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Liang Z, Sun X, Guo R, Wang H, Tian Y, Wang Y, Liu Y, Liu S. Association between glyphosate exposure and osteoarthritis in US adults: Especially in people who are obese and inactive in leisure time physical activity. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 927:172008. [PMID: 38547993 DOI: 10.1016/j.scitotenv.2024.172008] [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: 12/10/2023] [Revised: 03/16/2024] [Accepted: 03/25/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Little has been known on the effect of chronic glyphosate exposure on osteoarthritis (OA). The aim of this study was to investigate the association between glyphosate exposure and OA and to further investigate the different moderating effects of leisure time physical activity (LTPA) and body mass index (BMI) types on the association between glyphosate exposure and OA. METHODS Cross-sectional data from 2540 participants in the 2015-2018 National Health and Nutrition Examination Survey (NHANES) were used to explore the association between glyphosate exposure and OA. Multivariate logistic regression models and restricted cubic spline models were used to investigate the association between glyphosate exposure and OA, and further analyses were conducted to determine the association between glyphosate exposure and OA under different LTPA and BMI types. RESULTS Of the 2540 participants, 346 had OA. Participants with the highest glyphosate concentration (Q4) had a higher incidence of OA compared to participants with the lowest glyphosate concentration (Q1) (OR, 1.88; 95 % confidence interval [CI]: 1.13, 3.13), there was no nonlinear association between glyphosate and OA (non-linear P = 0.343). In the no LTPA group, glyphosate concentration in the Q4 group was correlated with OA (OR, 2.65; 95%CI: 1.27, 5.51). In the obese group, glyphosate concentration in the Q4 group was correlated with OA (OR, 2.74; 95 % CI: 1.48, 5.07). Among people with high BMI and inactive in LTPA, glyphosate concentrations in Q4 were associated with OA (OR, 2.19; 95 % CI: 1.07, 4.48). CONCLUSIONS Glyphosate is associated with OA odd, and physical activity and moderate weight loss can mitigate this association to some degree. This study provides a scientific basis for rational prevention of OA by regulation of LTPA and BMI under glyphosate exposure.
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Affiliation(s)
- Zhuoshuai Liang
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China
| | - Xiaoyue Sun
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China
| | - Ruifang Guo
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China
| | - Hongwei Wang
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China
| | - Yuyang Tian
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China
| | - Yujian Wang
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China
| | - Yawen Liu
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China.
| | - Siyu Liu
- Department of Epidemiology and Biostatistics, School of Public Health of Jilin University, Changchun 130021, China.
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Biscaro RC, Ochoa PGG, Ocampos GP, Arouca MM, de Camargo OP, de Rezende MU. SELF-MANAGEMENT PROGRAM (PARQVE) IMPROVES QUALITY OF LIFE IN SEVERE KNEE OSTEOARTHRITIS. ACTA ORTOPEDICA BRASILEIRA 2022; 30:e255939. [PMID: 35864826 PMCID: PMC9270049 DOI: 10.1590/1413-785220223001e255939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Accepted: 11/01/2021] [Indexed: 06/15/2023]
Abstract
OBJECTIVE To evaluate the effects of the self-management program PARQVE in patients with severe knee osteoarthritis (KOA). METHODS Prospective randomized controlled clinical trial with 65 grade IV Kelgren & Lawrence (K&L) KOA patients who were allocated into groups: Control (CG) and Intervention (IG). Both groups received usual care. IG also participated in two days of multi-professional interventions about OA (causes and treatment) and received the program's DVD and book. Standing X-rays were obtained at inclusion and Ahlback's classification was registered. Western Ontario and McMaster Universities Index (WOMAC), Numerical Rating Scale (NRS), Lequesne, weight, and body mass index (BMI) were obtained at inclusion, and after 6, 12 and 24 months. RESULTS Groups were similar at baseline, despite higher WOMAC stiffness scores and a greater number of Ahlback's grade 4 and 5 in the IG. Only the IG improved WOMAC and total functions (p<0.001) during the study period above 12%, but did not reach the minimal clinically important difference of 20%. Best results were in one year. Non-significant improvements were observed without changes in body composition (P>0.05). CONCLUSIONS Patients with severe KOA have mild to moderate function and quality of life improvement due to self-management program (PARQVE). Level of Evidence I; Therapeutic Studies; Prospective Randomized Controlled Trial.
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Affiliation(s)
- Raphael Carvalho Biscaro
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil
| | - Pablo Gabriel Garcia Ochoa
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil
| | - Guilherme Pereira Ocampos
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil
| | - Matheus Manolo Arouca
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil
| | - Olavo Pires de Camargo
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, Department of Orthopedics and Traumatology, HC-DOT/FMUSP, São Paulo, SP, Brazil
| | - Márcia Uchoa de Rezende
- Universidade de São Paulo, Faculty of Medicine, Hospital das Clínicas, Institute of Orthopedics and Traumatology, HC-FMUSP, São Paulo, SP, Brazil
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Runhaar J, Bierma-Zeinstra SM. The Challenges in the Primary Prevention of Osteoarthritis. Clin Geriatr Med 2022; 38:259-271. [DOI: 10.1016/j.cger.2021.11.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Jansen NEJ, Schiphof D, Oei E, Bosmans J, van Teeffelen J, Feleus A, Runhaar J, van Meurs J, Bierma-Zeinstra SMA, van Middelkoop M. Effectiveness and cost-effectiveness of a combined lifestyle intervention compared with usual care for patients with early-stage knee osteoarthritis who are overweight (LITE): protocol for a randomised controlled trial. BMJ Open 2022; 12:e059554. [PMID: 35246425 PMCID: PMC8900023 DOI: 10.1136/bmjopen-2021-059554] [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] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Obesity is the most important modifiable risk factor for knee osteoarthritis (KOA). Especially in an early stage of the disease, weight loss is important to prevent further clinical and structural progression. Since 2019, general practitioners (GPs) in the Netherlands can refer eligible patients to a combined lifestyle intervention (GLI) to promote physical activity, healthy nutrition and behavioural change. However, GPs scarcely refer patients with KOA to the GLI potentially due to a lack of evidence about the (cost-)effectiveness. The aim of this study is to determine the (cost-)effectiveness of the GLI for patients with early-stage KOA in primary care. METHODS AND ANALYSIS For this pragmatic, multi-centre randomised controlled trial, 234 participants (aged 45-70 years) with National Institute for Health and Care Excellence (NICE) guideline diagnosis of clinical KOA and a body mass index above 25 kg/m2 will be recruited using a range of online and offline strategies and from general practices in the Netherlands. Participants will receive nine 3-monthly questionnaires. In addition, participants will be invited for a physical examination, MRI assessment and blood collection at baseline and at 24-month follow-up. After the baseline assessment, participants are randomised to receive either the 24-month GLI programme in addition to usual care or usual care only. Primary outcomes are self-reported knee pain over 24 months, structural progression on MRI at 24 months, weight loss at 24 months, as well as societal costs and Quality-Adjusted Life-Years over 24-month follow-up. Analyses will be performed following the intention-to-treat principle using linear mixed-effects regression models. ETHICS AND DISSEMINATION Ethical approval was obtained through the Medical Ethical Committee of the Erasmus MC University Medical Center Rotterdam, The Netherlands (MEC-2020-0943). All participants will provide written informed consent. The results will be disseminated through publications in peer-reviewed journals, presentations at international conferences and among study participants and healthcare professionals. TRIAL REGISTRATION NUMBER Netherlands Trial Registry (NL9355).
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Affiliation(s)
- Nuria E J Jansen
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Edwin Oei
- Department of Radiology & Nuclear Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Judith Bosmans
- Department of Health Sciences, Faculty of Science, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Jolande van Teeffelen
- Dietician Practice in Primary Care, Diëtistenpraktijk HRC, Rotterdam, The Netherlands
| | - Anita Feleus
- Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joyce van Meurs
- Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus Medical Center, Rotterdam, The Netherlands
- Department of Orthopaedics, Erasmus Medical Center, Rotterdam, The Netherlands
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Runhaar J, Dam EB, Oei EH, Bierma-Zeinstra SM. Medial Cartilage Surface Integrity as a Surrogate Measure for Incident Radiographic Knee Osteoarthritis following Weight Changes. Cartilage 2021; 13:424S-427S. [PMID: 31829028 PMCID: PMC8739584 DOI: 10.1177/1947603519892305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Jos Runhaar
- Department of General Practice, Erasmus
MC University Medical Center Rotterdam, Rotterdam, the Netherlands,Jos Runhaar, Department of General Practice,
Erasmus MC University Medical Center Rotterdam, PO-Box 2040, Room NA 1911,
Rotterdam, 3000 CA, the Netherlands.
| | - Erik B. Dam
- Machine Learning Section, Department of
Computer Science, University of Copenhagen, Kobenhavns, Denmark,Biomediq A/S, Copenhagen, Denmark
| | - Edwin H.G. Oei
- Department of Radiology & Nuclear
Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, the
Netherlands
| | - Sita M.A. Bierma-Zeinstra
- Department of General Practice, and the
Department of Orthopedics, Erasmus MC University Medical Center Rotterdam,
Rotterdam, the Netherlands
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Whittaker JL, Runhaar J, Bierma-Zeinstra S, Roos EM. A lifespan approach to osteoarthritis prevention. Osteoarthritis Cartilage 2021; 29:1638-1653. [PMID: 34560260 DOI: 10.1016/j.joca.2021.06.015] [Citation(s) in RCA: 44] [Impact Index Per Article: 14.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 05/27/2021] [Accepted: 06/18/2021] [Indexed: 02/02/2023]
Abstract
Prevention is an attractive solution for the staggering and increasingly unmanageable burden of osteoarthritis. Despite this, the field of osteoarthritis prevention is relatively immature. To date, most of what is known about preventing osteoarthritis and risk factors for osteoarthritis is relative to the disease (underlying biology and pathophysiology) of osteoarthritis, with few studies considering risk factors for osteoarthritis illness, the force driving the personal, financial and societal burden. In this narrative review we will discuss what is known about osteoarthritis prevention, propose actionable prevention strategies related to obesity and joint injury which have emerged as important modifiable risk factors, identify where evidence is lacking, and give insight into what might be possible in terms of prevention by focussing on a lifespan approach to the illness of osteoarthritis, as opposed to a structural disease of the elderly. By targeting a non-specialist audience including scientists, clinicians, students, industry employees and others that are interested in osteoarthritis but who do not necessarily focus on osteoarthritis, the goal is to generate discourse and motivate inquiry which propel the field of osteoarthritis prevention into the mainstream.
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Affiliation(s)
- J L Whittaker
- Department of Physical Therapy, Faculty of Medicine, University of British Columbia, Arthritis Research Canada, Canada.
| | - J Runhaar
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands.
| | - S Bierma-Zeinstra
- Erasmus MC University Medical Center Rotterdam, Department of General Practice, Rotterdam, the Netherlands; Erasmus MC University Medical Center Rotterdam, Department of General Practice, and Department of Orthopaedics, Rotterdam, the Netherlands.
| | - E M Roos
- Department of Sports Science and Clinical Biomechanics, Musculoskeletal Function and Physiotherapy, University of Southern Denmark, Denmark.
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Rezende MU, Brito NLR, Farias FES, Silva CAC, Cernigoy CHA, Rodrigues da Silva JM, Moreira MM, Santana OFN, Hissadomi MI, Frucchi R, Pasqualin T, Campos GC, Pailo AF, Ocampos GP, Camargo OP. Improved function and strength in patients with knee osteoarthritis as a result of adding a two-day educational program to usual care. Prospective randomized trial. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100137. [DOI: 10.1016/j.ocarto.2020.100137] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 12/31/2020] [Indexed: 11/28/2022] Open
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Berry KM, Neogi T, Baker JF, Collins JM, Waggoner JR, Hsiao CW, Johnston SS, LaValley MP, Stokes A. Obesity Progression Between Young Adulthood and Midlife and Incident Arthritis: A Retrospective Cohort Study of US Adults. Arthritis Care Res (Hoboken) 2021; 73:318-327. [PMID: 32374930 PMCID: PMC7644635 DOI: 10.1002/acr.24252] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2019] [Accepted: 04/28/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To examine the association between weight change from young adulthood to midlife and the risk of incident arthritis. METHODS Using data from the National Health and Nutrition Examination Survey, we categorized participants into weight-change categories based on their recalled weight during young adulthood and midlife. We estimated the association of weight change and developing an arthritis condition over 10 years using adjusted Cox models. Findings were extrapolated to the US population to determine the proportion of incident arthritis cases that could be averted if the entire population maintained a normal body mass index (BMI) in young adulthood and midlife. RESULTS Among our sample of adults who were ages 40-69 years at their midlife weight measure (n = 13,669), 3,603 developed an arthritis condition. Compared with adults who maintained a normal-normal BMI, the normal-overweight, normal-obese, overweight-obese, and obese-obese groups had a significantly elevated risk of incident arthritis conditions. The obese-overweight group had a lower risk of incident arthritis conditions compared with the obese-obese group and a comparable risk to the overweight-overweight group. Nearly one-fourth of incident arthritis cases, corresponding to 2.7 million individuals, would have been averted under the hypothetical scenario where all individuals maintained normal weight from young adulthood to midlife. CONCLUSION Weight loss from young adulthood to midlife was associated with a substantially reduced risk of developing an arthritis condition. We found no evidence of residual risk from having been heavier earlier in life. Our findings highlight the critical need to expand obesity treatment and prevention to achieve meaningful reductions in the burden of arthritis.
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Affiliation(s)
- Kaitlyn M. Berry
- University of Minnesota School of Public Health, Minneapolis, MN, USA
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, USA
- Boston University School of Public Health, Boston, MA, USA
| | | | - Jason M. Collins
- University of North Carolina Gillings School of Global Public Health, NC, USA
| | | | | | - Stephen S. Johnston
- Epidemiology, Medical Devices, Johnson & Johnson, Inc., New Brunswick, NJ, USA
| | | | - Andrew Stokes
- Boston University School of Public Health, Boston, MA, USA
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9
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Dechaumet B, Cleret D, Linossier MT, Vanden-Bossche A, Chanon S, Lefai E, Laroche N, Lafage-Proust MH, Vico L. Hypergravity as a gravitational therapy mitigates the effects of knee osteoarthritis on the musculoskeletal system in a murine model. PLoS One 2020; 15:e0243098. [PMID: 33296408 PMCID: PMC7725345 DOI: 10.1371/journal.pone.0243098] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 11/13/2020] [Indexed: 12/12/2022] Open
Abstract
Insights into the effects of osteoarthritis (OA) and physical interventions on the musculoskeletal system are limited. Our goal was to analyze musculoskeletal changes in OA mice and test the efficacy of 8-week exposure to hypergravity, as a replacement of physical activity. 16-week-old male (C57BL/6J) mice allocated to sham control and OA groups not centrifuged (Ctrl 1g and OA 1g, respectively) or centrifuged at 2g acceleration (Ctrl 2g and OA 2g). OA 1g displayed decreased trabecular bone in the proximal tibia metaphysis and increased osteoclastic activity and local TNFα gene expression, all entirely prevented by 2g gravitational therapy. However, while cortical bone of tibia midshaft was preserved in OA 1g (vs. ctrl), it is thinner in OA 2g (vs. OA 1g). In the hind limb, OA at 1g increased fibers with lipid droplets by 48% in the tibialis anterior, a fact fully prevented by 2g. In Ctrl, 2g increased soleus, tibialis anterior and gastrocnemius masses. In the soleus of both Ctrl and OA, 2g induced larger fibers and a switch from type-II to type-I fiber. Catabolic (myostatin and its receptor activin RIIb and visfatine) and anabolic (FNDC5) genes dramatically increased in Ctrl 2g and OA 2g (p<0.01 vs 1g). Nevertheless, the overexpression of FNDC5 (and follistatine) was smaller in OA 2g than in Ctrl 2g. Thus, hypergravity in OA mice produced positive effects for trabecular bone and muscle typology, similar to resistance exercises, but negative effects for cortical bone.
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Affiliation(s)
- Benoit Dechaumet
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
| | - Damien Cleret
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
| | | | | | - Stéphanie Chanon
- CarMeN Laboratory, INSERM, INRA, University of Lyon, Pierre-Bénite, France
| | - Etienne Lefai
- CarMeN Laboratory, INSERM, INRA, University of Lyon, Pierre-Bénite, France
| | - Norbert Laroche
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
| | | | - Laurence Vico
- SAINBIOSE Laboratory, INSERM, University of Lyon, Saint-Etienne, France
- * E-mail:
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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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Chen L, Zheng JJY, Li G, Yuan J, Ebert JR, Li H, Papadimitriou J, Wang Q, Wood D, Jones CW, Zheng M. Pathogenesis and clinical management of obesity-related knee osteoarthritis: Impact of mechanical loading. J Orthop Translat 2020; 24:66-75. [PMID: 32695606 PMCID: PMC7349942 DOI: 10.1016/j.jot.2020.05.001] [Citation(s) in RCA: 56] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 04/28/2020] [Accepted: 05/02/2020] [Indexed: 12/16/2022] Open
Abstract
Obesity-related osteoarthritis (OA) is a complex, multifactorial condition that can cause significant impact on patients' quality of life. Whilst chronic inflammation, adipocytokines and metabolic factors are considered to be important pathogenic factors in obesity related OA, there has been limited investigation into the biomechanical impact of obesity on OA development. This review aims to demonstrate that mechanical factors are the major pathological cause of obesity-related OA. The effect of obesity on pathological changes to the osteochondral unit and surrounding connective tissues in OA is summarized, as well as the impact of obesity-related excessive and abnormal joint loading, concomitant joint malalignment and muscle weakness. An integrated therapeutic strategy based on this multi-factorial presentation is presented, to assist in the management of obesity related OA. THE TRANSLATIONAL POTENTIAL OF THIS ARTICLE Despite the high prevalence of obesity-related OA, there is no specific guideline available for obesity-related OA management. In this review, we demonstrated the pathological changes of obesity-related OA and summarized the impact of biomechanical factors by proposing a hypothetical model of obesity-related OA change. Therapeutic strategies based on adjusting abnormal mechanical effects are presented to assist in the management of obesity-related OA.
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Affiliation(s)
- Lianzhi Chen
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | | | - Guangyi Li
- Department of Orthopaedic Surgery, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Jun Yuan
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
| | - Jay R. Ebert
- School of Human Sciences (Exercise and Sport Science), University of Western Australia, Perth, Western Australia, Australia
| | - Hengyuan Li
- Department of Orthopedics, Second Affiliated Hospital of Zhejiang University, School of Medicine, Zhejiang, China
| | - John Papadimitriou
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Pathwest Laboratories, Perth, Western Australia, Australia
| | - Qingwen Wang
- Department of Rheumatism and Immunology, Peking University Shenzhen Hospital, Shenzhen, Guangdong, China
| | - David Wood
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
| | - Christopher W. Jones
- Fiona Stanley Hospital Group, Perth, Western Australia, Australia
- Curtin University Medical School, Perth, Western Australia, Australia
| | - Minghao Zheng
- Centre for Orthopaedic Research, Faculty of Health and Medical Sciences, University of Western Australia, Perth, Western Australia, Australia
- Perron Institute for Neurological and Translational Science, Perth, Western Australia, Australia
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Mobasheri A, Lambert C, Henrotin Y. Coll2-1 and Coll2-1NO2 as exemplars of collagen extracellular matrix turnover - biomarkers to facilitate the treatment of osteoarthritis? Expert Rev Mol Diagn 2019; 19:803-812. [PMID: 31327279 DOI: 10.1080/14737159.2019.1646641] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Introduction: Osteoarthritis (OA) is the most common form of arthritis. However, there are no structure or disease-modifying OA drugs (DMOADs). Introducing personalized healthcare to patients and health-care practitioners is a high priority for the management of arthritic and musculoskeletal diseases. However, there are no biomarker tools that can be used for patient stratification, disease management, and drug development. Biomarkers are capable of diagnosing and prognosing some arthritic and musculoskeletal diseases. Cartilage-based biomarkers have the potential to be used in this context to guide the precision treatment of OA. Areas covered: The aim of this review is to focus on the pre-clinical and clinical utility of the Coll2-1 and Coll2-1NO2 biomarkers as unique cartilage-based biomarkers that can guide the development of new treatments for OA. This expert report will begin with a background to collagens and their important biomechanical roles in the musculoskeletal system, but particularly cartilage, before exploring the data and scientific evidence to support the utility of Coll2-1 and Coll2-1NO2 as unique biomarkers. Expert opinion: This review summarises the authors' expert view on the pre-clinical and clinical utility of the Coll2-1 and Coll2-1NO2 biomarkers and their potential for use as drug development tools.
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Affiliation(s)
- Ali Mobasheri
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine , Vilnius , Lithuania.,Centre for Sport, Exercise and Osteoarthritis Versus Arthritis, Queen's Medical Centre , Nottingham , UK.,European Commission, The D-BOARD FP7 Consortium.,The APPROACH IMI Consortium.,Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu , Oulu , Finland
| | - Cecile Lambert
- Bone and Cartilage Research Unit, Arthropole Liège, Institute of Pathology, University of Liège , Liège , Belgium
| | - Yves Henrotin
- European Commission, The D-BOARD FP7 Consortium.,The APPROACH IMI Consortium.,Bone and Cartilage Research Unit, Arthropole Liège, Institute of Pathology, University of Liège , Liège , Belgium
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13
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Landsmeer MLA, de Vos BC, van der Plas P, van Middelkoop M, Vroegindeweij D, Bindels PJE, Oei EHG, Bierma-Zeinstra SMA, Runhaar J. Effect of weight change on progression of knee OA structural features assessed by MRI in overweight and obese women. Osteoarthritis Cartilage 2018; 26:1666-1674. [PMID: 30144512 DOI: 10.1016/j.joca.2018.08.006] [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: 04/04/2018] [Revised: 07/17/2018] [Accepted: 08/06/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate the effects of weight change on progression of knee osteoarthritis (OA) structural features by magnetic resonance imaging (MRI) in overweight and obese women without clinical knee OA. DESIGN 347 participants from the Prevention of Knee Osteoarthritis in Overweight Females (PROOF) study were classified with latent class growth analysis into a subgroup with steady weight (n = 260; +0.1 ± 4.0 kg, +0.2 ± 4.4%), weight gain (n = 43; +8.6 ± 4.0 kg, +9.8 ± 4.1%) or weight loss (n = 44; -9.0 ± 7.2 kg, -9.8 ± 7.5%) over 2.5 years. Baseline and follow-up 1.5T MRIs were scored with MRI Osteoarthritis Knee Score (MOAKS) for progression of bone marrow lesions (BMLs), cartilage defects, osteophytes, meniscal abnormalities, meniscal extrusion and synovitis. Associations between subgroups and change in MRI features at knee-level were assessed using adjusted Generalized Estimating Equations. RESULTS 687 knees from 347 women (median age 55.2 years, interquartile range (IQR) 5.5, median body mass index (BMI) 31.2 kg/m2, IQR 5.3) were analyzed. Progression of synovitis was 18% in the weight gain vs 7% in the stable weight subgroup (OR 2.88; 95%CI 1.39-5.94). The odds for progression of patellofemoral (PF) BMLs and cartilage defects increased with 62% (OR 1.62; 95%CI 0.92-2.84) and 53% (OR 1.53; 95%CI 0.92-2.56) in the weight gain vs the stable weight subgroup. CONCLUSIONS In overweight and obese women, progression of synovitis increased more than 2.5 times in a weight gain compared to a stable weight subgroup over 2.5 years. Large effect sizes were also found for the difference in progression of PF BMLs and PF cartilage defects between the weight gain and stable weight subgroup.
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Affiliation(s)
- M L A Landsmeer
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - B C de Vos
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - P van der Plas
- Department of Radiology, Spijkenisse Medical Center, Spijkenisse, The Netherlands.
| | - M van Middelkoop
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - D Vroegindeweij
- Department of Radiology, Maasstad Hospital, Rotterdam, The Netherlands.
| | - P J E Bindels
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - E H G Oei
- Department of Radiology & Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, the Netherlands.
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands; Department of Orthopaedics, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
| | - J Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, The Netherlands.
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Zhang Y, Niu J. Editorial: Shifting Gears in Osteoarthritis Research Toward Symptomatic Osteoarthritis. Arthritis Rheumatol 2018; 68:1797-800. [PMID: 27058963 DOI: 10.1002/art.39704] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2016] [Accepted: 03/29/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Yuqing Zhang
- Boston University School of Medicine, Boston, Massachusetts
| | - Jingbo Niu
- Boston University School of Medicine, Boston, Massachusetts
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15
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Kozijn AE, Gierman LM, van der Ham F, Mulder P, Morrison MC, Kühnast S, van der Heijden RA, Stavro PM, van Koppen A, Pieterman EJ, van den Hoek AM, Kleemann R, Princen HMG, Mastbergen SC, Lafeber FPJG, Zuurmond AM, Bobeldijk I, Weinans H, Stoop R. Variable cartilage degradation in mice with diet-induced metabolic dysfunction: food for thought. Osteoarthritis Cartilage 2018; 26:95-107. [PMID: 29074298 DOI: 10.1016/j.joca.2017.10.010] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Revised: 10/03/2017] [Accepted: 10/10/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Human cohort studies have demonstrated a role for systemic metabolic dysfunction in osteoarthritis (OA) pathogenesis in obese patients. To explore the mechanisms underlying this metabolic phenotype of OA, we examined cartilage degradation in the knees of mice from different genetic backgrounds in which a metabolic phenotype was established by various dietary approaches. DESIGN Wild-type C57BL/6J mice and genetically modified mice (hCRP, LDLr-/-. Leiden and ApoE*3Leiden.CETP mice) based on C57BL/6J background were used to investigate the contribution of inflammation and altered lipoprotein handling on diet-induced cartilage degradation. High-caloric diets of different macronutrient composition (i.e., high-carbohydrate or high-fat) were given in regimens of varying duration to induce a metabolic phenotype with aggravated cartilage degradation relative to controls. RESULTS Metabolic phenotypes were confirmed in all studies as mice developed obesity, hypercholesteremia, glucose intolerance and/or insulin resistance. Aggravated cartilage degradation was only observed in two out of the twelve experimental setups, specifically in long-term studies in male hCRP and female ApoE*3Leiden.CETP mice. C57BL/6J and LDLr-/-. Leiden mice did not develop HFD-induced OA under the conditions studied. Osteophyte formation and synovitis scores showed variable results between studies, but also between strains and gender. CONCLUSIONS Long-term feeding of high-caloric diets consistently induced a metabolic phenotype in various C57BL/6J (-based) mouse strains. In contrast, the induction of articular cartilage degradation proved variable, which suggests that an additional trigger might be necessary to accelerate diet-induced OA progression. Gender and genetic modifications that result in a humanized pro-inflammatory state (human CRP) or lipoprotein metabolism (human-E3L.CETP) were identified as important contributing factors.
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Affiliation(s)
- A E Kozijn
- Metabolic Health Research, TNO, Leiden, The Netherlands; Department of Orthopaedics, University Medical Center (UMC) Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - L M Gierman
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - F van der Ham
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - P Mulder
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - M C Morrison
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - S Kühnast
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - R A van der Heijden
- Department of Pathology and Medical Biology, UMC Groningen, Groningen, The Netherlands
| | - P M Stavro
- Bunge North America, Saint Louis, United States
| | - A van Koppen
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - E J Pieterman
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | | | - R Kleemann
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - H M G Princen
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - S C Mastbergen
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - F P J G Lafeber
- Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands
| | - A-M Zuurmond
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - I Bobeldijk
- Metabolic Health Research, TNO, Leiden, The Netherlands
| | - H Weinans
- Department of Orthopaedics, University Medical Center (UMC) Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Rheumatology & Clinical Immunology, UMC Utrecht, Utrecht University, Utrecht, The Netherlands; Department of Biomechanical Engineering, Delft University of Technology, Delft, The Netherlands
| | - R Stoop
- Metabolic Health Research, TNO, Leiden, The Netherlands.
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16
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Joseph GB, McCulloch CE, Nevitt MC, Neumann J, Gersing AS, Kretzschmar M, Schwaiger BJ, Lynch JA, Heilmeier U, Lane NE, Link TM. Tool for osteoarthritis risk prediction (TOARP) over 8 years using baseline clinical data, X-ray, and MRI: Data from the osteoarthritis initiative. J Magn Reson Imaging 2017; 47:1517-1526. [PMID: 29143404 DOI: 10.1002/jmri.25892] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2017] [Accepted: 10/24/2017] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA), a multifactorial disease causing joint degeneration, often leads to severe disability. The rising rates of disability highlight the need for implementing preventative measures at early stages of the disease, which would especially benefit subjects at high risk for OA development. PURPOSE To develop a risk prediction tool for moderate-severe OA (TOARP) over 8 years based on subject characteristics, knee radiographs, and MRI data at baseline using data from the Osteoarthritis Initiative (OAI). STUDY TYPE Retrospective. SUBJECTS 641 subjects with no/mild radiographic OA (Kellgren-Lawrence [KL] 0-2) and no clinically significant symptoms (Western Ontario and McMaster Universities Arthritis Index [WOMAC] 0-1) were selected from the OAI. FIELD STRENGTH/SEQUENCE MR images were obtained using 3.0T. ASSESSMENT Compartment-specific cartilage and meniscus morphology and cartilage T2 were assessed. Baseline subject demographics, risk factors, KL score, cartilage WORMS score, presence of meniscus tear, and cartilage T2 were used to predict the development of moderate/severe OA (KL = 3-4 or WOMAC pain ≥5 or total knee replacement [TKR]) over 8 years. STATISTICAL TESTS Best subsets variable selection followed by cross-validation were used to assess which combinations of variables best predict moderate/severe OA. RESULTS Model 1 included KL score, previous knee injury in the last 12 months, age, gender, and BMI. Model 2 included all variables in Model 1 plus presence of cartilage defects in the lateral femur and patella, and presence of a meniscal tear. Model 3 included all variables in Models 1 and 2, plus cartilage T2 in the medial tibia and medial femur. Compared to Model 1 (cross-validated AUC = 0.67), Model 3 performed significantly better (AUC = 0.72, P = 0.04), while Model 2 showed a statistical trend (AUC = 0.71, P = 0.08). DATA CONCLUSION We established a risk calculator for the development of moderate/severe knee OA over 8 years that includes radiographic and MRI data. The inclusion of MRI-based morphological abnormalities and cartilage T2 significantly improved model performance. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2018;47:1517-1526.
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Affiliation(s)
- Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Jan Neumann
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Martin Kretzschmar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - John A Lynch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Ursula Heilmeier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Nancy E Lane
- Department of Rheumatology, University of California, Davis, California, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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17
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Bierma-Zeinstra S, Waarsing J. The role of atherosclerosis in osteoarthritis. Best Pract Res Clin Rheumatol 2017; 31:613-633. [DOI: 10.1016/j.berh.2018.08.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 05/16/2018] [Accepted: 07/06/2018] [Indexed: 01/06/2023]
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18
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Joseph GB, McCulloch CE, Nevitt MC, Gersing AS, Schwaiger BJ, Kretzschmar M, Heilmeier U, Link TM. Medial femur T 2 Z-scores predict the probability of knee structural worsening over 4-8 years: Data from the osteoarthritis initiative. J Magn Reson Imaging 2017; 46:1128-1136. [PMID: 28206712 DOI: 10.1002/jmri.25662] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 01/24/2017] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE The purpose of this study was to determine the probability of structural worsening of knee cartilage and whole joint degeneration over 4-8 years based on cartilage T2 Z-scores at baseline. DESIGN Right knees with Kellgren-Lawrence (KL) grades of 0-2 in 587 participants from the Osteoarthritis Initiative were studied. 3T MR images were used to perform baseline cartilage T2 quantification and assess 4-year changes in cartilage morphology (WORMS scoring) in 5 regions. Changes in joint space narrowing (JSN) and KL were assessed over 8 years. T2 Z-scores were based on a reference database of knees without morphologic cartilage degeneration at baseline. Odds ratios for, and predicted probabilities of any worsening in WORMS cartilage, JSN and KL grade were obtained from logistic regression models. RESULTS A one-unit increase in the baseline medial femur T2 Z-score was associated with cartilage worsening in the same region (OR = 1.59; P < 0.0001) and in any region (OR = 1.37; P < 0.0001), and with worsening JSN (OR = 1.82; P < 0.0001) and KL grades (OR = 1.69; P < 0.0001). Predicted probabilities of worsening in knees with a medial femur T2 Z-score from 2-4 were 38% for medial femur cartilage WORMS, 70% for any cartilage region, 28% for increasing JSN and 31% for increasing KL grade. CONCLUSION Knees with elevated cartilage T2 (especially in the medial femur and those that are 2 to 4 SDs above the mean reference values) are significantly more likely to have structural worsening over 4 to 8 years. Knowing cartilage T2 Z-scores may aid in targeting prevention efforts at early stages of osteoarthritis. LEVEL OF EVIDENCE 2 Technical Efficacy: Stage 3 J. Magn. Reson. Imaging 2017;46:1128-1136.
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Affiliation(s)
- Gabby B Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Charles E McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Michael C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, California, USA
| | - Alexandra S Gersing
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Benedikt J Schwaiger
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Martin Kretzschmar
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Ursula Heilmeier
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
| | - Thomas M Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, California, USA
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19
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Affiliation(s)
- Gwo-Chin Lee
- 1Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
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20
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Sharma AV, Dudhamal TS, Gupta SK, Mahanta V. Clinical study of Agnikarma and Panchatikta Guggulu in the management of Sandhivata (osteoartheritis of knee joint). Ayu 2016; 37:38-44. [PMID: 28827954 PMCID: PMC5541466 DOI: 10.4103/ayu.ayu_103_14] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background: Sandhivata is a disease described under Vatavyadhi and resembles osteoarthritis (OA) in respect to etiology, pathology, and clinical features. Knee joints are more prone to be affected by this disease because it is the most frequently involved joint in daily works. Acharya Sushruta has indicated Agnikarma, when severe pain occurs in Twak, Mamsa, Sira, Snayu, Sandhi, and Asthi due to Vata Prakopa. Panchatikta Guggulu is a formulation mentioned in Chakradatta and Bhaishajya Ratnavali in the context of Kushtha Roga where it is also indicated for Sandhigata Vata and Asthigata Vata. Aims: The aim of this study is to evaluate the comparative effect of Agnikarma alone and Agnikarma along with Panchatikta Guggulu orally in Janugata Sandhivata (OA of knee joint). Materials and Methods: Thirty-three patients of Janugata Sandhivata were registered and randomly divided into two groups. In Group A (n = 18), Agnikarma was done with Panchadhatu Shalaka once every week for one month while in Group B (n = 15), Agnikarma along with Panchatikta Guggulu orally was given for one month. Weekly assessment was done for relief in Sandhishula (pain), Sparshaasahyata (tenderness), Sandhisphutana (crepitus), Sandhigraha (stiffness) by subjective gradation, and range of movement (ROM) was recorded in research proforma. Results: In Sandhishula, 86% relief was found in Group A whereas 77.78% relief was obtained in Group B. Sparshaasahyata was reduced by 69% in Group A while 87.78% in Group B. Nearly 39% improvement was seen in Sandhisphutana in Group A while 46.67% in Group B. In Sandhigraha, 63% relief was obtained in each of the groups. The patients got relief from the pain after first sitting of Agnikarma in both the groups. The relief was sustained for more than 3 months in most of the patients. There was no significant difference in radiological findings before and after treatment in both the groups. Conclusion: It was concluded that Agnikarma is effective in the management of pain in the Sandhivata. However, the addition of Panchatikta Guggulu in the treatment provides better efficacy on joint stiffness and crepitus. Further analysis showed that better relief in pain was observed in Group A while relief in tenderness, crepitus, and stiffness was found better in Group B.
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Affiliation(s)
- Aneesh Vasudeva Sharma
- Department of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
| | | | - Sanjay Kumar Gupta
- Department of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
| | - Vyasadeva Mahanta
- Department of Shalya Tantra, IPGT & RA, Gujarat Ayurved University, Jamnagar, Gujarat, India
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