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Kloprogge SES, Lachmipersad RMMR, Katier NN, Mailuhu AKEA, van Vooren JJ, van Ochten JMJ, Bindels PJEP, Bierma-Zeinstra SMAS, van Middelkoop MM. Prognostic factors and the value of radiographic osteoarthritis for persistent complaints after referral for ankle radiography. Semin Arthritis Rheum 2024; 68:152487. [PMID: 38996495 DOI: 10.1016/j.semarthrit.2024.152487] [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: 01/25/2024] [Revised: 06/04/2024] [Accepted: 06/06/2024] [Indexed: 07/14/2024]
Abstract
BACKGROUND Ankle symptoms are a common reason to consult the general practitioner and often persist for years. In a population referred for ankle radiography, the prevalence of radiographic osteoarthritis (OA) is substantial, but its additional predictive value for persistent symptoms is unknown. Therefore, we examined the prognosis of symptoms 2-3 years after referral for ankle radiography, assessed clinical prognostic factors, and the additional predictive value of radiographic OA for persistent ankle complaints. METHODS We included 893 adults referred for ankle radiography and studied the following candidate prognostic factors at baseline: age, sex, body mass index (BMI), referral for chronic complaints (>3 months), pain during activity (NRS-11) and presence of stiffness and functional loss as predominant symptom. X-rays were scored for radiographic OA. After 2-3 years participants were invited for a follow-up questionnaire including persistence of ankle complaints. To assess prognostic factors for persistent complaints, uni- and multivariable logistic regression were used. RESULTS Of the 194 responders at follow-up, ankle complaints persisted in 71(36.6 %). BMI (OR 1.08; 95 % CI 1.01-1.15), stiffness as predominant symptom (OR 1.69; 95 % CI 0.89-3.21), and chronic complaints (OR 2.84; 95 % CI 1.45-5.57) were in the initial model for persistent complaints (AUC=0.69). After adding radiographic OA (OR 2.36; 95 % CI 1.01-5.50), the AUC of the final model became 0.70. CONCLUSION Ankle complaints persist in a considerable proportion of patients 2-3 years after referral for ankle radiography. BMI, chronic complaints and radiographic OA are prognostic factors for persistent complaints, but the additional predictive value of radiographic OA on top of clinical factors is negligible.
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Affiliation(s)
- S E Sabine Kloprogge
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands.
| | | | - N Nienke Katier
- Department of radiology, Albert Schweitzer Hospital Dordrecht, the Netherlands
| | - A K E Adinda Mailuhu
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
| | | | - J M John van Ochten
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
| | - P J E Patrick Bindels
- Department of General Practice, Erasmus MC Medical University Center Rotterdam, the Netherlands
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Ma J, Guo G, Yue H, Xie C, Xie F, Chen Z, Gu Y, Zhang S, Fang M, Yao F. Tuina on knee pain and functional decline of lower limbs for patients with mild-to-moderate knee osteoarthritis in Shanghai: protocol for a multicentre, assessor-blinded, randomised controlled trial. BMJ Open 2024; 14:e083440. [PMID: 38866576 PMCID: PMC11177681 DOI: 10.1136/bmjopen-2023-083440] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Knee osteoarthritis (KOA) is one of the most common osteoarthritis, imposing substantial economic and medical burdens on both individuals and society. In China, Tuina has been selected as a complementary and alternative therapy to relieve knee pain and dysfunction symptoms. However, the current evidence is insufficient to support the efficacy of Tuina therapy in addressing knee pain and improving physical function. The trial aims to compare the effectiveness of Tuina with celecoxib, which is considered as the standard treatment, and to assess its potential as an alternative therapy through changes in outcome measures. METHODS AND ANALYSIS A total of 360 KOA patients aged between 40 and 70 years and classified as Kellgren and Lawrence grades I-II will be recruited from eight subcentral hospitals. The participants will be randomly assigned to either the treatment group (Tuina, Biw) or the control group (celecoxib, Qd), with both groups undergoing a 4-week intervention phase followed by an 8-week follow-up phase. The primary outcome is the change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale at week 4 compared with baseline. Secondary outcomes including WOMAC stiffness and function subscales, WOMAC total score, 36-item Short-Form Health Survey, Timed Up and Go test, Short Physical Performance Battery, gait analysis parameters and pain medication records will be assessed at weeks 4, 8 and 12. Any adverse events that occur during the trial will be promptly recorded. ETHICS AND DISSEMINATION This study has been approved by the Ethics Committee of Shanghai Municipal Hospital of Traditional Chinese Medicine (2023SHL-KY-16-01, 2023SHL-KY-16-02). Written informed consent will be obtained from all participants. Study results will be disseminated through peer-reviewed journals and conference presentations. TRIAL REGISTRATION NUMBER ChiCTR2300069416.
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Affiliation(s)
- Jianwen Ma
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Guangxin Guo
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Hongyu Yue
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
| | - Chaoqun Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fangfang Xie
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Ziying Chen
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Yuanjia Gu
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Shuaipan Zhang
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Min Fang
- Shanghai Shuguang Hospital Affiliated to Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Fei Yao
- Shanghai Municipal Hospital of Traditional Chinese Medicine, Shanghai, China
- School of Acupuncture-Moxibustion and Tuina, Shanghai University of Traditional Chinese Medicine, Shanghai, China
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Zhang Y, Li X, Wang Y, Ge L, Pan F, Winzenberg T, Cai G. Association of knee and hip osteoarthritis with the risk of falls and fractures: a systematic review and meta-analysis. Arthritis Res Ther 2023; 25:184. [PMID: 37770969 PMCID: PMC10540335 DOI: 10.1186/s13075-023-03179-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 09/23/2023] [Indexed: 09/30/2023] Open
Abstract
OBJECTIVE Studies evaluating the association of knee and hip osteoarthritis (OA) with falls and fractures have inconsistent findings. We aimed to investigate associations of symptomatic and radiographic knee and hip OA with risk of falls, recurrent falls, and fractures. METHODS We conducted an electronic search of databases from inception to February 2023. Two authors independently screened studies, extracted data, and assessed the risk of bias using the Newcastle-Ottawa Scale tool in eligible studies. Pooled odds ratios (ORs) with 95% confidence intervals (CIs) were calculated using random-effects models. RESULTS Of 17 studies included (n = 862849), 2 had a high risk of bias. Among studies that evaluated falls or fractures as outcomes, 7/8 (87.5%) and 5/11 (45.5%) were self-reported, respectively. Both symptomatic knee and hip OA were associated with increased risk of recurrent falls (knee: OR = 1.55, 95% CI 1.10 to 2.18; hip: OR = 1.50, 95% CI 1.28 to 1.75) but not falls or fractures. Radiographic knee OA increased risk of falls (OR = 1.28, 95% CI 1.03 to 1.59) and did not significantly increase risk of recurrent falls (OR = 1.39, 95% CI 0.97 to 1.97) or fractures (OR = 1.22, 95% CI 0.99 to 1.52). Radiographic hip OA decreased the risk of recurrent falls (OR = 0.70, 95% CI 0.51 to 0.96) but had no statistically significant association with fractures (OR = 1.16, 95% CI 0.79 to 1.71). CONCLUSION Symptomatic knee and hip OA were both associated with an increased risk of recurrent falls, and radiographic knee OA was associated with an increased risk of falls. No statistically significant associations of radiographic and symptomatic knee or hip OA with fractures were found.
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Affiliation(s)
- Youyou Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xiaoxi Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
- Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei, 230032, Anhui, China
| | - Tania Winzenberg
- School of Medicine, University of Tasmania, Hobart, TAS, Australia
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia.
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Kloprogge S, Katier N, Mailuhu A, van Vooren J, van Ochten J, Bindels P, Bierma-Zeinstra S, van Middelkoop M. Is radiographic osteoarthritis associated with pain and disability of the ankle? OSTEOARTHRITIS AND CARTILAGE OPEN 2023; 5:100383. [PMID: 37520149 PMCID: PMC10371817 DOI: 10.1016/j.ocarto.2023.100383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 07/03/2023] [Indexed: 08/01/2023] Open
Abstract
Objective Ankle osteoarthritis (OA) is relatively understudied. It often affects younger people compared to OA in other joints. Evidence on the association between radiographic OA and ankle symptoms remains contradicting. We therefore examined the association of degree of radiographic talocrural, subtalar and talonavicular OA with severity of ankle pain, disability and predominant symptoms. Method A cross-sectional study was conducted in a radiology department serving primary and secondary care. From the total study population (adults referred for ankle radiography), patients with chronic ankle complaints were selected (N = 231). Before radiography, participants completed a questionnaire on severity of ankle pain and disability using the Ankle Osteoarthritis Scale (AOS), and on their predominant symptoms, i.e. pain, functional loss, stiffness and/or instability. To assess the associations of the Kellgren-Lawrence scores (0, 1 or ≥2) with the primary outcomes (AOS), linear regression, and with the secondary outcomes predominant symptoms, logistic regression analyses were applied. Results Radiographic OA was not associated with AOS-pain and -disability. Radiographic talocrural OA was associated with functional loss (OR 3.26, 95% CI: 1.31; 8.11). A positive trend was seen between radiographic talonavicular OA and stiffness (OR 2.63, 95% CI: 0.97; 7.15). Conclusion The presence of radiographic OA is not associated with severity of ankle pain and disability in patients with chronic ankle complaints referred for ankle radiography. However, radiographic talocrural OA is associated with functional loss and radiographic talonavicular OA with stiffness as predominant symptom. These findings may contribute to better recognition of ankle OA in clinical practice.
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Affiliation(s)
- S.E. Kloprogge
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - N. Katier
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - A.K.E. Mailuhu
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - J. van Vooren
- Department of Radiology, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | - J.M. van Ochten
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - P.J.E. Bindels
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - S.M.A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
| | - M. van Middelkoop
- Department of General Practice, Erasmus MC Medical University Centre Rotterdam, Rotterdam, the Netherlands
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Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Kopec JA, Singer J, Wong H, Thorne A, Cibere J. Magnetic resonance imaging predictors (cartilage, osteophytes and meniscus) of prevalent and 3-year incident medial and lateral tibiofemoral knee joint tenderness and patellofemoral grind. BMC Musculoskelet Disord 2022; 23:1048. [DOI: 10.1186/s12891-022-06033-x] [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] [Received: 08/18/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Objective
To identify magnetic resonance imaging (MRI) predictors (cartilage [C], osteophytes [O] and meniscus [M] scores) of prevalent and 3-year incident medial tibiofemoral (MTF) and lateral tibiofemoral (LTF) knee joint tenderness and patellofemoral (PF) grind.
Methods
Population-based knee pain cohort aged 40–79 was assessed at baseline (N = 255), 3- and 7-year follow-up (N = 108 × 2 = 216). COM scores were measured at 6/8/6 subregions respectively. Age-sex-BMI adjusted logistic models predicted prevalence versus relevant COM predictors (medial, lateral or patellar / trochlear groove scores). Fully adjusted models also included all relevant COM predictors. Binary generalized estimating equations models predicting 3-year incidence were also adjusted for individual follow-up time between cycles.
Results
Significant predictors of prevalent MTF tenderness: medial femoral cartilage (fully adjusted odds ratio [aOR] 1.84; 95% confidence interval [CI] 1.11, 3.05), female (aOR = 3.05; 1.67, 5.58), BMI (aOR = 1.53 per 5 units BMI; 1.10, 2.11). Predictors of prevalent LTF tenderness: female (aOR = 2.18; 1.22, 3.90). There were no predictors of prevalent PF grind in the fully adjusted model. However, medial patellar osteophytes was predictive in the age-sex-BMI adjusted model. There were no predictors of 3-year incident MTF tenderness. Predictors of 3-year incident LTF tenderness: female (aOR = 3.83; 1.25, 11.77). Predictors of 3-year incident PF grind: lateral patellar osteophytes (aOR = 4.82; 1.69, 13.77). In the age-sex-BMI adjusted model, patellar cartilage was also a predictor.
Conclusion
We explored potential MRI predictors of prevalent and 3-year incident MTF/LTF knee joint tenderness and PF grind. These findings could guide preemptive strategies aimed at reducing these symptoms in the present and future (3-year incidence).
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Tuna S, Çelik B, Balcı N. The effect of physical therapy and exercise on pain and functional capacity according to the radiological grade of knee osteoarthritis. J Back Musculoskelet Rehabil 2022; 35:341-346. [PMID: 34366320 DOI: 10.3233/bmr-200287] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Physical therapy and exercise programs are frequently used in the treatment of knee osteoarthritis (OA). However, it is not known at what stage of knee OA it is more effective. OBJECTIVE The purpose of this work was to determine the relationship between the effectiveness of the physical therapy and exercise programs and the radiological findings presence/grade of knee OA. MATERIAL AND METHODS Overall, 92 patients (65F, 27M) with knee OA were enrolled in the retrospective study. Standard knee radiographs were graded according to Kellgren-Lawrence. Pain and functional status were evaluated using a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) at baseline, at the end of the physical therapy program (first month), and at third-month control visits. The demographic characteristics and VAS/WOMAC scores of the subjects were obtained from patient files. RESULTS We analyzed 131 knees of 92 patients with knee OA (65F, 27M, mean age 53.02 ± 11.13 years). The mean total VAS and WOMAC scores on the first and third months were significantly lower than the initial values (all p< 0.001). The mean VAS scores on the first and third months were significantly lower than the initial values in the group without radiological damage, but WOMAC scores were similar between the evaluations (p= 0.009, p 50 = 0.003, respectively). The mean VAS and WOMAC scores on the first and third months were significantly lower than the initial values in the grade 1 according to the Kellgren-Lawrence radiological grades (all p< 0.001). CONCLUSIONS According to the results of our study, physical therapy and exercise was effective on pain in all patients with knee OA, but only effective on knee functional capacity in the group with radiological findings, and especially more effective in patients with Kellgren-Lawrence grade 1.
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Affiliation(s)
- Serpil Tuna
- Department of Physical Medicine and Rehabilitation, Akdeniz University Medical School, Antalya, Turkey
| | - Berna Çelik
- Department of Physical Medicine and Rehabilitation, Kumluca State Hospital, Antalya, Turkey
| | - Nilüfer Balcı
- Department of Physical Medicine and Rehabilitation, Akdeniz University Medical School, Antalya, Turkey
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Knee osteoarthritis in midlife women. Menopause 2022; 29:748-755. [DOI: 10.1097/gme.0000000000001966] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Cai G, Li X, Zhang Y, Wang Y, Ma Y, Xu S, Shuai Z, Peng X, Pan F. Knee symptom but not radiographic knee osteoarthritis increases the risk of falls and fractures: results from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2022; 30:436-442. [PMID: 34863991 DOI: 10.1016/j.joca.2021.11.015] [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: 08/06/2021] [Revised: 11/23/2021] [Accepted: 11/24/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To describe the effect of knee symptoms and radiographic osteoarthritis (ROA) on the risk of falls, recurrent falls, and fractures. DESIGN Participants from the Osteoarthritis Initiative were classified as having 'no', 'unilateral' or 'bilateral' knee symptoms (≥19 on a 0-96 Western Ontario and McMaster Universities Osteoarthritis Index) and ROA (Kellgren-Lawrence grade ≥2) for each visit. Self-reported falls and fractures in the past 12 months were extracted at baseline and follow-up visits until month 96. Recurrent falls were defined as having ≥2 falls in the past 12 months. Hazard ratios (HR) with 95% confidence intervals (CI) were estimated using mixed-effects complementary log-log regression. RESULTS Of 4465 participants, 3145 (70%), 1681 (38%), and 806 (18%) experienced at least one fall, recurrent fall, and fracture, respectively, over 96 months. Compared to participants without symptomatic knee, unilateral and bilateral knee symptoms were associated with a 17% increased risk of falls and a 36-46% increased risk of recurrent falls, and bilateral knee symptoms increased the risk of fractures (HR 1.45, 95%CI 1.17 to 1.81). Compared to participants with no ROA in either knee, bilateral ROA was associated with a reduced risk of falls (HR 0.87, 95%CI 0.77 to 0.99) and fractures (HR 0.78, 95%CI 0.64 to 0.96). No statistically significant interactions between knee symptoms and ROA were observed. CONCLUSIONS This large population-based study showed that knee symptoms but not ROA increased the risk of falls, recurrent falls, and fractures, and that adults with bilateral ROA may have a lower risk of falls and fractures.
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Affiliation(s)
- G Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - X Li
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - Y Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - Y Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - Y Ma
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
| | - S Xu
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China.
| | - Z Shuai
- Department of Rheumatism and Immunity, The First Affiliated Hospital of Anhui Medical University, Hefei 230022, Anhui, China.
| | - X Peng
- Department of Obstetrics and Gynaecology, The First Affiliated Hospital of Anhui Medical University, Hefei 230088, Anhui, China.
| | - F Pan
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei 230032, Anhui, China; Inflammation and Immune Mediated Diseases Laboratory of Anhui Province, Hefei 230032, Anhui, China.
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Saito M, Nishitani K, Ito H, Ikezoe T, Furu M, Okahata A, Nigoro K, Kawata T, Nakamura S, Kuriyama S, Tabara Y, Ichihashi N, Tsuboyama T, Matsuda F, Matsuda S. Tenderness of the knee is associated with thinning of the articular cartilage evaluated with ultrasonography in a community-based cohort: The Nagahama study. Mod Rheumatol 2021:roab040. [PMID: 34910204 DOI: 10.1093/mr/roab040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2021] [Revised: 04/02/2021] [Accepted: 07/09/2021] [Indexed: 11/14/2022]
Abstract
OBJECTIVES This study aimed to elucidate the association between joint line tenderness (JLT) of the knee and knee joint structural changes evaluated with ultrasonography (US) for the early diagnosis of knee osteoarthritis (KOA). METHODS This cross-sectional study included 121 participants (age 71.7 ± 5.8 years, 75 women) from a community-based population. Bilateral structural changes in the knee joint were evaluated with US, and the presence or absence of JLT was evaluated using a pressure algometer. Logistic regression analysis was performed to evaluate the odds ratios (ORs) of US findings for the presence of JLT. Moreover, when the analysis was limited to knees with pre-/early radiographic KOA, the ORs were also calculated using logistic regression analysis. RESULTS Among the 242 knees, 38 had medial JLT, which was significantly associated with female sex (OR 11.87) and loss of cartilage thickness of the distal medial femoral condyle (CTh-MFC) (OR 0.12). Among 96 knees with Kellgren-Lawrence grade ≤ 2, 18 knees had medial JLT, which was also significantly associated with loss of CTh-MFC (OR 0.07) and medial osteophytes (OR 2.01). CONCLUSIONS JLT is significantly associated with thinning of the femoral cartilage and larger osteophytes in elderly patients, even in those with pre-/early radiographic KOA.
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Grants
- 25293141, 26670313, 26293198, 17H04182, 17H04126, 17H04123, 18K18450 Ministry of Education, Culture, Sports, Science and Technology of Japan
- ek0109070, ek0109070, ek0109196, ek0109348 Practical Research Project for Rare/Intractable Diseases
- H26-Choju-Ippan-001, dk0207006, dk0207027 Comprehensive Research on Aging and Health Science Research Grants for Dementia R&D
- kk0205008 Integrated Database of Clinical and Genomic Information
- ek0210066, ek0210096, ek0210116 Practical Research Project for Lifestyle-related Diseases including Cardiovascular Diseases and Diabetes Mellitus
- le0110005 Japan Agency for Medical Research and Development
- Takeda Medical Research Foundation
- Mitsubishi Foundation
- Daiwa Securities Health Foundation
- Sumitomo Foundation
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Affiliation(s)
- Motoo Saito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kohei Nishitani
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tome Ikezoe
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Moritoshi Furu
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akinori Okahata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kazuya Nigoro
- Department of Drug Discovery Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tomotoshi Kawata
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichiro Nakamura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinichi Kuriyama
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Department of Health Informatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Noriaki Ichihashi
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Tadao Tsuboyama
- Human Health Sciences, Kyoto University Graduate School of Medicine, Kyoto, Japan
- School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Fumihiko Matsuda
- Department of Health Informatics, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Yılmaz N, Bağcıer F. The Evaluation of Postural Stability and Fall Risk in Patients with Primary Hip Osteoarthritis. Indian J Orthop 2021; 56:263-270. [PMID: 35140857 PMCID: PMC8790000 DOI: 10.1007/s43465-021-00464-9] [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: 02/09/2021] [Accepted: 07/20/2021] [Indexed: 02/04/2023]
Abstract
BACKGROUND The hip is a significant weight-bearing joint and hip osteoarthritis (HOA) is one of the common musculoskeletal disorders. HOA may affect postural stability and fall risk by disrupting joint biomechanics. METHODS Fourty patients with unilateral primary HOA and a control group consisting of 41 healthy subjects were included in the study. HOA was radiographically graded by Kellgren Lawrence (KL) HOA classification. There were 26 patients with mild HOA (KL grade ≤ 2) and 14 patients with moderate-severe HOA (KL grade ≥ 3). The falls efficacy scale-international was used to assess fear of falling. Postural stability and the fall risk were evaluated by using the Biodex Stability System. RESULTS The postural stability and the fall risk indices were statistically significantly higher in the study group. Also, there was a positive correlation between the number of falls in the last 1 year, weight, and body mass index; and these correlations were statistically significant (r 0.686, p 0.003; r 0.477, p 0.002; r 0.444, p 0.004). There was no statistically significant difference in fall risk by the HOA was mild or moderate-severe. CONCLUSIONS Determining the deterioration in postural stability and the fall risk in patients with both mild and moderate-severe HOA may be a stimulus for early initiation of postural stability exercises in HOA.
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Affiliation(s)
- Nurdan Yılmaz
- Department of Physical Therapy and Rehabilitation, Medical Faculty of Tokat Gaziosmanpaşa University, Tokat, Turkey
| | - Fatih Bağcıer
- Department of Physical Therapy and Rehabilitation, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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Ranganath LR, Khedr M, Vinjamuri S, Gallagher JA. Characterizing the alkaptonuria joint and spine phenotype and assessing the effect of homogentisic acid lowering therapy in a large cohort of 87 patients. J Inherit Metab Dis 2021; 44:666-676. [PMID: 33452825 DOI: 10.1002/jimd.12363] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2020] [Revised: 01/07/2021] [Accepted: 01/13/2021] [Indexed: 01/18/2023]
Abstract
A large alkaptonuria (AKU) cohort was studied to better characterize the poorly understood spondyloarthropathy of rare disease AKU. Eighty-seven patients attended the National Alkaptonuria Centre (NAC) between 2007 and 2020. Seven only attended once. Fifty-seven attended more than once and received nitisinone 2 mg daily. Twenty-three attended at least twice without receiving nitisinone. Assessments included questionnaire analysis, 18F Positron emission tomography computerised tomography (PETCT), as well as photographs of ochronotic pigment in eyes and ears at baseline when 2 mg nitisinone was commenced and yearly thereafter. Blood and urine samples were collected for chemical measurement. The prevalence of ochronosis, as well as pain, PETCT and combined pain and PETCT scores, was greatly increased at 90.5%, 85.7%, 100%, and 100%, respectively. Joint pain scores were greatest in proximal joints in upper and lower limbs. PETCT joint scores were higher in proximal joints in upper limb but higher in distal joints in the lower limb. Spine pain scores were highest in lumbar, followed by cervical, thoracic, and cervical regions at 77.4%, 59.5%, 46.4%, and 25%, respectively. PETCT spine scores were highest in thoracic followed by lumbar, cervical, and sacroiliac regions at 74.4%, 70.7%, 64.6%, and 47.8% respectively; ochronosis associated closely with spondyloarthropathy scores (R = .65; P < .0001). Nitisinone reversed ochronosis significantly, with a similar pattern of decreased joint and spine disease. Spondyloarthropathy is a highly prevalent feature in this NAC cohort. Ochronosis appears to be associated with spondyloarthropathy. Nitisinone decreases ochronosis and had a similar nonsignificant effect pattern on spondyloarthropathy.
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Affiliation(s)
- Lakshminarayan R Ranganath
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool University Hospital, Liverpool, UK
- Department of Musculoskeletal Biology, University of Liverpool, Liverpool, UK
| | - Milad Khedr
- Department of Clinical Biochemistry & Metabolic Medicine, Royal Liverpool University Hospital, Liverpool, UK
| | | | - James A Gallagher
- Department of Musculoskeletal Biology, University of Liverpool, Liverpool, UK
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12
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Sonographic evaluation of lateral meniscal extrusion: implementation and validation. Arch Orthop Trauma Surg 2021; 141:271-281. [PMID: 33215303 PMCID: PMC7886729 DOI: 10.1007/s00402-020-03683-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 11/04/2020] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Meniscal extrusion (ME) is an important indicator of and prognostic factor for various knee pathologies. To date, no standardized protocol for the ultrasound-based examination of lateral ME exists. The purpose of the present study was to test the reliability and validity of lateral ME measurements using a standardized ultrasound-based examination protocol. MATERIALS AND METHODS A group consisting of 11 healthy volunteers (Group I, male and female, 18-45 years) as well as a group of 10 consecutive patients who had undergone all-inside lateral meniscal radial tear repair were included (Group II, male and female, 23-43 years). Lateral ME, the main outcome parameter, was measured by ultrasound (US; both groups) and magnetic resonance imaging (MRI; Group II only). Both knees of all subjects were examined in an unloaded state and under axial compression of the knee (50% of body weight). Repeated measurements obtained in Group I by 2 observers were used for reliability testing, and the validity of US was assessed through comparison with MRI data (Group II). RESULTS A total of 66 US images of Group I, obtained by each observer, were analyzed for reliability testing. Forty US and MR images of Group II were assessed for validation. Results showed good interrater (ICC = 0.904) and excellent intrarater (ICC = 0.942) reliability of US-based measurements of lateral ME. Agreement with MRI results was poor (ICC = 0.439), with US systematically overestimating results by 1.1 mm on average. CONCLUSIONS Ultrasound is a reliable, quick and cost-effective technique for lateral ME measurement, but results are not readily comparable with MRI. TRIAL REGISTRATION The study was registered in the European Union Clinical Trials Register (EudraCT-Number: 2017-005037-24).
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra SMA. The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort. J Clin Med 2020; 9:jcm9103374. [PMID: 33096821 PMCID: PMC7594082 DOI: 10.3390/jcm9103374] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 10/08/2020] [Accepted: 10/19/2020] [Indexed: 01/18/2023] Open
Abstract
Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
- Correspondence: ; Tel.: +31(0)-10-7044192; Fax: +31(0)-10-7044766
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, 2333 ZA Leiden, The Netherlands;
| | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam Rheumatology & Immunology Center, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Johannes W. J. Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, 3584 CX Utrecht, The Netherlands;
| | - Sita M. A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands; (Q.W.); (S.M.A.B.-Z.)
- Department of Orthopaedics, Erasmus MC University Medical Center Rotterdam, 3015 GD Rotterdam, The Netherlands
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Özden F, Nadiye Karaman Ö, Tuğay N, Yalın Kilinç C, Mihriban Kilinç R, Umut Tuğay B. The relationship of radiographic findings with pain, function, and quality of life in patients with knee osteoarthritis. J Clin Orthop Trauma 2020; 11:S512-S517. [PMID: 32774020 PMCID: PMC7394788 DOI: 10.1016/j.jcot.2020.04.006] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 03/31/2020] [Accepted: 04/04/2020] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of the study was to investigate the relationship between pain, function and quality of life with radiographic findings in patients with knee osteoarthritis (OA). METHODS A total of 86 patients diagnosed with knee OA were included in the study. Demographic, physical, and pathological information was collected. Visual analog scale (VAS) was used to determine pain levels. The evaluation of radiographic findings was conducted by Kellgren-Lawrence (K&L) rating scale. The Turkish version of the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) questionnaire was used to evaluate the patient's disability and functional status. The objective functional status was assessed using the commonly used physical performance test, the Timed up and Go Test (TUG). The Turkish version of the Short Form 36 (SF-36) questionnaire was used for quality of life assessment. The "Spearman rank correlation coefficient" was used to investigate the relationship between pain, function and quality of life with radiographic findings. RESULTS The mean age of the participants was 61.08 ± 9.27 years. There was a strong correlation between VAS at activity and K&L (p < 0.05). There was a negative correlation between Physical Function (PF) (p < 0.05) and General Health (GH) (p < 0.05) subscore of the SF-36 with K&L. In addition, K&L and TUG were positively correlated (p < 0.05). CONCLUSION Radiographic findings were associated with pain in activity and functional status based on physical performance, but not with clinical results based on Patient Reported Outcome Measures (PROMs). As the patient's radiographic findings worsened, the level of pain increased and functionality decreased.
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Affiliation(s)
- Fatih Özden
- Muğla Sıtkı Koçman University, Köyceğiz Vocational School of Health Services, Elderly Care Department, Köyceğiz, Muğla, Turkey
| | - Özgür Nadiye Karaman
- Muğla Sıtkı Koçman University, Training and Research Hospital, Physical Therapy and Rehabilitation Unit, Kötekli, Muğla, Turkey
| | - Nazan Tuğay
- Muğla Sıtkı Koçman University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kötekli, Muğla, Turkey
| | - Cem Yalın Kilinç
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Orthopedics and Traumatology, Kötekli, Muğla, Turkey
| | - Rabia Mihriban Kilinç
- Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Radiology, Kötekli, Muğla, Turkey
| | - Baki Umut Tuğay
- Muğla Sıtkı Koçman University, Faculty of Health Sciences, Department of Physiotherapy and Rehabilitation, Kötekli, Muğla, Turkey
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Özden F, Nadiye Karaman Ö, Tuğay N, Yalın Kilinç C, Mihriban Kilinç R, Umut Tuğay B. The relationship of radiographic findings with pain, function, and quality of life in patients with knee osteoarthritis. J Clin Orthop Trauma 2020; 11:S512-S517. [DOI: https:/doi.org/10.1016/j.jcot.2020.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
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Kaur Bahia R, Quais S, Suhail A. Relationship of Pain, Function and Quality of Life with Disease Grading among Patients with Knee Osteoarthritis. ASIAN JOURNAL OF PHARMACEUTICAL RESEARCH AND HEALTH CARE 2020. [DOI: 10.18311/ajprhc/2021/27254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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17
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Kauppinen K, Pylväläinen J, Pamilo K, Helminen O, Haapea M, Saarakkala SS, Nevalainen MT. Association between grayscale sonographic and clinical findings in severe knee osteoarthritis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:75-81. [PMID: 31580500 DOI: 10.1002/jcu.22779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. METHODS One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. RESULTS Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). CONCLUSIONS US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.
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Affiliation(s)
- Kyösti Kauppinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juho Pylväläinen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Olli Helminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Simo S Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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Shere C, Fuggle NR, Edward MH, Parsons CM, Jameson KA, Cooper C, Dennison EM, Ward KA. Jumping Joints: The Complex Relationship Between Osteoarthritis and Jumping Mechanography. Calcif Tissue Int 2020; 106:115-123. [PMID: 31655874 PMCID: PMC6994439 DOI: 10.1007/s00223-019-00622-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2019] [Accepted: 10/09/2019] [Indexed: 12/31/2022]
Abstract
We investigated the relationship between lower limb osteoarthritis (OA) and muscle strength and power (assessed by jumping mechanography) in UK community-dwelling older adults. We recruited 249 older adults (144 males, 105 females). OA was assessed clinically at the knee according to ACR criteria and radiographically, at the knee and hip, using Kellgren and Lawrence grading. Two-footed jumping tests were performed using a Leonardo Mechanography Ground Reaction Force Platform to assess maximum muscle force, power and Esslinger Fitness Index. Linear regression was used to assess the relationship between OA and jumping outcomes. Results are presented as β (95% confidence interval). The mean age of participants was 75.2 years (SD 2.6). Males had a significantly higher maximum relative power during lift off (mean 25.7 W/kg vs. 19.9 W/kg) and maximum total force during lift off (mean 21.0 N/kg vs. 19.1 N/kg) than females. In adjusted models, we found significant associations in males between clinical knee OA and maximum relative power [- 6.00 (CI - 9.10, - 2.94)] and Esslinger Fitness Index [- 19.3 (- 29.0, - 9.7)]. In females, radiographic knee OA was associated with total maximum power [- 2.0 (- 3.9, - 0.1)] and Esslinger Fitness Index [- 8.2 (- 15.9, - 0.4)]. No significant associations were observed for maximum total force. We observed significant negative associations between maximum relative power and Esslinger Fitness Index and clinical knee OA in males and radiographic knee OA in females. We have used novel methodology to demonstrate relationships between muscle function and OA in older adults.
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Affiliation(s)
- C Shere
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - N R Fuggle
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - M H Edward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - C M Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - K A Jameson
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK.
- National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.
- National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK.
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
| | - K A Ward
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Tremona Road, Southampton, SO16 6YD, UK
- MRC Nutrition and Bone Health Research Group, Cambridge, UK
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Qiu Y, Lin C, Liu Q, Zhong Q, Tao K, Xing D, Li H, Lin J. Imaging features in incident radiographic patellofemoral osteoarthritis: the Beijing Shunyi osteoarthritis (BJS) study. BMC Musculoskelet Disord 2019; 20:359. [PMID: 31391019 PMCID: PMC6686263 DOI: 10.1186/s12891-019-2730-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2019] [Accepted: 07/19/2019] [Indexed: 11/10/2022] Open
Abstract
Background The present study aims to describe the imaging features in incident radiographic patellofemoral osteoarthritis (RPFOA) population in a Chinese suburban area. Methods The Beijing Shunyi osteoarthritis (BJS) study was a population-based, longitudinal and prospective study. Residents were recruited by randomized cluster sampling in 2014 and were followed 3 years later. Home interviews and clinical examinations were performed; weight-bearing posterior-anterior semi-flexed (45-degree) views of the tibiofemoral (TF) joints and skyline (45-degree) views of the patellofemoral (PF) joints were included. For each batch of study films (n = 100), 20 films from the year 2014 and 20 previously read PF radiographs were fed back to test inter−/intra-reader repeatability. The imaging features of incident RPFOA were analyzed. Narrative statistics, independent-sample t-tests, and nonparametric tests were performed. Results A total of 1295 participants (2590 knees) were recruited at baseline in 2014, and 967 (74.7%) residents were followed in 2017. Of all the knees (n = 1537) without RPFOA at baseline, 139 knees (13.3%) across 119 people developed incident RPFOA. Compared with the whole population, age (p = 0.031), body mass index (BMI, p = 0.042), and incidence of knee pain symptoms (p < 0.01) were significantly different in the incident RPFOA population, while range of motion (ROM, p = 0.052) and gender (0/1, p = 0.203) showed no significance. In the incident population, the changes of each imaging indicator grade were evaluated—lateral patellofemoral osteophyte (LPOST, increased by 1.02), medial patellofemoral osteophyte (MPOST, increased by 0.49), lateral joint space narrowing (LJSN, increased by 0.30), medial joint space narrowing (MJSN, increased by 0.06); indicator grade progress decreases, respectively. The progress of LPOST was the fastest among the four indicators (p < 0.01). Conclusions In this population-based longitudinal study, among the incident RPFOA population, the imaging indicators show that marginal patellofemoral osteophyte is more pronounced than patellofemoral joint space narrowing. LPOST is the fastest-progressing indicator among all the radiographic features, which is also the most common imaging manifestation of RPFOA. In the incident RPFOA population, the proportion of elders, women, higher-BMI individuals, and people suffering knee pain is more than the normal population.
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Affiliation(s)
- Yudian Qiu
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China
| | - Chutong Lin
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China
| | - Qiang Liu
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China
| | - Qunjie Zhong
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China.,Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Ke Tao
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China
| | - Dan Xing
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China
| | - Hu Li
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China
| | - Jianhao Lin
- Institution of Arthritis, Peking University People's Hospital, NO11 South street of Xizhimen, Xicheng district, Beijing, China.
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20
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Clynes MA, Jameson KA, Edwards MH, Cooper C, Dennison EM. Impact of osteoarthritis on activities of daily living: does joint site matter? Aging Clin Exp Res 2019; 31:1049-1056. [PMID: 30903599 PMCID: PMC6661019 DOI: 10.1007/s40520-019-01163-0] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 02/27/2019] [Indexed: 12/13/2022]
Abstract
Background We consider the relationships between a clinical and radiological diagnosis of knee or hip OA and activities of daily-living (ADL) in older adults. Methods Data were available for 222 men and 221 women from the Hertfordshire Cohort Study (HCS) who also participated in the UK component of the European Project on Osteoarthritis (EPOSA). Participants completed the EuroQoL survey where they reported if they had difficulties with mobility, self-care, usual activities and movement around their house. Hip and knee radiographs were graded for overall Kellgren and Lawrence score (positive definition defined as a 2 or above). Clinical OA was defined using American College of Rheumatology criteria. Results In men, a clinical diagnosis of hip or knee OA were both associated with reported difficulties in mobility, ability to self-care and performing usual-activities (hip OA: OR 17.6, 95% CI 2.07, 149, p = 0.009; OR 12.5, 95% CI 2.51, 62.3, p = 0.002; OR 4.92, 95% CI 1.06, 22.8, p = 0.042 respectively. Knee OA: OR 8.18, 95% CI 3.32, 20.2, p < 0.001; OR 4.29, 95% CI 1.34, 13.7, p = 0.014; OR 5.32, 95% CI 2.26, 12.5, p < 0.001 respectively). Similar relationships were seen in women, where in addition, a radiological diagnosis of knee OA was associated with difficulties performing usual activities (OR 3.25, 95% CI 1.61, 6.54, p = 0.001). In general, men with OA reported stronger associations between moving around the house, specifically around the kitchen (clinical hip OA: OR 13.7, 95% CI 2.20, 85.6, p = 0.005; clinical knee OA OR 8.45, 95% CI 1.97, 36.2, p = 0.004) than women. Discussion and conclusion Clinical OA is strongly related to the ability to undertake ADL in older adults and should be considered in clinic consultations when seeing patients with OA.
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Clynes MA, Parsons C, Edwards MH, Tobias JH, Deere K, Cooper C, Dennison EM. A diagnosis of knee osteoarthritis does not predict physical activity 2 years later in older adults: findings from the Hertfordshire Cohort Study. Rheumatol Int 2019; 39:1405-1411. [PMID: 31037363 DOI: 10.1007/s00296-019-04309-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/16/2019] [Indexed: 10/26/2022]
Abstract
Osteoarthritis (OA) can negatively impact levels of physical activity (PA), although current clinical advice promotes the benefits of staying active in preventing joint degeneration. In this study, we examine how knee OA, assessed by self-report, clinical assessment and radiographic assessment, impacts upon objectively measured PA 2 years later. The study population is comprised of 114 subjects from the Hertfordshire Cohort Study (HCS). The presence of OA at the knee was determined from self-report, and clinical and radiological examination, defined according to American College of Rheumatology (ACR) criteria and Kellgren and Lawrence grading system. Two years later, Gulf Coast Data Concepts (GCDC) tri-axial accelerometers were used to measure day-to-day levels of PA. Vertical acceleration peaks over 7 days, expressed in g units, were categorised into low (0.5 ≤ g < 1.0), medium (1.0 ≤ g < 1.5) and high (≥ 1.5 g) impacts. The study comprises 69 men and 45 women. The mean (SD) age was 78.5 (2.6) for men and 78.6 (2.7) for women. Low count numbers were recorded in the medium and high impact bands. We found no significant reduction in low, medium or high impacts in individuals who had been previously diagnosed with self-reported, radiographic or clinical knee OA in this sample after adjustment for age, sex and BMI. In our cohort, participants with knee OA were no less likely to partake in objectively measured weight-bearing activity 2 years after assessment than counterparts without a diagnosis of knee OA.
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Affiliation(s)
- Michael A Clynes
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.
| | - Camille Parsons
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Mark H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.,Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | - Jonathan H Tobias
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Kevin Deere
- Musculoskeletal Research Unit, Translational Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK.,National Institute for Health Research Biomedical Research Centre, University of Southampton and University Hospital Southampton NHS Foundation Trust, Southampton, UK.,National Institute for Health Research Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Osteoarthritis year in review 2018: imaging. Osteoarthritis Cartilage 2019; 27:401-411. [PMID: 30590194 DOI: 10.1016/j.joca.2018.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a narrative review of the most relevant original research published in 2017/2018 on osteoarthritis imaging. METHODS The PubMed database was used to recover all relevant articles pertaining to osteoarthritis and medical imaging published between 1 April 2017 and 31 March 2018. Review articles, case studies and in vitro or animal studies were excluded. The original publications were subjectively sorted based on relevance, novelty and impact. RESULTS AND CONCLUSIONS The publication search yielded 1,155 references. In the assessed publications, the most common imaging modalities were radiography (N = 708) and magnetic resonance imaging (MRI) (355), followed by computed tomography (CT) (220), ultrasound (85) and nuclear medicine (17). An overview of the most important publications to the osteoarthritis (OA) research community is presented in this narrative review. Imaging studies play an increasingly important role in OA research, and have helped us to understand better the pathophysiology of OA. Radiography and MRI continue to be the most applied imaging modalities, while quantitative MRI methods and texture analysis are becoming more popular. The value of ultrasound in OA research has been demonstrated. Several multi-modality predictive models have been developed. Deep learning has potential for more automatic and standardized analyses in future OA imaging research.
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Syddall HE, Simmonds SJ, Carter SA, Robinson SM, Dennison EM, Cooper C. The Hertfordshire Cohort Study: an overview. F1000Res 2019; 8:82. [PMID: 30828442 PMCID: PMC6381804 DOI: 10.12688/f1000research.17457.1] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/21/2018] [Indexed: 12/24/2022] Open
Abstract
The Hertfordshire Cohort Study is a nationally unique study of men and women born in the English county of Hertfordshire in the early part of the 20
th century. Records that detail their health in infancy and childhood have been preserved, their sociodemographic, lifestyle, medical and biological attributes have been characterised in later life, and routinely collected data on their hospital use and mortality have been acquired. This paper provides an overview of the study since its inception in the 1980s, including its methods, findings, and plans for its future.
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Affiliation(s)
- Holly E Syddall
- MRC Lifecourse Epidemiology Unit, Southampton, Hampshire, SO16 6YD, UK
| | | | - Sarah A Carter
- MRC Lifecourse Epidemiology Unit, Southampton, Hampshire, SO16 6YD, UK
| | - Sian M Robinson
- MRC Lifecourse Epidemiology Unit, Southampton, Hampshire, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, Hampshire, SO16 6YD, UK
| | - Elaine M Dennison
- MRC Lifecourse Epidemiology Unit, Southampton, Hampshire, SO16 6YD, UK
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, Southampton, Hampshire, SO16 6YD, UK.,NIHR Southampton Biomedical Research Centre, University of Southampton, Southampton, Hampshire, SO16 6YD, UK.,NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, Oxfordshire, OX3 7LD, UK
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Magnetic resonance imaging of patellofemoral osteoarthritis: intertester reliability and associations with knee pain and function. Clin Rheumatol 2019; 38:1469-1476. [PMID: 30617597 DOI: 10.1007/s10067-018-04414-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2018] [Revised: 12/12/2018] [Accepted: 12/25/2018] [Indexed: 12/20/2022]
Abstract
OBJECTIVES We examined the intertester reliability of patellofemoral compartment (PFC) osteoarthritis (OA) severity using magnetic resonance images (MRI) and a modified Kellgren and Lawrence (K&L) system. Second, we determined if these grades were associated with clinical tests of PFC involvement or self-reported pain/difficulty with stair climbing. Third, we assessed the association between PFC OA severity and knee pain or disability, after accounting for potential confounders including tibiofemoral OA severity. METHOD We examined the 9-year Osteoarthritis Initiative data from 114 subjects in the year prior to undergoing knee arthroplasty. The weighted kappa (κw) was used to determine intertester reliability, and the Pearson chi-square was used to assess associations among PFC OA scores and clinical tests. Multiple regressions were used to determine independent associations between self-reported pain/function and PFC OA. RESULTS Reliability was substantial (κw = 0.73 (SE = 0.05)). Chi-square associations between PFC OA severity and clinical tests were not significant (p > 0.05). Multiple regression models between PFC OA and self-reported pain or function scores were not significant (p > 0.05). CONCLUSIONS MRI-based measures of PFC OA were highly reliable indicating that musculoskeletal radiologists can reliably grade the PFCs of subjects using MRI. The extent of PFC OA is not associated with either clinical tests of PFC involvement or activities associated with PFC pain in persons with moderate to severe symptomatic tibiofemoral and PFC OA.
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Martel-Pelletier J, Maheu E, Pelletier JP, Alekseeva L, Mkinsi O, Branco J, Monod P, Planta F, Reginster JY, Rannou F. A new decision tree for diagnosis of osteoarthritis in primary care: international consensus of experts. Aging Clin Exp Res 2019; 31:19-30. [PMID: 30539541 PMCID: PMC6514162 DOI: 10.1007/s40520-018-1077-8] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Accepted: 11/16/2018] [Indexed: 01/01/2023]
Abstract
Background and aims Although osteoarthritis (OA) is managed mainly in primary care, general practitioners (GPs) are not always trained in its diagnosis, which leads to diagnostic delays, unnecessary resource utilization, and suboptimal patient outcomes. Methods To address this situation, an International Rheumatologic Board (IRB) of 8 experts from 3 continents developed guidelines for the diagnosis of OA in primary care. The focus was three major topologies: hip, knee, and hand/finger OA. The IRB used American College of Rheumatology diagnostic criteria. Results Care pathways based on clinical and radiological findings were developed to identify intervention thresholds for GPs/specialists. To optimize usefulness in the primary care setting, the guidelines were formatted as an uncomplicated, but comprehensive one-page decision tree for each topology, highlighting key aspects of the evaluation process and incorporating red flags. In a two-phase validation stage, the draft guidelines were evaluated by rheumatologists and GPs for project execution, content and perceived benefit. The strength of the guidelines lies in their user-friendly diagram and potential for broad application. Such guidelines will allow GPs to make an easy but definite diagnosis of OA and offer clear guidance about situations requiring an expert opinion. The guidelines have potential to improve patient outcomes and reduce the number of unnecessary procedures. Discussion and conclusions This project demonstrated the feasibility of developing easy-to-use and effective visual decision trees to facilitate the diagnosis and management of OA of the hip, knee and hand/finger in primary care. The next step should be to conduct a large impact study of implementation of these recommendations in the diagnostic management of OA in general practice in different areas.
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Affiliation(s)
- Johanne Martel-Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | - Emmanuel Maheu
- Rheumatology Department, Saint-Antoine Hospital, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Canada
| | | | - Ouafa Mkinsi
- Ibn Rochd University Hospital, Casablanca, Morocco
| | - Jaime Branco
- Department of Rheumatology, NOVA Medical School, CEDOC, Universidade Nova de Lisboa, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | | | | | - Jean-Yves Reginster
- Department of Public Health, Epidemiology, and Health Economics, University of Liège, Liège, Belgium
- Belgium and WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - François Rannou
- Service de rééducation et réadaptation de l'appareil locomoteur et des pathologies du rachis, Laboratoire de Pharmacologie, Toxicologie et Signalisation Cellulaire, Univ. Paris Descartes, PRES Sorbonne Paris Cité, Hôpital Cochin, Assistance Publique -Hôpitaux de Paris, INSERM UMR-S 1124, UFR Biomédicale des Saints Pères, Paris, France.
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