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Osteoarthritis in the Carpometacarpal Joint of the ThumbPrevalence and Associations with Disability and Mortality
Mikko M. Haara, MD1; Markku Heliövaara, MD2; Heikki Kröger, MD1; Jari P.A. Arokoski, MD, PhD3; Pirjo Manninen, MD4; Alpo Kärkkäinen, MD5; Paul Knekt, PhD2; Olli Impivaara, MD6; Arpo Aromaa, MD2
1 Department of Orthopaedic Surgery, Kuopio University Hospital, P.O. Box 1627, FIN-70211 Kuopio, Finland. E-mail address for M. Haara: mhaara@hytti.uku.fi. E-mail address for H. Kröger: heikki.kroger@kuh.fi
2 National Public Health Institute, Mannerheimintie 166, FIN-00300 Helsinki, Finland. E-mail address for M. Heliövaara: markku.heliovaara@ktl.fi. E-mail address for P. Knekt: paul.knekt@ktl.fi. E-mail address for A. Aromaa: arpo.aromaa@ktl.fi
3 Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, P.O. Box 1777, FIN-70211 Kuopio, Finland. E-mail address: jari.arokoski@kuh.fi
4 Department of Research and Development in Occupational Health and Safety, Finnish Institute of Occupational Health, P.O. Box 93, FIN-70701 Kuopio, Finland. E-mail address: pirjo.manninen@ttl.fi
5 Hämeenkatu 18, FIN-33200 Tampere, Finland. E-mail address: a.karkkainen@rontgentutka.fi
6 Research Department, Social Insurance Institution, Peltolantie 3, FIN-20720 Turku, Finland. E-mail address: olli.impivaara@kela.fi
View Disclosures and Other Information
In support of the research or preparation of this manuscript, M.M. Haara received grants or outside funding from Evo-Funding of Kuopio University Hospital and Duodecim Foundation, Finland. None of the authors received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or nonprofit organization with which the authors are affiliated or associated.
Investigation performed at Department of Orthopaedic Surgery, Kuopio University Hospital, and Bone and Cartilage Research Unit, Kuopio University, Kuopio, Finland

The Journal of Bone and Joint Surgery, Incorporated
J Bone Joint Surg Am, 2004 Jul 01;86(7):1452-1457
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Background: This study was designed to investigate the prevalence of osteoarthritis in the carpometacarpal joint of the thumb in adults thirty years of age or older in Finland.

Methods: Between 1978 and 1980, a representative population sample of 8000 Finns thirty years of age or older were invited to have a comprehensive health examination; 90% accepted. Hand radiographs were made of 3595 subjects. Since the examination, the subjects have been followed systematically to assess work disability and mortality by reviewing registers covering the whole population.

Results: The age-adjusted prevalence of thumb carpometacarpal osteoarthritis of Kellgren grade 2, 3, or 4 was 7% for men and 15% for women. After adjustment for age, sex, and other alleged risk factors, body mass index was found to be directly proportional to the prevalence of thumb carpometacarpal osteoarthritis in both sexes. The adjusted odds ratio was 1.29 (95% confidence interval, 1.15 to 1.43) per 5-kg/m2 increment in body mass index. No significant association was found between the physical workload history and thumb carpometacarpal osteoarthritis. Restricted mobility of the thumb and local tenderness and swelling were frequently found in conjunction with radiographic evidence of thumb carpometacarpal osteoarthritis. Advanced (grade-3 or 4) thumb carpometacarpal osteoarthritis predicted the total mortality rate in men (adjusted relative risk, 1.32; 95% confidence interval, 1.03 to 1.69). Radiographic signs of thumb carpometacarpal osteoarthritis did not predict work disability.

Conclusions and Clinical Relevance: Obesity is a strong determinant of thumb carpometacarpal osteoarthritis in both sexes. The effect of thumb carpometacarpal osteoarthritis on disability and mortality in the general population is modest. Because of the rarity of ensuing disability, carpometacarpal osteoarthritis of the thumb is likely to be underdiagnosed in clinical practice.

Level of Evidence: Prognostic study, Level II-1 (retrospective study). See Instructions to Authors for a complete description of levels of evidence.

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    These activities have been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint sponsorship of the American Academy of Orthopaedic Surgeons and The Journal of Bone and Joint Surgery, Inc. The American Academy of Orthopaedic Surgeons is accredited by the ACCME to provide continuing medical education for physicians.
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