Bård Natvig

Obesity and osteoarthritis in knee, hip and/or hand: An epidemiological study in the general population with 10 years follow-up

BackgroundObesity is one of the most important risk factors for osteoarthritis (OA) in knee(s). However, the relationship between obesity and OA in hand(s) and hip(s) remains controversial and needs further investigation. The purpose of this study was to investigate the impact of obesity on incident osteoarthritis (OA) in hip, knee, and hand in a general population followed in 10 years.MethodsA total of 1854 people aged 24–76 years in 1994 participated in a Norwegian study on musculoskeletal pain in both 1994 and 2004. Participants with OA or rheumatoid arthritis in 1994 and those above 74 years in 1994 were excluded, leaving n = 1675 for the analyses. The main outcome measure was OA diagnosis at follow-up based on self-report. Obesity was defined by a body mass index (BMI) of 30 and above.ResultsAt 10-years follow-up the incidence rates were 5.8% (CI 4.3–7.3) for hip OA, 7.3% (CI 5.7–9.0) for knee OA, and 5.6% (CI 4.2–7.1) for hand OA. When adjusting for age, gender, work status and leisure time activities, a high BMI (> 30) was significantly associated with knee OA (OR 2.81; 95%CI 1.32–5.96), and a dose-response relationship was found for this association. Obesity was also significantly associated with hand OA (OR 2.59; 1.08–6.19), but not with hip OA (OR 1.11; 0.41–2.97). There was no statistically significant interaction effect between BMI and gender, age or any of the other confounding variables.ConclusionA high BMI was significantly associated with knee OA and hand OA, but not with hip OA.

Localized or widespread musculoskeletal pain: does it matter?

&NA; Although epidemiological descriptions indicate that musculoskeletal pain is often widespread, still a lot of musculoskeletal pain is diagnosed and treated as localized pain. This led us to question whether localized pain exists at all and to evaluate its functional impact compared with that of widespread musculoskeletal pain. Therefore, this study aimed to describe the prevalence of localized and widespread musculoskeletal pain and its association to functional ability. In 2004, questionnaires about musculoskeletal pain were mailed to seven age groups in Ullensaker, Norway: 24–26, 34–36, 44–46, 54–56, 64–66, 74–76, and 84–86 years old. In total, 3325 persons participated (participation rate 54.4%). We excluded the oldest age group and persons who did not respond to any questions about pain during the previous week, thus reducing the participants in this study to 3179. Although musculoskeletal pain occurred frequently in the population, localized pain, in the meaning of single site pain, was relatively rare. Most people having musculoskeletal pain reported pain from a number of sites. Furthermore, experiencing single site pain did not have a large impact on physical fitness, feelings, or daily and social activities. Functional problems increased markedly, in an almost linear way with increasing number of pain sites. These findings suggest that musculoskeletal pain usually coexists with pain in other body regions and that the functional consequences are highly dependent on how widespread the pain is. This should have important implications for future research into musculoskeletal pain, and for clinical and social insurance medicine.

Does the number of musculoskeletal pain sites predict work disability? A 14-year prospective study

Various risk factors associated with disability pensioning have been reported. This study investigated the relationship between the number of pain sites and risk of receiving a disability pension. We hypothesised that risk of work disability would increase as the number of pain sites increased, even after controlling for potential confounders. In 1990 and 2004, questionnaire on musculoskeletal pain was sent via post to six age groups in Ullensaker, Norway. Data on demographic, health and work‐related variables were also collected. After excluding individuals due to reach retirement age in 2004, we followed 1354 (66%) persons who were classified in 1990 as “employed”, “unemployed”, “homemaker”, or “student”. Among them, 176 persons had received long‐term or permanent work disability pension in 2004. Bivariate analyses showed that the prevalence of disability pensions was strongly associated with the number of pain sites. Controlling for gender and age almost unaltered the relationship. However, a model controlling for all significant confounders showed that general health and sick leave previous year captured almost all the predictive power of the number of pain sites on work disability. Since these variables could be seen as intermediate variables and not confounders, they were excluded in a new model which gave a strong “dose–response” relationship between number of pain sites and disability with a 10‐fold increase from 0 to 9–10 pain sites. The predictive validity of the number of pain sites in determining future disability renders this simple measurement useful for future research on musculoskeletal pain and functioning.

Change in the number of musculoskeletal pain sites: A 14-year prospective study

Abstract Musculoskeletal pain that affects multiple body sites is typically regarded as comorbidity to single‐site pain. Pain present in multiple sites, however, is more severe and disabling compared to single‐site pain. This study aimed to prospectively investigate the change in the number of pain sites over 14 years, in addition to identifying predictors of multi‐site pain. In 1990 and 2004, questionnaires about musculoskeletal pain were mailed to six birth cohorts in Ullensaker, Norway. Data on demographic, lifestyle, and health‐related variables were also collected. Participation rate in 1990 was 67.2% and among those 60.4% participated in 2004. A slight increase in the average number of pain sites occurred between 1990 and 2004, but results showed a relatively stable pattern of pain reporting over a period of 14 years. Several demographic, lifestyle, and health‐related variables in 1990 predicted the number of pain sites at follow‐up in the bivariate analyses. However, only sex, age, sleep quality, and educational level remained significant in the final multivariate model after controlling for the number of pain sites at baseline. The final model explained 35% of the variance, of which nearly 80% was accounted for by the number of pain sites at baseline. As the pattern of reporting the number of pain sites appears relatively stable across adulthood and baseline multi‐site pain demonstrated strong predictive utility, studies investigating the occurrence of multi‐site pain in children and adolescents are recommended to determine potential causal factors contributing to the early course and development of multi‐site musculoskeletal pain.

Low back pain as a predictor of long-term work disability

Aim: To investigate low back pain (LBP), with and without other musculoskeletal pains, as a predictor of long-term work disability. Method: A four-year prospective study was conducted. All inhabitants in the municipality of Ullensaker, Norway, born in 1928-30, 1938-40, 1948-50, 1958-60 and 1968-70, received a mailed questionnaire in 1990 and 1994. The present study comprised the 1,788 responders who were working in 1990. Of these, 1426 (80%) returned the questionnaire four years later. The main outcome measure was long-term work disability (>eight weeks) in 1994. Results: LBP in 1990 predicted long-term work disability in 1994 (odds ratio (OR) = 1.95, 95% confidence interval (CI)= 1.39- 2.74 ) . Localized LBP however, did not predict long-term work disability, while LBP accompanied by widespread pain did (OR= 3.52, 95% CI = 1.09- 11.37) , also after adjustments for demographic, lifestyle, and work-related factors. Other predictors of long-term work disability were high age, sick leave last year, heavy lifting in the job, poor sleep quality and smoking. Conclusion: LBP in persons with widespread musculoskeletal pain predicted long-term work disability, while localized LBP did not.

Self-reported Bodily Pain in Schoolchildren

It has been suggested that musculoskeletal symptoms develop from early age and can be regarded as a lifespan phenomenon. The study of childhood pain might provide a better understanding of the origin of chronic pain in adults. In a study of 569 schoolchildren, aged 10-15 years, in a local community close to Oslo, 75% reported that they usually experience bodily pain. Girls reported more pain than boys. 25% of those reporting pain experience symptoms several days a week. Knee symptoms and back pain were most frequently reported. Thirty-seven % of the girls reported headache, only 20% of the boys. Girls also reported more neck and shoulder pain than boys. The oldest respondents reported symptoms from more body parts. Symptoms from several body parts were more frequent among girls. Thirty-eight % of the respondents reported that it sometimes is hard to concentrate because of the pain, and 26% reported that they sometimes have to use medication. The consequences of pain increased with increasing age and increasing number of body parts affected. The results are consistent with findings in the adult population.

Sleep problems: a predictor of long-term work disability? A four-year prospective study

Aims: This study investigates sleep problems as a predictor of long-term work disability. Methods: Data from a community-based four-year prospective study were used. In 1990, all inhabitants of the municipality of Ullensaker, Norway, belonging to six age cohorts (20-22, 30-32, 40-42, 50-52, 60-62, and 70-72 years), were mailed a questionnaire .Of the 1,788 responders who were working and not older than 62 years, 1,426 ( 80%) returned a second questionnaire four years later ( 1994) . Results: Reporting mediocre or poor sleep ( in contrast to good) in 1990 was significantly related to long-term work disability ( > 8 weeks) during the previous 12 months in 1994 ( odds ratio=2.16; 95% confidence interval=1.26-3.72) , after adjustments for age, gender, civil status, body mass index, emotional symptoms, musculoskeletal pain, self-evaluated health, smoking, physical exercise, job satisfaction, and work characteristics .Conclusion: The study indicates that sleep problems are a predictor of long-term work disability.

Musculoskeletal symptoms in a local community

Musculoskeletal complaints are common. In a population survey in a local community 40 kilometres northeast of Oslo, only 15% did not report musculoskeletal symptoms during the last year. Just as ma...

Musculoskeletal disorders as causes of sick leave and disability benefits

BACKGROUND Musculoskeletal disorders make up a heterogeneous group. Our aim was to describe the variation in social insurance benefits for the most prevalent disorders within this group. MATERIAL AND METHODS The study was based on the Norwegian labour and welfare administrations registers on sickness benefits and disability benefits. RESULTS Of the musculoskeletal disorders, low back conditions are the most frequent causes of sick leave and disability benefits, and account for 11 and 9% respectively. Neck and shoulder disorders are also common causes of sick leave, while osteoarthritis and fibromyalgia are common causes of disability benefits and each account for 5% of all new cases. INTERPRETATION The labour and welfare administration should continue to focus on musculoskeletal disorders to prevent long-term sick leave and permanent absence from work.

Bodily pain, sleep problems and mental distress in schoolchildren.

It has been suggested that childhood pain could be the beginning of a career with chronic disabling pain. Bodily pain is frequent in children. We examined the association between self‐reported bodily pain, mental distress and sleep problems in schoolchildren to test the following hypotheses: (i) that self‐reported bodily pain is associated with mental distress and sleep problems, (ii) that the association is dependent on the localization of pain, and (iii) that the association increases with number of painful areas. Eighty‐six percent of the pupils (569) in the 4th form (mean age 10.5 y), 7th form (mean age 13.5 y) and 9th form (mean age 15.5 y) from all the schools in a local community answered a questionnaire about self‐esteem, body‐image, physical activity and bodily pain. We found a strong association between the reporting of pain, mental distress and sleep problems. Pain in the knees was the only problem reported more frequently by boys than by girls, and knee pain did not show the same association with mental distress and sleep problems as pain from other regions.