than pre-defined thresholds were categorized as good prognosis. Relative risks (RRs) for progression and good prognosis with 95% confidence interval (95% CI) were calculated by comparing the highest tertile or category to the lowest tertile, for baseline determinants (age, sex, BMI, WOMAC pain and function scores, pain on physical examination, total range of motion (tROM), osteophytes and joint space narrowing (JSN) scores), and for worsening in WOMAC pain and function score in 1-year. Adjustments were performed for age, sex, and BMI. Follow-up was completed by 117 patients (81%, median age 60 years, 84% female); 62 (53%) and 31 patients (26%) showed progression and good prognosis, respectively. These following determinants were associated with progression: pain on physical examination (RR 1.2 (1.0 to 1.5)); tROM (1.4 (1.1 to 1.6); worsening in WOMAC pain (1.9 (1.2 to 2.3)); worsening in WOMAC function (2.4 (1.7 to 2.6)); osteophytes 1.5 (1.0 to 1.8); and JSN scores (2.3 (1.5 to 2.7)). Worsening in WOMAC pain (0.1 (0.1 to 0.8)) and function score (0.1 (0.1 to 0.7)), were negatively associated with good prognosis. Worsening of self-reported pain and function in one year, limited tROM and higher osteophytes and JSN scores were associated with clinical progression. Worsening in WOMAC pain and function score in 1- year were associated with lower risk to have good prognosis. These findings help to inform patients with regard to their OA prognosis.PLoS ONE 10/2011; 6(10):e25426. DOI:10.1371/journal.pone.0025426 · 3.23 Impact Factor
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ABSTRACT: OBJECTIVE: To compare inflammation as assessed by ultrasound between patients with the subset erosive hand osteoarthritis (EOA) versus non-EOA. METHODS: Consecutive hand osteoarthritis (HOA) patients (fulfilling ACR criteria) were included. Eighteen interphalangeal joints were scored on radiographs using the Verbruggen-Veys anatomical phase score; E and R phases were defined as erosive. Patients were assigned to EOA when at least one joint was erosive. Effusion, synovial thickening and power Doppler signal (PDS) were scored with ultrasound on a 4-point scale. Generalised estimated equation analyses were used to compare ultrasound features between EOA and HOA, and to associate ultrasound features with.anatomical phases; OR with 95% CI were calculated with adjustments for patient effects and confounders. RESULTS: Of 55 HOA patients (mean age 61 years, 86% women) 51% had EOA. In 94 erosive joints, synovial thickening, effusion and PDS were found in 13%, 50% and 15%, respectively; in 896 non-erosive joints in 10%, 26% and 8%, respectively. In summated scores of PDS, effusion was higher in EOA than in non-EOA. Effusion and synovial thickening were more frequent in S, J, E and R phases compared to N phase. PDS was only associated with E phase (OR 5.3, 95% CI 1.3 to 20.5) not with other phases. Non-erosive joints in EOA demonstrated more PDS (OR 3.2, 95% CI 1.6 to 6.4) and effusion (OR 2.2, 95% CI 1.2 to 3.8) in comparison to joints in non-EOA. CONCLUSIONS: Inflammatory signs are more frequent in EOA than in non-EOA, not only in erosive joints but also in non-erosive joints, suggesting an underlying systemic cause for erosive evolution.Annals of the rheumatic diseases 07/2012; 72(6). DOI:10.1136/annrheumdis-2012-201458 · 10.38 Impact Factor