BACKGROUND We examined the association of three common chronic conditions (obesity, diabetes mellitus [DM], and cardiovascular disease [CVD]) with transitions among states of hip osteoarthritis (HOA). METHODS This longitudinal analysis used data from the Johnston County Osteoarthritis Project (JoCo OA, n = 3857), a community-based study in North Carolina, USA, with 18.4 ± 1.5 years of follow-up. Transitions across the following states were modeled: development of radiographic HOA (rHOA; Kellgren-Lawrence grade [KLG] of< 2); development of hip symptoms (self-reported hip pain, aching, or stiffness on most days) or symptomatic HOA (sxHOA; rHOA and symptoms in the same hip), and resolution of symptoms. Obesity (body mass index ≥ 30 kg/m2) and self-reported DM and CVD were the time-dependent comorbid conditions of interest. Markov multi-state models were used to estimate adjusted hazard ratios and 95% confidence intervals to describe the associations between the conditions and HOA states. RESULTS The sample included 33% African Americans, 39% men, with a mean (SD) age of 62.2 (9.8) years; the frequencies of the comorbidities increased substantially over time. When considered individually, obesity was associated with incident hip symptoms, while CVD and DM were associated with reduced symptom resolution. For those with > 1 comorbidity, the likelihood of incident sxHOA increased, while that of symptom resolution significantly decreased. When stratified by sex, the association between obesity and incident symptoms was only seen in women; among men with DM versus men without, there was a significant (~ 75%) reduction in symptom resolution in those with rHOA. When stratified by race, African Americans with DM, versus those without, were much more likely to develop sxHOA. CONCLUSIONS Comorbid chronic conditions are common in individuals with OA, and these conditions have a significant impact on the persistence and progression of HOA. OA management decisions, both pharmacologic and non-pharmacologic, should include considerations of the inter-relationships between OA and common comorbidities such as DM and CVD.

中文翻译：

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在基于社区的研究中，合并症，髋骨关节炎状态之间的过渡和症状：多状态时间事件模型方法。

背景我们研究了三种常见的慢性疾病（肥胖，糖尿病[DM]和心血管疾病[CVD]）与髋骨关节炎（HOA）状态之间的转换之间的关系。方法该纵向分析使用了约翰斯顿县骨关节炎项目（JoCo OA，n = 3857）的数据，该项目是一项在美国北卡罗来纳州进行的社区研究，随访时间为18.4±1.5年。对以下状态的转换进行了建模：放射线HOA的发展（rHOA； Kellgren-Lawrence等级[KLG]小于2）；髋关节症状的发展（大多数情况下自我报告的髋关节疼痛，疼痛或僵硬）或有症状的HOA（sxHOA； rHOA和同一髋关节的症状），以及症状的缓解。肥胖（体重指数≥30 kg / m2）以及自我报告的DM和CVD是与时间相关的合并症。马尔可夫多状态模型用于估计调整后的危险比和95％置信区间，以描述条件与HOA状态之间的关联。结果样本包括33％的非洲裔美国人，39％的男性，平均（SD）年龄为62.2（9.8）岁。合并症的频率随着时间的推移而显着增加。单独考虑时，肥胖与髋部症状有关，而CVD和DM与症状缓解相关。对于合并症> 1的患者，发生sxHOA的可能性增加，而症状缓解的可能性显着降低。按性别分层时，肥胖和突发症状之间的关联仅在女性中发现；在患有DM的男性和没有DM的男性中，rHOA的症状缓解显着降低（〜75％）。当按种族分层时，患有DM的非裔美国人与未患有DM的非裔美国人更有可能患sxHOA。结论合并性慢性病在OA患者中很常见，这些疾病对HOA的持久性和进展有重大影响。OA管理决策，包括药理学和非药理学，都应考虑OA与常见合并症（如DM和CVD）之间的相互关系。