Multicenter Osteoarthritis Study (MOST) Renewal

骨关节炎(OA)是最常见的关节炎形式，膝关节或髋部的疾病是导致 残疾。大多数膝关节和髋关节骨性关节炎的流行病学研究都集中在放射学疾病上，但有症状的骨性关节炎 应该是预防骨性关节炎研究的一个主要重点，因为有症状的疾病会导致残疾和 对社会和公共卫生的巨大影响。骨质疏松症可能是可以预防的，但只有有限的数量，主要是 已确定不可更改的风险因素，即使特定活动等可更改的风险因素， 肌肉无力、本体感觉缺陷、微量营养素缺乏和结构性因素已经被提出， 可能在很大程度上影响疾病风险。预防机会是最相关的，也最有可能被利用 那些已经患有疾病或感染风险最高的人。 这项建议将四种新的方法引入膝骨性关节炎的流行病学研究：L.A侧重于 症状性疾病，2.风险因素的综合评估，包括可改变的因素，3.重点关注那些 谁将真正从预防机会中受益，那些已经患有疾病的人或那些处于高危状态的人 4.采用比以前更全面、更可重现的成像技术。 包括最先进的射线照相技术和核磁共振成像。MRI提供了关于结构因素的丰富信息 这些异常可能会影响疾病的风险。 这项研究的总体目标是纵向评估三组因素的影响： 生物力学因素(蹲、跪、爬楼梯、穿高跟鞋、股四头肌无力和 本体感觉缺陷)、骨骼和结构因素(MRI上的骨密度、骨髓和半月板病变)以及 微量营养素缺乏(维生素C、E和D)对症状性和放射学疾病的发生和发展的影响 年龄在50到79岁之间的男性和女性的人群样本中的膝骨性关节炎。虽然这个项目的重点是膝盖 我们还纳入了对髋关节骨性关节炎的研究。 我们建议招募一个以社区为基础的样本，包括3000名可能患有膝骨性关节炎或患有膝骨性关节炎的男性和女性 骨性关节炎的风险很高。高危人群将包括超重、有膝部症状的人和患有 有膝盖受伤或手术史。受试者将通过症状问卷、X光照片和 核磁共振成像，并将跟踪36个月的发展或进展的症状或放射学的骨性关节炎。 分析将重点放在这些重要风险因素与办公自动化结果之间的关系上。 这项大型、多方面的研究提供了明确的解决潜在重要风险因素与 一种主要致残性疾病的发展或进展，并提供对疾病生物学和 潜在的疾病预防机会。

Osteoarthritis (OA) is the most common form of arthritis, and disease in the knee or hip are leading causes of disability. Most epidemiologic studies of knee and hip OA have focused on radiographic disease, but symptomatic OA should be a major focus of studies on preventing OA, because symptomatic disease causes disability and has formidable societal and public health impacts. OA is potentially preventable, but only a limited number of mostly nonmodifiable risk factors has been identified, even though modifiable risk factors such as particular activities, muscle weakness, proprioceptive deficits, micronutrient deficiencies and structural factors have been proposed and may affect substantially the risk of disease. Prevention opportunities are most relevant and are most likely to be used by those who already have disease or who are at highest risk of getting it. This proposal introduces four new approaches into the epidemiologic study of knee osteoarthritis: l.a focus on symptomatic disease, 2. a comprehensive evaluation of risk factors including modifiable ones, 3. a focus on those who would really benefit from prevention opportunities, those who already have disease or those who are at high risk of getting it and 4. the incorporation of more comprehensive and reproducible imaging than has previously been used including, state of the art radiographic techniques and MRI. MRI provides rich information on structural factors in which abnormalities may affect the risk of disease. The overall objective of this study is to evaluate longitudinally the effects of three groups of factors: biomechanical factors (squatting, kneeling, stair climbing, wearing high heeled shoes, quadriceps weakness and proprioceptive deficits), bone and structural factors (bone density, bone marrow and meniscal lesions on MRI) and micronutrient deficiencies (vitamin C, E and D) on the occurrence and progression of symptomatic and radiographic knee OA in a population-based sample of men and women aged 50 to 79. Although the focus of this project is knee OA, we also incorporate a study of hip OA. We propose to recruit a community-based sample of 3,000 men and women likely to either have knee OA or be at high risk of OA. High risk groups will include those who are overweight, those with knee symptoms and those with a history of knee injuries or operations. Subjects will be evaluated with symptom questionnaires, radiographs and MRI's and will be followed 36 months for the development or progression of symptomatic or radiographic OA. Analyses will focus on the relation of these important risk factors and OA outcomes. This large, multifaceted study offers to address definitively the relation of potentially important risk factors to the development or progression of a major disabling disease and to provide new insights into disease biology and potential opportunities for disease prevention.