CONCISE REPORTS Association between osteoarthritis of the hand and knee in a population of skeletons from London

Objective—To examine the relation between osteoarthritis of the hand and knee in a group of skeletons dating to the 18th and early 19th centuries from two sites in London. Methods—This was a case-control study of 115 cases and controls matched for age and sex. Cases were skeletons with osteoarthritis of the hands; cases and controls were assessed for the presence of osteoarthritis of any compartment of the knee. Results—Cases had a significant odds ratio (OR) for osteoarthritis of the knee compared with controls: OR 5.98, 95% confidence interval (CI) 1.25 to 56.37. Cases with osteoarthritis of the distal interphalangeal (DIP), proximal interphalangeal (PIP), and first carpometacarpal (CMC1) joints had increased but nonsignificant odds ratios for osteoarthritis of the knee in the order DIP > PIP > CMC1. Cases with multifocal osteoarthritis of the hands had a significantly increased odds ratio for osteoarthritis of the knee: OR 11.67, 95% CI 1.13 to 379.57. Conclusions—The study confirms the association between osteoarthritis of the hand and the knee seen in contemporary populations and suggests that it is not of very recent origin. (Ann Rheum Dis 1997;56:116–118) A subset of osteoarthritis in which the hand and knee are both involved has been recognised clinically for many years and was confirmed epidemiologically by Cushnagen and Dieppe for a group of women, but not men, attending a rheumatology clinic. The association was studied more recently by Hirsch and her colleagues in the participants of the Baltimore longitudinal study of aging. These investigators examined joints of the hand radiologically and identified three groups: those with osteoarthritis of the distal interphalangeal joint (DIP), proximal interphalangeal joint (PIP), and first carpometacarpal joint (CMC1) and they also defined a fourth group of individuals with at least two of these joints aVected. They found significant crude odds ratios for knee osteoarthritis for all four groups, the highest value being for the group with multiple joint involvement. Osteoarthritis is a disease which occurs commonly in the skeleton and is straightforward to diagnose; on these grounds it has been a disease to which palaeopathologists have given a good deal of attention. It occurs at all periods but some changes in the pattern of osteoarthritis seem to have taken place over time. For example, osteoarthritis of the hip was more common than osteoarthritis of the knee in the medieval period, but in post-medieval skeletons the converse is the case. 4 Osteoarthritis of the knee is the more common form in contemporary populations but whether the change from the earlier pattern is due to a increase in osteoarthritis of the knee or to a decrease in osteoarthritis of the hip is at present unclear from the skeletal evidence. To see whether the association between osteoarthritis of the hand and the knee was of recent origin, it has been studied in a group of skeletons recovered from archaeological sites dating from the late 18th and early 19th centuries. Methods The skeletons came from two sites in London, Farringdon Street and Christ Church, Spitalfields. The cemetery in Farringdon Street was an overflow cemetery for the St Bride’s Parish and was used from the middle of the 18th century to the early 19th century; the crypt at Spitalfields was used for burials between 1729 and 1857. The skeletons had all been sexed and aged, using standard anthropological methods for other purposes before this study was undertaken; osteoarthritis was never used as an aging criterion. The skeletons were placed into one of two 10 year age bands (35-44 or 45-54) or an age group of 55+. Osteoarthritis was diagnosed whenever a joint surface showed the presence of eburnation since this is considered to be pathognomonic of the condition in palaeopathological material. Cases were taken as skeletons with osteoarthritis of the hands and for which age and sex had been reliably ascertained. It was a condition of entry to the study that both hands and both knee joints were present, and that at least one surface representative of each of the Annals of the Rheumatic Diseases 1997;56:116–118 116 St Mary’s Hospital, Praed Street, London W2 1NY; Institute of Archaeology, University College London, London WC1H 0PY, United Kingdom H A Waldron Correspondence to: Dr H A Waldron, 31 Maidstone Road, London N11 2TR. Accepted for publication 7 November 1996 group.bmj.com on April 9, 2017 Published by http://ard.bmj.com/ Downloaded from