OA strongly affects difficulty in walking

Influence of arthritis greater than heart disease or diabetes.

One in four older adults reported having difficulty walking, with osteoarthritis (OA) of the knee or hip having a larger influence on this than comorbidities such as diabetes and cardiovascular disease, a population-based study.

Forest walk. Roger Bates, flickr

by Nancy Walsh Senior Staff Writer, MedPage Today May 19, 2017

In a survey of 18,490 Canadian adults, the predicted probability for self-reported difficulty in walking was 5-10% for a healthy, normal-weight, middle-income 60-year-old woman, and 10-20% if she had diabetes and cardiovascular disease, according to the research by Gillian A. Hawker, MD, director of the Canadian Osteoarthritis Research Program and physician-in-chief of Women’s College Hospital of the University of Toronto, and colleagues.

But if a woman in the study had OA in two hips or knees but no other chronic conditions, the predicted probability of difficulty was 40%. The probability then rose to 60-70% if she had OA in two hips or two knees plus cardiovascular disease and diabetes, and to 80% with OA in both hips and knees plus cardiovascular disease and diabetes, the researchers reported in Arthritis Care & Research.

“North Americans are witnessing an unprecedented rise in the numbers living with obesity and well into old age, and thus with multiple chronic conditions. Despite this, chronic disease strategies and clinical practice guidelines remain single-disease-focused and have largely ignored musculoskeletal conditions, for which obesity and longevity are also risk factors.”

Little is known about the influence of OA specifically on other chronic conditions, although difficulty in walking has been associated with multiple other conditions such as cardiovascular disease, cancer, and stroke, and adverse outcomes including lower quality of life, higher risk for institutionalization, cardiovascular events, and death.

Therefore, to quantify the role of symptomatic knee and hip OA compared with other conditions in difficulty walking, Hawker and colleagues conducted a survey of adults age 55 and older in two areas of Ontario from 1996 to 1998.

Participants completed a questionnaire that included information on demographics, body mass index, overall health status, joint symptoms, and difficulty walking during the previous 3 months. The survey data were linked with the province’s administrative databases for verification.

The mean age of participants was 68, and 60% were women. Hypertension was present in 42.8% of the participants, OA in 19%, obesity in 12%, diabetes in 11.4%, and cardiovascular disease in 10.9%. A total of 25.4% reported difficulty in walking, and those patients more often were women and obese and had lower incomes as well as chronic health problems.

In a multivariate analysis, independent associations for walking difficulty were seen for multiple factors, including older age, female sex, body mass index, hypertension, diabetes, cardiovascular disease, peripheral vascular disease, malignancy, history of hip fracture, and the number of knees and hips with OA.

In a multivariate model that included hip and knee OA as separate covariates, both were seen to have significant associations with walking difficulty. The adjusted odds ratios were 11.97 (95% CI 10.07-14.22) for two affected hips versus none and 9.43 (95% CI 8.41-10.59) for two knees versus none.

Then, in a final adjusted model, odds ratios compared with zero affected joints were as follows (P<0.01 for all):

One joint, OR 5.05 (95% CI 4.43-5.76)
Two joints, OR 8.68 (95% CI 7.70-9.78)
Three joints, OR 13.98 (95% CI 11.07-17.65)
Four joints, OR 21.17 (95% CI 16.46-27.23)

The predicted probability of walking difficulty with OA and cardiovascular disease plus diabetes was then determined with construction of a nomogram from the final model, which permitted individualized risk estimates to be calculated from points assigned to predictor variables in the model.

The only other conditions aside from OA that had a greater influence in the nomogram were body mass index over 40 mg/m2 and peripheral vascular disease, but because the prevalence of these factors was low, the overall probability effect was minimal, the researchers wrote.

“We believe our findings have high clinical relevance to primary care physicians and internal medicine specialists beyond rheumatology, and indicate a need for a more patient-centered, integrated, and comprehensive approach to care for the growing numbers living with multiple conditions, many of whom have painful OA.”

Previous research has demonstrated that older people with multiple chronic conditions are more concerned with factors such as mobility, independence, and relief of pain than with issues specific to their chronic medical conditions, Hawker et al noted. Accordingly, “management of OA may be a higher priority for older people with multi-morbidity than rigorous management of some other conditions, if choices must be made.”

Limitations of the analysis, the team said, included the cross-sectional design and reliance on self-reporting for joint symptoms.

Hawker noted receiving support as the Sir John and Lady Eaton Professor and Chair of Medicine at the University of Toronto, and one co-author reported receiving support from a Canadian Respiratory Research Network Fellowship Training Award.

Source MedPage Today

References

The Impact of Osteoarthritis on Difficulty Walking: A Population-Based Study, King LK, Kendzerska T, Waugh EJ, and Hawker GA. (2017), Arthritis Care & Research. Accepted Author Manuscript. doi:10.1002/acr.23250