Epidemiologic studies for osteoarthritis: new versus conventional study design approaches

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Current insights into osteoarthritis epidemiology

Osteoarthritis (OA) is the most common form of arthritis. Symptomatic knee OA occurs in approximately 13% of persons who are aged 60 and older [1]. Its prevalence is approximately 6.1% for knees (unpublished data) in U.S. adults who are aged 30 and older; thus, approximately 12 million persons have symptomatic knee OA. Because, of its prevalence, knee OA has a formidable impact on the burden of disability in older Americans. OA is ranked as either the top or second leading cause of disability

Too few cases to study risk factors for disease onset

Despite valuable information from epidemiologic evidence about risk factors for OA, insights have been limited. Until now, epidemiologic studies have focused on samples that were recruited randomly from the general population (or recruited without over sampling those who had OA). This has been necessary to estimate disease incidence and prevalence. Although some studies have been large, with samples ranging from 1000 to more than 5000 subjects, rates of incident disease (or new onset cases per

Defining those who are at high risk of developing symptomatic knee osteoarthritis for studies of disease onset

Many epidemiologic studies of OA, including the Framingham Study, have documented that persons who are overweight and those who have a history of knee injury or operation are at high risk of later knee OA [28]. To incorporate this information into the design and planning of large cohort studies of incident knee OA, we derived a specific level of risk associated with these factors and the risk of disease in different gender and age subgroups using data from the Framingham Osteoarthritis Study

The Multicenter Osteoarthritis Study and the Osteoarthritis Initiative

Two large, prospective cohort studies that focus on the risk factors for knee OA recently were undertaken with funding from the National Institutes of Health and other sources. The Multicenter Osteoarthritis Study (MOST) began in 2001 and the Osteoarthritis Initiative (OAI) started in 2002. Both are in the process of recruiting and studying subjects. The two studies share several important design strategies, but they also differ in important details. MOST and OAI address the limitations of

Summary

MOST and OAI will be the first large-scale epidemiologic studies to focus on OA among those who have symptomatic disease and those who are at high risk of symptomatic disease. Targeting these subjects is practical (they will provide sufficient cases of disease to perform an efficient longitudinal study) and relevant; they are the subjects who will be targeted by any preventative interventions. These are the individuals who are interested in preventing disease. Direct clinical and public health

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    Supported by NIH Grants, AR47785, AGU0118820, AGU0119069, and N01AR22258.

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