Epidemiologic and etiologic approach of osteoarthritis

Effects of Running on the Development of Knee Osteoarthritis: An Updated Systematic Review at Short-Term Follow-up

Background

Some studies have suggested that running increases the risk of knee osteoarthritis (OA), while others believe it serves a protective function.

Purpose

To perform an updated systematic review of the literature to determine the effects of running on the development of knee OA.

Study Design

Systematic review; Level of evidence, 4.

Methods

A systematic review was performed by searching the PubMed, Cochrane Library, and Embase databases to identify studies evaluating the effect of cumulative running on the development of knee OA or chondral damage based on imaging and/or patient-reported outcomes (PROs). The search terms used were "knee AND osteoarthritis AND (run OR running OR runner)." Patients were evaluated based on plain radiographs, magnetic resonance imaging (MRI), and PROs (presence of knee pain, Health Assessment Questionnaire-Disability Index, and the Knee injury and Osteoarthritis Outcome Score).

Results

Seventeen studies (6 level 2 studies, 9 level 3 studies, and 2 level 4 studies), with 7194 runners and 6947 nonrunners, met the inclusion criteria. The mean follow-up time was 55.8 months in the runner group and 99.7 months in the nonrunner group. The mean age was 56.2 years in the runner group and 61.6 years in the nonrunner group. The overall percentage of men was 58.5%. There was a significantly higher prevalence of knee pain in the nonrunner group (P < .0001). Although 1 study found a significantly higher prevalence of osteophytes in the tibiofemoral (TF) and patellofemoral (PF) joints within the runner group, multiple studies found no significant differences in the prevalence of radiographic knee OA (based on TF/PF joint-space narrowing or Kellgren-Lawrence grade) or cartilage thickness on MRI between runners and nonrunners (P > .05). One study found a significantly higher risk of knee OA progressing to total knee replacement among nonrunners (4.6% vs 2.6%; P = .014).

Conclusion

In the short term, running is not associated with worsening PROs or radiological signs of knee OA and may be protective against generalized knee pain.

Functional Outcomes Following Microfragmented Adipose Tissue Versus Bone Marrow Aspirate Concentrate Injections for Symptomatic Knee Osteoarthritis

This study aimed to determine whether autologous orthobiologic tissue source affects pain and functional outcomes in patients with symptomatic knee osteoarthritis (OA) who received microfragmented adipose tissue (MFAT) or bone marrow aspirate concentrate (BMAC) injection. We retrospectively reviewed prospectively collected data from patients who received BMAC or MFAT injection for symptomatic knee OA. Patients completed baseline and follow-up surveys. Each survey included the Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire, Emory Quality of Life (EQOL) questionnaire, and Visual Analog Scale (VAS) for pain. The follow-up responses were compared with baseline for all patients and between BMAC and MFAT groups. A total of 110 patients met inclusion criteria, with 76 patients (BMAC 41, MFAT 35) and 106 knees (BMAC 58, MFAT 48) having appropriate follow-up data. The BMAC group included 17 females and 24 males, with a mean age of 59 ± 11 years. The MFAT group included 23 females and 12 males, with a mean age of 63 ± 11 years. Minimum follow-up time was 0.5 years. Mean follow-up time was 1.80 ± 0.88 years for BMAC and 1.09 ± 0.49 years for MFAT. Both groups had significant improvement in EQOL, VAS, and all KOOS parameters preprocedure versus postprocedure (p < .001). There was not a significant difference when comparing postprocedure scores between groups (p = .09, .38, .63, .94, .17, .15, .70, respectively). These data demonstrate significant improvement in pain and function with both MFAT and BMAC injections in patients with symptomatic knee OA without a significant difference in improvement when comparing the two autologous tissue sources. Stem Cells Translational Medicine 2019;8:1149-1156.

Attenuation of inflammation and cartilage degradation by sulfasalazine-containing hyaluronic acid on osteoarthritis rat model

The aim of this study was to investigate the effects of a sulfasalazine-containing hyaluronic acid (SASP/HA) systems on in vitro anti-inflammation and the alleviation of cartilage degradation in both lipopolysaccharide (LPS)-stimulated synoviocytes and a rat model of monosodium iodoacetate (MIA)-induced osteoarthritis (OA). The SASP/HA resulted in long-term release of SASP from the SASP/HA for up to 60 days in a sustained manner. In vitro studies performed using real-time polymerase chain reaction (PCR) assay revealed that the SASP/HA was able to effectively and dose-dependently inhibit the mRNA expression levels of pro-inflammatory cytokines such as matrix metalloproteinases-3 (MMP-3), cyclooxygenase-2 (COX-2), interleukin-6 (IL-6), and tumor necrosis factor-α (TNF-α) in LPS-stimulated synoviocytes. In vivo studies showed that intra articular injection of SASP/HA greatly reduced the MIA-stimulated mRNA expression of MMP-3, COX-2, IL-6, and TNF-α in blood. Furthermore, these significant anti-inflammatory effects of SASP/HA contributed markedly to the alleviation of progression of MIA-induced OA and cartilage degradation, as demonstrated by X-ray, micro-computed tomography (micro-CT), gross findings, and histological evaluations. Therefore, our findings indicated that the long-term and sustained delivery of SASP using HA can play a therapeutic role in alleviating inflammation as well as protecting against cartilage damage in OA.

Nanoengineered particles for enhanced intra-articular retention and delivery of proteins

Localized intra-articular delivery of anti-inflammatory proteins can reduce inflammation in osteoarthritis but poses a challenge because of raid clearance within few hours of injection. A new class of polymer is developed that forms self-assembled nanoparticles ranging from 300 to 900 nm and demonstrates particle size dependent prolonged retention in intra-articular joint spaces compared to bolus protein over a period of 14 d.

Cigarette smoking and risk of total knee replacement for severe osteoarthritis among Chinese in Singapore--the Singapore Chinese health study

PURPOSE

Data on the effects of cigarette smoking with osteoarthritis (OA) are inconsistent and no study has examined the effect of smoking cessation. We examined smoking status, duration, dosage and cessation in association with risk of total knee replacement (TKR) for severe knee OA among elderly Chinese in Singapore.

METHODS

We used data from the Singapore Chinese Health Study, a population-based prospective cohort of 63,257 Chinese men and women aged 45-74 years during enrollment between 1993 and 1998. Detailed information on smoking, current diet and lifestyle factors were obtained through in person interviews. As of 31 December 2011, 1,973 incident TKR cases for severe knee OA had been identified via linkage with nationwide hospital discharge database. We used Cox regression methods to examine smoking in relation to TKR risk with adjustment for age, gender, education, body mass index (BMI), comorbidities and physical activity level.

RESULTS

Compared to never smokers, current smokers had a 51% decrease in risk of TKR [Hazards ratio (HR) = 0.49; 95% confidence interval (CI) = 0.40-0.60]. Among current smokers, there was a very strong dose-dependent association between increasing duration and dosage of smoking with decreasing risk of TKR (P for trend <0.0001). Among former smokers, there was a dose-dependent response between decrease in duration of smoking cessation and reduction in TKR risk (P for trend = 0.034).

CONCLUSION

Our findings strongly implicate smoking as a protective factor for TKR indicated for severe knee OA. This concurs with experimental data that nicotine promotes proliferation and collagen synthesis in chondrocytes.

MATN3 gene polymorphism is associated with osteoarthritis in Chinese Han population: a community-based case-control study

Background. The matrilin, especially matrilin-3 (MATN3), are reported to play important roles in the pathophysiology of osteoarthritis (OA). To explore the relationship between MATN3 SNP6 (rs8176070) and primary OA, we conducted a community-based case-control study. Methods. A total of 732 community residents aged 40–84 years participated in the community-based study in Northeast China. After taking physical and radiographic examinations, 420 of the residents were diagnosed OA (216 women and 204 men). The other 312 individuals without any symptoms of osteoarthritis or signs in the radiographs (156 women and 156 men) were considered as healthy controls. After obtaining the DNA of case and control groups, genotypes of the MATN3 SNP6 were determined by polymerase chain reaction followed by restriction enzyme digestion. The numbers of patients with different OA subtypes were also calculated. Results. The distribution of genotypes and alleles of the MATN3 SNP6 between OA patients and controls was different significantly. The BB carrier tends to be associated with the increased osteoarthritis (P = 0.025, OR = 1.724, 95% CI = 1.071–2.77), especially the knee osteoarthritis (P = 0.021, OR = 2.402, 95% CI = 1.141–5.060) and lumber osteoarthritis (P = 0.020, OR = 1.880, 95% CI = 1.103–3.204). Bb carrier increased hand osteoarthritis risk (P = 0.002, OR = 5.380, 95% CI = 1.828–15.835). The B allele might have an effect on the increased knee osteoarthritis (P = 0.000, OR = 3.143, 95% CI = 2.283–4.328). Conclusion. These findings suggest that the MATN3 gene polymorphism might be associated with osteoarthritis in the Chinese Han population.

Self-assembling nanoparticles for intra-articular delivery of anti-inflammatory proteins

Intra-articular delivery of therapeutics to modulate osteoarthritis (OA) is challenging. Delivery of interleukin-1 receptor antagonist (IL-1Ra), the natural protein inhibitor of IL-1, to modulate IL-1-based inflammation through gene therapy or bolus protein injections has emerged as a promising therapy for OA. However, these approaches suffer from rapid clearance and reduced potency over time. Nano/microparticles represent a promising strategy for overcoming the shortcomings of intra-articular drug delivery. However, these delivery vehicles are limited for delivery of protein therapeutics due to their hydrophobic character, low drug loading efficiency, and harsh chemical conditions during particle processing. We designed a new block copolymer that assembles into submicron-scale particles and provides for covalently tethering proteins to the particle surface for controlled intra-articular protein delivery. This block copolymer self-assembles into 300 nm-diameter particles with a protein tethering moiety for surface covalent conjugation of IL-1Ra protein. This copolymer particle system efficiently bound IL-1Ra and maintained protein bioactivity in vitro. Furthermore, particle-tethered IL-1Ra bound specifically to target synoviocyte cells via surface IL-1 receptors. Importantly, IL-1Ra nanoparticles inhibited IL-1-mediated signaling to equivalent levels as soluble IL-1Ra. Finally, the ability of nanoparticles to retain IL-1Ra in the rat stifle joint was evaluated by in vivo imaging over 14 days. IL-1Ra-tethered nanoparticles significantly increased the retention time of IL-1Ra in the rat stifle joint over 14 days with enhanced IL-1Ra half-life (3.01 days) compared to that of soluble IL-1Ra (0.96 days) and without inducing degenerative changes in cartilage structure or composition.

Estudo da estimulação elétrica nervosa transcutânea (TENS) nível sensório para efeito de analgesia em pacientes com osteoartrose de joelho

INTRODUÇÃO: A osteoartrose de joelho (OAJ) é uma das patologias que mais afetam o aparelho locomotor e interferem de forma considerável nas atividades da vida diária, acometendo os indivíduos em faixa etária variável e em diversos graus e níveis de dor articular. OBJETIVOS: Por causa da importância da articulação do joelho nas atividades locomotoras, os pacientes com osteoartrose de joelho sofrem com a limitação de movimento e rigidez articular. O objetivo do presente estudo foi avaliar o efeito da estimulação elétrica nervosa transcutânea (TENS) nível sensório para tratamento de dor em pacientes com diagnóstico de osteoartrose de joelho, utilizando escalas de avaliação de dor. MÉTODOS: Foram estudados 10 pacientes com diagnóstico de osteoartrose de joelho, utilizando uma modalidade fisioterapêutica, a eletroterapia, especificamente a (TENS), com parâmetros de 80 Hz e 140 µs, com um total de 10 sessões, 30 minutos para cada sessão, o período total de tratamento compreendeu 4 semanas. Nesse total de 10 sessões, cada paciente foi entrevistado com um questionário na 1ª sessão, na 5ª e na 10ª sessão. Os formulários utilizados foram questionário da dor McGill - Melzack, escala Analógica visual da dor, escala numérica com expressão facial de sofrimento. RESULTADOS: O resultado com a TENS nível sensório para efeito de analgesia mostra que as diferenças foram estatisticamente significativas (p < 0,05) para escala Analógica visual da dor e o Questionário da Dor McGill. CONCLUSÃO: Nossos resultados sugerem que a TENS nível sensório reduz a dor e melhora a funcionalidade do joelho.

Effect of an education programme for patients with osteoarthritis in primary care--a randomized controlled trial

BACKGROUND

Osteoarthritis (OA) is a degenerative disease, considered to be one of the major public health problems. Research suggests that patient education is feasible and valuable for achieving improvements in quality of life, in function, well-being and improved coping. Since 1994, Primary Health Care in Malmö has used a patient education programme directed towards OA. The aim of this study was to evaluate the effects of this education programme for patients with OA in primary health care in terms of self-efficacy, function and self-perceived health.

METHOD

The study was a single-blind, randomized controlled trial (RCT) in which the EuroQol-5D and Arthritis self-efficacy scale were used to measure self-perceived health and self-efficacy and function was measured with Grip Ability Test for the upper extremity and five different functional tests for the lower extremity.

RESULTS

We found differences between the intervention group and the control group, comparing the results at baseline and after 6 months in EuroQol-5D (p < 0.001) and in standing one leg eyes closed (p = 0.02) in favour of the intervention group. No other differences between the groups were found.

CONCLUSION

This study has shown that patient education for patients with osteoarthritis is feasible in a primary health care setting and can improve self-perceived health as well as function in some degree, but not self-efficacy. Further research to investigate the effect of exercise performance on function, as well as self-efficacy is warranted.

TRIAL REGISTRATION

The trial is registered with ClinicalTrials.gov.

REGISTRATION NUMBER

NCT00979914.

Miscellaneous conditions of the shoulder: anatomical, clinical, and pictorial review emphasizing potential pitfalls in imaging diagnosis

The purpose of this article is to review the key imaging findings in major categories of pathology affecting the shoulder joint including hydroxyapatite deposition disease, rotator cuff interval pathology, acromioclavicular joint pathology, glenohumeral osteoarthrosis, and synovial inflammatory processes, with specific emphasis on findings that have associated pitfalls in imaging diagnosis. The pathophysiology and clinical manifestations of the above mentioned categories of pathology will be reviewed, followed in each section by a detailed pictorial review of the key imaging findings in each category including plain film, computed tomography, and magnetic resonance imaging findings as applicable. Imaging challenges that relate to both diagnosis and characterization will be addressed with each type of pathology. The goal is that after reading this article, the reader will be able to recognize the key imaging findings in major categories of pathology affecting the shoulder joint and will become familiar with the potential pitfalls in their imaging diagnosis.

Rheumatic Disease in the Elderly: Rheumatoid Arthritis

This article summarizes the different aspects of rheumatoid arthritis and the spectrum of diseases that can present as rheumatoid arthritis in the elderly population. With the ageing of the western population, different forms of inflammatory arthritis' prevalence and incidence are increasing in elderly persons. Difficulties in establishing the diagnosis and introducing new treatment modalities in this patient group pose a great challenge for clinicians. The management of inflammatory arthritis in the elderly requires special consideration in regard to the comorbidities and increased frequency of adverse events. There is substantial need for improving aspects of diagnostic and therapeutic interventions that will reduce the impact of inflammatory arthritis in the growing elderly population.

Finger osteoarthritis and differences in dental work tasks

Mechanical load has been proposed as a risk factor for hand osteoarthritis. Dentists produce high manual forces in their work tasks. We studied whether the pattern of dental work tasks was associated with finger osteoarthritis. Radiographs of both hands of 291 middle-aged female dentists were examined for the presence of osteoarthritis. Patterns of dental work tasks during work history were empirically defined by cluster analysis. Three patterns emerged reflecting high, moderate, and mild task variation. Age, specialization, years in clinical work, various activities requiring hand use, family history of Heberden's nodes, body mass index, and smoking were accounted for in logistic regression analyses. The dentists with a history of low task variation had a greater prevalence of osteoarthritis in the thumb, index, and middle fingers compared with dentists with high variation (OR 2.22; 95%CI 1.04-4.91). The pattern of dental work task history is associated with the localization of osteoarthritis in the fingers.

Investigations in generalized osteoarthritis. Part 2: special histological features in generalized osteoarthritis (histological investigations in Heberden's nodes using a histological score)

OBJECTIVE

In accordance with the literature, our previous epidemiological, clinical and genetical investigations have confirmed a correlation between generalized osteoarthritis (GOA) and Heberden's nodes. Heberden's nodes can be considered as genetic markers for the existence of a generalized osteoarthritic predisposition. The present study's concern was to establish whether there are special histological features in this disease.

METHODS

Layered sections of 218 distal finger joints from 56 deceased persons were investigated using a histological-histochemical score modified by Mankin.

RESULTS

In Heberden's nodes, we found all the typical degradative sequences of the osteoarthritic process but also some specific modifications. The osteoarthritis (OA) starts with a subchondral ossification and manifests a reactive tidemark flaking. At this time, the surface of the cartilage is not yet destroyed. Later on, there is progression of general degradation. Significant differentiation from the control group is possible using a histological score.

CONCLUSIONS

In patients with Heberden's nodes, the OA starts with the subchondral ossification. Heberden's nodes are the specific manifestation of GOA in the distal finger joints. Further studies are therefore required to assess whether the same pathogenetic mechanism can be seen in OA of the large joints in GOA.

Rheumatic disease in the elderly: rheumatoid arthritis

This review summarizes the different aspects of rheumatoid arthritis and the spectrum of diseases that can present as rheumatoid arthritis-like arthritis in the elderly population. With the aging of Western population, different forms of inflammatory arthritis' prevalence and incidence are increasing in the elderly persons. Difficulties in establishing the diagnosis and introducing new treatment modalities in this patient group poses a great challenge for the clinicians. The management of inflammatory arthritis in the elderly requires special consideration in regard to the comorbidities and increased frequency of adverse events. There is definitely a substantial need for improving different aspects of diagnostic and therapeutic interventions that will reduce the impact of inflammatory arthritis in the growing elderly population.

Lack of benefit of a primary care-based nurse-led education programme for people with osteoarthritis of the knee

Osteoarthritis (OA) is the commonest cause of locomotor disability and forms a major element of the workload of the primary care team. There is evidence that patient education may improve quality of life, physical functioning, mental health and coping as well as reducing health service use. The aim of this study was to evaluate the effectiveness of a primary care-based patient education programme (PEP) using a randomised controlled trial. A cluster randomised controlled trial, involving 22 practices, was used to determine the efficacy of a nurse-led education programme. The programme consisted of a home visit and four 1-h teaching sessions. Patients were assessed at baseline and then 1, 3, 6 and 12 months post intervention using 36-item Short Form (SF-36), Western Ontario and McMaster Universities Arthritis Index (WOMAC), arthritis helplessness index and a patient knowledge questionnaire. Direct interviews were used at baseline and at the 12-month follow-up. There were no differences in depression, OA knowledge, pain or physical ability at either 1 month or 1 year between the two groups. Control practices (65 patients from 12 practices) recruited significantly fewer patients than intervention practices (105 patients from ten practices, p = 0.02). Control practices had more doctors (p = 0.02), more non-white patients (p = 0.007), fewer patients living alone (p = 0.005) and lower levels of disability (p = 0.008). We detected a lack of benefit of PEP for people with OA of the knee. This was thought to be due in part to the short intervention time employed and the heterogeneous nature of the disease and the population studied.

Isolated Acromioclavicular Joint Pathology in the Symptomatic Shoulder on Magnetic Resonance Imaging

The acromioclavicular (AC) joint is a synovial joint that is predisposed to painful syndromes because of mechanical stress or developmental variation. It is often overlooked in the evaluation of patients with shoulder pain, however. Isolated AC joint pathology was studied on magnetic resonance imaging scans of patients with symptoms suggesting rotator cuff pathology. The conditions identified included osteoarthritis, distal clavicle osteolysis, and os acromiale syndrome.

Magnetic resonance relaxivity of dendrimer-linked nitroxides

The relaxivity and bioreduction rates of eight dendrimer-linked nitroxides varying in the number of nitroxides per molecule were measured and the potential use of these compounds as MR contrast agents was demonstrated. The T(1) and T(2) relaxivities, measured at room temperature and 1.5 T, varied linearly with the number of nitroxides per molecule for compounds with up to 16 nitroxides per molecule. Fourth-generation polypropylenimide- (DAB) and third-generation polyamidoamine- (PAMAM) dendrimer-linked nitroxides were found to have greater relaxivity than gadolinium diethylenetriaminepentaacetic acid (Gd-DTPA). The greater number of nitroxides per dendrimer increased relaxivity over that of a single nitroxide, allowing a decreased dose to achieve differential contrast with MR evaluations. Rates of nitroxide bioreduction were below detection threshold using EPR spectroscopy for generation 2 dendrimers and higher. A pilot assessment of in vivo cartilage uptake that compared intraarticular injection of three structurally different dendrimer-linked nitroxides with Gd-DTPA and with saline demonstrated high affinity of the DAB-dendrimer-linked nitroxides for normal rabbit articular cartilage. From these results, it is evident that target-specific dendrimer-linked nitroxides can be designed.

Effect of age and gender on the safety, tolerability, and pharmacokinetics of BAY 12-9566 in healthy subjects

The impact of age and gender on the single-dose pharmacokinetics, safety, and tolerability of BAY 12-9566 was evaluated in healthy subjects. Volunteers were grouped according to age and gender (13 young males, 11 elderly males, and 12 elderly females) and then randomized in a 2:1 ratio to receive a single oral 50 mg dose of BAY 12-9566 or placebo. Serial plasma samples were collected up to 336 hours postdose and assayed for BAY 12-9566. Peak plasma concentration, time to reach peak plasma concentration, the area under the concentration-time curve, oral clearance, volume of distribution, and elimination half-life were calculated. BAY 12-9566 was well tolerated in all treatment groups, and no serious adverse events occurred during the study. Substantial age- or gender-related differences were not observed for any of the pharmacokinetic parameters tested. Based on these pharmacokinetic and tolerability profiles, age- or gender-related dose adjustments were not required for BAY 12-9566.

An update on the science and therapy of obesity and its relationship to osteoarthritis

Obesity and osteoarthritis are two commonly encountered clinical problems that can lead to significant physical and emotional disability. This report examines the association between obesity and osteoarthritis, and discusses potential mechanisms by which obesity influences osteoarthritis. Special attention is devoted to reviewing the molecular and genetic mechanisms that underlie the development of clinical obesity. Improved understanding of obesity will hopefully lead to improved treatment and subsequent amelioration of this important risk factor for osteoarthritis.

Clinical, radiologic, demographic, and occupational aspects of hand osteoarthritis in the elderly

OBJECTIVE

Osteoarthritis (OA) of the hand is common in elderly patients. The aim of this study was to characterize OA frequency, severity, and distribution and to trace interrelationships between these findings and the demographic, occupational, and medical data from elderly Jewish nonrheumatologic patients.

METHODS

Study participants were 253 consecutive patients admitted to a geriatric center for a variety of nonrheumatic medical conditions. Excluded patients were those with rheumatoid arthritis; neurologic, orthopedic, or other conditions that would interfere with symmetric hand function; and mental or medical states that would interfere with history taking and radiographic studies. Patient occupations were graded as workload degree (on a scale of 1 to 3) and as the total occupational score (workload degree multiplied by the duration of each job). Clinical findings of Heberden nodes, Bouchard nodes, and malignment, graded on a scale of 0 to 3, were summed as the clinical OA score. Hand radiographs were independently read (modified Altman method), grading 5 parameters in each joint on a scale of 0 to 3, summed as a radiologic OA score. Statistical analyses included the Student t test, chi(2) test, ANOVA, Pearson correlation, and partial correlation coefficients.

RESULTS

Among 253 elderly patients (171 women, 82 men; mean age, 79 years) OA was frequent (occurring in about 80% of patients), involving most severely the second and third distal interphalangeal, right first interphalangeal, and both first carpometacarpal joints. The prevalence of OA was similar in women and men, with higher scores in women, and reached significance only in the distal interphalangeal joints. Metacarpophalangeal joints were more involved in men. Age had a clear influence on OA scores. Ethnicity affected OA severity, with Ashkenazi Jews having significantly higher scores than Sepharadi Jews. Dominant hands had significantly higher global OA scores as well as isolated joint scores (except for the first carpometacarpal joint). Occupational load, housekeeping tasks, and the number of children did not influence the total or specific joint OA scores. Associated conditions such as obesity, diabetes, hypothyroidism, and chondro calcinosis were not associated with more pronounced OA.

CONCLUSIONS

Hand OA was prevalent in our elderly cohort, and its severity was influenced by inherent traits such as age, female gender, ethnicity, and handedness. In contrast, acquired factors such as workload, number of children, and associated diseases did not appear to influence OA expression.

Pharmacokinetics, safety, and tolerability of BAY 12-9566 and nonsteroidal anti-inflammatory agents (naproxen, ibuprofen) during coadministration in patients with osteoarthritis

The pharmacokinetic interactions between BAY 12-9566 and two nonsteroidal anti-inflammatory drugs (NSAIDs), naproxen and ibuprofen, were investigated in osteoarthritis (OA) patients. The study comprised six groups: two NSAID groups with three levels of treatment (BAY 12-9566 400 mg, BAY 12-9566 100 mg, and placebo). Plasma pharmacokinetic parameters (AUC(0-tau), Cmax, and tmax) were determined for each treatment group following 5 days of NSAID administration, 14 days of BAY 12-9566 administration, and 14 days of concurrent NSAID and BAY 12-9566 administration. For most conditions, the total plasma drug concentrations of both NSAID and BAY 12-9566 were diminished by coadministration; total plasma BAY 12-9566 was not affected by ibuprofen treatment. Importantly, the free drug concentrations were largely unaffected by coadministration. Most side effects were mild or moderate in intensity, and all events, with the exception of headache, were reported in both NSAID groups and in both placebo and BAY 12-9566 groups.

Glenohumeral osteoarthrosis after Putti-Platt repair

The Putti-Platt capsulorraphy for recurrent anterior dislocation of the glenohumeral joint was performed in 139 shoulders between 1955 and 1985. Sixty-six (46%) operated shoulders were studied with a mean follow-up period of 22 years (range 10 to 40 years). There were 52 shoulders of men and 14 shoulders of women; 45% of the shoulders were on the dominant side. Two patients underwent surgery on both shoulders. The average age of the patients was 49.3 years (range 33 to 74 years). Evaluation was based on patient history and the results of physical examination and radiography. The redislocation rate was low (only 3%), and 71% of the patients did not have pain, strength loss, stiffness, or instability in the operated shoulder. Radiographs were made of all shoulders, including the nonoperated shoulders. Osteoarthrotic changes of the glenohumeral joint were found in 40 (61%) shoulders. Arthrosis was mild in 23 (35%) shoulders, moderate in 13 (20%) shoulders, and severe in 4 (6%) shoulders. The rate of glenohumeral arthrosis is increased in patients who have undergone a Putti-Platt procedure and is positively correlated with the length of time since surgery. No correlation was found in this study between external rotation at 6 months after operation and the development of glenohumeral arthrosis. The number of dislocations before operation was correlated with the severity of arthrosis but not with its incidence.

The impact of hemiparalysis on the expression of osteoarthritis

OBJECTIVE

Primary generalized osteoarthritis (OA), the most prevalent joint disease, is usually symmetric. Sporadic case reports mention decreased OA manifestations in limbs in which there are neurologic deficits, but no systematic research has been published. The aim of the present study was to examine these observations in a planned and controlled survey in a group of patients with OA.

METHODS

Seventy-five geriatric patients with a history of stroke and hemiparalysis were studied clinically and radiographically (hand radiographs; graded according to a modified Altman method) for the presence and the degree of OA in the hands. Detailed clinical and radiologic scores were calculated for each hand. Demographic, occupational, and neurologic data were collected. Patients with other joint or neurologic conditions were excluded. A group of 55 elderly patients without stroke were similarly studied (controls). Scores in the paralyzed hand were compared with those in the nonparalyzed hand in the stroke patients and subgroups (by Student's paired t-test and Wilcoxon test). Scores in the dominant hands were compared with those in the nondominant hands in stroke patients and control subjects (by Student's paired t-test and Mann-Whitney test). Correlation between the degree of neurologic damage and OA asymmetry (Pearson's correlation coefficient) was also sought.

RESULTS

Paralyzed hands showed significantly fewer OA changes than nonparalyzed hands, both clinically and radiologically. This trend, accentuated in patients with more severe paralysis, disappeared in those with mild residual paresis. Asymmetry of OA was more pronounced in patients with flaccid, compared with spastic, paralysis. The degree of paralysis and loss of muscle strength correlated with the degree of OA asymmetry. Women had significantly higher OA scores than men. In the control group, dominant hands had higher OA scores, but this finding was concealed among hemiparalyzed patients. Lifetime gross occupational load and present grip strength did not correlate with the degree of OA.

CONCLUSION

In elderly patients, hemiparalysis reduces ipsilateral hand expression of OA, while OA is accentuated (or increased) in the dominant hand of patients without paralysis. This first systematic study confirms the findings of previous case reports and lends support to the role of biomechanical factors in the development of OA.

Factors affecting radiographic progression of knee osteoarthritis

OBJECTIVES

To evaluate the prognostic significance of patient characteristics and radiographic features at the knee for outcome of knee osteoarthritis.

METHODS

This was a prospective observational study of 350 osteoarthritic knees. Clinical and radiographic data were obtained on 188 hospital referred patients (mean age 70, range 34-91 years).

RESULTS

Median duration of follow up was two years (range 1-5 years). The majority of patients (48%) reported deterioration, but 23% experienced improvement in symptoms during the study period. Reported exercise tolerance remained unchanged in the majority (62%) and deteriorated in 35%. Change in at least one individual radiographic feature of osteoarthritis was seen in 252 (72%) knees: increase in joint space narrowing occurred in 52%, osteophyte in 32%, cysts in 19%, sclerosis in 14%, and attrition in 30%. Increase in Kellgren grade occurred in 137 (39%) knees. Knee effusion, osteoarthritis at multiple joint sites, and nodal change associated with change in Kellgren grade (odds ratios 1.03, 2.39, and 1.80; 95% confidence intervals (CI) 1.01 to 1.05, 1.16 to 4.93, and 1.02 to 3.17, respectively); warmth at the knee associated with change in any radiographic feature (odds ratio 2.22; 95% CI 1.19 to 4.14). Development of, or increase in, attrition and joint space narrowing associated with worsening symptoms and function and occurred with increased frequency in knees with effusions, clinical warmth and calcium pyrophosphate crystals in synovial fluid (p < 0.05).

CONCLUSIONS

A high rate of change, radiographic more than clinical, was seen in osteoarthritic knees during this study. Poor clinical and radiographic outcome associated with calcium pyrophosphate crystal deposition and clinical inflammation as reflected by knee effusion and warmth.

Association of overweight, trauma and workload with coxarthrosis. A health survey of 7,217 persons

In a population sample health survey, body mass, previous trauma and physical stress were studied for associations with coxarthrosis. A sample of 8,000 persons representative of the Finnish population aged 30 or over was invited for examination, and 90 percent participated. On the basis of a standardized clinical examination, a physician diagnosed coxarthrosis in 6 percent of the women and 4 percent of the men. The prevalence rose with age. In persons with a past traumatic lower-limb injury, the odds ratio of unilateral coxarthrosis was 2.1 and of bilateral coxarthrosis 1.5, as adjusted for sex, age and other determinants using logistic regression. The sum index reflecting self-reported features of physical stress in present or previous occupations was directly proportional to the prevalence of coxarthrosis. Body mass index (kg/m2) was closely associated with bilateral coxarthrosis; the adjusted odds ratio (95 percent confidence intervals) for indices > 35, compared to those < 25, was 2.8 (1.4-5.7). In terms of the population attributable fraction, prior trauma, physical stress and body mass were estimated to explain 59 percent of the prevalence of coxarthrosis. The potential for primary prevention may be great, but longitudinal population studies are necessary to elucidate causal significance of the risk factors.

Radiographic patterns and associations of osteoarthritis of the knee in patients referred to hospital

OBJECTIVES

To investigate differing patterns and associations of osteoarthritis of the knee in patients referred to hospital.

METHODS

Two hundred and fifty two consecutive patients (161 women, 91 men; mean age 70 years, range 34-91 years) referred to hospital with osteoarthritis of the knee underwent clinical, radiographic, and synovial fluid screening.

RESULTS

Radiographic changes of osteoarthritis of the knee (definite narrowing with or without osteoarthritic features) were bilateral in 85% of patients. Of 470 knees affected, 277 (59%) were affected in two compartments and 28 (6%) in three compartments. Unilateral and isolated medial tibiofemoral osteoarthritis were more common in men. Calcium pyrophosphate crystal deposition was common (synovial fluid identification in 132 (28%) knees; knee chondrocalcinosis in 76 (30%) patients) and associated with disability, bilateral, multicompartmental and severe radiographic osteoarthritis, marked osteophytosis, attrition, and cysts. Multiple clinical nodes (58 (23%) patients) and radiographic polyarticular interphalangeal osteoarthritis (66 (26%) patients) were associated with a higher frequency of inactivity pain, disability, multicompartmental and severe radiographic change. Forestier's disease predominated in men but showed no other associations.

CONCLUSIONS

In a group of patients referred to hospital osteoarthritis of the knee is usually bilateral and affects more than one compartment. Severe and multicompartmental radiographic changes are associated with calcium pyrophosphate crystal deposition, nodal change, and polyarticular interphalangeal osteoarthritis.

Association of radiographic changes of osteoarthritis, symptoms, and synovial fluid particles in 300 knees

Associations between compartmental distribution of radiographic changes of osteoarthritis (OA), individual features of OA (joint space loss, sclerosis, cyst, osteophyte; each scored 0-3), and presence of synovial fluid calcium particles (calcium pyrophosphate dihydrate (CPPD) crystals identified by polarised light microscopy and other calcium particles by alizarin red positivity (ARP) were sought in 300 osteoarthritic knees (178 patients; mean age 72, range 33-96 years). Patients whose knees were symptom free as well as those with symptoms were included. Osteoarthritis of two or three compartments but not unicompartmental OA was associated with the presence of CPPD or ARP. Involvement of any compartment (not just patellofemoral), and higher mean scores for both total and individual osteoarthritis changes (except cysts) was associated with CPPD and ARP; CPPD, but not ARP, was associated with symptoms: knees reported as having symptoms had higher mean total OA scores. Femoral cortical erosion, found more often in women, was associated with higher mean total OA score at the patellofemoral compartment but not with the presence of particles. Attrition, remodelling, and chondrocalcinosis (each scored as present or absent) occurred more often in knees with CPPD. Age did not correlate with any aspect of the OA score. This study confirms the association of calcium particles with the process of OA. Unlike previous studies confined to symptomatic knees, a radiographic pattern specific to CPPD ('pyrophosphate arthropathy') did not emerge.

Quantitative imaging of osteoarthritis

Plain-film radiography currently remains the mainstay of imaging for diagnosis and follow-up in osteoarthritis (OA). However, recent studies have questioned some aspects of its use, particularly the correlation between radiographically evident joint-space narrowing and articular cartilage loss. The results with imaging modalities such as magnetic resonance imaging and ultrasound suggest that these methods will allow accurate noninvasive definition of the structure of articular cartilage and other soft tissues of joints. Other modalities, including microfocal radiography and high-resolution computed tomography, can produce detailed images of trabecular structure and bony alterations in osteoarthritis. Improvements in image analysis and data manipulation, including three-dimensional reconstruction and digitized storage and measurement of images, will likely enable improved quantitative assessment of the abnormalities demonstrated by these techniques. One can hope that such developments will facilitate not only improved detection and definition of OA, but also better evaluation of the effectiveness of pharmacological and physical therapy in practice and in clinical trials.

Risk factors for disability among U.S. adults with arthritis

This article studies risk factors for physical and social disability among U.S. adults ages 55+ who have arthritis, compared to non-arthritis persons of those ages. The dependent variables refer to difficulties in walking, physical functioning (motions and strength), personal care, and household care. The data set is the Supplement on Aging (SOA) (n = 16,148) that accompanied the 1984 National Health Interview Survey. The SOA data are cross-sectional; relationships of risk factors to disability suggest causation but do not directly demonstrate it. Logistic regressions show that risk factors are similar for arthritis and non-arthritis people, with one important exception. (1) The similarities are: For both groups, odds of disability rise with age, diminish with education, and are higher for non-whites and non-married persons. Disability rises with number of chronic diseases and impairments, and it is elevated for underweight persons (Body Mass Index (BMI) less than 20; further analysis indicates this reflects incomplete control of their severe illness status). Long duration of arthritis and recent medical care for it are associated with disability. (2) The exception is: Severe overweight (BMI greater than or equal to 30) is a disability risk factor for arthritis people, but not for non-arthritis people. Previous research has shown that obesity/overweight is a risk factor for etiology of osteoarthritis; our analysis now shows its continued importance for disability when the disease is present.

Long distance running and osteoarthrosis

In order to evaluate the effect of long-term, long distance running on the incidence of degenerative joint disease in the lower extremities, we examined the hips, knees, and ankles of 30 long distance runners who had been serious competitive runners in the early 1950s (at the age of 20 to 30 years). Of three runners who were no longer active, one had stopped running in the late 1970s because of osteoarthrosis of both the lower and upper extremity joints. The remaining 27 runners (90%) were still active, having run 20 to 40 km/week (12 to 24 miles/week) for a median of 40 years. Subjective, objective, and roentgenographic data were compared with the data for 27 nonrunning controls matched as to age, weight, height, and occupation. No differences in joint alignment, range of motion, or complaints of pain were found between runners and nonrunners. Roentgenographic examinations for cartilage thickness, grade of degeneration, and osteophytosis were also without significant differences between the two groups. Thus, our observations suggest that a lifetime of long distance running at mileage levels comparable to those of recreational runners today is not associated with premature osteoarthrosis in the joints of the lower extremities.

Impulsive forces during walking and their clinical implications

During normal walking, repetitive impulsive forces are introduced into the musculo-skeletal system. At heelstrike, there is a sharp irregularity in the ground reaction force, known as the heelstrike transient. As a result of experimental evidence indicating possible correlations between impulse loading and joint degeneration, research interest in heelstrike transients has intensified. This paper outlines the nature of the heelstrike transient and the use of accelerometers and force platforms for skeletal transient investigation. Attention is given to two experiments that analysed the response of the human body to the impact forces experienced during walking. The possible causative links between excessive impulsive loading and the progression of two pathological conditions-osteoarthritis and low back pain, respectively-are discussed in detail.

HLA-A, B antigens and alpha 1-antitrypsin phenotypes in nodal generalised osteoarthritis and erosive osteoarthritis

HLA-A, B and alpha 1-antitrypsin phenotypes were studied in 90 unrelated patients with established nodal generalised osteoarthritis (OA). Compared with standard reference populations, independently increased frequency of the HLA-A1B8 and MZ alpha 1-antitrypsin phenotypes were observed (27% v 11.5%, relative risk 2.79, and 12% v 3.6%, relative risk 3.73 respectively). These associations related to developed of nodal generalised OA rather than to severity as judged by the summated radiographic scores for hand OA. Ten patients had marked subchondral radiographic erosions and were further classified as erosive OA; these patients had an increased frequency of the MS alpha 1-antitrypsin phenotype (30% v 9%) and higher radiographic OA scores corrected for presence of erosions. This first report of two independent genetic markers in nodal generalised OA is of interest in relation to the increasingly recognised inflammatory component of the osteoarthritis process.

Occupation and osteoarthritis

From the aspect of industry, OA is one of the most important diseases as it frequently affects the active age group of the population and is the source of considerable loss of working hours and of disability. In addition, it has a detrimental effect on the quality of life. Epidemiological investigations fail to provide sufficient proof as to whether mechanical overloading of occupational origin, or due to sports, will lead to a higher incidence of OA. Mechanical and occupational stress is more likely to play a role in the articular localization of the disease. It is difficult to prove the occupational origin of OA and, in consequence, there is a considerable difference in the adoption of preventative measures in various countries. The clarification of the relationship between occupation and OA requires further, carefully planned, prospective epidemiological studies, including the investigation of both radiological and clinical symptoms and signs. Compressive, torsional, pulling and angular movements common in certain occupations or sports may result in injuries of soft tissue, thus increasing the development of OA. Consequently, the main task is prevention at the place of work or in sporting activities.

Outcome of an osteoarthritis education program for low-literacy patients taught by indigenous instructors

A 10-h osteoarthritis education course was developed and evaluated for older low-income patients with osteoarthritis. Indigenous community leaders were trained to teach the course within inner-city neighborhoods of Hartford, Connecticut. Significant differences were obtained using a quasi-experimental group, pre/post-test design. There was a significant increase in knowledge (P less than 0.001) both on a verbal knowledge test and a picture story test (P less than 0.001). There was a significant increase in scores on an exercise scale (P less than 0.001). Attitude toward one's illness improved. There was a slight improvement in function which was not significant. Use of adaptive equipment increased as a direct result of the program. The course was well accepted and enjoyed by the participants.

Early histopathologic and ultrastructural alterations in femorotibial joints of partial medial meniscectomized guinea pigs

The articular cartilage from femorotibial joints of partial medial meniscectomized male guinea pigs was evaluated at 24, 48, 72, and 96 hours post-surgery to determine the sequential histopathologic and ultrastructural alterations. At 24 hours post-surgery, histopathologic alterations were in the superficial and middle layers and consisted of degeneration and necrosis of chondrocytes and minimal decreased intensity of toluidine blue matrix staining. Changes in chondrocytes and matrix became progressively more extensive 48 hours after surgery. Ultrastructurally, the changes in the superficial matrix appeared to be the result of loss of the fine granular material interspersed between collagen fibers. At 72 and 96 hours post-surgery, chondrocyte loss was extensive and surface fibrillation was seen. These findings suggested that chondrocyte death was the initial important event which led to progressive severe cartilage degeneration in this model.

Generalised osteoarthritis: an evolutionary problem?

Polyarticular osteoarthritis (OA) has a distinctive pattern of joint involvement. Some joints, such as the first metatarsophalangeal joint, are commonly affected, whereas others, such as the shoulder, are rarely involved. This distinct pattern of involvement may represent a subset of OA--generalised OA. Analysis of the pattern of change in joint function in the recent evolutionary development of man suggests a hypothesis that explains the pattern of joint involvement in generalised OA. Joints most commonly affected have undergone recent rapid evolutionary change to a new function that has resulted in increased loading. These joints are therefore relatively underdesigned, have little functional reserve, and are likely to fail often and early. Joints that are rarely affected have changed to a function with reduced loading. They are relatively overdesigned and have a large functional reserve, so fail rarely and late.

The prevalence of osteoarthrosis of the sacroiliac joints in an urban population

Little attention has been paid to the sacroiliac joints especially with respect to the occurrence of degenerative changes. Two hundred thirty nine of the 1200 persons with rheumatic complaints were examined. In 186 of them osteoarthritis of the sacroiliac joints was found (78%). Among test subjects 51.6% suffered from the low back pain.