Medication use and comorbidities in an increasingly younger osteoarthritis population: an 18-year retrospective open-cohort study
Jove GrahamTonia NovosatHaiyan SunBrian J. PiperJoseph A. BoscarinoMelissa S. KernVanessa A. HaydukCraig BeckR.L. RobinsonEdward CaseyJerry HallPatricia DorlingEric A. Wright
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Objectives As understanding of the pathogenesis and treatment strategies for osteoarthritis (OA) evolves, it is important to understand how patient factors are also changing. Our goal was to examine demographics and known risk factors of patients with OA over time. Design Open-cohort retrospective study using electronic health records. Setting Large US integrated health system with 7 hospitals, 2.6 million outpatient clinic visits and 97 300 hospital admissions annually in a mostly rural geographic region. Participants Adult patients with at least two encounters and a diagnosis of OA or OA-relevant surgery between 2001 and 2018. Because of geographic region, over 96% of participants were white/Caucasian. Interventions None. Primary and secondary outcome measures Descriptive statistics were used to examine age, sex, body mass index (BMI), Charlson Comorbidity Index, major comorbidities and OA-relevant prescribing over time. Results We identified 290 897 patients with OA. Prevalence of OA increased significantly from 6.7% to 33.5% and incidence increased 37% (from 3772 to 5142 new cases per 100 000 patients per year) (p<0.0001). Percentage of females declined from 65.3% to 60.8%, and percentage of patients with OA in the youngest age bracket (18–45 years) increased significantly (6.2% to 22.7%, p<0.0001). The percentage of patients with OA with BMI ≥30 remained above 50% over the time period. Patients had low comorbidity overall, but anxiety, depression and gastro-oesophageal reflux disease showed the largest increases in prevalence. Opioid use (tramadol and non-tramadol) showed peaks followed by declines, while most other medications increased slightly in use or remained steady. Conclusions We observe increasing OA prevalence and a greater proportion of younger patients over time. With better understanding of how characteristics of patients with OA are changing over time, we can develop better approaches for managing disease burden in the future.Keywords:
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Obesity is one of the most important risk factors of knee osteoarthritis (KOA), but its impact on clinical and functional consequences is less clear. The main objective of this cross-sectional study was to describe the relation between body mass index (BMI) and clinical expression of KOA. Participants with BMI ≥ 25 kg/m2 and KOA completed anonymous self-administered questionnaires. They were classified according to BMI in three groups: overweight (BMI 25-30 kg/m2), stage I obesity (BMI 30-35 kg/m2) and stage II/III obesity (BMI ≥ 35 kg/m2). The groups were compared in terms of pain, physical disability, level of physical activity (PA) and fears and beliefs concerning KOA. Among the 391 individuals included, 57.0% were overweight, 28.4% had stage I obesity and 14.6% had stage II/III obesity. Mean pain score on a 10-point visual analog scale was 4.3 (SD 2.4), 5.0 (SD 2.6) and 5.2 (SD 2.3) with overweight, stage I and stage II/III obesity, respectively (p = 0.0367). The mean WOMAC function score (out of 100) was 36.2 (SD 20.1), 39.5 (SD 21.4) and 45.6 (SD 18.4), respectively (p = 0.0409). The Knee Osteoarthritis Fears and Beliefs Questionnaire total score (KOFBEQ), daily activity score and physician score significantly differed among BMI groups (p = 0.0204, p = 0.0389 and p = 0.0413, respectively), and the PA level significantly differed (p = 0.0219). We found a dose-response relation between BMI and the clinical consequences of KOA. Strategies to treat KOA should differ by obesity severity. High PA level was associated with low BMI and contributes to preventing the clinical consequences of KOA.
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Background and Purpose: Obesity and depression are highly comorbid and far from effective treating. Celastrol was reported useful for obesity, but its role in the obesity-depression comorbidity remains unknown. This study aims to investigate the efficacy and associated mechanism of celastrol in this comorbidity.
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Summary Objective Osteoarthritis is highly prevalent and, on aggregate, is one of the largest contributors to US spending on hospital‐based health care. This study sought to examine body mass index (BMI)–related variation in the association of osteoarthritis with healthcare utilization and expenditures. Methods This is a retrospective study using administrative insurance claims linked to electronic health records. Study patients were aged ≥ 18 years with ≥1 BMI measurement recorded in 2014, with the first ( index ) BMI ≥ 25 kg m −2 . Study outcomes and covariates were measured during a 1‐year evaluation period spanning 6 months before and after index. Multivariable regression analyses examined the association of BMI with osteoarthritis prevalence, and the combined associations of osteoarthritis and BMI with osteoarthritis‐related medication utilization, all‐cause hospitalization, and healthcare expenditures. Results A total of 256 459 patients (median age = 56 y) met study eligibility criteria; 14.8% (38 050) had osteoarthritis. In multivariable analyses, the adjusted prevalence of osteoarthritis increased with increasing BMI (12.7% in patients who were overweight [25.0‐29.9 kg m −2 ] to 21.9% in patients with class III obesity [BMI ≥ 40 kg m −2 ], P < .001). Among patients with osteoarthritis, increasing BMI (from overweight to class III obesity) was associated with increased (all P < .01): utilization rates for analgesic medications (41.5‐53.5%); rates of all‐cause hospitalization (26.3%‐32.0%); and total healthcare expenditures ($18 204‐$23 372). Conclusion The prevalence and economic burden of osteoarthritis grow with increasing BMI; primary prevention of weight‐related osteoarthritis and secondary weight management may help to alleviate this burden.
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Currently, depression and obesity are chronic disorders considered public health problems because of their association with functional impairment, ominous healthcare costs, and increased morbidity and mortality rates worldwide. However, based on the high prevalence of both pathologies, a possible relationship between obesity and depression has been presumed and studied in recent years, demonstrated through observational epidemiological studies and meta-analyses, positioning them as commonly comorbid chronic diseases.
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Background: Knee osteoarthritis and obesity are both major health problems. It is now admitted that the prevalence of knee osteoarthritis gets higher with obesity and that weight loss helps knee function and allows patients to avoid surgery. Objectives: The aim of this study was to study the influence of obesity on knee osteoarthritis features. Methods: A cross-sectional study was conducted in the university hospital Taher Sfar of Tunisia over a period of 6 months. Patients who had knee osteoarthritis confirmed by radiographs were included. Sociodemographic, clinical, radiological and therapeutic data were collected from medical records and visits. Obesity was defined by a body mass index (BMI) ≥30. Functional impairment was assessed by the Womac index and Lequesne index. Results: The study included 186 patients. There were 31 males and 155 femmes. The mean age was 60±10 years. The percentage of obese patients was 53,8%. The mean age was similar in both groups obese and non obese. There were more women in the obese group compared to the non obese group (p=0.0001), more patients who had diabetes mellitus and dyslipidemia (p=0.002). Non-obese patients had a shorter duration of symptoms with no statistical significance (p=0.151). Obese patients had more involvement of both knees (p<0.0001). Obesity did not have an impact on pain severity. Severity of radiological images (p=0,0001) were more frequent in obese patients. Functional impairment was similar in both groups. However, the percentage of patients having a very important functional impairment with Lequesne index was higher in obese patients (p<0.029). Obese patients also needed more physical therapy sessions (p=0.035). Conclusion: Knee osteoarthritis in obese patients is characterized with the femlae gender predominance, bilateral knee involvement, and a more severe images on radiographs. Thus the need for better control of weight and the importance of physical activity. References: [1]Coggon D, Reading I, Croft P, et al. Knee osteoarthritis and obesity. Int J Obes Relat Metab Disord J Int Assoc Study Obes 2001; 25: 622–627. Disclosure of Interests: None declared
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Rationale: Contrary to the general population, in patients with chronic obstructive pulmonary disease (COPD) a low body mass index (BMI) is associated with excess mortality, while obesity appears protective (obesity paradox). We hypothesized that BMI is associated with a distinct number and expressi
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Obesity and depression represent two fundamental problems of public health at a global level; paediatric obesity is alarming both per se and through the risk of maintaining the obese status in adulthood and of continuing to be exposed to comorbidity, implicitly. On the other hand, depression in children is a genuine diagnostic problem (considering its masked clinical symptomatology) and a diagnostic necessity (considering its severe consequences and mostly the pathological alterations of food-related behaviour). This paper seeks to elaborate a synthesis of the current scientific literature regarding the causes of obesity – depression comorbidities in children, with a focus on the interrelation and common etiopathogenic origin.
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The epidemiological study of multiple sclerosis (MS) has been done in the population (927 400 people) of the North-Western Administrative District (SZAO) of Moscow for the period of 2008-2012. In average for the 5 years the prevalence of MS was amounted to 53.38 cases per 100 000 population, incidence was 2.16 cases per 100 000 population and the mortality rate was 0.23 cases per 100 000 population. Thus, the population of SZAO belongs to high-incidence area. An increase in the prevalence of MS as well as a reduction of incidence and mortality were observed during a comparative analysis with the epidemiological indicators of MS in Moscow in the period of 1991-1996. Such dynamics of epidemiological indicators is due to the accumulation of patients in population that, in the first place, is related with the quality improvement of diagnostic and therapeutic-rehabilitative measures which increased the frequency of early diagnosis and patient's life expectancy together with the implementation of disease-modifying therapy (DMT) and modern methods of symptomatic treatment.
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Osteoarthritis (OA) is the most common articular disease of the developed world and a leading cause of chronic disability, mostly as a consequence of the knee OA and/or hip OA. In spite of misrecognition of the exact cause, a number of studies have shown that obesity represents one of the most important risk factors and it is also a predictor for progression of OA, especially of a knee joint and less of the hip joint. Relationship between body mass index (BMI) and OA of the knee is mainly linear, and duration of increasedjoint loading or gaining weight is also significant. Studies about obesity and hand OA are contradictory. Risk gradient for BMI and the hip OA is somewhere between the knee and the hand gradient. Disability may be significantly relieved if a body weight is decreased for more than 5.1%. Twenty seven percent of cases of hip arthroplasty and 69% knee arthroplasty may be attributed to obesity. Nonpharmacologic treatment of OA includes treatment of obesity.
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