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What If We Prevent Obesity? Risk Reduction in Knee Osteoarthritis Estimated Through a Meta-Analysis of Observational Studies
Abstract
To summarize the overall relative risk of knee osteoarthritis (OA) associated with body mass index, and to estimate the potential risk reduction due to the control of this risk factor.
Six electronic databases were searched up to July 2010. Relative risk was estimated using odds ratio (OR). A random-effects model was used to pool the results. Risk reduction was estimated using population-attributable risk percentage (PAR%), i.e., the proportion of knee OA that would have been avoided if obesity had not been present in the population. The percentage of obesity in different populations was obtained from the International Obesity Task Force.
Forty-seven studies (446,219 subjects) were included in the meta-analysis, of which there were 14 cohort, 19 cross-sectional, and 14 case-control studies. The overall pooled ORs for overweight and obese individuals were 2.02 (95% confidence interval [95% CI] 1.84-2.22) and 3.91 (95% CI 3.32-4.56), respectively. Risk reduction in terms of PAR% for knee OA varied from 8% in China to 50% in the US, depending on the prevalence of overweight and obesity. The reduction was greater in severe symptomatic OA than in asymptomatic radiographic OA.
Obesity is a risk factor for many conditions, including knee OA. The benefit of modifying this risk factor may cause significant risk reduction of knee OA in the general population, especially in Western countries where obesity is prevalent.
... With the ageing population and prolongation of working life, a large increase in the prevalence of disabling OA is to be expected, imposing a high burden on health care services [3]. Although modifiable risk factors of OA are known, evidence for the prevention potential of targeting these factors is limited [15,16]. The importance of a risk factor for the prevention of a health outcome can be assessed by the population attributable fraction (PAF). ...
... According to a systematic review and meta-analysis, 5% of new cases of knee pain in adults >50 years of age were attributed to knee injury [6]. PAF associated with excess body weight varied between 8 and 60%, depending on the prevalence of overweight/obesity and the severity of knee OA [6,15]. The largest PAFs were observed for severe symptomatic knee OA awaiting total joint replacement and the smallest for asymptomatic radiographic knee OA [15]. ...
... PAF associated with excess body weight varied between 8 and 60%, depending on the prevalence of overweight/obesity and the severity of knee OA [6,15]. The largest PAFs were observed for severe symptomatic knee OA awaiting total joint replacement and the smallest for asymptomatic radiographic knee OA [15]. Studies in earlier 1990s estimating aetiological fractions suggested that 20-40% of hip OA might result from physically demanding occupations [17,18]. ...
Objectives:
To explore the relative contribution of cumulative physical workload, sociodemographic and lifestyle factors, as well as prior injury to hospitalization due to knee and hip OA.
Methods:
We examined a nationally representative sample of persons aged 30-59 years, who participated in a comprehensive health examination (the Health 2000 Study). A total of 4642 participants were followed from mid-2000 to end-2015 for the first hospitalization due to knee or hip OA using the National Hospital Discharge Register. We examined the association of possible risk factors with the outcome using a competing risk regression model (death was treated as competing risk) and calculated population attributable fractions for statistically significant risk factors.
Results:
Baseline age and BMI as well as injury were associated with the risk of first hospitalization due to knee and hip OA. Composite cumulative workload was associated with a dose-response pattern with hospitalizations due to knee OA and with hospitalizations due to hip OA at a younger age only. Altogether, prior injury, high BMI and intermediate to high composite cumulative workload accounted for 70% of hospitalizations due to knee OA. High BMI alone accounted for 61% and prior injury only for 6% of hospitalizations due to hip OA.
Conclusion:
Our results suggest that overweight/obesity, prior injury and cumulative physical workload are the most important modifiable risk factors that need to be targeted in the prevention of knee OA leading to hospitalization. A substantial proportion of hospitalizations due to hip OA can be reduced by controlling excess body weight.
... Given the known relationship between obesity and increased risk of TKR [35], we also performed sensitivity analyses to evaluate the impact of two contrasting assumptions regarding future population obesity rates. For these analyses, data on obesity trends were obtained from the ABS Australian Health Surveys and the relative risk (RR) of TKR associated with overweight and obesity was obtained from a meta-analysis [35]. ...
... Given the known relationship between obesity and increased risk of TKR [35], we also performed sensitivity analyses to evaluate the impact of two contrasting assumptions regarding future population obesity rates. For these analyses, data on obesity trends were obtained from the ABS Australian Health Surveys and the relative risk (RR) of TKR associated with overweight and obesity was obtained from a meta-analysis [35]. We chose pooled risk estimates as these involved a large number of studies and patients, and were similar to the Australian estimates [35]. ...
... For these analyses, data on obesity trends were obtained from the ABS Australian Health Surveys and the relative risk (RR) of TKR associated with overweight and obesity was obtained from a meta-analysis [35]. We chose pooled risk estimates as these involved a large number of studies and patients, and were similar to the Australian estimates [35]. The population attributable fraction (PAF) for obesity was calculated using a modified Peto-Lopez formula [36], which combines the population distribution of a risk factor and RR of having a single outcome. ...
Background
Comprehensive national joint replacement registries with well-validated data offer unique opportunities for examining the potential future burden of hip and knee osteoarthritis (OA) at a population level. This study aimed to forecast the burden of primary total knee (TKR) and hip replacements (THR) performed for OA in Australia to the year 2030, and to model the impact of contrasting obesity scenarios on TKR burden.
Methods
De-identified TKR and THR data for 2003–2013 were obtained from the Australian Orthopaedic Association National Joint Replacement Registry. Population projections and obesity trends were obtained from the Australian Bureau of Statistics, with public and private hospital costs sourced from the National Hospital Cost Data Collection. Procedure rates were projected according to two scenarios: (1) constant rate of surgery from 2013 onwards; and (2) continued growth in surgery rates based on 2003–2013 growth. Sensitivity analyses were used to estimate future TKR burden if: (1) obesity rates continued to increase linearly; or (2) 1–5% of the overweight or obese population attained a normal body mass index.
Results
Based on recent growth, the incidence of TKR and THR for OA is estimated to rise by 276% and 208%, respectively, by 2030. The total cost to the healthcare system would be $AUD5.32 billion, of which $AUD3.54 billion relates to the private sector. Projected growth in obesity rates would result in 24,707 additional TKRs totalling $AUD521 million. A population-level reduction in obesity could result in up to 8062 fewer procedures and cost savings of up to $AUD170 million.
Conclusions
If surgery trends for OA continue, Australia faces an unsustainable joint replacement burden by 2030, with significant healthcare budget and health workforce implications. Strategies to reduce national obesity could produce important TKR savings.
... [5][6][7] Through the recent decades, several studies have been performed concerning the links between dietary factors and OA. [8][9][10] Moreover, overweight is related with a two-time higher ORs of OA while obesity had approximately 4 times higher ORs of OA in comparison with subjects with normal body mass index (BMI). 10 Most of investigations targeted on restricting calorie intake to develop weight loss, have established favorable short-term impacts on weight loss, inflammation, and physical dysfunction. ...
... [8][9][10] Moreover, overweight is related with a two-time higher ORs of OA while obesity had approximately 4 times higher ORs of OA in comparison with subjects with normal body mass index (BMI). 10 Most of investigations targeted on restricting calorie intake to develop weight loss, have established favorable short-term impacts on weight loss, inflammation, and physical dysfunction. 11,12 Nevertheless, unwanted effects of calorie constraint on lean muscle mass 13 and problems in conserving weight loss in the long-term period 14 has directed investigators to search for substitute dietary interventions that may be more sustainable but equivalent concerning body fat mass and inflammatory consequences. ...
Introduction : Knee osteoarthritis (KOA) is the most common degenerative joint disease resulting in bone pain and disability. The aim of current study is to determine diet quality by healthy eating index (HEI)-2015 in association with pain and functional status among a sample of participants with primary knee OA. Methods : In this cross-sectional study, 220 patients with knee OA were recruited via convenience sampling in the outpatient clinics of Tabriz University of Medical Sciences between April and September 2018. The HEI-2015 score was calculated from dietary data collected using a Food Frequency Questionnaire (FFQ). Visual analogue scale, Western Ontario and McMaster Universities Osteoarthritis Index and the SF36 quality of life (QoL) questionnaire were applied to measure the pain intensity, functional status and QoL in the participants, respectively. Participants were categorized based on the quintile cutoff points of HEI score including 42-62, 63-69, 70-75, 76-78 and 79-100. Results : The mean score of HEI was 70.62±10.18 (range: 42–89). Participants with greater HEI- 2015 scores had higher total energy intake (P=0.008) and greater dietary intake of carbohydrates (P=0.01), protein (P=0.009), monounsaturated fatty acids (P=0.01), polyunsaturated fatty acids (P=0.007) and fiber (P=0.009) and lower intake of saturated fatty acids (P=0.005). Participants in higher quintiles of HEI had significantly lower pain intensity (P=0.001) and higher scores of physical function (P=0.001), pain (P=0.001) and role limitation due to physical problems (P=0.005) subscales of SF-36 QoL questionnaire in comparison with participants in lower quintiles of HEI-2015. Conclusion : The HEI-2015 score is associated with pain intensity and two domain of QoL in patients with knee OA.
... OA is one of the leading causes of immobility in older adults living in the U.S. and is often closely associated and/or exacerbated by obesity [7]. Findings from a meta-analysis of 47 observational studies showed that preventing obesity, often a low-grade inflammatory state [8,9], could reduce the risk of knee OA by up to 50% [10]. Additionally, overweight was associated with two-times higher odds of OA while obesity had almost four times higher odds of OA compared to adults with normal body mass index (BMI) [10]. ...
... Findings from a meta-analysis of 47 observational studies showed that preventing obesity, often a low-grade inflammatory state [8,9], could reduce the risk of knee OA by up to 50% [10]. Additionally, overweight was associated with two-times higher odds of OA while obesity had almost four times higher odds of OA compared to adults with normal body mass index (BMI) [10]. OA symptoms, including chronic pain, morning stiffness, and sensations of grating joints may also be related to systemic and local (synovial) low-grade inflammation [11,12]. ...
Osteoarthritis (OA) is a leading cause of immobility in the United States and is associated with older age, inflammation, and obesity. Prudent dietary patterns have been associated with disease prevention, yet little evidence exists describing diet quality (DQ) in older overweight or obese African American (AA) adults with OA and its relation to body composition. We conducted a secondary data analysis of a dataset containing alternate Healthy Eating Index-2010 (AHEI-2010), body composition, OA severity, and serum interleukin-6 (IL-6) data from 126 AA females (aged 60–87 years) with OA to examine the relationships between these variables. Our sample had poor DQ and reported having higher OA severity as measured by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Interleukin-6 was negatively correlated with AHEI-2010, and AHEI-2010 and the WOMAC physical function subcategory (WOMACpf) were significant predictors of IL-6 (odds ratio (OR): 0.95, 95% confidence interval (CI) 0.92–0.99 and 1.04, 95% CI 1.01–1.07, respectively, p < 0.05) but not body composition. In conclusion, AHEI-2010 and WOMACpf were significant predictors of inflammation (IL-6) and AHEI-2010 accounted for ~16% of the variation of IL-6 (inflammation) in this sample.
... Obesity is a significant concern among the United States population, a concern that is estimated to have reached a prevalence of 32% in men and 36% in women. 1 Obesity is defined as a body mass index (BMI) of >30 and has been directly correlated to the development of osteoarthritis of the knee. 2 A recent study examining the national trends of obesity in total knee arthroplasty (TKA) among the Medicare/Medicaid patient population found that from 2002 to 2009, the number of patients who received TKA and were obese rose from 11 to 20%. 3 The effects of obesity in TKA has implications in both economic burden and clinical outcomes. A recent study looked at the economic effects of obesity, determining that with every five-unit increase in BMI beyond 30 kg/m 2 had an associated increase of $250 to $300 in costs with primary TKA and a $600 to $650 increase of costs in revision TKA. 4 In addition, a literature review performed by a workgroup of total joint arthroplasty surgeons from the American Association of Hip and Knee Surgeons (AAHKS) found that TKA patients who had a BMI !40 was the threshold for which the majority of perioperative complications, including infection and revision rates, appear to increase substantially. 5 Current literature consists of studies that examine data from previous years and have not been updated to reflect new trends. ...
... Therefore, the purpose of this study was to evaluate the impact different severities of obesity have on primary and revision TKA, specifically: (1) incidence and trends over time; (2) annual growth rate; and (3) admission costs from 2010 to 2014. ...
An increasing number of total knee arthroplasties (TKAs) are performed on obese patients. It is imperative to remain up to date on the effect of obesity on surgical outcomes and reimbursement trends. The purpose of this study was to evaluate the impact different severities of obesity have on primary and revision TKA, specifically: (1) incidence and trends over time; (2) annual growth rate; and (3) admission costs from 2010 to 2014. A retrospective review of a large commercial private payer database within the PearlDiver Supercomputer application (Warsaw, IN) of TKA procedures was conducted. Patients who underwent TKA and subsequent revision were identified by Current Procedural Terminology (CPT) and ninth revision International Classification of Disease (ICD-9) codes. The index procedure was linked with ICD-9 codes for body mass indexes (BMIs) from <19 to >70. Statistical analysis was primarily descriptive to demonstrate the revision incidence and reimbursement deviations due to BMI. Compound annual growth rate (CAGR) was also calculated. Our query returned a total of 87,607 TKA patients within the study BMI ranges. The majority of patients had a BMI of 40 to 44.9 (12.2%) and least in the BMI >70 (0.2%) range. BMI of 40 to 44.9 had the highest overall 5-year mean reimbursement of $11,521 and the highest overall mean 5-year deviation from normal BMI (19–24) patients of $3,300. The incidence and burden of TKA revision was highest in patients with a BMI of 60 to 69.9 (21 and 17.3%, respectively). Average 5-year revision reimbursement and deviation from normal BMI (19–24) was highest in patients with a BMI of 40 to 44.9 ($13,883 and $4,030, respectively). The number of obese patients receiving TKA is steadily rising. The cost of treating obese patients rises as BMI deviates from normal, as does the incidence of revision surgery. Therefore, surgeons must be active in counseling patients on weight optimization as part of preoperative standard of care.
... Thus, the study did not estimate OA prevalence in the entire South Korean older population. Our findings agree with the results of previous studies, showing that obesity is related to OA in various populations, [16,17] and revealing that this association also exists in the South Korean population. Moreover, our results show the prevalence of radiologically-confirmed knee and hip OA in the South Korean older population (7.9% and 29.6% of older men and women, respectively). ...
There are few studies on the association between obesity and radiologically-confirmed osteoarthritis (OA) in the South Korean older population. We investigated the association between obesity and radiologically-confirmed OA in a nationally-representative sample of the South Korean older population. The study population comprised 5811 participants (2530 men and 3281 women) aged ≥60 years selected from the 2010 to 2012 Korea National Health and Nutrition Examination Survey. Radiographic OA was defined as Kellgren-Lawrence grade ≥ 2 on either the knee or hip area in radiographic images. The odds ratios and 95% confidence intervals for OA were determined using multiple logistic regression analyses after adjusting for confounding factors. Overall, 7.9% and 29.6% of older men and women had OA, respectively. A U-shaped curve with the nadir in the appropriate body weight (body mass index 18.5-23 kg/m2) revealed that 9.0%, 6.8%, 8.1%, and 9.1% of older men and 24.5%, 21.6%, 27.1%, and 38.4% of older women who were underweight, normal weight, overweight, and obese, respectively, had OA. Compared with normal-weight people, the odds ratios (95% confidence intervals) for OA in obese subjects were 1.73 (1.13-2.64) and 2.76 (2.13-3.56) for older men and women, respectively, after adjusting for age, comorbidities, lifestyle behaviors, and socioeconomic status. Obesity was significantly associated with an increased risk of OA in the South Korean older population. This finding suggests that efforts to maintain appropriate body weight and reduce excessive body weight should be considered to reduce the risk of OA in older adults.
... Previous research with respect to dietary risk factors for OA has focused mainly on overall nutritional intake such as body mass index (BMI), rather than on specific foods. [6,7] In addition, no population-based studies have examined the relationship between common beverage consumption and knee OA in Korea or worldwide. ...
The purposes were to analyze correlations between the frequency of beverage drinking (coffee, green tea, milk, and soft drinks) and the presence of radiographic knee osteoarthritis (OA) in relation to sex. We performed this study using the Korea National Health and Nutrition Examination Survey (KHANES V-1, 2). We examined data from 5503 subjects after exclusion. We utilized the food frequency questionnaires from KHANES, and reorganized them into 2 or 3 groups according to the frequency of beverage consumption. We analyzed the relationship between radiographic knee OA and beverage consumption statistically after adjusting confounding factors with multivariable logistic regression analysis. Knee OA was inversely associated with coffee consumption only in women (P < .05). The odds ratio of knee OA was lower in those who drank at least a cup of coffee than in those who did not drink coffee in women (P for trend < .05). However, there was no significant linear trend of the odds ratio of each group in both sexes for drinking other beverages. As the coffee consumption increased, the radiographic knee OA group showed decreasing linear trend only in women. However, other beverages did not show a significant relation to the radiographic knee OA in both sexes.
... Obesity is a global problem resulting in excessive morbidity and mortality. In recent years, considerable evidence has emerged that obesity and OA are one of the most important risk factors for peripheral joint problems, especially in the hips and knees [5][6][7][8][9]. In turn, weight-loss interventions have been shown to provide significant improvements in pain and disability for OA patients [10]. ...
Purpose
It has been found that childhood obesity (CO) may play an important role in the onset and progression of osteoarthritis (OA). Thus we conducted this mendelian randomisation analysis (MR) to evaluate the causal association between childhood obesity and osteoarthritis.
Methods
Instrumental variables (IVs) were obtained from publicly available genome-wide association study datasets. The leave-one-out sensitivity test, MR Pleiotropy RESidual Sum and Outlier test (MR-PRESSO), and Cochran’s Q test were used to confirm the heterogeneity and pleiotropy of identified IVs, then five different models, including the inverse variance weighted model (IVW), weighted median estimator model (WME), weighted model-based method (WM), MR-Egger regression model (MER), and MR-Robust Adjusted Profile Score (MRAPS) were applied in this MR analysis.
Results
After excluding all outliers identified by the MR-PRESSO test, no evident directional pleiotropy was found. Significant heterogeneity was found in the secondary MR and as a result, the multiplicative random-effect model was used. Significant causal association between CO and OA (OR 1.0075, 95% CI [1.0054, 1.0010], p = 8.12 × 10⁻¹³). The secondary MR also revealed that CO was causally associated with knee OA (OR 1.1067, 95% CI [1.0769, 1.1373], p = 3.30 × 10⁻¹³) and hip OA (OR 1.1272, 95% CI [1.0610, 1.1976], p = 1.07 × 10⁻⁴). The accuracy and robustness of these findings were confirmed by sensitivity tests.
Conclusion
There appears to be a causal relationship between childhood obesity and OA. Our results indicate that individuals with a history of childhood obesity require specific clinical attention to prevent the development of knee and hip OA.
... In addition, obesity is an important risk factor involved in the etiology of osteoarthritis by the aggravation of the mechanical constraints exerted on the articulation. Indeed, obese or overweight people are more likely to suffer from knee and hip osteoarthritis [10] with varying degrees of the impairment of their quality of life [11]. Knee osteoarthritis is particularly highly related to obesity. ...
... An obese individual is more likely to undergo a joint replacement and a decade earlier than his normal counterparts (3). A meta-analysis of observational studies by Muthuri et al. has shown that a reduction of body weight may reduce the risk of developing symptomatic KOA among adults (4). ...
Obesity and Knee Osteoarthritis (KOA) has a proven association. The obese individuals are likely to have early and more severe KOA, and the complications and overall results of surgery are also inferior. Hence, weight reduction is of paramount importance for these individuals. Due to the inability to do intense physical activities, these individuals cannot lose weight and instead perpetually kept gaining weight. Hence, intermittent fasting as a non-operative means of weight reduction is an attractive and viable option. This review article would help sensitize the Orthopaedic Surgeons about fasting in weight reduction and assisting the KOA. Hence, the choice of intermittent fasting should be offered to obese patients with KOA for weight reduction.
... Osteoarthritis is a common disease and affects approximately 240 million people, as estimated from global disease burden studies. 1 It is one of the top 10 disabling diseases among developed countries. 2 Knee and hip osteoarthritis, the two most common types of osteoarthritis, account for 2.4% of all years lived with disability (YLDs). 1 As Methodological quality of systematic reviews on interventions for osteoarthritis: a cross-sectional study a result, osteoarthritis has been consistently ranked on the lists of leading contributors to global YLDs. 1 Age and obesity are two important risk factors for the development of osteoarthritis, [3][4][5][6] which suggests that aging and the increasing obesity population will further contribute to the rapid increase of osteoarthritis prevalence. This will increase the burden of osteoarthritis and lead to a significant challenge to public health and health care system. ...
Background
Healthcare providers need reliable evidence for supporting the adoption of new interventions, of which the source of evidence often originates from systematic reviews (SRs). However, little assessment on the rigor of SRs related to osteoarthritis interventions has been conducted. This cross-sectional study aimed to evaluate the methodological quality and predictors among SRs on osteoarthritis interventions.
Methods
Four electronic databases (Cochrane Database of Systematic Reviews, MEDLINE, Embase, and PsycINFO) were searched, from 1 January 2008 to 10 October 2019. An SR was eligible if it focused on osteoarthritis interventions, and we performed at least one meta-analysis. Methodological quality was assessed using the validated AMSTAR 2 instrument. Multivariate regression analyses were conducted to assess predictors of methodological quality.
Results
In total, 167 SRs were included. The most SRs were non-Cochrane reviews (88.6%), and 54.5% investigated non-pharmacological interventions. Only seven (4.2%) had high methodological quality. Respectively, eight (4.8%), 25 (15.0%), and 127 (76.0%) SRs had moderate, low, and critically low quality. Main methodological weaknesses were as follows: only 16.8% registered protocol a priori, 4.2% searched literature comprehensively, 25.7% included lists of excluded studies with justifications, and 30.5% assessed risk of bias appropriately by considering allocation concealment, blinding of patients and assessors, random sequence generation and selective reported outcomes. Cochrane reviews [adjusted odds ratio (AOR) 251.5, 95% confidence interval (CI) 35.5–1782.6], being updates of previous SRs (AOR 3.9, 95% CI 1.1–13.7), and SRs published after 2017 (AOR 7.7, 95% CI 2.8–21.5) were positively related to higher methodological quality.
Conclusion
Despite signs of improvement in recent years, most of the SRs on osteoarthritis interventions have critically low methodological quality, especially among non-Cochrane reviews. Future SRs should be improved by conducting comprehensive literature search, justifying excluded studies, publishing a protocol, and assessing the risk of bias of included studies appropriately.
... Increased body weight is considered to be an important modifiable risk factor for the onset and progression of pain and radiographic findings [168][169][170] of OA, specifically at the knee and hip [124,[171][172][173]. In symptomatic knee OA, this risk is doubled with every 3-4 kg/m 2 increase in Body Mass Index (BMI) [168]. ...
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
... In addition, obesity is an important risk factor involved in the etiology of osteoarthritis by the aggravation of the mechanical constraints exerted on the articulation. Indeed, obese or overweight people are more likely to suffer from knee and hip osteoarthritis [10] with varying degrees of the impairment of their quality of life [11]. Knee osteoarthritis is particularly highly related to obesity. ...
Abstract
Introduction: obesity has aroused these last time a significant interest because of his strong association with osteoarthritis by the worsening of the mechanical constraints exerted on the articulation. Considered as degenerative disease and debilitating, the prevalence of osteoarthritis does not cease to increase due to the increase in both the life expectancy and the prevalence of obesity. The objective of this study is to assess the link between obesity and the susceptibility of the occurrence of the osteoarthritis of the lower limbs in a sample of women. Methodology: The study was undertaken on 137 women from 11 urban and rural localities of an agricultural province of Morocco, El Jadida. The evaluation of symptomatic the susceptibility of the occurrence of osteoarthritis of the lower members among the participants was performed using the Moroccan version of the WOMAC index for the lower limbs. Another questionnaire has allowed collecting socio-demographic data and anthropometric measurements in the surveyed in order to establish the relationship between obesity and the occurrence of osteoarthritis risk. Results: The study data show that the female population surveyed was 45±13years old and mostly obese (77%). The susceptibility of osteoarthritis of the lower limbs in both forms is much more expressed at the age > 50 years with a rate of 22%. Three dimensions WOMAC (pain, stiffness and functional embarrassment) are felt much among postmenopausal women than those in age to procreate (9.53±5.95 vs 5.61±5.0); (3.74±2.63 vs 2.47±2.36) and (31.08±19.55 vs 21.50±16.63) respectively. The perception of WOMAC pain and functional repercussion related to the susceptibility of osteoarthritis are expressed much among women having a morbid obesity with respective averages (15.40; 48.80 vs 6.12; 23.12). For the waist/hip (WHR), the pain and the functional embarrassment perceived by the WOMAC are reported much among women having an android morphotype (86.13%) than those with a gynoïde morphotype (5.10%). Conclusion: The study results report a link between obesity and the risk of occurrence of osteoarthritis. His prevention is important and his magnitude varies according to the age and to the osteoarthritis location. The Data is also discussed according to the energy impact. Keywords: Obesity, BMI, WHR, knee osteoarthritis, coccyx osteoarthritis, Womac
... Obesity is one of the most clinically significant and preventable risk factors for developing osteoarthritis (OA). 1,2 There are no disease-modifying treatments for OA, and current pain medications such as opioids and nonsteroidal anti-inflammatory drugs have limited long-term efficacy as well as adverse side effects. 3 Obesity increases OA risk in both knee and hand joints, although the impact is greatest for the knee, where risk is elevated >2-fold. ...
Background:
Obesity increases knee osteoarthritis (OA) risk through metabolic, inflammatory, and biomechanical factors, but how these systemic and local mediators interact to drive OA pathology is not well understood. We tested the effect of voluntary running exercise after chronic diet-induced obesity on knee OA-related cartilage and bone pathology in mice. We then used a correlation-based network analysis to identify systemic and local factors associated with early-stage knee OA phenotypes among the different diet and exercise groups.
Methods:
Male C57BL/6J mice were fed a defined control (10% kcal fat) or high fat (HF) (60% kcal fat) diet from 6 to 37 weeks of age. At 25 weeks, one-half of the mice from each diet group were housed in cages with running wheels for the remainder of the study. Histology, micro computed tomography, and magnetic resonance imaging were used to evaluate changes in joint tissue structure and OA pathology. These local variables were then compared to systemic metabolic (body mass, body fat, and glucose tolerance), inflammatory (serum adipokines and inflammatory mediators), and functional (mechanical tactile sensitivity and grip strength) outcomes using a correlation-based network analysis. Diet and exercise effects were evaluated by two-way analysis of variance.
Results:
An HF diet increased the infrapatellar fat pad size and posterior joint osteophytes, and wheel running primarily altered the subchondral cortical and trabecular bone. Neither HF diet nor exercise altered average knee cartilage OA scores compared to control groups. However, the coefficient of variation was ≥25% for many outcomes, and some mice in both diet groups developed moderate OA (≥33% maximum score). This supported using correlation-based network analyses to identify systemic and local factors associated with early-stage knee OA phenotypes. In wheel-running cohorts, an HF diet reduced the network size compared to the control diet group despite similar running distances, suggesting that diet-induced obesity dampens the effects of exercise on systemic and local OA-related factors. Each of the 4 diet and activity groups showed mostly unique networks of local and systemic factors correlated with early-stage knee OA.
Conclusion:
Despite minimal group-level effects of chronic diet-induced obesity and voluntary wheel running on knee OA pathology under the current test durations, diet and exercise substantially altered the relationships among systemic and local variables associated with early-stage knee OA. These results suggest that distinct pre-OA phenotypes may exist prior to the development of disease.
... Beyond the fact of leptin increases the synthesis of TNF-b, a stimulator of osteophyte formation 14 , the consequent result of low-grade inflammation plays a pathophysiological role in OA because it can affect muscle function, lower the individual' s pain threshold, and affect chondrocyte homeostasis, leading directly to cartilage matrix degradation 12,15 . Thus, weight loss and body composition improvement is gaining increasing importance for KOA prevention and management 3,4,13,16 . ...
Introduction:
Knee osteoarthritis(KOA) has a considerable prevalence in obese individuals and recommendations of weight loss for KOA management are gaining greater importance. Exercise is recommended to interrupt the cycle obesity-KOA-pain-inactivity, where walking is the most common exercise pattern recommended for obese individuals who initiate a weight loss exercise program. Thus this study aimed to analyse the factors which can affect the walking capacity in obese adults with symptomatic KOA.
Methods:
48 obese adults (age=55±7years; BMI=35±5 Kg/m2) with clinical and radiological KOA completed self-reported questionnaires (Knee Injury and Osteoarthritis Outcome Score, Brief Pain Inventory and Beck Depression Inventory), physical function tests (Six Minutes Walking Test-6MWT, chair sit and reach-CSRT, five repetition sit-to-stand test-FRSTST, handgrip strength-HST, isokinetic knee strength) and body composition was determined.
Results:
The best model (F= 41.485; p<.001) explained 73% of the 6MWT's variance, where fat mass of the most painful limb, knee pain severity and lower limb strength were the strongest predictors of the 6MWT.
Conclusion:
Despite the importance of lower limb fat mass and strength, pain was the only variable that appeared as a predictor of 6MWT in the three tested models. The existence of knee pain affects the capacity to walk or to perform weight bearing exercises and consequently the exercise's adherence, compromising the objective of body composition improvement. Thus, authors suggest that, additionally to the lower limb strengthening, knee pain should be screened, controlled and acknowledged for exercise prescription. This study is inserted in the PICO Project (Clinical trial: NCT01832545).
... Nearly 80% of the participants defined as having knee OA were overweight or obese. Obesity is the best known risk factor for knee OA development [39], and diet therapy focused at weight reduction by means of caloric restriction including limited consumption of dietary fat is indicated for knee OA patients that are overweight or obese [40,41]. Consequently, it could be argued that as a result of dietary therapy, consumption of full-fat dairy, including Dutch cheese, was lower in individuals with than without knee OA (as can be seen from Table 3), which would indicate reverse causation. ...
Purpose
Observational studies showed inverse associations between milk consumption and knee osteoarthritis (knee OA). There is lack of information on the role of specific dairy product categories. We explored the association between dairy consumption and the presence of knee osteoarthritis in 3010 individuals aged 40–75 years participating in The Maastricht Study.
Methods
The presence of knee OA was defined according to a slightly modified version of the American College of Rheumatology (ACR) clinical classification criteria. Data on dairy consumption were appraised by a 253-item FFQ covering 47 dairy products with categorization on fat content, fermentation or dairy type. Multivariable logistic regression analyses were performed to estimate odd ratios (ORs) and 95% confidence intervals (95%CI), while correcting for relevant factors.
Results
427 (14%) participants were classified as having knee OA. Significant inverse associations were observed between the presence of knee OA and intake of full-fat dairy and Dutch, primarily semi-hard, cheese, with OR for the highest compared to the lowest tertile of intake of 0.68 (95%CI 0.50–0.92) for full-fat dairy, and 0.75 (95%CI 0.56–0.99) for Dutch cheese. No significant associations were found for other dairy product categories.
Conclusion
In this Dutch population, higher intake of full-fat dairy and Dutch cheese, but not milk, was cross-sectionally associated with the lower presence of knee OA. Prospective studies need to assess the relationship between dairy consumption, and in particular semi-hard cheeses, with incident knee OA.
... [29][30][31] For chronic disease management, weight loss has been indicated to decrease osteoarthritis; this recommendation comes from a meta-analysis that evaluated various orthopaedic observational studies utilizing database sources. [32] However, to employ this in a patient-centered manner physicians must take this a step further. Surgeons must also evaluate a patient's ability to adhere to this recommendation. ...
Population health is a concept that emerged from the desire of providers to care for patients in a manner that produces the best possible outcomes while minimizing cost. It may be defined as the study of medical data of large groups of people in order to recognize and investigate patterns. This information is then used to create disease management guidelines that streamline care and regulate practice patterns. Whereas population health looks to recognize commonalities in data, the concept of patient-centered care focuses on embracing individualization and increasing the involvement of each patient within their treatment planning. Combining both perspectives creates a challenge for providers and patients to strike the proper balance between adhering to standardized guidelines based on the treatment methods and outcomes recognized in populations and applying it clinically to individual patients. A significant contribution of population health studies is the identification of risk factors associated with increased rates of complications following total joint arthroplasty as well as preventative measures for conditions such as osteoarthritis. However, to employ these findings in a patient-centered manner orthopaedic surgeons must take this a step further and also evaluate a patient’s ability to adhere to the recommendations by exploring factors such as home environment and socioeconomic factors, thus proactively addressing issues that could hinder patient compliance. With focused collection methods of acquiring data, these two practices of care will hopefully begin to see less divergence when it comes to applying data derived from population health initiatives to individual patients in a patient-centered manner.
... The effect of the treatments in Table 1 were extracted from systematic literature reviews, meta-analyses of randomized controlled trials, published randomized controlled trials and cohort studies that assessed the effectiveness of these 10 types of treatments. 12,[22][23][24][25][26][27][28][29][30][31][32] The treatment effect is assumed to influence a patient's progression of the disease by changing the transition probability of a patient moving from one state in the model to a more severe state. We made the assumption that the treatment effect on each of the transition probabilities is the same for all patient subgroups and at all stages over the course of the disease (Appendix III, Supplemental Digital Content 1, http://links.lww. ...
Background:
Disparities in the presentation of knee osteoarthritis (OA) and in the utilization of treatment across sex, racial, and ethnic groups in the United States are well documented.
Objectives:
We used a Markov model to calculate lifetime costs of knee OA treatment. We then used the model results to compute costs of disparities in treatment by race, ethnicity, sex, and socioeconomic status.
Research design:
We used the literature to construct a Markov Model of knee OA and publicly available data to create the model parameters and patient populations of interest. An expert panel of physicians, who treated a large number of patients with knee OA, constructed treatment pathways. Direct costs were based on the literature and indirect costs were derived from the Medical Expenditure Panel Survey.
Results:
We found that failing to obtain effective treatment increased costs and limited benefits for all groups. Delaying treatment imposed a greater cost across all groups and decreased benefits. Lost income because of lower labor market productivity comprised a substantial proportion of the lifetime costs of knee OA. Population simulations demonstrated that as the diversity of the US population increases, the societal costs of racial and ethnic disparities in treatment utilization for knee OA will increase.
Conclusions:
Our results show that disparities in treatment of knee OA are costly. All stakeholders involved in treatment decisions for knee OA patients should consider costs associated with delaying and forgoing treatment, especially for disadvantaged populations. Such decisions may lead to higher costs and worse health outcomes.
... Future studies are needed to validate if such an interaction with gender does exist. Our study 38 , as well as many others 3,39,40 , has established higher BMI as one of the most important risk factors for severe OA, probably due to the biochemical stress induced on the knee joint. The aforementioned study among men only in a Veteran Affair hospital showed that compared to control subjects, those with gout had a much higher prevalence of KOA among non-obese men compared to those who were obese 11 . ...
Objective:
While cross-sectional and retrospective case-control studies suggest that gout is associated with knee osteoarthritis (KOA), no prospective study has evaluated the risk of total knee replacement (TKR) for KOA in association with gout. We prospectively evaluated the association between gout and the risk of TKR due to severe KOA.
Design:
We used data from the Singapore Chinese Health Study, a prospective cohort with 63,257 Chinese adults aged 45-74 years at recruitment (1993-1998). Self-report of physician-diagnosed gout was enquired at follow-up I interview (1999-2004) from 52,322 subjects. TKR cases for KOA after follow-up I were identified via linkage with nationwide hospital discharge database through 31 December 2011. Multivariable Cox proportional hazards regression model was applied with adjustment for potential risk factors of KOA.
Results:
Among 51,858 subjects (22,180 men and 29,678 women) included in this analysis, after average 9.7 follow-up years, there were 1,435 cases of TKR. Gout was associated with 39% higher risk of TKR in women [hazard Ratio (HR) 1.39; 95% confidence interval (CI) 1.08 -1.79] but not in men (HR 0.78; 95% CI 0.49-1.23). The positive gout-TKR association in women remained after excluding participants with self-reported history of arthritis (HR 1.57; 95% CI 1.04-2.37). This association was stronger in women who were lean (BMI<23 kg/m(2)) (HR 2.17; 95% CI 1.30-3.64) compared to their heavier counterparts (Pinteraction= 0.016).
Conclusion:
Gout is associated with risk of severe KOA, especially in lean women, suggesting the crystal arthritis may play a role in the pathogenesis or progression of OA.
... 8 Evidence shows that increased body weight and obesity are associated with osteoarthritis (OA) of the knee and, ultimately, the need for TKA. In 1988, Felson and Anderson first reported obesity as an independent risk factor for the development of OA. 9,10 Once the damage to the articular cartilage progresses to the level of bone-tobone contact, total knee arthroplasty is the definitive treatment to relieve pain and restore functional loss caused by severe progressive OA. Conflicted findings have been found in the previous studies done by the individuals in comparison between the obese and nonobese patients. ...
p class="abstract"> Background: The present study was carried out with the objective to assess the influence of morbid obesity on the outcome after TKR and with the aim to compare the outcome following TKR in a consecutive series of morbidly obese patients (BMI >40 kg/m<sup>2</sup>), and matched it with group of non-obese patients (BMI <30 kg/m<sup>2</sup>).
Methods: The study period planned was of two years. The totals of 100 patients undergoing total knee replacement were selected for the study period. On the basis of body mass index inclusion criteria for the two groups were decided. Of the total 100 patients, they were divided into two groups. One group 1 consisted of obese patients with total of 50 patients and group 2 consisted of non-obese patient with total of 50 patients.
Results: At the end of two years when the data was compared with the preoperative assessment, it was found to significantly better where value of p was <0.001. However when the comparison was done between the two groups, it was found that scores were lower in the group 1 patients which included the obese patients.
Conclusions: Total knee arthroplasty is a safe and efficacious operation in obese patients with no significantly greater risk of complications. However, post-operative clinical scores and absolute improvement in the scores are statistically superior in non-obese patients at one year follow-up. Obese patients should be started on weight loss programs and counselled about possible inferior results for total knee replacement. </p
... Despite this difference, knee joint moments as assessed in this study were comparable in the APM leg and healthy controls, irrespective of whether joint moments were normalized to body weight and body height. Nevertheless, given that a higher BMI is a risk factor for OA 28 and that a higher weight can increase knee joint contact force, 26 overweight patients undergoing APM should consider weight management. ...
Background:
Altered knee joint biomechanics is thought to play a role in the pathogenesis of knee osteoarthritis and has been reported in patients after arthroscopic partial meniscectomy (APM) while performing various activities. Longitudinally, understanding knee joint biomechanics during jogging may assist future studies to assess the implications of jogging on knee joint health in this population.
Purpose:
To investigate knee joint biomechanics during jogging in patients 3 months after APM and a healthy control group at baseline and 2 years later at follow-up.
Study design:
Controlled laboratory study.
Methods:
Seventy-eight patients who underwent medial APM and 38 healthy controls underwent a 3-dimensional motion analysis during barefoot overground jogging at baseline. Sixty-four patients who underwent APM and 23 controls returned at follow-up. External peak moments (flexion and adduction) and the peak knee flexion angle during stance were evaluated for the APM leg, non-APM leg (nonoperated leg), and control leg.
Results:
At baseline, the peak knee flexion angle was 1.4° lower in the APM leg compared with the non-APM leg ( P = .03). No differences were found between the moments in the APM leg compared with the control leg (all P > .05). However, the normalized peak knee adduction moment was 35% higher in the non-APM leg compared with the control leg ( P = .008). In the non-APM leg, the normalized peak knee adduction and flexion moments were higher compared with the APM leg by 16% and 10%, respectively, at baseline ( P ≤ .004). Despite the increase in the peak knee flexion moment in the APM leg compared with the non-APM leg ( P < .001), there were no differences in the peak knee flexion moment or any other parameter assessed at 2-year follow-up between the legs ( P > .05).
Conclusion:
Comparing the APM leg and control leg, no differences in knee joint biomechanics during jogging for the variables assessed were observed. Higher knee moments in the non-APM leg may have clinical implications for the noninvolved leg. Kinematic differences were small (~1.4°) and therefore of questionable clinical relevance.
Clinical relevance:
These results may facilitate future clinical research regarding the implications of jogging on knee joint health in middle-aged, overweight patients after APM.
... Aging populations and obesogenic environments are increasing the prevalence and comorbidity of metabolic and musculoskeletal diseases [24,25]. In the United States, approximately 35% of all adults and 50% of adults aged 60 years and older are estimated to have the metabolic syndrome [26]. ...
Obesity and associated metabolic diseases collectively referred to as the metabolic syndrome increase the risk of skeletal and synovial joint diseases, including osteoarthritis (OA). The relationship between obesity and musculoskeletal diseases is complex, involving biomechanical, dietary, genetic, inflammatory, and metabolic factors. Recent findings illustrate how changes in cellular metabolism and metabolic signaling pathways alter skeletal development, remodeling, and homeostasis, especially in response to biomechanical and inflammatory stressors. Consequently, a better understanding of the energy metabolism of diarthrodial joint cells and tissues, including bone, cartilage, and synovium, may lead to new strategies to treat or prevent synovial joint diseases such as OA. This rationale was the basis of a workshop presented at the 2016 Annual ORS Meeting in Orlando, FL on the emerging role of metabolic signaling in synovial joint remodeling and OA. The topics we covered included (i) the relationship between metabolic syndrome and OA in clinical and pre-clinical studies, (ii) the effect of biomechanical loading on chondrocyte metabolism, (iii) the effect of Wnt signaling on osteoblast carbohydrate and amino acid metabolism with respect to bone anabolism, and (iv) the role of AMP-activated protein kinase in chondrocyte energetic and biomechanical stress responses in the context of cartilage injury, aging, and OA. Although challenges exist for measuring in vivo changes in synovial joint tissue metabolism, the findings presented herein provide multiple lines of evidence to support a central role for disrupted cellular energy metabolism in the pathogenesis of OA. This article is protected by copyright. All rights reserved.
... In addition there are acquired causes or contributory causes such as overloading or inappropriate straining of the joints due to congenital deformities (e.g. axial misalignment, hip dysplasia), following injuries and accidents or by being overweight [22]. ...
English version of "Prävalenz ausgewählter muskuloskelettaler Erkrankungen. Ergebnisse der Studie zur Gesundheit Erwachsener in Deutschland (DEGS1)"
Osteoarthritis (OA) is the most common articular disorder that causes chronic disability because of the progressive resorption of bone and cartilage and results in joint failure specifically in elder population. Its incident rate varies according to region and ethnicity. A cross-sectional study was conducted among 191 housewives belonging to Lahore,Islamabad and other major cities of Pakistan in 2017 to assess the awareness level of OA. Data were collected through a structured questionnaire that included personal details of participants, their awareness about osteoarthritis, its causes, treatment, and its effects. Then, data were analyzed by using SPSS and appropriate statistical tests like Chi-squaredfor different variables. Almost 40% of the population sample belonged to 30-40 years of age group. Overall, about 39% participants had awarenessabout various aspects of OA and 57% individual had the awareness about the general information of OA. Awareness about factors affecting the OA condition was the lowest, only 24% individuals had the self-awareness about this. In this study, there was no significant association between the aspects about the awareness of OA with different age groups. Most housewives of Lahore and other areas of Pakistan had poor to moderate awareness of OA. Proper awareness of OA will result in the better understanding of promising management modalities for the treatment of OA.
Objective:
To define the association between change in body mass index (BMI) and the risk of knee and hip replacement.
Methods:
We used data from three independent cohort studies: the Osteoarthritis Initiative (OAI), the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study, which collected data from adults (45 to 79 years of age) with or at risk of clinically significant knee osteoarthritis. We conducted Cox proportional hazards regression analysis with clustering of both knees and hips per person to determine the association between change in BMI (our exposure of interest) and the incidence of primary knee and hip replacement over 7 to 10 years' follow-up. Change in BMI (in kg/m2 ) was calculated between baseline and the last follow-up visit before knee or hip replacement, or - for knees and hips that were not replaced - the last follow-up visit.
Results:
A total of 16,362 knees from 8181 participants, and 16,406 hips from 8203 participants, were eligible for inclusion in our knee and hip analyses, respectively. Change in BMI was positively associated with the risk of knee replacement (adjusted hazard ratio 1.03; 95% confidence interval [CI] 1.00 to 1.06) but not hip replacement (adjusted hazard ratio 1.00; 95% CI 0.95 to 1.04). The association between change in BMI and knee replacement was independent of participants' BMI category at baseline (i.e., normal, overweight, or obese).
Conclusion:
Public health strategies incorporating weight loss interventions could reduce the burden of knee but not hip replacement surgery.
Article History: Osteoarthritis (OA) is the most common articular disorder that causes chronic disability because of the progressive resorption of bone and cartilage and results in joint failure specifically in elder population. Its incident rate varies according to region and ethnicity. A cross-sectional study was conducted among 191 housewives belonging to Lahore,Islamabad and other major cities of Pakistan in 2017 to assess the awareness level of OA. Data were collected through a structured questionnaire that included personal details of participants, their awareness about osteoarthritis, its causes, treatment, and its effects. Then, data were analyzed by using SPSS and appropriate statistical tests like Chi-squaredfor different variables. Almost 40% of the population sample belonged to 30-40 years of age group. Overall, about 39% participants had awarenessabout various aspects of OA and 57% individual had the awareness about the general information of OA. Awareness about factors affecting the OA condition was the lowest, only 24% individuals had the self-awareness about this. In this study, there was no significant association between the aspects about the awareness of OA with different age groups. Most housewives of Lahore and other areas of Pakistan had poor to moderate awareness of OA. Proper awareness of OA will result in the better understanding of promising management modalities for the treatment of OA.
Objective
Obesity was once considered a risk factor for knee osteoarthritis (OA) primarily for biomechanical reasons. Here we provide an additional perspective by discussing how obesity also increases OA risk by altering metabolism and inflammation.
Design
This narrative review is presented in four sections: 1) metabolic syndrome and OA, 2) metabolic biomarkers of OA, 3) evidence for dysregulated chondrocyte metabolism in OA, and 4) metabolic inflammation: joint tissue mediators and mechanisms.
Results
Metabolic syndrome and its components are strongly associated with OA. However, evidence for a causal relationship is context dependent, varying by joint, gender, diagnostic criteria, and demographics, with additional environmental and genetic interactions yet to be fully defined. Importantly, some aspects of the etiology of obesity-induced OA appear to be distinct between men and women, especially regarding the role of adipose tissue. Metabolomic analyses of serum and synovial fluid have identified potential diagnostic biomarkers of knee OA and prognostic biomarkers of disease progression. Connecting these biomarkers to cellular pathophysiology will require future in vivo studies of joint tissue metabolism. Such studies will help reveal when a metabolic process or a metabolite itself is a causal factor in disease progression. Current evidence points towards impaired chondrocyte metabolic homeostasis and metabolic-immune dysregulation as likely factors connecting obesity to the increased risk of OA.
Conclusions
A deeper understanding of how obesity alters metabolic and inflammatory pathways in synovial joint tissues is expected to provide new therapeutic targets and an improved definition of “metabolic” and “obesity” OA phenotypes.
Introduction: Osteoarthritis (OA) is a chronic disorder and the most common form of arthritis. OA leads to the breakdown of tissues and cartilage and the loss of combined function, causing symptoms of pain, stiffness, reduced physical function and limited movement. Incidence rates vary according to region and ethnicity. Materials and Methods: A cross-sectional study involving the general population of Sudair was conducted to assess the awareness and knowledge levels of OA from June to December 2020. In all, 387 residents participated, and data were collected using a pre-tested questionnaire. Data were analysed by SPSS, and appropriate statistical tests such as One-sample t-test, Chi-squared and Fisher's exact tests were applied for quantitative and qualitative variables. Results: Almost 80% of the sample belonged to the age group of 18–50 years. More than 50% were men. Overall, 199 (51.42%) participants had moderate knowledge of OA, 134 (34.63%) had poor knowledge, and only 14% had adequate knowledge. Men had significantly poorer knowledge than women (P = 0.018). Participants with a previous history and family history of OA had significantly more knowledge than the healthy participants with previous experience of OA (P < 0.001). Conclusion: The majority of the participants who lived in Sudair had moderate knowledge of OA. Previous knowledge of OA because of previous diagnosis or family history of OA led to improved awareness of OA.
Introduction
Obesity has been associated with several complications, including musculoskeletal disorders. Aim of the present systematic review was to identify all available evidence on the relationship between fibromyalgia (FM) and obesity, including epidemiological association, impact of obesity on FM severity and effect of weight loss strategies on FM symptoms.
Methods
MedLine, Cochrane Central Register of Controlled Trials and Web of Science databases were searched up to September 2020 to identify eligible articles. Data from studies reporting the prevalence of obesity in FM patients were pooled using a random-effects model.
Results
After removal of duplicate records, 393 studies proceeded to review. A total of 41 articles were deemed eligible for inclusion in final synthesis. Quality assessment revealed that the overall risk of bias was high.
The overall prevalence of obesity in FM was 35.7% (95% CI: 31.8 – 39.9%), with higher figures reported for USA.
The majority of studies included demonstrated that obesity is associated with different domains of the disorder, including composite measures of activity, pain severity, tender point count, stiffness, fatigue, physical functioning/disability, sleep, cognitive dysfunction, and quality of life; the strength of correlation was weak on average. Inconsistent data were available regarding the correlation with depression and anxiety.
Only few studies addressed the effect of therapeutic weight loss in FM, either by bariatric surgery, diet/exercise combination or behavioral weight loss, providing preliminary evidence for a potential benefit of weight loss in ameliorating FM symptoms.
Conclusions
Available data support a potential interplay between obesity and FM-related symptoms. Weight management should be encouraged in patients with FM.
Higher body mass index (BMI) is associated with osteoarthritis (OA) in both weight-bearing and non-weight-bearing joints, suggesting a link between OA and poor metabolic health beyond mechanical loading. This risk may be influenced by systemic factors accompanying BMI. Fluctuations in concentrations of metabolites may mark or even contribute to development of OA. This study explores the association of metabolites with radiographic knee/hip OA prevalence and progression. A 1H-NMR-metabolomics assay was performed on plasma samples of 1564 cases for prevalent OA and 2,125 controls collected from the Rotterdam Study, CHECK, GARP/NORREF and LUMC-arthroplasty cohorts. OA prevalence and 5 to 10 year progression was assessed by means of Kellgren-Lawrence (KL) score and the OARSI-atlas. End-stage knee/hip OA (TJA) was defined as indication for arthroplasty surgery. Controls did not have OA at baseline or follow-up. Principal component analysis of 227 metabolites demonstrated 23 factors, of which 19 remained interpretable after quality-control. Associations of factor scores with OA definitions were investigated with logistic regression. Fatty acids chain length (FALen), which was included in two factors which associated with TJA, was individually associated with both overall OA as well as TJA. Increased Fatty Acid chain Length is associated with OA.
Background
The utilization of total knee replacement (TKR) has increased significantly. The objective of this study was to assess the impact of changes in population demography (population growth, ageing and gender) and body mass indices (BMIs) on the additional volume of knee replacement surgery undertaken in Australia.
Methods
Using national data, we compared estimates based on changes in population demography and BMIs to the reported increase in TKR between 2007 and 2017. The costs of additional surgery were estimated using the National Hospital Cost Data Collection.
Results
An additional 25 814 TKRs were performed in 2017 compared to 2007. Contributions from population growth, ageing and changing BMIs were 27.1%, 10.4%, and 6.3%–15.3%, respectively. Other drivers contributed between 47.2% and 56.2%, representing 12 176–14 506 TKRs at a financial cost of A$320.9 million to A$382.3 million per year in 2017.
Conclusion
The volume of additional surgery being performed considerably exceeded estimates based on changing population demography and rising rates of obesity. The other drivers of additional TKR utilization will likely have significant implications for the health budget and warrant further investigation. This may involve an examination of the current indications for surgery and the cost‐effectiveness of TKR in various settings, reviewing patient expectations and preferences, and assessing the impact of policies which relate to the funding and provision of TKR.
Although osteoarthritis (OA) was historically referred to as the non-inflammatory arthritis, it is now considered a condition involving persistent low-grade inflammation and activation of innate inflammatory pathways. Synovitis increases the risk of OA onset and progression and involves the recruitment of monocytes, lymphocytes, and other leukocytes. In particular, macrophages are important mediators of synovial inflammatory activity and pathologic cartilage and bone responses that are characteristic of OA. Advances in understanding how damage-associated molecular patterns (DAMPs) trigger monocyte/macrophage recruitment and activation in joints provide opportunities for disease-modifying therapies. However, the complexity and plasticity of macrophage phenotypes that exist in vivo have thus far prevented the successful development of macrophage-targeted treatments. Current studies show that synovial macrophages are derived from distinct cellular lineages, which correspond to unique functional roles for maintaining joint homeostasis. An improved understanding of the aetiology of synovial inflammation in specific OA-subtypes, such as with obesity or genetic risk, is a potential strategy for developing patient selection criteria for future precision therapies.
It has been found that obese people have a higher proportion in suffering from osteoarthritis (OA), not only in the weight-bearing joints like knee and hip joints, even in non-weight-bearing joints such as hand joints. One of the reasons is because the large amount of adipose tissue secretes some factors, which can promote the occurrence of arthritis. As an important structure of the knee joint, the infrapatellar fat pad (IPFP) is actually a piece of adipose tissue. The aim of this review is to offer a comprehensive view of the anatomy and physiological characteristics of IPFP and its relationship with the pathological process of OA, indicating the important function of IPFP in OA. At the same time, with the development of adipose derived stem cells in the treatment of OA, owing to its special advantages, the IPFP is becoming a kind of important, minimally invasive fat stem cell source, providing a new approach for the treatment of OA. We hope that this review will offer an overview of all published data regarding the IPFP and will indicate novel directions for future research.
Introduction
There is little research on identifying modifiable risk factors that predict future interference of pain with daily activity in people with joint pain, and the estimation of the corresponding population attributable risk (PAR). The present study therefore investigated modifiable predictors of pain interference and estimated maximum potential gain from intervention in adults with joint pain.
Methods
A population‐based cohort aged ≥50 years was recruited from eight general practices in North Staffordshire, UK. Participants (n = 1878) had joint pain at baseline lasting ≥3 months and indicated no pain interference. Adjusted associations of self‐reported, potentially modifiable prognostic factors (body mass index, anxiety/depressive symptoms, widespread pain, inadequate joint pain control, physical inactivity, sleep problems, smoking and alcohol intake) with onset of pain interference 3 years later were estimated via Poisson regression, and corresponding PAR estimates were obtained.
Results
Inadequate joint‐specific pain control, insomnia and infrequent walking were found to be independently significantly associated with the onset of pain interference after 3 years, with associated PARs of 6.3% (95% confidence interval −0.3, 12.4), 7.6% (−0.4, 15.0) and 8.0% (0.1, 15.2), respectively, with only the PAR for infrequent walking deemed statistically significant. The PAR associated with insomnia, infrequent walking and inadequate control of joint pain simultaneously was 20.3% (8.6, 30.4).
Conclusions
There is potential to reduce moderately the onset of pain interference from joint pain in the over‐50s if clinical and public health interventions targeted pain management and insomnia, and promoted an active lifestyle. However, most of the onset of significant pain interference in the over‐50s, would not be prevented, even assuming that these factors could be eliminated.
Introduction:
Chronic knee, hip and back pain is extremely prevalent. Management guidelines emphasise maintaining physical activity and healthy weight to reduce pain and improve physical and mental wellbeing. Unfortunately, few people receive support to make lifestyle changes. We evaluated whether a health trainer-led 'joint pain advice' (JPA) service delivering person-centred lifestyle coaching was feasible, acceptable and effective for people with knee, hip and back pain.
Methods:
Feasibility of delivering a JPA service was assessed by documenting whether the health trainers could deliver JPA and its uptake. Nine health trainers delivered JPA. Participants were offered up to four appointments. At each appointment, health trainers gave people information about their condition, co-developed care plans, suggested self-management strategies and used behavioural change techniques (motivational interviewing, goal-setting and action planning) to increase physical activity and reduce body weight. Pain, function, physical activity and body mass index (BMI) were collected at baseline, 3 weeks, 6 weeks and 6 months. Focus groups captured people's opinions of the service's effectiveness, acceptability and usefulness.
Results:
Of the 105 people who enquired about JPA, 85 (81%) used the service, after which their physical activity and function improved, and pain, use of analgesia and BMI decreased. They felt more knowledgeable and better motivated to adopt and maintain healthier behaviours. They attributed these improvements to the JPA service, because of its better consultations and collaborative holistic approach. Only a minority attended all four appointments because they felt they received sufficient advice from the initial appointments. The health trainers gained knowledge and skills to support clients with musculoskeletal conditions.
Conclusions:
Using a holistic, patient-centred approach, health trainers can deliver lifestyle advice to people with chronic knee, hip or back pain safely, effectively and efficiently. The service was popular with recipients and health trainers, and helped people adopt healthier lifestyles that lead to reduced pain and other clinical improvements.
Osteoarthritis is a leading cause of disability and source of societal cost in older adults. With an ageing and increasingly obese population, this syndrome is becoming even more prevalent than in previous decades. In recent years, we have gained important insights into the cause and pathogenesis of pain in osteoarthritis. The diagnosis of osteoarthritis is clinically based despite the widespread overuse of imaging methods. Management should be tailored to the presenting individual and focus on core treatments, including self-management and education, exercise, and weight loss as relevant. Surgery should be reserved for those that have not responded appropriately to less invasive methods. Prevention and disease modification are areas being targeted by various research endeavours, which have indicated great potential thus far. This narrative Seminar provides an update on the pathogenesis, diagnosis, management, and future research on osteoarthritis for a clinical audience.
Objectives
It is unclear whether blood lead level (BLL) is associated with osteoarthritis (OA). The objectives of this study were to address the relationship between BLL and OA and to assess whether degree of obesity, evaluated as body mass index (BMI), mediates BLL-related OA.
Study design
This study was performed using data obtained from 884 postmenopausal women (≥55 years old) in the Korea National Health and Nutrition Examination Survey 2010-2012. OA in back, hip, and knee was assessed by radiographic examination (rOA) and radiographic examination and symptoms (sxOA). Multivariable logistic regression analyses were performed to investigate the BLL–OA relationship. Mediation analyses were performed to address the contribution of BMI to BLL-related OA.
Results
Odds ratio (OR) for knee rOA with the highest tertile of BLL was 1.56 [95% confidence interval (CI) = 1.08–2.25] compared with the lowest tertile; there were significant linear trends across tertiles. With adjustments for confounders without BMI, continuous BLL was significantly associated with rOA (OR = 1.89, 95% CI = 1.27–2.80) and sxOA (OR = 1.69, 95% CI = 1.03–2.80) in the knee. After further adjusting for BMI, however, these significances were attenuated or disappeared. BMI was significantly associated with BLL, rOA of knee, and sxOA of knee and back. BMI significantly mediated the BLL–rOA association of the knee (21.1%) and back (46.5%) and the BLL–sxOA association of the knee (22.0%). The population-attributable fraction of rOA caused by BLL greater than the median (2.216 μg/dL) was 8.7% (95% CI = 1.1%–16.2%, P value = 0.024).
Conclusions
BLL was significantly associated with knee OA in Korean postmenopausal women. BMI considerably mediated the effects of BLL on knee OA.
The burden of non-communicable diseases, such as osteoarthritis (OA), continues to increase for individuals and society. Regrettably, in many instances, healthcare professionals fail to manage OA optimally. There is growing disparity between the strength of evidence supporting interventions for OA and the frequency of their use in practice. Physical activity and exercise, weight management and education are key management components supported by evidence yet lack appropriate implementation. Furthermore, a recognition that treatment earlier in the disease process may halt progression or reverse structural changes has not been translated into clinical practice. We have largely failed to put pathways and procedures in place that promote a proactive approach to facilitate better outcomes in OA. This paper aims to highlight areas of evidence-based practical management that could improve patient outcomes if used more effectively.
Degenerative Erkrankungen spielen besonders für die ältere und alte Bevölkerung in Deutschland eine große Rolle. Der Umgang mit degenerativen Erkrankungen lässt sich für Betroffene und Angehörige durch gezielte, auf das Erkrankungsbild abgestimmte Beratung unterstützen. Hier gilt es insbesondere die Perspektive des Patienten, seine persönlichen Erfahrungen, Erwartungen und sein Informationsbedürfnis kennen zu lernen und miteinzubeziehen. Ein eingehendes Verständnis für die subjektive Wirklichkeit des Patienten, d. h. sein subjektives Krankheitserleben, das Wissen um seinen Lebenskontext, Werte und Bedürfnisse sind für eine Versorgung wichtig. Das trägt zu einer verbesserten Adherence und Compliance der Patienten bei und fördert den Umgang mit der Erkrankung. Hierfür kann darüber hinaus eine Kompetenzförderung zu den Besonderheiten der Erkrankung für am Versorgungsprozess beteiligte Berufsgruppen wertvoll und hilfreich sein.
The objective of the study was to investigate the effect of bariatric surgery-induced weight loss on knee gait and cartilage degeneration in osteoarthritis by combining magnetic resonance imaging, gait analysis, finite element modeling and cartilage degeneration algorithm. Gait analyses were performed for obese subjects before and one-year after the bariatric surgery. Finite element models were created before and after weight loss for those subjects who had not severe tibio-femoral knee cartilage loss. Knee cartilage degenerations were predicted using an adaptive cartilage degeneration algorithm which is based on cumulative overloading of cartilage, leading to iteratively altered cartilage properties during osteoarthritis. The average weight loss was 25.7±11.0kg corresponding to a 9.2±3.9kg/m2 decrease in BMI. External knee rotation moment increased and minimum knee flexion angle decreased significantly (p<0.05) after weight loss. Moreover, weight loss decreased maximum cartilage degeneration by 5±23% and 13±11% on the medial and lateral tibial cartilage surfaces, respectively. Average degenerated volumes in the medial and lateral tibial cartilage decreased by 3±31% and 7±32%, respectively, after weight loss. However, also increased degeneration levels could be observed due to altered knee kinetics. The present results suggest that moderate weight loss changes knee kinetics and kinematics and can slow-down cartilage degeneration for certain patients and knee compartment. Simulation results also suggest that prediction of cartilage degeneration is subject-specific and depend highly on the altered gait loading, not just the patient's weight.
Introduction: Gonarthrosis of the knee is a chronic inflammatory condition presents in patients over 40; obesity as risk factor is of increasing interest for health systems and according to World Health Statistics of the World Health Organization, Venezuela is the country of South America with the highest rates of this condition. Statistics of the National Institute of Nutrition of Venezuela show that Zulia rates are over the national average with 35% of obese. In the practice of Traumatology of La Cañada Municipality we have observed a high incidence of patients with overweight and it stimulated us to do the present study. Objective: to characterize the patients with Gonarthrosis of knee those were attended in the CDC. Material and Methods: a descriptive transversal study was conducted in the CDC of La Cañada de Urdaneta Municipality, Zulia Province, Venezuela from January 2012 to December 2014 with a sample of 360 patients out of a universe of 6740. Results: the lowest age was 35 years and the highest 93, mean 55.5 years. 86.6% were female and half of the patients had family history of osteoarthritis of the knee, while 93% were overweight. Chief complain of 60% of the patients was pain for one year or less. 49 % of the cases showed severe to moderate X ray signs as well as decrease of the muscular force of lower limbs in 71% of the patients. Conclusions: the risk factor most influenced was increased BMI in patients with Gonarthrosis. Keywords: gonarthrosis of the knee, risk factors, obesity, body mass index.
Introduction:
Chronic knee and hip pain is prevalent, impairing mobility, function and quality of life. Allied health professions (AHPs) are better trained and have more time than general practitioners in primary care to advise and support people to adopt healthier lifestyles (maintain healthy weight, increase physical activity) that reduce joint pain. We evaluated whether AHP-led primary care delivering person-centred, practical lifestyle coaching was a feasible, effective way to manage chronic knee and/or hip pain.
Methods:
At initial assessment the 'Joint Pain Advisor' assessed pain, function, quality of life, physical activity, waist circumference and body mass, taught simple self-management strategies and used behaviour change techniques (motivational interviewing, goal setting, action/coping planning) to alter participants' lifestyles. Participants were invited for 6-week and 6-month reviews, when the Advisor reassessed clinical outcomes, fed back progress and reinforced health messages. Feasibility and effectiveness of the service was evaluated using quantitative and qualitative methods.
Results:
Uptake of the service was good: 498 people used the service. Between initial assessment and reviews, participants' pain, function, quality of life, weight, waist circumference and physical activity improved (p < 0.005). Service user satisfaction was high; they reported easier access to advice and support tailored to their needs that translated into clinical benefits and a more efficient pathway reducing unnecessary consultations and investigations. Relatively few people returned for a 6-month review as they considered they had received sufficient advice.
Conclusions:
AHP-led care is a popular, effective, efficient and sustainable way to manage joint pain, without compromising safety or quality of care.
Osteoarthritis (OA) is one of the major health problems that’s development and progression is obesity-related. We believe that higher levels of insulin may explains this link especially. High levels of insulin in obesity and metabolic syndrome can induce numerous complications. Insulin can increase proliferation of chondrocyte but simultaneously, it prevents their differentiation. Moreover, hyperinsulinemia reduces the circulating level of serum T4 and conversion of T4 to T3, mimicking hypothyroidism, because thyroid hormones are necessary for the maturation of chondrocytes. So maybe decreasing insulin levels, prevents OA progression or improve the treatment process.
Osteoarthritis (OA) is one of the most common causes of disability in adults. The prevalence increases with age, with a surprising 13.9 % of the population over 25 years old being affected and 33.6 % of the population over 65 years old affected [1].
Osteoarthritis (OA) represents a large burden on healthcare resources worldwide with continually increasing prevalence. This has led to renewed interest in the causes and pathogenesis of the condition. In recent years, there has been a move away from a simple ‘wear and tear’ model of cartilage to one of a complex inflammatory process involving cellular and extracellular derangements that allow a catabolic state to dominate. Ultimately, OA is now seen as pan-joint disease involving synovium, menisci, ligaments and muscle, in addition to cartilage. There are several classification systems including radiographic, MRI-based, clinical and combined classification systems. As radiographs only detect OA in latter stages, there has been a focus on early diagnosis using MRI and serum biomarkers. New physiological MRI sequences can now measure the proteoglycan content in cartilage and new semiquantitative analyses have been developed to score total knee joint involvement in the disease process. Serum biomarkers can be divided into those that are collagen breakdown products and those that are inflammatory cytokines; these can be used in early detection of OA before radiographic appearances arise. The risk factors for OA include ageing, knee injury, obesity, altered limb alignment, impaired muscle strength, female gender, heavy physical work and genetic susceptibility. Research continues to identify the mechanisms involved that lead to OA development, with possibly unique processes underpinning each risk factor. Our understanding of the pathophysiology of OA will continue to improve in the next few years which should lead to new intervention strategies that target different processes. More informative MRI sequences will continue to be developed and the optimum combination of biomarkers to detect early OA will need to be identified. Genetic studies will continue to identify new susceptibility loci that could be targeted in future therapies.
Introduction:
Metabolic factors may contribute to osteoarthritis (OA).This study employed metabolomics analyses to determine if differences in metabolite profiles could distinguish people with knee OA who exhibited radiographic progression.
Methods:
Urine samples obtained at baseline and 18 months from overweight and obese adults in the Intensive Diet and Exercise for Arthritis (IDEA) trial were selected from two subgroups (n=22 each) for metabolomics analysis: a group that exhibited radiographic progression (≥0.7mm decrease in joint space width, JSW) and an age, gender, and BMI matched group who did not progress (≤0.35mm decrease in JSW). Multivariate analysis methods, including orthogonal partial least square discriminate analysis, were used to identify metabolite profiles that separated progressors and non-progressors. Plasma levels of IL-6 and C-reactive protein were evaluated as inflammatory markers.
Results:
Multivariate analysis of the binned metabolomics data distinguished progressors from non-progressors. Library matching revealed that glycolate, hippurate, and trigonelline were among the important metabolites for distinguishing progressors from non-progressors at baseline whereas alanine, N,N-dimethyglycine, glycolate, hippurate, histidine, and trigonelline, were among the metabolites that were important for the discrimination at 18 months. In non-progressors, IL-6 decreased from baseline to 18 months while IL-6 was unchanged in progressors; the change over time in IL-6 was significantly different between groups.
Conclusion:
These findings support a role for metabolic factors in the progression of knee OA and suggest that measurement of metabolites could be useful to predict progression. Further investigation in a larger sample that would include targeted investigation of specific metabolites is warranted.
Because of the pressure for timely, informed decisions in public health and clinical practice and the explosion of information in the scientific literature, research results must be synthesized. Meta-analyses are increasingly used to address this problem, and they often evaluate observational studies. A workshop was held in Atlanta, Ga, in April 1997, to examine the reporting of meta-analyses of observational studies and to make recommendations to aid authors, reviewers, editors, and readers.
Twenty-seven participants were selected by a steering committee, based on expertise in clinical practice, trials, statistics, epidemiology, social sciences, and biomedical editing. Deliberations of the workshop were open to other interested scientists. Funding for this activity was provided by the Centers for Disease Control and Prevention.
We conducted a systematic review of the published literature on the conduct and reporting of meta-analyses in observational studies using MEDLINE, Educational Research Information Center (ERIC), PsycLIT, and the Current Index to Statistics. We also examined reference lists of the 32 studies retrieved and contacted experts in the field. Participants were assigned to small-group discussions on the subjects of bias, searching and abstracting, heterogeneity, study categorization, and statistical methods.
From the material presented at the workshop, the authors developed a checklist summarizing recommendations for reporting meta-analyses of observational studies. The checklist and supporting evidence were circulated to all conference attendees and additional experts. All suggestions for revisions were addressed.
The proposed checklist contains specifications for reporting of meta-analyses of observational studies in epidemiology, including background, search strategy, methods, results, discussion, and conclusion. Use of the checklist should improve the usefulness of meta-analyses for authors, reviewers, editors, readers, and decision makers. An evaluation plan is suggested and research areas are explored.
Objective: Funnel plots (plots of effect estimates against sample size) may be useful to detect bias in meta-analyses that were later contradicted by large trials. We examined whether a simple test of asymmetry of funnel plots predicts discordance of results when meta-analyses are compared to large trials, and we assessed the prevalence of bias in published meta-analyses. Design: Medline search to identify pairs consisting of a meta-analysis and a single large trial (concordance of results was assumed if effects were in the same direction and the meta-analytic estimate was within 30
Background
Obesity is one of the most important risk factors for osteoarthritis (OA) in knee(s). However, the relationship between obesity and OA in hand(s) and hip(s) remains controversial and needs further investigation. The purpose of this study was to investigate the impact of obesity on incident osteoarthritis (OA) in hip, knee, and hand in a general population followed in 10 years.
Methods
A total of 1854 people aged 24–76 years in 1994 participated in a Norwegian study on musculoskeletal pain in both 1994 and 2004. Participants with OA or rheumatoid arthritis in 1994 and those above 74 years in 1994 were excluded, leaving n = 1675 for the analyses. The main outcome measure was OA diagnosis at follow-up based on self-report. Obesity was defined by a body mass index (BMI) of 30 and above.
Results
At 10-years follow-up the incidence rates were 5.8% (CI 4.3–7.3) for hip OA, 7.3% (CI 5.7–9.0) for knee OA, and 5.6% (CI 4.2–7.1) for hand OA. When adjusting for age, gender, work status and leisure time activities, a high BMI (> 30) was significantly associated with knee OA (OR 2.81; 95%CI 1.32–5.96), and a dose-response relationship was found for this association. Obesity was also significantly associated with hand OA (OR 2.59; 1.08–6.19), but not with hip OA (OR 1.11; 0.41–2.97). There was no statistically significant interaction effect between BMI and gender, age or any of the other confounding variables.
Conclusion
A high BMI was significantly associated with knee OA and hand OA, but not with hip OA.
A number of occupational risk factors are discussed in relation to the development and progress of knee joint diseases (for example, working in a kneeling or squatting posture, lifting and carrying heavy weights). Besides the occupational factors, a number of individual risk factors are important. The distinction between work-related and other factors is crucial in assessing the risk and in deriving preventive measures in occupational health.
In a case-control study, patients with and without symptomatic knee osteoarthritis (OA) were questioned by means of a standardised questionnaire complemented by a semi-standardised interview. Controls were matched and assigned to the cases by gender and age. Conditional logistic regression was used in analysing data.
In total, 739 cases and 571 controls were included in the study. In women and men, several individual and occupational predictors for knee OA could be described: obesity (odds ratio (OR) up to 17.65 in women and up to 12.56 in men); kneeling/squatting (women, OR 2.52 (>8,934 hours/life); men, 2.16 (574 to 12,244 hours/life), 2.47 (>12,244 hours/life)); genetic predisposition (women, OR 2.17; men, OR 2.37); and sports with a risk of unapparent trauma (women, OR 2.47 (>or=1,440 hours/life); men, 2.58 (>or=3,232 hours/life)). In women, malalignment of the knee (OR 11.54), pain in the knee already in childhood (OR 2.08), and the daily lifting and carrying of loads (>or=1,088 tons/life, OR 2.13) were related to an increased OR; sitting and smoking led to a reduced OR.
The results support a dose-response relationship between kneeling/squatting and symptomatic knee OA in men and, for the first time, in women. The results concerning general and occupational predictors for knee OA reflect the findings from the literature quite well. Yet occupational risks such as jumping or climbing stairs/ladders, as discussed in the literature, did not correlate with symptomatic knee OA in the present study. With regards to occupational health, prevention measures should focus on the reduction of kneeling activities and the lifting and carrying of loads as well as general risk factors, most notably the reduction of obesity. More intervention studies of the effectiveness of tools and working methods for reducing knee straining activities are needed.
The purpose of this study was to estimate the prevalence of radiographic and symptomatic knee osteoarthritis (OA) among community residents and to elucidate the relevant risk factors. This prospective, population-based study was conducted on residents over 50 yr of age in Chuncheon. Subjects completed an interview based on a standardized questionnaire and clinical evaluation including standardized weight bearing semiflexed knee A-P radiographs. We defined a subject with the Kellgren and Lawrence grade >or=2 as having radiographic knee OA (ROA). Symptomatic knee OA (SOA) was defined by the presence of both ROA and knee pain. We obtained symptom information and radiographs from 504 subjects. The prevalence of ROA and SOA was 37.3% and 24.2%, respectively. The prevalence of both ROA and SOA was significantly higher among women than among men. Multivariate analysis revealed that the presence of hypertension, and a manual occupation were significantly associated with the presence of ROA and SOA. Lower level of education was significantly associated with the presence of ROA, and female sex with the presence of SOA. In conclusion, both ROA and SOA are common in the aged adult population of Korea, with preponderance for women.
The prevalence of obesity increased in the United States between 1976-1980 and 1988-1994 and again between 1988-1994 and 1999-2000.
To examine trends in obesity from 1999 through 2008 and the current prevalence of obesity and overweight for 2007-2008.
Analysis of height and weight measurements from 5555 adult men and women aged 20 years or older obtained in 2007-2008 as part of the National Health and Nutrition Examination Survey (NHANES), a nationally representative sample of the US population. Data from the NHANES obtained in 2007-2008 were compared with results obtained from 1999 through 2006.
Estimates of the prevalence of overweight and obesity in adults. Overweight was defined as a body mass index (BMI) of 25.0 to 29.9. Obesity was defined as a BMI of 30.0 or higher.
In 2007-2008, the age-adjusted prevalence of obesity was 33.8% (95% confidence interval [CI], 31.6%-36.0%) overall, 32.2% (95% CI, 29.5%-35.0%) among men, and 35.5% (95% CI, 33.2%-37.7%) among women. The corresponding prevalence estimates for overweight and obesity combined (BMI > or = 25) were 68.0% (95% CI, 66.3%-69.8%), 72.3% (95% CI, 70.4%-74.1%), and 64.1% (95% CI, 61.3%-66.9%). Obesity prevalence varied by age group and by racial and ethnic group for both men and women. Over the 10-year period, obesity showed no significant trend among women (adjusted odds ratio [AOR] for 2007-2008 vs 1999-2000, 1.12 [95% CI, 0.89-1.32]). For men, there was a significant linear trend (AOR for 2007-2008 vs 1999-2000, 1.32 [95% CI, 1.12-1.58]); however, the 3 most recent data points did not differ significantly from each other.
In 2007-2008, the prevalence of obesity was 32.2% among adult men and 35.5% among adult women. The increases in the prevalence of obesity previously observed do not appear to be continuing at the same rate over the past 10 years, particularly for women and possibly for men.
The aim of this study is to examine the dose-response relationships between age, "lifestyle factors" (body mass index, tobacco smoking, sports), and symptomatic knee osteoarthritis in a population-based case-control study. Additionally, the study aims to investigate the mode of interaction between body mass index (BMI) and physical workload (occupational kneeling/squatting and lifting/carrying of loads) with respect to the risk of symptomatic knee osteoarthritis.
In five orthopedic clinics and five practices, 295 male patients aged 25-70 with radiographically confirmed knee osteoarthritis associated with chronic complaints were recruited. The control group comprised 327 male control subjects. In a structured personal interview, body weight at different ages, body height, cumulative amount of smoking, and cumulative duration of different sports activities until the date of first diagnosis of knee osteoarthritis were elicited. Adjusted odds ratios (OR) and 95% confidence intervals (CI) were calculated using unconditional logistic regression analysis. An interaction analysis for the parameters BMI and kneeling/squatting respective lifting/carrying of loads was performed. Population attributable risks (PAR) for knee osteoarthritis were determined for BMI solely and for the combination of BMI with occupational kneeling/squatting and lifting/carrying of loads, respectively.
Age and overweight were strongly associated with the diagnosis of knee osteoarthritis. Compared with persons less than 35 years old, persons who were at least 65 years old had an odds ratio (OR) of 19.0 (95% CI 6.1-58.7) for knee osteoarthritis. Persons with a BMI > or = 28.41 kg/m2 had a strongly elevated risk of knee osteoarthritis (OR 10.8; 95% CI 4.8-24.3) compared to persons with a BMI < 22.86 kg/m2. Heavy tobacco smoking (> or = 55.5 pack years) was associated with a decreased knee osteoarthritis risk in comparison with never-smoking (OR 0.2; 95% CI 0.1-0.5). Ball games (handball, volleyball, basketball) and cycling were associated with symptomatic knee osteoarthritis (OR 4.0; 95% CI 1.8-8.9 and OR 3.7; 95% CI 1.7-7.8 in the highest category of cumulative duration, respectively); to a weaker degree jogging, swimming, and soccer also were positively related to symptomatic knee osteoarthritis. Combining the two parameters, BMI and kneeling/squatting into one variable led to a multiplicative interaction mode for symptomatic knee osteoarthritis. For persons with elevated BMI in combination with moderate to high exposure to occupational kneeling/squatting, the population attributable risk (PAR) was 4%. The PAR for elevated BMI in combination with moderate to high exposure to occupational lifting/carrying of loads was 7%.
In accordance with the literature, we find a strong association between BMI and knee osteoarthritis risk. Considering the relatively high prevalence of occupational manual materials handling, prevention of knee osteoarthritis should not only focus on body weight reduction, but should also take into account work organizational measures particularly aiming to reduce occupational lifting and carrying of loads.
Knee osteoarthritis (OA) is common in elderly populations, and independent predictors of knee OA in Japanese have not been thoroughly investigated. The aim of this study was to identify independent factors associated with radiographic knee OA in an elderly Japanese population by using multiple logistic regression analysis in order to use them to predict knee OA. Subjects of this cross-sectional study were 1,256 participants (548 men and 708 women) in the fourth Matsudai Knee Osteoarthritis Survey conducted in 2000. Knee OA was diagnosed based on X-ray findings, according to the Kellgren and Lawrence scale (grade 0-IV). Demographic and physical characteristics, past disease history, the femorotibial angle (FTA, an index of varus alignment of the knee joint), thrust, history of knee effusion, round back, and history of knee injury were obtained. The average age of the subjects was 70.4 years (SD 6.2). The prevalences of grade≥II knee OA were 223/548 (40.7%) in men and 465/708 (65.7%) in women. Stepwise multiple logistic regression analysis showed female sex odds ratio ((OR)=2.46), age (OR=1.06), body mass index ((BMI), Q1-4 v.s. Q5) (OR=2.09), history of knee injury (OR=1.76), FTA (OR=1.15), thrust (OR=1.81) history of knee effusion (OR=2.08), and round back (OR=1.47) to be significant factors associated with grade≥II knee OA. In conclusion, FTA, thrust, knee effusion, and round back are possible predictors of knee OA in elderly Japanese, independent of already known predictors, such as sex, age, BMI, and history of knee injury. Causal relationships should be further investigated.
Total joint replacement is considered a surrogate measure for symptomatic end-stage osteoarthritis. It is unknown whether the adipose mass and the distribution of adipose mass are associated with the risk of primary knee and hip replacement for osteoarthritis. The aim of the present investigation was to examine this in a cohort study.
A total of 39,023 healthy volunteers from Melbourne, Australia were recruited for a prospective cohort study during 1990 to 1994. Their body mass index, waist circumference, and waist-to-hip ratio were obtained from direct anthropometric measurements. The fat mass and percentage fat were estimated from bioelectrical impedance analysis. Primary knee and hip replacements for osteoarthritis between 1 January 2001 and 31 December 2005 were determined by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazards regression models were used to estimate the hazard ratios (HRs) for primary joint replacement associated with each adiposity measure.
Comparing the fourth quartile with the first, there was a threefold to fourfold increased risk of primary joint replacement associated with body weight (HR = 3.44, 95% confidence interval (CI) = 2.83 to 4.18), body mass index (HR = 3.44, 95% CI = 2.80 to 4.22), fat mass (HR = 3.51, 95% CI = 2.87 to 4.30), and percentage fat (HR = 2.99, 95% CI = 2.46 to 3.63). The waist circumference (HR = 2.77, 95% CI = 2.26 to 3.39) and waist-to-hip ratio (HR = 1.46, 95% CI = 1.21 to 1.76) were less strongly associated with the risk. Except for the waist-to-hip ratio, which was not significantly associated with hip replacement risk, all adiposity measures were associated with the risk of both knee and hip joint replacement, and were significantly stronger risk factors for knee.
Risk of primary knee and hip joint replacement for osteoarthritis relates to both adipose mass and central adiposity. This relationship suggests both biomechanical and metabolic mechanisms associated with adiposity contribute to the risk of joint replacement, with stronger evidence at the knee rather than the hip.
This study aims to project the prevalence of adult obesity to 2012 by age groups and social class, by extrapolating the prevalence trends from 1993 to 2004. Repeated cross-sectional surveys were carried out of representative samples of the general population living in households in England conducted annually (1993 to 2004).
Participants were classified as obese if their body mass index was over 30 kg/m(2). Projections of obesity prevalence by 2012 were based on three scenarios: extrapolation of linear trend in prevalence from 1993 to 2004; acceleration (or slowing down) in rate of change based on the best fitting curve (power or exponential); and extrapolation of linear trend based on the six most recent years (1999 to 2004).
The prevalence of obesity increased significantly from 1993 to 2004 from 13.6% to 24.0% among men and from 16.9% to 24.4% among women. If obesity prevalence continues to increase at the same rate, it is projected that the prevalence of obesity in 2012 will be 32.1% (95% CI 30.4 to 34.8) in men and 31.0% (95% CI 29.0 to 33.1) in women. The projected 2012 prevalence for adults in manual social classes is higher (43%) than for adults in non-manual social classes (35%).
If recent trends in adult obesity continue, about a third of all adults (almost 13 million individuals) would be obese by 2012. Of these, around 43% are from manual social classes, thereby adding to the public health burden of obesity-related illnesses. This highlights the need for public health action to halt or reverse current trends and narrow social class inequalities in health.
The natural history and prognostic factors of cartilage loss in osteoarthritis of the knee were studied in subjects from a general population survey on rheumatic diseases in 1975-8. Baseline data were collected by questionnaire, physical examination, and weightbearing anteroposterior knee radiographs. Follow up of the subjects aged 46-68 years with radiological osteoarthritis grade 2-4 (Kellgren) took place in 1988-9. Cartilage loss was assessed by two observers who scored the change in joint space width between two radiographs. Thirty four per cent had cartilage loss. Prognostic factors and adjusted odds ratios (ORs) (95% confidence intervals) were: body mass index OR = 11.1 (3.3 to 37.3) fourth v first quartile; body weight OR = 7.9 (2.6 to 24.0) third v first tertile; age OR = 3.8 (1.1 to 13.4) > 60 v < or = 49 years; Heberden's nodes OR = 6.0 (1.5 to 23.1); clinical diagnosis of generalised osteoarthritis OR = 3.3 (1.3 to 8.3); and previous bow legs or knock knees OR = 5.1 (1.1 to 23.1). The relation of age with cartilage loss was also confounded by the presence of Heberden's nodes or a diagnosis of generalised osteoarthritis. There was no statistically significant relation for gender, meniscectomy, injury, uric acid concentration, chondrocalcinosis, smoking, and occupation related factors, except possibly standing.
The authors used data from the United States first national Health and Nutrition Examination Survey of 1971–1975 (HANES I) to explore the cross-sectional associations between radiographic osteoarthritis of the knee and a variety of putative risk factors. A total of 5,193 black and white study participants aged 35– 74 years, 315 of whom had x-ray-diagnosed osteoarthritis of the knee, were available for analysis. After controlling for confounders, the authors found significant associations of knee osteoarthritis with overweight, race, and occupation, all of which have been suggested by smaller cross-sectional studies. They then focused specifically on those factors. For overweight, they found a strong association between current obesity and osteoarthritis of the knee, with a dose-response effect not previously assessed. This association was also seen for self-reported minimum adult weight, a proxy for long-term obesity, and was present in persons with asymptomatic osteoarthritis of the knee. These findings strongly suggest that obesity is causative. HANES I was the first study in which racial differences in osteoarthritis of the knee could be assessed within the same country. The black women who were studied had an increased risk of disease (odds ratio (OR) = 2.12, 95% confidence interval (Cl) = 1.39−3.23) after controlling for age and weight, although the black men did not. Finally, the authors used the US Department of Labor Dictionary of Occupational Titles to obtain characterizations of the physical demands and knee-bending stress associated with occupations and to study the relation between physical demands of jobs and osteoarthritis of the knee. They found for persons aged 55–64 years an association between knee-bending demands and osteoarthritis of the knee (men, OR = 2.45, 95% CI = 1.21−4.97; women, OR = 3.49, 95% CI = 1.22−10.52). Since such occupational physical demands are common, the authors conclude that they may be associated with a substantial proportion of osteoarthritis of the knee.
Aim: To explore the prevalence and pathogenetic features of knee osteoarthritis among the middle-aged and elderly people in the urban and rural of Xi'an, so as to provide some available evidence for precaution and treatment of osteoarthritis of the knee. Methods: From May to October 2005, those aged above 40 years, had been living in Xi'an for a long time were investigated except someone had been gone out for more than 1 year. 1 450 people from 8 communities and 5 counties were involved according to multiple stage cluster s ampling. The unified questionnaire, including general state of health, present history, past history, physical examination etc, was carried out and all subjects were given both knees normotopia and lateral position radiographic examination. Excluded other etiological factors, some of them were finally diagnosed as idiopathic osteoarthritis of knee if they had clinical symptoms and a radiographic grade above Kellgren & Lawrence II grade. Results: Among the 1 450 persons involved in the result analysis, there were 704 men and 746 women. 176 persons including 100 urban and 76 rural ones were diagnosed as idiopathic osteoarthritis of knee. 1 The total prevalence of idiopathic osteoarthritis of knee was 12.1%, radiographic osteophyte of knee was 19.2%, friction sound of knee was 18.3%, right and left keens were 2.5% and 2.1% respectively. 2 The prevalence of knee osteoarthritis of women was 2.5 times of that of the men (17.2%, 6.8%, P =0.000); the prevalence of radiographic osteophyte of women was 2.3 times of that of the men (26.5%, 11.4%, P=0.000); There was no significant difference in the prevalence of symptomatic knee between women and men (54.7%, 47.4%). 3 The prevalence of knee osteoarthritis and osteophyte increased with the augment of age, so was the symptomatic knee, except the stages of 56-60 years and 66-70 years. 4 The prevalence of knee osteoarthritis of urban was higher slightly than that of rural patients, which had no significant difference (12.9%, 11.2%). However, the prevalence of symptomatic knee of urban was higher significantly than that of rural. (56.3%, 45.3%, P=0.003). There was no significant difference in the formation of osteophyte between urban and rural patients (21.4%, 16.6%). 5 There was no obvious difference in the prevalence of osteoarthritis and osteophyte among different work (manual workers: 11.6%, 18.4%; non-manual workers: 14.4%, 22.3%). The prevalence of symptomatic knee of non-manual workers was significantly higher than that of manual workers (non-manual workers: 62.6%, manual worker: 48.5%, P=0.003). 6 In women, with increasing of the body mass index, the prevalence of osteoarthritis of knee was significantly increased. But this change was not been observed in men. 7 The symptom of knee was closely related to the size of osteophyte formed in patellofemoral joint and lateral shin joint. 8 The earlier the menopause, the easier the osteoarthritis appeared, and the worse the osteophyte. Squatting position to defecate could easily cause osteoarthritis, and osteophyte in knee. The prevalence of osteoarthritis, and osteophyte for drinkers was higher than no drinking people. 9 The risk factors for osteoarthritis included female and overweight, and bean and meat could prevent the osteoarthritis. Conclusion: Old age, female and obesity serve as risk factors for the osteoarthritis of knee.
Aim: To make clear the angle of the anterior cruciate ligament (ACL) to the coronary plane, and further adjust the scan angle by MRI and set up new scan method. Methods: The experiment was performed from September 2004 to January 2005 at MRI center for extremities of Southwest Hospital, Third Military Medical University of Chinese PLA and anatomic department, Third Military Medical University of Chinese PLA. 120 adult MRI images (60 males and 60 females) of clear ACL were grouped according to left and right knee and sex. Angle of ACL to the coronary plane as well as the length and width of ACL were measured on Artoscan-C. The anatomic section of fresh Chinese adult knee joint at sagittal position was performed in modified TK-6350 digital milling machine and ACL was observed after dissecting. Angle of ACL to the coronary plane was treated with oblique coronary image at knee joint, and the MRI scanning direction was the same to the axon of ACL oblique coronary direction. Simple operation was analyzed, and oblique coronary scanning was established. Results: 1 There was no significant difference for the data of ACL measured at oblique sagittal left or right knees (P > 0.05). 2 At the oblique sagittal images the length and the thickness of ACL measured was of very significant differences in gender which the males' was higher than that of females [(36.45±1.98), (34.52±1.93) mm; (6.09±1.07), (5.45 ±1.13) mm,P < 0.01], and the angle to the coronary plane was of significant differences which the male was higher than the females [(36.4±2.5)°, (35.4±2.5)°, P < 0.05]. The angle of ACL to the coronary plane in the posture of extension was certain relatively. It went flatly. We could make thin oblique coronary scan in MRI by that certain angle. Conclusion: Thin oblique coronary MRI scan method is a good way to show anatomic structure of ACL.
Aim: To understand the risk factors of knee osteoarthritis in the middle-aged and elder population in different areas of China. Methods: The investigation was performed from July to August 2005. 1 A total of 6218 persons who had formal residence certification and over 40 years old were enrolled from 6 cities (Xi'an, Shijiazhuang, Shanghai, Guangzhou, Harbin and Chengdu) of 6 administration regions (northwest, northern China, eastern China, central south, northeast and southwest) of China with stratified-multi-steps-cluster sampling method. They received knee osteoarthritis epidemiology investigation (containing general condition, present history, past history, physical inspection, X-ray inspection and disease diagnosis, totally 94 problems and 141 variance indexes). 4808 persons with symptoms received X-ray in knee. 2 Diagnostic criterion of knee osteoarthritis was positive clinical symptom as well as at least two grades of X-ray Kellgren & Lawrence. 3 Incidence rate was calculated. The 83 variances were analyzed with multiple factors non-conditional Logistic regression analysis with EpiInfo 6.0 and SPSS 10.0 softwares. Odds ratio (OR) was used to express the contacted intensity between disease and exposed factors. OR > 1 indicated that risk of disease increased, and had positive correlation with exposed factors. OR < 1 indicated that risk of disease decreased, and had negative correlation with exposed factors. Results: 1 The total knee osteoarthritis prevalence rate was 15.6% in the six cities, of which it was 7.7% in Xi'an, 11.2% in Shijiazhuang, 9.8% in Shanghai, 30.5% in Guangzhou, 16.9% in Harbin and 17.5% in Chengdu. There was significant difference in the prevalence rate in each city (P < 0.01). 2 The most common risk factors of knee osteoarthritis in six cities were old age (OR=1.032-1.181), stay to excrete long (OR=1.021-1.077), high body mass (OR=1.048-1.073) and to start drink years (OR=1.008-1.028), sport worker (OR=1.651,Xi'an), history of osteoporosis (OR=3.311, Shijiazhuang), smoking (OR=2.654, Shijiazhuang), history of rheumatoid osteoarthritis (OR=4.964, Shanghai), high education (OR=2.593, Shanghai), women (OR=2.510, Guangzhou), history of osteoarthritis in sisters(OR=13.251, Harbin) and history of osteoarthritis in mother (OR=5.683, Chengdu) exposed in different cities analyzed with Logistic regression analysis. Conclusion: Some common risk factors of knee osteoarthritis do exist in six cities in China such as old age, stay to excrete long, high body mass and to start drink years. Meanwhile, the main risk factor is different in different cities.
▪ Objective: To evaluate the effect of weight loss in preventing symptomatic knee osteoarthritis in women.
▪ Design: Cohort analytic study.
▪ Setting: The Framingham Study, based on a sample of a defined population.
▪ Patients: Women who participated in the Framingham Knee Osteoarthritis Study (1983 to 1985): Sixty-four out of 796 women studied had recent-onset symptomatic knee osteoarthritis (knee symptoms plus radiographically confirmed osteoarthritis) were compared with women without disease.
▪ Measurements: Recalled date of symptom onset was used as the incident date of disease. Historical weight was defined as baseline body mass index up to 12 years before symptom onset. Change in body mass index was assessed at several intervals before the current examination. Odds ratios assessing the association between weight change and knee osteoarthritis were adjusted for age, baseline body mass index, history of previous knee injury, habitual physical activity level, occupational physical labor, smoking status, and attained education.
▪ Results: Weight change significantly affected the risk for the development of knee osteoarthritis. For example, a decrease in body mass index of 2 units or more (weight loss, approximately 5.1 kg) over the 10 years before the current examination decreased the odds for developing osteoarthritis by over 50% (odds ratio, 0.46; 95% Cl, 0.24 to 0.86; P = 0.02). Among those women with a high risk for osteoarthritis due to elevated baseline body mass index (> 25), weight loss also decreased the risk (for 2 units of body mass index, odds ratio, 0.41 ; P = 0.02). Weight gain was associated with a slightly increased risk for osteoarthritis, which was not statistically significant.
▪ Conclusion: Weight loss reduces the risk for symptomatic knee osteoarthritis in women.
Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weightbearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability. Ann Intern Med. 2000;133:635-646. www.annals.org For author affiliations and current addresses, see end of text.
Results: Participants born in Italy and Greece had a lower rate of primary joint replacement compared with those born in Australia [hazard ratio (HR) 0.32, 95% confidence interval (CI) 0.26−0.39, P < 0.001], independent of age, gender, body mass index, education level, and physical functioning. This lower rate was observed for joint replacements performed in private hospitals (HR 0.17, 95% CI 0.13−0.23), but not for joint replacements performed in public hospitals (HR 0.96, 95% CI 0.72−1.29). Conclusions: People born in Italy and Greece had a lower rate of primary joint replacement for osteoarthritis in this cohort study, compared to Australian-born people, which could not simply be explained by factors such as education level and physical functioning, despite being overweight. This may be due to poorer access to health care or social factors and preferences regarding treatment. However, it may reflect ethnic differences in rates of progression to end stage osteoarthritis. Understanding this warrants further investigation.
A 14-year longitudinal study of middle-aged women was conducted to evaluate the role of obesity in the initiation and progression of idiopathic knee osteoarthritis and to investigate the effect of weight loss on its natural course. Of the 1191 women participating in the first Matsudai Knee Osteoarthritis Survey in 1979, 608 women without possible secondary osteoarthritis were re-evaluated in 1993. Data were collected by questionnaire, physical examination, and weight-bearing anteroposterior knee radiographs. The mean age of the subjects was 51.3 (range 40–65) years with mean body mass index (BMI) of 23.0 (range 16.0–34.7) at the first survey. Incident disease was defined if a grade 0 knee (a modified Kellgren and Lawrence scale) at the first survey advanced to grade 2 or higher at follow-up. Progression of the disease was defined if a grade 1 or 2 knee advanced to a higher grade at follow-up. We found that higher BMI at the first survey increased the risk of both the initiation and progression of knee osteoarthritis. Obese women (BMI≧25.0) with a decrease in body mass index of 2 units or more during the 14 years had a lower risk for radiological deterioration, although weight gain did not alter the risk significantly.
Aim: To determine the risk factors of symptomatic osteoarthritis (OA) of the knee.
Methods: Two hundred and thirty-nine cases of symptomatic OA of the knee (ACR Criteria for OA 1986) with radiographic OA (Kellgren-Lawrence I or more) taken from a rheumatology outpatient clinic were compared to 279 controls without radiographic (Kellgren-Lawrence 0) OA taken from general internal medicine outpatient clinic at the same hospital. Independent variables to be assessed were age, sex, ethnic group, body mass index (BMI), education, marital status, parity, smoking, and history of acute trauma, hysterectomy, anatomical abnormality of knee, diabetes mellitus, and uric acid levels. Multiple logistic regression analysis was done to assess the independent risk factors.
Results: After going through the steps of multiple logistic regressions analysis, the results were: symptomatic cases compared to controls: age > 50 (OR: 1.86, 95% CI = 1.78–2.82), being female (OR: 2.08, 95% CI = 1.35–3.50), BMI > 25 units (OR: 3.28, 95% CI = 2.20–4.89), elementary education (OR: 0.29, 95% CI = 0.14–0.61) and genu valgus (OR: 4.07, 95% CI = 2.43–7.93). For the female subset of symptomatic cases compared with controls: age > 50 (OR: 9.34, 95% CI = 4.77–18.24), BMI > 25 units (OR: 5.27, 95% CI = 2.85–9.73) and genu valgus (OR: 13.64, 95% CI = 4.58–41.44).
Conclusions: Age > 50, being female, BMI > 25 units and genu valgus, may be the risk factors for symptomatic OA of the knee.
Objective
Preventive strategies against knee osteoarthritis (OA) require a knowledge of risk factors that influence the initiation of the disorder and its subsequent progression. This population-based longitudinal study was performed to address this issue.Methods
Ninety-nine men and 255 women aged ≥55 years had baseline interviews and weight-bearing knee radiographs in 1990–1991. Repeat radiographs were obtained in 1995–1996 (mean followup duration 5.1 years, median age at followup 75.8 years). Risk factors assessed at baseline were tested for their association with incident and progressive radiographic knee OA by logistic regression.ResultsRates of incidence and progression were 2.5% and 3.6% per year, respectively. After adjusting for age and sex, the risk of incident radiographic knee OA was significantly increased among subjects with higher baseline body mass index (odds ratio [OR] 18.3, 95% confidence interval [95% CI] 5.1–65.1, highest versus lowest third), previous knee injury (OR 4.8, 95% CI 1.0–24.1), and a history of regular sports participation (OR 3.2, 95% CI 1.1–9.1). Knee pain at baseline (OR 2.4, 95% CI 0.7–8.0) and Heberden's nodes (OR 2.0, 95% CI 0.7–5.7) were weakly associated with progression. Analyses based on individual radiographic features (osteophyte formation and joint space narrowing) supported differences in risk factors for either feature.Conclusion
Most currently recognized risk factors for prevalent knee OA (obesity, knee injury, and physical activity) influence incidence more than radiographic progression. Furthermore, these factors might selectively influence osteophyte formation more than joint space narrowing. These findings are consistent with knee OA being initiated by joint injury, but with progression being a consequence of impaired intrinsic repair capacity.
The objective of this work was to address the relationship between physical activity in the workplace and subsequent musculoskeletal pain syndromes. We performed a survey of 5,042 men and women aged 70–75 years, selected from the retirement population of a large national employer (the post office). Subjects were sent a short postal questionnaire enquiring about all occupations held for at least 1 year, the physical activities performed in those jobs, and about recent rheumatic symptoms. The 1-month period prevalence of rheumatic symptoms ranged from 19.9% for hip pain or stiffness in men to 50% for knee pain or stiffness in women. Symptoms were more common in women than men at all sites and there were significant (P < 0.001) associations between symptoms at different sites. Obesity was significantly (P < 0.001) associated with the risk of pain or stiffness at the knee and hip. Prolonged occupational exposure (20+ years) to heavy lifting was associated with hip pain (RR = 1.5; 95% CI = 1.2–1.8); and prolonged exposure to working with arms elevated was associated with an increased risk of shoulder pain (RR = 1.4; 95% CI = 1.2–1.6). Tall stature (P = 0.003) and heavy lifting (P < 0.001) were both associated with increased risks of low back pain among men. This survey confirms the high prevalence of musculoskeletal symptoms observed in previous population-based studies. Associations between occupational activities and musculoskeletal symptoms were specific for activity type and skeletal site involved. Our results imply that the adverse effects of these occupational activities can be found many years after cessation of exposure. Am. J. Ind. Med. 32:76-83, 1997. © 1997 Wiley-Liss, Inc.
Meta-analysis provides a systematic and quantitative approach to the summary of results from randomized studies. Whilst many authors have published actual meta-analyses concerning specific therapeutic questions, less has been published about comprehensive methodology. This article presents a general parametric approach, which utilizes efficient score statistics and Fisher's information, and relates this to different methods suggested by previous authors. Normally distributed, binary, ordinal and survival data are considered. Both the fixed effects and random effects model for treatments are described.
Objective
To assess the risk of knee osteoarthritis (OA) associated with kneeling, squatting, and other occupational activities.Methods
We compared 518 patients who were listed for surgical treatment of knee OA and an equal number of control subjects from the same communities who were matched for sex and age. Histories of knee injury and occupational activities were ascertained at interview, height and weight were measured, and the hands were examined for Heberden's nodes. Data were analyzed by conditional logistic regression.ResultsAfter adjustment for body mass index (BMI), history of knee injury, and the presence of Heberden's nodes, risk was elevated in subjects who reported prolonged kneeling or squatting (odds ratio [OR] 1.9; 95% confidence interval [95% CI] 1.3–2.8), walking >2 miles/day (OR 1.9; 95% CI 1.4–2.8), and regularly lifting weights of at least 25 kg (OR 1.7; 95% CI 1.2–2.6) in the course of their work. The risks associated with kneeling and squatting were higher in subjects who also reported occupational lifting, and appeared to interact multiplicatively with the risk conferred by obesity. People with a BMI of ≥30 kg/m2 whose work had entailed prolonged kneeling or squatting had an OR of 14.7 (95% CI 7.2–30.2), compared with subjects with a BMI <25 kg/m2 who were not exposed to occupational kneeling or squatting.Conclusion
There is now strong evidence for an occupational hazard of knee OA resulting from prolonged kneeling and squatting. One approach to reducing this risk may lie in the avoidance of obesity in people who perform this sort of work.
We assessed the probability that mid-aged women with a Kellgren and Lawrence (K-L) score of 1 are likely to progress to a score of 2 or regress to a score of zero at a second time point, 2-3 years later.
Osteoarthritis (OA) of measurements (weight-bearing X-rays and interviews) were undertaken in women from the Southeast Michigan population who were > or =40 years of age, and who participated in both the 1995 and 1998 measurements (N=679).
Of the 17.1 % of women with a 1995 K-L score of 1 in their right knee, 37.1% had a K-L score of 1 in 1998 while 32.8 % had a score of > or =2 and 30.2% had a score of zero. For 26.0% of women, the score progressed by at least one unit over the 2.5 year period whereas scores for only 7.0% of women regressed in the same time period. Women who had a K-L score of 1 in the right knee in 1995 were 2.5 times more likely to have a K-L score of 1 in 1998 (95% CI=1.6-3.8); and were 2.2 times more likely to have a K-L score of 2 or greater (95% CI=1.4-3.5) in 1998 compared with other scores. These women were 74% less likely to have a score of zero in 1998 (95% CI=0.2-0.4). Further, other risk factors, specifically age and BMI were predictors of increasing K-L grade in 1998.
These findings suggest that a score of 1 is part of the advancement to emergent OAK; and suggest the following criteria to characterize individuals who are at an intervenable stage on the pathway toward OAK: age > or =40, BMI > or =30, and K-L score of > or =1. From the perspective of both the individual and the examiner, these assessment characteristics are relatively simple to assess clinically.
Over the past decade, there has been an increase in the number of revision total hip and knee arthroplasties performed in the United States. The purpose of this study was to formulate projections for the number of primary and revision total hip and knee arthroplasties that will be performed in the United States through 2030.
The Nationwide Inpatient Sample (1990 to 2003) was used in conjunction with United States Census Bureau data to quantify primary and revision arthroplasty rates as a function of age, gender, race and/or ethnicity, and census region. Projections were performed with use of Poisson regression on historical procedure rates in combination with population projections from 2005 to 2030.
By 2030, the demand for primary total hip arthroplasties is estimated to grow by 174% to 572,000. The demand for primary total knee arthroplasties is projected to grow by 673% to 3.48 million procedures. The demand for hip revision procedures is projected to double by the year 2026, while the demand for knee revisions is expected to double by 2015. Although hip revisions are currently more frequently performed than knee revisions, the demand for knee revisions is expected to surpass the demand for hip revisions after 2007. Overall, total hip and total knee revisions are projected to grow by 137% and 601%, respectively, between 2005 and 2030.
These large projected increases in demand for total hip and knee arthroplasties provide a quantitative basis for future policy decisions related to the numbers of orthopaedic surgeons needed to perform these procedures and the deployment of appropriate resources to serve this need.
To update evidence for available therapies in the treatment of hip and knee osteoarthritis (OA) and to examine whether research evidence has changed from 31 January 2006 to 31 January 2009.
A systematic literature search was undertaken using MEDLINE, EMBASE, CINAHL, AMED, Science Citation Index and the Cochrane Library. The quality of studies was assessed. Effect sizes (ESs) and numbers needed to treat were calculated for efficacy. Relative risks, hazard ratios (HRs) or odds ratios were estimated for side effects. Publication bias and heterogeneity were examined. Sensitivity analysis was undertaken to compare the evidence pooled in different years and different qualities. Cumulative meta-analysis was used to examine the stability of evidence.
Sixty-four systematic reviews, 266 randomised controlled trials (RCTs) and 21 new economic evaluations (EEs) were published between 2006 and 2009. Of 51 treatment modalities, new data on efficacy have been published for more than half (26/39, 67%) of those for which research evidence was available in 2006. Among non-pharmacological therapies, ES for pain relief was unchanged for self-management, education, exercise and acupuncture. However, with new evidence the ES for pain relief for weight reduction reached statistical significance, increasing from 0.13 [95% confidence interval (CI) -0.12, 0.36] in 2006 to 0.20 (95% CI 0.00, 0.39) in 2009. By contrast, the ES for electromagnetic therapy which was large in 2006 (ES=0.77, 95% CI 0.36, 1.17) was no longer significant (ES=0.16, 95% CI -0.08, 0.39). Among pharmacological therapies, the cumulative evidence for the benefits and harms of oral and topical non-steroidal anti-inflammatory drugs, diacerhein and intra-articular (IA) corticosteroid was not greatly changed. The ES for pain relief with acetaminophen diminished numerically, but not significantly, from 0.21 (0.02, 0.41) to 0.14 (0.05, 0.22) and was no longer significant when analysis was restricted to high quality trials (ES=0.10, 95% CI -0.0, 0.23). New evidence for increased risks of hospitalisation due to perforation, peptic ulceration and bleeding with acetaminophen >3g/day have been published (HR=1.20, 95% CI 1.03, 1.40). ES for pain relief from IA hyaluronic acid, glucosamine sulphate, chondroitin sulphate and avocado soybean unsponifiables also diminished and there was greater heterogeneity of outcomes and more evidence of publication bias. Among surgical treatments further negative RCTs of lavage/debridement were published and the pooled results demonstrated that benefits from this modality of therapy were no greater than those obtained from placebo.
Publication of a large amount of new research evidence has resulted in changes in the calculated risk-benefit ratio for some treatments for OA. Regular updating of research evidence can help to guide best clinical practice.