Risk Factors For Knee OA Research Articles

Epidemiology of knee osteoarthritis

Introduction. Osteoarthritis of the knee joint is a progressive incurable disease, which in the case of a severe course at a late stage leads to total joint replacement. Recently, experts have focused their attention to the prevention and treatment of early osteoarthritis, so it is important to understand the prevalence, frequency, and modified risk factors for knee OA. The aim is to investigate the patterns of morbidity and prevalence of osteoarthritis of the knee joint on the basis of scientific analysis of relevant modern literature. Materials and methods. Research material – scientific articles in the MEDLINE database for the period 2016–2020, reflecting the epidemiological indicators of osteoarthritis of the knee joint, and additional search for articles from bibliographic lists of selected literature sources. Research methods – a systematic review of relevant sources of literature. Results. Osteoarthritis of the knee joint is one of the most common diseases of the musculoskeletal system. The frequency of osteoarthritis steadily increases with age, overweight. The progressive nature of the disease, the presence of persistent pain lead to limited functionality and reduced efficiency; such patients in some cases require surgical treatment aimed at replacing the compromised joint, which requires significant economic costs, medical rehabilitation and social readaptation of patients and is a heavy burden for both the patient and society as a whole. The lack of correlation between clinical symptoms and radiological signs of osteoarthritis of the knee joint leads to low availability of orthopedic care: more than 30 % of patients with a first diagnosis have a pronounced stage of the disease, and in some cases the pathology is diagnosed only in connection with complications; the diagnosis of osteoarthritis due to the high percentage of painless development of the disease (40 %) is often established in the terminal stages. All this indicates the need for further research on various factors influencing the frequency, prevalence, economic and social burden of osteoarthritis of the knee. Conclusions. Osteoarthritis of the knee joint is characterized by high incidence, which increases with age, progressive course, limited functional capabilities. Treatment of such patients requires significant economic costs of society. A significant increase in the prevalence of osteoarthritis of the knee is associated with increased life expectancy, obesity and some other factors that require further research.

Foot and ankle pain and risk of incident knee osteoarthritis and knee pain: Data from the Multicentre Osteoarthritis Study

ObjectivesTo examine whether foot and/or ankle pain increases the risk of knee OA. DesignWe utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain. ResultsNo statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes. ConclusionsAnkle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.

Association between current medication use and progression of radiographic knee osteoarthritis: data from the osteoarthritis initiative.

ObjectiveUse of specific medications may accelerate the progression of radiographic knee OA (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA.MethodsWe used longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (Kellgren–Lawrence grade ≥2) and excluded those with a history of knee-related injury/surgery and other musculoskeletal disorders. Current medication use (use/non-use in the previous 30 days) and radiographic medial minimum joint space width (mJSW) data were available at baseline and annually up to 96 months follow-up. We used random effects, panel regression to assess the association between current medication use (non-users as reference group) and change in mJSW.ResultsOf 2054 eligible participants, 2003 participants with baseline mJSW data were included [55.7% female, mean age 63.3 (s.d. 8.98) years]. Of seven medication classes, at baseline NSAIDs were the most frequently used analgesia (14.7%), anti-histamine (10.4%) use was frequent and the following comorbidity medications were used most frequently: statins (27.4%), anti-hypertensives (up to 15.0%), anti-depressant/anxiolytics/psychotropics (14.0%), osteoporosis-related medication (10.9%) and diabetes-related medication (6.9%). Compared with current non-users, current use of NSAIDs was associated with a loss of mJSW (b = −0.042, 95% CI −0.08, −0.0004). No other associations were observed.ConclusionsIn current users of NSAIDs, mJSW loss was increased compared with current non-users in participants with RKOA. Clinical trials are required to assess the potential disease-modifying effects of these medications.

Incidence of primary osteoarthritis knee below 40 years of age and its etiological factors: OPD survey of 200 knee pain patients

Introduction: For decades, knee OA had been viewed as a disease mostly affecting older population, consequently, only few population-based studies have examined the frequency and characteristics of OA knee in persons under the age of 40 years leading to dearth of literature over this subject matter. Recent evidence however, documents increased incidence of two key risk factors for knee OA – traumatic knee injury and obesity, particularly in the young. Studies have shown that mean age of onset of osteoarthritis knee has decreased over couple of decades and projected incidence of the disease in young is on the rise. Materials and Methods: Patients of either sex coming to the OPD of the Department of Orthopaedics with chief complaint of knee pain were assessed as per the preformed and pretested questionnaire and subjected to AP view of both knee in standing position until 200 such cases with age ? 40yrs were separated. The cases were assessed as per Kellgren Lawrence grading. The patients were also assessed for height, weight, BMI and other parameters. Cases were selected carefully after excluding the subjects as per the adopted exclusion criterion. Results: After survey of 200 knee pain patients below 40 years of age, over a period of one and a half years, incidence of primary osteoarthritis knee on the radiological basis was found to be 6.54%. Mean age of 200 subjects were 34.7 years with female: male ratio being 6:1(p=0.004). 82.1% cases of OA had BMI >24.9kg/m2 (p=0.004) whereas 80 females cases had BMI>24.9kg/m2 (p=0.007). 53.5% cases had predominantly sitting/ squatting /kneeling as household habits (p=0.02). 67.8% cases were of medium activity group on the basis of their occupation while 57.1% (p=0.05) of cases had history of OA knees in the first degree relatives. Conclusion: The incidence of OA knee in the young is increasing. Knowing the risk factors and disease volume in younger age groups would allow primary prevention of OA to be implemented in young

3414 Association of blood pressure and biochemical knee cartilage composition assessed by T2 relaxation time measurements: Data from the Osteoarthritis Initiative

OBJECTIVES/SPECIFIC AIMS: The goal of this study was to investigate the associations of systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP) with knee articular cartilage composition using magnetic resonance imaging (MRI)-based T2 relaxation time measurements in study participants from the Osteoarthritis Initiative (OAI). METHODS/STUDY POPULATION: In this longitudinal study, 1,139 participants from the OAI, a multi-center, observational study of the evolution of knee OA, were selected using the following inclusion criteria: right knee Kellgren Lawrence (KL) score (radiographic classification of OA severity) 0-2 indicating no to mild radiographic OA at baseline, no history of rheumatoid arthritis at baseline, available blood pressure measurements at baseline, available T2 measurements in at least three knee compartments at baseline and 48-month follow-up. Linear regression models were performed using standardized values for SBP, DBP and PP as primary predictors and change in cartilage T2 over 48 months, a measure of cartilage matrix quality and degeneration, as the primary outcome. PP was defined as SBP minus DBP. Change in superficial layer and deep layer cartilage T2, which reflect differences in the laminar organization of knee cartilage T2, were also included as outcomes. Statistical models were adjusted for common risk factors for knee OA (baseline age, sex, BMI, KL score) as well as number of currently used anti-hypertensive medications (AHM) reported at baseline. We included AHMs whose primary indication was the treatment of hypertension including beta blockers, angiotensin-converting enzyme (ACE) inhibitors, angiotensin II receptor blockers (ARB), thiazides, chlorthalidone, dihydropyridine calcium channel blockers (CCB) and aliskiren. All predictors, outcomes and covariates (except sex) were analyzed as continuous variables. We included interaction terms in the models to evaluate whether the covariates (age, sex, BMI, KL score, number of AHMs) modified the association of SBP, DBP and PP with cartilage T2. RESULTS/ANTICIPATED RESULTS: The average age of all study participants was 58.8 years (SD ± 8.6) with a higher proportion of men (59.4%), average body mass index (BMI) was 28.3 (SD ± 4.5), average SBP was 122.4 (SD ± 15.4) mmHg, average DBP was 75.5 (SD ± 9.6) mmHg and 469 (38.1%) study participants were taking at least one AHM. Higher baseline DBP was significantly associated with a faster increase in global T2 (0.22 [0.10,0.35], P < 0.001), global deep layer T2 (0.20 [0.03,0.36], P < 0.022) and global superficial layer T2 (0.39 [0.20,0.58], P < 0.001). These associations were significant in both unadjusted and the models adjusted for age, sex, BMI and KL score. No significant associations were found between SBP or PP and cartilage T2 and no significant interactions were found between SBP, DBP, PP and the covariates. DISCUSSION/SIGNIFICANCE OF IMPACT: Higher baseline DBP was associated with a faster increase in knee cartilage T2, suggesting accelerated cartilage degeneration. This association was stronger for the superficial layer of knee cartilage T2 compared to the deep layer. Although further basic mechanistic studies are needed to elucidate the underlying pathophysiology of this relationship, these results suggest lowering DBP may influence knee OA.

Quantitative cartilage thickness change in radiographically normal knees with and without OA risk factors – data from the OAI

Purpose: Quantitative cartilage thickness change, as measured by MRI, has been intensively explored as an imaging biomarker of structural progression in knee OA, and its sensitivity has been reported for various radiographic baseline disease severity strata. However, whether significant femorotibial cartilage change occurs in knees without radiographic knee OA, and whether it differs between knees from persons with and without common risk factors for knee OA, is unknown. The purpose of this work hence was 1) To explore location-independent and region-specific measures of quantitative cartilage thickness change by MRI in knees without any evidence of radiographic knee OA in either knee; 2) To test the hypothesis that knees from persons with common risk factors for knee OA display significantly greater cartilage thinning (and thickening) than knees from persons without risk factors. Methods: In the Osteoarthritis Initiative, a longitudinal cohort study of knee OA, we assessed the right knees of participants without any signs of radiographic knee OA (bilaterally KLG0; centralized readings). Of 755 knees, 77 were from healthy reference OAI participants (no pain, no risk factors for knee OA, 60% female; age 55.4 ± 7.3 y; BMI 24.4 ± 3.2 kg/m2) and 678 from incident cohort participants (various levels of pain and risk factors of knee OA, 57% female; age 59.6 ± 8.8 y; BMI 26.7 ± 4.2 kg/m2). The femoro-tibial cartilages were segmented and subregional thickness change was computed from year 1 and 4 (Y1/Y4) follow-up MRI data, using the sagittal DESS sequence and Chondrometrics software. Thinning (and thickening) scores were computed by summarizing all negative (and positive) subregion changes in each participant (primary analysis). Subregions and ordered values (OV) of subregional change were included as exploratory outcomes. Changes were reported including 95% CIs; statistical comparisons between both groups were made using the unpaired Welch t-test and Cohen D. Results: In KLG0 knees with risk factors (risk cohort), the cartilage thinning score over 3 years exceed the thickening score by approx. 20% and was significantly greater than the thinning score in healthy reference cohort knees. (Fig. 1; Table 1: P = 0.002). Cartilage thickening scores, however, were similar between both Groups (Fig. 1). 9 (of 16) OVs suggested greater thinning in the “risk cohort” compared with the reference cohort (Table 1; Fig. 2), whereas only 2 subregions (cLT; icMF) suggested greater thinning, and 2 regions (iMT, ccMF) less thickening in “risk cohort” than in reference cohort knees (data not shown). Conclusions: Among individuals without radiographic evidence of OA in either knee, knees from persons at higher risk for OA experienced significantly greater cartilage thinning than those from persons without risk factors for knee OA, whilst the observed magnitude of cartilage thickening was similar between groups. Greater thinning in KLG0 knees with risk factors was most prominent in the (central) lateral compartment; yet, location-independent analysis was superior to region-specific analysis in elucidating these subtle between-group differences.Table 13-year cartilage thickness change in KLG0 knees without and with risk factors for knee OA[μm]Healthy kneesRisk kneesP-ValueEffect sizeMeanSD95% CIMeanSD95% CIT-TestCohen's DThinn. Score−634516(−673, −596)−501319(−573, −429)<0.01−0.27Thick. Score529366(501, 556)537308(467, 607)0.83−0.02OV 1−166121(−175, −157)−14291(−163, −122)0.04−0.20OV 2−11685(−122, −109)−9855(−110, −85)0.01−0.22OV 3−8869(−94, −83)−7548(−86, −64)0.03−0.20OV 1614380(137, 149)14474(127, 160)0.970.00 Open table in a new tab

Participation in some sports, not running, increases risk of knee and hip osteoarthritis

The rates of reduction of hip replacement (an end-stage treatment of hip OA) were 35.1%, 50.4%, and 38.5%, respectively. These data, combined with the body mass index (BMI) data of the runners, suggest that running reduced OA and hip replacement risk partially due to the lower BMI associated with runners. Furthermore, the study showed that increased running speed, distance, or years of running did not increase OA risk, but seemed to increase risk of hip replacement. The results also demonstrated that running presents no increased risk for OA compared to walking. The author argued that running may decrease OA more than walking due to the larger percentage of runners (89.5%) who exceeded 1.8 MET-h/day compared to walkers (52.8%). However, the study did not report jointspecific OA in the runners. This prospective cohort study has a large sample size, exceeding the number of surveyed runners 10 times compared to the number of runners surveyed in all previous cross-sectional running studies combined. 3 OA risks associated with participation in other vigorous sports are not clearly evidenced and consistent in the literature. A recent systematic review and meta-analysis on the effects of sport activities on OA predictions (hip, knee, and ankle) provide some new insight. 4 The review, which initially identified 1294 studies and included 43 qualified studies according to a pre-defined set of criteria, included studies that had a large variation in the number of participants (16e8000) and duration of the study period (30 monthse40 years). Regarding the relationship between OA and sport activity, 12 papers met the inclusion criteria, including two retrospective cohort studies, two case series studies, seven caseecontrol studies, and one cross-sectional study. Either radiographic or magnetic resonance imaging was used to define OA in most of the studies; questionnaire, physician diagnosis, and selfreported pain and disability were also used in some of the studies. It was reported that participation in team sports was a risk factor for knee OA onset prior to 45 years of age. 5 One study identified participation in soccer as a risk factor for knee OA 6 while another study did not identify it as a risk factor. 7 Females had an increased risk of developing knee OA compared to males when participating in gymnastics or Kung Fu. 8 A caseecontrol study showed that an increased risk of developing knee OA was associated with participation in soccer, ice hockey, and tennis, but not in track and field, skiing, and orienteering. 9 However, after adjustment for knee

FRI0587-HPR Symptomatic hand oa is related to higher body mass index (BMI) early in life, and lower bmi later in life. results from a 20 year population based prospective cohort study.

BackgroundObesity is a known risk factor for knee OA and to a lesser extent for hip OA. There is moderate evidence that obesity is a risk factor for radiographic hand...

Obesity and knee osteoarthritis

The association between obesity and knee osteoarthritis, and specifically the role of obesity as a risk factor for knee osteoarthritis has been well documented. A systematic review and meta-analysis by Blagojevic et al. in Osteoarthr Cartil 18(1):24-33, (2010) examined 36 papers reporting on BMI and found that all studies demonstrated obesity and being overweight to be risk factors for knee osteoarthritis. The effect size for obesity as a risk factor for knee OA was reported to be I² = 97%, and the random effects pooled odds ratio for obesity compared to normal weight was 2.63 with a 95% CI of 2.28-3.05. This review summarises recent findings involving the association between knee osteoarthritis and obesity: the potential mechanisms of the link between the two disease states; and the potential benefits of weight loss on obese, knee osteoarthritis patients. Studies for inclusion in our report were identified using: MEDLINE; EMBASE; PUBMED; Cochrane Central Register of Controlled Trials; CINAHL; and reference lists of relevant articles. A number of recent studies involving the association between obesity and knee osteoarthritis have since been published. A large, population-based prospective study (n = 823) conducted by Toivanen et al. with a follow-up of 22 years found that the risk for knee osteoarthritis was 7 times greater for people with BMI ≥ 30 compared to the control of people with BMI <25. A prospective cohort study of the Norwegian population by Grotle et al. that followed 1,675 patients reported that BMI >30 was significantly associated with osteoarthritis of the knee, with odds ratio of 2.81, and 95% CI of 1.32-5.96. Lohmander et al. found that in a large cohort study of 27,960 patients from the Swedish population, the relative risk for knee osteoarthritis (fourth quartile compared to first quartile) was 8.1, with a 95% CI of 5.3-12.4. Finally, a case-control study from Holliday et al. with 1,042 knee osteoarthritis patients and 1,121 matched controls reported that the adjusted odds ratio for knee osteoarthritis in patients with BMI >30 was 7.48 with 95% CI of 5.45-10.27. Recent prospective studies demonstrate obesity as a primary risk factor for incident knee osteoarthritis. The potential mechanisms to link obesity and knee osteoarthritis, as both a biomechanical and metabolic condition are strongly linked. It has been established that weight loss for obese patients with knee osteoarthritis is clinically beneficial, for pain reduction, and for improved function. The exact mechanism linking obesity and osteoarthritis is complex; however, it is our opinion that further evidence supporting the link between the two diseases will be useful in providing clinicians and researchers with targets for physical therapy and pharmacological management of obese patients with knee osteoarthritis.

Osteoarthritis of the knees in the COPCORD world

This paper examines and summarizes data on knee osteoarthritis (AO) in Community Oriented Program For Control Of Rheumatic Disorders (COPCORD) publications. A literature search was made through PubMed, Google, Proceedings of Asia-Pacific League of Associations for Rheumatology (APLAR) congresses, and Abstracts from APLAR congresses. Data were compiled to examine the prevalence of knee OA and knee pain, sex ratio, urban/rural differences and other risk factors. Data on knee pain and OA were available in a total of 36 COPCORD publications. The pooled prevalence of knee OA was 7.9% in adults above the age of 15 years. It was more common in women. Overweight, squatting and cycling appeared to be modifiable risk factors for knee OA. OA of the knee is the commonest rheumatic disease in studied communities. Further research is needed for identification of its modifiable risk factors and development of strategies for reduction of the community burden of this malady.

Prevalence and associated factors of knee osteoarthritis in a community-based population in Heilongjiang, Northeast China

Few data exist concerning the prevalence of knee OA and associated factors in Northeast China. This study was undertaken to estimate the prevalence of radiographic and symptomatic knee OA among community residents and to elucidate relevant risk factors. Unmatched case-control study was adopted to study risk factors of knee OA. Radiographic OA was evaluated according to the Kellgren and Lawrence grading scheme. Statistical analyses included tests and logistic model regressions. A total of 1,196 people aged 40-84 years participated in the community-based health survey in Northeast China in 2005. Survey participants completed an interviewer-based questionnaire. The standardized prevalence of symptomatic knee OA was 16.05% and it was significantly higher in women than in men (19.87% vs. 11.91%, = 13.76, P < 0.001). There was also an increased tendency with age in both sex (men: x (2) = 29.67, P (trend) < 0.001; women: x (2) = 40.26, P (trend) < 0.001). The prevalence of symptomatic knee OA was significantly higher than that in Beijing and Shantou, while lower than that in Wuchuan county of inner Mongolia with nonsignificant difference. Logistic regressions revealed that age, sex, BMI, and work status might be risk factors for knee OA in urban residents, whereas age, BMI, and smoking habits might be risk factors in rural dwellers. Symptomatic knee OA is extremely common with preponderance for elderly women and constitutes a major public health problem. The findings will be useful to guide the distribution of future health care resources and preventive strategies.

Factors associated with radiographic osteoarthritis of the knee among community-dwelling Japanese women: the Hizen-Oshima Study

BackgroundOsteoarthritis (OA) of the knee is the most common form of arthritis and is a major contributor to functional impairment and reduced independence in older adults. In Japan, knee OA is a frequent cause of pain and disability, but few epidemiological studies have examined the demographic or lifestyle factors that influence OA of the knee. We examine the risk factors for OA of the knee among Japanese community-dwelling women aged 40–89 years (mean age 64.2, SD 9.6 years). MethodsAnteroposterior weight-bearing knee radiographs were graded according to the criteria described by Kellgren-Lawrence (K/L). We defined knee OA as a K/L grade of 2 or higher (using a 0–4 scale) based on the plain radiographs. History of knee injury, type of occupation, and daily intake of antioxidant nutrients including vitamin C and carotene were obtained from questionnaires. ResultsAmong the 582 subjects, 195 women (33.5%) suffered from knee OA. Logistic regression analysis showed that older age [odds ratio (OR) 1.8, 95% confidence interval (95% CI) 1.6–2.1 per 5-year increase], higher body mass index (OR 2.2, 95% CI 1.7–3.0 per 5-unit increase) and previous knee injury (OR 3.1, 95% CI 1.7–5.6) were associated with knee OA. The occupation of farming and intake of antioxidant nutrients were not associated with knee OA. ConclusionOlder age, obesity and previous knee injury represent independent risk factors for knee OA among Japanese women.

The relationship between body composition and structural changes at the knee

Obesity is an important risk factor for knee OA. Evidence suggests that fat and muscle have differential effects on the pathogenesis of disease. The aim of this study was to examine the relationship between body composition and knee structure, including knee cartilage volume, defects and bone marrow lesions (BMLs). A total of 153 subjects aged 25-60 years, 81% females, were recruited across a range of BMI (18-55 kg/m2) for a study examining the relationship between obesity and musculoskeletal disease. MRI was performed of the dominant knee. Cartilage volume, defects and BMLs were measured using validated methods. Body composition was measured using dual X-ray absorptiometry. There was an 81 (95% CI: 69, 94) mm3 increase in cartilage volume for every 1 kg increase in skeletal muscle mass. Fat mass was not significantly associated with cartilage volume. Fat mass, but not skeletal muscle mass, was a risk factor for cartilage defects and BMLs. For every 1 kg increase in total body fat there was an increased risk of cartilage defects (OR=1.31, 95% CI: 1.04, 1.64) and BMLs (OR=1.09, 95% CI: 1.01, 1.18). In this relatively healthy population, fat mass was associated with increased cartilage defects and BMLs, which are features of early knee OA. In contrast, skeletal muscle mass was positively associated with cartilage volume, which may be due to coinheritance, a commonality of environmental factors associated with cartilage accrual or a protective effect of increased muscle.

61 THE KNEE PAIN MAP: THE RELIABILITY AND REPRODUCIBILITY OF ASSESSING KNEE PAIN LOCALIZATION AND PATTERNS IN PARTICIPANTS FROM THE OSTEOARTHRITIS INITIATIVE

62 – Table 1 OA definitions Hypermobility Non-Hypermobility Odds 95% CI (% OA affected) (% OA affected) Ratio* Hand: Modified ACR criteria 2.6% 15.4% 0.15 0.02–1.12 Hand: Gogo criteria 2.6% 17.8% 0.12 0.02–0.94 Hand: Any single joint involvement by examination 18.4% 42.9% 0.30 0.30–0.71 Knee: ACR criteria 11.1% 34.4% 0.24 0.67–0.85 *Odds of OA compoaring hypermobility to non-hypermobility group; Hand OA data available for n=287; Knee OA data available for n=120. Conclusions: We have successfully demonstrated a system to identify and record the localization and pattern of pain in knee OA with excellent reliability. Knee pain was most often described as localized, with the medial and lateral joint lines as the most commonly reported zones. Only a small minority of patients reported diffuse pain or were unable to localize their knee pain. Additional studies are needed to determine if specific knee pain patterns or locations correlate with known risk factors for knee OA or with areas of pathologic changes seen on x-rays or MRIs in patients with knee OA.

Osteoarthritis of the knee and hip and activity: a systematic international review and synthesis (OASIS)

The goal of this study was to determine which activities in four domains, daily life, exercises, sports and occupational activities, should be recommended, in favor or against, for the patient suffering from knee or hip OA. Methods Scientific literature was searched in Medline, Embase and Cochrane databases for articles in French or English, reporting original data. The articles were evaluated with standardized epidemiological criteria. Seventy-two articles were retained. Recommendations were graded according to the level of scientific evidence (A high, B moderate, C clinical consensus) and were formulated for primary care. Conclusions and recommendations For activity of daily life (ADL), the OASIS group states with a moderate level of scientific evidence, that ADL are a risk factor for knee OA and that risk increases with intensity and duration of activity. The group concludes that healthy subjects as well as OA patients in general can pursue a high level of physical activity, provided the activity is not painful and does not predispose to trauma (grade B). Radiographic or clinical OA is not a contraindication to promoting activity in patients who have a sedentary lifestyle (grade C). For exercises and other structured activities pursued with a goal of health improvement, the group states with a high level of scientific evidence that they have a favourable effect on pain and function in the sedentary knee OA patient. The OASIS group recommends the practice of exercises and other structured activities for the sedentary patient with knee OA (grade A). Static exercises are not favored over dynamic exercises, availability, preference and tolerance being the criteria for the choice of an exercise (grade A). As results deteriorate when exercises are stopped, they should be performed at a frequency of between one and three times per week (grade B). Professional assistance can be useful in improving initial compliance and perseverance (grade B). There is no scientific argument to support halting exercise in case of an OA flare-up (grade C). For sports and recreational activity, the group states with a high degree of scientific evidence, that these activities are a risk factor for knee and hip OA and that the risk correlates with intensity and duration of exposure. The group also states, with a high degree of scientific evidence, that the risk of OA associated with sport is lesser than that associated with a history of trauma and overweight. No firm conclusion could be drawn about the possible protective role of sports such as cycling, swimming or golf. The OASIS group recommends that athletes should be informed that joint trauma is a greater risk factor than the practice of sport (Grade A). The high level athlete should be informed that the risk of OA is associated with the duration and intensity of exposure (Grade B). The OA patient can continue to engage regularly in recreational sports as long as the activity does not cause pain (Grade C). The OA patient who practices a sport at risk for joint trauma should be encouraged to change sport (Grade C). For occupational activity, the OASIS group states with a high level of scientific evidence that there is a relationship between occupational activity and OA of the knee and hip. The precise nature of biomechanical stresses leading to OA remains unclear but factors such as high loads on the joint, unnatural body position, heavy lifting, climbing and jumping may contribute to knee and hip OA. The group recommends that taking an occupational history should always be part of managing the OA patient (Grade B). In the knee or hip OA patient, work-related activity that produces or maintains pain should be avoided (Grade B). Physicians should be alerted by the early knee and hip signs and symptoms in workers exposed to stresses that are known or supposed to favour knee or hip OA (Grade C).