Associations of Arthritis-Attributable Interference with Routine Life Activities: A Modifiable Source of Compromised Quality-of-Life.

OBJECTIVE: Arthritis patients experience the impact of disease beyond routinely assessed clinical measures. We characterized arthritis-attributable interference in four important routine life domains: 1) recreation/leisure/hobbies; 2) household chores; 3) errands/shopping; and 4) social activities. METHODS: Participants were from the Arthritis Conditions Health Effects Survey (2005-2006), a cross-sectional survey of noninstitutionalized US adults 45 years or older with doctor-diagnosed arthritis (n = 1793). We estimated the prevalence of "a lot" of arthritis-attributable interference and quantified the associations between sociodemographic, clinical, and psychological characteristics and "a lot" of arthritis-attributable interference (vs "a little" or "none") in each domain using prevalence ratios (PRs) in multivariable (MV)-adjusted logistic regression models. RESULTS: An estimated 1 in 5 to 1 in 4 adults with arthritis reported "a lot" of arthritis-attributable interference in recreation/leisure/hobbies (27%), household chores (25%), errands/shopping (22%), and social activities (18%). The highest prevalence of "a lot" of arthritis-attributable interference was for those unable to work/disabled or reporting severe arthritis symptoms (pain, stiffness, fatigue), anxiety, depression, or no/low confidence in ability to manage arthritis, across domains. In MV-adjusted models, those unable to work/disabled, currently seeing a doctor, or reporting fair/poor self-rated health, severe joint pain, anxiety, or no/low confidence in ability to manage arthritis were more likely to report arthritis-attributable interference than their respective counterparts. Magnitudes varied by domain but were consistently strongest for those unable to work/disabled (MV PR range = 1.8-2.5) and with fair/poor health (MV PR range = 1.7-2.7). CONCLUSION: Many characteristics associated with arthritis-attributable interference in routine life activities are potentially modifiable, suggesting unmet need for use of existing evidence-based interventions that address these characteristics and reduce interferences to improve quality of life.

Employment exit and entry among U.S. adults with and without arthritis during the Great Recession. A longitudinal study: 2007-2009, NHIS/MEPS.

BACKGROUND: Negative employment consequences of arthritis are known but not fully understood. Examining transitions in and out of work can provide valuable information. OBJECTIVE: To examine associations of arthritis with employment during the Great Recession and predictors of employment transitions. METHODS: Data were for 3,277 adults ages 30-62 years with and without arthritis from the 2007 National Health Interview Survey followed in the Medical Expenditure Panel Survey 2008-2009. Employment (working vs. not working) was ascertained at baseline and five follow-ups. We estimated Kaplan Meier survival curves with 95% confidence intervals (CI) separately for time to stopping work (working at baseline) and starting work (not working at baseline) using Cox proportional hazards regression models with hazard ratios (HR). RESULTS: Arthritis was significantly associated with greater risk of stopping work (HR = 1.7, 95% CI = 1.3-2.2; adjusted HR= 1.5, 95% CI = 1.1-2.0) and significantly associated with 40% lower chance of starting work (HR = 0.6, 95% CI = 0.4-0.8), which reversed on adjustment (HR = 1.5, 95% CI = 1.0-2.2). Employment predictors were mixed by outcome. CONCLUSIONS: During the Great Recession, adults with arthritis stopped work at higher rates and started work at lower rates than those without arthritis.

Differences in the diagnosis and management of systemic lupus erythematosus by primary care and specialist providers in the American Indian/Alaska Native population.

Objectives The objective of this study is to investigate differences in the diagnosis and management of systemic lupus erythematosus (SLE) by primary care and specialist physicians in a population-based registry. Methods This study includes individuals from the 2009 Indian Health Service lupus registry population with a diagnosis of SLE documented by either a primary care provider or specialist. SLE classification criteria, laboratory testing, and medication use at any time during the course of disease were determined by medical record abstraction. Results Of the 320 individuals with a diagnosis of SLE, 249 had the diagnosis documented by a specialist, with 71 documented by primary care. Individuals with a specialist diagnosis of SLE were more likely to have medical record documentation of meeting criteria for SLE by all criteria sets (American College of Rheumatology, 79% vs 22%; Boston Weighted, 82% vs 32%; and Systemic Lupus International Collaborating Clinics, 83% vs 35%; p < 0.001 for all comparisons). In addition, specialist diagnosis was associated with documentation of ever having been tested for anti-double-stranded DNA antibody and complement 3 and complement 4 ( p < 0.001). Documentation of ever receiving hydroxychloroquine was also more common with specialist diagnosis (86% vs 64%, p < 0.001). Conclusions Within the population studied, specialist diagnosis of SLE was associated with a higher likelihood of having SLE classification criteria documented, being tested for biomarkers of disease, and ever receiving treatment with hydroxychloroquine. These data support efforts both to increase specialist access for patients with suspected SLE and to provide lupus education to primary care providers.

Annual incidence rates of hip symptoms and three hip OA outcomes from a U.S. population-based cohort study: the Johnston County Osteoarthritis Project.

OBJECTIVE: Estimate annual incidence rates (IRs) of hip symptoms and three osteoarthritis (OA) outcomes (radiographic, symptomatic, and severe radiographic) overall and by race, sociodemographic characteristics, and hip OA risk factors. DESIGN: Analyze baseline (1991-1997) and first follow-up (1999-2003) data (n = 1446) from the Johnston County Osteoarthritis Project, a population-based, prospective study of adults ≥45 years in North Carolina. Hip symptoms were pain, aching, and/or stiffness on most days, or groin pain. Radiographic and severe radiographic OA were Kellgren-Lawrence (KL) grades ≥2 and ≥3, respectively. Symptomatic OA was radiographic OA with symptoms in the same hip. Sociodemographics were age, gender, race, highest attained education, and annual household income. Hip OA risk factors were self-reported body mass index (BMI) at age 18 years, clinically measured BMI at baseline, and history of hip injury. RESULTS: Annual IRs (median = 5.5 years follow-up) were 37, 23, 13, and 2.9 per 1000 person-years for hip symptoms, and radiographic, symptomatic, and severe radiographic hip OA, respectively. We found low IRs of radiographic and symptomatic hip OA among African Americans and high IRs of hip symptoms among the obese and the very poor. Across outcomes, IRs were highest for those with hip injury. CONCLUSION: No prior studies have reported IRs of hip symptoms; IRs of radiographic and severe radiographic hip OA were similar to, and the IR of symptomatic hip OA was higher than, previous estimates. Prevention efforts should target low socioeconomic status (SES) populations and obese adults; interventions for hip OA and hip symptoms are imperative for those with hip injuries.

Meeting physical activity guidelines and the risk of incident knee osteoarthritis: a population-based prospective cohort study.

OBJECTIVE: Knee osteoarthritis (OA) is a leading cause of disability and joint pain. Although other risk factors of knee OA have been identified, how physical activity affects incident knee OA remains unclear. METHODS: Using data from the first (1999-2004) and second (2005-2010) followup periods of the Johnston County Osteoarthritis Project study, we tested the association between meeting physical activity guidelines and incident knee outcomes among 1,522 adults ages ≥45 years. The median followup time was 6.5 years (range 4.0-10.2 years). Physical activity at baseline (moderate-equivalent physical activity minutes/week) was calculated using the Minnesota Leisure Time Physical Activity questionnaire. Incident knee radiographic OA (ROA) was defined as the development of Kellgren/Lawrence grade ≥2 in a knee at followup. Incident knee symptomatic ROA (sROA) was defined as the development of ROA and symptoms in at least 1 knee at followup. Weibull regression modeling was used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) for interval-censored data. RESULTS: In multivariable models, meeting the 2008 Department of Health and Human Services (HHS) physical activity guidelines (≥150 minutes/week) was not significantly associated with ROA (HR 1.20 [95% CI 0.92-1.56]) or sROA (HR 1.24 [95% CI 0.87-1.76]). Adults in the highest level (≥300 minutes/week) of physical activity had a higher risk of knee ROA and sROA compared with inactive (0 to <10 minutes/week) participants; however, these associations were not statistically significant (HR 1.62 [95% CI 0.97-2.68] and HR 1.42 [95% CI 0.76-2.65], respectively). CONCLUSION: Meeting the HHS physical activity guidelines was not associated with incident knee ROA or sROA in a cohort of middle-aged and older adults.

One in four people may develop symptomatic hip osteoarthritis in his or her lifetime.

OBJECTIVE: To estimate the lifetime risk of symptomatic hip osteoarthritis (OA). DESIGN: We analyzed data from the Johnston County Osteoarthritis Project [a longitudinal population-based study of OA in North Carolina, United States (n=3068)]. The weighted baseline sample comprised 18% blacks and 54% women, and the mean age was 63 years (range=45-93). Symptomatic hip OA was defined as a Kellgren-Lawrence (K-L) radiographic score of ≥ 2 (anterior-posterior pelvis X-rays) and pain, aching or stiffness on most days, or groin pain, in the same hip. Lifetime risk, defined as the proportion who developed symptomatic hip OA in at least one hip by age 85, among people who live to age 85, was modeled using logistic regression with repeated measures (through generalized estimating equations). RESULTS: Lifetime risk of symptomatic hip OA was 25.3% [95% confidence interval (CI)=21.3-29.3]. Lifetime risk was similar by sex, race, highest educational attainment, and hip injury history. We studied lifetime risk by body mass index (BMI) in three forms: at age 18; at baseline and follow-up; and at age 18, baseline and follow-up and found no differences in estimates. CONCLUSION: The burden of symptomatic hip OA is substantial with one in four people developing this condition by age 85. The similar race-specific estimates suggest that racial disparities in total hip replacements are not attributable to differences in disease occurrence. Despite increasing evidence that obesity predicts an increased risk of both hip OA and joint replacement, we found no association between BMI and lifetime risk.

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.

Differences in radiographic features of knee osteoarthritis in African-Americans and Caucasians: the Johnston county osteoarthritis project.

OBJECTIVE: To examine racial differences in tibiofemoral joint (TFJ) and patellofemoral joint (PFJ) radiographic osteoarthritis in African-American (AA) and Caucasian men and women. METHOD: Multiple logistic regression was used to evaluate cross-sectional associations between race and tibiofemoral osteoarthritis (TF-OA) and the presence, severity and location of individual radiographic features of tibiofemoral joint osteoarthritis [TFJ-OA] (osteophytes, joint space narrowing [JSN], sclerosis and cysts) and patellofemoral joint osteoarthritis (PFJ-OA) (osteophytes, JSN and sclerosis), using data from the Johnston County Osteoarthritis Project. Proportional odds ratios (POR) assessed severity of TF-OA, TFJ and PFJ osteophytes, and JSN, adjusting for confounders. Generalized estimating equations accounted for auto-correlation of knees. RESULTS: Among 3187 participants (32.5% AAs; 62% women; mean age 62 years), 6300 TFJ and 1957 PFJ were included. Compared to Caucasians, AA men were more likely to have TF-OA (adjusted odds ratio [aOR]=1.36; 95% CI, 1.00-1.86); tri-compartmental TFJ and PFJ osteophytes (aOR=3.06; 95%CI=1.96-4.78), and TFJ and PFJ sclerosis. AA women were more likely than Caucasian to have medial TFJ and tri-compartmental osteophytes (aOR=2.13; 1.55-2.94), and lateral TFJ sclerosis. AAs had more severe TF-OA than Caucasians (adjusted cumulative odds ratio [aPOR]=2.08; 95% CI, 1.19-3.64 for men; aPOR=1.56; 95% CI, 1.06-2.29 for women) and were more likely to have lateral TFJ JSN. CONCLUSIONS: Compared to Caucasians, AAs were more likely to have more severe TF-OA; tri-compartmental disease; and lateral JSN. Further research to clarify the discrepancy between radiographic features in OA among races appears warranted.

Racial differences in self-reported pain and function among individuals with radiographic hip and knee osteoarthritis: the Johnston County Osteoarthritis Project.

OBJECTIVE: This study compared pain and function among African Americans and Caucasian with radiographic hip and/or knee osteoarthritis (OA), controlling for radiographic severity and other patient characteristics. METHODS: Participants were 1368 individuals (32% African American) from the Johnston County Osteoarthritis Project with only knee OA, only hip OA, and both knee and hip OA. Linear regression models examined racial differences in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total scores and pain and function subscales, adjusting for radiographic severity, age, gender, education, body mass index (BMI), depressive symptoms, and WOMAC pain (last variable in models of function). RESULTS: Among those with only knee OA, African Americans had significantly worse mean WOMAC total scores than Caucasian (32.8 vs 24.3, P<0.001), and worse pain and function scores (P<0.001). Racial differences in WOMAC total, pain, and function scores persisted when controlling for radiographic severity and demographic factors but were not significant when also controlling for BMI and depressive symptoms. In models of WOMAC function, pain was the most strongly associated variable and substantially reduced the association of race with function. There were no racial differences in WOMAC scores among those with only hip OA or with both knee and hip OA. CONCLUSION: Among participants with knee OA, racial differences in pain and function may be explained by BMI and depressive symptoms, and racial differences in function may also be largely influenced by pain. Improving management of weight and depressive symptoms may be key steps toward reducing racial disparities in knee OA symptoms.

Symptoms of the knee and hip in individuals with and without limb length inequality.

OBJECTIVE: This cross-sectional study examined the association of limb length inequality (LLI) with chronic joint symptoms at the hip and knee in a large, community-based sample, adjusting for the presence of radiographic osteoarthritis (OA) and other confounders. METHODS: The total study group comprised 3012 participants with complete knee symptoms data, 3007 participants with complete hip symptoms data, and 206 with LLI>or=2 cm. Presence of chronic knee symptoms was defined as report of pain, aching, or stiffness (symptoms) of the knee on most days. Presence of chronic hip symptoms was defined as hip pain, aching, or stiffness on most days or groin pain. Multiple logistic regression models were used to examine the relationship of LLI with knee and hip symptoms, while adjusting for demographic and clinical factors, radiographic knee or hip OA and history of knee or hip problems (joint injury, fracture, surgery, or congenital anomalies). RESULTS: Participants with LLI were more likely than those without LLI to have knee symptoms (56.8% vs 43.0%, P<0.001), and hip symptoms (49.5% vs 40.0%, P=0.09). In adjusted models, knee symptoms were significantly associated with presence of LLI (adjusted odds ratio [aOR]=1.41, 95% confidence interval, [95% CI] 1.02-1.97), but the relationship between hip symptoms and LLI (aOR=1.20, 95% CI 0.87-1.67) was not statistically significant. CONCLUSION: LLI was moderately associated with chronic knee symptoms and less strongly associated with hip symptoms. LLI may be a new modifiable risk factor for therapy of people with knee or hip symptoms.

Failure of serum transforming growth factor-beta (TGF-beta1) 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.

Joint-specific hand symptoms and self-reported and performance-based functional status in African Americans and Caucasians: The Johnston County Osteoarthritis Project.

OBJECTIVE: To assess associations between joint-specific hand symptoms and self-reported and performance-based functional status. METHODS: Participants were from the population-based Johnston County Osteoarthritis Project. Symptoms in the distal interphalangeal (DIP), proximal interphalangeal (PIP), first carpometacarpal (CMC), and metacarpophalangeal (MCP) joints were assessed on a 30-joint diagram of both hands. Self-reported function was assessed by Health Assessment Questionnaire (HAQ) and performance-based function by timed repeated chair stands and 8-foot walk time. Separate multiple logistic regression models examined associations between symptoms in specific hand joint groups, symptoms in >/=2 hand joint groups and number of symptomatic hand joints, and functional status measures, controlling for age, race/ethnicity, sex, body mass index, radiographic knee and hip OA, knee and hip symptoms and depressive symptoms. RESULTS: Those with symptomatic hand joint groups were more likely than those without these complaints to report more difficulty and require longer times for performance measures. Those with 2 or more symptomatic hand joint groups were more likely to have higher HAQ scores (OR = 1.97 (1.53 to 2.53)) and require more time to complete 5 chair stands (OR = 1.98 (1.23 to 3.18)) and the 8 foot walk test (OR = 1.49 (1.12 to 1.99)). CONCLUSIONS: Joint-specific hand symptoms are associated with difficulty performing upper- or lower-extremity tasks, independent of knee and hip OA and symptoms, suggesting that studies examining functional status in OA should not ignore symptomatic joints beyond the joint site of interest, even when functional measures appear to be specific for the joint site under study.

Relationship of limb length inequality with radiographic knee and hip osteoarthritis.

OBJECTIVE: This study examined the relationship of limb length inequality (LLI) with radiographic hip and knee osteoarthritis (OA) in a large, community-based sample. METHODS: The total study group comprised 926 participants with radiographic knee OA, 796 with radiographic hip OA, and 210 (6.6%) with LLI >or=2cm. The presence of radiographic OA was defined as Kellgren/Lawrence (K/L) grade >or=2. Multiple logistic regression models were used to examine the relationship of LLI with hip and knee OA, while controlling for age, gender, race, body mass index, and history of hip or knee problems (joint injury, fracture, surgery, or congenital anomalies). RESULTS: In unadjusted analyses, participants with LLI were more likely than those without LLI to have radiographic knee OA (45.1% vs 28.3%, P<0.001) and radiographic hip OA (35.2% vs 28.7%, P=0.063). In multiple logistic regression models, knee OA was significantly associated with presence of LLI (adjusted Odds Ratio [aOR]=1.80, 95% Confidence Interval [95% CI] 1.29-2.52), but there was no significant relationship between hip OA and LLI (aOR=1.20, 95% CI 0.86-1.67). Among participants with LLI, right hip OA was more common when the contralateral limb was longer than when the ipsilateral limb was longer (30.3% vs 17.5%, P=0.070). CONCLUSION: LLI was associated with radiographic knee OA, controlling for other important variables. Future research should examine the relationship of LLI with hip or knee OA incidence, progression, and symptom severity, as well as the efficacy for LLI corrective treatments in OA.

Prevalence and impact of arthritis among nursing home residents.

OBJECTIVE: To determine the prevalence, characteristics, and impact of arthritis in the US nursing home population. METHODS: A national cross sectional sample of US nursing homes (8138 sampled residents in 1406 nursing homes) from the 1997 National Nursing Home Survey provided demographic and functional characteristics for residents with primary arthritis, any arthritis, or no arthritis diagnosis at admission. RESULTS: Of the estimated 1.6 million current nursing home residents in 1997, only 43,000 (3%) had a primary and 300,000 (19%) had any arthritis diagnosis at admission. People with a primary or any arthritis diagnosis received physical/occupational therapy, used wheelchairs and walking aids, and needed assistance with walking and transferring more often than those with no arthritis diagnosis. CONCLUSIONS: These national estimates suggest that arthritis is underreported in nursing home residents. Because arthritis contributes to an increased physical burden on staff and decreased functional capability of residents, both staff and residents can benefit from better diagnosis, intervention, and education.

Serum cartilage oligomeric matrix protein and clinical signs and symptoms of potential pre-radiographic hip and knee pathology.

OBJECTIVE: To examine the cross-sectional relationship between serum cartilage oligomeric matrix protein (COMP) and hip and knee clinical signs and symptoms in a sample of adults without radiographic hip or knee osteoarthritis (OA). DESIGN: A total of 145 persons with available sera and no evidence of radiographic hip or knee OA (Kellgren-Lawrence grade 0) were randomly selected from the Caucasian participants of the Johnston County Osteoarthritis Project. COMP was quantified by a competitive ELISA assay with a monoclonal antibody 17-C10. Hip and knee clinical signs and symptoms were assessed by physical examination and interview, and their associations with Ln COMP analysed with general linear models. RESULTS: After adjustment for age, gender, body mass index (BMI), and other symptomatic joints, mean Ln COMP was statistically significantly higher among persons with hip-related clinical signs (P=0.018), among those with hip-related symptoms (P=0.046), and among individuals meeting American College of Rheumatology clinical criteria for hip OA (P=0.021). There were no statistically significant associations between any of the knee-related clinical signs and symptoms and Ln COMP. CONCLUSION: Serum COMP may be useful as a biomarker of pre-radiographic hip joint pathology; its utility as a biomarker of pre-radiographic knee joint pathology is unclear.

Inactivity-Associated medical costs among US adults with arthritis.

OBJECTIVE: To analyze direct medical costs among US adults with arthritis and estimate the proportion associated with inactivity. METHODS: In the 1987 National Medical Expenditure Survey, arthritis was defined using questions on self-reported, doctor-diagnosed arthritis or rheumatism. Physical activity was defined using a self-report question on level of activity. Inactivity-associated medical costs were derived by subtracting costs for active adults from costs for inactive adults after controlling for functional limitation. RESULTS: Among 5,486 adults with arthritis, inactive persons had higher medical costs than did active persons in all demographic groups examined. In multivariate models adjusting for key covariates, the proportion of costs associated with inactivity averaged 12.4% ($1,250 in 2000 dollars) and ranged from 7.8% to 14.3% among various demographic groups. CONCLUSION: Inactivity-associated medical costs among persons with arthritis are considerable. Physical activity interventions may be a cost-effective strategy for reducing the burden of arthritis.

Serum carotenoids and radiographic knee osteoarthritis: the Johnston County Osteoarthritis Project.

OBJECTIVE: Antioxidant intake has been associated with less progression of radiographic knee osteoarthritis (OA), but studies of carotenoid biomarkers and OA have not been done. We examined associations between serum concentrations of nine naturally occurring carotenoids and radiographic knee OA. DESIGN: The study design was matched case-control. Sera were analysed by high-performance liquid chromatography for nine carotenoids: lutein, zeaxanthin, alpha- and beta-cryptoxanthin, trans- and cis-lycopene, alpha-carotene, and trans- and cis-beta-carotene. Conditional logistic regression was used to estimate the association between tertiles of each carotenoid and radiographic knee OA, independent of body mass index, education, serum cholesterol, and the other carotenoids. SETTING: Johnston County, North Carolina, United States of America. SUBJECTS: Two-hundred cases with radiographic knee OA (Kellgren-Lawrence grades > or = 2) and 200 controls (Kellgren-Lawrence grade = 0) were randomly selected from the Johnston County Osteoarthritis Project, and were matched on age, gender and race. RESULTS: Participants with serum levels of lutein or beta-cryptoxanthin in the highest tertile were approximately 70% less likely to have knee OA than controls (odds ratio (OR) [95% confidence interval (CI)] = 0.28 [0.11, 0.73] and 0.36 [0.14, 0.95], respectively). Those in the highest tertile of trans-beta-carotene (OR = 6.40 [1.86, 22.1]) and zeaxanthin (OR = 3.06 [1.19, 7.85]) were more likely to have knee OA. CONCLUSIONS: While certain carotenoids may protect against knee OA, others may increase the odds of knee OA. Further study of carotenoids and knee OA are warranted before clinical recommendations about these substances and knee OA can be made.

Osteoarthritis: new insights. Part 1: the disease and its risk factors.

Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weight-bearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability.

The role of personal health concerns and knowledge of the health effects of hormone replacement therapy (HRT) on the ever use of HRT by menopausal women, aged 50-54 years.

UNLABELLED: Previous studies of factors important in a woman's decision to use hormone replacement therapy (HRT) infrequently have simultaneously considered the effects of personal concern for chronic medical disorders that begin at the time of the menopause (such as osteoporosis and heart disease) and knowledge of the beneficial and adverse effects of HRT on these conditions (increased risk of uterine and breast cancers). Moreover, few studies have been performed in broad-based populations that have included black women. This study was undertaken to determine the cross-sectional association of concern for chronic medical disorders that begin at the time of the menopause and knowledge of the effects of HRT on these disorders on the ever use of HRT in a biracial cohort of postmenopausal women. Two hundred eight-eight women, aged 50-54 years, who were members of an HMO, who reported their last menstrual period to be more than 1 year ago, and who were aware of HRT, were examined by questionnaire. Of the cohort, 21.2% were black. Concern for chronic medical disorders that begin at the time of the menopause was modest (approximately 50%). Knowledge of the effects of HRT on breast cancer, uterine cancer, and heart disease was low (approximately 30%). Only for osteoporosis was knowledge high (approximately 65%). On adjusted analysis, concern for heart disease was weakly associated with ever use of HRT, but only for white women. The factors most strongly associated with initiating HRT were a doctor's recommendation to use HRT and satisfaction with a doctor's counseling. Having menopausal symptoms was associated with ever use of HRT in black women. Black women were only 30% as likely as white women to ever use HRT after adjustment for baseline differences. CONCLUSION: In this study, personal concerns for medical conditions that begin at the time of the menopause and knowledge of the effects of HRT on these conditions were low. Only personal concern for heart disease among white women was independently, but weakly, associated with ever use of HRT. Black women were less likely than white women to ever use HRT, even after adjustment for baseline differences between them.