Clinical, radiologic, demographic, and occupational aspects of hand osteoarthritis in the elderly*

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Abstract

Objective: Osteoarthritis (OA) of the hand is common in elderly patients. The aim of this study was to characterize OA frequency, severity, and distribution and to trace interrelationships between these findings and the demographic, occupational, and medical data from elderly Jewish nonrheumatologic patients. Methods: Study participants were 253 consecutive patients admitted to a geriatric center for a variety of nonrheumatic medical conditions. Excluded patients were those with rheumatoid arthritis; neurologic, orthopedic, or other conditions that would interfere with symmetric hand function; and mental or medical states that would interfere with history taking and radiographic studies. Patient occupations were graded as workload degree (on a scale of 1 to 3) and as the total occupational score (workload degree multiplied by the duration of each job). Clinical findings of Heberden nodes, Bouchard nodes, and malignment, graded on a scale of 0 to 3, were summed as the clinical OA score. Hand radiographs were independently read (modified Altman method), grading 5 parameters in each joint on a scale of 0 to 3, summed as a radiologic OA score. Statistical analyses included the Student t test, χ2 test, ANOVA, Pearson correlation, and partial correlation coefficients. Results: Among 253 elderly patients (171 women, 82 men; mean age, 79 years) OA was frequent (occurring in about 80% of patients), involving most severely the second and third distal interphalangeal, right first interphalangeal, and both first carpometacarpal joints. The prevalence of OA was similar in women and men, with higher scores in women, and reached significance only in the distal interphalangeal joints. Metacarpophalangeal joints were more involved in men. Age had a clear influence on OA scores. Ethnicity affected OA severity, with Ashkenazi Jews having significantly higher scores than Sepharadi Jews. Dominant hands had significantly higher global OA scores as well as isolated joint scores (except for the first carpometacarpal joint). Occupational load, housekeeping tasks, and the number of children did not influence the total or specific joint OA scores. Associated conditions such as obesity, diabetes, hypothyroidism, and chondro calcinosis were not associated with more pronounced OA. Conclusions: Hand OA was prevalent in our elderly cohort, and its severity was influenced by inherent traits such as age, female gender, ethnicity, and handedness. In contrast, acquired factors such as workload, number of children, and associated diseases did not appear to influence OA expression. Semin Arthritis Rheum 30:321-331. Copyright © 2001 by W.B. Saunders Company

Section snippets

Patients

Patients admitted to the Shmuel Horofeh geriatric medical center for any reason during a 6-month period were consecutively recruited into the study and approved by the local research ethics committee after they gave informed consent. Excluded were patients with rheumatoid arthritis and those with neurologic, orthopedic, or other conditions that could interfere with the free symmetrical use of both hands. Patients mentally unable to comply with the administered questionnaire and patients whose

Results

Two hundred fifty-three elderly patients, 171 women and 82 men, with a mean age of 78.8 years were evaluated. Their demographic data are reported in Table 1.

Discussion

Our cohort of 253 elderly general geriatrics patients enabled us to conduct the study from a nonrheumatologic perspective. Additional differences between this study and most series are the relatively very advanced age (mean, 78.8 years), Jewish ethnicity, and the ability to define European (Ashkenazi) versus Mediterranean-Asian (Sepharadi) provenance. Clinical and radiologic data, together with demographic and past occupational data were studied and analyzed to characterize OA and to evaluate

Acknowledgements

The authors thank Aylon Neumann, MSc for his assistance with statistical analysis.

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    *

    Address reprint requests to Dan Caspi, MD, Head, Rheumatology Day-Care Unit, Tel Aviv Souraski Medical Center, 6 Weizmann St, Tel Aviv 64239, Israel. E-mail: [email protected]

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