According to the document, arthritis prevalence is rising in India. An analysis of over 6.4 million arthritis test samples from 2014-2017 across India found that more women have rheumatoid arthritis than men, and high inflammation marker levels were more common in East India. Arthritis affects over 180 million people in India, more than diseases like diabetes, AIDS, and cancer. Common types of arthritis in India include osteoarthritis, gout, and rheumatoid arthritis. The analysis highlights regional differences in inflammation marker levels and suggests arthritis is a growing public health concern in India.

1. ARTHRITIS- 2020-B
https://www.business-standard.com/article/news-ani/arthritis-prevalence-rising-among-indians-
analysis-117101200150_1.html
Arthritis prevalence rising among
Indians: Analysis
ANI | New Delhi [India] Last Updatedat October 12, 2017 07:57IST
An analysis done by SRL Diagnostics on tests for Arthritis done in its laboratories revealed that more
women than men in India are suffering from Rheumatoid Arthritis.
The analysis also revealed that high ESR and CRP levels prescribed in patients of arthritis and, indicative
of persistent inflammation of joints, were more commonly found in the East zone, followed by the North
zone while a high Uric Acid levels pointing towards Gout were seen more in the North zone followed by the
East zone.
The data is based on more than 6.4 million samples received for Arthritis (bone health) testing over the last
3.5 years since January 2014 at SRL Laboratories across India.
Arthritis affects more than 180 million people in India - prevalence higher than many well-known diseases
such as diabetes, AIDS and cancer. Around 14% of the Indian population seeks a doctor's help every year
for this joint disease.
While the mainstay of diagnostics in bone and joint disorders is Radiology e.g. X-ray, CT-scan, MRI and
DEXA scan, laboratory tests are used for screening or for monitoring the progress of the disease.
Lab Tests
Blood tests are done as aids to arrive at a diagnosis and are not definitive in diagnosing arthritis.
- Inflammation Tests
· ESR (Erthrocyte Sedimentation Rate)
· CRP (C-reactive protein)
- Test for Rheumatoid Arthritis
· Rheumatoid factor
- Test for Gout
· Uric Acid
Osteoarthritis

2. The most prevalent form of arthritis, Osteoarthritis has been affecting 15 million adults annually with a
prevalence ranging 22% to 39% in India. Other common joint conditions affecting Indians are gout and
rheumatoid arthritis.
Osteoarthritis is more commonly observed in women and more prevalent with ageing. Studies have
observed that nearly 45% of women over the age of 65 years have symptoms while radiological evidence is
found in 70% of those over 65 years.
Rheumatoid Arthritis
An autoimmune disease, this mainly affects tissues around the joints. Most frequent in adults, it afflicts
between 0.5%-1% of the population in India. Women are three to four times more frequently affected than
men. Onset generally occurs in the 35-55 year age group.
Gout
One of the most common causes of inflammatory arthritis, Gout is three to four times more common in men
and the obese aged 50 years or above.
Analysis highlights:
· Abnormal ESR and CRP levels (indicative of persistent inflammation of joints) were more commonly seen
in the East zone, where lab tests showed higher abnormal values for CRP (61.23 %), ESR (53.78 %) and
RF (14.34%) compared to other parts of the country.
· Abnormal Uric Acid levels indicating Gout were seen more commonly in the North zone (23.19%) followed
by the East.
· ESR (56.71%, 61-85 age group), CRP (80.13%, 85+ years), RF (12.77%, 61-85 years) and UA (34.76%,
85+ years) levels were higher in people in their forties onwards.
Dr Avinash Phadke, President - Technology & Mentor (Clinical Pathology), SRL Diagnostics, said,
"Although the word 'arthritis' means joint inflammation, the term is used to describe more than 100
rheumatic diseases and conditions affecting the bones and tissues. Alarmingly, India will emerge as the
capital of Osteoarthritis by 2025 with more than 60 million to be likely affected. Ironically, one of the main
reasons is the increasing longevity of India's population, another being fast-rising obesity. Early signs
should not be ignored; early diagnosis and treatment can save the joints. Maintaining joint health lifelong
should be a goal of everyone's life.
(This story has not been edited by Business Standard staff and is auto-generated from a syndicated feed.)
First Published: Thu, October 12 2017. 07:57 IST

3. https://emedicine.medscape.com/article/331715-overview#a5
Drugs & Diseases > Rheumatology
Rheumatoid Arthritis (RA)
Updated: Feb 07, 2020
 Author: Howard R Smith, MD; Chief Editor: Herbert S Diamond, MD more...

Epidemiology
Worldwide, the annual incidence of RA is approximately 3 cases per
10,000 population, and the prevalence rate is approximately 1%, increasing
with age and peaking between the ages of 35 and 50 years. RA affects all
populations, though it is much more prevalent in some groups (eg, 5-6% in
some Native American groups) and much less prevalent in others (eg,
black persons from the Caribbean region).
First-degree relatives of individuals with RA are at 2- to 3-fold higher risk for
the disease. Disease concordance in monozygotic twins is approximately
15-20%, suggesting that nongenetic factors play an important role

4. https://www.rheumatology.org/Learning-Center/Statistics
Statistics
Access the latest rheumatology-related statistics on the prevalence of rheumatic diseases, the
rheumatology workforce, and graduate medical education.
Rheumatology Workforce Study
The American College of Rheumatology contracted with the Academy for Academic Leadership
(AAL) to conduct the 2015 Rheumatology Workforce Study. This purpose of this workforce study
was to describe the character and composition of the current rheumatology workforce, recognize
demographic and employment trends, inform workforce and succession planning for the
ACR/ARP to ensure appropriate access to care for patients with rheumatic diseases, identify
potential paths for the evolution of workforce supply and demand and their associated
implications, and more. Read about the rheumatology workforce study and access the report.
Prevalence Statistics
The Centers for Disease Control and Prevention March 2017 Vital Signs announced data
estimating that 54.4 million U.S. adults suffer from arthritis - equating to about 25% of the
population. Arthritis is the leading cause of disability, and causes pain, aching, stiffness, and
swelling of the joints. The most common types are osteoarthritis, rheumatoid arthritis, gout,
lupus, and fibromyalgia.

5. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3240153/
Arthritis Res. 2002; 4(Suppl 3): S265–S272.
Published online 2002 May 9. doi: 10.1186/ar578
PMCID: PMC3240153
PMID: 12110146
Epidemiologyand genetics of rheumatoid arthritis
Alan J Silman 1
and Jacqueline E Pearson1
Author information Article notes Copyright and License information Disclaimer
Corresponding author.
Alan J Silman: ku.ca.nam@namlis.nala
Abstract
Chapter summary
The prevalence of rheumatoid arthritis (RA) is relatively constant in many populations,at 0.5–1.0%. However, a
high prevalence of RA has been reported in the Pima Indians (5.3%) and in the Chippewa Indians (6.8%). In
contrast,low occurrences have been reported in populations from China and Japan. These data support a genetic
role in disease risk. Studies have so far shown that the familial recurrence risk in RA is small compared with
other autoimmune diseases.The main genetic risk factor of RA is the HLA DRB1 alleles, and this has
consistently been shown in many populations throughout the world. The strongest susceptibility factor so far has
been the HLA DRB1*0404 allele. Tumour necrosis factor alleles have also been linked with RA. However, it is
estimated that these genes can explain only 50% of the genetic effect. A number of other non-MHC genes have
thus been investigated and linked with RA (e.g. corticotrophin releasing hormone, oestrogen synthase,IFN-γ
and othercytokines). Environmental factors have also been studied in relation to RA. Female sex hormones may
play a protective role in RA; for example, the use of the oral contraceptive pill and pregnancy are both
associated with a decreased risk. However, the postpartumperiod has been highlighted as a risk period for the
development of RA. Furthermore, breastfeeding after a first pregnancy poses the greatest risk. Exposure to
infection may act as a trigger for RA, and a number of agents have been implicated (e.g. Epstein–Barr virus,
parvovirus and some bacteria such as Proteus and Mycoplasma). However, the epidemiological data so far are
inconclusive. There has recently been renewed interest in the link between cigarette smoking and RA, and the
data presented so far are consistent with and suggestive ofan increased risk.
Keywords: environment, family studies,HLA, occurrence, rheumatoid arthritis

6. https://www.cdc.gov/arthritis/data_statistics/arthritis-related-stats.htm
Centre for Disease Control & Prevention (USA): Saving Lives, Protecting People
Arthritis-Related Statistics
 US Prevalence of Arthritis
 ProjectedPrevalence
 Prevalence byAge/Race/Gender
 Overweight/Obesity
 Severe JointPain
 Disability/Limitations
 ArthritisCosts
 More Information
 References
Find basic statistics about arthritis, such as prevalence, disabilities and limitations, quality of
life, and costs.
Note: There are different data sources for some of the arthritis related statistics; therefore,
case definitions and terminology will also vary. Learn more about arthritis case definitions.
Common Types of Arthritis
Osteoarthritis is the most common form of arthritis. Gout, fibromyalgia, and rheumatoid
arthritis are other common rheumatic conditions.
Learn more about specific types of arthritis.
Prevalence of Arthritis in the United States
National Prevalence
 From 2013–2015, an estimated 54.4 million US adults (22.7%) annually had ever been told by a
doctor that they had some form of arthritis, rheumatoid arthritis, gout, lupus, or
fibromyalgia.1 Learn more about national arthritis statistics.
Prevalence by State
 The percentage of adults with arthritis varies by state, ranging from 17.2% in Hawaii to 33.6% in
West Virginia in 2015. Learn more about state-level arthritis statistics.
 To view arthritis prevalence estimates by state, go to the interactive map on the Chronic Disease
Indicators database and select a state on the map.
 For detailed state-level estimates, see the MMWR Surveillance Summary:“Geographic
Variations in Arthritis Prevalence, Health-Related Characteristics, and Management—United
States, 2015.”

7. Prevalence by County
 The percentage of adults with arthritis varies considerably by county, ranging from 11.2% to
42.7% in 2015. Learn more about county-level arthritis statistics.
Prevalence by Census Track or Largest Cities
 The percentage of adults with arthritis varies by census track or within each of the 500 largest
cities in the United States.
 To view arthritis prevalence estimates by census track or large city, go to the interactive map on
the 500 Cities Database and select location type.
 Projected Prevalence of Arthritis in US Adults
 By 2040, an estimated 78 million (26%) US adults aged 18 years or older are projected to have
doctor-diagnosed arthritis.2
 Learn more about future arthritis burden.


8. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3266664/
Arthritis Rheum. 2008 Jan; 58(1): 26–35.
Estimates of the Prevalence of Arthritis and Other Rheumatic
Conditions in the United States, Part II
Reva C. Lawrence, MPH,1
David T. Felson, MD, MPH,2
Charles G. Helmick, MD,3
Lesley M. Arnold,
MD,4
Hyon Choi, MD, DrPH,5
Richard A. Deyo, MD, MPH,6
Sherine Gabriel, MD, MSc,7
Rosemarie
Hirsch, MD, MPH,8
Marc C. Hochberg, MD, MPH,9
Gene G. Hunder, MD,7
Joanne M. Jordan, MD,
MPH,10
Jeffrey N. Katz, MD,11
Hilal Maradit Kremers, MD, MSc,7
and Frederick Wolfe, MD12
, for the
National Arthritis Data Workgroup
1- NIH, Bethesda, Maryland
2- 2Boston University School of Medicine, Boston, Massachusetts
3- 3CDC, Atlanta, Georgia
4- 4University of Cincinnati, Cincinnati, Ohio
5- 5Massachusetts General Hospital, Boston
6- 6Oregon Health and Science University, Portland
7- 7Mayo Clinic, Rochester, Minnesota
8- 8CDC, Hyattsville, Maryland
9- 9University of Maryland School of Medicine, Baltimore
10- 10University of North Carolina at Chapel Hill
11- 11Brigham and Women’s Hospital, Boston, Massachusetts
12- 12National Data Bank for Rheumatic Diseases, Wichita, Kansas
Address correspondence and reprint requests to Charles G. Helmick, MD, Arthritis Program, CDC, 4770 Buford
Highw ay, K51, Atlanta, GA 30341-3717. vog.cdc@kcimleHC
Abstract
Objective
To provide a single source for the best available estimates of the US prevalence of and number of individuals
affected by osteoarthritis,polymyalgia rheumatica and giant cell arteritis, gout, fibromyalgia, and carpal tunnel
syndrome, as well as the symptoms of neck and back pain. A companion article (part I) addresses additional
conditions.
Methods
The National Arthritis Data Workgroup reviewed published analyses from available national surveys,such as
the National Health and Nutrition Examination Survey and the National Health Interview Survey. Because data
based on national population samples are unavailable for most specific rheumatic conditions, we derived
estimates from published studies of smaller, defined populations.For specific conditions,the best available

9. prevalence estimates were applied to the corresponding 2005 US population estimates from the Census Bureau,
to estimate the number affected with each condition.
Results
We estimated that among US adults,nearly 27 million have clinical osteoarthritis (up from the estimate of 21
million for 1995), 711,000 have polymyalgia rheumatica, 228,000 have giant cell arteritis, up to 3.0 million
have had self-reported gout in the past year (up from the estimate of 2.1 million for 1995), 5.0 million have
fibromyalgia, 4–10 million have carpal tunnel syndrome, 59 million have had low back pain in the past 3
months, and 30.1 million have had neck pain in the past 3 months.
Conclusion
Estimates for many specific rheumatic conditions rely on a few, small studies of uncertain generalizability to the
US population. This report provides the best available prevalence estimates for the US, but for most specific
conditions more studies generalizable to the US or addressing understudied populations are needed.
METHODS
The purpose of this study,definitions of general terminology, and methods used for ascertaining the data and
generating the estimates are described in the companion article (1).
RESULTS
OA is the most common type of arthritis. We estimated prevalence for each of the most commonly affected
joints (knees, hips, and hands)as well as for overall OA.
Estimating the prevalence of OA is difficult because the structuralchanges of the disease occur in most persons
as they get older, but these changes may not be accompanied by symptoms. Furthermore, prevalence estimates
vary considerably depending on whether only moderate and severe radiographic changes are counted or mild
changes are also included.
Clinically defined OA
Study examiners characterize a person as having OA on the basis of symptoms and physical examination
findings. The National Health and Nutrition Examination Survey I (NHANES I) (2) showed that 12.1% of the
US population ages 25–74 years had clinically defined OA of some joint.
Radiographically defined OA
Generally, researchers grade radiographs according to the Kellgren/Lawrence scale (3), which defines OA on
the basis of the presence of osteophytes(outgrowths ofbone at the margin of the joint). We summarized
prevalence data primarily from 3 recent US population-based studies:the NHANES III, the Framingham
Osteoarthritis Study, and the Johnston County Osteoarthritis Project. In these studies,participants had to appear
in person to undergo radiographic testing,and the validity of the estimates could be compromised if only
individuals who had symptoms (instead of all individuals) attended.High participation rates for radiography
(>70%) in all 3 studies make this unlikely.
In phase 2 of the NHANES III (1991–1994), prevalence of knee OA was assessed in adults age ≥60 years; this
was the only study to use non–weight-bearing radiographs,a method that minimizes joint space narrowing
evident with weight bearing (4). The Framingham Osteoarthritis Study was a survey of knee and hand OA in
~2,400 adults age ≥26 years from suburban Boston,Massachusetts (5,6). The Johnston County Osteoarthritis
Project was a study of hip and knee OA in ~3,000 African American and white adults age ≥45 years in a rural
county in North Carolina (7). The prevalence of knee OA in adults age ≥45 was 19.2% in Framingham and
27.8% in Johnston County,and the prevalence among adults age ≥60 was 37.4% in the NHANES III (Table 1).
The prevalence of hip OA was high (27.0%) in Johnston County adults age ≥45, but in anotherUS community -
based study of4,855 women age ≥65 years, prevalence was found to be only 7.2% (8). In the latter study,hip
OA was defined based on individual features, but the discordance among study results leaves uncertainty

10. regarding to the prevalence of hip OA. The prevalence of hand OA in Framingham adults was 27.2% overall
and reached ≥80% among older adults,but only a minority of persons with radiographic OA have pain in these
joints.
Table 1
Prevalence of radiographic OA in the hands,knees, and hips, by age and sex, from population-based studies*
Anatomic site,
age, years Source (ref.)
% with mild, moderate,
or severe OA
Male Female Total
Hands,≥26 FraminghamOA study (6) 25.9 28.2 27.2
Knees†
≥26 FraminghamOA study (5) 14.1 13.7 13.8
≥45 FraminghamOA study (5) 18.6 19.3 19.2
≥45 Johnston County OA Project (7) 24.3 30.1 27.8
≥60 NHANES III (4) 31.2 42.1 37.4
Hips,≥45 Johnston County OA Project (10) 25.7 26.9 27.0

11. *Estimates represent prevalence per 100persons age-standardized to the projected 2000Census population (see ref. 63) except
for National Health and Nutrition Examination Survey III (NHANES III) estimates, which were adjusted to the 1980 Census
population.
†
All data on radiographic knee osteoarthritis (OA) are based on anteroposterior radiographs and therefore captureonly
tibiofemoral OA. Inclusion ofpatellofemoral imaging would probably yield higher prevalenceestimates.
OA prevalence increased with age and affected the hands and knees of women more frequently than men,
especially in persons age ≥50 years. In Johnston County and in the NHANES III, African Americans were more
likely than whites to have radiographic knee OA. A study ofperimenopausal women in Michigan also
demonstrated that African Americans were more likely than whites to have radiographic knee and hand OA (9).
In the NHANES III, the prevalence of radiographic knee OA was significantly higher in non-Hispanic African
Americans than in non-Hispanic whites or Mexican Americans (52.4%, 36.2%, and 37.6%, respectively) (4). In
Johnston County,the prevalence of radiographic hip OA was comparable in African Americans and whites (10).
Symptomatic OA
Persons are considered to have symptomatic OA if they have frequent pain in a joint and radiographic evidence
of OA in that joint, although sometimes this pain may not actually emanate from the arthritis seen on the
radiograph. Most prevalence surveys require that a person have pain in a joint on most days of a recent month,
to meet the definition for presence of symptoms.
The prevalence of symptomatic knee OA was 4.9% among adults age ≥26 years in the Framingham study,
16.7% among adults age ≥45 in the Johnston County study,and 12.1% among adults aged ≥60 in the NHANES
III study (Table 2).
Table 2
Prevalence of symptomatic OA (symptoms and radiographic changes of OA in the symptomatic joint) in the
hands,knees, and hips, by age and sex, from population-based studies*
Anatomic site,
age, years Source (ref.)
% with symptomatic OA
Male Female Total
Hands,≥26 FraminghamOA study (6) 3.8 9.2 6.8
Knees
≥26 FraminghamOA study (5) 4.6 4.9 4.9
≥45 FraminghamOA study (5) 5.9 7.2 6.7
≥45 Johnston County OA Project (7) 13.5 18.7 16.7
≥60 NHANES III (4) 10.0 13.6 12.1
Hips,≥45 Johnston County OA Project (10) 8.7 9.3 9.2
*Adjusted to the projected 2000 population age≥18 years (see ref. 63) except for National Health and
Nutrition Examination Survey III (NHANES III) estimates, which were adjusted to the 1980 Census population.
OA = osteoarthritis.

12. https://pubmed.ncbi.nlm.nih.gov/18163481/,
https://onlinelibrary.wiley.com/doi/full/10.1002/art.23177
Arthritis Rheum, .2008 Jan;58(1):15-25.
Estimates of the prevalence of arthritis and other rheumatic conditions in the United States.
Part I
CharlesG Helmick 1,DavidTFelson,RevaCLawrence,Sherine Gabriel, Rosemarie Hirsch,CKent
Kwoh,MatthewH Liang,Hilal Maradit Kremers, MaureenDMayes, PeterA Merkel,StanleyR
Pillemer,JohnDReveille, JohnHStone,National ArthritisDataWorkgroup
Free article
Abstract
Objective: To provide a single source for the best available estimates of the US prevalence of and
number of individuals affected by arthritis overall, rheumatoid arthritis, juvenile arthritis, the
spondylarthritides, systemic lupus erythematosus, systemic sclerosis, and Sjögren's syndrome. A
companion article (part II) addresses additional conditions.
Methods: The National Arthritis Data Workgroup reviewed published analyses from available national
surveys, such as the National Health and Nutrition Examination Survey and the National Health
Interview Survey (NHIS). For analysis of overall arthritis, we used the NHIS. Because data based on
national population samples are unavailable for most specific rheumatic conditions, we derived
estimates from published studies of smaller, defined populations. For specific conditions, the best
available prevalence estimates were applied to the corresponding 2005 US population estimates from
the Census Bureau, to estimate the number affected with each condition.
Results: More than 21% of US adults (46.4 million persons) were found to have self-reported doctor-
diagnosed arthritis. We estimated that rheumatoid arthritis affects 1.3 million adults (down from the
estimate of 2.1 million for 1995), juvenile arthritis affects 294,000 children, spondylarthritides affect
from 0.6 million to 2.4 million adults, systemic lupus erythematosus affects from 161,000 to 322,000
adults, systemic sclerosis affects 49,000 adults, and primary Sjögren's syndrome affects from 0.4
million to 3.1 million adults.
Conclusion: Arthritis and other rheumatic conditions continue to be a large and growing public
health problem. Estimates for many specific rheumatic conditions rely on a few, small studies of
uncertain generalizability to the US population. This report provides the best available prevalence
estimates for the US, but for most specific conditions, more studies generalizable to the US or
addressing understudied populations are needed.

13. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5017174/
ndian J Orthop. 2016 Sep; 50(5): 518–522.
Epidemiology of knee osteoarthritis in India and related factors
Chandra Prakash Pal, Pulkesh Singh,1
Sanjay Chaturvedi,2
Kaushal Kumar Pruthi, and Ashok Vij3
Address for correspondence: Dr. Chandra Prakash Pal, Department of Orthopaedics, S.N. Medical
College, Agra - 282 002, Uttar Pradesh, India. E-mail: moc.liamg@ohtropcrd
Abstract
Background:
Among the chronic rheumatic diseases,hip and knee osteoarthritis (OA) is the most prevalent and is a leading
cause of pain and disability in most countries worldwide. Its prevalence increases with age and generally affects
women more frequently than men. OA is strongly associated with aging and heavy physical occupational
activity, a required livelihood for many people living in rural communities in developing countries. Determining
region-specific OA prevalence and risk factor profiles will provide important information for planning future
cost effective preventive strategies and health care services.
Materials and Methods:
The study was a community based cross sectionalstudy to find out the prevalence of primary knee OA in India
which has a population of 1.252 billion. The study was done across five sites in India. Each site was further
divided into big city, small city, town, and village. The total sample size was 5000 subjects.Tools consisted of a
structured questionnaire and plain skiagrams for confirmation of OA. Diagnosis was done using Kellgren and
Lawrence scale for osteoarthritis.
Results:
Overall prevalence of knee OA was found to be 28.7%. The associated factors were found to be female gender
(prevalence of 31.6%) (P = 0.007), obesity (P = 0.04), age (P = 0.001) and sedentary work (P = 0.001).
Conclusions:
There is scarcity of studies done in India which has varied socio geographical background and communities. We
conducted this study for analyzing the current prevalence of OA in different locations. This study has evidenced
a large percentage of population as borderline OA; therefore, it depends mainly on the prevention of modifiable
risk factors to preserve at ease movement in elderly population through awareness programs.
Keywords: Knee osteoarthritis,prevalence, related factors
MeSh terms: Osteoarthritis, knee, knee joint, risk factors, epidemiology
INTRODUCTION
Osteoarthritis (OA) is a chronic degenerative disorder of multifactorial etiology characterized by the loss of
articular cartilage, hypertrophy of bone at the margins, subchondral sclerosis,and range of biochemical and
morphological alterations of the synovial membrane and joint capsule.1
Pathological changes in the late stage of OA include softening, ulceration, and focal disintegration of the
articular cartilage. Synovial inflammation also may occur.2,3
Typical clinical symptoms are pain, particularly
after prolonged activity and weight-bearing; whereas stiffness is experienced after inactivity.2
It is probably not
a single disease but represents the final end result of various disorders leading to joint failure.1,2
It is also known
as degenerative arthritis, which commonly affects the hands,feet, spine, and large weight-bearing joints, such as
the hips and knees.1,2

14. Most cases of OA have no known cause and are referred to as primary OA.3
Primary osteoarthritis is mostly
related to aging.1,2
It can present as localized, generalized, or as erosive OA.3,4
Secondary osteoarthritis is caused
by anotherdisease or condition.4
Osteoarthritis is the second most common rheumatologic problem and it is the most frequent joint disease with a
prevalence of 22% to 39% in India.1,3
OA is more common in women than men, but the prevalence increases
dramatically with age.1,2,5
Nearly, 45% of women over the age of 65 years have symptoms while radiological
evidence is found in 70% of those over 65 years.2,4,5
OA of the knee is a major cause of mobility impairment,
particularly among females.2,5
OA was estimated to be the 10th
leading cause of nonfatal burden.2,4
Self report surveys may not accurately estimate OA as there could be unknown cases in the community.6
There
are few studies of OA that have used a radiological classification of disease. X-ray findings do not always match
symptoms, but prevalence based on radiography is probably a reasonable population estimate.7
OA of the knee
is more prevalent as per the literature available.7
Therefore, for finding the current burden of OA and its association with lifestyle related factors, it was essential
to undertake such a study on the prevalence of knee OA in Indian population.
RESULTS
The study used radiographic diagnosis for the confirmation of knee OA. The Kellgren and Lawrence scale of
OA grading was used for the same. Analysis was done using SPSS software package for statistical analysis
version 17. Chi-square test and t-test were used.The present study shows a prevalence of 28.7% in the overall
sample [Table 1]. The prevalence was higher in villages (31.1%) and big cities (33.1%) as compared to towns
(17.1%) and small cities (17.2%) [Table 2].
The association of gender and OA of this study is in congruence with the available literatures on knee
OA. OA of the knees was found to be more prevalent in females (31.6%) than in males (28.1%). This
finding is statistically significant (P = 0.007).
The study found that the prevalence of OA knees increased with increase in body mass index (BMI).
Knee OA prevalence was significantly (P = 0.007) low in underweight people (28%) as compared to
normal weight and obese participants (33%). Prevalence was found to be highest in people who are
overweight and/or obese [Table 3]. The prevalence was highest among the age group of 60 and above
and lowest in people in the age group of 40–50 years (P = 0.001) [Table 4]. The prevalence of knee
OA was highest in participants who are unemployed. Although statistically significant (P = 0.0001), a
cause–effect relationship cannot be derived. This is so because the unemployed group may include
people who were retired. In such cases,the OA may have been due to age rather than being
unemployed. Prevalence was lowest among participants who worked as daily wage workers/laborers
(22.2%). Prevalence was highest in participants who have a sedentary lifestyle followed by
participants with a physically demanding lifestyle and active lifestyle. This difference was statistically
significant (P = 0.001) showing that the prevalence of OA was lowest in participants who had a fairly
active physical activity level [Table 5]. Since the study recorded the current level of physical activity,
it may be possible of having OA that may be more due to age rather than lifestyle. Moreover, people
with severe OA may have changed their lifestyle. OA prevalence was found to be significantly more
(P = 0.001) in participants who used Western toilet (42.1%) as compared to those who used Indian
toilet (29.7%) or both types (38.8%), but it reflects more a condition of difficulty to use Indian toilet
than a predisposition to OA.
Prevalence was higher in participants who do not exercise (83.9%) compared to participants who
exercise (36.0%). Although the questionnaire gathered information on the type of exercises done,
there was no significant difference in the prevalence of OA among different exercise groups.
DISCUSSION
OA indeterminately occurs in elderly age group.1,2,5
OA occurs commonly in females above 45 years of age
while before 45 years, it is common in males.2,5
The studies done on females for identifying the relation between
estrogen and the prevalence of OA in menopausal age showed contradictory results.

15. The prevalence of OA is available for the USA and European populations,but there are scare studies done in
other regions.5
In 1990, it was the 10th
leading cause of nonfatal diseases contributed 2.8% years of
disability.7
An estimated prevalence of symptomatic OA is 18% in females and 9.6% in men.2,7
In global burden
of diseases,in 2000, it was the 4th
leading cause of years lived with disability (YLD) leading to 3% YLD.3
The COPCORD study also showed a higher prevalence in urban as compared to the rural prevalence of OA in
Bangladesh.8,9
In a study done in Beijing's urban population10
and Wuchuan's rural population,11
it was observed
that Wuchuan men had a prevalence ratio (PR) 2.5, 95% confidence interval (CI) (1.6-3.8) and symptomatic
knee OA (PR 1.9, 95% CI 1.3-2.9). A Chinese cohort study showed two to three times higher bilateral knee
prevalence as compared to a Framingham study.11
In an observationalstudy done in rural Tibetan region, the
prevalence of knee pain was 25% and significantly associated in 50 years as compared to younger
people.12
Similarly, a study done by Muraki et al. on Japanese population in symptomatic and radiographically
confirmed knee OA cases,it was evidenced to have higher prevalence in two mountain regions as compared to
rural and urban population.13
In a house-to-house survey done by Salve et al. in South Delhi among 260 perimenopausal women, the
prevalence of OA was found to be higher in lower socioeconomic than higher socioeconomic population.14
A
study done by Sharma et al. had similar results, but with lesser prevalence than this study.15
Recently, a cohort
study done by Martin et al. showed that BMI is positively associated with knee OA in women and suggested
that more active individuals have lower risk of knee OA.16
In a metaanalysis done by Blagojevo et al., it showed
that BMI is a risk factor for OA.17
The various modifiable risk factors are repetitive movement of joints, obesity,
infection, and injuries. The occupational physical activities include monotonous motions and great forces such
as kneeling, squatting on joints,18,19,20,21,22,23,24,25
climbing,26
and heavy weight lifting. Kellgren showed that the
first-degree relatives of probands had twice higher risk than others.The genetic OA and progression study by
Riyazi et al. in multiple sites showed the evidence of familial hereditability of OA of hand, hip, and spine, but
not in knee.27
This study has evidenced a large percentage of subthreshold population,that is, K-L Grade 1 which is
considered as borderline or doubtfull as far as OA diagnosis is considered.This needs to be addressed.
Awareness program should be initiated at community level which is needed for the prevention of OA of knee at
early age. We would like to suggest that a longitudinal cohort study can be planned which, in long run, will
prove the impact of physical activity, habits,and lifestyles. Stress on early diagnosis on the onset of symptoms
should be encouraged among the general population.Studies to understand howmany people with symptoms of
OA seek medical advice are required to understand the treatment seeking behavior and pain tolerance associated
with OA.

16. https://pubmed.ncbi.nlm.nih.gov/21331574/
Review
Prevalence of arthritis in India and Pakistan: a
review
EhtishamAkhter1,SairaBilal,AdnanKiani,UzmaHaque
 Rheumatol Int. 2011 Jul;31(7):857. Kiani, Adnan [added]
 1Johns Hopkins University, Baltimore, MD, USA. ehtishamakhter@yahoo.com
Abstract
Recent studies of rheumatoid arthritis worldwide suggest that prevalence of arthritis is higher in
Europe and North America than in developing countries. Prevalence data for major arthritis disorders
have been compiled in West for several decades, but figures from the third world are just emerging. A
coordinated effort by WHO and ILAR (International League Against Rheumatism) has resulted in
collecting data for countries like Philippines, China, Malaysia, Indonesia, and rural South Africa but the
information about prevalence of arthritis in India and Pakistan is scarce. Since both countries, i.e., India
and Pakistan, share some ethnic identity, we reviewed published literature to examine the prevalence
of arthritis in these countries. Medline and Pubmed were searched for suitable articles about arthritis
from 1980 and onwards. Findings from these articles were reviewed and summarized. The prevalence,
clinical features, and laboratory findings of rheumatoid arthritis are compiled for both India and
Pakistan. Data collected from these two countries were compared with each other, and some of the
characteristics of the disease were compared with Europe and North America. It is found to be quite
similar to developed countries. Additionally, juvenile rheumatoid arthritis is of different variety than
reported in West. It is more of polyarticular onset type while in West pauciarticular predominates.
Additionally, in systemic onset, JRA uveitis and ANA are common finding in developed countries; on
the other hand, they are hardly seen in this region. Although the prevalence of arthritis in Pakistan and
India is similar to Western countries, there are inherent differences (clinical features, laboratory
findings) in the presentation of disease. The major strength of the study is that it is the first to pool
reports to provide an estimate of the disease in the Indian subcontinent. Scarcity of data is one of the
major limitations. This study helps to understand the pattern of disease in this part of country that can
be stepping-stone for policy makers to draft policies that can affect target population more
appropriately.