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Szilagyi IA, Waarsing JH, van Meurs JBJ, Bierma-Zeinstra SMA, Schiphof D. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatology (Oxford) 2023; 62:2037-2047. [PMID: 36495186 PMCID: PMC10234207 DOI: 10.1093/rheumatology/keac688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/01/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Previous systematic reviews focused on the evidence of common risk factors for knee OA (KOA); however, the effect and strength of association between risk factors and KOA might be different between the two sexes. The aim of the present systematic review was to determine the current evidence on sex differences in the association between risk factors and KOA and their prevalence. METHODS We searched the following electronic bibliographic databases: MEDLINE (PubMed), EMBASE and Web of Science. A methodological quality assessment was conducted independently by two researchers according to an adapted version of the standardized set of criteria known as the Newcastle-Ottawa Quality Assessment Scale (NOS). The NOS, a star system, was converted to three categories of quality. RESULTS In total, 27 studies reported sex-specific risk estimates on several risk factors for KOA. Out of the 22 longitudinal cohort studies (except one nested case-control), 12 were of good quality and 10 were of fair quality. The five cross-sectional studies consisted of one of good, three of fair and one of poor quality. There was an indication of sex differences in risk factors leading to higher risk of KOA: high BMI, alcohol consumption, atherosclerosis and high vitamin E levels in women, and high physical activity, soft drink consumption and abdominal obesity in men. Knee injury, high blood pressure and low step rate seem to affect both women and men. CONCLUSION More good quality studies are needed to assess sex differences in risk factors for KOA, especially for symptomatic/clinical OA.
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Affiliation(s)
- Ingrid A Szilagyi
- Correspondence to: Ingrid A. Szilagyi, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2400, Rotterdam 3000 CA, The Netherlands. E-mail:
| | - Jan H Waarsing
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Tudorachi NB, Totu T, Eva I, Bărbieru B, Totu EE, Fifere A, Pinteală T, Sîrbu PD, Ardeleanu V. Knee Osteoarthritis in Relation to the Risk Factors of the Metabolic Syndrome Components and Environment of Origin. J Clin Med 2022; 11:jcm11247302. [PMID: 36555918 PMCID: PMC9781325 DOI: 10.3390/jcm11247302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2022] [Revised: 11/26/2022] [Accepted: 12/06/2022] [Indexed: 12/14/2022] Open
Abstract
Background: Knee osteoarthritis (KOA) is a chronic degenerative pathology that is associated with multiple risk factors such as age, sex, obesity, or metabolic syndrome (MetS). The present clinical trial aimed to investigate the influence of the environment of origin, body mass index (BMI), and MetS parameters on the KOA differentiated degrees. Methods: 85 patients were admitted for the clinical study. The KOA presence was investigated using X-rays analysis. The Kellgren−Lawrence classification (KL) of the KOA severity and the MetS characteristic parameters using freshly collected blood were performed for each patient. All data collected were used for ANOVA statistic interpretation. Results: The total cholesterol and glycemia were found to be statistically significant (p < 0.028, and p < 0.03, respectively), with a high level in patients with severe KOA compared to healthy ones. Patients from rural regions are 5.18 times more prone to develop severe KOA when compared to ones from urban areas. Conclusions: The results of the statistical analysis confirmed the correlation between the incidence and severity of KOA and the influence of increased values of BMI, glycemia, triglycerides, and total cholesterol. The investigations revealed a statistically significant influence of the environment of origin on the KOA degree of the patients.
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Affiliation(s)
- Nicoleta Bianca Tudorachi
- Faculty of Medicine, “Ovidius” University of Constanța, Mamaia Boulevard 124, 900527 Constanța, Romania
| | - Tiberiu Totu
- Department of Health Sciences and Technology (D-HEST), ETH Zurich, 8093 Zurich, Switzerland
| | - Iuliana Eva
- Radiology and Medical Imaging Laboratory, “Iacob Czihac” Emergency Military Clinical Hospital, 7-9 General Henri Mathias Berthelot St., 700483 Iași, Romania
| | - Bogdan Bărbieru
- Department of Orthopedics and Traumatology, “Iacob Czihac” Emergency Military Clinical Hospital, 7-9 General Henri Mathias Berthelot St., 700483 Iași, Romania
| | - Eugenia Eftimie Totu
- Department of Analytical Chemistry and Environmental Engineering, Faculty of Industrial Chemistry and Biotechnologies, University Politehnica of Bucharest, 1-5 Polizu Street, Sector 1, 011061 Bucharest, Romania
- Correspondence: (E.E.T.); (A.F.)
| | - Adrian Fifere
- Centre of Advanced Research in Bionanoconjugates and Biopolymers, “Petru Poni” Institute of Macromolecular Chemistry, 41A Grigore Ghica Voda Alley, 700487 Iași, Romania
- Correspondence: (E.E.T.); (A.F.)
| | - Tudor Pinteală
- Department of Orthopedics and Traumatology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, 16 University Street, 7001 Iași, Romania
| | - Paul-Dan Sîrbu
- Department of Orthopedics and Traumatology, Faculty of Medicine, Grigore T Popa University of Medicine and Pharmacy, 16 University Street, 7001 Iași, Romania
| | - Valeriu Ardeleanu
- Faculty of Medicine, “Ovidius” University of Constanța, Mamaia Boulevard 124, 900527 Constanța, Romania
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Goode AP, Cleveland RJ, George SZ, Schwartz TA, Kraus VB, Renner JB, Gracely RH, DeFrate LE, Hu D, Jordan JM, Golightly YM. Predictors of Lumbar Spine Degeneration and Low Back Pain in the Community: The Johnston County Osteoarthritis Project. Arthritis Care Res (Hoboken) 2022; 74:1659-1666. [PMID: 33973412 PMCID: PMC8578580 DOI: 10.1002/acr.24643] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 04/23/2021] [Accepted: 05/04/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To determine the incidence and worsening of lumbar spine structure and low back pain (LBP) and whether they are predicted by demographic characteristics or clinical characteristics or appendicular joint osteoarthritis (OA). METHODS Paired baseline (2003-2004) and follow-up (2006-2010) lumbar spine radiographs from the Johnston County Osteoarthritis Project were graded for osteophytes (OST), disc space narrowing (DSN), spondylolisthesis, and presence of facet joint OA (FOA). Spine OA was defined as at least mild OST and mild DSN at the same level for any level of the lumbar spine. LBP, comorbidities, and back injury were self-reported. Weibull models were used to estimate hazard ratios (HRs) and 95% confidence intervals (95% CIs) of spine phenotypes accounting for potential predictors including demographic characteristics, clinical characteristics, comorbidities, obesity, and appendicular OA. RESULTS Obesity was a consistent and strong predictor of incidence of DSN (HR 1.80 [95% CI 1.09-2.98]), spine OA (HR 1.56 [95% CI 1.01-2.41]), FOA (HR 4.99 [95% CI 1.46-17.10]), spondylolisthesis (HR 1.87 [95% CI 1.02-3.43]), and LBP (HR 1.75 [95% CI 1.19-2.56]), and worsening of DSN (HR 1.51 [95% CI 1.09-2.09]) and LBP (HR 1.51 [95% CI 1.12-2.06]). Knee OA was a predictor of incident FOA (HR 4.18 [95% CI 1.44-12.2]). Spine OA (HR 1.80 [95% CI 1.24-2.63]) and OST (HR 1.85 [95% CI 1.02-3.36]) were predictors of incidence of LBP. Hip OA (HR 1.39 [95% CI 1.04-1.85]) and OST (HR 1.58 [95% CI 1.00-2.49]) were predictors of LBP worsening. CONCLUSION Among the multiple predictors of spine phenotypes, obesity was a common predictor for both incidence and worsening of lumbar spine degeneration and LBP.
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Affiliation(s)
- Adam P. Goode
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, NC, USA
| | - Rebecca J. Cleveland
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Steven Z. George
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Clinical Research Institute, Duke University School of Medicine, Durham, NC, USA
| | - Todd A. Schwartz
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Biostatistics, University of North Carolina, Chapel Hill, NC, USA
| | - Virginia B. Kraus
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Duke Molecular Physiology Institute and Department of Medicine, Duke University School of Medicine, Durham, NC, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina, Chapel Hill, NC, USA
| | - Richard H. Gracely
- Department of Endodontics, Adams School of Dentistry, University of North Carolina, Chapel Hill, NC, USA
| | - Louis E. DeFrate
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC, USA
- Department of Mechanical Engineering and Materials Science, Duke University, Durham, NC, USA
- Department of Biomedical Engineering, Duke University, Durham, NC, USA
| | - David Hu
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
| | - Joanne M. Jordan
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Orthopedics, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
- Injury Prevention Research Center, University of North Carolina, Chapel Hill, NC, USA
- Division of Physical Therapy, University of North Carolina, Chapel Hill, NC, USA
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How Do Drugs Affect the Skeleton? Implications for Forensic Anthropology. BIOLOGY 2022; 11:biology11040524. [PMID: 35453723 PMCID: PMC9030599 DOI: 10.3390/biology11040524] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Revised: 02/21/2022] [Accepted: 03/18/2022] [Indexed: 01/10/2023]
Abstract
Simple Summary Forensic anthropologists analyze human remains to assist in the identification of the deceased, predominantly by assessing age-at-death, sex, stature, ancestry and any unique identifying features. Whilst methods have been established to create this biological profile of the skeleton, these may be influenced by a number of factors. This paper, for the first time, provides an overview from a reading of the clinical and pharmacological literature to explore whether the intake of drugs can affect the skeleton and whether these may have implications for forensic anthropology casework. In effect, drugs such as tobacco, heroin, and prescription medications can alter bone mineral density, can increase the risk of fractures, destroy bone and changes to the dentition. By considering how drugs can affect the skeleton, forensic anthropologists can be aware of this when attempting to identify the deceased. Abstract Forensic anthropologists rely on a number of parameters when analyzing human skeletal remains to assist in the identification of the deceased, predominantly age-at-death, sex, stature, ancestry or population affinity, and any unique identifying features. During the examination of human remains, it is important to be aware that the skeletal features considered when applying anthropological methods may be influenced and modified by a number of factors, and particular to this article, prescription drugs (including medical and non-medical use) and other commonly used drugs. In view of this, this paper aims to review the medical, clinical and pharmacological literature to enable an assessment of those drug groups that as side effects have the potential to have an adverse effect on the skeleton, and explore whether or not they can influence the estimation of age-at-death, sex and other indicators of the biological profile. Moreover, it may be that the observation of certain alterations or inconsistencies in the skeleton may relate to the use of drugs or medication, and this in turn may help narrow down the list of missing persons to which a set of human remains could belong. The information gathered from the clinical and medical literature has been extracted with a forensic anthropological perspective and provides an awareness on how several drugs, such as opioids, cocaine, corticosteroids, non-steroidal anti-inflammatory drugs, alcohol, tobacco and others have notable effects on bone. Through different mechanisms, drugs can alter bone mineral density, causing osteopenia, osteoporosis, increase the risk of fractures, osteonecrosis, and oral changes. Not much has been written on the influence of drugs on the skeleton from the forensic anthropological practitioner perspective; and this review, in spite of its limitations and the requirement of further research, aims to investigate the current knowledge of the possible effects of both prescription and recreational drugs on bones, contributing to providing a better awareness in forensic anthropological practice and assisting in the identification process of the deceased.
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Alenazi AM, Alqahtani BA, Vennu V, Alshehri MM, Alanazi AD, Alrawaili SM, Khunti K, Segal NA, Bindawas SM. Gait Speed as a Predictor for Diabetes Incidence in People with or at Risk of Knee Osteoarthritis: A Longitudinal Analysis from the Osteoarthritis Initiative. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:4414. [PMID: 33919455 PMCID: PMC8122394 DOI: 10.3390/ijerph18094414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Revised: 03/30/2021] [Accepted: 04/16/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND This study examined the association between baseline gait speed with incident diabetes mellitus (DM) among people with or at elevated risk for knee OA. MATERIALS AND METHODS Participants from the Osteoarthritis Initiative, aged 45 to 79 years, where included. Participants with or at risk of knee OA from baseline to the 96-month visit were included. Participants with self-reported DM at baseline were excluded. DM incidence was followed over the 4-time points. Gait speed was measured at baseline using a 20-m walk test. Generalized estimating equations with logistic regression were utilized for analyses. Receiver operator characteristic curves and area under the curve were used to determine the cutoff score for baseline speed. RESULTS Of the 4313 participants included in the analyses (58.7% females), 301 participants had a cumulative incidence of DM of 7.0% during follow-up. Decreased gait speed was a significant predictor of incident DM (RR 0.44, p = 0.018). The threshold for baseline gait speed that predicted incident DM was 1.32 m/s with an area under the curve of 0.59 (p < 0.001). CONCLUSIONS Baseline gait speed could be an important screening tool for identifying people at risk of incident diabetes, and the determined cutoff value for gait speed should be examined in future research.
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Affiliation(s)
- Aqeel M. Alenazi
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Bader A. Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Vishal Vennu
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (V.V.); (S.M.B.)
| | - Mohammed M. Alshehri
- Department of Physical Therapy, College of Applied Medical Sciences, Jazan University, Jizan 45142, Saudi Arabia;
| | - Ahmad D. Alanazi
- Department of Physical Therapy, College of Applied Medical Sciences, Majmaah University, Al Majmaah 11952, Saudi Arabia;
| | - Saud M. Alrawaili
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, AlKharj 11942, Saudi Arabia; (B.A.A.); (S.M.A.)
| | - Kamlesh Khunti
- Diabetes Research Centre, University of Leicester, Leicester General Hospital, Gwendolen Road, Leicester LE5 4PW, UK;
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS 66160, USA;
| | - Saad M. Bindawas
- Department of Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 11433, Saudi Arabia; (V.V.); (S.M.B.)
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Wang H, Zhu Z, Wu J, Wang H, Gao L, Xiao J. Effect of type II diabetes-induced osteoarthritis on articular cartilage aging in rats: A study in vivo and in vitro. Exp Gerontol 2021; 150:111354. [PMID: 33872738 DOI: 10.1016/j.exger.2021.111354] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/05/2021] [Accepted: 04/07/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVES Some evidence suggests that type II diabetes mellitus (T2DM) and osteoarthritis (OA) usually occur together clinically, and the symptoms are more obvious compared with non-diabetic patients with OA. We aimed to explore the effects in cartilage degradation, damage, and aging after T2DM combined with OA. METHODS Thirty male Sprague-Dawley (SD) rats were randomly divided into the young-control group (YCG, n = 10), old-control group (OCG, n = 10), and old T2DM-induced OA group (OTOG, n = 10) after the pre-experiment. T2DM model was established using a high-fat diet and streptozotocin. In vivo, all rats were evaluated by behavior, histology, immunohistochemistry, and enzyme-linked immunosorbent assay (ELISA). In vitro, chondrocytes of 17-day-old SD rats were cultured to obtain the passage 1 (P1) and passage 5 (P5) chondrocytes. The effects of different concentrations glucose on chondrocyte senescence were evaluated by chondrocyte staining, immunofluorescence, western blotting, and ROS analysis. RESULTS The results of histology (hematoxylin-eosin staining, safranin O-fast green staining, alizarin red S staining, and Mankin score), immunohistochemistry (COL-II, MMP-13, and p21), ELISA (IL-6 and IL-8), western blotting (COL-II, MMP-13, p21, p53, and p16), immunofluorescence, and ROS analysis indicated that the degeneration and aging in the articular cartilage of OTOG were more serious than other groups. Moreover, high concentration glucose can accelerated the degradation and aging degree of cartilage. The changes in P5 are more obvious than in P1 cells. CONCLUSION T2DM-induced OA can aggravate the aging of articular cartilage in aging individuals. High concentration glucose can cause a certain degree of damage, degradation, and aging of chondrocytes.
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Affiliation(s)
- Haoran Wang
- Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Zihan Zhu
- Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Junnan Wu
- Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Hongbin Wang
- Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Li Gao
- Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China
| | - Jianhua Xiao
- Laboratory of the Provincial Education Department of Heilongjiang for Common Animal Disease Prevention and Treatment, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China.
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Perry TA, Wang X, Nevitt M, Abdelshaheed C, Arden N, Hunter DJ. Association between current medication use and progression of radiographic knee osteoarthritis: data from the Osteoarthritis Initiative. Rheumatology (Oxford) 2021; 60:4624-4632. [PMID: 33502488 PMCID: PMC8487312 DOI: 10.1093/rheumatology/keab059] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/14/2020] [Indexed: 02/02/2023] Open
Abstract
Objective Use of specific medications may accelerate the progression of radiographic knee OA (RKOA). Our aim was to examine the effect of medication use on the progression of RKOA. Methods We used longitudinal data from the Osteoarthritis Initiative (OAI), an observational study of risk factors for knee OA. At baseline, we selected participants with RKOA (Kellgren–Lawrence grade ≥2) and excluded those with a history of knee-related injury/surgery and other musculoskeletal disorders. Current medication use (use/non-use in the previous 30 days) and radiographic medial minimum joint space width (mJSW) data were available at baseline and annually up to 96 months follow-up. We used random effects, panel regression to assess the association between current medication use (non-users as reference group) and change in mJSW. Results Of 2054 eligible participants, 2003 participants with baseline mJSW data were included [55.7% female, mean age 63.3 (s.d. 8.98) years]. Of seven medication classes, at baseline NSAIDs were the most frequently used analgesia (14.7%), anti-histamine (10.4%) use was frequent and the following comorbidity medications were used most frequently: statins (27.4%), anti-hypertensives (up to 15.0%), anti-depressant/anxiolytics/psychotropics (14.0%), osteoporosis-related medication (10.9%) and diabetes-related medication (6.9%). Compared with current non-users, current use of NSAIDs was associated with a loss of mJSW (b = −0.042, 95% CI −0.08, −0.0004). No other associations were observed. Conclusions In current users of NSAIDs, mJSW loss was increased compared with current non-users in participants with RKOA. Clinical trials are required to assess the potential disease-modifying effects of these medications.
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Affiliation(s)
- Thomas A Perry
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom.,Institute of Bone and Joint Research, Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Xia Wang
- Institute of Bone and Joint Research, Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Michael Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Christina Abdelshaheed
- Faculty of Medicine and Health, School of Public Health, University of Sydney, New South Wales, Australia.,Institute for Musculoskeletal Health, University of Sydney, Sydney, Australia
| | - Nigel Arden
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Botnar Research Centre, University of Oxford, Oxford, United Kingdom.,MRC Lifecourse Epidemiology Unit, Southampton General Hospital, University of Southampton, Southampton, United Kingdom
| | - David J Hunter
- Institute of Bone and Joint Research, Rheumatology Department, Royal North Shore Hospital, University of Sydney, Sydney, New South Wales, Australia
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Roman-Blas JA, Mendoza-Torres LA, Largo R, Herrero-Beaumont G. Setting up distinctive outcome measures for each osteoarthritis phenotype. Ther Adv Musculoskelet Dis 2020; 12:1759720X20937966. [PMID: 32973934 PMCID: PMC7491224 DOI: 10.1177/1759720x20937966] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Accepted: 06/05/2020] [Indexed: 12/16/2022] Open
Abstract
Osteoarthritis (OA) is an evolving chronic joint disease with a huge global impact. Given the intricate nature of the etiopathogenesis and subsequent high heterogeneity in the clinical course of OA, it is crucial to discriminate between etiopathogenic endotypes and clinical phenotypes, especially in the early stages of the disease. In this sense, we propose that an OA phenotype should be properly assessed with a set of outcome measures including those specifically related to the main underlying pathophysiological mechanisms. Thus, each OA phenotype can be related to different and clinically meaningful outcomes. OA phenotyping would lead to an adequate patient stratification in well-designed clinical trials and the discovery of precise therapeutic approaches. A significant effort will be required in this field in light of inconclusive results of clinical trials of tissue-targeting agents for the treatment of OA.
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Affiliation(s)
- Jorge A Roman-Blas
- Joint and Bone Research Unit, IIS-Fundacion Jimenez Diaz, UAM, Av. Reyes Catolicos 2, Madrid, 28040, Spain
| | | | - Raquel Largo
- Joint and Bone Research Unit, IIS-Fundacion Jimenez Diaz UAM, Madrid, Spain
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Alenazi AM, Alshehri MM, Alothman S, Alqahtani BA, Rucker J, Sharma NK, Bindawas SM, Kluding PM. The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative. Phys Ther 2020; 100:1977-1986. [PMID: 32750122 PMCID: PMC7596886 DOI: 10.1093/ptj/pzaa144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) and diabetes mellitus (DM) often coexist and can result in negative outcomes. DM can affect pain and walking speed in people with knee OA; however, the impact of DM on OA is understudied. The purpose of this study was to investigate the association between diabetes and knee pain locations, pain severity while walking, and walking speed in people with knee OA. METHODS A cross-sectional analysis was used. Data from 1790 individuals from the Osteoarthritis Initiative (mean [SD] age = 69 [8.7] years) with knee pain were included and grouped into knee OA and diabetes (n = 236) or knee OA only (n = 1554). Knee pain locations were categorized as no pain, localized pain, regional pain, or diffuse pain. Knee pain during a 20-m walk test was categorized as no pain, mild, moderate, or severe knee pain. Walking speed was measured using the 20-m walk test. Multinomial and linear regression analyses were performed. RESULTS Diabetes was associated with regional knee pain (odds ratio [OR] = 1.77; 95% CI = 1.01-3.11). Diabetes was associated only with moderate (OR = 1.78; 95% CI = 1.02-3.10) or severe (OR = 2.52; 95% CI = 1.01-6.28) pain while walking. Diabetes was associated with decreased walking speed (B = -0.064; 95% CI = -0.09 to -0.03). CONCLUSIONS Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA. IMPACT Clinicians can use a knee pain map for examining knee pain locations for people with diabetes and knee OA. Knee pain during walking and walking speed should be screened for people with knee OA and diabetes because of the influence of diabetes on these parameters in this population. LAY SUMMARY Diabetes might be associated with specific knee pain locations, pain during activities such as walking, and reduced walking speed in people with knee OA.
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Affiliation(s)
| | | | - Shaima Alothman
- Lifestyle and Health Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
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Metabolic syndrome, hypertension, and hyperglycemia were positively associated with knee osteoarthritis, while dyslipidemia showed no association with knee osteoarthritis. Clin Rheumatol 2020; 40:711-724. [PMID: 32705443 DOI: 10.1007/s10067-020-05216-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2019] [Revised: 05/05/2020] [Accepted: 06/02/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVE Metabolic syndrome (MetS) is a clustering of at least three of the following four medical conditions: obesity, hypertension, dyslipidemia, and hyperglycemia. We aimed to discover the relationships between these diseases and osteoarthritis (OA) of the knee. METHODS We searched four databases (EMBASE, PubMed, Cochrane Library, and MEDLINE), as well as articles on websites and conference materials. Study effect estimates and their 95% confidence intervals (CIs) were extracted and calculated. Sensitivity analyses were undertaken to determine inter-study heterogeneity. Finally, we tested for publication bias to determine whether the outcome of the meta-analysis was robust. RESULTS A total of 1609 articles were identified, 40 of which were included. In radiological studies, the relationships with OA were increased for people with the following diseases: metabolic syndrome (OR 1.418, 95% CI 1.162 to 1.730), hypertension (OR 1.701, 95% CI 1.411 to 2.052), and hyperglycemia (OR 1.225, 95% CI 1.054 to 1.424). In symptomatic studies, the outcomes were similar in metabolic syndrome (OR 1.174, 95% CI 1.034 to 1.332) and hypertension (OR 1.324, 95% CI 1.186 to 1.478) studies, while there were no associations in hyperglycemia (OR 0.975, 95% CI 0.860 to 1.106) studies. There was no correlation between dyslipidemia and OA, whether in radiological studies (OR 1.216, 95% CI 0.968 to 1.529) or symptomatic studies (OR 1.050, 95% CI 0.961 to 1.146). CONCLUSIONS In both studies, metabolic syndrome and hypertension were positively associated with knee OA, and dyslipidemia showed no correlations. Hyperglycemia was associated with OA in radiological studies, while results were reversed in symptomatic studies. Key Points • The hypothesis that metabolic syndrome and its components increase the risk for knee osteoarthritis is attractive; thus, this meta-analysis may help us find out the answer. • There were lots of large-scale studies here, and the total participants were considerable; and this meta-analysis was relatively robust because of reasonable heterogeneity and publication bias. • Targeted education and effective management of risk factors may be helpful for reducing the prevalence of knee osteoarthritis.
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Insulin Resistance in Osteoarthritis: Similar Mechanisms to Type 2 Diabetes Mellitus. J Nutr Metab 2020; 2020:4143802. [PMID: 32566279 PMCID: PMC7261331 DOI: 10.1155/2020/4143802] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/01/2020] [Accepted: 05/11/2020] [Indexed: 02/06/2023] Open
Abstract
Osteoarthritis (OA) and type 2 diabetes mellitus (T2D) are two of the most widespread chronic diseases. OA and T2D have common epidemiologic traits, are considered heterogenic multifactorial pathologies that develop through the interaction of genetic and environmental factors, and have common risk factors. In addition, both of these diseases often manifest in a single patient. Despite differences in clinical manifestations, both diseases are characterized by disturbances in cellular metabolism and by an insulin-resistant state primarily associated with the production and utilization of energy. However, currently, the primary cause of OA development and progression is not clear. In addition, although OA is manifested as a joint disease, evidence has accumulated that it affects the whole body. As pathological insulin resistance is viewed as a driving force of T2D development, now, we present evidence that the molecular and cellular metabolic disturbances associated with OA are linked to an insulin-resistant state similar to T2D. Moreover, the alterations in cellular energy requirements associated with insulin resistance could affect many metabolic changes in the body that eventually result in pathology and could serve as a unified mechanism that also functions in many metabolic diseases. However, these issues have not been comprehensively described. Therefore, here, we discuss the basic molecular mechanisms underlying the pathological processes associated with the development of insulin resistance; the major inducers, regulators, and metabolic consequences of insulin resistance; and instruments for controlling insulin resistance as a new approach to therapy.
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Rogers-Soeder TS, Lane NE, Walimbe M, Schwartz AV, Tolstykh I, Felson DT, Lewis CE, Segal NA, Nevitt MC. Association of Diabetes Mellitus and Biomarkers of Abnormal Glucose Metabolism With Incident Radiographic Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2020; 72:98-106. [PMID: 30418707 PMCID: PMC6511494 DOI: 10.1002/acr.23809] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Accepted: 11/06/2018] [Indexed: 01/08/2023]
Abstract
OBJECTIVE The association of diabetes mellitus (DM) with increased risk of knee osteoarthritis (OA) is uncertain. We evaluated associations of DM and biomarkers of abnormal glucose metabolism with incident radiographic knee OA, controlling for body mass index (BMI). METHODS Participants (mean ± SD age 60.6 ± 7.8 years; mean ± SD body mass index [BMI] 29.1 ± 4.9 kg/m2 ) were from the Multicenter Osteoarthritis Study and did not have radiographic knee OA at baseline (Kellgren/Lawrence [K/L] grade <2 bilaterally). A random sample (n = 987) was selected and stratified by BMI. Baseline serum fasting glucose and homeostasis model assessment-estimated insulin resistance (HOMA-IR) were measured. Participants were categorized as having DM based on self-report, use of medication, or fasting glucose ≥126 mg/dl. Incident radiographic knee OA (K/L grade ≥2 or knee replacement) was assessed at 3 follow-up visits (30, 60, and 84 months). Knee-level pooled logistic regression analysis was performed to obtain odds ratios (ORs) (95% confidence interval [95% CI]) for associations of DM status and biomarkers of abnormal glucose metabolism with incident radiographic knee OA. RESULTS After adjustment for BMI, the odds of incident radiographic knee OA were not associated with baseline DM status nor with levels of fasting glucose and HOMA-IR, overall and in men. In women, HOMA-IR was inversely associated with odds of incident radiographic knee OA (adjusted OR 0.80 [95% CI 0.69-0.94], P = 0.005). CONCLUSION DM and higher levels of biomarkers of abnormal glucose metabolism were not associated with increased odds of incident radiographic knee OA after adjusting for BMI in this cohort overall. A possible protective association of higher HOMA-IR with incident radiographic knee OA in women warrants further investigation.
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Affiliation(s)
- Tara S. Rogers-Soeder
- Center for Musculoskeletal Health, Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, USA
| | - Nancy E. Lane
- Center for Musculoskeletal Health, Department of Internal Medicine, University of California at Davis School of Medicine, Sacramento, CA, USA
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Mona Walimbe
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
- Division of Endocrinology and Metabolism, Department of Medicine, University of California San Francisco, San Francisco, CA, USA
| | - Ann V. Schwartz
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - Irina Tolstykh
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
| | - David T. Felson
- Clinical Epidemiology Unit, Boston University School of Medicine, Boston, MA, USA
- University of Manchester and Central Manchester Foundation Trust, Manchester, UK
| | - Cora E. Lewis
- Division of Preventive Medicine, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Neil A. Segal
- Department of Rehabilitation Medicine, University of Kansas, Kansas City, KS, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, CA, USA
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Veronese N, Cooper C, Reginster JY, Hochberg M, Branco J, Bruyère O, Chapurlat R, Al-Daghri N, Dennison E, Herrero-Beaumont G, Kaux JF, Maheu E, Rizzoli R, Roth R, Rovati LC, Uebelhart D, Vlaskovska M, Scheen A. Type 2 diabetes mellitus and osteoarthritis. Semin Arthritis Rheum 2019; 49:9-19. [PMID: 30712918 PMCID: PMC6642878 DOI: 10.1016/j.semarthrit.2019.01.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) are common diseases that frequently co-exist, along with overweight/obesity. While the mechanical impact of excess body weight on joints may explain lower limb OA, we sought to explore whether T2DM is linked to OA outside of excess weight and whether T2DM may play a role in OA pathophysiology. The consequence of T2DM on OA outcomes is a question of research interest. METHODS We conducted a critical review of the literature to explore the association between T2DM and OA, whether any association is site-specific for OA, and whether the presence of T2DM impacts on OA outcomes. We also reviewed the literature to assess the safety of anti-OA treatments in patients with T2DM. RESULTS T2DM has a pathogenic effect on OA through 2 major pathways involving oxidative stress and low-grade chronic inflammation resulting from chronic hyperglycemia and insulin resistance. T2DM is a risk factor for OA progression and has a negative impact on arthroplasty outcomes. Evidence is mounting for safety concerns with some of the most frequently prescribed anti-OA medications, including paracetamol, non-steroidal anti-inflammatory drugs, and corticosteroid injections, while other anti-OA medications may be safely prescribed in OA patients with T2DM, such as glucosamine and intra-articular hyaluronic acid. CONCLUSIONS Future research is needed to better understand whether diabetes control and prevention can modulate OA occurrence and progression. The selection of therapy to treat OA symptoms in patients with T2DM may require careful consideration of the evidence based to avoid untoward safety issues.
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Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium; Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000 Liège, Belgium; Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Marc Hochberg
- Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research, Education and Clinical Center, Baltimore, MD, USA; Medical Care Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA
| | - Jaime Branco
- CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Department of Rheumatology, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium; Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000 Liège, Belgium
| | - Roland Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 Lyon cedex 03, France
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology, Bone and Joint Research Unit, Fundación Jiménez Diaz, Universidad Autonoma, Madrid, Spain
| | - Jean-François Kaux
- Department of Physical & Rehabilitation Medicine and Sports Traumatology, SportS(2), FIFA Medical Centre of Excellence, University and University Hospital of Liège, 4000 Liège, Belgium
| | - Emmanuel Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, 4 Blvd. Beaumarchais, 75011 Paris, France
| | - René Rizzoli
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium; Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Roland Roth
- Max-Reger-Strasse 17-19, 45128 Essen-Suedviertel, Germany
| | - Lucio C Rovati
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy; Department of Clinical Research, Rottapharm Biotech, Monza, Italy
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Department of Orthopaedics and Traumatology, Hôpital du Valais (HVS), Centre Hospitalier du Valais Romand (CHVR), CVP, Crans-Montana, Switzerland
| | - Mila Vlaskovska
- Medical University Sofia, Medical Faculty, Department of Pharmacology, 2, Zdrave str., 1431 Sofia, Bulgaria
| | - André Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders and Clinical Pharmacology Unit, Department of Medicine, University of Liège, CHU Liège, Sart Tilman B35, B-4000 Liège, Belgium
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