E044 Long-term hand pain outcomes in hand osteoarthritis and their determinants in the Chingford 1000 Women Study

Abstract Background/Aims Hand pain and hand osteoarthritis are common, particularly among peri-/post-menopausal women. Despite this, there are few studies on long-term outcomes and their determinants in this population. We examined associations between demographic and clinical factors including female reproductive and hormonal exposures on hand pain in women over 20 years. Methods The “Chingford 1000 Women Study” is a community-based cohort of females aged 45-64 years representing a high-risk population for painful hand osteoarthritis. Participants were recruited from general practice and followed for over 20 years. Those with other painful hand conditions (e.g. inflammatory arthritis) were excluded. Baseline variables analysed included age, BMI, hand joint bony swelling (binary), hand radiographic osteoarthritis (ROA, binary), previous hysterectomy, bilateral oophorectomy and (in post-menopausal females) use/duration of hormone replacement therapy (HRT). ‘Symptomatic established hand osteoarthritis’ (seHOA) was defined as hand pain plus bony swelling and/or ROA ≥2 hand joints. Our outcomes included presence/absence of hand pain in either hand at i) Year 10 and ii) Year 20 respectively (binary), and iii) number of visits at which hand pain was reported in ‘complete cases’ (with Years-3,5,10,15&20 data). Associations between exposures and outcomes were assessed fitting a logistic regression adjusting for age+BMI alone or in a multivariable model, using STATA IC 18.0. Results Of 834 eligible participants, 249 (30%) reported hand pain at baseline, of whom 174 (70%) had seHOA. By Year 20, cohort retention was 435 (52%), of whom 367 (84%) provided hand pain information at all necessary visits for the complete case analysis. At Years 10 and 20 respectively, prevalence of hand pain was 85 (13%) and 74 (17%), representing 32 (25%) and 19 (25%) of those with seHOA at baseline. Persistent hand pain (at all visits after pain initially reported) was infrequent: 18 (5%) of all complete cases and 6 (10%) of those with baseline seHOA. Baseline hand joint bony swelling and/or ROA were associated with future reporting of hand pain (at both Years 10 and 20) in those with baseline hand pain. In the absence of baseline pain, there were no such associations. In age+BMI-adjusted models, bilateral oophorectomy and prior HRT use (≥2 years) were each associated with hand pain at Year-10: relative risk (RR) 2.5(95% CI: 1.5,4.3) and 2.1(95% CI: 1.2,3.7) respectively. Only the association of bilateral oophorectomy with hand pain persisted in the multivariable model. In age+BMI-adjusted models, hysterectomy, bilateral oophorectomy and baseline HRT use were all associated with greater odds of more visits with reported hand pain. Conclusion We describe long-term outcomes for females experiencing hand pain and osteoarthritis. They add to evidence that bilateral oophorectomy and hysterectomy, themselves associated with either abrupt loss of oestrogen/other sex hormones and/or their dysregulation, appear to be important risk factors for long-term hand pain. Disclosure M. Gulati: Grants/research support; M.G. has a Clinical Research Fellowship from Versus Arthritis [Grant number 21604]. M.G. is in receipt of a Clarendon Scholarship [Oxford University Press]. T.A. Perry: None. D.J. Hart: None. T.D. Spector: None. M. Schlussel: None. G.S. Collins: None. K. Vincent: Consultancies; K.V. has had consultancy fees paid to her institution from Gedeon Richter, Reckitts, AbbVie, Bayer Healthcare and Gesynta. Honoraria; K.V. has received honoraria for lectures. T.L. Vincent: Consultancies; T.V. is a current advisory board member for Zoetis. Grants/research support; T.V. has received research funding in the past 5 years from Pfizer, UCB, Novartis, Fidia, Biosplice. N.K. Arden: None. A. Silman: None. F.E. Watt: Consultancies; F.W. has received consultancy fees from Pfizer in the past 5 years. Grants/research support; F.W has a fellowship from UK Research & Innovation (UKRI) [Grant numbers MR/S016538/1, MR/S016538/2 and MR/Y003470/1).