Retinal Arteriolar Narrowing and Incidence of Knee Replacement for Osteoarthritis: A Prospective Cohort Study

Sultana Monira Hussain¹, Yuanyuan Wang², Jonathan E Shaw³, Dianna J Magliano³, Tien Yin Wong⁴, Anita Wluka², Stephen Graves⁵, Robyn J Tapp⁶ and Flavia Cicuttini², ¹Department of Epidemiology and Preventive Medicine,, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, ²Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia, ³Baker IDI Heart and Diabetes Institute, Melbourne, Australia, ⁴Singapore Eye Research Institute, Singapore, Singapore, ⁵Australian Orthopaedic Association National Joint Replacement Registry, Adelaide, Australia, ⁶The University of Melbourne, Melbourne, Australia

Meeting: 2014 ACR/ARHP Annual Meeting

Keywords: Epidemiologic methods and osteoarthritis

Session Information

Title: Osteoarthritis - Clinical Aspects: Epidemiology and Pathogenesis

Session Type: Abstract Submissions (ACR)

Background/Purpose:

Epidemiological studies suggest that macrovascular disease is involved in the pathogenesis of osteoarthritis (OA) possibly through reduced nutrition to the joint. However, the role of the microcirculation in the pathogenesis of OA remains unclear. The retinal vasculature provides a unique window to assess the microcirculation noninvasively and directly. This study examined the association between retinal vascular caliber and incidence of knee replacement for OA.

Methods:

1,838 participants of the Australian Diabetes, Obesity and Lifestyle Study – a population-based, national prospective cohort study, had retinal vascular caliber measured in 1999-2000 using a nonmydriatic digital fundus camera and a validated computer-based program. Participants were aged >40 years at joint replacement data collection commencement. The incidence of knee replacement for OA during 2002-2011 was determined by linking cohort records to the Australian Orthopaedic Association National Joint Replacement Registry. Cox proportional hazard regression models were used to estimate the hazard ratio (HR) and 95% confidence interval (CI) for the incidence of knee replacement due to OA associated with retinal vascular caliber, with age as the time scale. Follow-up for joint replacement (calculation of person-time) began 1 January 2002, and ended at the date of first knee replacement for OA or date of censoring. Retinal vascular caliber was standardized so that HR represents the effect of a one-standard-deviation difference in caliber. Retinal vascular caliber was also categorized into tertiles based on the analysis sample. The widest tertile was used as the referent category. Each analysis was adjusted for sex and body mass index (BMI), and further adjusted for physical activity, HbA1c, and cardiovascular risk factors (systolic blood pressure, total cholesterol and microalbuminuria).

Results:

77 participants underwent knee replacement for OA. At baseline, these participants had narrower retinal arteriolar calibre than those who did not need knee replacement (166.1±24.8µm vs. 174.3±24.5µm, p=0.004). Narrower retinal arteriolar caliber was associated with an increased risk of knee replacement (HR 1.25, 95%CI 1.00-1.56, per 1 standard deviation decrease in retinal arteriolar caliber); and participants with arteriolar caliber in the narrower two-thirds of the cohort had twice the risk of knee replacement compared with those in the widest one-third (HR 2.00, 95%CI 1.07-3.74, p=0.03) after adjustment for sex, BMI, physical activity and HbA1c. Further adjustment for the cardiovascular risk factors did not change the associations. There was no association for retinal venular caliber.

Conclusion:

Persons with narrower retinal arteriolar caliber had a higher risk of knee replacement for OA, suggesting a role of microvascular disease in the pathogenesis of knee OA.

Disclosure:

S. M. Hussain,
None;

Y. Wang,
None;

J. E. Shaw,
None;

D. J. Magliano,
None;

T. Y. Wong,
None;

A. Wluka,
None;

S. Graves,
None;

R. J. Tapp,
None;

F. Cicuttini,
None.

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