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Lee S, Neogi T, Mcginley B, Wang N, Frey-Law L, Torabian KA, Aoyagi K, Stefanik JJ, Carlesso LC, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Associations of Pain Sensitivity and Conditioned Pain Modulation with Physical Activity: Findings from the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2024:S1063-4584(24)01195-6. [PMID: 38763431 DOI: 10.1016/j.joca.2024.04.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/21/2024]
Abstract
OBJECTIVE Individuals with chronic pain due to knee osteoarthritis (OA) are insufficiently physically active, and alterations of facilitatory and inhibitory nociceptive signaling are common in this population. Our objective was to examine the association of these alterations in nociceptive signaling with objective accelerometer-based measures of physical activity in a large observational cohort. DESIGN We used data from the Multicenter Osteoarthritis Study (MOST). Measures of peripheral and central pain sensitivity included pressure pain threshold (PPT) at the knee and mechanical temporal summation (TS) at the wrist, respectively. The presence of descending pain inhibition was assessed by conditioned pain modulation (CPM). Physical activity was quantitatively assessed over 7-days using a lower back-worn activity monitor. Summary metrics included steps/day, activity intensity, and sedentary time. Linear regression analyses were used to evaluate the association of pain sensitivity and the presence of descending pain inhibition with physical activity measures. RESULTS Data from 1,873 participants was analyzed (55.9% female, age = 62.8±10.0 years). People having greater peripheral and central sensitivity showed lower step counts. CPM was not significantly related to any of the physical activity measures, and none of the exposures were significantly related to sedentary time. CONCLUSIONS In this cohort, greater peripheral and central sensitivity were associated with reduced levels of objectively-assessed daily step counts. Further research may investigate ways to modify or treat heightened pain sensitivity as a means to increase physical activity in older adults with knee OA.
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Affiliation(s)
- Soyoung Lee
- Department of Physical Therapy, Boston University.
| | - Tuhina Neogi
- Division of Rheumatology, Boston University School of Medicine.
| | | | - Na Wang
- School of Public Health, Boston University.
| | - Laura Frey-Law
- Physical Therapy & Rehabilitation Science, University of Iowa.
| | | | - Kosaku Aoyagi
- Division of Rheumatology, Boston University School of Medicine.
| | - Joshua J Stefanik
- Division of Rheumatology, Boston University School of Medicine; Department of Physical Therapy, Northeastern University.
| | | | - Jeffrey M Hausdorff
- Tel Aviv Sourasky Medical Center; Tel Aviv Sourasky Medical Center, Israel; Rush University Medical Center, Chicago.
| | | | - Neil A Segal
- Department of Rehabilitation Medicine, University of Kansas.
| | - Cora E Lewis
- Department of Epidemiology, University of Alabama at Birmingham.
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco.
| | - Deepak Kumar
- Department of Physical Therapy, Boston University; Division of Rheumatology, Boston University School of Medicine.
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2
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Segal NA, Nilges JM, Oo WM. Sex differences in osteoarthritis prevalence, pain perception, physical function and therapeutics. Osteoarthritis Cartilage 2024:S1063-4584(24)01150-6. [PMID: 38588890 DOI: 10.1016/j.joca.2024.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 03/19/2024] [Accepted: 04/02/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE Women have a higher prevalence of osteoarthritis (OA) and worse clinical courses than men. However, the underlying factors and therapeutic outcomes of these sex-specific differences are incompletely researched. This review examines the current state of knowledge regarding sex differences in OA prevalence, risk factors, pain severity, functional outcomes, and use and response to therapeutics. METHODS PubMed database was used with the title keyword combinations "{gender OR sex} AND osteoarthritis" plus additional manual search of the included papers for pertinent references, yielding 212 references. Additional references were added and 343 that were reviewed for appropriateness. RESULTS Globally, women account for 60% of people with osteoarthritis with a greater difference after age 40. The higher risk for women may be due to differences in joint anatomy, alignment, muscle strength, hormonal influences, obesity, and/or genetics. At the same radiographic severity, women have greater pain severity than men, which may be explained by biologically distinct pain pathways, differential activation of central pain pathways, differences in pain sensitivity, perception, reporting, and coping strategies. Women have greater limitations of physical function and performance than men independent of BMI, OA severity, injury history, amount of weekly exercise. Women also have greater use of analgesic medications than men but less use of arthroplasty and poorer prognosis after surgical interventions. CONCLUSIONS The recognition of sex differences in OA manifestations and management could guide tailoring of sex-specific treatment protocols, and analysis of sex as a biological variable in future research would enhance development of precision medicine.
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Affiliation(s)
- Neil A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | | | - Win Min Oo
- The University of Sydney, Sydney, Australia; University of Medicine, Mandalay, Mandalay, Myanmar.
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Bacon KL, Felson DT, Jafarzadeh SR, Kolachalama VB, Hausdorff JM, Gazit E, Stefanik JJ, Corrigan P, Segal NA, Lewis CE, Nevitt MC, Kumar D. Gait Alterations and Association With Worsening Knee Pain and Physical Function: A Machine Learning Approach With Wearable Sensors in the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2024. [PMID: 38523250 DOI: 10.1002/acr.25327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/23/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The objective of this study was to identify gait alterations related to worsening knee pain and worsening physical function, using machine learning approaches applied to wearable sensor-derived data from a large observational cohort. METHODS Participants in the Multicenter Osteoarthritis Study (MOST) completed a 20-m walk test wearing inertial sensors on their lower back and ankles. Parameters describing spatiotemporal features of gait were extracted from these data. We used an ensemble machine learning technique ("super learning") to optimally discriminate between those with and without worsening physical function and, separately, those with and without worsening pain over two years. We then used log-binomial regression to evaluate associations of the top 10 influential variables selected with super learning with each outcome. We also assessed whether the relation of altered gait with worsening function was mediated by changes in pain. RESULTS Of 2,324 participants, 29% and 24% had worsening knee pain and function over two years, respectively. From the super learner, several gait parameters were found to be influential for worsening pain and for worsening function. After adjusting for confounders, greater gait asymmetry, longer average step length, and lower dominant frequency were associated with worsening pain, and lower cadence was associated with worsening function. Worsening pain partially mediated the association of cadence with function. CONCLUSION We identified gait alterations associated with worsening knee pain and those associated with worsening physical function. These alterations could be assessed with wearable sensors in clinical settings. Further research should determine whether they might be therapeutic targets to prevent worsening pain and worsening function.
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Affiliation(s)
| | | | | | | | - Jeffrey M Hausdorff
- Tel Aviv University and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and Rush University Medical Center, Chicago, Illinois
| | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City
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Hiett A, Li S, Segal NA. A rare complication of percutaneous ultrasonic tenotomy in a 66-year-old man with calcific Achilles tendinopathy. PM R 2024; 16:194-196. [PMID: 37229567 DOI: 10.1002/pmrj.12999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Revised: 04/14/2023] [Accepted: 05/11/2023] [Indexed: 05/27/2023]
Affiliation(s)
- Andrew Hiett
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Susan Li
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Neil A Segal
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, USA
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Schadow JE, Maxey D, Smith TO, Finnilä MAJ, Manske SL, Segal NA, Wong AKO, Davey RA, Turmezei T, Stok KS. Systematic review of computed tomography parameters used for the assessment of subchondral bone in osteoarthritis. Bone 2024; 178:116948. [PMID: 37926204 DOI: 10.1016/j.bone.2023.116948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2023] [Revised: 10/04/2023] [Accepted: 10/19/2023] [Indexed: 11/07/2023]
Abstract
OBJECTIVE To systematically review the published parameters for the assessment of subchondral bone in human osteoarthritis (OA) using computed tomography (CT) and gain an overview of current practices and standards. DESIGN A literature search of Medline, Embase and Cochrane Library databases was performed with search strategies tailored to each database (search from 2010 to January 2023). The search results were screened independently by two reviewers against pre-determined inclusion and exclusion criteria. Studies were deemed eligible if conducted in vivo/ex vivo in human adults (>18 years) using any type of CT to assess subchondral bone in OA. Extracted data from eligible studies were compiled in a qualitative summary and formal narrative synthesis. RESULTS This analysis included 202 studies. Four groups of CT modalities were identified to have been used for subchondral bone assessment in OA across nine anatomical locations. Subchondral bone parameters measuring similar features of OA were combined in six categories: (i) microstructure, (ii) bone adaptation, (iii) gross morphology (iv) mineralisation, (v) joint space, and (vi) mechanical properties. CONCLUSIONS Clinically meaningful parameter categories were identified as well as categories with the potential to become relevant in the clinical field. Furthermore, we stress the importance of quantification of parameters to improve their sensitivity and reliability for the evaluation of OA disease progression and the need for standardised measurement methods to improve their clinical value.
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Affiliation(s)
- Jemima E Schadow
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
| | - David Maxey
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom.
| | - Toby O Smith
- Warwick Medical School, University of Warwick, United Kingdom.
| | - Mikko A J Finnilä
- Research Unit of Health Science and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.
| | - Sarah L Manske
- Department of Radiology, McCaig Institute for Bone and Joint Health, Cumming School of Medicine, University of Calgary, Calgary, Canada.
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, United States.
| | - Andy Kin On Wong
- Joint Department of Medical Imaging, University Health Network, Toronto, Canada; Schroeder's Arthritis Institute, Toronto General Hospital Research Institute, University Health Network, Toronto, Canada.
| | - Rachel A Davey
- Department of Medicine, Austin Health, University of Melbourne, Melbourne, Australia.
| | - Tom Turmezei
- Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Norwich, United Kingdom; Norwich Medical School, University of East Anglia, Norwich, United Kingdom.
| | - Kathryn S Stok
- Department of Biomedical Engineering, The University of Melbourne, Melbourne, Australia.
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Lewis CL, Segal NA, Rabasa GV, LaValley MP, Williams GN, Nevitt MC, Lewis CE, Felson DT, Stefanik JJ. Hip Abductor Weakness and Its Association With New or Worsened Knee Pain: Data From the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2023; 75:2328-2335. [PMID: 37221156 PMCID: PMC10803067 DOI: 10.1002/acr.25160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Revised: 05/05/2023] [Accepted: 05/18/2023] [Indexed: 05/25/2023]
Abstract
OBJECTIVE Hip abductors, important for controlling pelvic and femoral orientation during gait, may affect knee pain. Our objective was to evaluate the relation of hip abductor strength to worsened or new-onset frequent knee pain. Given previously noted associations of knee extensor strength with osteoarthritis in women, we performed sex-specific analyses. METHODS We used data from the Multicenter Osteoarthritis study. Hip abductor and knee extensor strength was measured. Knee pain was assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire and a question about frequent knee pain at baseline (144-month visit), and 8, 16, and 24 months thereafter. Knee pain outcomes were worsened knee pain (2-point increase in WOMAC pain) and incident frequent knee pain (answering yes to the frequent knee pain question among those without frequent knee pain at baseline). Leg-specific analyses tested hip abductor strength as a risk factor for worsened and new frequent knee pain, adjusting for potential covariates. Additionally, we stratified by knee extensor strength (high versus low). RESULTS Among women, compared to the highest quartile of hip abductor strength, the lowest quartile had 1.7 (95% confidence interval [95% CI] 1.1-2.6) times the odds of worsened knee pain; significant associations were limited to women with high knee extensor strength (odds ratio 2.0 [95% CI 1.1-3.5]). We found no relation of abductor strength to worsening knee pain in men or with incident frequent knee pain in men or women. CONCLUSION Hip abductor weakness was associated with worsening knee pain in women with strong knee extensors, but not with incident frequent knee pain in men or women. Knee extensor strength may be necessary, but not sufficient, to prevent pain worsening.
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Affiliation(s)
| | - Neil A Segal
- University of Kansas Medical Center, Kansas City
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Costello KE, Felson DT, Jafarzadeh SR, Guermazi A, Roemer FW, Segal NA, Lewis CE, Nevitt MC, Lewis CL, Kolachalama VB, Kumar D. Gait, physical activity and tibiofemoral cartilage damage: a longitudinal machine learning analysis in the Multicenter Osteoarthritis Study. Br J Sports Med 2023; 57:1018-1024. [PMID: 36868795 PMCID: PMC10423491 DOI: 10.1136/bjsports-2022-106142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To (1) develop and evaluate a machine learning model incorporating gait and physical activity to predict medial tibiofemoral cartilage worsening over 2 years in individuals without advanced knee osteoarthritis and (2) identify influential predictors in the model and quantify their effect on cartilage worsening. DESIGN An ensemble machine learning model was developed to predict worsened cartilage MRI Osteoarthritis Knee Score at follow-up from gait, physical activity, clinical and demographic data from the Multicenter Osteoarthritis Study. Model performance was evaluated in repeated cross-validations. The top 10 predictors of the outcome across 100 held-out test sets were identified by a variable importance measure. Their effect on the outcome was quantified by g-computation. RESULTS Of 947 legs in the analysis, 14% experienced medial cartilage worsening at follow-up. The median (2.5-97.5th percentile) area under the receiver operating characteristic curve across the 100 held-out test sets was 0.73 (0.65-0.79). Baseline cartilage damage, higher Kellgren-Lawrence grade, greater pain during walking, higher lateral ground reaction force impulse, greater time spent lying and lower vertical ground reaction force unloading rate were associated with greater risk of cartilage worsening. Similar results were found for the subset of knees with baseline cartilage damage. CONCLUSIONS A machine learning approach incorporating gait, physical activity and clinical/demographic features showed good performance for predicting cartilage worsening over 2 years. While identifying potential intervention targets from the model is challenging, lateral ground reaction force impulse, time spent lying and vertical ground reaction force unloading rate should be investigated further as potential early intervention targets to reduce medial tibiofemoral cartilage worsening.
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Affiliation(s)
- Kerry E Costello
- Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, USA
- Physical Therapy, Boston University, Boston, Massachusetts, USA
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T Felson
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - S Reza Jafarzadeh
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ali Guermazi
- Radiology, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Frank W Roemer
- Radiology, Universitatsklinikum Erlangen, Erlangen, Germany
- Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Neil A Segal
- Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Cora E Lewis
- Epidemiology, The University of Alabama, Birmingham, Alabama, USA
| | - Michael C Nevitt
- Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Cara L Lewis
- Physical Therapy, Boston University, Boston, Massachusetts, USA
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vijaya B Kolachalama
- Computational Biomedicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Computer Science, Boston University, Boston, Massachusetts, USA
| | - Deepak Kumar
- Physical Therapy, Boston University, Boston, Massachusetts, USA
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
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Alenazi AM, Alhowimel AS, Alshehri MM, Alqahtani BA, Alhwoaimel NA, Segal NA, Kluding PM. Osteoarthritis and Diabetes: Where Are We and Where Should We Go? Diagnostics (Basel) 2023; 13:diagnostics13081386. [PMID: 37189487 DOI: 10.3390/diagnostics13081386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.
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Affiliation(s)
- Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Mohammed M Alshehri
- Departement of Physical Therapy, Jazan University, Jazan 45142, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Norah A Alhwoaimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Neil A Segal
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MI 66160, USA
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MI 66160, USA
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Segal NA, Nevitt MC, Morales Aquino M, McFadden E, Ho M, Duryea J, Tolstykh I, Cheng H, He J, Lynch JA, Felson DT, Anderson DD. Improved responsiveness to change in joint space width over 24-month follow-up: comparison of 3D JSW on weight-bearing CT vs 2D JSW on radiographs in the MOST study. Osteoarthritis Cartilage 2023; 31:406-413. [PMID: 36526151 PMCID: PMC9974913 DOI: 10.1016/j.joca.2022.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 11/13/2022] [Accepted: 12/06/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Radiographic joint space width (JSW) has been a standard for measuring knee osteoarthritis (OA) structural change. Limitations in the responsiveness of this approach might be overcome by instead measuring 3D JSW on weight-bearing CT (WBCT). This study compared the responsiveness of 3D JSW measurements using WBCT with the responsiveness of radiographic 2D JSW. DESIGN Standing, fixed-flexion knee radiographs (XR) and WBCT were acquired ancillary to the 144- and 168-month Multicenter Osteoarthritis Study visits. Tibiofemoral JSW was measured on both XR and WBCT. Responsiveness to change was defined by the standardized response mean (SRM) for change in JSW (1) at predetermined mediolateral locations (JSWx) on both modalities and (2) in the following subregions measured on WBCT images: central medial and lateral femur (CMF/CLF) and tibia (CMT/CLT), and anterior and posterior tibia (AMT/ALT, PMT/MLT). RESULTS Baseline and 24-month follow-up JSWx measurements were completed for 265 participants (58.1% women). Responsiveness of 3D JSWx for medial tibiofemoral compartment on coronal WBCT (SRM range: -0.18, -0.24) exceeded that for 2D JSWx (-0.10, -0.16). Responsiveness of 3D JSW subregional mean (-0.06, -0.36) and maximal (-1.14, -1.75) CMF and CMT and maximal CLF/CLT 3D JSW changes were statistically significantly greater in comparison with respective medial and lateral 2D JSWx (P ≤ 0.002). CONCLUSIONS Subregional 3D JSW on WBCT is substantially more responsive to 24-month changes in tibiofemoral joint structure compared to radiographic measurements. Use of subregional 3D JSW on WBCT could enable improved detection of OA structural progression over a 24-month duration in comparison with measurements made on XR.
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Affiliation(s)
- N A Segal
- University of Kansas Medical Center, Kansas City, KS, USA; The University of Iowa, Iowa City, IA, USA.
| | - M C Nevitt
- University of California-San Francisco, San Francisco, CA, USA
| | | | - E McFadden
- The University of Iowa, Iowa City, IA, USA
| | - M Ho
- The University of Iowa, Iowa City, IA, USA
| | - J Duryea
- Harvard University, Cambridge, MA, USA
| | - I Tolstykh
- University of California-San Francisco, San Francisco, CA, USA
| | - H Cheng
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J He
- University of Kansas Medical Center, Kansas City, KS, USA
| | - J A Lynch
- University of California-San Francisco, San Francisco, CA, USA
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Hayashi D, Roemer FW, Link T, Li X, Kogan F, Segal NA, Omoumi P, Guermazi A. Latest advancements in imaging techniques in OA. Ther Adv Musculoskelet Dis 2022; 14:1759720X221146621. [PMID: 36601087 PMCID: PMC9806406 DOI: 10.1177/1759720x221146621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Accepted: 12/05/2022] [Indexed: 12/28/2022] Open
Abstract
The osteoarthritis (OA) research community has been advocating a shift from radiography-based screening criteria and outcome measures in OA clinical trials to a magnetic resonance imaging (MRI)-based definition of eligibility and endpoint. For conventional morphological MRI, various semiquantitative evaluation tools are available. We have lately witnessed a remarkable technological advance in MRI techniques, including compositional/physiologic imaging and automated quantitative analyses of articular and periarticular structures. More recently, additional technologies were introduced, including positron emission tomography (PET)-MRI, weight-bearing computed tomography (CT), photon-counting spectral CT, shear wave elastography, contrast-enhanced ultrasound, multiscale X-ray phase contrast imaging, and spectroscopic photoacoustic imaging of cartilage. On top of these, we now live in an era in which artificial intelligence is increasingly utilized in medicine. Osteoarthritis imaging is no exception. Successful implementation of artificial intelligence (AI) will hopefully improve the workflow of radiologists, as well as the level of precision and reproducibility in the interpretation of images.
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Affiliation(s)
- Daichi Hayashi
- Department of Radiology, Renaissance School of Medicine at Stony Brook University, Stony Brook, NY, USA,Department of Radiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA
| | - Frank W. Roemer
- Department of Radiology, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA,Department of Radiology, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU), Erlangen, Germany
| | - Thomas Link
- Department of Radiology, University of California San Francisco, San Franciso, CA, USA
| | - Xiaojuan Li
- Department of Radiology, Cleveland Clinic Lerner College of Medicine, Cleveland, OH, USA
| | - Feliks Kogan
- Department of Radiology, Stanford University, Stanford, CA, USA
| | - Neil A. Segal
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS, USA
| | - Patrick Omoumi
- Department of Radiology, Lausanne University Hospital, University of Lausanne, Lausanne, Switzerland
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Bacon KL, Felson DT, Jafarzadeh SR, Kolachalama VB, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Relation of gait measures with mild unilateral knee pain during walking using machine learning. Sci Rep 2022; 12:22200. [PMID: 36564397 PMCID: PMC9789148 DOI: 10.1038/s41598-022-21142-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Gait alterations in those with mild unilateral knee pain during walking may provide clues to modifiable alterations that affect progression of knee pain and osteoarthritis (OA). To examine this, we applied machine learning (ML) approaches to gait data from wearable sensors in a large observational knee OA cohort, the Multicenter Osteoarthritis (MOST) study. Participants completed a 20-m walk test wearing sensors on their trunk and ankles. Parameters describing spatiotemporal features of gait and symmetry, variability and complexity were extracted. We used an ensemble ML technique ("super learning") to identify gait variables in our cross-sectional data associated with the presence/absence of unilateral knee pain. We then used logistic regression to determine the association of selected gait variables with odds of mild knee pain. Of 2066 participants (mean age 63.6 [SD: 10.4] years, 56% female), 21.3% had mild unilateral pain while walking. Gait parameters selected in the ML process as influential included step regularity, sample entropy, gait speed, and amplitude dominant frequency, among others. In adjusted cross-sectional analyses, lower levels of step regularity (i.e., greater gait variability) and lower sample entropy(i.e., lower gait complexity) were associated with increased likelihood of unilateral mild pain while walking [aOR 0.80 (0.64-1.00) and aOR 0.79 (0.66-0.95), respectively].
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Affiliation(s)
- Kathryn L Bacon
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA.
| | - David T Felson
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | - S Reza Jafarzadeh
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | | | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neil A Segal
- University of Kansas Medical Center, Kansas City, USA
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Deepak Kumar
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
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Rabe KG, Stockman TJ, Kern AM, Wirth W, Eckstein F, Sharma L, Lynch JA, Nevitt MC, Anderson DD, Segal NA. Longitudinal Relationship Between Tibiofemoral Contact Stress at Baseline and Worsening of Knee Pain Over 84 Months in the Multicenter Osteoarthritis Study. Am J Phys Med Rehabil 2022; 101:726-732. [PMID: 34620738 PMCID: PMC8986881 DOI: 10.1097/phm.0000000000001899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to determine whether tibiofemoral contact stress predicts risk for worsening knee pain over 84 ms in adults aged 50-79 yrs with or at elevated risk for knee osteoarthritis. DESIGN Baseline tibiofemoral contact stress was estimated using discrete element analysis. Other baseline measures included weight, height, hip-knee-ankle alignment, Kellgren-Lawrence grade, and Western Ontario and McMaster Universities Osteoarthritis Index pain subscale. Logistic regression models assessed the association between baseline contact stress and 84-mo worsening of Western Ontario and McMaster Universities Osteoarthritis Index pain subscale. RESULTS Data from the dominant knee (72.6% Kellgren-Lawrence grade 0/1 and 27.4% Kellgren-Lawrence grade ≥ 2) of 208 participants (64.4% female, mean ± SD body mass index = 29.6 ± 5.1 kg/m 2 ) were analyzed. Baseline mean and peak contact stress were 3.3 ± 0.9 and 9.4 ± 4.3 MPa, respectively. Forty-seven knees met the criterion for worsening pain. The highest tertiles in comparison with the lowest tertiles of mean (odds ratio [95% confidence interval] = 2.47 [1.03-5.95], P = 0.04) and peak (2.49 [1.03-5.98], P = 0.04) contact stress were associated with worsening pain at 84 mos, after adjustment for age, sex, race, clinic site, and baseline pain. Post hoc sensitivity analyses including adjustment for body mass index and hip-knee-ankle alignment attenuated the effect. CONCLUSIONS These findings suggest that elevated tibiofemoral contact stress can predict the development of worsening of knee pain.
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Affiliation(s)
- Kaitlin G Rabe
- From the University of Kansas Medical Center, Kansas City, Kansas (KGR, NAS); University of Iowa, Iowa City, Iowa (TJS, AMK, DDA, NAS); Department of Imaging and Funktional Musculoskeletal Research, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria (WW, FE); Chondrometrics GmbH, Ainring, Germany (WW, FE); Northwestern University, Chicago, Illinois (LS); and University of California San Francisco, San Francisco, California (JAL, MCN)
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Turmezei TD, Low SB, Rupret S, Treece GM, Gee AH, MacKay JW, Lynch JA, Poole KES, Segal NA. Multiparametric 3-D analysis of bone and joint space width at the knee from weight bearing computed tomography. Osteoarthr Imaging 2022; 2:100069. [PMID: 36249485 PMCID: PMC9559750 DOI: 10.1016/j.ostima.2022.100069] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
OBJECTIVE Computed tomography (CT) can deliver multiple parameters relevant to osteoarthritis. In this study we demonstrate that a 3-D multiparametric approach at the weight bearing knee with cone beam CT is feasible, can include multiple parameters from across the joint space, and can reveal stronger relationships with disease status in combination. DESIGN 33 participants with knee weight bearing CT (WBCT) were analysed with joint space mapping and cortical bone mapping to deliver joint space width (JSW), subchondral bone plate thickness, endocortical thickness, and trabecular attenuation at both sides of the joint. All data were co-localised to the same canonical surface. Statistical parametric mapping (SPM) was applied in uni- and multivariate models to demonstrate significant dependence of parameters on Kellgren & Lawrence grade (KLG). Correlation between JSW and bony parameters and 2-week test-retest repeatability were also calculated. RESULTS SPM revealed that the central-to-posterior medial tibiofemoral joint space was significantly narrowed by up to 0.5 mm with significantly higher tibial trabecular attenuation up to 50 units for each increment in KLG as single features, and in a wider distribution when combined (p<0.05). These were also more strongly correlated with worsening KLG grade category. Test-retest repeatability was subvoxel (0.37 mm) for nearly all thickness parameters. CONCLUSIONS 3-D JSW and tibial trabecular attenuation are repeatable and significantly dependent on radiographic disease severity at the weight bearing knee joint not just alone, but more strongly in combination. A quantitative multiparametric approach with WBCT may have potential for more sensitive investigation of disease progression in osteoarthritis.
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Affiliation(s)
- Tom D Turmezei
- Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, UK
- University of East Anglia, Norwich Research Park, Norwich, UK
| | - Samantha B Low
- University of East Anglia, Norwich Research Park, Norwich, UK
| | - Simon Rupret
- University Hospitals Bristol and Weston NHS Foundation Trust, Marlborough Street, Bristol, UK
| | - Graham M Treece
- Cambridge University Engineering Department, Trumpington Street, Cambridge, UK
| | - Andrew H Gee
- Cambridge University Engineering Department, Trumpington Street, Cambridge, UK
| | - James W MacKay
- Norfolk and Norwich University Hospital NHS Foundation Trust, Colney Lane, Norwich, UK
- University of East Anglia, Norwich Research Park, Norwich, UK
| | - John A Lynch
- University of California San Francisco, 550 16th Street, San Francisco, USA
| | - Kenneth ES Poole
- University of Cambridge Department of Medicine, Hills Road, Cambridge, UK
| | - Neil A Segal
- University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, USA
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Murphy MT, Wang N, Felson DT, Nevitt MC, Lewis CE, Frey-Law L, Guermazi A, Segal NA. Association between hamstring coactivation during isokinetic quadriceps strength testing and knee cartilage worsening over 24 months. Osteoarthritis Cartilage 2022; 30:823-831. [PMID: 35307535 PMCID: PMC9450915 DOI: 10.1016/j.joca.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This study aimed to determine longitudinal associations, including sex-specific differences, between greater knee flexor antagonist coactivation and worsening cartilage morphology in knees with or at risk for osteoarthritis (OA). DESIGN Baseline measurements were collected at the 60-month visit of a longitudinal osteoarthritis study following community-dwelling participants (MOST). Knee flexor and extensor muscle activity were measured with surface electromyography during a maximal isokinetic knee extension task. MRI analyzed knee cartilage morphology at baseline and 24-month follow-up. Multivariable adjusted logistic regression models were used to assess associations between coactivation level and cartilage morphology worsening. RESULTS Analysis of 373 women (mean ± SD age 67.4 ± 7.3 years and BMI 29.7 ± 5.0 kg/m2) and 240 men (66.5 ± 7.8 years and 29.9 ± 4.5 kg/m2) revealed that women had greater medial (P < 0.001), lateral (P < 0.001), and combined (P < 0.001) hamstring coactivation than men. In both sexes, combined hamstring coactivation was associated with patellofemoral cartilage morphology worsening [1.23 (1.02, 1.49)] and to a less significant degree with whole knee cartilage morphology worsening [1.21 (0.98, 1.49)]. In men, greater combined hamstring coactivation was associated with increased risk for whole knee [1.59 (1.06, 2.39)] and patellofemoral [1.38 (1.01, 1.88)] cartilage morphology worsening and point estimates suggested association between medial hamstring coactivation and medial tibiofemoral cartilage morphology worsening. No significant associations were detected between greater hamstring coactivation and cartilage morphology worsening in women. CONCLUSIONS These findings suggest a longitudinal relationship between antagonist hamstring coactivation during isokinetic knee extensor testing and worsening of cartilage morphology over 24 months in men with or at risk for knee OA.
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Affiliation(s)
- M T Murphy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160, USA.
| | - N Wang
- Department of Biostatistics and Epidemiology, Boston University, Boston, MA, USA.
| | - D T Felson
- Department of Epidemiology, Boston University, Boston, MA, USA.
| | - M C Nevitt
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA.
| | - C E Lewis
- Department of Epidemiology, University of Alabama at Birmingham, Birmingham, AL, USA.
| | - L Frey-Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa City, IA, USA.
| | - A Guermazi
- Department of Radiology, Boston University, Boston, MA, USA.
| | - N A Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160, USA.
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Perry TA, Segal NA. An open-label, single-arm trial of cryoneurolysis for improvements in pain, Activities of Daily Living and Quality of Life in patients with symptomatic ankle osteoarthritis. Osteoarthritis and Cartilage Open 2022; 4:100272. [DOI: 10.1016/j.ocarto.2022.100272] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 04/13/2022] [Accepted: 05/08/2022] [Indexed: 10/18/2022] Open
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Segal NA, Anderson DD. Editorial commentary on Fritz et al. article entitled 'Three-dimensional analysis for quantification of knee joint space width with weight-bearing CT: comparison with non-weight-bearing CT and weight-bearing radiography'. Osteoarthritis Cartilage 2022; 30:629-632. [PMID: 34968720 DOI: 10.1016/j.joca.2021.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2021] [Revised: 12/06/2021] [Accepted: 12/17/2021] [Indexed: 02/02/2023]
Affiliation(s)
- N A Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, USA; Department of Orthopedics and Rehabilitation, University of Iowa, USA.
| | - D D Anderson
- Department of Rehabilitation Medicine, University of Kansas Medical Center, USA; Department of Orthopedics and Rehabilitation, University of Iowa, USA
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Meek AW, Heavrin AM, Mikesky AE, Segal NA, Riley ZA. Subject factors influencing blood flow restriction in the arm at low cuff pressures. Clin Physiol Funct Imaging 2022; 42:233-240. [PMID: 35319161 DOI: 10.1111/cpf.12752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 03/18/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Limb circumference predicts the pressure needed for complete occlusion. However, that relationship is inconsistent at moderate pressures typical of effective blood flow restriction (BFR) training. The purpose of this study was to investigate the influence of subject factors on BFR at low restriction pressures in the arm. METHODS Fifty subjects had arm anthropometrics assessed by peripheral quantitative computed tomography (pQCT), sum of skinfold thickness (sumSKF) and Gulick tape (Gulick tape circumference [Gulick Circ.]) at cuff level. Blood flow (BF) was measured with ultrasound at baseline and five restrictive pressures (20, 30, 40, 50 and 60 mmHg). Relationships between subject characteristics and BFR were assessed using Pearson's correlations and hierarchical regression. RESULTS BF decreased (p < 0.05) at each incremental pressure. Regression models including percent muscle composition (%Muscle), pQCT circumference and systolic blood pressure (SBP), were significant at all five pressures (R2 = 0.18-0.49). %Muscle explained the most variance at each pressure. Regression models including sumSKF, Gulick Circ. and SBP, were significant at 30-60 mmHg (R2 = 0.28-0.49). SumSKF explained the most variance at each pressure. CONCLUSIONS At low pressures (20-60 mmHg), there is considerable variability in the magnitude of BFR across individuals. Arm composition factors (muscle and fat) explained the greatest variance at each cuff pressure and may be the most important consideration when using BFR protocols.
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Affiliation(s)
- Anthony W Meek
- Department of Kinesiology, School of Health and Human Sciences, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Adam M Heavrin
- Department of Exercise Science, Franklin College, Franklin, Indiana, USA
| | - Alan E Mikesky
- Department of Kinesiology, School of Health and Human Sciences, Indiana University-Purdue University, Indianapolis, Indiana, USA
| | - Neil A Segal
- Department of Physical Medicine and Rehabilitation, University of Kansas, Kansas City, Missouri, USA
| | - Zachary A Riley
- Department of Kinesiology, School of Health and Human Sciences, Indiana University-Purdue University, Indianapolis, Indiana, USA
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Perry TA, Segal NA, Bowen C, Gates L, Arden N, Nevitt MC. Foot and ankle pain and risk of incident knee osteoarthritis and knee pain: Data from the Multicentre Osteoarthritis Study. Osteoarthr Cartil Open 2022; 3:100210. [PMID: 34977597 PMCID: PMC8683744 DOI: 10.1016/j.ocarto.2021.100210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2021] [Accepted: 08/20/2021] [Indexed: 11/29/2022] Open
Abstract
Objectives To examine whether foot and/or ankle pain increases the risk of knee OA. Design We utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain. Results No statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes. Conclusions Ankle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.
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Affiliation(s)
- Thomas A. Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- Corresponding author. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Old Road, Oxford, OX3 7LD, United Kingdom.
| | - Neil A. Segal
- University of Kansas Medical Centre, Kansas City, KS, USA
- The University of Iowa, Iowa City, USA
| | - Catherine Bowen
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Lucy Gates
- School of Health Sciences, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, United Kingdom
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, University of Southampton, Southampton, United Kingdom
| | - Nigel Arden
- Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, 550 16th St, San Francisco, CA 94158, USA
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Segal NA, Murphy MT, Everist BM, Brown KD, He J, Lynch JA, Nevitt MC. Clinical value of weight-bearing CT and radiographs for detecting patellofemoral cartilage visualized by MRI in the MOST study. Osteoarthritis Cartilage 2021; 29:1540-1548. [PMID: 34332048 PMCID: PMC8542599 DOI: 10.1016/j.joca.2021.07.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Revised: 06/28/2021] [Accepted: 07/13/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The patellofemoral joint is frequently affected by osteoarthritis (PFOA) and is incompletely imaged on radiographs (XR). Weight-Bearing CT (WBCT) could offer advantages for visualization. This study determined the sensitivity, specificity, and accuracy of axial WBCT and lateral XR for detection of PFOA features in comparison with cartilage damage on MRI. DESIGN A convenience sample of 60 right knees from the MOST cohort were analyzed. WBCT and XR were read for OARSI JSN score and MRI for MOAKS cartilage score by two experienced musculoskeletal radiologists blinded to participant. Using MOAKS scoring on MRI (referent standard), the sensitivity, specificity and accuracy of patellofemoral OARSI JSN scores based on WBCT and XR were compared. RESULTS The mean ± SD age and BMI for the participants included (66.7% women) were 67.6 ± 9.8 years and 30.0 ± 5.3 kg/m2 respectively. WBCT demonstrated significantly greater sensitivity (0.85-0.97 on WBCT vs 0.47-0.57 on XR) and accuracy (0.85-0.92 on WBCT vs 0.48-0.57 on XR) for all parameters except lateral full-thickness cartilage loss (McNemar's test p-values all <0.001). There was moderate-to-strong and low-to-moderate agreement between PFOA findings on WBCT and XR, respectively, and semi-quantitative scores of PF cartilage on MRI. Inter-rater reliability for XR JSN [weighted kappa = 0.83 (0.64, 1.0)], WBCT JSN [kappa = 0.60 (0.48, 0.72)] and MRI MOAKS-CM [kappa = 0.70 (0.61, 0.79)] readings were good. CONCLUSION WBCT demonstrates significantly greater sensitivity and accuracy than radiographs for identification of PFOA. Given the same Relative Radiation Level as XR and improved visualization, WBCT holds promise to improve understanding of the weight-bearing patellofemoral joint.
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Affiliation(s)
- Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Mailstop 1046, Kansas City, KS, 66160
| | - Michael T. Murphy
- Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, KS, USA
| | - Brian M. Everist
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Kevin D. Brown
- Department of Radiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Jianghua He
- Department of Biostatistics and Data Science, University of Kansas Medical Center, Kansas City, KS, USA
| | - John A. Lynch
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
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McGuire D, Bowes M, Brett A, Segal NA, Miller M, Rosen D, Kumagai Y. Study TPX-100-5: intra-articular TPX-100 significantly delays pathological bone shape change and stabilizes cartilage in moderate to severe bilateral knee OA. Arthritis Res Ther 2021; 23:242. [PMID: 34535197 PMCID: PMC8447757 DOI: 10.1186/s13075-021-02622-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 09/05/2021] [Indexed: 11/18/2022] Open
Abstract
Background TPX-100, a promotor of osteoblast and chondroblast differentiation, is a potential osteoarthritis (OA) therapy. This retrospective study compared MRI 3D femoral bone shape changes (B-scores) after intra-articular TPX-100 or placebo and analyzed the relationship between cartilage thickness and bone shape change over 12 months. Methods One hundred and four participants with bilateral moderate to severe knee cartilage defects were randomized to receive TPX-100 (200 mg) or placebo. Each subject’s contralateral placebo-treated knee served as a paired internal control. After MRI quality control, 78/93 subjects (84%; 156 knees) were analyzed for quantitative femoral B-score and cartilage thickness. All analyses were performed centrally, blind to treatment assignment and clinical data. Results TPX-100-treated knees (n = 78) demonstrated a statistically significant decrease in pathologic bone shape change compared with placebo-treated knees at 6 and 12 months: 0.0298 (95% C.I. − 0.037, 0.097) vs 0.1246 (95% C.I. 0.067, 0.182) (P = 0.02), and 0.0856 (95% C.I. 0.013, 0.158) vs. 0.1969 (95% C.I. 0.123, 0.271) (P = 0.01), respectively. The correlation between bone shape change and medial and total tibiofemoral cartilage thickness changes at 12 months was statistically significant in TPX-100-treated knees (P < 0.01). Conclusions This is the first report of a potential therapy demonstrating a significant effect on bone shape measured by B-score in knee OA. These data, in combination with previously reported statistically significant and clinically meaningful improvements in WOMAC physical function versus placebo, support TPX-100 as a candidate for disease modification in knee OA. Trial registration NIH ClinicalTrials.gov, NCT01925261. Registered 15 August 2013 Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02622-8.
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Affiliation(s)
| | | | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City, KS, USA
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21
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Costello KE, Felson DT, Neogi T, Segal NA, Lewis CE, Gross KD, Nevitt MC, Lewis CL, Kumar D. Ground reaction force patterns in knees with and without radiographic osteoarthritis and pain: descriptive analyses of a large cohort (the Multicenter Osteoarthritis Study). Osteoarthritis Cartilage 2021; 29:1138-1146. [PMID: 33757856 PMCID: PMC8319033 DOI: 10.1016/j.joca.2021.03.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Revised: 02/22/2021] [Accepted: 03/10/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To compare ground reaction force patterns (GRF) during walking among legs defined by presence or absence of knee pain and/or radiographic knee osteoarthritis (ROA). METHOD Principal component analysis extracted major modes of variation (PCs) in GRF data from the Multicenter Osteoarthritis Study during self-paced walking. Legs were categorized as pain + ROA (n = 168), ROA only (n = 303), pain only (n = 476), or control (n = 1877). Relationships between group and GRF PCs were examined using Generalized Estimating Equations, adjusted for age, sex, body mass index, race, and clinic site with and without additional adjustment for gait speed. RESULTS With or without speed adjustment, pain + ROA had flatter vertical GRF waveforms than control (speed adjusted PC2 difference [95%CI]: -66 [-113,-20]), pain + ROA and ROA only had higher lateral GRF at impact and greater mid-stance medial GRF than control (speed adjusted PC3 difference: 9 [3,16] and 6 [2,10], respectively), and ROA only had higher early vs late medial GRF than control (speed adjusted PC2 difference: 7 [2,13]). Pain only had flatter vertical GRF waveforms and a smaller difference between anterior and posterior GRF than control only without speed adjustment. CONCLUSION In this large sample, sustained mid-stance loading and higher impact loads were identified in legs with ROA or ROA and pain, even when adjusting for differences in gait speed and other confounders. While it remains to be seen whether these features precede or result from ROA and pain, the presence of these patterns in the speed-adjusted models could have implications on gait interventions aimed to change joint loading.
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Affiliation(s)
- Kerry E. Costello
- Boston University, Boston, MA,Boston University School of Medicine, Boston, MA
| | | | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA
| | - Neil A. Segal
- University of Kansas Medical Center, Kansas City, KS,The University of Iowa, Iowa City, IA
| | | | | | | | - Cara L. Lewis
- Boston University, Boston, MA,Boston University School of Medicine, Boston, MA
| | - Deepak Kumar
- Boston University, Boston, MA,Boston University School of Medicine, Boston, MA
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Alenazi AM, Alqahtani BA, Vennu V, Alshehri MM, Alanazi AD, Alrawaili SM, Khunti K, Segal NA, Bindawas SM. Gait Speed as a Predictor for Diabetes Incidence in People with or at Risk of Knee Osteoarthritis: A Longitudinal Analysis from the Osteoarthritis Initiative. Int J Environ Res Public Health 2021; 18:4414. [PMID: 33919455 PMCID: PMC8122394 DOI: 10.3390/ijerph18094414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA. MATERIALS AND METHODS Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visit were included. Participants with self-reported DM at baseline were excluded. DM incidence was followed over the 4-time points. Gait speed was measured at baseline using a 20-m walk test. Generalized estimating equations with logistic regression were utilized for analyses. Receiver operator characteristic curves and area under the curve were used to determine the cutoff score for baseline speed. RESULTS Of the 4313 participants included in the analyses (58.7% females), 301 participants had a cumulative incidence of DM of 7.0% during follow-up. Decreased gait speed was a significant predictor of incident DM (RR 0.44, p = 0.018). The threshold for baseline gait speed that predicted incident DM was 1.32 m/s with an area under the curve of 0.59 (p < 0.001). CONCLUSIONS Baseline gait speed could be an important screening tool for identifying people at risk of incident diabetes, and the determined cutoff value for gait speed should be examined in future research.
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Affiliation(s)
- Aqeel M. Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Bader A. Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (V.V.); (S.M.B.)
| | - Mohammed M. Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia;
| | - Ahmad D. Alanazi
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia;
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK;
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Saad M. Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (V.V.); (S.M.B.)
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Turmezei TD, B Low S, Rupret S, Treece GM, Gee AH, MacKay JW, Lynch JA, Poole KES, Segal NA. Quantitative Three-dimensional Assessment of Knee Joint Space Width from Weight-bearing CT. Radiology 2021; 299:649-659. [PMID: 33847516 DOI: 10.1148/radiol.2021203928] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Background Imaging of structural disease in osteoarthritis has traditionally relied on MRI and radiography. Joint space mapping (JSM) can be used to quantitatively map joint space width (JSW) in three dimensions from CT images. Purpose To demonstrate the reproducibility, repeatability, and feasibility of JSM of the knee using weight-bearing CT images. Materials and Methods Two convenience samples of weight-bearing CT images of left and right knees with radiographic Kellgren-Lawrence grades (KLGs) less than or equal to 2 were acquired from 2014 to 2018 and were analyzed retrospectively with JSM to deliver three-dimensional JSW maps. For reproducibility, images of three sets of knees were used for novice training, and then the JSM output was compared against an expert's assessment. JSM was also performed on 2-week follow-up images in the second cohort, yielding three-dimensional JSW difference maps for repeatability. Statistical parametric mapping was performed on all knee imaging data (KLG, 0-4) to show the feasibility of a surface-based analysis in three dimensions. Results Reproducibility (in 20 individuals; mean age, 58 years ± 7 [standard deviation]; mean body mass index, 28 kg/m2 ± 6; 14 women) and repeatability (in nine individuals; mean age, 53 years ± 6; mean body mass index, 26 kg/m2 ± 4; seven women) reached their lowest performance at a smallest detectable difference less than ±0.1 mm in the central medial tibiofemoral joint space for individuals without radiographically demonstrated disease. The average root mean square coefficient of variation was less than 5% across all groups. Statistical parametric mapping (33 individuals; mean age, 57 years ± 7; mean body mass index, 27 kg/m2 ± 6; 23 women) showed that the central-to-posterior medial joint space was significantly narrower by 0.5 mm for each incremental increase in the KLG (threshold P < .05). One knee (KLG, 2) demonstrated a baseline versus 24-month change in its three-dimensional JSW distribution that was beyond the smallest detectable difference across the lateral joint space. Conclusion Joint space mapping of the knee using weight-bearing CT images is feasible, demonstrating a relationship between the three-dimensional joint space width distribution and structural joint disease. It is reliably learned by novice users, can be personalized for disease phenotypes, and can be used to achieve a smallest detectable difference that is at least 50% smaller than that reported to be achieved at the highest performance level in radiography. © RSNA, 2021 Online supplemental material is available for this article. See also the editorial by Roemer in this issue.
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Affiliation(s)
- Tom D Turmezei
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Samantha B Low
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Simon Rupret
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Graham M Treece
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Andrew H Gee
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - James W MacKay
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - John A Lynch
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Kenneth E S Poole
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
| | - Neil A Segal
- From the Department of Radiology, Norfolk and Norwich University Hospitals NHS Foundation Trust, Colney Lane, Norwich NR4 7UY, England (T.D.T., J.W.M.); Norwich Medical School, University of East Anglia, Norwich, England (T.D.T., J.W.M.); Royal Liverpool University Hospital, Liverpool, England (S.B.L.); Department of Radiology, University Hospitals Bristol and Weston NHS Foundation Trust, Bristol, England (S.R.); Departments of Engineering (G.M.T., A.H.G.) and Medicine (K.E.S.P.), University of Cambridge, Cambridge, England; Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, Calif (J.A.L.); and Department of Physical Medicine and Rehabilitation, Kansas University Medical Center, Kansas City, Kan (N.A.S.)
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Schroeder A, Wang N, Felson DT, Lewis CE, Nevitt MC, Segal NA. Knee Extensor and Flexor Torque Variability During Maximal Strength Testing and Change in Knee Pain and Physical Function at 60-Mo Follow-Up: The Multicenter Osteoarthritis Study (MOST). Am J Phys Med Rehabil 2021; 100:196-201. [PMID: 32932359 PMCID: PMC8024112 DOI: 10.1097/phm.0000000000001587] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT As the population ages, there is a growing burden owing to musculoskeletal diseases, such as knee osteoarthritis, and subsequent functional decline. In the absence of a cure, there is a need to identify factors amenable to intervention to prevent or slow this process. The Multicenter Osteoarthritis Study cohort was developed for this purpose. In this study, associations between variability in peak knee flexor and extensor torque at baseline and worsening of pain and physical function over the subsequent 60 mos were assessed in a cohort of 2680 participants. The highest quartile of baseline knee flexor torque variability was found to be associated longitudinally with worsening pain (fourth quartile ß estimate, mean ± SE, 0.49 ± 0.19; P = 0.0115; with R2 = 0.28 and P for trend across quartiles = 0.0370) and physical function scores (fourth quartile ß estimate, mean ± SE, 1.39 ± 0.64; P = 0.0296; with R2 = 0.25 and P for trend across quartiles = 0.0371), after adjusting for baseline knee osteoarthritis and maximum knee flexor torque. There were no associations between baseline knee extensor torque and worsening pain or physical function by 60 mos. The presence of greater variability in maximum knee flexor strength may identify patients who may benefit from therapies aimed at preventing worsening knee pain and physical function.
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Affiliation(s)
- Allison Schroeder
- From the Department of PM&R, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (AS); Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts (NW); Boston University, Boston, Massachusetts (DTF); University of Alabama at Birmingham, Birmingham, Alabama (CEL); University of California, San Francisco, San Francisco, California (MCN); University of Kansas Medical Center, Kansas City, Kansas (NAS); and The University of Iowa, Iowa City, Iowa (NAS)
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Hu B, Han D, Nevitt MC, Wise BL, Segal NA. The Longitudinal Relationship Between Physical Activity and Joint Space Narrowing: 48-Month Follow-Up Data from the Osteoarthritis Initiative. Arthritis Care Res (Hoboken) 2021; 74:1163-1171. [PMID: 33411980 DOI: 10.1002/acr.24554] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Revised: 12/15/2020] [Accepted: 01/05/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To determine whether amount of physical activity (PA) is a determinant of joint space narrowing (JSN) worsening over 48-months in participants with knee osteoarthritis (OA). METHODS Data were obtained from the Osteoarthritis Initiative. PA, measured using the Physical Activity Scale for the Elderly (PASE), was defined as the mean value of the annual measurements conducted prior to development of worsening JSN. Worsening JSN was defined as at least a partial grade increase in OARSI JSN score over 48 months, in comparison with baseline. Restricted cubic spline (RCS) function was used to group participants based on the linear association between PA and JSN worsening. A pooled logistic regression model was used to evaluate the association between PA and JSN worsening adjusted for confounders. RESULTS 2,167 participants were included. In total, 625 (28.8%) participants had JSN worsening over 48 months. Compared with PASE score of 140-180, PASE scores of 100-140 and >220 associated with an increased risk of JSN worsening in men with OR (95% CI) of 1.73 (1.07, 2.81) and 1.83 (1.14, 2.93) respectively. Similarly, in participants with Kellgren and Lawrence grade 2, compared with a PASE score of 140-180, PASE score of <100 and >220 were associated with increased risks of JSN worsening, with OR (95% CIs) of 1.69 (1.13, 2.54) and 1.64 (1.05, 2.56) respectively. CONCLUSION Compared to moderate PA, higher or lower amounts of PA are associated with elevated risk for JSN worsening in men and in participants with KL grade 2 knees.
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Affiliation(s)
- Bo Hu
- Medical Research and Biometrics Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - DongBai Han
- School of Public Health and Hebei Province Key Laboratory of Occupational Health and Safety for Coal Industry, North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Michael C Nevitt
- Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA, USA
| | - Barton L Wise
- Internal Medicine, University of California, Davis School of Medicine, Sacramento, CA, USA
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS, USA
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26
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Stefanik JJ, Frey-Law L, Segal NA, Niu J, Lewis CE, Nevitt MC, Neogi T. The relation of peripheral and central sensitization to muscle co-contraction: the MOST study. Osteoarthritis Cartilage 2020; 28:1214-1219. [PMID: 32585174 PMCID: PMC7727285 DOI: 10.1016/j.joca.2020.06.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 05/27/2020] [Accepted: 06/12/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To examine the relation of pain sensitization to altered motor activity in knee OA as assessed by hamstrings muscle co-contraction during maximal effort knee extension. DESIGN Medial, lateral, and overall hamstring co-contraction was assessed in the Multicenter Osteoarthritis (MOST) Study cohort using electromyography during isokinetic knee extension at 60°/second. Mechanical temporal summation of pain (TS) was assessed at the right wrist and pressure pain thresholds (PPT) were assessed at the patellae; PPTs were categorized into sex-specific tertiles. Muscle co-contraction was categorized into age- and sex-specific tertiles. We evaluated the relation of measures of sensitization to muscle co-contraction using a generalized logistic regression model. RESULTS 1633 participants were included: mean age and BMI was 67.3 ± 7.7 years and 30.3 ± 5.6 kg/m2, respectively; 58% were female. Presence of TS was associated with higher overall (OR 1.3, 95% confidence interval (CI) (1.0-1.8)), medial (1.4 (1.0-1.9), and lateral (1.3 (1.0, 1.9)) hamstring co-contraction. The lowest PPT tertile (greater sensitivity) was associated with higher overall (1.5 (1.0, 2.3)) and medial (1.5 (1.0, 2.3)) hamstring co-contraction compared with those in the highest PPT tertile. CONCLUSION Greater pain sensitization, as assessed by presence of TS at the wrist and low patellar PPT, was associated with greater overall and medial hamstring co-contraction during knee extension. This provides support to the possibility that peripheral and/or central nervous system alterations may not only affect pain sensitivity, but also motor function.
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Affiliation(s)
- J J Stefanik
- Northeastern University, Boston, MA, USA; Boston University School of Medicine, Boston, MA, USA.
| | | | - N A Segal
- University of Iowa, Iowa City, USA; University of Kansas Medical Center, Kansas City, KS, USA
| | - J Niu
- Baylor College of Medicine, Houston, TX, USA
| | - C E Lewis
- Univerity of Alabama at Birmingham, Birmingham, USA
| | - M C Nevitt
- University of California San Francisco, San Francisco, USA
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA
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Sisante JF, Wang N, Felson DT, Nevitt MC, Lewis CE, Frey-Law L, Segal NA. Influence of Antagonistic Hamstring Coactivation on Measurement of Quadriceps Strength in Older Adults. PM R 2020; 12:470-478. [PMID: 31585496 PMCID: PMC8016551 DOI: 10.1002/pmrj.12253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2018] [Accepted: 08/06/2019] [Indexed: 11/08/2022]
Abstract
BACKGROUND There is limited understanding of how antagonist muscle coactivation relates to measurement of strength in both individuals with and without knee osteoarthritis (KOA). OBJECTIVE This study sought to determine whether hamstring coactivation during a maximal quadriceps activation task attenuates net quadriceps strength. DESIGN Cross-sectional cohort analysis was conducted using data from the 60-month visit of the Multicenter Osteoarthritis Study (MOST). SETTING Laboratory. PARTICIPANTS A sample of 2328 community-dwelling MOST participants between the ages of 55 and 84 years, with or at elevated risk for KOA, completed the 60-month MOST follow-up visit. Of these, 1666 met inclusion criteria for the current study. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Quadriceps strength; percentage of combined hamstring coactivation (HC), medial HC, and lateral HC. Quadriceps and hamstring strength were assessed using an isokinetic dynamometer. Surface electromyography was used to assess muscle activation patterns. General linear models, adjusted for age, BMI, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Kellgren-Lawrence (KL) grade and study site, modeled the relationship between antagonist hamstring coactivation and quadriceps strength. RESULTS Men had significantly greater quadriceps strength (P < .001), history of knee injury (P < .001) and surgery (P = .002), and greater presence of varus malalignment (P < .001). Women had greater pain (P < .001) and proportion of KL grade ≥2 (P = .017). Gender-specific analyses revealed combined HC (P = .013) and lateral HC inversely associated with quadriceps strength in women (P = .023) but not in men (combined HC P = .320, lateral HC P = .755). A nonlinear association was detected between quadriceps strength and medial HC. Assessment of quartiles of medial HC revealed the third quartile had reduced quadriceps strength when compared to the lowest quartile of coactivation in both men and women. CONCLUSIONS Hamstring coactivation attenuates measured quadriceps strength in women with or at elevated risk for KOA. LEVEL OF EVIDENCE II.
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Affiliation(s)
| | - Na Wang
- Boston University, Boston, MA, United States
| | | | - Michael C. Nevitt
- University of California San Francisco, San Francisco, CA, United States
| | - Cora E. Lewis
- University of Alabama at Birmingham, Birmingham, AL, United States
| | | | - Neil A. Segal
- The University of Kansas, Kansas City, KS, United States
- The University of Iowa, Iowa City, IA, United States
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Heronemus MJ, Rabe K, Tolstykh I, Gross KD, Wise BL, Nevitt MC, Lewis CE, Hillstrom HJ, Segal NA. The Association of Parity with Greater Dynamic Pronation of the Feet. PM R 2020; 13:144-152. [PMID: 32281293 DOI: 10.1002/pmrj.12381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 04/02/2020] [Accepted: 04/06/2020] [Indexed: 11/07/2022]
Abstract
BACKGROUND Postpartum women are at increased risk for lower limb musculoskeletal disorders. Foot arch collapse following pregnancy has been reported as a mechanism for this increased risk. However, dynamic changes during gait in postpartum women have not been reported. Therefore, we assessed the association between parity and dynamic foot pronation during gait. OBJECTIVE To determine (1) if there is an association between parity and dynamic foot pronation (center of pressure excursion index, CPEI) during gait; and (2) the extent to which there is a dose-effect of parity on foot pronation. DESIGN The Multicenter Osteoarthritis Study (MOST) Study is a longitudinal cohort study of adults with or at risk for knee osteoarthritis (OA). SETTING Two communities in the United States, Birmingham, Alabama and Iowa City, Iowa. INTERVENTIONS Not applicable PARTICIPANTS: A population-based sample of 1177 MOST participants who were female, had complete CPEI and parity data and completed the baseline, 30- and 60-month visits. MAIN OUTCOME MEASURES Odds of a one quintile decrease in CPEI by parity group and mean CPEI by parity group. RESULTS In 1177 women, mean age was 67.7 years and mean body mass index (BMI) was 30.6 kg/m2 . As parity increased, there was significantly greater foot pronation, lower mean CPEI: 19.1 (18.2-20.1), 18.9 (18.4-19.4), 18 (17.5-18.6) to 17.5 (16.4-18.6) in the 0 to 4 and >5 children groups, respectively; (P = .002), which remained significant after adjusting for race and clinic site (P = .005). There was a positive linear trend (β = 1.08, 1.03-1.14) in odds ratios of a one quintile decrease in CPEI (greater pronation) with increasing parity level (P = .004), which remained significant after adjusting for race and clinic site (P = .01). After adjusting for age and BMI, these two associations were no longer statistically significant. CONCLUSIONS This study indicates a positive correlation between parity and greater dynamic pronation of the feet.
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Affiliation(s)
- Marc J Heronemus
- Rehabilitation Medicine, The University of Kansas, Kansas City, KS, USA.,Physical Medicine and Rehabilitation, The University of Colorado, Aurora, CO, USA
| | - Kaitlin Rabe
- Rehabilitation Medicine, The University of Kansas, Kansas City, KS, USA.,Bioengineering, The University of Texas at Dallas, Richardson, TX, USA
| | - Irina Tolstykh
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - K Douglas Gross
- Physical Therapy, Massachusetts General Hospital Institute of Health Professions, Boston, MA, USA
| | - Barton L Wise
- Internal Medicine, Rheumatology, University of California Davis, Davis, CA, USA
| | - Michael C Nevitt
- Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Cora E Lewis
- Medicine, Preventive Medicine, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Howard J Hillstrom
- Rehabilitation Department, Hospital for Special Surgery, New York, NY, USA
| | - Neil A Segal
- Rehabilitation Medicine, The University of Kansas, Kansas City, KS, USA.,Epidemiology, The University of Iowa, Iowa City, IA, USA
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Hart HF, Gross KD, Crossley KM, Barton CJ, Felson DT, Guermazi A, Roemer F, Segal NA, Lewis CE, Nevitt MC, Stefanik JJ. Step Rate and Worsening of Patellofemoral and Tibiofemoral Joint Osteoarthritis in Women and Men: The Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2020; 72:107-113. [PMID: 30821927 PMCID: PMC6717684 DOI: 10.1002/acr.23864] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Accepted: 02/26/2019] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the association of self-selected walking step rate with worsening of cartilage damage in the patellofemoral (PF) joint and tibiofemoral (TF) joint compartments at a 2-year follow-up visit. METHODS The Multicenter Osteoarthritis Study (MOST) is a prospective cohort of men and women with or at risk of knee osteoarthritis. Self-selected step rate was measured using an instrumented GAITRite walkway (CIR Systems) at the 60-month visit. Cartilage damage was semiquantitatively graded on magnetic resonance images at the 60- and 84-month visits in the medial and lateral PF and TF compartments. Step rate was divided into quartiles, and logistic regression was used to determine the association of step rate with the risk of worsening cartilage damage in men and women separately. Analyses were adjusted for age, body mass index, and knee injury/surgery. RESULTS A total of 1,089 participants were included. Mean ± SD age was 66.9 ± 7.5 years, mean ± SD body mass index was 29.6 ± 4.7 kg/m2 , and 62.3% of the participants were women. Women with the lowest step rate had increased risk of lateral PF (risk ratio [RR] 2.1 [95% confidence interval (95% CI) 1.1-3.8]) and TF (RR 1.8 [95% CI 1.1-2.9]) cartilage damage worsening 2 years later compared to those with the highest step rate. Men with the lowest step rate had increased risk of medial TF cartilage damage worsening 2 years later (RR 2.1 [95% CI 1.1-3.9]). CONCLUSION Lower step rate was associated with increased risk of cartilage damage worsening in the lateral PF and TF compartments in women and worsening medial TF joint damage in men. Future research is necessary to understand the influence of step rate manipulation on joint biomechanics in women and men.
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Affiliation(s)
- Harvi F. Hart
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, Australia
- Faculty of Health Sciences and Bone and Joint Institute, The University of Western Ontario, Ontario, Canada
| | - K. Douglas Gross
- Massachusetts General Hospital Institute of Health Professions, Charlestown, Massachusetts, USA
| | - Kay M. Crossley
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, Australia
| | - Christian J. Barton
- La Trobe Sport and Exercise Medicine Research Centre, La Trobe University, Victoria, Australia
| | | | - Ali Guermazi
- Boston University, School of Medicine, Massachusetts, USA
| | - Frank Roemer
- University of Erlangen-Nuremberg, Erlangen, Germany
| | - Neil A. Segal
- University of Kansas Medical Center, Kansas City, Kansas, USA
- The University of Iowa, Iowa City, Iowa, USA
| | | | | | - Joshua J. Stefanik
- Boston University, School of Medicine, Massachusetts, USA
- Department of Physical Therapy, Movement, and Rehabilitation Sciences, Northeastern University, Boston, USA
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Rogers-Soeder TS, Lane NE, Walimbe M, Schwartz AV, Tolstykh I, Felson DT, Lewis CE, Segal NA, Nevitt MC. Association of Diabetes Mellitus and Biomarkers of Abnormal Glucose Metabolism With Incident Radiographic Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:98-106. [PMID: 30418707 PMCID: PMC6511494 DOI: 10.1002/acr.23809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The association of diabetes mellitus (DM) with increased risk of knee osteoarthritis (OA) is uncertain. We evaluated associations of DM and biomarkers of abnormal glucose metabolism with incident radiographic knee OA, controlling for body mass index (BMI). METHODS Participants (mean ± SD age 60.6 ± 7.8 years; mean ± SD body mass index [BMI] 29.1 ± 4.9 kg/m2 ) were from the Multicenter Osteoarthritis Study and did not have radiographic knee OA at baseline (Kellgren/Lawrence [K/L] grade <2 bilaterally). A random sample (n = 987) was selected and stratified by BMI. Baseline serum fasting glucose and homeostasis model assessment-estimated insulin resistance (HOMA-IR) were measured. Participants were categorized as having DM based on self-report, use of medication, or fasting glucose ≥126 mg/dl. Incident radiographic knee OA (K/L grade ≥2 or knee replacement) was assessed at 3 follow-up visits (30, 60, and 84 months). Knee-level pooled logistic regression analysis was performed to obtain odds ratios (ORs) (95% confidence interval [95% CI]) for associations of DM status and biomarkers of abnormal glucose metabolism with incident radiographic knee OA. RESULTS After adjustment for BMI, the odds of incident radiographic knee OA were not associated with baseline DM status nor with levels of fasting glucose and HOMA-IR, overall and in men. In women, HOMA-IR was inversely associated with odds of incident radiographic knee OA (adjusted OR 0.80 [95% CI 0.69-0.94], P = 0.005). CONCLUSION DM and higher levels of biomarkers of abnormal glucose metabolism were not associated with increased odds of incident radiographic knee OA after adjusting for BMI in this cohort overall. A possible protective association of higher HOMA-IR with incident radiographic knee OA in women warrants further investigation.
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Affiliation(s)
- Tara S. Rogers-Soeder
- Center for Musculoskeletal Health, Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, USA
| | - Nancy E. Lane
- Center for Musculoskeletal Health, Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Mona Walimbe
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ann V. Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Irina Tolstykh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - David T. Felson
- Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA
- University of Manchester and Central Manchester Foundation Trust, Manchester, UK
| | - Cora E. Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, KS, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Kothari MD, Rabe KG, Anderson DD, Nevitt MC, Lynch JA, Segal NA, Franz H. The Relationship of Three-Dimensional Joint Space Width on Weight Bearing CT With Pain and Physical Function. J Orthop Res 2019; 38:10.1002/jor.24566. [PMID: 31840831 PMCID: PMC8016550 DOI: 10.1002/jor.24566] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2019] [Accepted: 12/04/2019] [Indexed: 02/04/2023]
Abstract
Limitations of plain radiographs may contribute to poor sensitivity in the detection of knee osteoarthritis and poor correlation with pain and physical function. 3D joint space width, measured from weight bearing CT images, may yield a more accurate correlation with patients' symptoms. We assessed the cross-sectional association between 3D joint space width and self-reported pain and physical function. 528 knees (57% women) were analyzed from Multicenter Osteoarthritis Study participants. An upright weight bearing CT scanner was used to acquire bilateral, weight-bearing fixed-flexion images of the knees. A 3D dataset was reconstructed from cone beam projections and joint space width was calculated across the joint surface. The percentages of the apposed medial tibiofemoral joint surface with joint space width <2.0mm and <2.5mm respectively were calculated. Pain and physical function were measured using Western Ontario and McMaster Universities Osteoarthritis Index. Participants who reported greater pain severity tended to have a greater joint area with joint space width <2.0mm (p=.07 for the highest vs. the lowest tertile). Participants who reported greater functional limitations had a greater joint area with joint space width <2.0mm (p=.02 for the highest vs. the lowest tertile). There appears to be an association between the medial tibiofemoral area with joint space width <2.0mm and pain and physical function. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Mayank Dineshkumar Kothari
- The University of Kansas, Kansas City, 3901 Rainbow Boulevard, Mailstop 1046; KUMC Department of Rehabilitation Medicine, Kansas City, KS, 66160
| | - Kaitlin G Rabe
- The University of Texas at Dallas, 800 West Campbell Rd, BSB 11 Richardson, Richardson, TX, 75080
| | | | - Michael C Nevitt
- The University of California, San Francisco, San Francisco, 550 16th St, 2nd Floor, UCSF Dept of Epidemiology & Biostatistics, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94143
| | - John A Lynch
- The University of California, San Francisco, San Francisco, 550 16th St, 2nd Floor, UCSF Dept of Epidemiology & Biostatistics, Mission Hall: Global Health & Clinical Sciences Building, San Francisco, CA, 94143
| | - Neil A Segal
- The University of Kansas, Kansas City, 3901 Rainbow Boulevard, Mailstop 1046; KUMC Department of Rehabilitation Medicine, Kansas City, KS, 66160
| | - Hayden Franz
- The University of Kansas, Kansas City, 3901 Rainbow Boulevard, Mailstop 1046; KUMC Department of Rehabilitation Medicine, Kansas City, KS, 66160
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Culvenor AG, Segal NA, Guermazi A, Roemer F, Felson DT, Nevitt MC, Lewis CE, Stefanik JJ. Sex-Specific Influence of Quadriceps Weakness on Worsening Patellofemoral and Tibiofemoral Cartilage Damage: A Prospective Cohort Study. Arthritis Care Res (Hoboken) 2019; 71:1360-1365. [PMID: 30295439 PMCID: PMC6453735 DOI: 10.1002/acr.23773] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 10/02/2018] [Indexed: 01/05/2023]
Abstract
OBJECTIVE Reports on quadriceps weakness as a risk factor for incident and progressive knee osteoarthritis are conflicting, potentially due to differing effects of muscle strength on patellofemoral and tibiofemoral compartments. This study aimed to examine the sex-specific relation of quadriceps strength to worsening patellofemoral and tibiofemoral cartilage damage over 84 months. METHODS The Multicenter Osteoarthritis Study is a cohort study of individuals with or at risk for knee osteoarthritis. Maximal quadriceps strength was assessed at baseline. Cartilage damage was semiquantitatively assessed by magnetic resonance imaging at baseline and 84-month follow-up using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Worsening patellofemoral and tibiofemoral cartilage damage was defined as any WORMS score increase in each subregion within medial and lateral compartments separately. Logistic regression with generalized estimating equations was used to assess the sex-specific relation of quadriceps strength to worsening cartilage damage. RESULTS A total of 1,018 participants (mean ± SD age 61 ± 8 years, and mean ± SD body mass index 29.3 ± 4.5 kg/m2 ; 64% female) were included. Quadriceps weakness increased the risk of worsening lateral patellofemoral cartilage damage in women (risk ratio for lowest versus highest quartile of strength 1.50 [95% confidence interval 1.03-2.20]; P = 0.007 for linear trend) but not in men. There was generally no association between quadriceps weakness and worsening cartilage damage in the medial or lateral tibiofemoral compartment for either women or men. CONCLUSION Low quadriceps strength increased the risk of worsening cartilage damage in the lateral patellofemoral joint of women, suggesting that optimizing quadriceps strength may help prevent worsening of structural damage in the patellofemoral joint in women.
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Affiliation(s)
- Adam G. Culvenor
- Paracelsus Medical University Salzburg and Nuremburg, Salzburg, Austria, and La Trobe University School of Allied HealthBundooraVictoriaAustralia
| | - Neil A. Segal
- University of Iowa, Iowa City, and University of KansasKansas City
| | - Ali Guermazi
- Boston University School of MedicineBostonMassachusetts
| | - Frank Roemer
- Boston University School of Medicine, Boston, Massachusetts, and University of Erlangen‐NuremburgErlangenGermany
| | - David T. Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester and Central Manchester NHS Foundation TrustManchesterUK
| | | | | | - Joshua J. Stefanik
- Boston University School of Medicine, Boston, Massachusetts, and University of DelawareNewark
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Bacon KL, Segal NA, Øiestad BE, Lewis CE, Nevitt MC, Brown C, LaValley MP, McCulloch CE, Felson DT. Thresholds in the Relationship of Quadriceps Strength With Functional Limitations in Women With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:1186-1193. [PMID: 30156759 PMCID: PMC6395532 DOI: 10.1002/acr.23740] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 08/21/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To investigate thresholds of strength below which individuals with knee osteoarthritis (OA) may have more difficulty carrying out physical functions of daily life. Individuals below such thresholds might benefit more from strengthening interventions than those with greater strength. METHODS We studied individuals with symptomatic OA at baseline in the Multicenter Osteoarthritis Study who had knee extensor strength measured isokinetically at 60º/second. Participants underwent a 20-meter walk test and a sit-to-stand test and answered questions from the Western Ontario and McMaster Universities Osteoarthritis Index. Physical function results were plotted against measures of quadriceps strength (Nm) (and as strength:body weight) for the worst knee. Loess technique was used to examine inflection points. Nonlinear relationships were examined in piecewise linear regression models. Differences were tested using linear and logistic regression models. RESULTS The study had 834 participants (65.8% women). The mean ± SD age of the participants was 62.9 ± 7.9 years. In women, there were thresholds of strength below which the slope of strength versus function was steeper: walking speed (<58 Nm), chair stand time (<32 Nm), and the McMaster Universities Osteoarthritis Index functions of rising from a chair and getting on/off the toilet (<38 Nm). We found no thresholds in men. Loess analyses using strength:weight showed similar results. CONCLUSION In individuals with symptomatic knee OA, thresholds in the strength function relationship may help identify individuals, especially women, at the brink of disability insofar as strength and capacity for daily tasks. In those with low strength, small increments in strength may be associated with improvement in function and greater ease with common daily life, emphasizing the importance of preventing loss of strength.
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Affiliation(s)
| | | | | | | | | | - Carrie Brown
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - David T. Felson
- Boston University, Boston, Massachusetts and NIHR Manchester Musculoskeletal Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, UK
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Johnson C, Sisante JF, Alm J, Smith M, Segal NA. Cryoneurolysis for the Treatment of Lateral Femoral Cutaneous Nerve Pain: A Case Report. PM R 2019; 12:423-424. [PMID: 31397972 DOI: 10.1002/pmrj.12234] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022]
Affiliation(s)
- Ciara Johnson
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Jason-Flor Sisante
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - John Alm
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - McCasey Smith
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, KS
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Bacon KL, Segal NA, Øiestad BE, Lewis CE, Nevitt MC, Brown C, Felson DT. Concurrent Change in Quadriceps Strength and Physical Function Over Five Years in the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2019; 71:1044-1051. [PMID: 30221484 PMCID: PMC6421097 DOI: 10.1002/acr.23754] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2017] [Accepted: 08/21/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Quadriceps weakness, associated with functional limitations, is a target of treatment of knee osteoarthritis (OA). Limited data exist on the relationship between modest strength increases and improvements in function. The aim of this study was to evaluate concurrent change in strength and physical function over 5 years. METHODS Among subjects from the Multicenter Osteoarthritis (MOST) study, we excluded those with knee replacement after baseline. A 3-category variable defined whether, at 5 years, knee extensor strength increased, decreased, or remained within 15% of baseline, a clinically important cut-off. The outcomes were the 5-times sit-to-stand test, 20-meter walk test, Western Ontario and McMaster Universities Osteoarthritis (WOMAC) physical function score, and 3 individual physical functions from WOMAC: arising from a chair, going up stairs, and getting on/off toilet. Linear and logistic models, stratified by sex, evaluated associations between change in strength and change in physical function over 5 years. To compare weaker versus stronger women, we stratified analyses at 56 Nm baseline strength. RESULTS Among 1,534 participants (60.6% women), 22% of men and 30% of women increased strength by at least 15% at 5 years. Compared with women whose strength did not change, women whose strength increased had improved chair stand performance (odds ratio 2.27 [95% confidence interval 1.56, 3.30]) but no improvement in other functions. In men, an increase in strength was not associated with significant improvement in physical function. Similar results were observed for a 20% or 30% increase. CONCLUSION Modest improvement in quadriceps strength was associated with improved chair stand performance in women but not in men. Most functions did not improve with an increase in strength, and targeted interventions may be required to improve functional status.
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Affiliation(s)
| | - Neil A. Segal
- University of Kansas Medical Center, Kansas City, Kansas and The
University of Iowa, Iowa City, Iowa
| | | | | | | | - Carrie Brown
- Boston University School of Medicine, Boston, Massachusetts
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36
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Kim C, Nevitt M, Guermazi A, Niu J, Clancy M, Tolstykh I, Jungmann PM, Lane NE, Segal NA, Harvey WF, Lewis CE, Felson DT. Brief Report: Leg Length Inequality and Hip Osteoarthritis in the Multicenter Osteoarthritis Study and the Osteoarthritis Initiative. Arthritis Rheumatol 2019; 70:1572-1576. [PMID: 29700988 DOI: 10.1002/art.40537] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2018] [Accepted: 04/19/2018] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Studies suggest that persons with a leg length inequality (LLI) of ≥2 cm have an increased risk of developing knee osteoarthritis (OA) in that limb. The present study was undertaken to examine whether LLI also confers an increased risk of hip OA. METHODS Using long limb radiographs from subjects in the Multicenter Arthritis Study (MOST) and the Osteoarthritis Initiative (OAI), we measured LLI and scored hip radiographs that were obtained at baseline and 3-5-year follow-up. The associations of LLI of ≥1 cm and LLI of ≥2 cm with radiographic hip OA were examined cross-sectionally and longitudinally, assessing risk in shorter limbs and longer limbs compared to limbs from subjects with no LLI. We carried out logistic regression analyses with generalized estimating equations and adjusted for age, sex, body mass index, height, and cohort of origin. RESULTS There were 1,966 subjects from the MOST and 2,627 subjects from the OAI. Twelve percent had LLI of ≥1 cm and 1% had LLI of ≥2 cm. For LLI ≥1 cm, the adjusted odds ratio for prevalent hip OA in the shorter leg was 1.47 (95% confidence interval [95% CI] 1.07-2.02) and for LLI ≥2 cm, it was 2.15 (95% CI 0.87-5.34). For LLI ≥1 cm, the odds of incident hip OA in the shorter leg were 1.39 (95% CI 0.81-2.39) while for LLI ≥2 cm, they were 4.20 (95% CI 1.26-14.03). We found no increased risk of hip OA in longer limbs. CONCLUSION Our findings suggest that, as with knee OA, legs that are at least 2 cm shorter than the contralateral leg are at increased risk of hip OA.
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Affiliation(s)
- Chan Kim
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Pia M Jungmann
- University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City
| | | | | | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and NIHR Manchester Musculoskeletal Biomedical Research Centre, University of Manchester, Manchester, UK
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Carlesso LC, Segal NA, Frey-Law L, Zhang Y, Na L, Nevitt M, Lewis CE, Neogi T. Pain Susceptibility Phenotypes in Those Free of Knee Pain With or at Risk of Knee Osteoarthritis: The Multicenter Osteoarthritis Study. Arthritis Rheumatol 2019; 71:542-549. [PMID: 30307131 PMCID: PMC6442725 DOI: 10.1002/art.40752] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2018] [Accepted: 10/03/2018] [Indexed: 01/25/2023]
Abstract
OBJECTIVE It is not clear why some individuals develop pain with knee osteoarthritis (OA). We undertook this study to identify pain susceptibility phenotypes (PSPs) and their relationship to incident persistent knee pain (PKP) 2 years later. METHODS We identified individuals free of PKP from the Multicenter Osteoarthritis Study, a longitudinal cohort of older adults with or at risk of knee OA. Latent class analysis was used to determine PSPs that may contribute to development of PKP apart from structural pathology. These included widespread pain, poor sleep, and psychological factors as well as pressure pain threshold and temporal summation (TS) as determined by quantitative sensory testing (QST). We used logistic regression to evaluate the association of sociodemographic factors with PSPs and the relationship of PSPs to the development of PKP over 2 years. RESULTS A total of 852 participants were included (mean age 67 years, body mass index 29.5 kg/m2 , 55% women). Four PSPs were identified, primarily characterized by varying proportions (low/absent, moderate, or high) of the presence of pressure pain sensitivity and of facilitated TS, reflecting different measures of sensitization. Subjects in the PSP with a high proportion of pressure pain sensitivity and a moderate proportion of facilitated TS were twice as likely to develop incident PKP over 2 years (odds ratio 1.98 [95% confidence interval 1.07-3.68]) compared with subjects in the PSP having a low proportion of sensitization by both measures. CONCLUSION Four PSPs were identified, 3 of which were predominated by QST evidence of sensitization and 1 of which was associated with developing PKP 2 years later. Prevention or amelioration of sensitization may be a novel approach to preventing onset of PKP in OA.
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Affiliation(s)
- Lisa C. Carlesso
- School of Rehabilitation, Université de Montréal,
Hôptial Maisonneuve Rosemont Research Institute, Montréal,
Canada
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical
Center, Kansas City, USA
| | - Laura Frey-Law
- Department of Physical Therapy and Rehabilitation Science, College
of Medicine, University of Iowa, Iowa city, USA
| | - Yuqing Zhang
- Clinical Epidemiology Research Training Unit, Boston University
School of Medicine, Boston, USA
| | - Lu Na
- Clinical Epidemiology Research Training Unit, Boston University
School of Medicine, Boston, USA
| | - Michael Nevitt
- Department of Epidemiology and Biostatistics, University of
California at San Francisco, San Francisco, USA
| | - Core E. Lewis
- Division of Preventive Medicine, University of Alabama at
Birmingham, School of Medicine, Birmingham, USA
| | - Tuhina Neogi
- Clinical Epidemiology Research Training Unit, Boston University
School of Medicine, Boston, USA
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Kedgley AE, Saw TH, Segal NA, Hansen UN, Bull AMJ, Masouros SD. Predicting meniscal tear stability across knee-joint flexion using finite-element analysis. Knee Surg Sports Traumatol Arthrosc 2019; 27:206-214. [PMID: 30097687 PMCID: PMC6510819 DOI: 10.1007/s00167-018-5090-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2017] [Accepted: 07/31/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE To analyse the stress distribution through longitudinal and radial meniscal tears in three tear locations in weight-bearing conditions and use it to ascertain the impact of tear location and type on the potential for healing of meniscal tears. METHODS Subject-specific finite-element models of a healthy knee under static loading at 0°, 20°, and 30° knee flexion were developed from unloaded magnetic resonance images and weight-bearing, contrast-enhanced computed tomography images. Simulations were then run after introducing tears into the anterior, posterior, and midsections of the menisci. RESULTS Absolute differences between the displacements of anterior and posterior segments modelled in the intact state and those quantified from in vivo weight-bearing images were less than 0.5 mm. There were tear-location-dependent differences between hoop stress distributions along the inner and outer surfaces of longitudinal tears; the longitudinal tear surfaces were compressed together to the greatest degree in the lateral meniscus and were most consistently in compression on the midsections of both menisci. Radial tears resulted in an increase in stress at the tear apex and in a consistent small compression of the tear surfaces throughout the flexion range when in the posterior segment of the lateral meniscus. CONCLUSIONS Both the type of meniscal tear and its location within the meniscus influenced the stresses on the tear surfaces under weight bearing. Results agree with clinical observations and suggest reasons for the inverse correlation between longitudinal tear length and healing, the inferior healing ability of medial compared with lateral menisci, and the superior healing ability of radial tears in the posterior segment of the lateral meniscus compared with other radial tears. This study has shown that meniscal tear location in addition to type likely plays a crucial role in dictating the success of non-operative treatment of the menisci. This may be used in decision making regarding conservative or surgical management.
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Affiliation(s)
- Angela E. Kedgley
- Department of Bioengineering, Imperial College London, Royal School of Mines Building, South Kensington Campus, London, SW7 2AZ UK
| | - Teng-Hui Saw
- Department of Bioengineering, Imperial College London, Royal School of Mines Building, South Kensington Campus, London, SW7 2AZ UK
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Boulevard, Kansas City, KS 66160 USA
| | - Ulrich N. Hansen
- Department of Mechanical Engineering, Imperial College London, City and Guilds Building, South Kensington Campus, London, SW7 2AZ UK
| | - Anthony M. J. Bull
- Department of Bioengineering, Imperial College London, Royal School of Mines Building, South Kensington Campus, London, SW7 2AZ UK
| | - Spyros D. Masouros
- Department of Bioengineering, Imperial College London, Royal School of Mines Building, South Kensington Campus, London, SW7 2AZ UK
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Steidle-Kloc E, Rabe K, Eckstein F, Wirth W, Glass NA, Segal NA. Is muscle strength in a painful limb affected by knee pain status of the contralateral limb? - Data from the Osteoarthritis Initiative. Ann Anat 2018; 221:68-75. [PMID: 30240905 DOI: 10.1016/j.aanat.2018.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 07/27/2018] [Accepted: 08/21/2018] [Indexed: 11/18/2022]
Abstract
Contralateral knee pain has been suggested to be associated with muscle weakness in a pain-free knee, potentially through a mechanism of central nervous inhibition. Whether contralateral knee pain also affects muscle strength in a painful knee, however, is unknown. Here we study the extent to which isometric muscle strength differs between matched painful limbs of people with unilateral knee pain vs. matched painful limbs people with bilateral knee pain. To that end, 163 participants with unilateral knee pain were identified from the Osteoarthritis Initiative. Unilaterally painful (UP) limbs were defined as having numerical rating scale (NRS) ≥4/10, infrequent/frequent pain in the painful limb, while contralateral pain-free limbs were defined by NRS=0-1, no/infrequent pain and Western Ontario and McMaster Universities Arthritis Index (WOMAC) ≤1. The comparator group were matched bilaterally painful (BP) limbs. Maximum isometric muscle strength (N) was compared between 1:1 matched BP and UP limbs. Extensor strength was found to be lower in BP limbs than in UP limbs, (-2.9%; p=0.39) but this difference was not statistically significant. Extensor strength was significantly lower in the UP vs. contralateral pain-free limbs (-6.2%; p<0.001). No differences were observed between BP and contralateral painful limbs (0.6%; p=0.87). In conclusion, the current results identify a slight reduction of maximum knee extensor strength in a painful limb, when the contralateral knee is also painful. In contrast to pain-free limbs, this effect did not reach statistical significance, but the overall findings support the concept of central nervous inhibition of muscle strength by contralateral knee pain.
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Affiliation(s)
- Eva Steidle-Kloc
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria.
| | - Kaitlin Rabe
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, Kansas, United States
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
| | - Wolfgang Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria
| | - Natalie A Glass
- Department of Orthopedics and Rehabilitation, University of Iowa, Iowa City, Iowa, United States
| | - Neil A Segal
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, Kansas, United States
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Rabe KG, Matsuse H, Jackson A, Segal NA. Evaluation of the Combined Application of Neuromuscular Electrical Stimulation and Volitional Contractions on Thigh Muscle Strength, Knee Pain, and Physical Performance in Women at Risk for Knee Osteoarthritis: A Randomized Controlled Trial. PM R 2018; 10:1301-1310. [PMID: 29852286 DOI: 10.1016/j.pmrj.2018.05.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2017] [Revised: 04/18/2018] [Accepted: 05/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Knee osteoarthritis (OA) is a leading cause of disability that is associated with quadriceps weakness. However, strengthening in people with or with risk factors for knee OA can be poorly tolerated. OBJECTIVE To assess the efficacy of a 12-week low-load exercise program, using a hybrid training system (HTS) that uses the combination of neuromuscular electrical stimulation and volitional contractions, for improving thigh muscle strength, knee pain relief, and physical performance in women with or with risk factors for knee OA. DESIGN Randomized, single-blinded, controlled trial. SETTING Exercise training laboratory. PARTICIPANTS Forty-two women 44-85 years old with risk factors for knee OA. INTERVENTIONS Participants randomized to 12 weeks of biweekly low-load resistance training with the HTS or on an isokinetic dynamometer (control). OUTCOMES Maximum isokinetic knee extensor torque. Secondary measures included maximum isokinetic knee flexor torque, knee pain (Knee Injury and Osteoarthritis Outcome Score), and timed 20-m walk and chair stand tests. RESULTS The HTS and control treatments resulted in muscle strengthening, decreased knee pain, and improved physical performance. HTS group quadriceps and hamstring strength increased by 0.06 ± 0.04 Nm/kg (P > .05) and 0.05 ± 0.02 Nm/kg (P = .02), respectively. Control group quadriceps and hamstring strength increased by 0.03 ± 0.04 Nm/kg (P > .05) and 0.06 ± 0.02 Nm/kg (P = .009), respectively. Knee pain decreased by 11.9 ± 11.5 points (P < .001) for the HTS group and 14.1 ± 15.4 points (P = .001) for the control group. The 20-m walk time decreased by 1.60 ± 2.04 seconds (P = .005) and 0.95 ± 1.2 seconds (P = .004), and chair stand time decreased by 4.8 ± 10.0 seconds (P > .05) and 1.9 ± 4.7 seconds (P > .05) in the HTS and control groups, respectively. These results did not differ statistically between the HTS and control groups. CONCLUSIONS These results suggest the HTS is effective for alleviating pain and improving physical performance in women with risk factors for knee OA. However, the HTS does not appear to be superior to low-load resistance training for improving muscle strength, pain relief, or physical function. CLINICAL TRIAL REGISTRATION NUMBER NCT02802878. LEVEL OF EVIDENCE I.
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Affiliation(s)
- Kaitlin G Rabe
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS(∗)
| | - Hiroo Matsuse
- Department of Orthopedics, Kurume University School of Medicine, Kurume, Fukuoka, Japan(†)
| | - Anthony Jackson
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS(‡)
| | - Neil A Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, MS 1046, Kansas City, KS 66160(§).
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Vaughan MW, LaValley MP, Felson DT, Orsmond GI, Niu J, Lewis CE, Segal NA, Nevitt MC, Keysor JJ. Affect and Incident Participation Restriction in Adults With Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2018; 70:542-549. [PMID: 28686817 DOI: 10.1002/acr.23308] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 06/27/2017] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Participation restriction, common among people with knee osteoarthritis (OA), may be influenced by affect. We examined the risk of incident participation restriction over 84 months conferred by positive and negative affect among people with knee OA. METHODS Participants were from the Multicenter Osteoarthritis Study and had or were at high risk of knee OA. Participation restriction was measured using the Instrumental Role Limitation subscale of the Late-Life Disability Index, and affect was measured using the positive affect and depressed mood subscales of the Center for Epidemiologic Studies Depression Scale. Robust Poisson regression was used to calculate the risk of incident participation restriction over 84 months conferred by combinations of low and high positive and negative affect, adjusting for covariates. RESULTS Of 1,810 baseline participants (mean age 62.1 years, 56% female), 470 (26%) had incident participation restriction over 84 months. Participants with low positive affect had 20% greater risk of incident participation restriction than those with high positive affect; participants with high negative affect had 50% greater risk of incident participation restriction compared to those with low negative affect. Participants with both low positive and high negative affect had 80% greater risk of incident participation restriction compared to other combinations of positive and negative affect. CONCLUSION Low positive and high negative affect, both alone and in combination, increase the risk of participation restriction among adults with knee OA. Efforts aimed at preventing participation restriction in this population should consider these mood states.
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Affiliation(s)
| | | | | | | | - Jingbo Niu
- Baylor College of Medicine, Houston, Texas
| | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City
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Hu B, Skou ST, Wise BL, Williams GN, Nevitt MC, Segal NA. Lower Quadriceps Rate of Force Development Is Associated With Worsening Physical Function in Adults With or at Risk for Knee Osteoarthritis: 36-Month Follow-Up Data From the Osteoarthritis Initiative. Arch Phys Med Rehabil 2018; 99:1352-1359. [PMID: 29408538 DOI: 10.1016/j.apmr.2017.12.027] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Revised: 11/16/2017] [Accepted: 12/19/2017] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To determine the association between quadriceps rate of force development (RFD) and decline in self-reported physical function and objective measures of physical performance. DESIGN Longitudinal cohort study. SETTING Community-based sample from 4 urban areas. PARTICIPANTS Osteoarthritis Initiative participants with or at risk for knee osteoarthritis, who had no history of knee/hip replacement, knee injury, or rheumatoid arthritis (N=2630). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Quadriceps RFD (N/s) was measured during isometric strength testing. Worsening physical function was defined as the minimal clinically important difference for worsening self-reported Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) physical function subscale score, 20-m walk time, and repeated chair stand time over 36 months. RESULTS Compared with the slowest tertile of RFD, the fastest tertile had a lower risk for worsening of WOMAC physical function subscale score at 36-month follow-up, with an odds ratio (OR) of .68 (95% confidence interval [CI], .51-.92) after adjustment for age, sex, body mass index, depression, history of chronic diseases, and knee pain. In women, in comparison with the slowest tertile of RFD, the fastest tertile had a lower risk for worsening of WOMAC physical function subscale score at 36-month follow-up, with an adjusted OR of .57 (95% CI, .38-.86). This decreased risk did not reach statistical significance in men (OR, 0.81; 95% CI, 0.52-1.27). No statistically significant associations were detected between baseline RFD and walk or chair stand times. CONCLUSIONS Our results indicate that higher RFD is associated with decreased risk for worsening self-reported physical function but not with decreased risk for worsening of physical performance.
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Affiliation(s)
- Bo Hu
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS; School of Public Health and Hebei Province Key Laboratory of Occupational Health and Safety for Coal Industry, North China University of Science and Technology, Tangshan, Hebei Province, China
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Slagelse, Denmark
| | - Barton L Wise
- University of California, Davis School of Medicine, Sacramento, CA
| | - Glenn N Williams
- Physical Therapy and Rehabilitation Sciences, Drexel University, Philadelphia, PA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California-San Francisco, San Francisco, CA
| | - Neil A Segal
- Department of Rehabilitation Medicine, The University of Kansas, Kansas City, KS.
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Nevitt MC, Tolstykh I, Shakoor N, Nguyen USDT, Segal NA, Lewis C, Felson DT. Symptoms of Knee Instability as Risk Factors for Recurrent Falls. Arthritis Care Res (Hoboken) 2017; 68:1089-97. [PMID: 26853236 DOI: 10.1002/acr.22811] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2015] [Revised: 10/02/2015] [Accepted: 12/01/2015] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Whether knee instability contributes to the increased risk of falls and fractures observed in persons with knee osteoarthritis (OA) has not been studied. We examined the association of knee buckling with the risk of falling and fall-related consequences in older adults with, or at high risk for, knee OA. METHODS At the 60-month visit of the Multicenter Osteoarthritis Study, men and women ages 55-84 years were asked about knee buckling in the past 3 months and whether they fell when a knee buckled. Falls and fall-related injuries in the past 12 months and balance confidence were assessed at 60 and 84 months. Multivariate logistic regression was used to assess the association of knee buckling with falls and their consequences. RESULTS A total of 1,842 subjects (59% women, mean ± SD age 66.9 ± 7.8 years, and body mass index 30.3 ± 5.7) were included. At 60 months 16.8% reported buckling and at 84 months 14.1% had recurrent (≥2) falls. Bucklers at 60 months had a 1.6- to 2.5-fold greater odds of recurrent falls, fear of falling, and poor balance confidence at 84 months. Those who fell when a knee buckled at baseline had a 4.5-fold, 2-fold, and 3-fold increased odds 2 years later of recurrent falls, significant fall injuries, and fall injuries that limited activity, respectively, and were 4 times more likely to have poor balance confidence. CONCLUSION Interventions that reduce knee buckling may help prevent falls, fall-related injuries, and adverse psychological consequences of falls in persons with knee OA.
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Affiliation(s)
| | | | | | | | | | | | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and the University of Manchester, Manchester, UK
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Segal NA, Frick E, Duryea J, Nevitt MC, Niu J, Torner JC, Felson DT, Anderson DD. Comparison of tibiofemoral joint space width measurements from standing CT and fixed flexion radiography. J Orthop Res 2017; 35:1388-1395. [PMID: 27504863 PMCID: PMC5299055 DOI: 10.1002/jor.23387] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Accepted: 07/29/2016] [Indexed: 02/04/2023]
Abstract
The objective of this project was to determine the relationship between medial tibiofemoral joint space width measured on fixed-flexion radiographs and the three-dimensional joint space width distribution on low-dose, standing CT (SCT) imaging. At the 84-month visit of the Multicenter Osteoarthritis Study, 20 participants were recruited. A commercial SCT scanner for the foot and ankle was modified to image knees while standing. Medial tibiofemoral joint space width was assessed on radiographs at fixed locations from 15% to 30% of compartment width using validated software and on SCT by mapping the distances between three-dimensional subchondral bone surfaces. Individual joint space width values from radiographs were compared with three-dimensional joint space width values from corresponding sagittal plane locations using paired t-tests and correlation coefficients. For the four medial-most tibiofemoral locations, radiographic joint space width values exceeded the minimal joint space width on SCT by a mean of 2.0 mm and were approximately equal to the 61st percentile value of the joint space width distribution at each respective sagittal-plane location. Correlation coefficients at these locations were 0.91-0.97 and the offsets between joint space width values from radiographs and SCT measurements were consistent. There were greater offsets and variability in the offsets between modalities closer to the tibial spine. Joint space width measurements on fixed-flexion radiographs are highly correlated with three-dimensional joint space width from SCT. In addition to avoiding bony overlap obscuring the joint, a limitation of radiographs, the current study supports a role for SCT in the evaluation of tibiofemoral OA. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:1388-1395, 2017.
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Affiliation(s)
- Neil A. Segal
- Department of Rehabilitation, The University of Kansas (Kansas City, KS)
- Department of Epidemiology, The University of Iowa College of Public Health (Iowa City, IA)
| | - Eric Frick
- Department of Orthopaedics & Rehabilitation, The University of Iowa (Iowa City, IA)
| | - Jeffrey Duryea
- Brigham and Women's Hospital/Harvard Medical School (Boston, MA, USA)
| | - Michael C. Nevitt
- Department of Epidemiology & Biostatistics, University of California, San Francisco (San Francisco, CA)
| | - Jingbo Niu
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine (Boston, MA)
| | - James C. Torner
- Department of Epidemiology, The University of Iowa College of Public Health (Iowa City, IA)
| | - David T. Felson
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine (Boston, MA)
| | - Donald D. Anderson
- Department of Orthopaedics & Rehabilitation, The University of Iowa (Iowa City, IA)
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Segal NA, Frick E, Duryea J, Roemer F, Guermazi A, Nevitt MC, Torner JC, Felson DT, Anderson DD. Correlations of Medial Joint Space Width on Fixed-Flexed Standing Computed Tomography and Radiographs With Cartilage and Meniscal Morphology on Magnetic Resonance Imaging. Arthritis Care Res (Hoboken) 2017; 68:1410-6. [PMID: 26991547 DOI: 10.1002/acr.22888] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/11/2016] [Accepted: 03/15/2016] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To assess whether medial tibiofemoral joint space width (JSW) on 3-dimensional (3-D) standing computed tomography (SCT) correlates more closely with magnetic resonance imaging cartilage morphology (CM) and meniscal scores than does radiographic 2-D JSW. METHODS Participants in the Multicenter Osteoarthritis Study, who had standing fixed-flexion posteroanterior knee radiographs, were recruited. Medial tibiofemoral 3-D JSW on SCT and 2-D JSW on fixed-flexion radiographs were compared with medial tibiofemoral cartilage and meniscal morphology using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations between the area of the articular surface with 3-D JSW <2.5 mm on SCT, radiographic minimal 2-D JSW, and the WORMS-CM and meniscal scores were assessed using Spearman's rho. RESULTS For the 19 participants included (33 knees), mean ± SD age was 66.9 ± 5.4 years, body mass index was 29.5 ± 4.4 kg/m(2) , 42.1% of participants were female, and the Kellgren/Lawrence grades were 0 (21.2%), 1 (36.4%), 2 (18.2%), and 3 (24.2%). The articular surface area with 3-D JSW <2.5 mm on SCT correlated with WORMS-CM scores for the central medial tibia (rs = 0.84, P < 0.001), central medial femur (rs = 0.60, P < 0.007), and posterior medial meniscal tear (rs = 0.39, P < 0.026), as did other cut points for 3-D JSW. Correlations with radiographic minimal 2-D JSW were -0.66, -0.52, and -0.40, respectively, differing from SCT only for tibial cartilage (P = 0.001). CONCLUSION Greater surface area with a low JSW, measured by SCT, correlates more strongly with the severity of tibial cartilage lesions, while correlating with medial femoral cartilage and meniscal damage to a similar extent as radiographic minimal JSW. SCT may enable valid stratification of participants in clinical trials, through quickly and inexpensively characterizing osteoarthritis features.
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Affiliation(s)
- N A Segal
- University of Kansas, Kansas City, and University of Iowa, Iowa City.
| | - E Frick
- University of Iowa, Iowa City
| | - J Duryea
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - F Roemer
- Boston University, Boston, Massachusetts
| | - A Guermazi
- Boston University, Boston, Massachusetts
| | | | | | - D T Felson
- Boston University, Boston, Massachusetts
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Vaughan MW, Felson DT, LaValley MP, Orsmond GI, Niu J, Lewis CE, Segal NA, Nevitt MC, Keysor JJ. Perceived Community Environmental Factors and Risk of Five-Year Participation Restriction Among Older Adults With or at Risk of Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2017; 69:952-958. [PMID: 28129478 DOI: 10.1002/acr.23085] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2016] [Revised: 08/19/2016] [Accepted: 09/06/2016] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Older adults with knee osteoarthritis (OA) who live in environments with mobility barriers may be at greater risk of developing participation restrictions, defined as difficulties in engagement in life situations. We investigated the risk of participation restriction over 5 years due to self-reported environmental features among older adults with knee OA. METHODS Participants from the Multicenter Osteoarthritis (MOST) Study self-reported participation at baseline, 30 months, and 60 months using the instrumental role subscale of the Late Life Disability Index (LLDI). Data on self-reported environmental features were from the Home and Community Environment questionnaire administered in the MOST Knee Pain and Disability study, an ancillary study of MOST. The relative risks (RRs) of developing participation restriction at 60 months, indicated by an LLDI score <67.6 out of a possible 100, due to reported high community mobility barriers and high transportation facilitators, were calculated using robust Poisson regression, adjusting for covariates. RESULTS Sixty-nine of the 322 participants (27%) developed participation restriction by 60 months. Participants reporting high community mobility barriers at baseline had 1.8 times the risk (95% confidence interval [95% CI] 1.2-2.7) of participation restriction at 60 months, after adjusting for covariates. Self-report of high transportation facilitators at baseline resulted in a reduced but statistically nonsignificant risk of participation restriction at 60 months (RR 0.7, 95% CI 0.4-1.1). CONCLUSION Higher perceived environmental barriers impact the risk of long-term participation restriction among older adults with or at risk of knee OA. Approaches aimed at reducing the development of participation restrictions in this population should consider decreasing environmental barriers.
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Affiliation(s)
| | | | | | | | - Jingbo Niu
- Baylor College of Medicine, Houston, Texas
| | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City
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Carlesso LC, Niu J, Segal NA, Frey-Law LA, Lewis CE, Nevitt MC, Neogi T. The Effect of Widespread Pain on Knee Pain Worsening, Incident Knee Osteoarthritis (OA), and Incident Knee Pain: The Multicenter OA (MOST) Study. J Rheumatol 2017; 44:493-498. [PMID: 28250143 PMCID: PMC5468496 DOI: 10.3899/jrheum.160853] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2017] [Indexed: 01/25/2023]
Abstract
OBJECTIVE Whether widespread pain (WSP) affects the risk of developing knee pain or knee osteoarthritis (OA) is unknown and could enhance understanding of pain mechanisms in OA. METHODS Subjects from the Multicenter OA (MOST) study, a US National Institutes of Health-funded prospective cohort of older adults with or at risk of knee OA, were characterized regarding WSP, defined as pain above and below the waist on both sides of the body and axially using a standard homunculus, excluding knee pain at 60 months (baseline). Followup occurred 2 years later. We assessed the relation of WSP to odds of knee pain worsening (≥ 2-point increase in the Western Ontario and McMaster Universities Arthritis Index pain subscale) using logistic regression, and to odds of incident radiographic knee OA (ROA; Kellgren-Lawrence arthritis scale ≥ grade 2 of either knee among those free of ROA at baseline) and incident consistent frequent knee pain (CFKP; knee pain on most days during the past month among participants free of knee pain at baseline) in 1 or both knees using multinomial regression adjusting for potential confounders. RESULTS There were 1752 participants available for analysis [mean age (SD) 67.0 yrs (7.7), body mass index 30.5 kg/m2 (5.9), 59% women]. Baseline presence of WSP was not associated with worsened knee pain (adjusted OR 1.15, 95% CI 0.89-1.48, p = 0.30), ROA (adjusted OR 0.86, 95% CI 0.46-1.63, p = 0.65), or incident CFKP (adjusted OR 1.69, 95% CI 0.96-2.96, p = 0.07). CONCLUSION WSP was not significantly associated with worsening knee pain, incident ROA, or CFKP. Development of knee pain and ROA does not appear to be influenced by underlying WSP.
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Affiliation(s)
- Lisa C Carlesso
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA.
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine.
| | - Jingbo Niu
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Neil A Segal
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Laura A Frey-Law
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Cora E Lewis
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Michael C Nevitt
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Tuhina Neogi
- From the School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute, Montreal, Quebec, Canada; Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, Massachusetts; Department of Rehabilitation Medicine, University of Kansas Medical Center, Kansas City, Kansas; Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa, Iowa City, Iowa; Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine, Birmingham, Alabama; Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
- L.C. Carlesso, BSc PT, MSc PT, PhD, Assistant Professor, School of Rehabilitation, Faculty of Medicine, Université de Montréal, Hôpital Maisonneuve Rosemont Research Institute; J. Niu, DSc, Boston University School of Medicine; N.A. Segal, MD, MS, Department of Rehabilitation Medicine, University of Kansas Medical Center; L.A. Frey-Law, MPT, MS, PhD, Associate Professor, Department of Physical Therapy and Rehabilitation Science, College of Medicine, University of Iowa; C.E. Lewis, MD, MSPH, Division of Preventive Medicine, University of Alabama at Birmingham, School of Medicine; M.C. Nevitt, PhD, Adjunct Professor, Department of Epidemiology and Biostatistics, University of California; T. Neogi, MD, PhD, Associate Professor of Medicine, Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
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Segal NA, Bergin J, Kern A, Findlay C, Anderson DD. Test-retest reliability of tibiofemoral joint space width measurements made using a low-dose standing CT scanner. Skeletal Radiol 2017; 46:217-222. [PMID: 27909787 PMCID: PMC5179299 DOI: 10.1007/s00256-016-2539-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2016] [Revised: 10/21/2016] [Accepted: 11/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the test-retest reliability of knee joint space width (JSW) measurements made using standing CT (SCT) imaging. SUBJECTS AND METHODS This prospective two-visit study included 50 knees from 30 subjects (66% female; mean ± SD age 58.2 ± 11.3 years; BMI 29.1 ± 5.6 kg/m2; 38% KL grade 0-1). Tibiofemoral geometry was obtained from bilateral, approximately 20° fixed-flexed SCT images acquired at visits 2 weeks apart. For each compartment, the total joint area was defined as the area with a JSW <10 mm. The summary measurements of interest were the percentage of the total joint area with a JSW less than 0.5-mm thresholds between 2.0 and 5.0 mm in each tibiofemoral compartment. Test-retest reliability of the summary JSW measurements was assessed by intraclass correlation coefficients (ICC 2,1) for the percentage area engaged at each threshold of JSW and root-mean-square errors (RMSE) were calculated to assess reproducibility. RESULTS The ICCs were excellent for each threshold assessed, ranging from 0.95 to 0.97 for the lateral and 0.90 to 0.97 for the medial compartment. RMSE ranged from 1.1 to 7.2% for the lateral and from 3.1 to 9.1% for the medial compartment, with better reproducibility at smaller JSW thresholds. CONCLUSION The knee joint positioning protocol used demonstrated high day-to-day reliability for SCT 3D tibiofemoral JSW summary measurements repeated 2 weeks apart. Low-dose SCT provides a great deal of information about the joint while maintaining high reliability, making it a suitable alternative to plain radiographs for evaluating JSW in people with knee OA.
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Affiliation(s)
- Neil A. Segal
- Professor, Department of Rehabilitation Medicine, The University of Kansas (Kansas City, KS)
| | | | | | | | - Donald D. Anderson
- Professor, Department of Orthopaedics and Rehabilitation, The University of Iowa (Iowa City, IA)
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Shakoor N, Felson DT, Niu J, Nguyen US, Segal NA, Singh JA, Nevitt MC. The Association of Vibratory Perception and Muscle Strength With the Incidence and Worsening of Knee Instability: The Multicenter Osteoarthritis Study. Arthritis Rheumatol 2016; 69:94-102. [PMID: 27564789 DOI: 10.1002/art.39821] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 07/19/2016] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To examine neuromuscular factors that predict the incidence and progression of knee instability symptoms in older adults with or at high risk of knee osteoarthritis (OA). METHODS At the 60-month clinic visit, participants in the Multicenter Osteoarthritis Study underwent evaluation of quantitative vibratory sense at the knee and isokinetic quadriceps muscle strength. At this 60-month visit, participants were also asked about knee buckling and sensations of knee shifting or slipping without buckling in the past 3 months and then were asked the same questions at the 72- and 84-month follow-up visits. We performed a person-based analysis using Poisson regression analysis with robust error variance to estimate adjusted relative risks (RRs) for the association of vibratory sense and muscle strength with the incidence and worsening of knee slipping/shifting, buckling, and overall knee instability symptoms (either buckling or knee shifting/slipping), with adjustment for relevant confounders. RESULTS A total of 1,803 participants (61% women) were included. Approximately one-third of the participants reported incident or worsening of instability symptoms over the study period. After adjustment for relevant confounders, better vibratory acuity (adjusted RR 0.78, 95% confidence interval [95% CI] 0.56-1.09), P = 0.020 for trend) and greater quadriceps strength (adjusted RR 0.53, 95% CI 0.38-0.75, P < 0.001) protected against incident knee instability symptoms. Greater quadriceps strength (adjusted RR 0.73, 95% CI 0.58-0.92, P = 0.008) also protected against worsening of knee instability symptoms. CONCLUSION Vibratory acuity and quadriceps muscle strength are important predictors of the incidence and worsening of knee instability over 2 years. These neuromuscular factors are potentially modifiable and should be considered in interventional studies of instability in persons with or at risk of knee OA.
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Affiliation(s)
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester, Manchester, UK
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Jasvinder A Singh
- University of Alabama at Birmingham and Birmingham Veterans Affairs Medical Center, Birmingham, Alabama
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50
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Thorlund JB, Felson DT, Segal NA, Nevitt MC, Niu J, Neogi T, Lewis CE, Guermazi A, Roemer F, Englund M. Effect of Knee Extensor Strength on Incident Radiographic and Symptomatic Knee Osteoarthritis in Individuals With Meniscal Pathology: Data From the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2016; 68:1640-1646. [PMID: 26991698 DOI: 10.1002/acr.22889] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2015] [Revised: 02/05/2016] [Accepted: 03/15/2016] [Indexed: 02/03/2023]
Abstract
OBJECTIVE High knee extensor strength may be important to protect against the development of knee osteoarthritis (OA) in populations at elevated risk, such as individuals with meniscal pathology. We investigated the extent to which high knee extensor muscle strength was associated with a decreased risk of developing radiographic or symptomatic knee OA in individuals with medial meniscal pathology. METHODS We studied knees that at the baseline visit of the Multicenter Osteoarthritis Study had medial meniscal pathology but did not have radiographic knee OA (373 knees in 373 participants) or symptomatic knee OA (combination of radiographic knee OA and frequent knee symptoms; 531 knees in 531 participants). Isokinetic knee extensor strength was measured at baseline, and participants were followed for development of incident radiographic knee OA or incident symptomatic knee OA at 84 months. Separate binomial regression analyses with robust SEs adjusted for age, history of knee surgery, physical activity level, and clinic site were conducted for men and women. RESULTS High knee extensor strength (normalized by allometric scaling) was associated with a reduced risk of radiographic knee OA in women (relative risk [RR] 0.52, 95% confidence interval [95% CI] 0.29-0.94) but not in men (RR 0.56, 95% CI 0.27-1.16). High knee extensor strength did not protect against the development of symptomatic knee OA, either in women or men. CONCLUSION The results only partly confirm the hypothesis that high knee extensor muscle strength protects against later development of knee OA in individuals with medial meniscal pathology.
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Affiliation(s)
| | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts
| | | | | | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | - Frank Roemer
- Boston University School of Medicine, Boston, Massachusetts, and University of Erlangen-Nuremberg, Erlangen, Germany
| | - Martin Englund
- Boston University School of Medicine, Boston, Massachusetts, and Lund University, Lund, Sweden
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