PATTERNS OF KNEE, HIP AND HAND OSTEOARTHRITIS IN KENYATTA NATIONAL HOSPITAL

Citation:
G.O.Oyoo, H.A.Nour, M. D. JOSHI. "PATTERNS OF KNEE, HIP AND HAND OSTEOARTHRITIS IN KENYATTA NATIONAL HOSPITAL." EOAJ. 2013;7(7):1-56.

Abstract:

Background: Osteoarthritis (OA) is one of the most common chronic rheumatic disorders and is associated
with significant morbidity and disability. Few studies examined the spectrum of rheumatic diseases in sub-
Saharan Africa. Obesity is not only a risk factor for incidence of OA but also for the progression of the
disease.
Objective: The aim of the study was to determine the patterns of knee, hip and hand osteoarthritis as well
as obesity prevalence in the patients with established disease.
Design: A cross-sectional descriptive study.
Methods: Patients with knee, hip and hand osteoarthritis were examined to describe the patterns of
osteoarthritis in 201 patients who fulfilled the ACR diagnostic criteria. Their body mass indices were also
studied to determine the prevalence of obesity in this cohort of patients.
Results: A total of 201 patients with knee, hip or hand osteoarthritis were studied. Of these participants,
77% had knee OA, 15% hip OA, 3% hand OA and 5% had combined knee and hip OA. Obese participants
were 41% and 32% were overweight. There were 89 (44.3%) participants with bilateral knee or hip disease
while 112(55.7%) had unilateral disease. Obesity was more common in participants with knee than in hip OA
(45.3% vs 10.3% respectively) P < 0.001. The bilateral disease was higher in obese (55.2%) and overweight
(44.6%) participants compared to participants with normal body mass indices (26.5%) P value < 0.007.
Conclusion: Knee OA was very common and the majority of the patients were overweight and obese.
Bilateral OA was more prevalent in obese and overweight participants compared to normal weight
participants. Obesity is an easily modifiable risk factor for knee OA so it can be made a valid target for
preventing as well as halting the progression of OA.
INTRODUCTION
Osteoarthritis (OA) is the most prevalent of chronic
rheumatic disorders in the world (1). The prevalence
is increasing as populations are aging and epidemic
obesity is in the rise. OA is estimated to be the fourth
leading cause of disability in most countries worldwide
(2). Worldwide, around 10% of the population who
are 60 years or older have symptomatic problems
attributable to OA (3). Knee, hip, hand and spine
are typically the affected joints. Knee OA is the most
common form and it is associated with profound
clinical and public health burden (4). Risk factors
include obesity, joint injury, previous joint surgery and
occupational bending and lifting. Of these, obesity is
the most powerful and modifiable risk factor for the
development of OA (5). It has been shown that 24%
of surgical cases due to knee OA can be prevented if
overweight and obese reduce their weights by 5Kg or
until they keep their BMIs in the recommended range
(6). On the other hand, maintaining an ideal weight not
only reduces the onset of the disease but also alleviates
the pain, reduces the disability and improves the quality
of life (7,8). The access to modalities of treatments of
the established disease, particularly the surgical aspect
of it, is beyond the reach of the most of the people living
in the developing countries like Kenya. We do not have
local data on the magnitude of the disease in our set up
as well as the prevalence of obesity in this population
with the disease. For these reasons and because obesity
is modifiable risk factor, we examined patients with
specific joint osteoarthritis and determined the obesity
prevalence in a simple descriptive cross-sectional
hospital based study.
MATERIALS AND METHODS
Subjects: Participants of this study were patients with
primary knee, hip and hand OA who were attending
the outpatient rheumatology and orthopaedic clinics in
Kenyatta National Hospital during the periods between
August and December 2012. A total of 2100 patients
with rheumatic diseases, (88%) from the orthopaedic
and rheumatology clinics (12%) were screened for
diagnostic label of knee, hip or hand OA confirmed
by ACR criteria. Of them, 210 (10%) patients were
eligible so 1890 (90%) patients were excluded. Nine
patients declined to give consent. In the final analysis,
201 patients were studied. Their consent was sought.
All procedures were in accordance with the institutional

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