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

项目摘要/摘要 骨关节炎(OA)是一种流行的和衰弱的年龄相关的健康状况，导致身体和 心理社会衰退，生活质量下降，国家开支上升。相当多的证据 显示了患有骨性关节炎的生活负担中的健康差异。具体地说，患有膝关节炎的非裔美国人 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 白色的。疼痛是导致功能受限和身体残疾的关键因素。心理社会压力 预测慢性疼痛的发生，与慢性疼痛生活在一起会增加心理社会压力。 各民族在环境和社会文化压力暴露方面存在差异。重要的是，身体的设计是为了 适应和加强，并在应对压力时充分恢复。然而，持续的压力可能会对 这种系统会导致调节失调和功能障碍，这就是所谓的平衡负荷。持续应激与慢性 疼痛会导致包括大脑在内的多个生物系统的功能改变。结构和 观察到慢性精神分裂症患者的大脑功能改变和加速衰老。 疼痛，包括膝盖骨关节炎。与应激相关的生物功能改变也已在 患有慢性疼痛的个人。这些生物变化可能导致发病率和死亡率的增加。 在患有慢性疼痛和骨性关节炎的患者中。然而，尚不清楚的是：1)非裔美国人和非 患有膝骨性关节炎的西班牙裔白人在衰老的生物学指标上存在差异，2)生物学老化指标是 相互关联，以及3)衰老的生物学指标预测与骨关节炎相关的种族群体差异 健康结果。重要的是，有证据表明，促进健康的行为和心理社会因素可能 调节骨性关节炎相关疼痛和压力的生物学后果。我们将调查一项全面的 在对200名成年人的四年纵向分析中，跨越三个时间点的一系列生物-心理-社会测量 用膝盖骨关节炎(100名非洲裔美国人和100名非西班牙裔白人)来确定压力的影响 暴露于生物老化指标(不平衡负荷、端粒长度和脑结构/功能)，以及 生物衰老指标与膝骨性关节炎健康种族差异的关系 结果。我们还将评估风险和韧性因素可能产生的调节作用。调查结果将1) 有助于更好地理解压力、恢复力、衰老和健康结果动态；2) 促进确定对应激相关暴露敏感并可指示健康的生物标记- 相关的系统功能；以及3)阐明可作为临床目标的弹性因素 不同种族之间的差异，并改善整体健康状况。

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.