Epidemiology of osteoarthritis

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

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

A country	Total number of cases, mln	Number of cases per 100 population	Year	Link
Netherlands	-	18.5	1975	Social Security Service
West Germany	20	16	1974	Federal Service for Statistics
Austria	-	15.4	1977	Josenhans
Denmark	0.560	14	1957	Robecchi et al.
United Kingdom	5.8	Eleven	1976	LBR * UK
France	4	8	1976	Rubens-Duval and Chaouat
USA	20	7th	1976	Public Health Service Arthritis Foundation
Switzerland	-	8-13	1977	Federated LBR
Italy	5.5	10	1986	Italian LBR
Spain	4	12.7	1992	Spanish LBR
Worldwide	200	4	1971	WHO

Note. * LBR - League against rheumatism.

Before describing the prevalence of osteoarthritis in the world, it should be noted that in two epidemiological studies, two types of criteria for diagnosing the disease have generally been used - X-ray according to Kellgren and Lawrence (1957) and the criteria for ACR. According to the latter, the diagnosis of osteoarthritis is established only in those cases when there is a major symptom - pain in the joints during most days of the previous month. Naturally, the prevalence of osteoarthritis, assessed using different criteria, will be different and, probably, this figure is underestimated when using the ACR criteria in comparison with the traditional radiographic evaluation.

In the United States, the most profound epidemiology of osteoarthritis has been studied in 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). Later data from these two studies were summarized by the National Arthritis Data Work Group in 1989 and 1998.

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

Region	Prevalence of arthrosis				Morbidity with 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
Vinnytsia	2386	3175	3317.16	3625.1	522	591	650.77	586.3
Volynska	2755	3094	3261 79	3378.9	340	446	526.29	538.2
The	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
Zhitomirskaya	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
Zaporozhye	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
Kievskaya	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
Luhansk	810	1161	113877	1168.3	179	350	330.82	339.7
Lviv	318	700	764.38	877.7	121	310	290.6	365.5
Mykolayiv	558	668	796.98	894.4	132	204	238.31	271.2
Odesa	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
Sumy	1273	1606	1828.03	2115.5	261	365	420.15	465 4
Ternopil	1568	1896	$ 202.99	2113.6	197	234	282.82	273.6
Kharkivska	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
Khmelnytskyi	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
Kiev	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

Diagnosis of osteoarthritis was based on x-ray signs of osteoarthritis in the joints of the hands and lower limbs (NHES) and in the knee and hip joints (NHANES-I). The last study in the diagnosis of osteoarthritis also took into account the clinical picture of the disease.

According to the NHES and NHANES-I data, about one third of those aged 25 to 74 years have radiographic signs of osteoarthrosis of at least one localization. In particular, in 33% there was a significant osteoarthrosis of the joints of the hands, in 22% - osteoarthrosis of the joints of the feet, 4% - of the knee joints. Among people aged 55 to 74 years, osteoarthritis of the joints of the hands was diagnosed in 70%, joints in 40%, gonarthrosis in 10%, coxarthrosis in 3%. Among 6913 examined within the framework of NHANES-I, osteoarthritis was diagnosed in 12% of persons aged 25 to 74 years. Using data from 1990, the National Arthritis Data Work Group concluded that more than 20 million adults in the US have clinical signs of osteoarthritis.

According to the Framinghem Osteoarthritis Study (a study of the prevalence of osteoarthritis among Americans - representatives of the Caucasoid race aged 63 to 93 years), one third of individuals have reliable radiographic signs of knee osteoarthritis. Similar data were obtained during the Baltimore Longitudinal Study on Aging.

The prevalence of the manifest osteoarthritis of the knee joints was studied in NHANES-I and the Framinghem Osteoarthritis Study. Osteoarthritis was considered manifest if the patient complained of pain in the knee joints for the majority of days for at least one month. According to NHANES-I, the prevalence of manifest gonarthrosis was 1.6% among persons aged 25-74 years), according to the Framinghem Osteoarthritis Study - 9.5% among persons aged 63-93 years.

A survey conducted in Spain in 1990 on the prevalence of rheumatic diseases showed that 12.7% of respondents (25.7% over the age of 60) have complaints typical of some rheumatic diseases, of which 43% (29, 4% of men and 52.3% of women) complained of the presence of symptoms of osteoarthritis.

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

Structure of the incidence of rheumatic diseases in Italy in 1994

Disease	Total number of patients	% of the total number of patients with rheumatic diseases
Osteoarthritis	4M	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 Rheumatic Arthritis	500 thousand.	0.01
Other rheumatic pathologies	100 thousand	1.82
Generally	5 million 500 thousand.	100

According to the epidemiological study of the prevalence of chronic diseases in the highlands of Scotland, the prevalence of O. A. Colonization was 65% of the population.

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

In the UK, the prevalence of coxarthrosis III-IV stage according to Kellgren and Lawrence in the age group over 55 was 8.4% in women and 3.1% in men. In the Netherlands, the prevalence of osteoarthritis in people over 60 years of age is estimated at 5.6% for women and 3.7% for men. In a prospective study of 1,205 radiographs in Sweden, it was found that the prevalence of coxarthrosis rises from less than 1% in the age group below the age of 55 to 10% in persons over 85 years of age; the average prevalence of osteoarthritis among persons over 55 years of age was 3.1% without differences by sex. In the Netherlands, the prevalence of coxarthrosis II-IV stages by Kellgren and Lawrence is about 3% in the age group of 45-49 years.

The prevalence of osteoarthritis of the knee joints varies widely, given to various researchers. So, according to JA Kellgren and JS. Lawrence (1958), in the age group of 55 years - 64 years in women this figure was 40.7%, in men - 29.8%. TD Spector and co-authors (1991) found osteoarthritis of the knee joints in 2.9% of women aged 45-65 years. In the Dutch study, gonarthrosis was diagnosed in 7,7-14,3% of persons aged 45-49 years.

In a 12-year prospective observation, 258 persons from the general population over the age of 45 years found that about 25% of women and 10% of men during this period had radiographic signs of osteoarthritis of the knee joints. According to E. Bagge and co-authors (1992), in the age group of 75-79 years, the incidence of osteoarthritis of the small joints of the hands was 13.6%, of the knee joints 4.5% over a five-year period. JP Masse et al (1992) found that the average age of onset of chronic pain in women with lateral patellofemoral (patellar-femoral), medial and lateral tibiofemoral (tibial-femoral) osteoarthritis was 56.6 + 12.62.7 + 12 and 69 , 2 + 10 years respectively. In men, pain in the knee joints appeared somewhat later: at the age of 60.5 ± 10 years with lateral patellofemoral osteoarthritis and 64 +10 years with medial tibiofemoral osteoarthritis.

In the US, osteoarthritis ranks second after cardiovascular disease as the reason for premature retirement (more than 5% per year).

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

Region, 2001.	Adult population		The able-bodied population
	Abs. Number	At 10 thousand.	Abs. Number	At 10 thousand.
Volynska	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
The	56.0	0.2	3.0	0.01
Zaporozhye	0.0	0.0	0.0	0.0
Mykolayiv	69.0	0.7	48.0	0.6
Odesa	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
Luhansk	107.0	0.5	68.0	0.4
Poltava	224 0	1.6	84.0	0.9
Sumy	4.0	0.04	3.0	0.04
Kharkivska	221.0	0.9	121.0	0.7
Chernihiv	66.0	0.6	29.0	0.4
Vinnytsia	179.0	1.2	80.0	0.8
Zhitomirskaya	125.0	1.1	80.0	1.0
Kievskaya	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
Khmelnytskyi	95.0	0.8	72.0	0.9
Kiev	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

[1], [2], [3], [4], [5], [6], [7], [8], [9], [10],

Economic aspects of osteoarthritis

The pathology of the musculoskeletal system, in which osteoarthritis takes the leading place, leads to significant losses in the economic, social and psychological spheres. Losses associated with the diseases of this group have increased in recent years and constitute 1-2.5% of the gross national income of developed countries of the world such as the USA, Canada, Great Britain, France, Australia. In 1980 in the United States of America, the costs associated with musculoskeletal diseases 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 of direct costs (medicines, visits to doctors, laboratory tests, X-ray studies, rehabilitation therapy, etc.) and about 600 million francs of indirect costs associated with losses in the workplace where patients with osteoarthritis are engaged. In the UK, non-steroidal anti-inflammatory drugs (NSAIDs) consume about 219 million pounds sterling per year (most of them spend patients with osteoarthritis), which is 5% of the total cost of drugs. In Norway, an amount equivalent to £ 8 million is spent annually on NSAIDs.

[11], [12], [13], [14], [15], [16],