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Riedstra NS, Boel F, van Buuren M, Eygendaal D, Bierma-Zeinstra S, Runhaar J, Agricola R. Pincer Morphology Is Not Associated With Hip Osteoarthritis Unless Hip Pain Is Present: Follow-Up Data From a Prospective Cohort Study. Arthritis Care Res (Hoboken) 2024; 76:644-651. [PMID: 38130018 DOI: 10.1002/acr.25285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/10/2023] [Accepted: 12/19/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVE The objective of this study was to assess the relationship between pincer morphology and radiographic hip osteoarthritis (RHOA) over 2, 5, 8, and 10 years' follow-up and to study the interaction between pincer morphology and pain. METHODS Individuals from the prospective Cohort Hip and Cohort Knee study were drawn. Anteroposterior pelvic and false profile radiographs were obtained. Hips free of definite RHOA (Kellgren and Lawrence [KL] grade 0 or 1) at baseline were included. Pincer morphology was defined as a lateral or anterior center edge angle or both ≥40° at baseline. Incident RHOA was defined as KL ≥ 2 or total hip replacement at follow-up. Multivariable logistic regression with generalized estimating equations estimated the associations at follow-up. Associations were expressed as unadjusted odds ratios (ORs) and adjusted ORs with 95% confidence intervals (CIs). An interaction term was added to investigate whether pincer morphology had a different effect on symptomatic hips. RESULTS Incident RHOA developed in 69 hips (5%) at 2 years' follow-up, in 178 hips (14%) at 5 years' follow-up, in 279 hips (24%) at 8 years' follow-up, and in 495 hips (42%) at 10 years' follow-up. No significant associations were found between pincer morphology and incident RHOA (adjusted OR 0.35 [95% CI 0.06-2.15]; adjusted OR 1.50 [95% CI 0.94-2.38]). Significant interactions between pain and anterior pincer morphology in predicting incident RHOA were found at 5, 8, and 10 years' follow-up (OR 1.97 [95% CI 1.03-3.78]; OR 3.41 [95% CI 1.35-8.61]). CONCLUSION No associations were found between radiographic pincer morphology and incident RHOA at any follow-up moment. Anteriorly located pincer morphology with hip pain, however, was significantly associated with incident RHOA. This highlights the importance of studying symptoms and hip morphology simultaneously.
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Affiliation(s)
| | - Fleur Boel
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | | | | | | | - Jos Runhaar
- Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Rintje Agricola
- Erasmus University Medical Center, Rotterdam, The Netherlands
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2
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Kopp PT, Yang C, Yang H, Katz JN, Paltiel AD, Hunter DJ, Callahan LF, Mihalko SL, Newman JJ, DeVita P, Loeser RF, Miller GD, Messier SP, Losina E. Cost-Effectiveness of Community-Based Diet and Exercise for Patients with Knee Osteoarthritis and Obesity or Overweight. Arthritis Care Res (Hoboken) 2024. [PMID: 38450873 DOI: 10.1002/acr.25323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Revised: 01/19/2024] [Accepted: 03/05/2024] [Indexed: 03/08/2024]
Abstract
OBJECTIVE Obesity exacerbates pain and functional limitation in persons with knee osteoarthritis (OA). In the Weight Loss and Exercise for Communities with Arthritis in North Carolina (WE-CAN) study, a community-based diet and exercise (D + E) intervention led to an additional 6 kg weight loss and 20% greater pain relief in persons with knee OA and body mass index (BMI) >27 kg/m2 relative to a group-based health education (HE) intervention. We sought to determine the incremental cost-effectiveness of the usual care (UC), UC + HE, and UC + (D + E) programs, comparing each strategy with the "next-best" strategy ranked by increasing lifetime cost. METHODS We used the Osteoarthritis Policy Model to project long-term clinical and economic benefits of the WE-CAN interventions. We considered three strategies: UC, UC + HE, and UC + (D + E). We derived cohort characteristics, weight, and pain reduction from the WE-CAN trial. Our outcomes included quality-adjusted life years (QALYs), cost, and incremental cost-effectiveness ratios (ICERs). RESULTS In a cohort with mean age 65 years, BMI 37 kg/m2, and Western Ontario and McMaster Universities Osteoarthritis Index pain score 38 (scale 0-100, 100 = worst), UC leads to 9.36 QALYs/person, compared with 9.44 QALYs for UC + HE and 9.49 QALYS for UC + (D + E). The corresponding lifetime costs are $147,102, $148,139, and $151,478. From the societal perspective, UC + HE leads to an ICER of $12,700/QALY; adding D + E to UC leads to an ICER of $61,700/QALY. CONCLUSION The community-based D + E program for persons with knee OA and BMI >27kg/m2 could be cost-effective for willingness-to-pay thresholds greater than $62,000/QALY. These findings suggest that incorporation of community-based D + E programs into OA care may be beneficial for public health.
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Affiliation(s)
- Paul T Kopp
- Brigham and Women's Hospital, Boston, Massachusetts
| | | | - Heidi Yang
- Brigham and Women's Hospital, Boston, Massachusetts
| | - Jeffrey N Katz
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | | | - David J Hunter
- University of Sydney, Sydney, New South Wales, Australia
| | | | | | | | - Paul DeVita
- East Carolina University, Greenville, North Carolina
| | | | - Gary D Miller
- Wake Forest University, Winston-Salem, North Carolina
| | | | - Elena Losina
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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3
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Farooq MU, Ullah Z, Khan A, Gwak J. DC-AAE: Dual channel adversarial autoencoder with multitask learning for KL-grade classification in knee radiographs. Comput Biol Med 2023; 167:107570. [PMID: 37897960 DOI: 10.1016/j.compbiomed.2023.107570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Revised: 08/25/2023] [Accepted: 10/10/2023] [Indexed: 10/30/2023]
Abstract
Knee osteoarthritis (OA) is a frequent musculoskeletal disorder that leads to physical disability in older adults. Manual OA assessment is performed via visual inspection, which is highly subjective as it suffers from moderate to high inter-observer variability. Many deep learning-based techniques have been proposed to address this issue. However, owing to the limited amount of labelled data, all existing solutions have limitations in terms of performance or the number of classes. This paper proposes a novel fully automatic Kellgren and Lawrence (KL) grade classification scheme in knee radiographs. We developed a semi-supervised multi-task learning-based approach that enables the exploitation of additional unlabelled data in an unsupervised as well as supervised manner. Specifically, we propose a dual-channel adversarial autoencoder, which is first trained in an unsupervised manner for reconstruction tasks only. To exploit the additional data in a supervised way, we propose a multi-task learning framework by introducing an auxiliary task. In particular, we use leg side identification as an auxiliary task, which allows the use of more datasets, e.g., CHECK dataset. The work demonstrates that the utilization of additional data can improve the primary task of KL-grade classification for which only limited labelled data is available. This semi-supervised learning essentially helps to improve the feature learning ability of our framework, which leads to improved performance for KL-grade classification. We rigorously evaluated our proposed model on the two largest publicly available datasets for various aspects, i.e., overall performance, the effect of additional unlabelled samples and auxiliary tasks, robustness analysis, and ablation study. The proposed model achieved the accuracy, precision, recall, and F1 score of 75.53%, 74.1%, 78.51%, and 75.34%, respectively. Furthermore, the experimental results show that the suggested model not only achieves state-of-the-art performance on two publicly available datasets but also exhibits remarkable robustness.
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Affiliation(s)
- Muhammad Umar Farooq
- Department of IT, Energy Convergence (BK21 FOUR), Korea National University of Transportation, Chungju 27469, South Korea
| | - Zahid Ullah
- Department of Software, Korea National University of Transportation, Chungju 27469, South Korea
| | - Asifullah Khan
- Pattern Recognition Lab, DCIS, PIEAS, Nilore, Islamabad 45650, Pakistan
| | - Jeonghwan Gwak
- Department of IT, Energy Convergence (BK21 FOUR), Korea National University of Transportation, Chungju 27469, South Korea; Department of Software, Korea National University of Transportation, Chungju 27469, South Korea; Department of Biomedical Engineering, Korea National University of Transportation, Chungju 27469, South Korea; Department of AI Robotics Engineering, Korea National University of Transportation, Chungju 27469, South Korea.
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Rayegan H, Nguyen H, Weinans H, Gielis W, Ahmadi Brooghani S, Custers R, van Egmond N, Lindner C, Arbabi V. Automated Radiographic Measurements of Knee Osteoarthritis. Cartilage 2023; 14:413-423. [PMID: 37265053 PMCID: PMC10807738 DOI: 10.1177/19476035231166126] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 12/27/2022] [Accepted: 03/12/2023] [Indexed: 06/03/2023] Open
Abstract
OBJECTIVE Herewith, we report the development of Orthopedic Digital Image Analysis (ODIA) software that is developed to obtain quantitative measurements of knee osteoarthritis (OA) radiographs automatically. Manual segmentation and measurement of OA parameters currently hamper large-cohort analyses, and therefore, automated and reproducible methods are a valuable addition in OA research. This study aims to test the automated ODIA measurements and compare them with available manual Knee Imaging Digital Analysis (KIDA) measurements as comparison. DESIGN This study included data from the CHECK (Cohort Hip and Cohort Knee) initiative, a prospective multicentre cohort study in the Netherlands with 1,002 participants. Knee radiographs obtained at baseline of the CHECK cohort were included and mean medial/lateral joint space width (JSW), minimal JSW, joint line convergence angle (JLCA), eminence heights, and subchondral bone intensities were compared between ODIA and KIDA. RESULTS Of the potential 2,004 radiographs, 1,743 were included for analyses. Poor intraclass correlation coefficients (ICCs) were reported for the JLCA (0.422) and minimal JSW (0.299). The mean medial and lateral JSW, eminence height, and subchondral bone intensities reported a moderate to good ICC (0.7 or higher). Discrepancies in JLCA and minimal JSW between the 2 methods were mostly a problem in the lateral tibia plateau. CONCLUSIONS The current ODIA tool provides important measurements of OA parameters in an automated manner from standard radiographs of the knee. Given the automated and computerized methodology that has very high reproducibility, ODIA is suitable for large epidemiological cohorts with various follow-up time points to investigate structural progression, such as CHECK or the Osteoarthritis Initiative (OAI).
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Affiliation(s)
- H. Rayegan
- Orthopaedic-BioMechanics Research Group, University of Birjand, Birjand, Iran
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - H.C. Nguyen
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- 3D Lab, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - H. Weinans
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Biomechanical Engineering, Faculty of Mechanical, Maritime and Materials Engineering (3mE), Delft University of Technology, Delft, The Netherlands
| | - W.P. Gielis
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - S.Y. Ahmadi Brooghani
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
| | - R.J.H. Custers
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - N. van Egmond
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - C. Lindner
- Division of Informatics, Imaging & Data Sciences, The University of Manchester, Manchester, UK
| | - V. Arbabi
- Orthopaedic-BioMechanics Research Group, University of Birjand, Birjand, Iran
- Department of Mechanical Engineering, Faculty of Engineering, University of Birjand, Birjand, Iran
- Department of Orthopaedic Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Tang J, van Buuren MMA, Riedstra NS, Boel F, Runhaar J, Bierma-Zeinstra S, Agricola R. Cam morphology is strongly and consistently associated with development of radiographic hip osteoarthritis throughout 4 follow-up visits within 10 years. Osteoarthritis Cartilage 2023; 31:1650-1656. [PMID: 37598743 DOI: 10.1016/j.joca.2023.08.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Revised: 08/15/2023] [Accepted: 08/16/2023] [Indexed: 08/22/2023]
Abstract
OBJECTIVE To determine the association between cam morphology and the development of radiographic hip osteoarthritis (RHOA) at four time points within 10-year follow-up. DESIGN The nationwide prospective Cohort Hip and Cohort Knee study includes 1002 participants aged 45-65 years with 2-, 5-, 8-, and 10-year follow-ups. The associations of cam morphology (alpha angle >60°) and large cam morphology (alpha angle >78°) in hips free of osteoarthritis at baseline (Kellgren & Lawrence (KL) grade <2) with the development of both incident RHOA (KL grade≥2) and end-stage RHOA (KL grade≥3) were estimated using logistic regression with generalized estimating equation at each follow-up and using Cox regression over 10 years, adjusted for age, sex, and body mass index. RESULTS Both cam morphology and large cam morphology were associated with the development of incident RHOA at all follow-ups with adjusted Odd Ratios (aORs) ranging from 2.7 (95% Confidence interval 1.8-4.1) to 2.9 (95% CI 2.0-4.4) for cam morphology and ranging from 2.5 (95% CI 1.5-4.3) to 4.2 (95% CI 2.2-8.3) for large cam morphology. For end-stage RHOA, cam morphology resulted in aORs ranging from 4.9 (95% CI 1.8-13.2) to 8.5 (95% CI 1.1-64.4), and aORs for large cam morphology ranged from 6.7 (95% CI 3.1-14.7) to 12.7 (95% CI 1.9-84.4). CONCLUSIONS Cam morphology poses the hip at 2-13 times increased odds for developing RHOA within a 10-year follow-up. The association was particularly strong for large cam morphology and end-stage RHOA, while the strength of association was consistent over time.
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Affiliation(s)
- Jinchi Tang
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Michiel M A van Buuren
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Noortje S Riedstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Fleur Boel
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Sita Bierma-Zeinstra
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Rintje Agricola
- Department of Orthopedics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
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Bizzarri D, Reinders MJT, Beekman M, Slagboom PE, van den Akker EB. Technical Report: A Comprehensive Comparison between Different Quantification Versions of Nightingale Health's 1H-NMR Metabolomics Platform. Metabolites 2023; 13:1181. [PMID: 38132863 PMCID: PMC10745109 DOI: 10.3390/metabo13121181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2023] [Revised: 11/07/2023] [Accepted: 11/17/2023] [Indexed: 12/23/2023] Open
Abstract
1H-NMR metabolomics data is increasingly used to track health and disease. Nightingale Health, a major supplier of 1H-NMR metabolomics, has recently updated the quantification strategy to further align with clinical standards. Such updates, however, might influence backward replicability, particularly affecting studies with repeated measures. Using data from BBMRI-NL consortium (~28,000 samples from 28 cohorts), we compared Nightingale data, originally released in 2014 and 2016, with a re-quantified version released in 2020, of which both versions were based on the same NMR spectra. Apart from two discontinued and twenty-three new analytes, we generally observe a high concordance between quantification versions with 73 out of 222 (33%) analytes showing a mean ρ > 0.9 across all cohorts. Conversely, five analytes consistently showed lower Spearman's correlations (ρ < 0.7) between versions, namely acetoacetate, LDL-L, saturated fatty acids, S-HDL-C, and sphingomyelins. Furthermore, previously trained multi-analyte scores, such as MetaboAge or MetaboHealth, might be particularly sensitive to platform changes. Whereas MetaboHealth replicated well, the MetaboAge score had to be retrained due to use of discontinued analytes. Notably, both scores in the re-quantified data recapitulated mortality associations observed previously. Concluding, we urge caution in utilizing different platform versions to avoid mixing analytes, having different units, or simply being discontinued.
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Affiliation(s)
- Daniele Bizzarri
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
- Leiden Computational Biology Center, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
- Delft Bioinformatics Lab., Department of Intelligent Systems, TU Delft, 2628 XE Delft, The Netherlands
| | - Marcel J. T. Reinders
- Leiden Computational Biology Center, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
- Delft Bioinformatics Lab., Department of Intelligent Systems, TU Delft, 2628 XE Delft, The Netherlands
| | - Marian Beekman
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
| | - P. Eline Slagboom
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
- Max Planck Institute for the Biology of Ageing, 50931 Cologne, Germany
| | - Erik B. van den Akker
- Molecular Epidemiology, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
- Leiden Computational Biology Center, Department of Biomedical Data Science, Leiden University Medical Center, 2333 ZC Leiden, The Netherlands
- Delft Bioinformatics Lab., Department of Intelligent Systems, TU Delft, 2628 XE Delft, The Netherlands
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Liew JW, King LK, Mahmoudian A, Wang Q, Atkinson HF, Flynn DB, Appleton CT, Englund M, Haugen IK, Lohmander LS, Runhaar J, Neogi T, Hawker G. A scoping review of how early-stage knee osteoarthritis has been defined. Osteoarthritis Cartilage 2023; 31:1234-1241. [PMID: 37225053 PMCID: PMC10528892 DOI: 10.1016/j.joca.2023.04.015] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 04/14/2023] [Accepted: 04/27/2023] [Indexed: 05/26/2023]
Abstract
BACKGROUND Early-stage knee osteoarthritis (KOA) classification criteria will enable consistent identification and trial recruitment of individuals with knee osteoarthritis (OA) at an earlier stage of the disease when interventions may be more effective. Toward this goal, we identified how early-stage KOA has been defined in the literature. METHODS We performed a scoping literature review in PubMed, EMBASE, Cochrane, and Web of Science, including human studies where early-stage KOA was included as a study population or outcome. Extracted data included demographics, symptoms/history, examination, laboratory, imaging, performance-based measures, gross inspection/histopathologic domains, and the components of composite early-stage KOA definitions. RESULTS Of 6142 articles identified, 211 were included in data synthesis. An early-stage KOA definition was used for study inclusion in 194 studies, to define study outcomes in 11 studies, and in the context of new criteria development or validation in six studies. The element most often used to define early-stage KOA was Kellgren-Lawrence (KL) grade (151 studies, 72%), followed by symptoms (118 studies, 56%), and demographic characteristics (73 studies, 35%); 14 studies (6%) used previously developed early-stage KOA composite criteria. Among studies defining early-stage KOA radiographically, 52 studies defined early-stage KOA by KL grade alone; of these 52, 44 (85%) studies included individuals with KL grade 2 or higher in their definitions. CONCLUSION Early-stage KOA is variably defined in the published literature. Most studies included KL grades of 2 or higher within their definitions, which reflects established or later-stage OA. These findings underscore the need to develop and validate classification criteria for early-stage KOA.
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Affiliation(s)
- Jean W Liew
- Boston University School of Medicine, Boston, MA, USA
| | - Lauren K King
- Department of Medicine, University of Toronto, Canada
| | - Armaghan Mahmoudian
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden; Department of Movement Sciences and Health, University of West Florida, FL, USA
| | - Qiuke Wang
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Hayden F Atkinson
- Faculty of Health Sciences, University of Western Ontario, London, Canada
| | - David B Flynn
- Boston University School of Medicine, Boston, MA, USA
| | - C Thomas Appleton
- Department of Physiology and Pharmacology Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada; Department of Medicine, The University of Western Ontario, London, Canada; Western Bone and Joint Institute, London, Ontario, Canada
| | - Martin Englund
- Department of Clinical Sciences Lund, Orthopedics, Clinical Epidemiology Unit, Lund University, Lund, Sweden
| | - Ida K Haugen
- Center for Treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Lund, Sweden
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, the Netherlands
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, USA
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Driban JB, Harkey MS, McAlindon TE, Lo GH. The importance of context and intent when defining early-stage knee osteoarthritis. Osteoarthritis Cartilage 2023; 31:1145-1147. [PMID: 37328046 DOI: 10.1016/j.joca.2023.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Revised: 06/01/2023] [Accepted: 06/07/2023] [Indexed: 06/18/2023]
Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA.
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, MI, USA.
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center; Boston, MA, USA.
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey, VAMC, Houston, TX, USA; Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA.
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9
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van Berkel AC, Schiphof D, Waarsing JH, Runhaar J, van Ochten JM, Bindels PJ, Bierma-Zeinstra SM. Nocturnal pain and fatigue in middle-aged persons with hip symptoms suspected to be osteoarthritis, is there a link in 10-year follow-up of the CHECK study? OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100363. [PMID: 37214788 PMCID: PMC10192639 DOI: 10.1016/j.ocarto.2023.100363] [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: 09/27/2022] [Accepted: 04/11/2023] [Indexed: 05/24/2023] Open
Abstract
Objective To explore the prevalence of nocturnal pain and fatigue in participants with hip symptoms suspected to be early osteoarthritis (OA) and to test the mediating effect of nocturnal pain on the association between hip OA pain and fatigue. Methods We included participants with hip pain but no knee pain at baseline, from the Cohort Hip and Cohort Knee (CHECK)-study. Severity of hip OA pain was determined using the Numeric-Rating-Scale-pain-score last week. Fatigue was assessed using the SF-36 Fatigue subscale. Nocturnal pain was determined using the WOMAC-question: "How much pain have you experienced in the last 48 h at night while in bed?". Hip OA pain, nocturnal pain and fatigue were measured repeatedly during 10-year follow-up. Path analysis were used per time point to determine the direct effect of OA pain on fatigue and the indirect effect through nocturnal pain. Results In 170 participants (female: 76%; mean age: 55.7 years; mean BMI: 25.5 kg/m2) the prevalence of nocturnal pain varied between 22 and 35% and the prevalence of fatigue ranged between 14 and 18%. Hip OA pain was associated with nocturnal pain and fatigue. The direct effect of hip OA pain on fatigue was significant at all-time points. No significant mediating effect of nocturnal pain was found. Conclusion In this cohort of participants suspected to have early hip OA, the prevalence of fatigue remained stable and the prevalence of nocturnal pain decreased slightly over 10-year follow-up. We did not find a mediating effect of nocturnal pain in the pathway between hip OA pain and fatigue.
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Affiliation(s)
- Annemaria C. van Berkel
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jan H. Waarsing
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - John M. van Ochten
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Patrick J.E. Bindels
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Sita M.A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, the Netherlands
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10
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Salis Z, Sainsbury A. Association of Change in Body Mass Index With Incidence and Progression of the Structural Defects of Hip Osteoarthritis: Data From the Osteoarthritis Initiative and the Cohort Hip and Cohort Knee study. Arthritis Care Res (Hoboken) 2023; 75:1527-1537. [PMID: 36354244 PMCID: PMC10952232 DOI: 10.1002/acr.25057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 10/14/2022] [Accepted: 11/08/2022] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To define the association between change in body mass index (BMI) and the incidence and progression of structural defects of hip osteoarthritis as assessed by radiography. METHODS We used data from 2 independent cohort studies: the Osteoarthritis Initiative (OAI) and the Cohort Hip and Cohort Knee (CHECK) study. Our exposure was change in BMI from baseline to 4-5 years' follow-up. Our outcomes were the incidence and progression of structural defects of hip osteoarthritis as assessed using a modified Croft grade in OAI and the Kellgren/Lawrence grade in the CHECK study. To study incidence, we created incidence cohorts of hips without definite overall structural defects at baseline (i.e., grade <2) and then investigated the odds of hips having definite overall structural defects at follow-up (i.e., grade ≥2). To study progression, we created progression cohorts of hips with definite overall structural defects at baseline (i.e., grade ≥2) and then investigated the odds of having a grade increase of ≥1 from baseline to follow-up. RESULTS There was a total of 5,896 and 1,377 hips in the incidence cohorts, and 303 and 129 hips in the progression cohorts for the OAI and CHECK study, respectively. Change in BMI (decrease or increase) was not associated with any change in odds of the incidence or progression of definite structural defects of hip osteoarthritis in either the OAI or CHECK cohorts. CONCLUSION Weight loss may not be an effective strategy for preventing, slowing, or delaying the structural defects of hip osteoarthritis over 4-5 years.
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Affiliation(s)
- Zubeyir Salis
- University of New South WalesKensingtonNew South WalesAustralia
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11
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Durán-Sotuela A, Fernandez-Moreno M, Suárez-Ulloa V, Vázquez-García J, Relaño S, Hermida-Gómez T, Balboa-Barreiro V, Lourido-Salas L, Calamia V, Fernandez-Puente P, Ruiz-Romero C, Fernández-Tajes J, Vaamonde-García C, de Andrés MC, Oreiro N, Blanco FJ, Rego-Perez I. A meta-analysis and a functional study support the influence of mtDNA variant m.16519C on the risk of rapid progression of knee osteoarthritis. Ann Rheum Dis 2023:ard-2022-223570. [PMID: 37024296 DOI: 10.1136/ard-2022-223570] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 03/17/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVES To identify mitochondrial DNA (mtDNA) genetic variants associated with the risk of rapid progression of knee osteoarthritis (OA) and to characterise their functional significance using a cellular model of transmitochondrial cybrids. METHODS Three prospective cohorts contributed participants. The osteoarthritis initiative (OAI) included 1095 subjects, the Cohort Hip and Cohort Knee included 373 and 326 came from the PROspective Cohort of Osteoarthritis from A Coruña. mtDNA variants were screened in an initial subset of 450 subjects from the OAI by in-depth sequencing of mtDNA. A meta-analysis of the three cohorts was performed. A model of cybrids was constructed to study the functional consequences of harbouring the risk mtDNA variant by assessing: mtDNA copy number, mitochondrial biosynthesis, mitochondrial fission and fusion, mitochondrial reactive oxygen species (ROS), oxidative stress, autophagy and a whole transcriptome analysis by RNA-sequencing. RESULTS mtDNA variant m.16519C is over-represented in rapid progressors (combined OR 1.546; 95% CI 1.163 to 2.054; p=0.0027). Cybrids with this variant show increased mtDNA copy number and decreased mitochondrial biosynthesis; they produce higher amounts of mitochondrial ROS, are less resistant to oxidative stress, show a lower expression of the mitochondrial fission-related gene fission mitochondrial 1 and an impairment of autophagic flux. In addition, its presence modulates the transcriptome of cybrids, especially in terms of inflammation, where interleukin 6 emerges as one of the most differentially expressed genes. CONCLUSIONS The presence of the mtDNA variant m.16519C increases the risk of rapid progression of knee OA. Among the most modulated biological processes associated with this variant, inflammation and negative regulation of cellular process stand out. The design of therapies based on the maintenance of mitochondrial function is recommended.
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Affiliation(s)
- Alejandro Durán-Sotuela
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Mercedes Fernandez-Moreno
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Victoria Suárez-Ulloa
- Grupo de Avances en Telemedicina e Informática Sanitaria (ATIS), Plataforma de Bioinformática, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Jorge Vázquez-García
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Sara Relaño
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Tamara Hermida-Gómez
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
- Grupo GBTTC-CHUAC, Centro de Investigación Biomédica en Red Bioingeniería Biomateriales y Nanomedicina, Madrid, Spain
| | - Vanesa Balboa-Barreiro
- Unidad de apoyo a la investigación, Grupo de Investigación en Enfermería y Cuidados en Salud, Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Lucia Lourido-Salas
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Valentina Calamia
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Patricia Fernandez-Puente
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Cristina Ruiz-Romero
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
- Grupo GBTTC-CHUAC, Centro de Investigación Biomédica en Red Bioingeniería Biomateriales y Nanomedicina, Madrid, Spain
| | - Juan Fernández-Tajes
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Carlos Vaamonde-García
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - María C de Andrés
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
| | - Natividad Oreiro
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
- Grupo GBTTC-CHUAC, Centro de Investigación Biomédica en Red Bioingeniería Biomateriales y Nanomedicina, Madrid, Spain
| | - Francisco J Blanco
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
- Grupo de Investigación en Reumatología y Salud (GIR-S), Departamento de Fisioterapia, Medicina y Ciencias Biomédicas, Facultad de Fisioterapia, Campus de Oza, Universidade da Coruña, A Coruna, Galicia, Spain
| | - Ignacio Rego-Perez
- Grupo de Investigación en Reumatología (GIR), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), Instituto de Investigación Biomédica de A Coruña, A Coruna, Galicia, Spain
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Riedstra N, Vinge R, Herfkens J, Eygendaal D, Bierma-Zeinstra S, Runhaar J, van Buuren M, Agricola R. Acetabular dysplasia and the risk of developing hip osteoarthritis at 2,5,8, and 10 years follow-up in a prospective nationwide cohort study (CHECK). Semin Arthritis Rheum 2023; 60:152194. [PMID: 37011579 DOI: 10.1016/j.semarthrit.2023.152194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2023] [Accepted: 03/14/2023] [Indexed: 04/01/2023]
Abstract
OBJECTIVE To assess the relationship between acetabular dysplasia (AD) and the risk of incident and end-stage radiographic hip osteoarthritis (RHOA) over 2,5,8 and 10 years. DESIGN Individuals (n = 1002) aged between 45 and 65 from the prospective Cohort Hip and Cohort Knee (CHECK) were studied. Anteroposterior pelvic radiographs were obtained at baseline and 2,5,8, and 10-years follow-up. False profile radiographs were obtained at baseline. AD was defined as a lateral center edge angle, an anterior center edge angle, or both <25° at baseline. The risk of developing RHOA was determined at each follow-up moment. Incident RHOA was defined by Kellgren & Lawrence (KL) grade ≥2 or total hip replacement (THR), end-stage RHOA by a KL grade ≥3 or THR. Associations were expressed in odds ratios (OR) using logistic regression with generalized estimating equations. RESULTS AD was associated with the development of incident RHOA at 2 years follow-up (OR 2.46, 95% CI 1.00-6.04), 5 years follow-up (OR 2.28, 95% CI 1.20-4.31), and 8 years follow-up (OR 1.86, 95%CI 1.22-2.83). AD was only associated with end-stage RHOA at 5 years follow-up (OR 3.75, 95% CI 1.02-13.77). No statistically significant associations were observed between AD and RHOA at 10-years follow-up. CONCLUSION Baseline AD in individuals between 45 and 65 years is associated with an increased risk of developing RHOA within 2- and 5 years. However, this association seems to weaken after 8 years and disappears after 10 years.
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Telles RW, Machado LAC, Costa-Silva L, Barreto SM. Cohort Profile Update: The Brazilian Longitudinal Study of Adult Health Musculoskeletal (ELSA-Brasil MSK) cohort. Int J Epidemiol 2022; 51:e391-e400. [PMID: 35474011 DOI: 10.1093/ije/dyac084] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 04/06/2022] [Indexed: 01/21/2023] Open
Affiliation(s)
- Rosa Weiss Telles
- Faculdade de Medicina, Universidade Federal da Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas-UFMG/EBSERH, Belo Horizonte, Brazil
| | | | | | - Sandhi Maria Barreto
- Faculdade de Medicina, Universidade Federal da Minas Gerais, Belo Horizonte, Brazil.,Hospital das Clínicas-UFMG/EBSERH, Belo Horizonte, Brazil
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14
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Rondas GA, Macri EM, Oei EH, Bierma-Zeinstra SM, Rijkels-Otters HB, Runhaar J. Association between hip pain and radiographic hip osteoarthritis in primary care: the CHECK cohort. Br J Gen Pract 2022; 72:BJGP.2021.0547. [PMID: 36127152 PMCID: PMC9512408 DOI: 10.3399/bjgp.2021.0547] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 06/08/2022] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND The diagnosis of hip osteoarthritis (OA) is often based on clinical symptoms, such as pain and stiffness, and radiographic features. However, the association between hip pain and hip radiographic OA (ROA) remains uncertain. AIM To examine the association between hip pain and hip ROA. DESIGN AND SETTING Cross-sectional analysis of a Dutch cohort, the Cohort Hip and Cohort Knee (CHECK) study. METHOD The participants (aged 45-65 years) had all experienced hip and/or knee pain for which they had not had a prior consultation or were within 6 months of their first consultation with a GP. Using weight-bearing anteroposterior pelvis radiographs, definite and early-stage hip ROA were defined as Kellgren and Lawrence grade ≥2 and ≥1, respectively. Presence of ROA and pain was assessed in the hips of all participants. The association between hip pain and ROA was assessed using generalised estimating equations. RESULTS The prevalence of definite ROA was 11.0% (n = 218/1982 hips), with prevalence in painful and pain-free hips of 13.3% (n = 105/789) and 9.5% (n = 113/1193), respectively. Prevalence of early-stage hip ROA was 35.3% (n = 700/1982), with prevalence in painful and pain-free hips of 41.2% (n = 325/789) and 31.4% (n = 375/1193), respectively. Compared with pain-free hips, the odds ratio painful hips was 1.51 (95% confidence interval [CI] = 1.16 to 1.98) for definite ROA and 1.47 (95% CI = 1.24 to 1.75) for early-stage ROA. CONCLUSION Hip pain was associated with definite and early-stage hip ROA, yet the overall ROA prevalence was modest and the prevalence among pain-free hips was substantial. Therefore, radiographs provided little assistance with help to identify patients with hip OA among patients who recently presented with hip or knee complaints.
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Affiliation(s)
| | - Erin M Macri
- Department of Orthopaedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - Edwin Hg Oei
- Department of Radiology and Nuclear Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice and Department of Orthopedics & Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam
| | | | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma J, Bierma-Zeinstra S. Diagnosis for early stage knee osteoarthritis: probability stratification, internal and external validation; data from the CHECK and OAI cohorts. Semin Arthritis Rheum 2022; 55:152007. [DOI: 10.1016/j.semarthrit.2022.152007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/22/2022] [Accepted: 04/11/2022] [Indexed: 10/18/2022]
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16
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Herfkens J, van Buuren MMA, Riedstra NS, Verhaar JAN, Mascarenhas VV, Agricola R. Adding false-profile radiographs improves detection of developmental dysplasia of the hip, data from the CHECK cohort. J Hip Preserv Surg 2022; 9:3-9. [PMID: 35651710 PMCID: PMC9142192 DOI: 10.1093/jhps/hnac008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 12/09/2021] [Accepted: 01/06/2022] [Indexed: 11/14/2022] Open
Abstract
The aim of this study was to determine the additional value of the false-profile (FP) view radiograph in the diagnosis of developmental dysplasia of the hip (DDH), as compared with an anteroposterior (AP) pelvic radiograph only, and evaluate the correlation between the Wiberg-lateral center edge angle (W-LCEA) and Wiberg-anterior center edge angle (W-ACEA). We used baseline data from a nationwide prospective cohort study (Cohort Hip and Cohort Knee). DDH was quantified on AP pelvic and FP hip radiographs using semi-automatic measurements of the W-LCEA and W-ACEA. A threshold of <20° was used to determine DDH for both the W-LCEA and the W-ACEA. The proportion of DDH only present on the FP view determined the FP view additional value. The correlation between the W-LCEA and W-ACEA was determined. In total 720 participants (1391 hips) were included. DDH was present in 74 hips (5.3%), of which 32 were only present on the FP view radiograph (43.2%). The Pearson correlation coefficient between W-LCEA and W-ACEA of all included hips was 0.547 (95% confidence interval: 0.503–0.591) and 0.441 (95% confidence interval: 0.231–0.652) in hips with DDH. A mean difference of 9.4° (SD 8.09) was present between the W-LCEA and the W-ACEA in the hips with DDH. There is a strong additional value of the FP radiograph in the diagnosis of DDH. Over 4 out of 10 (43.2%) individuals’ DDH will be missed when only using the AP radiograph. In hips with DDH a moderate correlation between W-LCEA and W-ACEA was calculated indicating that joints with normal acetabular coverage on the AP view can still be undercovered on the FP view.
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Affiliation(s)
- Julie Herfkens
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Michiel M A van Buuren
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Noortje S Riedstra
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Jan A N Verhaar
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, Zuid-Holland, The Netherlands
| | - Vasco V Mascarenhas
- MSK Imaging Unit (UIME), Imaging Center, Hospital da Luz, Lisbon, Indiana, Portugal
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Oreiro-Villar N, Raga AC, Rego-Pérez I, Pértega S, Silva-Diaz M, Freire M, Fernández-López C, Blanco FJ. PROCOAC (PROspective COhort of A Coruña) description: Spanish prospective cohort to study osteoarthritis. REUMATOLOGIA CLINICA 2022; 18:100-104. [PMID: 35153032 DOI: 10.1016/j.reumae.2020.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 08/08/2020] [Indexed: 06/14/2023]
Abstract
INTRODUCTION AND OBJECTIVE The use of well characterized osteoarthritis (OA) cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). METHODS The Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: I) Patients older than 55 years who underwent an abdominal x-ray to study both hips II) Patients diagnosed with radiographic hand OA according to ACR criteria III) Patients diagnosed with radiographic knee or hip OA according to ACR criteria. Follow-up was performed every two years collecting clinical, analytical, genetic and radiographic information. RESULTS The cohort consists of 937 patients, 873 have radiographic knee OA, 783 hip OA and 679 hand OA. The mean age of the population is 63.9±8.9 years and the average BMI is 29.6±5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Twenty-one point four percent and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7% respectively. Of the population, 44.1% has only 1 joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR=1.11; p<.001), BMI (OR=1.11; p=.002) and total WOMAC (OR=1.03; p=.005) are the only risk factors if we compare the involvement of a single location versus three. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL≤2 grade, and therefore a significantly higher percentage of patients with knee OA experienced pain (66.1%) compared to patients with OA hip (21.1%) (p<.001). CONCLUSIONS The PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip OA; as well as determining factors that are associated with the different OA phenotypes.
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Affiliation(s)
- Natividad Oreiro-Villar
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, Spain
| | - Ana C Raga
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, Spain
| | - Ignacio Rego-Pérez
- Grupo de Genómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, Spain
| | - Sonia Pértega
- Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, Spain
| | - Maite Silva-Diaz
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, Spain; Grupo de Genómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, Spain; Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, Spain
| | - Mercedes Freire
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, Spain
| | - Carlos Fernández-López
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, Spain
| | - Francisco J Blanco
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, Spain.
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. Diagnosis of early stage knee osteoarthritis based on early clinical course: data from the CHECK cohort. Arthritis Res Ther 2021; 23:217. [PMID: 34412670 PMCID: PMC8375192 DOI: 10.1186/s13075-021-02598-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/03/2021] [Indexed: 12/23/2022] Open
Abstract
Background Early diagnosis of knee osteoarthritis (OA) is important in managing this disease, but such an early diagnostic tool is still lacking in clinical practice. The purpose of this study was to develop diagnostic models for early stage knee OA based on the first 2-year clinical course after the patient’s initial presentation in primary care and to identify whether these course factors had additive discriminative value over baseline factors. Methods We extracted eligible patients’ clinical and radiographic data from the CHECK cohort and formed the first 2-year course factors according to the factors’ changes over the 2 years. Clinical expert consensus-based diagnosis, which was made via evaluating patients’ 5- to 10-year follow-up data, was used as the outcome factor. Four models were developed: model 1, included clinical course factors only; model 2, included clinical and radiographic course factors; model 3, clinical baseline factors + clinical course factors; and model 4, clinical and radiographic baseline factors + clinical and radiographic course factors. All the models were built by a generalized estimating equation with a backward selection method. Area under the receiver operating characteristic curve (AUC) and its 95% confidence interval (CI) were calculated for assessing model discrimination. Delong’s method compared AUCs. Results Seven hundred sixty-one patients with 1185 symptomatic knees were included in this study. Thirty-seven percent knees were diagnosed as OA at follow-up. Model 1 contained 6 clinical course factors; model 2: 6 clinical and 3 radiographic course factors; model 3: 6 baseline clinical factors combined with 5 clinical course factors; and model 4: 4 clinical and 1 radiographic baseline factors combined with 5 clinical and 3 radiographic course factors. Model discriminations are as follows: model 1, AUC 0.70 (95% CI 0.67–0.74); model 2, 0.74 (95% CI 0.71–0.77); model 3, 0.77 (95% CI 0.74–0.80); and model 4, 0.80 (95% CI 0.77–0.82). AUCs of model 3 and model 4 were slightly but significantly higher than corresponding baseline-factor models (model 3 0.77 vs 0.75, p = 0.031; model 4 0.80 vs 0.76, p = 0.003). Conclusions Four diagnostic models were developed with “fair” to “good” discriminations. First 2-year course factors had additive discriminative value over baseline factors. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02598-5.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Boers
- Department of Epidemiology & Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedics, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
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Taylor J, Dekker S, Jurg D, Skandsen J, Grossman M, Marijnissen AK, Ladel C, Mobasheri A, Larkin J, Weinans H, Kanter-Schlifke I. Making the patient voice heard in a research consortium: experiences from an EU project (IMI-APPROACH). RESEARCH INVOLVEMENT AND ENGAGEMENT 2021; 7:24. [PMID: 33971982 PMCID: PMC8107424 DOI: 10.1186/s40900-021-00267-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Accepted: 03/31/2021] [Indexed: 05/12/2023]
Abstract
APPROACH is an EU-wide research consortium with the goal to identify different subgroups of knee osteoarthritis to enable future differential diagnosis and treatment. During a 2-year clinical study images, biomarkers and clinical data are collected from people living with knee osteoarthritis and data are analyzed to confirm patterns that can indicate such different subgroups. A Patient Council (PC) has been set up at project initiation and consists of five people from Norway, The Netherlands and UK. Initially, this group of individuals had to learn how to effectively work with each other and with the researchers. Today, the PC is a strong team that is fully integrated in the consortium and acknowledged by researchers as an important sounding board. The article describes this journey looking at formal processes of involvement - organizational structure, budget, meetings - and more informal processes such as building relationships and changing researcher perceptions. It describes how the PC helped improve the experience and engagement of study participants by providing input to the clinical protocol and ensuring effective communication (e.g. through direct interactions with participants and newsletters). Furthermore, the PC is helping with dissemination of results and project advocacy, and overall provides the patient perspective to researchers. Additionally, the authors experienced and describe the intangible benefits such as a shift in researcher attitudes and a sense of community and purpose for PC members. Importantly, learnings reported in this article also include the challenges, such as effective integration of the PC with researchers' work in the early phase of the project. TRIAL REGISTRATION: US National Library of Medicine, NCT03883568 , retrospectively registered 21 March 2019.
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Affiliation(s)
- Jane Taylor
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Sjouke Dekker
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Diny Jurg
- The APPROACH Patient Council, Utrecht, The Netherlands
| | - Jon Skandsen
- The APPROACH Patient Council, Utrecht, The Netherlands
| | | | - Anne-Karien Marijnissen
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands
| | | | - Ali Mobasheri
- University of Oulu, Oulu Finland State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- University Medical Center Utrecht, Utrecht, The Netherlands
| | | | - Harrie Weinans
- Rheumatology & Clinical Immunology, University Medical Center Utrecht, Heidelberglaan 100, Utrecht, 3584 CX The Netherlands
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Oreiro-Villar N, Raga AC, Rego-Pérez I, Pértega S, Silva-Diaz M, Freire M, Fernández-López C, Blanco FJ. PROCOAC (PROspective COhort of A Coruña) description: Spanish prospective cohort to study osteoarthritis. REUMATOLOGIA CLINICA 2020; 18:S1699-258X(20)30231-X. [PMID: 33191152 DOI: 10.1016/j.reuma.2020.08.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 08/07/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
INTRODUCTION AND OBJECTIVE The use of well characterized osteoarthritis cohorts is mandatory for the study and knowledge of this disease. Currently, there is no prospective cohort in this pathology in Spain. The objective of this work is to describe the first osteoarthritis cohort in Spain, PROCOAC (Cohort PROspectiva de A Coruña). METHODS The Unit of Rheumatology of the University Hospital of A Coruña started a prospective follow-up study in 2006. The patient inclusion criteria were: a) patients older than 55 years who underwent an abdominal x-ray to study both hips; b) patients diagnosed with radiographic hand osteoarthritis according to ACR criteria; c) patients diagnosed with radiographic knee or hip osteoarthritis according to ACR criteria. Follow-up was performed every 2years collecting clinical, analytical, genetic and radiographic information. RESULTS The cohort consists of 937 patients, 873 have radiographic knee osteoarthritis, 783 hip osteoarthritis and 679 hand osteoarthritis. The mean age of the population is 63.9±8.9 years and the average BMI is 29.6±5.1. More than half of the population has high blood pressure and 17% diabetes. The predominant osteoarthritis in the hand is nodular (78.1%), followed by trapeziometacarpal (55.3%) and erosive (18.4%). Of them, 21.4% and 43.1% are healthy at knee and hip level respectively; observing a grade 1 in 26% and 37%; a grade 2 in 26.7% and 11.5%; a grade 3 in 14.9% and 4%; and a grade 4 in 9.4% and 3.7%, respectively. Of the population, 44.1% has only one joint affected, 39.9% has 2 and 13.4% has 3 joints affected. Age (OR=1.11; P <.001), BMI (OR=1.11; P=.002) and total WOMAC (OR=1.03; P=.005) are the only risk factors if we compare the involvement of a single location versus 3. A discrepancy between pain and radiographic damage at the joint level was also detected in patients with KL ≤ 2 grade, and therefore a significantly higher percentage of patients with knee osteoarthritis experienced pain (66.1%) compared to patients with osteoarthritis hip (21.1%) (P<.001). CONCLUSIONS The PROCOAC cohort is an instrument that allows studies of incidence and progression in hand, knee and hip osteoarthritis; as well as determining factors that are associated with the different osteoarthritis phenotypes.
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Affiliation(s)
- Natividad Oreiro-Villar
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, España
| | - Ana C Raga
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, España
| | - Ignacio Rego-Pérez
- Grupo de Genómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, España
| | - Sonia Pértega
- Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, España
| | - Maite Silva-Diaz
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, España; Grupo de Genómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, España; Unidad de Epidemiología Clínica y Bioestadística, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas, Universidade da Coruña, La Coruña, España
| | - Mercedes Freire
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, España
| | - Carlos Fernández-López
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, España
| | - Francisco J Blanco
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña, Complexo Hospitalario Universitario de A Coruña, Sergas. Universidade da Coruña, La Coruña, España.
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Bennett AN, Dyball DM, Boos CJ, Fear NT, Schofield S, Bull AMJ, Cullinan P. Study protocol for a prospective, longitudinal cohort study investigating the medical and psychosocial outcomes of UK combat casualties from the Afghanistan war: the ADVANCE Study. BMJ Open 2020; 10:e037850. [PMID: 33127630 PMCID: PMC7604820 DOI: 10.1136/bmjopen-2020-037850] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 07/16/2020] [Accepted: 09/21/2020] [Indexed: 12/27/2022] Open
Abstract
INTRODUCTION The Afghanistan war (2003-2014) was a unique period in military medicine. Many service personnel survived injuries of a severity that would have been fatal at any other time in history; the long-term health outcomes of such injuries are unknown. The ArmeD SerVices TrAuma and RehabilitatioN OutComE (ADVANCE) study aims to determine the long-term effects on both medical and psychosocial health of servicemen surviving this severe combat related trauma. METHODS AND ANALYSIS ADVANCE is a prospective cohort study. 1200 Afghanistan-deployed male UK military personnel and veterans will be recruited and will be studied at 0, 3, 6, 10, 15 and 20 years. Half are personnel who sustained combat trauma; a comparison group of the same size has been frequency matched based on deployment to Afghanistan, age, sex, service, rank and role. Participants undergo a series of physical health tests and questionnaires through which information is collected on cardiovascular disease (CVD), CVD risk factors, musculoskeletal disease, mental health, functional and social outcomes, quality of life, employment and mortality. ETHICS AND DISSEMINATION The ADVANCE Study has approval from the Ministry of Defence Research Ethics Committee (protocol no:357/PPE/12) agreed 15 January 2013. Its results will be disseminated through manuscripts in clinical/academic journals and presentations at professional conferences, and through participant and stakeholder communications. TRIAL REGISTRATION NUMBER The ADVANCE Study is registered at ISRCTN ID: ISRCTN57285353.
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Affiliation(s)
- Alexander N Bennett
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Daniel Mark Dyball
- Academic Department of Military Rehabilitation, Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- King's Centre for Military Health Research, King's College London, London, UK
| | - Christopher J Boos
- Department of Cardiology, University Hospital Dorset, NHS Trust, Poole, UK
| | - Nicola T Fear
- King's Centre for Military Health Research, King's College London, London, UK
- Academic Department for Military Mental Health, King's College London, London, UK
| | - Susie Schofield
- National Heart and Lung Institute, Imperial College London, London, UK
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Imperial College London, London, UK
| | - Paul Cullinan
- Occupational and Environmental Medicine, National Heart and Lung Institute, Imperial College, London, UK
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Serum fatty acid chain length associates with prevalent symptomatic end-stage osteoarthritis, independent of BMI. Sci Rep 2020; 10:15459. [PMID: 32963331 PMCID: PMC7508826 DOI: 10.1038/s41598-020-71811-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 08/20/2020] [Indexed: 12/20/2022] Open
Abstract
Higher body mass index (BMI) is associated with osteoarthritis (OA) in both weight-bearing and non-weight-bearing joints, suggesting a link between OA and poor metabolic health beyond mechanical loading. This risk may be influenced by systemic factors accompanying BMI. Fluctuations in concentrations of metabolites may mark or even contribute to development of OA. This study explores the association of metabolites with radiographic knee/hip OA prevalence and progression. A 1H-NMR-metabolomics assay was performed on plasma samples of 1564 cases for prevalent OA and 2,125 controls collected from the Rotterdam Study, CHECK, GARP/NORREF and LUMC-arthroplasty cohorts. OA prevalence and 5 to 10 year progression was assessed by means of Kellgren-Lawrence (KL) score and the OARSI-atlas. End-stage knee/hip OA (TJA) was defined as indication for arthroplasty surgery. Controls did not have OA at baseline or follow-up. Principal component analysis of 227 metabolites demonstrated 23 factors, of which 19 remained interpretable after quality-control. Associations of factor scores with OA definitions were investigated with logistic regression. Fatty acids chain length (FALen), which was included in two factors which associated with TJA, was individually associated with both overall OA as well as TJA. Increased Fatty Acid chain Length is associated with OA.
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23
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van den Berg R, Jongbloed EM, Kuchuk NO, Koes BW, Oei EHG, Bierma-Zeinstra SMA, Luijsterburg PAJ. Association Between Self-Reported Spinal Morning Stiffness and Radiographic Evidence of Lumbar Disk Degeneration in Participants of the Cohort Hip and Cohort Knee (CHECK) Study. Phys Ther 2020; 100:255-267. [PMID: 31742363 DOI: 10.1093/ptj/pzz170] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Revised: 04/24/2019] [Accepted: 06/28/2019] [Indexed: 02/09/2023]
Abstract
BACKGROUND Low back pain (LBP) is very common and is a main cause of limited activity and work absence. Patients with LBP may also report spinal morning stiffness; this symptom could be useful for identifying subgroups with signs and symptoms related to spinal osteoarthritis. OBJECTIVE This study investigated whether an association exists between reported spinal morning stiffness and radiographic evidence of lumbar disk degeneration (LDD) in people with LBP and a history of pain of the hip and/or knee. DESIGN This cross-sectional study used 8-year follow-up data from the Cohort Hip and Cohort Knee study. METHODS The association between spinal morning stiffness and radiographic LDD features was assessed with multivariable logistic regression models. RESULTS The presence of osteophytes was significantly associated with spinal morning stiffness (odds ratio [OR] = 2.1 [95% confidence interval [CI] = 1.3-3.2]) as was the presence of grade 2 or 3 disk space narrowing (OR = 2.0 [95% CI = 1.1-3.5]). There was also a significant association between morning stiffness persisting for > 30 minutes and grade 2 osteophytes (OR = 2.6 [95% CI = 1.1-6.2]) and grade 1 disk space narrowing (OR = 2.0 [95% CI = 1.1-3.6]). Furthermore, there was a significant association between moderate spinal morning stiffness and the presence of osteophytes (OR = 2.0 [95% CI = 1.2-3.2]). Both the presence of osteophytes and disk space narrowing were significantly associated with severe spinal morning stiffness (for osteophytes: OR = 2.0 [95% CI = 1.2-3.7]; for narrowing at L1-S1: OR = 1.8 [95% CI = 1.1-3.1]). LIMITATIONS Only lumbar lateral radiographs were available for each participant, implying that the LDD features could have been underestimated. The quality of the radiographs was not consistent. CONCLUSIONS This study showed an association between self-reported spinal morning stiffness and symptomatic LDD. When morning stiffness lasted > 30 minutes, there was a significant association with the features of LDD. The association was stronger when the severity of spinal morning stiffness increased.
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Affiliation(s)
- Roxanne van den Berg
- Department of General Practice, Erasmus University Medical Center, PO Box 2040, 3000 CA Rotterdam, the Netherlands
| | | | - Natalia O Kuchuk
- Department of Rheumatology and Clinical Immunology, University Medical Center, Utrecht, the Netherlands; and Department of Rheumatology, Tergooi Hospital, Hilversum, the Netherlands
| | - Bart W Koes
- Department of General Practice, Erasmus University Medical Center
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus University Medical Center
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, and Department of Orthopedics, Erasmus University Medical Center
| | - Pim A J Luijsterburg
- Department of General Practice, Erasmus University Medical Center.*S.M.A. Bierma-Zeinstra and P.A.J. Luijsterburg contributed equally to the work
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Obesity is related to incidence of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee (CHECK) study. Rheumatol Int 2019; 40:227-232. [DOI: 10.1007/s00296-019-04472-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Accepted: 10/31/2019] [Indexed: 10/25/2022]
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Schiphof D, Runhaar J, Waarsing JH, van Spil WE, van Middelkoop M, Bierma-Zeinstra SMA. The clinical and radiographic course of early knee and hip osteoarthritis over 10 years in CHECK (Cohort Hip and Cohort Knee). Osteoarthritis Cartilage 2019; 27:1491-1500. [PMID: 31202721 DOI: 10.1016/j.joca.2019.06.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 05/29/2019] [Accepted: 06/03/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the radiographic and symptomatic course in subjects with hip or knee complaints suspected of early osteoarthritis (OA). DESIGN CHECK (Cohort Hip and Cohort Knee) is a multicenter, prospective observational cohort study of 1,002 subjects with first complaints in knee(s) and/or hip(s) (age 56 ± 5 years; 79% female; body mass index (BMI) 26 ± 4 kg/m2). Visits took place at baseline and at 2, 5, 8, and 10 year follow-up. At each visit, questionnaires were administered, physical examination performed, and X-ray images obtained. Clinical OA was defined according to the clinical American College of Rheumatism (ACR) criteria. Radiographic OA (ROA) was defined as Kellgren and Lawrence score (K&L) ≥2. RESULTS 83% of the subjects reported knee pain, 59% hip pain, and 42% reported both hip and knee pain at baseline. 85% of the subjects completed 10-year follow-up. Pain scores remained rather stable over time, although individual scores fluctuated. A total of 138 subjects never fulfilled the clinical American College of Rheumatology (ACR) criteria. 60% (n = 601) had ROA in one or both knees, and 51% (n = 513) had ROA in one or both hips at 10 years. Only 13.5% of the subjects did not develop ROA after 10 years. Most joint replacements (n = 52 (57%)) took place in subjects with multiple affected joints. CONCLUSIONS The symptomatic course in subjects with hip or knee complaints suspected of OA remained fairly stable on population level, though individual scores fluctuated. The radiological course was progressive, with joint replacements particularly in subjects with both hip and knee OA.
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Affiliation(s)
- D Schiphof
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - J H Waarsing
- Department of Orthopedics, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - W E van Spil
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht, the Netherlands
| | - M van Middelkoop
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Orthopedics, Erasmus University Medical Center, Rotterdam, the Netherlands.
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Bieleman HJ, Stewart R, Reneman MF, van Ittersum WM, van der Schans CP, Drossaers-Bakker KW, Oosterveld FGJ. Trajectories of Physical Work Capacity in Early Symptomatic Osteoarthritis of Hip and Knee: Results from the Cohort Hip and Cohort Knee (CHECK) Study. JOURNAL OF OCCUPATIONAL REHABILITATION 2019; 29:483-492. [PMID: 30151630 DOI: 10.1007/s10926-018-9809-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/08/2023]
Abstract
Purpose To evaluate the 5-year course of physical work capacity of participants with early symptomatic osteoarthritis (OA) of the hip and/or the knee; to identify trajectories and explore the relationship between trajectories and covariates. Methods In a prospective cohort study, physical work capacity was measured at baseline, using a test protocol (functional capacity evaluation) consisting of work-related physical activities. Participants were invited to participate in 1, 2 and 5 year follow-up measurements. Multilevel analysis and latent classes analysis were performed, in models with test performances as dependent variables and age, sex, work status, self-reported function (Western Ontario McMasters Arthritis Scale-WOMAC), body mass index (BMI) and time as independent variables. Multiple imputation was used to control for the influence of missing data. Results At baseline and after 1, 2 and 5 years there were 96, 64, 61 and 35 participants. Mean (SD) age at baseline was 56 (4.9) years, 84% were females. There was no statistically significant change in test performances (lifting low and high, carrying, static overhead work, repetitive bending, repetitive rotations) between the 4 measurements. Male sex, younger age and better self-reported function were statistically significant (p < 0.05) determinants of higher performance on most of the tests; having a paid job, BMI and progression of time were not. Three trajectories were identified: 'weak giving way', 'stable and able', and 'strong with decline'. Discussion In subgroups of participants with early symptomatic OA, determined by age, sex and self-reported function, physical work capacity seems to be a stable characteristic over 5 years.
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Affiliation(s)
- H J Bieleman
- Saxion Universities of Applied Sciences, P.O. Box 70.000, 7500 KB, Enschede, The Netherlands.
| | - R Stewart
- University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - M F Reneman
- University Medical Centre, University of Groningen, Groningen, The Netherlands
| | - W M van Ittersum
- Hanze University of Applied Sciences, Groningen, The Netherlands
| | | | | | - F G J Oosterveld
- Saxion Universities of Applied Sciences, P.O. Box 70.000, 7500 KB, Enschede, The Netherlands
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Abstract
Mitochondria and mitochondrial DNA (mtDNA) variation are now recognized as important factors in the development of osteoarthritis (OA). Mitochondria are the energy powerhouses of the cell, and also regulate different processes involved in the pathogenesis of OA including inflammation, apoptosis, calcium metabolism and the generation of reactive oxygen species (ROS) and reactive nitrogen species (RNS). Mitochondria contain their own genetic material, mtDNA, which evolved through the sequential accumulation of mtDNA variants to enable humans to adapt to different climates. The ROS and reactive metabolic intermediates that are by-products of mitochondrial metabolism are regulated in part by mtDNA and are among the signals that transmit information between mitochondria and the nucleus. These signals can alter nuclear gene expression and, when disrupted, affect a number of cellular processes and metabolic pathways, leading to disease. mtDNA variation influences OA-associated phenotypes, including those related to metabolism, inflammation and even ageing, as well as nuclear epigenetic regulation. This influence also enables the use of specific mtDNA haplogroups as complementary diagnostic and prognostic biomarkers of OA.
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Abstract
The classification and monitoring of individuals with early knee osteoarthritis (OA) are important considerations for the design and evaluation of therapeutic interventions and require the identification of appropriate outcome measures. Potential outcome domains to assess for early OA include patient-reported outcomes (such as pain, function and quality of life), features of clinical examination (such as joint line tenderness and crepitus), objective measures of physical function, levels of physical activity, features of imaging modalities (such as of magnetic resonance imaging) and biochemical markers in body fluid. Patient characteristics such as adiposity and biomechanics of the knee could also have relevance to the assessment of early OA. Importantly, research is needed to enable the selection of outcome measures that are feasible, reliable and validated in individuals at risk of knee OA or with early knee OA. In this Perspectives article, potential outcome measures for early symptomatic knee OA are discussed, including those measures that could be of use in clinical practice and/or the research setting.
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Damen J, van Rijn RM, Emans PJ, Hilberdink WKHA, Wesseling J, Oei EHG, Bierma-Zeinstra SMA. Prevalence and development of hip and knee osteoarthritis according to American College of Rheumatology criteria in the CHECK cohort. Arthritis Res Ther 2019; 21:4. [PMID: 30611305 PMCID: PMC6321652 DOI: 10.1186/s13075-018-1785-7] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2018] [Accepted: 12/03/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND We aimed to evaluate the prevalence of hip and knee osteoarthritis (HOA and KOA) according to American College of Rheumatology (ACR) criteria among participants with suspected early symptomatic osteoarthritis (OA) in the CHECK cohort. We also assessed whether participants not fulfilling ACR criteria at baseline develop ACR-defined OA at 2-year and/or 5-year follow up, and which baseline factors are associated with this development. METHODS The CHECK cohort included 1002 subjects with first presentation of knee and/or hip complaints. The primary outcome was onset of HOA and/or KOA according to the ACR criteria, including the clinical classification criteria and the combined clinical and radiographic classification criteria at 2-year and/or 5-year follow up. RESULTS Of the participants with hip complaints, 63% (n = 370) were classified as having HOA at baseline according to the ACR criteria. Of those not classified with HOA at baseline, 40% developed HOA according to the clinical or combined clinical/radiographic ACR criteria after 2 and/or 5 years. Up to 92% of participants (n = 829) with knee complaints were classified as having KOA at baseline; of those not classified with KOA at baseline, 55% developed KOA according to the clinical ACR criteria or the clinical/radiographic ACR criteria after 2 and/or 5 years. The following factors were associated with development of HOA: morning stiffness (OR 2.39; 95% CI 1.14-4.98), painful internal rotation (OR 2.53; 95% CI 1.23-5.19), hip flexion < 115° (OR 2.33; 95% CI 1.17-4.64) and erythrocyte sedimentation rate (ESR) < 20 mm/h (OR 2.94; 95% CI 1.13-7.61). No variables were associated with development of KOA at 2-year and/or 5-year follow up. CONCLUSIONS A large proportion of persons with hip complaints not fulfilling the ACR criteria at baseline develop HOA after 2 and/or 5 years of follow up. Almost all persons with knee complaints already fulfill the clinical and/or radiographic ACR criteria for OA, and half of the persons not fulfilling criteria at baseline will do so after 5 years of follow up. Several individual ACR criteria for HOA at baseline were associated with the development of HOA at follow up. This association was not proven for KOA, probably because of the small number of subjects developing KOA in this study.
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Affiliation(s)
- Jurgen Damen
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.
| | - Rogier M van Rijn
- National Institute of Mental Health and Addiction, Trimbos Institute, Utrecht, the Netherlands
| | - Pieter J Emans
- Department of Orthopaedic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | | | - Janet Wesseling
- Dutch association for Rheumatology, UMC Utrecht, Utrecht, the Netherlands
| | - Edwin H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000, CA, Rotterdam, the Netherlands.,Department of Orthopaedics, Erasmus MC, University Medical Center, Rotterdam, the Netherlands
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Differential item functioning of the PROMIS physical function, pain interference, and pain behavior item banks across patients with different musculoskeletal disorders and persons from the general population. Qual Life Res 2019; 28:1231-1243. [PMID: 30600494 DOI: 10.1007/s11136-018-2087-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/10/2018] [Indexed: 01/09/2023]
Abstract
PURPOSE To investigate the validity of comparisons across patients with different musculoskeletal disorders and persons from the general population by evaluating differential item functioning (DIF) for the PROMIS physical function (PROMIS-PF), pain interference (PROMIS-PI), and pain behavior (PROMIS-PB) item banks. METHODS Patients with chronic pain, rheumatoid arthritis (RA), or osteoarthritis (OA); patients receiving physiotherapy (PT); and persons from the Dutch general population completed the full Dutch-Flemish PROMIS-PF (121-items), PROMIS-PI (40-items), or PROMIS-PB (39-items) banks. DIF was assessed with ordinal logistic regression models and McFadden's pseudo R2-change of ≥ 2% as critical value. The impact of DIF on item scores and the T-scores per bank was examined by inspecting item characteristic curves (ICCs) and test characteristic curves (TCCs). RESULTS 2762 patients with chronic pain, 2029 with RA, 1247 with OA, 805 receiving PT, and 1310 healthy persons participated. For the PROMIS-PF, 25 out of 121 items were flagged for DIF, of which 10 items were flagged in multiple comparisons. For the PROMIS-PI, only 2 out of 40 items were flagged for DIF and for the PROMIS-PB, only 3 out of 39 items. Most DIF items had R2 values just above the critical value of 2% and all showed uniform DIF. The ICCs and TCCs showed that the magnitude and impact of DIF on the item and T-scores were negligible. CONCLUSIONS This study supports the universal applicability of PROMIS across (patient) populations. Comparisons across patients with different musculoskeletal disorders and persons from the general population are valid, when applying the PROMIS-PF, PROMIS-PI, and PROMIS-PB banks.
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Halilaj E, Le Y, Hicks JL, Hastie TJ, Delp SL. Modeling and predicting osteoarthritis progression: data from the osteoarthritis initiative. Osteoarthritis Cartilage 2018; 26:1643-1650. [PMID: 30130590 PMCID: PMC6469859 DOI: 10.1016/j.joca.2018.08.003] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2018] [Revised: 07/19/2018] [Accepted: 08/07/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The goal of this study was to model the longitudinal progression of knee osteoarthritis (OA) and build a prognostic tool that uses data collected in 1 year to predict disease progression over 8 years. DESIGN To model OA progression, we used a mixed-effects mixture model and 8-year data from the Osteoarthritis Initiative (OAI)-specifically, joint space width measurements from X-rays and pain scores from the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire. We included 1243 subjects who at enrollment were classified as being at high risk of developing OA based on age, body mass index (BMI), and medical and occupational histories. After clustering subjects based on radiographic and pain progression, we used clinical variables collected within the first year to build least absolute shrinkage and selection (LASSO) regression models for predicting the probabilities of belonging to each cluster. Areas under the receiver operating characteristic curve (AUC) represent predictive performance on held-out data. RESULTS Based on joint space narrowing, subjects clustered as progressing or non-progressing. Based on pain scores, they clustered as stable, improving, or worsening. Radiographic progression could be predicted with high accuracy (AUC = .86) using data from two visits spanning 1 year, whereas pain progression could be predicted with high accuracy (AUC = .95) using data from a single visit. Joint space narrowing and pain progression were not associated. CONCLUSION Statistical models for characterizing and predicting OA progression promise to improve clinical trial design and OA prevention efforts in the future.
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Affiliation(s)
- E Halilaj
- Department of Bioengineering, Stanford University, USA.
| | - Y Le
- Department of Statistics, Stanford University, USA
| | - J L Hicks
- Department of Bioengineering, Stanford University, USA
| | - T J Hastie
- Department of Statistics, Stanford University, USA
| | - S L Delp
- Departments of Bioengineering, Mechanical Engineering, and Orthopaedic Surgery, Stanford University, USA
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van Tunen JAC, Peat G, Bricca A, Larsen LB, Søndergaard J, Thilsing T, Roos EM, Thorlund JB. Association of osteoarthritis risk factors with knee and hip pain in a population-based sample of 29-59 year olds in Denmark: a cross-sectional analysis. BMC Musculoskelet Disord 2018; 19:300. [PMID: 30126395 PMCID: PMC6102878 DOI: 10.1186/s12891-018-2183-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2018] [Accepted: 07/11/2018] [Indexed: 12/11/2022] Open
Abstract
Background This study aimed to a) describe the prevalence of knee and hip osteoarthritis risk factors in a population of 29–59 year old individuals, b) estimate the association between persistent knee/hip pain and osteoarthritis risk factors, and c) describe the prevalence of osteoarthritis risk factors, including specific biomechanical risk factors, in individuals with prolonged persistent knee or hip pain. Methods Participants completed the “Early Detection and Prevention” pilot study questionnaire, including items on presence of knee/hip pain within the last month and osteoarthritis risk factors. Individuals reporting knee/hip problems completed a second questionnaire, including items about most problematic joint and specific biomechanical osteoarthritis risk factors. After describing the prevalence of persistent knee/hip pain and osteoarthritis risk factors among respondents stratified for sex and age, logistic regression was used to estimate the strength of associations between osteoarthritis risk factors and presence of knee/hip pain. The prevalence of prolonged persistent pain (i.e. knee/hip pain reported at both questionnaires) and osteoarthritis risk factors among respondents with prolonged persistent knee and hip pain, were described. Results Two thousand six hundred sixty-one respondents completed the first survey. The one-month prevalence of persistent knee/hip pain was 27%. Previous knee/hip injury was associated with persistent knee/hip pain for both sexes in all age groups, while a family history of osteoarthritis was associated with persistent knee/hip pain in all age groups except for 29–39 year old men. A higher BMI was associated with persistent knee/hip pain in 40–59 year old women, and 50–59 year old men. Eight hundred sixty seven respondents completed the second questionnaire. Knee/hip injuries and surgeries were more common in individuals with prolonged persistent knee than hip pain. Conclusions Knee/hip pain within the last month was frequent among individuals aged 29–59 years. Multiple known osteoarthritis risk factors were associated with presence of knee/hip pain. Joint injury and previous surgery were more common in individuals with knee than hip pain. The results support the notion that joint injury and overweight during early adulthood are signs of a trajectory towards symptomatic osteoarthritis later in life and may help earlier identification of groups at high risk of future symptomatic osteoarthritis. Trial registration ClinicalTrials.gov (NCT02797392). Registered April 29,2016.
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Affiliation(s)
- Joyce A C van Tunen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - George Peat
- Research Institute for Primary Care & Health Sciences, Arthritis Research UK Primary Care Centre, Keele University, Staffordshire, UK
| | - Alessio Bricca
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Lars B Larsen
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - Jens Søndergaard
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - Trine Thilsing
- Research Unit for General Practice, University of Southern Denmark, Odense, Denmark
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jonas B Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
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Zengini E, Hatzikotoulas K, Tachmazidou I, Steinberg J, Hartwig FP, Southam L, Hackinger S, Boer CG, Styrkarsdottir U, Gilly A, Suveges D, Killian B, Ingvarsson T, Jonsson H, Babis GC, McCaskie A, Uitterlinden AG, van Meurs JBJ, Thorsteinsdottir U, Stefansson K, Davey Smith G, Wilkinson JM, Zeggini E. Genome-wide analyses using UK Biobank data provide insights into the genetic architecture of osteoarthritis. Nat Genet 2018; 50:549-558. [PMID: 29559693 PMCID: PMC5896734 DOI: 10.1038/s41588-018-0079-y] [Citation(s) in RCA: 175] [Impact Index Per Article: 29.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 01/29/2018] [Indexed: 12/19/2022]
Abstract
Osteoarthritis is a common complex disease imposing a large public-health burden. Here, we performed a genome-wide association study for osteoarthritis, using data across 16.5 million variants from the UK Biobank resource. After performing replication and meta-analysis in up to 30,727 cases and 297,191 controls, we identified nine new osteoarthritis loci, in all of which the most likely causal variant was noncoding. For three loci, we detected association with biologically relevant radiographic endophenotypes, and in five signals we identified genes that were differentially expressed in degraded compared with intact articular cartilage from patients with osteoarthritis. We established causal effects on osteoarthritis for higher body mass index but not for triglyceride levels or genetic predisposition to type 2 diabetes.
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Affiliation(s)
- Eleni Zengini
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
- 5th Psychiatric Department, Dromokaiteio Psychiatric Hospital, Athens, Greece
| | | | - Ioanna Tachmazidou
- Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
- GSK, R&D Target Sciences, Medicines Research Centre, Stevenage, UK
| | - Julia Steinberg
- Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
- Cancer Research Division, Cancer Council NSW, Sydney, New South Wales, Australia
| | - Fernando P Hartwig
- Postgraduate Program in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Lorraine Southam
- Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
- Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | | | - Cindy G Boer
- Departments of Internal Medicine and Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | | | - Arthur Gilly
- Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Daniel Suveges
- Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Britt Killian
- Human Genetics, Wellcome Trust Sanger Institute, Hinxton, UK
| | - Thorvaldur Ingvarsson
- Department of Orthopaedic Surgery, Akureyri Hospital, Akureyri, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Institution of Health Science, University of Akureyri, Akureyri, Iceland
| | - Helgi Jonsson
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
- Department of Medicine, Landspitali, National University Hospital of Iceland, Reykjavik, Iceland
| | - George C Babis
- 2nd Department of Orthopaedic Surgery, Konstantopouleio General Hospital, National and Kapodistrian University of Athens, Athens, Greece
| | - Andrew McCaskie
- Division of Trauma & Orthopaedic Surgery, Department of Surgery, University of Cambridge, Addenbrooke's Hospital, Cambridge, UK
| | - Andre G Uitterlinden
- Departments of Internal Medicine and Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Joyce B J van Meurs
- Departments of Internal Medicine and Epidemiology, Erasmus MC, Rotterdam, the Netherlands
| | - Unnur Thorsteinsdottir
- deCODE genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Kari Stefansson
- deCODE genetics/Amgen, Reykjavik, Iceland
- Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - George Davey Smith
- Medical Research Council Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Sciences, University of Bristol, Bristol, UK
- National Institute for Health Research, Bristol Biomedical Research Centre, University Hospitals Bristol, NHS Foundation Trust and University of Bristol, Bristol, UK
| | - Jeremy M Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
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Luyten FP, Bierma-Zeinstra S, Dell'Accio F, Kraus VB, Nakata K, Sekiya I, Arden NK, Lohmander LS. Toward classification criteria for early osteoarthritis of the knee. Semin Arthritis Rheum 2018; 47:457-463. [PMID: 28917712 DOI: 10.1016/j.semarthrit.2017.08.006] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2017] [Revised: 07/24/2017] [Accepted: 08/04/2017] [Indexed: 01/06/2023]
Abstract
OBJECTIVE To propose draft classification criteria for early stage osteoarthritis (OA) of the knee for use in a primary care setting. METHODS A group of basic scientists, physician-scientists, rheumatologists, orthopedic surgeons, and physiotherapists in a workshop setting discussed potential classification criteria for early osteoarthritis of the knee. The workshop was divided into sessions around relevant topics with short state of the art presentations followed by breakout sessions, consensus discussions, and consolidation into a consensus document. RESULTS Three classes of criteria were agreed: (1) Pain, symptoms/signs, self-reported function, and quality of life using tools such as KOOS: scoring ≤85% in at least 2 out of these 4 categories; (2) Clinical examination: at least 1 present out of joint line tenderness or crepitus; (3) Knee radiographs: Kellgren & Lawrence (KL) grade of 0 or 1. MRI is at present not recommended as an aid to identify or define early OA in routine clinical practice or primary care, in light of the absence of validated consensus criteria and the high population prevalence of structural joint changes detected by this method. Biomarkers may have future utility in early OA classification, but no individual or set of biomarkers is yet robust enough. CONCLUSION Based on our consensus proposal, draft classification criteria for early OA of the knee for use in clinical studies should include patient reported outcomes such as pain and function, together with clinical signs and KL grade 0-1 on radiographs.
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Affiliation(s)
- F P Luyten
- Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, KU Leuven, Herestraat 49 Box 813, B-3000 Leuven, Belgium.
| | - S Bierma-Zeinstra
- Department of General Practice, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands; Department of Orthopedics, University Medical Center Rotterdam, Erasmus MC, Rotterdam, the Netherlands
| | - F Dell'Accio
- William Harvey Research Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - V B Kraus
- Division of Rheumatology, Duke Molecular Physiology Institute, Duke University School of Medicine, Durham, NC
| | - K Nakata
- Medicine for Sports and Performing Arts, Department of Health and Sport Sciences, Osaka University Graduate School of Medicine, Osaka, Japan
| | - I Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - N K Arden
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, England
| | - L S Lohmander
- Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
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The Association Between Self-reported Low Back Pain and Radiographic Lumbar Disc Degeneration of the Cohort Hip and Cohort Knee (CHECK) Study. Spine (Phila Pa 1976) 2017; 42:1464-1471. [PMID: 28542106 DOI: 10.1097/brs.0000000000002228] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Cross-sectional study, nested in a prospective cohort (Cohort Hip and Knee, CHECK). OBJECTIVE Low back pain (LBP) is very common and the main cause of activity limitations and work absence throughout the world. Although lumbar disc degeneration (LDD) is suggested as a cause of LBP, this association remains debatable. Therefore, this study assessed the association between the radiographic features of LDD and the presence of self-reported LBP, LBP persisting longer than 3 months, the perceived severity of LBP and presence of neuropathic pain. SUMMARY OF BACKGROUND DATA Previous literature suggests an association between LBP and both the LDD definitions osteophytes and disc space narrowing. There are no studies that have explored the association between LDD and neuropathic pain. METHODS Associations between the radiographic LDD using two definitions (i.e., osteophytes, disc space narrowing) versus the presence of LBP, LBP > 3 months, severe LBP and neuropathic pain, were analyzed with logistic regression models. RESULTS A total of 699 participants completed the questionnaire and had a lumbar radiograph. Radiographs were scored by two independent observers. Osteophytes were present in 98% of the population and disc space narrowing in 67%. Osteophytes were not significantly associated with LBP (OR = 1.2, 95% CI 0.9-1.7). Disc space narrowing was significantly associated with the presence of LBP and neuropathic pain (OR = 1.7, 95% CI = 1.2-2.4 and OR 1.7, 95% CI 1.1-2.7, respectively). The presence of a LBP severity score of ≥4, and LBP persisting > 3 months were not significantly associated with the two definitions of LDD. CONCLUSION This study shows the presence of an association between disc space narrowing, whereas no association was found between osteophytes and LBP. We are the first to report an association between disc space narrowing and neuropathic pain. LEVEL OF EVIDENCE 3.
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Fernandes GS, Sarmanova A, Warner S, Harvey H, Akin-Akinyosoye K, Richardson H, Frowd N, Marshall L, Stocks J, Hall M, Valdes AM, Walsh D, Zhang W, Doherty M. Knee pain and related health in the community study (KPIC): a cohort study protocol. BMC Musculoskelet Disord 2017; 18:404. [PMID: 28934932 PMCID: PMC5609004 DOI: 10.1186/s12891-017-1761-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Accepted: 09/13/2017] [Indexed: 04/10/2023] Open
Affiliation(s)
- G S Fernandes
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A Sarmanova
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - S Warner
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - H Harvey
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - K Akin-Akinyosoye
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - H Richardson
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom
| | - N Frowd
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - L Marshall
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - J Stocks
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - M Hall
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A M Valdes
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - D Walsh
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - W Zhang
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom. .,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom. .,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.
| | - M Doherty
- Academic Rheumatology, Division of Rheumatology, Orthopedics and Dermatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
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Clinical Prediction Models for Patients With Nontraumatic Knee Pain in Primary Care: A Systematic Review and Internal Validation Study. J Orthop Sports Phys Ther 2017. [PMID: 28622751 DOI: 10.2519/jospt.2017.7142] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Systematic review and validation study. Background Many prognostic models of knee pain outcomes have been developed for use in primary care. Variability among published studies with regard to patient population, outcome measures, and relevant prognostic factors hampers the generalizability and implementation of these models. Objectives To summarize existing prognostic models in patients with knee pain in a primary care setting and to develop and internally validate new summary prognostic models. Methods After a sensitive search strategy, 2 reviewers independently selected prognostic models for patients with nontraumatic knee pain and assessed the methodological quality of the included studies. All predictors of the included studies were evaluated, summarized, and classified. The predictors assessed in multiple studies of sufficient quality are presented in this review. Using data from the Musculoskeletal System Study (BAS) cohort of patients with a new episode of knee pain, recruited consecutively by Dutch general medical practitioners (n = 372), we used predictors with a strong level of evidence to develop new prognostic models for each outcome measure and internally validated these models. Results Sixteen studies were eligible for inclusion. We considered 11 studies to be of sufficient quality. None of these studies validated their models. Five predictors with strong evidence were related to function and 6 to recovery, and were used to compose 2 prognostic models for patients with knee pain at 1 year. Running these new models in another data set showed explained variances (R2) of 0.36 (function) and 0.33 (recovery). The area under the curve of the recovery model was 0.79. After internal validation, the adjusted R2 values of the models were 0.30 (function) and 0.20 (recovery), and the area under the curve was 0.73. Conclusion We developed 2 valid prognostic models for function and recovery for patients with nontraumatic knee pain, based on predictors with strong evidence. A longer duration of complaints predicted poorer function but did not adequately predict chance of recovery. Level of Evidence Prognosis, levels 1a and 1b. J Orthop Sports Phys Ther 2017;47(8):518-529. Epub 16 Jun 2017. doi:10.2519/jospt.2017.7142.
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Characteristics associated with joint replacement in early symptomatic knee or hip osteoarthritis: 6-year results from a nationwide prospective cohort study (CHECK). Br J Gen Pract 2017; 67:e724-e731. [PMID: 28760738 DOI: 10.3399/bjgp17x692165] [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] [Received: 12/17/2016] [Accepted: 03/08/2017] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Many patients with osteoarthritis (OA) of the knee and/or hip undergo total joint replacement (TJR) because of severely progressed symptoms. AIM To determine patient and disease characteristics associated with undergoing TJR in participants with recent-onset knee and/or hip OA. DESIGN AND SETTING Participants with hip or knee pain from the nationwide prospective Cohort Hip and Cohort Knee (CHECK) study were included. METHOD The outcome measure was total hip arthroplasty (THA) or total knee arthroplasty (TKA) during 6 years of follow-up. Joint-dependent characteristics were compared using generalised estimating equations (GEE). Multivariable models were built for both subgroups. Differences in symptomatic and radiographic progression were determined between baseline and 2-year follow-up (T2). RESULTS The knee subgroup included 751 participants (1502 knees), and there were 538 participants in the hip subgroup (1076 hips). Nineteen participants (22 knees) underwent TKA and 53 participants (62 hips) THA. Participants who underwent TKA had higher baseline body mass index, painful knee flexion, and higher Kellgren and Lawrence scores. Participants who underwent THA had painful internal hip rotation and showed more severe radiographic OA features. Participants who underwent TKA or THA showed more rapid symptomatic and radiographic OA progression at T2. CONCLUSION In patients with recent-onset knee or hip pain, radiographic OA features already exist and a substantial number of patients fulfil existing criteria for knee and hip OA. A trend was observed in rapid progression of radiographic and symptomatic OA severity among patients with TKA and THA. Early detection of OA by the GP is important in managing knee and hip OA.
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Incidence, prevalence, natural course and prognosis of patellofemoral osteoarthritis: the Cohort Hip and Cohort Knee study. Osteoarthritis Cartilage 2017; 25:647-653. [PMID: 27940216 DOI: 10.1016/j.joca.2016.12.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2016] [Revised: 10/17/2016] [Accepted: 12/01/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the proportion of isolated patellofemoral osteoarthritis (PFOA) compared to tibiofemoral osteoarthritis (TFOA) in middle-aged participants with early osteoarthritis (OA) symptoms of the knee; to describe the natural course of PFOA compared with that of TFOA and to identify whether patients with PFOA have a different phenotype compared to patients with TFOA, or with combined PFOA and TFOA (combined osteoarthritis (COA)). DESIGN Participants with early OA symptoms of the knee were selected, completed questionnaires, underwent physical examination, and had knee radiographs at baseline, and at 2 and 5 years follow-up. Based on radiographs, participants were classified as having isolated TFOA, isolated PFOA, COA, or no radiographic OA. Multivariate logistic regression was used to identify participant characteristics associated with a specific group of OA at 2 years follow-up. RESULTS The cohort comprised 845 participants (mean age 55.9 years). At baseline, 116 had PFOA, none had TFOA or COA. Of these 116 participants, 66.3% had developed COA at 5 years follow-up. At 2 years follow-up, PFOA, TFOA and COA were present in 77 (10.8%), 39 (5.5%) and 83 (11.6%) participants, respectively. Multivariate regression analyses at 2 years follow-up showed that participants with radiographic PFOA or TFOA were not significantly different from each other with respect to signs and symptoms. CONCLUSIONS These results suggest that OA is more likely to start in the patellofemoral joint and then progress to COA in individuals with symptoms of early knee OA. No differences in TFOA and PFOA phenotypes were determined with respect to signs and symptoms.
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Migliore A, Scirè CA, Carmona L, Beaumont GH, Bizzi E, Branco J, Carrara G, Chevalier X, Collaku L, Aslanidis S, Denisov L, Di Matteo L, Bianchi G, Diracoglu D, Frediani B, Maheu E, Martusevich N, Bagnato GF, Scarpellini M, Minisola G, Akkoc N, Ramonda R, Barskova T, Babic-Naglic D, Muelas JVM, Ionescu R, Rashkov R, Damjanov N, Cerinic MM. The challenge of the definition of early symptomatic knee osteoarthritis: a proposal of criteria and red flags from an international initiative promoted by the Italian Society for Rheumatology. Rheumatol Int 2017; 37:1227-1236. [DOI: 10.1007/s00296-017-3700-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2016] [Accepted: 03/14/2017] [Indexed: 10/19/2022]
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The Influence of Knee Pain Location on Symptoms, Functional Status, and Knee-related Quality of Life in Older Adults With Chronic Knee Pain: Data From the Osteoarthritis Initiative. Clin J Pain 2017; 32:463-70. [PMID: 26308705 DOI: 10.1097/ajp.0000000000000291] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate whether knee pain location can influence symptoms, functional status, and knee-related quality of life in older adults with chronic knee pain. MATERIALS AND METHODS A total of 2959 painful knees from the Osteoarthritis Initiative database were analyzed. Trained interviewers recorded patient-reported location of knee pain. Painful knees were divided into 3 groups of patellofemoral only pain, tibiofemoral only pain, and combined pain. Self-reported knee-specific symptoms, functional status, and knee-related quality of life were assessed using the Knee Injury and Osteoarthritis Outcome Score. RESULTS The most common knee pain pattern was tibiofemoral only pain (62%), followed by patellofemoral only pain (23%), and combined pain (15%). The combined pain pattern was associated with greater odds of reporting pain, symptoms, sports, or recreational activity limitations and lower knee-related quality of life compared with either isolated knee pain patterns, after adjusting for demographics and radiographic disease severity. Individual item analysis further revealed that patients with combined pain had greater odds of reporting difficulty with daily weight-bearing activities that required knee bending compared with tibiofemoral or patellofemoral only pain patterns. Furthermore, symptoms, functional status, and knee-related quality of life were comparable between patients with patellofemoral and tibiofemoral only pain patterns, after adjusting for demographics and radiographic disease severity. DISCUSSION Combined patellofemoral and tibiofemoral pain is associated with poorer clinical presentation compared with isolated knee pain from either location. In addition, patellofemoral pain in isolation may be as important as tibiofemoral pain in causing symptoms and functional limitation in older adults with chronic knee pain.
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Damen J, Runhaar J, Kloppenburg M, Meijer R, Bierma-Zeinstra SMA, Oei EHG. Additional Value of Different Radiographic Views on the Identification of Early Radiographic Hip and Knee Osteoarthritis and Its Progression: A Cohort Study. Arthritis Care Res (Hoboken) 2017; 69:1644-1650. [PMID: 28125169 DOI: 10.1002/acr.23206] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2016] [Accepted: 01/24/2017] [Indexed: 11/11/2022]
Abstract
OBJECTIVE To investigate the prevalence and progression of early radiographic osteoarthritis (OA) of the hip and knee on different radiographic views, to determine whether different radiographic views have additional value in detecting early hip and knee radiographic OA cases or progression. METHODS In the Cohort Hip and Cohort Knee (CHECK) study (n = 1,002), 5 different radiographs were obtained: an anteroposterior and faux profile view of the hips, and posteroanterior, mediolateral, and skyline views of the knees. The prevalence of radiographic OA was estimated based on each view separately and in combinations. We determined whether different radiographic views have additional value in detecting and determining the progression of radiographic OA cases, compared to standard projections. RESULTS In the hip, we found 22.9% more cases when we combined both views. In the knee, we detected 79.7% more radiographic OA cases when we combined information from all 3 different radiographic views than when using only the posteroanterior view. Progression was seen in 33.1% more cases when using 2 hip radiographs, and in 65.1% more cases when using 3 knee radiographs. CONCLUSION The use of different radiographic views increased the number of participants classified as having radiographic OA in an early OA cohort, both at baseline and at followup. The progression of early radiographic OA is demonstrated more frequently when multiple different radiographic views are used.
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Affiliation(s)
- Jurgen Damen
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jos Runhaar
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | | | - Rik Meijer
- Wilhelmina Hospital Assen, Assen, The Netherlands
| | | | - Edwin H G Oei
- Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Abbott JH, Usiskin IM, Wilson R, Hansen P, Losina E. The quality-of-life burden of knee osteoarthritis in New Zealand adults: A model-based evaluation. PLoS One 2017; 12:e0185676. [PMID: 29065119 PMCID: PMC5655469 DOI: 10.1371/journal.pone.0185676] [Citation(s) in RCA: 46] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 09/18/2017] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Knee osteoarthritis is a leading global cause of health-related quality of life loss. The aim of this project was to quantify health losses arising from knee osteoarthritis in New Zealand (NZ) in terms of quality-adjusted life years (QALYs) lost. METHODS The Osteoarthritis Policy Model (OAPol), a validated Monte Carlo computer simulation model, was used to estimate QALYs lost due to knee osteoarthritis in the NZ adult population aged 40-84 over their lifetimes from the base year of 2006 until death. Data were from the NZ Health Survey, NZ Burden of Diseases, NZ Census, and relevant literature. QALYs were derived from NZ EQ-5D value set 2. Sensitivity to health state valuation, disease and pain prevalence were assessed in secondary analyses. RESULTS Based on NZ EQ-5D health state valuations, mean health losses due to knee osteoarthritis over people's lifetimes in NZ are 3.44 QALYs per person, corresponding to 467,240 QALYs across the adult population. Average estimated per person QALY losses are higher for non-Māori females (3.55) than Māori females (3.38), and higher for non-Māori males (3.34) than Māori males (2.60). The proportion of QALYs lost out of the total quality-adjusted life expectancy for those without knee osteoarthritis is similar across all subgroups, ranging from 20 to 23 percent. CONCLUSIONS At both the individual and population levels, knee osteoarthritis is responsible for large lifetime QALY losses. QALY losses are higher for females than males due to greater prevalence of knee osteoarthritis and higher life expectancy, and lower for Māori than non-Māori due to lower life expectancy. Large health gains are potentially realisable from public health and policy measures aimed at decreasing incidence, progression, pain, and disability of osteoarthritis.
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Affiliation(s)
- J. Haxby Abbott
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- * E-mail:
| | - Ilana M. Usiskin
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
| | - Ross Wilson
- Centre for Musculoskeletal Outcomes Research, Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Paul Hansen
- Department of Economics, University of Otago, Dunedin, New Zealand
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, United States of America
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Fernández-Moreno M, Soto-Hermida A, Vázquez-Mosquera ME, Cortés-Pereira E, Relaño S, Hermida-Gómez T, Pértega S, Oreiro-Villar N, Fernández-López C, Garesse R, Blanco FJ, Rego-Pérez I. Mitochondrial DNA haplogroups influence the risk of incident knee osteoarthritis in OAI and CHECK cohorts. A meta-analysis and functional study. Ann Rheum Dis 2016; 76:1114-1122. [DOI: 10.1136/annrheumdis-2016-210131] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2016] [Revised: 09/22/2016] [Accepted: 11/05/2016] [Indexed: 11/03/2022]
Abstract
ObjectiveTo evaluate the influence of the mitochondrial DNA (mtDNA) haplogroups in the risk of incident knee osteoarthritis (OA) and to explain the functional consequences of this association to identify potential diagnostic biomarkers and therapeutic targets.MethodsTwo prospective cohorts contributed participants. The osteoarthritis initiative (OAI) included 2579 subjects of the incidence subcohort, and the cohort hip and cohort knee (CHECK) included 635, both with 8-year follow-up. The analysis included the association of mtDNA haplogroups with the rate of incident knee OA in subjects from both cohorts followed by a subsequent meta-analysis. Transmitochondrial cybrids harbouring haplogroup J or H were constructed to detect differences between them in relation to physiological features including specific mitochondrial metabolic parameters, reactive oxygen species production, oxidative stress and apoptosis.ResultsCompared with H, the haplogroup J associates with decreased risk of incident knee OA in subjects from OAI (HR=0.680; 95% CI 0.470 to 0.968; p<0.05) and CHECK (HR=0.728; 95% CI 0.469 to 0.998; p<0.05). The subsequent meta-analysis including 3214 cases showed that the haplogroup J associates with a lower risk of incident knee OA (HR=0.702; 95% CI 0.541 to 0.912; p=0.008). J cybrids show a lower free radical production, higher cell survival under oxidative stress conditions, lower grade of apoptosis as well as lower expression of the mitochondrially related pro-apoptotic gene BCL2 binding component 3 (BBC3). In addition, J cybrids also show a lower mitochondrial respiration and glycolysis leading to decreased ATP production.ConclusionsThe physiological effects of the haplogroup J are beneficial to have a lower rate of incident knee OA over time. Potential drugs to treat OA could focus on emulating the mitochondrial behaviour of this haplogroup.
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Fernández-Moreno M, Soto-Hermida A, Vázquez-Mosquera ME, Cortés-Pereira E, Pértega S, Relaño S, Oreiro-Villar N, Fernández-López C, Blanco FJ, Rego-Pérez I. A replication study and meta-analysis of mitochondrial DNA variants in the radiographic progression of knee osteoarthritis. Rheumatology (Oxford) 2016; 56:263-270. [PMID: 27864563 DOI: 10.1093/rheumatology/kew394] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Revised: 10/03/2016] [Indexed: 01/20/2023] Open
Abstract
OBJECTIVE To conduct a replication study and meta-analysis involving the study of mtDNA variants in the radiographic progression of OA in different cohorts worldwide, including Cohort Hip and Cohort Knee (CHECK), the OA Initiative and a cohort from Spain. METHODS The influence of the haplogroups in the rate of radiographic progression at 96 months in 431 subjects from CHECK was assessed in terms of Kellgren and Lawrence (KL) grade. Progression was defined as a change from KL ⩾ 1 at baseline to any higher grade during the follow-up. Extended Cox proportional hazard models were used to analyse the influence of mtDNA variants in the rate of radiographic knee OA progression. A subsequent meta-analysis of 1603 subjects following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines was conducted to combine the data of individual studies. A sensitivity analysis was performed to validate the stability of the results. RESULTS CHECK subjects carrying the haplogroup T showed the lowest rate of radiographic knee OA progression [hazard ratio (HR) 0.645 (95% CI 0.419, 0.978); P < 0.05]. When pooled, subjects within the superhaplogroup JT showed the same trend [HR 0.707 (95% CI 0.501, 0.965); P < 0.05]. BMI [HR 1.046 (95% CI 1.018, 1.073); P < 0.05] and bilateral OA [HR 2.266 (95% CI 1.733, 2.954); P < 0.05] at baseline are risk factors for radiographic knee OA progression as well. In the meta-analysis there was a reduced rate of radiographic progression in subjects with haplogroup T [HR 0.612 (95% CI 0.454, 0.824); P = 0.001] or in the superhaplogroup JT [HR 0.765 (95% CI 0.624, 0.938); P = 0.009]. Sensitivity analysis revealed that the results were robust. CONCLUSION The mtDNA variants in the superhaplogroup JT associate with a reduced rate of radiographic OA progression. The mtDNA polymorphisms in the superhaplogroup JT emerge as potential complementary genetic biomarkers for disease progression.
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Affiliation(s)
- Mercedes Fernández-Moreno
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias.,CIBER-BBN Instituto de Salud Carlos III, INIBIC-CHUAC
| | - Angel Soto-Hermida
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
| | - María E Vázquez-Mosquera
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
| | - Estefanía Cortés-Pereira
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
| | | | - Sara Relaño
- Plataforma de Genómica, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias, A Coruña, 15006, España, Spain
| | - Natividad Oreiro-Villar
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
| | - Carlos Fernández-López
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
| | - Francisco J Blanco
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
| | - Ignacio Rego-Pérez
- Servicio de Reumatología, Instituto de Investigación Biomédica de A Coruña (INIBIC), Complexo Hospitalario Universitario de A Coruña (CHUAC), Sergas, Universidade da Coruña (UDC), As Xubias
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van Oudenaarde K, Jobke B, Oostveen ACM, Marijnissen ACA, Wolterbeek R, Wesseling J, Bierma-Zeinstra SMA, Bloem HL, Reijnierse M, Kloppenburg M. Predictive value of MRI features for development of radiographic osteoarthritis in a cohort of participants with pre-radiographic knee osteoarthritis—the CHECK study. Rheumatology (Oxford) 2016; 56:113-120. [DOI: 10.1093/rheumatology/kew368] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 09/06/2016] [Indexed: 11/13/2022] Open
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Villafañe JH, Valdes K, Berjano P, Wajon A. Clinical Update: Conservative Management of Carpometacarpal Joint Osteoarthritis. J Rheumatol 2016; 42:1728-9. [PMID: 26330130 DOI: 10.3899/jrheum.150416] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Affiliation(s)
- Jorge Hugo Villafañe
- Researcher, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) Don Gnocchi Foundation, Milan, Italy;
| | | | | | - Anne Wajon
- Macquarie Hand Therapy, Sydney, Australia
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Botterman J, Bode C, Siemons L, van de Laar MA, Dekker J. Exploring Fatigue Trajectories in Early Symptomatic Knee and Hip Osteoarthritis: 6-year Results from the CHECK Study. J Rheumatol 2016; 43:1413-20. [DOI: 10.3899/jrheum.150820] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/15/2016] [Indexed: 01/24/2023]
Abstract
Objective.To examine whether different groups of fatigue trajectories can be identified among patients with early symptomatic osteoarthritis (OA) of the knee or hip, to describe the level of fatigue severity within each of these fatigue groups, and to investigate the involvement of age, sex, use of medication, comorbidity, and OA severity in relation to group membership.Methods.Six years of followup data on fatigue (Medical Outcomes Study Short Form-36 Vitality scale) came from the Cohort Hip and Cohort Knee (CHECK) cohort. Growth mixture modeling was applied to identify distinct fatigue trajectories as well as to take into account the effects of the patient characteristics.Results.Three fatigue trajectories were identified: low fatigue, low-to-high fatigue, and high fatigue. Latter trajectories showed considerable overlap from years 2 to 6, but differed in some patient characteristics in comparison with each other and in comparison with the low fatigue group. Comorbidity, medication use, and sex were significantly associated with the identified trajectories. Women, individuals with a comorbid disease, and those who used medication were more likely to follow a high fatigue trajectory.Conclusion.These findings suggest heterogeneous development of fatigue in the early OA population associated with varying patient characteristics. Further, this study shows that a considerable number of patients with OA already experience elevated levels of fatigue at an early stage of OA. While these findings need to be replicated, the identification of these trajectories with differing patient characteristics may warrant tailored psychosocial interventions for patients with elevated levels of fatigue.
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Bastick AN, Verkleij SPJ, Damen J, Wesseling J, Hilberdink WKHA, Bindels PJE, Bierma-Zeinstra SMA. Defining hip pain trajectories in early symptomatic hip osteoarthritis--5 year results from a nationwide prospective cohort study (CHECK). Osteoarthritis Cartilage 2016; 24:768-75. [PMID: 26854794 DOI: 10.1016/j.joca.2015.11.023] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 10/20/2015] [Accepted: 11/19/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To define distinct hip pain trajectories in individuals with early symptomatic hip osteoarthritis (OA) and to determine risk factors for these pain trajectories. METHOD Data were obtained from the nationwide prospective Cohort Hip and Cohort Knee (CHECK) study. Participants with hip pain or stiffness and a completed 5-year follow-up were included. Baseline demographic, anamnestic, physical examination characteristics were assessed. Outcome was annually assessed by the Numeric Rating Scale (NRS) for pain. Pain trajectories were retrieved by latent class growth analysis (LCGA). Multinomial logistic regression was used to calculate risk ratios. RESULTS 545 participants were included. Four distinct pain trajectories were uncovered by LCGA. We found significant differences in baseline characteristics, including body mass index (BMI); symptom severity; pain coping strategies and in criteria for clinical hip OA (American College of Rheumatology (ACR)). Lower education, higher activity limitation scores, frequent use of pain transformation as coping strategy and painful internal hip rotation were more often associated with trajectories characterized by more severe pain. No association was found for baseline radiographic features. CONCLUSION We defined four distinct pain trajectories over 5 years follow-up in individuals with early symptomatic hip OA, suggesting there are differences in symptomatic progression of hip OA. Baseline radiographic severity was not associated with the pain trajectories. Future research should be aimed at measuring symptomatic progression of hip OA with even more frequent symptom assessment.
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Affiliation(s)
- A N Bastick
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - S P J Verkleij
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Damen
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Wesseling
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands.
| | - W K H A Hilberdink
- Allied Health Care Center for Rheumatology and Rehabilitation (AHCRR), Groningen, The Netherlands.
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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50
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Losina E, Collins JE. Forecasting the future pain in hip OA: can we rely on pain trajectories? Osteoarthritis Cartilage 2016; 24:765-7. [PMID: 26854793 DOI: 10.1016/j.joca.2016.01.989] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2015] [Revised: 01/22/2016] [Accepted: 01/26/2016] [Indexed: 02/02/2023]
Affiliation(s)
- E Losina
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA.
| | - J E Collins
- Orthopedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopedic Surgery, Brigham and Women's Hospital and Harvard Medical School, Boston, MA, USA
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