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Targeting physical activity, depression could reduce mortality in OA
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LIVERPOOL, England — Low walking frequency and depression were associated with an increase in mortality in patients with osteoarthritis, according to findings presented here.
Simran Parmar, MD, of Keele University in Newcastle-under-Lyme, England, said that OA is the most common joint condition and the fourth leading cause of disability worldwide. “There is moderate evidence of increased mortality for rheumatoid arthritis,” he said, but stressed that some data sets show this increase, while others fail to demonstrate it. “[However,] there is a bit of an unclear relationship between OA and premature mortality.”
Baseline data for the current set, the North Staffordshire OA Project, were accrued in April 2002. The analysis includes information from 8,066 patients followed through February 2012. The mortality rate during follow-up was 14%, according to Parmar.
Results indicated an increase in mortality among patients with OA compared with those who did not have OA (HR = 1.39; 95% CI, 1.238-1.569). “We observed a 39.4% increase in mortality for participants with osteoarthritis,” Parmar said. “The assumption of the proportional hazard ratio has been met.”
This trend persisted in the adjusted analysis (HR = 1.15; 95% CI, 1.01-1.31), according to Parmar. The adjusted analysis accounted for a group of proposed mediators, including depression, anxiety, low walking frequency, cognitive impairment, insomnia and obesity.
“The reason we chose these is because they can be easy targets for therapy in primary care” he said. “They may have a direct or indirect pathway of effect on mortality.”
Low walking frequency was the strongest mediator of OA-associated mortality, according to the findings. It carried both a direct (HR = 1.01; 95% CI, 0.9-1.14) and indirect (HR = 1.12; 95% CI, 1.01-1.27) effect. Depression was the next most important mediator of mortality, carrying an indirect effect (HR = 1.1; 95% CI, 1.07-1.15). A similar indirect effect was reported for cognitive impairment (HR = 1.05; 95% CI, 1.02-1.08), according to Parmar. He added that obesity failed to mediate mortality in this population.
“Low walking frequency, depression and cognitive impairment could be potential targets of therapy for osteoarthritis in primary care,” Parmar concluded. “Encouraging physical activity and considering the impact of comorbidities can help reduce the risk of mortality in adults with osteoarthritis.” – by Rob Volansky
Reference: Parmar S, et al. Abstract #9. Presented at: OARSI 2018 World Congress on Osteoarthritis; April 26-29; Liverpool, England.
Disclosure: Parmar reports no relevant financial disclosures.