The Arthritis Research Institute of America contributes to the growing body of medical literature on osteoarthritis. Here is a partial listing of our recent publications.

The effects of strength training among persons with hand osteoarthritis: a two-year follow-up study.
Journal of Hand Therapy (2007)
Rogers MW, Wilder FV.
Hand exercise is recommended for hand osteoarthritis (OA) management, but few efficacy studies have been published. The purpose of the study was to determine the effects of two years of whole body strength training and gripper exercise on hand strength, pain, and function in adults with radiographic evidence of hand OA. Older adults (N=55; 71.5+/-6.5 years; 80% female) participated in a two-year, three times per week strength training regimen. Bilateral gripper exercise weight (i.e., isotonic grip strength), isometric grip strength, pain, and self-reported hand, and finger function were recorded at baseline and 24 months. Isotonic grip strength increased 1.94 kg (20.14 kg baseline, 22.09 kg follow-up; p <0.0003). Right and left isometric grip increased 3.62 kg (25.83 kg baseline, 29.45 kg follow-up; p<0.002) and 2.95 kg (22.73 kg baseline, 25.65 kg follow-up; p<0.0005), respectively. Hand pain decreased from 4.77 to 2.62 (p<0.006). Hand and finger function scores showed minimal dysfunction at baseline and follow-up. Results suggest strength training safely increases dynamic and static grip strength and reduces pain in older persons with hand OA.

Joint-specific prevalence of osteoarthritis of the hand.
Osteoarthritis Cartilage (2006)
Wilder FV, Barrett JP, Farina EJ.
To quantify the prevalence of radiographic hand osteoarthritis (OA) among a group of community-dwelling individuals. Joint-specific prevalence rates/100 of radiographic OA of the hand were quantified and reported by age, gender, and dominant hand. Data from a community-based, longitudinal study designed to follow the natural history of OA were used. Participants were ambulatory men and women, ages 40 years and older, with and without radiographic hand OA (N = 3327). Bilateral hand OA was examined at three joints: second distal interphalangeal joints (DIP), third proximal interphalangeal joints (PIP), and first carpometacarpal joint of the thumb (CMC). The ordinal scale of Kellgren and Lawrence (0-4) was used to determine OA status (grades 2+). Radiographic hand OA status was determined for all persons in the study group comprised of 2302 women (69%) and 1025 men (31%). The sample sizes for the age groups (years) were 532 (40-49), 905 (50-59), 998 (60-69), 749 (70-79), and 143 (80+). Overall, the DIP joint demonstrated the highest OA prevalence, while the PIP joint showed the lowest prevalence. Joint-specific hand OA prevalence rates for second DIP, third PIP, and first CMC were 35%, 18%, and 21%, respectively. Expectedly, hand OA prevalence for all joints increased with age. With exceptions, women demonstrated higher hand OA prevalence rates for the three sites examined. However, among men aged 40-49, the second DIP joint OA rate was higher (13%) compared with women (8%). Additionally, men in that age group demonstrated an elevated first CMC joint OA rate (9%) compared with women (5%). Gender-specific hand dominance analyses demonstrated that the majority of individuals with unilateral second DIP or third PIP OA presented in their dominant hand. However, among those with unilateral first CMC OA, both genders displayed a tendency to present in their nondominant hand. These findings suggest the need for further investigation of the role gender can play in the development of hand OA in populations under 60 years of age. Additional epidemiological studies addressing hand OA will serve to bridge the gap between the current levels of knowledge about the knee and the hand. The disease burden of hand OA affects a large percentage of the population. Research efforts that more exhaustively characterize the prevalence of hand OA may contribute toward interventions that, ultimately, impact a rapidly growing segment of our population.

Positive hindfoot valgus and osteoarthritis of the first metatarsophalangeal joint.
Foot and Ankle International (2006)
Mahiquez MY, Wilder FV, and Stephens HM.
The aim of this retrospective cohort study was to evaluate the association between increased hindfoot valgus and the subsequent development of osteoarthritis of the first metatarsophalangeal (MTP) joint. Specifically, our hypothesis was that among individuals free from first MTP joint osteoarthritis, those who have positive hindfoot valgus are more likely to develop first MTP joint osteoarthritis than are those individuals with normal hindfoot alignment. Our sample consisted of 1592 men and women, 40 years of age or older, participating in the Clearwater Osteoarthritis Study (1988 to 2001). Biennial physical examinations, including serial radiographs, were conducted. The Kellgren and Lawrence ordinal scale was used to determine radiographic evidence (grades 2+) of the study outcomes and incidence of first MTP joint osteoarthritis. Standing hindfoot valgus was assessed visually by a registered nurse, with a hindfoot valgus measurement of more than 5 degrees classified as a positive hindfoot valgus. Individuals with hindfoot valgus were 23% more likely to subsequently develop first MTP joint osteoarthritis than were those without hindfoot malalignment (risk ratio = 1.23; p-value < 0.006). This risk estimate reflects the potential influence of age, gender, and body mass index. Our data suggest that hindfoot valgus may increase the risk of developing foot osteoarthritis. The association of hindfoot valgus with first MTP joint osteoarthritis in this epidemiological assessment is supportive of the mechanical theory for the development of osteoarthritis. The authors speculate that future, related studies may determine that osteoarthritis prevention strategies can be broadened to include individuals with positive hindfoot valgus.

Exercise and Osteoarthritis: Are we stopping too early? Findings from the Clearwater Exercise Study
Journal of Aging and Physical Activity (2006)
Wilder, FV, Barrett, JP, and Farina, EJ
The value of exercise for persons with knee osteoarthritis (OA) receives continuing consideration. The optimal length of study follow-up time remains unclear. A case-series of persons with knee OA participating in an exercise intervention was followed for two years. We quantified the change in knee pain scores during Months 1-12 and during Months 13-24. Eleven individuals with radiographic knee OA, and knee pain scores of 2+, were evaluated. Pain scores were collected weekly from participants who exercised three times weekly. Participants demonstrated pain reduction during both time periods. Pain reduction during Months 13-24, -10.7%, was slightly higher than pain reduction during Months 1-12, -7.8%. Among persons with knee OA who exercise, our findings suggest that knee pain amelioration continues beyond twelve months. Clinicians should consider encouraging longterm exercise programs for knee OA patients. To best characterize effect of exercise on knee pain, researchers designing clinical trials may want to lengthen the study's duration.

Effect of regular exercise on the radiographic progression of foot osteoarthritis.
Journal of the American Podiatric Medical Association (2005)
Wilder FV, Barrett JP Jr, Farina EJ.
Among the elderly, osteoarthritis often causes chronic pain and disability. Although research has addressed the association between exercise and osteoarthritis, few studies have examined the effect of exercise on the radiographic progression of osteoarthritis. We investigated the relationship between ongoing exercise and radiographic progression of foot osteoarthritis. The first metatarsophalangeal and medial cuneiform-first tarsometatarsal joints were assessed. Joint-specific osteoarthritis radiographic progression scores were determined using four assessments: joint space narrowing, osteophytes, sclerosis, and a composite score. This cohort study included a subset of 221 men and women aged 40 to 91 years participating in a community-based osteoarthritis study. Adjusted risk estimates (95% confidence intervals) summarizing the relationship between ongoing exercise and radiographic progression in the first metatarsophalangeal joint ranged from 0.34 (0.11-0.99) for osteophytes to 0.66 (0.23-1.92) for sclerosis; because only eight individuals experienced medial cuneiform-first tarsometatarsal joint progression, these estimates were less stable, ranging from 2.41 (0.49-11.83) for composite to 4.29 (0.11-166.52) for osteophytes. Overall, our findings do not suggest that regular exercise is a risk factor for foot osteoarthritis progression. Future replication studies are warranted to confirm these findings.

The association of radiographic foot osteoarthritis and radiographic osteoarthritis at other sites
Osteoarthritis and Cartilage (2005)
Wilder FV, Barrett JP, Farina EJ.

Objective
To quantify the association between radiographic foot osteoarthritis (OA) and radiographic OA at four joints: second distal interphalangeal (DIP), third proximal interphalangeal (PIP), first carpometacarpal (CMC), and the knee.

Method
Data collected for the Clearwater Osteoarthritis Study (COS) were analyzed (N=3436). The study outcome was first metatarso-phalangeal joint (first MTP) OA status. The predictor variables were second DIP, third PIP, first CMC, and knee OA. The Kellgren and Lawrence scale determined OA status. The strength of the association between foot OA and other sites was further explored by unilateral and bilateral categories.

Results
For both genders, we found a significant, positive relationship between grade 2+ foot OA and second DIP, third PIP, first CMC, and knee OA. This relationship maintained its significance after adjustment for age, body mass index, and occupational history. Adjusted odds ratios ranged from 3.2 for the second DIP joint (P 0.0001) to 3.7 for the knee joint (P 0.0001). Relative to unilateral joint disease, co-existing bilateral disease yielded a significantly elevated risk for foot OA for all joints examined. While other studies have not specifically examined co-occurrence with foot OA, our findings are consistent with results from related studies..

Conclusion
There is a dearth of studies exploring foot OA. Our findings support the theory of a systemic etiology involved in the development of OA. Future epidemiological studies that further distinguish the relationship between OA at differing sites will provide an enhanced ability to describe the respective influences of mechanical and systemic factors in the development of this disease.

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The association between medication usage and dropout status among participants of an exercise study for people with osteoarthritis
Physical Therapy (2005)
Wilder FV, Barrett JP, Farina EJ.

Background and Purpose
Little is known about predictors of dropout status in exercise studies for people with osteoarthritis. Losses to follow-up can pose serious threats to study validity. The purpose of this study was to assess the ability of arthritis medication usage the month prior to enrollment to predict dropout status among participants in an exercise study for people with osteoarthritis.

Subject and Method
Men and women who participated in an exercise study for people with osteoarthritis (N=143) were followed. Participants who completed 24+ months of the exercise program were considered retained, whereas individuals who withdrew prior to 24 months were considered dropouts.

Results
Of the 143 participants analyzed, 78 (55%) completed 24+ months of the exercise program and 65 (45%) dropped out. Among those who reported arthritis medication usage, 54% were lost to follow-up. The group reporting no usage of arthritis medication had a 20% dropout rate (odds ratio=3.5, 95% confidence interval=1.6-7.6). The final adjusted model controlling for baseline health status, body mass index, and the interaction between baseline health status and body mass index indicated that those individuals who reported arthritis medication usage were more than 4 times more likely to drop out than were those who reported no arthritis medication usage (odds ratio=4.5, 95% confidence interval=1.8-11.4).

Discussion and Conclusion
The results showed that self-reported arthritis medication usage the month prior to study enrollment was associated with subsequent dropout status among this group of exercisers with osteoarthritis. Further identification of baseline characteristics predictive of participant dropout status may benefit future exercise studies. A priori knowledge of "at-risk" exercise study participants will afford the opportunity for the timely allocation of appropriate resources aimed at reducing losses to follow-up.

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Osteoarthritis pain and weather
Rheumatology (2003)
Wilder FV, Hall BJ, Barrett JP
Objective
To evaluate the association between weather (barometric pressure, precipitation and temperature) and pain among individuals with osteoarthritis (OA) (n=154) at the following sites: neck, hand, shoulder, knee and foot.

Method
This prospective study evaluated men and women, aged 49-90 yr, participating in a community-based, osteoarthritis exercise study (June 1998-January 2002). Weekly self-reported pain scores were collected using a visual analogue scale. Statistical tests, including regression and correlation analyses, were conducted. P values < 0.001 were considered significant.

Results
The total number of pain recordings varied by site, ranging from 2269 (feet) to 6061 (hands). The mean temperature was 23 degrees C with a low of 0 degrees C and a high of 36 degrees C. Precipitation levels ranged from 0.00-21.08 cm, with a mean of 0.36 cm. Most associations explored produced non-significant findings. However, among women with hand OA, higher pain was significantly associated with days of rising barometric pressure (P < 0.001).

Conclusion
Among a population of exercisers aged 49 yr and older, overall these findings did not support the hypothesis that weather is associated with pain. While some associations were suggestive of a relationship, largely these findings indicate that weather is quite modestly, if at all, associated with pain from OA.

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Smoking and osteoarthritis: is there an association? The Clearwater Osteoarthritis Study
Osteoarthritis and Cartilage (2003)
Wilder FV, Hall BJ, Barrett JP.
Objective
To evaluate the association between cigarette smoking and the subsequent development of osteoarthritis (OA) at four separate sites: knee, hand, foot and cervical spine.

Method
This cohort study examined 2505 men and women aged 40 years and older participating in the longitudinal Clearwater Osteoarthritis Study (1988-current). Biennial physical exams, including serial radiographs, as well as historical information, were collected. The Lawrence and Kellgren ordinal scale was used to determine radiological evidence of the study outcome, OA. Self-reported history of smoking behavior was used to determine the study exposure. Smoking was classified using four approaches: (1) ever/never, (2) former/never, (3) current/never, and (4) dose.

Results
Among the individuals at study entry, radiologically confirmed incident OA was detected during the follow-up period at four sites: knee (32%), hand (49%), foot (28%), and cervical spine (52%). Approximately 11% were self-reported current smokers. Unadjusted analyses indicated that individuals classified as current smokers demonstrated significant levels of protection from OA at all four sites investigated. However, adjusted point estimates ranging from 0.60-1.48 were suggestive of no association between smoking and the development of OA at any of the four sites investigated.

Conclusion
Based upon the findings of this prospective study, smoking does not appear to convey a clinically significant level of protection against the development of radiologically-confirmed OA. While these findings corroborate previous studies indicating no association between smoking and OA, anecdotal evidence warrants investigation into the role that cigarette smoking may play in the symptomatology of OA. Copyright 2003 OsteoArthritis Research Society International. Published by Elsevier Science Ltd.

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History of acute knee injury and osteoarthritis of the knee: a prospective epidemiological assessment. The Clearwater Osteoarthritis Study
Osteoarthritis and Cartilage (2002)
Wilder FV, Hall BJ, Barrett JP Jr, Lemrow NB.
Objective
To evaluate the association between acute joint injury to the knee and knee osteoarthritis (OA).

Design
Prospective cohort. Sample size = 1,436. Men and women aged 40 years and older participating in the population-based Clearwater Osteoarthritis Study (1988-current) with biennial physical exams including serial radiographs. Radiologically confirmed knee OA = 27%; self-reported knee injury = 11%. Lawrence and Kellgren ordinal scale was used to determine radiological evidence of the study outcome, knee OA. Self-reported history of knee injury was used to determine the study exposure.

Results
Individuals with a history of knee injury were 7.4 (95% C.I. 5.9-9.4) times as likely to develop knee OA than were those individuals who did not have a history of knee injury.

Conclusion
Acute knee joint injury appears to be a risk factor for the development of knee OA. Prevention strategies for OA should be targeted to those individuals with a history of acute knee injury.

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Physical activity as a risk factor for osteoarthritis of the knee
Annals of Epidemiology (1994)
Imeokparia RL, Barrett JP, Arrieta MI, Leaverton PE, Wilson AA, Hall BJ, Marlowe SM.
A case-control study was conducted to evaluate the association between knee osteoarthritis (OA) and physical activity (PA) among a community group aged 40 years and older. Case patients (85 males, 154 females) had radiologically confirmed knee OA with grade 2+ changes, according to Kellgren and Lawrence criteria. Control subjects (85 males, 154 females) had no radiologic evidence of knee OA. A statistically significant positive association between high PA level and knee OA was observed for women, with an age-adjusted odds ratio (OR) of 1.66 and 95% confidence interval (CI) of 1.01 to 2.72. In men no association was observed (OR = 0.95; 95% CI, 0.49 to 1.83). These associations persisted when controlling simultaneously for potential confounders including age, obesity, history of knee injury, and socioeconomic status, indicating that the OA-PA association is limited to women. One possible explanation is that risk factors for knee OA are influenced by hormones.

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Osteoarthritis (OA)
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Osteoarthritis
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What Is Facet Joint Osteoarthritis?
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Combination Approach Found to Aid Knee Osteoarthritis Middle-aged patients in
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Effectiveness of diclofenac versus acetaminophen
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Correlation of pain relief with physical function in hand osteoarthritis
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Arthritis
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FDA: JNJ Unit Failed To Test Tylenol For Contaminants
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Exploring the Link Between Depression and Inflammation and Pain in Rheumatoid
Iin a cross-sectional analysis of 218 patients with rheumatoid arthritis (RA) recruited from a Japanese academic rheumatology clinic.... More

Eastern Health dealing with arthritis backlog
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