Interdisziplinäres Fachgespräch „Gonarthrose“ - Deutsche ...

Prof. Coggon, Southampton:
I think in the Framingham Study there
were positive associations with occupational
exposure to kneeling and squatting
and heavy physical work. With regard to
the evidence on recreational exposures, I
would agree that there is not much evidence
linking osteoarthritis of the knee
with recreational physical exposures,
which is why we didn’t fi nd it necessary to
collect information and adjust for it in the
analysis of occupational exposures. The
one exception to that is football injuries.
Injuries to the knee that can lead to later
osteoarthritis. But I think we need go back
and just remind ourselves of what the
Framingham Study showed. My recollection
is that there was an association with
kneeling and squatting and with heavy
work in the Framingham Study – but you
may be right.
Dr. Frank, Karlsruhe:
Mich interessiert in diesem Zusammenhang
die Untersuchung zu den Hebedenschen
Knoten, die Sie gemacht haben.
Auch hier haben Sie eine positive statistische
Assoziation gefunden, ich nehme an,
im Zusammenhang mit der Frage, ob die
Leute eine rheumatische Disposition hatten.
Ich interessiere mich in dem Zusammenhang
auch dafür, ob Sie weitere
Co-Morbidität auf orthopädischem Gebiet
untersucht haben, denn wir wissen ja,
dass Leute mit einer Erkrankung der Knie,
der Hüfte oder der Wirbelsäule häufi g
eine beträchtliche orthopädische und
auch eine internistische Co-Morbidität
aufweisen. Haben Sie das untersucht?
Prof. Coggon, Southampton:
We restricted ourself in this study to looking
at Heberden’s nodes as the most
easily ascertainable marker for a possible
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systemic tendency to osteoarthritis. There
is quite a lot of evidence that some individuals
presumably for genetic reasons are
predisposed to osteoarthritis at multiple
joints. The distal interphalangeal joint is
one of the most frequently affected sites.
And it is relatively accessible so you do
not have to x-ray somebody in order to
ascertain it. The training in the ascertainment
was done by my rheumatological
colleague, and the nurses were asked to
classify people according to its presence.
We have previously shown that it was also
associated with hip-osteoarthritis in another
case-control-study. We didn’t look at
the other joints. There could be an association
because of a systemic tendency. Of
course there could also be an association
because of changes in mechanical loading.
If you have knee osteoarthritis on one side
then that changes your gait and may put
increased stresses on other joints as a consequence.
So there at least are two mechanisms
by which having osteoarthritis in
one joint could be associated with having
the disease in other joints as well. But our
purpose in looking at Heberden’s nodes
was specifi cally to try to get a measure of
generalised tendency to osteoarthritis.
Prof. Bolm-Audorff, Wiesbaden:
I have also a question to the Heberden’s
nodes. There is discussion according the
issue between occupational exposure like
heavy grip and osteoarthritis of the fi ngerjoints.
When you fi nd an association
between defi ned Heberden’s nodes and
osteoarthritis of the knee this might be
confounded by occupational exposure in
heavy workers which also have an osteoarthritis
of the fi nger joints. Have you tried
to adjust it?