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Verlinden VJA, de Kruijf M, Bierma-Zeinstra SMA, Hofman A, Uitterlinden AG, Ikram MA, van Meurs JBJ, van der Geest JN. Asymptomatic radiographic hip osteoarthritis is associated with gait differences, especially in women: A population-based study. Gait Posture 2017; 54:248-254. [PMID: 28359929 DOI: 10.1016/j.gaitpost.2017.03.009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 01/12/2017] [Accepted: 03/06/2017] [Indexed: 02/02/2023]
Abstract
BACKGROUND Hip and knee osteoarthritis (OA) are debilitating diseases that impair gait at severe stages. Although associations between OA and gait are established for normal walking, little is known about its relation with turning and tandem (heel-to-toe) walking. Furthermore, it is unknown how asymptomatic OA associates with gait, and whether associations differ by sex. We investigated how symptomatic and asymptomatic hip and knee OA associate with gait in community-dwelling individuals. METHODS In 2706 participants of a population-based cohort study, gait was assessed by electronic walkway and summarised into seven gait domains. Hip and knee radiographs were graded for radiographic OA (ROA) using the Kellgren and Lawrence (K&L) score. Linear regression was used to investigate associations between ROA and gait. Analyses were repeated including only participants with asymptomatic ROA, defined as a K&L-score of 2 without pain. RESULTS In total, 177 participants (6.5%) had hip ROA and 441 (16.3%) knee ROA. We found no associations of knee ROA with gait. Hip ROA associated with Rhythm, Tandem, and Turning. Furthermore, unilateral hip ROA associated with larger gait asymmetry and gait differences in osteoarthritic and non-osteoarthritic leg, when compared to people without hip ROA. Associations between hip ROA and gait were generally stronger for women than men. Associations for hip ROA remained after restricting to asymptomatic ROA. CONCLUSION Hip ROA, but not knee ROA, associates with gait differences in normal walking, turning, and tandem walking in community-dwelling individuals. These associations differ between the sexes, and are already present for asymptomatic ROA.
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Affiliation(s)
- Vincentius J A Verlinden
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Marjolein de Kruijf
- Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, Mass., USA
| | - André G Uitterlinden
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jos N van der Geest
- Department of Neuroscience, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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de Kruijf M, Verlinden VJA, Huygen FJPM, Hofman A, van der Geest JN, Uitterlinden AG, Bierma-Zeinstra SMA, Ikram MA, van Meurs JBJ. Chronic joint pain in the lower body is associated with gait differences independent from radiographic osteoarthritis. Gait Posture 2015. [PMID: 26210905 DOI: 10.1016/j.gaitpost.2015.06.193] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Gait is an important indicator of health. Chronic lower body pain may impair gait and lead to morbidity and mortality. We investigated the associations between lower body pain and gait in community-dwelling individuals, independent from osteoarthritis (OA). This population based cohort study included 2304 Rotterdam Study participants who underwent electronic walkway gait assessment. Thirty different variables resulting from gait assessment were summarized into seven gait domains using principle components analysis: i.e. Rhythm, Variability, Phases, Pace, Tandem, Turning, and Base of Support. Chronic lower body pain was assessed using pain drawings. OA was defined as a Kellgren & Lawrence score of 2 or higher on radiographs of the hip and/or knee. Linear regression analysis was used to study associations. Participants with chronic pain in the leg and hip, had lower Rhythm, Phases, and Pace, independent from OA. Additionally, we found unilateral pain to associate with larger gait asymmetry. No associations were found between chronic pain and the other gait domains, including gait variability. However, within individuals with hip pain, gait variability was higher in individuals with radiographic OA compared to those without OA. This is the first population based study showing chronic lower body pain associates with gait differences independent from OA. Participants with pain were found to walk with slower and smaller steps, longer double support and more asymmetry. Proper care and treatment of chronic pain could be a way of reducing gait problems and thereby fall risk and associated mortality. In addition, gait assessment may help identifying individuals with OA from those having pain due to other causes.
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Affiliation(s)
- Marjolein de Kruijf
- Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Anesthesiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands.
| | - Vincentius J A Verlinden
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Department of Anesthesiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Albert Hofman
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Jos N van der Geest
- Department of Neuroscience, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Andre G Uitterlinden
- Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Radiology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands; Department of Neurology, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus MC University Medical Centre Rotterdam, Rotterdam, The Netherlands
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Peters MJ, Broer L, Willemen HLDM, Eiriksdottir G, Hocking LJ, Holliday KL, Horan MA, Meulenbelt I, Neogi T, Popham M, Schmidt CO, Soni A, Valdes AM, Amin N, Dennison EM, Eijkelkamp N, Harris TB, Hart DJ, Hofman A, Huygen FJPM, Jameson KA, Jones GT, Launer LJ, Kerkhof HJM, de Kruijf M, McBeth J, Kloppenburg M, Ollier WE, Oostra B, Payton A, Rivadeneira F, Smith BH, Smith AV, Stolk L, Teumer A, Thomson W, Uitterlinden AG, Wang K, van Wingerden SH, Arden NK, Cooper C, Felson D, Gudnason V, Macfarlane GJ, Pendleton N, Slagboom PE, Spector TD, Völzke H, Kavelaars A, van Duijn CM, Williams FMK, van Meurs JBJ. Genome-wide association study meta-analysis of chronic widespread pain: evidence for involvement of the 5p15.2 region. Ann Rheum Dis 2013; 72:427-36. [PMID: 22956598 PMCID: PMC3691951 DOI: 10.1136/annrheumdis-2012-201742] [Citation(s) in RCA: 101] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 07/19/2012] [Indexed: 12/31/2022]
Abstract
BACKGROUND AND OBJECTIVES Chronic widespread pain (CWP) is a common disorder affecting ∼10% of the general population and has an estimated heritability of 48-52%. In the first large-scale genome-wide association study (GWAS) meta-analysis, we aimed to identify common genetic variants associated with CWP. METHODS We conducted a GWAS meta-analysis in 1308 female CWP cases and 5791 controls of European descent, and replicated the effects of the genetic variants with suggestive evidence for association in 1480 CWP cases and 7989 controls. Subsequently, we studied gene expression levels of the nearest genes in two chronic inflammatory pain mouse models, and examined 92 genetic variants previously described associated with pain. RESULTS The minor C-allele of rs13361160 on chromosome 5p15.2, located upstream of chaperonin-containing-TCP1-complex-5 gene (CCT5) and downstream of FAM173B, was found to be associated with a 30% higher risk of CWP (minor allele frequency=43%; OR=1.30, 95% CI 1.19 to 1.42, p=1.2×10(-8)). Combined with the replication, we observed a slightly attenuated OR of 1.17 (95% CI 1.10 to 1.24, p=4.7×10(-7)) with moderate heterogeneity (I2=28.4%). However, in a sensitivity analysis that only allowed studies with joint-specific pain, the combined association was genome-wide significant (OR=1.23, 95% CI 1.14 to 1.32, p=3.4×10(-8), I2=0%). Expression levels of Cct5 and Fam173b in mice with inflammatory pain were higher in the lumbar spinal cord, not in the lumbar dorsal root ganglions, compared to mice without pain. None of the 92 genetic variants previously described were significantly associated with pain (p>7.7×10(-4)). CONCLUSIONS We identified a common genetic variant on chromosome 5p15.2 associated with joint-specific CWP in humans. This work suggests that CCT5 and FAM173B are promising targets in the regulation of pain.
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Affiliation(s)
- Marjolein J Peters
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam, The Netherlands
| | - Linda Broer
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Hanneke L D M Willemen
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, The Netherlands
| | | | - Lynne J Hocking
- Aberdeen Pain Research Collaboration (Musculoskeletal Research), University of Aberdeen, Aberdeen, UK
| | - Kate L Holliday
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Michael A Horan
- Mental Health and Neurodegeneration Group, School Community Based Medicine, University of Manchester, Manchester, UK
| | - Ingrid Meulenbelt
- Department of Medical Statistics and Bioinformatics, Section of Molecular Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tuhina Neogi
- Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Maria Popham
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Carsten O Schmidt
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Anushka Soni
- NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Ana M Valdes
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Najaf Amin
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- School of Biological Sciences, Victoria University of Wellington, Wellington, New Zealand
| | - Niels Eijkelkamp
- Molecular Nociception Group, University College London, London, UK
| | - Tamara B Harris
- Intramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, USA
| | - Deborah J Hart
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Albert Hofman
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J P M Huygen
- Department of Anaesthesiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Karen A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Gareth T Jones
- Aberdeen Pain Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Lenore J Launer
- Intramural Research Program, Laboratory of Epidemiology, Demography, and Biometry, National Institute on Aging, Bethesda, Maryland, USA
| | - Hanneke J M Kerkhof
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam, The Netherlands
| | - Marjolein de Kruijf
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam, The Netherlands
- Department of Anaesthesiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - John McBeth
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - William E Ollier
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Ben Oostra
- Department of Clinical Genetics, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Antony Payton
- Centre for Integrated Genomic Medical Research, University of Manchester, Manchester, UK
| | - Fernando Rivadeneira
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Blair H Smith
- Medical Research Institute, University of Dundee, Dundee, UK
| | - Albert V Smith
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Lisette Stolk
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam, The Netherlands
| | - Alexander Teumer
- Institute of Functional Genomics, Ernst Moritz Arndt University Greifswald, University of Greifswald, Greifswald, Germany
| | - Wendy Thomson
- Arthritis Research UK Epidemiology Unit, Manchester Academic Health Science Centre, University of Manchester, Manchester, UK
| | - André G Uitterlinden
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ke Wang
- Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Sophie H van Wingerden
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Nigel K Arden
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
- NIHR Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Felson
- Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vilmundur Gudnason
- Icelandic Heart Association Research Institute, Kopavogur, Iceland
- Department of Medicine, University of Iceland, Reykjavik, Iceland
| | - Gary J Macfarlane
- Aberdeen Pain Research Collaboration (Epidemiology Group), University of Aberdeen, Aberdeen, UK
| | - Neil Pendleton
- Mental Health and Neurodegeneration Group, School Community Based Medicine, University of Manchester, Manchester, UK
| | - P Eline Slagboom
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam, The Netherlands
- Department of Medical Statistics and Bioinformatics, Section of Molecular Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Henry Völzke
- Institute for Community Medicine, University of Greifswald, Greifswald, Germany
| | - Annemieke Kavelaars
- Laboratory of Neuroimmunology and Developmental Origins of Disease, University Medical Center Utrecht, The Netherlands
| | - Cornelia M van Duijn
- Department of Epidemiology, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frances M K Williams
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus Medical Center Rotterdam, Rotterdam, The Netherlands
- The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging (NGI-NCHA), Leiden/Rotterdam, The Netherlands
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