Ann Rheum Dis 72:646-651 doi:10.1136/annrheumdis-2011-201178
  • Clinical and epidemiological research
  • Extended report

Association of atherosclerosis with presence and progression of osteoarthritis: the Rotterdam Study

  1. Sita Bierma-Zeinstra1,4,5
  1. 1General Practice, Erasmus University Medical Centre, Rotterdam, The Netherlands
  2. 2Department of Epidemiology, Erasmus University Medical Centre, Rotterdam, The Netherlands
  3. 3Netherlands Genomics Initiative, Rotterdam, The Netherlands
  4. 4Department of Orthopaedic Surgery and Traumatology, University Hospital, Antwerp, Belgium
  5. 5Department of Orthopaedics, Erasmus University Medical Centre, Rotterdam, The Netherlands
  6. 6Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands
  1. Correspondence to Theun Antonius Hoeven, Erasmus University Medical Centre, General Practice, Rotterdam 3015 CA, The Netherlands; t.hoeven{at}
  1. Contributors All co-authors contributed to the realisation of this paper and of course revised the paper several times. Contributions to different parts of the paper are categorised in order of importance MK, data management vascular variables, methodology (measures of atherosclerosis, co-factors), discussion; SC, data management osteoarthritis hip and knee, introduction, discussion; HJMK, data management hand osteoarthritis, methodology (assessment of osteoarthritis, statistical analysis); JBvM, introduction, statistical analysis, discussion; OF, abstract, introduction, discussion, methodology; AH, data management, methodology (bias), discussion; PB, abstract, discussion, methodology; JW, data management, discussion, methodology, abstract; SBZ, abstract, introduction, study design, discussion.

  • Accepted 15 April 2012
  • Published Online First 6 May 2012


Objective This study examined whether vascular alterations are associated with the presence and progression of osteoarthritis of the knee, the hip and the different hand joints in a large prospective cohort study.

Methods In this population-based study involving participants aged 55 years and older (Rotterdam Study I), men (n=2372) and women (n=3278) were analysed separately. x-Rays of the knee, hip and hand were scored using the Kellgren and Lawrence score for osteoarthritis at baseline, after 6.6 years and 10 years. Measures of atherosclerosis (carotid intima media thickness (IMT) and carotid plaque) and data on covariates (age, body mass index, hypertension, cholesterol ratio, diabetes mellitus and smoking) were collected at baseline. Multivariate logistic regression models with generalised estimated equations were used to calculate OR and corresponding 95% CI. Secondary multiple comparison adjustment resulted in a significance level of p<0.0021.

Results In women, IMT showed an independent association with the prevalence of knee osteoarthritis (adjusted OR (aOR) 1.7, 1.1 to 2.7), and carotid plaque with distal interphalangeal (DIP) osteoarthritis (aOR 1.4, 1.2 to 1.7) and with metacarpophalangeal osteoarthritis (aOR 1.5, 1.1 to 2.2). An independent association for IMT with progression of metacarpophalangeal osteoarthritis was found in women (aOR 2.9, 1.18 to 6.93). Additional adjustment for multiple testing yielded a significant association between carotid plaque and DIP osteoarthritis in women (p<0.001).

Conclusions This study showed independent associations of atherosclerosis with osteoarthritis of the knee and hand joints in women. The evidence was most solid for a relation with DIP osteoarthritis. More research is needed to confirm the associations and examine the differential association with various joints.


  • Funding This study was funded by the Dutch Arthritis Foundation.

  • Ethics approval The study was approved by the ethics committee of the Erasmus University Medical Centre, Rotterdam.

  • Patient consent Obtained.

  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.