People whose index finger is shorter than their ring finger are at higher risk of osteoarthritis

Jan 7 2008

A study of more than 2,000 people, published in the journal Arthritis and Rheumatism, suggests that people whose index finger is shorter than their ring finger are up to twice as likely to suffer from the condition, which is the most common form of arthritis.

Index to ring finger length ratio (referred to as 2D:4D) is a trait known for its differences between the sexes. Men typically have shorter second than fourth digits; in women, these fingers tend to be about equal in length. Smaller 2D:4D ratios have intriguing hormonal connections, including higher prenatal testosterone levels, lower oestrogen concentrations, and higher sperm counts. Reduction in this ratio has also been linked to athletic and sexual prowess.

Whether this trait affects the risk of osteoarthritis (OA), the most common form of arthritis that may associate with both physical activity and oestrogen deficiency, has not been examined — until now.

Researchers at The University of Nottingham conducted a case-control study to assess the relationship between the 2D: 4D ratio and the risk of knee and hip OA. Their findings suggest that having a relatively long ring finger to index finger ratio raises the risk for developing OA of the knee, independent of other risk factors and particularly among women.

For the study, 2,049 case subjects were recruited from hospital orthopaedic surgery lists and a rheumatology clinic in Nottingham. All had clinically significant symptomatic OA of the knees or hips, requiring consideration of joint replacement surgery. Recruited from hospital lists of patients who had undergone intravenous urography (IVU) within the past five years, 1,123 individuals with no radiographic evidence of hip or knee OA, no present hip or knee symptoms, and no history of joint disease or joint surgery served as a control group.

The study population was comprised of both men and women, with an average age of approximately 67 years for cases and 63 years for controls.

Radiographs of both knees and the pelvis were obtained for all participants. Every participant also underwent separate radiographs of the right and left hands. Researchers then assessed the 2D:4D length ratio from radiographs using three methods: a direct visual comparison of the two finger ends, the measured ratio from the base to the tip of the upper finger joints, and the measured ratio of the metacarpal bone lengths.

Hands radiographs were classified visually as either type 1, index finger longer than the ring finger; type 2, index finger equal to the ring finger; or type 3, index finger shorter than the ring finger. Not surprisingly, men were 2.5 times more likely than women to have the type 3 pattern.

Using blind comparisons of hand radiographs with both knee and hip radiographs from random case and control samples combined with statistical analysis and odds ratios, researchers assessed the relationship between 2D:4D length ratio and OA. Compared with the other finger types, the type 3 finger was associated with an increased risk of OA involving any part of the knee or the hip, and including the presence of arthritic finger nodes. Of particular note, the risk of knee OA in participants with the type 3 finger pattern was nearly double that of the risk for participants without this pattern. Women with this finger pattern had a greater risk of knee OA than men.

Among participants of both sexes, researchers also found an interesting trend: the smaller the 2D:4D upper finger joint ratio, the greater the risk of OA of the tibiofemoral knee joint. Finally, after adjusting for established OA risk factors — age, sex, body mass index, joint injury, and lack of physical activity — the strong association of smaller 2D:4D length ratio with the risk for knee OA was deemed independent.

Professor Michael Doherty, lead researcher, said: “The 2D:4D length ratio appears to be a new risk factor for the development of OA. Specifically, women with the ‘male' pattern of 2D:4D length ratio — that is, ring finger relatively longer than the index finger — are more likely to develop knee OA.”

As the first study to examine the relationship between 2D:4D length ratio and OA, it also raises questions.

“The underlying mechanism of the risk is unclear,” Professor Doherty stressed, “and merits further exploration.”