Epidemiology and prognosis of osteoarthritis 111 Joost Dekker PhD Department of Rehabilitation...
-
Upload
oscar-lloyd -
Category
Documents
-
view
213 -
download
0
Transcript of Epidemiology and prognosis of osteoarthritis 111 Joost Dekker PhD Department of Rehabilitation...
Epidemiology and prognosis of osteoarthritis
111
Joost Dekker PhDDepartment of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center, Amsterdam, Netherlands
Contents
• Definitions
• Prevalence, Incidence
• Prognostic factors for development of OA
• Course and prognosis of activity limitations in OA
2
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
4
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 OA5
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
• Systematic review– Overweight, obesity– Previous knee injury– Female gender– Age– Occupational factors (see also Ezzat et al, Physiotherapy Canada, 2014)
– Intense physical activity
14
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
16
Course of activity limitations
• Highly variable
• Worse, stable and better functioning
18
Dekker, 2009
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
20
Prognosis of pain and physical functioning in knee OA - Systematic review
• 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
• 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.
21
de Rooij et al, submitted
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
22