Prevalence of symptomatic knee, hand, and hip osteoarthritis in Greece. The ESORDIG study

OBJECTIVE: To assess the prevalence of symptomatic knee, hand, and hip osteoarthritis (OA) in the general adult population of Greece. METHODS: This cross-sectional population based study was conducted on the total adult population of 7 communities (8547 subjects) and on 2100 out of 5686 randomly selected subjects in an additional 2 communities. Sixteen rheumatologists visited the target population at their homes; an interview based on a standardized questionnaire was conducted and clinical evaluation and laboratory investigations were done, when necessary. ACR classification criteria were used for diagnosing symptomatic OA. RESULTS: Of the final target population of 10,647 subjects, 8740 (82.1%) participated in the study. The age and sex adjusted prevalence of symptomatic knee, hand, and hip OA was 6.0% (95% CI 5.6-6.4), 2% (1.8-2.2), and 0.9% (0.7-1.1), respectively. Symptomatic knee, hand, and hip OA prevalence was significantly higher among women than men and increased significantly with age. Symptomatic knee OA was significantly more common in the rural compared to urban and suburban populations. Logistic regression analysis showed a significant association of female sex and age > or = 50 years with all sites of OA, of obesity with knee and hip OA, and of a low level of education with knee OA. CONCLUSION: Symptomatic knee, hand, and hip OA is common in the general adult population of Greece, showing a female preponderance and a prevalence increasing with age. Female sex and age are risk factors for all sites of OA, obesity for knee and hip OA, and a low level of education for knee OA.     

Involvement of different risk factors in clinically severe large joint osteoarthritis according to the presence of hand interphalangeal nodes

Objective

To quantify the differences in risk factors influencing total hip replacement (THR) and total knee replacement (TKR) based on the presence versus absence of multiple interphalangeal nodes in 2 or more rays of the fingers of each hand in patients with large joint osteoarthritis (OA).

Methods

A group of 3,800 patients with large joint OA who underwent total joint replacement (1,201 of whom had the nodal phenotype) and 1,906 control subjects from 2 case–control studies and a population‐based cohort in the UK were studied. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated for the risk of total joint replacement in association with age, sex, body mass index (BMI), height, and prevalence of the T allele in the GDF5 rs143383 polymorphism. ORs for total joint replacement were compared between cases of nodal OA and cases of non‐nodal OA and between patients who underwent TKR and those who underwent THR.

Results

Age, sex, and BMI had significantly higher ORs for an association with total joint replacement in nodal OA cases than in non‐nodal OA cases. The GDF5 polymorphism was significantly associated with THR in cases of nodal OA, but not in cases of non‐nodal OA, and increased height was a risk factor for THR in non‐nodal OA cases only. Female sex was a protective risk factor for TKR in non‐nodal OA cases (OR 0.60, 95% CI 0.52–0.70) but was predisposing for TKR in the nodal form of OA (OR 1.83, 95% CI 1.49–2.26). The nodal phenotype was associated with a significantly higher risk of undergoing both THR and TKR (OR 1.46, 95% CI 1.09–1.94) and also a significantly higher risk of bilateral TKR (OR 1.70, 95% CI 1.37–2.11), but, paradoxically, was associated with a lower risk of bilateral THR (OR 0.72, 95% CI 0.56–0.91).

Conclusion

Nodal and non‐nodal forms of large joint OA have significantly different risk factors and outcomes, indicating a different etiology for the 2 forms of OA. With regard to the likelihood of undergoing THR, this appears to be, at least in part, genetically determined.

     

Comparison of the prevalence of radiographic osteoarthritis of the knee and hand between Japan and the United States

OBJECTIVE: There is no direct international comparison of the prevalence of osteoarthritis (OA) between Japanese and Caucasians. We compared the prevalence of radiographic knee and hand OA between women in Hizen-Oshima, Japan, and in Framingham, Massachusetts, USA. METHODS: A population based cross sectional study among 358 women in Japan and 815 women in the USA aged 63 years or older for knee joints, and 157 women in Japan and 655 women in the USA aged 71 years or older for hands. Radiographs were obtained of knees and hands, and were graded according to the Kellgren-Lawrence (K-L) criteria. Definite OA was defined as K-L grade 2 or higher, present in at least one joint of a given group. A person was defined as having OA or not in a given joint group, and we used logistic regression with the US group as referent to determine the prevalence odds ratio of OA among Japanese. RESULTS: The age adjusted prevalence of knee OA in Japanese women was higher than in Caucasians (OR 1.96, 95% CI 1.50-2.56), while the prevalence of hand OA other than distal interphalangeal joint in Japanese was lower than in Caucasians (OR for proximal interphalangeal joint 0.66, 95% CI 0.46-0.93; OR for metacarpophalangeal joint 0.62, 95% CI 0.42-0.90), especially base of thumb OA (OR 0.15, 95% CI 0.11-0.22). CONCLUSION: These findings suggest site-specific differences in the prevalence of OA that may be attributed to genetic and/or environmental factors.     

RO/SS-A and La/SS-B: Autoantigens in Sjögren’s syndrome?

Hand osteoarthritis (OA) is a common disease frequently affecting middle-aged women. Prevalence estimates for OA vary widely depending on the age and sex of the population studied, the assessment tools used, and the specific joint sites analyzed OA is characterized by the degradation of articular cartilage, subchondral bone changes and osteophyte formation at the joint margins leading to joint failure. The pathogenesis of the disease and its evolution are multifactorial involving biomechanical, metabolic, hormonal, and genetic factors. Moreover, the role of inflammation has recently been advanced as pivotal in OA onset and progression. In particular, an uncommon variant of hand OA, erosive hand OA, is characterized by inflammatory and degenerative interphalangeal proximal and distal joints. The diagnosis of different types of hand OA is centered on clinical and laboratory investigations which can distinguish the peculiar aspects of these forms. Joint and bone assessments in hand OA are widely studied but there is no agreement with regard to established parameters to make a definitive diagnosis. This report focuses on the laboratory and clinimetric assessments that can be used to distinguish hand OA subtypes and addresses the debatable association with low bone mineral density in osteoporosis.     

Joint-specific hand symptoms and self-reported and performance-based functional status in African Americans and Caucasians: The Johnston County Osteoarthritis Project

Objective

To assess associations between joint‐specific hand symptoms and self‐reported and performance‐based functional status.

Methods

Participants were from the population‐based Johnston County Osteoarthritis Project. Symptoms in the distal interphalangeal (DIP), proximal interphalangeal (PIP), first carpometacarpal (CMC), and metacarpophalangeal (MCP) joints were assessed on a 30‐joint diagram of both hands. Self‐reported function was assessed by Health Assessment Questionnaire (HAQ) and performance‐based function by timed repeated chair stands and 8‐foot walk time. Separate multiple logistic regression models examined associations between symptoms in specific hand joint groups, symptoms in ⩾2 hand joint groups and number of symptomatic hand joints, and functional status measures, controlling for age, race/ethnicity, sex, body mass index, radiographic knee and hip OA, knee and hip symptoms and depressive symptoms.

Results

Those with symptomatic hand joint groups were more likely than those without these complaints to report more difficulty and require longer times for performance measures. Those with 2 or more symptomatic hand joint groups were more likely to have higher HAQ scores (OR = 1.97 (1.53 to 2.53)) and require more time to complete 5 chair stands (OR = 1.98 (1.23 to 3.18)) and the 8 foot walk test (OR = 1.49 (1.12 to 1.99)).

Conclusions

Joint‐specific hand symptoms are associated with difficulty performing upper‐ or lower‐extremity tasks, independent of knee and hip OA and symptoms, suggesting that studies examining functional status in OA should not ignore symptomatic joints beyond the joint site of interest, even when functional measures appear to be specific for the joint site under study.Osteoarthritis (OA) is a common cause of pain and disability.^1,2 Pain, aching or stiffness attributed to hand OA is associated with functional limitations in activities requiring use of the hands.^3,4 Individuals with OA of both the hands and knees have higher (worse) Health Assessment Questionnaire (HAQ) scores than those with isolated hand or knee OA.⁵ Unrecognised concomitant hand symptoms could potentially confound studies using the HAQ to follow symptoms of hip or knee OA, especially since a significant number of patients with isolated hip or knee OA alone will develop hand OA over time.⁵ Despite this, investigations of the impact of upper‐ or lower‐extremity OA traditionally use questions, functional tests or even selected components of the HAQ restricted to upper‐ or lower‐extremity function.^4,6,7 We have previously reported an association between knee pain and difficulty performing not just lower‐extremity tasks but upper‐extremity tasks as well, suggesting possible concomitant upper‐extremity involvement in the participants in the Johnston County Osteoarthritis Project.⁸ In this study, we examined associations between joint‐specific hand symptoms, as surrogate measures of hand OA, and self‐reported and performance‐based measures of functional status. Additionally, we evaluated whether these associations were independent of radiographic hip and knee OA and hip and knee symptoms, and whether these associations varied by race/ethnicity, sex, and the presence of knee or hip symptoms.     

Scintigraphic hand osteoarthritis (OA)--prevalence, joint distribution, and association with OA at other sites.

OBJECTIVE: To assess the information available from routine bone scans on prevalence and joint distribution of osteoarthritis (OA), particularly of the hand. METHODS: Consecutive whole body bone scans of 414 patients, including a special hand projection, were analyzed for evidence of OA related uptake. After exclusions for various reasons, 297 scans were considered "representative" with regard to hand OA (108 male and 189 female patients). Kappa values for interreader agreement ranged from 0.61 to 0.82 for hand joints and was slightly lower for other joints. RESULTS: The prevalence of positive hand joints was low before the age of 40, but increased rapidly in the 5th and 6th decade to reach a plateau. Women had a higher prevalence of uptake than men in the carpometacarpal-1 (CMC1) joint and patella. Uptake was similar on the dominant and non-dominant sides in all joints with the exception of the shoulder. Subchondral knee uptake prevalence tended to decrease in the oldest age groups, but other joint sites showed a steadily increasing prevalence throughout life. Hand symptoms were related to distal interphalangeal (DIP) and CMC1 uptake, thumb symptoms with first metacarpophalangeal joint (MCP1) CMC1 uptake, and knee symptoms with the subchondral knee uptake pattern. Affected hand joint distribution was characterized by a strong bilateral concordance within rows, and an association was seen between subchondral knee uptake and hand involvement, particularly in the DIP joints, but to a lesser degree also with CMC1 and proximal interphalangeal (PIP) uptake. Association between spinal sites and between the forefoot and the knee was also observed. CONCLUSION: Bone scintigraphy is valuable method in epidemiological studies of OA, with acceptable interreader reproducibility and relation to joint symptoms. Although much of the current findings seem comparable with previous radiologic studies, they provide new ideas about age related patterns and joint subsets, possibly indicating a difference in pathogenetic mechanisms among joints in OA.     

The prevalence of symptomatic knee and distal interphalangeal joint osteoarthritis in the urban population of Antalya, Turkey

The aim of this cross-sectional study was to estimate the prevalence and risk factors of symptomatic knee and distal interphalangeal (DIP) joint osteoarthritis (OA) in the elderly (50 years of age) urban population of Antalya, Turkey. According to the 1997 national census, Antalyas population was 508,840. By random cluster sampling, 655 individuals aged 50 years or more were interviewed face-to-face and subjected to structured interviews regarding knee pain, worsening pain on exertion, and the gelling phenomenon. They were also asked about performing namaz (a fundamental act of worship in Islam performed five times a day), smoking, type of residence, type of toilet, work style, and duration of walking per day. They were also questioned about swelling in DIP joints. In the case of suspicion of knee OA, the individuals were invited to the hospital for further evaluation by physical examination and direct roentgenogram. The diagnosis of knee OA was based on clinical or clinical and radiographic findings. The prevalence of symptomatic knee OA was determined as 14.8% in the population aged 50 years or over. Advanced age, female sex, namaz, and type of residence were found to be associated with knee OA. The rate of symptomatic knee OA was significantly lower in smokers and those walking more than 2 h per day. Female sex was also strongly associated with OA DIP joints. OA of DIP joints was found significantly associated with symptomatic knee OA. The latter is a major health problem in the elderly population, especially in about one fourth of women aged 50 years or over. These data suggest that advanced age, female sex, and type of residence are risk factors.     

High-resolution ultrasonography and 3.0 T magnetic resonance imaging in erosive and nodal hand osteoarthritis: high frequency of erosions in nodal osteoarthritis

Erosive osteoarthritis (EOA) is defined as hand osteoarthritis (OA) with interphalangeal joint erosions on plain radiographs. We sought to find ultrasound (US) and magnetic resonance imaging (MRI) features that could distinguish EOA from nodal hand OA (NOA). Symptomatic consecutive patients with hand OA as defined by the American College of Rheumatology criteria (13 EOA patients as defined by erosion in ≥1 interphalangeal joint and seven nodal OA patients) and five normal individuals were examined by plain radiography, US, and MRI. Patients and controls underwent evaluation of metacarpophalangeal and interphalangeal joints by US, and all fingers from second to fifth digit by MRI. A total of 240 joints in symptomatic patients were examined by both imaging modalities. Synovitis, osteophytes, cartilage loss, and erosions were frequently detected in the joints of patients with EOA and NOA. Six of seven patients with NOA had joint erosions that were seen on MRI or US scan but seen on plain radiographs. The overall concordance between MRI and US findings was substantial for osteophytes (κ?=?0.79) and excellent for cysts (κ?=?0.85), erosions (κ?=?0.84), synovitis (κ?=?0.82), and tenosynovitis (κ?=?0.83) in both groups. Inflammatory changes, such as effusions and synovitis, and structural changes, such as erosions, were frequently detected by US and MRI in EOA and nodal OA. These findings may support the hypothesis that EOA could not be a separate entity but may represent the severe end of the spectrum of hand OA.     

Lower prevalence of hand osteoarthritis among Chinese subjects in Beijing compared with white subjects in the United States: the Beijing Osteoarthritis Study

OBJECTIVE: Fewer Chinese subjects in Beijing have hip osteoarthritis (OA) compared with whites in the United States, but as many or more Chinese subjects have knee OA. If these differences are due to a systemic predilection for disease, then the prevalence of hand OA, the best indicator of generalized disease, should be different in China. The goals of this study were to estimate the prevalence of hand OA among elderly Chinese in Beijing, and to compare it with that among elderly whites in the United States. METHODS: We recruited a random sample of Beijing residents ages > or =60 years. Subjects answered questions on joint symptoms and provided posteroanterior radiographs of the hand. The protocol was identical to that used in the Framingham, Massachusetts OA Study. The hand radiographs from the Beijing OA Study were read intermingled with films from the Framingham OA Study. We defined a hand joint as having radiographic OA if it had a Kellgren and Lawrence grade >/=2. Symptomatic OA was present when both radiographic OA and self-reported pain were present in the same joint. We classified a subject as having radiographic or symptomatic hand OA if at least 1 hand joint had radiographic or symptomatic OA. We estimated the prevalence of hand OA in elderly subjects in Beijing and compared it with the prevalence of hand OA in elderly subjects from Framingham, using an age-standardized prevalence ratio. RESULTS: We obtained both symptom information and hand radiographs from 2,525 subjects. Despite the older age of the group, only 44.5% of men and 47.0% of women had radiographic hand OA. Symptomatic hand OA occurred in 3.0% of men and 5.8% of women. Compared with white men in Framingham, the Beijing Chinese men had a much lower prevalence of radiographic hand OA (age-adjusted prevalence ratio 0.64, 95% confidence interval [95% CI] 0.58-0.70) and symptomatic hand OA (age-adjusted prevalence ratio 0.25, 95% CI 0.16-0.34). The proportion of multiple hand joints affected by OA in Chinese men was also significantly lower than in white men. A similar magnitude of difference was also observed in the women. However, prevalence of symptomatic OA at the metacarpophalangeal (MCP) joints in Chinese men and prevalence of radiographic OA at the MCP joints in Chinese women were similar to those in their white counterparts in Framingham. CONCLUSION: Elderly Chinese subjects in Beijing had a much lower prevalence of hand OA than did elderly whites in Framingham, Massachusetts. Coupled with the exceedingly low prevalence of hip OA in China, these results may suggest that the overall predilection for OA is less among subjects in China than among whites in the United States.     

Finger joint pain in relation to radiographic osteoarthritis and joint location--a study of middle-aged female dentists and teachers

OBJECTIVES: To investigate the associations of radiographic finger joint osteoarthritis (ROA), hand laterality (right/left) and anatomical location within the hand, with finger joint pain. METHODS: Radiographs of both hands of 295 female dentists and 248 female teachers were examined for the presence of osteoarthritis in each finger joint, using grades 0 = no OA, 1 = doubtful OA, 2 = mild OA, 3 = moderate OA, 4 = severe OA. Information on the occurrence of pain in each finger joint during the past 30 days and hand laterality was obtained by questionnaire. RESULTS: Compared with subjects with no ROA, the prevalence ratio (PR) of finger joint pain was 1.92 [95% confidence interval (CI) 1.61-2.34] among those with mild ROA and 5.34 (4.51-6.54) among those with at least moderate ROA, based on a multivariate log-binomial regression model. Pain was slightly more common in the right than in the left hand (1.27; 1.15-1.40). Compared with the little finger, more pain occurred in the thumb (2.67; 2.25-3.16), the index finger (1.76; 1.50-2.07) and the middle finger (1.47; 1.24-1.74). Further, pain was more common in the proximal interphalangeal (1.77; 1.56-2.00) and the distal interphalangeal (1.51; 1.29-1.76) joints than in the metacarpophalangeal joints. The strength of the association between ROA and finger joint pain increased with the severity of pain. CONCLUSIONS: Our findings suggest that ROA, anatomic localization within the hand, and hand laterality have independent effects on finger joint pain.     

Joint-specific prevalence and radiographic pattern of hand osteoarthritis in Korean

We investigated the prevalence and involvement patterns of radiographic osteoarthritis (OA) with hand symptoms among Korean people and compared the difference in prevalence of hand OA between racial groups. Hand radiographs in 299 Korean subjects (266 female, 33 male) ≥40 years of age were examined, who had hand arthralgia. The study population was comprised of 206 patients who had radiographic OA at least at one hand joint. Radiographic OA (Kellgren–Lawrence scale ≥2 grades) was evaluated for 16 joints of each hand. The most prevalent OA was in the interphalangeal joints (IP) of thumb, followed by the distal interphalangeal joints (DIP) of index finger, DIP of middle and fifth finger in the frequency of order. The involvement of metacarpophalangeal joints (MP) was relatively common in 1st–3rd MP. Hand OA in Korean was higher in the thumb IP and lower in the thumb carpometacarpal joints compared with Caucasian previously reported. Moreover, the higher OA frequency of 1st–3rd MP was not in accordance with other studies in Caucasian and other Asian populations. The patterns of radiographic hand OA were symmetric (OR 15.68), clustered by ray (OR 8.69) and row (OR 6.66). In conclusion, our study showed that thumb IP and 2nd/3rd/5th DIP should be included in the assessment of radiologic hand OA in Koreans.     

A radiographic comparison of erosive osteoarthritis and idiopathic nodal osteoarthritis.

Clinical, radiographic and histologic features suggest that inflammation is central to the pathogenesis of erosive osteoarthritis (OA). Since mediators of inflammation may activate osteoclasts and stimulate release of metalloproteinases in joint cartilage, we hypothesized that patients with erosive OA may have more joint space narrowing and less proliferative bone response (osteophytes, sclerosis) than those with idiopathic nodal OA. Hand radiographs of 33 patients with erosive OA and 33 age and sex matched patients with nodal OA were evaluated for prevalence and severity of joint space narrowing, osteophytes, subchondral sclerosis, subchondral cysts, erosions and subchondral collapse. While the prevalence and severity of OA was greater at each joint in erosive OA than in nodal OA, significant differences (p less than 0.05) were confined largely to the interphalangeal joints. Among patients with erosive OA, radiographic features of OA were more severe in joints with erosive changes than in joints that did not show erosive change (p less than 0.01 in most cases). Notably, when joints with erosive change were excluded, only joint space narrowing was more severe in patients with erosive OA than in the corresponding joints of patients with nodal OA (p less than 0.001). Our analysis did not support the hypothesis that inflammatory mediators modify chondro or osteoneogenesis in erosive OA.     

Prevalence and risk factors for hand osteoarthritis

IntroductionHand osteoarthritis (OA) is a highly prevalent disease with a significant physical and social burden. Thus we decided to find out prevalence of hand OA in the patients above 40 year of age who presented to us with either hand symptoms or knee OA.MethodsPostero-anterior hand radiographs were taken of both hands to confirm the diagnosis of hand OA. Fifteen joints were evaluated for the presence of osteophytes, joint space narrowing, sclerosis, and cysts. 358 patients attending Rheumatology OPD of two tertiary care centers in Eastern India in one year participated in study.ResultsNinety nine (27.65%) of 358 subjects had radiological hand OA. Among the 222 patients with knee OA 90 (40.5%) patients had hand OA. Nine (6.6%) of 136 patients with hand symptoms alone had hand OA. Overall 212 (59.21%) of 358 patients had symptoms in hand joints and of them 49 (23.2%) patients had hand OA positive. Female sex, older age, BMI >25, family history of OA or diabetes mellitus increased the risk of radiological hand OA. Knee OA increased the risk of hand OA both symptomatic and asymptomatic.ConclusionHand OA is common and a good quality X ray of hand is an initial investigation to diagnose hand OA. Presence of Knee OA increases risk of hand OA.     

Prevalence and associated factors of knee osteoarthritis in a community-based population in Heilongjiang, Northeast China

Few data exist concerning the prevalence of knee OA and associated factors in Northeast China. This study was undertaken to estimate the prevalence of radiographic and symptomatic knee OA among community residents and to elucidate relevant risk factors. Unmatched case–control study was adopted to study risk factors of knee OA. Radiographic OA was evaluated according to the Kellgren and Lawrence grading scheme. Statistical analyses included tests and logistic model regressions. A total of 1,196 people aged 40–84 years participated in the community-based health survey in Northeast China in 2005. Survey participants completed an interviewer-based questionnaire. The standardized prevalence of symptomatic knee OA was 16.05% and it was significantly higher in women than in men (19.87% vs. 11.91%, = 13.76, P < 0.001). There was also an increased tendency with age in both sex (men:  x ² = 29.67, P _trend < 0.001; women: x ² = 40.26, P _trend < 0.001). The prevalence of symptomatic knee OA was significantly higher than that in Beijing and Shantou, while lower than that in Wuchuan county of inner Mongolia with nonsignificant difference. Logistic regressions revealed that age, sex, BMI, and work status might be risk factors for knee OA in urban residents, whereas age, BMI, and smoking habits might be risk factors in rural dwellers. Symptomatic knee OA is extremely common with preponderance for elderly women and constitutes a major public health problem. The findings will be useful to guide the distribution of future health care resources and preventive strategies.     

Lifetime Risk and Age at Diagnosis of Symptomatic Knee Osteoarthritis in the US

Objective

To estimate the incidence and lifetime risk of diagnosed symptomatic knee osteoarthritis (OA) and the age at diagnosis of knee OA based on self‐reports in the US population.

Methods

We estimated the incidence of diagnosed symptomatic knee OA in the US by combining data on age‐, sex‐, and obesity‐specific prevalence from the 2007–2008 National Health Interview Survey, with disease duration estimates derived from the Osteoarthritis Policy (OAPol) Model, a validated computer simulation model of knee OA. We used the OAPol Model to estimate the mean and median ages at diagnosis and lifetime risk.

Results

The estimated incidence of diagnosed symptomatic knee OA was highest among adults ages 55–64 years, ranging from 0.37% per year for nonobese men to 1.02% per year for obese women. The estimated median age at knee OA diagnosis was 55 years. The estimated lifetime risk was 13.83%, ranging from 9.60% for nonobese men to 23.87% in obese women. Approximately 9.29% of the US population is diagnosed with symptomatic knee OA by age 60 years.

Conclusion

The diagnosis of symptomatic knee OA occurs relatively early in life, suggesting that prevention programs should be offered relatively early in the life course. Further research is needed to understand the future burden of health care utilization resulting from earlier diagnosis of knee OA.     

Proprioception,dynamic balance and maximal quadriceps strength in females with knee osteoarthritis and normal control subjects

Background: Osteoarthritis (OA) is one of the most common musculoskeletal complaints worldwide. The knee is the most frequently involved joint of the lower limb in OA. Knee joint proprioception, dynamic balance and maximal quadriceps strength may be impaired in patients with knee OA. Objective: To investigate whether females with knee OA have reduced knee joint proprioception, balance responses and quadriceps strength compared with normal controls. Methods: We undertook a cross‐sectional study of 30 females with knee OA and 30 controls. Knee joint proprioception was measured using electrogoniometer. Dynamic balance response was determined using a step test. Quadriceps strength was measured isometrically using a modified Tornvall chair. Results: Subjects with OA had greater mean error, poorer dynamic balance and less quadriceps strength than non‐symptomatic ones (P < 0.001). Increasing age was associated with a decline in proprioceptive acuity for both controls and patients (r = 0.40, P < 0.001). In subjects with knee OA, decreased dynamic balance was associated with increasing weight (r = 0.30, P < 0.001) and reduced quadriceps strength (r = –0.37, P = 0.002). Conclusion: Compared with age and sex‐matched controls, females with symptomatic knee OA have reduced knee proprioception, balance responses and quadriceps strength.     

Hand use and patterns of joint involvement in osteoarthritis. A comparison of female dentists and teachers

OBJECTIVES: To investigate the effect of mechanical stress on finger osteoarthritis (OA) by comparing women from two occupations with different hand load but the same socio-economic grade, and to investigate whether hand load may affect the pattern of joint involvement in OA. METHODS: Radiographs of both hands of 295 dentists and 248 teachers were examined. Each interphalangeal (distal, proximal and thumb interphalangeal) and the metacarpophalangeal joints were graded (0 = no OA, 4 = severe OA) separately by using reference images. The co-involvement of different hand joints was analysed by logistic regression. RESULTS: The distal interphalangeal joints were the most frequently involved joints. The non-dominant hand was more frequently affected by OA of grade 2 or more than the dominant hand. The prevalence of OA of grade 2 or more in any finger joint and also in any distal interphalangeal joint was higher among the teachers compared with the dentists (59 vs 48%, P = 0.020 and 58 vs 47%, P < 0.010 respectively). Finger OA showed more clustering in the ring and little fingers and more row clustering and symmetry in the teachers than in the dentists [age-adjusted odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.10-2.23, OR = 1.84, 95% CI 1.28-2.64, and OR = 1.98, 95% CI 1.38-2.86 respectively]. The OR of more severe OA (grade 3 or more) in the right-hand thumb and the index and middle fingers was significantly elevated among the dentists compared with the teachers (OR 2.61, 95% CI 1.03-6.59). CONCLUSION: Our findings indicate that finger OA in middle-aged women is highly prevalent and often polyarticular. Hand use may have a protective effect on finger joint OA, whereas continuing joint overload may lead to joint impairment.     

Prevalence of hand osteoarthritis and its relationship to hand pain and grip strength in Japan: The third survey of the ROAD study

Objectives: To examine the prevalence and pattern of hand osteoarthritis (HOA), and determine its relationship with grip strength and hand pain.

Methods: Among the participants of the third survey of the Research on Osteoarthritis/Osteoporosis Against Disability (ROAD) study, 507 Japanese men and 1028 Japanese women were included. Radiographs of both hands were graded for osteoarthritis (OA) using the modified Kellgren–Lawrence (KL) scale. HOA was defined as the presence of at least one affected joint. The absence or presence of subchondral erosion was also scored.

Results: The prevalence of HOA (KL grade?≥2) was 89.9% in men and 92.3% in women (p?=?0.11), and it was significantly associated with age. OA in the distal interphalangeal (DIP) joint was the highest overall. After adjusting for age, sex, body mass index, and the residing area, both severity (KL grade?≥3) and erosion were significantly related to low grip strength and hand pain. With regard to the joint groups, severe OA in the DIP and first carpometacarpal joints were related to hand pain.

Conclusion: This study showed a high prevalence of radiographic HOA and a significant relationship between hand pain and the severity of HOA, in addition to erosion.     

Brief Report: Differences in multijoint symptomatic osteoarthritis phenotypes by race and sex: The Johnston County Osteoarthritis Project

Objective

To determine differences in the phenotypes (patterns) of multiple‐joint symptomatic osteoarthritis (OA) involvement by race and sex.

Methods

A cross‐sectional analysis of symptomatic OA phenotypes was performed in a community‐based cohort, comprising subjects for whom data were collected from 4 sites of symptomatic OA involvement (the hands, knees, hips, and lumbosacral [LS] spine) at a single visit (2003–2010). Mutually exclusive phenotypes describing all combinations of these 4 sites were compared by race and by sex, using Fisher's exact tests. For those phenotypes occurring in >40 subjects, logistic regression was performed, with adjustments for race, sex, age, and body mass index (BMI), and interactions of race and sex were assessed.

Results

The sample included 1,650 participants, of whom 36% were men and 32% were African American. The mean age of the subjects was 66 years, and the mean BMI was 31 kg/m². Overall, in this sample, 13% of subjects had symptomatic hand OA, 25% had symptomatic knee OA, 11% had symptomatic hip OA, and 28% had symptomatic LS spine OA. African Americans, as compared with Caucasians, were less likely to have involvement of symptomatic OA in the hand only, or in some combination of the hand and other sites, but were more likely to have involvement of the knee only. Men, as compared to women, were less likely to have involvement of the hand only, but were more likely to have involvement of the LS spine only.

Conclusion

There are differences in the phenotypes of multiple‐joint symptomatic OA involvement by race and by sex that may influence the definitions of multiple‐joint, or generalized, OA.

     

Incidence of symptomatic hand,hip, and knee osteoarthritis among patients in a health maintenance organization

Objective. To quantify the incidence of symptomatic hand, hip, and knee osteoarthritis (OA) among members of the Fallon Community Health Plan, a health maintenance organization located in central Massachusetts. Methods. Incident OA was defined as the first evidence of OA by radiography (grade ≥2 on the Kellgren-Lawrence scale of 0–4) plus joint symptoms at the time the radiograph was obtained or up to 1 year before the radiograph was obtained. Results. The age- and sex-standardized incidence rate for hand OA was 100/100,000 person-years (95% confidence interval [95% CI] 86, 115), for hip OA 88/100,000 person-years (95% CI 75, 101), and for knee OA 240/100,000 person-years (95% CI 218, 262). The incidence of hand, hip, and knee OA increased with age, and women had higher rates than men, especially after age 50. A leveling off or decline occurred for both groups around the age of 80. Conclusion. In a large study of symptomatic OA we observed incidence rates that increased with age. In women ages 70-89, the incidence of knee OA approached 1% per year.and women had higher rates than men, especially after age 50. A leveling off or decline occurred for both groups around the age of 80.