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Steen Pettersen P, Neogi T, Magnusson K, Mathiessen A, Hammer HB, Uhlig T, Kvien TK, Haugen IK. Associations between joint pathologies and central sensitization in persons with hand osteoarthritis: results from the Nor-Hand study. Rheumatology (Oxford) 2022; 61:2316-2324. [PMID: 34559196 PMCID: PMC9157061 DOI: 10.1093/rheumatology/keab708] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 09/10/2021] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVE Pain sensitization is associated with pain severity in persons with hand OA. What contributes to pain sensitization is unclear. This study explores whether hand OA pathologies and symptom duration are related to central sensitization. METHOD Participants with hand OA in the Nor-Hand study underwent bilateral hand radiography and US examination. Central sensitization was assessed with pressure pain thresholds (PPT) at remote sites (wrist, trapezius and tibialis anterior muscles) and temporal summation. We examined whether hand OA pathologies, independent of each other, including structural severity (Kellgren-Lawrence sum score, presence of erosive hand OA), inflammatory severity (greyscale synovitis and power Doppler activity sum scores) and symptom duration, were related to central sensitization, adjusting for age, sex, BMI, comorbidities and OA-severity of knee/hip. RESULTS In 291 participants (88% women, median age 61 years, interquartile range 57-66 years) Kellgren-Lawrence, greyscale synovitis and power Doppler activity sum scores were not associated with lower PPTs at remote sites. Persons with erosive hand OA had lower PPTs at the wrist (adjusted beta -0.75, 95% CI -1.32, -0.19) and tibialis anterior (adjusted beta -0.82, 95% CI -1.54, -0.09) and had greater temporal summation (adjusted beta 0.56, 95% CI 0.12, 1.01) compared with persons with non-erosive disease. No associations were found for symptom duration. CONCLUSIONS A person's overall amount of structural or inflammatory hand OA pathologies was not associated with central sensitization. Although persons with erosive hand OA showed greater signs of central sensitization, the small differences suggest that central sensitization is mainly explained by factors other than joint pathologies.
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Affiliation(s)
- Pernille Steen Pettersen
- Division of Rheumatology and Research, Diakonhjemmet Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Tuhina Neogi
- Section of Rheumatology, Boston University School of Medicine, Boston, MA, USA
| | - Karin Magnusson
- Orthopaedics, Clinical Epidemiology Unit, Department of Clinical Sciences, Faculty of Medicine, Lund University, Lund, Sweden
- Norwegian Institute of Public Health, Cluster for Health Services Research
| | | | - Hilde Berner Hammer
- Division of Rheumatology and Research, Diakonhjemmet Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Till Uhlig
- Faculty of Medicine, University of Oslo, Oslo, Norway
- National Advisory Unit on Rehabilitation in Rheumatology, Diakonhjemmet Hospital, Oslo, Norway
| | - Tore K Kvien
- Division of Rheumatology and Research, Diakonhjemmet Hospital
- Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital
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Valdrighi N, Vago JP, Blom AB, van de Loo FA, Blaney Davidson EN. Innate Immunity at the Core of Sex Differences in Osteoarthritic Pain? Front Pharmacol 2022; 13:881500. [PMID: 35662714 PMCID: PMC9160873 DOI: 10.3389/fphar.2022.881500] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 04/29/2022] [Indexed: 11/24/2022] Open
Abstract
Osteoarthritis (OA) is a progressive whole-joint disease; no disease-modifying drugs are currently available to stop or slow its process. Symptoms alleviation is the only treatment option. OA is the major cause of chronic pain in adults, with pain being the main symptom driving patients to seek medical help. OA pathophysiology is closely associated with the innate immune system, which is also closely linked to pain mediators leading to joint pain. Pain research has shown sex differences in the biology of pain, including sexually dimorphic responses from key cell types in the innate immune system. Not only is OA more prevalent in women than in men, but women patients also show worse OA outcomes, partially due to experiencing more pain symptoms despite having similar levels of structural damage. The cause of sex differences in OA and OA pain is poorly understood. This review provides an overview of the involvement of innate immunity in OA pain in joints and in the dorsal root ganglion. We summarize the emerging evidence of sex differences regarding innate immunity in OA pain. Our main goal with this review was to provide a scientific foundation for future research leading to alternative pain relief therapies targeting innate immunity that consider sex differences. This will ultimately lead to a more effective treatment of pain in both women and men.
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Mibu A, Nishigami T, Tanaka K, Yono S, Manfuku M, Imai R. Does a combination of self‐reported signs related to central sensitization and pressure pain threshold allow for a more detailed classification of pain‐related characteristics in patients with chronic musculoskeletal pain?: A cross‐sectional study. Pain Pract 2022; 22:556-563. [DOI: 10.1111/papr.13125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 04/29/2022] [Indexed: 11/30/2022]
Affiliation(s)
- Akira Mibu
- Department of Physical Therapy, Konan Women’s University Kobe Hyogo Japan
| | - Tomohiko Nishigami
- Department of Physical Therapy, Faculty of Health and Welfare Prefectural University of Hiroshima Mihara Hiroshima Japan
| | | | - Satoko Yono
- Department of Rehabilitation, Tanabe Orthopaedics Osaka Osaka Japan
| | | | - Ryota Imai
- Department of Physical Therapy Osaka Kawasaki Rehabilitation University Osaka Japan
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Dravid AA, M. Dhanabalan K, Agarwal S, Agarwal R. Resolvin D1-loaded nanoliposomes promote M2 macrophage polarization and are effective in the treatment of osteoarthritis. Bioeng Transl Med 2022; 7:e10281. [PMID: 35600665 PMCID: PMC9115708 DOI: 10.1002/btm2.10281] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/19/2021] [Accepted: 09/22/2021] [Indexed: 11/24/2022] Open
Abstract
Current treatments for osteoarthritis (OA) offer symptomatic relief but do not prevent or halt the disease progression. Chronic low-grade inflammation is considered a significant driver of OA. Specialized proresolution mediators are powerful agents of resolution but have a short in vivo half-life. In this study, we have engineered a Resolvin D1 (RvD1)-loaded nanoliposomal formulation (Lipo-RvD1) that targets and resolves the OA-associated inflammation. This formulation creates a depot of the RvD1 molecules that allows the controlled release of the molecule for up to 11 days in vitro. In surgically induced mice model of OA, only controlled-release formulation of Lipo-RvD1 was able to treat the progressing cartilage damage when administered a month after the surgery, while the free drug was unable to prevent cartilage damage. We found that Lipo-RvD1 functions by damping the proinflammatory activity of synovial macrophages and recruiting a higher number of M2 macrophages at the site of inflammation. Our Lipo-RvD1 formulation was able to target and suppress the formation of the osteophytes and showed analgesic effect, thus emphasizing its ability to treat clinical symptoms of OA. Such controlled-release formulation of RvD1 could represent a patient-compliant treatment for OA.
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Affiliation(s)
- Ameya A. Dravid
- BioSystems Science and EngineeringIndian Institute of ScienceBangaloreKarnatakaIndia
| | - Kaamini M. Dhanabalan
- BioSystems Science and EngineeringIndian Institute of ScienceBangaloreKarnatakaIndia
| | - Smriti Agarwal
- BioSystems Science and EngineeringIndian Institute of ScienceBangaloreKarnatakaIndia
| | - Rachit Agarwal
- BioSystems Science and EngineeringIndian Institute of ScienceBangaloreKarnatakaIndia
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Wood MJ, Miller RE, Malfait AM. The Genesis of Pain in Osteoarthritis: Inflammation as a Mediator of Osteoarthritis Pain. Clin Geriatr Med 2022; 38:221-238. [PMID: 35410677 PMCID: PMC9053380 DOI: 10.1016/j.cger.2021.11.013] [Citation(s) in RCA: 43] [Impact Index Per Article: 21.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Chronic pain is a substantial personal and societal burden worldwide. Osteoarthritis (OA) is one of the leading causes of chronic pain and is increasing in prevalence in accordance with a global aging population. In addition to affecting patients' physical lives, chronic pain also adversely affects patients' mental wellbeing. However, there remain no pharmacologic interventions to slow down the progression of OA and pain-alleviating therapies are largely unsuccessful. The presence of low-level inflammation in OA has been recognized for many years as a major pathogenic driver of joint damage. Inflammatory mechanisms can occur locally in joint tissues, such as the synovium, within the sensory nervous system, as well as systemically, caused by modifiable and unmodifiable factors. Understanding how inflammation may contribute to, and modify pain in OA will be instrumental in identifying new druggable targets for analgesic therapies. In this narrative review, we discuss recent insights into inflammatory mechanisms in OA pain. We discuss how local inflammation in the joint can contribute to mechanical sensitization and to the structural neuroplasticity of joint nociceptors, through pro-inflammatory factors such as nerve growth factor, cytokines, and chemokines. We consider the role of synovitis, and the amplifying mechanisms of neuroimmune interactions. We then explore emerging evidence around the role of neuroinflammation in the dorsal root ganglia and dorsal horn. Finally, we discuss how systemic inflammation associated with obesity may modify OA pain and suggest future research directions.
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Affiliation(s)
- Matthew J Wood
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Room 340, 1735 W Harrison Street, Chicago, IL 60612, USA
| | - Rachel E Miller
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, Room 714, 1735 W Harrison Street, Chicago, IL 60612, USA
| | - Anne-Marie Malfait
- Department of Internal Medicine, Division of Rheumatology, Rush University Medical Center, 1611 W Harrison Street, Suite 510, Chicago, IL 60612, USA.
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Detection of altered pain facilitatory and inhibitory mechanisms in patients with knee osteoarthritis by using a simple bedside tool kit (QuantiPain). Pain Rep 2022; 7:e998. [PMID: 35392651 PMCID: PMC8984378 DOI: 10.1097/pr9.0000000000000998] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/25/2022] [Accepted: 02/10/2022] [Indexed: 11/26/2022] Open
Abstract
Supplemental Digital Content is Available in the Text. A simple bedside quantitative sensory testing tool kit demonstrated acceptable reliability and assessment validity for detecting altered pain facilitatory and inhibitory mechanisms in patients with painful osteoarthritis. Purpose: Altered pain facilitatory and inhibitory mechanisms have been recognized as an important manifestation in patients with chronic pain, and quantitative sensory testing (QST) can act as a proxy for this process. We have recently developed a simple bedside QST tool kit (QuantiPain) for more clinical use. The purpose of this study was to investigate its test–retest reliability and to evaluate its validity compared with the laboratory-based QST protocols in patients with knee osteoarthritis (OA). Methods: QuantiPain consists of 3 items: “pressure algometer” (for pressure pain thresholds [PPTs]), “pinprick” (for temporal summation of pain [TSP]), and “conditioning clamp” (for conditioned pain modulation [CPM]). In experiment-A, intrarater and interrater test–retest reliabilities were investigated in 21 young healthy subjects by using interclass correlation coefficient (ICC). In experiment-B, 40 unilateral painful patients with OA and 40 age-matched, healthy control subjects were included to compare the bedside tool kit against the computerized pressure algometry. Results: In experiment-A, excellent to moderate intrarater and interrater reliabilities were achieved in PPT and TSP (ICC: 0.60–0.92) while the agreements of CPM were good to poor (ICC: 0.37–0.80). In experiment-B, localized and widespread decrease of PPT, facilitated TSP, and impaired CPM was found by using the bedside tool kit in patients with OA compared with controls (P < 0.05). The data were significantly correlated with the established laboratory-based tools (R = 0.281–0.848, P < 0.05). Conclusion: QuantiPain demonstrated acceptable test–retest reliability and assessment validity with the sensitivity to separate patients with painful OA from controls, which has a potential to create more practical approach for quantifying altered pain mechanisms in clinical settings.
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Vincent TL, Alliston T, Kapoor M, Loeser RF, Troeberg L, Little CB. Osteoarthritis Pathophysiology: Therapeutic Target Discovery may Require a Multifaceted Approach. Clin Geriatr Med 2022; 38:193-219. [PMID: 35410676 PMCID: PMC9107912 DOI: 10.1016/j.cger.2021.11.015] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Molecular understanding of osteoarthritis (OA) has greatly increased through careful analysis of tissue samples, preclinical models, and large-scale agnostic "-omic" studies. There is broad acceptance that systemic and biomechanical signals affect multiple tissues of the joint, each of which could potentially be targeted to improve patient outcomes. In this review six experts in different aspects of OA pathogenesis provide their independent view on what they believe to be good tractable approaches to OA target discovery. We conclude that molecular discovery has been high but future transformative studies require a multidisciplinary holistic approach to develop therapeutic strategies with high clinical efficacy.
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Affiliation(s)
- Tonia L Vincent
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, Oxford OX3 7FY, UK
| | - Tamara Alliston
- Department of Orthopaedic Surgery, University of California San Francisco, San Francisco, CA 94143, USA
| | - Mohit Kapoor
- Department of Surgery and Laboratory Medicine and Pathobiology, Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, University of Toronto, Toronto, Canada
| | - Richard F Loeser
- Department of Medicine, Division of Rheumatology, Allergy and Immunology and the Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Linda Troeberg
- University of East Anglia, Norwich Medical School, Norwich NR4 7UQ, UK
| | - Christopher B Little
- Raymond Purves Bone and Joint Research Laboratories, Kolling Institute University of Sydney Faculty of Medicine and Health at Royal North Shore Hospital, St. Leonards, New South Wales 2065, Australia.
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Gowler PRW, Turnbull J, Shahtaheri M, Gohir S, Kelly T, McReynolds C, Yang J, Jha RR, Fernandes GS, Zhang W, Doherty M, Walsh DA, Hammock BD, Valdes AM, Barrett DA, Chapman V. Clinical and Preclinical Evidence for Roles of Soluble Epoxide Hydrolase in Osteoarthritis Knee Pain. Arthritis Rheumatol 2022; 74:623-633. [PMID: 34672113 PMCID: PMC8957539 DOI: 10.1002/art.42000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chronic pain due to osteoarthritis (OA) is a major clinical problem, and existing analgesics often have limited beneficial effects and/or adverse effects, necessitating the development of novel therapies. Epoxyeicosatrienoic acids (EETs) are endogenous antiinflammatory mediators, rapidly metabolized by soluble epoxide hydrolase (EH) to dihydroxyeicosatrienoic acids (DHETs). We undertook this study to assess whether soluble EH-driven metabolism of EETs to DHETs plays a critical role in chronic joint pain associated with OA and provides a new target for treatment. METHODS Potential associations of chronic knee pain with single-nucleotide polymorphisms (SNPs) in the gene-encoding soluble EH and with circulating levels of EETs and DHETs were investigated in human subjects. A surgically induced murine model of OA was used to determine the effects of both acute and chronic selective inhibition of soluble EH by N-[1-(1-oxopropy)-4-piperidinyl]-N'-(trifluoromethoxy)phenyl]-urea (TPPU) on weight-bearing asymmetry, hind paw withdrawal thresholds, joint histology, and circulating concentrations of EETs and DHETs. RESULTS In human subjects with chronic knee pain, 3 pain measures were associated with SNPs of the soluble EH gene EPHX2, and in 2 separate cohorts of subjects, circulating levels of EETs and DHETs were also associated with 3 pain measures. In the murine OA model, systemic administration of TPPU both acutely and chronically reversed established pain behaviors and decreased circulating levels of 8,9-DHET and 14,15-DHET. EET levels were unchanged by TPPU administration. CONCLUSION Our novel findings support a role of soluble EH in OA pain and suggest that inhibition of soluble EH and protection of endogenous EETs from catabolism represents a potential new therapeutic target for OA pain.
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Affiliation(s)
- Peter R. W. Gowler
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
| | - James Turnbull
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy. University of Nottingham, UK
| | - Mohsen Shahtaheri
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Sameer Gohir
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Tony Kelly
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Cindy McReynolds
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Centre, University of California, Davis, USA
| | - Jun Yang
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Centre, University of California, Davis, USA
| | - Rakesh R. Jha
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy. University of Nottingham, UK
| | - Gwen S. Fernandes
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Weiya Zhang
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Michael Doherty
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - David A. Walsh
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Bruce D. Hammock
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Centre, University of California, Davis, USA
| | - Ana. M. Valdes
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - David A. Barrett
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy. University of Nottingham, UK
| | - Victoria Chapman
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
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Wei J, Liu L, Li Z, Lyu T, Zhao L, Xu X, Song Y, Dai Y, Li B. Fire Needling Acupuncture Suppresses Cartilage Damage by Mediating Macrophage Polarization in Mice with Knee Osteoarthritis. J Pain Res 2022; 15:1071-1082. [PMID: 35444462 PMCID: PMC9013919 DOI: 10.2147/jpr.s360555] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Accepted: 03/31/2022] [Indexed: 12/24/2022] Open
Affiliation(s)
- Jiangyan Wei
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Lu Liu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Zhijuan Li
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Tianli Lyu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Luopeng Zhao
- Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Institute of Traditional Chinese Medicine, Beijing, People’s Republic of China
| | - Xiaobai Xu
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Yine Song
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Yidan Dai
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
| | - Bin Li
- Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, Beijing, People’s Republic of China
- Correspondence: Bin Li, Department of Acupuncture and Moxibustion, Beijing Hospital of Traditional Chinese Medicine, Capital Medical University, Beijing Key Laboratory of Acupuncture Neuromodulation, 23 Meishuguan Back Street, Dongcheng District, Beijing, 100010, People’s Republic of China, Tel +86-18910781852, Fax +86-87906055, Email
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Aoyagi K, Liew JW, Farrar JT, Wang N, Carlesso L, Kumar D, Frey Law L, Lewis CE, Nevitt M, Neogi T. Does weight-bearing versus non-weight-bearing pain reflect different pain mechanisms in knee osteoarthritis?: the Multicenter Osteoarthritis Study (MOST). Osteoarthritis Cartilage 2022; 30:545-550. [PMID: 34801670 PMCID: PMC8940656 DOI: 10.1016/j.joca.2021.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is predominantly characterized by pain with weight-bearing activities. Pain at rest also occurs but the mechanisms for this are not clear. We evaluated the relations of nociceptive signal alterations to weight-bearing and non-weight-bearing pain in knee OA. DESIGN We used data from a NIH-funded longitudinal cohort of older adults with or at risk of knee OA. We evaluated quantitative sensory testing (QST) measures (pressure pain threshold (PPT) at patellae and the wrist; mechanical temporal summation (TS); conditioned pain modulation (CPM)). Each WOMAC pain question was dichotomized as having at least moderate pain, and we further categorized them as weight-bearing pain and non-weight-bearing pain. We evaluated the relation of QST measures to each pain outcome using logistic regression, adjusting for potential confounders. RESULTS 2,749 participants (5,479 knees) were included (mean age 64 ± 11, 57% female). Each SD unit decrease in patellar PPT was associated with greater odds of both weight-bearing pain (OR 1.51 (95% CI 1.27, 1.79)) and non-weight-bearing pain (OR 1.46 (1.20-1.77)), while wrist PPT was associated with greater odds of weight-bearing pain (OR 1.27 (1.15, 1.39)) but only with pain during sitting/lying (OR 1.20 (1.01, 1.43)). TS was significantly associated with greater odds of pain with walking and stairs (OR 1.11 (1.01, 1.23), 1.11 (1.03, 1.20), respectively). CPM was not associated with any pain outcomes. CONCLUSIONS Our findings challenge the hypothesis that non-weight-bearing pain may reflect greater pain sensitization and/or inefficient CPM than weight-bearing pain in knee OA, suggesting other mechanisms are likely responsible.
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Affiliation(s)
- K Aoyagi
- Boston University School of Medicine, Boston, MA, USA.
| | - J W Liew
- Boston University School of Medicine, Boston, MA, USA.
| | - J T Farrar
- University of Pennsylvania School of Medicine, Philadelphia, PA, USA.
| | - N Wang
- Boston University School of Public Health, Boston, MA, USA.
| | | | - D Kumar
- Boston University School of Medicine, Boston, MA, USA.
| | | | - C E Lewis
- University of Alabama, Birmingham, AL, USA.
| | - M Nevitt
- University of California San Francisco, San Francisco, CA, USA.
| | - T Neogi
- Boston University School of Medicine, Boston, MA, USA.
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Philpott HT, Birmingham TB, Dima R, Pinto R, Bryant D, Appleton CT. Test-Retest Reliability and Sensitivity to Change of Ultrasound-Based Methods of Measuring Synovial Inflammation in Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:902-910. [PMID: 35294110 DOI: 10.1002/acr.24882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess test-retest reliability of musculoskeletal ultrasound (US) measures of inflammation in patients with knee osteoarthritis (OA) and to assess the sensitivity to change of US measures of inflammation in patients with knee OA. METHODS To mimic a common clinical scenario, 36 patients (n = 70 knees) with symptomatic knee OA who were in stable condition underwent 2 assessments within 14 days by different operators and different US machines, graded by a single rater. Test-retest reliability was measured using Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and absolute agreement parameters. A total of 51 patients (n = 72 knees) were tested immediately before and 21-28 days after intraarticular glucocorticoid injection to investigate sensitivity to change and longitudinal construct validity. Paired t-tests and standardized response mean (SRM) were used to assess sensitivity to change. Multivariate linear regression was used to investigate longitudinal construct validity of US with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, while adjusting for covariates. RESULTS US measures of inflammation demonstrated moderate (κ = 0.41, 0.60) to substantial (κ = 0.61, 0.80) agreement. Quantitative measures of synovitis and effusion demonstrated good test-retest reliability (ICC2,1 0.71, 0.92). US measures of synovitis and effusion demonstrated low-to-moderate sensitivity to change (SRM -0.29, -0.50). The associations between changes in US measures and KOOS pain scores over time were low, and 95% confidence intervals included zero. CONCLUSION In a clinical setting, US measures of inflammatory features of knee OA have substantial reliability and low-to-moderate sensitivity to change, whereas measures of structural OA features are less reliable. Longitudinal construct validity of US measures of synovitis and effusion to KOOS pain scores is not strongly supported.
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Affiliation(s)
- Holly T Philpott
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Trevor B Birmingham
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Robert Dima
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Ryan Pinto
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Dianne Bryant
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - C Thomas Appleton
- Bone and Joint Institute, Schulich School of Medicine and Dentistry, and London Health Sciences Centre-University Hospital, University of Western Ontario, London, Ontario, Canada
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Carlesso LC, Feldman DE, Vendittoli PA, LaVoie F, Choinière M, Bolduc MÈ, Fernandes J, Newman N, Sabouret P. Use of IMMPACT Recommendations to Explore Pain Phenotypes in People with Knee Osteoarthritis. PAIN MEDICINE 2022; 23:1708-1716. [PMID: 35266543 DOI: 10.1093/pm/pnac044] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a disease of multiple phenotypes of which a chronic pain phenotype (PP) is known. Previous PP studies have focused on one domain of pain and included heterogenous variables. We sought to identify multidimensional PPs using the IMMPACT recommendations and their relationship to clinical outcomes. METHODS Participants >40 years of age with knee OA having a first-time orthopaedic consultation at five university affiliated hospitals in Montreal, Quebec and Hamilton (Canada) were recruited. Latent profile analysis was used to determine PPs (classes) using variables recommended by IMMPACT. This included pain variability, intensity and qualities, somatization, anxiodepressive symptoms, sleep, fatigue, pain catastrophizing, neuropathic pain, and quantitative sensory tests. We used MANOVA and Chi-square tests to assess differences in participant characteristics across the classes and linear and Poisson regression to evaluate the association of classes to outcomes of physical performance tests, self-reported function and provincial healthcare data. RESULTS 343 participants were included (mean age 64 years, 64% female). Three classes were identified with increasing pain burden (class3 > class1), characterized by significant differences across most self-report measures and temporal summation, and differed in terms of female sex, younger age, lower optimism and pain self-efficacy. Participants in class2 and class3 had significantly worse self-reported function, stair climb and 40m walk tests, and higher rates of healthcare usage compared to those in class1. CONCLUSIONS Three distinct PPs guided by IMMPACT recommendations were identified, predominated by self-report measures and temporal summation. Using this standardized approach may improve PP study variability and comparison.
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Affiliation(s)
- Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Associate, Research Institute St. Joseph's Hamilton, Canada; School of Rehabilitation, Université de Montreal, Montreal, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, School of Public Health, Department of Social and Preventive Medicine, Université de Montreal,Centre for interdisciplinary research in rehabilitation,Institute of Public Health Research,Université de Montréal, Montreal, Canada
| | - Pascal-André Vendittoli
- Département de Chirurgie, Hôpital Maisonneuve-Rosemont,Université de Montréal, Montréal, QC, Canada
| | - Frédéric LaVoie
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada; Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Ève Bolduc
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julio Fernandes
- Department of Orthopaedic Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada; Faculty of Medicine, Université de Montréal, Montréal, Canada; Department of Orthopaedic Surgery, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Nicholas Newman
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pierre Sabouret
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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Micro-fragmentation is a valid alternative to cell expansion and enzymatic digestion of adipose tissue for the treatment of knee osteoarthritis: a comparative preclinical study. Knee Surg Sports Traumatol Arthrosc 2022; 30:773-781. [PMID: 33464397 DOI: 10.1007/s00167-020-06373-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Accepted: 11/11/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE The aim of this study was to compare three procedures to exploit adipose-derived cells for the treatment of osteoarthritis (OA) in a preclinical model, to understand their therapeutic potential and identify the most suitable approach for the clinical application. METHODS Biological samples from adipose tissue, processed by mechanical micro-fragmentation (MF), enzymatic digestion (SVF) or cell expansion (ADSCs), were first characterized in vitro and then used in vivo in a surgically induced OA rabbit model: Group 1-control group (untreated 12 knees/saline 12 knees), Group 2-MF (24 knees), Group 3-SVF (24 knees), Group 4-ADSCs (24 knees). Macroscopic, histological, histomorphometric, immunohistochemical and blood and synovial fluid analyses were evaluated at 2 and 4 months from the treatments. RESULTS Samples obtained by the three procedures yielded 85-95% of viable cells. In vivo assessments showed no significant side effects or inflammatory responses after the injection. The macroscopic Hanashi score did not show significant differences among treated groups and controls. The histopathological evaluation of synovial tissues showed lower signs of synovitis for MF, although the semiquantitative analysis (Krenn score) did not reach statistical significance. Instead, MF showed the best results both in terms of qualitative and semi-quantitative evaluations of articular cartilage, with a more uniform staining, a smoother surface and a significantly better Laverty score (p = 0.004). CONCLUSION MF, SVF, and expanded ADSCs did not elicit significant local or systemic adverse reactions in this preclinical OA model. Among the different methods used to exploit the adipose tissue potential, MF showed the most promising findings in particular in terms of protection of the articular surface from the joint degenerative OA processes. LEVEL OF EVIDENCE Preclinical animal study.
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Pan TT, Gao W, Song ZH, Long DD, Cao P, Hu R, Chen DY, Zhou WJ, Jin Y, Hu SS, Wei W, Chai XQ, Zhang Z, Wang D. Glutamatergic neurons and myeloid cells in the anterior cingulate cortex mediate secondary hyperalgesia in chronic joint inflammatory pain. Brain Behav Immun 2022; 101:62-77. [PMID: 34973395 DOI: 10.1016/j.bbi.2021.12.021] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/20/2021] [Accepted: 12/24/2021] [Indexed: 02/06/2023] Open
Affiliation(s)
- Ting-Ting Pan
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Wei Gao
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Zi-Hua Song
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China; Innovation Laboratory of Terahertz Biophysics, National Innovation Institute of Defense Technology, Beijing 100071, China
| | - Dan-Dan Long
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Peng Cao
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Rui Hu
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Dan-Yang Chen
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Wen-Jie Zhou
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Yan Jin
- Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Shan-Shan Hu
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China
| | - Wei Wei
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China
| | - Xiao-Qing Chai
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China
| | - Zhi Zhang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China; Department of Neurobiology, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, PR China
| | - Di Wang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei 230001, China.
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65
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Wang D, Chai XQ, Hu SS, Pan F. Joint synovial macrophages as a potential target for intra-articular treatment of osteoarthritis-related pain. Osteoarthritis Cartilage 2022; 30:406-415. [PMID: 34861384 DOI: 10.1016/j.joca.2021.11.014] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 10/19/2021] [Accepted: 11/22/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis is the most common form of joint disease and is one of the leading causes of chronic pain. Given the multi-factorial nature, numerous efforts have been made to clarify the multiple factors impacting the pain symptoms and joint pathology, including synovial macrophages in particular. Accumulating evidence from studies involving human participants and experimental animal models suggests that accumulating macrophages in synovial tissue are implicated in peripherally mediated pain sensitization of affected joints in osteoarthritis. Crosstalk between synovial macrophages and the innervating primary nociceptive neurons is thought to contribute to this facilitated pain processing by the peripheral nervous system. Due to high plasticity and complexity of synovial macrophages in the joint, safe therapies targeting single cells or molecules are currently lacking. Using advanced technologies (such as single-cell RNA sequencing and mass cytometry), studies have shown that diverse subpopulations of synovial macrophages exist in the distinct synovial microenvironments of specific osteoarthritis subtypes. Considerable progress has been made in delineating the molecular mechanisms of various subsets of synovial macrophages in the development of osteoarthritis. To develop a novel intra-articular treatment paradigm targeting synovial macrophages, we have summarized in this review the recent advances in identifying the functional consequences of synovial macrophage sub-populations and understanding of the molecular mechanisms driving macrophage-mediated remodeling.
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Affiliation(s)
- D Wang
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei 230001, China.
| | - X-Q Chai
- Pain Clinic, Department of Anesthesiology, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China (USTC), Hefei 230001, China.
| | - S-S Hu
- The Key Laboratory of Anti-inflammatory and Immune Medicine, Ministry of Education, PR China (Anhui Medical University), Institute of Clinical Pharmacology, Anhui Medical University, Hefei 230032, China.
| | - F Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS 7000, Australia.
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Meurot C, Martin C, Sudre L, Breton J, Bougault C, Rattenbach R, Bismuth K, Jacques C, Berenbaum F. Liraglutide, a glucagon-like peptide 1 receptor agonist, exerts analgesic, anti-inflammatory and anti-degradative actions in osteoarthritis. Sci Rep 2022; 12:1567. [PMID: 35091584 PMCID: PMC8799666 DOI: 10.1038/s41598-022-05323-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Accepted: 01/11/2022] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is a common disabling disease worldwide, with no effective and safe disease-modifying drugs (DMOAD) in the market. However, studies suggest that drugs, such as liraglutide, which possess strong potential in decreasing low-grade systemic inflammation may be effective in treating OA. Therefore, the aim of this study was to examine the anti-inflammatory, analgesic, and anti-degradative effects in OA using in vitro and in vivo experiments. The results showed that intra-articular injection of liraglutide alleviated pain-related behavior in in vivo sodium monoiodoacetate OA mouse model, which was probably driven by the GLP-1R-mediated anti-inflammatory activity of liraglutide. Moreover, liraglutide treatment significantly decreased IL-6, PGE2 and nitric oxide secretion, and the expression of inflammatory genes in vitro in chondrocytes and macrophages in a dose-dependent manner. Additionally, liraglutide shifted polarized macrophage phenotype in vitro from the pro-inflammatory M1 phenotype to the M2 anti-inflammatory phenotype. Furthermore, liraglutide exerted anti-catabolic activity by significantly decreasing the activities of metalloproteinases and aggrecanases, a family of catabolic enzymes involved in cartilage breakdown in vitro. Overall, the findings of this study showed that liraglutide ameliorated OA-associated pain, possess anti-inflammatory and analgesic properties, and could constitute a novel therapeutic candidate for OA treatment.
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Affiliation(s)
| | | | | | | | - C Bougault
- Sorbonne University, INSERM CRSA St-Antoine, Paris, France
| | - R Rattenbach
- 4P-Pharma, Lille, France
- 4Moving Biotech, Lille, France
| | | | - C Jacques
- Sorbonne University, INSERM CRSA St-Antoine, Paris, France
| | - F Berenbaum
- 4Moving Biotech, Lille, France.
- Sorbonne University, INSERM CRSA, Rheumatology Department, AP-HP St-Antoine, Paris, France.
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Weaver KR, Griffioen MA, Klinedinst NJ, Galik E, Duarte AC, Colloca L, Resnick B, Dorsey SG, Renn CL. Quantitative Sensory Testing Across Chronic Pain Conditions and Use in Special Populations. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 2:779068. [PMID: 35295425 PMCID: PMC8915716 DOI: 10.3389/fpain.2021.779068] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 12/07/2021] [Indexed: 02/01/2023]
Abstract
Chronic pain imposes a significant burden to the healthcare system and adversely affects patients' quality of life. Traditional subjective assessments, however, do not adequately capture the complex phenomenon of pain, which is influenced by a multitude of factors including environmental, developmental, genetic, and psychological. Quantitative sensory testing (QST), established as a protocol to examine thermal and mechanical sensory function, offers insight on potential mechanisms contributing to an individual's experience of pain, by assessing their perceived response to standardized delivery of stimuli. Although the use of QST as a research methodology has been described in the literature in reference to specific pain populations, this manuscript details application of QST across a variety of chronic pain conditions. Specific conditions include lower extremity chronic pain, knee osteoarthritis, chronic low back pain, temporomandibular joint disorder, and irritable bowel syndrome. Furthermore, we describe the use of QST in placebo/nocebo research, and discuss the use of QST in vulnerable populations such as those with dementia. We illustrate how the evaluation of peripheral sensory nerve function holds clinical promise in targeting interventions, and how using QST can enhance patient education regarding prognostic outcomes with particular treatments. Incorporation of QST methodology in research investigations may facilitate the identification of common mechanisms underlying chronic pain conditions, guide the development of non-pharmacological behavioral interventions to reduce pain and pain-related morbidity, and enhance our efforts toward reducing the burden of chronic pain.
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Affiliation(s)
- Kristen R. Weaver
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States,Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, United States,*Correspondence: Kristen R. Weaver
| | - Mari A. Griffioen
- Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, United States,College of Health Sciences, School of Nursing, University of Delaware, Newark, DE, United States
| | - N. Jennifer Klinedinst
- Department of Organizational Systems and Adult Health, School of Nursing, University of Maryland, Baltimore, MD, United States
| | - Elizabeth Galik
- Department of Organizational Systems and Adult Health, School of Nursing, University of Maryland, Baltimore, MD, United States
| | - Ana C. Duarte
- Department of Family and Community Health, School of Nursing, University of Maryland, Baltimore, MD, United States
| | - Luana Colloca
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States,Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, United States
| | - Barbara Resnick
- Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, United States,Department of Organizational Systems and Adult Health, School of Nursing, University of Maryland, Baltimore, MD, United States
| | - Susan G. Dorsey
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States,Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, United States
| | - Cynthia L. Renn
- Department of Pain and Translational Symptom Science, School of Nursing, University of Maryland, Baltimore, MD, United States,Center to Advance Chronic Pain Research (CACPR), University of Maryland, Baltimore, MD, United States
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Liu YC, Hsiao HT, Wang JCF, Wen TC, Chen SL. TGF-β1 in plasma and cerebrospinal fluid can be used as a biological indicator of chronic pain in patients with osteoarthritis. PLoS One 2022; 17:e0262074. [PMID: 35061744 PMCID: PMC8782532 DOI: 10.1371/journal.pone.0262074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 12/18/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction Previous studies have demonstrated that cytokines, transforming growth factor (TGF-β1), and brain-derived neurotrophic factor (BDNF) can impact the intensity of pain in rodents. However, the roles of cytokines, TGF-β1 and BDNF in humans with chronic pain in osteoarthritis remains unclear, and no comparison between plasma and central cerebral spinal fluid (CSF) has been conducted. Methods Patients with osteoarthritis who were scheduled to receive spinal anesthesia were enrolled. The intensity of pain was evaluated with a visual analogue scale (VAS). In addition, patients with genitourinary system (GU) diseases and without obvious pain (VAS 0–1) were included as a comparison (control) group. The levels of TGF-β1, BDNF, tumor necrosis factor-α (TNF-α), and interleukin (IL)-8 within the CSF and plasma were collected and evaluated before surgery. Results The plasma and CSF TGF-β1 levels were significantly lower in the osteoarthritis patients with pain (VAS ≥ 3) than in the GU control patients. Downregulation of plasma BDNF was also found in osteoarthritis patients with pain. The Spearman correlation analysis showed that the VAS pain scores were significantly negatively correlated with the levels of TGF-β1 in the CSF of patients with osteoarthritis. However, there was no significant correlations between the pain scores and the levels of BDNF, TNF-α, and IL-8 in either the CSF or plasma. Conclusions TGF-β1 but not BDNF, TNF-α, or IL-8 may be an important biological indicator in the CSF of osteoarthritis patients with chronic pain.
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Affiliation(s)
- Yen-Chin Liu
- Department of Anesthesiology, Kaohsiung Medical University (KMU) Hospital, KMU, Kaohsiung, Taiwan
- Department of Anesthesiology, National Cheng Kung University Hospital (NCKU), College of Medicine, NCKU, Tainan, Taiwan
| | - Hung-Tsung Hsiao
- Department of Anesthesiology, National Cheng Kung University Hospital (NCKU), College of Medicine, NCKU, Tainan, Taiwan
| | - Jeffrey Chi-Fei Wang
- Department of Anesthesiology, National Cheng Kung University Hospital (NCKU), College of Medicine, NCKU, Tainan, Taiwan
| | - Tzu-Cheng Wen
- School of Medicine, College of Medicine, NCKU, Tainan, Taiwan
| | - Shiou-Lan Chen
- Graduate Institute of Medicine & M.Sc. Program in Tropical Medicine, College of Medicine, KMU, Kaohsiung, Taiwan
- Department of Medical Research, KMU Hospital, Kaohsiung, Taiwan
- Drug Development and Value Creation Research Center, KMU, Kaohsiung, Taiwan
- College of Professional Studies, National Pingtung University, Taiwan
- * E-mail:
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Carlesso LC, Law LF, Wang N, Nevitt M, Lewis CE, Neogi T. Association of Pain Sensitization and Conditioned Pain Modulation to Pain Patterns in Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 74:107-112. [PMID: 32882103 PMCID: PMC7925701 DOI: 10.1002/acr.24437] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Revised: 08/10/2020] [Accepted: 08/27/2020] [Indexed: 01/25/2023]
Abstract
OBJECTIVE To examine the cross-sectional association of ascending pain mechanisms, implicated in pain sensitization, and descending pain modulation with pain patterns and unpredictability of pain. METHODS The Multicenter Osteoarthritis Study is a longitudinal cohort of older adults with or at risk of knee osteoarthritis. Peripheral and central ascending pain mechanisms were assessed using quantitative sensory tests, pressure pain thresholds using a handheld pressure algometer (knee/peripheral and wrist/central), and temporal summation using weighted probes (wrist/central). Descending modulation was assessed by conditioned pain modulation using pressure pain thresholds and a forearm ischemia test. Pain patterns were characterized based on responses to the Intermittent and Constant Osteoarthritis Pain questionnaire: 1) no intermittent or constant pain, 2) intermittent pain only, 3) constant pain only, and 4) combined constant and intermittent pain. A question regarding frequency assessed unpredictable pain. We assessed the association of quantitative sensory test measures to pain patterns using regression models with generalized estimating equations. RESULTS There were 2,794 participants (mean age 63.9 years, body mass index 29.5 kg/m2 , and 57% female). Lower pain sensitization by wrist pressure pain threshold (odds ratio [OR] 0.80 [95% confidence interval (95% CI) 0.68, 0.93]) and adequate conditioned pain modulation (OR 1.45 [95% CI 1.10, 1.92]) were associated with having constant ± intermittent pain compared with intermittent pain only. Higher pain sensitization (by pressure pain thresholds and temporal summation) was associated with a higher likelihood of unpredictable pain. CONCLUSION Knee pain patterns appear to be related to peripheral ± central facilitated ascending pain mechanisms and descending modulatory mechanisms. These findings highlight the need for a broader approach to understanding pain mechanisms by symptomatic disease progression.
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Affiliation(s)
- Lisa C. Carlesso
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada
| | - Laura Frey Law
- Department of Physical Therapy and Rehabilitation Science, University of Iowa, Iowa city, Iowa, USA
| | - Na Wang
- Biostatistics and Epidemiology Data Analytics Center (BEDAC), Boston University School of Public Health, Boston, Massachusetts, USA
| | - Michael Nevitt
- University of California, San Francisco, California, USA
| | - Cora E. Lewis
- Department of Epidemiology, University of Alabama at Birmingham, School of Public Health, Birmingham, Alabama, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts, USA
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Kampen WU, Boddenberg-Pätzold B, Fischer M, Gabriel M, Klett R, Konijnenberg M, Kresnik E, Lellouche H, Paycha F, Terslev L, Turkmen C, van der Zant F, Antunovic L, Panagiotidis E, Gnanasegaran G, Kuwert T, Van den Wyngaert T. The EANM guideline for radiosynoviorthesis. Eur J Nucl Med Mol Imaging 2022; 49:681-708. [PMID: 34671820 PMCID: PMC8803784 DOI: 10.1007/s00259-021-05541-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Accepted: 08/23/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE Radiosynoviorthesis (RSO) using the intraarticular application of beta-particle emitting radiocolloids has for decades been used for the local treatment of inflammatory joint diseases. The injected radiopharmaceuticals are phagocytized by the superficial macrophages of the synovial membrane, resulting in sclerosis and fibrosis of the formerly inflamed tissue, finally leading to reduced joint effusion and alleviation of joint pain. METHODS The European Association of Nuclear Medicine (EANM) has written and approved these guidelines in tight collaboration with an international team of clinical experts, including rheumatologists. Besides clinical and procedural aspects, different national legislative issues, dosimetric considerations, possible complications, and side effects are addressed. CONCLUSION These guidelines will assist nuclear medicine physicians in performing radiosynoviorthesis. Since there are differences regarding the radiopharmaceuticals approved for RSO and the official indications between several European countries, this guideline can only give a framework that must be adopted individually.
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Affiliation(s)
- W U Kampen
- Nuklearmedizin Spitalerhof, Radiologische Allianz, Spitalerstraße 8, 20095, Hamburg, Germany
| | | | - M Fischer
- Praxis Für Radiologie Und Nuklearmedizin, Friedrich-Ebert-Straße 50, 34117, Kassel, Germany
| | - M Gabriel
- Institute of Nuclear Medicine and Endocrinology, Kepler University Hospital Linz GmbH, Medical Faculty, Johannes Kepler University Linz, Altenberger Strasse 69, 4040 Linz and Krankenhausstrasse 9, 4020, Linz, Austria
| | - R Klett
- ÜBAG Für Nuklearmedizin, Hanau-Frankfurt-Offenbach-Gießen, Standort Gießen, Paul-Zipp-Str. 171-173, 35398, Gießen, Germany
| | - M Konijnenberg
- Erasmus MC, Nucleaire geneeskunde, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - E Kresnik
- Privatklinik Villach, Institut Für Nuklearmedizin, Dr.-Walter-Hochsteinerstrasse 4, 9504, Warmbad Villach, Austria
| | - H Lellouche
- Unité Rhumatologique de Affections de La Main, Centre Viggo Petersen, Hôpital Lariboisiere, 2 rue Ambroise Paré, 75010, Paris, France
- Institut de Rhumatologie Interventionnelle, 13 rue Thouin, 75005, Paris, France
| | - F Paycha
- Service de Médecine Nucléaire, Hôpital Lariboisière, Assistance Publique- Hôpitaux de Paris, 2 rue Ambroise Paré, 75010, Paris, France
| | - L Terslev
- Center for Rheumatology and Spine Diseases, Copenhagen University Hospital, Rigshospitalet, Valdemar Hansens Vej 17, 2600, Glostrup, Denmark
| | - C Turkmen
- Department of Nuclear Medicine, Istanbul Medical Faculty, Istanbul University, Istanbul, 34390, Turkey
| | - F van der Zant
- Nucleaire Geneeskunde, Noordwest Ziekenhuisgroep, Postbus 501, 1800 AM, Alkmaar, Netherlands
| | - L Antunovic
- Diagnostic Imaging Department, IRCCS Humanitas Research Hospital, Via Manzoni 56, Milan, 20089, Rozzano, Italy
| | - E Panagiotidis
- Department of Nuclear Medicine, Oncology Center 'Theageneio', Al Symeonidis 2 str, P.C 54007, Thessaloniki, Greece
| | - G Gnanasegaran
- Department of Nuclear Medicine, Royal Free London NHS Foundation Trust, London, UK
| | - T Kuwert
- Clinic of Nuclear Medicine, Friedrich-Alexander-University, Erlangen-Nürnberg, Erlangen, Germany.
| | - T Van den Wyngaert
- Antwerp University Hospital, Drie Eikenstraat 655, 2650, Edegem, Belgium
- Molecular Imaging Center Antwerp (MICA - IPPON), Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
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Chiba D, Ohyama T, Sasaki E, Daimon M, Nakaji S, Ishibashi Y. Higher fasting blood glucose worsens knee symptoms in patients with radiographic knee osteoarthritis and comorbid central sensitization: an Iwaki cohort study. Arthritis Res Ther 2022; 24:269. [PMID: 36510322 PMCID: PMC9745982 DOI: 10.1186/s13075-022-02951-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2022] [Accepted: 11/04/2022] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Although cross-sectional and cohort data suggest that higher serum blood glucose levels in patients with knee osteoarthritis (KOA) are associated with more severe knee symptoms, little is known about the longitudinal relationship between serum blood glucose and knee symptoms, particularly considering central sensitization (CS) comorbidity, which also worsens knee symptoms. METHODS We evaluated the longitudinal relationship between serum blood glucose and knee symptoms by dividing the cohort of patients with KOA into those with and without CS. We hypothesized that higher serum blood glucose levels would worsen knee symptoms. A total of 297 participants (mean age: 59.6 years; females: 211; average BMI: 23.7 kg/m2) were enrolled in this study. At baseline, plain radiographs of the bilateral knee joints were evaluated according to the Kellgren-Lawrence grade (KLG). All participants exhibited at least a KLG ≥ 2 in each knee. At baseline, fasting blood glucose (FBG) and Central Sensitization Inventory-9 (CSI-9) were evaluated; ≥ 10 points on the CSI-9 was defined as CS+. Knee injury and Osteoarthritis Outcome Score (KOOS) was evaluated at baseline and at 1-year follow-up; the change in KOOS (ΔKOOS) was calculated by subtracting the KOOS at baseline from that at the 1-year follow-up. Multiple linear regression analysis was conducted with ΔKOOS as the dependent variable and FBG at baseline as the independent variable, adjusted for age, sex, BMI, and CSI-9 at baseline. RESULTS Of the 297 subjects, 48 (16.2 %) were defined as CS+. In the CS - group, there was no association between FBG levels at baseline and ΔKOOS. In contrast, FBG at baseline was negatively associated with ΔKOOS pain (B = - 0.448; p = 0.003), ADL (B = - 0.438; p = 0.003), and sports (B = - 0.706; p = 0.007). CONCLUSIONS In patients with radiographic KOA and CS, higher blood glucose levels were associated with deteriorated knee symptoms during the 1-year follow-up. Healthcare providers should pay attention to controlling blood glucose, particularly in patients with KOA and concurrent CS, to mitigate their knee symptoms. STUDY DESIGN Retrospective cohort study (evidence level: III).
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Affiliation(s)
- Daisuke Chiba
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Tetsushi Ohyama
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Eiji Sasaki
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Makoto Daimon
- grid.257016.70000 0001 0673 6172Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Shigeyuki Nakaji
- grid.257016.70000 0001 0673 6172Department of Social Medicine, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
| | - Yasuyuki Ishibashi
- grid.257016.70000 0001 0673 6172Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, 5 Zaifu-cho, Hirosaki, Aomori, 036-8562 Japan
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72
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Li J, Wang Y, Chen D, Liu-Bryan R. Oral administration of berberine limits post-traumatic osteoarthritis development and associated pain via AMP-activated protein kinase (AMPK) in mice. Osteoarthritis Cartilage 2022; 30:160-171. [PMID: 34687898 PMCID: PMC8712393 DOI: 10.1016/j.joca.2021.10.004] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2021] [Revised: 09/30/2021] [Accepted: 10/18/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE We investigated the effect of berberine, a natural plant product that can activate AMP-activated protein kinase (AMPK), on Osteoarthritis (OA) development and associated pain in mice. DESIGN Human primary knee chondrocytes were utilized to investigate how AMPK is activated by berberine. Both global knockout (KO) of AMPKα1 and congenic wild type (WT) mice were subjected to the post-traumatic OA through destabilization of medial meniscus (DMM) surgery. Two weeks after surgery, the mice were randomly divided into two groups with one group receiving berberine chloride daily via drinking water and were sacrificed at 6 and 12 weeks after surgery. OA severity was assessed by histological and histomorphometric analyses of cartilage degradation, synovitis, and osteophyte formation. OA-associated pain behavior was also determined. Immunohistochemistry (IHC) analyses were carried out to examine changes in AMPK signaling. RESULTS Berberine induced phosphorylation of AMPKα (Thr172) via liver kinase B1 (LKB1), the major upstream kinase of AMPK, in chondrocytes in vitro. Both WT and AMPKα1KO developed OA and associated pain post DMM surgery. However, treatment with berberine significantly reduced severity of OA and associated pain in WT but not AMPKα1KO mice. IHC analysis of WT DMM knee cartilage further revealed that berberine inhibited concomitant loss of expression and phosphorylation of AMPKα and expression of SIRT1 and SIRT3, suggesting an important role of activation of AMPK signaling in mediating beneficial effect of berberine. CONCLUSIONS Berberine acts through AMPK to reduce joint structural damage and pain associated with post-traumatic OA in mice in vivo.
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Affiliation(s)
- Jun Li
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - Yun Wang
- Department of Medicine, University of California San Diego, La Jolla, USA.,Present address: Valo Health, Lexington, MA, USA
| | - Di Chen
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,Present address: Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China
| | - Ru Liu-Bryan
- VA San Diego Healthcare System, San Diego, USA.,Department of Medicine, University of California San Diego, La Jolla, USA.,Correspondence to: Ru Liu-Bryan, VA San Diego Healthcare System, 111K, 3350 La Jolla Village Drive, San Diego, CA 92161. Telephone: 858 552 8585. Fax: 858 552 7425. , or Di Chen, Faculty of Pharmaceutical Sciences, Shenzhen Institute of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China. Telephone: 86-0755-8658-5255. Fax: 86-0755-8639-2299.
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73
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Arant KR, Katz JN, Neogi T. Quantitative sensory testing: identifying pain characteristics in patients with osteoarthritis. Osteoarthritis Cartilage 2022; 30:17-31. [PMID: 34597800 PMCID: PMC8712382 DOI: 10.1016/j.joca.2021.09.011] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/29/2021] [Accepted: 09/01/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE This review outlines the most commonly used quantitative sensory tests to identify pain sensitization. We examine cross-sectional associations between quantitative sensory testing (QST) measures and OA symptoms and severity, along with longitudinal associations between QST findings and response to surgical and non-surgical treatments for OA. DESIGN We conducted a search in PubMed for English language papers including 'osteoarthritis' and 'quantitative sensory testing' as search terms. Papers that did not pertain specifically to OA or QST were excluded. RESULTS Pressure Pain Threshold (PPT), Conditioned Pain Modulation (CPM), and Temporal Summation (TS) are the QST measures used most frequently to identify pain sensitization. Findings indicate that persons with knee OA often exhibit lower PPT thresholds, inefficient CPM, and facilitated TS as compared with controls who do not have OA, supporting the discriminant validity of QST. Pre-treatment QST has shown some success in identifying persons who experience less pain relief from surgical and non-surgical treatments for knee OA. Post-treatment QST has shown that sometimes PPT and CPM can normalize (PPT thresholds increase, and CPM becomes efficient) in patients for whom joint replacement is successful. Recent studies indicate that QST measures are more closely associated with pain severity than OA radiographic severity, suggesting that sensitization may be a trait rather than a state. CONCLUSIONS QST may have a role in identifying persons who are susceptible to chronic pain and may offer an opportunity for personalized, more effective treatment of OA.
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Affiliation(s)
- K R Arant
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA.
| | - J N Katz
- The Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA, USA; Harvard Medical School and Chan Harvard School of Public Health, Boston, MA, USA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, USA; Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, Boston, MA, USA.
| | - T Neogi
- Section of Rheumatology, Boston University School of Medicine and Boston Medical Center, Boston, MA, USA.
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74
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Meurot C, Jacques C, Martin C, Sudre L, Breton J, Rattenbach R, Bismuth K, Berenbaum F. Targeting the GLP-1/GLP-1R axis to treat osteoarthritis: A new opportunity? J Orthop Translat 2022; 32:121-129. [PMID: 35280931 PMCID: PMC8888891 DOI: 10.1016/j.jot.2022.02.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 01/31/2022] [Accepted: 02/01/2022] [Indexed: 01/15/2023] Open
Abstract
Osteoarthritis (OA) is a degenerative joint disease affecting millions of people worldwide. In OA, chondrocytes, synovial cells and other joint cells become activated when exposed to an abnormal environment, including mechanical stress, inflammatory cytokines or disorganization of matrix proteins. Several analogues of the hormones called incretins have been developed and are used notably for treating type 2 diabetes mellitus. Data has accumulated to suggest that incretinomimetics, which bind to the glucagon-like peptide-1 receptor (GLP-1R), have beneficial pleiotropic effects such as immunomodulation, anti-inflammation and neuronal protection. Thus, because of their anti-inflammatory properties, GLP-1-based therapies could benefit OA patients. This review focuses on the GLP-1R pathway, molecular mechanisms and phenotypes related to OA pathogenesis. The translational potential of this article The search for new therapeutic targets to treat people suffering from OA remains urgent as there is currently no disease-modifyingtherapy available for this disease. This review discusses how GLP-1 analogues could be potential DMOADs for treating OA thanks to their anti-inflammatory, immunoregulatory and differentiation properties.
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Affiliation(s)
| | - C. Jacques
- Sorbonne University, INSERM UMRS_938 and Labex Transimmunom, CDR St-Antoine Paris, Paris, France
| | | | | | | | - R. Rattenbach
- 4P-Pharma, Lille, France
- 4Moving Biotech, Lille, France
| | | | - F. Berenbaum
- 4Moving Biotech, Lille, France
- APHP, Sorbonne University, Rheumatology Department, INSERM UMRS_938, CDR St-Antoine Paris, Paris, France
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75
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Kouraki A, Doherty M, Fernandes GS, Zhang W, Walsh DA, Kelly A, Valdes AM. Different genes may be involved in distal and local sensitisation: a genome-wide gene-based association study and meta-analysis. Eur J Pain 2021; 26:740-753. [PMID: 34958702 PMCID: PMC9303629 DOI: 10.1002/ejp.1902] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Revised: 11/11/2021] [Accepted: 12/25/2021] [Indexed: 11/22/2022]
Abstract
Background Neuropathic pain symptoms and signs of increased pain sensitization in osteoarthritis (OA) patients may explain persistent pain after total joint replacement (TJR). Therefore, identifying genetic markers associated with pain sensitization and neuropathic‐like pain phenotypes could be clinically important in identifying targets for early intervention. Methods We performed a genome‐wide gene‐based association study (GWGAS) using pressure pain detection thresholds (PPTs) from distal pain‐free sites (anterior tibia), a measure of distal sensitization, and from proximal pain‐affected sites (lateral joint line), a measure of local sensitization, in 320 knee OA participants from the Knee Pain and related health in the Community (KPIC) cohort. We next performed gene‐based fixed‐effects meta‐analysis of PPTs and a neuropathic‐like pain phenotype using genome‐wide association study (GWAS) data from KPIC and from an independent cohort of 613 post‐TJR participants, respectively. Results The most significant genes associated with distal and local sensitization were OR5B3 and BRDT, respectively. We also found previously identified neuropathic pain‐associated genes—KCNA1, MTOR, ADORA1 and SCN3B—associated with PPT at the anterior tibia and an inflammatory pain gene—PTAFR—associated with PPT at the lateral joint line. Meta‐analysis results of anterior tibia and neuropathic‐like pain phenotypes revealed genes associated with bone morphogenesis, neuro‐inflammation, obesity, type 2 diabetes, cardiovascular disease and cognitive function. Conclusions Overall, our results suggest that different biological processes might be involved in distal and local sensitization, and common genetic mechanisms might be implicated in distal sensitization and neuropathic‐like pain. Future studies are needed to replicate these findings. Significance To the best of our knowledge, this is the first GWAS for pain sensitization and the first gene‐based meta‐analysis of pain sensitization and neuropathic‐like pain. Higher pain sensitization and neuropathic pain symptoms are associated with persistent pain after surgery hence, identifying genetic biomarkers and molecular pathways associated with these traits is clinically relevant.
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Affiliation(s)
- A Kouraki
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - M Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.,Versus Arthritis Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - G S Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, BS1 6EH, United Kingdom
| | - W Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.,Versus Arthritis Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - D A Walsh
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.,Versus Arthritis Centre for Sports, Exercise and Osteoarthritis, University of Nottingham, Nottingham, NG7 2UH, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A Kelly
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
| | - A M Valdes
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham City Hospital, Nottingham, NG5 1PB, United Kingdom.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, NG5 1PB, United Kingdom.,NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, NG5 1PB, United Kingdom
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76
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Pharmaceutical therapeutics for articular regeneration and restoration: state-of-the-art technology for screening small molecular drugs. Cell Mol Life Sci 2021; 78:8127-8155. [PMID: 34783870 PMCID: PMC8593173 DOI: 10.1007/s00018-021-03983-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2021] [Revised: 09/20/2021] [Accepted: 10/14/2021] [Indexed: 02/07/2023]
Abstract
Articular cartilage damage caused by sports injury or osteoarthritis (OA) has gained increased attention as a worldwide health burden. Pharmaceutical treatments are considered cost-effective means of promoting cartilage regeneration, but are limited by their inability to generate sufficient functional chondrocytes and modify disease progression. Small molecular chemical compounds are an abundant source of new pharmaceutical therapeutics for cartilage regeneration, as they have advantages in design, fabrication, and application, and, when used in combination, act as powerful tools for manipulating cellular fate. In this review, we present current achievements in the development of small molecular drugs for cartilage regeneration, particularly in the fields of chondrocyte generation and reversion of chondrocyte degenerative phenotypes. Several clinically or preclinically available small molecules, which have been shown to facilitate chondrogenesis, chondrocyte dedifferentiation, and cellular reprogramming, and subsequently ameliorate cartilage degeneration by targeting inflammation, matrix degradation, metabolism, and epigenetics, are summarized. Notably, this review introduces essential parameters for high-throughput screening strategies, including models of different chondrogenic cell sources, phenotype readout methodologies, and transferable advanced systems from other fields. Overall, this review provides new insights into future pharmaceutical therapies for cartilage regeneration.
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77
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Pujol J, Martínez-Vilavella G, Doreste A, Blanco-Hinojo L, Ojeda F, Llorente-Onaindia J, Polino L, Deus J, Monfort J. Tapentadol effects on brain response to pain in sensitized patients with knee osteoarthritis. Rheumatology (Oxford) 2021; 61:2335-2345. [PMID: 34636838 DOI: 10.1093/rheumatology/keab761] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Accepted: 10/04/2021] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVE Pain sensitization, in the form of knee tenderness and anatomically spread hyperalgesia, is notably common in patients with knee osteoarthritis and is often refractory to conventional interventions. Tapentadol, as an opioid receptor agonist and noradrenaline reuptake inhibitor, has been proposed as a potentially effective symptomatic treatment for pain-sensitized osteoarthritis patients. We empirically tested whether tapentadol could attenuate brain response to painful stimulation on the tender knee using functional MRI. METHODS Pressure painful stimulation was applied to the articular interline and the tibial surface, a commonly sensitized site surrounding the joint. Thirty patients completed the crossover trial designed to compare prolonged release tapentadol and placebo effects administered over 14 days. RESULTS We found no effects in the direction of the prediction. Instead, patients administered with tapentadol showed stronger activation in response to pressure on the tender site in the right prefrontal cortex and somatosensory cortices. The somatosensory effect was compatible with the spread of neural activation around the knee cortical representation. Consistent with the functional MRI findings, the patients showed higher clinical ratings of pain sensitization under tapentadol and a significant positive association was identified between the number of tapentadol tablets and the evoked subjective pain. CONCLUSION The tapentadol effect paradoxically involved both the spread of the somatosensory cortex response and a stronger activation in prefrontal areas with a recognized role in the appraisal of pain sensations. Further studies are warranted to explore how osteoarthritis patients may benefit from powerful analgesic drugs without the associated risks of prolonged use. EudraCT-[2016-005082-31].
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Affiliation(s)
- Jesus Pujol
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | | | - Andrea Doreste
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Laura Blanco-Hinojo
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Centro Investigación Biomédica en Red de Salud Mental, CIBERSAM G21, Barcelona, Spain
| | - Fabiola Ojeda
- Rheumatology Department, Hospital del Mar, Barcelona, Spain
| | | | - Luciano Polino
- Rheumatology Department, Hospital del Mar, Barcelona, Spain
| | - Joan Deus
- MRI Research Unit, Department of Radiology, Hospital del Mar, Barcelona, Spain.,Department of Clinical and Health Psychology, Autonomous University of Barcelona, Barcelona, Spain
| | - Jordi Monfort
- Rheumatology Department, Hospital del Mar, Barcelona, Spain
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Rankin J, Rudy-Froese B, Hoyt C, Ramsahoi K, Gareau L, Howatt W, Carlesso LC. Quantitative Sensory Testing Protocols to Evaluate Central and Peripheral Sensitization in Knee OA: A Scoping Review. PAIN MEDICINE 2021; 23:526-557. [PMID: 34581816 DOI: 10.1093/pm/pnab285] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 09/01/2021] [Indexed: 11/12/2022]
Abstract
OBJECTIVE This scoping review analyzed various quantitative sensory testing methodologies used in the assessment of sensitization and how sensitization is defined in people with knee osteoarthritis. DESIGN A scoping review. SETTING All clinical and research settings. SUBJECTS Non-surgical adults with knee osteoarthritis. METHODS This scoping review was guided by existing scoping review methodologies. Relevant studies were extracted from the following electronic databases: Medical Literature Analysis and Retrieval System Online, Excerpta Medica Database, Allied and Complementary Medicine Database and the Cumulative Index to Nursing Allied Health Literature. Abstract and full article screening and data extraction were performed in pairs. Information on quantitative sensory testing techniques and parameters was extracted and summarized in tables. General and technique specific definitions of sensitization were extracted from included texts. RESULTS Our search yielded 4199 articles, of which 50 were included in our review. The most common quantitative sensory test was pressure pain threshold. In total 28 unique testing sites were found speaking to the high degree of variability between studies. Sensitization was poorly defined with only 8 studies fully operationalizing it, 22 partially, and the remainder did not provide sufficient information to meet our criteria. CONCLUSION This scoping review has provided an overview of the most common methods of quantitative sensory testing being implemented in the assessment of nervous system sensitization to nociceptive signaling in people with knee osteoarthritis. This study provides a foundation for future development of quantitative sensory testing methodology for research and clinical practice in the osteoarthritis population.
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Affiliation(s)
- Jonathan Rankin
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | | | - Curtis Hoyt
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - Keenu Ramsahoi
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - Liam Gareau
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - William Howatt
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada
| | - Lisa C Carlesso
- McMaster University, School of Rehabilitation Sciences, Hamilton, Canada.,Université de Montréal, School of Rehabilitation, Montréal, Canada
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79
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Dong F, Jiang M, Zhang Z, Li F, Lian Y. C1q/TNF-related protein-9 suppresses inflammation in synovial cells from patients with osteoarthritis. Scand J Rheumatol 2021; 51:368-373. [PMID: 34514937 DOI: 10.1080/03009742.2021.1946996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objective: Synovial inflammation contributes to cartilage degeneration and osteoarthritis (OA) development. Targeting the inflammation process may provide a promising strategy for OA treatment. It has been demonstrated that C1q/tumour necrosis factor-related protein-9 (CTRP9) has immunosuppression capabilities. Thus, we conducted this study to investigate the role of CTRP9 in OA and its therapeutic potential.Method: The expression level of CTRP9 was quantified in peripheral blood mononuclear cells (PBMCs), serum, and synovial cells (SCs) isolated from OA patients by quantitative polymerase chain reaction and enzyme-linked immunosorbent assay. The relationship between the expression level of CTRP9 and the disease activity of OA was determined. The inflammation-suppressing effects of CTRP9 were assessed in vitro.Results: The expression level of CTRP9 was increased in the PBMCs and serum of OA compared to healthy controls. The serum level of CTRP9 was found to be positively correlated with erythrocyte sedimentation rate, C-reactive protein, and visual analogue scale score. In addition, CTRP9 protein suppressed the expression of pro-inflammatory cytokines, including tumour necrosis factor-α, interleukin-6, and interleukin-1β, in PBMCs and SCs in vitro. CTRP9 was increased in OA patients and positively correlated with the disease activity. The recombinant CTRP9 had inflammation-suppressing activities in vitro.Conclusion: CTRP9 may have therapeutic potential for treating OA.Osteoarthritis (OA) is characterized as cartilage destruction resulting from synovial inflammation (1-6). According to the clinical symptoms and levels of inflammation, OA has been divided into primary generalized osteoarthritis (PGOA) and erosive inflammatory osteoarthritis (EIOA) (7). The only available treatment for OA is joint replacement. Thus, it is necessary to develop novel and effective therapeutic strategies to treat OA.Because synovial inflammation contributes to OA development, targeting the inflammation process may provide a promising strategy for OA treatment. Previous investigations showed that pro-inflammatory factors promoted OA development (8-10), while anti-inflammatory factors suppressed it (11-14). Thus, we conducted the present study to investigate the role of C1q/tumour necrosis factor-related protein-9 (CTRP9), an anti-inflammatory factor (15), in OA, and its therapeutic potential.
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Affiliation(s)
- F Dong
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - M Jiang
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Z Zhang
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - F Li
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
| | - Y Lian
- Department of Orthopaedic Surgery, The Fourth Affiliated Hospital of Harbin Medical University, Harbin, P.R. China
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Tucker L, Trumble TN, Groschen D, Dobbs E, Baldo CF, Wendt-Hornickle E, Guedes AGP. Targeting Soluble Epoxide Hydrolase and Cyclooxygenases Enhance Joint Pain Control, Stimulate Collagen Synthesis, and Protect Chondrocytes From Cytokine-Induced Apoptosis. Front Vet Sci 2021; 8:685824. [PMID: 34422942 PMCID: PMC8375305 DOI: 10.3389/fvets.2021.685824] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/08/2021] [Indexed: 01/06/2023] Open
Abstract
Objective: To determine the symptomatic and disease-modifying capabilities of sEH and COX inhibitors during joint inflammation. Methods: Using a blinded, randomized, crossover experimental design, 6 adult healthy horses were injected with lipopolysaccharide (LPS; 3 μg) from E. coli in a radiocarpal joint and concurrently received the non-selective cyclooxygenase (COX) inhibitor phenylbutazone (2 mg/kg), the sEH inhibitor t-TUCB (1 mg/kg) or both (2 mg/kg phenylbutazone and 0.1, 0.3, and 1 mg/kg t-TUCB) intravenously. There were at least 30 days washout between treatments. Joint pain (assessed via inertial sensors and peak vertical forces), synovial fluid concentrations of prostanoids (PGE2, TxB2), cytokines (IL-1β, IL-6, TNF-α) and biomarkers of collagen synthesis (CPII) and degradation (C2C) were measured at pre-determined intervals over a 48-h period. The anti-apoptotic effect of COX and sEH inhibitors was determined via ELISA technique in primary equine chondrocytes incubated with TNF-α (10 ng/ml) for 24 h. Apoptosis was also determined in chondrocytes incubated with sEH-generated metabolites. Results: Combined COX and sEH inhibition produced significantly better control of joint pain, prostanoid responses, and collagen synthesis-degradation balance compared to each compound separately. When administered separately, pain control was superior with COX vs. sEH inhibition. Cytokine responses were not different during COX and/or sEH inhibition. In cultured chondrocytes, sEH inhibition alone or combined with COX inhibition, but not COX inhibition alone had significant anti-apoptotic effects. However, sEH-generated metabolites caused concentration-dependent apoptosis. Conclusions: Combined COX and sEH inhibition optimize pain control, attenuate loss of articular cartilage matrix during joint inflammation and cytokine-induced chondrocyte apoptosis.
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Affiliation(s)
- Laura Tucker
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
| | - Troy N Trumble
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
| | - Donna Groschen
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
| | - Erica Dobbs
- Department of Veterinary Population Medicine, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
| | - Caroline F Baldo
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
| | - Erin Wendt-Hornickle
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
| | - Alonso G P Guedes
- Department of Veterinary Clinical Sciences, College of Veterinary Medicine, University of Minnesota, Saint Paul, MN, United States
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Patients With High Chronic Postoperative Knee Pain 5 Years After Total Knee Replacement Demonstrate Low-grad Inflammation, Impairment of Function, and High Levels of Pain Catastrophizing. Clin J Pain 2021; 37:161-167. [PMID: 33290348 DOI: 10.1097/ajp.0000000000000907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 11/23/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Total knee replacement (TKR) normally provides improvements of physical function and reduces pain. However, ∼20% of the patients report chronic postoperative knee pain. The aims of the present study were to assess the pain, physical function, and physiological characteristics 5 years after TKR surgery. MATERIALS AND METHODS Eighty patients were recruited 5 years after TKR and divided into 2 groups based on their average 24-hour knee pain intensity assessed on a visual analog scale (VAS 0 to 10) ("high pain group": VAS≥3; "low pain group": VAS<3). The patients completed the PainDETECT Questionnaire (PDQ), Oxford Knee Score (OKS), Pain Catastrophizing Scale, and Forgotten Joint Score-12. Furthermore, the patients underwent a clinical examination of the knees and high-sensitivity serum C-reactive protein was measured as an inflammatory marker. RESULTS A total of 53% of the patients in the high pain group were not satisfied with the outcome, while only 11% of the patients in the low pain group was not satisfied, and the pain intensities in the 2 groups were 5.1 (4.6 to 5 to 6) and 1.1 (0.6 to 1.5) (P<0.001), respectively. Furthermore, the high pain group demonstrates worse scores in: Forgotten Joint Score-12 (P=0.001), OKS function (P<0.001), OKS pain (P<0.001), and Pain Catastrophizing Scale (P<0.001).The high pain group demonstrated increased level of high-sensitivity serum C-reactive protein (4.3 mg/L [3.2 to 5.5] vs. 1.7 mg/L [1.2 to 2.2], P<0.001), and decreased range of motion in the knee (110 vs. 119-degree range of motion, P=0.013). DISCUSSION Patients with high chronic postoperative knee pain 5 years after TKR demonstrate decreased physical function, higher levels of catastrophizing thoughts, and increased levels of inflammation.
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Philpott HT, Birmingham TB, Pinto R, Primeau CA, Arsenault D, Lanting B, Zhu Y, Appleton CT. Synovitis is associated with constant pain in knee osteoarthritis: a cross-sectional study of OMERACT knee ultrasound scores. J Rheumatol 2021; 49:89-97. [PMID: 34393106 DOI: 10.3899/jrheum.210285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association between ultrasound (US)-detected knee inflammation and intermittent and constant pain experiences in patients with knee osteoarthritis (OA). METHODS Participants with radiographically early- (KL ≤ 2) and late-stage (KL ≥ 3) disease and frequent symptoms underwent musculoskeletal US measures of inflammation using the OMERACT knee US scoring system. Pain experiences were captured using the Intermittent and Constant OA Pain (ICOAP) tool. We assessed the association between US-synovitis and ICOAP pain experiences using a series of linear, logistic, or multinomial logistic regression models (as appropriate for each variable), while adjusting for age, sex, body mass index (BMI), and radiographic stage. Secondary analyses were performed similarly by radiographic stage. RESULTS Pain and synovitis measures from 248 patients (453 knees) were included. Worse synovitis was associated with higher ICOAP constant pain scores (β 8.05 [95%CI 0.67, 15.43]), but not intermittent pain scores. Moderate-to-severe synovitis was associated with a 4.73-fold increased relative risk [95%CI 1.06, 8.80] of a constant pain pattern. In secondary analyses, moderate-to-severe synovitis in early radiographic OA was associated with 2.70-higher odds [95%CI 1.04, 7.02] of any constant pain, 3.28-higher odds [95%CI 1.43, 7.52] of any intermittent pain, and with higher intermittent (β 10.47 [95%CI 1.03, 19.91]) and constant (β 12.62 [95%CI 3.02, 22.23]) pain scores. No associations identified for synovitis in those with late radiographic OA. CONCLUSION In patients with knee OA, moderate-to-severe synovitis is most strongly associated with constant pain. Inflammation may play context-specific roles across pain experiences, especially in earlier radiographic stages of knee OA.
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Affiliation(s)
- Holly T Philpott
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Trevor B Birmingham
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Ryan Pinto
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Codie A Primeau
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Dominique Arsenault
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Brent Lanting
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Yayuan Zhu
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - C Thomas Appleton
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
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Allison C, Korey L, John Z S. A novel computational technique for the quantification of temporal summation in healthy individuals. Musculoskelet Sci Pract 2021; 54:102400. [PMID: 34022750 DOI: 10.1016/j.msksp.2021.102400] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Revised: 04/12/2021] [Accepted: 05/10/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The pathophysiology of chronic musculoskeletal pain is linked to the neurophysiologic condition known as central sensitization. Developing reliable, sensitive and clinically feasible techniques for quantifying central sensitization is a timely priority for advancing the field of chronic pain diagnosis and management. OBJECTIVE To compare the sensitivity of the Windup Ratio, a commonly employed Quantitative Sensory Testing (QST) technique, to a novel approach, the Sumsquare method, for detecting changes in experimentally induced central sensitization. DESIGN Individual, randomized, controlled experimental study. METHODS A total of 37 subjects assigned to experimental (N = 18) and control (N = 19) groups. Central sensitization was experimentally induced in the C5-C6 spinal segments using topical capsaicin (0.075%); controls received a non-sensitizing placebo (Lubriderm). Windup (temporal summation) was assessed using weighted pinpricks (MRC Systems, Heidelberg, Germany) applied within regions of secondary hyperalgesia surrounding the topical capsaicin. A train of 10 stimuli was applied at baseline, 10, 20 and 30 min post-topical application and participants provided numeric pain ratings after each pinprick application. Sumsquare and Windup Ratio outcomes were calculated using the pain rating data. RESULTS Sumsquare outcome was significantly increased at all time points (10, 20, 30 min) post-sensitization (p < 0.05); in contrast, no differences in Windup Ratio from baseline were observed at any time point post-sensitization (p > 0.05). CONCLUSIONS Sumsquare outcome offers greater sensitivity than Windup Ratio for detecting changes in experimentally induced central sensitization. These findings introduce a novel method for assessing changes in central sensitization in patients presenting with chronic musculoskeletal pain hypersensitivity.
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Affiliation(s)
- Clouse Allison
- Human Health and Nutritional Science, University of Guelph, Guelph, Canada
| | - Loi Korey
- Human Health and Nutritional Science, University of Guelph, Guelph, Canada
| | - Srbely John Z
- Human Health and Nutritional Science, University of Guelph, Guelph, Canada.
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84
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Lai-Zhao Y, Pitchers KK, Appleton CT. Transient anabolic effects of synovium in early post-traumatic osteoarthritis: a novel ex vivo joint tissue co-culture system for investigating synovium-chondrocyte interactions. Osteoarthritis Cartilage 2021; 29:1060-1070. [PMID: 33757858 DOI: 10.1016/j.joca.2021.03.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 03/11/2021] [Accepted: 03/15/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) is a serious joint disease with no disease-modifying medical treatment. To develop treatments targeting synovium, we must improve our understanding of the effects of OA-related changes in synovial physiology on joint tissue outcomes. The aim of this study was to investigate the effects of synovial pathology due to post-traumatic OA (PTOA) on articular chondrocyte physiology. METHODS We first developed and validated a novel joint tissue co-culture system to model the biological interactions between synovium and articular chondrocytes. Whole-joint synovial tissue from a surgical rat model of PTOA vs sham and surgical-naïve controls was placed into a co-culture system with adult primary articular chondrocytes (n = 4-5). The effects of PTOA synovium on chondrocyte anabolic, inflammatory, and catabolic gene expression and sulfated glycosaminoglycan (sGAG) secretion and aggrecan synthesis were tested, and results from early and later stages of PTOA development were compared. RESULTS Synovial injury by arthrotomy (sham surgery) alone decreased primary chondrocyte expression of genes including Col2a1 (0.36 ± 0.15-fold) and Acan (0.41 ± 0.28-fold). Early PTOA synovium rescued the suppression of Acan, induced increased sGAG secretion (3.94 ± 0.44 μg/mL vs surgery-naïve 2.41 ± 0.55 and sham 2.92 ± 0.73 μg/mL controls), and upregulated Mmp3 (3.73 ± 2.62-fold) and Prg4 (4.93 ± 4.29-fold). These effects were lost with later stage PTOA synovium. CONCLUSIONS Early PTOA synovium induces transient anabolic responses in articular chondrocytes rather than pro-inflammatory responses that would require inhibition. These results suggest that PTOA synovium plays at least a partially protective role and that loss of these protective effects may contribute to PTOA progression.
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Affiliation(s)
- Y Lai-Zhao
- Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada.
| | - K K Pitchers
- Department of Physiology and Pharmacology, The University of Western Ontario, Canada
| | - C T Appleton
- Department of Medicine, Schulich School of Medicine and Dentistry, The University of Western Ontario, London, Canada; Department of Physiology and Pharmacology, London, Canada.
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Jackson A, Frobert O, Boye Larsen D, Arendt-Nielsen L, Björkenheim A. Patients with symptomatic permanent atrial fibrillation show quantitative signs of pain sensitisation. Open Heart 2021; 8:openhrt-2021-001699. [PMID: 34140311 PMCID: PMC8212408 DOI: 10.1136/openhrt-2021-001699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Accepted: 06/02/2021] [Indexed: 11/05/2022] Open
Abstract
Objective Most patients with atrial fibrillation (AF) report symptoms, while one-third are asymptomatic. We hypothesised that sensory processing, in particular pain, differs in patients with symptomatic and asymptomatic AF. Methods Thirty individuals with permanent AF (15 symptomatic and 15 asymptomatic) completed the Atrial Fibrillation 6 (AF6) and short form 36 Health Survey questionnaires and underwent quantitative pain sensitisation testing using pressure algometry at the sternum (referred pain area) and the tibialis anterior muscle (generalised pain area). The primary objective was to assess differences in pressure pain thresholds (PPT), temporal summation of pain (TSP) and conditioned pain modulation (CPM) in the two groups. The secondary objective was to determine association of demographic and clinical parameters to measures of pain sensitisation. Results The symptomatic group had lower PPTs at both tibialis (p=0.004) and sternum (p=0.01), and impaired CPM (p=0.025) and facilitated TSP (p=0.008) at the tibialis but not sternum, compared with the asymptomatic group. The AF6 sum score was negatively correlated to PPT on both tibialis (r=−0.50, p=0.005) and sternum (r=−0.42, p=0.02) and positively correlated to TSP on both tibialis (r=0.57, p=0.001) and sternum (r=0.45, p=0.01), but not to CPM. The physical component summary score was positively correlated to the PPT on both tibialis (r=0.52, p=0.003) and sternum (r=0.40, p=0.03) and negatively to TSP on the tibialis (r=−0.53, p=0.003) but not sternum. Conclusions Patients with symptomatic AF exhibit lower pain tolerance than patients with asymptomatic AF, as well as impaired pain inhibitory control and facilitated summation of pain, indicating that pain sensitisation may be of importance in symptomatic AF. Trial registration number NCT04649437.
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Affiliation(s)
- Adam Jackson
- Department of Cardiology, Örebro University Hospital, Sweden, Örebro, Sweden
| | - Ole Frobert
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Sweden, Örebro, Sweden
| | - Dennis Boye Larsen
- Department of Health Science and Technology and the Center for Sensory-Motor Interaction/Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Lars Arendt-Nielsen
- Department of Health Science and Technology and the Center for Sensory-Motor Interaction/Center for Neuroplasticity and Pain, Faculty of Medicine, Aalborg University, Aalborg, Denmark
| | - Anna Björkenheim
- Department of Cardiology, Faculty of Medicine and Health, Örebro University, Sweden, Örebro, Sweden
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Pratscher S, Mickle AM, Marks JG, Rocha H, Bartsch F, Schmidt J, Tejera L, Garcia S, Custodero C, Jean F, Garvan C, Johnson AJ, Pop R, Greene A, Woods AJ, Staud R, Fillingim RB, Keil A, Sibille KT. Optimizing Chronic Pain Treatment with Enhanced Neuroplastic Responsiveness: A Pilot Randomized Controlled Trial. Nutrients 2021; 13:1556. [PMID: 34063083 PMCID: PMC8147927 DOI: 10.3390/nu13051556] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Revised: 04/23/2021] [Accepted: 04/30/2021] [Indexed: 02/07/2023] Open
Abstract
Chronic pain affects mental and physical health and alters brain structure and function. Interventions that reduce chronic pain are also associated with changes in the brain. A number of non-invasive strategies can promote improved learning and memory and increase neuroplasticity in older adults. Intermittent fasting and glucose administration represent two such strategies with the potential to optimize the neurobiological environment to increase responsiveness to recognized pain treatments. The purpose of the pilot study was to test the feasibility and acceptability of intermittent fasting and glucose administration paired with a recognized pain treatment activity, relaxation and guided imagery. A total of 32 adults (44% W, 56% M), 50 to 85 years of age, with chronic knee pain for three months or greater participated in the study. Four sessions were completed over an approximate two-week period. Findings indicate the ability to recruit, randomize, and retain participants in the protocol. The procedures and measures were reasonable and completed without incident. Participant adherence was high and exit interview feedback positive. In summary, the pilot study was feasible and acceptable, providing the evidence necessary to move forward with a larger clinical trial.
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Affiliation(s)
- Steven Pratscher
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - Angela M. Mickle
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - John G. Marks
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
| | - Harold Rocha
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Felix Bartsch
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Jeffrey Schmidt
- College of Health Professions and Sciences, University of Central Florida, Orlando, FL 32816, USA;
| | - Lazaro Tejera
- Department of Interdisciplinary Medicine, University of Bari, 70125 Bari, Italy; (L.T.); (C.C.)
| | - Steven Garcia
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Carlo Custodero
- Department of Interdisciplinary Medicine, University of Bari, 70125 Bari, Italy; (L.T.); (C.C.)
| | - Federlin Jean
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL 32611, USA;
| | - Cynthia Garvan
- Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA;
| | - Alisa J. Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - Ralisa Pop
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
| | - Anthony Greene
- Counseling and Wellness Center, University of Florida, Gainesville, FL 32611, USA;
| | - Adam J. Woods
- Department of Clinical and Health Psychology, Center for Cognitive Aging and Memory Clinical Translational Research, University of Florida, Gainesville, FL 32611, USA;
| | - Roland Staud
- Department of Medicine, University of Florida, Gainesville, FL 32611, USA;
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Community of Dentistry, University of Florida, Gainesville, FL 32611, USA;
| | - Andreas Keil
- Department of Psychology, University of Florida, Gainesville, FL 32611, USA; (H.R.); (F.B.); (S.G.); (A.K.)
| | - Kimberly T. Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL 32611, USA; (S.P.); (J.G.M.); (A.J.J.); (R.P.); (R.B.F.)
- Department of Aging & Geriatric Research, University of Florida, Gainesville, FL 32611, USA;
- Department of Anesthesiology, University of Florida, Gainesville, FL 32611, USA;
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87
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Pan TT, Pan F, Gao W, Hu SS, Wang D. Involvement of Macrophages and Spinal Microglia in Osteoarthritis Pain. Curr Rheumatol Rep 2021; 23:29. [PMID: 33893883 DOI: 10.1007/s11926-021-00997-w] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/23/2021] [Indexed: 12/30/2022]
Abstract
PURPOSE OF REVIEW Chronic pain in osteoarthritis (OA) is characterized by pain sensitization, which involves both peripheral and central mechanisms. Studies suggest synovial macrophage and spinal microglia are implicated in pain sensitization in OA. We, therefore, reviewed the evidence of whether synovial macrophage and spinal microglia facilitated pain sensitization at diverse levels and how this event occurred in OA. RECENT FINDINGS Peripherally, joint inflammation is now believed to be a source of OA-related pain. Synovial macrophages accumulate in OA inflamed synovium and display a pro-inflammatory phenotype. Abundant macrophage-derived pro-inflammatory cytokines and other pain-causing substance facilitate hyperexcitation of primary sensory neuron in OA-related pain. Thus, activated synovial macrophage was considered a predictor for phenotyping of OA pain clinically. In response to affected joint-derived strong nociception, aberrant neuronal excitability is often associated with the hyperactivity of microglia in the spinal dorsal horn, thereby leading to central sensitization. Hyperactivity of synovial macrophage and spinal microglia underlies the mechanisms of pain sensitization at the peripheral and central level in OA. This concept provides not only a clinically relevant strategy for identifying the phenotype of OA-related pain but also has the potential to develop individualized interventions for OA, particularly in those patients with hyperactivity of macrophage and microglia.
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Affiliation(s)
- Ting-Ting Pan
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Feng Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Wei Gao
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China
| | - Shan-Shan Hu
- Institute of Clinical Pharmacology, Anhui Medical University, Hefei, 230032, China
| | - Di Wang
- Department of Anesthesiology, Pain Clinic, First Affiliated Hospital of USTC (Anhui Provincial Hospital), Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, China.
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Abstract
There is a well-established historical observation that structural joint damage by plain X-ray correlates poorly with symptomatic disease in osteoarthritis (OA). This is often attributed to the inability to visualise soft-tissue pathology within the joint and the recognition of heterogeneous patient factors that drive central pain sensitisation. A major issue is the relative paucity of mechanistic studies in which molecular pathogenesis of pain is interrogated in relation to tissue pathology. Nonetheless, in recent years, three broad approaches have been deployed to attempt to address this: correlative clinical studies of peripheral and central pain outcomes using magnetic resonance imaging, where soft-tissue processes can be visualised; molecular studies on tissue from patients with OA; and careful molecular interrogation of preclinical models of OA across the disease time course. Studies have taken advantage of established clinical molecular targets such as nerve growth factor. Not only is the regulation of nerve growth factor within the joint being used to explore the relationship between tissue pathology and the origins of pain in OA, but it also provides a core model on which other molecules present within the joint can modulate the pain response. In this narrative review, how molecular and pathological tissue change relates to joint pain in OA will be discussed. Finally, a model for how tissue damage may lead to pain over the disease course will be proposed.
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Abstract
PURPOSE OF REVIEW Osteoarthritis is a degenerative joint disease that features pain as a hallmark symptom. This review summarises progress and obstacles in our understanding of pain mechanisms in arthritis. RECENT FINDINGS Pain phenotypes in osteoarthritis are poorly characterized in clinical studies and animal studies are largely carti-centric. Different animal models incur variable disease progression patterns and activation of distinct pain pathways, but studies reporting both structural and pain outcomes permit better translational insights. In patients, classification of osteoarthritis disease severity is only based on structural integrity of the joint, but pain outcomes do not consistently correlate with joint damage. The complexity of this relationship underlines the need for pain detection in criteria for osteoarthritis classification and patient-reported outcome measures. SUMMARY Variable inflammatory and neuropathic components and spatiotemporal evolution underlie the heterogeneity of osteoarthritis pain phenotypes, which must be considered to adequately stratify patients. Revised classification of osteoarthritis at different stages encompassing both structural and pain outcomes would significantly improve detection and diagnosis at both early and late stages of disease. These are necessary advancements in the field that would also improve trial design and provide better understanding of basic mechanisms of disease progression and pain in osteoarthritis.
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Atkinson HF, Birmingham TB, Primeau CA, Schulz JM, Appleton CT, Pritchett SL, Giffin JR. Association between changes in knee load and effusion-synovitis: evidence of mechano-inflammation in knee osteoarthritis using high tibial osteotomy as a model. Osteoarthritis Cartilage 2021; 29:222-229. [PMID: 33290812 DOI: 10.1016/j.joca.2020.11.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Revised: 10/19/2020] [Accepted: 11/19/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although mechanically-induced inflammation is an appealing explanation linking different etiologic factors in osteoarthritis (OA), clinical research investigating changes in both biomechanics and joint inflammation is limited. The purpose of this study was to evaluate the association between change in surrogate measures of knee load and knee effusion-synovitis in patients with medial compartment knee OA undergoing high tibial osteotomy (HTO). METHODS Thirty-six patients with medial compartment knee OA and varus alignment underwent 3D gait analysis and 3T magnetic resonance imaging (MRI) preoperatively and 1 year after medial opening wedge HTO. Primary outcome measures were the change in the external knee adduction moment impulse during walking and change in knee suprapatellar effusion-synovitis volume manually segmented on MRI by one blinded assessor. RESULTS Mean (SD) knee adduction moment impulse [24.0 (6.5) Nm•s] and knee effusion-synovitis volume [8976.7 (8016.9) mm3] suggested substantial preoperative medial knee load and inflammation. 1-year postoperative changes in knee adduction moment impulse [-10.1 Nm•s (95%CI: -12.7, -7.4)], and knee effusion-synovitis volume [-1856 mm3 (95%CI: -3830, 117)] were positively correlated [r = 0.60 (95% CI 0.34, 0.78)]. Simple linear regression suggested a 448 mm3 (95%CI: 241, 656) reduction in knee effusion-synovitis volume per 1 Nm•s reduction in knee adduction moment impulse. Change in knee adduction moment impulse explained 36% (R2 = 0.36) of the variance of change in knee effusion-synovitis volume. CONCLUSIONS Reduction in medial knee load is positively associated with reduction in knee inflammation after HTO, suggesting the phenomenon of mechano-inflammation in patients with knee OA.
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Affiliation(s)
- H F Atkinson
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada.
| | - T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada.
| | - C A Primeau
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada.
| | - J M Schulz
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Canada; Bone and Joint Institute, University of Western Ontario, London, Canada.
| | - C T Appleton
- Bone and Joint Institute, University of Western Ontario, London, Canada; Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
| | - S L Pritchett
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
| | - J R Giffin
- Bone and Joint Institute, University of Western Ontario, London, Canada; Schulich School of Medicine & Dentistry, University of Western Ontario, London, Canada.
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91
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Abstract
Brain-derived neurotrophic factor (BDNF) and the high-affinity receptor tropomyosin receptor kinase B (TrkB) have important roles in neuronal survival and in spinal sensitization mechanisms associated with chronic pain. Recent clinical evidence also supports a peripheral role of BDNF in osteoarthritis (OA), with synovial expression of TrkB associated with higher OA pain. The aim of this study was to use clinical samples and animal models to explore the potential contribution of knee joint BDNF/TrkB signalling to chronic OA pain. Brain-derived neurotrophic factor and TrkB mRNA and protein were present in knee synovia from OA patients (16 women, 14 men, median age 67 years [interquartile range: 61-73]). There was a significant positive correlation between mRNA expression of NTRK2 (TrkB) and the proinflammatory chemokine fractalkine in the OA synovia. Using the surgical medial meniscal transection (MNX) model and the chemical monosodium iodoacetate (MIA) model of OA pain in male rats, the effects of peripheral BDNF injection, vs sequestering endogenous BDNF with TrkB-Fc chimera, on established pain behaviour were determined. Intra-articular injection of BDNF augmented established OA pain behaviour in MIA rats, but had no effect in controls. Intra-articular injection of the TrkB-Fc chimera acutely reversed pain behaviour to a similar extent in both models of OA pain (weight-bearing asymmetry MIA: -11 ± 4%, MNX: -12 ± 4%), compared to vehicle treatment. Our data suggesting a contribution of peripheral knee joint BDNF/TrkB signalling in the maintenance of chronic OA joint pain support further investigation of the therapeutic potential of this target.
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92
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Laitner MH, Erickson LC, Ortman E. Understanding the Impact of Sex and Gender in Osteoarthritis: Assessing Research Gaps and Unmet Needs. J Womens Health (Larchmt) 2020; 30:634-641. [PMID: 33325792 DOI: 10.1089/jwh.2020.8828] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Osteoarthritis (OA) affects more than 300 million individuals globally, with higher prevalence in women than in men. In addition, OA affects women and men differently, with women demonstrating both increased disease severity and disability. The Society for Women's Health Research (SWHR) convened an interdisciplinary group of expert researchers and clinicians for a roundtable meeting to review the current state of the science on OA and to identify knowledge gaps in the scientific literature, especially as they relate to the topics of sex and gender. The current review summarizes discussions from the roundtable and prioritizes areas of need that warrant further attention in OA research, diagnosis, care, and education. Improvements in basic and clinical research, clinical practice, patient education, and policy are needed to allow for better understanding as to the pathogenesis of sex- and gender-related disparities in OA.
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Affiliation(s)
- Melissa H Laitner
- The Society for Women's Health Research, Washington, District of Columbia, USA
| | | | - Emily Ortman
- The Society for Women's Health Research, Washington, District of Columbia, USA
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Bonet IJM, Araldi D, Bogen O, Levine JD. Involvement of TACAN, a Mechanotransducing Ion Channel, in Inflammatory But Not Neuropathic Hyperalgesia in the Rat. THE JOURNAL OF PAIN 2020; 22:498-508. [PMID: 33232830 DOI: 10.1016/j.jpain.2020.11.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 11/09/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022]
Abstract
TACAN (Tmem120A), a mechanotransducing ion channel highly expressed in a subset of nociceptors, has recently been shown to contribute to detection of noxious mechanical stimulation. In the present study we evaluated its role in sensitization to mechanical stimuli associated with preclinical models of inflammatory and chemotherapy-induced neuropathic pain (CIPN). Intrathecal administration of an oligodeoxynucleotide antisense (AS-ODN) to TACAN mRNA attenuated TACAN protein expression in rat dorsal root ganglia (DRG). While TACAN AS-ODN produced only a modest increase in mechanical nociceptive threshold, it markedly reduced mechanical hyperalgesia produced by intradermal administration of prostaglandin E2, tumor necrosis factor alpha, and low molecular weight hyaluronan, and systemic administration of lipopolysaccharide, compatible with a prominent role of TACAN in mechanical hyperalgesia produced by inflammation. In contrast, TACAN AS-ODN had no effect on mechanical hyperalgesia associated with CIPN produced by oxaliplatin or paclitaxel. Our results provide evidence that TACAN plays a role in mechanical hyperalgesia induced by pronociceptive inflammatory mediators, but not CIPN, compatible with multiple mechanisms mediating mechanical nociception, and sensitization to mechanical stimuli in preclinical models of inflammatory versus CIPN. PERSPECTIVE: We evaluated the role of TACAN, a mechanotransducing ion channel in nociceptors, in preclinical models of inflammatory and CIPN. Attenuation of TACAN expression reduced hyperalgesia produced by inflammatory mediators but had not chemotherapeutic agents. Our findings support the presence of multiple mechanotransducers in nociceptors.
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Affiliation(s)
- Ivan J M Bonet
- Departments of Medicine and Oral & Maxillofacial Surgery, and Division of Neuroscience, UCSF Pain and Addiction Research Center, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, California
| | - Dionéia Araldi
- Departments of Medicine and Oral & Maxillofacial Surgery, and Division of Neuroscience, UCSF Pain and Addiction Research Center, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, California
| | - Oliver Bogen
- Departments of Medicine and Oral & Maxillofacial Surgery, and Division of Neuroscience, UCSF Pain and Addiction Research Center, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, California
| | - Jon D Levine
- Departments of Medicine and Oral & Maxillofacial Surgery, and Division of Neuroscience, UCSF Pain and Addiction Research Center, University of California at San Francisco, 513 Parnassus Avenue, San Francisco, California.
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94
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Abstract
The prevalence of osteoarthritis (OA) and the burden associated with the disease are steadily increasing worldwide, representing a major public health challenge for the coming decades. The lack of specific treatments for OA has led to it being recognized as a serious disease that has an unmet medical need. Advances in the understanding of OA pathophysiology have enabled the identification of a variety of potential therapeutic targets involved in the structural progression of OA, some of which are promising and under clinical investigation in randomized controlled trials. Emerging therapies include those targeting matrix-degrading proteases or senescent chondrocytes, promoting cartilage repair or limiting bone remodelling, local low-grade inflammation or Wnt signalling. In addition to these potentially disease-modifying OA drugs (DMOADs), several targets are being explored for the treatment of OA-related pain, such as nerve growth factor inhibitors. The results of these studies are expected to considerably reshape the landscape of OA management over the next few years. This Review describes the pathophysiological processes targeted by emerging therapies for OA, along with relevant clinical data and discussion of the main challenges for the further development of these therapies, to provide context for the latest advances in the field of pharmaceutical therapies for OA.
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95
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Ängeby Möller K, Aulin C, Baharpoor A, Svensson CI. Pain behaviour assessments by gait and weight bearing in surgically induced osteoarthritis and inflammatory arthritis. Physiol Behav 2020; 225:113079. [PMID: 32679132 DOI: 10.1016/j.physbeh.2020.113079] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Revised: 06/28/2020] [Accepted: 07/13/2020] [Indexed: 01/29/2023]
Abstract
OBJECTIVE . Osteoarthritis (OA) is the most common cause of joint pain. Animal models and relevant assays for measurement of pain-related behaviours are important tools for studies of mechanisms inducing and sustaining pain in OA. The aim of this study was to evaluate two different assessments of weight bearing; stationary and during locomotion, and to explore their feasibility to detect analgesic effects in vivo. Two fundamentally different mouse models of joint arthritis were investigated; surgical transection of the anterior cruciate ligament (ACLT) resulting in destabilization of the joint with subsequent structural deterioration resembling OA, and monoarthritis induced by injection of Complete Freund´s Adjuvant (CFA) into the ankle joint capsule. DESIGN . Mice were subjected to ACLT or CFA injection into the ankle joint. Stationary weight bearing was performed up to twenty weeks after ACLT, and for two weeks after CFA. In addition, mice with CFA-induced monoarthritis were assessed for gait and weight bearing during locomotion, and the effects of an anti-NGF antibody (MEDI578) were tested. End point histopathological analysis was performed in knee joints of ACLT mice, and in mice with ankle joint injection of CFA at eight days after injection. RESULTS . Both the surgical ACLT and CFA-induced monoarthritis reduced stationary weight bearing on the affected paw. The reduction in weight bearing was compensated by all other legs, but differently when stationary compared to during locomotion in the CFA-injected mice. The behavioural effects of ACLT correlated to the structural changes of the joint. In the CFA-induced monoarthritis, showing a massive infiltration of inflammatory cells at 8 days, MEDI578 significantly attenuated the pain-like behaviours. CONCLUSIONS . The pain-like behaviour detected is mainly due to inflammation and not to the same degree to structural changes in the joint. Behavioural effects after ACLT were too small for pharmacological evaluation of pain relief. In contrast, the inflammation after CFA injection caused a long-lasting effect on pain-like behaviours such as weight bearing and gait, which could be attenuated by administration of an anti NGF antibody.
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Affiliation(s)
- Kristina Ängeby Möller
- Department of Physiology and Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden.
| | - Cecilia Aulin
- Department of Medicine, Division of Rheumatology, CMM L8:03, SE-171 76 Stockholm, Sweden
| | - Azar Baharpoor
- Department of Physiology and Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
| | - Camilla I Svensson
- Department of Physiology and Pharmacology, Karolinska Institutet, SE-171 77 Stockholm, Sweden
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Vincent TL. Of mice and men: converging on a common molecular understanding of osteoarthritis. THE LANCET. RHEUMATOLOGY 2020; 2:e633-e645. [PMID: 32989436 PMCID: PMC7511206 DOI: 10.1016/s2665-9913(20)30279-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Despite an increasing burden of osteoarthritis in developed societies, target discovery has been slow and there are currently no approved disease-modifying osteoarthritis drugs. This lack of progress is due in part to a series of misconceptions over the years: that osteoarthritis is an inevitable consequence of ageing, that damaged articular cartilage cannot heal itself, and that osteoarthritis is driven by synovial inflammation similar to that seen in rheumatoid arthritis. Molecular interrogation of disease through ex-vivo tissue analysis, in-vitro studies, and preclinical models have radically reshaped the knowledge landscape. Inflammation in osteoarthritis appears to be distinct from that seen in rheumatoid arthritis. Recent randomised controlled trials, using treatments repurposed from rheumatoid arthritis, have largely been unsuccessful. Genome-wide studies point to defects in repair pathways, which accords well with recent promise using growth factor therapies or Wnt pathway antagonism. Nerve growth factor has emerged as a robust target in osteoarthritis pain in phase 2-3 trials. These studies, both positive and negative, align well with those in preclinical surgical models of osteoarthritis, indicating that pathogenic mechanisms identified in mice can lead researchers to valid human targets. Several novel candidate pathways are emerging from preclinical studies that offer hope of future translational impact. Enhancing trust between industry, basic, and clinical scientists will optimise our collective chance of success.
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Affiliation(s)
- Tonia L Vincent
- Centre for Osteoarthritis Pathogenesis, Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK
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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] [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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Zhang L, Li T, Wang R, Xu J, Zhou L, Yan L, Hu Z, Li H, Liu F, Du W, Tong P, Wu H, Zhang S, Shan L, Efferth T. Evaluation of Long-Time Decoction-Detoxicated Hei-Shun-Pian (Processed Aconitum carmichaeli Debeaux Lateral Root With Peel) for Its Acute Toxicity and Therapeutic Effect on Mono-Iodoacetate Induced Osteoarthritis. Front Pharmacol 2020; 11:1053. [PMID: 32848727 PMCID: PMC7396609 DOI: 10.3389/fphar.2020.01053] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2020] [Accepted: 06/29/2020] [Indexed: 11/29/2022] Open
Abstract
Background As a degenerative joint disease with severe cartilage destruction and pain, osteoarthritis (OA) has no satisfactory therapy to date. In traditional Chinese medicine (TCM), Aconitum carmichaeli Debeaux derived Hei-shun-pian (Hsp) has been developed for joint pain treatment. However, it causes adverse events in OA patients. Long-time decoction has been traditionally applied to reduce the aconite toxicity of Hsp and other aconite herbs, but its detoxifying effect is uncertain. Methods Hsp was extracted with dilute decoction times (30, 60, and 120 min) and evaluated by toxicological, chemical, pharmacological assays. Acute toxicity assay and chemical analysis were employed to determine the toxicity and chemoprofile of Hsp extracts, respectively. Since the detoxified Hsp (dHsp) was defined, its therapeutic effect was evaluated by using an OA rat model induced by monosodium iodoacetate. dHsp at 14 g/kg was orally administered for 28 days, and the pain assessments (mechanical withdrawal threshold and thermal withdrawal latency) and histopathological analyses (HE and safranin-O staining) were performed. Real-time PCR (qPCR) was applied to determine the molecular actions of dHsp on cartilage tissue and on chondrocytes. MTT assay was conducted to evaluate the effect of dHsp on the cell viability of chondrocytes. The cellular and molecular assays were also conducted to analyze the functions of chemical components in dHsp. Results The chemoprofile result showed that the contents of toxic alkaloids (aconitine, mesaconitine, and hypaconitine) were decreased but that of non-toxic alkaloids (benzoylaconitine, benzoylmesaconitine, and benzoylhypaconitine) were increased with increasing decoction time. Acute toxicity assay showed that only Hsp extract with 120 min decoction was non-toxic within the therapeutic dose range. Thus, it was defined as dHsp for further experiment. In OA experiment, dHsp significantly attenuated joint pain and prevented articular degeneration from MIA attack. qPCR data showed that dHsp restored the abnormal expressions of Col10, Mmp2, Sox5, Adamts4/5/9, and up-regulated Col2 expression in rat cartilage. In vitro, dHsp-containing serum significantly proliferated rat chondrocytes and regulated the gene expressions of Col2, Mmp1, Adamts9, and Aggrecan in a similar way as the in vivo data. Moreover, aconitine, mesaconitine, and hypaconitine exerted cytotoxic effects on chondrocytes, while benzoylaconitine and benzoylhypaconitine except benzoylmesaconitine exhibited similar molecular actions to dHsp, indicating contributions of benzoylaconitine and benzoylhypaconitine to dHsp. Conclusions This study defined dHsp and demonstrated dHsp as a potential analgesic and disease modifying agent against OA with molecular actions on the suppression of chondrocyte hypertrophy and extracellular matrix degradation, providing a promising TCM candidate for OA therapy.
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Affiliation(s)
- Lei Zhang
- School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, China
| | - Ting Li
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Rongrong Wang
- College of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Jiaan Xu
- College of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Zhou
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Li Yan
- College of Pharmacy, Zhejiang Chinese Medical University, Hangzhou, China
| | - Zhengyan Hu
- Department of Physicochemistry and Toxicology, Center for Disease Control and Prevention of Zhejiang Province, Hangzhou, China
| | - Hongwen Li
- Experimental and Training Center, Zhejiang Pharmaceutical College, Ningbo, China
| | - Fucun Liu
- Department of Orthopaedics, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wenxi Du
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Peijian Tong
- School of Biological and Chemical Engineering, Zhejiang University of Science and Technology, Hangzhou, China
| | - Huiling Wu
- The First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Shanxing Zhang
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Letian Shan
- The First Affiliated Hospital, Zhejiang Chinese Medical University, Hangzhou, China
| | - Thomas Efferth
- Department of Pharmaceutical Biology, Institute of Pharmacy and Biochemistry, Johannes Gutenberg University, Mainz, Germany
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Blom AB, van den Bosch MH, Blaney Davidson EN, Roth J, Vogl T, van de Loo FA, Koenders M, van der Kraan PM, Geven EJ, van Lent PL. The alarmins S100A8 and S100A9 mediate acute pain in experimental synovitis. Arthritis Res Ther 2020; 22:199. [PMID: 32854769 PMCID: PMC7457270 DOI: 10.1186/s13075-020-02295-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 08/17/2020] [Indexed: 01/15/2023] Open
Abstract
Background Synovitis-associated pain is mediated by inflammatory factors that may include S100A8/9, which is able to stimulate nociceptive neurons via Toll-like receptor 4. In this study, we investigated the role of S100A9 in pain response during acute synovitis. Methods Acute synovitis was induced by streptococcal cell wall (SCW) injection in the knee joint of C57Bl/6 (WT) and S100A9−/− mice. The expression of S100A8/A9 was determined in serum and synovium by ELISA and immunohistochemistry. Inflammation was investigated by 99mTc accumulation, synovial cytokine release, and histology at days 1, 2, and 7. To assess pain, weight distribution, gait analysis, and mechanical allodynia were monitored. Activation markers in afferent neurons were determined by qPCR and immunohistochemistry in the dorsal root ganglia (DRG). Differences between groups were tested using a one-way or two-way analysis of variance (ANOVA). Differences in histology were tested with a non-parametric Mann–Whitney U test. p values lower than 0.05 were considered significant. Results Intra-articular SCW injection resulted in increased synovial expression and serum levels of S100A8/A9 at day 1. These increased levels, however, did not contribute to the development of inflammation, since this was equal in S100A9−/− mice. WT mice showed a significantly decreased percentage of weight bearing on the SCW hind paw on day 1, while S100A9−/− mice showed no reduction. Gait analysis showed increased “limping” behavior in WT, but not S100A9−/− mice. Mechanical allodynia was observed but not different between WT and S100A9−/− when measuring paw withdrawal threshold. The gene expression of neuron activation markers NAV1.7, ATF3, and GAP43 in DRG was significantly increased in arthritic WT mice at day 1 but not in S100A9−/− mice. Conclusions S100A8/9, released from the synovium upon inflammation, is an important mediator of pain response in the knee during the acute phase of inflammation.
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Affiliation(s)
- Arjen B Blom
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands.
| | - Martijn H van den Bosch
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Esmeralda N Blaney Davidson
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Johannes Roth
- Institute of Immunology, University of Münster, Münster, Germany
| | - Thomas Vogl
- Institute of Immunology, University of Münster, Münster, Germany
| | - Fons A van de Loo
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Marije Koenders
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Peter M van der Kraan
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Edwin J Geven
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
| | - Peter L van Lent
- Experimental Rheumatology, Radboud university medical center, Geert Grooteplein 28, 6525 GA, Nijmegen, The Netherlands
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100
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Sánchez Romero EA, Fernández Carnero J, Villafañe JH, Calvo-Lobo C, Ochoa Sáez V, Burgos Caballero V, Laguarta Val S, Pedersini P, Pecos Martín D. Prevalence of Myofascial Trigger Points in Patients with Mild to Moderate Painful Knee Osteoarthritis: A Secondary Analysis. J Clin Med 2020; 9:jcm9082561. [PMID: 32784592 PMCID: PMC7464556 DOI: 10.3390/jcm9082561] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 07/17/2020] [Accepted: 08/04/2020] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVE To determine the prevalence of myofascial trigger points (MTrPs) and the correlation between the number of MTrPs and pain and function in patients presenting knee pain osteoarthritis (OA). METHODS This was a secondary analysis of data from a cross-sectional study. The prevalence of MTrPs located in tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles was studied in 114 patients (71 men and 43 women) with knee OA. Pain and functionality were assessed with a numerical pain rating scale (NPRS), the Western Ontario, McMaster Universities Osteoarthritis Index (WOMAC) score, the Barthel Index, and the timed up and go test. RESULTS The prevalence of latent MTrPs was detected via palpation and was estimated to be 50%, 35%, 25%, 29%, 33%, and 12% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. The prevalence of active MTrPs was estimated to be 11%, 17%, 30%, 18%, 25%, and 17% for tensor fasciae latae, hip adductors, hamstrings, quadriceps, gastrocnemius, and popliteus muscles, respectively. Pain was measured with the NPRS scale and was poorly correlated with the prevalence of latent MTrPs (r = 0.2; p = 0.03) and active MTrPs (r = 0.23; p = 0.01) in the hamstrings. Disability was moderately correlated with the number of latent MTrPs in the tensor fasciae latae muscle (Barthel, r = 0.26; p = 0.01 and WOMAC, r = 0.19; p = 0.04). CONCLUSIONS This secondary analysis found that the prevalence of the MTrPs varied from 11% to 50% in different muscles of patients with mild to moderate painful knee osteoarthritis. Pain was correlated poorly with the prevalence of latent and active MTrPs in the hamstring muscles, and disability correlated moderately with the number of latent MTrPs in tensor fasciae latae.
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Affiliation(s)
- Eleuterio A. Sánchez Romero
- Department of Physiotherapy, Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Correspondence: (E.A.S.R.); (J.F.C.)
| | - Josué Fernández Carnero
- Musculoskeletal Pain and Motor Control Research Group, Faculty of Health Sciences, Universidad Europea de Madrid, 28670 Madrid, Spain
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28943 Madrid, Spain;
- La Paz Hospital Institute for Health Research, IdiPAZ, 28922 Madrid, Spain
- Grupo Multidisciplinar de Investigación y Tratamiento del Dolor, Grupo de Excelencia Investigadora URJC-Banco de Santander, 28922 Madrid, Spain
- Correspondence: (E.A.S.R.); (J.F.C.)
| | | | - César Calvo-Lobo
- Faculty of Nursing, Physiotherapy and Podiatry, Complutense University of Madrid, 28040 Madrid, Spain;
| | - Victoria Ochoa Sáez
- Older-adult care center "Manuel Herranz", Pozuelo de Alarcón, 28223 Madrid, Spain; (V.O.S.); (V.B.C.)
| | - Verónica Burgos Caballero
- Older-adult care center "Manuel Herranz", Pozuelo de Alarcón, 28223 Madrid, Spain; (V.O.S.); (V.B.C.)
| | - Sofia Laguarta Val
- Department of Physical Therapy, Occupational Therapy, Rehabilitation and Physical Medicine, Rey Juan Carlos University, 28943 Madrid, Spain;
| | - Paolo Pedersini
- IRCCS Fondazione Don Carlo Gnocchi, 20161 Milan, Italy; (J.H.V.); (P.P.)
| | - Daniel Pecos Martín
- Department of Physical Therapy of Alcalá University, Alcalá de Henares, 28805 Madrid, Spain;
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