1001
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Functional gain following knee replacement in patients aged 75 and older: a prospective follow-up study. Aging Clin Exp Res 2015; 27:865-76. [PMID: 25800623 DOI: 10.1007/s40520-015-0348-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 03/05/2015] [Indexed: 10/23/2022]
Abstract
BACKGROUND AND AIMS The aim of this prospective follow-up study was to analyze which patient characteristics predict better functional ability, as well as improvement in the ability, following knee replacement in the aged. The focus was on the impact of specific comorbidities and radiologic data. METHODS Knee osteoarthritis patients aged ≥75 years (n = 167) scheduled for knee replacement answered to a questionnaire asking about performance in the activities of daily living (ADL) before the operation, and 1 year afterwards. Radiologic data were evaluated from the latest radiographs, and comorbidity data from patient records. The primary outcome was a sum score indicating how many ADLs (out of 10) the patient was able to perform without difficulty. The factors associated with ADL performance were analyzed with adjustment for age, gender, Charlson's comorbidity index and Kellgren-Lawrence score. RESULTS Knee replacement resulted in improved performance in almost all the analyzed ADL activities. Except for cardiac diseases, the effect of the analyzed comorbidities on ADL performance was not significant. Older patients and women attained lower final functional ability than younger patients and men, but improved similarly. In more progressed osteoarthritis, the final ability was lower, but the improvement gained was greater. CONCLUSIONS Comorbidity, age, or more progressed osteoarthritis should not be considered an impediment to knee replacement. Even though the final functional ability may be lower in some, the improvement gained by surgery is similar regardless of comorbidity, and was more pronounced in more progressed disease.
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1002
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Glover TL, Goodin BR, King CD, Sibille KT, Herbert MS, Sotolongo AS, Cruz-Almeida Y, Bartley EJ, Bulls HW, Horgas AL, Redden DT, Riley JL, Staud R, Fessler BJ, Bradley LA, Fillingim RB. A Cross-sectional Examination of Vitamin D, Obesity, and Measures of Pain and Function in Middle-aged and Older Adults With Knee Osteoarthritis. Clin J Pain 2015; 31:1060-7. [PMID: 25569220 PMCID: PMC4494986 DOI: 10.1097/ajp.0000000000000210] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
OBJECTIVES The prevalence of knee osteoarthritis (OA) is increasing with the aging population and is exacerbated by the growing numbers of obese older adults. Low levels of vitamin D, measured by serum 25-hydroxyvitamin D (25(OH)D), in older adults and obese individuals are correlated with several negative health conditions, including chronic pain. This cross-sectional study sought to examine the interactive influence of 25(OH)D levels and obesity on knee OA pain and functional performance measures. METHODS The sample consisted of 256 (63% female) racially diverse (55% black/African Americans) middle-aged and older adults (mean age 56.8 y). Blood was collected for analysis of 25(OH)D by high-performance liquid chromatography. Participants provided self-report regarding knee OA pain and underwent a lower extremity functional performance test. RESULTS Results demonstrated that obesity was associated with lower levels of 25(OH)D. Participants with adequate 25(OH)D levels reported significantly less knee OA pain compared with participants with deficient or insufficient levels, regardless of obesity status. Furthermore, there was a significant interaction between obesity and 25(OH)D levels for lower extremity functional performance, such that obese individuals with adequate 25(OH)D levels demonstrated better performance than those obese participants with deficient or insufficient 25(OH)D levels. DISCUSSION The mechanisms by which adequate 25(OH)D levels are associated with pain severity and improved function have not been completely elucidated. It may be that the pleiotropic role of biologically active 25(OH)D influences pain and pain processing through peripheral and central mechanisms. Alternatively, higher levels of pain may lead to reduced outdoor activity, which may contribute to both obesity and decreased vitamin D. Thus, investigating vitamin D status in obese and nonobese individuals with knee OA warrants further study.
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Affiliation(s)
- Toni L. Glover
- University of Florida, College of Nursing, Adult and Elderly Nursing, Gainesville FL
| | - Burel R. Goodin
- University of Alabama at Birmingham, Departments of Psychology and Anesthesiology, Birmingham, AL
| | - Christopher D. King
- University of Florida, College of Dentistry, Department of Community Dentistry and Behavioral Science, Gainesville, FL
| | - Kimberly T. Sibille
- University of Florida, Institute on Aging, Department of Aging and Geriatric Research, Gainesville, FL
| | - Matthew S. Herbert
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL
| | - Adriana S. Sotolongo
- University of Alabama at Birmingham, Department of Medicine, Division of Clinical Immunology and Rheumatology, Birmingham, AL
| | - Yenisel Cruz-Almeida
- University of Florida, Institute on Aging, Department of Aging and Geriatric Research, Gainesville, FL
| | - Emily J. Bartley
- University of Florida, College of Dentistry, Department of Community Dentistry and Behavioral Science, Gainesville, FL
| | - Hailey W. Bulls
- University of Alabama at Birmingham, Department of Psychology, Birmingham, AL
| | - Ann L. Horgas
- University of Florida, College of Nursing, Adult and Elderly Nursing, Gainesville FL
| | - David T. Redden
- University of Alabama at Birmingham, Department of Biostatistics, Birmingham, AL
| | - Joseph L. Riley
- University of Florida, College of Dentistry, Department of Community Dentistry and Behavioral Science, Gainesville, FL
| | - Roland Staud
- University of Florida, Department of Medicine, Gainesville, FL
| | - Barri J. Fessler
- University of Alabama at Birmingham School of Medicine, Department of Clinical Immunology and Rheumatology, Birmingham, AL
| | - Laurence A. Bradley
- University of Alabama at Birmingham, Department of Medicine, Division of Clinical Immunology and Rheumatology, Birmingham, AL
| | - Roger B. Fillingim
- University of Florida, College of Dentistry, Department of Community Dentistry and Behavioral Science, Gainesville, FL
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1003
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Altman R, Hochberg M, Gibofsky A, Jaros M, Young C. Efficacy and safety of low-dose SoluMatrix meloxicam in the treatment of osteoarthritis pain: a 12-week, phase 3 study. Curr Med Res Opin 2015; 31:2331-43. [PMID: 26503347 DOI: 10.1185/03007995.2015.1112772] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVE Nonsteroidal anti-inflammatory drugs (NSAIDs) such as meloxicam are commonly used to treat osteoarthritis (OA) but are associated with potentially serious dose-related adverse events (AEs). SoluMatrix meloxicam has been developed with the goal of enabling effective treatment at low doses. This phase 3 study evaluated the efficacy and safety of low-dose SoluMatrix meloxicam capsules 5 mg and 10 mg administered once daily for 12 weeks in patients with OA-related pain. RESEARCH DESIGN AND METHODS This randomized, double-blind study enrolled patients ≥40 years of age with confirmed hip or knee OA (Kellgren-Lawrence grade II-III) who were chronic users of NSAIDs and/or acetaminophen for OA pain and had Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale mean scores ≥40 mm. Eligible patients experienced an OA pain flare (defined as a ≥15 mm increase in the WOMAC pain subscale score) following discontinuation of NSAIDs/acetaminophen. Patients were randomized to receive once-daily SoluMatrix meloxicam 5 mg or 10 mg, or placebo for 12 weeks. ClinicalTrials.gov identifier: NCT01787188. MAIN OUTCOME MEASURES The primary outcome measure was the mean change from baseline in WOMAC pain subscale score at week 12. RESULTS Low-dose SoluMatrix meloxicam 5 mg (-36.52 [2.49]; P = 0.0005) and 10 mg (-34.41 [2.68]; P = 0.0059) once-daily treatment significantly reduced the mean (standard error) WOMAC pain subscale score from baseline at week 12 compared with placebo (-25.68 [2.64]). Patients treated with SoluMatrix meloxicam 5 mg or 10 mg reported significantly greater improvements in total WOMAC score and in WOMAC stiffness and function subscale scores at 12 weeks compared with placebo. The most common AEs in the combined low-dose SoluMatrix meloxicam group were headache, diarrhea, nausea, osteoarthritis, and urinary tract infection. CONCLUSIONS Low-dose SoluMatrix meloxicam may have a potential role as a new therapeutic option for the management of OA-related pain.
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Affiliation(s)
- Roy Altman
- a a University of California, David Geffen School of Medicine , Los Angeles , CA , USA
| | - Marc Hochberg
- b b University of Maryland School of Medicine , Baltimore , MD , USA
| | | | - Mark Jaros
- d d Summit Analytical LLC , Denver , CO , USA
| | - Clarence Young
- e e Iroko Pharmaceuticals, LLC , Philadelphia , PA , USA
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1004
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González-Huerta NC, Borgonio-Cuadra VM, Zenteno JC, Cortés-González S, Duarte-Salazar C, Miranda-Duarte A. D14 repeat polymorphism of the asporin gene is associated with primary osteoarthritis of the knee in a Mexican Mestizo population. Int J Rheum Dis 2015; 20:1935-1941. [PMID: 26620055 DOI: 10.1111/1756-185x.12797] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Asporin is a novel extracellular matrix protein (ECM) with an important role in the development of osteoarthritis (OA), because it has been reported that functional polymorphisms in the aspartic acid repeat (D) of the asporin gene (ASPN) are associated with susceptibility to OA. AIM This study was planned to investigate the association of the ASPN polymorphism with primary OA of the knee in a Mexican population, including several countryside regions. METHODS We conducted a case-control study in which 93 cases with primary OA of the knee and 118 controls were included. Cases included patients > 40 years of age, with a body mass index (BMI) ≤ 27 and a radiologic score for OA of the knee of ≥ 2. Controls were subjects > 40 years of age with a radiologic score of < 2. The D repeat polymorphism was genotyped and logistic regression was developed to evaluate risk magnitude. RESULTS The D14 allele was more common in our cases and was associated with an increased risk for developing OA, while the frequencies of the remaining alleles did not exhibit differences. CONCLUSION Our data suggest that the D14 allele of the ASPN polymorphism could exert an influence on primary OA of the knee etiology in a Mexican Mestizo population.
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Affiliation(s)
| | | | - Juan Carlos Zenteno
- Department of Biochemistry, Faculty of Medicine, Universidad Nacional Autónoma de México (UNAM), México City, México.,Department of Genetics, Instituto de Oftalmología "Conde de Valenciana", México City, México
| | - Socorro Cortés-González
- Department of Magnetic Resonance, Instituto Nacional de Rehabilitación (INR), México City, México
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1005
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Aesthetic discomfort in hand osteoarthritis: results from the LIège Hand Osteoarthritis Cohort (LIHOC). Arthritis Res Ther 2015; 17:346. [PMID: 26620999 PMCID: PMC4666038 DOI: 10.1186/s13075-015-0807-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Accepted: 09/28/2015] [Indexed: 11/11/2022] Open
Abstract
Introduction The primary complaint of patients with hand osteoarthritis (OA) is frequently the inelegant appearance of their hands. Only one study has been conducted to assess the magnitude of and identify the determinants of aesthetic discomfort in hand OA. Methods The LIège Hand Osteoarthritis Cohort is a prospective cohort of 203 patients diagnosed with hand OA. At baseline, these patients rated their aesthetic discomfort on a 100-mm visual analogue scale (VAS) and used a Likert scale (range 0–7) to quantify the magnitude of their aesthetic damage. Results The median value of the aesthetic discomfort VAS was 35.0 [interquartile range (Q1–Q3) 6.0–59.0]. The median damage was rated 3.0 (Q1–Q3 1.0–4.0), corresponding to a moderate level. Both were significantly (p < 0.02) associated with the female gender, the duration of hand OA, the radiological severity of OA (Verbruggen–Veys and Kellgren–Lawrence scales) and pain, disability, or stiffness [Australian Canadian Osteoarthritis Hand Index (AUSCAN) and Functional Index for Hand Osteoarthritis ]. After a stepwise analysis, the parameters correlated to the aesthetic discomfort were the presence of erosive joints (p = 0.0048), the AUSCAN score (p < 0.0001), the number of joints with severe radiological damage (p = 0.023), and gender (p = 0.0009). For aesthetic damage, the parameters associated were AUSCAN score (p < 0.0001), duration of hand OA >10 years (p = 0.001), and presence of erosive joints (p < 0.0001). Compared with patients with low aesthetic discomfort (VAS ≤33 mm), those with the highest discomfort (VAS ≥66 mm) had more erosive OA (p = 0.014), a higher Verbruggen and Veys score (p = 0.0039), and a higher AUSCAN score (p < 0.001). Conclusions Aesthetic discomfort and damage are significant complaints in patients with hand OA. The determinants of the magnitude of these are gender, radiological severity, duration of hand OA, presence of erosive joints, and impact on pain, function, and stiffness as assessed with the AUSCAN. Electronic supplementary material The online version of this article (doi:10.1186/s13075-015-0807-y) contains supplementary material, which is available to authorized users.
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1006
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Can We Identify Patients with High Risk of Osteoarthritis Progression Who Will Respond to Treatment? A Focus on Biomarkers and Frailty. Drugs Aging 2015; 32:525-35. [PMID: 26085027 PMCID: PMC4516900 DOI: 10.1007/s40266-015-0276-7] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoarthritis (OA), a disease affecting different patient phenotypes, appears as an optimal candidate for personalized healthcare. The aim of the discussions of the European Society for Clinical and Economic Aspects of Osteoporosis and Osteoarthritis (ESCEO) working group was to explore the value of markers of different sources in defining different phenotypes of patients with OA. The ESCEO organized a series of meetings to explore the possibility of identifying patients who would most benefit from treatment for OA, on the basis of recent data and expert opinion. In the first meeting, patient phenotypes were identified according to the number of affected joints, biomechanical factors, and the presence of lesions in the subchondral bone. In the second meeting, summarized in the present article, the working group explored other markers involved in OA. Profiles of patients may be defined according to their level of pain, functional limitation, and presence of coexistent chronic conditions including frailty status. A considerable amount of data suggests that magnetic resonance imaging may also assist in delineating different phenotypes of patients with OA. Among multiple biochemical biomarkers identified, none is sufficiently validated and recognized to identify patients who should be treated. Considerable efforts are also being made to identify genetic and epigenetic factors involved in OA, but results are still limited. The many potential biomarkers that could be used as potential stratifiers are promising, but more research is needed to characterize and qualify the existing biomarkers and to identify new candidates.
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1007
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Shen S, Wang H, Zhang J, Wang F, Chen M. T1ρ magnetic resonance imaging quantification of early articular cartilage degeneration in a rabbit model. BMC Musculoskelet Disord 2015; 16:361. [PMID: 26585246 PMCID: PMC4653945 DOI: 10.1186/s12891-015-0810-0] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2015] [Accepted: 11/10/2015] [Indexed: 11/10/2022] Open
Abstract
Background Osteoarthritis (OA) is a serious problem in the recent aging society, and early diagnosis and intervention of articular cartilage degeneration are very important for the onset of OA. Therefore, development of newer MRI techniques is necessary and expected for detection of early articular cartilage degeneration. Methods 24 rabbits were randomly divided into four equal experimental groups (Group A, B, C, D) to establish articular cartilage models in different grades of early degeneration by injecting papain into the left knee joint cavity. Another 8 rabbits were considered as blank control (Group E), and then randomized into four subgroups (EA, EB, EC, ED). T1ρ and T2-weighted images of the bilateral knee joints were obtained for rabbits by using 3.0 T MRI. Group A, B, C, and D were imaged respectively at 1, 2, 3, and 4 weeks post-operation, and EA, EB, EC, ED underwent the same period imaging. Rabbits were sacrificed after scanning and the femoral condyle cartilage (FCC) was histological examined. T1ρ values of the femoral condyle cartilage were measured and statistically analyzed, and contrasted with the histologic results. Results T1ρ values of the left side in experimental groups were significantly higher than the right side (P < 0.05), and which increased gradually with the passage of post-operation time (P < 0.05). Histological examination demonstrated the proteoglycan content of the left side decreased, and indicated the occurrence of early degeneration. Conclusions T1ρ MRI can sensitively and quantitatively reflect the change in proteoglycans prior to the morphologic alterations of articular cartilage, and T1ρ value is gradually increased with a decrease in proteoglycan content, therefore that T1ρ could potentially act as a reliable tool to identify early cartilage degeneration.
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Affiliation(s)
- Si Shen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Hao Wang
- Pain Clinic, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Jing Zhang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Fei Wang
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
| | - Meng Chen
- Medical Imaging Center, The First Affiliated Hospital of Jinan University, Guangzhou, 510630, China.
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1008
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Effectiveness and Safety of Manufactured Chinese Herbal Formula for Knee Osteoarthritis: Insights from a Systematic Review. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2015; 2015:328642. [PMID: 26609310 PMCID: PMC4644564 DOI: 10.1155/2015/328642] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/10/2015] [Revised: 09/07/2015] [Accepted: 09/20/2015] [Indexed: 01/22/2023]
Abstract
Objective. To assess the current clinical evidence of manufactured Chinese herbal formulae (MCHF) for knee osteoarthritis (KOA). Methods. Seven databases were searched from inception to May 2015. Eligible randomized controlled trials investigating the effectiveness of MCHF for KOA were included. Data extraction, methodological assessment, and meta-analyses were conducted according to the Cochrane standards. Results. A total of 17 kinds of MCHF were identified from the twenty-six included trials. Meta-analyses showed that MCHF significantly relieved the global pain of knee joints, either used alone or combined with routine treatments. Additionally, MCHF plus routine treatments significantly decreased the scores of WOMAC and Lequesne index. However, there were no statistical differences between MCHF group and routine treatment group in walk-related pain and WOMAC scores. No significant differences were found in Lysholm scores. There were twenty-one trials that mentioned adverse events. A pooled analysis showed that adverse events occurred more frequently in control group compared with MCHF group. Conclusions. Our results indicated that MCHF showed some potential benefits for KOA. However, we still cannot draw firm conclusions due to the poor methodological quality of included trials. More high-quality RCTs would help to confirm the evidence.
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1009
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da Silva Pinto CZ, Alpendre FT, Stier CJN, Maziero ECS, de Alencar PGC, de Almeida Cruz ED. Characterization of hip and knee arthroplasties and factors associated with infection. Rev Bras Ortop 2015; 50:694-9. [PMID: 27218082 PMCID: PMC4867922 DOI: 10.1016/j.rboe.2015.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2014] [Accepted: 01/14/2015] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To characterize arthroplasty procedures, calculate the surgical infection rate and identify related risk factors. METHODS This was a retrospective cohort study. Data on operations performed between 2010 and 2012 were gathered from documental sources and were analyzed with the aid of statistical software, using Fisher's exact test, Student's t test and the nonparametric Mann-Whitney and Wilcoxon tests. RESULTS 421 total arthroplasty procedures performed on 346 patients were analyzed, of which 208 were on the knee and 213 on the hip. It was found that 18 patients (4.3%) were infected. Among these, 15 (83.33%) were reoperated and 2 (15.74%) died. The prevalence of infection in primary total hip arthroplasty procedures was 3%; in primary total knee arthroplasty, 6.14%; and in revision of total knee arthroplasty, 3.45%. Staphylococcus aureus was prevalent. The length of the surgical procedure showed a tendency toward being a risk factor (p = 0.067). CONCLUSION The prevalence of infection in cases of primary total knee arthroplasty was greater than in other cases. No statistically significant risk factors for infection were identified.
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1010
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Caracterização de artroplastias de quadril e joelho e fatores associados à infecção. Rev Bras Ortop 2015. [DOI: 10.1016/j.rbo.2015.04.017] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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1011
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Regnaux J, Lefevre‐Colau M, Trinquart L, Nguyen C, Boutron I, Brosseau L, Ravaud P. High-intensity versus low-intensity physical activity or exercise in people with hip or knee osteoarthritis. Cochrane Database Syst Rev 2015; 2015:CD010203. [PMID: 26513223 PMCID: PMC9270723 DOI: 10.1002/14651858.cd010203.pub2] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Exercise or physical activity is recommended for improving pain and functional status in people with knee or hip osteoarthritis. These are complex interventions whose effectiveness depends on one or more components that are often poorly identified. It has been suggested that health benefits may be greater with high-intensity rather than low-intensity exercise or physical activity. OBJECTIVES To determine the benefits and harms of high- versus low-intensity physical activity or exercise programs in people with hip or knee osteoarthritis. SEARCH METHODS We searched the Cochrane Central Register of Controlled Trials (CENTRAL; issue 06, 2014), MEDLINE (194 8 to June 2014) , EMBASE (198 0 to June 2014), CINAHL (1982 to June 2014), PEDro (1929 to June 2014), SCOPUS (to June 2014) and the World Health Organization (WHO) International Clinical Registry Platform (to June 2014) for articles, without a language restriction. We also handsearched relevant conference proceedings, trials, and reference lists and contacted researchers and experts in the field to identify additional studies. SELECTION CRITERIA We included randomized controlled trials of people with knee or hip osteoarthritis that compared high- versus low-intensity physical activity or exercise programs between the experimental and control group.High-intensity physical activity or exercise programs training had to refer to an increase in the overall amount of training time (frequency, duration, number of sessions) or the amount of work (strength, number of repetitions) or effort/energy expenditure (exertion, heart rate, effort). DATA COLLECTION AND ANALYSIS Two review authors independently assessed study eligibility and extracted data on trial details. We contacted authors for additional information if necessary. We assessed the quality of the body of evidence for these outcomes using the GRADE approach. MAIN RESULTS We included reports for six studies of 656 participants that compared high- and low-intensity exercise programs; five studies exclusively recruited people with symptomatic knee osteoarthritis (620 participants), and one study exclusively recruited people with hip or knee osteoarthritis (36 participants). The majority of the participants were females (70%). No studies evaluated physical activity programs. We found the overall quality of evidence to be low to very low due to concerns about study limitations and imprecision (small number of studies, large confidence intervals) for the major outcomes using the GRADE approach. Most of the studies had an unclear or high risk of bias for several domains, and we judged five of the six studies to be at high risk for performance, detection, and attrition bias.Low-quality evidence indicated reduced pain on a 20-point Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain scale (mean difference (MD) -0.84, 95% confidence interval (CI) -1.63 to -0.04; 4% absolute reduction, 95% CI -8% to 0%; number needed to treat for an additional beneficial outcome (NNTB) 11, 95% CI 14 to 22) and improved physical function on the 68-point WOMAC disability subscale (MD -2.65, 95% CI -5.29 to -0.01; 4% absolute reduction; NNTB 10, 95% CI 8 to 13) immediately at the end of the exercise programs (from 8 to 24 weeks). However, these results are unlikely to be of clinical importance. These small improvements did not continue at longer-term follow-up (up to 40 weeks after the end of the intervention). We are uncertain of the effect on quality of life, as only one study reported this outcome (0 to 200 scale; MD 4.3, 95% CI -6.5 to 15.2; 2% absolute reduction; very low level of evidence).Our subgroup analyses provided uncertain evidence as to whether increased exercise time (duration, number of sessions) and level of resistance (strength or effort) have an impact on the exercise program effects.Three studies reported withdrawals due to adverse events. The number of dropouts was small. Only one study systematically monitored adverse effects, but four studies reported some adverse effects related to knee pain associated with an exercise program. We are uncertain as to whether high intensity increases the number of adverse effects (Peto odds ratio 1.72, 95% CI 0.51 to 5.81; - 2% absolute risk reduction; very low level of evidence). None of the included studies reported serious adverse events. AUTHORS' CONCLUSIONS We found very low-quality to low-quality evidence for no important clinical benefit of high-intensity compared to low-intensity exercise programs in improving pain and physical function in the short term. There was insufficient evidence to determine the effect of different types of intensity of exercise programs.We are uncertain as to whether higher-intensity exercise programs may induce more harmful effects than those of lower intensity; this must be evaluated by further studies. Withdrawals due to adverse events were poorly monitored and not reported systematically in each group. We downgraded the evidence to low or very low because of the risk of bias, inconsistency, and imprecision.The small number of studies comparing high- and low-intensity exercise programs in osteoarthritis underscores the need for more studies investigating the dose-response relationship in exercise programs. In particular, further studies are needed to establish the minimal intensity of exercise programs needed for clinical effect and the highest intensity patients can tolerate. Larger studies should comply with the Consolidated Standards of Reporting Trials (CONSORT) checklist and systematically report harms data to evaluate the potential impact of highest intensities of exercise programs in people with joint damage.
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Affiliation(s)
- Jean‐Philippe Regnaux
- INSERM U1153METHODS teamParisFrance
- EHESP Rennes, Sorbonne Paris CitéParisFrance
- French Cochrane CenterParisFrance
| | - Marie‐Martine Lefevre‐Colau
- French Cochrane CenterParisFrance
- INSERM U1153ECaMO teamParisFrance
- Sorbonne Paris Cité, Faculté de MédecineParis Descartes UniversityParisFrance
- AP‐HP (Assistance Publique des Hôpitaux de Paris), Hôpital CochinRheumatic and musculoskeletal disease Institute, Department of Physical Medicine and Rehabilitation,ParisFrance
| | - Ludovic Trinquart
- Hôpital Hôtel‐DieuFrench Cochrane Centre1 place du Parvis Notre‐DameParisFrance75004
| | - Christelle Nguyen
- Hôpital Cochin, Assistance publique‐Hôpitaux de Paris, Université Paris‐DescartesService de Médecine Physique et de Réadaptation27, Rue du Faubourg Saint‐JacquesParisFrance75014
| | - Isabelle Boutron
- INSERM U1153METHODS teamParisFrance
- French Cochrane CenterParisFrance
- Sorbonne Paris Cité, Faculté de MédecineParis Descartes UniversityParisFrance
- AP‐HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel DieuCentre d'Épidémiologie Clinique1, place du Parvis Notre‐DameParisFrance
| | - Lucie Brosseau
- University of OttawaSchool of Rehabilitation Sciences, Faculty of Health Sciences451 Smyth RoadOttawaONCanadaK1H 8M5
| | - Philippe Ravaud
- INSERM U1153METHODS teamParisFrance
- French Cochrane CenterParisFrance
- Sorbonne Paris Cité, Faculté de MédecineParis Descartes UniversityParisFrance
- AP‐HP (Assistance Publique des Hôpitaux de Paris), Hôpital Hôtel DieuCentre d'Épidémiologie Clinique1, place du Parvis Notre‐DameParisFrance
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1012
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Mat S, Tan PJ, Ng CT, Fadzli F, Rozalli FI, Khoo EM, Hill KD, Tan MP. Mild Joint Symptoms Are Associated with Lower Risk of Falls than Asymptomatic Individuals with Radiological Evidence of Osteoarthritis. PLoS One 2015; 10:e0141368. [PMID: 26491868 PMCID: PMC4619628 DOI: 10.1371/journal.pone.0141368] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2015] [Accepted: 10/03/2015] [Indexed: 11/19/2022] Open
Abstract
Osteoarthritis (OA) exacerbates skeletal muscle functioning, leading to postural instability and increased falls risk. However, the link between impaired physical function, OA and falls have not been elucidated. We investigated the role of impaired physical function as a potential mediator in the association between OA and falls. This study included 389 participants [229 fallers (≥2 falls or one injurious fall in the past 12 months), 160 non-fallers (no history of falls)], age (≥65 years) from a randomized controlled trial, the Malaysian Falls Assessment and Intervention Trial (MyFAIT). Physical function was assessed using Timed Up and Go (TUG) and Functional Reach (FR) tests. Knee and hip OA were diagnosed using three methods: Clinical, Radiological and Self-report. OA symptom severity was assessed using the Western Ontario and McMaster Universities Arthritis Index (WOMAC). The total WOMAC score was categorized to asymptomatic, mild, moderate and severe symptoms. Individuals with radiological OA and ‘mild’ overall symptoms on the WOMAC score had reduced risk of falls compared to asymptomatic OA [OR: 0.402(0.172–0.940), p = 0.042]. Individuals with clinical OA and ‘severe’ overall symptoms had increased risk of falls compared to those with ‘mild’ OA [OR: 4.487(1.883–10.693), p = 0.005]. In individuals with radiological OA, mild symptoms appear protective of falls while those with clinical OA and severe symptoms have increased falls risk compared to those with mild symptoms. Both relationships between OA and falls were not mediated by physical limitations. Larger prospective studies are needed for further evaluation.
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Affiliation(s)
- Sumaiyah Mat
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Pey June Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Chin Teck Ng
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Rheumatology & Immunology, Singapore General Hospital, Singapore, Singapare
| | - Farhana Fadzli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Faizatul I. Rozalli
- Department of Biomedical Imaging, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Ee Ming Khoo
- Department of Primary Care Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Keith D. Hill
- School of Physiotherapy and Exercise Science, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia
| | - Maw Pin Tan
- Ageing and Age-Associated Disorders Research Group, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Division of Geriatric Medicine, Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- * E-mail:
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1013
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Arnold JT, Bruce-Low S, Sammut L. The impact of 12 weeks walking football on health and fitness in males over 50 years of age. BMJ Open Sport Exerc Med 2015; 1:bmjsem-2015-000048. [PMID: 27900112 PMCID: PMC5117019 DOI: 10.1136/bmjsem-2015-000048] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/21/2015] [Indexed: 01/24/2023] Open
Abstract
Aim To describe and characterise anthropometrical and fitness changes following a 12-week walking football programme in individuals over the age of 50 years. Methods Following ethical approval, 10 male participants (mean (SD): age 66 (7) years) with a range of comorbidities completed a 12-week walking football programme, consisting of a single 2 h training session each week. Body mass, fat mass, fat free mass, maximal oxygen consumption, maximal heart rate, exercise time to exhaustion and isometric hand-grip strength, were assessed at baseline and immediately following the intervention. Week-0–12 intervention differences were determined using means (95% CIs) and t tests; effect sizes were calculated using Cohen's d (0.2 small, 0.5 medium, 0.8 large). Results 12 weeks walking football significantly reduced body fat mass (week 0, 27.4 (9.0) kg versus week 12, 24.4 (8.9) kg, p=<0.05, d=1.0) and reduced percentage body fat (week 0, 30.3 (8.2) % versus week 12, 27.5 (8.5) %, p=<0.05, d=1.0). A significant increase in time to volitional exhaustion during increamental exercise (week 0, 545 (102) s versus week 12, 603 (102) s, p=<0.05, d=0.7) was observed without any change in peak blood lactate. Non-significant differences with medium effect sizes were seen for a reduction whole body mass, increase in lean body mass and a reduction in body mass index. Conclusions This investigation suggests the potential efficacy of walking football as a public health intervention, even in populations presenting a range of comorbidities, with future research investigating its move to scale.
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Affiliation(s)
- Josh Timothy Arnold
- School of Sport, Health and Social Sciences, Southampton Solent University , Southampton, Hampshire , UK
| | - Stewart Bruce-Low
- School of Sport, Health and Social Sciences, Southampton Solent University , Southampton, Hampshire , UK
| | - Luke Sammut
- University Hospital Southampton NHS Foundation Trust , Southampton, Hampshire , UK
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1014
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Estimating the Burden of Osteoarthritis to Plan for the Future. Arthritis Care Res (Hoboken) 2015; 67:1379-86. [DOI: 10.1002/acr.22612] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2014] [Revised: 03/04/2015] [Accepted: 04/28/2015] [Indexed: 11/07/2022]
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1015
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Fang WH, Huang GS, Chang HF, Chen CY, Kang CY, Wang CC, Lin C, Yang JH, Su W, Kao S, Su SL. Gender differences between WOMAC index scores, health-related quality of life and physical performance in an elderly Taiwanese population with knee osteoarthritis. BMJ Open 2015; 5:e008542. [PMID: 26373405 PMCID: PMC4577945 DOI: 10.1136/bmjopen-2015-008542] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE To investigate the importance of the WOMAC index score, health-related quality of life and physical performance in each domain affected by knee osteoarthritis (OA) and to identify gender differences in the importance of these domains and physical performances. MATERIAL AND METHODS We performed a population-based study for radiographic knee OA among participants aged more than 65 years. Demographic data were collected and anthropometric measurement, radiographic assessment, the WOMAC index score, the short-form 12 (SF-12), the Timed and Up to Go Test (TUGT) and the Five Times Sit to Stand Test (FTSST) were performed. RESULT There were 901 individuals (409 males and 492 females) aged 74.04±6.92 (male: 76.35±7.33; female: 72.12±5.92) years included in this study. The WOMAC scores of participants with OA were higher than those without OA in males and females (male: 11.97±15.79 vs 8.23±12.84, p<0.001; female: 10.61±14.97 vs 7.59±3.31, p=0.032). The physical component summary (PCS) score was only significant in females with knee OA (62.14±24.66 vs 66.59±23.85, p=0.043), while the mental component summary (MCS) score was only significant in males with knee OA (78.02±18.59 vs 81.98±15.46, p=0.02). The TUGT and FTSST were not significant in individuals with and without OA in males and females. Moreover, the multivariate results for the WOMAC score were significant for females (3.928 (95% CI 1.287 to 6.569), p=0.004). CONCLUSIONS The PCS domains of SF-12 and MCS domains of SF-12 are crucial in Taiwanese females and elderly males, respectively, with knee OA. Different evaluation and treatment strategies based on gender differences should be considered in elderly Taiwanese patients with knee OA to improve their quality of life.
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Affiliation(s)
- Wen-Hui Fang
- Department of Family and Community Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Guo-Shu Huang
- Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Hsien-Feng Chang
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Ching-Yang Chen
- Division of Radiology, National Defense Medical Center Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, ROC
| | - Chi-Yu Kang
- Department of Aviation Medicine and Physical examination, National Defense Medical Center Tri-Service General Hospital Songshan Branch, Taipei, Taiwan, ROC
| | - Chih-Chien Wang
- Department of Orthopedics, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Chin Lin
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Jia-Hwa Yang
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Wen Su
- Department of Nursing, Chang Gung University of Science and Technology, Taoyuan, Taiwan, ROC
| | - SenYeong Kao
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
| | - Sui-Lung Su
- School of Public Health, National Defense Medical Center, Taipei, Taiwan, ROC
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1016
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Visser AW, de Mutsert R, Bloem JL, Reijnierse M, Kazato H, le Cessie S, den Heijer M, Rosendaal FR, Kloppenburg M. Do knee osteoarthritis and fat-free mass interact in their impact on health-related quality of life in men? Results from a population-based cohort. Arthritis Care Res (Hoboken) 2015; 67:981-8. [PMID: 25604852 DOI: 10.1002/acr.22550] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2014] [Revised: 12/23/2014] [Accepted: 01/13/2015] [Indexed: 12/25/2022]
Abstract
OBJECTIVE To investigate whether obesity and other risk factors interact with knee osteoarthritis (OA) in its adverse impact on health-related quality of life (HRQOL). METHODS In 1,262 participants of the Netherlands Epidemiology of Obesity Study, a population-based cohort (age 45-65 years, 53% women, and median body mass index [BMI] 27 kg/m(2) ), knee OA was defined following modified American College of Rheumatology criteria. BMI and fat-free mass (as proxy for muscle mass) were assessed by bioelectrical impedance analysis, and comorbidities by self-report. HRQOL was assessed using the Short Form 36 physical component summary (PCS) score. Linear regression analyses were performed to examine associations between knee OA and PCS score, adjusting for age and sex and stratified for BMI, fat-free mass, and comorbidities. RESULTS Knee OA (prevalence 16%) was associated with a 7.2-points lower PCS score (95% confidence interval -9.5, -4.8). PCS score was also negatively associated with obesity and comorbidities; however, no interaction with knee OA was seen. Low fat-free mass was associated with a lower PCS score and interacted with knee OA in men. Interaction between concurring OA and low fat-free mass attributed to 64% of the decrease in PCS score, as compared with men without OA and with high fat-free mass. CONCLUSION Knee OA was associated with a lower HRQOL, as were its risk factors, obesity, comorbidities, and low fat-free mass. In men, fat-free mass interacted with knee OA, leading to an additional decrease of HRQOL in the case of concurrence. Especially in the former, improvement of fat-free mass may improve HRQOL in knee OA patients.
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Affiliation(s)
| | | | | | | | - Hanako Kazato
- Leiden University Medical Center, Leiden, The Netherlands
| | | | - Martin den Heijer
- Leiden University Medical Center, Leiden, and Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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1017
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Waller A, Forshaw K, Carey M, Robinson S, Kerridge R, Proietto A, Sanson-Fisher R. Optimizing Patient Preparation and Surgical Experience Using eHealth Technology. JMIR Med Inform 2015; 3:e29. [PMID: 26330206 PMCID: PMC4705017 DOI: 10.2196/medinform.4286] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2015] [Revised: 05/07/2015] [Accepted: 07/13/2015] [Indexed: 11/13/2022] Open
Abstract
With population growth and aging, it is expected that the demand for surgical services will increase. However, increased complexity of procedures, time pressures on staff, and the demand for a patient-centered approach continue to challenge a system characterized by finite health care resources. Suboptimal care is reported in each phase of surgical care, from the time of consent to discharge and long-term follow-up. Novel strategies are thus needed to address these challenges to produce effective and sustainable improvements in surgical care across the care pathway. The eHealth programs represent a potential strategy for improving the quality of care delivered across various phases of care, thereby improving patient outcomes. This discussion paper describes (1) the key functions of eHealth programs including information gathering, transfer, and exchange; (2) examples of eHealth programs in overcoming challenges to optimal surgical care across the care pathway; and (3) the potential challenges and future directions for implementing eHealth programs in this setting. The eHealth programs are a promising alternative for collecting patient-reported outcome data, providing access to credible health information and strategies to enable patients to take an active role in their own health care, and promote efficient communication between patients and health care providers. However, additional rigorous intervention studies examining the needs of potential role of eHealth programs in augmenting patients' preparation and recovery from surgery, and subsequent impact on patient outcomes and processes of care are needed to advance the field. Furthermore, evidence for the benefits of eHealth programs in supporting carers and strategies to maximize engagement from end users are needed.
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Affiliation(s)
- Amy Waller
- University of Newcastle & Hunter Medical Research Institute, Health Behaviour Research Group, Callaghan, Australia.
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1018
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Sun AX, Lin H, Beck AM, Kilroy EJ, Tuan RS. Projection Stereolithographic Fabrication of Human Adipose Stem Cell-Incorporated Biodegradable Scaffolds for Cartilage Tissue Engineering. Front Bioeng Biotechnol 2015; 3:115. [PMID: 26347860 PMCID: PMC4539543 DOI: 10.3389/fbioe.2015.00115] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Accepted: 07/28/2015] [Indexed: 01/08/2023] Open
Abstract
The poor self-healing ability of cartilage necessitates the development of methods for cartilage regeneration. Scaffold construction with live stem cell incorporation and subsequent differentiation presents a promising route. Projection stereolithography (PSL) offers high resolution and processing speed as well as the ability to fabricate scaffolds that precisely fit the anatomy of cartilage defects using medical imaging as the design template. We report here the use of a visible-light-based PSL (VL-PSL) system to encapsulate human adipose-derived stem cells (hASCs) into a biodegradable polymer [poly-d,l-lactic acid/polyethylene glycol/poly-d,l-lactic acid (PDLLA-PEG)]/hyaluronic acid (HA) matrix to produce live cell constructs with customized architectures. After fabrication, hASCs showed high viability (84%) and were uniformly distributed throughout the constructs, which possessed high mechanical properties with a compressive modulus of 780 kPa. The hASC-seeded constructs were then cultured in control or TGF-β3-containing chondrogenic medium for up to 28 days. In chondrogenic medium-treated group (TGF-β3 group), hASCs maintained 77% viability and expressed chondrogenic genes Sox9, collagen type II, and aggrecan at 11, 232, and 2.29 × 10(5) fold increases, respectively compared to levels at day 0 in non-chondrogenic medium. The TGF-β3 group also produced a collagen type II and glycosaminoglycan-rich extracellular matrix, detected by immunohistochemistry, Alcian blue staining, and Safranin O staining suggesting robust chondrogenesis within the scaffold. Without chondroinductive addition (Control group), cell viability decreased with time (65% at 28 days) and showed poor cartilage matrix deposition. After 28 days, mechanical strength of the TGF-β3 group remained high at 240 kPa. Thus, the PSL and PDLLA-PEG/HA-based fabrication method using adult stem cells is a promising approach in producing mechanically competent engineered cartilage for joint cartilage resurfacing.
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Affiliation(s)
- Aaron X Sun
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA ; Medical Scientist Training Program, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
| | - Hang Lin
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA
| | - Angela M Beck
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA ; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering , Pittsburgh, PA , USA
| | - Evan J Kilroy
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA ; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering , Pittsburgh, PA , USA
| | - Rocky S Tuan
- Center for Cellular and Molecular Engineering, Department of Orthopaedic Surgery, University of Pittsburgh School of Medicine , Pittsburgh, PA , USA ; Department of Bioengineering, University of Pittsburgh Swanson School of Engineering , Pittsburgh, PA , USA
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1019
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Ma H, Wu W, Yang X, Liu J, Gong Y. Genetic effects of common polymorphisms in estrogen receptor alpha gene on osteoarthritis: a meta-analysis. Int J Clin Exp Med 2015; 8:13446-13454. [PMID: 26550281 PMCID: PMC4612966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2015] [Accepted: 05/28/2015] [Indexed: 06/05/2023]
Abstract
OBJECTIVE The estrogen receptor alpha (ESR1) gene has been implicated in the etiology of osteoarthritis (OA). However, the results are conflicting. We assessed the association of three common ESR1 polymorphisms, rs2234693, rs9340799 and rs2228480, with OA in this meta-analysis. METHODS A comprehensive search was performed to identify related studies. Pooled odds ratio (OR) with 95% confidence interval (CI) was calculated using fixed or random effects model. RESULTS 15 studies (7036 cases and 9669 controls) for rs2234693 polymorphism, 14 studies (3904 cases and 6991 controls) for rs9340799 and 3 studies (331 cases and 619 controls) for rs2228480 polymorphism were identified. The final results indicated that the G allele in ESR1 rs9340799 was associated with decreased OA risk (GG+GA vs. AA: OR=0.878, 95% CI=0.792-0.972, P=0.012; G vs. A: OR=0.902, 95% CI=0.836-0.975, P=0.009). The A allele in rs2228480 might be associated with increased OA risk. But no significant association of rs2234693 polymorphism with OA susceptibility was observed. CONCLUSIONS This meta-analysis indicates rs9340799 and rs2228480 rather than rs2234693 polymorphisms are associated with the incidence of OA. Some stable associations should be further confirmed in future.
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Affiliation(s)
- Hecheng Ma
- Department of Bone and Joint, The First Hospital of Jilin University Changchun 130021, Jilin, China
| | - Weiqian Wu
- Department of Bone and Joint, The First Hospital of Jilin University Changchun 130021, Jilin, China
| | - Xiaodi Yang
- Department of Bone and Joint, The First Hospital of Jilin University Changchun 130021, Jilin, China
| | - Jianguo Liu
- Department of Bone and Joint, The First Hospital of Jilin University Changchun 130021, Jilin, China
| | - Yubao Gong
- Department of Bone and Joint, The First Hospital of Jilin University Changchun 130021, Jilin, China
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1020
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Stearic acid induces proinflammatory cytokine production partly through activation of lactate-HIF1α pathway in chondrocytes. Sci Rep 2015; 5:13092. [PMID: 26271607 PMCID: PMC4536527 DOI: 10.1038/srep13092] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Accepted: 07/17/2015] [Indexed: 12/22/2022] Open
Abstract
The biomechanics stress and chronic inflammation in obesity are causally linked to osteoarthritis. However, the metabolic factors mediating obesity-related osteoarthritis are still obscure. Here we scanned and identified at least two elevated metabolites (stearic acid and lactate) from the plasma of diet-induced obese mice. We found that stearic acid potentiated LDH-a-dependent production of lactate, which further stabilized HIF1α protein and increased VEGF and proinflammatory cytokine expression in primary mouse chondrocytes. Treatment with LDH-a and HIF1α inhibitors notably attenuated stearic acid-or high fat diet-stimulated proinflammatory cytokine production in vitro and in vivo. Furthermore, positive correlation of plasma lactate, cartilage HIF1α and cytokine levels with the body mass index was observed in subjects with osteoarthritis. In conclusion, saturated free fatty acid induced proinflammatory cytokine production partly through activation of a novel lactate-HIF1α pathway in chondrocytes. Our findings hold promise of developing novel clinical strategies for the management of obesity-related diseases such as osteoarthritis.
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1021
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Andrioti D, Kyprianou K, Charalambous G. How much do rheumatologists and orthopaedists doctors' modalities impact the cost of arthritis in Cyprus? BMC Musculoskelet Disord 2015; 16:193. [PMID: 26268588 PMCID: PMC4535390 DOI: 10.1186/s12891-015-0643-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2015] [Accepted: 07/23/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Osteoarthritis is one of the primary causes of long-term functional disability. With an estimated 13.5% prevalence in the general population contributes to a significant financial burden both for patients and healthcare systems. The purpose of this research is to highlight the direct annual cost of the disease to the private healthcare sector of Nicosia. METHODS A questionnaire based on Greek and international research was completed between 10/1/2012 and 11/30/2012, with a sample of 20 doctors specialists in orthopaedics and rheumatology (50% of practising physicians in the private sector). An assessment of the annual cost of medical procedures and tests, pharmacologic therapies (modalities) and supplies per patient followed, based on current costs. Direct costs were assessed through the micro-costing "bottom-up" approach. We isolated and separately priced the original diagnosis, followed by each stage of the disease. RESULTS The cost for the six predominant medical tests to establish a diagnosis and exclude mainly RA such as ESR, CPR, and X-ray as well as a physician's office visit was 150€ per patient. The average direct cost per patient during stages 1, 2 and 3 of the disease was 280.54€, 1,834.64€ and 5,641.72€ annually, respectively, with an annual average of 2,573€ per patient. CONCLUSIONS Even though during the period of the study, the country had not yet established clinical guidelines, the participating physicians followed international practices. Significant rise in the cost in each stage of the disease was found, with additional increases in the following years as a result of the expected increased prevalence of the disease. It is noted here that uninsured patients, as well as those who qualified for free medical care, they seek these services in the private sector, and had to pay out of pocket money for examination and treatment. These patients, thus, contended with a serious financial burden. Therefore, it is important to inform them very extensively regarding evidence-based management of the disease to aid them in coping with this chronic illness.
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Affiliation(s)
- Despena Andrioti
- Centre of Maritime Health and Society, University of Southern Denmark, Niels Bohrs vej 9, 6700, Esbjerg, Denmark.
| | - Kypros Kyprianou
- Fredrick University, 7, Y. Frederickou Str., Pallouriotisa, Nicosia, 1036, Cyprus.
| | - George Charalambous
- Fredrick University, 7, Y. Frederickou Str., Pallouriotisa, Nicosia, 1036, Cyprus.
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1022
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Caramés B, Olmer M, Kiosses WB, Lotz MK. The relationship of autophagy defects to cartilage damage during joint aging in a mouse model. Arthritis Rheumatol 2015; 67:1568-76. [PMID: 25708836 DOI: 10.1002/art.39073] [Citation(s) in RCA: 147] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2014] [Accepted: 02/10/2015] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Aging is a main risk factor for osteo arthritis (OA), the most prevalent musculoskeletal disorder. Defects in autophagy, an essential cellular homeostasis mechanism, have recently been observed in OA articular cartilage. The objectives of this study were to establish the constitutive level of autophagy activation in normal cartilage and to monitor the temporal relationship between changes in autophagy and aging-related degradation of cartilage in a mouse model. METHODS In GFP-LC3-transgenic mice, green fluorescent protein (GFP)-light chain 3 (LC3) is ubiquitously expressed, and the accumulation of GFP puncta, representing autophagosomes, was quantified by confocal microscopy as a measure of autophagy activation. Expression of the autophagy proteins autophagy-related protein 5 (ATG-5) and microtubule-associated protein 1 light chain 3 (LC3) was analyzed by immunohistochemistry. Cartilage cellularity, apoptotic cell death, and cartilage structural damage and changes in synovium and bone were examined by histology and immunohistochemistry. RESULTS Basal autophagy activation was detected in liver and knee articular cartilage from young (6-month-old) mice, with higher levels in cartilage than in liver in the same animals. In 28-month-old mice, there was a statistically significant reduction in the total number of autophagic vesicles per cell (P < 0.01) and in the total area of vesicles per cell (P < 0.01) in the articular cartilage as compared to that from young 6-month-old mice. With increasing age, the expression of ATG-5 and LC3 decreased, and this was followed by a reduction in cartilage cellularity and an increase in the apoptosis marker poly(ADP-ribose) polymerase p85. Cartilage structural damage progressed in an age-dependent manner subsequent to the autophagy changes. CONCLUSION Autophagy is constitutively activated in normal cartilage. This is compromised with aging and precedes cartilage cell death and structural damage.
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Affiliation(s)
- Beatriz Caramés
- The Scripps Research Institute La Jolla California and Instituto de Investigación Biomédica de A Coruña Complexo Hospitalario Universitario de A Coruña SERGAS and Universidade da Coruña, A Coruña, Spain
| | - Merissa Olmer
- The Scripps Research Institute, La Jolla, California
| | | | - Martin K Lotz
- The Scripps Research Institute, La Jolla, California
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1023
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Nemes S, Rolfson O, W-Dahl A, Garellick G, Sundberg M, Kärrholm J, Robertsson O. Historical view and future demand for knee arthroplasty in Sweden. Acta Orthop 2015; 86:426-31. [PMID: 25806653 PMCID: PMC4513596 DOI: 10.3109/17453674.2015.1034608] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND AND PURPOSE The incidence of knee osteoarthritis will most likely increase. We analyzed historical trends in the incidence of knee arthroplasty in Sweden between 1975 and 2013, in order to be able to provide projections of future demand. PATIENTS AND METHODS We obtained information on all knee arthroplasties in Sweden in the period 1975-2013 from the Swedish Knee Arthroplasty Register, and used public domain data from Statistics Sweden on the evolution of and forecasts for the Swedish population. We forecast the incidence, presuming the existence of a maximum incidence. RESULTS We found that the incidence of knee arthroplasty will continue to increase until a projected upper incidence level of about 469 total knee replacements per 10(5) Swedish residents aged 40 years and older is reached around the year 2130. In 2020, the estimated incidence of total knee arthroplasties per 10(5) Swedish residents aged 40 years and older will be 334 (95% prediction interval (PI): 281-374) and in 2030 it will be 382 (PI: 308-441). Using officially forecast population growth data, around 17,500 operations would be expected to be performed in 2020 and around 21,700 would be expected to be performed in 2030. INTERPRETATION Today's levels of knee arthroplasty are well below the expected maximum incidence, and we expect a continued annual increase in the total number of knee arthroplasties performed.
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Affiliation(s)
| | - Ola Rolfson
- The Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg,Harris Orthopaedic Laboratory, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Annette W-Dahl
- The Swedish Knee Arthroplasty Register, Lund,Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Göran Garellick
- The Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Martin Sundberg
- The Swedish Knee Arthroplasty Register, Lund,Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Johan Kärrholm
- The Swedish Hip Arthroplasty Register, Gothenburg,Department of Orthopedics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg
| | - Otto Robertsson
- The Swedish Knee Arthroplasty Register, Lund,Orthopedics, Department of Clinical Sciences, Lund University, Lund, Sweden
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1024
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Abstract
Treatment options for osteoarthritis (OA) beyond pain relief or total knee replacement are very limited. Because of this, attention has shifted to identifying which factors increase the risk of OA in vulnerable populations in order to be able to give recommendations to delay disease onset or to slow disease progression. The gold standard is then to use principles of risk management, first to provide subject-specific estimates of risk and then to find ways of reducing that risk. Population studies of OA risk based on statistical associations do not provide such individually tailored information. Here we argue that mechanistic models of cartilage tissue maintenance and damage coupled to statistical models incorporating model uncertainty, united within the framework of structural reliability analysis, provide an avenue for bridging the disciplines of epidemiology, cell biology, genetics and biomechanics. Such models promise subject-specific OA risk assessment and personalized strategies for mitigating or even avoiding OA. We illustrate the proposed approach with a simple model of cartilage extracellular matrix synthesis and loss regulated by daily physical activity.
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1025
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Golightly YM, Allen KD, Stechuchak KM, Coffman CJ, Keefe FJ. Associations of coping strategies with diary based pain variables among Caucasian and African American patients with osteoarthritis. Int J Behav Med 2015; 22:101-8. [PMID: 24590828 DOI: 10.1007/s12529-013-9365-3] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
PURPOSE The purposes of this study are to examine the associations between pain coping strategies and daily diary-based pain measures and to determine whether these associations differed by race (African American and Caucasian). METHODS Primary care patients from the Durham Veterans Affairs and Duke University Medical Centers (N = 153) with hand, hip, or knee osteoarthritis (OA) completed electronic pain diaries on a one-weekend day and one weekday. The maximum, range (maximum minus minimum pain), and area under the curve (AUC) of joint pain ratings were calculated. Pain coping (Coping Strategies Questionnaire (CSQ) coping attempts, catastrophizing, and praying/hoping subscale scores) was assessed prior to diary entries and at the end of each diary day (total, problem-focused, and emotion-focused scores from Stone and Neale's Daily Coping Inventory). Pearson correlations between pain variables and coping measures were examined. Linear mixed models were fit including age, race, weekend/weekday, study enrollment site, education level, pain medication use, self-rated health, Arthritis Impact Measurement Scales affect and function subscales, and interactions of coping measures with race and weekend day/weekday status. RESULTS Correlations between coping and pain measures were 0.12-0.45. In adjusted models, maximum pain and pain range were associated with all three diary-based coping measures; maximum pain was associated with CSQ coping attempts; and AUC was associated with CSQ praying/hoping. Interactions were not significant. CONCLUSIONS Among participants with OA, pain coping strategies were related to important aspects of the pain experience, particularly pain range and maximum pain. However, race did not modify associations of pain coping strategy use and the pain experience.
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Affiliation(s)
- Yvonne M Golightly
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA,
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1026
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Hou PW, Fu PK, Hsu HC, Hsieh CL. Traditional Chinese medicine in patients with osteoarthritis of the knee. J Tradit Complement Med 2015; 5:182-96. [PMID: 26587390 PMCID: PMC4624358 DOI: 10.1016/j.jtcme.2015.06.002] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 05/14/2015] [Accepted: 06/04/2015] [Indexed: 11/20/2022] Open
Abstract
To evaluate whether the use of traditional Chinese medicine (TCM; 中醫 zhōng yī) influences symptoms or functional outcomes in patients with osteoarthritis (OA) of the knee (膝關節炎 xī guān jié yán). A systematic review of randomized control trials was conducted. Searches for studies in PubMed that were performed between 1965 and August 2013, and retrieved studies were subjected to reference screening. The types of studies included in our review were 1) placebo-based or comparative studies; 2) open label, single-blinded or double-blinded studies; 3) studies evaluating the efficacy of TCM for treating OA of the knee; and 4) studies evaluating only TCM or combination preparations. Trials were conducted with participants over 18 years of age with knee pain and at least three of the following characteristics: 1) an age greater than 50 years; 2) morning stiffness lasting for fewer than 30 min; 3) a crackling or grating sensation; 4) bony tenderness of the knee; 5) bony enlargement of the knee; or 6) no detectable warmth of the joint to the touch. Studies were rated for risk of bias and graded for quality. After screening, 104 studies that satisfied the eligibility requirements were identified, and only 18 randomized control trials were included in the quantitative and qualitative synthesis. Upon review, we found “moderate-quality” evidence of effects from acupuncture (針灸 zhēn jiǔ) on pain, which was measured using a visual analogue scale, and physical function, which was measured using qigong (氣功 qì gōng) with motion. “Low-quality” evidence was found regarding the effects of acupuncture on physical function, and no evidence was found regarding the effects of herbal medicine on pain or physical function. Herbal patches (藥布 yào bù) appeared to affect pain and physical and function, but these effects were not found to be significant. The initial findings included in this review suggest that acupuncture is a promising intervention according to the primary outcome measure, pain, and qigong with motion is an effective method for treating physical function. However, according to the Grades of Recommendation, Assessment, Development, and Evaluation criteria, only moderate-quality evidence was found in these studies. Further rigorous studies are warranted to investigate the application of TCM in treating OA of knee.
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Affiliation(s)
- Pu-Wei Hou
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Pin-Kuei Fu
- Division of Critical Care and Respiratory Therapy, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung 40705, Taiwan
| | - Hsin-Cheng Hsu
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
| | - Ching-Liang Hsieh
- Department of Chinese Medicine, China Medical University Hospital, Taichung 40447, Taiwan
- Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, Taichung 40402, Taiwan
- Corresponding author. Graduate Institute of Integrated Medicine, College of Chinese Medicine, China Medical University, 91 Hsueh-Shih Road, Taichung 40402, Taiwan. Tel.: +886 4 22053366x3500; fax: +886 4 22037690.
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1027
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Runhaar J, Luijsterburg P, Dekker J, Bierma-Zeinstra SMA. Identifying potential working mechanisms behind the positive effects of exercise therapy on pain and function in osteoarthritis; a systematic review. Osteoarthritis Cartilage 2015; 23:1071-82. [PMID: 25865391 DOI: 10.1016/j.joca.2014.12.027] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2014] [Revised: 12/08/2014] [Accepted: 12/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although physical exercise is the commonly recommended for osteoarthritis (OA) patients, the working mechanism behind the positive effects of physical exercise on pain and function is a black box phenomenon. In the present study we aimed to identify possible mediators in the relation between physical exercise and improvements of pain and function in OA patients. DESIGN A systematic search for all studies evaluating the effects of physical exercise in OA patients and select those that additionally reported the change in any physiological factor from pre-to post-exercise. RESULTS In total, 94 studies evaluating 112 intervention groups were included. Most included studies evaluated subjects with solely knee OA (96 out of 112 groups). Based on the measured physiological factors within the included studies, 12 categories of possible mediators were formed. Muscle strength and ROM/flexibility were the most measured categories of possible mediators with 61 and 21 intervention groups measuring one or more physiological factors within these categories, respectively. 60% (31 out of 52) of the studies showed a significant increase in knee extensor muscle strength and 71% (22 out of 31) in knee flexor muscle strength over the intervention period. All 5 studies evaluating extension impairments and 10 out of 12 studies (83%) measuring proprioception found a significant change from pre-to post-intervention. CONCLUSION An increase of upper leg strength, a decrease of extension impairments and improvement in proprioception were identified as possible mediators in the positive association between physical exercise and OA symptoms.
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Affiliation(s)
- J Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - P Luijsterburg
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - J Dekker
- Department of Rehabilitation Medicine and Department of Psychiatry, VU University Medical Center, Amsterdam, The Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands; Department of Orthopedics, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.
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1028
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Buford TW, Fillingim RB, Manini TM, Sibille KT, Vincent KR, Wu SS. Kaatsu training to enhance physical function of older adults with knee osteoarthritis: Design of a randomized controlled trial. Contemp Clin Trials 2015; 43:217-22. [PMID: 26111922 PMCID: PMC4522335 DOI: 10.1016/j.cct.2015.06.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2015] [Revised: 06/18/2015] [Accepted: 06/20/2015] [Indexed: 01/24/2023]
Abstract
As the U.S. population ages, efficacious interventions are needed to manage pain and maintain physical function among older adults with osteoarthritis (OA). Skeletal muscle weakness is a primary contributory factor to pain and functional decline among persons with OA, thus interventions are needed that improve muscle strength. High-load resistance exercise is the best-known method of improving muscle strength; however high-compressive loads commonly induce significant joint pain among persons with OA. Thus interventions with low-compressive loads are needed which improve muscle strength while limiting joint stress. This study is investigating the potential of an innovative training paradigm, known as Kaatsu, for this purpose. Kaatsu involves performing low-load exercise while externally-applied compression partially restricts blood flow to the active skeletal muscle. The objective of this randomized, single-masked pilot trial is to evaluate the efficacy and feasibility of chronic Kaatsu training for improving skeletal muscle strength and physical function among older adults. Participants aged ≥ 60 years with physical limitations and symptomatic knee OA will be randomly assigned to engage in a 3-month intervention of either (1) center-based, moderate-load resistance training, or (2) Kaatsu training matched for overall workload. Study dependent outcomes include the change in 1) knee extensor strength, 2) objective measures of physical function, and 3) subjective measures of physical function and pain. This study will provide novel information regarding the therapeutic potential of Kaatsu training while also informing about the long-term clinical viability of the paradigm by evaluating participant safety, discomfort, and willingness to continually engage in the intervention.
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Affiliation(s)
- Thomas W Buford
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States.
| | - Roger B Fillingim
- Department of Community Dentistry and Behavioral Science, College of Dentistry, University of Florida, Gainesville, FL, United States
| | - Todd M Manini
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Kimberly T Sibille
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Kevin R Vincent
- Department of Orthopaedics and Rehabilitation, College of Medicine, University of Florida, Gainesville, FL, United States
| | - Samuel S Wu
- Department of Biostatistics, Colleges of Public Health & Health Professions and College of Medicine, University of Florida, Gainesville, FL, United States
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1029
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Grip H, Tengman E, Häger CK. Dynamic knee stability estimated by finite helical axis methods during functional performance approximately twenty years after anterior cruciate ligament injury. J Biomech 2015; 48:1906-14. [DOI: 10.1016/j.jbiomech.2015.04.016] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Revised: 04/10/2015] [Accepted: 04/12/2015] [Indexed: 12/14/2022]
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1030
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Hoxha F, Tafaj A, Roshi E, Burazeri G. Distribution of Risk Factors in Male and Female Primary Health Care Patients with Osteoarthritis in Albania. Med Arch 2015; 69:145-8. [PMID: 26261379 PMCID: PMC4500384 DOI: 10.5455/medarh.2015.69.145-148] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2015] [Accepted: 05/18/2015] [Indexed: 11/06/2022] Open
Abstract
Aim: We aimed to describe the distribution of the main risk factors among primary health care users diagnosed with osteoarthritis in Albania, a post-communist country in South Eastern Europe. Methods: Our study involved all individuals who were diagnosed with osteoarthritis over a two-year period (January 2013 – December 2014) in several primary health care centers in Tirana, the Albanian capital. On the whole, during this two-year period, 1179 adult individuals were diagnosed with osteoarthritis (521 men aged 60.1±10.6 years and 658 women aged 58.1±9.6 years). According to the criteria of the American College of Rheumatology, the diagnosis of osteoarthritis was based on the history of the disease, physical examination, laboratory findings and radiological findings. Binary logistic regression was used to assess the sex-differences regarding the major risk factors among individuals diagnosed with osteoarthritis. Results: In multivariable-adjusted logistic regression models, female gender was inversely associated with smoking (OR=0.39, 95%CI=0.27-0.56), alcohol intake (OR=0.08, 95%CI=0.06-0.10), overweight but not obesity (OR=0.65, 95%CI=0.46-0.91 and OR=0.74, 95%CI=0.46-1.18, respectively), weight lifting (OR=0.38, 95%CI=0.22-0.66) and heavy physical exercise (OR=0.69, 95%CI=0.46-1.03). Conversely, female gender was positively related to genetic factors (OR=2.17, 95%CI=1.55-3.04) and preexisting inflammatory diseases (OR=1.53, 95%CI=0.93-2.53). Conclusion: This study offers useful evidence about the distribution of the main risk factors for osteoarthritis in adult individuals diagnosed with osteoarthritis in Albania. This information may support health professionals and decision-makers in Albania for evidence-based health planning and policy formulation in order to control the toll of osteoarthritis in this transitional society.
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Affiliation(s)
| | | | | | - Genc Burazeri
- Department of International Health, School for Public Health and Primary Care (CAPHRI), Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, The Netherlands
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1031
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O'Leary H, Smart KM, Moloney NA, Blake C, Doody CM. Pain sensitisation and the risk of poor outcome following physiotherapy for patients with moderate to severe knee osteoarthritis: protocol for a prospective cohort study. BMJ Open 2015; 5:e007430. [PMID: 26059523 PMCID: PMC4466621 DOI: 10.1136/bmjopen-2014-007430] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
INTRODUCTION Pain is the dominant symptom of knee osteoarthritis (OA), and recent evidence suggests factors outside of local joint pathology, such as pain sensitisation, can contribute significantly to the pain experience. It is unknown how pain sensitisation influences outcomes from commonly employed interventions such as physiotherapy. The aims of this study are, first, to provide a comprehensive description of the somatosensory characteristics of people with pain associated with knee OA. Second, we will investigate if indicators of pain sensitisation in patients with knee osteoarthritis are predictive of non-response to physiotherapy. METHODS AND ANALYSIS This is a multicentre prospective cohort study with 140 participants. Eligible patients with moderate to severe symptomatic knee osteoarthritis will be identified at outpatient orthopaedic and rheumatology clinics. A baseline assessment will provide a comprehensive description of the somatosensory characteristics of each participant by means of clinical examination, quantitative sensory testing, and validated questionnaires measuring pain and functional capacity. Participants will then undergo physiotherapy treatment. The primary outcome will be non-response to physiotherapy on completion of the physiotherapy treatment programme as defined by the Osteoarthritis Research Society International treatment responder criteria. A principal component analysis will identify measures related to pain sensitisation to include in the predictive model. Regression analyses will explore the relationship between responder status and pain sensitisation while accounting for confounders. ETHICS AND DISSEMINATION This study has been approved by St James' Hospital/AMNCH Research Ethics Committee and by the St Vincent's Healthcare Group Ethics and Medical Research Committee. The results will be presented at international conferences and published in a peer review journal. TRIAL REGISTRATION NUMBER NCT02310945.
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Affiliation(s)
- Helen O'Leary
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Keith M Smart
- Physiotherapy Department, St Vincent's University Hospital, Dublin, Ireland
| | - Niamh A Moloney
- Discipline of Physiotherapy, Department of Health Sciences, Macquarie University, Sydney, New South Wales, Australia
| | - Catherine Blake
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
| | - Catherine M Doody
- School of Public Health, Physiotherapy and Population Science, University College Dublin, Dublin, Ireland
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1032
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Mata J, Cabrera S, Sanchís P, Valentí P, Hernández P, Fortuny R, Lirola S, Aguilar JL. Electro-acupuncture for treatment of knee pain from osteoarthritis and the possible endocrinology changes: a study protocol for a randomized controlled trial. Trials 2015; 16:248. [PMID: 26037626 PMCID: PMC4462085 DOI: 10.1186/s13063-015-0766-2] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2014] [Accepted: 05/20/2015] [Indexed: 12/03/2022] Open
Abstract
Background Osteoarthritis of the knee is a major cause of disability among adults. Electro-acupuncture is considered a potentially useful treatment for osteoarthritis. The purpose of this study is to assess the efficacy of electro-acupuncture on pain control, pain perception, plasma cortisol and beta-endorphin levels, patient-perceived quality of life, and pain medication use in patients with chronic knee pain. Methods/design This study is a placebo-controlled, randomized, double-blind, parallel design trial. One hundred sixty out-patients who are more than 50 years old and who have osteoarthritis of the knee will be recruited from the island of Mallorca, Spain. Each participant will be randomly placed into one of two groups: (sham) electro-acupuncture non-insertion technique and real electro-acupuncture. Acupuncture treatments will be the Traditional Chinese Medicine type. The patients will be evaluated after a period of 1 month (with two weekly sessions), 3 months (with one monthly session), 6 months (with one session every 45 days), and 1 year later with follow-up sessions at the end of the study (with one session every 2 months). The primary outcomes will be based on the observed changes from the baseline of the visual analogue scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for pain measured at 12 weeks after the end of treatment. Also to be included in the study are the possible changes in the secondary efficacy variables from baseline as assessed by the Short Form 36 version 2 health survey (patient-perceived quality of life), patient plasma cortisol and beta-endorphin levels at the different treatment stages, the Goldberg Anxiety and Depression Scale, pain medication use, functional capacity and stiffness (WOMAC subscales), and a VAS. These variables will be assessed at 1 month, 3 months, 6 months, and 1 year after study commencement. Discussion The findings from this study will help to determine whether electro-acupuncture is effective for chronic knee pain management in older people and whether electro-acupuncture can deliver results for the improvement of pain relief, stiffness, and disability. The study will therefore be a major step toward understanding the roles of the hypothalamic-pituitary-adrenal axis and the endogenous opioid system in the effectiveness of electro-acupuncture for chronic pain. Trial registration ClinicalTrials.gov identifier NCT02299713 (11 Nov. 2014).
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Affiliation(s)
- Javier Mata
- Anaesthesiology and Clinic Pain Department, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
| | - Sandra Cabrera
- Catalan Institute of Oncology, Germans Trias I Pujol Hospital, Ctra. Del Canyet s/n., 08916, Badalona, Spain.
| | - Pilar Sanchís
- Research Unit, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
| | - Pedro Valentí
- Anaesthesiology and Clinic Pain Department, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
| | - Patricia Hernández
- Anaesthesiology and Clinic Pain Department, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
| | - Regina Fortuny
- Clinical and Haematology Analysis Laboratory, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
| | - Serafin Lirola
- Traumatology Department, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
| | - Jose Luis Aguilar
- Anaesthesiology and Clinic Pain Department, Son Llàtzer Hospital, Ctra. de Manacor kilómetro 4, 07198, Palma de Mallorca, Spain.
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1033
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Abstract
Epidemiological evidence points strongly to a hazard of hip osteoarthritis from heavy manual work. Harmful exposures may be reduced by the elimination or redesign of processes and the use of mechanical aids. Reducing obesity might help to protect workers whose need to perform heavy lifting cannot be eliminated. Particularly high relative risks have been reported in farmers, and hip osteoarthritis is a prescribed occupational disease in the UK for long-term employees in agriculture. Even where it is not attributable to employment, hip osteoarthritis impacts importantly on the capacity to work. Factors that may influence work participation include the severity of disease, the physical demands of the job, age and the size of the employer. Published research does not provide a strong guide to the timing of return to work following hip arthroplasty for osteoarthritis, and it is unclear whether patients should avoid heavy manual tasks in their future employment.
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Affiliation(s)
- E Clare Harris
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - David Coggon
- Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK.
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1034
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Fischenich KM, Lewis J, Kindsfater KA, Bailey TS, Haut Donahue TL. Effects of degeneration on the compressive and tensile properties of human meniscus. J Biomech 2015; 48:1407-11. [DOI: 10.1016/j.jbiomech.2015.02.042] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2015] [Accepted: 02/17/2015] [Indexed: 01/03/2023]
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1035
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Eftekharsadat B, Babaei-Ghazani A, Habibzadeh A, Kolahi B. Efficacy of action potential simulation and interferential therapy in the rehabilitation of patients with knee osteoarthritis. Ther Adv Musculoskelet Dis 2015; 7:67-75. [PMID: 26029268 DOI: 10.1177/1759720x15575724] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE Knee osteoarthritis (OA) is the main cause of pain, physical impairment and chronic disability in older people. Electrotherapeutic modalities such as interferential therapy (IFT) and action potential simulation (APS) are used for the treatment of knee OA. In this study, we aim to evaluate the therapeutic effects of APS and IFT on knee OA. METHODS In this randomized clinical trial, 67 patients (94% female and 6% male with mean age of 52.80 ± 8.16 years) with mild and moderate knee OA were randomly assigned to be treated with APS (n = 34) or IFT (n = 33) for 10 sessions in 4 weeks. Baseline and post-treatment Western Ontario and McMaster Universities Osteoarthritis (WOMAC) subscales, visual analogue scale (VAS) and timed up and go (TUG) test were measured in all patients. RESULTS VAS and WOMAC subscales were significantly improved after treatment in APS and IFT groups (p < 0.001 for all). TUG was also significantly improved after treatment in APS group (p < 0.001), but TUG changes in IFT was not significant (p = 0.09). There was no significant difference in VAS, TUG and WOMAC subscales values before and after treatment as well as the mean improvement in VAS, TUG and WOMAC subscales during study between groups. CONCLUSION Short-term treatment with both APS and IFT could significantly reduce pain and improve physical function in patients with knee OA.
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Affiliation(s)
- Bina Eftekharsadat
- Physical Medicine and Rehabilitation Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Arash Babaei-Ghazani
- Department of Physical Medicine and Rehabilitation, Iran University of Medical Sciences, Firozgar Hospital, Valiasr square, Tehran 1593748711, Iran
| | - Afshin Habibzadeh
- Medical Education Research Center, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Babak Kolahi
- Physical Medicine and Rehabilitation Specialist, Tabriz University of Medical Sciences, Tabriz, Iran
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1036
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Xu L, Li Z, Liu SY, Xu SY, Ni GX. Asporin and osteoarthritis. Osteoarthritis Cartilage 2015; 23:933-9. [PMID: 25689697 DOI: 10.1016/j.joca.2015.02.011] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/05/2015] [Accepted: 02/08/2015] [Indexed: 02/08/2023]
Abstract
OBJECTIVE To provide an overview of the literature describing the role of asporin, a small leucine-rich proteoglycan (SLRP), in osteoarthritis (OA). METHOD A literature search was performed and reviewed using the narrative approach. RESULTS As a class I SLRP member, asporin, is distinct from other SLRPs. Accumulating evidence demonstrates the involvement of asporin in OA pathogenesis. Many human studies have been conducted to explore the association between the D-repeat polymorphisms and OA susceptibility, but these yield inconsistent results. Possible mechanisms for the involvement of asporin in OA pathology include its influence on TGF-β (transforming growth factor-β) signaling pathways and collagen mineralization. To date, no studies were found to use an asporin-deficient animal model that would help to understand disease mechanisms. Many issues must be addressed to clarify the link between asporin and OA to provide a novel therapeutic strategy for OA, perhaps through controlling and modifying the TGF-β-ECM system. CONCLUSIONS Studies examined demonstrate the involvement of asporin in OA pathogenesis, and possible mechanisms by which asporin may be involved in this process have been proposed. However, large-scale interracial studies should be conducted to investigate the association between asporin and OA, and further investigations are needed to obtain a better understanding of the disease mechanism, develop novel therapeutic strategies, and explore new approaches for diagnosis of OA.
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Affiliation(s)
- L Xu
- Department of Orthopeadics and Traumatology, Nanfang Hospital, Southern Medical University, China
| | - Z Li
- Department of Orthopeadics and Traumatology, Nanfang Hospital, Southern Medical University, China
| | - S-Y Liu
- Department of Orthopeadics and Traumatology, Nanfang Hospital, Southern Medical University, China
| | - S-Y Xu
- Department of Orthopeadics and Traumatology, Nanfang Hospital, Southern Medical University, China
| | - G-X Ni
- Department of Orthopeadics and Traumatology, Nanfang Hospital, Southern Medical University, China.
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1037
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Bolon B, Grisanti M, Villasenor K, Morony S, Feige U, Simonet WS. Generalized Degenerative Joint Disease in Osteoprotegerin (Opg) Null Mutant Mice. Vet Pathol 2015; 52:873-82. [PMID: 26018435 DOI: 10.1177/0300985815586221] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Bone structure is modulated by the interaction between receptor activator of nuclear factor-κB (RANK) and RANK ligand (RANKL). Osteoprotegerin (OPG), a decoy receptor for RANKL, modifies osteoclast-mediated bone resorption directly and spares articular cartilage indirectly in rodents with immune-mediated arthritis by preventing subchondral bone destruction. The OPG/RANKL balance also seems to be critical in maintaining joint integrity in osteoarthritis, a condition featuring articular bone and cartilage damage in the absence of profound inflammation. The current study explored the role of OPG in sparing articular cartilage by evaluating joint lesions in adult C57BL/6J mice lacking osteoprotegerin (Opg (-) (/-)). At 3, 5, 7, 9, and 12 months of age, both sexes of Opg (-) (/-) mice developed severe degenerative joint disease (DJD) characterized by progressive loss of cartilage matrix and eventually articular cartilage. Lesions developed earlier and more severely in Opg (-) (/-) mice relative to age-matched, wild-type (Opg (+) (/+)), or heterozygous (Opg (+) (/-)) littermates (P ≤ .05). The femorotibial joint was affected bilaterally at 3 months, while other key weight-bearing diarthrodial joints (eg, coxofemoral, scapulohumeral, humeroradioulnar) were affected later and unilaterally. Cortical bone in subchondral plates and long bone diaphyses of Opg (-) (/-) mice but not Opg (+/+) or Opg (+) (/-) animals was osteoporotic by 3 months of age (P ≤ .05); the extent of porosity was less than the degree of DJD. Closure of the physes in long bones (P ≤ .05) and cartilage retention in the femoral primary spongiosa (P ≤ .05) affected chiefly Opg (-) (/-) mice. These data suggest that OPG plays an essential direct role in maintaining cartilage integrity in the articular surfaces and physes.
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Affiliation(s)
- B Bolon
- The Ohio State University, Columbus, OH, USA
| | | | | | - S Morony
- Amgen, Inc., Thousand Oaks, CA, USA
| | - U Feige
- EUROCBI GmbH, Benglen, Zurich, Switzerland
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1038
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Boris Chan PM, Zhu L, Wen CY, Chiu KY. Subchondral bone proteomics in osteoarthritis: Current status and perspectives. J Orthop Translat 2015; 3:71-77. [PMID: 30035042 PMCID: PMC5982390 DOI: 10.1016/j.jot.2015.02.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2014] [Revised: 02/11/2015] [Accepted: 02/16/2015] [Indexed: 12/11/2022] Open
Abstract
Osteoarthritis (OA) is the most common degenerative joint disorder. OA was conceived as a “wear and tear” problem of articular cartilage, yet there is a lack of treatment options to delay or rescue articular cartilage degeneration once it is established. Actually, the degradation of articular cartilage is related to a complex network of biochemical pathways involving the diffusion of catabolic factors within and between different joint tissues and particularly bone and cartilage. Advanced proteomics technology provides a powerful tool to allow us to build up a library of such factors. Factors that govern the bone-cartilage interplay could be the candidate diagnostic biomarkers and therapeutic targets for OA. Currently, a growing body of proteomic studies has been done to unveil a number of inflammatory cytokines, proteases, and cartilaginous matrix cleavages in the blood serum, synovial fluid, and articular cartilage from OA patients. Little information is available regarding the protein profiles of disturbances at subchondral bone in the pathophysiology of OA. The technical difficulties in protein extraction from tissues particularly bone and quantitative analyses of protein profile are discussed; cellular proteomics of the defective osteoblasts and secretomics for the osteoblasts–chondrocytes crosstalk are proposed to supplement the information obtained from the bone tissue proteomics.
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Affiliation(s)
- Pok Man Boris Chan
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, Hong Kong, China
| | - Lin Zhu
- Department of Chemistry, The University of Hong Kong, Pokfulam, Hong Kong, China
| | - Chun Yi Wen
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, Hong Kong, China
- Corresponding authors. Department of Orthopaedics and Traumatology, L9-12, Lab Block, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong, China.
| | - Kwong Yuen Chiu
- Department of Orthopaedics and Traumatology, Li Ka Shing Faculty of Medicine, Hong Kong, China
- Corresponding authors. Department of Orthopaedics and Traumatology, L9-12, Lab Block, Li Ka Shing Faculty of Medicine Building, 21 Sassoon Road, Pokfulam, Hong Kong, China.
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1039
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The role of adipocytokines in the pathogenesis of knee joint osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2015; 39:1211-7. [PMID: 25716111 DOI: 10.1007/s00264-015-2707-9] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/23/2014] [Accepted: 02/07/2015] [Indexed: 01/03/2023]
Abstract
Osteoarthritis (OA) is one of the most common causes of musculoskeletal disability in the world. Traditionally, it has been thought that obesity contributes to the development and progression of OA by increased mechanical load of the joint structures. Nevertheless, studies have shown that adipose tissue-derived cytokines (adipocytokines) are a possible link between obesity and OA. Furthermore, according to recent findings, not only articular cartilage may be the main target of these cytokines but also the synovial membrane, subchondral bone and infrapatellar fat pad may be encompassed in the process of degradation. This review presents the most recent reports on the contribution of adipocytokines to the knee joint cartilage degradation, osteophyte formation, infrapatellar fat pad alterations and synovitis.
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1040
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Wright EA, Katz JN, Abrams S, Solomon DH, Losina E. Trends in prescription of opioids from 2003-2009 in persons with knee osteoarthritis. Arthritis Care Res (Hoboken) 2015; 66:1489-95. [PMID: 24782079 DOI: 10.1002/acr.22360] [Citation(s) in RCA: 114] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 04/22/2014] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) of the knee is a painful condition affecting ∼13% of persons ages >65 years. We sought to examine whether the use of opioids in older persons with OA has increased over the past decade and what patient characteristics may correlate with their use. METHODS We assembled national cohorts of individuals with knee OA using data from the 2003, 2006, and 2009 waves of the Medicare Current Beneficiary Survey. The survey data contained information on demographics, health status, and prescribed medications linked to Medicare claims. We used multivariate logistic regression to establish whether opioid use changed over time and to identify factors associated with greater opioid use. The outcome was defined as receiving ≥1 opioid prescription in the study year. RESULTS The mean age and sex were similar across years (77 years and 69% women, respectively). There was a significant increase in opioid prescribing between 2003 and 2009, with 31% of patients receiving opioids in 2003, 39% in 2006, and 40% in 2009 (odds ratio [OR] 1.5, 95% confidence interval [95% CI] 1.1-2.0 for 2006 and 2009 compared with 2003). Independent correlates of opioid use across time periods included female sex (OR 1.5, 95% CI 1.2-2.0), functional limitation (OR 2.1, 95% CI 1.6-2.7), poor self-reported health status (OR 1.6, 95% CI 1.2-2.0), chronic obstructive pulmonary disease (OR 1.4, 95% CI 1.0-1.8), and musculoskeletal disease besides OA (OR 1.9, 95% CI 1.2-2.8). CONCLUSION As the prevalence and incidence of knee OA continues to increase, the public health impact of greater opioid use should be monitored carefully.
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Affiliation(s)
- Elizabeth A Wright
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
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1041
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Rufino AT, Ribeiro M, Sousa C, Judas F, Salgueiro L, Cavaleiro C, Mendes AF. Evaluation of the anti-inflammatory, anti-catabolic and pro-anabolic effects of E-caryophyllene, myrcene and limonene in a cell model of osteoarthritis. Eur J Pharmacol 2015; 750:141-50. [PMID: 25622554 DOI: 10.1016/j.ejphar.2015.01.018] [Citation(s) in RCA: 108] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Revised: 01/14/2015] [Accepted: 01/16/2015] [Indexed: 11/26/2022]
Abstract
Osteoarthritis is a progressive joint disease and a major cause of disability for which no curative therapies are yet available. To identify compounds with potential anti-osteoarthritic properties, in this study, we screened one sesquiterpene, E-caryophyllene, and two monoterpenes, myrcene and limonene, hydrocarbon compounds for anti-inflammatory, anti-catabolic and pro-anabolic activities in human chondrocytes. At non-cytotoxic concentrations, myrcene and limonene inhibited IL-1β-induced nitric oxide production (IC50=37.3μg/ml and 85.3µg/ml, respectively), but E-caryophyllene was inactive. Myrcene, and limonene to a lesser extent, also decreased IL-1β-induced NF-κB, JNK and p38 activation and the expression of inflammatory (iNOS) and catabolic (MMP-1 and MMP-13) genes, while increasing the expression of anti-catabolic genes (TIMP-1 and -3 by myrcene and TIMP-1 by limonene). Limonene increased ERK1/2 activation by 30%, while myrcene decreased it by 26%, relative to IL-1β-treated cells. None of the compounds tested was able to increase the expression of cartilage matrix-specific genes (collagen II and aggrecan), but both compounds prevented the increased expression of the non-cartilage specific, collagen I, induced by IL-1β. These data show that myrcene has significant anti-inflammatory and anti-catabolic effects in human chondrocytes and, thus, its ability to halt or, at least, slow down cartilage destruction and osteoarthritis progression warrants further investigation.
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Affiliation(s)
- Ana Teresa Rufino
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Madalena Ribeiro
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Cátia Sousa
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Fernando Judas
- Orthopedics Department and Bone Bank, University and Hospital Center of Coimbra, Coimbra, Portugal; Faculty of Medicine, University of Coimbra, Coimbra, Portugal.
| | - Lígia Salgueiro
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Centro de Estudos Farmacêuticos, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Carlos Cavaleiro
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Centro de Estudos Farmacêuticos, Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
| | - Alexandrina Ferreira Mendes
- Centre for Neuroscience and Cell Biology, University of Coimbra, Coimbra, Portugal; Faculty of Pharmacy, University of Coimbra, Coimbra, Portugal.
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1042
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Semanik PA, Lee J, Song J, Chang RW, Sohn MW, Ehrlich-Jones LS, Ainsworth BE, Nevitt MM, Kwoh CK, Dunlop DD. Accelerometer-monitored sedentary behavior and observed physical function loss. Am J Public Health 2015; 105:560-6. [PMID: 25602883 DOI: 10.2105/ajph.2014.302270] [Citation(s) in RCA: 59] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined whether objectively measured sedentary behavior is related to subsequent functional loss among community-dwelling adults with or at high risk for knee osteoarthritis. METHODS We analyzed longitudinal data (2008-2012) from 1659 Osteoarthritis Initiative participants aged 49 to 83 years in 4 cities. Baseline sedentary time was assessed by accelerometer monitoring. Functional loss (gait speed and chair stand testing) was regressed on baseline sedentary time and covariates (baseline function; socioeconomics [age, gender, race/ethnicity, income, education], health factors [obesity, depression, comorbidities, knee symptoms, knee osteoarthritis severity, prior knee injury, other lower extremity pain, smoking], and moderate-to-vigorous activity). RESULTS This cohort spent almost two thirds of their waking hours (average=9.8 h) in sedentary behaviors. Sedentary time was significantly positively associated with subsequent functional loss in both gait speed (-1.66 ft/min decrease per 10% increment sedentary percentage waking hours) and chair stand rate (-0.75 repetitions/min decrease), controlling for covariates. CONCLUSIONS Being less sedentary was related to less future decline in function, independent of time spent in moderate-to-vigorous activity. Both limiting sedentary activities and promoting physical activity in adults with knee osteoarthritis may be important in maintaining function.
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Affiliation(s)
- Pamela A Semanik
- Pamela A. Semanik is with the College of Nursing, Rush University, Chicago, IL. Barbara E. Ainsworth is with the School of Nutrition and Health Promotion, College of Health Solutions, Phoenix, Arizona. Jungwha Lee, Jing Song, Rowland W. Chang, and Dorothy D. Dunlop are with the Feinberg School of Medicine, Northwestern University, Chicago. Min-Woong Sohn is with the School of Medicine, University of Virginia, Charlottesville. Linda S. Ehrlich-Jones is with the Center for Rehabilitation Outcome Research, Rehabilitation Institute of Chicago. Michael M. Nevitt is with the Coordinating Center, University of California, San Francisco. C. Kent Kwoh is with University of Arizona Medical Center, Tucson
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1043
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Trueba Davalillo CÁ, Trueba Vasavilbaso C, Navarrete Álvarez JM, Coronel Granado P, García Jiménez OA, Gimeno Del Sol M, Gil Orbezo F. Clinical efficacy of intra-articular injections in knee osteoarthritis: a prospective randomized study comparing hyaluronic acid and betamethasone. Open Access Rheumatol 2015; 7:9-18. [PMID: 27790040 PMCID: PMC5045121 DOI: 10.2147/oarrr.s74553] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Osteoarthritis (OA) is the most common joint disease and leading cause of disability. Intra-articular (IA) administration of hyaluronic acid (HA) or corticosteroids (CS) have been previously studied, though using insufficient number of patients or short follow-up periods. Objective We evaluate HA and CS in patients with knee OA in terms of clinical efficacy over 12 months. Methods We used a prospective, randomized study with parallel groups. Randomized patients received IA injections of HA or betamethasone (BM). The primary outcomes were improvement in pain using Visual Analog Scale and function in the Western Ontario and McMaster University Osteoarthritis Index (Likert scale). Follow-up visits were scheduled at 3 months, 6 months, 9 months, and 12 months. Results A total of 200 patients were included. Pain was significantly reduced in both groups at the first follow-ups. At 12 months, the mean pain reduction in the HA group was 33.6% (95% CI: 31.1–36.1) compared to 8.2% (95% CI: 5.2–11.1) in BM (P<0.0001). Function improvement was higher in HA through every visit, and mean improvement at 12 months was 47.5% (95% CI: 45.6–49.3) in HA patients vs 13.2% (95% CI: 11.4–14.9) in the BM group (P<0.0001). All patients from both groups achieved the Minimal Clinically Important Improvement (MCII) for both pain and function up to 6 months. At 9 months and 12 months, the MCII figures were higher in HA group with ≥80% compared to ≤10% in BM group (P<0.0001). Adverse reactions were rare and related to the administration procedure. Conclusion Both treatments effectively controlled OA symptoms. BM showed higher short-term effectiveness, while HA showed better long-term effectiveness, maintaining clinical efficacy in a large number of patients 1 year after administration.
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Affiliation(s)
| | | | | | | | | | | | - Félix Gil Orbezo
- Orthopedic service, Hospital Español de México, México DF, Mexico
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1044
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Pickering ME, Chapurlat R, Kocher L, Peter-Derex L. Sleep Disturbances and Osteoarthritis. Pain Pract 2015; 16:237-44. [PMID: 25639339 DOI: 10.1111/papr.12271] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2014] [Revised: 10/06/2014] [Accepted: 11/02/2014] [Indexed: 02/06/2023]
Abstract
Sleep disturbances are particularly troublesome in patients with painful rheumatic disease. This article reviews the literature specifically published on sleep disturbances in osteoarthritis, a prevalent pathology and leading cause of disability. Several aspects of the relationship between sleep and osteoarthritis are discussed, including epidemiology, pathophysiological hypotheses, and treatment outcomes. Sleep is of central importance in the well-being of patients and should systematically be assessed in patients with osteoarthritis. When needed, a specific treatment of sleep disorders should be associated with an optimal management of pain to achieve synergistic improvements in quality of life. More large-scale studies are needed to identify predictive factors of sleep impairment in osteoarthritis.
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Affiliation(s)
| | - Roland Chapurlat
- Rheumatology Department, Hôpital E Herriot, Lyon, France.,Clinical Research, INSERM UMR 1033, Lyon, France.,University Lyon 1, Lyon, France
| | - Laurence Kocher
- Neurology and Sleep Department, Hôpital Lyon Sud, Lyon, France
| | - Laure Peter-Derex
- University Lyon 1, Lyon, France.,Neurology and Sleep Department, Hôpital Lyon Sud, Lyon, France.,"Neuropain" Team, INSERM U1028/5292, Centre de Recherche en Neurosciences, Lyon, France
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1045
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Men with Early Degrees of Knee Osteoarthritis Present Functional and Morphological Impairments of the Quadriceps Femoris Muscle. Am J Phys Med Rehabil 2015; 94:70-81. [DOI: 10.1097/phm.0000000000000143] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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1046
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Abstract
Osteoarthritis (OA) is a common degenerative joint disease, the pathological mechanism of which is currently unknown. Genetic alteration is one of the key contributing factors for OA pathology. Recent evidence suggests that epigenetic and microRNA regulation of critical genes may contribute to OA development. In this article, we review the epigenetic and microRNA regulations of genes related to OA development. Potential therapeutic strategies may be developed on the basis of novel findings.
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Affiliation(s)
- Di Chen
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, 60612, USA
| | - Jie Shen
- Department of Orthopedic Surgery, Washington University, St. Louis, MO, 63110, USA
| | - Tianqian Hui
- Department of Biochemistry, Rush University Medical Center, Chicago, IL, 60612, USA
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1047
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Menz H, Roddy E, Marshall M, Thomas M, Rathod T, Myers H, Thomas E, Peat G. Demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis: cross-sectional findings from the Clinical Assessment Study of the Foot. Osteoarthritis Cartilage 2015; 23:77-82. [PMID: 25450852 PMCID: PMC4291455 DOI: 10.1016/j.joca.2014.10.007] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 07/30/2014] [Accepted: 10/19/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To explore demographic and clinical factors associated with radiographic severity of first metatarsophalangeal joint osteoarthritis (OA) (First MTPJ OA). DESIGN Adults aged ≥50 years registered with four general practices were mailed a Health Survey. Responders reporting foot pain within the last 12 months were invited to undergo a clinical assessment and weight-bearing dorso-plantar and lateral radiographs of both feet. Radiographic first MTPJ OA in the most severely affected foot was graded into four categories using a validated atlas. Differences in selected demographic and clinical factors were explored across the four radiographic severity subgroups using analysis of variance (ANOVA) and ordinal regression. RESULTS Clinical and radiographic data were available from 517 participants, categorised as having no (n = 105), mild (n = 228), moderate (n = 122) or severe (n = 62) first MTPJ OA. Increased radiographic severity was associated with older age and lower educational attainment. After adjusting for age, increased radiographic first MTPJ OA severity was significantly associated with an increased prevalence of dorsal hallux and first MTPJ pain, hallux valgus, first interphalangeal joint (IPJ) hyperextension, keratotic lesions on the dorsal aspect of the hallux and first MTPJ, decreased first MTPJ dorsiflexion, ankle/subtalar joint eversion and ankle joint dorsiflexion range of motion, and a trend towards a more pronated foot posture. CONCLUSIONS This cross-sectional study has identified several dose-response associations between radiographic severity of first MTPJ OA and a range of demographic and clinical factors. These findings highlight the progressive nature of first MTPJ OA and provide insights into the spectrum of presentation of the condition in clinical practice.
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Affiliation(s)
- H.B. Menz
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom,Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia,Address correspondence and reprint requests to: H.B. Menz, Lower Extremity and Gait Studies Program, School of Allied Health, La Trobe University, Bundoora, Victoria 3086, Australia. Tel: 61-(3)-9479-5801; Fax: 61-(3)-9479-5415.
| | - E. Roddy
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - M. Marshall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - M.J. Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - T. Rathod
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - H. Myers
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - E. Thomas
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
| | - G.M. Peat
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences, Keele University, Keele, Staffordshire, ST5 5BG, United Kingdom
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1048
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Karlsson MK, Karlsson C, Magnusson H, Cöster M, von Schewelov T, Nilsson JÅ, Brudin L, Rosengren BE. Individuals with primary osteoarthritis have different phenotypes depending on the affected joint - a case control study from southern sweden including 514 participants. Open Orthop J 2014; 8:450-6. [PMID: 25614774 PMCID: PMC4298037 DOI: 10.2174/1874325001408010450] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 11/06/2014] [Accepted: 11/13/2014] [Indexed: 01/28/2023] Open
Abstract
Objective: The aim of this study was to evaluate whether primary osteoarthritis (OA), independent of affected joint, is associated with a phenotype that is different from the phenotype in a normative cohort.
Material and Methods: We included 274 patients with primary OA, 30 women and 32 men (mean age 66 years, range 42-84) with primary hip OA, 38 women and 74 men (mean age 61 years; range 34-85) with primary knee OA, 42 women and 19 men (men age 64 years, range 42-87) with primary ankle or foot OA and 20 women and 19 men (mean age 66 years, range 47-88) with primary hand or finger OA. Of all patients included with OA, 23% had hip OA, 41% knee OA, 22% ankle or foot OA and 14% hand or finger OA. Serving as references were 122 women and 118 men of the same ages who were population-based, included as a control cohort. We measured total body BMD (g/cm2) and proportion of fat and lean mass (%) with dual energy X-ray absorptiometry. Height, weight and BMI (kg/m2) were also assessed. We then calculated Z-scores (number of standard deviations difference from the mean value of the control cohort) in the OA patients and compared these between the groups.
Results: Individuals with hand OA and controls had similar phenotype. Individuals with lower extremity OA, irrespective of the affected joint, had similar weight, BMI and BMD, but higher than in individuals with hand OA and controls (all p<0.05). Individuals with lower extremity OA had higher fat and lower lean mass than individuals with hand OA and controls (all p<0.001).
Conclusion: Individuals with primary OA in the lower extremity have a phenotype with higher BMD, higher BMI, proportionally higher fat content and lower lean body mass content. The different skeletal phenotypes in our patients with OA in the lower extremity and patients with hand OA indicate that separate pathophysiologic pathways may be responsible for primary OA in different joints
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Affiliation(s)
- Magnus K Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Caroline Karlsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Håkan Magnusson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Maria Cöster
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Tord von Schewelov
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Jan Åke Nilsson
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Lars Brudin
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
| | - Björn E Rosengren
- Clinical and Molecular Osteoporosis Research Unit, Departments of Orthopedics and Clinical Sciences, Lund University, Skåne University Hospital, Malmö and Department of Clinical Physiology, Kalmar Hospital, Kalmar, Sweden
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1049
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Brouwer RW, Huizinga MR, Duivenvoorden T, van Raaij TM, Verhagen AP, Bierma-Zeinstra SMA, Verhaar JAN. Osteotomy for treating knee osteoarthritis. Cochrane Database Syst Rev 2014; 2014:CD004019. [PMID: 25503775 PMCID: PMC7173694 DOI: 10.1002/14651858.cd004019.pub4] [Citation(s) in RCA: 64] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND Patients with unicompartmental osteoarthritis of the knee can be treated with an osteotomy. The goal of an osteotomy is to unload the diseased compartment of the knee. This is the second update of the original review published in The Cochrane Library, Issue 1, 2005. OBJECTIVES To assess the benefits and harms of an osteotomy for treating patients with knee osteoarthritis, including the following main outcomes scores: treatment failure, pain and function scores, health-related quality of life, serious adverse events, mortality and reoperation rate. SEARCH METHODS The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE and EMBASE (Current Contents, HealthSTAR) were searched until November 2013 for this second update. SELECTION CRITERIA Randomised and controlled clinical trials comparing an osteotomy with other treatments for patients with unicompartmental osteoarthritis of the knee. DATA COLLECTION AND ANALYSIS Two review authors independently selected trials, extracted data and assessed risk of bias using the domains recommended in the 'Risk of bias' tool of The Cochrane Collaboration. The quality of the results was analysed by performing overall grading of evidence by outcome using the GRADE (Grades of Recommendation, Assessment, Development and Evaluation) approach. MAIN RESULTS Eight new studies were included in this update, for a total of 21 included studies involving 1065 people.In four studies, the randomised sequence was adequately generated and clearly described. In eight studies, allocation concealment was adequately generated and described. In four studies, the blinding procedures were sufficient. In six studies, incomplete outcome data were not adequately addressed. Furthermore, in 11 studies, the selective outcome reporting item was unclear because no study protocol was provided.Follow-up of studies comparing different osteotomy techniques was too short to measure treatment failure, which implicates revision to a knee arthroplasty.Four studies evaluated a closing wedge high tibial osteotomy (CW-HTO) with another high tibial osteotomy (aHTO). Based on these studies, the CW-HTO group had 1.8% (95% confidence interval (CI) -7.7% to 4.2%; low-quality evidence) more pain compared with the aHTO group; this finding was not statistically significant. Pooled function in the CW-HTO group was 0.5% (95% CI -3.8% to 2.8%; low-quality evidence) higher compared with the aHTO group; this finding was not statistically significant. No data on health-related quality of life and mortality were presented.Serious adverse events were reported in only four studies and were not significantly different (low-quality evidence) between groups. The reoperation rate were scored as early hardware removal because of pain and pin track infection due to the external fixator. Risk of reoperation was 2.6 (95% CI 1.5 to 4.5; low-quality evidence) times higher in the aHTO group compared with the CW-HTO group, and this finding was statistically significant.The quality of evidence for most outcomes comparing different osteotomy techniques was downgraded to low because of the numbers of available studies, the numbers of participants and limitations in design.Two studies compared high tibial osteotomy versus unicompartmental knee replacement. Treatment failure and pain and function scores were not different between groups after a mean follow-up of 7.5 years. The osteotomy group reported more adverse events when compared with the unicompartmental knee replacement group, but the difference was not statistically significant. No data on health-related quality of life and mortality were presented.No study compared an osteotomy versus conservative treatment.Ten included studies compared differences in perioperative or postoperative conditions after high tibial osteotomy. In most of these studies, no statistically significant differences in outcomes were noted between groups. AUTHORS' CONCLUSIONS The conclusion of this update did not change: Valgus high tibial osteotomy reduces pain and improves knee function in patients with medial compartmental osteoarthritis of the knee. However, this conclusion is based on within-group comparisons, not on non-operative controls. No evidence suggests differences between different osteotomy techniques. No evidence shows whether an osteotomy is more effective than alternative surgical treatment such as unicompartmental knee replacement or non-operative treatment. So far, the results of this updated review do not justify a conclusion on benefit of specific high tibial osteotomy technique for knee osteoarthritis.
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Affiliation(s)
- Reinoud W Brouwer
- Department of Orthopaedic Surgery,Martini Hospital, PO Box 30033, Groningen, 9700 RM, Netherlands. .
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Brody LT. Knee osteoarthritis: Clinical connections to articular cartilage structure and function. Phys Ther Sport 2014; 16:301-16. [PMID: 25783021 DOI: 10.1016/j.ptsp.2014.12.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 11/26/2014] [Accepted: 12/03/2014] [Indexed: 12/14/2022]
Abstract
Articular cartilage is a unique biphasic material that supports a lifetime of compressive and shear forces across joints. When articular cartilage deteriorates, whether due to injury, wear and tear or normal aging, osteoarthritis and resultant pain can ensue. Understanding the basic science of the structure and biomechanics of articular cartilage can help clinicians guide their patients to appropriate activity and loading choices. The purpose of this article is to examine how articular cartilage structure and mechanics, may interact with risk factors to contribute to OA and how this interaction provides guidelines for intervention choices This paper will review the microstructure of articular cartilage, its mechanical properties and link this information to clinical decision making.
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Affiliation(s)
- Lori Thein Brody
- University of Wisconsin Hospital and Clinics, Research Park Clinic, 621 Science Drive, Madison, WI 53711, USA; Orthopaedic and Sports Science, Rocky Mountain University of Health Professions, 122 East 1700 South, Bldg. C, Provo, UT 84606, USA.
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