Osteoarthritis, a condition where the protective cartilage at the ends of bones breaks down, may more than double the risk of rapidly developing multiple severe long-term conditions, according to a 20-year study published in the journal RMD Open.
Researchers have discovered that osteoarthritis can significantly speed up the progression to multimorbidity, which is the presence of multiple long-term health conditions.
The study identified four different speeds at which people develop multimorbidity.
Persistent low levels of physical activity, a high-calorie diet, and chronic low-grade inflammation are thought to link osteoarthritis to other long-term conditions.
Osteoarthritis affects over 500 million people worldwide, with age, injury, family history, and female sex being known risk factors.
To understand how quickly osteoarthritis leads to other conditions, researchers analyzed healthcare data from the Skåne region in Sweden, which includes around 1.4 million residents.
They focused on people aged 40 and above who had lived in the region since 1998 and were newly diagnosed with osteoarthritis between 2008 and 2009.
This group included 9,846 individuals with an average age of 66, of which 58% were women.
These individuals were matched with two people of the same age and sex who did not have osteoarthritis, totaling 19,692 people.
The study tracked the number of conditions each person developed from 1998 onward until death, relocation, or the end of 2019.
Of the participants, 5,318 were newly diagnosed with knee osteoarthritis, 2,479 with hip osteoarthritis, 988 with hand osteoarthritis, 714 with osteoarthritis in other joints, and 499 with generalized osteoarthritis.
Out of all participants, 1,296 did not develop any other long-term conditions, but 28,242 did. Four patterns of progression emerged:
- Mild Multimorbidity Late Progression (Class 1): Slow progression to multimorbidity with an average of around three conditions by the end of the study.
- Mild Multimorbidity Early Progression (Class 2): Faster progression than Class 1 but with fewer severe conditions.
- Moderate Multimorbidity (Class 3): Intermediate progression with a moderate number of conditions.
- Severe Multimorbidity (Class 4): Rapid progression with the highest number of conditions, averaging around 10 by the end of the study.
In 1998, participants across all classes had one or no long-term conditions. By the end of the study, those in Class 1 had the fewest conditions, while those in Class 4 had the most, with 57% of Class 4 participants having died.
The prevalence of osteoarthritis was lowest in Class 1 (29%) and highest in Class 4 (42%). Osteoarthritis was associated with a 29% increased risk of being in Class 1 but more than doubled the risk of being in Class 4.
The study suggests that osteoarthritis can sometimes precede multimorbidity, indicating that it is part of a disease continuum leading to more severe conditions. Age is a major factor in developing long-term conditions, but the link between osteoarthritis and multimorbidity persists beyond age.
As an observational study, it cannot conclusively determine cause and effect. The study also did not account for physical activity, diet, or body weight, which may influence the development of long-term conditions.
The researchers suggest that low physical activity, high-calorie diet, and chronic low-grade inflammation could partially explain the link between osteoarthritis and other chronic diseases.
This study highlights the significant impact of osteoarthritis on the rapid development of multiple severe long-term conditions, emphasizing the need for further research and potential lifestyle interventions to mitigate these risks.
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