Abstract

Background: Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. Osteoarthritis has a multifactorial etiology as aging, joint injury and trauma, obesity, genetics, anatomic Factors, demographics and gut-joint axis. Aim: The aim of the current study is to assess the effect of elderly women's socio-demographic characteristics on knee osteoarthritis pain. Design: A descriptive cross-sectional research design was utilized in the current study. Setting: the study was carried out at Beni-Suef university hospital in orthopedics outpatient clinic and the physiotherapy unit. Subjects: A non-probability consecutive sampling technique of a total 300 studied women was recruited in the current study. Tools: interviewing questionnaire, and Visual Analog scale (VAS). Results: revealed that reveals that, more than two-thirds (70%) of studied elderly women had severe pain, 40.0% of elderly women aged 60-70 years old, 38.3% with intermediate education, 46.3% of retied, 39.7% of urban dwellers, 58% of married and 39.3% of who had inadequate family income elderly women documented severe pain level. Conclusion: Severe levels of pain were more prevalent among younger, intermittent educational level, lower income, retired, married, and urban elderly women. Statistically significance differences between elderly women’ pain level and their age and monthly income were revealed. While, there were highly statistically significant differences between elderly women’ pain level and their educational level, occupational status, marital status and residence place. Recommendations: Developing a simplified illustrated and comprehensive Arabic booklet including information about osteoarthritis, its therapeutic regimen and coping strategies.

1. Introduction

Osteoarthritis (OA) is the most common form of arthritis. Some people call it degenerative joint disease or “wear and tear” arthritis. It occurs most frequently in the hands, hips, and knees. With OA, the cartilage within a joint begins to break down and the underlying bone begins to change. These changes usually develop slowly and get worse over time. OA can cause pain, stiffness, and swelling. In some cases it also causes reduced function and disability; some people are no longer able to do daily tasks or work ^{1, 2, 3, 4}.

Osteoarthritis has a multifactorial etiology as aging, joint injury and trauma, obesity, genetics, anatomic Factors, demographics and gut-joint axis. Considering that OA is most common among the elderly. Aging drives changes in the joint tissues, making the joint increasingly susceptible to the development and progression of OA over time. Modification of the mechanical properties of the cartilage, influenced by rearrangement of the extracellular matrix (ECM), accumulation of advanced glycation end-products (AGEs), decreased aggrecan size, diminished hydration, and expanded collagen cleavage, lead to its increased susceptibility to degeneration ^{5, 6, 7, 8}.

Joint injury and trauma; Articular cartilage is capable of enduring the repetitive stress. However, it remains susceptible to trauma that can damage the cartilage and subchondral bone. Such damage, along with intra-articular fracture, can increase the risk of OA progression. The pathologic changes are frequently evident within 10 years after injury, with the time of beginning affected to some extent by the patient’s age at the time of injury. The presence of elevated host inflammatory mediators, including interleukin-6 (IL-6) and tumor necrosis factor alpha (TNF-α), and the degradation of collagen and proteoglycan after injuries involving the joint initiate the OA process ^{9, 10, 11, 12}.

Obesity has a direct and indirect effect on OA. Increased body weight, indicated by elevated body mass index (BMI) in obese patients, results in significant overloading and injury to the weight-bearing joint. Additionally, elevated BMI also results in metabolic abnormalities indicated by the leptin and adiponectin production by adipocytes within adipose tissue that have been associated with direct effects on the joint tissues that promote the development of OA. The proinflammatory cytokines produced by macrophages, i.e., IL-6 and TNF-α, have been implicated in the promotion of the proinflammatory state during OA ^{14, 15, 16}.

Hereditary forms of OA because of certain uncommon mutations in type II, IX, or XI collagen, common collagens found in articular cartilage, result in premature OA that can begin as early as adolescence, bringing about a severe, destructive form of arthritis that influences various joints. However, the evidence connecting genetic factors with OA of the lower extremity joints such as the knee or hip is less conclusive in comparison to that for OA of the hands ^{17, 18, 19}.

The shape of the joint can influence the development of OA. A significant anatomic factor identified with knee OA is lower extremity alignment. Moreover, other factors that can increase the risk for OA development and progression in the knee include a leg length discrepancy of ≥1 cm, varus and valgus deformities, and tearing of the cruciate ligament. Individuals with either varus alignment (bow-legged) or valgus alignment are at increased risk of tibiofemoral OA ²⁰.

The association of gut dysbiosis and OA was established when quantitative and qualitative alterations to the gut microbiota (GM) demonstrated a sustained, low-grade, and chronic systemic inflammation, subsequently manifested in OA. In an undisturbed state, the GM performs several functions such as nutrient absorption, maintenance of metabolic homeostasis, protection from infections, and development of systemic and mucosal immunity. In gut dysbiosis, perturbation of the GM resulted in perturbation of immune response and the host metabolism. Together, these disruptions exacerbated OA pathophysiology ²¹.

2. Aim of the Study

The aim of the current study is to assess the effect of elderly women's socio-demographic characteristics on knee osteoarthritis pain

Are elderly women's socio-demographic characteristics having effect on knee osteoarthritis pain?

3. Subjects and Methods

A descriptive cross-sectional research design.

Beni-Suef university hospital in orthopedics outpatient clinic and the physiotherapy unit.

3.2.2.1. Sample Size: The estimated sample size is 278 subjects. This was increased to 300 to anticipate a non-response rate of about 10%.

3.2.2.2. Sampling Type: A non-probability consecutive sampling technique was used to recruit elderly women according to the eligibility criteria.

3.2.2.3. Sample criteria: Any elderly women suffering from knee osteoarthritis (OA) pain and attended the study settings was selected in the study sample after fulfilled the following criteria.

Inclusion criteria: Elderly (age ≥65 years old), Diagnosed as having knee osteoarthritis (OA) for at least one year; this will be confirmed by chart review or medical report and history.

Exclusion criteria: Cognitive impairment, Life-threatening or functionally severely limiting health problems other than OA (e.g., cancer, Chronic Obstructive Pulmonary Disease COPD, etc.).

A. Interviewing questionnaire: it was developed by the researcher; it is consisted of Demographic data which was developed by the researcher in an Arabic language. This part was concerned with elderly women's demographic characteristics, such as; age, educational level, occupational status, marital status and residence.

B. Visual Analog scale (VAS): It was adapted from Hawker et al, (2011). It aimed to assess pain severity among elderly women with knee osteoarthritis and include numbers from 1 to 10 in box that described how much knee pain patient feel ²².

v The scoring system:- The total score of this scale was 10 and classified into three categories based on the following: No pain = 0, Moderate pain = 1<6, and Sever pain = 6-10

Tool was examined by a panel of five experts in the field of community health nursing, reliability was tested using Cronbach’s Alpha coefficients

A pilot study was carried out on 30 patients (10%) of the study subjects to test the clarity, applicability, feasibility and relevance of the tools used and to determine the needed time for the application of the study tools.

The actual work of this study started and completed within eight months from beginning of August (2021) to the end of March (2022).

The research approval was obtained from the faculty scientific ethical committee before starting the study.

An official written letter was issued from the faculty of Nursing in Beni-Suef University to the director of Beni-Suef University Hospital in which the study was conducted by which permission obtained for data collection and help in conducting the study in their facilities.

The data were collected, coded and entered into a suitable excel sheet and analyzed using an appropriate statistical method. Data were analyzed using statistical program for social science (SPSS) version 26.0, quantitative data were expressed as a mean ± standard deviation (SD), and qualitative data were expressed as frequency and percentage. Chi-square (X²) test of significance was used in order to compare proportions between qualitative parameters.

4. Results

Table 1 shows that, around two-thirds (60.7%) of studied elderly women had ages ranged from 65 <70 year with Mean ± SD (69.8±4.71), more than half (50.7%) of them had secondary education, 50.7% of them had retired from governmental jobs. While, 39.7% of them lived at urban areas, and 29.7% of studied elderly women were widow, 48.0% of them had adequate family income and 9.7% of them were living alone.

Figure 1 reveals that, more than two-thirds (70%) of studied elderly women had severe pain and (30%) of them had moderate pain level.

Figure 2 shows that, 40.0% of elderly women aged 60-70 years old had severe pain. There was a statistically significance differences between elderly women’ pain level and their age (p≤0.05).

Figure 3 reveals that, 38.3% of elderly women with intermediate education had severe pain. There was a highly statistically significance differences between elderly women’ pain level and level of education (p≤0.0001).

Figure 4 demonstrates that, 46.3% of retied elderly women had severe pain. There was a highly statistically significance differences between elderly women’ pain level and occupation (p≤0.0001).

Figure 5 reveals that, 58% of married elderly women had severe pain. There was a highly statistically significance differences between elderly women’ pain level and marital status (p≤0.0001).

Figure 6 portrays that, 39.7% of elderly women who had severe pain were urban dwellers. There was a highly statistically significance differences between elderly women’ pain level and their residences (p≤0.0001).

Figure 7 shows that, 39.3% of elderly women who had severe pain were had inadequate family income. There was a statistically significance differences between elderly women’ pain level and their income (p≤0.05).

5. Discussion

Osteoarthritis (OA) is a chronic, autoimmune, systemic, connective-tissue disease characterized by progressive synovitis in symmetrical joints, which leads to severe disabilities and premature mortality. The most severe effects of rheumatoid arthritis (OA) are loss of physical function and chronic pain, which may have a major impact on different areas of the person’s existence. People with OA have significantly worse results in physical functioning in particular. However, OA also has a major impact on other areas of human life, e.g., social relationships, family life, and psychological well-being ^{23, 24, 25, 26}.

Recent research studied pointed out that there is increasing evidence for the role of nurses in the management of patients with chronic inflammatory arthritis. Community health nurses help patients with OA achieve the ultimate goal of remission or low disease activity. Based on the patient’s individual needs, encourage and assist patient to establish health behaviors and activities that promote rest and exercise, reduce stress, and encourage independence ^{27, 28, 29}. So the aim of the current study was to assess the effect of elderly women's socio-demographic characteristics on knee osteoarthritis pain.

The current study found that more than half of the elderly women were aged between 65 and 70, with a mean age of 69.8 years, and lived in rural areas. Also, more than half of the women had retired from governmental employment, and more than two thirds of them were married. These results are consistent with those of Abdelaleem et al. (2018), who found that the majority of patients were married and between the ages of 50 and 70 ³⁰. Stlind et al., (2022), who stated that most of the analyzed sample resided in metropolitan environments and were employed, disagree with the conclusions of the current study ³¹.

About the education level of the studied sample, the results of the current study indicated that approximately half of the studied women had a secondary education in terms of educational attainment. Jormand et al. (2022), who claimed that more than half of the tested sample lacked an education, disagree with these study conclusions ³².

The current study's findings about the prevalence of OA in the investigated ladies revealed that more than one third of the elderly women experienced knee joint problems for at least five years. These results are in line with those of Jaiswal et al., (2022) who reported that over half of the group under study had rheumatoid arthritis diseases from five years prior ³³.

Regarding the relation between studied women level of pain and their personnel characteristics including personnel characteristics shows that, there were a statistically significance differences between elderly women’ pain level and their age and monthly income. While, there were highly statistically significant differences between elderly women’ pain level and their educational level, occupational status, marital status and residence place. These findings are in the same line with Aiyegbusi et al., (2019) who illustrated that there was a significant relation between studied sample rheumatoid arthritis pain and their personnel characteristics (p< 0.05) ³⁴.

Based on the result of the current study it was found that severe levels of pain were more prevalent among younger elderly women. This may attribute that younger one still have ability to work or practices exercise that in turn reduce pain. This is in line with Wei, et al, (2020) who denoted that Females have a higher risk of developing OA. The incidence rate of OA in women aged ≥65 years is 68% as compared to 58% among men aged ≥65 years. The strong association of OA with age could explain why OA is more common in the postmenopausal years. Postmenopausal women are more susceptible to knee arthritis because of their increased levels of calcitonin and bone desorption. However, there is some evidence that the loss of estrogen could be a contributing factor ³⁵.

In United States of America, there were 5270.81 prevalent cases of OA. The prevalence was higher in women (3170.44 cases in 2019) than in men (2100.37 cases in 2019) of all ages, and greatest in those aged 60–64 years in both sexes. Also, knee, hip, and other joint OA increased, but decreased for hand OA ³⁶. As the incidence and prevalence of osteoarthritis rise with increasing age, extended life expectancy will result in a greater number of people with the condition. In the United Kingdom (UK) 20% to 30% of elders over 60 years have symptomatic osteoarthritis. In the Middle East, more than one million people suffer from OA in Iraq, Yemen, Saudi Arabia, and Syria ³⁷.

In Egypt prevalence of OA is 8.5% in the total adult population, approximately 85% of individuals over the age of 75 years of age experience some symptoms of osteoarthritis. 40% of individuals with the disorder experience significant difficulties with daily activities to the point of interfering with work-related or social roles. Also, 29.5% most prevalent diseases among elderly females. This might be due to the postmenopausal osteoporotic changes among females ²².

Moreover, it was found that severe levels of pain were more prevalent among lower income, retired, married, and urban elderly women. This is expected as retired ones when they loss their job may not replace their activities by other concerns as exercise. Also, low income married women may not concentrate on their health and diets as they have not enough money and have many duties for their families that affect and increase intensity of pain. In addition, urban dweller did not have chances for enough green areas, fresh air and foods that increase energy and activity that in turn affect general health. This is not surprise to find statistical significance differences between elderly women’ pain level and their age monthly income, educational level, occupational status, marital status and residence place as all these factors can affect their life style ^{38, 39, 40}.

6. Conclusion

Based on the result of the current study it can be concluded that: Severe levels of pain were more prevalent among younger, intermittent educational level, lower income, retired, married, and urban elderly women. Statistically significance differences between elderly women’ pain level and their age and monthly income were revealed. While, there were highly statistically significant differences between elderly women’ pain level and their educational level, occupational status, marital status and residence place.

7. Recommendations

1. Health education through mass media concerning how to deal with osteoarthritis.

2. Developing a simplified illustrated and comprehensive Arabic booklet including information about osteoarthritis, its therapeutic regimen and coping strategies.

References