title: Hand osteoarthritis in relation to mortality and incidence of cardiovascular disease: data from the Framingham heart study.
abstract: OBJECTIVE
  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.
authors.affiliation: Department of Rheumatology, Diakonhjemmet Hospital, Oslo, Norway.
authors.forename: Ida K
authors.initials: IK
authors.lastname: Haugen
authors.affiliation: Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA Department of Cardiology, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Vasan S
authors.initials: VS
authors.lastname: Ramachandran
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Devyani
authors.initials: D
authors.lastname: Misra
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Tuhina
authors.initials: T
authors.lastname: Neogi
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Jingbo
authors.initials: J
authors.lastname: Niu
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Tianzhong
authors.initials: T
authors.lastname: Yang
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Zhang
authors.affiliation: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts, USA.
authors.forename: David T
authors.initials: DT
authors.lastname: Felson
mesh_terms: D000368:Aged; D020520:Brain Infarction / Q000453:epidemiology* / Q000401:mortality; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality; D003327:Coronary Disease / Q000453:epidemiology* / Q000401:mortality; D005260:Female; D050823:Hand Joints / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000453:epidemiology* / Q000401:mortality; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D010003:Osteoarthritis / Q000000981:diagnostic imaging / Q000453:epidemiology*; D011859:Radiography; D013223:Statistics as Topic
keywords: Cardiovascular Disease; Epidemiology; Hand Osteoarthritis; Osteoarthritis
references.citation: BMC Musculoskelet Disord. 2012 Aug 21;13:150
references.pmid: 22906083
references.citation: Ann Rheum Dis. 2012 Oct;71(10):1606-15
references.pmid: 22736093
references.citation: J Rheumatol. 2011 Aug;38(8):1665-70
references.pmid: 21572158
references.citation: Scand J Rheumatol. 2001;30(3):169-71
references.pmid: 11469529
references.citation: Clin Exp Rheumatol. 2008 Sep-Oct;26(5 Suppl 51):S120-4
references.pmid: 19026154
references.citation: Am Heart J. 1986 Jun;111(6):1177-92
references.pmid: 3716991
references.citation: Best Pract Res Clin Rheumatol. 2001 Dec;15(5):693-709
references.pmid: 11812016
references.citation: J Rheumatol. 1996 Apr;23(4):716-22
references.pmid: 8730133
references.citation: Ann Rheum Dis. 2003 Feb;62(2):151-8
references.pmid: 12525385
references.citation: Circulation. 1999 Mar 9;99(9):1165-72
references.pmid: 10069784
references.citation: J Bone Joint Surg Am. 2004 Jul;86(7):1452-7
references.pmid: 15252092
references.citation: Nat Rev Rheumatol. 2012 Dec;8(12):729-37
references.pmid: 22907293
references.citation: Ann Rheum Dis. 2011 Jun;70(6):1087-90
references.pmid: 21367759
references.citation: Ann Rheum Dis. 2011 Sep;70(9):1581-6
references.pmid: 21622766
references.citation: Arthritis Rheum. 2006 May;54(5):1378-89
references.pmid: 16645966
references.citation: Saudi Med J. 2003 Jul;24(7):745-7
references.pmid: 12883606
references.citation: Prev Med. 1975 Dec;4(4):518-25
references.pmid: 1208363
references.citation: Am J Public Health Nations Health. 1967 Jun;57(6):1015-24
references.pmid: 6067346
references.citation: Curr Atheroscler Rep. 2011 Aug;13(4):298-305
references.pmid: 21626308
references.citation: Osteoarthritis Cartilage. 2012 Nov;20(11):1217-26
references.pmid: 22796312
references.citation: Ann Rheum Dis. 2009 Nov;68(11):1696-700
references.pmid: 19033292
references.citation: Am J Epidemiol. 1995 Feb 1;141(3):225-34
references.pmid: 7840096
references.citation: J Rheumatol. 1998 Sep;25(9):1827-32
references.pmid: 9733467
references.citation: Clin Exp Rheumatol. 2009 Mar-Apr;27(2):347-53
references.pmid: 19473582
references.citation: BMJ. 2011 Mar 08;342:d1165
references.pmid: 21385807
references.citation: Heart Fail Rev. 2012 Sep;17(4-5):581-8
references.pmid: 21626426
references.citation: Ann Rheum Dis. 2007 Jun;66(6):764-70
references.pmid: 17412741
references.citation: Am J Epidemiol. 1997 Jan 1;145(1):72-80
references.pmid: 8982025
references.citation: Arthritis Res Ther. 2009;11(3):R80
references.pmid: 19490621
references.citation: Eur J Intern Med. 2012 Oct;23(7):575-9
references.pmid: 22841864
references.citation: Ann Rheum Dis. 2013 May;72(5):646-51
references.pmid: 22563029
references.citation: Diabet Med. 1998 Jul;15(7):539-53
references.pmid: 9686693
references.citation: Am J Epidemiol. 2002 Dec 1;156(11):1021-7
references.pmid: 12446258
references.citation: Ann Rheum Dis. 2010 Apr;69(4):761-5
references.pmid: 19487215
references.citation: Ann Rheum Dis. 2005 Nov;64(11):1539-41
references.pmid: 16107512
references.citation: Ann Rheum Dis. 2012 Jun;71(6):899-904
references.pmid: 22121126