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Farrokhi S, Gunterstockman BM, Hendershot BD, Russell Esposito E, McCabe CT, Watrous JR. Post-Traumatic Osteoarthritis, Psychological Health, and Quality of Life After Lower Limb Injury in U.S. Service Members. Mil Med 2024; 189:e1805-e1812. [PMID: 38109721 DOI: 10.1093/milmed/usad475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 11/06/2023] [Accepted: 11/29/2023] [Indexed: 12/20/2023] Open
Abstract
INTRODUCTION The aims of this project were to assess (1) the prevalence and timing of post-traumatic osteoarthritis (PTOA) after a traumatic lower limb injury, (2) the risk of PTOA based on injury type, and (3) the association of PTOA with psychological health and quality of life (QoL). MATERIALS AND METHODS The Wounded Warrior Recovery Project (WWRP) database and the Expeditionary Medical Encounters Dataset were queried to identify service members injured during deployment. The Military Health System Data Repository was utilized to extract medical record data to identify individuals with PTOA. Data on PTSD, depression symptoms, and QoL were extracted from the WWRP. RESULTS Of the 2,061 WWRP participants with lower limb injuries, 124 (6%) were diagnosed with PTOA, with first PTOA diagnosis occurring 3.8 ± 3.1 years after injury. Of the injury categories identified, only fractures were associated with high odds of lower limb PTOA (adjusted odds ratio [OR] = 3.92, 95% confidence interval [CI]: 2.38, 6.44). Individuals with PTOA diagnoses reported lower QoL scores relative to those without PTOA (F(1,2057) = 14.21, B = -0.05, P < .05). Additionally, rates of PTSD and depression symptoms were high but not different between those with or without PTOA. CONCLUSIONS Despite a low prevalence of lower limb PTOA in our study, fractures increased the risk of PTOA after deployment-related injuries. Additionally, those with PTOA reported lower QoL scores relative to those without PTOA. The findings of this study highlight the personalized needs of patients with trauma beyond just the repair of the immediate injury.
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Affiliation(s)
- Shawn Farrokhi
- Department of Physical Therapy, Chapman University, Rinker Health Science Campus, Irvine, CA 92618, USA
| | - Brittney Mazzone Gunterstockman
- Doctor of Physical Therapy Program, Lincoln Memorial University, Debusk College of Osteopathic Medicine, Knoxville, TN 37932, USA
| | - Brad D Hendershot
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Department of Rehabilitation, Research and Development Section, Walter Reed National Military Medical Center, Bethesda, MD 20814, USA
| | - Elizabeth Russell Esposito
- Extremity Trauma and Amputation Center of Excellence, Defense Health Agency, Falls Church, VA 22042, USA
- Department of Rehabilitation Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
- Center for Limb Loss & MoBility (CLiMB), VA Puget Sound Health Care System, Seattle, WA 98108, USA
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Aalders MB, van der List JP, Keijser LCM, Benner JL. Anxiety and depression prior to total knee arthroplasty are associated with worse pain and subjective function: A prospective comparative study. Knee Surg Sports Traumatol Arthrosc 2024. [PMID: 38943459 DOI: 10.1002/ksa.12336] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Revised: 06/13/2024] [Accepted: 06/16/2024] [Indexed: 07/01/2024]
Abstract
PURPOSE The aim of this study was to investigate the influence of preoperative anxiety and depression on subjective function, pain and revision rates following total knee arthroplasty (TKA). METHODS A prospective comparative study was conducted, including 349 patients undergoing TKA surgery between January 2019 and April 2021. Patients completed the Hospital Anxiety and Depression Scale (HADS) questionnaire preoperatively, and a set of Patient-Reported Outcome Measures (PROMs) preoperatively and at 6, 12 and 24 months postoperatively. Patients were categorized into anxiety and depression groups based on HADS scores. PROMs included the Knee injury and Osteoarthritis Outcome Score-Physical Function Shortform (KOOS-PS), Oxford Knee Score (OKS) and NRS-Pain. Differences in PROM scores between the anxiety/depression group and, respectively, nonanxiety/nondepression group were assessed, as well as differences in minimal clinical important difference (MCID) and attainment of Patient Acceptable Symptom State (PASS). Lastly, revision rates were compared. RESULTS Anxiety and depression groups exhibited inferior subjective function preoperatively and postoperatively compared to nonanxiety and nondepression groups (all p < 0.05), experienced more pain preoperatively (p < 0.001) and also postoperatively for depression patients (all p < 0.05). Significantly fewer patients with anxiety and depression reached the PASS for KOOS-PS, OKS and NRS-Pain (all p < 0.05). There were no differences in the proportion of patients reaching the MCID for all PROMs (all p > 0.060), and revision rates did not differ between groups (both p > 0.96). CONCLUSION Preoperative anxiety and depression negatively influence subjective function and pain preoperatively and up to 2-year follow-up in patients undergoing TKA. Revision rates did not differ between groups, and there were no relevant differences in clinical improvement of subjective function and pain. LEVEL OF EVIDENCE Level II, prospective comparative study.
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Affiliation(s)
- Margot B Aalders
- Department of Orthopaedic Surgery and Sports Medicine, Amsterdam UMC, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, NorthWest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | | | - Lucien C M Keijser
- Department of Orthopaedic Surgery, NorthWest Clinics, Alkmaar, The Netherlands
- Department of Orthopaedic Surgery, Flinders University, Adelaide, South Australia, Australia
| | - Joyce L Benner
- Department of Orthopaedic Surgery, NorthWest Clinics, Alkmaar, The Netherlands
- Centre for Orthopaedic Research Alkmaar (CORAL), Alkmaar, The Netherlands
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Gheisary Z, Hoja I, Liu J, Papagerakis P, Weber LP, Fenton M, Katselis GS, Lieffers JRL, Papagerakis S. Association of Sleep Quality and General, Mental, and Oral Health with Lifestyle Traits (Dietary Intake, Smoking Status) in Arthritis: A Cross-Sectional Study from the Canadian Community Health Survey (CCHS). Nutrients 2024; 16:2091. [PMID: 38999838 PMCID: PMC11243648 DOI: 10.3390/nu16132091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2024] [Revised: 06/23/2024] [Accepted: 06/24/2024] [Indexed: 07/14/2024] Open
Abstract
Arthritis is associated with health challenges. Lifestyle traits are believed to influence arthritis development and progression; however, data to support personalized treatment regimens based on holistic lifestyle factors are missing. This study aims to provide a comprehensive list of associations between lifestyle traits and the health status of individuals with arthritis in the Canadian population, using binary logistic regression analysis on data from the Canadian Community Health Survey, which includes 104,359 respondents. Firstly, we explored the association between arthritis and various aspects of health status including self-reported lifestyle factors. Secondly, we examined the associations between self-reported dietary intake and smoking status with general, mental, and oral health, and sleep disturbance among individuals both with and without arthritis. Our analysis revealed that individuals with arthritis reported considerably poorer general, mental, and oral health, and poorer sleep quality compared to those without arthritis. Associations were also found between self-reported dietary intake and various measures of health status in individuals with arthritis. Smoking and exposure to passive smoking were associated not only with arthritis but also with compromised sleep quality and poorer general, mental, and oral health in people with and without arthritis. This study highlights the need for personalized and holistic approaches that may include a combination of dietary interventions, oral health improvements, sleep therapies, and smoking cessation for improved arthritis prevention and care.
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Affiliation(s)
- Zohre Gheisary
- Department of Biochemistry, Microbiology, and Immunology, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada;
| | - Ibrahim Hoja
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
- Health Sciences, College of Medicine, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Juxin Liu
- Department of Mathematics and Statistics, College of Arts and Science, University of Saskatchewan, 106 Wiggins Road, Saskatoon, SK S7N 5E6, Canada;
| | - Petros Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
| | - Lynn P. Weber
- Department of Veterinary Biomedical Sciences, Western College of Veterinary Medicine, University of Saskatchewan, 52 Campus Drive, Saskatoon, SK S7N 5B4, Canada;
| | - Mark Fenton
- Division of Respirology, Critical Care, and Sleep Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5E5, Canada;
| | - George S. Katselis
- Department of Medicine, Canadian Centre for Rural and Agricultural Health, College of Medicine, University of Saskatchewan, 104 Clinic Place, Saskatoon, SK S7N 2Z4, Canada;
| | - Jessica R. L. Lieffers
- College of Pharmacy and Nutrition, University of Saskatchewan, 107 Wiggins Road, Saskatoon, SK S7N 5E5, Canada
| | - Silvana Papagerakis
- Laboratory of Precision Oral Health and Chronobiology, Faculty of Dentistry, Laval University, Dental Medicine Pavilion, 2420, rue de la Terrasse, Quebec City, QC G1V 0A6, Canada; (I.H.); (P.P.)
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Montilla-Herrador J, Lozano-Meca J, Lozano-Guadalajara JV, Gacto-Sánchez M. The Efficacy of the Addition of tDCS and TENS to an Education and Exercise Program in Subjects with Knee Osteoarthritis: A Randomized Controlled Trial. Biomedicines 2024; 12:1186. [PMID: 38927392 PMCID: PMC11200463 DOI: 10.3390/biomedicines12061186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2024] [Revised: 05/17/2024] [Accepted: 05/23/2024] [Indexed: 06/28/2024] Open
Abstract
Knee osteoarthritis (KOA) has a significant impact on patients' quality of life. This study aimed to assess the effectiveness of integrating transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) into an education and exercise program with the aim of decreasing pain and improving physical function in KOA. A randomized controlled trial with 65 KOA patients was conducted. The subjects were assigned to one of the following three groups: education and active exercise plus (1) double active tDCS and TENS, (2) active tDCS and sham TENS, and (3) double sham tDCS and TENS. Sessions were conducted over a 20 min period, whilst data on pain, chronic pain clinical variables, and physical function were collected. Although all groups showed improvement in pain-related symptoms in the short and medium term, the addition of tDCS and/or TENS did not significantly enhance the benefits of the exercise and education program. These findings suggest that an education and active exercise program in the treatment of KOA has a positive effect on pain, with or without the addition of tDCS and/or TENS.
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Affiliation(s)
- Joaquina Montilla-Herrador
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum, University of Murcia, Instituto de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB), El Palmar, 30120 Murcia, Spain; (J.M.-H.); (M.G.-S.)
| | - Jose Lozano-Meca
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum, University of Murcia, Instituto de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB), El Palmar, 30120 Murcia, Spain; (J.M.-H.); (M.G.-S.)
| | | | - Mariano Gacto-Sánchez
- Department of Physical Therapy, Faculty of Medicine, CEIR Campus Mare Nostrum, University of Murcia, Instituto de Investigación Biosanitaria-Virgen de la Arrixaca (IMIB), El Palmar, 30120 Murcia, Spain; (J.M.-H.); (M.G.-S.)
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Jayakumar P, Crijns TJ, Misciagna W, Manickas-Hill O, Malay M, Jiranek W, Mather RC, Lentz TA. What Are the Underlying Mental Health Constructs Associated With Level of Capability in People With Knee and Hip Osteoarthritis? Clin Orthop Relat Res 2024; 482:633-644. [PMID: 38393957 PMCID: PMC10937005 DOI: 10.1097/corr.0000000000003003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 01/11/2024] [Indexed: 02/25/2024]
Abstract
BACKGROUND Mental health characteristics such as negative mood, fear avoidance, unhelpful thoughts regarding pain, and low self-efficacy are associated with symptom intensity and capability among patients with hip and knee osteoarthritis (OA). Knowledge gaps remain regarding the conceptual and statistical overlap of these constructs and which of these are most strongly associated with capability in people with OA. Further study of these underlying factors can inform us which mental health assessments to prioritize and how to incorporate them into whole-person, psychologically informed care. QUESTIONS/PURPOSES (1) What are the distinct underlying factors that can be identified using statistical grouping of responses to a multidimensional mental health survey administered to patients with OA? (2) What are the associations between these distinct underlying factors and capability in knee OA (measured using the Knee Injury and Osteoarthritis Outcome Score, Joint Replacement [KOOS JR]) and hip OA (measured using Hip Disability and Osteoarthritis Outcome Score, Joint Replacement [HOOS JR]), accounting for sociodemographic and clinical factors? METHODS We performed a retrospective cross-sectional analysis of adult patients who were referred to our program with a primary complaint of hip or knee pain secondary to OA between October 2017 and December 2020. Of the 2006 patients in the database, 38% (760) were excluded because they did not have a diagnosis of primary osteoarthritis, and 23% (292 of 1246) were excluded owing to missing data, leaving 954 patients available for analysis. Seventy-three percent (697) were women, with a mean age of 61 ± 10 years; 65% (623) of patients were White, and 52% (498) were insured under a commercial plan or via their employer. We analyzed demographic data, patient-reported outcome measures, and a multidimensional mental health survey (the 10-item Optimal Screening for Prediction of Referral and Outcome-Yellow Flag [OSPRO-YF] assessment tool), which are routinely collected for all patients at their baseline new-patient visit. To answer our first question about identifying underlying mental health factors, we performed an exploratory factor analysis of the OSPRO-YF score estimates. This technique helped identify statistically distinct underlying factors for the entire cohort based on extracting the maximum common variance among the variables of the OSPRO-YF. The exploratory factor analysis established how strongly different mental health characteristics were intercorrelated. A scree plot technique was then applied to reduce these factor groupings (based on Eigenvalues above 1.0) into a set of distinct factors. Predicted factor scores of these latent variables were generated and were subsequently used as explanatory variables in the multivariable analysis that identified variables associated with HOOS JR and KOOS JR scores. RESULTS Two underlying mental health factors were identified using exploratory factor analysis and the scree plot; we labeled them "pain coping" and "mood." For patients with knee OA, after accounting for confounders, worse mood and worse pain coping were associated with greater levels of incapability (KOOS JR) in separate models but when analyzed in a combined model, pain coping (regression coefficient -4.3 [95% confidence interval -5.4 to -3.2], partial R 2 0.076; p < 0.001) had the strongest relationship, and mood was no longer associated. Similarly, for hip OA, pain coping (regression coefficient -5.4 [95% CI -7.8 to -3.1], partial R 2 0.10; p < 0.001) had the strongest relationship, and mood was no longer associated. CONCLUSION This study simplifies the multitude of mental health assessments into two underlying factors: cognition (pain coping) and feelings (mood). When considered together, the association between capability and pain coping was dominant, signaling the importance of a mental health assessment in orthopaedic care to go beyond focusing on unhelpful feelings and mood (assessment of depression and anxiety) alone to include measures of pain coping, such as the Pain Catastrophizing Scale or Tampa Scale for Kinesiophobia, both of which have been used extensively in patients with musculoskeletal conditions. LEVEL OF EVIDENCE Level III, prognostic study.
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Affiliation(s)
- Prakash Jayakumar
- The Musculoskeletal Institute, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Practice Transformation Unit, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Tom J. Crijns
- Department of Orthopaedic Surgery, Mayo Clinic, Phoenix, AZ, USA
| | - Will Misciagna
- The Musculoskeletal Institute, The University of Texas at Austin, Dell Medical School, Austin, TX, USA
| | - Olivia Manickas-Hill
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Practice Transformation Unit, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Morven Malay
- Practice Transformation Unit, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Department of Physical Therapy and Occupational Therapy, Duke University, Durham, NC, USA
| | - William Jiranek
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Practice Transformation Unit, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Richard C. Mather
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Practice Transformation Unit, Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
| | - Trevor A. Lentz
- Department of Orthopaedic Surgery, Duke University, Durham, NC, USA
- Duke-Margolis Center for Health Policy, Duke University, Durham, NC, USA
- Duke Clinical Research Institute, Duke University, Durham, NC, USA
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Amodeo G, Magni G, Galimberti G, Riboldi B, Franchi S, Sacerdote P, Ceruti S. Neuroinflammation in osteoarthritis: From pain to mood disorders. Biochem Pharmacol 2024:116182. [PMID: 38556026 DOI: 10.1016/j.bcp.2024.116182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2024] [Revised: 03/19/2024] [Accepted: 03/28/2024] [Indexed: 04/02/2024]
Abstract
Osteoarthritis (OA) is the most common form of musculoskeletal disease, and its prevalence is increasing due to the aging of the population. Chronic pain is the most burdensome symptom of OA that significantly lowers patients' quality of life, also due to its frequent association with emotional comorbidities, such as anxiety and depression. In recent years, both chronic pain and mood alterations have been linked to the development of neuroinflammation in the peripheral nervous system, spinal cord and supraspinal brain areas. Thus, mechanisms at the basis of the development of the neuroinflammatory process may indicate promising targets for novel treatment for pain and affective comorbidities that accompany OA. In order to assess the key role of neuroinflammation in the maintenance of chronic pain and its potential involvement in development of psychiatric components, the monoiodoacetate (MIA) model of OA in rodents has been used and validated. In the present commentary article, we aim to summarize up-to-date results achieved in this experimental model of OA, focusing on glia activation and cytokine production in the sciatic nerve, dorsal root ganglia (DRGs), spinal cord and brain areas. The association of a neuroinflammatory state with the development of pain and anxiety- and depression-like behaviors are discussed. Results suggest that cells and molecules involved in neuroinflammation may represent novel targets for innovative pharmacological treatments of OA pain and mood comorbidities.
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Affiliation(s)
- Giada Amodeo
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Giulia Magni
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Giulia Galimberti
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Benedetta Riboldi
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Silvia Franchi
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Paola Sacerdote
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy
| | - Stefania Ceruti
- Laboratory of Pain Therapy and Neuroimmunology, Department of Pharmacological and Biomolecular Sciences "Rodolfo Paoletti", Università degli Studi di Milano, Via Balzaretti, 9 -20133 Milan (IT), Italy.
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Modarresi S, Pearson N, Madden K, Fahnestock M, Bowdish D, Carlesso LC. Feasibility of pain informed movement program for people with knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100401. [PMID: 37664869 PMCID: PMC10474231 DOI: 10.1016/j.ocarto.2023.100401] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Accepted: 08/09/2023] [Indexed: 09/05/2023] Open
Abstract
Objective To establish the feasibility of an intervention consisting of neuromuscular exercise, mind-body techniques, and pain neuroscience education (PNE), referred to as Pain Informed Movement in people with knee Osteoarthritis (KOA). This program has the potential to improve our understanding of intrinsic pain modulation and its role in the management of chronic pain. Methods This was a single-arm feasibility trial with a nested qualitative component. Primary outcome: complete follow-up. Inclusion criteria: age ≥40 years, KOA clinical diagnosis or meeting KOA NICE criteria, and pain intensity ≥3/10. The program consisted of 8-week in-person and at-home exercise sessions. PNE and mind-body techniques were provided as videos and integrated into the exercise sessions. Participants completed questionnaires and physical assessments including blood draws at baseline and program completion. Secondary feasibility outcomes: acceptability of the intervention, burden, rates of recruitment, compliance and adherence, and adverse events. A priori success criteria were identified. Participants were invited to an online focus group. Results 19 participants were enrolled, with a complete follow-up rate of 74% (mean age 63.3 years (SD 10.5), 73% female), indicating modifications were necessary to proceed. All other success criteria were met. The focus groups revealed that the video content pertaining to the mind-body techniques would benefit from on screen demonstrations. Conclusion The Pain Informed Movement program is deemed feasible, with minor modifications needed to proceed. A pilot two-arm RCT will be conducted to establish the feasibility and explore potential effects of Pain Informed Movement compared to conventional neuromuscular exercise and standard OA education.
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Affiliation(s)
- Shirin Modarresi
- Michael DeGroote Institute for Pain Research and Care (IPRC), McMaster University, Hamilton, ON, Canada
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
| | - Neil Pearson
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Kim Madden
- Department of Surgery, McMaster University, Hamilton, ON, Canada
- Research Institute of St. Joe's, Hamilton, ON, Canada
| | - Margaret Fahnestock
- Department of Psychiatry & Behavioural Neurosciences, McMaster University, Hamilton, ON, Canada
| | - Dawn Bowdish
- Firestone Institute for Respiratory Health & McMaster Immunology Research Centre, Hamilton, ON, Canada
| | - Lisa C. Carlesso
- School of Rehabilitation Science, Faculty of Health Science, McMaster University, Hamilton, ON, Canada
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Liu Y, Chen R, Zhang Y, Wang Q, Ren JL, Wang CX, Xu YK. Clinical value of ankle flexion and extension exercises combined with a psychological intervention in knee osteoarthritis. World J Psychiatry 2023; 13:743-752. [PMID: 38058689 PMCID: PMC10696294 DOI: 10.5498/wjp.v13.i10.743] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 08/28/2023] [Accepted: 09/05/2023] [Indexed: 10/11/2023] Open
Abstract
BACKGROUND Considering the limited effectiveness of clinical interventions for knee osteoarthritis (KOA), it is necessary to continue to explore appropriate and effective treatment strategies to improve the condition of KOA patients. AIM To clarify the influence of ankle flexion and extension exercises combined with a psychological intervention on the psychological status and activities of daily living (ADLs) of patients with KOA. METHODS The research participants were 116 KOA patients admitted to The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine between May 2019 and May 2022, including 54 patients receiving routine treatment, care and psychological intervention (control group) and 62 patients additionally treated with ankle flexion and extension exercises (research group). The two groups were comparatively analyzed in terms of psychological status (Self-rating Anxiety/Depression Scale, SDS/SAS), ADLs, knee joint function (Lysholm Knee Scoring Scale), pain (Visual Analog Scale, VAS), fatigue (Multidimensional Fatigue Inventory, MFI), and quality of life (QoL; Short-Form 36 Item Health Survey, SF-36). RESULTS After evaluation, it was found that the postinterventional SDS, SAS, VAS, and MFI scores in the research group were significantly reduced compared with the baseline (before the intervention) values and those of the control group, while the postinterventional Lysholm, ADL and SF-36 scores were markedly elevated. CONCLUSION Therefore, ankle flexion and extension exercises are highly effective in easing negative psychological status, enhancing ADLs, daily living ability, knee joint function and QoL, and relieving pain and fatigue in KOA patients, thus warranting clinical promotion.
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Affiliation(s)
- Yang Liu
- Department of Orthopedics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 524000, Guizhou Province, China
| | - Rong Chen
- Department of Anesthesiology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 524000, Guizhou Province, China
| | - Yang Zhang
- Department of Anesthesiology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 524000, Guizhou Province, China
| | - Qin Wang
- Department of Rheumatology and Immunology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 524000, Guizhou Province, China
| | - Jiang-Li Ren
- Department of Neurology, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 524000, Guizhou Province, China
| | - Chang-Xu Wang
- Graduate School, Guizhou University of Traditional Chinese Medicine, Guiyang 550002, Guizhou Province, China
| | - Yuan-Kun Xu
- Department of Orthopedics, The First Affiliated Hospital of Guizhou University of Traditional Chinese Medicine, Guiyang 524000, Guizhou Province, China
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Burley CV, Casey AN, Jones MD, Wright KE, Parmenter BJ. Nonpharmacological approaches for pain and symptoms of depression in people with osteoarthritis: systematic review and meta-analyses. Sci Rep 2023; 13:15449. [PMID: 37723233 PMCID: PMC10507102 DOI: 10.1038/s41598-023-41709-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 08/30/2023] [Indexed: 09/20/2023] Open
Abstract
People with osteoarthritis often experience pain and depression. These meta-analyses examined and compared nonpharmacological randomized controlled trials (RCTs) for pain and symptoms of depression in people living with osteoarthritis. RCTs published up until April 2022 were sourced by searching electronic databases EMBASE, PUBMED & MEDLINE, Web of Science, CINAHL and PEDro. Random-effects meta-analyses were performed to calculate pooled effect sizes (ES) and 95% confidence intervals (CI) for pain and depression. Subgroup analyses examined intervention subtypes. For pain, 29 interventions (n = 4382; 65 ± 6.9 years; 70% female), revealed a significant effect on reducing pain (ES = 0.43, 95% CI [0.25, 0.61], p < 0.001). Effect sizes were significant (p < 0.001) for movement meditation (ES = 0.52; 95% CI [0.35, 0.69]), multimodal approaches (ES = 0.37; 95% CI [0.22, 0.51]), and psychological therapy (ES = 0.21; 95% CI [0.11, 0.31]), and significant (p = 0.046) for resistance exercise (ES = 0.43, 95% CI [- 0.07, 0.94]. Aerobic exercise alone did not improve pain. For depression, 28 interventions (n = 3377; 63 ± 7.0 years; 69% female), revealed a significant effect on reducing depressive symptoms (ES = 0.29, 95% CI [0.08, 0.49], p < 0.001). Effect sizes were significant for movement meditation (ES = 0.30; 95% CI [0.06, 0.55], p = 0.008) and multimodal interventions (ES = 0.12; 95% CI [0.07, 0.18], p < 0.001). Resistance/aerobic exercise or therapy alone did not improve depressive symptoms. Mind-body approaches were more effective than aerobic/resistance exercise or therapy alone for reducing pain and depression in people with osteoarthritis.Systematic review registration: PROSPERO CRD42022338051.
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Affiliation(s)
- Claire V Burley
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, Australia.
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, Australia.
| | - Anne-Nicole Casey
- Centre for Healthy Brain Ageing, School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Matthew D Jones
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
- Centre for Pain IMPACT, Neuroscience Research Australia, Sydney, Australia
| | - Kemi E Wright
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
| | - Belinda J Parmenter
- UNSW Medicine & Health Lifestyle Clinic, School of Health Sciences, University of New South Wales, Sydney, Australia
- Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia
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10
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Galimberti G, Amodeo G, Magni G, Riboldi B, Balboni G, Onnis V, Ceruti S, Sacerdote P, Franchi S. Prokineticin System Is a Pharmacological Target to Counteract Pain and Its Comorbid Mood Alterations in an Osteoarthritis Murine Model. Cells 2023; 12:2255. [PMID: 37759478 PMCID: PMC10526764 DOI: 10.3390/cells12182255] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 08/31/2023] [Accepted: 09/05/2023] [Indexed: 09/29/2023] Open
Abstract
Osteoarthritis (OA) is the most prevalent joint disease associated with chronic pain. OA pain is often accompanied by mood disorders. We addressed the role of the Prokineticin (PK) system in pain and mood alterations in a mice OA model induced with monosodium iodoacetate (MIA). The effect of a PK antagonist (PC1) was compared to that of diclofenac. C57BL/6J male mice injected with MIA in the knee joint were characterized by allodynia, motor deficits, and fatigue. Twenty-eight days after MIA, in the knee joint, we measured high mRNA of PK2 and its receptor PKR1, pro-inflammatory cytokines, and MMP13. At the same time, in the sciatic nerve and spinal cord, we found increased levels of PK2, PKR1, IL-1β, and IL-6. These changes were in the presence of high GFAP and CD11b mRNA in the sciatic nerve and GFAP in the spinal cord. OA mice were also characterized by anxiety, depression, and neuroinflammation in the prefrontal cortex and hippocampus. In both stations, we found increased pro-inflammatory cytokines. In addition, PK upregulation and reactive astrogliosis in the hippocampus and microglia reactivity in the prefrontal cortex were detected. PC1 reduced joint inflammation and neuroinflammation in PNS and CNS and counteracted OA pain and emotional disturbances.
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Affiliation(s)
- Giulia Galimberti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
| | - Giada Amodeo
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
| | - Giulia Magni
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
| | - Benedetta Riboldi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
| | - Gianfranco Balboni
- Department of Life and Environmental Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.B.); (V.O.)
| | - Valentina Onnis
- Department of Life and Environmental Sciences, University of Cagliari, 09124 Cagliari, Italy; (G.B.); (V.O.)
| | - Stefania Ceruti
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
| | - Paola Sacerdote
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
| | - Silvia Franchi
- Department of Pharmacological and Biomolecular Sciences, University of Milan, 20133 Milan, Italy; (G.G.); (G.A.); (G.M.); (B.R.); (S.C.); (P.S.)
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11
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Warmerdam AMT, Luppino FS, Visser LG. The occurrence and extent of anxiety and distress among Dutch travellers after encountering an animal associated injury. Trop Dis Travel Med Vaccines 2023; 9:11. [PMID: 37580813 PMCID: PMC10426805 DOI: 10.1186/s40794-023-00193-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 05/29/2023] [Indexed: 08/16/2023] Open
Abstract
BACKGROUND Prompt administration of post-exposure prophylaxis (PEP) is crucial to prevent a fatal rabies infection after an animal associated injury (AAI), preferably within 24 h. PEP, especially in case of a type III injury for which rabies immune globulin (RIG) is needed, is difficult to obtain abroad. This, along with the fear of potentially having contracted a lethal disease, might be an important source for anxiety and distress. We investigated the occurrence and extent of self-reported anxiety and distress at different timepoints among Dutch travellers after encountering an AAI, and the involved factors. METHODS A retrospective quantitative observational study was conducted including insured Dutch travellers who actively contacted Eurocross Assistance after encountering an AAI abroad. An online questionnaire was designed to measure anxiety and distress levels, using the HADS (Hospital Anxiety and Depression Scale) and distress thermometer at three time points: departure from home (T1), post-AAI (T2), and treatment administration (T3). Statistical analyses included T-tests, Chi-square tests, and ANCOVA analyses. RESULTS We showed a significant increase in mean anxiety and distress scores at T2, and a significant decrease at T3. Women were more often anxious and distressed. Between T1 and T2, PrEP, and being aware of the risks were positively associated with anxiety levels, and PrEP and WHO region Africa with distress levels. Between T2 and T3, anxiety levels remained higher for monkey-induced injury, thoracic injuries, and WHO region Southeast Asia. PEP-delay between 24-48 h resulted in decreased distress levels at this time period, while type II injury elevated distress levels. CONCLUSIONS This study showed significant anxiety and distress levels after an AAI among the vast majority of travellers, which is detrimental to their health-related quality of life (HR-QOL). This highlights the importance of proper pre-travel information. In the context of rabies prevention, these results suggest that pre-travel advice and policy makers should also take aspects of HR-QOL into consideration.
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Affiliation(s)
| | | | - Leo G Visser
- Department of Infectious Diseases, Leiden University Medical Centre, Leiden, the Netherlands
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12
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Tuncay Duruöz M, Öz N, Gürsoy DE, Hande Gezer H. Clinical aspects and outcomes in osteoarthritis. Best Pract Res Clin Rheumatol 2023; 37:101855. [PMID: 37524622 DOI: 10.1016/j.berh.2023.101855] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
Osteoarthritis (OA) is the most prevalent type of arthritis worldwide, and its incidence significantly increases with age. It commonly affects the knees, hips, spine, big toes, and hands. OA can be identified through clinical examination, symptoms, and imaging methods. Its main symptoms include pain, stiffness, and limitations in joint movement. Examinations may reveal coarse crepitus, bony enlargement, and tenderness at the joint line. In severe cases of OA, rest pain, night pain, and deformity may occur. OA can lead to decreased physical activity, function, and quality of life due to symptoms such as pain and stiffness. To evaluate these impacts, patient-reported outcome measures (PROMs) are necessary. Various generic, disease-specific, and joint-specific PROMs have been developed and used in clinical practice to assess the outcomes of OA.
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Affiliation(s)
- Mehmet Tuncay Duruöz
- Marmara University School of Medicine, Physical Medicine, Rehabilitation Department, Rheumatology Division, Istanbul, Turkey; Eastern Mediterranean University, Faculty of Medicine, Famagusta, North Cyprus.
| | - Nuran Öz
- Marmara University School of Medicine, Physical Medicine, Rehabilitation Department, Rheumatology Division, Istanbul, Turkey
| | - Didem Erdem Gürsoy
- İstanbul Prof. Dr. Cemil Taşçıoğlu City Hospital, Physical Medicine and Rehabilitation Department, Rheumatology Clinic, Istanbul, Turkeye
| | - Halise Hande Gezer
- Marmara University School of Medicine, Physical Medicine, Rehabilitation Department, Rheumatology Division, Istanbul, Turkey
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13
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Zhang S, Li T, Feng Y, Zhang K, Zou J, Weng X, Yuan Y, Zhang L. Exercise improves subchondral bone microenvironment through regulating bone-cartilage crosstalk. Front Endocrinol (Lausanne) 2023; 14:1159393. [PMID: 37288291 PMCID: PMC10242115 DOI: 10.3389/fendo.2023.1159393] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 05/04/2023] [Indexed: 06/09/2023] Open
Abstract
Articular cartilage degeneration has been proved to cause a variety of joint diseases, among which osteoarthritis is the most typical. Osteoarthritis is characterized by articular cartilage degeneration and persistent pain, which affects the quality of life of patients as well as brings a heavy burden to society. The occurrence and development of osteoarthritis is related to the disorder of the subchondral bone microenvironment. Appropriate exercise can improve the subchondral bone microenvironment, thus playing an essential role in preventing and treating osteoarthritis. However, the exact mechanism whereby exercise improves the subchondral bone microenvironment remains unclear. There is biomechanical interaction as well as biochemical crosstalk between bone and cartilage. And the crosstalk between bone and cartilage is the key to bone-cartilage homeostasis maintenance. From the perspective of biomechanical and biochemical crosstalk between bone and cartilage, this paper reviews the effects of exercise-mediated bone-cartilage crosstalk on the subchondral bone microenvironment, aiming to provide a theoretical basis for the prevention and treatment of degenerative bone diseases.
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Affiliation(s)
- Shihua Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- School of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Tingting Li
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Yao Feng
- School of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Keping Zhang
- School of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Jun Zou
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Xiquan Weng
- School of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Yu Yuan
- School of Exercise and Health, Guangzhou Sport University, Guangzhou, China
| | - Lan Zhang
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
- College of Sports and Health, Shandong Sport University, Jinan, China
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14
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Alenazi AM, Alhowimel AS, Alshehri MM, Alqahtani BA, Alhwoaimel NA, Segal NA, Kluding PM. Osteoarthritis and Diabetes: Where Are We and Where Should We Go? Diagnostics (Basel) 2023; 13:diagnostics13081386. [PMID: 37189487 DOI: 10.3390/diagnostics13081386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.
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Affiliation(s)
- Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Mohammed M Alshehri
- Departement of Physical Therapy, Jazan University, Jazan 45142, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Norah A Alhwoaimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Neil A Segal
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MI 66160, USA
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MI 66160, USA
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15
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Jang JH, Kim J, Kwon O, Jung SY, Lee HJ, Cho SY, Park JM, Ko CN, Park SU, Kim H. Effectiveness and Therapeutic Mechanism of Pharmacopuncture for Pain in Parkinson's Disease: A Study Protocol for a Pilot Pragmatic Randomized, Assessor-Blinded, Usual Care-Controlled, Three-Arm Parallel Trial. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1776. [PMID: 36767158 PMCID: PMC9914000 DOI: 10.3390/ijerph20031776] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/06/2023] [Accepted: 01/17/2023] [Indexed: 06/18/2023]
Abstract
Pain in Parkinson's disease (PD) represents a complex phenotype known to decrease quality of life. This pragmatic randomized, controlled clinical trial evaluated the efficacy of pharmacopuncture (PA) for improving pain symptoms and investigated the corresponding therapeutic mechanisms in patients with PD. Ninety patients with PD-related pain were randomly allocated to receive either PA, manual acupuncture, or usual care in a 1:1:1 ratio; sixty healthy controls were included for comparative analysis of brain imaging data. Over 12 weeks, study treatment provided 2 days per week for 8 weeks with a follow-up period of 4 weeks. The primary outcome measure was the King's Parkinson's Disease Pain Scale score for assessing improvement in PD-related pain, including a sub-analysis to investigate the pattern of changes in pain according to a PD-related pain mechanism-based classification. Secondary outcome measures included a numerical rating scale-based assessment of the intensity and location of pain and changes in pain-associated symptoms, such as depression, anxiety, and sleep disorders. Exploratory outcome measures included structural and functional brain patterns on magnetic resonance imaging, blood molecular signature changes, gait analysis, facial expression and movement assessment in response to emotional stimuli, and a traditional Korean medicine syndrome differentiation questionnaire. The trial findings provided important clinical evidence for the effectiveness of PA in the management of PD-related pain and its associated symptoms, and helped elucidate the mechanism of its therapeutic effect on PD-related pain.
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Affiliation(s)
- Jung-Hee Jang
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Jieun Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Ojin Kwon
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - So Young Jung
- Clinical Research Coordinating Team, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
| | - Hye-Jin Lee
- Department of Korean Medicine Cardiology and Neurology, Graduate School, Kyung Hee University, Seoul 02447, Republic of Korea
| | - Seung-Yeon Cho
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Jung-Mi Park
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Chang-Nam Ko
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Seong-Uk Park
- Department of Cardiology and Neurology, College of Korean Medicine, Kyung Hee University, 26, Kyungheedae-ro, Dongdaemun-gu, Seoul 02447, Republic of Korea
| | - Hyungjun Kim
- Clinical Medicine Division, Korea Institute of Oriental Medicine, Daejeon 34054, Republic of Korea
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16
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Al Saleh J, Almoallim H, Elzorkany B, Al Belooshi A, Batouk O, Fathy M, Vainstein N, Kaki AM. Assessing the Burden of Osteoarthritis in Africa and the Middle East: A Rapid Evidence Assessment. Open Access Rheumatol 2023; 15:23-32. [PMID: 36945659 PMCID: PMC10024869 DOI: 10.2147/oarrr.s390778] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2022] [Accepted: 02/28/2023] [Indexed: 03/17/2023] Open
Abstract
Introduction/Objectives This rapid evidence assessment (REA) was conducted to assess the burden of weight-bearing joint osteoarthritis in the developing countries of Africa and the Middle East. Methods Our REA methodology used a standardized search strategy to identify observational studies, published between January 1, 2010, and April 23, 2020, reporting on outcomes pertaining to the epidemiology and humanistic or economic burden of weight-bearing osteoarthritis. Relevant data from the included studies were used for qualitative analysis. Results Among the 20 publications reporting on knee osteoarthritis in 10 countries in Africa and the Middle East, 2 also reported on hip, and 1 on foot osteoarthritis. Prevalence of symptomatic/radiographic knee OA was 9-14% among rheumatology outpatients and 31-34% among those with mixed etiology osteoarthritis. Prevalence of knee OA diagnosed by magnetic resonance imaging was 70% among patients ≥40 years of age attending a hospital in Saudi Arabia. Quality-of-life outcomes were reported in 16 publications and suggested a substantial humanistic burden of osteoarthritis, including worse pain, function, and quality of life, and more depression; comparisons between studies were hampered by the variety of tools and scoring scales used, however. No studies reported on economic outcomes. Conclusion This REA indicates a substantial burden of osteoarthritis in weight-bearing joints in Africa and the Middle East, consistent with publications from other regions of the world.
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Affiliation(s)
- Jamal Al Saleh
- Department of Rheumatology, Dubai Hospital, Dubai Health Authority, Dubai, United Arab Emirates
| | - Hani Almoallim
- Department of Medicine, Medical College, Umm Al-Qura University, Makkah, Saudi Arabia
| | | | - Ali Al Belooshi
- Mediclinic City Hospital, Department of Surgery, UAE University, Dubai, United Arab Emirates
| | - Omar Batouk
- King Saud bin Abdulaziz University for Health Sciences, National Guard Health Affairs, Jeddah, Saudi Arabia
| | | | | | - Abdullah M Kaki
- Department of Anesthesia and Critical Care, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
- Correspondence: Abdullah M Kaki, MD, FRCPC, Professor of Anesthesiology and Pain Medicine, Faculty of Medicine, King Abdulaziz University, PO Box 2907, Jeddah, 21461, Saudi Arabia, Tel/Fax +966126408335, Email ;
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17
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Primetis E, Drakopoulos D, Sieron D, Meusburger H, Szyluk K, Niemiec P, Obmann VC, Peters AA, Huber AT, Ebner L, Delimpasis G, Christe A. Knee Diameter and Cross-Sectional Area as Biomarkers for Cartilage Knee Degeneration on Magnetic Resonance Images. MEDICINA (KAUNAS, LITHUANIA) 2022; 59:medicina59010027. [PMID: 36676651 PMCID: PMC9865157 DOI: 10.3390/medicina59010027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/16/2022] [Accepted: 12/20/2022] [Indexed: 12/24/2022]
Abstract
Background and Objectives: Osteoarthritis (OA) of the knee is a degenerative disorder characterized by damage to the joint cartilage, pain, swelling, and walking disability. The purpose of this study was to assess whether demographic and radiologic parameters (knee diameters and knee cross-sectional area from magnetic resonance (MR) images) could be used as surrogate biomarkers for the prediction of OA. Materials and Methods: The knee diameters and cross-sectional areas of 481 patients were measured on knee MR images, and the corresponding demographic parameters were extracted from the patients' clinical records. The images were graded based on the modified Outerbridge arthroscopic classification that was used as ground truth. Receiver-operating characteristic (ROC) analysis was performed on the collected data. Results: ROC analysis established that age was the most accurate predictor of severe knee cartilage degeneration (corresponding to Outerbridge grades 3 and 4) with an area under the curve (AUC) of the specificity-sensitivity plot of 0.865 ± 0.02. An age over 41 years was associated with a sensitivity and specificity for severe degeneration of 82.8% (CI: 77.5-87.3%), and 76.4% (CI: 70.4-81.6%), respectively. The second-best degeneration predictor was the normalized knee cross-sectional area, with an AUC of 0.767 ± 0.04), followed by BMI (AUC = 0.739 ± 0.02), and normalized knee maximal diameter (AUC = 0.724 ± 0.05), meaning that knee degeneration increases with increasing knee diameter. Conclusions: Age is the best predictor of knee damage progression in OA and can be used as surrogate marker for knee degeneration. Knee diameters and cross-sectional area also correlate with the extent of cartilage lesions. Though less-accurate predictors of damage progression than age, they have predictive value and are therefore easily available surrogate markers of OA that can be used also by general practitioners and orthopedic surgeons.
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Affiliation(s)
- Elias Primetis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dionysios Drakopoulos
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Dominik Sieron
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Hugo Meusburger
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Karol Szyluk
- Department of Physiotherapy, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
- District Hospital of Orthopaedics and Trauma Surgery, Bytomska 62 St., 41-940 Piekary Slaskie, Poland
| | - Paweł Niemiec
- Department of Biochemistry and Medical Genetics, Faculty of Health Sciences in Katowice, Medical University of Silesia in Katowice, 40-752 Katowice, Poland
| | - Verena C. Obmann
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Alan A. Peters
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Adrian T. Huber
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Lukas Ebner
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
| | - Georgios Delimpasis
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
| | - Andreas Christe
- Department of Radiology SLS, Inselgroup, Bern University Hospital, University of Bern, Freiburgstrasse 10, 3010 Bern, Switzerland
- Department of Diagnostic, Interventional and Pediatric Radiology, Inselspital, Bern University Hospital, University of Bern, 3010 Bern, Switzerland
- Correspondence:
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18
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Gao W, Long DD, Pan TT, Hu R, Chen DY, Mao Y, Chai XQ, Jin Y, Zhang Z, Wang D. Dexmedetomidine alleviates anxiety-like behavior in mice following peripheral nerve injury by reducing the hyperactivity of glutamatergic neurons in the anterior cingulate cortex. Biochem Pharmacol 2022; 206:115293. [DOI: 10.1016/j.bcp.2022.115293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/02/2022] [Accepted: 10/03/2022] [Indexed: 11/28/2022]
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Trends and Racial/Ethnic Differences in Health Care Spending Stratified by Gender among Adults with Arthritis in the United States 2011-2019. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159014. [PMID: 35897384 PMCID: PMC9329708 DOI: 10.3390/ijerph19159014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 07/21/2022] [Accepted: 07/22/2022] [Indexed: 02/05/2023]
Abstract
The purpose of this study was to determine if there were racial/ethnic differences and patterns for individual office-based visit expenditures by gender among a nationally representative sample of adults with arthritis. We retrospectively analyzed pooled data from the 2011 to 2019 Medical Expenditure Panel Survey of adults who self-reported an arthritis diagnosis, stratified by gender (men = 13,378; women = 33,261). Our dependent variable was office-based visit expenditures. Our independent variables were survey year (categorized as 2011-2013, 2014-2016, 2017-2019) and race/ethnicity (non-Hispanic White, non-Hispanic Black, Hispanic, non-Hispanic Asian, non-Hispanic other/multiracial). We conducted trends analysis to assess for changes in expenditures over time. We utilized a two-part model to assess differences in office-based expenditures among participants who had any office-based expenditure and then calculated the average marginal effects. The unadjusted office-based visit expenditures increased significantly across the study period for both men and women with arthritis, as well as for some racial and ethnic groups depending on gender. Differing racial and ethnic patterns of expenditures by gender remained after accounting for socio-demographic, healthcare access, and health status factors. Delaying care was an independent driver of higher office-based expenditures for women with arthritis but not men. Our findings reinforce the escalating burden of healthcare costs among U.S. adults with arthritis across genders and certain racial and ethnic groups.
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Jayakumar P, Galea VP, Geng M, Moore MG, Bozic KJ, Koenig KM. Functional Outcomes of a Musculoskeletal Integrated Practice Providing Comprehensive Whole Person Care for Hip Osteoarthritis. J Arthroplasty 2022; 37:S471-S478.e1. [PMID: 35288247 DOI: 10.1016/j.arth.2022.03.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Revised: 03/03/2022] [Accepted: 03/03/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND Outcomes of hip osteoarthritis (OA) management within integrated practice units (IPUs) are lacking. This study reports 6-month and 1-year patient-reported outcomes (PROs) of IPU care, the proportion of patients achieving minimal clinically important difference (MCID) and substantial clinical benefit (SCB) at 1 year, and baseline factors associated with the likelihood of achieving MCID and SCB. METHODS We retrospectively evaluated 1009 new patients presenting to an IPU with hip OA between October 2017 and June 2020. Patients experienced multidisciplinary team-based management. Individuals with baseline and 6-month PROs or baseline and 1-year PROs (Hip Disability and Osteoarthritis Outcome Score Joint Replacement, HOOS JR) were included. We used anchor-based MCID and SCB thresholds and multivariable binary logistic regression models to identify baseline factors associated with achieving 1-year MCID and SCB. RESULTS HOOS JR increased from baseline to 6 months (Δ = 19.1 ± 2.1, P = .065) and baseline to 1 year (Δ = 35.8 ± 2.9, P < .001). At 1 year, 72.7% (IPU only) and 88% (IPU-based total hip arthroplasty [THA]) achieved MCID (P < .001), and 62.3% (IPU only) and 88% (IPU-based THA) achieved SCB (P < .001). In multivariable regression, lower baseline HOOS JR scores (r = 0.96, P = .04), undergoing THA (r = 0.213, P < .001), and fewer symptoms of generalized anxiety (r = 0.932, P = .018) were independently associated with achieving MCID at 1 year. The same factors were independently associated with achieving SCB at 1 year. Lower baseline anxiety (Generalized Anxiety Disorder Questionnaire-7 item) and greater hip-related preoperative limitations result in greater likelihood of achieving MCID and SCB. CONCLUSION Significant improvements in patient outcomes can be achieved by IPUs providing comprehensive care for hip OA including the management of psychological distress. Future prospective studies should compare the outcomes of IPUs with traditional care in managing diverse patient phenotypes.
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Affiliation(s)
| | - Vincent P Galea
- The University of Texas at Austin, Dell Medical School, Austin, TX; New York Medical College, School of Medicine, New York, NY
| | - Michael Geng
- The University of Texas at Austin, Dell Medical School, Austin, TX; Texas A&M University, Engineering Medicine Program, Houston, TX
| | - Meredith G Moore
- The University of Texas at Austin, Dell Medical School, Austin, TX; Department of Plastic Surgery, University of South Florida, Tampa, FL
| | - Kevin J Bozic
- The University of Texas at Austin, Dell Medical School, Austin, TX
| | - Karl M Koenig
- The University of Texas at Austin, Dell Medical School, Austin, TX
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21
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Terpstra SE, van de Stadt L, Boonen A, Damman W, Rosendaal F, Kloppenburg M. Hand osteoarthritis is associated with limitations in paid and unpaid work participation and related societal costs: the HOSTAS cohort. RMD Open 2022; 8:rmdopen-2022-002367. [PMID: 35906024 PMCID: PMC9345053 DOI: 10.1136/rmdopen-2022-002367] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 05/30/2022] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES Data on work participation impairment and related societal costs for patients with hand osteoarthritis (OA) are scarce. Therefore, we aimed to investigate the association of hand OA with work limitations and costs of productivity loss in paid and unpaid work. METHODS We used data from the Hand Osteoarthritis in Secondary Care cohort, including patients with hand OA diagnosed by their treating rheumatologist. Using the validated Health and Labour Questionnaire, we assessed experienced unpaid and paid work restrictions, unpaid work replacement by others and inefficiency and absence during paid work related to hand OA over the last 2 weeks. Societal costs (€) per hour of paid and unpaid work were estimated using Dutch salary data in 2019. RESULTS 381 patients were included (mean age 61 years, 84% women, 26% high education level, 55% having any comorbidity). Replacement of unpaid work by others due to hand OA was necessary for 171 out of 381 patients (45%). Paid work was reported by 181/381 patients (47%), of whom 13/181 (7%) reported absenteeism, 28/181 (15%) unproductive hours at work and 120/181 (66%) paid work restrictions due to hand OA.Total estimated work-related societal costs per patient with hand OA (381 patients) were €94 (95% CI 59 to 130) per 2 weeks (€2452, 95% CI 1528 to 3377 per year). CONCLUSIONS Hand OA is associated with impairment in paid and unpaid work participation, which translates into substantial societal costs of lost productivity. These results highlight the importance of adequate hand OA treatment.
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Affiliation(s)
| | | | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center and the Caphri Research Institute Maastricht University, Maastricht, The Netherlands
| | - Wendy Damman
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits Rosendaal
- Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Margreet Kloppenburg
- Rheumatology, Leiden University Medical Center, Leiden, The Netherlands.,Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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22
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Zhou Q, Chen J, Yu W, Yang K, Guo T, Niu P, Ye Y, Liu A. The Effectiveness of Duloxetine for Knee Osteoarthritis: An Overview of Systematic Reviews. Front Physiol 2022; 13:906597. [PMID: 35860654 PMCID: PMC9292134 DOI: 10.3389/fphys.2022.906597] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Knee osteoarthritis (KOA) has become a public health problem. Several systematic reviews (SRs) have reported that duloxetine may be an effective treatment for improving pain and depressive symptoms in patients with KOA. Aim: To evaluate the available results and provide scientific evidence for the efficacy and safety of duloxetine for KOA. Methods: A comprehensive search strategy was conducted across eight databases from inception to 31 December 2021. Two researchers independently selected eligible studies, collected data and evaluated those included SRs’ quality. For assessing methodological quality, the Assessing the Methodological Quality of Systematic Reviews 2 (AMSTAR 2) was employed. Risk of Bias in Systematic Reviews (ROBIS) was used to assess the risk of bias. Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) was utilized for assessing reporting quality. In addition, the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to determine primary outcome indicators’ evidence quality. Results: Totally 6 SRs were contained in this overview. After assessment based on AMSTAR 2, ROBIS, and PRISMA, unsatisfactory results in terms of methodological quality, risk of bias as well as reporting quality, were obtained. Limitations included a search of grey literature, the reasons for selecting the study type, an excluded study list and the specific reasons, reporting bias assessment, and reporting of potential sources of conflict of interest. According to the GRADE results, the evidence quality was high in 0, moderate in 5, low in 19, and very low in 36. Limitations were the most commonly downgraded factor, followed by publication bias and inconsistency. Conclusion: Duloxetine may be an effective treatment for improving pain and depressive symptoms in KOA patients with acceptable adverse events. However, due to the low quality of the available evidence, the original study design and the quality of evidence from SRs should be further improved, so as to provide strong scientific evidence for definitive conclusions. Systematic Review Registration: PROSPERO; (http://www.crd.york.ac.uk/PROSPERO/), identifier (CRD42021289823).
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Affiliation(s)
- Qinxin Zhou
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Jixin Chen
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Weijie Yu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Kun Yang
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Tianci Guo
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Puyu Niu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Yuntian Ye
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
| | - Aifeng Liu
- Department of Orthopaedic Surgery, First Teaching Hospital of Tianjin University of Traditional Chinese Medicine, Tianjin, China
- National Clinical Research Center for Chinese Medicine Acupuncture and Moxibustion, Tianjin, China
- *Correspondence: Aifeng Liu,
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23
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Gonzalez-Navarro B, Gonzalez-Parreño S, Perez-Aznar A, Miralles-Muñoz FA, Lizaur-Utrilla A, Vizcaya-Moreno MF. Negative Association of Subclinical Hypothyroidism on Improvement in Patient-Reported Outcomes After Total Knee Arthroplasty. J Arthroplasty 2022; 37:864-868. [PMID: 35114322 DOI: 10.1016/j.arth.2022.01.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2021] [Revised: 12/11/2021] [Accepted: 01/22/2022] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The purpose of this study is to analyze the potential influence of subclinical hypothyroidism (SCH) on improvement in patient-reported outcome measures following primary total knee arthroplasty. METHODS A prospective, comparative cohort study between 92 SCH and 90 euthyroid patients was performed. Patients were followed up to 5 postoperative years. Patient-reported outcome measure was assessed by the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire. The Knee Society Scores were used for functional evaluation, and 5-point Likert scale for patient satisfaction. The Hospital Anxiety and Depression scale was also used. RESULTS All outcome scores significantly improved from preoperative to final follow-up in both groups (P = .001). There were no significant differences between groups in Knee Society Scores (P = .057) at the final follow-up, but Western Ontario and McMaster Universities Osteoarthritis Index scores were significantly lower in the SCH group (P = .015). Likewise, the patient satisfaction rate was significant lower in the SCH group (0.010). CONCLUSION SCH patients have a slower functional recovery than euthyroid patients, and trended toward lower improvements in patient-reported scores. Depression was the most important negative factor. The findings of this study can provide the surgeon with an important information for better counseling the SCH patients.
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Affiliation(s)
| | | | - Adolfo Perez-Aznar
- Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain
| | | | - Alejandro Lizaur-Utrilla
- Department of Orthopaedic Surgery, Elda University Hospital, Elda, Alicante, Spain; Department of Traumatology and Orthopaedics, Miguel Hernandez University, San Juan de Alicante, Alicante, Spain
| | - M Flores Vizcaya-Moreno
- Unit of Clinical Nursing Research, Faculty of Health Sciences, University of Alicante, San Vicente del Raspeig, Alicante, Spain
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24
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Illeez OG, Oktay KNK, Aktas I, Ozkan FU, Nazligül T, Begoglu FA, Kaysin MY, Atici A, Akpinar P. Comparison of the effects of duloxetine and pregabalin on pain and associated factors in patients with knee osteoarthritis. Rev Assoc Med Bras (1992) 2022; 68:377-383. [PMID: 35442367 DOI: 10.1590/1806-9282.20211047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 01/07/2022] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the effects of duloxetine and pregabalin primarily on pain and functional status in patients with knee osteoarthritis and secondarily on quality of life, depression, anxiety, and sleep disturbance. METHODS A total of 66 patients with knee osteoarthritis were randomized to use duloxetine or pregabalin. Patients were evaluated by Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36, Beck Depression Inventory, Beck Anxiety Inventory, and Pittsburg Sleep Quality Index before the treatment and after 4 and 12 weeks of treatment. RESULTS Improvements occurred in Visual Analog Scale, Neuropathic Pain Diagnostic Questionnaire, Western Ontario and McMaster University Osteoarthritis Index, Short Form-36 (with an exception of the mental health subgroup scores in duloxetine-treated group), Beck Depression Inventory, and Beck Anxiety Inventory scores in both groups from 4 weeks after baseline. Pittsburg Sleep Quality Index total scores and SF-36 mental health subgroup scores started to improve on the 4th and 12th weeks in pregabalin- and duloxetine-treated groups, respectively. CONCLUSION Osteoarthritis pain, a complex outcome with nociceptive and neuropathic components, leads to central sensitization in a chronic phase. Using centrally acting drugs in the control of pain and associated symptoms would increase the probability of treatment success.
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Affiliation(s)
- Ozge Gulsum Illeez
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Kubra Neslihan Kurt Oktay
- Yeditepe University Faculty of Medicine, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Ilknur Aktas
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Feyza Unlu Ozkan
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Tuba Nazligül
- University of Health Sciences, Van Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Van, Turkey
| | - Feyza Akan Begoglu
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Meryem Yilmaz Kaysin
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Arzu Atici
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
| | - Pinar Akpinar
- University of Health Sciences Fatih Sultan Mehmet Training and Research Hospital, Department of Physical Medicine and Rehabilitation - Istanbul, Turkey
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25
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Health, Psychological and Demographic Predictors of Depression in People with Fibromyalgia and Osteoarthritis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19063413. [PMID: 35329109 PMCID: PMC8950397 DOI: 10.3390/ijerph19063413] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/05/2022] [Revised: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 02/04/2023]
Abstract
Depression is common in people with fibromyalgia (FM) and osteoarthritis (OA) and has been linked to adverse health outcomes in these conditions. The purpose of this study was to examine differences in predictors of depression among individuals with FM and OA using a range of health, demographic, and psychological variables. Of the total 963 participants, 600 were diagnosed with FM, and 363 with OA. The Quality of Well-Being Scale (QWB) was used to assess health status. The Fibromyalgia Impact Questionnaire (FIQ) and the Arthritis Impact Measurement Scale (AIMS) were used to measure disease-specific impact. Additionally, participants completed self-efficacy and helplessness assessments. Depression was measured using the Center for Epidemiological Studies Scale (CES-D). The results of a moderated linear regression showed that higher depression scores were associated with lower health status and a greater condition impact, especially in the FM group. Self-efficacy and helplessness predicted depression in both groups, but more strongly in FM. White participants with OA were more depressed than their non-White counterparts, while the opposite was true for FM. These findings indicate that improving health status and psychological well-being might alleviate depression in both FM and OA.
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26
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Carlesso LC, Feldman DE, Vendittoli PA, LaVoie F, Choinière M, Bolduc MÈ, Fernandes J, Newman N, Sabouret P. Use of IMMPACT Recommendations to Explore Pain Phenotypes in People with Knee Osteoarthritis. PAIN MEDICINE 2022; 23:1708-1716. [PMID: 35266543 DOI: 10.1093/pm/pnac044] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/24/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a disease of multiple phenotypes of which a chronic pain phenotype (PP) is known. Previous PP studies have focused on one domain of pain and included heterogenous variables. We sought to identify multidimensional PPs using the IMMPACT recommendations and their relationship to clinical outcomes. METHODS Participants >40 years of age with knee OA having a first-time orthopaedic consultation at five university affiliated hospitals in Montreal, Quebec and Hamilton (Canada) were recruited. Latent profile analysis was used to determine PPs (classes) using variables recommended by IMMPACT. This included pain variability, intensity and qualities, somatization, anxiodepressive symptoms, sleep, fatigue, pain catastrophizing, neuropathic pain, and quantitative sensory tests. We used MANOVA and Chi-square tests to assess differences in participant characteristics across the classes and linear and Poisson regression to evaluate the association of classes to outcomes of physical performance tests, self-reported function and provincial healthcare data. RESULTS 343 participants were included (mean age 64 years, 64% female). Three classes were identified with increasing pain burden (class3 > class1), characterized by significant differences across most self-report measures and temporal summation, and differed in terms of female sex, younger age, lower optimism and pain self-efficacy. Participants in class2 and class3 had significantly worse self-reported function, stair climb and 40m walk tests, and higher rates of healthcare usage compared to those in class1. CONCLUSIONS Three distinct PPs guided by IMMPACT recommendations were identified, predominated by self-report measures and temporal summation. Using this standardized approach may improve PP study variability and comparison.
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Affiliation(s)
- Lisa C Carlesso
- School of Rehabilitation Science, McMaster University, Associate, Research Institute St. Joseph's Hamilton, Canada; School of Rehabilitation, Université de Montreal, Montreal, Canada
| | - Debbie Ehrmann Feldman
- School of Rehabilitation, School of Public Health, Department of Social and Preventive Medicine, Université de Montreal,Centre for interdisciplinary research in rehabilitation,Institute of Public Health Research,Université de Montréal, Montreal, Canada
| | - Pascal-André Vendittoli
- Département de Chirurgie, Hôpital Maisonneuve-Rosemont,Université de Montréal, Montréal, QC, Canada
| | - Frédéric LaVoie
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Manon Choinière
- Department of Anesthesiology and Pain Medicine, Université de Montréal, Montreal, Canada; Research Center of the Centre hospitalier de l'Université de Montréal, Montreal, Canada
| | - Marie-Ève Bolduc
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Julio Fernandes
- Department of Orthopaedic Surgery, Hôpital du Sacré-Coeur de Montréal, Montréal, Canada; Faculty of Medicine, Université de Montréal, Montréal, Canada; Department of Orthopaedic Surgery, Hôpital Jean-Talon, Montréal, QC, Canada
| | - Nicholas Newman
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
| | - Pierre Sabouret
- Service de chirurgie orthopédique,Centre Hospitalier de l'Université de Montréal, Montréal, Québec, Canada
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27
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Atukorala I, Downie A, Pathmeswaran A, Deveza LMA, Chang T, Zhang Y, Hunter DJ. Short-term pain trajectories in patients with knee osteoarthritis. Int J Rheum Dis 2022; 25:281-294. [PMID: 35080125 DOI: 10.1111/1756-185x.14267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/06/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
AIM It is unknown if pain in knee osteoarthritis (KOA) follows distinct patterns over the short term. Therefore, the aim of this study was to identify whether persons with a previous history of KOA pain fluctuations have distinct trajectories of pain over 90 days and to examine associations between baseline characteristics and pain trajectories. METHOD People with a previous history of KOA were selected from a web-based longitudinal study. Baseline variables were sex, age, being obese/overweight, years of KOA, knee injury, knee buckling, satisfactory Lubben Social Support Score, pain and stress scales, Intermittent Constant Osteoarthritis Pain Score (ICOAP), medication use, and physical activity. Participants completed a Knee Injury and Osteoarthritis Outcomes Score (KOOS) pain subscale (KOOS-p, rated 0 = extreme to 100 = no knee problems) at 10-day intervals for 90 days. Short-term KOOS-p trajectories were identified using latent growth mixture modeling and the baseline risk factors for these pain trajectories were examined. RESULTS Participants (n = 313) had a mean age of 62.2 (SD ± 8.1) years and and a body mass index of 29.8 (SD ± 6.6) kg/m2 . The three-class latent growth mixture modeling quadratic model with best fit indices was chosen (based on lowest sample-size-adjusted Bayesian Information Criterion, high probability of belonging, interpretability). Three distinct pain trajectory clusters (over 90 days) were identified: low-moderate pain at baseline with large improvement (n = 11), minimal change in pain over 90 days (n = 248), and moderate-high pain with worsening (n = 46). Higher ICOAP (intermittent scale), perceived stress, negative affect score, and knee buckling at baseline were associated with a worse knee pain trajectory (P < 0.05). CONCLUSIONS Persons with KOA showed unique short-term pain trajectories over 90 days, with distinct characteristics at baseline associated with each trajectory.
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Affiliation(s)
- Inoshi Atukorala
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Aron Downie
- Faculty of Medicine and Health, Sydney School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | | | - Leticia Miranda Alle Deveza
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David John Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
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28
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Zhuang SZ, Chen PJ, Han J, Xiao WH. Beneficial Effects and Potential Mechanisms of Tai Chi on Lower Limb Osteoarthritis: A Biopsychosocial Perspective. Chin J Integr Med 2021; 29:368-376. [PMID: 34921649 DOI: 10.1007/s11655-021-3529-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 01/15/2023]
Abstract
Lower limb osteoarthritis (OA) is a chronic, multifactorial disease characterized by impaired physical function, chronic pain, compromised psychological health and decreased social functioning. Chronic inflammation plays a critical role in the pathophysiology of OA. Tai Chi is a type of classical mind-body exercise derived from ancient Chinese martial arts. Evidence supports that Tai Chi has significant benefits for relieving lower limb OA symptoms. Using a biopsychosocial framework, this review aims to elucidate the beneficial effects of Tai Chi in lower limb OA and disentangle its potential mechanisms from the perspective of biology, psychology, and social factors. Complex biomechanical, biochemical, neurological, psychological, and social mechanisms, including strengthening of muscles, proprioception improvement, joint mechanical stress reduction, change of brain activation and sensitization, attenuation of inflammation, emotion modulation and social support, are discussed.
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Affiliation(s)
- Shu-Zhao Zhuang
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, 200438, China
| | - Pei-Jie Chen
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, 200438, China
| | - Jia Han
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, 200438, China
| | - Wei-Hua Xiao
- Shanghai Frontiers Science Research Base of Exercise and Metabolic Health, Shanghai University of Sport, Shanghai, 200438, China.
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29
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Anxiety enhances pain in a model of osteoarthritis and is associated with altered endogenous opioid function and reduced opioid analgesia. Pain Rep 2021; 6:e956. [PMID: 35128295 PMCID: PMC8568395 DOI: 10.1097/pr9.0000000000000956] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2021] [Accepted: 08/02/2021] [Indexed: 01/15/2023] Open
Abstract
Introduction Negative affect, including anxiety and depression, is prevalent in chronic pain states such as osteoarthritis (OA) and associated with greater use of opioid analgesics, potentially contributing to present and future opioid crises. Objectives We tested the hypothesis that the interaction between anxiety, chronic pain, and opioid use results from altered endogenous opioid function. Methods A genetic model of negative affect, the Wistar-Kyoto (WKY) rat, was combined with intra-articular injection of monosodium iodoacetate (MIA; 1 mg) to mimic clinical presentation. Effects of systemic morphine (0.5-3.5 mg·kg-1) on pain behaviour and spinal nociceptive neuronal activity were compared in WKY and normo-anxiety Wistar rats 3 weeks after MIA injection. Endogenous opioid function was probed by the blockade of opioid receptors (0.1-1 mg·kg-1 systemic naloxone), quantification of plasma β-endorphin, and expression and phosphorylation of spinal mu-opioid receptor (MOR). Results Monosodium iodoacetate-treated WKY rats had enhanced OA-like pain, blunted morphine-induced analgesia, and greater mechanical hypersensitivity following systemic naloxone, compared with Wistar rats, and elevated plasma β-endorphin levels compared with saline-treated WKY controls. Increased MOR phosphorylation at the master site (serine residue 375) in the spinal cord dorsal horn of WKY rats with OA-like pain (P = 0.0312) indicated greater MOR desensitization. Conclusions Reduced clinical analgesic efficacy of morphine was recapitulated in a model of high anxiety and OA-like pain, in which endogenous opioid tone was altered, and MOR function attenuated, in the absence of previous exogenous opioid ligand exposure. These findings shed new light on the mechanisms underlying the increased opioid analgesic use in high anxiety patients with chronic pain.
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Hashiesh HM, Sharma C, Goyal SN, Jha NK, Ojha S. Pharmacological Properties, Therapeutic Potential and Molecular Mechanisms of JWH133, a CB2 Receptor-Selective Agonist. Front Pharmacol 2021; 12:702675. [PMID: 34393784 PMCID: PMC8363263 DOI: 10.3389/fphar.2021.702675] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 07/02/2021] [Indexed: 12/15/2022] Open
Abstract
The endocannabinoid system has attracted attention as a pharmacological target for several pathological conditions. Cannabinoid (CB2)-selective agonists have been the focus of pharmacological studies because modulation of the CB2 receptor (CB2R) can be useful in the treatment of pain, inflammation, arthritis, addiction, and cancer among other possible therapeutic applications while circumventing CNS-related adverse effects. Increasing number of evidences from different independent preclinical studies have suggested new perspectives on the involvement of CB2R signaling in inflammation, infection and immunity, thus play important role in cancer, cardiovascular, renal, hepatic and metabolic diseases. JWH133 is a synthetic agonist with high CB2R selectivity and showed to exert CB2R mediated antioxidant, anti-inflammatory, anticancer, cardioprotective, hepatoprotective, gastroprotective, nephroprotective, and immunomodulatory activities. Cumulative evidences suggest that JWH133 protects against hepatic injury, renal injury, cardiotoxicity, fibrosis, rheumatoid arthritis, and cancer as well as against oxidative damage and inflammation, inhibits fibrosis and apoptosis, and acts as an immunosuppressant. This review provides a comprehensive overview of the polypharmacological properties and therapeutic potential of JWH133. This review also presents molecular mechanism and signaling pathways of JWH133 under various pathological conditions except neurological diseases. Based on the available data, this review proposes the possibilities of developing JWH133 as a promising therapeutic agent; however, further safety and toxicity studies in preclinical studies and clinical trials in humans are warranted.
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Affiliation(s)
- Hebaallah Mamdouh Hashiesh
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Charu Sharma
- Department of Internal Medicine, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
| | - Sameer N Goyal
- Shri Vile Parle Kelavani Mandal's Institute of Pharmacy, Dhule, India
| | - Niraj Kumar Jha
- Department of Biotechnology, School of Engineering and Technology (SET), Sharda University, Greater Noida, India
| | - Shreesh Ojha
- Department of Pharmacology and Therapeutics, College of Medicine and Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates.,Zayed Bin Sultan Center for Health Sciences, United Arab Emirates University, Al Ain, United Arab Emirates
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Innes KE, Sambamoorthi U. The Association of Osteoarthritis and Related Pain Burden to Incident Alzheimer's Disease and Related Dementias: A Retrospective Cohort Study of U.S. Medicare Beneficiaries. J Alzheimers Dis 2021; 75:789-805. [PMID: 32333589 DOI: 10.3233/jad-191311] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
BACKGROUND Emerging evidence suggests osteoarthritis (OA) and related symptom burden may increase risk for Alzheimer's disease and related dementias (ADRD). However, longitudinal studies are sparse, and none have examined the potential mediating effects of mood or sleep disorders. OBJECTIVE To determine the association of OA and related pain to incident ADRD in U.S. elders. METHODS In this retrospective cohort study, we used baseline and two-year follow-up data from linked Medicare claims and Medicare Current Beneficiary Survey files (11 pooled cohorts, 2001-2013). The study sample comprised 16,934 community-dwelling adults≥65 years, ADRD-free at baseline and enrolled in fee-for-service Medicare. Logistic regression was used to assess the association of OA and related pain (back, neck, joint, neuropathic) to incident ADRD, explore the mediating inlfuence of mood and insomnia-related sleep disorders, and (sensitivity analyses) account for potential survival bias. RESULTS Overall, 25.5% of beneficiaries had OA at baseline (21.0% with OA and pain); 1149 elders (5.7%) were subsequently diagnosed with ADRD. Compared to beneficiaries without OA, those with OA were significantly more likely to receive a diagnosis of incident ADRD after adjustment for sociodemographics, lifestyle characteristics, comorbidities, and medications (adjusted odds ratio (AOR) = 1.23 (95% confidence interval (CI) 1.06, 1.42). Elders with OA and pain at baseline were significantly more likely to be diagnosed with incident ADRD than were those without OA or pain (AOR = 1.31, CI 1.08, 1.58). Sensitivity analyses yielded similar findings. Inclusion of depression/anxiety, but not sleep disorders, substantially attenuated these associations. CONCLUSION Findings of this study suggest that: OA is associated with elevated ADRD risk, this association is particularly pronounced in those with OA and pain, and mood disorders may partially mediate this relationship.
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Affiliation(s)
- Kim E Innes
- Department of Epidemiology, West Virginia University School of Public Health, Morgantown, WV, USA
| | - Usha Sambamoorthi
- Department of Pharmaceutical Systems and Policy, West Virginia University School of Pharmacy, Morgantown, WV, USA
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Dimmek DJ, Korallus C, Buyny S, Christoph G, Lichtinghagen R, Jacobs R, Nugraha B. Brain-Derived Neurotrophic Factor and Immune Cells in Osteoarthritis, Chronic Low Back Pain, and Chronic Widespread Pain Patients: Association with Anxiety and Depression. MEDICINA (KAUNAS, LITHUANIA) 2021; 57:327. [PMID: 33915758 PMCID: PMC8065931 DOI: 10.3390/medicina57040327] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/17/2021] [Accepted: 03/25/2021] [Indexed: 01/09/2023]
Abstract
Background and Objectives: Musculoskeletal dysfunction can induce several types of chronic pain syndromes. It is of particular interest to elucidate the pathomechanism of different forms of chronic pain. It is possible that patients who have developed chronic widespread pain (CWP) may endure different pathomechanisms as compared to those who suffer from local pain (osteoarthritis, OA) and regional pain (chronic low back pain, cLBP), especially with regard to pain regulation and its related biomediators. The aim of this study was to determine the differences in pathomechanisms among these patients by measuring pain-related biomediators, particularly brain-derived neurotrophic factor (BDNF). Additionally, subpopulations of immune cells were determined in parallel. Materials and Methods: Patients and healthy subjects (HSs) were recruited (age and gender-matched). BDNF was measured from serum samples of patients and HSs and the data of body composition parameters were recorded. Additionally, both patients and HSs were asked to fill in questionnaires related to pain intensity, anxiety, and depression. Results: Our results highlight that the levels of both free and total BDNF are significantly lower in pain patients compared to HSs, with p values of 0.041 and 0.024, respectively. The number of CD3- CD56bright natural killer (NK) cells shows significant differences between the groups. Comparing all chronic pain patients with HSs reveals a significantly lower number of CD4+ CD8+ T cells (p = 0.031), CD3- CD56bright NK cells (p = 0.049) and CD20+ CD3- cells (p = 0.007). Conclusions: To conclude, it seems that a general conformity between the pathomechanisms of different chronic pain diseases exists, although there are unique findings only in specific chronic pain patients.
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Affiliation(s)
- Dominique Josephine Dimmek
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany; (D.J.D.); (C.K.); (G.C.)
| | - Christoph Korallus
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany; (D.J.D.); (C.K.); (G.C.)
| | - Sabine Buyny
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany; (S.B.); (R.J.)
| | - Gutenbrunner Christoph
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany; (D.J.D.); (C.K.); (G.C.)
| | - Ralf Lichtinghagen
- Institute of Clinical Chemistry, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany;
| | - Roland Jacobs
- Department of Rheumatology and Clinical Immunology, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany; (S.B.); (R.J.)
| | - Boya Nugraha
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str.1, 30625 Hannover, Germany; (D.J.D.); (C.K.); (G.C.)
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The Relationship Between Pain and Quality of Life Among Adults With Knee Osteoarthritis: The Mediating Effects of Lower Extremity Functional Status and Depression. Orthop Nurs 2021; 40:73-80. [PMID: 33756534 DOI: 10.1097/nor.0000000000000740] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Pain, lower extremity functional status, and depression have been associated with quality of life among patients with knee osteoarthritis (KOA). However, little is known about the manner in which these factors influence quality of life. The present study examined the mediating effects of lower extremity functional status and depression on the relationship between pain and quality of life among adults with KOA. A descriptive cross-sectional study was conducted among 135 adults with KOA who visited an orthopaedic outpatient clinic in Korea. The participants responded to the Numeric Rating Scale, Lower Extremity Functional Scale, Beck Depression Inventory, and the Korean version of the World Health Organization Quality of Life-BREF. Mediation analysis was conducted using the PROCESS macro for SPSS. The serial mediating effects of lower extremity functional status and depression on the relationship between pain and quality of life were significant. These findings suggest that the assessment and management of lower extremity functional status and depression are important means by which the quality of life of adults with painful KOA can be improved.
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Poon CLL, Cheong P, Tan JWM, Thumboo J, Woon EL, Clark RA, Cheok G, Pua YH. Associations of the modified STarT back tool and Hospital Anxiety and Depression Scale (HADS) with gait speed and knee pain in knee osteoarthritis: a retrospective cohort study. Disabil Rehabil 2021; 44:4452-4458. [PMID: 33577352 DOI: 10.1080/09638288.2021.1883750] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The association of the modified STarT Back Tool (mSBT) psychosocial measure with gait speed and knee pain in knee osteoarthritis is not well defined. This study aimed to, in patients with knee osteoarthritis, (i) examine the convergent validity of mSBT with the Hospital Anxiety and Depression Scale (HADS) and (ii) compare the predictive validity of mSBT and HADS with gait speed and knee pain. METHODS We performed a retrospective cohort analysis of mSBT, HADS, gait speed, and knee pain outcomes data collected from 119 patients who received outpatient physical therapy. Of these patients who were evaluated at their first (baseline) physical therapy visit, 55 had available data at the Week-16 follow-up visit. RESULTS mSBT and HADS showed moderately strong pairwise correlations (Spearman correlation > 0.57; p < 0.001). After adjusting for age, sex, body weight, and knee impairment variables in multivariable linear mixed-effects analyses, mSBT was associated with gait speed (p < 0.001) and knee pain intensity (p < 0.001) and it had comparable strength of association as HADS. In within-patient regression analyses, change in mSBT was associated with changes in gait speed (p = 0.04) and knee pain (p = 0.01) over 16 weeks. CONCLUSION The mSBT had convergent validity with HADS and it showed predictive validity with gait speed and knee pain in knee osteoarthritis. Although broader validation is required, the 5-item mSBT psychosocial measure may be applied as part of routine clinical care to assess psychological distress in patients with knee osteoarthritis. IMPLICATIONS FOR REHABILITATION The 5-item psychosocial subscale of the modified STarT Back tool (mSBT) showed good convergent validity with the 14-item Hospital Anxiety and Depression Scale in patients with knee osteoarthritis. The mSBT psychosocial subscale showed predictive validity, at both cross-sectional and longitudinal levels, with gait speed and knee pain in patients with knee osteoarthritis. The mSBT can potentially be used in the busy clinical setting to assess psychological distress in patients with knee osteoarthritis.
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Affiliation(s)
- Cheryl Lian-Li Poon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Philip Cheong
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - John Wei-Ming Tan
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Julian Thumboo
- Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore.,Department of Rheumatology and Immunology, Singapore General Hospital, Singapore, Singapore.,Health Services Research and Evaluation, Singhealth Office of Regional Health, Singapore, Singapore
| | - Ee-Lin Woon
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore
| | - Ross Allan Clark
- Research Health Institute, University of the Sunshine Coast, Sunshine Coast, Australia
| | - Gary Cheok
- Department of Physiotherapy, National Healthcare Group Polyclinics, Singapore, Singapore
| | - Yong-Hao Pua
- Department of Physiotherapy, Singapore General Hospital, Singapore, Singapore.,Medicine Academic Programme, Duke-NUS Graduate Medical School, Singapore, Singapore
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McClendon J, Essien UR, Youk A, Ibrahim SA, Vina E, Kwoh CK, Hausmann LRM. Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination. Arthritis Care Res (Hoboken) 2021; 73:11-17. [PMID: 33026710 DOI: 10.1002/acr.24481] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Accepted: 10/01/2020] [Indexed: 12/11/2022]
Abstract
OBJECTIVE Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain. METHODS We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female sex, African American race, annual income of <$20,000, and/or unemployed due to disability). We used linear regression models and Sobel's test of mediation to examine hypotheses. RESULTS The mean ± SD number of social disadvantages was 1.3 ± 1.0. Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (P < 0.001 for all). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z = 3.75, P < 0.001) as well as pain severity (Z = 2.24, P = 0.025). CONCLUSION Perceived discrimination is an important psychosocial stressor that contributes to worsening OA-related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.
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Affiliation(s)
- Juliette McClendon
- National Center for PTSD, Veterans Affairs Boston Healthcare System and Boston University School of Medicine, Boston, Massachusetts
| | - Utibe R Essien
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
| | - Ada Youk
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, Graduate School of Public Health, Pittsburgh, Pennsylvania
| | - Said A Ibrahim
- Corporal Michael J. Crescenz Veterans Affairs Medical Center and University of Pennsylvania, School of Medicine, Philadelphia, and Weill Cornell Medicine, New York, New York
| | - Ernest Vina
- University of Arizona, College of Medicine, and University of Arizona Arthritis Center, Tucson
| | - C Kent Kwoh
- University of Arizona, College of Medicine, and University of Arizona Arthritis Center, Tucson
| | - Leslie R M Hausmann
- Veterans Affairs Pittsburgh Healthcare System and University of Pittsburgh, School of Medicine, Pittsburgh, Pennsylvania
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Zarean E, Azadeh A, Pirali H, Doroushi B, Edrisi A, Ahmadi A, Baharizadeh A, Torkian S. Association between depression, anxiety, and insomnia with musculoskeletal pain source: a multi-center study. MIDDLE EAST CURRENT PSYCHIATRY 2021. [DOI: 10.1186/s43045-021-00083-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Abstract
Background
Musculoskeletal pain syndrome (MPS) is one of the modern diseases. Musculoskeletal pain (MP) may develop at any age and impact physical and mental health. This study aimed to evaluate the association between anxiety, depression, and insomnia with musculoskeletal pain source. This cross-sectional study was conducted on 450 patients with musculoskeletal pain. Goldberg depression (GB), Beck Anxiety Inventory (BAI), and Morin Insomnia Severity Index (ISI) questionnaires were used to collect data. Participants have divided into two groups: individuals with unknown musculoskeletal pain sources and individuals with known musculoskeletal pain sources. Anxiety, depression, and insomnia scores were compared between the two groups. For statistical analysis of data mean (SD), frequency (%), Chi-square, Mann-Whitney test, and Logistic regression models were used. All analysis was performed using SPSS 26.
Results
In this study, 39.4% of the participants were in severe depression, 31.1% in severe anxiety, 34.7% in the no clinically significant, and 32.9% in the sub-threshold insomnia group. There was a significant difference between the severity of anxiety and insomnia in the two groups with the known and unknown pain sources (p < 0.05). However, the score of depression (OR = 1.00, 95% CI 0.99–1.01), anxiety (OR = 1.00, 95% CI 0.99–1.02), and insomnia (OR = 1.01, 95% CI 0.98–1.03) was not related to the pain source.
Conclusion
There was a statistically significant relationship between anxiety and insomnia severity with musculoskeletal pain source. According to the high prevalence of depression, anxiety, and depression in both groups with known and unknown musculoskeletal pain sources, the cooperation of orthopedists, rheumatologists, and physical therapists with psychiatrist can be useful in improving the condition of patients.
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Multicentre, clinical trial of burst spinal cord stimulation for neck and upper limb pain NU-BURST: a trial protocol. Neurol Sci 2021; 42:3285-3296. [PMID: 33387056 DOI: 10.1007/s10072-020-04907-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND Spinal cord stimulation (SCS) is an established therapy for chronic neuropathic pain and most frequently utilised for Failed Back Surgery Syndrome (FBSS). BurstDR™ also known as DeRidder Burst-SCS, a novel waveform, has demonstrated superiority to conventional tonic stimulation of the thoracic spine in FBSS. There are case reports of an improvement in multidimensional pain outcomes using DeRidder Burst-SCS in the cervical spine for chronic neck and cervical radicular pain. The safety and efficacy of cervical DeRidder Burst-SCS stimulation still however remain undetermined. METHODS/DESIGN This is a prospective, multicentre feasibility trial evaluating the safety and therapeutic efficacy of DeRidder Burst-SCS stimulation for the treatment of chronic intractable neck pain with or without radiation to the arm, shoulder, and upper back. After baseline evaluation, subjects will undergo an SCS trial using the Abbott Invisible Trial system according to standard clinical procedures. During the trial phase, SCS leads will be implanted in the cervical epidural space. At the end of the SCS trial, subjects experiencing at least 50% pain relief will be considered for permanent implant. Pain intensity, medication usage, and other multidimensional pain outcomes will be collected. The timing of these will be at baseline, end of the SCS trial and at 3-, 6-, and 12-month visits. Incidence of adverse events will be collected throughout the study duration. DISCUSSION The results of this feasibility study will validate the efficacy and safety of DeRidder Burst-SCS stimulation in the cervical spine. The results obtained in this study will potentially be used to generate a level 1 evidence-based study with formal statistical hypotheses testing. TRIAL REGISTRATION www.clinicaltrials.gov Identifier: NCT03159169.
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Hafkamp FJ, de Vries J, Gosens T, den Oudsten BL. The Relationship Between Psychological Aspects and Trajectories of Symptoms in Total Knee Arthroplasty and Total Hip Arthroplasty. J Arthroplasty 2021; 36:78-87. [PMID: 32893058 DOI: 10.1016/j.arth.2020.07.071] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2020] [Revised: 07/02/2020] [Accepted: 07/27/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND This study aimed to examine different trajectories of physical symptoms in hip and knee arthroplasty patients from presurgery to 1 year postsurgery and relate this to preoperative anxiety and depressive symptoms. METHODS Patients (N = 345) completed the Hip injury and Osteoarthritis Outcome Score or the Knee injury and Osteoarthritis Outcome Score to examine their preoperative and postoperative pain, stiffness, and function, presurgery, and 3, 6, and 12 months postsurgery. Presurgery anxiety and depressive symptoms were assessed using the 7-item Generalized Anxiety Disorder Scale and the 9-item Patient Health Questionnaire. Latent trajectory analysis was used to identify different subgroups in trajectories. The step-3 method was used to assess subgroup characteristics. RESULTS The effect of time on pain, function, and stiffness was different between subgroups of patients. Knee patients belonged mainly to classes with least improvement. Least improvement in pain was characterized by a combination of high levels of both anxiety and depressive symptoms. Anxiety and depressive symptoms were independently related to less reduction in stiffness while little improvement in function was characterized by higher depressive symptoms. CONCLUSION The results of this study indicate that anxiety and depressive symptoms were significantly, but differently, related to the distinct physical symptoms examined.
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Affiliation(s)
- Frederique J Hafkamp
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
| | - Jolanda de Vries
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands; Department of Medical Psychology, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Taco Gosens
- Department of Orthopedics, Elisabeth-TweeSteden Hospital, Tilburg, The Netherlands
| | - Brenda L den Oudsten
- Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Center of Research on Psychological and Somatic Disorders (CoRPS), Tilburg University, Tilburg, The Netherlands
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Barbosa IM, de Sousa TG, Fernandes LM, Campos JSM, Nogueira JBS, Bezerra MJC. Mind Health Before and After Total Knee Arthroplasty. Rev Bras Ortop 2020; 55:783-786. [PMID: 33364660 PMCID: PMC7748925 DOI: 10.1055/s-0040-1708519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2019] [Accepted: 12/20/2019] [Indexed: 11/20/2022] Open
Abstract
Objective To assess the preoperative and postoperative outcomes of patients diagnosed with severe knee osteoarthritis who underwent a total knee arthroplasty (TKA) using a mobile-bearing implant with a rotating platform and removing the posterior cruciate ligament. The present study focused on the outcomes relative to depression, pain, functional limitations, and fall episodes. Methods The Lequesne questionnaire was used to assess pain and functional limitations before and after TKA. In addition, the geriatric depression scale (GDS) was also used. Episodes of falls before and after the surgery were estimated. Results The mean Lequesne score before the surgery was 15.95, and that after surgery was 6.5. This finding was statistically significant ( p < 0.001). The mean GDS score before the surgery was 7.43, and that after TKA was 2.22 ( p < 0.001). The mean number of fall occurrences before the procedure, over a 1-year period, was 1.22, and that after TKA was 0.27 ( p = 0.004). A direct relationship was found between the Lequesne scores before the surgery and the GDS scores ( p = 0.004). Conclusions Total knee arthroplasty resulted in the improvement of pain and functional limitation, decrease or disappearance of the depressive condition, and decrease of fall rates in the evaluated patients.
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Affiliation(s)
| | | | | | | | | | - Marcelo José Cortez Bezerra
- Departamento de Ortopedia, Santa Casa da Misericórdia de Fortaleza, Fortaleza, CE, Brasil
- Departamento de Ortopedia, Universidade Unifor, Fortaleza, CE, Brasil
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Lenhard NK, Sullivan JK, Ross EL, Song S, Edwards RR, Hunter DJ, Neogi T, Katz JN, Losina E. Does screening for depressive symptoms help optimize duloxetine use in knee OA patients with moderate pain? A cost-effectiveness analysis. Arthritis Care Res (Hoboken) 2020; 74:776-789. [PMID: 33253496 PMCID: PMC8164641 DOI: 10.1002/acr.24519] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 01/18/2021] [Accepted: 11/24/2020] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Duloxetine is an FDA-approved treatment for both osteoarthritis (OA) pain and depression, but uptake of duloxetine in knee OA management varies. We examined the cost-effectiveness of adding duloxetine to knee OA care with or without depression screening. METHODS We used the Osteoarthritis Policy Model, a validated computer microsimulation of knee OA, to examine the value of duloxetine for knee OA patients with moderate pain by comparing three strategies: 1) usual care (UC); 2) duloxetine for those who screen positive for depression on the Patient Health Questionnaire 9 (PHQ-9) + UC; and 3) universal duloxetine + UC. Outcomes included quality-adjusted life years (QALYs), lifetime direct medical costs, and incremental cost-effectiveness ratios (ICERs), discounted at 3% annually. Model inputs, drawn from published literature and national databases, included: annual cost of duloxetine, $721-$937; average pain reduction for duloxetine, 17.5 points on the WOMAC pain scale (0-100); likelihood of depression remission with duloxetine, 27.4%. We considered two willingness-to-pay (WTP) thresholds of $50,000/QALY and $100,000/QALY. We varied parameters related to the PHQ-9 and duloxetine's cost, efficacy, and toxicities to address uncertainty in model inputs. RESULTS The screening strategy led to an additional 17 QALYs per 1,000 subjects and increased costs by $289/subject (ICER=$17,000/QALY). Universal duloxetine led to an additional 31 QALYs per 1,000 subjects and $1,205/subject (ICER=$39,300/QALY). Under the majority of sensitivity analyses, universal duloxetine was cost-effective at the $100,000/QALY threshold. CONCLUSION Adding duloxetine to usual care for knee OA patients with moderate pain, regardless of depressive symptoms, is cost-effective at frequently-used WTP thresholds.
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Affiliation(s)
- Nora K Lenhard
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - James K Sullivan
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Eric L Ross
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA, 02114, USA.,Department of Psychiatry, McLean Hospital, Belmont, MA, 02478, USA.,Harvard Medical School, Harvard University, Boston, MA, 02115, USA
| | - Shuang Song
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Robert R Edwards
- Department of Anesthesiology, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - David J Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Rheumatology Department, Royal North Shore Hospital, Sydney, Australia
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, MA, 02118, USA
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery Brigham and Women's Hospital, Boston, MA, 02115, USA.,Harvard Medical School, Harvard University, Boston, MA, 02115, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation eValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery Brigham and Women's Hospital, Boston, MA, 02115, USA.,Harvard Medical School, Harvard University, Boston, MA, 02115, USA.,Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA, 02115, USA.,Department of Biostatistics, Boston University School of Public Health, Boston, MA, 02118, USA
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Alenazi AM, Alshehri MM, Alqahtani BA, Alanazi AD, Bindawas SM. Combined diabetes and arthritis are associated with declined gait speed. Clin Rheumatol 2020; 40:1593-1598. [PMID: 32856200 DOI: 10.1007/s10067-020-05370-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Revised: 08/17/2020] [Accepted: 08/24/2020] [Indexed: 02/03/2023]
Abstract
This study investigated the association of combined arthritis and diabetes, diabetes only, and arthritis only compared with neither with gait speed in the general population. This cross-sectional study included data from the second wave of Midlife in the United States-2 (MIDUS 2) project 4: Biomarker Project, 2004-2009. The MIDUS 2 biomarker project included 1255 individuals aged between 34 and 84 years. Participants were categorized into four groups: combined arthritis and diabetes, diabetes only, arthritis only, or neither. The main outcome measure was gait speed measured by the 50-ft walk test. Covariates included age, gender, body mass index (BMI), depression symptoms, and number of chronic conditions/symptoms. A total of 1255 participants were included with mean age 54.52 ± 11.71, of those 713 (56.8%) participants were females. The results showed that combined arthritis and diabetes was significantly associated with a greater decline in gait speed (B = - 0.11, 95% confidence interval (CI) [- 0.17 to - 0.6], p < 0.001). Arthritis and diabetes were independently significantly associated with decreased gait speed (B = - 0.072, 95% CI [- 0.10 to - 0.043], p < 0.001), (B = - 0.064, 95% CI [- 0.12 to - 0.012], p = 0.015), respectively. Combined arthritis and diabetes was associated with a greater decline in gait speed compared with diabetes only, arthritis only, or neither group. Key Points • Combined arthritis and diabetes were associated with declined gait speed. • Gait speed did not differ between people with arthritis compared with people with diabetes. • We recommended including gait speed assessment in regular clinical visits to capture gait speed declines for further health assessments.
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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, Saudi Arabia.
| | | | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
| | - Ahmad D Alanazi
- Department of Physical Therapy, Majmaah University, Majmaah, Saudi Arabia
| | - Saad M Bindawas
- Department of Rehabilitation Science, King Saud University, Riyadh, Saudi Arabia
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Relationship between radiological severity and physical and mental health in elderly individuals with knee osteoarthritis. Arthritis Res Ther 2020; 22:187. [PMID: 32787968 PMCID: PMC7425047 DOI: 10.1186/s13075-020-02280-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2020] [Accepted: 07/28/2020] [Indexed: 11/21/2022] Open
Abstract
Background This study aimed to investigate the relationship between radiological severity, as assessed by the individual grades and grouped grades (grades “0 and 1” and “2 to 4”) of the Kellgren-Lawrence scale (K&Ls), and depression symptoms, cognitive loss, risk of falls, and quality of life in relation to knee osteoarthritis, as assessed by other instruments. Methods Data recorded between 2013 and 2014 in Amparo (São Paulo, Brazil) were retrieved for analysis. A total of 181 elderly patients who had knee osteoarthritis and underwent a radiologic exam were evaluated for depressive symptoms, cognitive loss, quality of life, and risk of falls by the Geriatric Depression Scale (GDS), Mini-Mental State Examination (MMSE), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), timed up and go test (TUG), and Berg balance scale (BBS). For statistical analyses, Fisher’s exact test, Mann-Whitney test, Kruskal-Wallis test, and Spearman’s coefficient analysis were used. Results There was no significant relationship between the scores of the instruments investigated and the individual K&Ls grades. However, when the K&Ls scores were assessed by groups, grades “2 to 4” were associated with the worst WOMAC score and the highest frequency and risk of falls according to the BBS but not according to TUG. For the GDS and MMSE, no significant relationships with the K&Ls grades were found. In addition, the K&Ls grade was correlated with the WOMAC score, regardless of the domain. Conclusion The radiological scores of the Kellgren-Lawrence (K&L) scale were associated with poorer WOMAC and BBS scores only when the K&Ls scores were evaluated in groups, and the WOMAC score was associated with an increase in the radiological grade.
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Abdul-Razzak KK, Kofahi RM. Carpel tunnel syndrome: A link with vitamin D and calcium. Biomed Rep 2020; 13:15. [PMID: 32765854 DOI: 10.3892/br.2020.1322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 05/20/2020] [Indexed: 11/06/2022] Open
Abstract
Carpal tunnel syndrome (CTS) and vitamin D deficiency are two conditions that cause chronic pain and are thus associated with psychological issues as well. The aim of the present study was to evaluate vitamin D levels, daily calcium intake, musculoskeletal pain and psychological symptoms in patients with CTS. The study included 48 patients with CTS and age-sex matched controls. Serum vitamin D levels were measured, and psychological symptoms were assessed using a Hospital Anxiety and Depression Scale. A Pain DETECT questionnaire was used to assess musculoskeletal pain (MSP) sites and severity. The results showed that vitamin D deficiency was considerably more prevalent in patients with CTS (95.8%) compared with controls (22.9%). Clinical anxiety (35.4 vs. 6.3%) and clinical depression (29.2 vs. 4.2%) were also more common in patients with CTS compared with controls. All the patients with CTS exhibited MSP, whereas none of the controls reported any MSP. Anxiety was significantly and inversely associated with vitamin D levels (r2=-0.482; P<0.01), total daily calcium intake (r2=-0.294: P<0.05), and positively associated with body mass index (BMI; r2=0.200; P≤0.05) and depression (r2=0.587; P<0.01). Depression was significantly and inversely associated with vitamin D levels (r2=-0.269; P<0.01) and total daily calcium intake (r2=-0.236; P<0.05). Logistic regression analysis showed that with every unit increase in serum vitamin D levels, the odds of CTS were decreased 1.22x. While a one-unit increase in anxiety total score was associated with a 14% increase in the odds of having CTS after adjusting for different confounders. In conclusion, vitamin D deficiency, MSP and psychological symptoms are common in patients with CTS. Serum vitamin D levels and anxiety were significant independent predictors of CTS. Based on the results of the present study, it was shown that housewives had an equivalent chance of suffering from CTS morbidity as other high-risk professions. Further studies are required to confirm if vitamin D supplementation could prevent the onset of CTS.
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Affiliation(s)
- Khalid Khaleel Abdul-Razzak
- Department of Clinical Pharmacy, Faculty of Pharmacy, Jordan University of Science and Technology, Irbid 22110, Jordan
| | - Raid Mohammed Kofahi
- Department of Neuroscience, Faculty of Medicine, Jordan University of Science and Technology, Irbid-22110, Jordan
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Elucidating vulnerability to inflammation-induced hyperalgesia: Predictors of increased musculoskeletal pain sensitivity during experimental endotoxemia. Brain Behav Immun 2020; 88:302-307. [PMID: 32592864 DOI: 10.1016/j.bbi.2020.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 05/15/2020] [Accepted: 06/18/2020] [Indexed: 11/22/2022] Open
Abstract
Despite broad clinical implications, the mechanisms linking inflammation and pain remain incompletely understood. Using human experimental endotoxemia as a translational model of systemic inflammation, we aimed to elucidate putative vulnerability factors of inflammation-induced musculoskeletal hyperalgesia. We pooled data from three published randomized controlled trials, resulting in a sample of N = 98 healthy volunteers who received either low-dose endotoxin (lipopolysaccharide) or vehicle (saline) intravenously. As measure of musculoskeletal pain sensitivity, pressure pain thresholds (PPTs) were assessed at baseline and 3 h post injection with a handheld algometer for the low back (erector spinae muscle), calf (gastrocnemius muscle), and shoulder region (deltoid muscle). Implementing multiple regression models, we tested the contribution of putative vulnerability factors on musculoskeletal hyperalgesia during systemic inflammation, including acute changes in pro-inflammatory cytokines, state anxiety and mood, as well as pre-existing symptoms of anxiety and depression. Endotoxin application led to significant increases in plasma cytokines, state anxiety, and negative mood, and significantly decreased PPTs for all muscle groups. Regression models revealed that greater M. erector spinae PPT changes were predicted by higher HADS-anxiety scores. Higher TNF-α concentration emerged as predictor for M. gastrocnemius PPT changes, and more pronounced TNF-α increase and higher HADS-anxiety were predictive for M. deltoideus PPTs. HADS scores emerged as predictor for a mean PPT score (computed across all body sites). Together, our results indicate that musculoskeletal hyperalgesia during systemic inflammation is related to pro-inflammatory cytokines, specifically TNF-α. Importantly, subclinical anxiety symptoms (even though in a low and normal range in this cohort of healthy volunteers) may contribute to inflammation-induced hyperalgesia, making individuals more vulnerable to the detrimental effects of systemic inflammation.
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Rewald S, Lenssen AT, Emans PJ, de Bie RA, van Breukelen G, Mesters I. Aquatic Cycling Improves Knee Pain and Physical Functioning in Patients With Knee Osteoarthritis: A Randomized Controlled Trial. Arch Phys Med Rehabil 2020; 101:1288-1295. [DOI: 10.1016/j.apmr.2019.12.023] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2019] [Revised: 11/25/2019] [Accepted: 12/27/2019] [Indexed: 11/28/2022]
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Reynaud V, Verdilos A, Pereira B, Boisgard S, Costes F, Coudeyre E. Core Outcome Measurement Instruments for Clinical Trials of Total Knee Arthroplasty: A Systematic Review. J Clin Med 2020; 9:jcm9082439. [PMID: 32751523 PMCID: PMC7463550 DOI: 10.3390/jcm9082439] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/21/2020] [Accepted: 07/27/2020] [Indexed: 12/11/2022] Open
Abstract
(1) Background: We have updated knowledge of the psychometric qualities of patient-reported outcome measures and, for the first time, systematically reviewed and compared the psychometric qualities of physical tests for patients with knee osteoarthritis who are undergoing total knee arthroplasty. This work was conducted to facilitate the choice of the most appropriate instruments to use in studies and clinical practice. (2) Methods: A search of medical databases up to December 2019 identified the studies and thus the instruments used. The quality of the measurement properties was assessed by the Bot et al. criteria. (3) Results: We identified 20 studies involving 25 instruments. Half of the instruments were questionnaires (n = 13). Among the condition-specific instruments, the Oxford knee score, Knee injury and Osteoarthritis Outcomes Score, and the Western Ontario and McMaster Universities Osteoarthritis index had the highest overall scores. Concerning generic tools, the Medical Outcomes Study Short-Form 36 (SF-36) or SF-12 obtained the highest overall score. For patient-specific tools, the Hospital Anxiety and Depression Scale ranked the highest. Some physical tests seemed robust in psychometric properties: 6-min Walk Test, five times Sit-To-Stand test, Timed Up and Go test strength testing of knee flexor/extensor by isometric or isokinetic dynamometer and Pressure Pain Threshold. (4) Conclusion: To make stronger recommendations, key areas such as reproducibility, responsiveness to clinical change, and minimal important change still need more rigorous evaluations. Some promising physical tests (e.g., actimetry) lack validation and require rigorous studies to be used as a core set of outcomes in future studies.
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Affiliation(s)
- Vivien Reynaud
- Plateforme d’Exploration de la Mobilité, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
- Correspondence: ; Tel.: +33-47375-0900
| | - Anargyros Verdilos
- Plateforme d’Exploration de la Mobilité, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Bruno Pereira
- Unité de Biostatistique, CHU Clermont-Ferrand, Direction Recherche Clinique et Innovation, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Stéphane Boisgard
- Service d’Orthopédie Traumatologie, CNRS, SIGMA Clermont, CHU Clermont-Ferrand, Université Clermont Auvergne, ICCF, F-63000 Clermont–Ferrand, France;
| | - Frédéric Costes
- Plateforme d’Exploration de la Mobilité, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
| | - Emmanuel Coudeyre
- Service de Médecine Physique et de Réadaptation, INRAE, UNH, CHU Clermont-Ferrand, Université Clermont Auvergne, F-63000 Clermont–Ferrand, France;
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Sayre EC, Esdaile JM, Kopec JA, Singer J, Wong H, Thorne A, Guermazi A, Nicolaou S, Cibere J. Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis. BMC Musculoskelet Disord 2020; 21:467. [PMID: 32677938 PMCID: PMC7367326 DOI: 10.1186/s12891-020-03496-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models. Methods A population-based cohort (n = 122) with knee pain, aged 40–79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike’s information criterion. Results Baseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50–59 vs. 40–49 OR = 0.31 [0.11, 0.85]; 60–69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46). Conclusion Specific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.
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Affiliation(s)
- Eric C Sayre
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
| | - John M Esdaile
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,Medicine, University of British Columbia, Vancouver, BC, Canada.,Medicine, University of Calgary, Calgary, AB, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joel Singer
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anona Thorne
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ali Guermazi
- Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Savvas Nicolaou
- Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,Medicine, University of British Columbia, Vancouver, BC, Canada
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DUICA L, SZAKÁCS J, SILIȘTEANU Sînziana Călina. Study on the correlation between knee osteoarthritis and anxiety in patients aged over 55. BALNEO RESEARCH JOURNAL 2020. [DOI: 10.12680/balneo.2020.323] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Introduction. Osteoarthritis, which is a cause of chronic pain and disability with manifestation in any joint, with greater frequency in the joints of the lower limbs, upper limbs, but also at the spine level , affects around 250 million people in the entire world. This condition affects around 10% of the global population (18) and has an impressive impact on people, as it is one of the first 5 causes of disability. Material and method. The objectives of the treatment made by the patients diagnosed with knee osteoarthritis were: pain reduction, increased joint amplitude, increased muscle strength, increased muscle tone, increased quality of life and reintegration into the family and social environment. In the study, there were discussed demographic data regarding the patients. In order to assess the pain parameter, the VAS scale was used, as well as WOMAC subscales. To assess the quality of life of patients with knee osteoarthritis, the QOL scale (Quality of Life) was used. Anxiety was assessed with the help of a test that comprises the evaluation of symptoms at the cognitive, behavioral and physical level. Results and discussions. The pain was evaluated on the VAS scale, having a statistically significant evolution for the evaluation moments. Also with the help of the WOMAC index, two other parameters were evaluated, namely joint rigidity and functional capacity, the results being statistically significant in the 3 evaluation moments. The patients’ anxiety was evaluated with the help of the anxiety test; the results obtained were statistically significant at the 3 evaluation moments. Conclusions. It is vital that the recovery treatment in osteoarthritis be individualized and adapted to the age group. In our group, it enabled the reduction of pain and anxiety, the increase of the functional capacity and the quality of the patients’ lives.Taking into account the fact that the most affected group in the study group was the active professional one, we can evaluate the size of the recovery and the social, family and professional integration for these patients.
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Affiliation(s)
- Lavinia DUICA
- 1 Lucian Blaga University of Sibiu, Faculty of Medicine, Sibiu, România 2 Hospital of Psychiatry „Doctor Gheorghe Preda” Sibiu, Romania
| | - Juliánna SZAKÁCS
- 3George Emil Palade University of Medicine, Pharmacy, Science, and Technology of Targu Mures, Faculty of Medicine, Department of Biophysics
| | - SILIȘTEANU Sînziana Călina
- 4 Railway Hospital Iasi - Specialty Ambulatory of Suceava 5 "Stefan cel Mare" University of Suceava FEFS-DSDU
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Park E, Kim H, Choi IH, Han HM, Han K, Jung HH, Im GJ. Psychiatric Distress as a Common Risk Factor for Tinnitus and Joint Pain: A National Population-Based Survey. Clin Exp Otorhinolaryngol 2019; 13:234-240. [PMID: 31842535 PMCID: PMC7435435 DOI: 10.21053/ceo.2019.00563] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 09/30/2019] [Indexed: 12/25/2022] Open
Abstract
OBJECTIVES This study aimed to investigate the relationship between tinnitus and joint pain from representative samples of Koreans. METHODS The demographics and the responses to a questionnaire about tinnitus and joint pain severity and mental health status of adults aged ≥50 years in the 2010-2012 Korean National Health and Nutrition Examination Survey were analyzed. RESULTS Among 9,032 individuals, 26.7% reported experiencing tinnitus within the past year. Participants with tinnitus were more frequently older, hearing loss, and had lower education levels, income, and body weight. Participants with regular exercise and sleep had a lower tinnitus prevalence. The incidences of stress, depressed mood, and suicidal ideation were significantly higher in the tinnitus group and participants with joint pain. The rates of participants with tinnitus according to the number of joint pain sites (zero, one, two, and three) was 22.1%, 31.4%, 33.3%, and 44.2%, and those of participants with severely annoying tinnitus according to the number of joint pain sites (zero, one, two, and three) were 3.3%, 6.8%, 7.9%, and 10.7%, respectively. CONCLUSION Tinnitus prevalence and severity were significantly related to joint pain, and both conditions were related to psychiatric distress. Thus, the authors suggest that psychiatric distress as a common risk factor for tinnitus and joint pain should be considered when deciding treatment strategies and in guiding public health policy.
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Affiliation(s)
- Euyhyun Park
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hyunjung Kim
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - In Hak Choi
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Hye Min Han
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Kyungdo Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hak Hyun Jung
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
| | - Gi Jung Im
- Department of Otolaryngology-Head and Neck Surgery, Korea University College of Medicine, Seoul, Korea
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López-Ruiz M, Losilla JM, Monfort J, Portell M, Gutiérrez T, Poca V, Garcia-Fructuoso F, Llorente J, Garcia-Fontanals A, Deus J. Central sensitization in knee osteoarthritis and fibromyalgia: Beyond depression and anxiety. PLoS One 2019; 14:e0225836. [PMID: 31805099 PMCID: PMC6894784 DOI: 10.1371/journal.pone.0225836] [Citation(s) in RCA: 32] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2019] [Accepted: 11/13/2019] [Indexed: 12/21/2022] Open
Abstract
Objectives To determine the psychopathological profile of patients with central sensitization (CS) in a sample of knee osteoarthritis, with and without CS, and fibromyalgia, and to compare their psychopathological profiles. Methods The final sample consists of 19 patients with osteoarthritis and CS (mean 66.37 years ± 8.77), 41 osteoarthritis patients without CS (mean 66.8 ± 7.39 years), 47 fibromyalgia patients (mean 46.47 years ± 7.92) and 26 control subjects (mean 51.56 years ± 11.41). The psychopathological profile was evaluated with the Millon Multiaxial Clinical Inventory. Results The average score of MCMI-III reflect higher scores in the fibromyalgia and osteoarthritis-CS groups. Patients with osteoarthritis-CS are more likely to report larger scores in Borderline and Major Depression scales. Fibromyalgia patients are more likely to report more increased scores in Somatoform and Major Depression, versus osteoarthritis-CS group. Fibromyalgia patients versus osteoarthritis without CS are more likely to report higher scores in Schizoid, Depression, Histrionic, Sadistic, Borderline, Somatoform, Posttraumatic Stress Disorder and Major Depression scales. Discussion Patients with CS have less differences in their psychopathological profiles as well as in both osteoarthritis groups and greatest differences are obtained between the fibromyalgia and osteoarthritis without CS, so perhaps presence of CS is the key to differentiate those groups and not chronic pain. An exhaustive assessment brings more accurate psychopathological profiles, thus better psychological treatment could be applied.
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Affiliation(s)
- Marina López-Ruiz
- Service of Psychiatry and Psychology, HM-Sant Jordi Clinic, Barcelona, Spain
- * E-mail:
| | - Josep Maria Losilla
- Department of Methodology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
| | - Jordi Monfort
- Rheumatology Service, Hospital del Mar, Barcelona, Spain
| | - Mariona Portell
- Department of Methodology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
| | - Teresa Gutiérrez
- Department of Clinical and Health Psychology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
| | - Violant Poca
- Rheumatology Service, Institute Ferran of Rheumatology (IFR), Barcelona, Spain
| | | | - Jone Llorente
- Rheumatology Service, Hospital del Mar, Barcelona, Spain
| | | | - Joan Deus
- Service of Psychiatry and Psychology, HM-Sant Jordi Clinic, Barcelona, Spain
- Department of Clinical and Health Psychology, Faculty of Psychology of Autonomous University of Barcelona, Cerdanyola del Vallés, Spain
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