[Epidemiology of knee osteoarthritis: results of the longitudinal study of Baltimore on the aging].
Explore the source record for details and available documents.
Adult↗
Biomedical subjects
M C Hochberg
Publications and source records attributed to M C Hochberg.
Acute monoarthritis: a practical approach to assessment and treatment.
A basic approach to the patient presenting with acute monoarthritis includes a careful history, a physical examination and a selected battery of laboratory tests and radiographs. Because of the possibility of septic joint, rapid assessment and treatment are required. The most common causes of acute monoarthritis are trauma, crystals (gout and pseudogout) and infection. The most important cause of acute monoarthritis is infection, which must be excluded through the use of diagnostic joint aspiration and culture of synovial fluid.
Acute Disease↗
Association of estrogen replacement therapy with the risk of osteoarthritis of the hip in elderly white women. Study of Osteoporotic Fractures Research Group.
OBJECTIVE: To determine whether postmenopausal estrogen replacement therapy is associated with a reduced risk of radiographic findings of osteoarthritis (OA) of the hip. DESIGN: Cross-sectional study. SUBJECTS: White women (N = 4366; age, > or = 65 years) who were participants in a cohort study of osteoporotic fractures. MEASUREMENTS AND METHODS: Radiographs of the pelvis that were obtained in all subjects were assessed for radiographic features of OA of the hip on a summary scale of 0 (none) to 4 (severe OA). Postmenopausal estrogen use was assessed by interview. The association of current and past oral estrogen use with OA of the hip was analyzed by using logistic regression, adjusting for potential confounding variables (eg, indicators of osteoporosis and correlates of estrogen use). RESULTS: Five hundred thirty-nine women (12.3%) had mild or greater radiographic findings of OA of the hip in at least 1 hip, and 214 women (4.9%) had moderate to severe findings; 17% and 24% of the women were current and past users of oral estrogen, respectively. Women who were currently using oral estrogen had a significantly reduced risk of any OA of the hip (adjusted odds ratio [OR], 0.62; 95% confidence interval [CI], 0.49-0.86) and moderate to severe manifestation of disease (OR, 0.54; 95% CI, 0.33-0.88). Current users who had taken estrogen for 10 years or longer had a greater reduction in the risk of any OA of the hip (OR, 0.57; 95% CI, 0.40-0.82) compared with that of users for less than 10 years (OR, 0.75; 95% CI, 0.47-1.24). Current estrogen use for 10 years or longer was associated with a nonsignificant trend for a reduced risk of moderate to severe symptomatic disease (OR, 0.59; 95% CI, 0.28-1.29). CONCLUSION: Postmenopausal estrogen replacement therapy may protect against OA of the hip in elderly white women.
Aged↗
Preferences in the management of osteoarthritis of the hip and knee: results of a survey of community-based rheumatologists in the United States.
OBJECTIVE: To determine rheumatologists' preferences in the medical management of osteoarthritis (OA) of the hip and knee, and examine possible variations in these preferences. METHODS: A stratified random sample of 1,001 rheumatologists in community-based practice in the United States was surveyed by mail. RESULTS: Responses were obtained form 594 subjects (529 white, 499 male, mean +/- SD age 47.4 +/- 8.1 years). Over 80% used acetaminophen or nonaspirin, nonsteroidal antiinflammatory drugs (NSAIDs) either always or frequently for the management of OA of the hip and knee. A majority used the following nonpharmacologic methods either always or frequently: weight loss, cane or crutch, physical and/or occupational therapy referral, and exercise. Variation in practice preferences was noted by age (< 47 versus > or = 47 years), sex, board certification in rheumatology, and number of patients seen per month. Respondents felt that severe pain and limitation of function were the most important factors in recommending total join arthroplasty for patients. CONCLUSION: These data demonstrate that practicing rheumatologists most often use either acetaminophen and/or NSAIDs in combination with nonpharmacologic methods in the medical management of OA of the hip and knee. The existence of variation in practice preferences has policy implications.
Aged↗
Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of sociodemographic factors, obesity, and knee pain.
OBJECTIVE: This study examined the roles of sociodemographic factors (age, race, gender, education, marital status), obesity, and severity of radiographic knee osteoarthritis (OA) and knee pain on self-reported functional status. METHODS: The sample included 1,272 African-American and Caucasian individuals, aged 45 years or older, from the Johnston County Osteoarthritis Project. Analysis of variance was used to assess variation in mean Health Assessment Questionnaire (HAQ) scores by the above variables. RESULTS: Mean HAQ scores differed by severity of radiographic knee OA and knee pain, obesity, and all demographic factors (P < 0.0001), except race. Only age, female sex, obesity, and knee pain severity were independent effects (P < 0.0009). Disability associated with knee pain varied by both radiographic knee OA severity and obesity. CONCLUSIONS: Knee pain severity was more important than radiographic knee OA severity in determining disability. Obesity was independently associated with disability and compounded disability from knee pain. Studies of disability in knee OA should include assessment of obesity, severity of radiographic knee OA, and severity of knee pain, as well as their interactions.
Activities of Daily Living↗
Lack of association between augmentation mammoplasty and systemic sclerosis (scleroderma).
OBJECTIVE: To examine the possible association between augmentation mammoplasty and systemic sclerosis (SSc; scleroderma). METHODS: Eight hundred thirty-seven women with a clinical diagnosis of SSc, recruited as a volunteer sample from 3 university-based, tertiary care scleroderma clinical research centers, and 2,507 race-matched local control women, recruited by the technique of random-digit-dialing and frequency-matched on age, completed a questionnaire providing data on history of augmentation mammoplasty, including possible complications of the procedure. The odds ratio (OR) and 95 percent confidence interval (95% CI) for the association of augmentation mammoplasty with SSc were estimated by multivariate logistic regression analysis with adjustment for age, race and center, and by conditional logistic regression analysis with adjustment for age. RESULTS: Eleven (1.31%) of the 837 cases reported a history of augmentation mammoplasty prior to diagnosis of SSc, compared with 31 (1.24%) of the 2,507 controls. The adjusted OR from the unmatched analysis was 1.07 (95% CI 0.53-2.13), while that from the matched analysis was 1.11 (95% CI 0.55-2.24). CONCLUSION: These results fail to demonstrate a significant association between augmentation mammoplasty and SSc, and are consistent with those reported from other epidemiologic studies.
Adult↗
Ethnic differences in self-reported functional status in the rural south: the Johnston County Osteoarthritis Project.
OBJECTIVE: We examined ethnic differences in self-reported functional status in a rural, population-based sample in North Carolina. METHODS: Data from 1,197 African-American and Caucasian participants, aged 45 and older, in the Johnston County Osteoarthritis Project were analyzed using multiple logistic regression to examine differences in difficulty performing tasks of the Health Assessment Questionnaire (HAQ) and in risk factor profiles associated with difficulty. RESULTS: Forty-three percent reported difficulty in one or more HAQ tasks. African-Americans were more likely than Caucasians to report difficulty performing 3 tasks (P < 0.04); these differences were minimal after adjustment for confounders. For some tasks, risk factor profiles included body mass index in African-Americans only, and age and female gender more often in Caucasians. Low educational attainment was part of the risk factor profile for walking in African-Americans. CONCLUSIONS: Differences in proportions of African-Americans and Caucasians reporting difficulty in performance of HAQ tasks were minimal, but risk factor profiles for difficulty appeared to vary by ethnicity.
Activities of Daily Living↗
Aspirin and NSAID use in older women: effect on bone mineral density and fracture risk. Study of Osteoporotic Fractures Research Group.
Prostaglandin inhibition by aspirin or nonsteroidal anti-inflammatory drug (NSAIDs) may inhibit bone loss and preserve bone mineral density (BMD) in vitro and in animal models. The effect of these agents on BMD and fracture risk in postmenopausal women in unknown. We assessed the risk factors for osteoporosis and the use of aspirin and NSAIDs in 7786 white women over age 65. Axial BMD was measured at the same time, and fractures were prospectively documented over the subsequent 4 years of follow-up. In age-adjusted analyses, daily use of aspirin or NSAIDs was associated with a 2.3-5.8% increase in BMD of the hip and spine. The relationship persisted even after adjustment for weight, a variety of medications, self-reported arthritis, and for radiographic findings of osteoarthritis, but the multiply adjusted increase in BMD was only 1.0-3.1%. Fracture risk was similar among daily users of aspirin and NSAIDs and nonusers. After adjustment for potential confounders, among daily aspirin users the relative risk of hip fracture was 1.1 (95% confidence interval [CI]: 0.7, 1.6), and among daily NSAID users the risk was 0.9 (CI: 0.6, 1.4). Considering all nonspine fractures together, the risk among aspirin users was 1.0 (CI: 0.8. 1.2), and among NSAID users the risk was also 1.0 (CI; 0.8, 1.2). Regular use of aspirin or NSAIDs may have a modest beneficial effect on BMD in postmenopausal women. This effect persists after adjustment for obesity and the presence of osteoarthritis. However, among women who take aspirin or NSAIDs regularly, there is no clinically significant protective effect on the subsequent risk of fractures.
Aged↗
The association of augmentation mammoplasty with connective tissue disease, including systematic sclerosis (scleroderma): a meta-analysis.
Explore the source record for details and available documents.
Breast Implants↗
Health-related quality of life after total hip replacement.
Total hip replacement (THR) is a commonly performed orthopedic procedure with an increasing rate of utilization. It is performed to relieve symptoms of pain and help restore the loss of function that follows advanced hip diseases, including osteoarthritis, rheumatoid arthritis, and avascular necrosis. Although there are numerous studies evaluating patient outcomes after THR with respect to physical functioning and pain relief, relatively few studies have specifically evaluated changes in health-related quality of life (QOL). We reviewed a total of 20 studies that evaluated changes in QOL after THR. Results of all studies were consistent in showing beneficial and often dramatic improvements in QOL after elective THR. These improvements were most likely to occur within the first 3 to 6 months after THR. Future research should assess the impact of both patient-level predictors and the role of various surgical approaches in contributing to successful outcomes after THR.
Arthritis↗
Occupational and environmental influences on scleroderma.
This article has reviewed available data on the environmental agents, including occupational factors, that might influence susceptibility to scleroderma. None of the exposures considered could act independently in causing the disease and individually would only be responsible for a small proportion of cases. Nonetheless, they do provide useful insight into the possible mechanisms of disease causation.
Breast Implants↗
Quantitative radiography in osteoarthritis: analysis.
This article has reviewed the use of semiquantitative individual feature scales based on standard photographs in published atlases, and quantitative techniques, including chondrometry, high-definition microfocal radiography, and computerized digital image analysis, and commented on their use in longitudinal studies of osteoarthritis where data are obtained from the reading of serial radiographs. For investigators planning future studies involving the reading of already available radiographs, the use of computerized digital image analysis, if available, is recommended for measurement of joint space because of its superior reliability; if this is not available, then chondrometry should be used. Other individual features should be scored using a standard atlas. For investigators planning new studies, especially therapeutic trials, recent guidelines recommended by a World Health Organization Satellite Workshop on 'The standardization of methods for the assessment of articular cartilage changes in osteoarthritis of the knee and hip joint' should be followed (Dieppe, 1995).
Arthrography↗
Association of hand and knee osteoarthritis: evidence for a polyarticular disease subset.
OBJECTIVE: To examine the association between hand and knee osteoarthritis (OA) in a community based population. METHODS: Radiographs of 695 participants aged > or = 40 years in the Baltimore Longitudinal Study of Aging were read for changes of OA, using Kellgren-Lawrence grade > or = 2 as the case definition. RESULTS: Logistic regression analyses, adjusting for age, gender and body mass index, revealed a significant association between OA in the knee and the following joint groups: distal and proximal interphalangeal (DIP, PIP) and Hand2 (OA in two or more hand joint groups) for grade 2-4 and grade 3-4 disease, and the first carpometacarpal (CMC1) joint for grade 3-4 disease. CONCLUSION: There is an association between OA in hand sites and the knee. The strength of the associations increases with increasing disease severity. For the PIP site, there is a trend toward increasing strength of association for increasing numbers of affected joints and bilateral disease.
Adult↗
Severity of radiographic findings in hip osteoarthritis associated with total hip arthroplasty.
OBJECTIVE: The decision to perform total hip arthroplasty (THA) in patients with osteoarthritis (OA) of the hip is based largely on patients' reports of pain and disability and not on radiographic findings of OA. We determine the severity of radiographic OA and its association with disability in patients undergoing THA. METHODS: Individual radiographic features (osteophytes, joint space narrowing, sclerosis, cysts, deformity) and global severity of hip OA were assessed in 95 consecutive elderly patients with hip OA undergoing THA who were enrolled in a Patient Outcome Research Team (PORT) project. RESULTS: Eighty-seven patients (91.5%) had either severe or moderate OA in the hip to be replaced; 17% of these had a previous contralateral THA. Only 8 patients (8.4%) had mild or no signs of OA in the hip to be replaced and 4 (50%) of these patients had their opposite hip replaced previously. CONCLUSION: These data indicate that radiographic features of moderate to severe hip OA are associated with clinical findings and the necessity to perform THA in the majority of patients. Patients who have had a prior hip replacement, however, may be more likely to have a contralateral replacement done earlier (p = 0.03), before radiographic signs are evident.
Aged↗
Rheumatic and musculoskeletal diseases and impaired quality of life: a challenge for rheumatologists.
Explore the source record for details and available documents.
Humans↗
Development and progression of osteoarthritis.
Explore the source record for details and available documents.
Disease Progression↗
Validity of self-reported rheumatoid arthritis in elderly women.
OBJECTIVE: To determine the validity of a self-reported physician diagnosis of rheumatoid arthritis (RA) in elderly women. METHODS: Women with self-reported RA were contacted and permission requested to contact their physician. Physicians were mailed a questionnaire requesting information on the subject's arthritic condition. Hand radiographs obtained at study entry were read for changes of RA. RESULTS: The self-reported diagnosis of RA could be confirmed in 26 (21%) individuals. CONCLUSION: The positive predictive value of self-reported RA was low in this cohort. Caution needs to be exercised in the use and interpretation of self-report data concerning arthritic conditions in epidemiologic studies.
Aged↗