CME: Symptomatic Knee OA on the Rise

CME: Symptomatic Knee OA on the Rise
Author Information (click to view)

David T. Felson, MD, MPH

Professor of Medicine & Epidemiology
Associate Director, Clinical Translational Science Award Training Program
Chief, Multidisciplinary
Clinical Research Center
Boston University School of Medicine

David T. Felson, MD, MPH, has indicated to Physician’s Weekly that he has no financial interests to report.

 

Figure 1 (click to view)
Figure 2 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  1. Explain the findings of a study that examined whether the increased prevalence of knee pain or of symptomatic knee osteoarthritis in the United States is due to an aging and increasingly obese U.S. population.
  2. Discuss the important implications of these findings.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwJan4.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria – Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
David T. Felson, MD, MPH
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
 AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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David T. Felson, MD, MPH (click to view)

David T. Felson, MD, MPH

Professor of Medicine & Epidemiology
Associate Director, Clinical Translational Science Award Training Program
Chief, Multidisciplinary
Clinical Research Center
Boston University School of Medicine

David T. Felson, MD, MPH, has indicated to Physician’s Weekly that he has no financial interests to report.

 

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The prevalence of knee pain and symptomatic knee osteoarthritis (OA) appears to have increased substantially over a span of more than 20 years. As rates of knee OA increase, greater vigilance is needed for providing the most appropriate therapies to treat the condition.
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Throughout the United States, the rate of knee replacement operations has surged in recent years. Experts have speculated that the increased prevalence of knee pain or of symptomatic knee osteoarthritis (OA) is due to an aging and increasingly obese U.S. population, which in turn may be the cause for the increase in knee surgeries. However, formal assessments of the secular trend of knee pain and symptomatic knee OA have been lacking.

In the Annals of Internal Medicine, David T. Felson, MD, MPH, and colleagues addressed this void when they conducted a study examining whether a change in the prevalence of knee pain and symptomatic OA could be attributed to age, BMI, and radiographic knee OA. “It’s largely unknown if the increase in knee replacements was due to patients seeking the procedure more often,” explains Dr. Felson. “We also don’t have a great deal of data on the trends in knee OA.”

Key Findings

For their study, Dr. Felson and colleagues collected data from six National Health and Nutrition Examination Surveys (NHANES) conducted between 1971 and 2004 and from three examination periods in the Framingham Osteoarthritis (FOA) study between 1983 and 2005. “We wanted to see if the prevalence of knee OA had increased over time,” Dr. Felson says. In all samples studied, the age-adjusted prevalence of knee pain and symptomatic knee OA increased substantially over time. Between 1974 and 1994, the prevalence of knee pain—with adjustment for age and BMI—increased by about 65% among Caucasian and Mexican men and women and among African-American women in NHANES (Figure 1). In FOA, the age and BMI-adjusted prevalence of knee pain and symptomatic knee OA approximately doubled in women and tripled in men over a 20-year period (Figure 2). Among those with radiographic OA, the prevalence of knee pain tripled in women and more than quadrupled in men during this period.

 

“We recognize that age and weight are both risk factors for knee OA,” says Dr. Felson, “but with the FOA data, the prevalence of knee OA still increased substantially, even after adjusting for both factors. This suggests that some of the increasing prevalence is not explained by the aging population and their increasing weight. It could be due to a higher tendency of patients having trouble with and reporting pain. Another factor may be that middle- and older-age patients are developing knee pain as a result of participating in athletic activities that they typically would not have engaged in previously.”

Important Implications

The increased prevalence of knee pain may translate into higher demand for knee replacement, but the subjects analyzed in the study by Dr. Felson and colleagues were not followed to the point of knee replacement. “Unfortunately, it’s a hard topic to study,” Dr. Felson explains. “Information on disease prevalence is required over multiple decades, and researchers must use the same definitions in order to test whether prevalence has changed over time. That is a daunting challenge, but one that we need to take so that we can get a better idea of the real prevalence of knee OA and then tie this information to specific factors.”

Dr. Felson says clinicians should recognize that knee OA is a condition that will be encountered more frequently in the coming years. “Because many of these patients require knee replacements—and these surgeries make up an enormous sum of healthcare spending—physicians should become increasingly familiar with the multiple treatment options that are available,” says Dr. Felson. “It would behoove us to determine what nonsurgical therapies are effective in relieving pain so that we can hopefully delay the need for knee replacement surgery. Unfortunately, many physicians tend to prescribe analgesics or anti-inflammatory drugs and hope for the best. It’s important to be more proactive and consider other potentially effective therapies in the spectrum of available treatment options for knee OA.”

To gain a better understanding of the available treatment options for knee OA, Dr. Felson recommends that clinicians use resources and guidelines from trusted organizations, such as the American Association of Orthopaedic Surgeons and the American College of Rheumatology. “These associations offer helpful information about non-pharmacologic and pharmacologic therapies,” he says. “They’re a good starting point, but clinicians should remember that each patient is unique and will need to have treatments tailored to their specific condition. There are many effective options available, but the key is to work collaboratively with patients so that the right treatment is used as early as possible in the disease course.”

Readings & Resources (click to view)

Nguyen U, Zhang Y, Zhu Y, et al. Increasing prevalence of knee pain and symptomatic knee osteoarthritis. Ann Intern Med. 2011;155:725-732. Available at http://annals.org/article.aspx?articleid=1033191.

Zeni J, Axe M, Snyder-Mackler L. Clinical predictors of elective total joint replacement in persons with end-stage knee osteoarthritis. BMC Musculoskelet Disord. 2010;11:86.

Culliford D, Maskell J, Beard D, et al. Temporal trends in hip and knee replacement in the United Kingdom: 1991 to 2006. J Bone Joint Surg Br. 2010;92:130-135.

Grotle M, Hagen K, Natvig B, et al. Prevalence and burden of osteoarthritis: results from a population survey in Norway. J Rheumatol. 2008;35:677-684.

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