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Mohamed KE, Larsen AT, Melander S, Andersen F, Kerrn EB, Karsdal MA, Henriksen K. The dual amylin and calcitonin receptor agonist KBP-336 elicits a unique combination of weight loss, antinociception and bone protection - a novel disease-modifying osteoarthritis drug. Arthritis Res Ther 2024; 26:129. [PMID: 38997785 PMCID: PMC11241783 DOI: 10.1186/s13075-024-03361-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 06/30/2024] [Indexed: 07/14/2024] Open
Abstract
BACKGROUND Despite the extensive research to provide a disease-modifying osteoarthritis drug (DMOAD), there is still no approved DMOAD. Dual amylin and calcitonin receptor agonists (DACRA) can provide metabolic benefits along with antinociceptive and potential structural preserving effects. In these studies, we tested a DACRA named KBP-336 on a metabolic model of OA in meniscectomised (MNX) rats. METHODS We evaluated KBP-336's effect on pain-like symptoms in Sprague Dawley (SD) rats on high-fat diet (HFD) that underwent meniscectomy using the von Frey test to measure the 50% paw withdrawal threshold (PWT) and analyzed using one-way ANOVA. Short in vivo studies and in vitro cell receptor expression systems were used to illustrate receptor pharmacology. RESULTS After 30 weeks on HFD, including an 8-week treatment, female MNX animals receiving KBP-336 4.5 nmol/Kg/72 h had lower body weight and smaller adipose tissues than their vehicle-treated counterparts. After 20 weeks on HFD, including an 8-week treatment, male rats receiving KBP-336 had lower body weight than the vehicle group. In both the female and male rats, the MNX groups on KBP-336 treatment had a higher PWT than the vehicle-treated MNX group. Aiming to identify the receptor influencing pain alleviation, KBP-336 was compared to the long-acting human calcitonin (hCTA). Single-dose studies on 12-week-old male rats showed that hCTA lowers CTX-I without affecting food intake, confirming its calcitonin receptor selectivity. On the metabolic OA model with 18 weeks of HFD, including 6-week treatment, hCTA at 100 nmol/Kg/24 h and KBP-336 at 0.5, 1.5, and 4.5 nmol/Kg/72 h produced significantly higher PWT in MNX animals compared to MNX animals on vehicle treatment. hCTA and KBP-336 at 0.5 nmol/Kg did not affect body weight and fat tissues. CONCLUSION Overall, KBP-336 improved the pain observed in the metabolic OA model. Calcitonin receptor activation proved to be essential in this antinociceptive effect.
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Affiliation(s)
- Khaled Elhady Mohamed
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark.
- Department of Drug Design and Pharmacology, University of Copenhagen, Copenhagen, Denmark.
| | - Anna Thorsø Larsen
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark
| | - Simone Melander
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark
| | - Frederik Andersen
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark
| | - Ellen Barendorff Kerrn
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark
| | - Morten Asser Karsdal
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark
- KeyBioscience AG, Stans, Switzerland
| | - Kim Henriksen
- Nordic Bioscience Biomarkers and Research, Herlev Hovedgade 207, Herlev, DK-2730, Denmark
- KeyBioscience AG, Stans, Switzerland
- Department of Molecular and Medical Biology, Roskilde University Center, Roskilde, Denmark
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Ng N, Parkinson L, Brown WJ, Moorin R, Peeters GMEEG. Lifestyle behaviour changes associated with osteoarthritis: a prospective cohort study. Sci Rep 2024; 14:6242. [PMID: 38485979 PMCID: PMC10940587 DOI: 10.1038/s41598-024-54810-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 02/16/2024] [Indexed: 03/18/2024] Open
Abstract
The aim of this prospective cohort study was to compare changes in lifestyle behaviours over nine years in women who were and were not diagnosed with osteoarthritis (OA). Data were from the 1945-51 cohort of the Australian Longitudinal Study on Women's Health (aged 50-55 in 2001) who completed written surveys in 2001, 2004, 2007 and 2010. The sample included 610 women who were, and 3810 women who were not diagnosed with OA between 2004 and 2007. Descriptive statistics were used to assess changes in lifestyle behaviours (weight, sitting time, physical activity, alcohol and smoking) in the two groups, over three survey intervals: from 2001-2004 (prior to diagnosis); from 2004-2007 (around diagnosis); and from 2007-2010 (following diagnosis). Compared with women without OA (28%), a greater proportion of women with OA (38%) made at least one positive lifestyle change (p < 0.001). These included losing > 5 kg (9.8% vs. 14.4%, p < 0.001), and reducing sitting time by an hour (29.5% vs. 39.1%, p < 0.001) following diagnosis. However, women with OA also made negative lifestyle changes (35% vs. 29%, p < 0.001), for example, gaining > 5 kg around the time of diagnosis (21.4% vs. 14.5%, p < 0.001) and increasing sitting time by an hour following diagnosis (38.4% vs. 32.3%, p = 0.003). More women with OA also started smoking following diagnosis (8.9% vs. 0.8%, p < 0.001). While some women made positive changes in lifestyle behaviours during and following OA diagnosis, others made negative changes. Consistent support from clinicians for managing OA symptoms may enable patients to make more positive changes in lifestyle behaviours.
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Affiliation(s)
- Norman Ng
- School of Human Movement and Nutrition Science (#26B), The University of Queensland, Blair Drive, St Lucia Campus, Brisbane, QLD, 4072, Australia.
| | | | - Wendy J Brown
- School of Human Movement and Nutrition Science (#26B), The University of Queensland, Blair Drive, St Lucia Campus, Brisbane, QLD, 4072, Australia
- Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia
| | - Rachael Moorin
- School of Public Health, Curtin University, Perth, Australia
| | - G M E E Geeske Peeters
- Department of Geriatric Medicine, Radboud University Medical Centre, Nijmegen, Netherlands
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Haag L, Richardson J, Haig C, Cunningham Y, Fraser H, Brosnahan N, Ibbotson T, Ormerod J, White C, McIntosh E, O'Donnell K, Sattar N, McConnachie A, Lean M, Blane D, Combet E. Baseline Characteristics in the Remote Diet Intervention to REduce long-COVID Symptoms Trial (ReDIRECT). NIHR OPEN RESEARCH 2024; 4:7. [PMID: 39145102 PMCID: PMC11320183 DOI: 10.3310/nihropenres.13522.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 01/19/2024] [Indexed: 08/16/2024]
Abstract
Background The persistence of symptoms for ≥12 weeks after a COVID-19 infection is known as Long COVID (LC), a condition with unclear pathophysiology and no proven treatments to date. Living with obesity is a risk factor for LC and has symptoms which may overlap with and aggravate LC. Methods ReDIRECT is a remotely delivered trial assessing whether weight management can reduce LC symptoms. We recruited people with LC and BMI >27kg/m 2. The intervention was delivered remotely by dietitians, with online data collection (medical and dietary history, COVID-19 infection and vaccination, body composition, LC history/symptoms, blood pressure, quality of life, sociodemographic data). Participants self-selected the dominant LC symptoms they most wanted to improve from the intervention. Results Participants (n=234) in England (64%) and Scotland (30%) were mainly women (85%) of white ethnicity (90%), with 13% living in the 20% most deprived areas, a mean age of 46 (SD10) years, and median BMI of 35kg/m 2 (IQR 32-40). Before starting the study, 30% reported more than one COVID-19 infection (82% confirmed with one or more positive tests). LC Diagnosis was mainly by GPs (71%), other healthcare professionals (9%), or self-diagnosed (21%). The median total number of symptoms was 6 (IQR 4-8). Self-selected dominant LC symptoms included fatigue (54%), breathlessness (16%), pain (12%), anxiety/depression (1%) and "other" (17%). At baseline, 82% were taking medication, 57% reported 1+ other medical conditions. Quality of life was poor; 20% were on long-term sick leave or reduced working hours. Most (92%) reported having gained weight since contracting COVID-19 (median weight change +11.5 kg, range -11.5 to +45.3 kg). Conclusions Symptoms linked to LC and overweight are diverse and complex. Remote trial delivery enabled rapid recruitment across the UK yet certain groups (e.g. men and those from ethnic minority groups) were under-represented. Trial registration ISRCTN registry ( ISRCTN12595520, 25/11/2021).
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Affiliation(s)
- Laura Haag
- Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, G31 2ER, UK
| | - Janice Richardson
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Caroline Haig
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Yvonne Cunningham
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Heather Fraser
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | | | - Tracy Ibbotson
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | | | | | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Kate O'Donnell
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Mike Lean
- Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, G31 2ER, UK
| | - David Blane
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, G12 8TA, UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, Scotland, G31 2ER, UK
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Salis Z, Driban JB, McAlindon TE, Sainsbury A. Evaluation of a measure of end-stage knee osteoarthritis compared to total knee replacement: An observational study using multicohort data. Semin Arthritis Rheum 2024; 64:152336. [PMID: 38096677 DOI: 10.1016/j.semarthrit.2023.152336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 10/31/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To determine if an end-stage knee osteoarthritis (esKOA) measure, based on symptomatic and radiographic criteria, can indicate progression to severe KOA earlier and with fewer research participants than total knee replacement (TKR). We employed both interventional and observational study designs as examples to estimate the required sample sizes. EsKOA in a knee was declared if either of the following two conditions were met: 1) moderate, intense, or severe symptoms of KOA indicated by pain and disability measurement and severe KOA indicated by radiographically-assessed knee structure; 2) intense or severe symptoms of KOA indicated by pain and disability measurement and frequent knee pain with mild or moderate KOA as indicated by radiographically-assessed knee structure. METHODS We examined the association between weight loss from baseline to 2-to-2.5-year and 4-to-5-year follow-ups and the odds of esKOA and TKR in 5,593 participants (10,357 knees) from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST). We also estimated the sample sizes needed for interventional and observational study designs to detect a 10, 20, or 50% reduction in the incidence of esKOA and TKR. RESULTS The association of weight loss with both esKOA and TKR was detected at the 4-to-5-year follow-up. However, at the 2-to-2.5-year follow-up, the association was detected for esKOA but not TKR. The required sample sizes for detecting associations of weight loss with the incidence of esKOA were 85% to 93% smaller than those for TKR at the 4-to-5-year and 2-to-2.5-year follow-ups, respectively. CONCLUSION The esKOA measure enables shorter and smaller studies compared to using TKR as an outcome.
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Affiliation(s)
- Zubeyir Salis
- Division of Rheumatology, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland; School of Human Sciences, The University of Western Australia, Perth, WA, Australia; Centre for Big Data Research in Health, The University of New South Wales, Kensington, NSW, Australia.
| | - Jeffrey B Driban
- Department of Population and Quantitative Health Sciences, UMass Chan Medical School, MA, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA, USA
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Perth, WA, Australia
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Tong B, Chen H, Wang M, Liu P, Wang C, Zeng W, Li D, Shang S. Association of body composition and physical activity with pain and function in knee osteoarthritis patients: a cross-sectional study. BMJ Open 2024; 14:e076043. [PMID: 38233052 PMCID: PMC10806729 DOI: 10.1136/bmjopen-2023-076043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2023] [Accepted: 12/18/2023] [Indexed: 01/19/2024] Open
Abstract
OBJECTIVE The objective of this study is to delineate disparities between patients with knee osteoarthritis (KOA) based on obesity status, investigate the interplay among body composition, physical activity and knee pain/function in patients with KOA and conduct subgroup analyses focusing on those with KOA and obesity. DESIGN Cross-sectional study. SETTING Residents of eight communities in Shijiazhuang, Hebei Province, China, were surveyed from March 2021 to November 2021. PARTICIPANTS 178 patients with symptomatic KOA aged 40 years or older were included. MAIN OUTCOMES AND MEASURES The primary outcome measure was knee pain, assessed using the Western Ontario and McMaster Universities Osteoarthritis Index-pain (WOMAC-P) scale. Secondary outcome measures included function, evaluated through the WOMAC-function (WOMAC-F) scale and the Five-Time-Sit-to-Stand Test (FTSST). Data analysis involved t-tests, Wilcoxon rank-sum tests, χ2 tests, linear and logistical regression analysis. RESULTS Participants (n=178) were 41-80 years of age (median: 65, P25-P75: 58-70), and 82% were female. Obese patients (n=103) had worse knee pain and self-reported function (p<0.05). In general patients with KOA, body fat mass was positively associated with bilateral knee pain (β=1.21 (95% CI 0.03 to 0.15)), WOMAC-P scores (β=0.25 (95% CI 0.23 to 1.22)), WOMAC-F scores (β=0.28 (95% CI 0.35 to 1.29)) and FTSST (β=0.19 (95% CI 0.03 to 0.42)), moderate-intensity to low-intensity physical activity was negatively associated with bilateral knee pain (β=-0.80 (95% CI -0.10 to -0.01)) and Skeletal Muscle Index (SMI) was negatively associated with WOMAC-F scores (β=-0.16 (95% CI -0.66 to -0.03)). In patients with KOA and obesity, SMI was negatively associated with FTSST (β=-0.30 (95% CI -3.94 to -0.00)). CONCLUSION Patients with KOA and obesity had worse knee pain and self-reported function compared with non-obese patients. Greater fat mass, lower muscle mass and lower moderate-intensity to low-intensity physical activity were associated with increased knee pain and poor self-reported function. More skeletal muscle mass was associated with the improvement of objective function.
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Affiliation(s)
- Beibei Tong
- Peking University School of Nursing, Peking University, Beijing, China
| | - Hongbo Chen
- Nursing Department of Peking University Third Hospital, Peking University Third Hospital, Beijing, China
| | - Mengqi Wang
- Peking University School of Nursing, Peking University, Beijing, China
| | - Peiyuan Liu
- Peking University School of Nursing, Peking University, Beijing, China
| | - Cui Wang
- Peking University School of Nursing, Peking University, Beijing, China
| | - Wen Zeng
- Peking University School of Nursing, Peking University, Beijing, China
| | - Dan Li
- Peking University School of Nursing, Peking University, Beijing, China
| | - Shaomei Shang
- Peking University School of Nursing, Peking University, Beijing, China
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Carlson SR, Imam N, Seidenstein A, Klein G. Evaluation of weight loss counsel for Osteoarthritis patients: A cross-sectional analysis of NHANES 2011-2018. Osteoarthritis Cartilage 2024; 32:82-92. [PMID: 37777150 DOI: 10.1016/j.joca.2023.08.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 08/23/2023] [Accepted: 08/29/2023] [Indexed: 10/02/2023]
Abstract
OBJECTIVE Though health care providers (HCPs) know the importance of weight loss counsel for Osteoarthritis (OA), little is known about how frequently it is practiced and even less of its effectiveness. Thus, we analyzed the prevalence and effectiveness of weight counsel receipt in overweight/obese OA patients. DESIGN Using 2011-2018 National Health and Nutrition Examination Survey data, we cross-sectionally analyzed overweight/obese patients in the United States to determine the prevalence of receipt of HCP weight counsel in those with OA and among other variables. We used multivariate logistic regression models to calculate odds ratios of being counseled and of achieving ten percent weight loss in groups with and without counsel. Mean weight losses were also compared among groups. RESULTS 39,156 patients were identified, of whom 1948 met inclusion criteria. Overall, 51.89% of overweight/obese OA patients received weight counseling. The odds of receiving counsel varied with several demographic variables. The odds of achieving 10% weight loss in those counseled was 1.84 times (95% confidence interval: 1.028, 3.299) that of those not counseled (p = 0.04). In contrast, patients counseled lost a mean of 0.49 pounds while those not counseled gained a mean of 0.03 pounds, a difference which was not statistically significant (p = 0.59). CONCLUSION Prevalence of weight counsel receipt for OA has not changed significantly between 2011 and 2018. Though counsel for weight more frequently leads to adequate weight loss in those with OA, the average weight loss is minimal regardless of counsel. Thus, refinement of this intervention may be needed to bolster weight loss.
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Affiliation(s)
- Steven R Carlson
- Hackensack Meridian School of Medicine, United States; Hackensack Meridian Health, Department of Orthopedics, United States.
| | - Nareena Imam
- Rutgers Robert Wood Johnson Medical School, United States.
| | - Ari Seidenstein
- Hackensack Meridian School of Medicine, United States; Hackensack Meridian Health, Department of Orthopedics, United States; Holy Name Medical Center, United States.
| | - Gregg Klein
- Hackensack Meridian School of Medicine, United States; Hackensack Meridian Health, Department of Orthopedics, United States; Holy Name Medical Center, United States.
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Vincent HK, Johnson AJ, Sibille KT, Vincent KR, Cruz-Almeida Y. Weight-cycling over 6 years is associated with pain, physical function and depression in the Osteoarthritis Initiative cohort. Sci Rep 2023; 13:17045. [PMID: 37813940 PMCID: PMC10562481 DOI: 10.1038/s41598-023-44052-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/03/2023] [Indexed: 10/11/2023] Open
Abstract
Body weight significantly impacts health and quality of life, and is a leading risk factor for the development of knee osteoarthritis (OA). Weight cycling may have more negative health consequences compared to steady high or low weight. Using the Osteoarthritis Initiative dataset, we investigated the effects of weight cycling on physical function, quality of life, and depression over 72-months compared to stable or unidirectional body weight trajectories. Participants (n = 731) had knee OA and were classified as: (1) stable-low (BMI < 25), (2) stable-overweight (BMI = 25-29.9), and (3) stable-obese (BMI ≥ 30); (4) steady-weight-loss; (5) steady-weight-gain (weight loss/gain ≥ 2.2 kg every 2-years); (6) gain-loss-gain weight cycling, and (7) loss-gain-loss weight cycling (weight loss/gain with return to baseline), based on bi-annual assessments. We compared Knee Injury and Osteoarthritis Outcome Knee-Related Quality of Life, Function in Sports and Recreation, Physical Activity in the Elderly, Short Form SF-12, repeated chair rise, 20-m gait speed, and Center for Epidemiological Studies Depression using repeated-measures ANOVA. The steady weight loss group demonstrated the worst pain, physical function, and depressive symptoms over time (p's < 0.05). More research is needed to confirm these findings, and elucidate the mechanisms by which steady weight loss is associated with functional decline in knee OA.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL, 32608, USA.
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.
| | - Alisa J Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
- Phenotyping and Assessment in Neuroscience Lab, University of Florida, Gainesville, FL, USA
| | - Kim T Sibille
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL, 32608, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Translational Research in Assessment and Intervention Lab, University of Florida, Gainesville, FL, USA
| | - Kevin R Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, PO Box 112730, Gainesville, FL, 32608, USA
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
- Department of Community Dentistry and Behavioral Science, University of Florida, Gainesville, FL, USA
- Phenotyping and Assessment in Neuroscience Lab, University of Florida, Gainesville, FL, USA
- Department of Neuroscience, University of Florida, Gainesville, FL, USA
- Department of Epidemiology, University of Florida, Gainesville, FL, USA
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Haag L, Richardson J, Cunningham Y, Fraser H, Brosnahan N, Ibbotson T, Ormerod J, White C, McIntosh E, O'Donnell K, Sattar N, McConnachie A, Lean MEJ, Blane DN, Combet E. The remote diet intervention to reduce Long COVID symptoms trial (ReDIRECT): protocol for a randomised controlled trial to determine the effectiveness and cost-effectiveness of a remotely delivered supported weight management programme for people with Long COVID and excess weight, with personalised improvement goals. NIHR OPEN RESEARCH 2023; 2:57. [PMID: 37881302 PMCID: PMC10593354 DOI: 10.3310/nihropenres.13315.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/28/2023] [Indexed: 10/27/2023]
Abstract
Objectves The Remote Diet Intervention to Reduce Long COVID Symptoms Trial (ReDIRECT) evaluates whether the digitally delivered, evidence-based, cost-effective Counterweight-Plus weight management programme improves symptoms of Long COVID in people with overweight/obesity. Methods Baseline randomised, non-blinded design with 240 participants allocated in a 1:1 ratio either to continue usual care or to add the remotely delivered Counterweight-Plus weight management programme, which includes a Counterweight dietitian supported delivery of 12 weeks total diet replacement, food reintroduction, and long-term weight loss maintenance. Randomisation is achieved by accessing a web-based randomisation system incorporated into the study web portal developed by a registered Clinical Trials Unit. We are using an innovative approach to outcome personalisation, with each participant selecting their most dominant Long COVID symptom as their primary outcome assessed at six months. Participants in the control arm enter the weight management programme after six months. We are recruiting participants from social media and existing networks (e.g., Long COVID Scotland groups), through newspaper advertisements and from primary care. Main inclusion criteria: people with Long COVID symptoms persisting > three months, aged 18 years or above, body mass index (BMI) above 27kg/m 2 (>25kg/m 2 for South Asians). The trial includes a process evaluation (involving qualitative interviews with participants and analysis of data on dose, fidelity and reach of the intervention) and economic evaluation (within-trial and long-term cost-utility analyses). Anticipated results The recruitment for this study started in December 2021 and ended in July 2022. Project results are not yet available and will be shared via peer-reviewed publication once the six-months outcomes have been analysed. Trial registration Current Controlled Trials ISRCTN12595520.
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Affiliation(s)
- Laura Haag
- Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G31 2ER, UK
| | - Janice Richardson
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, UK
| | - Yvonne Cunningham
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Heather Fraser
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | | | - Tracy Ibbotson
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | | | | | - Emma McIntosh
- Health Economics and Health Technology Assessment, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 8RZ, UK
| | - Kate O'Donnell
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Naveed Sattar
- School of Cardiovascular and Metabolic Health, University of Glasgow, Glasgow, G12 8TA, UK
| | - Alex McConnachie
- Robertson Centre for Biostatistics, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Michael E. J. Lean
- Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G31 2ER, UK
| | - David N. Blane
- General Practice & Primary Care, School of Health and Wellbeing, University of Glasgow, Glasgow, G12 9LX, UK
| | - Emilie Combet
- Human Nutrition, School of Medicine, Dentistry & Nursing, University of Glasgow, Glasgow, G31 2ER, UK
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Salis Z, Gallego B, Sainsbury A. Researchers in rheumatology should avoid categorization of continuous predictor variables. BMC Med Res Methodol 2023; 23:104. [PMID: 37101144 PMCID: PMC10134601 DOI: 10.1186/s12874-023-01926-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 04/18/2023] [Indexed: 04/28/2023] Open
Abstract
BACKGROUND Rheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology. METHODS We conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes. RESULTS For eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association). CONCLUSIONS Categorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.
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Affiliation(s)
- Zubeyir Salis
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Blanca Gallego
- The University of New South Wales, Centre for Big Data Research in Health, Kensington, NSW, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Crawley, Perth, WA, 6009, Australia.
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Ferreira AS, Mentiplay BF, Taborda B, Pazzinatto MF, de Azevedo FM, de Oliveira Silva D. Overweight and obesity in young adults with patellofemoral pain: Impact on functional capacity and strength. JOURNAL OF SPORT AND HEALTH SCIENCE 2023; 12:202-211. [PMID: 33296724 PMCID: PMC10105019 DOI: 10.1016/j.jshs.2020.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Revised: 10/05/2020] [Accepted: 10/29/2020] [Indexed: 05/04/2023]
Abstract
PURPOSE This study aimed to (a) investigate the proportion of overweight/obesity in a cohort of young adults with patellofemoral pain (PFP) and (b) explore the association of body mass index (BMI), body fat, and lean mass with functional capacity and hip and knee strength in people with PFP. METHODS We included a mixed-sex sample of young adults (18-35 years old) with PFP (n = 100). Measurements for BMI, percentage of body fat, and lean mass (assessed by bioelectrical impedance) were obtained. Functional capacity was assessed by the Anterior Knee Pain Scale, plank test, and single-leg hop test. Strength of the knee extensors, knee flexors, and hip abductors was evaluated isometrically using an isokinetic dynamometer. The proportion of overweight/obesity was calculated based on BMI. The association between BMI, body fat, and lean mass and functional capacity and strength was investigated using partial correlations, followed by hierarchical regression analysis, adjusted for covariates (sex, bilateral pain, and current pain level). RESULTS A total of 38% of our cohort had their BMI categorized as overweight/obese. Higher BMI was associated with poor functional capacity (ΔR2 = 0.06-0.12, p ≤ 0.001) and with knee flexion strength only (ΔR2 = 0.04, p = 0.030). Higher body fat was associated with poor functional capacity (ΔR2 = 0.05-0.15, p ≤ 0.015) and reduced strength (ΔR2 = 0.15-0.23, p < 0.001). Lower lean mass was associated with poor functional capacity (ΔR2 = 0.04-0.13, p ≤ 0.032) and reduced strength (ΔR2 = 0.29- 0.31, p < 0.001). CONCLUSION BMI, body fat, and lean mass should be considered in the assessment and management of young people with PFP because it may be detrimental to function and strength.
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Affiliation(s)
- Amanda Schenatto Ferreira
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil.
| | - Benjamin F Mentiplay
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Bianca Taborda
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil
| | - Marcella Ferraz Pazzinatto
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
| | - Fábio Mícolis de Azevedo
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil
| | - Danilo de Oliveira Silva
- Department of Physiotherapy, School of Science and Technology, Sao Paulo State University (UNESP), Presidente Prudente, 19060-900, Brazil; La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, VIC 3086, Australia
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11
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Solanki P, Hussain SM, Abidi J, Cheng J, Fairley JL, Page MJ, Cicuttini FM, Wluka AE. Association between weight gain and knee osteoarthritis: a systematic review. Osteoarthritis Cartilage 2023; 31:300-316. [PMID: 36511280 DOI: 10.1016/j.joca.2022.10.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 10/25/2022] [Accepted: 10/25/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE Although weight loss is recommended to manage knee osteoarthritis (KOA), adults tend to gain weight with age which may affect KOA symptoms and progression. We conducted a systematic review and data synthesis to investigate the association between weight gain and KOA, defined by clinical features, structural progression, and total knee replacement (TKR). DESIGN MEDLINE and EMBASE were systematically searched for controlled trials and cohort studies of participants with (or at risk of) KOA examining the relationship between weight gain and KOA clinical features (pain, function, quality of life), structural progression, and TKR. Risk of bias was assessed using the ROBINS-I tool. Results were organised by outcome, with meta-analyses performed where appropriate. RESULTS Twenty-three studies were included. Results showed significant detrimental effects of weight gain on pain (4 of 7 studies), stiffness (2 of 2 studies), function (5 of 6 studies), and the single studies examining quality of life, and clinical and radiographic KOA. Weight gain adversely affected cartilage (6 of 9 studies), bone marrow lesions (1 of 4 studies), meniscal damage (1 of 3 studies) and effusion/synovitis (1 of 1 study). Weight gain significantly increased TKR (3 of 6 studies): meta-analysis of 2 with available data demonstrated significant increases in TKR/5 kg weight gain in women, HR 1.34 (95% CI 1.18-1.51), and in men, HR 1.25 (95% CI 1.16-1.34). CONCLUSIONS Weight gain in adults is associated with increased clinical and structural KOA and TKR. Prevention of weight gain should be considered to improve outcomes in KOA.
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Affiliation(s)
- P Solanki
- School of Public Health and Preventive Medicine, Monash University, Australia; Alfred Health, Melbourne, Australia.
| | - S M Hussain
- School of Public Health and Preventive Medicine, Monash University, Australia.
| | - J Abidi
- School of Public Health and Preventive Medicine, Monash University, Australia.
| | - J Cheng
- School of Public Health and Preventive Medicine, Monash University, Australia; Alfred Health, Melbourne, Australia.
| | - J L Fairley
- Alfred Health, Melbourne, Australia; The University of Melbourne, Parkville, Australia.
| | - M J Page
- School of Public Health and Preventive Medicine, Monash University, Australia.
| | - F M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Australia; Alfred Health, Melbourne, Australia.
| | - A E Wluka
- School of Public Health and Preventive Medicine, Monash University, Australia; Alfred Health, Melbourne, Australia.
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12
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Kostic AM, Leifer VP, Gong Y, Robinson MK, Collins JE, Neogi T, Messier SP, Hunter DJ, Selzer F, Suter LG, Katz JN, Losina E. Cost-Effectiveness of Surgical Weight-Loss Interventions for Patients With Knee Osteoarthritis and Class III Obesity. Arthritis Care Res (Hoboken) 2023; 75:491-500. [PMID: 35657632 PMCID: PMC9827536 DOI: 10.1002/acr.24967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2022] [Revised: 05/20/2022] [Accepted: 05/31/2022] [Indexed: 01/12/2023]
Abstract
OBJECTIVE Class III obesity (body mass index [BMI] ≥40 kg/m2 ) is associated with worse knee pain and total knee replacement (TKR) outcomes. Because bariatric surgery yields sustainable weight loss for individuals with BMI ≥40 kg/m2 , our objective was to establish the value of Roux-en-Y gastric bypass (RYGB) and laparoscopic sleeve gastrectomy (LSG) in conjunction with usual care for knee osteoarthritis (OA) patients with BMI ≥40 kg/m2 . METHODS We used the Osteoarthritis Policy model to assess long-term clinical benefits, costs, and cost-effectiveness of RYGB and LSG. We derived model inputs for efficacy, costs, and complications associated with these treatments from published data. Primary outcomes included quality-adjusted life-years (QALYs), lifetime costs, and incremental cost-effectiveness ratios (ICERs), all discounted at 3%/year. This analysis was conducted from a health care sector perspective. We performed sensitivity analyses to evaluate uncertainty in input parameters. RESULTS The usual care + RYGB strategy increased the quality-adjusted life expectancy by 1.35 years and lifetime costs by $7,209, compared to usual care alone (ICER = $5,300/QALY). The usual care + LSG strategy yielded less benefit than usual care + RYGB and was dominated. Relative to usual care alone, both usual care + RYGB and usual care + LSG reduced opioid use from 13% to 4%, and increased TKR usage from 30% to 50% and 41%, respectively. For cohorts with BMI between 38 and 41 kg/m2 , usual care + LSG dominated usual care + RYGB. In the probabilistic sensitivity analysis, at a willingness-to-pay threshold of $50,000/QALY, usual care + RYGB and usual care + LSG were cost-effective in 70% and 30% of iterations, respectively. CONCLUSION RYGB offers good value among knee OA patients with BMI ≥40 kg/m2 , while LSG may provide good value among those with BMI between 35 and 41 kg/m2 .
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Affiliation(s)
- Aleksandra M. Kostic
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Valia P. Leifer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Yusi Gong
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Carle Illinois College of Medicine, Champaign, IL, USA
| | - Malcolm K. Robinson
- Harvard Medical School, Boston, MA, USA
- Department of Surgery, Brigham and Women’s Hospital, Boston, MA, USA
| | - Jamie E. Collins
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Tuhina Neogi
- Section of Rheumatology, Department of Medicine, Boston University of School of Medicine, Boston, MA, USA
| | - Stephen P. Messier
- Department of Health and Exercise Science, Wake Forest University, Salem, NC, USA
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital and Kolling Institute, University of Sydney, Sydney, Australia
| | - Faith Selzer
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
| | - Lisa G. Suter
- Section of Rheumatology, Yale School of Medicine, New Haven, CT, USA
- Section of Rheumatology, Veterans Affairs Medical Center, West Haven, CT, USA
- Center for Outcomes Research and Evaluation, Yale-New Haven Health System, New Haven, CT, USA
| | - Jeffrey N. Katz
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Section of Clinical Sciences, Division of Rheumatology, Immunology and Allergy, Brigham and Women’s Hospital, Boston, MA, USA
- Departments of Epidemiology and Environmental Health, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Elena Losina
- Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe), Department of Orthopaedic Surgery, Brigham and Women’s Hospital, Boston, MA, USA
- Harvard Medical School, Boston, MA, USA
- Department of Biostatistics, Boston University School of Public Health, Boston, MA
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13
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Mihalko SL, Messier SP. From weight loss to weight gain: utilizing the full spectrum of weight management for behavioral intervention. Osteoarthritis Cartilage 2023; 31:295-297. [PMID: 36473674 DOI: 10.1016/j.joca.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2022] [Revised: 11/26/2022] [Accepted: 11/30/2022] [Indexed: 12/12/2022]
Affiliation(s)
- S L Mihalko
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA; Department of Social Sciences and Health Policy, Wake Forest University School of Medicine, Winston-Salem, NC, USA.
| | - S P Messier
- J.B. Snow Biomechanics Laboratory, Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC, USA; Department of Rheumatology and Immunology, Wake Forest University School of Medicine, Winston-Salem, NC, USA
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14
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Manfredi JM, Jacob SI, Boger BL, Norton EM. A one-health approach to identifying and mitigating the impact of endocrine disorders on human and equine athletes. Am J Vet Res 2022; 84:ajvr.22.11.0194. [PMID: 36563063 DOI: 10.2460/ajvr.22.11.0194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Endocrinopathies affect multiple species in ever-increasing percentages of their populations, creating an opportunity to apply one-health approaches to determining creative preventative measures and therapies in athletes. Obesity and alterations in insulin and glucose dynamics are medical concerns that play a role in whole-body health and homeostasis in both horses and humans. The role and impact of endocrine disorders on the musculoskeletal, cardiovascular, and reproductive systems are of particular interest to the athlete. Elucidation of both physiologic and pathophysiologic mechanisms involved in disease processes, starting in utero, is important for development of prevention and treatment strategies for the health and well-being of all species. This review focuses on the unrecognized effects of endocrine disorders associated with the origins of metabolic disease; inflammation at the intersection of endocrine disease and related diseases in the musculoskeletal, cardiovascular, and reproductive systems; novel interventions; and diagnostics that are informed via multiomic and one-health approaches. Readers interested in further details on specific equine performance conditions associated with endocrine disease are invited to read the companion Currents in One Health by Manfredi et al, JAVMA, February 2023.
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Affiliation(s)
- Jane M Manfredi
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Sarah I Jacob
- Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Brooke L Boger
- Comparative Medicine and Integrative Biology, Department of Pathobiology and Diagnostic Investigation, College of Veterinary Medicine, Michigan State University, East Lansing, MI
| | - Elaine M Norton
- Department of Animal and Comparative Biomedical Sciences, College of Agriculture and Life Sciences, The University of Arizona, Tucson, AZ
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15
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Wiciński M, Szwedowski D, Wróbel Ł, Jeka S, Zabrzyński J. The Influence of Body Mass Index on Growth Factor Composition in the Platelet-Rich Plasma in Patients with Knee Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:40. [PMID: 36612361 PMCID: PMC9819567 DOI: 10.3390/ijerph20010040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 12/15/2022] [Accepted: 12/17/2022] [Indexed: 06/17/2023]
Abstract
BACKGROUND An abnormally high body mass index is strongly associated with knee osteoarthritis. Usually, obese patients are excluded from clinical trials involving PRP intra-articular injections. Growth factors have been demonstrated to have a disease-modifying effect on KOA treatment, even though data on their influence on treatment effectiveness in obese patients are lacking. PURPOSE To prospectively compare the level of selected growth factors including transforming growth factor-b (TGF-β), epidermal growth factor (EGF), fibroblast growth factor, insulin-like growth factor-1 (IGF-1), platelet-derived growth factor (PDGF), vascular endothelial growth factor (VEGF), and fibroblast growth factor-2 (FGF-2) in platelet-rich plasma (PRP) in obese patients and patients with normal BMI. METHODS A total of 49 patients were included in the study according to inclusion and exclusion criteria. The groups strongly differed in body mass index (median values 21.6 vs. 32.15). Concentrations of growth factors were measured with an enzyme-linked immunosorbent assay. Statistical significance was determined with the Mann-Whitney U test. The compliance of the distribution of the results with the normal distribution was checked using the Shapiro-Wilk test separately for both groups. RESULTS There were no statistically significant differences in median marker levels between groups. Statistically significant Pearson correlations were observed between IGF-1 serum level and age (weak negative, r = -0.294, p = 0.041) and gender (moderate positive, r = 0.392, 0.005). CONCLUSIONS BMI does not influence the level of selected growth factors in patients with knee osteoarthritis. Obese and non-obese patients had similar compositions of PDGF, TGF-β, EGF, FGF-2, IGF-1, and VEGF. PRP can be used in both groups with similar effects associated with growth factors' influence on articular cartilage.
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Affiliation(s)
- Michał Wiciński
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Dawid Szwedowski
- Department of Organic Chemistry, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Dr. A. Jurasza St. 2, 85-094 Bydgoszcz, Poland
- Orthopedic Arthroscopic Surgery International (O.A.S.I.) Bioresearch Foundation, Gobbi N.P.O., 20133 Milan, Italy
| | - Łukasz Wróbel
- Department of Pharmacology and Therapeutics, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
| | - Sławomir Jeka
- Department of Rheumatology and Connective Tissue Diseases, University Hospital No. 2, Collegium Medicum, Nicolaus Copernicus University, 85168 Bydgoszcz, Poland
| | - Jan Zabrzyński
- Department of General Orthopedics, Musculoskeletal Oncology and Trauma Surgery, University of Medical Sciences, 61-701 Poznan, Poland
- Department of Pathology, Faculty of Medicine, Collegium Medicum, Nicolaus Copernicus University, M. Curie 9, 85-090 Bydgoszcz, Poland
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16
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Ammitzbøll-Danielsen M, Terslev L. Optimizing the anti-inflammatory strategies in (osteo)arthritis: local or systemic? THE QUARTERLY JOURNAL OF NUCLEAR MEDICINE AND MOLECULAR IMAGING : OFFICIAL PUBLICATION OF THE ITALIAN ASSOCIATION OF NUCLEAR MEDICINE (AIMN) [AND] THE INTERNATIONAL ASSOCIATION OF RADIOPHARMACOLOGY (IAR), [AND] SECTION OF THE SOCIETY OF... 2022; 66:311-318. [PMID: 35838028 DOI: 10.23736/s1824-4785.22.03477-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Arthritis is affecting millions of people globally, involvement and distribution depending on the type of arthritis. The most common arthritic conditions are osteoarthritis (OA) and rheumatoid arthritis (RA). Despite the pathogeneses being fundamentally different, both joint diseases share the same need for local treatment of synovitis. No current treatment can stop the progression of OA. Local articulate treatment including glucocorticoid (GC) injections, radiosynoviorthesis (RSO) and surgical synovectomy are the only options to relieve pain and temporally improve movability before surgical intervention. For RA, despite effective systemic treatments, similarly need for local articulate treatment is still present, especially early in the disease, but also in case of recurrent episodes of disease flare. Current evidence supports local GC injection as first line treatment for persistent synovitis in a single or a few joints. RSO provides an evident and effective alternative for GC refractory synovitis, especially in early RA. Surgical synovectomy is an invasive alternative, but with less documented efficacy. Whether one unsuccessful intraarticular GC injection is enough to change of mode of action for local treatment is still unclear and needs to be further investigated. In conclusion persistent single joint synovitis in OA and RA is well treated with local treatment. Intra-articular GC injection is considered as first line of treatment, but RSO provides an additional treatment alternative with less side effects and better evidence of efficacy than surgical synovectomy.
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Affiliation(s)
- Mads Ammitzbøll-Danielsen
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark -
- Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark -
| | - Lene Terslev
- Center for Rheumatology and Spine Diseases, Rigshospitalet, Denmark
- Copenhagen Center for Arthritis Research, Rigshospitalet, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
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17
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Afshar F, Abdolahi N, Amin G, Esmaily H, Ziayie S, Azimi S, Darvishi B, Afshar S. A randomized, double-blind placebo-controlled phase I clinical study on safety and efficacy of the G-Rup® syrup (a mixture of ginger extract and honey) in symptomatic treatment of knee osteoarthritis. J Clin Pharm Ther 2022; 47:2295-2301. [PMID: 36453014 DOI: 10.1111/jcpt.13812] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2022] [Revised: 09/02/2022] [Accepted: 09/04/2022] [Indexed: 12/03/2022]
Abstract
WHAT IS KNOWN AND OBJECTIVES Present study evaluated the safety profile and efficacy of G-Rup® syrup (100 mg/ml ginger extract plus 150 mg/ml honey) in symptomatic treatment of knee osteoarthritis (OA). METHODS Patients diagnosed with knee OA were randomly assigned (1:1) to receive either of a 30 ml twice daily regimen of G-Rup® syrup or placebo over a 12-week period. Primary endpoints of the study comprised of an improvement in the joint's stiffness, physical functioning and pain score, assessed by WOMAC questionnaire and the visual analog scale (VAS). Secondary objectives comprised of safety and tolerability of the syrup by patients. RESULTS AND DISCUSSION The 30 ml twice-daily regimen of G-Rup® syrup was safe and well tolerated by patients. Moreover, in whole studied time points, treatment with G-Rup® syrup could significantly Power the VAS score (p < 0.001) whereas improving WOMAC total score (p < 0.001) and pain (p < 0.001), physical functioning (p < 0.001), and stiffness sub-scores (p = 0.006) compared to the placebo receiving group. WHAT IS NEW AND CONCLUSION Based on obtained results, the G-Rup® syrup, composed of a combination of honey and ginger, may be a proper supplementary choice, along with routine therapeutic regimens, for improvement of symptomatic treatment of OA.
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Affiliation(s)
- Fariba Afshar
- Department of internal medicine, Faculty of Medicine, Tehran Medical Sciences, Islamic Azad University, Tehran, Iran
| | - Nafiseh Abdolahi
- Rheumatology Research Center, Golestan University of Medical Sciences, Gorgan, Iran
| | - Gholamreza Amin
- Herbal Plants Department, School of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran
| | - Hadi Esmaily
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Ziayie
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Azimi
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Behnam Darvishi
- Department of Orthopedics, Rasoul Akram Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Shima Afshar
- Department of Clinical Pharmacy, School of Pharmacy, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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18
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Alghadir AH, Khan M. Factors affecting pain and physical functions in patients with knee osteoarthritis: An observational study. Medicine (Baltimore) 2022; 101:e31748. [PMID: 36451427 PMCID: PMC9704912 DOI: 10.1097/md.0000000000031748] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Knee osteoarthritis (KOA) is more common as people age and have a higher body mass index (BMI). We must know the role of various factors in pain and physical functions in patients with KOA. Therefore, the present study sought to examine the factors associated with pain and physical functions in individuals with KOA. This cross-sectional observational study included patients with KOA (n = 125; 57 men, 68 women; mean age 52.9 years). Using the visual analogue scale and a reduced version of the Western Ontario McMaster Universities Osteoarthritis Index, pain severity and physical functions were assessed. Demographic factors such as age, BMI, sex, and Kellgren-Lawrence (K/L) radiographic grade of KOA were analyzed. Age (R = 0.263, P < .001), BMI (R = 0.379, P < .001), and K/L grade (R = 0.844, P < .001) were significantly associated with knee pain. Similarly, age (R = 0.310, P < .001), BMI (R = 0.374, P < .001), and K/L grade (R = 0.862, P < .001) were associated with physical functions. No significant association of sex with pain (R = 0.071, P = .440) and physical functions (R = 0.055, P = .545) was observed. Age, BMI, and K/L grade explained 71% and 74% of knee pain and physical functions, respectively. Age, BMI, and radiographic (K/L) grades were associated with pain and physical functions in patients with KOA. K/L grade was the most significant predictor of pain and physical functions in KOA.
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Affiliation(s)
- Ahmad H Alghadir
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Leźnicka K, Pawlak M, Maciejewska-Skrendo A, Buczny J, Wojtkowska A, Pawlus G, Machoy-Mokrzyńska A, Jażdżewska A. Is Physical Activity an Effective Factor for Modulating Pressure Pain Threshold and Pain Tolerance after Cardiovascular Incidents? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11276. [PMID: 36141549 PMCID: PMC9517088 DOI: 10.3390/ijerph191811276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/27/2022] [Accepted: 09/06/2022] [Indexed: 06/16/2023]
Abstract
The purpose of this study was to investigate whether regular physical activity can alter the pressure pain threshold, pain tolerance, and subjective pain perception in individuals who have experienced a cardiovascular event. The study involved 85 individuals aged 37 to 84 years (M = 65.36) who qualified for outpatient cardiac rehabilitation, which consisted of 24 physical training sessions. The patients were all tested twice: on the first and last day of the outpatient cardiac rehabilitation program. Assessments of the pressure pain threshold and pain tolerance were performed with an algometer. To assess the pain coping strategies, the Pain Coping Strategies Questionnaire (CSQ) and parenting styles were measured retrospectively with subjective survey questions. The main results of the study showed that patients achieved significantly higher pressure pain thresholds after a physical training cycle (ps < 0.05, η2 = 0.05-0.14), but found no differences in the pain tolerance (ps > 0.05). A lower preference for the better pain coping strategy explanation (ß = -0.42, p = 0.013) and growing up in a family with a less neglectful atmosphere (ß = -0.35, p = 0.008) were associated with increased pressure pain threshold after physical training. The results suggest that physical activity is an important factor in modulating the pressure pain threshold.
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Affiliation(s)
- Katarzyna Leźnicka
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| | - Maciej Pawlak
- Department of Physiology and Biochemistry, Poznan University of Physical Education, 61-871 Poznan, Poland
| | - Agnieszka Maciejewska-Skrendo
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
- Institute of Physical Culture and Health Promotion, University of Szczecin, 70-237 Szczecin, Poland
| | - Jacek Buczny
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 81-745 Sopot, Poland
- Department of Experimental and Applied Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit, 1081 HV Amsterdam, The Netherlands
| | - Anna Wojtkowska
- Institute of Psychology, SWPS University of Social Sciences and Humanities, 53-238 Wroclaw, Poland
| | - Grzegorz Pawlus
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
| | - Anna Machoy-Mokrzyńska
- Department of Experimental and Clinical Pharmacology, Pomeranian Medical University, 70-111 Szczecin, Poland
| | - Aleksandra Jażdżewska
- Department of Physical Education, Academy of Physical Education and Sport, ul. Kazimierza Górskiego 1, 80-336 Gdansk, Poland
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20
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Lo GH, Richard MJ, McAlindon TE, Park C, Strayhorn MT, Harkey MS, Price LL, Eaton CB, Driban JB. Increased risk of incident knee osteoarthritis in those with greater work-related physical activity. Occup Environ Med 2022; 79:543-549. [PMID: 35618387 PMCID: PMC9337839 DOI: 10.1136/oemed-2022-108212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 05/05/2022] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Occupations involving greater physical activity may increase risk for knee osteoarthritis (OA). Existing studies have not evaluated work-related physical activity before OA onset. Hence, we aimed to evaluate the association between work-related physical activity and knee OA incidence. METHODS We performed a person-based longitudinal study using Osteoarthritis Initiative (OAI) data among people who volunteered or worked for pay without baseline radiographic knee OA or knee pain. Bilateral knee radiographs were obtained at baseline and annual follow-ups. We defined radiographic OA as Kellgren-Lawrence grade ≥2. Questions from the Physical Activity Scale for the Elderly at baseline and annual OAI visits provided information about work-related physical activity level and hours. We performed logistic regression with work-related physical activity level ( mainly sitting , standing and some walking , walking while handling some materials ) and hours as predictors. The outcome was incident person-based radiographic OA within the ensuing 12 months, over 48 months. RESULTS Among 951 participants (2819 observations), higher work-related physical activity levels had greater adjusted ORs for incident radiographic OA (people with jobs with standing and some walking : 1.11 (0.60-2.08), and walking while handling some materials : 1.90 (1.03-3.52), when compared with those with mainly sitting work-related activity ). There was no association between number of hours worked and incident radiographic OA. CONCLUSIONS People performing work that require walking while handling some materials have greater odds of incident knee OA than those with jobs mostly involving sitting. Strategies are needed to mitigate risk factors predisposing them to radiographic OA.
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Affiliation(s)
- Grace H Lo
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA .,Medical Care Line and Research Care Line, Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Michael J Richard
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
| | - Chantel Park
- Division of Rheumatology, Thomas Jefferson University Hospital, Philadelphia, Pennsylvania, USA
| | - Michael T Strayhorn
- Department of Medicine, Baylor College of Medicine, Houston, Texas, USA.,Houston VA HSR&D Center for Innovations in Quality, Effectiveness and Safety, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA
| | - Matthew S Harkey
- Department of Kinesiology, Michigan State University, East Lansing, Michigan, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, Massachusetts, USA
| | - Charles B Eaton
- Department of Family Medicine, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.,Department of Epidemiology, School of Public Health of Brown University, Providence, Rhode Island, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, Massachusetts, USA
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21
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Oo WM, Mobasheri A, Hunter DJ. A narrative review of anti-obesity medications for obese patients with osteoarthritis. Expert Opin Pharmacother 2022; 23:1381-1395. [PMID: 35855642 DOI: 10.1080/14656566.2022.2104636] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
INTRODUCTION : The prevalence of both obesity and osteoarthritis (OA) are increasing worldwide (twindemic), and the association between the two chronic diseases is also well-established. AREAS COVERED : In this narrative review, we will briefly describe the double burdens of both diseases, the impact of weight loss or gain on OA incidence and structural progression and discuss the biomechanical and anti-inflammatory mechanisms mediating these effects. FDA-approved anti-obesity drugs are summarized in terms of their clinical efficacy and safety profile, and the completed or ongoing phase 2/3 clinical trials of such drugs in OA patients with obesity are examined. EXPERT OPINION : We will discuss the perspectives related to principles of prescription of anti-obesity drugs, the potential role of phenotype-guided approach, time to drug effects in clinical trials, sustainability of weight loss based on the real-world studies, the importance of concomitant therapies such as dieting and exercises, and the role of weight loss on non-weight bearing OA joints. Although obesity is the major risk factor for OA pathogenesis and progression, and there are a variety of anti-obesity medications on the market, research on the use of these disease-modifying drugs in OA (DMOAD) is still sparse..
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland.,Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania.,Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.,World Health Organization Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liege, Belgium
| | - David J Hunter
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.,Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
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22
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Shahid A, Inam‐Ur‐Raheem M, Iahtisham‐Ul‐Haq , Nawaz MY, Rashid MH, Oz F, Proestos C, Aadil RM. Diet and lifestyle modifications: An update on non‐pharmacological approach in the management of osteoarthritis. J FOOD PROCESS PRES 2022. [DOI: 10.1111/jfpp.16786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Arashi Shahid
- National Institute of Food Science and Technology University of Agriculture Faisalabad Pakistan
| | - Muhammad Inam‐Ur‐Raheem
- National Institute of Food Science and Technology University of Agriculture Faisalabad Pakistan
| | - Iahtisham‐Ul‐Haq
- Kauser Abdulla Malik School of Life Sciences Forman Christian College (A Chartered University) Punjab Pakistan
| | - Muhammad Yasir Nawaz
- Department of Pathology Faculty of Veterinary Science, University of Agriculture Faisalabad Faisalabad Pakistan
| | - Muhammad Hamdan Rashid
- National Institute of Food Science and Technology University of Agriculture Faisalabad Pakistan
| | - Fatih Oz
- Department of Food Engineering, Faculty of Agriculture Ataturk University Erzurum Turkey
| | - Charalampos Proestos
- Laboratory of Food Chemistry, Department of Chemistry National and Kapodistrian University of Athens Zografou Athens Greece
| | - Rana Muhammad Aadil
- National Institute of Food Science and Technology University of Agriculture Faisalabad Pakistan
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23
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24
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Rubino F, Logue J, Bøgelund M, Madsen ME, Cancino A, Høy M, Panton UH. Attitudes about the treatment of obesity among healthcare providers involved in the care of obesity-related diseases: A survey across medical specialties in multiple European countries. Obes Sci Pract 2021; 7:659-668. [PMID: 34877005 PMCID: PMC8633947 DOI: 10.1002/osp4.518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Revised: 03/18/2021] [Accepted: 04/25/2021] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND RATIONALE Obesity is associated with the development and progression of many diseases. Understanding and management of obesity have become increasingly important; however, a knowledge gap remains between how healthcare providers (HCPs) consider weight-loss treatment and the importance of weight loss for improving obesity-related diseases. OBJECTIVE The objective of this study was to investigate how HCPs assess obesity, how they interpret the relationship between obesity and 12 recognized co-morbidities of obesity (excluding diabetes), and their view about the value of various weight-loss therapies. METHODS This was a cross-sectional, non-interventional, descriptive study. Participants were medical doctors (HCPs) from eight European countries. RESULTS Eighty-nine percent of the 197 HCPs that completed the survey considered obesity a disease. For most of the 12 obesity-related diseases under consideration, a majority of HCPs agreed that weight loss could reverse the disease or prevent progression. Among HCPs who have recommended weight loss, lifestyle interventions were by far the most common recommendation. However, more than three out of four HCPs stated that they would be likely to prescribe anti-obesity medications if available and reimbursed. CONCLUSION Most HCPs in this survey consider obesity a disease that needs to be treated. However, the majority of HCPs appear to prefer recommending lifestyle changes, although it is well documented that weight loss obtained by lifestyle changes is difficult to maintain. These results underscore the need for improved education of HCPs involved in the treatment of obesity-related diseases.
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Affiliation(s)
| | | | | | | | | | - Maria Høy
- Novo Nordisk North West Europe Pharmaceuticals A/SCopenhagenDenmark
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25
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Gudbergsen H, Overgaard A, Henriksen M, Wæhrens EE, Bliddal H, Christensen R, Nielsen SM, Boesen M, Knop FK, Astrup A, Rasmussen MU, Bartholdy C, Daugaard CL, Ellegaard K, Heitmann BL, Bartels EM, Danneskiold-Samsøe B, Kristensen LE. Liraglutide after diet-induced weight loss for pain and weight control in knee osteoarthritis: a randomized controlled trial. Am J Clin Nutr 2021; 113:314-323. [PMID: 33471039 DOI: 10.1093/ajcn/nqaa328] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2020] [Accepted: 10/14/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Weight loss is critical for preventing and managing obesity-related diseases. There is a notable lack of valid and reliable means to manage patients with overweight/obesity and knee osteoarthritis (KOA). OBJECTIVE To determine the efficacy and safety of liraglutide in a 30 mg/d dosing in patients with overweight/obesity and KOA. METHODS The trial was designed as a randomized controlled trial including patients between the age of 18 and 74 y with KOA and a BMI ≥27 (measured in kg/m2).Patients underwent a pre-random assignment diet intervention (week -8 to 0). At week 0, patients having lost >5% of their body weight were randomly assigned to liraglutide 3 mg/d or placebo for 52 wk. The coprimary outcomes were changes in body weight and the Knee injury and Osteoarthritis Outcome Score (KOOS) pain subscale from week 0 to 52. RESULTS In total, 168 patients enrolled and 156 were randomly assigned to receive liraglutide or placebo. Patients experienced a significant reduction in body weight and KOOS pain during the pre-random assignment dietary intervention period (week -8 to 0). From week 0 to 52 there was a significant difference in body weight between the liraglutide and placebo group (mean changes: -2.8 and +1.2 kg, respectively; group difference, 3.9 kg; 95% CI: -6.9, -1.0; P = 0.008). There was, however, no group difference in KOOS pain (mean changes: 0.4 and -0.6 points, respectively; group difference, 0.9 points; 95% CI: -3.9, 5.7; P = 0.71). Treatment-emergent adverse events related to the gastrointestinal system were experienced by 50.2% and 39.2% of patients in the liraglutide and placebo groups, respectively. CONCLUSIONS In patients with KOA and overweight/obesity liraglutide added after an 8-wk pre-random assignment diet induced a significant weight loss at >52 wk but did not reduce knee pain compared to placebo. This trial was registered at clinicaltrials.gov as NCT02905864.
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Affiliation(s)
- Henrik Gudbergsen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Anders Overgaard
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Marius Henriksen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen Denmark
| | - Eva Ejlersen Wæhrens
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Research Initiative for Activity Studies and Occupational Therapy, Research Unit for General Practice, Institute of Public Health, University of Southern Denmark, Odense, Denmark
| | - Henning Bliddal
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Robin Christensen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Sabrina Mai Nielsen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Odense, Denmark
| | - Mikael Boesen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Department of Radiology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Filip Krag Knop
- NNF Center for Clinical Metabolic Research, Gentofte Hospital, University of Copenhagen, Hellerup, Denmark.,Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Arne Astrup
- Department of Nutrition, Exercise and Sports, Faculty of Science, University of Copenhagen, Copenhagen, Denmark
| | - Marianne Uggen Rasmussen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Cecilie Bartholdy
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Department of Physical and Occupational Therapy, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Copenhagen Denmark
| | - Cecilie Laubjerg Daugaard
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Karen Ellegaard
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Berit Lilienthal Heitmann
- Research Unit for Dietary Studies at The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Department of Public Health, Section for General Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Else Marie Bartels
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark.,Department of Neurology, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Bispebjerg, Denmark
| | - Bente Danneskiold-Samsøe
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
| | - Lars Erik Kristensen
- The Parker Institute, Bispebjerg-Frederiksberg Hospital, University of Copenhagen, Frederiksberg, Denmark
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26
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Jaiswal A, Goswami K, Haldar P, Salve HR, Singh U. Prevalence of knee osteoarthritis, its determinants, and impact on the quality of life in elderly persons in rural Ballabgarh, Haryana. J Family Med Prim Care 2021; 10:354-360. [PMID: 34017753 PMCID: PMC8132764 DOI: 10.4103/jfmpc.jfmpc_1477_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2020] [Revised: 09/17/2020] [Accepted: 10/20/2020] [Indexed: 11/25/2022] Open
Abstract
Background: Osteoarthritis (OA) is the most common type of arthritis and a very common disease of elderly. It is one of the leading causes of disability. The present study was conducted to estimate the burden of the knee OA among rural elderly. Methods: A community-based cross-sectional study was conducted among 500 randomly selected elderly resident of rural Ballabgarh, Haryana. A semi-structured interview schedule was used by a trained investigator for face-to-face interview, clinical examination of knee using American College of Rheumatology criteria, and quality of life assessment using WHOQOL-BREF. Results: Almost two-third of the participants among 454 elderly recruited, suffered from knee OA (292, 64.3%) had knee OA. History of a knee injury, a family history of knee pain, current physical activity and smoking status were found to be significantly associated with knee OA, in multivariate logistic regression model. Elderly suffering from knee OA had significantly lower quality-of-life scores contrasted to those not (p-value < 0.001). The scores were significantly lower for all the domains (P-value <0.001) among elderly suffering with the knee OA, with the maximum effect seen in psychological, and physical domain. Conclusion: Rural elderly of Ballabgarh, Haryana, had a high burden of knee OA. Elderly suffering from knee OA had significantly lower perception of their quality of life most affected is the psychological and physical domains of quality of life.
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Affiliation(s)
- Abhishek Jaiswal
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Kiran Goswami
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Partha Haldar
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - Harshal Ramesh Salve
- Centre for Community Medicine, All India Institute of Medical Sciences, New Delhi, India
| | - U Singh
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, New Delhi, India
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27
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Godziuk K, Prado CM, Beaupre L, Jones CA, Werle JR, Forhan M. A critical review of weight loss recommendations before total knee arthroplasty. Joint Bone Spine 2020; 88:105114. [PMID: 33278590 DOI: 10.1016/j.jbspin.2020.105114] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/13/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Increased infection risk after total knee arthroplasty (TKA) in patients with a higher body mass index (BMI), particularly a BMI ≥40kg/m2, suggests that BMI reduction (through weight loss) prior to TKA may be important. However, the impact of weight loss on TKA risk reduction is unclear. Furthermore, weight loss could have detrimental consequences with respect to muscle loss and development of sarcopenic obesity, whereby a potential weight loss paradox in adults with advanced knee OA and obesity may be present. Using a critical review approach, we examined the current evidence supporting weight loss in adults with obesity and advanced knee osteoarthritis (OA). We focused on three key areas: (1) TKA complication risk with severe obesity compared to obesity (BMI ≥40kg/m2 versus 30.0-39.9kg/m2); (2) weight loss recommendations for individuals with advanced knee OA; and (3) TKA outcomes after pre-surgical weight loss. METHODS Medline and CINAHL databases were examined from Jan 2010 to May 2020 to identify high-level and/or clinically-influential evidence (systematic reviews, meta-analyses and clinical practice guidelines). RESULTS The literature does not show a clear relationship between weight loss and reduction in TKA complications, and no indication that a patients' individual risk is lowered by reducing their BMI from a threshold of ≥40kg/m2 to ≤39.9kg/m2. Studies that have found a benefit of weight loss for knee OA have not included patients with higher BMIs (≥40kg/m2) or more advanced knee OA. Furthermore, there is unclear evidence of a benefit of pre-surgical weight loss on TKA outcomes. These are important evidence gaps, suggesting that recommendations for BMI reduction prior to TKA should be tempered by the current uncertainty in the literature. CONCLUSION Evidence to support a benefit of weight loss prior to TKA is lacking. Until knowledge gaps are clarified, it is recommended that practitioners consider individual patient needs and risk before recommending weight loss (and therefore BMI reduction).
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Affiliation(s)
- Kristine Godziuk
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 - 114 Street, 2-64 Corbett Hall, T6G 2G4 Edmonton, AB, Canada.
| | - Carla M Prado
- Department of Agricultural, Food and Nutritional Science, Faculty of Agricultural, Life and Environmental Sciences, University of Alberta, Edmonton, AB, Canada
| | - Lauren Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Jason R Werle
- Section of Orthopaedic Surgery, Department of Surgery, University of Calgary, Calgary, AB, Canada
| | - Mary Forhan
- Department of Occupational Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 8205 - 114 Street, 2-64 Corbett Hall, T6G 2G4 Edmonton, AB, Canada
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28
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Kao MH, Tsai YF. Clinical Effectiveness of a Self-Regulation Theory-Based Self-Management Intervention for Adults With Knee Osteoarthritis: A Long-Term Follow-Up. J Nurs Scholarsh 2020; 52:643-651. [PMID: 33166027 DOI: 10.1111/jnu.12608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE To determine if there are long-term effects of a self-management intervention guided by self-regulation theory for adults with knee osteoarthritis at 6 and 12 months after completing the intervention. DESIGN This long-term follow-up study used a longitudinal quasi-experimental design with repeated measures. METHODS A convenience sample of 127 patients with knee osteoarthritis who were 45 to 64 years of age were recruited from outpatient clinics in Taiwan. The Self-Management Needs of Knee Osteoarthritis Scale was used to assess self-management needs at enrollment (baseline). To evaluate the long-term effects, participants were reassessed at 6 and 12 months after the intervention using the following questionnaires: The Knee Injury and Osteoarthritis Outcome Score, Healthcare Outcomes, and the Short-Form Health Survey. Generalized estimating equations compared assessments at baseline with scores at 6 and 12 months following completion of the intervention. Multiple regression was used to examine significant factors associated with the assessments. FINDINGS Participants had moderate levels of self-management needs. When assessments at 6 months were compared with baseline, scores for knee symptoms and physical function and quality of life showed significant improvements; significant reductions were seen in body mass index, unplanned medical consultations, and pain medication doses. Assessments at 12 months compared with baseline measures indicated these improvements were maintained. These improvements were significant from baseline measures at both 6 months and 12 months after adjustments were made for time and other significant variables. CONCLUSIONS Twelve months after completion of the intervention, the significant improvements seen at 6 months were maintained. Our findings demonstrate that the self-management intervention had significant long-term effects on knee symptoms and physical function, body mass index and pain medication doses, and overall quality of life for patients with moderate self-management needs of knee osteoarthritis. CLINICAL RELEVANCE Clinical care of knee osteoarthritis that includes a self-regulation theory-based self-management intervention could provide long-term benefits to patients.
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Affiliation(s)
- Mei-Hua Kao
- Assistant Professor, Department of Nursing, Mackay Junior College of Medicine, Nursing, and Management, Sanzhi, New Taipei City, Taiwan
| | - Yun-Fang Tsai
- Professor, Chair of School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan; Department of Nursing, Chang Gung University of Science and Technology, Tao-Yuan; and Department of Psychiatry, Chang Gung Memorial Hospital at Keelung, Keelung, Taiwan
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29
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He LR, de Almeida Prado PS. An evaluation of the relationship between the degree of entheseal changes and the severity of osteodegenerative processes at fibrocartilaginous entheses. Anat Rec (Hoboken) 2020; 304:1255-1265. [PMID: 33073487 DOI: 10.1002/ar.24541] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Revised: 09/08/2020] [Accepted: 09/11/2020] [Indexed: 12/13/2022]
Abstract
An enthesis refers to the interface at which a tendon or a ligament integrates into the periosteum. Its morphology can be influenced by intrinsic factors such as sex, age, and extrinsic factors such as levels of activity, which will in turn impact on bone remodeling and lead to morphological changes. In bioarcheology, entheseal changes have had a long tradition of being used for the reconstruction of past activities. The literature has shown that in some cases of osteoarthritis, entheseal changes are associated with osteoarthritic manifestations. This work aims to evaluate the relationship between the degree of entheseal changes and the severity of osteodegenerative processes. The studied materials consisted of 30 humeri and 30 femora from the osteological collection at St George's University of London. Intensities of both entheseal changes and osteodegenerative processes were macroscopically assessed and scored. The difference in scores of entheseal changes between osteoarthritic groups and nonosteoarthritic groups is statistically significant at a confidence level of 95% (α = .05) for both the humeri and femora. Results show a positive correlation between the degree of entheseal changes and the severity of osteodegenerative processes in the femora, suggesting that enthesis may play a role in osteoarthritis. Findings from this work supports the proposed hypothesis that the degree of entheseal changes and the severity of osteoarthritic manifestation are related. This work contributes to current knowledge that osteoarthritis is a disease involving the whole joint; the enthesis could potentially be a target for the diagnosis of osteoarthritis.
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Affiliation(s)
- Laura Ruoqiao He
- Institute of Medical & Biomedical Education, St George's University of London, London, UK
| | - Patricia Shirley de Almeida Prado
- Institute of Medical & Biomedical Education, St George's University of London, London, UK
- Department of Bio-morphology, Federal University of Bahia, Salvador, Brazil
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30
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Price A, Smith J, Dakin H, Kang S, Eibich P, Cook J, Gray A, Harris K, Middleton R, Gibbons E, Benedetto E, Smith S, Dawson J, Fitzpatrick R, Sayers A, Miller L, Marques E, Gooberman-Hill R, Blom A, Judge A, Arden N, Murray D, Glyn-Jones S, Barker K, Carr A, Beard D. The Arthroplasty Candidacy Help Engine tool to select candidates for hip and knee replacement surgery: development and economic modelling. Health Technol Assess 2020; 23:1-216. [PMID: 31287051 DOI: 10.3310/hta23320] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND There is no good evidence to support the use of patient-reported outcome measures (PROMs) in setting preoperative thresholds for referral for hip and knee replacement surgery. Despite this, the practice is widespread in the NHS. OBJECTIVES/RESEARCH QUESTIONS Can clinical outcome tools be used to set thresholds for hip or knee replacement? What is the relationship between the choice of threshold and the cost-effectiveness of surgery? METHODS A systematic review identified PROMs used to assess patients undergoing hip/knee replacement. Their measurement properties were compared and supplemented by analysis of existing data sets. For each candidate score, we calculated the absolute threshold (a preoperative level above which there is no potential for improvement) and relative thresholds (preoperative levels above which individuals are less likely to improve than others). Owing to their measurement properties and the availability of data from their current widespread use in the NHS, the Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were selected as the most appropriate scores to use in developing the Arthroplasty Candidacy Help Engine (ACHE) tool. The change in score and the probability of an improvement were then calculated and modelled using preoperative and postoperative OKS/OHSs and PROM scores, thereby creating the ACHE tool. Markov models were used to assess the cost-effectiveness of total hip/knee arthroplasty in the NHS for different preoperative values of OKS/OHSs over a 10-year period. The threshold values were used to model how the ACHE tool may change the number of referrals in a single UK musculoskeletal hub. A user group was established that included patients, members of the public and health-care representatives, to provide stakeholder feedback throughout the research process. RESULTS From a shortlist of four scores, the OHS and OKS were selected for the ACHE tool based on their measurement properties, calculated preoperative thresholds and cost-effectiveness data. The absolute threshold was 40 for the OHS and 41 for the OKS using the preferred improvement criterion. A range of relative thresholds were calculated based on the relationship between a patient's preoperative score and their probability of improving after surgery. For example, a preoperative OHS of 35 or an OKS of 30 translates to a 75% probability of achieving a good outcome from surgical intervention. The economic evaluation demonstrated that hip and knee arthroplasty cost of < £20,000 per quality-adjusted life-year for patients with any preoperative score below the absolute thresholds (40 for the OHS and 41 for the OKS). Arthroplasty was most cost-effective for patients with lower preoperative scores. LIMITATIONS The ACHE tool supports but does not replace the shared decision-making process required before an individual decides whether or not to undergo surgery. CONCLUSION The OHS and OKS can be used in the ACHE tool to assess an individual patient's suitability for hip/knee replacement surgery. The system enables evidence-based and informed threshold setting in accordance with local resources and policies. At a population level, both hip and knee arthroplasty are highly cost-effective right up to the absolute threshold for intervention. Our stakeholder user group felt that the ACHE tool was a useful evidence-based clinical tool to aid referrals and that it should be trialled in NHS clinical practice to establish its feasibility. FUTURE WORK Future work could include (1) a real-world study of the ACHE tool to determine its acceptability to patients and general practitioners and (2) a study of the role of the ACHE tool in supporting referral decisions. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Andrew Price
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - James Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Helen Dakin
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Sujin Kang
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Peter Eibich
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Jonathan Cook
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Alastair Gray
- Health Economics Research Centre, University of Oxford, Oxford, UK
| | - Kristina Harris
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Robert Middleton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Elizabeth Gibbons
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Elena Benedetto
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Stephanie Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jill Dawson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Adrian Sayers
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Laura Miller
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Elsa Marques
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | | | - Ashley Blom
- Musculoskeletal Research Unit, University of Bristol, Bristol, UK
| | - Andrew Judge
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Murray
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sion Glyn-Jones
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Karen Barker
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Andrew Carr
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - David Beard
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Christiansen MB, Thoma LM, Master H, Voinier D, White DK. The Association of an Increasing Waist Circumference and Risk of Incident Low Physical Function in Adults with Knee Osteoarthritis. J Rheumatol 2020; 47:1550-1556. [PMID: 32173659 PMCID: PMC7492478 DOI: 10.3899/jrheum.190876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/28/2020] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To investigate an 8-year change in waist circumference (WC) with the risk of incident low physical function over 1 year in adults with, or at risk of, knee osteoarthritis (OA). METHODS Data from the Osteoarthritis Initiative were used. Change in WC was measured from study enrollment (0 month) to the 96-month visit and classified as Increase (≥ 5cm gain) or Maintain (< 5cm gain). We identified World Health Organization (WHO) risk category based on WC at study enrollment as Large WC (males ≥ 102 cm, females ≥ 88 cm) or Small WC (males < 102 cm, females < 88 cm). The outcome was incident low physical function (≥ 28 Western Ontario and McMaster Universities Osteoarthritis Index physical function subscale) at the 108-month visit. To investigate the association of the 8-year change in WC with the risk of low physical function, we calculated risk ratios (95% CI) and adjusted for potential confounders. We repeated the analyses stratified by the WHO disease risk category. RESULTS The Increase WC group had 1.43 (95% CI 1.04-1.96) times the risk of incident low physical function compared to adults in the Maintain WC group. Adults with a Large WC at baseline who increased WC had 1.55 (95% CI 1.00-2.37) times the risk of incident low physical function compared to those who maintained WC. Adults with a Small WC at baseline who increased WC had 1.97 (95% CI 0.84-4.63) times the risk compared to those who maintained WC. CONCLUSION Increasing WC increases the risk of incident low physical function in the following year. Maintaining WC may mitigate developing low physical function.
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Affiliation(s)
- Meredith B Christiansen
- M.B. Christiansen, Research Assistant, DPT, D. Voinier, Research Assistant, DPT, D.K. White, Associate Professor, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Delaware;
| | - Louise M Thoma
- L.M. Thoma, Assistant Professor, PhD, Division of Physical Therapy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hiral Master
- H. Master, Postdoctoral Research Fellow, PhD, Department of Orthopedic Surgery and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Dana Voinier
- M.B. Christiansen, Research Assistant, DPT, D. Voinier, Research Assistant, DPT, D.K. White, Associate Professor, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Delaware
| | - Daniel K White
- M.B. Christiansen, Research Assistant, DPT, D. Voinier, Research Assistant, DPT, D.K. White, Associate Professor, ScD, Department of Physical Therapy, College of Health Sciences, and Biomechanics and Movement Science Interdisciplinary Program, University of Delaware, Delaware
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Arthritis and the role of endogenous glucocorticoids. Bone Res 2020; 8:33. [PMID: 32963891 PMCID: PMC7478967 DOI: 10.1038/s41413-020-00112-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Rheumatoid arthritis and osteoarthritis, the most common forms of arthritis, are chronic, painful, and disabling conditions. Although both diseases differ in etiology, they manifest in progressive joint destruction characterized by pathological changes in the articular cartilage, bone, and synovium. While the potent anti-inflammatory properties of therapeutic (i.e., exogenous) glucocorticoids have been heavily researched and are widely used in clinical practice, the role of endogenous glucocorticoids in arthritis susceptibility and disease progression remains poorly understood. Current evidence from mouse models suggests that local endogenous glucocorticoid signaling is upregulated by the pro-inflammatory microenvironment in rheumatoid arthritis and by aging-related mechanisms in osteoarthritis. Furthermore, these models indicate that endogenous glucocorticoid signaling in macrophages, mast cells, and chondrocytes has anti-inflammatory effects, while signaling in fibroblast-like synoviocytes, myocytes, osteoblasts, and osteocytes has pro-inflammatory actions in rheumatoid arthritis. Conversely, in osteoarthritis, endogenous glucocorticoid signaling in both osteoblasts and chondrocytes has destructive actions. Together these studies provide insights into the role of endogenous glucocorticoids in the pathogenesis of both inflammatory and degenerative joint disease.
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Karasavvidis T, Hirschmann MT, Kort NP, Terzidis I, Totlis T. Home-based management of knee osteoarthritis during COVID-19 pandemic: literature review and evidence-based recommendations. J Exp Orthop 2020; 7:52. [PMID: 32686011 PMCID: PMC7369444 DOI: 10.1186/s40634-020-00271-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2020] [Accepted: 07/09/2020] [Indexed: 01/26/2023] Open
Abstract
Purpose To provide evidence-based recommendations for patients with severe knee osteoarthritis (OA), who had their knee surgery postponed due to the COVID-19 pandemic. Methods PubMed/Medline, Scopus and Cochrane Central databases were systematically reviewed for studies reporting outcomes of home-based treatments for knee OA. Due to between-study differences in treatment strategy and reporting methods the results were not pooled and findings of the current review were presented in a narrative manner. Results The comprehensive literature search yielded 33 eligible studies that were included in this review. Management is performed at home and consists of exercise, proper nutrition, physical therapy and use of corrective and assistive orthotics. Virtual education on self-management strategies should be part of coping with knee OA. Initiating an exercise programme involving gymnastics, stretching, home cycling and muscle strengthening is highly recommended. Obese patients are encouraged to set weight loss goals and adopt a healthy diet. Potential benefits but weak evidence has been shown for the use of knee braces, sleeves, foot orthotics or cushioned footwear. Walking aids may be prescribed, when considered necessary, along with the provision of instructions for their use. Conclusion When bridging the time to rescheduled surgery, it is essential to use appropriate home-based tools for the management of knee OA if pain is to be reduced and need for analgesics or opioid use is to be diminished while maintaining or even improving the functioning and avoiding further limitation of range of motion and subsequent muscular atrophies. Finally, none of these treatments may completely substitute for the life-changing effect of a total knee arthroplasty in patients with severe knee OA. Hence, the subsequent goal is to gradually and safely reinstate elective surgery.
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Affiliation(s)
- Theofilos Karasavvidis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece
| | - Michael T Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), 4101 Bruderholz, Basel, Switzerland
| | - Nanne P Kort
- CortoClinics, Steeg 6E, 5482 WN, Schijndel, The Netherlands
| | - Ioannis Terzidis
- Thessaloniki Minimally Invasive Surgery Orthopaedic Center, St. Luke's Hospital, 55236, Panorama, Greece
| | - Trifon Totlis
- School of Medicine, Faculty of Health Sciences, Aristotle University of Thessaloniki, University Campus, 54124, Thessaloniki, Greece. .,Thessaloniki Minimally Invasive Surgery Orthopaedic Center, St. Luke's Hospital, 55236, Panorama, Greece.
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Raggi A, Leonardi M, Mellor-Marsá B, Moneta MV, Sanchez-Niubo A, Tyrovolas S, Giné-Vázquez I, Haro JM, Chatterji S, Bobak M, Ayuso-Mateos JL, Arndt H, Hossin MZ, Bickenbach J, Koskinen S, Tobiasz-Adamczyk B, Panagiotakos D, Corso B. Predictors of pain in general ageing populations: results from a multi-country analysis based on ATHLOS harmonized database. J Headache Pain 2020; 21:45. [PMID: 32375641 PMCID: PMC7201730 DOI: 10.1186/s10194-020-01116-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 04/24/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Pain is a common symptom, often associated with neurological and musculoskeletal conditions, and experienced especially by females and by older people, and with increasing trends in general populations. Different risk factors for pain have been identified, but generally from studies with limited samples and a limited number of candidate predictors. The aim of this study is to evaluate the predictors of pain from a large set of variables and respondents. METHODS We used part of the harmonized dataset of ATHLOS project, selecting studies and waves with a longitudinal course, and in which pain was absent at baseline and with no missing at follow-up. Predictors were selected based on missing distribution and univariable association with pain, and were selected from the following domains: Socio-demographic and economic characteristics, Lifestyle and health behaviours, Health status and functional limitations, Diseases, Physical measures, Cognition, personality and other psychological measures, and Social environment. Hierarchical logistic regression models were then applied to identify significant predictors. RESULTS A total of 13,545 subjects were included of whom 5348 (39.5%) developed pain between baseline and the average 5.2 years' follow-up. Baseline risk factors for pain were female gender (OR 1.34), engaging in vigorous exercise (OR 2.51), being obese (OR 1.36) and suffering from the loss of a close person (OR 1.88) whereas follow-up risk factors were low energy levels/fatigue (1.93), difficulties with walking (1.69), self-rated health referred as poor (OR 2.20) or average to moderate (OR 1.57) and presence of sleep problems (1.80). CONCLUSIONS Our results showed that 39.5% of respondents developed pain over a five-year follow-up period, that there are proximal and distal risk factors for pain, and that part of them are directly modifiable. Actions aimed at improving sleep, reducing weight among obese people and treating fatigue would positively impact on pain onset, and avoiding vigorous exercise should be advised to people aged 60 or over, in particular if female or obese.
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Affiliation(s)
- Alberto Raggi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy
| | - Matilde Leonardi
- Neurology, Public Health and Disability Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, Via Celoria 11, 20133, Milan, Italy.
| | - Blanca Mellor-Marsá
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Maria V Moneta
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
| | - Albert Sanchez-Niubo
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Stefanos Tyrovolas
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Iago Giné-Vázquez
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Josep M Haro
- Parc Sanitari Sant Joan de Déu, Fundacion Sant Joan de Deu, Barcelona, Spain
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
| | - Somnath Chatterji
- Information, Evidence and Research, World Health Organization, Geneva, Switzerland
| | - Martin Bobak
- Research Department of Epidemiology and Public Health, University College London, London, UK
| | - Jose L Ayuso-Mateos
- Instituto de Salud Carlos III, Centro de Investigación Biomédica en Red de Salud Mental, CIBERSAM, Madrid, Spain
- Department of Psychiatry, Universidad Autónoma de Madrid, Madrid, Spain
- Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa, Madrid, Spain
| | | | - Muhammad Z Hossin
- Department of Global Public Health, Karolinska Institute, Stockholm, Sweden
| | - Jerome Bickenbach
- Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Seppo Koskinen
- Finnish Institute for Health and Welfare (THL), Helsinki, Finland
| | - Beata Tobiasz-Adamczyk
- Department of Epidemiology and Population Studies, Faculty of Health Sciences, Jagiellonian University Medical College, Krakow, Poland
| | - Demosthenes Panagiotakos
- Department of Nutrition and Dietetics, School of Health Science and Education, Harokopio University, Athens, Greece
| | - Barbara Corso
- National Research Council, Neuroscience Institute, Padova, Italy
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da Silva Soares F, Moreira VMPS, Alves LV, Dionisio VC. What is the influence of severity levels of knee osteoarthritis on gait initiation? Clin Biomech (Bristol, Avon) 2020; 74:51-57. [PMID: 32145669 DOI: 10.1016/j.clinbiomech.2020.02.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2019] [Revised: 02/07/2020] [Accepted: 02/13/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The anticipatory postural adjustments required for gait initiation have not yet been investigated in older adults with different levels of severity of knee osteoarthritis. This study aimed to evaluate the anticipatory postural adjustments adopted by older adults with different severity levels of knee osteoarthritis during gait initiation. METHODS Sixty-seven older adults with knee osteoarthritis (mild, moderate, and severe levels) and 11 healthy older adults control were evaluated bilaterally with a force plate to analyze gait initiation. The center of pressure trajectory during gait initiation was divided into four phases: three anticipatory postural adjustments, and a locomotor phase. The length, duration, and velocity of each phase were calculated. FINDINGS The results showed that during the right and left limbs swing forward, the severe and moderate knee osteoarthritis groups presented a significant reduction in the length of anticipatory postural adjustment phases, locomotion, duration, and velocity (P < 0.05). The severe knee osteoarthritis group presented a significantly higher body mass index (P < 0.003) than the other groups. However, just the healthy group presented a correlation between body mass index and anticipatory postural adjustments. INTERPRETATION Our results demonstrated that older adults with severe and moderate levels of knee osteoarthritis adopt longer lasting and slower anticipatory postural adjustment phases, lower locomotion, and lower center of pressure displacement during gait initiation, suggesting that this population has adaptive strategy in performing gait initiation, which is significantly changed by the knee osteoarthritis severity level.
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Affiliation(s)
- Fabiana da Silva Soares
- Doctor Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
| | | | - Luiza Vinhal Alves
- Physical Therapy Course, Federal University of Uberlandia, Uberlândia, Brazil
| | - Valdeci Carlos Dionisio
- Physical Therapy Course, Federal University of Uberlandia, Uberlândia, Brazil; Doctor Program in Health Sciences, Faculty of Medicine, Federal University of Uberlândia, Uberlândia, Brazil.
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Level of obesity is directly associated with the clinical and functional consequences of knee osteoarthritis. Sci Rep 2020; 10:3601. [PMID: 32107449 PMCID: PMC7046749 DOI: 10.1038/s41598-020-60587-1] [Citation(s) in RCA: 96] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 01/31/2020] [Indexed: 12/14/2022] Open
Abstract
Obesity is one of the most important risk factors of knee osteoarthritis (KOA), but its impact on clinical and functional consequences is less clear. The main objective of this cross-sectional study was to describe the relation between body mass index (BMI) and clinical expression of KOA. Participants with BMI ≥ 25 kg/m2 and KOA completed anonymous self-administered questionnaires. They were classified according to BMI in three groups: overweight (BMI 25-30 kg/m2), stage I obesity (BMI 30-35 kg/m2) and stage II/III obesity (BMI ≥ 35 kg/m2). The groups were compared in terms of pain, physical disability, level of physical activity (PA) and fears and beliefs concerning KOA. Among the 391 individuals included, 57.0% were overweight, 28.4% had stage I obesity and 14.6% had stage II/III obesity. Mean pain score on a 10-point visual analog scale was 4.3 (SD 2.4), 5.0 (SD 2.6) and 5.2 (SD 2.3) with overweight, stage I and stage II/III obesity, respectively (p = 0.0367). The mean WOMAC function score (out of 100) was 36.2 (SD 20.1), 39.5 (SD 21.4) and 45.6 (SD 18.4), respectively (p = 0.0409). The Knee Osteoarthritis Fears and Beliefs Questionnaire total score (KOFBEQ), daily activity score and physician score significantly differed among BMI groups (p = 0.0204, p = 0.0389 and p = 0.0413, respectively), and the PA level significantly differed (p = 0.0219). We found a dose-response relation between BMI and the clinical consequences of KOA. Strategies to treat KOA should differ by obesity severity. High PA level was associated with low BMI and contributes to preventing the clinical consequences of KOA.
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Mahendira L, Jones C, Papachristos A, Waddell J, Rubin L. Comparative clinical and cost analysis between surgical and non-surgical intervention for knee osteoarthritis. INTERNATIONAL ORTHOPAEDICS 2020; 44:77-83. [PMID: 31520177 PMCID: PMC6938792 DOI: 10.1007/s00264-019-04405-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Accepted: 08/27/2019] [Indexed: 12/22/2022]
Abstract
OBJECTIVE To evaluate the management and costs of osteoarthritis of the knee (OAK), a progressive joint disease due to bone and cartilage degeneration, with significant personal and societal impact. METHODS We prospectively analyzed the clinical outcomes and quantifiable cumulative direct costs of patients with OAK referred to our multidisciplinary OA program over a two year time period. One hundred thirty-one subjects were assessed. All demonstrated radiographic criteria for moderate to severe OAK. Western Ontario McMaster Osteoarthritis Index (WOMAC), Minimal Clinically Important Improvement (MCII), and change in BMI were recorded and analyzed. Total medical and surgical direct costs for all subjects during the two year time period were determined. RESULTS Five patients underwent total joint replacement during the two years of study. Among the group as a whole, a significant overall improvement in WOMAC scores was noted at the two year time point follow-up. After dividing the group into tertiles by baseline WOMAC scores, 46% achieved MCII. Significant weight loss was noted for individuals with baseline BMI of > 30. As all patients were considered "de facto" surgical candidates at referral, an average net savings of $9551.10 of direct costs per patient, or a potential total of $1,203,438.60 for the entire group, could be inferred as a result of medical as opposed to surgical management. CONCLUSION These findings support the benefits of multidisciplinary medical management for patients with significant OAK. This approach is clinically beneficial and may provide significant cost savings. Such models of care can substantially improve the long-term outcome of this highly prevalent condition and reduce societal and financial burdens.
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Affiliation(s)
- Luxme Mahendira
- Division of Rheumatology, Unity Health-Saint Michael's Hospital, 30 Bond Street, Bond Wing 3-061, Toronto, Ontario, M5B 1W8, Canada
| | - Caroline Jones
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada
| | - Angelo Papachristos
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada
| | - James Waddell
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada
- Division of Orthopedics, Unity Health-Saint Michael's Hospital, 55 Queen St E. Suite 207, Toronto, Ontario, M5C 1R6, Canada
| | - Laurence Rubin
- Division of Rheumatology, Unity Health-Saint Michael's Hospital, 30 Bond Street, Bond Wing 3-061, Toronto, Ontario, M5B 1W8, Canada.
- Mobility Program, Unity Health-Saint Michael's Hospital, 30 Bond Street, Toronto, Ontario, M5B 1W8, Canada.
- Faculty of Medicine, University of Toronto, Toronto, M5S 1A8, Canada.
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Daugaard CL, Hangaard S, Bartels EM, Gudbergsen H, Christensen R, Bliddal H, Englund M, Conaghan PG, Boesen M. The effects of weight loss on imaging outcomes in osteoarthritis of the hip or knee in people who are overweight or obese: a systematic review. Osteoarthritis Cartilage 2020; 28:10-21. [PMID: 31778811 DOI: 10.1016/j.joca.2019.10.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 10/25/2019] [Accepted: 10/28/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the structural effects of weight loss on hip or knee osteoarthritis (OA) and to summarize which structural joint pathologies have been examined and the evidence for the outcome measurement instruments applied. DESIGN Based on a pre-specified protocol (available: PROSPERO CRD42017065263), we conducted a systematic search of the bibliographic databases, Medline, Embase and Web of Science identifying longitudinal articles reporting the effects of weight loss on structural imaging outcomes in OA of the hip or knee in people who are overweight or obese. RESULTS From 1625 potentially eligible records, 14 articles (from 6 cohorts) were included. 2 cohorts were derived from RCTs. Evaluated pathologies were: articular cartilage (n = 7), joint space width (n = 3), bone marrow lesions (n = 5), synovitis (n = 2), effusion (n = 1), meniscus (n = 3), bone marrow density (n = 1) and infrapatellar fat pad (IPFP; n = 2). Cartilage showed conflicting results when evaluating cartilage thickness by direct thickness measurements. Compositional dGEMRIC and T2 mapping measures in early knee OA showed trends towards reduced cartilage degeneration. Joint space width on conventional radiographs showed no change. Weight loss reduced the size of the IPFP. Synovitis and effusion were not affected. Following weight loss DXA showed bone loss at the hip. CONCLUSION We did not find consistent evidence of the effects of weight loss on OA structural pathology in people who are overweight or obese. There is a need to achieve consensus on which structural pathologies and measurements to apply in weight loss and OA research.
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Affiliation(s)
- C L Daugaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - S Hangaard
- Dept. of Radiology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - E M Bartels
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark; Dept. of Neurology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - H Gudbergsen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - R Christensen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark; Research Unit of Rheumatology, Department of Clinical Research, University of Southern Denmark, Odense University Hospital, Denmark.
| | - H Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - M Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden.
| | - P G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomedical Research Centre, Leeds, UK.
| | - M Boesen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark; Dept. of Radiology, Copenhagen University Hospital, Bispebjerg & Frederiksberg, Copenhagen, Denmark.
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Miaskowski C, Blyth F, Nicosia F, Haan M, Keefe F, Smith A, Ritchie C. A Biopsychosocial Model of Chronic Pain for Older Adults. PAIN MEDICINE 2019; 21:1793-1805. [DOI: 10.1093/pm/pnz329] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Abstract
Population
Comprehensive evaluation of chronic pain in older adults is multifaceted.
Objective and Methods
Research on chronic pain in older adults needs to be guided by sound conceptual models. The purpose of this paper is to describe an adaptation of the Biopsychosocial Model (BPS) of Chronic Pain for older adults. The extant literature was reviewed, and selected research findings that provide the empiric foundation for this adaptation of the BPS model of chronic pain are summarized. The paper concludes with a discussion of specific recommendations for how this adapted model can be used to guide future research.
Conclusions
This adaptation of the BPS model of chronic pain for older adults provides a comprehensive framework to guide future research in this vulnerable population.
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Affiliation(s)
| | - Fiona Blyth
- School of Medicine, The University of Sydney, Sydney, Australia
| | - Francesca Nicosia
- School of Medicine, University of California, San Francisco, California
| | - Mary Haan
- School of Medicine, University of California, San Francisco, California
| | - Frances Keefe
- School of Medicine, Duke University, Durham, North Carolina, USA
| | - Alexander Smith
- School of Medicine, University of California, San Francisco, California
| | - Christine Ritchie
- School of Medicine, University of California, San Francisco, California
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Rice D, McNair P, Huysmans E, Letzen J, Finan P. Best Evidence Rehabilitation for Chronic Pain Part 5: Osteoarthritis. J Clin Med 2019; 8:jcm8111769. [PMID: 31652929 PMCID: PMC6912819 DOI: 10.3390/jcm8111769] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2019] [Accepted: 09/30/2019] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) is a leading cause of chronic pain and disability in older adults, which most commonly affects the joints of the knee, hip, and hand. To date, there are no established disease modifying interventions that can halt or reverse OA progression. Therefore, treatment is focused on alleviating pain and maintaining or improving physical and psychological function. Rehabilitation is widely recommended as first-line treatment for OA as, in many cases, it is safer and more effective than the best-established pharmacological interventions. In this article, we describe the presentation of OA pain and give an overview of its peripheral and central mechanisms. We then provide a state-of-the-art review of rehabilitation for OA pain—including self-management programs, exercise, weight loss, cognitive behavioral therapy, adjunct therapies, and the use of aids and devices. Next, we explore several promising directions for clinical practice, including novel education strategies to target unhelpful illness and treatment beliefs, methods to enhance the efficacy of exercise interventions, and innovative, brain-directed treatments. Finally, we discuss potential future research in areas, such as treatment adherence and personalized rehabilitation for OA pain.
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Affiliation(s)
- David Rice
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
- Waitemata Pain Service, Department of Anaesthesiology and Perioperative Medicine, Waitemata District Health Board, Auckland 1142, New Zealand.
| | - Peter McNair
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland 1142, New Zealand.
| | - Eva Huysmans
- Pain in Motion International Research Group.
- Department of Physiotherapy, Human Physiology and Anatomy, Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussel, Belgium.
- Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium.
- I-CHER, Interuniversity Center for Health Economics Research, 1090 Brussels, Belgium.
- Department of Physical Medicine and Physiotherapy, Universitair Ziekenhuis Brussel, 1090 Brussels, Belgium.
| | - Janelle Letzen
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
| | - Patrick Finan
- Department of Psychiatry & Behavioral Sciences, Johns Hopkins University, Baltimore, MD 21287, USA.
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Pattinson AL, Nassar N, da Luz FQ, Hay P, Touyz S, Sainsbury A. The Real Happy Study: Protocol for a Prospective Assessment of the Real-World Effectiveness of the HAPIFED Program-a Healthy APproach to we Ight management and Food in Eating Disorders. Behav Sci (Basel) 2019; 9:bs9070072. [PMID: 31266238 PMCID: PMC6680425 DOI: 10.3390/bs9070072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Revised: 06/12/2019] [Accepted: 06/25/2019] [Indexed: 01/16/2023] Open
Abstract
The prevalence of obesity with comorbid binge eating behaviour is growing at a faster rate than that seen for either obesity or eating disorders as separate conditions. Approximately 6% of the population are affected and they potentially face a lifetime of poor physical and mental health outcomes and an inability to sustain long-term weight loss. Current treatment options are inadequate in that they typically address either obesity or eating disorders exclusively, not the combination of both conditions. By treating one condition without treating the other, relapse is common, and patients are often left disappointed with their lack of weight loss. An integrated approach to treating these individuals is needed to prevent a worsening of the comorbidities associated with excess body weight and eating disorders. A new therapy has recently been developed, named HAPIFED, which addresses both overweight/obesity and comorbid binge eating behaviour with the combination of behavioural weight loss therapy and cognitive behaviour therapy-enhanced (CBT-E). The aim of this paper is to document the protocol for the Real Happy Study, which will evaluate the effectiveness of the HAPIFED program in treating overweight or obesity with comorbid binge-eating behaviour in a real-world setting.
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Affiliation(s)
- Andrea L Pattinson
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Natasha Nassar
- Child Population and Translational Health Research, Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia
| | - Felipe Q da Luz
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia
| | - Phillipa Hay
- Translational Health Research Institute (THRI), School of Medicine, Western Sydney University, Penrith, NSW 2751, Australia
| | - Stephen Touyz
- School of Psychology, Faculty of Science, The University of Sydney, NSW 2006, Australia
| | - Amanda Sainsbury
- The Boden Institute of Obesity, Nutrition, Exercise & Eating Disorders, Faculty of Medicine and Health, Charles Perkins Centre, The University of Sydney, NSW 2006, Australia.
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Diet-induced weight loss alone or combined with exercise in overweight or obese people with knee osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum 2019; 48:765-777. [DOI: 10.1016/j.semarthrit.2018.06.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Revised: 06/09/2018] [Accepted: 06/12/2018] [Indexed: 12/29/2022]
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Greaney ML, Cohen SA, Ward-Ritacco CL, Riebe D. Rural-Urban Variation in Weight Loss Recommendations Among US Older Adults with Arthritis and Obesity. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16060946. [PMID: 30884784 PMCID: PMC6466170 DOI: 10.3390/ijerph16060946] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/01/2019] [Revised: 03/07/2019] [Accepted: 03/13/2019] [Indexed: 12/11/2022]
Abstract
Purpose: Weight loss is advantageous for individuals with obesity and arthritis. Therefore, this study was conducted to determine if there are differences by rural-urban status among older adults with these conditions who reported being advised by a health care provider to lose weight for arthritis or to ameliorate arthritis symptoms. Methods: A cross-sectional analysis of 2011 Behavioral Risk Factor Surveillance System (BRFSS) data. Respondents reported if they had been diagnosed with arthritis and if they received a provider weight loss recommendation (WLR). The analytic sample was limited to older adults aged 60⁻79 living in the five states that administered the examined BRFSS arthritis module who had body mass index ≥ 30 kg/m² and reported having arthritis (n = 2920). The respondent's county of residence was linked to the corresponding county-level population density from the US Decennial Census to determine rural-urban status. A generalized linear model examined the association between receipt of a WLR and population density, controlling for demographics. Results: The sample was 83.6% white, 57.8% female, and 63.2% received a WLR. Respondents from more urban counties were more likely to receive a WLR (p value for trend <0.001). Additionally, older respondents, men, individuals with less than a high school education, and whites had a decreased likelihood of receiving a WLR. Conclusions: The analysis identified notable rural-urban differences with respondents in more urban counties being more likely to receive a WLR. Furthermore, there were differences in those who received a WLR by age, sex, and education. Reasons for these differences should be explored.
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Affiliation(s)
- Mary L Greaney
- Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Steven A Cohen
- Health Studies, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Christie L Ward-Ritacco
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
| | - Deborah Riebe
- Department of Kinesiology, University of Rhode Island, 25 West Independence Way, Kingston, RI 02881, USA.
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A pragmatic approach to prevent post-traumatic osteoarthritis after sport or exercise-related joint injury. Best Pract Res Clin Rheumatol 2019; 33:158-171. [PMID: 31431269 DOI: 10.1016/j.berh.2019.02.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Lower extremity musculoskeletal injuries are common in sport and exercise, and associated with increased risk of obesity and post-traumatic osteoarthritis (PTOA). Unlike other forms of osteoarthritis, PTOA is common at a younger age and associated with more rapid progression, which may impact career choices, long-term general health and reduce quality of life. Individuals who suffer an activity-related joint injury and present with abnormal joint morphology, elevated adiposity, weak musculature, or become physically inactive are at increased risk of PTOA. Insufficient exercise therapy or incomplete rehabilitation, premature return-to-sport and re-injury, unrealistic expectations, or poor nutrition may further elevate this risk. Delay in surgical interventions in lieu of exercise therapy to optimize muscle strength and neuromuscular control while addressing fear of movement to guarantee resumption of physical activity, completeness of rehabilitation before return-to-sport, education that promotes realistic expectations and self-management, and nutritional counseling are the best approaches for delaying or preventing PTOA.
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46
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Gatenholm B, Brittberg M. Neuropeptides: important regulators of joint homeostasis. Knee Surg Sports Traumatol Arthrosc 2019; 27:942-949. [PMID: 30039292 DOI: 10.1007/s00167-018-5074-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2018] [Accepted: 07/17/2018] [Indexed: 12/31/2022]
Abstract
PURPOSE This review explores the mechanisms of joint pain with a special focus on the role of neuropeptides in pain transmission and their potential role in the progression of joint degeneration as seen in osteoarthritis. METHODS A literature search was performed on papers published between January 1990 and September 2017 using the Web of Science Core Collection, MEDLINE and Scopus databases. RESULTS What is seen in the subchondral bone and synovia is mirrored in the central nervous system (CNS). Substance P, calcitonin gene-related peptide, vasoactive intestinal peptide and neuropeptide Y are the major peptides involved both in the generation of pain as well as reducing pain post-joint trauma. The interplay between them and other neuropeptides and cytokines influence how noxious stimuli are transduced, transmitted and modulated for a final pain perception as part of a complex cascade of events. There is a close interaction between the different components in the joint that together cross-talk to adapt to load and catabolic factors during injury and inflammation. CONCLUSION The articular joint should be seen as an organ where local joint pain development and maintenance is influenced by interplay between the local transmitters in the joints as well as their dependence on the CNS. A slow-release cocktail of mixed antibodies targeted against neuropeptides and receptor blockers/stimulators involved in the events of early joint pain or any inflammatory joint disease is a future treatment target. LEVEL OF EVIDENCE V.
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Affiliation(s)
- Birgitta Gatenholm
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden. .,Sahlgrenska University Hospital, Mölndal, Sweden.
| | - Mats Brittberg
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy at the University of Gothenburg, Gothenburg, Sweden.,Hallands Sjukhus, Kungsbacka, Sweden
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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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Alrushud AS, Rushton AB, Bhogal G, Pressdee F, Greig CA. Effect of a combined programme of dietary restriction and physical activity on the physical function and body composition of obese middle-aged and older adults with knee OA (DRPA): protocol for a feasibility study. BMJ Open 2018; 8:e021051. [PMID: 30552242 PMCID: PMC6303593 DOI: 10.1136/bmjopen-2017-021051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Revised: 06/20/2018] [Accepted: 09/12/2018] [Indexed: 11/15/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is the most common chronic illness among older adults. Up to the submission date of this protocol, there are no published UK studies reporting the efficacy of a combined intervention programme of physical activity and dietary restriction on the musculoskeletal function of obese older adults with knee OA in spite of the clinical recommendation for exercise and diet for people with knee OA. The aim of this study is to assess the feasibility and acceptability of a combined dietary restriction and physical activity intervention programme and collect preliminary data. METHOD AND ANALYSIS This single-arm intervention study is scheduled to begin in September 2017 and conclude in November 2018. It will take place at the Royal Orthopaedic Hospital (ROH), Birmingham and the School of Sport, Exercise and Rehabilitation Sciences (SportExR), University of Birmingham. Participants will receive a physiotherapy usual care programme for knee OA for 1 month, after which they will continue to exercise in their local gym/leisure facility for 3 months. Participants will also follow dietary restriction throughout the 4-month intervention. Mixed analysis techniques will be used to analyse the quantitative and qualitative outcome measures. ETHICS AND DISSEMINATION It is approved by ROH R&D Foundation Trust and the Health Research Authority. The Consort Guidelines and checklist will be reviewed prior to generating any publications for the trial to ensure they meet the standards required for submission to high-quality peer-reviewed journals. TRIAL REGISTRATION NUMBER ISRCTN12906938.
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Affiliation(s)
- Asma S Alrushud
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
| | - Alison B Rushton
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing and Health, University of Birmingham, Birmingham, UK
| | - Gurjit Bhogal
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Fraser Pressdee
- The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK
| | - Carolyn A Greig
- School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK
- MRC-Arthritis Research UK Centre for Musculoskeletal Ageing and Health, University of Birmingham, Birmingham, UK
- National Institute for Health Research (NIHR) Birmingham Biomedical Research Centre, Birmingham, UK
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Chu IJH, Lim AYT, Ng CLW. Effects of meaningful weight loss beyond symptomatic relief in adults with knee osteoarthritis and obesity: a systematic review and meta-analysis. Obes Rev 2018; 19:1597-1607. [PMID: 30051952 DOI: 10.1111/obr.12726] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2018] [Revised: 05/24/2018] [Accepted: 06/04/2018] [Indexed: 12/31/2022]
Abstract
Existing clinical guidelines recommend weight loss for adults with knee osteoarthritis and obesity, but the supporting evidence to date remains inadequate. There is also no pooled data on physical function and quality of life. This study aims to examine the efficacy of weight loss on pain, self-reported disability, physical function and quality of life in adults with knee osteoarthritis and obesity. A systematic database search (from 1990 to June 2017) was conducted, and seven studies were eligible for inclusion. The meta-analyses demonstrated that a 5% to 10% weight loss significantly improved pain (effect size 0.33, 95% confidence intervals 0.17 to 0.48), self-reported disability (effect size 0.42, 95% confidence intervals 0.25 to 0.59) and quality of life (physical) (effect size 0.39, 95% confidence intervals 0.24 to 0.54). The results were based on adults with mean body mass index 33.6 to 36.4 kg m-2 and mild to moderate knee osteoarthritis. Results for physical function were inconclusive due to the lack of eligible studies and incomprehensive outcome measures used.
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Affiliation(s)
- I J H Chu
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - A Y T Lim
- Department of Physiotherapy, Singapore General Hospital, Singapore
| | - C L W Ng
- Department of Physiotherapy, Singapore General Hospital, Singapore
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50
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Thomas S, Browne H, Mobasheri A, Rayman MP. What is the evidence for a role for diet and nutrition in osteoarthritis? Rheumatology (Oxford) 2018; 57:iv61-iv74. [PMID: 29684218 PMCID: PMC5905611 DOI: 10.1093/rheumatology/key011] [Citation(s) in RCA: 104] [Impact Index Per Article: 17.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2017] [Indexed: 01/01/2023] Open
Abstract
As current treatment options in OA are very limited, OA patients would benefit greatly from some ability to self-manage their condition. Since diet may potentially affect OA, we reviewed the literature on the relationship between nutrition and OA risk or progression, aiming to provide guidance for clinicians. For overweight/obese patients, weight reduction, ideally incorporating exercise, is paramount. The association between metabolic syndrome, type-2 diabetes and OA risk or progression may partly explain the apparent benefit of dietary-lipid modification resulting from increased consumption of long-chain omega-3 fatty-acids from oily fish/fish oil supplements. A strong association between OA and raised serum cholesterol together with clinical effects in statin users suggests a potential benefit of reduction of cholesterol by dietary means. Patients should ensure that they meet the recommended intakes for micronutrients such as vitamin K, which has a role in bone/cartilage mineralization. Evidence for a role of vitamin D supplementation in OA is unconvincing.
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Affiliation(s)
- Sally Thomas
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Heather Browne
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
| | - Ali Mobasheri
- School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, Arthritis Research UK Centre for Musculoskeletal Ageing Research, Queen's Medical Centre, Nottingham, UK.,Department of Regenerative Medicine, State Research Institute, Centre for Innovative Medicine, Santariskiu 5, 08661 Vilnius, Republic of Lithuania
| | - Margaret P Rayman
- Department of Nutritional Sciences, School of Biosciences and Medicine, University of Surrey, Guildford, UK
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