(OARSI 2014) A prospective population-based study from Ontario shows that disability from osteoarthritis, either in walking or in manual dexterity, has an impact on cardiovascular and diabetes risk.
Walking disability from knee or hip osteoarthritis (OA) is a risk factor for cardiovascular disease (CVD), and also for complications of diabetes.
Walking disability was as great a cardiovascular risk as history of a cardiovascular event itself, in two population-based cohort studies reported by researchers from Toronto. By reducing physical activity, poorly treated OA may increase cardiovascular risk and diabetes complications, they say, and functional limitations of OA of the hands may further interfere with patients' ability to manage diabetes.
The entire population age ≥55 of two Ontario regions was recruited into a screening study from 1996-98. Of those, 2,225 had OA confirmed on examination and x-ray, of whom 2,143 had complete data and were included in an analysis. Nearly three-fourths (73) reported walking difficulty, as defined byeither use of a walking aid or Health Assessment Questionnaire (HAQ) walking disability subscale >0.
These subjects were followed for a median of nine years, by which time 1,460 (68%) had reached the CVD composite outcome (emergency department visit, hospitalization for acute myocardial infarction, coronary heart failure, stroke, or death). After controlling for CVD risk factors, both pre-existing CVD and walking disability remained significant independent predictors of risk for the composite outcome. Baseline HAQ of 2 (vs. 0) and history of CVD each increased risk for subsequent CVD or death by 50%.
Of 2,220 OA cohort participants, 440 had diabetes at baseline. Walking disability at baseline was independently and significantly associated with an increased risk for a diabetes complication. In another analysis, grip strength was also a significant and increased risk for a diabetes complication. Among the possible explanations: Painful OA could have a negative impact on diabetes self-management.