Epidemiology of osteoarthritis and associated comorbidities in the United Kingdom

Background Osteoarthritis (OA) is very common and is the main cause of chronic joint pain and disability in older people. According to this systematic review nearly 67% of people with OA had comorbidity. There is little information available on how the incidence and prevalence of OA has changed over the past 20 years in the UK, and what is the likelihood of having other chronic conditions, their progression, and associated outcomes. Objectives This research aimed to answer five questions: 1) how common is osteoarthritis in the UK and what are the trends over the past twenty years; 2) are people with osteoarthritis more likely to have other chronic conditions and multimorbidity (two or more conditions in an individual)than people without osteoarthritis; 3) in people with OA how do these long-term conditions coexist; 4) how does the group of long-term conditions progress with time; and 5) does the presence of long-term conditions in osteoarthritis add to the burden both to patients and to health services. Methods A large nationally representative UK primary care database known as the Clinical Practice Research Datalink(CPRD)GOLD was used for the study. Six different studies were performed in this thesis in people aged 20 years or more with OA and age, sex, and practice matched controls. These are:1) epidemiology of osteoarthritis in the UK (chapter 3); 2) risk of comorbidities occurring before and after the diagnosis of osteoarthritis using both case-control and cohort design(chapter 4); 3) clusters of multimorbidity in people with OA and controls using latent class analysis (chapter 5); 4) illness pathways (transition and trajectories) of multimorbidity clusters in people with OA and controls using latent transition analysis and latent class growth analysis, respectively (chapter 6 and 7); 5) outcomes such as all-cause mortality, outpatient visits, inpatient admission and disability adjusted life years (DALYs) associated with OA and their comorbidities (chapter 8). Results The prevalence of OA in the UK primary care in 2017 was 10.7% and the incidence was 6.8 per 1000 person-years in people aged 20 and over. OA was more common in women compared to men and increased with age, especially after age 40 years. The prevalence has increased at a rate of 1.4% per year since 1998, whereas the incidence is declining at a rate of -1.6% per year. The burden of joint pain defined as OA is quite high, constituting nearly one third of primary care adult patients. People with OA are more likely to have multimorbidity prior to (aOR1.71, 95%CI1.69-1.74) and after the diagnosis of OA (aHR1.29, 95%CI1.28-1.30) than people without OA. Musculoskeletal (MSK), gastrointestinal (GI), cardiovascular (CV) and psychological conditions were associated with OA before and after the diagnosis of OA, whereas dementia and systemic lupus erythematous (SLE)were only associated with OA after its diagnosis. Other conditions that showed significant associations with OA both before and after diagnosis, were anaemia, inflammatory bowel disease (IBD), benign prostatic hypertrophy (BPH), gall stones, liver diseases, cancer, and hearing impairment. Five multimorbidity clusters were identified in OA. These clusters were led by both pain and hypertension, hypertension only, depression, back pain only, and relative healthy group (lowest number of any conditions). Over time, comorbidity clusters changed after the diagnosis of OA. About 30% of people changed from the cluster driven by either back pain or hypertension to the cluster driven by both back pain and hypertension. The accumulation of multimorbidity in people with OA happens in five different ways, and 17.5% of people develop multimorbidity quicker compared to relative healthy group. Obesity, smoking and alcohol use during the diagnosis of OA are strongly associated with the faster development of multimorbidity. People with OA were 1.2 times more likely to consult with general practitioners (GP),1.1 times more likely to be hospitalised, 3.25 times likely to get higher DALYs and 1.9 times more likely to die. Within OA, people with multimorbidity had higher mortality, burden, and health utilisations. Conclusions OA affects one in ten people aged 20 years or more in the UK. The burden of both GP diagnosed OA and joint pain in primary care is consistently high and increasing further. People with OA are more likely to develop other chronic conditions. Five different comorbidity clusters have been identified. While younger people are likely to have pain and depression, the elderly are likely to have CV-MSK comorbidities. The growth of multimorbidity in people with OA differs with 17.5% developing it faster than others. People with OA and CV-MSK and CV comorbidity have worse health outcomes. This information from this study can be used to develop personalised care in primary care. Further research is needed to understand the causality between OA and comorbidity

A Study on the Prevalence of Alcohol Consumption, Tobacco Use and Sexual Behaviour among Adolescents in Urban Areas of the Udupi District, Karnataka, India

Objectives: The aim of this study was to assess the prevalence of alcohol consumption, tobacco use and risky sexual behaviour among adolescents, and to evaluate the socioeconomic factors potentially influencing these behaviours. Methods: This cross-sectional study was conducted from January to April 2011 among 376 adolescents (15–19 years old) studying in different schools and colleges in Udupi, India. The Youth Risk Behavior Survey questionnaire and guidelines were followed for data collection. Participants’ alcohol consumption, smoking habits and sexual behaviour patterns were explored. Univariate analysis followed by multivariate logistic regression was done. Results: The prevalence of alcohol consumption, tobacco use and sexual activity was found to occur in 5.7%, 7.2% and 5.5% of participants, respectively. The mean age of the participants’ first sexual activity, consumption of alcohol and tobacco use was reported to be approximately 16.8 years. Multivariate analysis showed that males were more likely to have used alcohol and tobacco. Other factors, such as religion and tobacco use among family members, were found to be influential. Conclusion: The potential coexistence of multiple risk behaviours in a student demands an integrated approach. Emphasis should be placed on health education in schools and an increased awareness among parents in order to prevent adolescents’ behaviours from becoming a risk to their health

Comorbidities in Osteoarthritis: a systematic review and meta-analysis of observational studies

ObjectivesOsteoarthritis (OA) is a common chronic condition in older people but its association with other chronic conditions is largely unknown. This study aimed to systematically review the literature on comorbidities in people with OA compared to those without.MethodsWe searched four databases for observational studies on comorbidities in people with OA. Studies of OA only or in comparison with non‐OA controls were included. Risk of bias and study quality was assessed using the Newcastle‐Ottawa Scale (NOS). The prevalence of comorbidities in the OA group and prevalence ratio (PR) and 95% confidence interval (CI) between OA and non‐OA groups were calculated.ResultsForty‐two studies from 16 countries (27 case‐only and 15 comparative studies) met the inclusion criteria. Mean age of participants varied from 51 to 76 years. Pooled prevalence of any comorbidity was 67% (95%CI: 57%‐74%) in people with OA versus 56% (95%CI: 44%‐68%) in people without OA. The pooled PR for any comorbidity was 1.21 (95%CI: 1.02‐1.45). The PR increased from 0.73 (95%CI: 0.43‐1.25) for one comorbidity, to 1.58 (95%CI: 1.03‐2.42) for two, and 1.94 (95%CI 1.45‐ 2.59) for three or more comorbidities. The key comorbidities associated with OA were stroke (PR 2.61; 95%CI: 2.13‐3.21), peptic ulcer (PR 2.36; 95%CI: 1.71‐3.27) and metabolic syndrome (PR 1.94; 95%CI 1.21‐3.12).ConclusionsPeople with OA are more likely to have other chronic conditions. The association is dose‐dependent in terms of the number of comorbidities, suggesting multimorbidities. Further studies on the causality of this association and clinical implications are needed

Green Care kuntoutumisen tukena mielenterveyskuntoutujien palvelukodissa

Tämän opinnäytetyön tavoitteena oli suunnitella ja toteuttaa Green Care-menetelmillä toiminnallisia ryhmiä. Ryhmien tavoitteena oli selvittää mielenterveyskuntoutujien kokemuksia eräässä mielenterveys- ja päihdekuntoutujien palvelukodissa. Opinnäytetyön tavoitteena oli myös tarkastella Green Care-menetelmien merkitystä palvelukodin asiakkaiden kuntoutumiseen. Opinnäytetyön tarkoituksena oli myös lisätä mielenterveys- ja päihdekuntoutujien palvelukodin palvelutarjontaa ja toimintatapoja Green Care-menetelmien avulla. Palvelukoti tarjoaa asumis-, kuntoutus- ja tukipalveluja 30:lle päihde- ja mielenterveyskuntoutujalle ja siellä noudatetaan yhteisöllisyyden periaatteita. Opinnäytetyön viitekehyksessä kuvaan erilaisia Green Care-menetelmiä ja niiden hyvinvointivaikutuksia sekä Green Caren etiikkaa. Kerron myös Green Care-käsitteestä, sen historiasta sekä esiintymisestä Suomessa. Green Care-toimintaa pidetään sateenvarjokäsitteenä erilaisille luontolähtöisille ja eläinavusteisille menetelmille, joilla pyritään edistämään ihmisten sosiaalista, fyysistä, psyykkistä ja koulutuksellista hyvinvointia. Green Care-toiminnan keskeisimmät elementit ovat luonto, luonnossa tapahtuva ja luontoelementtejä käyttävä toiminta sekä yhteisö, jossa toiminta tapahtuu. Teoriaosuudessa kerron myös mielenterveyskuntouksesta, sen käsitteistä ja kuntoutuksen prosessista. Kuvaan myös kuntoutusvalmiutta ja toimintakyvyn arviointia sekä mielenterveystyön etiikkaa. Mielenterveys on hyvinvoinnin tila, jossa ihminen näkee omat kykynsä selviytyä elämän haasteista ja työstä ja ottaa osaa yhteisönsä toimintaan. Opinnäytetyö on toiminnallinen opinnäytetyö, jonka tutkimuksellisessa osuudessa on käytetty osallistuvaa havainnointia ja avointa haastattelua. Haastattelut olivat ryhmähaastatteluja ja kolmelle asiakkaalle tehtiin myös yksilöhaastattelut. Tutkimuksen tulokset on analysoitu teemoittelun avulla. Sekä havaintojen että haastattelujen perusteella palvelukodin asiakkaat kokivat Green Care-menetelmät positiivisina, aktivoivina ja erilaisia hyvinvointivaikutuksia tuottavina. Yleisimmin koettu hyvinvointivaikutus oli menetelmien rauhoittava vaikutus. Green Care-toiminnan merkitystä palvelukodin mielenterveyskuntoutujille oli vaikea arvioida neljän toimintakerran avulla, mutta viitteitä antavana tuloksena voidaan pitää kahden asiakkaan toimintakyvyn lisääntymistä toiminnan aikana. Palvelukodin asiakkaat osallistuivat Green Care-menetelmillä toteutettuihin toimintaryhmiin aktiivisemmin kuin koskaan aikaisemmin ulkopuolisen tahon järjestämään toimintaan. Näiden kokemusten vuoksi palvelukoti aikoo hyödyntää jatkossa luontolähtöisiä menetelmiä enemmän palveluissaan. Opinnäytetyön tulokset ovat hyvin saman suuntaiset kuin Green Care-toiminnasta tehdyissä tutkimuksissa Suomessa ja ulkomailla. Menetelmien hyvinvointivaikutuksista on olemassa paljon näyttöä erilaisille asiakasryhmille. Mielenterveys- ja päihdekuntoutujien palvelukodissa, jossa opinnäytetyö tehtiin, ei ollut aikaisemmin juurikaan hyödynnetty luontoa asiakkaiden kuntoutumisen tukena. Neljä toimintakertaa oli melko lyhyt aika arvioida, miten Green Care-toiminnat tukevat asiakkaiden kuntoutumista palvelukodissa, joten toivon, että asiaa tutkitaan lisää, kun palvelukodissa on käytetty Green Care-toimintoja vähintään vuoden ajan.Using Green Care methods to support rehabilitation of mental health rehabilitees in a service flat. This thesis goal was to plan and help groups with certain functions and “Green Care” methods. The main goal of the groups was to find out about the experiences of mental health rehabilitees in one mental health and drug addict institution. The idea of the thesis was also to study the meaning of “Green Care” methods in the rehabilitation of rehabilitees in the institution. The goal was to increase the services and methods in the mental health and drug addict institution using “Green Care” methods. The service flats provide housing, rehabilitation and other support services to 30 mental health and drug addict rehabilitees and they try to bring a community spirit within the service. In the framework of the thesis I give information about the different “Green Care” methods, the welfare effects and the ethics of “Green Care”. I also described the concept of “Green Care”, its history and its appearance in Finland. “Green Care” methods are known as a rainbow concept of different methods were nature and animals play a part in advancing humans` social, physical, metal and educational welfare. The main elements in “Green Care” methods are nature, activities in nature and the use of nature elements. Also the community were the actions take place is important. In the theory part I wrote about mental health rehabilitation, concepts and the process of rehabilitation. I described the willingness for rehabilitation, the ability to function and the ethics of mental work. Mental health is a state of welfare where you can see your ability to survive the challenges of life and work and you can take part in a community’s functions. The thesis is a functional thesis in which there was used an examinational part, participating observation and open interviews. The interviews were group interviews and three customers also participated in the individual interviews. The results of the examination were analysed using the theme method. When analysing the results of the examination it was discovered that the customers of the mental health and drug addict institution found “Green Care” methods positive, activating and providing welfare. The customers found that the methods had a calming effect. The meaning of “Green Care” methods to the institutions rehabilitees was hard to estimate based on four visits to the service flats. But some progress was seen on two rehabilitees ability to function during the time “Green Care” methods were used. The customers in the service flats participated more willingly to functioning groups using “Green Care” methods than to any other functioning groups that were organized by an outsider. Because of these experiences the institution will use more nature based methods in its services. The results of the thesis are very similar to other examinations made in Finland and other countries about “Green Care” methods. The welfare effects of the methods used show various evidence using different customer groups. Nature was hardly ever used as a method of rehabilitation for the customers in the mental health and drug addict institution in which the thesis was made. Four times using the methods was quite a short time to evaluate how “Creen Care” methods was quite a short time to evaluate how “Green Care” methods support the rehabilitation of the customers in the service flat so I hope that there is a possibility to study the rehabilitees more when the methods are used at least for a year

Constitutional morphological features and risk of hip osteoarthritis: A case-control study using standard radiographs

© Author(s) (or their employer(s)) 2020. No commercial re-use. See rights and permissions. Published by BMJ. Objectives: To evaluate the risk of association with hip osteoarthritis (OA) of 14 morphological features measured on standard antero-posterior pelvis radiographs. Methods: A case-control study of 566 symptomatic unilateral hip OA cases and 1108 controls without hip OA, using the Genetics of OA and Lifestyle database. Unaffected hips of cases were assumed to reflect pre-OA morphology of the contralateral affected hip. ORs with 95% CI adjusted for confounding factors were calculated using logistic regression. Hierarchical clustering on principal component method was used to identify clusters of morphological features. Proportional risk contribution (PRC) of these morphological features in the context of other risk factors of hip OA was estimated using receiver operating characteristic analysis. Results: All morphological features showed right-left symmetry in controls. Each feature was associated with hip OA after adjusting for age, gender and body mass index. Increased sourcil angle had the strongest association (OR: 6.93, 95% CI 5.16 to 9.32). Three clusters were identified. The PRC varied between individual features, as well as between clusters. It was 35% (95% CI 31% to 40%) for all 14 morphological features, compared to 21% (95% CI 19% to 24%) for all other well-established risk factors. Conclusions: Constitutional morphological variation strongly associates with hip OA development and may explain much of its heritability. Relevant morphological measures can be assessed readily on standard radiographs to help predict risk of hip OA. Prospective studies are required to provide further support for causality

Comorbidities and use of analgesics in people with knee pain: a study in the Nottingham Knee Pain and Health in the Community (KPIC) cohort

Objectives: The aims were to examine the prevalence of comorbidities and role of oral analgesic use in people with knee pain (KP) compared with those without. Methods: The Knee Pain and related health In the Community (KPIC) cohort comprises community-derived adults aged ≥40 years, irrespective of knee pain. Thirty-six comorbidities across 10 systems were compared between people with KP and controls without KP or knee OA. Multivariable logistic regression analysis was used to determine the adjusted odds ratio (aOR) and 95% CI for multimorbidity (at least two chronic conditions) and each specific comorbidity. Both prescribed and over-the-counter analgesics were included in the model, and their interactions with KP for comorbidity outcomes were examined. Results: Two thousand eight hundred and thirty-two cases with KP and 2518 controls were selected from 9506 baseline participants. The mean age of KP cases was 62.2 years, and 57% were women. Overall, 29% of the total study population had multimorbidity (KP cases 34.4%; controls 23.8%). After adjustment for age, sex, BMI and analgesic use, KP was significantly associated with multimorbidity (aOR 1.35; 95% CI 1.17, 1.56) and with cardiovascular (aOR 1.25; 95% CI 1.08, 1.44), gastrointestinal (aOR 1.34; 95% CI 1.04, 1.92), chronic widespread pain (aOR 1.54; 95% CI 1.29, 1.86) and neurological (aOR 1.32; 95% CI 1.01, 1.76) comorbidities. For multimorbidity, the use of paracetamol and opioids interacted positively with KP, whereas the use of NSAIDs interacted negatively for seven comorbidities. Conclusion: People with KP are more likely to have other chronic conditions. The long-term benefits and harms of this change remain to be investigated. Trial registration: ClinicalTrials.gov, http://clinicaltrials.gov, NCT02098070

The Causal Association Between Osteoarthritis and Common Comorbidities: A Mendelian Randomisation Study

ObjectiveTo investigate the causal association between Osteoarthritis (OA) and five comorbidities: depression, tiredness, multisite chronic pain, irritable bowel syndrome (IBS) and gout.DesignThis study used two-sample Mendelian Randomisation (MR). To select the OA genetic instruments, we used data from the largest recent genome-wide association study (GWAS) of OA (GO Consortium), with a focus on OA of the knee (62,497 cases, 333,557 controls), hip (35,445 cases, 316,943 controls) and hand (20,901 cases, 282,881 controls). Genetic associations for comorbidities were selected from GWAS for depression (246,363 cases, 561,190 controls), tiredness (449,019 participants), multisite chronic pain (387,649 participants), IBS (53,400 cases, 433,201 controls) and gout (6543 cases, 456,390 controls). We performed a bidirectional MR analysis using the inverse variance weighted method, for both joint specific and overall OA.ResultsHip OA had a causal effect on multisite chronic pain (per unit change 0.02, 95% CI 0.01 to 0.04). Multisite chronic pain had a causal effect on knee (odd ratio (OR) 2.74, 95% CI 2.20 to 3.41), hip (OR 2.12, 95% CI 1.54 to 2.92), hand (OR 2.24, 95% CI 1.59 to 3.16) and overall OA (OR 2.44, 95% CI, 2.06 to 2.86). In addition, depression and tiredness had causal effects on knee and hand, but not hip, OA.ConclusionsApart from Hip OA to multisite chronic pain, other joint OA did not have causal effects on these comorbidities. In contrast, multisite chronic pain had a causal effect on any painful OA

The association between antihypertensive treatment and serious adverse events by age and frailty: A cohort study

BACKGROUND: Antihypertensives are effective at reducing the risk of cardiovascular disease, but limited data exist quantifying their association with serious adverse events, particularly in older people with frailty. This study aimed to examine this association using nationally representative electronic health record data. METHODS AND FINDINGS: This was a retrospective cohort study utilising linked data from 1,256 general practices across England held within the Clinical Practice Research Datalink between 1998 and 2018. Included patients were aged 40+ years, with a systolic blood pressure reading between 130 and 179 mm Hg, and not previously prescribed antihypertensive treatment. The main exposure was defined as a first prescription of antihypertensive treatment. The primary outcome was hospitalisation or death within 10 years from falls. Secondary outcomes were hypotension, syncope, fractures, acute kidney injury, electrolyte abnormalities, and primary care attendance with gout. The association between treatment and these serious adverse events was examined by Cox regression adjusted for propensity score. This propensity score was generated from a multivariable logistic regression model with patient characteristics, medical history and medication prescriptions as covariates, and new antihypertensive treatment as the outcome. Subgroup analyses were undertaken by age and frailty. Of 3,834,056 patients followed for a median of 7.1 years, 484,187 (12.6%) were prescribed new antihypertensive treatment in the 12 months before the index date (baseline). Antihypertensives were associated with an increased risk of hospitalisation or death from falls (adjusted hazard ratio [aHR] 1.23, 95% confidence interval (CI) 1.21 to 1.26), hypotension (aHR 1.32, 95% CI 1.29 to 1.35), syncope (aHR 1.20, 95% CI 1.17 to 1.22), acute kidney injury (aHR 1.44, 95% CI 1.41 to 1.47), electrolyte abnormalities (aHR 1.45, 95% CI 1.43 to 1.48), and primary care attendance with gout (aHR 1.35, 95% CI 1.32 to 1.37). The absolute risk of serious adverse events with treatment was very low, with 6 fall events per 10,000 patients treated per year. In older patients (80 to 89 years) and those with severe frailty, this absolute risk was increased, with 61 and 84 fall events per 10,000 patients treated per year (respectively). Findings were consistent in sensitivity analyses using different approaches to address confounding and taking into account the competing risk of death. A strength of this analysis is that it provides evidence regarding the association between antihypertensive treatment and serious adverse events, in a population of patients more representative than those enrolled in previous randomised controlled trials. Although treatment effect estimates fell within the 95% CIs of those from such trials, these analyses were observational in nature and so bias from unmeasured confounding cannot be ruled out. CONCLUSIONS: Antihypertensive treatment was associated with serious adverse events. Overall, the absolute risk of this harm was low, with the exception of older patients and those with moderate to severe frailty, where the risks were similar to the likelihood of benefit from treatment. In these populations, physicians may want to consider alternative approaches to management of blood pressure and refrain from prescribing new treatment