title: Association between weight or body mass index and hand osteoarthritis: a systematic review.
abstract: OBJECTIVE
  To investigate the association between weight or body mass index (BMI) and the development of hand osteoarthritis.
  
  
  METHODS
  Systematic review of observational studies. Medical databases were searched up to April 2008. Articles that presented data on the association between weight and hand osteoarthritis were selected. The qualities of these studies were then assessed by two independent reviewers using a 19 criteria scoring system. Using the mean scores of all studies as a cut-off value, the studies were deemed as high or low quality. Study quality and study designs were combined to determine the level of evidence using best-evidence synthesis, which consisted of five levels of evidence.
  
  
  RESULTS
  From the 25 studies included, two had cohort, three case-control and 20 cross-sectional study designs. Fifteen studies were considered high-quality studies. Of these high-quality studies, one cohort, two case-control and seven cross-sectional studies showed a positive association between weight or BMI and hand osteoarthritis. Based on three high-quality studies with preferred study designs (one cohort and two case-control) with a positive association, the level of evidence of the association between overweight and developing hand osteoarthritis is moderate. The approximate risk ratio of this association is 1.9.
  
  
  CONCLUSIONS
  Weight or BMI is associated with the development of hand osteoarthritis. The level of evidence of published studies is moderate according to best-evidence synthesis. Further high-quality cohort or case-control studies are needed to elucidate the role of weight in hand osteoarthritis.
authors.affiliation: Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands. e.yusuf@lumc.nl
authors.forename: Erlangga
authors.initials: E
authors.lastname: Yusuf
authors.forename: Rob G
authors.initials: RG
authors.lastname: Nelissen
authors.forename: Andreea
authors.initials: A
authors.lastname: Ioan-Facsinay
authors.forename: Vedrana
authors.initials: V
authors.lastname: Stojanovic-Susulic
authors.forename: Jeroen
authors.initials: J
authors.lastname: DeGroot
authors.forename: Gerjo
authors.initials: G
authors.lastname: van Osch
authors.forename: Saskia
authors.initials: S
authors.lastname: Middeldorp
authors.forename: Tom W J
authors.initials: TW
authors.lastname: Huizinga
authors.forename: Margreet
authors.initials: M
authors.lastname: Kloppenburg
mesh_terms: D015992:Body Mass Index; D001835:Body Weight / Q000502:physiology; D019317:Evidence-Based Medicine / Q000379:methods; D050823:Hand Joints; D006801:Humans; D010003:Osteoarthritis / Q000209:etiology* / Q000503:physiopathology; D050177:Overweight / Q000150:complications*; D017594:Publication Bias