High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990�2015: Findings from the Global Burden of Disease Study 2015

Background and purpose � Osteoarthritis (OA) imposes a substantial burden on individuals and societies. We report on the burden of knee and hip OA in the Nordic region. Patients and methods � We used the findings from the 2015 Global Burden of Diseases Study to explore prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of OA in the 6 Nordic countries during 1990�2015 (population of about 27 million in 2015). Results � During 1990�2015, the number of prevalent OA cases increased by 43 to 1,507,587 (95 uncertainty interval UI 1,454,338�1,564,778) in the region. OA accounted for 1.3% (UI 1.0�1.7) of YLDs in 1990, increasing to 1.6% (UI 1.2�2.0) in 2015. Of 315 causes studied, OA was the 15th leading cause of YLDs, causing 52,661 (UI 34,056�77,499) YLDs in 2015; of these 23% were attributable to high body mass index. The highest relative importance of OA was reported for women aged 65�74 years (8th leading cause of YLDs in 2015). Among the top 30 leading causes of YLDs in the region, OA had the 5th greatest relative increase in total YLDs during 1990�2015. From 1990 to 2015, increase in age-standardized YLDs from OA in the region was slightly lower than increase at the global level (7.5% vs. 10.5%). OA was, however, responsible for a higher proportional burden of DALYs in the region compared with the global level. Interpretation � The OA burden is high and rising in the Nordic region. With population growth, aging, and the obesity epidemic, a substantial rise in the burden of OA is expected and should be addressed in health policies. © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation

High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990�2015: Findings from the Global Burden of Disease Study 2015

Background and purpose � Osteoarthritis (OA) imposes a substantial burden on individuals and societies. We report on the burden of knee and hip OA in the Nordic region. Patients and methods � We used the findings from the 2015 Global Burden of Diseases Study to explore prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of OA in the 6 Nordic countries during 1990�2015 (population of about 27 million in 2015). Results � During 1990�2015, the number of prevalent OA cases increased by 43 to 1,507,587 (95 uncertainty interval UI 1,454,338�1,564,778) in the region. OA accounted for 1.3% (UI 1.0�1.7) of YLDs in 1990, increasing to 1.6% (UI 1.2�2.0) in 2015. Of 315 causes studied, OA was the 15th leading cause of YLDs, causing 52,661 (UI 34,056�77,499) YLDs in 2015; of these 23% were attributable to high body mass index. The highest relative importance of OA was reported for women aged 65�74 years (8th leading cause of YLDs in 2015). Among the top 30 leading causes of YLDs in the region, OA had the 5th greatest relative increase in total YLDs during 1990�2015. From 1990 to 2015, increase in age-standardized YLDs from OA in the region was slightly lower than increase at the global level (7.5% vs. 10.5%). OA was, however, responsible for a higher proportional burden of DALYs in the region compared with the global level. Interpretation � The OA burden is high and rising in the Nordic region. With population growth, aging, and the obesity epidemic, a substantial rise in the burden of OA is expected and should be addressed in health policies. © 2017 The Author(s). Published by Taylor & Francis on behalf of the Nordic Orthopedic Federation

Is increased joint loading detrimental to obese patients with knee osteoarthritis? A secondary data analysis from a randomized trial

SummaryObjectiveTo investigate whether increased knee joint loading due to improved ambulatory function and walking speed following weight loss achieved over 16 weeks accelerates symptomatic and structural disease progression over a subsequent 1 year weight maintenance period in an obese population with knee osteoarthritis (OA).MethodsData from a prospective study of weight loss in obese patients with knee OA (the CARtilage in obese knee OsteoarThritis (CAROT) study) were used to determine changes in knee joint compressive loadings (model estimated) during walking after a successful 16 week weight loss intervention. The participants were divided into ‘Unloaders’ (participants that reduced joint loads) and ‘Loaders’ (participants that increased joint loads). The primary symptomatic outcome was changes in knee symptoms, measured with the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire, during a subsequent 52 weeks weight maintenance period. The primary structural outcome was changes in tibiofemoral cartilage loss assessed semi-quantitatively (Boston Leeds Knee Osteoarthritis Score (BLOKS) from MRI after the 52 weight maintenance period.Results157 participants (82% of the CAROT cohort) with medial and/or lateral knee OA were classified as Unloaders (n = 100) or Loaders (n = 57). The groups showed similar significant changes in symptoms (group difference: −2.4 KOOS points [95% CI −6.8:1.9]) and cartilage loss (group difference: −0.06 BLOKS points [95% CI −0.22:0.11) after 1 year, with no statistically significant differences between Loaders and Unloaders.ConclusionFor obese patients undergoing a significant weight loss, increased knee joint loading for 1 year was not associated with accelerated symptomatic and structural disease progression compared to a similar weight loss group that had reduced ambulatory compressive knee joint loads.Clinicaltrials.govNCT00655941

Individual patient data meta-analysis of trials investigating the effectiveness of intra-articular glucocorticoid injections in patients with knee or hip osteoarthritis

Based on small to moderate effect sizes for the wide range of symptomatic treatments in osteoarthritis (OA), and on the heterogeneity of OA patients, treatment guidelines for OA have stressed the need for research on clinical predictors of response to different treatments. A meta-analysis to quantify the effect modified by the predictors using individual patient data (IPD) is suggested. The initiative to collect and analyze IPD in OA research is commenced by the OA Trial Bank. The study aims are therefore: to evaluate the efficacy of intra-articular glucocorticoids for knee or hip OA in specific subgroups of patients with severe pain and (mild) inflammatory signs, over both short-term and long-term follow-up, using IPD from existing studies; to reach consensus on the rules for cooperation in a consortium; and to develop and explore the methodological issues of meta-analysis with individual OA patient data. For the current IPD analysis we will collect and synthesize IPD from randomized trials studying the effect of intra-articular glucocorticoid injections in patients with hip or knee OA. Subgroup analyses will be performed for the primary outcome of pain at both short-term and long-term follow-up, in the subgroups of patients with and without severe pain and with and without inflammatory signs. This study protocol includes the first study of the OA Trial Bank, an international collaboration that initiates meta-analyses on predefined subgroups of OA patients from existing literature. This approach ensures a widely supported initiative and is therefore likely to be successful in data collection of existing trials. The collaboration developed (that is, the OA Trial Bank) may also lead to future IPD analyses on subgroups of patients with several intervention strategies applied in OA patients

The OA Trial Bank: Meta-analysis of individual patient data from knee and hip osteoarthritis trials show that patients with severe pain exhibit greater benefit from intra-articular glucocorticoids

Objective: To evaluate the efficacy of intra-articular (IA) glucocorticoids for knee or hip osteoarthritis (OA) in specific subgroups of patients with severe pain and inflammatory signs using individual patient data (IPD) from existing trials. Design: Randomized trials evaluating one or more IA glucocorticoid preparation in patients with knee or hip OA, published from 1995 up to June 2012 were selected from the literature. IPD obtained from original trials included patient and disease characteristics and outcomes measured. The primary outcome was pain severity at short-term follow-up (up to 4 weeks). The subgroup factors assessed included severe pain (≥70 points, 0-100 scale) and signs of inflammation (dichotomized in present or not) at baseline. Multilevel regression analyses were applied to estimate the magnitude of the effects in the subgroups with the individuals nested within each study. Results: Seven out of 43 published randomized clinical trials (n = 620) were included. Patients with severe baseline pain had a significantly larger reduction in short-term pain, but not in mid- and long-term pain, compared to those with less severe pain at baseline (Mean Difference 13.91; 95% Confidence Interval 1.50-26.31) when receiving IA glucocorticoid injection compared to placebo. No statistical significant interaction effects were found between inflammatory signs and IA glucocorticoid injections compared to placebo and to tidal irrigation at all follow-up points. Conclusions: This IPD meta-analysis demonstrates that patients with severe knee pain at baseline derive more benefit from IA glucocorticoid injection at short-term follow-up than those with less severe pain at baseline