The association between hormonal and reproductive factors and hand osteoarthritis.
OBJECTIVE
To describe the association of reproductive and hormonal factors with the presence and severity of hand osteoarthritis (OA) in Tasmanian women.


METHODS
Cross-sectional study of 348 women from 76 families. A structured questionnaire collected information regarding reproductive history and the use of estrogen containing medications. Hand OA was assessed by two observers using the Altman atlas for joint space narrowing and osteophytes at distal interphalangeal (DIP) and carpometacarpal (CMC) joints, as well as Heberden's nodes (HN) based on hand photography.


RESULTS
The prevalence of hand OA was high in this sample at 65-70%. Parity, increasing age at menopause and years of menstruation were associated with both symptomatic hand OA and a more severe DIP score (but not presence of radiographic disease) while both current and ever use of hormone replacement therapy (HRT) were significantly associated with increased prevalence of HN and severity of HN and DIP OA (all P<0.05). HRT usage less than 5 years was associated with increased severity of both DIP disease and HN. No factors were associated with CMC disease apart from ever breast-feeding which was protective (OR 0.37, 95% CI 0.18-0.79).


CONCLUSIONS
These results require confirmation in clinical trials or carefully controlled longitudinal studies but suggest that estrogen exposure around the time of disease onset (either endogenous or exogenous) may have a "priming" effect on the severity of DIP OA while breast-feeding in earlier life may be protective for CMC OA.
Cooley
Helen M
HM
Menzies Centre for Population Health Research, GPO Box 252-23, Hobart, Tasmania 7000, Australia.
Stankovich
James
J
Jones
Graeme
G
D000368:Aged; D003430:Cross-Sectional Studies; D004967:Estrogens / Q000008:administration & dosage*; D005260:Female; D006225:Hand; D006801:Humans; D008875:Middle Aged; D010003:Osteoarthritis / Q000453:epidemiology* / Q000209:etiology / Q000235:genetics / Q000473:pathology; D015995:Prevalence; D017584:Reproductive History; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires; D013648:Tasmania / Q000453:epidemiology; D044465:White People / Q000235:genetics
D004967:Estrogens