11
Update on the epidemiology, risk factors and disease outcomes of osteoarthritis

https://doi.org/10.1016/j.berh.2018.10.007Get rights and content

Abstract

Osteoarthritis (OA) is the most frequent form of arthritis and a leading cause of pain and disability worldwide. OA can affect any synovial joint, although the hip, knee, hand, foot and spine are the most commonly affected sites. Knowledge about the occurrence and risk factors for OA is important to define the clinical and public health burden of the disease to understand mechanisms of disease occurrence and may also help to inform the development of population-wide prevention strategies. In this article, we review the occurrence and risk factors for OA and also consider patient-reported outcome measures that have been used for the assessment of the disease.

Introduction

Osteoarthritis (OA) is the most common form of arthritis worldwide and a major cause of disability in middle-age and older adults [1]. The most frequently affected joints are the hip, knee, hand, foot and spine, although OA can affect any joint. It is estimated that symptomatic OA affects one in eight men and women in the US (27–31 million) [1], [2], and worldwide, it is estimated that 250 million people have knee OA [3]. OA is an important cause of disability, with hip and knee OA accounting for 17 million years lived with disability or 2.2% of all-cause years lived with disability [3], [4]. OA is linked to substantive economic costs estimated in developed countries to be between 1% and 2.5% of GDP [5], [6]. The bulk (85%) of the direct costs of OA treatment are due to the costs of joint replacement surgery [7]. In the UK, there were over 185,000 primary hip and knee replacements performed in 2016, with the number set to increase substantially related in part to the ageing population [8], [9].

Although cartilage loss remains the signature pathological feature of OA, it is currently recognised that OA is a disease of the whole joint, with pathological changes in the bone, the soft tissues including synovium, menisci and ligaments. OA may be characterised as primary if there is no identifiable underlying cause and secondary if there is an underlying cause or significant triggering event such as prior trauma. The main symptoms of OA include pain, stiffness and loss of function. There is, however, discordance between the presence of symptoms and radiographic change, and many people with radiographic OA (up to 50%) do not have associated symptoms [10]. The reason for this apparent discordance is unclear, although it is likely in part because plain radiography is an insensitive indicator of the structural and nociceptive changes that occur in OA.

OA can be classified on the basis of radiographic criteria alone or combination criteria including symptoms and radiographic changes (symptomatic OA). The most widely used radiographic criteria are the Kellgren-Lawrence method, which characterises disease as one of the five grades (0–4) based on the presence of joint space narrowing, osteophytes and sclerosis of the subchondral bone [11]. There are, however, limitations related in part to inconsistencies in scoring and also the reliance on the presence of osteophytes, and other criteria have been developed on the basis of scoring of individual radiographic features of the disease [12].

Section snippets

Prevalence

Most of the published data on prevalence derive from population-based radiographic surveys. Plain radiographs are insensitive to early disease, and therefore, these studies tend to underestimate disease occurrence. In a survey of individuals with neither radiographic signs nor symptoms of OA, by magnetic resonance imaging, a more sensitive indicator of joint damage, abnormalities thought to be associated with knee OA were detected in 89% of cases [13]. Estimates of the occurrence of OA vary in

Incidence

Using data from the Fallon Community Health Plan, a health maintenance organisation in Central Massachusetts, among adults aged 20–89 years, the age- and sex-standardised incidence of knee OA was 240/100,000 person years, hip OA was 88/100,000 person years and hand OA was 100/100,000 person years [21]. Incidence increased with age, however, with a levelling off or decline at older ages (>80 years) and with rates greater in women than in men, especially after the age of 50 years [21]. Data from

Lifetime risk

Using data from the Johnston County OA project, it is has been estimated that 40% of adults from the age of 45 years will develop symptomatic hand OA by the age of 85 years for those who live up to that age; this is similar to the corresponding risk of symptomatic knee OA (45%), though greater than that for hip OA (25%) [23], [24], [25]. Using data based on self-report, however, from the US National Health Interview Survey, the lifetime risk of symptomatic knee OA from the age of 25 years was

Influence of race and ethnicity

There are ethnic differences in the occurrence of OA. European and American data do not appear to differ markedly in the occurrence of disease for hand, knee and hip OA [27]. Chinese men and women have a lower prevalence of both radiographic and symptomatic hand OA and radiographic hip OA than Caucasians [28], [29]. The prevalence of radiographic knee OA, however, is similar in Chinese and Caucasian men, whereas prevalence of both radiographic and symptomatic knee OA appears to be greater in

Secular change

With the demographic change to a more elderly population, the number of people with OA is set to increase. Such demographic change is likely to be compounded by the increase in the prevalence of obesity, which is a major risk factor for the disease. Data from Canada suggest that the numbers of people with OA will increase from 4.4 million in 2010 to 10.4 million in 2040 [42]. More recent data from Sweden suggest an increase in clinically diagnosed OA (any site) from 26.6% in 2012 to 29.5% in

Summary

OA is the most frequent form of arthritis and a leading cause of pain and disability. The prevalence of OA increases with age, and the number of people affected is set to increase because of increasing life expectancy. There is important variation in the frequency of OA in different racial and ethnic groups, which may provide clues to the pathogenesis of the disease. Genetic and environmental factors including obesity and trauma are important determinants of disease. The use of validated PROMs

Conflicts of interest

The authors have no conflicts of interest.

Funding

No funding to declare.

References (157)

  • V.B. Kraus et al.

    Call for standardized definitions of osteoarthritis and risk stratification for clinical trials and clinical use

    Osteoarthritis Cartilage OARS Osteoarthritis Res Soc

    (2015)
  • A.G. Day-Williams et al.

    A variant in MCF2L is associated with osteoarthritis

    Am J Hum Genet

    (2011)
  • V. Silverwood et al.

    Current evidence on risk factors for knee osteoarthritis in older adults: a systematic review and meta-analysis

    Osteoarthr Cartil

    (2015)
  • A.C. Gelber et al.

    Body mass index in young men and the risk of subsequent knee and hip osteoarthritis

    Am J Med

    (1999)
  • L. Kong et al.

    Association between smoking and risk of knee osteoarthritis: a systematic review and meta-analysis

    Osteoarthr Cartil

    (2017)
  • D.T. Felson et al.

    Smoking and osteoarthritis: a review of the evidence and its implications

    Osteoarthr Cartil

    (2015)
  • D. Misra et al.

    Vitamin K deficiency is associated with incident knee osteoarthritis

    Am J Med

    (2013)
  • M.K. Shea et al.

    The association between vitamin K status and knee osteoarthritis features in older adults: the Health, Aging and Body Composition Study

    Osteoarthritis Cartilage OARS Osteoarthritis Res Soc

    (2015)
  • N. Diao et al.

    Effect of vitamin D supplementation on knee osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

    Clin Biochem

    (2017)
  • A.I. Hellevik et al.

    Age of menarche is associated with knee joint replacement due to primary osteoarthritis (The HUNT Study and the Norwegian Arthroplasty Register)

    Osteoarthr Cartil

    (2017)
  • F.E. Watt

    Hand osteoarthritis, menopause and menopausal hormone therapy

    Maturitas

    (2016)
  • E. Maheu et al.

    Hand osteoarthritis patients characteristics according to the existence of a hormone replacement therapy

    Osteoarthr Cartil

    (2000)
  • R.C. Lawrence et al.

    Estimates of the prevalence of arthritis and other rheumatic conditions in the United States. Part II

    Arthritis Rheum

    (2008)
  • M.G. Cisternas et al.

    Alternative methods for defining osteoarthritis and the impact on estimating prevalence in a US population-based survey

    Arthritis Care Res

    (2016)
  • A. Chen et al.

    The global economic cost of osteoarthritis: how the UK compares

    Arthritis

    (2012)
  • N.J. Regsitry

    14th annual report

    (2017)
  • M.T. Hannan et al.

    Analysis of the discordance between radiographic changes and knee pain in osteoarthritis of the knee

    J Rheumatol

    (2000)
  • J.H. Kellgren et al.

    Radiological assessment of osteo-arthrosis

    Ann Rheum Dis

    (1957)
  • R.D. Altman et al.

    Atlas of individual radiographic features in osteoarthritis

    Osteoarthritis Cartilage OARS Osteoarthritis Res Soc

    (1995)
  • A. Guermazi et al.

    Prevalence of abnormalities in knees detected by MRI in adults without knee osteoarthritis: population based observational study (Framingham Osteoarthritis Study)

    Bmj

    (2012)
  • D.T. Felson et al.

    The prevalence of knee osteoarthritis in the elderly. The Framingham Osteoarthritis Study

    Arthritis Rheum

    (1987)
  • G. Peat et al.

    Knee pain and osteoarthritis in older adults: a review of community burden and current use of primary health care

    Ann Rheum Dis

    (2001)
  • J.L. van Saase et al.

    Epidemiology of osteoarthritis: zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations

    Ann Rheum Dis

    (1989)
  • U.S. Nguyen et al.

    Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data

    Ann Intern Med

    (2011)
  • C. Kim et al.

    Prevalence of radiographic and symptomatic hip osteoarthritis in an urban United States community: the Framingham osteoarthritis study

    Arthritis & rheumatology (Hoboken, NJ)

    (2014)
  • I.K. Haugen et al.

    Prevalence, incidence and progression of hand osteoarthritis in the general population: the Framingham Osteoarthritis Study

    Ann Rheum Dis

    (2011)
  • S.A. Oliveria et al.

    Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization

    Arthritis Rheum

    (1995)
  • K.M. Leyland et al.

    The natural history of radiographic knee osteoarthritis: a fourteen-year population-based cohort study

    Arthritis Rheum

    (2012)
  • L. Murphy et al.

    Lifetime risk of symptomatic knee osteoarthritis

    Arthritis Rheum

    (2008)
  • J. Qin et al.

    Lifetime risk of symptomatic hand osteoarthritis: the johnston county osteoarthritis project

    Arthritis & rheumatology (Hoboken, NJ)

    (2017)
  • E. Losina et al.

    Lifetime risk and age at diagnosis of symptomatic knee osteoarthritis in the US

    Arthritis Care Res

    (2013)
  • J. Martel-Pelletier et al.

    Osteoarthritis

    Nat Rev Dis Prim

    (2016)
  • M.C. Nevitt et al.

    Very low prevalence of hip osteoarthritis among Chinese elderly in Beijing, China, compared with whites in the United States: the Beijing osteoarthritis study

    Arthritis Rheum

    (2002)
  • Y. Zhang et al.

    Lower prevalence of hand osteoarthritis among Chinese subjects in Beijing compared with white subjects in the United States: the Beijing Osteoarthritis Study

    Arthritis Rheum

    (2003)
  • Y. Zhang et al.

    Comparison of the prevalence of knee osteoarthritis between the elderly Chinese population in Beijing and whites in the United States: the Beijing Osteoarthritis Study

    Arthritis Rheum

    (2001)
  • D.T. Felson et al.

    High prevalence of lateral knee osteoarthritis in Beijing Chinese compared with Framingham Caucasian subjects

    Arthritis Rheum

    (2002)
  • J.J. Anderson et al.

    Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work

    Am J Epidemiol

    (1988)
  • C.F. Dillon et al.

    Prevalence of knee osteoarthritis in the United States: arthritis data from the third national health and nutrition examination survey 1991-94

    J Rheumatol

    (2006)
  • J.M. Jordan et al.

    Prevalence of knee symptoms and radiographic and symptomatic knee osteoarthritis in african americans and caucasians: the johnston county osteoarthritis project

    J Rheumatol

    (2007)
  • A.E. Nelson et al.

    Differences in multijoint radiographic osteoarthritis phenotypes among african americans and caucasians: the johnston county osteoarthritis project

    Arthritis Rheum

    (2011)
  • Cited by (0)

    View full text