Amanda E. Nelson

Prevalence of Hip Symptoms and Radiographic and Symptomatic Hip Osteoarthritis in African Americans and Caucasians: The Johnston County Osteoarthritis Project

Objective. To report contemporary estimates of the prevalence of hip-related osteoarthritis (OA) outcomes in African Americans and Caucasians aged ≥ 45 years. Methods. Weighted prevalence estimates and their corresponding 95% confidence intervals for hip symptoms, radiographic hip OA, symptomatic hip OA, and severe radiographic hip OA were calculated using SUDAAN® for age, race, and sex subgroups among 3068 participants (33% African Americans, 38% men) in the baseline examination (1991–97) of The Johnston County Osteoarthritis Project, a population-based study of OA in North Carolina. Radiographic hip OA was defined as Kellgren-Lawrence radiographic grade ≥ 2, moderate/severe radiographic hip OA as grades 3 and 4, and symptomatic hip OA as hip symptoms in a hip with radiographic OA. Results. Hip symptoms were present in 36%; 28% had radiographic hip OA; nearly 10% had symptomatic hip OA; and 2.5% had moderate/severe radiographic hip OA. Prevalence of all 4 outcomes was higher in older individuals; most outcomes were higher for women and African Americans. Conclusion. African Americans in this population do not have a lower prevalence of hip-related OA outcomes as previous studies suggested. Increasing public and health system awareness of the relatively high prevalence of these outcomes, which can be disabling, may help to decrease their effects and ultimately prevent them.

A systematic review of recommendations and guidelines for the management of osteoarthritis: The Chronic Osteoarthritis Management Initiative of the U.S. Bone and Joint Initiative

PURPOSE Although a number of osteoarthritis (OA) management guidelines exist, uptake has been suboptimal. Our aim was to review and critically evaluate existing OA management guidelines to better understand potential issues and barriers. METHODS A systematic review of the literature in MEDLINE published from January 1, 2000 to April 1, 2013 was performed and supplemented by bibliographic reviews, following PRISMA guidelines and a written protocol. Following initial title and abstract screening, 2 authors independently reviewed full-text articles; a third settled disagreements. Two independent reviewers extracted data into a standardized form. Two authors independently assessed guideline quality using the AGREE II instrument; three generated summary recommendations based on the extracted guideline data. RESULTS Overall, 16 articles were included in the final review. There was broad agreement on recommendations by the various organizations. For non-pharmacologic modalities, education/self-management, exercise, weight loss if overweight, walking aids as indicated, and thermal modalities were widely recommended. For appropriate patients, joint replacement was recommended; arthroscopy with debridement was not recommended for symptomatic knee OA. Pharmacologic modalities most recommended included acetaminophen/paracetamol (first line) and NSAIDs (topical or oral, second line). Intra-articular corticosteroids were generally recommended for hip and knee OA. Controversy remains about the use of acupuncture, knee braces, heel wedges, intra-articular hyaluronans, and glucosamine/chondroitin. CONCLUSIONS The relative agreement on many OA management recommendations across organizations indicates a problem with dissemination and implementation rather than a lack of quality guidelines. Future efforts should focus on optimizing implementation in primary care settings, where the majority of OA care occurs.

Characterization of individual radiographic features of hip osteoarthritis in African American and white women and men: The Johnston County Osteoarthritis Project

To describe differences in radiographic features of hip osteoarthritis (OA) between African American and white men and women.

Association of Incident Symptomatic Hip Osteoarthritis With Differences in Hip Shape by Active Shape Modeling: The Johnston County Osteoarthritis Project

To investigate hip shape by active shape modeling (ASM) as a potential predictor of incident radiographic hip osteoarthritis (RHOA) and symptomatic hip osteoarthritis (SRHOA).

Brief Report: Differences in multijoint symptomatic osteoarthritis phenotypes by race and sex: The Johnston County Osteoarthritis Project

OBJECTIVE To determine differences in the phenotypes (patterns) of multiple-joint symptomatic osteoarthritis (OA) involvement by race and sex. METHODS A cross-sectional analysis of symptomatic OA phenotypes was performed in a community-based cohort, comprising subjects for whom data were collected from 4 sites of symptomatic OA involvement (the hands, knees, hips, and lumbosacral [LS] spine) at a single visit (2003-2010). Mutually exclusive phenotypes describing all combinations of these 4 sites were compared by race and by sex, using Fishers exact tests. For those phenotypes occurring in >40 subjects, logistic regression was performed, with adjustments for race, sex, age, and body mass index (BMI), and interactions of race and sex were assessed. RESULTS The sample included 1,650 participants, of whom 36% were men and 32% were African American. The mean age of the subjects was 66 years, and the mean BMI was 31 kg/m(2). Overall, in this sample, 13% of subjects had symptomatic hand OA, 25% had symptomatic knee OA, 11% had symptomatic hip OA, and 28% had symptomatic LS spine OA. African Americans, as compared with Caucasians, were less likely to have involvement of symptomatic OA in the hand only, or in some combination of the hand and other sites, but were more likely to have involvement of the knee only. Men, as compared to women, were less likely to have involvement of the hand only, but were more likely to have involvement of the LS spine only. CONCLUSION There are differences in the phenotypes of multiple-joint symptomatic OA involvement by race and by sex that may influence the definitions of multiple-joint, or generalized, OA.

Psychometric Properties of the Foot and Ankle Outcome Score in a Community‐Based Study of Adults With and Without Osteoarthritis

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.

Cross-sectional comparison of extended anteroposterior and posteroanterior fixed flexion positioning to assess radiographic osteoarthritis at the knee: The Johnston County Osteoarthritis Project

To compare values for Kellgren/Lawrence (K/L) scale grade, joint space narrowing (JSN), and osteophytes in anteroposterior (AP) extended and fixed flexion posteroanterior (PA) radiographs obtained during a single clinic visit (the first followup of the Johnston County Osteoarthritis Project).

Failure of serum transforming growth factor-beta (TGF-β1) as a biomarker of radiographic osteoarthritis at the knee and hip: a cross-sectional analysis in the Johnston County Osteoarthritis Project

PURPOSE To assess associations between serum transforming growth factor-beta (TGF-beta1) and radiographic knee and hip osteoarthritis (rOA) in African American (AA) and White men and women. METHODS Baseline data from 330 participants in the Johnston County Osteoarthritis Project were used in the analysis. Radiographs were scored with the Kellgren-Lawrence scale and rOA defined as grade> or =2. Individual radiographic features (IRFs) were rated 0-3. TGF-beta1 was measured using a sandwich enzyme-linked immunosorbent assay (ELISA). General linear models were used to estimate associations between lnTGF-beta1 and rOA presence, laterality or severity, and IRF presence and severity, adjusting for age, gender, race and body mass index. Interactions by race and gender were considered significant at P<0.1. RESULTS Mean lnTGF-beta1 levels were higher among AAs compared to Whites, and among women compared to men (P<0.009). Mean lnTGF-beta1 levels were higher in those with knee osteophytes (OST), but this association was not significant after adjustment. There were no other significant differences in mean lnTGF-beta1 levels by presence, laterality, or severity of knee or hip rOA or IRFs. No race or gender interactions were identified, although a borderline significant association between lnTGF-beta1 and knee OST was seen among AAs (P<0.06). CONCLUSIONS Although serum TGF-beta1 varied by race and gender and several rOA variables, there were no independent significant associations with presence, laterality, or severity of knee or hip rOA by K-L grade or IRFs, suggesting that serum TGF-beta1 is unlikely to be useful as a stand-alone biomarker in OA studies. A possible association between TGF-beta1 and OST in AAs cannot be excluded.

Lower‐Extremity Osteoarthritis and the Risk of Falls in a Community‐Based Longitudinal Study of Adults With and Without Osteoarthritis

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.

Serum transforming growth factor-beta 1 is not a robust biomarker of incident and progressive radiographic osteoarthritis at the hip and knee: the Johnston County Osteoarthritis Project☆

PURPOSE To test whether serum transforming growth factor-beta 1 (TGF-beta1) predicts incident and progressive hip or knee radiographic OA (rOA). METHODS Serum TGF-beta1 was measured for 330 participants aged 45 years and older in the Johnston County Osteoarthritis Project, with paired longitudinal films available for 618 hips and 658 knees. Incident and progressive rOA were defined using Kellgren-Lawrence (K-L) grade as well as osteophyte (OST) and joint space narrowing (JSN) scores. Natural logarithm transformation was used to produce near-normal distributions for continuous TGF-beta1 (lnTGF-beta1). Separate multivariable Weibull regression models were used to provide hazard ratios (HRs) for a 1-unit increase lnTGF-beta1 with each rOA outcome, accounting for variable follow-up times and clustering by individual, adjusted for age, race, gender, and body mass index (BMI). Interaction terms were considered statistically significant at P<0.10. RESULTS The mean (+/-SD) age of the sample was 61.9+/-9.7 years, the mean BMI was 30.3+/-6.9 kg/m(2), with 60.6% women and 42.4% AA. The mean (+/-SD) TGF-beta1 was 17.8+/-6.1 ng/ml; follow-up time was 6.1+/-1.3 years. There were no significant interactions by race or gender. HRs showed no significant relationship between lnTGF-beta1 and incident or progressive rOA, OST, or JSN, at the knee or the hip. CONCLUSIONS Levels of TGF-beta1 do not predict incident or progressive rOA, OST, or JSN at the hip or knee in this longitudinal, population-based study, making it unlikely that TGF-beta1 will be a robust biomarker for rOA in future studies.