Hand osteoarthritis in relation to mortality and incidence of cardiovascular disease: data from the Framingham Heart Study

Abstract

Objectives To study whether hand osteoarthritis (OA) is associated with increased mortality and cardiovascular events in a large community based cohort (Framingham Heart Study) in which OA, mortality and cardiovascular events have been carefully assessed. Methods We examined whether symptomatic (≥1 joint (s) with radiographic OA and pain in the same joint) and radiographic hand OA (≥1 joint(s) with radiographic OA without pain) were associated with mortality and incident cardiovascular events (coronary heart disease, congestive heart failure and/or atherothrombotic brain infarction) using Cox proportional hazards models. In the adjusted models, we included possible confounding factors from baseline (eg, metabolic factors, medication use, smoking/alcohol). We also adjusted for the number of painful joints in the lower limb and physical inactivity. Results We evaluated 1348 participants (53.8% women) with mean (SD) age of 62.2 (8.2) years, of whom 540 (40.1%) and 186 (13.8%) had radiographic and symptomatic hand OA, respectively. There was no association between hand OA and mortality. Although there was no significant relation to incident cardiovascular events overall or a relation of radiographic hand OA with events, we found a significant association between symptomatic hand OA and incident coronary heart disease (myocardial infarction/coronary insufficiency syndrome) (HR 2.26, 95% CI 1.22 to 4.18). The association remained after additional adjustment for pain in the lower limb or physical inactivity. Conclusions Symptomatic hand OA, but not radiographic hand OA, was associated with an increased risk of coronary heart disease events. The results suggest an effect of pain, which may be a possible marker of inflammation.

Osteoarthritis and mortality: A prospective cohort study and systematic review with meta-analysis

“…After excluding 2,124 articles based on title/abstract review, 15 articles were fully retrieved and six were included [37][38][39][40][41][42] along with data from the PRO.V.A study (Supplementary Figure 1). For one conference abstract 38 , additional data were gathered from the Authors.…”

“…40 A possible reason is that hand OA was associated with a reduced cancer-related mortality. 40 The reasons of this association are not known and further research is obviously needed.…”

“…The assessment of OA was heterogeneous across studies with two 37,38 and five (PRO.V.A) and [39][40][41][42] reporting a radiological and a combined (clinical + radiological) assessment, respectively. Different methods of death ascertainment were also observed, but six out of seven were of high reliability and quality [37][38][39][40][41] . Finally, among the studies included, four provided data also for CVD mortality (PRO.V.A) and 37,38,41 .…”

“…40 A possible reason is that hand OA was associated with a reduced cancer-related mortality. 40 The reasons of this association are not known and further research is obviously needed.Our data from the meta-analysis suggests that people with OA are at increased risk of premature mortality due to CVD also after accounting for potential confounders. pertaining to site-specific OA are preliminary and should be interpreted with cautious.…”

“…In a great part of the strata heterogeneity remained high. However, in some studies there was a significantly higher risk of overall mortality and a moderate-to-substantial reduction of between-18 study heterogeneity: European studies; death ascertainment using death certificates; multiple joints affected; radiological diagnosis of OA.Since the pooled HR for hand OA on overall mortality appeared to be marginally protective (p=0.07), a sensitivity analysis was conducted to remove the effect of three datasets (PRO.V.A 40,41 ). This analysis demonstrated that for hand OA, pooled HR for mortality was 1.18 (95% CI: 1.07 to 1.30; p=0.001; I 2 =48%)…”