Health Disparities in Osteoarthritis: Biological Aging, Stress, and Pain - Modulation by Resilience Factors

项目总结/摘要 骨关节炎（OA）是一种流行的和使人衰弱的与年龄相关的健康状况， 心理社会衰退，生活质量下降，国家开支增加。相当多的证据 显示了OA生活负担的健康差异。具体来说，患有膝关节OA的非洲裔美国人 与非西班牙裔相比，经历更大的临床疼痛、功能限制和生活质量下降 白人疼痛是导致功能限制和身体残疾的关键因素。心理社会应激 预测慢性疼痛的发作，慢性疼痛的生活有助于增加心理社会压力。 各族裔群体在环境和社会文化压力暴露方面各不相同。重要的是，身体被设计成 适应和加强与充分恢复应对压力。然而，持续的压力可能会对 该系统导致称为非稳态负荷的失调和功能障碍。持续的压力和慢性 疼痛有助于改变包括大脑在内的多个生物系统的功能。结构和 在患有慢性脑梗死的个体中观察到脑功能变化和加速老化。 疼痛，包括膝关节OA。与压力相关的生物功能的改变也被表明， 患有慢性疼痛的人。这些生物学变化可能导致发病率和死亡率增加 慢性疼痛和骨关节炎患者中。然而，目前尚不清楚的是：1）非裔美国人和非- 患有膝关节OA的西班牙裔白人在衰老的生物学指标上存在差异，2）衰老的生物学指标是 3）衰老的生物学指标预测骨关节炎相关的种族差异 健康成果。重要的是，有证据表明，健康促进行为和心理社会因素可能 调节OA相关疼痛和压力的生物学后果。我们将全面调查 在对200名成年人进行的为期4年的纵向分析中， 膝关节OA（100名非裔美国人和100名非西班牙裔白人），以确定压力的影响 暴露于生物学老化指标（非稳态负荷、端粒长度和大脑结构/功能），以及 老化生物学指标与膝关节骨性关节炎健康的种族差异之间的关系 结果。我们亦会评估风险及抗逆力因素可能带来的调节作用。调查结果将1） 有助于更好地理解压力，弹性，衰老和健康结果动态; 2） 促进确定对与压力有关的接触敏感并能表明健康状况的生物标志物， 相关的系统功能;和3）阐明弹性因素，可作为临床目标，以减少 种族群体在OA方面的差异，并改善整体健康结果。

Project Summary/Abstract Osteoarthritis (OA) is a prevalent and debilitating age-related health condition contributing toward physical and psychosocial decline, reduced quality of life, and rising national expenses. Considerable evidence demonstrates health disparities in the burdens of living with OA. Specifically, African Americans with knee OA experience greater clinical pain, functional limitations, and decreased quality of life compared to non-Hispanic whites. Pain is a key factor contributing to functional limitations and physical disability. Psychosocial stress predicts the onset of chronic pain and living with chronic pain contributes to increased psychosocial stress. Ethnic groups differ in environmental and sociocultural stress exposures. Importantly, the body is designed to adapt and strengthen with adequate recovery in response stress. However, persistent stress can take a toll on the system resulting in dysregulation and dysfunction known as allostatic load. Persistent stress and chronic pain contribute toward altered functioning across multiple biological systems including the brain. Structural and functional changes and accelerated aging in the brain have been observed among individuals with chronic pain, including those with knee OA. Altered stress-related biological functioning has also been indicated in individuals with chronic pain. These biological changes likely contribute to increased morbidity and mortality among those with chronic pain and OA. What is not known however is whether: 1) African Americans and non- Hispanic whites with knee OA differ across biological measures of aging, 2) biological measures of aging are inter-related, and 3) biological measures of aging predict ethnic group differences in osteoarthritis-related health outcomes. Importantly, there is evidence that health promoting behaviors and psychosocial factors may modulate the biological consequences of OA-related pain and stress. We will investigate a comprehensive array of biopsychosocial measures across three time points in a four year longitudinal analysis of 200 adults with knee OA (100 African Americans and 100 non-Hispanic whites) to determine the influence of stress exposure on measures of biological aging (allostatic load, telomere length, and brain structure/function), and the relationship between biological measures of aging and ethnic group differences in knee OA health outcomes. We will also evaluate the possible modulating effect of risk and resilience factors. Findings will 1) contribute to an improved understanding of the stress, resilience, aging, and health outcome dynamic; 2) promote the identification of biological markers sensitive to stress related exposure and indicative of health- related system functioning; and 3) elucidate resilience factors that may serve as clinical targets to reduce ethnic group disparities in OA and improve overall health outcomes.