Objective. Few data exist concerning the natural history of lumbar spine disc degeneration and associated risk factors. We therefore undertook this study to examine the radiographic progression of lumbar spine disc degeneration over the course of 9 years in a population-based inception cohort of women from the Chingford Study.Methods. Seven hundred ninety-six paired lumbar spine radiographs were read by a single reader for anterior osteophytes (AO) and disc space narrowing (DSN) using the Lane atlas at each lumbar disc space (L1-5). Disc degeneration was defined using thresholds of AO and DSN grade 1؉ in one or more vertebrae (L1-5) within a subject. Progression was defined as an increase in grade in an affected year-1 vertebra. Potential risk factors were assessed using odds ratios and 95% confidence intervals adjusted for age, body mass index (BMI), and other potential confounders in logistic regression models using the STATA statistical package.Results. The mean ؎ SD age at baseline was 53.8 ؎ 6.0 years, and mean ؎ SD BMI was 25.4 ؎ 4.1 kg/m 2 . Progression rates for AO and DSN were 4% per annum and 3% per annum, respectively. Progression of DSN was predicted by age, back pain, and radiographic hip and knee osteoarthritis (OA). Progression of AO was predicted by age and radiographic hip OA, with borderline significance for BMI >30 kg/m 2 . No significant effects were seen for smoking, physical activity, hormone replacement therapy use, multiparity, or hand OA.Conclusion. This is the first population-based longitudinal study to assess progression of the individual radiographic features of AO and DSN in lumbar spine disc degeneration. We demonstrated progression rates of 3-4% per annum, with important risk factors for progression, including age, back pain, and radiographic OA at the hip and knee.Lumbar spine disc degeneration is characterized by disc space narrowing (DSN) and the presence of anterior vertebral osteophytes (AO). There is no consensus as to whether this is a form of osteoarthritis (OA) or a separate phenomenon, although lumbar spine disc degeneration is often labeled spinal OA and included in studies as a component of radiographic OA (1-3). There is a marked paucity of epidemiologic and populationbased data on disc degeneration. Investigators in crosssectional studies have reported similar prevalence rates increasing with age (2,4-6). Ethnic and sex differences have been demonstrated in some studies (2), and two recent magnetic resonance imaging (MRI) studies have shown the importance of genetic factors (7,8).Investigators in a number of studies have reported risk factor associations for prevalent disc degeneration. These risk factors include body mass index (BMI), back pain, occupational exposures, and heavy physical activity; however, the results are inconsistent (2,5,9,10). No clear association has been demonstrated with smoking, alcohol consumption, and hormone replacement therapy use. These results are likely to be limited by potential biases related to selection and consequences of the dise...

Our results suggest a role for genes regulating inflammatory pathways in the radiographic progression of spine degeneration. This could prove a fruitful area for future therapeutics for the spine and other joints.

Acute gout episodes in hospital are variably investigated and treated with frequent suboptimal management. We recommend establishment of a hospital-wide protocol to support decision-making regarding investigations, treatment and follow up.

Background:The association between progression of knee osteoarthritis and progression of osteoarthritis at sites distant from the knee is unclear because of a lack of multisite longitudinal progression data. Objective: To examine the association between radiological progression of knee osteoarthritis and osteoarthritis of the hands, hips, and lumbar spine in a population based cohort. Methods: 914 women had knee x rays taken 10 years apart, which were read for the presence of osteophytes and joint space narrowing (JSN). Progression status was available for hand, hip, and lumbar spine x rays over the same 8 to 10 year period. The association between progression of knee osteoarthritis and osteoarthritis at other sites was analysed using odds ratios (OR) and 95% confidence intervals (CI) in logistic regression models. Results: 89 of 133 women had progression of knee osteoarthritis based on osteophytes, and 51 of 148 based on JSN definition. Progression of JSN in the knee was predicted by progression in lumbar spine disc space narrowing (OR = 2.9 (95% CI 1.2 to 7.5)) and hip JSN (OR = 2.0 (1.0 to 4.2)). No consistent effects were seen for hand osteoarthritis. The associations remained after adjustment for age and body mass index. Conclusions: Progression of knee osteoarthritis is associated with progression of lumbar spine and hip osteoarthritis. This may have implications for trial methodology, the selection of patients for osteoarthritis research, and advice for patients on prognosis of osteoarthritis.