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Burden of Disease: Osteoarthritis

Burden of Disease: Osteoarthritis. Joanne M. Jordan, MD MPH Bone and Joint Decade October 2009. OA Epidemiology. 27 million Americans 25% of those 60 years and older have significant OA-related pain and disability Highest cause of work loss in U.S .

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Burden of Disease: Osteoarthritis

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  1. Burden of Disease: Osteoarthritis Joanne M. Jordan, MD MPH Bone and Joint Decade October 2009

  2. OA Epidemiology • 27 million Americans • 25% of those 60 years and older have significant OA-related pain and disability • Highest cause of work loss in U.S. • Interferes with physical activity to treat DM, CVD

  3. OA Epidemiology • Approximately 12% of adults > 60 years with symptomaticknee OA •  direct medical costs $1000to $4100 (in 2006 US dollars) per person-year • 500,000 TKAs in the United States in 2005 costing > $11 billion.

  4. OA: definition • “degenerative disease, a consequence of age-related changes, genetic predisposition, and abnormal biomechanical forces that lead to joint failure”1 • mechanically induced but chemically driven 1 Pelletier JP et al. Arthritis Rheum 2001

  5. Aging increases susceptibility • Mechanical stress • Gait, muscle weakness, proprioception, weight • ↓ability of chondrocyte to repair and maintain tissue • ↓synthesis; smaller PG and link proteins • ↓response to anabolic factors • ↑apoptosis

  6. OA as a genetic condition • Stecher, 1941 •  gen’l OA in sisters of women w/ DIP nodes • Twin studies • Heritability estimates • rOA scores, JSN, cartilage thickness, biomarkers • Segregation analysis • multigenerational analysis • delineate patterns of inheritance • Pedigrees of precocious OA • Genetically isolated populations • Hip OA in Iceland

  7. Prevalence of symptomatic OA in the hands, knees, and hips, from US population-based studies* * Adjusted to the projected 2000 population age ≥18 years except for National Health and Nutrition Examination Survey III (NHANES III) estimates, which were adjusted to the 1980 Census population. OA = osteoarthritis.

  8. The Johnston County OA Project Study began in 1990 ~4000 participants Followed every 5 years Oversampled for AAs

  9. Odds Ratios for knee OA in African Americans compared to Caucasians • TF-OA (K-L grade) ♂ : aOR= 1.36 (1.00-1.86) aPOR= 2.08 (1.19-3.65) ♀: aOR= 1.00 (0.81-1.23) aPOR= 1.56(1.06-2.29) Femur Tibia • Braga L, et al. Osteo & Cart 2009 September [Epub ahead of print].

  10. 9 Mutually exclusive phenotypes • Isolated: • Hand • TFJ (knee) • PFJ • Hip • Combinations: • TFJ/PFJ • Hand/knee • Hand/hip • Knee/hip • Hand/knee/hip

  11. Phenotypes LESS common in AAs Unadjusted Frequencies Adjusted Odds Ratio by Race p<0.001 p=0.02 p<0.001 % *Adjusted for age, gender, BMI Fisher’s exact test and exact logistic

  12. Phenotypes MORE common in AAs Unadjusted Frequencies Adjusted Odds Ratio by Race p<0.001 p<0.01 p<0.01 % p=0.02 *Adjusted for age, gender, BMI

  13. RESULTS: Radiographic Knee OA Incidence

  14. RESULTS: Radiographic Knee OA Incidence p = 0.04 p = 0.04 p = 0.0005

  15. RESULTS: Knee OA IncidenceAdjusted Model

  16. RESULTS: Radiographic Knee OA Progression p=0.39 p=0.003

  17. RESULTS: Knee OA Progression Adjusted Model

  18. Lifetime risk of sx Knee OA • Murphy L, et al. Arthritis Rheum 2008;59(9):1207-13.

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