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Different Phenotypes of Osteoarthritis in the Lumbar Spine Reflected by Demographic and Clinical Characteristics: The Johnston County Osteoarthritis Project

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Arthritis Care & Research
Authors:
Adam Goode at Duke University
Adam Goode
Rebecca J Cleveland at University of North Carolina at Chapel Hill
Rebecca J Cleveland
Steven Z. George
Steven Z. George
Steven Z. George
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Virginia B Kraus at Duke University
Virginia B Kraus
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Abstract and Figures

Objective To determine if associations between demographic and clinical characteristics and appendicular joint osteoarthritis (OA) reflect different phenotypes of OA in the lumbar spine. Methods Participants were from the Johnston County OA Project. Demographic information consisted of age, sex, and race (white and African American), and clinical characteristics consisted of body mass index (BMI), low back pain and injury, and knee, hip, and hand OA. Participants were categorized as having spine OA, facet joint OA, both spine OA and facet joint OA, or neither spine OA nor facet joint OA (referent group). Multinomial regression models were used to determine odds ratios (ORs) and 95% confidence intervals (95% CIs). Results Of 1,793 participants, the mean ± SD age was 66.2 ± 10.1 years, and the mean ± SD BMI was 30.7 ± 6.2. The majority of the participants were women (n = 1,144 [63.8%]), and 31.8% of the participants (n = 570) were African American. Eighteen percent of participants had neither spine OA nor facet joint OA, 22.8% had facet joint OA, 13.2% had spine OA, and 46.0% had both spine OA and facet joint OA. In adjusted analyses, African Americans were less likely to have facet joint OA (OR 0.68 [95% CI 0.49–0.95]) or both spine OA and facet joint OA (OR 0.51 [95% CI 0.37–0.70]). Women were more likely to have facet joint OA (OR 1.71 [95% CI 1.24–2.36]). Having a BMI of ≥30 was associated with having facet joint OA (OR 1.76 [95% CI 1.28–2.42]) and both spine OA and facet joint OA (OR 1.85 [95% CI 1.37–2.51]). Knee OA was associated with all 3 OA groups, while lower back injury was associated only with those with spine OA. Participants with hip OA were less likely to have facet joint OA. Conclusion Race, sex, BMI, hip OA, and lower back injury may help identify different OA phenotypes in the lumbar spine.
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974
Arthritis Care & Research
Vol. 72, No. 7, July 2020, pp 974–981
DOI 10.1002/acr.23918
© 2019, American College of Rheumatology
Dierent Phenotypes of Osteoarthritis in the Lumbar Spine
Reected by Demographic and Clinical Characteristics:
The Johnston County Osteoarthritis Project
Adam P.Goode,1 Rebecca J.Cleveland,2 Steven Z.George,1 Virginia B.Kraus,3 Todd A.Schwartz,2
Richard H.Gracely,2 Joanne M.Jordan,2 and Yvonne M.Golightly2
Objective. To determine if associations between demographic and clinical characteristics and appendicular joint
osteoarthritis (OA) reect different phenotypes of OA in the lumbar spine.
Methods. Participants were from the Johnston County OA Project. Demographic information consisted of age,
sex, and race (white and African American), and clinical characteristics consisted of body mass index (BMI), low back
pain and injury, and knee, hip, and hand OA. Participants were categorized as having spine OA, facet joint OA, both
spine OA and facet joint OA, or neither spine OA nor facet joint OA (referent group). Multinomial regression models
were used to determine odds ratios (ORs) and 95% condence intervals (95% CIs).
Results. Of 1,793 participants, the mean ± SD age was 66.2 ± 10.1 years, and the mean ± SD BMI was 30.7 ±
6.2. The majority of the participants were women (n = 1,144 [63.8%]), and 31.8% of the participants (n = 570) were
African American. Eighteen percent of participants had neither spine OA nor facet joint OA, 22.8% had facet joint OA,
13.2% had spine OA, and 46.0% had both spine OA and facet joint OA. In adjusted analyses, African Americans were
less likely to have facet joint OA (OR 0.68 [95% CI 0.49–0.95]) or both spine OA and facet joint OA (OR 0.51 [95% CI
0.37–0.70]). Women were more likely to have facet joint OA (OR 1.71 [95% CI 1.24–2.36]). Having a BMI of ≥30 was
associated with having facet joint OA (OR 1.76 [95% CI 1.28–2.42]) and both spine OA and facet joint OA (OR 1.85
[95% CI 1.37–2.51]). Knee OA was associated with all 3 OA groups, while lower back injury was associated only with
those with spine OA. Participants with hip OA were less likely to have facet joint OA.
Conclusion. Race, sex, BMI, hip OA, and lower back injury may help identify different OA phenotypes in the
lumbar spine.
INTRODUCTION
Chronic low back pain impacts over 31 million Americans
at any given time (1), has increased 3- fold in prevalence over a
10- year period (2), and results in $100–$200 billion per year in
total US expenditures (3). Chronic low back pain can be due to a
number of etiologies, including degeneration of the intervertebral
disc (IVD) and facet joint osteoarthritis (OA). Improved diagnosis
of these poorly understood etiologies is critically important (4–10).
While most treatment options for chronic low back pain have min-
imal side effects or harms, some complications do exist (11–13).
A better understanding of the etiologic process of spine degener-
ation may improve the delivery of interventions to specic lumbar
spine structures.
OA in the spine has been characterized by the combination
of mild radiographic disc space narrowing (DSN) (analogous to
joint space narrowing in an appendicular joint) and at least mild
radiographic vertebral osteophyte formation (at the same lumbar
The contents of this article are solely the responsibility of the authors and
do not necessarily represent the ocial views of the Centers for Disease Control
and Prevention, the National Institutes of Health, the National Institute of Arthri
tis and Musculoskeletal and Skin Diseases, or the National Institute on Aging.
The Johnston County Osteoarthritis Project is supported in part by the CDC/
Association of Schools of Public Health (cooperative agreements S043, S1734,
and S3486) and the NIH/National Institute of Arthritis and Musculoskeletal and
Skin Diseases (NIAMS) Multipurpose Arthritis and Musculoskeletal Disease
Center (grant 5P60AR30701), the NIAMS Multidisciplinary Clinical Research
Center (grant 5P60AR4946503), and the National Institute on Aging (grant
P30AG028716). Drs. Goode, Cleveland, George, Kraus, Schwartz, and Jordan’s
work was supported by the NIAMS (grant R01AR071440). Dr. Golightly’s work
was supported by the NIAMS (grants R01AR06774301 and R01AR071440).
1Adam P. Goode, DPT, PhD, Steven Z. George, PT, PhD: Duke University
School of Medicine and Duke University, Durham, North Carolina; 2Rebecca
J. Cleveland, PhD, Todd A. Schwartz, DrPH, Richard H. Gracely, PhD, Joanne
M. Jordan, MD, MPH, Yvonne M. Golightly, PT, PhD: University of North
Carolina, Chapel Hill; 3Virginia B. Kraus, MD, PhD: Duke University School of
Medicine, Durham, North Carolina.
No potential conicts of interest relevant to this article were
reported.
Address correspondence to Adam P. Goode, DPT, PhD, Department of
Orthopedic Surgery, 200 Morris Street, Durham, NC 27701. Email: Adam.
goode@duke.edu.
Submitted for publication December 3, 2018; accepted in revised form
April 30, 2019.
... Chronic low back pain (LBP) impacts over 31 million Americans [1] and has increased threefold in prevalence over a 10-year period [2], resulting in $100-$200 billion per year in total U.S healthcare expenditures [3]. Chronic LBP is associated with a number of etiologies, including degeneration of the intervertebral disc (IVD), vertebral osteophytes (OST), and facet joint osteoarthritis (FOA) [4][5][6][7][8]. However, determining which, if any, of these structures contributes to the development of LBP is a major clinical challenge. ...
... Both DSN and OST were dichotomized as absent (none) or present (mild, moderate, or severe). Our prior analyses have examined different cut-offs for defining DSN and OST without any significant change in the findings [5,6,[9][10][11]. The intra-rater reliability of this radiologist for the spine features has been reported previously with weighted kappa scores of 0.89 for DSN, 0.90 for OST, and 0.73 for FOA [10]. ...
Biomarker clusters differentiate phenotypes of lumbar spine degeneration and low back pain: The Johnston County Osteoarthritis Project
Article
  • May 2022
Objective Describe the association between biomarkers and lumbar spine degeneration (vertebral osteophytes [OST], facet joint osteoarthritis [FOA], and disc space narrowing [DSN]), for persons with and without low back pain (LBP) and determine whether clusters based on biomarkers differentiate lumbar spine structure with and without LBP. Methods Using data from the Johnston County Osteoarthritis Project (2006–2010), we measured serum N-cadherin, Keratin-19, Lumican, CXCL6, RANTES, HA, IL-6, BDNF, OPG, and NPY, and urinary CTX-II. Biomarkers were used to group participants using k-means cluster analysis. Logistic regression models were used to compare biomarker clusters. Results The sample consisted of 731 participants with biospecimens and lumbar spine radiographic data. Three biomarker subgroups were identified: one characterized by structural degenerative changes; another characterized by structural degenerative changes and inflammation, with pain; and a referent cluster with lower levels of biomarkers, pain, and structural degenerative changes. Compared to the referent subgroup, the structural change subgroup was associated with DSN (OR = 1.94, 95% CI 1.30–2.90) and FOA (OR = 1.72, 95% CI 1.12–2.62), and the subgroup with structural degenerative change, inflammation, and pain was associated with OST with LBP (OR = 1.60, 95% CI 1.04–2.46), FOA with LBP (OR = 1.59, 95% CI 1.04–2.45), and LBP (OR = 1.63, 95% CI 1.11–2.41). The subgroup with structural degenerative changes was more likely to have OST (OR = 1.82, 95% CI 1.06–3.13) and less likely to have FOA with LBP (OR = 0.62, 95% CI 0.40–0.96) compared to the group with inflammation and pain. Conclusion Clustering by biomarkers may assist in differentiating patients for specific clinical interventions aimed at decreasing LBP.
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... Concomitant hip disease is present in approximately 32% of patients with lumbar degenerative disease 3,4 . Given this prevalence of concomitant hip OA and the close biomechanical relationship between the hip and spine, multiple studies have characterized the biomechanical changes induced by hip OA [5][6][7][8] . ...
Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity Prevalence and Impact on Spine Surgery Outcomes
Article
  • Apr 2024
  • J BONE JOINT SURG AM
Background: Hip osteoarthritis (OA) is common in patients with adult spinal deformity (ASD). Limited data exist on the prevalence of hip OA in patients with ASD, or on its impact on baseline and postoperative alignment and patient-reported outcome measures (PROMs). Therefore, this paper will assess the prevalence and impact of hip OA on alignment and PROMs. Methods: Patients with ASD who underwent L1-pelvis or longer fusions were included. Two independent reviewers graded hip OA with the Kellgren-Lawrence (KL) classification and stratified it by severity into non-severe (KL grade 1 or 2) and severe (KL grade 3 or 4). Radiographic parameters and PROMs were compared among 3 patient groups: Hip-Spine (hip KL grade 3 or 4 bilaterally), Unilateral (UL)-Hip (hip KL grade 3 or 4 unilaterally), or Spine (hip KL grade 1 or 2 bilaterally). Results: Of 520 patients with ASD who met inclusion criteria for an OA prevalence analysis, 34% (177 of 520) had severe bilateral hip OA and unilateral or bilateral hip arthroplasty had been performed in 8.7% (45 of 520). A subset of 165 patients had all data components and were examined: 68 Hip-Spine, 32 UL-Hip, and 65 Spine. Hip-Spine patients were older (67.9 ± 9.5 years, versus 59.6 ± 10.1 years for Spine and 65.8 ± 7.5 years for UL-Hip; p < 0.001) and had a higher frailty index (4.3 ± 2.6, versus 2.7 ± 2.0 for UL-Hip and 2.9 ± 2.0 for Spine; p < 0.001). At 1 year, the groups had similar lumbar lordosis, yet the HipSpine patients had a worse sagittal vertebral axis (SVA) measurement (45.9± 45.5 mm, versus 25.1± 37.1 mm for UL-Hip and 19.0 ± 39.3 mm for Spine; p = 0.001). Hip-Spine patients also had worse Veterans RAND-12 Physical Component Summary scores at baseline (25.7 ± 9.3, versus 28.7 ± 9.8 for UL-Hip and 31.3 ± 10.5 for Spine; p = 0.005) and 1 year postoperatively (34.5 ± 11.4, versus 40.3 ± 10.4 for UL-Hip and 40.1 ± 10.9 for Spine; p = 0.006). Conclusions: This study of operatively treated ASD revealed that 1 in 3 patients had severe hip OA bilaterally. Such patients with severe bilateral hip OA had worse baseline SVA and PROMs that persisted 1 year following ASD surgery, despite correction of lordosis.
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... 12 One study reported that 44% and 34% of people with imaging findings associated with lumbar spine spondylosis also had radiographic knee and hip osteoarthritis, respectively. 13 Buckland et al., found that although patients with severe osteoarthritis have a more limited range-of-motion, there are greater changes in PT from standing to sitting compared to patients with less severe osteoarthritis. 14 Outside of this, however, there is scarce data on the impact of hip and knee osteoarthritis on compensatory © 2024 Wolters Kluwer Health, Inc. ...
Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity
Article
  • Feb 2024
  • SPINE
Study Design Retrospective review of prospectively collected data. Objective To investigate the effect of lower extremity osteoarthritis on sagittal alignment and compensatory mechanisms in adult spinal deformity (ASD). Background Spine, hip, and knee pathologies often overlap in ASD patients. Limited data exists on how lower extremity osteoarthritis impacts sagittal alignment and compensatory mechanisms in ASD. Methods 527 pre-operative ASD patients with full body radiographs were included. Patients were grouped by Kellgren-Lawrence grade of bilateral hips and knees and stratified by quartile of T1-Pelvic Angle (T1PA) severity into low-, mid-, high-, and severe-T1PA. Full body alignment and compensation were compared across quartiles. Regression analysis examined the incremental impact of hip and knee osteoarthritis severity on compensation. Results The mean T1PA for low-, mid-, high-, and severe-T1PA groups was 7.3°, 19.5°, 27.8°, 41.6°, respectively. Mid-T1PA patients with severe hip osteoarthritis had an increased sagittal vertical axis and global sagittal alignment ( P <0.001). Increasing hip osteoarthritis severity resulted in decreased pelvic tilt ( P =0.001) and sacrofemoral angle ( P <0.001), but increased knee flexion ( P =0.012). Regression analysis revealed with increasing T1PA, pelvic tilt correlated inversely with hip osteoarthritis and positively with knee osteoarthritis (r ² =0.812). Hip osteoarthritis decreased compensation via sacrofemoral angle ( β -coefficient=−0.206). Knee and hip osteoarthritis contributed to greater knee flexion ( β -coefficients=0.215, 0.101; respectively). For pelvic shift, only hip osteoarthritis significantly contributed to the model ( β -coefficient=0.100). Conclusions For the same magnitude of spinal deformity, increased hip osteoarthritis severity was associated with worse truncal and full body alignment with posterior translation of the pelvis. Patients with severe hip and knee osteoarthritis exhibited decreased hip extension and pelvic tilt, but increased knee flexion. This examines sagittal alignment and compensation in ASD patients with hip and knee arthritis and may help delineate whether hip and knee flexion is due to spinal deformity compensation or lower extremity osteoarthritis.
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... 6 The most commonly affected joints include the hands and weight-bearing joints (hips, knees, and spine). 6,[8][9][10] Symptoms such as joint pain, stiffness, and diminished physical function are commonly reported. 10,11 OA is a recognized contributor to the progressive decline in physical function. ...
Myofascial Pain as an Unseen Comorbidity in Osteoarthritis: A Scoping Review
Article
  • Feb 2023
  • CLIN J PAIN
Objective: This review aimed to identify, summarize, and appraise the evidence supporting the coexistence of myofascial pain (MPS) and trigger points (MTrP) in osteoarthritis (OA), and the effectiveness of MTrPs treatments in OA-related pain and physical function outcomes. Methods: Three databases were searched from inception to June 2022. We included observational and experimental studies to fulfill our 2 study aims. Two independent reviewers conducted 2-phase screening procedures and risk of bias using checklist tools for cross-sectional, quasi-experimental, and randomized control trials. Patient characteristics, findings of active and latent MTrPs in relevant muscles, treatments, and pain and physical function outcomes were extracted from low-risk bias studies. Results: The literature search yielded 2898 articles, of which 6 observational and 7 experimental studies had a low bias risk and the data extracted. Active MTrPs in knee OA patients was more evident in the quadriceps and hamstring muscles than in healthy individuals. Dry needling on active MTrPs improved pain and physical function in the short term compared with sham treatment in hip OA patients. In knee OA, dry needling on latent or active MTrPs improved pain and functional outcomes compared with sham needling but did not result in better pain and physical outcomes when combined with a physical exercise program. Discussion: The presence of active versus latent MTrPs seems to be a more sensitive discriminating feature of OA given that latent is often present in OA and healthy individuals. Dry needling on active MTrPs improved pain and physical function in the short term compared with sham treatment in hip OA patients. However, the small sample size and the few number of studies limit any firm recommendation on the treatment
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... Similar to knee and hip OA, LSS is most often a result of degenerative changes [11] and these diseases may co-exist in people with either index condition [12]. Supporting this hypothesis, a recent analysis from the Johnston County OA Project found 44% and 34% of people with imaging findings associated with lumbar spine OA also had image-defined knee and hip OA, respectively [13]. Clinical evidence also suggests lower extremity arthritis is common in people with LSS undergoing surgery [14,15]. ...
Prevalence of multimorbid degenerative lumbar spinal stenosis with knee or hip osteoarthritis: a systematic review and meta-analysis
Article
Full-text available
Background Musculoskeletal multimorbidity is common and coexisting lumbar spinal stenosis (LSS) with knee or hip osteoarthritis (OA) has been reported. The aim of this review was to report the prevalence of multimorbid degenerative LSS with knee or hip OA based on clinical and/or imaging case definitions. Methods Literature searches were performed in MEDLINE, EMBASE, CENTRAL, and CINAHL up to May 2021. Studies involving adults with cross-sectional data to estimate the prevalence of co-occurring LSS with knee or hip OA were included. Study selection, data extraction, and risk of bias assessment were performed independently by two reviewers. Results were stratified according to index and comorbid condition, and by case definitions (imaging, clinical, and combined). Results Ten studies from five countries out of 3891 citations met the inclusion criteria. Sample sizes ranged from 44 to 2,857,999 (median 230) and the mean age in the included studies range from 61 to 73 years (median 66 years). All studies were from secondary care or mixed settings. Nine studies used a combined definition of LSS and one used a clinical definition. Imaging, clinical, and combined case definitions of knee and hip OA were used. The prevalence of multimorbid LSS and knee or hip OA ranged from 0 to 54%, depending on the specified index condition and case definitions used. Six studies each provided prevalence data for index LSS and comorbid knee OA (prevalence range: 5 to 41%) and comorbid hip OA (prevalence range: 2 to 35%). Two studies provided prevalence data for index knee OA and comorbid LSS (prevalence range 17 to 54%). No studies reporting prevalence data for index hip OA and comorbid LSS were found. Few studies used comparable case definitions and all but one study were rated as high risk of bias. Conclusions There is evidence that multimorbid LSS with knee or hip OA occurs in people (0 to 54%), although results are based on studies with high risk of bias and surgical populations. Variability in LSS and OA case definitions limit the comparability of studies and prevalence estimates should therefore be interpreted with caution. Review registration PROSPERO ( CRD42020177759 ).
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... Although similar to appendicular OA, degenerative changes at the functional spinal unit and the cascade of structural and symptomatic manifestations are not uniformly recognized as OA. Various terms relating to spinal degeneration exist, including spondylosis, osteoarthritis, osteophytosis, spondylolisthesis, spinal stenosis, and others, highlighting the need for a definition of spinal OA (1,2,8). Recently, there have been calls to define spinal degeneration for the purposes of targeting prevention, disease modification, characterizing phenotypes, treatment, and ultimately improving clinical outcomes (9). ...
Consensus for Statements Regarding a Definition for Spinal Osteoarthritis for Use in Research and Clinical Practice: A Delphi Study
Article
Full-text available
  • Jan 2023
Objective To determine consensus among an international, multidisciplinary group of experts regarding definitions of spinal osteoarthritis for research and for clinical practice. Methods A 15‐member, multidisciplinary steering committee generated 117 statements for a 3‐round Delphi study. Experts in back pain and/or osteoarthritis were identified and invited to participate. In round 1, participants could propose additional statements for voting. All statements were rated on a 1–9 Likert scale, and consensus was set at ≥70% of respondents agreeing or disagreeing with the statement and <15% of respondents providing the opposite response. Results In total, 255 experts from 11 different professional backgrounds were invited. From 173 available experts, 116 consented to participate. In round 1, 103 participants completed the survey, followed by 85 of 111 participants in round 2 (77%) and 87 of 101 participants in round 3 (86%). One‐third of participants were from Europe (30%), most were male (58%), one‐fifth were physical therapists (21%), and over one‐third had been in their profession for 11–20 years (35%). Of 131 statements, consensus was achieved for 71 statements (54%): 53 in agreement (75%) and 18 in disagreement (25%). Conclusion Although there was consensus for statements for definitions of spinal osteoarthritis that were analogous to definitions of osteoarthritis in appendicular joints, a future definition still needs refinement. Importantly, this Delphi highlighted that a future definition should be considered across a spectrum of structural changes and patient symptoms and expressed on a progressive scale.
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... FOA was graded as absent or present at each lumbar level, while DSN and OST were graded in a semiquantitative fashion (0 = none, 1 = mild, 2 = moderate, and 3 = severe). Spine OA was defined as the presence of at least mild OST and mild DSN at the same vertebral level (23,24), which is similar to studies that define spine degeneration with the Kellgren/Lawrence (K/L) atlas (13,17). Spondylolisthesis was graded based on the translation of the vertebrae relative to the diameter of the affected intervertebral disc space, with 0 = no listhesis, 1 = ≤25%, 2 = 26-50%, 3 = 51-75%, 4 = 76-100%, and 5 = >100% translation. ...
Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project
Article
Full-text available
  • Jun 2022
Objective To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). Methods Paired baseline (2003–2004) and follow‐up (2006–2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self‐reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. Results Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09–2.98]), spine OA (HR 1.56 [95% CI 1.01–2.41]), FOA (HR 4.99 [95% CI 1.46–17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02–3.43]), and LBP (HR 1.75 [95% CI 1.19–2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09–2.09]) and LBP (HR 1.51 [95% CI 1.12–2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44–12.2]). Spine OA (HR 1.80 [95% CI 1.24–2.63]) and OST (HR 1.85 [95% CI 1.02–3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04–1.85]) and OST (HR 1.58 [95% CI 1.00–2.49]) were predictors of LBP worsening. Conclusion Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.
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... However, there is evidence suggesting knee OA and low back pain commonly co-exist [24] and low back pain has been identified as a risk factor for the development of knee pain in older adults [35]. A recent study also found the presence of radiographic knee OA was associated with all phenotypes of spinal OA (odds ratios ranging from 1.8 to 4.3) [36], which may represent the spinal changes found in LSS. ...
Prevalence of multimorbid degenerative lumbar spinal stenosis with knee and/or hip osteoarthritis: Protocol for a systematic review and meta-analysis
Article
Full-text available
  • Oct 2020
Background Lumbar spinal stenosis (LSS) and knee and hip osteoarthritis (OA) are prevalent conditions in the aging population and published literature suggests they share many symptoms and often are present at the same time in patients. However, no prevalence estimates of multimorbid LSS and knee and/or hip OA are currently available. The primary objective of this systematic review is therefore to estimate the prevalence of multimorbid LSS with knee and/or hip OA using radiological, clinical, and combined case definitions. Methods This systematic review protocol has been designed according to the guidelines from the Cochrane Collaboration and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. A comprehensive search will be performed in the following databases: MEDLINE, EMBASE, CENTRAL, and CINAHL. Forward citation tracking will be performed in Web of Science. No restriction for publication date and language will be applied in the literature search, but only articles in English will be included. The search strategy will include the following domains: LSS, knee OA, and hip OA. Retrieved citations will be screened by two authors independently. Disagreements will be discussed until consensus, and a third reviewer will be consulted if consensus cannot be reached. Data extraction and assessment of risk of bias assessment will be done by two authors independently, using a standardized data extraction form and a modified risk of bias tool for prevalence studies. Meta-analysis estimating prevalence with 95% CI will be performed using a random effects model. Meta-regression analyses will be performed to investigate the impact of the following covariates: LSS clinical presentations, sample population, healthcare setting, risk of bias, and other patient characteristics on prevalence estimates for multimorbid LSS and knee and/or hip OA. Discussion The results of this review will provide the first estimates of the prevalence of multimorbid LSS and hip and knee OA based on various case definitions. The impact of covariates such as LSS clinical presentations, sample population, healthcare setting, risk of bias, and patient characteristics on prevalence estimates will also be presented. Systematic review registration PROSPERO, awaiting registration
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The Impact of Spinopelvic Alignment on the Facet Joint Degeneration
Article
Full-text available
  • Mar 2023
Study Design Retrospective Cohort. Objectives This study aims to evaluate the relations between facet joint degeneration (FD) and sagittal spinopelvic parameters. Second, the association of FD with degenerative disc disease (DDD) and lumbar disc herniations (LDH) was assessed. Methods The radiologic data of 192 patients was retrospectively analyzed. Total, proximal, and distal lumbar lordosis (LL, PLL, and DLL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and sacral table angle (STA) were measured on lumbar x-ray plates. DDD and FD was graded on the MRI images. The apex of lumbar lordosis and PI-LL imbalance were noted in each patient. Correlation analyses were performed. Results Age and body mass index (BMI) were correlated with FD. LL and DLL are positively associated with upper-level FDs (L1-2 and L2-3) (P < 0,05). PLL were positively associated with lower level FD (L5-S1) (P < 0,05). A significant increase in PI was associated with FD in L2-3 and L4-5. A larger PT was found in FD in L4. The PI-LL imbalance was not correlated with the FD. Correlation between DDD and LDH and FD was observed in each level (P < 0,01). The level of FD is not affected by the apex of the curve. Conclusion Age and BMI have a direct impact on FD. However, spinopelvic parameters influence the severity of FD rather than its occurrence. In addition to the effects of lumbar lordosis as a single entity, it is essential to consider separately the effects of proximal and distal lumbar lordosis at the FD level.
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Biomarkers and Longitudinal Changes in Lumbar Spine Degeneration and Low Back Pain: The Johnston County Osteoarthritis Project
Article
  • Feb 2023
  • OSTEOARTHR CARTILAGE
Objective: To determine if baseline biomarkers are associated with longitudinal changes in the worsening of disc space narrowing (DSN), vertebral osteophytes (OST), and low back pain (LBP). Design: Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for severity of DSN and OST. LBP severity was self-reported. Concentrations of analytes (cytokines, proteoglycans, and neuropeptides) were quantified by immunoassay. Pressure-pain threshold (PPT), a marker of sensitivity to pressure pain, was measured with a standard dolorimeter. Binary logistic regression models were used to estimate odd ratios (OR) and 95% confidence intervals (CI) of biomarker levels with DSN, OST, or LBP. Interactions were tested between biomarker levels and the number of affected lumbar spine levels or LBP. Results: We included participants (n=723) with biospecimens, PPT, and paired lumbar spine radiographic data. Baseline Lumican, a proteoglycan reflective of extracellular matrix changes, was associated with longitudinal changes in DSN worsening (OR=3.19 [95% CI 1.22, 8.01]). Baseline brain-derived neuropathic factor, a neuropeptide, (OR=1.80 [95% CI 1.03, 3.16]) was associated with longitudinal changes in OST worsening, which may reflect osteoclast genesis. Baseline hyaluronic acid (OR=1.31 [95% CI 1.01, 1.71]), indicative of systemic inflammation, and PPT (OR=1.56 [95% CI 1.02, 2.31]) were associated with longitudinal increases in LBP severity. Conclusion: These findings suggest that baseline biomarkers are associated with longitudinal changes occurring in structures of the lumbar spine (DSN vs OST). Markers of inflammation and perceived pressure pain sensitivity were associated with longitudinal worsening of LBP.
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Osteoarthritis and intervertebral disc degeneration: Quite different, quite similar
Article
Full-text available
  • Aug 2018
Intervertebral disc degeneration describes the vicious cycle of the deterioration of intervertebral discs and can eventually result in degenerative disc disease (DDD), which is accompanied by low‐back pain, the musculoskeletal disorder with the largest socio‐economic impact world‐wide. In more severe stages, intervertebral disc degeneration is accompanied by loss of joint space, subchondral sclerosis and osteophytes, similar to osteoarthritis in the articular joint. Inspired by this resemblance, we investigated the analogy between human intervertebral discs and articular joints. Although embryonic origin and anatomy suggest substantial differences between the two types of joint, some features of cell physiology and extracellular matrix in the nucleus pulposus and articular cartilage share numerous parallels. Moreover, there are great similarities in the response to mechanical loading and the matrix‐degrading factors involved in the cascade of degeneration in both tissues. This suggests that the local environment of the cell is more important to its behaviour than embryonic origin. Nevertheless, osteoarthritis is widely regarded as a true disease, while intervertebral disc degeneration is often regarded as a radiological finding and degenerative disc disease is undervalued as a cause of chronic low‐back pain by clinicians, patients and society. Emphasizing the similarities rather than the differences between the two diseases may create more awareness in the clinic, improve diagnostics in degenerative disc disease, and provide cross‐fertilization of clinicians and scientists involved in both intervertebral disc degeneration and osteoarthritis. This article is protected by copyright. All rights reserved.
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The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Statement: Guidelines for Reporting Observational Studies
Article
Full-text available
  • Jun 2008
  • REV ESP SALUD PUBLIC
Much biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study's generalisability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September, 2004, with methodologists, researchers, and journal editors to draft a che-cklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. 18 items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed explanation and elaboration document is published separately and is freely available on the websites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE statement will contribute to improving the quality of reporting of observational studies.
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Body mass index and risk of knee osteoarthritis: Systematic review and meta-analysis of prospective studies
Article
Full-text available
  • Dec 2015
Objectives Obesity is suggested to be a risk factor for knee osteoarthritis (OA). This meta-analysis aimed to examine the relationship between body mass index (BMI) and the risk of knee OA in published prospective studies. Design Meta-analysis. Studies reviewed An extensive literature review was performed, and relevant studies published in English were retrieved from the computerised databases MEDLINE, EMBASE and Cochrane. Methods The effect estimate (RR or HR) and its 95% CI are investigated on the basis of the evaluation of differences of knee OR risk in overweight or obesity versus those with normal weight. Category-specific risk estimates were further transformed into estimates of the RR in terms of per increase of 5 in BMI by using the generalised least-squares method for trend estimation. Studies were independently reviewed by two investigators. Subgroup analysis was performed. Heterogeneity and publication bias were assessed. Data from eligible studies were extracted, and the meta-analysis was performed by using the STATA software V.12.0. Results 14 studies were finally included in the analysis. The results showed that overweight and obesity were significantly associated with higher knee OA risks of 2.45 (95% CI 1.88 to 3.20, p<0.001) and 4.55 (95% CI 2.90 to 7.13, p<0.001), respectively. The risk of knee OA increases by 35% (95% CI 1.18 to 1.53, p<0.001) with a 5 kg/m2 increase in BMI. Subgroup analysis showed that obesity was an independent predictor of knee OA risk regardless of the study country, sample size, gender proportion of participants, duration of follow-up, presence of adjusted knee injury and assessed study quality above or below an NOS score of 8. No publication bias was detected. Conclusions Obesity was a robust risk factor for knee OA. Professionals should take a possible weight reduction into account for the treatment of knee OA whenever a patient is significantly overweight.
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A magnetic resonance imaging framework for quantifying intervertebral disc deformation in vivo: Reliability and application to diurnal variations in lumbar disc shape
Article
  • Feb 2018
  • J BIOMECH
Low back pain is a significant socioeconomic burden in the United States and lumbar intervertebral disc degeneration is frequently implicated as a cause. The discs play an important mechanical role in the spine, yet the relationship between disc function and back pain is poorly defined. The objective of this work was to develop a technique using magnetic resonance imaging (MRI) and three-dimensional modeling to measure in vivo disc deformations. Using this method, we found that disc geometry was measurable with precision less than the in-plane dimensions of a voxel (≈100 µm, 10% of the MRI pixel size). Furthermore, there was excellent agreement between mean disc height, disc perimeter, disc volume and regional disc height measurements for multiple trials from an individual rater (standard deviation <3.1% across all measurements) and between mean height, perimeter, and volume measurements made by two independent raters (error <1.5% across all measurements). We then used this measurement system to track diurnal deformations in the L5-S1 disc in a young, healthy population (n = 8; age 24.1 ± 3.3 yrs; 2 M/6F). We measured decreases in the mean disc height (-8%) and volume (-9%) with no changes in perimeter over an eight-hour workday. We found that the largest height losses occurred in the posterior (-13%) and posterior-lateral (-14%) regions adjacent to the outer annulus fibrosus. Diurnal annulus fibrosus (AF) strains induced by posterior and posterior-lateral height loss may increase the risk for posterior disc herniation or posterior AF tears. These preliminary findings lay a foundation for determining how deviations from normal deformations may contribute to back pain.
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Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: The Johnston County Osteoarthritis Project
Article
  • Jul 2017
Objective: To determine differences in biomarker levels between radiographic phenotypes of facet joint osteoarthritis (FOA) only, spine OA only ((disc space narrowing (DSN) and vertebral osteophytes (OST)) or the combination of FOA and spine OA. Design: A cross-sectional analysis of data from 555 participants in the Johnston County Osteoarthritis Project was performed. Lumbar spine levels were graded by severity (OST and DSN) and presence (FOA) of degeneration. Biomarkers included hyaluronan (HA) and type II collagen (CTX-II). Adjusted risk ratios (aRRR) were estimated using multinomial regression, with adjustment for age, race, sex, body mass index (BMI), and radiographic OA (knee, hip, hand). Interactions were tested between sex, race and low back symptoms. Results: FOA only was present in 22.4%, 14.5% had spine OA only, and 34.6% had the combination of FOA and spine OA. Compared to the reference group of neither FOA or spine OA, a one unit higher ln HA level was associated with 31% higher relative risk ratio (RRR=1.31 ((95% 1.03, 1.67)) of having FOA only, while, a one unit higher ln uCTX-II level was associated with 84% higher relative risk ratio (RRR=1.84 ((95% CI 1.19, 2.84)) of having spine OA only. No significant interactions were identified. Conclusion: Interestingly, OA affecting the synovial facet joint was associated with a marker of inflammation (HA). Spine OA, affecting intervertebral discs that contain collagen type II, was associated with a marker reflecting collagen type II degradation (CTX-II). These findings suggest that biomarkers may reflect the different pathophysiologic processes of lumbar spine OA phenotypes.
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Body mass index and hand osteoarthritis susceptibility: An updated meta-analysis
Article
  • Nov 2016
Aim: Numerous epidemiologic studies have evaluated the association between overweight and hand osteoarthritis; However, the existing results are inconsistent. Methods: Systematic searches were performed and reference lists from the retrieved trials were searched. This meta-analysis and meta-regression was executed to identify all English-language articles that quantitatively assess the strength of associations between body mass index and hand osteoarthritis risk. Study-specific incremental estimates were standardized to determine the risk associated with a 5 kg/m(2) increase in body mass index. We conducted the study according to the guidelines for the meta-analysis of observational studies in epidemiology. Results: Of the 21 studies included, 13 were cross-sectional studies, three were case control studies and five were cohort studies. The pooled summary estimates were 1.10 (95%CI: 0.98-1.24) with no significant difference (P = 0.09). Subgroup analysis shows that body mass index was positively associated with hand osteoarthritis in cross-sectional studies (1.05 [95%CI: 1.02-1.08] P < 0.01), while with no significant difference was found in case-control studies (1.28 [95%CI: 0.87-1.88]) and in cohort studies (1.06 [95%CI: 0.71-1.58]) (P = 0.21 and P = 0.77, respectively). A weak but significant effect on radiographic hand osteoarthritis risk was found. The summary estimates were 1.06 (95%CI: 1.02-1.10) in studies defined by radiography and 1.25 (95%CI: 1.06-1.49) by radiography and clinically (P < 0 .01 and P = 0.01, respectively). Conclusion: It appears that increased body mass index contributes to a positively moderate effect on susceptibility to hand osteoarthritis, as defined radiographically and/or radiographically and clinically. The effects vary by study design and osteoarthritis definition.
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The impact of arthritis in rural populations
Article
  • Jan 1995
Objective. Rural residents may experience more arthritis and disability than urban dwellers. This paper reviews data on arthritis in rural areas and describes a new study, the Johnston County Osteoarthritis Project, a population-based study of osteoarthritis (OA) of the knee and hip in rural North Carolina. Methods. Published reports of urban and rural comparisons of arthritis were reviewed. Data from the first 1,432 African-American and Caucasian participants in the Johnston County Osteoarthritis Project were analyzed. Radiographic knee and hip OA were defined as a Kellgren-Lawrence grade ≥ 2. Functional ability was assessed by the Health Assessment Questionnaire, timed chair stands, and 8-foot walk time. Unweighted prevalences of knee and hip OA were calculated for age, sex, and racial groups. Associations between hip and knee OA, and hip and knee pain and functional ability were examined. Results. Hip OA was present in 27.9% and knee OA in 38.4% of participants. Both were strongly related to age (P < 0.0001), but only knee OA to female sex (odds ratio = 1.33, 95% confidence interval 1.05, 1.68). Neither hip OA nor knee OA was related to race. Hip OA, hip pain, knee OA, and knee pain was each associated with self-reported and observed functional ability. Conclusion. Residents in rural areas may experience more arthritis and disability than previously expected. Contrary to other studies, African-American and Caucasian residents of rural Johnston County, North Carolina, have similar high rates of knee and hip OA. Further study is needed to address urban/rural differences in arthritis and its impact, with adequate control of confounders, standard definitions of rural/urban and of disease, and assessment of multiple arthritis outcomes.
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Association of Knee Injuries With Accelerated Knee Osteoarthritis Progression: Data From the Osteoarthritis Initiative
Article
  • Nov 2014
Objective: We aimed to evaluate whether a recent knee injury was associated with accelerated knee osteoarthritis (OA) progression. Methods: In the Osteoarthritis Initiative, we studied participants free of knee OA on their baseline radiographs (Kellgren/Lawrence [K/L] <2). We compared 3 groups as follows: 1) individuals with accelerated progression of knee OA: defined as having at least 1 knee that progressed to end-stage knee OA (K/L grade 3 or 4) within 48 months, 2) common knee OA progression: at least 1 knee increased in radiographic scoring within 48 months (excluding those defined as accelerated knee OA), and 3) no knee OA: no change in K/L grade in either knee. At baseline, participants were asked if their knees had ever been injured, and at each annual visit they were asked about injuries during the prior 12 months. We used multinomial logistic regressions to determine whether a new knee injury was associated with the outcome of accelerated knee OA or common knee OA progression, after adjusting for age, sex, body mass index, static knee malalignment, and systolic blood pressure. Results: A knee injury during the total observation period was associated with accelerated knee OA progression (n = 54; odds ratio [OR] 3.14) but not common knee OA progression (n = 187; OR 1.08). Furthermore, a more recent knee injury (within a year of the outcome) was associated with accelerated (OR 8.46) and common knee OA progression (OR 3.12). Conclusion: Recent knee injuries are associated with accelerated knee OA. Most concerning is that certain injuries may be associated with a rapid cascade toward joint failure in less than 1 year.
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