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The Framingham Knee Osteoarthritis study is a population-based study of independently living elderly examining the prevalence of radiographic and symptomatic knee osteoarthritis. This group was assessed in the early 1980s at which time they had been observed for over 35 years and many risk factors for osteoarthritis had been ascertained. Results from this study suggest that knee osteoarthritis increases in prevalence throughout the elderly years, more so in women than in men. Also, studies of risk factors have shown that obesity precedes and increases the risk of knee osteoarthritis, especially in women. Other risk factors documented by the Framingham Osteoarthritis study to be important as risk factors for disease include knee injury, chondrocalcinosis, and occupational knee bending and physical labor. Radiographic knee osteoarthritis was negatively associated with smoking. No clearcut relationship of osteoarthritis with estrogen use in women was found. In terms of disability, lower extremity dysfunction is common in patients with knee osteoarthritis, but upper extremity dysfunction is not, and symptoms and severe degrees of radiographic osteoarthritis are associated with higher risks of dysfunction.
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PMID:The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. 228 48

The strength of the associations of knee injury and obesity with osteoarthritis of the knee was studied for 3,885 adults aged 45-74 years who received knee x-rays in the First National Health and Nutrition Examination Survey, 1971-1975. Bilateral osteoarthritis was more prevalent (5%) than unilateral osteoarthritis (2%). Bilateral osteoarthritis was twice as prevalent in women as in men; however, there was no sex difference in the prevalence of unilateral osteoarthritis. Odds ratios calculated by means of polychotomous logistic regression indicated that obesity, knee injury, and age were significantly associated with both unilateral and bilateral knee osteoarthritis. Obesity was a stronger predictor of bilateral osteoarthritis than was knee injury (odds ratio (OR) = 6.6 for obesity, 3.5 for right knee injury, and 3.0 for left knee injury; 95% confidence interval (CI) 4.71-9.18, 1.80-6.83, and 1.51-6.11, respectively). Knee injury was a stronger predictor of unilateral osteoarthritis than was obesity (OR = 3.4 and 2.4 for obesity in the right and left knee, respectively (95% CI 1.55-7.29 and 0.96-5.75) and OR = 16.3 and 10.9 for injury in the right and left knee, respectively (95% CI 6.50-40.89 and 3.72-31.93]. These findings suggest that different pathogenetic processes may exist for unilateral and bilateral knee osteoarthritis.
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PMID:The association of knee injury and obesity with unilateral and bilateral osteoarthritis of the knee. 275 Jul 27

This study investigated the role of obesity (body mass index, total body weight, triceps skinfold, subscapular skinfold) compared with other anthropometric variables (body fat distribution, muscularity, elbow breadth, bitrochanteric breadth) in order to explain previously noted sex differences in osteoarthritis of the knee. Anthropometric measures, self-reported symptoms, and knee x-ray data were analyzed for 3,905 adults aged 45-74 years with valid x-ray data from the First National Health and Nutrition Examination Survey, 1971-1975. Prevalence of knee osteoarthritis was 4.9% in women and 2.6% in men. The relative risk for women compared with men increased from 1.57 at 45-54 years to 2.14 at 65-74 years. Adjusting for body mass index and subscapular and triceps skinfolds reduced the sex difference, whereas adjusting for total body weight, body fat distribution, muscularity, and skeletal size increased the sex difference. Body mass index was the variable that best reduced the sex difference when the other variables were included in the analysis; it did not, however, eliminate the sex difference. No sex differences were found in the strength of the association between anthropometric variables and osteoarthritis, nor was there evidence to suggest that obesity is a consequence of knee osteoarthritis rather than a risk factor.
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PMID:Sex differences in osteoarthritis of the knee. The role of obesity. 335 3

The authors used data from the United States first national Health and Nutrition Examination Survey of 1971-1975 (HANES I) to explore the cross-sectional associations between radiographic osteoarthritis of the knee and a variety of putative risk factors. A total of 5,193 black and white study participants aged 35-74 years, 315 of whom had x-ray-diagnosed osteoarthritis of the knee, were available for analysis. After controlling for confounders, the authors found significant associations of knee osteoarthritis with overweight, race, and occupation, all of which have been suggested by smaller cross-sectional studies. They then focused specifically on those factors. For overweight, they found a strong association between current obesity and osteoarthritis of the knee, with a dose-response effect not previously assessed. This association was also seen for self-reported minimum adult weight, a proxy for long-term obesity, and was present in persons with asymptomatic osteoarthritis of the knee. These findings strongly suggest that obesity is causative. HANES I was the first study in which racial differences in osteoarthritis of the knee could be assessed within the same country. The black women who were studied had an increased risk of disease (odds ratio (OR) = 2.12, 95% confidence interval (CI) = 1.39-3.23) after controlling for age and weight, although the black men did not. Finally, the authors used the US Department of Labor Dictionary of Occupational Titles to obtain characterizations of the physical demands and knee-bending stress associated with occupations and to study the relation between physical demands of jobs and osteoarthritis of the knee. They found for persons aged 55-64 years an association between knee-bending demands and osteoarthritis of the knee (men, OR = 2.45, 95% CI = 1.21-4.97; women, OR = 3.49, 95% CI = 1.22-10.52). Since such occupational physical demands are common, the authors conclude that they may be associated with a substantial proportion of osteoarthritis of the knee.
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PMID:Factors associated with osteoarthritis of the knee in the first national Health and Nutrition Examination Survey (HANES I). Evidence for an association with overweight, race, and physical demands of work. 338 25

To clarify the natural history of osteoarthritis of the knee joint, a field study of the knee joint was performed on the inhabitants of Matsudai Town, Niigata Prefecture in 1979 and 1986. The study included the same 979 individuals, involving 820 women and 159 men, aged between 40 and 65 years in 1986 as in 1979. Narrowing of the femoro-tibial joint space was found in 17.7% and 26.1% of the women, and in 5.3% and 12.0% of the men, in 1979 and 1986, respectively. The individuals without osteoarthritic change and those with subchondral sclerosis or osteophytes in the femoro-tibial joint space exhibited less progressive changes in symptoms and radiographic findings. On the other hand, many of those in whom the joint space was more than 50% narrowed compared with the contralateral joint space had persistent pain, suggesting that they were candidates for active treatment. There were about twice as many women as men with symptomatic osteoarthritis of the knee. A comparative study of a group of women with, and a group of women without, radiographic progression in arthritic changes, indicated that the factors correlated with worsening osteoarthritis of the knee included aging, obesity, varus deformity of the knee, severity of inflammation, and flexion contracture of the knee.
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PMID:[Osteoarthritis of the knee joint: a field study]. 796 28

Reported here are the results of a study on the significance of osteophyte formation in the osteoarthritic knee joint. The osteophyte formation was examined in a total of 795 cases involving 1040 joints. Of these, 415 cases (660 joints) had no symptoms of osteoarthritis of the knee joint (Group A); while the other 380 (380 joints) had primary osteoarthritis of the knee joint (Group B). The osteophyte location and osteophyte length were determined in all cases of Group A and Group B. The rate of annual increase in osteophyte length was determined in 224 cases (369 joints) of Group A (average study period: 7.1 years) and in 122 cases (122 joints) of Group B (average study period: 7.5 years). A special measuring unit called the "spur index" was devised for the present study to determine a corrected measurement of the osteophyte length; 1 spur index unit corresponded to 1/100 of the width of the proximal tibial articular surface. By using this spur index, measurements could be corrected for the magnifying effect of X-ray photography and for variations in the size of knee joints. On the assumption that age, obesity, arteriolosclerosis and femorotibial angle were factors that promoted the progression of osteoarthritis in the knee joint, the correlation between the osteophyte length and each of these factors was investigated. A significant difference in osteophyte length, and in the annual increase in osteophyte length, was found between Group A and Group B, but no difference between them with regard to osteophyte location. A significant correlation was found between the osteophyte formation and each of the above-mentioned factors. The correlation was strongest with the femorotibial angle followed by age, arteriolosclerosis and obesity, in that order.
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PMID:[Osteophyte formation in the knee joint: a radiological study]. 818 96

One thousand and three women aged 45-64 from the Chingford general population survey were studied cross sectionally to find the effect of quantity and distribution of body fat on the prevalence of radiologically confirmed osteoarthritis (OA) in the knee, carpometacarpal (CMC), distal interphalangeal (DIP), and proximal interphalangeal (PIP) joints. Obesity was classified as the upper tertile of body mass index (BMI kg/m2); the boundaries of the middle tertile were 23.4 and 26.4 kg/m2. The age adjusted odds ratio (OR) [and 95% confidence interval (CI)] of radiographic OA at the knee comparing the high and low tertile of BMI was 6.17 (3.26-11.71) and for bilateral knee radiographic OA was 17.99 (6.25-51.73). Comparing the middle and low tertile of BMI, the odds ratio for radiographic OA knee was 2.86 (1.44-5.68). For other joints the association between BMI and radiographic OA was less strong; the OR at CMC was 1.71 (1.05-2.78), at DIP was 1.52 (0.90-2.57), and at PIP was 1.23 (0.52-2.91). For all joints except PIP these OR increased if the diagnostic criteria included knee pain for at least a month, clinically evident swelling at the DIP or PIP, and pain or tenderness at the CMC. Recalled weight at age 20 years, or recalled maximum weight improved prediction of radiographic OA from current BMI, but measurement of fat distribution from circumference of waist, hip and thigh did not. Our results confirm that excess body weight is a powerful predictor of OA of the knee in middle aged women, and a modest predictor of DIP and CMC OA.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:The relationship of obesity, fat distribution and osteoarthritis in women in the general population: the Chingford Study. 847 72

The prevalence and pattern of osteoarthritis of the knee and its association with obesity among security forces personnel was investigated. A single survey with a control group was done at the Mobile Hospital, Ministry of Interior, Makkah Al Mukarramah. One hundred twenty-five patients presenting to the orthopedic clinic with painful knees of at least 12 months duration gave detailed histories and were treated with bi-planar conventional radiography; they were matched with a similar number from the clinics of internal medicine without painful knees. One hundred three patients (82.4%) with 126 painful knees had various degrees of osteoarthritis. The mean age was 41 and 41.76 years for the patient and control group, respectively. The medial tibio-femoral and patello-femoral compartment were involved in 116 cases (92%). Fifty-nine knees (46.8%) had mild, 46 (36.5%) had moderate, and 21 (16.6%) had severe osteoarthritis changes. There were statistically significant differences between the two groups for weight and Quetelet index of body mass (p < 0.047 and < 0.0001). In the study group, the mean Quetelet body index was 31.6638 kg/m2, and in the control group it was 28.5633 kg/m2. The prevalence of osteoarthritis among the security forces personnel was 1.19%. The medial and patello-femoral compartment was affected in the majority of cases, and obesity was confirmed as one of the important causes of osteoarthritis in the Saudi Arabian population.
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PMID:Osteoarthritis of the knee among Saudi Arabian security forces personnel. 885 24

The prevalence of rheumatic diseases in developing countries is largely unknown. Studies which allow comparison of data within the contrasting communities of the Third World and the developed world have the potential to provide insights into disease aetiologies. The current study compared the frequency of rheumatic symptoms (point prevalence) amongst 1997 adults distributed evenly between poor rural and poor urban communities and relatively affluent urban people. Comparisons were also made with similarly but previously derived prevalence rates of rheumatic symptoms and rheumatoid arthritis (RA) in south Pakistan and Pakistanis in England. A significantly higher prevalence of joint pain was seen in the north compared with the south. RA was more common in the north and similar to the frequency amongst Pakistanis resident in England. Ethnic and genetic susceptibility might have accounted for this. There was significantly more soft-tissue rheumatism and back pain in the northern rural population compared with those in the city. Fibromyalgia was almost completely absent from the urban affluent, but osteoarthritis of the knee was significantly more common in this community, perhaps due to relative obesity. RA was least in the urban poor, a phenomenon that might be attributable to earlier death of females or other undetermined factors.
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PMID:Prevalence of the major rheumatic disorders in the adult population of north Pakistan. 965 Oct 74

The principal risk factors of osteoarthritis of the knee are: age, obesity and gender. It is hypothesized that long-duration walking (e. g. 20 min) in the elderly obese will lead to quadriceps fatigue. Changes in the gait pattern due to fatigue will lead to altered knee kinematics at heelstrike and consequently decreased shock absorption. This scenario will result in an increased rate of loading and possibly an increase in the overall magnitude of peak ground reaction forces, both of which could cause articular cartilage degeneration. Obese females are at an overall higher risk of developing osteoarthritis than males. This gender discrepancy may be explained by the fact that females have a higher percentage of body fat content (lower proportion of lean mass) that may increase the rate of quadriceps fatigue. These biomechanical hypotheses can be examined by studying continuous periods of walking in which ground reaction forces, knee kinematics and electromyography data are recorded.
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PMID:Obesity and osteoarthritis of the knee: hypotheses concerning the relationship between ground reaction forces and quadriceps fatigue in long-duration walking. 1079 Jul 48


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