Diabetes is an independent predictor for severe osteoarthritis: results from a longitudinal cohort study

Georg Schett, Arndt Kleyer, Carlo Perricone, Enijad Sahinbegovic, Annamaria Iagnocco, Jochen Zwerina, Rolando Lorenzini, Franz Aschenbrenner, Francis Berenbaum, Maria-Antonietta D'Agostino, Johann Willeit, Stefan Kiechl, Georg Schett, Arndt Kleyer, Carlo Perricone, Enijad Sahinbegovic, Annamaria Iagnocco, Jochen Zwerina, Rolando Lorenzini, Franz Aschenbrenner, Francis Berenbaum, Maria-Antonietta D'Agostino, Johann Willeit, Stefan Kiechl

Abstract

Objective: To evaluate if type 2 diabetes is an independent risk predictor for severe osteoarthritis (OA).

Research design and methods: Population-based cohort study with an age- and sex-stratified random sample of 927 men and women aged 40-80 years and followed over 20 years (1990-2010).

Results: Rates of arthroplasty (95% CI) were 17.7 (9.4-30.2) per 1,000 person-years in patients with type 2 diabetes and 5.3 (4.1-6.6) per 1,000 person-years in those without (P < 0.001). Type 2 diabetes emerged as an independent risk predictor for arthroplasty: hazard ratios (95% CI), 3.8 (2.1-6.8) (P < 0.001) in an unadjusted analysis and 2.1 (1.1-3.8) (P = 0.023) after adjustment for age, BMI, and other risk factors for OA. The probability of arthroplasty increased with disease duration of type 2 diabetes and applied to men and women, as well as subgroups according to age and BMI. Our findings were corroborated in cross-sectional evaluation by more severe clinical symptoms of OA and structural joint changes in subjects with type 2 diabetes compared with those without type 2 diabetes.

Conclusions: Type 2 diabetes predicts the development of severe OA independent of age and BMI. Our findings strengthen the concept of a strong metabolic component in the pathogenesis of OA.

Figures

Figure 1
Figure 1
A: Disease duration of type 2 diabetes in diabetic patients with and without arthroplasty due to severe OA. B: Cumulative hazard curves for total knee and hip arthroplasty (OA) by type 2 diabetes status, 1990–2010 (n = 927) (P = 0.023).

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