Occupational Risk in Knee Osteoarthritis: A Systematic Review and Meta‐Analysis of Observational Studies

Abstract

Objective To assess the association between occupational exposures and knee osteoarthritis (OA). Methods We systematically searched for observational studies that examined the relationship between occupational exposures and knee OA and total knee replacement. Four databases were searched up to October 1, 2019. Two reviewers independently assessed study quality using the Newcastle‐Ottawa Scale and evidence quality using the Grading of Recommendations Assessment, Development and Evaluation approach. Subgroup meta‐analyses were conducted for important study characteristics and each type of occupational exposure. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were estimated for the meta‐analysis using random‐effects models. Results Eighty eligible studies were identified including 25 case–control (n = 20,505 total participants), 36 cross‐sectional (n = 139,463 total participants), and 19 cohort studies (n = 16,824,492 total participants). A synthesis of 71 studies suggested increased odds of knee OA (OR 1.52 [95% CI 1.37–1.69]) by combining different physically demanding jobs and occupational activities as compared to sedentary occupations and/or low‐exposure groups. Odds of knee OA were greater in males and in industry‐based studies and studies assessing lifetime occupational exposures. There were 9 specific job titles that were associated with knee OA, including farmer, builder, metal worker, and floor layer. Occupational lifting, kneeling, climbing, squatting, and standing were all associated with higher odds of knee OA as compared to the odds of knee OA in sedentary workers. Conclusion Strenuous, physically demanding occupations and occupational activities were associated with increased odds of knee OA as supported by moderate‐quality evidence. Specifically, agricultural and construction sectors, which typically involve heavy lifting, frequent climbing, prolonged kneeling, squatting, and standing, carried increased odds of knee OA.

Triggers for acute flare in adults with, or at risk of, knee osteoarthritis: a web-based case-crossover study in community-dwelling adults

“…Collectively, our observations provide support for our hypothesis that intermittent activity-related exposures are risk factors for flares. Mechanical exposures, including occupational physical loading 41 , 42 , often associated with incidence and progression, may also contribute to ‘acute-on-chronic’ flares. These exposures have been proposed to have an etiological role, and also represent potentially modifiable risk factors for the etiopathogenesis 14 .…”

Factors Associated With Clinical and Radiographic Severity in People With Osteoarthritis: A Cross-Sectional Population-Based Study

“…In the northern region of Portugal, industrial employment is higher than the national average, and agriculture, forestry, construction, and manufacturing industries are important sources of employment ( 53 ). A recent systematic review concludes that people in the agriculture, construction, and metal industries have a higher probability of developing knee OA ( 54 ). Additionally, due to current sociodemographic characteristics of this region and the projected prevalence of chronic diseases and long-term disability, the northern region of Portugal is expected have a higher proportion of individuals with at least one chronic disease and long-term disability in 2031, mainly due to lower education levels ( 55 ).…”

Causal Association of Coffee Consumption and Total, Knee, Hip and Self-Reported Osteoarthritis: A Mendelian Randomization Study

“…The incidence and prevalence of OA have risen rapidly in the past few years. The pathogenesis of OA is complex and not completely explained, but adverse lifestyles and health conditions, including excessive physical labor ( 4 ), drinking alcohol ( 5 ), smoking ( 6 ), Type 2 diabetes, and obesity ( 7 , 8 ), as well as an increase of sex hormone-binding globulin (SHBG), calcium, testosterone (T) and estradiol (E2) ( 9 ), and an overburden of pathologic factors such as inflammatory cytokines and matrix degradation are known to contribute ( 10 , 11 ). Additionally, previous epidemiological studies have reported an association between coffee consumption and OA risk ( 12 ).…”