The preventive and therapeutic role of physical activity in knee osteoarthritis

Association of life's simple 7 with osteoarthritis risk: a cross-sectional study from NHANES 2009-2018

Background

The Life's Simple 7 (LS7) metric is a comprehensive index evaluating cardiovascular health from a holistic perspective, integrating seven cardiovascular-related health factors and behaviors. However, the relationship between LS7 and the likelihood of developing osteoarthritis (OA) remains unclear. Therefore, this study investigated the possible association between LS7 and OA.

Methods

Using data from the National Health and Nutrition Examination Survey from 2009 to 2018, 19,603 participants were included in this study. LS7 was treated as the independent variable, whereas OA served as the dependent variable. The association between LS7 and OA was assessed by performing a weighted logistic regression analysis. To evaluate the stability of the findings, subgroup analyses were conducted. Additionally, restricted cubic spline (RCS) analysis was conducted to explore potential nonlinear relationships between LS7 and OA.

Results

LS7 scores were significantly negatively correlated with OA risk (OR: 0.808, 95% CI: 0.786-0.830). Analysis of LS7 categories indicated that individuals with ideal scores had a 55.9% lower OA risk than those with poor scores (OR: 0.559, 95% CI: 0.379-0.823). Subgroup analysis demonstrated that factors such as age, gender, marital status, BMI, and blood pressure moderated the relationship between LS7 and OA in inconsistent ways. The RCS analysis revealed a significant nonlinear negative association between LS7 scores and OA risk (p-nonlinear < 0.001).

Conclusion

This study suggests a nonlinear negative correlation between LS7 and OA risk, implying that better cardiovascular health may be linked to a reduced risk of developing OA. However, the relationship varies across different subgroups.

Association between sedentary behavior, physical activity, and osteoarthritis: results from NHANES 2007-2020 and Mendelian randomization analysis

Introduction

Osteoarthritis (OA) is a prevalent and debilitating disorder that affects the joints and has a complex array of causes. While sedentary behavior (SB) and physical activity (PA) have been implicated in OA risk, the relationship between these factors and OA development remains unclear. This study investigates the correlation and potential causality between SB, PA, and OA using both cross-sectional and Mendelian randomization (MR) analysis.

Methods

We conducted a two-phase study that included a cross-sectional analysis using data from the National Health and Nutrition Examination Survey (NHANES) and a MR analysis. A weighted analysis was performed on data from the NHANES to explore the relationship between SB, PA, and the risk of OA. Logistic regression was used to assess the association between SB, PA, and OA, adjusting for potential confounders. Non-parametric curve fitting was applied to examine the dose-response relationship between PA levels and OA onset. Additionally, MR was utilized to infer the genetic causality between SB, PA, and OA risk, using genetic instruments as proxies for SB and PA.

Results

The final analysis, which included 24,738 participants, revealed that OA prevalence was 13.47%, with individuals diagnosed with OA exhibiting significantly higher levels of SB and lower levels of PA. A U-shaped relationship was observed between PA and OA risk, with a decrease in OA incidence as PA levels increased, although the protective effect of PA was less pronounced in individuals with severe SB. MR analysis indicated that genetically inferred SB was associated with a higher likelihood of OA (IVW OR 1.20, 95% CI 1.13-1.28), while increased PA was inversely associated with OA risk (IVW OR 0.85, 95% CI 0.73-0.98).

Conclusion

This research emphasizes the significance of SB and PA as modifiable factors influencing the risk of OA. It is recommended that individuals at risk of OA should aim to participate in regular physical activity and minimize sedentary behavior to lower their risk of developing the disease. The MR analysis results support the potential causal impact of SB and PA on OA, providing valuable information for the development of therapeutic and rehabilitative strategies.

Predictors of Satisfaction in Patients with Knee Osteoarthritis Treated with a Single Injection of Mannitol-Modified Crosslinked Hyaluronate Derivative

Background/Objectives: There is a gap between the very positive opinion of patients and doctors regarding knee viscosupplementation (VS) and the contrasting results of controlled studies. The objective of this study was to evaluate the overall satisfaction and predictors of satisfaction with VS in patients with knee osteoarthritis treated with VS. Methods: Post-hoc analysis of a cross-sectional study in patients with knee OA treated with one injection of a mannitol-modified cross-linked HA (HANOX-M-XL). The primary outcome was satisfaction, self-assessed semi-quantitatively by the patients. Demographics, radiological features, comorbidities, OA and comorbidities treatments, and lifestyle associated with satisfaction were studied in bivariate and multivariate analysis. Results: 89 patients (124 knees) were analyzed. A total of 88.7% were satisfied with the treatment. Satisfaction was correlated with duration of effectiveness (DoE) and negatively correlated with BMI. Satisfaction was higher in active versus sedentary patients, in tibiofemoral involvement, in Kellgren-Lawrence grade 1-3 versus 4, and in subjects not requiring intraarticular corticosteroid (IACS) concomitantly to VS. Satisfied subjects were older than dissatisfied ones. In multivariate analysis, older age, K-L grade < 4, absence of IACS, and longer DoE were associated with higher rates of satisfaction. Conclusions: We identified several predictive factors of patient satisfaction after VS of the knee. Alongside these objective factors, there are probably subjective factors linked to patient beliefs, fears, and expectations impacting satisfaction.

A Review of Current Approaches to Pain Management in Knee Osteoarthritis with a Focus on Italian Clinical Landscape

The global cases of knee osteoarthritis (KOA) are projected to increase by 74.9% by 2050. Currently, over half of patients remain dissatisfied with their pain relief. This review addresses unmet needs for moderate-to-severe KOA pain; it offers evidence and insights for improved management. Italian experts from the fields of rheumatology, physical medicine and rehabilitation, orthopedics, primary care, and pain therapy have identified several key issues. They emphasized the need for standardized care protocols to address inconsistencies in patient management across different specialties. Early diagnosis is crucial, as cartilage responds better to early protective and structural therapies. Faster access to physiatrist evaluation and reimbursement for physical, rehabilitative, and pharmacological treatments, including intra-articular (IA) therapy, could reduce access disparities. Concerns surround the adverse effects of oral pharmacological treatments, highlighting the need for safer alternatives. Patient satisfaction with corticosteroids and hyaluronic acid-based IA therapies reduces over time and there is no consensus on the optimal IA therapy protocol. Surgery should be reserved for severe symptoms and radiographic KOA evidence, as chronic pain post-surgery poses significant societal and economic burdens. The experts advocate for a multidisciplinary approach, promoting interaction and collaboration between specialists and general practitioners, to enhance KOA care and treatment consistency in Italy.

A Cross-Sectional Study of Factors Predicting the Duration of the Efficacy of Viscosupplementation in Knee Osteoarthritis

Background: An advanced radiological stage and obesity are predictive of poorer and shorter responses to viscosupplementation in patients with knee osteoarthritis (OA). Very little is known regarding the impact of other factors such as sport practice, comorbidities, or anatomical features of OA. Methods: This study aimed to investigate patients' and OA characteristics associated with the duration of the effectiveness (DE) of viscosupplementation in patients with knee OA. It was a cross-sectional, single-centre clinical trial in patients with knee OA treated with intra-articular (IA) hyaluronic acid (HA) injection(s) within the previous 3 years. The investigators collected data regarding demographic and radiographic features (Kellgren-Lawrence grade and involved knee compartments), dosing regimen (single or repeat injections), the presence and volume of joint effusion, previous or concomitant IA corticosteroid injection, the number of previous viscosupplementations, and comorbidities. Patients completed a questionnaire including the self-assessment of DE (the number of weeks during which viscosupplementation was effective on symptoms), the activity level (sedentary, active, or athletic), and the level of sport activity (light, moderate, or intensive). Predictors of the DE were studied in bivariate and multivariate analyses. Results: In total, 105 patients (149 knees) were analysed (62% women, mean age 66.1 ± 13.2 years, mean BMI 27.5 ± 7.5 kg/m2). The mean DE was 48.2 ± 24.8 weeks. In bivariate analysis, the predictors of a shorter DE were BMI > 27.5 kg/m2, more than three previous viscosupplementations, Kellgren-Lawrence grade 4, sedentary patients, and multicompartmental involvement. In the multivariate analysis, four independent factors remained associated with a shorter DE: BMI > 27.5 kg/m2, multicompartmental knee involvement, number of viscosupplementations >3, and sedentary lifestyle. A statistically significant association between a longer DE and arterial hypertension was found, suggesting a beneficial effect of certain antihypertensive medications. Conclusions: This study confirms that being overweight significantly reduces the duration of the effectiveness of viscosupplementation. It also shows that viscosupplementation is more lastingly effective in unicompartmental OA and among active or athletic patients. The duration of effectiveness decreases when the treatment is repeated more than three times.