Recommendations for the delivery of therapeutic exercise for people with knee and/or hip osteoarthritis. An international consensus study from the OARSI Rehabilitation Discussion Group

OBJECTIVE

To develop evidence-informed recommendations to support the delivery of best practice therapeutic exercise for people with knee and/or hip osteoarthritis (OA).

DESIGN

A multi-stage, evidence-informed, international multi-disciplinary consensus process that included: 1) a narrative literature review to synthesise existing evidence; 2) generation of evidence-informed proposition statements about delivery of exercise for people with knee and/or hip OA by an international multi-disciplinary expert panel, with statements refined and analysed thematically; 3) an e-Delphi survey with the expert panel to gain consensus on the most important statements; 4) a final round of statement refinement and thematic analysis to group remaining statements into domains.

RESULTS

The expert panel included 318 members (academics, health care professionals and exercise providers, patient representatives) from 43 countries. Final recommendations comprised 54 specific proposition statements across 11 broad domains: 1) use an evidence-based approach; 2) consider exercise in the context of living with OA and pain; 3) undertake a comprehensive baseline assessment with follow-up; 4) set goals; 5) consider the type of exercise; 6) consider the dose of exercise; 7) modify and progress exercise; 8) individualise exercise; 9) optimise the delivery of exercise; 10) focus on exercise adherence; and 11) provide education about OA and the role of exercise.

CONCLUSION

The breadth of issues identified as important by the international diverse expert panel highlights that delivering therapeutic exercise for OA is multi-dimensional and complex.

POS0084-PARE IMPACT OF OSTEOARTHRITIS ON PATIENT QUALITY OF LIFE: IS THERE AN EVOLUTION BETWEEN THE 2013 AND 2021 LARGE-SCALE SURVEYS “STOP OSTEOARTHRITIS” CONDUCTED IN FRANCE AND BELGIUM?

Background

Osteoarthritis (OA) is the most common form of arthritis, affecting more than 500 million people globally. OA is characterized by chronic mechanical pain and stiffness in the joints, limiting patient physical activities, leading to sedentarism, and disability. The results of the French web-based survey “Stop OA” (N=4227 participants) conducted in 2013 were presented at EULAR 2014. They evidenced the heavy burden of OA in France.

Objectives

The survey was repeated in France/Belgium between 2019 and 2021 (N=3465). This study aimed at assessing the impact of OA on patient quality of life and looking at a potential evolution between the two surveys.

Methods

Participants were invited to complete the survey questionnaire online via the website www.stop-arthrose.org. The questions focused on demographic and socio-economic aspects, history of the disease, physical activities, beliefs about OA, its impact on daily life, assessment of health status and the consequences, as well as the needs and expectations of the participants.

Results

3465 questionnaires (France N = 2822, Belgium N = 643) were thus collected between September 2019 and January 2021. The average filling time of the survey was 40 minutes. In the 2021 survey, 80.8% of participants (mean age 60 years, 80.3% women) declared that OA had a negative impact on their morale and 64.1% that they had a deteriorated self-image due to the disease. 25% of participants thought that difficulties in their couple were caused by OA and 33% reported problems in sexual life. 24.8% found it hard to cope with the discouragement generated by the disease. Even if psychological repercussions were observed in 21.2%, less than 5% consulted a psychologist. The impact on leisure (78.1%) and family life (61.9%) was also significant, as well as on social activities (58.0%) and professional life (43.7%). The disease also hindered walking (67.4%) and prevented daily actions (32.0%). Some help was necessary, mainly for gardening or tinkering (28.7%), picking up or opening objects (22.9%) as well as shopping and household chores (17.7%). 50% reported difficulty falling asleep and 67.6% were being woken up at night during their sleep because of pain caused by OA. Fatigue was difficult to live with for 47.9% of the participants. Compared to the results of the 2013 survey, there was no significant improvement evidenced in any of the areas studied.

Conclusion

OA represents a real burden that affects the mental health of patients, their relationships and the quality of their sleep. There has been no improvement of OA impact in patient’ quality of life between the two surveys (i.e., 8 years). This reflects the lack of resources for research to find new treatments and implement evidence-based therapeutic strategies in the current medical practice. A better understanding of these repercussions will allow effective strategies to be adopted in order to deal with these issues.

References

[1]L. Grange, F. Rannou, F. Berembaum, P. Richette, F. Beroud, A. Chaussier-Delboy, X. Chevalier, C. Dreux, P.A. Joseph, C. Roques, A. Sautet, F. Srour, J. Giraud, D.R. Bertholon, F. Nock, H. Servy, First national osteoarthritis patients survey in France: patients insights first, 2014 PARE00022.

Acknowledgements

Acknowledgements to expanscience, Labhra, UBSA, and Tilman laboratory for their institutional support

Disclosure of Interests

LAURENT GRANGE Speakers bureau: Expanscience, IBSA, Consultant of: Lohmann & Rauscher, Grunenthal, MSD, Grant/research support from: Thuasne, Sublimed, Remedee, Celine Mathy: None declared, Francoise Alliot Launois: None declared, Gerard Chales: None declared, Laurence Seidel: None declared, Adelin Albert: None declared, Rik Lories Speakers bureau: Abbvie, Boehringer-Ingelheim, Celgene, Eli-Lilly, Galapagos, Janssen, Kabi-Fresenius, MSD, Novartis, Pfizer, Sandoz, Biosplice (Samumed) and UCB., Consultant of: Abbvie, Amgen (formerly Celgeneà, Eli-Lilly, Galapagos, Janssen, Kabi-Fresenius, MSD, Novartis, Pfizer, Sandoz, Biosplice (Samumed) and UCB., Yves Henrotin Consultant of: Tilman, Nestlé, Wobenzym, Genequine, Expanscience, Lahra, Biose

POS1112 A RANDOMIZED, CROSS-OVER STUDY TO INVESTIGATE THE EFFECT OF WEIGHT-BEARING VS NON-WEIGHT-BEARING EXERCISE AND CARDIOVASCULAR STRESS ON TYPE II COLLAGEN TURNOVER IN KNEE OSTEOARTHRITIS PATIENTS – BIOMARKER DATA FROM THE EFEX-OA-02 STUDY

Background

Biomechanical stress is a prerequisite for OA development and studies have shown a difference in the effect of impact- and shear stress2, although studies of the direct impact of exercise on cartilage turnover have not demonstrated clear trends1.

Objectives

Exploring how weight-bearing (WB), non-weight-bearing (NWB) exercise and cardiovascular stress influence circulating biomarkers of cartilage extracellular matrix turnover in OA.

Methods

EFEX-OA-02 was a randomized, cross-over, clinical study investigating the direct effect of exercise on joint biomarkers in knee OA. Subjects were randomized to an order of cycling and running followed by adrenaline infusion and finally resting one week apart. Exercise and infusion sessions were multiphasic, consisting of 4x5-minute intervals. Peak cardiorespiratory stress (PCS) per interval was set to ≥80% of the heart rate reserve during exercise. Blood samples were obtained before, during, at five time points after and 24 h post exercise/infusion. For adrenaline infusion, 0.06 mg/kg of adrenaline was prepared in a 50 mL saline solution and administered intravenously. At rest, samples were collected at corresponding time points, except for the 24 h sample, which was omitted. Levels of serum C2M, T2CM (type II collagen degradation) and PRO-C2 (type II collagen formation) were measured using ELISA-assays (Nordic Bioscience). Coll2-1 and Coll2-1NO2 (type II collagen degradation) were measured using ELISA (Artialis).

Changes in biomarker concentrations after activity were compared to baseline (BL) and the corresponding resting samples. We used ANCOVA and Dunnett’s test with geometric means of change from BL up to 240 min as the dependent variable and subject and activity as covariates. Paired t-test was used to compare values at 24-hour to BL.

Results

Forty subjects were included. Mean age was 60.4 years (SD: 8.7), 24 (60%) were females, mean BMI was 27.0 kg/m2 (SD: 3.5), 18 had cumulated KL grade of 2 or 3 (45%) and 22 (55%) had KL 4, 5 or 6. and mean KOOS pain at BL was 67.5 (SD: 15.2) corresponding to mild-moderate pain. All subjects reached minimum PCS during exercise, but only an average of 70% (SD: 8.7) of that during infusion.

Cycling induced a small reduction in C2M (peak: -5.3%, 95%CI: -7.8 to -2.7%). PRO-C2 increased rapidly in response to cycling (peak: 11.7%, 95%CI: 4.3 to 19.1%) and running (peak: 12.9%, 95%CI: 3.54 to 22.2%). T2CM decreased up to one hour after cycling (peak: -10.8%, 95%CI: -15.1 to -6.5%) and running (peak: -9.5%, 95%CI: -15.5 to -3.6%), similar to adrenaline, then increased. Coll2-1NO2 increased rapidly following cycling (peak: 12.5%, 95%CI: 2.8 to 22.2%) and running (peak: 9.8%, 95%CI: 0.26 to 19.6%). Trends of increase was found in Coll2-1 (21.3%, 95%CI: 2.9 to 39.6) and Coll2-1NO2 (11.6%, 95%CI: -7.9 to 31.1%) in response to running at 240 min (Figure 1 – Error bars: SE, *Change to resting, †Change from BL, */†: P < 0.05, **/††: P < 0.01 ***/†††: P<0.001).

Figure 1.

At 24h PRO-C2 reduced -9.4% (95%CI: -18.2 to -0.5%) after cycling, Coll2-1NO2 reduced -8.33% (95%CI: -17.0 to 0.3%) after running and T2CM elevated by 6.0% (95%CI: -0.8 to 12.8%) after running and 7.1% (95%CI: 0.5 to 13.7%) after cycling.

Conclusion

Running, cycling and adrenaline infusion induced rapid small-to-moderate changes in circulating biomarkers reflecting type II collagen turnover. Changes after adrenaline-infusion suggests a cardiovascular contribution to exercise-induced changes. This model could potentially be used to evaluate treatment effects on collagen turnover.

References

[1]Bjerre-Bastos JJ, Karsdal MA, Boesen M, Bliddal H, Bay-Jensen A, Andersen JR, Bihlet AR: The acute and long-term impact of physical activity on biochemical markers and MRI measures in osteoarthritis—Perspectives for clinical osteoarthritis research. Transl Sport Med, 2020.

[2]Vincent TL: Mechanoflammation in osteoarthritis pathogenesis. Semin Arthritis Rheum, 2019.

Disclosure of Interests

Jonathan Bjerre-Bastos: None declared, Casper Sejersen: None declared, Henning Bay Nielsen: None declared, Mikael Boesen Speakers bureau: Speaker for Novartis and Eli Lilly, Niels Secher: None declared, Gregorio Distajo: None declared, Vincent Flood: None declared, Yves Henrotin Employee of: Founder and President of Artialis SA, Melanie Uebelhoer Employee of: Employee of Artialis, Abigail Mackey: None declared, Peter Krustrup: None declared, Carl-Christian Kitchen: None declared, Ema Petersen: None declared, Christian Thudium Shareholder of: Shareholder Nordic Bioscience A/S, Employee of: Full-time employee at Nordic Bioscience A/S, Jeppe Ragnar Andersen Employee of: Full-time employee of NBCD/Sanos Group A/S, Asger Reinstrup Bihlet Employee of: Full-time employee of NBCD/Sanos Group A/S

Osteoarthritis in year 2021: biochemical markers

OBJECTIVE

To summarize recent scientific advances in protein-derived soluble biomarkers of osteoarthritis.

DESIGN

A systematic search on the PubMed electronic database of clinical studies on protein-derived soluble biochemical markers of osteoarthritis in humans that were published between January 1st 2020 and March 31th 2021. The studies were selected on the basis of objective criteria and summarized in a table. Then they were described in a narrative review.

RESULTS

Out of 1971 publications, 48 fulfilled all selection criteria and 16 were selected by the author for the narrative review. The papers were classified according their clinical significance as defined in the BIPEDS classification. Two papers investigated the "burden of disease", two were dedicated to "investigative biomarkers", four papers question the "prognosis", three the "efficacy of treatment" and five the "diagnosis and phenotyping" value of protein-derived biomarkers.

CONCLUSIONS

Currently, biomarkers research is focused on their use as tools to identify molecular endotypes and clinical phenotypes and to facilitate patient screening and monitoring in clinical trials. This approach should allow a more targeted management of patients suffering from osteoarthritis.

POS0281 RUBUS IDAEUS LEAF EXTRACT IMPROVES SYMPTOMS IN KNEE OSTEOARTHRITIS PATIENTS: RESULTS FROM A DOUBLE BLIND RANDOMIZED CLINICAL STUDY

Background:

Osteoarthritis (OA) is the most common cause of disability in older adults. Currently, the aim of the patient management is to reduce symptoms and to improve quality of life using therapeutic modalities with no adverse effects (1). Unfortunately, the first line treatments of OA symptoms remain nonsteroidal anti-inflammatory drugs (NSAIDS) and paracetamol which if long-term administration are associated with severe adverse effects. Therefore, we need of save alternative to manage chronic OA symptoms. One candidate is Rubus idaeus (raspberry) leaf extract rich in flavonoids and phenols known to inhibit inflammatory responses.

Objectives:

The aim of this study was to investigate the effects of a 12-weeks intervention with an ethanolic extract from Rubus idaeus leaf on symptoms of knee OA.

Methods:

The study was a randomized, double-blind, placebo-controlled, monocentric trial of 198 subjects with femoro-tibial OA. Subjects were randomized equally to receive one daily treatment during 3 months either of 1 cap of Rubus idaeus leaf extract 400 mg, or 200 mg or placebo (maltodextrine). The main objective of this first exploratory study was to assess pain reduction over time. Pain was measured using different scales from the Western Ontario McMaster osteoarthritis index (WOMAC) to the knee pain VAS.

Results:

In the ITT population, Rubus idaeus leaf extract 400 mg and 200 mg after 12 weeks of treatment reduced pain measured by the VAS respectively of -10.93 (1.95) mm and -8.51 (1.92) mm compared to baseline, while placebo group had a -3.84 (1.89) mm reduction. The mean pain decrease induced by Rubus ideaus leaf extract was over – 7 mm which is clinically relevant, and reached clinically statistical difference compared to placebo with the highest dose (p=0.017; 95% CI, -13.11 to -1.07). Interestingly, subgroup analysis on the participants with a BMI>25, highlighted clinically relevant pain reduction for the 400 and 200 mg doses compared to baseline of respectively -13.36 (2.26) mm and -11.25 (2.14) mm (placebo = -0.37 (2.16) mm). The reduction was statistically different versus placebo for both doses (400 mg p<0.0001; 95% CI, (-19.95 to -6.04) and 200 mg p=0.0008; 95% CI, (-17.64 to -4.12). There was no effect on the WOMAC subscale of pain.

Conclusion:

Rubus idaeus leaf extract, even at the low dose of 200 mg, was effective to relieve pain at short-term in-patient with knee OA. As Rubus idaeus leaf extract is well tolerated, it could be an alternative to nonsteroidal anti-inflammatory drugs and paracetamol to relieve knee joint pain in OA patients.

References:

[1]Bannuru RR, Osani MC, Vaysbrot EE, Arden NK, Bennell K, Bierma-Zeinstra SMA, Kraus VB, Lohmander LS, Abbott JH, Bhandari M, Blanco FJ, Espinosa R, Haugen IK, Lin J, Mandl LA, Moilanen E, Nakamura N, Snyder-Mackler L, Trojian T, Underwood M, McAlindon TE. OARSI guidelines for the non-surgical management of knee, hip, and polyarticular osteoarthritis. Osteoarthritis Cartilage. 2019 Nov;27(11):1578-1589.

Disclosure of Interests:

Yves Henrotin Speakers bureau: Expanscience, Nestlé, Tilman, Consultant of: Naturex SA, Artialis SA, Tilman SA, Seigakaku, Stemmatters, Expanscience, Romain Le Cozannet Employee of: Naturex SA, Pascale Franca-Berthon Employee of: Naturex SA, Romain Truillet Employee of: Atlanstat, Martine Cohen Solal: None declared

AB0073 BOSWELLIA SERRATA EXTRACT AND CURCUMIN INCREASE GDF15 PRODUCTION BY HUMAN PRIMARY OSTEOARTHRITIS CHONDROCYTES: A NEW MECHANISM OF ACTION

Background:

Boswellia serrata extract (BSE) and curcumin are used to relief symptoms in osteoarthritis (OA).

Objectives:

This study aims to better understand the mode of action of these compounds on OA chondrocytesin vitro.

Methods:

Therapeutic plasmatic concentrations of the different components of BSE correspond to anin vitrorange from 25 to 100 µg/ml of total BSE (100 µg/ml of BSE corresponds to 9.2 µM of 11-keto-β-boswellic acid (KBA), 5.2 µM of acetylKBA, 22 µM de αBA, 34 µM de βBA, 4.4 µM de acetylαBA and 13.2 acetyl βBA), and between 2 to 10 µM for bioavaibility-increased curcumin. BSE (5-100 µg/ml) and curcumin (0.04 to 4 µg/ml corresponding to 0.1 to 10 µM) were tested separately on primary chondrocytes from 3 OA patients. Lactate Deshydrogenase LDH, nitrite (NO2), interleukin (IL)-6 and Growth Differentiation Factor (GDF)15 were quantified in 72h-treated supernatant using enzyme activity, Griess reaction and ELISAs, respectively.

Results:

No mortality was observed at the tested concentrations. BSE and curcumin both decreased concentration-dependently NO2and IL-6 production, and increased GDF15 production. For NO2production, the decrease was observed from 0.2 µg/ml of curcumin and 10 µg/ml of BSE. For IL-6 production, the decrease was observed from 1 µg/ml for curcumin and 10 µg/ml for BSE. For GDF-15, the increase was observed from 2 µg/ml for curcumin and 50 µg/ml for BSE. Maximal effect was observed at 4 µg/ml for curcumin: -67% NO2(p<0.0001), -71% IL-6 (p=0.0001) and +80% GDF15 (p<0.0001) and at 100 µg/ml for BSE: -40% NO2(p=0.0003), -70% IL-6 (p=0.0003) and +73% for GDF15 (p=0.0017).

Conclusion:

At therapeutic plasmatic concentrations, BSE and curcumin decreased the production of NO2and IL-6, two inflammatory mediators. Furthermore, BSE and curcumin enhanced GDF-15 production, an anti-inflammatory growth factor. GDF15 was first identified as Macrophage inhibitory cytokine-1 or NSAID-activated gene-1 (by a prostanoid-independent manner), and is known as a regulator of inflammatory, cell repair and apoptosis pathways. GDF-15 has pro-apoptotic and anti-tumorigenic activity in vitro and in vivo. It could represent a new pathway explaining the beneficial effects of BSE and the curcumin on synovium inflammation and cartilage degradation.

Disclosure of Interests:

christelle sanchez: None declared, Jérémie Zappia: None declared, Yvan Dierckxsens Shareholder of: Tilman SA, Employee of: Tilman SA, Jean-Pierre Delcour: None declared, Yves Henrotin Grant/research support from: HEEL, TILMAN

AB0072 A MULTICOMPONENT MEDICATION PROMOTES CHONDROGENESIS AND REDUCES MMP-13 IN PRIMARY ARTICULAR CHONDROCYTES FROM KNEE OSTEOARTHRITIS PATIENTS IN VITRO

Background:

HE-1100 is a multicomponent medicinal product. Initial preclinical data potentially suggest a preventive effect on cartilage degradation.

Objectives:

This study aims to understand the mode of action of HE-1100 on OA chondrocytesin vitro.

Methods:

Primary chondrocytes were obtained from 10 knee osteoarthritis (OA) patients undergoing knee replacement surgery. The cultures were treated with 20% (v/v) HE-1100 or placebo. Samples were collected for subsequent RNA extraction using standard methods. The reads were generated with Illumina NextSeq5000 sequencer and aligned to the human reference genome (UCSC hg19) to generate the transcriptome. Differential expression analysis between HE-1100 and placebo was made in R using the DESeq2 package to identify the differentially expressed genes in the OA-associated regulatory pathways. The protein production of the selected genes was quantified by ELISA in 10 independent human OA chondrocytes cultures.

Results:

According to the DESeq2 analysis, HE-1100 significantly modified the expression of 13 genes in OA chondrocytes by at least 10% with an adjusted p-value < 0.05: EGR1 (+93%), FOS (+87%), NR4A1 (+43%), DUSP1 (+18%), ZFP36 (+18%), ZFP36L1 (+14%), NFKBIZ (+16%) and CYR61 (+14%) were upregulated and ATF7IP (-10%), TXNIP (-11%), C10orf10 (-12%), CLEC3A (-12%) and MMP13 (-18%) were downregulated after 24h HE-1100 treatment. HE-1100 significantly increased (2.3 fold +/-1.2 after 24h, p=0.0444 and 2.3-fold +/-1.0 after 72h, p=0.0239) the CYR61 protein production by human OA chondrocytes. After 72h, HE-1100 slightly but not significantly increased aggrecan production by 14 ± 19 % (p=0.1117) and significantly increased type II collagen pro-peptide production by 27 ± 20 % (p=0.0147). For both time points CYR61 production by OA chondrocytes was positively and significantly correlated with aggrecan (r=0.66, p=0.0004) and type II collagen pro-peptide (r=0.64, p=0.0008) production. In alginate beads culture, pro-MMP-13 was significantly decreased by HE-1100 treated cultures from day 7 to day 14 (from -16 to -25 %, p<0.05) and from day 17 to 21 (-22 %, p=0.0331) in comparison to controls.

Conclusion:

HE-1100 significantly modified the expression of DUSP1, C10orf10, ZFP36/L1 and CLEC3A, which are pathway mediators involved in MMP-13 expression and activation. Further, long-term (28 days) treatment with HE-1100 significantly reduced the production of pro-MMP-13, the inactive precursor of the metalloproteinase MMP-13 involved in type II collagen degradation. HE-1100 also promoted extracellular matrix formation probably through CYR61 production, a growth factor well correlated with type II collagen and aggrecan production.

References:

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Acknowledgments:

We would like to thank the staff of the GIGA ULiège Genomic Next Generation Sequencing platform for performing the RNA sequencing and Benoit Charloteaux for his help in RNAseq data analysis.

Disclosure of Interests:

christelle sanchez: None declared, Kathrin Hemmer Employee of: Heel, Natascha Kroemmelbein Employee of: Heel, Bernd Seilheimer Employee of: Heel, Jean-Emile Dubuc: None declared, Christophe Antoine Employee of: Artialis, Yves Henrotin Grant/research support from: HEEL, TILMAN

FRI0653-HPR AN OLEUROPEIN-BASED DIETARY SUPPLEMENT IMPROVES JOINT FUNCTIONALITY IN OLDER PEOPLE WITH HIGH KNEE JOINT PAIN

Background:

OLE provides oleuropein the most prevalent phenolic component in olive leaves and has been shown to have potent anti-inflammatory and anti-oxidant effects potentially interesting for joint health (1).

Objectives:

The aim of this study was to investigate the effects of a 6-month intervention with an Olive Leaf Extract (OLE) standardized for oleuropein content on knee functionality and biomarkers of bone/cartilage metabolism and inflammation.

Methods:

The study was a randomized, double-blind, placebo-controlled, multi-centric trial of 124 subjects with mild knee pain or mobility issues. Subjects were randomized equally to receive twice a day one capsule of either maltodextrin (control treatment, CT) or 125-mg OLE (BonoliveTM, an Olive Leaf Extract containing 50 mg of Oleuropein) for 6 months. The co-primary endpoints were Knee injury and Osteoarthritis Outcome Score (KOOS) using a self-administered questionnaire and serum Coll2-1NO2 specific biomarker of cartilage degradation. The secondary endpoints were each of the five sub-scales of the KOOS questionnaire, Knee pain VAS score at rest and at walking, OARSI core set of performance-based tests and serum biomarkers (Coll2-1, MPO, CTX1, osteocalcin, PGE2 and Vplex cytokines assay in serum) and concentration of Oleuropein’s metabolites in urine.

Results:

Primary (global KOOS score, biomarker Coll2-1 NO2) and secondary endpoints (the five subscales of the KOOS score) improved time dependently in both groups. OLE treatment showed significantly elevated urinary oleuropein metabolites (oleuropein aglycone, hydroxytyrosol, homovanillyl alcohol and isomer of homovanillyl alcohol), and was well tolerated without significant differences in number of subjects with adverse events. At 6 months, OLE group showed a higher global KOOS score compared to placebo (treatment difference = 3.73; 95% CI = [-4.08;11.54]; p = 0.34), without significant changes of inflammatory and cartilage remodeling biomarkers. Subgroup analyses demonstrated a large and significant treatment effect of OLE in subjects with high walking pain at baseline (14.4; 95% CI = [1.19;27.63], p=0.03). This was observed at 6 months for the global KOOS score and each different subscale and for pain at walking (-23.07;95% CI = [-41.8;-4.2];p=0.02). These treatment effects at 6 months were significant for KOOS score as well as for the subscales Pain and QoL and the pain at walking.

Conclusion:

OLE was not effective on joint discomfort in people with low to moderate pain at baseline but significantly benefited subjects with high pain at treatment initiation. As oleuropein is well-tolerated, OLE can be used to relieve knee joint pain and enhance mobility in subjects with articular pain the most painful subjects.

References:

[1] Horcajada MN, Sanchez C, Membrez Scalfo F, Drion P, Comblain F, Taralla S, Donneau AF, Offord EA, Henrotin Y. Oleuropein or rutin consumption decreases the spontaneous development of osteoarthritis in the Hartley guinea pig. Osteoarthritis Cartilage. 2015 Jan;23(1):94-102

Disclosure of Interests:

Marie-Noelle Horcajada Employee of: nestlé, Maurice Beaumont Employee of: nestle, Nicolas Sauvageot Employee of: Nestlé, Laure Poquet Employee of: Nestlé, Madleen Saboudjian Employee of: Nestlé, Anne-Christine Hick Employee of: Artialis SA, Berenice Costes Employee of: Artialis SA, Laetitia Garcia Employee of: Artialis, Yves Henrotin Grant/research support from: HEEL, TILMAN

FRI0405 CARTILAGE BIOMARKERS S-COLL2-1 AND S-COLL2-1NO2 ARE HELPFUL IN IDENTIFYING KNEE OSTEOARTHRITIS PATIENTS AT RISK OF DISEASE WORSENING

Background:

Coll2-1 is a peptide of 9 amino acid located in the triple helix of type II collagen molecule reflecting cartilage degradation (1). Coll2-1NO2 is the nitrated form of Coll2-1 and considered as a biomarker of the inflammatory-related cartilage degradation (2). This peptide is involved in osteoarthritis physiopathology since it was demonstrated that Coll2-1 induced synovitis in rat.

Objectives:

To identify if biochemical markers s-Coll2-1 and s-Coll2-1NO2 are associated to knee osteoarthritis (OA), focusing on pain, function as well as structural features assessed by MRI in various knee compartments and to assess their ability at predicting knee OA worsening.

Methods:

116 subjects with knee OA were followed during one year with pain, function and MRI evaluation (PRODIGE study,NCT02070224). Type II collagen-specific biomarker Coll2-1 and its nitrated form Coll2-1NO2 were directly measured in serum using immunoassays at baseline and after three, six and twelve months follow-up.

Results:

sColl2-1 and sColl2-1NO2 were associated to several baseline knee features quantified with Whole-Organ Magnetic Resonance Imaging Score (WORMS). S-Coll2-1 was significantly correlated with bursitis (r=0.29, P<0.01), bone attrition (r=0.25, P=0.01), cysts (r=0.24, P=0.02) and cartilage (r=0.23, P=0.03) WORMS sub-scores for the whole joint as well as with the medial femorotibial joint sum score (r=0.26, P=0.01) and medial femorotibial joint cartilage (r=0.23, P=0.02). s-Coll2-1NO2 was correlated with WORMS total score (r=0.23, P=0.02), WORMS scores in the patellofemoral (r=0.23, P=0.02) and medial femorotibial compartments (r=0.21, P=0.03) and with osteophytes scores (r=0.27, P<0.01). Baseline s-Coll2-1NO2 was higher in subjects with a pain worsening (426.4 pg/mL [278.04-566.95]) as compared to non-progressors (306.84 [200.37-427.84]) over one year (AUC=0.655, P=0.015).

Conclusion:

Cartilage biomarkers s-Coll2-1 and s-Coll2-1NO2 are associated to several knee OA features quantified with WORMS scoring system on MRI. Serum values of Coll2-1NO2 are also associated to a worsening of target knee pain over one year. Coll2-1 and Coll2-1NO2, in association with other structural features, pain and function, could help at identifying OA phenotypes and patients at risk of OA worsening.

References:

[1]Mobasheri A, Lambert C, Henrotin Y. Coll2-1 and Coll2-1NO2 as exemplars of collagen extracellular matrix turnover - biomarkers to facilitate the treatment of osteoarthritis? Expert Rev Mol Diagn. 2019 Sep;19(9):803-812. doi: 10.1080/14737159.2019.1646641. Epub 2019 Sep 4.

[2]Lambert C, Borderie D, Dubuc JE, Rannou F, Henrotin Y. Type II collagen peptide Coll2-1 is an actor of synovitis. Osteoarthritis Cartilage. 2019 Nov;27(11):1680-1691. doi: 10.1016/j.joca.2019.07.009. Epub 2019 Jul 17.

Acknowledgments:

PRODIGE study (NCT02070224) was performed in the framework of a convention between the Walloon region and ARTIALIS SA. (convention n°6905).

Disclosure of Interests:

Yves Henrotin Grant/research support from: HEEL, TILMAN, Berenice Costes Employee of: Artialis SA, Michel Malaise: None declared, Damien Loeuille: None declared, Thierry Conrozier Consultant of: LABRHA, SANOFI, MEDAC, Yves Maugars: None declared, Franz Pelousse Shareholder of: Sodiray, Jean-Marc Lemaire Shareholder of: Sodiray, Thibault Helleputte Shareholder of: DNAlytics, Cedric Tits Employee of: DNAlytics, Elisabeth Cobraiville Employee of: Artialis SA, Sebastien Pirson Employee of: Artialis, Laetitia Garcia Employee of: Artialis, Alain Labasse Employee of: Artialis SA, Anne-Christine Hick Employee of: Artialis SA

Type II collagen peptide Coll2-1 is an actor of synovitis

OBJECTIVE

We evaluated the ability of Coll2-1, a type II collagen peptide, to activate pro-inflammatory pathways in synovial cells and to induce arthritis in Lewis rats.

METHOD

Human synoviocytes and chondrocytes from knee OA patients were cultured for 24 h with/without Coll2-1 and/or purified immunoglobulin G (AS0619) binding specifically this peptide, and/or CLI-095, a TLR-4 signaling inhibitor and/or apocynin and diphenyleneiodonium, Reactive oxygen species (ROS) production inhibitors. The Interleukin (IL)-8 and Vascular Endothelium Growth Factor (VEGF) expression, the IL-8 production, the IκB-α and p65 phosphorylation and ROS were evaluated. Coll2-1 peptide, bovine type II collagen (CIA), streptococcal cell wall (SCW) or saline solution were injected into Lewis rats. The Coll2-1 peptide was injected subcutaneously (SC; 20-200μg/100μl/animal) or intra-articularly (IA; 0.5-5μg/50μl/animal) and compared to CIA injected in SC (200μg/100μl/animal) and SCW in IA (5μg/50μl/animal). The animals were injected on day 0 and monitored for 28 days. Histological lesions assessment was performed using an arthritis score.

RESULTS

Coll2-1 peptide significantly increased IL-8 gene expression and production by synoviocytes. AS0619 and CLI-095 significantly decreased IL-8 expression. Coll2-1 induced p65 and IκBα phosphorylation and oxidative stress inhibitors decreased it. In human chondrocytes culture, Coll2-1 significantly increased MMP-3 and VEGF gene expression. In Lewis rats, CIA, SCW or Coll2-1 injection triggered arthritis. Like CIA or SCW, Coll2-1 induced synovitis, loss of cartilage proteoglycans, cartilage structure lesion and subchondral bone remodeling.

CONCLUSIONS

Coll2-1 activates synoviocytes to produce IL-8 and induces arthritis in rat. These findings suggest that neutralizing Coll2-1 could be a therapeutic approach of arthritis.

Bio-optimized Curcuma longa extract is efficient on knee osteoarthritis pain: a double-blind multicenter randomized placebo controlled three-arm study

Objectives

Comparison of two doses of bio-optimized Curcuma longa extract (BCL) in the management of symptomatic knee osteoarthritis (OA).

Methods

A prospective, randomized, 3-month, double-blind, multicenter, three-group, placebo-controlled trial assessing Patient Global Assessment of Disease Activity (PGADA) and serum sColl2-1, a biomarker of cartilage degradation, as co-primary endpoints. Pain on visual analog scale (VAS), Knee injury and Osteoarthritis Outcome Score (KOOS), and paracetamol/non-steroidal anti-inflammatory drug (NSAID) consumption were used as secondary endpoints.

Results

One hundred fifty patients with knee OA were followed for 90 days. Low and high doses of BCL showed a greater decrease of PGADA than placebo. Analysis of sColl2-1 showed in the placebo and BCL low-dose groups, but not in the BCL high-dose group, a transient but non-significant increase of sColl2-1 between T0 and T1. Thereafter, in all groups, sColl2-1 decreased between T1 and T3 (all p < 0.01), but no difference between the groups was found. Pain reduction at day 90 in the low- and high-dose BCL groups (− 29.5 mm and − 36.5 mm) was higher than that in the placebo (− 8 mm; p = 0.018). The global KOOS significantly decreased overtime, but changes were comparable across treatment arms. The ratio of patients with adverse events (AE) related to the product was similar in the placebo and treatment groups, but the number of AE linked to the product was higher in the high-dose BCL group compared to the placebo (p = 0.012).

Conclusions

BCL appeared safe and well-tolerated with no evidence of severe adverse effects. Efficacy analysis suggested positive trends for measurements of PGADA and serum levels of an OA biomarker and showed a rapid and significant decrease of pain in knee OA (Trial registration: ISRCTN, ISRCTN12345678. Registered 21 September 2016—retrospectively registered, https://clinicaltrials.gov/ct2/show/NCT02909621?term=osteoarthritis+curcumin&rank=5—Evaluation of FLEXOFYTOL® Versus PLACEBO (COPRA) NCT02909621).

Electronic supplementary material

The online version of this article (10.1186/s13075-019-1960-5) contains supplementary material, which is available to authorized users.

A machine learning approach for the identification of new biomarkers for knee osteoarthritis development in overweight and obese women

OBJECTIVE

Knee osteoarthritis (OA) is among the higher contributors to global disability. Despite its high prevalence, currently, there is no cure for this disease. Furthermore, the available diagnostic approaches have large precision errors and low sensitivity. Therefore, there is a need for new biomarkers to correctly identify early knee OA.

METHOD

We have created an analytics pipeline based on machine learning to identify small models (having few variables) that predict the 30-months incidence of knee OA (using multiple clinical and structural OA outcome measures) in overweight middle-aged women without knee OA at baseline. The data included clinical variables, food and pain questionnaires, biochemical markers (BM) and imaging-based information.

RESULTS

All the models showed high performance (AUC > 0.7) while using only a few variables. We identified both the importance of each variable within the models as well its direction. Finally, we compared the performance of two models with the state-of-the-art approaches available in the literature.

CONCLUSIONS

We showed the potential of applying machine learning to generate predictive models for the knee OA incidence. Imaging-based information were found particularly important in the proposed models. Furthermore, our analysis confirmed the relevance of known BM for knee OA. Overall, we propose five highly predictive small models that can be possibly adopted for an early prediction of knee OA.

Relationship between weight loss in obese knee osteoarthritis patients and serum biomarkers of cartilage breakdown: secondary analyses of a randomised trial

OBJECTIVE

To explore effects of weight loss and maintenance on serum cartilage biomarkers denaturation neoepitope for Collagen2 (Coll2-1) and Fibulin3 fragment (Fib3-2), as well as correlations between Coll2-1 and Fib3-2 and symptomatic improvement, in a knee osteoarthritis (KOA) population.

DESIGN

192 obese KOA patients followed a 16 week weight loss intervention and 52 weeks weight maintenance (ClinicalTrials.gov identifier: NCT00655941). Assessments were at 0, 8, 16 and 68 weeks. Serum Coll2-1 and Fib3-2 were determined with ELISA, and symptoms by the Knee Osteoarthritis Outcome Score (KOOS) questionnaire. Changes from week 0 and association between changes from baseline in body weight and Coll2-1, Fib3-2, and the 5 KOOS domains were assessed at all time points.

RESULTS

Coll2-1 changes from baseline showed a decrease at week 8 (P = 0.0002), no change at week 16 (P = 0.49), and an increase at week 68 (P = 0.036). Fib3-2 showed an increase from baseline at week 8 (P = 0.0015) and 16 (P < 0.0001), but none at week 68 (P = 0.23). No statistically significant correlations were found between changes in body weight and Coll2-1 and Fib3-2 at any time point (r < 0.05; P > 0.49). At all time-points there were significant positive correlations between changes from baseline in Coll2-1 and in KOOS_{Sports/Recreation} (week 8, 16, 68: r = 0.17; P = 0.03; r = 0.16; P = 0.04; and r = 0.17; P = 0.04, respectively).

CONCLUSION

The clinical improvement after a substantial weight loss and weight maintenance in KOA patients was not associated with decrease in markers of cartilage breakdown Coll2-1 or Fib3-2, even with indications of a slightly negative effect.

Chondrocyte secretome: a source of novel insights and exploratory biomarkers of osteoarthritis

The extracellular matrix (ECM) of articular cartilage is comprised of complex networks of proteins and glycoproteins, all of which are expressed by its resident cell, the chondrocyte. Cartilage is a unique tissue given its complexity and ability to resist repeated load and deformation. The mechanisms by which articular cartilage maintains its integrity throughout our lifetime is not fully understood, however there are numerous regulatory pathways known to govern ECM turnover in response to mechanical stimuli. To further our understanding of this field, we envision that proteomic analysis of the secretome will provide information on how the chondrocyte remodels the surrounding ECM in response to load, in addition to providing information on the metabolic state of the cell. In this review, we attempt to summarize the recent mass spectrometry-based proteomic discoveries in healthy and diseased cartilage and chondrocytes, to facilitate the discovery of novel biomarkers linked to degenerative pathologies, such as osteoarthritis (OA).

[Orthopaedic manual therapy : definition, characteristics and update on the situation in Belgium]

Although orthopaedic manual therapy (OMT) has existed for decades, and although a recent Belgian Royal Decree, published in 2014, recognized it as a particular professional qualification in physiotherapy for the treatment of neuromusculoskeletal dysfunctions, OMT remains little known by patients, but also by healthcare professionals. Yet, this professional qualification, based on clinical reasoning, using highly specific treatments, guided by the best available scientific and clinical evidence and the specific biopsychosocial characteristics of each patient, is the subject of a growing number of scientific studies pointing out its effectiveness. This article summarizes the knowledge related to OMT (definition, history, characteristics, techniques, indications, access and reimbursement) and describes its situation in Belgium.

Osteoarthritis biomarkers derived from cartilage extracellular matrix: Current status and future perspectives

Specific soluble biomarkers can be powerful tools for the diagnosis, prognosis and personalized management of osteoarthritis (OA). Biomarkers are potential indicators of the effect of a drug on cartilage metabolism and provide crucial information about the mechanisms of drug action. In this review, we address key questions concerning the use of biomarkers in OA management: Why do we need soluble biomarkers? What are the most widely investigated biomarkers derived from cartilage extracellular matrix? What are the most common pitfalls in interpreting soluble biomarker measurements? What are the perspectives and future research directions in this field? We review current evidence to propose that cartilage-derived soluble biomarkers are complementary "drug development tools" that can be applied during drug development from preclinical research to clinical evaluation. In the future, such biomarkers could be surrogate markers of clinical and/or imaging outcomes. Successful standardization and implementation of automated biomarker assays will facilitate their use in companion diagnostics in the context of personalized medicine for enhanced management of OA.

Fibulin-3 fragments are prognostic biomarkers of osteoarthritis incidence in overweight and obese women

OBJECTIVE

To determine the association between three fibulin-3 peptides and the incidence of radiographic and clinical knee osteoarthritis (OA).

DESIGN

Women between 50 and 60 years, with a BMI ≥27 kg/m(2), free of knee OA, were recruited. Using binary logistic regression, the association between baseline concentration of serum fibulin (Fib)3-1, Fib3-2 and Fib3-3 and incidence of clinical and radiographic knee OA after 30 months of follow-up was evaluated.

RESULTS

Baseline and follow-up measurements were available for 241 women with a mean age of 55.9 ± 3.2 years and mean BMI of 31.7 ± 3.6 kg/m(2). None of the concentrations of the three Fib3 epitopes were associated with the incidence of medial or lateral joint space narrowing (JSN) ≥1.0 mm or the incidence of Kellgren & Lawrence (K&L) grade ≥2 after 30 months. All three Fib3 epitopes were associated with the incidence of the clinical and radiographic ACR-criteria and Fib3-1 and Fib3-3 also with chronic pain at follow-up. When adjusted for the other Fib3 peptide concentrations, only Fib3-1 was significantly associated to the incidence of the American College of Rheumatology (ACR)-criteria (OR 3.2 [1.2-8.7]) and chronic pain at follow-up (OR 3.0 [1.2-7.7]).

CONCLUSIONS

Baseline fibulin-3 concentrations are associated with the incidence of clinical knee OA among middle-aged overweight and obese women. Therewith, they meet the criteria of a prognostic biomarker according to the BIPED biomarker classification for OA. Further validation of the fibulin-3 epitopes seems warranted in order to better distinguish subgroups of individuals at increased risk for knee OA development.

Osteoarthritis year in review 2015: soluble biomarkers and the BIPED criteria

OBJECTIVE

To review and summarize biomarker data published from April 2014 to May 2015 to provide insight to the ongoing work in the field of osteoarthritis (OA). Furthermore, to summarize the BIPED criteria and set it in context of the medical needs of 2015.

METHODS

PubMed was used as searching machine: Time period 2014/04/01-2015/05/01, MeSH term [Biomarker] AND [Osteoarthritis], Language; English, Full text available. Reviews were excluded. Only papers describing protein based biomarkers measured in human body fluids from OA patients were included.

RESULTS

Biomarkers of joint tissue turnover, cytokines, chemokines and peptide arrays were measured in different cohorts and studies. Amongst those were previously tested biomarkers such as osteocalcin, Carboxy-terminal cross-linked fragment of type II collagen (CTX-II) and cartilage oligomeric matrix protein (COMP). A majority of the biomarker were classified as I, B or B biomarkers according to the BIPED criteria. Work is continuing on testing biomarkers in OA. There is still a huge, unmet medical need to identify, test, validate and qualify novel and well-known biomarkers. A pre-requisite for this is better characterization and classification of biomarkers to their needs, which may not be reached before higher understanding of OA phenotypes has been gained. In addition, we provide some references to some recent guidelines from Food and Drug Administration (FDA) and European Medicines Agency (EMA) on qualification and usage of biomarkers for drug development and personalized medicine, which may provide value to the field.

[THE MALADAPTIVE BELIEFS OF PATIENTS WITH LOW BACK PAIN. A NARRATIVE REVIEW]

OBJECTIVE

to summarize the knowledge regarding the maladaptive beliefs of patients with non-specific low back pain.

METHODS

a narrative literature review on these beliefs was conducted by an international and multidisciplinary team of experts in the field.

RESULTS

these beliefs, which can result in negative consequences on functioning and on patient prognosis, have various origins: family and friends, media, previous experience and/or health care professionals' messages. The latter, who have a considerable and enduring influence, have the potential to change and correct the patients' misbeliefs; however, they can also reinforce them in case of inappropriate messages and attitudes. Informing and educating the patient (by means of reassurance, explanations of the non-systematic association pain-injury, encouragement to get and stay physically active) are the basis of treatment. Taking into account the consequences of some words which may be misinterpreted, the results of imaging should be wisely discussed with the patient. Pain neurophysiology education and cognitive behavioral therapy (i.a., in vivo graded exposure techniques) are effective additional treatments.

CONCLUSIONS

Misbeliefs are frequent in patient with low back pain. They do need to be looked for and corrected.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for hand osteoarthritis

Hand osteoarthritis (OA) is a very frequent disease, but yet understudied. However, a lot of works have been published in the past 10 years, and much has been done to better understand its clinical course and structural progression. Despite this new knowledge, few therapeutic trials have been conducted in hand OA. The last OARSI recommendations for the conduct of clinical trials in hand OA dates back to 2006. The present recommendations aimed at updating previous recommendations, by incorporating new data. The purpose of this expert opinion, consensus driven exercise is to provide evidence-based guidance on the design, execution and analysis of clinical trials in hand OA, where published evidence is available, supplemented by expert opinion, where evidence is lacking, to perform clinical trials in hand OA, both for symptom and for structure-modification. They indicate core outcome measurement sets for studies in hand OA, and list the methods and instruments that should be used to measure symptoms or structure. For both symptom- and structure-modification, at least pain, physical function, patient global assessment, HR-QoL, joint activity and hand strength should be assessed. In addition, for structure-modification trials, structural progression should be measured by radiographic changes. We also provide a research agenda listing many unsolved issues that seem to most urgently need to be addressed from the perspective of performing "good" clinical trials in hand OA. These updated OARSI recommendations should allow for better standardizing the conduct of clinical trials in hand OA in the next future.

OARSI Clinical Trials Recommendations: Design and conduct of clinical trials for hip osteoarthritis

The ability to assess the efficacy and effectiveness of an intervention for the treatment of hip osteoarthritis (OA) requires strong clinical trial methodology. This consensus paper provides recommendations based on a narrative literature review and best judgment of the members of the committee for clinical trials of hip OA. We provide recommendations on clinical trial design, outcome measures, including structural (radiography), and patient and physician global assessments, performance based measures, molecular markers and experimental endpoints including MRI imaging. This information can be utilized by sponsors of trials for new therapeutic agents for hip OA.

OARSI Clinical Trials Recommendations: Design, conduct, and reporting of clinical trials for knee osteoarthritis

The goal of this document is to update the original OARSI recommendations specifically for the design, conduct, and reporting of clinical trials that target symptom or structure modification among individuals with knee osteoarthritis (OA). To develop recommendations for the design, conduct, and reporting of clinical trials for knee OA we initially drafted recommendations through an iterative process. Members of the working group included representatives from industry and academia. After the working group members reviewed a final draft, they scored the appropriateness for recommendations. After the members voted we calculated the median score among the nine members of the working group who completed the score. The document includes 25 recommendations regarding randomization, blocking and stratification, blinding, enhancing accuracy of patient-reported outcomes (PRO), selecting a study population and index knee, describing interventions, patient-reported and physical performance measures, structural outcome measures, biochemical biomarkers, and reporting recommendations. In summary, the working group identified 25 recommendations that represent the current best practices regarding clinical trials that target symptom or structure modification among individuals with knee OA. These updated recommendations incorporate novel technologies (e.g., magnetic resonance imaging (MRI)) and strategies to address the heterogeneity of knee OA.

Bone sialoprotein as a potential key factor implicated in the pathophysiology of osteoarthritis

OBJECTIVE

We previously identified an association between bone sialoprotein (BSP) and osteoarthritic (OA) chondrocyte hypertrophy but the precise role of BSP in ostearthritis (OA) has not been extensively studied. This study aimed to confirm the association between BSP and OA chondrocyte hypertrophy, to define its effect on molecules produced by chondrocytes and to analyse its association with cartilage degradation and vascular density at the osteochondral junction.

METHOD

Human OA chondrocytes were cultivated in order to increase hypertrophic differentiation. The effect of parathyroid hormone-related peptide (PTHrP), interleukin (IL)-1β or tumour necrosis factor (TNF)-α on BSP was analysed by real-time reverse transcription polymerase chain reaction (RT-PCR) and western blot. The effects of BSP on OA chondrocytes production of inflammatory response mediators (IL-6, nitric oxide), major matrix molecule (aggrecan), matrix metalloprotease-3 and angiogenic factors (vascular endothelial growth factor, basic fibroblast growth factor, IL-8, and thrombospondin-1) were investigated. BSP was detected by immunohistochemistry and was associated with cartilage lesions severity and vascular density.

RESULTS

PTHrP significantly decreased BSP, confirming its association with chondrocyte hypertrophy. In presence of IL-1β, BSP stimulated IL-8 synthesis, a pro-angiogenic cytokine but decreased the production of TSP-1, an angiogenesis inhibitor. The presence of BSP-immunoreactive chondrocytes in cartilage was associated with the severity of histological cartilage lesions and with vascular density at the osteochondral junction.

CONCLUSION

This study supports the implication of BSP in the pathology of OA and suggests that it could be a key mediator of the hypertrophic chondrocytes-induced angiogenesis. To control chondrocyte hypertrophic differentiation is promising in the treatment of OA.

OARSI guidelines for the non-surgical management of knee osteoarthritis

OBJECTIVE

To develop concise, up-to-date, patient-focused, evidence-based, expert consensus guidelines for the management of knee osteoarthritis (OA), intended to inform patients, physicians, and allied healthcare professionals worldwide.

METHOD

Thirteen experts from relevant medical disciplines (primary care, rheumatology, orthopedics, physical therapy, physical medicine and rehabilitation, and evidence-based medicine), three continents and ten countries (USA, UK, France, Netherlands, Belgium, Sweden, Denmark, Australia, Japan, and Canada) and a patient representative comprised the Osteoarthritis Guidelines Development Group (OAGDG). Based on previous OA guidelines and a systematic review of the OA literature, 29 treatment modalities were considered for recommendation. Evidence published subsequent to the 2010 OARSI guidelines was based on a systematic review conducted by the OA Research Society International (OARSI) evidence team at Tufts Medical Center, Boston, USA. Medline, EMBASE, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials were initially searched in first quarter 2012 and last searched in March 2013. Included evidence was assessed for quality using Assessment of Multiple Systematic Reviews (AMSTAR) criteria, and published criticism of included evidence was also considered. To provide recommendations for individuals with a range of health profiles and OA burden, treatment recommendations were stratified into four clinical sub-phenotypes. Consensus recommendations were produced using the RAND/UCLA Appropriateness Method and Delphi voting process. Treatments were recommended as Appropriate, Uncertain, or Not Appropriate, for each of four clinical sub-phenotypes and accompanied by 1-10 risk and benefit scores.

RESULTS

Appropriate treatment modalities for all individuals with knee OA included biomechanical interventions, intra-articular corticosteroids, exercise (land-based and water-based), self-management and education, strength training, and weight management. Treatments appropriate for specific clinical sub-phenotypes included acetaminophen (paracetamol), balneotherapy, capsaicin, cane (walking stick), duloxetine, oral non-steroidal anti-inflammatory drugs (NSAIDs; COX-2 selective and non-selective), and topical NSAIDs. Treatments of uncertain appropriateness for specific clinical sub-phenotypes included acupuncture, avocado soybean unsaponfiables, chondroitin, crutches, diacerein, glucosamine, intra-articular hyaluronic acid, opioids (oral and transdermal), rosehip, transcutaneous electrical nerve stimulation, and ultrasound. Treatments voted not appropriate included risedronate and electrotherapy (neuromuscular electrical stimulation).

CONCLUSION

These evidence-based consensus recommendations provide guidance to patients and practitioners on treatments applicable to all individuals with knee OA, as well as therapies that can be considered according to individualized patient needs and preferences.

Consequences of chondrocyte hypertrophy on osteoarthritic cartilage: potential effect on angiogenesis

OBJECTIVE

The aim of this study was to investigate the link between the hypertrophic phenotype of chondrocytes and angiogenesis in osteoarthritis (OA) and more particularly to demonstrate that OA hypertrophic chondrocytes potentially express a phenotype promoting angiogenesis through the expression of factors controlling endothelial cells migration, invasion and adhesion.

METHOD

Human OA chondrocytes were cultivated in alginate beads in medium supplemented with 10% fetal bovine serum (FBS) to induce chondrocyte hypertrophy. The hypertrophic phenotype was characterized throughout 28 days of culture by measuring the expression of specific genes and by a microscopic observation of cellular morphology. The effect of media conditioned by OA hypertrophic chondrocyte on endothelial cells migration, invasion and adhesion was evaluated in functional assays. Moreover, hypertrophic OA chondrocytes were tested for the expression of angiogenic factors by real-time RT-PCR.

RESULTS

Specific markers of hypertrophy and observation of cellular morphology attested of the hypertrophic phenotype of chondrocytes in our culture model. Functional angiogenesis assays showed that factors produced by hypertrophic chondrocytes stimulated migration, invasion and adhesion of endothelial cells. Among the evaluated angiogenic factors, bone sialoprotein (BSP) was the most highly upregulated in hypertrophic chondrocytes. The inhibition of endothelial cell adhesion by a GRGDS peptide confirmed the implication of RGD domain proteins, like BSP, in hypertrophic chondrocyte-induced adhesion of endothelial cells.

CONCLUSION

Hypertrophic differentiation of chondrocyte may promote angiogenesis. Our findings established the relation of BSP with OA chondrocyte hypertrophy and suggested that this factor could constitute a potential target to control cartilage neovascularisation in OA.

Protective effect of a new biomaterial against the development of experimental osteoarthritis lesions in rabbit: a pilot study evaluating the intra-articular injection of alginate-chitosan beads dispersed in an hydrogel

OBJECTIVE

This study aimed to evaluate the structural benefit of a new biomaterial composed of alginate-chitosan (AC) beads dispersed in a hydrogel (H) derived from chitosan on the development of osteoarthritis (OA) in rabbit.

DESIGN

OA was induced by the surgical transection of the anterior cruciate ligament in rabbits. Animals received a single intra-articular injection (900 μl) of AC beads in H hydrogel, H hydrogel alone or saline a week after surgery. OA development was followed by X-rays. Blood samples were collected throughout the study to measure biological markers (Prostaglandins E2 - PGE2 and C reactive protein - CRP). Macroscopic observation and histological evaluation of articular cartilage and synovial membrane were performed 6 weeks after surgery.

RESULTS

AC beads in H hydrogel prevented from the development of OA based on the reduction of the Kellgren & Lawrence (K&L) score. It also significantly reduced the histological score of cartilage lesion severity. This effect was homogenous on every joint compartment. It was due to a significant effect on cartilage structure and cellularity scores. The injection of AC beads in H hydrogel also tended to reduce the synovial membrane inflammation. No significant variation of biological markers was noted.

CONCLUSIONS

The present pilot study provides interesting and promising results for the use of AC beads in H hydrogel in animal. It indeed prevented the development of OA cartilage lesions without inflammatory signs. The potencies of this biomaterial to protect OA joint should be further documented. It could then represent a new alternative for viscosupplementation in human OA management.

Identification of differential pattern of protein expression in canine osteoarthritis serum after anterior cruciate ligament transection: a proteomic analysis

Osteoarthritis (OA) management remains a great challenge and there is considerable effort to understand its pathophysiology and to identify new therapeutic targets and biomarkers. Canine OA surgically induced by the transection of the anterior cruciate ligament (ACLT) is a widely used and relevant model. This study reports a proteome mapping of dog serum and an analysis of the differentially expressed proteins between before and after ACLT. In the first part of the study, 261 picked protein spots were identified from preparative 2D gels and 71 different proteins were identified among the 261 spots present on the reference map. Canine serum proteome mapping reveals the presence of proteins of interest, such as fetuin B, complement C3 and C1s and pregnancy zone protein. The comparison between serum from dogs before and after ACLT reveals the differential expression of several proteins that could play a key role in the pathogenesis of OA. A number of proteins, such as fetuin B and complement C3, were increased in dog OA serum whereas others, such as hyaluronan binding protein 2, inter-alpha-trypsin inhibitor H4 (ITIH4), complement C1s and C4 and haptoglobin were decreased. Some of these proteins could be candidate biomarkers for diagnosis, prognosis and treatment evaluation. The results of the study also reinforced the similarities between dog experimental OA and human cases of OA.

Early decrease of serum biomarkers of type II collagen degradation (Coll2-1) and joint inflammation (Coll2-1 NO₂ ) by hyaluronic acid intra-articular injections in patients with knee osteoarthritis: a research study part of the Biovisco study

To measure the evolution of the serum levels of specific Osteoarthritis (OA) biomarker, Coll2-1 and Coll2-1 NO₂ in knee osteoarthritic patients after viscosupplementation (VS). Fifty-one patients with unilateral symptomatic knee were recruited for this prospective open label study. They received three intra-articular injections of 2 ml of hyaluronic acid (Hylan GF-20) and were followed for 3 months. Walking pain was evaluated and serum samples were taken at each visit. Coll2-1 and Coll2-1 NO₂ were measured in the serum using specific immunoassays. Variations over time of each parameter and predictive factor of response were studied. Forty-five patients were analyzed. The serum concentrations of Coll2-1 and Coll2-1 NO₂ were significantly higher in KL III/IV patients compared to KL I/II patients at baseline and decreased systematically over time after VS. Its effect was ever more pronounced in patients with KL III/IV. The serum concentration of Coll2-1 was significantly lower at baseline in responders than in non-responders. This study suggests a rapid slowdown of type II collagen degradation and joint inflammation after VS with Hylan G-20 and gives additional information for the validation of accurate biomarkers for OA. The serum level of Coll2-1 appeared to be a predictive factor for response to treatment.

Symptom and structure modification in osteoarthritis with pharmaceutical-grade chondroitin sulfate: what's the evidence?

OBJECTIVES

Osteoarthritis is a chronic disease characterized by irreversible damage to joint structures, including loss of articular cartilage, osteophyte formation, alterations in the subchondral bone and synovial inflammation. It has been shown that chondroitin sulfate interferes with the progression of structural changes in joint tissues and is used in the management of patients with osteoarthritis.

METHODS

This review summarizes data from relevant reports describing the mechanisms of action of chondroitin sulfate that may explain the beneficial effects of the drug and examines the evidence for clinical efficacy of oral chondroitin sulfate in osteoarthritis. Data included in the review were derived from a literature search in PubMed. Literature searches were performed in PubMed using the search terms 'chondroitin sulfate', 'pharmaceutical-grade', 'osteoarthritis', 'randomized clinical trials', 'humans'. The MEDLINE database was searched from January 1996 through August 2012 for all randomized controlled trials, meta-analyses, systematic reviews, and review articles of chondroitin sulfate in osteoarthritis.

RESULTS

Chondroitin sulfate exerts in vitro a beneficial effect on the metabolism of different cell lines: chondrocytes, synoviocytes and cells from subchondral bone, all involved in osteoarthritis. It increases type II collagen and proteoglycan synthesis in human articular chondrocytes and is able to reduce the production of some pro-inflammatory factors and proteases, to reduce the cellular death process, and improve the anabolic/catabolic balance of the extracellular cartilage matrix (ECM). Clinical trials have reported a beneficial effect of chondroitin sulfate on pain and function. The structure-modifying effects of chondroitin sulfate have been reported and analyzed in recent meta-analyses. The results in knee osteoarthritis demonstrate a small but significant reduction in the rate of decline in joint space width. Because chondroitin sulfate quality of several nutraceuticals has been found to be poor, it is recommended that pharmaceutical-grade chondroitin sulfate is used rather than food supplements in the treatment of OA. Chondroitin sulfate is recommended by several guidelines from international societies in the management of knee and hip OA. Furthermore, its safety profile is favorable when compared with many other therapies used in OA.

CONCLUSION

Chondroitin sulfate is an effective and safe treatment option for patients with osteoarthritis.

Effectiveness of preventive back educational interventions for low back pain: a critical review of randomized controlled clinical trials

PURPOSE

A systematic search was conducted to study the efficiency of preventive educational interventions mainly focused on a biomechanical/biomedical model.

METHODS

The PubMed electronic database and the Cochrane Library were searched based on a combination of keywords related to low back pain (LBP) and posture education. Only randomized controlled trial (RCT) studying the efficiency on outcomes directly related to LBP of a preventive intervention programme mainly based on education of proper care of the back for subjects not seeking treatment were included. References of the articles meeting these inclusion criteria were also checked to identify other potential citations. Besides, a methodological study assessment of the included RCTs was performed.

RESULTS

Nine studies, all conducted at the workplace were included in this review. Their mean quality level was low (5.1/12) and among the four studies with a huge sample size (n > 400 subjects), only one had an acceptable methodological quality score (6/12). The education interventions differed widely from one study to another. No significant differences between the control and education groups were found at the follow-up in eight out of the nine studies on the incidence of back pain, disability and sick leave.

CONCLUSIONS

The results of the RCTs included in this review suggest that educational interventions mainly focused on a biomechanical/biomedical model are not effective in preventing LBP. However, taking into account the methodological quality level of the RCTs as well as the very short and heterogeneous interventions often proposed, additional high-quality studies with a longer education period are needed to conclude that such interventions are inefficient.

Subchondral bone and osteoarthritis: biological and cellular aspects

The subchondral bone is involved in the pathophysiology of osteoarthritis (OA), both by biochemical and mechanical pathways. Overloaded OA subchondral bone osteoblasts express a pro-angiogenic and pro-inflammatory phenotype which contributes to explain the structural changes (sclerosis and bone marrow lesion) visible in OA subchondral bone. Further, microfractures and conjonctivo-vascular structures constitute exchange routes between bone and the overlying cartilage for mediators produced by osteoblasts. This narrative review describes these physiopathological mechanisms and identifies possible therapeutic targets for pharmacological modalities.

Coll2-1, Coll2-1NO2 and myeloperoxidase serum levels in erosive and non-erosive osteoarthritis of the hands

OBJECTIVE

Erosive osteoarthritis of the hand (EHOA) is thought to be an aggressive variant of hand osteoarthritis (HOA) characterised by prominent local inflammation and radiographic aspects of bone erosions in interphalangeal (IP) joints. However, rare studies have until now investigated the value of biomarkers in these patients. Thus, we determined Coll2-1, a marker of type II collagen denaturation, its nitrated form (Coll2-1NO2) and myeloperoxidase (MPO) levels in serum of patients with EHOA vs non-EHOA and subsequently evaluated their relationships with disease indices of severity and activity.

METHODS

Coll2-1, Coll2-1NO2 and MPO were measured using specific immunoassays in 82 patients, 57 with EHOA, all females, median age 59 (41-74 yrs) and 20 with non-EHOA, all females, median age 55 (43-73 yrs), fulfilling the American College of Rheumatology (ACR) criteria for hand OA. EHOA was characterized by the presence of at least one central bone erosion on radiograph in the IP joints. Patients were also evaluated for disease duration, number of affected (swollen and painful or tender) joints, radiographic score (RS) by Kallman scale and high sensitivity C-reactive protein (hsCRP).

RESULTS

Serum levels of MPO were higher in EHOA (230.0 ± 152.1 ng/ml) than in non-EHOA (160.2 ± 111.5 ng/ml, P=0.037). Coll2-1NO2 levels trended towards an elevation in EHOA compared non-EHOA (0.40 ± 0.86 vs 0.22 ± 0.14 nmol/l, P=0.06), while Coll2-1 levels were not different. Correlations were found for disease duration and both MPO (R(2)=0.48, P=0.001) and Coll2-1NO2 (R(2)=0.73, P=0.01) after the splitting of the population in subgroups according to a cut off value above the 50th percentile. A correlation was found between hsCRP and MPO (R(2)=0.57, P=0.01).

CONCLUSIONS

This study clearly demonstrates an elevation of some serum biomarkers in EHOA, in comparison with non-EHOA. In particular, MPO, hsCRP and the ratio Coll2-1NO2/Coll2-1 discriminated the two subsets of hand osteoarthritis (HOA), and a trend was also observed for Coll2-1NO2. These data suggest that these biomarkers could be helpful for the diagnosis of EHOA.

Osteoarthritis year 2011 in review: biochemical markers of osteoarthritis: an overview of research and initiatives

The "year in review" session is a key moment of the Osteoarthritis Research Society International (OARSI) Congress. This is a unique opportunity for opinion leaders to summarize and comment the recent advances in one particular field of osteoarthritis research. This review is a summary of selected studies related to soluble biomarkers published between September 1st, 2010 and August 30th, 2011 and identified by a pubmed search using the terms "biomarkers" and "osteoarthritis". In addition, I have selected some works presented during the 2011 OARSI Congress. This year was dominated by the publication of a consensus paper on the qualification of osteoarthritis (OA) biomarkers by the OARSI/Food Drug Administration (FDA) Osteoarthritis Biomarkers Working Group, and of proteomes of chondrocyte vesicles, urine and serum.

Relationship between arthroscopic joint evaluation and the levels of Coll2-1, Coll2-1NO(2), and myeloperoxidase in the blood and synovial fluid of horses affected with osteochondrosis of the tarsocrural joint

OBJECTIVE

To evaluate the levels of plasmatic and synovial Coll2-1, Coll2-1NO(2) and myeloperoxidase (MPO) in horses with osteochondral lesions of the tarsocrural joint and to investigate how these levels relate to arthroscopic findings of inflammation and degeneration.

MATERIALS AND METHODS

Venous blood and synovial fluid samples were collected from 63 horses presented for arthroscopic removal of osteochondral fragments in the tarsocrural joint. Prior to removal of the osteochondral fragment, an exploration of the joint was performed and an inflammatory and degenerative score was determined. The blood and synovial levels of Coll2-1, Coll2-1NO(2) and MPO were also measured. The effects of the arthroscopic evaluation (inflammatory and degenerative classes) on the blood and synovial markers were evaluated using a linear model (GLM procedure), and correlations between biochemical markers in the blood and synovial fluid and the arthroscopic evaluation (inflammatory and degenerative classes) were established (Pearson's correlations).

RESULTS

Significantly higher levels of Coll2-1 were detected in synovial fluid of higher degenerative classes. There was a significant correlation between the degenerative score and the synovial levels of Coll2-1 (r=0.27). According to the logistic regression model, there was a significant effect of the degenerative class on synovial levels of Coll2-1.

CONCLUSIONS

Coll2-1 correlates well with the degenerative state of tarsocrural joints as evaluated by arthroscopy. This marker can therefore be classified as a burden-of-disease marker in the assessment of joint disease in horses.

Application of biomarkers in the development of drugs intended for the treatment of osteoarthritis

OBJECTIVE

Osteoarthritis (OA) is a chronic and slowly progressive disease for which biomarkers may be able to provide a more rapid indication of therapeutic responses to therapy than is currently available; this could accelerate and facilitate OA drug discovery and development programs. The goal of this document is to provide a summary and guide to the application of in vitro (biochemical and other soluble) biomarkers in the development of drugs for OA and to outline and stimulate a research agenda that will further this goal.

METHODS

The Biomarkers Working Group representing experts in the field of OA biomarker research from both academia and industry developed this consensus document between 2007 and 2009 at the behest of the Osteoarthritis Research Society International Federal Drug Administration initiative (OARSI FDA initiative).

RESULTS

This document summarizes definitions and classification systems for biomarkers, the current outcome measures used in OA clinical trials, applications and potential utility of biomarkers for development of OA therapeutics, the current state of qualification of OA-related biomarkers, pathways for biomarker qualification, critical needs to advance the use of biomarkers for drug development, recommendations regarding practices and clinical trials, and a research agenda to advance the science of OA-related biomarkers.

CONCLUSIONS

Although many OA-related biomarkers are currently available they exist in various states of qualification and validation. The biomarkers that are likely to have the earliest beneficial impact on clinical trials fall into two general categories, those that will allow targeting of subjects most likely to either respond and/or progress (prognostic value) within a reasonable and manageable time frame for a clinical study (for instance within 1-2 years for an OA trial), and those that provide early feedback for preclinical decision-making and for trial organizers that a drug is having the desired biochemical effect. As in vitro biomarkers are increasingly investigated in the context of specific drug treatments, advances in the field can be expected that will lead to rapid expansion of the list of available biomarkers with increasing understanding of the molecular processes that they represent.