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DiNicola ES, Martinez AV, Walker L, Wu Y, Burnikel BG, Mercuri J. Cigarette smoke extract exacerbates progression of osteoarthritic-like changes in cartilage explant cultures. J Orthop Res 2024; 42:1682-1695. [PMID: 38460961 DOI: 10.1002/jor.25828] [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: 11/16/2023] [Revised: 02/04/2024] [Accepted: 02/13/2024] [Indexed: 03/11/2024]
Abstract
Established risk factors for osteoarthritis (OA) include obesity, joint injury, age, race, and genetics. However, the relationship between cigarette smoking and OA has yet to be established. In the present study, we have employed the use of cigarette smoke extract (CSE), the water-soluble vapor phase of cigarette smoke, with porcine cartilage explants to investigate the effects of cigarette smoking on cartilage catabolism at the tissue level. Articular cartilage explants were first exposed to 2.5%, 5%, and 10% CSE to assess its effects on cartilage homeostasis. Following, the effects of CSE on OA-like inflammation was observed by culturing explants with a combined treatment of IL-1β and TNF-α and 10% CSE (CSE + OA). Cartilage explants were assessed for changes in viability, biochemical composition, extracellular matrix (ECM) integrity, and equilibrium mechanical properties (aggregate modulus and hydraulic permeability). CSE alone leads to both a time- and dose-dependent decrease in chondrocyte viability but does not significantly affect sGAG content, percent sGAG loss, or the ECM integrity of cartilage explants. When IL-1β and TNF-α were combined with 10% CSE, this led to a synergistic effect with more significant losses in viability, significantly more sGAG loss, and significantly higher production of ROS than OA-like inflammation only. Cartilage explant equilibrium mechanical properties were unaffected. Within the timeframe of this study, CSE alone does not cause OA but when combined with OA-like inflammation leads to worsened articular cartilage degeneration as measured by chondrocyte viability, sGAG loss, proteoglycan staining, and ROS production.
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Affiliation(s)
- Emily Sawvell DiNicola
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina, USA
- Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, South Carolina, USA
| | - Andrea Vera Martinez
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina, USA
- Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, South Carolina, USA
| | - Lizzie Walker
- Orthopaedic Bioengineering Laboratory, Medical University of South Carolina, Department of Bioengineering, Clemson University, Charleston, South Carolina, USA
| | - Yongren Wu
- Orthopaedic Bioengineering Laboratory, Medical University of South Carolina, Department of Bioengineering, Clemson University, Charleston, South Carolina, USA
| | - Brian G Burnikel
- Prisma Health Steadman Hawkins Clinic of the Carolinas - Patewood, Greenville, South Carolina, USA
| | - Jeremy Mercuri
- Department of Bioengineering, The Laboratory of Orthopaedic Tissue Regeneration & Orthobiologics, Clemson University, Clemson, South Carolina, USA
- Frank H. Stelling and C. Dayton Riddle Orthopaedic Education and Research Laboratory, Clemson University Biomedical Engineering Innovation Campus, Greenville, South Carolina, USA
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Li H, Chan L, Chan P, Wen C. An interpretable knee replacement risk assessment system for osteoarthritis patients. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100440. [PMID: 38385105 PMCID: PMC10878788 DOI: 10.1016/j.ocarto.2024.100440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 02/23/2024] Open
Abstract
Objective Knee osteoarthritis (OA) is a complex disease with heterogeneous representations. Although it is modifiable to prevention and early treatment, there still lacks a reliable and accurate prognostic tool. Hence, we aim to develop a quantitative and self-administrable knee replacement (KR) risk stratification system for knee osteoarthritis (KOA) patients with clinical features. Method A total of 14 baseline features were extracted from 9592 cases in the Osteoarthritis Initiative (OAI) cohort. A survival model was constructed using the Random Survival Forests algorithm. The prediction performance was evaluated with the concordance index (C-index) and average receiver operating characteristic curve (AUC). A three-class KR risk stratification system was built to differentiate three distinct KR-free survival groups. Thereafter, Shapley Additive Explanations (SHAP) was introduced for model explanation. Results KR incidence was accurately predicted by the model with a C-index of 0.770 (±0.0215) and an average AUC of 0.807 (±0.0181) with 14 clinical features. Three distinct survival groups were observed from the ten-point KR risk stratification system with a four-year KR rate of 0.79%, 5.78%, and 16.2% from the low, medium, and high-risk groups respectively. KR is mainly caused by pain medication use, age, surgery history, diabetes, and a high body mass index, as revealed by SHAP. Conclusion A self-administrable and interpretable KR survival model was developed, underscoring a KR risk scoring system to stratify KOA patients. It will encourage regular self-assessments within the community and facilitate personalised healthcare for both primary and secondary prevention of KOA.
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Affiliation(s)
- H.H.T. Li
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
- Department of Prosthetics and Orthotics, Tuen Mun Hospital, Hong Kong
| | - L.C. Chan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
| | - P.K. Chan
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | - C. Wen
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong
- Research Institute of Smart Ageing, The Hong Kong Polytechnic University, Hong Kong
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Ogunsola AS, Hlas AC, Marinier MC, Elkins J. The Predictors of Osteoarthritis Among U.S. Adults: National Health and Nutrition Examination Survey, 2005 to 2018. Cureus 2024; 16:e63469. [PMID: 39077301 PMCID: PMC11285812 DOI: 10.7759/cureus.63469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/27/2024] [Indexed: 07/31/2024] Open
Abstract
Background Osteoarthritis (OA) is a leading cause of disability in the United States (U.S.) population, and its prevalence continues to rise. Traditionally, extreme joint loading was described as the leading cause of OA; however, recent studies suggest OA may arise from more complex mechanisms. This study aimed to identify the association between OA and various health predictors among U.S. adults. Methods National Health and Nutrition Examination Survey (NHANES) data of adult participants from 2005 to 2018 was reviewed. OA diagnosis was patient-reported, and other health variables were assessed based on patient-reported, laboratory, and examination data. A multivariable survey logistic regression model was used to estimate adjusted odds ratios and confidence intervals (95% CIs). Stratified analysis based on BMI category was additionally performed to assess the modifying effect of obesity on the association between OA and health predictors. Results A total of 42,143 participants were included in this study. OA prevalence was highest in patients ages [Formula: see text] 65 years, females, non-obese individuals, non-Hispanic Whites, and those with at least college education. After controlling for multiple confounding demographic variables and comorbidities, the odds of OA increased with aging, female sex, obesity, high cholesterol, hypertension, diabetes, depression, and thyroid disease. Non-Hispanic White patients and those with less than a high school education also had higher odds of OA. After stratified analysis, aging, female sex, and severe depression demonstrated similar associations with OA across each BMI strata. Having at least a college-level education additionally conferred a similar association with OA across each BMI strata. Conclusion The odds of OA increased with aging, female sex, obesity, less than high school education, high cholesterol, hypertension, diabetes, depression, and thyroid disease. Further studies are needed to characterize the mechanisms of these associations. Given the myriad of factors that influence OA development and progression, the utilization of multidisciplinary and holistic care of OA patients is recommended to limit the influence of other health predictors and reduce ensuing pain, disability, and other complications that result from OA.
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Affiliation(s)
- Ayobami S Ogunsola
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Arman C Hlas
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Michael C Marinier
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
| | - Jacob Elkins
- Department of Orthopaedics and Rehabilitation, University of Iowa Hospitals and Clinics, Iowa City, USA
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Şirik M, Yetkin Dİ, İnan İ. Assessment of the relationship between smoking and meniscal injury. Radiol Bras 2023; 56:336-342. [PMID: 38504814 PMCID: PMC10948157 DOI: 10.1590/0100-3984.2023.0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 07/19/2023] [Accepted: 08/17/2023] [Indexed: 03/21/2024] Open
Abstract
Objective To determine whether being a smoker and the years of smoking correlate with the presence and degree of meniscal injury. Materials and Methods Individuals who underwent magnetic resonance imaging of the knee were divided into two groups: smokers and nonsmokers. For each smoker, the total smoking history was calculated by multiplying the daily consumption (packs/day) by the years of smoking, and the result is expressed as pack-years. In the evaluation of meniscal injury, the grade of injury was recorded. The thickness of the subcutaneous adipose tissue, as an indicator of obesity, was measured at the medial knee on axial plane images. The relationships that smoking and obesity had with meniscal injury were analyzed statistically. Results A total of 156 individuals were included in the study. The smoker group consisted of 48 individuals (30.8%), and the nonsmoker group consisted of 108 (69.2%). The meniscus was normal in one (2.1%) of the smokers and in 32 (29.6%) of the nonsmokers (p < 0.0001). The median subcutaneous adipose tissue thickness was 23 mm and 24 mm in the smokers and nonsmokers, respectively (p = 0.900). A moderate but statistically significant correlation was observed between packs/day and injury grade, as well as between pack-years and injury grade (r = 0.462, p = 0.001 and r = 0.523, p = 0.001, respectively). Smoking and age significantly increased the risk of meniscal injury, by 31.221 times (p = 0.001) and 1.076 times (p < 0.001), respectively. Conclusion Our findings indicate that current smoking and smoking history correlate significantly with meniscal injury grade.
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Affiliation(s)
- Mehmet Şirik
- Department of Radiology, Faculty of Medicine, Adıyaman
University, Adıyaman, Turkey
| | - Duygu İmre Yetkin
- Department of Radiology, Faculty of Medicine, Adıyaman
University, Adıyaman, Turkey
| | - İbrahim İnan
- King’s College Hospital, Dubai, United Arab Emirates
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Shen Z, Wang Y, Xing X, Jones G, Cai G. Association of smoking with cartilage loss of knee osteoarthritis: data from two longitudinal cohorts. BMC Musculoskelet Disord 2023; 24:812. [PMID: 37833699 PMCID: PMC10571432 DOI: 10.1186/s12891-023-06953-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 10/10/2023] [Indexed: 10/15/2023] Open
Abstract
BACKGROUND Previous studies have been inconsistent concerning the association between smoking and risk of osteoarthritis (OA). This study aimed to explore the associations of smoking status and change in cartilage volume of OA in two longitudinal cohorts. METHODS Subjects from the Osteoarthritis Initiative cohort (OAI, n = 593) and the Tasmanian Older Adult Cohort (TASOAC, n = 394) were included in this study. For both cohorts, participants were classified into three groups based on their smoking status, namely 'never', 'former', and 'current' smokers. The outcome measures were the annual rate of change of tibiofemoral cartilage volume over 2 years in OAI and of tibial cartilage volume over 2.6 years in TASOAC. Potential confounders were balanced using the inverse probability of treatment weighting (IPTW) method. RESULTS Overall, 42.3% and 37.4% of participants were former smokers, and 5.7% and 9.3% were current smokers in the OAI and TASOAC cohorts, respectively. Compared to never smokers, neither former nor current smoking was associated with risk of the annual rate of change of tibiofemoral cartilage volume in OAI (former smoker: β=-0.068%/year, 95% confidence interval [CI] -0.824 to 0.688, p = 0.860; current smoker: β=-0.222%/year, 95% CI -0.565 to 0.120, p = 0.204) and tibial cartilage volume in TASOAC (former smoker: β = 0.001%/year, 95% CI -0.986 to 0.989, p = 0.998; current smoker: β=-0.839%/year, 95% CI -2.520 to 0.844, p = 0.329). CONCLUSIONS Our findings from two independent cohorts consistently showed that smoking was not associated with knee cartilage loss in older adults.
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Affiliation(s)
- Ziyuan Shen
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xing Xing
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology. BIOLOGY 2022; 11:biology11040524. [PMID: 35453723 PMCID: PMC9030599 DOI: 10.3390/biology11040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023]
Abstract
Simple Summary Forensic anthropologists analyze human remains to assist in the identification of the deceased, predominantly by assessing age-at-death, sex, stature, ancestry and any unique identifying features. Whilst methods have been established to create this biological profile of the skeleton, these may be influenced by a number of factors. This paper, for the first time, provides an overview from a reading of the clinical and pharmacological literature to explore whether the intake of drugs can affect the skeleton and whether these may have implications for forensic anthropology casework. In effect, drugs such as tobacco, heroin, and prescription medications can alter bone mineral density, can increase the risk of fractures, destroy bone and changes to the dentition. By considering how drugs can affect the skeleton, forensic anthropologists can be aware of this when attempting to identify the deceased. Abstract Forensic anthropologists rely on a number of parameters when analyzing human skeletal remains to assist in the identification of the deceased, predominantly age-at-death, sex, stature, ancestry or population affinity, and any unique identifying features. During the examination of human remains, it is important to be aware that the skeletal features considered when applying anthropological methods may be influenced and modified by a number of factors, and particular to this article, prescription drugs (including medical and non-medical use) and other commonly used drugs. In view of this, this paper aims to review the medical, clinical and pharmacological literature to enable an assessment of those drug groups that as side effects have the potential to have an adverse effect on the skeleton, and explore whether or not they can influence the estimation of age-at-death, sex and other indicators of the biological profile. Moreover, it may be that the observation of certain alterations or inconsistencies in the skeleton may relate to the use of drugs or medication, and this in turn may help narrow down the list of missing persons to which a set of human remains could belong. The information gathered from the clinical and medical literature has been extracted with a forensic anthropological perspective and provides an awareness on how several drugs, such as opioids, cocaine, corticosteroids, non-steroidal anti-inflammatory drugs, alcohol, tobacco and others have notable effects on bone. Through different mechanisms, drugs can alter bone mineral density, causing osteopenia, osteoporosis, increase the risk of fractures, osteonecrosis, and oral changes. Not much has been written on the influence of drugs on the skeleton from the forensic anthropological practitioner perspective; and this review, in spite of its limitations and the requirement of further research, aims to investigate the current knowledge of the possible effects of both prescription and recreational drugs on bones, contributing to providing a better awareness in forensic anthropological practice and assisting in the identification process of the deceased.
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Li G, Cheng T, Yu X. The Impact of Trace Elements on Osteoarthritis. Front Med (Lausanne) 2022; 8:771297. [PMID: 35004740 PMCID: PMC8732765 DOI: 10.3389/fmed.2021.771297] [Citation(s) in RCA: 20] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 11/30/2021] [Indexed: 12/14/2022] Open
Abstract
Osteoarthritis (OA) is a progressive degenerative disease characterized by cartilage degradation, synovial inflammation, subchondral sclerosis and osteophyte formation. It has a multifactorial etiology with potential contributions from heredity, endocrine function, abnormal mechanical load and nutrition. Of particular considerations are trace element status. Several trace elements, such as boron and magnesium are essential for normal development of the bone and joint in human. While cadmium correlates with the severity of OA. The present review focuses on the roles of trace elements (boron, cadmium, copper, iron, magnesium, manganese, selenium, zinc) in OA and explores the mechanisms by which they act.
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Affiliation(s)
- Guoyong Li
- Department of Orthopaedics, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
| | - Tao Cheng
- Department of Orthopaedics, Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China
| | - Xuefeng Yu
- Department of Orthopaedics, The Fourth Affiliated Hospital of Nanchang University, Nanchang, China
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Liu YP, Wen YH, Tang J, Wei Y, You R, Zhu XL, Li J, Chen L, Ling L, Zhang N, Zou X, Hua YJ, Chen YM, Chen L, Lu LX, Chen MY, Wen WP. Endoscopic surgery compared with intensity-modulated radiotherapy in resectable locally recurrent nasopharyngeal carcinoma: a multicentre, open-label, randomised, controlled, phase 3 trial. Lancet Oncol 2021; 22:381-390. [PMID: 33600761 DOI: 10.1016/s1470-2045(20)30673-2] [Citation(s) in RCA: 67] [Impact Index Per Article: 22.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Revised: 10/23/2020] [Accepted: 10/28/2020] [Indexed: 12/08/2022]
Abstract
BACKGROUND The role of surgery compared with reirradiation in the primary treatment of patients with resectable, locally recurrent nasopharyngeal carcinoma (NPC) who have previously received radiotherapy is a matter of debate. In this trial, we compared the efficacy and safety outcomes of salvage endoscopic surgery versus intensity-modulated radiotherapy (IMRT) in patients with resectable locally recurrent NPC. METHODS This multicentre, open-label, randomised, controlled, phase 3 trial was done in three hospitals in southern China. We included patients aged 18-70 years with a Karnofsky Performance Status score of at least 70 who were histopathologically diagnosed with undifferentiated or differentiated, non-keratinising, locally recurrent NPC with tumours confined to the nasopharyngeal cavity, the post-naris or nasal septum, the superficial parapharyngeal space, or the base wall of the sphenoid sinus. Eligible patients were randomly assigned (1:1) to receive either endoscopic nasopharyngectomy (ENPG group) or IMRT (IMRT group). Randomisation was done manually using a computer-generated random number code and patients were stratified by treatment centre. Treatment group assignment was not masked. The primary endpoint was overall survival, compared between the groups at 3 years. Efficacy analyses were done by intention to treat. Safety analysis was done in patients who received treatment according to the treatment they actually received. This trial was prospectively registered at the Chinese Clinical Trial Registry, ChiCTR-TRC-11001573, and is currently in follow-up. FINDINGS Between Sept 30, 2011, and Jan 16, 2017, 200 eligible patients were randomly assigned to receive either ENPG (n=100) or IMRT (n=100). At a median follow-up of 56·0 months (IQR 42·0-69·0), 74 patients had died (29 [29%] of 100 patients in the ENPG group and 45 [45%] of 100 patients in the IMRT group). The 3-year overall survival was 85·8% (95% CI 78·9-92·7) in the ENPG group and 68·0% (58·6-77·4) in the IMRT group (hazard ratio 0·47, 95% CI 0·29-0·76; p=0·0015). The most common grade 3 or worse radiation-related late adverse event was pharyngeal mucositis (in five [5%] of 99 patients who underwent ENPG and 26 [26%] of 101 patients who underwent IMRT). Five [5%] of the 99 patients who underwent ENPG and 20 [20%] of the 101 patients who underwent IMRT died due to late toxic effects specific to radiotherapy; attribution to previous radiotherapy or trial radiotherapy is unclear due to the long-term nature of radiation-related toxicity. INTERPRETATION Endoscopic surgery significantly improved overall survival compared with IMRT in patients with resectable locally recurrent NPC. These results suggest that ENPG could be considered as the standard treatment option for this patient population, although long-term follow-up is needed to further determine the efficacy and toxicity of this strategy. FUNDING Sun Yat-sen University Clinical Research 5010 Program.
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Affiliation(s)
- You-Ping Liu
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China; Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yi-Hui Wen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
| | - Jun Tang
- Department of Otolaryngology, The First People's Hospital of Foshan, Foshan, China
| | - Yi Wei
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
| | - Rui You
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Xiao-Lin Zhu
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
| | - Jian Li
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
| | - Lin Chen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China
| | - Li Ling
- Department of Medical Statistics, School of Public Health, and Center for Migrant Health Policy, Sun Yat-sen University, Guangzhou, China
| | - Ning Zhang
- Department of Radiation Oncology, The First People's Hospital of Foshan, Foshan, China
| | - Xiong Zou
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Yi-Jun Hua
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - You-Mou Chen
- Department of Otolaryngology, The First People's Hospital of Foshan, Foshan, China
| | - Lei Chen
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Li-Xia Lu
- Department of Radiation Oncology, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Ming-Yuan Chen
- Department of Nasopharyngeal Carcinoma, Sun Yat-sen University Cancer Centre, State Key Laboratory of Oncology in South China, Collaborative Innovation Centre for Cancer Medicine, Guangdong Key Laboratory of Nasopharyngeal Carcinoma Diagnosis and Therapy, Guangzhou, China
| | - Wei-Ping Wen
- Department of Otolaryngology, the First Affiliated Hospital of Sun Yat-sen University, Guangzhou Key Laboratory of Otorhinolaryngology, Otorhinolaryngology Institute of Sun Yat-sen University, Guangzhou, China; Department of Otolaryngology, the Sixth Affiliated Hospital of Sun Yat-sen University, Guangzhou, China.
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Roux CH, Coste J, Roger C, Fontas E, Rat AC, Guillemin F. Impact of smoking on femorotibial and hip osteoarthritis progression: 3-year follow-up data from the KHOALA cohort. Joint Bone Spine 2020; 88:105077. [PMID: 32950705 DOI: 10.1016/j.jbspin.2020.09.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 09/08/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVES To evaluate the clinical and structural impact of smoking on knee and hip osteoarthritis at baseline and after 3years. METHODS Observational data on the progressive effects of smoking at baseline and after 3years were collected from The Knee and Hip Osteoarthritis Long-Term Assessment cohort comprising a French population of patients aged 40-75years with symptomatic lower limb osteoarthritis. Clinical (the Western Ontario and McMaster Universities Arthritis Index and Harris scores) and structural (radiography for osteophyte detection and joint-space narrowing assessment) were conducted. The tobacco usage categories were 'never smoker', 'former smoker', and 'current smoker'. RESULTS Of the 873 subjects included, 215 (25%) were former smokers and 119 (14%) were current smokers. Multivariate analyses revealed that former and current smokers had fewer knee osteophytes in the medial compartment at baseline (odds ratio [OR]=0.64 [0.41-0.99] and 0.63 [0.36-1.11], respectively), lower osteophyte development in the lateral condyle after 3years (OR=011 [0.03-0.45] and 0.15 [0.03-0.97]), and lower osteophyte development in the lateral tibial plateau after 3years (OR=0.22 [0.06-0.75] and 0.68 [0.14-3.35]). Higher tobacco consumption and longer duration of consumption were significantly associated with fewer knee osteophytes at baseline and lower osteophyte development at 3years. CONCLUSION Although cigarette smoking did not influence knee function, pain, or the need for replacement surgery, current and former smokers developed fewer osteophytes. This relationship may be linked to the quantity and duration of consumption. Our results provide further insight into the smoking-related pathophysiology of osteoarthritis.
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Affiliation(s)
- Christian Hubert Roux
- Rheumatology Department, University Nice Sophia Antipolis, LAMHESS, EA 6312, CHU Nice, Nice, France.
| | - Joël Coste
- Biostatistics and Epidemiology Unit, Assistance Publique-Hôpitaux de Paris, Hôtel Dieu, Paris, France
| | - Coralie Roger
- Department of Clinical Research and Innovation, University Hospital of Nice, Nice, France
| | - Eric Fontas
- Department of Clinical Research and Innovation, University Hospital of Nice, Nice, France
| | - Anne-Christine Rat
- CIC 1433 Clinical Epidemiology, Inserm, CHRU University of Lorraine, Nancy, France
| | - Francis Guillemin
- CIC 1433 Clinical Epidemiology, Inserm, CHRU University of Lorraine, Nancy, France
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Zhu Z, Yu Q, Leng X, Han W, Li Z, Huang C, Gu J, Zhao Y, Wang K, Li T, Mei Y, Xu J, Zhang Z, Hunter D, Cicuttini F, Zeng X, Ding C. Can low-dose methotrexate reduce effusion-synovitis and symptoms in patients with mid- to late-stage knee osteoarthritis? Study protocol for a randomised, double-blind, and placebo-controlled trial. Trials 2020; 21:795. [PMID: 32938470 PMCID: PMC7493135 DOI: 10.1186/s13063-020-04687-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Accepted: 08/14/2020] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a common chronic disease in older adults. Currently, there are no effective therapies to reduce disease severity and progression of knee OA (KOA), particularly in mid- to late-stages. This study aims to examine the effect of methotrexate (MTX) on knee effusion-synovitis and pain in symptomatic patients with mid- to late-stage KOA. METHODS/DESIGN This protocol describes a multicentre randomised placebo-controlled clinical trial aiming to recruit 200 participants with mid- to late-stage symptomatic KOA and with effusion-synovitis grade of ≥ 2. Participants will be randomly allocated to the MTX group (start from 5 mg per week for the first 2 weeks and increase to 10 mg per week for the second 2 weeks and 15 mg per week for the remaining period if tolerated) or the placebo group. Primary outcomes are effusion-synovitis size measured by magnetic resonance imaging (MRI) and knee pain assessed by visual analogue scale (VAS). Secondary outcomes are signal intensity alteration within infrapatellar fat pad (IPFP) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total score and subscores, and the Outcome Measures in Rheumatology Arthritis Clinical Trials-Osteoarthritis Research Society International (OMERACT-OARSI) responders. Both intention-to-treat and per-protocol analyses will be performed. DISCUSSION If MTX intervention can relieve symptoms and reduce inflammation in patients with mid- to late-stage KOA, it has the potential for significant clinical and public health impact as this low-cost and commonly used intervention would delay the time to knee replacement, leading to substantial cost savings and improve quality of life. TRIAL REGISTRATION ClinicalTrials.gov NCT03815448 . Registered on 21 January 2019.
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Affiliation(s)
- Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,Department of Rheumatology and Clinical Immunology, Zhujiang Hospital of Southern Medical University, Guangzhou, China.,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Qinghong Yu
- Department of Rheumatology and Clinical Immunology, Zhujiang Hospital of Southern Medical University, Guangzhou, China
| | - Xiaomei Leng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Weiyu Han
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China
| | - Zhanguo Li
- Department of Rheumatology & Immunology, Peking University People's Hospital, Beijing, China
| | - Cibo Huang
- Department of Rheumatology, Beijing Hospital, National Center of Gerontology, Beijing, China
| | - Jieruo Gu
- Department of Rheumatology, 3rd Affiliated Hospital of Sun Yet-Sen University Guangzhou, Guangzhou, Guangdong, China
| | - Yi Zhao
- Department of Rheumatology & Allergy, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Kang Wang
- Department of Rheumatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Tianwang Li
- Department of Rheumatology and Immunology, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - Yifang Mei
- Department of Rheumatology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - Jianhua Xu
- Department of Rheumatology, the First Affiliated Hospital of Anhui Medical University, Hefei, Anhui, China
| | - Zhiyi Zhang
- Department of Rheumatology, the First Affiliated Hospital of Harbin Medical University, Harbin, China
| | - David Hunter
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.,Department of Rheumatology, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia
| | - Xiaofeng Zeng
- Department of Rheumatology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Changhai Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China. .,Department of Rheumatology and Clinical Immunology, Zhujiang Hospital of Southern Medical University, Guangzhou, China. .,Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
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11
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Yessica Eduviges ZC, Martínez-Nava G, Reyes-Hinojosa D, Mendoza-Soto L, Fernández-Torres J, López-Reyes A, Olivos-Meza A, Armienta-Hernández MA, Ruíz-Huerta EA, de Jesús González-Guadarrama M, Sandoval BV, Landa-Solís C, Sánchez-Sánchez R, Suarez-Ahedo C, Lozada-Pérez CA, Gutiérrez-Ruiz MC, Clavijo-Cornejo D, Pineda C, Jacobo-Albavera L, Domínguez-Pérez M, Martínez-Flores K. Impact of cadmium toxicity on cartilage loss in a 3D in vitro model. ENVIRONMENTAL TOXICOLOGY AND PHARMACOLOGY 2020; 74:103307. [PMID: 31830724 DOI: 10.1016/j.etap.2019.103307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 11/22/2019] [Accepted: 11/26/2019] [Indexed: 06/10/2023]
Abstract
Osteoarthritis (OA) is the gradual loss of articular cartilage and decrease in subchondral space. One of the risk factors Exposure to cadmium (Cd) through tobacco smoke has been identified as a major OA risk factor. There are no reports addressing the role of Cd in OA progression at the molecular level. Our findings revealed that Cd can promote the activation of metalloproteinases (MMP1, MMP3, MMP9 y MMP13), affecting the expression of COL2A1 and ACAN, and decreasing the presence of glycosaminoglycans and proteoglycans through an inflammatory response related to IL-1β y a IL-6, as well as oxidative by producing ROS like O2-• and H2O2. In conclusion, our findings suggest a cytotoxic role of Cd in the articular cartilage, which could affect OA development.
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Affiliation(s)
- Zamudio-Cuevas Yessica Eduviges
- Synovial Fluid, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Gabriela Martínez-Nava
- Synovial Fluid, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Daniel Reyes-Hinojosa
- Synovial Fluid, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Luzia Mendoza-Soto
- Synovial Fluid, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Javier Fernández-Torres
- Synovial Fluid, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Alberto López-Reyes
- Gerosciences, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Anell Olivos-Meza
- Orthopedic Sports Medicine and Arthroscopy Service, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - María Aurora Armienta-Hernández
- Departament of Natural Resources, Institute of Geophysics, UNAM. Circuito de la investigación Científica s/n, Ciudad Universitaria, Cd. Universitaria, C.P. 04150. Mexico City, Mexico
| | - Esther Aurora Ruíz-Huerta
- Departament of Natural Resources, Institute of Geophysics, UNAM. Circuito de la investigación Científica s/n, Ciudad Universitaria, Cd. Universitaria, C.P. 04150. Mexico City, Mexico
| | - María de Jesús González-Guadarrama
- Departament of Natural Resources, Institute of Geophysics, UNAM. Circuito de la investigación Científica s/n, Ciudad Universitaria, Cd. Universitaria, C.P. 04150. Mexico City, Mexico
| | - Bertha Vargas Sandoval
- Microscopy Laboratory, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Carlos Landa-Solís
- Tissue Engineering and Cell Therapy and Regenerative Medicine Unit, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Roberto Sánchez-Sánchez
- Tissue Engineering and Cell Therapy and Regenerative Medicine Unit, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Carlos Suarez-Ahedo
- Departament of Adult Joint Reconstruction, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - Carlos Alberto Lozada-Pérez
- Rheumatology Service, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico
| | - María Concepción Gutiérrez-Ruiz
- Department of Health Sciences, Autonomous Metropolitan University, Laboratory of Experimental Medicine, Unit of Translational Medicine, Institute of Biomedical Research, UNAM, National Institute of Cardiology "Ignacio Chávez", Mexico City, Mexico
| | - Denise Clavijo-Cornejo
- Division of Musculoskeletal and Rheumatic Disorders. National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico City, Mexico
| | - Carlos Pineda
- Division of Musculoskeletal and Rheumatic Disorders. National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico City, Mexico
| | - Leonor Jacobo-Albavera
- Genomics of Cardiovascular Diseases Laboratory, National Institute of Genomic Medicine, Periférico Sur 4809, Col. Arenal Tepepan, C.P. 14610, Mexico
| | - Mayra Domínguez-Pérez
- Genomics of Cardiovascular Diseases Laboratory, National Institute of Genomic Medicine, Periférico Sur 4809, Col. Arenal Tepepan, C.P. 14610, Mexico
| | - Karina Martínez-Flores
- Synovial Fluid, National Institute of Rehabilitation, Calzada México-Xochimilco No. 289, Col. Arenal de Guadalupe, C.P. 14389, Mexico.
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Yamamoto SS, Yacyshyn E, Jhangri GS, Chopra A, Parmar D, Jones CA. Household air pollution and arthritis in low-and middle-income countries: Cross-sectional evidence from the World Health Organization's study on Global Ageing and Adult Health. PLoS One 2019; 14:e0226738. [PMID: 31881058 PMCID: PMC6934325 DOI: 10.1371/journal.pone.0226738] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2018] [Accepted: 12/06/2019] [Indexed: 02/07/2023] Open
Abstract
Background Evidence points to a clear link between air pollution exposure and several chronic diseases though investigations regarding arthritis are still lacking. Emerging evidence suggests an association between ambient air pollution and rheumatoid arthritis. Household air pollution exposure, conversely, is largely unstudied but may be an important consideration for arthritis, particularly in low- and middle-income countries (LMICs), where cooking and heating activities can generate high indoor air pollutant levels. Methods We investigated the association of household air pollution (electricity vs. gas; kerosene/paraffin; coal/charcoal; wood; or agriculture/crop/animal dung/shrubs/grass as the main fuel used for cooking) and arthritis in six LMICs (China, Ghana, India, Mexico, the Russian Federation, South Africa) using data from Wave I of the World Health Organization Study on Global AGEing and Adult Health (SAGE) (2007–2010). Multivariable analyses were adjusted for sociodemographic, household and lifestyle characteristics and several comorbidities. Results The use of gas (aOR = 1.76, 95%CI: 1.40–2.21); coal (aOR = 1.74, 95%CI: 1.22–2.47); wood (aOR = 1.69, 95%CI: 1.30–2.19); or agriculture/crop/animal dung/shrubs/grass: aOR = 1.95 (1.46–2.61) fuels for cooking were strongly associated with an increased odds of arthritis, compared to electricity in cluster and stratified adjusted analyses. Gender (female), age (≥50 years), overweight (25.0 ≤BMI<30.0 kg/m2), obesity (BMI ≥30.0 kg/m2), former and current alcohol consumption, and the comorbidities angina pectoris, diabetes, chronic lung disease, depression and hypertension were also associated with a higher odds of arthritis. Underweight (BMI<18.5 kg/m2) and higher education levels (college/university completed/post-graduate studies) were associated with a lower odds of arthritis. Conclusions These findings suggest that exposure to household air pollution from cook fuels is associated with an increased odds of arthritis in these regions, which warrants further investigation.
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Affiliation(s)
- Shelby S. Yamamoto
- School of Public Health, University of Alberta, Edmonton, Canada
- * E-mail:
| | - Elaine Yacyshyn
- Division of Rheumatology, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Canada
| | - Gian S. Jhangri
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Divya Parmar
- School of Health Sciences, City, University of London, London, England, United Kingdom
| | - C. Allyson Jones
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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13
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Associations between alcohol, smoking, and cartilage composition and knee joint morphology: Data from the Osteoarthritis Initiative. OSTEOARTHRITIS AND CARTILAGE OPEN 2019; 1:100006. [DOI: 10.1016/j.ocarto.2019.100006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 10/17/2019] [Indexed: 11/16/2022] Open
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14
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Cai X, Gao L, Cucchiarini M, Madry H. Association of Nicotine with Osteochondrogenesis and Osteoarthritis Development: The State of the Art of Preclinical Research. J Clin Med 2019; 8:jcm8101699. [PMID: 31623196 PMCID: PMC6832988 DOI: 10.3390/jcm8101699] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/02/2019] [Accepted: 10/10/2019] [Indexed: 12/27/2022] Open
Abstract
The deleterious effects of nicotine on various health conditions have been well documented. Although many orthopedic diseases are adversely affected by nicotine, little is known about its preclinical effects on chondrogenesis or osteogenesis, cartilage formation, osteoarthritis (OA), and osteochondral repair. A systematic review was conducted examining the current scientific evidence on the effects of nicotine on chondrogenesis or osteogenesis in vitro, possible consequences of prenatal nicotine exposure (PNE) on cartilage and OA susceptibility in the offspring, and whether nicotine affects OA development and osteochondral repair in vivo, always focusing on their underlying mechanisms. The data reveal dose-dependent effects on articular chondrocytes and on the chondrogenesis and osteogenesis of medicinal signaling cells in vitro, with lower doses often resulting in positive effects and higher doses causing negative effects. PNE negatively affects articular cartilage development and induces OA in the offspring without or with nicotine exposure. In contrast, protective effects on OA development were only reported in monosodium iodoacetate-induced small animal models. Finally, nicotine repressed MSC-based osteochondral repair in vivo. Future studies need to investigate dose-dependent clinical effects of smoking on cartilage quality in offspring, OA susceptibility and progression, and osteochondral repair more in detail, thus identifying possible thresholds for its pathological effects.
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Affiliation(s)
- Xiaoyu Cai
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, 66421 Homburg/Saar, Germany.
| | - Liang Gao
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, 66421 Homburg/Saar, Germany.
| | - Magali Cucchiarini
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, 66421 Homburg/Saar, Germany.
| | - Henning Madry
- Center of Experimental Orthopaedics, Saarland University Medical Center and Saarland University, 66421 Homburg/Saar, Germany.
- Department of Orthopaedic Surgery, Saarland University Medical Center and Saarland University, 66421 Homburg/Saar, Germany.
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Prevalence of osteoarthritis and association between smoking patterns and osteoarthritis in China: a cross-sectional study. FRONTIERS OF NURSING 2018. [DOI: 10.2478/fon-2018-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Abstract
Objective
The aims of this study were to estimate the prevalence of radiographic osteoarthritis (OA) and to assess the association between smoking patterns and OA prevalence in adults aged 50 years or older belonging to the Shanxi province of China.
Methods
A cross-sectional study in the rural regions of the Shanxi province was conducted among 2638 Chinese adults (aged ≥50 years). Demographic characteristics and behavioral information were collected through epidemiological surveys. All participants with joint pain underwent plain radiographic examination and were diagnosed by a professional orthopedist. Associations between smoking patterns and the prevalence of OA were assessed using binary logistic regression modeling.
Results
Among 2638 individuals (men, 50.3% and women, 49.7%; mean age, 61.5 years) included in the analysis, 49.8% had radiographic OA and 27.5% had knee OA. The prevalence of radiographic OA was higher in women than in men (P<0.001). After adjusting for potential confounding factors, there was a nonsignificant correlation between smoking and OA prevalence in the multivariate model. Odds ratios (ORs) for all types of OA and knee OA were higher in active and passive smokers than in nonsmoking individuals after adjustments (OR 1.374; 95% confidence interval [CI] 1.049–1.802; OR 1.440; 95% CI 1.059–1.958, respectively).
Conclusions
This study showed that smoking may not be an independent risk factor for OA; however, there was a positive correlation between active and passive smoking and OA.
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AL-Bashaireh AM, Haddad LG, Weaver M, Kelly DL, Chengguo X, Yoon S. The Effect of Tobacco Smoking on Musculoskeletal Health: A Systematic Review. JOURNAL OF ENVIRONMENTAL AND PUBLIC HEALTH 2018; 2018:4184190. [PMID: 30112011 PMCID: PMC6077562 DOI: 10.1155/2018/4184190] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 05/30/2018] [Indexed: 12/14/2022]
Abstract
This systematic review explored associations between smoking and health outcomes involving the musculoskeletal system. AMSTAR criteria were followed. A comprehensive search of PubMed, Web of Science, and Science Direct returned 243 articles meeting inclusion criteria. A majority of studies found smoking has negative effects on the musculoskeletal system. In research on bones, smoking was associated with lower BMD, increased fracture risk, periodontitis, alveolar bone loss, and dental implant failure. In research on joints, smoking was associated with increased joint disease activity, poor functional outcomes, and poor therapeutic response. There was also evidence of adverse effects on muscles, tendons, cartilage, and ligaments. There were few studies on the musculoskeletal health outcomes of secondhand smoke, smoking cessation, or other modes of smoking, such as waterpipes or electronic cigarettes. This review found evidence that suggests tobacco smoking has negative effects on the health outcomes of the musculoskeletal system. There is a need for further research to understand mechanisms of action for the effects of smoking on the musculoskeletal system and to increase awareness of healthcare providers and community members of the adverse effects of smoking on the musculoskeletal system.
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Affiliation(s)
| | - Linda G. Haddad
- College of Health and Human Services, University of North Carolina Wilmington, Wilmington, NC, USA
| | - Michael Weaver
- College of Nursing, University of Florida, Gainesville, FL, USA
| | | | - Xing Chengguo
- College of Pharmacy, University of Florida, Gainesville, FL, USA
| | - Saunjoo Yoon
- College of Nursing, University of Florida, Gainesville, FL, USA
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Akahane M, Yoshihara S, Maeyashiki A, Tanaka Y, Imamura T. Lifestyle factors are significantly associated with the locomotive syndrome: a cross-sectional study. BMC Geriatr 2017; 17:241. [PMID: 29047351 PMCID: PMC5648444 DOI: 10.1186/s12877-017-0630-1] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2016] [Accepted: 10/08/2017] [Indexed: 01/23/2023] Open
Abstract
Background The Japanese Orthopedic Association first proposed the concept of “locomotive syndrome” in 2007. It refers to circumstances in which elderly people need nursing care services or are at high risk of requiring such services within a short time. Recently, the public health burden of providing nursing care for elderly individuals has increased. Therefore, locomotive syndrome, and the means of preventing it, are a major public health focus in Japan. The purpose of this study was to investigate the relationships of lifestyle factors, such as smoking, alcohol consumption, sleep duration, and dental health, with locomotive syndrome. Methods We conducted a cross-sectional study using an internet panel survey. The participants comprised 747 individuals aged 30–90 years. Factors related to demographics (age, sex), general health (number of teeth, presence of periodontal disease), and lifestyle (smoking, alcohol consumption, sleep duration) were assessed. We also used the 25-question Geriatric Locomotive Function Scale to determine whether each participant had locomotive syndrome. Multivariate analysis was conducted using logistic regression to investigate the independent relationships between locomotive syndrome and lifestyle factors after adjusting for sex and age. Results A greater proportion of women (17.7%) than men (11.2%) had locomotive syndrome (p < 0.05). Participants aged ≥65 years showed significantly higher percentages (men: 21.4%, women: 75.7%) of locomotive syndrome compared with those aged <65 years (p < 0.05). Logistic regression analysis revealed that older age (≥ 65 years), sex, current smoking status, number of existing teeth, and presence of periodontal disease were associated with locomotive syndrome, whereas sleep duration was not. The frequency of alcohol consumption, except for daily drinking, was also associated with locomotive syndrome. Conclusion Our study indicates that lifestyle factors, such as smoking and number of existing teeth, may partly affect the prevalence of locomotive syndrome. Hence, lifestyle modifications, such as improving oral hygiene and promoting cessation of smoking, are important means to reduce the risk of locomotive syndrome and should be promoted by public health staff.
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Affiliation(s)
- Manabu Akahane
- Department of Public Health, Health Management and Policy, Nara Medical University Faculty of Medicine, Shijo 840, Kashihara, Nara, Japan.
| | - Shingo Yoshihara
- Department of Public Health, Health Management and Policy, Nara Medical University Faculty of Medicine, Shijo 840, Kashihara, Nara, Japan
| | - Akie Maeyashiki
- Department of Public Health, Health Management and Policy, Nara Medical University Faculty of Medicine, Shijo 840, Kashihara, Nara, Japan
| | - Yasuhito Tanaka
- Department of Public Health, Health Management and Policy, Nara Medical University Faculty of Medicine, Shijo 840, Kashihara, Nara, Japan
| | - Tomoaki Imamura
- Department of Public Health, Health Management and Policy, Nara Medical University Faculty of Medicine, Shijo 840, Kashihara, Nara, Japan
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Lu M, Han W, Wang K, Zhu Z, Antony B, Cicuttini F, Yin Z, Jones G, Ding C. Associations between proximal tibiofibular joint (PTFJ) types and knee osteoarthritic changes in older adults. Osteoarthritis Cartilage 2017; 25:1452-1458. [PMID: 28583898 DOI: 10.1016/j.joca.2017.05.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 05/12/2017] [Accepted: 05/25/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the cross-sectional associations between proximal tibiofibular joint (PTFJ) type configurations and knee joint structural abnormalities in older adults. METHODS A total of 967 community-based participants were studied. T1-weighted fat-suppressed magnetic resonance image (MRI) with spoiled gradient recalled echo sequence was utilized to assess the PTFJ type configurations. Knee cartilage volume, cartilage defects, bone marrow lesions and osteophytes were measured. Linear regression and binary logistic regression analyses were used to examine the associations between PTFJ type configurations and knee joint cartilage volume as well as knee structural abnormalities, respectively, after adjustment for potential confounders. RESULTS Seven PTFJ types including plane (49.4%), trochoid (31.9%), double trochoid (4.3%), saddle (5.4%), condylar (5.3%), trochlear (3.5%) and ball & socket (0.2%) were observed. Plane type was used as the comparator. In multivariable analyses, irregular joint types (comprising the five uncommon joint types) were associated negatively with cartilage volume, and positively with knee cartilage defects, bone marrow lesions and osteophytes in the lateral (but not medial) compartments. In contrast, trochoid type was only associated with reduced femoral cartilage volume, but not with knee cartilage defects, bone marrow lesions and osteophytes. CONCLUSIONS Irregular PTFJ joint shapes are associated with osteoarthritic changes in the lateral, but not medial, tibiofemoral compartment in older adults. The causal relationship needs to be examined in future longitudinal studies.
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Affiliation(s)
- M Lu
- Department of Orthopaedics, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - K Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Z Yin
- Department of Orthopaedics, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Zhu Z, Laslett LL, Jin X, Han W, Antony B, Wang X, Lu M, Cicuttini F, Jones G, Ding C. Association between MRI-detected osteophytes and changes in knee structures and pain in older adults: a cohort study. Osteoarthritis Cartilage 2017; 25:1084-1092. [PMID: 28115233 DOI: 10.1016/j.joca.2017.01.007] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Revised: 12/14/2016] [Accepted: 01/12/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe cross-sectional and longitudinal associations between magnetic resonance imaging (MRI)-detected osteophytes (OPs) and knee structural abnormalities and knee pain in older adults. METHOD A prospective population-based cohort study of 895 participants aged 50-80 years (mean age 62 years, 50% female) was performed. T1-or T2-weighted fat suppressed MRI was used to assess knee OPs, cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and after 2.6 years. Radiographically-detected OPs were scored according to the Osteoarthritis Research Society International (OARSI) atlas. Knee pain was assessed using a self-administered questionnaire at baseline, 2.6 and 5 years later. RESULTS 85% of participants had MRI-detected OPs at baseline, while 10% of participants had radiographically-detected OPs. Cross-sectionally, higher gardes of MRI-detected OPs in all compartments were significantly, independently and site-specifically associated with higher prevalences of cartilage defects and BMLs, lower cartilage volume and higher prevalence of knee pain. Longitudinally, higher gardes of baseline MRI-detected OPs site-specifically predicted greater risks of any increase in cartilage defects or BMLs, and loss of cartilage volume in medial and lateral tibiofemoral (LTF) and total compartments over 2.6 years in multivariable analyses. These significant associations were similar in those without radiographically-detected OPs. MTF and total OP scores were significantly associated with change in total knee pain over 2.6 and 5 years but these became non-significant after adjustment for cartilage defects and BMLs. CONCLUSION MRI-detected knee OPs are common and appear to be clinically relevant to knee structural changes in older adults.
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Affiliation(s)
- Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - X Jin
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopedics, Guangdong Province, China; School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - X Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - M Lu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopedics, Guangdong Province, China; School of Basic Medical Science, Southern Medical University, Guangzhou, Guangdong, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Plausible Roles for RAGE in Conditions Exacerbated by Direct and Indirect (Secondhand) Smoke Exposure. Int J Mol Sci 2017; 18:ijms18030652. [PMID: 28304347 PMCID: PMC5372664 DOI: 10.3390/ijms18030652] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Revised: 03/07/2017] [Accepted: 03/14/2017] [Indexed: 02/07/2023] Open
Abstract
Approximately 1 billion people smoke worldwide, and the burden placed on society by primary and secondhand smokers is expected to increase. Smoking is the leading risk factor for myriad health complications stemming from diverse pathogenic programs. First- and second-hand cigarette smoke contains thousands of constituents, including several carcinogens and cytotoxic chemicals that orchestrate chronic inflammatory responses and destructive remodeling events. In the current review, we outline details related to compromised pulmonary and systemic conditions related to smoke exposure. Specifically, data are discussed relative to impaired lung physiology, cancer mechanisms, maternal-fetal complications, cardiometabolic, and joint disorders in the context of smoke exposure exacerbations. As a general unifying mechanism, the receptor for advanced glycation end-products (RAGE) and its signaling axis is increasingly considered central to smoke-related pathogenesis. RAGE is a multi-ligand cell surface receptor whose expression increases following cigarette smoke exposure. RAGE signaling participates in the underpinning of inflammatory mechanisms mediated by requisite cytokines, chemokines, and remodeling enzymes. Understanding the biological contributions of RAGE during cigarette smoke-induced inflammation may provide critically important insight into the pathology of lung disease and systemic complications that combine during the demise of those exposed.
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Pan F, Blizzard L, Tian J, Cicuttini F, Winzenberg T, Ding C, Jones G. The interaction between weight and family history of total knee replacement with knee cartilage: a 10-year prospective study. Osteoarthritis Cartilage 2017; 25:227-233. [PMID: 27789341 DOI: 10.1016/j.joca.2016.10.013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 10/11/2016] [Accepted: 10/17/2016] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Although being overweight or obese is an important risk factor for the development of knee osteoarthritis (OA), the interplay between weight and genetic factors remains unclear. This study aimed to examine the associations between weight and knee cartilage volume/defects over 10 years in offspring having at least one parent with a total knee replacement (TKR) for primary knee OA and in controls without a knee OA family history. METHOD 367 participants (183 offspring and 184 controls) aged from 26 to 61 years were recruited at baseline, and followed at 2 and 10 years later. T1-weighted magnetic resonance imaging (MRI) of the right knee was used to measure cartilage volume/defects at each time-point. Mixed-effects models were used with adjustment for potential confounders. RESULTS Study participants were middle-age adults (mean age 45 years, mean weight 77.5 kg at baseline). In multivariable analysis, increasing body weight was deleteriously associated with medial tibiofemoral cartilage volume (β = -0.28 ml, per 1 SD increase, 95% CI -0.49 to -0.07) and presence of medial tibiofemoral cartilage defects (RR = 1.27, per 1 SD increase, 95% CI 1.07 to 1.51) in offspring over 10 years. Similar associations were observed for lateral tibiofemoral cartilage volume (β = -0.19 ml, P = 0.059), and defects (RR = 1.24, P = 0.049). However, there were no statistically significant associations between weight and cartilage volume or defects in controls. CONCLUSION The adverse effects of increasing weight are stronger in the offspring of people with knee replacement for knee OA suggesting genetics-environment interaction with regard to overweight/obesity in the pathogenesis of knee OA particularly in the early stages.
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Affiliation(s)
- F Pan
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
| | - L Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
| | - J Tian
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University Medical School, Commercial Road, Melbourne 3181, Australia.
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, Tasmania 7000, Australia.
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Han W, Aitken D, Zhu Z, Halliday A, Wang X, Antony B, Cicuttini F, Jones G, Ding C. Hypointense signals in the infrapatellar fat pad assessed by magnetic resonance imaging are associated with knee symptoms and structure in older adults: a cohort study. Arthritis Res Ther 2016; 18:234. [PMID: 27729069 PMCID: PMC5059934 DOI: 10.1186/s13075-016-1130-y] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2016] [Accepted: 09/20/2016] [Indexed: 02/07/2023] Open
Abstract
Background There are few clinical and epidemiological studies reporting the association between abnormal changes within the IPFP and knee osteoarthritic changes. This study aims to describe the associations between hypointense signals in the infrapatellar fat pad (IPFP) and knee structural change and symptoms in older adults. Methods Participants (n = 874) were selected randomly from local community and followed up 2.7 years later (range 2.6–3.3 years). T1- or T2-weighted fat-suppressed magnetic resonance imaging (MRI) was assessed for IPFP hypointense signal, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index (WOMAC) questionnaire. Radiographic osteoarthritis was assessed using the OARSI atlas. Results Cross-sectionally, hypointense signals in the IPFP were significantly associated with a higher risk of knee cartilage defects at all sites, tibiofemoral BMLs and knee pain in multivariable analyses. Longitudinally, baseline signal abnormalities were significantly and positively associated with increases in knee cartilage defects (OR: 2.27, 95 % CI: 1.61–3.21), BMLs (OR: 1.91, 95 % CI: 1.39–2.62), and knee pain (OR: 1.36, 95 % CI: 1.05–1.76) in multivariable analyses. The associations with cartilage defects remained significant after adjustment for BMLs, but the associations with BMLs and knee pain decreased in magnitude or became non-significant after further adjustment for cartilage defects. Conclusions Hypointense signals in the IPFP were associated primarily with increased knee cartilage defects and also with BMLs and knee symptoms in cross-sectional and longitudinal analyses, suggesting the abnormality represented by this signal has a potentially important role in osteoarthritis progression. Electronic supplementary material The online version of this article (doi:10.1186/s13075-016-1130-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia.,Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia.,Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
| | - Andrew Halliday
- Department of Radiology, Royal Hobart Hospital, Hobart, TAS, Australia
| | - Xia Wang
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Private Bag 23, Hobart, TAS, 7000, Australia. .,Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China. .,Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
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Patellofemoral Bone Marrow Lesions: Natural History and Associations With Pain and Structure. Arthritis Care Res (Hoboken) 2016; 68:1647-1654. [DOI: 10.1002/acr.22871] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2015] [Revised: 01/13/2016] [Accepted: 02/16/2016] [Indexed: 11/07/2022]
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Ijaz Khan H, Chou L, Aitken D, McBride A, Ding C, Blizzard L, Pelletier JP, Martel-Pelletier J, Cicuttini F, Jones G. Correlation Between Changes in Global Knee Structures Assessed by Magnetic Resonance Imaging and Radiographic Osteoarthritis Changes Over Ten Years in a Midlife Cohort. Arthritis Care Res (Hoboken) 2016; 68:958-64. [DOI: 10.1002/acr.22778] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 09/10/2015] [Accepted: 10/27/2015] [Indexed: 12/12/2022]
Affiliation(s)
- Hussain Ijaz Khan
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Louisa Chou
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Andrew McBride
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
| | | | | | | | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart; Tasmania Australia
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Hong JY, Han K, Shin DH, Chun EM. Quality of Life Analysis and Smoking Correlation in Symptomatic Spine Osteoarthritis: A Nationwide Health Survey Analysis of an Elderly Population with EQ-5D. PLoS One 2016; 11:e0151315. [PMID: 26991429 PMCID: PMC4798754 DOI: 10.1371/journal.pone.0151315] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2015] [Accepted: 02/26/2016] [Indexed: 11/19/2022] Open
Abstract
Objectives To analyze quality of life in people with symptomatic spine osteoarthritis (OA) using the results of a cross-sectional, nationwide survey. Materials and Methods This study used data from the Fifth Korean National Health and Nutrition Examination Survey (KNHANES V-5; 2010–2012). After excluding ineligible subjects, the total number of subjects in the study was 8,963, including 4,091 males and 4,872 females. All participants reported disabilities related to spine OA. Plain radiographs of the spine were taken for all participants. Results Age, sex, smoking, drinking, education, and income level were significantly related to spine OA morbidity (P<0.05). OA morbidity was significantly higher in female ex-smokers (OR; 2.94, P<0.05). Quality of life (EQ-5D: L1~5) was significantly compromised in the group with spine OA compared to the group without spine OA (P<0.05). Overall, LQ 1, 2, 3, 4, and 5 domain scores were significantly higher in the group with spine OA (P<0.05). In the group with spine OA, quality of life was reduced on more than three questions for 34.3% of the group (EQ-5D: grade≥2); on two questions, for 18.5% of the group; and on one question, for 11.1% of the group. Mental stress, melancholy, and suicidal thinking were also more common in the group with spine OA (P<0.05). The group with radiographic spine OA but without symptoms did not have compromised EQ-5D scores, whereas the group with radiographic OA and symptoms showed a significantly reduced quality of life. Conclusions Quality of life was significantly reduced in the group with symptomatic spine OA in a large cross-sectional analysis. Physicians should consider quality of life in the treatment of patients with spine OA
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Affiliation(s)
- Jae-Young Hong
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, Catholic University, Seoul, South Korea
| | - Dong-Hyup Shin
- Department of Orthopedics, Korea University Ansan Hospital, Ansan, South Korea
| | - Eun Mi Chun
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, Ewha Womans University Mokdong Hospital, Seoul, South Korea
- * E-mail:
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Dubé CE, Liu SH, Driban JB, McAlindon TE, Eaton CB, Lapane KL. The relationship between smoking and knee osteoarthritis in the Osteoarthritis Initiative. Osteoarthritis Cartilage 2016; 24:465-72. [PMID: 26432984 PMCID: PMC4761327 DOI: 10.1016/j.joca.2015.09.015] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2015] [Revised: 09/15/2015] [Accepted: 09/22/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To estimate the extent that smoking history is associated with symptoms and disease progression among individuals with radiographically confirmed knee Osteoarthritis (OA). METHOD Both cross-sectional (baseline) and longitudinal studies employed data from the Osteoarthritis Initiative (OAI) (n = 2250 participants). Smoking history was assessed at baseline with 44% current or former smokers. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to measure knee pain, stiffness, and physical function. Disease progression was measured using joint space width (JSW). We used adjusted multivariable linear models to examine the relationship between smoking status and exposure in pack years (PY) with symptoms and JSW at baseline. Changes in symptoms and JSW over time were further assessed. RESULTS In cross-sectional analyses, compared to never-smokers high PY (≥15 PY) was associated with slightly greater pain (beta 0.36, 95% CI: 0.01-0.71) and stiffness (beta 0.20, 95% CI: 0.03-0.37); and low PY (<15 PY) was associated with better JSW (beta 0.15, 95% CI: 0.02-0.28). Current smoking was associated with greater pain (beta 0.59, 95% CI: 0.04-1.15) compared to never-smokers. These associations were not confirmed in the longitudinal study. Longitudinally, no associations were found between high or low PY or baseline smoking status with changes in symptoms (at 72 months) or JSW (at 48 months). CONCLUSION Cross-sectional findings are likely due residual confounding. The more robust longitudinal analysis found no associations between smoking status and symptoms or JSW. Long-term smoking provides no benefits to knee OA patients while exposing them to other well-documented serious health risks.
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Affiliation(s)
- C E Dubé
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - S-H Liu
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
| | - J B Driban
- Division of Rheumatology, Tufts Medical Center, Boston, MA 02111, USA.
| | - T E McAlindon
- Division of Rheumatology, Tufts Medical Center, Boston, MA 02111, USA.
| | - C B Eaton
- Center for Primary Care and Prevention, Memorial Hospital of Rhode Island, Pawtucket, RI 02860, USA; Department of Family Medicine, Warren Alpert Medical School, School of Public Health, Brown University, Providence, RI 02912, USA; Department of Epidemiology, Warren Alpert Medical School, School of Public Health, Brown University, Providence, RI 02912, USA.
| | - K L Lapane
- Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA 01655, USA.
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Kang K, Shin JS, Lee J, Lee YJ, Kim MR, Park KB, Ha IH. Association between direct and indirect smoking and osteoarthritis prevalence in Koreans: a cross-sectional study. BMJ Open 2016; 6:e010062. [PMID: 26892791 PMCID: PMC4762105 DOI: 10.1136/bmjopen-2015-010062] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVES To assess the association between smoking patterns and knee and hip joint osteoarthritis (OA) prevalence in Koreans aged 50 years or older with focus on knee OA. DESIGN Cross-sectional study using nationally representative data. SETTING Data were collected at portable Health Examination Centres in Korea. PARTICIPANTS Data of 9064 participants of the 5th Korean National Health and Nutrition Examination Survey (2010-2012) aged 50 years or older who received knee or hip joint X-rays out of 31,596 total surveyees were analysed. PRIMARY OUTCOME MEASURES OA prevalence by smoking behaviour (current smoking, past smoking, indirect smoking and non-smoking). SECONDARY OUTCOME MEASURES Estimated risk of OA by smoking amount, period, pack-years and indirect smoking exposure time to assess the association between smoking-related factors and knee OA by calculating ORs and adjusting for covariates in a complex sampling design. A multinomial logistic regression analysis and backward elimination method was used. RESULTS OA prevalence in Koreans aged 50 years or older was 13.9%, with prevalence about 3.5 times higher in women (men 5.7%, women 20.1%). ORs for knee and hip joint OA prevalence by smoking behaviour in male indirect-smokers were lower than those in non-smokers in age and sex (OR 0.271; 95% CI 0.088 to 0.828), and selective adjustments (OR 0.314; 95% CI 0.102 to 0.966). All other analyses for smoking behaviour and total OA prevalence, and knee OA prevalence were not significantly different. Associations between smoking amount, period, pack-years and knee OA prevalence were non-significant in ever-smokers. Associations between indirect smoking exposure time and knee OA prevalence were also non-significant. CONCLUSIONS This study found that though direct and previous smoking and OA prevalence were not associated, there was a weak relationship between indirect smoking and OA.
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Affiliation(s)
- Kyungrae Kang
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Joon-Shik Shin
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Jinho Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Yoon Jae Lee
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Me-Riong Kim
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - Ki Byung Park
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
| | - In-Hyuk Ha
- Jaseng Spine and Joint Research Institute, Jaseng Medical Foundation, Seoul, Republic of Korea
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McBride A, Khan HI, Aitken D, Chou L, Ding C, Blizzard L, Pelletier JP, Martel-Pelletier J, Cicuttini F, Jones G. Does cartilage volume measurement or radiographic osteoarthritis at baseline independently predict ten-year cartilage volume loss? BMC Musculoskelet Disord 2016; 17:54. [PMID: 26832148 PMCID: PMC4736132 DOI: 10.1186/s12891-016-0900-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/28/2015] [Accepted: 01/23/2016] [Indexed: 01/09/2023] Open
Abstract
Background The aim of this study was to examine whether cartilage volume as measured by MRI and radiographic osteoarthritis (OA) at baseline predict cartilage volume loss over ten years independent of each other and other structural co-pathologies. Methods 219 participants [mean-age 45(26–61); 57 % female] were studied at baseline and ten years. Approximately half were the adult offspring of subjects who underwent knee replacement for OA and the remainder were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed on radiographs and cartilage volume (tibiofemoral), cartilage defects, bone marrow lesions and meniscal tears/extrusion were assessed on MRI. Results Mean absolute and percentage per annum cartilage volume loss was 1284 mm3 and 1.91 % respectively in the medial compartment and 1007 mm3 and 1.38 % respectively in the lateral compartment. Higher baseline tibiofemoral cartilage volume was independently associated with greater absolute cartilage volume loss in both medial (β(95 % CI) = −300 (−399,−200)) and lateral (β = −338 (−443,−233)) compartments and percentage per annum loss in the lateral compartment(β = −0.15 (−0.29, −0.01)). Baseline JSN and osteophytes were associated with cartilage volume loss in the univariable analysis, however these associations did not persist after adjustment for other structural co-pathologies. Conclusion Cross-sectional cartilage volume measurement independently predicts cartilage volume loss over 10 years and can be used to identify fast progressors in clinical trials. Radiographic JSN and osteophytes on the other hand are a reflection of other co-pathologies assessed on MRI and do not independently predict cartilage volume loss over 10 years.
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Affiliation(s)
- Andrew McBride
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
| | - Hussain Ijaz Khan
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
| | - Louisa Chou
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
| | - Leigh Blizzard
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada.
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Medical Science 1 Building, Private Bag 23 17-Liverpool Street, Hobart, 7000, Australia.
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Change in knee structure and change in tibiofemoral joint space width: a five year longitudinal population-based study. BMC Musculoskelet Disord 2016; 17:25. [PMID: 26767503 PMCID: PMC4714529 DOI: 10.1186/s12891-016-0879-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 01/06/2016] [Indexed: 11/18/2022] Open
Abstract
Background Change in knee cartilage volume is frequently used as a proxy for change in knee joint space width over time, but longitudinal data on these associations is limited. We aimed to determine whether change in knee cartilage volume, new or worsening meniscal extrusion (ME), meniscal tears and cartilage defects over 2.4 years correlated with change in joint space width (JSW) over 5 years in older community dwelling adults. Methods Participants (n = 153) had their right knee imaged using MR imaging and x-ray at baseline, and after 2.4 years (MRI) and 5 years (x-ray). Cartilage volume, cartilage defects, meniscal extrusions and meniscal tears were assessed on sagittal T1-weighted fat-suppressed MRI. JSW was assessed using standard fixed semi-flexed view radiographs, and scored on those with adequate alignment. Results Participants were 51–79 (mean 62) years old; 48 % were female. Cartilage volume reduced over time (medial −134 ± 202 μL/year, lateral −106 ± 165 μL/year, p < 0.001), as did JSW (medial −0.05 ± 0.16 mm/year, lateral −0.12 ± 0.24 mm/year, p < 0.001). In multivariable analysis, the only consistent predictor of change in JSW was new or worsening ME (medial tibia R2 3.1 %, p = 0.031; medial femur R2 3.2 %, p = 0.024); change in cartilage volume correlated with change in JSW laterally (R2 4.8 %, p = 0.007) and was borderline medially (R2 2.2 %, p = 0.064); there was no association for meniscal tears or cartilage defects. The magnitude of these associations were similar albeit somewhat greater for ME in participants with radiographic OA (R2 6.2 %, p = 0.017). Conclusion Change in ME and cartilage volume weakly predict change in JSW, but the vast majority of the variation remains unexplained. Since MRI examines cartilage directly while radiographs examine it indirectly, these results cast doubt on the validity of using JSW as a proxy measure of cartilage loss.
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Han W, Aitken D, Zhu Z, Halliday A, Wang X, Antony B, Cicuttini F, Jones G, Ding C. Signal intensity alteration in the infrapatellar fat pad at baseline for the prediction of knee symptoms and structure in older adults: a cohort study. Ann Rheum Dis 2015; 75:1783-8. [PMID: 26612337 DOI: 10.1136/annrheumdis-2015-208360] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2015] [Accepted: 11/01/2015] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To describe the associations between infrapatellar fat pad (IPFP) signal intensity alteration at baseline and knee symptoms and structural changes in older adults. METHODS A total of 874 subjects (mean 62.1 years, 50.1% female) selected randomly from local community were studied at baseline and 770 were followed up (only 357 had MRI at follow-up) over 2.6 years. T1-weighted or T2-weighted fat suppressed MRI was used to assess IPFP signal intensity alteration (0-3), cartilage volume, cartilage defects and bone marrow lesions (BMLs) at baseline and 2.6 years later. Knee pain was assessed by self-administered Western Ontario and McMaster Osteoarthritis Index questionnaire. Radiographic osteoarthritis (OA) was assessed. RESULTS In cross-sectional analyses, IPFP signal intensity alteration was significantly and positively associated with total knee pain as well as knee cartilage defects, BMLs and knee radiographic OA and negatively associated with patellar cartilage volume after adjustment for age, sex, body mass index and/or radiographic OA. Longitudinally, baseline signal intensity alteration within IPFP was significantly and positively associated with increases in knee pain when going upstairs/downstairs as well as increases in tibiofemoral cartilage defects and BMLs, and negatively associated with change in lateral tibial cartilage volume in multivariable analyses. CONCLUSIONS IPFP signal intensity alteration at baseline was associated with knee structural abnormalities and clinical symptoms cross-sectionally and longitudinally in older adults, suggesting that it may serve as an important imaging biomarker in knee OA.
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Affiliation(s)
- Weiyu Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Zhaohua Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Andrew Halliday
- Department of Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Xia Wang
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Flavia Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - Changhai Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China
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Wang J, Antony B, Zhu Z, Han W, Pan F, Wang X, Jin X, Liu Z, Cicuttini F, Jones G, Ding C. Association of patellar bone marrow lesions with knee pain, patellar cartilage defect and patellar cartilage volume loss in older adults: a cohort study. Osteoarthritis Cartilage 2015; 23:1330-6. [PMID: 25724258 DOI: 10.1016/j.joca.2015.02.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2014] [Revised: 01/22/2015] [Accepted: 02/13/2015] [Indexed: 02/02/2023]
Abstract
AIM To examine the cross-sectional and longitudinal associations of patellar bone marrow lesion (BMLs) with knee pain, cartilage defects and cartilage volume in older adults. METHODS A total of 904 randomly selected subjects (mean 62.4 years, 49.9% female) were studied. Fat suppressed T1-weighted spoiled gradient recall and T2-weighted fast spin echo magnetic resonance imaging (MRI) sequences were used to assess cartilage volume, cartilage defects and/or BMLs at baseline (n = 904) and 2.6 (range: 1.4-4.8) years' follow-up (n = 414). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire at baseline (n = 904) and follow-up (n = 790). RESULTS The prevalence of any patellar BMLs was 19% and was higher in those with tibiofemoral BMLs. In multivariable analyses, patellar BMLs were positively associated with any knee pain at baseline and an increase in knee pain when going up/down stairs (odds ratio (OR): 1.67, 95% confidence interval (CI): 1.08, 2.59) but not with other knee pain subscales. Patella BMLs were also associated with patellar cartilage defects both at baseline and change over time (OR: 1.76, 95% CI: 1.00, 3.70) but not tibiofemoral defects. Patellar BMLs were negatively associated with baseline and change in patella cartilage volume (β: -2.10%, 95% CI: -3.39%, -0.80%). These associations remained significant after further adjustment for tibiofemoral BMLs. CONCLUSIONS Patellar BMLs were consistently associated with increased knee pain especially going up/down stairs, increased patellar cartilage defects, and decreased patellar cartilage volume cross-sectionally and longitudinally, suggesting a predominantly compartment specific role for patellar BMLs.
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Affiliation(s)
- J Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of General Surgery, Yan'an Hospital of Kunming Medical University, Kunming Yan'an Hospital, Kunming, China
| | - B Antony
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Z Zhu
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - W Han
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - F Pan
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - X Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - X Jin
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - Z Liu
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Felson D, Zhang Y. Smoking and osteoarthritis: a review of the evidence and its implications. Osteoarthritis Cartilage 2015; 23:331-3. [PMID: 25454371 PMCID: PMC5473429 DOI: 10.1016/j.joca.2014.11.022] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2014] [Revised: 10/03/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
A number of reports including a recent publication in Osteoarthritis and Cartilage have suggested that smokers have a lower than expected prevalence of osteoarthritis (OA) than nonsmokers. We review the evidence linking smoking with OA, suggest approaches whereby the direct and indirect effects of smoking on OA might be distinguished, highlight two diseases, ulcerative colitis and Parkinson's disease, where smoking is protective, discuss mechanisms by which nicotine might act and lastly explore the association of smoking with enhanced musculoskeletal pain.
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Affiliation(s)
- D.T. Felson
- Address correspondence and reprint requests to: D.T. Felson, 650 Albany Street, X-205, Boston, MA 02118, USA., Tel: 617-638-5180
| | - Y. Zhang
- Clinical Epidemiology Research & Training Unit, Boston University School of Medicine, Boston, MA, USA
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Khan HI, Aitken D, Chou L, McBride A, Ding C, Blizzard L, Pelletier JP, Pelletier JM, Cicuttini F, Jones G. A family history of knee joint replacement increases the progression of knee radiographic osteoarthritis and medial tibial cartilage volume loss over 10 years. Osteoarthritis Cartilage 2015; 23:203-9. [PMID: 25464166 DOI: 10.1016/j.joca.2014.11.016] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2014] [Revised: 11/11/2014] [Accepted: 11/14/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Osteoarthritis (OA) has a genetic component but it is uncertain if the offspring of those with knee OA are at a greater risk. The aim of this study was to describe radiographic OA (ROA) progression and cartilage loss over 10 years in a midlife cohort with some having a family history of OA and some community based controls. METHODS 220 participants [mean-age 45 (26-61); 57% female] were studied at baseline and 10 years. Half were adult offspring of subjects who underwent knee replacement for OA and the remainder were randomly selected controls. Joint space narrowing (JSN) and osteophytes were assessed on radiographs and cartilage volume (tibial, femoral and patellar), cartilage defects, bone marrow lesions (BMLs) and meniscal tears were assessed on Magnetic resonance imaging (MRI). RESULTS For ROA, there was a significant difference between offspring and controls in unadjusted analysis for change in total ROA, medial JSN, total medial, total lateral and total osteophyte scores. This difference persisted for medial JSN (difference in ratios = +1.93 (+1.04, +3.51)) only, after adjustment for confounders and baseline differences. In unadjusted analysis for cartilage loss, offspring lost more cartilage at the medial tibial (difference in means = -79.13 (-161.92, +3.71)) site only. This difference became of borderline significance after adjustment for baseline differences (P = 0.055). CONCLUSION The offspring of subjects having a total knee replacement have a greater worsening of ROA (both JSN and osteophytes) and higher medial tibial cartilage volume loss over 10 years. Most of these changes are mediated by differences in baseline characteristics of offspring and controls except for increase in medial JSN.
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Affiliation(s)
- H I Khan
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
| | - D Aitken
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
| | - L Chou
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
| | - A McBride
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
| | - C Ding
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
| | - L Blizzard
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
| | - J-P Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, QC, Canada.
| | - J M Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Notre-Dame Hospital, Montreal, QC, Canada.
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Australia.
| | - G Jones
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Australia.
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Yucesoy B, Charles LE, Baker B, Burchfiel CM. Occupational and genetic risk factors for osteoarthritis: a review. Work 2015; 50:261-73. [PMID: 24004806 PMCID: PMC4562436 DOI: 10.3233/wor-131739] [Citation(s) in RCA: 75] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Osteoarthritis (OA) is a multifactorial disease with strong genetic and occupational components. Although published studies have described several risk factors for OA, very few studies have investigated the occupational and genetic factors that contribute to this debilitating condition. OBJECTIVE To describe occupational and genetic factors that may contribute to the risk of developing (OA). METHODS A literature search was conducted in PubMed using the search terms osteoarthritis, occupation, work, and genetics. RESULTS Heavy physical work load was the most common occupational risk factor for OA in several anatomical locations. Other factors include kneeling and regular stair climbing, crawling, bending and whole body vibration, and repetitive movements. Numerous studies have also shown the influence of genetic variability in the pathogenesis of OA. Genetic variants of several groups of genes e.g., cartilage extracellular matrix structural genes and the genes related to bone density have been implicated in disease pathogenesis. CONCLUSION This review shows that occupational factors were extensively studied in knee OA unlike OA of other anatomical regions. Although genetic association studies performed to date identified a number of risk variants, some of these associations have not been consistently replicated across different studies and populations. Therefore, more research is needed.
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Affiliation(s)
- Berran Yucesoy
- Toxicology and Molecular Biology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Luenda E. Charles
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Brent Baker
- Toxicology and Molecular Biology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
| | - Cecil M. Burchfiel
- Biostatistics and Epidemiology Branch, Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV, USA
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Wang J, Han W, Wang X, Pan F, Liu Z, Halliday A, Jin X, Antony B, Cicuttini F, Jones G, Ding C. Mass effect and signal intensity alteration in the suprapatellar fat pad: associations with knee symptoms and structure. Osteoarthritis Cartilage 2014; 22:1619-26. [PMID: 24882527 DOI: 10.1016/j.joca.2014.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 04/22/2014] [Accepted: 05/21/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe cross-sectional associations between mass effect or signal intensity alteration of the suprapatellar fat pad (SPFP) with knee symptoms and structure in older adults. METHODS A cross-sectional sample of 904 randomly selected subjects (mean 62.4 years, 49.9% female) was studied. T1- or T2-weighted fat suppressed magnetic resonance imaging (MRI) was used to assess mass effect or signal intensity alteration of SPFP, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. The Osteoarthritis Research Society International (OARSI) atlas was used to assess knee osteophyte, joint space narrowing (JSN) and radiographic osteoarthritis (ROA). Univariable and multivariable linear or logistic regression analyses were used to examine the associations. RESULTS After adjustment for confounders including age, sex, body mass index (BMI), disease status, tibial bone area and/or ROA, the presence of SPFP mass effect was significantly associated with any knee pain (OR: 2.39; 95% confidence interval (CI): 1.54, 3.70) and ROA (OR: 2.10; 95% CI: 1.33, 3.31) but not with cartilage volume, cartilage defects or BMLs. The presence of SPFP signal intensity alteration was significantly associated with any knee pain (OR: 1.90; 95% CI: 1.43, 2.53), ROA (OR: 1.83; 95% CI: 1.37, 2.45), any BMLs (OR: 1.55; 95% CI: 1.17, 2.06) but not with cartilage volume and cartilage defects. Significant associations with knee pain and BMLs were more evident in subjects with ROA. Presence of SPFP mass effect and/or signal intensity alteration combined was associated with any tibial cartilage defects (OR: 1.45; 95% CI: 1.04, 2.04). CONCLUSIONS SPFP mass effect and/or signal intensity alterations are deleteriously associated with knee pain, radiographic OA and BMLs in this cross-sectional study, suggesting that SPFP abnormalities may contribute to pain and structural abnormalities in the knee.
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Affiliation(s)
- J Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of General Surgery, Yan'an Hospital of Kunming Medical University, Kunming Yan'an Hospital, Kunming, China
| | - W Han
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - X Wang
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - F Pan
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, Anhui, China
| | - Z Liu
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopedics, 3rd Affiliated Hospital of Southern Medical University, Guangzhou, China
| | - A Halliday
- Department of Radiology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - X Jin
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - B Antony
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Arthritis Research Institute, 1st Affiliated Hospital, Anhui Medical University, Hefei, Anhui, China.
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Jones G, Winzenberg TM, Callisaya ML, Laslett LL. Lifestyle modifications to improve musculoskeletal and bone health and reduce disability--a life-course approach. Best Pract Res Clin Rheumatol 2014; 28:461-78. [PMID: 25481426 DOI: 10.1016/j.berh.2014.07.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
This review covers the evidence relating to lifestye modification in the big three musculoskeletal conditions: osteoarthritis, osteoporosis and rheumatoid arthritis. Lifestyle is of considerable importance in the first two and there is emerging evidence for rheumatoid arthritis despite it not traditionally being considered a lifestyle disease.
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Affiliation(s)
- Graeme Jones
- Menzies Research Institute Tasmania, University of Tasmania, Private bag 23, Hobart, Tasmania 7000, Australia.
| | - Tania M Winzenberg
- Menzies Research Institute Tasmania, University of Tasmania, Private bag 23, Hobart, Tasmania 7000, Australia.
| | - Michele L Callisaya
- Menzies Research Institute Tasmania, University of Tasmania, Private bag 23, Hobart, Tasmania 7000, Australia; Department of Medicine, Monash University, 246 Clayton Rd, Clayton, Victoria 3168, Australia.
| | - Laura L Laslett
- Menzies Research Institute Tasmania, University of Tasmania, Private bag 23, Hobart, Tasmania 7000, Australia.
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Aitken D, Ding C, Pelletier JP, Martel-Pelletier J, Cicuttini F, Jones G. Responsiveness of Magnetic Resonance Imaging-derived Measures Over 2.7 Years. J Rheumatol 2014; 41:2060-7. [DOI: 10.3899/jrheum.130953] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Objective.To compare the responsiveness of magnetic resonance imaging (MRI)-derived measures of knee osteoarthritis over 2.7 years.Methods.There were 430 community-based participants (mean age 63.0 yrs, range 51–79 yrs; 51% female) measured at baseline and 2.7 years later. MRI of the right knee at both timepoints was performed to assess cartilage volume, cartilage defects, bone marrow lesions (BML), meniscal pathology, and tibial bone area. Global measurements were calculated as the sum of tibial and femoral measures. Standardized response mean (SRM) was calculated as the mean of change divided by the SD of change.Results.Global tibiofemoral cartilage volume and cartilage defects had the best SRM of −0.80 and 0.62, respectively. Site-specific measurements were lower (SRM range for cartilage volume −0.48 to −0.54 and cartilage defects 0.33 to 0.49). The SRM for BML was 0.12, meniscal pathology 0.39, and tibial bone area −0.09. Cartilage volume and/or defects tended to be more responsive in those with knee pain, those who were obese, those who were older, and those with radiographic osteoarthritis.Conclusion.Global cartilage volume demonstrated the best sensitivity to change, suggesting that if we relied solely on SRM to optimize clinical trial design, then cartilage volume would be the best outcome measure. However, clinical trials have shown that cartilage volume may be less responsive to treatment compared to other measures that have lower SRM (such as BML). Therefore, although one can optimize trial efficiency by finding more responsive endpoints, both sensitivity to change and magnitude of benefit should be considered.
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Parkerson HA, Zvolensky MJ, Asmundson GJG. Understanding the relationship between smoking and pain. Expert Rev Neurother 2014; 13:1407-14. [PMID: 24236905 DOI: 10.1586/14737175.2013.859524] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This review provides an overview of evidence regarding several key mechanisms pertinent to understanding the co-occurrence of smoking dependence and pain, both potentially costly conditions, and highlights treatment implications and future research directions. We describe each of pain and smoking dependence and introduce a revised integrative reciprocal model that explains their co-occurrence. We then provide a selective review of evidence pertinent to direct and indirect pathways between variables postulated in the model. We also provide general recommendations for improving assessment and treatment of smokers with clinically significant pain. We conclude with a targeted agenda for future investigation of the co-occurrence of smoking and pain. Empirical efforts directed at testing postulates of the proposed integrative model may yield a better understanding of the nature of the relationship between these prevalent and costly health conditions as well as evidence-based preventive and treatment strategies for people who experience nicotine dependence and pain-related disability.
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Affiliation(s)
- Holly A Parkerson
- Department of Psychology, University of Regina, Regina, Saskatchewan, Canada S4S 0A2
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Foong YC, Khan HI, Blizzard L, Ding C, Cicuttini F, Jones G, Aitken D. The clinical significance, natural history and predictors of bone marrow lesion change over eight years. Arthritis Res Ther 2014; 16:R149. [PMID: 25022807 PMCID: PMC4223560 DOI: 10.1186/ar4611] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Accepted: 07/02/2014] [Indexed: 12/28/2022] Open
Abstract
Introduction There is increasing evidence to suggest that bone marrow lesions (BMLs) play a key role in the pathogenesis of osteoarthritis (OA). However, there is a lack of long term data. The aim of this study was to describe the natural history of knee BMLs, their association with knee pain and examine predictors of BML change over eight years. Methods A total of 198 subjects (109 adult offspring of subjects who had a knee replacement and 89 community-based controls) were studied. Knee pain and BML size were assessed at two and ten year visits. Results At the two year visit, 64% of participants (n = 127) had 229 BMLs (34% patella, 26% femoral and 40% tibial). Over eight years, 24% (55/229) increased in size, 55% (125/229) remained stable and 21% (49/229) decreased in size or resolved completely. Of the participants without BMLs at baseline, 52% (37/71) developed incident BMLs. After adjusting for confounders, eight year change in total BML size was associated with change in knee pain in offspring (β = 2.50, 95% confidence interval (CI) 0.96 to 4.05) but not controls. This association was stronger in males. Incident BMLs were associated with increase in pain (β = 3.60, 95% CI 1.14 to 6.05). Body mass index (BMI) and strenuous activity (but not radiographic osteoarthritis or smoking) were associated with an increase in BML size. Conclusion In this midlife cohort, the proportion of BMLs increasing in size was similar to those decreasing in size with the majority remaining stable. Change in BMLs was predicted by BMI and strenuous activity. An increase in BML size or a new BML resulted in an increase in pain especially in males and those with a family history of OA.
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Han W, Cai S, Liu Z, Jin X, Wang X, Antony B, Cao Y, Aitken D, Cicuttini F, Jones G, Ding C. Infrapatellar fat pad in the knee: is local fat good or bad for knee osteoarthritis? Arthritis Res Ther 2014; 16:R145. [PMID: 25008048 PMCID: PMC4227074 DOI: 10.1186/ar4607] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2013] [Accepted: 06/25/2014] [Indexed: 12/30/2022] Open
Abstract
Introduction Recent studies regarding the infrapatellar fat pad (IPFP) mainly focus on the roles of the cells derived from the IPFP. There have been few clinical or epidemiological studies reporting on the association between the IPFP and knee osteoarthritis (OA). Our objective is to generate hypotheses regarding the associations between IPFP maximum area and knee OA measures in older adults. Methods A total of 977 subjects between 50 and 80 years of age (mean, 62.4 years) participated in the study. Radiographic knee osteophyte and joint space narrowing (JSN) were assessed using the Osteoarthritis Research Society International atlas. T1- or T2-weighted fat suppressed magnetic resonance imaging (MRI) was utilized to assess IPFP maximum area, cartilage volume, cartilage defects, and bone marrow lesions (BMLs). Knee pain was assessed by self-administered Western Ontario McMaster Osteoarthritis Index (WOMAC) questionnaire. Results After adjustment for potential confounders, IPFP maximum area was significantly associated with joint space narrowing (odds ratio (OR): 0.75, 95% confidence interval (CI): 0.62 to 0.91 (medial), 0.77, 95% CI: 0.62 to 0.96 (lateral)) and medial osteophytes (OR: 0.52, 95% CI: 0.35 to 0.76), knee tibial and patellar cartilage volume (β: 56.9 to 164.9 mm3/cm2, all P <0.001), tibial cartilage defects (OR: 0.58, 95% CI: 0.41 to 0.81 (medial), 0.53, 95% CI: 0.40-0.71 (lateral)), any BMLs (OR: 0.77, 95% CI: 0.63 to 0.94), and knee pain on a flat surface (OR: 0.79, 95% CI: 0.63 to 0.98). IPFP maximum area was negatively, but not significantly, associated with femoral cartilage defects, lateral tibiofemoral BMLs, and total knee pain or other knee pain subscales. Conclusion IPFP maximum area is beneficially associated with radiographic OA, MRI structural pathology and knee pain on a flat surface suggesting a protective role for IPFP possibly through shock absorption. Consequently, we must pay special attention to IPFP in the clinical settings, avoiding resection of normal IPFP in knee surgery.
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Tibiofemoral subchondral surface ratio (SSR) is a predictor of osteoarthritis symptoms and radiographic progression: data from the Osteoarthritis Initiative (OAI). Osteoarthritis Cartilage 2014; 22:771-8. [PMID: 24742954 DOI: 10.1016/j.joca.2014.04.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2013] [Revised: 02/15/2014] [Accepted: 04/04/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Symptomatic knee osteoarthritis (OA) is poorly correlated with radiographic severity, but subchondral bone measures may be useful for risk assessment as bone shape is grossly unaffected at early radiographic stages. We sought to determine whether compartment-specific size mismatch in the naturally asymmetric tibiofemoral joint, measured as tibiofemoral subchondral surface ratio (SSR): (1) predicts incident symptoms, (2) predicts incident or progressive OA, (3) is reproducible and time invariant. DESIGN OA Initiative participants with baseline MRIs and up to 48-month follow-up (n = 1,338) were analyzed. Logistic regression was used to determine the association between SSR and incident symptoms, incident OA, and progression of OA after adjusting for demographic, radiologic, injury-related, and lifestyle-related factors. Reproducibility was assessed as % coefficient of variation (CV) on repeat MRI studies at baseline and 24 months. RESULTS Increased medial SSR is protective against incident symptoms at 48 months (per 0.1 increase: OR 0.48 CI 0.30, 0.75; P = 0.001). Increased lateral SSR values are protective against lateral OA incidence (OR 0.23 CI 0.06, 0.77; P = 0.016) or progression (OR 0.66 CI 0.43, 0.99; P = 0.049) at 24 months. Both medial and lateral SSR are stable over time (medial: mean change 0.001 SD 0.016; lateral: mean change 0.000 SD 0.017) and are highly reproducible (3.0% CV medial SSR; 2.7% CV lateral SSR). CONCLUSIONS A larger medial SSR is protective against developing OA-related symptoms. A larger lateral SSR is protective against lateral OA incidence or progression. Finally, lateral and medial SSR are stable over time and are highly reproducible across MRI studies.
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Affiliation(s)
- Tiffany K. Gill
- School of Medicine; The University of Adelaide; Adelaide South Australia Australia
| | - Catherine L. Hill
- Rheumatology Unit; The Queen Elizabeth Hospital; Adelaide South Australia Australia
- The Health Observatory; The University of Adelaide; Adelaide South Australia Australia
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Mnatzaganian G, Ryan P, Reid CM, Davidson DC, Hiller JE. Smoking and primary total hip or knee replacement due to osteoarthritis in 54,288 elderly men and women. BMC Musculoskelet Disord 2013; 14:262. [PMID: 24006845 PMCID: PMC3844303 DOI: 10.1186/1471-2474-14-262] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2013] [Accepted: 09/03/2013] [Indexed: 01/28/2023] Open
Abstract
Background The reported association of smoking with risk of undergoing a total joint replacement (TJR) due to osteoarthritis (OA) is not consistent. We evaluated the independent association between smoking and primary TJR in a large cohort. Methods The electronic records of 54,288 men and women, who were initially recruited for the Second Australian National Blood Pressure study, were linked to the Australian Orthopaedic Association National Joint Replacement Registry to detect total hip replacement (THR) or total knee replacement (TKR) due to osteoarthritis. Competing risk regressions that accounted for the competing risk of death estimated the subhazard ratios for TJR. One-way and probabilistic sensitivity analyses were undertaken to represent uncertainty in the classification of smoking exposure and socioeconomic disadvantage scores. Results An independent inverse association was found between smoking and risk of THR and TKR observed in both men and women. Compared to non-smokers, male and female smokers were respectively 40% and 30% less likely to undergo a TJR. This significant association persisted after controlling for age, co-morbidities, body mass index (BMI), physical exercise, and socioeconomic disadvantage. The overweight and obese were significantly more likely to undergo TJR compared to those with normal weight. A dose–response relationship between BMI and TJR was observed (P < 0.001). Socioeconomic status was not independently associated with risk of either THR or TKR. Conclusion The strengths of the inverse association between smoking and TJR, the temporal relationship of the association, together with the consistency in the findings warrant further investigation about the role of smoking in the pathogenesis of osteoarthritis causing TJR.
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Affiliation(s)
- George Mnatzaganian
- Faculty of Health Sciences, Australian Catholic University, Room 8,70, Level 8, 250 Victoria Parade, East Melbourne, Victoria, VIC, 3065, Australia.
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Pearce F, Hui M, Ding C, Doherty M, Zhang W. Does Smoking Reduce the Progression of Osteoarthritis? Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken) 2013; 65:1026-33. [DOI: 10.1002/acr.21954] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2012] [Accepted: 12/21/2012] [Indexed: 12/19/2022]
Affiliation(s)
| | | | - Changhai Ding
- Menzies Research Institute; University of Tasmania; Hobart; Tasmania; Australia
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Abstract
➤ Cigarette smoking decreases bone mineral density and increases the risk of sustaining a fracture or tendon injury, with partial reversibility of these risks with long-term cessation of smoking. ➤ Cigarette smoking increases the risk for perioperative complications, nonunion and delayed union of fractures, infection, and soft-tissue and wound-healing complications. ➤ Brief preoperative cessation of smoking may mitigate these perioperative risks. ➤ Informed-consent discussions should include notification of the higher risk of perioperative complications with cigarette smoking and the benefits of temporary cessation of smoking.
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Affiliation(s)
- John J Lee
- Department of Orthopaedic Surgery, University of Michigan, 2912 Taubman Center, 1500 East Medical Center Drive SPC 5328, Ann Arbor, MI 48109, USA
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Knee cartilage defects in a sample of older adults: natural history, clinical significance and factors influencing change over 2.9 years. Osteoarthritis Cartilage 2012; 20:1541-7. [PMID: 22960091 DOI: 10.1016/j.joca.2012.08.026] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2012] [Revised: 08/28/2012] [Accepted: 08/29/2012] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the natural history of knee cartilage defects, and their relationship to cartilage volume loss and risk of knee replacement in a longitudinal study of older adults. DESIGN 395 randomly selected older adults (mean age 62.7 years) had magnetic resonance imaging of their right knee at baseline and approximately 2.9 years later to determine cartilage defect grade (0-4), cartilage volume, medial and lateral tibial bone size, and presence of bone marrow lesions (BMLs). Height, weight, body mass index (BMI) and radiographic osteoarthritis were measured by standard protocols. RESULTS At baseline higher grade cartilage defects (grade ≥2) were significantly associated with age, BMI, lateral tibial bone size, BMLs, and radiographic osteoarthritis. Over 2.9 years, the average defect score increased statistically significantly in all compartments; however, the majority of defects remained stable and regression of defects was rare. Baseline factors associated with increase in defect score over 2.9 years were radiographic osteoarthritis, tibial bone size, BMI and being female. In multivariate analysis, baseline cartilage defect grade predicted cartilage volume loss at the medial tibia, lateral tibia and patella over 2.9 years (β = -1.78% to -1.27% per annum per 1 grade increase, P < 0.05 for all comparisons), and risk of knee replacement over 5 years (odds ratio (OR) = 1.73 per 1 grade increase, P = 0.001). CONCLUSION Knee cartilage defects in older adults are common but less likely to regress than in younger life. They independently predict cartilage volume loss and risk of knee replacement, suggesting they are potential targets for intervention.
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Ding C, Stannus O, Cicuttini F, Antony B, Jones G. Body fat is associated with increased and lean mass with decreased knee cartilage loss in older adults: a prospective cohort study. Int J Obes (Lond) 2012; 37:822-7. [PMID: 22907692 DOI: 10.1038/ijo.2012.136] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE To determine the associations between body composition at baseline and knee cartilage loss over 2.9 years in older adults. METHODS A total of 395 randomly selected subjects (mean 62 years, range 51-81, 50% female) were studied at baseline and 2.9 years later. T1-weighted fat-suppressed magnetic resonance imaging of the right knee was performed to determine knee cartilage volume and tibial bone area at baseline and follow-up. Height, weight and radiographic osteoarthritis were measured by standard protocols at baseline. Fat mass and lean mass were measured by dual-energy X-ray absorptiometry at baseline. RESULTS Tibial cartilage volume decreased by 2.0-2.7% per annum. In multivariable analysis, annual change in medial cartilage volume was negatively and significantly associated with body mass index (β: -0.14% per kg m(-2), 95% confidence interval (CI): -0.25%, -0.02%), percentage total body fat (β: -0.19% per %, 95% CI: -0.30%, -0.07%) and percentage trunk fat (β: -0.10% per %, 95% CI: -0.19%, -0.02%), and positively associated with percentage lean mass (β: 0.20% per %, 95% CI: 0.08%, 0.32%). Change in lateral tibial cartilage volume was also significantly associated with percentage total body fat (β: -0.11% per %, 95% CI: -0.21%, -0.001%) and total lean mass (β: 0.13% per kg, 95% CI: 0.04%, 0.22%). These were independent of sex and age even though both were also significant predictors. CONCLUSIONS Body fat adversely affects tibial cartilage loss over time, whereas lean mass is protective. Strategies aimed at reducing body fat but increasing lean mass may reduce knee cartilage loss in older people.
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Affiliation(s)
- C Ding
- Menzies Research Institute, University of Tasmania, Hobart, Tasmania, Australia.
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Doré DA, Winzenberg TM, Ding C, Otahal P, Pelletier JP, Martel-Pelletier J, Cicuttini FM, Jones G. The association between objectively measured physical activity and knee structural change using MRI. Ann Rheum Dis 2012; 72:1170-5. [PMID: 22896739 DOI: 10.1136/annrheumdis-2012-201691] [Citation(s) in RCA: 80] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES This study describes the longitudinal association between objectively assessed physical activity (PA) and knee structural change measured using MRI. METHODS 405 community-dwelling adults aged 51-81 years were measured at baseline and approximately 2.7 years later. MRI of the right knee at baseline and follow-up was performed to evaluate bone marrow lesions (BMLs), meniscal pathology, cartilage defects, and cartilage volume. PA was assessed at baseline by pedometer (steps/day). RESULTS Doing ≥10 000 steps/day was associated with BML increases (RR 1.97, 95% CI 1.19 to 3.27, p=0.009). Participants doing ≥10 000 steps/day had a 1.52 times (95% CI 1.05 to 2.20, p=0.027) greater risk of increasing meniscal pathology score, which increased to 2.49 (95% CI 1.05 to 3.93, p=0.002) in those with adverse meniscal pathology at baseline. Doing ≥10 000 steps/day was associated with a greater risk of increasing cartilage defect score in those with prevalent BMLs at baseline (RR 1.36, 95% CI 1.03 to 1.69, p=0.013). Steps/day was protective against volume loss in those with more baseline cartilage volume but led to increased cartilage loss in those with less baseline cartilage volume. (p=0.046 for interaction). CONCLUSIONS PA was deleteriously associated with knee structural change, especially in those with pre-existing knee structural abnormalities. This suggests individuals with knee abnormalities should avoid doing ≥10 000 steps/day. Alternatives to weight-bearing activity may be needed in order to maintain PA levels required for other aspects of health.
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Affiliation(s)
- Dawn A Doré
- Menzies Research Institute Tasmania, University of Tasmania, Hobart, Tasmania, Australia.
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Wang Y, Wluka AE, Jones G, Ding C, Cicuttini FM. Use magnetic resonance imaging to assess articular cartilage. Ther Adv Musculoskelet Dis 2012; 4:77-97. [PMID: 22870497 PMCID: PMC3383521 DOI: 10.1177/1759720x11431005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Magnetic resonance imaging (MRI) enables a noninvasive, three-dimensional assessment of the entire joint, simultaneously allowing the direct visualization of articular cartilage. Thus, MRI has become the imaging modality of choice in both clinical and research settings of musculoskeletal diseases, particular for osteoarthritis (OA). Although radiography, the current gold standard for the assessment of OA, has had recent significant technical advances, radiographic methods have significant limitations when used to measure disease progression. MRI allows accurate and reliable assessment of articular cartilage which is sensitive to change, providing the opportunity to better examine and understand preclinical and very subtle early abnormalities in articular cartilage, prior to the onset of radiographic disease. MRI enables quantitative (cartilage volume and thickness) and semiquantitative assessment of articular cartilage morphology, and quantitative assessment of cartilage matrix composition. Cartilage volume and defects have demonstrated adequate validity, accuracy, reliability and sensitivity to change. They are correlated to radiographic changes and clinical outcomes such as pain and joint replacement. Measures of cartilage matrix composition show promise as they seem to relate to cartilage morphology and symptoms. MRI-derived cartilage measurements provide a useful tool for exploring the effect of modifiable factors on articular cartilage prior to clinical disease and identifying the potential preventive strategies. MRI represents a useful approach to monitoring the natural history of OA and evaluating the effect of therapeutic agents. MRI assessment of articular cartilage has tremendous potential for large-scale epidemiological studies of OA progression, and for clinical trials of treatment response to disease-modifying OA drugs.
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Jungmann PM, Salzmann GM, Schmal H, Pestka JM, Südkamp NP, Niemeyer P. Autologous chondrocyte implantation for treatment of cartilage defects of the knee: what predicts the need for reintervention? Am J Sports Med 2012; 40:58-67. [PMID: 21969180 DOI: 10.1177/0363546511423522] [Citation(s) in RCA: 85] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Autologous chondrocyte implantation (ACI) is a well-established treatment option for isolated cartilage defects of the knee joint, providing satisfying outcome. However, cases of treatment failure with the need for surgical reintervention are reported; typical patient's individual and environmental risk factors have previously not been described. HYPOTHESIS The need for reintervention after ACI is associated with specific preoperative detectable individual risk factors. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS A total of 413 patients following ACI (first, second, and third generation) were filtered for those who required revision surgery during their follow-up time (2-11.8 years). Factors were analyzed that might have significant effects on increased revision rate. Using preoperatively collected data, all patients were grouped according to 12 standard prognostic factors. Apart from odds ratio and Pearson χ(2) test, statistical analysis of risk factors was performed with multivariate binary logistic regression models and Cox regression, the method of choice for survival time data. RESULTS After a follow-up of 4.4 ± 0.9 years (limited to 5 years), a total of 88 patients (21.3%) had undergone surgical revision. The time to revision surgery was 1.8 ± 1.1 years. Four prognostic factors associated with a significantly higher risk for reintervention were detected: (1) female gender (Cox survival fit: P = .033), (2) previous surgeries of the affected joint (P = .002), (3) previous bone marrow stimulation (P = .041), and (4) periosteum patch-covered ACI (P = .028). An influence of patient age, body mass index (BMI), defect number, defect size, lesion origin, lesion location, parallel treatment, or smoking on the risk for reintervention could not be observed. CONCLUSION The study identifies clear facts that significantly increase the risk of revision surgery. These facts can be easily obtained preoperatively and may be taken into consideration when indicating ACI.
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Affiliation(s)
- Pia M Jungmann
- Department of Orthopedic Surgery and Traumatology, Freiburg University Hospital, Freiburg, Germany.
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