Risk factors for knee osteoarthritis in Japanese men: a case-control study

Men and Women's Occupational Activities and the Risk of Developing Osteoarthritis of the Knee, Hip, or Hands: A Systematic Review and Recommendations for Future Research

Objective

To systematically review the evidence for an increased risk of osteoarthritis in the hip, knee, hand, wrist, finger, ankle, foot, shoulder, neck, and spine related to diverse occupational activities of men and women and to examine dose‐response information related to the frequency, intensity, and duration of work exposures and the risk of osteoarthritis (OA).

Methods

Established guidelines for systematic reviews in occupational health and safety studies were followed. MEDLINE, Embase, CINAHL, and Cochrane Library were searched from inception to December 2017. Studies were reviewed for relevance, quality was appraised, and data were extracted and synthesized.

Results

Sixty‐nine studies from 23 countries yielded strong and moderate evidence for lifting, cumulative physical loads, full‐body vibration, and kneeling/squatting/bending as increasing the risks of developing OA in men and women. Strong and moderate evidence existed for no increased risk of OA related to sitting, standing, and walking (hip and knee OA), lifting and carrying (knee OA), climbing ladders (knee OA), driving (knee OA), and highly repetitive tasks (hand OA). Variability in dose‐response data resulted in an inability to synthesize these data.

Conclusion

Evidence points to the potential for OA occupational recommendations and practice considerations to be developed for women and men. However, research attention is needed to overcome deficits in the measurement and recall of specific work activities so that recommendations and practice considerations can provide the specificity needed to be adopted in workplaces.

Risk factors of knee osteoarthritis: A case-control study

Background and Objective

Knee osteoarthritis is one of the most common rheumatologic problems. To investigate risk factors related to the knee osteoarthritis a case-control study was performed using cases diagnosed in the Community Oriented Program for Control of Rheumatic Diseases (COPCORD) study, stage I.

Methods

Using data from the 2012 COPCORD study, stage-I that was conducted in Sanandaj, northwestern of Iran, we runned a case-control study in 2014-2015. Cases were 700 knee osteoarthritis using American College of Rheumatology (ACR) criteria, frequency matched with 700 healthy controls that were randomly selected from the general population.

Results

In multivariate analysis, statistical significant relation was observed between knee OA and some studied factors such as body mass index (P <0.001), lodging (living in highland vs. plain) (P <0.001), type of used toilet (regular vs. toilet) (P <0.001), history of using high-heeled shoes (>3 cm) (P = 0.005), history of knee Injury (P = 0.04), history of lower limb fracture (P = 0.02), Number of pregnancies (P <0.001) and history of pain and swelling (lasting for one months) (P = 0.04).

Conclusions

Living in highland area, using regular toilet, having knee injury and lower limb fracture in the past were most significant associated factors with occurrence of knee osteoarthritis.

Factory and construction work is associated with an increased risk of severe lumbar spinal stenosis on MRI: A case control analysis within the wakayama spine study

BACKGROUND

To explore the association of MRI-diagnosed severe lumbar spinal stenosis with occupation.

METHODS

Occupational data were collected by questionnaire and all participants underwent spine MRI scans using the same protocol. Central lumbar spinal stenosis (LSS) was graded qualitatively. Those with severe LSS (>two-thirds narrowing) were compared with the controls with lesser degrees of stenosis or no stenosis.

RESULTS

Data were available for 722 subjects, mean age 70.1 years. 239 (33%) cases with severe LSS were identified. Factory/construction workers had an almost four-fold increased risk of severe LSS after adjustment for age, sex, smoking, and walking speed amongst those aged <75 years (OR 3.97, 95%CI 1.46-10.85). Severe LSS was also associated with squatting ≥1 h/day (OR 1.76, 95%CI 1.01-3.07) but this association became non-significant after adjustment.

CONCLUSION

Further research is needed but this study adds more evidence that occupational factors are associated with an increased risk and/or severity of degenerative disease of the lumbar spine.

Knee pain in nursing home workers after implementation of a safe resident handling program

PURPOSE

Approximately 25-30% of nursing personnel experience knee pain (KP). We sought to identify physical and psychosocial work exposures, and personal factors related to prevalent, incident, and persistent KP 5-8 years after safe resident handing program (SRHP) implementation in nursing homes.

METHODS

Health and exposure information was obtained from worker surveys 5-6 years ("F5") and 7-8 years ("F6") post-SRHP implementation. Prevalent KP correlates were examined at F5; persistent and incident KP predictors were analyzed at F6, utilizing robust Poisson multivariable regression.

RESULTS

F5 KP prevalence (19.7%) was associated with combined physical exposures, and with either high job strain or low social support, in separate models. Two-year persistent KP was similarly associated with these psychosocial exposures. Being overweight was associated with KP in all analyses.

CONCLUSIONS

The SRHP program did not eliminate knee physical loading, which should be reduced to prevent nursing home worker KP. Workplace psychosocial exposures (high job strain, low social support) also appeared germane.

Occupational Exposure to Knee Loading and the Risk of Osteoarthritis of the Knee: A Systematic Review and a Dose-Response Meta-Analysis

BACKGROUND

Osteoarthritis of the knee is considered to be related to knee straining activities at work. The objective of this review is to assess the exposure dose-response relation between kneeling or squatting, lifting, and climbing stairs at work, and knee osteoarthritis.

METHODS

We included cohort and case-control studies. For each study that reported enough data, we calculated the odds ratio (OR) per 5,000 hours of cumulative kneeling and per 100,000 kg of cumulative lifting. We pooled these incremental ORs in a random effects meta-analysis.

RESULTS

We included 15 studies (2 cohort and 13 case-control studies) of which nine assessed risks in more than two exposure categories. We considered all but one study at high risk of bias. The incremental OR per 5,000 hours of kneeling was 1.26 (95% confidence interval 1.17-1.35, 5 studies, moderate quality evidence) for a log-linear exposure dose-response model. For lifting, there was no exposure dose-response per 100,000 kg of lifetime lifting (OR 1.00, 95% confidence interval 1.00-1.01). For climbing, an exposure dose-response could not be calculated.

CONCLUSION

There is moderate quality evidence that longer cumulative exposure to kneeling or squatting at work leads to a higher risk of osteoarthritis of the knee. For other exposure, there was no exposure dose-response or there were insufficient data to establish this. More reliable exposure measurements would increase the quality of the evidence.

Occupational and genetic risk factors for osteoarthritis: a review

BACKGROUND

Osteoarthritis (OA) is a multifactorial disease with strong genetic and occupational components. Although published studies have described several risk factors for OA, very few studies have investigated the occupational and genetic factors that contribute to this debilitating condition.

OBJECTIVE

To describe occupational and genetic factors that may contribute to the risk of developing (OA).

METHODS

A literature search was conducted in PubMed using the search terms osteoarthritis, occupation, work, and genetics.

RESULTS

Heavy physical work load was the most common occupational risk factor for OA in several anatomical locations. Other factors include kneeling and regular stair climbing, crawling, bending and whole body vibration, and repetitive movements. Numerous studies have also shown the influence of genetic variability in the pathogenesis of OA. Genetic variants of several groups of genes e.g., cartilage extracellular matrix structural genes and the genes related to bone density have been implicated in disease pathogenesis.

CONCLUSION

This review shows that occupational factors were extensively studied in knee OA unlike OA of other anatomical regions. Although genetic association studies performed to date identified a number of risk variants, some of these associations have not been consistently replicated across different studies and populations. Therefore, more research is needed.

Occupational physical loading tasks and knee osteoarthritis: a review of the evidence

Purpose : To perform a systematic review with best evidence synthesis examining the literature on the relationship between occupational loading tasks and knee osteoarthritis (OA).

METHODS

Two databases were searched to identify articles published between 1946 and April, 2011. Eligible studies were those that (1) included adults reporting on their employment history; (2) measured individuals' exposure to work-related activities with heavy loading in the knee joint; and (3) identified presence of knee OA (determined by X-ray), cartilage defects associated with knee OA (identified by magnetic resonance imaging), or joint replacement surgery.

RESULTS

A total of 32 articles from 31 studies met the inclusion criteria. We found moderate evidence that combined heavy lifting and kneeling is a risk factor for knee OA, with odds ratios (OR) varying from 1.8 to 7.9, and limited evidence for heavy lifting (OR=1.4-7.3), kneeling (OR=1.5-6.9), stair climbing (OR=1.6-5.1), and occupational groups (OR=1.4-4.7) as risk factors. When examined by sex, moderate level evidence of knee OA was found in men; however, the evidence in women was limited.

CONCLUSIONS

Further high-quality prospective studies are warranted to provide further evidence on the role of occupational loading tasks in knee OA, particularly in women.

Investigation of the biomechanical effect of variable stiffness shoe on external knee adduction moment in various dynamic exercises

Background

The growing ageing population and high prevalence of knee osteoarthritis (OA) in athletes across nations have created a strong demand for improved non-invasive therapeutic alternatives for knee OA. The aim of this study is to investigate the effect of the variable stiffness shoe (VSS), a new non-invasive therapeutic approach, on external knee adduction moment (EKAM) in various dynamic exercises. EKAM is believed to have positive correlation with the progression and development of knee OA.

Methods

Thirty young participants (16 male and 14 female; age 22.6 ± 1.9 years) from National University of Singapore were enrolled in this study. The tested activities were walking, running, drop-landing, and lateral hopping. All the dynamic exercises were recorded simultaneously by the 8-camera VICON Motion Systems (Oxford Metric, UK) with a sampling rate of 100 Hz.

Results

The results showed that the EKAM was reduced in all the dynamic exercises with the use of VSS. The VSS produced significant reductions in the peak EKAM during walking (4.97%, p = 0.039), running (11.15%, p = 0.011), drop-landing (11.18%, p = 0.038) and lateral hopping (17.34%, p = 0.023) as compared to the control shoe.

Conclusions

The reduction of EKAM with the use of VSS in various dynamic exercises demonstrates its potential in delaying the onset and the progression of knee OA in early stage of knee OA patients.

Occupational activities and osteoarthritis of the knee

BACKGROUND

The prevalence of knee osteoarthritis (OA) is rising and the search for interventions to mitigate risk is intensifying. This review considers the contribution of occupational activities to disease occurrence and the lessons for prevention.

SOURCES

Systematic search in Embase and Medline covering the period 1996 to November 2011.

AREAS OF AGREEMENT

Reasonably good evidence exists that physical work activities (especially kneeling, squatting, lifting and climbing) can cause and/or aggravate knee OA. These exposures should be reduced where possible. Obese workers with such exposures are at additional risk of knee OA and should therefore particularly be encouraged to lose weight. AREAS OF UNCERTAINTY/RESEARCH NEED: Workplace interventions and policies to prevent knee OA have seldom been evaluated. Moreover, their implementation can be problematic. However, the need for research to optimize the design of work in relation to knee OA is pressing, given population trends towards extended working life.

The epidemiology of osteoarthritis in Asia

Worldwide, osteoarthritis (OA) is estimated to be the fourth leading cause of disability. Most of this disability burden is attributable to the involvement of the hips or the knees. OA is strongly associated with ageing and the Asian region is ageing rapidly. Further, OA has been associated with heavy physical occupational activity, a required livelihood for many people living in rural communities in developing countries. Unfortunately, joint replacement surgery, an effective intervention for people with severe OA involving the hips or knees, is inaccessible to most people in these regions. On the other hand, obesity, another major risk factor, may be less prevalent, although it is on the increase. Determining region-specific OA prevalence and risk factor profiles will provide important information for planning future cost-effective preventive strategies and health care services. An update of what is currently known about the prevalence of hip and knee OA from population-based studies conducted in the Asian region is presented in this review. Many of the recent studies have conducted comparisons between urban and rural areas and poor and affluent communities. The results of Asian-based studies evaluating risk factors from population-based cohorts or case-control studies, and the current evidence on OA morbidity burden in Asia is also outlined.

Body mass index and susceptibility to knee osteoarthritis: a systematic review and meta-analysis

OBJECTIVE

Excess bodyweight, expressed as increased body mass index, is associated with osteoarthritis risk, especially in weight bearing joints. However, the strength of the association was inconsistent. The study was conducted to quantitatively assess the association between body mass index and the risk of knee osteoarthritis and investigate the difference of the strength stratified by sex, study type and osteoarthritis definition.

METHODS

We used published guidelines of the Meta-analysis of Observational Studies in Epidemiology Group (MOOSE) to perform the meta-analysis. The search strategy employed included computerized bibliographic searches of MEDLINE, PubMed, EMBASE, The Cochran Library and references of published manuscripts. Study-specific incremental estimates were standardized to determine the risk of knee osteoarthritis associated with a 5 kg/m(2) increase in BMI.

RESULTS

Twenty-one studies were included in the study. The results showed that body mass index was significantly positive associated with osteoarthritis risk in knee site. A 5-unit increase in body mass index was associated with an 35% increased risk of knee osteoarthritis (RR: 1.35; 95%CI: 1.21, 1.51). Magnitude of the association was significantly stronger in women than that in men with significant difference (men, RR: 1.22; 95%CI: 1.19, 1.25; women, RR: 1.38; 95%CI: 1.23, 1.54; p=0.04). The summary effect size was 1.25(95%CI: 1.18, 1.32) in case-control studies and 1.37 (95%CI: 1.19, 1.56) in cohort studies (p=0.28). Body mass index was positively associated with knee osteoarthritis defined by radiography and/or clinical symptom (RR: 1.25, 95%CI: 1.17, 1.35) and clinical surgery (RR: 1.54, 95%CI: 1.29, 1.83). The latter tended to be stronger than the former (p<0.01).

CONCLUSION

Increased body mass index contribute to a substantially increased risk of knee OA. The magnitude of the association varies by sex and OA definition.

Risk factors for the incidence and progression of radiographic osteoarthritis of the knee among Japanese

This longitudinal study aimed to identify risk factors for the incidence and progression of radiographic knee osteoarthritis (OA). We examined the inhabitants of Miyagawa village aged ≥ 65 years every two years between 1997 and 2007. Anteroposterior radiographs of both knees were graded for OA using the Kellgren-Lawrence (K/L) grading system. Knee OA was defined as grade ≥ 2. We recorded the incidence of knee OA among participants in whom both knees changed from K/L grades 0 or 1 to ≥ 2 over a four-year follow-up period. We also recorded the progression of knee OA using this threshold among patients in whom one or both knees changed from K/L grades 2 or 3 to any higher grade over the follow-up period. Baseline data obtained from standard questionnaires, physical findings and X-rays included age, gender, body mass index (BMI), osteoporosis, Heberden's nodes, knee range of motion (ROM), knee pain and cigarette smoking. The rates of incidence and progression of knee OA among 360 participants (241 women, 119 men) who fulfilled the study criteria were 4.0 and 6.0% per year, respectively. Female gender (odds ratio [OR] 2.849, 95% confidence interval [CI] 1.170-6.944) and high BMI (OR 1.243, 95% CI 1.095-1.411) were significantly associated with the incidence of knee OA, and restricted knee ROM (OR 0.941, 95% CI 0.892-0.992) was significantly associated with knee OA progression. Patients with a low knee ROM relative to grade of radiographic knee OA require more careful follow-up than those with a higher ROM.