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

Objective: Osteoarthritis (OA) of the hand is common in elderly patients. T he aim of this study was to characterize OA frequency, severity, and distri bution and to trace interrelationships between these findings and the demog raphic, occupational, and medical data from elderly Jewish nonrheumatologic patients. Methods: Study participants were 253 consecutive patients admitted to a ger iatric center for a variety of nonrheumatic medical conditions. Excluded pa tients were those with rheumatoid arthritis; neurologic, orthopedic, or oth er conditions that would interfere with symmetric hand function; and mental or medical states that would interfere with history taking and radiographi c studies. Patient occupations were graded as workload degree (on a scale o f 1 to 3) and as the total occupational score (workload degree multiplied b y 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 clin ical OA score. Hand radiographs were independently read (modified Altman me thod), 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, chi (2) 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 sever ely the second and third distal interphalangeal, right first interphalangea l, and both first carpometacarpal joints. The prevalence of OA was similar in women and men, with higher scores in women, and reached significance onl y in the distal interphalangeal joints. Metacarpophalangeal joints were mor e involved in men. Age had a clear influence on OA scores. Ethnicity affect ed OA severity, with Ashkenazi Jews having significantly higher scores than Sepharadi Jews. Dominant hands had significantly higher global OA scores a s well as isolated joint scores (except for the first carpometacarpal joint ). Occupational load, housekeeping tasks, and the number of children did no t influence the total or specific joint OA scores. Associated conditions su ch as obesity, diabetes, hypothyroidism, and chondrocalcinosis were not ass ociated 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, an d handedness. In contrast, acquired factors such as workload, number of chi ldren, and associated diseases did not appear to influence OA expression. Semin Arthritis Rheum 30:321-331. Copyright (C) 2001 by W.B. Saunders Compa ny.