Pain Increases the Risk of Developing Frailty in Older Adults with Osteoarthritis

Association between frailty and postherpetic neuralgia in the older adult with herpes zoster

Introduction

Chronic pain is closely related to frailty.

Methods

A total of 300 older adult patients diagnosed with HZ were selected and admitted to our hospital in 2024. A basic data questionnaire gathered baseline information, and the FRAIL scale was employed to evaluate their initial frailty status. Patients who were non-frail at baseline were followed up for 3 months. They were categorized into the PHN group and the non-PHN group based on the occurrence of neuropathic pain during follow-up. Diverse scales were employed to evaluate frailty, nutritional status, anxiety, and depression among participants. The Chi-square or Kruskal-Wallis tests were employed to compare the two groups. The logistic regression model was undertaken to explore the impact of PHN on frailty.

Results

Among the 300 older adult patients with HZ who satisfied the inclusion criteria, follow-up data were collected from 215 patients, comprising 85 cases in the PHN group and 130 cases in the non-PHN group. A prospective analysis of the 215 baseline non-frail patients showed that the incidence of frailty in older HZ patients was 14.9%. Univariate analysis revealed that the distributions of lesion site, lesion area, depression status, anxiety status, COPD, and nutritional score were statistically significant between the two groups (χ2 = 6.127, 4.846, 13.316, 12.967, 6.234, H = 2.592, P < 0.05). Nevertheless, the distributions of age, gender, marital status, education level, hypertension, and diabetes were not statistically significant (P > 0.05). Binary logistic regression analysis indicated that, after comprehensive adjustment for age, gender, lesion site, lesion area, depression status, anxiety status, COPD, and nutritional score, patients with PHN exhibited an higher risk of frailty compared to the non-PHN cohort (22 cases, OR = 3.279, 95% CI = 1.327-8.105; P = 0.010).

Conclusion

Postherpetic neuralgia increases the risk of frailty and is a significant factor influencing the progression of frailty in the older adult.

Association Between Musculoskeletal Pain and Frailty Over Time in Older Adults

BACKGROUND AND PURPOSE

There is a high frequency of frailty in patients with musculoskeletal pain. Pain from osteoarthritis and lower back pain may be associated with frailty. However, the future risk of frailty among older adults with pain remains unclear. Thus, the primary objective of this study was to examine the association between musculoskeletal pain and the risk of becoming prefrail and frail in older adults.

PARTICIPANTS AND METHODS

A secondary analysis was performed using data from baseline and 1-, 2-, 3-, 4-, 6-, and 8-year follow-ups of the Osteoarthritis Initiative (OAI). The OAI recruited participants from 4 clinical sites in the United States, between February 2004 and May 2006. A self-reported questionnaire was used to determine the baseline musculoskeletal pain status in older adults (n = 1780) 65 years and older, including pain in the lower back, hip, knee, and at 2 or more sites. Using the Fried phenotypic criteria, participants were classified as nonfrail, prefrail, and frail at each period over 8 years.

RESULTS

After adjusting for age, sex, race, education, marital status, annual income, smoking status, comorbidities, and body mass index, binary logistic regression modeling using generalized estimating equations revealed that in older adults musculoskeletal pain in the lower back and at multiple sites was associated with a slightly but significantly decreased risk of prefrailty over time (adjusted odds ratio [AOR] = 0.98, 95% CI = 0.95-0.99, P = .019; AOR = 0.96, CI = 0.92-0.99, P = .032). The association between musculoskeletal pain and frailty among older adults was not statistically significant (all P > .05).

CONCLUSIONS

Musculoskeletal pain did not independently significantly increase the risk of prefrailty or frailty over time. It remains possible that when musculoskeletal is combined with other factors, the risk of prefrailty and frailty may be heightened. Further research into the combination of characteristics that best predict prefrailty and frailty, including but not limited to musculoskeletal pain, is warranted.

Associations among frailty conditions and pain indicators: Data from 22 356 European older adults

AIM

Recent studies supported the presence of a relationship between pain and frailty, but more research is needed to highlight the pain-frailty association. The study aimed to investigate the prevalence and the influence of different pain indicators on frailty while controlling for age, sex and country.

METHODS

This observational study used data from the sixth wave of the SHARE survey. A sample of 22 356 community-dwelling individuals aged >60 years from six European countries (Spain, Estonia, France, Greece, Czech Republic and Sweden) was analyzed. The pain was measured through assessment of medication used for joint pain or other types of pain, pain location, polypharmacy and pain level. Frailty was assessed with the modified Fried Frailty phenotype.

RESULTS

Pain indicators, especially widespread pain and pain severity, were significantly associated with prefrailty (odds ratio 3.30, 95% CI 2.40, 4.55; and odds ratio 0.61, 95% CI 0.51, 0.72) and frailty status (odds ratio 4.69, 95% CI 3.31, 6.67; and odds ratio 0.37, 95% CI 0.30, 0.44). Advancing age and female sex consistently correlated with increased prefrailty (odds ratio 1.06, 95% CI 1.05, 1.07; and odds ratio 1.36, 95% CI 1.22, 1.53) and frailty risk (odds ratio 1.11, 95% CI 1.10, 1.12; and odds ratio 1.71, 95% CI 1.48, 1.96). Country-specific differences emerged, with Spaniards showing higher odds ratios of prefrailty and frailty compared with Swedish, French and Czech individuals, whereas Greeks showed elevated odds ratios compared with Spaniards. The factors associated jointly explained 27.5% of the variance in frailty categories.

CONCLUSION

Significant associations were identified, particularly with widespread pain and pain severity, highlighting their impact on frailty. Country-specific variations in frailty prevalence were observed, alongside consistent associations with advancing age and female sex. These findings provide valuable insights into the intricate interplay between pain and frailty, offering the potential for targeted interventions in older adults' care through tailored pain management strategies. Geriatr Gerontol Int 2024; 24: 1362-1369.

Does autoimmune diseases increase the risk of frailty? A Mendelian randomization study

Background

The causality of autoimmune diseases with frailty has not been firmly established. We conducted this Mendelian randomization (MR) study to unveil the causal associations between autoimmune diseases with frailty.

Methods

A MR analyses were performed to explore the relationships between autoimmune disease and frailty, using summary genome-wide association statistics.

Results

Through a comprehensive and meticulous screening process, we incorporated 46, 7, 12, 20, 5, and 53 single nucleotide polymorphisms (SNPs) as instrumental variables (IVs) for hypothyroidism, hyperthyroidism, rheumatoid arthritis (RA), type 1 diabetes (T1D), multiple sclerosis (MS), and overall autoimmune disease, respectively. Our analysis revealed that hypothyroidism (OR = 1.023, 95% CI: 1.008-1.038, p = 0.0015), hyperthyroidism (OR = 1.024, 95% CI: 1.004-1.045, p = 0.0163), RA (OR = 1.031, 95% CI: 1.011-1.052, p = 0.0017), T1D (OR = 1.011, 95% CI: 1.004-1.017, p = 0.0012), and overall autoimmune disease (OR = 1.044, 95% CI: 1.028-1.061, p = 5.32*10^-8) exhibited a positive causal effect on frailty. Conversely, there may be a negative causal association between MS (OR = 0.984, 95% CI: 0.977-0.992, p = 4.87*10^-5) and frailty. Cochran's Q test indicated heterogeneity among IVs derived from hypothyroidism, hyperthyroidism, T1D, and overall autoimmune diseases. The MR-Egger regression analyzes revealed an absence of horizontal pleiotropy in any of the conducted analyses.

Conclusion

This study elucidates that hypothyroidism, hyperthyroidism, RA, T1D, and overall autoimmune disease were linked to an elevated risk of frailty. Conversely, MS appears to be associated with a potential decrease in the risk of frailty.

The genetic causal association between hip or knee osteoarthritis and frailty: a two-sample Mendelian randomization analysis

Introduction

Osteoarthritis of the hip or knee has been reported to be linked to an increased risk of frailty. However, a definitive conclusion about whether hip or knee osteoarthritis increases susceptibility to frailty remains elusive.

Material and methods

The instrumental variables (IVs) used in this analysis were sourced from publicly available genome-wide association study (GWAS) datasets. We used a two-sample Mendelian randomization analysis to evaluate the plausible causal nexus between hip or knee osteoarthritis and frailty.

Results

We included a total of 25 single-nucleotide polymorphisms (SNPs) as instrumental variables through rigorous and comprehensive screening. The results of this analysis suggested that hip or knee osteoarthritis is associated with an elevated risk of frailty. These results remained robust and consistent across multiple calculation methods, including inverse variance weighted (OR = 1.082, 95% CI: 1.0532-1.1125, p = 1.36 × 10-8), MR-Egger regression (OR = 1.175, 95% CI: 1.0162-1.3604, p = 0.040), weighted median estimation (OR = 1.078, 95% CI: 1.0365-1.1219, p = 1.831 × 10-4), weighted mode analysis (OR = 1.089, 95% CI: 1.0078-1.1771, p = 0.041) and simple mode analysis (OR = 1.093, 95% CI: 1.0112-1.1830, p = 0.034). Cochran's Q test showed no evidence of heterogeneity among the IV estimates derived from individual variants, and the MR-Egger regression analysis indicated that the presence of horizontal pleiotropy was unlikely to introduce bias into the results (intercept: -0.0044, p = 0.549).

Conclusions

Two-sample Mendelian randomization analysis effectively identified hip or knee osteoarthritis as a contributing risk factor for frailty.

An update of murine models and their methodologies in immune-mediated joint damage and pain research

Murine models have played an indispensable role in the understanding of rheumatic and musculoskeletal disorders (RMD), elucidating the genetic, endocrine and biomechanical pathways involved in joint pathology and associated pain. To date, the available models in RMD can be classified as induced or spontaneous, both incorporating transgenic alternatives that improve specific insights. It is worth noting that the selection of the most appropriate model together with the evaluation of their specific characteristics and technical capabilities are crucial when designing the experiments. Furthermore, it is also imperative to consistently adhere to the ethical standards concerning animal experimentation. Recognizing the inherent limitation that any model can entirely encapsulates the complexity of the pathophysiology of these conditions, the aim of this review is to provide an updated overview on the methodology of current murine models in major arthropathies and their immune-mediated pathways, addressing to basic, translational and pharmacological research in joint damage and pain.

Associations of Osteoarthritis with Prevalence and Incidence of Cardiovascular Disease over 10 Years in Community-Dwelling Older Adults: The Sydney Memory and Ageing Study

INTRODUCTION

The data are limited for the association between osteoarthritis (OA) and cardiovascular disease (CVD) in community-based older populations and whether there is sex difference. This study aimed to examine the relationship between OA and prevalence and incidence of CVD over 10 years in community-dwelling older adults.

METHODS

Data on self-reported OA, high cholesterol, hypertension, and type 2 diabetes were collected from 1,025 community-dwelling participants aged 70-90 years in the Sydney Memory and Ageing Study. The presence of CVD at baseline was defined as self-reported presence of stroke, heart attack, transient ischaemic attack, angina, aortic aneurysm, or claudication. The incidence of CVD was defined by a combination of incident self-reported CVD or CVD mortality at different follow-up timepoints over 10 years.

RESULTS

At baseline, 395 (38.5%) participants self-reported OA (252 [44.6%] women, 143 [31.1%] men). Self-reported OA was associated with increased prevalence of CVD in women (OR 1.67, 95% CI 1.12-2.47) but not men (1.26, 0.80-1.98). In the total population, self-reported OA at baseline was associated with increased incidence of CVD at 4 years (OR 1.77, 95% CI 1.10-2.83), 6 years (1.59, 1.03-2.46), 8 years (1.56, 1.02-2.38), and 10 years (1.66, 1.10-2.50), but not at 2 years (1.43, 0.79-2.57). Significant associations were observed in female participants at 4, 8, and 10 years, with no significant associations seen in male participants.

CONCLUSION

OA was associated with increased prevalence at baseline and incidence of CVD over 10 years in community-based older adults, especially women. Identifying those with OA to target their cardiovascular risk factors while managing their OA has the potential to reduce the burden of CVD in older people, particularly women.

Impact of frailty severity and severe pain on cognitive function for community-dwelling older adults with arthritis: a cross-sectional study in Korea

Pain is a major symptom of arthritis in older adults, often leading to frailty and cognitive decline. However, few studies have investigated the relationship among pain, frailty, and cognitive function in older adults with arthritis. This study aimed to investigate the factors influencing cognitive function and the impact of frailty severity and pain on cognitive function in older adults with arthritis using a Korean population-based dataset. This cross-sectional descriptive study involved the secondary data of 1089 participants from the seventh and eighth waves of the Korean Longitudinal Study on Aging. We examined general characteristics, health behaviors, health conditions (including severe pain and frailty), and cognitive function. Participants were categorized based on the presence or absence of pain severity and frailty status as follows: robust, only severe pain, only prefrail, prefrail with severe pain, only frail, and frail with severe pain. Multiple linear regression analysis was performed to establish correlations between groups and cognitive function. The only-prefrail group was the largest (19.7%) among participants experiencing either pain or frailty. Advanced age, sex, level of education, and visual and hearing impairments were significantly associated with cognitive function. Compared to the robust group, only prefrail (β = -1.54, confidence interval [CI] = - 2.33; - 0.76), prefrail with severe pain (β = - 2.69, CI = - 3.52; - 1.87), only frail (β = - 4.02, CI = - 5.08; - 2.97), and frail with severe pain (β = - 5.03, CI = - 5.99; - 4.08) groups were associated with lower Mini-Mental State Examination scores. The study confirmed that severe pain alone does not significantly impact cognitive function in older adults with arthritis. To prevent cognitive decline in this group, assessment of both pain and frailty severity is essential to predict high-risk groups and provide appropriate interventions, such as transfer to hospitals or primary clinics according to the severity of pain and frailty.

Knee osteoarthritis with a high grade of Kellgren-Lawrence score is associated with a worse frailty status, KNHANES 2010-2013

Frailty as a syndrome of physical decline in late life is associated with adverse health outcomes. Knee osteoarthritis (KOA) could contribute to frailty conditions. The objective of this study was to evaluate the impact of KOA on frailty risk in a Korean National Health and Nutrition Examination Survey (KNHANES) cohort. In this study (N, total = 11,910, age; 64.10 years old [63.94-64.27; mean 95% CI], sex (female, %); 6,752 (56.69)), KOA patients were defined as those with knee joint pain and grade 2 Kellgren-Lawrence (K-L) or more on plain radiographic images who were 40 years old or older in Korean population data of KNHANES. The frailty index was calculated using 46 items related to co-morbidities and laboratory parameters. The impact of KOA on frailty risk was evaluated with logistic regression analyses. The prevalence of KOA patients was 35.6% [95% CI 34.7-36.46]. In polytomous logistic regression, the relative risk ratio (RRR) of KOA was significantly increased in the pre-frail group (2.76, 95% CI 2.30-3.31) and the frail group (7.28, 95% CI 5.90-8.98). RRR of frailty was significantly increased in patients with K-L grade 3 (1.36, 95% CI 1.13-1.63) and K-L grade 4 (2.19, 95% CI 1.72-2.79). Older age, higher BMI, smoking status, alcohol intake, low-income status, higher WBC count, higher platelet count, higher serum creatinine level and low estimated GFR were significantly associated with increased frailty risk. High hemoglobin and regular walking habits were associated with decreased frailty risk in KOA patients. In this large observation population- based survey cohort, KOA is linked to an increased risk of frailty syndrome. We found a significant connection between KOA and frailty syndrome. These results show that we need to think about the overall health of people with KOA and give them special care to prevent frailty syndrome.

Relationship Between Chronic Pain Types (Nociceptive and Neuropathic-Like Symptoms) and Frailty in Community-Dwelling Japanese Older Adults: A Cross-Sectional Study

Purpose

Chronic pain may accelerate the development of frailty in older adults through a variety of mechanisms. There are no published investigations of the influence of neuropathic-like symptoms on physical frailty. We investigated the association between chronic pain types (nociceptive and neuropathic-like symptoms) and frailty in community-dwelling Japanese older adults.

Participants and Methods

This was a population-based cross-sectional study conducted in 2017 in the city of Itoshima, Japan of 917 participants aged 65-75 years, not in need of long-term care, who had completed the physical function tests and questionnaires administered at measurement sessions held at community centers at three sites over a 1- to 2-month period. Their chronic pain types were classified as no-chronic pain, nociceptive pain, and neuropathic-like symptoms according to their painDETECT scores. Frailty phenotypes were defined by the following five components: unintentional weight loss, low grip strength, exhaustion, slow gait speed, and low physical activity. A logistic regression model was used to compute the odds ratios (ORs) and 95% confidence interval (CIs) for frailty status outcomes.

Results

The prevalence of pre-frailty was 51.9%, and that of frailty was 5.1%. In multinomial logistic regression analyses, compared to the no-chronic pain group, the OR for the presence of pre-frailty among the participants with nociceptive pain was 1.54 (95% CI: 1.04-2.30, p=0.03), and the OR for the presence of frailty among the participants with neuropathic-like symptoms was 4.37 (95% CI: 1.10-17.37, p=0.04). The neuropathic sensory symptoms of burning, tingling/prickling, and numbness were each associated with frailty, but not with the risk of pre-frailty.

Conclusion

Neuropathic-like symptoms were significantly associated with the presence of frailty in community-dwelling Japanese older adults. Chronic pain types might have different effects on frailty status.

A review of quality-of-life in elderly osteoarthritis

INTRODUCTION

Osteoarthritis (OA) is the commonest joint disease in the world. Although aging is not invariably associated with OA, aging of the musculoskeletal system increases susceptibility to OA. Pain and reduced function due to OA, negatively impact health-related quality of life (HRQoL) in the elderly.

AREAS COVERED

We searched PubMed and Google Scholar with search term "osteoarthritis' combined with terms 'elderly' 'ageing' 'healthrelated quality of life' 'burden' "prevalence 'hip osteoarthritis' 'knee osteoarthritis' 'hand osteoarthritis' to identify relevant articles. This article discusses the global impact and joint-specific burden due to OA and the challenges in assessment of HRQoL in elderly with OA. We further describe some HRQoL determinants that particularly impact elderly persons with OA. These determinants include physical activity, falls, psychosocial consequences, sarcopaenia, sexual health, and incontinence. The usefulness of physical performance measures, as an adjunct to assessing HRQoL is explored. The review concludes by outlining strategies to improve HRQoL.

EXPERT OPINION

Assessment of HRQoL in elderly with OA is mandatory if effective interventions/treatment are to be instituted. But existent HRQoL assessments have shortcomings when used in elderly§. It is recommended that determinants of QoL which are unique to the elderly, be examined with greater detail and weightage in future studies.

Global Burden of osteoarthritis associated with high body mass index in 204 countries and territories, 1990-2019: findings from the Global Burden of Disease Study 2019

OBJECTIVE

To quantify the burden of osteoarthritis (OA) associated with high body mass index (BMI) across 204 countries and territories from 1990 to 2019.

METHODS

This study extracted global, regional, and national data on years lived with disability (YLD) of OA associated with high BMI from GBD 2019. The YLD burden of OA associated with high BMI was systematically analyzed by age, SDI, sex, and EAPC.

RESULTS

At the global level, ~2.67 million (95% UI: 1.04, 5.75) YLD were attributable to OA associated with high BMI, with an age-standardized rate of 31.9 (95% UI: 12.4, 68.75) YLD per 100,000 population in 2019. There was a 0.5 increase (95% UI: 0.35, 0.79) over the 30 years with an EAPC of 1.45. In 2019, Australasia {57.49 (95% UI: 23.62, 125.38)}, high-income North America {56.2 (95% UI: 23.32, 121.97)}, and Andean Latin America {49.77 (95% UI: 19.73, 111.73)} had the highest age-standardized YLD rates. The population aged at 60-74 group had a higher YLD rate for both males and females. Females tended to be more sensitive to the OA associated with high BMI than male in any region.

CONCLUSIONS

In summary, the YLD rate of OA associated with high BMI presented a continuous upward trend in most countries. Women and older people are more sensitive to OA due to physiological and psychological factors. Controlling modifiable risk factors such as maintaining an appropriate BMI is needed for disease prevention.

Association of pain and risk of falls in community-dwelling adults: a prospective study in the Survey of Health, Ageing and Retirement in Europe (SHARE)

PURPOSE

To investigate the longitudinal associations between pain and falls risks in adults.

METHODS

Prospective cohort study on data from 40,636 community-dwelling adults ≥ 50 years assessed in Wave 5 and 6 in the Survey of Health, Ageing and Retirement in Europe (SHARE). Socio-demographic and clinical information was collected at baseline (Wave 5). At 2-year follow-up (Wave 6), falls in the previous 6 months were recorded. The longitudinal associations between pain intensity, number of pain sites and pain in specific anatomic sites, respectively, and falls risk were analysed by binary logistic regression models; odds ratios (95% confidence intervals) were calculated. All analyses were adjusted for socio-demographic and clinical factors and stratified by sex.

RESULTS

Mean age was 65.8 years (standard deviation 9.3; range 50-103); 22,486 (55.3%) participants were women. At follow-up, 2805 (6.9%) participants reported fall(s) in the previous 6 months. After adjustment, participants with moderate and severe pain at baseline had an increased falls risk at follow-up of 1.35 (1.21-1.51) and 1.52 (1.31-1.75), respectively, compared to those without pain (both p < 0.001); mild pain was not associated with falls risk. Associations between pain intensity and falls risk were greater at younger age (p for interaction < 0.001). Among participants with pain, pain in ≥ 2 sites or all over (multisite pain) was associated with an increased falls risk of 1.29 (1.14-1.45) compared to pain in one site (p < 0.001).

CONCLUSIONS

Moderate, severe and multisite pain were associated with an increased risk of subsequent falls in adults.

Chronic pain after surgery and trauma: current situation and future directions

Chronic post-surgical pain (CPSP) stands as a major health issue. The unchanged incidence over the last two decades underlines both the failure of predictive models developed until now and the lack of efficacy of common “preventive” strategies (pharmacotherapy and regional analgesic techniques) applied in current clinical practice. The recognition of CPSP as a disease and the release of a common definition of the condition is an important progress in the field. CPSP predictive scores exist but none has presently demonstrated an impact on patient care. New clinical directions based on the resolution of postoperative pain, a complex and highly dynamic process supported by individual pain trajectories, argue for predictive models and preventive strategies extended to the subacute pain period i.e. after hospital discharge.

Prevalence and Characteristics of Frailty at 6 months FollOwing Total Hip and Knee Arthroplasty in Patients With End-Stage OA

Introduction

Lower-limb osteoarthritis (OA) in the elderly can be a risk factor for frailty, which is the preliminary of disability, but it may be reversible with appropriate interventions. We aimed to use the Kihon Check List (KCL) to assess multiple domains of frailty and to identify the characteristics of frailty in patients with hip or knee OA following total joint arthroplasty.

Materials and Methods

This study included 136 ≥ 65-year-old patients (mean age: 73.0 years) who underwent total arthroplasty with end-stage hip and knee OA. We assessed frailty status, instrumental activities of daily living (IADL), and health-related quality of life (HRQoL) according to the KCL, functional ambulatory index (FAI) and EuroQol-5 Dimension (EQ5D), respectively, as well as the extent of pain preoperatively and at postoperative 6 months.

Results

Using KCL, seventy-eight (57.4%) patients were frail preoperatively, but the prevalence significantly decreased to 52 patients (38.2%) at postoperative 6 months. Total arthroplasty intervention provided significant improvements in the total KCL scores, including the physical domain (P < .01), pain (P < .01), FAI scores (P < .01), and EQ5D (P < .01), but not the social domain. Multivariate logistic regression analysis identified age at surgery (OR: .93, 95% CI: .86-.99) and preoperative FAI score (OR: 1.10, 95% CI: 1.03-1.19) as independent predictors of postoperative frailty.

Conclusions

Total arthroplasty procedures on patients with hip and knee OA reduced their KCL score, but social aspects were less improved than physical aspects in the shortterm. Older age and preoperative lower IADL score can be useful for accurately estimating less improvement of frailty in the early postoperative phase. Our results suggest that long term follow-up of OA is needed to provide comprehensive interventions, including in social aspects, especially for patients with lower activity.

Senescent preosteoclast secretome promotes metabolic syndrome associated osteoarthritis through cyclooxygenase 2

Background

Metabolic syndrome-associated osteoarthritis (MetS-OA) is a distinct osteoarthritis phenotype defined by the coexistence of MetS or its individual components. Despite the high prevalence of MetS-OA, its pathogenic mechanisms are unclear. The aim of this study was to determine the role of cellular senescence in the development of MetS-OA.

Methods

Analysis of the human osteoarthritis initiative (OAI) dataset was conducted to investigate the MRI subchondral bone features of MetS-human OA participants. Joint phenotype and senescent cells were evaluated in two MetS-OA mouse models: high-fat diet (HFD)-challenged mice and STR/Ort mice. In addition, the molecular mechanisms by which preosteoclasts become senescent as well as how the senescent preosteoclasts impair subchondral bone microenvironment were characterized using in vitro preosteoclast culture system.

Results

Humans and mice with MetS are more likely to develop osteoarthritis-related subchondral bone alterations than those without MetS. MetS-OA mice exhibited a rapid increase in joint subchondral bone plate and trabecular thickness before articular cartilage degeneration. Subchondral preosteoclasts undergo senescence at the pre- or early-osteoarthritis stage and acquire a unique secretome to stimulate osteoblast differentiation and inhibit osteoclast differentiation. Antagonizing preosteoclast senescence markedly mitigates pathological subchondral alterations and osteoarthritis progression in MetS-OA mice. At the molecular level, preosteoclast secretome activates COX2-PGE2, resulting in stimulated differentiation of osteoblast progenitors for subchondral bone formation. Administration of a selective COX2 inhibitor attenuated subchondral bone alteration and osteoarthritis progression in MetS-OA mice. Longitudinal analyses of the human Osteoarthritis Initiative (OAI) cohort dataset also revealed that COX2 inhibitor use, relative to non-selective nonsteroidal antiinflammatory drug use, is associated with less progression of osteoarthritis and subchondral bone marrow lesion worsening in participants with MetS-OA.

Conclusions

Our findings suggest a central role of a senescent preosteoclast secretome-COX2/PGE2 axis in the pathogenesis of MetS-OA, in which selective COX2 inhibitors may have disease-modifying potential.

Funding

This work was supported by the National Institutes of Health grant R01AG068226 and R01AG072090 to MW, R01AR079620 to SD, and P01AG066603 to XC.

Path Model Factors Associated with Depressive Symptoms among Older Thais Living in Rural Areas

Depressive symptoms are complex and are often more severe in older people. However, there is limited research exploring the causal relationships between depression and its associated factors in the geriatric population, particularly in Thailand. We aimed to evaluate the direction of these complex relationships in the Thai population. A cross-sectional design was conducted on 312 Thai community-dwelling older adults aged 60 years or above who registered for primary care services. The participants were recruited from July 2019 to January 2020, and they responded to standard assessments. The relationships between pain, the number of medications, frailty, locomotive syndrome, and depressive symptoms were investigated using path analysis. The results showed that most participants were women and had multiple diseases, mild pain, frailty, and grade I−II locomotive syndrome. The prevalence of depressive symptoms was 16%. The model showed significant positive direct and indirect paths from locomotive syndrome to depressive symptoms (β = 0.296, p < 0.01; β = 0.099, p < 0.01, respectively). There was a significant positive direct path from frailty to depressive symptoms (β = 0.219, p < 0.01) and a significant positive indirect path from pain to depressive symptoms (β = 0.096, p < 0.01).

Physical resilience as a moderator of the relationship between frailty and disability in older adults with osteoarthritis

AIMS

Frailty is a leading cause of deteriorating physical function of older adults with osteoarthritis. This study examined a model of frailty with the goals of (1) exploring the direct effect of osteoarthritic symptoms on disability and the mediating effect of frailty on disability and (2) determining whether both effects are moderated by physical resilience.

DESIGN

A cross-sectional descriptive study.

METHODS

Data collection was conducted among patients 65-92 years of age (N = 235) who visited primary medical centres for the management of chronic arthritic pain between July and December 2019. Participants completed a questionnaire measuring osteoarthritic symptoms, frailty, physical resilience, and disability. SPSS 25.0 was used to analyse the conditional process model. This study was reported following the STROBE guidelines.

RESULTS

Frailty was shown to be a mediator between osteoarthritic symptoms and disability. Furthermore, physical resilience played a role as a moderator in both the direct and indirect pathways of this mediating relationship.

CONCLUSION

The findings emphasize the detrimental effects of osteoarthritic symptoms on disability through frailty, and the moderated mediation results suggest that these effects were conditional on physical resilience, which is a modifiable internal resource of individuals. When planning nursing interventions for older adults with osteoarthritis, nurses need to consider physical resilience as a moderator to prevent frailty and disability.

Cellular senescence in musculoskeletal homeostasis, diseases, and regeneration

Emerging insights into cellular senescence highlight the relevance of senescence in musculoskeletal disorders, which represent the leading global cause of disability. Cellular senescence was initially described by Hayflick et al. in 1961 as an irreversible nondividing state in in vitro cell culture studies. We now know that cellular senescence can occur in vivo in response to various stressors as a heterogeneous and tissue-specific cell state with a secretome phenotype acquired after the initial growth arrest. In the past two decades, compelling evidence from preclinical models and human data show an accumulation of senescent cells in many components of the musculoskeletal system. Cellular senescence is therefore a defining feature of age-related musculoskeletal disorders, and targeted elimination of these cells has emerged recently as a promising therapeutic approach to ameliorate tissue damage and promote repair and regeneration of the skeleton and skeletal muscles. In this review, we summarize evidence of the role of senescent cells in the maintenance of bone homeostasis during childhood and their contribution to the pathogenesis of chronic musculoskeletal disorders, including osteoporosis, osteoarthritis, and sarcopenia. We highlight the diversity of the senescent cells in the microenvironment of bone, joint, and skeletal muscle tissue, as well as the mechanisms by which these senescent cells are involved in musculoskeletal diseases. In addition, we discuss how identifying and targeting senescent cells might positively affect pathologic progression and musculoskeletal system regeneration.

Assessing Prevalence and Factors Related to Frailty in Community-Dwelling Older Adults: A Multinomial Logistic Analysis

Frailty is an age-related clinical condition that typically involves a deterioration in the physiological capacity of various organ systems and heightens the patient’s susceptibility to stressors. For this reason, one of the main research goals currently being addressed is that of characterising the impact of frailty in different settings. The main aim of this study is to determine the prevalence of Fried’s frailty phenotype among community-dwelling older people and to analyse the factors associated with frailty. In this research study, 582 persons aged 65 years or more participated in this cross-sectional study that was conducted at primary healthcare centres in Málaga, Spain. Sociodemographic, clinical, functional and comprehensive drug therapy data were compiled. The relationship between the independent variables and the different states of frailty was analysed by using a multinomial logistic regression model. Frailty was present in 24.1% of the study sample (95% CI = 20.7–27.6) of whom 54.3% were found to be pre-frail and 21.6% were non-frail. The study variable most strongly associated with frailty was the female gender (OR = 20.54, 95% CI = 9.10–46.3). Other factors found to be associated with the state of frailty included age, dependence for the instrumental activities of daily living (IADL), polymedication, osteoarticular pathology and psychopathology. This study confirms the high prevalence of frailty among community-dwelling older people. Frailty may be associated with many factors. Some of these associated factors may be preventable or modifiable and, thus, provide clinically relevant targets for intervention. This is particularly the case for depressive symptoms, the clinical control of osteoarthritis and the use of polypharmacy.

Gender and Sex Are Key Determinants in Osteoarthritis Not Only Confounding Variables. A Systematic Review of Clinical Data

Many risk factors for osteoarthritis (OA) have been noted, while gender/sex differences have been understated. The work aimed to systematically review literature investigating as primary aim the relationship between gender/sex related discriminants and OA. The search was performed in PubMed, Science Direct and Web of Knowledge in the last 10 years. Inclusion criteria were limited to clinical studies of patients affected by OA in any joints, analyzing as primary aim gender/sex differences. Exclusion criteria were review articles, in vitro, in vivo and ex vivo studies, case series studies and papers in which gender/sex differences were adjusted as confounding variable. Of the 120 records screened, 42 studies were included. Different clinical outcomes were analyzed: morphometric differences, followed by kinematics, pain, functional outcomes after arthroplasty and health care needs of patients. Women appear to use more health care, have higher OA prevalence, clinical pain and inflammation, decreased cartilage volume, physical difficulty, and smaller joint parameters and dimensions, as compared to men. No in-depth studies or mechanistic studies analyzing biomarker differential expressions, molecular pathways and omic profiles were found that might drive preclinical and clinical research towards sex-/gender-oriented protocols.

Frailty prevalence according to the Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) definition, and its variables associated, in patients with symptomatic knee osteoarthritis: findings from a cross-sectional study

Background

Frailty is a frequent condition in patients with knee osteoarthritis (KOA). However, there are different constructs on how to define it. Survey of Health, Ageing and Retirement in Europe-Frailty Instrument (SHARE-FI) is one of them.

Aim

To assess the prevalence of frailty, according to the SHARE-FI definition in patients with symptomatic KOA, and to establish its associated factors.

Methods

Symptomatic KOA patients were evaluated for pain symptoms, quality of life, comorbidities, ongoing drug therapy, and radiological damage. Patients were categorised according to the SHARE-FI definition into frail, pre-frail, and non-frail, and compared to a group of healthy controls associated by age and gender.

Results

170 symptomatic KOA patients (76.5% female, mean age 70.1 years) and 186 healthy controls were included. According to SHARE-FI criteria, 35 patients (20.6%) were categorised frail, 50 (29.4%) pre-frail, and 85 (50%) non-frail. The prevalence of frail or pre-frail subjects was statistically significantly higher in patients with symptomatic KOA. Stratifying the patients according to the frailty categories, frail subjects showed significantly higher mean values of pain. The results from logistic regression analysis revealed that polypharmacy (p = 0.003), pain (p = 0.016) and comorbidities (p = 0.035) were the variables independently associated with frailty in symptomatic KOA.

Discussion

Frailty or pre-frailty, defined by SHARE-FI, is common in symptomatic KOA. The main factors associated with frailty were polypharmacy, pain and comorbidity burden.

Conclusions

SHARE-FI can represent an useful tool to define frailty in symptomatic KOA.

Frailty in Rheumatic Diseases

Frailty is a syndrome characterized by the decline in the physiologic reserve and function of several systems, leading to increased vulnerability and adverse health outcomes. While common in the elderly, recent studies have underlined the higher prevalence of frailty in chronic diseases, independent of age. The pathophysiological mechanisms that contribute to frailty have not been completely understood, although significant progresses have recently been made. In this context, chronic inflammation is likely to play a pivotal role, both directly and indirectly through other systems, such as the musculoskeletal, endocrine, and neurological systems. Rheumatic diseases are characterized by chronic inflammation and accumulation of deficits during time. Therefore, studies have recently started to explore the link between frailty and rheumatic diseases, and in this review, we report what has been described so far. Frailty is dynamic and potentially reversible with 8.3%-17.9% of older adults spontaneously improving their frailty status over time. Muscle strength is likely the most significant influencing factor which could be improved with training thus pointing at the need to maintain physical activity. Not surprisingly, frailty is more prevalent in patients affected by rheumatic diseases than in healthy controls, regardless of age and is associated with high disease activity to affect the clinical outcomes, largely due to chronic inflammation. More importantly, the treatment of the underlying condition may prevent frailty. Scales to assess frailty in patients affected by rheumatic diseases have been proposed, but larger casuistries are needed to validate disease-specific indexes, which could allow more accurate prognostic estimates than demographic and disease-related variables alone. Frail patients can be more vulnerable and more difficult to treat, due to the risk of side effects, therefore frailty should be taken into account in clinical decisions. Clinical trials addressing frailty could identify patients who are less likely to tolerate potentially toxic medications and might benefit from more conservative regimens. In conclusion, the implementation of the concept of frailty in rheumatology will allow a better understanding of the patient global health, a finest risk stratification and a more individualized management strategy.

Association between frailty and chronic pain among older adults: a systematic review and meta-analysis

PURPOSE

Frailty and chronic pain are prevalent among older adults. However, no study has systematically reviewed the association between frailty and chronic pain in older adults. Therefore, we aimed to estimate the prevalence of frailty and prefrailty among older adults with chronic pain and review the longitudinal association between frailty status and chronic pain.

METHODS

Embase, Medline, Pubmed, and Cochrane library were searched from inception to March 2020. The methodological quality of the studies was assessed using the Newcastle Ottawa Scale. Random effect models and Mantel-Haenszel weighting were adopted to synthesize the estimates.

RESULTS

Among the initial 846 articles retrieved, 24 were included in the review (12 cross-sectional, and 12 longitudinal). The pooled prevalence in persons with chronic pain was 18% (95% CI 14-23%; I² = 98.7%) for frailty and 43% (95% CI 36-51%; I² = 98.2%) for prefrailty. The pooled prevalence of chronic pain was 50% (95% CI 45-55%; I² = 88.3%) for individuals with frailty and 37% (95% CI 31-42%; I² = 97.1%) for individuals with prefrailty. Persons with chronic pain were 1.85 (95% CI 1.49-2.28; I² = 93.2%) times more likely to develop frailty after an average follow-up of 5.8 years compared to those without.

CONCLUSION

Frailty and prefrailty are common in persons with chronic pain. Chronic pain among non-frail older persons significantly predicts the incidence of frailty after an average follow-up of 5.8 years. Future studies should explore the efficacy of different pain management strategies in reducing physical frailty and clarify the association of other types of frailty (cognitive, social and psychological) with chronic pain.

Quality of life outcomes in patients undergoing knee replacement surgery: longitudinal findings from the QPro-Gin study

Background

Many patients report postoperative pain, limited improvement in physical function and poor quality of life (QOL) after knee replacement surgery. Our study uses baseline predictors of change to investigate the QOL of patients with knee osteoarthritis 3-months after knee replacement surgery.

Methods

A prospective observational study was designed to evaluate patients (n = 132) scheduled for uni-compartmental or total knee replacement surgery who were assessed at baseline (preoperatively) and 3-months after. Physical and mental endpoints based on the component scores of the SF-12 and on the Western Ontario and McMaster Universities Arthritis (WOMAC) index were used to investigate patients’ QOL. Generalised estimating equation methodology was used to assess patients’ baseline characteristics (age, sex, education, body mass index (BMI), comorbidity, depressive symptoms, cognitive impairment, smoking/alcohol and type of surgery), the study endpoints and their changes over a 3-month post-surgery period. Stratified analyses by rehabilitation status after discharge were performed.

Results

Longitudinal data analysis showed that the baseline factors associated with improvement in general QOL at the 3-month post-surgery assessment were higher BMI, a high comorbidity, total (as opposed to unicompartmental) knee replacement and low education level. Data analysis of the patients who underwent rehabilitation after discharge revealed that the current smokers’ physical QOL worsened over time. The general QOL was unchanged over time in the presence of depressive symptomatology.

Conclusions

These findings underline the importance of using comprehensive assessment methods to identify factors affecting functionality and QOL, and developing interventions to improve the health/wellbeing of patients after knee replacement.

Frailty modifies the intervention effect of chair yoga on pain among older adults with lower extremity osteoarthritis: Secondary analysis of a nonpharmacological intervention trial

OBJECTIVE

In an 8-week nonpharmacological pain intervention trial among older adults with lower extremity osteoarthritis (OA), we aimed to examine: a) the baseline frailty level of the participants; b) whether such intervention is more beneficial for baseline frailer older adults than for their counterparts with less frailty; and c) whether the intervention could also alter frailty.

METHODS

Participants were randomly assigned to either chair yoga (CY) or health education program (HEP) groups and attended twice-weekly 45-minute CY or HEP sessions for 8 weeks. Following a standard procedure, 82 variables were used to construct a frailty index (FI, 0-1). Primary outcomes were: Western Ontario and McMaster Universities (WOMAC) pain and pain interference. Linear mixed-effects models were used to evaluate the modifying effect of baseline frailty on the intervention effect of CY on primary outcomes. Similar models were used to evaluate the effect of CY on frailty.

RESULTS

A total of 112 participants (n = 63 CY, n = 49 HEP; 75.3 [SD = 7.5] years) with 85 females (75.9%) were included. The mean values of baseline FI for the CY and HEP groups were similar (0.428 [0.05] and 0.433 [0.05], P = 0.355). Each 0.01 increment in baseline FI was associated with higher WOMAC pain (beta = 0.28, P < 0.001) and pain interference (beta = 0.51, P < 0.001). There was a significant interaction effect between intervention, time, and baseline FI (P = 0.020 for WOMAC pain; P = 0.010 for pain interference), indicating that participants with higher level of baseline FI had greater declines in WOMAC pain and pain interference. There was no significantly greater decline in FI for the CY group compared to the HEP group (between-group difference - 0.01; P = 0.509) and there were no significant trend changes in FI (P for interaction = 0.605).

CONCLUSIONS

Frailty modifies the intervention effect of CY on pain among older adults with lower extremity OA, underscoring the importance of assessing frailty to improve the management of pain in this population.

Longitudinal Relationship Between Knee Pain Status and Incident Frailty: Data from the Osteoarthritis Initiative

Objective

Examine the longitudinal association between knee pain and prefrailty/frailty.

Design

Longitudinal study.

Setting

Five clinical centers across the United States.

Subject

Data from 3,053 nonfrail participants aged 45-79 years at baseline from the Osteoarthritis Initiative.

Methods

According to self-reported knee pain at baseline, the participants were placed into three groups: no knee pain (N = 1,600), unilateral knee pain (N = 822), and bilateral knee pain (N = 631). Frailty status was assessed over time using the five frailty indicators (unintentional weight loss, exhaustion, weak energy, slow gait speed, and little physical activity). Based on the number of frailty indicators present, prefrailty (1-2) and frailty (≥3) were diagnosed. Generalized estimating equations logistic regression analyses were conducted to examine the relationship between knee pain status and prefrailty/frailty.

Results

After adjusting for age, sex, race, education, marital status, smoking status, comorbidities, and body mass index, unilateral knee pain at baseline was associated with an increased odds of developing prefrailty (odds ratio [OR] = 1.14, 95% confidence interval [CI] = 1.01-1.27) and frailty (OR = 1.89, 95% CI = 1.38-2.62), and bilateral knee pain at baseline was also associated with an increased risk of prefrailty (OR = 1.41, 95% CI = 1.24-1.62) and frailty (OR = 2.21, 95% CI = 1.63-3.01) over time in comparison with no knee pain. The interaction of knee pain status by time was not significantly associated with either prefrailty or frailty.

Conclusions

Knee pain (particularly bilateral knee pain) is associated with an increased risk of developing prefrailty and frailty over time.

Pain is not associated with cognitive decline in older adults: A four-year longitudinal study

The finding of a potential association between pain and cognitive decline is limited to a few cross-sectional studies with relatively samples. We therefore aimed to investigate whether the presence and severity of pain at baseline could predict a decline in cognitive function over four years of follow-up in the English Longitudinal Study of Ageing. At baseline, participants with no dementia who were "often troubled by pain" were considered to have pain. Pain severity was categorized as mild, moderate, or severe. Cognitive function was explored through verbal fluency (assessed by asking how many different animals the participants could name in 60 s), memory (sum of immediate and delayed verbal memory) and processing speed (number of target letters correctly identified on the letter cancellation task). Multivariable linear regression was used (exposure: pain; outcomes: cognitive change between follow-up and baseline, based on standardized residuals). Altogether, 6515 community-dwelling people with a mean age of 65 years (women = 57.3%) were included. Over a 4-year follow-up, after adjusting for 26 potential confounders, no association between pain (yes vs. no) and verbal fluency (beta = 0.02; 95%CI: -0.15 to 0.18), memory (0.05; 95%CI: -0.28 to 0.38), or processing speed (0.55; 95%CI: -18.4 to 2.93) at follow-up was found. Only severe pain was associated with greater decline in memory (-0.36; 95%CI: -0.68 to -0.04). In conclusion, in older people, pain was not associated with worsening in cognition, except for severe pain, which was marginally associated with worsening in memory tests. Further longitudinal studies are needed to confirm or refute our findings.

Shared genetic influence on frailty and chronic widespread pain: a study from TwinsUK

Introduction

frailty is an increased vulnerability to adverse health outcomes, across multiple physiological systems, with both environmental and genetic drivers. The two most commonly used measures are Rockwood’s frailty index (FI) and Fried’s frailty phenotype (FP).

Material and methods

the present study included 3626 individuals from the TwinsUK Adult Twin Registry. We used the classical twin model to determine whether FI and FP share the same latent aetiological factors. We also investigated the relationship between frailty and chronic widespread musculoskeletal pain (CWP), another holistic age-related condition with significant clinical impact.

Results

FP and FI shared underlying genetic and environmental aetiology. CWP was associated with both frailty measures, and health deficits appeared to mediate the relationship between phenotypic frailty and pain. Latent genetic factors underpinning CWP were shared with frailty. While frailty was increased in the twins reporting pain, co-twin regression analysis indicated that the relationship between CWP and frailty is reduced after accounting for shared genetic and environmental factors.

Conclusions

both measures of frailty tap the same root causes, thus this work helps unify frailty research. We confirmed a strong association between CWP and frailty, and showed a large and significant shared genetic aetiology of both phenomena. Our findings argue against pain being a significant causative factor in the development of frailty, favouring common causation. This study highlights the need to manage CWP in frail individuals and undertake a Comprehensive Geriatric Assessment in individuals presenting with CWP. Finally, the search for genetic factors underpinning CWP and frailty could be aided by integrating measures of pain and frailty.