Abstract
BackgroundWe examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA).MethodsThis longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in North Carolina, USA, with 18.4 ± 1.5 years of follow-up. Transitions across the following states were modeled: development of radiographic HOA (rHOA; Kellgren-Lawrence grade [KLG] of< 2); development of hip symptoms (self-reported hip pain, aching, or stiffness on most days) or symptomatic HOA (sxHOA; rHOA and symptoms in the same hip), and resolution of symptoms. Obesity (body mass index ≥ 30 kg/m2) and self-reported DM and CVD were the time-dependent comorbid conditions of interest. Markov multi-state models were used to estimate adjusted hazard ratios and 95% confidence intervals to describe the associations between the conditions and HOA states.ResultsThe sample included 33% African Americans, 39% men, with a mean (SD) age of 62.2 (9.8) years; the frequencies of the comorbidities increased substantially over time. When considered individually, obesity was associated with incident hip symptoms, while CVD and DM were associated with reduced symptom resolution. For those with > 1 comorbidity, the likelihood of incident sxHOA increased, while that of symptom resolution significantly decreased. When stratified by sex, the association between obesity and incident symptoms was only seen in women; among men with DM versus men without, there was a significant (~ 75%) reduction in symptom resolution in those with rHOA. When stratified by race, African Americans with DM, versus those without, were much more likely to develop sxHOA.ConclusionsComorbid chronic conditions are common in individuals with OA, and these conditions have a significant impact on the persistence and progression of HOA. OA management decisions, both pharmacologic and non-pharmacologic, should include considerations of the inter-relationships between OA and common comorbidities such as DM and CVD.
Highlights
We examined the association of three common chronic conditions with transitions among states of hip osteoarthritis (HOA)
The evidence that OA is associated with cardiovascular disease (CVD), diabetes mellitus (DM), or features of the metabolic syndrome is mixed and is overall stronger for knee OA compared with HOA [6]
By the end of the follow-up period, asymptomatic radiographic HOA (rHOA) had increased to 34% and Symptomatic hip osteoarthritis (sxHOA) had increased to 15%
Summary
We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). Osteoarthritis (OA) in general has been associated with a substantially higher risk of cardiovascular disease (CVD) [1] and of premature mortality [2], some of this increased risk is likely explained by walking disability [3] Conditions such as CVD and diabetes mellitus (DM) are commonly comorbid with OA and have been associated with poorer outcomes, for example following joint replacement [4]. The Johnston County OA Project has extensive longitudinal data on HOA, including symptoms and radiographs and the presence and development of obesity and comorbid conditions, including DM and CVD Using this unique dataset, we aimed to determine the associations between prevalent or incident obesity, DM, and CVD and the transitions among key states of HOA (e.g., development or resolution of symptoms, or development of radiographic damage)
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