Epidemiology

The first epidemiological studies on osteoarthritis were reported about 60 years ago in England, using only questionnaires and clinical examination to evaluate incapacity and invalidism due to the disease. These methods, however, lacked diagnostic reliability, and classification of the disease was difficult. Later, use of roentgenograms to detect changes allowed for the classification of OA ranging from mild to severe, depending on the loss of cartilage and the presence of bony overgrowth. The cartilage loss is seen as joint space narrowing, whereas bony overgrowth can be one or more of the following: osteophytes, bony eburnation, or increased bone density. Early physical findings such as Heberden's nodes may precede radiographic changes.

Various surveys have explored demographic factors associated with osteoarthritis. A study of skeletal remains of contemporary white and black Americans, twelfth-century Native Americans, and protohistoric Alaskan Eskimos showed that those who underwent the heaviest mechanical stresses suffered the most severe joint involvement (Denko 1989). Climate does not influence the prevalence of OA. In two groups of Native Americans of the same ethnic descent but with one living in a cold mountain region and the other in a hot desert, no differences were found in radiographs of the hands and feet. Hereditary predisposition to Heberden's nodes have been found in half of the observed cases. The remaining cases are thought to be traumatic.

Differences in patterns of affected joints occur in different ethnic groups. Heberden's nodes are rare in blacks, as is nonnodal generalized osteoarthritis. Occupational factors may play a role in the incidence, especially in males. Studies from Great Britain, United States, and France show osteoarthritis to be a major cause of incapacity, economic loss, and social disadvantage in persons over the age of 50. Hip disease is more common in white populations than in blacks and Native Americans. Asian populations have a low incidence of hip disease, but incidence of OA of the fingers in Asia is high, as is the incidence in Europeans. Knee disease shows less difference among ethnic groups, being similarly prevalent in whites and blacks in South Africa and Jamaica (Peyron 1984).

Protective factors are few, including mainly the absence of mechanical stress such as that resulting from motor impairment, hemiplegia, or poliomyelitis. Predisposition to osteoarthritis occurs in individuals who have pseudogout (calcium pyrophosphate deposition disease). Deposits of urate crystals such as that occurring in gout also predispose the individual to osteoarthritis.

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