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Logo of bmcmudisBioMed Centralsearchsubmit a manuscriptregisterthis articleBMC Musculoskeletal Disorders
BMC Musculoskelet Disord. 2012; 13: 20.
Published online Feb 16, 2012. doi:  10.1186/1471-2474-13-20
PMCID: PMC3293753
The use of digital photographs for the diagnosis of hand osteoarthritis: the AGES-Reykjavik study
Helgi Jonsson,corresponding author1 Gudrun P Helgadottir,2 Thor Aspelund,3 Johanna E Sverrisdottir,4 Gudny Eiriksdottir,4 Sigurdur Sigurdsson,4 Gudmundur J Eliasson,5 Asbjorn Jonsson,1 Thorvaldur Ingvarsson,6 Tamara B Harris,7 Lenore Launer,7 and Vilmundur Gudnason3
1Landspitalinn University Hospital, University of Iceland, IS-108 Fossvogur, Reykjavik, ICELAND
2University of Iceland, Reykjavik, ICELAND
3Icelandic Heart Association, University of Iceland, Reykjavik, ICELAND
4Icelandic Heart Association, Kopavogur, ICELAND
5Roentgen Domus Medica, Reykjavik, ICELAND
6Akureyri Central Hospital, Akureyri, ICELAND
7National Institute on Aging, Bethesda, MD, USA
corresponding authorCorresponding author.
Helgi Jonsson: helgi/at/; Gudrun P Helgadottir: ghelgadottir/at/; Thor Aspelund: aspelund/at/; Johanna E Sverrisdottir: johanna/at/; Gudny Eiriksdottir: gudny/at/; Sigurdur Sigurdsson: sigurdur/at/; Gudmundur J Eliasson: gje/at/; Asbjorn Jonsson: asjon/at/; Thorvaldur Ingvarsson: thi/at/; Tamara B Harris: harris99/at/; Lenore Launer: LaunerL/at/; Vilmundur Gudnason: v.gudnason/at/
Received October 14, 2011; Accepted February 16, 2012.
The objective of the study was to standardize a method using digital photographs to diagnose and grade hand osteoarthritis (HOA), to compare it with radiographs and clinical examination with regard to prevalence and relation to symptoms, and finally to construct a simple shortened version suitable for use in very large studies, where a global estimate may be preferable.
High quality photographs with standard distance and hand positioning were analysed for the presence of HOA and subsequently compared with standard radiographs and clinical examination in 381 random participants in the AGES-Reykjavik Study, a large population study. The mean age of the participants was 76 years.
Using the photographic method, the most commonly affected joints were the second DIP joints followed by the third DIP joints and second and third PIP joints. Both interobserver (ICC = 0.83) and intraobserver reading agreements (ICC = 0.89) were acceptable. On comparison with radiography and clinical examination, aggregate scores were significantly correlated (Rs 0.35-0.69), more so in females (Rs 0.53-0.72) than males. Hand pain in males showed very little association with HOA findings by the three methods but all methods showed a comparable moderate association with hand pain in females. The performance of photography in predicting pain on most days for at least a month in females was comparable to that of radiography and clinical examination (AUC 0.63 p = 0.004). Analysis of intermittent pain yielded similar results for in the DIP and PIP joints (OR 3.2-3.3, p < 0.01), but for the CMC1 joints, both radiography (OR 9.0, p < 0.0001), and clinical examination (OR 9.8, p < 0.0001), had higher predictive odds ratios for pain than photography (OR 3.6, p < 0.0001)., A shortened, rapidly performed form of reading photographs also showed a high degree of correlation with the other methods (Rs 0.56-0.82).
High quality hand photographs can be used to diagnose and grade hand osteoarthritis. The method has the advantage of being inexpensive and easy to perform. By using a slightly simplified method of reading, it appears to be highly suitable for use in large studies.
Keywords: Hand ostearthritis, Generalized osteoarthritis, Epidemiology, Imaging, Photography
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