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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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Cao H, Zhou X, Xu B, Hu H, Guo J, Wang M, Li N, Jun Z. Advances in the study of mitophagy in osteoarthritis. J Zhejiang Univ Sci B 2024; 25:197-211. [PMID: 38453635 PMCID: PMC10918408 DOI: 10.1631/jzus.b2300402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Accepted: 08/21/2023] [Indexed: 03/09/2024]
Abstract
Osteoarthritis (OA), characterized by cartilage degeneration, synovial inflammation, and subchondral bone remodeling, is among the most common musculoskeletal disorders globally in people over 60 years of age. The initiation and progression of OA involves the abnormal metabolism of chondrocytes as an important pathogenic process. Cartilage degeneration features mitochondrial dysfunction as one of the important causative factors of abnormal chondrocyte metabolism. Therefore, maintaining mitochondrial homeostasis is an important strategy to mitigate OA. Mitophagy is a vital process for autophagosomes to target, engulf, and remove damaged and dysfunctional mitochondria, thereby maintaining mitochondrial homeostasis. Cumulative studies have revealed a strong association between mitophagy and OA, suggesting that the regulation of mitophagy may be a novel therapeutic direction for OA. By reviewing the literature on mitophagy and OA published in recent years, this paper elaborates the potential mechanism of mitophagy regulating OA, thus providing a theoretical basis for studies related to mitophagy to develop new treatment options for OA.
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Affiliation(s)
- Hong Cao
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
- National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai 200433, China
| | - Xuchang Zhou
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing 100084, China
| | - Bowen Xu
- National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai 200433, China
| | - Han Hu
- National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai 200433, China
| | - Jianming Guo
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
| | - Miao Wang
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai 200438, China
| | - Nan Li
- National Key Laboratory of Immunity and Inflammation, Naval Medical University, Shanghai 200433, China.
| | - Zou Jun
- Department of Sport Rehabilitation, Shanghai University of Sport, Shanghai 200438, China.
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3
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Pelletier JP, Paiement P, Dorais M, Raynauld JP, Martel-Pelletier J. Risk factors for the long-term incidence and progression of knee osteoarthritis in older adults: role of nonsurgical injury. Ther Adv Chronic Dis 2023; 14:20406223231169715. [PMID: 37197137 PMCID: PMC10184209 DOI: 10.1177/20406223231169715] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 03/28/2023] [Indexed: 05/19/2023] Open
Abstract
Background For one of the most chronic medical conditions, osteoarthritis, uncertainties remain on the impact of injury chronology, the role of repeat injury on the incidence/progression of this disease and the need for knee arthroplasty. Objectives To explore, in an older adult population, how nonsurgical knee injuries relate to osteoarthritis incidence/progression and the weight of independent risk factors for arthroplasty. Design A cohort study design evaluates the long-term impact of injuries on knee osteoarthritis outcomes. Methods Knees with no prior injury (n = 6358) and with at least one injury (n = 819) ⩽20 years before study inclusion were from the Osteoarthritis Initiative cohort. Sociodemographic, clinical and structural [X-ray, magnetic resonance imaging (MRI)] data at study inclusion and changes within 96 months were analysed. Statistics included a mixed model for repeated measurements, generalized estimating equations and multivariable Cox regression with covariates. Results At inclusion, knees with prior injury demonstrated greater incidence and severity of osteoarthritis (p ⩽ 0.001). At 96 months, there was a greater increase in symptoms [Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain, p = 0.002], joint space width (JSW, p = 0.039) loss, medial cartilage volume loss (CVL, p ⩽ 0.001) and bone marrow lesion size (BML, p ⩽ 0.049). Knees with/without injury at inclusion but with new ones over time had a pronounced increase in symptoms (all WOMAC scores, p ⩽ 0.001), JSW loss, lateral (without) and medial CVL, lateral (without) and medial meniscal extrusion and medial BML (without; all p ⩽ 0.030). Levels of lateral and medial meniscal extrusion (without) and symptoms (with/without; all WOMAC scores, p ⩽ 0.001) were all accentuated with a repeated new injury. Risk factors associated with the highest knee arthroplasty occurrence are new meniscal extrusion and new injury (p ⩽ 0.001). Conclusion This study highlights the importance of nonsurgical knee injury in older adults as an independent risk factor for knee osteoarthritis and arthroplasty. These data will be beneficial in clinical practice as they will help identify individuals at greater risk of significant disease progression and worst disease outcomes for a customized therapeutic approach.
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Affiliation(s)
- Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), 900 Saint-Denis, Room R11.412A, Montreal, QC H2X 0A9, Canada
| | - Patrice Paiement
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Marc Dorais
- StatSciences Inc., Notre-Dame-de-l’Île-Perrot, QC, Canada
| | - Jean-Pierre Raynauld
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
| | - Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, QC, Canada
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4
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Sanchez-Lopez E, Coras R, Torres A, Lane NE, Guma M. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol 2022; 18:258-275. [PMID: 35165404 PMCID: PMC9050956 DOI: 10.1038/s41584-022-00749-9] [Citation(s) in RCA: 276] [Impact Index Per Article: 138.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) is a progressive degenerative disease resulting in joint deterioration. Synovial inflammation is present in the OA joint and has been associated with radiographic and pain progression. Several OA risk factors, including ageing, obesity, trauma and mechanical loading, play a role in OA pathogenesis, likely by modifying synovial biology. In addition, other factors, such as mitochondrial dysfunction, damage-associated molecular patterns, cytokines, metabolites and crystals in the synovium, activate synovial cells and mediate synovial inflammation. An understanding of the activated pathways that are involved in OA-related synovial inflammation could form the basis for the stratification of patients and the development of novel therapeutics. This Review focuses on the biology of the OA synovium, how the cells residing in or recruited to the synovium interact with each other, how they become activated, how they contribute to OA progression and their interplay with other joint structures.
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Affiliation(s)
- Elsa Sanchez-Lopez
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Roxana Coras
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Alyssa Torres
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Nancy E Lane
- Division of Rheumatology, Department of Medicine, University of California Davis, Davis, CA, USA
| | - Monica Guma
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
- San Diego VA Healthcare Service, San Diego, CA, USA.
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5
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Allen KD, Thoma LM, Golightly YM. Epidemiology of osteoarthritis. Osteoarthritis Cartilage 2022; 30:184-195. [PMID: 34534661 PMCID: PMC10735233 DOI: 10.1016/j.joca.2021.04.020] [Citation(s) in RCA: 181] [Impact Index Per Article: 90.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 04/01/2021] [Accepted: 04/19/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarize the current state of the evidence regarding osteoarthritis (OA) prevalence, incidence and risk factors at the person-level and joint-level. DESIGN This was a narrative review that took a comprehensive approach regarding inclusion of potential risk factors. The review complements prior reviews of OA epidemiology, with a focus on new research and emerging topics since 2017, as well as seminal studies. RESULTS Studies continue to illustrate the high prevalence of OA worldwide, with a greater burden among older individuals, women, some racial and ethnic groups, and individuals with lower socioeconomic status. Modifiable risk factors for OA with the strongest evidence are obesity and joint injury. Topics of high interest or emerging evidence for a potential association with OA risk or progression include specific vitamins and diets, high blood pressure, genetic factors, metformin use, bone mineral density, abnormal joint shape and malalignment, and lower muscle strength/quality. Studies also continue to highlight the heterogenous nature of OA, with strong interest in understanding and defining OA phenotypes. CONCLUSIONS OA is an increasingly prevalent condition with worldwide impacts on many health outcomes. The strong evidence for obesity and joint injury as OA risk factors calls for heightened efforts to mitigate these risks at clinical and public health levels. There is also a need for continued research regarding how potential person- and joint-level risk factors may interact to influence the development and progression of OA.
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Affiliation(s)
- K D Allen
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Center for Health Services Research in Primary Care, Department of Veterans Affairs Medical Center, Durham, NC, USA.
| | - L M Thoma
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Y M Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Division of Physical Therapy, Department of Allied Health Sciences, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA; Injury Prevention Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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6
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Wang K, Esbensen Q, Karlsen T, Eftang C, Owesen C, Aroen A, Jakobsen R. Low-Input RNA-Sequencing in Patients with Cartilage Lesions, Osteoarthritis, and Healthy Cartilage. Cartilage 2021; 13:550S-562S. [PMID: 34775802 PMCID: PMC8808811 DOI: 10.1177/19476035211057245] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE To analyze and compare cartilage samples from 3 groups of patients utilizing low-input RNA-sequencing. DESIGN Cartilage biopsies were collected from patients in 3 groups (n = 48): Cartilage lesion (CL) patients had at least ICRS grade 2, osteoarthritis (OA) samples were taken from patients undergoing knee replacement, and healthy cartilage (HC) was taken from ACL-reconstruction patients without CLs. RNA was isolated using an optimized protocol. RNA samples were assessed for quality and sequenced with a low-input SmartSeq2 protocol. RESULTS RNA isolation yielded 48 samples with sufficient quality for sequencing. After quality control, 13 samples in the OA group, 9 in the HC group, and 9 in the CL group were included in the analysis. There was a high degree of co-clustering between the HC and CL groups with only 6 genes significantly up- or downregulated. OA and the combined HC/CL group clustered significantly separate from each other, yielding 659 significantly upregulated and 1,369 downregulated genes. GO-term analysis revealed that genes matched to cartilage and connective tissue development terms. CONCLUSION The gene expression profiles from the 3 groups suggest that there are no major differences in gene expression between cartilage from knees with a cartilage injury and knees without an apparent cartilage injury. OA cartilage, as expected, showed markedly different gene expression from the other 2 groups. The gene expression profiles resulting from this low-input RNA-sequencing study offer opportunities to discover new pathways not previously recognized that may be explored in future studies.
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Affiliation(s)
- Katherine Wang
- Faculty of Medicine, University of
Oslo, Oslo, Norway,Oslo Sports Trauma Research Center,
Norwegian School of Sports Sciences, Oslo, Norway,Department of Orthopaedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Katherine Wang, Faculty of Medicine,
University of Oslo, P.O. Box 1072 Blindern, 0316 Oslo, Norway.
| | - Q.Y. Esbensen
- Department of Clinical Molecular
Biology (EpiGen), Akershus University Hospital, Lørenskog, Norway,Department of Clinical Molecular
Biology, University of Oslo, Oslo, Norway
| | - T.A. Karlsen
- Norwegian Center for Stem Cell
Research, Department of Immunology and Transfusion Medicine, Oslo University
Hospital, Rikshospitalet, Oslo, Norway
| | - C.N. Eftang
- Department of Pathology, Akershus
University Hospital, Lørenskog, Norway
| | - C. Owesen
- Department of Orthopaedic Surgery,
Akershus University Hospital, Lørenskog, Norway
| | - A. Aroen
- Oslo Sports Trauma Research Center,
Norwegian School of Sports Sciences, Oslo, Norway,Department of Orthopaedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Institute of Clinical Medicine, Faculty
of Medicine, University of Oslo, Oslo, Norway
| | - R.B. Jakobsen
- Department of Orthopaedic Surgery,
Akershus University Hospital, Lørenskog, Norway,Department of Health Management and
Health Economics, Institute of Health and Society, Faculty of Medicine, University
of Oslo, Oslo, Norway
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7
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Foreman SC, Liu Y, Nevitt MC, Neumann J, Joseph GB, Lane NE, McCulloch CE, Link TM. Meniscal Root Tears and Extrusion Are Significantly Associated with the Development of Accelerated Knee Osteoarthritis: Data from the Osteoarthritis Initiative. Cartilage 2021; 13:239S-248S. [PMID: 32567341 PMCID: PMC8808926 DOI: 10.1177/1947603520934525] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To identify joint structural risk factors, measured using quantitative compositional and semiquantitative magnetic resonance imaging (MRI) scoring, associated with the development of accelerated knee osteoarthritis (AKOA) compared with a more normal rate of knee osteoarthritis (OA) development. DESIGN From the Osteoarthritis Initiative we selected knees with no radiographic OA (Kellgren-Lawrence grade [KL] 0/1) that developed advanced-stage OA (KL 3/4; AKOA) within a 4-year timeframe and a comparison group with a more normal rate of OA development (KL 0/1 to KL 2 in 4 years). MRIs at the beginning of the 4-year timeframe were assessed for cartilage T2 values and structural abnormalities using a modified Whole-Organ Magnetic Resonance Imaging Score (WORMS). Associations of MRI findings with AKOA versus normal OA were assessed using multivariable logistic regression models. RESULTS A total of 106 AKOA and 168 subjects with normal OA development were included. Mean cartilage T2 values were not significantly associated with AKOA (odds ratio [OR] 1.06; 95% confidence interval [CI] 0.82-1.36). Risk factors for AKOA development included higher meniscus maximum scores (OR 1.37; 95% CI 1.11-1.68), presence of meniscal extrusion (OR 6.30; 95% CI 2.57-15.49), presence of root tears (OR 4.64; 95% CI 1.61-13.34), and higher medial tibia cartilage lesion scores (OR 1.96; 95% CI 1.19-3.24). CONCLUSIONS We identified meniscal damage, especially meniscal extrusion and meniscal root tears as risk factors for AKOA development. These findings contribute to identifying subjects at risk of AKOA at an early stage when preventative measures targeting modifiable risk factors such as meniscal repair surgery could still be effective.
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Affiliation(s)
- Sarah C. Foreman
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA,Department of Radiology, Technische
Universität München, Munich, Germany,Sarah C. Foreman, Department of Radiology
and Biomedical Imaging, University of California, San Francisco, 185 Berry
Street, Lobby 6, Suite 350, San Francisco, CA 94107, USA.
| | - Yao Liu
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, CA, USA
| | - Jan Neumann
- Department of Radiology, Technische
Universität München, Munich, Germany
| | - Gabby B. Joseph
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA
| | - Nancy E. Lane
- Department of Medicine, University of
California, Davis, CA, USA
| | - Charles E. McCulloch
- Department of Epidemiology and
Biostatistics, University of California, San Francisco, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical
Imaging, University of California, San Francisco, CA, USA
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8
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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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9
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Davis JE, Ward RJ, MacKay JW, Lu B, Price LL, McAlindon TE, Eaton CB, Barbe MF, Lo GH, Harkey MS, Driban JB. Effusion-synovitis and infrapatellar fat pad signal intensity alteration differentiate accelerated knee osteoarthritis. Rheumatology (Oxford) 2020; 58:418-426. [PMID: 30346594 DOI: 10.1093/rheumatology/key305] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2018] [Accepted: 09/04/2018] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVES To determine whether greater effusion-synovitis volume and infrapatellar fat pad (IFP) signal intensity alteration differentiate incident accelerated knee OA (KOA) from a gradual onset of KOA or no KOA. METHODS We classified three sex-matched groups of participants in the Osteoarthritis Initiative who had a knee with no radiographic KOA at baseline (recruited 2004-06; Kellgren-Lawrence <2; n = 125/group): accelerated KOA: ⩾1 knee progressed to Kellgren-Lawrence grade ⩾3 within 48 months; common KOA: ⩾1 knee increased in radiographic scoring within 48 months; and no KOA: both knees had the same Kellgren-Lawrence grade at baseline and 48 months. The observation period included up to 2 years before and after when the group criteria were met. Two musculoskeletal radiologists reported presence of IFP signal intensity alteration and independent readers used a semi-automated method to segment effusion-synovitis volume. We used generalized linear mixed models with group and time as independent variables, as well as testing a group-by-time interaction. RESULTS Starting at 2 years before disease onset, adults who developed accelerated KOA had greater effusion-synovitis volume than their peers (accelerated KOA: 11.94 ± 0.90 cm3, KOA: 8.29 ± 1.19 cm3, no KOA: 8.14 ± 0.90 cm3) and have greater odds of having IFP signal intensity alteration than those with no KOA (odds ratio = 2.07, 95% CI = 1.14-3.78). Starting at 1 year prior to disease onset, those with accelerated KOA have greater than twice the odds of having IFP signal intensity alteration than those with common KOA. CONCLUSION People with IFP signal intensity alteration and/or greater effusion-synovitis volume in the absence of radiographic KOA may be at high risk for accelerated KOA, which may be characterized by local inflammation.
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Affiliation(s)
- Julie E Davis
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, Boston, MA, USA
| | - James W MacKay
- Department of Radiology, University of Cambridge School of Clinical Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Bing Lu
- Brigham & Women's Hospital and Harvard Medical School, Tufts University, Boston, MA, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts University, 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
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, 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
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10
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Foreman SC, Neumann J, Joseph GB, Nevitt MC, McCulloch CE, Lane NE, Link TM. Longitudinal MRI structural findings observed in accelerated knee osteoarthritis: data from the Osteoarthritis Initiative. Skeletal Radiol 2019; 48:1949-1959. [PMID: 31209509 PMCID: PMC6814533 DOI: 10.1007/s00256-019-03242-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Revised: 04/26/2019] [Accepted: 05/12/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To analyze structural, longitudinal MRI findings during the development of accelerated knee osteoarthritis (AKOA) over 4 years. MATERIALS AND METHODS From the Osteoarthritis Initiative (OAI), knees with no radiographic osteoarthritis (KL 0/1) developing advanced-stage osteoarthritis (KL 3/4; AKOA) within a 4-year (y) timeframe were selected. MRIs were graded using the modified Whole-Organ Magnetic Resonance Imaging Score (WORMS) at the beginning of the 4-year timeframe (index visit), at 2-year, and 4-year follow-up. Morphological and clinical findings associated with KL 3/4 onset within 2 years compared to 4 years were assessed using generalized estimating equations. RESULTS AKOA was found in 162 knees of 149 subjects (age 63.25 ± 8.3; 103 females; BMI 29.4 ± 3.9). Moderate to severe meniscal lesions WORMS ≥ 3 were present in 25% (41/162) at the index visit, 64% (104/162) at 2-year and 93% (151/162) at 4-year follow-up. Meniscal extrusion was the most prevalent finding (ranging from 18% at the index visit, 45% at 2-year and 94% at 4-year follow-up) and root tears were the most common types of tears (9% at the index visit; 22% at 2 years and 38% at 4 years). Risk factors associated with KL 3/4 onset within 2 years included root tears at the index visit (adjusted OR, 2.82; 95% CI: 1.33, 6.00; p = 0.007) and incident knee injury (42%, 49/116 vs. 24%, 11/46, p = 0.032). CONCLUSIONS Meniscal abnormalities, in particular extrusion and root tears, were the most prevalent morphological features found in subjects with AKOA. These results suggest that meniscal abnormalities have a significant role in accelerated progression of OA.
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Affiliation(s)
- Sarah C. Foreman
- Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco CA, USA
| | - Jan Neumann
- Department of Radiology, Technical University of Munich; Munich, Germany
| | - Gabby B. Joseph
- Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, CA, USA
| | - Michael C. Nevitt
- Department of Epidemiology and Biostatistics, University of California, San Francisco; San Francisco, CA, USA
| | - Charles E. McCulloch
- Department of Epidemiology and Biostatistics, University of California, San Francisco; San Francisco, CA, USA
| | - Nancy E. Lane
- Department of Medicine, University of California, Davis, CA, USA
| | - Thomas M. Link
- Department of Radiology and Biomedical Imaging, University of California, San Francisco; San Francisco, CA, USA
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Davis JE, Harkey MS, Liu SH, Lapane K, Price LL, Lu B, Lo GH, Eaton CB, Barbe MF, McAlindon TE, Driban JB. Adults With Incident Accelerated Knee Osteoarthritis Are More Likely to Use Pharmacological Treatment Options and Receive Arthroscopic Knee Surgery: Data From the Osteoarthritis Initiative. ACR Open Rheumatol 2019; 1:359-364. [PMID: 31777814 PMCID: PMC6857962 DOI: 10.1002/acr2.11058] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 06/28/2019] [Indexed: 01/29/2023] Open
Abstract
Objective To determine if people with incident accelerated knee osteoarthritis (AKOA) were more likely to receive a pharmacological treatment or arthroscopic knee surgery than those with typical knee osteoarthritis (KOA) or no KOA. Methods We conducted a nested cohort study using data from baseline and the first 8 years of the Osteoarthritis Initiative. Eligible participants had no radiographic KOA at baseline (Kellgren‐Lawrence [KL] < 2). We classified three groups using KL grades: 1) AKOA: knee progressed to advanced‐stage KOA (KL 3/4) in 4 years or less, 2) typical KOA: knee increased in KL grade by 8 years (excluding AKOA), and 3) No KOA: no change in KL grade by 8 years. The outcome was self‐reported arthroscopic knee surgery or a pharmacological treatment option: nonsteroidal anti‐inflammatory drugs (NSAIDs), hyaluronic acid injections, intra‐articular corticosteroid injections, or prescription analgesics. Between‐group differences in therapeutic use were evaluated with Chi‐square tests. Results Adults who developed AKOA (n = 92) were more likely to report arthroscopic knee surgery (AKOA: 32%, KOA [n = 380]: 8%, no KOA [n = 875]: 3%; P < 0.001), hyaluronic acid injections (AKOA: 10%, KOA: 4%, no KOA: 1%; P < 0.001), intra‐articular corticosteroid injections (AKOA: 30%, KOA: 7%, no KOA: 4%; P < 0.001), and NSAID use (over the counter: AKOA: 65%, KOA: 48%, and no KOA: 46%; P = 0.003; prescription: AKOA: 61%, KOA: 43%, no KOA: 41%; P = 0.002). Conclusion Adults with AKOA are more likely to receive pharmacological treatment or arthroscopic knee surgery than their peers. Adults with AKOA are an important patient population that is understudied in clinical research despite their use of greater health care resources.
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Affiliation(s)
| | - Matthew S Harkey
- Tufts Medical Center, Boston, Massachusetts, and University of Massachusetts Medical School Worcester Massachusetts
| | - Shao-Hsien Liu
- University of Massachusetts Medical School Worcester Massachusetts
| | - Kate Lapane
- University of Massachusetts Medical School Worcester Massachusetts
| | - Lori Lyn Price
- Tufts Medical Center, Boston, Massachusetts and Tufts University Boston Massachusetts
| | - Bing Lu
- Brigham & Women's Hospital and Harvard Medical School Boston Massachusetts
| | - Grace H Lo
- Houston Health Services Research and Development (HSR&D) Center of Excellence, Houston, Texas and Baylor College of Medicine Houston Texas
| | - Charles B Eaton
- Alpert Medical School of Brown University Pawtucket Rhode Island
| | - Mary F Barbe
- Temple University School of Medicine Philadelphia Pennsylvania
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Davis JE, Harkey MS, Ward RJ, Mackay JW, Lu B, Price LL, Eaton CB, Barbe MF, Lo GH, McAlindon TE, Driban JB. Characterizing the distinct structural changes associated with self-reported knee injury among individuals with incident knee osteoarthritis: Data from the osteoarthritis initiative. Clin Anat 2018; 31:330-334. [PMID: 29380495 DOI: 10.1002/ca.23054] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 01/25/2018] [Accepted: 01/26/2018] [Indexed: 11/09/2022]
Abstract
We aimed to characterize the agreement between distinct structural changes on magnetic resonance (MR) imaging and self-reported injury in the 12 months leading to incident common or accelerated knee osteoarthritis (KOA). We conducted a descriptive study using data from baseline and the first 4 annual visits of the Osteoarthritis Initiative. Knees had no radiographic KOA at baseline (Kellgren-Lawrence [KL]<2). We classified two groups: (1) accelerated KOA: a knee developed advanced-stage KOA (KL = 3 or 4) within 48 months and (2) common KOA: a knee increased in radiographic severity (excluding those with accelerated KOA). Adults were 1:1 matched based on sex. The index visit was when a person met the accelerated or common KOA criteria. We limited our sample to people with MR images and self-reported injury data at index visit and year prior. Among 226 people, we found fair agreement between self-reported injuries and distinct structural changes (kappa = 0.24 to 0.31). Most distinct structural changes were medial meniscal pathology. No distinct structural changes (e.g., root or radial tears) appeared to differ between adults who reported or did not report an injury; except, all subchondral fractures occurred in adults who developed accelerated KOA and reported an injury. While there is fair agreement between self-reported knee injuries and distinct structural changes, there is some discordance. Self-reported injury may represent a different construct from distinct structural changes that occur after joint trauma. Clin. Anat. 31:330-334, 2018. © 2018 Wiley Periodicals, Inc.
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Affiliation(s)
- Julie E Davis
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111
| | - Matthew S Harkey
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111
| | - Robert J Ward
- Department of Radiology, Tufts Medical Center, 800 Washington Street, Boson, Massachusetts, 02111
| | - James W Mackay
- Department of Radiology, University of Cambridge School of Clinical Medicine, Level 5, Addenbrooke's Hospital, Cambridge, CB2 0QQ, United Kingdom
| | - Bing Lu
- Brigham & Women's Hospital and Harvard Medical School, Boston, Massachusetts, 02115
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Tufts Clinical and Translational Science Institute, Tufts University, Boston, Massachusetts, 02111
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, Rhode Island, 02860
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, Pennsylvania, 19140
| | - 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, Texas 77030.,Section of Immunology, Allergy, and Rheumatology, Baylor College of Medicine, Houston, BCM-285, Houston, Texas, 77030
| | - Timothy E McAlindon
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111
| | - Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Boston, Massachusetts, 02111
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