Epidemiology of osteoarthritis and associated comorbidities

Expanding the ABCC-tool for osteoarthritis: Development and content validation

Objective

Osteoarthritis (OA) care should be more person-centered based on physical, emotional and social aspects, instead of the current stepped-care approach solely based on physical symptoms, according to OA patients. By developing a novel module for OA in the Assessment of Burden of Chronic Condition (ABCC)-tool, a tool based on these three aspects, experienced quality of OA care and shared-decision making are expected to improve.

Design

The development of the novel OA module involved a triangular iterative process, interviewing OA patients and healthcare professionals in the field of OA, an expert panel and a literature search to identify the needs to improve OA care. Patients provided feedback on the first version of the OA module, leading to a second version. This second version was used to evaluate content validity. OA patients and healthcare professionals in the field of OA were asked to evaluate relevance, comprehensiveness and comprehensibility, based on the COSMIN methodology. For healthcare professionals, the item-content validity index (I-CVI) was calculated.

Results

The module includes questions about pain, kinesiophobia and joint stiffness. For all three questions, 94% of the patients found these questions important for patients with OA. The I-CVI scores of the healthcare professionals ranged from 1.0 (pain, kinesiophobia) to 0.75 (joint stiffness).

Conclusion

A novel, condition-specific OA module is developed for the ABCC-tool, as a supplement to the generic questions. The module includes three questions, to measure OA specific complaints. This novel module is intended to make the ABCC-tool more elaborate and useable for a larger population.

Moderate to Severe Osteoarthritis: What is the Economic Burden for Patients and the Health Care System? Insights from the "PONOS" Study

OBJECTIVE

To assess the economic burden of moderate to severe osteoarthritis (OA) management for patients and the health care system in Greece.

DESIGN

A noninterventional, cross-sectional, prospective, epidemiological analysis of data from the medical records of patients with moderate to severe OA, recruited in a single visit from 9 sites in Greece. Outcomes included health care resource use (direct/indirect costs) associated with this patient population.

RESULTS

A total of 164 patients were included in the analysis: mean age was 70.5 years, and the majority of participants were females (78.7%). The presence of comorbidities was reported by 87.2% of patients, with hypertension being the most frequently reported (53.7%). Paracetamol was the most commonly used analgesic treatment (96%), followed by systemic nonsteroidal anti-inflammatory drugs (NSAIDs) (75%) and opioids (50%). The mean overall annual direct costs per patient was estimated at 1,675.3€, with approximately half incurred by the National Health Insurance Fund, whereas the mean overall annual indirect cost (absenteeism of patients and informal caregivers) was estimated at 3,501.4€. Joint replacement (JR) procedures and paid care were the major drivers of annual direct costs in this patient population (4,326.3€ and 9,360.0€, respectively).

CONCLUSIONS

This real-world analysis of direct and indirect costs confirmed the substantial economic burden imposed by moderate to severe OA to the health care system and the patients. Our findings emphasize the need for interventions to enhance disease management, to improve patients' health outcomes and reduce the global burden of OA on society.

Influence of postoperative hypoalbuminemia and human serum albumin supplementation on incision healing following total knee arthroplasty for knee osteoarthritis: a retrospective study

With distinct advantages in clinical application, total knee arthroplasty (TKA) is an effective surgical option for treating end-stage osteoarthritis in the knee. After TKA, incisional problems are one of the major factors influencing the speed in which patients recover. Although it is widely acknowledged that preoperative hypoalbuminemia and the incidence of incisional complications are significantly associated, it is still unclear if postoperative hypoalbuminemia raises the risk of incisional complications following TKA. Furthermore, human serum albumin (HSA) is frequently utilized domestically and internationally to treat postoperative hypoalbuminemia; nevertheless, there is ongoing discussion on whether HSA supplementation can enhance postoperative clinical outcomes. To investigate the relationship between hypoalbuminemia and suboptimal incision healing following TKA, as well as to determine whether HSA supplementation can enhance incision healing after surgery, we collected clinical data for this study. The study sample consisted of 22 patients with poorly healed incisions and 120 cases with normal healing of incisions who underwent TKA treatment for knee osteoarthritis (KOA) in the operator's hospital's Department of Orthopaedics between July 1, 2020, and July 1, 2023. To determine the prevalence of postoperative poor incision healing, data on patients' basic characteristics, preoperative test results, surgical data, postoperative test results, and postoperative incision healing were gathered. The contributing factors to inadequate recovery after surgery were examined using SPSS software. After controlling for confounding variables, a multivariate regression analysis model was used to examine the relationship between postoperative hypoalbuminemia, HSA supplementation, and poor incision healing. 22 cases (15.49%) had poor wound healing following surgery. The findings of multivariate regression analysis after controlling for confounders indicated that there was no correlation between poor wound healing and postoperative albumin level (P > 0.05). Similarly, there was no association (P > 0.05) seen between HSA supplementation and poor incision healing. Following the TKA, postoperative hypoalbuminemia does not raise the risk of incisional problems, and postoperative HSA supplementation neither lowers nor enhances the risk of inadequate incisional healing.

The Implications of Brain-Derived Neurotrophic Factor in the Biological Activities of Platelet-Rich Plasma

Platelet-rich plasma (PRP) is a biological blood-derived therapeutic obtained from whole blood that contains higher levels of platelets. PRP has been primarily used to mitigate joint degeneration and chronic pain in osteoarthritis (OA). This clinical applicability is based mechanistically on the release of several proteins by platelets that can restore joint homeostasis. Platelets are the primary source of brain-derived neurotrophic factor (BDNF) outside the central nervous system. Interestingly, BDNF and PRP share key biological activities with clinical applicability for OA management, such as anti-inflammatory, anti-apoptotic, and antioxidant. However, the role of BDNF in PRP therapeutic activities is still unknown. Thus, this work aimed to investigate the implications of BDNF in therapeutic outcomes provided by PRP therapy in vitro and in-vivo, using the MIA-OA animal model in male Wistar rats. Initially, the PRP was characterized, obtaining a leukocyte-poor-platelet-rich plasma (LP-PRP). Our assays indicated that platelets activated by Calcium release BDNF, and suppression of M1 macrophage polarization induced by LP-PRP depends on BDNF full-length receptor, Tropomyosin Kinase-B (TrkB). OA animals were given LP-PRP intra-articular and showed functional recovery in gait, joint pain, inflammation, and tissue damage caused by MIA. Immunohistochemistry for activating transcriptional factor-3 (ATF-3) on L4/L5 dorsal root ganglia showed the LP-PRP decreased the nerve injury induced by MIA. All these LP-PRP therapeutic activities were reversed in the presence of TrkB receptor antagonist. Our results suggest that the therapeutic effects of LP-PRP in alleviating OA symptoms in rats depend on BDNF/TrkB activity.

Old Before Their Time? The Impact of Osteoarthritis on Younger Adults

OBJECTIVE

Osteoarthritis (OA) is frequently perceived as a disease of the elderly and an inevitable result of aging. Because OA studies often are restricted to older adults, there is limited information on OA in younger adults. This study describes the burden of OA across a wide age range and compares younger and older adults.

METHODS

Descriptive analysis of the Survey on Living with Chronic Diseases in Canada - Arthritis Component, a nationally representative survey of Canadians ≥20 years who reported an arthritis diagnosis in the Canadian Community Health Survey, a general health population survey. Analyses were restricted to those reporting OA and no other kind of arthritis (n = 1,749).

RESULTS

In the representative group with OA, 55.4% were younger than 65 years. The mean age at diagnosis was 50 years, with 30.4% reporting being diagnosed before age 45 years. Younger adults reported similar symptom severity as their older counterparts with OA regarding the mean number of affected joint sites, severity of pain and fatigue, and activity limitations. In the youngest age group, those with OA were significantly more likely to report fair or poor overall and mental health and life dissatisfaction compared with their general counterparts; the same was not the case in the oldest age group.

CONCLUSION

OA is not uncommon among younger and middle-aged adults, and they experience OA impacts comparable with those for older adults. These findings suggest that younger adults with OA will live many years with symptoms and disability and highlight a need for effective OA management across ages.

Demographic, health, physical activity, and workplace factors are associated with lower healthy working life expectancy and life expectancy at age 50

Although retirement ages are rising in the United Kingdom and other countries, the average number of years people in England can expect to spend both healthy and work from age 50 (Healthy Working Life Expectancy; HWLE) is less than the number of years to the State Pension age. This study aimed to estimate HWLE with the presence and absence of selected health, socio-demographic, physical activity, and workplace factors relevant to stakeholders focusing on improving work participation. Data from 11,540 adults in the English Longitudinal Study of Ageing were analysed using a continuous time 3-state multi-state model. Age-adjusted hazard rate ratios (aHRR) were estimated for transitions between health and work states associated with individual and combinations of health, socio-demographic, and workplace factors. HWLE from age 50 was 3.3 years fewer on average for people with pain interference (6.54 years with 95% confidence interval [6.07, 7.01]) compared to those without (9.79 [9.50, 10.08]). Osteoarthritis and mental health problems were associated with 2.2 and 2.9 fewer healthy working years respectively (HWLE for people without osteoarthritis: 9.50 years [9.22, 9.79]; HWLE with osteoarthritis: 7.29 years [6.20, 8.39]; HWLE without mental health problems: 9.76 years [9.48, 10.05]; HWLE with mental health problems: 6.87 years [1.58, 12.15]). Obesity and physical inactivity were associated with 0.9 and 2.0 fewer healthy working years respectively (HWLE without obesity: 9.31 years [9.01, 9.62]; HWLE with obesity: 8.44 years [8.02, 8.86]; HWLE without physical inactivity: 9.62 years [9.32, 9.91]; HWLE with physical inactivity: 7.67 years [7.23, 8.12]). Workers without autonomy at work or with inadequate support at work were expected to lose 1.8 and 1.7 years respectively in work with good health from age 50 (HWLE for workers with autonomy: 9.50 years [9.20, 9.79]; HWLE for workers lacking autonomy: 7.67 years [7.22, 8.12]; HWLE for workers with support: 9.52 years [9.22, 9.82]; HWLE for workers with inadequate support: 7.86 years [7.22, 8.12]). This study identified demographic, health, physical activity, and workplace factors associated with lower HWLE and life expectancy at age 50. Identifying the extent of the impact on healthy working life highlights these factors as targets and the potential to mitigate against premature work exit is encouraging to policy-makers seeking to extend working life as well as people with musculoskeletal and mental health conditions and their employers. The HWLE gaps suggest that interventions are needed to promote the health, wellbeing and work outcomes of subpopulations with long-term health conditions.

Enlarged colony housing promotes linear progression of subchondral bone remodeling in joint instability rat models

Objective: Osteoarthritis (OA) is a disease with high prevalence and an unmet medical need for disease modifying treatments. In rat models, OA-like subchondral bone and cartilage changes can be induced by instability surgery with different severity levels. Factors which determine structural changes additionally comprise the study duration and activity-impacted joint loading. Methods: A medial meniscal tear (MMT) or anterior cruciate ligament transection with partial meniscectomy (ACLT+pMx) was induced unilaterally in rats housed in a rat colony cage (RCC), allowing high activity levels including jumping and stair climbing. In parallel, ACLT+pMx rats were housed in Type IV cages. The time course of OA-related changes was investigated at 4, 8, 12, and 16 weeks after surgery by micro-CT, gait analysis and joint diameter measurements. Results: Gait disturbance was observed after 2 weeks and to a similar extend in all models. The increase in ipsilateral joint diameters peaked after 2 weeks and were more pronounced after ACLT+pMx compared to MMT-surgery, but independent of housing. Micro-CT analysis revealed that increases in osseous tibial width were most distinct after ACLT+pMx in RCC and progressed continuously until week sixteen. In contrast, osseous tibial width of ipsilateral joints in MMT RCC and ACLT+pMx Type IV groups did not increase further after week twelve. In contralateral joints, this parameter was not affected, regardless of the model or caging. However, a significant increase in bone volume fraction and trabecular thickness was observed over time in the femur and tibia of both ipsilateral and contralateral knees. Here, the medial tibial compartment of the operated joint was most affected and linear changes were most pronounced in the ACLT+pMx RCC group. Conclusion: Increased movement of animals in colony cages leads to robust structural changes in subchondral bone after surgically induced joint instability over time, while in regular Type IV housing maximal changes are reached in week twelve. The new insights into the differentiation of the models, particularly with respect to the linear progression of bone changes in ACLT+pMx in the RCC, may be useful for the design of chronic OA-studies within a longer lifespan and therefore supporting the development of novel therapies.

The impact of moderate to severe osteoarthritis on the physical performance and quality of life: a cross-sectional study in Greek patients (PONOS study)

BACKGROUND

Osteoarthritis (OA) represents a leading cause of disability with limited data available for the Greek patients.

OBJECTIVES

To evaluate the impact of moderate to severe symptomatic hip/knee OA under treatment on physical performance and quality of life.

METHODS

A non-interventional, cross-sectional, epidemiological study of patients with moderate/severe OA, recruited in a single visit from 9 expert sites in Athens, Greece. Assessments were based on commonly used outcome scales: the Hip disability and Osteoarthritis Outcome Score (HOOS), the Knee Injury and Osteoarthritis Outcome Score (KOOS) and the EuroQol-5-Dimensions 3-levels questionnaire (EQ-5D-3L).

RESULTS

One hundred sixty-four patients were included in the analysis. Most of the patients were females (78.7%), with a mean age of 70.5 ± 10.2 years. Comorbidities were reported by 87.2% of patients with hypertension being the most frequently reported (53.7%), followed by dyslipidemia (31.1%), obesity (24.4%) and diabetes mellitus (23.2%). Paracetamol was the most common treatment (96%), followed by NSAIDs (75%), opioids (50%) and locally applied medications (42.7%). Both hip and knee OA patients showed substantial deterioration in health-related quality of life (QoL) and health status as reflected by the HOOS/KOOS (Function in sport and recreation was the most impaired subscale, followed by Hip- or Knee-related QoL). The mean EQ-5D-3L index score was 0.396 ± 0.319 and the mean EQ-VAS score was 52.1 ± 1.9. When compared indirectly to the local population norms our OA population had worse QoL indices.

CONCLUSION

Our findings suggest the functional disability and impaired QoL of Greek patients with moderate/severe hip/knee OA under treatment emphasizing the need for novel treatments that will reduce the burden of the disease.

Comparison of postural sway in individuals with and without dynamic knee valgus

BACKGROUND

Dynamic knee valgus (DKV) is a multi-planar faulty movement pattern that can cause faulty postural control. The primary objective of this study is to investigate the differences in postural sway (PS) between individuals aged 18-30 years old diagnosed with and without DKV.

METHODS

In this cross-sectional study, 62 students (39 males and 23 females) with and without DKV (age: 24.58 ± 2.63 years) were selected and assigned to two groups by conducting the single-leg squat test in the screening stage. The Biodex balance system was then employed to compare the two groups in PS. Mann-Whitney U test was conducted to compare the groups in PS (p ≤ 0.05).

RESULTS

The study's findings indicate that individuals with DKV did not exhibit any significant differences, compared to those without, about the anterior-posterior stability index (with p values for both static and dynamic situations at 0.309 and 0.198, respectively), medial-lateral stability index (with p values for both static and dynamic situations at 0.883 and 0.500, respectively), and overall stability index (with p values for both static and dynamic situations at 0.277 and 0.086, respectively).

CONCLUSION

Though several possible factors could contribute to the lack of significant differences in postural sway between individuals with and without DKV, such as measurement tool differences, variable sensitivity in postural stability tests, and differences in movement variability and test stance, we recommend analyzing postural sway in more functional tasks and with different methodological patterns in future studies. Such research could help develop targeted interventions for individuals with DKV and offer a better understanding of the relationship between postural control and DKV.

Biopsychosocial, work-related, and environmental factors affecting work participation in people with Osteoarthritis: a systematic review

PURPOSE

Osteoarthritis (OA) causes pain and disability, with onset often during working age. Joint pain is associated with functional difficulties and may lead to work instability. The aims of this systematic review are to identify: the impact of OA on work participation; and biopsychosocial and work-related factors associated with absenteeism, presenteeism, work transitions, work impairment, work accommodations, and premature work loss.

METHODS

Four databases were searched, including Medline. The Joanna Briggs Institute Critical Appraisal tools were used for quality assessment, with narrative synthesis to pool findings due to heterogeneity of study designs and work outcomes.

RESULTS

Nineteen studies met quality criteria (eight cohort; 11 cross-sectional): nine included OA of any joint(s), five knee-only, four knee and/or hip, and one knee, hip, and hand OA. All were conducted in high income countries. Absenteeism due to OA was low. Presenteeism rates were four times greater than absenteeism. Performing physically intensive work was associated with absenteeism, presenteeism, and premature work loss due to OA. Moderate-to-severe joint pain and pain interference were associated with presenteeism, work transition, and premature work loss. A smaller number of studies found that comorbidities were associated with absenteeism and work transitions. Two studies reported low co-worker support was associated with work transitions and premature work loss.

CONCLUSIONS

Physically intensive work, moderate-to-severe joint pain, co-morbidities, and low co-worker support potentially affects work participation in OA. Further research, using longitudinal study designs and examining the links between OA and biopsychosocial factors e.g., workplace accommodations, is needed to identify targets for interventions.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO 2019 CRD42019133343 .

The Effectiveness of Tuina in Relieving Pain, Negative Emotions, and Disability in Knee Osteoarthritis: A Randomized Controlled Trial

OBJECTIVE

To evaluate the effectiveness of Tuina in relieving the pain, negative emotions, and disability of patients with knee osteoarthritis (KOA).

DESIGN

Single-center, parallel, randomized controlled trial.

SETTING

Shanghai Guanghua Integrated Chinese and Western Medicine Hospital, Shanghai, China.

SUBJECTS

Adult patients with KOA who were able to speak Chinese and self-report symptoms were eligible.

METHODS

A total of 104 patients were randomly allocated to receive the 6-week treatment of Tuina (Tuina group) or celecoxib (celecoxib group). Data on pain, negative emotions, and disability were collected at baseline, at week 2, 4, and 6, and follow-up (1 month after the last treatment). The primary outcomes were the pressure pain thresholds. The secondary outcomes were: (1) numerical rating scale at rest and with movement; (2) Hamilton Anxiety Scale; (3) Hamilton Depression Scale; (4) Western Ontario and McMaster Universities Osteoarthritis Index; and (5) clinical effective rate. The adverse events of the trial were evaluated.

RESULTS

In total, 99 patients completed the follow-up. Generalized linear mixed models were constructed to analyse the between-group differences. Statistically significant differences were found in the interaction effects (P < .05). In evaluating the group effect, statistical differences were found at week 6 and follow-up (P < .05). Further, all variables showed a time effect (P < .05). A statistical difference in the clinical effective rate was found between the Tuina and celecoxib groups (P < .05).

CONCLUSIONS

Tuina produced superior effects for pain, negative emotions, and disability over time, as compared to celecoxib in patients with KOA.

Dynamic knee valgus prevalence in children and its association with pain intensity, foot mobility, and sex- A cross-sectional study

Introduction

Knee pain can impact the performance of activities and sports participation in children. Dynamic knee valgus is a movement pattern commonly related to health conditions that may be associated with sex and foot kinematics in children.

Objective

To assess the prevalence of dynamic knee valgus and its relationship with foot mobility, sex, and knee pain in children.

Method

A cross-sectional observational study was carried out with 144 children (10-18 years old). The pain level was investigated using the Visual Analog Pain Scale and categorized into no pain/minor pain (≤2 cm), moderate pain (3-4,9 cm), and severe pain (≥5.0 cm). Foot mobility was assessed using the adapted navicular drop test and categorized into poor/adequate foot mobility (0.0 cm-0.9 cm) and greater foot mobility (≥1.0 cm). The dynamic knee valgus presence was checked using the step-down test. The association analysis was performed using simple tabulation considering the cluster effect. The Prevalence Ratios and the respective confidence intervals (95%) were estimated from Multiple Poisson Regression with robust variance. A significance level of 5% was adopted.

Results

The dynamic knee valgus prevalence was 26.3% and 26.9% in the right and left lower limbs, respectively. Females presented greater dynamic knee valgus frequency in the left lower limb than males. The dynamic knee valgus presence in males was associated with foot mobility in right (p = 0.001) (Prevalence Ratio: 9.33 Confidence Interval: 2.93-29.72) and left lower limbs (p = 0.003) (Prevalence Ratio: 6.25 Confidence Interval: 1.7-22.62).

Conclusion

Male and female children showed different relationships of the analyzed factors, suggesting that characteristics related to sex may impact the aspects linked to dynamic knee in children.

Exercise-induced modulation of myokine irisin in bone and cartilage tissue—Positive effects on osteoarthritis: A narrative review

Osteoarthritis is a chronic degenerative musculoskeletal disease characterized by pathological changes in joint structures along with the incidence of which increases with age. Exercise is recommended for all clinical treatment guidelines of osteoarthritis, but the exact molecular mechanisms are still unknown. Irisin is a newly discovered myokine released mainly by skeletal muscle in recent years—a biologically active protein capable of being released into the bloodstream as an endocrine factor, the synthesis and secretion of which is specifically induced by exercise-induced muscle contraction. Although the discovery of irisin is relatively recent, its role in affecting bone density and cartilage homeostasis has been reported. Here, we review the production and structural characteristics of irisin and discuss the effects of the different types of exercise involved in the current study on irisin and the role of irisin in anti-aging. In addition, the role of irisin in the regulation of bone mineral density, bone metabolism, and its role in chondrocyte homeostasis and metabolism is reviewed. A series of studies on irisin have provided new insights into the mechanisms of exercise training in improving bone density, resisting cartilage degeneration, and maintaining the overall environmental homeostasis of the joint. These studies further contribute to the understanding of the role of exercise in the fight against osteoarthritis and will provide an important reference and aid in the development of the field of osteoarthritis prevention and treatment.

Cooled and traditional thermal radiofrequency ablation of genicular nerves in patients with chronic knee pain: a comparative outcomes analysis

INTRODUCTION

Genicular nerve radiofrequency ablation (GNRFA) is a minimally invasive intervention for patients with chronic knee pain (CKP) not responding to conservative treatments. Few investigations have compared treatment outcomes of cooled-RFA (c-RFA) and thermal-RFA (t-RFA), two common approaches of GNRFA. This study aims to investigate and compare outcomes, including probability of treatment success, between c-RFA and t-RFA in patients with CKP.

METHODS

This retrospective cohort study analyzed a total of 208 propensity score matched patients, including 104 patients who received c-RFA and 104 patients who received t-RFA. The primary outcome was probability of pain relief after the procedure, defined as reduction in Numeric Rating Scale (NRS) pain score of 2 or greater. The secondary outcomes were degree of NRS pain score reductions, duration of relief, and the probability of patients receiving TKA within 1 year of treatment.

RESULTS

T-RFA was associated with a higher probability of pain relief within 1, 3, and 6 months after procedure when compared with c-RFA. Probabilities of pain relief from t-RFA and c-RFA were 62% (95% CI 51% to 71%) and 43% (95% CI 34% to 53%; p=0.01) within 1 month, 78% (95% CI 68% to 85%) and 55% (95% CI 45% to 64%; p<0.001) within 3 months, and 79% (95% CI 70% to 86%) and 59% (95% CI 49% to 68%; p<0.01) within 6 months, respectively. t-RFA was also associated with greater mean NRS pain score reduction at 1 month after procedure: -4.71 (95% CI -5.3 to -4.1) when compared with -3.59 (95% CI -4.3 to -2.9; p=0.02) from c-RFA. T-RFA and c-RFA were comparable in pain score reduction at 3, 6, 9 and 12 months after procedure. Both groups demonstrated comparable duration of relief and probability of patients receiving TKA within 1 year.

DISCUSSION

Both t-RFA and c-RFA effectively reduced NRS pain scores in most patients with CKP within the 1 year follow-up period. Genicular nerve t-RFA was associated with a higher probability of treatment success and a greater degree of pain relief at 1 month after the procedure when compared with c-RFA in propensity score matched patients with CKP.

Therapeutic effects of statins on osteoarthritis: A review

Osteoarthritis (OA) is a progressive joint disease. The etiology of OA is considered to be multifactorial. Currently, there is no definitive treatment for OA, and the existing treatments are not very effective. Hypercholesterolemia is considered a novel risk factor for the development of OA. Statins act as a competitive inhibitor of the β-hydroxy β-methylglutaryl-CoA (HMG-CoA) reductase and are widely used to manage hypercholesterolemia. Inhibition of HMG-CoA reductase results in reduced synthesis of a metabolite named mevalonate, thereby reducing cholesterol biosynthesis in subsequent steps. By this mechanism, statins such as atorvastatin and simvastatin could potentially have a preventive impact on joint cartilage experiencing osteoarthritic deterioration by reducing serum cholesterol levels. Atorvastatin can protect cartilage degradation following interleukin-1β-stimulation. Atorvastatin stimulates the STAT1-caspase-3 signaling pathway that was shown to be responsible for its anti-inflammatory effects on the knee joint. Simvastatin had chondroprotective effects on OA in vitro by reducing matrix metalloproteinases expression patterns. In this study, we tried to review the therapeutic effects of statins on OA.

Comorbidities and use of analgesics in people with knee pain: a study in the Nottingham Knee Pain and Health in the Community (KPIC) cohort

Objectives

The aims were to examine the prevalence of comorbidities and role of oral analgesic use in people with knee pain (KP) compared with those without.

Methods

The Knee Pain and related health In the Community (KPIC) cohort comprises community-derived adults aged ≥40 years, irrespective of knee pain. Thirty-six comorbidities across 10 systems were compared between people with KP and controls without KP or knee OA. Multivariable logistic regression analysis was used to determine the adjusted odds ratio (aOR) and 95% CI for multimorbidity (at least two chronic conditions) and each specific comorbidity. Both prescribed and over-the-counter analgesics were included in the model, and their interactions with KP for comorbidity outcomes were examined.

Results

Two thousand eight hundred and thirty-two cases with KP and 2518 controls were selected from 9506 baseline participants. The mean age of KP cases was 62.2 years, and 57% were women. Overall, 29% of the total study population had multimorbidity (KP cases 34.4%; controls 23.8%). After adjustment for age, sex, BMI and analgesic use, KP was significantly associated with multimorbidity (aOR 1.35; 95% CI 1.17, 1.56) and with cardiovascular (aOR 1.25; 95% CI 1.08, 1.44), gastrointestinal (aOR 1.34; 95% CI 1.04, 1.92), chronic widespread pain (aOR 1.54; 95% CI 1.29, 1.86) and neurological (aOR 1.32; 95% CI 1.01, 1.76) comorbidities. For multimorbidity, the use of paracetamol and opioids interacted positively with KP, whereas the use of NSAIDs interacted negatively for seven comorbidities.

Conclusion

People with KP are more likely to have other chronic conditions. The long-term benefits and harms of this change remain to be investigated.

Trial registration

ClinicalTrials.gov, http://clinicaltrials.gov, NCT02098070.

The Influence of Athletes' Age in the Onset of Osteoarthritis: A Systematic Review

PURPOSE

Whether sport participation is a risk factor for osteoarthritis (OA) development or progression is controversial. Mechanical overload, injuries, genetics, and acquired disorders concur to the onset of OA, with high variability between sports and participants. This study investigated the association between participation in specific sports and the risk of developing knee and hip OA in athletes at different ages. We hypothesized that young athletes who are exposed to high levels of physical activities have a greater risk of developing OA.

MATERIALS AND METHODS

This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. PubMed, Google scholar, EMABSE, and Web of Science were accessed in October 2021. No time constrains were used for the search. All the published clinical studies reporting data about relationship between physical activity, OA, and age were included.

RESULTS

The Newcastle-Ottawa Scale resulted in a final score ≥7 for all studies, attesting good quality of the methodological assessment. Data from 27,364 patients were retrieved. The mean age was 48.2±16.7 years. In all, 21.8% were women.

CONCLUSIONS

Our systematic review suggests an association between high levels of physical activities and knee and hip OA in men younger than 50 years. People who practice intense physical activity, such as professional athletes or heavy workers, are more prone to develop early-onset OA.

The Role of Mechanically-Activated Ion Channels Piezo1, Piezo2, and TRPV4 in Chondrocyte Mechanotransduction and Mechano-Therapeutics for Osteoarthritis

Mechanical factors play critical roles in the pathogenesis of joint disorders like osteoarthritis (OA), a prevalent progressive degenerative joint disease that causes debilitating pain. Chondrocytes in the cartilage are responsible for extracellular matrix (ECM) turnover, and mechanical stimuli heavily influence cartilage maintenance, degeneration, and regeneration via mechanotransduction of chondrocytes. Thus, understanding the disease-associated mechanotransduction mechanisms can shed light on developing effective therapeutic strategies for OA through targeting mechanotransducers to halt progressive cartilage degeneration. Mechanosensitive Ca2+-permeating channels are robustly expressed in primary articular chondrocytes and trigger force-dependent cartilage remodeling and injury responses. This review discusses the current understanding of the roles of Piezo1, Piezo2, and TRPV4 mechanosensitive ion channels in cartilage health and disease with a highlight on the potential mechanotheraputic strategies to target these channels and prevent cartilage degeneration associated with OA.

Comorbidities in osteoarthritis (ComOA): a combined cross-sectional, case-control and cohort study using large electronic health records in four European countries

INTRODUCTION

Osteoarthritis (OA) is one of the leading chronic conditions in the older population. People with OA are more likely to have one or more other chronic conditions than those without. However, the temporal associations, clusters of the comorbidities, role of analgesics and the causality and variation between populations are yet to be investigated. This paper describes the protocol of a multinational study in four European countries (UK, Netherlands, Sweden and Spain) exploring comorbidities in people with OA.

METHODS AND ANALYSIS

This multinational study will investigate (1) the temporal associations of 61 identified comorbidities with OA, (2) the clusters and trajectories of comorbidities in people with OA, (3) the role of analgesics on incidence of comorbidities in people with OA, (4) the potential biomarkers and causality between OA and the comorbidities, and (5) variations between countries.A combined case-control and cohort study will be conducted to find the temporal association of OA with the comorbidities using the national or regional health databases. Latent class analysis will be performed to identify the clusters at baseline and joint latent class analysis will be used to examine trajectories during the follow-up. A cohort study will be undertaken to evaluate the role of non-steroidal anti-inflammatory drugs (NSAIDs), opioids and paracetamol on the incidence of comorbidities. Mendelian randomisation will be performed to investigate the potential biomarkers for causality between OA and the comorbidities using the UK Biobank and the Rotterdam Study databases. Finally, a meta-analyses will be used to examine the variations and pool the results from different countries.

ETHICS AND DISSEMINATION

Research ethics was obtained according to each database requirement. Results will be disseminated through the FOREUM website, scientific meetings, publications and in partnership with patient organisations.

Physical and financial impacts caused by the COVID-19 pandemic exacerbate knee pain: A longitudinal study of a large-scale general population

OBJECTIVES

This study aimed to evaluate the changes in knee pain, a dominant cause of physical disability, following the coronavirus disease (COVID-19) pandemic, and to identify factors affecting the changes in knee pain.

METHODS

We analysed the pre- and post-COVID-19 longitudinal data set of the Nagahama Study. Knee pain was assessed using the Knee Society Score (KSS). The estimated KSS from the age and sex using regression model in the pre- and post-COVID-19 data set was compared. Factors including the activity score, educational level, and various impacts of COVID-19 were analysed for correlation analyses with changes in KSS.

RESULTS

Data collected from 6409 participants showed statistically significant differences in KSS, pre- (mean = 22.0; SD = 4.4) and post-COVID-19 (mean = 19.5; SD = 6.4). Low activity score (p = .008), low educational level (p < .001), and undesirable financial impact (p = .030) were independently associated with knee pain exacerbation.

CONCLUSION

The harmful effects of the COVID-19 pandemic on knee pain were suggested. People should be encouraged to engage in physical activities, such as walking, despite the state of emergency. Furthermore, social support for economically disadvantaged groups may improve healthcare access, preventing the acute exacerbations of knee pain.

Hip Joint Cartilage Defects in Professional Ballet Dancers: A 5-year Longitudinal Study

OBJECTIVE

A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years.

DESIGN

Longitudinal.

SETTING

Professional ballet company.

PARTICIPANTS

Twenty-one professional ballet dancers (52% men).

INDEPENDENT VARIABLES

Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS-pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI).

MAIN OUTCOME MEASURE

Change in cartilage defect score on MRI between baseline and 5-year follow-up.

RESULTS

Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores <100 at follow-up. There were no time-loss hip injuries over 5 years. Two (33%) dancers with cartilage defects recorded hip-related pain (one reported minor training modification). Femoral neck-shaft angles (NSAs) were lower in men with cartilage defects [129.3 degrees (3.4 degrees)] compared with those without cartilage defects [138.4 degrees (4.5 degrees); P = 0.004].

CONCLUSIONS

Elite level ballet did not negatively affect cartilage health over 5 years. Cartilage defects were related to low femoral NSAs. Most cartilage defects did not progress and there was minimal impact on dance participation and pain levels. Longer follow-up is required to determine the long-term sequelae for those with cartilage defects.

LEVEL OF EVIDENCE

1b.

Identifying hub genes and immune infiltration of osteoarthritis using comprehensive bioinformatics analysis

Background

Osteoarthritis (OA) is the most common chronic degenerative joint disorder globally that is characterized by synovitis, cartilage degeneration, joint space stenosis, and sub-cartilage bone hyperplasia. However, the pathophysiologic mechanisms of OA have not been thoroughly investigated.

Methods

In this study, we conducted various bioinformatics analyses to identify hub biomarkers and immune infiltration in OA. The gene expression profiles of synovial tissues from 29 healthy controls and 36 OA samples were obtained from the gene expression omnibus database to identify differentially expressed genes (DEGs). The CIBERSORT algorithm was used to explore the association between immune infiltration and arthritis.

Results

Eighteen hub DEGs were identified as critical biomarkers for OA. Through gene ontology and pathway enrichment analyses, it was found that these DEGs were primarily involved in PI3K-Akt signaling pathway and Rap1 signaling pathway. Furthermore, immune infiltration analysis revealed differences in immune infiltration between patients with OA and healthy controls. The hub gene ZNF160 was closely related to immune cells, especially mast cell activation in OA.

Conclusion

Overall, this study presented a novel method to identify hub DEGs and their correlation with immune infiltration, which may provide novel insights into the diagnosis and treatment of patients with OA.

Molecular-Morphological Relationships of the Scaffold Protein FKBP51 and Inflammatory Processes in Knee Osteoarthritis

Knee osteoarthritis (OA) is one of the most prevalent chronic conditions affecting the adult population. OA is no longer thought to come from a purely biomechanical origin but rather one that has been increasingly recognized to include a persistent low-grade inflammatory component. Intra-articular corticosteroid injections (IACSI) have become a widely used method for treating pain in patients with OA as an effective symptomatic treatment. However, as the disease progresses, IACSI become ineffective. FKBP51 is a regulatory protein of the glucocorticoid receptor function and have been shown to be dysregulated in several pathological scenario's including chronic inflammation. Despite of these facts, to our knowledge, there are no previous studies of the expression and possible role of FKBP51 in OA. We investigated by double and triple immunofluorescence confocal microscopy the cellular and subcellular expression of FKBP51 and its relations with inflammation factors in osteoarthritic knee joint tissues: specifically, in the tibial plateau knee cartilage, Hoffa's fat pad and suprapatellar synovial tissue of the knee. Our results show co-expression of FKBP51 with TNF-α, IL-6, CD31 and CD34 in OA chondrocytes, synovial membrane cells and adipocytes in Hoffa's fat pad. FKBP51 is also abundant in nerve fibers within the fat pad. Co-expression of FKBP51 protein with these markers may be indicative of its contribution to inflammatory processes and associated chronic pain in OA.

Systematic analysis reveals that colony housing aligns gait profiles and strengthens link between histological and micro-CT bone markers in rat models of osteoarthritis

Osteoarthritis (OA) etiopathogenesis is complex with strong environmental/lifestyle determinants that, in laboratory animals, extend to social context and stress levels. This study seeks to identify whether colony housing of rats exerts a social impact on locomotion behaviors to influence alignment between symptomatic (gait) and structural (bone micro-CT measures, cartilage morphometry, and histology) OA outcome measures. Rats were randomly allocated to conventional (type IV; n = 48) or rat colony cage (RCC; n = 30) housing, further randomized to OA surgical models (ACLT + tMx, MMT or DMM) or no surgery (control), and maintained for 19 weeks during which multiple gait recordings were made. Standard histological grading and bone micro-CT data were collected at necropsy. Principal component analysis was used to summarize the variation in gait, micro-CT or histology. Linear mixed effects model or two-way ANOVA was employed to evaluate the impact of the housing system, surgery and time on gait, or micro-CT and histology components Analyses reveal that RCC exaggerates trends in gait change via a combined effect of the housing system and surgery. Intriguingly, RCC-housed nonoperated control rats showed similar gait changes to rats subjected to surgery; the latter exhibited significant structural joint changes in both systems. Stronger correlation between histological and micro-CT bone changes were found in medial and lateral tibia joint compartments of rats housed in RCC system. This study has established that rat social housing exaggerates outcomes in traditional histological measures of OA, generates stronger links between histology and micro-CT bone changes and removes gait differences as a variable in their etiology.

AMPK Signaling in Energy Control, Cartilage Biology, and Osteoarthritis

The adenosine monophosphate (AMP)-activated protein kinase (AMPK) was initially identified as an enzyme acting as an "energy sensor" in maintaining energy homeostasis via serine/threonine phosphorylation when low cellular adenosine triphosphate (ATP) level was sensed. AMPK participates in catabolic and anabolic processes at the molecular and cellular levels and is involved in appetite-regulating circuit in the hypothalamus. AMPK signaling also modulates energy metabolism in organs such as adipose tissue, brain, muscle, and heart, which are highly dependent on energy consumption via adjusting the AMP/ADP:ATP ratio. In clinics, biguanides and thiazolidinediones are prescribed to patients with metabolic disorders through activating AMPK signaling and inhibiting complex I in the mitochondria, leading to a reduction in mitochondrial respiration and elevated ATP production. The role of AMPK in mediating skeletal development and related diseases remains obscure. In this review, in addition to discuss the emerging advances of AMPK studies in energy control, we will also illustrate current discoveries of AMPK in chondrocyte homeostasis, osteoarthritis (OA) development, and the signaling interaction of AMPK with other pathways, such as mTOR (mechanistic target of rapamycin), Wnt, and NF-κB (nuclear factor κB) under OA condition.

Long non-coding RNA KCNQ1OT1 promotes cell viability and migration as well as inhibiting degradation of CHON-001 cells by regulating miR-126-5p/TRPS1 axis

BACKGROUND

Osteoarthritis (OA) is defined as a degenerative disease. Pivotal roles of long non-coding RNA (lncRNAs) in OA are widely elucidated. Herein, we intend to explore the function and molecular mechanism of lncRNA KCNQ1OT1 in CHON-001 cells.

METHODS

Relative expression of KCNQ1OT1, miR-126-5p and TRPS1 was determined by quantitative real-time polymerase chain reaction (qRT-PCR). Cell viability was examined by MTT assay. The migratory ability of chondrocytes was assessed by transwell assay. Western blot was used to determine relative protein expression of collagen II, MMP13 and TRPS1. Dual-luciferase reporter (DLR) assay was applied to test the target of lncRNA KCNQ1OT1 or miR-126-5p.

RESULTS

Relative expression of KCNQ1OT1 and TRPS1 was reduced, whereas miR-126-5p was augmented in cartilage tissues of post-traumatic OA patients compared to those of subjects without post-traumatic OA. Increased KCNQ1OT1 or decreased miR-126-5p enhanced cell viability and migration, and repressed extracellular matrix (ECM) degradation in CHON-001 cells. MiR-126-5p was the downstream target of KCNQ1OT1, and it could directly target TRPS1. There was an inverse correlation between KCNQ1OT1 and miR-126-5p or between miR-126-5p and TRPS1. Meantime, there was a positive correlation between KCNQ1OT1 and TRPS1. The promoting impacts of KCNQ1OT1 on cell viability and migration as well as the suppressive impact of KCNQ1OT1 on ECM degradation were partially abolished by miR-126-5p overexpression or TRPS1 knockdown in CHON-001 cells.

CONCLUSIONS

Overexpression of KCNQ1OT1 attenuates the development of OA by sponging miR-126-5p to target TRPS1. Our findings may provide a possible therapeutic strategy for human OA in clinic.

Effect of medial foot loading self-practice on lower limb kinematics in young individuals with asymptomatic varus knee alignment

BACKGROUND

Varus alignment of the knee is a risk factor for developing knee osteoarthritis. Recently, voluntary shifting the plantar pressure distribution medially (medial foot loading) during gait has been found to reduce knee adduction angle during stance, which may lower the joint load. However, it is not yet known whether such effect would persist after long-term self-practice. This study aimed to determine whether medial foot loading can be an effective self-care protocol for reducing the knee adduction angle.

METHODS

Eight subjects with asymptomatic varus knee alignment were trained on medial foot loading once in a laboratory, then carried out as self-practice for 8 weeks outside the laboratory. Spatiotemporal gait parameters and lower limb joint kinematics data were collected during natural walking prior to the training (baseline walking), during the practice session immediately after the initial training (trained walking), and during natural walking after the self-practice period (post-practice walking).

RESULTS

Participants walked significantly faster after the self-practice period with longer step length compared with the baseline. The knee adduction angle at initial contact, maximum angle during stance, and mean angle during a gait cycle were significantly decreased during both the trained and post-practice walking compared with baseline. The 8-week self-practice caused larger decrements in the three angles than the single training, but no significant differences were found between the two conditions.

CONCLUSIONS

Self-practice of medial foot loading walking could be an effective gait strategy to reduce the knee adduction angle. The effect could be sustained for individuals with asymptomatic varus knee alignment.

Role of platelet-rich plasma in the treatment of osteoarthritis: a meta-analysis

OBJECTIVE

The clinical efficacy of platelet-rich plasma (PRP) in the treatment of osteoarthritis remains controversial. In this paper, we evaluated the clinical efficacy of PRP in the treatment of osteoarthritis using meta-analysis, providing evidence for the selection of clinical treatment options.

METHODS

We performed a computer-based search of PubMed, Embase, and the Cochrane Library databases to retrieve articles using the search terms "platelet-rich plasma", "osteoarthrosis", and "knee joint". Quality evaluation and data extraction were performed. The combined effect was assessed using RevMan 5.3 software.

RESULTS

Five randomized controlled trials, involving 320 patients, were included in this study. No significant differences were observed in the International Knee Documentation Committee score, visual analog scale (VAS) score, or the absolute value of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score between the experimental and control groups. The absolute value of the VAS score and change in the WOMAC score were significantly decreased and patient satisfaction was increased in the experimental group, as compared with the control group.

CONCLUSION

The findings of this meta-analysis suggest that intra-articular injection of PRP is an effective treatment for osteoarthritis that can reduce post-operative pain, improve locomotor function, and increase patient satisfaction.

Risk Factors for Knee Osteoarthritis in Retired Professional Footballers: A Cross-Sectional Study

OBJECTIVE

To determine risk factors for 3 knee osteoarthritis (KOA) outcomes, knee pain (KP), radiographic KOA (RKOA), and total knee replacement (TKR) in professional footballers.

DESIGN

This was a cross-sectional study involving a postal questionnaire, followed by radiographic assessment in a subcohort of responders.

SETTINGS AND PARTICIPANTS

Four thousand seven hundred seventy-five questionnaires were sent to retired professional footballers, who had played in the English football league, and 1207 responded. Of these, 470 underwent knee radiographs.

ASSESSMENT OF RISK FACTORS

Potential factors include age, body mass index (BMI), knee alignment, a history of football-related knee injury, and training hours (during career) were collected through the questionnaire.

MAIN OUTCOME MEASURES

Knee osteoarthritis outcomes were current KP (pain for most days of the previous month), TKR (self-reported), and RKOA (observed through radiographs).

RESULTS

Football-related injury was the strongest risk factor for KP [adjusted odds ratio (aOR), 4.22; 95% confidence interval (CI), 3.26-5.48], RKOA [aOR, 2.88; 95% CI, 1.81-4.59], and TKR [aOR, 4.83; 95% CI, 2.87-8.13]. Footballers had a 7% increased risk of RKOA for every 1000 hours trained. Although age and gout were associated with all 3 KOA outcomes, BMI, nodal osteoarthritis (OA), a family history of OA, knee malalignment, and 2D:4D ratio were associated with one or another of these 3 KOA outcomes.

CONCLUSION

This study is the first to examine KOA risk factors in retired professional footballers. The study has identified several risk factors, both specific (eg, knee injury and training dose) and nonspecific (eg, age and gout) to footballers. This may be used to develop prevention strategies to reduce the risk of KOA in professional footballers after retirement.

Chondroprotection and Molecular Mechanism of Action of Phytonutraceuticals on Osteoarthritis

Osteoarthritis (OA) is a degenerative joint disease and an important cause of incapacitation. There is a lack of drugs and effective treatments that stop or slow the OA progression. Modern pharmacological treatments, such as analgesics, have analgesic effects but do not affect the course of OA. Long-term use of these drugs can lead to serious side effects. Given the OA nature, it is likely that lifelong treatment will be required to stop or slow its progression. Therefore, there is an urgent need for disease-modifying OA treatments that are also safe for clinical use over long periods. Phytonutraceuticals are herbal products that provide a therapeutic effect, including disease prevention, which not only have favorable safety characteristics but may have an alleviating effect on the OA and its symptoms. An estimated 47% of OA patients use alternative drugs, including phytonutraceuticals. The review studies the efficacy and action mechanism of widely used phytonutraceuticals, analyzes the available experimental and clinical data on the effect of some phytonutraceuticals (phytoflavonoids, polyphenols, and bioflavonoids) on OA, and examines the known molecular effect and the possibility of their use for chondroprotection.

"It's the single best thing I've done in the last 10 years": a qualitative study exploring patient and dietitian experiences with, and perceptions of, a multi-component dietary weight loss program for knee osteoarthritis

OBJECTIVE

Explore patient and dietitian experiences with a multi-component dietary weight loss program for knee osteoarthritis to understand enablers and challenges to success at 6-months.

DESIGN

Qualitative study embedded within a randomised controlled trial. Semi-structured individual interviews with 24 patients with knee osteoarthritis who undertook, and five dietitians who supervised, a weight management program (involving a ketogenic very low calorie diet (VLCD), video consultations, educational resources) over 6 months. Data were thematically analysed.

RESULTS

Five themes were developed: (1) ease and convenience of program facilitated adherence (structure and simplicity of the meal replacements; not feeling hungry on diet; convenience of consulting via video) (2) social and professional support crucial for success (encouragement from partner, family, and friends; guidance from, and accountability to, dietitian; anxiety around going at it alone) (3) program was engaging and motivating (determination to stick to program; rapid weight loss helped motivation) (4) holistic nature of program was important (suite of high-quality educational resources; exercise important to compliment weight loss) (5) rewarding experience and lifelong impact (improved knee pain and function; positive lifestyle change).

CONCLUSIONS

Patients and dietitians described positive experiences with the weight management program, valuing its simplicity, effectiveness, and convenience. Support from dietitians and a comprehensive suite of educational resources, incorporated with an exercise program, were considered crucial for success. Findings suggest this multi-component dietary program is an acceptable weight loss method in people with knee osteoarthritis that may benefit symptoms. Strategies for supporting long-term independent weight management should be a focus of future research.

Meta-analysis Comparing Celecoxib with Diclofenac Sodium in Patients with Knee Osteoarthritis

Objective

To compare the efficacy and safety of celecoxib and diclofenac sodium in patients with knee osteoarthritis (KOA).

Methods

Clinical controlled trials (CCTs) and randomized controlled trials (RCTs) from online databases comparing the efficacy of celecoxib and diclofenac sodium in the treatment of KOA were retrieved. The main outcomes included the treatment effect, C-reactive protein (CRP) level, erythrocyte sedimentation rate (ESR), visual analog scale (VAS) score, and complication rate. The Cochrane risk of bias (ROB) tool in Review Manager 5.3.5 was used to assess methodological quality.

Results

Twelve studies (N = 2,350) were included in this meta-analysis. The meta-analysis indicated that celecoxib reduced pain more effectively than diclofenac sodium in patients with KOA, as evaluated by the VAS score. In addition, celecoxib has certain advantages in terms of better treatment effects and greater reductions in the ESR, CRP level, and complication rate.

Conclusions

Celecoxib is superior to diclofenac sodium in the treatment of KOA. However, well-designed and high-quality RCTs are still needed.

Influence of Comorbidities on Short-term Functional Outcomes after Unilateral Total Knee Arthroplasty

OBJECTIVE

To determine the effect of comorbidities on physical function and quality of life (QoL) of patients at 3-months after total knee arthroplasty (TKA).

DESIGN

Data from 140 patients who underwent a primary unilateral TKA were examined retrospectively. Comorbidities were osteoporosis, presarcopenia, degenerative spine disease, diabetes, and hypertension. All patients completed the following: range of motion (ROM), stair climbing test (SCT), 6-minute walk test (6MWT), timed up-and-go test (TUG), peak torque (PT) of the knee extensor and flexor, instrumental gait analysis, Western Ontario McMaster Universities Osteoarthritis Index (WOMAC) and EuroQoL five dimensions (EQ-5D) questionnaire.

RESULTS

Univariate analyses revealed that osteoporosis led to a significantly longer time to complete the SCT-ascent, SCT-descent, and TUG, and to lower scores for the 6MWT and PT of the knee extensor. Patients with degenerative spine disease showed significant negative scores for knee extension ROM. Diabetes showed a negative correlation with PT of the knee extensor and knee flexion ROM, and a higher WOMAC-stiffness score. Multivariable linear regression analysis showed that WOMAC-stiffness remained independently associated with diabetes. 6MWT, TUG, and SCT-ascent. PT of the knee extensors showed a significant association with osteoporosis.

CONCLUSION

Comorbidities, particularly osteoporosis and diabetes, affect short-term functional outcomes 3 months after TKA.

Osteoarthritis, mobility-related comorbidities and mortality: an overview of meta-analyses

Aims:

The objective of this review was to examine the relationship between osteoarthritis (OA) and mobility-related comorbidities, specifically diabetes mellitus (DM) and cardiovascular disease (CVD). It also investigated the relationship between OA and mortality.

Methods:

An overview of meta-analyses was conducted by performing two targeted searches from inception to June 2020. The association between OA and (i) DM or CVD (via PubMed and Embase); and (ii) mortality (via PubMed) was investigated. Meta-analyses were selected if they included studies that examined adults with OA at any site and reported associations between OA and DM, CVD, or mortality. Evidence was synthesized qualitatively.

Results:

Six meta-analyses met inclusion criteria. One meta-analysis of 20 studies demonstrated a statistically significant association between OA and DM, with pooled odds ratio of 1.41 (95% confidence interval: 1.21, 1.65; n = 1,040,175 patients). One meta-analysis of 15 studies demonstrated significantly increased risk of CVD among OA patients, with a pooled risk ratio of 1.24 (1.12, 1.37, n = 358,944 patients). Stratified by type of CVD, OA was shown to be associated with increased heart failure (HF) and ischemic heart disease (IHD) and reduced transient ischemic attack (TIA). There was no association reported for stroke or myocardial infarction (MI). Three meta-analyses did not find a significant association between OA (any site) and all-cause mortality. However, OA was found to be significantly associated with cardiovascular-related death across two meta-analyses.

Conclusion:

The identified meta-analyses reported significantly increased risk of both DM and CVD (particularly, HF and IHD) among OA patients. It was not possible to confirm consistent directional or causal relationships. OA was found to be associated with increased mortality, but mostly in relation to CVD-related mortality, suggesting that further study is warranted in this area.

Effectiveness of a Program Combining Strengthening, Stretching, and Aerobic Training Exercises in a Standing versus a Sitting Position in Overweight Subjects with Knee Osteoarthritis: A Randomized Controlled Trial

There is an increasing incidence, prevalence, and burden of knee osteoarthritis due to a global increase in obesity and an aging population. The aim of the present study was to compare the effectiveness of the addition of aerobic exercises performed in an unloaded or loaded position to a conventional exercise program in overweight subjects with knee osteoarthritis. Twenty-four subjects were randomly allocated to receive 36 sessions of 30-min duration of either sitting aerobic exercises (experimental group) or standing aerobic exercises (control group). Pain intensity, knee disability, and quality-of-life data were collected at baseline and at 12, 24, and 36 sessions. Generalized linear mixed models (GLMMs) were constructed for the analysis of the differences. Significant differences were found in the experimental group for self-reported pain and knee pain and disability at 24 and 36 sessions (p < 0.05). Significant between-group differences were observed in change in self-reported knee pain and disability and quality of life from baseline to 24th- and 36th-session measurements in favor of the experimental group. Adherence to treatment was higher in the experimental group. Adding aerobic exercises in an unloaded position to a conventional exercise program produced superior effects over time for self-reported knee pain, knee pain and disability and quality of life compared to loaded aerobic exercises in overweight subjects with knee osteoarthritis.

Osteoarthritis in Pseudoxanthoma Elasticum Patients: An Explorative Imaging Study

Pseudoxanthoma elasticum (PXE) is a systemic disease affecting the skin, eyes, and cardiovascular system of patients. Cardiovascular disease is associated with osteoarthritis (OA), which is the most common cause of joint pain. There is a lack of systematic investigations on joint manifestations in PXE in the literature. In this explorative study, we aimed to investigate whether patients with PXE are more at risk for developing osseous signs of OA. Patients with PXE and hospital controls with whole-body low-dose CT examinations available were included. OA was assessed using the OsteoArthritis Computed Tomography (OACT)-score, which is a 4-point Likert scale, in the acromioclavicular (AC), glenohumeral (GH), facet, hip, knee, and ankle joints. Additionally, intervertebral disc degeneration was scored. Data were analyzed using ordinal logistic regression adjusted for age, body mass index (BMI), and smoking status. In total, 106 PXE patients (age 56 (48-64), 42% males, BMI 25.3 (22.7-28.2)) and 87 hospital controls (age 55 (43-67), 46% males, BMI 26.0 (22.5-29.2)) were included. PXE patients were more likely to have a higher OA score for the AC joints (OR 2.00 (1.12-3.61)), tibiofemoral joint (OR 2.63 (1.40-5.07)), and patellofemoral joint (2.22 (1.18-4.24)). For the other joints, the prevalence and severity of OA did not differ significantly. This study suggests that patients with PXE are more likely to have structural OA of the knee and AC joints, which needs clinical confirmation in larger groups and further investigation into the mechanism.

Comparative efficacy and safety of injection therapies for knee osteoarthritis: A protocol for systematic review and Bayesian network meta analysis

INTRODUCTION

There are many injection methods for the treatment of knee osteoarthritis, but there is no comprehensive comparison, based on the fixed effect model.

METHODS

According to the retrieval strategy, we searched randomized controlled trials (RCTs) randomly from PubMed, the Cochrane Library, Embase, the China National Knowledge Infrastructure (CNKI), Wanfang Database from their inceptions to August 2020, and 2 members of us selected literatures and extracted data independently. Methodological quality was assessed by using the Cochrane bias risk tool, and meta-analysis was performed by using the Stat.14.0.

RESULTS

This study will evaluate the effectiveness and safety of different injectable drugs for the treatment of knee osteoarthritis and rank the efficacies of drugs, then to determine the optimal treatment.

CONCLUSION

This study will provide evidence for the choice of injection therapy for knee osteoarthritis.

INPLASY REGISTRATION NUMBER

INPLASY202080099.

Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations

Purpose

To provide evidence-based recommendations for patients with severe knee osteoarthritis (OA), who had their knee surgery postponed due to the COVID-19 pandemic.

Methods

PubMed/Medline, Scopus and Cochrane Central databases were systematically reviewed for studies reporting outcomes of home-based treatments for knee OA. Due to between-study differences in treatment strategy and reporting methods the results were not pooled and findings of the current review were presented in a narrative manner.

Results

The comprehensive literature search yielded 33 eligible studies that were included in this review. Management is performed at home and consists of exercise, proper nutrition, physical therapy and use of corrective and assistive orthotics. Virtual education on self-management strategies should be part of coping with knee OA. Initiating an exercise programme involving gymnastics, stretching, home cycling and muscle strengthening is highly recommended. Obese patients are encouraged to set weight loss goals and adopt a healthy diet. Potential benefits but weak evidence has been shown for the use of knee braces, sleeves, foot orthotics or cushioned footwear. Walking aids may be prescribed, when considered necessary, along with the provision of instructions for their use.

Conclusion

When bridging the time to rescheduled surgery, it is essential to use appropriate home-based tools for the management of knee OA if pain is to be reduced and need for analgesics or opioid use is to be diminished while maintaining or even improving the functioning and avoiding further limitation of range of motion and subsequent muscular atrophies. Finally, none of these treatments may completely substitute for the life-changing effect of a total knee arthroplasty in patients with severe knee OA. Hence, the subsequent goal is to gradually and safely reinstate elective surgery.

Intra-articular injections of allogeneic human adipose-derived mesenchymal progenitor cells in patients with symptomatic bilateral knee osteoarthritis: a Phase I pilot study

Aim: This study investigated the safety and clinical outcomes of expanded allogeneic human adipose-derived mesenchymal progenitor cells injected into patients with symptomatic, bilateral knee osteoarthritis. Design: In this single-site, randomized, double-blind, dose-ranging, Phase I study, patients were randomized to three treatment groups (low dose, 1 × 10⁷ cells; medium dose, 2 × 10⁷ cells; high dose, 5 × 10⁷ cells). All patients received two bilateral intra-articular injections: week 0 (baseline) and week 3. The primary end point was adverse events within 48 weeks. Secondary end points were measured with Western Ontario and McMaster Universities Osteoarthritis index, visual analog scale, short form-36 at weeks 12, 24 and 48. Quantitative MRI measurements of cartilage volume were compared from baseline and week 48. Results: A total of 22 subjects were enrolled of which 19 (86%) completed the study. Adverse events were transient, including mild to moderate pain and swelling of injection site. Improvements from baseline were measured in the secondary end points. MRI assessments showed slight improvements in the low-dose group. Conclusion: Safety and improvements in pain and function after intra-articular injections of allogeneic human adipose-derived mesenchymal progenitor cells into arthritic patients was demonstrated.

Meta-analysis Comparing Platelet-Rich Plasma vs Hyaluronic Acid Injection in Patients with Knee Osteoarthritis

PURPOSE

The purpose of this meta-analysis was to compare platelet-rich plasma (PRP) and hyaluronic acid (HA) in patients with knee osteoarthritis (KOA).

METHODS

Randomized controlled trials (RCTs) comparing the use of PRP and HA in KOA patients were retrieved from each database from the establishment date to April 2018. Outcome measurements were the Western Ontario and McMaster Universities Arthritis Index (WOMAC), visual analog scale (VAS), International Knee Documentation Committee, and Lequesne Index scores and adverse events. The pooled data were evaluated with Review Manager 5.3.5.

RESULTS

Fifteen RCTs (N = 1,314) were included in our meta-analysis. The present meta-analysis indicated that PRP injections reduced pain more effectively than HA injections in patients with KOA at six and 12 months of follow-up, as evaluated by the WOMAC pain score; the VAS pain score showed a significant difference at 12 months. Moreover, better functional improvement was observed in the PRP group, as demonstrated by the WOMAC function score at three, six, and 12 months. Additionally, PRP injections did not display different adverse event rates compared with HA injections.

CONCLUSION

In terms of long-term pain relief and functional improvement, PRP injections might be more effective than HA injections as a treatment for KOA. The optimal dosage, the timing interval and frequency of injections, and the ideal treatment for different stages of KOA remain areas of concern for future investigations.

Predicting physical activity and cardiovascular risk and quality of life in adults with osteoarthritis at risk for metabolic syndrome: A test of the information-motivation-behavioral skills model

Aim

To examine a hypothetical model of physical activity and health outcomes (cardiovascular risk and quality of life) based on the information-motivation-behavioural skills model in adults.

Design

A cross-sectional survey.

Methods

A total of 165 adults with osteoarthritis at risk for metabolic syndrome were recruited between October 2016 and September 2017 from the outpatient clinic in South Korea. Data were collected on the model constructs such as cognitive function, social support, depressive symptoms, barriers to self-efficacy, physical activity and quality of life. A hypothetical model was tested using the AMOS 25.0 program.

Results

Cognitive function and barriers to self-efficacy had a direct effect on physical activity. Physical activity had a direct effect on cardiovascular risk, while social support and depressive symptoms had a direct effect on quality of life.

Conclusions

The information-motivation-behavioural skills model can predict physical activity and, in turn, cardiovascular risk and quality of life in adults with osteoarthritis at risk for metabolic syndrome.

Celecoxib vs diclofenac sodium in patients with knee osteoarthritis: A protocol for systematic review and meta analysis

BACKGROUND

Knee osteoarthritis (KOA) is one of the most common chronic muscular diseases in old people. The purpose of this meta-analysis was to compare celecoxib and diclofenac sodium in patients with knee osteoarthritis (KOA).

METHODS

Randomized controlled trials (RCTs) and clinical controlled trials (CCTs) comparing the use of celecoxib and diclofenac sodium in KOA patients were retrieved from each database from the date of database inception to September 2019. The outcome measurements were the treatment effect, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and complication rate. The pooled data were evaluated with Review Manager 5.3.5.

RESULTS

The literature will provide a high-quality analysis of the current evidence supporting celecoxib for KOA based on various comprehensive assessments including the treatment effect, visual analog scale (VAS) score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) level, and complication rate.

CONCLUSION

This proposed systematic review will provide up-to-date evidence to assess the effect of celecoxib in the treatment for patients with KOA. RESEARCH REGISTRY REGISTRATION NUMBER:: reviewregistry827.

GSK3787-Loaded Poly(Ester Amide) Particles for Intra-Articular Drug Delivery

Osteoarthritis (OA) is a debilitating joint disorder affecting more than 240 million people. There is no disease modifying therapeutic, and drugs that are used to alleviate OA symptoms result in side effects. Recent research indicates that inhibition of peroxisome proliferator-activated receptor δ (PPARδ) in cartilage may attenuate the development or progression of OA. PPARδ antagonists such as GSK3787 exist, but would benefit from delivery to joints to avoid side effects. Described here is the loading of GSK3787 into poly(ester amide) (PEA) particles. The particles contained 8 wt.% drug and had mean diameters of about 600 nm. Differential scanning calorimetry indicated the drug was in crystalline domains in the particles. Atomic force microscopy was used to measure the Young's moduli of individual particles as 2.8 MPa. In vitro drug release studies showed 11% GSK3787 was released over 30 days. Studies in immature murine articular cartilage (IMAC) cells indicated low toxicity from the drug, empty particles, and drug-loaded particles and that the particles were not taken up by the cells. Ex vivo studies on murine joints showed that the particles could be injected into the joint space and resided there for at least 7 days. Overall, these results indicate that GSK3787-loaded PEA particles warrant further investigation as a delivery system for potential OA therapy.

Dyslipidemia Might Be Associated with an Increased Risk of Osteoarthritis

Background

According to several studies, the autoimmune response may lead to osteoarthritis and dyslipidemia and may affect the homeostasis of the human body's internal environment and then cause its own immune regulation. Consequently, the risk of osteoarthritis might be increased by dyslipidemia, but this association is not universally acknowledged. Therefore, a systematic review and meta-analysis was conducted to study the relationship between dyslipidemia and the risk of osteoarthritis.

Methods

In this study, PubMed, EMBASE, and the ISI Web of Science were used to identify related studies published before July 2018. The relationship between dyslipidemia and the risk of osteoarthritis was evaluated on the basis of relative risk (RR) values and the corresponding 95% confidence intervals (CIs). To further investigate this relationship, we also employed the random effects model proposed by DerSimonian and Laird.

Results

A total of nine studies were included to study the effect of dyslipidemia on the risk of osteoarthritis, including four cohort, three case-control, and two cross-sectional studies. Among these studies, six stated data for knee osteoarthritis, two reported on hand osteoarthritis, and one reported on hip osteoarthritis. A total of 53,955 participants were included in the meta-analysis, comprising 22,501 patients with OA (19,733 hand OA, 2,679 knee OA, and 89 hip OA). Based on the meta-analysis of case-control and cross-sectional studies, osteoarthritis was clearly higher in those with dyslipidemia compared to those who did not suffer from dyslipidemia (case-control: OR = 1.37; 95%CI = 1.27–1.46; cross-sectional: OR = 1.33; 95%CI = 1.21-1.46). In addition, the meta-analysis of cohort studies did not present any relationship between dyslipidemia and OA (RR = 1.00; 95%CI = 0.85–1.14).

Conclusions

Even though our meta-analysis of case-control and cross-sectional studies suggested a strong relationship between dyslipidemia and osteoarthritis; this relationship was not validated by our meta-analysis of only cohort studies. As a result, further investigation needs to be conducted on the relationship between dyslipidemia and osteoarthritis, considering the significant public health relevance of the topic.

Impact of Prevalence Ratios of Chondroitin Sulfate (CS)- 4 and -6 Isomers Derived from Marine Sources in Cell Proliferation and Chondrogenic Differentiation Processes

Osteoarthritis is the most prevalent rheumatic disease. During disease progression, differences have been described in the prevalence of chondroitin sulfate (CS) isomers. Marine derived-CS present a higher proportion of the 6S isomer, offering therapeutic potential. Accordingly, we evaluated the effect of exogenous supplementation of CS, derived from the small spotted catshark (Scyliorhinus canicula), blue shark (Prionace glauca), thornback skate (Raja clavata) and bovine CS (reference), on the proliferation of osteochondral cell lines (MG-63 and T/C-28a2) and the chondrogenic differentiation of mesenchymal stromal cells (MSCs). MG-G3 proliferation was comparable between R. clavata (CS-6 intermediate ratio) and bovine CS (CS-4 enrichment), for concentrations below 0.5 mg/mL, defined as a toxicity threshold. T/C-28a2 proliferation was significantly improved by intermediate ratios of CS-6 and -4 isomers (S. canicula and R. clavata). A dose-dependent response was observed for S. canicula (200 µg/mL vs 50 and 10 µg/mL) and bovine CS (200 and 100 µg/mL vs 10 µg/mL). CS sulfation patterns discretely affected MSCs chondrogenesis; even though S. canicula and R. clavata CS up-regulated chondrogenic markers expression (aggrecan and collagen type II) these were not statistically significant. We demonstrate that intermediate values of CS-4 and -6 isomers improve cell proliferation and offer potential for chondrogenic promotion, although more studies are needed to elucidate its mechanism of action.

The effects of weight loss on imaging outcomes in osteoarthritis of the hip or knee in people who are overweight or obese: a systematic review

OBJECTIVE

To evaluate the structural effects of weight loss on hip or knee osteoarthritis (OA) and to summarize which structural joint pathologies have been examined and the evidence for the outcome measurement instruments applied.

DESIGN

Based on a pre-specified protocol (available: PROSPERO CRD42017065263), we conducted a systematic search of the bibliographic databases, Medline, Embase and Web of Science identifying longitudinal articles reporting the effects of weight loss on structural imaging outcomes in OA of the hip or knee in people who are overweight or obese.

RESULTS

From 1625 potentially eligible records, 14 articles (from 6 cohorts) were included. 2 cohorts were derived from RCTs. Evaluated pathologies were: articular cartilage (n = 7), joint space width (n = 3), bone marrow lesions (n = 5), synovitis (n = 2), effusion (n = 1), meniscus (n = 3), bone marrow density (n = 1) and infrapatellar fat pad (IPFP; n = 2). Cartilage showed conflicting results when evaluating cartilage thickness by direct thickness measurements. Compositional dGEMRIC and T2 mapping measures in early knee OA showed trends towards reduced cartilage degeneration. Joint space width on conventional radiographs showed no change. Weight loss reduced the size of the IPFP. Synovitis and effusion were not affected. Following weight loss DXA showed bone loss at the hip.

CONCLUSION

We did not find consistent evidence of the effects of weight loss on OA structural pathology in people who are overweight or obese. There is a need to achieve consensus on which structural pathologies and measurements to apply in weight loss and OA research.