The contribution of age and obesity to the number of painful joint sites in individuals reporting osteoarthritis: a population-based study

Abstract

Objective: To investigate the association of OA risk factors with number of painful joint sites in a representative population sample.

Methods: Analysis of the 2009 Survey on Living with Chronic Diseases in Canada - Arthritis Component (n = 1614) for respondents reporting symptomatic OA. Variables: painful joints sites (hands, wrists, elbows, shoulders, hips, knees, ankles, feet, back, neck), joint symptom duration, sociodemographic characteristics, smoking, comorbidities and BMI. Zero-truncated negative binomial regressions were used to investigate the association between number of painful joint sites and the variables. Generalizability of findings was assessed by a similar analysis in a clinical hip/knee OA sample.

Results: The sample comprised 73% women and 56% were aged <65 years. The mean number of painful joint sites was 3.8: 84% reported pain at ≥2 sites, and 45% at ≥4 sites. Age, BMI, education and smoking were not associated with the number of joint sites. Significant associations were found with being female [rate ratio (RR) = 1.23, 95% CI 1.09, 1.39], having more comorbidities (RR = 1.11, 95% CI 1.07, 1.15) and longer symptom duration (RR = 1.16, 95% CI 1.09, 1.24), although the increase in joint sites with duration was small. Similar regression results were found with the clinical OA sample.

Conclusion: The lack of an association of age and BMI (obesity) with number of painful joint sites in OA raises questions about the role of these risk factors and our understanding of OA as a multi-joint disease. Filling this knowledge gap is critical to making progress with defining OA phenotypes and identifying potential aetiological mechanisms.

Keywords: BMI; GOA; MJOA; age; generalized osteoarthritis; joints; obesity; osteoarthritis; sex.

Fig. 1

Flow chart of the sample selection from the CCHS 2008 for the SLCDC-A 2009 ^aThe 2009 SLCDC included two questionnaires: one questionnaire for arthritis and one questionnaire for hypertension. To reduce response burden, every respondent sampled could receive only one questionnaire even if they reported both chronic conditions in the CCHS 2008. The sample allocation by questionnaire was done proportionally to the size of the number of 2008 CCHS respondent for each condition and weighting adjustments were made to account for individuals with arthritis and hypertension not selected for the arthritis questionnaire.

Fig. 2

Mean painful joint sites by age and symptom duration: 2009 SLCDC-A OA sample (n = 1614) ^aBased on 95% CIs (given in Table 1) there is a significant difference in the mean number of painful joint sites for the longest duration (20+ years) with each other duration period. There is no difference between the adjacent categories 0–5 and 6–10 years, and 6–10 and 11–19 years, but the difference in mean count between 0–5 and 11–19 years is significant.