Epidemiology and prognosis of osteoarthritis

1. Epidemiology and prognosis of osteoarthritis Joost Dekker PhD Department of Rehabilitation Medicine & Department of Psychiatry VU University Medical Center, Amsterdam, Netherlands 1 1

2. Contents • Definitions • Prevalence, Incidence • Prognostic factors for development of OA • Course and prognosis of activity limitations in OA

3. Definitions • Radiographic OA • Kellgren – Lawrence grading • KL ≥ 2 (KL ≥ 1)

4. 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

5. 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 OA

6. Prevalence and Incidence

7. Suri et al, PM&R, 2012

9. Prognostic factors for development of OA (radiographic, symptomatic)

10. Suri et al, PM&R, 2012

11. 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

13. Silverwood et al, 2015 • Meta-analysis

14. 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

16. 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

17. Course and prognosis of activity limitations

18. Course of activity limitations • Highly variable • Worse, stable and better functioning Dekker, 2009

19. Course of activity limitations in early knee OA Holla et al, 2014

20. 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

21. Prognosis of pain and physical functioning in knee OA - Systematic review 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. • 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 de Rooij et al, submitted

22. 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