Body weight, body mass index, and incident symptomatic osteoarthritis of the hand, hip, and knee.

Studies have shown a positive association between obesity and knee osteoarthritis. Studies evaluating hand or hip osteoarthritis and weight, however, have assessed x-ray osteoarthritis or been cross-sectional, or both, and results of these have been inconsistent. We assessed the association between body weight, body mass index, and incident symptomatic osteoarthritis in 134 matched case-control pairs of women who were part of a case-control study on estrogen replacement therapy and osteoarthritis. We identified incident symptomatic osteoarthritis cases of the hand, hip, and knee in women ages 20-89 years who were members of a health plan between January 1, 1990 and December 31, 1993. For each case we selected a control woman who was matched by closest date of birth to the case. Medical records were reviewed to obtain weight and height information for the period before disease onset. After controlling for estrogen use, smoking status, height, and health care use, we found that body weight was a predictor of incident osteoarthritis of the hand, hip, and knee. Odds ratios ranged from 3.0 to 10.5 for women in the upper tertiles of weight compared with women in the lowest tertile. Similar associations were observed for body mass index. Our results suggest that obesity is associated with the development of incident osteoarthritis at all joints studied.

Estrogen replacement therapy and urinary tract infections in postmenopausal women aged 45-89.

OBJECTIVE: An elevated risk of urinary tract infections (UTIs) in postmenopausal women has been attributed to an increase in the vaginal pH. Estrogen replacement therapy (ERT) helps restore the vaginal milieu and may have a beneficial effect on risk of infection. Studies examining the association between ERT and UTIs have been inconsistent. We conducted a nested case control study to clarify this relationship in women aged 45-89. DESIGN: For each case, we selected up to five control women, matched by year of birth. We used pharmacy records to classify women as new users, past users, ongoing users (past and new users), and never users of ERT. There were 254 cases and 1,268 controls. RESULTS: The risk ratio for UTI was 1.02 [95% confidence interval (CI) 0.74, 1.40] for any use versus never use, after adjustment for health care utilization. The risk ratio for the association between new use and UTI was 1.13 (95% CI 0.46, 2.77). For ongoing users the risk ratio was 1.08 (95% CI 0.76, 1.54), whereas the risk ratio for past use was 0.77 (95% CI 0.39, 1.48). CONCLUSIONS: Our results do not support a protective effect of ERT on the risk of UTIs.

Incidence of symptomatic hand, hip, and knee osteoarthritis among patients in a health maintenance organization.

OBJECTIVE: To quantify the incidence of symptomatic hand, hip, and knee osteoarthritis (OA) among members of the Fallon Community Health Plan, a health maintenance organization located in central Massachusetts. METHODS: Incident OA was defined as the first evidence of OA by radiography (grade > or = 2 on the Kellgren-Lawrence scale of 0-4) plus joint symptoms at the time the radiograph was obtained or up to 1 year before the radiograph was obtained. RESULTS: The age- and sex-standardized incidence rate for hand OA was 100/100,000 person-years (95% confidence interval [95% CI] 86, 115), for hip OA 88/100,000 person-years (95% CI 75, 101), and for knee OA 240/100,000 person-years (95% CI 218, 262). The incidence of hand, hip, and knee OA increased with age, and women had higher rates than men, especially after age 50. A leveling off or decline occurred for both groups around the age of 80. CONCLUSION: In a large study of symptomatic OA we observed incidence rates that increased with age. In women ages 70-89, the incidence of knee OA approached 1% per year.