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Epidemiology and Prognosis of Osteoarthritis: Insights and Risk Factors for Development and Management

Learn about the definitions, prevalence, and course of osteoarthritis. Discover the prognostic factors and subgroups affecting activity limitations. Explore risk factors and prognosis related to pain and physical functioning in knee OA.

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Epidemiology and Prognosis of Osteoarthritis: Insights and Risk Factors for Development and Management

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  1. Epidemiology and prognosis of osteoarthritis Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center, Amsterdam, Netherlands 1 1

  2. Contents • Definitions • Prevalence, Incidence • Prognostic factors for development of OA • Course and prognosis of activity limitations in OA

  3. Definitions • Radiographic OA • Kellgren – Lawrence grading • KL ≥ 2 (KL ≥ 1)

  4. Kellgren & Lawrence grading 0 - No radiographic features of osteoarthritis 1 - Possible joint space narrowing and osteophyte formation 2 - Definite osteophyte formation with possible joint space narrowing 3 - Multiple osteophytes, definite joint space narrowing, sclerosis and possible bony deformity 4 - Large osteophytes, marked joint space narrowing, severe sclerosis and definite bony deformity

  5. Definitions • Radiographic OA • Kellgren – Lawrence grading • KL ≥ 2 (KL ≥ 1) • Symptomatic OA • Radiographic + symptoms (pain, stiffness) • Clinical OA • Symptoms • American College of Rheumatology (ACR) criteria • Knee pain in older people • Activity limitations in OA

  6. Prevalence and Incidence

  7. Suri et al, PM&R, 2012

  8. Prognostic factors for development of OA (radiographic, symptomatic)

  9. Suri et al, PM&R, 2012

  10. Suri, Morgenroth and Hunter, PM&R, 2012 • Figure 1: Potential risk factors • Narrative review • Evidence for some risk factors for incidence/progression of OA • Age, gender, overweight/obesity • Joint injury, limb-length inequality, alignment, hip dysplasia • Evidence for other risk factors less clear

  11. Silverwood et al, 2015 • Meta-analysis

  12. Silverwood et al, 2015 • Systematic review • Overweight, obesity • Previous knee injury • Female gender • Age • Occupational factors (see also Ezzat et al, Physiotherapy Canada, 2014) • Intense physical activity

  13. Risk factors for the development of OA (radiographic, symptomatic) • Evidence from meta-analyses and systematic reviews • Systemic factors : Age, gender, overweight/obesity • Local factors: Joint injury, limb-length inequality, alignment, hip dysplasia, occupational factors, intense physical activity, muscle weakness • Rapid developments • Evidence will change

  14. Course and prognosis of activity limitations

  15. Course of activity limitations • Highly variable • Worse, stable and better functioning Dekker, 2009

  16. Course of activity limitations in early knee OA Holla et al, 2014

  17. Characteristics of the subgroups • Subgroup 2 (‘moderate outcome’) compared with Subgroup 1 (‘good outcome’) • Higher BMI • Greater knee pain, hip pain • Less vitality/more fatigue • ≥3 comorbidities • Subgroup 3 (‘poor outcome’) compared with Subgroup 1 (‘good outcome’) • Younger age • Greater knee pain, hip pain • Bony tenderness, lower range of active knee flexion, osteophytosis • Less vitality/more fatigue • Resting/avoidance of activity • ≥3 comorbidities

  18. Prognosis of pain and physical functioning in knee OA - Systematic review Strong evidence on Clinical factors lower walking speed more disability higher morbidity count poor general health Psychosocial factors lower vitality poor mental health more depressive symptoms. • Strong evidence on • Knee characteristics • worsening in radiographic osteoarthritis • bilateral knee symptoms • higher knee pain at baseline • worsening of knee pain • pain on patella-femoral joint compression • lower knee extension strength de Rooij et al, submitted

  19. Summary • Radiographic OA, Symptomatic OA, Clinical OA, Activity limitations in OA • Risk factors for the development of OA (radiographic, symptomatic) • Systemic factors : Age, gender, overweight/obesity • Local factors: Joint injury, limb-length inequality, alignment, hip dysplasia, occupational factors, intense physical activity, muscle weakness • Activity limitations in OA • Highly variable • Knee characteristics, clinical factors, psychosocial factors

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