1
|
Ather S, Naeem A, Teh J. Imaging Response to Treatment in Rheumatology. Radiol Clin North Am 2024; 62:877-888. [PMID: 39059978 DOI: 10.1016/j.rcl.2024.02.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/28/2024]
Abstract
This article highlights the crucial role of various imaging techniques in the diagnosis and monitoring of rheumatologic diseases. It provides an overview of the different modalities available for imaging rheumatic diseases, the disease processes they are able to demonstrate, and their utility in the monitoring response to therapy. It emphasizes the need for a multifaceted approach that combines radiography, ultrasound, MR imaging, and PET imaging to gain a comprehensive understanding of disease progression and treatment response. Standardized grading systems along with quantitative imaging techniques are playing an increasing role in monitoring disease activity and assessing response to therapy.
Collapse
Affiliation(s)
- Sarim Ather
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK.
| | - Adil Naeem
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| | - James Teh
- Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Oxford, UK
| |
Collapse
|
2
|
Luo Q, Zhang S, Yang Q, Deng Y, Yi H, Li X. Causal factors for osteoarthritis risk revealed by mendelian randomization analysis. Aging Clin Exp Res 2024; 36:176. [PMID: 39172202 PMCID: PMC11341639 DOI: 10.1007/s40520-024-02812-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2024] [Accepted: 07/15/2024] [Indexed: 08/23/2024]
Abstract
Osteoarthritis (OA), a prevalent chronic disease among the elderly, presents a complex pathogenesis and currently lacks effective treatment. Traditional observational studies are time-consuming, labor-intensive, susceptible to confounding factors, and cannot establish causal relationships. Mendelian randomization (MR) analysis, leveraging genetic variation to assess causal associations between exposures and outcomes, offers a cost-effective and efficient alternative. Over the past decade, large-scale genome-wide association studies have identified numerous genetic variants linked to OA risk factors, facilitating MR study design. In this review, we systematically identified 52 MR studies meeting specific criteria and evaluated their quality, exploring the impact of lifestyle, nutrition, comorbidities, circulating metabolites, plasma proteins, and other health factors on OA risk. We discuss the results and potential mechanisms of MR findings, addressing conflicting evidence based on existing literature and our prior research. With the ongoing expansion of genome-wide association data, we anticipate MR's role in future OA studies to broaden, particularly in drug development research using targeted MR approaches. We thus aim for this paper to offer valuable insights for researchers and clinicians in related fields.
Collapse
Affiliation(s)
- Qingfeng Luo
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Shiyong Zhang
- Department of Joint Surgery, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, 510080, Guangdong, China
| | - Qiyuan Yang
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Yuyi Deng
- State Key Laboratory of Ultrasound in Medicine and Engineering, Chongqing Medical University, Chongqing, 400016, China
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Hengjing Yi
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China
| | - Xingsheng Li
- Chongqing Key Laboratory of Ultrasound Molecular Imaging, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
- Department of Geriatrics, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, 400010, China.
| |
Collapse
|
3
|
González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
Collapse
Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
| |
Collapse
|
4
|
Wu T, Wang C, Li K. Quantitative analysis and stochastic modeling of osteophyte formation and growth process on human vertebrae based on radiographs: a follow-up study. Sci Rep 2024; 14:9393. [PMID: 38658644 PMCID: PMC11043460 DOI: 10.1038/s41598-024-60212-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 04/19/2024] [Indexed: 04/26/2024] Open
Abstract
Osteophytes are frequently observed in elderly people and most commonly appear at the anterior edge of the cervical and lumbar vertebrae body. The anterior osteophytes keep developing and will lead to neck/back pain over time. In clinical practice, the accurate measurement of the anterior osteophyte length and the understanding of the temporal progression of anterior osteophyte growth are of vital importance to clinicians for effective treatment planning. This study proposes a new measuring method using the osteophyte ratio index to quantify anterior osteophyte length based on lateral radiographs. Moreover, we develop a continuous stochastic degradation model with time-related functions to characterize the anterior osteophyte formation and growth process on cervical and lumbar vertebrae over time. Follow-up data of anterior osteophytes up to 9 years are obtained for measurement and model validation. The agreement test indicates excellent reproducibility for our measuring method. The proposed model accurately fits the osteophyte growth paths. The model predicts the mean time to onset of pain and obtained survival function of the degenerative vertebrae. This research opens the door to future quantification and mathematical modeling of the anterior osteophyte growth on human cervical and lumbar vertebrae. The measured follow-up data is shared for future studies.
Collapse
Affiliation(s)
- Tong Wu
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China
| | - Changxi Wang
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, 610207, China.
| | - Kang Li
- West China Biomedical Big Data Center, West China Hospital, Sichuan University, Chengdu, 610041, China.
- Orthopedics Department of West China Hospital, Sichuan University, Chengdu, 610041, China.
- Sichuan University - Pittsburgh Institute, Sichuan University, Chengdu, 610207, China.
| |
Collapse
|
5
|
Li B, Guo Z, Qu J, Zhan Y, Shen Z, Lei X. The value of different involvement patterns of the knee "synovio-entheseal complex" in the differential diagnosis of spondyloarthritis, rheumatoid arthritis, and osteoarthritis: an MRI-based study. Eur Radiol 2023; 33:3178-3187. [PMID: 36892646 DOI: 10.1007/s00330-023-09485-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 12/25/2022] [Accepted: 01/25/2023] [Indexed: 03/10/2023]
Abstract
OBJECTIVES To explore the different involvement patterns of the knee "synovio-entheseal complex (SEC)" on MRI in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA). METHODS This study retrospectively included 120 patients (male:female, 55:65) with a mean age of 39.20 years diagnosed with SPA (n = 40), RA (n = 40), and OA (n = 40) at the First Central Hospital of Tianjin between January 2020 and May 2022. Six knee entheses were assessed by two musculoskeletal radiologists according to the SEC definition. Bone marrow lesions associated with entheses include bone marrow edema (BME) and bone erosion (BE), which were classified as entheseal or peri-entheseal based on their relationship to the entheses. Three groups (OA, RA, and SPA) were established to characterize the location of enthesitis and the different SEC involvement patterns. Inter-group and intra-group differences were analyzed using the ANOVA or chi-square tests, and the inter-class correlation coefficient (ICC) test was used to determine inter-reader agreement. RESULTS The study contained a total of 720 entheses. The SEC-based analysis revealed different involvement patterns in three groups. The OA group had the most abnormal signals in tendons/ligaments (p = 0.002). The RA group had considerably greater synovitis (p = 0.002). The majority of peri-entheseal BE was identified in the OA and RA groups (p = 0.003). Furthermore, entheseal BME in the SPA group was significantly different from those in the other two groups (p < 0.001). CONCLUSIONS SEC involvement patterns differed in SPA, RA, and OA, which is important for differential diagnosis. SEC should be used as a whole evaluation method in clinical practice. KEY POINTS • The "synovio-entheseal complex (SEC)" explained differences and characteristic alterations in the knee joint in patients with spondyloarthritis (SPA), rheumatoid arthritis (RA), and osteoarthritis (OA). • The various SEC involvement patterns are crucial for differentiating SPA, RA, and OA. • When "knee pain" is the only symptom, a detailed identification of characteristic alterations in the knee joint of SPA patients may help timely treatment and delay the structural damage.
Collapse
Affiliation(s)
- Boya Li
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Zikang Guo
- First Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Jin Qu
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Ying Zhan
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China
| | - Zhiwei Shen
- Clinical Science, Philips Healthcare, Beijing, China
| | - Xinwei Lei
- Department of Radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, Tianjin, China. .,Department of radiology, Tianjin First Central Hospital, Tianjin Institute of Imaging Medicine, NO. 24 Fukang Road, Nankai District, Tianjin, 300192, China.
| |
Collapse
|
6
|
Jadzic J, Zagorac S, Djuric M, Djonic D. Hip structure analysis and femoral osteodensitometry in aged postmenopausal women with hip osteoarthritis and femoral neck fracture. INTERNATIONAL ORTHOPAEDICS 2022; 46:2747-2755. [PMID: 36222881 DOI: 10.1007/s00264-022-05602-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2022] [Accepted: 09/28/2022] [Indexed: 11/07/2022]
Abstract
PURPOSE Osteoarthritis (OA), osteoporosis, and bone fractures are frequent aging-related conditions. Regardless of the growing research interest in the effects of hip OA on femoral fracture risk, data about the region specificity of osteodensitometric and hip structure analysis (HSA) parameters of the proximal femora are lacking in aged postmenopausal women with hip OA compared to individuals with femoral neck fragility fracture. METHODS This study included 76 postmenopausal women admitted for total hip arthroplasty due to non-traumatic femoral neck fracture (FN_Fx group, n = 39) and hip osteoarthritis (OA group, n = 37). RESULTS Osteodensitometric parameters differed significantly between the OA and FN_Fx groups, depicting lower bone mineral density in the FN_Fx group (p < 0.05). The most significant increase in these parameters was registered in the intertrochanteric region of the OA group. Moreover, the OA-induced changes in HSA-derived parameters displayed significant regional heterogeneity, with the intertrochanteric region showing the most notable difference between OA and FN_Fx group. CONCLUSION Our data may indicate that OA displayed the most prominent positive effect on the intertrochanteric femoral region, revealing the regional heterogeneity in structural geometry and biomechanical indices of proximal femora in OA individuals. Since we did not observe significant differences in the femoral neck region, we may speculate that OA does not have a substantial protective effect on the femoral neck fracture risk in aged postmenopausal women.
Collapse
Affiliation(s)
- Jelena Jadzic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Slavisa Zagorac
- University Clinic for Orthopedic Surgery and Traumatology, University Clinical Centre of Serbia, Belgrade, Serbia
| | - Marija Djuric
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr Subotica no. 4/II, 11000, Belgrade, Serbia
| | - Danijela Djonic
- Center of Bone Biology, Faculty of Medicine, University of Belgrade, Dr Subotica no. 4/II, 11000, Belgrade, Serbia.
| |
Collapse
|
7
|
Abstract
The Austin friars in Cambridge was an important religious institution between the late thirteenth and mid-sixteenth centuries. Excavations have revealed well-dated and contextualised burials associated with the friary, as well as a range of material culture. The burials have been subject to a wide range of analyses including osteology, palaeopathology, stable isotopes, ancient DNA and geometric morphometrics. Significantly the distinction between clothed and shrouded burials allows members of the Augustinian order and the laity to be identified. This represents the best-understood published group of burials from an Austin friars in the British Isles and emphasises the importance of nuanced interpretation, as burial at friaries was a structured and multi-local phenomenon. These burials and other material can be interpreted in terms of both mendicant ideals and anti-fraternal criticisms.
Collapse
Affiliation(s)
- Craig Cessford
- Cambridge Archaeological Unit, University of Cambridge, Cambridge, UK
| | - Benjamin Neil
- Cambridge Archaeological Unit, University of Cambridge, Cambridge, UK
| |
Collapse
|
8
|
Zucker BE, Ebsim R, Lindner C, Hardcastle S, Cootes T, Tobias JH, Whitehouse MR, Gregson CL, Faber BG, Hartley AE. High bone mass and cam morphology are independently related to hip osteoarthritis: findings from the High Bone Mass cohort. BMC Musculoskelet Disord 2022; 23:757. [PMID: 35933372 PMCID: PMC9356486 DOI: 10.1186/s12891-022-05603-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 06/22/2022] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND High bone mass (HBM, BMD Z-score ≥ + 3.2) and cam morphology (bulging of lateral femoral head) are associated with greater odds of prevalent radiographic hip osteoarthritis (rHOA). As cam morphology is itself a manifestation of increased bone deposition around the femoral head, it is conceivable that cam morphology may mediate the relationship between HBM and rHOA. We therefore aimed to determine if individuals with HBM have increased odds of prevalent cam morphology. In addition, we investigated whether the relationship between cam and prevalent and incident osteoarthritis was preserved in a HBM population. METHODS In the HBM study, a UK based cohort of adults with unexplained HBM and their relatives and spouses (controls), we determined the presence of cam morphology using semi-automatic methods of alpha angle derivation from pelvic radiographs. Associations between HBM status and presence of cam morphology, and between cam morphology and presence of rHOA (or its subphenotypes: osteophytes, joint space narrowing, cysts, and subchondral sclerosis) were determined using multivariable logistic regression, adjusting for age, sex, height, weight, and adolescent physical activity levels. The association between cam at baseline and incidence of rHOA after an average of 8 years was determined. Generalised estimating equations accounted for individual-level clustering. RESULTS The study included 352 individuals, of whom 235 (66.7%) were female and 234 (66.5%) had HBM. Included individuals contributed 694 hips, of which 143 had a cam deformity (20.6%). There was no evidence of an association between HBM and cam morphology (OR = 0.97 [95% CI: 0.63-1.51], p = 0.90) but a strong relationship was observed between cam morphology and rHOA (OR = 3.96 [2.63-5.98], p = 5.46 × 10-11) and rHOA subphenotypes joint space narrowing (OR = 3.70 [2.48-5.54], p = 1.76 × 10-10), subchondral sclerosis (OR = 3.28 [1.60-6.60], p = 9.57 × 10-4) and osteophytes (OR = 3.01 [1.87-4.87], p = 6.37 × 10-6). Cam morphology was not associated with incident osteoarthritis (OR = 0.76 [0.16-3.49], p = 0.72). CONCLUSIONS The relationship between cam morphology and rHOA seen in other studies is preserved in a HBM population. This study suggests that the risk of OA conferred by high BMD and by cam morphology are mediated via distinct pathways.
Collapse
Affiliation(s)
- B. E. Zucker
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
| | - R. Ebsim
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - C. Lindner
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - S. Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
| | - T. Cootes
- Division of Informatics, Imaging and Data Sciences, The University of Manchester, Manchester, UK
| | - J. H. Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - M. R. Whitehouse
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- National Institute for Health Research Bristol Biomedical Research Centre, University Hospitals Bristol and Weston NHS Foundation Trust and University of Bristol, Bristol, UK
| | - C. L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
| | - B. G. Faber
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| | - A. E. Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, l, Learning and Research Building, Level 1, Southmead Hospita, Bristol, BS10 5NB UK
- MRC Integrative Epidemiology Unit (IEU), Bristol Medical School, University of Bristol, Oakfield House, Oakfield Grove, Bristol, BS8 2BN UK
| |
Collapse
|
9
|
Wei Z, Li F, Pi G. Association Between Gut Microbiota and Osteoarthritis: A Review of Evidence for Potential Mechanisms and Therapeutics. Front Cell Infect Microbiol 2022; 12:812596. [PMID: 35372125 PMCID: PMC8966131 DOI: 10.3389/fcimb.2022.812596] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Accepted: 02/24/2022] [Indexed: 12/12/2022] Open
Abstract
Osteoarthritis (OA) is a multifactorial joint disease characterized by degeneration of articular cartilage, which leads to joints pain, disability and reduced quality of life in patients with OA. Interpreting the potential mechanisms underlying OA pathogenesis is crucial to the development of new disease modifying treatments. Although multiple factors contribute to the initiation and progression of OA, gut microbiota has gradually been regarded as an important pathogenic factor in the development of OA. Gut microbiota can be regarded as a multifunctional “organ”, closely related to a series of immune, metabolic and neurological functions. This review summarized research evidences supporting the correlation between gut microbiota and OA, and interpreted the potential mechanisms underlying the correlation from four aspects: immune system, metabolism, gut-brain axis and gut microbiota modulation. Future research should focus on whether there are specific gut microbiota composition or even specific pathogens and the corresponding signaling pathways that contribute to the initiation and progression of OA, and validate the potential of targeting gut microbiota for the treatment of patients with OA.
Collapse
Affiliation(s)
| | - Feng Li
- *Correspondence: Feng Li, ; Guofu Pi,
| | - Guofu Pi
- *Correspondence: Feng Li, ; Guofu Pi,
| |
Collapse
|
10
|
Fang F, Sup M, Luzzi A, Ferrer X, Thomopoulos S. Hedgehog signaling underlying tendon and enthesis development and pathology. Matrix Biol 2022; 105:87-103. [PMID: 34954379 PMCID: PMC8821161 DOI: 10.1016/j.matbio.2021.12.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Revised: 12/18/2021] [Accepted: 12/19/2021] [Indexed: 02/08/2023]
Abstract
Hedgehog (Hh) signaling has been widely acknowledged to play essential roles in many developmental processes, including endochondral ossification and growth plate maintenance. Furthermore, a rising number of studies have shown that Hh signaling is necessary for tendon enthesis development. Specifically, the well-tuned regulation of Hh signaling during development drives the formation of a mineral gradient across the tendon enthesis fibrocartilage. However, aberrant Hh signaling can also lead to pathologic heterotopic ossification in tendon or osteophyte formation at the enthesis. Therefore, the therapeutic potential of Hh signaling modulation for treating tendon and enthesis diseases remains uncertain. For example, increased Hh signaling may enhance tendon-to-bone healing by promoting the formation of mineralized fibrocartilage at the healing interface, but pathologic heterotopic ossification may also be triggered in the adjacent tendon. Further work is needed to elucidate the distinct functions of Hh signaling in the tendon and enthesis to support the development of therapies that target the pathway.
Collapse
Affiliation(s)
- Fei Fang
- Department of Orthopedic Surgery, Columbia University, Black Building, Room 1408, 650W 168 ST, New York, NY 10032-3702, United States
| | - McKenzie Sup
- Department of Biomedical Engineering, Columbia University, New York, NY, United States
| | - Andrew Luzzi
- Department of Orthopedic Surgery, Columbia University, Black Building, Room 1408, 650W 168 ST, New York, NY 10032-3702, United States
| | - Xavier Ferrer
- Department of Orthopedic Surgery, Columbia University, Black Building, Room 1408, 650W 168 ST, New York, NY 10032-3702, United States
| | - Stavros Thomopoulos
- Department of Orthopedic Surgery, Columbia University, Black Building, Room 1408, 650W 168 ST, New York, NY 10032-3702, United States; Department of Biomedical Engineering, Columbia University, New York, NY, United States.
| |
Collapse
|
11
|
Lin L, Luo P, Yang M, Wang J, Hou W, Xu P. Causal relationship between osteoporosis and osteoarthritis: A two-sample Mendelian randomized study. Front Endocrinol (Lausanne) 2022; 13:1011246. [PMID: 36339427 PMCID: PMC9633945 DOI: 10.3389/fendo.2022.1011246] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Accepted: 10/11/2022] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION At present, clinical studies have confirmed that osteoporosis (OP) has an inverse relationship with osteoarthritis (OA), but it has not been proven from the point of view of genetics, so our study hopes to clarify the potential effect of OP on OA at the level of gene prediction through two-sample Mendelian randomization (MR) analysis. METHODS A two-sample MR was adopted to research the causal relationship of OP with OA (including total OA, knee OA and hip OA). All data come from a public shared database. Such traditional methods as simple and weighted models, inverse variance weighted, weighted median, and Mendelian Randomization (MR-Egger) regression were employed to assess the causal effect of OP on OA. We used the Pleiotrophy RESidual Sum and Outlier (MR-PRESSO) method and MR-Egger method to study sensitivity. The leave-one-out test is used to determine the influence of outliers. The heterogeneity was calculated by using Cochran Q statistics and MR-Egger regression in the inverse variance-weighted (IVW) method. P > 0.05 indicates that there is a large heterogeneity. MR-Robust Adjustment Profile Score (RAPS) is stable to both systematic and specific multiplicity, so we used MR-RAPS as a supplementary method to verify the results of IVW. RESULTS According to the results of IVW, we found that there was a causal relationship between OP and total OA, and OP reduced the incidence of total OA (beta=-0.285, OR=0.751, P value< 0.016). The MR estimation of the causal effect of OP on knee OA suggested that the genetic prediction of OP was negatively correlated with knee osteoarthritis (KOA) (IVW: beta=-6.11, OR=0.002, P value< 0.016). The IVW results suggested that OP was causally related to hip OA, and OP had a protective effect on hip OA (beta=-5.48, OR=4.15e-3, P value= 3.99e-3). Except for heterogeneity in the analysis of OP and knee OA, there was no horizontal pleiotropy or heterogeneity in the other analyses. CONCLUSION We explored the causal relationship between OP and OA through a two-sample MR analysis and found that OP can reduce the incidence of OA (including knee OA and hip OA).
Collapse
|
12
|
Jensen R, Christensen AF, Hartlev LB, Thomsen JS, Boel L, Laursen M, Revald PH, Varnum C, Keller KK, Hauge EM. Calcified cartilage differs in patients with end-stage primary osteoarthritis and secondary osteoarthritis due to rheumatoid arthritis of the hip joint. Scand J Rheumatol 2021; 51:441-451. [PMID: 34514946 DOI: 10.1080/03009742.2021.1952754] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Objectives: Despite distinct aetiologies, the end-stages of primary osteoarthritis (OA) and secondary OA are described by common radiological features. However, the morphology of the bone-cartilage unit may differ depending on the pathogenesis. In this cross-sectional study, we aimed to investigate the histological differences in the bone-cartilage unit of the femoral head between patients with primary OA and secondary OA due to rheumatoid arthritis (RA).Method: Femoral heads were obtained from 12 patients with primary OA, six patients with secondary OA due to RA, and 12 control subjects. The femoral heads were investigated using stereological methods to ensure unbiased quantification.Results: The volume (mean difference [95% confidence interval]) (2.1 [0.5;3.8] cm3, p = 0.016) and thickness (413 [78.9;747] µm, p = 0.029) of the articular cartilage and the thickness of the calcified cartilage (56.4 [0.4;113] µm, p = 0.017) were larger in patients with primary OA than in patients with secondary OA due to RA. Femoral head volume (1.2 [-3.6;6.1] cm3, p = 0.598), bone volume fraction (-1.1 [-2.8;5.1] cm3, p = 0.553), subchondral bone thickness (-2.5 [-212;207] µm, p = 0.980), and osteophyte area (25.3 [-53.6;104] cm2, p = 0.506) did not differ between patients.Conclusion: The thicker calcified cartilage in primary OA preceding the loss of articular cartilage can be attributed to endochondral ossification. Patients with secondary OA due to RA had severely thinner calcified cartilage as the pathogenesis is driven by inflammation and is characterized by a generalized and more severe loss of articular cartilage.
Collapse
Affiliation(s)
- R Jensen
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - A F Christensen
- Department of Internal Medicine, Lillebaelt Hospital, Vejle, Denmark
| | - L B Hartlev
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Randers Regional Hospital, Randers, Denmark
| | - J S Thomsen
- Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Lwt Boel
- Institute of Forensic Medicine, Aarhus University, Aarhus, Denmark
| | - M Laursen
- Orthopaedic Surgery Research Unit, Aalborg University Hospital, Aalborg, Denmark
| | - P H Revald
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - C Varnum
- Department of Orthopaedic Surgery, Lillebaelt Hospital, Vejle, Denmark
| | - K K Keller
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - E-M Hauge
- Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| |
Collapse
|
13
|
Rosinsky PJ, Yelton MJ, Ankem HK, Meghpara MB, Maldonado DR, Shapira J, Yelton BR, Lall AC, Domb BG. Pertrochanteric Calcifications in Patients With Greater Trochanteric Pain Syndrome: Description, Prevalence, and Correlation With Intraoperatively Diagnosed Hip Abductor Tendon Injuries. Am J Sports Med 2021; 49:1759-1768. [PMID: 33956532 DOI: 10.1177/03635465211008104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pertrochanteric calcifications can be found in patients with greater trochanteric pain syndrome (GTPS). A systematic description of the types and prevalence of these calcifications has not been undertaken. Furthermore, there is conflicting evidence regarding their association with abductor tendon injuries. PURPOSE (1) To describe the various types and prevalence of pertrochanteric calcifications in patients presenting for the surgical management of recalcitrant GTPS. (2) To evaluate the association of the various calcifications with intraoperatively diagnosed hip abductor tendon injuries, including tendinosis, partial-thickness tears, and full-thickness tears. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Patients undergoing surgical management for GTPS, in isolation or as an ancillary procedure during hip arthroscopy for femoroacetabular impingement, between April 2008 and February 2020 were included. Of these, 85 procedures were isolated treatment of GTPS and the remaining 628 were ancillary to hip arthroscopy. Radiographs were scrutinized for the presence of pertrochanteric calcifications. The hip abductor tendon status was intraoperatively classified as intact, partial-thickness tear, or full-thickness tear. The prevalence and correlation of the various radiographic findings in relation to the intraoperatively classified tendon condition were analyzed via the odds ratio (OR). RESULTS Surgery was performed on 713 hips with recalcitrant GTPS. No tear was found in 340 hips (47.7%), 289 hips (40.5%) had a partial-thickness tear, and 84 hips (11.8%) had a full-thickness tear. Radiographically, 102 hips (14.3%) demonstrated proximally directed enthesophytes, and 34 (4.8%) had distally directed enthesophytes. In addition, 75 hips (10.5%) had amorphous calcifications, 47 (6.6%) had isolated ossicles, and 110 (15.4%) had surface irregularities. The presence of any calcification was associated with partial-thickness tears (OR, 1.67 [95% CI, 1.21-2.21]; P = .002) and full-thickness tears (OR, 6.40 [95% CI, 3.91-10.47]; P < .001). Distally directed enthesophytes (OR, 10.18 [95% CI, 3.08-33.63]; P < .001) and proximally directed enthesophytes (OR, 8.69 [95% CI, 4.66-16.21]; P < .001) were the findings with the highest OR for the presence of any type of tear. Distally directed enthesophytes were the findings with the highest OR for a full-thickness tear (OR, 15.79 [95% CI, 7.55-33.06]; P < .001). Isolated ossicles were the findings with the highest OR for a partial-thickness tear (OR, 1.73 [95% CI, 0.96-3.13]; P = .070). CONCLUSION Pertrochanteric calcifications were common radiographic findings in patients with GTPS and can help guide management in these patients. Proximally and distally directed enthesophytes were strong predictors for the presence of a hip abductor tendon tear, and specifically a full-thickness tear, and increasing size of the findings was associated with more severe tendon injuries.
Collapse
Affiliation(s)
| | | | - Hari K Ankem
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Mitchell B Meghpara
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA
| | | | - Jacob Shapira
- American Hip Institute Research Foundation, Chicago, Illinois, USA
| | - Brent R Yelton
- Oakland University William Beaumont School of Medicine, Auburn Hills, Michigan, USA
| | - Ajay C Lall
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| | - Benjamin G Domb
- American Hip Institute Research Foundation, Chicago, Illinois, USA.,AMITA Health St Alexius Medical Center, Hoffman Estates, Illinois, USA.,American Hip Institute, Chicago, Illinois, USA
| |
Collapse
|
14
|
Mascarenhas S, Couette N. A Systematic Review of the Inclusion of Non-Inflammatory Ultrasonographic Enthesopathy Findings in Enthesitis Scoring Indices. Diagnostics (Basel) 2021; 11:diagnostics11040669. [PMID: 33917826 PMCID: PMC8068272 DOI: 10.3390/diagnostics11040669] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/21/2021] [Accepted: 03/25/2021] [Indexed: 11/16/2022] Open
Abstract
Ultrasound has advanced the diagnosis and management of patients with inflammatory rheumatic conditions. It can be used to identify and monitor enthesitis, a cardinal feature of spondyloarthropthies. Several enthesitis scoring systems utilizing ultrasound to determine entheseal involvement have been developed. These scoring systems generally rely on determining the presence or absence of erosions, tendon enlargement, power Doppler signal, or enthesophytes. This systematic review identified ultrasound scoring systems that have been utilized for evaluating enthesitis and what key components derive the score. Review of these scoring systems, however, demonstrated confounding as some of the score components including enthesophytes may be seen in non-inflammatory conditions and some components including erosions can be seen from chronic damage, but not necessarily indicate active inflammatory disease. What is furthermore limiting is that currently there is not an agreed upon term to describe non-inflammatory enthesopathies, further complicating these scoring systems. This review highlights the need for a more comprehensive ultrasound enthesopathy scoring index.
Collapse
|
15
|
Hartley A, Gregson CL, Paternoster L, Tobias JH. Osteoarthritis: Insights Offered by the Study of Bone Mass Genetics. Curr Osteoporos Rep 2021; 19:115-122. [PMID: 33538965 PMCID: PMC8016765 DOI: 10.1007/s11914-021-00655-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/19/2021] [Indexed: 11/21/2022]
Abstract
PURPOSE OF REVIEW This paper reviews how bone genetics has contributed to our understanding of the pathogenesis of osteoarthritis. As well as identifying specific genetic mechanisms involved in osteoporosis which also contribute to osteoarthritis, we review whether bone mineral density (BMD) plays a causal role in OA development. RECENT FINDINGS We examined whether those genetically predisposed to elevated BMD are at increased risk of developing OA, using our high bone mass (HBM) cohort. HBM individuals were found to have a greater prevalence of OA compared with family controls and greater development of radiographic features of OA over 8 years, with predominantly osteophytic OA. Initial Mendelian randomisation analysis provided additional support for a causal effect of increased BMD on increased OA risk. In contrast, more recent investigation estimates this relationship to be bi-directional. However, both these findings could be explained instead by shared biological pathways. Pathways which contribute to BMD appear to play an important role in OA development, likely reflecting shared common mechanisms as opposed to a causal effect of raised BMD on OA. Studies in HBM individuals suggest this reflects an important role of mechanisms involved in bone formation in OA development; however further work is required to establish whether the same applies to more common forms of OA within the general population.
Collapse
Affiliation(s)
- A Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrated Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
- MRC Integrated Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - L Paternoster
- MRC Integrated Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
- MRC Integrated Epidemiology Unit, Bristol Medical School, University of Bristol, Bristol, UK.
| |
Collapse
|
16
|
Porrino J, Sunku P, Wang A, Haims A, Richardson ML. Exophytic External Occipital Protuberance Prevalence Pre- and Post-iPhone Introduction: A Retrospective Cohort. THE YALE JOURNAL OF BIOLOGY AND MEDICINE 2021; 94:65-71. [PMID: 33795983 PMCID: PMC7995952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Abstract
Introduction: In controversial fashion, the presence of an enlarged external occipital protuberance has been recently linked to excessive use of handheld electronic devices. We sought to determine the prevalence of this protuberance in a diverse age group of adults from two separate time periods, before and approximately 10 years after the release of the iPhone, to further characterize this theory, as if indeed valid, such a relationship could direct preventative behavior. Materials and Methods: Eighty-two cervical spine radiographs between March 7, 2007 through June 29, 2007 and 147 cervical spine radiographs between October 25, 2017 through January 1, 2018 were reviewed for the presence or absence of an exophytic external occipital protuberance. Influence of sex and age were also assessed. Results: There were 41/82 (50%) patients within the 2007 pre-iPhone group with an exophytic external occipital protuberance, ranging from 2.7-33.8 mm in length. Twenty-seven out of 82 (32.9%) had an external occipital protuberance at or above 10 mm. There were 49/147 (33.3%) patients within the 2017 post-iPhone group with an exophytic external occipital protuberance, ranging from 4.4-53.8 mm in length. Thirty-three out of 147 (22.4%) had an external occipital protuberance at or above 10 mm. When considering accessibility to the iPhone, sex, and age to the presence of an exophytic external occipital protuberance, only sex has a statistically significant association, p=0.000000033. Conclusion: We found no significant association with iPhone accessibility and an exophytic external occipital protuberance. Due to inherent limitations in the retrospective nature of the study, future research is needed to better examine the association of handheld electronic devices with exophytic external occipital protuberances.
Collapse
Affiliation(s)
- Jack Porrino
- Yale Radiology and Biomedical Imaging, Yale University,
New Haven, CT, USA,To whom all correspondence should be addressed:
Jack Porrino, MD, Yale Radiology and Biomedical Imaging, 330 Cedar Street, New
Haven, CT, 06520; Tel: 203-785-2385, Fax: 203-785-3024,
| | - Pranay Sunku
- Yale Radiology and Biomedical Imaging, Yale University,
New Haven, CT, USA
| | - Annie Wang
- Yale Radiology and Biomedical Imaging, Yale University,
New Haven, CT, USA
| | - Andrew Haims
- Yale Radiology and Biomedical Imaging, Yale University,
New Haven, CT, USA
| | | |
Collapse
|
17
|
Scott ME, Dust WN, Cooper DML, Walker EG, Lieverse AR. The physiopathology of osteoarthritis: Paleopathological implications of non-articular lesions from a modern surgical sample. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2021; 32:31-40. [PMID: 33276205 DOI: 10.1016/j.ijpp.2020.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Revised: 11/02/2020] [Accepted: 11/17/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVES This research focused on osteoarthritis (OA) lesions on modern patients to 1) identify consistently observed lesions not included within current paleopathological measures of OA, 2) assess the correspondence of bone and cartilage lesions with clinical OA diagnostic criteria, and 3) discuss the correspondence of bone lesions with sources of pain reported in clinical literature. MATERIALS Tibial plateaus from 62 patients undergoing total knee replacement surgery due to OA were examined. METHODS Plateaus were scored for several non-standard OA criteria, including non-articular and X-ray visible lesions and pre-maceration cartilage lesions, as well as articular surface criteria standard in paleopathology. RESULTS Proliferative bone in the intercondylar region was present in 95 % of specimens, while areas of dense trabecular bone and lytic defects, both on the inferior side of the plateaus, were present in 98 % and 83 %, respectively. CONCLUSIONS The inferior lytic defects may be physical evidence of bone marrow lesions (BML), a clinical OA indicator visible via MRI. Previous research has linked BML to pain, inflammation, and ligament pathology. The latter conditions have also been associated with intercondylar enthesophytes and third intercondylar tubercle of Parsons (TITP), both of which were observed in the intercondylar regions. SIGNIFICANCE Several non-articular lesions not currently included in paleopathological measures of OA were consistently observed. SUGGESTIONS FOR FUTURE RESEARCH A similar analysis of a control sample of non-OA tibial plateaus would better contextualize these results. LIMITATIONS The sample's high average age (65.8 years) and severe OA stage may hamper generalizability to archaeological collections.
Collapse
Affiliation(s)
- Maryann E Scott
- Department of Archaeology and Anthropology, University of Saskatchewan, 55 Campus Dr., Saskatoon, Saskatchewan, S7N 5B1, Canada.
| | - William N Dust
- Division of Orthopedics, Royal University Hospital, 103 Hospital Dr., Saskatoon, Saskatchewan, S7N 0W8, Canada
| | - David M L Cooper
- Department of Anatomy, Physiology and Pharmacology, University of Saskatchewan, GA20 Health Sciences Building, 107 Wiggins Rd., Saskatoon, Saskatchewan, S7N 5E5, Canada
| | - Ernest G Walker
- Department of Archaeology and Anthropology, University of Saskatchewan, 55 Campus Dr., Saskatoon, Saskatchewan, S7N 5B1, Canada
| | - Angela R Lieverse
- Department of Archaeology and Anthropology, University of Saskatchewan, 55 Campus Dr., Saskatoon, Saskatchewan, S7N 5B1, Canada
| |
Collapse
|
18
|
Hartley A, Hardcastle SA, Frysz M, Parkinson J, Paternoster L, McCloskey E, Poole KES, Javaid MK, Aye M, Moss K, Williams M, Tobias JH, Gregson CL. Increased development of radiographic hip osteoarthritis in individuals with high bone mass: a prospective cohort study. Arthritis Res Ther 2021; 23:4. [PMID: 33407835 PMCID: PMC7788917 DOI: 10.1186/s13075-020-02371-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 11/09/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Individuals with high bone mass (HBM) have a greater odds of prevalent radiographic hip osteoarthritis (OA), reflecting an association with bone-forming OA sub-phenotypes (e.g. osteophytosis, subchondral sclerosis). As the role of bone mineral density (BMD) in hip OA progression is unclear, we aimed to determine if individuals with HBM have increased incidence and/or progression of bone-forming OA sub-phenotypes. METHODS We analysed an adult cohort with and without HBM (L1 and/or total hip BMD Z-score > + 3.2) with pelvic radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Superior/inferior acetabular/femoral osteophyte and medial/superior joint space narrowing (JSN) grades were summed and Δosteophyte and ΔJSN derived. Pain and functional limitations were quantified using the WOMAC questionnaire. Associations between HBM status and change in OA sub-phenotypes were determined using multivariable linear/logistic regression, adjusting for age, sex, height, total body fat mass, follow-up time and baseline sub-phenotype grade. Generalised estimating equations accounted for individual-level clustering. RESULTS Of 136 individuals, 62% had HBM at baseline, 72% were female and mean (SD) age was 59 (10) years. HBM was positively associated with both Δosteophytes and ΔJSN (adjusted mean grade differences between individuals with and without HBM βosteophyte = 0.30 [0.01, 0.58], p = 0.019 and βJSN = 0.10 [0.01, 0.18], p = 0.019). Incident subchondral sclerosis was rare. HBM individuals had higher WOMAC hip functional limitation scores (β = 8.3 [0.7, 15.98], p = 0.032). CONCLUSIONS HBM is associated with the worsening of hip osteophytes and JSN over an average of 8 years, as well as increased hip pain and functional limitation.
Collapse
Affiliation(s)
- April Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK. .,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Sarah A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - Monika Frysz
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Jon Parkinson
- Division of Informatics, Imaging & Data Sciences, Faculty of Medical and Human Sciences, University of Manchester, Manchester, UK
| | - Lavinia Paternoster
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Eugene McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre For Bone Research, University of Sheffield, Sheffield, UK.,Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK.,Centre for Integrated Research into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
| | - Kenneth E S Poole
- Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge, UK
| | - Muhammad K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Mo Aye
- Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - Katie Moss
- Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK
| | - Martin Williams
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.,MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
19
|
Abstract
The phenotypic trait of high bone mass (HBM) is an excellent example of the nexus between common and rare disease genetics. HBM may arise from carriage of many 'high bone mineral density [BMD]'-associated alleles, and certainly the genetic architecture of individuals with HBM is enriched with high BMD variants identified through genome-wide association studies of BMD. HBM may also arise as a monogenic skeletal disorder, due to abnormalities in bone formation, bone resorption, and/or bone turnover. Individuals with monogenic disorders of HBM usually, though not invariably, have other skeletal abnormalities (such as mandible enlargement) and thus are best regarded as having a skeletal dysplasia rather than just isolated high BMD. A binary etiological division of HBM into polygenic vs. monogenic, however, would be excessively simplistic: the phenotype of individuals carrying rare variants of large effect can still be modified by their common variant polygenic background, and by the environment. HBM disorders-whether predominantly polygenic or monogenic in origin-are not only interesting clinically and genetically: they provide insights into bone processes that can be exploited therapeutically, with benefits both for individuals with these rare bone disorders and importantly for the many people affected by the commonest bone disease worldwide-i.e., osteoporosis. In this review we detail the genetic architecture of HBM; we provide a conceptual framework for considering HBM in the clinical context; and we discuss monogenic and polygenic causes of HBM with particular emphasis on anabolic causes of HBM.
Collapse
Affiliation(s)
- Celia L. Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, United Kingdom
| | - Emma L. Duncan
- Department of Twin Research & Genetic Epidemiology, School of Life Course Sciences, Faculty of Life Sciences and Medicine, King’s College London, London, United Kingdom
| |
Collapse
|
20
|
Hartley A, Hardcastle SA, Paternoster L, McCloskey E, Poole KES, Javaid MK, Aye M, Moss K, Granell R, Gregory J, Williams M, Tobias JH, Gregson CL. Individuals with high bone mass have increased progression of radiographic and clinical features of knee osteoarthritis. Osteoarthritis Cartilage 2020; 28:1180-1190. [PMID: 32417557 DOI: 10.1016/j.joca.2020.03.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Revised: 03/16/2020] [Accepted: 03/26/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE High bone mass (HBM) is associated with an increased prevalence of radiographic knee OA (kOA), characterized by osteophytosis. We aimed to determine if progression of radiographic kOA, and its sub-phenotypes, is increased in HBM and whether observed changes are clinically relevant. DESIGN A cohort with and without HBM (L1 and/or total hip bone mineral density Z-score≥+3.2) had knee radiographs collected at baseline and 8-year follow-up. Sub-phenotypes were graded using the OARSI atlas. Medial/lateral tibial/femoral osteophyte and medial/lateral joint space narrowing (JSN) grades were summed and Δosteophytes, ΔJSN derived. Pain, function and stiffness were quantified using the WOMAC questionnaire. Associations between HBM status and sub-phenotype progression were determined using multivariable linear/poisson regression, adjusting for age, sex, height, baseline sub-phenotype grade, menopause, education and total body fat mass (TBFM). Generalized estimating equations accounted for individual-level clustering. RESULTS 169 individuals had repeated radiographs, providing 330 knee images; 63% had HBM, 73% were female, mean (SD) age was 58 (12) years. Whilst HBM was not clearly associated with overall Kellgren-Lawrence measured progression (RR = 1.55 [0.56.4.32]), HBM was positively associated with both Δosteophytes and ΔJSN individually (adjusted mean differences between individuals with and without HBM 0.45 [0.01.0.89] and 0.15 [0.01.0.29], respectively). HBM individuals had higher WOMAC knee pain scores (β = 7.42 [1.17.13.66]), largely explained by adjustment for osteophyte score (58% attenuated) rather than JSN (30% attenuated) or TBFM (16% attenuated). The same pattern was observed for symptomatic stiffness and functional limitation. CONCLUSIONS HBM is associated with osteophyte progression, which appears to contribute to increased reported pain, stiffness and functional loss.
Collapse
Affiliation(s)
- A Hartley
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - S A Hardcastle
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; Royal National Hospital for Rheumatic Diseases, Royal United Hospitals Bath NHS Foundation Trust, Bath, UK
| | - L Paternoster
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - E McCloskey
- Academic Unit of Bone Metabolism, Department of Oncology and Metabolism, The Mellanby Centre for Bone Research, University of Sheffield, Sheffield, UK; Centre for Metabolic Diseases, University of Sheffield Medical School, Sheffield, UK; Centre for Integrated Research Into Musculoskeletal Ageing, University of Sheffield Medical School, Sheffield, UK
| | - K E S Poole
- Cambridge NIHR Biomedical Research Centre and the Wellcome Trust Clinical Research Facility, Cambridge
| | - M K Javaid
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Aye
- Department of Diabetes, Endocrinology and Metabolism, Hull and East Yorkshire Hospitals NHS Trust, Hull, UK
| | - K Moss
- Centre for Rheumatology, St George's Hospital, St George's Healthcare NHS Trust, London, UK
| | - R Granell
- MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - J Gregory
- Institute of Medical Science, School of Medicine, University of Aberdeen, Aberdeen, UK
| | - M Williams
- Department of Radiology, Southmead Hospital, North Bristol NHS Trust, Bristol UK
| | - J H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK; MRC Integrative Epidemiology Unit, Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - C L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| |
Collapse
|
21
|
Nevitt MC, Felson DT. High bone density and radiographic osteoarthritis: questions answered and unanswered. Osteoarthritis Cartilage 2020; 28:1151-1153. [PMID: 32417559 PMCID: PMC10411125 DOI: 10.1016/j.joca.2020.05.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 05/07/2020] [Indexed: 02/02/2023]
Affiliation(s)
- M C Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco, USA
| | - D T Felson
- Department of Rheumatology, Boston University School of Medicine, Boston, USA; University of Manchester Centre for Epidemiology, NIHR Manchester BRC, Manchester University NHS Trust, Manchester, UK.
| |
Collapse
|
22
|
Differential patterns of pathology in and interaction between joint tissues in long-term osteoarthritis with different initiating causes: phenotype matters. Osteoarthritis Cartilage 2020; 28:953-965. [PMID: 32360537 DOI: 10.1016/j.joca.2020.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Revised: 03/23/2020] [Accepted: 04/15/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine if osteoarthritis (OA) progression and joint tissue-pathology associations link specific animal models to different human OA phenotypes. DESIGN Male 11-week-old C57BL6 mice had unilateral medial-meniscal-destabilization (DMM) or antigen-induced-arthritis (AIA). Joint tissue histopathology was scored day-3 to week-16. Tissue-pathology associations (corrected for time and at week-16) were determined by partial correlation coefficients, and odds ratios (OR) calculated for likelihood of cartilage damage and joint inflammation by ordinal-logistic-regression. RESULTS Despite distinct temporal patterns of progression, by week-16 joint-wide OA pathology in DMM and AIA was equivalent. Significant pathology associations common to both models included: osteophyte size and maturity (r > 0.4); subchondral bone (SCB) sclerosis and osteophyte maturity (r > 0.25); cartilage erosion and chondrocyte hypertrophy/apoptosis (r > 0.4), SCB sclerosis (r > 0.26), osteophyte size (r > 0.3), and maturity (r > 0.32). DMM-specific associations were between cartilage proteoglycan loss and structural damage (r = 0.56), osteophyte maturity (r = 0.49), size (r = 0.45), and SCB sclerosis (r = 0.28). AIA-specific associations were between SCB sclerosis and chondrocyte hypertrophy/apoptosis (r = 0.40) and osteophyte size (r = 0.37); and synovitis with cartilage structural damage (r = 0.18). No tissue-pathology associations were common to both models at week-16. Increased likelihood of cartilage structural damage was associated with: chondrocyte hypertrophy/apoptosis (OR>1.7), and osteophyte size (OR>2.3) in both models; SCB sclerosis (OR = 2.0) and proteoglycan loss (OR = 2.4) in DMM; and synovitis (OR = 1.2) in AIA. Joint inflammation was associated positively with cartilage proteoglycan loss (OR = 1.4) and inversely with osteophyte size (OR = 0.21) in AIA only. CONCLUSION This study highlights the importance of defining OA-models by initiating mechanisms and progression, not just end-stage joint-tissue pathology.
Collapse
|
23
|
Venne G, Tse MY, Pang SC, Ellis RE. Mechanically-induced osteophyte in the rat knee. Osteoarthritis Cartilage 2020; 28:853-864. [PMID: 32147535 DOI: 10.1016/j.joca.2020.02.834] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2019] [Revised: 02/11/2020] [Accepted: 02/17/2020] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Osteophytes are common anatomical signs of advanced osteoarthritis. It remains unclear whether they develop from physio-molecular, and/or mechanical stimuli. This study examined the effects of mechanical impact on the knee joint periosteum leading to osteophyte formation. DESIGN Eighteen mature rats received one single impact load of 53 N (30 MPa) to the periosteum of the experimental medial femoral condyles. Contralateral knees were used as controls. Animals were sacrificed at 24 h, 3, 6 and 9 weeks post-impact. Distal femurs were harvested and prepared for histology. Hematoxylin and Eosin, and Masson's trichrome stained slides were examined by light microscopy. Nuclear density was quantified to assess the tissue reaction. RESULTS 24 h: The synovium membrane, fibrous and cambium periosteum were damaged. Blood infiltration pooled in the impacted medial collateral ligament (MCL) region. Week 3: A cartilaginous tissue spur, chondrophyte, was found in every rat at the impacted site of the MCL. Chondrophytes were composed of fibrocartilage and cartilage matrix, with signs of cartilage mineralization and remodelling activity. Week 6: Chondrophytes presented signs of more advanced mineralisation, recognized as osteophytes. Week 9: Osteophytes appeared to be more mineralized with almost no cartilage tissue. CONCLUSIONS Osteophytes can be induced with a single mechanical impact applied to the periosteum in rat knees. These data indicate that a moderate trauma to the periosteal layer of the joint may play a role in osteophyte development.
Collapse
Affiliation(s)
- G Venne
- Department of Anatomy and Cell Biology, McGill University, Montreal, QC, Canada; 3640, Rue University, Montréal, QC, H3A 0C7, Canada.
| | - M Y Tse
- Department Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - S C Pang
- Department Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
| | - R E Ellis
- Department Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada; Human Mobility Research Center, Kingston General Hospital, 76 Stuart Street, Kingston, ON, K7L 2V7, Canada; Department of Surgery, Queen's University, Kingston, ON, Canada; Kingston General Hospital, Kingston, ON, Canada; Department of Mechanical and Materials Engineering, Queen's University, Kingston, ON, Canada; School of Computing, Queen's University, Kingston, ON, Canada
| |
Collapse
|
24
|
Broitman S, Herman A, Stern M, Lidar M, Eshed I. Enthesopathy of the anterior chest wall joints in patients with diffuse idiopathic skeletal hyperostosis (DISH): a retrospective analysis of computed tomography scans. Skeletal Radiol 2020; 49:461-467. [PMID: 31501958 DOI: 10.1007/s00256-019-03307-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/22/2019] [Accepted: 08/27/2019] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate and characterize anterior chest wall (ACW) joint's enthesopathy on CT scans in patients with DISH compared with age- and gender-matched control group. MATERIAL AND METHODS Retrospective evaluation for enthesopathy features of ACW joints-sterno-clavicular (SCJ), manubrio-sternal (MSJ), costo-sternal 1-7 (CSJ)-on chest CT scans of subjects with DISH (Resnick criteria) and of age- and gender-matched control subjects was performed. 183 subjects (DISH: 92, control: 91); male:female: 126:57, average age: 71.7 years (range 50-94) were evaluated. Total enthesopathy scores per subjects and per each joint were compared. RESULTS Total enthesopathy score of ACW joints was significantly higher among DISH compared to controls (64.03 ± 15.1, 50.47 ± 12.4, p < 0.001). At joint level, SCJ and CSJ enthesopathy, but not MSJ was significantly more prevalent in DISH compared to controls. CONCLUSION ACW joints' enthesopathy as seen on CT scans, an entity not included in the Resnick classification criteria, is common among DISH subjects. The difference between SCJ and CSJ prevalence compared to MSJ may result from different joint type. ACW joints' enthesopathy may be considered to be included in future modified radiographic criteria for DISH.
Collapse
Affiliation(s)
- Shani Broitman
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel
| | - Amir Herman
- Department of Orthopedic Surgery, Assuta Ashdod Medical Center, Ashdod, affiliated to Ben Gurion University, Beer Sheva, Israel
| | - Myriam Stern
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel
| | - Merav Lidar
- Rheumatology Unit, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Iris Eshed
- Department of Diagnostic Imaging, Sheba Medical Center, affiliated to the Sackler Faculty of Medicine, Tel Aviv University, Tel Hashomer, 52621, Tel Aviv, Israel.
| |
Collapse
|
25
|
Funck-Brentano T, Nethander M, Movérare-Skrtic S, Richette P, Ohlsson C. Causal Factors for Knee, Hip, and Hand Osteoarthritis: A Mendelian Randomization Study in the UK Biobank. Arthritis Rheumatol 2019; 71:1634-1641. [PMID: 31099188 PMCID: PMC6790695 DOI: 10.1002/art.40928] [Citation(s) in RCA: 113] [Impact Index Per Article: 22.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2018] [Accepted: 05/09/2019] [Indexed: 12/27/2022]
Abstract
OBJECTIVE There is no curative treatment for osteoarthritis (OA), which is the most common form of arthritis. This study was undertaken to identify causal risk factors of knee, hip, and hand OA. METHODS Individual-level data from 384,838 unrelated participants in the UK Biobank study were analyzed. Mendelian randomization (MR) analyses were performed to test for causality for body mass index (BMI), bone mineral density (BMD), serum high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, and triglyceride levels, type 2 diabetes, systolic blood pressure (BP), and C-reactive protein (CRP) levels. The primary outcome measure was OA determined using hospital diagnoses (all sites, n = 48,431; knee, n = 19,727; hip, n = 11,875; hand, n = 2,330). Odds ratios (ORs) with 95% confidence intervals (95% CIs) were calculated. RESULTS MR analyses demonstrated a robust causal association of genetically determined BMI with all OA (OR per SD increase 1.57 [95% CI 1.44-1.71]), and with knee OA and hip OA, but not with hand OA. Increased genetically determined femoral neck BMD was causally associated with all OA (OR per SD increase 1.14 [95% CI 1.06-1.22]), knee OA, and hip OA. Low systolic BP was causally associated with all OA (OR per SD decrease 1.55 [95% CI 1.29-1.87]), knee OA, and hip OA. There was no evidence of causality for the other tested metabolic factors or CRP level. CONCLUSION Our findings indicate that BMI exerts a major causal effect on the risk of OA at weight-bearing joints, but not at the hand. Evidence of causality of all OA, knee OA, and hip OA was also observed for high femoral neck BMD and low systolic BP. However, we found no evidence of causality for other metabolic factors or CRP level.
Collapse
Affiliation(s)
| | | | | | - Pascal Richette
- AP-HP, Hospital Lariboisière, INSERM U1132, Université Paris Diderot, Université de Paris, Paris, France
| | | |
Collapse
|
26
|
Bone mineral density is increased in the cadmium-induced omphalocele chick model by using three-dimensional micro-computed tomography. Pediatr Surg Int 2019; 35:911-914. [PMID: 31203385 DOI: 10.1007/s00383-019-04501-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
PURPOSE The cadmium (Cd) chick model has been described as a reliable model of omphalocele. Skeletal anomalies, including lumber lordosis, can be seen in the Cd chick model, as well as in the human omphalocele. Bone deformations, such as lordosis, are associated with high bone mineral density (BMD). Recently, three-dimensional microcomputed tomography (3DMCT) has been used to investigate skeletal development in small animal embryos. We used 3DMCT to test the hypothesis that the BMD is increased in the Cd-induced omphalocele chick model. METHODS After a 60-h incubation, chicks were exposed to either chick saline or Cd in ovo. Chick embryos were harvested at embryonic day 16.5 (E16.5) and were divided into control (n = 8) and Cd (n = 9). Chicks were then scanned by 3DMCT. The body volume, bone volume, bone/body volume ratio, bone mineral quantity and BMD were analysed statistically (significance was accepted at p < 0.05). RESULTS Bone mineral density (mg/cm3) was significantly increased in the Cd group compared to control group (235.3 ± 11.7 vs 223.4 ± 4.6, p < 0.05), whereas there was no significant difference in the bone/body volume ratio between the Cd group and the control group (0.7 ± 0.1 vs 0.6 ± 0.0). The body volume (cm3) (0.3 ± 0.2 vs 0.3 ± 0.1), bone volume (cm3) (0.2 ± 0.2 vs 0.2 ± 0.1), and bone mineral quantity (mg) (51.3 ± 41.6 vs 41.5 ± 16.5) were not significantly different between the two groups. CONCLUSIONS Increased BMD may be associated with lordosis of the vertebral column in the Cd-induced omphalocele chick model, stimulating osteogenesis by activating the canonical Wnt signalling pathway.
Collapse
|
27
|
Braun J, Baraliakos X. Active and chronic sacroiliitis, spondylitis and enthesitis, How specific are imaging findings for axial spondyloarthritis? Rheumatology (Oxford) 2018; 58:1321-1324. [DOI: 10.1093/rheumatology/key372] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2018] [Indexed: 01/20/2023] Open
Affiliation(s)
- Juergen Braun
- Rheumazentrum Ruhrgebiet, Herne, and Ruhr University Bochum, Herne, Germany
| | - Xenofon Baraliakos
- Rheumazentrum Ruhrgebiet, Herne, and Ruhr University Bochum, Herne, Germany
| |
Collapse
|
28
|
Ezra D, Hershkovitz I, Salame K, Alperovitch-Najenson D, Slon V. Osteophytes in the Cervical Vertebral Bodies (C3-C7)-Demographical Perspectives. Anat Rec (Hoboken) 2018; 302:226-231. [PMID: 30290057 DOI: 10.1002/ar.23901] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2017] [Revised: 10/21/2017] [Accepted: 11/14/2017] [Indexed: 11/10/2022]
Abstract
Vertebral osteophytes are an age-dependent manifestation of degenerative changes in the spine. We aimed to determine the prevalence and severity of cervical osteophytosis in a large study population. To do so, we developed a grading system for osteophytosis, enabling the assessment of their presence and severity in the cervical spine, and applied it to the analysis of dried cervical vertebral bodies (C3-C7) from 273 individuals. Statistical analyses were carried out per motion segment, while testing for the effect of age, sex, and ethnicity. The highest prevalence of osteophytes was found in motion segment C5/C6 (48.2%), followed by C4/C5 (44.1%), and last C6/C7 and C3/C4 (40.5%). Severe osteophytes are most commonly seen in motion segment C5/C6. In all motion segments, the inferior discal surface of the upper vertebra manifests more osteophytes than the superior discal surface of the lower one. Osteophytes prevalence is sex-dependent only in the upper cervical vertebrae (C3-C4), and age- and ethnicity-dependent for all vertebrae. Anat Rec, 302:226-231, 2019. © 2018 Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- David Ezra
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,School of Nursing Sciences, Tel Aviv Yaffo Academic College, Tel Aviv, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel.,The Steinhardt Museum of Natural History and National Research Center, Tel Aviv University, Tel Aviv, Israel
| | - Khalil Salame
- Department of Neurosurgery, Tel Aviv Sourasky Medical Center, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Viviane Slon
- Department of Anatomy and Anthropology, Sackler Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| |
Collapse
|
29
|
Gregson CL, Newell F, Leo PJ, Clark GR, Paternoster L, Marshall M, Forgetta V, Morris JA, Ge B, Bao X, Duncan Bassett JH, Williams GR, Youlten SE, Croucher PI, Davey Smith G, Evans DM, Kemp JP, Brown MA, Tobias JH, Duncan EL. Genome-wide association study of extreme high bone mass: Contribution of common genetic variation to extreme BMD phenotypes and potential novel BMD-associated genes. Bone 2018; 114:62-71. [PMID: 29883787 PMCID: PMC6086337 DOI: 10.1016/j.bone.2018.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 05/13/2018] [Accepted: 06/02/2018] [Indexed: 12/29/2022]
Abstract
BACKGROUND Generalised high bone mass (HBM), associated with features of a mild skeletal dysplasia, has a prevalence of 0.18% in a UK DXA-scanned adult population. We hypothesized that the genetic component of extreme HBM includes contributions from common variants of small effect and rarer variants of large effect, both enriched in an extreme phenotype cohort. METHODS We performed a genome-wide association study (GWAS) of adults with either extreme high or low BMD. Adults included individuals with unexplained extreme HBM (n = 240) from the UK with BMD Z-scores ≥+3.2, high BMD females from the Anglo-Australasian Osteoporosis Genetics Consortium (AOGC) (n = 1055) with Z-scores +1.5 to +4.0 and low BMD females also part of AOGC (n = 900), with Z-scores -1.5 to -4.0. Following imputation, we tested association between 6,379,332 SNPs and total hip and lumbar spine BMD Z-scores. For potential target genes, we assessed expression in human osteoblasts and murine osteocytes. RESULTS We observed significant enrichment for associations with established BMD-associated loci, particularly those known to regulate endochondral ossification and Wnt signalling, suggesting that part of the genetic contribution to unexplained HBM is polygenic. Further, we identified associations exceeding genome-wide significance between BMD and four loci: two established BMD-associated loci (5q14.3 containing MEF2C and 1p36.12 containing WNT4) and two novel loci: 5p13.3 containing NPR3 (rs9292469; minor allele frequency [MAF] = 0.33%) associated with lumbar spine BMD and 11p15.2 containing SPON1 (rs2697825; MAF = 0.17%) associated with total hip BMD. Mouse models with mutations in either Npr3 or Spon1 have been reported, both have altered skeletal phenotypes, providing in vivo validation that these genes are physiologically important in bone. NRP3 regulates endochondral ossification and skeletal growth, whilst SPON1 modulates TGF-β regulated BMP-driven osteoblast differentiation. Rs9292469 (downstream of NPR3) also showed some evidence for association with forearm BMD in the independent GEFOS sample (n = 32,965). We found Spon1 was highly expressed in murine osteocytes from the tibiae, femora, humeri and calvaria, whereas Npr3 expression was more variable. CONCLUSION We report the most extreme-truncate GWAS of BMD performed to date. Our findings, suggest potentially new anabolic bone regulatory pathways that warrant further study.
Collapse
Affiliation(s)
- Celia L Gregson
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK.
| | - Felicity Newell
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia
| | - Paul J Leo
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia
| | - Graeme R Clark
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia
| | | | - Mhairi Marshall
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia
| | - Vincenzo Forgetta
- Department of Human Genetics, McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, Canada
| | - John A Morris
- Department of Human Genetics, McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, Canada
| | - Bing Ge
- Department of Human Genetics, McGill University and Genome Quebec Innovation Centre, Montreal, Quebec, Canada; Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Quebec, Canada
| | - Xiao Bao
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia
| | - J H Duncan Bassett
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, UK
| | - Graham R Williams
- Molecular Endocrinology Laboratory, Department of Medicine, Imperial College London, Hammersmith Campus, London W12 0NN, UK
| | - Scott E Youlten
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia
| | - Peter I Croucher
- The Garvan Institute of Medical Research, Sydney, New South Wales, Australia; St Vincent's Clinical School, University of New South Wales Medicine, Sydney, New South Wales, Australia
| | | | - David M Evans
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - John P Kemp
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; University of Queensland Diamantina Institute, Translational Research Institute, Brisbane, Queensland, Australia
| | - Matthew A Brown
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia
| | - Jon H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Emma L Duncan
- Translational Genomics Group, Institute of Health and Biomedical Innovation, Queensland University of Technology at Translational Research Institute, 37 Kent Street, Woolloongabba 4102, QLD, Australia; Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia
| |
Collapse
|
30
|
Anterior inferior iliac spine morphology: quantitative and qualitative assessment in an asymptomatic population. Surg Radiol Anat 2018; 40:1275-1281. [PMID: 30073394 DOI: 10.1007/s00276-018-2075-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 07/30/2018] [Indexed: 10/28/2022]
Abstract
PURPOSE To assess the prevalence of anterior inferior iliac spine (AIIS) types, and to investigate the quantitative measurements that characterize AIIS morphology in an asymptomatic adult population. METHODS In this prospective study, 358 hips from 179 consecutive subjects (age range, 19-82 years; 91 males, 88 females), who underwent CT examination for reasons other than hip problems and were negative for hip impingement test, were analyzed. AIIS types were determined (1, flat wall of the ilium between distal end of AIIS and acetebular rim; 2, bony eminence between distal end of AIIS and acetebular rim; and 3, extension of AIIS to the anterior superior acetebular rim) and AIIS tip angle (TA), direct distance (DD) of the anterior acetabular rim to AIIS as well as projectional distances in vertical (VD) and horizontal (HD) planes were measured. Age- and gender-related factors were searched using two-way ANOVA test under three age groups (18-39, 40-59, and ≥ 60 years). RESULTS There were 238 (66.5%) type 1, 118 (33.0%) type 2, and two (0.5%) type 3 AIISs, with significant difference between AIIS types among age groups and genders (P < 0.001). VD and DD showed age- and gender-related (P < 0.001, P < 0.001), and TA demonstrated gender-related differences (P < 0.001). Inter-observer agreement was good for TA and moderate to poor for other measurements. CONCLUSIONS Type 1 AIIS is the most common shape across all age groups in adult females and in young and middle-aged adult males. TA, DD, and VD might be reliably used for the evaluation of AIIS morphology.
Collapse
|
31
|
Sexually dimorphic tibia shape is linked to natural osteoarthritis in STR/Ort mice. Osteoarthritis Cartilage 2018; 26:807-817. [PMID: 29604337 PMCID: PMC5987380 DOI: 10.1016/j.joca.2018.03.008] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/14/2018] [Accepted: 03/19/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Human osteoarthritis (OA) is detected only at late stages. Male STR/Ort mice develop knee OA spontaneously with known longitudinal trajectory, offering scope to identify OA predisposing factors. We exploit the lack of overt OA in female STR/Ort and in both sexes of parental, control CBA mice to explore whether early divergence in tibial bone mass or shape are linked to emergent OA. METHOD We undertook detailed micro-CT comparisons of trabecular and cortical bone, multiple structural/architectural parameters and finite element modelling (FEM) of the tibia from male and female STR/Ort and CBA mice at 8-10 (pre-OA), 18-20 (OA onset) and 40 + weeks (advanced OA) of age. RESULTS We found higher trabecular bone mass in female STR/Ort than in either OA-prone male STR/Ort or non-prone CBA mice. Cortical bone, as expected, showed greater cross-sectional area in male than female CBA, which surprisingly was reversed in STR/Ort mice. STR/Ort also exhibited higher cortical bone mass than CBA mice. Our analyses revealed similar tibial ellipticity, yet greater predicted resistance to torsion in male than female CBA mice. In contrast, male STR/Ort exhibited greater ellipticity than both female STR/Ort and CBA mice at specific cortical sites. Longitudinal analysis revealed greater tibia curvature and shape deviations in male STR/Ort mice that coincided with onset and were more pronounced in late OA. CONCLUSION Generalised higher bone mass in STR/Ort mice is more marked in non OA-prone females, but pre-OA divergence in bone shape is restricted to male STR/Ort mice in which OA develops spontaneously.
Collapse
|
32
|
Shahar D, Evans J, Sayers MGL. Large enthesophytes in teenage skulls: Mechanical, inflammatory and genetic considerations. Clin Biomech (Bristol, Avon) 2018; 53:60-64. [PMID: 29448082 DOI: 10.1016/j.clinbiomech.2018.02.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2017] [Revised: 11/07/2017] [Accepted: 02/05/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The literature implies that large enthesophytes are exclusive to genetically predisposed individuals and to Spondyloarthropathies sufferers. Accordingly, the aim of this investigation and report was to assess the involvement of genetic predisposition, inflammatory and/or mechanical influences in the development of large enthesophytes in a sample population of teenagers presenting with large enthesophytes emanating from the external occipital protuberance. METHODS Analysis was based on four teenage males (13-16 year-old) possessing 14.5-30.5 mm enthesophytes projecting from the external occipital protuberance. This study included assessment of radiographs, MRI scans, blood-work, history, the SF-36 health survey, and the comparison of these data with the relevant literature to describe the interrelationships between the presence of enlarged external occipital protuberance, forward head protraction, active inflammation and/or genetic factors. FINDINGS Known genetic markers (e.g. HLA-B27) were not detected by allele-specific primers and both ESR and CRP tests were negative. Additionally, MRI analyses failed to detect active localised inflammation at the external occipital protuberance and surrounding structures. The health survey yielded normal parameters for all participants. All participants displayed significantly large Forward Head Protraction values (>40 mm), and interviews with participants and their parents indicated that concerns related to posture were prevalent since early childhood. INTERPRETATION This report suggests that mechanical load has an important role in enthesophyte development, irrespective the involvement of inflammatory or genetic factors.
Collapse
Affiliation(s)
- David Shahar
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia.
| | - John Evans
- Sunshine Coast Radiology, Birtinya, Australia
| | - Mark G L Sayers
- School of Health and Sport Sciences, University of the Sunshine Coast, Maroochydore, QLD, Australia
| |
Collapse
|
33
|
Abstract
The Orthopaedic Section of the American Physical Therapy Association (APTA) has an ongoing effort to create evidence-based practice guidelines for orthopaedic physical therapy management of patients with musculoskeletal impairments described in the World Health Organization's International Classification of Functioning, Disability, and Health (ICF). The purpose of these revised clinical practice guidelines is to review recent peer-reviewed literature and make recommendations related to hip pain and mobility deficits. J Orthop Sports Phys Ther. 2017;47(6):A1-A37. doi:10.2519/jospt.2017.0301.
Collapse
|
34
|
Gregson CL, Hardcastle SA, Murphy A, Faber B, Fraser WD, Williams M, Davey Smith G, Tobias JH. High Bone Mass is associated with bone-forming features of osteoarthritis in non-weight bearing joints independent of body mass index. Bone 2017; 97:306-313. [PMID: 28082078 PMCID: PMC5378151 DOI: 10.1016/j.bone.2017.01.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 11/05/2016] [Accepted: 01/06/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVES High Bone Mass (HBM) is associated with (a) radiographic knee osteoarthritis (OA), partly mediated by increased BMI, and (b) pelvic enthesophytes and hip osteophytes, suggestive of a bone-forming phenotype. We aimed to establish whether HBM is associated with radiographic features of OA in non-weight-bearing (hand) joints, and whether such OA demonstrates a bone-forming phenotype. METHODS HBM cases (BMD Z-scores≥+3.2) were compared with family controls. A blinded assessor graded all PA hand radiographs for: osteophytes (0-3), joint space narrowing (JSN) (0-3), subchondral sclerosis (0-1), at the index Distal Interphalangeal Joint (DIPJ) and 1st Carpometacarpal Joint (CMCJ), using an established atlas. Analyses used a random effects logistic regression model, adjusting a priori for age and gender. Mediating roles of BMI and bone turnover markers (BTMs) were explored by further adjustment. RESULTS 314 HBM cases (mean age 61.1years, 74% female) and 183 controls (54.3years, 46% female) were included. Osteophytes (grade≥1) were more common in HBM (DIPJ: 67% vs. 45%, CMCJ: 69% vs. 50%), with adjusted OR [95% CI] 1.82 [1.11, 2.97], p=0.017 and 1.89 [1.19, 3.01], p=0.007 respectively; no differences were seen in JSN. Further adjustment for BMI failed to attenuate ORs for osteophytes in HBM cases vs. controls; DIPJ 1.72 [1.05, 2.83], p=0.032, CMCJ 1.76 [1.00, 3.06], p=0.049. Adjustment for BTMs (concentrations lower amongst HBM cases) did not attenuate ORs. CONCLUSIONS HBM is positively associated with OA in non-weight-bearing joints, independent of BMI. HBM-associated OA is characterised by osteophytes, consistent with a bone-forming phenotype, rather than JSN reflecting cartilage loss. Systemic factors (e.g. genetic architecture) which govern HBM may also increase bone-forming OA risk.
Collapse
Affiliation(s)
- C L Gregson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK.
| | - S A Hardcastle
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK; MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - A Murphy
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - B Faber
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - W D Fraser
- Department of Medicine, Norwich Medical School, University of East Anglia, Norwich, UK
| | - M Williams
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - G Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - J H Tobias
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| |
Collapse
|
35
|
Abstract
PURPOSE OF REVIEW Osteoporosis and osteoarthritis are different diseases, with differences in risk factors, bone mineral density (BMD), BMI, phenotype, morbidity and mortality. We review new data on the role of bone metabolism in osteoporosis and osteoarthritis. RECENT FINDINGS The insights in the common convergent and divergent risk factors between osteoarthritis and osteoporosis have resulted in new findings on the role of BMD, BMI, falls, genetics and epigenetics in the pathophysiology of both diseases and on the increased fracture risk in osteoporosis and osteoarthritis. The relation between BMD, BMI and fracture risk in osteoarthritis is dependent on the stage, definition and location of the osteoarthritis and method of BMD measurement. It has been suggested that osteoarthritis should be further specified in terms of bone involvement. SUMMARY These new findings open the way to better understand the bone subtypes of osteoarthritis (osteoporotic, bone forming and erosive) and the common and different ways bone is involved in osteoporosis and osteoarthritis. Much can be expected from further prospective studies, when taking into account the heterogeneous nature of both osteoporosis and osteoarthritis.
Collapse
|
36
|
Abstract
An osteophyte is a fibrocartilage-capped bony outgrowth that is one of the features of osteoarthritis. This study reviewed the types, risk factors, pathophysiology, clinical presentations, and medical and surgical treatment of osteophytes. Extraspinal osteophytes are classified as marginal, central, periosteal, or capsular, whereas vertebral osteophytes are classified as traction or claw. Risk factors for development of osteophytes include age, body mass index, physical activity, and other genetic and environmental factors. Transforming growth factor β plays a role in the pathophysiology of osteophyte formation. Osteophytes can cause pain, limit range of motion, affect quality of life, and cause multiple symptoms at the spine. Medical treatment involves the use of bisphosphonates and other non-steroidal anti-inflammatory agents. Surgical treatment in the form of cheilectomy for impingement syndromes during joint replacement is recommended.
Collapse
Affiliation(s)
- Siu Him Janus Wong
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong
| | | | | |
Collapse
|
37
|
Shahar D, Sayers MGL. A morphological adaptation? The prevalence of enlarged external occipital protuberance in young adults. J Anat 2016; 229:286-91. [PMID: 27426020 DOI: 10.1111/joa.12466] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2016] [Indexed: 11/26/2022] Open
Abstract
Enthesophytes are bony projections that arise from the sites of ligament, tendon or joint capsule attachment to a bone. They are seen rarely in radiographic findings in young adults, as these bony adaptations are assumed to develop slowly over time. However, in recent years, the presence of an enlarged external occipital protuberance (EEOP) has been observed frequently in radiographs of relatively young patients at the clinic of the lead author. Accordingly, the aim of this project was to assess the prevalence of an EEOP in a young adult population. Analysis involved a retrospective analysis of 218 lateral cervical radiographic studies of 18-30-year-old participants. Group A (n = 108; males = 45, females = 63) consisted of asymptomatic university students, while Group B (n = 110; males = 50, females = 60) were an age-matched mildly symptomatic, non-student population. The external occipital protuberance (EOP) size was defined as the distance from the most superior point of the EOP (origin) to a point on the EOP that is most distal from the skull. To avoid ambiguity, the threshold for recording the size of an EOP was set at 5 mm, and an EOP was classified as enlarged if it exceeded 10 mm. Reliability testing was also undertaken. Results indicated that an EEOP was present in 41% of the total population, with 10% of all participants presenting with an EOP ≥ 20 mm. An EEOP was significantly more common in males (67.4%) than in females (20.3%), with the mean EEOP size for the combined male population (15 ± 7 mm) being significantly larger (P < 0.001) than for females (10 ± 4 mm). The longest EEOP in the male population was 35.7 mm, while in the female population it was 25.5 mm. Additionally, the mean EEOP size for Group A (14 ± 7 mm) was also significantly greater (P = 0.006) than that recorded for Group B (12 ± 6 mm). This study identified that an EEOP is a condition that is prevalent in the populations tested. The age of the populations, and the prevalence of EEOP, suggest that biomechanical drivers for this phenomenon may be the main reason for this condition in these populations.
Collapse
Affiliation(s)
- David Shahar
- School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| | - Mark G L Sayers
- School of Health and Sport Sciences, University of the Sunshine Coast, Sunshine Coast, QLD, Australia
| |
Collapse
|
38
|
Abstract
PURPOSE OF REVIEW Increasing evidence show that bone is a key factor in the development of osteoarthritis. This article reviews the latest results of basic and clinical research on the role of the subchondral bone in osteoarthritis. RECENT FINDINGS Early changes in the subchondral bone can predict subsequent symptoms or disease structural progression. New tools may help clinicians to stratify different osteoarthritis phenotypes with regards to bone remodeling status. SUMMARY The involvement of bone in osteoarthritis has long been thought to be secondary to cartilage damage as an adaptation of the joint. Recent clinical studies with MRI have demonstrated that bone changes could be observed in early stages of the disease, even preceding cartilage lesions. Moreover, there is clear evidence of an association between subchondral bone mineral density and osteoarthritis. The level of bone remodeling plays a critical role under mechanical loading conditions as demonstrated by consistent experimental studies. Yet new clinical biomarkers are being developed to assess the bone phenotype of osteoarthritic patients. This stratification strategy is likely to better identify groups of patients who would benefit from bone-acting drugs to decrease disease progression and improve pain and disability.
Collapse
|
39
|
Sharma L. Osteoarthritis year in review 2015: clinical. Osteoarthritis Cartilage 2016; 24:36-48. [PMID: 26707991 PMCID: PMC4693145 DOI: 10.1016/j.joca.2015.07.026] [Citation(s) in RCA: 59] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 07/21/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
The purpose of this review is to highlight clinical research in osteoarthritis (OA). A literature search was conducted using PubMed (http://www.ncbi.nlm.nih.gov/pubmed/) with the search terms "osteoarthritis [All Fields] AND treatment [All Fields]" and the following limits activated: humans, English language, all adult 19+ years, published between April 1, 2014 and April 1, 2015. A second literature search was then conducted with the search terms "osteoarthritis [All Fields] AND epidemiology [All Fields]", with the same limits. Reports of surgical outcome, case series, surgical technique, tissue sample or culture studies, trial protocols, and pilot studies were excluded. Of 1523, 150 were considered relevant. Among epidemiologic and observational clinical studies, themes included physical activity, early knee OA, and confidence/instability/falls. Symptom outcomes of pharmacologic treatments were reported for methotrexate, adalimumab, anti-nerve growth factor monoclonal antibodies, strontium ranelate, bisphosphonates, glucosamine, and chondroitin sulfate, and structural outcomes of pharmacologic treatments for strontium ranelate, recombinant human fibroblast growth factor 18, and glucosamine and chondroitin sulfate. Symptom outcomes of non-pharmacologic interventions were reported for: neuromuscular exercise, quadriceps strengthening, weight reduction and maintenance, TENS, therapeutic ultrasound, stepped care strategies, cognitive behavior therapy for sleep disturbance, acupuncture, gait modification, booster physical therapy, a web-based therapeutic exercise resource center for knee OA; hip physical therapy for hip OA; and joint protection and hand exercises for hand OA. Structure outcomes of non-pharmacologic interventions were reported for patellofemoral bracing.
Collapse
|
40
|
Wang Y, Teichtahl AJ, Cicuttini FM. Osteoarthritis year in review 2015: imaging. Osteoarthritis Cartilage 2016; 24:49-57. [PMID: 26707992 DOI: 10.1016/j.joca.2015.07.027] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 07/30/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE This narrative review covers original publications related to imaging in osteoarthritis (OA) published in English between 1 April 2014 and 30 April 2015. Novel lessons relating to imaging are described. METHODS An extensive PubMed database search was performed based on, but not limited to the terms "OA" in combination with "Magnetic resonance imaging (MRI)", "Imaging", "Radiography", "Ultrasound", "Computed tomography (CT)" and "Nuclear medicine" to extract relevant studies. In vitro data and animal studies were excluded. This review focuses on the new developments and observations based on the aforementioned imaging modalities, as well as a 'whole-organ' approach by presenting findings from different tissues (bone, meniscus, synovium, muscle and fat) and joints (hip, lumbar spine and hand). RESULTS AND CONCLUSIONS Over the past year, studies using imagine have made a major contribution to the understanding of the pathogenesis of OA. Significant work has continued at the knee, with MRI now being increasingly used to assess structural endpoints in clinical trials. This offers the exciting opportunity to explore potential disease modifying OA therapies. There has been a clear interest in the role of bone in the pathogenesis of OA. There is now a growing body of literature examining the pathogenesis of OA at the hip, lumbar spine and hand. The future of imaging in OA offers the exciting potential to better understand the disease process across all joints and develop more effective preventive and therapeutic interventions.
Collapse
Affiliation(s)
- Y Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia
| | - A J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia; Baker IDI Heart and Diabetes Institute, Commercial Road, Melbourne, VIC 3004, Australia
| | - F M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Alfred Hospital, Melbourne, VIC 3004, Australia.
| |
Collapse
|
41
|
Mays S. Bone-formers and bone-losers in an archaeological population. AMERICAN JOURNAL OF PHYSICAL ANTHROPOLOGY 2015; 159:577-84. [PMID: 26667211 PMCID: PMC5064654 DOI: 10.1002/ajpa.22912] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2015] [Revised: 11/12/2015] [Accepted: 11/19/2015] [Indexed: 11/22/2022]
Abstract
Objectives Recent biomedical research suggests that, in modern human populations, individuals may vary in their inherent tendency toward bone formation at skeletal and extra‐skeletal locations. However, the nature of this phenomenon is incompletely understood, and the extent to which it might apply to past populations is unclear. It is hypothesized that if there is inter‐individual variation in some overall tendency toward bone formation in skeletal and extra‐skeletal sites then there should be a positive relationship between ligamentous ossification and thickness of cortical bone. This work is a test of this hypothesis in an archaeological population. Materials and Methods The study material comprises adult skeletons (N = 137 individuals) of documented age at death from 18th to 19th century London. It examines the relationship between bone deposition in the anterior longitudinal ligament (ALL) in the thoracic spine and cortical index (CI) at the metacarpal measured by radiogrammetry. Results Controlling for the potential confounders age, sex, skeletal completeness, occupation (males) and parity (females), there was a positive association between ossification into the ALL and CI. This reflects lesser medullary cavity width in those showing ALL ossification. Discussion Ligamentous ossification in the axial skeleton and peripheral cortical bone status are linked, individuals with ALL ossification showing lesser resorption of cortical bone at the endosteal surface. This is consistent with the idea of inter‐individual variation in some general bone‐forming/bone‐losing tendency in this 200 year old study population, but there was no evidence of a link between ALL ossification and increased skeletal subperiosteal bone deposition. Am J Phys Anthropol 159:577–584, 2016. © 2015 The Authors American Journal of Physical Anthropology Published by Wiley Periodicals, Inc.
Collapse
Affiliation(s)
- Simon Mays
- Research Department, Historic England, Portsmouth, PO4 9LD, UK
| |
Collapse
|
42
|
Abstract
CONTEXT Estimation of adult age from skeletal remains is problematic due to the weak and variable relationship between age indicators and age. OBJECTIVES To assess the proportion of variation in age indicators that is associated with factors other than age and to attempt to identify what those factors might be. METHODS The paper focuses on frequently used adult bony age markers. A literature search (principally using Web of Science) is conducted to assess the proportion of variation in age indicators associated with factors other than age. The biology of these age markers is discussed, as are factors other than age that might affect their expression. RESULTS Typically, ∼60% of variation in bony age indicators is associated with factors other than age. Factors including inherent metabolic propensity to form bone in soft tissue, vitamin D status, hormonal and reproductive factors, energy balance, biomechanical variables and genetic factors may be responsible for this variation, but empirical studies are few. CONCLUSION Most variation in adult skeletal age markers is due to factors other than age; dry bone study of historic documented skeletal collections and high resolution CT scanning in modern cadavers or living individuals is needed to identify these factors.
Collapse
Affiliation(s)
- Simon Mays
- a Historic England, Fort Cumberland , Eastney , Portsmouth , UK
| |
Collapse
|
43
|
Osteoarthritis and bone mineral density: are strong bones bad for joints? BONEKEY REPORTS 2015; 4:624. [PMID: 25628884 PMCID: PMC4303262 DOI: 10.1038/bonekey.2014.119] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2014] [Accepted: 11/19/2014] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is a common and disabling joint disorder affecting millions of people worldwide. In OA, pathological changes are seen in all of the joint tissues including bone. Although both cross-sectional and longitudinal epidemiological studies have consistently demonstrated an association between higher bone mineral density (BMD) and OA, suggesting that increased BMD is a risk factor for OA, the mechanisms underlying this observation remain unclear. Recently, novel approaches to examining the BMD-OA relationship have included studying the disease in individuals with extreme high bone mass, and analyses searching for genetic variants associated with both BMD variation and OA, suggesting possible pleiotropic effects on bone mass and OA risk. These studies have yielded valuable insights into potentially relevant pathways that might one day be exploited therapeutically. Although animal models have suggested that drugs reducing bone turnover (antiresorptives) may retard OA progression, it remains to be seen whether this approach will prove to be useful in human OA. Identifying individuals with a phenotype of OA predominantly driven by increased bone formation could help improve the overall response to these treatments. This review aims to summarise current knowledge regarding the complex relationship between BMD and OA.
Collapse
|