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38
Received: 10 September 2019 / Accepted: 21 September 2019 / Published online: 30 October 2019 UDK 616.72-007.248+685.382
EPIDEMIOLOGICAL ASPECTS OF OSTEOARTHRITIS AND TOTAL ARTHROPLASTY
Dinara S. Serikova-Esengeldina1, https://orcid.org/0000-0002-9470-9488
Maiya V. Goremykina1, https://orcid.org/0000-0003-1686-528X
Natalya E. Glushkova1, https://orcid.org/0000-0003-1400-8436
1 «Semey Medical University» NCJSC, Semey city, Republic of Kazakhstan.
Abstract
Background. In the field of osteoarthritis study, both epidemiological and clinical researches are carried out. If epidemiological studies can identify the prevalence and risk factors for the development of the disease, then clinical studies reveal the prospects for drug and interventional therapy of osteoarthritis.
Search strategy. We have performed a search and analysis of relevant information of English-language and domestic sources published over the past 10 years. The search for English-language resources was carried out in the scientific database Pubmed (https://www.ncbi.nlm.nih.gov), to work with sources in Russian and Kazakh, the scientific electronic library e-Library (https: //elibrary.ru) was used.
The Pubmed database was searched for: (Osteoarthritis [Mesh]) And Osteoarthritis / Epidemiology [Mesh] (153 results), (Osteoarthritis [Mesh]) And Osteoarthritis / Surgery [Mesh] (480 results), as well as ("Arthroplasty, replacement, knee / epidemiology [Mesh]) and "Osteoarthritis" [Mesh] (59 results) ("Osteoarthritis, replacement', "Hip / epidemiology') [Mesh] (66 results). The eLibrary resource searched in Russian and English for the keywords: osteoarthritis, hip joint replacement, coxarthrosis, gonarthrosis, (4 results).
The criteria for inclusion in the review were: search depth: from January 1, 2009 to October 1, 2018; publication languages: English, Kazakh, Russian; age of study participant: 18 years and older; methods of intervention: surgical; type of articles - full-textured epidemiological and clinical studies.
The results of the study. A total of 762 articles were found. For the subsequent analysis, 33 articles were selected that met the inclusion criteria and excluded duplication or repetition of information.
Conclusion. The results of this review study showed that the prevalence of OA remains equally high throughout the world, and temporal trends reflect a trend towards an increase in morbidity due to an aging population and an increase in the proportion of obese patients. The highest epidemiological indicators of large joint arthroplasty (arthroplasty) for OA are traditionally observed in countries with a high standard of living. However, the widespread introduction of high-tech standards of medical care for patients with coxarthrosis and gonarthrosis in the Republic of Kazakhstan requires further study.
Keywords: osteoarthritis, endoprosthetics, gonarthrosis, coxarthrosis, arthroplasty.
Резюме
ЭПИДЕМИОЛОГИЧЕСКИЕ АСПЕКТЫ ОСТЕОАРТРОЗА И ТОТАЛЬНОГО ЭНДОПРОТЕЗИРОВАНИЯ
Динара С. Серикова-Есенгельдина1, https://orcid.org/0000-0002-9470-9488
Майя В. Горемыкина1, https://orcid.org/0000-0003-1686-528X
Наталья Е. Глушкова1, https://orcid.org/0000-0003-1400-8436
1 НАО «Медицинский университет Семей», г. Семей, Республика Казахстан.
Актуальность. В сфере изучения остеоартроза проводятся как эпидемиологические, так и клинические исследования. Если эпидемиологические исследования позволяют выявить распространенность и факторы риска развития заболевания, то клинические исследования раскрывают перспективы лекарственной и интервенционной терапии остеоартроза.
Стратегия поиска. Нами был выполнен поиск и анализ релевантной информации англоязычных и отечественных источников, опубликованных за последние 10 лет. Поиск англоязычных ресурсов проводился в научной базе данных Pubmed (https://www.ncbi.nlm.nih.gov), для работы источниками на русском и казахском языках использовалась научная электронная библиотека e-Library (https: //elibrary.ru).
В базе данных Pubmed поиск осуществляли по запросам: («Остеоартрит» [Mesh]) И «Остеоартрит / эпидемиология» [Mesh] (153 результатов), («Остеоартрит» [Mesh]) И «Остеоартрит / хирургия» [Mesh] (480 результатов), а также («Артропластика, замена, колено / эпидемиология» [Mesh]) И «Остеоартрит» [Mesh] (59 результатов) («Артроз, замена», «Бедро / эпидемиология») [Mesh] (66 результатов). В ресурсе eLibrary поиск
проводили на русском и английском языках по ключевым словам: остеоартроз, эндопротезирование тазобедренного сустава, коксартроз, гонартроз, (4 результата).
Критериями включения в обзор были: глубина поиска: с 1 января 2009 года по 1 октября 2018 года; языки публикации: английский, казахский, русский; возраст участника исследования: 18 лет и старше; методы вмешательства: хирургические; вид статей - полнотекстовые эпидемиологические и клинические исследования.
Результаты исследования. Всего было найдено 762 статьи. Для последующего анализа было отобрано 33 статьи, отвечающие критериям включения и исключающие дублирование или повтор информации.
Заключение. Результаты данного обзорного исследования показали, что распространенность ОА остается одинаково высокой во всем мире, а временные тенденции отражают тенденцию к увеличению заболеваемости вследствие старения населения и увеличения доли пациентов с ожирением. Самые высокие эпидемиологические показатели эндопротезирования крупных суставов (артропластики) при ОА традиционно наблюдаются в странах с высоким уровнем жизни. Однако широкое внедрение высокотехнологичных стандартов медицинской помощи пациентам с коксартрозом и гонартрозом в Республике Казахстан требует дальнейшего изучения.
Ключевые слова: остеартроз, эндопротезирование, гонартроз, коксартроз, артропластика.
Туйшдеме
ОСТЕОАРТРОЗДЫН ЖЭНЕ ЖАППАЙ ЭНДОПРОТЕЗДЕУДЩ ЭПИДЕМИОЛОГИЯЛЫК АСПЕКТ1ЛЕР1
Динара С. Серикова-Есенгельдина1, https://orcid.org/0000-0002-9470-9488
Майя В. Горемыкина1, https://orcid.org/0000-0003-1686-528X
Наталья Е. Глушкова1, https://orcid.org/0000-0003-1400-8436
1 КеАК «Семей медициналык университет», Семей к., Казакстан Республикасы
бзектшН. Остеоартрозды зерттеу саласында эпидемиологиялык, сондай -ак клиникалык зерттеулер етюзтедг Егер эпидемиологиялык зерттеулер ауруларды дамыту каупУч таралуы мен факторларын аныктауга мYмкiндiк берсе, онда клиникалык зерттеулер остеоартрозды 4 дэртк жэне интервенциялык терапиясыныч перспективаларын ашады.
1здену стратегиясы. Бiзбен сочгы 10 жылда жарияланган агылшын тiлдес жэне отандык тYпн¥скаларды iздеу жэне релевантты акпараттарды талдау орындалды.
Агылшын ттщеп ресурстарды iздеу Pubmed (https://www.ncbi.nlm.nih.gov) гылыми базасында, орыс жэне казак ттдерщеп дереккездермен жумыс жасау Yшiн, e-Library (https: //elibrary.ru) гылыми электрондык ютапханасы колданылды. Pubmed м8лiметтер базасында мынадай етiнiмдер бойынша iздеулер: («Остеоартрит» [Mesh]) жэне «Остеоартрит/Эпидемиология» [Mesh] (153 н8тиже), («Остеоартрит» [Mesh]) ж8не «Остеоартрит/ Хирургия» [Mesh] (480) н8тижелер), сонымен катар («Артропластика, ауыстыру, тiзе/эпидемиология» [Mesh]) ж8не «Остеоартрит» [Mesh] (59 н8тиже) («Артроз, ауыстыру», «Жамбас/эпидемиология») [Mesh] (66 н8тиже). E-Library ресурсында орыс ж8не агылшын тiлдерiнде кiлт сездердi iздеу жYргiзiлдi: остеоартроз, жамбас буындарын ндопротездеу, коксартроз, гонартроз, (4 н8тиже).
Шолуга енгiзу критерилерi болды: iздеу теречдИ: 2009 жылдыч 01 качтарынан 2018 жылдыч 01 казанына дейЫ; жарияланмыдар тiлi: агылшын, казак, орыс; зерттеуге катысушылар жасы: 18 жас ж8не одан жогары; араласу 8дютерг хирургиялык; макалалар тYрi - толык м8тiндi эпидемиологиялык ж8не клиникалык зерттеулер.
Зерттеу нэтижелерг Барлыгы 762 макала табылды. Кейiнгi талдау Yшiн косу критерийлерЫе с8йкес келетiн ж8не акпараттыч кайталануын немесе кайталануын болдырмайтын 33 макала тачдалды.
Корытынды. Осы шолу зерттеуУч н8тижелерi бYкiл 8лемде ОА-ныч таралуы бiрдей дечгейде болып отыргандыгын керсеттi, ал уакытша YPДiстер картаюга ж8не семiздiкке шалдыккан наукастар саныныч есуiне байланысты аурудыч есу тенденциясын керсетедi. Yлкен бiрлескен артропластиканыч (артропластиканыч) жогары эпидемиологиялык керсеткiштерi емiр сYPУ дечгейi жогары елдерде д8стYрлi тYPде байкалады. Алайда, ^азакстан Республикасында коксартроз ж8не гонартроз аурулары бар наукастарга медициналык кемектiч жогары технологиялык стандарттарын кечiнен енгiзу 8рi карайгы зерттеудi талап етедi.
Нег'1зг'1 свздер: остеартроз, эндопротездеу, гонартроз, коксартроз, артропластика.
Библиографическая ссылка:
Серикова-Есенгельдина Д.С., Горемыкина М.В., Глушкова Н.Е. Эпидемиологические аспекты остеоартроза и тотального эндопротезирования // Наука и Здравоохранение. 2019. 5 (Т.21). С. 5-10.
Serikova-Esengeldina D.S., Goremykina M.V., Glushkova N.E. Epidemiological aspects of osteoarthritis and total arthroplasty // Nauka i Zdravookhranenie [Science & Healthcare]. 2019, (Vol.21) 5, pp. 5-10.
Серикова-Есенгельдина Д.С., Горемыкина М.В., Глушкова Н.Е. Остеоартроздыч ж8не жаппай эндопротездеудiч эпидемиологиялык аспектiлерi // Гылым ж8не Денсаулык сактау. 2019. 5 (Т.21). Б. 5-10.
Introduction
Osteoarthritis is a progressive degenerative joint change that occurs mainly in elderly people. Modern concepts of pathogenesis put in the forefront biochemical changes and biomechanical stress in affected articular cartilage, while the theory of age-related changes is considered to be obsolete [1, 17]. Among all the publishing of Europe and CIS countries the term "osteoarthritis/osteoarthritisdeformans"is most common.
In the international classification of diseases of the 10th revision osteoarthritis (OA) combines the following headings: M 15 (polyarthritis), M16 (coxarthrosis/hip arthrosis), M17 (gonarthrosis/knee arthrosis), M18 (arthrosis of the first metacarpal joint), M19 (other arthrosis). Such categorization is convenient, because it includes both primary and posttraumaticosteoarthritis [2].
Since OA is characterizedmainly by the large joints (knee and hip) damage, it becomes clear why OA is the leading cause of functional insufficiency of the lower extremities among the elderly people. The proportion of OA in the rate of the average life expectancy decline is 40% among men and 47% among women. The risks increase even more in the category of adult population suffering from obesity [3].
Up to date, OA is one of the most common diseases in General medical practice with a projected increase in prevalence due to ageing of the population and increasing prevalence of obesity [3]. These data are confirmed in research made by Lawrence and co-author (2008), according to which the number of people suffering from OA at the age of 25 years and older has increased in one decade: from 21 million in 1995 to 27 million in 2005 [3]. The purpose of our review is to study the prevalence and other epidemiological indicators of OA and endoprosthetics of large joints according to foreign and domestic literature.
Materials and methods
The search for English-language resources was carried out in the database of abstracts Pubmed (https://www.ncbi.nlm.nih.gov), for work with links in Russian and Kazakh languages were used scientific electronic library e-Library (https://elibrary.ru).
The following list of keywordswas developed in order to search for information: osteoarthritis, endoprosthesis, gonarthrosis, coxarthrosis (osteoarthrosis,
endoprosthetics/joint replacement, coxarthrosis, gonartrosis).
The following search syntax wasused onMeSH in the Pubmed online database: ("Osteoarthritis"[Mesh]) AND "Osteoarthritis/epidemiology"[Mesh] (153 results), ("Osteoarthritis"[Mesh]) AND "Osteoarthritis/surgery"[Mesh] (480 results), and ("Arthroplasty, Replacement, Knee/epidemiology"[Mesh]) AND "Osteoarthritis"[Mesh] (59 results) ("Osteoarthritis"[Mesh]) AND "Arthroplasty, Replacement, Hip/epidemiology"[Mesh] (66 results). The search by key words in Russian and English indicating the location was set up on the resource eLibrary: osteoarthritis, hip replacement, coxarthrosis, gonarthrosis, Kazakhstan, Russian Federation (4 results).
The main criteria included into the review were: the depth of the search: from January 1, 2009 to October 1, 2018; publication languages: English, Kazakh, Russian; age of the sample understudy: 18 and older; methods of
intervention: surgical; type of articles - full-text epidemiological and clinical studies.
According to the results of the search for sources all authors of the article according to the search syntax and included criteria, as well as the elimination of duplicate entries were selected 33 articles for inclusion in the review.
Results
Prevalence and incidence of osteoarthritis
Osteoarthritis is the most common disease of the musculoskeletal system and one of the most important public health problems [4,18]. Although epidemiological data on the prevalence and incidence of OA vary according to the results of numerous studies, one thing remains common for all sources - a significant number of the adult population is exposed to the studied pathology [5,6]. It is worth noting the approaches used in the diagnosis of OA. OA may be defined on pathological and radiological study, as well as clinically. In the English-language literature, the most popular method is x-ray examination with the interpretation of the results byKellgren and Lawrencesystem. The scale ranks the degree of severity from 0 to 4 points with the intelligence of AO by x-ray signs in the presence of 2 points or more [19].
Recent cohort and population-based studies present results on the prevalence of OA in various joints based on both clinical and radiological data. According to the study made by Kim with co-authors (2014), age-standardized prevalence of OA based on clinical and radiological criteria was 19,6% (95% CI 16.7-23.0%) and 4.2% (95% CI 2.96.1%), respectively. The sample included 978 people aged 50 year old and older who lived in the city of Framingham from 2002 to 2005 (middle age 63.5 years old; women 56%). Another interesting result of the study was the fact that the frequency of diagnosis of hip joint OA, exposed on the basis of x-ray examination,in men was statistically significantly higher than in women (24.7% vs. 13.6%; p<0.001) (7).
The prevalence of knee joint OA in Malmo (Sweden) in a cohort of adults aged 56 to 84 years old according to clinical and radiological data was 25.5% (95% CI 24.126.1%) and 15.4% (95% CI 14.2-16.7%), respectively. The study involved 10,000 residents, 62% of whom were women, and the average age of the sample was 70 years old (standard deviation is 7.6 years). The average body mass index in the studied population was 27.1 kg / m2 [8]. According to Kalichmanand co-authors (2014) the frequency of OA of the foot joints varies from 0.1% to 61%, and such a scale depends on age, gender and clinical features [9].
A large population-based two-stage cross-sectional study was conducted in the UK as part of the North Staffordshire Osteoarthritis Project. Twenty-six thousand adults over 50 years old were interviewed using specially designed questionnaires, the response rate was 72%. About half of the respondents were affected by at least one group of joints (hip, knee, hands and feet) (53.23%; 95% CI 52.3 - 54.1%), and one in five participants with OA had joint function disorders (21.87%; 95% CI 21.2 - 22.5%). The more groups of joints were involved in the pathological process, the higher chance of the development of functional disorders.According to the North Staffordshire Osteoarthritis Project, the prevalence of OA was higher among women,
and the risk of development was associated with age. When extrapolating the results of this study to the population of England, the authors suggested that the prevalence of OA with functional joint disorders can reach 3.5 million, including 1.45 million patients aged 50-65 years old and 370000 patients older than 85 years [10].
According to a systematic review conducted as part of the global burden of disease study (2010), the prevalence of OA of knee joint is 3.8% and coxarthrosis is 0.85%. Among the 300 studied diseases, OA ranks 11th among the causes of disability in the adult population [11]. A growing number of studies on the prevalence and incidence of OA use huge administrative databases [12,13,14,15]. The Moriatis study (2014) used a Swedish population register covering data from 1998 to 2012. The authors analyzed data from the town of Skane in southern Sweden with a population of 1.24 million people.Over 15 years, the register recorded all cases ofOA carpometacarpal articulation diagnosed by a General practitioner in the adult population over 20 years old. According to the results of the analysis, the frequency of the studied nosology among adults averaged 1.4% (2.2% among women and 0.62% among men). The average age of patients with OA carpometacarpal was 67.7±11.4 years; 78.5% of diagnoses were determined in female patients. The highest frequency of the disease recorded among women aged 70-74 years old (5,3%) and men aged 80-84 years old (1.7 percent).The age of the first diagnosis of the studied nosology also has gender characteristics (60-69 years old - in women; 70-79 years old - in men) (12). The continuation of this study was the prediction of the disease prevalence in 2032 based on the analysis of 531254 records of the health Register Skane. The incidence of OA among persons aged over 45 years old in 2012 was 26.6% (95% CI 26.5-26.8%). In most cases knee joints wereaffected (13.8%), followed by hip joints (5.8%) and wrist joints (3.1%). In every fourth recorded case, the patient had multiple affected joints. The authors' calculations predict an increase in the prevalence of OA among people older than 45 from 26.6% to 29.5% (any joint), from 13.8% to 15.7% for gonarthrosis and from 5.8% to 6.9% for coxarthrosis by 2032 [15].
Another population-based study on the incidence of OA was conducted in Western Canada in 2014. The authors analyzed a database of calls for medical help (n=640000) in British Columbia in the period from 1991/1992 to 2008/2009. As the criteria for the diagnosis of OA, the researchers chose: 1 - at least one General practitioner visitor an apply to hospital; 2-at least 2 doctorvisits or 1 apply to a hospital. In 2008/2009, the overall incidence of OA according to criterion 1 was 14.6% among men and 16.3% among women (per 1000 person in a year). Between 2000/2001 and 2008/2009, the overall crude incidence increased by 2.5-3.3% for men and women.Age-standardized incidence increased by 0.6-0.8% among men, there was not observed such trend among women [13]. A similar study was also conducted in Spain, the register SIDIAP contained records of more than 5 million inhabitants of Catalonia. The incidence was assessed with the consideration of theOA diagnosis of the knee, hip joints and hands with the use of ICD-10 coding among persons older than 40 years old in the period from 2006 to 2010. According to the results of the study, the authors noted a
constant increase in gonarthrosis and coxarthrosis due to age. The highest ratio of the prevalence of nosology in women to the same indicator among men was the highest in the age group of 70-75 years old, while the mentioned indicator for the OA of the joints of the hands was the highest in the group of 50-55 years old [14].
We have to understand that studies based on the analysis of databases of the register have certain limitations in view of the inaccuracies of diagnosis in accordance with ICD-10, but at the same time,without a large population-based studies, it is impossible to study the burden and trends in the development of the disease [16]. An example of a population-based study using Kazakhstan's national statistical data is the article by M. Nogayeva (2015). According to the author in the structure of diseases of the musculoskeletal system in 2012, gonarthrosis accounted for 10.9%, and coxarthrosis was first diagnosed in 4.4% of cases. Dynamics of growthof hip and ankle joints OA for 2011-2012 was 1.1% [24].
We should also focus on the epidemiological indicators of post-traumatic osteoarthritis (POA), since this class of joint lesions has a slightly different etiopathogenetic characteristic [23]. The results of analytical studies indicate a higher (4.2 times) risk of gonarthrosis in persons with a history of knee injuries [20]. The epidemiological situation is rather different with regard to the prevalence of ankle OA. According Valderabbano (2009) 78% with the ankle joint POA indicate a history of trauma to the specified region of body [21]. Among the risk factors for the development of POA it is worth noting the intense physical activity on the affected joints. For example, the frequency of post-traumatic coxarthrosis among military personnel can reach 20% [22].
Epidemiology of hip and knee endoprosthetics in osteoarthritis
Endoprosthetics (another term used in foreign literature - arthroplasty) is the most frequently recommended modality of surgical intervention in the final stages of the hip and knee joints OA [25,26]. From the standpoint of evidence-based medicine, this approach is also justified: the results of a systematic review of Nelson and co-authors (2014) showed that elective endoprosthetics may be recommended for a certain proportion of patients with gonarthrosis or coxarthrosis, while arthroscopy with removal of damaged tissues is not recommended in cases of symptomatic gonarthrosis [27].
Information on the prevalence of surgical interventions in OA varies depending on the specifics of the studied region. So, according to Kremersand co-authors (2010) the frequency of total endoprosthetics in the United States in 2010 was 0.83% and 1.52% for hip and knee joints, respectively. The frequency of interventions was significantly higher among women and increased with age, reaching 5.26% for total hip replacement and 10.38% for gonarthrosis in persons over 80 years old. The presented data was obtained in the analysis of 2.5 million and 4.7 million cases of endoprosthesis replacement in coxarthrosis and gonarthrosis, respectively [28].
The fact of high prevalence of endoprosthesis replacement in the countries with developed economy is remarkable. The frequency of endoprostheticsin the knee joints pathology in the United Kingdom in 2009 reached
77500 cases, while 103601 similar surgeries were performedin South Korea in 2002-2005 [29,30]. In the United States of America the rate of joint replacement in kneeOA increased from 31.2 per 100,000 person-years (95% CI of 25.3 37.1 per cent) in the period 1971-1976 to 220,9 (95% CI 206,7-235,0%) in 2008 (31). In the United Kingdom, the same rate also increased from 43 per 100,000 person-years in 1991 to 137 per 100,000 person-years in 2006 for women [32]. Similar trends are also observed in South Korea, and Scandinavia [33]. Carr and co-authors (2012) note the importance of maintaining national registers of endoprosthesis cases in OA not only for epidemiological descriptive studies, but also for monitoring long-term outcomes of surgical intervention in this category of patients [34].
Epidemiological characteristics of endoprosthesisin knee and hip joints OA also has age, gender and ethnic characteristics. According to Gullifordand co-authors (2010) the average age of knee replacement patients in the UK was 70 years old, with a statistically significant change between 1991 and 2006. The ratio of operated women to men accounts to 1.4:1 [32], thatalso remained stable under study over 15 years. Blum and co-authors (2012) note the phenomenon of less popularity of endoprosthesis among people of the Negro race in comparison to the representatives of the European race in the United States [35]. In addition, one should not forget about the differences in the health systems of different countries in determining the criteria that serve as absolute and relative indications for surgical intervention in OA of large joints [36]. In the Republic of Kazakhstan, according to Zharmukhambetov E. (2014), the number of surgical interventions on the joints in 2013 amounted to 12,717 cases, the share of endoprosthesis in coxarthrosis was 24.7%, and in gonarthrosis - 10.8%. The author of the study notes that the number of surgical interventions for knee replacement increased by 64.3% (517 to 1447) in the period from 2011 to 2013 [37].
Conclusion
The literature review of the English-language and domestic literature showed that the prevalence of OA remains equally high throughout the world, and the time trends reflect the tendency to increase morbidity due to the aging of the population and the increase in the proportion of patients with obesity. The highest epidemiological indicators of large joint endoprosthesis (arthroplasty) in OA have traditionally been observed in countries with a high standard of living. However, the widespread introduction of high-tech medical care standards for patients with coxarthrosis and gonarthrosis in the Republic of Kazakhstan leads to further study of other aspects of the disease.
Литература:
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2. Ногаева М.Г. Остеоартроз у взрослого населения Республики Казахстан // Терапевтический архив 2015. №5. С.65-68.
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Контактная информация:
Серикова-Есенгельдина Динара Сериковна - докторант PhD по специальности «Общественное
здравоохранение», НАО «Медицинский университет Семей», г. Семей, Республика Казахстан.
Почтовый адрес: Республика Казахстан, 071400, г. Семей, ул. Абая, 103.
Телефон: 87785886986
E-mail: dinara_esengeldina@mail.ru
