Epidemiology of osteoarthritis

Diseases of the musculoskeletal system, combined in class XIII of the ICD, are considered worldwide as one of the most common pathologies of modern society. Among them, osteoarthrosis is the most common pathology of synovial joints. The prevalence of osteoarthrosis in the population (6.43%) correlates with age and reaches maximum rates (13.9%) in people over 45 years old. The incidence of osteoarthrosis in Ukraine is 497.1, prevalence - 2200.6 per 100,000 population, which is significantly lower than world indicators (in the USA - 700 and 6500, respectively).

Incidence of rheumatic diseases in different countries of the world (according to Ciocci A., 1999)

Country	Total number of cases, million	Number of cases per 100 population	Year	Link
Netherlands	-	18.5	1975	Social Security Service
Germany	20	16	1974	Federal Statistics Service
Austria	-	15.4	1977	Josenhans
Denmark	0,560	14	1957	Robecchi et al.
United Kingdom	5.8	11	1976	LBR* UK
France	4	8	1976	Rubens-Duval and Chaouat
USA	20	7	1976	Public Health Service Arthritis Foundation
Switzerland	-	8-13	1977	Federal LBR
Italy	5.5	10	1986	Italian LBR
Spain	4	12.7	1992	Spanish LBR
All over the world	200	4	1971	WHO

Note: *LBR - League Against Rheumatism.

Before presenting the data on the prevalence of osteoarthritis in the world, it should be noted that in various epidemiological studies, as a rule, two types of criteria for diagnosing the disease were used - radiological according to Kellgren and Lawrence (1957) and ACR criteria. According to the latter, the diagnosis of osteoarthritis is established only in cases where the main symptom is present - joint pain during most days of the previous month. Naturally, the prevalence of osteoarthritis, assessed using different criteria, will be different and, probably, this indicator is underestimated when using ACR criteria compared to traditional radiological assessment.

In the United States, the epidemiology of osteoarthritis has been studied most thoroughly by two national programs, the National Health Examination Survey (NHES) and the First National Health and Nutrition Examination Survey (NHANES-I), which were conducted from 1960 to 1962 and from 1971 to 1975, respectively (National Center for Health Statistics). The data from these two studies were later summarized by the National Arthritis Data Work Group in 1989 and 1998.

Dynamics of prevalence rates of arthrosis and morbidity in 1997, 1999-2001 (per 100 thousand population) (according to Kovalenko V.N. et al., 2002)

Region	Prevalence of arthrosis				Incidence of arthrosis
	1997	1999	2000	2001	1997	1999	2000	2001
Ukraine	1212	1790	1968,5	2200,6	254	420	453.84	497.1
Autonomous Republic of Crimea	805	1037	1175,18	1422,0	180	269	319.5	312.3
Vinnitskaya	2386	3175	3317,16	3625.1	522	591	650.77	586.3
Volyn	2755	3094	3261 79	3378.9	340	446	526.29	538.2
Dnepropetrovsk	1096	1894	2104,64	2377 8	346	602	676,01	745.2
Donetsk	1896	2668	2709,95	3012,5	307	460	453.66	566.8
Zhitomir	1121	2107	3319.27	4552,0	173	426	488.2	677.1
Transcarpathian	360	977	1335.24	2136.9	89	337	473.25	668,0
Zaporizhzhya	862	1207	1210,53	1234.4	141	356	279.16	335.3
Ivano-Frankivsk	2353	3645	3963,99	4159.3	530	780	937.84	962.3
Kyiv	686	1287	1459.4	1550,1	190	352	411.77	415.6
Kirovograd	1331	1988	2237,42	2465.7	219	365	435.47	439 3
Lugansk	810	1161	113877	1168.3	179	350	330.82	339.7
Lviv	318	700	764.38	877.7	121	310	290.6	365.5
Nikolaevskaya	558	668	796.98	894.4	132	204	238.31	271.2
Odessa	1729	2239	2355,66	2478,5	385	535	556.55	575.5
Poltava	464	829	970.93	1032.8	96	321	366.7	364.6
Rivne	640	1075	1063.28	1107.8	116	239	238.78	239.3
Sumskaya	1273	1606	1828,03	2115,5	261	365	420.15	465 4
Ternopil	1568	1896	2072.99	2113.6	197	234	282.82	273.6
Kharkiv	933	1189	1265,75	1317.6	226	323	357.28	456 9
Kherson	633	2109	2677,82	3074.3	248	775	724.55	797,0
Khmelnitskaya	983	1318	1451,12	1480,0	152	257	298.94	296.5
Cherkasy	2058	2950	343719	4420,0	442	534	675.5	660.9
Chernivtsi	2772	3447	3811,79	3909.9	454	417	681.84	370.8
Chernihiv	1428	2253	2304.32	2539.8	315	517	433.2	539.3
City of Kyiv	690	1239	1419.51	1559.3	202	395	405.29	467.3
City of Sevastopol	982	1665	1653.92	1789,1	215	384	343.9	397.8

The diagnosis of osteoarthritis was based on radiographic evidence of osteoarthritis in the joints of the hands and lower extremities (NHES) and in the knee and hip joints (NHANES-I). In the latter study, the clinical picture of the disease was also taken into account when diagnosing osteoarthritis.

According to NHES and NHANES-I, about one third of individuals aged 25 to 74 years have radiographic evidence of osteoarthritis in at least one location. In particular, 33% have definite osteoarthritis of the hand joints, 22% have osteoarthritis of the foot joints, and 4% have osteoarthritis of the knee joints. Among individuals aged 55 to 74 years, osteoarthritis of the hand joints was diagnosed in 70%, of the foot joints in 40%, gonarthrosis in 10%, and coxarthrosis in 3%. Among 6,913 individuals examined in NHANES-I, osteoarthritis was diagnosed in 12% of individuals aged 25 to 74 years. Using data for 1990, the National Arthritis Data Work Group concluded that more than 20 million adults in the United States have clinical evidence of osteoarthritis.

According to the Framingham Osteoarthritis Study (a study of the prevalence of osteoarthritis in Americans - representatives of the Caucasian race aged 63 to 93 years), one third of individuals have reliable radiographic evidence of osteoarthritis of the knee joint. Similar data were obtained in the Baltimore Longitudinal Study on Aging.

The prevalence of overt knee osteoarthritis was studied in NHANES-I and the Framinghem Osteoarthritis Study. Osteoarthritis was considered overt if the patient complained of knee pain on most days for at least one month. According to NHANES-I, the prevalence of overt knee osteoarthritis was 1.6% among individuals aged 25-74 years; according to the Framinghem Osteoarthritis Study, it was 9.5% among individuals aged 63-93 years.

A 1990 survey of the prevalence of rheumatic diseases in Spain showed that 12.7% of respondents (25.7% over 60 years of age) reported complaints typical of some rheumatic diseases, of which 43% (29.4% of men and 52.3% of women) complained of symptoms of osteoarthritis.

According to 1994 data, there were 4 million patients with osteoarthritis in Italy, which constituted 72% of all patients with rheumatic diseases.

Structure of rheumatic diseases incidence in Italy in 1994

Disease	Total number of patients	% of the total number of patients with rheumatic diseases
Osteoarthritis	4 million	72.63
Extra-articular rheumatism	700 thousand	12.71
Rheumatoid arthritis	410 thousand	7.45
Ankylosing spondylitis	151 thousand	2.74
Gouty arthritis	112 thousand	2.03
Diseases of connective tissue	33.6 thousand	0.61
Acute rheumatoid arthritis	500 thousand	0.01
Other rheumopathies	100 thousand	1.82
All in all	5 million 500 thousand	100

According to an epidemiological study of the prevalence of chronic diseases in the highlands of Scotland, the prevalence of telknifenotnogo A. was 65 Via 00 of the population.

I. Petersson (1996) found osteoarthrosis of the joints of the hands in 10% of people aged 40-49 years and in 92% (more than 90% of women, 80% of men) over the age of 70 years living in Europe. In the populations of Sweden and the Netherlands, the prevalence of osteoarthrosis of the joints of the hands in the age group over 70 years was 92 and 75%, respectively, in people over 15 years - 22 and 29%, respectively.

In the UK, the prevalence of Kellgren and Lawrence grades III–IV osteoarthritis in the over-55 age group was 8.4% in women and 3.1% in men. In the Netherlands, the prevalence of osteoarthritis in people over 60 years was estimated at 5.6% in women and 3.7% in men. A prospective study of 12,051 radiographs in Sweden found that the prevalence of coxarthrosis increased from less than 1% in the under-55 age group to 10% in people over 85 years; the mean prevalence of osteoarthritis in people over 55 years was 3.1%, with no difference by sex. In the Netherlands, the prevalence of Kellgren and Lawrence grades II–IV osteoarthritis is about 3% in the 45–49 age group.

The prevalence of osteoarthritis of the knee joints varies widely, according to different researchers. Thus, according to JA Kellgren and JS Lawrence (1958), in the age group of 55-64 years, this figure was 40.7% for women and 29.8% for men. TD Spector et al. (1991) found osteoarthritis of the knee joints in 2.9% of women aged 45-65 years. In a Dutch study, gonarthrosis was diagnosed in 7.7-14.3% of people aged 45-49 years.

In a 12-year prospective observation of 258 individuals from the general population over 45 years of age, it was found that about 25% of women and 10% of men developed radiographic signs of knee osteoarthritis during this period. According to E. Bagge et al. (1992), in the age group of 75-79 years, the incidence of osteoarthritis of the small joints of the hands was 13.6%, and of the knee joints - 4.5% over a five-year period. J. P. Masse et al. (1992) found that the average age of onset of chronic pain in women with lateral patellofemoral (patella-femoral), medial and lateral tibiofemoral (tibiofemoral) osteoarthritis was 56.6+12, 62.7+12 and 69.2+10 years, respectively. In men, knee joint pain appeared somewhat later: at the age of 60.5±10 years with lateral patellofemoral osteoarthrosis and 64+10 years with medial tibiofemoral osteoarthrosis.

In the United States, osteoarthritis is the second leading cause of premature retirement after cardiovascular disease (more than 5% per year).

Primary disability of the population due to deforming arthrosis by regions of Ukraine (according to Kovalenko V.N. et al., 2002)

Region, 2001	Adult population		Working-age population
	Abs. number	For 10 thousand.	Abs. number	For 10 thousand.
Volyn	68.0	0.8	58.0	1.0
Transcarpathian	66.0	0.7	56.0	0.7
Ivano-Frankivsk	1.0	0.01	1.0	0.01
Lviv	157.0	0.7	115.0	0.7
Rivne	91.0	1.0	55.0	0.8
Ternopil	94.0	1.0	58.0	0.9
Chernivtsi	46.0	0.6	38.0	0.7
Autonomous Republic of Crimea	138.0	0.8	71.0	0.6
Dnepropetrovsk	56.0	0.2	3.0	0.01
Zaporizhzhya	0,0	0,0	0,0	0,0
Nikolaevskaya	69.0	0.7	48.0	0.6
Odessa	228,0	1,1	118.0	0.8
Kherson	45.0	0.5	25.0	0.4
City of Sevastopol	73.0	2,3	28.0	1,2
Donetsk	407,0	1.0	275.0	1.0
Lugansk	107.0	0.5	68.0	0.4
Poltava	224 0	1.6	84.0	0.9
Sumskaya	4.0	0.04	3.0	0.04
Kharkiv	221.0	0.9	121.0	0.7
Chernihiv	66.0	0.6	29.0	0.4
Vinnitskaya	179.0	1,2	80.0	0.8
Zhitomir	125.0	1,1	80.0	1.0
Kyiv	133.0	0.9	76.0	0.7
Kirovograd	138.0	1.5	86.0	1.4
Cherkasy	200,0	1.7	61.0	0.8
Khmelnitskaya	95.0	0.8	72.0	0.9
City of Kyiv	265.0	1,2	32.0	0.2
Ukraine, 2001	2773,0	0.8	1360,0	0.6
Ukraine, 2000	3223,0	0.8	1652,0	0.6

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Economic aspects of osteoarthritis

Pathology of the musculoskeletal system, in which osteoarthrosis occupies a leading place, leads to significant losses in the economic, social and psychological spheres. Losses associated with diseases of this group have increased in recent years and amount to 1-2.5% of the gross national income of such developed countries as the USA, Canada, Great Britain, France and Australia. In 1980, in the United States of America, expenses associated with diseases of the musculoskeletal system amounted to 21 billion dollars (1% of the gross national product), in 1988 - 54.6 billion dollars, and in 1992 - 64.8 billion dollars. In 1986, in Canada, these losses were estimated at 8.3 billion Canadian dollars; In France, 4 billion French francs in direct costs (medicines, doctor visits, laboratory tests, X-rays, rehabilitation therapy, etc.) and about 600 million francs in indirect costs associated with losses in production where osteoarthritis patients are employed. In the UK, about 219 million pounds sterling are spent on non-steroidal anti-inflammatory drugs (NSAIDs) per year (most of which is spent by osteoarthritis patients), which is 5% of total drug costs. In Norway, the equivalent of 8 million pounds sterling is spent on NSAIDs annually.

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