1
|
O'Sullivan O, Stocks J, Schofield S, Bilzon J, Boos CJ, Bull AMJ, Fear NT, Watt FE, Bennett AN, Kluzek S, Valdes AM. Association of serum biomarkers with radiographic knee osteoarthritis, knee pain and function in a young, male, trauma-exposed population - Findings from the ADVANCE study. Osteoarthritis Cartilage 2024:S1063-4584(24)01321-9. [PMID: 39103080 DOI: 10.1016/j.joca.2024.07.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 07/04/2024] [Accepted: 07/30/2024] [Indexed: 08/07/2024]
Abstract
OBJECTIVE The ArmeD SerVices TrAuma RehabilitatioN OutComE (ADVANCE) study is investigating long-term combat-injury outcomes; this sub-study aims to understand the association of osteoarthritis (OA) biomarkers with knee radiographic OA (rOA), pain and function in this high-risk population for post-traumatic OA. DESIGN ADVANCE compares combat-injured participants with age, rank, deployment and job-role frequency-matched uninjured participants. Post-injury immunoassay-measured serum biomarkers, knee radiographs, Knee Injury and Osteoarthritis Outcome Scale, and six-minute walk tests are reported. The primary analysis, adjusted for age, body mass, socioeconomic status, and ethnicity, was to determine any differences in biomarkers between those with/without combat injury, rOA and pain. Secondary analyses were performed to compare post-traumatic/idiopathic OA, painful/painfree rOA and injury patterns. RESULTS A total of 1145 male participants were recruited, aged 34.1 ± 5.4, 8.9 ± 2.2 years post-injury (n = 579 trauma-exposed, of which, traumatic-amputation n = 161) or deployment (n = 566 matched). Cartilage oligomeric matrix protein (COMP) was significantly higher in the combat-injured group compared to uninjured (p = 0.01). Notably, COMP was significantly lower in the traumatic-amputation group compared to non-amputees (p < 0.001), decreasing relative to number of amputations (p < 0.001). Leptin was higher (p = 0.005) and adiponectin lower (p = 0.017) in those with v without knee pain, associated with an increased risk of 22% and 17% for pain, and 46% and 34% for painful rOA, respectively. There were no significant differences between trauma-exposed and unexposed participants with rOA. CONCLUSIONS The most notable findings of this large, unique study are the similarities between those with rOA regardless of trauma-exposure, the injury-pattern and traumatic-amputation-associated differences in COMP, and the relationship between adipokines and pain.
Collapse
Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK; Academic Unit of Injury, Recovery and Inflammation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK. oliver.o'
| | - Joanne Stocks
- Academic Unit of Injury, Recovery and Inflammation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK.
| | - Susie Schofield
- National Heart and Lung Institute, Imperial College London, London, UK.
| | - James Bilzon
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Bath, Bath, UK; Department for Health, University of Bath, Bath, UK.
| | - Christopher J Boos
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK; Faculty of Health & Social Sciences, Bournemouth University, Bournemouth, UK.
| | - Anthony M J Bull
- Centre for Blast Injury Studies, Department of Bioengineering, Imperial College London, London, UK.
| | - Nicola T Fear
- Academic Department of Military Mental Health, King's College London, London, UK.
| | - Fiona E Watt
- Department of Immunology and Inflammation, Imperial College London, London, UK; Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, University of Oxford, Oxford, UK.
| | - Alexander N Bennett
- Academic Department of Military Rehabilitation (ADMR), Defence Medical Rehabilitation Centre (DMRC), Stanford Hall, Loughborough, UK; National Heart and Lung Institute, Imperial College London, London, UK.
| | - Stefan Kluzek
- Academic Unit of Injury, Recovery and Inflammation Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK.
| | - Ana M Valdes
- Nottingham NIHR Biomedical Research Centre, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK; Department of Twin Research & Genetic Epidemiology, King's College London, London, UK.
| |
Collapse
|
2
|
O'Sullivan O, Behan FP, Coppack RJ, Stocks J, Kluzek S, Valdes AM, Bennett AN. Osteoarthritis in the UK Armed Forces: a review of its impact, treatment and future research. BMJ Mil Health 2024; 170:359-364. [PMID: 37491135 DOI: 10.1136/military-2023-002390] [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: 03/02/2023] [Accepted: 05/31/2023] [Indexed: 07/27/2023]
Abstract
Within the UK Armed Forces, musculoskeletal injuries account for over half of all medical downgrades and discharges. Data from other Armed Forces show that osteoarthritis (OA), more common in military personnel, is likely to contribute to this, both in its primary form and following injury (post-traumatic OA, PTOA), which typically presents in the third or fourth decade. OA is not a progressive 'wear and tear' disease, as previously thought, but a heterogenous condition with multiple aetiologies and modulators, including joint damage, abnormal morphology, altered biomechanics, genetics, low-grade inflammation and dysregulated metabolism. Currently, clinical diagnosis, based on symptomatic or radiological criteria, is followed by supportive measures, including education, exercise, analgesia, potentially surgical intervention, with a particular focus on exercise rehabilitation within the UK military. Developments in OA have led to a new paradigm of organ failure, with an emphasis on early diagnosis and risk stratification, prevention strategies (primary, secondary and tertiary) and improved aetiological classification using genotypes and phenotypes to guide management, with the introduction of biological markers (biomarkers) potentially having a role in all these areas. In the UK Armed Forces, there are multiple research studies focused on OA risk factors, epidemiology, biomarkers and effectiveness of different interventions. This review aims to highlight OA, especially PTOA, as an important diagnosis to consider in serving personnel, outline current and future management options, and detail current research trends within the Defence Medical Services.
Collapse
Affiliation(s)
- Oliver O'Sullivan
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - F P Behan
- Department of Bioengineering, Imperial College London, London, UK
| | - R J Coppack
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
| | - J Stocks
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
| | - S Kluzek
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
- Centre for Sport, Exercise and Osteoarthritis Research, Versus Arthritis, Nottingham, UK
| | - A M Valdes
- Academic Unit of Injury, Recovery and Inflammation Sciences, University of Nottingham, Nottingham, UK
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - A N Bennett
- Academic Department of Military Rehabilitation, DMRC Stanford Hall, Loughborough, LE12 5QW, UK
- National Heart and Lung Institute, Faculty of Medicine, Imperial College London, London, UK
| |
Collapse
|
3
|
Huang L, Zhang Y, Li Q. Investigating the causal relationship between physical activity and incident knee osteoarthritis: a two-sample Mendelian randomization study. Sci Rep 2024; 14:1663. [PMID: 38238411 PMCID: PMC10796638 DOI: 10.1038/s41598-024-52175-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/15/2024] [Indexed: 01/22/2024] Open
Abstract
There is evidence that physical activity (PA) has a long-term positive impact on disease. Whether PA is a risk factor for knee osteoarthritis (OA) is still controversial. The purpose of this study was to explore whether there is a causal relationship between PA and knee OA. We extracted PA and knee OA data from genome-wide association study (GWAS) databases. We used single-nucleotide polymorphisms (SNPs) as instrumental variables. We performed MR analysis by random-effects inverse-variance weighting (IVW), MR‒Egger, weighted median, simple mode, and weighted mode methods. We evaluated the stability and reliability of the results through sensitivity analysis. There was no significant association between PA and knee OA (p > 0.05). We did not detect any pleiotropy (MR‒Egger intercept test et al.: p > 0.05). The sensitivity analysis confirmed our results (p > 0.05). There is no causal relationship between PA and knee OA.
Collapse
Affiliation(s)
- Liufang Huang
- Department of Rehabilitation Medicine, People's Hospital of Guanghan City, 75 Hankou Road, Luocheng Town, Guanghan City, Sichuan Province, People's Republic of China
| | - Yuling Zhang
- Department of Rehabilitation Medicine, People's Hospital of Guanghan City, 75 Hankou Road, Luocheng Town, Guanghan City, Sichuan Province, People's Republic of China
| | - Qian Li
- Department of Rehabilitation Medicine, People's Hospital of Guanghan City, 75 Hankou Road, Luocheng Town, Guanghan City, Sichuan Province, People's Republic of China.
| |
Collapse
|
4
|
O'Connell D, Golightly Y, Lisee C, Pietrosimone B. Interlimb differences in T1ρ MRI relaxation times linked with symptomatic knee osteoarthritis following anterior cruciate ligament reconstruction. Knee 2023; 41:353-359. [PMID: 36842267 DOI: 10.1016/j.knee.2023.02.006] [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: 09/27/2022] [Revised: 12/28/2022] [Accepted: 02/12/2023] [Indexed: 02/28/2023]
Abstract
BACKGROUND Lower proteoglycan density, as estimated by greater T1ρ magnetic resonance imaging (MRI) relaxation times, may be an indicator of early osteoarthritis development. We examined associations between femoral cartilage inter-limb T1ρ MRI relaxation time ratios and clinically relevant knee symptoms at 12 months following anterior crucial ligament reconstruction (ACLR). METHODS Twenty-nine individuals completed the Knee Osteoarthritis Outcome Score (KOOS) and underwent MRI 12 months following ACLR for this cross-sectional study. Participants were categorized as symptomatic or asymptomatic for clinically relevant knee symptoms consistent with osteoarthritis based on a standard KOOS classification. T1ρ MRI relaxation times were segmented in the weightbearing regions of lateral and medial femoral condyle (LFC and MFC). Inter-limb T1ρ MRI relaxation time ratios were calculated by normalizing the ACLR to the uninjured knee. T-tests were used to compare LFC and MFC interlimb T1ρ relaxation time ratios between individuals with and without knee symptoms. A Receiver Operating Characteristic (ROC) Curve analysis was used to determine a critical inter-limb T1ρ relaxation time ratio identifying symptomatic patients. Odds ratios (OR) and 95% confidence intervals (CI) estimated the association between the critical value and clinically relevant knee symptoms. RESULTS Symptomatic individuals had significantly higher LFC inter-limb T1ρ MRI relaxation time ratios compared to asymptomatic individuals (p = 0.04). Individuals with an LFC inter-limb T1ρ MRI relaxation time ratio >1.11 were more likely to have symptoms (OR 8.5; 95%CI = 1.25-57.93). CONCLUSION Individuals with greater inter-limb LFC T1ρ MRI relaxation time ratios 12 months post-ACLR may be more likely to exhibit symptoms consistent with knee OA.
Collapse
Affiliation(s)
- Daniel O'Connell
- UNC School of Medicine, University of North Carolina at Chapel Hill, NC, United States
| | - Yvonne Golightly
- Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, NC, United States; Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, NC, United States; College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, United States
| | - Caroline Lisee
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States.
| | - Brian Pietrosimone
- Department of Exercise and Sports Science, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States
| |
Collapse
|