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Effects of physical environment on the evolution of Kashin-Beck disease in Tibet

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Abstract

In previous studies we observed a proximo-distal gradient of lesion frequencies along the limb, with the distal joints being the most often affected. This suggests an associated effect of environmental factors on the most exposed joints. On a population of 820 children (mean age 13 years) of endemic areas distributed in groups of healthy and severity stages I to III of KBD (Kashin-Beck disease), the effects of different working activities were studied. Heavy work like that of a ploughman were compared to light physical work, e.g. school children, and exposure to cold and history of frostbite were also considered. The most severe stages, II and III, were present in 72% of the ploughman vs. 29% of the schoolchildren, 70% of the shepherds vs. 30% (p < 0.001) of the schoolchildren, and in 65% of the shepherds working in winter vs. 40% of those working in the other seasons (p < 0.001). In the group with history of frostbite, 58% present the severest stages vs. 40% without (p < 0.001). The results confirm a highly significant relation between microtrauma and cold and the severity of the KBD alterations.

Résumé

Dans nos précédentes études, nous avions observé un gradient de fréquence proximo-distale des lésions le long des membres, les articulations distales étant les plus souvent atteintes. Ceci suggère un effet associé des facteurs environnementaux sur les articulations les plus exposées. Sur une population de 820 enfants (âge moyen 13ans) provenant de régions endémiques et distribués en groupes sains et de stades de gravité de la maladie de KASHIN-BECK s´échelonnant de I à III, nous avons étudié les effets de différents types d´activités. Les travaux lourds, comme celui de laboureur, ont été comparés à une activité plus légère telle que celle d´écolier. Les stades les plus sévères (II et III) sont présents chez 72% des laboureurs contre 29% chez les écoliers, chez 70% des bergers contre 30% des écoliers (p<0.001) et chez 65% des bergers travaillant en hiver contre 40% chez ceux travaillant pendant les autres saisons (p<0.001). Dans le groupe présentant des antécédents de gelure, 58% présentent les stades les plus sévères contre 40% dans le groupe sans antécédents (p<0.001). Ces résultats confirment une relation très hautement significative entre les microtraumas et l´exposition au froid et la sévérité des lésions de la maladie de Kashin-Beck..

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Acknowledgements

We would like to ackowledge the KBD Foundation.

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Authors and Affiliations

  1. Hôpital Erasme, Service d’Orthopédie Traumatologie, Université Libre de Bruxelles (ULB), 808 route de Lennik, 1070, Brussels, Belgium

    M. Hinsenkamp & J. -F. Collard

  2. Kashin-Beck Disease Foundation, 6 rue de l’Aunée, 6953, Forrières, Belgium

    F. Mathieu & W. Claus

  3. Department of Biostatistcs and Medical Computing & IRIBHN, Université Libre de Bruxelles (ULB), 808 route de Lennik, 1070, Brussels, Belgium

    V. de Maertelaer

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  1. M. Hinsenkamp
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  2. F. Mathieu
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  3. W. Claus
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  4. J. -F. Collard
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  5. V. de Maertelaer
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Correspondence to M. Hinsenkamp.

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Hinsenkamp, M., Mathieu, F., Claus, W. et al. Effects of physical environment on the evolution of Kashin-Beck disease in Tibet. International Orthopaedics (SICOT) 33, 1085–1088 (2009). https://doi.org/10.1007/s00264-009-0738-9

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  • DOI: https://doi.org/10.1007/s00264-009-0738-9

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