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Golightly YM, Renner JB, Helmick CG, Jordan JM, Nelson AE. Looking back on 30+ years of the Johnston County Osteoarthritis Project while looking forward with the Johnston County Health Study: A narrative review. Osteoarthritis Cartilage 2024; 32:430-438. [PMID: 38237761 DOI: 10.1016/j.joca.2024.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/29/2023] [Accepted: 01/08/2024] [Indexed: 01/22/2024]
Abstract
Over the last 30 years, knowledge of the epidemiology of osteoarthritis (OA) has dramatically advanced, and Osteoarthritis and Cartilage has been on the forefront of disseminating research findings from large OA cohort studies, including the Johnston County OA Project (JoCoOA). The JoCoOA is a population-based, prospective longitudinal cohort that began roughly 30 years ago with a key focus on understanding prevalence, incidence, and progression of OA, as well as its risk factors, in a predominantly rural population of Black and White adults 45+ years old in a county in the southeastern United States. Selected OA results that will be discussed in this review include racial differences, lifetime risk, biomarkers, mortality, and OA risk factors. The new Johnston County Health Study will also be introduced. This new cohort study of OA and comorbid conditions builds upon current OA knowledge and JoCoOA infrastructure and is designed to reflect changes in demographics and urbanization in the county and the region.
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Affiliation(s)
- Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA.
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | | | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Novin S, Alvarez C, Renner JB, Golightly YM, Nelson AE. Features of Knee and Multijoint Osteoarthritis by Sex and Race and Ethnicity: A Preliminary Analysis in the Johnston County Health Study. J Rheumatol 2023; 51:jrheum.2023-0479. [PMID: 37714542 PMCID: PMC10940227 DOI: 10.3899/jrheum.2023-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To evaluate knee osteoarthritis (KOA) and multijoint osteoarthritis (MJOA), and to compare features by sex and race and ethnicity in a population-based cohort. METHODS Participants (n = 544) enrolled in the Johnston County Health Study (JoCoHS) as of January 2023 were categorized by radiographic and symptomatic KOA and MJOA phenotypes, and frequencies were compared by sex and race and ethnicity. Symptoms were assessed according to the Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain, aching, and stiffness (PAS) scores at various joints. Models produced estimates (odds ratio [OR] or mean ratios [MR] and 95% CI) adjusted for age, BMI (kg/m2), and education. RESULTS Men had twice the odds of having MJOA-6 (≥ 3 lower extremity joints affected); there were no significant differences in MJOA phenotypes by race and ethnicity. Women had 50% higher odds of having KOA or having various features of KOA. Women reported significantly worse KOOS Symptoms scores (MR 1.25). Black participants had higher odds of more severe KOA (OR 1.47), subchondral sclerosis (OR 2.06), and medial tibial osteophytes (OR 1.50). Black participants reported worse KOOS Symptoms than White participants (MR 1.18). Although not statistically significant, Hispanic participants (vs non-Hispanic participants) appeared to have lower odds of radiographic changes but reported worse symptoms. CONCLUSION Preliminary findings in the diverse JoCoHS cohort suggest more lower extremity- predominant MJOA in men compared to women. Women and Black participants had more KOA features and more severe symptoms. Hispanic participants appear to have higher pain and symptoms scores despite having fewer structural changes. Studies in diverse populations are needed to understand the burden of OA.
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Affiliation(s)
- Sherwin Novin
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Subbu K, Renner JB, Rubin JE. Extensive Osteonecrosis After Glucocorticoids: Clinical Response to Bisphosphonate. JCEM Case Rep 2023; 1:luac006. [PMID: 37908238 PMCID: PMC10578391 DOI: 10.1210/jcemcr/luac006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Indexed: 11/02/2023]
Abstract
Osteonecrosis is a devastating complication of long-term glucocorticoid therapy that has been described in both malignant and nonmalignant diseases. Its incidence has been found to greater than 50% using magnetic resonance imaging in asymptomatic patients, thus osteonecrosis is likely underdiagnosed. Recent studies have suggested that treatment with bisphosphonates can improve pain and mobility and decrease bone marrow edema. We describe a patient with acute lymphoblastic leukemia who presented with debilitating osteonecrosis after treatment with prednisone for a total cumulative dose of 5100 mg. Magnetic resonance imaging revealed extensive infarcts of her bilateral tibiae and femora and left humerus, talus, and calcaneus consistent with osteonecrosis that had persisted for more than 2 years. Her severe knee, shoulder, and ankle pain was treated with 1 dose zolendronic acid. Despite a prolonged acute phase reaction, the patient's symptoms improved with near total resolution of pain.
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Affiliation(s)
- Karthik Subbu
- Division of Endocrinology, Diabetes, and Metabolism, University of North Carolina, NC 27514, USA
| | - Jordan B Renner
- Departments of Radiology and Health Sciences, University of North Carolina, NC 27514, USA
| | - Janet E Rubin
- Division of Endocrinology, Diabetes, and Metabolism, University of North Carolina, NC 27514, USA
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Golightly YM, Shiue KY, Nocera M, Guermazi A, Cantrell J, Renner JB, Padua DA, Cameron KL, Svoboda SJ, Jordan JM, Loeser RF, Kraus VB, Lohmander LS, Beutler AI, Marshall SW. Association of Traumatic Knee Injury With Radiographic Evidence of Knee Osteoarthritis in Military Officers. Arthritis Care Res (Hoboken) 2022. [PMID: 36530032 DOI: 10.1002/acr.25072] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 11/03/2022] [Accepted: 12/13/2022] [Indexed: 12/23/2022]
Abstract
OBJECTIVE The association between knee injury and knee osteoarthritis (OA) is understudied relative to its importance, particularly in younger populations. This study was undertaken to examine the association of knee injury with radiographic features of knee OA in military officers, who have a physically demanding profession and high rates of knee injury. METHODS Participants were recruited in 2015-2017 from an existing program that enrolled 6,452 military officers during 2004-2009. Officers with a history of knee ligament or meniscal injuries (n = 117 via medical record review) were compared to officers with no history of knee injury (n = 143). Bilateral posteroanterior knee radiographs were obtained using a standardized fixed-flexion positioning frame. All images were read for Kellgren/Lawrence (K/L) grade, osteophyte (OST), and joint space narrowing (JSN) scores. Data were analyzed using linear-risk regression models with generalized estimating equations. RESULTS Injured and noninjured participants were similar (mean age 28 years, mean body mass index 25 kg/m2 , ~40% female). The mean time from first knee injury to imaging among injured participants was 9.2 years. Compared with noninjured knees, greater prevalence of radiographic OA (K/L grade ≥ 2), OST (grade ≥ 1), and JSN (grade ≥ 1) was observed among injured knees, with prevalence differences of +16% (95% confidence interval [95% CI] 10%, 22%), +29% (95% CI 20%, 38%), and + 17% (95% CI 10%, 24%), respectively. Approximately 1 in 6 officers with prior knee injury progressed to radiographic OA by age 30 years. CONCLUSION At the midpoint of a projected 20-year military career, officers with a history of traumatic knee injury have a markedly increased prevalence of knee radiographic OA compared to officers without injury.
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Affiliation(s)
- Yvonne M Golightly
- University of North Carolina, Chapel Hill, and University of Nebraska Medical Center, Omaha
| | | | | | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | - Kenneth L Cameron
- Keller Army Hospital, West Point, New York, and Uniformed Services University, Bethesda, Maryland
| | | | | | | | | | | | - Anthony I Beutler
- Uniformed Services University, Bethesda, Maryland, and Intermountain Healthcare, Salt Lake City, Utah
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Nelson AE, Smith JA, Alvarez C, Arbeeva L, Renner JB, Murphy LB, Jordan JM, Golightly YM, Duryea J. Associations Between Baseline and Longitudinal Semiautomated Quantitative Joint Space Width at the Hip and Incident Hip Osteoarthritis: Data From a Community-Based Cohort. Arthritis Care Res (Hoboken) 2022; 74:1978-1988. [PMID: 34219398 PMCID: PMC8727661 DOI: 10.1002/acr.24742] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2021] [Revised: 06/17/2021] [Accepted: 07/01/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To evaluate quantitative joint space width (JSW) at 10-, 30-, and 50-degree locations in relation to incident radiographic and symptomatic hip osteoarthritis (HOA) in a community-based cohort. METHODS Data were from Johnston County OA Project participants with supine hip radiographs at each of 4 time points; all had Kellgren/Lawrence (K/L) grades and quantitative JSW. We assessed covariates (age, race, height, weight, body mass index [BMI]) associated with quantitative JSW and hip-level associations between quantitative JSW and HOA over time using sex-stratified and multivariable-adjusted linear mixed models. A cluster analysis with logistic regression estimated associations between quantitative JSW trajectory groups and incident radiographic HOA and symptomatic HOA. RESULTS At baseline, 397 participants (784 hips, 41% men, 24% Black, mean age 57 years) had a mean BMI of 29 kg/m2 . Over a mean of 18 years, 20% and 12% developed incident K/L grade-defined radiographic HOA or symptomatic HOA, respectively. Quantitative JSW was more sensitive to changes over time at 50 degrees. Values were stable among men but declined over time in women. Heavier women lost more quantitative JSW; changes in quantitative JSW were not significantly associated with race, education, or injury in women or men. In women only, loss of quantitative JSW over time was associated with 2-3 times higher odds of radiographic HOA and symptomatic HOA; among women and men, narrower baseline quantitative JSW was associated with these outcomes. CONCLUSION Hip quantitative JSW demonstrates marked differences in respect to sex, with significant loss over time only in women. Loss of quantitative JSW over time in women and narrower baseline quantitative JSW in men and women were associated with incident radiographic HOA and symptomatic HOA.
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Affiliation(s)
- Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jacquelyn A. Smith
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Rheumatology Associates, Louisville, KY
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Liubov Arbeeva
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Louise B. Murphy
- Centers for Disease Control and Prevention, Atlanta, GA; Optum Life Sciences, Inc., Eden Prairie, MN
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC
- Department of Epidemiology-Gillings School of Global Public Health, Injury Prevention Research Center, and Division of Physical Therapy-Department of Allied Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Jeffrey Duryea
- Department of Radiology, Brigham and Women’s Hospital, Boston, MA
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Goode AP, Cleveland RJ, George SZ, Schwartz TA, Kraus VB, Renner JB, Gracely RH, DeFrate LE, Hu D, Jordan JM, Golightly YM. Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2022; 74:1659-1666. [PMID: 33973412 PMCID: PMC8578580 DOI: 10.1002/acr.24643] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). METHODS Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self-reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. RESULTS Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09-2.98]), spine OA (HR 1.56 [95% CI 1.01-2.41]), FOA (HR 4.99 [95% CI 1.46-17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02-3.43]), and LBP (HR 1.75 [95% CI 1.19-2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09-2.09]) and LBP (HR 1.51 [95% CI 1.12-2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44-12.2]). Spine OA (HR 1.80 [95% CI 1.24-2.63]) and OST (HR 1.85 [95% CI 1.02-3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04-1.85]) and OST (HR 1.58 [95% CI 1.00-2.49]) were predictors of LBP worsening. CONCLUSION Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.
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Affiliation(s)
- Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Richard H. Gracely
- Department of Endodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
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Alexander LC, Huebner JL, Cicconetti G, Jordan JM, Renner JB, Doherty M, Wilson AG, Hochberg MC, Loeser R, Kraus VB. Tibiofemoral knee osteoarthritis progresses symmetrically by knee compartment in the GOGO cohort. Osteoarthritis and Cartilage Open 2022; 4. [PMID: 36081777 PMCID: PMC9451142 DOI: 10.1016/j.ocarto.2022.100288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Objective: To evaluate the degree of symmetry of knee osteoarthritis (OA) structural severity and progression of participants with a mean follow-up time of 3.8 years. Design: Participants from the Genetics of Generalized Osteoarthritis (GOGO) study (n = 705) were selected on the basis of radiographic evidence of OA in at least 1 knee, availability of radiographs at baseline and follow-up, and no history of prior knee injury or surgery. Incidence and progression of osteoarthritis were determined by radiographic Kellgren-Lawrence (KL) grade; compartmental OA progression was determined by change in joint space width of lateral and medial tibiofemoral compartments. Total OA progression was the sum of change in KL grade of both knees. Results: Compared with left knees, right knees had more severe KL grades at baseline (p = 0.0002) and follow-up (p = 0.0004), McNemar′s χ2 = 34.16 and 26.08, respectively; however, both knees progressed similarly (p = 0.121, McNemar′s χ2 = 10.09). Compartmental changes were symmetric across knees: medial r = 0.287, p = 0.0002; lateral r = 0.593, p = 0.0002. Change in joint space width in the medial compartment was negatively correlated with change in the lateral compartment of the same knee (left knees: r = −0.293, p = 0.021; right knees: r = −0.195, p = 0.0002). Conclusions: Although right knees tended to have more severe OA at both baseline and follow-up, radiographic progression did not differ by knee and compartmental progression correlated across knees. Given this trend in generalized OA, the risk of progression for both knees should be considered, even if only one knee has radiographic OA at baseline.
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Nelson AE, Hu D, Arbeeva L, Alvarez C, Cleveland RJ, Schwartz TA, Murphy LB, Helmick CG, Callahan LF, Renner JB, Jordan JM, Golightly YM. Point prevalence of hip symptoms, radiographic, and symptomatic OA at five time points: The Johnston County Osteoarthritis Project, 1991–2018. Osteoarthritis and Cartilage Open 2022; 4. [DOI: 10.1016/j.ocarto.2022.100251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Loeser RF, Arbeeva L, Kelley K, Fodor AA, Sun S, Ulici V, Longobardi L, Cui Y, Stewart DA, Sumner SJ, Azcarate-Peril MA, Sartor RB, Carroll IM, Renner JB, Jordan JM, Nelson AE. Association of Increased Serum Lipopolysaccharide, But Not Microbial Dysbiosis, With Obesity-Related Osteoarthritis. Arthritis Rheumatol 2022; 74:227-236. [PMID: 34423918 PMCID: PMC8795472 DOI: 10.1002/art.41955] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 07/19/2021] [Accepted: 08/19/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To test the hypothesis that an altered gut microbiota (dysbiosis) plays a role in obesity-associated osteoarthritis (OA). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Richard F. Loeser
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina,Corresponding author: Richard F. Loeser, Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, 3300 Thurston Building, Campus Box 7280, University of North Carolina School of Medicine, Chapel Hill, North Carolina, 27599, USA, Phone: 919-966-7042;
| | - Liubov Arbeeva
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Kathryn Kelley
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Anthony A. Fodor
- Dept. of Bioinformatics and Genomics, University of North Carolina-Charlotte, North Carolina
| | - Shan Sun
- Dept. of Bioinformatics and Genomics, University of North Carolina-Charlotte, North Carolina
| | - Veronica Ulici
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Lara Longobardi
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Yang Cui
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | | | - Susan J. Sumner
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | - M. Andrea Azcarate-Peril
- Division of Gastroenterology and Hepatology and UNC Microbiome Core, Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - R. Balfour Sartor
- Division of Gastroenterology and Hepatology and Center for Gastrointestinal Biology and Disease, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Ian M. Carroll
- Department of Nutrition, University of North Carolina, Chapel Hill, NC
| | - Jordan B. Renner
- Department of Radiology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Joanne M. Jordan
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Amanda E. Nelson
- Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Nelson AE, Hu D, Arbeeva L, Alvarez C, Cleveland RJ, Schwartz TA, Murphy LB, Helmick CG, Callahan LF, Renner JB, Jordan JM, Golightly YM. The Prevalence of Knee Symptoms, Radiographic, and Symptomatic Osteoarthritis at Four Time Points: The Johnston County Osteoarthritis Project, 1999-2018. ACR Open Rheumatol 2021; 3:558-565. [PMID: 34245232 PMCID: PMC8363850 DOI: 10.1002/acr2.11295] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Accepted: 05/19/2021] [Indexed: 12/03/2022] Open
Abstract
Objective To 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). Methods Data 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). Results Most 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%). Conclusion These updated estimates demonstrate a large and increasing burden of knee OA, particularly among women and Black individuals.
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Affiliation(s)
| | - David Hu
- University of North Carolina at Chapel Hill
| | | | | | | | | | - Louise B. Murphy
- Centers for Disease Control and PreventionAtlantaGeorgiaUnited States
- Optum Life SciencesEden PrairieMinnesotaUnited States
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Golightly YM, Alvarez C, Arbeeva LS, Cleveland RJ, Schwartz TA, Renner JB, Murphy LB, Callahan LF, Jordan JM, Nelson AE. Associations of Comorbid Conditions and Transitions Across States of Knee Osteoarthritis in a Community-Based Cohort. ACR Open Rheumatol 2021; 3:512-521. [PMID: 34196495 PMCID: PMC8363852 DOI: 10.1002/acr2.11287] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/06/2021] [Indexed: 12/27/2022] Open
Abstract
OBJECTIVE To examine relationships between knee osteoarthritis (KOA) and obesity, diabetes mellitus (DM), and cardiovascular disease (CVD). METHODS Associations of time-dependent obesity, DM, and CVD with KOA transition states over approximately 18 years were examined among 4093 participants from a community-based cohort. Transition states were 1) no knee symptoms and no radiographic KOA (rKOA; Kellgren-Lawrence grade ≥2 in at least one knee), 2) asymptomatic rKOA, 3) knee symptoms only, 4) symptomatic rKOA (sxKOA; rKOA and symptoms in same knee). Markov multistate models estimated adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs) for associations between comorbid conditions and transitions across states, adjusting for baseline age, sex, race, education, enrollment cohort, birth year, and time-dependent knee injury history. RESULTS At baseline, 40% of participants had obesity, 13% had DM, and 22% had CVD (mean age = 61 years; 34% Black; 37% male). Compared with those without obesity, those with obesity had a higher hazard of worsening from no rKOA/no symptoms to asymptomatic rKOA (aHR = 1.7; 95% CI = 1.3-2.2) and from knee symptoms to sxKOA (aHR = 1.7; 95% CI = 1.3-2.3), as well as a lower hazard of symptom resolution from sxKOA to asymptomatic rKOA (aHR = 0.5 [95% = CI 0.4-0.7]). Compared with those without CVD, those with CVD had a higher hazard of worsening from no rKOA/symptoms to knee symptoms (aHR = 1.5; 95% CI = 1.1-2.1). DM was not associated with transitions of rKOA. CONCLUSION Prevention of obesity and CVD may limit the development or worsening of rKOA and symptoms.
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Cleveland RJ, Alvarez C, Nelson AE, Schwartz TA, Renner JB, Jordan JM, Callahan LF. Hip symptoms are associated with premature mortality: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2020; 28:1330-1340. [PMID: 32777267 PMCID: PMC7530042 DOI: 10.1016/j.joca.2020.07.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/17/2020] [Accepted: 07/28/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the impact of hip osteoarthritis (OA) and/or hip symptoms on excess mortality. DESIGN 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. RESULTS 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). CONCLUSIONS 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.
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Affiliation(s)
- Rebecca J. Cleveland
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA,School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - Jordan B. Renner
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, School of Medicine, University of North Carolina, Chapel Hill, NC, USA,Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA,Departments of Orthopaedics and Social Medicine, University of North Carolina, Chapel Hill, NC, USA
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Flowers P, Nelson AE, Hannan MT, Hillstrom HJ, Renner JB, Jordan JM, Golightly YM. Foot Osteoarthritis Frequency and Associated Factors in a Community-Based Cross-Sectional Study of White and African American Adults. Arthritis Care Res (Hoboken) 2020; 73:1784-1788. [PMID: 32813324 DOI: 10.1002/acr.24427] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 08/05/2020] [Indexed: 11/05/2022]
Abstract
OBJECTIVE 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. METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
| | | | - Marian T Hannan
- Hebrew SeniorLife and Harvard Medical School, Boston, Massachusetts
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Yerich NV, Alvarez C, Schwartz TA, Savage-Guin S, Renner JB, Bakewell CJ, Kohler MJ, Lin J, Samuels J, Nelson AE. A Standardized, Pragmatic Approach to Knee Ultrasound for Clinical Research in Osteoarthritis: The Johnston County Osteoarthritis Project. ACR Open Rheumatol 2020; 2:438-448. [PMID: 32597564 PMCID: PMC7368135 DOI: 10.1002/acr2.11159] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2019] [Accepted: 05/21/2020] [Indexed: 11/05/2022] Open
Abstract
Objective This 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. Methods We 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. Results Overall 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. Conclusion US 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.
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Affiliation(s)
| | | | | | | | | | | | | | - Janice Lin
- Stanford Health Care, Palo Alto, California
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15
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Snyder EA, Alvarez C, Golightly YM, Renner JB, Jordan JM, Nelson AE. Incidence and progression of hand osteoarthritis in a large community-based cohort: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2020; 28:446-452. [PMID: 32084589 PMCID: PMC7108963 DOI: 10.1016/j.joca.2020.02.028] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 12/23/2019] [Accepted: 02/03/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the incidence and progression of radiographic and symptomatic hand osteoarthritis (rHOA and sxHOA) in a large community-based cohort. DESIGN 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. RESULTS 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. CONCLUSION This study provides much needed information about the natural history of HOA, a common and frequently debilitating condition, in the general population.
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Affiliation(s)
- E A Snyder
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Medicine, University of North Carolina at Chapel Hill, USA.
| | - C Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA.
| | - Y M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - J B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Radiology, University of North Carolina at Chapel Hill, USA.
| | - J M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Medicine, University of North Carolina at Chapel Hill, USA; Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, USA.
| | - A E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, USA; Department of Medicine, University of North Carolina at Chapel Hill, USA.
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Scherzer ZA, Alvarez C, Renner JB, Murphy LB, Schwartz TA, Jordan JM, Golightly YM, Nelson AE. Effects of Comorbid Cardiovascular Disease and Diabetes on Hand Osteoarthritis, Pain, and Functional State Transitions: The Johnston County Osteoarthritis Project. J Rheumatol 2020; 47:1541-1549. [PMID: 32062598 DOI: 10.3899/jrheum.191075] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The purpose of this study is to examine the course of hand osteoarthritis (HOA) and its relationship with cardiovascular disease (CVD) and diabetes (DM). METHODS 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. RESULTS 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. CONCLUSION 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.
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Affiliation(s)
- Zachary A Scherzer
- Z.A. Scherzer, BS, Medical Student, Oakland University William Beaumont School of Medicine, Rochester, Missouri, and Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Carolina Alvarez
- C. Alvarez, MS, Statistician, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jordan B Renner
- J.B. Renner, MD, Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Louise B Murphy
- L.B. Murphy, PhD, Senior Service Fellow/Epidemiologist, Division of Population Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Todd A Schwartz
- T.A. Schwartz, DrPH, Associate Professor of Biostatistics, Thurston Arthritis Research Center, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Joanne M Jordan
- J.M. Jordan, MD, MPH, Joseph P. Archie, Jr. Eminent Professor of Medicine and Vice Dean for Faculty Affairs and Leadership Development, Thurston Arthritis Research Center, and Department of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Yvonne M Golightly
- Y.M. Golightly, PT, PhD, Assistant Professor of Epidemiology, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, and Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Amanda E Nelson
- A.E. Nelson, MD, MSCR, Associate Professor of Medicine, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Alvarez C, Cleveland RJ, Schwartz TA, Renner JB, Murphy LB, Jordan JM, Callahan LF, Golightly YM, Nelson AE. Comorbid conditions and the transition among states of hip osteoarthritis and symptoms in a community-based study: a multi-state time-to-event model approach. Arthritis Res Ther 2020; 22:12. [PMID: 31959228 PMCID: PMC6972032 DOI: 10.1186/s13075-020-2101-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2019] [Accepted: 01/09/2020] [Indexed: 12/22/2022] Open
Abstract
Background We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). Methods This longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in North Carolina, USA, with 18.4 ± 1.5 years of follow-up. Transitions across the following states were modeled: development of radiographic HOA (rHOA; Kellgren-Lawrence grade [KLG] of< 2); development of hip symptoms (self-reported hip pain, aching, or stiffness on most days) or symptomatic HOA (sxHOA; rHOA and symptoms in the same hip), and resolution of symptoms. Obesity (body mass index ≥ 30 kg/m2) and self-reported DM and CVD were the time-dependent comorbid conditions of interest. Markov multi-state models were used to estimate adjusted hazard ratios and 95% confidence intervals to describe the associations between the conditions and HOA states. Results The sample included 33% African Americans, 39% men, with a mean (SD) age of 62.2 (9.8) years; the frequencies of the comorbidities increased substantially over time. When considered individually, obesity was associated with incident hip symptoms, while CVD and DM were associated with reduced symptom resolution. For those with > 1 comorbidity, the likelihood of incident sxHOA increased, while that of symptom resolution significantly decreased. When stratified by sex, the association between obesity and incident symptoms was only seen in women; among men with DM versus men without, there was a significant (~ 75%) reduction in symptom resolution in those with rHOA. When stratified by race, African Americans with DM, versus those without, were much more likely to develop sxHOA. Conclusions Comorbid chronic conditions are common in individuals with OA, and these conditions have a significant impact on the persistence and progression of HOA. OA management decisions, both pharmacologic and non-pharmacologic, should include considerations of the inter-relationships between OA and common comorbidities such as DM and CVD.
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Affiliation(s)
- Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 3106E McGavran-Greenberg Hall, Campus Box #7420, Chapel Hill, NC, 27599-7420, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Radiology, University of North Carolina at Chapel Hill, 509 Old Infirmary Bldg, Campus Box #7510, Chapel Hill, NC, 27599-7510, USA
| | - Louise B Murphy
- Centers for Disease Control and Prevention, 4770 Buford Highway NE MS S106-7, Atlanta, GA, 30341, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, USA.,Division of Physical Therapy, Department of Allied Health, University of North Carolina at Chapel Hill, Chapel Hill, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA. .,School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, USA.
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Golightly YM, Hannan MT, Nelson AE, Hillstrom HJ, Cleveland RJ, Kraus VB, Schwartz TA, Goode AP, Flowers P, Renner JB, Jordan JM. Relationship of Joint Hypermobility with Ankle and Foot Radiographic Osteoarthritis and Symptoms in a Community-Based Cohort. Arthritis Care Res (Hoboken) 2020; 71:538-544. [PMID: 29953742 DOI: 10.1002/acr.23686] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2017] [Accepted: 06/26/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To explore associations of joint hypermobility (a condition where range of motion is greater than normal) with ankle and foot radiographic osteoarthritis (OA) and symptoms in a large community-based cohort of African American and white adults ages 55-94 years old. METHODS Ankle and foot radiographs and joint hypermobility data (Beighton score for joint hypermobility criteria) were available for 848 participants (from 2003 to 2010) in this cross-sectional study. General joint hypermobility was defined as a Beighton score ≥4 (range 0-9); knee hypermobility was defined as hyperextension of at least 1 knee. Standing anteroposterior and lateral foot radiographs were read with standard atlases for Kellgren-Lawrence grade, osteophytes, and joint space narrowing (JSN) at the tibiotalar joint, and for osteophytes and JSN to define OA at 5 foot joints. Ankle or foot symptoms were self-reported. Separate person-based logistic regression models were used to estimate associations of ankle and foot OA and symptom outcomes with hypermobility measures, adjusting for age, sex, race, body mass index, and history of ankle/foot injury. RESULTS This sample cohort included 577 women (68%) and 280 African Americans (33%). The mean age of the participants was 71 years, with a mean body mass index of 31 kg/m2 . The general joint hypermobility of the participants was 7% and knee hypermobility was 4%. Having a history of ankle injury was 11.5%, and foot injury was 3.8%. Although general joint hypermobility was not associated with ankle and foot outcomes, knee hypermobility was associated with ankle symptoms, foot symptoms, and talonavicular OA (adjusted odds ratios of 4.4, 2.4, and 3.0, respectively). CONCLUSION Knee joint hypermobility may be related to talonavicular OA and to ankle and foot symptoms.
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Affiliation(s)
| | - Marian T Hannan
- Institute for Aging Research, Hebrew Senior Life and Harvard Medical School, Boston, MA
| | | | | | | | | | | | - Adam P Goode
- Duke University School of Medicine, Durham, North Carolina
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Gullo TR, Golightly YM, Flowers P, Jordan JM, Renner JB, Schwartz TA, Kraus VB, Hannan MT, Cleveland RJ, Nelson AE. Joint hypermobility is not positively associated with prevalent multiple joint osteoarthritis: a cross-sectional study of older adults. BMC Musculoskelet Disord 2019; 20:165. [PMID: 30975124 PMCID: PMC6460832 DOI: 10.1186/s12891-019-2550-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/28/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND This cross-sectional study evaluated associations of joint hypermobility and multiple joint osteoarthritis (MJOA) in a community-based cohort of adults 45+ years of age. METHODS MJOA and joint hypermobility data were from 1677 participants (mean age 69 years, 68% women) who completed research clinic visits during 2003-2010. Prevalent MJOA was defined in four ways. Radiographic OA (rOA) was defined as Kellgren-Lawrence (KL) > 2 at any included study joint; symptomatic OA (sxOA) required both symptoms and rOA in a joint. Joint hypermobility was defined as a Beighton score of > 4. Separate logistic regression models were used to estimate odds ratios (OR) between joint hypermobility and each MJOA definition, adjusting for age, sex, race, body mass index, and baseline visit. RESULTS In this cohort, 4% had Beighton score > 4 and 63% met any definition of MJOA. Joint hypermobility was associated with significantly lower odds of radiographic and symptomatic MJOA-1 (multiple joint OA-definition 1: involvement of > 1 IP (interphalangeal) nodes and > 2 sites of hip, knee, and spine; 74 and 58% lower, respectively). However, for the other MJOA definitions (i.e., MJOA-2:involvement of > 2 IP joints, > 1 carpometacarpal [CMC] joints, and knee or hip sites; MJOA-3: involvement of > 5 joint sites from among distal interphalangeal, proximal interphalangeal, CMC, hip, knee, or spine sites; and MJOA-4:involvement of > 2 lower body sites (hip, knee, or spine), there were no statistically significant associations. For associations between site-specific hypermobility and any MJOA definition, most adjusted ORs were less than one, but few were statistically significant. CONCLUSIONS Overall, joint hypermobility was not positively associated with any definition of prevalent MJOA in this cohort, and an inverse association existed with one definition of MJOA. Longitudinal studies are needed to determine the contribution of hypermobility to the incidence and progression of MJOA outcomes.
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Affiliation(s)
- Terese R Gullo
- The Ohio State University College of Medicine, Columbus, OH, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
| | - Portia Flowers
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | | | - Marian T Hannan
- Institute for Aging Research, Hebrew SeniorLife, and Harvard Medical School, Boston, MA, USA
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.
- Department of Medicine, University of North Carolina, Chapel Hill, USA.
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20
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Goode AP, Cleveland RJ, Schwartz TA, Nelson AE, Kraus VB, Hillstrom HJ, Hannan MT, Flowers P, Renner JB, Jordan JM, Golightly YM. Relationship of joint hypermobility with low Back pain and lumbar spine osteoarthritis. BMC Musculoskelet Disord 2019; 20:158. [PMID: 30967130 PMCID: PMC6456963 DOI: 10.1186/s12891-019-2523-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 03/21/2019] [Indexed: 01/07/2023] Open
Abstract
BACKGROUND Chronic low back pain (cLBP) affects millions of Americans and costs billions. Studies suggest a link between cLBP and joint hypermobility. METHODS We conducted cross-sectional primary analyses of joint hypermobility and cLBP, lumbar spine osteoarthritis (OA), and lumbar facet joint OA (FOA) in 3 large studies-the Generalized Osteoarthritis Study, Genetics of Generalized Osteoarthritis Study, and Johnston County Osteoarthritis Project (total n = 5072). Associations of joint hypermobility and Beighton trunk flexion with cLBP and lumbar OA were estimated using separate adjusted logistic regression models. Adjusted pooled odds ratios (pORs) and 95% confidence intervals (CIs) were then summarized-using random effect univariate, multivariate crude, and adjusted models-and heterogeneity was determined (I2 statistic). RESULTS In univariate models, hypermobility was associated with symptomatic FOA (pOR = 0.64 [95% CI 0.44, 0.93]) but this result was not found in the multivariate models. In multivariate adjusted models, hypermobility was not significantly associated with cLBP and lumbar OA, but trunk flexion was inversely associated with cLBP (pOR = 0.40 [95% 0.26, 0.62]), spine OA (pOR = 0.66 [95% CI 0.50, 0.87]), symptomatic spine OA (pOR = 0.39 [95% CI 0.28, 0.53]), and symptomatic FOA (pOR = 0.53 [95% CI 0.37, 0.77]). Generally, between-study heterogeneity was moderate-high. CONCLUSIONS Hypermobility was not associated with cLBP or lumbar OA. The inverse association of trunk flexion with cLBP and lumbar OA may indicate a role for a flexible spine in avoiding or managing these conditions.
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Affiliation(s)
- Adam P Goode
- Department of Orthopedic Surgery, Duke University School of Medicine, Durham, NC, USA. .,Duke Clinical Research Institute, Duke University, Durham, NC, USA. .,Duke Department of Population Health Sciences, Durham, NC, USA.
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Todd A Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Virginia B Kraus
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | | | - Marian T Hannan
- Institute for Aging Research, Hebrew Senior Life, and Harvard Medical School, Boston, MA, USA
| | - Portia Flowers
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Medicine, University of North Carolina, Chapel Hill, NC, USA.,Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA.,Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA.,Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
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21
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Raveendran R, Stiller JL, Alvarez C, Renner JB, Schwartz TA, Arden NK, Jordan JM, Nelson AE. Population-based prevalence of multiple radiographically-defined hip morphologies: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2018; 26:54-61. [PMID: 29024801 PMCID: PMC5732866 DOI: 10.1016/j.joca.2017.10.002] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 09/19/2017] [Accepted: 10/01/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To provide the first prevalence estimates of different radiographic hip morphologies relevant to dysplasia and femoroacetabular impingement in a well-characterized USA population-based cohort. METHODS Cross-sectional data were from the baseline examination (1991-1997) of a large population-based prospective longitudinal cohort study (The Johnston County Osteoarthritis Project). HipMorf software (Oxford, UK) was used to assess hip morphology on anteroposterior (AP) pelvis radiographs. Weighted, sex-stratified prevalence estimates and 95% confidence intervals for four key hip morphologies (AP alpha angle, triangular index sign, lateral center edge angle (LCEA), and protrusio acetabula) were derived and further stratified by age, race and body mass index (BMI). RESULTS A total of 5192 hips from 2596 individuals were included (31% African American, 43% male, mean age 63 years, mean BMI 29 kg/m2). Cam morphology was seen in more than 25% of men and 10% of women. Mild dysplasia was present in about 1/3 of men and women, while pincer morphology was identified in 7% of men and 10% of women. Femoral side (cam) morphologies were more common and more frequently bilateral among men, while pincer morphologies were more common in women; mixed morphologies were infrequent. African-Americans were more likely to have protrusio acetabula than whites. CONCLUSION We report the first population-based prevalence estimates of radiographic hip morphologies relevant to femoroacetabular impingement (FAI) and dysplasia in the USA. These morphologies are very common, with ¼ men and 1/10 women having cam morphology, 1/3 of all adults having mild dysplasia, and 1/15 men and 1/10 women having pincer morphology in at least one hip.
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Affiliation(s)
- Reshmi Raveendran
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jamie L. Stiller
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Nigel K. Arden
- Arthritis Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford, Oxford, UK
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
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22
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Daghestani HN, Jordan JM, Renner JB, Doherty M, Wilson AG, Kraus VB. Serum N-propeptide of collagen IIA (PIIANP) as a marker of radiographic osteoarthritis burden. PLoS One 2017; 12:e0190251. [PMID: 29287118 PMCID: PMC5747482 DOI: 10.1371/journal.pone.0190251] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 12/11/2017] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Cartilage homeostasis relies on a balance of catabolism and anabolism of cartilage matrix. Our goal was to evaluate the burden of radiographic osteoarthritis and serum levels of type IIA procollagen amino terminal propeptide (sPIIANP), a biomarker representing type II collagen synthesis, in osteoarthritis. METHODS OA burden was quantified on the basis of radiographic features as total joint faces with an osteophyte, joint space narrowing, or in the spine, disc space narrowing. sPIIANP was measured in 1,235 participants from the Genetics of Generalized Osteoarthritis study using a competitive enzyme-linked immunosorbent assay. Separate multivariable linear regression models, adjusted for age, sex, and body mass index and additionally for ipsilateral osteophytes or joint/disc space narrowing, were used to assess the independent association of sPIIANP with osteophytes and with joint/disc space narrowing burden in knees, hips, hands and spine, individually and together. RESULTS After full adjustment, sPIIANP was significantly associated with a lesser burden of hip joint space narrowing and knee osteophytes. sPIIANP was associated with a lesser burden of hand joint space narrowing but a greater burden of hand osteophytes; these results were only evident upon adjustment for osteoarthritic features in all other joints. There were no associations of sPIIANP and features of spine osteoarthritis. CONCLUSIONS Higher cartilage collagen synthesis, as reflected in systemic PIIANP concentrations, was associated with lesser burden of osteoarthritic features in lower extremity joints (knees and hips), even accounting for osteoarthritis burden in hands and spine, age, sex and body mass index. These results suggest that pro-anabolic agents may be appropriate for early treatment to prevent severe lower extremity large joint osteoarthritis.
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Affiliation(s)
- Hikmat N. Daghestani
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States of America
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, United States of America
| | - Jordan B. Renner
- Department of Radiology, University of North Carolina at Chapel Hill, NC, United States of America
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - A. Gerry Wilson
- Conway Institute for Biomolecuar & Biomedical Research University College Dublin, Dublin, Ireland
| | - Virginia B. Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, United States of America
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, United States of America
- * E-mail:
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23
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Barbour KE, Murphy LB, Helmick CG, Hootman JM, Renner JB, Jordan JM. Bone Mineral Density and the Risk of Hip and Knee Osteoarthritis: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2017; 69:1863-1870. [PMID: 28129489 DOI: 10.1002/acr.23211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 01/24/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To address knowledge gaps regarding the relationship between bone mineral density (BMD) and incident hip or knee osteoarthritis (OA); specifically, lack of information regarding hip OA or symptomatic outcomes. METHODS Using data (n = 1,474) from the Johnston County Osteoarthritis Project's first (1999-2004) and second (2005-2010) followup of participants ages ≥45 years, we examined the association between total hip BMD and both hip and knee OA. Total hip BMD was measured using dual x-ray absorptiometry, and participants were classified into sex-specific quartiles (low, intermediate low, intermediate high, and high). Radiographic OA (ROA) was defined as development of Kellgren/Lawrence grade ≥2. Symptomatic ROA (sROA) was defined as onset of both ROA and symptoms. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs). RESULTS Median followup time was 6.5 years (range 4.0-10.2 years). In multivariate models, and compared with participants with low BMD, those with intermediate high and high BMD were less likely to develop hip sROA (HR 0.52 [95% CI 0.31-0.86] and 0.56 [95% CI 0.31-0.86], respectively; P = 0.024 for trend); high BMD was not associated (HR 0.69 [95% CI 0.45-1.06]) with risk of hip ROA. Compared with participants with low BMD, those with intermediate low and intermediate high total hip BMD were more likely to develop knee sROA (HR 2.15 [95% CI 1.40-3.30] and 1.65 [95% CI 1.02-2.67], respectively; P = 0.325 for trend); similar associations were seen with knee ROA. CONCLUSION Our findings suggest that higher BMD may reduce the risk of hip sROA, while intermediate levels may increase the risk of both knee sROA and ROA.
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Affiliation(s)
- Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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Liu Y, Yau MS, Yerges-Armstrong LM, Duggan DJ, Renner JB, Hochberg MC, Mitchell BD, Jackson RD, Jordan JM. Genetic Determinants of Radiographic Knee Osteoarthritis in African Americans. J Rheumatol 2017; 44:1652-1658. [PMID: 28916551 PMCID: PMC5668168 DOI: 10.3899/jrheum.161488] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2017] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The etiology of knee osteoarthritis (OA), the most common form of arthritis, is complex and may differ by race or ethnicity. In recent years, genetic studies have identified many genetic variants associated with OA, but nearly all the studies were conducted in European whites and Asian Americans. Few studies have focused on the genetics of knee OA in African Americans. METHODS We performed a genome-wide association study of radiographic knee OA in 1217 African Americans from 2 North American cohort studies: 590 subjects from the Johnston County Osteoarthritis Project and 627 subjects from the Osteoarthritis Initiative. Analyses were conducted in each cohort separately and combined in an inverse variance fixed effects metaanalysis, which were then included in pathway analyses. We additionally tested 12 single-nucleotide polymorphisms robustly associated with OA in European white populations for association in African Americans. RESULTS We identified a genome-wide significant variant in LINC01006 (minor allele frequency 12%; p = 4.11 × 10-9) that is less common in European white populations (minor allele frequency < 3%). Five other independent loci reached suggestive significance (p < 1 × 10-6). In pathway analyses, dorsal/ventral neural tube patterning and iron ion transport pathways were significantly associated with knee OA in African Americans (false discovery rate < 0.05). We found no evidence that previously reported OA susceptibility variants in European whites were associated with knee OA in African Americans. CONCLUSION These results highlight differences in the genetic architecture of knee OA between African American and European whites. This finding underscores the need to include more diverse populations in OA genetics studies.
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Affiliation(s)
- Youfang Liu
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - Michelle S Yau
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA.
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina.
| | - Laura M Yerges-Armstrong
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - David J Duggan
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - Jordan B Renner
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - Marc C Hochberg
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - Braxton D Mitchell
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - Rebecca D Jackson
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
| | - Joanne M Jordan
- From the Thurston Arthritis Research Center, and the Department of Radiology, and the Departments of Medicine and Orthopaedics, University of North Carolina, Chapel Hill, North Carolina; Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; Medical Care Clinical Center, Veterans Affairs Maryland Health Care System; Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center, Baltimore, Maryland; Institute for Aging Research, Hebrew SeniorLife; Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts; Translational Genomics Research Institute, Phoenix, Arizona; Department of Internal Medicine, Ohio State University, Columbus, Ohio, USA
- Y. Liu, PhD, Thurston Arthritis Research Center, University of North Carolina; M.S. Yau, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Institute for Aging Research, Hebrew SeniorLife, and the Department of Medicine, Beth Israel Deaconess Medical Center and Harvard Medical School; L.M. Yerges-Armstrong, PhD, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine; D.J. Duggan, PhD, Translational Genomics Research Institute; J.B. Renner, MD, Thurston Arthritis Research Center, and the Department of Radiology, University of North Carolina; M.C. Hochberg, MD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and the Medical Care Clinical Center, Veterans Affairs Maryland Health Care System, and the Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; B.D. Mitchell, PhD, MPH, Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, and Geriatric Research, Education and Clinical Center, Veterans Affairs Medical Center; R.D. Jackson, MD, Department of Internal Medicine, Ohio State University; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, University of North Carolina, and Departments of Medicine and Orthopaedics, University of North Carolina
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Goode AP, Nelson AE, Kraus VB, Renner JB, Jordan JM. Biomarkers reflect differences in osteoarthritis phenotypes of the lumbar spine: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2017; 25:1672-1679. [PMID: 28711584 PMCID: PMC5605465 DOI: 10.1016/j.joca.2017.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2016] [Revised: 06/02/2017] [Accepted: 07/05/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine differences in biomarker levels between radiographic phenotypes of facet joint osteoarthritis (FOA) only, spine OA only ((disc space narrowing (DSN) and vertebral osteophytes (OST)) or the combination of FOA and spine OA. DESIGN A cross-sectional analysis of data from 555 participants in the Johnston County Osteoarthritis Project was performed. Lumbar spine levels were graded by severity (OST and DSN) and presence (FOA) of degeneration. Biomarkers included hyaluronan (HA) and type II collagen (CTX-II). Adjusted risk ratios (aRRR) were estimated using multinomial regression, with adjustment for age, race, sex, body mass index (BMI), and radiographic OA (knee, hip, hand). Interactions were tested between sex, race and low back symptoms. RESULTS FOA only was present in 22.4%, 14.5% had spine OA only, and 34.6% had the combination of FOA and spine OA. Compared to the reference group of neither FOA or spine OA, a one unit higher ln HA level was associated with 31% higher relative risk ratio (RRR = 1.31 (95% 1.03, 1.67)) of having FOA only, while, a one unit higher lnuCTX-II level was associated with 84% higher relative risk ratio (RRR = 1.84 (95% CI 1.19, 2.84)) of having spine OA only. No significant interactions were identified. CONCLUSION Interestingly, OA affecting the synovial facet joint was associated with a marker of inflammation (HA). Spine OA, affecting intervertebral discs that contain collagen type II, was associated with a marker reflecting collagen type II degradation (CTX-II). These findings suggest that biomarkers may reflect the different pathophysiologic processes of lumbar spine OA phenotypes.
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Affiliation(s)
- Adam P. Goode
- Associate Professor, Department of Orthopedic Surgery, Duke Clinical Research Institute, Duke University School of Medicine
| | - Amanda E. Nelson
- Assistant Professor, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
| | - Virginia B. Kraus
- Professor, Duke Molecular Physiology Institute and Division of Rheumatology, Duke University School of Medicine, Durham, NC
| | - Jordan B. Renner
- Professor, Thurston Arthritis Research Center, Department of Radiology, University of North Carolina, Chapel Hill
| | - Joanne M. Jordan
- Professor, Thurston Arthritis Research Center, University of North Carolina, Chapel Hill
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Nelson AE, Golightly YM, Lateef S, Renner JB, Jordan JM, Aspden RM, Hillstrom H, Gregory JS. Cross-sectional associations between variations in ankle shape by statistical shape modeling, injury history, and race: the Johnston County Osteoarthritis Project. J Foot Ankle Res 2017; 10:34. [PMID: 28770007 PMCID: PMC5530536 DOI: 10.1186/s13047-017-0216-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2017] [Accepted: 07/17/2017] [Indexed: 02/07/2023] Open
Abstract
Background Injury is an important risk factor for osteoarthritis (OA), a highly prevalent and disabling joint disease. Joint shape is linked to OA, but the interplay of injury and joint shape and their combined role in OA, particularly at the ankle, is not well known. Therefore, we explored cross-sectional associations between ankle shape and injury in a large community-based cohort. Methods Ankles without radiographic OA were selected from the current data collection of the Johnston County OA Project. Ankles with self-reported prior injury were included as injury cases (n = 108) along with 1:1 randomly selected non-injured ankles. To define ankle shape, a 68 point model on weight-bearing lateral ankle radiographs was entered into a statistical shape model, producing a mean shape and a set of continuous variables (modes) representing variation in that shape. Nineteen modes, explaining 80% of shape variance, were simultaneously included in a logistic regression model with injury status as the dependent variable, adjusted for intra-person correlation, sex, race, body mass index (BMI), baseline OA radiographic grade, and baseline symptoms. Results A total of 194 participants (213 ankles) were included; mean age 71 years, BMI 30 kg/m2, 67% white and 71% women. Injured ankles were more often symptomatic and from whites. In a model adjusted only for intra-person correlation, associations were seen between injury status and modes 1, 6, 13, and 19. In a fully adjusted model, race strongly affected the estimate for mode 1 (which was no longer statistically significant). Conclusions This study showed variations in ankle shape and history of injury as well as with race. These novel findings may indicate a change in ankle morphology following injury, or that ankle morphology predisposes to injury, and suggest that ankle shape is a potentially important factor in the development of ankle OA.
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Affiliation(s)
- Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Yvonne M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.,Injury Prevention Research Center University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Shahmeer Lateef
- University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box 7280, Chapel Hill, NC 27599-7280 USA.,University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC USA.,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC USA.,Department of Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC USA
| | - Richard M Aspden
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - Howard Hillstrom
- Leon Root Motion Analysis Laboratory, Hospital for Special Surgery, New York City, NY USA
| | - Jennifer S Gregory
- Arthritis and Musculoskeletal Medicine, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
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Yau MS, Yerges-Armstrong LM, Liu Y, Lewis CE, Duggan DJ, Renner JB, Torner J, Felson DT, McCulloch CE, Kwoh CK, Nevitt MC, Hochberg MC, Mitchell BD, Jordan JM, Jackson RD. Genome-Wide Association Study of Radiographic Knee Osteoarthritis in North American Caucasians. Arthritis Rheumatol 2017; 69:343-351. [PMID: 27696742 DOI: 10.1002/art.39932] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2016] [Accepted: 09/13/2016] [Indexed: 12/23/2022]
Abstract
OBJECTIVE A major barrier to genetic studies of osteoarthritis (OA) is the need to obtain large numbers of individuals with standardized radiographic evaluations for OA. To address this gap, we performed a genome-wide association study (GWAS) of radiographically defined tibiofemoral knee OA in 3,898 cases and 3,168 controls from 4 well-characterized North American cohorts, and we performed replication analysis of previously reported OA loci. METHODS We performed meta-analysis using a 2-stage design. Stage 1 (discovery) consisted of a GWAS meta-analysis of radiographic knee OA carried out in the Osteoarthritis Initiative and the Johnston County Osteoarthritis Project. Knee OA was defined as definite osteophytes and possible joint space narrowing or total joint replacement in one or both knees. Stage 2 (validation) was performed in the Multicenter Osteoarthritis Study and the Genetics of Osteoarthritis study. We genotyped lead meta-analysis variants (P ≤ 1 × 10-4 ) from stage 1 and tested the association between these variants and knee OA. We then combined results from all cohorts in a meta-analysis. RESULTS Lead variants from stage 1, representing 49 unique loci, were analyzed in stage 2; none met genome-wide significance in the combined analysis of stage 1 and stage 2. We validated 1 locus (rs4867568 near LSP1P3) with nominal significance (P < 0.05), which was also our top finding in the combined meta-analysis (odds ratio [OR] 0.84 [95% confidence interval (95% CI) 0.79-0.91], P = 3.02 × 10-6 ). We observed nominally significant associations (P < 0.05) with 3 previously reported OA loci: rs143383 in GDF5 (OR 1.12 [95% CI 1.04-1.21], P = 2.13 × 10-3 ), rs835487 in CHST11 (OR 0.93 [95% CI 0.85-0.99], P = 0.03), and rs8044769 in FTO (OR 1.10 [95% CI 1.03-1.19], P = 6.13 × 10-3 ). CONCLUSION These findings provide suggestive evidence of a novel knee OA locus and confirm previously reported associations in GDF5, CHST11, and FTO.
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Affiliation(s)
| | | | | | | | - David J Duggan
- Translational Genomics Research Institute, Phoenix, Arizona
| | | | | | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | | | - Marc C Hochberg
- University of Maryland School of Medicine and Veterans Administration Medical Center, Baltimore
| | - Braxton D Mitchell
- University of Maryland School of Medicine and Veterans Administration Medical Center, Baltimore
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Qin J, Barbour KE, Murphy LB, Nelson AE, Schwartz TA, Helmick CG, Allen KD, Renner JB, Baker NA, Jordan JM. Lifetime Risk of Symptomatic Hand Osteoarthritis: The Johnston County Osteoarthritis Project. Arthritis Rheumatol 2017; 69:1204-1212. [PMID: 28470947 DOI: 10.1002/art.40097] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2016] [Accepted: 03/09/2017] [Indexed: 12/25/2022]
Abstract
OBJECTIVE Symptomatic hand osteoarthritis (OA) is a common condition that affects hand strength and function, and causes disability in activities of daily living. Prior studies have estimated that the lifetime risk of symptomatic knee OA is 45% and that of hip OA is 25%. The objective of the present study was to estimate the overall lifetime risk of symptomatic hand OA, and the stratified lifetime risk according to potential risk factors. METHODS Data were obtained from 2,218 adult subjects (ages ≥45 years) in the Johnston County Osteoarthritis Project, a population-based prospective cohort study among residents of Johnston County, North Carolina. Data for the present study were collected from 2 of the follow-up cycles (1999-2004 and 2005-2010). Symptomatic hand OA was defined as the presence of both self-reported symptoms and radiographic OA in the same hand. Lifetime risk, defined as the proportion of the population who will develop symptomatic hand OA in at least 1 hand by age 85 years, was estimated from models using generalized estimating equations. RESULTS Overall, the lifetime risk of symptomatic hand OA was 39.8% (95% confidence interval [95% CI] 34.4-45.3%). In this population, nearly 1 in 2 women (47.2%, 95% CI 40.6-53.9%) had an estimated lifetime risk of developing symptomatic hand OA by age 85 years, compared with 1 in 4 men (24.6%, 95% CI 19.5-30.5%). Race-specific symptomatic hand OA risk estimates were 41.4% (95% CI 35.5-47.6%) among whites and 29.2% (95% CI 20.5-39.7%) among African Americans. The lifetime risk of symptomatic hand OA among individuals with obesity (47.1%, 95% CI 37.8-56.7%) was 11 percentage points higher than that in individuals without obesity (36.1%, 95% CI 29.7-42.9%). CONCLUSION These findings demonstrate the substantial burden of symptomatic hand OA overall and in sociodemographic and clinical subgroups. Increased use of public health and clinical interventions is needed to address its impact.
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Affiliation(s)
- Jin Qin
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Kamil E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Louise B Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Lateef S, Golightly YM, Renner JB, Jordan JM, Nelson AE. A Cross-sectional Analysis of Radiographic Ankle Osteoarthritis Frequency and Associated Factors: The Johnston County Osteoarthritis Project. J Rheumatol 2017; 44:499-504. [PMID: 28202744 DOI: 10.3899/jrheum.161076] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2017] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Because there are no epidemiologic data regarding the frequency of ankle osteoarthritis (OA) in a general population, we sought to analyze this disabling condition in a large, well-characterized, community-based cohort of older individuals. METHODS Cross-sectional data, including ankle radiographs, were from the most recent data collection (2013-2015) of the Johnston County OA Project. Radiographic ankle OA (rAOA) was defined as a Kellgren-Lawrence arthritis grading scale of ≥ 2 on weight-bearing lateral and mortise radiographs. The presence of pain, aching, or stiffness in the ankles as well as history of ankle injury (limiting ability to walk for at least 2 days) were assessed. Chi-square statistics (categorical variables) and Student t tests (continuous variables) were used to compare all participant characteristics by rAOA status. Joint-based logistic regression models with generalized estimating equations were used to examine associations of rAOA and covariates of interest [age, body mass index (BMI), sex, race, ankle symptoms, and injury history]. RESULTS Of 864 participants with available data, 68% were women, 34% were African American, with a mean age of 72 years and BMI of 31 kg/m2. Nearly 7% of this sample had rAOA. Increasing age, high BMI, history of ankle injury, and presence of ankle symptoms were all independently associated with greater odds of having rAOA; no significant differences were seen by sex or race. CONCLUSION The frequency of rAOA was higher than estimates generally quoted in the literature. While injury was an important contributor, other factors such as age, BMI, and symptoms were also significantly associated with rAOA.
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Affiliation(s)
- Shahmeer Lateef
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA.,S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Yvonne M Golightly
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA.,S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Jordan B Renner
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA.,S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Joanne M Jordan
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA.,S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine
| | - Amanda E Nelson
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill (UNC); UNC School of Medicine; Department of Epidemiology, Gillings School of Global Public Health, UNC; Injury Prevention Research Center UNC; Department of Radiology, UNC; Department of Orthopedics, UNC, Chapel Hill, North Carolina, USA. .,S. Lateef, BS, UNC Medical Student, Thurston Arthritis Research Center, UNC, and UNC School of Medicine; Y.M. Golightly, PT, PhD, UNC Assistant Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Injury Prevention Research Center UNC; J.B. Renner, MD, UNC Professor of Radiology and Allied Health Sciences, Thurston Arthritis Research Center, UNC, and Department of Radiology, UNC; J.M. Jordan, MD, MPH, UNC Joseph P. Archie, Jr. Eminent Professor of Medicine, Chief of Division of Rheumatology, Allergy and Immunology, Director of Thurston Arthritis Research Center, Executive Associate Dean of Faculty Affairs and Leadership Development, Adjunct Professor of Epidemiology, Thurston Arthritis Research Center, UNC, and UNC School of Medicine, and Department of Epidemiology, Gillings School of Global Public Health, UNC, and Department of Orthopaedics, UNC; A.E. Nelson, MD, MSCR, UNC Assistant Professor of Medicine, Thurston Arthritis Research Center, UNC, and UNC School of Medicine.
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Kraus VB, Hargrove DE, Hunter DJ, Renner JB, Jordan JM. Establishment of reference intervals for osteoarthritis-related soluble biomarkers: the FNIH/OARSI OA Biomarkers Consortium. Ann Rheum Dis 2016; 76:179-185. [PMID: 27343253 DOI: 10.1136/annrheumdis-2016-209253] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2016] [Revised: 05/04/2016] [Accepted: 05/17/2016] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To establish reference intervals for osteoarthritis (OA)-related biomarkers used in the Foundation for the National Institutes of Health (FNIH) OA Biomarkers Consortium Project. METHODS A total of 129 'multijoint controls' were selected from 2722 African-American and Caucasian men and women in the Johnston County Osteoarthritis Project. The majority (79%) of those eligible (with biospecimens and baseline data) also had one or more follow-up evaluations 5-15 years later. Multijoint controls were selected to be free of radiographic hand, hip, knee and lumbar spine osteoarthritis (OA), to have no knee or hip symptoms, and minimal hand and spine symptoms at all available time points. Eighteen biomarkers were evaluated in serum (s) and/or urine (u) by ELISA. Reference intervals and partitioning by gender and race were performed with EP Evaluator software. RESULTS Controls were 64% women, 33% African-Americans, mean age 59 years and mean body mass index 29 kg/m2. Three biomarkers were associated with age: sHyaluronan (positively), sN-terminal propeptide of collagen IIA (positively) and sCol2-3/4 C-terminal cleavage product of types I and II collagen (negatively). Exploratory analyses suggested that separate reference intervals may be warranted on the basis of gender for uC-terminal cross-linked telopeptide of type II collagen (uCTXII), sMatrix metalloproteinase-3, uNitrated type II collagen degradation fragment (uCol2-1 NO2) and sHyaluronan, and on the basis of race for uCTXII, sCartilage oligomeric matrix protein, sC-terminal cross-linked telopeptide of type I collagen and uCol2-1 NO2. CONCLUSIONS To our knowledge, this represents the best and most stringent control group ever assayed for OA-related biomarkers. These well-phenotyped controls, representing a similar age demographic to that of the OA Initiative-FNIH main study sample, provide a context for interpretation of OA subject biomarker data. The freely available data set also provides a reference for future human studies.
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Affiliation(s)
- Virginia B Kraus
- Division of Rheumatology, Department of Medicine, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, North Carolina, USA
| | | | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia
| | - Jordan B Renner
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joanne M Jordan
- Department of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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An H, Marron JS, Schwartz TA, Renner JB, Liu F, Lynch JA, Lane NE, Jordan JM, Nelson AE. Novel statistical methodology reveals that hip shape is associated with incident radiographic hip osteoarthritis among African American women. Osteoarthritis Cartilage 2016; 24:640-6. [PMID: 26620089 PMCID: PMC4799754 DOI: 10.1016/j.joca.2015.11.013] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2015] [Revised: 10/17/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
INTRODUCTION Hip shape is a risk factor for the development of hip osteoarthritis (OA), and current methods to assess hip shape from radiographs are limited; therefore this study explored current and novel methods to assess hip shape. METHODS Data from a prior case-control study nested in the Johnston County OA Project were used, including 382 hips (from 342 individuals). Hips were classified by radiographic hip OA (RHOA) status as RHOA cases (baseline Kellgren Lawrence grade [KLG] 0 or 1, follow-up [mean 6 years] KLG ≥ 2) or controls (KLG = 0 or 1 at both baseline and follow-up). Proximal femur shape was assessed using a 60-point model as previously described. The current analysis explored commonly used principal component analysis (PCA), as well as novel statistical methodologies suited to high dimension low sample size settings (Distance Weighted Discrimination [DWD] and Distance Projection Permutation [DiProPerm] hypothesis testing) to assess differences between cases and controls. RESULTS Using these novel methodologies, we were able to better characterize morphologic differences by sex and race. In particular, the proximal femurs of African American women demonstrated significantly different shapes between cases and controls, implying an important role for sex and race in the development of RHOA. Notably, discrimination was improved with the use of DWD and DiProPerm compared to PCA. CONCLUSIONS DWD with DiProPerm significance testing provides improved discrimination of variation in hip morphology between groups, and enables subgroup analyses even under small sample sizes.
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Affiliation(s)
- H An
- Department of Statistics and Operations Research, University of North Carolina, Hanes Hall CB 3260, Chapel Hill, NC 27599, USA.
| | - J S Marron
- Department of Statistics and Operations Research, University of North Carolina, Hanes Hall CB 3260, Chapel Hill, NC 27599, USA.
| | - T A Schwartz
- Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina, 3106E McGavran-Greenberg Hall CB 7420, Chapel Hill, NC 27599, USA.
| | - J B Renner
- Department of Radiology, University of North Carolina, 509 Old Infirmary Bldg CB 7510, Chapel Hill, NC 27599, USA; Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
| | - F Liu
- University of California at San Francisco, Mission Hall: Global Health & Clinical Sciences Bldg, 550 16th St, 2nd Floor, San Francisco, CA 94158-2549, USA.
| | - J A Lynch
- University of California at San Francisco, Mission Hall: Global Health & Clinical Sciences Bldg, 550 16th St, 2nd Floor, San Francisco, CA 94158-2549, USA.
| | - N E Lane
- University of California Davis School of Medicine, 451 Health Sciences Dr, Davis, CA 95616, USA.
| | - J M Jordan
- Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
| | - A E Nelson
- Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building CB 7280, Chapel Hill, NC 27599, USA.
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Nelson AE, Stiller JL, Shi XA, Leyland KM, Renner JB, Schwartz TA, Arden NK, Jordan JM. Measures of hip morphology are related to development of worsening radiographic hip osteoarthritis over 6 to 13 year follow-up: the Johnston County Osteoarthritis Project. Osteoarthritis Cartilage 2016; 24:443-50. [PMID: 26497609 PMCID: PMC4761268 DOI: 10.1016/j.joca.2015.10.007] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2015] [Revised: 09/16/2015] [Accepted: 10/13/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We sought to describe the effect of alterations in hip morphology with respect to worsening hip OA in a community-based sample including African American (AA) and white men and women. METHODS This nested case-control study defined case hips as Kellgren Lawrence grade (KLG) <3 on baseline supine pelvis radiographs and KLG ≥3 or THR for OA at the 1st or 2nd follow-up visit (mean 6 and 13 years, respectively); control hips had KLG <3 at both visits, with gender/race distribution similar to cases. Hip morphology was assessed using HipMorf software (Oxford, UK). Descriptive means and standard errors were obtained from generalized estimating equation (GEE) models. Sex-stratified GEE regression models (accounting for within-person correlation), adjusted for age, race, BMI, and side were then employed. RESULTS A total of 120 individuals (239 hips; 71 case/168 control) were included (25% male, 26% AA, mean age 62 years, BMI 30 kg/m(2)). Case hips tended to have greater baseline AP alpha angles, smaller minimum joint space width (mJSW) and more frequent triangular index signs. Adjusted results among men revealed that higher AP alpha angle, Gosvig ratio, and acetabular index were positively associated with case hips; coxa profunda was negatively associated. Among women, greater AP alpha angle, smaller mJSW, protrusio acetabuli, and triangular index sign were associated with case hips. CONCLUSIONS We confirmed an increased risk of worsening hip OA due to baseline features of cam deformity among men and women, as well as protrusio acetabuli among women, and provide the first estimates of these measures in AAs.
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Affiliation(s)
- Amanda E. Nelson
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Medicine, University of North Carolina at
Chapel Hill, Chapel Hill, NC USA
| | - Jamie L. Stiller
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC USA
| | | | - Kirsten M. Leyland
- NIHR Musculoskeletal Biomedical Research Unit and Arthritis
Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford,
Oxford, UK
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Radiology, University of North Carolina at
Chapel Hill, Chapel Hill, NC USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Biostatistics, Gillings School of Global
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
USA
| | - Nigel K. Arden
- NIHR Musculoskeletal Biomedical Research Unit and Arthritis
Research UK Centre for Sport, Exercise, and Osteoarthritis, University of Oxford,
Oxford, UK
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North
Carolina at Chapel Hill, Chapel Hill, NC USA,Department of Medicine, University of North Carolina at
Chapel Hill, Chapel Hill, NC USA,Department of Epidemiology, Gillings School of Global
Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC
USA,Department of Orthopaedics, University of North Carolina at
Chapel Hill, Chapel Hill, NC USA
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Foley B, Cleveland RJ, Renner JB, Jordan JM, Nelson AE. Racial differences in associations between baseline patterns of radiographic osteoarthritis and multiple definitions of progression of hip osteoarthritis: the Johnston County Osteoarthritis Project. Arthritis Res Ther 2015; 17:366. [PMID: 26680278 PMCID: PMC4704544 DOI: 10.1186/s13075-015-0806-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2015] [Accepted: 09/28/2015] [Indexed: 01/03/2023] Open
Abstract
Background To identify baseline radiographic features that predict hip osteoarthritis (HOA) progression, and to explore differences in these associations by race. Methods Radiographs from the community-based Johnston County OA Project were scored using Kellgren-Lawrence (KL) grade and for presence and location of joint space narrowing (JSN), osteophytes, and subchondral changes. Associations between these features and HOA progression (increase of at least 1 KL grade, interval hip replacement, range of motion [ROM, a reduction of ≥10° in internal rotation], or disability [increase of ≥0.2 in Health Assessment Questionnaire scores], or Any of these) were assessed using logistic regression, adjusting for age, gender, race, hip injury, BMI, education, smoking and follow-up time, accounting for multiple comparisons. Race interactions were assessed and analyses stratified as indicated. Results The sample (n = 1,422) included 40 % men and 26 % African American (AA) participants, with mean age 61 years and BMI 29 kg/m2. The baseline frequency of radiographic hip OA (RHOA) between Caucasians and AAs was similar (23 %), although some radiographic features differed. AAs were more likely to have progression defined by ROM or disability or Any progression; Caucasians were more likely to have RHOA progression. JSN, subchondral sclerosis, and medial osteophytes were associated with increased RHOA progression overall; JSN was associated with disability progression only in AAs, while lateral osteophytes were associated with ROM progression only in Caucasians. Conclusions AAs and Caucasians exhibited differences in the radiographic presentation and progression patterns of HOA, with AAs reporting progressive pain and disability, while Caucasians had more RHOA progression.
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Affiliation(s)
- Bridget Foley
- University of New England College of Osteopathic Medicine, Biddeford, ME, USA. .,Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA.
| | - Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA.
| | - Jordan B Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Radiology, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Joanne M Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. .,Department of Orthopaedics, University of North Carolina at Chapel Hill School of Medicine, Chapel Hill, NC, USA.
| | - Amanda E Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA. .,Department of Medicine, University of North Carolina at Chapel Hill School of Medicine, 3300 Doc J. Thurston Bldg, CB #7280, Chapel Hill, NC, 27599-7280, USA.
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Nelson AE, Golightly YM, Renner JB, Schwartz TA, Liu F, Lynch JA, Gregory JS, Aspden RM, Lane NE, Jordan JM. Variations in Hip Shape Are Associated with Radiographic Knee Osteoarthritis: Cross-sectional and Longitudinal Analyses of the Johnston County Osteoarthritis Project. J Rheumatol 2015; 43:405-10. [PMID: 26669914 DOI: 10.3899/jrheum.150559] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2015] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Hip shape by statistical shape modeling (SSM) is associated with hip radiographic osteoarthritis (rOA). We examined associations between hip shape and knee rOA given the biomechanical interrelationships between these joints. METHODS Bilateral baseline hip shape assessments [for those with at least 1 hip with a Kellgren-Lawrence arthritis grading scale (KL) 0 or 1] from the Johnston County Osteoarthritis Project were available. Proximal femur shape was defined on baseline pelvis radiographs and evaluated by SSM, producing mean shape and continuous variables representing independent modes of variation (14 modes = 95% of shape variance). Outcomes included prevalent [baseline KL ≥ 2 or total knee replacement (TKR)], incident (baseline KL 0/1 with followup ≥ 2), and progressive knee rOA (KL increase of ≥ 1 or TKR). Limb-based logistic regression models for ipsilateral and contralateral comparisons were adjusted for age, sex, race, body mass index (BMI), and hip rOA, accounting for intraperson correlations. RESULTS We evaluated 681 hips and 682 knees from 342 individuals (61% women, 83% white, mean age 62 yrs, BMI 29 kg/m(2)). Ninety-nine knees (15%) had prevalent rOA (4 knees with TKR). Lower modes 2 and 3 scores were associated with ipsilateral prevalent knee rOA, and only lower mode 3 scores were associated with contralateral prevalent knee rOA. No statistically significant associations were seen for incident or progressive knee rOA. CONCLUSION Variations in hip shape were associated with prevalent, but not incident or progressive, knee rOA in this cohort, and may reflect biomechanical differences between limbs, genetic influences, or common factors related to both hip shape and knee rOA.
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Affiliation(s)
- Amanda E Nelson
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill.
| | - Yvonne M Golightly
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jordan B Renner
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Todd A Schwartz
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Felix Liu
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - John A Lynch
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Jenny S Gregory
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Richard M Aspden
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Nancy E Lane
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
| | - Joanne M Jordan
- From the Thurston Arthritis Research Center, University of North Carolina at Chapel Hill; Department of Medicine, and Department of Radiology, and Department of Orthopedics, University of North Carolina at Chapel Hill; Department of Epidemiology, and Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California at San Francisco, San Francisco; University of California at Davis, Sacramento, California, USA; Musculoskeletal Research Programme, University of Aberdeen, Aberdeen, UK.A.E. Nelson, MD, MSCR, Thurston Arthritis Research Center, and Department of Medicine, University of North Carolina at Chapel Hill; Y.M. Golightly, PT, PhD, Thurston Arthritis Research Center, and Department of Epidemiology, Gillings School of Global Public Health, and Injury Prevention Research Center, University of North Carolina at Chapel Hill; J.B. Renner, MD, Department of Radiology, University of North Carolina at Chapel Hill; T.A. Schwartz, DrPH, Department of Biostatistics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill; F. Liu, MS, University of California at San Francisco; J.A. Lynch, PhD, University of California at San Francisco; J.S. Gregory, PhD, Musculoskeletal Research Programme, University of Aberdeen; R.M. Aspden, PhD, DSc, Musculoskeletal Research Programme, University of Aberdeen; N.E. Lane, MD, University of California at Davis; J.M. Jordan, MD, MPH, Thurston Arthritis Research Center, and Department of Medicine and Department of Orthopedics, and Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill
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Kraus VB, Kilfoil TM, Hash TW, McDaniel G, Renner JB, Carrino JA, Adams S. Atlas of radiographic features of osteoarthritis of the ankle and hindfoot. Osteoarthritis Cartilage 2015; 23:2059-2085. [PMID: 26318654 PMCID: PMC4663119 DOI: 10.1016/j.joca.2015.08.008] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2015] [Revised: 06/28/2015] [Accepted: 08/18/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To develop a radiographic atlas of osteoarthritis (OA) for use as a template and guide for standardized scoring of radiographic features of OA of the ankle and hindfoot joints. METHOD Under Institutional Review Board approval, ankle and hindfoot images were selected from a cohort study and from among cases that underwent ankle radiography during a 6-month period at Duke University Medical Center. Missing OA pathology was obtained through supplementation of cases with the assistance of a foot and ankle specialist in Orthopaedic surgery and a musculoskeletal radiologist. Images were obtained and reviewed without patient identifying information. Images went through multiple rounds of review and final images were selected by consensus of the study team. For intra-rater and inter-rater reliability, the kappa statistic was calculated for two readings by three musculoskeletal radiologists, a minimum of two weeks apart, of ankle and hindfoot radiographs from 30 anonymized subjects. RESULTS The atlas demonstrates individual radiographic features (osteophyte and joint space narrowing (JSN)) and Kellgren-Lawrence grade for all aspects of the talocrural (ankle joint proper) and talocalcaneal (subtalar) joints. Reliability of scoring based on the atlas was quite good to excellent for most features indicated. Additional examples of ankle joint findings are illustrated including sclerosis, os trigonum, subchondral cysts and talar tilt. CONCLUSIONS It is anticipated that this atlas will assist with standardization of scoring of ankle and hindfoot OA by basic and clinical OA researchers.
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Affiliation(s)
- Virginia Byers Kraus
- Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Terrence M Kilfoil
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Thomas W. Hash
- Department of Radiology, Duke University School of Medicine, Durham, NC
| | - Gary McDaniel
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC
| | - Jordan B Renner
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - John A. Carrino
- Department of Radiology, Department of Radiology, Weill Medical College of Cornell University, Hospital for Special Surgery, New York, NY
| | - Samuel Adams
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
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Golightly YM, Hannan MT, Dufour AB, Renner JB, Jordan JM. Factors associated with hallux valgus in a community-based cross-sectional study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken) 2015; 67:791-8. [PMID: 25418024 DOI: 10.1002/acr.22517] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2014] [Revised: 08/27/2014] [Accepted: 11/11/2014] [Indexed: 11/09/2022]
Abstract
OBJECTIVE To determine whether hallux valgus (HV) was associated with potential risk factors, including foot pain in a large, biracial cohort of older men and women. METHODS We conducted a cross-sectional analysis of cohort members of the Johnston County Osteoarthritis Project, of whom 1,502 had complete clinical and demographic data available (mean age 68 years, mean body mass index [BMI] 31.3 kg/m(2) , 68% women, and 30% African American). The presence of HV was assessed visually using a validated examination. Multivariate logistic regression models with generalized estimating equations for the total sample and for each sex and race subgroup were used to examine the effect of age, BMI, foot pain, pes planus, and knee or hip radiographic osteoarthritis (OA) on HV. RESULTS HV was present in 64% of the total sample (69% for African American men, 70% for African American women, 54% for white men, and 65% for white women). The association between HV and foot pain was elevated but not statistically significant (adjusted odds ratio [aOR] 1.21, 95% confidence interval 0.99-1.47). Women, African Americans, older individuals, and those with pes planus or knee/hip OA had significantly higher odds of HV (aOR 1.17-1.48). Participants with higher BMI had lower odds of HV compared to those with normal BMI (aOR 0.54-0.72). Overall, patterns of associations were similar across subgroups. CONCLUSION HV was associated with female sex, African American race, older age, pes planus, and knee/hip OA, and inversely associated with higher BMI. Early prevention and intervention approaches may be needed in high-risk groups; longitudinal studies would inform these approaches.
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Affiliation(s)
| | - Marian T Hannan
- Institute for Aging Research, Hebrew SeniorLife, and Harvard Medical School, Boston, Massachusetts
| | - Alyssa B Dufour
- Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, Boston, Massachusetts
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Doré AL, Golightly YM, Mercer VS, Shi XA, Renner JB, Jordan JM, Nelson AE. Lower-extremity osteoarthritis and the risk of falls in a community-based longitudinal study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken) 2015; 67:633-9. [PMID: 25331686 DOI: 10.1002/acr.22499] [Citation(s) in RCA: 74] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2014] [Revised: 10/01/2014] [Accepted: 10/14/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Knee and hip osteoarthritis (OA) are known risk factors for falls, but whether they together additionally contribute to falls risk is unknown. This study utilizes a biracial cohort of men and women to examine the influence of lower-extremity OA burden on the risk for future falls. METHODS A longitudinal analysis was performed using data from 2 time points of a large cohort. The outcome of interest was falls at followup. Covariates included age, sex, race, body mass index, a history of prior falls, symptomatic OA of the hip and/or knee, a history of neurologic or pulmonary diseases, and current use of narcotic medications. Symptomatic OA was defined as patient-reported symptoms and radiographic evidence of OA in the same joint. Logistic regression analyses were used to determine associations between covariates and falls at followup. RESULTS The odds of falling increased with an increasing number of lower-extremity symptomatic OA joints: those with 1 joint had 53% higher odds, those with 2 joints had 74% higher odds, and those with 3-4 OA joints had 85% higher odds. When controlling for covariates, patients who had symptomatic knee or hip OA had an increased likelihood of falling (adjusted odds ratio [aOR] 1.39, 95% confidence interval [95% CI] 1.02-1.88 and aOR 1.60, 95% CI 1.14-2.24, respectively). CONCLUSION This study reveals the risk for falls increases with additional symptomatic OA lower-extremity joints and confirms that symptomatic hip and knee OA are important risk factors for falls.
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Gourlay ML, Renner JB, Spang JT, Rubin JE. Subchondral insufficiency fracture of the knee: a non-traumatic injury with prolonged recovery time. BMJ Case Rep 2015; 2015:bcr-2015-209399. [PMID: 26055598 DOI: 10.1136/bcr-2015-209399] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Subchondral insufficiency fractures are non-traumatic fractures that occur immediately below the cartilage of a joint. Although low bone density may be present concurrently, it is not the underlying cause of subchondral insufficiency fractures in the majority of patients. Patients with subchondral insufficiency fracture characteristically have unremarkable plain radiographs, while MRI examination may reveal extensive bone marrow oedema and subchondral bone collapse. This article presents a 51-year-old postmenopausal woman, a physician, who had subchondral insufficiency fractures of the knee associated with prolonged standing during clinical work. She was treated with partial weight bearing on crutches until 14 months after the injury, viscosupplementation at 4 months to treat osteoarthritis and teriparatide treatment to improve bone healing at 7 months. By 26 months after the injury, she tolerated independent walking with a fabric knee support but still experienced mild posterolateral knee pain and numbness on prolonged standing.
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Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jordan B Renner
- Department of Radiology, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Jeffrey T Spang
- Department of Orthopaedic Surgery, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Janet E Rubin
- Department of Medicine/Endocrinology, University of North Carolina, Chapel Hill, North Carolina, USA
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Fu Q, Cao J, Renner JB, Jordan JM, Caterson B, Duance V, Luo M, Kraus VB. Radiographic features of hand osteoarthritis in adult Kashin-Beck Disease (KBD): the Yongshou KBD study. Osteoarthritis Cartilage 2015; 23:868-73. [PMID: 25623625 PMCID: PMC4769644 DOI: 10.1016/j.joca.2015.01.009] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/13/2015] [Accepted: 01/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Kashin-Beck Disease (KBD) is a rare and severe osteoarthropathy endemic to China. We evaluated the frequency and patterns of hand radiographic osteoarthritis (rOA) in adults with and without KBD. METHODS Han Chinese (N = 438) from Yongshou County of central China underwent right hand radiography for determining case status. Presence of KBD was based on characteristic radiographic deformities of articular ends of bones including articular surface depression, carpal crowding, any subchondral bone deformities in the proximal end of phalanges or first metacarpal bone, or the distal ends of metacarpal bones 2-5, and any bony enlargement with deformity of the distal ends of phalanges. Hand rOA severity was determined by osteophyte (OST), joint space narrowing (JSN), and Kellgren and Lawrence (KL) grades. RESULTS This study included 127 KBD and 311 non-KBD adults of similar mean age (39 years) and body mass index (BMI) (21 kg/m(2)). Inter- and intra-rater reliability for radiographic determination of case status and rOA features was high (kappa 0.72-0.96). Compared to non-KBD, KBD adults had significantly more severe hand rOA of the thumb, distal interphalangeal (DIP), proximal interphalangeal (PIP) and metacarpophalangeal (MCP) joints. Only KBD adults had end-stage carpometacapal (CMC) disease. In KBD, DIPs and PIPs were more affected than MCPs and the frequency of OSTs was significantly higher in PIPs than DIPs. CONCLUSIONS Compared with age-matched adults from the same area and farming occupation, KBD hand rOA was more widespread and severe, particularly of PIPs and CMCs. The ability to differentiate adult KBD from non-KBD hand rOA will facilitate genetic analyses of the vast majority of affected individuals.
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Affiliation(s)
- Qiang Fu
- Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi’an, Shaanxi, P.R. China,Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Medical Center, Ministry of Education, Xi’an, Shaanxi, P.R. China,Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA,Address correspondence and reprint requests to: Qiang Fu, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi'an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Junling Cao, MD, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi’an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Virginia Byers Kraus, MD, PhD, Department of Medicine, Duke University Medical Center, Box 3416, GSRB1 Building, Durham, NC, 27710, USA. Tel: 1-919-681 6652; Fax: 1-919-684 8907;
| | - Junling Cao
- Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi’an, Shaanxi, P.R. China,Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Medical Center, Ministry of Education, Xi’an, Shaanxi, P.R. China,Address correspondence and reprint requests to: Qiang Fu, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi'an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Junling Cao, MD, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi’an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Virginia Byers Kraus, MD, PhD, Department of Medicine, Duke University Medical Center, Box 3416, GSRB1 Building, Durham, NC, 27710, USA. Tel: 1-919-681 6652; Fax: 1-919-684 8907;
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,Department of Medicine and Orthopaedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Bruce Caterson
- Connective Tissue Biology Laboratories, School of Biosciences, Cardiff University, UK
| | - Victor Duance
- Connective Tissue Biology Laboratories, School of Biosciences, Cardiff University, UK
| | - Mingxiu Luo
- Institute of Endemic Diseases, School of Public Health, Xi'an Jiaotong University Medical Center, Xi’an, Shaanxi, P.R. China,Key Laboratory of Environment and Genes Related to Diseases, Xi’an Jiaotong University Medical Center, Ministry of Education, Xi’an, Shaanxi, P.R. China
| | - Virginia Byers Kraus
- Division of Rheumatology, Department of Medicine, Duke University School of Medicine, Durham, NC, USA,Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC, USA,Address correspondence and reprint requests to: Qiang Fu, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi'an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Junling Cao, MD, Institute of Endemic Diseases, Division of Public Health, School of Medicine, Xi’an Jiaotong University, 76 West Yanta Road, Xi’an, Shaanxi, 710061, P.R. China. Tel: 86-29-8265 5193; Fax: 86-29-8265 5032; , or Virginia Byers Kraus, MD, PhD, Department of Medicine, Duke University Medical Center, Box 3416, GSRB1 Building, Durham, NC, 27710, USA. Tel: 1-919-681 6652; Fax: 1-919-684 8907;
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Goode AP, Shi XA, Gracely RH, Renner JB, Jordan JM. Associations between pressure-pain threshold, symptoms, and radiographic knee and hip osteoarthritis. Arthritis Care Res (Hoboken) 2015; 66:1513-9. [PMID: 24643946 DOI: 10.1002/acr.22321] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2013] [Accepted: 03/11/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine the association between generalized evoked pressure pain sensitivity with distal pressure-pain threshold (PPT) and the presence, severity, or number of involved knee/hip joints with radiographic osteoarthritis (rOA) or related symptoms. METHODS Data for these cross-sectional analyses come from the second followup (2008-11) of the Johnston County Osteoarthritis Project (n = 1,602). PPT measurements were averaged over 2 trials from both the left and right trapezius. Outcomes of radiographic knee and hip OA were both defined by a Kellgren/Lawrence score of 2-4 and site-specific symptoms were ascertained at clinical interview. Associations were determined with multiple logistic regression models and two-way interactions were tested at P < 0.05. RESULTS The sample was 67.2% women and 31.0% African American. Participants' mean ± SD age was 67.9 ± 9.0 years, mean ± SD body mass index was 31.5 ± 7.1 kg/m(2) , mean ± SD Center for Epidemiologic Studies Depression Scale score was 6.5 ± 7.4, and mean ± SD total PPT was 3.6 ± 0.7 kg. Significant associations were found between PPT and self-reported knee/hip symptoms. No significant associations were found between PPT and presence, severity, or number of joints with knee and hip rOA without accompanying symptoms. No significant interactions were found with demographic or clinical characteristics. CONCLUSION PPT was significantly associated with self-reported single and multijoint symptoms. In contrast, after adjustment, PPT measured at the trapezius was not associated with asymptomatic knee or hip rOA. As such, PPT may prove to be a useful indicator of rOA pain processing and of why individuals respond favorably and others do not to treatments targeting rOA.
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Allen KD, Golightly YM, Callahan LF, Helmick CG, Ibrahim SA, Kwoh CK, Renner JB, Jordan JM. Race and sex differences in willingness to undergo total joint replacement: the Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2014; 66:1193-202. [PMID: 24470235 PMCID: PMC4207433 DOI: 10.1002/acr.22295] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 01/21/2014] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Using data from the community-based Johnston County Osteoarthritis Project, we examined race and sex variations in willingness to undergo, and perceptions regarding, total joint replacement (TJR). METHODS Analyses were conducted for the total sample who participated in a followup measurement period from 2006-2010 (n = 1,522) and a subsample with symptomatic hip and/or knee osteoarthritis (sOA; n = 445). Participants indicated how willing they would be to have TJR (hip or knee) if their doctor recommended it; responses were categorized as "definitely" or "probably" willing versus "unsure," "probably not," or "definitely not" willing, or "don't know." Participants answered 7 questions regarding perceptions of TJR outcomes. Multivariable logistic regression models of willingness included participant characteristics (including socioeconomic status) and TJR perception variables that were associated with willingness at the P < 0.1 level in bivariate analyses. RESULTS African Americans had lower odds of willingness to undergo TJR than whites in the total sample (adjusted odds ratio [OR] 0.47 [95% confidence interval (95% CI) 0.31-0.72]) and the sOA subsample (adjusted OR 0.42 [95% CI 0.25-0.69]). There were no sex differences in willingness. African Americans expected poorer TJR outcomes than whites, but sex differences were minimal; perceptions of TJR outcomes were not significantly associated with willingness. CONCLUSION In this community sample, race differences in TJR willingness and perceptions were substantial, but sex differences were small. Perceptions of TJR did not appear to affect willingness or explain race differences in willingness.
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Affiliation(s)
- Kelli D. Allen
- Health Services Research and Development Service, Durham Veterans Affairs Medical Center, Durham, NC, USA
- Department of Medicine, Division of General Internal Medicine, Duke University Medical Center, Durham, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Leigh F. Callahan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
- Department of Orthopaedics, University of North Carolina at Chapel Hill, NC, USA
- Department of Social Medicine, University of North Carolina at Chapel Hill, NC, USA
| | | | - Said A. Ibrahim
- Center for Health Equity Research and Promotion, Veterans Affairs Medical Center; Perelman University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - C. Kent Kwoh
- Division of Rheumatology and University of Arizona Arthritis Center, University of Arizona, Tucson, AZ
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina at Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, NC, USA
- Department of Orthopaedics, University of North Carolina at Chapel Hill, NC, USA
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Evans DS, Cailotto F, Parimi N, Valdes AM, Castaño-Betancourt MC, Liu Y, Kaplan RC, Bidlingmaier M, Vasan RS, Teumer A, Tranah GJ, Nevitt MC, Cummings SR, Orwoll ES, Barrett-Connor E, Renner JB, Jordan JM, Doherty M, Doherty SA, Uitterlinden AG, van Meurs JBJ, Spector TD, Lories RJ, Lane NE. Genome-wide association and functional studies identify a role for IGFBP3 in hip osteoarthritis. Ann Rheum Dis 2014; 74:1861-7. [PMID: 24928840 DOI: 10.1136/annrheumdis-2013-205020] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 05/22/2014] [Indexed: 01/10/2023]
Abstract
OBJECTIVES To identify genetic associations with hip osteoarthritis (HOA), we performed a meta-analysis of genome-wide association studies (GWAS) of HOA. METHODS The GWAS meta-analysis included approximately 2.5 million imputed HapMap single nucleotide polymorphisms (SNPs). HOA cases and controls defined radiographically and by total hip replacement were selected from the Osteoporotic Fractures in Men (MrOS) Study and the Study of Osteoporotic Fractures (SOF) (654 cases and 4697 controls, combined). Replication of genome-wide significant SNP associations (p ≤5×10(-8)) was examined in five studies (3243 cases and 6891 controls, combined). Functional studies were performed using in vitro models of chondrogenesis and osteogenesis. RESULTS The A allele of rs788748, located 65 kb upstream of the IGFBP3 gene, was associated with lower HOA odds at the genome-wide significance level in the discovery stage (OR 0.71, p=2×10(-8)). The association replicated in five studies (OR 0.92, p=0.020), but the joint analysis of discovery and replication results was not genome-wide significant (p=1×10(-6)). In separate study populations, the rs788748 A allele was also associated with lower circulating IGFBP3 protein levels (p=4×10(-13)), suggesting that this SNP or a variant in linkage disequilibrium could be an IGFBP3 regulatory variant. Results from functional studies were consistent with association results. Chondrocyte hypertrophy, a deleterious event in OA pathogenesis, was largely prevented upon IGFBP3 knockdown in chondrocytes. Furthermore, IGFBP3 overexpression induced cartilage catabolism and osteogenic differentiation. CONCLUSIONS Results from GWAS and functional studies provided suggestive links between IGFBP3 and HOA.
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Affiliation(s)
- Daniel S Evans
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Frederic Cailotto
- Laboratory of Tissue Homeostasis and Disease, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium
| | - Neeta Parimi
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Ana M Valdes
- Department of Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Martha C Castaño-Betancourt
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Rotterdam/Leiden, The Netherlands
| | - Youfang Liu
- Departments of Medicine and Orthopedics, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | | | - Martin Bidlingmaier
- Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Ramachandran S Vasan
- California Pacific Medical Center Research Institute, San Francisco, California, USA Laboratory of Tissue Homeostasis and Disease, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium Department of Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Rotterdam/Leiden, The Netherlands Departments of Medicine and Orthopedics, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Albert Einstein College of Medicine, Bronx, New York, USA Medizinische Klinik und Poliklinik IV, Ludwig-Maximilians-Universität München, Munich, Germany Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA Institute of Functional Genomics, Ernst Moritz Arndt University, University of Greifswald, Greifswald, Germany Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA School of Medicine, Oregon Health & Science University, Portland, Oregon, USA Division of Epidemiology, Departments of Family and Preventive Medicine and Medicine, University of California San Diego, La Jolla, California, USA Departments of Medicine and Radiology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands Department of Twin Research and Genetic Epidemiology Unit, King's College London, London, UK Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium University of California at Davis, Sacramento, California, USA
| | - Alexander Teumer
- Section of Preventive Medicine and Epidemiology, Boston University School of Medicine, Boston, Massachusetts, USA Institute of Functional Genomics, Ernst Moritz Arndt University, University of Greifswald, Greifswald, Germany
| | - Gregory J Tranah
- California Pacific Medical Center Research Institute, San Francisco, California, USA Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Steven R Cummings
- California Pacific Medical Center Research Institute, San Francisco, California, USA
| | - Eric S Orwoll
- School of Medicine, Oregon Health & Science University, Portland, Oregon, USA
| | - Elizabeth Barrett-Connor
- Division of Epidemiology, Departments of Family and Preventive Medicine and Medicine, University of California San Diego, La Jolla, California, USA
| | - Jordan B Renner
- Departments of Medicine and Radiology, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Joanne M Jordan
- Departments of Medicine and Orthopedics, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Sally A Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham City Hospital, Nottingham, UK
| | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Rotterdam/Leiden, The Netherlands Department of Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology Unit, King's College London, London, UK
| | - Rik J Lories
- Laboratory of Tissue Homeostasis and Disease, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Leuven, Belgium Division of Rheumatology, University Hospitals Leuven, Leuven, Belgium
| | - Nancy E Lane
- University of California at Davis, Sacramento, California, USA
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Yerges-Armstrong LM, Yau MS, Liu Y, Krishnan S, Renner JB, Eaton CB, Kwoh CK, Nevitt MC, Duggan DJ, Mitchell BD, Jordan JM, Hochberg MC, Jackson RD. Association analysis of BMD-associated SNPs with knee osteoarthritis. J Bone Miner Res 2014; 29:1373-9. [PMID: 24339167 PMCID: PMC4080308 DOI: 10.1002/jbmr.2160] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Revised: 11/19/2013] [Accepted: 12/03/2013] [Indexed: 01/27/2023]
Abstract
Osteoarthritis (OA) risk is widely recognized to be heritable but few loci have been identified. Observational studies have identified higher systemic bone mineral density (BMD) to be associated with an increased risk of radiographic knee osteoarthritis. With this in mind, we sought to evaluate whether well-established genetic loci for variance in BMD are associated with risk for radiographic OA in the Osteoarthritis Initiative (OAI) and the Johnston County Osteoarthritis (JoCo) Project. Cases had at least one knee with definite radiographic OA, defined as the presence of definite osteophytes with or without joint space narrowing (Kellgren-Lawrence [KL] grade ≥ 2) and controls were absent for definite radiographic OA in both knees (KL grade ≤ 1 bilaterally). There were 2014 and 658 Caucasian cases, respectively, in the OAI and JoCo Studies, and 953 and 823 controls. Single nucleotide polymorphisms (SNPs) were identified for association analysis from the literature. Genotyping was carried out on Illumina 2.5M and 1M arrays in Genetic Components of Knee OA (GeCKO) and JoCo, respectively and imputation was done. Association analyses were carried out separately in each cohort with adjustments for age, body mass index (BMI), and sex, and then parameter estimates were combined across the two cohorts by meta-analysis. We identified four SNPs significantly associated with prevalent radiographic knee OA. The strongest signal (p = 0.0009; OR = 1.22; 95% CI, 1.08-1.37) maps to 12q3, which contains a gene coding for SP7. Additional loci map to 7p14.1 (TXNDC3), 11q13.2 (LRP5), and 11p14.1 (LIN7C). For all four loci the allele associated with higher BMD was associated with higher odds of OA. A BMD risk allele score was not significantly associated with OA risk. This meta-analysis demonstrates that several genomewide association studies (GWAS)-identified BMD SNPs are nominally associated with prevalent radiographic knee OA and further supports the hypothesis that BMD, or its determinants, may be a risk factor contributing to OA development. © 2014 American Society for Bone and Mineral Research.
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Affiliation(s)
- Laura M Yerges-Armstrong
- Program in Personalized and Genomic Medicine, Division of Endocrinology, Diabetes, and Nutrition, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
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Golightly YM, Devellis RF, Nelson AE, Hannan MT, Lohmander LS, Renner JB, Jordan JM. Psychometric properties of the foot and ankle outcome score in a community-based study of adults with and without osteoarthritis. Arthritis Care Res (Hoboken) 2014; 66:395-403. [PMID: 24023029 DOI: 10.1002/acr.22162] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2013] [Accepted: 09/03/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Foot and ankle problems are common in adults, and large observational studies are needed to advance our understanding of the etiology and impact of these conditions. Valid and reliable measures of foot and ankle symptoms and physical function are necessary for this research. This study examined psychometric properties of the Foot and Ankle Outcome Score (FAOS) subscales (pain, other symptoms, activities of daily living [ADL], sport and recreational function [sport/recreation], and foot- and ankle-related quality of life [QOL]) in a large, community-based sample of African American and white men and women ages ≥50 years. METHODS Johnston County Osteoarthritis Project participants (n = 1,670) completed the 42-item FAOS (mean age 69 years, 68% women, 31% African American, mean body mass index [BMI] 31.5 kg/m(2) ). Internal consistency, test-retest reliability, convergent validity, and structural validity of each subscale were examined for the sample and for subgroups according to race, sex, age, BMI, presence of knee or hip osteoarthritis, and presence of knee, hip, or low back symptoms. RESULTS For the sample and each subgroup, Cronbach's alpha coefficients ranged from 0.95-0.97 (pain), 0.97-0.98 (ADL), 0.94-0.96 (sport/recreation), 0.89-0.92 (QOL), and 0.72-0.82 (symptoms). Correlation coefficients ranged from 0.24-0.52 for pain and symptoms subscales with foot and ankle symptoms and from 0.30-0.55 for ADL and sport/recreation subscales with the Western Ontario and McMaster Universities Osteoarthritis Index function subscale. Intraclass correlation coefficients for test-retest reliability ranged from 0.63-0.81. Items loaded on a single factor for each subscale except symptoms (2 factors). CONCLUSION The FAOS exhibited sufficient reliability and validity in this large cohort study.
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Nelson AE, Liu F, Lynch JA, Renner JB, Schwartz TA, Lane NE, Jordan JM. Association of incident symptomatic hip osteoarthritis with differences in hip shape by active shape modeling: the Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2014; 66:74-81. [PMID: 23926053 DOI: 10.1002/acr.22094] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 07/29/2013] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate hip shape by active shape modeling (ASM) as a potential predictor of incident radiographic hip osteoarthritis (RHOA) and symptomatic hip osteoarthritis (SRHOA). METHODS All hips developing RHOA from baseline (Kellgren/Lawrence [K/L] grade 0/1) to mean 6-year followup (K/L grade ≥2, 190 hips) and 1:1 control hips (K/L grade 0/1 at both times, 192 hips) were included. Proximal femur shape was defined on baseline anteroposterior pelvis radiographs and submitted to ASM, producing a mean shape and continuous variables representing independent modes of shape variation. Mode scores (n = 14, explaining 95% of shape variance) were simultaneously included in logistic regression models with incident RHOA and SRHOA as dependent variables, adjusted for intraperson correlations, sex, race, body mass index (BMI), baseline K/L grade, and/or symptoms. RESULTS We evaluated 382 hips from 342 individuals: 61% women and 83% white, with mean age 62 years and mean BMI 29 kg/m(2) . Several modes differed by sex and race, but no modes were associated with incident RHOA overall. Among men only, modes 1 and 2 were significantly associated (for a 1-SD decrease in mode 1 score: odds ratio [OR] 1.7 [95% confidence interval (95% CI) 1.1-2.5] and for a 1-SD increase in mode 2 score: OR 1.5 [95% CI 1.0-2.2]) with incident RHOA. A 1-SD decrease in mode 2 or 3 score increased the odds of SRHOA by 50%. CONCLUSION This study confirms other reports that variations in proximal femur shape have a modest association with incident hip OA. The observation of proximal femur shape associations with hip symptoms requires further investigation.
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Barbour KE, Hootman JM, Helmick CG, Murphy LB, Theis KA, Schwartz TA, Kalsbeek WD, Renner JB, Jordan JM. Meeting physical activity guidelines and the risk of incident knee osteoarthritis: a population-based prospective cohort study. Arthritis Care Res (Hoboken) 2014; 66:139-46. [PMID: 23983187 DOI: 10.1002/acr.22120] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2013] [Accepted: 07/15/2013] [Indexed: 11/09/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a leading cause of disability and joint pain. Although other risk factors of knee OA have been identified, how physical activity affects incident knee OA remains unclear. METHODS Using data from the first (1999-2004) and second (2005-2010) followup periods of the Johnston County Osteoarthritis Project study, we tested the association between meeting physical activity guidelines and incident knee outcomes among 1,522 adults ages ≥45 years. The median followup time was 6.5 years (range 4.0-10.2 years). Physical activity at baseline (moderate-equivalent physical activity minutes/week) was calculated using the Minnesota Leisure Time Physical Activity questionnaire. Incident knee radiographic OA (ROA) was defined as the development of Kellgren/Lawrence grade ≥2 in a knee at followup. Incident knee symptomatic ROA (sROA) was defined as the development of ROA and symptoms in at least 1 knee at followup. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for interval-censored data. RESULTS In multivariable models, meeting the 2008 Department of Health and Human Services (HHS) physical activity guidelines (≥150 minutes/week) was not significantly associated with ROA (HR 1.20 [95% CI 0.92-1.56]) or sROA (HR 1.24 [95% CI 0.87-1.76]). Adults in the highest level (≥300 minutes/week) of physical activity had a higher risk of knee ROA and sROA compared with inactive (0 to <10 minutes/week) participants; however, these associations were not statistically significant (HR 1.62 [95% CI 0.97-2.68] and HR 1.42 [95% CI 0.76-2.65], respectively). CONCLUSION Meeting the HHS physical activity guidelines was not associated with incident knee ROA or sROA in a cohort of middle-aged and older adults.
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Affiliation(s)
- K E Barbour
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Aslam I, Perjar I, Shi XA, Renner JB, Kraus VB, Golightly YM, Jordan JM, Nelson AE. Associations between biomarkers of joint metabolism, hand osteoarthritis, and hand pain and function: the Johnston County Osteoarthritis Project. J Rheumatol 2014; 41:938-44. [PMID: 24584914 DOI: 10.3899/jrheum.130904] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To determine the associations between joint metabolism biomarkers and hand radiographic osteoarthritis [(rOA), based on Kellgren Lawrence (KL) grade ≥ 2], symptoms, and function. METHODS Cross-sectional data were available for 663 participants (mean age 63 yrs, 63% white, 49% women). Three definitions of hand rOA were considered: (1) a composite measure involving at least 3 hand joints distributed bilaterally with 2 of 3 in the same joint group, including ≥ 1 distal interphalangeal joint, without metacarpophalangeal (MCP) swelling; (2) rOA in at least 1 joint of a group; and (3) number of joints with KL ≥ 2. We assessed hand symptoms and the 15-item Australian Canadian Hand Osteoarthritis Index (AUSCAN; Likert format). We measured serum cartilage oligomeric matrix protein (sCOMP), hyaluronic acid (sHA), carboxy-terminal propeptide of type II collagen, type II collagen degradation product, urinary C-terminal crosslinked telopeptide of type II collagen, and urinary N-terminal crosslinked telopeptide. Linear regression models were performed to assess associations between each biomarker with hand rOA, AUSCAN, and symptoms, adjusting for age, sex, race, current smoking/drinking status, body mass index, and hip and knee rOA. RESULTS In adjusted analyses, MCP (p < 0.0001) and carpometacarpal rOA (p = 0.003), and a higher number of hand joints with rOA (p = 0.009), were associated with higher levels of sHA. Positive associations were seen between AUSCAN and hand symptoms and levels of sCOMP (p ≤ 0.003) and sHA (p ≤ 0.048). CONCLUSION Hand symptoms and higher AUSCAN scores were independently associated with higher levels of both sCOMP and sHA; hand rOA was associated only with sHA levels.
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Affiliation(s)
- Imran Aslam
- From the Northeast Ohio Medical School, Rootstown, Ohio; the School of Medicine, the Thurston Arthritis Research Center, the Department of Radiology, the Department of Epidemiology, and the Department of Orthopedics, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill; SAS Institute, Cary; Duke University School of Medicine, Durham, NC, USA
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Gourlay ML, Hammett-Stabler CA, Renner JB, Rubin JE. Associations between Body Composition, Hormonal and Lifestyle Factors, Bone Turnover, and BMD. J Bone Metab 2014; 21:61-8. [PMID: 24707468 PMCID: PMC3970292 DOI: 10.11005/jbm.2014.21.1.61] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2013] [Revised: 02/14/2014] [Accepted: 02/14/2014] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The relative importance of body composition, lifestyle factors, bone turnover and hormonal factors in determining bone mineral density (BMD) is unknown. We studied younger postmenopausal women to determine whether modifiable or nonmodifiable risk factors for osteoporosis have stronger associations with BMD. METHODS In multivariable linear regression models, we tested associations between non-bone body composition measures, self-reported measures of physical activity and dietary intake, urinary N-telopeptide (NTx), sex hormone concentrations, and BMD in 109 postmenopausal women aged 50 to 64 years, adjusting for current hormone therapy use and clinical risk factors for low BMD. Lean mass, fat mass and areal BMD (aBMD) at the lumbar spine, femoral neck, total hip and distal radius were measured using dual energy X-ray absorptiometry. RESULTS Higher body weight and self-reported nonwhite race were independently associated with higher aBMD at the lumbar spine, femoral neck, total hip and distal radius. Lean and fat mass were not independently associated with aBMD. Older age and higher urinary NTx were independently associated with lower aBMD at the distal radius but not at weight-bearing sites. Sensitivity analyses demonstrated lack of an independent association between total daily protein or calorie intake and BMD. CONCLUSIONS BMD, weight and race were the most important determinants of aBMD at all sites. Older age and higher bone turnover were independently associated with lower aBMD at the distal radius. In a limited analysis, self-reported physical activity, dietary protein and calorie intake were not associated with aBMD after adjustment for the other variables.
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Affiliation(s)
- Margaret L Gourlay
- Department of Family Medicine, University of North Carolina, Chapel Hill, NC, USA
| | | | - Jordan B Renner
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Janet E Rubin
- Department of Medicine and Division of Endocrinology, University of North Carolina, Chapel Hill, NC, USA
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Kraus VB, Worrell TW, Renner JB, Coleman RE, Pieper CF. High prevalence of contralateral ankle abnormalities in association with knee osteoarthritis and malalignment. Osteoarthritis Cartilage 2013; 21:1693-9. [PMID: 23867580 PMCID: PMC3795812 DOI: 10.1016/j.joca.2013.07.008] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2012] [Revised: 07/03/2013] [Accepted: 07/09/2013] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate ankle joint abnormalities in a knee osteoarthritis (OA) cohort. METHODS Participants (n = 159) with symptomatic and radiographic OA in at least one knee underwent technetium-99m methylene diphosphonate bone scan (scored 0-3) of the ankles and forefeet. Knee radiographs were graded for OA features of joint space narrowing (JSN) and osteophyte (OST). Ankle symptoms and history of ankle injury were assessed by self-report. Knee alignment was measured from a long-limb radiograph. Ankle radiographs were obtained on those who returned for follow-up (n = 138) and were graded for ankle tibiotalar JSN and OST. DESIGN Ankle scintigraphic abnormalities were frequent (31% of individuals, one-third bilateral). Ankle symptoms were reported by 23% of individuals and history of ankle injury by 24%. Controlling for gender, age, body mass index (BMI), and contralateral predictor, ankle scintigraphic abnormalities were associated with: ipsilateral ankle symptoms (P = 0.005); contralateral knee JSN (P = 0.001), knee OST (P = 0.006) and knee malalignment (P = 0.08); and history of ankle injury or surgery of either ankle (P < 0.0001). At follow-up, scintigraphic abnormalities of the ankle were strongly associated with presence of tibiotalar radiographic OA (P < 0.0001). CONCLUSIONS Although considered rare, we observed a high prevalence of radiographic features of ankle OA in this knee OA cohort. History of overt ankle injury did not appear to account for the majority of ankle abnormalities. These results are consistent with a probable kinematic association of knee OA pathology and contralateral ankle abnormalities and suggest that interventions targeting mechanical factors may be needed to prevent ankle OA in the setting of knee OA.
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Affiliation(s)
- V B Kraus
- Departments of Medicine, Duke University Medical Center, Durham, NC 27710, USA.
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Cleveland RJ, Luong MLN, Knight JB, Schoster B, Renner JB, Jordan JM, Callahan LF. Independent associations of socioeconomic factors with disability and pain in adults with knee osteoarthritis. BMC Musculoskelet Disord 2013; 14:297. [PMID: 24134116 PMCID: PMC3906978 DOI: 10.1186/1471-2474-14-297] [Citation(s) in RCA: 54] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2013] [Accepted: 10/11/2013] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND The purpose of this study is to explore the relationship between function, pain and stiffness outcomes with individual and community socioeconomic status (SES) measures among individuals with radiographic knee osteoarthritis (rOA). METHODS Cross-sectional data from the Johnston County Osteoarthritis Project were analyzed for adults age 45 and older with knee rOA (n = 782) and a subset with both radiographic and symptomatic knee OA (n = 471). Function, pain and stiffness were measured using the Western Ontario and McMasters Universities Index of Osteoarthritis (WOMAC). Individual SES measures included educational attainment (<12 years, ≥12 years) and occupation type (managerial, non-managerial), while community SES was measured using Census block group poverty rate (<12%, 12-25%, ≥25%). SES measures were individually and simultaneously examined in linear regression models adjusting for age, gender, race, body mass index (BMI), occupational physical activity score (PAS), comorbidity count, and presence of hip symptoms. RESULTS In analyses among all individuals with rOA, models which included individual SES measures were observed to show that occupation was significantly associated with WOMAC Function (β =2.91, 95% Confidence Interval (CI) = 0.68-5.14), WOMAC Pain (β =0.93, 95% CI = 0.26-1.59) and WOMAC Total scores (β =4.05, 95% CI = 1.04-7.05), and education was significantly associated with WOMAC Function (β =3.57, 95% CI = 1.25-5.90) and WOMAC Total (β =4.56, 95% CI = 1.41-7.70) scores. In multivariable models including all SES measures simultaneously, most associations were attenuated. However, statistically significant results for education remained between WOMAC Function (β =2.83, 95% CI = 0.38-5.28) and WOMAC Total (β =3.48, 95% CI = 0.18-6.78), as well as for the association between occupation and WOMAC Pain (β =0.78, 95% CI = 0.08-1.48). In rOA subgroup analyses restricted to those with symptoms, we observed a significant increase in WOMAC Pain (β =1.36, 95% CI = 0.07-2.66) among individuals living in a block group with poverty rates greater than 25%, an association that remained when all SES measures were considered simultaneously (β =1.35, 95% CI = 0.06-2.64). CONCLUSIONS Lower individual and community SES are both associated with worse function and pain among adults with knee rOA.
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Affiliation(s)
- Rebecca J Cleveland
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - My-Linh N Luong
- Department of Health Behavior, Gillings School of Global Public Health, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joshua B Knight
- University of North Carolina School of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Britta Schoster
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan B Renner
- Thurston Arthritis Research Center and Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Joanne M Jordan
- Thurston Arthritis Research Center and Departments of Medicine and Orthopedics, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Leigh F Callahan
- Thurston Arthritis Research Center and Departments of Medicine and Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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