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Objective: While symmetry and clustering of radiographic hand osteoarthritis (OA) have been described in middle-aged women, these have not been studied in elderly individuals and similar investigations are lacking for symptomatic hand OA. The goal of this study was to study patterns of joint involvement in symptomatic hand OA among elderly Caucasian men and women., Methods: Using data from the Framingham Osteoarthritis Study, we defined a joint as having symptomatic OA if it had symptoms and radiographic OA (Kellgren and Lawrence grade > or =2). We assessed clustering of symptomatic OA using a chi(2)-test and evaluated the interrelationship of occurrence of symptomatic OA among different joints with generalized estimating equations., Results: Of 976 subjects (age 71-99 yr, 36% men) examined, symptomatic OA more often affected multiple hand joints in an individual than would be expected by chance (P<0.001). The presence of symptomatic OA at a particular joint was strongly associated with symptomatic OA in the same joint of the opposite hand, followed by other joints in the same row of the same hand, and then other joints in the same ray of the same hand. The symmetrical pattern of symptomatic OA was more apparent in women than in men., Conclusion: Our study demonstrates that symptomatic OA often affects multiple hand joints, and is more likely to cluster by row than by ray. The disease also occurs in a remarkably symmetrical pattern, especially in women.

Osteoarthritis is one of the most common joint disorders in the elderly, yet few studies have targeted symptomatic osteoarthritis, especially symptomatic hand osteoarthritis. The authors conducted a survey in 1992-1993 among an elderly population to estimate the prevalence of symptomatic hand osteoarthritis and to assess its impact on grip strength and functional activities. Framingham Study subjects received hand radiographs and answered queries on joint symptoms. Functional activities were assessed using an interviewer-administered questionnaire. Grip strength and observed functional performance were evaluated using standard procedures. A hand joint was defined as having symptomatic osteoarthritis if both symptoms and radiographic evidence of osteoarthritis were present. Of 1,041 subjects aged 71-100 years (36% men), the prevalence of symptomatic hand osteoarthritis was higher in women (26.2%) than in men (13.4%). Compared with those without symptomatic hand osteoarthritis, subjects with the disease had 10% reduced maximal grip strength, reported more difficulty writing, handling, or fingering small objects (odds ratio = 3.4), and showed more self-reported and observed difficulty carrying a 10-pound (4.5-kg) bundle (odds ratio = 1.7 and 1.6, respectively). In conclusion, in the context of a remarkable paucity of data on the epidemiology of symptomatic hand osteoarthritis, this study suggests that symptomatic hand osteoarthritis is a common disease among elders and frequently impairs hand function.

Quadriceps strength may protect against knee osteoarthritis (OA), but muscle activity is a major determinant of forces at the hand joints. Gripping objects is a common task during which high muscular forces are sustained, particularly at the proximal hand joints (metacarpophalangeal (MCP) joints and thumb base). The association between maximal grip strength and incident OA at different hand joints was examined in a longitudinal study of radiographic hand OA. Subjects with higher maximal grip strength were at increased risk for development of OA in the proximal interphalangeal (PIP) joints, MCP and thumb base joints in men; and in the MCP in women. No association was found between maximal grip strength and incident distal interphalangeal (DIP) joints OA in men or women. The conclusion is that increased grip strength, which is the major force of loading across proximal hand joints, increases the risk of OA in those joints.

Objective: In knees, quadriceps strength may protect against osteoarthritis (OA). Muscle activity is a major determinant of forces at the hand joints, and grip is a common task during which high muscle forces are sustained, especially at the proximal hand joints (metacarpophalangeal [MCP] joints and thumb base). This longitudinal study of radiographic hand OA examined the association between incident OA at different hand joints and maximal grip strength., Methods: Four hand joint groups were studied: distal interphalangeal (DIP), proximal interphalangeal (PIP), MCP, and the base of the thumb (carpometacarpal and scaphotrapezial combined). Subjects were members of the Framingham OA Study who had a baseline radiograph in 1967-1969 and a followup radiograph in 1992-1993 (mean followup 24 years) and had no prevalent radiographic OA in any hand joint at baseline. Incident disease was defined as development of OA defined as a modified Kellgren/Lawrence grade of > or =2. Grip strength was measured in kilograms by dynamometer in 1958-1961 and again in 1960-1963, and the 2 measures were averaged and divided into sex-specific tertiles. Joint-based analysis was performed by adjusting for age, physical activity, and occupational category using the lowest grip strength tertile as the referent., Results: Baseline and followup radiographs were obtained from 746 subjects. Of these, 453 subjects with no prevalent OA at baseline were eligible for analysis. In men, higher maximal grip strength was associated with an increased risk of OA in the PIP (highest tertile odds ratio [OR] 2.8 compared with lowest tertile, 95% confidence interval [95% CI] 1.2-6.7), MCP (highest tertile OR 2.9, 95% CI 1.1-7.4), and thumb base joints (highest tertile OR 2.8, 95% CI 1.1-7.4). In women, there was increased risk of OA in the MCP joints (highest tertile OR 2.7, 95% CI 1.1-6.4)., Conclusion: Men with high maximal grip strength are at increased risk for the development of OA in the PIP, MCP, and thumb base joints, and women, in the MCP joints. No association was found between maximal grip strength and incident OA in the DIP joints of men or women.

Objective: To investigate the inheritance of generalized osteoarthritis (OA)., Methods: OA was identified on hand and knee radiographs obtained from members of the Framingham Study cohort (the parents) in 1967-1970 and 1992-1993, and from their adult children in the Framingham Offspring Study in 1993-1994. All hand and knee radiographs evaluated for OA were graded using the Kellgren and Lawrence (K/L) scale. A measure of generalized OA was defined as the count of the number of hand and knee joints affected, as determined by the proportion of joints with a K/L grade > or =2. The OA count, treated as a continuous variable, was adjusted for age, body mass index, and a measure of physical activity for each joint area (hand or knee). Calculations were made separately for each generation and each sex, and correlations were analyzed against the standardized residual of OA. Segregation analysis was used to test whether OA aggregated in families, and if its transmission fit a Mendelian pattern., Results: A total of 337 nuclear families with 2 parents and at least 1 biologic offspring were studied. In parents, the mean age was 61.2 years at the time of hand radiographs and 72.8 years at the time of knee radiographs, which were mostly obtained at a later examination. The mean age at the time of radiographs in offspring was 53.9 years. Using standardized residuals, parent-offspring and sibling-sibling correlations ranged from 0.115 to 0.306. In segregation analyses, models testing the hypotheses of no familial aggregation, no familial transmission, or a Mendelian gene alone were all rejected (P < 0.001 for each of these models). The best-fitting models were mixed models with a Mendelian mode of inheritance and a residual multifactorial component. The Mendelian recessive model provided the best fit., Conclusion: These analyses support a significant genetic contribution to OA, with evidence for a major recessive gene and a multifactorial component, representing either polygenic or environmental factors.

Overweight people are at high risk of developing knee osteoarthritis (OA) and may also be at increased risk of hand and hip OA. Furthermore, being overweight accelerates disease progression in knee OA. While the increased joint stress accompanying obesity may explain the strong linkage between obesity and knee OA risk, it does not necessarily explain why obese people have a high risk of disease in the hand nor why obese women are at higher comparative risk of knee disease than obese men. Unfortunately, studies of metabolic factors linked to obesity have not provided an explanation for these findings. There are a paucity of data on weight loss as a treatment for OA, but preliminary information suggests it is especially effective in knee disease and that even small amounts of weight reduction may have favourable effects.

Objective: Osteoarthritis (OA) is the most common type of arthritis; involvement of joints in the hand is highly prevalent, especially in the elderly. Few data are available on the incidence of hand OA in men and women or on the association between OA in one hand joint with incidence in others., Methods: We studied the cumulative incidence of radiographic hand OA in a population based group of men and women, and evaluated whether baseline OA in one joint affected OA rates in other joints in the hand. Study subjects were 751 members of the Framingham Study cohort, who had a baseline right hand radiograph taken in 1967-1969 (mean age 55+/-5.58) and followup radiographs 24 years later., Results: In those without OA at baseline, women had more incident disease than men in almost all hand joints, but the joints most frequently affected were the same in both sexes: the distal interphalangeal (DIP), followed by the base of the thumb, proximal interphalangeal (PIP), and metacarpophalangeal (MCP) joints. The MCP joint group was the only one in which the incidence in men was comparable to incidence in women. Prevalent OA in one or more joints in a row (e.g., MCP) markedly increased the risk of incident OA in other joints in the same row. Also, prevalent OA in one joint in a finger (a ray) increased the risk of incident OA in other joints in that ray. Prevalent OA in either DIP or PIP joints at baseline substantially increased the risk of incident OA in all other hand joints. Thumb base OA at baseline increased risk in MCP joints, and to a lesser extent, DIP and PIP joints., Conclusion: Cumulative incidence was generally higher in women than men, baseline OA in one joint in a row markedly increased the risk of developing OA in other joints in the same row, and baseline OA in a joint in a ray similarly increased risk in that ray. Interphalangeal joint OA at baseline appeared to increase subsequent OA in all hand joints, baseline OA in the thumb was not as strong a predictor. This descriptive information on incidence of radiographic hand OA should generate new hypotheses about why OA affects hands in particular patterns.

Objective: To assess whether current thyroid status is associated with chondrocalcinosis or osteoarthritis (OA), we examined the cross sectional association of serum thyrotropin (thyroid stimulating hormone, TSH) with chondrocalcinosis and with knee OA in members of the Framingham OA study., Methods: Knee radiographs were taken at the 18th biennial examination (1983-85) and measurement of serum TSH at either the 15th (1977-79) or the 18th biennial examination. Chondrocalcinosis was dichotomized as absent or present and knee OA was based on a Kellgren and Lawrence score of grade 2 or greater in either knee. Thyroid status was determined by serum TSH concentration classed into clinically relevant categories: < or = 0.1 mU/l(low); > 0.1 < 0.4 mU/l (slightly low); 0.4 to 5.0 mU/l (normal); > 5 < or = 10 mU/l (slightly high); and > 10 mU/l (high)., Results: Data were collected on 577 men and 798 women. We found no association between elevated serum TSH concentration and chondrocalcinosis. Our results, though not statistically significant, suggest an inverse relation, with an odds ratio (OR) of 0.41 (95% CI 0.10, 1.73) for those subjects. in the highest TSH group and 1.79 (95% CI 0.39, 8.24) for those in the lowest TSH group, compared to subjects in the normal range. We found no association between serum TSH concentration and radiographic knee OA, with an OR of 0.85 (95% CI 0.47, 1.51) for those in the highest serum TSH group and 1.51 (95 CI 0.54, 4.22) for those in the lowest TSH group, compared to the normal group. Exclusion of subjects taking thyroid hormone confirmed these null results., Conclusion: There was no evidence, in a large unselected population of older persons, of a significant association between current thyroid status and either chondrocalcinosis or OA.