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Haara et al recently published a study assessing epidemiological aspects of osteoarthritis (OA) in Finland.1 A finding of interest was their identification of OA (in any finger joint) as a predictor of cardiovascular death among men, with the authors suggesting an undetermined metabolic factor as a mechanism.
It may be that the disability conferred by OA in the lower limbs delays presentation of patients with ischaemic heart disease owing to a lack of exertional symptoms. Thus treatment to reduce risk is delayed. Additionally, some patients who also have generalised OA and are less physically active may be at higher risk of cardiac events.2
Occupation and levels of education have been used as surrogates of social class.3 Certain jobs that require repetitive movements or heavier work intensity increase the risk of developing OA,4 although occupation is not always linked to the development of hand OA.5 Generally, manual workers, whose jobs demand higher physical input, are poorly paid compared with professionals.
Haara et al found no link between duration of education and OA of the fingers, but the association between OA and earlier death may, nevertheless, be mediated by an effect of social class. Death due to coronary disease is known to be associated with lower socioeconomic groups. Another Finnish study noted higher incidence of myocardial infarction in those of lower income, with higher pre-hospital, 28 day, and 12 month mortality rates.6 These higher rates may reflect differences in prevalence and awareness of cardiac risk factors among the different socioeconomic groups, which may also contribute to higher cardiovascular death in men with OA.
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