Whilst certain factors have been extensively reviewed (for example, body mass index), more longitudinal studies are needed to investigate the association of physical occupational and other patient-determined factors with future knee OA. The quality of such studies also needs to be improved. However, there are identifiable factors which can be targeted for prevention of disabling knee pain.

In addition to a focus on obesity, there is potential for primary prevention of knee pain by tackling knee injuries and treating depression. Other factors are likely to determine whether the knee pain then progresses. An area for future research is the ineffectiveness of current health care in halting or reversing progression of knee pain at a population level.

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BACKGROUNDOne hypothesis has posited whether abnormal lipid metabolism might be a causal factor in the pathogenesis of osteoarthritis (OA). Routine statin use in clinical practice provides the basis for a natural experiment in testing this hypothesis.OBJECTIVETo test the hypothesis that statins reduce the long-term occurrence of clinically defined OA.DESIGNCohort design with a 10-year follow-up.PARTICIPANTS16,609 adults cardiovascular disease cohorts aged 40 years and over from the UK General Practice Research Database with data available to 31 December 2006.INTERVENTIONStatins were summarised as annual mean daily dose and dose change over two-year time periods.MAIN MEASURESIncident episode of clinically defined osteoarthritis was assessed within 2 years, and at 4-year and 10-year follow-up time periods, using Cox and discrete time survival analysis. Covariates included age, gender, deprivation, body mass index, cholesterol level, pain-modifying drug co-therapies, and duration and severity of cardiovascular disease.KEY RESULTSHigher therapeutic dose of statin, with a treatment duration of at least 2 years was associated with a significant reduction in clinical OA compared to non-statin users in the follow-up time period. The estimated adjusted rate ratios were as follows: lowest statin dose quartile 1: 2.5 (95 % CI 2.3, 2.9); quartile 2: 1.3 (1.1, 1.5); quartile 3: 0.8 (0.7, 0.95); and highest statin dose quartile 4: 0.4 (0.3, 0.5). The largest statin dose increments were associated with significant reductions estimated at 18 % in OA outcome within 2 years and 40 % after 4 years, compared to non-statin users.CONCLUSIONSThis longitudinal study from a national clinical practice setting provides evidence that higher statin dose and larger statin dose increments were associated with a reduction in clinically defined OA outcome.

These findings support the use of alternative, relatively pain-free forms of exercise in the clinical management of patients with intermittent claudication.