Objective. Type 3 finger length pattern (longer fourth digit than second digit) is influenced by prenatal androgens and has been studied previously as a biomarker for sexually dimorphic traits. Because osteoarthritis (OA) and chronic pain are known to be sexually dimorphic traits, we evaluated the association between finger length pattern and OA and chronic joint pain. Methods. This study was part of the Rotterdam Study, a prospective population-based cohort study. We examined 4,784 participants. Associations between type 3 finger length and radiologic knee, hip, and hand OA and chronic joint pain were analyzed using a logistic regression model. Our results for OA were combined with previously published data in a meta-analysis. Results. Participants with type 3 finger length pattern had an odds ratio of 1.64 for hand OA (P = 1.06 x 10(-7)). No associations with radiologic knee or hip OA were observed in the Rotterdam Study. The meta-analysis of previously published data and our novel data showed a significant association between type 3 finger length pattern and clinical symptomatic knee OA, but no association was found with radiologic knee OA. In addition, within the Rotterdam Study, we observed an odds ratio of 1.41 for individuals having joint pain at multiple sites (P = 1.4 x 10(-3)). Conclusion. Type 3 finger length pattern, as an indicator of prenatal androgen exposure, was associated with having symptomatic knee OA, chronic pain, and hand OA. Therefore, it may be applicable as an easy measurable biomarker to identify susceptible subjects for these traits.