[Lifelong heavy agricultural work and development of arthrosis of the hand--a case study]

Heavy physical work load is a known determinant of osteoarthritis of the hip, which may account for the high risk observed among farmers. On the other hand, the data on influence of heavy manual work in the pathogenesis of hand osteoarthritis are still controversial. We examined 25 retired farm laborers who strenuously worked for more than 50 years. The investigation included a history of professional activity, clinical and radiological examination of the hands, hips and knees, MRI of hand and laboratory evaluation of 4 participants. Interestingly, the farm laborers with osteoarthritis of the hands, hardly complained. In many of the proximal interphalangeal joints, a discrepancy was observed between the clinical hypertrophic changes and the radiological osteoarthritis which was weak or absent. This difference was less pronounced in the distal interphalangeal joints. Furthermore the distribution pattern of the osteoarthritis of the hand was striking with an over-proportional involvement of the metacarpophalangeal joints and less pronounced of the intercarpal joints. Most often both hands have been affected and the typical localization of the metacarphophalangeal joint osteoarthritis was the first, second and third finger. In all but one participant we found at least unilateral osteoarthritis of the hip and compared to the hands, complaints were more severe. Our findings support the hypothesis that the distribution of osteoarthritis in the hand is affected by lifelong farming. As shown by the data on proximal interphalangeal joints, the periarticular tissue can adapt to the mechanical load in the strength grip.