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Alsobhi M, Gmmash A, Aldhabi R, Almaddah MR, Ameen A, Almotairi F, Basuodan R, Khan F. Physical Therapists' Attitudes, Beliefs, and Barriers Regarding Fall Screening and Prevention among Patients with Knee Osteoarthritis: A Cross-Sectional Study. Healthcare (Basel) 2024; 12:718. [PMID: 38610140 PMCID: PMC11011968 DOI: 10.3390/healthcare12070718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 03/15/2024] [Accepted: 03/22/2024] [Indexed: 04/14/2024] Open
Abstract
Falls are commonly associated with knee osteoarthritis and represent a significant financial burden on the healthcare system. Therefore, the discovery of physical therapists' attitudes and practices regarding fall screening and prevention among patients with osteoarthritis should be investigated. Moreover, this study aimed to identify barriers that might limit its implementation among this population. A cross-sectional study design was used to collect the data. The electronic survey targeted licensed physical therapy professionals who currently work in clinical or academic settings in Saudi Arabia. The data were analyzed descriptively and inferentially using chi-square. Two hundred and six licensed physical therapists completed the survey, 119 females (57.8%) and 87 males (42.2%). The results of the structural equation modelling analysis showed that intention to use fall screening and management strategies was positively associated with the history of falls, identifying risk factors of falls, and documentation of risk factors of falls (p ≤ 0.0001). The most reported barriers to implement fall screening and prevention were lack of knowledge (n = 92, 45%), lack of training/skills (n = 84, 41%), and time constraints (n = 57, 45%), followed by patient compliance with 38% of the responses. The findings highlighted the importance of identifying the key opportunities for knowledge translation in clinical practices to enhance the sufficient implementation of fall screening and management in osteoarthritis care.
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Affiliation(s)
- Mashael Alsobhi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Afnan Gmmash
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Rawan Aldhabi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Muataz R. Almaddah
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Alaa Ameen
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Fae Almotairi
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
| | - Reem Basuodan
- Department of Rehabilitation Sciences, College of Health and Rehabilitation Sciences, Princess Nourah bint Abdulrahman University, P.O. Box 84428, Riyadh 11671, Saudi Arabia
| | - Fayaz Khan
- Department of Physical Therapy, Faculty of Medical Rehabilitation Sciences, King Abdulaziz University, Jeddah 22252, Saudi Arabia
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2
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Khor A, Ma CA, Hong C, Hui LLY, Leung YY. Diabetes mellitus is not a risk factor for osteoarthritis. RMD Open 2021; 6:rmdopen-2019-001030. [PMID: 32060073 PMCID: PMC7046958 DOI: 10.1136/rmdopen-2019-001030] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 12/18/2019] [Accepted: 12/21/2019] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Association between diabetes mellitus (DM) and risk of osteoarthritis (OA) can be confounded by body mass index (BMI), a strong risk factor for both conditions. We evaluate the association between DM or hyperglycaemia with OA using systematic review and meta-analysis. METHODS We searched PubMed and Web of Science databases in English for studies that gave information on the association between DM and OA. Two meta-analysis models were conducted to address: (1) risk of DM comparing subjects with and without OA and (2) risk of OA comparing subjects with and without DM. As far as available, risk estimates that adjusted for BMI were used. RESULTS 31 studies with a pooled population size of 295 100 subjects were reviewed. 16 and 15 studies reported positive associations and null/ negative associations between DM and OA. 68.8% of positive studies had adjusted for BMI, compared with 93.3% of null/negative studies. In meta-analysis model 1, there was an increase prevalence of DM in subjects with OA compared with those without (OR 1.56, 95% CI 1.28 to 1.89). In meta-analysis model 2, there was no increased risk of OA (OR 1.14, 95% CI 0.98 to 1.33) in subjects with DM compared with those without, regardless of gender and OA sites. Comparing subjects with DM to those without, an increased risk of OA was noted in cross-sectional studies, but not in case-control and prospective cohort studies. CONCLUSIONS This meta-analysis does not support DM as an independent risk factor for OA. BMI was probably the most important confounding factor.
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Affiliation(s)
- Andrew Khor
- Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | | | - Cassandra Hong
- Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Duke-NUS Medical School, Singapore, Singapore
| | - Laura Li-Yao Hui
- Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore
| | - Ying Ying Leung
- Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore .,Duke-NUS Medical School, Singapore, Singapore
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3
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Liu Y, Jing J, Yu H, Zhang J, Cao Q, Zhang X, Liu J, Zhang S, Cheng W. Expression profiles of long non-coding RNAs in the cartilage of patients with knee osteoarthritis and normal individuals. Exp Ther Med 2021; 21:365. [PMID: 33732338 PMCID: PMC7903471 DOI: 10.3892/etm.2021.9796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2019] [Accepted: 12/12/2019] [Indexed: 11/22/2022] Open
Abstract
Knee osteoarthritis is caused by a multifactorial imbalance in the synthesis and degradation of knee chondrocytes, subchondral bone and extracellular matrix. Abnormal expression of long non-coding RNAs (lncRNAs) affects the metabolism, synovitis, autophagy and apoptosis of chondrocytes, as well as the production of cartilage matrix. The aim of the present study was to identify novel targets for the treatment of osteoarthritis and to examine the pathogenesis of the disease. The lncRNA expression profiles of seven patients with knee osteoarthritis and six healthy controls were examined by RNA-sequencing. Differentially expressed lncRNAs were selected for bioinformatics analyses, including Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway enrichment. Reverse transcription-quantitative PCR (RT-qPCR) was used to further investigate the differential expression of the lncRNAs. A total of 23,583 lncRNAs were identified in osteoarthritis cartilage, including 5,255 upregulated and 5,690 downregulated lncRNAs, compared with normal cartilage. Although there were more downregulated lncRNAs compared with upregulated lncRNAs, among the changed lncRNAs (fold-change >6), there were more upregulated lncRNAs compared with downregulated lncRNAs. Several lncRNAs exhibiting differences were identified as potential therapeutic targets in knee osteoarthritis. GO and KEGG pathway analyses were performed for the target genes of the differentially expressed lncRNAs. RT-qPCR validation was performed on three randomly selected upregulated and downregulated lncRNAs. The results of RT-qPCR were consistent with the findings obtained by RNA-sequencing analysis. The findings from the present study may contribute to the diagnosis of osteoarthritis and may predict the development of osteoarthritis. Furthermore, the differentially expressed lncRNAs may aid in the identification of novel candidate targets for the treatment of knee osteoarthritis.
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Affiliation(s)
- Yanchang Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Juehua Jing
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Haoran Yu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Jisen Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Qiliang Cao
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Xin Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Jianjun Liu
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Shuo Zhang
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
| | - Wendan Cheng
- Department of Orthopedic Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, Anhui 230601, P.R. China
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4
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Driban JB, Harkey MS, Barbe MF, Ward RJ, MacKay JW, Davis JE, Lu B, Price LL, Eaton CB, Lo GH, McAlindon TE. Risk factors and the natural history of accelerated knee osteoarthritis: a narrative review. BMC Musculoskelet Disord 2020; 21:332. [PMID: 32471412 PMCID: PMC7260785 DOI: 10.1186/s12891-020-03367-2] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2019] [Accepted: 05/25/2020] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Osteoarthritis is generally a slowly progressive disorder. However, at least 1 in 7 people with incident knee osteoarthritis develop an abrupt progression to advanced-stage radiographic disease, many within 12 months. We summarize what is known - primarily based on findings from the Osteoarthritis Initiative - about the risk factors and natural history of accelerated knee osteoarthritis (AKOA) - defined as a transition from no radiographic knee osteoarthritis to advanced-stage disease < 4 years - and put these findings in context with typical osteoarthritis (slowly progressing disease), aging, prior case reports/series, and relevant animal models. Risk factors in the 2 to 4 years before radiographic manifestation of AKOA (onset) include older age, higher body mass index, altered joint alignment, contralateral osteoarthritis, greater pre-radiographic disease burden (structural, symptoms, and function), or low fasting glucose. One to 2 years before AKOA onset people often exhibit rapid articular cartilage loss, larger bone marrow lesions and effusion-synovitis, more meniscal pathology, slower chair-stand or walking pace, and increased global impact of arthritis than adults with typical knee osteoarthritis. Increased joint symptoms predispose a person to new joint trauma, which for someone who develops AKOA is often characterized by a destabilizing meniscal tear (e.g., radial or root tear). One in 7 people with AKOA onset subsequently receive a knee replacement during a 9-year period. The median time from any increase in radiographic severity to knee replacement is only 2.3 years. Despite some similarities, AKOA is different than other rapidly progressive arthropathies and collapsing these phenomena together or extracting results from one type of osteoarthritis to another should be avoided until further research comparing these types of osteoarthritis is conducted. Animal models that induce meniscal damage in the presence of other risk factors or create an incongruent distribution of loading on joints create an accelerated form of osteoarthritis compared to other models and may offer insights into AKOA. CONCLUSION Accelerated knee osteoarthritis is unique from typical knee osteoarthritis. The incidence of AKOA in the Osteoarthritis Initiative and Chingford Study is substantial. AKOA needs to be taken into account and studied in epidemiologic studies and clinical trials.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.
| | - Matthew S Harkey
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.,Department of Quantitative Health Sciences, University of Massachusetts Medical School, Worcester, MA, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, 800 Washington Street, Boston, MA, 02111, USA
| | - James W MacKay
- Department of Radiology, University of Cambridge School of Clinical Medicine, Box 218, Level 5, Addenbrooke's Hospital, Cambridge, CB2 0QQ, UK.,Department of Radiology, Norwich Medical School, University of East Anglia, Research Park NR4 7U1, Norwich, UK
| | - Julie E Davis
- Milken Institute of Public Health, The George Washington University, 950 New Hampshire Ave NW, Washington, DC, 20052, USA
| | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, 75 Francis Street PBB-B3, Boston, MA, 02115, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.,Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington Street, Box #63, Boston, MA, 02111, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, 111 Brewster Street, Pawtucket, RI, 02860, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA.,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX. 1 Baylor Plaza, BCM-285, Houston, TX, 77030, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Allergy & Immunology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
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5
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Liu W, Balu N, Canton G, Hippe DS, Watase H, Waterton JC, Hatsukami T, Yuan C. Understanding Atherosclerosis Through an Osteoarthritis Data Set. Arterioscler Thromb Vasc Biol 2020; 39:1018-1025. [PMID: 31070477 DOI: 10.1161/atvbaha.119.312513] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
Atherosclerotic cardiovascular disease remains a worldwide epidemic and one of the leading causes of death nowadays. Vessel wall imaging can be used to understand the development and progression of atherosclerosis, but it is rarely done because of the high cost. We recently identified the Osteoarthritis Initiative, a large prospective cohort study of knee osteoarthritis, which might serve as a valuable source for atherosclerosis research with its serial knee magnetic resonance imaging data. We have found that these images are suitable for vessel wall image analysis of the lower extremity arteries. Here, we will introduce the Osteoarthritis Initiative data set and explain why it could be used for cardiovascular research purposes. Also, we will briefly comment on peripheral artery atherosclerosis as it is covered in the Osteoarthritis Initiative image data set and review the use of vessel wall imaging for studying atherosclerosis. We think data mining of imaging studies, not originally designed on cardiovascular research, can not only maximize the value of the imaging data set but also boost our understanding of atherosclerosis.
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Affiliation(s)
- Wenjin Liu
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Niranjan Balu
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Gador Canton
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Daniel S Hippe
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
| | - Hiroko Watase
- Division of Vascular Surgery, Department of Surgery (H.W., T.H.), University of Washington, Seattle
| | - John C Waterton
- Centre for Imaging Sciences, Manchester Academic Health Science Centre, The University of Manchester, United Kingdom (J.C.W.)
| | - Thomas Hatsukami
- Division of Vascular Surgery, Department of Surgery (H.W., T.H.), University of Washington, Seattle
| | - Chun Yuan
- From the Department of Radiology (W.L., N.B., G.C., D.S.H., C.Y.), University of Washington, Seattle
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6
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Price LL, Harkey MS, Ward RJ, MacKay JW, Zhang M, Pang J, Davis JE, McAlindon TE, Lo GH, Amin M, Eaton CB, Lu B, Duryea J, Barbe MF, Driban JB. Role of Magnetic Resonance Imaging in Classifying Individuals Who Will Develop Accelerated Radiographic Knee Osteoarthritis. J Orthop Res 2019; 37:2420-2428. [PMID: 31297900 PMCID: PMC6778707 DOI: 10.1002/jor.24413] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Accepted: 07/05/2019] [Indexed: 02/04/2023]
Abstract
We assessed whether adding magnetic resonance (MR)-based features to a base model of clinically accessible participant characteristics (i.e., serological, radiographic, demographic, symptoms, and physical function) improved classification of adults who developed accelerated radiographic knee osteoarthritis (AKOA) or not over the subsequent 4 years. We conducted a case-control study using radiographs from baseline and the first four annual visits of the osteoarthritis initiative to define groups. Eligible individuals had no radiographic KOA in either knee at baseline (Kellgren-Lawrence [KL] grade <2). We classified two groups matched on sex (i) AKOA: at least one knee developed advanced-stage KOA (KL = 3 or 4) within 48 months and (ii) did not develop AKOA within 48 months. The MR-based features were assessments of bone, effusion/synovitis, tendons, ligaments, cartilage, and menisci. All characteristics and MR-based features were from the baseline visit. Classification and regression tree analyses were performed to determine classification rules and identify statistically important variables. The CART models with and without MR features each explained approximately 40% of the variability. Adding MR-based features to the model yielded modest improvements in specificity (0.90 vs. 0.82) but lower sensitivity (0.62 vs. 0.70) than the base model. There was consistent evidence that serum glucose, effusion-synovitis volume, and cruciate ligament degeneration are statistically important variables in classifying individuals who will develop AKOA. We found common MR-based measures failed to dramatically improve classification. These findings also show a complex interplay among participant characteristics and a need to identify novel characteristics to improve classification. © 2019 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 37:2420-2428, 2019.
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Affiliation(s)
- Lori Lyn Price
- Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA
| | - Matthew S. Harkey
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA,Department of Population and Quantitative Health Sciences, University of Massachusetts Medical School,
Worcester, MA, USA
| | - Robert J. Ward
- Department of Radiology, Tufts Medical Center, Boston, MA, USA
| | - James W. MacKay
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Ming Zhang
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Jincheng Pang
- Internal Medicine Research Unit, Pfizer, Cambridge, MA, USA
| | - Julie E. Davis
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Timothy E. McAlindon
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
| | - Grace H. Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development Center of
Excellence Michael E. DeBakey VAMC, Houston, TX, USA,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Mamta Amin
- Temple University School of Medicine, Philadelphia, PA, USA
| | | | - Bing Lu
- Brigham & Women’s Hospital and Harvard Medical School, Boston, MA
| | - Jeffrey Duryea
- Department of Radiology, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA,
USA
| | - Mary F. Barbe
- Temple University School of Medicine, Philadelphia, PA, USA
| | - Jeffrey B. Driban
- Division of Rheumatology, Allergy, and Immunology, Tufts Medical Center, Boston, MA
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7
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Harkey MS, Price LL, McAlindon TE, Davis JE, Stout AC, Lu B, Zhang M, Eaton CB, Barbe MF, Lo GH, Driban JB. Association Between Declining Walking Speed and Increasing Bone Marrow Lesion and Effusion Volume in Individuals with Accelerated Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2019; 71:259-270. [PMID: 29882630 DOI: 10.1002/acr.23613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2018] [Accepted: 06/05/2018] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To determine whether a decline in walking speed during the year prior to disease onset is associated with concurrent changes in cartilage, bone marrow lesions (BMLs), or effusion in adults who develop common knee osteoarthritis (OA), accelerated knee OA, or no knee OA. METHODS We identified 3 groups from the Osteoarthritis Initiative based on annual radiographs from baseline to 48 months: accelerated knee OA, common knee OA, and no knee OA. We used the cartilage damage index (CDI) to assess tibiofemoral cartilage damage and used a semiautomated program to measure BML and effusion volume. Walking speed was assessed as an individual's habitual walking speed over 20 meters. One-year change in walking speed and structural measures were calculated as index visit measurements minus measurements from the year prior visit. Logistic regression models were used to determine whether change in walking speed (exposure) was associated with change in each structural measure (outcome) for the overall group and then separately for the accelerated knee OA, common knee OA, and no knee OA groups. RESULTS Adults who slowed their walking speed were almost twice as likely to present with increased BML volume, with a significant association (odds ratio 3.04 [95% confidence interval (95% CI) 1.03-8.95]) among adults with accelerated knee OA. Adults with accelerated knee OA who slowed their walking speed were approximately 3.4 times (95% CI 1.10-10.49) more likely to present with increased effusion volume. Walking speed change was not significantly associated with CDI change. CONCLUSION A change in an easily assessable clinical examination (i.e., 20-meter walk test) was associated with concurrent worsening in BML and effusion volume in adults who developed accelerated knee OA.
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Affiliation(s)
| | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | | | | | | | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Ming Zhang
- Tufts Medical Center, Boston, Massachusetts
| | - Charles B Eaton
- Alpert Medical School of Brown University, Pawtucket, Rhode Island
| | - Mary F Barbe
- Temple University School of Medicine, Philadelphia, Pennsylvania
| | - Grace H Lo
- Michael E. DeBakey Veterans Affairs Medical Center and Baylor College of Medicine, Houston Texas
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8
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Driban JB, Davis JE, Lu B, Price LL, Ward RJ, MacKay JW, Eaton CB, Lo GH, Barbe MF, Zhang M, Pang J, Stout AC, Harkey MS, McAlindon TE. Accelerated Knee Osteoarthritis Is Characterized by Destabilizing Meniscal Tears and Preradiographic Structural Disease Burden. Arthritis Rheumatol 2019; 71:1089-1100. [PMID: 30592385 DOI: 10.1002/art.40826] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 12/20/2018] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To determine whether accelerated knee osteoarthritis (KOA) is preceded by, and characterized over time by, destabilizing meniscal tears or other pathologic changes. METHODS We selected 3 sex-matched groups of subjects from the first 48 months of the Osteoarthritis Initiative, comprising adults who had a knee without KOA (Kellgren/Lawrence [K/L] radiographic grade <2) at baseline. Subjects in the accelerated KOA group developed KOA of K/L grade ≥3, those with typical KOA showed increased K/L radiographic scores, and those with no KOA had the same K/L grade over time. An index visit was the visit when the radiographic criteria for accelerated KOA and typical KOA were met (the no KOA group was matched to the accelerated KOA group). The observation period was up to 2 years before and after an index visit. Radiologists reviewed magnetic resonance (MR) images of the index knee and identified destabilizing meniscal tears (root tears, radial tears, complex tears), miscellaneous pathologic features (acute ligamentous or tendinous injuries, attrition, subchondral insufficiency fractures, other incidental findings), and meniscal damage in >2 of 6 regions (3 regions per meniscus: anterior horn, body, posterior horn). In addition, bone marrow lesions (BMLs) and cartilage damage on MR images were quantified. Linear mixed regression models were performed to analyze the results. RESULTS At 1 year before the index visit, >75% of adults with accelerated KOA had meniscal damage in ≥2 regions (odds ratio 3.19 [95% confidence interval 1.70-5.97] versus adults with typical KOA). By the index visit, meniscal damage in ≥2 regions was ubiquitous in adults with accelerated KOA, including 42% of subjects having evidence of a destabilizing meniscal tear (versus 14% of subjects with typical KOA). These changes corresponded to findings of larger BMLs and greater cartilage loss in the accelerated KOA group. CONCLUSION Accelerated KOA is characterized by destabilizing meniscal tears in a knee compromised by meniscal damage in >2 regions, and also characterized by the presence of large BMLs and greater cartilage loss.
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Affiliation(s)
| | | | - Bing Lu
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts
| | - Lori Lyn Price
- Tufts Medical Center and Tufts University, Boston, Massachusetts
| | | | - James W MacKay
- University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Charles B Eaton
- Alpert Medical School of Brown University, Pawtucket, Rhode Island
| | - Grace H Lo
- Baylor College of Medicine and Michael E. DeBakey VAMC, Houston, Texas
| | - Mary F Barbe
- Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania
| | - Ming Zhang
- Tufts Medical Center, Boston, Massachusetts
| | | | | | - Matthew S Harkey
- Tufts Medical Center, Boston, Massachusetts, and University of Massachusetts Medical School, Worcester
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9
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Saberi Hosnijeh F, Bierma-Zeinstra SM, Bay-Jensen AC. Osteoarthritis year in review 2018: biomarkers (biochemical markers). Osteoarthritis Cartilage 2019; 27:412-423. [PMID: 30552966 DOI: 10.1016/j.joca.2018.12.002] [Citation(s) in RCA: 53] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2018] [Revised: 11/23/2018] [Accepted: 12/05/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE The aim of this narrative review is to summarize important findings from biochemical marker studies relevant to osteoarthritis (OA) in the context of new discoveries and clinical and scientific need. DESIGN We conducted a systematic search of electronic medical databases (Embase, Medline, Web of Science, Cochrane central) between 01-03-2017 and 31-03-2018. The search was restricted to human studies, English language and full text available publications while reviews were excluded. Only papers describing protein based biomarkers measured in human body fluids (blood, urine and synovial fluid (SF)) were included. Of the 992 papers, 86 were reviewed here, with inclusion primarily based on relevance to OA biochemical markers. RESULTS This review highlights a selection of studies based on their quality and perceived importance to the field mainly including those that1 evaluate prognostic value of biomarkers for OA progression (i.e., biomarkers reflecting change in composition of joint tissues and biomarkers of inflammation)2, help in assessment of intervention efficacy, and3 are innovative and uncover new candidate biomarkers, or use new approaches in biomarker discovery. CONCLUSIONS Key findings and implications for possible clinical utility of biochemical markers are summarized and discussed. Given the paucity of robust biomarkers within the field, and the heterogeneity of the condition, enormous works are needed for development and validation of novel and clinically applicable biomarkers to reduce the impact of this highly prevalent and debilitating condition.
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Affiliation(s)
- F Saberi Hosnijeh
- Immunology Department, Erasmus University Medical Center, Rotterdam, the Netherlands; Institute for Risk Assessment Sciences (IRAS), Utrecht University, Utrecht, the Netherlands.
| | - S M Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - A C Bay-Jensen
- Biomarker and Research, Nordic Bioscience, Herlev, Denmark.
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10
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Wu TJ, Fong YC, Lin CY, Huang YL, Tang CH. Glucose enhances aggrecan expression in chondrocytes via the PKCα/p38-miR141-3p signaling pathway. J Cell Physiol 2018; 233:6878-6887. [PMID: 29319178 DOI: 10.1002/jcp.26451] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 01/05/2018] [Indexed: 01/01/2023]
Abstract
Aggrecan is a high molecular weight proteoglycan that plays a critical role in cartilage structure and the function of joints, providing intervertebral disc and cartilage with the ability to resist compressive loads. Aggrecan degradation in articular cartilage is a significant event in early-stage osteoarthritis (OA). Currently, no effective treatment exists for OA other than pain relief. Dextrose (D-glucose) prolotherapy has shown promising activity in the treatment of different musculoskeletal disorders, including OA. However, little is known about the molecular mechanism of the glucose effect in OA and on the regulation of chondrogenesis. We show for the first time that glucose upregulates aggrecan expression and subsequent chondrogenesis in ATDC5 cells. Moreover, we found that glucose-induced aggrecan expression is mediated through the protein kinase Cα (PKCα)- and p38-dependent pathway. As demonstrated by microRNA (miR) and luciferase analyses, the glucose-induced PKCα/p38 signaling axis is responsible for downregulating miR141-3p which targets to the 3'untranslated region of aggrecan. In summary, we show that glucose enhances chondrogenesis by upregulating aggrecan expression via the PKCα-p38-miR141-3p signaling pathway. This result provides new insights into the mechanism of glucose on chondrogenesis.
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Affiliation(s)
- Tsung-Ju Wu
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Physical Medicine and Rehabilitation, Changhua Christian Hospital, Changhua, Taiwan
| | - Yi-Chin Fong
- Department of Orthopaedic Surgery, China Medical University Beigang Hospital, Yun-Lin County, Taiwan.,Department of Sports Medicine, College of Health Care, China Medical University, Taichung, Taiwan
| | - Chih-Yang Lin
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan
| | - Yuan-Li Huang
- Department of Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Department of Medical Research, China Medical University Hospital, Taichung, Taiwan
| | - Chih-Hsin Tang
- Graduate Institute of Basic Medical Science, China Medical University, Taichung, Taiwan.,Department of Biotechnology, College of Medical and Health Science, Asia University, Taichung, Taiwan.,Department of Pharmacology, School of Medicine, China Medical University, Taichung, Taiwan
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11
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Driban JB, McAlindon TE, Amin M, Price LL, Eaton CB, Davis JE, Lu B, Lo GH, Duryea J, Barbe MF. Risk factors can classify individuals who develop accelerated knee osteoarthritis: Data from the osteoarthritis initiative. J Orthop Res 2018; 36:876-880. [PMID: 28776751 PMCID: PMC5797506 DOI: 10.1002/jor.23675] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Accepted: 08/01/2017] [Indexed: 02/04/2023]
Abstract
We assessed which combinations of risk factors can classify adults who develop accelerated knee osteoarthritis (KOA) or not and which factors are most important. We conducted a case-control study using data from baseline and the first four annual visits of the Osteoarthritis Initiative. Participants had no radiographic KOA at baseline (Kellgren-Lawrence [KL]<2). We classified three groups (matched on sex): (i) accelerated KOA: >1 knee developed advance-stage KOA (KL = 3 or 4) within 48 months; (ii) typical KOA: >1 knee increased in radiographic scoring (excluding those with accelerated KOA); and (iii) No KOA: no change in KL grade by 48 months. We selected eight predictors: Serum concentrations for C-reactive protein, glycated serum protein (GSP), and glucose; age; sex; body mass index; coronal tibial slope, and femorotibial alignment. We performed a classification and regression tree (CART) analysis to determine rules for classifying individuals as accelerated KOA or not (no KOA and typical KOA). The most important baseline variables for classifying individuals with incident accelerated KOA (in order of importance) were age, glucose concentrations, BMI, and static alignment. Individuals <63.5 years were likely not to develop accelerated KOA, except when overweight. Individuals >63.5 years were more likely to develop accelerated KOA except when their glucose levels were >81.98 mg/dl and they did not have varus malalignment. The unexplained variance of the CART = 69%. These analyses highlight the complex interactions among four risk factors that may classify individuals who will develop accelerated KOA but more research is needed to uncover novel risk factors. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 36:876-880, 2018.
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Affiliation(s)
| | | | - Mamta Amin
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA,Tufts Clinical and Translational Science Institute, Tufts University, Boston, MA, USA
| | - Charles B. Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, RI, USA
| | - Julie E. Davis
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Bing Lu
- Division of Rheumatology, Immunology & Allergy, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Grace H. Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, TX, USA
| | - Jeffrey Duryea
- Department of Radiology, Brigham & Women’s Hospital and Harvard Medical School, Boston, MA, USA
| | - Mary F. Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
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12
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Stout AC, Barbe MF, Eaton CB, Amin M, Al-Eid F, Price LL, Lu B, Lo GH, Zhang M, Pang J, McAlindon TE, Driban JB. Inflammation and glucose homeostasis are associated with specific structural features among adults without knee osteoarthritis: a cross-sectional study from the osteoarthritis initiative. BMC Musculoskelet Disord 2018; 19:1. [PMID: 29304778 PMCID: PMC5755424 DOI: 10.1186/s12891-017-1921-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2017] [Accepted: 12/22/2017] [Indexed: 12/11/2022] Open
Abstract
Background Greater age and body mass index are strong risk factors for osteoarthritis (OA). Older and overweight individuals may be more susceptible to OA because these factors alter tissue turnover in menisci, articular cartilage, and bone via altered glucose homeostasis and inflammation. Understanding the role of inflammation and glucose homeostasis on structural features of early-stage OA may help identify therapeutic targets to delay or prevent the onset of OA among subsets of adults with these features. We examined if serum concentrations of glucose homeostasis (glucose, glycated serum protein [GSP]) or inflammation (C-reactive protein [CRP]) were associated with prevalent knee bone marrow lesions (BMLs) or effusion among adults without knee OA. Methods We conducted a cross-sectional study using baseline data from the Osteoarthritis Initiative. We selected participants who had no radiographic knee OA but were at high risk for knee OA. Blinded staff conducted assays for CRP, GSP, and glucose. Readers segmented BML volume and effusion using semi-automated programs. Our outcomes were prevalent BML (knee with a BML volume > 1 cm3) and effusion (knee with an effusion volume > 7.5 cm3). We used logistic regression models with CRP, GSP, or glucose concentrations as the predictors. We adjusted for age, sex, body mass index (BMI), and Physical Activity Scale for the Elderly (PASE) scores. Results We included 343 participants: mean age = 59 ± 9 years, BMI = 27.9 ± 4.5 kg/m2, PASE score = 171 ± 82, and 64% female. Only CRP was associated with BML prevalence (odds ratio [OR] = 1.43, 95% confidence interval [CI] = 1.09 to 1.87). For effusion, we found an interaction between BMI and CRP: only among adults with a BMI <25 kg/m2 was there a significant trend towards a positive association between CRP and effusion (OR = 1.40, 95% CI = 1.00 to 1.97). We detected a U-shaped relationship between GSP and effusion prevalence. Fasting glucose levels were not significantly associated with the presence of baseline effusion or BML. Conclusions Among individuals without knee OA, CRP may be related to the presence of BMLs and effusion among normal weight individuals. Abnormal GSP may be associated with effusion. Future studies should explore whether inflammation and glucose homeostasis are predictive of symptomatic knee OA.
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Affiliation(s)
- Alina C Stout
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, 111 Brewster Street, Pawtucket, RI, 02860, USA
| | - Mamta Amin
- Department of Anatomy and Cell Biology, Temple University School of Medicine, 3500 North Broad Street, Philadelphia, PA, 19140, USA
| | - Fatimah Al-Eid
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, 800 Washington Street, Box #63, Boston, MA, 02111, USA.,Tufts Clinical and Translational Science Institute, Tufts University, 800 Washington Street, Box #63, Boston, MA, 02111, USA
| | - Bing Lu
- Brigham & Women's Hospital and Harvard Medical School, 75 Francis Street PBB-B3, Boston, MA, 02115, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, 2002 Holcombe Blvd, Houston, TX, 77030, USA.,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, 1 Baylor Plaza, BCM-285, Houston, TX, 77030, USA
| | - Ming Zhang
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Jincheng Pang
- Department of Electrical Engineering, Tufts University, 161 College Avenue, Medford, MA, 02155, USA
| | - Timothy E McAlindon
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA
| | - Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box #406, Boston, MA, 02111, USA.
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13
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A single recent injury is a potent risk factor for the development of accelerated knee osteoarthritis: data from the osteoarthritis initiative. Rheumatol Int 2017; 37:1759-1764. [PMID: 28831543 DOI: 10.1007/s00296-017-3802-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2017] [Accepted: 08/17/2017] [Indexed: 01/29/2023]
Abstract
We examined the association between previously reported modifiable risk factors for accelerated knee osteoarthritis (AKOA) at the Osteoarthritis Initiative's (OAI) baseline and 48-month visits among adults who develop AKOA between the 48- and 96-month visits. We conducted a case-control study using data from the OAI baseline to the 96-month visit. Participants had no radiographic knee osteoarthritis (KOA) in the index knee at OAI baseline and 48-month visits [Kellgren-Lawrence (KL) <2]. We classified 2 groups: (1) AKOA: >1 knee developed advance-stage KOA (KL = 3 or 4) between 48- and 96-month visits and (2) No KOA: no KOA and no change in radiographic severity bilaterally over 96 months. We used logistic regression models to evaluate the association between the outcome of AKOA (versus no KOA) and several modifiable risk factors collected at OAI baseline and 48-month visits [body mass index (BMI), systolic blood pressure, comorbidity score, and NSAID use]. We also explored a new injury from baseline to 48 months and from 48- to 96 months. Adults with greater baseline and 48-month BMI were more likely to develop AKOA. Injury was only associated with AKOA onset when it occurred within 4 years of developing AKOA [prior 2 years: odds ratio = 6.21; 95% confidence interval (CI) 3.40, 11.35; 2-4 years prior: odds ratio = 4.42, 95% CI 2.06, 9.50]. BMI may consistently predispose an adult to AKOA, but certain injuries are likely a catalyst for AKOA.
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