Thumb carpometacarpal (CMC) osteoarthritis (OA) is a widespread, disabling disease that is far more prevalent in woman than men. The disease affects 15% of adults over age 30, and two-thirds of women over the age of 55. While the pathophysiology of osteoarthritis is considered to be multifactorial, abnormal joint kinematics and altered cartilage contact are believed to trigger and sustain the disease via the production of non-physiologic contact stresses, which in turn lead to chondrocyte derangement, necrosis, and cartilage degradation. However, at this point there is only limited data on thumb CMC joint biomechanics in normal or OA-affected individuals, and there are no longitudinal studies of joint biomechanics as the disease progresses. Accordingly, the broader, long-term objective of this study is to explore the role of biomechanics and morphology in basilar thumb joint osteoarthritis in an effort to identify biomechanical markers for the initiation and progression of the disease that will ultimately improve prognosis and treatment. The specific objective of the work outlined in this application is to follow disease progression longitudinally in a existing cohort of thumb CMC OA patients, acquiring biomechanical, radiographic, and clinical data at 4.5- and 6-year follow-ups using our innovative techniques, as a follow-on to data collected at baseline (0 yr), 1.5 and 3 years, during the previous funding cycle. Evaluation of the role of biomechanics and morphology in basilar thumb joint osteoarthritis will be accomplished via two specific aims.
Aim 1 will evaluate joint instability as a potential marker for thumb CMC OA progression in an existing cohort of women and men who presented with early stage CMC OA (pain but no gross radiographic changes).
Aim 2 will determine if the rate of thumb CMC OA progression in women is greater than in men, and if any differential rate of disease progression is associated with corresponding differences in joint instability and bone shape changes.
Both aims will be evaluated via long-term follow-up of 85 early OA patients. Innovative biomechanical markers and standardized clinical outcome measures will be used to address the hypotheses outlined in each aim. At each follow-up visit (years 4.5 and 6) CMC joint motion (arthrokinematics) and instability during three high-demand tasks will be assessed with our state-of-art computed tomography-based markerless bone registration techniques. Wrist/hand-directed histories and physical exams will also be obtained, as will quantitative assessments of thumb range of motion and strength, three sets of standardized patient-reported functional assessments, and plain radiographs, using the same protocols and survey instruments used during the previous funding cycle. The significance of this proposal is the long-term longitudinal study and the identification of biomechanical markers for CMC OA progression. This information is crucial for future basic and clinical research studies and for the rational design of innovative new strategies for prevention and treatment.

Public Health Relevance

Osteoarthritis in the joint at the base of the thumb is an extremely common disease of aging, especially in women. At present the cause is not well understood, but differences in joint stability and shape of the joint are strongly implicated by previous studies. This study is designed to evaluate the role of biomechanics in basilar thumb joint osteoarthritis, in an effort to find measurements that can predict how severely thumb osteoarthritis will progress in each patient. These findings will ultimately improve prognosis and treatment of thumb osteoarthritis.

Agency
National Institute of Health (NIH)
Institute
National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS)
Type
Research Project (R01)
Project #
5R01AR059185-08
Application #
9546505
Study Section
Special Emphasis Panel (ZRG1)
Program Officer
Zheng, Xincheng
Project Start
2011-07-15
Project End
2021-08-31
Budget Start
2018-09-01
Budget End
2019-08-31
Support Year
8
Fiscal Year
2018
Total Cost
Indirect Cost
Name
Rhode Island Hospital
Department
Type
DUNS #
075710996
City
Providence
State
RI
Country
United States
Zip Code
02903
Coughlan, Monica J; Bourdillon, Alexandra; Crisco, Joseph J et al. (2017) Reduction in Cylindrical Grasp Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clin Orthop Relat Res 475:522-528
McQuillan, Thomas J; Kenney, Deborah; Crisco, Joseph J et al. (2016) Weaker Functional Pinch Strength Is Associated With Early Thumb Carpometacarpal Osteoarthritis. Clin Orthop Relat Res 474:557-61
Halilaj, Eni; Rainbow, Michael J; Moore, Douglas C et al. (2015) In vivo recruitment patterns in the anterior oblique and dorsoradial ligaments of the first carpometacarpal joint. J Biomech 48:1893-8
Halilaj, Eni; Moore, Douglas C; Patel, Tarpit K et al. (2015) Early osteoarthritis of the trapeziometacarpal joint is not associated with joint instability during typical isometric loading. J Orthop Res 33:1639-45
Guang, Stephanie; Crisco, Trey (2015) Radiographic Evaluation of the Carpometacarpal Joint in Early Stage Osteoarthritis Severity and Joint Laxity. R I Med J (2013) 98:23-4
Schneider, M T Y; Zhang, J; Crisco, J J et al. (2015) Men and women have similarly shaped carpometacarpal joint bones. J Biomech 48:3420-6
Halilaj, Eni; Moore, Douglas C; Patel, Tarpit K et al. (2015) Older asymptomatic women exhibit patterns of thumb carpometacarpal joint space narrowing that precede changes associated with early osteoarthritis. J Biomech 48:3643-9
Crisco, Joseph J; Halilaj, Eni; Moore, Douglas C et al. (2015) In Vivo kinematics of the trapeziometacarpal joint during thumb extension-flexion and abduction-adduction. J Hand Surg Am 40:289-96
Crisco, Joseph J; Patel, Tarpit; Halilaj, Eni et al. (2015) The Envelope of Physiological Motion of the First Carpometacarpal Joint. J Biomech Eng 137:101002
Ladd, Amy L; Messana, Joseph M; Berger, Aaron J et al. (2015) Correlation of clinical disease severity to radiographic thumb osteoarthritis index. J Hand Surg Am 40:474-82

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