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Occurrence of comorbidity following osteoarthritis diagnosis: a cohort study in the Netherlands

Kamps, Anne; Runhaar, Jos; de Ridder, Maria A.J.; de Wilde, Marcel; van der Lei, Johan; Zhang, Weiya; Prieto-Alhambra, Daniel; Englund, Martin; de Schepper, Evelien I.T.; Bierma-Zeinstra, Sita M.A.

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Anne Kamps

Jos Runhaar

Maria A.J. de Ridder

Marcel de Wilde

Johan van der Lei

Daniel Prieto-Alhambra

Martin Englund

Evelien I.T. de Schepper

Sita M.A. Bierma-Zeinstra


To determine the risk of comorbidity following diagnosis of knee or hip osteoarthritis (OA).

A cohort study was conducted using the Integrated Primary Care Information database, containing electronic health records of 2.5 million patients from the Netherlands. Adults at risk for OA were included. Diagnosis of knee or hip OA (=exposure) and 58 long-term comorbidities (=outcome) were defined by diagnostic codes following the International Classification of Primary Care (ICPC) coding system. Time between the start of follow-up and incident diagnosis of OA was defined as unexposed, and between diagnosis of OA and the end of follow-up as exposed. Age and sex adjusted hazard ratios (HRs) comparing comorbidity rates in exposed and unexposed patient time were estimated with 99.9% confidence intervals (CI).

The study population consisted of 1,890,712 patients. For 30 of the 58 studied comorbidities, exposure to knee OA showed a HR larger than 1. Largest positive associations (HR with (99.9% CIs)) were found for obesity 2.55 (2.29-2.84) and fibromyalgia 2.06 (1.53-2.77). For two conditions a HR<1 was found, other comorbidities showed no association with exposure to knee OA. For 26 comorbidities, exposure to hip OA showed a HR larger than 1. The largest were found for polymyalgia rheumatica 1.81 (1.41-2.32) and fibromyalgia 1.70 (1.10-2.63). All other comorbidities showed no associations with hip OA.

This study showed that many comorbidities were diagnosed more often in patients with knee or hip OA. This suggests that the management of OA should consider the risk of other long-term-conditions.


Kamps, A., Runhaar, J., de Ridder, M. A., de Wilde, M., van der Lei, J., Zhang, W., …Bierma-Zeinstra, S. M. (2023). Occurrence of comorbidity following osteoarthritis diagnosis: a cohort study in the Netherlands. Osteoarthritis and Cartilage, 31(4), 519-528.

Journal Article Type Article
Acceptance Date Dec 7, 2022
Online Publication Date Dec 14, 2022
Publication Date 2023-04
Deposit Date Mar 6, 2023
Publicly Available Date Mar 6, 2023
Journal Osteoarthritis and Cartilage
Print ISSN 1063-4584
Electronic ISSN 1522-9653
Peer Reviewed Peer Reviewed
Volume 31
Issue 4
Pages 519-528
Public URL
Publisher URL
Additional Information Published by Elsevier Ltd on behalf of Osteoarthritis Research Society International. This is an open access article under the CC BY license