Hand use and patterns of joint involvement in osteoarthritis. A comparison of female dentists and teachers

To investigate the effect of mechanical stress on finger osteoarthritis (OA) by comparing women from two occupations with different hand load but the same socio-economic grade, and to investigate whether hand load may affect the pattern of joint involvement in OA.

Radiographs of both hands of 295 dentists and 248 teachers were examined. Each interphalangeal (distal, proximal and thumb interphalangeal) and the metacarpophalangeal joints were graded (0 = no OA, 4 = severe OA) separately by using reference images. The co-involvement of different hand joints was analysed by logistic regression.

The distal interphalangeal joints were the most frequently involved joints. The non-dominant hand was more frequently affected by OA of grade 2 or more than the dominant hand. The prevalence of OA of grade 2 or more in any finger joint and also in any distal interphalangeal joint was higher among the teachers compared with the dentists (59 vs 48%, P = 0.020 and 58 vs 47%, P < 0.010 respectively). Finger OA showed more clustering in the ring and little fingers and more row clustering and symmetry in the teachers than in the dentists [age-adjusted odds ratio (OR) = 1.57, 95% confidence interval (CI) 1.10-2.23, OR = 1.84, 95% CI 1.28-2.64, and OR = 1.98, 95% CI 1.38-2.86 respectively]. The OR of more severe OA (grade 3 or more) in the right-hand thumb and the index and middle fingers was significantly elevated among the dentists compared with the teachers (OR 2.61, 95% CI 1.03-6.59).

Our findings indicate that finger OA in middle-aged women is highly prevalent and often polyarticular. Hand use may have a protective effect on finger joint OA, whereas continuing joint overload may lead to joint impairment.