1
Osteoarthritis: Epidemiology

https://doi.org/10.1016/j.berh.2005.09.007Get rights and content

Osteoarthritis (OA) is the most common joint disorder in the world. In Western populations it is one of the most frequent causes of pain, loss of function and disability in adults. Radiographic evidence of OA occurs in the majority of people by 65 years of age and in about 80% of those aged over 75 years. In the US it is second only to ischaemic heart disease as a cause of work disability in men over 50 years of age, and accounts for more hospitalizations than rheumatoid arthritis (RA) each year. Despite this public health impact, OA remains an enigmatic condition to the epidemiologist. In this chapter, we will review the definition and classification of OA, its prevalence, incidence, risk factors and natural history.

Section snippets

Definition

OA can be defined by joint symptoms, by structural pathology (e.g. on X-ray), or by the combination of the two. The primary symptoms include joint pain and stiffness. The joint pathology is diverse and includes focal damage and loss of articular cartilage, abnormal remodelling and attrition of subarticular bone, osteophytes (bone growth at the joint margins), ligamentous laxity, weakening of periarticular muscles, and in some cases synovial distension and inflammation.1 It is now widely viewed

Diagnostic criteria

The most widely used diagnostic criteria were developed by the American College of Rheumatology (ACR).10, 11 These criteria identify subjects with clinical OA using joint pain for most days of the prior month as the major inclusion criterion. This contrasts with the use of radiographic changes alone wherein many subjects do not report joint pain. The algorithms for classification were developed by comparing patients with clinically diagnosed OA and controls with site-specific joint pain due to

Classification

Two major systems have been proposed for the classification of OA: aetiological and articular. The recognition that pathological and radiological features of OA could follow almost any established joint disorder led to the suggestion that OA could be classified as primary (idiopathic) or secondary. Several disorders are well recognized as causes of secondary OA. They can be divided into four main categories (Table 3). However, the distinction between primary and secondary OA is not always

Prevalence and incidence

The individual joints most commonly affected by OA are the knee, hip, hand, spine and foot, with the wrists, shoulders and ankles less frequently developing OA.18 The population impact is greatest for OA of the hips and knees, since disease is common at these sites, and pain and stiffness in large weight-bearing joints often lead to significant problems with mobility and to disability requiring expensive surgical treatments.19 In the US alone, the combined number of knee and hip joint

Risk factors for osteoarthritis

Epidemiological patterns in the occurrence of OA—the characteristics of those who develop the disease, which joints are affected, and at what age—provide potential clues to disease pathogenesis. A conceptual model for the pathogenesis of OA that has gained acceptance in recent years provides a framework for understanding these clues. Several important tenets of this model are: (1) cartilage, bone, muscles, ligaments and other joint tissues and structures function as a biomechanical organ system

Natural history

Disease evolution in knee OA is slow, usually taking several years. There is emerging evidence that, once established, the condition can remain relatively stable for many years. The correlation between clinical outcome and radiographic course is relatively weak; a large study144 demonstrated that although radiographic improvement was rare, overall clinical improvement at 1 year follow-up was common. Longer-term studies confirmed that radiographic deterioration occurs in one-third to two-thirds

Determinants of progression in osteoarthritis

Just as the natural history of OA differs at different joint sites, the factors which contribute to disease progression also appear to be joint-specific. These determinants have been less well studied than the risk factors for prevalent disease. However, Table 7 summarizes the known determinants of progression at the knee and hip. At both sites multiple joint involvement appears to be a determinant of accelerated disease. Schouten and colleagues24 found that a diagnosis of generalized OA

Conclusion

Osteoarthritis is now firmly established as a public health problem. There have been advances in defining the disorder and measuring its component features clinically, radiographically, and by other investigative techniques. The descriptive epidemiological characteristics of osteoarthritis as it affects various joint sites have been elucidated, and the risk factors for prevalent disease are clearly understood for the knee, hip and hand. Epidemiological information on the rate of progression of

References (147)

  • A.M. Parfitt et al.

    Vitamin D and bone health in the elderly

    The American Journal of Clinical Nutrition

    (1982)
  • C.W. Hutton

    Osteoarthritis: the cause not result of joint failure?

    Annals of the Rheumatic Diseases

    (1989)
  • J.H. Kellgren et al.

    Radiological assessment of osteo-arthrosis

    Annals of the Rheumatic Diseases

    (1957)
  • T.D. Spector et al.

    Definition of osteoarthritis of the knee for epidemiological studies

    Annals of the Rheumatic Diseases

    (1993)
  • D.A. Kallman et al.

    New radiographic grading scales for osteoarthritis of the hand. Reliability for determining prevalence and progression

    Arthritis and Rheumatism

    (1989)
  • P. Croft et al.

    Defining osteoarthritis of the hip for epidemiologic studies

    American Journal of Epidemiology

    (1990)
  • R.D. Altman et al.

    Atlas of individual radiographic features in osteoarthritis

    Osteoarthritis and Cartilage

    (1995)
  • S. Burnett et al.

    A Radiographic Atlas of Osteoarthritis

    (1994)
  • J.S. Lawrence

    Rheumatism in Populations

    (1977)
  • R. Altman et al.

    The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hand

    Arthritis and Rheumatism

    (1990)
  • R. Altman et al.

    The American College of Rheumatology criteria for the classification and reporting of osteoarthritis of the hip

    Arthritis and Rheumatism

    (1991)
  • J. Cushnaghan et al.

    Study of 500 patients with limb joint osteoarthritis. I. Analysis by age, sex, and distribution of symptomatic joint sites

    Annals of the Rheumatic Diseases

    (1991)
  • J.H. Kellgren et al.

    Generalized osteoarthritis and Heberden's nodes

    British Medical Journal

    (1952)
  • P. Egger et al.

    Patterns of joint involvement in osteoarthritis of the hand: the Chingford Study

    The Journal of Rheumatology

    (1995)
  • C. Cooper et al.

    Generalized osteoarthritis in women: pattern of joint involvement and approaches to definition for epidemiological studies

    The Journal of Rheumatology

    (1996)
  • P.D. Utsinger et al.

    Roentgenologic, immunologic, and therapeutic study of erosive (inflammatory) osteoarthritis

    Archives of Internal Medicine

    (1978)
  • A.B. Newman et al.

    Strength and muscle quality in a well-functioning cohort of older adults: the health, aging and body composition study

    Journal of the American Geriatrics Society

    (2003)
  • A.A. Guccione et al.

    The effects of specific medical conditions on the functional limitations of elders in the Framingham Study

    American Journal of Public Health

    (1994)
  • 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

    Annals of the Rheumatic Diseases

    (1989)
  • R.C. Lawrence et al.

    Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

    Arthritis and Rheumatism

    (1998)
  • G. Peat et al.

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

    Annals of the Rheumatic Diseases

    (2001)
  • Jordan K, Sawyer S, Coakley P, Smith H, Cooper C, Arden NK. The use of conventional and complementary treatements for...
  • S.A. Oliveria et al.

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

    Arthritis and Rheumatism

    (1995)
  • D.T. Felson et al.

    Osteoarthritis: new insights. Part 1: the disease and its risk factors

    Annals of Internal Medicine

    (2000)
  • P. Dieppe

    The classification and diagnosis of osteoarthritis

  • L. Sharma

    Local factors in osteoarthritis

    Current Opinion in Rheumatology

    (1995)
  • P. Dieppe et al.

    The natural course and prognosis of osteoarthritis

  • J.S. Hernborg

    The natural course of untreated osteoarthritis of the knee

    Clinical Orthopaedics

    (1977)
  • D.T. Felson et al.

    The incidence and natural history of knee osteoarthritis in the elderly

    Arthritis and Rheumatism

    (1995)
  • C. Cooper et al.

    Risk factors for the incidence and progression of radiographic knee osteoarthritis

    Arthritis and Rheumatism

    (2000)
  • M. Dougados et al.

    Radiological progression of hip osteoarthritis: definition, risk factors and correlations with clinical status

    Annals of the Rheumatic Diseases

    (1996)
  • J.S. Lawrence et al.

    Osteo-arthritis: prevalence in the population and relationship between symptoms and X-ray changes

    Annals of the Rheumatic Diseases

    (1966)
  • D.T. Felson et al.

    The prevalence of knee osteoarthritis in the elderly

    Arthritis and Rheumatism

    (1987)
  • R.C. Lawrence et al.

    Estimates of the prevalence of arthritis and selected musculoskeletal disorders in the United States

    Arthritis and Rheumatism

    (1998)
  • J.L. van Saase et al.

    Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations

    Annals of the Rheumatic Diseases

    (1989)
  • D. Kallman et al.

    The longitudinal course of hand osteoarthritis in a male population

    Arthritis and Rheumatism

    (1990)
  • S.A. Oliveria et al.

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

    Arthritis and Rheumatism

    (1995)
  • L. Sharma et al.

    Laxity in health and osteoarthritic knees

    Arthritis and Rheumatism

    (1999)
  • J.H. Kellgren et al.

    Generalized osteoarthritis and Heberden's nodes

    British Medical Journal

    (1952)
  • J. Ledingham et al.

    Radiographic progression of hospital referred osteoarthritis of the hip

    Annals of the Rheumatic Diseases

    (1993)
  • Cited by (909)

    • Metabolomics/lipidomics of osteoarthritis and inflammation

      2024, Comprehensive Analytical Chemistry
    View all citing articles on Scopus
    View full text