Does the impact of osteoarthritis vary by age, gender and social deprivation? A community study using the International Classification of Functioning, Disability and Health

Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics

OBJECTIVE

Women have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics.

METHODS

PubMed database was used with the title keyword combinations "{gender OR sex} AND osteoarthritis" plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 that were reviewed for appropriateness.

RESULTS

Globally, women account for 60% of people with osteoarthritis with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions.

CONCLUSIONS

The recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.

Factors associated with social participation and community ambulation in people with osteoarthritis: Findings from the Canadian Longitudinal Study on Aging

AIM

Walking in the community allows participation in meaningful activities which positively influences self-rated health and quality of life. Our objective was to identify factors associated with social participation and community ambulation in a representative sample of Canadian adults with osteoarthritis (OA).

METHODS

Data were from >3800 participants in the Baseline Tracking Dataset of the Canadian Longitudinal Study on Aging with OA of the hip and/or knee. Outcomes included frequency of participation in 8 community-based activities (past year, social participation), and frequency walking outside the home (past 7 days, community ambulation). Explanatory variables (15 for social participation, 11 for community ambulation) established in previous literature were evaluated. Variables significant in univariate binary logistic regression models were entered into multivariable models.

RESULTS

Frequency of social participation was greater for females, and individuals with higher levels of education. Those who were younger, dissatisfied with life, and had difficulty walking 2-3 blocks were less likely to participate. Having fewer chronic conditions, being younger, being single/widowed and being interviewed in spring/summer were associated with more frequent ambulation. Lower self-rated health, difficulty walking 2-3 blocks, pain and being female were associated with less frequent walking outside the home.

CONCLUSION

Many factors influence frequency of social participation and community ambulation. The ability to walk short distances is positively associated with both outcomes. This important factor can and should be addressed clinically to improve health and quality of life in people with OA.

Do the WHO-ICF personal factors "age" and "sex" impact limited activity and restricted participation category profiles differently between younger and older women and men in multimodal chronic back pain rehabilitation?

PURPOSE

To investigate if the International Classification of Functioning and Health (ICF) context factors "age" and "sex" would impact the disablement and respective improvement with rehabilitation defined with the ICF core set for chronic low back pain (cLBP). Furthermore, associations between limitations/restrictions and measures of body function or quality of life were of interest.

MATERIALS AND METHODS

One thousand five hundred and twelve employed cLBP patients who completed 6 months of outpatient rehabilitation and for whom complete assessments were available before and after rehabilitation. Rehabilitation comprised of progressive resistance training, psychological counseling, and educational sessions. Main outcome measures were the ICF-activity/participation core categories automatically predicted from random forests and utilizing information from the Roland Morris Disability Questionnaire and Pain Disability Index.

RESULTS

Generalized linear-mixed models revealed that upon completion of rehabilitation the presence of a limitation within the ICF activity "walking" significantly decreased with significant between-group differences. The category "doing housework" demonstrated gender-specific differences, and both gender- and age-specific differences were observed for work-related participation categories. There were no meaningful associations between ICF limitation/restriction categories and body function measures (point-biserial/Spearman's correlations).

CONCLUSIONS

The personal factors "age" and "sex" impact some ICF limitation/restriction categories in cLBP; appropriately addressing these personal features could further improve phase III rehabilitation outcome.Implications for rehabilitationConsistent with calls to explore the age and sex/gender influence on health and disease, little is known how these factors affect the disablement of individuals with chronic back pain.The factors "age" and "sex" drive differences in some categories within the ICF activity/restriction categories.If age- and gender-specific features in activities and participation are not appropriately addressed through interventions, rehabilitation outcome may remain suboptimal in cLBP.

Interrelations between factors related to physical activity in inactive adults with knee pain

PURPOSE

The purpose was to explore interrelations between factors related to engagement in physical activity in inactive adults with knee pain.

METHOD

Inactive adults with knee pain (n = 35) participated in six focus groups designed to inquire about barriers and facilitators related with engagement in physical activity. Directed content analysis and inductive thematic analysis were used to identify factors related to physical activity and associated interrelations respectively. As an exploratory analysis, sex differences in barriers and facilitators to physical activity were assessed.

RESULTS

In this cohort (age = 60.9 ± 8.6 years; 22 females), self-reported physical activity was 26.3 ± 46.8 min/week. Factors related to physical activity were grouped into domains of physical status, psychological status, environment, knowledge, and resources. It was seen that the interrelations between a person and their environment, as well as, between impairments and everyday responsibilities influenced engagement in physical activity. Females were more likely to identify physical and psychological status, social expectations, and lack of knowledge as barriers. Males indicated a preference for using mobile technologies to overcome barriers.

CONCLUSION

Interplay of various barriers and facilitators is related to engagement in physical activity in inactive older adults with knee pain. Interventions to promote physical activity should address these interrelations and sex differences.Implications for rehabilitationInterrelations between individual factors related to engagement in physical activity and sex differences in these factors are present in inactive adults with knee pain.Interventions to improve physical activity should be implemented by addressing factors and interrelations between factors related to physical activity in inactive adults with knee pain.Interventions to address low levels of physical activity in adults with knee pain should take into account sex differences.

Impact of osteoarthritis on activities of daily living: does joint site matter?

Background

We consider the relationships between a clinical and radiological diagnosis of knee or hip OA and activities of daily-living (ADL) in older adults.

Methods

Data were available for 222 men and 221 women from the Hertfordshire Cohort Study (HCS) who also participated in the UK component of the European Project on Osteoarthritis (EPOSA). Participants completed the EuroQoL survey where they reported if they had difficulties with mobility, self-care, usual activities and movement around their house. Hip and knee radiographs were graded for overall Kellgren and Lawrence score (positive definition defined as a 2 or above). Clinical OA was defined using American College of Rheumatology criteria.

Results

In men, a clinical diagnosis of hip or knee OA were both associated with reported difficulties in mobility, ability to self-care and performing usual-activities (hip OA: OR 17.6, 95% CI 2.07, 149, p = 0.009; OR 12.5, 95% CI 2.51, 62.3, p = 0.002; OR 4.92, 95% CI 1.06, 22.8, p = 0.042 respectively. Knee OA: OR 8.18, 95% CI 3.32, 20.2, p < 0.001; OR 4.29, 95% CI 1.34, 13.7, p = 0.014; OR 5.32, 95% CI 2.26, 12.5, p < 0.001 respectively). Similar relationships were seen in women, where in addition, a radiological diagnosis of knee OA was associated with difficulties performing usual activities (OR 3.25, 95% CI 1.61, 6.54, p = 0.001). In general, men with OA reported stronger associations between moving around the house, specifically around the kitchen (clinical hip OA: OR 13.7, 95% CI 2.20, 85.6, p = 0.005; clinical knee OA OR 8.45, 95% CI 1.97, 36.2, p = 0.004) than women.

Discussion and conclusion

Clinical OA is strongly related to the ability to undertake ADL in older adults and should be considered in clinic consultations when seeing patients with OA.