Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom; Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, St Leonards, Sydney, New South Wales, 2065, Australia.
Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, St Leonards, Sydney, New South Wales, 2065, Australia.
Semin Arthritis Rheum. 2020 Oct;50(5):1006-1014. doi: 10.1016/j.semarthrit.2020.08.003. Epub 2020 Aug 8.
To examine the effect of occupation on knee osteoarthritis (OA) and total knee replacement (TKR) in working-aged adults.
We used longitudinal data from the Chingford, Osteoarthritis Initiative (OAI) and Multicentre Osteoarthritis (MOST) studies. Participants with musculoskeletal disorders and/or a history of knee-related surgery were excluded. Participants were followed for up to 19-years (Chingford), 96-months (OAI) and 60-months (MOST) for incident outcomes including radiographic knee OA (RKOA), symptomatic RKOA and TKR. In those with baseline RKOA, progression was defined as the time from RKOA incidence to primary TKR. Occupational job categories and work-place physical activities were assigned to levels of workload. Logistic regression was used to examine the relationship between workload and incident outcomes with survival analyses used to assess progression (reference group: sedentary occupations).
Heavy manual occupations were associated with a 2-fold increased risk (OR: 2.07, 95% CI 1.03 to 4.15) of incident RKOA in the OAI only. Men working in heavy manual occupations in MOST (2.7, 95% CI 1.17 to 6.26) and light manual occupations in OAI (2.00, 95% CI 1.09 to 3.68) had a 2-fold increased risk of incident RKOA. No association was observed among women. Increasing workload was associated with an increased risk of symptomatic RKOA in the OAI and MOST. Light work may be associated with a decreased risk of incident TKR and disease progression.
Heavy manual work carries an increased risk of incident knee OA; particularly among men. Workload may influence the occurrence of TKR and disease progression.
探讨职业对工作年龄段成年人膝关节骨关节炎（OA）和全膝关节置换术（TKR）的影响。
我们使用来自 Chingford、Osteoarthritis Initiative（OAI）和 Multicentre Osteoarthritis（MOST）研究的纵向数据。排除患有肌肉骨骼疾病和/或膝关节相关手术史的参与者。在 Chingford 研究中，参与者随访时间长达 19 年；在 OAI 研究中，随访时间长达 96 个月；在 MOST 研究中，随访时间长达 60 个月，以观察包括放射学膝关节 OA（RKOA）、有症状的 RKOA 和 TKR 在内的新发结局。对于基线时已患有 RKOA 的患者，进展定义为从 RKOA 发病到初次 TKR 的时间。职业工作类别和工作场所体力活动被分配到工作负荷水平。使用逻辑回归来检验工作负荷与新发结局之间的关系，使用生存分析来评估进展情况（参考组：久坐职业）。
仅在 OAI 中，重体力劳动职业与 RKOA 新发风险增加 2 倍相关（OR：2.07，95%CI 1.03 至 4.15）。在 MOST 中，从事重体力劳动的男性（2.7，95%CI 1.17 至 6.26）和从事轻体力劳动的男性（2.00，95%CI 1.09 至 3.68）发生 RKOA 新发的风险增加 2 倍。在女性中未观察到相关性。OAI 和 MOST 中，工作负荷增加与有症状的 RKOA 风险增加相关。轻度工作可能与新发 TKR 和疾病进展的风险降低相关。
重体力劳动会增加膝关节 OA 的新发风险；尤其是男性。工作负荷可能会影响 TKR 的发生和疾病的进展。
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