Osteo-Arthrosis: Prevalence in the Population and Relationship between Symptoms and X-ray Changes

From a study of rheumatic complaints in an urban population (Kellgren, Lawrence, and Aitken-Swan, 1953), it was concluded that osteo-arthrosis was the most frequent cause of loss of work due to rheumatic disease in females and that it came third as a cause of such incapacity in males. Anderson, Duthie, and Moody (1962) and Anderson and Duthie (1963) have since reached similar conclusions in groups of miners and dock-workers. The relative importance of osteo-arthrosis was confirmed by Mason (1956), who found it to be by far the largest diagnostic group among patients attending a physiotherapy department. In an x-ray survey of a random sample of the Leigh population aged 55 to 64 years, it was found that 83 per cent. of males and 87 per cent. of females had osteo-arthrosis in one joint or other and that the condition was present in four or more joints in 29 per cent. of males and 47 per cent. of females (Kellgren and Lawrence, 1958). In a later study in which samples of the population from age 15 were examined, it was observed that both the number of joints involved and the severity of the disease as determined radiologically was similar in males and females up to age 54, but that the disease thereafter became more severe and more generalized in females (Kellgren, Lawrence, and Bier, 1963). The joint pattern was also similar in males and females in the younger age groups but changed after age 55, when the distal and proximal interphalangeal joints of the fingers, the metacarpophalangeal, and the 1st carpometacarpal joints were more frequently affected in females. The wrists and hips, on the other hand, were more commonly affected in males. But, although osteo-arthrosis occurs with considerable frequency in population samples and is almost universal in the older age groups, mere prevalence statistics give little indication of its importance to the community whether as a cause of suffering or of economic loss. In a survey of coalmining and other occupational groups in which routine x-rays of the knees were taken, it was found that only 24 per cent. of men with definite radiological evidence of osteo-arthrosis gave a history of pain in the knees. Of those without radiological evidence, 8 per cent. gave such a history (Kellgren and Lawrence, 1952). The reasons for this low complaint rate and the factors which determine the occurrence of symptoms are by no means clear. A climatic influence has been suggested. Thus, in a survey of rheumatic complaints in Leigh, complaints attributed to osteoarthrosis were rather more frequent in those working in cold or wet conditions than in those in a more equable environment (Kellgren and others, 1953). Coal-miners working in a wet seam lost more work from knee symptoms than those in dry seams, though the radiological changes were no different (Lawrence, 1955). Moreover, textile and foundry employees working in a warm environment have been found to have less incapacity than the rest of the population despite a high prevalence of radiological change (Lawrence, 1961; Lawrence, Dingwall-Fordyce, and Molyneux, 1966). Duthie, on the other hand, has found no evidence of any climatic influence. Cobb, Merchant, and Rubin (1957) observed that pain and swelling in osteo-arthrosic joints were seldom found without morning stiffness and that persons with x-ray evidence of osteo-arthrosis but no morning stiffness had only a small chance of having pain at the relevant site. They suggested that most of the symptoms of osteo-arthrosis are at least in part due to a rheumatoid component. Kellgren (1961) suggested that some of the painful episodes in this condition may be due to a ligamentous sprain or traumatic synovitis following minor injury to a joint rendered unstable by the disease. In the present paper the prevalence of osteoarthrosis in populations in Northern England is reported and its relationship to symptoms in the region of the joints investigated.