The global burden of hip and knee osteoarthritis: estimates from the global burden of disease 2010 study

Challenges and controversies of complex interventions in osteoarthritis management: recognizing inappropriate and discordant care

A number of controversies and challenges exist for the management of OA in health care. This paper describes the challenges and gaps in OA care, particularly in relation to population health management, complex interventions and outcomes. It sets this in the context of competing health priorities and multimorbidity, access to high quality conservative care, non-pharmacological therapies, resource limitations and models of care. The overuse of some therapies and neglect of others are discussed, as well as the potential for self-management. The roles of patient and public involvement and the healthcare team are highlighted in enhancing best care for OA and providing solutions for closing the evidence-to-practice gap. Implementation of models of care offer one solution to the challenges and progress of such implementation is described. Areas for further research are highlighted.

Radiographic knee osteoarthritis impacts multiple dimensions of health-related quality of life: data from the Osteoarthritis Initiative

Objectives

To estimate the multi-dimensional health impact of radiographic knee OA and quantify the overall health-related quality of life (HRQoL) burden, using a preference-based health utilities measure.

Methods

Data on self-reported HRQoL, measured using the SF-12 multi-dimensional health state instrument, were obtained for 2895 patients with radiographic knee OA (Kellgren-Lawrence grade of at least 2) from the Osteoarthritis Initiative and for a general population sample of 3202 from the National Health Measurement Study. The SF-12 was converted to the six-dimensional SF-6D classification to compute preference-based health utilities. Generalized ordinal regression and multinomial regression were used to estimate the health loss on each SF-6D dimension for Osteoarthritis Initiative participants with radiographic knee OA relative to the general population, adjusted for differences in age, BMI, sex, ethnicity and educational level. Predicted SF-6D profiles were then used to compute the average HRQoL loss attributable to radiographic knee OA.

Results

Radiographic knee OA was associated with substantial health losses on all dimensions of the SF-6D except for social functioning. Health losses increased with the radiographic severity of OA in dimensions related to physical health, while there was no relationship between worse radiographic disease and worse self-assessed health in mental and emotional dimensions of health. Overall, radiographic knee OA was associated with a HRQoL detriment of 0.040-0.044 at Kellgren-Lawrence grade 2, increasing to 0.045-0.050 at grade 3 and 0.073-0.081 at grade 4.

Conclusion

Radiographic knee OA is significantly associated with worse HRQoL across most dimensions of health.

EULAR recommendations for the health professional's approach to pain management in inflammatory arthritis and osteoarthritis

Pain is the predominant symptom for people with inflammatory arthritis (IA) and osteoarthritis (OA) mandating the development of evidence-based recommendations for the health professional's approach to pain management. A multidisciplinary task force including professionals and patient representatives conducted a systematic literature review of systematic reviews to evaluate evidence regarding effects on pain of multiple treatment modalities. Overarching principles and recommendations regarding assessment and pain treatment were specified on the basis of reviewed evidence and expert opinion. From 2914 review studies initially identified, 186 met inclusion criteria. The task force emphasised the importance for the health professional to adopt a patient-centred framework within a biopsychosocial perspective, to have sufficient knowledge of IA and OA pathogenesis, and to be able to differentiate localised and generalised pain. Treatment is guided by scientific evidence and the assessment of patient needs, preferences and priorities; pain characteristics; previous and ongoing pain treatments; inflammation and joint damage; and psychological and other pain-related factors. Pain treatment options typically include education complemented by physical activity and exercise, orthotics, psychological and social interventions, sleep hygiene education, weight management, pharmacological and joint-specific treatment options, or interdisciplinary pain management. Effects on pain were most uniformly positive for physical activity and exercise interventions, and for psychological interventions. Effects on pain for educational interventions, orthotics, weight management and multidisciplinary treatment were shown for particular disease groups. Underpinned by available systematic reviews and meta-analyses, these recommendations enable health professionals to provide knowledgeable pain-management support for people with IA and OA.

Osteoarthritis and stem cell therapy in humans: a systematic review

OBJECTIVE

Osteoarthritis (OA) is a leading cause of disability in the world. Mesenchymal stem cells (MSCs) have been studied to treat OA. This review was performed to systematically assess the quality of literature and compare the procedural specifics surrounding MSC therapy for osteoarthritis.

DESIGN

PubMed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials were searched for studies using MSCs for OA treatment (final search December 2017). Outcomes of interest included study evidence level, patient demographics, MSC protocol, treatment results and adverse events. Level I and II evidence articles were further analyzed.

RESULTS

Sixty-one of 3,172 articles were identified. These studies treated 2,390 patients with osteoarthritis. Most used adipose-derived stem cells (ADSCs) (n = 29) or bone marrow-derived stem cells (BMSCs) (n = 30) though the preparation varied within group. 57% of the sixty-one studies were level IV evidence, leaving five level I and nine level II studies containing 288 patients to be further analyzed. Eight studies used BMSCs, five ADSCs and one peripheral blood stem cells (PBSCs). The risk of bias in these studies showed five level I studies at low risk with seven level II at moderate and two at high risk.

CONCLUSION

While studies support the notion that MSC therapy has a positive effect on OA patients, there is limited high quality evidence and long-term follow-up. The present study summarizes the specifics of high level evidence studies and identifies a lack of consistency, including a diversity of MSC preparations, and thus a lack of reproducibility amongst these articles' methods.

Can we prevent OA? Epidemiology and public health insights and implications

This narrative review discusses the potential of prevention of OA in different stages of the disease. The theoretical background for primary prevention (i.e. prevention of occurrence of definite structural or clinical OA in subjects free of the disease) and secondary prevention (i.e. prevention of progression of the disease in subjects with pre-clinical pathological changes to the joint) is provided and evidence for effective strategies is discussed. Since direct evidence for the prevention of OA development and progression is scarce, indirect evidence enhancing our current knowledge on the potential of OA prevention is additionally discussed. Also, implications of preventive strategies for study design and public health are considered. Prevention of OA has great potential, but as deliberated in the current review, there are still large gaps in our current knowledge and the implications of preventive strategies for the development and progression of OA require consideration.

Gait patterns, symptoms, and function in patients with isolated tibiofemoral osteoarthritis and combined tibiofemoral and patellofemoral osteoarthritis

The purpose of this study was to compare hip and knee biomechanics during walking in individuals with isolated tibiofemoral osteoarthritis (TFOA), combined TFOA and patellofemoral osteoarthritis (PFOA), and those without knee osteoarthritis (OA), and to compare patient-reported symptoms and function in individuals with isolated TFOA and those with combined TFOA and PFOA. Participants with and without knee OA were assessed and categorized into (i) no OA, (ii) isolated TFOA, and (iii) combined TFOA and PFOA, based on Kellgren and Lawrence diagnostic criteria. Quantitative motion analyses were conducted during walking, and hip and knee kinematics, and external moments were calculated. Peak values in the sagittal and frontal planes during stance phase were computed. Patient-reported symptoms and function data were obtained using the Western Ontario McMaster Universities Arthritis Index. Multivariate analyses of variance were conducted to compare between-group differences in gait and patient-reported symptoms and function data. The results showed no statistically significant differences in hip and knee kinematics and external moments between the three groups. Relative to those with isolated TFOA, individuals with combined TFOA and PFOA had greater pain (mean difference [95%CI]: 1.5 [0.05-3.1]), stiffness (0.8 [0.02-1.5]), and poorer function (5.4 [0.2-10.7]). In conclusion, the combined TFOA and PFOA radiographic disease pattern is associated with worse pain and function compared to the isolated TFOA disease pattern. The results of the present study provide no indications that treatments designed to change walking biomechanics should differ between individuals with isolated TFOA and those with combined TFOA and PFOA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:1666-1672, 2018.

Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis

Synopsis Osteoarthritis (OA) of the hip and knee is among the leading causes of global disability, highlighting the need for early, targeted, and effective treatment. The benefits of exercise therapy in people with hip and knee OA are substantial and supported by high-quality evidence, underlining that it should be part of first-line treatment in clinical practice. Furthermore, unlike other treatments for OA, such as analgesia and surgery, exercise therapy is not associated with risk of serious harm. Helping people with OA become more physically active, along with structured exercise therapy targeting symptoms and impairments, is crucial, considering that the majority of people with hip and knee OA do not meet physical activity recommendations. Osteoarthritis is associated with a range of chronic comorbidities, including type 2 diabetes, cardiovascular disease, and dementia, all of which are associated with chronic low-grade inflammation. Physical activity and exercise therapy not only improve symptoms and impairments of OA, but are also effective in preventing at least 35 chronic conditions and treating at least 26 chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. Patient education may be crucial to ensure long-term adherence and sustained positive effects on symptoms, impairments, physical activity levels, and comorbidities. J Orthop Sports Phys Ther 2018;48(6):439-447. Epub 18 Apr 2018. doi:10.2519/jospt.2018.7877.

Effect of Fucoidan on Anterior Cruciate Ligament Transection and Medial Meniscectomy Induced Osteoarthritis in High-Fat Diet-Induced Obese Rats

Osteoarthritis (OA) has become one of the most common disabilities among elders, especially in females. Obesity and mechanical injuries caused by OA are attributed to joint loading, cartilage disintegration, and bone loss, as well as inflammation. Pharmacological and non-pharmacological treatments can be used for OA. Fucoidan possesses several bioactivities such as antitumor, antiviral, anticoagulation, anti-obesity, and immunomodulation. This study aims to investigate the effect of fucoidan in surgery-induced OA on rats with diet-induced obesity. OA was induced by an anterior cruciate ligament transection and a partial medial meniscectomy (ACLT + MMx). The male SD rats were fed with a high-fat diet (HFD) for 4 weeks to induce obesity before causing ACLT + MMx to induce OA. The OA rats were administered with intragastric water or fucoidan in three different concentrations (32 mg/kg, 64 mg/kg, and 320 mg/kg) after the surgeries for 40 days with an HFD. We observed that the swelling in the knee joint was alleviated and the hind paw weight distribution was rectified after feeding them with fucoidan and that there was no significant effect on the weight gain and feed intake. Fucoidan administration indicated no significant variation on the high-density lipoprotein (HDL)-Cholesterol level, but it did indicate reduced plasma triglycerides and low-density lipoprotein (LDL)-Cholesterol levels. In addition, the weight-bearing tests showed an improvement in the fucoidan-treated group. Our results suggested that fucoidan may improve meniscal/ligamentous injury and obesity-induced OA.

Intra-articular clearance of labeled dextrans from naive and arthritic rat knee joints

OBJECTIVE

Determine the effects of arthritis on the trans-synovial clearance of small and large model compounds following local delivery to the knee joint in a rat model.

DESIGN

Intra-articular delivery was studied in rat knee joints in an osteoarthritis model of joint instability (medial collateral ligament and meniscus transection model or MMT). Fluorescently-labeled 10 kDa or 500 kDa dextran was injected in the arthritic or unoperated control (naive) joints 3 weeks after surgical destabilization, and the temporal clearance pattern was evaluated via in vivo regional fluorescence imaging, dextran concentrations in plasma and draining lymph nodes, and by quantification of fluorescence in histological synovium sections. Together these data were used to evaluate the effect of osteoarthritis and solute size on the rate of drug clearance from the joint.

RESULTS

Clearance of 10 kDa dextran from the joint space quantified using in vivo fluorescence imaging of the knee joint region was not significantly different between naive and MMT joints. In contrast, clearance of 500 kDa dextran was significantly reduced for MMT joints when compared to naive joints by fluorescence in vivo imaging. Drug accumulation in lymph nodes and plasma were lower for the 500 kDa dextran as compared to 10 kDa dextran, and lymph node levels were further reduced with the presence of osteoarthritis. Furthermore, synovium was significantly thicker in MMT joints than in naive joints and image analysis of joint tissue sections revealed different trans-synovial distributions of 10 and 500 kDa dextran.

CONCLUSION

Large macromolecules were retained in the arthritic joint longer than in the healthy joint, while smaller molecules were cleared similarly in healthy and arthritic joints. In vivo fluorescence imaging, plasma and lymph node concentrations, and spatial distributions of drug fluorescence identified differences in higher molecular weight clearance between naive and arthritic disease states. Findings may relate to a thickening of synovium for joints with induced arthritis, and support the concept that intra-articular drug delivery effectiveness may vary with the state of joint pathology.

Oxymatrine exerts protective effects on osteoarthritis via modulating chondrocyte homoeostasis and suppressing osteoclastogenesis

Osteoarthritis (OA) is a common degenerative disease characterized by the progressive destruction both articular cartilage and the subchondral bone. The agents that can effectively suppress chondrocyte degradation and subchondral bone loss are crucial for the prevention and treatment of OA. Oxymatrine (OMT) is a natural compound with anti‐inflammatory and antitumour properties. We found that OMT exhibited a strong inhibitory effect on LPS‐induced chondrocyte inflammation and catabolism. To further support our results, fresh human cartilage explants were treated with LPS to establish an ex vivo degradation model, and the results revealed that OMT inhibited the catabolic events of LPS‐stimulated human cartilage and substantially attenuated the degradation of articular cartilage ex vivo. As subchondral bone remodelling is involved in OA progression, and osteoclasts are a unique cell type in bone resorption, we investigated the effects of OMT on osteoclastogenesis, and the results demonstrated that OMT suppresses RANKL‐induced osteoclastogenesis by suppressing the RANKL‐induced NFATc1 and c‐fos signalling pathway in vitro. Further, we found that the anti‐inflammatory and anti‐osteoclastic effects of oxymatrine are mediated via the inhibition of the NF‐κB and MAPK pathways. In animal studies, OMT suppressed the ACLT‐induced cartilage degradation, and TUNEL assays further confirmed the protective effect of OMT on chondrocyte apoptosis. MicroCT analysis revealed that OMT had an attenuating effect on ACLT‐induced subchondral bone loss in vivo. Taken together, these results show that OMT interferes with the vicious cycle associated with OA and may be a potential therapeutic agent for abnormal subchondral bone loss and cartilage degradation in osteoarthritis.

Initial derivation of diagnostic clusters combining history elements and physical examination tests for symptomatic knee osteoarthritis

INTRODUCTION

The aim of the present study was to assess the validity of clusters combining history elements and physical examination tests to diagnose symptomatic knee osteoarthritis (SOA) compared with other knee disorders.

METHODS

This was a prospective diagnostic accuracy study, in which 279 consecutive patients consulting for a knee complaint were assessed. History elements and standardized physical examination tests were obtained independently by a physiotherapist and compared with an expert physician's composite diagnosis, including clinical examination and imaging. Recursive partitioning was used to develop diagnostic clusters for SOA. Diagnostic accuracy measures were calculated, including sensitivity, specificity, and positive and negative likelihood ratios (LR+/-), with associated 95% confidence intervals (CIs).

RESULTS

A total of 129 patients had a diagnosis of SOA (46.2%). Most cases (76%) had combined tibiofemoral and patellofemoral knee OA and 63% had radiological Kellgren-Lawrence grades of 2 or 3. Different combinations of history elements and physical examination tests were used in clusters accurately to discriminate SOA from other knee disorders. These included age of patients, body mass index, presence of valgus/varus knee misalignment, palpable knee crepitus and limited passive knee extension. Two clusters to rule in SOA reached an LR+ of 13.6 (95% CI 6.5 to 28.4) and three clusters to rule out SOA reached an LR- of 0.11 (95% CI 0.06 to 0.20).

DISCUSSION

Diagnostic clusters combining history elements and physical examination tests were able to support the differential diagnosis of SOA compared with various knee disorders without relying systematically on imaging. This could support primary care clinicians' role in the efficient management of these patients.

Feasibility of Na18F PET/CT and MRI for Noninvasive In Vivo Quantification of Knee Pathophysiological Bone Metabolism in a Canine Model of Post-traumatic Osteoarthritis

Purpose:

To assess and quantify by molecular imaging knee osseous metabolic changes serially in an in vivo canine model of posttraumatic osteoarthritis (PTOA) of the knee utilizing sodium fluoride (Na¹⁸F) positron emission tomography (PET)/computed tomography (CT) coregistered with magnetic resonance imaging (MRI).

Materials and Methods:

Sodium fluoride PET imaging of 5 canines was performed prior to anterior cruciate ligament transection (ACLT) and 2 times post-ACLT (3 and 12 weeks). The PET/CT was coregistered with MRI, enabling serial anatomically guided visual and quantitative three-dimensional (3D) region of interest (ROI) assessment by maximum standardized uptake value.

Results:

Prior to ACLT, every 3D ROI assessed in both knees showed no Na¹⁸F uptake above background. The uptake of Na¹⁸F in the bone of the ACLT knees increased exponentially, presenting significantly higher uptake at 12 weeks in every region compared to the ACLT knees at baseline. Furthermore, the uninjured contralateral limb and the ipsilateral distal bones and joints presented Na¹⁸F uptake at 3 and 12 weeks post-ACLT.

Conclusion:

This study demonstrated that Na¹⁸F PET/CT coregistered with MRI is a feasible molecular imaging biomarker to assess knee osseous metabolic changes serially in an in vivo canine model of knee PTOA. Moreover, it brings a novel musculoskeletal preclinical imaging methodology that can provide unique insights into PTOA pathophysiology.

Inverted Rearfoot posture in subjects with coexisting patellofemoral osteoarthritis in medial knee osteoarthritis: an exploratory study

Background

While abnormal rearfoot posture and its relationship to patellofemoral (PF) pain has been thoroughly discussed in the literature, its relationship to patellofemoral osteoarthritis (PFOA) has not been determined. This study aimed to examine whether rearfoot posture is associated with a higher prevalence of radiographic PFOA in a compartment-specific manner in patients with medial tibiofemoral osteoarthritis (TFOA).

Methods

Participants from orthopedic clinics (n = 68, age 56–90 years, 75.0% female), diagnosed with radiographic medial TFOA (Kellgren/Lawrence [K/L] grade ≥ 2) were included in this study. The presence of PFOA and static rearfoot posture were evaluated using a radiographic skyline view and a footprint automatic measurement apparatus, respectively. The relationship between rearfoot posture and PFOA was examined using analysis of covariance and propensity score-adjusted logistic regression analysis.

Results

On average, patients with coexisting PFOA and medial TFOA (n = 39) had an inverted calcaneus 3.1° greater than those with isolated medial TFOA (n = 29). Increased calcaneus inverted angle was significantly associated with a higher probability of the presence of medial PFOA (odds ratio: 1.180, 95% confidence interval: [1.005, 1.439]; p = 0.043). Calcaneus inverted angle was not associated with higher odds of lateral PFOA presence based on the adjusted values.

Conclusions

The presence of an inverted rearfoot was associated with PFOA. Although these findings do not clearly indicate a biomechanical link between rearfoot posture and PFOA, this study shed light on the potential relationship between altered rearfoot posture and PFOA, as can be seen between rearfoot abnormality and PF pain.

Knee pain and health-related quality of life among older patients with different knee osteoarthritis severity in Saudi Arabia

Objective

There is a lack of knowledge about health-related quality of life (HRQoL) in Saudi patients with musculoskeletal impairment, particularly among older adult populations. Thus, the current research aimed to determine the association of knee osteoarthritis (OA) severity with knee pain (KP) and HRQoL among older patients in Riyadh, Saudi Arabia.

Methods

In a multicenter cross-sectional study, we recruited 209 consecutive males and females aged ≥55 years with radiographically diagnosed knee OA from five hospitals across Riyadh, Saudi Arabia. According to the Kellgren & Lawrence classification, patients were classified into two groups: mild/moderate knee OA (n = 126) and severe knee OA (n = 83). KP and HRQoL were assessed using the pain visual analogue scale (VAS) and the 36-Item Short Form Health Survey (SF-36), respectively. A higher score on the pain VAS and the SF-36 represented worse KP and better HRQoL, respectively.

Results

Severe knee OA was significantly associated with an increased score of 3.47 (p <.0001) points on the pain VAS compared with the score reported by patients with mild/moderate knee OA. Additionally, it was significantly associated with reduced scores of 6.83 and 5.82 (both: p <.0001) points on the physical and mental composite summary subscales of the SF-36, respectively, compared with the scores of patients with mild/moderate knee OA, even after adjusting for all covariates.

Conclusion

Older patients with severe knee OA had significantly worse KP and reduced HRQoL compared to patients with mild/moderate knee conditions, even after controlling for confounders.

Factors associated with pain and osteoarthritis at the hip and knee in Great Britain's Olympians: a cross-sectional study

BACKGROUND

Knowledge of the epidemiology and potentially modifiable factors associated with musculoskeletal disease is an important first step in injury prevention among elite athletes.

AIM

This study investigated the prevalence and factors associated with pain and osteoarthritis (OA) at the hip and knee in Great Britain's (GB) Olympians aged 40 and older.

METHODS

This is a cross-sectional study. A survey was distributed to 2742 GB Olympians living in 30 countries. Of the 714 (26.0%) who responded, 605 were eligible for analysis (ie, aged 40 and older).

RESULTS

The prevalence of hip and knee pain was 22.4% and 26.1%, and of hip and knee OA was 11.1% and 14.2%, respectively. Using a multivariable model, injury was associated with OA at the hip (adjusted OR (aOR) 10.85; 95% CI 3.80 to 30.96) and knee (aOR 4.92; 95% CI 2.58 to 9.38), and pain at the hip (aOR 5.55; 95% CI 1.83 to 16.86) and knee (aOR 2.65; 95% CI 1.57 to 4.46). Widespread pain was associated with pain at the hip (aOR 7.63; 95% CI 1.84 to 31.72) and knee (aOR 4.77; 95% CI 1.58 to 14.41). Older age, obesity, knee malalignment, comorbidities, hypermobility and weight-bearing exercise were associated with hip and knee OA and/or pain.

CONCLUSIONS

This study detected an association between several factors and hip and knee pain/OA in retired GB Olympic athletes. These associations require further substantiation in retired athletes from other National Olympic Committees, and through comparison with the general population. Longitudinal follow-up is needed to investigate the factors associated with the onset and progression of OA/pain, and to determine if modulation of such factors can reduce the prevalence of pain and OA in this population.

Is high-intensity interval cycling feasible and more beneficial than continuous cycling for knee osteoarthritic patients? Results of a randomised control feasibility trial

Background

Knee osteoarthritis (OA) patients often suffer joint pain and stiffness, which contributes to negative changes in body composition, strength, physical performance (function), physical activity and health-related quality of life. To reduce these symptoms and side effects of knee OA, moderate-intensity continuous training (MICT) cycling is often recommended. While resistance training is considered the optimal form of training to improve sarcopenic outcomes, it imposes higher joint loads and requires supervision, either initially or continuously by trained exercise professionals. Therefore, this pilot study sought to gain some insight into the feasibility and potential benefits of high-intensity interval training (HIIT) cycling as an alternative exercise option to MICT cycling for individuals with knee OA.

Methods

Twenty-seven middle-aged and older adults with knee OA were randomly allocated to either MICT or HIIT, with both programs involving four unsupervised home-based cycling sessions (∼25 min per session) each week for eight weeks. Feasibility was assessed by enrolment rate, withdrawal rate, exercise adherence and number of adverse effects. Efficacy was assessed by health-related quality of life (Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and Lequesne index), physical function (Timed Up and Go (TUG), Sit to Stand (STS) and preferred gait speed) and body composition (body mass, BMI, body fat percentage and muscle mass).

Results

Twenty-seven of the interested 50 potential participants (54%) enrolled in the study, with 17 of the 27 participants completing the trial (withdrawal rate of 37%); with the primary withdrawal reasons being unrelated injuries or illness or family related issues. Of the 17 participants who completed the trial, exercise adherence was very high (HIIT 94%; MICT 88%). While only three individuals (one in the MICT and two in the HIIT group) reported adverse events, a total of 28 adverse events were reported, with 24 of these attributed to one HIIT participant. Pre–post-test analyses indicated both groups significantly improved their WOMAC scores, with the HIIT group also significantly improving in the TUG and STS. The only significant between-group difference was observed in the TUG, whereby the HIIT group improved significantly more than the MICT group. No significant changes were observed in the Lequesne index, gait speed or body composition for either group.

Discussion

An unsupervised home-based HIIT cycle program appears somewhat feasible for middle-aged and older adults with knee OA and may produce similar improvements in health-related quality of life but greater improvements in physical function than MICT. These results need to be confirmed in larger randomised controlled trials to better elucidate the potential for HIIT to improve outcomes for those with knee OA. Additional research needs to identify and modify the potential barriers affecting the initiation and adherence to home-based HIIT cycling exercise programs by individuals with knee OA.

Differential contributions of peripheral and central mechanisms to pain in a rodent model of osteoarthritis

The mechanisms underlying the transition from acute nociceptive pain to centrally maintained chronic pain are not clear. We have studied the contributions of the peripheral and central nervous systems during the development of osteoarthritis (OA) pain. Male Sprague-Dawley rats received unilateral intra-articular injections of monosodium iodoacetate (MIA 1 mg) or saline, and weight-bearing (WB) asymmetry and distal allodynia measured. Subgroups of rats received intra-articular injections of, QX-314 (membrane impermeable local anaesthetic) + capsaicin, QX-314, capsaicin or vehicle on days 7, 14 or 28 post-MIA and WB and PWT remeasured. On days 7&14 post-MIA, but not day 28, QX-314 + capsaicin signficantly attenuated changes in WB induced by MIA, illustrating a crucial role for TRPV1 expressing nociceptors in early OA pain. The role of top-down control of spinal excitability was investigated. The mu-opioid receptor agonist DAMGO was microinjected into the rostroventral medulla, to activate endogenous pain modulatory systems, in MIA and control rats and reflex excitability measured using electromyography. DAMGO (3 ng) had a significantly larger inhibitory effect in MIA treated rats than in controls. These data show distinct temporal contribtuions of TRPV1 expressing nociceptors and opioidergic pain control systems at later timepoints.

Quercetin attenuates mitochondrial dysfunction and biogenesis via upregulated AMPK/SIRT1 signaling pathway in OA rats

Despite the severity of osteoarthritis (OA), current medical therapy strategies for OA aim at symptom control and pain reduction, as there is no ideal drug for effective OA treatment. OA rat model was used to explore the therapeutic function of quercetin on remission of OA, by determining the reactive oxygen species (ROS) levels, mitochondrial function and extracellular matrix integrity. Quercetin could attenuate ROS generation and augment the glutathione (GSH) and glutathione peroxidase (GPx) expression levels in OA rat. Quercetin not only enhanced mitochondrial membrane potential, oxygen consumption, adenosine triphosphate (ATP) levels in mitochondria, but also increased the mitochondrial copy number. Furthermore, the interlukin (IL)-1β-induced accumulation of nitric oxide (NO), matrixmetalloproteinase (MMP)-3) and MMP-13 could be suppressed by quercetin. Finally, we confirmed that the therapeutic properties of quercetin on OA might function through the adenosine monophosphate-activated protein kinase/sirtuin 1 (AMPK/SIRT1) signaling pathway. In summary, quercetin could alleviate OA through attenuating the ROS levels, reversing the mitochondrial dysfunction and keeping the integrality of extracellular matrix of joint cartilage. The underlying mechanism might involve the regulation of AMPK/SIRT1 signaling pathway.

"Knee osteoarthritis and current research for evidence-are we on the right way?"

PURPOSE

An estimated 85% of research is of limited value or wasted because the wrong research questions are addressed. We sought to identify research gaps using American Academy of Orthopaedic Surgeon (AAOS) clinical practice guidelines Treatment of Osteoarthritis of the Knee and Surgical Management of Osteoarthritis of the Knee. Using these recommendations, we conducted searches of ClinicalTrials.gov to discover the extent to which new and ongoing research addresses areas of deficiency.

METHODS

For each recommendation in the AAOS guidelines, we created participants, intervention, comparator, outcomes questions, and search strings using a systematic process. Searches were then conducted of ClinicalTrials.gov to locate relevant studies.

RESULTS

Our searches of ClinicalTrials.gov returned 945 studies for surgical and 1416 for non-surgical management of osteoarthritis. Of the 945 studies returned using our search string for surgical trials, 186 (20%) were relevant to 30 (79%) of the 38 recommendations made within the surgical management guideline. Of the 1416 studies returned using our search for non-surgical trials, 360 (25%) were relevant to 16 (89%) of the 18 recommendations made within the conservative management guideline.

CONCLUSIONS

The development of clinical practice guidelines is a unique opportunity to simultaneously redefine day-to-day decision-making and provide a critical analysis of the status of the literature. Upon our search of the literature since the guidelines introduction, we have found that some inconclusive areas have received more attention than others. Our results should guide researchers towards conducting research on the topics most in need and, by doing so, strengthen the clinical practice guideline recommendations.

Minimum Performance on Clinical Tests of Physical Function to Predict Walking 6,000 Steps/Day in Knee Osteoarthritis: An Observational Study

OBJECTIVE

Evidence of physical function difficulties, such as difficulty rising from a chair, may limit daily walking for people with knee osteoarthritis (OA). The purpose of this study was to identify minimum performance thresholds on clinical tests of physical function predictive to walking ≥6,000 steps/day. This benchmark is known to discriminate people with knee OA who develop functional limitation over time from those who do not.

METHODS

Using data from the Osteoarthritis Initiative, we quantified daily walking as average steps/day from an accelerometer (Actigraph GT1M) worn for ≥10 hours/day over 1 week. Physical function was quantified using 3 performance-based clinical tests: 5 times sit-to-stand test, walking speed (tested over 20 meters), and 400-meter walk test. To identify minimum performance thresholds for daily walking, we calculated physical function values corresponding to high specificity (80-95%) to predict walking ≥6,000 steps/day.

RESULTS

Among 1,925 participants (mean ± SD age 65.1 ± 9.1 years, mean ± SD body mass index 28.4 ± 4.8 kg/m² , and 55% female) with valid accelerometer data, 54.9% walked ≥6,000 steps/day. High specificity thresholds of physical function for walking ≥6,000 steps/day ranged 11.4-14.0 seconds on the 5 times sit-to-stand test, 1.13-1.26 meters/second for walking speed, or 315-349 seconds on the 400-meter walk test.

CONCLUSION

Not meeting these minimum performance thresholds on clinical tests of physical function may indicate inadequate physical ability to walk ≥6,000 steps/day for people with knee OA. Rehabilitation may be indicated to address underlying impairments limiting physical function.

How does exercise dose affect patients with long-term osteoarthritis of the knee? A study protocol of a randomised controlled trial in Sweden and Norway: the SWENOR Study

INTRODUCTION

Osteoarthritis (OA) of the knee is characterised by knee pain, disability and degenerative changes, and places a burden on societies all over the world. Exercise therapy is an often-used modality, but there is little evidence of what type of exercise dose is the most effective, indicating a need for controlled studies of the effect of different dosages. Thus, the aim of the study described in this protocol is to evaluate the effects of high-dose versus low-dose medical exercise therapy (MET) in patients with knee OA.

METHODS AND ANALYSIS

This is a multicentre prospective randomised two-arm trial with blinded assessment and data analysis. We are planning to include 200 patients aged 45-85 years with symptomatic (pain and decreased functioning) and X-ray verified diagnosis of knee OA. Those eligible for participation will be randomly allocated to either high-dose (n=100) or low-dose (n=100) MET. All patients receive three supervised treatments each week for 12 weeks, giving a total of 36 MET sessions. The high-dose group exercises for 70-90 min compared with 20-30 min for the low-dose group. The high-dose group exercises for a longer time, and receives a greater number of exercises with more repetitions and sets. Background and outcome variables are recorded at inclusion, and outcome measures are collected after every sixth treatment, at the end of treatment, and at 6-month and 12-month follow-ups. Primary outcome is self-rated knee functioning and pain using the Knee Injury and Osteoarthritis Outcome Score (KOOS). The primary end point is at the end of treatment after 3 months, and secondary end points are at 6 months and 12 months after the end of treatment.

ETHICS AND DISSEMINATION

This project has been approved by the Regional Research Ethics Committees in Stockholm, Sweden, and in Norway. Our results will be submitted to peer-reviewed journals and presented at national and international conferences.

TRIAL REGISTRATION NUMBER

NCT02024126; Pre-results.

Multicomponent Exercise Improves Physical Functioning but Not Cognition and Hemodynamic Parameters in Elderly Osteoarthritis Patients Regardless of Hypertension

The present study aimed to investigate the impact of a 6-month multicomponent exercise program (MCEP) on physical function, cognition, and hemodynamic parameters of elderly normotensive (NTS) and hypertensive (HTS) osteoarthritis patients. A total of 99 elderly osteoarthritis patients (44 NTS and 55 HTS) were recruited and submitted to functional, cognitive, and hemodynamic evaluations before and after six months of a MCEP. The program of exercise was performed twice a week at moderate intensity. The physical exercises aggregated functional and walking exercises. Results indicate that 6 months of MCEP were able to improve one-leg stand and mobility (walking speeds) of osteoarthritis patients regardless of hypertension. On the other hand, cognitive and hemodynamic parameters were not altered after the MCEP. The findings of the present study demonstrate that 6 months of MCEP were able to improve the physical functioning (i.e., usual and maximal walking speed and balance) of osteoarthritis patients regardless of hypertensive condition.

Running does not increase symptoms or structural progression in people with knee osteoarthritis: data from the osteoarthritis initiative

Higher levels of moderate to vigorous physical activity improve all-cause mortality and cardiovascular events. However, the effect of running, a moderate to vigorous activity, in those with knee osteoarthritis (OA), a common arthritis that occurs with aging, a high-risk group for mortality and cardiovascular events, is unclear. Therefore, we aimed to evaluate the association of self-selected running on OA symptom and structure progression in people with knee OA. This nested cohort study within the Osteoarthritis Initiative (OAI) (2004-2014) included those at least 50 years old with OA in at least one knee. Runners were defined using a self-administered questionnaire at the 96-month visit. At baseline and 48-months, symptoms were assessed and radiographs were scored for Kellgren-Lawrence (KL) grade (2-4) and medial Joint Space Narrowing (JSN) score (0-3). We evaluated the association of self-selected running with outcomes: KL worsening, medial JSN worsening, new knee pain, and improved knee pain over 48 months, adjusting for baseline age, sex, body mass index (BMI), KL score, contralateral KL score, contralateral knee pain, and injury. If data were not available at the 48-month visit, then they were imputed from the 36-month visit. One thousand two hundred three participants had a mean age of 63.2 (7.9) years, BMI of 29.5 (4.6) kg/m², 45.3% male, and 11.5% runners. Data from 8% of participants required imputation. Adjusted odds ratios for KL grade worsening and new frequent knee pain were 0.9 (0.6-1.3) and 0.9 (0.6-1.6) respectively. Adjusted odds ratio for frequent knee pain resolution was 1.7 (1.0-2.8). Among individuals 50 years old and older with knee OA, self-selected running is associated with improved knee pain and not with worsening knee pain or radiographically defined structural progression. Therefore, self-selected running, which is likely influenced by knee symptoms and may result in lower intensity and shorter duration sessions of exercise, need not be discouraged in people with knee OA.

A device for high-throughput monitoring of degradation in soft tissue samples

This work describes the design and validation of a novel device, the High-Throughput Degradation Monitoring Device (HDD), for monitoring the degradation of 24 soft tissue samples over incubation periods of several days inside a cell culture incubator. The device quantifies sample degradation by monitoring its deformation induced by a static gravity load. Initial instrument design and experimental protocol development focused on quantifying cartilage degeneration. Characterization of measurement errors, caused mainly by thermal transients and by translating the instrument sensor, demonstrated that HDD can quantify sample degradation with <6 μm precision and <10 μm temperature-induced errors. HDD capabilities were evaluated in a pilot study that monitored the degradation of fresh ex vivo human cartilage samples by collagenase solutions over three days. HDD could robustly resolve the effects of collagenase concentration as small as 0.5 mg/ml. Careful sample preparation resulted in measurements that did not suffer from donor-to-donor variation (coefficient of variance <70%). Due to its unique combination of sample throughput, measurement precision, temporal sampling and experimental versality, HDD provides a novel biomechanics-based experimental platform for quantifying the effects of proteins (cytokines, growth factors, enzymes, antibodies) or small molecules on the degradation of soft tissues or tissue engineering constructs. Thereby, HDD can complement established tools and in vitro models in important applications including drug screening and biomaterial development.

Quality of Life in Symptomatic Individuals After Anterior Cruciate Ligament Reconstruction, With and Without Radiographic Knee Osteoarthritis

Study Design Clinical measurement, cross-sectional. Background Individuals who have undergone anterior cruciate ligament (ACL) reconstruction commonly experience long-term impairments in quality of life (QoL), which may be related to persistent knee symptoms or radiographic osteoarthritis (ROA). Understanding the impact of knee symptoms and ROA on QoL after ACL reconstruction may assist in the development of appropriate management strategies. Objectives To (1) compare QoL between groups of individuals after ACL reconstruction (including those who are symptomatic with ROA, symptomatic without ROA, and asymptomatic [unknown ROA status]), and (2) identify specific aspects of QoL impairment in symptomatic individuals with and without ROA post ACL reconstruction. Methods One hundred thirteen participants completed QoL measures (Knee injury and Osteoarthritis Outcome Score QoL subscale [KOOS-QoL], Anterior Cruciate Ligament Quality of Life [ACL-QoL], Assessment of Quality of Life-8 Dimensions [AQoL-8D]) 5 to 20 years after ACL reconstruction. Eighty-one symptomatic individuals underwent radiographs, and 32 asymptomatic individuals formed a comparison group. Radiographic osteoarthritis was defined as a Kellgren-Lawrence grade of 2 or greater for the tibiofemoral and/or patellofemoral joints. Mann-Whitney U tests compared outcomes between groups. Individual ACL-QoL items were used to explore specific aspects of QoL. Results In symptomatic individuals after ACL reconstruction, ROA was related to worse knee-related outcomes on the KOOS-QoL (median, 50; interquartile range [IQR], 38-69 versus median, 69; IQR, 56-81; P<.001) and the ACL-QoL (median, 51; IQR, 38-71 versus median, 66; IQR, 50-82; P = .04). The AQoL-8D scores showed that health-related QoL was impaired in both symptomatic groups compared to the asymptomatic group. The ACL-QoL item scores revealed greater limitations and concern surrounding sport and exercise and social/emotional difficulties in the symptomatic group with ROA. Conclusion Osteoarthritis is associated with worse knee-related QoL in symptomatic individuals after ACL reconstruction. Diagnosing ROA in symptomatic individuals after ACL reconstruction may be valuable, because these individuals may require unique management. Targeted strategies to facilitate participation in satisfying activities have potential to improve QoL in symptomatic people with ROA after ACL reconstruction. J Orthop Sports Phys Ther 2018;48(5):398-408. doi:10.2519/jospt.2018.7830.

Current status and future prospects for disease modification in osteoarthritis

OA is a chronic, progressive and disabling joint disease, leading to a poor quality of life and an enormous social and economic burden. Current therapies for OA patients remain limited, which creates an area of huge unmet medical need. For some time, researchers have been looking for approaches that can inhibit the structural progression of OA. A variety of potential disease-modifying OA drugs have been developed, targeting cartilage, inflammatory pathways or subchondral bone. In addition, non-pharmacological therapies, including joint distraction and weight loss, draw increasing attention, with some showing disease-modifying potential. Thus we performed a comprehensive review to discuss the current status of disease-modifying therapies in OA and appraise the potentials of emerging novel agents.

Quality of life assessment in musculo-skeletal health

Musculoskeletal disorders affect morbidity, quality of life and mortality, and represent an increasing economic and societal burden in the context of population aging and increased life expectancy. Improvement of quality of life should be one of the priorities of any interventions to prevent and treat musculoskeletal disorders in the ageing population. Two main approaches, namely generic and disease-specific instruments, can be applied to measure health-related quality of life. Among the generic tools available in scientific literature, the short form 36 questionnaire (SF-36) and the Euroqol five item questionnaire (EQ-5D) are two of the most popular questionnaires used to quantify the health related quality of life in people with musculoskeletal disorders. However, because generic tools may not always be able to detect subtle effects of a specific condition on quality of life, a specific tool is highly valuable. Specific tools improve the ability to clinically characterize quality of life in subjects with a specific musculoskeletal disorder, as well as the capacity to assess changes over time in the QoL of these subjects. The recent development of specific tools should help to validate preventive and therapeutic interventions in this field.

A Placebo-Controlled Double-Blind Study Demonstrates the Clinical Efficacy of a Novel Herbal Formulation for Relieving Joint Discomfort in Human Subjects with Osteoarthritis of Knee

LI73014F2 is a novel composition prepared from extracts of Terminalia chebula fruit, Curcuma longa rhizome, and Boswellia serrata gum resin with synergistic benefit in 5-Lipoxygenase (5-LOX) inhibition. This herbal composition with strong anti-5-LOX activity exhibited significant pain relief as indicated through improvements in weight-bearing capacity in a monosodium iodoacetate-induced osteoarthritis (OA) model of Sprague-Dawley rats. A 90-day randomized, placebo-controlled double-blind study evaluates the clinical efficacy and tolerability of LI73014F2 in the management of symptoms of OA of the knee (Clinical Trial Registration No. CTRI/2014/01/004338). Subjects, (n = 105), were randomized into three groups: placebo (n = 35), 200 mg/day of LI73014F2 (n = 35), and 400 mg/day of LI73014F2 (n = 35). All study participants were evaluated for pain and physical function by using standard tools, that is, Visual Analog Scale, Lequesne's Functional Index, and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at the baseline (day 0) and on day 14 ± 3, 30 ± 3, 60 ± 3, and at the end of the study (day 90 ± 3). In addition, routine examinations on biochemical parameters in serum, urine, and hematological parameters were conducted on each visit to assess the safety of the study material. At the end of the trial period, LI73014F2 conferred significant pain relief, improved physical function, and quality of life in OA patients. In conclusion, preclinical and clinical data together strongly suggest that the herbal formulation LI73014F2 is a safe and effective intervention for management of joint discomfort, demonstrating efficacy as early as 14 days.

JNK pathway in osteoarthritis: pathological and therapeutic aspects

CONTEXT

Osteoarthritis (OA) is a common chronic degenerative joint disease resulting in physical disability and reduced quality of life. Different biochemical signaling pathways are involved in the progression of OA, including the c-Jun NH2-terminal kinase (JNK) signal transduction pathway.

OBJECTIVE

In this study, we have reviewed the recent updates on the association of JNK pathway with OA.

METHODS

In this review, we have explored the databases like PubMed, Google Scholar, Medline, Scopus, etc., and collected the most relevant papers of JNK signaling pathway involved in the pathogenesis and therapeutics of OA Results: JNK has been shown by scientific studies to be activated (phosphorylated) in OA that can play a key role in the cartilage destruction. Activation of JNK causes the phosphorylation of c-Jun that causes decreased proteoglycan synthesis and enhanced production of matrix metalloproteinase 13 (MMP-13). Overproduction of MMP-13 by chondrocytes plays a central role in cartilage degeneration in OA. Thus, targeting JNK pathway might be a promising therapeutic application for the prevention and treatment of OA. A number of JNK-inhibitors have been used in vitro and in vivo studies; however, not yet been translated into human use.

CONCLUSIONS

This review study indicates that JNK pathway plays an important role in development and progression of OA, and targeting the JNK pathway might be a potential approach for the treatment of OA in future.

miR‑486‑5p is upregulated in osteoarthritis and inhibits chondrocyte proliferation and migration by suppressing SMAD2

Osteoarthritis (OA) is the most common form of arthritis and is caused by the breakdown of joint cartilage. The present study aimed to investigate an effective method for the treatment of OA. It was demonstrated that, compared with other patients, patients with OA exhibited lower mRNA expression levels of SMAD family member 2 (SMAD2). MicroRNA (miR)‑486‑5p was predicted to bind with SMAD2, which was verified by dual‑luciferase reporter assay. Compared withcontrol patients who had no known history of OA or rheumatoid arthritis, patients with OA exhibited higher miR‑486‑5p expression level. Treatment with miR‑486‑5p mimics inhibited proliferation and migration of CHON‑001 human chondrocytes, and also inhibited the expression levels of type II collagen and aggrecan. However, treatment with a miR‑486‑5p inhibitor promoted proliferation and migration, and the expression of type II collagen and aggrecan. Short interfering RNA‑directed silencing of SMAD2 reversed the upregulated proliferation and migration and the expression level of type II collagen and aggrecan induced by the miR‑486‑5p inhibitor. In conclusion, the results of the present study indicated that miR‑486‑5p was upregulated in OA and may inhibit chondrocyte proliferation and migration by suppressing SMAD2.

Long non-protein coding RNA DANCR functions as a competing endogenous RNA to regulate osteoarthritis progression via miR-577/SphK2 axis

Long noncoding RNAs (lncRNAs) have been known to be involved in multiple diverse diseases, including osteoarthritis (OA). This study aimed to explore the role of differentiation antagonizing non-protein coding RNA (DANCR) in OA and identify the potential molecular mechanisms. The expression of DANCR in cartilage samples from patients with OA was detected using quantitative reverse transcription-polymerase chain reaction. The effects of DANCR on the viability of OA chondrocytes and apoptosis were explored using cell counting kit 8 assay and flow cytometry assay, respectively. Additionally, the interaction among DANCR, miR-577, and SphK2 was explored using dual-luciferase reporter and RIP assays. The present study found that DANCR was significantly upregulated in patients with OA. Functional assays demonstrated that DANCR inhibition suppressed the proliferation of OA chondrocytes and induced cell apoptosis. The study also showed that DANCR acted as a competitive endogenous RNA to sponge miR-577, which targeted the mRNA of SphK2 to regulate the survival of OA chondrocytes. In conclusion, the study revealed that lncRNA DANCR might promote the proliferation of OA chondrocytes and reduce apoptosis through the miR-577/SphK2 axis. Thus, lncRNA DANCR might be considered as a potential therapeutic target for OA treatment.

Sinew acupuncture for knee osteoarthritis: study protocol for a randomized sham-controlled trial

Background

Sinew acupuncture is a new modality of acupuncture in which needles are inserted into acupoints, ashi points or spasm points of sinew and muscles along the meridian sinew pathway. A previous observational study revealed that sinew acupuncture has immediate analgesic effects on various soft tissue injuries, including knee injuries. However, no rigorous trials have been conducted. This study aims to examine whether sinew acupuncture can safely relieve pain and symptoms of knee osteoarthritis (KOA) and improve patients’ functional movement and quality of life.

Methods/design

A randomized, sham-controlled, patient- and assessor-blinded trial will be conducted to compare the efficacy of sinew acupuncture and sham acupuncture. Subjects will be assessed by the physician and acupuncturists. A sample of eighty-six eligible subjects will be randomized into either the sinew acupuncture group or the sham acupuncture group. The intervention will be performed in the Hong Kong Tuberculosis Association Chinese Medicine Clinic cum Training Centre of the University of Hong Kong by acupuncturists with over 3 years of acupuncture experience. Subjects will receive 10 sessions of interventions for 4 weeks, followed by a 6-week follow-up. The visual analogue scale (VAS) score at week 4 will be the primary outcome. The Western Ontario and McMasters University Osteoarthritis Index (WOMAC), Timed Up & Go Test (TUG), 8-step Stair Climb Test (SCT) and the 36-Item Short Form Survey (SF-36) will be secondary outcomes.

Discussion

Sinew acupuncture is a potential alternative non-pharmacological therapy for KOA. This rigorous trial will expand our knowledge of whether sinew acupuncture reduces pain intensity and improves symptoms, functional movements, and quality of life of KOA patients.

Trial registration

The study was registered at ClinicalTrials.gov (Identifier: NCT03099317) in March 2017.

Patient trajectories and their impact on mobility, social participation and quality of life in patients with vertigo/dizziness/balance disorders and osteoarthritis (MobilE-TRA): study protocol of an observational, practice-based cohort study

INTRODUCTION

Mobility limitations have a multitude of different negative consequences on elderly patients including decreasing opportunities for social participation, increasing the risk for morbidity and mortality. However, current healthcare has several shortcomings regarding mobility sustainment of older adults, namely a narrow focus on the underlying pathology, fragmentation of care across services and health professions and deficiencies in personalising care based on patients' needs and experiences. A tailored healthcare strategy targeted at mobility of older adults is still missing.

OBJECTIVE

The objective is to develop multiprofessional care pathways targeted at mobility sustainment and social participation in patients with vertigo/dizziness/balance disorders (VDB) and osteoarthritis (OA) .

METHODS

Data regarding quality of life, mobility limitation, pain, stiffness and physical function is collected in a longitudinal observational study between 2017 and 2019. General practitioners (GPs) recruit their patients with VDB or OA. Patients who visited their GP in the last quarter will be identified in the practice software based on VDB and OA-related International Classification of Diseases 10th Revision. Study material will be sent from the practice to patients by mail. Six months and 12 months after baseline, all patients will receive a mail directly from the study team containing the follow-up questionnaire. GPs fill out questionnaires regarding patient diagnostics, therapy and referrals.

ETHICS AND DISSEMINATION

The study was approved by the ethical committee of the Ludwig-Maximilians-Universität München and of the Technische Universität Dresden. Results will be published in scientific, peer-reviewed journals and at national and international conferences. Results will be disseminated via newsletters, the project website and a regional conference for representatives of local and national authorities.

Association between the Great China Famine exposure in early life and risk of arthritis in adulthood

BACKGROUND

The association between famine exposure in early life and risk of arthritis (combination of osteoarthritis and inflammatory arthritis) in adulthood is unclear. The aim of this study is to explore the association.

METHODS

A total of 4124 subjects were selected from the national data of the China Health and Retirement Longitudinal Study in 2011-2012. Doctor-diagnosed arthritis was self-reported in participants' questionnaire. Birthdates were used to categorise participants into famine-exposed and non-exposed groups. Logistic regression model was used to explore the association of famine exposure in early life with the risk of arthritis in adulthood.

RESULTS

The prevalence of arthritis in both infant-exposed and preschool-exposed groups was significantly higher than those in the non-exposed group (35.0% and 30.6% vs 27.3%; p<0.05). Compared with the non-exposed group, the infant-exposed group showed a significantly elevated risk of arthritis in adulthood after adjusting for confounding factors (OR=1.65; 95% CI 1.29 to 2.11; p<0.001). In the stratified analysis, we found that participants who lived in severely affected areas (OR=1.91; 95% CI 1.41 to 2.59; p<0.001), who are female (OR=2.21; 95% CI 1.57 to 3.11; p<0.001) and those with a body mass index ≥24.0 kg/m² (OR=2.46; 95% CI 1.70 to 3.55; p<0.001) in the infant-exposed group had increased risk of arthritis in adulthood. Similar results were additionally observed when age-balanced control group was used.

CONCLUSION

Great China Famine exposure in infancy may be associated with an elevated risk of arthritis in adulthood, particularly in women and participants with adiposity. These findings suggest nutrition intervention in infancy and weight control in later life may reduce the risk of arthritis in adulthood.

Anti-osteoarthritic effects of ChondroT in a rat model of collagenase-induced osteoarthritis

Background

Previously, we reported that ChondorT showed significant anti-arthritis and anti-inflammatory effects. ChondroT, a new herbal medication, consists of the water extracts of Osterici Radix, Lonicerae Folium, Angelicae Gigantis Radix, Clematidis Radix, and Phellodendri Cortex (6:4:4:4:3). The objective of this study was to investigate the effects of ChondroT in collagenase-induced osteoarthritis rat model.

Methods

Osteoarthritis was induced by the injection of collagenase into the right knee joint cavity of rats. The samples were divided into seven groups [intact (n = 6), control (n = 6), indomethacin (n = 6), Joins tab (n = 6), ChondroT50 (n = 6), ChondroT100 (n = 6), and ChondroT200 (n = 6)]. The control group was administered normal saline, indomethacin group was administered indomethacin (2 mg/kg), and Joins tab group was administered Joins Tab (20 mg/kg). The ChondroT50, ChondroT100, and ChondroT200 groups were administered 50, 100, and 200 mg/kg of ChondroT, respectively. All oral administrations were initiated 7 days after the induction of arthritis and were continued for a total of 12 days. At the end of the experiment, serum aminotransferase, albumin, blood urea nitrogen, creatinine, leukocyte, and inflammatory cytokines [tumor necrosis factor (TNF)-α, interleukin (IL)-1β, and IL-6] were analyzed. Hematoxylin and eosin (H&E) and safranin O-fast green staining of the articular structures of the knee joint were performed.

Results

TNF-α and IL-1β decreased in the ChondroT100 and ChondroT200 groups compared with those in the control group. IL-6 and aspartate aminotransferase decreased in the ChondroT50, ChondroT100, and ChondroT200 groups compared with that in the control group. Albumin, WBC and lymphocytes decreased in the ChondroT100 and ChondroT200 groups compared with those in the control group. In H&E stain, synoviocytes, cartilage lacunae, and chondrocytes were well preserved in the ChondroT100 and ChondroT200 groups, and safranin O-fast staining showed a clear reaction of proteoglycans in the ChondroT100 and ChondroT200 groups.

Conclusions

Based on these results, it can be proposed that ChondroT has anti-osteoarthritic effects on collagenase-induced rat model.

Implementation of telemedicine for knee osteoarthritis: study protocol for a randomized controlled trial

BACKGROUND

Osteoarthritis (OA) is the most prevalent chronic joint disease, characterized by joint structural deterioration, pain and loss of function among the elders. It is also associated with several extra-articular symptoms (fatigue, sleep disorders, anxiety and depression) and a reduction of life quality. Studies have revealed that patients with OA benefitted from enhanced management via telemedicine. Guangdong Online Hospital (GOH) is the first officially recognized web-based hospital that provides telemedicine service in China. However, the effective implementation of GOH telemedicine (GOHT) to enhance management for patients with OA remains unknown.

METHODS/DESIGN

An assessor-blinded, parallel randomized controlled trial will be performed to study the feasibility and effectiveness of GOHT in the enhanced management of OA. Forty participants with knee OA will be recruited for a 6-month study. Patients meeting the inclusion criteria will be randomly allocated to receive conventional therapy (CT) or conventional therapy plus a brief GOH-based intervention (CT-GOHT). The primary outcome is the feasibility of a full-scale randomized controlled trial. The secondary outcomes include the self-reported total score of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Multidimensional Fatigue Inventory (MFI), the Pittsburgh Sleep Quality Index (PSQI) and the Hospital Anxiety and Depression Scale (HADS). Assessments will be performed at baseline, 2 weeks, 3 months and 6 months later after the initiation of the study.

DISCUSSION

This trial is intended to test the application of GOHT in the chronic management in knee OA. The hypothesis is that OA patients may receive disease management via this network platform conveniently and effectively, especially those in the remote areas of our country. GOHT telemedicine would be an attractive alternative to traditional methods for disease management in knee OA. The results could provide preliminary experiences and guidance for an upcoming full-scale randomized controlled trial (RCT) in disease management via telemedicine.

TRIAL REGISTRATION

ChiCTR: ChiCTR1800014465 . Registered on 16 January 2018.

Views of general practitioners toward physiotherapy management of osteoarthritis-a qualitative study

Background: Osteoarthritis (OA) is a major cause of pain and physical disability, and general practitioners (GPs) are usually the first point of contact for patients. Physiotherapy has been shown as effective in the management of lower-limb OA. The aim was to explore the beliefs of GPs on the physiotherapy management of lower-limb OA in primary care. Methods: This is a qualitative study evaluating GP views about physiotherapy in Sheffield, South Yorkshire, UK. Participating GPs were recruited by systematic sampling, and invitation was given to GPs in 10 practices in the four localities in Sheffield. Semistructured interviews were completed and framework analysis was used to analyze the data. Results: Eight GPs were interviewed and six themes emerged from analysis of the data: perspective on OA, management strategy, views on patients, views on physiotherapy, working collaboratively, and suggestions for service improvements. GPs had a positive impression and knowledge of physiotherapy, but lacked understanding of the processes involved in treatment and limited awareness of clinical guidelines regarding the management of OA. Improvements in communication and collaborative working were critical issues suggested by the participants. Conclusion: This study found that GPs who were interviewed had a limited understanding on the role of physiotherapists and of clinical guidelines. Interprofessional communication was not as good as it should have been. A reconfiguration of the Sheffield musculoskeletal pathway may help achieve more effective collaborative working and a better outcome for patients.

Finite element evaluation of the newest ISO testing standard for polyethylene total knee replacement liners

Current treatment for end-stage osteoarthritis is total knee replacement. Given that the number of total knee replacement surgeries is expected to approach 3.48 million by 2030, understanding long-term failure is important. One of the preclinical tests for total knee replacements is carried out using mechanical wear testing under generic walking conditions. Used for this purpose is the International Standards Organization's generic walking profile. Recently this standard was updated by reversing the direction of anterior/posterior translation and internal/external rotation. The effects of this change have not been investigated, and therefore, it is unknown if comparisons between wear tests utilizing the old and new version of the standard are valid. In this study, we used a finite element model along with a frictional energy-based wear model to compare the kinematic inputs, contact conditions, and wear from the older and newer versions of the ISO standard. Simulator-tested components were used to validate the computational model. We found that there were no visible similarities in the contact conditions between the old and new versions of the standard. The new version of the standard had a lower wear rate but covered a larger portion of the articular surface. Locations of wear also varied considerably. The results of the study suggest that major differences between the old and new standard exist, and therefore, historical wear results should be compared with caution to newly obtained results.

Projected Burden of Osteoarthritis and Rheumatoid Arthritis in Australia: A Population-Level Analysis

OBJECTIVE

To forecast the prevalence and direct health care costs of osteoarthritis (OA) and rheumatoid arthritis (RA) in Australia to the year 2030.

METHODS

An epidemiologic model of the Australian population was developed. Data on the national prevalence of OA and RA were obtained from the Australian Bureau of Statistics (ABS) 2014-2015 National Health Survey. Future prevalence was estimated using ABS population projections for 2020, 2025, and 2030. Available government data on direct health care expenditure for OA and RA were modeled to forecast costs (in Australian $) for the years 2020, 2025, and 2030, from the perspective of the Australian public health care system.

RESULTS

The number of people with OA is expected to increase nationally from almost 2.2 million in 2015 to almost 3.1 million Australians in 2030. The number of people with RA is projected to increase from 422,309 in 2015 to 579,915 in 2030. Health care costs for OA were estimated to be over $2.1 billion in 2015; by the year 2030, these are forecast to exceed $2.9 billion ($970 for every person with the condition). Health care costs for RA were estimated to be over $550 million in 2015, including $273 million spent on biologic disease-modifying antirheumatic drugs. Health care costs for RA are projected to rise to over $755 million by the year 2030.

CONCLUSION

OA and RA are costly conditions that will impose an increasing health care burden at the population level. These projections provide tangible data that can be used to map future health service provision to expected need.

A 6-week hip muscle strengthening and lumbopelvic-hip core stabilization program to improve pain, function, and quality of life in persons with patellofemoral osteoarthritis: a feasibility pilot study

Background

Patellofemoral joint (PFJ) osteoarthritis (OA) is prevalent in middle-aged and older adults. Despite this, there are minimal studies which have examined conservative interventions for PFJ OA. Weakness of proximal lower extremity muscles is associated with PFJ OA. It is unknown if a hip muscle strengthening and lumbopelvic-hip core stabilization program will improve symptoms and function in persons with PFJ OA. This study examined the feasibility and impact of a 6-week hip muscle strengthening and core stabilization program on pain, symptoms, physical performance, peak muscle torques, and quality of life in persons with PFJ OA.

Methods

Ten females with PFJ OA and ten age- and sex-matched controls participated in baseline tests. PFJ OA participants attended ten twice-a-week hip strengthening and core stabilization exercise sessions. Outcome measures included questionnaires, the Timed-Up-and-Go, and peak isometric torque of hip and quadriceps muscles. Data were tested for normality; parametric and non-parametric tests were used as appropriate.

Results

At baseline, the PFJ OA group had significantly worse symptoms, slower Timed-Up-and-Go performance, and lower muscle torques than control participants. PFJ OA group adherence to supervised exercise sessions was adequate. All PFJ OA participants attended at least nine exercise sessions. Five PFJ OA participants returned 6-month follow-up questionnaires, which was considered fair retention. The PFJ OA participants' self-reported pain, symptoms, function in daily living, function in sport, and quality of life all improved at 6 weeks (P < 0.05). Timed-Up-and-Go time score improved at 6 weeks (P = 0.005). Peak hip external rotator torque increased (P = 0.01). Improvements in pain and self-reported function were no longer significant 6 months following completion of the intervention.

Conclusions

PFJ OA participants were adherent to the supervised sessions of the intervention. Improvement in symptoms, physical performance, and muscle torque were found after 6 weeks. Participant retention at 6 months was fair, and significant changes were no longer present. Our findings suggest that a hip strengthening and core stabilization program may be beneficial to improve symptoms, function, and physical performance in persons with PFJ OA. Future studies are needed, and additional measures should be taken to improve long-term adherence to exercise.

Trial registration

ClinicalTrials.gov NCT02825238. Registered 6 July 2016 (retrospectively registered).

Profile of osteoarthritic patients undergoing hip or knee arthroplasty, a step toward a definition of the "need for surgery"

AIMS

The objective of this study is to characterize, based on clinical, radiographic, health-related, quality-of-life-related, and demographic variables, the profile of a large, homogeneous, cohort of patients undergoing knee or hip arthroplasty, in a public hospital. Current regulatory guidelines for structure-modifying agent are not clear regarding hard clinical endpoint. The "need for surgery" has been suggested as a potential relevant outcome, but, until now, it is poorly defined. By characterizing a large number of patients who undergo total hip or total knee replacement, this paper aims at providing a contribution to the better definition of the "need for surgery" in advanced OA of the lower limbs.

METHODS

Consecutive patients who underwent primary knee arthroplasty (KA) or hip arthroplasty (HA) between December 2008 and February 2013, in an academic hospital, and who were diagnosed with hip or knee osteoarthritis (OA) (ACR criteria). Data collected at baseline included demographic and clinical data; Kellgren-Lawrence radiological grading; Western Ontario and Mc Master Universities Arthritis Index (WOMAC); EuroQol five dimensions questionnaire and EuroQol visual analog scale; and 36-item Short Form Health Survey.

RESULTS

626 subjects were included, 346 with hip OA and 280 with knee OA. Significant differences between subjects in need of an HA or of a KA were seen in terms of age (66.5 years versus 65 for hip), duration of complaints (2188 days versus 1146.5 for hip), BMI (28.68 kg/m² versus 27.07), radiological status (severe OA were found in 79.85% in knee group and 68.73% in hip group), comorbidities (FCI higher in knee group), traumatic of surgical history (37 versus 6%), and health-related quality of life and function (patients with HA had a poorer clinical status regarding WOMAC and WOMAC subscale).

CONCLUSION

Significant differences were observed between patients undergoing KA or HA. These differences might be useful to better understand the "need for surgery" status in these indications. This concept may help to define responders and failures to pharmacological treatment of OA.

Development and validation of a new population-based simulation model of osteoarthritis in New Zealand

OBJECTIVE

To describe the construction and preliminary validation of a new population-based microsimulation model developed to analyse the health and economic burden and cost-effectiveness of treatments for knee osteoarthritis (OA) in New Zealand (NZ).

METHOD

We developed the New Zealand Management of Osteoarthritis (NZ-MOA) model, a discrete-time state-transition microsimulation model of the natural history of radiographic knee OA. In this article, we report on the model structure, derivation of input data, validation of baseline model parameters against external data sources, and validation of model outputs by comparison of the predicted population health loss with previous estimates.

RESULTS

The NZ-MOA model simulates both the structural progression of radiographic knee OA and the stochastic development of multiple disease symptoms. Input parameters were sourced from NZ population-based data where possible, and from international sources where NZ-specific data were not available. The predicted distributions of structural OA severity and health utility detriments associated with OA were externally validated against other sources of evidence, and uncertainty resulting from key input parameters was quantified. The resulting lifetime and current population health-loss burden was consistent with estimates of previous studies.

CONCLUSION

The new NZ-MOA model provides reliable estimates of the health loss associated with knee OA in the NZ population. The model structure is suitable for analysis of the effects of a range of potential treatments, and will be used in future work to evaluate the cost-effectiveness of recommended interventions within the NZ healthcare system.

High and rising burden of hip and knee osteoarthritis in the Nordic region, 1990-2015

Background and purpose - Osteoarthritis (OA) imposes a substantial burden on individuals and societies. We report on the burden of knee and hip OA in the Nordic region. Patients and methods - We used the findings from the 2015 Global Burden of Diseases Study to explore prevalence, years lived with disability (YLDs), and disability-adjusted life-years (DALYs) of OA in the 6 Nordic countries during 1990-2015 (population of about 27 million in 2015). Results - During 1990-2015, the number of prevalent OA cases increased by 43% to 1,507,587 (95% uncertainty interval [UI] 1,454,338-1,564,778) in the region. OA accounted for 1.3% (UI 1.0-1.7) of YLDs in 1990, increasing to 1.6% (UI 1.2-2.0) in 2015. Of 315 causes studied, OA was the 15th leading cause of YLDs, causing 52,661 (UI 34,056-77,499) YLDs in 2015; of these 23% were attributable to high body mass index. The highest relative importance of OA was reported for women aged 65-74 years (8th leading cause of YLDs in 2015). Among the top 30 leading causes of YLDs in the region, OA had the 5th greatest relative increase in total YLDs during 1990-2015. From 1990 to 2015, increase in age-standardized YLDs from OA in the region was slightly lower than increase at the global level (7.5% vs. 10.5%). OA was, however, responsible for a higher proportional burden of DALYs in the region compared with the global level. Interpretation - The OA burden is high and rising in the Nordic region. With population growth, aging, and the obesity epidemic, a substantial rise in the burden of OA is expected and should be addressed in health policies.

The Top 50 most-cited articles on Total Ankle Arthroplasty: A bibliometric analysis

Total Ankle Arthroplasty (TAA) is a relatively new and evolving field in Foot and Ankle surgery. We conducted a citation analysis to identify the characteristics of the top 50 most cited articles on total ankle arthroplasty. Using the Web of Science database and the search strategy total ankle arthroplasty OR total ankle replacement, we identified 2445 articles. After filtering for relevant articles, the top 50 cited articles on total ankle arthroplasty were retrieved for descriptive and statistical analysis. The publication years ranged from 1979 to 2013. USA was the most productive country in terms of research output, followed by the UK. Though citation analysis has its flaws, this is a comprehensive list of the top 50 articles significantly impacting literature on total ankle arthroplasty. Based on our study, we conclude that there is marked deficiency of high level articles with respect to the number of citations and future researches need to cater to this question to produce high quality studies.

Immediate preoperative outcomes of pain neuroscience education for patients undergoing total knee arthroplasty: A case series

BACKGROUND

Standard preoperative education for total knee arthroplasty (TKA) has been shown to have no effect on postoperative outcomes. This may be because such education programs fail to educate patients about pain. Pain neuroscience education (PNE) focuses on teaching people more about pain from a neurobiological and neurophysiological perspective.

DESIGN AND SETTING

Case Series.

AIM

To determine the immediate effects, if any, of providing PNE before TKA surgery on patient self-report measures.

PARTICIPANTS

Twelve patients (female = 10) prior to TKA for knee osteoarthritis (OA).

INTERVENTION

Preoperative educational session by a physical therapist on the neuroscience of pain, accompanied by an evidence-based booklet.

MAIN OUTCOME MEASURES

Comparison of pre- and post-PNE self-report measures on knee pain (NPRS), Pain Catastrophization Scale (PCS), fear of movement (TSK), and beliefs about TKA; as well as three physical performance measures - knee flexion active range of motion, 40 m self-paced walk, and pressure pain threshold (PPT).

RESULTS

Immediately following the PNE, patients had statistically significant lower TSK scores, increased PPT, and improved beliefs about their upcoming surgery. There were no significant changes in knee pain, function, or flexion active range of motion.

CONCLUSIONS

Results appear to suggest that immediately after PNE, patients scheduled for TKA had statistically significant changes in fear of movement, decreased sensitivity to pain and positive shifts in their beliefs about their future knee surgery. Larger trials with control/comparison groups are warranted to determine the true effects of preoperative PNE for patients about to undergo TKA.

The impact of anxiety and catastrophizing on interleukin-6 responses to acute painful stress

Objective

To examine the influence of anxiety and pain-related catastrophizing on the time course of acute interleukin-6 (IL-6) responses to standardized noxious stimulation among patients with chronic pain.

Methods

Data were collected from 48 participants in the following demographically matched groups: patients with chronic pain (n=36) and healthy controls (n=12). Participants underwent a series of Quantitative Sensory Testing (QST) procedures assessing responses to mechanical and thermal stimuli during two separate visits, in a randomized order. One visit consisted of standard, moderately painful QST procedures, while the other visit involved nonpainful analogs to these testing procedures. Blood samples were taken at baseline, and then for up to 2 hours after QST in order to study the time course of IL-6 responses.

Results

Results of multilevel analyses revealed that IL-6 responses increased across assessment time points in both visits (p<0.001). While patients with chronic pain and healthy controls did not differ in the magnitude of IL-6 responses, psychological factors influenced IL-6 trajectories only in the chronic pain group. Among patients, increases in catastrophizing over the course of the QST session were associated with elevated IL-6 responses only during the painful QST session (p<0.05). When controlling for anxiety, results indicated that the main multilevel model among patients remained significant (p<0.05).

Conclusion

Under specific conditions (eg, application of a painful stressor), catastrophizing may be associated with amplified proinflammatory responses in patients with persistent pain. These findings suggest that psychosocial interventions that reduce negative pain-related cognitions may benefit patients’ inflammatory profiles.

Osteoarthritis-patterns, cardio-metabolic risk factors and risk of all-cause mortality: 20 years follow-up in patients after hip or knee replacement

Osteoarthritis (OA) is a common musculoskeletal disorder and occur in different patterns. However, its impact on long-term all-cause-mortality is inconclusive. Study aims: Investigate 20-year all-cause-mortality in patients with hip/knee arthroplasty (recruited 1995/1996, N = 809) from the Ulm Osteoarthritis Study-cohort, in comparison to general population. Furthermore, to enlighten the triangle between baseline life-style and cardio-metabolic risk factors, phenotypic OA-patterns (laterality, generalization, cause) and all-cause-mortality. Mortality was assessed during 20 years follow-up. Standardized mortality ratios (SMR), adjusted odds ratios and hazard ratios (aHR) were calculated. After five years cohort-mortality was reduced compared to the general population, however 20 years later assimilated (SMR = 1.11; 95%-CI 0.73-1.49). OA-patterns were associated with age, cholesterol, and overweight/obesity. In comparison to primary OA decreased mortality was observed for patients with secondary OA (aHR = 0.76; 95%-CI 0.61-0.95) adjusted for age, smoking, overweight/obesity, diabetes, hypertension, cardiac insufficiency, uric acid, and lower cholesterol. There was no increased mortality in patients after 20 years follow-up compared to general population. Significantly decreased mortality in secondary compared to primary OA suggests a subtype-specific involvement of systemic co-factors in determination of all-cause-mortality. Because cardio-metabolic risk factors were associated with increased risk of bilateral OA and lower long-term survival, those risk factors should be consequently targeted in OA-patients.

Smartphone APPlications in the clinical care and management of Rheumatic Diseases

BACKGROUND

Rheumatic diseases (RDs) are the most common cause of severe long-term pain and physical disability, affecting hundreds of millions of people around the world. Smartphones technology have the potential to become an important tool that rheumatologist can employ in the clinical care management of RD.

METHODS

Research of the published literature on the principle electronic databases available as Ovid MEDLINE, Health Technology Assessment Database, Embase, and PsycINFO was conducted, and the studies evaluated eligible were reviewed.

RESULTS

Our search produced 120 results from which 47 eligible articles were identified reporting studies of smartphone apps for patients with RD. All examined feasibility and five assessed the efficacy of a smartphone intervention for clinical care management.

CONCLUSIONS

It has been demonstrated a strong evidence for the feasibility of using smartphone to enhance care of patients with RD.  Based on the available literature and our personal experiences, we consider useful the development of some mobile phone apps, to simplify and assist the rheumatologist during his clinical practice. Still remains limited data on the efficacy of such interventions.