Osteoarthritis risk factors
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Mohammadamin Rezazadehsaatlou [2].
Overview
Risk Factors
Osteoarthritis is a multifactorial disease and the interactions between systemic and local factors play important role in development and prognosis of OA.
Table 1 Risk factors for development of osteoarthritis Risk factor Hip OA Knee OA Hand OA Obesity (þ) þ (þ) Age þþ þ Female sex (þ) þ þ Ethnicity (vs. Caucasian) Chinese 2 þ 2 Genotype þþ þ Bone mineral density þþ þ Smoking Muscle Grip strength þ Quadriceps strength (2) þ, good evidence increases risk; (þ), weak evidence increases risk; blank, inconsistent or no evidence of increased risk; (2), weak evidence of protective effect; 2, good evidence of protective effect.
I: Systemic risk factors for Osteoarthritis
Gender
knee, hip, and hand osteoarthritis are higher in women than men. Also, it has been reported that the frequency of osteoarthritis in women and men are 68% and 58% respectively. And it has been reported that women have a greater levels of pain and disability.
Race
There are significant differences about the prevalence and the joint involvement patterns of OA between different racial and ethnic groups. The African American women had similar OA of Hip similar to white women. Its been reported that the knee OA in USA is more common in Blacks than whites. prevalence of hip OA in among whites in Africa and the Caribbean was higher than Blacks. In another study comparing the prevalence of knee OA between Chinese and whites in USA, despite of higher rate of obesity among whites the knee OA was higher among Chinese women. the frequencies of Hand OA and hip OA in Chinese population is 50% and 10% of normal population. which can be concluded that the lower risk of hip and hand OA can be due to the genetic factors while the higher prevalence of knee OA can be linked to their squatting and other daily and occupational physical activities which cause excessive pressure on their knee.
Age
Age plays an important roll in development of osteoarthritis. The correlation between age and the occurrence of OA is complex. Higher age through oxidative damage, thinning of cartilage, muscle weakening, reduces the basic cellular mechanisms that maintain tissue homeostasis which leads to an insufficient response to stress or joint injury, demolition of joint tissue destruction. Higher age leads to decreasing in the tensile property of cartilage in articular cartilage in accumulation of glycation consequently it can cause mechanical failure
Genetics
Its been showed that genetic factors play important roles in development and even the prognosis of osteoarthritis. genetic factors are leads to osteoarthritis in nearly 70%of cases. Also, specific genes such as: chromosomes 2, 3, 4, 6, 7, 11, 16, the X.Its been reported that there is a strong correlation between the chromosome 2q13–32 and particular types of OA. For example: Chromosomes 4, 6, 7, and 16 (susceptible locus: 4q35, 6p12.3–q13, 7q34-7q36.3, 7p15-7p21, 7q22, and 16p12.3-p12.1, respectively) are linked for hip and hand OA. Also, previously mentioned locus of chromosome 4 and 7 are also linked to knee OA
Hormones
The osteoarthritis of knee, hip, and hand significantly increases around the time of menopause. Because of this its been hypothesized that hormonal factors might be involved in the occurrence of OA. Up to this time there is no report regarding the confirmation regarding the possible correlation between sex hormones and hand, knee, or hip OA in women. Osteocalcin, as a marker of bone turnover, decreases in women after their menopause which consequently women after menopause are more susceptible to knee arthritis.
Diet
Dietary related agents have an important roll in OA. Lower vitamin D, vitamin C, and selenium intakes have been associated with an increased risk of progression of knee OA in older population. Also, Using unrefined carbohydrates and Junk foods in daily diet increase the chance of chronic diseases. Meanwhile, chondrocytes as an important and powerful origin of reactive oxygen species (ROC). chondrocytes can damage cartilage collagen and synovial fluid hyaluronate. Meanwhile, micronutrients antioxidants, by providing defense against tissue injuries, are helpful to protect against osteoarthritis.
Smoking
Smoking is proven to be correlated with a increased risk for cartilage loss and knee pain in OA.
II: Local risk factors for Osteoarthritis
Physical activity
Doing repetitive and excessive joint loading which is common in specific heavy physical activities such as long-distance runners, Karate, kung fu, and gymnastic could increase the risk of Knee injury and developing OA in involved joints.
Trauma and injury to Joint
The traumatic injuries are known to have strong association with development of OA. Acute injuries such as bone fractures and dislocations, meniscal tearing and cruciate tearing, direct damage to local tissues, normal biomechanics disruption, increase the risk of OA development. Articular cartilage bears pressures from daily physical activities. Joints injuries and trauma the cartilage can influence their flexibility, eliminate cellular system and consequently decrease the subchondral loading capablity.
Obesity
Higher body mass index (BMI) is a well known predictor for risk factors of OA. Its been reported that the correlation between obesity and knee OA is greater than than with hip OA. Also, OA is associated with the metabolic syndrome, cardiovascular risk factors such as hypertension and hypercholesterolemia. Although, the association between diabetes and OA is contradictory; but its been hypothesized that higher glucose concentrations product ROS and glycation leading to the cartilage degeneration and degradation. Meanwhile, since high BMI and obesity are considered as the major risk factor for OA, its been found that weight loss improves patient outcomes.
A meta-analysis of weight reduction and knee osteoarthritis concluded that weight loss of 5 percent from baseline was sufficient to reduce disability.15Additionally, pain and disability were reduced if patients lost more than 6 kg (13.2 lb).15 Aerobic exercise is important for weight loss, but can be challenging in persons with osteoarthritis of weight-bearing joints. Swimming, elliptical training, cycling, and upper body exercise may help in such cases.
Occupation
Occupation facing with heavy loads and having stress activities such as workers whose jobs require repeated pincer grip and prolonged squatting and kneeling are consequently associated hand OA and knee OA, respectively.
Congenital abnormalities
The mechanical alignment of the knee plays an important roll in distributing the pressure through the articular surfaces. In a normal knee, 60-70% of the pressure is transferred through the medial compartment. Any structural problems like valgus or varus influences pressure distribution in joint and this misalignment plays an important roll in development and progression of OA.