Adipokine genes and radiographic hand osteoarthritis in Finnish women: a cross-sectional study.

OBJECTIVES: Available evidence suggests that genetic factors and overweight play major roles in the aetiology of osteoarthritis (OA). We analysed the association of 18 single-nucleotide polymorphisms (SNPs) from nine adipokine and adipokine receptor genes (LEP, LEPR, ADIPOQ, RETN, NAMPT, SERPINA12, ITLN1, RARRES2, and APLN) with radiographic hand OA. METHOD: The study design was cross-sectional. Bilateral hand radiographs of 542 occupationally active Finnish female dentists and teachers aged 45-63 years were examined and classified for the presence of hand OA using reference images. Hand OA was defined as at least three finger joints with radiographic OA of grade 2-4. The genotypes were determined using polymerase chain reaction-based methods. Body mass index (BMI) was calculated based on self-reported height and measured weight. Associations of the individual SNPs and their haplotypes with hand OA were tested using logistic regression analysis. RESULTS: The minor allele of RETN rs10401670 was associated with a decreased [odds ratio (OR) = 0.73, 95% confidence interval (CI) 0.55-0.97, p = 0.03] and RARRES2 rs4721 with an increased (OR 1.41, 95% CI 1.07-1.87, p = 0.01) prevalence of hand OA. Also, LEPR AC (OR 1.54, 95% CI 1.01-2.35, p = 0.05) and RETN GGTT (OR 0.58, 95% CI 0.37-0.93, p = 0.02) haplotypes were associated with hand OA. These associations were modified by BMI when comparing normal and overweight women. However, the associations lost their statistical significance after adjusting for multiple testing. CONCLUSION: Our results suggest weak associations between the studied variations in LEPR, RARRES2, and RETN genes and hand OA in Finnish women, and that the associations are modified by BMI. However, these associations could not be verified in the current study.

EULAR revised recommendations for the management of fibromyalgia.

OBJECTIVE: The original European League Against Rheumatism recommendations for managing fibromyalgia assessed evidence up to 2005. The paucity of studies meant that most recommendations were 'expert opinion'. METHODS: A multidisciplinary group from 12 countries assessed evidence with a focus on systematic reviews and meta-analyses concerned with pharmacological/non-pharmacological management for fibromyalgia. A review, in May 2015, identified eligible publications and key outcomes assessed were pain, fatigue, sleep and daily functioning. The Grading of Recommendations Assessment, Development and Evaluation system was used for making recommendations. RESULTS: 2979 titles were identified: from these 275 full papers were selected for review and 107 reviews (and/or meta-analyses) evaluated as eligible. Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise. Based on expert opinion, a graduated approach, the following four main stages are suggested underpinned by shared decision-making with patients. Initial management should involve patient education and focus on non-pharmacological therapies. In case of non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programme (for severe disability). CONCLUSIONS: These recommendations are underpinned by high-quality reviews and meta-analyses. The size of effect for most treatments is relatively modest. We propose research priorities clarifying who will benefit from specific interventions, their effect in combination and organisation of healthcare systems to optimise outcome.

Association between occupational psychosocial factors and waist circumference is modified by diet among men.

BACKGROUND/OBJECTIVES: Occupational psychosocial stress has been identified as a risk factor for obesity, whereas dietary habits have a key role in weight control. We examined whether dietary habits modify the association between occupational psychosocial factors and waist circumference. SUBJECTS/METHODS: Data comprised 31-year-old men (n=2222) and women (n=2053) in the Northern Finland Birth Cohort 1966. Waist circumference was measured and data on occupational psychosocial factors (demands, control and social support) and other characteristics were obtained through questionnaires. Healthy and unhealthy diet indices were constructed according to the current dietary guidelines. Associations were examined using analysis of variance adjusted for body mass index at age 14, basic education level, leisure-time physical activity, alcohol consumption, smoking, stress-related eating behaviour and parity. RESULTS: Among men, high job demands and high job control were associated with greater waist circumferences, and there were interactions between unhealthy diet and job demands (P=0.043) and job control (P=0.036) in relation to waist circumference. The waist of men with high demands or high control and low consumption of unhealthy foods (red/processed meat, hamburgers and pizzas, fried potatoes, sugar-sweetened soft drinks and white bread) was smaller than that of men with high demands or high control and high consumption of such foods. No associations were found among women. CONCLUSIONS: A diet based on the current dietary guidelines seems to cancel out the adverse effects of occupational psychosocial factors on waist circumference among young men. Longitudinal studies are needed to assess the risks for obesity-related diseases arising from psychosocial work environments and dietary habits.

Multisite musculoskeletal pain predicts medically certified disability retirement among Finns.

BACKGROUND: Musculoskeletal pain at several sites (multisite pain) is more common than single-site pain. Little is known on its effects on disability pension (DP) retirement. METHODS: A nationally representative sample comprised 4071 Finns in the workforce aged 30 to 63. Data (questionnaire, interview, clinical examination) were gathered in 2000-2001 and linked with national DP registers for 2000-2011. Pain during the preceding month in 18 locations was combined into four sites (neck, upper limbs, low back, lower limbs). Hazard ratios (HR) of DP were estimated by Cox regression. RESULTS: The HR of any DP (n = 477) was 1.6 (95% confidence interval 1.2-2.1) for one, 2.5 (1.9-3.3) for two, 3.1 (2.3-4.3) for three and 5.6 (4.0-7.8) for four pain sites, when adjusted for age and gender. When additionally adjusted for clinically assessed chronic diseases, the HRs varied from 1.4 (1.0-1.8) to 3.5 (2.5-4.9), respectively. When further adjusted for physical and psychosocial workload, education, body mass index, smoking, exercise and sleep disorders, the HRs were 1.3 (0.9-1.7), 1.6 (1.2-2.2), 1.8 (1.3-2.5) and 2.5 (1.8-3.6). The number of pain sites was especially strong in predicting DPs due to musculoskeletal diseases (HRs in the full model; 3.1 to 4.3), but it also predicted DPs due to other somatic diseases (respective HRs 1.3 to 2.3); pain in all four sites was also predictive of DPs due to mental disorders (full model HR 2.2). CONCLUSIONS: The number of pain sites independently predicted DP retirement. Employees with multisite pain may need specific support to maintain their work ability.

Multi-site pain and working conditions as predictors of work ability in a 4-year follow-up among food industry employees.

BACKGROUND: We investigated the separate and joint effects of multi-site musculoskeletal pain and physical and psychosocial exposures at work on future work ability. METHODS: A survey was conducted among employees of a Finnish food industry company in 2005 (n = 1201) and a follow-up survey in 2009 (n = 734). Information on self-assessed work ability (current work ability on a scale from 0 to 10; 7 = poor work ability), multi-site musculoskeletal pain (pain in at least two anatomical areas of four), leisure-time physical activity, body mass index and physical and psychosocial exposures was obtained by questionnaire. The separate and joint effects of multi-site pain and work exposures on work ability at follow-up, among subjects with good work ability at baseline, were assessed by logistic regression, and p-values for the interaction derived. RESULTS: Compared with subjects with neither multi-site pain nor adverse work exposure, multi-site pain at baseline increased the risk of poor work ability at follow-up, allowing for age, gender, occupational class, body mass index and leisure-time physical activity. The separate effects of the work exposures on work ability were somewhat smaller than those of multi-site pain. Multi-site pain had an interactive effect with work environment and awkward postures, such that no association of multi-site pain with poor work ability was seen when work environment was poor or awkward postures present. CONCLUSIONS: The decline in work ability connected with multi-site pain was not increased by exposure to adverse physical or psychosocial factors at work.

Risk factors of chronic neck pain: a prospective study among middle-aged employees.

OBJECTIVE: To study the associations of sociodemographic factors, working conditions, lifestyle and previous pain in the spine with new onset chronic neck pain (NP). METHODS: The participants were municipal employees free of chronic NP at baseline, aged 40, 45, 50, 55 or 60 years (n = 5277, 80% women). Self-reported data on occupational class, working conditions, body mass index, smoking, exercise, mental well-being, sleep problems, NP and low back pain (LBP) were obtained from baseline questionnaire surveys in 2000-2002. The question on chronic NP was repeated in a follow-up in 2007. Logistic regression analysis was used. RESULTS: The incidence of chronic NP was 15% in women and 9% in men. In multivariable analysis among women, acute NP [odds ratio (OR) 3.8, 95% confidence interval (CI) 2.9-5.1], chronic LBP (1.6, 1.2-2.2), reporting current workplace bullying (OR 1.6, 95% CI 1.1-2.4), earlier bullying at the present workplace (1.6, 1.2-2.0), and earlier bullying in another workplace (1.8, 1.3-2.4), frequent sleep problems (1.5, 1.2-2.0), overweight (1.2, 1.0-1.5), and obesity (1.4, 1.1-1.8) predicted chronic NP at follow-up. Men with acute NP (2.3, 1.4-3.8), chronic LBP (2.3, 1.2-4.3), manual occupational class (1.8, 1.1-3.1) and high work-related emotional exhaustion (1.9, 1.1-3.3) at baseline had an increased risk of new onset chronic NP. CONCLUSIONS: We found potentially modifiable predictors of chronic NP among employees: workplace bullying, sleep problems, and high body mass index in women, and work-related emotional exhaustion in men. In both genders, previous acute NP and chronic LBP were predictive of chronic NP.

Recommendations for standardization and phenotype definitions in genetic studies of osteoarthritis: the TREAT-OA consortium.

OBJECTIVE: To address the need for standardization of osteoarthritis (OA) phenotypes by examining the effect of heterogeneity among symptomatic (SOA) and radiographic osteoarthritis (ROA) phenotypes. METHODS: Descriptions of OA phenotypes of the 28 studies involved in the TREAT-OA consortium were collected. We investigated whether different OA definitions result in different association results by creating various hip OA definitions in one large population based cohort (the Rotterdam Study I (RSI)) and testing those for association with gender, age and body mass index using one-way ANOVA. For ROA, we standardized the hip-, knee- and hand ROA definitions and calculated prevalence's of ROA before and after standardization in nine cohort studies. This procedure could only be performed in cohort studies and standardization of SOA definitions was not feasible at this moment. RESULTS: In this consortium, all studies with SOA phenotypes (knee, hip and hand) used a different definition and/or assessment of OA status. For knee-, hip- and hand ROA five, four and seven different definitions were used, respectively. Different hip ROA definitions do lead to different association results. For example, we showed in the RSI that hip OA defined as "at least definite joint space narrowing (JSN) and one definite osteophyte" was not associated with gender (P =0.22), but defined as "at least one definite osteophyte" was significantly associated with gender (P=3×10(-9)). Therefore, a standardization process was undertaken for ROA definitions. Before standardization a wide range of ROA prevalence's was observed in the nine cohorts studied. After standardization the range in prevalence of knee- and hip ROA was small. CONCLUSION: Phenotype definitions influence the prevalence of OA and association with clinical variables. ROA phenotypes within the TREAT-OA consortium were standardized to reduce heterogeneity and improve power in future genetics studies.

Hand osteoarthritis and pinch grip strength among middle-aged female dentists and teachers.

OBJECTIVES: Among female dentists and teachers, we investigated the relationship of pinch grip strength with radiographic hand osteoarthritis (OA) and hand joint pain. MATERIALS AND METHODS: We studied 295 female dentists and 248 female teachers aged 45-63 years for pinch grip strength using the Martin Vigorimeter. Hand radiographs were examined for the presence of OA in the wrist and each joint of the first, second, and third fingers. Joint pain and tasks with high hand loading during leisure were assessed by questionnaire. Glove size was used as proxy for hand size. RESULTS: Symptomatic hand OA (jointwise co-occurrence of radiological findings and pain) increased the risk of low pinch grip strength in both hands, with an odds ratio (OR) of 3.3 (95% CI 1.8-6.2) for the right and 2.0 (95% CI 1.1-3.8) for the left hand, allowing for age, occupation, body mass index (BMI), hand size, and hand-loading leisure-time activity. The occurrence of findings and pain in non-corresponding joints was also associated with pinch grip strength in the right hand, but not in the left. Having only radiographic findings or pain was not associated with pinch grip strength. CONCLUSIONS: Our findings support the view that hand function is related to the severity of hand OA.

Prospective study on shoulder symptoms among kitchen workers in relation to self-perceived and observed work load.

OBJECTIVES: To study the occurrence of shoulder symptoms among professional kitchen workers, and whether reduction in self-perceived and observed physical work load decreases future symptoms. METHODS: In this prospective study conducted in 2002-2005 in municipal kitchens in Finland, changes during a 1-year follow-up in the physical strenuousness of work tasks were self-assessed by 376 female workers (substudy I). Changes in exposure to manual lifting and awkward upper arm posture during the follow-up were also observed by experts in 69 kitchens with 183 workers (substudy II). Information on shoulder symptoms was collected with questionnaires at baseline and at follow-up. The risk of shoulder symptoms at follow-up related to changes in exposure was estimated with logistic regression. RESULTS: The 3-month prevalence of shoulder pain was 34% at baseline and 41% at follow-up. Reduction during follow-up in work tasks perceived as the most strenuous physically (ie, receiving and storing raw food) led to a significantly reduced risk of future shoulder pain with an adjusted odds ratio (OR) of 0.41 (95% CI 0.17 to 0.98) and trouble caused by the pain with an OR of 0.34 (0.14 to 0.83). The observed reduction in lifting was also associated with a lower risk for future shoulder symptoms. CONCLUSIONS: Reduction in lifting showed beneficial protective effects on the shoulder. Although more risk factor and intervention studies are needed to estimate the health impacts of kitchen work, special attention should be paid to work tasks that include lifting when assessing risk and designing preventive measures.

COL2A1 gene polymorphisms and susceptibility to osteoarthritis of the hand in Finnish women.

OBJECTIVES: To study the role of two COL2A1 single nucleotide polymorphisms (rs3737548 and rs2276455) and their haplotypes in individual susceptibility to osteoarthritis (OA) of the hand in Finnish women. METHODS: Bilateral hand radiographs of 543 Finnish female dentists and teachers aged 45-63 years were examined and classified for the presence of OA by using reference images. The COL2A1 genotypes were determined by PCR-based methods. Data regarding other risk factors were collected by questionnaire. The haplotypes were statistically reconstructed from the genotype data by the PHASE program. Associations between the genotypes/diplotypes and hand OA were studied by logistic regression. RESULTS: Allowing for age and occupation, the carriage of at least one COL2A1 intron 33 minor allele was associated with an increased risk of hand OA (odds ratio (OR) 1.58, 95% CI 1.05 to 2.36) and the number of affected joints. When stratified by occupation, the increased risk associated with the intron 33 minor allele carriage appeared to be mainly attributable to the dentists (OR 2.18, 95% CI 1.18 to 4.06). The 2-1 haplotype (exon 5B minor allele-intron 33 major allele) posed a significantly higher risk of hand OA (OR 3.21, 95% CI 1.08 to 9.55) compared with non-carriers. Moreover, an interaction was observed between intron 33 minor allele carriage and low task variation history in dental work (OR 2.87, 95% CI 1.05 to 7.89 for their joint effect). CONCLUSIONS: The results suggest that the studied COL2A1 gene polymorphisms may play a role in the aetiology of hand OA and that this effect may be enhanced by repetitive loading work tasks.

The effect of pain on sickness absence among middle-aged municipal employees.

OBJECTIVES: To study the effects of pain on sickness absence, taking into account physical and psychosocial work load and socio-economic position. METHODS: Data consisted of City of Helsinki personnel register data on sickness absence and a cross-sectional questionnaire survey which was carried out among employees of the City of Helsinki who reached the age of 40, 45, 50, 55 or 60 years during the years 2000-2002 (n = 8960, response rate 67%). Data sets were combined for those who gave permission for such linkage (78%). The main statistical method was negative binomial regression analysis. RESULTS: The burden of pain on sickness absence was dependent on the duration of absence: the longer the duration, the higher the burden. Self-certified absence was equally predicted by acute and chronic pain, but medically certified absence was more clearly predicted by chronic pain. Adjustments for a range of work load factors and socio-economic position showed that pain was a relatively independent determinant of subsequent sickness absence, but in particular physical work load and socio-economic position explained a small proportion of the association. Overall, pain accounted for 13% of self-certified absence among women and 8% among men. Corresponding figures were 23% and 25% for medically certified 4-14-day sickness absence and 37% and 30% for absence of over 2 weeks. CONCLUSIONS: The burden of pain on medically certified sickness absence is considerable. Prevention of pain problems is vital for reducing sickness absence rates.

Evaluation of work-related psychosocial factors and regional musculoskeletal pain: results from a EULAR Task Force.

OBJECTIVES: To establish whether review articles provide consistent conclusions on associations between workplace psychosocial factors and musculoskeletal pain and, if differences exist, to explore whether this is related to the methods used. METHODS: Reviews, reported up to February 2007, that included consideration of workplace psychosocial factors and upper limb, back or knee pain were identified through searches of multiple databases. The specific work-related psychosocial factors considered were job demands, support, job autonomy and job satisfaction. The conclusions of each review on one or more of the psychosocial/musculoskeletal pain associations were extracted. RESULTS: 15 review articles were identified that considered one or more of the regional pain syndromes included in the study. For back pain, the most consistent conclusions (four reviews positive out of six) were with high job demands and low job satisfaction. The studies of upper limb pain were exclusively related to shoulder and/or neck pain, and the most consistent positive conclusions were with high and low job demands (four reviews positive out of six and two reviews positive out of three, respectively). For knee pain, only a single review was identified. For individual reviews of back and upper limb pain, there were marked differences in the number of associations concluded to be positive between reviews. CONCLUSIONS: The reasons for reviews coming to different conclusions included that they were often evaluating different bodies of evidence (according to their search criteria, the year when the review was conducted, the role that quality assessment played in whether studies contributed to evidence, and the combination of risk factors addressed in individual studies), but more important was whether the review specified explicit criteria for making conclusions on strength of evidence. These conclusions emphasise the importance of developing standardised methods for conducting such evaluations of existing evidence and the importance of new longitudinal studies for clarifying the temporal relationship between psychosocial factors and musculoskeletal pain in the workplace.

A randomised controlled trial on whether a participatory ergonomics intervention could prevent musculoskeletal disorders.

OBJECTIVES: To examine the efficacy of a participatory ergonomics intervention in preventing musculoskeletal disorders among kitchen workers. Participatory ergonomics is commonly recommended to reduce musculoskeletal disorders, but evidence for its effectiveness is sparse. METHODS: A cluster randomised controlled trial among the 504 workers of 119 kitchens in Finland was conducted during 2002-2005. Kitchens were randomised to an intervention (n = 59) and control (n = 60) group. The duration of the intervention that guided the workers to identify strenuous work tasks and to seek solutions for decreasing physical and mental workload, was 11 to 14 months. In total, 402 ergonomic changes were implemented. The main outcome measures were the occurrence of and trouble caused by musculoskeletal pain in seven anatomical sites, local fatigue after work, and sick leave due to musculoskeletal disorders. Individual level data were collected by a questionnaire at baseline and every 3 months during the intervention and 1-year follow-up period. All response rates exceeded 92%. RESULTS: No systematic differences in any outcome variable were found between the intervention and control groups during the intervention or during the 1-year follow-up. CONCLUSIONS: The intervention did not reduce perceived physical work load and no evidence was found for the efficacy of the intervention in preventing musculoskeletal disorders among kitchen workers. It may be that a more comprehensive redesign of work organisation and processes is needed, taking more account of workers' physical and mental resources.

Visual scoring of atherosclerosis in chest computed tomography: findings among male construction workers.

BACKGROUND: Standard chest computed tomography (CT) examinations may contain valuable and underused information on atherosclerosis. PURPOSE: To study the retrospective scoring of chest atherosclerosis in CT studies performed for reasons other than cardiovascular. MATERIAL AND METHODS: Unenhanced CT images originally used for lung cancer screening of 505 male construction workers were retrospectively analyzed for chest atherosclerotic calcifications (coronary, aortic, and precervical artery origins). Findings were compared between those with a prediagnosed cardiovascular disease or diabetes (n = 180) and disease-free subjects (n = 325). RESULTS: Arterial calcifications (all) occurred among 96.6% of the subjects and coronary calcifications among 91.7%. The average total calcium score of the diseased subjects was 8.34 vs. 5.13 in the disease-free group (P<0.001). All calcification scores increased with age. In multivariable analyses, systolic blood pressure, erythrocyte sedimentation rate, and smoking were generally associated with high scores, while high stature and high diastolic blood pressure were mainly associated with low scores. Nonsignificant positive associations between asbestos exposure and coronary calcifications were found. CONCLUSION: Our scoring method agreed well with preknown cardiovascular risk factors, indicating the method's usability. Chest CT examinations contain valuable information concerning atherosclerosis. This can be used epidemiologically or to reveal occult atherosclerotic disease.

Association between overweight and dip osteoarthritis among middle-aged Finnish female dentists and teachers.

SUMMARY: The objective of this study was to examine associations between body mass index (BMI) and symptomatic and non-symptomatic radiographic osteoarthritis in the distal interphalangeal joints (DIP ROA). The subjects were 295 female dentists and 248 female teachers aged 45-63 years randomly selected from the registers of the Finnish Dental Association and the Finnish Teachers' Trade Union of the Helsinki metropolitan region. Radiographs of both hands were examined for the presence of osteoarthritis in each DIP joint. Information on the occurrence of pain in each DIP joint during the past 30 days and hand laterality was obtained by questionnaire. Current BMI was based on self-reported height and measured weight. BMI at the age of 25 years was based on self-reported height and weight. Overweight was defined as BMI ≥ 25.0 kg/m(2). Allowing for age, occupation, hand-loading leisure-time physical activity and smoking history, the risk of symptomatic DIP ROA was increased in currently overweight women (OR 1.98, 95% CI 1.18-3.34) and in women with overweight both currently and at the age of 25 (7.55; 1.33-42.83). The OR for an increase of one standard deviation in BMI at the age of 25 was 1.20 (1.05-1.38) and that for a similar increase in current BMI 1.08 (1.01-1.16), adjusted as above. No relationship of BMI with non-symptomatic DIP ROA or joint pain only was found. The study provides evidence that the risk of symptomatic DIP ROA is increased among overweight middle-aged women. Consideration even of BMI at young adulthood further underlines the association.:

Finger joint pain in relation to radiographic osteoarthritis and joint location--a study of middle-aged female dentists and teachers.

OBJECTIVES: To investigate the associations of radiographic finger joint osteoarthritis (ROA), hand laterality (right/left) and anatomical location within the hand, with finger joint pain. METHODS: Radiographs of both hands of 295 female dentists and 248 female teachers were examined for the presence of osteoarthritis in each finger joint, using grades 0 = no OA, 1 = doubtful OA, 2 = mild OA, 3 = moderate OA, 4 = severe OA. Information on the occurrence of pain in each finger joint during the past 30 days and hand laterality was obtained by questionnaire. RESULTS: Compared with subjects with no ROA, the prevalence ratio (PR) of finger joint pain was 1.92 [95% confidence interval (CI) 1.61-2.34] among those with mild ROA and 5.34 (4.51-6.54) among those with at least moderate ROA, based on a multivariate log-binomial regression model. Pain was slightly more common in the right than in the left hand (1.27; 1.15-1.40). Compared with the little finger, more pain occurred in the thumb (2.67; 2.25-3.16), the index finger (1.76; 1.50-2.07) and the middle finger (1.47; 1.24-1.74). Further, pain was more common in the proximal interphalangeal (1.77; 1.56-2.00) and the distal interphalangeal (1.51; 1.29-1.76) joints than in the metacarpophalangeal joints. The strength of the association between ROA and finger joint pain increased with the severity of pain. CONCLUSIONS: Our findings suggest that ROA, anatomic localization within the hand, and hand laterality have independent effects on finger joint pain.

Increased absence due to sickness among employees with fibromyalgia.

BACKGROUND: Little is known about the effect of fibromyalgia on absence due to sickness in working populations. OBJECTIVE: To examine the risk of absence due to sickness among employees with fibromyalgia. METHODS: A prospective cohort study with 1-year follow-up of recorded and certified absence due to sickness after a survey of chronic diseases among 34 100 Finnish public sector employees (27 360 women and 6740 men) aged 17-65 years at baseline in 2000-2. RESULTS: 20 224 days of absence due to sickness for the 644 employees with fibromyalgia and 454 816 days for others were documented. Of those with fibromyalgia, 67% had co-occurring chronic conditions such as osteoarthritis, rheumatoid arthritis, depression or other psychiatric disorders. Compared with employees with none of these chronic conditions, the hazard ratio (HR) adjusted for age, sex and occupational status was 1.85-fold (95% confidence interval (CI) 1.53 to 2.18) for people with fibromyalgia alone and 2.63-fold (95% CI 2.34 to 2.96) for employees with fibromyalgia with coexisting conditions. The excess rate of absence due to sickness was 61 episodes/100 person-years among people with fibromyalgia alone. Among employees with musculoskeletal and psychiatric disorders, secondary fibromyalgia was associated with a 1.4-1.5-fold increase in risk of absence. CONCLUSION: Fibromyalgia is associated with a substantially increased risk of medically certified absence due to sickness that is not accounted for by coexisting osteoarthritis, rheumatoid arthritis or psychiatric disorders.

Aggrecan core protein of a certain length is protective against hand osteoarthritis.

OBJECTIVE: To study the contribution of aggrecan VNTR (variable number of tandem repeats) polymorphism to clinically differing manifestations of hand osteoarthritis (OA). DESIGN: Five hundred thirty Finnish females representing two academically similar occupations with completely diverse exposure to hand load were included. Radiographs of hands were analysed, the OA findings were graded and the subjects were divided into categories. Aggrecan VNTR alleles were identified by Southern hybridization. Statistical analyses were used to compare joint involvement and pathological findings with the prevalences of the alleles and genotypes. RESULTS: Subjects homozygous for the most common aggrecan VNTR allele, A27 with 27 repeats, had a significantly lower risk of hand OA, with OR 0.46 (95% CI 0.27-0.78) for OA of grade 2 or more. Our results suggest that carrying two copies of the alleles with less than 27 repeats could predispose a subject to a severe hand OA (OR 2.45, 95% CI 1.17-5.12) and carrying two copies of the alleles with more than 27 repeats also increases the risk of the disease (OR 1.73, 95% CI 1.03-2.89). CONCLUSIONS: These findings indicate that allele A27 provides protection from hand OA and that alleles shorter or longer than this may predispose subjects to the disease. Furthermore, they suggest that a certain number of tandem repeats provide for optimal functioning of the aggrecan molecule and that the contribution of genetic factors to the development of hand OA may be even more important than that of environmental factors.

Stability and prediction of physical activity in 5-, 10-, and 28-year follow-up studies among industrial employees.

The aim of the study was to examine the stability of voluntary and household physical activity (PA) and to compare it with that of the use of the most common stimulants. The prospective cohort study comprised of follow-ups at 5, 10, and 28 years at baseline in 1973 in four plants of an industrial corporation in Finland. A systematic, non-proportional sample (n=902, age range 18-64 years) stratified for age, gender, and occupational status was drawn from the employees. Scores of PA were based on a questionnaire and interviews. Logistic regression models with proportional odds assumptions were counted. The 5-year stability (Spearman's rho) of PA time was 0.44 (PA intensity 0.44), the respective 10-year coefficient was 0.26 (0.32), and that in the 28-year follow-up was 0.18 (0.20). The stability of PA decreased rapidly from 1973 to 1983 and more slowly thereafter. Changes along the follow-up reflect a polarization of the distributions of PA within the sample. Age and an initially low level of activity were the strongest predictors of inactivity. The stability coefficient of smoking and alcohol consumption was twice as high as that of PA. Stimulant use was a greater factor in the individual's lifestyle than PA.

How consistently distributed are the socioeconomic differences in severe back morbidity by age and gender? A population based study of hospitalisation among Finnish employees.

AIMS: To study the socioeconomic distribution of severe back morbidity by age and gender, and to examine to what extent the differences in back morbidity between socioeconomic groups are particularly related to manual work in different age groups. METHODS: Hospital admissions in 1996 for back disorders of 25-64 year old men (3123 of a total 743,961) and women (3043 of 773,936) from the Finnish Hospital Discharge Register were linked with demographic and socioeconomic data from the 1995 population census. Poisson regression analysis was used to calculate the rate ratios for back related hospitalisation by occupational class and education. The distribution of cases according to occupational status and education was presented in relation to the whole occupationally active workforce by age and gender. RESULTS: Blue-collar (manual) workers had a higher risk of being hospitalised because of back disorders compared with white-collar employees (non-manual) in all age groups among both genders. Manual work versus non-manual work was associated with a 1.3 to 1.4-fold risk (95% CI 1.0 to 1.8) among women and a 1.3 to 1.6-fold risk (95% CI 1.1 to 2.2) among men. The risk of hospitalisation was further inversely associated with educational level within manual and non-manual work in all other age groups except in those aged 55-64 years. Gender related differences were much smaller compared with the socioeconomic ones. CONCLUSIONS: Socioeconomic differences in back morbidity leading to hospitalisation were consistent by age and gender. The results suggest that not only the physical strenuousness of work, but also other causes of severe back disorders are clustered around a subject's socioeconomic status, indicated by formal education. This may have implications for prevention and the planning of rehabilitation.