Johnston County Research Articles

Point prevalence of hip symptoms, radiographic, and symptomatic OA at five time points: The Johnston County Osteoarthritis Project, 1991–2018

ObjectiveTo describe the point prevalence of hip symptoms, radiographic hip osteoarthritis (rHOA), severe rHOA, and symptomatic rHOA (sxHOA) at five time points in the longitudinal, population-based Johnston County Osteoarthritis Project (JoCoOA). DesignData were from 3068 JoCoOA participants who attended up to five study visits (1991–2018). Standardized supine pelvis radiographs were read by a single, expert musculoskeletal radiologist with high reliability. The four outcomes were: 1) self-reported hip symptoms: “On most days, do you have pain, aching, or stiffness in your right/left hip?“; 2) rHOA: Kellgren-Lawrence grade (KLG) of 2–4; 3) severe rHOA: KLG of 3–4; and 4) sxHOA: both symptoms and rHOA in the same joint. Weighted point prevalence and 95% confidence intervals (CI) were generated overall and by age group (45–54, 55–64, 65–74, 75+ years), sex, race (Black/White), and body mass index (BMI; 18.5–24.9; 25–29.9; 30+ kg/m2). ResultsAt the most recent follow-up (2017–2018), the point prevalence (%) of hip symptoms, rHOA, severe rHOA, and sxHOA were 30% (95% CI 25%, 35%), 53% (95% CI 48%, 58%), 9% (95% CI 6%, 12%), and 15% (95% CI 11%, 19%), respectively. RHOA and severe rHOA were most prevalent in those 75+ years. Women were more likely than men to have hip symptoms and sxHOA. No consistent trends were noted by race or BMI. ConclusionThese updated point prevalence estimates demonstrate a large and increasing burden of HOA in the general population, particularly with aging. Black and White individuals were affected similarly in this cohort.

Association of Increased Serum Lipopolysaccharide, But Not Microbial Dysbiosis, With Obesity-Related Osteoarthritis.

To test the hypothesis that an altered gut microbiota (dysbiosis) plays a role in obesity-associated osteoarthritis (OA). Stool and blood samples were collected from 92 participants with a body mass index (BMI) ≥30 kg/m2 , recruited from the Johnston County Osteoarthritis Project. OA patients (n = 50) had hand and knee OA (Kellgren/Lawrence [K/L] grade ≥2 or arthroplasty). Controls (n = 42) had no hand OA and a K/L grade of 0-1 for the knees. Compositional analysis of stool samples was carried out by 16S ribosomal RNA amplicon sequencing. Alpha- and beta-diversity and differences in taxa relative abundances were determined. Blood samples were used for multiplex cytokine analysis and measures of lipopolysaccharide (LPS) and LPS binding protein. Germ-free mice were gavaged with patient- or control-pooled fecal samples and fed a 40% fat, high-sucrose diet for 40 weeks. Knee OA was evaluated histologically. On average, OA patients were slightly older than the controls, consisted of more women, and had a higher mean BMI, higher mean Western Ontario and McMaster Universities Osteoarthritis Index pain score, and higher mean K/L grade. There were no significant differences in α- or β-diversity or genus level composition between patients and controls. Patients had higher plasma levels of osteopontin (P = 0.01) and serum LPS (P < 0.0001) compared to controls. Mice transplanted with patient or control microbiota exhibited a significant difference in α-diversity (P = 0.02) and β-diversity, but no differences in OA severity were observed. The lack of differences in the gut microbiota, but increased serum LPS levels, suggest the possibility that increased intestinal permeability allowing for greater absorption of LPS, rather than a dysbiotic microbiota, may contribute to the development of OA associated with obesity.

Foot Osteoarthritis Frequency and Associated Factors in a Community-Based Cross-Sectional Study of White and African American Adults.

Few studies have explored foot osteoarthritis (OA) in the general population. The purpose of this study was to determine the frequency of foot OA and identify associated factors in a cross-sectional analysis of a large community-based cohort. Data were from the 2013-2015 study visit of the Johnston County OA Project. Radiographic OA of the foot was defined using the La Trobe radiographic atlas (≥2 osteophytes or joint space narrowing in at least 1 of 5 joints). Symptomatic OA of the foot was defined as foot radiographic OA with pain, aching, or stiffness in the same foot. At the foot-level, separate logistic regression models with generalized estimating equations to account for intraperson correlations were performed to examine associations of foot radiographic OA or symptomatic OA with age, body mass index (BMI), sex, race, educational attainment, and previous foot injury. Of 864 participants with available data (mean age 71 years, mean BMI 30 kg/m2 , 68% women, 33% African American, 13% <12 years of schooling), 22% had foot radiographic OA, 20% had foot symptoms, and 5% had foot symptomatic OA. Radiographic, but not symptomatic, foot OA was more common in African American than White participants. Participants with obesity, compared to normal weight, had >2 times the odds of radiographic OA and >5 times the odds of symptomatic OA in adjusted models. Foot radiographic OA and foot symptoms were common in the sample, but both conditions simultaneously (i.e., symptomatic OA) occurred infrequently. Notably, obesity was linked with foot symptomatic OA, perhaps implicating metabolic or mechanical influences.

Sociodemographic and Clinical Predictors of Prescription Opioid Use in a Longitudinal Community-Based Cohort Study of Middle-Aged and Older Adults.

ObjectivesIdentifying factors associated with opioid use in middle-aged and older adults is a fundamental step in the mitigation of potentially unnecessary opioid consumption and opioid-related harms.MethodsUsing longitudinal data on a community-based cohort of adults aged 50–90 years residing in Johnston County, North Carolina, we examined sociodemographic and clinical factors in non-opioid users (n = 786) at baseline (2006–2010) as predictors of opioid use at follow-up (2013–2015). Variables included age, sex, race, obesity, educational attainment, employment status, household poverty rate, marital status, depressive symptoms, social support, pain catastrophizing, pain sensitivity, insurance status, polypharmacy, and smoking status.ResultsAt follow-up, 13% of participants were using prescription opioids. In the multivariable model, high pain catastrophizing (adjusted odds ratio; 95% confidence interval = 2.14; 1.33–3.46), polypharmacy (2.08; 1.23–3.53), and history of depressive symptoms (2.00; 1.19–3.38) were independent markers of opioid use.DiscussionFindings support the assessment of these modifiable factors during clinical encounters in patients ≥ 50 years old with chronic pain.

The Prevalence of Knee Symptoms, Radiographic, and Symptomatic Osteoarthritis at Four Time Points: The Johnston County Osteoarthritis Project, 1999-2018.

ObjectiveTo describe point prevalence of knee symptoms, radiographic knee osteoarthritis (rKOA), severe rKOA, and symptomatic rKOA at four time points in the longitudinal, population‐based Johnston County Osteoarthritis Project (JoCo OA).MethodsData were from 2573 JoCo OA participants with up to 18 years of follow‐up (1999‐2018) and standardized fixed‐flexion knee radiographs read by a single, reliable expert musculoskeletal radiologist. The four outcomes were 1) self‐reported knee symptoms, defined by “On most days, do you have pain, aching, or stiffness in your right/left knee?”; 2) rKOA, defined as a Kellgren‐Lawrence grade (KLG) of 2 to 4); 3) severe rKOA, defined as a KLG of 3 or 4; and 4) symptomatic rKOA, defined as both symptoms and rKOA in the same joint. Weighted prevalence estimates and 95% confidence intervals (CIs) were generated overall and by age group, sex, race, and body mass index (BMI).ResultsMost recently (2017‐2018, T4), the overall prevalence (percentage) of knee symptoms, rKOA, severe rKOA, and symptomatic rKOA was 41% (95% CI: 35‐47%), 61% (95% CI: 56‐67%), 35% (95% CI: 30‐40%), and 30% (95% CI: 24‐35%), respectively. From time point T1 to T4, prevalence increased for rKOA, severe rKOA, and symptomatic rKOA but not for knee symptoms. The prevalence of both severe rKOA (17‐39%) and symptomatic rKOA (23‐30%) was consistently higher among women. The prevalence of all outcomes was higher among those with higher BMI and among Black participants at all time points, particularly rKOA (35‐69%) and severe rKOA (22‐46%).ConclusionThese updated estimates demonstrate a large and increasing burden of knee OA, particularly among women and Black individuals.

Untargeted Fecal Metabolomics to Investigate the Role of the Microbiome and Nutrients in Osteoarthritis

Abstract Objectives The objective of this study was to determine if perturbations in gut microbial composition and the gut metabolome could be linked to individuals with obesity and osteoarthritis (OA). Methods Fecal samples were collected from 92 participants with obesity recruited from the Johnston County Osteoarthritis Project. OA cases (n = 59) had radiographic hand plus knee OA, defined as involvement of at least 3 joints across both hands, and a Kellgren-Lawrence (KL) grade 2–4 in at least one knee. Controls (n = 33) were without hand OA and with KL grade 0–1 knees. Fecal metabolomes were analyzed by a UHPLC/Q Exactive HFx mass spectrometer. Microbiome composition was determined in fecal samples by 16S ribosomal RNA amplicon sequencing (rRNA-seq). Stepwise logistic regression models were built to determine predictors of OA status. Spearman correlations were performed to determine associations between metabolites and microbiota in OA or healthy individuals. Results Untargeted metabolomics analysis indicated that OA cases had significantly higher levels of di- and tri-peptides (P &amp;lt; 0.05), and significant perturbations (P &amp;lt; 0.1) in microbial metabolites. Pathway analysis revealed several significantly perturbed pathways (P &amp;lt; 0.05) associated with OA, including leukotriene metabolism, amino acid metabolism and fatty acid utilization. Logistic regression models selected metabolites associated with the microbiota and leaky gut syndrome as significant predictors of OA status, particularly when combined with the 16S rRNA sequencing data. Omega-3/6 polyunsaturated fatty acids (PUFAs) levels were significantly correlated with the phyla Bacteriodetes and Firmicutes. Conclusions Adults with obesity and OA have distinct fecal metabolomes characterized by perturbations in microbial metabolites, PUFAs, and protein digestion compared with healthy controls. These metabolic perturbations suggest a role of intestinal inflammation and leaky gut in OA. Funding Sources Supported by the Arthritis Foundation, the National Center for Advancing Translational Sciences (NCATS) (UL1TR002489), and the National Institute of Arthritis and Musculoskeletal and Skin Diseases (P30AR072580).

The association between walking speed from short- and standard-distance tests with the risk of all-cause mortality among adults with radiographic knee osteoarthritis: data from three large United States cohort studies

Adults with radiographic knee OA (rKOA) are at increased risk of mortality and walking difficulty may modify this relation. Little is known about specific aspects of walking difficulty that increase mortality risk. We investigated the association of walking speed (objective measure of walking difficulty) with mortality and examined the threshold that best discriminated this risk in adults with rKOA. Participants with rKOA from the Johnston County Osteoarthritis Project (JoCoOA, longitudinal population-based cohort), Osteoarthritis Initiative and Multicenter Osteoarthritis Study (OAI and MOST, cohorts of individuals with or at high risk of knee OA) were included. Baseline speed was measured via 2.4-meter (m) walk test (short-distance) in JoCoOA and 20-m walk test (standard-distance) in OAI and MOST. To examine the association of walking speed with mortality risk over 9years, hazard ratios (HR) and 95% confidence intervals (CI) were calculated from Cox regression models adjusted for potential confounders. A Maximal Likelihood Ratio Chi-square Approach was utilized to identify an optimal threshold of walking speed predictive of mortality. Deaths after 9 years of follow-up occurred in 23.3% (290/1244) of JoCoOA and 5.9% (249/4215) of OAI+MOST. Walking 0.2m/s slower during short- and standard-distance walk tests was associated with 23% (aHR [95%CI]; 1.23 [1.10, 1.39]) and 25% (1.25 [1.09, 1.43]) higher mortality risk, respectively. Walking <0.5m/s on short-distance and <1.2m/s standard-distance walk tests, best discriminated those with and without mortality risk. Slower walking speed measured via short- and standard-distance walk tests was associated with increased mortality risk in adults with rKOA.

Hip symptoms are associated with premature mortality: the Johnston County Osteoarthritis Project

To investigate the impact of hip osteoarthritis (OA) and/or hip symptoms on excess mortality. We analyzed data from 3,919 individuals in a community-based prospective cohort of African Americans and Caucasians age ≥45 years. Women ≥50 years of age and all men underwent supine anteroposterior pelvic radiography at baseline, with the participant's feet in 15 degrees of internal rotation. Hip radiographic (rOA) was defined as a Kellgren-Lawrence grade of ≥2 in at least one hip. Participants completed questionnaires at baseline to determine presence of hip symptoms and covariate status. Participants with symptomatic hip rOA (SxOA) are a subset of individuals with hip rOA and symptoms in the same hip. Multiple imputation was used to impute missing values of covariates. Mortality was determined through 2015 and follow-up time was calculated from baseline assessment until death or censoring which took place when a participant was lost to follow-up or reached the end of study period. Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI). We carried out additional analyses stratified by sex, race, age and obesity. Mean follow-up time was 14.2 years during which 1762 deaths occurred. There were 29.9% participants in our population with hip rOA at baseline. Compared to those with neither hip rOA nor hip symptoms, we observed an increased risk of all-cause mortality in participants with hip symptoms alone (HR=1.28, 95% CI=1.13-1.46), but no association for hip rOA either with or without symptoms. In stratified analyses we observed increased associations for hip symptoms alone and hip sxOA in those <65 years (43% and 39% increase, respectively) and in Caucasians (34% and 21% increase, respectively). Individuals who had hip symptoms without hip rOA had an increased risk of mortality. These effects were particularly strong for those who were <65 years of age and Caucasians. Effective interventions to identify those with hip pain in order to lessen it could reduce premature mortality.

A Standardized, Pragmatic Approach to Knee Ultrasound for Clinical Research in Osteoarthritis: The Johnston County Osteoarthritis Project.

ObjectiveThis study sought to develop and employ a comprehensive and standardized ultrasound (US) protocol and scoring atlas for the evaluation of features relevant to knee osteoarthritis (KOA) in a community‐based cohort in the United States, with the goals of demonstrating feasibility, reliability, and validity.MethodsWe utilized data from the fourth follow‐up (2016‐2018) of the Johnston County OA Project, which includes individuals with (~50%) and without radiographic KOA. All participants underwent standardized knee radiography and completed standard questionnaires including the Knee Injury and Osteoarthritis Outcome Score (KOOS). Bilateral knee US images were obtained by a trained sonographer using a standardized protocol and scored by trained rheumatologists using an atlas developed for this study. A total of 396 knees were each scored by two readers according to the atlas. Associations between US features, radiographic findings (graded by an expert radiologist), and KOOS scores were assessed.ResultsOverall interreader reliability for US scoring was fair to moderate. The strongest correlations between US and radiographic features were seen for osteophytes, and similarly strong correlations were seen between US osteophytes and overall radiographic Kellgren‐Lawrence Grade, demonstrating criterion validity. Features of effusion/synovitis and osteophytes were most associated with KOOS pain and impaired function.ConclusionUS is a feasible, reliable, and valid method to assess features relevant to KOA in clinical and research settings. The protocol and atlas developed in this study can be utilized to evaluate KOA in a standardized fashion in future clinical studies, enabling greater utilization of this valuable modality in osteoarthritis.

Predominant lifetime occupation and associations with painful and structural knee osteoarthritis: An international participant-level cohort collaboration

With adults working to older ages, occupation is an important, yet less modifiable domain of physical activity to consider in the risk of knee osteoarthritis (OA). This study aimed to investigate the association between predominant lifetime occupation and prevalent knee OA. Participant-level data were used from five international community-based cohorts: Johnston County Osteoarthritis Project, the Hertfordshire Cohort Study, the Multicenter Osteoarthritis Study, the Tasmanian Cohort Study and Framingham Osteoarthritis Study. Self-reported predominant occupation was categorized into sedentary, light, light manual and heavy manual levels. Cross-sectional associations between predominant lifetime occupation and knee OA outcomes including prevalence of radiographic knee OA (RKOA), symptomatic RKOA and knee pain, were assessed using logistic regression, accounting for cohort clustering. Data for 7391 participants were included. 24.7% reported sedentary lifetime occupation, 30.0% light, 35.9% light manual and 9.4% heavy manual. 43.3% presented with RKOA, 52.1% with knee pain and 29.0% with symptomatic RKOA. There was over a two-fold increase in the odds of having RKOA, knee pain and symptomatic RKOA in those whose with heavy manual compared to sedentary occupations ((odds ratio (OR): 2.14; 95% confidence interval (CI): 1.79, 2.58), (OR: 2.19; 95% CI: 1.78, 2.70), (OR: 2.41; 95% CI: 1.94, 2.99) respectively). This large international multi-cohort study demonstrated an association of heavy manual work with RKOA, symptomatic RKOA and knee pain. Measures that protect workers and are designed to reduce heavy manual related activities remain a priority to reduce the risk of knee OA.

Different Phenotypes of Osteoarthritis in the Lumbar Spine Reflected by Demographic and Clinical Characteristics: The Johnston County Osteoarthritis Project.

To determine if associations between demographic and clinical characteristics and appendicular joint osteoarthritis (OA) reflect different phenotypes of OA in the lumbar spine. Participants were from the Johnston County OA Project. Demographic information consisted of age, sex, and race (white and African American), and clinical characteristics consisted of body mass index (BMI), low back pain and injury, and knee, hip, and hand OA. Participants were categorized as having spine OA, facet joint OA, both spine OA and facet joint OA, or neither spine OA nor facet joint OA (referent group). Multinomial regression models were used to determine odds ratios (ORs) and 95% confidence intervals (95% CIs). Of 1,793 participants, the mean ± SD age was 66.2 ± 10.1 years, and the mean ± SD BMI was 30.7 ± 6.2. The majority of the participants were women (n = 1,144 [63.8%]), and 31.8% of the participants (n = 570) were African American. Eighteen percent of participants had neither spine OA nor facet joint OA, 22.8% had facet joint OA, 13.2% had spine OA, and 46.0% had both spine OA and facet joint OA. In adjusted analyses, African Americans were less likely to have facet joint OA (OR 0.68 [95% CI 0.49-0.95]) or both spine OA and facet joint OA (OR 0.51 [95% CI 0.37-0.70]). Women were more likely to have facet joint OA (OR 1.71 [95% CI 1.24-2.36]). Having a BMI of ≥30 was associated with having facet joint OA (OR 1.76 [95% CI 1.28-2.42]) and both spine OA and facet joint OA (OR 1.85 [95% CI 1.37-2.51]). Knee OA was associated with all 3 OA groups, while lower back injury was associated only with those with spine OA. Participants with hip OA were less likely to have facet joint OA. Race, sex, BMI, hip OA, and lower back injury may help identify different OA phenotypes in the lumbar spine.

Application of Traditional and Emerging Methods for the Joint Analysis of Repeated Measurements With Time-to-Event Outcomes in Rheumatology.

The goal of this paper is to describe approaches for the joint analysis of repeatedly measured data with time-to-event end points, first separately and then in the framework of a single comprehensive model, emphasizing the efficiency of the latter approach. Data from the Johnston County Osteoarthritis (JoCo OA) Project will be used as an example to investigate the relationship between the change in repeatedly measured body mass index (BMI) and the time-to-event end point of incident worsening of radiographic knee OA that was defined as an increased Kellgren/Lawrence grade in at least 1 knee over time. First, we provide an overview of the methods for analyzing repeated measurements and time-to-event end points separately. Then, we describe traditional (Cox proportional hazards model [CoxPH]) and emerging (joint model [JM]) approaches, both of which allow combined analysis of repeated measures with a time-to-event end point in the framework of a single statistical model. Finally, we apply the models to JoCo OA data and interpret and compare the results from the different approaches. Applications of the JM (but not the CoxPH) showed that the risk of worsening radiographic OA is higher when BMI is higher or increasing, thus illustrating the advantages of the JM for analyzing such dynamic measures in a longitudinal study. Joint models are preferable for simultaneous analyses of repeated measurement and time-to-event outcomes, particularly in the context of chronic disease, where dependency between the time-to-event end point and the longitudinal trajectory of repeated measurements is inherent.

Incidence and progression of foot osteoarthritis: the Johnston county osteoarthritis project

Purpose: To describe the incidence and progression of foot osteoarthritis (OA) in a large population-based cohort. Methods: Data were obtained from the Johnston County Osteoarthritis Project (JoCoOA), a prospective population-based cohort of African American and Caucasian residents of Johnston County, North Carolina. Participants completed foot radiographs at baseline (2013-2015) and follow-up (2016-2018). Five specific joints were examined: the first metatarsophalangeal (1st MTP), first cuneometatarsal (1st CMT), second cuneometatarsal (2nd CMT), naviculocuneiform (NC), and talonavicular (TN). Using the La Trobe Foot Atlas, which examines osteophytes (OP, score 0-3) and joint space narrowing (JSN, score 0-3) in the five specified joints, incident foot radiographic OA (rOA) was defined as baseline score <2 OP and JSN in all 5 joints with ≥2 OP or JSN at follow-up in any of the 5 joints. Progression was defined as worsening score of OP or JSN in a joint with baseline foot rOA. At baseline and follow-up, participants were asked to rate their pain, aching, or stiffness [PAS] in each foot as 0-10 (none to extreme) on most days of any month in the past 12 months. PAS worsening was defined as an increase in the PAS from baseline to follow-up. The Foot and Ankle Outcome Score (FAOS), a 42-item questionnaire assessing patient relevant outcomes in five subscales (pain, other symptoms, activities of daily living [ADL], sport and recreation function [Sports & Rec], foot and ankle-related quality of life [QOL]) was also obtained. Joint-based logistic regression models with generalized estimating equations were used to examine associations of foot rOA incidence and progression and covariates of interest (refer to Table 1 for full list). Two-way interactions between risk factors and foot rOA status at baseline were assessed at a 0.10 alpha level and adjusted odds ratios and 95% confidence intervals (aOR [95% CI]) were shown by baseline status if significant; otherwise overall associations were shown. Results: A total of 541 participants were included with radiographs of 1082 feet. Table 1 shows baseline characteristics: 71% were women, with mean age of 69 years; 35% were African American and 53% were obese. The most commonly affected joint at baseline was the first MTP (42%) followed by the TN (31%). Table 1 shows the incidence and progression of foot rOA. Among 928 feet without baseline rOA, 4% developed incident foot rOA and roughly 2% of those had PAS of the same foot at follow-up. Among 154 feet with baseline foot rOA, 55% had radiographic progression and 16% of those had PAS of the same foot at follow-up. Female sex and higher BMI were associated with incident foot rOA, while self-reported history of gout was associated with increased odds of both incidence and progression of foot rOA (Table 2). A history of foot injury was associated with significantly increased odds of foot OA with PAS present, but not for rOA alone. Although work disability was not associated with increased odds of foot rOA incidence or progression, it was associated with PAS and FAOS worsening particularly for pain, ADL, and Sports & Rec subscales (Table 3). BMI was associated with increased odds for worsening of all FAOS subscales. Age was not associated with worsening of FAOS symptoms or QOL. Gout was associated with increased odds of worsening for FAOS ADL and Sports & Rec subscales. Conclusions: Progression of foot rOA is relatively common although it is not necessarily related to worsening symptoms. Older age was not found to be associated with incidence or progression of foot rOA suggesting that other factors may be more important such as sex, BMI and history of gout. Given increased risk of foot rOA with higher BMI, BMI may be a modifiable risk factor for the development of foot rOA, similar to other weight-bearing joints such as the hip and knee. Strategies for prevention of foot injuries may be particularly important for foot rOA with symptoms. Further studies should determine if interventions, such as weight loss or intensive gout control, could lead to better symptom control in foot OA and should examine the association of foot OA with OA at other joints.

Incidence and progression of ankle osteoarthritis: the Johnston county osteoarthritis project

Purpose: Osteoarthritis involving the ankles has been relatively understudied. We have previously demonstrated associations of older age, obesity, and prior injury with prevalent radiographic ankle OA (rAOA) in a community-based cohort (Lateef 2017), but little is known about ankle OA incidence and progression over time. The current project assessed the incidence and progression of ankle OA from the third (2013-2015, baseline) to the fourth (2016-18) follow-up (mean 3.5 years later) in the Johnston County OA Project.

The population-based prevalence of hip symptoms, radiographic, and symptomatic hip OA over 26 years: the Johnston county osteoarthritis project

The population-based prevalence of hip symptoms, radiographic, and symptomatic hip OA over 26 years: the Johnston county osteoarthritis project

The population-based prevalence of knee symptoms, radiographic, and symptomatic OA over 18 years: the Johnston county osteoarthritis project

The population-based prevalence of knee symptoms, radiographic, and symptomatic OA over 18 years: the Johnston county osteoarthritis project

Hand osteoarthritis is associated with mortality among men: the Johnston county osteoarthritis project

Purpose: Prior studies have suggested a role for symptomatic hand osteoarthritis (OA) in mortality. We therefore sought to explore whether hand OA measures are associated with death before subsequent follow-up, independent of lifestyle factors and comorbidities associated with premature death, and whether these associations differed by sex.

Incidence and progression of hand osteoarthritis in a large community-based cohort: the Johnston County Osteoarthritis Project

To describe the incidence and progression of radiographic and symptomatic hand osteoarthritis (rHOA and sxHOA) in a large community-based cohort. Data were from the Johnston County OA Project (1999-2015, 12±1.2 years follow-up, age 45+). Participants had bilateral hand radiographs each visit, read for Kellgren-Lawrence grade (KLG) at 30 joints. We defined rHOA as KLG ≥2 in ≥1 joint. SxHOA was defined in a hand/joint with rHOA and self-reported symptoms or tenderness on exam. Incidence was assessed in those without, while progression was assessed in those with, baseline rHOA. Proportions or medians are reported; differences by sex and race were assessed using models appropriate for dichotomous or continuous definitions, additionally adjusted for age, education, body mass index (BMI), and weight change. Of 800 participants (68% women, 32% African American, mean age 60 years), 327 had baseline rHOA and were older, more often white and female, than those without rHOA (n=473). The incidence of HOA was high, for rHOA (60%) and for sxHOA (13%). Women were more likely than men to have incident HOA, particularly for distal interphalangeal joint radiographic osteoarthritis (DIP rOA) (adjusted odds ratios (aOR) 1.60 95% confidence intervals (95% CI) [1.03, 2.49]) and sxHOA (aOR 2.98 [1.50, 5.91]). Progressive HOA was more similar by sex, although thumb base rOA progressed more frequently in women than in men (aOR 2.56 [1.44, 4.55]). Particularly HOA incidence, but also progression, was more frequent among whites compared with African Americans. This study provides much needed information about the natural history of HOA, a common and frequently debilitating condition, in the general population.

Is the association between knee injury and knee osteoarthritis modified by the presence of general joint hypermobility?

To evaluate whether joint hypermobility modifies the association between knee joint injury and knee osteoarthritis (OA) among adults. Data were from three studies: Genetics of Generalized Osteoarthritis (GOGO; N=2,341), Genetics of Osteoarthritis (GO; N=1,872), and the population-based Johnston County Osteoarthritis Project (JoCoOA; N=1,937). Knee injury was defined as a self-report of prior fracture or severe injury to either knee. OA was defined using three variables: knee pain (pain, aching, or stiffness of the knee on most days), radiographic OA (rOA; Kellgren-Lawrence grade 2-4), and symptomatic OA (sxOA; knee rOA with knee pain). Joint hypermobility was defined as Beighton score ≥4. For each study, separate logistic regression models, stratified by joint hypermobility, were used to estimate the association of knee injury with knee pain, rOA, and sxOA, adjusting for age, sex, body mass index, and race (JoCoOA only); statistical interactions between injury and hypermobility were assessed (p-value<0.10). In all three studies, knee injury was associated with OA variables of knee pain, rOA, and sxOA (adjusted odds ratios [aOR] range 1.83-3.75). The association of knee injury with rOA and sxOA was magnified among individuals with vs. without joint hypermobility in GOGO: rOA aOR 11.0, 95% confidence interval [CI] 4.0-30.1 vs. 2.7, 95% CI 2.0-3.6, p=0.009; sxOA aOR 9.2, 95% CI 3.5-24.3 vs. 3.3, 95% CI 2.4-4.4, p=0.032. Interactions were not statistically significant in GO or JoCoOA. In a general adult population, the presence of joint hypermobility may not modify the strong association between knee injury and OA.

Effects of Comorbid Cardiovascular Disease and Diabetes on Hand Osteoarthritis, Pain, and Functional State Transitions: The Johnston County Osteoarthritis Project.

The purpose of this study is to examine the course of hand osteoarthritis (HOA) and its relationship with cardiovascular disease (CVD) and diabetes (DM). Data were collected at 3 timepoints from 845 Johnston County Osteoarthritis Project participants (two-thirds women, one-third African Americans, mean age 60 yrs) with and without HOA, CVD, or DM. A diagnosis of radiographic HOA (rHOA) required a Kellgren-Lawrence severity grade of ≥ 2 in at least 3 joints in each hand. A 4-state progressive model included transitions based on rHOA and pain or function as defined using the Australian/Canadian HOA Index (AUSCAN). Markov multistate models estimated HR (aHR) and 95% CI for associations between DM or CVD and specific state transitions, adjusting for baseline and time-varying covariates. Participants with DM (vs those without DM) were more likely to experience worsening pain with rHOA. Individuals who had or developed CVD (vs those who did not) were significantly less likely to experience symptomatic improvement, regardless of rHOA status. Those with DM or CVD (vs those without these comorbidities) were less likely to experience improvement in function, although this was statistically significant only for those with DM and no rHOA. Overall, having or developing DM and/or CVD reduced the likelihood of symptomatic and functional improvement over time, suggesting an effect of comorbid CVD and DM on the clinical and radiographic course of HOA. Additional studies are needed to confirm these findings.