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2023 EULAR classification criteria for hand osteoarthritis

A EULAR consensus group has established classification criteria for overall hand osteoarthritis (OA) and its subtypes (interphalangeal OA and thumb base OA).

The criteria require two mandatory criteria to be met:

  1. must have symptoms (pain, aching and/or stiffness) in at least one target joint on most days of the previous 6 weeks.

  2. joint symptoms are not be better explained by other injury or disease, crystal arthropathies, non-inflammatory hand conditions or systemic inflammatory joint diseases. (Authors caution about inclusion of psoriasis patients, given the difficulty distinguishing hand OA from Psoriatic arthritis).

A point-based classification system is based on age, duration of morning stiffness, number of joints with osteophytes and joint space narrowing, and concordance between symptoms and radiographic findings. To be classified (diagnosed) the following cut-offs were proposed: 

  • Overall hand OA - 9 or more points on a 0–15 scale

  • Interphalangeal OA and thumb base OA -  8 points

These new classification criteria allow for the inclusion of more homogenous patient populations in research studies and clinical trials for overall hand OA.

REQUIRED: Target population (mandatory criteria): persons with pain, aching and/or stiffness in at least one target joint (bilateral second–fifth DIPs, second-fifth PIPs, IP1 and thumb base joints) on most days of the previous 6 weeks, and no other disease or acute injury that can explain the symptoms.

Classification criteria points (range: 0-15)

  • Age: <45 years=0;  45–54 years=1;  55–64 years=2;  65 years and above=3
  • Morning stiffness (DIPs, PIPs, IP1, CMC1) : 30 min or less=2;  none=1;  more than 30 min=0
  • Number of joints (DIPs, PIPs, IP1, CMC1) with osteophytes: None=0; 1–2 joint(s)=2; 3–5 joints=3; 6 or more=4
  • Number of joints (DIPs, PIPs, IP1, CMC1) with Joint space narrowing: None=0; 1–2 joint(s)=1; 3–5 Jts=2; 6 or more=3
  • Symptom-structure concordance*: No=0;  Yes=3

*Radiographic OA (osteophytes or JSN) in at least 50% of the joints (DIPs, PIPs, IP1 and CMC1), in which the person has experienced pain, aching and/or stiffness on most days of the previous 6 weeks.


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The author has no conflicts of interest to disclose related to this subject