Knee Osteoarthritis: Epidemiology, Pathogenesis, and Mesenchymal Stem Cells: What Else Is New? An Update

Effectiveness of prior intra-articular corticosteroid injection in elderly patients with knee osteoarthritis undergoing progressive resistance training: a randomized controlled trial

OBJECTIVE

To evaluate the effectiveness of intra-articular injections (IAIs) with triamcinolone hexacetonide (TH) combined with a progressive resistance exercise program (PREP) in improving pain, function, muscle strength, and quality of life in elderly patients with knee osteoarthritis (OA).

METHODS

Fifty-nine elderly individuals with knee OA were randomized into three groups: IAI with TH (IAI-TH) + PREP, IAI with saline solution (IAI-SS) + PREP, and IAI with placebo + PREP. The IAIs were administered once, one week before starting PREP, which was performed twice weekly for 12 weeks. Outcomes assessed at baseline and at 2, 6, and 12 weeks post-IAI included pain (Numerical Pain Scale - NPS), swelling, function (Western Ontario and McMaster Universities Osteoarthritis Index - WOMAC), quality of life (Short Form-36 - SF-36), performance tests (Six-Minute Walk Test - 6MWT, Timed Up and Go Test - TUGT, Short Physical Performance Battery - SPPB), and muscle strength (one-repetition maximum test - 1RM). Due to the COVID-19 pandemic, only 15 participants per group completed the study protocol.

RESULTS

All groups showed significant intragroup improvements over time in pain, function, muscle strength, and quality of life. However, no statistically significant differences were found between the groups for any of the assessed outcomes. The bodily pain domain of the SF-36 and analgesic consumption were the only measures showing differences over time.

CONCLUSION

The combination of IAI-TH and a 12-week PREP (twice weekly) was not superior to IAI-SS or placebo combined with the same PREP in improving pain, function, or quality of life in elderly patients with knee OA. These findings highlight the role of exercise as a key therapeutic strategy, regardless of prior IAI. Future studies with larger sample sizes and long-term follow-ups are needed to better assess the role of intra-articular corticosteroid injections in OA rehabilitation.

CLINICAL TRIAL NUMBER

ensaiosclinicos.gov.br (RBR-556md5g). Registered 27 October 2022.

Human umbilical cord mesenchymal stem cell-derived exosomal miR-199a-3p inhibits the MAPK4/NF-κB signaling pathway to relieve osteoarthritis

BACKGROUND

There is currently no effective treatment for osteoarthritis (OA), which is the most common joint disorder leading to disability. Although human umbilical cord mesenchymal stem cells (hUC-MSCs) are promising OA treatments, their use is limited by the condition itself, and understanding of the underlying mechanisms of OA is lacking.

AIM

To explore the specific molecular mechanism by which hUC-MSC-derived exosomal miR-199a-3p improves OA.

METHODS

Sodium iodoacetate was injected into rat articulations to construct an animal model of OA. Interleukin (IL)-1β was used to induce human chondrocytes (CHON-001) to construct an OA chondrocyte model. Exosomes in hUC-MSCs were isolated using Ribo™ Exosome Isolation Reagent. Real-time reverse transcriptase-polymerase chain reaction and western blotting were used to detect the expression of related genes and proteins, and damage to CHON-001 cells and rat articular cartilage tissue was evaluated by enzyme-linked immunosorbent assay, terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate-nick end labelling staining and hematoxylin and eosin staining.

RESULTS

hUC-MSC-derived exosomes (hUC-MSC-Exos) inhibited the expression of IL-1β-induced inflammatory cytokines, namely, IL-6, IL-8 and tumor necrosis factor-α. hUC-MSC-Exos also improved the viability but inhibited the apoptosis of CHON-001 cells, improved the pathological condition of articular cartilage tissue and alleviated the development of OA in vivo. Mechanistically, hUC-MSC-Exos downregulated the expression of mitogen-activated protein kinase 4 by delivering miR-199a-3p, thereby inhibiting the activation of the nuclear factor-kappaB signaling pathway, alleviating IL-1β-induced chondrocyte inflammation and apoptosis, and ultimately improving the development of OA.

CONCLUSION

hUC-MSC-derived exosomal miR-199a-3p alleviates OA by inhibiting the mitogen-activated protein kinase 4/nuclear factor-kappaB signaling pathway. The present findings suggest that miR-199a-3p delivery by hUC-MSC-Exos may be a novel strategy for the treatment of OA.

Nanomaterial-Based Drug Delivery Systems Targeting Functional Cells for Osteoarthritis Treatment: Mechanisms, Challenges and Future Prospects

Osteoarthritis (OA) represents a chronic joint disease characterized by articular cartilage degeneration, synovial inflammation, and subchondral bone erosions. Functional cells in OA mainly include macrophages, synoviocytes, chondrocytes, and mesenchymal stem cells. These cells can secrete cytokines and non-coding RNAs and exosomes and interact with each other to coregulate the progression of OA. Some nanomaterial-based drug delivery systems (DDSs) surface ligands can alleviate OA by targeting receptors on the surface of functional cells. Meanwhile, other nanomaterial-based DDSs, whose surfaces are masked by the cell membranes or extracellular vesicles of these functional cells, treat OA by targeting and attacking the diseased site. When ligand-modified nanomaterials target specific functional cells to treat OA, the functional cells are attacked. Functional cells become attackers, similar to arrows, when their cell membranes or extracellular vesicles are modified into nanomaterials to deliver drugs for OA treatment. An increasing number of studies have been conducted on nanomaterial-based DDS-targeted functional cells for the treatment of OA, but none has summarized the corresponding research progress and mechanism of action. In this review, the related references on the treatment of osteoarthritis with nanomaterial-based DDSs targeting functional cells have been included, and how a variety of functional cells can be engineered into nanomaterial-based DDSs serving as targets or arrows to treat OA has been summarised for the first time, providing a new idea and method for the targeted treatment of OA.

Mediating role of pain sensitization in preoperative and postoperative pain in knee osteoarthritis patients

OBJECTIVE

This study aims to explore the relationship between preoperative and postoperative pain in patients with knee osteoarthritis (KOA) undergoing total knee arthroplasty (TKA) and unicompartmental knee arthroplasty (UKR), and to assess the mediating roles of central and peripheral sensitization.

METHODS

This prospective cohort study enrolled a total of 105 eligible KOA patients. The Visual Analog Scale (VAS) was used to assess preoperative and postoperative pain levels. Multivariate linear regression analysis and Bootstrap mediation analysis were conducted to investigate the impact of preoperative pain intensity on postoperative pain.

RESULTS

This study revealed a significant positive correlation between preoperative VAS scores during movement and pain scores 3 days postoperatively (β = 0.4018, p = 0.0017), as well as a significant correlation with pain scores 6 months postoperatively (β = 0.735, p = 0.004). Central sensitization (β = 0.0446, p < 0.0001) and peripheral sensitization (β = 0.0333, p = 0.0015) exhibited significant mediation effects between preoperative and postoperative pain. Additionally, preoperative VAS scores (B = 1.107, p = 0.014, OR = 3.027), age (B = 0.207, p = 0.036, OR = 1.229), and duration of arthritis (B = 0.190, p = 0.013, OR = 1.210) were significant predictors of postoperative analgesic demand.

CONCLUSION

This study demonstrates that preoperative pain intensity is closely related to postoperative pain in KOA patients undergoing TKA and UKR, with central and peripheral sensitization playing significant mediating roles in this process. In particular, preoperative pain management is crucial for alleviating postoperative pain and improving patients' quality of life. Therefore, when formulating individualized pain management strategies, the central and peripheral sensitivity of patients should be comprehensively considered. Future research is necessary to develop and evaluate innovative pain control methods integrating central and peripheral mechanisms to optimize postoperative rehabilitation and long-term health outcomes.

Unraveling the crucial role of SDF-1 in osteoarthritis progression: IL6/HIF-1α positive feedback and chondrocyte ferroptosis

BACKGROUND

Osteoarthritis (OA) is a common joint disease with an incompletely understood pathogenesis. SDF-1, a key factor in cartilage matrix degradation, is involved in OA cartilage degeneration, yet its mechanism, especially regarding ferroptosis, remains unclear. This study focuses on elucidating the role of SDF-1-induced chondrocyte ferroptosis and the IL6/HIF-1α signalling axis in OA.

METHODS

A rabbit OA model was created via SDF-1 induction. Knee cartilage tissues were sequenced and analyzed bioinformatically to identify key genes, and explore critical pathways. Clinical tissue samples were utilized to validate their clinical relevance. Furthermore, cell and rabbit models were constructed through gene interference and pathway blocking. The expression of related genes and proteins was detected by QPCR, ELISA, Western blot, and immunofluorescence. Additionally, OA and ferroptosis indicators such as cell viability, immunohistochemistry, ROS, lipid ROS, Fe2+, MDA, and mitochondrial morphology were evaluated to uncover the molecular mechanism by which SDF-1 regulates the IL6/HIF-1α signalling axis to mediate chondrocyte ferroptosis.

RESULTS

Bioinformatics revealed that ferroptosis was significantly activated in SDF-1-induced OA, with IL6 and HIF-1 pathways implicated. In vitro and in vivo, SDF-1 increased the expression and secretion of MMP13 but decreased COL2A1 and ACAN in chondrocytes, leading to OA-like changes. It also suppressed the expression levels of SLC7A11 and GPX4, upregulated the gene and protein levels of ACSL4, promoted the accumulation of MDA, Fe2+, and ROS, and caused mitochondrial morphological changes. These ferroptosis manifestations could be alleviated by the ferroptosis inhibitor Fer-1. IL6 was an important mediator of SDF-1-induced ferroptosis, and knocking down IL6 also inhibited chondrocyte ferroptosis changes. Overexpressing IL6 (oeIL6) and using PX478 to inhibit the HIF-1 signalling pathway showed that PX478 could significantly relieve the cytotoxicity produced by the culture of oeIL6 and SDF-1, enhance chondrocyte viability, reverse the decreased expression of SLC7A11 and GPX4 caused by oeIL6, increase the expression of ACSL4, reverse the accumulation of MDA, Fe2+, and ROS. Moreover, PX478 could also significantly reduce the expression and secretion of IL6.

CONCLUSION

SDF-1 mediates chondrocyte ferroptosis via the IL6/HIF-1α positive feedback, promoting OA.

High glucose induces senescence in synovial mesenchymal stem cells through mitochondrial dysfunction

PURPOSE

To investigate the impact of high glucose on the senescence of synovial mesenchymal stem cells (SMSCs) and to elucidate the role of mitochondrial dysfunction in this process.

METHODS

‌SMSCs were treated with medium containing high glucose (25 mmol/L) or low glucose (5.5 mmol/L) concentrations. The effects of high glucose concentrations on the proliferation, senescence, mitochondrial reactive oxygen species (ROS) levels, mitochondrial fission, and mitophagy of SMSCs were investigated. First, the impact of 24-hour high glucose treatment on SMSCs was investigated‌. After this initial 24-hour exposure, the medium was subsequently changed to low glucose, and the cells were cultivated for an additional 24 h; this was then compared with the effects of continuous 48-hour high-glucose exposure and continuous 48-hour low-glucose exposure.

RESULTS

High glucose concentrations did not promote the proliferation of SMSCs but rather accelerated their senescence by ‌upregulating‌ the mRNA expression of senescence-associated secretory phenotype (SASP) genes and increasing the number of senescence-associated β-galactosidase (SA-β-gal)-positive cells. Additionally, high glucose ‌concentrations elevated‌ ROS levels in mitochondria and ‌facilitated‌ mitochondrial fission; they also ‌inhibited‌ the mitophagy of SMSCs by suppressing the expression of mitophagy-related proteins (PINK1, PARKIN, and LC3B). High glucose-induced suppression of mRNA (Il-6, Cxcl1, Dnm1, Pink1, Prkn, Lc3b) and protein (P21) expression, along with increased SA-β-gal-positive cell numbers and elevated MitoSOX intensity, can be reversed by terminating the high glucose treatment.

CONCLUSION

High glucose concentrations induce senescence in SMSCs via mitochondrial dysfunction, manifested as ROS accumulation, excessive fission, and mitophagy suppression. Glucose normalization reversed senescence phenotypes, accompanied by restored mitophagy and reduced oxidative stress. Mitochondrial dysfunction may be one of the key mechanisms underlying high glucose-induced senescence in SMSCs.

Effectiveness of Kinesio taping without physical therapy for knee osteoarthritis: a systematic review and meta-analysis of randomized controlled trials

Knee osteoarthritis (KOA) is a common musculoskeletal disorder causing pain and stiffness. Kinesio tape (KT) is a flexible tape used for various musculoskeletal conditions, including KOA. This study systematically evaluates the effectiveness of KT without conventional physical therapy for KOA. A comprehensive search was conducted through PubMed, Scopus, Cochrane Library, Embase, and Web of Science from inception to March 2025 for randomized trials evaluating KT without physical therapy for KOA (Prospero: CRD42024615432). The risk of bias was assessed using the ROB-2 tool, and the data analysis was conducted using Review Manager V5.4. A total of 16 randomized trials were included. KT significantly reduced the post-treatment pain at rest (MD: -0.75, 95% CI: -1.15, -0.34) and during movement (MD: -0.92, 95% CI: -1.65, -0.20) compared to sham KT. However, KT did not demonstrate a significant effect on long-term pain reduction. Additionally, KT significantly improved the WOMAC total score (MD: -0.60, 95% CI: -1.19, -0.01) and increased knee flexion range of motion (FROM) (MD: 6.04, 95% CI: 3.13, 8.96). However, KT showed no significant effect on knee extension range of motion (MD: -0.23, 95% CI: -1.70, 1.25). No risk of publication bias observed. KT reduces pain, improves function, and enhances knee FROM in KOA patients even without physical therapy. However, its long-term effects remain uncertain. Future studies should evaluate the long-term application of KT and its integration with other KOA management strategies. Prospero ID CRD42024615432.

Exploring patients' experiences of self-management in rehabilitation following total knee arthroplasty: A qualitative study

Self-management during the rehabilitation of patients following total knee arthroplasty presents several challenges, with approximately 20% of patients failing to meet their recovery expectations due to inadequate self-management during the postoperative rehabilitation process. This study aimed to explore the experiences of patients with self-management during rehabilitation after total knee arthroplasty. Twenty-four participants who had undergone total knee arthroplasty in China participated in semi-structured interviews. Content analysis was used to analyze the interview data, revealing four themes: distress from postoperative complications, knowledge and guidance needs during the rehabilitation process, negative beliefs and attitudes, and fears and worries. The results indicated that participants' self-management during rehabilitation after surgery was hindered by postoperative complications. Additionally, the participants exhibited negative attitudes and experienced psychological issues related to self-management during rehabilitation. We recommend that future rehabilitation efforts for patients following total knee arthroplasty should emphasize enhanced guidance and supervision, while also addressing their psychological challenges.

Advances in cell therapy for orthopedic diseases: bridging immune modulation and regeneration

Orthopedic diseases pose significant challenges to public health due to their high prevalence, debilitating effects, and limited treatment options. Additionally, orthopedic tumors, such as osteosarcoma, chondrosarcoma, and Ewing sarcoma, further complicate the treatment landscape. Current therapies, including pharmacological treatments and joint replacement, address symptoms but fail to promote true tissue regeneration. Cell-based therapies, which have shown successful clinical results in cancers and other diseases, have emerged as a promising solution to repair damaged tissues and restore function in orthopedic diseases and tumors. This review discusses the advances and potential application of cell therapy for orthopedic diseases, with a particular focus on osteoarthritis, bone fractures, cartilage degeneration, and the treatment of orthopedic tumors. We explore the potential of mesenchymal stromal cells (MSCs), chondrocyte transplantation, engineered immune cells and induced pluripotent stem cells to enhance tissue regeneration by modulating the immune response and addressing inflammation. Ultimately, the integration of cutting-edge cell therapy, immune modulation, and molecular targeting strategies could revolutionize the treatment of orthopedic diseases and tumors, providing hope for patients seeking long-term solutions to debilitating conditions.

Effectiveness of Stromal Vascular Fraction (SVF) and Platelet-Rich Plasma (PRP) in Patients With Knee Osteoarthritis: Protocol for a Phase 3, Prospective, Randomized, Controlled, Multicenter Study (SPOST Study)

BACKGROUND

Available evidence on the conservative treatment of knee osteoarthritis still leaves questions about the efficacy of platelet-rich plasma (PRP) and whether stromal vascular fraction (SVF) offers a superior therapeutic tool.

OBJECTIVE

This study aims to assess the clinical efficacy of SVF as adjuvant therapy to PRP on functionality and tissue regeneration for knee osteoarthritis.

METHODS

In a multicenter, randomized, triple-blind, controlled trial, 108 individuals with knee osteoarthritis will be block-randomized in a 1:1 ratio. Patients will receive an initial single PRP or PRP + SVF injection followed by PRP doses at 1 month and 2 months. The primary endpoint is functional improvement measured with the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at the 6-month follow-up. Secondary endpoints, collected at the 1-month, 2-month, 3-month, 6-month, and 12-month follow-ups, will include the pain visual analogue scale during maximal physical activity, WOMAC score, length of time to return to work and sports in days, magnetic resonance imaging (MRI)-based Whole-Organ Magnetic Resonance Imaging Score (WORMS), Magnetic Resonance Observation of Cartilage Repair Tissue (MOCART) score, MRI Area Measurement and Depth and Underlying Structures (AMADEUS) score at 6 months and at 12 months, adverse events, and serious adverse events.

RESULTS

Participant recruitment and data collection are expected to begin in July 2025 and finish in July 2027. Final end points will be gathered in August 2027, and the results are expected to be published in late 2027.

CONCLUSIONS

The study results will provide insight into the clinical efficacy of SVF as adjuvant therapy to PRP on functionality and tissue regeneration in patients with knee osteoarthritis.

TRIAL REGISTRATION

ClinicalTrials.gov (NCT05660824); https://clinicaltrials.gov/study/NCT05660824.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/62659.

Physical modalities for the treatment of knee osteoarthritis: a network meta-analysis

OBJECTIVE

This network meta-analysis (NMA) aimed to compare the efficacy of various physical modalities in alleviating pain, stiffness, and functional impairment in patients with knee osteoarthritis (KOA).

METHODS

In accordance with PRISMA-P guidelines, we systematically searched nine databases(CNKI, VIP Database, Wanfang Database, SinoMed, PubMed, Embase, CINAHL, Web of Science, and the Cochrane Library) from inception to October 2024 to identify randomized controlled trials (RCTs) evaluating physical therapies for KOA. The interventions assessed included electrical stimulation therapy (EST), low-level light therapy (LLLT), thermotherapy (TT), cryotherapy (CT), and extracorporeal shock wave therapy (ESWT), with resistance and range of motion exercises (RRE) serving as comparators. Outcome measures comprised the Visual Analog Scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 6-minute walk test (6 MWT). Bayesian network meta-analyses and pairwise meta-analyses were performed using Stata 17.0 and R 4.4.1 software.

RESULTS

32 RCTs involving 2,078 participants were included. LLLT demonstrated the highest efficacy for pain reduction (VAS: MD=-3.32, 95% CI:-3.82 to-0.75; WOMAC pain: MD=-3.74, 95% CI:-6.68 to-0.72) and joint function improvement (SUCRA = 79.8). ESWT ranked second for pain relief (VAS: MD=-1.31, 95% CI:-2.42 to-0.16) and mobility enhancement (6 MWT: SUCRA = 71.5), while TT showed superior efficacy in reducing stiffness (WOMAC stiffness: MD=-2.09, 95%CI:-3.06 to-0.94; SUCRA = 98.1). In contrast, ultrasonic therapy (UT) did not provide significant benefits.

CONCLUSIONS

The findings suggest that LLLT and ESWT may be optimal for pain relief and functional improvement in patients with KOA, whereas TT appears to be the most effective in reducing stiffness. Optimal dosing parameters of these physical modalities are crucial for maximizing clinical benefits. Clinicians should individualize treatment strategies based on patient-specific factors. Future large-scale RCTs are warranted to validate these protocols and address the heterogeneity of existing evidence.

CLINICAL TRIAL NUMBER

Not applicable.

Evaluating Robotic-Assisted Total Knee Arthroplasty Compared to Conventional Methods: A Systematic Review of the Literature in the United States

BACKGROUND

Robotic-assisted total knee arthroplasty (rTKA) offers a new method of surgical management for advanced arthritis of the knee. The objective of this review was to evaluate the current literature evidence comparing rTKA to conventional methods (cTKA) across multiple outcome measures.

METHODS

PubMed was used to perform a review of articles that discussed outcomes of primary rTKA. Forty-four articles were selected.

RESULTS

rTKA improves surgical precision and accuracy compared with cTKA, potentially leading to better functional outcomes and fewer complications. rTKA has longer intraoperative times and higher initial costs but leads to shorter hospital stays, lower readmission rates, reduced long-term costs and less revisions. Patient-reported outcomes for rTKA indicate less postoperative pain, reduced opioid use, and improved function.

CONCLUSIONS

rTKA may provide improved outcomes compared with cTKA. More robust clinical evidence from US-based multicenter prospective propensity matched trials is needed to fully delineate the long-term benefits and limitations of rTKA.

Sodium hyaluronate and acupotomy bone decompression alleviates inflammatory responses in patients with knee osteoarthritis

OBJECTIVE

Knee osteoarthritis (KOA), predominantly affecting middle-aged and elderly populations, induces localized joint pain and functional impairment. It was to evaluate the effectiveness of acupotomy bone decompression (ABD) combined with sodium hyaluronate (SH) intra-articular injection on inflammatory responses in treating KOA.

METHODS

Clinical data from 128 patients with KOA were retrospectively collected, categorized into SH group (n = 55) and ABD + SH group (n = 73). Pain was assessed using the visual analogue scale (VAS), knee joint function was evaluated, and knee joint balance and gait parameters were measured. The status of articular cartilage and bone marrow edema was evaluated using quantitative magnetic resonance imaging (MRI). Interleukin (IL)-6, IL-1β, tumor necrosis factor (TNF)-α, matrix metalloproteinase (MMP)-3, MMP-9, and hypersensitive C-reactive protein (hs-CRP) were detected.

RESULTS

ABD + SH group showed drastic reductions in VAS scores, decreased indices of different axial balances, and increased stride length and walking speed versus the SH group (P < 0.05). Quantitative MRI examination revealed that relative to the SH group, ABD + SH group exhibited increased thickness of articular cartilage and reduced area of bone marrow edema post-treatment (P < 0.05). Post-treatment levels of hs-CRP, IL-6, IL-1β, TNF-α, MMP-3, and MMP-9 were markedly lower in the ABD + SH group versus SH group (P < 0.05). Moreover, the clinical effective rate in the ABD + SH group was drastically superior to the SH group (95.9% vs. 78.2%, P < 0.05).

CONCLUSION

Combining ABD with SH treatment for KOA effectively alleviates patient pain and inflammatory responses.

Comprehensive multiomics analysis identifies PYCARD as a key pyroptosis-related gene in osteoarthritis synovial macrophages

Background

Osteoarthritis (OA) is a chronic joint disease that significantly impairs quality of life. Synovitis plays a pivotal role in OA progression, and pyroptosis, a form of programmed cell death associated with innate immune inflammation, may contribute to the pathogenesis of OA synovitis. Nevertheless, the precise role of pyroptosis in OA pathogenesis remains poorly understood.

Methods

We performed an analysis of bulk RNA sequencing data to examine the expression profiles of pyroptosis-related genes in the OA synovium. A LASSO-Cox regression model was employed to identify pivotal genes. Single-cell RNA sequencing data were used to validate the expression of these genes in specific synovial cell clusters. Differentially expressed genes (DEGs) in macrophages with high or low expression levels of core genes were subjected to enrichment analysis. A protein-protein interaction (PPI) network was constructed to identify hub genes, and potential therapeutic compounds were predicted. Consensus clustering analysis was performed to examine the correlations between hub genes and disease status. After identifying PYCARD as the core pyroptosis gene in OA macrophages, we assessed the expression levels of PYCARD in the OA synovium and validated the expression of PYCARD and its related core genes in M1 macrophages.

Results

A total of twenty pyroptosis-related DEGs were identified, and six core genes were selected through LASSO regression. PYCARD was identified as the key pyroptosis gene in macrophages. Furthermore, 57 therapeutic compounds targeting these genes were predicted. Validation confirmed the upregulation of PYCARD in the OA synovium and M1 macrophages.

Conclusion

PYCARD was identified as the core pyroptosis gene in OA macrophages, and 57 potential therapeutic compounds were identified. This study offers valuable insights into potential treatment targets for OA.

Cathepsin K Inhibitors as Potential Drugs for the Treatment of Osteoarthritis

Links between cathepsin K and the pathophysiology of osteoarthritis (OA) can be established, not least because of the overabundance of cathepsin K in the serum of OA patients and the upregulation of cathepsin K in degraded cartilage in animal models of OA. Chondrocytes, chondroclasts, or osteoclasts contribute to the accumulated cathepsin K at the diseased osteochondral junction. After a general presentation of OA and cartilage physiology, as well as its degradation processes, we describe the function of cathepsin K and its effect on cartilage degradation via type II collagen cleavage. An overview of the most promising cathepsin K inhibitors is then presented, together with their in vitro effects. Although intensive research on cathepsin K inhibitors initially focused on bone resorption, there is growing interest in the potential of these drugs to prevent cartilage degradation. In this review, we summarize the pre-clinical and clinical trials that support the use of cathepsin K inhibitors in the treatment of OA. To date, no molecules of this type are commercially available, although a few have undergone clinical trials, but we believe that the development of cathepsin K inhibitors could broaden the therapeutic arsenal for the treatment of OA.

Impact of low-load blood flow restriction training on knee osteoarthritis pain and muscle strength: a systematic review and meta-analysis of randomized controlled trials

Objectives

The effectiveness of low-load blood flow restriction training (LL-BFRT) in alleviating symptoms in patients with knee osteoarthritis (KOA) remains inconclusive. This systematic review and meta-analysis aim to comprehensively assess the effects of LL-BFRT compared to conventional resistance training on pain, muscle strength, and functional capacity in individuals with KOA.

Data sources

PubMed, Embase, Web of Science, EBSCO, Scopus, and Cochrane trails were searched.

Study selection

We included randomized controlled trials involving patients with KOA, in which the intervention group underwent LL-BFRT.

Data extraction

Literature quality and risk of bias were assessed using the Physiotherapy Evidence Database (PEDro) scale and the Cochrane Risk-of-Bias Tool (ROB 2). Data were extracted using a predefined table, including outcomes such as pain, quadriceps muscle strength, 30-s sit-to-stand test (30STS) and Timed Up and Go test (TUG).

Result

Ten studies were included in the meta-analysis. The pooled results indicated that, compared to conventional resistance training, LL-BFRT significantly improved knee joint pain [SMD = 0.25, 95%CI (0.02, 0.48), P = 0.03], increased quadriceps muscle strength [SMD = 0.46, 95%CI (0.04, 0.88), P = 0.03], and enhanced performance on the 30s sit-to-stand test (30STS) [WMD = 1.71, 95%CI (0.30, 3.11), P = 0.02]. However, no significant difference was observed in the improvement of the Timed Up and Go test (TUG) [WMD = -0.13, 95%CI (-0.51, 0.24), P = 0.49]. Subgroup analysis revealed that interventions with an occlusion pressure >100 mmHg and a duration ≤6 weeks had a significant impact on pain relief, quadriceps muscle strength, and the 30STS performance. For patients with KOA aged >65 years, LL-BFRT was more effective in alleviating pain, while for patients aged ≤65 years, it demonstrated more significant improvements in quadriceps strength and 30STS performance.

Conclusion

Limited evidence suggests that LL-BFRT may be more effective than conventional resistance training in improving pain, quadriceps muscle strength, and 30STS performance in patients with KOA, while exhibiting a comparable effect on TUG test.

Systematic Review Registration

https://www.crd.york.ac.uk/prospero/#myprospero, identifier CRD42024603542.

Efficacy and safety of pregabalin for postoperative pain after total hip and knee arthroplasty: a systematic review and meta-analysis

INTRODUCTION

The prevalence of osteoarthritis and postoperative neuropathic pain after arthroplasty highlights the necessity for improved pain management. Many patients develop chronic neuropathic pain, necessitating targeted interventions. Research on pregabalin's effectiveness in pain relief has yielded conflicting findings, necessitating further exploration to determine its therapeutic value. This study sought to assess pregabalin's efficacy and safety in postoperative pain management, reconcile inconsistent literature, and enhance understanding of its clinical use.

METHODS

This study followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A systematic search was conducted across four major databases to select clinical trials. Statistical analysis was performed using Review Manager 5.4.1, applying fixed- or random-effects models depending on heterogeneity (I2). Subgroup analyses were conducted based on the type, timing, and dosage of pregabalin administered.

RESULTS

Pregabalin was associated with significantly reduced pain during movement at 24 h (MD -0.62, 95%CI -1.02 to -0.23), 48 h (MD -0.53, 95%CI -0.90 to -0.15), and 72 h (MD -0.59, 95%CI -1.05 to -0.12) post-surgery. Opioid consumption was also significantly lower at 24 h (SMD - 0.50, 95%CI -0.80 to -0.20), 48 h (SMD - 0.76, 95%CI -1.34 to -0.19), and 72 h (SMD - 1.33, 95%CI -2.16 to -0.49). While there were no significant improvements in the range of motion at 24 and 48 h, pregabalin was associated with significantly enhanced range of motion at 72 h (SMD 1.11, 95%CI 0.12, 2.09). Treatment with pregabalin was associated with a significant decrease in the odds of nausea (OR 0.30, 95%CI 0.09 to 0.99) and vomiting after total knee arthroplasty (TKA) (OR 0.17, 95%CI 0.04 to 0.65). Additionally, pregabalin exposure was associated with increased sedation after TKA (OR 2.27, 95%CI, 1.13 to 4.56) and total hip arthroplasty (THA) (OR 2.54, 95%CI 1.11 to 5.79), as well as blurred vision at 24 h in TKA/THA patients (OR 4.68, 95%CI 1.37 to 15.99; n = 95; I2 = 34). There was no significant association with other adverse events. The administration of pregabalin for more than 24 h before surgery was associated with maximal reductions in pain and opioid use at 72 h post-surgery.

CONCLUSION

Pregabalin was associated with significantly reduced postoperative pain and opioid use following total joint arthroplasty while enhancing mobility on the third day, with acceptable tolerability and safety.

Epigenetic mechanisms of Nsd1-mediated histone methylation modifications in chondrocyte ferroptosis in knee osteoarthritis

Knee osteoarthritis (KOA) is a degenerative joint disease characterized by pain, stiffness, and impaired mobility, with current therapies offering limited efficacy. This study investigates the epigenetic role of nuclear receptor-binding SET domain protein 1 (NSD1) in KOA pathogenesis. A KOA mouse model was established, and adenoviral vectors were employed to upregulate Nsd1 and inhibit SRY-box transcription factor 9 (Sox9), followed by histopathological assessments. We examined changes in cell morphology, proliferation, viability, and ferroptosis-related markers. The expression of NSD1, SOX9, and acyl-CoA synthetase long-chain family member 4 (ACSL4) was analyzed, along with the enrichment of NSD1 and dimethylated lysine 36 of histone 3 (H3K36me2) on the SOX9 promoter and SOX9 on the ACSL4 promoter. Additionally, the binding relationship between SOX9 and the ACSL4 promoter sequence was analyzed. Our results revealed that NSD1 expression was reduced in KOA mouse tissues and interleukin-1β-stimulated chondrocytes. NSD1 upregulation alleviated KOA, promoted chondrocyte proliferation and viability, and inhibited ferroptosis. Mechanistically, NSD1 enhanced H3K36me2 to upregulate SOX9 expression, which in turn suppressed ACSL4 expression and ferroptosis. SOX9 inhibition partially reversed the protective effect of NSD1 overexpression. In summary, NSD1 upregulation mitigates chondrocyte ferroptosis and ameliorates KOA by modulating H3K36me2 to upregulate SOX9 and downregulate ACSL4 expression.

Efficacy and mechanisms of curcumin in the treatment of osteoarthritis: A scoping review

Osteoarthritis (OA) is a degenerative joint disease that primarily affects the elderly worldwide. It is characterized by local inflammation, which can be targeted therapeutically using natural anti-inflammatory compounds such as curcumin. This scoping review explores the therapeutic effects and mechanisms of curcumin in OA management. A total of 50 relevant original studies published in English were selected from PubMed, Web of Science, and Scopus using specific search strings, regardless of study type. These studies demonstrated curcumin's anti-inflammatory, protective, and anti-apoptotic effects on chondrocytes. Curcumin has been shown to stimulate chondrocyte proliferation and collagen production while inhibiting matrix metalloproteinase activity. These mechanisms contribute to curcumin's ability to alleviate pain and improve joint function in OA patients. While the findings highlight curcumin's potential in OA management, further research is needed to enhance its bioavailability and determine optimal formulations, dosages, and administration routes.

The impact of blood flow restriction training combined with low-load resistance training on the risk of falls in patients with knee osteoarthritis in China: a single-centre, two-arm, single-blind, parallel randomised controlled trial protocol

INTRODUCTION

Patients with knee osteoarthritis are at a higher risk of falls compared to healthy individuals, thereby increasing the likelihood of accidental injury. Resistance training is an important strategy for managing knee osteoarthritis. Although some studies suggest that blood flow restriction training combined with low-load resistance training (LL-BFRT) is a beneficial treatment approach, its effect on fall risk and balance function in patients with knee osteoarthritis remains unclear. We aim to conduct a randomised controlled trial to assess the effectiveness of combined training in reducing fall risk and improving function in patients with knee osteoarthritis.

METHODS AND ANALYSIS

We will conduct a single-blind pilot randomised controlled trial involving patients with knee osteoarthritis. 98 patients will be randomly assigned to either the LL-BFRT group or the low-load resistance training (LL-RT) group, with a 1:1 allocation ratio. Both groups will undergo a 4-week intervention. Follow-up assessments will be conducted at baseline, 4 weeks, 16 weeks, 28 weeks and 52 weeks. The primary outcome will be the measurement of the fall risk stability index and overall stability index using the Biodex Balance System. Secondary outcomes include the Numerical Rating Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the 30 s Chair Stand Test, proprioception testing, the Timed Up and Go Test, the Short Form-36 scores, compliance and adverse events. Intention-to-treat principles will be applied in data analysis.

ETHICS AND DISSEMINATION

This study has been approved by the Ethics Review Committee of the First Hospital of Quanzhou Affiliated Fujian Medical University (2024-K161). The results of the study will be disseminated through peer-reviewed publications.

TRIAL REGISTRATION NUMBER

ChiCTR2400087829.

Evaluation of Functional Outcomes, Survivorship and Complications of Hypoallergenic Fixed-Bearing Medial and Lateral Unicompartmental Knee Arthroplasty: A Minimum 2-Year Follow-Up

Background: Unicompartmental knee arthroplasty (UKA) is a viable treatment option for patients with isolated knee osteoarthritis. This study evaluated the clinical outcomes of the JII UK (Smith & Nephew, Memphis, TN, USA) hypoallergenic, fixed-bearing UKA implant in a medium cohort of patients undergoing both medial and lateral procedures with a short-term follow-up. Methods: A retrospective review was conducted on 257 consecutive patients who underwent primary UKA using the JII UK implant between December 2020 and December 2022. Clinical outcomes were assessed using the Knee Society Score (KSS), Knee Society Function Score (KSFS), Oxford Knee Score (OKS), UCLA Activity Score, Forgotten Joint Score (FJS-12), and satisfaction. Survivorship analysis was performed, and complications were recorded. Results: At the 2-year follow-up, the implant survival rate was 99.61%. Statistical significant improvements were observed in all clinical scores, with high patient satisfaction. The mean UCLA Activity Score increased from 4.53 preoperatively to 7.3 at 24 months. Conclusions: This study demonstrates promising short-term clinical outcomes for the hypoallergenic fixed-bearing medial and lateral UKA implant, with high patient satisfaction and a low complication rate. Further studies with longer follow-up periods are warranted to confirm these findings.

Lower extremity joint kinematics in individuals with and without bilateral knee osteoarthritis during normal and narrow-base walking: A cross-sectional study

BACKGROUND

Knee osteoarthritis (KOA) is a prevalent musculoskeletal disease affecting joint mechanics. Considering the effect of step-width changes on the biomechanics of gait, especially the alteration of stability dynamics during narrow-base gait, this study investigated the kinematic parameters of the lower extremities during both normal and narrow-base walking in individuals with and without KOA.

METHODS

A cross-sectional study with 20 individuals with bilateral KOA and 20 controls was conducted. Participants walked on a treadmill at a preferred speed across normal and narrow paths. Joint angles and angular velocities in the sagittal and frontal planes were recorded, and mixed ANOVA was used to analyze group × condition effects.

RESULTS

Significant main effects of walking condition were observed for hip (p = 0.001) and ankle angles (p = 0.002) in the frontal plane, and knee (p = 0.004) and ankle angular velocities (p = 0.002) in the sagittal plane. Moreover, there were significant main effects of group on the hip (p = 0.01) and knee angles (p = 0.04) in the sagittal plane. KOA group showed higher peak hip adduction (p < 0.001) and ankle inversion (p = 0.02]) during narrow-base walking than on the normal path. People with KOA had also significantly higher peak angular velocity of knee flexion (p = 0.03), ankle dorsiflexion (p = 0.002), and ankle inversion (p = 0.03) during narrow-base walking.

CONCLUSIONS

The findings suggest that KOA and narrow-base gait challenges may trigger distinct kinematic adaptation strategies, potentially contributing to cartilage degeneration and altering balance mechanisms.

The short- and long-term effects of a fall prevention program on the frequency of falls following total knee replacement: A pragmatic single-blinded randomized controlled trial protocol

BACKGROUND

Falling following total knee replacement (TKR) is a significant issue, and can result in serious fatal and non-fatal injuries. The proposed study aims to investigate the short and long-term effects of integrating a falls prevention program into conventional physiotherapy versus just conventional physiotherapy on the number of falls, and any subsequent effects on balance, and functional ability among TKR patients.

METHODS AND DESIGN

This is a parallel group prospective (52 weeks) randomized single-blinded pragmatic controlled trial conducted at Alrazi Orthopedic Hospital, in Kuwait. Sample size will be 90 pariticpants (45 participants in each group). Particpants will be randomized to intervention or control group. Outcome measures will be collected at baseline, 12 weeks and 52 weeks by investigators who are blinded to treatment allocation. Primary outcome will be fall rate assessed at 52 weeks following the TKR surgery. Secondary outcomes will include knee range of motion, severity of pain, 10-m walk test, Timed Up and Go test, Berg Balance Scale, 30-s sit to stand, patient adherence to home program and patient's satisfaction. Two-way multivariate ANOVA (group × time) will be performed to assess the group (experimental and control group) differences over time (baseline, 12, and 52 weeks).

DISCUSSION

Investigating the physiotherapy programs that could minimize or prevent the risk of falling among TKR patients seems important. The proposed study will be the first step toward determining the exercise program that could be effective in reducing the number of falls among TKR patients.

TRIAL REGISTRATION

ClinicalTrials.gov, Identifier NCT05642260.

miR-378a-3p Regulates the BMP2-Smad Pathway to Promote Chondrogenic Differentiation of Synovium-Derived Mesenchymal Stem Cells

This study aims to elucidate the role of miR-378a-3p in facilitating the proliferation and differentiation of synovium-derived mesenchymal stem cells (SMSCs) into chondrocytes. The effects of overexpressing miR-378a-3p on SMSCs were investigated through histological analysis, quantitative PCR, and western blotting. Then we identified binding sites of miR-378a-3p with BMP2 through Gene Ontology and Kyoto Encyclopedia of Genes and Genomes analyses and predictions from the RegRNA 2.0 database. Subsequently, BMP2 was confirmed as the target by which miR-378a-3p promotes the chondrogenic differentiation of SMSCs using a luciferase reporter gene assay and an miR-378a-3p RNA interference plasmid. Finally, by constructing a rat model with articular cartilage damage, we detected the reparative effects of miR-378a-3p overexpression on cartilage damage. Additionally, we verified the mechanism by which miR-378a-3p promotes chondrogenic differentiation in SMSCs. MiR-378a-3p enhances the proliferation and differentiation of SMSCs into chondrocytes by modulating the BMP2-Smad signaling pathway, thereby facilitating repair processes for articular cartilage injuries in rats. Notably, knockdown of BMP2 diminished the reparative efficacy of miR-378a-3p on articular cartilage damage. Upregulation of miR-378a-3p promotes chondrogenic differentiation in SMSCs through activation of the BMP2-Smad pathway, positioning it as a potential therapeutic target for osteoarthritis.

Mechanism of action and new developments in the study of curcumin in the treatment of osteoarthritis: a narrative review

Osteoarthritis is a degenerative joint disease that affects the aging population worldwide. It has an underlying inflammatory cause that leads to loss of chondrocytes, reducing the cartilage layer at the affected joints. Compounds with anti-inflammatory properties are potential therapeutic agents for osteoarthritis. Curcumin, derived from species of the Curcuma, is an anti-inflammatory compound. The purpose of this review is to summarize the anti-osteoarthritic effects of curcumin from clinical and preclinical studies. Many clinical trials have been conducted to determine curcumin's effectiveness in osteoarthritis patients. Available studies have shown that curcumin prevents chondrocyte apoptosis and inhibits the release of proteoglycans and metalloproteinases as well as the expression of cyclooxygenase, prostaglandin E-2, and inflammatory cytokines in chondrocytes. The mechanism of action of curcumin also involves multiple cell signaling pathways, including Nuclear factor kappa-B(NF-κB), Mitogen-activated protein kinase (MAPK), Wnt/β-catenin pathway (Wnt/β-catenin), The Janus kinase 2/signal transducer and activator of transcription 3 (JAK2/STAT3), Nuclear factor erythroid 2-related factor 2/antioxidant response elements/heme oxygenase-1(Nrf2/ARE/HO-1), and Phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT)/mammalian target of rapamycin (PI3K/AKT/mTOR) signaling pathways. Curcumin further reduced the release of inflammatory factors and apoptosis by inhibiting the activation of NF-κB. In addition, curcumin modulates the MAPK, Nrf2/ARE/HO-1, and PI3K/Akt/mTOR signaling pathways and affects cell proliferation and apoptosis processes, a series of effects that together promote the healthy state of chondrocytes. In conclusion, curcumin, as a natural plant compound, exhibits significant anti-inflammatory potential by modulating inflammatory factors associated with articular osteoarthritis through multiple mechanisms. Its protective effects on articular cartilage and synovium make it a promising candidate for the treatment of OA. Future studies should further explore the mechanism of action of curcumin and its optimal dosage and therapeutic regimen in clinical applications, to provide more effective therapeutic options for osteoarthritis patients.

Identify the potential target of efferocytosis in knee osteoarthritis synovial tissue: a bioinformatics and machine learning-based study

Introduction

Knee osteoarthritis (KOA) is a degenerative joint disease characterized by the progressive deterioration of cartilage and synovial inflammation. A critical mechanism in the pathogenesis of KOA is impaired efferocytosis in synovial tissue. The present study aimed to identify and validate key efferocytosis-related genes (EFRGs) in KOA synovial tissue by using comprehensive bioinformatics and machine learning approaches.

Methods

We integrated three datasets (GSE55235, GSE55457, and GSE12021) from the Gene Expression Omnibus database to screen differentially expressed genes (DEGs) associated with efferocytosis and performed weighted gene co-expression network analysis. Subsequently, we utilized univariate logistic regression analysis, least absolute shrinkage and selection operator regression, support vector machine, and random forest algorithms to further refine these genes. The results were then inputted into multivariate logistic regression analysis to construct a diagnostic nomogram. Public datasets and quantitative real-time PCR experiments were employed for validation. Additionally, immune infiltration analysis was conducted with CIBERSORT using the combined datasets.

Results

Analysis of the intersection between DEGs and EFRGs identified 12 KOA-related efferocytosis DEGs. Further refinement through machine learning algorithms and multivariate logistic regression revealed UCP2, CX3CR1, and CEBPB as hub genes. Immune infiltration analysis demonstrated significant correlations between immune cell components and the expression levels of these hub genes. Validation using independent datasets and experimental approaches confirmed the robustness of these findings.

Conclusions

This study successfully identified three hub genes (UCP2, CX3CR1, and CEBPB) with significant expression alterations in KOA, demonstrating high diagnostic potential and close associations with impaired efferocytosis. These targets may modulate synovial efferocytosis-related immune processes, offering novel therapeutic avenues for KOA intervention.

Pathogen Distribution, Drug Resistance, and Postoperative High-Quality Nursing Intervention Effectiveness in Knee Osteoarthritis Patients After Knee Arthroplasty With Postoperative Infection

Objective

To analyze the distribution and drug resistance of pathogens in patients with postoperative infection following knee arthroplasty (TKA) for knee osteoarthritis (KOA) and to explore the effectiveness of high-quality nursing interventions postoperatively.

Methods

A retrospective analysis was conducted on clinical data from 87 KOA patients who underwent TKA and developed postoperative wound infections (infection group) at the first Affiliated Hospital of Harbin Medical University from July 2022 to September 2024. Another 87 patients without postoperative infection during the same period were selected as the control group. Deep wound exudate samples were collected from the infection group for pathogen culture, isolation, and identification. Drug susceptibility testing was performed using the K-B disk diffusion method. Additionally, venous blood samples were collected from both the infection and control groups one week after surgery, and serum levels of inflammatory markers [interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), procalcitonin (PCT)] were measured using enzyme-linked immunosorbent assay (ELISA). According to the type of nursing interventions received, the infection group was divided into the conventional care group (n=43, receiving standard orthopedic perioperative care) and the high-quality care group (n=44, receiving comprehensive high-quality care based on routine care). The pain levels [Visual Analog Scale (VAS) scores], knee joint function [Hospital for Special Surgery (HSS) knee scores], activities of daily living (modified Barthel index), and patient satisfaction [Newcastle Satisfaction with Nursing Service (NSNS) scale] were compared between the two groups.

Results

Among the 87 KOA patients with postoperative infection after TKA, 83 patients had a single pathogen infection, and 4 patients had mixed infections with two pathogens, resulting in the cultivation and isolation of 91 pathogens. Of these, 63 (69.23%) were Gram-positive bacteria, primarily Staphylococcus aureus (29.67%) and Staphylococcus epidermidis (17.58%). There were 25 (27.47%) Gram-negative bacteria, primarily Escherichia coli (9.89%) and Pseudomonas aeruginosa (6.59%). Three (3.30%) fungal strains were isolated, all identified as Candida albicans. Gram-positive bacteria showed high resistance to penicillin, benzylpenicillin, ampicillin, erythromycin, clindamycin, ciprofloxacin, and gentamicin, but low resistance to gatifloxacin, and no resistance to vancomycin or teicoplanin. Gram-negative bacteria showed high resistance to ciprofloxacin, levofloxacin, gentamicin, and tobramycin, but low resistance to cefepime, imipenem, meropenem, gatifloxacin, and amikacin. The infection group had significantly higher serum levels of IL-6, TNF-α, and PCT compared to the control group (P<0.05). The VAS scores at 24 hours, 3 days, and 7 days postoperatively were significantly lower in the high-quality care group compared to the conventional care group (P<0.05). The HSS scores and modified Barthel index scores at 3 months postoperatively were higher than preoperative values in both groups, with a greater improvement observed in the high-quality care group (P<0.05). The satisfaction rate in the high-quality care group (93.18%) was significantly higher than in the conventional care group (74.42%) (P<0.05).

Conclusion

The primary pathogens causing postoperative wound infections in KOA patients after TKA are Gram-positive bacteria, with Staphylococcus aureus and Staphylococcus epidermidis being predominant. Serum levels of inflammatory markers are significantly higher in infection patients compared to non-infection patients. High-quality nursing interventions can effectively alleviate postoperative pain, promote recovery of knee joint function, enhance activities of daily living, and improve patient satisfaction.

Periosteal Electrical Dry Needling Efficacy in Knee Osteoarthritis: A Systematic Review

PURPOSE OF REVIEW

Osteoarthritis is a "wear and tear" injury characterized by degeneration of articular cartilage, formation of osteophytes, microfractures, and sclerosis. These physiological changes result in joint pain, stiffness, and deformity. One potential treatment for this is periosteal electrical dry needling.

RECENT FINDINGS

We performed a systematic search for studies in PubMed, Google Scholar, Embase, and Cochrane. Sources published from 2014 to the present were eligible for inclusion in the review. After an initial search, 48 studies were identified, 22 of which were duplicates that were subsequently removed. The remaining 26 were filtered by title and abstract, resulting in six studies approved for final analysis. Of the six, four found significant improvement in pain and mobility after dry needling was administered as either an adjuvant or stand-alone therapy. Electrical Dry Needling is a promising treatment for Knee Osteoarthritis. More large-scale randomized control trials are needed to evaluate its efficacy as a stand-alone treatment more fully. This review demonstrates some support for dry needling in alleviating knee pain and immobility. Future studies are needed to examine the long-term effects of dry needling and its comparative efficacy to standard treatment.

Pyroptosis: candidate key targets for mesenchymal stem cell-derived exosomes for the treatment of bone-related diseases

Bone-related diseases impact a large portion of the global population and, due to their high disability rates and limited treatment options, pose significant medical and economic challenges. Mesenchymal stem cells (MSCs) can differentiate into multiple cell types and offer strong regenerative potential, making them promising for treating various diseases. However, issues with the immune response and cell survival limit the effectiveness of cell transplantation. This has led to increased interest in cell-free stem cell therapy, particularly the use of exosomes, which is the most studied form of this approach. Exosomes are extracellular vesicles that contain proteins, lipids, and nucleic acids and play a key role in cell communication and material exchange. Pyroptosis, a form of cell death involved in innate immunity, is also associated with many diseases. Studies have shown that MSC-derived exosomes have therapeutic potential for treating a range of conditions by regulating inflammation and pyroptosis. This study explored the role of MSC-derived exosomes in modulating pyroptosis to improve the treatment of bone-related diseases.

Efficacy and safety of mesenchymal stromal cell transplantation in the treatment of autoimmune and rheumatic immune diseases: a systematic review and meta-analysis of randomized controlled trials

OBJECTIVE

This study aims to assess the effectiveness and safety of mesenchymal stem cell (MSC) transplantation in the treatment of autoimmune and rheumatic immune diseases through randomized controlled trials (RCTs).

METHODS

Two researchers conducted a comprehensive search of Chinese and English databases from their inception until Dec. 2023. The literature screening and data extraction were then performed. Statistical analysis was carried out using RevMan 5.4 software.

RESULTS

A total of 42 relevant RCTs, involving 2,183 participants, were ultimately included in this study. These RCTs encompassed four types of rheumatic immune and bone diseases, namely rheumatoid arthritis (RA), osteoarthritis (OA), spondyloarthritis, systemic sclerosis arthritis, systemic lupus erythematosus (SLE), inflammatory bowel disease, multiple sclerosis, primary Sjögren's syndrome (PSS). The systematic review indicates that MSC transplantation may improve spondyloarthritis, RA, PSS. The meta-analysis reveals that MSC transplantation significantly improved symptoms in patients with OA [VAS (visual analogue scale): bone marrow: SMD = - 0.95, 95% CI - 1.55 to - 0.36, P = 0.002; umbilical cord: SMD = - 1.25, 95% CI - 2.04 to - 0.46, P = 0.002; adipose tissue: SMD = -1.26, 95% CI -1.99 to - 0.52, P = 0.0009)], SLE [Systemic lupus erythematosus disease activity index (SLEDAI): SMD = - 2.32, 95% CI - 3.59 to - 1.06, P = 0.0003], inflammatory bowel disease [clinical efficacy: RR = 2.02, 95% CI 1.53 to 2.67, P < 0.00001]. However, MSC transplantation may not improve the symptoms of multiple sclerosis and systemic sclerosis (Ssc). Importantly, MSC transplantation did not increase the incidence of adverse events (OA: RR = 1.23, 95% CI 0.93 to 1.65, P = 0.15; SLE: RR = 0.83, 95% CI 0.28 to 2.51, P = 0.76; Inflammatory bowel disease: RR = 0.99, 95% CI 0.81 to 1.22, P = 0.96; Multiple sclerosis: RR = 1.12, 95% CI 0.81 to 1.53, P = 0.50), supporting its safety profile across the included studies. These findings suggest that MSC transplantation holds promise for several rheumatic and autoimmune diseases while highlighting areas where further research is warranted.

CONCLUSION

MSC transplantation may have the potential to treat autoimmune and rheumatic immune diseases. Moreover. MSC transplantation appears to be relatively safe and could be considered as a viable alternative treatment option for autoimmune and rheumatic immune diseases.

B Cell Activation, Differentiation, and Their Potential Molecular Mechanisms in Osteoarthritic Synovial Tissue

Objective

The objective of this study was to characterize the activation and differentiation of B cells in the synovium of osteoarthritis (OA) and to explore the underlying molecular mechanisms.

Methods

Peripheral blood and synovial samples from OA patients at different stages were collected, and flow cytometry was employed to analyze the activation and differentiation of B cells. Immunofluorescence staining of joint synovium from OA mice at different stages was conducted to assess mice joint synovium B cell activation and differentiation. Co-culture experiments of synovial fibroblasts with B cells were performed to investigate the influence of synovial cells on B cell activation and differentiation. Finally, transcriptome analysis was utilized to identify potential key molecules and pathways.

Results

In OA patients, the infiltration, activation, and differentiation of B cells in synovium and peripheral blood exhibited distinct characteristics. Specifically, the proportion of activated CD86+ B cells and the differentiation marker HLA-DR+ increased with disease severity, whereas the proportion of the differentiation marker IgM decreased. The proportion of CD38+ B cells also decreased with increasing severity, although this change lacked statistical significance. Immunofluorescence staining of CD19+ and CD86+ cells in mice indicated increased expression with greater OA severity. Co-culture experiments demonstrated that OA synovial fibroblasts promoted B cell activation and differentiation, as evidenced by higher expression levels of CD86+ and HLA-DR+ in the OA group compared to controls. Additionally, the proportion of naive B cells decreased as disease severity progressed.

Conclusion

Synovial fibroblasts in OA have been shown to promote the differentiation and activation of B cells, indicating that B cells play a significant role in the pathogenesis of synovium inflammation in OA.

Coixol-Loaded Hydrogels Promote Osteochondral Defect Repair via Modulation of Ferroptosis and Autophagy in Chondrocytes

Osteoarthritis (OA) is a chronic multifactorial disease characterized by cartilage degeneration, pain, and reduced mobility. Current therapies primarily aim to relieve pain and restore function, but they often have limited effectiveness and side effects. Coixol, a bioactive compound from Coix lacryma-jobi L., exhibits anti-inflammatory and analgesic properties, suggesting potential benefits in OA treatment. This study explored the effects of coixol on OA chondrocytes. Primary chondrocytes from OA rats were isolated and treated with varying concentrations of coixol. Cell viability and proliferation were assessed by using CCK-8 assays. The expression of genes related to ferroptosis and autophagy was analyzed through RT-qPCR, Western blot, and immunofluorescence. Moreover, the study investigated the characteristics and performance of coixol-loaded PDLLA-PEG-PDLLA (PLEL)/gelatin sponge (GS) hydrogels (Coixol@PLEL/GS) for enhancing osteochondral defect repair by specifically targeting chondrocyte ferroptosis and autophagy. The characteristics of coixol-loaded PDLLA-PEG-PDLLA/gelatin sponge (Coixol@PLEL/GS) hydrogels were evaluated using cryo-scanning electron microscopy (SEM) or SEM, and coixol release kinetics were determined. In vivo, a rat osteochondral defect model was used to assess the efficacy of Coixol@PLEL/GS in osteochondral defect repair using International Cartilage Repair Society (ICRS) scores, Safranin O/Fast green staining, Toluidine blue staining, and immunofluorescence. Coixol significantly increased the viability and proliferation of OA chondrocytes in a dose-dependent manner. Furthermore, coixol inhibited ferroptosis and stimulated autophagy, as evidenced by the upregulation of related genes. In vivo, Coixol@PLEL/GS remarkably enhanced the repair of osteochondral defects compared to that of control groups. In conclusion, coixol protects OA chondrocytes by improving survival, inhibiting ferroptosis, and activating autophagy, highlighting its potential as a therapeutic strategy for OA treatment.

Regulation of fibroblast phenotype in osteoarthritis using CDKN1A-loaded copper sulfide nanoparticles delivered by mesenchymal stem cells

This study aimed to investigate the regulation of fibroblast phenotypes by mesenchymal stem cells (MSCs) delivering copper sulfide (CuS) nanoparticles (NPs) loaded with CDKN1A plasmids and their role in cartilage repair during osteoarthritis (OA). Single-cell RNA sequencing data from the GEO database were analyzed to identify subpopulations within the OA immune microenvironment. Quality control, filtering, principal component analysis (PCA) dimensionality reduction, and tSNE clustering were performed to obtain detailed cell subtypes. Pseudotime analysis was used to understand the developmental trajectory of fibroblasts, and GO/KEGG enrichment analyses highlighted biological processes related to fibroblast function. Transcriptomic data and WGCNA identified CDKN1A as a key regulatory gene. A biomimetic CuS@CDKN1A nanosystem was constructed and loaded into MSCs to create MSCs@CuS@CDKN1A. The characterization of this system confirmed its efficient cellular uptake by fibroblasts. In vitro experiments demonstrated that MSCs@CuS@CDKN1A significantly modulated fibroblast phenotypes and improved the structure, proliferation, reduced apoptosis, and enhanced migration of IL-1β-stimulated chondrocytes. In vivo, an OA mouse model was treated with intra-articular injections of MSCs@CuS@CDKN1A. Micro-CT scans revealed a significant reduction in osteophyte formation and improved joint space compared with control groups. Histological analysis, including H&E, Safranin O-Fast Green, and toluidine blue staining, confirmed improved cartilage integrity, whereas the International Osteoarthritis Research Society (OARSI) scoring indicated reduced disease severity. Immunofluorescence showed upregulated CDKN1A expression, decreased MMP13, and reduced α-SMA expression in fibroblast subtypes. Major organs exhibited no signs of toxicity, confirming the biocompatibility and safety of the treatment. These findings suggest that MSCs@CuS@CDKN1A can effectively regulate fibroblast activity and promote cartilage repair, providing a promising therapeutic strategy for OA treatment.NEW & NOTEWORTHY This study introduces MSCs@CuS@CDKN1A, a nanoengineered MSC platform that targets fibroblast phenotypes in osteoarthritis (OA). By modulating CDKN1A expression, this innovative approach not only enhances cartilage repair but also effectively mitigates fibroblast-driven inflammation, marking a significant advancement in OA therapeutics with demonstrated efficacy and biocompatibility.

Influence of an aquatic resistance progressive exercise and low-level laser therapy on musculoskeletal atrophy: an experimental model of knee osteoarthritis

The aim of this study was to evaluate the effectiveness of an aquatic progressive resistance exercise (APRE) and PBM (associated or not) on morphology of skeletal muscle and biochemical markers using an experimental model of knee osteoarthritis (OA). Fifty male Wistar rats were randomly distributed into 5 groups: control group (CG); OA control (OAC); OA submitted to APRE (OAE); OA submitted to PBM (OAL); OA submitted to APRE and PBM (OAEL). Trained rats performed a water-jumping program carrying a load equivalent to 50-80% of their body mass strapped to their chest. Laser irradiation (808 nm) was performed on 2 points of the knee joint. Treatments (3 days a week, for 8 weeks) started 4 weeks after the OA induction. The results showed that all OA groups presented a significantly increase in the muscle cross-section area (CSA) and a decrease in muscle fiber density compared to CG. Moreover, both trained groups presented a reduced expression of atrogin and an intense myoD immunoexpression in the laser exercised animals. The results demonstrate that APRE was effective in reducing muscle atrophy markers and its association with PBM could be effective in modulating molecules involved in muscle recovery in knee OA.

Posteromedial opening wedge high tibial osteotomy has favourable outcomes in simultaneous medial meniscus posterior root repair and varus medial knee osteoarthritis patients without concomitant root tear

PURPOSE

To evaluate the radiological and clinical outcomes in two patient groups: first, varus aligned medial meniscus posterior root tear (MMPRT) patients who underwent posteromedial open wedge high tibial osteotomy (PMOWHTO) and simultaneous root repair; second, patients with varus medial knee osteoarthritis without MMPRT who underwent PMOWHTO.

METHODS

Patients had MMPRT repair concomitant with PMOWHTO and varus medial knee osteoarthritis without concomitant root tear patients who underwent PMOWHTO and were reviewed. Radiographic parameters, medial meniscus extrusion (MME) and Knee Society Scores [KSSs, including the following subscores: knee score (KS) and knee function score (KFS)] were evaluated. Continious variables are expressed as the median and interquartile range (IQR) [IQR: (Q1;Q3); Q1: median of lower half, Q3: median of upper half]. The minimum follow-up period was 24 months [29 (28;35) months].

RESULTS

A total of 36 knees of 34 patients underwent PMOWHTO were included. Patients were divided into two groups according to the presence or absence of a MMPRT. Nineteen of the 36 knees had MMPRTs, and all of them had concomitant root repair (Group 1). Seventeen of the 36 patients did not have MMPRTs (Group 2). The posterior tibial slope (PTS) decreased postoperatively in a total of 36 knees (p < 0.001). There were no significant changes in MME postoperatively in any intragroup comparison. The preoperative and follow-up MMEs of Group 1 were greater than those of Group 2 (p < 0.001). The KSs and KFSs in both Group 1 and Group 2 increased during follow-up [KS; Group 1: 43 (36;53) vs. 86 (84;95), p < 0.001. Group 2: 49 (45;57) vs. 89 (80;93), p < 0.001. KFS; Group 1: 60 (50;60) vs. 90 (80;100), p < 0.001. Group 2: 60 (50;60) vs. 80 (80;90), p < 0.001]. All knees achieved minimal clinically important difference (MCID) in terms of KSs. Eighteen (95%) knees achieved MCID in Group 1, and 17 (100%) achieved MCID in Group 2 in terms of KFSs. There were no differences between Groups 1 and 2 in terms of preoperative and follow-up KSs or preoperative KFSs. The follow-up KFSs in Group 1 was significantly greater than that in Group 2 (p = 0.032).

CONCLUSIONS

PMOWHTO has favourable clinical and radiological outcomes and prevents PTS increase in simultaneous MMPRT repair and varus medial knee osteoarthritis patients without concomitant root tear.

LEVEL OF EVIDENCE

Level IV, case series.

The Efficacy and Brain Network Mechanism of Acupuncture for Knee Osteoarthritis: A Study Protocol for Randomized Controlled Neuroimaging Trial

Purpose

Knee osteoarthritis (KOA) is a prevalent degenerative bone and joint disease observed in clinical practice. While acupuncture has demonstrated efficacy in treating KOA, the central mechanisms underlying its effects remain ambiguous. Recently, functional magnetic resonance imaging (fMRI) has been extensively applied in studying the brain mechanisms of acupuncture analgesia. Currently, network analysis based on brain connectomics is a focal point in acupuncture imaging research. Therefore, this study uses KOA as the research vehicle, focuses on the abnormal connectivity patterns of brain functional networks, and integrates clinical pain assessments to thoroughly investigate the central mechanisms of acupuncture therapeutic effects on KOA.

Patients and Methods

In this parallel, randomized, sham-controlled neuroimaging trial, 60 KOA patients will be randomly divided into the acupuncture group and sham acupuncture group in a 1:1 ratio, treated three times weekly for a total of 12 sessions. Patients will undergo clinical symptom assessments and cranial fMRI scans at baseline (-1-0 weeks), post-treatment (4 weeks), and at the follow-up (16 weeks). Forty healthy subjects will be recruited for observation, with a single MRI scan conducted only at baseline (-1-0 week). The primary efficacy indicator will be the change in NRS score after four weeks of treatment, with secondary outcomes including WOMAC, STAI, and safety assessments. fMRI observations will employ independent component analysis, brain network construction, and functional connectivity, complemented by Pearson correlation analysis to explore the relationship between brain responses and clinical improvements.

Conclusion

This study will initially uncover how acupuncture intervention for chronic KOA pain centrally regulates and exerts therapeutic effects through the modulation of abnormal brain network functional connectivity patterns, with a demonstrated long-term effect.

Ethics and Dissemination

This study has been approved by the ethics committee of Shandong University of Traditional Chinese Medicine Affiliated Hospital ((2024) Lunshen No. (028) - KY).

Clinical Trial Registration

This study has been approved by registered in the Chinese Clinical Trial Registry (ChiCTR2400083695).

Long-Term Efficacy of Carboxymethyl-Chitosan in Advanced Knee Osteoarthritis: A Twelve-Month Follow-Up Study on Non-Responders to Hyaluronic Acid

Background: Knee osteoarthritis (OA) is a prevalent degenerative joint disease characterized by the degeneration of joint cartilage. Knee OA leads to pain, stiffness, swelling, and decreased mobility, significantly impacting the quality of life of affected people. Advanced-stage osteoarthritis often necessitates surgical intervention due to poor response to conventional treatments, such as intra-articular hyaluronic acid (HA). Carboxymethyl-chitosan (CM-C), an emerging therapeutic agent, has shown potential in reducing inflammation, improving lubrication, and enhancing joint function. This study aimed to evaluate the long-term efficacy of CM-C injections in patients with advanced knee osteoarthritis, non-responders to HA. Methods: This retrospective study included 16 patients (mean age: 79.56 years) with Kellgren-Lawrence grade 3-4 knee OA treated with a single intra-articular injection of CM-C. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) at baseline (T0), one month (T1), three months (T2), six months (T3), and twelve months (T4). Results: Significant pain reduction was observed at early follow up, (VAS: T1 p = 0.0002, T2 p = 0.0265; KOOS Pain: T1 p = 0.0014). However, pain partially returned by T3 and T4. KOOS activities of daily living (p = 0.0005), QoL (p = 0.0396), and Sport and Free Time (p = 0.0367) subscales showed significant improvement at T1, though worsening trends were observed in subsequent follow up with raw values suggesting persistent benefits. Strong negative correlations were found between VAS and KOOS subscales at various follow ups. Conclusions: A single CM-C injection demonstrated early pain relief and functional improvement in advanced knee OA for non-responders to HA. However, the long-term effects may diminish over time, necessitating a careful consideration of re-treatment strategies or combined therapies.

A meta-analysis and systematic review of the clinical efficacy and safety of platelet-rich plasma combined with hyaluronic acid (PRP + HA) versus PRP monotherapy for knee osteoarthritis (KOA)

INTRODUCTION

KOA, a chronic degenerative joint disease, is commonly treated with intra-articular HA and PRP, used alone or in combination. However, the efficacy and safety of combination therapy (PRP + HA) remain unclear.

AIM

The aim of this systematic review and meta-analysis is to assess the clinical effectiveness and safety profile of PRP + HA versus PRP monotherapy for KOA.

MATERIAL AND METHODS

A systematic search was conducted using four electronic databases (PubMed, EMBASE, Scopus, and Cochrane Library) to select publications published in peer-reviewed journals. The mean difference (MD) and risk ratio (RR) was calculated, along with their 95% confidence intervals. We assessed heterogeneity using Cochrane Q and I2statistics and the appropriate p-value. The analysis used RevMan 5.4. GRADE system was used for evidence assessment for each outcome parameter.

RESULTS

This meta-analysis of 11 RCTs (n = 1023 KOA patients) revealed that PRP + HA has substantial effectiveness than PRP alone in reducing OMAC total scores [MD -1.77 (95% CI -2.20 to - 1.34); I2 = 10%, and p < 0.001], VAS scores [MD -4.27 (95% CI -4.96 to - 3.58); I2 = 13%, and p < 0.001], and Lequesne index score [MD -5.48 (95% CI -6.56 to - 4.40); I2 = 16%, and p < 0.001], while increasing IKDC scores [MD -2.10 (95% CI -3.70 to - 0.50); I2 = 9%, and p = 0.01], with low risk of adverse events [RR 0.41 (95% CI 0.35 to 0.48); I2 = 12%, and p < 0.001].

CONCLUSION

This meta-analysis reveals that, for patients with KOA, PRP + HA therapy is safe and yields better outcomes in pain relief and functional improvement compared to PRP monotherapy.

Duhuo Jisheng Decoction in reduction of inflammatory response via Transforming growth factor-β/Smad signaling pathway for repairing rabbit articular cartilage Injury: A Randomized Controlled Trial

OBJECTIVE

This study aims to investigate the mechanism underlying the effect of Duhuo Jisheng Decoction on the repair of rabbit articular cartilage injury through a reduction in the inflammatory response mediated by the Transforming growth factor (TGF)-β/Smad signaling pathway.

METHODS

A rabbit articular cartilage injury model was constructed using a ring bone extraction drill. Twenty-four Japanese white rabbits were randomly divided into six groups, namely Sham operation, model, low-dose Duhuo Jisheng Decoction, medium-dose Duhuo Jisheng Decoction, high-dose Duhuo Jisheng Decoction, and positive control groups. The treatment lasted 12 weeks. Gross observation, International Cartilage Repair Society score, Wakitani score, and Micro-computed tomography analysis were used to evaluate the structural repair of cartilage injury. Histology and immunohistochemistry were used to observe the proteoglycan, P-TβRII, P-Smad2, and type II collagen expression levels. Enzyme-linked immunosorbent assay was used to analyze the concentrations of Matrix Metalloproteinase-13 and Syndecan-4 in the joint fluid; and RT-PCR and Western Blot were used to observe the mRNA and protein expressions of ALK5, Sox-9, P-Smad3, and TGF-β1 at the injury repair site.

RESULTS

The repair effect of cartilage injury, as seen through gross observation and quantitative scoring, was better in all the Duhuo Jisheng Decoction treatment groups than in the model group. The medium dose group of Duhuo Jisheng Decoction had the best repair effect. We observed remarkable structural restoration of cartilage injury in the medium-dose Duhuo Jisheng Decoction group, with the subchondral bone presenting a distinct hierarchy, and parameters such as bone volume fraction and trabecular separation/spacing being significantly augmented. We found high expression levels of proteoglycans, P-TβRII, P-Smad2, and type II collagen. The concentrations of Matrix Metalloproteinase-13 and Syndecan-4 in the joint fluid were significantly lower following treatment. The low gene expression levels of ALK5, Sox-9, P-Smad3, and TGF-β1 in the injury site of the model group could be reversed in the medium-dose Duhuo Jisheng Decoction group.

CONCLUSION

Duhuo Jisheng Decoction can repair rabbit cartilage injury and reverse the levels of inflammatory factors in the joint fluid. The mechanism underlying its therapeutic effect is related to the activation of the TGF-β/Smad signaling pathway. This study provides a reliable basis for using Duhuo Jisheng Decoction to treat cartilage injury following knee osteoarthritis.

A Mediation Appraisal of Neuropathic-like Symptoms, Pain Catastrophizing, and Central Sensitization-Related Signs in Adults with Knee Osteoarthritis-A Cross-Sectional Study

Objective. To investigate the relationships among neuropathic pain (NP), pain catastrophizing (PC), and central sensitization (CS) in relation to functional status and radiological damage in patients with knee osteoarthritis (OA). Methods. This cross-sectional study included knee OA patients derived from an observational cohort. The Spearman correlation test was used to analyze the relationship between the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and the PainDetect Questionnaire (PDQ), Central Sensitization Inventory (CSI), and Pain Catastrophizing Scale (PCS). The Kruskal-Wallis test was employed to compare WOMAC scores according to CSI categories. A multivariate analysis was conducted to identify predictors of functional ability, with the WOMAC score as the dependent variable and the independent variables including pain-related indices such as PCS, PDQ, and CSI, along with Kellgren-Lawrence (K-L) grading and demographic characteristics. Results. This study included 149 patients (76.5% female; mean age 71.5 years; mean duration of pain 8.1 years). In total, 23.5% exhibited NP, 30.9% showed PC, and 33.6% had CS. Higher mean values of WOMAC were correlated with CSI categories (p < 0.0001). WOMAC showed a significant relationship with CSI (rho = 0.791; p < 0.0001), PDQ (rho = 0.766; p < 0.0001), and PCS (rho = 0.536; p < 0.0001). In the multiple regression analysis, WOMAC was independently associated with CSI (p < 0.0001), PDQ (p < 0.0001), and PC (p = 0.0001). No association was observed between the K-L grading and the other variables. Conclusions. A reduced functional capacity in patients with knee OA is correlated with the presence of NP, PC and CS, without being significantly associated with radiological damage.

Voices from the clinic: a qualitative analysis of physiotherapy strategies in musculoskeletal care for knee osteoarthritis patients

BACKGROUND

Physiotherapy has emerged as an important health strategy to deliver lifestyle, exercise and physical activity for people with knee osteoarthritis. However, little is known about the extent to which physiotherapists adhere to clinical practice guidelines. This study aimed to explore the perspectives and care patterns of physiotherapists in Sydney, Australia on their delivery of knee osteoarthritis care and how this aligns with the 2019 Osteoarthritis Research Society International (OARSI) guidelines.

METHODS

We invited thirty-three physiotherapists from nine private practices in metropolitan Sydney to partake in a semi-structured interview. The interviews were digitally recorded and transcribed verbatim. The data collected were analysed deductively using content analysis, comparing guidelines to current care patterns, while their perspectives were inductively analysed through thematic analysis.

RESULTS

Thirty physiotherapists participated (age range 22-63 years, 17 male and 13 female). Interview responses indicated that most physiotherapists were satisfied with their care of knee osteoarthritis patients. Most physiotherapists delivered "core" guideline-based care of education and land-based exercise. Recommendations of modalities of exercise, including hydrotherapy and manual therapy, were discussed and were perceived to be beneficial despite not being "core" clinical guideline recommendations. Current treatment strategies focussed on disease severity, symptom presentation and/or patient exercise history with little emphasis on education about osteoarthritis pathophysiology and drug-based pain relief. The thematic analysis identified two over-arching themes; (1) capacity to deliver and awareness of evidence-based care and (2) perceived recommendations for future physiotherapy management. Participants identified notable areas of potential service improvement including developing stronger and more effective reimbursement models, increased consult times and improved patient access.

CONCLUSION

The study provided unique insights towards physiotherapists' current usual knee osteoarthritis care and their perceived barriers to delivering guideline-based care. Thus, informing a need for future studies to focus on developing specific and detailed guidelines if physiotherapists are to align more closely to the core guideline-based recommendations.

TRIAL REGISTRATION

This study was part of a larger study, with the full protocol published and registered at ClinicalTrials (ACTRN12620000188932, ACTRN12620000218998) 19/02/2020).

Manual Tibial Distraction in Seated Position for Identification of Intra-articular Knee Joint Lesions: A Case Report Presenting a Novel Clinical Special Test

The meniscus is a weight-bearing, intra-articular, fibrocartilaginous structure that is frequently injured. Traditional special tests for diagnosis of intra-articular lesions of the knee involve provocative tests with compressive or torsional components, often leading to increased pain. With this case study, we aim to introduce the Tibial Distraction Test (TDT), a novel clinical special test for the assessment of intra-articular knee joint lesions, including meniscus injury and osteoarthritis (OA), without provoking pain. A 30-year-old man presented to the clinic with right knee pain and swelling of two months duration following a forceful extension and internal rotation motion which led to a catch then audible pop and discomfort. The patient's initial assessment included McMurray's test, joint line palpation, and Apley's compression tests with positive results for each test. A second examiner, blinded to the initial examination, assessed the patient using the proposed TDT. The patient reported pain relief, indicating a positive result. Subsequent magnetic resonance imaging (MRI) confirmed the diagnosis of a medial meniscus tear. Arthroscopy showed a full-thickness meniscal tear and debridement was performed. At one month's follow-up, the patient returned to baseline function with resolution of symptoms. Diagnosing intra-articular lesions of the knee requires a thorough history and examination, frequently including painful provocative clinical special tests in a patient already presenting with pain as a primary complaint. Our case presents a novel manual clinical special test in a seated position which appears to be a pain-relieving test that may be used to assess for intra-articular knee joint lesions.

Milk fat globule-epidermal growth factor 8 exerts anti-osteoarthritis effects by inhibiting apoptosis and inducing autophagy in mouse chondrocytes

Osteoarthritis (OA) is a chronic degenerative joint disease, characterized by cartilage injury. Milk fat globule-epidermal growth factor 8 (MFG-E8) exhibited anti-inflammatory effects, with undefined mechanism in OA. Eighteen C57BL/6 J mice were randomized into Sham and destabilization of medial meniscus (DMM) groups, with DMM surgery for OA model establishment. Subsequently, DMM mice received rmMFG-E8 (50 ng/g) as rmMFG-E8 group (n = 6). HE staining and Safranin O/Fast green staining for cartilage tissue pathological damage, TUNEL staining for apoptosis, ELISA for pro-inflammatory factors, and immunohistochemistry were performed. Following extraction of primary mouse chondrocytes, cells were randomized into Control, OA (10 ng/mL IL-1β), OA + rmMFG-E8 (500 ng/mL), and OA + rmMFG-E8+3-MA (autophagy inhibitor, 5 mM) groups. Cell viability by CCK8, pro-inflammatory factors by qRT-PCR, and apoptosis by flow cytometry were detected. In vivo and in vitro, transmission electron microscopy for autophagy and Western blot for autophagy- and apoptosis-related expression were conducted. In vivo, DMM group showed severe cartilage tissue damage, higher matrix metalloproteinase 13 (MMP13), Cleaved caspase-3, Cleaved PARP, Bax, TNF-α, IL-1β, IL-6 levels, and lower Bcl-2, MFG-E8, Collagen II, LC3II/LC3I, Beclin1, and ATG5 expression. Further rmMFG-E8 intervention improved mobility and pathological damage in DMM mice, with lower MMP13 expression. In vitro, rmMFG-E8 in OA group reduced TNF-α, IL-1β, IL-6, Cleaved caspase-3, Cleaved PARP, Bax, and P62 levels, and enhanced cell viability, Bcl-2, LC3II/LC3I, Beclin1, and ATG5 expression. Further 3-MA treatment up-regulated apoptosis and decreased cell viability and autophagy. Therefore, MFG-E8 exerts anti-OA effects by inhibiting apoptosis and inducing autophagy, offering a new potential target for OA treatment.

Guilu Erxian glue reduces endoplasmic reticulum stress-mediated apoptosis and restores the balance of extracellular matrix synthesis and degradation in chondrocytes by inhibiting the ATF6/GRP78/CHOP signaling pathway

Knee Osteoarthritis (KOA) is characterized by phenotypic alterations, apoptosis, and the breakdown of the extracellular matrix (ECM) in the superficial articular cartilage cells. The inflammatory response activates the Endoplasmic Reticulum Stress (ERS) signaling pathway, which plays a critical role in the pathophysiology and progression of KOA. Chondrocytes stimulated by thapsigargin(TG)exhibit heightened ERS and significantly increase the expression of ERS-associated proteins. Key mediators of ERS-induced apoptosis include X-box-binding protein 1(XBP1), elevated levels of the protein transport protein Sec61 subunit (SEC61), and C/EBP homologous protein (CHOP). While the precise mechanism of action of Guilu Erxian Glue (GEG), a medication commonly used in the clinical treatment of KOA, remains to be fully elucidated, our research has shown that GEG mitigates the imbalance between ECM synthesis and degradation, as well as chondrocyte apoptosis resulting from ERS. This effect is likely achieved through the suppression of the Activating Transcription Factor 6 (ATF6)/Glucose-Regulatory Protein 78 (GRP78)/CHOP signaling pathway. In summary,our research results indicate that GEG can activate the ATF6/GRP78/CHOP signaling pathway to restore endoplasmic reticulum (ER) homeostasis in chondrocytes, thereby reducing chondrocyte apoptosis and ultimately promoting the balance between ECM synthesis and degradation.

Mapping two decades of research in rheumatology-specific journals: a topic modeling analysis with BERTopic

Background

Rheumatology has experienced notable changes in the last decades. New drugs, including biologic agents and Janus kinase (JAK) inhibitors, have blossomed. Concepts such as window of opportunity, arthralgia suspicious for progression, or difficult-to-treat rheumatoid arthritis (RA) have appeared; and new management approaches and strategies such as treat-to-target have become popular. Statistical learning methods, gene therapy, telemedicine, or precision medicine are other advancements that have gained relevance in the field. To better characterize the research landscape and advances in rheumatology, automatic and efficient approaches based on natural language processing (NLP) should be used.

Objectives

The objective of this study is to use topic modeling (TM) techniques to uncover key topics and trends in rheumatology research conducted in the last 23 years.

Design

Retrospective study.

Methods

This study analyzed 96,004 abstracts published between 2000 and December 31, 2023, drawn from 34 specialized rheumatology journals obtained from PubMed. BERTopic, a novel TM approach that considers semantic relationships among words and their context, was used to uncover topics. Up to 30 different models were trained. Based on the number of topics, outliers, and topic coherence score, two of them were finally selected, and the topics were manually labeled by two rheumatologists. Word clouds and hierarchical clustering visualizations were computed. Finally, hot and cold trends were identified using linear regression models.

Results

Abstracts were classified into 45 and 47 topics. The most frequent topics were RA, systemic lupus erythematosus, and osteoarthritis. Expected topics such as COVID-19 or JAK inhibitors were identified after conducting dynamic TM. Topics such as spinal surgery or bone fractures have gained relevance in recent years; however, antiphospholipid syndrome or septic arthritis have lost momentum.

Conclusion

Our study utilized advanced NLP techniques to analyze the rheumatology research landscape and identify key themes and emerging trends. The results highlight the dynamic and varied nature of rheumatology research, illustrating how interest in certain topics has shifted over time.

Application characteristics and clinical effectiveness of clinical finding staging in guiding non-surgical treatment of knee osteoarthritis involving 92 medical institutions

BACKGROUND

Accumulating evidence suggests that the radiographic phenotypes of patients with knee osteoarthritis (KOA) often do not correlate with their clinical findings, which are the primary reason for seeking medical care. Therefore, at OARSI 2024, we proposed a clinical finding staging system-Chinese medicine staging (CMS)-to guide the treatment of KOA. However, the clinical effectiveness and application characteristics of CMS in guiding non-surgical treatment of KOA remain unclear.

METHODS

A total of 14,985 KOA patients were included in the study. Data from 13,983 patients were used to analyze the characteristics of CMS application, while 1465 patients were used to evaluate CMS-guided clinical effectiveness, and 152 patients were included in a comparative analysis of clinical effectiveness without CMS guidance. The demographic characteristics of the CMS-using population were examined, and the correlation between CMS and treatment modalities was analyzed to clarify CMS application characteristics. VAS and WOMAC scores were compared between the CMS-guided and non-CMS-guided groups both before treatment and at week 8 of treatment, using the minimal clinically significant difference as the benchmark.

RESULTS

In application characteristics, regarding nonsurgical treatments, an increase in the CMS led to a decrease in basic treatment and an increase in nonpharmacological and pharmacological treatments (P < 0.001). Regarding surgical treatments, no change in the proportion of surgical interventions was observed with worsening CMS (P > 0.05). In clinical effectiveness, at week 8 of treatment, VAS scores and WOMAC scores were significantly lower in CMS-guided group (VSA: 3.51; 95% CI, 3.42-3.60, Pain: 3.55; 95% CI, 3.40-3.70, Stiffness: 1.18; 95% CI, 1.11-1.25, Function: 12.57; 95% CI, 12.07-13.08, Total: 17.31; 95% CI, 16.63-17.99), which had a higher net difference than non-CMS-guided group (VSA: 3.30; 95% CI, 3.05-3.54, Pain: 3.14; 95% CI, 2.68-3.60, Stiffness: 0.95; 95% CI, 0.76-1.15, Function: 11.36; 95% CI, 9.80-12.91, Total: 15.45; 95% CI, 13.40-17.49). The net differences in CMS-guided group were all higher than in MCID.

CONCLUSION

CMS is consistent with the patient's clinical finding, is suitable for guiding non-surgical treatment of KOA and can achieve clinically significant therapeutic effects.

Effect of warm needle therapy guided by ultrasound on pain relief and improvement of physical function in patients with knee osteoarthritis

BACKGROUND

Conventional treatments for knee osteoarthritis (KOA) often fall short in providing optimal outcomes.

OBJECTIVE

To evaluate the effect of warm needle therapy guided by ultrasound on pain relief and physical function in patients with KOA.

METHODS

In this retrospective study, the clinical records of patients with KOA undergoing either meloxicam alone or meloxicam combined with warm needle therapy were reviewed. Various parameters, including pain evaluations, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, range of motion for knee flexion, knee society scores, quality of life scores, inflammatory factor levels, and patient satisfaction were comparatively analyzed.

RESULTS

A total of 140 patients were included, including 68 patients treated by Meloxicam and 72 patients treated by Meloxicam and warm needle therapy. Following treatment, the meloxicam combined with warm needle therapy group exhibited lower pain scores (3.62±1.98 vs. 4.38±1.95, P=0.023), improved WOMAC scores (27.82±8.75 vs. 31.25±8.82, P=0.022), increased range of motion (136.82°±8.58° vs. 133.43°±8.86°, P=0.023), higher knee society scores (93.32±7.21 vs. 90.21±7.78, P=0.016), and superior Short Form-36 Health Survey (SF-36) scores (81.24±6.33 vs. 78.43±6.85, P=0.013). Furthermore, a significant reduction in inflammatory factors including interleukin-8 (IL-8), matrix metalloproteinase-3 (MMP-3), Interleukin-1 beta (IL-1β), Tumor Necrosis Factor-alpha (TNF-α), and cyclooxygenase-2 (COX-2) levels was observed in the meloxicam combined with warm needle therapy group compared to the meloxicam alone group (all P<0.05). Patient satisfaction was likewise notably higher in the meloxicam combined with warm needle therapy group (8.43±2.15 vs. 7.58±2.24, P=0.024), with a greater proportion of patients willing to recommend the treatment (81.94% vs. 64.71%, P=0.034).

CONCLUSION

Warm needle therapy guided by ultrasound, in combination with meloxicam, significantly improves pain relief, physical function, inflammatory modulation, and patient satisfaction in KOA patients.

One-day surgery is safe and effective in unicompartmental knee arthroplasty: A prospective comparative study at 1 year of follow-up

PURPOSE

To compare the outcomes and complications of two perioperative protocols for the management of patients who underwent medial unicompartmental knee arthroplasty (UKA): 24 h (1-day surgery [OS]) versus 72 h (enhanced recovery after surgery [ERAS]) of the length of hospital stay (LOS). In our hypothesis, the reduction of the LOS from 3 to 1 day did not influence the outcomes and complications.

METHODS

A total of 42 patients (21 in each group) with isolated anteromedial knee osteoarthritis and meeting specific criteria were prospectively included in the study. Clinical outcomes included Knee Society Score (KSS) and Forgotten joint score while pain evaluation was performed using a Visual Analogue Scale (VAS). Functional outcomes were assessed measuring the knee range of motion (ROM) while radiographic outcomes were evaluated measuring the amelioration of the varus deformity through the hip-knee-ankle angle (HKA).

RESULTS

Clinical and functional outcomes did not significantly differ between the two groups. Complications occurred in 9.5% of OS and 4.7% of ERAS group patients. Significant improvements in knee ROM, VAS pain, KSS and HKA angle were observed postsurgery, with no significant differences between groups except in KSS expectations and function trends.

CONCLUSION

The OS protocol is safe and effective and LOS, in a well-defined fast-track protocol, did not significantly impact clinical and functional outcomes. OS may lead to reduced hospitalisation costs and potential reductions in complications associated with prolonged stays, benefiting both patients and healthcare facilities. However, further research with larger sample sizes and longer follow-up periods is needed to confirm these findings. Early mobilisation and rehabilitation protocols are key components of successful patient recovery following UKA procedures.

LEVEL OF EVIDENCE

Level II.

The role of mechanosensitive ion channel Piezo1 in knee osteoarthritis inflammation

Mechanosensitive ion channel Piezo1 is known to mediate a variety of inflammatory pathways and is also involved in the occurrence and development of many orthopedic diseases. Although its role in the inflammatory mechanism of knee osteoarthritis (KOA) has been reported, a systematic explanation is yet to be seen. This article aims to summarize the role of inflammatory responses in the pathogenesis of KOA and elucidate the mechanism by which the Piezo1-mediated inflammatory response contributes to the pathogenesis of KOA, providing a theoretical basis for the prevention and treatment of knee osteoarthritis. The results indicate that in the mechanism leading to knee osteoarthritis, Piezo1 can mediate the inflammatory response through chondrocytes and synovial cells, participating in the pathological progression of KOA. Piezo1 has the potential to become a new target for the prevention and treatment of this disease. Additionally, as pain is one of the most severe manifestations in KOA patients, the inflammatory response mediated by Piezo1, which causes the release of inflammatory mediators and pro-inflammatory factors leading to pain, can be further explored.

Vinpocetine protects against osteoarthritis by inhibiting ferroptosis and extracellular matrix degradation via activation of the Nrf2/GPX4 pathway

BACKGROUND

Osteoarthritis (OA) is a progressive joint condition marked by the slow degradation of articular cartilage. Vinpocetine (Vin), a synthetic derivative of vincamine derived from the vinca plant, exhibits anti-inflammatory and antioxidant properties. Nevertheless, the specific role and mechanism of Vin in the treatment of OA remain largely unexplored.

OBJECTIVES

The study is designed to uncover the impacts of Vin on tert‑butyl hydroperoxide (TBHP)-induced ferroptosis and to explore its potential role and underlying mechanisms in the treatment of OA. Concurrently, we established an OA mouse model through medial meniscal instability surgery to assess the therapeutic effects of Vin in vivo.

METHODS

Through network pharmacology analysis, we have identified the key targets and potential pathways of Vin. To simulate an oxidative stress-induced OA environment in vitro, we induced chondrocyte injury using TBHP. We tested how Vin affects chondrocytes under TBHP induction by DHE and DCFH-DA probes, BODIPY-C11 and FerroOrange staining, mitochondrial function assessment, Western blotting, co-immunoprecipitation, and immunofluorescence techniques. Simultaneously, we established an OA mouse model through medial meniscal instability surgery to assess the in vivo therapeutic effects of Vin. In this model, we used X-ray and micro-CT imaging, SO staining, TB staining, H&E staining, and immunohistochemistry to analyze the role of Vin in detail.

RESULTS

This study demonstrated that Vin effectively suppressed TBHP-induced ferroptosis and extracellular matrix (ECM) degradation and significantly lessened mitochondrial damage associated with ferroptosis. In the OA mouse model, Vin improved cartilage degeneration, subchondral remodeling, synovitis, and ECM degradation. Vin worked by activating the Nrf2/GPX4 pathway and inhibiting the Keap1-Nrf2 interaction. This study focused on the function of ferroptosis in OA and its influence on chondrocyte damage and disease progression, offering novel perspectives on potential treatments.

CONCLUSION

Vin activated the Nrf2/GPX4 pathway, thereby slowing OA progression, inhibiting ferroptosis, and preventing ECM degradation.