Osteoarthritis: New Insights. Part 1: The Disease and Its Risk Factors

Osteoarthritis: New Insights. Part 1: The Disease and Its Risk Factors

Conference Chair: David T. Felson, MD, MPH;
Conference Organizer: Reva C. Lawrence, MPH;
Discussants: Paul A. Dieppe, MD;
Rosemarie Hirsch, MD, MPH;
Charles G. Helmick, MD;
Joanne M. Jordan, MD, MPH;
Raynard S. Kington, MD, PhD;
Nancy E. Lane, MD;
Michael C. Nevitt, PhD;
Yuqing Zhang, DSc;
MaryFran Sowers, PhD;
Timothy McAlindon, MD, MPH;
Tim D. Spector, MD, MSc;
A. Robin Poole, PhD, DSc;
Susan Z. Yanovski, MD;
Gerard Ateshian, PhD;
Leena Sharma, MD;
Joseph A. Buckwalter, MD;
Kenneth D. Brandt, MD; and
James F. Fries, MD

From Boston University School of Medicine, Boston, Massachusetts; National Institute of Arthritis and Musculoskeletal and Skin Diseases and National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, Bethesda, Maryland; MRC Health Services Research Collaboration, University of Bristol, Bristol, United Kingdom; Centers for Disease Control and Prevention, Atlanta, Georgia; University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; University of California, San Francisco, San Francisco, and Stanford University School of Medicine, Palo Alto, California; University of Michigan, Ann Arbor, Michigan; St. Thomas' Hospital, London, United Kingdom; Shriners Hospital for Children and McGill University, Montreal, Quebec, Canada; Columbia University, New York, New York; Northwestern University, Chicago, Illinois; University of Iowa Hospitals, Iowa City, Iowa; and Indiana University School of Medicine, Indianapolis, Indiana.

Abstract

Osteoarthritis is the most common form of arthritis, affecting millions of people in the United States. It is a complex disease whose etiology bridges biomechanics and biochemistry. Evidence is growing for the role of systemic factors (such as genetics, dietary intake, estrogen use, and bone density) and of local biomechanical factors (such as muscle weakness, obesity, and joint laxity). These risk factors are particularly important in weight-bearing joints, and modifying them may present opportunities for prevention of osteoarthritis-related pain and disability. Major advances in management to reduce pain and disability are yielding a panoply of available treatments ranging from nutriceuticals to chondrocyte transplantation, new oral anti-inflammatory medications, and health education. This article is part 1 of a two-part summary of a National Institutes of Health conference. The conference brought together experts on osteoarthritis from diverse backgrounds and provided a multidisciplinary and comprehensive summary of recent advances in the prevention of osteoarthritis onset, progression, and disability. Part 1 focuses on a new understanding of what osteoarthritis is and on risk factors that predispose to disease occurrence. It concludes with a discussion of the impact of osteoarthritis on disability.

Article and Author Information

An edited summary of a Scientific Conference held on 23–24 July 1999 at the National Institutes of Health, Bethesda, Maryland.
Authors who wish to cite a section of the conference and specifically indicate its author may use this example for the form of the reference: Jordan JM, Kington RS, Lane NE, Nevitt MC, Zhang Y, Sowers MF, et al. Systemic risk factors for osteoarthritis. In: Felson DT, conference chair. Osteoarthritis: new insights. Part 1: The disease and its risk factors. Ann Intern Med. 2000; 133:637-639.
Acknowledgments: The authors thank the conference moderators who helped synthesize the thoughts presented here: Allan Gelber, MD; Margaret Lethbridge-Cejku, PhD; Roland W. Moskowitz, MD; Van C. Mow, PhD; Stephen B. Trippel, MD; and Steven N. Blair, PED. They also thank Cori Vanchieri, Constance Raab, and Susan Stark for editorial assistance.
Grant Support: The conference was initiated, organized, and funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health (NIH), which also coordinated and funded the reporting of the proceedings. Cofunding for the conference was provided by the NIH Office of Disease Prevention, NIH National Center for Complementary and Alternative Medicine, NIH Office of Research on Women's Health, NIH Office of Behavioral and Social Sciences Research, NIH National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, Centers for Disease Control and Prevention, Arthritis Foundation, and American Academy of Orthopaedic Surgeons.
Requests for Single Reprints: Reva C. Lawrence, MPH, National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 45, Room 5AS-37G, Bethesda, MD 20892-6500.
Current Author Addresses: Drs. Felson and McAlindon: Boston University School of Medicine, 715 Albany Street, Room A203, Boston, MA 02118.
Ms. Lawrence: National Institute of Arthritis and Musculoskeletal and Skin Diseases, National Institutes of Health, Building 45, Room 5AS-37G, Bethesda, MD 20892-6500.
Dr. Dieppe: MRC Health Services Research Collaboration, University of Bristol, Canynge Hall, Whiteladies Road, Bristol BS8 2PR, United Kingdom.
Dr. Hirsch: Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Road, Presidential Building, Room 900, Hyattsville, MD 20782.
Dr. Helmick: National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, 4770 Burford Highway, NE, MS K45, Atlanta, GA 30341.
Dr. Jordan: Thurston Arthritis Research Center, University of North Carolina, 3310 Thurston Building, CB 7330, Chapel Hill, NC 27599-7330.
Dr. Kington: Division of Health Examination Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, 6525 Belcrest Road, Presidential Building, Room 1000, Hyattsville, MD 20782.
Dr. Lane: Division of Rheumatology, University of California at San Francisco, 1001 Potrero Avenue, Building 30, Room 3300, San Francisco, CA 94110.
Dr. Nevitt: Department of Epidemiology and Biostatistics, University of California at San Francisco, 74 New Montgomery Street, Suite 600, San Francisco, CA 94105.
Dr. Zhang: Arthritis Center, Boston University School of Medicine, 80 East Concord Street, Room A203, Boston, MA 02115.
Dr. Sowers: University of Michigan, 109 S. Observatory, Ann Arbor, MI 48109-2029.
Dr. Spector: Twin Research and Genetic Epidemiology Unit, St. Thomas' Hospital, London SE1 7EH, United Kingdom.
Dr. Poole: Joint Diseases Laboratory, Shriners Hospitals for Children and Department of Surgery, McGill University, 1529 Cedar Avenue, Montreal, Quebec H3G1A6, Canada.
Dr. Yanovski: National Institute of Diabetes and Digestive and Kidney Diseases, National Institutes of Health, 45 Center Drive, Room 6AN18B, Bethesda, MD 20892-6600.
Dr. Ateshian: Orthopedic Research Laboratories, Columbia University, Black Building 1412, 630 West 168th Street, New York, NY 10032.
Dr. Sharma: Northwestern University, 303 East Chicago Avenue, Ward Building 3-315, Chicago, IL 60611.
Dr. Buckwalter: Department of Orthopaedics, University of Iowa Hospitals, 200 Hawkins Drive, Room 01013JPP, Iowa City, IA 52242.
Dr. Brandt: Rheumatology Division, Indiana University School of Medicine, 541 Clinical Drive, Room 492, Indianapolis, IN 46202.
Dr. Fries: Stanford University School of Medicine, 1000 Welch Road, Suite 203, Palo Alto, CA 94304-5755.