1Osteoarthritis: Epidemiology
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
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