An Overview of Osteoarthri0s

Transcription

1 An Overview of Osteoarthri0s Yvonne M. Golightly, PT, MS, PhD Grant Program Officer, OA Ac<on Alliance Thurston Arthri<s Research Center Research Assistant Professor, Epidemiology University of North Carolina at Chapel Hill

2 Overview What is osteoarthritis (OA)? How common is OA? What is the public health impact of OA? What are the risk factors for OA? What are the treatments for OA?

3 What is OA? cartilage bone Normal Osteoarthri0s Slide from Dr. Richard Loeser

4 Defini0ons of OA Clinical OA abnormali<es on physical examina<on consistent with OA Radiographic OA presence of definite osteophyte (bone spur) or joint space narrowing (car<lage loss) on plain radiographs Symptoma0c OA pain, aching, or s<ffness in a joint with radiographic OA

5 Radiographic Features of OA joint space narrowing (car0lage loss) osteophytes (bone spurs) sclerosis (thickening)

6 Distribu0on of OA Variable number of joints Characteris0c loca0ons Hands Knees Hips Spine Feet Nature Review. Drug Discovery, 2015.

7 OA Symptoms and Signs Pain is related to use Pain gets worse during the day Minimal morning s<ffness S<ffness auer inac<vity Range of mo<on decreases Joint instability Bony enlargement Crepitus Variable swelling

8 Joint Symptoms & Signs: Hand Bony enlargement of distal interphalangeal joints & proximal interphalangeal joints Nodes may be inflamed with warmth Involvement of first carpometacarpal joint Bilateral involvement of mul<ple joints Metacarpophalangeal joints affected h\p:// Support/Criteria/ACR-Endorsed-Criteria

9 Joint Symptoms & Signs: Knee Insidious onset of pain with limited range of mo<on Pain & limita<on with walking, transferring, & stair climbing Sensa<on of instability Locking sensa<on Crepitus and bony enlargement Effusions, when present, are ouen cool without redness Malalignment is ouen seen in severe disease Normal Varus Valgus

10 Joint Symptoms & Signs: Hip Groin pain Vague pain in thigh, bu\ock, low back, or even in ipsilateral knee Limita<ons in walking, bending, transferring, stair climbing Limited internal rota<on of affected hip In advanced disease, visible deformity, hip flexion contracture, or severe limita<ons of range of mo<on

11 How Common is OA? Clinical arthri0s (mostly OA) : 52.5 million (22.7%) adults with arthri<s 2040: 78 million (26%) adults Barbour KE et al. MMWR 2013 Hootman JM et al. Arthri7s Rheumatol, in press. Life0me risk 1 in 2 for knee OA 1 in 4 for hip OA Murphy LB et al. Arthri7s Rheum, Murphy LB et al. Osteoarthri7s Car7lage, 2010.

12 Prevalence of OA in US Adults Radiographic hand OA 1 joint in adults 55+ years 67% of women 55% of men Radiographic knee OA 14 to 37% Radiographic hip OA 1 to 27% Lawrence RC, et al. Arthri7s Rheum Dillon CF, et al. J Rheumatol Felson DT, et al. Arthri7s Rheum Jordan JM, et al. J Rheumatol Dagenais S, et al. Clin Orthop Relat Res Dahaghin S, et al. Ann Rheum Dis h\p://

13 What is the Public Health Impact of OA? Most common cause of disability & work limita0ons in adults in US 43% (22.7 million) of 52.5 million adults with doctordiagnosed arthri<s report arthri<s-a\ributable limita<ons 24% of adults with doctor-diagnosed arthri0s report no leisure 0me physical ac0vity Compared 18.6% of adults without arthri<s (ageadjusted prevalence es<mates)

14 Cost of OA Cost to society > $100 billion/year Hospital expenditures in 2009 for joint replacements Knee = $28.5 billion Hip = $13.9 billion Job-related OA costs $3.4 to $13.2 billion per year Murphy L, Helmick CG. Am J Nurs Buckwalter JA. Clin Orthoped Rel Res

15 OA: A Public Health Problem

16 What are risk factors for OA? Person-level (systemic) Sex (female/male) Race/ethnicity Age Obesity (hand,knee,hip) Metabolic factors Nutri<onal factors Gene<cs Suscep0bility to OA Joint-level (biomechanics) Obesity (knee, hip) Joint injury / overuse Malignment (knee) Joint deformity / shape (hip) Bone density (hip, knee) Muscle weakness (knee) Leg length inequality (knee, hip) Occupa<on Physical Ac<vity/Sedentary Joint site & severity of OA

17 Prevalence of OA by Sex Site (Age in Years) Source Men (%) Women (%) Total (%) Hands ( 26) Framingham Knees 26 Framingham Framingham Johnston County NHANES III Hips ( 45) Johnston County Zhang Y, et al. Am J Epidemiol Felson DT, et al. Arthri7s Rheum Jordan JM, et al. J Rheumatol Dillon CF, et al. J Rheumatol Jordan JM, et al. J Rheumatol

18 Race and OA Johnston County OA Project: African-American & White Hip OA men: AA 32.2% v. White 23.8% women: AA 40.3% v. White 39.4% Knee OA Men AA vs. White: Adjusted odds ra0o (aor) = 1.36 ( ) Severe OA: 2.08 ( ) Women AA vs. White: aor = 1.00 ( ) Severe OA: 1.56 ( ) Jordan JM, et al. J Rheumatol Braga L, et al. Osteoarthritis Cartilage Nelson AE, et al. Arthritis Care Res (Hoboken)

19 A disease of old age? Na0onal Health Interview Study million adults with symptoma0c knee OA <45 years old: ~2 million years old: ~ 6 million Over half with symptoma>c knee OA were younger than 65 years old! Deshpande BR et al. Arthri7s Care Res (Hoboken), in press.

20 Aging vs OA changes in Car0lage Not wear and tear Not inevitable consequence of aging Lotz and Loeser, Bone 2012 Slide by Dr. Richard Loeser

21 Old without OA Community-based study of 90 year olds living in Netherlands (N=82) Absence of radiographic OA in hands, hips, and knees 16% Strongly associated with lower BMI No family history of nodal hand OA (suggests favorable gene<cs) Absence of knee OA associated with being male Goekoop et al, Scand J Rheumatol, 2011

22 Life0me Prevalence of Symptoma0c Radiographic Knee OA women,obese men,obese Obesity! women,non-obese men,non-obese Losina E, et al. Arthri7s Care Res (Hoboken)

23 Life0me Risk of Symptoma0c Knee OA Life0me Risk % (95% CI) Overall 44.7 ( ) Body Mass Index, kg/m 2 <25 (normal weight) 30.2 ( ) 25 <30 (overweight) 46.9 ( ) 30 (obese) 60.5 ( ) History of knee injury No 42.3 ( ) Yes 56.8 ( ) Murphy L, et al. Arthri7s Rheum

24 60 Injury and Prevalence of OA 50 NFL Re0rees Prevalence (%) US Males Age group Golightly YM, Marshall SW, Callahan LF, Guskiewicz K. Early-onset arthri<s in re<red Na<onal Football League players. Journal of Physical Ac7vity and Health Sep;6(5):

25 What are the treatments for OA? OA is a chronic disease without a cure Goals of treatment: Management of symptoms Pain, aching, s0ffness, swelling Maintaining or improving joint mobility & flexibility Enhancing physical func0on Maintaining a healthy weight Achieving recommended levels of physical ac0vity

26 Treatments for OA instruc0on in joint protec0on assis0ve devices, bracing use of thermal modali0es use of oral/topical NSAIDs, tramadol, topical capsaicin intra-ar0cular cor0costeroid injec0ons self-management programs aerobic, aqua0c, resistance exercises weight loss for overweight pa0ents joint arthroplasty

27 Exercise Programs and OA Ac0ve Living Every Day (ALED) Aqua0c Exercise Associa0on (AEA) Arthri0s Founda0on Aqua0cs Program (AFAP) AEA Arthri0s Founda0on Exercise Program (AFEP) Enhance Fitness (EF) Fit and Strong Walk with Ease (WWE) Tai Chi for Arthri0s hsp://

28 Diet & Exercise for OA Diet or Diet + Exercise Reduces Abnormal Stress Decreased Joint Loads Reduces Abnormal Physiology Lowers Inflamma<on Less Pain Less Disability Messier SP, et al. JAMA

29 Challenges of Trea0ng Chronic Disease Cardiovascular Disease Hypertension OA Abnormal Physiology Hyperlipidemia High Blood Pressure Joint metabolic abnormality Disease Phase Silent Disease Symptoma0c Disease Atherosclerosis Heart a\ack; heart failure Vascular s<ffness Pre radiographic Stroke Painful radiographic OA Kraus VB, Nevi\ M, Sandell LK. Osteoarthri<s Car<lage. 2010; 18(6):

30 OA Summary OA is the most common form of arthri<s and a leading cause of disability. OA likely represents a final common pathway of many different factors including gene<cs, environment, and many biomechanical contributors. Person-level risk factors for OA include age, female sex, obesity, gene<cs, and metabolic and nutri<onal factors. Joint-level risk factors for OA include injury, obesity, occupa<on, physical ac<vity, muscle strength, alignment, leg-length inequality, and bone/joint morphology.

31 OA Summary OA is not a wear and tear condi<on that is an inevitable consequence of aging. Signs and symptoms of OA include: pain with use and worsening during day, minimal morning s<ffness, decreased range of mo<on, joint instability, bony enlargement, crepitus, and variable swelling. Few treatment op<ons for OA exist, and there is a need for a more proac<ve approach to OA management.

32 Thank you! facebook.com/oaac<on