Women, Black patients face more severe knee OA; men at higher risk in lower extremities
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Key takeaways:
- Men have a higher risk for multi-joint osteoarthritis in three or more joints out of the hip, knee, ankle or foot.
- The researchers aim to conduct future studies as the sample size increases.
Men are at greater risk for multi-joint osteoarthritis in their lower extremities vs. women, while women and Black patients demonstrate more severe knee OA features, according to data published in The Journal of Rheumatology.
“Considerable heterogeneity in the disease, from its pathological mechanisms to its presentation, makes epidemiological research in OA challenging,” Sherwin Novin, MD, of the University of North Carolina at Chapel Hill, and colleagues wrote.
“Differences between race and ethnicity and sex are postulated to play a role in symptom presentation,” they added. “There are robust data revealing that Black patients with [knee OA (KOA)] experience greater pain and disability compared to white patients. However, such comparisons in radiographic features, pain, and function in other ethnic groups, specifically Hispanic patients, are not well described.”
To compare differences in knee and multi-joint OA features based on sex, race and ethnicity, Novin and colleagues conducted a population-based cohort study using data from 544 participants in the Johnson County Health Study. Among the included patients, the mean age was 55.3 (SD = 9.5) years, while 33.1% were male, 68.2% were white, 22.8% were Black and 9% were Hispanic.
The researchers determined OA phenotypes by radiographic features and self-report scores. Demographic associations were revealed using logistic regression models adjusted for age, BMI and education.
According to the researchers, men demonstrated a significantly higher risk for multi-joint OA in three or more joints out of the hip, knee, ankle or foot, both radiographically (OR = 2.27; 95% CI, 1.1-4.69) and symptomatically (OR = 2.33; 95% CI, 1.07-5.07). Meanwhile, women were significantly more likely to have radiographic knee OA than men (OR = 1.56; 95% CI, 1.04-2.35), particularly in regard to features such as lateral joint space narrowing (OR = 1.88; 95% CI, 1-3.54), medial tibial osteophytes (OR = 1.67; 95% CI, 1.21-2.3) and sclerosis (OR = 1.61; 95% CI, 1.07-2.44).
Race and ethnicity analyses revealed a significantly higher risk for radiographic knee OA among Black individuals than white (OR = 1.63; 95% CI, 1.06-2.51), as well as a higher likelihood of demonstrating advanced grades of most radiographic features. Hispanic participants, meanwhile, had lower odds of advanced knee OA radiographic features vs. white participants, significantly in Kellgren-Lawrence grade severity (OR = 0.6; 95% CI, 0.36-1).
There were no differences in pain, aching and stiffness symptom severity by race and ethnicity, according to the researchers. In multi-joint OA, there were no statistically significant differences between Black and white participants, while Hispanic enrollment was too low to compare with white participants, they wrote.
The study’s “most significant” limitation was its low sample size, particularly among Hispanic participants (n = 49), Novin and colleagues wrote. Since the Johnson County Health Study cohort is still enrolling, they aim to conduct future studies expanding on these results “as our sample size increases,” they wrote.
“Men were found to more commonly express [multi-joint OA (MJOA)-6], suggesting a possible association between lower extremity-predominant MJOA compared to women in this younger group,” Novin and colleagues wrote. “We found no statistically significant association in MJOA phenotypes by race and ethnicity. Regarding KOA, women and Black participants generally had more features of KOA and more severe pain and symptom outcomes, consistent with the literature.
“Interestingly, our preliminary data suggest that Hispanic individuals may express most MJOA subtypes less frequently than white individuals, along with fewer knee-level outcomes, despite typically reporting higher pain and symptoms scores,” they added. “Although our data are currently limited by sample size, we expect the growing and diverse [Johnson County Health Study] cohort to allow us the opportunity to contribute unique and beneficial knowledge to the OA literature.”
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