Zoetermeer Survey. Comparison of Radiological Osteoarthritis in a Dutch Population with That in 10 Other Populations
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Ann Rheum Dis: first published as 10.1136/ard.48.4.271 on 1 April 1989. Downloaded from Annals of the Rheumatic Diseases, 1989; 48, 271-280 Scientific papers Epidemiology of osteoarthritis: Zoetermeer survey. Comparison of radiological osteoarthritis in a Dutch population with that in 10 other populations JAN L C M VAN SAASE,13 LEO K J VAN ROMUNDE,1 ARNOLD CATS ,2 JAN P VANDENBROUCKE,3 AND HANS A VALKENBURG1 From the 'Department of Epidemiology, Erasmus University Medical School, Rotterdam, The Netherlands; and the Departments of 2Rheumatology and 3Clinical Epidemiology, Leiden State University, Leiden, The Netherlands SUMMARY The prevalence of mild and severe radiological osteoarthritis was investigated in a random sample of 6585 inhabitants of a Dutch village. Radiographs were graded 0-4 according to the criteria described by Kellgren and Lawrence. The prevalence of radiological osteoarthritis increased strongly with age and was highest for cervical spine (peak: men 84.8%, women 84-3%), lumbar spine (peak: 71-9%, women 67.3%), and distal interphalangeal joints of the hands (peak: men 64-4%, women 76%). Prevalence did not exceed 10% in sacroiliac joints, lateral carpometacarpal joints, and tarsometatarsal joints. Severe radiological osteoarthritis (grade 3 or grade 4) was uncommon under age 45; in elderly persons the prevalence of severe radiological osteoarthritis did not exceed 20% except for the cervical and lumbar spine, distal interphalangeal joints of the hands and, in women only, metacarpophalangeal joints, first carpometacarpal joints, http://ard.bmj.com/ first metatarsophalangeal joints, and knees. Overall, differences between men and women were small except for hips and knees; however, severe radiological osteoarthritis was found in a higher proportion in most of the joints in women. Our data were compared with data from similar population surveys. The slope between joint involvement and age was strikingly constant for most of the joints. Differences between populations were mainly differences in level. These differences of prevalence of radiological osteoarthritis may be attributed to interobserver differences-that is, different criteria used to establish radiological osteoarthritis, in addition to on October 1, 2021 by guest. Protected copyright. genetic or environmental factors, or both. Key words: prevalence, human. Osteoarthritis causes morbidity that will be of age 25. osteoarthritis mainly affects older age increasing importance in populations with greater groups.2 3 Several investigations compared the pre- proportions of elderly people. Epidemiology can valence of osteoarthritis in different races, different help establish the causes of chronic diseases like populations, and different geographic areas. osteoarthritis.1 One of the major tools used by Although a number of carefully conducted large epidemiologists to accomplish this is a comparison population surveys are available, only a limited of populations. Epidemiological studies have shown number of these were adequately compared.7 In that radiological osteoarthritis is a ubiquitous dis- this paper we describe the prevalence of radiological order. Although present in some individuals around osteoarthritis of 22 joints and groups of joints in a random population sample of 6585 inhabitants of Accepted for publication 4 August 1988. Zoetermeer in the Netherlands. The results are Correspondence to Dr Jan L C M van Saase, Department of Clinical Epidemiology, Leiden State University, PO Box 9600, compared with results from 10 similar population 2300 RC Leiden, The Netherlands. surveys. 271 Ann Rheum Dis: first published as 10.1136/ard.48.4.271 on 1 April 1989. Downloaded from 272 van Saase, van Romunde, Cats, Vandenbroucke, Valkenburg Subjects and methods history, rheumatic complaints, profession, daily activities, drug use, schooling history, and lifestyle ZOETERMEER POPULATION habits by a questionnaire. In a specially equipped To study the prevalence and determinants of centre joints were investigated, blood pressure, rheumatic and cardiovascular diseases a population weight, and height were measured, and radiographs survey was conducted between 1975 and 1978 in two were taken of all 6585 participants. Blood was districts of Zoetermeer, a suburban metropolitan obtained for determination of rheumatoid factor, area near The Hague in The Netherlands.8 Respon- total serum cholesterol, and uric acid. dents were inhabitants of the original agricultural village and the recently built parts, which were RADIOGRAPHS principally inhabited by white collar workers. All Radiographs were obtained of hands, forefeet, and inhabitants of the old village centre and one part of lateral cervical spine. Several additional radiographs the new area were invited to participate in this were taken of all respondents of 45 years and older: survey. Of 4134 eligible men and 4523 eligible lumbar spine in anteflexion and dorsiflexion and women of 19 years and older, 6585 (76-1%) partici- pelvis and knees in anteroposterior and standing pated in the study (3109 men, 3476 women). Survey position. During the last year of the survey radio- completion was greatest between 20 and 64 years of graphs of both shoulders were taken of all respon- age (78.2%) and was only 61% in those over 65. dents of 45 years and older. Examination of radio- Information was gathered on previous medical graphs was performed by two investigators indepen- ZOETERMEER POPULATION (EPOZ) ZOETERMEEIR POPULATION (EPOZ) (B) Men: handjointts radiological oslteoarthritis grade > 2 DIP http://ard.bmj.com/ MCP CMC-I Fig. 1 Age specificprevalences of WRIST PIP osteoarthritis ofhands andfeetfor CARPUS inhabitants ofZoetermeer. DIP=distal interphalangealjoints; CMC-L ... I w C CMC-I=first carpometacarpal 20 30 40 S0 00 70 s0 20 30 40 70 INY0 joint; MCP=metacarpophalangeal on October 1, 2021 by guest. Protected copyright. AGE IN YEARS AGE IIN YEARS joints; PIP=proximal ZOETERMEER POPULATION (EPOZ) ZOETERMEEIR POPULATION (EPOZ) interphalangealjoints; (D) CMC-L=second to fifth Men: feetlointi .e radiologIcal osiiteoarthritiste8arthntis grade >>22 carpometacarpaljoints; a MTP-I=first metatarsophalangeal coI joint; MTP-L=second tofifth 2 metatarsophalangeal joints; TMT=tarsometatarsaljoints. 0 MTP-I ma, PIP 0 />~< TMT AGE IN YEARS Ann Rheum Dis: first published as 10.1136/ard.48.4.271 on 1 April 1989. Downloaded from Epidemiology of osteoarthritis 273 dently, based on the grading system for radiological CRITERIA FOR CHOICE OF COMPARISON osteoarthritis according to the Atlas of Standard POPULATIONS Radiographs of arthritis.9 This atlas contains radio- Population surveys suited for comparison were cross graphic examples of osteoarthritis of several joints sectional and contained random or stratified popula- in several stages of the disease. A five point scale tion samples. Not all surveys could be used: radio- has been used for staging (O=absent, 1=dubious, graphs had to be available of nearly all respondents 2=mild, 3=moderate, 4=severe). Small joints of without regard to complaints; an acceptable sample hands and feet were graded as groups (Figs 1 and 2) size of above 500 participants was necessary; sex and according to the most affected joint of the whole age specific information about radiological osteo- group. Right and left side were not separated, arthritis had to be available; and the radiological except for hips, knees, shoulders, and sacroiliac osteoarthritis data had to be presented for individual joints. When a one point difference in grading joints or groups of joints. Furthermore, information occurred between both investigators the higher about the origin of the population, the sample size, score was accepted, but where there was greater the sampling technique, and the range of age and of disagreement about the grading or when one obser- joints for which radiographs had been taken had to ver scored grade 1 and the other grade 2 the films be available. Table 1 presents the basic data of 10 were reassessed at a joint reading session until a populations with a total of 22 629 participants. Two final score was agreed. Interobserver and intraob- large surveys, the Alaskan Eskimo1 and the server agreement has been discussed elsewhere.10 Jamaican survey,12 were not included because no ZOETERMEER POPULATION (EPOZ) ZOETERMEER POPULATION (EPOZ) (A) 100' (B) Women: hips, knees, shoulders and SI-joints Men: hips, knees, shoulders and Si-joints .Lo radiological osteoarthritis grade > 2 radiological osteoarthritis grade > 2 c t 80 0to ao 0 z 0 .3 0 0.o 0CO 70- http://ard.bmj.com/ 0 C. co a KNEE-L KNEE-R Fig. 2 Age specific prevalences HIP-R ofosteoarthritis oflarge joints and Y 10 0 _5RSHOUL-R/L disc degeneration for inhabitants 4 -QJ-~~~~SR/L ofZoetermeer. L = left; R = right; .0 on October 1, 2021 by guest. Protected copyright. 40 60 70 20 30 *0 S0 60 70 30 SHOUL=shoulder; SI=sacroiliac AGE INSI YEARSYA AGE IN YEARS CD joints; CS-DD=cervical spine disc ZOETERMEER POPULATION (EPOZ) ZOETERMEER POPULATION (EPOZ) degeneration; LS-DD=lumbar 0 (C) t*oo (D) Women: spine-radiological osteoarthritis Men: spine-radiological osteoarthritis spine disc degeneration; and disc degeneration grade > 2 ._ ,o ] and disc degeneration grade > 2 CS-OA=cervical spine osteoarthritis. 0 C* 0 E 3: D4 D AGE IN YEARS AGE IN YEARS Ann Rheum Dis: first published as 10.1136/ard.48.4.271 on 1 April 1989. Downloaded from 274 van Saase, van Romunde, Cats, Vandenbroucke, Valkenburg Table 1 Radiological osteoarthritis datafrom JOpopulation surveys Population Age