PainSci summary of Wallace 2017?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible. ★★★★☆4-star ratings are for bigger/better studies and reviews published in more prestigious journals, with only quibbles. Ratings are a highly subjective opinion, and subject to revision at any time. If you think this paper has been incorrectly rated, please let me know.
Knee osteoarthritis is thought of a “wear-and-tear” problem aggravated by weight and age. In this experiment, this assumption was tested for the first time using “long-term historical or evolutionary data.” They looked at the skeletal remains of older people with a well-documented body mass index from the last two centuries (industrial and post-industrial); they also looked at prehistoric knees. The prevalence of osteoarthritis has roughly doubled in recent history (20th century) — and that number didn’t change when weight and age were factored out. The implications are clear: loading and longer lifespans are almost certainly not the cause of knee arthritis!
So what, then? Although this data doesn’t show it, the unconfirmed but obvious candidate is the surge in the modern lifestyle diseases: metabolic syndrome, diabetes, heart disease (see Kluzek et al or Jiang to start down that rabbit hole). Which is good news: those problems are more preventable than aging.
original abstract†Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.
Knee osteoarthritis (OA) is believed to be highly prevalent today because of recent increases in life expectancy and body mass index (BMI), but this assumption has not been tested using long-term historical or evolutionary data. We analyzed long-term trends in knee OA prevalence in the United States using cadaver-derived skeletons of people aged ≥50 y whose BMI at death was documented and who lived during the early industrial era (1800s to early 1900s; n = 1,581) and the modern postindustrial era (late 1900s to early 2000s; n = 819). Knee OA among individuals estimated to be ≥50 y old was also assessed in archeologically derived skeletons of prehistoric hunter-gatherers and early farmers (6000-300 B.P.; n = 176). OA was diagnosed based on the presence of eburnation (polish from bone-on-bone contact). Overall, knee OA prevalence was found to be 16% among the postindustrial sample but only 6% and 8% among the early industrial and prehistoric samples, respectively. After controlling for age, BMI, and other variables, knee OA prevalence was 2.1-fold higher (95% confidence interval, 1.5-3.1) in the postindustrial sample than in the early industrial sample. Our results indicate that increases in longevity and BMI are insufficient to explain the approximate doubling of knee OA prevalence that has occurred in the United States since the mid-20th century. Knee OA is thus more preventable than is commonly assumed, but prevention will require research on additional independent risk factors that either arose or have become amplified in the postindustrial era.
- “Is musculoskeletal pain more common now than 40 years ago? Two population-based cross-sectional studies,” E F Harkness, G J Macfarlane, A J Silman, and J McBeth, Rheumatology (Oxford), 2005.
- “Has the prevalence of invalidating musculoskeletal pain changed over the last 15 years (1993-2006)? A Spanish population-based survey,” Silvia Jiménez-Sánchez, Rodrigo Jiménez-García, Valentín Hernández-Barrera, Manuel Villanueva-Martínez, Antonio Ríos-Luna, and César Fernández-de-las-Peñas, Journal of Pain, 2010.
- “Expenditures and Health Status Among Adults With Back and Neck Problems,” Brook I. Martin, Richard A. Deyo, Sohail K. Mirza, Judith A. Turner, Bryan A. Comstock, William Hollingworth, and Sean D. Sullivan, Journal of the American Medical Association, 2008.
- “Is osteoarthritis a metabolic disorder?,” S Kluzek, J L Newton, and N K Arden, Br Med Bull, 2015.
- “Body mass index and hand osteoarthritis susceptibility: an updated meta-analysis,” Liying Jiang, Xiaohua Xie, Yidan Wang, Yingchen Wang, Yihua Lu, Tian Tian, Minjie Chu, and Yi Shen, Int J Rheum Dis, 2016.
- “Low-grade inflammation as a key mediator of the pathogenesis of osteoarthritis,” William H Robinson, Christin M Lepus, Qian Wang, Harini Raghu, Rong Mao, Tamsin M Lindstrom, and Jeremy Sokolove, Nat Rev Rheumatol, 2016.
- “Misconceptions and the Acceptance of Evidence-based Nonsurgical Interventions for Knee Osteoarthritis. A Qualitative Study,” Samantha Bunzli, Penny O'Brien BHealthSci, Darshini Ayton, Michelle Dowsey, Jane Gunn, Peter Choong, and Jo-Anne Manski-Nankervis, Clinical Orthopaedics & Related Research, 2019.
These two articles on PainScience.com cite Wallace 2017 as a source:
- PS Complete Guide to Headaches — Detailed, readable, science-based self-help for tension headaches and other common musculoskeletal headaches
- PS Your Back Is Not Out of Alignment — Debunking the obsession with alignment, posture, and other biomechanical bogeymen as major causes of pain
This page is part of the PainScience BIBLIOGRAPHY, which contains plain language summaries of thousands of scientific papers & others sources. It’s like a highly specialized blog. A few highlights:
- Effectiveness of customised foot orthoses for Achilles tendinopathy: a randomised controlled trial. Munteanu 2015 Br J Sports Med.
- A Bayesian model-averaged meta-analysis of the power pose effect with informed and default priors: the case of felt power. Gronau 2017 Comprehensive Results in Social Psychology.
- The neck and headaches. Bogduk 2014 Neurol Clin.
- Agreement of self-reported items and clinically assessed nerve root involvement (or sciatica) in a primary care setting. Konstantinou 2012 Eur Spine J.
- Effect of NSAIDs on Recovery From Acute Skeletal Muscle Injury: A Systematic Review and Meta-analysis. Morelli 2017 Am J Sports Med.