nach oben

Erschienen in:

08.01.2020 | Original Article

Identifying subgroups of community-dwelling older adults and their prospective associations with long-term knee osteoarthritis outcomes

verfasst von: Ishanka P. Munugoda, Feng Pan, Karen Wills, Siti M. Mattap, Flavia Cicuttini, Stephen E. Graves, Michelle Lorimer, Graeme Jones, Michele L. Callisaya, Dawn Aitken

Erschienen in: Clinical Rheumatology | Ausgabe 5/2020

Einloggen, um Zugang zu erhalten

Abstract

Objectives

To identify subgroups of community-dwelling older adults and to assess their longitudinal associations with long-term osteoarthritis (OA) outcomes.

Methods

1046 older adults aged 50–80 years were studied. At baseline, body mass index (BMI), pedometer-measured ambulatory activity (AA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) determined knee pain and information on comorbidities were obtained. Tibial cartilage volume and bone-marrow lesions (BMLs) were assessed using MRI at baseline and 10 years and total knee replacements (TKR) by data linkage to the Australian Orthopaedic Association National Joint Replacement Registry. Latent class analysis was used to determine participant subgroups, considering baseline BMI, AA, pain and comorbidities, and linear mixed-effects or log-binomial models were used to assess the associations.

Results

Three subgroups/classes were identified: subgroup 1 (43%): Normal/overweight participants with higher AA, lower pain and lower comorbidities; subgroup 2 (32%): Overweight participants with lower AA, mild pain and higher comorbidities; subgroup 3 (25%): Obese participants with lower AA, mild pain and higher comorbidities. Subgroup 3 had greater cartilage volume loss (β − 60.56 mm³, 95% CI − 105.91, − 15.21) and a higher risk of TKR (RR 3.19, 95% CI 1.75, 5.81), compared to subgroup 1. Subgroup 2 was not associated with cartilage volume change (β 13.06 mm³, 95% CI − 30.87, 57.00) or risk of TKR (RR 1.16, 95% CI 0.56, 2.36), compared to subgroup 1. Subgroup membership was not associated with worsening BMLs.

Conclusions

Our findings suggest the existence of homogeneous subgroups of participants and support the utility of identifying patterns of characteristics/risk factors that may cluster together and using them to identify subgroups of people who may be at a higher risk of developing and/or progressing OA.

Key Points

• Complex interplay among characteristics/factors leads to conflicting evidence between ambulatory activity and knee osteoarthritis.

• Distinct subgroups are identifiable based on ambulatory activity, body mass index, knee pain, and comorbidities.

• Identifying subgroups can be used to determine those who are at risk of developing/progressing osteoarthritis.

Nur mit Berechtigung zugänglich

Murphy SL, Lyden AK, Phillips K, Clauw DJ, Williams DA (2011) Subgroups of older adults with osteoarthritis based upon differing comorbid symptom presentations and potential underlying pain mechanisms. Arthritis Res Ther 13(4):R135PubMedPubMedCentralCrossRef

Cross M, Smith E, Hoy D, Nolte S, Ackerman I, Fransen M, Bridgett L, Williams S, Guillemin F, Hill CL, Laslett LL, Jones G, Cicuttini F, Osborne R, Vos T, Buchbinder R, Woolf A, March L (2014) The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study. Ann Rheum Dis 73(7):1323–1330PubMedCrossRef

Dore DA, Winzenberg TM, Ding C, Otahal P, Pelletier JP, Martel-Pelletier J, Cicuttini FM, Jones G (2013) The association between objectively measured physical activity and knee structural change using MRI. Ann Rheum Dis 72(7):1170–1175

Wang Y, Simpson JA, Wluka AE, Teichtahl AJ, English DR, Giles GG, Graves S, Cicuttini FM (2009) Relationship between body adiposity measures and risk of primary knee and hip replacement for osteoarthritis: a prospective cohort study. Arthritis Res Ther 11(2):R31PubMedPubMedCentralCrossRef

Aspden RM (2011) Obesity punches above its weight in osteoarthritis. Nat Rev Rheumatol 7(1):65–68PubMedCrossRef

Timmins KA, Leech RD, Batt ME, Edwards KL (2016) Running and knee osteoarthritis a systematic review and meta-analysis. Am J Sports Med 45(6):1447–1457PubMedCrossRef

Munugoda I, Wills K, Cicuttini F, Graves S, Lorimer M, Jones G, Callisaya ML, Aitken D (2018) The association between ambulatory activity, body composition and hip or knee joint replacement due to osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 26(5):671–679PubMedCrossRef

Brandt KD, Dieppe P, Radin EL (2008) Etiopathogenesis of osteoarthritis. Rheum Dis Clin North Am 34(3):531–559PubMedCrossRef

Felson DT (2010) Identifying different osteoarthritis phenotypes through epidemiology. Osteoarthritis Cartilage 18(5):601–604PubMedPubMedCentralCrossRef

10.

Lo GH, McAlindon TE, Hawker GA, Driban JB, Price LL, Song J, Eaton CB, Hochberg MC, Jackson RD, Kwoh CK, Nevitt MC, Dunlop DD (2015) Symptom assessment in knee osteoarthritis needs to account for physical activity level. Arthritis Rheum 67(11):2897–2904

11.

Dell’Isola A, Allan R, Smith S, Marreiros SS, Steultjens M (2016) Identification of clinical phenotypes in knee osteoarthritis: a systematic review of the literature. BMC Musculoskelet Disord 17(1):425PubMedPubMedCentralCrossRef

12.

Deveza LA, Melo L, Yamato TP, Mills K, Ravi V, Hunter DJ (2017) Knee osteoarthritis phenotypes and their relevance for outcomes: a systematic review. Osteoarthritis Cartilage 25(12):1926–1941PubMedCrossRef

13.

Deveza LA, Loeser RF (2017) Is osteoarthritis one disease or a collection of many? Rheumatology (Oxford) 57(suppl_4):iv34–iv42CrossRef

14.

Hakola L, Hassinen M, Komulainen P, Lakka T, Savonen K, Rauramaa R (2015) Correlates of low physical activity levels in aging men and women: the DR’s EXTRA study (ISRCTN45977199). J Aging Phys Act 23(2):247–255PubMedCrossRef

15.

Koeneman MA, Verheijden MW, Chinapaw MJ, Hopman-Rock M (2011) Determinants of physical activity and exercise in healthy older adults: a systematic review. Int J Behav Nutr Phys Act 8:142PubMedPubMedCentralCrossRef

16.

Hawker G, Stewart L, French M, Cibere J, Jordan J, March L, Suarez-Almazor M, Gooberman-Hill R (2008) Understanding the pain experience in hip and knee osteoarthritis–an OARSI/OMERACT initiative. Osteoarthritis Cartilage 16(4):415–422PubMedCrossRef

17.

Davis AM, Perruccio AV, Canizares M, Hawker GA, Roos EM, Maillefert JF, Lohmander LS (2009) Comparative, validity and responsiveness of the HOOS-PS and KOOS-PS to the WOMAC physical function subscale in total joint replacement for osteoarthritis. Osteoarthritis Cartilage 17(7):843–847PubMedCrossRef

18.

Dore D, Quinn S, Ding C, Winzenberg T, Zhai G, Cicuttini F, Jones G (2010) Natural history and clinical significance of MRI-detected bone marrow lesions at the knee: a prospective study in community dwelling older adults. Arthritis Res Ther 12(6):R223PubMedPubMedCentralCrossRef

19.

Jones G, Glisson M, Hynes K, Cicuttini F (2000) Sex and site differences in cartilage development. Arthritis Rheum 43(11):2543–2549PubMedCrossRef

20.

Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) (2018) Hip, knee & shoulder arthroplasty: 2018 annual report. AOA, Adelaide https://aoanjrr.sahmri.com/documents/10180/576950/Hip%2C%20Knee%20%26%20Shoulder%20Arthroplasty (Accessed Sep 2019)

21.

Bellamy N, Buchanan WW, Goldsmith CH, Campbell J, Stitt LW (1988) Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol 15(12):1833–1840PubMed

22.

Saunders J, Ding C, Cicuttini F, Jones G (2012) Radiographic osteoarthritis and pain are independent predictors of knee cartilage loss: a prospective study. Intern Med J 42(3):274–280PubMedCrossRef

23.

Berlin KS, Williams NA, Parra GR (2014) An introduction to latent variable mixture modeling (part 1): overview and cross-sectional latent class and latent profile analyses. J Pediatr Psychol 39(2):174–187PubMedCrossRef

24.

Nylund KL, Asparouhov T, Muthén BO (2007) Deciding on the number of classes in latent class analysis and growth mixture modeling: a Monte Carlo simulation study. Struct Equ Modeling 14(4):535–569CrossRef

25.

Kittelson AJ, Stevens-Lapsley JE, Schmiege SJ (2016) Determination of pain phenotypes in knee osteoarthritis: a latent class analysis using data from the osteoarthritis initiative. Arthritis Care Res (Hoboken) 68(5):612–620CrossRef

26.

Merz EL, Roesch SC (2011) A latent profile analysis of the five factor model of personality: modeling trait interactions. Pers Individ Differ 51(8):915–919CrossRef

27.

Nguyen TV, Eisman JA (2000) Assessment of significant change in BMD: a new approach. J Bone Miner Res 15(2):369–370PubMedCrossRef

28.

Rogers W, 1994 Regression standard errors in clustered samples. Stata J. 3(13)

29.

Gademan MG, Hofstede SN, Vliet Vlieland TP, Nelissen RG, Marang-van de Mheen PJ (2016) Indication criteria for total hip or knee arthroplasty in osteoarthritis: a state-of-the-science overview. BMC Musculoskelet Disord 17(1):463PubMedPubMedCentralCrossRef

30.

Greenland S (1989) Modeling and variable selection in epidemiologic analysis. Am J Public Health 79(3):340–349PubMedPubMedCentralCrossRef

31.

Vansteelandt S, Carpenter J, Kenward MG (2010) Analysis of incomplete data using inverse probability weighting and doubly robust estimators. Methodology (Gott) 6(1):37–48CrossRef

32.

Little RJ, D'agostino R, Cohen ML, Dickersin K, Emerson SS, Farrar JT, Frangakis C, Hogan JW, Molenberghs G, Murphy SA, Neaton JD, Rotnitzky A, Scharfstein D, Shih WJ, Siegel JP, Stern H (2012) The prevention and treatment of missing data in clinical trials. N Engl J Med 367(14):1355–1360

33.

Knoop J, van der Leeden M, Thorstensson CA, Roorda LD, Lems WF, Knol DL, Steultjens MP, Dekker J (2011) Identification of phenotypes with different clinical outcomes in knee osteoarthritis: data from the osteoarthritis initiative. Arthritis Care Res 63(11):1535–1542CrossRef

34.

Waarsing JH, Bierma-Zeinstra SM, Weinans H (2015) Distinct subtypes of knee osteoarthritis: data from the osteoarthritis initiative. Rheumatology (Oxford) 54(9):1650–1658CrossRef

35.

Carlesso LC, Segal NA, Frey-Law L, Zhang Y, Lu N, Nevitt M, Lewis CE, Neogi T (2018) Pain susceptibility phenotypes in those free of knee pain with or at risk of knee osteoarthritis: the multicenter osteoarthritis study. Arthritis Rheum 71(4):542–549

36.

Pan F, Tian J, Cicuttini F, Jones G, Aitken D (2018) Differentiating knee pain phenotypes in older adults: a prospective cohort study. Rheumatology (Oxford) 58(2):274–283CrossRef

37.

Ettinger WH Jr, Burns R, Messier SP, Applegate W, Rejeski WJ, Morgan T, Shumaker S, Berry MJ, O'Toole M, Monu J, Craven T (1997) A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The fitness arthritis and seniors trial (FAST). JAMA 277(1):25–31

38.

Pelletier JP, Raynauld JP, Berthiaume MJ, Abram F, Choquette D, Haraoui B, Beary JF, Cline GA, Meyer JM, Martel-Pelletier J (2007) Risk factors associated with the loss of cartilage volume on weight-bearing areas in knee osteoarthritis patients assessed by quantitative magnetic resonance imaging: a longitudinal study. Arthritis Res Ther 9(4):R74PubMedPubMedCentralCrossRef

39.

Berry PA, Wluka AE, Davies-Tuck ML, Wang Y, Strauss BJ, Dixon JB, Proietto J, Jones G, Cicuttini FM (2010) The relationship between body composition and structural changes at the knee. Rheumatology (Oxford) 49(12):2362–2369CrossRef

40.

Landsmeer MLA, de Vos BC, van der Plas P, van Middelkoop M, Vroegindeweij D, Bindels PJE, Oei EHG, Bierma-Zeinstra SMA, Runhaar J (2018) Effect of weight change on progression of knee OA structural features assessed by MRI in overweight and obese women. Osteoarthritis Cartilage 26(12):1666–1674PubMedCrossRef

41.

Autenrieth CS, Kirchberger I, Heier M, Zimmermann A-K, Peters A, Döring A, Thorand B (2013) Physical activity is inversely associated with multimorbidity in elderly men: results from the KORA-Age Augsburg Study. Prev Med 57(1):17–19PubMedCrossRef

42.

Cimarras-Otal C, Calderón-Larrañaga A, Poblador-Plou B, González-Rubio F, Gimeno-Feliu LA, Arjol-Serrano JL, Prados-Torres A (2014) Association between physical activity, multimorbidity, self-rated health and functional limitation in the Spanish population. BMC Public Health 14(1):1170

43.

Cohen E, Lee YC (2015) A mechanism-based approach to the management of osteoarthritis pain. Curr Osteoporos Rep 13(6):399–406PubMedPubMedCentralCrossRef

44.

Burgel P-R, Paillasseur J-L, Roche N 2014 Identification of clinical phenotypes using cluster analyses in COPD patients with multiple comorbidities. Biomed Res Int. 2014

45.

Bauman AE, Reis RS, Sallis JF, Wells JC, Loos RJ, Martin BW, Lancet Physical Activity Series Working Group (2012) Correlates of physical activity: why are some people physically active and others not? Lancet 380(9838):258–271

Titel: Identifying subgroups of community-dwelling older adults and their prospective associations with long-term knee osteoarthritis outcomes
verfasst von: Ishanka P. Munugoda
Feng Pan
Karen Wills
Siti M. Mattap
Flavia Cicuttini
Stephen E. Graves
Michelle Lorimer
Graeme Jones
Michele L. Callisaya
Dawn Aitken
Publikationsdatum: 08.01.2020
Verlag: Springer London
Erschienen in: Clinical Rheumatology / Ausgabe 5/2020
Print ISSN: 0770-3198
Elektronische ISSN: 1434-9949
DOI: https://doi.org/10.1007/s10067-019-04920-8

Leitlinien kompakt für die Innere Medizin

Mit medbee Pocketcards sicher entscheiden.

^{Seit 2022 gehört die medbee GmbH zum Springer Medizin Verlag}

Kostenlos registrieren

Neu im Fachgebiet Innere Medizin

Proximale Humerusfraktur: Auch 100-Jährige operieren?

01.05.2024 DCK 2024 Kongressbericht

Mit dem demographischen Wandel versorgt auch die Chirurgie immer mehr betagte Menschen. Von Entwicklungen wie Fast-Track können auch ältere Menschen profitieren und bei proximaler Humerusfraktur können selbst manche 100-Jährige noch sicher operiert werden.

Update Innere Medizin

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Springer Medizin

Identifying subgroups of community-dwelling older adults and their prospective associations with long-term knee osteoarthritis outcomes