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Identifying subgroups of community-dwelling older adults and their prospective associations with long-term knee osteoarthritis outcomes

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Abstract

Objectives

To identify subgroups of community-dwelling older adults and to assess their longitudinal associations with long-term osteoarthritis (OA) outcomes.

Methods

1046 older adults aged 50–80 years were studied. At baseline, body mass index (BMI), pedometer-measured ambulatory activity (AA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) determined knee pain and information on comorbidities were obtained. Tibial cartilage volume and bone-marrow lesions (BMLs) were assessed using MRI at baseline and 10 years and total knee replacements (TKR) by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Latent class analysis was used to determine participant subgroups, considering baseline BMI, AA, pain and comorbidities, and linear mixed-effects or log-binomial models were used to assess the associations.

Results

Three subgroups/classes were identified: subgroup 1 (43%): Normal/overweight participants with higher AA, lower pain and lower comorbidities; subgroup 2 (32%): Overweight participants with lower AA, mild pain and higher comorbidities; subgroup 3 (25%): Obese participants with lower AA, mild pain and higher comorbidities. Subgroup 3 had greater cartilage volume loss (β − 60.56 mm3, 95% CI − 105.91, − 15.21) and a higher risk of TKR (RR 3.19, 95% CI 1.75, 5.81), compared to subgroup 1. Subgroup 2 was not associated with cartilage volume change (β 13.06 mm3, 95% CI − 30.87, 57.00) or risk of TKR (RR 1.16, 95% CI 0.56, 2.36), compared to subgroup 1. Subgroup membership was not associated with worsening BMLs.

Conclusions

Our findings suggest the existence of homogeneous subgroups of participants and support the utility of identifying patterns of characteristics/risk factors that may cluster together and using them to identify subgroups of people who may be at a higher risk of developing and/or progressing OA.

Key Points

• Complex interplay among characteristics/factors leads to conflicting evidence between ambulatory activity and knee osteoarthritis.

• Distinct subgroups are identifiable based on ambulatory activity, body mass index, knee pain, and comorbidities.

• Identifying subgroups can be used to determine those who are at risk of developing/progressing osteoarthritis.

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Acknowledgements

We thank all the participants who made this study possible.

Authors roles/contributors

Ishanka P. Munugoda was responsible for data acquisition, management and cleaning, carried out analysis and interpretation of data, prepared the initial manuscript draught and completed manuscript revisions and the final draught. Feng Pan and Karen Wills participated in analysis and interpretation of the data, and critically revised the manuscript. Flavia Cicuttini designed and carried out the study planning, participated in analysis and interpretation of the data, and critically revised the manuscript. Siti M. Mattap, Stephen E. Graves and Michelle Lorimer helped in data collection, participated in interpretation of the data, and critically revised the manuscript. Graeme Jones designed and carried out the study planning, participated in analysis and interpretation of the data, and critically revised the manuscript. Michele L. Callisaya designed and carried out the study planning, participated in analysis and interpretation of the data and critically revised the manuscript. Dawn Aitken designed and carried out the study planning, helped in data management, participated in analysis and interpretation of the data, assisted with the initial manuscript draught, and critically revised the manuscript. All authors have approved the final manuscript.

Funding

This work was supported by the National Health and Medical Research Council of Australia (NHMRC Grant ID- 302204); Tasmanian Community Fund (Grant ID-D0015018); Masonic Centenary Medical Research Foundation; Royal Hobart Hospital Research Foundation; and Arthritis Foundation of Australia (Grant ID—MRI06161). Funding bodies did not have any input at any stage of the conduct of this study, data analysis or writing of the manuscript.

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Authors and Affiliations

  1. Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia

    Ishanka P. Munugoda, Feng Pan, Karen Wills, Siti M. Mattap, Graeme Jones, Michele L. Callisaya & Dawn Aitken

  2. Department of Epidemiology and Preventive Medicine, Monash University Medical School, Melbourne, Victoria, Australia

    Flavia Cicuttini

  3. Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR), Adelaide, South Australia, Australia

    Stephen E. Graves

  4. South Australian Health and Medical Research Institute (SAHMRI), Adelaide, South Australia, Australia

    Michelle Lorimer

  5. Peninsula Clinical School, Central Clinical School, Monash University, Melbourne, Victoria, Australia

    Michele L. Callisaya

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  1. Ishanka P. Munugoda
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  2. Feng Pan
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  7. Michelle Lorimer
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  8. Graeme Jones
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Corresponding author

Correspondence to Ishanka P. Munugoda.

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Conflict of interests

G. Jones has received consulting fees and payments for lectures from multiple pharmaceutical companies. However, no institution/company funded or had any input at any stage of the conduct of this study, data analysis or writing of the manuscript. Other authors declare no conflicts of interests.

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The research was conducted in compliance with the Helsinki Declaration. Ethical approval was granted by the Southern Tasmanian Health and Medical Human Research Ethics Committee. Written informed consent was obtained from all participants.

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Munugoda, I.P., Pan, F., Wills, K. et al. Identifying subgroups of community-dwelling older adults and their prospective associations with long-term knee osteoarthritis outcomes. Clin Rheumatol 39, 1429–1437 (2020). https://doi.org/10.1007/s10067-019-04920-8

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  • DOI: https://doi.org/10.1007/s10067-019-04920-8

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