Study protocol for a randomised controlled trial of diacerein versus placebo to treat knee osteoarthritis with effusion-synovitis (DICKENS)

Imaging-based measures of synovitis in knee osteoarthritis: A scoping review and narrative synthesis

Background

Synovitis has emerged as a tissue target of importance in OA research and is commonly evaluated with medical imaging.

Objectives

The purpose of this scoping review was to identify and describe the medical imaging techniques and definitions used by knee OA researchers to assess synovitis, summarize their advantages and disadvantages, and identify opportunities for future work.

Eligibility criteria

We included full-text peer-reviewed English publications including adults diagnosed with knee OA. Studies were included if one or more medical imaging modalities were used to assess synovitis in the knee.Studies of inflammatory arthritis, joint replacement, and synovial joints other than the knee were excluded. Animal studies and literature syntheses were also excluded.

Sources

MEDLINE, SCOPUS, and Google scholar databases were systematically searched for publications (2000-2023) using the following medical subject headings (MeSH): "osteoarthritis, knee", "magnetic resonance imaging", "ultrasonography", "synovitis".

Results

1154 articles were identified from searching medical databases. After removal of duplicates, abstract screening, and full text reading, 251 articles were included in the final review. MRI is the most common modality employed to assess knee synovitis, followed by US imaging. Varied imaging techniques used in the assessment of joint synovitis may be targeting divergent constructs of synovial remodeling and inflammation, which complicates interpretation of results.

Conclusions

There is no consensus on the best method for imaging of knee synovitis in OA. Future work may benefit from the evaluation of synovitis separate from joint effusion, and their associations with histologic findings to discriminate between features of synovial inflammation and remodeling.

Association between serum high-sensitivity C-reactive protein levels and osteoarthritis in adults from NHANES 2015 to 2018

To explore the association between serum high-sensitivity C-reactive protein (HSCRP) levels and osteoarthritis (OA) in adults, providing new evidence for the diagnosis of adult OA. We selected data from the 2015-2018 National Health and Nutrition Examination Survey (NHANES) and conducted a cross-sectional study. Serum HSCRP levels were extracted from laboratory data, and OA patients were identified through questionnaire responses. Participants under the age of 20 and those with incomplete data were excluded. We used multivariable logistic regression models, restricted cubic spline (RCS) functions, and stratified analyses to study the association between serum HSCRP levels and osteoarthritis in adults. After screening, a total of 9,948 participants were included, among whom 1,196 were osteoarthritis patients, representing a prevalence rate of 12.02%. Multivariable logistic regression analysis, along with three adjusted models, showed a positive correlation between serum HSCRP levels and the occurrence of osteoarthritis in adults. Compared to the lowest HSCRP quartile, the highest quartile showed a 1.86-fold higher prevalence of OA (95% confidence interval: 1.55 ~ 2.23, P < 0.001). The restricted cubic spline analysis showed a significant increase in OA incidence with rising serum HSCRP levels (P < 0.05). Subgroup and forest plot analyses indicated a positive correlation between HSCRP levels and osteoarthritis across different subgroups, such as age, gender, hypertension status, activity status, drinking status, and Smoke status (P < 0.05). There is a positive correlation between serum HSCRP levels and the occurrence of osteoarthritis in adults. When a patient's serum HSCRP level is elevated, the possibility of osteoarthritis should be considered.

The relationship between serum uric acid and gastrointestinal bleeding in peritoneal dialysis patients: a propensity score analysis

PURPOSE

Gastrointestinal bleeding is an important gastrointestinal complication among peritoneal dialysis patients and correlated with a higher risk of mortality. Increased uric acid levels are a significant complication for peritoneal dialysis patients and have been associated with an increased risk of hemorrhagic stroke. The objective of the present study was to investigate the relationship between serum uric acid levels and gastrointestinal bleeding in peritoneal dialysis patients.

METHODS

A total of 2498 peritoneal dialysis patients were recruited. Based on the optimal uric acid cutoff value, two groups of patients were divided. We constructed a propensity-score-matched population of 1762 patients by matching sex, age, and body mass index. Survival outcomes between the two groups were compared using adjusted Kaplan-Meier curves. We constructed the restricted cubic splines regression to assess the correlation between levels of uric acid and gastrointestinal bleeding. A multivariate Cox proportional hazards regression was performed to test whether higher levels of uric acid are an independent risk factor for gastrointestinal bleeding. We performed a forest plot to show interaction effects in different subgroups.

RESULTS

According to restricted cubic splines regression, uric acid levels were positively correlated with the risk of gastrointestinal bleeding events. After adjusted different confounding factors, patients with high levels of uric acid were prone to experience gastrointestinal bleeding (HR 1.868, 95%CI 1.001-3.486). In subgroups, the interaction between higher levels of uric acid and utilizing proton pump inhibitors was significant (P for interaction = 0.034). Further research found that taking proton pump inhibitors could decrease the risk of gastrointestinal bleeding in peritoneal dialysis patients accompanied high levels of uric acid.

CONCLUSION

The baseline high levels of uric acid are an independent risk factor for gastrointestinal bleeding in patients undergoing peritoneal dialysis.

Inflammation as a therapeutic target for osteoarthritis: A literature review of clinical trials

The burden of osteoarthritis (OA) is rapidly increasing with population aging, but there are still no approved disease-modifying drugs available. Accumulating evidence has shown that OA is a heterogeneous disease with multiple phenotypes, and it is unlikely to respond to one-size-fits-all treatments. Inflammation is recognized as an important phenotype of OA and is associated with worse pain and joint deterioration. Therefore, it is believed that anti-inflammatory treatments may be more effective for OA with an inflammatory phenotype. In this review, we summarized clinical trials that evaluated anti-inflammatory treatments for OA and discussed whether these treatments are more effective in inflammatory OA phenotypes compared to general OA patients.

Metformin for knee osteoarthritis with obesity: study protocol for a randomised, double-blind, placebo-controlled trial

INTRODUCTION

Over half of the populations with knee osteoarthritis (OA) have obesity. These individuals have many other shared metabolic risk factors. Metformin is a safe, inexpensive, well-tolerated drug that has pleiotropic effects, including structural protection, anti-inflammatory and analgesic effects in OA, specifically the knee. The aim of this randomised, double-blind, placebo-controlled trial is to determine whether metformin reduces knee pain over 6 months in individuals with symptomatic knee OA who are overweight or obese.

METHODS AND ANALYSIS

One hundred and two participants with symptomatic knee OA and overweight or obesity will be recruited from the community in Melbourne, Australia, and randomly allocated in a 1:1 ratio to receive either metformin 2 g or identical placebo daily for 6 months. The primary outcome is reduction of knee pain [assessed by 100 mm Visual Analogue Scale (VAS)] at 6 months. The secondary outcomes are OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) responder criteria [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, function and participant's global assessment (VAS)] at 6 months; change in knee pain, stiffness, function using WOMAC at 6 months and quality of life at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups.

ETHICS AND DISSEMINATION

Ethics approval has been obtained from the Alfred Hospital Ethics Committee (708/20) and Monash University Human Research Ethics Committee (28498). Written informed consent will be obtained from all the participants. The findings will be disseminated through peer-review publications and conference presentations.

TRIAL REGISTRATION NUMBER

ACTRN12621000710820 .

Harnessing the multifunctionality of lipid-based drug delivery systems for the local treatment of osteoarthritis

Osteoarthritis (OA) is a widespread joint condition affecting millions globally, presenting a growing socioeconomic burden thus making the development of more effective therapeutic strategies crucial. This review emphasizes recent advancements in lipid-based drug delivery systems (DDSs) for intra-articular administration of OA therapeutics, encompassing non-steroidal anti-inflammatory drugs, corticosteroids, small molecule disease-modifying OA drugs, and RNA therapeutics. Liposomes, lipid nanoparticles, lipidic mesophases, extracellular vesicles and composite systems exhibit enhanced stability, targeted delivery, and extended joint retention, which contribute to improved therapeutic outcomes and minimized systemic drug exposure. Although active targeting strategies hold promise, further research is needed to assess their targeting efficiency in physiologically relevant conditions. Simultaneously, multifunctional DDSs capable of delivering combinations of distinct therapeutic classes offer synergistic effects and superior OA treatment outcomes. The development of such long-acting systems that resist rapid clearance from the joint space is crucial, where particle size and targeting capabilities emerge as vital factors. Additionally, combining cartilage lubrication properties with sustained drug delivery has demonstrated potential in animal models, meriting further investigation in human clinical trials. This review highlights the crucial need for direct, head-to-head comparisons of novel DDSs with standard treatments, particularly within the same drug class. These comparisons are essential in accurately evaluating their effectiveness, safety, and clinical applicability, and are set to significantly shape the future of OA therapy.

Update on recent developments in imaging of inflammation in osteoarthritis: a narrative review

Synovitis is an important component of the osteoarthritis (OA) disease process, particularly regarding the "inflammatory phenotype" of OA. Imaging plays an important role in the assessment of synovitis in OA with MRI and ultrasound being the most deployed imaging modalities. Contrast-enhanced (CE) MRI, particularly dynamic CEMRI (DCEMRI) is the ideal method for synovitis assessment, but for several reasons CEMRI is not commonly performed for OA imaging in general. Effusion-synovitis and Hoffa-synovitis are commonly used as surrogate markers of synovitis on non-contrast-enhanced (NCE) MRI and have been used in many epidemiological observational studies of knee OA. Several semiquantitative MRI scoring systems are available for the evaluation of synovitis in knee OA. Synovitis can be a target tissue for disease-modifying OA drug (DMOAD) clinical trials. Both MRI and ultrasound may be used to determine the eligibility and assess the therapeutic efficacy of DMOAD approaches. Ultrasound is mostly used for evaluation of synovitis in hand OA, while MRI is typically used for larger joints, namely knees and hips. The role of other modalities such as CT (including dual-energy CT) and nuclear medicine imaging (such as positron-emission tomography (PET) and its hybrid imaging) is limited in the context of synovitis assessment in OA. Despite research efforts to develop NCEMRI-based synovitis evaluation methods, these typically underestimate the severity of synovitis compared to CEMRI, and thus more research is needed before we can rely only on NCEMRI.