膝关节疼痛和症状性膝骨关节炎患病率的增加：调查和队列数据。

Increasing prevalence of knee pain and symptomatic knee osteoarthritis: survey and cohort data.

机构信息

Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, and Brigham and Women's Hospital, Boston, Massachusetts 02118, USA.

出版信息

Ann Intern Med. 2011 Dec 6;155(11):725-32. doi: 10.7326/0003-4819-155-11-201112060-00004.

DOI:10.7326/0003-4819-155-11-201112060-00004

PMID:22147711

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3408027/

Abstract

BACKGROUND: A recent surge in knee replacements is assumed to be due to aging and increased obesity of the U.S. population. OBJECTIVE: To assess whether age, obesity, and change in radiographic knee osteoarthritis explain the trend in knee pain and osteoarthritis. DESIGN: Cross-sectional, using data from 6 NHANES (National Health and Nutrition Examination Survey) surveys between 1971 and 2004 and from 3 examination periods in the FOA (Framingham Osteoarthritis) Study between 1983 through 2005. SETTING: U.S. population. PARTICIPANTS: NHANES participants (white or African American; aged 60 to 74 years) and FOA Study participants (mostly white; aged ≥70 years) were included. MEASUREMENTS: NHANES participants were asked about pain in or around the knee on most days. In the FOA Study, participants were asked about knee pain and had bilateral weight-bearing anteroposterior knee radiography to define radiographic knee osteoarthritis. Radiographic evidence and self-reported pain were used to define symptomatic knee osteoarthritis. The age- and age- and body mass index (BMI)-adjusted prevalences of knee pain and osteoarthritis at later examinations were compared with that of earlier examinations by using the ratio of the prevalence estimates. RESULTS: Age- and BMI-adjusted prevalence of knee pain increased by about 65% in NHANES from 1974 to 1994 among non-Hispanic white and Mexican American men and women and among African American women. In the FOA Study, the age- and BMI-adjusted prevalence of knee pain and symptomatic knee osteoarthritis approximately doubled in women and tripled in men over 20 years. No such trend was observed in the prevalence of radiographic knee osteoarthritis in FOA Study participants. After age adjustment, additional adjustment for BMI resulted in a 10% to 25% decrease in the prevalence ratios for knee pain and symptomatic knee osteoarthritis. LIMITATIONS: Differences in sampling of FOA Study participants over time or birth cohort effects cannot be ruled out as possible explanations of the increased reporting of knee pain. Increases in prevalence at the last interval in the FOA Study might be due to differences in cohort membership by interval. CONCLUSION: Results suggest that the prevalence of knee pain has increased substantially over 20 years, independent of age and BMI. Obesity accounted for only part of this increase. Symptomatic knee osteoarthritis increased but radiographic knee osteoarthritis did not. PRIMARY FUNDING SOURCE: American College of Rheumatology Research and Education Foundation and National Institutes of Health. The FOA Study was funded by the National Heart, Lung, and Blood Institute (for the parent Framingham Heart Study), National Institute on Aging, and National Institute of Arthritis and Musculoskeletal and Skin Diseases (FOA Study), National Institutes of Health.

摘要

背景：膝关节置换手术的近期增加被认为是由于美国人口的老龄化和肥胖率的上升。

目的：评估年龄、肥胖和影像学膝关节骨关节炎的变化是否可以解释膝关节疼痛和骨关节炎的趋势。

设计：横断面研究，使用了 1971 年至 2004 年期间的 6 次 NHANES（国家健康和营养检查调查）调查数据，以及 1983 年至 2005 年期间 3 次 FOA（弗雷明汉骨关节炎）研究的检查期数据。

地点：美国人群。

参与者：NHANES 参与者（白种人或非裔美国人；年龄 60 至 74 岁）和 FOA 研究参与者（主要为白种人；年龄≥70 岁）被纳入研究。

测量方法：NHANES 参与者被问及膝关节周围或膝关节疼痛的情况。在 FOA 研究中，参与者被问及膝关节疼痛情况，并进行双侧负重前后位膝关节 X 线摄影，以确定影像学膝关节骨关节炎。影像学证据和自我报告的疼痛用于定义有症状的膝关节骨关节炎。通过使用患病率估计值的比值，比较后期检查与早期检查时膝关节疼痛和骨关节炎的年龄和年龄及体重指数（BMI）调整后的患病率。

结果：在 NHANES 中，非西班牙裔白人和墨西哥裔美国男性和女性以及非裔美国女性的膝关节疼痛的年龄和 BMI 调整后的患病率在 1974 年至 1994 年间增加了约 65%。在 FOA 研究中，女性的膝关节疼痛和有症状的膝关节骨关节炎的年龄和 BMI 调整后的患病率在 20 年内增加了约 1 倍，男性增加了约 3 倍。在 FOA 研究参与者中，没有观察到影像学膝关节骨关节炎的患病率有类似的趋势。在年龄调整后，BMI 的额外调整导致膝关节疼痛和有症状的膝关节骨关节炎的患病率比值降低 10%至 25%。

局限性：随着时间的推移，FOA 研究参与者的抽样差异或出生队列效应可能无法排除作为膝关节疼痛报告增加的可能解释。在 FOA 研究的最后一个间隔中，患病率的增加可能是由于间隔内的队列成员差异造成的。

结论：结果表明，膝关节疼痛的患病率在 20 年内大幅增加，与年龄和 BMI 无关。肥胖仅解释了这种增加的一部分。有症状的膝关节骨关节炎增加了，但影像学膝关节骨关节炎没有。

主要资金来源：美国风湿病学会研究与教育基金会和美国国立卫生研究院。FOA 研究由美国国立心肺血液研究所（Framingham 心脏研究的母体）、美国国立老龄问题研究所和美国国立关节炎、肌肉骨骼和皮肤病研究所（FOA 研究）、美国国立卫生研究院共同资助。