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LETTERS: Iain Chambers, John Lourie, Peter Lanyon, Kenneth Muir, Sally Doherty, and Michael Doherty Genetic contribution to osteoarthritis of the hip BMJ 2001; 322: 1247 [Full text]

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Transmission by genes and culture

Dominic Stevens   (12 June 2001)

Transmission by genes and culture 12 June 2001
Dominic Stevens, General Practitioner 65 Riverview Grove Send response to journal: Re: Transmission by genes and culture	EDITOR - The paper by Lanyon et al (1) adds evidence that there is familial aggregation of osteoarthritis in various joints. Their study and the studies they quote suggest that individual genes may be found to be involved, but that environmental factors are important. Croft (2) suggests "the possibility that aspects of life in countries outside Europe and America might protect against hip arthritis. One suggestion is that squatting, with the hip contained comfortably under even pressure in the acetabulum, protects and nurtures mechanical resistance to deformity of the hip. But what is good for the hip is in biomechanical terms potentially harmful to the knee." Noriko Yoshimura at al (3) suggest that "further geographic studies" of hip OA "are required to characterize the profile of risk in different populations, and to shed light on the interplay between constitutional and mechanical factors in its pathogenesis" Posture and activity may both be important. I have reported (4) the observation that in a Saudi Arabian Primary Care Facility, arthritis of the medial compartment of the knee was strikingly common and that hip arthritis was almost unknown. I speculated that the traditional sitting posture, on the floor with ankles crossed and hips widely abducted and externally rotated, puts pressure on the medial compartments of the knees. I wondered if the opposite hip posture - adduction and internal rotation - which occurs when sitting on a chair with legs crossed at the thighs, might contribute to the higher prevalence of hip arthritis in the UK. This posture might be a familial characteristic by copying rather that through the genes. Dominic Stevens General Practitioner London W4 3QP dominic@debbies.freeserve.co.uk 1 Lanyon P, Muir K, Doherty S, Doherty M. Assessment of a genetic contribution to osteoarthritis of the hip: sibling study. BMJ 2000; 321: 479-483 2 Croft,P.The occurrence of osteoarthritis outside Europe. In Proceedings of a workshop in collaboration with the EULAR standing committed for epidemiology, 8 - 10 Feb 1996. Orenas, Sweden. Annals of Rheumatic Diseases 1996;55:661 - 664 3 Yoshimura N, Sasaki S, Iwasaki K, Danjoh S, Kinoshita H, Yasuda T, Tamaki T, Hashimoto T, Kellingray S, Croft P, Coggon D, Cooper C. Occupational lifting is associated with hip osteoarthritis: a Japanese case-control study.J Rheumatol. 2000 Feb;27(2):434-40. 4 Stevens.D, The nature and causes of osteoarthritis. Letter. BMJ 1983; 286: 897