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SHORT COMMUNICATION
Year : 2010  |  Volume : 54  |  Issue : 3  |  Page : 155-157  

Prevalence of knee osteoarthritis amongst perimenopausal women in an urban resettlement colony in South Delhi


1 Junior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
2 Senior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
3 Professor, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India

Date of Web Publication18-Jan-2011

Correspondence Address:
Harshal Salve
Junior Resident, Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi
India
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Source of Support: Dr. N. Baridalyne, Assistant Professor, Centre for Community Medicine, Conflict of Interest: None


DOI: 10.4103/0019-557X.75739

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   Abstract 

A community-based cross-sectional study was carried out in an urban resettlement colony in South Delhi to study the prevalence of knee osteoarthritis in women aged ≥40 years and treatment seeking behavior of women suffering from osteoarthritis. Osteoarthritis was diagnosed by using clinical criteria given by American College of Rheumatology for diagnosis of Idiopathic Osteoarthritis of knee joints. A total 260 women were interviewed out of which 123 (47.3%) women were found to be suffering from knee osteoarthritis. Prevalence of osteoarthritis found to be increased with age. Less than half of those with osteoarthritis underwent treatment. With this high prevalence of osteoarthritis, there is need to spread awareness about the disease, its prevention, and rehabilitation in the community.

Keywords: Knee osteoarthritis, perimenopausal women


How to cite this article:
Salve H, Gupta V, Palanivel C, Yadav K, Singh B. Prevalence of knee osteoarthritis amongst perimenopausal women in an urban resettlement colony in South Delhi. Indian J Public Health 2010;54:155-7

How to cite this URL:
Salve H, Gupta V, Palanivel C, Yadav K, Singh B. Prevalence of knee osteoarthritis amongst perimenopausal women in an urban resettlement colony in South Delhi. Indian J Public Health [serial online] 2010 [cited 2019 May 26];54:155-7. Available from: http://www.ijph.in/text.asp?2010/54/3/155/75739

Osteoarthritis is the fourth leading cause of Year Lived with Disability (YLDs), accounting for 3.0% of total global YLDs. [1] It also accounts for the decrease in activities of daily living (ADL) in elderly dependent population in the community. [2] Although osteoarthritis affects both males and females, prevalence of osteoarthritis reported to increase in females during perimenopausal age and remains high throughout menopause as compared to males. [3] Many experimental, clinical and epidemiological studies suggest that loss of estrogen at the time of menopause increases a woman's risk of getting osteoarthritis. [3] Average menopausal age in Indian women is 46.3 years as compared to 51 years in western countries. [4] This predisposes Indian women to the risk of developing osteoarthritis at earlier age compared to their western counterpart.

Further, it is important to know treatment-seeking behavior of women about osteoarthritis to plan interventions for its prevention and management. Therefore, the authors studied the prevalence of osteoarthritis and treatment seeking behavior in women more than 40 years in an urban resettlement colony in South Delhi.

The cross-sectional study was carried out in an urban resettlement colony at Dr. Ambedkar Nagar located in South Delhi during 15 January to 28 February 2009. The majority of population in this area is migrated from surrounding states of Delhi. Standard of living of people in these colonies is very much comparable to any other urban slum area. This area also serves as field practice area under Urban Health Programme by Centre for Community Medicine of All India Institute of Medical Sciences, New Delhi.

A previous study in Indian settings particularly in urban area reports prevalence of osteoarthritis in elderly female around 30%. [5] Using this prevalence and assuming 20% relative error and 10% non-response, the sample size of 260 was calculated. [6] One block out of six blocks under field practice area was selected randomly. House to house survey was carried out in the selected block to recruit women ≥40 years to complete required sample size.

An interview schedule was prepared where information of selected sociodemographic factors and treatment seeking behavior of women regarding joint problems was obtained. Interview schedule was translated into Hindi, pretested and modified accordingly before use. Osteoarthritis was diagnosed by using clinical criteria given by American College of Rheumatology for classification of idiopathic osteoarthritis of knee which can be used in community for diagnosis of osteoarthritis with 95% sensitivity and 69% specificity. [7],[8] It includes knee joint pain with any five of the following: age > 40 years, presence of crepitus, stiffness < 30 min, bony enlargement, bony tenderness, and absence of palpable warmth [Table 1].
Table 1 :American College of Rheumatology criteria for classification of idiopathic osteoarthritis of knee joints

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Data collectors were trained for knee joint examination. For quality assurance all diagnosed osteoarthritis cases and 10% of negative cases were re-examined by a clinician. Informed consent was taken before each interview. Data were entered into Microsoft Excel and analysed by using SPSS version 13.

A total of 510 houses were visited and 260 women were recruited in the study. Almost 39% were more than 60 years of age, 32% belongs to 50-59 years, and remaining women were below 50 years of age. The majority of 193 (74%) of women were from the middle socioeconomic class. Most (65.4%) of the women were illiterate. Out of 260 women, 123 (47.3%) (95% CI: 41.2-53.4) were diagnosed to have osteoarthritis according to American College of Rheumatology criteria (Clinical). Prevalence of osteoarthritis in various age groups is mentioned in [Table 2]. Prevalence of osteoarthritis was found to be high in illiterate women as compared to literate women. It was found to be higher in the low socioeconomic class 32(55.2%) as compared to 89(44.8%) in the middle socioeconomic class.
Table 2 :Prevalence of osteoarthritis in various age groups

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Out of 123 women with osteoarthritis only 53(43%) were currently on treatment, out of which 40(78.4%) receiving treatment from government facility whereas remaining seeking treatment from private practitioners, chemist and traditional healers. More than half of women (57%) suffering from osteoarthritis did not seek any kind of treatment.

This study reported a high prevalence (47.3%) of osteoarthritis in women more than 40 years of age in an urban resettlement colony in South Delhi. Sharma et al. from Chandigarh reported higher and Joshi et al. reported lower prevalence of osteoarthritis in elderly female than that present in this study. [5],[9] Prevalence of osteoarthritis was reported to increase with the age which is as similar as reported in previous studies. [5],[9]

The study showed that less than half of women were on treatment and few of treatment seeking women were receiving treatment from faith healer and chemist. This can be attributed to the lack of awareness regarding osteoarthritis, disabling complication of osteoarthritis, and lack of family support among women in this particular region. All these problems decrease the quality of life of women in these communities.

The major limitation of this study was that the authors used clinical criteria with sensitivity of 95% and specificity of 69% for diagnosis of osteoarthritis because of limited availability radiological and laboratory services in this community. In contrast to the previous studies, this study included both perimenopausal and elderly menopausal women in the community, which implies women in the country are developing osteoarthritis at relatively younger age. Therefore, osteoarthritis is a major public health issue especially in elderly dependant population in this country. There is need of immediate attention toward this issue in the form of estimation of problem of osteoarthritis and various risk factors responsible for the development osteoarthritis especially in perimenopausal women in the country. There is need to take appropriate steps in order to increase awareness regarding osteoarthritis in the community regarding importance of daily exercise, proper positioning of the knee joint during daily activities and also control over the other modifiable known risk factors such as obesity. Adequate treatment and rehabilitative services in the form of physiotherapy and advanced therapy such as joint replacement could be made more easily available in affordable cost for patients with osteoarthritis in the community.


   Acknowledgments Top


Author express their thanks to Dr. Baridalyne N, Assistant Professor, Centre for Community, Medicine for her timely guidance and Manpreet U, Mohansingh M, Ketan K, Mrinaal, G, Himanshu, Hardik S, Nishant G, Lakshmi M, Naveen P, Kaustav M, M.B.B.S. students of All India Institute of Medical Sciences for their useful contribution in data collection.

 
   References Top

1.World Health Organization. World Health Report 2002. Reducing Risks, Promoting Healthy Life. Geneva: WHO; 2002.   Back to cited text no. 1
    
2.Felson DT. The epidemiology of knee osteoarthritis: results from the Framingham Osteoarthritis Study. Semin Arthritis Rheum 1990;20:42-50.  Back to cited text no. 2
[PUBMED]    
3.Spector TD, Campion GD. Generalized osteoarthritis is a hormonally mediated disease. Ann Rheum Dis 1989;48:2566.  Back to cited text no. 3
    
4.Kapur P, Sinha B, Pereira BM. Measuring climacteric symptoms and age at natural menopause in an Indian population using the Greene Climacteric Scale Menopause. 2008 Dec 4. [Epub ahead of print] Available from: http://www.ncbi.nlm.nih.gov/pubmed/19057415 [last accessed on 2009 Jun 1].  Back to cited text no. 4
    
5.Joshi K, Rajesh K, Avasthi A. Morbidity profile and its relationship with disability and psychological distress among elderly people in Northern India. Int J Epidemiol 2003;32:978-87.   Back to cited text no. 5
    
6.Lwanga SK, Lemeshow S. Sample size determination in health studies; Estimation of population proportion with specified absolute precision. Geneva: World Health Organization; 1991.   Back to cited text no. 6
    
7.Altman R, Asch E, Bloch D, Bole G, Borenstein D, Brandt K, et al. The American college of rheumatology criteria for the classification and reporting of osteoarthritis of knee. Arthritis Rheum 1986;29:1039-49.  Back to cited text no. 7
[PUBMED]    
8.Joshi VL, Chopra A. Is there an urban-rural divide? Population surveys of rheumatic musculoskeletal disorders in the Pune region of India using the COPCORD. Bhigwan model Journal of Rheumatolgy 2009;36:614-22. Available from: http://www.ncbi.nlm.nih.gov/pubmed/19208598 [last accessed on 2009 June 1].  Back to cited text no. 8
    
9.Sharma MK, Swami HM, Bhatia V. An epidemiological study of correlates of osteo-arthritis in geriatric population of UT Chandigarh. Indian J Community Med 2007;32:1-3.  Back to cited text no. 9
    



 
 
    Tables

  [Table 1], [Table 2]


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