Project title: The Development of a Risk Prediction Model for Hand Osteoarthritis

Grant Holder: Karishma Shah

Position: Clinical Research Fellow in Hand Surgery & DPhil (PhD) student

Summary of project/progress /findings (approx 300 words)

I have completed two systematic reviews for the development and progression of finger interphalangeal joint (IPJ) osteoarthritis (OA). These have both been registered on PROSPERO: PROSPERO 2019 CRD42019121034 and PROSPERO 2019 CRD42019116782.

I have undertaken two Delphi studies, recruiting Delphi panels through the BSSH registry of Full Members, to identify which risk factors Consultant Hand Surgeons think are important for the development and progression of finger IPJ OA. The potential risk factors were taken from the Chingford 1000 Women Study, which I have gained access to through my DPhil at the University of Oxford. The results of the Delphis have been published as a Short Report in the Journal of Hand Surgery (European): https://www.ncbi.nlm.nih.gov/pubmed/31364478.

I have compared the results of the systematic reviews and the Delphis. This has shown that hand surgeons are able to identify important risk factors, but that risk factors established in the literature are not fully appreciated within the hand surgery community. I presented these results as a Podium (oral) presentation at the NIHR CRN Wessex, Thames Valley and South Midlands Meeting in Oxford, June 2019, and as a Poster presentation at the Osteoarthritis Cutting Edge meeting in Oxford, June 2019.

I have completed the project analysing the relationship between hand injury and hand OA in cricketers. The results showed that the odds of hand pain and hand OA are increased in cricketers with a history of hand injury. I presented the results as a Podium presentation at the OARSI World Congress in Toronto, May 2019, and as a Poster presentation at the IFSSH Triennial Congress in Berlin, June 2019.

Whilst attending and presenting at the OARSI and IFSSH conferences, I was able to establish collaborations with teams in North Carolina and in Rotterdam, studying hand OA. We are planning to work collaboratively to pool our international datasets, to better understand risk factors for hand OA development and progression.

What is the relevance/value of this research to hand surgery:

OA is one of the largest health-care burdens worldwide, leading to morbidity and high costs for disease management and due to loss of work. Radiographic hand OA is one of the most common types of OA, occurring most frequently in women, and in younger age groups than other types of OA.

The systematic reviews have shown there are risk factors for IPJ OA development and progression identified in the literature. However, most studies do not appreciate the relationship between different risk factors, and the overall effect multiple risk factors have on a patient’s chance of developing OA, and of OA progressing. Similarly, an awareness and understanding of these risk factors is not well established within the hand surgery community, as shown in the Delphi studies.

The study on cricketers found that injury is a risk factor for hand OA and pain in the future. This is similar to findings in the lower limb. It highlights the need for hand injury prevention strategies, particularly in sport.

If we are able to better understand why some people develop OA, and why only specific people with OA have progressive disease, we will be able to identify these people in the community. This provides an opportunity to prevent or delay the disease. It will also lead to more efficient referrals of patients to secondary and tertiary care, an aim of the GIRFT study. It will also enable us to more appropriately investigate patients, a priority of the Commission on the Future of Surgery.

Please list presentations based on work performed in this study

Podium (Oral) presentations:

Risk factors for the Development and Progression of Finger Interphalangeal Joint Osteoarthritis: Systematic Reviews and Delphi Studies. NIHR CRN Wessex, Thames Valley and South Midlands Meeting. Oxford, June 2019

The Odds of Hand pain and Osteoarthritis in Individuals with a History of Cricket-related Hand Injury.  OARSI World Congress. Toronto, May 2019

Poster presentations:

Shah K, Cai H, Yang X, Lane J, van Santen J, Collins GS, Filbay S, Arden NK, Furniss D. Risk Factors for the Development and Progression of Finger Interphalangeal Joint Osteoarthritis: Systematic Reviews and Delphi Studies. Osteoarthritis Cutting Edge meeting. Oxford, June 2019

Shah K, Furniss D, Peirce N, Arden N, Filbay S. Is hand dominance and a history of hand injury associated with a higher prevalence of hand pain and osteoarthritis in cricketers? IFSSH Triennial Congress. Berlin, June 2019

Please state what additional research this study has/is leading to

The studies have highlighted the need to better understand the natural history of hand OA. Recently, IPJ and base of thumb OA have come to be recognised as different diseases, and OA in one joint as independent to OA in another joint. I plan to undertake a study to describe the prevalence, incidence and progression of IPJ OA in the Chingford 1000 Women Study. The Chingford 1000 Women Study has been shown to be presentative of the female UK population.

The systematic reviews and Delphi studies have concluded there is a lack of translation data from the literature to the clinical setting. It has also highlighted the need to understand the relationship between risk factors, as would naturally occur in a patient. I therefore plan to develop risk prediction models for the development and progression of IPJ OA, using the Chingford 1000 Women Study. This will statistically identify risk factors for IPJ OA, and will quantitatively analyse the relationship between different risk factors.

Please list any further funding or grant applications (with outcome), which have resulted from the award of this grant

• University of Oxford: Medical Sciences Divisional Scholarship- for DPhil (PhD) tuition fees for 3 years: approx. £72,000
• University of Southampton: Medical School bursary- to attend OARSI World Congress: £125
• Lady Margaret Hall, University of Oxford: Glasgow Fund- to attend OARSI World Congress: £300
• University of Oxford: Santander Travel Award- to attend IFSSH Triennial Congress: £1,000

How has this grant awards helped your career development?

• Started a DPhil (PhD) in Musculoskeletal Sciences, at the University of Oxford.
• Attended the OARSI World Congress 2019, allowing me to network with physicians, surgeons, allied health professionals and epidemiologists. This has led me to set up international collaborations