Osteoarthritis prevalence and modifiable factors: a population study

Depression in patients with knee osteoarthritis: risk factors and associations with joint symptoms

Background

To describe demographic and clinical factors associated with the presence and incidence of depression and explore the temporal relationship between depression and joint symptoms in patients with symptomatic knee osteoarthritis (OA).

Methods

Three hundred ninety-seven participants were selected from a randomized controlled trial in people with symptomatic knee OA and vitamin D deficiency (age 63.3 ± 7.1 year, 48.6% female). Depression severity and knee joint symptoms were assessed using the patient health questionnaire (PHQ-9) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively, at baseline and 24 months.

Results

The presence and incidence of depression was 25.4 and 11.2%, respectively. At baseline, having younger age, a higher body mass index (BMI), greater scores of WOMAC pain (PR: 1.05, 95%CI:1.03, 1.07), dysfunction (PR: 1.02, 95%CI:1.01, 1.02) and stiffness (PR: 1.05, 95%CI: 1.02, 1.09), lower education level, having more than one comorbidity and having two or more painful body sites were significantly associated with a higher presence of depression. Over 24 months, being female, having a higher WOMAC pain (RR: 1.05, 95%CI: 1.02, 1.09) and dysfunction score (RR: 1.02, 95%CI: 1.01, 1.03) at baseline and having two or more painful sites were significantly associated with a higher incidence of depression. In contrast, baseline depression was not associated with changes in knee joint symptoms over 24 months.

Conclusion

Knee OA risk factors and joint symptoms, along with co-existing multi-site pain are associated with the presence and development of depression. This suggests that managing common OA risk factors and joint symptoms may be important for prevention and treatment depression in patients with knee OA.

Trial registration

ClinicalTrials.gov identifier: NCT01176344.

Anzctr.org.au identifier: ACTRN12610000495022.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-020-03875-1.

Global, regional prevalence, incidence and risk factors of knee osteoarthritis in population-based studies

BACKGROUND

Knee osteoarthritis (OA) is a major cause of disability in the elderly, however, there are few studies to estimate the global prevalence, incidence, and risk factors of knee OA.

METHODS

For this study, we searched PUBMED, EMBASE and SCOPUS from inception to April 4, 2020, without language restriction. We identified eligible studies with information on the prevalence or incidence of knee OA in population-based observational studies and extracted data from published reports. We did random-effects meta-analysis to generate estimates. This study was registered with PROSPERO (CRD42020181035).

FINDINGS

Out of 9570 records identified, 88 studies with 10,081,952 participants were eligible for this study. The pooled global prevalence of knee OA was 16⋅0% (95% CI, 14⋅3%-17⋅8%) in individuals aged 15 and over and was 22⋅9% (95% CI, 19⋅8%-26⋅1%) in individuals aged 40 and over. Correspondingly, there are around 654⋅1 (95% CI, 565⋅6-745⋅6) million individuals (40 years and older) with knee OA in 2020 worldwide. The pooled global incidence of knee OA was 203 per 10,000 person-years (95% CI, 106-331) in individuals aged 20 and over. Correspondingly, there are around annual 86⋅7 (95% CI, 45⋅3-141⋅3) million individuals (20 years and older) with incident knee OA in 2020 worldwide. The prevalence and incidence varied substantially between individual countries and increased with age. The ratios of prevalence and incidence in females and males were 1⋅69 (95% CI, 1⋅59-1⋅80, p<0⋅00) and 1⋅39 (95% CI, 1⋅24-1⋅56, p<0⋅00), respectively.

INTERPRETATION

Our study provides the global prevalence (16⋅0% [95% CI, 14⋅3%-17⋅8%]) and incidence (203 per 10,000 person-years [95% CI, 106-331]) of knee OA. These findings can be used to better assess the global health burden of knee OA. Further prospective cohort studies are warranted to identify modifiable risk factors for providing effectively preventive strategies in the early stages of the disease.

FUNDING

This work was supported by grants from the National Natural Science Foundation of China (nos. 81772384 and 81572174).

Correlation between osteoarthritis and monocyte chemotactic protein-1 expression: a meta-analysis

Objective

We evaluated the association between monocyte chemotactic protein-1 (MCP-1) and osteoarthritis.

Methods

We searched PubMed, Cochrane Library, Embase, Web of Science, China National Knowledge Infrastructure (CNKI), VIP (Chinese database), and Wan Fang (Chinese database) (before May 10, 2020), with no language limitations. STATA version 12.0 and Revman version 5.3 were used for data analysis. The standard mean difference (SMD) and corresponding 95% confidence intervals (95% CIs) were calculated. Nine clinical studies, including 376 patients with osteoarthritis and 306 healthy controls, were evaluated.

Results

The combined SMDs of MCP-1 expression levels suggested that MCP-1 expression was significantly higher in patients with osteoarthritis than healthy controls (SMD = 1.97, 95% CI = 0.66–3.28, p = 0.003). Moreover, subgroup analysis implied that osteoarthritis patients from both Asians and mixed populations had higher MCP-1 expression levels than controls, whereas Caucasians did not (p > 0.05). Serum MCP-1 levels (SMD = 2.83, 95% CI = 1.07–4.6, p < 0.00001) were significantly higher in patients with osteoarthritis than in controls; however, this difference was not significant in synovial fluid and cartilage tissue. Subgroup analysis for ethnicity showed that MCP-1 levels were significantly higher in Chinese, Dutch, and Brazilian patients with osteoarthritis than in control groups, although significant differences were not observed for American and Italian subgroups.

Conclusions

Our meta-analysis demonstrated that MCP-1 expression levels were higher in patients with osteoarthritis than in healthy controls and that MCP-1 may play important roles in the progression of osteoarthritis. Serum MCP-1 levels may serve as a potential biomarker for the diagnosis of osteoarthritis.

A patients' view of OA: the Global Osteoarthritis Patient Perception Survey (GOAPPS), a pilot study

BACKGROUND

Globally, osteoarthritis (OA) is the third condition associated with disability. There is still poor treatment in OA but science holds the key to finding better treatments and a cure. It is essential to learn what's important to patients from them to implement the most effective OA management. The OA Patients Task Force, conducted the Global OA Patient Perception Survey (GOAPPS)-the first global survey made by patients to analize the quality of life (QoL) & patient perceptions of care. The goal was to collect data on OA patients' perception of OA to understand patients' needs and expectations to improve OA management.

METHODS

Observational, cross-sectional study by online survey data collection from six countries, translated into three languages. The questionnaire was comprised of 3 sections: patient demographics and clinical symptomology characteristics; relationship with physicians: perception of attention, treatment, and information provided; and OA impact on daily activity and QoL. The results of the survey were evaluated using the Limited Data Set. The survey results were analyzed using descriptive statistics to characterize the patients' answers. Additionally, Cronbach's alpha was calculated to determine internal consistency validity.

RESULTS

A total of 1512 surveys were completed in 6 countries. 84.2% of respondents reported pain/tenderness and 91.1% experienced limitations to physical activities. 42.3% of patients were not satisfied with their current OA treatment. 86% had comorbidities, especially hypertension, and obesity. 51.3 and 78% would like access to additional drug or additional non-drug/non-surgical treatments respectively. 48.2% of patients perceived their QoL to be affected by OA. The Cronbach's alpha was 0.61.

CONCLUSIONS

OA has a significant impact on patients' daily activities and their desire to play an active role in managing this disease. Patients are seeking additional treatments, especially no pharmacological/no surgical treatments stressing the need for investing in clinical research, implementing OA preventive measures, and managing interventions to improve the healthcare value chain in OA.

Geospatial patterns of comorbidity prevalence among people with osteoarthritis in Alberta Canada

BACKGROUND

Knowledge of geospatial pattern in comorbidities prevalence is critical to an understanding of the local health needs among people with osteoarthritis (OA). It provides valuable information for targeting optimal OA treatment and management at the local level. However, there is, at present, limited evidence about the geospatial pattern of comorbidity prevalence in Alberta, Canada.

METHODS

Five administrative health datasets were linked to identify OA cases and comorbidities using validated case definitions. We explored the geospatial pattern in comorbidity prevalence at two standard geographic areas levels defined by the Alberta Health Services: descriptive analysis at rural-urban continuum level; spatial analysis (global Moran's I, hot spot analysis, cluster and outlier analysis) at the local geographic area (LGA) level. We compared area-level indicators in comorbidities hotspots to those in the rest of Alberta (non-hotspots).

RESULTS

Among 359,638 OA cases in 2013, approximately 60% of people resided in Metro and Urban areas, compared to 2% in Rural Remote areas. All comorbidity groups exhibited statistically significant spatial autocorrelation (hypertension: Moran's I index 0.24, z score 4.61). Comorbidity hotspots, except depression, were located primarily in Rural and Rural Remote areas. Depression was more prevalent in Metro (Edmonton-Abbottsfield: 194 cases per 1000 population, 95%CI 192-195) and Urban LGAs (Lethbridge-North: 169, 95%CI 168-171) compared to Rural areas (Fox Creek: 65, 95%CI 63-68). Comorbidities hotspots included a higher percentage of First Nations or Inuit people. People with OA living in hotspots had lower socioeconomic status and less access to care compared to non-hotspots.

CONCLUSIONS

The findings highlight notable rural-urban disparities in comorbidities prevalence among people with OA in Alberta, Canada. Our study provides valuable evidence for policy and decision makers to design programs that ensure patients with OA receive optimal health management tailored to their local needs and a reduction in current OA health disparities.

Non-neoplastic Disease Outside the Spine-Genicular Artery Embolization and Adhesive Capsulitis Embolization

Initial research into the treatment of pain secondary to knee osteoarthritis and shoulder adhesive capsulitis with embolization have yielded promising results. With further investigation, embolization may become a mainstay of treatment for pain from these two conditions.

Associations Between Vitamins C and D Intake and Cartilage Composition and Knee Joint Morphology Over 4 Years: Data From the Osteoarthritis Initiative

OBJECTIVE

To determine the cross-sectional and longitudinal associations of vitamin C and D intake with magnetic resonance imaging (MRI) measures of cartilage composition (T2) and joint structure (cartilage, meniscus, and bone marrow) using data from the Osteoarthritis Initiative (OAI) cohort.

METHODS

A total of 1,785 subjects with radiographic Kellgren/Lawrence knee grades 0-3 in the right knee were selected from the OAI database. Vitamins C and vitamin D intake (diet, supplements, and total) were assessed using the Block Brief 2000 Food Frequency Questionnaire at baseline. The MRI analysis protocol included 3T cartilage T2 quantification and semiquantitative joint morphology gradings (Whole-Organ Magnetic Resonance Imaging Score [WORMS]) at baseline and 4 years. Linear regression was used to assess the association between standardized baseline vitamin intake and both baseline WORMS scores and standardized cartilage T2 values.

RESULTS

Higher vitamin C intake was associated with lower average cartilage T2 values, medial tibia T2 values, and medial tibia WORMS scores (standardized coefficient range -0.07 to -0.05, P < 0.05). Higher vitamin D intake was associated with a lower cartilage WORMS sum score and medial femur WORMS score (standardized coefficient range -0.24 to -0.09, P < 0.05). Consistent use of vitamin D supplements of 400 IU at least once a week over 4 years was associated with significantly less worsening of cartilage, meniscus, and bone marrow abnormalities (odds ratio range 0.40-0.56, P < 0.05).

CONCLUSION

Supplementation with vitamin D over 4 years was associated with significantly less progression of knee joint abnormalities. Given the observational nature of this study, future longitudinal randomized controlled trials of vitamin D supplementation are warranted.

Patients with lateral compartment knee osteoarthritis during arthroscopy are at highest risk of subsequent knee arthroplasty

BACKGROUND

Arthroscopic treatment of knee osteoarthritis has declined, in part due to concerns with conversion to arthroplasty. Some studies have investigated the demographic predictors for conversion to arthroplasty, few have assessed the risk factors within the knee itself. Our aim was to analyse the demographics and anatomical wear features of a large cohort of patients undergoing knee arthroscopy.

METHODS

A retrospective analysis of 1760 cases spanning over 17 years undergoing knee arthroscopy was performed. Patients were 36 years or older at time of the index arthroscopy. Each patient received the International Cartilage Regeneration and Joint Preservation Society (ICRS) grade of all regions as well an estimate of the remaining meniscal percentage. Demographic factors as well as intraoperatively collected data were analysed as predictive variables for subsequent conversion to arthroplasty using a multi-step Cox regression analysis.

RESULTS

A total of 102 patients (6.2%) were converted to arthroplasty. Age at arthroscopy (hazard ratio (HR) 1.073; 95% confidence interval (CI) 1.058-1.088) and ICRS grade of the lateral tibial plateau (HR 1.166; 95% CI 1.066-1.276) were statistically significant predicting variables for conversion to arthroplasty.

CONCLUSIONS

The results of this study indicate that higher ICRS grade of the lateral tibial plateau at arthroscopy is the most significant predictor for conversion to knee arthroplasty, with a hazard equal to an increase in age. The absence of these factors does not justify arthroscopic treatment of patients with knee osteoarthritis.

LEVEL OF EVIDENCE

III.

Prevalence, risk factors, and health seeking behavior for knee osteoarthritis among adult population in rural Jammu - A Community based Cross Sectional Study

CONTEXT

Osteoarthritis (OA) is a degenerative joint disease, having multifactorial etiology affecting mainly the articular cartilage. Knee OA with its physical symptoms affects daily activities thereby deteriorating the quality of life. Most of the patients delay their visit to health sectors for seeking medical care in musculoskeletal conditions.

AIMS

To find the prevalence and determinants of osteoarthritis among the adult population in the rural area and to assess their health-seeking behavior.

SETTINGS AND DESIGN

A community-based, cross-sectional study.

METHODS AND MATERIAL

A community-based, cross-sectional study was conducted among 232 adults living in a rural area in village Kirpind of R.S. Pura block, Jammu. Knee OA was diagnosed using the clinical criteria laid down by the American College of Rheumatology (ACR).

STATISTICAL ANALYSIS USED

Descriptive statistics, OR with 95% CI, and Chi-square test were used for the purpose of analysis.

RESULTS

The overall prevalence of knee osteoarthritis was 35.7% (females: 44.5% Males: 23.1%). Age more than 60 years, female gender, history of trauma, BMI >30 were found to be significantly associated with higher odds of OA knee (P < 0.05). Descriptive statistics, OR with 95% CI and Chi-square test were used for the purpose of analysis.

CONCLUSIONS

Strategies focusing on creating awareness among the rural elderly regarding the role of a balanced diet, exercise, and weight management along sensitization of primary health care providers concerning benefits of early screening, diagnosis, and referral should be undertaken to minimize this burden.

The Prevalence of Symptomatic Knee Osteoarthritis in Relation to Age, Sex, Area, Region, and Body Mass Index in China: A Systematic Review and Meta-Analysis

Purpose: This study aimed to investigate the overall prevalence of symptomatic knee osteoarthritis (OA) in China by conducting a meta-analysis.

Methods: Six databases were searched for articles published from the date of inception to October 1, 2017, based on the Population, Intervention, Comparator, Outcomes (PICO) framework. The review was in line with preferred reporting items for systematic reviews and meta-analyses (PRISMA) guidelines. The χ²-based Q statistic and I² metrics were used for exploring the sources of heterogeneity. Random models were utilized to obtain prevalence estimates due to the heterogeneity that was observed. Comprehensive Meta-Analysis version 2.0 was used for assessing publication bias by inspecting funnel plots and Egger's tests.

Results: Twenty-one eligible studies (74,908 participants in total) were identified. The overall pooled prevalence of symptomatic knee OA in China was 14.6%. The prevalence of symptomatic knee OA presented a rapid growth trend between the periods of 1990–2008 and 2008–2013 (9.1 vs. 20.1%, p = 0.005). However, after 2013, the prevalence dropped to 14.9% (p = 0.01). The prevalence rates of symptomatic knee OA increased with age and presented an almost linear growth after 40 years of age. Compared with males (10.9%), females (19.1%) exhibited a higher prevalence of symptomatic knee OA (p = 0.015). The symptomatic knee OA prevalence was significantly higher in rural than it was in urban areas (16.9 vs. 11.1%, p = 0.037).

Conclusion: For symptomatic knee OA intervention, more attention should be paid to females, people in rural areas, and people aged over 40 years.

Parkinson Disease Associated Differences in Elective Orthopedic Surgery Outcomes: A National Readmissions Database Analysis

Background:

Advances in the treatment of Parkinson’s disease (PD) have allowed for improvements in mortality and quality survival, making the management of comorbid conditions of aging, such as osteoarthritis, crucial.

Objective:

To determine the extent to which PD impacts hospitalization outcomes after an elective orthopedic procedure.

Methods:

This retrospective cohort study used data from the National Readmissions Database and included adults ages 40 and above with and without PD. Primary outcomes included length of stay of the index admission, discharge disposition and 30-day readmission. Logistic regression was used to compare the odds of readmission for PD patients compared to non-PD. Clinical conditions associated with readmission were compared between the two groups.

Results:

A total of 4,781 subjects with PD and 947,475 subjects without PD met inclusion criteria. Length of stay (LOS) during the index admission was longer for PD patients. PD patients were much more likely to be discharged to inpatient post-acute care (49.3% vs 26.2%) while non-PD subjects were more likely to be discharged home with (31.9% [PD] vs 44.8% [non-PD]) or without home health (18.7% [PD] vs 28.9% [non-PD]). A total of 271 PD patients (5.66%) and 28,079 non-PD patients (2.96%) were readmitted within 30 days following surgery. After adjusting for age, sex, socioeconomic status, expected payer, comorbidities, index admission LOS, year and discharge disposition, PD subjects were 31% more likely to be readmitted than non-PD subjects (AOR 1.31, 1.07–1.62).

Conclusions:

Parkinson’s disease patients were readmitted more often than non-PD patients, although the rate of readmission was still low.

Comparison of the added effects of kinesio taping and extracorporeal shockwave therapy to exercise alone in knee osteoarthritis

INTRODUCTION

Pain and functional limitations affect quality of life of patients with knee osteoarthritis (OA).

PURPOSE

The purpose of this study was to compare the effects of two different applications (Kinesio taping; KT and Extracorporeal Shock Wave Therapy; ESWT) added to an home-exercise program on pain, strength and function in patients with knee OA.

METHODS

Sixty voluntary female subjects were randomly assigned into groups of; KT (n = 22), ESWT (n = 18) and control (CON) (n = 20) respectively. KT and ESWT were applied for 6 weeks and all the groups were taken home exercise program during 12 weeks in all groups. The outcome measures were; Visual Analog Scale for pain (during squat, rest and sleep), Isokinetic strength for quadriceps and hamstring strength, 'The Knee Injury and Osteoarthritis Outcome Survey', Timed Up & Go and 10 m Walk tests for function. The assessments were carried out at baseline, 6th and 12th weeks.

RESULTS

The mean age was 58.8 ± 6.2 years. Significant improvements were observed in all groups in all tests (p < .05). There was no difference found between groups (p > .05) except pain levels during sleep. CON group showed significant reduction in pain during sleep compared to ESWT group (p < .05).

CONCLUSION

KT and ESWT have similar effects in terms of decreasing pain, improving knee strength and function in patients with knee OA. However it can be said that if a well-designed home exercise program were done by the patients correctly and regularly then it will be the best treatment option for patients with knee OA.

Prevalence of Opioid and Benzodiazepine Prescriptions for Osteoarthritis

OBJECTIVE

Opioids and benzodiazepines are commonly used for management of osteoarthritis, despite evidence-based recommendations to the contrary. This study aimed to quantify the prevalence of opioid and benzodiazepine prescribing for osteoarthritis. Additionally, we aimed to characterize risk factors for prescription drug misuse, abuse, and diversion among this population.

METHODS

We conducted a descriptive analysis of adult outpatient encounters with a primary diagnosis of osteoarthritis during a 1-year period at a large health care system, excluding cancer and outpatient procedures. Demographic data, prescription data, and patient-specific risk factors were collected. Descriptive analysis was conducted to characterize arthritis patients who received and did not receive prescription opioids.

RESULTS

During 1 year, our system had 31,123 outpatient encounters for osteoarthritis. Opioids and benzodiazepines were prescribed for nearly 27% of the encounters (n = 8,420). In all, 43% of the encounters involved patients age ≥65 years. Hydrocodone-acetaminophen was the most common medication prescribed (34.3%). Most prescriptions were written by pain specialists (53%). A total of 35.5% of patients had a risk factor for prescription misuse, the most prevalent being early refill and a history of receiving ≥3 prescriptions in the past month.

CONCLUSION

Prescriptions for opioids and benzodiazepines continue to be written for osteoarthritis. These prescriptions may pose a risk for adverse outcomes since >1 in 5 patients receiving prescriptions had a risk factor for misuse. Continued efforts to improve compliance with evidence-based guidelines as well as multimodal and alternative pain management pathways are critical to help curb the use of opioids for management of osteoarthritis-related pain.

LEVEL OF EVIDENCE

level IV.

Cannabis for pain in orthopedics: a systematic review focusing on study methodology

Background

Medical cannabis use is an emerging topic of interest in orthopedics. Although there is a large amount of literature on medical cannabis use for managing various types of pain, few studies have focused on orthopedic conditions. There is little high-quality evidence in core orthopedic areas. The objective of this study was to summarize the literature on the efficacy of cannabis use for pain related to orthopedic conditions.

Methods

We conducted a systematic review of the literature on the use of cannabinoids for pain management in core orthopedic conditions. Two independent reviewers extracted information on reporting quality, risk of bias, drugs, population, control, duration of study, pain outcomes and the authors’ conclusions regarding efficacy for pain outcomes.

Results

We identified 33 orthopedic studies, including 21 primary studies and 12 reviews. Study quality was generally low to moderate. Six of the included studies had a control group and 15 were noncontrolled studies. Methodologies, drugs and protocols of administration varied greatly across studies. Study conclusions were generally positive in noncontrolled studies and mixed in controlled studies. Studies using higher doses tended to conclude that cannabis use was effective, but the potential for harmful effects may also be increased with higher doses.

Conclusion

Variability in the methodologies used in cannabis research makes it challenging to draw conclusions about dosing, routes and frequency of administration. Most of the existing evidence suggests that medical cannabis use is effective, but this efficacy has been demonstrated only when either there is no comparator or cannabis is compared with placebo. Studies using an active comparator have not demonstrated efficacy. Future research should focus on improving study reporting and methodologic quality so that protocols that optimize pain control while minimizing harmful effects can be determined.

The Effect of Neuromuscular Electrical Stimulation During Walking on Muscle Strength and Knee Pain in Obese Women With Knee Pain: A Randomized Controlled Trial

OBJECTIVE

The aim of the study was to assess the effectiveness of a hybrid training system with walking that simultaneously applies electrical stimulation to the knee extensors/flexors during walking in obese women with knee pain.

DESIGN

This is a randomized, single-blind (assessor), controlled trial. Twenty-eight obese women with knee pain were randomized to 12 weeks of biweekly walking with either hybrid training system with walking or with transcutaneous electrical nerve stimulation (control). Primary outcomes (maximum isokinetic knee extensor torque and maximum isokinetic knee flexor torque) and secondary outcomes (20-m walk time, chair-stand time, stair-climb time, knee pain, and knee-related quality life) were evaluated. Change-point regression analyses were used to model the interaction for the primary outcomes. Two-sample t tests were used on pre-post change scores in secondary outcomes.

RESULTS

Knee extensor torque increased significantly more in the hybrid training system with walking group than the control group when baseline knee extensor torque was greater than 57.2 Nm (P = 0.0033). When baseline knee flexor torque was at 30 or 50 Nm, there was a trend toward greater increase in the hybrid training system with walking group than the control group (P = 0.0566, P = 0.0737, respectively). There were no significant differences between groups in secondary outcomes.

CONCLUSIONS

These results suggest that hybrid training system with walking is effective for improving knee extensor torque in obese women with knee pain. However, the superiority of hybrid training system with walking may vary depending on baseline knee muscle strength.

Prevalence of symptomatic osteoarthritis in Spain: EPISER2016 study

INTRODUCTION

The Spanish Society of Rheumatology carried out the EPISER2000 study in 2000 to determine the prevalence of osteoarthritis and other rheumatic diseases in the Spanish population. Recent sociodemographic changes and lifestyle habits in Spain justified updating the epidemiological data on osteoarthritis and other rheumatic diseases (EPISER2016-study).

OBJECTIVE

To estimate the prevalence of symptomatic osteoarthritis of the cervical spine, lumbar spine, hip, knee and hand in the adult population in Spain.

MATERIAL AND METHODS

Cross-sectional population-based study. A multistage and stratified random cluster sampling was carried out. The participants were contacted by telephone to complete an osteoarthritis screening questionnaire. A rheumatologist confirmed or discarded the diagnosis. The ACR-clinical-criteria were used to diagnose hand-osteoarthritis and the ACR-clinical-radiological criteria to diagnose knee- and hip-osteoarthritis. To estimate the prevalence and its 95% confidence interval, weights were calculated according to the probability of selection in each of the sampling stages.

RESULTS

The prevalence of osteoarthritis in Spain in one or more of the locations studied was 29.35%. The prevalence of cervical-osteoarthritis was 10.10% and of lumbar-osteoarthritis 15.52%. Both are more frequent in women and at older ages, as well as in people with low levels of education and obesity. The prevalence of hip-osteoarthritis was 5.13%, that of knee-osteoarthritis 13.83%, these are associated with female sex, overweight and obesity. The prevalence of hand osteoarthritis was 7.73%. It is more frequent in women, who are obese, with a low educational level and who are older.

CONCLUSION

The EPISER2016 study is the first to analyse the prevalence of symptomatic osteoarthritis in 5 locations (cervical, lumbar, knee, hip and hands) in Spain. Lumbar spine osteoarthritis is the most prevalent.

Dietary antioxidants, non-enzymatic antioxidant capacity and the risk of osteoarthritis in the Swedish National March Cohort

PURPOSE

Oxidative stress might play an important role in the development of osteoarthritis, but not much is known about the effect of antioxidants on osteoarthritis risk. We, therefore, aimed to investigate the effect of dietary vitamin C, E, beta-carotene, and non-enzymatic antioxidant capacity (NEAC), which measures overall antioxidant activity from the diet, on the risk of osteoarthritis.

METHODS

For this study 43,865 men and women from the Swedish National March Cohort (SNMC) were followed for up to 19 years. We computed dietary intake of vitamin C, E and beta-carotene using information from a Food Frequency Questionnaire (FFQ). To estimate dietary NEAC we combined the information from the FFQ with food item-specific antioxidant capacity values from an antioxidant food database. Cases of osteoarthritis were identified through the Swedish National Patient Registers. We categorized all exposure variables into sex-specific quartiles and used multivariable-adjusted Cox proportional hazards regression models to estimate hazard ratios (HRs) with 95% confidence intervals (95% CIs).

RESULTS

In total, we observed 5976 cases of OA during 469,148 person-years of follow-up. After adjusting for potential confounders, we did not find any association between vitamin C, beta-carotene and NEAC (p-values for trend > 0.5), but a positive association was found with higher dietary vitamin E intake (HR Q4 vs Q1: 1.11; 95% CI 1.02-1.21; p for trend = 0.01) and the risk of OA.

CONCLUSION

Our findings do not provide evidence for dietary antioxidants to protect from the development of OA, and a higher dietary vitamin E intake might even increase the risk.

Load carriage magnitude and locomotion strategy alter knee total joint moment during bipedal ambulatory tasks in recruit-aged women

Knee osteoarthritis (OA) is prevalent among female soldiers, resulting in limited duty and long term adverse ambulatory effects. A proposed mechanism to the development of knee OA is the assiduous execution of load carriage tasks. Soldiers are often required to maintain a walking gait with load at velocities beyond their gait transition velocity (GTV) known as forced marching. The primary aim of this investigation is to determine the interactive effects of load magnitude and locomotion pattern on relative knee total joint moment (KTJM) in healthy recruit-aged women. The secondary aims are to determine knee total joint moment limb differences and to determine the interactive effect of load magnitude and locomotion pattern on the percent contributions of each plane of motion moment. Individuals were tasked with running and forced marching at 10% above their GTV at body weight (BW) and with an additional 25% and 45% of their BW. KTJM was analyzed at two specific gait events of heel-strike and mid-stance. At heel-strike, forced marching exhibited greater KTJM compared to run for all load conditions but running had greater KTJM than forced marching at mid-stance. The forced marching pattern exhibited larger KTJM for the dominant limb at both gait events compared to running. Lastly, at mid-stance the knee adduction moment percent (KAM%) contribution was greater for forced marching compared to running. The forced marching pattern demonstrates joint kinetics that may be more deleterious with prolonged exposure. Likewise, forced marching induced KAM% similar to those already suffering from knee OA.

Low back pain and radiographic severity as predictors in hip osteoarthritis patients receiving steroid injection therapy

INTRODUCTION

We investigated the effects of lower back pain (LBP) on measures of pain, disability, and function in highly symptomatic hip OA patients receiving intra-articular steroid injection (IASI) therapy. We also investigated the effect of radiographic severity of hip OA for comparison to LBP.

METHODS

97 consenting subjects with symptomatic hip OA presenting for IASI were evaluated at baseline, assessed over an 8-week period, and followed at least 1 year later for new arthroplasty. At baseline and 8 weeks follow-up patient demographics, presence/absence of back pain, physical function tests, a single anteroposterior pelvis x-ray, and subjective scores of pain, stiffness and function (VAS and WOMAC) were collected. We also followed which subjects proceeded to obtain total hip arthroplasty in the examined hip.

RESULTS

Cohorts with LBP reported significantly worse scores for all of VAS pain and WOMAC questionnaires but showed no difference in ROM and were not more likely to proceed to arthroplasty. Cohorts with severe radiographic OA had significantly worsened scores for stiffness (χ² = 6.74, p = 0.009), decreased ROM (p < 0.01), and were more likely to proceed to arthroplasty (χ² = 9.79, p = 0.044).

DISCUSSION

Back pain has a substantial effect on clinical parameters relevant to assessment of severity of hip OA, especially self-reported pain and function. This finding highlights LBP as a significant confounding factor in hip OA patient assessments and will inform future studies to determine the most effective treatment strategies for hip OA patients.

Cannabis and Pain Treatment-A Review of the Clinical Utility and a Practical Approach in Light of Uncertainty

Over the past decade the phenomenon of cannabis as a legitimate form of treatment for pain has overwhelmed the medical community, especially in the field of pain. From a status of a schedule 1 substance having no currently accepted medical use and being considered to have high potential for abuse, its use has mushroomed to over 50,000 legal medical users per year in Israel alone. There appear to be many reasons behind this phenomenon-medical, sociological, and economical. Thus, what is cannabis? An abusive substance or a medication? Should it be incorporated into current biomedical practice, and how should it be administered? Finally, what is the evidence for the beneficial and detrimental effects of cannabis? This article reviews and discusses the current literature regarding the beneficial and the detrimental effects of medical cannabis in the treatment of pain. We further discuss the problems and challenges facing the medical community in this domain and offer a practical approach to deal with these challenges.

Comparison of physical activity among different subsets of patients with knee or hip osteoarthritis and the general population

To compare the amount of physical activity (PA) among patients with different subsets of knee or hip osteoarthritis (OA) and the general population. Secondary analyses of data of subjects ≥ 50 years from four studies: a study on the effectiveness of an educational program for OA patients in primary care (n = 110), a RCT on the effectiveness of a multidisciplinary self-management program for patients with generalized OA in secondary care (n = 131), a survey among patients who underwent total joint arthroplasty (TJA) for end-stage OA (n = 510), and a survey among the general population in the Netherlands (n = 3374). The Short QUestionnaire to ASssess Health-enhancing physical activity (SQUASH) was used to assess PA in all 4 studies. Differences in PA were analysed by multivariable linear regression analyses, adjusted for age, body mass index and sex. In all groups, at least one-third of total time spent on PA was of at least moderate-intensity. Unadjusted mean duration (hours/week) of at least moderate-intensity PA was 15.3, 12.3, 18.1 and 17.8 for patients in primary, secondary care, post TJA, and the general population, respectively. Adjusted analyses showed that patients post TJA spent 5.6 h [95% CI: 1.5; 9.7] more time on PA of at least moderate-intensity than patients in secondary care. The reported amount of PA of at least moderate-intensity was high in different subsets of OA and the general population. Regarding the amount of PA in patients with different subsets of OA, there was a substantial difference between patients in secondary care and post TJA patients.

Timing of Intra-Articular Injection of Synovial Mesenchymal Stem Cells Affects Cartilage Restoration in a Partial Thickness Cartilage Defect Model in Rats

OBJECTIVE

We investigated the effect of administration of intra-articular mesenchymal stem cells (MSCs) on cartilage repair at different timings, and the distribution of MSCs in the knee.

DESIGN

A partial thickness cartilage defect (PTCD) was created on the medial femoral condyle in 14-week-old Sprague-Dawley rats. Intra-articular injection of 1 × 10⁶ MSCs was performed at 3 time points, namely at the time of surgery (0w group), at 1 week after surgery (1w group), and at 2 weeks after surgery (2w group). For the control, 50 μL phosphate-buffered saline was injected at the time of surgery. The femoral condyles were collected at 6 weeks after creation of PTCD and assessed histologically. To investigate the distribution of MSCs, fluorescent-labeled MSCs were injected into the knee joint.

RESULTS

In the control group, the cartilage lesion was distinguishable from surrounding cartilage. In the 0w group, hypocellularity and a slight decrease in safranin O stainability were observed around the injured area, but cartilage was restored to a nearly normal condition. In contrast, in the 1w and 2w groups, the cartilage surface was irregular and safranin O stainability in the injured and surrounding areas was poor. Histological score in the 0w group was significantly better than in the control, 1w, and 2w groups. At 1 day postinjection, fluorescent-labeled MSCs were mostly distributed in synovium. However, no migration into the PTCD was observed.

CONCLUSIONS

Early intra-articular injection of MSCs was effective in enhancing cartilage healing in a rat PTCD model. Injected MSCs were distributed in synovium, not in cartilage surrounding the PTCD.

LncRNA MCM3AP-AS1 regulates miR-142-3p/HMGB1 to promote LPS-induced chondrocyte apoptosis

Abstract

Background

The role of long non-coding RNA (lncRNA) Minichromosome Maintenance Complex Component 3 Associated Protein (MCM3AP) Antisense RNA 1 (MCM3AP-AS1) has been analyzed in liver cancer. But its role in osteoarthritis (OA) is unknown. Through bioinformatics analysis, we predicted that MCM3AP-AS1 may interact with miR-142-3p, which is a major player in OA. This study aimed to investigate the roles of MCM3AP-AS1 in OA and to explore its interactions with microRNA miR-142-3p.

Methods

Differential expressions of MCM3AP-AS1 in OA patients and healthy participants were analyzed by performing quantitative PCR (qPCR). To analyze the relationship between MCM3AP-AS1 and miR-142-3p, human chondrocytes were transfected with MCM3AP-AS1 over-expression vector and miR-142-3p mimic. MCM3AP-AS1, miR-142-3p and high mobility group protein B1 (HMGB1) mRNA expression levels were measured by qPCR.

Results

We found that MCM3AP-AS1 was up-regulated in OA. Bioinformatics analysis showed that MCM3AP-AS1 may interact with miR-142-3p, which can inhibit the apoptosis of chondrocytes. In addition, over-expression of MCM3AP-AS1 and miR-142-3p failed to affect the expression of each other. Instead, MCM3AP-AS1 over-expression led to up-regulated expressions of HMGB1, which is a target of miR-142-3p. Lipopolysaccharide (LPS) treatment led to the up-regulated expressions of MCM3AP-AS1 in chondrocytes. In cell apoptosis assay, MCM3AP-AS1 and HMGB1 over-expression led to increased apoptotic rate of chondrocytes. MiR-142-3p over-expression played an opposite role and attenuated the effects of MCM3AP-AS1 over-expression.

Conclusions

MCM3AP-AS1 may regulate miR-142-3p/HMGB1 to promote LPS-induced chondrocyte apoptosis.

Evaluating risk factors involved in the alteration of biomechanics in relation to knee osteoarthritis

The knee joint is very complex in terms of degrees of mobility and for normal biomechanics it is necessary for all the anatomical structures at this level to be within physiological limits. Problems can be caused by a number of risk factors such as age, sex, weight, or local risk factors such as patellar changes represented by patela alta or patella baja, which can lead to instability of the lower limb. Risk factors that may influence the development and progression of knee osteoarthritis have been evaluated. Changes in patellar position in relation to knee osteoarthritis were also studied. A group of 377 patients hospitalized for unilateral or bilateral knee pain with instability were included in the study. 239 of the 377 starting group presented knee osteoarthritis, constituting the study group. The risk factors analyzed were age, patient sex, BMI, weight status, anatomical changes in position of the patella (patella alta and patella baja), COBB angle and spine deviation. The results indicated that obesity, anatomical changes in the position of the patella, (patella alta), COBB angle and spine deviations represent significant risk factors in the onset of knee osteoarthritis. Key words: risk factors, joint instability, knee osteoarthritis,

Applications of RNA interference in the treatment of arthritis

RNA interference (RNAi) is a cellular mechanism for post-transcriptional gene regulation mediated by small interfering RNA (siRNA) and microRNA. siRNA-based therapy holds significant promise for the treatment of a wide-range of arthritic diseases. siRNA selectively suppresses the expression of a gene product and can thus achieve the specificity that is lacking in small molecule inhibitors. The potential use of siRNA-based therapy in arthritis, however, has not progressed to clinical trials despite ample evidence for efficacy in preclinical studies. One of the main challenges to clinical translation is the lack of a suitable delivery vehicle to efficiently and safely access diverse pathologies. Moreover, the ideal targets in treatment of arthritides remain elusive given the complexity and heterogeneity of these disease pathogeneses. Herein, we review recent preclinical studies that use RNAi-based drug delivery systems to mitigate inflammation in models of rheumatoid arthritis and osteoarthritis. We discuss a self-assembling peptide-based nanostructure that demonstrates the potential of overcoming many of the critical barriers preventing the translation of this technology to the clinic.

Magnetic resonance evaluation of knee osteoarthritis among the Saudi Population

Background and Objectives

Osteoarthritis (OA) is the most prevalent worldwide joint degenerative disorder with high morbidities and disabilities. The current study aimed to investigate the prevalence of knee osteoarthritis (KOA) in Arar by using magnetic resonance imaging (MRI).

Methods

The prevalence of KOA was studied in Arar through MRI evaluation of randomly chosen sample from patients and their relatives attending the Prince Abdul Aziz Bin Mussad Hospital from October 2015 to November 2016.

Results

A total of 410 participants were enrolled in the study [328 (80%) male and 82 (20%) females]. After MRI, 163 participants [39.75% (95% CI) = 35.14 - 44.57%)] were diagnosed with KOA. The prevalence of OA was about 25.6% (95% CI = 20.8 - 31.1%) below the age of 40 years, which was found to increase by age in the enrolled volunteers. KOA prevalence was higher in females than males (75.6% and 27.7% respectively). There was a significant association between the age and genders of the participants and the prevalence of OA (p-value < 0.0001 for both variables). There was also a significant association between the age and gender of the participants and the MRI-estimated grading (p-value < 0.0001 and 0.0044 respectively).

Conclusion

KOA is a common disease among Arar young population, especially females. Its prevalence increases by age with higher grades of severity affecting the elderly.

Physical activity and health-related quality of life in former elite and recreational cricketers from the UK with upper extremity or lower extremity persistent joint pain: a cross-sectional study

OBJECTIVE

To evaluate and compare physical activity (PA) and health-related quality of life (HRQoL) in former elite and recreational cricketers with upper extremity (UE), lower extremity (LE) or no joint pain.

STUDY DESIGN

Cross-sectional cohort.

SETTING

Despite the high prevalence of joint pain in former athletes, the impact of UE pain and LE pain on PA and HRQoL and potential differences between former recreational and elite athletes are poorly understood.

PARTICIPANTS

703 former cricketers aged ≥18 years (mean age 58.7, SD 12.9, played an average of 30 (IQR 20-40) seasons, 72% of whom had played at a recreational level) were recruited through the Cricket Health and Wellbeing Study and met eligibility requirements (UE pain, LE pain or no joint pain (defined as pain on most days of the past month)).

PRIMARY AND SECONDARY OUTCOMES

The International Physical Activity Questionnaire-Short Form collected weekly metabolic equivalents (METS), while the Short-Form 8 collected physical (PCS) and mental (MCS) component scores. Kruskal-Wallis tests with Dunn's post-hoc and multivariable linear regressions were performed.

RESULTS

Weekly METS were similar in former cricketers with UE pain (median (IQR) 2560 (722-4398)), LE pain (2215 (527-3903)) and no pain (2449 (695-4203), p=0.39). MCS were similar between groups (UE pain 56.0 (52.1-60.0); LE pain 55.2 (51.1-59.4); no pain 54.7 (50.7-58.7), p=0.38). PCS were more impaired in former cricketers with UE pain (49.8 (44.9-54.8)) or LE pain (46.7 (41.0-51.9)) compared with no pain (54.2 (51.5-56.9), p<0.0001). Former cricketers with LE pain reported worse PCS than those with UE pain (p=0.04). Similar relationships were observed in former elite and recreational cricketers.

CONCLUSION

Despite impaired physical components of HRQoL in former cricketers with UE pain or LE pain, pain was not related to PA levels or mental components of HRQoL. Physical components of HRQoL were most impaired in those with LE pain, and findings were similar among former elite and recreational cricketers.

Applications of Computer Modeling and Simulation in Cartilage Tissue Engineering

BACKGROUND

Advances in cartilage tissue engineering have demonstrated noteworthy potential for developing cartilage for implantation onto sites impacted by joint degeneration and injury. To supplement resource-intensive in vivo and in vitro studies required for cartilage tissue engineering, computational models and simulations can assist in enhancing experimental design.

METHODS

Research articles pertinent to cartilage tissue engineering and computer modeling were identified, reviewed, and summarized. Various applications of computer modeling for cartilage tissue engineering are highlighted, limitations of in silico modeling are addressed, and suggestions for future work are enumerated.

RESULTS

Computational modeling can help better characterize shear stresses generated by bioreactor fluid flow, refine scaffold geometry, customize the mechanical properties of engineered cartilage tissue, and model rates of cell growth and dynamics. Thus, results from in silico studies can help resourcefully enhance in vitro and in vivo studies; however, the limitations of these studies, such as the underlying assumptions and simplifications applied in each model, should always be addressed and justified where applicable. In silico models should also seek validation and verification when possible.

CONCLUSION

Future studies may adopt similar approaches to supplement in vitro trials and further investigate effects of mechanical stimulation on chondrocyte and stem cell dynamics. Additionally, as precision medicine, machine learning, and powerful open-source software become more popular and accessible, applications of multi-scale and multiphysics computational models in cartilage tissue engineering are expected to increase.

Running Dose and Risk of Developing Lower-Extremity Osteoarthritis

Whether or not running leads to the development of knee and hip osteoarthritis has been a much-debated topic and is often a question patients pose to their physicians. Recent literature adds to a growing body of evidence suggesting that lower-dose running may be protective against the development of osteoarthritis, whereas higher-dose running may increase one's risk of developing lower-extremity osteoarthritis. However, running dose remains challenging to define, leading to difficulty in providing firm recommendations to patients regarding the degree of running which may be safe. Furthermore, when counseling patients regarding their risk of developing lower-extremity osteoarthritis secondary to running, clinicians must consider many additional factors, such as the numerous health benefits from running and individual risk factors for developing osteoarthritis.

Efficacy and safety of avocado-soybean unsaponifiables for the treatment of hip and knee osteoarthritis: A systematic review and meta-analysis of randomized placebo-controlled trials

OBJECTIVE

We performed a systematic review and meta-analysis from randomized controlled trials to examine the efficacy and safety of avocado-soybean unsaponifiables (ASU) in patients with hip or knee osteoarthritis (OA).

DATA SOURCES

Medline, SCOPUS, Web of Science, and Google Scholar databases were searched for randomized placebo-controlled trials.

STUDY SELECTION

Original studies were randomized placebo-controlled trials evaluating the effect of orally administered ASU on knee or hip OA symptoms using the Lequesne index, visual analog scale (VAS) and/or joint space width (JSW).

DATA EXTRACTION

Meta-analysis was conducted using a random-effects model and generic inverse variance method. Heterogeneity was tested using the I² statistic index.

DATA SYNTHESIS

Avocado-soybean unsaponifiables therapy had a significant reduction on pain by VAS assessment (weighted mean difference [WMD]: -9.64 mm, 95% CI: -17.43, -1.84; P = .02; I²  = 92%). A subanalysis according to the type of OA showed that ASU significantly decreased both VAS and Lequesne index in knee OA (WMD: -17.36, 95% CI: -25.91, -8.82; P < .0001; I²  = 87% and WMD: -2.33, 95% CI: -2.88, -1.78; P < .00001; I²  = 18%, respectively) but not in hip OA. Finally, ASU supplementation showed no significant differences for adverse events compared to placebo (relative risk: 1.02, 95% CI: 0.83, 1.25; P = .88; I²  = 0%).

CONCLUSION

Results of this meta-analysis suggest a beneficial effect of ASU treatment in symptomatic knee OA but not in hip OA. Additionally, adverse events were similar in patients receiving ASU therapy or placebo.

Identification of Knee Osteoarthritis Based on Bayesian Network: Pilot Study

Background

Early identification of knee osteoarthritis (OA) can improve treatment outcomes and reduce medical costs. However, there are major limitations among existing classification or prediction models, including abstract data processing and complicated dataset attributes, which hinder their applications in clinical practice.

Objective

The aim of this study was to propose a Bayesian network (BN)–based classification model to classify people with knee OA. The proposed model can be treated as a prescreening tool, which can provide decision support for health professionals.

Methods

The proposed model’s structure was based on a 3-level BN structure and then retrained by the Bayesian Search (BS) learning algorithm. The model’s parameters were determined by the expectation-maximization algorithm. The used dataset included backgrounds, the target disease, and predictors. The performance of the model was evaluated based on classification accuracy, area under the curve (AUC), specificity, sensitivity, positive predictive value (PPV), and negative predictive value (NPV); it was also compared with other well-known classification models. A test was also performed to explore whether physical fitness tests could improve the performance of the proposed model.

Results

A total of 249 elderly people between the ages of 60 and 80 years, living in the Kongjiang community (Shanghai), were recruited from April to September 2007. A total of 157 instances were adopted as the dataset after data preprocessing. The experimental results showed that the results of the proposed model were higher than, or equal to, the mean scores of other classification models: .754 for accuracy, .78 for AUC, .78 for specificity, and .73 for sensitivity. The proposed model provided .45 for PPV and .92 for NPV at the prevalence of 20%. The proposed model also showed a significant improvement when compared with the traditional BN model: 6.3% increase in accuracy (from .709 to .754), 4.0% increase in AUC (from .75 to .78), 6.8% increase in specificity (from .73 to .78), 5.8% increase in sensitivity (from .69 to .73), 15.4% increase in PPV (from .39 to .45), and 2.2% increase in NPV (from .90 to .92). Furthermore, the test results showed that the performance of the proposed model could be largely enhanced through physical fitness tests in 3 evaluation indices: 10.6% increase in accuracy (from .682 to .754), 16.4% increase in AUC (from .67 to .78), and 30.0% increase in specificity (from .60 to .78).

Conclusions

The proposed model presents a promising method to classify people with knee OA when compared with other classification models and the traditional BN model. It could be implemented in clinical practice as a prescreening tool for knee OA, which would not only improve the quality of health care for elderly people but also reduce overall medical costs.

The Effect of the Phytocomplex Electrophoresis on the Clinical Symptomatology and Quality of Life of Patients with the Knee Joint Osteoarthritis

BACKGROUND:

Improving the effectiveness of rehabilitation of patients with osteoarthritis necessitates the use of drug electrophoresis with sinusoidal modulated currents (SMC-electrophoresis) in conjunction with drug therapy. The phytocomplex is proposed for electrophoresis composed of the compared, alfalfa and hops dry extract, containing flavonoids, coumestans, polysaccharides, steroids, essential amino acids, vitamins, mineral components and causing its possible use in osteoarthritis.

AIM:

The research aims to study the effect of the phytocomplex SMC-electrophoresis on the clinical symptoms and quality of life of patients with the knee joint osteoarthritis.

METHODS:

One hundred and eight patients were randomly distributed into 3 groups (n = 36). The phytocomplex SMC-electrophoresis was assigned to the first group, the amplipulse therapy (SMC) – to the second group, and the “basic” drug therapy – to the third group. The drug therapy of the patients of the third group was comparable with the drug treatment of those in the first two groups. The concentration of phytocomplex in the working solution was 10%. The electrotherapy was carried out in the aligned SMC mode in the first and fourth kind of works. Comparative indicators were as follows: WOMAC index, pain level on a visual analogue scale (VAS), Lequesne index, joint range of motion (JROM), articular and tendon indices, quality of life as per Health Assessment Questionnaire (HAQ).

RESULTS:

The use of the phytocomplex SMC-electrophoresis had a more pronounced positive effect on pain, knee joint function and quality of life of the patients compared with the treatment with drugs alone or using amplitude therapy. This was especially pronounced immediately after the rehabilitation. The analgesic effect was consistently maintained in the patients of the first group for up to 6 – 12 months, the second group – up to 3 – 6 months in terms of the level of pain according to the WOMAC and Lequesne indices, VAS, articular and tendon indices. Stable results have been obtained for improving the functions of the knee joint for up to 6 – 12 months using the phytocomplex SMC-electrophoresis as per the WOMAC and Lequesne indices. In the treatment by the phytocomplex SMC-electrophoresis, no side effects were registered.

CONCLUSION:

The obtained results give grounds for further research on the evaluation of the effectiveness of using the phytocomplex SMC-electrophoresis in microcirculatory disorders in the affected joint, for correcting connective tissue metabolism and electrolyte metabolism in the patients with the knee joint osteoarthritis.

The two-year incidence of hip osteoarthritis after arthroscopic hip surgery for femoroacetabular impingement syndrome

Background

One of the reported goals of hip preservation surgery is to prevent or delay the onset of osteoarthritis. This includes arthroscopic surgery to manage Femoroacetabular Impingement (FAI) Syndrome. The purpose of this study was to describe the prevalence of clinically-diagnosed hip OA within 2 years after hip arthroscopy for FAI syndrome, and 2) determine which variables predict a clinical diagnosis of OA after arthroscopy.

Methods

Observational analysis of patients undergoing hip arthroscopy between 2004 and 2013, utilizing the Military Health System Data Repository. Individuals with prior cases of osteoarthritis were excluded. Presence of osteoarthritis was based on diagnostic codes rendered by a medical provider in patient medical records. Adjusted odds ratios (95% CI) for an osteoarthritis diagnosis were reported for relevant clinical and demographic variables.

Results

Of 1870 participants in this young cohort (mean age 32.2 years), 21.9% (N = 409) had a postoperative clinical diagnosis of hip osteoarthritis within 2 years. The 3 significant predictors in the final model were older age (OR = 1.04; 95%CI = 1.02, 1.05), male sex (OR = 1.31; 95%CI = 1.04, 1.65), and having undergone an additional hip surgery (OR = 2.33; 95% CI = 1.72, 3.16). Military status and post-surgical complications were not risk factors.

Conclusion

A clinical diagnosis of hip osteoarthritis was found in approximately 22% of young patients undergoing hip arthroscopy in as little as 2 years. These rates may differ when using alternate criteria to define OA, such as radiographs, and likely underestimate the prevalence. A more comprehensive approach, considering various criteria to detect OA will likely be necessary to accurately identify the true rates. Females were at lower risk, while increasing age and multiple surgeries increased the risk for an OA diagnosis. OA onset still occurs after “hip preservation” surgery in a substantial number of individuals within 2 years. This should be considered when estimating rates of disease prevention after surgery. Prospective trials with sound methodology are needed to determine accurate rates and robust predictors of osteoarthritis onset after hip preservation surgery.

lncRNA DILC is downregulated in osteoarthritis and regulates IL-6 expression in chondrocytes

Excessive production of interleukin 6 (IL-6) is involved in the pathogenesis of osteoarthritis. It has been reported that long noncoding RNA (lncRNA) DILC inhibited IL-6 to regulate liver cancer stem cells. Therefore, lncRNA DILC may also participate in osteoarthritis. We found that lncRNA DILC was downregulated, while IL-6 was upregulated in plasma of osteoarthritis patients comparing to the control group. Levels of plasma lncRNA DILC and IL-6 were significantly and inversely correlated only in patients with osteoarthritis. Downregulation of lncRNA DILC effectively distinguished patients with osteoarthritis from the control group. Overexpression of lncRNA DILC resulted in inhibited IL-6 expression in chondrocytes, while treatment with exogenous IL-6 did not affect lncRNA DILC expression. However, lncRNA DILC overexpression did not affect the proliferation and apoptosis of chondrocytes. Therefore, lncRNA DILC is downregulated in osteoarthritis and regulates IL-6 expression in chondrocytes.

Interaction between GDF5 gene polymorphisms and environment factors increased the risk of knee osteoarthritis: a case-control study

Using a case–control design, we assessed the association between single nucleotide polymorphisms (SNPs) of growth and differentiation factor 5 (GDF5)/rs143383 gene and interaction with environments and knee osteoarthritis (KOA). We recruited 288 KOA patients from the First Clinical College, Henan University of Chinese Medicine between June 2017 and May 2018. There was significant difference in genotype distribution between case group and control group (χ² = 22.661, P=0.000). The minor C allele was significantly higher in the case group than that in the control group (20.5 vs 8.1%, P=0.000, odds ratio (OR) = 1.62, 95% confidence interval (CI): 1.29–2.03). Significant differences were also observed in other gene models. For age, all models show significant differences (P<0.05) for those whose age was more than 60 years, and no significant difference was observed for those under 60 years. For non-smoking group, there were significant differences between case group and control group, and for smoker, significance level was found in TT compared with CC and allele gene models. Patients with drinking and Bbody mass index (MI )≥ 24 also showed significant relationship between rs143383 and osteoarthritis (OA) under the following models: TT vs CC (P=0.000, P=0.018), TT/CT vs CC (P=0.043), TT vs CT/CC (P=0.000, P=0.009), and T vs C (P=0.024, P=0.000). Other gene models indicated no significance (P>0.05). Our results revealed a possible genetic association between GDF5 and KOA, and the TT genotype of rs143383 increased the risk of KOA in Chinese Han population. The interaction between GDF5 gene and drinking, smoking, and obesity further increased the risk of KOA.

Can effusion-synovitis measured on ultrasound or MRI predict response to intra-articular steroid injection in hip osteoarthritis?

OBJECTIVES

Intra-articular steroid injection (IASI) is an effective therapy for hip osteoarthritis (OA), but carries risks and provides significant pain relief to only two thirds of patients. We attempted to predict response to IASI in hip OA patients using baseline clinical, ultrasound, and MRI data.

METHODS

Observational study of 97 subjects with symptomatic hip OA presenting for IASI. At baseline and 8 weeks we obtained hip MRI, grayscale and Doppler ultrasound, clinical range of motion (ROM), timed-up and go test (TUG) scores, and self-reported Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain, stiffness, and function scores. Bone-capsule distance (BCD) measurements of inflammation on hip ultrasound and MRI were measured at three locations: the proximal-most uncovered portion of the femoral head, the superficial-most (apex) portion of the femoral head, and the largest fluid pocket at the femoral neck.

RESULTS

Ultrasound and MRI BCD correlated with each other significantly and strongly at the apex and neck. Power Doppler findings did not correlate significantly with any other imaging indices. Eight weeks post-injection, WOMAC pain, function, and stiffness scores significantly improved and TUG time improved nearly to the level of significance, but there were no significant changes in ultrasound, MRI, or Doppler indices. Baseline variables were not significantly different between responder and nonresponder WOMAC pain or TUG time cohorts.

CONCLUSION

Basic measures of inflammation on ultrasound and MRI are highly related to each other, but provide little insight into patient function and pain after IASI. Other mechanisms to explain improvement in patient status after IASI are likely at work.

Hip Osteoarthritis and Physical Workload: Influence of Study Quality on Risk Estimations-A Meta-Analysis of Epidemiological Findings

In this paper, we critically evaluate the quality of epidemiological evidence on hip osteoarthritis and workload published so far. The influence of study quality on risk estimations was analyzed in sensitivity meta-analyses and meta-regression analyses. Comprehensive searches for epidemiological studies of hip osteoarthritis and occupational workload were performed in literature databases and current reviews. All studies were assessed on the basis of study design, defined quality scores, and relevant confounders considered. In total, 34 suitable studies were identified for critical evaluation. Of these, 20 are prevalence studies and 14 incidence studies. Strong heterogeneity is observed in study design, quality level, and estimated exposure parameters. A consistent positive association between heavy physical workload and hip osteoarthritis was observed only among the male populations, not among the female populations. In general, cohort studies provided lower effect estimates than cross-sectional and population-based case-control studies. Studies with high quality scores also produced lower effect estimates than studies with low quality scores. Consideration of BMI as a confounder in published studies also yielded lower effect estimates than studies without consideration of BMI as a confounder. Our analyses indicate that high-quality studies of the association between occupational workload and hip osteoarthritis provide lower effect estimates than studies of lower quality.

Knowledge of knee osteoarthritis among general population in Aseer region

Background

Osteoarthritis (OA) is the most common articular disease of the developed country and cause of chronic disability, and may cause joint failure. OA is one of the most prevalent situation that gives rise to disability, especially in elderly population.

Aim

To assess the knowledge of knee OA among general population in Aseer region.

Materials and Methods

A cross-sectional survey was conducted in Aseer region including 1052 participants. The participants were included by visiting the public areas in different cities in Aseer region where many people of different social and economic level were available, and because of the the nature of Saudi community regarding home-to-home interviews.

Results

The research included 1052 participants from different areas in Aseer region. The ages of participants ranged from 17 to 80 years old, with a mean age of 38 ± 12 years old. Approximately 89.0% of the sampled population had good awareness regarding preventive measures of knee OA. The second highest awareness level was recorded for relieving the measures of knee OA as 84.1% of the sampled population recorded good level of knowledge. In general, 82.6% of the population had good awareness level regarding OA in total.

Conclusions and Recommendations

The current research revealed that the awareness of the general population in Aseer region regarding knee OA was more than satisfactory, especially for preventive measures, relieving measures, and its risk factors.

Identification of Novel Genes in Osteoarthritic Fibroblast-Like Synoviocytes Using Next-Generation Sequencing and Bioinformatics Approaches

Synovitis in osteoarthritis (OA) the consequence of low grade inflammatory process caused by cartilage breakdown products that stimulated the production of pro-inflammatory mediators by fibroblast-like synoviocytes (FLS). FLS participate in joint homeostasis and low grade inflammation in the joint microenvironment triggers FLS transformation. In the current study, we aimed to identify differentially expressed genes and potential miRNA regulations in human OA FLS through deep sequencing and bioinformatics approaches. The 245 differentially expressed genes in OA FLS were identified, and pathway analysis using various bioinformatics databases indicated their enrichment in functions related to altered extracellular matrix organization, cell adhesion and cellular movement. Moreover, among the 14 dysregulated genes with potential miRNA regulations identified, src kinase associated phosphoprotein 2 (SKAP2), adaptor related protein complex 1 sigma 2 subunit (AP1S2), PHD finger protein 21A (PHF21A), lipoma preferred partner (LPP), and transcription factor AP-2 alpha (TFAP2A) showed similar expression patterns in OA FLS and OA synovial tissue datasets in Gene Expression Omnibus database. Ingenuity Pathway Analysis identified the dysregulated LPP participated in cell migration and cell spreading of OA FLS, which was potentially regulated by miR-141-3p. The current findings suggested new perspectives into understanding the novel molecular signatures of FLS involved in the pathogenesis of OA, which may be potential therapeutic targets.

Assessing the Impact of a Game-Centered Mobile App on Community-Dwelling Older Adults' Health Activation

Background:

Older adults experience normative age-graded declines in physical and cognitive performance and many must manage one or more chronic conditions. Exercise programs can help to improve both their physical health and their knowledge, skill, and confidence in managing aspects of their own healthcare, yet a significant barrier is motivating them to adhere to such programs. The purpose of this investigation was to evaluate the impact of a game-centered mobile app (Bingocize®) on older adults’ knowledge, skill, and confidence for managing aspects of their healthcare.

Methods:

Community-dwelling older adults (N=84) with mobility and not engaged in any structured exercise program were recruited from rural community senior centers in Kentucky and Tennessee. Participants were randomly assigned to (a) a version that included health education, or (b) health education and an exercise component. Participants used the app in a group setting for 10 weeks, twice per week, for one hour. The Patient Activation Measure (PAM-10) was used to assess group changes in knowledge, skill, and confidence for managing aspects of their healthcare. The design was a two (Group: Exercise + Health Education vs. Health Education-only) x two (Time: Pre- vs. Post-intervention) and an analyses of variance, with significance p<.05, was used to detect within and between group differences.

Results:

PAM-10 values significantly increased from pre- to post-intervention for both groups, as did knowledge of the health topics (all p < 0.05). Attendance was >93% in both groups.

Conclusions:

Bingocize® engendered high attendance and improved health activation of older adults; however, additional research is needed to examine whether changes in activation result in long-term changes in health behaviour. The Bingocize® mobile app is an enjoyable and effective way to increase health activation in community-dwelling older adults.

Role of full-thickness cartilage defects in knee osteoarthritis (OA) incidence and progression: Data from the OA Initiative

The purpose of this study is to determine whether full-thickness tibiofemoral cartilage defects are predictive of incident radiographic OA, progression of radiographic OA, and progression to severe radiographic OA. Participants in the OA Initiative (n = 1317, 38.1% male, mean age 60.9 years SD 9.2) with baseline MRIs and Kellgren-Lawrence (KL) OA grade 0-3 (none to moderate OA) were included. All participants had follow-up radiographs at mean 4.9 years (max 8.0). The effect of full-thickness defect presence, size, and location on risk of incident OA (KL grade 2+), overall progression of OA (increase in KL grade 1+ points), or compartment-specific OA progression was assessed with Cox proportional hazards modeling with adjustment for demographic factors, weight, and knee alignment. The yearly incidence of tibiofemoral OA was 0.3% (CI 0.2-0.4%); defect presence, size, and location were not associated with incident OA risk. The yearly rate of OA progression was 3.8% in participants without tibiofemoral full-thickness defects, 6.7% with medial defects, and 6.3% with lateral defects. Medial bipolar (kissing) lesions were an independent risk factor for OA progression as well as medial compartment progression. Lateral tibial-sided full-thickness defects increased risk of lateral progression (increase in lateral OARSI grade). In older adults, isolated full-thickness cartilage defects do not increase short-term risk of incident OA. However, in the setting of preexisting mild or moderate OA, medial bipolar (kissing) defects increase risk of overall OA progression (KL grade) as well as progression of medial compartment OA. Lateral tibial defects increase risk of lateral compartment OA progression. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.

Structured Education and Neuromuscular Exercise Program for Hip and/or Knee Osteoarthritis: A Health Technology Assessment

BACKGROUND

Osteoarthritis is a chronic disorder and the most common form of arthritis. The joints most commonly affected are the hip and knee. The progression of osteoarthritis results in the breakdown of tissues and cartilage and the loss of joint function, causing symptoms such as pain, stiffness, reduced physical function, and limited movement. Although there is no cure for osteoarthritis, treatment options are available to manage symptoms and optimize quality of life. Clinical guidelines recommend education, exercise, and weight loss (when necessary) as the first line of treatment.

METHODS

We conducted a health technology assessment, which included an evaluation of the effectiveness, safety, and cost-effectiveness of a structured education and neuromuscular exercise program for the management of hip and/or knee osteoarthritis. We also assessed the budget impact of publicly funding such a program, and we spoke with people with osteoarthritis to gain an understanding of their preferences and values. We performed a systematic review of the clinical and economic literature published between January 1, 2008, and October 4, 2017. We also performed a grey literature search of health technology assessment websites. We assessed the risk of bias of each study, and we assessed the quality of the body of evidence according to the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) Working Group criteria. To evaluate the cost-effectiveness of a structured education and neuromuscular exercise program for adults with knee osteoarthritis, we conducted a cost-utility analysis from the perspective of the Ontario Ministry of Health and Long-Term Care. We also estimated the budget impact of publicly funding such a program in Ontario over the next 5 years. To contextualize the potential value of this type of program as a treatment option, we spoke with people with hip and/or knee osteoarthritis.

RESULTS

Ten studies met our inclusion criteria for the clinical evidence review. Compared with usual care, a structured education and neuromuscular exercise program showed statistically significant short-term improvements in pain (GRADE low) and physical function (GRADE moderate), as well as statistically significant long-term improvements in performing activities of daily living (GRADE moderate) and in quality of life (GRADE moderate). The short-term improvements in pain and physical function appeared to be sustained into the medium term. Compared with patient education, a structured education and neuromuscular exercise program showed statistically significant short-term improvements in pain (GRADE low) and physical function (GRADE low) and sustained long-term improvement in physical function.Our primary economic evaluation showed that, compared with usual care, a group-based structured education and neuromuscular exercise program consisting of two educational sessions and 24 exercise sessions for the management of knee osteoarthritis was associated with an incremental cost of $719 (95% confidence interval [CI]: $410-$1,118) and an incremental quality-adjusted survival of 0.03 quality-adjusted life-years (QALYs) (95% CI: -0.006 to 0.06), resulting in an incremental cost-effectiveness ratio (ICER) of $23,967 per QALY gained. The budget impact of publicly funding a group-based structured education and neuromuscular exercise program consisting of two educational sessions and 24 exercise sessions would range from $21.4 million to $91.6 million per year over the next 5 years. The budget impact of publicly funding a program consisting of two educational sessions and 12 exercise sessions would range from $12.4 million to $53.2 million per year over the next 5 years.People with hip and/or knee osteoarthritis with whom we spoke reported on the negative impact of osteoarthritis on their physical functioning and quality of life. Those with experience of a structured education and neuromuscular exercise program reported favourably on the program, stating they felt that participation in the program had strengthened their muscles and reduced the negative impact of their symptoms. The cost of such programs was reported as a barrier to access.

CONCLUSIONS

There is moderate-quality evidence that, compared with usual care, a structured education and neuromuscular exercise program improves physical function, quality of life, and the ability to perform activities of daily living. There is low-quality evidence that, compared with usual care, this type of program improves pain. Low-quality evidence suggests that, compared with patient education, a structured education and neuromuscular exercise program improves pain and physical function.A group-based structured education and neuromuscular exercise program may be cost-effective for the nonsurgical management of knee osteoarthritis. Publicly funding a group-based structured education and neuromuscular exercise program for hip and/or knee osteoarthritis in Ontario would lead to additional costs to the health system of $21.4 million to $91.6 million per year over the next 5 years. If the program could be delivered with a smaller number of 12 exercise sessions, the budget impact would be reduced to between $12.4 million and $53.2 million over the next 5 years.Structured education and neuromuscular exercise programs are perceived favourably by people with hip and/or knee osteoarthritis. However, the cost of such programs may be a barrier to access.

Association between the aspartic acid D-repeat polymorphisms and osteoarthritis susceptibility: An updated systematic review and meta-analyses

OBJECTIVES

Association between the D-repeat of asporin (ASPN) gene and osteoarthritis (OA) was still inconsistent. We performed this meta-analysis to systematically assess the D-repeat polymorphisms in OA susceptibility.

METHODS

Relevant studies were enrolled by searching databases. Odd ratios (ORs) with 95% confidence intervals (95% CIs) were used for evaluating the association between ASPN gene and OA. Heterogeneity was calculated using the Q statistic, and three different subgroup analyses were performed on ethnicity, gender, and OA positions respectively. False discovery rate (FDR) was applied to regulate the multiple comparisons.

RESULTS

Twelve qualified articles involving 5190 OA patients and 5167 healthy controls were included. With D13 polymorphism, Caucasian male patients have low OA susceptibility (P = .008, PFDR = .024, OR [95% CI] = 0.83 [0.73-0.95]). As to D14 polymorphism, all male patients (P = .0004, PFDR = .001, OR [95% CI] = 1.38 [1.15-1.64]), Asian male patients (P = .01, PFDR = .01, OR [95% CI] = 1.72 [1.11-2.66]), and Caucasian male patients (P = .005, PFDR = .001, OR [95% CI] = 1.32 [1.09-1.60]) have high OA susceptibility. In the pooled-population of KOA with D14 polymorphism, overall male patients (P = .03, PFDR = .045, OR [95% CI] = 1.35 [1.02-1.78]) and Asian male patients (P = .01, PFDR = .03, OR [95% CI] = 1.72 [1.11-2.66]) have high OA risk. With D16 polymorphism, Latin America patients may have high OA risk (P = .04, PFDR = .15, OR [95% CI] = 1.43 [1.02-2.01]).

CONCLUSION

Our results suggest that D-repeat of ASPN gene is mainly associated with male patients. The D13 polymorphism plays a protective role for OA in Caucasians male individuals while D14 plays a risk factor for KOA in male patients.

Age trajectories of musculoskeletal morbidities in adults with cerebral palsy

BACKGROUND

Individuals with cerebral palsy (CP) are at an increased risk for age-related morbidities due to functional impairments, maladapted growth, and altered body composition. While musculoskeletal (MSK) deficits are present in children, little is understood about MSK morbidity throughout the lifespan in those with CP. The purpose of this study was to examine the age-related trajectories of MSK morbidity and multimorbidity throughout adulthood in those with CP.

METHODS

A clinic-based sample of adults with CP (n = 1395; ≥18 years) was examined to determine prevalence of MSK morbidities at the University of Michigan Medical Center. Logistic regression was used to determine the effects of age on individual MSK morbidities and multimorbidity (i.e., ≥2 morbidities) after adjusting for sex, race, weight, and smoking.

RESULTS

With the 18-30 year age group as the reference, the adjusted odds of osteopenia was lower in the 41-50 and >50 year age groups, the odds of osteoporosis and rheumatoid arthritis was higher in 41-50 and >50 year age groups, and the odds of osteoarthritis was higher in 31-40, 41-50, and >50 year age groups. The adjusted odds of MSK multimorbidity increased substantially with increasing age for 31-40 year olds (OR: 1.919; 95% CI 1.05-3.52), 41-50 year olds (OR: 4.30; 95% CI 2.40-7.69), and >50 year olds (OR: 6.05; 95% CI 3.56-10.27).

CONCLUSIONS

Adults with CP are at high risk for MSK morbidities across all ages. Future studies are needed to examine the global aging trajectories of MSK health among adults with CP. Study findings highlight the importance of maximizing MSK accretion, and developing programs to assist individuals with CP and their caregivers to maintain MSK mass and function throughout the lifespan.

Resveratrol Supplementation Reduces Pain and Inflammation in Knee Osteoarthritis Patients Treated with Meloxicam: A Randomized Placebo-Controlled Study

Resveratrol, a polyphenolic compound, is a powerful antioxidant with remarkable anti-inflammatory properties. Inflammation and pain plays an important role in the pathogenesis of knee osteoarthritis (OA) and could cause tissue damage and morbidity. The aim of this study was to evaluate the anti-inflammatory and pain reduction activities of orally administered resveratrol in patients with knee OA. We carried out a 90-day pilot study to evaluate the ability of orally administered resveratrol, as an adjuvant with meloxicam, to decrease knee joint pain and biomarkers of inflammation in comparison with a placebo. One hundred ten men and women (45-75 years old) diagnosed with mild to moderate knee OA were treated with 15 mg per day meloxicam and either 500 mg per day resveratrol or placebo for 90 days in a double-blind, randomized control trial. Pain severity was evaluated at the beginning and at the end of treatment using Visual Analogue Scale-100 scores. Fasting blood was collected to determine serum interleukins 1β and 6, tumor necrosis factor-α, C-reactive protein, and complement proteins C3 and C4. The resveratrol-treated group experienced a time-dependent significant decrease in pain severity (P < .001). Serum levels of the biochemical markers were significantly reduced compared with the placebo-treated group (P < .01). These findings suggest that resveratrol may be an effective "add-on" option with meloxicam in the treatment of patients with mild to moderate knee OA.