Influence of meteorological elements on balance control and pain in patients with symptomatic knee osteoarthritis

Analysis of common differential gene expression in synovial cells of osteoarthritis and rheumatoid arthritis

OBJECTIVE

To elucidate potential molecular mechanisms differentiating osteoarthritis (OA) and rheumatoid arthritis (RA) through a bioinformatics analysis of differentially expressed genes (DEGs) in patient synovial cells, aiming to provide new insights for clinical treatment strategies.

MATERIALS AND METHODS

Gene expression datasets GSE1919, GSE82107, and GSE77298 were downloaded from the Gene Expression Omnibus (GEO) database to serve as the training groups, with GSE55235 being used as the validation dataset. The OA and RA data from the GSE1919 dataset were merged with the standardized data from GSE82107 and GSE77298, followed by batch effect removal to obtain the merged datasets of differential expressed genes (DEGs) for OA and RA. Intersection analysis was conducted on the DEGs between the two conditions to identify commonly upregulated and downregulated DEGs. Enrichment analysis was then performed on these common co-expressed DEGs, and a protein-protein interaction (PPI) network was constructed to identify hub genes. These hub genes were further analyzed using the GENEMANIA online platform and subjected to enrichment analysis. Subsequent validation analysis was conducted using the GSE55235 dataset.

RESULTS

The analysis of differentially expressed genes in the synovial cells from patients with Osteoarthritis (OA) and Rheumatoid Arthritis (RA), compared to a control group (individuals without OA or RA), revealed significant changes in gene expression patterns. Specifically, the genes APOD, FASN, and SCD were observed to have lower expression levels in the synovial cells of both OA and RA patients, indicating downregulation within the pathological context of these diseases. In contrast, the SDC1 gene was found to be upregulated, displaying higher expression levels in the synovial cells of OA and RA patients compared to normal controls.Additionally, a noteworthy observation was the downregulation of the transcription factor PPARG in the synovial cells of patients with OA and RA. The decrease in expression levels of PPARG further validates the alteration in lipid metabolism and inflammatory processes associated with the pathogenesis of OA and RA. These findings underscore the significance of these genes and the transcription factor not only as biomarkers for differential diagnosis between OA and RA but also as potential targets for therapeutic interventions aimed at modulating their expression to counteract disease progression.

CONCLUSION

The outcomes of this investigation reveal the existence of potentially shared molecular mechanisms within Osteoarthritis (OA) and Rheumatoid Arthritis (RA). The identification of APOD, FASN, SDC1, TNFSF11 as key target genes, along with their downstream transcription factor PPARG, highlights common potential factors implicated in both diseases. A deeper examination and exploration of these findings could pave the way for new candidate targets and directions in therapeutic research aimed at treating both OA and RA. This study underscores the significance of leveraging bioinformatics approaches to unravel complex disease mechanisms, offering a promising avenue for the development of more effective and targeted treatments.

Pain and Weather associations - Action Mechanisms; Personalized profiling

It is a well-known hypothesis that weather can influence human health, including pain sensation. The primary meteorological factors are atmospheric pressure, wind, humidity, precipitation, and temperature, which vary from the climate and seasons, but the parameters of space weather (e.g., geomagnetic and cosmic ray activities) also may affect our body condition. Despite a significant number of experimental studies, reviews, and meta-analyses concerning the potential role of weather in pain sensitivity, the findings are heterogeneous and lack consensus. Therefore, rather than attempting a comprehensive analysis of the entire literature on the effects of weather on different pain types, this study highlights the potential action mechanisms of the meteorological factors, and the possible causes of the controversial results. The few data available about the individual evaluations are discussed in detail to reveal the significance of the personalized analysis of the possible relationships between the most available weather parameters and the pain scores. The use of special algorithms may enable the individual integration of different data for a precise outcome concerning the link between pain sensitivity and weather parameters. It is presumed that despite the high level of interindividual differences in response to meteorological parameters, the patients can be clustered in different groups based on their sensitivity to the weather parameters with a possible disparate treatment design. This information may help patients to control their daily activities and aid physicians to plan more valuable management for patients with pain states when the weather conditions change.

Effect of autogenous osteochondral mosaicplasty on the balance control of patients with cartilage defects of the knee: a pilot study

BACKGROUND

Autogenous osteochondral mosaicplasty (AOM) is a widely used optimal surgical technique for cartilage repair in young patients with focal articular cartilage defects. However, the alterations in balance control in these patients after AOM have not been sufficiently investigated. This study aimed to compare different balance control performances between the patients with knee cartilage defects and healthy controls before and after AOM, as well as evaluate the influence of AOM on balance control in these patients.

METHODS

Static posturographic tests were performed in twenty-four patients who were scheduled for AOM two weeks pre-, three months, and one year postoperatively, along with thirty matched controls, respectively. All participants underwent posturography under four standing conditions: eyes open and closed, without and with foam support to assess the balance control ability. Subsequently, patient-reported outcome measures (PROMs) were synchronously obtained and analyzed.

RESULTS

Compared to the control subjects, less efficient balance control was observed in study patients at three testing phases (p < 0.05), whereas no alterations in postural control were visible in these patients within a year following AOM (p > 0.05). Significant improvements were found in all PROMs such as the International Knee Documentation Committee, the Lysholm Knee Score, and the visual analogue scale in the study patients postoperatively (p < 0.01).

CONCLUSION

The results indicated that patients with knee cartilage defects have a prominent balance control deficit compared to healthy individuals. Furthermore, AOM does not improve balance control in these patients for at least one year postoperatively, and more effective approaches for postural regulation are required for the management of cartilage defect patients.

Climate and human health: a review of publication trends in the International Journal of Biometeorology

The climate-health nexus is well documented in the field of biometeorology. Since its inception, Biometeorology has in many ways become the umbrella under which much of this collaborative research has been conducted. Whilst a range of review papers have considered the development of biometeorological research and its coverage in this journal, and a few have reviewed the literature on specific diseases, none have focused on the sub-field of climate and health as a whole. Since its first issue in 1957, the International Journal of Biometeorology has published a total of 2183 papers that broadly consider human health and its relationship with climate. In this review, we identify a total of 180 (8.3%, n = 2183) of these papers that specifically focus on the intersection between meteorological variables and specific, named diagnosable diseases, and explore the publication trends thereof. The number of publications on climate and health in the journal increases considerably since 2011. The largest number of publications on the topic was in 2017 (18) followed by 2021 (17). Of the 180 studies conducted, respiratory diseases accounted for 37.2% of the publications, cardiovascular disease 17%, and cerebrovascular disease 11.1%. The literature on climate and health in the journal is dominated by studies from the global North, with a particular focus on Asia and Europe. Only 2.2% and 8.3% of these studies explore empirical evidence from the African continent and South America respectively. These findings highlight the importance of continued research on climate and human health, especially in low- and lower-middle-income countries, the populations of which are more vulnerable to climate-sensitive illnesses.

Association between weather and utilisation of physical therapy in patients with osteoarthritis: a case-crossover study

Background

During varied weather conditions, patients with osteoarthritis experience different severity of symptoms and signs. However, weather may also cause barriers or incentives for patients to seek medical services. These factors may result in changes in medical utilisation; however, no studies have investigated whether the probability of physical therapy utilisation among patients with osteoarthritis is associated with changes in meteorological factors.

Method

By using a secondary data of NHID in Taiwan, we conducted a population-based, retrospective study with case-crossover design for patients initially diagnosed with osteoarthritis between 2000 and 2013. The meteorological factors of months with the lowest treatment rate were used as patients’ own control periods and compared with the parameters of months with high treatment frequency. The risk of exposure to different meteorological factors, including mean temperature, daily highest temperature, daily minimum temperature, diurnal temperature range, relative humidity, and barometric pressure, was estimated and represented by odds ratios (ORs) and 95% confidence intervals (CIs).

Results

A total of 8,130 patients were recruited. Regardless of univariate or multivariable analysis, increased daily highest temperature enhanced the frequency of physical therapy (OR: 1.04; 95% CI: 1.02–1.05; p < 0.01; OR: 1.07; 95% CI: 1.04–1.10; p < 0.01). When the weather was hotter (> 23 °C), higher diurnal temperature range and humidity resulted in an increase in the utilisation of physical therapy. However, when the weather was colder (< 23 °C), reverse effects were observed.

Conclusions

An increase in temperature increases the probability of physical therapy resource use. Therefore, temperature, along with other meteorological factors, may play a key role in the utilization of physical therapy among patients with osteoarthritis.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05233-9.

Effect of ambient temperature on outpatient admission for osteoarthritis and rheumatoid arthritis in a subtropical Chinese city

Background

Current findings on the impact of weather conditions on osteoarthritis (OA) and rheumatoid arthritis (RA) are sparse and not conclusive. This study aimed to investigate the relationship between temperature change and OA/RA admission.

Methods

Daily OA/RA admission, meteorological data and pollutants from 1 January 2014 to 31 December 2017 in Hefei, China, were collected. We quantified the relationship between ambient temperature and OA/RA admission using a distributed lag nonlinear model (DLNM). Stratified analyses by gender and age were also examined.

Results

Temperature decrease was significantly associated with RA admission (25th percentile of temperature versus 50th percentile of temperature), with the acute and largest effect at current days lag (RR: 1.057, 95%CI: 1.005–1.111). However, no significant association between temperature and OA admission was observed. When conducting subgroup analyses by individual characteristics, we found that females and patients aged 41–65 years were more vulnerable to temperature decrease than males, patients aged 0–40 and ≧66 years, respectively.

Conclusions

This study suggested that temperature decrease was a risk factor for increases in RA admission. Females and patients aged 41–65 years were particularly vulnerable to the effect of temperature decrease.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11994-0.

Self-Reported Weather Sensitivity is Associated with Clinical Symptoms and Structural Abnormalities in Patients with Knee Osteoarthritis: A Cross-Sectional Study

INTRODUCTION

Patients with knee osteoarthritis (KOA) often complain about clinical symptoms affected by weather-related factors. The purpose of the present study was to use cross-sectional analysis to determine whether weather sensitivity was associated with clinical symptoms, as well as structure abnormalities, in KOA patients.

METHODS

Data from 80 participants were obtained from the Feng Hans Shi Effects on OA (FHS) study, an OA cohort study initiated in China in 2015. The weather sensitivity of each participant was determined by a self-reported questionnaire. The following measurements were used to assess clinical outcomes: Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) for symptoms, and semi-quantitative Whole-Organ Magnetic Resonance Imaging Score (WORMS) for cartilage defects and marrow abnormalities of magnetic resonance imaging (MRI). Chi-square with Cochran-Armitage test for trend and regression analysis were used to evaluate the associations between weather sensitivity and WOMAC and WORMS of KOA patients.

RESULTS

Most of the KOA participants (57.5%) perceived the weather as affecting their knee-joint clinical symptoms. After adjusting for age, gender, and body mass index (BMI), weather sensitivity was not only associated with knee pain [OR = 3.3 (95% CI 1.1, 9.9), P = 0.032], dysfunction [OR = 5.5 (95% CI 1.8, 16.8), P = 0.003], and overall clinical symptoms [OR = 3.3 (95% CI 1.1, 10.2), P = 0.034], but also associated with cartilage defect [OR = 3.1 (95% CI 1.1, 8.5), P = 0.027] and marrow abnormality [OR = 3.0 (95% CI 1.1, 8.1), P = 0.029].

CONCLUSIONS

In KOA patients, weather sensitivity was associated with clinical symptoms and structural abnormalities. Future longitudinal study is warranted for the causal relationship. INFOGRAPHIC.

State-level Google search volumes for neck and shoulder pain correlate with psychosocial and behavioral health indicators

BACKGROUND

There is growing interest in passively-generated online search data for health sciences research, but limited use to address musculoskeletal illness.

QUESTIONS/PURPOSES

(1) To determine geographic and seasonal patterns in Google queries for shoulder, knee, hip, and neck pain across the United States, and (2) to quantify the state-level correlation of the volume of online symptom searches with rates of various population health indicators.

METHODS

Using Google trends, we identified queries for shoulder, knee, hip, and neck pain in every state of the United States during 2018. We assessed the correlation of state-level Google search volumes with 9 population health indicators extracted from the 2018 Behavioral Risk Factor Surveillance System survey: tobacco use, obesity, diabetes, hyperlipidemia, depression, arthritis, cardiovascular disease, participation in physical activities, and college education.

RESULTS

Neck and shoulder pain were the most common queries in most Southern states, while knee pain was generally the top query elsewhere. Queries for neck and shoulder pain peaked during the late fall and winter, while searches for knee and hip pain peaked in the spring. State-level search volumes for shoulder and neck pain correlated closely with all health indicators--particularly with tobacco use, obesity, cardiovascular disease, hyperlipidemia, participation in physical activities and college education. The only strong correlation of hip pain queries was with self-reported prevalence of arthritis. Knee pain queries were not associated with any of the studied health indicators.

CONCLUSION

This study highlights the potential of search engine data to be utilized as population-level health indicators. The state-level correlation of psychosocial and behavioral health indicators with online search volumes for neck and shoulder pain may reflect the influence of mental and social health on the experience of pain.

Are weather conditions associated with chronic musculoskeletal pain? Review of results and methodologies

Many people believe that weather influences chronic musculoskeletal pain. Previous studies on this association are narratively reviewed, with particular focus on comparing methodologies and summarising study findings in light of study quality. We searched 5 databases (Medline, Embase, Web of Science, PsycINFO, and Scopus) for observational studies on the association between weather variables and self-reported musculoskeletal pain severity. Of 4707 located articles, 43 were eligible for inclusion. The majority (67%) found some association between pain and a weather variable. Temperature, atmospheric pressure, relative humidity, and precipitation were most often investigated. For each weather variable, some studies found an association with pain (in either direction), and others did not. Most studies (86%) had a longitudinal study design, usually collecting outcome data for less than a month, from fewer than 100 participants. Most studies blinded participants to study aims but were at a high risk of misclassification of exposure and did not meet reporting requirements. Pain severity was most often self-reported (84%) on a numeric rating scale or visual analog scale. Weather data were collected from local weather stations, usually on the assumption that participants stayed in their home city. Analysis methods, preparation of weather data, and adjustment for covariates varied widely between studies. The association between weather and pain has been difficult to characterise. To obtain more clarity, future studies should address 3 main limitations of the previous literature: small sample sizes and short study durations, misclassification of exposure, and approach to statistical analysis (specifically, multiple comparisons and adjusting for covariates).

Spa therapy with physical rehabilitation is an alternative to usual spa therapy protocol in symptomatic knee osteoarthritis

The objective of the study was to demonstrate the non-inferiority of low-frequency spa therapy combined with rehabilitation (Spa-rehab) versus standard spa therapy at 6 months for symptomatic knee osteoarthritis (KOA). A prospective, randomized, monocenter, non-inferiority trial with recruitment of community-based symptomatic KOA patients was performed. Standard spa therapy comprised standardized spa treatment, 6 days a week for 3 weeks, and Spa-rehab therapy comprised spa sessions, 3 days a week for 3 weeks, followed by a dedicated rehabilitation program, 3 days a week for 3 weeks. The primary endpoint was achieving at 6 months a minimal clinically important improvement (MCII) for pain on a visual analog scale and/or an MCII for function on the WOMAC index and no knee surgery (composite MCII). Secondary endpoints were composite MCII at 3 months and achieving a Patient Acceptable Symptom State (PASS) for pain and function at 3 and 6 months. Among 283 patients included, 145 were allocated to standard spa therapy and 138 to Spa-rehab therapy. We could not demonstrate the non-inferiority of Spa-rehab therapy for the primary endpoint: difference for responders − 0.08 [90% CI (− 0.18 to 0.02), p = 0.14]. However, the difference test between the groups was not significant (p = 0.18). Spa-rehab therapy was not inferior to standard spa therapy for the composite MCII at 3 months or the PASS at 3 and 6 months. Spa-rehab therapy can reasonably be proposed to patients with symptomatic KOA. This protocol may be more cost-effective than standard spa therapy and avoid absenteeism from work and accommodation costs for patients who live close to a centre.

Comparison of high-frequency intensive balneotherapy with low-frequency balneotherapy combined with land-based exercise on postural control in symptomatic knee osteoarthritis: a randomized clinical trial

Knee osteoarthritis (KOA) can generate postural control impairments which can increase fall risk. Land-based exercise (LBE) and balneotherapy are two modalities currently prescribed, but the impact of the latter on balance control has not been studied. This study aimed to compare two programs of balneotherapy with or without LBE to improve postural control, looking at frequency and duration of treatment. A total of 236 KOA patients (mean age = 64 years) were included in this prospective and randomized study: 122 patients went through 3 weeks of standardized continuous balneotherapy (high frequency/short duration) program (Gr1) and 114 went through 3 weeks of discontinuous (low frequency) balneotherapy program followed by 3 weeks of LBE (Gr2). The total number of treatment sessions was the same for both groups. Posturography was carried out before balneotherapy (W0) and at 3 (W3), 6 (W6), and 12 (W12) weeks after the beginning of treatment. Postural control increased in Gr1 from W0 to W3 and from W0 to W12 and in Gr2 from W0 to W6 and from W3 to W6. The improvement was greater in Gr1 from W0 to W3 and from W6 to W12 and in Gr2 from W3 to W6. High-frequency intensive balneotherapy improved posture control at 3 weeks, while low-frequency balneotherapy did not. This improvement persisted over a 12-week assessment period at the same level. LBE generated an improvement that did not persist over time. Sustained improvement of postural control requires high-frequency repetition of consecutive balneotherapy sessions.

Comparison of an Innovative Rehabilitation, Combining Reduced Conventional Rehabilitation with Balneotherapy, and a Conventional Rehabilitation after Anterior Cruciate Ligament Reconstruction in Athletes

Background

Instability of the knee, related to anterior cruciate ligament injury, is treated by surgical reconstruction. During recovery, a loss of proprioceptive input can have a significant impact. Few studies have evaluated the benefits of rehabilitation of the knee in aquatic environment on functional outcomes.

Objective

This study aimed to compare an innovative rehabilitation protocol combining reduced conventional rehabilitation with aquatic rehabilitation, with a conventional rehabilitation, according to the National French Health Authority, in terms of kinetics, development of proprioceptive skills, and functional improvement of the knee.

Methods

67 patients, who were amateur or professional athletes, were randomized into two groups: 35 patients followed the conventional rehabilitation protocol (Gr1) and 32 patients followed the innovative rehabilitation protocol (Gr2). Patients were evaluated before surgery, and at 2 weeks, 1, 2, and 6 months after surgery using posturography, and evaluation of muscular strength, walking performance and proprioception. This study is multicenter, prospective, randomized, and controlled with a group of patients following conventional rehabilitation (level of evidence I).

Results

For the same quality of postural control, Gr2 relied more on somesthesia than Gr1 at 6 months. The affected side had an impact on postural control and in particular on the preoperative lateralization, at 2 weeks and at 1 month. Lateralization depended on the affected knee, with less important lateralization in Gr2 preoperatively and at 1 month. The quadriceps muscular strength was higher in Gr2 than in Gr1 at 2 and 6 months and muscle strength of the external hamstring was greater in Gr2 than in Gr1 at 6 months. The isokinetic test showed a greater quadriceps muscular strength in Gr2. Gr2 showed a greater walking distance than Gr1 at one month. Gr2 showed an improvement in the proprioceptive capacities of the operated limb in flexion for the first 2 months.

Conclusion

The effectiveness of the innovative rehabilitation program permits faster recovery, allowing for an earlier return to social, sporting, and professional activities. Faster retrieval of knee function following aquatic rehabilitation would prevent both short-term risk of lesions of the contralateral limb due to overcompensation and long-term risk of surgery due to osteoarthritis.

Registration of clinical trials

NCT02225613.