Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis

By Uyen-Sa D. T. Nguyen, Yuqing Zhang, Yanyan Zhu, J. Niu, Bin Zhang, P. Aliabadi, David T Felson. Annals of Internal Medicine, 2011

603 citations recorded by the source corpus.

Background Recent surge in knee replacements has been assumed to be due to aging and increased obesity of the US population. Objectives We described the trend in prevalences of knee pain and symptomatic knee osteoarthritis and assessed whether age, obesity, and change in radiographic osteoarthritis explained this trend. Design We used data from six National Health and Nutrition Examination Surveys (NHANES) between 1971 and 2004 and from three examination periods in the Framingham Osteoarthritis (FOA) Study between 1983 through 2005 (Original cohort 1983–5 and 1992–5, Offspring 1992–5 and 2002–5, and a Community sample 2002–5). Setting NHANES included nationally representative samples of the non-institutionalized US population, and the Framingham Study was a population-based cohort. Participants We included data from NHANES participants 60 to 74 years of age, of White or Black race, and data from Framingham Study of mostly White participants, 70 years or older. Measurements Subjects in NHANES were asked about pain in or around the knee on most days. In the Framingham Study, subjects were asked about knee pain and had bilateral weight-bearing anteroposterior knee x-rays to define radiographic osteoarthritis. We used radiographic evidence and pain to define symptomatic osteoarthritis. We used marginal standardization with logistic regression first to calculate age-adjusted, and then age and BMI-adjusted prevalence by sex, and compared the adjusted prevalence of knee pain and osteoarthritis at later exams with earlier exams using the ratio of the prevalence estimates. Results The age-adjusted prevalence of knee pain and symptomatic osteoarthritis increased over time in all samples studied. With adjustment for both age and BMI the prevalence of knee pain increased by about 65% in NHANES from 1974 to 1994 among Non-Hispanic White and Mexican men and women and among African American women. In the Framingham Osteoarthritis (FOA) Study, the age and body mass index (BMI)-adjusted prevalences of knee pain and symptomatic knee osteoarthritis approximately doubled in women and tripled in men over a 20-year period. No such increasing trend was observed in radiographic osteoarthritis prevalence in Framingham subjects. After age adjustment, additionally adjusting for BMI resulted in a 10–25% decrease in the prevalence ratios for knee pain and symptomatic knee osteoarthritis. Limitations We cannot rule out differences in sampling of Framingham subjects over time or birth cohort effects (generational factors) as possible explanations of the increased reporting of knee pain. Increases in prevalence at the last time period in Framingham might be due to differences in cohort membership by time period. Conclusions Results suggest that independent of age and BMI prevalence of knee pain has increased substantially over a 20–year period. Obesity accounted for only part of this increase. In the FOA Study, there was an increase in symptomatic osteoarthritis but no increase in radiographic osteoarthritis. Primary Funding Source The American College of Rheumatology Research and Education Foundation Rheumatology Scientist Development Award, NIH AR47785 and AG18393, and NHLBI, Framingham Heart Study (NHLBI/NIH Contract #N01-HC-25195) and the Boston University School of Medicine.

Subfields: Rheumatology, Surgery

View Paper: https://www.semanticscholar.org/paper/02aa2e3066a6b22146578c50e120ca83c6eda218

How researchers see this paper

The researchers whose trusted networks rank it highest, strongest advocate first. Every researcher gets a different order.

  1. I. Wallace
  2. David T Felson
  3. R. Jurmain
  4. Steven Worthington
  5. Kimberly T. Wren
  6. H. Maijanen
  7. Robert J. Woods
  8. D. Lieberman

Citations in the corpus