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Mendy A, Park J, Vieira ER. Osteoarthritis and risk of mortality in the USA: a population-based cohort study. Int J Epidemiol 2019; 47:1821-1829. [PMID: 30169829 PMCID: PMC7263761 DOI: 10.1093/ije/dyy187] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2018] [Indexed: 12/28/2022] Open
Abstract
Background Osteoarthritis (OA) is the most common joint disease, but its association with mortality is unclear. Methods We analysed data on adult participants in the 1988–94 and 1999–2010 National Health and Nutrition Examination Surveys, followed for mortality through 2011. OA was defined by self-report, and in a subset of participants 60 years or older with knee X-rays, radiographic knee OA (RKOA) was defined as Kellgren–Lawrence score ≥2. Cox proportional hazards were used to determine the mortality hazard ratio (HR) associated with self-reported OA and RKOA, adjusting for covariates. Results The sample included 51 938 participants followed for a median 8.9 years; 2589 of them had knee X-rays and were followed for a median of 13.6 years. Self-reported OA and RKOA prevalences were 6.6% and 40.6%, respectively. Self-reported OA was not associated with mortality. RKOA was associated with an increased risk of mortality from cardiovascular diseases (CVD) {HR 1.43 [95% confidence interval (CI): 1.32, 1.64]}, diabetes [HR 2.04 (1.87, 2.23)] and renal diseases [HR 1.14 (1.04, 1.25)], but with a reduced risk of cancer mortality [HR 0.88 (0.80, 0.96)]. Participants with early RKOA onset (diagnosed before age 40) had a higher risk of mortality from all causes [HR 1.53 (1.43, 1.65)] and from diabetes [HR 7.18 (5.45, 9.45)]. Obese participants with RKOA were at increased risk of mortality from CVD [HR 1.89 (1.56, 2.29)] and from diabetes [HR: 3.42 (3.01, 3.88)]. Conclusions Self-reported OA was not associated with mortality. RKOA was associated with higher CVD, diabetes and renal mortality, especially in people with early onset of the disease or with obesity.
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Affiliation(s)
- Angelico Mendy
- College of Public Health, University of Iowa, Iowa City, IA, USA
| | - JuYoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, FL, USA
| | - Edgar Ramos Vieira
- Department of Physical Therapy, Florida International University, Miami, FL, USA
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202
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Hoglund LT, Folkins E, Pontiggia L, Knapp MW. The Validity, Reliability, Measurement Error, and Minimum Detectable Change of the 30-Second Fast-Paced Walk Test in Persons with Knee Osteoarthritis: A Novel Test of Short-Distance Walking Ability. ACR Open Rheumatol 2019; 1:279-286. [PMID: 31777804 PMCID: PMC6858032 DOI: 10.1002/acr2.1040] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Objective To develop and establish the reliability, validity, measurement error, and minimum detectable change of a novel 30‐second fast‐paced walk test (30SFW) in persons with knee osteoarthritis (OA) that is easy to administer and can quantify walking performance in persons of all abilities. Methods Twenty females with symptomatic knee OA (mean age [SD] 58.30 [8.05] years) and 20 age‐ and sex‐matched asymptomatic controls (57.25 [8.71] years) participated in the study. Participants completed questionnaires of demographic and clinical data, the Knee Injury and Osteoarthritis Outcome Score (KOOS), and the 36‐item Short Form Health Survey (SF‐36) followed by 30SFW performance. Participants returned 2‐7 days later and performed the 30SFW again. Results The knee OA group reported function that was worse than controls (all KOOS subscales; P < 0.0001). The 30SFW intrarater and interrater reliability were excellent [ICC(2,1) = 0.95‐0.99]. Knee OA participants walked a shorter distance in the 30SFW than controls (mean [SD]: OA 44.4 m [9.5 m]; control 58.1 m [7.8 m]; P < 0.0001). Positive strong correlations were found between the 30SFW and the KOOS–Activity of Daily Living, SF‐36‐Physical Functioning, and SF‐36‐Physical Health Composite scores (P < 0.0001). A nonsignificant, weak correlation between 30SFW and SF‐36‐Mental Health scores was present (r = 0.32, P = 0.05). Conclusion The 30SFW has excellent intrarater and interrater reliability. The 30SFW demonstrated excellent known groups, convergent, and discriminant validity as a measure of short‐distance walking ability in persons with knee OA. Clinicians and researchers should consider using the 30SFW to quantify walking ability in persons with knee OA and assess walking ability change.
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Affiliation(s)
| | - Eric Folkins
- University of the Sciences in Philadelphia Philadelphia Pennsylvania
| | - Laura Pontiggia
- University of the Sciences in Philadelphia Philadelphia Pennsylvania
| | - Michael W Knapp
- University of the Sciences in Philadelphia Philadelphia Pennsylvania
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Abstract
BACKGROUND Mortality after THA and TKA is lower than expected for several years after surgery when compared with age- and sex-adjusted population data. With long-term followup (beyond approximately 10 years), some evidence has suggested that this trend reverses, such that postsurgical mortality is higher than expected as more time passes. However, the degree to which this may be the case has not been clearly established. QUESTIONS/PURPOSES In this large-registry study, we asked: What is the long-term mortality after THA and TKA compared with the expected mortality, adjusted for age, sex, and calendar year. METHODS Using data on 243,057 THAs and 363,355 TKAs performed for osteoarthritis from the Australian Orthopaedic Association National Joint Replacement Registry (AOANJRR) from 2003 to 2016, and life tables from the Australian Bureau of Statistics the Standardised Mortality Ratio (SMR), relative mortality and excess mortality (relative to the expected mortality for people of the same sex and age in the same country) was calculated separately for hips and knees. The AOANJRR contains near-complete (98%-100%) data from all hospitals in Australia performing arthroplasty but does not include followup data on people who have left the country. Followup was from the date of surgery to 13 years, mean 5.8 years. RESULTS We found a lower-than-expected mortality for THA and TKA in the early years after surgery. This association diminished over time and the mortality became higher than expected after 12 years for both THA and TKA. For THA, the excess mortality (per thousand people) increased from 11 fewer deaths (95% CI, 10-11 fewer) after 1 year to four more deaths (95% CI, 0-9 more) in the 13th year, and the SMR increased from 0.50 (95% CI, 0.48-0.52) after 1 year to 1.07 (95% CI, 0.99-1.14) in the 13th year. For TKA, the excess mortality (per thousand people) increased from 12 fewer deaths (95% CI, 12-13 fewer) after 1 year to five more deaths (95% CI 2-9 more) in the 13th year, and the SMR increased from 0.39 (95% CI, 0.37-0.40) after 1 year to 1.09 (95% CI, 1.03-1.15) in the 13th year. CONCLUSIONS Mortality after hip and knee arthroplasty is lower than expected (based on population norms) in the first 8 years to 9 years but gradually increases over time, becoming higher than expected after 12 years. The lower-than-expected mortality in the early years after surgery is likely the result of patient selection with patients undergoing primary arthroplasty having better health at the time of surgery than that of the age- and sex-matched population. The increasing mortality over time cannot be regression to the mean, as late mortality is higher than expected, moving beyond the mean. It is important to understand if there are modifiable factors associated with this increased mortality. The reasons for the change are uncertain. Factors to consider in future research include determining the effect of different patient factors on late mortality. Some of these included higher obesity rates for joint replacement patients and the association or causal impact of osteoarthritis and/or its treatment to increase late mortality in a similar manner to other forms of arthritis. There is also a possibility that the arthroplasty device itself may affect late mortality. LEVEL OF EVIDENCE Level III, therapeutic study.
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204
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Turkiewicz A, Kiadaliri AA, Englund M. Cause-specific mortality in osteoarthritis of peripheral joints. Osteoarthritis Cartilage 2019; 27:848-854. [PMID: 30797945 DOI: 10.1016/j.joca.2019.02.793] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Revised: 01/28/2019] [Accepted: 02/07/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To estimate cause-specific mortality in osteoarthritis patients compared to the general population. METHODS We identified all residents in southern Sweden aged 45-84 years in 2003. Through the Skåne Healthcare Register (SHR) we identified those diagnosed with osteoarthritis in peripheral joints between 1998 and 2003. We followed all residents from 2004 until relocation outside of the region, death, or end of 2014. We classified the underlying cause of death from death certificates into: cardiovascular and neoplasms, diabetes, infections, dementia, diseases of digestive system, or other causes. For estimation, we used multi-state adjusted Cox proportional hazards models. RESULTS We identified 15,901 patients (mean age [SD] 67 years [10], 41% men) with prevalent doctor-diagnosed osteoarthritis in knee, 9347 in hip, 4004 in hand and 5447 in other peripheral joints among 469,177 residents. For most causes of death in osteoarthritis patients, we found no increased mortality, with hazard ratios (HRs) close to 1, similar for men and women. However, for knee and hip osteoarthritis and cardiovascular death, HRs were non proportional and increased to 1.19 (95%CI 1.10, 1.28) and 1.13 (1.03, 1.24) during 9-11 years of follow-up, mostly due to excess mortality from chronic ischemic heart diseases and heart failure. CONCLUSIONS The risk of cardiovascular excess deaths increases with duration of knee and hip osteoarthritis. The major contributors are chronic ischemic heart diseases and heart failure. Our results call for improved implementation of osteoarthritis treatment guidelines, with major focus on interventions to address mobility limitations and maintaining or increase physical activity level.
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Affiliation(s)
- A Turkiewicz
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
| | - A A Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
| | - M Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences, Lund, Lund University, Lund, Sweden.
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205
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Clinical characteristics and disability in patients with knee osteoarthritis: real world experience from Bulgaria. Reumatologia 2019; 57:78-84. [PMID: 31130745 PMCID: PMC6532116 DOI: 10.5114/reum.2019.84812] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Accepted: 04/05/2019] [Indexed: 01/04/2023] Open
Abstract
Objectives Although knee osteoarthritis (KOA) is a leading cause of impaired functioning among older adults globally, little is still known about the complex mechanisms of disability accumulation in these patients. The aim of the study was to analyze the clinical parameters of patients with KOA in a Bulgarian population and to determine which of these clinical characteristics define disability to the greatest extent. Material and methods Patients aged 40–80 years with symptomatic KOA were included. The assessment tools for pain, clinical disease severity, and disability were the pain visual analogue scale (VAS) and disease-specific questionnaires: Algofunctional Index of Lequesne, Western Ontario and McMaster Universities OA Index (WOMAC), and the Health Assessment Questionnaire-Disability Index (HAQ-DI), respectively. Radiographs of the knees were obtained and graded according to the Kellgren-Lawrence (KL) system. Results One hundred and thirty-two patients (81% women) participated in the study. The median values of VAS (mm), WOMAC, Lequesne, and HAQ-DI scores were 52, 37.5, 11, 0.88, respectively. Men had milder disease, resulting in lower VAS, WOMAC, Lequesne, and HAQ-DI scores and less structural damage compared to women (p < 0.05). WOMAC index correlated positively with age of the patients but not with duration of the complaints. Patients with severe and very severe pain did not differ in their HAQ-DI, disease severity and KL grading. WOMAC physical function score and Lequesne index were independent predictors for the HAQ-DI in patients with KOA. Conclusions Bulgarian patients with KOA had moderate disability which showed a strong relationship with physical function of WOMAC and disease severity. Multiple layers of causality coexist to determine the knee pain in Bulgarian patients with KOA.
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206
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Hawke LJ, Shields N, Dowsey MM, Choong PFM, Taylor NF. Effectiveness of behavioural interventions on physical activity levels after hip or knee joint replacement: a systematic review. Disabil Rehabil 2019; 42:3573-3580. [PMID: 31067136 DOI: 10.1080/09638288.2019.1603328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Purpose: To evaluate the effect of behavioural interventions on levels of physical activity after hip or knee joint replacement.Materials and methods: A systematic review with meta-analysis of randomised controlled trials to determine the effectiveness of behavioural interventions to increase physical activity levels after hip or knee joint replacement. Six databases were searched. Standardised mean differences (SMD) were calculated. The GRADE approach was used to evaluate the level of evidence of each meta-analysis.Results: From a yield of five trials, physical activity was quantified as active minutes per day, daily energy expenditure and daily steps. There was low to moderate-quality evidence from three meta-analyses with observed positive effects that could not conclude whether behavioural interventions increased physical activity in active minutes per day (SMD = 0.18, 95% CI -0.14, 0.51), daily energy expenditure (SMD = 0.31, 95% CI -0.24, 0.87) or daily steps (MD = 844.7, 95% CI -178.6, 1,868.0).Conclusions: The effectiveness of behavioural interventions to address the low levels of physical activity levels observed after hip or knee joint replacement remains uncertain.Implications for rehabilitationPhysical activity levels after hip or knee joint replacements fail to meet recommended daily activity guidelines, increasing the associated risk of cardiovascular disease and early mortality.Rehabilitation interventions that target behaviour change may have an impact in increasing physical activity levels after hip or knee joint replacement surgery.The optimal type and timing of behavioural interventions to effectively increase physical activity levels in this cohort remains unclear.Rehabilitation professionals are advised to highlight the benefits of meeting physical activity recommendations (150 min of moderate-intensity aerobic physical activity or 75 min of vigorous-intensity aerobic physical activity per week) to people who have undergone hip or knee joint replacement, and that behavioural intervention may support patients to meet these recommendations.
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Affiliation(s)
- Lyndon J Hawke
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
| | - Nora Shields
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia
| | - Michelle M Dowsey
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Australia.,The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Peter F M Choong
- Department of Orthopaedics, St Vincent's Hospital, Melbourne, Australia.,The University of Melbourne Department of Surgery, St. Vincent's Hospital, Melbourne, Australia
| | - Nicholas F Taylor
- School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia.,Allied Health Clinical Research Office, Eastern Health, Box Hill, Australia
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Hurley MV, Semple A, Sibley F, Walker A. Evaluation of a health trainer–led service for people with knee, hip and back pain. Perspect Public Health 2019; 139:308-315. [DOI: 10.1177/1757913919833721] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Aims: Chronic knee, hip and back pain is extremely prevalent. Management guidelines emphasise maintaining physical activity and healthy weight to reduce pain and improve physical and mental wellbeing. Unfortunately, few people receive support to make lifestyle changes. We evaluated whether a health trainer—led ‘joint pain advice’ (JPA) service delivering person-centred lifestyle coaching was feasible, acceptable and effective for people with knee, hip and back pain. Methods: Feasibility of delivering a JPA service was assessed by documenting whether the health trainers could deliver JPA and its uptake. Nine health trainers delivered JPA. Participants were offered up to four appointments. At each appointment, health trainers gave people information about their condition, co-developed care plans, suggested self-management strategies and used behavioural change techniques (motivational interviewing, goal-setting and action planning) to increase physical activity and reduce body weight. Pain, function, physical activity and body mass index (BMI) were collected at baseline, 3 weeks, 6 weeks and 6 months. Focus groups captured people’s opinions of the service’s effectiveness, acceptability and usefulness. Results: Of the 105 people who enquired about JPA, 85 (81%) used the service, after which their physical activity and function improved, and pain, use of analgesia and BMI decreased. They felt more knowledgeable and better motivated to adopt and maintain healthier behaviours. They attributed these improvements to the JPA service, because of its better consultations and collaborative holistic approach. Only a minority attended all four appointments because they felt they received sufficient advice from the initial appointments. The health trainers gained knowledge and skills to support clients with musculoskeletal conditions. Conclusions: Using a holistic, patient-centred approach, health trainers can deliver lifestyle advice to people with chronic knee, hip or back pain safely, effectively and efficiently. The service was popular with recipients and health trainers, and helped people adopt healthier lifestyles that lead to reduced pain and other clinical improvements.
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Affiliation(s)
- MV Hurley
- Musculoskeletal Programme, Health Innovation Network, London, UK
- Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, 6th Floor, Hunter Wing, Cranmer Terrace, London SW17 0RE, UK
| | - A Semple
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - F Sibley
- Musculoskeletal Programme, Health Innovation Network, London, UK
| | - A Walker
- Musculoskeletal Programme, Health Innovation Network, London, UK
- Faculty of Health, Social Care and Education, St George’s University of London and Kingston University, London, UK
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Hindy G, Åkesson KE, Melander O, Aragam KG, Haas ME, Nilsson PM, Kadam UT, Orho-Melander M. Cardiometabolic Polygenic Risk Scores and Osteoarthritis Outcomes: A Mendelian Randomization Study Using Data From the Malmö Diet and Cancer Study and the UK Biobank. Arthritis Rheumatol 2019; 71:925-934. [PMID: 30615301 PMCID: PMC6563114 DOI: 10.1002/art.40812] [Citation(s) in RCA: 33] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2018] [Accepted: 12/13/2018] [Indexed: 12/18/2022]
Abstract
Objective To investigate the causal role of cardiometabolic risk factors in osteoarthritis (OA) using associated genetic variants. Methods We studied 27,691 adults from the Malmö Diet and Cancer Study (MDCS) and replicated novel findings among 376,435 adults from the UK Biobank. Trait‐specific polygenic risk scores for low‐density lipoprotein (LDL) and high‐density lipoprotein (HDL) cholesterol levels, triglyceride levels, body mass index (BMI), fasting plasma glucose (FPG) levels, and systolic blood pressure (BP) were used to test the associations of genetically predicted elevations in each trait with incident OA diagnosis (n = 3,559), OA joint replacement (n = 2,780), or both (total OA; n = 4,226) in Mendelian randomization (MR) analyses in the MDCS, and with self‐reported and/or hospital‐diagnosed OA (n = 65,213) in the UK Biobank. Multivariable MR, MR‐Egger, and weighted median MR were used to adjust for potential pleiotropic biases. Results In the MDCS, genetically predicted elevation in LDL cholesterol level was associated with a lower risk of OA diagnosis (odds ratio [OR] 0.83 [95% confidence interval (95% CI) 0.73–0.95] per 1SD increase) and total OA (OR 0.87 [95% CI 0.78–0.98]), which was supported by multivariable MR for OA diagnosis (OR 0.84 [95% CI 0.75–0.95]) and total OA (0.87 [95% CI 0.78–0.97]), and by conventional 2‐sample MR for OA diagnosis (OR 0.86 [95% CI 0.75–0.98]). MR‐Egger indicated no pleiotropic bias. Genetically predicted elevation in BMI was associated with an increased risk of OA diagnosis (OR 1.65 [95% CI 1.14–2.41]), while MR‐Egger indicated pleiotropic bias and a larger association with OA diagnosis (OR 3.25 [1.26–8.39]), OA joint replacement (OR 3.81 [95% CI 1.39–10.4]), and total OA (OR 3.41 [95% CI 1.43–8.15]). No associations were observed between genetically predicted HDL cholesterol level, triglyceride level, FPG level, or systolic BP and OA outcomes. The associations with LDL cholesterol levels were replicated in the UK Biobank (OR 0.95 [95% CI 0.93–0.98]). Conclusion Our MR study provides evidence of a causal role of lower LDL cholesterol level and higher BMI in OA.
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Affiliation(s)
- George Hindy
- Lund University, Lund, Sweden, and Broad Institute, Cambridge, Massachusetts
| | | | | | - Krishna G Aragam
- Broad Institute, Cambridge, Massachusetts, and Massachusetts General Hospital, Boston, Massachusetts
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Cooper C, Chapurlat R, Al-Daghri N, Herrero-Beaumont G, Bruyère O, Rannou F, Roth R, Uebelhart D, Reginster JY. Safety of Oral Non-Selective Non-Steroidal Anti-Inflammatory Drugs in Osteoarthritis: What Does the Literature Say? Drugs Aging 2019; 36:15-24. [PMID: 31073921 PMCID: PMC6509083 DOI: 10.1007/s40266-019-00660-1] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Non-steroidal anti-inflammatory drugs (NSAIDs) are widely recommended and prescribed to treat pain in osteoarthritis. While measured to have a moderate effect on pain in osteoarthritis, NSAIDs have been associated with wide-ranging adverse events affecting the gastrointestinal, cardiovascular, and renal systems. Gastrointestinal toxicity is found with all NSAIDs, which may be of particular concern when treating older patients with osteoarthritis, and gastric adverse events may be reduced by taking a concomitant gastroprotective agent, although intestinal adverse events are not ameliorated. Cardiovascular toxicity is associated with all NSAIDs to some extent and the degree of risk appears to be pharmacotherapy specific. An increased risk of acute myocardial infarction and heart failure is observed with all NSAIDs, while an elevated risk of hemorrhagic stroke appears to be restricted to the use of diclofenac and meloxicam. All NSAIDs have the potential to induce acute kidney injury, and patients with osteoarthritis with co-morbid conditions including hypertension, heart failure, and diabetes mellitus are at increased risk. Osteoarthritis is associated with excess mortality, which may be explained by reduced levels of physical activity owing to lower limb pain, presence of comorbid conditions, and the adverse effects of anti-osteoarthritis medications especially NSAIDs. This narrative review of recent literature identifies data on the safety of non-selective NSAIDs to better understand the risk:benefit of using NSAIDs to manage pain in osteoarthritis.
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Affiliation(s)
- Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD UK
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
- WHO Collaborating Centre for Public Heath Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Roland Chapurlat
- INSERM, UMR 1033, Université de Lyon, Hôpital E Herriot, Lyon, France
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Gabriel Herrero-Beaumont
- Rheumatology Service, Joint and Bone Research Unit, Autonomous University of Madrid, Fundación Jiménez Díaz, Madrid, Spain
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Heath Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - François Rannou
- Division of Physical Medicine and Rehabilitation, Department of Rheumatology, AP-HP Cochin Hospital, INSERM U1124, Université Paris Descartes Sorbonne Paris Cité, Paris, France
| | - Roland Roth
- Max-Reger-Strasse 17-19, Essen-Suedviertel, Germany
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Department of Orthopaedics and Traumatology, Hôpital du Valais, Centre Hospitalier du Valais Romand, CVP, Crans-Montana, Switzerland
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Heath Aspects of Musculoskeletal Health and Aging, Liège, Belgium
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
- Department of Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
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Rabago D, Kansariwala I, Marshall D, Nourani B, Stiffler-Joachim M, Heiderscheit B. Dextrose Prolotherapy for Symptomatic Knee Osteoarthritis: Feasibility, Acceptability, and Patient-Oriented Outcomes in a Pilot-Level Quality Improvement Project. J Altern Complement Med 2019; 25:406-412. [PMID: 30688517 DOI: 10.1089/acm.2018.0361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Affiliation(s)
- David Rabago
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Ina Kansariwala
- University of Wisconsin School of Medicine and Public Health Madison, WI
| | - David Marshall
- University of Wisconsin School of Medicine and Public Health Madison, WI
| | - Bobby Nourani
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Mikel Stiffler-Joachim
- UW Neuromuscular Biomechanics Laboratory, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
| | - Bryan Heiderscheit
- UW Neuromuscular Biomechanics Laboratory, Department of Orthopedics and Rehabilitation, University of Wisconsin School of Medicine and Public Health, Madison, WI
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211
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Cleveland R, Alvarez C, Schwartz T, Losina E, Renner J, Jordan J, Callahan L. The impact of painful knee osteoarthritis on mortality: a community-based cohort study with over 24 years of follow-up. Osteoarthritis Cartilage 2019; 27:593-602. [PMID: 30583096 PMCID: PMC7063854 DOI: 10.1016/j.joca.2018.12.008] [Citation(s) in RCA: 42] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Revised: 11/14/2018] [Accepted: 12/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the impact of knee osteoarthritis (OA) and/or knee pain on excess mortality. METHOD We analyzed data from 4,182 participants in a community-based prospective cohort study of African American and Caucasian men and women aged ≥45 years. Participants completed knee radiographs and questionnaires at baseline and at up to three follow-ups to determine knee OA (rOA), knee pain and covariate status. Mortality was determined through 2015. We used Cox proportional hazards regression with time-varying covariates (TVC) to estimate hazard ratios (HR) and 95% confidence intervals (CI). Additional analyses stratified by sex, race and age were carried out. RESULTS Median follow-up time was 14.6 years during which 1822 deaths occurred. Baseline knee radiographic osteoarthritis (rOA) was 27.7%, 38.8% at first follow-up, 52.6% at second follow-up and 61.9% at the third follow-up. Knee rOA with pain and knee pain alone were both associated with a >15% increase in premature all-cause mortality. In analyses stratified by sex, race and age, associations between knee pain, with or without knee rOA, and all-cause death were found among women, Caucasians, those ≤65 years of age, and those with a body mass index (BMI)≥30, with observed increased risks of death between 21% and 65%. We observed similar, somewhat attenuated, results for cardiovascular disease (CVD) deaths. CONCLUSION In models taking into account variables that change over time, individuals who had knee pain, alone or with knee rOA, had increased mortality. These effects were particularly strong among those obese. Effective interventions to reduce knee pain, particularly those including weight management and prevention of comorbidities, could reduce mortality.
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Affiliation(s)
- R.J. Cleveland
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA,Address correspondence and reprint requests to: R.J. Cleveland, Thurston Arthritis Research Center, University of North Carolina, 3300 Thurston Building, Campus Box #7280, Chapel Hill, NC 27599-7280, USA. Tel: 1 (919) 966-4533; Fax: 1 (919) 966-1739. (R.J. Cleveland)
| | - C. Alvarez
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - T.A. Schwartz
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA,School of Nursing, University of North Carolina, Chapel Hill, NC, USA
| | - E. Losina
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - J.B. Renner
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - J.M. Jordan
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - L.F. Callahan
- Thurston Arthritis Research Center, Department of Medicine, University of North Carolina, Chapel Hill, NC, USA,Department of Orthopaedics, University of North Carolina, Chapel Hill, NC, USA,Department of Social Medicine, University of North Carolina, Chapel Hill, NC, USA
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Durg S, Lobo M, Venkatachalam L, Rao G, Bhate J. A systematic review and meta-analysis of oxaceprol in the management of osteoarthritis: An evidence from randomized parallel-group controlled trials. Pharmacol Rep 2019; 71:374-383. [DOI: 10.1016/j.pharep.2018.12.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2018] [Revised: 11/10/2018] [Accepted: 12/21/2018] [Indexed: 01/27/2023]
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213
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Zhu Z, Aitken D, Cicuttini F, Jones G, Ding C. Ambulatory activity interacts with common risk factors for osteoarthritis to modify increases in MRI-detected osteophytes. Osteoarthritis Cartilage 2019; 27:650-658. [PMID: 30654117 DOI: 10.1016/j.joca.2018.12.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2018] [Revised: 12/10/2018] [Accepted: 12/24/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To investigate the longitudinal association between objectively measured ambulatory activity (AA) and knee MRI-detected osteophytes (OPs), and to test whether this relationship was modified by common risk factors for OA including sex, obesity, disease severity and knee injury history. METHODS 408 community-dwelling adults aged 51-81 years were assessed at baseline and 2.7 years. T1-weighted fat-suppressed MRI was used to evaluate knee OPs at both time points. AA was assessed at baseline by pedometers and categorized as: less active (≤7499 steps per day), moderately active (7500-9999 steps per day) and highly active (≥10,000 steps per day). RESULTS Statistically significant interactions were detected between knee OA risk factors and AA on increases in MRI-detected OPs (all P < 0.05). In stratified analyses, being moderately active, compared to being less active, was protective against an increase in MRI-detected OPs (score change of ≥1) in females (relative risk (RR) = 0.42, 95%CI, 0.25-0.70, P < 0.01), those who were obese (RR = 0.50, 95%CI, 0.30-0.83, P < 0.01), those with radiographic OA (ROA) (RR = 0.68, 95%CI, 0.47-0.97, P = 0.02) and those with a history of knee injury (RR = 0.27, 95%CI, 0.08-0.88, P = 0.02) in almost every knee compartment, after adjustment for confounders. No statistically significant associations were found in males, non-obese, non-ROA or non-injury groups. CONCLUSIONS Being moderately active is protective against an increase in MRI-detected OPs in females, those with ROA, those who are obese and those with a history of knee injury. These findings suggest that being moderately active is beneficial for individuals who are at higher risk of knee OA.
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Affiliation(s)
- Z Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - D Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliate Hospital of Anhui Medical University, Hefei, China.
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Abstract
Triamcinolone acetonide extended-release (ER) 32 mg (Zilretta®) is approved in the USA for the management of osteoarthritis (OA) pain of the knee and is administered as a single, 5 mL intra-articular (IA) injection. Although the therapeutic effects from IA corticosteroids are typically short-lived, triamcinolone acetonide ER is formulated in poly (lactic-co-glycolic acid) (PLGA) microspheres that slowly release triamcinolone acetonide in the synovium, enabling their prolonged presence in the joint. This reduces systemic exposure and lessens corticosteroid-related systemic adverse reactions, such as blood glucose elevations. In a 24-week, randomized, phase III clinical trial, triamcinolone acetonide ER 32 mg significantly improved mean average daily pain intensity in patients with knee OA relative to placebo, and pain, stiffness and physical function (according to WOMAC criteria) relative to placebo and triamcinolone acetonide crystalline suspension (CS). Triamcinolone acetonide ER was generally well tolerated, with a tolerability profile similar to that of triamcinolone acetonide CS and placebo. Findings from a single-arm phase IIIb study indicated that a repeat administration of triamcinolone acetonide ER may be similarly efficacious to an initial injection without having deleterious effects on cartilage or other aspects of joint structure. Thus, triamcinolone acetonide ER expands the treatment options available for the management of OA pain of the knee.
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Affiliation(s)
- Julia Paik
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand.
| | - Sean T Duggan
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
| | - Susan J Keam
- Springer, Private Bag 65901, Mairangi Bay, Auckland, 0754, New Zealand
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215
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Weber A, Mak SH, Berenbaum F, Sellam J, Zheng YP, Han Y, Wen C. Association between osteoarthritis and increased risk of dementia: A systemic review and meta-analysis. Medicine (Baltimore) 2019; 98:e14355. [PMID: 30855434 PMCID: PMC6417538 DOI: 10.1097/md.0000000000014355] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE To investigate the possible association between osteoarthritis (OA) and the risk of dementia. METHODS Cohort, case-control, and cross-sectional studies were obtained from wide literature search up to 20 April 2018 from following electronic databases: PubMed, Embase, Cochrane, using the MeSH terms: "osteoarthritis" AND "dementia". The literature search was then expanded to congress abstracts. After screening and selection of relevant studies by two investigators, data was extracted. Estimates were then calculated using a random-effect size model. Sensitivity-analysis was conducted for gender and age adjusted studies and pooled for studies with STROBE quality assessment score ≥75%. Publication bias was assessed by Funnel plot. Analyses were performed using Data Analysis and Statistical Software Version 14.2. RESULTS Nearly 1549 publication references were initially retrieved. Twenty-six publications were checked with full-text. Six observational studies with 388,252 individuals were included. OA was associated with a significantly increased risk for dementia (OR = 1.20; 95% confidence interval (CI), 1.03-1.39, I = 95.6%, P < .05). After pooling the studies with adjustment of age and gender, the risk increased (OR 1.36; 95% CI, 1.22-1.51, I = 75.6%, P < .0001). After pooling the study with a STROBE Quality score ≥75% the risk for dementia was slightly increased (OR 1.33; 95% CI, 1.17-1.5, I = 93.5%, p < 0.0001). CONCLUSIONS There is an association between osteoarthritis and the risk of dementia. This meta-analysis does not provide causality. Further prospective cohort studies are needed to clarify, if knee-, hip-, or hand-OA are independent risk factors for Alzheimer's disease and vascular dementia.
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Affiliation(s)
- Adrian Weber
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Shing hung Mak
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, PR China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Jérémie Sellam
- Department of Rheumatology, Sorbonne University, Saint-Antoine Hospital, Paris, France
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Yifan Han
- State Key Laboratory of Chinese Medicine and Molecular Pharmacology (Incubation), The Hong Kong Polytechnic University Shenzhen Research Institute, Shenzhen, PR China
- Department of Applied Biology and Chemical Technology, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
| | - Chunyi Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hung Hom, Hong Kong
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216
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Joseph KL, Hagen KB, Tveter AT, Magnusson K, Provan SA, Dagfinrud H. Osteoarthritis‐Related Walking Disability and Arterial Stiffness: Results From a Cross‐Sectional Study. Arthritis Care Res (Hoboken) 2019; 71:252-258. [DOI: 10.1002/acr.23697] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 05/15/2018] [Indexed: 12/22/2022]
Affiliation(s)
| | | | | | - Karin Magnusson
- Diakonhjemmet Hospital, Oslo, Norway and Lund University Lund Sweden
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217
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Holden MA, Waterfield J, Whittle R, Bennell K, Quicke JG, Chesterton L, Mallen CD. How do UK physiotherapists address weight loss among individuals with hip osteoarthritis? A mixed-methods study. Musculoskeletal Care 2019; 17:133-144. [PMID: 30663841 DOI: 10.1002/msc.1383] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 11/27/2018] [Accepted: 11/28/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Weight loss is recommended as a core treatment for individuals with hip osteoarthritis who are overweight or obese. Physiotherapists play an important role in managing patients with hip osteoarthritis, but little is known about how they address weight. We aimed to explore how UK-based physiotherapists currently address weight loss among individuals with hip OA. METHODS We carried out a mixed-methods study. A cross-sectional questionnaire was mailed to 3,126 UK-based musculoskeletal physiotherapists. Self-reported approaches to addressing weight loss among individuals with hip osteoarthritis were explored using a case vignette and associated clinical management questions. Semi-structured telephone interviews (n = 21) were completed with a purposeful sample of physiotherapists who returned the questionnaire and provided consent for further contact. Interview data were analysed thematically. RESULTS There was a 53% response rate to the questionnaires (n = 1,646), and 1,148 responders were eligible for analyses (based on having treated an individual with hip OA in the last 6 months). Eight-five per cent of physiotherapists reported that they would address the vignette patient's weight, usually via advice (70%). Interviews identified that advice often focused on the importance of weight loss, with some physiotherapists offering basic advice on how to achieve weight loss. Multiple factors influenced their approach, including confidence, perceived remit and patient receptiveness. CONCLUSIONS UK physiotherapists commonly address weight loss among patients with hip osteoarthritis, by offering advice relating to the importance of weight loss. However, provision of more specific guidance on how to achieve weight loss is variable. With additional training, physiotherapists could play an important role in supporting weight loss among patients with hip OA, thus potentially optimizing treatment outcomes.
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Affiliation(s)
- Melanie Ann Holden
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Jackie Waterfield
- Division of Dietetics, Nutrition & Biological Sciences, Physiotherapy, Podiatry and Radiography, School of Health Sciences, Queen Margaret University, Musselburgh, East Lothian, Scotland
| | - Rebecca Whittle
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Kim Bennell
- Centre for Health, Exercise & Sports Medicine, Department of Physiotherapy, University of Melbourne, Melbourne, VIC, Australia
| | - Jonathan George Quicke
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Linda Chesterton
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
| | - Christian David Mallen
- Arthritis Research UK Primary Care Centre, Institute for Primary Care and Health Sciences, Keele University, Newcastle-under-Lyme, England
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218
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Waugh E, King L, Gakhal N, Hawker G, Webster F, White D. Physical Activity Intervention in Primary Care and Rheumatology for the Management of Knee Osteoarthritis: A Review. Arthritis Care Res (Hoboken) 2019; 71:189-197. [PMID: 29920972 DOI: 10.1002/acr.23622] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2017] [Accepted: 06/12/2018] [Indexed: 02/06/2023]
Affiliation(s)
- Esther Waugh
- Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
| | - Lauren King
- University of Toronto, Toronto, Ontario, Canada
| | | | - Gillian Hawker
- Women's College Hospital, and University of Toronto, Toronto, Ontario, Canada
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219
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Martel-Pelletier J, Maheu E, Pelletier JP, Alekseeva L, Mkinsi O, Branco J, Monod P, Planta F, Reginster JY, Rannou F. A new decision tree for diagnosis of osteoarthritis in primary care: international consensus of experts. Aging Clin Exp Res 2019; 31:19-30. [PMID: 30539541 PMCID: PMC6514162 DOI: 10.1007/s40520-018-1077-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/16/2018] [Indexed: 01/01/2023]
Abstract
Background and aims Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. Methods To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA. The IRB used American College of Rheumatology diagnostic criteria. Results Care pathways based on clinical and radiological findings were developed to identify intervention thresholds for GPs/specialists. To optimize usefulness in the primary care setting, the guidelines were formatted as an uncomplicated, but comprehensive one-page decision tree for each topology, highlighting key aspects of the evaluation process and incorporating red flags. In a two-phase validation stage, the draft guidelines were evaluated by rheumatologists and GPs for project execution, content and perceived benefit. The strength of the guidelines lies in their user-friendly diagram and potential for broad application. Such guidelines will allow GPs to make an easy but definite diagnosis of OA and offer clear guidance about situations requiring an expert opinion. The guidelines have potential to improve patient outcomes and reduce the number of unnecessary procedures. Discussion and conclusions This project demonstrated the feasibility of developing easy-to-use and effective visual decision trees to facilitate the diagnosis and management of OA of the hip, knee and hand/finger in primary care. The next step should be to conduct a large impact study of implementation of these recommendations in the diagnostic management of OA in general practice in different areas.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Emmanuel Maheu
- Rheumatology Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | | | - Ouafa Mkinsi
- Ibn Rochd University Hospital, Casablanca, Morocco
| | - Jaime Branco
- Department of Rheumatology, NOVA Medical School, CEDOC, Universidade Nova de Lisboa, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | | | | | - Jean-Yves Reginster
- Department of Public Health, Epidemiology, and Health Economics, University of Liège, Liège, Belgium
- Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - François Rannou
- Service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Univ. Paris Descartes, PRES Sorbonne Paris Cité, Hôpital Cochin, Assistance Publique -Hôpitaux de Paris, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France.
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220
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Chahla J, Cole BJ. Editorial Commentary: Platelet-Rich Plasma for Knee Osteoarthritis: A "Novel" and Effective Symptomatic Approach. Arthroscopy 2019; 35:118-120. [PMID: 30611337 DOI: 10.1016/j.arthro.2018.07.036] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Accepted: 07/27/2018] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) constitutes a significant cause of disability, and it is now recognized as a source of increased mortality. Thus, several therapeutic approaches have been reported in the literature in an attempt to mitigate the symptoms of OA with varying degrees of success. Platelet-rich plasma (PRP) is being increasingly accepted as one of the most efficacious approaches for the symptomatic treatment of mild to moderate OA. Several confounding factors can affect the outcome of PRP such as age, grade of OA, PRP processing technique, and number and timing of these injections. However, numerous reports in the literature derived from PRP randomized clinical trials (compared with saline, hyaluronic acid, and other nonsurgical methods) suggest that successful outcomes can be achieved at least at 1-year postinjection with minimal complications.
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221
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Roseen EJ, LaValley MP, Li S, Saper RB, Felson DT, Fredman L. Association of Back Pain with All-Cause and Cause-Specific Mortality Among Older Women: a Cohort Study. J Gen Intern Med 2019; 34:90-97. [PMID: 30350028 PMCID: PMC6318166 DOI: 10.1007/s11606-018-4680-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2018] [Revised: 07/06/2018] [Accepted: 09/13/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND The impact of back pain on disability in older women is well-understood, but the influence of back pain on mortality is unclear. OBJECTIVE To examine whether back pain was associated with all-cause and cause-specific mortality in older women and mediation of this association by disability. DESIGN Prospective cohort study. SETTING The Study of Osteoporotic Fractures. PARTICIPANTS Women aged 65 or older. MEASUREMENT Our primary outcome, time to death, was assessed using all-cause and cause-specific adjusted Cox models. We used a four-category back pain exposure (no back pain, non-persistent, infrequent persistent, or frequent persistent back pain) that combined back pain frequency and persistence across baseline (1986-1988) and first follow-up (1989-1990) interviews. Disability measures (limitations of instrumental activities of daily living [IADL], slow chair stand time, and slow walking speed) from 1991 were considered a priori potential mediators. RESULTS Of 8321 women (mean age 71.5, SD = 5.1), 4975 (56%) died over a median follow-up of 14.1 years. A higher proportion of women with frequent persistent back pain died (65.8%) than those with no back pain (53.5%). In the fully adjusted model, women with frequent persistent back pain had higher hazard of all-cause (hazard ratio [HR] = 1.24 [95% CI, 1.11-1.39]), cardiovascular (HR = 1.34 [CI, 1.12-1.62]), and cancer (HR = 1.33, [CI 1.03-1.71]) mortality. No association with mortality was observed for other back pain categories. In mediation analyses, IADL limitations explained 47% of the effect of persistent frequent back pain on all-cause mortality, slow chair stand time, and walking speed, explained 27% and 24% (all significant, p < 0.001), respectively. LIMITATIONS Only white women were included. CONCLUSION Frequent persistent back pain was associated with increased mortality in older women. Much of this association was mediated by disability.
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Affiliation(s)
- Eric J. Roseen
- Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA USA
| | - Michael P. LaValley
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
| | - Shanshan Li
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA USA
| | - Robert B. Saper
- Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA USA
| | - David T. Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA USA
| | - Lisa Fredman
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
| | - For the Study of Osteoporotic Fractures
- Department of Family Medicine, Boston Medical Center, One Boston Medical Center Place, Boston, MA USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA USA
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, Boston, MA USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA USA
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Pahoff S, Meinert C, Bas O, Nguyen L, Klein TJ, Hutmacher DW. Effect of gelatin source and photoinitiator type on chondrocyte redifferentiation in gelatin methacryloyl-based tissue-engineered cartilage constructs. J Mater Chem B 2019; 7:1761-1772. [DOI: 10.1039/c8tb02607f] [Citation(s) in RCA: 64] [Impact Index Per Article: 12.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
This work investigates neocartilage formation in bovine and porcine gelatin methacryloyl-based hydrogels photocrosslinked using ultraviolet or visible light photoinitiator systems.
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Affiliation(s)
- Stephen Pahoff
- Institute of Health and Biomedical Innovation
- Queensland University of Technology
- 60 Musk Avenue
- Kelvin Grove
- Brisbane
| | - Christoph Meinert
- Institute of Health and Biomedical Innovation
- Queensland University of Technology
- 60 Musk Avenue
- Kelvin Grove
- Brisbane
| | - Onur Bas
- Institute of Health and Biomedical Innovation
- Queensland University of Technology
- 60 Musk Avenue
- Kelvin Grove
- Brisbane
| | - Long Nguyen
- Institute of Health and Biomedical Innovation
- Queensland University of Technology
- 60 Musk Avenue
- Kelvin Grove
- Brisbane
| | - Travis J. Klein
- Institute of Health and Biomedical Innovation
- Queensland University of Technology
- 60 Musk Avenue
- Kelvin Grove
- Brisbane
| | - Dietmar W. Hutmacher
- Institute of Health and Biomedical Innovation
- Queensland University of Technology
- 60 Musk Avenue
- Kelvin Grove
- Brisbane
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223
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Na A, Jansky L, Gugala Z. Clinical Characteristics of Patients with Type 2 Diabetes Mellitus Receiving a Primary Total Knee or Hip Arthroplasty. J Diabetes Res 2019; 2019:9459206. [PMID: 31828171 PMCID: PMC6885807 DOI: 10.1155/2019/9459206] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Revised: 10/07/2019] [Accepted: 10/16/2019] [Indexed: 11/17/2022] Open
Abstract
AIM The purpose of this study is to explore clinical characteristics of patients with T2DM receiving a primary knee (TKA) or hip (THA) arthroplasty to patients without T2DM receiving a TKA or THA and patients with T2DM with no history of osteoarthritis (OA). METHODS The study included a retrospective database review of 500 consecutive primary TKA or THA identified with ICD-9 codes and 100 consecutive T2DM patients. Patients who received a TKA or THA were screened for inclusion and exclusion and divided into with or without T2DM groups. A comparison group of patients with T2DM only without arthroplasty was screened to exclude patients with a history of OA or arthroplasty. All groups were compared based on demographic and relevant comorbidity differences. OA characteristics, including OA and previous arthroplasty of the involved and contralateral joints, were compared between patients with and without T2DM receiving a TKA or THA. Finally, patients with T2DM with and without TKA or THA were compared for T2DM differences. RESULTS Study results found that among those receiving a primary arthroplasty, patients with T2DM were more likely to be obese and older and reported cardiovascular, urinary, dyslipidemia, and peripheral neuropathy than those with T2DM. Among the T2DM individuals, those receiving an arthroplasty surgery were older and obese and more likely to report peripheral neuropathy; however, those with T2DM with no OA were more likely to report atherosclerosis and cardiovascular disease. Within the arthroplasty subgroup of individuals with T2DM, those requiring antidiabetic medication were 4.5 times more likely to have contralateral OA or arthroplasty. CONCLUSIONS The results of this study suggest that patients with T2DM requiring a primary arthroplasty are a unique subgroup that requires careful considerations as they are often older, have obesity, and specific comorbidities predisposing to worse postoperative outcomes than their non-T2DM arthroplasty counterparts. Therefore, clinical practice and future studies must consider strategies that would limit OA and arthroplasty management delays while accounting for comorbidities and patient characteristics.
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MESH Headings
- Age Distribution
- Aged
- Arthroplasty, Replacement, Hip
- Arthroplasty, Replacement, Knee
- Case-Control Studies
- Comorbidity
- Diabetes Mellitus, Type 2/epidemiology
- Diabetic Nephropathies/epidemiology
- Diabetic Neuropathies/epidemiology
- Dyslipidemias/epidemiology
- Female
- Humans
- Hypertension/epidemiology
- Male
- Middle Aged
- Obesity/epidemiology
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/surgery
- Peripheral Nervous System Diseases/epidemiology
- Renal Insufficiency, Chronic/epidemiology
- Retrospective Studies
- Texas/epidemiology
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Affiliation(s)
- Annalisa Na
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston 77555, USA
- Division of Rehabilitation Sciences, University of Texas Medical Branch, Galveston 77555, USA
| | - Laurie Jansky
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston 77555, USA
| | - Zbigniew Gugala
- Department of Orthopaedic Surgery and Rehabilitation, University of Texas Medical Branch, Galveston 77555, USA
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224
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The Long-Term Impact of Osteoarthritis Following Knee Surgery in Former College Athletes. J Sport Rehabil 2019; 28:33-38. [PMID: 28787229 DOI: 10.1123/jsr.2017-0115] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Revised: 07/05/2017] [Accepted: 07/17/2017] [Indexed: 11/18/2022]
Abstract
CONTEXT Individuals who sustain a knee surgery have been shown to have an increased likelihood to develop osteoarthritis (OA). OBJECTIVE Identify the consequences of knee surgery in a cohort of former college athletes. DESIGN Cross-sectional. SETTING Research laboratory. PARTICIPANTS A group of 100 former Division I college athletes aged 40-65 years (60 males and 40 females) participated in the study. INTERVENTIONS All individuals self-reported whether they sustained a knee injury during college requiring surgery and if they have been diagnosed with knee OA by a medical physician post knee injury. Individuals were categorized into 3 groups: no history of knee injury requiring surgery (33 males and 24 females; 54.53 [5.95] y), history of knee surgery in college with no diagnosis of OA later in life (4 males and 6 females; 51.26 [7.29] y), and history of knee surgery in college with physician diagnosed OA later in life (23 males and 10 females; 54.21 [7.64] y). All individuals completed the knee injury and osteoarthritis outcome score (KOOS) and short form-36 version 2. MAIN OUTCOME MEASURES Scores on the KOOS and short form-36 version 2. RESULTS A majority (76.7%) of individuals who had a knee surgery in college did develop OA. The largest mean differences were between the healthy knee and surgical knee/OA groups on the KOOS-quality of life scale (mean difference: 49.76; χ2(3) = 44.65; P < .001) and KOOS-sports scale (mean difference: 43.69; χ2(3) = 28.69; P < .001), with the surgical knee/OA group scoring worse. CONCLUSIONS Later in life functional limitations were observed in individuals who sustained a knee injury requiring surgery and developed OA. These findings support increased efforts toward prevention of knee injuries and consideration of the long-term implication when making treatment and return to activity decisions.
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The Clinical Efficacy and Safety of Gumiganghwal-Tang in Knee Osteoarthritis: A Phase II Randomized Double Blind Placebo Controlled Study. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2018; 2018:3165125. [PMID: 30538759 PMCID: PMC6261401 DOI: 10.1155/2018/3165125] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 10/13/2018] [Accepted: 11/06/2018] [Indexed: 12/29/2022]
Abstract
Background Gumiganghwal-tang (GMGHT) is a traditional herbal medicine consisting of nine different herbs. GMGHT inhibits the mRNA expression and production of inflammatory cytokines tumor necrosis factor-α (TNF- α), interleukin-6 (IL-6), and TNF- β on lipopolysaccharide- (LPS-) stimulated peritoneal macrophages in a dose-dependent manner. It is empirically used for the treatment of inflammatory disease, but there are few reports of clinical trials that investigate its efficacy and safety. The current study aimed to investigate the clinical efficacy and safety of GMGHT in patients with knee osteoarthritis (OA). Methods This was a multicenter, two-armed, double-blinded, randomized, placebo controlled study of GMGHT over 6 weeks. Eligible patients who fulfilled the American College of Rheumatology criteria for OA were randomized to receive either GMGHT or the placebo. Clinical assessments included measurement of knee pain and function using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), patient global assessment (PGA), and knee pain scores every 2 weeks. Results A total of 128 patients were enrolled (91.4% female; mean age, 58.7 ± 8.1 years). At baseline, pain visual analogue score (VAS) was 67.2 ± 1.4, resp. 71.3 ± 1.6 (treatment, resp. placebo group, p=0.84), and total WOMAC score was 55.2 ± 1.6, resp. 55.6 ± 1.5 (p = 0.84). After 6 weeks, the pain VAS was 43.0 ± 2.5, resp. 61.6 ± 2.5 (p < 0.01) and the total WOMAC score was 34.1 ± 2.4, resp. 46.9 ± 1.8 (p < 0.01). No patients withdrew because of treatment emergent adverse events. Expected adverse events including dyspepsia, liver function abnormality, and lower extremity edema were comparable between both groups. Conclusions Treatment with GMGHT resulted in significant improvement in pain, function, and global assessment, and it was generally safe and well tolerated in patients with OA.
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Georgiev T, Stoilov R. Bulgarian rheumatology: science and practice in a cost-constrained environment. Rheumatol Int 2018; 39:417-429. [PMID: 30413925 DOI: 10.1007/s00296-018-4202-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2018] [Accepted: 11/02/2018] [Indexed: 12/13/2022]
Abstract
Our aim was to appraise publications from Bulgaria, to assess their global impact, and to describe features and challenges unique to the rheumatology practice in Bulgaria characterized by stringent cost constraints. The Scopus database was queried on 25th July 2018 and data on the number of published documents, their Hirsch-indices and citations number were extracted. Published Bulgarian guidelines for the management of rheumatic diseases and the presented data on Bulgarian Rheumatology Society were identified based on prior knowledge of the authors. From all the identified 1082 document the most extensively researched areas were rheumatoid arthritis (RA), systemic lupus erythematosus (SLE), osteoporosis, and osteoarthritis (OA). For the last five years (from Jan 2013 to 25th July 2018) the number of publications was 293. We found that Bulgaria's international scientific collaboration in the field of rheumatology is focused on a handful of countries mainly from Europe. Although Bulgarian rheumatologists have access to costly biologic agents for treating their patients with rheumatic diseases, their funding may not be granted according to the current recommendations of European League against Rheumatism (EULAR) and national guidelines for the management of rheumatic diseases. Although the western world clearly dominates the production of scientific publications in rheumatology, Bulgarian rheumatology may present another perspective for diagnosis and management of patients with rheumatic diseases in a cost-stringent environment. Nevertheless, both rheumatology science and practice in Bulgaria still have a long way to go to take its deserved place among the other European countries.
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Affiliation(s)
- Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia, Bulgaria.
| | - Rumen Stoilov
- Clinic of Rheumatology, University Hospital "St. Ivan Rilski", Medical University-Sofia, Sofia, Bulgaria
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Keller K, Hobohm L, Engelhardt M. Impact of Atrial Fibrillation on Postoperative Adverse Outcomes of Surgical Patients With Knee Endoprosthetic Surgery. J Arthroplasty 2018; 33:3567-3573. [PMID: 30007790 DOI: 10.1016/j.arth.2018.06.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Revised: 06/04/2018] [Accepted: 06/18/2018] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Atrial fibrillation/flutter (AF) is associated with increased mortality, thromboembolism, heart failure, and adverse perioperative outcomes. We aimed to investigate the impact of AF on adverse in-hospital outcomes of hospitalized patients who underwent knee endoprosthetic surgery (KES). METHODS The nationwide German inpatient sample of the years 2005-2015 was used for this analysis. Patients who underwent KES were identified based on the surgical and interventional procedural codes (surgery and procedure code [Operationen-und Prozedurenschlüssel] 5-822), and patients were further stratified by AF (International Classification of Diseases and Related Health Problems code I48). We compared patients with and without AF who underwent KES as well as survivors vs nonsurvivors among patients with AF. Logistic regression models were used to investigate the impact of AF as a predictor for adverse in-hospital outcomes. RESULTS Overall, 1,642,875 hospitalized surgical patients (65.4% females, 49.5% aged >70 years) were included in the analysis. Of these, 93,748 patients (5.7%) were diagnosed with AF. Overall, 0.1% of the patients who underwent KES and 0.6% of the patients who underwent KES with additional AF died during in-hospital stay. All-cause death (risk ratio 5.97 [95% confidence interval {CI} 5.41-6.58], P < .001) and adverse in-hospital events (risk ratio 2.62 [95% CI 2.50-2.74], P < .001) occurred both more often in patients with AF compared to those without. AF was an important predictor for in-hospital death (odds ratio 2.09 [95% CI 1.88-2.32], P < .001) and adverse in-hospital events (odds ratio 1.76 [95% CI 1.68-1.85], P < .001) in patients who underwent KES independent of age, sex, and comorbidities. CONCLUSION In patients who underwent KES, AF is associated with increased in-hospital mortality and adverse in-hospital outcomes. Pneumonia, pulmonary embolism, shock, myocardial infarction, intracerebral bleeding, and stroke were the key complications promoting in-hospital death.
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Affiliation(s)
- Karsten Keller
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Team Doctor of the German Bundesliga Club 1. FSV Mainz 05 in the Soccer Season 2014/2015, Mainz, Germany
| | - Lukas Hobohm
- Center for Thrombosis and Hemostasis (CTH), University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany; Center of Cardiology, Cardiology I, University Medical Center Mainz (Johannes Gutenberg-University Mainz), Mainz, Germany
| | - Martin Engelhardt
- Department for Orthopedics, Trauma Surgery and Hand Surgery, Klinikum Osnabrück, Osnabrück, Germany; Olympic Doctor of the German Olympic Sports Confederation responsible for taking care of the German team at the Olympic Summer Games 2004 in Athena and 2008 in Beijing.; Head of the Institute for Applied Training Science Leipzig (IAT), Leipzig, Germany
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Castrejon I, Shakoor N, Chua JR, Block JA. Discordance of global assessment by patients and physicians is higher in osteoarthritis than in rheumatoid arthritis: a cross-sectional study from routine care. Rheumatol Int 2018; 38:2137-2145. [PMID: 30293155 DOI: 10.1007/s00296-018-4166-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022]
Abstract
The study compares patient-physician discordance in global assessment in patients with osteoarthritis (OA) versus patients with rheumatoid arthritis (RA) seen in routine care. This is a cross-sectional study conducted at an academic rheumatology center at which all patients are asked to complete a Multi-Dimensional Health Assessment Questionnaire (MDHAQ), which includes a patient global assessment (PATGL). Rheumatologists are encouraged to complete a physician questionnaire, which includes a physician global assessment (DOCGL). Patients with either OA or RA were identified using ICD9 codes and classified as positive discordance (PATGL-DOCGL ≥ 2), negative discordance (PATGL-DOCGL≤ - 2), and concordance (absolute difference between the two assessments < 2). Discordance was assessed by diagnosis. Agreement between patient and physician global assessments was evaluated using intraclass correlations. Logistic regression was performed to identify explanatory variables for positive discordance. The analysis included 243 OA and 216 RA patients. Mean PATGL was higher in OA versus RA (5.4 versus 4.2, p = 0.005), while mean DOCGL was similar (4.0 versus 3.8, p = 0.23) leading to a higher patient-physician discordance in OA (1.35 versus 0.43, p < 0.001). Positive discordance occurred in 34% of OA versus 18% of RA patients (p < 0.001). Intraclass correlation coefficients were 0.43 in OA versus 0.60 in RA patients. In logistic regressions, pain was the only statistically significant explanatory variable for discordance in both OA (OR 1.34, 95% CI 1.12-1.78) and RA (OR 1.47 95% CI 1.04-2.07). Patients with OA are more likely to be discordant with their rheumatologists than patients with RA because of a higher PATGL. Similarly to RA, the most important explanatory variable for discordance was higher pain.
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Affiliation(s)
- Isabel Castrejon
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA.
| | - Najia Shakoor
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Jacquelin R Chua
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
| | - Joel A Block
- Division of Rheumatology, Rush University Medical Center, 1161 West Harrison Street, Suite 510, Chicago, IL, 60612, USA
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229
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Physical activity levels after hip and knee joint replacement surgery: an observational study. Clin Rheumatol 2018; 38:665-674. [PMID: 30284079 DOI: 10.1007/s10067-018-4317-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2018] [Revised: 08/24/2018] [Accepted: 09/25/2018] [Indexed: 12/14/2022]
Abstract
Usual care after hip or knee joint replacement does not adequately address the problem of low physical activity levels. We aimed to determine whether exercise delivered in a group setting in the early stage of outpatient rehabilitation influenced self-reported physical activity levels after hip or knee joint replacement. A case series of 79 participants referred to a 6-week outpatient orthopaedic exercise group after total hip or knee replacement were evaluated using the International Physical Activity Questionnaire (IPAQ) short form. Physical function was evaluated using Osteoarthritis Research Society International (OARSI) recommended performance-based tests (30 s Chair Stand Test, 40 m Fast Pace Walk Test, Stair Climb Test, Timed Up and Go Test, 6 Minute Walk Test). Measures were assessed at admission, discharge and 6 weeks after group discharge. Non-parametric analysis was conducted for IPAQ scores. Analysis of functional measures was conducted with linear mixed models with time modelled as a repeated measure. Standard multiple regression and correlation analysis were conducted. Fifty-four participants completed the study. Self-reported activity levels improved significantly at program discharge but not at 6-week follow-up. All performance-based measures improved significantly at program discharge. Fast-paced walking and 6 Minute Walk Test measures continued to improve at 6-week follow-up. Group dynamics present in an outpatient rehabilitation exercise program may increase physical activity levels during group participation but not after group cessation. Performance in all functional measures improved at group discharge.
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230
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Gustafsson K, Rolfson O, Eriksson M, Dahlberg L, Kvist J. Study protocol for an observational register-based study on health and risk factors in patients with hip and knee osteoarthritis. BMJ Open 2018; 8:e022812. [PMID: 30287673 PMCID: PMC6194475 DOI: 10.1136/bmjopen-2018-022812] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
INTRODUCTION Hip and knee osteoarthritis is a leading cause of disability worldwide. Currently, the course of deterioration in pain and physical functioning in individuals with osteoarthritis is difficult to predict. Factors such as socioeconomic status and comorbidity contribute to progression of osteoarthritis, but clear associations have not been established. There is a need for early identification of individuals with slow disease development and a good prognosis, and those that should be recommended for future joint replacement surgery. METHODS AND ANALYSIS This nationwide register-based study will use data for approximately 75 000 patients who sought and received core treatment for osteoarthritis in primary healthcare, and were registered in the Swedish population-based National Quality Register for Better Management of Patients with Osteoarthritis. These data will be merged with data for replacement surgery, socioeconomic factors, healthcare consumption and comorbidity from the Swedish Hip Arthroplasty Register, the Swedish Knee Arthroplasty Register, Statistics Sweden and the National Board of Health and Welfare, Sweden. The linkage will be performed using personal identity numbers that are unique to all citizens in Sweden. ETHICS AND DISSEMINATION The study was approved by the Regional Ethical Review Board in Gothenburg, Sweden (dnr 1059-16). The results from this study will be submitted to peer-reviewed journals and reported at suitable national and international meetings. TRIAL REGISTRATION NUMBER NCT03438630.
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MESH Headings
- Aged
- Arthroplasty, Replacement, Ankle
- Arthroplasty, Replacement, Knee
- Databases, Factual
- Female
- Health Surveys
- Humans
- Male
- Middle Aged
- Observational Studies as Topic
- Osteoarthritis, Hip/epidemiology
- Osteoarthritis, Hip/physiopathology
- Osteoarthritis, Hip/surgery
- Osteoarthritis, Knee/epidemiology
- Osteoarthritis, Knee/physiopathology
- Osteoarthritis, Knee/surgery
- Pain Measurement
- Patient Reported Outcome Measures
- Quality of Life
- Registries/statistics & numerical data
- Reoperation/statistics & numerical data
- Risk Factors
- Sweden/epidemiology
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Affiliation(s)
- Kristin Gustafsson
- Department of Physiotherapy, Rehabilitation Centre, Ryhov County Hospital Jönköping, Jönköping, Sweden
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
| | - Ola Rolfson
- Department of Orthopaedics, Sahlgrenska Academy, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
| | - Marit Eriksson
- Department of Medical and Health Sciences, Linköping University, and Futurum, Region Jönköping County, Jönköping, Sweden
| | - Leif Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Faculty of Medicine, Lund University and Clinical Epidemiology Unit, Skåne University Hospital, Lund, Sweden
| | - Joanna Kvist
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
- Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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231
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Makris UE, Alvarez CA, Mortensen EM, Mansi IA. Association of Statin Use with Increased Risk of Musculoskeletal Conditions: A Retrospective Cohort Study. Drug Saf 2018; 41:939-950. [PMID: 29797239 PMCID: PMC6143406 DOI: 10.1007/s40264-018-0682-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Musculoskeletal conditions, including osteoarthritis (OA), result in tremendous disability and cost. Statins are among the most commonly prescribed medications and their use for primary prevention in many otherwise healthy individuals, including those who are physically active, is increasing. There is conflicting evidence regarding the relationship of statin use and musculoskeletal conditions. Given the rising disability associated with musculoskeletal conditions, understanding predisposing factors, including medication-related exposures, deserves further attention. OBJECTIVES We examined the association between statin use and the risk of being diagnosed with non-traumatic arthropathies, use-related injury, and undergoing rehabilitation in a cohort with longitudinal follow-up. METHODS Patients enrolled in a regional military healthcare system between 2003 and 2012 were evaluated in this retrospective cohort study. A propensity score was generated to match statin-users and nonusers using 115 baseline characteristics. Outcomes included ICD-9 diagnoses codes for Agency for Healthcare Research and Quality disease categories of: non-traumatic arthropathies, use-related injury and undergoing rehabilitation. Primary analysis examined the outcomes in statin-users and nonusers after propensity score matching using conditional logistic regression analysis. RESULTS Initially, 60,455 patients were identified. We propensity score-matched 6728 statin users with 6728 nonusers (52 years of age, ~ 47% women). In the propensity score-matched cohort, non-traumatic arthropathies occurred in 59.8% of statin users and 56.0% of nonusers [odds ratio (OR) 1.17, 95% confidence interval (95% CI) 1.09-1.25] and use related injury occurred in 31.9% of statin users and 29.8% of nonusers (OR 1.11, 95% CI 1.03-1.19). There was no difference between statin users and nonusers undergoing rehabilitation (22.6% among statin users, 21.9% among nonusers, OR 1.04, 95% CI 0.96-1.13). CONCLUSION Statin use was associated with a significant increased risk of non-traumatic arthropathies and use-related injury. Our results provide additional data that can inform patient and clinician conversations about the benefits and risks of statin use.
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Affiliation(s)
- Una E Makris
- Medical Service, VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, USA
- Division of Outcomes and Health Services Research, Departments of Internal Medicine and Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
| | - Carlos A Alvarez
- Department of Pharmacy Practice, Texas Tech University Health Sciences Center, Dallas, TX, USA
| | - Eric M Mortensen
- Division of Outcomes and Health Services Research, Departments of Internal Medicine and Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA
- University of Connecticut Medical Center, Farmington, CT, USA
| | - Ishak A Mansi
- Medical Service, VA North Texas Health Care System, 4500 S. Lancaster Road, Dallas, TX, USA.
- Division of Outcomes and Health Services Research, Departments of Internal Medicine and Clinical Sciences, UT Southwestern Medical Center, Dallas, TX, USA.
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232
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Williams A, Kamper SJ, Wiggers JH, O'Brien KM, Lee H, Wolfenden L, Yoong SL, Robson E, McAuley JH, Hartvigsen J, Williams CM. Musculoskeletal conditions may increase the risk of chronic disease: a systematic review and meta-analysis of cohort studies. BMC Med 2018; 16:167. [PMID: 30249247 PMCID: PMC6154805 DOI: 10.1186/s12916-018-1151-2] [Citation(s) in RCA: 123] [Impact Index Per Article: 20.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 08/14/2018] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Chronic diseases and musculoskeletal conditions have a significant global burden and frequently co-occur. Musculoskeletal conditions may contribute to the development of chronic disease; however, this has not been systematically synthesised. We aimed to investigate whether the most common musculoskeletal conditions, namely neck or back pain or osteoarthritis of the knee or hip, contribute to the development of chronic disease. METHODS We searched CINAHL, Embase, Medline, Medline in Process, PsycINFO, Scopus and Web of Science to February 8, 2018, for cohort studies reporting adjusted estimates of the association between baseline musculoskeletal conditions (neck or back pain or osteoarthritis of the knee or hip) and subsequent diagnosis of a chronic disease (cardiovascular disease, cancer, diabetes, chronic respiratory disease or obesity). Two independent reviewers performed data extraction and assessed study quality. Adjusted hazard ratios were pooled using the generic inverse variance method in random effect models, regardless of the type of musculoskeletal condition or chronic disease. PROSPERO CRD42016039519. RESULTS There were 13 cohort studies following 3,086,612 people. In the primary meta-analysis of adjusted estimates, osteoarthritis (n = 8 studies) and back pain (n = 2) were the exposures and cardiovascular disease (n = 8), cancer (n = 1) and diabetes (n = 1) were the outcomes. Pooled adjusted estimates from these 10 studies showed that people with a musculoskeletal condition have a 17% increase in the rate of developing a chronic disease compared to people without (hazard ratio 1.17, 95% confidence interval 1.13-1.22; I2 52%, total n = 2,686,113 people). CONCLUSIONS This meta-analysis found that musculoskeletal conditions may increase the risk of chronic disease. In particular, osteoarthritis appears to increase the risk of developing cardiovascular disease. Prevention and early treatment of musculoskeletal conditions and targeting associated chronic disease risk factors in people with long standing musculoskeletal conditions may play a role in preventing other chronic diseases. However, a greater understanding about why musculoskeletal conditions may increase the risk of chronic disease is needed.
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Affiliation(s)
- Amanda Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia. .,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia. .,Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia.
| | - Steven J Kamper
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia.,School of Public Health, University of Sydney, Lvl 10, King George V Building, Camperdown, NSW, 2050, Australia
| | - John H Wiggers
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Kate M O'Brien
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
| | - Hopin Lee
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia.,Neuroscience Research Australia (NeuRA), PO Box 1170, Randwick, NSW, 2031, Australia.,Nuffield Department of Orthopaedics Rheumatology and Musculoskeletal Sciences, Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Luke Wolfenden
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Sze Lin Yoong
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia
| | - Emma Robson
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
| | - James H McAuley
- Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia.,Neuroscience Research Australia (NeuRA), PO Box 1170, Randwick, NSW, 2031, Australia
| | - Jan Hartvigsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark.,Nordic Institute of Chiropractic and Clinical Biomechanics, Campusvej 55, 5230, Odense M, Denmark
| | - Christopher M Williams
- School of Medicine and Public Health, University of Newcastle, Callaghan, NSW, 2308, Australia.,Hunter New England Population Health, Locked Bag 10, Wallsend, NSW, 2287, Australia.,Centre for Pain, Health and Lifestyle, Ourimbah, NSW, Australia
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Abstract
Menisci in the knee joint are thought to provide stability, increased contact area, decreased contact pressures, and offer protection to the underlying articular cartilage and bone during joint loading. Meniscal loss or injury is typically accompanied by degenerative changes in the knee, leading to an increased risk for osteoarthritis in animals including humans. However, the detailed mechanisms underlying joint degeneration and the development of osteoarthritis remain largely unknown, and the acute effects of meniscal loss have not been studied systematically. We developed a microscopy-based system to study microscale joint mechanics in living mice loaded by controlled muscular contractions. Here, we show how meniscal loss is associated with rapid chondrocyte death (necrosis) in articular cartilage within hours of injury, and how intact menisci protect chondrocytes in vivo in the presence of intense muscle-based joint loading and/or injury to the articular cartilage. Our findings suggest that loading the knee after meniscal loss is associated with extensive cell death in intact and injured knees, and that early treatment interventions should be aimed at preventing chondrocyte death.
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234
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Editorial Commentary: Knee Meniscus and Hip Labrum: The Dilemma of Degenerative Tears. Arthroscopy 2018; 34:2709-2710. [PMID: 30173811 DOI: 10.1016/j.arthro.2018.07.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Accepted: 07/12/2018] [Indexed: 02/02/2023]
Abstract
The dilemma for orthopaedic surgeons attempting to solve the problem of treating a knee meniscal tear in an older patient has always been whether or not a conservative approach is of value and if a surgical approach will provide benefit to the patient. Today, the same might be said of hip labral tears. Physical therapy is a wonderful tool to strengthen muscles, but it does not correct underlying pathology, which is often the source of joint pain. In an older patient with a symptomatic internal derangement, it is important for surgeons and payers to recognize that a simple outpatient surgical procedure often can improve that patient's symptoms.
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235
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Innes KE, Selfe TK, Kandati S, Wen S, Huysmans Z. Effects of Mantra Meditation versus Music Listening on Knee Pain, Function, and Related Outcomes in Older Adults with Knee Osteoarthritis: An Exploratory Randomized Clinical Trial (RCT). EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE : ECAM 2018; 2018:7683897. [PMID: 30245732 PMCID: PMC6136530 DOI: 10.1155/2018/7683897] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 07/31/2018] [Accepted: 08/08/2018] [Indexed: 12/27/2022]
Abstract
OBJECTIVE Disease-modifying treatments for OA remain elusive, and commonly used medications can have serious side effects. Although meditation and music listening (ML) have been shown to improve outcomes in certain chronic pain populations, research in OA is sparse. In this pilot RCT, we explore the effects of two mind-body practices, mantra meditation (MM) and ML, on knee pain, function, and related outcomes in adults with knee OA. METHODS Twenty-two older ambulatory adults diagnosed with knee OA were randomized to a MM (N=11) or ML program (N=11) and asked to practice 15-20 minutes, twice daily for 8 weeks. Core outcomes included knee pain (Knee Injury and Osteoarthritis Outcome Score [KOOS] and Numeric Rating Scale), knee function (KOOS), and perceived OA severity (Patient Global Assessment). Additional outcomes included perceived stress (Perceived Stress Scale), mood (Profile of Mood States), sleep (Pittsburgh Sleep Quality Index), and health-related quality of life (QOL, SF-36). Participants were assessed at baseline and following completion of the program. RESULTS Twenty participants (91%) completed the study (9 MM, 11 ML). Compliance was excellent; participants completed an average of 12.1±0.83 sessions/week. Relative to baseline, participants in both groups demonstrated improvement post-intervention in all core outcomes, including knee pain, function, and perceived OA severity, as well as improvement in mood, perceived stress, and QOL (Physical Health) (p's≤0.05). Relative to ML, the MM group showed greater improvements in overall mood and sleep (p's≤0.04), QOL-Mental Health (p<0.07), kinesiophobia (p=0.09), and two domains of the KOOS (p's<0.09). CONCLUSIONS Findings of this exploratory RCT suggest that a simple MM and, possibly, ML program may be effective in reducing knee pain and dysfunction, decreasing stress, and improving mood, sleep, and QOL in adults with knee OA.
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Affiliation(s)
- Kim E. Innes
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Terry Kit Selfe
- Department of Biomedical and Health Information Services, Health Science Center Libraries, University of Florida, Gainesville, FL, USA
| | - Sahiti Kandati
- Department of Epidemiology, School of Public Health, West Virginia University, Morgantown, WV, USA
- School of Dentistry, SUNY-Buffalo, Buffalo, NY, USA
| | - Sijin Wen
- Department of Biostatistics, School of Public Health, West Virginia University, Morgantown, WV, USA
| | - Zenzi Huysmans
- College of Physical Activity and Sport Sciences, West Virginia University, Morgantown, WV, USA
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Zhang Y, Niu J. Editorial: Shifting Gears in Osteoarthritis Research Toward Symptomatic Osteoarthritis. Arthritis Rheumatol 2018; 68:1797-800. [PMID: 27058963 DOI: 10.1002/art.39704] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
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237
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Hitzl W, Heisinger S, Hobusch GM, Frank K, Cotofana S. Projected numbers of primary total knee replacement in Austria from 2015-2075. DER ORTHOPADE 2018; 48:144-149. [PMID: 30051278 DOI: 10.1007/s00132-018-3605-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND In 2012 and 2013 Austria had the highest rate of primary total knee replacements (TKR) amongst all European countries. This study was carried out to project the numbers of TKR and its associated costs in Austria into the year 2075. METHODS Demographic data and population projections between 2011-2075 were obtained from European and Austrian authorities. Information about the present incidence of primary TKRs was obtained from the Austrian Prosthesis Register. Current TKR associated costs were obtained from federal healthcare insurances as well as federal and state admission agencies. Projections were stratified by age and gender and given for the lower, most likely and upper scenarios. RESULTS Overall cost for the group of patients with primary TKR will increase by 50% for males and 32% for females by 2075. This increase is primarily driven by the increase in the population of men aged 80-90 years and 90+ years leading to an increase of 190% and 567% of the TKR associated costs. In comparison, women in these age groups are estimated to have an increase in TKR costs by 108% and 243%. CONCLUSION These numbers represent a substantial socioeconomic burden to the Austrian society in the near and distant future due to the upcoming demographic changes. The presented results have their limitation in the unpredictable nature of assumptions but might guide Austrian and other European authorities in their efforts to provide more cost-effective and more directed care for patients in need of primary TKR surgery.
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Affiliation(s)
- Wolfgang Hitzl
- Research Office, Biostatistics, Paracelsus Medical University Salzburg & Nuremberg, Strubergasse 21, 5020, Salzburg, Austria
| | - Stephan Heisinger
- Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Gerhard M Hobusch
- Department of Traumatology, Medical University of Vienna, Währinger Gürtel 18-20, 1090, Vienna, Austria
| | - Konstantin Frank
- Department for Hand, Plastic and Aesthetic Surgery, Ludwig-Maximilian-University Munich, Pettenkoferstr. 8a, 80336, Munich, Germany
| | - Sebastian Cotofana
- Department of Medical Education, Albany Medical College, 47 New Scotland Avenue MC-135, 12208, Albany, NY, USA.
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238
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Objectively measured early physical activity after total hip or knee arthroplasty. J Clin Monit Comput 2018; 33:509-522. [PMID: 30039461 DOI: 10.1007/s10877-018-0185-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Accepted: 07/17/2018] [Indexed: 01/07/2023]
Abstract
Although reduced early physical function after total hip- and knee arthroplasty (THA/TKA) is well-described, the underlying reasons have not been clarified with detailed studies on pathophysiological mechanisms related to recovery, thereby prohibiting advances in rehabilitation. Thus, we aimed to describe early post-THA/TKA physical activity measured by actigraphy and potential underlying pathophysiological mechanisms related to recovery in a well-defined cohort of THA and TKA patients. Daytime-activity was measured from 2 days before until 13 (THA) or 20 (TKA) days after surgery. The primary outcome was individualized recovery in activity, with secondary analyses of activity-intensities and association to the perioperative factors: sex, age, BMI, hemoglobin (hgb), C-reactive protein and postoperative pain. Eighty-one THA/TKA-patients were examined. A large inter-individual variation in early physical activity was found. On a group level, activity was significantly reduced compared to preoperatively the first 2 (THA) or 3 (TKA) weeks after surgery (mean-difference - 64 counts × 103/day, p < 0.001 and - 78 counts × 103/day, p < 0.001, respectively). All activity-intensities were affected with the largest decline in high intense activity. A slight overall improvement in activity was seen during the postoperative phase [THA: 1%/day (SD 2.15); TKA: 0.7%/day (SD 1.04)], but approximately 30% of THA and 20% of TKA patients had reduced and declining activity. Hgb, CRP, BMI (THA) and postoperative pain (TKA) were only weakly associated with impaired physical activity. Physical activity was reduced the first weeks following THA/TKA, but with large inter-individual variations in recovery profiles. No single pathogenic factor was associated with a poor recovery. Early risk stratified interventions are needed in patients on a suboptimal course.
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Zhu X, Sang L, Wu D, Rong J, Jiang L. Effectiveness and safety of glucosamine and chondroitin for the treatment of osteoarthritis: a meta-analysis of randomized controlled trials. J Orthop Surg Res 2018; 13:170. [PMID: 29980200 PMCID: PMC6035477 DOI: 10.1186/s13018-018-0871-5] [Citation(s) in RCA: 59] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Accepted: 06/25/2018] [Indexed: 12/20/2022] Open
Abstract
Objective To assess the symptomatic effectiveness and safety of oral symptomatic slow-acting drugs (SYSADOAs) on the treatment of knee and/or hip osteoarthritis, such as chondroitin, glucosamine, and combination treatment with chondroitin plus glucosamine. Methods We searched electronic database including PubMed, Embase, Cochrane Library, and the reference lists of relevant articles published from inception to May 22, 2018. An updated meta-analysis was performed to assess the effectiveness of these slow-acting drugs for osteoarthritis. Results Twenty-six articles describing 30 trials met our inclusion criteria and were included in the meta-analysis. The estimates between chondroitin and placebo showed that chondroitin could alleviate pain symptoms and improve function. Compared with placebo, glucosamine proved significant effect only on stiffness improvement. However, the combination therapy did not have enough evidence to be superior to placebo. Additionally, there was no significant difference in the incidence of AEs and discontinuations of AEs when compared with placebo. Conclusions Given the effectiveness of these symptomatic slow-acting drugs, oral chondroitin is more effective than placebo on relieving pain and improving physical function. Glucosamine showed effect on stiffness outcome. Regarding on the limited number of combination therapy, further studies need to investigate the accurate effectiveness. This information accompanied with the tolerability and economic costs of included treatments would be conducive to making decisions for clinicians. Electronic supplementary material The online version of this article (10.1186/s13018-018-0871-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Xiaoyue Zhu
- Baoshan Center for Disease Control and Prevention, Shanghai, People's Republic of China
| | - Lingli Sang
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Dandong Wu
- Department of Epidemiology, School of Public Health, Nantong University, Nantong, Jiangsu Province, People's Republic of China
| | - Jiesheng Rong
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Harbin Medical University, Harbin, Heilongjiang Province, People's Republic of China
| | - Liying Jiang
- Shanghai Key Laboratory for Molecular Imaging, Shanghai University of Medicine & Health Sciences, Shanghai, People's Republic of China.
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Ferreira MDC, Oliveira JCP, Zidan FF, Franciozi CEDS, Luzo MVM, Abdalla RJ. Artroplastia total de joelho e quadril: a preocupante realidade assistencial do Sistema Único de Saúde brasileiro. Rev Bras Ortop 2018. [DOI: 10.1016/j.rbo.2016.11.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
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Christiansen MB, Thoma LM, Master H, Schmitt LA, Pohlig R, White DK. A Physical Therapist-Administered Physical Activity Intervention After Total Knee Replacement: Protocol for a Randomized Controlled Trial. Phys Ther 2018; 98:578-584. [PMID: 29608733 PMCID: PMC6692704 DOI: 10.1093/ptj/pzy037] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 03/27/2018] [Indexed: 01/16/2023]
Abstract
BACKGROUND The definitive treatment for knee osteoarthritis is a total knee replacement, which results in a clinically meaningful improvement in pain and physical function. However, evidence suggests that physical activity (PA) remains unchanged after total knee replacement (TKR). OBJECTIVE The objective of this study is to investigate the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR. DESIGN This study will be a randomized controlled trial. SETTING The setting is an outpatient physical therapy clinic. PARTICIPANTS The participants are 125 individuals who are over the age of 45 and are seeking outpatient physical therapy following a unilateral TKR. INTERVENTION In addition to standardized physical therapy after TKR, the intervention group will receive, during physical therapy, a weekly PA intervention that includes a wearable activity tracking device, individualized step goals, and face-to-face feedback provided by a physical therapist. CONTROL The control group will receive standardized physical therapy alone after TKR. MEASUREMENTS The efficacy of the intervention will be measured as minutes per week spent in moderate to vigorous PA at enrollment, at discharge, and at 6 months and 12 months after discharge from physical therapy. The fidelity and safety of the intervention will be assessed throughout the study. LIMITATIONS Participants will not be masked, PA data will be collected after randomization, and the trial will be conducted at a single site. CONCLUSIONS The goal of this randomized controlled trial is to increase PA after TKR. A protocol for investigating the efficacy, fidelity, and safety of a physical therapist-administered PA intervention for people after TKR is presented. The findings will be used to support a large multisite clinical trial to test the effectiveness, implementation, and cost of this intervention.
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Affiliation(s)
- Meredith B Christiansen
- Department of Physical Therapy and Department of Biomechanics and Movement Science, University of Delaware, Newark, Delaware
| | | | - Hiral Master
- Department of Physical Therapy and Department of Biomechanics and Movement Science, University of Delaware
| | | | - Ryan Pohlig
- College of Health Sciences, University of Delaware
| | - Daniel K White
- Department of Physical Therapy and the Department of Biomechanics and Movement Science, University of Delaware, STAR Health Sciences Complex, 540 South College Avenue, Newark, DE 19713,Address all correspondence to Dr. White at:
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Brandes M, Wirsik N, Niehoff H, Heimsoth J, Möhring B. Impact of a tailored activity counselling intervention during inpatient rehabilitation after knee and hip arthroplasty - an explorative RCT. BMC Musculoskelet Disord 2018; 19:209. [PMID: 29960605 PMCID: PMC6026519 DOI: 10.1186/s12891-018-2130-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 06/11/2018] [Indexed: 01/24/2023] Open
Abstract
Background The aim of the study was to improve physical activity (PA), well-being and clinical outcome after total knee and hip arthroplasty through tailored activity counselling during inpatient rehabilitation. Methods 65 patients (aged 70.4 ± 7.3 years, BMI 28.5 ± 4.3) starting inpatient rehabilitation after primary knee or hip arthroplasty due to osteoarthritis were recruited and pseudo-randomized into an intervention (IG) and a control group (CG). Twice a week, the IG was encouraged to increase their daily step count by 5%. PA, e. g. number of steps, step frequency, or active minutes, was measured by step activity monitoring. Well-being and clinical outcome were assessed using the SF-36, Oxford Knee/Hip Score and Global rating of Change. Procedures were conducted at the onset of inpatient rehabilitation, and repeated one and 6 months after inpatient rehabilitation. Results Data sets were obtained from 49 patients (IG: n = 23, CG: n = 26). Both groups significantly increased their number of daily steps from the 1 month to the 6 months follow up after rehabilitation: CG: 9019 (95%CI: 7812, 10,226), IG: 9280 (7972, 10,588) and CG: 10921 (9571, 12,271), IG: 11326 (9862, 12,791) respectively. Additionally, well-being and clinical outcome improved significantly in both groups. No significant differences in physical activity, clinical outcome and well-being were found between the groups. Conclusions PA counselling during inpatient rehabilitation does not improve PA, well-being and clinical outcome in patients with primary knee or hip arthroplasty in addition to the rehabilitation program. PA interventions may be more effective after the completion of the inpatient rehabilitation phase. Trial registration DRKS DRKS00012682. Registered retrospectively on 03–07- 2017.
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Affiliation(s)
- Mirko Brandes
- Department of Prevention and Evaluation, Unit Applied Health Intervention Research, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Achterstraße 30, 28359, Bremen, Germany.
| | - Norman Wirsik
- Department of Biometry and Data Management, Unit Statistical Modelling of Primary Data, Leibniz Institute for Prevention Research and Epidemiology - BIPS GmbH, Bremen, Germany
| | - Hanna Niehoff
- Institute of Sports Science, Oldenburg University, Oldenburg, Germany
| | - Jörg Heimsoth
- Orthopaedic Department, Rehabilitation Centre Oldenburg, Oldenburg, Germany
| | - Bernd Möhring
- Orthopaedic Department, Rehabilitation Centre Oldenburg, Oldenburg, Germany
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243
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Jönsson T, Ekvall Hansson E, Thorstensson CA, Eek F, Bergman P, Dahlberg LE. The effect of education and supervised exercise on physical activity, pain, quality of life and self-efficacy - an intervention study with a reference group. BMC Musculoskelet Disord 2018; 19:198. [PMID: 30037339 PMCID: PMC6055349 DOI: 10.1186/s12891-018-2098-3] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 05/17/2018] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Individuals with knee and hip osteoarthritis (OA) are less physically active than people in general, and many of these individuals have adopted a sedentary lifestyle. In this study we evaluate the outcome of education and supervised exercise on the level of physical activity in individuals with knee or hip OA. We also evaluate the effect on pain, quality of life and self-efficacy. METHODS Of the 264 included individuals with knee or hip OA, 195 were allocated to the intervention group. The intervention group received education and supervised exercise that comprised information delivered by a physiotherapist and individually adapted exercises. The reference group consisted of 69 individuals with knee or hip OA awaiting joint replacement and receiving standard care. The primary outcome was physical activity (as measured with an accelerometer). The secondary outcomes were pain (Visual Analog Scale), quality of life (EQ-5D), and self-efficacy (Arthritis Self-Efficacy Scale, pain and other symptoms subscales). Participants in both groups were evaluated at baseline and after 3 months. The intervention group was also evaluated after 12 months. RESULTS No differences were found in the number of minutes spent in sedentary or in physical activity between the intervention and reference groups when comparing the baseline and 3 month follow-up. However, there was a significant difference in mean change (mean diff; 95% CI; significance) between the intervention group and reference group favoring the intervention group with regard to pain (13; 7 to 19; p < 0.001), quality of life (- 0.17; - 0.24 to - 0.10; p < 0.001), self-efficacy/other symptoms (- 5; - 10 to - 0.3; p < 0.04), and self-efficacy/pain (- 7; - 13 to - 2; p < 0.01). Improvements in pain and quality of life in the intervention group persisted at the 12-month follow-up. CONCLUSIONS Participation in an education and exercise program following the Swedish BOA program neither decreased the average amount of sedentary time nor increased the level of physical activity. However, participation in such a program resulted in decreased pain, increased quality of life, and increased self-efficacy. TRIAL REGISTRATION The trial is registered with ClinicalTrials.gov. Registration number: NCT02022566 . Retrospectively registered 12/18/2013.
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Affiliation(s)
- Thérése Jönsson
- Department of Clinical Sciences Lund, Orthopedics, Skane University Hospital, Lund University, Lund, Sweden
- BOA Registry, Centre of Registries, Västra Götaland, Gothenburg, Sweden
| | - Eva Ekvall Hansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Carina A. Thorstensson
- Department of Clinical Neuroscience and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frida Eek
- Department of Health Sciences, Division of Physiotherapy, Lund University, Lund, Sweden
| | - Patrick Bergman
- Department of Sport Science, Linnaeus University, Kalmar, Sweden
| | - Leif E. Dahlberg
- Department of Clinical Sciences Lund, Orthopedics, Skane University Hospital, Lund University, Lund, Sweden
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Ferreira MDC, Oliveira JCP, Zidan FF, Franciozi CEDS, Luzo MVM, Abdalla RJ. Total knee and hip arthroplasty: the reality of assistance in Brazilian public health care. Rev Bras Ortop 2018; 53:432-440. [PMID: 30027075 PMCID: PMC6052187 DOI: 10.1016/j.rboe.2018.05.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2016] [Accepted: 11/10/2016] [Indexed: 11/19/2022] Open
Abstract
Objective To analyze the number of hospital permits for total knee arthroplasty (TKA) and total hip arthroplasty (THA) in Brazil between 2008 and 2015, and correlate them with regional, national, and international demographic and epidemiological aspects. Methods Data on demographics, economic level, and TKA and THA were obtained from the website of the Ministry of Health/DATASUS, Brazilian Institute of Geography and Statistics, and the National Health Agency to assess the assistance provided by the Public Health Care System in arthroplasties for elderly Brazilian population without private health care. Results The South and Southeast had the best care, with 8.07 and 6.07 TKAs/100,000 inhabitants, one TKA per 1811 and 2624 seniors, 17.3 and 10.99 THAs/100,000 inhabitants, and one THA per 923 and 1427 seniors, respectively. The worst rates were found in the North and Northeast, with 0.88 and 0.98 TKAs/100,000, one TKA per 6930 and 10,411 seniors, 0.96 and 3.25 THAs/100,000, and one THA per 6849 and 2634 seniors, respectively. The national average was 4.00 TKAs/100,000, one TKA per 3249 seniors, 8.01 THAs/100,000, and one THA per 1586 seniors. The international average was 142.8 TKAs/100,000 and 191.8 THAs/100,000. Conclusion The results expressed unsatisfactory results for TKA and THA in Brazil, with greater relevance in the North and Northeast.
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245
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Bert J, Kenney J, Sgaglione NA, McClelland S, Brophy R, Toth J, Ruane J, Ali Y, Arquette S, Dasa V, Lopes M. Viscosupplementation for Osteoarthritis of the Knee: A Key Opinion Leader Panel Discussion. J Manag Care Spec Pharm 2018; 24:S2-S8. [PMID: 29851537 PMCID: PMC10408395 DOI: 10.18553/jmcp.2018.24.6-a.s2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
UNLABELLED With a sharp rise in the prevalence of osteoarthritis of the knee (OAK) in a younger population, new management strategies are needed to preserve mobility, improve patients' quality of life, and reduce the effects of potential disease-related comorbidities. Viscosupplementation with the use of hyaluronic acid (HA) injection is a treatment option for OAK that can provide lubrication and elastic shock absorption, leading to potential pain relief, improved function, and reduced stiffness. A key opinion leader (KOL) panel discussion was held December 3, 2016, with the objective of sharing opinions, ideas, information, and trends regarding OAK and the potential treatment and management offered by viscosupplementation. The panel concluded that viscosupplementation with HA injections presents a viable, cost-effective, and safe alternative for the treatment of OAK. DISCLOSURES This panel discussion and report was facilitated by Magellan Rx Manage-ment and funded by Sanofi. Bert and Ruane report fees from Sanofi outside of this project. Sgaglione reports royalty payments from Zimmer Biomet and Wolters Kluwer. Dasa has received fees from Bioventus and Myoscience. All the authors received an honorarium for work on this project. Lopes is employed by Magellan Rx Management.
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Affiliation(s)
- Jack Bert
- 1 University of Minnesota School of Medicine, Minneapolis
| | - Jim Kenney
- 2 Harvard Pilgrim Healthcare, Wellesley, Massachusetts
| | | | | | - Robert Brophy
- 5 Washington University School of Medicine, St. Louis, Missouri
| | - John Toth
- 6 Yale Health, New Haven, Connecticut
| | - Joseph Ruane
- 7 McConnell Spine, Sport, and Joint Center, Columbus, Ohio, and Ohio University College of Osteopathic Medicine, Athens
| | - Yousaf Ali
- 8 Icahn School of Medicine at Mt. Sinai, New York, New York
| | | | - Vinod Dasa
- 10 Louisiana State University Health Sciences Center, New Orleans; Oschner Kenner Medical Center, Kenner, Louisiana; Vector Medical, Boca Raton, Florida; and Touro University Nevada College of Osteopathic Medicine, Henderson, Nevada
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Physical Activity and Exercise Therapy Benefit More Than Just Symptoms and Impairments in People With Hip and Knee Osteoarthritis. J Orthop Sports Phys Ther 2018; 48:439-447. [PMID: 29669488 DOI: 10.2519/jospt.2018.7877] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Synopsis Osteoarthritis (OA) of the hip and knee is among the leading causes of global disability, highlighting the need for early, targeted, and effective treatment. The benefits of exercise therapy in people with hip and knee OA are substantial and supported by high-quality evidence, underlining that it should be part of first-line treatment in clinical practice. Furthermore, unlike other treatments for OA, such as analgesia and surgery, exercise therapy is not associated with risk of serious harm. Helping people with OA become more physically active, along with structured exercise therapy targeting symptoms and impairments, is crucial, considering that the majority of people with hip and knee OA do not meet physical activity recommendations. Osteoarthritis is associated with a range of chronic comorbidities, including type 2 diabetes, cardiovascular disease, and dementia, all of which are associated with chronic low-grade inflammation. Physical activity and exercise therapy not only improve symptoms and impairments of OA, but are also effective in preventing at least 35 chronic conditions and treating at least 26 chronic conditions, with one of the potential working mechanisms being exercise-induced anti-inflammatory effects. Patient education may be crucial to ensure long-term adherence and sustained positive effects on symptoms, impairments, physical activity levels, and comorbidities. J Orthop Sports Phys Ther 2018;48(6):439-447. Epub 18 Apr 2018. doi:10.2519/jospt.2018.7877.
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Education and Social Support as Key Factors in Osteoarthritis Management Programs: A Scoping Review. ARTHRITIS 2018; 2018:2496190. [PMID: 29854457 PMCID: PMC5964569 DOI: 10.1155/2018/2496190] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/19/2017] [Revised: 02/07/2018] [Accepted: 03/07/2018] [Indexed: 11/18/2022]
Abstract
Systematic reviews of self-management programs for osteoarthritis suggest minimal evidence of benefit and indicate substantial heterogeneity in interventions. The purpose of this scoping review was to describe the nature of self-management interventions provided to patients with osteoarthritis focusing on the inclusion and type of education and social support components. We searched PsycINFO, EMBASE, MEDLINE, and Cochrane Library databases from 1990 to 2016 to identify studies addressing community-based management strategies for osteoarthritis that included aspects of disease-specific education and ongoing social support. Results are presented as a narrative synthesis to facilitate integration of diverse evidence. Data were extracted from 23 studies that met our inclusion and exclusion criteria, describing complex, multicomponent interventions for osteoarthritis. All studies included education components, and 18 of these were osteoarthritis-specific. Social support was most often offered through peers and health care professionals, but also through exercise trainers/instructors and researchers, and lasted between 5 and 52 weeks. We charted positive social interaction offered by peers in group settings and emotional/informational support offered by health care professionals. Overall, descriptions of self-management provided limited documentation of the rationale or content of the programs. This suggests that more precise definitions of the theoretical underpinnings, components, and mechanisms would be useful for greater insight into best practices for osteoarthritis self-management programs.
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Biological Treatment for Osteoarthritis of the Knee: Moving from Bench to Bedside-Current Practical Concepts. Arthroscopy 2018; 34:1719-1729. [PMID: 29628381 DOI: 10.1016/j.arthro.2018.01.048] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 01/08/2018] [Accepted: 01/26/2018] [Indexed: 02/02/2023]
Abstract
Biological-based therapies for cartilage pathology have gained considerable recognition in the last few decades due to their potential benefits including their minimal invasiveness, capacity for unprecedented healing, and potential for rapid recovery. Consequently, these therapies are likely to have the most noteworthy impact on patients with degenerative joint changes who want to remain active. Currently, the most researched treatments include platelet-rich plasma (PRP), bone marrow aspirate concentrate (BMAC), and cell-based therapies. Although further basic science research and well-designed randomized clinical trials are needed to elucidate the long-term role of these therapies in the treatment of osteoarthritis, there is compelling evidence for their use for certain indications. This article aims to review the existing literature for biological-based treatment options for osteoarthritis, critically assessing the current evidence-based recommendations and identify potential avenues for development.
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249
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Injections for Knee Osteoarthritis: Corticosteroids, Viscosupplementation, Platelet-Rich Plasma, and Autologous Stem Cells. Arthroscopy 2018; 34:1730-1743. [PMID: 29656808 DOI: 10.1016/j.arthro.2018.02.022] [Citation(s) in RCA: 40] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2017] [Revised: 02/10/2018] [Accepted: 02/13/2018] [Indexed: 02/08/2023]
Abstract
This article reviews the benefits of corticosteroid, viscosupplementation, platelet-rich plasma, and autologous mesenchymal stem cell injections for the treatment of patients with knee osteoarthritis. Integrating injections into both clinical and surgical practices is complicated given existing health insurance reimbursement policies. This review describes the outcomes associated with these interventions and appropriate methods of navigating the existing reimbursement pathways to help providers implement these treatments into their practices.
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250
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Reliability and Construct Validity of the SENS Motion® Activity Measurement System as a Tool to Detect Sedentary Behaviour in Patients with Knee Osteoarthritis. ARTHRITIS 2018; 2018:6596278. [PMID: 29686901 PMCID: PMC5852870 DOI: 10.1155/2018/6596278] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/24/2017] [Revised: 12/20/2017] [Accepted: 01/21/2018] [Indexed: 11/22/2022]
Abstract
Physical inactivity is important to address, and an objective way of measuring inactivity is by accelerometry. The objective of this study was to determine the reliability and construct validity of the SENS motion system to record physical activity and inactivity in patients with knee osteoarthritis. Participants with an age > 40 years and an average weekly pain above 0 on a numeric rating scale (0 = no pain, 10 = worst pain) were included. Participants had a total of two study visits and at each visit participants completed a standardized activity. Data from 24 participants were analysed. A mean agreement of 99% (SD 3%) for sedentary behaviour and a mean agreement of 97% (SD 9%) for active behaviour were found. The agreement for “walking” was 28% (SD 18%). Mean agreement between recordings on the two visits was 96% (SD 8%) for sedentary behaviour and 99% (SD 1%) for active behaviour. The SENS motion activity measurement system can be regarded as a reliable and valid device for measuring sedentary behaviour in patients with knee OA, whereas detection of walking is not reliable and would require further work.
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