Over the last decade, our programme has broadened to include investigation of the lifecourse determinants of osteoarthritis. As part of a European consortium (EPOSA) addressing the natural history, socioeconomic and functional impact of lower limb osteoarthritis, we documented the relationship between physical performance and clinical OA. We also elucidated the natural history of knee pain and radiographic osteoarthritis over 15 years in the Chingford Study cohort, identifying early radiographic evidence of subchondral bone reaction (grade 1 osteophytosis), as a strong predictor of long-term progression of disease and arthroplasty outcome. We have extended this work to examine, in the UK CPRD and a parallel Spanish primary care database, the age- and sex-specific incidence rates of hand, hip and knee OA; and lifetime risks of total hip and knee arthroplasty, the potential sequelae of end-stage osteoarthritis. We developed a prototypic clinical prediction tool incorporating patient-reported outcome measures as well as other indices.