||| Original Article ||| DOI: 10.3329/bsmmuj.v12i2.41230 |
Occupation-related physical activities in osteoarthritis of the knee in female
Mohammed Emran, Syed Mozaffar Ahmed, Md. Israt Hasan and Ali Emran
Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Bangabandhu Sheikh Mujib Medical University, Shahbag, Dhaka, Bangladesh
The aim of this study was to determine the role of occupation-related physical activities in the osteoarthritis of the knee. The study was conducted on 87 female patients from September 2016 to August 2017. The same number of healthy females of the same age group were included as a control. Data was collected using a structured interviewer-administered questionnaire, enquiring about demographic data and details of risk factors. There were statistically significant (p<0.05) changes in the occupation-related physical activities like sustained knee bending, climbing stairs (>10 flights/day), kneeling (>30 min/day), squatting (>30 min/day), in patients when compared to the control group. However, there were no significant changes in other occupation-related physical activities. Obese (BMI ≥30 kg/m2) patients were found 29.9% in the patient and 17.2% in the control group. Patients with a positive family history of osteoarthritis of the knee were 13.8% in the case group and 3.4% in the control group. The difference was statistically significant (p<0.05) between the two groups. In conclusion, occupation-related physical activities like sustained knee bending, climbing stairs, kneeling and squatting had a significant association with osteoarthritis of the knee in the female.
Helicobacter pylori is a Gram negative bacterium which causes many upper gastrointestinal diseases. It mainly resides in the stomach, but it also produces a systemic host immunologic response and the release of various vasoactive and pro-inflammatory substances. Thus, H. pylori may be partly responsible for the occurrence of diseases in extradigestive areas such as ischemic heart disease, cardiovascular disease, Raynaud’s phenomenon and migraine. Another likely association is the glaucoma which thought to linked with H. pylori through some mechanisms include: Stimulating aggregation of platelet and platelet-leucocyte, stimulating release of pro-inflammatory and vasoactive substances, inducing cross mimicry between endothelial and H. pylori antigens and promoting apoptotic process.5 Recently various debate about their association.6 Some studies in Greece, china, Iran, and Australia have reported relatively higher association between H. pylori infection and open-angle glaucoma.7-11 However, other studies in Canada and Iran have not reported statistically significant differences between them.12-14 Other studies found that eradication of H. pylori may be beneficial in the management of chronic open-angle glaucoma.15 Thinking about these dispute, this study was done to compare the association of H. pylori infection in patients having primary open-angle glaucoma and control group of participants.
This study was carried out from March, 2015 to August, 2017. Forty patients with primary open-angle glaucoma were selected as case and 40 patients as control group as per inclusion and exclusion criteria. The selection criteria of cases were age between 40-80 years, intraocular pressure ≥21 mmHg, open anterior chamber angle in gonioscopy, optic nerve head changes as glaucomatous, visual field changes such as generalized depression, paracentral scotoma, nasal step. The patient with history of angle closure glaucoma or other kinds of glaucoma, diabetes mellitus, severe systemic disease and neoplasm, other serious eye diseases (corneal opacity, uveitis, central serous chorioretinopathy), previous gastric surgery or treatment of H. pylori eradication were excluded from the study. Inclusion criteria of the controls were age between 40-80 years, intraocular pressure <21 mmHg, normal perimetry, without any glaucomatous optic nerve changes and normotension. The patient with history of angle closure glaucoma or other kinds of glaucoma, diabetes mellitus, severe systemic disease and neoplasm, serious eye disease (corneal opacity, uveitis, central serous chorioretinopathy), previous gastric surgery or treatment of H. pylori eradication were excluded from the control. The purpose and procedures were briefly explained to all participants. Following inclusion and exclusion criteria, samples were collected by purposive sampling.
The complete clinical evaluation including history, physical examination, relevant ocular examinations, fundus examination, some special ocular examinations like – intraocular pressure, visual field analysis, gonioscopy were done.
Serologic assays
For the determination of serum levels of anti-pylori IGg antibody, blood samples were collected and evaluated by ELISA method (DRG H. pylori IgG kit-EIA-3057) (positive if anti H-pylori IgG level >20 U/mL).
Urea breath test
After an abstinence of proton pump inhibitor for 14 days and fasting for 2 hours, all patients were subsequently subjected to a 13C-urea breath test, performed accordance with the manufacturer’s recommendations (HCBT-01, Headway 13C-Urea Breath Analyzer, China). Patient went through for procedure: a) Blow up the first collection bag; b) take one 13C-urea capsule (75 mg urea); c) wait for 30 min; d) blow up the second collection bag and e) test two bags of breath samples with the analyzer. The results were obtained on-site and expressed as positive or negative.
Statistical analysis
All data were analyzed by using statistical package for social sciences (SPSS). Associations between two variables were measured by Chi-squared test. A probability ‘p’ value of 0.05 or less was considered as significant. Strength of association was determined by estimating odds ratio (OR) and their 95% confidence intervals (CI).
The mean age of both groups was 57 years. Among the 87 patients, 23 were doing activities with sustained knee bending, 18 with climbing stairs >10 flights/day, 17 with kneeling >30 min/day, 11 with squatting >30 min/day whereas, in control group, the values were 9, 8, 6, and 2 respectively. The p-value was found significant (p<0.05). The other occupation-related physical activities were not statistically significant (p>0.05) between the two groups (Table I).
| Occupation-related physical activities | Case (n= 87) |
Control (n= 87) |
p value |
|---|---|---|---|
Squatting (>30 min/day) |
11 |
2 |
0.009s |
Kneeling (>30 min/day) |
17 |
6 |
0.014s |
Climbing stairs (>10 flights/day) |
18 |
8 |
0.033s |
Walking (>2 miles/day) |
27 |
24 |
0.617ns |
Standing (>2 hours/day) |
31 |
26 |
0.419ns |
Sitting (>2 hours/day) |
26 |
21 |
0.393ns |
Sustained knee bending |
23 |
9 |
0.006s |
s= significant, ns= not significant |
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The number of patients with obesity (BMI ≥30 kg/m2) was 26 and in the control group, it was 15 which was statistically significant (p<0.05) between the two groups.
There were 12 patients with a positive family history of osteoarthritis of the knee and the value was 3 in the control group, which was significant (p<0.05).
This study reveals sustained knee bending, climbing stairs, kneeling, squatting were important in the development of osteoarthritis of the knee in the female. However, other occupation-related physical activities were not statistically significant (p>0.05) between the two groups. Obesity and family history of osteoarthritis of the knee were significantly higher in the case group than the control group.
This study agrees with Haq and Davatchi (2011) where squatting and cycling were modifiable risk factors for osteoarthritis of the knee.17
In a previous study, sustained knee bending was found responsible for osteoarthritis of the knee, in which 8 participants were in the case group and 11 were in the control group.18
The other study observed there was an association between the stair climbing and osteoarthritis of the knee and there is 2 times more possible chance to develop osteoarthritis of the knee due to stair climbing regularly.19
It is found in a study that occupational knee bending is a positive risk factor for the development of osteoarthritis of the knee. The odds of getting osteoarthritis with increased occupational knee bending were significantly higher than for those who had no knee bending. The odds ratio varied from 1.2 to 6.9 for different types of knee bending.20
Haq and Davatchi (2011) explained overweight as a risk factor for osteoarthritis of the knee17 but this study revealed that obesity a significant one and agree with Shakoor et al. (2009)21 and Dieppe (1995)22 Excess body weight is a risk for developing osteoarthritis of the knee.23 Obesity has been identified as a significant risk factor for osteoarthritis of the knee in Britain,24 Sweden,25 and Japan.26 A study in Morocco found that the mean BMI was 30.5 ± 4.4 kg/m2 in the case group and 27.6 ± 3.8 in control group. The difference was statistically significant (p<0.05) between the two groups.27 These findings support the result of this study. Some studies showed overweight as significant for osteoarthritis of the knee and there is 2.25 times more possible chance to occur osteoarthritis of the knee due to overweight.18, 19 Other studies also observed that 70.6% of patients had BMI ≥25.0 kg/m2 in men group and 47.7% in woman group.28 Mean BMI was high 29.4 ± 7.8 in osteoarthritis cases.29
According to review heritability for the osteoarthritis of the knee ranges between 43%.5 Some studies found an association between the positive family history and the osteoarthritis of the knee.18 Patil et al. (2012) reported 19.4% of patients had a positive family history in the female group.30 These are in favor of this present study.
Sustained knee bending, climbing stairs, kneeling, squatting, obesity, positive family history are risk factors for osteoarthritis of the knee.
There is no conflict of interest.
A well-informed, voluntary, signed written consent was taken in an understandable local language from the study subjects before enrollment after convincing them that privacy, anonymity, and confidentiality of data information identifying any patient were maintained strictly. Each patient enjoyed every right to participate or refuse or even withdraw from the study at any point in time. The protocol was approved by the Institutional Review Board of Bangabandhu Sheikh Mujib Medical University (BSMMU/2017/441).
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