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Mickle AM, Staud R, Garvan CS, Kusko DA, Sambuco N, Addison BR, Vincent KR, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Dispositional traits help explain individual differences in relationships between a radiographic knee osteoarthritis measure, pain, and physical function. Ther Adv Musculoskelet Dis 2024; 16:1759720X241235805. [PMID: 38516228 PMCID: PMC10956141 DOI: 10.1177/1759720x241235805] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2023] [Accepted: 02/02/2024] [Indexed: 03/23/2024] Open
Abstract
Background The concordance between radiograph-derived Kellgren-Lawrence (KL) scores for knee osteoarthritis (KOA) and experimental and clinical pain and KOA-related physical function is conflicting. Objectives We investigate whether the inclusion of dispositional traits reduces variability between KOA radiographic findings, experimental pain, clinical pain, and function in individuals with knee pain. Design This study is a cross-sectional, secondary analysis of data collected from the UPLOAD-II study. Methods Adults aged 45-85 years with and without knee pain were enrolled. Data collected included sociodemographics, knee radiographs, experimental pain, clinical pain and function, and trait affect. Vulnerable and protective dispositional traits were classified from combined positive and negative trait affect measures. KL scores were determined from the knee radiographs. Unadjusted and adjusted (age, sex, comorbidities, and body mass index) regression analyses were completed with SAS version 9.4 (Cary, NC, USA). Results The study included 218 individuals with a mean age of 58 years, 63.6% women, and 48.2% non-Hispanic black adults. Dispositional traits were associated with the experimental pain measures. No association between radiographic KOA and experimental pain was observed. In a combined and adjusted analysis, dispositional traits were predictive of knee punctate pain temporal summation (p = 0.0382). Both dispositional traits and radiographic KOA scores independently and combined were predictive of Graded Chronic Pain Scale pain and function, and Western Ontario and McMaster University pain and function (ps ⩽ 0.01). Improvements in R2 were noted across all models with the inclusion of dispositional traits. Conclusion Consideration of dispositional traits reduces the variability between radiographic KOA and pain and function. Non-pathological and associated pain-related psychological factors and dispositional traits might serve as parsimonious proxy tools to improve clinical assessments. Registration N/A.
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Affiliation(s)
- Angela M. Mickle
- Department of Physical Medicine & Rehabilitation, University of Florida, Campus Box 100242, 2004 Mowry Road, Gainesville, FL 32610, USA
- Department of Community Dentistry, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Cynthia S. Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Daniel A. Kusko
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Nicola Sambuco
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Brittany R. Addison
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - Kevin R. Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
- Department of Anesthesiology, Washington University, St. Louis, MO, USA
| | - Roger B. Fillingim
- Department of Community Dentistry, University of Florida, Gainesville, FL, USA
- Pain Research Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Kimberly T. Sibille
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, USA
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
- Pain Research Center of Excellence, University of Florida, Gainesville, FL, USA
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Onoi Y, Matsumoto T, Sobajima S, Tsubosaka M, Hayashi S, Matsushita T, Iwaguro H, Kuroda R. Clinical use of autologous adipose-derived stromal vascular fraction cell injections for hip osteoarthritis. Regen Ther 2023; 24:94-102. [PMID: 37363753 PMCID: PMC10285449 DOI: 10.1016/j.reth.2023.06.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 05/04/2023] [Accepted: 06/07/2023] [Indexed: 06/28/2023] Open
Abstract
Introduction Currently, studies on adipose-derived stromal vascular fraction (SVF) cells are attracting increasing attention because they have the potential to differentiate into a subset of cell types, such as bone marrow-derived mesenchymal stromal cells (MSCs), and are easier to harvest than MSCs, thus making them easier to apply clinically. This study evaluated the short-term clinical outcomes of SVF cell therapy for hip osteoarthritis (OA). Methods Forty-two patients were enrolled in this study; these patients received a single injection comprising an average of 3.8 (standard deviation [SD], ±1.3) × 107 SVF cells into the hip joint. All patients were followed-up for at least 6 months. The mean age of the patients was 60.2 years (SD, ±9.4 years). Kellgren-Lawrence (KL) grades II, III, and IV based on radiography were 13, 13, and 16 patients, respectively. SVF cells were obtained from the subcutaneous fat of the abdomen or breech using a Celution® 800/CRS system. The average cell viability of SVF cells was 90.8% (SD, ±2.8%). Clinical assessments were performed using the Harris Hip Score (HHS), Japanese Orthopaedic Association Hip Disease Evaluation Questionnaire (JHEQ) score, and visual analog scale (VAS) score to evaluate pain. Images were evaluated using radiography, and T2 mapping values were obtained using a 1.5-T magnetic resonance imaging system. These clinical and imaging assessments were followed from preoperatively to 6 months postoperatively. Results The HHS, JHEQ score, and VAS score improved significantly from 22.5 (SD, ±16.6), 26.6 (SD, ±11.3), and 75.5 (SD, ±15.8) preoperatively to 46.8 (SD, ±27.2), 39.4 (SD, ±19.7), and 46.5 (SD, ±27.9), respectively, at 6 months postoperatively. KL grade II showed significant improvement in clinical outcome from preoperative to postoperative, while KL grade IV showed slight or little improvement. The center edge angle, acetabular head index on the radiographs, and T2 mapping values did not change significantly from preoperatively to 6 months postoperatively. Conclusions SVF cell injection in the hip joint showed good short-term clinical efficacy for reducing hip OA symptoms. SVF cell therapy is thus an innovative and effective treatment for hip OA.
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Affiliation(s)
- Yuma Onoi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Tomoyuki Matsumoto
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Satoshi Sobajima
- Department of Orthopaedic Surgery, Sobajima Clinic, Osaka, Japan
| | - Masanori Tsubosaka
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Shinya Hayashi
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Takehiko Matsushita
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
| | - Hideki Iwaguro
- Department of Orthopaedic Surgery, Sobajima Clinic, Osaka, Japan
| | - Ryosuke Kuroda
- Department of Orthopaedic Surgery, Kobe University Graduate School of Medicine, Kobe, Japan
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Montesino-Goicolea S, Valdes-Hernandez P, Laffitte Nodarse C, Johnson AJ, Cole JH, Antoine LH, Goodin BR, Fillingim RB, Cruz-Almeida Y. Brain-predicted age difference mediates the association between PROMIS sleep impairment, and self-reported pain measure in persons with knee pain. AGING BRAIN 2023; 4:100088. [PMID: 37519450 PMCID: PMC10382912 DOI: 10.1016/j.nbas.2023.100088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 08/01/2023] Open
Abstract
Knee pain, the most common cause of musculoskeletal pain (MSK), constitutes a severe public health burden. Its neurobiological causes, however, remain poorly understood. Among many possible causes, it has been proposed that sleep problems could lead to an increase in chronic pain symptomatology, which may be driven by central nervous system changes. In fact, we previously found that brain cortical thickness mediated the relationship between sleep qualities and pain severity in older adults with MSK. We also demonstrated a significant difference in a machine-learning-derived brain-aging biomarker between participants with low-and high-impact knee pain. Considering this, we examined whether brain aging was associated with self-reported sleep and pain measures, and whether brain aging mediated the relationship between sleep problems and knee pain. Exploratory Spearman and Pearson partial correlations, controlling for age, sex, race and study site, showed a significant association of brain aging with sleep related impairment and self-reported pain measures. Moreover, mediation analysis showed that brain aging significantly mediated the effect of sleep related impairment on clinical pain and physical symptoms. Our findings extend our prior work demonstrating advanced brain aging among individuals with chronic pain and the mediating role of brain-aging on the association between sleep and pain severity. Future longitudinal studies are needed to further understand whether the brain can be a therapeutic target to reverse the possible effect of sleep problems on chronic pain.
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Affiliation(s)
- Soamy Montesino-Goicolea
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Pedro Valdes-Hernandez
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Chavier Laffitte Nodarse
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Alisa J. Johnson
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - James H. Cole
- Centre for Medical Image Computing, Department of Computer Science, University College London, UK
- Dementia Research Centre, Institute of Neurology, University College London, UK
| | - Lisa H. Antoine
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, United States
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, United States
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, United States
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, United States
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4
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Leung T, Janssen DM, van der Steen MC, Delvaux EJLG, Hendriks JGE, Janssen RPA. Digital Health Applications to Establish a Remote Diagnosis of Orthopedic Knee Disorders: Scoping Review. J Med Internet Res 2023; 25:e40504. [PMID: 36566450 PMCID: PMC9951077 DOI: 10.2196/40504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Revised: 10/04/2022] [Accepted: 12/23/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Knee pain is highly prevalent worldwide, and this number is expected to rise in the future. The COVID-19 outbreak, in combination with the aging population, rising health care costs, and the need to make health care more accessible worldwide, has led to an increasing demand for digital health care applications to deliver care for patients with musculoskeletal conditions. Digital health and other forms of telemedicine can add value in optimizing health care for patients and health care providers. This might reduce health care costs and make health care more accessible while maintaining a high level of quality. Although expectations are high, there is currently no overview comparing digital health applications with face-to-face contact in clinical trials to establish a primary knee diagnosis in orthopedic surgery. OBJECTIVE This study aimed to investigate the currently available digital health and telemedicine applications to establish a primary knee diagnosis in orthopedic surgery in the general population in comparison with imaging or face-to-face contact between patients and physicians. METHODS A scoping review was conducted using the PubMed and Embase databases according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) statement. The inclusion criteria were studies reporting methods to determine a primary knee diagnosis in orthopedic surgery using digital health or telemedicine. On April 28 and 29, 2021, searches were conducted in PubMed (MEDLINE) and Embase. Data charting was conducted using a predefined form and included details on general study information, study population, type of application, comparator, analyses, and key findings. A risk-of-bias analysis was not deemed relevant considering the scoping review design of the study. RESULTS After screening 5639 articles, 7 (0.12%) were included. In total, 2 categories to determine a primary diagnosis were identified: screening studies (4/7, 57%) and decision support studies (3/7, 43%). There was great heterogeneity in the included studies in algorithms used, disorders, input parameters, and outcome measurements. No more than 25 knee disorders were included in the studies. The included studies showed a relatively high sensitivity (67%-91%). The accuracy of the different studies was generally lower, with a specificity of 27% to 48% for decision support studies and 73% to 96% for screening studies. CONCLUSIONS This scoping review shows that there are a limited number of available applications to establish a remote diagnosis of knee disorders in orthopedic surgery. To date, there is limited evidence that digital health applications can assist patients or orthopedic surgeons in establishing the primary diagnosis of knee disorders. Future research should aim to integrate multiple sources of information and a standardized study design with close collaboration among clinicians, data scientists, data managers, lawyers, and service users to create reliable and secure databases.
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Affiliation(s)
| | - Daan M Janssen
- Department of Orthopedic Surgery & Trauma, Máxima Medical Center, Veldhoven, Netherlands
| | - Maria C van der Steen
- Department of Orthopedic Surgery & Trauma, Máxima Medical Center, Veldhoven, Netherlands.,Department of Orthopedic Surgery & Trauma, Catharina Hospital, Eindhoven, Netherlands
| | | | - Johannes G E Hendriks
- Department of Orthopedic Surgery & Trauma, Máxima Medical Center, Veldhoven, Netherlands
| | - Rob P A Janssen
- Department of Orthopedic Surgery & Trauma, Máxima Medical Center, Veldhoven, Netherlands.,Orthopedic Biomechanics, Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, Netherlands.,Value-Based Health Care, Department of Paramedical Sciences, Fontys University of Applied Sciences, Eindhoven, Netherlands
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5
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Montesino-Goicolea S, Meng L, Rani A, Huo Z, Foster TC, Fillingim RB, Cruz-Almeida Y. Enrichment of genomic pathways based on differential DNA methylation profiles associated with knee osteoarthritis pain. NEUROBIOLOGY OF PAIN (CAMBRIDGE, MASS.) 2022; 12:100107. [PMID: 36531611 PMCID: PMC9755025 DOI: 10.1016/j.ynpai.2022.100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Revised: 10/31/2022] [Accepted: 10/31/2022] [Indexed: 11/05/2022]
Abstract
Our study aimed to identify differentially methylated regions (i.e., genomic region where multiple adjacent CpG sites show differential methylation) and their enriched genomic pathways associated with knee osteoarthritis pain (KOA). We recruited cognitively healthy middle to older aged (age 45-85) adults with (n = 182) and without (n = 31) self-reported KOA pain. We also extracted DNA from peripheral blood that was analyzed using MethylationEPIC arrays. The R package minfi (Aryee et al., 2014) was used to perform methylation data preprocessing and quality control. To investigate biological pathways impacted by differential methylation, we performed pathway enrichment analysis using Ingenuity Pathway Analysis (IPA) to identify canonical pathways and upstream regulators. Annotated genes within ± 5 kb of the putative differentially methylated regions (DMRs, p < 0.05) were subjected to the IPA analysis. There was no significant difference in age, sex, study site between no pain and pain group (p > 0.05). Non-Hispanic black individuals were overrepresented in the pain group (p = 0.003). At raw p < 0.05 cutoff, we identified a total of 19,710 CpG probes, including 13,951 hypermethylated CpG probes, for which DNA methylation level was higher in the groups with highest pain grades. We also identified 5,759 hypomethylated CpG probes for which DNA methylation level was lower in the pain groups with higher pain grades. IPA revealed that pain-related DMRs were enriched across multiple pathways and upstream regulators. The top 10 canonical pathways were linked to cellular signaling processes related to immune responses (i.e., antigen presentation, PD-1, PD-L1 cancer immunotherapy, B cell development, IL-4 signaling, Th1 and Th2 activation pathway, and phagosome maturation). Moreover, in terms of upstream regulators, NDUFAF3 was the most significant (p = 8.6E-04) upstream regulator. Our findings support previous preliminary work suggesting the importance of epigenetic regulation of the immune system in knee pain and the need for future work to understand the epigenetic contributions to chronic pain.
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Affiliation(s)
- Soamy Montesino-Goicolea
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
| | - Lingsong Meng
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Asha Rani
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Zhiguang Huo
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas C. Foster
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B. Fillingim
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Center for Cognitive Aging & Memory, McKnight Brain Foundation, University of Florida, Gainesville, FL, USA
- Department of Biostatistics, College of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, College of Medicine, University of Florida, Gainesville, FL, USA
- Institute on Aging, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, USA
- Corresponding author at: PO Box 103628, 1329 SW 16th Street, Ste 5180 (zip 32608), Gainesville, FL 32610, USA. https://price.ctsi.ufl.edu/about-the-center/staff/yenisel-cruz-almeida/
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6
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Haider MZ, Bhuiyan R, Ahmed S, Zahid-Al-Quadir A, Choudhury MR, Haq SA, Zaman MM. Risk factors of knee osteoarthritis in Bangladeshi adults: a national survey. BMC Musculoskelet Disord 2022; 23:333. [PMID: 35395747 PMCID: PMC8991964 DOI: 10.1186/s12891-022-05253-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Knee osteoarthritis was reported as the second most prevalent condition in the national musculoskeletal survey. The purpose of this extended study was to identify risk factors for knee osteoarthritis in Bangladeshi adults. METHODS This cross-sectional study was conducted in rural and urban areas of Bangladesh using stratified multistage cluster sample of 2000 adults aged 18 years or older recruited at their households. The Modified Community Oriented Program for Control of Rheumatic Disorders (COPCORD) questionnaire was used to collect data. The diagnosis of knee osteoarthritis was made using the decision tree clinical categorization criteria of the American College of Rheumatology. Univariate and multivariate logistic regression analyses were done to identify the risk factors for knee osteoarthritis. RESULTS A total of 1843 individuals (892 men and 951 women) participated, and 134 had knee osteoarthritis yielding a prevalence of 7.3% (95% confidence interval (CI) 4.9 to 9.6%). The mean (standard deviation) age of the knee osteoarthritis patients was 51.7 (11.2) years. Multivariate logistic regression analysis found a significant association with increasing age (≥38 years OR 8.9, 95% CI 4.8-16.5; ≥58 years OR 13.9, 95% CI 6.9-28.0), low educational level (OR 1.7, 95% CI 1.0-2.7) and overweight (OR 1.9, 95% CI 1.2-2.9) with knee osteoarthritis. Knee osteoarthritis patients had a high likelihood of having work loss preceding 12 months (age and sex-adjusted OR 2.3; 95% CI 1.4-3.8; P < 0.01). CONCLUSIONS Knee osteoarthritis is a commonly prevalent musculoskeletal problem among Bangladeshi adults having link to work loss. Increasing age, low education and overweight are significant risk factors of knee osteoarthritis.
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Affiliation(s)
- Mohammad Ziaul Haider
- Tb Control and Training Institute, Dhaka, Bangladesh.,Present Address: 250 Bedded Tb Hospital, Dhaka, Bangladesh
| | - Rijwan Bhuiyan
- Ministry of Health and Family Welfare Coordination Center, Cox's Bazar, Bangladesh
| | - Shamim Ahmed
- Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh
| | | | | | - Syed Atiqul Haq
- Department of Rheumatology, BSM Medical University, Dhaka, Bangladesh
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Sambuco N, Mickle AM, Garvan C, Cardoso J, Johnson AJ, Kusko DA, Addison A, Glover TL, Staud R, Redden D, Goodin B, Fillingim RB, Sibille KT. Vulnerable Dispositional Traits and Chronic Pain: Predisposing but not Predetermining. THE JOURNAL OF PAIN 2022; 23:693-705. [PMID: 34856411 DOI: 10.1016/j.jpain.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 11/08/2021] [Accepted: 11/17/2021] [Indexed: 01/13/2023]
Abstract
Dispositional traits can be protective or contribute to increased vulnerability in individuals with chronic pain. This study aims to evaluate the association between two dispositional trait measures, affect balance style and multi-domain trait groups, with psychosocial measures, clinical pain, functional pain, and experimental pain at two years in individuals with chronic knee pain. The study is a prospective analysis of 168 community dwelling individuals aged 45 to 85 years old with knee pain with or at risk for knee osteoarthritis. At baseline, affect balance style and multi-domain trait groups were associated with psychosocial measures, clinical pain, and functional status. At the two-year time point, the multi-domain trait groups were associated with the clinical pain measures. Interestingly, individuals with previously demonstrated vulnerable traits showed more variability in dispositional trait status at the two-year time point compared to those with dispositional traits previously demonstrated as more protective. Findings reiterate that dispositional traits are predisposing but are not predetermining regarding pain-related experiences. PERSPECTIVE: Vulnerable and protective dispositional traits are positively and negatively associated with clinical pain and functional limitations respectively. Although considered relatively stable, a 30-50% shift in dispositional traits was indicated over a two-year period. Findings highlight that dispositional trait are modifiable and thus, predisposing but not predetermining for persisting chronic pain.
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Affiliation(s)
- Nicola Sambuco
- College of Public Health and Health Professions, Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida.
| | - Angela M Mickle
- College of Dentistry, Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Cynthia Garvan
- College of Medicine, Anesthesiology, University of Florida, Gainesville, Florida
| | - Josue Cardoso
- College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Alisa J Johnson
- College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Daniel A Kusko
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Adriana Addison
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Toni L Glover
- School of Nursing, Oakland University, Rochester, Michigan
| | - Roland Staud
- College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; College of Medicine, Rheumatology, University of Florida, Gainesville, Florida
| | - David Redden
- College of Medicine, Public Health, University of Alabama at Birmingham, Birmingham, Alabama
| | - Burel Goodin
- College of Arts and Science, Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roger B Fillingim
- College of Dentistry, Community Dentistry and Behavioral Science, University of Florida, Gainesville, Florida; College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- College of Dentistry, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida; College of Medicine, Anesthesiology, University of Florida, Gainesville, Florida; College of Medicine, Aging and Geriatric Research, University of Florida, Gainesville, Florida
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8
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Terry EL, Tanner JJ, Cardoso JS, Sibille KT, Lai S, Deshpande H, Deutsch G, Price CC, Staud R, Goodin BR, Redden DT, Fillingim RB. Associations between pain catastrophizing and resting-state functional brain connectivity: Ethnic/race group differences in persons with chronic knee pain. J Neurosci Res 2022; 100:1047-1062. [PMID: 35187703 PMCID: PMC8940639 DOI: 10.1002/jnr.25018] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 01/05/2022] [Accepted: 01/07/2022] [Indexed: 02/01/2023]
Abstract
Chronic pain is a significant public health problem, and the prevalence and societal impact continues to worsen annually. Multiple cognitive and emotional factors are known to modulate pain, including pain catastrophizing, which contributes to pain facilitation and is associated with altered resting-state functional connectivity in pain-related cortical and subcortical circuitry. Pain and catastrophizing levels are reported to be higher in non-Hispanic black (NHB) compared with non-Hispanic White (NHW) individuals. The current study, a substudy of a larger ongoing observational cohort investigation, investigated the pathways by which ethnicity/race influences the relationship between pain catastrophizing, clinical pain, and resting-state functional connectivity between anterior cingulate cortex (ACC), dorsolateral prefrontal cortex (dlPFC), insula, and primary somatosensory cortex (S1). Participants included 136 (66 NHBs and 70 NHWs) community-dwelling adults with knee osteoarthritis. Participants completed the Coping Strategies Questionnaire-Revised Pain Catastrophizing subscale and Western Ontario and McMaster Universities Osteoarthritis Index. Magnetic resonance imaging data were obtained, and resting-state functional connectivity was analyzed. Relative to NHW, the NHB participants were younger, reported lower income, were less likely to be married, and self-reported greater clinical pain and pain catastrophizing (ps < 0.05). Ethnicity/race moderated the mediation effects of catastrophizing on the relationship between clinical pain and resting-state functional connectivity between the ACC, dlPFC, insula, and S1. These results indicate the NHB and NHW groups demonstrated different relationships between pain, catastrophizing, and functional connectivity. These results provide evidence for a potentially important role of ethnicity/race in the interrelationships among pain, catastrophizing, and resting-state functional connectivity.
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Affiliation(s)
- Ellen L. Terry
- College of Nursing, Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, Florida, USA,Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
| | - Jared J. Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Josue S. Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
| | - Kimberly T. Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, USA
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, Florida, USA,CTSI Human Imaging Core, University of Florida, Gainesville, Florida, USA
| | - Hrishikesh Deshpande
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, USA,Division of Advanced Medical Imaging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Georg Deutsch
- Division of Molecular Imaging and Therapeutics, University of Alabama at Birmingham, Birmingham, Alabama, USA,Division of Advanced Medical Imaging Research, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Catherine C. Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, Florida, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - David T. Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida, USA
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9
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Tanner JJ, Cardoso J, Terry EL, Booker SQ, Glover TL, Garvan C, Deshpande H, Deutsch G, Lai S, Staud R, Addison A, Redden D, Goodin BR, Price CC, Fillingim RB, Sibille KT. Chronic Pain Severity and Sociodemographics: An Evaluation of the Neurobiological Interface. THE JOURNAL OF PAIN 2022; 23:248-262. [PMID: 34425249 PMCID: PMC8828699 DOI: 10.1016/j.jpain.2021.07.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 02/03/2023]
Abstract
Chronic pain is variably associated with brain structure. Phenotyping based on pain severity may address inconsistencies. Sociodemographic groups also differ in the experience of chronic pain severity. Whether differences by chronic pain severity and/or sociodemographic groups are indicated in pain-related areas of the brain is unknown. Relations between 2 measures of chronic pain severity and brain structure via T1-weighted MRI were investigated and sociodemographic group differences explored. The observational study included 142 community-dwelling (68 non-Hispanic Black [NHB] and 74 non-Hispanic White [NHW]) adults with/at risk for knee osteoarthritis. Relationships between chronic pain severity, sociodemographic groups, and a priori selected brain structures (postcentral gyrus, insula, medial orbitofrontal, anterior cingulate, rostral middle frontal gyrus, hippocampus, amygdala, thalamus) were explored. Chronic pain severity associated with cortical thickness. NHB participants reported lower sociodemographic protective factors and greater clinical pain compared to NHWs who reported higher sociodemographic protective factors and lower clinical pain. Greater chronic pain severity was associated with smaller amygdala volumes in the NHB group and larger amygdala volumes in the NHW group. Brain structure by chronic pain stage differed between and within sociodemographic groups. Overall, chronic pain severity and sociodemographic factors are associated with pain-related brain structures. Our findings highlight the importance of further investigating social and environmental contributions in the experience of chronic pain to unravel the complex array of factors contributing to disparities. PERSPECTIVE: The study presents data demonstrating structural brain relationships with clinical pain severity, characteristic pain intensity and chronic pain stage, differ by sociodemographic groups. Findings yield insights into potential sources of previous inconsistent pain-brain relationships and highlights the need for future investigations to address social and environmental factors in chronic pain disparities research.
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Affiliation(s)
- Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Josue Cardoso
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Ellen L Terry
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL,Department of Behavioral Nursing Science, University of Florida, Gainesville, FL
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL,Department of Behavioral Nursing Science, University of Florida, Gainesville, FL
| | - Toni L Glover
- School of Nursing, Oakland University, Rochester, MI
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL
| | | | - Georg Deutsch
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, FL
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL
| | - Adrianna Addison
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - David Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, AL,Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL,Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
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10
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Tanner JJ, Hanchate S, Price CC, Garvan C, Lai S, Staud R, Deshpande H, Deutsch G, Goodin BR, Fillingim RB, Sibille KT. Relationships Between Chronic Pain Stage, Cognition, Temporal Lobe Cortex, and Sociodemographic Variables. J Alzheimers Dis 2021; 80:1539-1551. [PMID: 33720889 DOI: 10.3233/jad-201345] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Non-Hispanic black (NHB) individuals have increased risk of Alzheimer's disease (AD) relative to non-Hispanic whites (NHW). Ethnicity/race can serve as a proxy sociodemographic variable for a complex representation of sociocultural and environmental factors. Chronic pain is a form of stress with high prevalence and sociodemographic disparities. Chronic pain is linked to lower cognition and accelerated biological aging. OBJECTIVE The purpose of this study is to seek understanding of potential cognitive and temporal lobe structural brain AD vulnerabilities based on chronic pain stage and ethnicity/race. METHODS Participants included 147 community dwelling NHB and NHW adults without dementia between 45-85 years old who had or were at risk of knee osteoarthritis. All participants received an MRI (3T Philips), the Montreal Cognitive Assessment (MoCA), and assessment of clinical knee pain stage. RESULTS There were ethnic/race group differences in MoCA scores but no relationships with chronic knee pain stage. Ethnicity/race moderated the relationship between AD-related temporal lobe thickness and chronic pain stage with quadratic patterns suggesting thinner cortex in high chronic pain stage NHB adults. CONCLUSION There appear to be complex relationships between chronic knee pain stage, temporal lobe cortex, and sociodemographic variables. Specifically, NHB participants without dementia but with high chronic knee pain stage appeared to have thinner temporal cortex in areas associated with AD. Understanding the effects of sociocultural and socioeconomic factors on health outcomes is the first step to challenging the disparities in healthcare that now appear to link disease conditions to neurodegenerative processes.
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Affiliation(s)
- Jared J Tanner
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA
| | - Shivani Hanchate
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Catherine C Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Song Lai
- Department of Radiation Oncology, University of Florida, Gainesville, FL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Hrishikesh Deshpande
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Georg Deutsch
- Department of Radiology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA.,Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Aging & Geriatric Research, University of Florida, Gainesville, FL, USA
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11
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Associations of pain catastrophizing with pain-related brain structure in individuals with or at risk for knee osteoarthritis: Sociodemographic considerations. Brain Imaging Behav 2021; 15:1769-1777. [PMID: 33095381 DOI: 10.1007/s11682-020-00372-w] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
Compelling evidence exists that non-Hispanic blacks (NHB) engage in pain catastrophizing (negatively evaluate one's ability to cope with pain) more often than non-Hispanic whites (NHW). Functional neuroimaging studies revealed that individuals with high levels of trait pain catastrophizing show increased cerebral responses to pain in several pain-related brain regions (e.g., insula, primary somatosensory cortex [S1]), but associations between brain structure and catastrophizing remain largely unexplored. The current investigation was conducted at the University of Florida and the University of Alabama at Birmingham. Participants were 129 community-dwelling adults with or at risk of knee osteoarthritis (OA). Participants completed the pain catastrophizing subscale of the Coping Strategies Questionnaire-Revised and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain intensity subscale. Magnetic Resonance Imaging data were obtained. MANOVA and Chi-Square analyses assessed sociodemographic/clinical differences stratified by ethnicity/race. Multivariate regression analyses with insula and somatosensory cortical thickness entered as dependent variables with catastrophizing and the interaction between catastrophizing and ethnicity/race as the independent variables. Covariates include education, body mass index, study site, and WOMAC pain (ethnicity/race was an additional covariate in non-stratified analyses). There were significant interactions between ethnicity/race, pain catastrophizing, and brain structure. Higher pain catastrophizing was associated with thinner S1 bilaterally (ps < .05) in NHW, but not NHB participants with or at risk for knee OA. These results suggest that pain catastrophizing might have differing effects on pain-related central pathways and may contribute to ethnic/race group differences in individuals with or at risk for knee OA.
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12
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Psychological Predictors of Perceived Age and Chronic Pain Impact in Individuals With and Without Knee Osteoarthritis. Clin J Pain 2021; 36:569-577. [PMID: 32398442 DOI: 10.1097/ajp.0000000000000842] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Chronological age is a risk factor in chronic pain; however, aging research supports the premise that physical and psychological health may better predict perceived age. Given the lack of evidence on perceived age in the context of chronic pain, the current study presents novel findings about the relationship between perceived age, chronic pain impact, and psychological function in adults with and without knee osteoarthritis. METHODS This secondary analysis was part of an ongoing multisite observational cohort study to understand the progression of knee pain and disability. Community-dwelling adults (N=227) ages 45+ completed measures of trait resilience, trait positive and negative affect, pain catastrophizing, subjective perceptions of age, and the Graded Chronic Pain Scale. RESULTS On average, participants reported feeling 10 years younger than their chronological age; however, this effect was attenuated in individuals reporting high-impact pain. Lower perceived age was associated with lower pain impact (low pain/low disability), while higher perceived age correlated with higher pain impact (high pain/high disability) and more adverse psychological effects. Using hierarchical linear regression, high-impact pain and positive affect emerged as statistically significant predictors of perceived age, whereas no differences were observed among trait resilience, negative affect, or pain catastrophizing. DISCUSSION These findings highlight the importance of a biopsychosocial approach in understanding the intersection between psychological and physical factors associated with chronic pain. Addressing negative self-perceptions of aging, while simultaneously augmenting positive affect, through psychological therapies may mitigate pain and disability.
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13
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Liu N, Birstler J, Venkatesh M, Hanrahan L, Chen G, Funk L. Obesity and BMI Cut Points for Associated Comorbidities: Electronic Health Record Study. J Med Internet Res 2021; 23:e24017. [PMID: 34383661 PMCID: PMC8386370 DOI: 10.2196/24017] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 11/01/2020] [Accepted: 06/21/2021] [Indexed: 01/30/2023] Open
Abstract
Background Studies have found associations between increasing BMIs and the development of various chronic health conditions. The BMI cut points, or thresholds beyond which comorbidity incidence can be accurately detected, are unknown. Objective The aim of this study is to identify whether BMI cut points exist for 11 obesity-related comorbidities. Methods US adults aged 18-75 years who had ≥3 health care visits at an academic medical center from 2008 to 2016 were identified from eHealth records. Pregnant patients, patients with cancer, and patients who had undergone bariatric surgery were excluded. Quantile regression, with BMI as the outcome, was used to evaluate the associations between BMI and disease incidence. A comorbidity was determined to have a cut point if the area under the receiver operating curve was >0.6. The cut point was defined as the BMI value that maximized the Youden index. Results We included 243,332 patients in the study cohort. The mean age and BMI were 46.8 (SD 15.3) years and 29.1 kg/m2, respectively. We found statistically significant associations between increasing BMIs and the incidence of all comorbidities except anxiety and cerebrovascular disease. Cut points were identified for hyperlipidemia (27.1 kg/m2), coronary artery disease (27.7 kg/m2), hypertension (28.4 kg/m2), osteoarthritis (28.7 kg/m2), obstructive sleep apnea (30.1 kg/m2), and type 2 diabetes (30.9 kg/m2). Conclusions The BMI cut points that accurately predicted the risks of developing 6 obesity-related comorbidities occurred when patients were overweight or barely met the criteria for class 1 obesity. Further studies using national, longitudinal data are needed to determine whether screening guidelines for appropriate comorbidities may need to be revised.
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Affiliation(s)
- Natalie Liu
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Jen Birstler
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Manasa Venkatesh
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States
| | - Lawrence Hanrahan
- Department of Family Medicine and Community Health, University of Wisconsin-Madison, Madison, WI, United States
| | - Guanhua Chen
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, WI, United States
| | - Luke Funk
- Department of Surgery, University of Wisconsin-Madison, Madison, WI, United States.,Department of Surgery, William S. Middleton Memorial VA, Madison, WI, United States
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14
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Fullwood D, Gomez RN, Huo Z, Cardoso JS, Bartley EJ, Booker SQ, Powell-Roach KL, Johnson AJ, Sibille KT, Addison AS, Goodin BR, Staud R, Redden DT, Fillingim RB, Terry EL. A Mediation Appraisal of Catastrophizing, Pain-Related Outcomes, and Race in Adults With Knee Osteoarthritis. THE JOURNAL OF PAIN 2021; 22:1452-1466. [PMID: 34033964 DOI: 10.1016/j.jpain.2021.04.018] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/19/2022]
Abstract
The current cross-sectional study investigates whether pain catastrophizing mediates the relationship between ethnicity/race and pain, disability and physical function in individuals with knee osteoarthritis. Furthermore, this study examined mediation at 2-year follow-up. Participants included 187 community-dwelling adults with unilateral or bilateral knee pain who screened positive for knee osteoarthritis. Participants completed several self-reported pain-related measures and pain catastrophizing subscale at baseline and 2-year follow-up. Non-Hispanic Black (NHB) adults reported greater pain, disability, and poorer functional performance compared to their non-Hispanic White (NHW) counterparts (Ps < .05). NHB adults also reported greater catastrophizing compared to NHW adults. Mediation analyses revealed that catastrophizing mediated the relationship between ethnicity/race and pain outcome measures. Specifically, NHB individuals reported significantly greater pain and disability, and exhibited lower levels of physical function, compared to NHW individuals, and these differences were mediated by higher levels of catastrophizing among NHB persons. Catastrophizing was a significant predictor of pain and disability 2-years later in both ethnic/race groups. These results suggest that pain catastrophizing is an important variable to consider in efforts to reduce ethnic/race group disparities in chronic pain. The findings are discussed in light of structural/systemic factors that may contribute to greater self-reports of pain catastrophizing among NHB individuals. PERSPECTIVE: The current study examines whether pain catastrophizing mediates the relationship between ethnicity/race and OA-related pain, disability, and functional impairment at baseline and during a 2-year follow-up period in non-Hispanic Black and non-Hispanic White adults with knee pain. These results point to the need for interventions that target pain catastrophizing.
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Affiliation(s)
- Dottington Fullwood
- University of Florida, Department of Aging and Geriatric Research, Gainesville, Florida
| | - Rebecca N Gomez
- University of Florida, College of Nursing, Gainesville, Florida
| | - Zhiguang Huo
- University of Florida, Department of Biostatistics, Gainesville, Florida
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Emily J Bartley
- University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Staja Q Booker
- University of Florida, College of Nursing, Gainesville, Florida
| | | | - Alisa J Johnson
- University of Florida, Department of Aging and Geriatric Research, Gainesville, Florida
| | - Kimberly T Sibille
- University of Florida, Department of Aging and Geriatric Research, Gainesville, Florida
| | - Adriana S Addison
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida
| | - Burel R Goodin
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida
| | - Roland Staud
- University of Florida, Department of Medicine, Gainesville, Florida
| | - David T Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, Alabama
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida; University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
| | - Ellen L Terry
- University of Florida, College of Nursing, Gainesville, Florida; University of Alabama at Birmingham, Department of Psychology, Birmingham, Alabama
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15
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Johnson AJ, Vasilopoulos T, Booker SQ, Cardoso J, Terry EL, Powell-Roach K, Staud R, Kusko DA, Addison AS, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:415. [PMID: 33952243 PMCID: PMC8101224 DOI: 10.1186/s12891-021-04284-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Pain is the hallmark symptom of knee osteoarthritis (OA), and varies widely across individuals. Previous research has demonstrated both fluctuating and stable pain trajectories in knee OA using various time periods. Changes in pain assessed quarterly (i.e. 3-month intervals) in knee OA are relatively unknown. The current study aimed to investigate temporal variations in pain over a one and a half year period (18 months) based on quarterly characteristic pain assessments, and to examine differences in pain patterns by sociodemographic and baseline pain characteristics. METHODS The sample included a prospective cohort of 188 participants (mean age 58 years; 63% female; 52% non-Hispanic Black) with or at risk for knee OA from an ongoing multisite investigation of ethnic/race group differences. Knee pain intensity was self-reported at baseline and quarterly over an18-month period. Baseline pain assessment also included frequency, duration, and total number of pain sites. Group-based trajectory modeling was used to identify distinct pain trajectories. Multinomial logistic regression was used to examine associations between sociodemographic characteristics, risk factors, and pain trajectory groups. RESULTS Pain trajectories were relatively stable among a sample of adults with knee pain. Four distinct pain trajectories emerged in the overall sample, with the largest proportion of participants (35.1%) classified in the moderate-high pain group. There were significant relationships between age, education, income, ethnicity/race and trajectory group; with younger, less educated, lower income, and non-Hispanic Black participants had a greater representation in the highest pain trajectory group. CONCLUSIONS Pain remained stable across a one and a half-year period in adults with or at risk for knee osteoarthritis, based on quarterly assessments. Certain sociodemographic variables (e.g. ethnicity/race, education, income, age) may contribute to an increased risk of experiencing greater pain.
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Affiliation(s)
- Alisa J. Johnson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Staja Q. Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Josue Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
| | - Ellen L. Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Daniel A. Kusko
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Adriana S. Addison
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - David T. Redden
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Kimberly T. Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Aging & Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL USA
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16
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Lall AC, Schwarzman GR, Battaglia MR, Chen SL, Maldonado DR, Domb BG. Effect of marital status on patient-reported outcomes following total hip arthroplasty: a matched analysis with minimum 2-year follow-up. Hip Int 2021; 31:362-368. [PMID: 31328566 DOI: 10.1177/1120700019864015] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Mental health and patient expectation have been identified as key predictors of recovery following THA; however, there is limited literature examining the effects of social support and marital status on patient-reported outcomes (PROs). METHODS Data were prospectively collected and retrospectively reviewed for patients who underwent THA between July 2008 and January 2016. Patients were included if they underwent primary THA during this period and if they had documented preoperative marital status of married, divorced, or never married. Married patients were group matched to non-married patients (divorced or never married) with similar sex, age, body mass index (BMI), gender distribution, and frequency of surgical approach. RESULTS There were 414 married patients and 98 non-married patients who were eligible and had minimum 2-year follow-up. Mean PROs were significantly worse in the non-married group than the married group for the following measures: modified Harris Hip Score (p = 0.002), Harris Hip Score (p = 0.002), Forgotten Joint Score (p = 0.04), and the physical portions of the Veterans RAND (p = 0.025) and Short Form (p = 0.02) surveys. CONCLUSIONS Our study demonstrated inferior absolute PRO scores at latest follow-up for patients who were non-married compared to married following THA. These results show that while total hip replacement may still yield clinical benefit in all patients, non-married patients may ultimately achieve an inferior functional status, and expectations should be adjusted accordingly. Physicians should assess levels of psychosocial support in their patients prior to undergoing hip arthroplasty in order to optimise results.
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17
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Diagnostic Accuracy of Patient History in the Diagnosis of Hip-Related Pain: A Systematic Review. Arch Phys Med Rehabil 2021; 102:2454-2463.e1. [PMID: 33930328 DOI: 10.1016/j.apmr.2021.03.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/29/2021] [Accepted: 03/31/2021] [Indexed: 11/23/2022]
Abstract
OBJECTIVE To investigate the diagnostic accuracy of patient history associated with hip pain. DATA SOURCES A systematic, computerized search of electronic databases (PubMed, MEDLINE, Cumulative Index of Nursing and Allied Health Literature, and Web of Science), a search of the gray literature, and review of the primary author's personal library was performed. Hip-specific search terms were combined with diagnostic accuracy and subjective or self-report history-based search terms using the Boolean operator "AND." STUDY SELECTION This systematic review was conducted and reported according to the protocol outlined by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The inclusion criteria were: (1) patients with hip pain; (2) the statistical association of at least 1 patient history item was reported; (3) study designs appropriate for diagnostic accuracy; (4) adults aged ≥18 years; (5) written in English; and (6) used an acceptable reference standard for diagnosed hip pathology. Titles and abstracts of all database-captured citations were independently screened by at least 2 reviewers. DATA EXTRACTION Two reviewers independently extracted information and data regarding author, year, study population, study design, criterion standard, and strength of association statistics associated with the subjective findings. DATA SYNTHESIS For hip osteoarthritis (OA), a family history of OA (positive likelihood ratio [+LR], 2.13), history of knee OA (+LR, 2.06), report of groin or anterior thigh pain (+LR, 2.51-3.86), self-reported limitation in range of motion of 1 or both hips (+LR, 2.87), constant low back pain or buttock pain (+LR, 6.50), groin pain on the same side (+LR, 3.63), and a screening questionnaire (+LR, 3.87-13.29) were the most significant findings. For intra-articular hip pathology, crepitus (+LR, 3.56) was the most significant finding. CONCLUSIONS Patient history plays a key role in differential diagnosis of hip pain and in some cases can be superior to objective tests and measures.
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18
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Terry EL, Booker SQ, Cardoso JS, Sibille KT, Bartley EJ, Glover TL, Vaughn IA, Thompson KA, Bulls HW, Addison AS, Staud R, Hughes LB, Edberg JC, Redden DT, Bradley LA, Goodin BR, Fillingim RB. Neuropathic-Like Pain Symptoms in a Community-Dwelling Sample with or at Risk for Knee Osteoarthritis. PAIN MEDICINE 2021; 21:125-137. [PMID: 31150093 DOI: 10.1093/pm/pnz112] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To characterize neuropathic-like pain among individuals with or at risk for knee osteoarthritis. SUBJECTS One hundred eighty-four individuals who self-identified as non-Hispanic black or non-Hispanic white and presented with unilateral or bilateral knee pain. DESIGN Neuropathic-like pain was assessed using the painDETECT, and those with high vs low neuropathic-like pain were compared on clinical pain, psychological symptoms, physical function, and quantitative sensory testing. Analyses were unadjusted, partially and fully adjusted for relevant covariates. RESULTS Thirty-two (17.4%) participants reported experiencing neuropathic-like pain features above the painDETECT clinical cut-score. The neuropathic-like pain group reported significantly greater pain severity on all measures of clinical pain and higher levels of psychological symptoms when fully adjusted for covariates, but no differences emerged for disability and lower extremity function. The neuropathic-like pain group also reported greater overall heat pain ratings during the heat pain threshold and increased temporal summation of heat pain in the fully adjusted model. Additionally, those with neuropathic-like pain symptoms reported greater painful after-sensations following heat pain temporal summation in all analyses. No significant group differences in pressure pain threshold emerged at any of the testing sites. In contrast, temporal summation of mechanical pain was significantly greater at both the index knee and the ipsilateral hand for the neuropathic-like pain group in all analyses. CONCLUSIONS Participants with or at risk for knee osteoarthritis who reported high neuropathic-like pain experienced significantly greater clinical pain and increased heat and mechanical temporal summation at the index knee and other body sites tested, suggesting central sensitization.
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Affiliation(s)
- Ellen L Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Staja Q Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Toni L Glover
- College of Nursing, University of Florida, Gainesville, Florida
| | - Ivana A Vaughn
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Kathryn A Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Hailey W Bulls
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL
| | - Adriana S Addison
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roland Staud
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
| | - Laura B Hughes
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Jeffrey C Edberg
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, Florida
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Schiavi P, Calderazzi F, Pedrini MF, Tacci F, Vaienti E, Pogliacomi F. Efficacy and safety of viscosupplementation with hyaluronic acid for hip osteoarthritis: results from a cross-sectional study with a minimum follow-up of 4 years. ACTA BIO-MEDICA : ATENEI PARMENSIS 2020; 91:e2020032. [PMID: 33559627 PMCID: PMC7944698 DOI: 10.23750/abm.v91i14-s.11110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Accepted: 12/14/2020] [Indexed: 11/23/2022]
Abstract
Background and aim of the work: Osteoarthritis is the most common cause of disability in elderly. Hip osteoarthritis is the second most frequent form affecting a large joint and the social and economic impact on society of its related disability is expected to increase. The purpose of this study was to verify the efficacy and safety of ultrasound-guided viscosupplementation with high weight hyaluronic acid in hip osteoarthritis. Methods: 183 patients with painful hip OA (Kellgren-Lawrence 1-2-3) were treated from January 2014 to December 2016 with viscosupplementation. Patients were evaluated before injection (T0) and after 1,2,3,4 (T1-T2-T3-T4) years through the VAS scale and Harris Hip Score (HHS). Patients who underwent to subsequent injections were followed and assessed. Subjects who underwent prosthesis were analyzed for a minimum of 6 months in order to detect any early postoperative complication. Results: The mean improvement of HHS and VAS between T0 and T1 was statistically significant. Patients who underwent subsequent injections showed a higher improvement even if statistical significance was not observed. Results showed that patients with grade 2 of osteoarthritis had the higher change in the scores. No adverse effects were registered. No early complications were reported in those patients who needed prosthesis. Discussion and Conclusions: Results observed confirm that ultrasound-guided viscosupplementation with high weight hyaluronic acid could be a possibility in the treatment of hip osteoarthritis, especially in patients with Kellgren-Lawrence grade 2 of disease. Subsequent injections are not characterized by similar positive effects. Outcomes of prosthetic surgery are not influenced by viscosupplementation.
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Affiliation(s)
- Paolo Schiavi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Filippo Calderazzi
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | | | - Fabrizio Tacci
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Enrico Vaienti
- Orthopaedic Clinic, Department of Medicine and Surgery, University Hospital of Parma, Italy.
| | - Francesco Pogliacomi
- PARMA UNIVERSITY DEPARTMENT OF SURGICAL SCIENCES ORTHOPAEDIC AND TRAUMATOLOGY SECTION.
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20
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Mickle AM, Garvan C, Service C, Pop R, Marks J, Wu S, Edberg JC, Staud R, Fillingim RB, Bartley EJ, Sibille KT. Relationships Between Pain, Life Stress, Sociodemographics, and Cortisol: Contributions of Pain Intensity and Financial Satisfaction. CHRONIC STRESS 2020; 4:2470547020975758. [PMID: 33403312 PMCID: PMC7745543 DOI: 10.1177/2470547020975758] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 11/03/2020] [Indexed: 11/16/2022]
Abstract
Objective The relationship between psychosocial stress and chronic pain is bidirectional. An improved understanding regarding the relationships among chronic pain, life stress, and ethnicity/race will inform identification of factors contributing to health disparities in chronic pain and improve health outcomes. This study aims to assess relationships between measures of clinical pain, life stress, sociodemographics, and salivary cortisol levels. Methods A cross-sectional analysis involving data from 105 non-Hispanic White (NHW) and non-Hispanic Black (NHB) participants aged 45–85 years old with or at risk for knee osteoarthritis. Data included sociodemographics, clinical pain, psychosocial stress, and salivary cortisol across five time points over an approximate 12-hour period. Non-parametric correlation analysis, sociodemographic group comparisons, and regression analyses were performed. Results Clinical pain and psychosocial stress were associated with salivary cortisol levels, particularly morning waking and the evening to morning awakening slope. With the inclusion of recognized explanatory variables, the Graded Chronic Pain Scale characteristic pain intensity and financial satisfaction were identified as the primary pain and psychosocial measures associated with cortisol levels. Sociodemographic group differences were indicated such that NHB participants reported higher pain-related disability, higher levels of discrimination, lower financial and material satisfaction, and showed higher evening salivary cortisol levels compared to NHW participants. In combined pain and psychosocial stress analyses, greater financial satisfaction, lower pain intensity, and lower depression were associated with higher morning waking saliva cortisol levels while greater financial satisfaction was the only variable associated with greater evening to morning awakening slope. Conclusion Our findings show relationships among clinical pain, psychosocial stress, sociodemographic factors, and salivary cortisol levels. Importantly, with inclusion of recognized explanatory variables, financial satisfaction remained the primary factor accounting for differences in morning waking cortisol and evening to morning awakening cortisol slope in an ethnic/racially diverse group of middle aged and older adults with or at risk for knee osteoarthritis.
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Affiliation(s)
- Angela M Mickle
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community of Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL, USA
| | - Chelsea Service
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Ralisa Pop
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - John Marks
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Stanley Wu
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Jeffrey C Edberg
- Department of Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roland Staud
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Emily J Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Community of Dentistry and Behavioral Sciences, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Aging & Geriatric Research, University of Florida, Gainesville, FL, USA
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21
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Berney M, McCarroll P, Glynn L, Lenehan B. Platelet-rich plasma injections for hip osteoarthritis: a review of the evidence. Ir J Med Sci 2020; 190:1021-1025. [PMID: 33015749 DOI: 10.1007/s11845-020-02388-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 09/23/2020] [Indexed: 12/26/2022]
Abstract
Osteoarthritis is a significant cause of chronic pain in the elderly population with hip osteoarthritis as one of the main causes of functional disability and joint pain in adults older than 55 years. Recently, platelet rich plasma (PRP) injections have been introduced for treatment of osteoarthritis. The aim of this systematic review is to assess its effectiveness in the management of hip osteoarthritis. We performed a search of the literature for published prospective studies that assessed the effectiveness of PRP injections in the treatment of hip osteoarthritis, with a minimum follow-up of 3 months. Primary outcome measures were WOMAC and VAS scores. Five trials were identified with 185 patients undergoing treatment with ultrasound-guided intra-articular injections of PRP, compared with patients treated with hyaluronic acid alone (n = 148) or hyaluronic acid combined with PRP (n = 31) in one study. PRP was shown to improve patient outcome scores at follow-up at 6 and 12 months; however, there was no significant difference seen between patients treated with PRP or hyaluronic acid alone. Following this systematic review, we cannot currently recommend the use of intra-articular injections of PRP for the treatment of hip OA. Given that intra-articular steroid injections are the only such injection recommended by international guidelines for the treatment of hip OA, further studies comparing PRP to steroid would be of benefit to determine the value of PRP injections in hip OA.
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Affiliation(s)
- Mark Berney
- University Hospital Limerick, Limerick, Ireland.
| | | | - Liam Glynn
- University Limerick Graduate Entry Medical School, Limerick, Ireland
| | - Brian Lenehan
- University Hospital Limerick, Limerick, Ireland.,University Limerick Graduate Entry Medical School, Limerick, Ireland
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22
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Johnson AJ, Sibille KT, Cardoso J, Terry EL, Powell-Roach KL, Goodin B, Staud R, Redden D, Fillingim RB, Booker SQ. Patterns and Correlates of Self-Management Strategies for Osteoarthritis-Related Pain Among Older Non-Hispanic Black and Non-Hispanic White Adults. Arthritis Care Res (Hoboken) 2020; 73:1648-1658. [PMID: 32741127 DOI: 10.1002/acr.24396] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 07/21/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a leading source of pain and disability among older adults. Self-management (SM) strategies are recommended to manage OA symptoms. Sociodemographic and clinical characteristics, along with other factors, may influence SM utilization rate. This study sought to examine the prevalence and correlates of SM use for pain among non-Hispanic Black patients (NHB) and non-Hispanic White patients (NHW) older adults with or at risk for knee OA. METHODS A secondary data analysis was conducted on the Understanding Pain and Limitations in Osteoarthritic Disease multisite observational study, which included NHB (n = 104) and NHW (n = 98) community-dwelling older adults with or at risk for knee OA. Participants completed measures of sociodemographics, pain SM use, coping, and clinical and experimental pain. RESULTS Clinical and experimental pain were significantly greater among NHBs compared to NHWs. There were no significant differences in use of total SM by ethnicity/race. Interestingly, multiple linear regression revealed that clinical and experimental pain indices, as well as coping, number of pain sites, age, and sex were differentially associated with total SM use between NHBs and NHWs. There were significant ethnicity/race by type of pain management interaction effects for pain measures. CONCLUSION SM is common among older adults with or at risk for knee OA pain, and the prevalence of SM does not differ by ethnicity/race, but many guideline-recommended interventions for OA are underutilized. Importantly, different factors were associated with the use of SM, highlighting distinct biopsychosocial mechanisms contributing to SM use in NHBs and NHWs.
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23
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Berg B, Roos EM, Englund M, Kise NJ, Tiulpin A, Saarakkala S, Engebretsen L, Eftang CN, Holm I, Risberg MA. Development of osteoarthritis in patients with degenerative meniscal tears treated with exercise therapy or surgery: a randomized controlled trial. Osteoarthritis Cartilage 2020; 28:897-906. [PMID: 32184135 DOI: 10.1016/j.joca.2020.01.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate progression of individual radiographic features 5 years following exercise therapy or arthroscopic partial meniscectomy as treatment for degenerative meniscal tear. DESIGN Randomized controlled trial including 140 adults, aged 35-60 years, with a magnetic resonance image verified degenerative meniscal tear, and 96% without definite radiographic knee osteoarthritis. Participants were randomized to either 12-weeks of supervised exercise therapy or arthroscopic partial meniscectomy. The primary outcome was between-group difference in progression of tibiofemoral joint space narrowing and marginal osteophytes at 5 years, assessed semi-quantitatively by the OARSI atlas. Secondary outcomes included incidence of radiographic knee osteoarthritis and symptomatic knee osteoarthritis, medial tibiofemoral fixed joint space width (quantitatively assessed), and patient-reported outcome measures. Statistical analyses were performed using a full analysis set. Per protocol and as treated analysis were also performed. RESULTS The risk ratios (95% CI) for progression of semi-quantitatively assessed joint space narrowing and medial and lateral osteophytes for the surgery group were 0.89 (0.55-1.44), 1.15 (0.79-1.68) and 0.77 (0.42-1.42), respectively, compared to the exercise therapy group. In secondary outcomes (full-set analysis) no statistically significant between-group differences were found. CONCLUSION The study was inconclusive with respect to potential differences in progression of individual radiographic features after surgical and non-surgical treatment for degenerative meniscal tear. Further, we found no strong evidence in support of differences in development of incident radiographic knee osteoarthritis or patient-reported outcomes between exercise therapy and arthroscopic partial meniscectomy. TRIAL REGISTRATION www.clinicaltrials.gov (NCT01002794).
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Affiliation(s)
- B Berg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
| | - M Englund
- Faculty of Medicine, Department of Clinical Sciences, Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden.
| | - N J Kise
- Department of Orthopedic Surgery, Martina Hansens Hospital, Sandvika, Norway.
| | - A Tiulpin
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - S Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland; Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland.
| | - L Engebretsen
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway; Medical and Scientific Department, International Olympic Committee, Lausanne, Switzerland.
| | - C N Eftang
- Department of Pathology, Akershus University Hospital, Lørenskog, Norway.
| | - I Holm
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Faculty of Medicine, Department of Interdisciplinary Health Sciences, University of Oslo, Oslo, Norway.
| | - M A Risberg
- Division of Orthopedic Surgery, Oslo University Hospital, Oslo, Norway; Department of Sports Medicine, Norwegian School of Sport Sciences, Oslo, Norway.
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Terry EL, Fullwood MD, Booker SQ, Cardoso JS, Sibille KT, Glover TL, Thompson KA, Addison AS, Goodin BR, Staud R, Hughes LB, Bradley LA, Redden DT, Bartley EJ, Fillingim RB. Everyday Discrimination in Adults with Knee Pain: The Role of Perceived Stress and Pain Catastrophizing. J Pain Res 2020; 13:883-895. [PMID: 32431537 PMCID: PMC7200232 DOI: 10.2147/jpr.s235632] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 04/03/2020] [Indexed: 12/28/2022] Open
Abstract
PURPOSE Research indicates pain-related disparities in the impact of knee osteoarthritis (OA) across both sex and ethnicity/race. While several factors likely contribute to these disparities, experiences of discrimination are associated with poor OA-related pain, disability, and functional performance. However, the mechanisms that mediate experiences of discrimination and OA-related outcomes are unclear. The current cross-sectional study examined the associations between everyday experiences of discrimination and clinical pain, disability and functional performance among non-Hispanic Black (NHB) and non-Hispanic White (NHW) persons with or at risk of knee OA and assessed the serial mediated model of perceived stress and pain catastrophizing on these relationships in women only. PATIENTS AND METHODS Participants were 188 community-dwelling adults who presented with unilateral or bilateral knee pain and screened positive for clinical knee pain. Participants completed several measures including experiences of discrimination, Perceived Stress Scale, Coping Strategies Questionnaire-Revised (CSQ-R): Pain Catastrophizing subscale, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Graded Chronic Pain Scale (GCPS), and Short Physical Performance Battery (SPPB). RESULTS As compared to NHW participants, NHB individuals reported experiencing significantly higher levels of discrimination (F(1, 175)=26.660, p<0.001), greater levels of pain catastrophizing (F(1, 180)=12.919, p<0.001), higher levels of clinical pain and disability, and lower levels of physical function (ps<0.05). However, perceived stress was positively correlated with discrimination in the NHW group only (NHW females: r=0.40, p<0.01; NHW males: r=0.37, p<0.05). Further, perceived stress and pain catastrophizing mediated the relationship between discrimination and outcome variables (WOMAC pain, GCPS interference [pain disability], and SPPB function) in female participants after controlling for relevant sociodemographic variables (study site, age, race, income, and body mass index). CONCLUSION These results may have implications for the treatment of perceived stress and catastrophizing as a means to reduce the negative impact of experiences of discrimination on the experience of chronic pain, particularly for women.
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Affiliation(s)
- Ellen L Terry
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States
| | - M Dottington Fullwood
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States
| | - Staja Q Booker
- Department of Biobehavioral Nursing Science, University of Florida, Gainesville, Florida, United States
| | - Josue S Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States
| | - Kimberly T Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, Florida, United States
| | - Toni L Glover
- Oakland University, School of Nursing, Rochester, MI, United States
| | - Kathryn A Thompson
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Adriana S Addison
- University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, Florida, United States
| | - Laura B Hughes
- University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States
| | - Laurence A Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology & Rheumatology, Birmingham, Alabama, United States
| | - David T Redden
- Department of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama, United States
| | - Emily J Bartley
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United States
| | - Roger B Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), Gainesville, Florida, United States
- University of Florida, Community Dentistry and Behavioral Science, Gainesville, Florida, United States
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25
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Optimism and Psychological Resilience are Beneficially Associated With Measures of Clinical and Experimental Pain in Adults With or at Risk for Knee Osteoarthritis. Clin J Pain 2019; 34:1164-1172. [PMID: 30036216 DOI: 10.1097/ajp.0000000000000642] [Citation(s) in RCA: 29] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
OBJECTIVES This cross-sectional study examined the associations among optimism, psychological resilience, endogenous pain inhibition, and clinical knee pain severity. Two hypotheses were tested. First, we hypothesized that experimentally tested endogenous pain inhibition would mediate the relationship between optimism and clinical knee pain severity. Second, it was also hypothesized that optimism would moderate the relationships of psychological resilience with endogenous pain inhibition and clinical knee pain severity, particularly for individuals with high optimism. METHODS A total of 150 individuals with or at risk for symptomatic knee osteoarthritis completed the Life Orientation Test-Revised, the Brief Resilience Scale, and the revised Short-Form McGill Pain Questionnaire-2 to assess optimism, psychological resilience, and clinical knee pain severity, respectively. Endogenous pain inhibition was examined experimentally using a conditioned pain modulation (CPM) protocol with algometry (test stimulus) and a cold pressor task (conditioning stimulus). RESULTS As hypothesized, results showed that increased CPM significantly mediated the association between higher optimism and lower clinical knee pain severity. Further, optimism moderated the association between psychological resilience and CPM. However, contrary to our hypothesis, greater psychological resilience was associated with enhanced CPM in individuals with low optimism only. DISCUSSION This study suggests that an optimistic outlook may beneficially impact clinical pain severity by altering endogenous pain modulatory capacity. Furthermore, individuals with low optimism (ie, pessimists) may be more adept at engaging resources that promote psychological resilience, which in turn, enhances endogenous pain modulatory capacity. Therefore, this study supports consideration of psychological resilience factors when evaluating experimental and clinical pain outcomes.
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Lukusa A, Malemba JJ, Lebughe P, Akilimali P, Mbuyi-Muamba JM. Clinical and radiological features of knee osteoarthritis in patients attending the university hospital of Kinshasa, Democratic Republic of Congo. Pan Afr Med J 2019; 34:29. [PMID: 31762897 PMCID: PMC6859011 DOI: 10.11604/pamj.2019.34.29.11283] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Accepted: 06/17/2019] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION The aim of the present study was to describe the clinical and radiological features of knee osteoarthritis in Congolese outpatients attending the University Hospital of Kinshasa (UHK). METHODS A cross-sectional study was performed in the rheumatology unit of the UHK from January to August 2012. Patients were consecutively recruited. The diagnosis of Osteoarthritis (OA) was based on the criteria of the American College for Rheumatology. Demographic, clinical and x-rays data were collected. The X-rays severity was assessed according to Kellgren and Lawrence's method. RESULTS 1049 patients attended the Rheumatology unit of the UHK during the study period. An accurate diagnosis was reported for 839 patients, of whom 376 (44.8%) suffered from OA. Knee OA was diagnosed in 118 patients (31.4% of all OA patients). 101 patients accepted to be included in the study, 78 women (77.2%) and 23 men (22.8%). Their average age was 58.9 ± 10 years. A body mass index (BMI) ≥ 25kg/m2 was observed in 68 patients of whom 28 were obese (BMI ≥ 30kg/m2). The main symptoms were a mechanical pain (100%), swelling (40.6%), crepitus (79.2%) and mobility reduction (X%). Knee deformities were observed in some patients. At baseline, radiological damages > stage 2 of Kellgren-Lawrence were found in 70 patients. CONCLUSION Knee OA is a common disease among outpatients who attend the unit of Rheumatology of the UHK. Its clinical profile is the same as what is reported in the literature. Obesity and skeletal abnormalities are encountered in the majority of patients.
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Affiliation(s)
- Adolphe Lukusa
- Internal Medicine Unit, Ngaliema Hospital, Kinshasa, DR Congo
| | | | - Pierrot Lebughe
- Rheumatology Unit, University Hospital of Kinshasa, Kinshasa, DR Congo
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Booker S, Cardoso J, Cruz-Almeida Y, Sibille KT, Terry EL, Powell-Roach KL, Riley JL, Goodin BR, Bartley EJ, Addison AS, Staud R, Redden D, Bradley L, Fillingim RB. Movement-evoked pain, physical function, and perceived stress: An observational study of ethnic/racial differences in aging non-Hispanic Blacks and non-Hispanic Whites with knee osteoarthritis. Exp Gerontol 2019; 124:110622. [PMID: 31154005 PMCID: PMC6660381 DOI: 10.1016/j.exger.2019.05.011] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 05/23/2019] [Accepted: 05/24/2019] [Indexed: 12/21/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a pervasive musculoskeletal condition, often exacerbated by movement-evoked pain (MEP). Despite established research demonstrating significant racial differences in OA pain, few studies have investigated ethnic/racial group differences in MEP and lower extremity function and their association with psychosocial factors, such as perceived stress. Therefore, the primary aims were: (1) to identify ethnic/racial group differences in persons with or at risk for knee OA pain based on MEP, physical performance, and perceived stress measures, and (2) to determine if perceived stress explains the relationship between MEP and function in non-Hispanic Blacks (NHBs) and non-Hispanic Whites (NHWs). METHODS A total of 162 NHB and NHW community-dwelling older adults (50-78 years of age) were included in this analysis from the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD) cross-sectional cohort study. Demographic, anthropometric, pain and functional parameters were assessed using a battery of validated instruments. Descriptive statistics, parametric, and multivariate analyses were conducted to determine ethnic/racial differences in perceived stress, MEP, and function. RESULTS Our results support the hypothesis that among persons with knee OA pain, NHBs have significantly greater MEP and lower functional level, despite similar levels of perceived stress. However, perceived stress was more strongly related to MEP in NHB compared to NHWs. Differences in function were limited to walking speed, where NHWs demonstrated faster gait speed. CONCLUSIONS Our cross-sectional study demonstrated important ethnic/racial differences in MEP and function. Also, perceived stress had a stronger effect on MEP in NHBs, suggesting that perceived stress may more strongly influence pain with physical movement among NHB adults. MEP may be a clinically important pain outcome to measure in persons with OA, and these data warrant future research on the impact of stress on pain and functional outcomes in older adults, particularly in NHBs.
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Affiliation(s)
- Staja Booker
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA.
| | - Josue Cardoso
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Yenisel Cruz-Almeida
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Kimberly T Sibille
- The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA; The University of Florida, Department of Aging & Geriatric Research, College of Medicine, Gainesville, FL 32611, USA
| | - Ellen L Terry
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Keesha L Powell-Roach
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Joseph L Riley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | - Burel R Goodin
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL 35294, USA
| | - Emily J Bartley
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
| | | | - Roland Staud
- The University of Florida, Department of Medicine, Gainesville, FL 32608, USA
| | - David Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL 35294, USA; University of Alabama at Birmingham, Department Medicine and Rheumatology, Birmingham, AL 35294, USA
| | - Laurence Bradley
- University of Alabama at Birmingham, Division of Clinical Immunology and Rheumatology, Birmingham, AL 35294, USA
| | - Roger B Fillingim
- The University of Florida, Department of Community Dentistry and Behavioral Science, Gainesville, FL 32610, USA; The University of Florida, Pain Research and Intervention Center of Excellence, Gainesville, FL 32610, USA
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At the Intersection of Ethnicity/Race and Poverty: Knee Pain and Physical Function. J Racial Ethn Health Disparities 2019; 6:1131-1143. [PMID: 31292922 DOI: 10.1007/s40615-019-00615-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2019] [Revised: 07/03/2019] [Accepted: 07/03/2019] [Indexed: 02/08/2023]
Abstract
BACKGROUND Knee osteoarthritis (OA) disproportionately affects racial and ethnic minorities. Non-Hispanic Blacks (NHB) report a higher prevalence and severity of knee OA symptoms than their non-Hispanic White (NHW) counterparts. The role of poverty in explaining this disparity remains unclear. OBJECTIVE The overall aim of this cross-sectional study was to determine whether ethnic/racial differences in knee pain and physical function varied according to poverty status. DESIGN NHB and NHW adults with or at risk of knee OA self-reported sociodemographic information, and completed the Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) and the Short Physical Performance Battery (SPPB). Annual income was adjusted for number of household occupants to determine poverty status (i.e., living above versus below poverty line). RESULTS Findings revealed 120 individuals living above the poverty line (49% NHB, 77% NHW) and 71 individuals living below the poverty line (51% NHB, 23% NHW). Adjusted multivariable models revealed significant ethnic/race by poverty status interactions for knee pain (p = 0.036) and physical function (p = 0.032) on the WOMAC, as well as physical function on the SPPB (p = 0.042). Post hoc contrasts generally revealed that NHW adults living above the poverty line experienced the least severe knee pain and best physical function, while NHB adults living below the poverty line experienced the most severe knee pain and poorest physical function. CONCLUSIONS Results of the present study add to the literature by emphasizing the importance of considering poverty and/or other indicators of socioeconomic status in studies examining ethnic/racial disparities in pain and physical function.
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Abstract
OBJECTIVES Osteoarthritis (OA) is associated with inflammation, chronic pain, functional limitations, and psychosocial distress. High omega-3 (n-3) polyunsaturated fatty acids (PUFAs) are associated with lower levels of inflammatory mediators, anti-nociception, and adaptive cognitive/emotional functioning. High omega-6 (n-6) PUFAs are associated with inflammation, nociception, and psychological distress. While findings related to n-3 supplementation in knee OA are mixed, consideration of the n-6:n-3 ratio and additional outcome measures may provide improved understanding of the potential relevance of these fatty acids in OA. On the basis of recommended and typical ranges of the n-6:n-3 ratio, we hypothesized that in adults with knee pain, those with a high n-6:n-3 ratio would have greater pain/functional limitations, experimental pain sensitivity, and psychosocial distress compared with those with a low n-6:n-3 ratio. MATERIALS AND METHODS A cross-sectional investigation of clinical and experimental pain and physical and psychosocial functioning was completed in 167 adults ages 45 to 85 meeting knee OA screening criteria. Blood samples were collected and the plasma n-6:n-3 PUFA ratio determined. Quartile splits were computed and low (n=42) and high (n=41) ratio groups were compared. RESULTS The high ratio group reported greater pain and functional limitations, (all Ps<0.04), mechanical temporal summation (hand and knee, P<0.05), and perceived stress (P=0.008) but not depressive symptoms. DISCUSSION In adults with knee pain, a high n-6:n-3 ratio is associated with greater clinical pain/functional limitations, experimental pain sensitivity, and psychosocial distress compared with a low ratio group. Findings support consideration of the n-6:n-3 PUFA ratio and additional clinical endpoints in future research efforts.
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Bartley EJ, Hossain NI, Gravlee CC, Sibille KT, Terry EL, Vaughn IA, Cardoso JS, Booker SQ, Glover TL, Goodin BR, Sotolongo A, Thompson KA, Bulls HW, Staud R, Edberg JC, Bradley LA, Fillingim RB. Race/Ethnicity Moderates the Association Between Psychosocial Resilience and Movement-Evoked Pain in Knee Osteoarthritis. ACR Open Rheumatol 2019; 1:16-25. [PMID: 31777776 PMCID: PMC6858004 DOI: 10.1002/acr2.1002] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective Racial/ethnic disparities in pain are well‐recognized, with non‐Hispanic blacks (NHBs) experiencing greater pain severity and pain‐related disability than non‐Hispanic whites (NHWs). Although numerous risk factors are posited as contributors to these disparities, there is limited research addressing how resilience differentially influences pain and functioning across race/ethnicity. Therefore, this study examined associations between measures of psychosocial resilience, clinical pain, and functional performance among adults with knee osteoarthritis (OA), and assessed the moderating role of race/ethnicity on these relationships. Methods In a secondary analysis of the Understanding Pain and Limitations in Osteoarthritic Disease (UPLOAD‐2) study, 201 individuals with knee OA (NHB = 105, NHW = 96) completed measures of resilience (ie, trait resilience, optimism, positive well‐being, social support, positive affect) and clinical pain, as well as a performance‐based measure assessing lower‐extremity function and movement‐evoked pain. Results Bivariate analyses showed that higher levels of psychosocial resilience were associated with lower clinical pain and disability and more optimal physical functioning. NHBs reported greater pain and disability, poorer lower‐extremity function, and higher movement‐evoked pain compared with NHWs; however, measures of psychosocial resilience were similar across race/ethnicity. In moderation analyses, higher optimism and positive well‐being were protective against movement‐evoked pain in NHBs, whereas higher levels of positive affect were associated with greater movement‐evoked pain in NHWs. Conclusion Our findings underscore the importance of psychosocial resilience on OA‐related pain and function and highlight the influence of race/ethnicity on the resilience‐pain relationship. Treatments aimed at targeting resilience may help mitigate racial/ethnic disparities in pain.
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Affiliation(s)
- Emily J Bartley
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | | | | | - Kimberly T Sibille
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | - Ellen L Terry
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | - Ivana A Vaughn
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | - Josue S Cardoso
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | - Staja Q Booker
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | | | | | | | | | | | - Roland Staud
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
| | | | | | - Roger B Fillingim
- University of Florida, Pain Research and Intervention Center of Excellence Gainesville Florida
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Ho KWD, Wallace MR, Sibille KT, Bartley EJ, Cruz-Almeida Y, Glover TL, King CD, Goodin BR, Addison A, Edberg JC, Staud R, Bradley LA, Fillingim RB. Single Nucleotide Polymorphism in the COL11A2 Gene Associated with Heat Pain Sensitivity in Knee Osteoarthritis. Mol Pain 2018; 13:1744806917724259. [PMID: 28741447 PMCID: PMC5562334 DOI: 10.1177/1744806917724259] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Pain is one of the most prominent symptoms of osteoarthritis. However, there is often discordance between the pain experienced by individuals with osteoarthritis and the degree of articular pathology. This suggests that individual differences, including genetic variability in the central processing of nociceptive stimuli, may impact the presentation of osteoarthritis. Here, we show that the single nucleotide polymorphism rs16868943 in the collagen gene COL11A2 is significantly associated with lowered heat pain tolerance on the arm in participants with knee osteoarthritis (P = 1.21 × 10−6, P = 0.0053 after Bonferroni correction, beta = −3.42). A total of 161 knee osteoarthritis participants were included and evaluated for heat, punctate and pressure pain sensitivity of the affected knee and the ipsilateral arm. Each participant was genotyped for 4392 single nucleotide polymorphisms in genes implicated in pain perception, inflammation and mood and tested for association with pain sensitivity. The minor A allele of single nucleotide polymorphism rs16868943 was significantly associated with lower arm heat pain tolerance after correction for age, gender, race, and study site. This single nucleotide polymorphism was also nominally associated with other measures of heat pain sensitivity, including lowered knee heat pain tolerance (P = 1.14 × 10−5, P = 0.05 after Bonferroni correction), lowered arm heat pain threshold (P = 0.0039, uncorrected) and lowered knee heat pain threshold (P = 0.003, uncorrected). Addition of genotypes from 91 participants without knee pain produced a significant interaction between knee osteoarthritis status and the rs16868943 single nucleotide polymorphism in heat pain tolerance (P = 1.71 × 10−5), such that rs16868943 was not associated with heat pain tolerance in participants without knee pain (P = 0.12, beta = 1.3). This is the first study to show genetic association with heat pain tolerance in individuals with osteoarthritis. The association is specific to participants who have already developed knee osteoarthritis, suggesting that the COL11A2 gene, which has previously been associated with familial osteoarthritis, may play a role in pain sensitization after the development of osteoarthritis.
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Affiliation(s)
| | - Margaret R Wallace
- Department of Molecular Genetics & Microbiology, University of Florida, Gainesville, FL
| | - Kimberly T Sibille
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Emily J Bartley
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
| | - Yenisel Cruz-Almeida
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL
| | - Toni L Glover
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Christopher D King
- Department of Anesthesia, Cincinnati Children's Hospital Medical Center (CCHMC), Cincinnati, OH
| | - Burel R Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL
| | - Adriana Addison
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Jeffrey C Edberg
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Roland Staud
- Pain Research & Intervention Center of Excellence, University of Florida, Gainesville, FL
| | - Laurence A Bradley
- Division of Clinical Immunology & Rheumatotology, Department of Medicine, University of Alabama at Birmingham, Birmingham, AL
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL
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Øiestad BE, Holm I, Risberg MA. Return to pivoting sport after ACL reconstruction: association with osteoarthritis and knee function at the 15-year follow-up. Br J Sports Med 2018; 52:1199-1204. [DOI: 10.1136/bjsports-2017-097718] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/02/2018] [Indexed: 01/12/2023]
Abstract
ObjectivesTo examine the associations between return to pivoting sport following ACL reconstruction (ACLR) and knee osteoarthritis (OA), and self-reported knee symptoms, function and quality of life after 15 years.MethodsStudy sample included 258 participants with ACLR 15 years previously. Return to pivoting sport (handball, soccer and basketball) data were collected by interviews, and symptomatic OA was defined as Kellgren and Lawrence grade ≥2 plus almost daily knee pain in the last month. Self-reported symptoms, function and quality of life were assessed with the Knee Injury and Osteoarthritis Outcome Score. Adjusted regression models were used to analyse the associations between return to pivoting sport and OA (present or not), and self-reported outcomes. P values ≤0.05 were considered statistically significant.ResultsTwo hundred and ten (81%) participants (57% men) with a mean age of 39.1 (±8.7) years completed the 15-year follow-up, and 109 (52%) had returned to pivoting sport. Returning to pivoting sport was associated with less symptomatic OA (OR 0.28, 95% CI 0.09 to 0.89) and radiographic OA (OR 0.40, 95% CI 0.17 to 0.98), adjusted for age, sex, combined injury, self-reported knee function, and time between injury and surgery. Those who returned to pivoting sport had better function in activities of daily living (ADL).ConclusionThe participants with ACLR who returned to pivoting sport had lower odds of knee OA and better self-reported ADL function. Further investigation is required to understand the clinical significance of these findings.
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Leung YY, Ma S, Noviani M, Wong SBS, Lee CM, Soh IAL, Thumboo J. Validation of screening questionnaires for evaluation of knee osteoarthritis prevalence in the general population of Singapore. Int J Rheum Dis 2017; 21:629-638. [PMID: 29271108 PMCID: PMC5887938 DOI: 10.1111/1756-185x.13252] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Background The prevalence of symptomatic knee osteoarthritis (KOA) in Singapore is unknown. We aimed to: (i) validate questionnaires to screen for symptomatic KOA; and (ii) estimate the prevalence of symptomatic KOA in Singapore using the validated algorithms. Methods Subjects aged ≥50 years were evaluated for symptomatic KOA based on American College of Rheumatology clinical and radiographic criteria in a rheumatology clinic, and completed three sets of adapted screening questionnaires. The better performing screening questionnaire with adequate sensitivity and specificity was adminitered to a nationally representative sample of survey subjects (n = 3364) to estimate the weighted prevalence of symptomatic KOA in Singapore. Results Out of 146 subjects evaluated in the clinic, 45 had symptomatic KOA. A screening algorithm which consisted of three KOA symptoms or one symptom plus physician‐diagnosed KOA produced high specificity (0.95, 95% confidence intervals [CI]: 0.88–0.98) but low sensivity (0.44, 95% CI: 0.30–0.60). Replacing the term ‘KOA’ with ‘physician‐diagnosed ageing‐related knee problem’ improved the sensivity (0.62, 95% CI: 0.47–0.76) without significantly compromising the specificity (0.87, 95% CI: 0.79–0.93). The prevalence of symptomatic KOA weighted to the Singapore population distribution were 4.7% and 11%, using the most conservative and more liberal algorithms, respectively. There was a sharp rise in prevalence after age of 40. The weighted prevalence of KOA was higher in women and among Indian and Malay than Chinese. Conclusion Our study adapted and validated questionnaires to the local context to screen for symptomatic KOA. We estimated the prevalence of symptomatic KOA in Singapore utilizing the better‐performing algorithms.
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Affiliation(s)
- Ying-Ying Leung
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore
| | - Stefan Ma
- Epidemiology& Disease Control Division, Ministry of Health, Singapore General Hospital, Singapore, Singapore
| | - Maria Noviani
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore
| | - Steven B-S Wong
- Department of Diagnostic Radiology, Singapore General Hospital, Singapore, Singapore
| | - Chee Min Lee
- Epidemiology& Disease Control Division, Ministry of Health, Singapore General Hospital, Singapore, Singapore
| | - Irene A-L Soh
- Epidemiology& Disease Control Division, Ministry of Health, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore General Hospital, Singapore, Singapore
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Mauro GL, Sanfilippo A, Scaturro D. The effectiveness of intra-articular injections of Hyalubrix ® combined with exercise therapy in the treatment of hip osteoarthritis. ACTA ACUST UNITED AC 2017; 14:146-152. [PMID: 29263723 DOI: 10.11138/ccmbm/2017.14.1.146] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Purpose Osteoarthritis (OA) is the most common joint disorder in the elderly, causing significant pain which negatively affects mobility and quality of life. The aim of the study was to assess the effectiveness of ultrasound image-guided intra-articular injections of Hyalubrix® combined with exercise therapy in the treatment of hip osteoarthritis. Methods This was a single site, prospective, open-label, Investigator-initiated study. Forty patients were enrolled and received three ultrasound image-guided injections of Hyalubrix®, 45 days apart, combined with three sessions a week of physical therapy (proprioceptive rehabilitation of the lower limbs; gait training; balance training) up to a total of 30 sessions (10 weeks), starting from one week after the first injection. Results The primary objective was to achieve a lasting reduction in OA symptoms related to pain during activity. During the course of the study the pain perceived by the patient during activity dropped from a mean value of 6.94 cm to a mean value of 1.46 cm and showed a statistically significant decrease from visit 1 compared to baseline (p < 0.05) which was confirmed at all the subsequent time points. Significant improvements were also observed in the evaluation of the secondary objectives: hip disability; OA-related pain at rest; daily functioning and NSAIDs intake. Conclusions Results from this study including 40 patients for a total of 65 treated hips demonstrate a significant improvement in OA-related pain, hip disability, and patient's daily functioning as well as a reduction in NSAIDs intake. Patients suffering from hip OA seem to benefit from the treatment with Hyalubrix® injections plus exercise therapy.
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Affiliation(s)
- Giulia Letizia Mauro
- Department of Physical and Rehabilitative Medicine, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Antonino Sanfilippo
- Department of Orthopaedics and Traumatology, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
| | - Dalila Scaturro
- Department of Physical and Rehabilitative Medicine, Azienda Ospedaliera Universitaria Policlinico "Paolo Giaccone", Palermo, Italy
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Seoane-Mato D, Sánchez-Piedra C, Silva-Fernández L, Sivera F, Blanco FJ, Pérez Ruiz F, Juan-Mas A, Pego-Reigosa JM, Narváez J, Quilis Martí N, Cortés Verdú R, Antón-Pagés F, Quevedo Vila V, Garrido Courel L, Del Amo NDV, Paniagua Zudaire I, Añez Sturchio G, Medina Varo F, Ruiz Tudela MDM, Romero Pérez A, Ballina J, Brandy García A, Fábregas Canales D, Font Gayá T, Bordoy Ferrer C, González Álvarez B, Casas Hernández L, Álvarez Reyes F, Delgado Sánchez M, Martínez Dubois C, Sánchez-Fernández SÁ, Rojas Vargas LM, García Morales PV, Olivé A, Rubio Muñoz P, Larrosa M, Navarro Ricos N, Graell Martín E, Chamizo E, Chaves Chaparro L, Rojas Herrera S, Pons Dolset J, Polo Ostariz MÁ, Ruiz-Alejos Garrido S, Macía Villa C, Cruz Valenciano A, González Gómez ML, Morcillo Valle M, Palma Sánchez D, Moreno Martínez MJ, Mayor González M, Atxotegi Sáenz de Buruaga J, Urionagüena Onaindia I, Blanco Cáceres BA, Díaz-González F, Bustabad S. Prevalence of rheumatic diseases in adult population in Spain (EPISER 2016 study): Aims and methodology. ACTA ACUST UNITED AC 2017; 15:90-96. [PMID: 28774657 DOI: 10.1016/j.reuma.2017.06.009] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 05/17/2017] [Accepted: 06/16/2017] [Indexed: 11/25/2022]
Abstract
AIMS To describe the methodology of the EPISER 2016 (study of the prevalence of rheumatic diseases in adult population in Spain), as well its strengths and limitations. The aim of this study is to estimate the prevalence of rheumatoid arthritis (RA), psoriatic arthritis (PsA), ankylosing spondylitis (AS), systemic lupus erythematosus (SLE), Sjögren's syndrome (SS), osteoarthritis (knee, hip, hands, and cervical and lumbar spine), fibromyalgia, gout and clinical osteoporotic fracture. MATERIAL AND METHOD Population-based, multicenter, cross-sectional study, with the participation of 45 municipalities in the 17 Spanish autonomous communities. The reference population will consist of adults aged 20 years and over residing in Spain. A computer-assisted telephone interview (CATI) system will be used for data collection. Diagnostic suspicions and diagnoses received by the participants will be studied by rheumatologists in the referral hospitals in the selected municipalities. STATISTICAL ANALYSIS the prevalence of the rheumatic diseases will be calculated using estimators and their 95% confidence intervals. Weights will be calculated in each of the sampling stages in accordance with the probability of selection. The distribution of the population in Spain will be obtained from the Spanish Statistics Institute. CONCLUSIONS Sociodemographic and lifestyle changes over the last 16 years justify EPISER 2016. This study will provide current data about the prevalences of RA, AS, PsA, SLE, SS, osteoarthritis, fibromyalgia, gout and clinical osteoporotic fracture. The results will allow comparisons with studies from other countries and EPISER 2000.
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Affiliation(s)
- Daniel Seoane-Mato
- Unidad de Investigación, Sociedad Española de Reumatología, Madrid, España
| | | | - Lucía Silva-Fernández
- Servicio de Reumatología, Complexo Hospitalario Universitario de Ferrol, Ferrol, A Coruña, España
| | - Francisca Sivera
- Servicio de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España
| | - Francisco J Blanco
- Servicio de Reumatología, Complejo Hospitalario Universitario de A Coruña, A Coruña, España
| | - Fernando Pérez Ruiz
- Servicio de Reumatología, Hospital Universitario Cruces, Baracaldo, Vizcaya, España
| | - Antonio Juan-Mas
- Servicio de Reumatología, Hospital Son Llàtzer, Palma de Mallorca, Baleares, España
| | - José M Pego-Reigosa
- Servicio de Reumatología, Complejo Hospitalario Universitario de Vigo, Grupo IRIDIS, Instituto de Investigación Sanitaria Galicia Sur (IISGS), Vigo, Pontevedra, España
| | - Javier Narváez
- Servicio de Reumatología, Hospital Universitario de Bellvitge, L'Hospitalet de Llobregat, Barcelona, España
| | - Neus Quilis Martí
- Servicio de Reumatología, Hospital General Universitario de Elda, Elda, Alicante, España
| | - Raúl Cortés Verdú
- Unidad de Reumatología, Hospital General de Ontinyent, Ontinyent, Valencia, España
| | - Fred Antón-Pagés
- Unidad de Reumatología, Complejo Asistencial Universitario de Palencia, Palencia, España
| | - Víctor Quevedo Vila
- Unidad de Reumatología, Hospital Comarcal de Monforte de Lemos, Monforte de Lemos, Lugo, España
| | - Laura Garrido Courel
- Servicio de Reumatología, Complejo Hospitalario de Navarra, Pamplona, Navarra, España
| | | | | | | | - Fermín Medina Varo
- Sección de Reumatología, Hospital Universitario Puerta del Mar, Cádiz, España
| | | | | | - Javier Ballina
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - Anahy Brandy García
- Servicio de Reumatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | | | - Teresa Font Gayá
- Servicio de Reumatología, Hospital Comarcal de Inca, Inca, Baleares, España
| | | | - Beatriz González Álvarez
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Laura Casas Hernández
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Fátima Álvarez Reyes
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Mónica Delgado Sánchez
- Servicio de Reumatología, Hospital Universitario Nuestra Señora de la Candelaria, Santa Cruz de Tenerife, España
| | - Cristina Martínez Dubois
- Servicio de Reumatología, Hospital Universitario Marqués de Valdecilla, Santander, Cantabria, España
| | | | - Luisa Marena Rojas Vargas
- Servicio de Reumatología, Complejo Hospitalario Mancha Centro, Alcázar de San Juan, Ciudad Real, España
| | | | - Alejandro Olivé
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, España
| | - Paula Rubio Muñoz
- Servicio de Reumatología, Hospital Universitari Germans Trias i Pujol , Badalona, Barcelona, España
| | - Marta Larrosa
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Noemí Navarro Ricos
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Eduard Graell Martín
- Servicio de Reumatología, Hospital Universitari Parc Taulí, Sabadell, Barcelona, España
| | - Eugenio Chamizo
- Servicio de Reumatología, Hospital de Mérida, Mérida, Badajoz, España
| | | | | | - Jordi Pons Dolset
- Unidad de Reumatología, Fundación Hospital Calahorra, Calahorra, La Rioja, España
| | | | | | - Cristina Macía Villa
- Sección de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | - Ana Cruz Valenciano
- Sección de Reumatología, Hospital Universitario Severo Ochoa, Leganés, Madrid, España
| | | | | | - Deseada Palma Sánchez
- Servicio de Reumatología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España
| | | | - Marta Mayor González
- Servicio de Reumatología, Hospital General Universitario Rafael Méndez, Lorca, Murcia, España
| | | | | | | | - Federico Díaz-González
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España; Universidad de La Laguna, Departamento de Medicina Interna, Dermatología y Psiquiatría, La Laguna, Santa Cruz de Tenerife, España
| | - Sagrario Bustabad
- Servicio de Reumatología, Hospital Universitario de Canarias, La Laguna, Santa Cruz de Tenerife, España.
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Cisternas MG, Murphy L, Sacks JJ, Solomon DH, Pasta DJ, Helmick CG. Alternative Methods for Defining Osteoarthritis and the Impact on Estimating Prevalence in a US Population-Based Survey. Arthritis Care Res (Hoboken) 2017; 68:574-80. [PMID: 26315529 DOI: 10.1002/acr.22721] [Citation(s) in RCA: 199] [Impact Index Per Article: 28.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2015] [Revised: 06/10/2015] [Accepted: 08/18/2015] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Provide a contemporary estimate of osteoarthritis (OA) by comparing the accuracy and prevalence of alternative definitions of OA. METHODS The Medical Expenditure Panel Survey (MEPS) household component (HC) records respondent-reported medical conditions as open-ended responses; professional coders translate these responses into International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes for the medical conditions files. Using these codes and other data from the MEPS-HC medical conditions files, we constructed 3 case definitions of OA and assessed them against medical provider diagnoses of ICD-9-CM 715 (osteoarthrosis and allied disorders) in a MEPS subsample. The 3 definitions were 1) strict = ICD-9-CM 715; 2) expanded = ICD-9-CM 715, 716 (other and unspecified arthropathies) OR 719 (other and unspecified disorders of joint); and 3) probable = strict OR expanded + respondent-reported prior diagnosis of OA or other arthritis excluding rheumatoid arthritis. RESULTS Sensitivity and specificity of the 3 definitions, respectively, were 34.6% and 97.5% for strict, 73.8% and 90.5% for expanded, and 62.9% and 93.5% for probable. CONCLUSION The strict definition for OA (ICD-9-CM 715) excludes many individuals with OA. The probable definition of OA has the optimal combination of sensitivity and specificity relative to the 2 other MEPS-based definitions and yields a national annual estimate of 30.8 million adults with OA (13.4% of US adult population) for 2008-2011.
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Affiliation(s)
| | - Louise Murphy
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Sibille KT, Chen H, Bartley EJ, Riley J, Glover TL, King CD, Zhang H, Cruz-Almeida Y, Goodin BR, Sotolongo A, Petrov ME, Herbert M, Bulls HW, Edberg JC, Staud R, Redden D, Bradley LA, Fillingim RB. Accelerated aging in adults with knee osteoarthritis pain: consideration for frequency, intensity, time, and total pain sites. Pain Rep 2017; 2:e591. [PMID: 29392207 PMCID: PMC5741297 DOI: 10.1097/pr9.0000000000000591] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2016] [Revised: 01/23/2017] [Accepted: 02/23/2017] [Indexed: 12/31/2022] Open
Abstract
INTRODUCTION Individuals with osteoarthritis (OA) show increased morbidity and mortality. Telomere length, a measure of cellular aging, predicts increased morbidity and mortality. Telomeres shorten with persisting biological and psychosocial stress. Living with chronic OA pain is stressful. Previous research exploring telomere length in people with OA has produced inconsistent results. Considering pain severity may clarify the relationship between OA and telomeres. OBJECTIVES We hypothesized that individuals with high OA chronic pain severity would have shorter telomeres than those with no or low chronic pain severity. METHODS One hundred thirty-six adults, ages 45 to 85 years old, with and without symptomatic knee OA were included in the analysis. Peripheral blood leukocyte telomere length was measured, and demographic, clinical, and functional data were collected. Participants were categorized into 5 pain severity groups based on an additive index of frequency, intensity, time or duration, and total number of pain sites (FITT). Covariates included age, sex, race or ethnicity, study site, and knee pain status. RESULTS The no or low chronic pain severity group had significantly longer telomeres compared with the high pain severity group, P = 0.025. A significant chronic pain severity dose response emerged for telomere length, P = 0.034. The FITT chronic pain severity index was highly correlated with the clinical and functional OA pain measures. However, individual clinical and functional measures were not associated with telomere length. CONCLUSION Results demonstrate accelerated cellular aging with high knee OA chronic pain severity and provide evidence for the potential utility of the FITT chronic pain severity index in capturing the biological burden of chronic pain.
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Affiliation(s)
- Kimberly T. Sibille
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Huaihou Chen
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Emily J. Bartley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Joseph Riley
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Toni L. Glover
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL, USA
| | - Christopher D. King
- Department of Anesthesia, Cincinnati Children's Hospital, Cincinnati, OH, USA
| | - Hang Zhang
- Department of Biostatistics, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Department of Aging and Geriatric Research, University of Florida, Gainesville, FL, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Burel R. Goodin
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Adriana Sotolongo
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Megan E. Petrov
- College of Nursing and Health Innovation, Arizona State University, Phoenix, AZ, USA
| | - Matthew Herbert
- Center of Excellence for Stress and Mental Health (CESAMH), VA San Diego Healthcare System and University of California, San Diego, CA, USA
| | - Hailey W. Bulls
- Department of Psychology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Jeffrey C. Edberg
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL, USA
| | - David Redden
- Biostatistics Department, School of Public Health University of Alabama at Birmingham, Birmingham, AL, USA
| | - Laurence A. Bradley
- Department of Medicine, Division of Clinical Immunology and Rheumatology, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Risberg MA, Oiestad BE, Gunderson R, Aune AK, Engebretsen L, Culvenor A, Holm I. Changes in Knee Osteoarthritis, Symptoms, and Function After Anterior Cruciate Ligament Reconstruction: A 20-Year Prospective Follow-up Study. Am J Sports Med 2016; 44:1215-24. [PMID: 26912282 DOI: 10.1177/0363546515626539] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Progression of tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA) and changes in knee function more than 15 years after anterior cruciate ligament reconstruction (ACLR) are not well understood. PURPOSE To examine the progression of knee OA and changes in symptoms and function in isolated and combined injuries from 15 to 20 years after ACLR. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 210 subjects with ACLR were prospectively followed. At the 15- and 20-year follow-ups, radiographs were obtained and classified by the Kellgren and Lawrence (K-L) grading system. Symptoms and function were evaluated with the Knee injury and Osteoarthritis Outcome Score (KOOS) as well as isokinetic quadriceps and hamstring muscle strength tests. RESULTS There were 168 subjects (80%) who returned for the 20-year follow-up, with a mean (±SD) age of 45 ± 9 years, mean body mass index of 27 ± 4, and median Tegner activity level of 4 (range, 0-9). The prevalence of radiographic TF and PF OA at the 20-year follow-up was 42% and 21%, respectively. Patients with ACL injuries and other combined injuries had significantly higher prevalence of radiographic TF OA compared with those who had isolated ACL injury (P < .0001). There was a 13% increase in radiographic TF OA (P = .001) and an 8% increase in PF OA (P = .015) from the 15- to the 20-year follow-up. A significant deterioration in knee symptoms and function was observed on the KOOS subscales (P ≤ .01), with the exception of quality of life (P = .14), as well as a decrease in quadriceps muscle strength and hamstring muscle strength (P < .0001). CONCLUSION The prevalence of radiographic TF and PF OA was 42% and 21%, respectively. A significantly higher prevalence of TF OA was found for subjects with combined injuries compared with those who had isolated ACL injury. The majority of the subjects were stable radiographically over the 5 years between follow-ups. A statistically significant deterioration in symptoms and function was noted, but the mean changes were of questionable clinical importance.
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Affiliation(s)
- May Arna Risberg
- Norwegian Research Center for Active Rehabilitation, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Department of Sport Medicine, Norwegian School of Sport Sciences, Oslo, Norway
| | - Britt Elin Oiestad
- Norwegian Research Center for Active Rehabilitation, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Oslo and Akerhus University College of Applied Sciences, Institute of Physiotherapy, Oslo, Norway
| | | | - Arne Kristian Aune
- Department of Orthopedic Surgery, Aleris, Drammen, Norway Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway
| | - Lars Engebretsen
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway
| | - Adam Culvenor
- Norwegian Research Center for Active Rehabilitation, Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Institute of Anatomy, Paracelsus Medical University Salzburg and Nuremburg, Salzburg, Austria
| | - Inger Holm
- Department of Orthopaedic Surgery, Oslo University Hospital, Oslo, Norway Institute of Health and Society, Faculty of Medicine, University of Oslo, Oslo, Norway
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Taipale M, Jakkula E, Kämäräinen OP, Gao P, Skarp S, Barral S, Kiviranta I, Kröger H, Ott J, Wei GH, Ala-Kokko L, Männikkö M. Targeted re-sequencing of linkage region on 2q21 identifies a novel functional variant for hip and knee osteoarthritis. Osteoarthritis Cartilage 2016; 24:655-63. [PMID: 26603474 DOI: 10.1016/j.joca.2015.10.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Revised: 09/24/2015] [Accepted: 10/21/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of the study was to identify genetic variants predisposing to primary hip and knee osteoarthritis (OA) in a sample of Finnish families. METHODS Genome wide analysis was performed using 15 independent families (279 individuals) originating from Central Finland identified as having multiple individuals with primary hip and/or knee OA. Targeted re-sequencing was performed for three samples from one 33-member, four-generation family contributing most significantly to the LOD score. In addition, exome sequencing was performed in three family members from the same family. RESULTS Genome wide linkage analysis identified a susceptibility locus on chromosome 2q21 with a multipoint LOD score of 3.91. Targeted re-sequencing and subsequent linkage analysis revealed a susceptibility insertion variant rs11446594. It locates in a predicted strong enhancer element region with maximum LOD score 3.42 under dominant model of inheritance. Insertion creates a recognition sequence for ELF3 and HMGA1 transcription factors. Their DNA-binding affinity is highly increased in the presence of A-allele compared to wild type null allele. CONCLUSION A potentially novel functional OA susceptibility variant was identified by targeted re-sequencing. This variant locates in a predicted regulatory site and creates a recognition sequence for ELF3 and HMGA1 transcription factors that are predicted to play a significant role in articular cartilage homeostasis.
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Affiliation(s)
- M Taipale
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland; Center for Life Course Epidemiology and Systems Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - E Jakkula
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland; Public Health Genomics Unit, National Institute for Health and Welfare, Helsinki, Finland
| | - O-P Kämäräinen
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland
| | - P Gao
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland
| | - S Skarp
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland; Center for Life Course Epidemiology and Systems Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - S Barral
- Gertrude H. Sergievsky Center, College for Physicians and Surgeons, Columbia University, New York, USA
| | - I Kiviranta
- Department of Orthopaedics and Traumatology, University of Helsinki and Helsinki University Central Hospital, Helsinki, Finland; Department of Orthopaedics and Traumatology, Jyväskylä Central Hospital, Jyväskylä, Finland
| | - H Kröger
- Department of Orthopaedics and Traumatology, Kuopio University Hospital, Kuopio, Finland; Bone and Cartilage Research Unit, University of Eastern Finland, Kuopio, Finland
| | - J Ott
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - G-H Wei
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland
| | - L Ala-Kokko
- Connective Tissue Gene Tests, Allentown, PA, USA
| | - M Männikkö
- Biocenter Oulu and Faculty of Biochemistry and Molecular Medicine, University of Oulu, Finland; Center for Life Course Epidemiology and Systems Medicine, Faculty of Medicine, University of Oulu, Oulu, Finland.
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Moe RH, Grotle M, Kjeken I, Olsen IC, Mowinckel P, Haavardsholm EA, Hagen KB, Kvien TK, Uhlig T. Effectiveness of an Integrated Multidisciplinary Osteoarthritis Outpatient Program versus Outpatient Clinic as Usual: A Randomized Controlled Trial. J Rheumatol 2015; 43:411-8. [DOI: 10.3899/jrheum.150157] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/07/2015] [Indexed: 12/24/2022]
Abstract
Objective.Osteoarthritis (OA) is one of the leading causes of pain and disability. Given the constraint in the provision of care, there is a need to develop and assess effectiveness of new treatment models. The objective was to compare satisfaction with and effectiveness of a new integrated multidisciplinary outpatient program with usual care in an outpatient clinic for patients with OA.Methods.Patients with clinical OA referred to a rheumatology outpatient clinic were randomized to a 3.5-h multidisciplinary group-based educational program followed by individual consultations, or to usual care. The primary outcome was satisfaction with the health service evaluated on a numerical rating scale (0 = extremely unsatisfied, 10 = extremely satisfied) after 4 months. Secondary outcomes included health-related quality of life measures.Results.Of 391 patients, 86.4% (n = 338) were women, and mean age was 61.2 (SD 8.0) years. At 4 months, patients who received integrated multidisciplinary care were significantly more satisfied with the health service compared with controls, with a mean difference of −1.05 (95% CI −1.68 to −0.43, p < 0.001). Among secondary outcomes, only self-efficacy with other symptoms scale (10–100) improved significantly in the multidisciplinary group compared with controls at 4 months (3.59, 95% CI 0.69–6.5, p = 0.02). At 12 months, the Australian/Canadian Hand Osteoarthritis Index pain (0–10) and fatigue scores (0–10) were slightly worse in the multidisciplinary group with differences of 0.38 (95% CI 0.06–0.71, p = 0.02) and 0.55 (95% CI 0.02–1.07, p = 0.04), respectively.Conclusion.Patients receiving an integrated multidisciplinary care model were more satisfied with healthcare than those receiving usual care, whereas there were no clinically relevant improvements in health outcomes.
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Drexler M, Gortzak Y, Sternheim A, Kollender Y, Amar E, Bickels J. The radiological evaluation of the hip joint after prosthetic arthroplasty of the proximal femur in patients with a tumour using a bipolar femoral head. Bone Joint J 2015; 97-B:1704-9. [DOI: 10.1302/0301-620x.97b12.36366] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Excision of the proximal femur for tumour with prosthetic reconstruction using a bipolar femoral head places a considerable load on the unreplaced acetabulum. We retrospectively reviewed the changes which occur around the affected hip joint by evaluating the post-operative radiographs of 65 consecutive patients who underwent proximal prosthetic arthroplasty of the femur, and in whom an acetabular component had not been used. There were 37 men and 28 women with a mean age of 57.3 years (17 to 93). Radiological assessment included the extent of degenerative change in the acetabulum, heterotopic ossification, and protrusio acetabuli. The mean follow-up was 9.1 years (2 to 11.8). Degenerative changes in the acetabulum were seen in three patients (4.6%), Brooker grade 1 or 2 heterotopic ossification in 17 (26%) and protrusion of the prosthetic head in nine (13.8%). A total of eight patients (12.3%) needed a revision. Five were revised to the same type of prosthesis and three (4.6%) were converted to a total hip arthroplasty. We conclude that radiological evidence of degenerative change, heterotopic ossification and protrusion occur in a few patients who undergo prosthetic arthroplasty of the proximal femur for tumour. The limited extent of these changes and the lack of associated symptoms do not justify the routine arthroplasty of the acetabulum in these patients. Cite this article: Bone Joint J 2015;97-B:1704–9
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Affiliation(s)
| | | | | | | | - E. Amar
- Tel-Aviv University, Tel-Aviv, Israel
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Plotnikoff R, Karunamuni N, Lytvyak E, Penfold C, Schopflocher D, Imayama I, Johnson ST, Raine K. Osteoarthritis prevalence and modifiable factors: a population study. BMC Public Health 2015; 15:1195. [PMID: 26619838 PMCID: PMC4666016 DOI: 10.1186/s12889-015-2529-0] [Citation(s) in RCA: 119] [Impact Index Per Article: 13.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2014] [Accepted: 11/19/2015] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This study's objectives were to investigate the prevalence of self-reported knee and hip osteoarthritis (OA) stratified by age and sex and to examine the association of modifiable factors with knee and hip OA prevalence. The study was conducted using randomly sampled data gathered from four communities in the province of Alberta, Canada. METHODS A large adult population sample (N = 4733) of individuals ≥18 years were selected. Health-related information was collected through telephone interviews and community measurement clinics for which a sub-sample (N = 1808) attended. Participants self-reported OA during telephone interviews. Clinic interviews further assessed if the diagnosis was made by a health care professional. Statistical analyses compared prevalence of OA between sexes and across age categories. Associations between modifiable factors for OA and the prevalence of knee and hip OA were assessed using binary logistic regression modelling. RESULTS Overall prevalence of self-reported OA in the total sample was 14.8 %, where 10.5 % of individuals reported having knee OA and 8.5 % reported having hip OA. Differences in prevalence were found for males and females across age categories for both knee and hip OA. In terms of modifiable factors, being obese (BMI >30 kg/m2) was significantly associated with the prevalence of knee (OR: 4.37; 95 % CI: 2.08,9.20) and hip (OR: 2.52; 95 % CI: 1.17,5.43) OA. Individuals who stand or walk a lot, but do not carry or lift things during their occupational activities were 2.0 times less likely to have hip OA (OR: 0.50; 95 % CI: 0.26,0.96). Individuals who usually lift or carry light loads or have to climb stairs or hills were 2.2 times less likely to have hip OA (OR: 0.45; 95 % CI: 0.21,0.95). The odds of having hip OA were 1.9 times lower in individuals consuming recommended or higher vitamin C intake (OR: 0.52; 95 % CI: 0.29,0.96). Significant differences in prevalence were found for both males and females across age categories. CONCLUSION The prevalence of knee and hip OA obtained in this study is comparable to other studies. Females have greater knee OA prevalence and a greater proportion of women have mobility limitations as well as hip and knee pain; it is important to target this sub-group.
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Affiliation(s)
- Ronald Plotnikoff
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | | | - Ellina Lytvyak
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
| | - Christopher Penfold
- Priority Research Centre for Physical Activity and Nutrition, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | | | - Ikuyo Imayama
- Fred Hutchinson Cancer Research Center Seattle, Washington, USA.
| | - Steven T Johnson
- Centre for Nursing and Health Studies, Athabasca University, Athabasca, AB, Canada.
| | - Kim Raine
- School of Public Health, University of Alberta, Edmonton, AB, Canada.
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Peeters G(G, Alshurafa M, Schaap L, de Vet HC. Diagnostic accuracy of self-reported arthritis in the general adult population is acceptable. J Clin Epidemiol 2015; 68:452-9. [DOI: 10.1016/j.jclinepi.2014.09.019] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 09/11/2014] [Accepted: 09/24/2014] [Indexed: 11/24/2022]
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Cunha-Miranda L, Faustino A, Alves C, Vicente V, Barbosa S. [Assessing the magnitude of osteoarthritis disadvantage on people's lives: the MOVES study]. REVISTA BRASILEIRA DE REUMATOLOGIA 2014; 55:22-30. [PMID: 25582997 DOI: 10.1016/j.rbr.2014.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 06/05/2014] [Accepted: 07/28/2014] [Indexed: 12/29/2022] Open
Abstract
INTRODUCTION Osteoarthritis (OA) is one of the ten most disabling diseases in developed countries and one of the leading causes of pain and disability over the world. Early diagnosis increases the likelihood of preventing disease progression. OBJECTIVES To estimate the prevalence of self-reported osteoarthritis and quality of life in Portuguese adults with 45 or more years old. METHODS Observational, cross-sectional study, implemented in households by face-to-face interview. RESULTS 1,039 subjects with mean age of 62 years and 54.2% female were included. The prevalence of self-reported osteoarthritis was 9.9%. Knees and hands were the most frequent site of disease. The prevalence of OA was higher in women and in participants without professional activity. Presence of OA was higher in participants with comorbidities. Most subjects have done some treatment at some point in time for this disease: 94.5% had drug therapy, 49.5% physiotherapy, and 19.8% physical activity. Pain was associated with height, with some disease locations specifically neck, lower spine and shoulders, SF12 scores of quality of life, and measurements of impact in daily living, severity of disease and disability. The impact of OA in daily living was greater in subjects that had been on sick leave or stopped working due to OA, had worse physical and mental health, and with more severe of disease. CONCLUSION This study confirmed that osteoarthritis is a very relevant disease with a high potential impact on quality of life, function and work ability and because of its prevalence with a very high growing social impact.
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Affiliation(s)
| | | | | | - Vera Vicente
- Eurotrials, Scientific Consultants, Lisboa, Portugal
| | - Sandra Barbosa
- AstraZeneca, Produtos Farmacêuticos, Lda., Barcarena, Portugal
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Richette P, Clerson P, Bouée S, Chalès G, Doherty M, Flipo RM, Lambert C, Lioté F, Poiraud T, Schaeverbeke T, Bardin T. Identification of patients with gout: elaboration of a questionnaire for epidemiological studies. Ann Rheum Dis 2014; 74:1684-90. [PMID: 24796335 DOI: 10.1136/annrheumdis-2013-204976] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2013] [Accepted: 04/10/2014] [Indexed: 11/04/2022]
Abstract
OBJECTIVES In France, the prevalence of gout is currently unknown. We aimed to design a questionnaire to detect gout that would be suitable for use in a telephone survey by non-physicians and assessed its performance. METHODS We designed a 62-item questionnaire covering comorbidities, clinical features and treatment of gout. In a case-control study, we enrolled patients with a history of arthritis who had undergone arthrocentesis for synovial fluid analysis and crystal detection. Cases were patients with crystal-proven gout and controls were patients who had arthritis and effusion with no monosodium urate crystals in synovial fluid. The questionnaire was administered by phone to cases and controls by non-physicians who were unaware of the patient diagnosis. Logistic regression analysis and classification and regression trees were used to select items discriminating cases and controls. RESULTS We interviewed 246 patients (102 cases and 142 controls). Two logistic regression models (sensitivity 88.0% and 87.5%; specificity 93.0% and 89.8%, respectively) and one classification and regression tree model (sensitivity 81.4%, specificity 93.7%) revealed 11 informative items that allowed for classifying 90.0%, 88.8% and 88.5% of patients, respectively. CONCLUSIONS We developed a questionnaire to detect gout containing 11 items that is fast and suitable for use in a telephone survey by non-physicians. The questionnaire demonstrated good properties for discriminating patients with and without gout. It will be administered in a large sample of the general population to estimate the prevalence of gout in France.
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Affiliation(s)
- P Richette
- Université Paris Diderot, UFR médicale, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, Cedex, France INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France
| | - P Clerson
- Orgamétrie Biostatistiques, Roubaix, France
| | - S Bouée
- Cemka-Eval, Bourg La Reine, France
| | - G Chalès
- Service de rhumatologie, Hôpital Sud, CHU Rennes, Université de Rennes-1, Rennes, Cedex, France
| | - M Doherty
- Academic Rheumatology, University of Nottingham, City Hospital, Nottingham, UK
| | - R M Flipo
- Service de Rhumatologie, Université de Lille 2, Hôpital Roger-Salengro, CHRU de Lille
| | - C Lambert
- Département médical, Ipsen, Boulogne, France
| | - F Lioté
- Université Paris Diderot, UFR médicale, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, Cedex, France INSERM 1132, Université Paris-Diderot, Hôpital Lariboisière, Paris, France
| | - T Poiraud
- Département médical, Ménarini, Rungis, France
| | - T Schaeverbeke
- Département de Rhumatologie, Hôpital Pellegrin, CHU de Bordeaux, place Amélie-Raba-Léon, Bordeaux, France
| | - T Bardin
- Université Paris Diderot, UFR médicale, Paris, France; Assistance Publique-Hôpitaux de Paris, Hôpital Lariboisiére, Fédération de Rhumatologie, Paris, Cedex, France
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Questionnaire to identify knee symptoms: development of a tool to identify early experiences consistent with knee osteoarthritis. Phys Ther 2014; 94:111-20. [PMID: 24009346 DOI: 10.2522/ptj.20130078] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023]
Abstract
BACKGROUND Current diagnostic procedures for knee osteoarthritis (OA) identify individuals late in the disease process. A questionnaire may be a useful and inexpensive method to screen for early symptoms of knee OA. OBJECTIVE The purpose of this study was to develop a brief, self-administered questionnaire for clinical and research settings to identify emerging knee problems in people who could benefit from conservative interventions. DESIGN This prospective study utilized a mixed-methods approach. METHODS AND RESULTS Questionnaire items were generated from interview data from individuals with emerging chronic knee problems. These items were reviewed by 16 rheumatology experts, resulting in a 35-item draft questionnaire. To reduce the number of items, questionnaires were mailed to 228 adults, aged 40 to 65 years, with evidence of ongoing knee problems. One hundred thirteen completed questionnaires were returned (63.1% response rate), with 105 usable questionnaires. Using principal components analysis, the number of items was reduced to a final 13-item version, the Questionnaire to Identify Knee Symptoms (QuIKS). The QuIKS has 4 subscales: medications, monitoring, interpreting, and modifying. The QuIKS demonstrated strong internal consistency. LIMITATIONS A sampling bias among respondents who provided data for item reduction likely means that the QuIKS reflects those who self-report knee problems to a health care provider, which may not be generalizable to the population. CONCLUSIONS The QuIKS is a short, self-administered questionnaire used to promote activity by identifying the experiences associated with early symptoms consistent with knee OA, such as monitoring intermittent symptoms, interpreting the meaning of these symptoms, modifying behaviors, and including the use of medications. If future work validates the QuIKS, its use in developing samples could expand our understanding of early disease and improve interventions.
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Battaglia M, Guaraldi F, Vannini F, Rossi G, Timoncini A, Buda R, Giannini S. Efficacy of ultrasound-guided intra-articular injections of platelet-rich plasma versus hyaluronic acid for hip osteoarthritis. Orthopedics 2013; 36:e1501-8. [PMID: 24579221 DOI: 10.3928/01477447-20131120-13] [Citation(s) in RCA: 98] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Intra-articular injections of platelet-rich plasma (PRP) and hyaluronic acid (HA) represent efficacious medical treatments for osteoarthritis (OA), although no comparative study on long-term efficacy in hip OA exists. The goals of the current study were to compare the clinical efficacy of PRP vs HA at 12 months of follow-up in patients with hip OA and evaluate the influence of the type of infiltration and patient age, sex, body mass index, and degree of OA on temporal clinical evolution. One hundred patients with chronic unilateral symptomatic hip OA were consecutively enrolled and randomly assigned to 1 of 2 groups: group A received PRP and group B received HA administered via intra-articular ultrasound-guided injections. Patients were evaluated at baseline and after 1, 3, 6, and 12 months using the Harris Hip Score (HHS) and visual analog scale (VAS). An overall improvement was detected in both groups between 1- and 3-month follow-up. Despite a slightly progressive worsening between 6- and 12-month follow-up, the final clinical scores remained higher compared with baseline (P<.0005), with no significant differences between PRP and HA. Regarding clinical temporal evolution, multivariate analysis showed that HHS was not influenced by the type of infiltration, patient age, sex, body mass index, or degree of OA, whereas a significant association was detected between OA grade IV and VAS evolution (P<.0005). Intra-articular injections of PRP are efficacious in terms of functional improvement and pain reduction but are not superior to HA in patients with symptomatic hip OA at 12-month follow-up.
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Abstract
Osteoarthritis (OA) is a disease of the joint, and age is the major risk factor for its development. Clinical manifestation of OA includes joint pain, stiffness, and loss of mobility. Currently, no pharmacological treatments are available to treat this specific joint disease; only symptom-modifying drugs are available. Improvement in imaging technology, identification of biomarkers, and increased understanding of the molecular basis of OA will aid in detecting the early stages of disease. Yet the development of interventional strategies remains elusive and will be critical for effective prevention of OA-associated joint destruction. The potential of cell-based therapies may be applicable in improving joint function in mild to more advanced cases of OA. Ongoing studies to understand the basis of this disease will eventually lead to prevention and treatment strategies and will also be a key in reducing the social and economic burden of this disease. Nurses are advised to provide an integrative approach of disease assessment and management in OA patients' care with a focus on education and implementation. Knowledge and understanding of OA and how this affects the individual patient form the basis for such an integrative approach to all-round patient care and disease management.
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Effects of Inpatient Rehabilitation in Hip and Knee Osteoarthritis: A Naturalistic Prospective Cohort Study With Intraindividual Control of Effects. Arch Phys Med Rehabil 2013; 94:2139-45. [DOI: 10.1016/j.apmr.2013.03.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Revised: 03/07/2013] [Accepted: 03/23/2013] [Indexed: 11/23/2022]
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Wang Y, Peng R, Ma R. Epidemiological investigation of osteoarthritis in middle-aged mongolian and senior residents of the inner mongolia autonomous region. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:e8303. [PMID: 24693375 PMCID: PMC3950787 DOI: 10.5812/ircmj.8303] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/24/2012] [Revised: 04/15/2013] [Accepted: 07/15/2013] [Indexed: 11/17/2022]
Abstract
Background To investigate the prevalence and characteristics of osteoarthritis (OA) in Mongolian middle-aged and senior residents of the Inner Mongolia autonomous region, compared with the prevalence of OA in different regions, to understand the OA-associated factors and provide theoretical evidences for intervention and prevention. Objectives Thereby the prevalence, distribution characteristics and correlative factors of OA in Mongolian middle-aged and senior residents in the Inner Mongolia autonomous region were investigated in this study. Materials and Methods Rural and urban residents in Hohhot, Baotou and Erdos were selected using stratified, multi-stage and cluster random sampling. 2000 residents aging over 45 filled out questionnaires, underwent specialized physical and X-ray examinations. The factors affecting OA were analyzed by the multivariate unconditional logistic regression. Results Obtained total of 1877 questionnaires were completed. 93% of the residents were unaware of OA-related issues. The prevalence of radiological OA and clinical OA (neck OA: 36.72%; waist OA: 44.02%; knee OA: 12.43%; hand OA: 6.83%) were 62.17% and 56.15%, respectively. Urban residents were more subjected to cervical spine (χ2 = 8.92, P = 0.005) and less to lumbar spine disease (χ2 = 10.32, P = 0.004) compared to rural ones. The prevalence of OA in knees and hands of females (χ2 = 8.65, P = 0.003) was significantly higher than males (χ2=4.37, P=0.042). The prevalence of OA in postmenopausal females was slightly higher than males (χ2 = 3.86, P = 0.052), with no statically significant difference. The risks of OA obviously increased with age. The residents with hypertension, diabetes and atherosclerosis were more subjected to OA. Conclusions The prevalence of OA in Mongolian middle-aged and senior residents in part of the Inner Mongolia autonomous region was similar to the other ethnic groups. The prevalence of OA was affected by age, gender, location, hypertension, diabetes, atherosclerosis and osteoporosis. The residents need further educations about OA prevention and treatment.
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Affiliation(s)
- Yuewen Wang
- Department of Orthopaedics, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Rui Peng
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
| | - Ruilian Ma
- Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China
- Corresponding Author: Ruilian Ma, Department of Pharmacy, Affiliated Hospital of Inner Mongolia Medical University, Hohhot, China. Tel/Fax: +86-4716636812, E-mail:
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