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Osteoarthritis in the Aged

Epidemiological Issues and Optimal Management

  • Epidemiology
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Summary

Osteoarthritis (OA) is the most common of the arthropathies. The prevalence increases significantly with age, with as many as 68% of women and 58% of men aged 65 years or older having radiological evidence of disease. With an aging population, OA will represent an increasingly significant healthcare burden.

The current treatment of patients with OA is purely symptomatic. As yet, there is no evidence that treatment changes the course of the disease. The current optimal treatment involves a combined approach which includes modification of risk factors, particularly obesity, and nonpharmacological treatments such as physiotherapy. If drugs are required in the treatment of OA, full dose regular paracetamol (acetaminophen) should be the first line of analgesic therapy. There is little evidence that the current over-reliance on long term treatment with nonsteroidal anti-inflammatory drugs (NSAIDs) is justified. If NSAIDs are used, it is necessary to regularly review their use and to be aware of their potential toxicity, particularly in the older age group.

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References

  1. Verbrugge LM. From sneezes to adieux: Stages of health for American men and women. In: Ward RA, Tobin SS, editors. Health in Aging: Sociological Issues and Policy Directions. New York: Springer, 1987: 17–57

    Google Scholar 

  2. Lawrence RC, Hochberg MC, Kelsey JL, et al. Estimates of the prevalence of selected arthritic and musculoskeletal diseases in the United States. J Rheum 1989; 16: 427–41

    PubMed  CAS  Google Scholar 

  3. Bulstrode C. Keeping up with orthopaedic epidemics [editorial]. BMJ 1987; 295: 514

    Article  PubMed  CAS  Google Scholar 

  4. Benn T, Wood PHN. Statistical appendix. Digest of data on rheumatic diseases. 4: Morbidity and mortality and hospital services for rheumatism sufferers. Ann Rheum Dis 1972; 31: 522–32

    Article  Google Scholar 

  5. Kramer JS, Yeltin EH, Epstein WV. Social and economic impacts of four musculoskeletal conditions: a study using national community-based data. Arthritis Rheum 1983; 26: 901–7

    Article  PubMed  CAS  Google Scholar 

  6. Altman RD, Asch E, Bloch DA, et al. Development of criteria for the classification and reporting of osteoarthritis: classification of osteoarthritis of the knee. Arthritis Rheum 1986; 29: 1039–49

    Article  PubMed  CAS  Google Scholar 

  7. Kellgren J H, Lawrence JS. Atlas of standard radiographs: the epidemiology of chronic rheumatism, vol. 2. Oxford: Black-well Scientific, 1963

    Google Scholar 

  8. National Center for Health Statistics. Osteoarthritis in adults by selective demographic characteristics, United States, 1960–1962. Rockville, Md: Department of Health, Education and Welfare, 1966

    Google Scholar 

  9. Lawrence JS. Rheumatism in populations. London: William Heinemann Medical, 1977: 98–155

    Google Scholar 

  10. Cunningham LS, Kelsy JL. Epidemiology of musculoskeletal impairments and associated disability. Am J Public Health 1984; 74: 574–9

    Article  PubMed  CAS  Google Scholar 

  11. Hochberg MC, Lawrence RC, Everett DF, et al. Epidemiologic association of pain in osteoarthritis of the knee: data from the National Health and Nutrition Examination Survey and the National Health and Nutrition Examination, vol. 1 — epidemiologic follow-up survey. Semin Arthritis Rheum 1989; 18 Suppl. 2: 4–9

    Article  PubMed  CAS  Google Scholar 

  12. Lawrence JS, Bremner JM, Biers F. Osteoarthritis: prevalence in the population and relationship between symptoms and x-ray changes. Ann Rheum Dis 1966; 25: 1–5

    PubMed  CAS  Google Scholar 

  13. Allander E. Prevalence, incidence, and remission rates of some common rheumatic diseases or syndromes. Scand J Rheumatol 1974; 3: 145–8

    Article  PubMed  CAS  Google Scholar 

  14. Lawrence JS. Rheumatism in populations. London: Heinemann, 1977: 99–100

    Google Scholar 

  15. Lawrence JS, Sebo M. The geography of osteoarthritis. In: Nuki G, editor. The aetiopathogenesis of osteoarthritis. London: Pitman, 1980: 155

    Google Scholar 

  16. Hoaglund FT, Yau ACAM, Wong WL. Osteoarthritis of the hip and other joints in Southern Chinese in Hong Kong. J Bone Joint Surg 1973; 55: 545–7

    PubMed  CAS  Google Scholar 

  17. Stecher RM. Heberden’s nodes: heredity in hypertrophic arthritis of the finger joints. Am J Med Sci 1941; 201: 801–5

    Article  Google Scholar 

  18. Kellgren JH, Lawrence JS, Bier F. Genetic factors in generalised osteoarthritis. Ann Rheum Dis 1963; 22: 237–55

    Article  PubMed  CAS  Google Scholar 

  19. Pelotie A, Vaisanen P, Ott J, et al. Previous position to familial osteoarthritis linked to type II collagen gene. Lancet 1989; 1: 924–7

    Article  Google Scholar 

  20. Hochberg, M.C. Epidemiology and genetics of osteoarthritis [review]. Curr Opin Rheumatol 1991; 3: 662–8

    Article  PubMed  CAS  Google Scholar 

  21. Felson DT. Epidemiology of hip and knee osteoarthritis. Epidemiol Rev 1988; 10: 1–28

    PubMed  CAS  Google Scholar 

  22. Danielsson L, Lindberg H, Nilsson B. Prevalence of coxarthrosis. Clin Orthop 1984; 191: 110–5

    PubMed  Google Scholar 

  23. Kellgren JH. Osteoarthritis in patients and populations. BMJ 1961; 1: 1–16

    Article  Google Scholar 

  24. Spector TD, Hart DJ, Brown P, et al. Frequency of osteoarthritis in hysterectomized women. J Rheumatol 1991; 18: 1877–83

    PubMed  CAS  Google Scholar 

  25. Felson DT. The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum 1990; 20: 42–50

    Article  PubMed  CAS  Google Scholar 

  26. Tyler JA. Insulin-like growth factor 1 can decrease degradation and promote synthesis of proteoglycan in cartilage exposed to cytokines. Biochem J 1989; 260: 543–8

    PubMed  CAS  Google Scholar 

  27. Dore S, Rousseau N, Pelletier J-P, et al. Expression of growth hormone receptor and absence of response to growth hormones in human articular cartilage [abstract]. 75th Annual Meeting of The Endocrine Society; 1993 Sept: Las Vegas (NV): 50

    Google Scholar 

  28. Denko CW, Boja B, Moskowski RW. Growth promoting peptides in osteoarthritis: insulin, insulin-like growth factor 1, growth factor. J Rheum 1990; 17: 1217–21

    PubMed  CAS  Google Scholar 

  29. Coates CL, Burwell RG, Lloyd-Jones K, et al. Somatomedin activity in synovial fluid from patients with joint diseases. Ann Rheum Dis 1978; 37: 303–14

    Article  PubMed  CAS  Google Scholar 

  30. Dore S, Pelletier J-P, DiBattista JA, et al. Human osteoathritic chondrocytes possess as increased number of insulin-like growth factor 1 binding sites but are unresponsive to its stimulation. Arthritis Rheum 1994; 37: 253–63

    Article  PubMed  CAS  Google Scholar 

  31. Scott JC, Hochberg MC. Osteoarthritis: I. Epidemiology. Md State Med J. 1984; 33: 712–16

    PubMed  CAS  Google Scholar 

  32. Hart DJ, Spector TD. The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. J Rheumatol 1993; 20: 331–5

    PubMed  CAS  Google Scholar 

  33. Felson DT, Zhang Y, Anthony JM, et al. Weight loss reduces the risk for symptomatic knee osteoarthritis in women: the Framingham Study. Ann Intern Med 1992; 116: 535–9

    PubMed  CAS  Google Scholar 

  34. Spector TD, Hart DJ, Doyle DV. Incidence and progression of Osteoarthritis in women with contralateral knee disease in the general population: the effect of obesity. Ann Rheum Dis 1994; 53: 565–8

    Article  PubMed  CAS  Google Scholar 

  35. Lawrence JS. Hypertension in relation to musculoskeletal disorders. Ann Rheum Dis 1975; 34: 451–6

    Article  PubMed  CAS  Google Scholar 

  36. Acheson RM, Collart AB. New Haven Survey of joint diseases: relationship between some systemic characteristics and osteoarthritis in a general population. Ann Rheum Dis 1975; 34: 379

    Article  PubMed  CAS  Google Scholar 

  37. Anderson JJ, Felson DT. Factors associated with osteoarthritis of the knee in the first national health and nutrition examination survey (NHANES I). Am J Epidemiol 1988; 128: 179–89

    PubMed  CAS  Google Scholar 

  38. Davis MA, Ettinger WH, Neuhaus JM, et al. Sex differences in osteoarthritis of the knee: the role of obesity. Am J Epidemiol 1988; 127: 1019–30

    PubMed  CAS  Google Scholar 

  39. Hart DJ, Doyle DV, Spector TD. The association between metabolic factors and knee osteoarthritis in women. J Rheumatol. In press

  40. Kelsey JL. The epidemiology of diseases of the hip: a review of the literature. Int J Epidemiol 1977; 6: 269–80

    Article  PubMed  CAS  Google Scholar 

  41. Kellgren JH, Moore R. Generalised osteoarthritis and Heberdens nodes. BMJ 1952; 1: 181–5

    Article  PubMed  CAS  Google Scholar 

  42. O’Brien WM, Clemett AR, Acheson RM. Symptoms and patterns of OA of the hand in the Newhaven survey of joint diseases. In: Bennett H, Wood P, editors. Population studies of rheumatic diseases. Amsterdam: Excerpta Medica, 1968: 398

    Google Scholar 

  43. Lawrence JS. Rheumatism in cotton operatives. Br J Indust Med 1961; 18: 270–6

    CAS  Google Scholar 

  44. Davis MA, Neuhaus JM, Ettinger WH, et al. Body fat distribution and osteoarthritis. Am J Epidemiol 1990; 132: 701–7

    PubMed  CAS  Google Scholar 

  45. Hochberg MC, Lethbridge-Cejku M, Plato CC, et al. Factors associated with osteoarthritis of the hand in males: data from the Baltimore Longitudinal Study of Aging. Am J Epidemiol 1991; 1121–7

  46. Sowers MF, Zobel D, Weissfeld L, et al. Progression of osteoarthritis of the hand and metacarpal bone loss: a twenty-year followup of incident cases. Arthritis Rheum 1991; 34: 36–42

    Article  PubMed  CAS  Google Scholar 

  47. Whittle J, Steinberg EP, Anderson GF, et al. Incidence and indications for total hip replacement among elderly Americans [abstract]. Arthritis Rheum 1990; 3 Suppl.: S139

    Google Scholar 

  48. Wiberg G. Studies on dysplastic acetabula and congenital subluxation of the hip. Acta Chir Scand 1980; 58 Suppl.: 7

    Google Scholar 

  49. Murray RO. The aetiology of primary osteoarthritis of the hip. Br J Radiol 1965; 36: 810–24

    Article  Google Scholar 

  50. Solomon L. Patterns of osteoarthritis of the hip. J Bone Joint Surg Br 1976; 58: 176–83

    PubMed  CAS  Google Scholar 

  51. Peyron JG. Is osteoarthritis a preventable disease? J Rheumatol 1991; 18 Suppl. 27: 2–3

    Google Scholar 

  52. Croft P, Cooper C, Wickham C, et al. Osteoarthritis of the hip and occupational activity. Scand J Work Environ Health 1992; 18: 59–63

    Article  PubMed  CAS  Google Scholar 

  53. Hochberg MC. Epidemiology of osteoarthritis: Current concepts and new insights. J Rheumatol 1991; 18 Suppl.: 4–6

    Google Scholar 

  54. Spector TD. The fat on the joint: osteoarthritis and obesity. J Rheumatol 1990; 17: 283–4

    PubMed  CAS  Google Scholar 

  55. Felson DT, Hannan MT, Naimark A, et al. Occupational physical demands, knee bending and knee osteoarthritis: results of the Framingham Study. J Rheumatol 1991; 18: 1587–92

    PubMed  CAS  Google Scholar 

  56. Hart DJ, Spector TD. Cigarette smoking and risk of osteoarthritis in women in the general population: the Chingford Study. Ann Rheum Dis 1993; 52: 93–6

    Article  PubMed  CAS  Google Scholar 

  57. Spector TD, Dacre JE, Harris PA, et al. The radiological progression of osteoarthritis; an eleven year follow-up study of the knee. Ann Rheum Dis 1992; 51: 1107–10

    Article  PubMed  CAS  Google Scholar 

  58. Schouten JSAG, van den Ouweland FA, Valkenburg HA. A twelve year follow-up study in the general population on prognostic factors of cartilage loss in osteoarthritis of the knee. Ann Rheum Dis 1992; 51: 932–43

    Article  PubMed  CAS  Google Scholar 

  59. Danielsson L. Incidence and prognosis of coxarthrosis. Acta Orthop Scand 1964; 66 Suppl.: 23

    Google Scholar 

  60. Hernborg JS, Nilsson BE. The natural course of untreated osteoarthritis of the knee. Clin Orthop 1977, 98: 130–7

    Google Scholar 

  61. Somerville KW, Fawlkner G, Langman MJS. Non-steroidal anti-inflammatory drugs and bleeding gastric ulcer. Lancet 1986; 1: 462–4

    Article  PubMed  CAS  Google Scholar 

  62. Brooks PM, Bell MA, Lee P, Rooney PJ, Dick WC. The effect of frusemide on indomethacin plasma levels. British J Clin Pharmacol 1974; 1: 485–487

    Article  CAS  Google Scholar 

  63. Rawles JM. Antagonism between non-steroidal anti-inflammatory drugs and diuretics. Scottish Med J 1982; 27: 37–40

    CAS  Google Scholar 

  64. Bradley JD, Brandt KD, Katz BP, et al. Comparison of an antiinflammatory dose of ibuprofen, an analgesic dose of ibuprofen, and acetaminophen in the treatment of patients with osteoarthritis of the knee. N Engl J Med 1991; 325: 87–91

    Article  PubMed  CAS  Google Scholar 

  65. March L, Irwig L, Schwarz J, Simpson J, Chock C, Brooks P. N of 1 trial comparing a non-steroidal anti-inflammatory drug with paracetamol in osteoarthritis. BMJ 1994; 309: 1041–5

    Article  PubMed  CAS  Google Scholar 

  66. Moxley TE, Royer GL, Hearron MS, et al. Ibuprofen versus buffered phenylbutazone in the treatment of osteoarthritis: double-blind trial. J Am Geriatr Soc 1975; 23: 343–9

    PubMed  CAS  Google Scholar 

  67. Cimmino MA, Cutolo M, Samanta E, et al. Short-term treatment of osteoarthritis: a comparison of sodium meclofenamate and ibuprofen. J Int Med Res 1982; 10: 46–52

    PubMed  CAS  Google Scholar 

  68. Herman J, Appel AM, Khosla RC, et al., The in vitro effect of select classes of non-steroidal anti-inflammatory drugs on normal cartilage metabolism. J Rheum 1986; 13: 1014–8

    PubMed  CAS  Google Scholar 

  69. Williams HJ, Ward JR, Egger MJ, et al. Comparison of naproxen and acetaminophen in a two-year study of treatment of osteoarthritis of the knee. Arthritis Rheum 1993; 9: 1196–1206

    Article  Google Scholar 

  70. Dieppe P, Cushnaghan J, Jasani MK, et al. A two-year, placebo-controlled trial of non-steroidal anti-inflammatory therapy in osteoarthritis of the knee joint. Br J Rheumatol 1993; 32: 595–600

    Article  PubMed  CAS  Google Scholar 

  71. Mayer JH. Carpometacarpal osteoarthritis of the thumb. Lancet 1970; 2: 207–9

    Google Scholar 

  72. Flanagan J, Tudor TL, Casale F, et al. Intraarticular injection for pain relief in patients awaiting hip replacement. Ann R Coll Surg Engl 1988; 70: 156–7

    PubMed  CAS  Google Scholar 

  73. Gibson T, Burry HC, Poswillo D. Effect of intra-articular corticosteroid injections in primate cartilage. Ann Rheum Dis 1976; 36: 74–9

    Article  Google Scholar 

  74. Moskowitz RW, Davis W, Sammarco J. Experimentally-induced corticosteroid arthropathy. Arthritis Rheum 1970; 13: 236–43

    Article  PubMed  CAS  Google Scholar 

  75. Behrens F, Shepherd N, Mitchell N. Alteration of rabbit articular cartilage by intra-articular injections of glucocorticoids. J Bone Joint Surg Am 1975; 58: 1157–60

    Google Scholar 

  76. Balch HW, Gibson JMC, El Ghoberey AF, et al. Repeated corticosteroid injections into knee joints. Rheumatol Rehabil 1977; 16: 137–40

    Article  PubMed  CAS  Google Scholar 

  77. Balazs EA, Denlinger JL. Viscosupplementation: a new concept in the treatment of osteoarthritis. J Rheumatol Suppl 1993; 39: 3–9

    PubMed  CAS  Google Scholar 

  78. Leardini G, Mattara L, Franceschini M, et al. Intra-articular treatment of knee osteoarthritis: a comparative study between hyaluronic acid and 6-methyl prednisolone acetate. Clin Exper Rheumatol 1991; 9: 375–81

    CAS  Google Scholar 

  79. Graf J, Neusei E, Schneider E, et al. Intra-articular treatment with hyaluronic acid in osteoarthritis of the knee joint: a controlled clinical trial versus mucopolysaccharide polysulfuric acid ester. Clin Exper Rheumatol 1993; 11: 367–72

    CAS  Google Scholar 

  80. Henderson EB, Smith EC, Pegley F, Blake DR. Intra-articular injections of 750 kD hyaluronan in the treatment of osteoarthritis: a randomised single centre double-blind placebo-controlled trial of 91 patients demonstrating lack of efficacy. Ann Rheum Dis 1994; 53: 529–34

    Article  PubMed  CAS  Google Scholar 

  81. Brookes PM, Potter SR, Buchanan WW. Non-steroidal anti-inflammatory drugs and OA: help or hinderance? J Rheumatol 1982; 9: 3–5

    Google Scholar 

  82. Denko CW. Treatment of osteoarthritis with Rumalon R. Arthritis Rheum 1978; 21: 494–6

    Article  PubMed  CAS  Google Scholar 

  83. Verbrugge LM, Gates DM, Ike RW. Risk factors for disability among US adults with arthritis. J Clin Epidemiol 1991; 44: 167–82

    Article  PubMed  CAS  Google Scholar 

  84. Weinberger M, Tierney WM, Booher P, et al. Can provision of information to patients with osteoarthritis improve functional status? Arthritis Rheum 1989; 32: 1577–83

    Article  PubMed  CAS  Google Scholar 

  85. Lorig KR, Mazonson PD, Holman HR. Evidence suggesting that health education for self-management in patients with chronic arthritis has sustained health benefits while reducing health care costs. Arthritis Rheum 1993; 36: 439–46

    Article  PubMed  CAS  Google Scholar 

  86. Bland JH, Cooper SM. Osteoarthritis: a review of the cell biology involved and evidence for reversibility — management rationally related to known genesis and pathophysiology. Semin Arthritis Rheum 1984; 14: 106–33

    Article  PubMed  CAS  Google Scholar 

  87. Chamberlain MA, Care G, Harfield B. Physiotherapy in osteoarthritis of the knees. Int Rehabil Med 1982; 4: 101–6

    PubMed  CAS  Google Scholar 

  88. Allegrante JP, Kovar PA, MacKenzie CR, et al. A walking education program for patients with osteoarthritis of the knee: theory and intervention strategies. Health Educ Q 1993; 20: 63–81

    Article  PubMed  CAS  Google Scholar 

  89. Kovar PA, Allegrante JP, MacKenzie CR, et al. Supervised fitness walking in patients with osteoarthritis of the knee: a randomized, controlled trial. Ann Intern Med 1992; 116: 529–34

    PubMed  CAS  Google Scholar 

  90. Keating EM, Faris PM, Ritter MA, et al. Use of lateral heel and sole wedges in the treatment of medial osteoarthritis of the knee. Orthop Rev 1993; 22: 921–4

    PubMed  CAS  Google Scholar 

  91. Tohyama H, Yasuda K, Kaneda K. Treatment of osteoarthritis of the knee with heel wedges. Int Orthop 1991; 15: 31–3

    Article  PubMed  CAS  Google Scholar 

  92. Cushnaghan J, McCarthy C, Dieppe P. Taping the patella medially: a new treatment for osteoarthritis of the knee joint? BMJ 1994; 308: 753–5

    Article  PubMed  CAS  Google Scholar 

  93. Charnley J, Cupic F. The nine and ten year results of the low function arthroplasty of the hip. Clin Orthopaed Rel Res 1973; 95: 9–25

    Google Scholar 

  94. Beckenbaugh RD, Iistrup DM. Total hip arthroplasty. J Bone Joint Surg 1978; 60A: 694–9

    Google Scholar 

  95. Collis DK, Steinhaus K. Total hip replacement without deep infection in a standard operating room. J Bone Joint Surg 1976; 58A: 446–50

    Google Scholar 

  96. Insall J, Scott WN, Ranawat CS. The total condylar knee prosthesis. J Bone Joint Surg 1979; 61A: 173–80

    Google Scholar 

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Cicuttini, F.M., Spector, T.D. Osteoarthritis in the Aged. Drugs & Aging 6, 409–420 (1995). https://doi.org/10.2165/00002512-199506050-00007

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