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We examined the associations of sociodemographic variables, health behaviors, health status and psychological well being with radiographic knee osteoarthritis (OA) and self-reported knee pain for 4056 US adults aged 45-74 years. Among persons with or without knee OA known correlates of radiographic knee OA (age, sex, race, obesity) were generally not associated with knee pain. Radiographic severity, psychological well being and health status were associated with knee pain, both among persons with and without radiographic knee OA, suggesting that nonradiographic correlates of self-reported knee pain are independent of whether a person has radiographic knee OA.
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PMID:Correlates of knee pain among US adults with and without radiographic knee osteoarthritis. 129 44

Educational attainment has been negatively associated with the prevalence, morbidity and mortality of many diseases. With knee osteoarthritis as an example, we used NHANES I data to examine whether the cross-sectional association between formal education and disease is due to known risk factors, and also whether educational attainment is more strongly associated with self-reported symptoms or with radiographic change. We found univariate associations between osteoarthritis and low levels of education. For radiographic knee osteoarthritis in women, and in both sexes combined, this relationship was explained by controlling for known risk factors, which included age, knee injury, race, obesity, and occupation. However, even after adjusting for these major risk factors and the presence of radiographic changes, reporting of knee pain and arthritis at any site remained significantly associated with low educational attainment, especially for those with less than or equal to 8 years of education.
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PMID:Educational attainment and osteoarthritis: differential associations with radiographic changes and symptom reporting. 157 30

This study used the Coping Strategies Questionnaire (CSQ) to investigate pain coping strategies in 52 rheumatoid arthritis patients who reported having knee pain 1 year or more following knee replacement surgery. Data analysis revealed that, as a group, these patients were active copers in that they reported frequent use of a variety of pain coping strategies. Pain coping strategies were found to be related to measures of pain and adjustment. Patients who rated their ability to control and decrease pain high and who rarely engaged in catastrophizing (i.e., who scored high on the Pain Control and Rational Thinking factor of the CSQ) had much lower levels of pain and psychological disability than patients who did not. Coping strategies were not found to relate to age, gender, obesity status or disability/compensation status. Taken together, these results suggest that an analysis of pain coping strategies may be helpful in understanding pain in arthritis patients who have pain following joint replacement surgery.
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PMID:Analyzing pain in rheumatoid arthritis patients. Pain coping strategies in patients who have had knee replacement surgery. 174 38

Data from 4225 persons from the National Health and Nutrition Examination Survey (HANES) was used to determine whether obesity was associated with osteoarthritis (OA) or joint pain. Subjects were divided into four groups on the basis of sex and race. We found that obesity was associated with OA of the knee for each sex/race group (p less than 0.01). The association was strongest for women, and it was present even for subjects without evidence of knee pain on physical examination. Frame size was not significantly associated with OA of the knee. Relative weight was weakly associated with OA of the hips in white women and nonwhite men but not significantly associated with OA of the sacroiliac joint. Diabetes did not seem to be an important risk factor for OA. These results suggest that the additional mechanical stress resulting from obesity is the principal reason for the association between obesity and OA.
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PMID:The association of obesity with joint pain and osteoarthritis in the HANES data. 395 17

We reviewed the clinical and radiographic characteristics and response to treatment of 11 children (16 knees) with idiopathic late-onset tibia vara (adolescent Blount's disease) followed for an average of 5.7 years (range, 3-10 years). The clinical characteristics were very consistent: black race; 2:1 male predominance; normal height; marked obesity; knee pain as the primary presenting complaint; and slowly progressive genu varum deformity that averaged 19 degrees (range, 10-45 degrees). Radiographically, the epiphyses were wedge shaped owing to medial flattening, the physes were irregular in thickness, and there was minimal, if any increased prominence of the proximal medial metaphysis. Nineteen proximal tibial valgus and diaphyseal fibula osteotomies were performed on 15 knees. There was a 50% rate of recurrent deformity in males with clinical onset at less than or equal to 10 years of age. Females and older males had no recurrences. Histopathologic studies of the physis performed on one case demonstrated abnormal cellular islands of hyaline cartilage, small foci of necrotic cartilage, prominent intertrabecular vascularity, and premature medial physeal closure. These data support late-onset tibia vara as a distinct entity closely related to the infantile form. They also suggest three specific forms of tibia vara based on the age at clinical onset: infantile (0-3 years), juvenile (4-10 years), and true adolescent (11 years or older). The juvenile group is characterized by a high rate of recurrence following surgical correction, whereas the others are not.
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PMID:Late-onset tibia vara: a comparative analysis. 669 60

This study examined the effects of comorbid medical conditions (heart disease, pulmonary disease, hypertension and obesity) on the association of radiographic knee osteoarthritis (OA) with long-term difficulty in physical function. Data are from the National Health and Nutrition Examination Survey, 1971-1975 (NHANES I), a prospective epidemiologic cohort study, and the NHANES Epidemiologic Follow-up Study, 1982-1984 (NHEFS) and included 4059 persons who were 45-74 years old and participated in the detailed examination component of NHANES I. Knee OA was ascertained by anterior-posterior bilateral radiographs of the knee and self-report of knee pain, heart and pulmonary disease by self report of disease or symptoms, and hypertension and obesity by blood pressure and weight measurements. The presence of symptomatic knee OA at NHANES I was associated with reported difficulty at NHEFS 1982-84 in functions which used the lower extremity (ambulation and transfer). The presence of coexistent chronic conditions, particularly heart disease, pulmonary disease and obesity, increased the likelihood of subsequent disability. These findings suggest that knee OA is associated with long-term physical disability, and that the presence of coexistent chronic disease may increase the amount of long-term disability from knee OA.
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PMID:Long-term physical functioning in persons with knee osteoarthritis from NHANES. I: Effects of comorbid medical conditions. 772 94

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 frequency of joint symptoms was determined amongst 2022 affluent and 2210 poor adults in Karachi, Pakistan. Joint pain was significantly (P = 0.025) more common amongst the affluent (6.6%) compared with the poor (5%) and this was due to a significantly greater frequency of knee pain in the richer community (3% vs 1.8%; P = 0.008). The prevalence increased with age and was more common in females. Almost half were associated with varus deformity, suggesting the presence of associated OA in a high proportion. The overall frequency of knee pain seemed no greater than in series reported from the West. Compared with age- and sex-matched controls, body weight was significantly greater amongst those with knee pain, both amongst the affluent (P = 0.005) and the poor (P = 0.02). Control subjects were heavier in the affluent population, suggesting that the greater frequency of knee symptoms in this community was due to their relative obesity. Knee bending at prayer was most common amongst the affluent controls and may indicate that religious observance also contributed to the problem in the richer population. Squatting was a characteristic of the poor who had less knee pain than the affluent. Knee flexing could not therefore be confidently implicated. No relationship could be demonstrated between knee pain and joint laxity.
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PMID:Knee pain amongst the poor and affluent in Pakistan. 861 27

The objective of this work was to address the relationship between physical activity in the workplace and subsequent musculoskeletal pain syndromes. We performed a survey of 5,042 men and women aged 70-75 years, selected from the retirement population of a large national employer (the post office). Subjects were sent a short postal questionnaire enquiring about all occupations held for at least 1 year, the physical activities performed in those jobs, and about recent rheumatic symptoms. The 1-month period prevalence of rheumatic symptoms ranged from 19.9% for hip pain or stiffness in men to 50% for knee pain or stiffness in women. Symptoms were more common in women than men at all sites and there were significant (P < 0.001) associations between symptoms at different sites. Obesity was significantly (P < 0.001) associated with the risk of pain or stiffness at the knee and hip. Prolonged occupational exposure (20+ years) to heavy lifting was associated with hip pain (RR = 1.5; 95% CI = 1.2-1.8); and prolonged exposure to working with arms elevated was associated with an increased risk of shoulder pain (RR = 1.4; 95% CI = 1.2-1.6). Tall stature (P = 0.003) and heavy lifting (P < 0.001) were both associated with increased risks of low back pain among men. This survey confirms the high prevalence of musculoskeletal symptoms observed in previous population-based studies. Associations between occupational activities and musculoskeletal symptoms were specific for activity type and skeletal site involved. Our results imply that the adverse effects of these occupational activities can be found many years after cessation of exposure.
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PMID:Occupational physical activity and long-term risk of musculoskeletal symptoms: a national survey of post office pensioners. 913 Dec 14

Psychosocial factors may explain some of the variation in pain reporting among individuals with knee OA. This has important potential implications for management; indeed, several studies (reviewed in ref. 56) have demonstrated that interventions may reduce knee pain without apparent halting or reversing of structural damage. Such interventions have included the simple provision of support by monthly telephone calls (57), self-management programs (58), and cognitive-behavioral approaches designed to teach patients ways of coping with their pain (59). These programs are even more effective if the spouse is involved (60). It should be noted that there may be a large placebo effect in these interventions, and the degree to which patients are responding simply to an interest being taken in them and their problems is unclear; at least one study has shown that formal cognitive-behavioral therapy is no better than didactic education at improving pain and function in knee OA (though both are beneficial) (61). Many studies examining the role of psychosocial factors have suffered from poor design; many, for example, fail to control for radiographic severity. Future studies should define how pain is identified (dichotomous, ever/never/current, severity), differentiate community and hospital subjects, and separate patients by type and location of OA. Studies should also control for other factors potentially associated with pain: obesity, comorbidity, muscle weakness, and aerobic fitness. Prospective studies would allow clarification of the cause and effect relationship between anxiety, depression, and pain, both in the community and in patients who have elected to seek medical help. In this way, we may increase our understanding of the complex interaction between mood, social factors, and pain reporting in knee OA and, thus, improve the effectiveness, already equivalent to many pharmacologic interventions, of treatments designed to address psychosocial factors.
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PMID:The relationship between psychosocial variables and pain reporting in osteoarthritis of the knee. 953 95


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