Older Adults without Radiographic Knee Osteoarthritis: Knee Alignment and Knee Range of Motion.

This study describes knee alignment and active knee range of motion (ROM) in a community-based group of 78-year old adults (n = 143) who did not have radiographic evidence of knee osteoarthritis in either knee (KL < 2). Although knee malalignment is a risk factor for knee osteoarthritis, most women and men had either valgus or varus alignments. Notably, no men were valgus in both knees. Women with both knees valgus had significantly greater body mass index (P > 0.001) than women with varus or straight knees. Men and women with valgus or varus knee alignments had generally lower ROM than individuals with both knees straight. In summary, this study highlights the complex relationships among knee alignment, ROM, body mass index, and gender in elderly adults without radiographic knee osteoarthritis.

Older Subjects without Radiographic Knee Osteoarthritis: Weight, Height, and Body Mass Index.

UNLABELLED: Osteoarthritis, the most common form of arthritis, conservatively affects 27 million American adults. While nearly all joints can be affected, knee osteoarthritis is of particular interest as it has the potential to severely limit mobility. Despite its ubiquity, not everyone is affected. Few studies on the characteristics of these persons exist. This descriptive paper examined older subjects without radiographic knee osteoarthritis (RKOA) at age 78, describing their height, weight and body mass index (BMI). Oldest subjects without RKOA at age 78 (n=143) were selected from the parent Clearwater Osteoarthritis Study, conducted from 1988-2009. Recalled weight and height for ages 25 and 45, as well as current weight and height were collected via questionnaire. Current measurements were also taken. BMI was derived. Absence of RKOA was determined using Kellgren-Lawrence criteria. DEMOGRAPHICS: mostly female (72%), all Caucasian, better educated than the average US citizen, and more subjects lived with others. At all three life-stages, weights and BMI were lower, while heights were comparable to US 2000 figures. BMI was in the "normal" category at age 25 and in the "overweight" category at age 78. Weight was under reported and height was over reported, but by less than the general population. Both the increase in weight and decrease in height with age were statistically significant. Absence of RKOA appears to be related to lower weights, average heights, and lower BMI, relative to population norms at all three life-stages. These findings also suggest that the relationship may be more complicated. Higher BMI is ubiquitously recognized as a risk factor for RKOA, yet the average BMI of the subjects without RKOA was in the "overweight" category at age 78. A possible explanation may be an "inflated" BMI based on decrease in height, not just increase in weight.

Does diabetes hide osteoarthritis pain?

Clinical practice and research efforts related to the highly prevalent and disabling disease, osteoarthritis (OA), have long been hampered by an inadequate case definition. Much of the difficulty is due to a lack of agreement between X-rays evidence of OA and a patient's report of pain at that site. Such discordance between reported pain and radiographic evidence of OA has been attributed to several factors. This paper proposes another possible explanation, for at least a portion of such patients. It is hypothesized that an insidiously increasing diabetic neuropathy, particularly in the lower extremity, while first causing some pain, may gradually inhibit the ability to feel pain which might have otherwise been reported by those patients without neuropathy. Many of these patients with early stage glucose dysmetabolism will proceed to develop overt type 2 diabetes; however, the pain-inhibiting neuropathy caused by glucose metabolism dysfunction may manifest long before such a diagnosis. The high prevalence of diabetes and pre-diabetic conditions, especially among the aged population, could mean that a substantial number of individuals with osteoarthritis will have both diseases to varying degrees over time. Validating and quantifying this hypothesized association would be useful to millions of persons and would significantly impact both research and clinical practice dealing with these major diseases of older persons.

Radiographic cervical spine osteoarthritis progression rates: a longitudinal assessment.

Relative to other sites, the cervical spine has received little attention in the osteoarthritis (OA) literature. Using data from a longitudinal study, we provide age-specific progression rates of radiographic cervical spine OA, by gender. Data from cohort subjects (ages 40+) from the Clearwater Osteoarthritis Study were analyzed (N = 707). All study subjects' demonstrated radiographic cervical spine OA at baseline (2+). Lateral cervical spine radiographs were taken biennially. The study outcome was radiographic disease progression. A grade increase of 1, or more, by the Lawrence and Kellgren ordinal scale was considered progression. Incidence rates were calculated as per 100 person-years of observation. We show that the progression rates for cervical spine OA increase with age. For all ages combined, men demonstrated higher rates of progression compared with women. However, among subjects in their forties and fifties, women were more likely to experience worsening of their disease when compared with men. Progression rates were similar for men and women in their sixties (8.2 and 8.0, respectively). Among subjects in their seventies, men demonstrated a significantly higher rate of progression compared with women (12.5 and 8.6, respectively). As the baby-boomer population continues to increase, cervical spine OA progression assessment can be a useful tool for health-care resource planning. Cervical spine OA research offers an abundance of opportunities. Instability as a precursor to the development of cervical spine OA warrants further research. Epidemiological studies addressing demographic differences (e.g., gender, age) in the incidence of cervical spine OA will contribute to the current knowledge base.