High Frequency of Osteophytes Detected by High-Resolution Ultrasound at the Finger Joints of Asymptomatic Factory Workers

Round 1

Reviewer 1 Report (Previous Reviewer 3)

Thanks for revising the manuscript according to the previous comments.

The grammar in the manuscript needs minor tweaking to ensure the text is correctly interpreted by the reader.

Author Response

Dear colleague, thank you for the reviews

                In order to make the text easier to understand, the formal text has been completely rewritten. Please find the revision with the marked changes at the end

Author Response File: Author Response.pdf

Reviewer 2 Report (Previous Reviewer 2)

In the cross-sectional study, the authors described the prevalence of hand osteoarthritis by estimating osteophytes using ultrasound imaging methods. The analysis is predominantly descriptive, and the writing of the manuscript has much room for improvement.

Major comments:

I find that the inconsistent use of abbreviations is a major hindrance to the comprehension of the manuscript. Please kindly define the abbreviations at first use.

What is the diagnostic accuracy of the ultrasound device used versus conventional radiography? If the authors have the relevant information, please add it to the method.

Did the authors perform a priori sample calculation to determine the optimal number of subjects?

The clinical data for the subjects were not well elaborated. I am not sure to what extent the relevant confounding factors, such as family history, BMI, previous trauma to the joints etc affect the prevalence of hand osteoarthritis. The authors only acknowledge the lack of workload data in the limitation paragraph.

Minor comments:

Please rephrase and define the population of interest clearly. At this moment, the authors mentioned: … HOA in a population-based cross-sectional study in a population working in the industry without known HOA diagnosis. What is population working in the industry? What industry are we talking about?

Page 4 line 8 and 9 are a paragraph of a single line. Please merge it with the previous paragraph.

Please be consistent with the labelling of Figures and Tables. Please refer to the instructions for authors.

For most of the Figures and Tables, the authors indicated that they are from the thesis of Giulini, M (2022). I am not sure that is necessary. If the thesis is published, please consult with the publishers on the permission to reuse the materials.

For Figure 4a-c, I am not sure how the cutoffs for age per gender (>50 years) and overall (>30 years) were decided. Also for proportion, what is the unit? I do believe that a pie chart will be a more suitable chart type.

The start of the discussion talks about hand grip strength, which is a simple parameter the author did not measure.

In the limitation, the authors mentioned the predominance of osteophytes at the right hand, but the implications were not elaborated clearly.

 

 

Please make sure the manuscript is properly proofread before resubmission.

Author Response

Dear colleague,

thank you for the extended review, which helped a lot to improve the work.

 

In the cross-sectional study, the authors described the prevalence of hand osteoarthritis by estimating osteophytes using ultrasound imaging methods. The analysis is predominantly descriptive, and the writing of the manuscript has much room for improvement.

In order to make the text easier to understand, the formal text has been completely rewritten. Please find the revision with the marked changes at the end

Major comments:

I find that the inconsistent use of abbreviations is a major hindrance to the comprehension of the manuscript. Please kindly define the abbreviations at first use.

Thank you for the support. Some uncommon (e.g. CR) and ambiguous (US) abbreviations have been replaced with full text.

What is the diagnostic accuracy of the ultrasound device used versus conventional radiography? If the authors have the relevant information, please add it to the method.

Thank you for that reolevant aspect. Mathiessen et al performed an ultrasonographic assessment of osteophytes in 127 patients with hand osteoarthritis: exploring reliability and associations with MRI, radiographs and  clinical joint findings (Ann Rheum Dis. 2013;72(1):51-56) demonstrating osteophytes, that are not detected in radiographs at baseline but evident in X-ray after 5 years.  He used US with a maximal frequency of 13 MHz, we used 18MHz with an even higher resolution. But the comparator X-ray has changed, too. From standard films to digital imaging. Thus, it is therefore not trivial to compare accuracy.

Did the authors perform a priori sample calculation to determine the optimal number of subjects?

The study was planned as an initiation for high resolution ultrasound screening for osteophytes. In anticipation of the prevalence of osteophytes based on epidemiological data in the population studied, assuming a normal age and sex distribution and an even distribution of workload, a test size of 100 subjects was considered sufficient. This was exceeded by far.

The clinical data for the subjects were not well elaborated. I am not sure to what extent the relevant confounding factors, such as family history, BMI, previous trauma to the joints etc affect the prevalence of hand osteoarthritis. The authors only acknowledge the lack of workload data in the limitation paragraph.

It would be good to have more clinical data like family history, weight, OA at other joints, trauma, cumulative lifetime working load. The design of the study, a screening examination of asymptomatic working people in their workplace, had to refrain from querying and recording medical diagnoses - for reasons of protection of medical data of the participants. Possible solutions for future studies were named. This aspect was added to the introduction and methods.

Minor comments:

 

Please rephrase and define the population of interest clearly. At this moment, the authors mentioned: … HOA in a population-based cross-sectional study in a population working in the industry without known HOA diagnosis. What is population working in the industry? What industry are we talking about?

This aspect was added to the introduction and methods in more detail, thank you. The industrial company asked not to be named.

Page 4 line 8 and 9 are a paragraph of a single line. Please merge it with the previous paragraph.

I don’t understand or find that comment (different lining in our versions?)

Please be consistent with the labelling of Figures and Tables. Please refer to the instructions for authors.

The labeling is consistent

For most of the Figures and Tables, the authors indicated that they are from the thesis of Giulini, M (2022). I am not sure that is necessary. If the thesis is published, please consult with the publishers on the permission to reuse the materials.

The indication at the figures has been removed, the thesis is named at the end

For Figure 4a-c, I am not sure how the cutoffs for age per gender (>50 years) and overall (>30 years) were decided. Also for proportion, what is the unit? I do believe that a pie chart will be a more suitable chart type.

The cut-offs are chosen by the cut-offs of a work on hand pain of workers (from U. Steinberg, S. Behrendt, G. Caffier, K. Schultz, M. Jakob Leitmerkmalmethode Manuelle Arbeitsprozesse Bundesanstalt für Arbeitsschutz und Arbeitsmedizin 2007; ISBN 978-3-88261-073-4).

The pie-chart would allow the presentation for every single group. Thus figures 4 a) and b) would be each 5 pies, 4c9 could not be transfered. We think a consisstent design is easier to understand.

The start of the discussion talks about hand grip strength, which is a simple parameter the author did not measure.

The trials giving evidence of grip strength as an independent predictor for survival have been published after our data sampling, thus we were not able to include that important measure. Newer cohorts like the NAKO have included grip strength. Nevertheless it shows the general importance of hands.

In the limitation, the authors mentioned the predominance of osteophytes at the right hand, but the implications were not elaborated clearly.

The explenation has been clarified. „Assuming a right handed majority in our cohort and a greater workload of the dominant hand, the higher prevalence of osteophytes on the right hand still suggests a role for mechanical factors.“

Author Response File: Author Response.pdf

Round 2

Reviewer 2 Report (Previous Reviewer 2)

The authors have addressed my comments sufficiently.

The language has improved significantly.

This manuscript is a resubmission of an earlier submission. The following is a list of the peer review reports and author responses from that submission.

Round 1

Reviewer 1 Report

Very ambitious study to include 11, 840 US images from over 427 subjects! very nice study. Minor suggestions line 58 misspelled word 'tenovaginitis" for tenosynovitis I hope!Line 76 describe the transducer size.  Line 80 add reference for this software if possible analyzing US images. Label on Table 1 does (and > grade 1 mean grade 2 or 3 or really >or equal to grade 1.Line 129 could authors make a comment as to the approximant number or % of clerical vs laborers as that information would be most helpful in understanding to very high prevalence of grade 1 osteophytes detected. line 194 was the presence of large osteophytes as only 5.2% sen equally in men vs women as most studies suggest presence of HOA higher in women.

Reviewer 2 Report

The authors investigated the prevalence of hand osteoarthritis using high-resolution ultrasound among factory workers. They found at least one osteophyte in 41.3% of the joints studied. The distribution of osteophytes according to joints and age is also studied.

My major comment on this study is that many important confounding factors are not collected in the study, such as nature of work, years of working, workload, history of OA, sex, menopausal status etc. These factors could influence the distribution of OA significantly.

It is not sure who scored the ultrasound images and whether qualified experts validate the findings. The authors cited Keen et al., Kortekaas et al., Mathiessen et al. for the scoring system but I think 1 reference will do.

Minor comments

Please do not start the sentence with a numerical number.

 

In the limitation paragraph, what do the authors mean by bias by indication?

Minor grammatical check will be needed.

Reviewer 3 Report

The study titled "High frequency of osteophytes detected by high resolution ultrasound at the finger joints of asymptomatic factory workers" is an interesting attempt to screen a cross-sectional sample of workers for osteophytes. Unfortunately, the study's results are descriptive in nature and do not have any scientific or clinical significance in the field of osteoarthritis. The US findings in no way indicate the presence of HOA nor can they be used to predict the risk of HOA without additional data. I strongly advice the authors to revise their objective and results that align with their research methods and data.

Grammatical errors are present throughout the manuscript and need a thorough review