Miura Hiromasa, Kawano Tsutomu, Takasugi Shin-Ichiro, Manabe Takashi, Hosokawa Akira, Iwamoto Yukihide
Department of Rehabilitation Medicine, Kyushu University Hospital, 3-1-1 Maidashi, Higashi-ku, Fukuoka 812-8582, Japan.
J Orthop Sci. 2008 Nov;13(6):487-91. doi: 10.1007/s00776-008-1270-2. Epub 2008 Dec 17.
The etiology and pathogenesis of hand osteoarthritis (OA) are not completely clarified, and several factors may cooperate in a multifactorial fashion in its development. The purpose of this study was to clarify the effects of the dominant hand that contribute to the development of distal interphalangeal (DIP) joint OA using epidemiological analyses.
A total of 518 subjects (156 men, 362 women) in a rural community were analyzed. Their mean age was 63.8 years for men and 60.7 years for women. Anteroposterior (AP) standing radiographs of bilateral knees, lateral views of the lumbar spine, and AP views of bilateral hands were obtained. Furthermore, a survey of their life patterns was conducted using self-administered questionnaires. Radiographic osteoarthritis was defined as Kellgren and Lawrence grade 2 or higher. Hand OA was limited to Heberden's nodes. Generalized OA (GOA) was defined as bilateral knee OA plus lumbar spine OA.
GOA was observed in 13.0% of the subjects. The incidence of DIP joint OA was significantly higher in the GOA group than that in the non-GOA group. In the GOA group, the incidence of right-hand DIP joint OA in right-handed and left-handed subjects was 37.5% and 40.0%, respectively, without a significant difference. In the non-GOA group, however, the incidence of right-hand DIP joint OA in right-handed and left-handed subjects was 16.4% and 3.2%, respectively, with a significant difference. With a multiple logistic regression model, the P value of the handedness was marginal (0.060), but a clear tendency of increase in the odds ratio (7.129) was observed in the dominant hand for the non- GOA group. In contrast, there was no effect of the handedness on right-hand DIP joint OA in the GOA group.
There are two subtypes of hand DIP joint OA in terms of the etiology. One is environmental, and the other is genetic.
手部骨关节炎（OA）的病因和发病机制尚未完全阐明，多种因素可能以多因素方式共同作用于其发展过程。本研究的目的是通过流行病学分析阐明优势手对远端指间关节（DIP）OA发展的影响。
对一个农村社区的518名受试者（156名男性，362名女性）进行分析。男性的平均年龄为63.8岁，女性为60.7岁。获取了双侧膝关节的前后位（AP）站立位X线片、腰椎侧位片以及双侧手部的AP位片。此外，使用自填问卷对他们的生活模式进行了调查。影像学骨关节炎定义为Kellgren和Lawrence分级2级或更高。手部OA仅限于赫伯登结节。全身性OA（GOA）定义为双侧膝关节OA加腰椎OA。
13.0%的受试者观察到GOA。GOA组中DIP关节OA的发病率显著高于非GOA组。在GOA组中，右利手和左利手受试者右手DIP关节OA的发病率分别为37.5%和40.0%，无显著差异。然而，在非GOA组中，右利手和左利手受试者右手DIP关节OA的发病率分别为16.4%和3.2%，有显著差异。在多元逻辑回归模型中，利手的P值接近临界值（0.060），但在非GOA组的优势手中观察到优势比有明显的增加趋势（7.129）。相比之下，利手对GOA组右手DIP关节OA没有影响。
从病因学角度来看，手部DIP关节OA有两种亚型。一种是环境因素导致的，另一种是遗传因素导致的。
