Osteoarthritis

The Role of Exerkines in the Treatment of Knee Osteoarthritis: From Mechanisms to Exercise Strategies

With the increasing prevalence of knee osteoarthritis (KOA), the limitations of traditional treatments, such as their limited efficacy in halting disease progression and their potential side effects, are becoming more evident. This situation has prompted scientists to seek more effective strategies. In recent years, exercise therapy has gained prominence in KOA treatment due to its safety, efficacy, and cost-effectiveness, which are underpinned by the molecular actions of exerkines. Unlike conventional therapies, exerkines offer specific advantages by targeting inflammatory responses, enhancing chondrocyte proliferation, and slowing cartilage degradation at the molecular level. This review explores the potential mechanisms involved in and application prospects of exerkines in KOA treatment and provides a comprehensive analysis of their role. Studies show that appropriate exercise not only promotes overall health, but also positively impacts KOA by stimulating exerkine production. The effectiveness of exerkines, however, is influenced by exercise modality, intensity, and duration of exercise, making the development of personalized exercise plans crucial for KOA patients. Based on these insights, this paper proposes targeted exercise strategies designed to maximize exerkine benefits, aiming to provide novel perspectives for KOA prevention and treatment.

The difference in bone mineral density between femur and tibia is related to tibia deformation in endstage knee osteoarthritis

BACKGROUND

This study investigated bone mineral density (BMD) around the knee joint to clarify the mechanism by which tibia deformation exceeds that of the femur in patients with end-stage knee osteoarthritis (KOA).

METHODS

We retrospectively analyzed 193 patients who underwent total knee arthroplasty for end-stage KOA with varus alignment. Preoperative T-score of the femur neck and femur total using dual-energy X-ray absorptiometry (DXA) and hounsfield units (HU) of the distal femur and proximal tibia using computed tomography (CT) were measured to asess the BMD. HU was measured by dividing the femur and tibia into medial, lateral, and total parts, respectively. Patients with medial proximal tibial angle (MPTA) ≥ 85° were considered 'group 1', and MPTA < 85° were 'group 2'. The HU between femur and tibia were compared in group 1. T-score, HU, and HU difference between group 1 and group 2 were compared.

RESULTS

The HU of the proximal tibia was lower than that of the distal femur (femur lateral > femur medial > tibia medial > tibia lateral). T-score (femur neck, femur total) and HU (femur lateral, femur total, tibia lateral) were lower in group 2 than in group 1. There was no difference in femur-tibia HU difference between groups.

CONCLUSION

The medial tibia collapse more than the medial femur in varus endstage KOA was associated with the lower BMD of the proximal tibia than that of the distal femur, and the MPTA collapse was affected by the absolute value of BMD rather than by the femur-tibia BMD difference.

Effects of transcranial direct current stimulation on pain and physical function in patients with knee osteoarthritis: a systematic review and meta-analysis

BACKGROUND

Keen Osteoarthritis (KOA) is a common chronic disabling disease characterized by joint pain and dysfunction, which seriously affects patients' quality of life. Recent studies have shown that transcranial direct current stimulation (tDCS) was a promising treatment for KOA.

PURPOSE

Investigate the effects of tDCS on pain and physical function in patients with KOA.

METHODS

Randomized controlled trials related to tDCS and KOA were systematically searched in the PubMed, Embase, Medline, Cochrane Library, CINHL, and Web of Science databases from inception to July 23, 2024. The pain intensity was evaluated using the visual analog scale or the numeric rating scale, and the pain sensitivity was assessed using conditioned pain modulation, pressure pain threshold, heat pain threshold, or heat pain tolerance. The physical function outcome was evaluated using the Western Ontario and McMaster Universities Osteoarthritis Index or the Knee injury and Osteoarthritis Outcome Score. Statistical analysis was performed using Review Manager 5.4.

RESULTS

Seven studies with a total of 503 participants were included. Compared to sham tDCS, tDCS was effective in reducing the short-term pain intensity (SMD: -0.58; 95% CI: -1.02, -0.14; p = 0.01) and pain sensitivity (SMD: -0.43; 95% CI: -0.70, -0.16; p = 0.002) but failed to significantly improve the long-term pain intensity (SMD: -0.26; 95% CI: -0.59, 0.08; p = 0.13) in KOA patients. In addition, tDCS did not significantly improve the short-term (SMD: -0.13; 95% CI: -0.35, 0.08; p = 0.22) and long-term (SMD: 0.02; 95% CI: -0.22, 0.25; p = 0.90) physical function in patients with KOA.

CONCLUSIONS

The tDCS can reduce short-term pain intensity and sensitivity but fails to significantly relieve long-term pain intensity and improve the physical function in patients with KOA. Thus, tDCS may be a potential therapeutic tool to reduce short-term pain intensity and pain sensitivity in patients with KOA.

Functional Electrical Stimulation of the Lateral Knee Muscles Can Reduce Peak Knee Adduction Moment during Stepping: A Pilot Study

Knee osteoarthritis (KOA) is an age-dependent disease dominantly affected by mechanical loading. Balancing the forces acting on the medial knee compartment has been the focus of KOA interventions. This pilot study investigated the effects of functional electrical stimulation (FES) of the biceps femoris and lateral gastrocnemius on reducing peak knee adduction moment (pKAM) in healthy adults and individuals with medial KOA while stepping on an instrumented elliptical system. Sixteen healthy individuals and five individuals with medial KOA stepped on the robotic stepping system, which measured footplate-reaction forces/torques and ankle kinematics and calculated 3-D knee moments in real time using inverse dynamics. Participants performed four different tasks: regular stepping without FES as the baseline condition, stepping with continuous FES of the lateral gastrocnemius (FESLG), biceps femoris (FESBF), and simultaneous FES of both lateral gastrocnemius and biceps femoris (FESLGBF), throughout the elliptical cycle. The 3-D knee moments, tibia kinematics, and footplate-reaction forces were compared between the baseline and the three FES stepping conditions. Healthy participants demonstrated lower pKAM during each of the three FES conditions compared to baseline (FESLG (p = 0.041), FESBF (p = 0.049), FESLGBF (p = 0.048)). Participants with KOA showed a trend of lower pKAM during FES, which was not statistically significant given the small sample available. Incorporating elliptical + FES as a training strategy is feasible and may help to enhance selective force generation of the targeted muscles and reduce the medial knee compartment loading.

Cathelicidin-BF regulates the AMPK/SIRT1/NF-κB pathway to ameliorate murine osteoarthritis: In vitro and in vivo studie

Osteoarthritis (OA) is a chronic degenerative disease with a significant prevalence that causes cartilage damage and can lead to disability. The main factors contributing to the onset and progression of OA include inflammation and degeneration of the extracellular matrix. Cathelicidin-BF (BF-30), a natural peptide derived from Bungarus fasciatus venom, has shown multiple important pharmacological effects. However, the action mechanism of BF-30 in OA treatment remains to be elucidated. In this research, X-ray and Safranin O staining were employed to evaluate the imageology and histomorphology differences in the knee joints of mice in vivo. Techniques such as Western blot analysis, RT-qPCR, ELISA, and immunofluorescence staining were applied to examine gene and protein level changes in in vitro experiments. It was found that BF-30 significantly decreased inflammation and enhanced extracellular matrix metabolism. For the first time, it was demonstrated that the positive effects of BF-30 are mediated through the activation of the AMPK/SIRT1/NF-κB pathway. Moreover, when BF-30 was co-administered with Compound C, an AMPK inhibitor, the therapeutic benefits of BF-30 were reversed in both in vivo and in vitro settings. In conclusion, the findings suggest that BF-30 could be a novel therapeutic agent for OA improvement.

A mechanistic review on growing multiple therapeutic applications of lutein and its global market research

Lutein is a naturally occurring carotenoid synthesized by plants and algae that has a beneficial effect on several biological processes and associated ailments. Its immediate application is in ophthalmology, where it significantly lowers the incidences of age-related macular degeneration (AMD). It also has anti-inflammatory action, treatment of diabetic retinopathy, and cataracts, and enhancement of visual contrast. To critically assess lutein biosynthesis, therapeutic applicability, and market research literature. We have discussed its theoretical frameworks, experimental evidence, limitations, as well as clinical trial results, and future research prospects. The literature for this review article was mined and compiled by collecting and analyzing articles from several databases, including ScienceDirect, Google Scholar, PubMed, Wiley Online Library, Patentscope, and ClinicalTrials.gov published until March 30, 2022. Patent publications were identified using the search terms like IC:(C07C67/56) AND EN_AB:(lutein) OR EN_TI:(lutein) OR EN_AB:(extraction) OR EN_TI:(process). According to the literature, lutein is an essential nutrient given that it cannot be synthesized in the human body and acts as an antioxidant, affecting AMD, diabetic retinopathy, Rheumatic diseases, inflammation, and cancer. Due to inadequate production and laborious extraction, lutein is expensive despite its high demand and applicability. Market research predicts a 6.3% compound annual growth rate for lutein by 2032. Optimizing lutein extraction for high yield and purity is necessary. Lutein has proven applicability in various ailments as well as cosmetics that can be developed as a candidate drug for various diseases discussed in the review.

Effects of Pomegranate (Punica granatum L.) Peel Extract Supplementation on Markers of Inflammation and Serum Matrix Metalloproteinase 1 in Women With Knee Osteoarthritis: A Randomized Double-Blind Placebo-Controlled Study

Objective

Osteoarthritis (OA) as a common musculoskeletal disorder is the main cause of disability in the world. The present study aimed to evaluate the effects of pomegranate peel extract (PPE) on some inflammatory markers and matrix maloproteinase1 (MMP1) in women with knee OA.

Methods

Sixty obese women with knee OA aged 38 to 60 years were included in this clinical trial. The women were allocated into intervention (n = 30) and placebo (n = 30) groups along with standard drug therapy receiving 500 mg PPE or placebo twice daily for 8 weeks, respectively. Three-day food records, anthropometric measurements, fasting blood samples, and physical activity questionnaires were gathered at the baseline and the end of the study.

Results

The supplementation of PPE significantly reduced the serum high-sensitivity C-reactive protein (hs-CRP), nuclear factor kappa-light-chain-enhancer of activated B cells (NF-ĸB), MMP1, and monocyte chemoattractant protein-1 (MCP-1) levels of the patients within the intervened group (all, P < .05) and compared with the placebo (P = .002, .045, .040, and .003, respectively) at the end of the study. The serum NF-ĸB levels significantly increased within the placebo group at the end of the trial (P = .002). Changes in other variables in the placebo group were not significant (P > .05).

Conclusions

The findings of this clinical trial indicated that PPE supplementation decreased serum inflammatory markers including hs-CRP, NF-ĸB, and MCP-1 and MMP1 levels in women with knee OA. PPE supplementation may be useful as a part of an integrated approach to modulating inflammatory complications in women with knee OA.

Impact of Prevention Strategies on Quality of Life in Patients with Osteoarthritis: A Meta-Analysis of Randomized Controlled Trials

OBJECTIVE

To evaluate the impact of prevention strategies on the quality of life in patients with osteoarthritis (OA) through a comprehensive analysis of randomized controlled trials (RCTs).

METHODS

A systematic search was conducted in multiple electronic databases, including Cochrane Library, PubMed, Embase, and ClinicalTrials.gov, up to June 10th, 2023. Eligible studies were RCTs assessing the effectiveness of prevention strategies in adult patients diagnosed with OA, with validated instruments used to measure quality of life outcomes. A total of 10 RCTs met the inclusion criteria and were included in the meta-analysis. The analyzed prevention strategies encompassed enhanced exercise, education, or a combination of both. The quality of evidence was evaluated using the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

The pooled results revealed a significant improvement in the quality of life of OA patients who underwent enhanced exercise or education compared to control groups (standardized mean difference = 0.44, 95% confidence interval 0.08-0.8). However, the overall quality of evidence was graded as low according to the Grading of Recommendations Assessment, Development and Evaluation assessment.

CONCLUSIONS

This meta-analysis provides evidence that prevention strategies, particularly enhanced exercise or education, have a positive impact on the quality of life in patients with OA. Despite the observed benefits, the overall quality of evidence is limited, highlighting the need for larger, well-designed trials to strengthen the evidence base. These findings underscore the importance of implementing effective prevention strategies in the management of OA to improve patient outcomes and enhance their quality of life. Further research is warranted to optimize the selection and implementation of prevention strategies for OA patients.

Effects of Analgesics on Self-Reported Physical Function and Walking Ability in People With Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis

OBJECTIVE

Hip and knee osteoarthritis are among the leading causes of global disability, and one of the main aims of the management is to improve physical function. The objective of this review was to investigate the effect of analgesics on physical function (self-reported physical function and walking ability).

METHODS

A systematic review and meta-analysis of the findings were performed. Randomized controlled trials investigating the effect of analgesics on self-reported physical function and walking ability were included. Analgesics were orally administered acetaminophen, nonsteroidal antiinflammatory drugs (NSAIDs), or opioids. Data were pooled in a random-effects model, and the standardized mean difference (SMD) with 95% CI was calculated (SMDs: 0.2-0.4 = small, 0.5-0.7 = medium, and ≥0.8 = large effect sizes). The quality of the evidence was evaluated according to the Grading of Recommendations Assessment, Development, and Evaluation approach.

RESULTS

A total of 1454 studies were identified, of which 33 were included. On self-reported physical function, the results showed low- to moderate-quality evidence for a small beneficial effect of acetaminophen (SMD = -0.13 [95% CI = -0.26 to 0.00]), NSAIDs (SMD = -0.32 [95% CI = -0.37 to -0.27]), or opioids (SMD = -0.20 [95% CI = -0.32 to -0.09]). There was moderate-quality evidence for a small effect of NSAIDs on pain during walking (SMD = -0.34 [95% CI = -0.45 to -0.23]).

CONCLUSION

In people with hip or knee osteoarthritis, there was low- to moderate-quality evidence for small beneficial effects of analgesics on physical function and walking ability.

IMPACT

Analgesics may improve physical function by reducing pain during exercise and walking.

Knee osteoarthritis: Current status and research progress in treatment (Review)

Knee osteoarthritis (KOA) is a common chronic articular disease worldwide. It is also the most common form of OA and is characterized by high morbidity and disability rates. With the gradual increase in life expectancy and ageing population, KOA not only affects the quality of life of patients, but also poses a burden on global public health. OA is a disease of unknown etiology and complex pathogenesis. It commonly affects joints subjected to greater loads and higher levels of activity. The knee joint, which is the most complex joint of the human body and bears the greatest load among all joints, is therefore most susceptible to development of OA. KOA lesions may involve articular cartilage, synovium, joint capsule and periarticular muscles, causing irreversible articular damage. Factors such as mechanical overload, inflammation, metabolism, hormonal changes and ageing serve key roles in the acceleration of KOA progression. The clinical diagnosis of KOA is primarily based on combined analysis of symptoms, signs, imaging and laboratory examination results. At present, there is no cure for KOA and the currently available therapies primarily focus on symptomatic treatment and delay of disease progression. Knee replacement surgery is typically performed in patients with advanced disease. The current study presents a review of epidemiological characteristics, risk factors, histopathological manifestations, pathogenesis, diagnosis, treatment modalities and progress in KOA research.

Burden of Hand Osteoarthritis in the Middle East and North Africa (MENA): An Epidemiological Analysis From 1990 to 2019

PURPOSE

Hand osteoarthritis (OA) is a common cause of disability in older people. Although often underemphasized, it may affect quality of life and imposes a considerable burden on the health system. This study evaluated the epidemiology of hand OA in the Middle East and North Africa (MENA) region.

METHODS

This epidemiological study was performed based on the Global Burden of Disease study from 1990 to 2019. The incidence, prevalence, and years lived with disability (YLD) in all 21 MENA countries during the study period were reported in rate, age-standardized, and percentage.

RESULTS

Hand osteoarthritis in MENA increased 2.7-fold, from 1.6 million cases to 4.3 million from 1990 to 2019 with an age-standardized incidence rate of 50.2 (95% CI, 38.2-66.4) per 100,000 people in 2019. Saudi Arabia had the highest age-standardized prevalence in both 1990 (2.3%) and 2019 (2.3%), whereas Turkey had the lowest (0.3%) in both years. Total YLDs due to hand osteoarthritis increased by more than 2.7-fold, from 50,335 to 135,336 during the study period. The highest rate of increase in YLD rate from 1990 to 2019 was in Iran (3.3) and the largest decrease was in Qatar (-11.5).

CONCLUSIONS

In contrast to the global trend, MENA hand OA prevalence and YLDs did not decrease between 1990 and 2019 and remained constant over time. Aging and increasing obesity rates, particularly among women, might be the contributing factors. Hand OA epidemiology varies by country, possibly due to genetic, ethnic, and environmental factors.

TYPE OF STUDY/LEVEL OF EVIDENCE

Prognostic II.

Ellagitannins and triterpenoids extracts of Anogeissus leiocarpus stem bark extracts: Protective effects against osteoarthritis

Osteoarthritis (OA) is a complex joint disease characterized by persistent pain. Unfortunately, current pharmacological therapies are unsatisfactory and characterized by side effects, reason why new strategies are needed. We tested the efficacy of different classes of compounds, ellagitannins and olean-type triterpenoids, contained in Anogeissus leiocarpus extract (Combretaceae family) in comparison to ellagitannins of Castanea sativa extract in a rat model of osteoarthritis induced by the intra-articular injection of sodium monoiodoacetate (MIA). The decoction of stem bark of A. leiocarpus AL-DEC-TOT (300 mg/kg; 4.8% triterpenoids; 11.0% tannins), the butanol extract AL-BuOH-EXT (120 mg/kg; triterpenoids 20.9%; tannins 6.4%) and its correlated aqueous residue AL-Res-H₂ O (300 mg/kg; triterpenoids 0.7%; tannins 8.7%) and the decoction of C. sativa, CS-DEC-TOT, (240 mg/kg; triterpenoids 0.65%; tannins 10.8%) were orally administered for two weeks starting from the day of the damage. Behavioural tests highlighted that all stem bark extracts of A. leiocarpus counteracted hypersensitivity development, reduced spontaneous pain, and improved motor skills. Histologically, AL-DEC-TOT, AL-BuOH-EXT and AL-Res-H₂ O were effective in preventing joint alterations. In conclusion, all the extracts were effective demonstrating that both olean-type triterpenoid and ellagitannin fractions have anti-hypersensitivity and restorative properties running the stem bark extracts of A. leiocarpus as a candidate in the treatment of OA.

High-intensity laser therapy on pain relief in symptomatic knee osteoarthritis: A systematic review and meta-analysis

BACKGROUND

Osteoarthritis is one of the leading causes of global disability and pain.

OBJECTIVE

To investigate whether High-Intensity Laser therapy has superior pain-relieving effects in individuals with symptomatic knee osteoarthritis.

METHODS

Searches were conducted using CENTRAL, MEDLINE, CINAHL, EMBASE, Web of Science, PEDro, and related reference lists with language limed to English. Clinical trials investigating the effectiveness of High-Intensity Laser therapy compared to other laser therapies, conventional therapies or exercises on knee osteoarthritis pain were included. The screening and selection of studies, data extraction, and methodological quality assessment were performed by two independent researchers. Studies were quantitatively integrated using the Review Manager Software and qualitative analysis using the criteria recommended by the Cochrane Collaboration.

RESULTS

Nine studies meeting the eligibility criteria were identified, among which only one study was identified as excellent methodology quality, six was marked as good quality, and the remaining two studies were regarded as fair or poor quality. All studies reported positive effects of High-Intensity Laser therapy on knee osteoarthritis pain. Two studies (136 people) gave indication that there was moderate evidence that High-Intensity Laser therapy could be a promising new possibility in pain relief among patients with knee osteoarthritis compared with sham laser therapy in a short-term treatment (MD, -2.04, 95% CI, -2.12 to -1.96; Z= 51.01, P< 0.01). Four studies (160 people) showed that High-Intensity Laser therapy could be an effective modality on treating pain compared to conventional physiotherapies in decreasing visual analog scale score (MD, -0.98, 95% CI, -1.19 to -0.76; Z= 9.02, P< 0.01). Three studies (123 people) demonstrated that High-Intensity Laser therapy combined with exercises was more effective than placebo laser or lower-intensity laser combined with exercises in alleviating pain in patients with knee osteoarthritis (MD, -1.54, 95% CI, -1.84 to -1.24; Z= 10.06, P< 0.01).

CONCLUSION

High-Intensity Laser therapy could be a promising and recommended modality in alleviating knee osteoarthritis pain, especially when it was implemented in combination with exercises.

Association between hip pain and radiographic hip osteoarthritis in primary care: the CHECK cohort

BACKGROUND

The diagnosis of hip osteoarthritis (OA) is often based on clinical symptoms, such as pain and stiffness, and radiographic features. However, the association between hip pain and hip radiographic OA (ROA) remains uncertain.

AIM

To examine the association between hip pain and hip ROA.

DESIGN AND SETTING

Cross-sectional analysis of a Dutch cohort, the Cohort Hip and Cohort Knee (CHECK) study.

METHOD

The participants (aged 45-65 years) had all experienced hip and/or knee pain for which they had not had a prior consultation or were within 6 months of their first consultation with a GP. Using weight-bearing anteroposterior pelvis radiographs, definite and early-stage hip ROA were defined as Kellgren and Lawrence grade ≥2 and ≥1, respectively. Presence of ROA and pain was assessed in the hips of all participants. The association between hip pain and ROA was assessed using generalised estimating equations.

RESULTS

The prevalence of definite ROA was 11.0% (n = 218/1982 hips), with prevalence in painful and pain-free hips of 13.3% (n = 105/789) and 9.5% (n = 113/1193), respectively. Prevalence of early-stage hip ROA was 35.3% (n = 700/1982), with prevalence in painful and pain-free hips of 41.2% (n = 325/789) and 31.4% (n = 375/1193), respectively. Compared with pain-free hips, the odds ratio painful hips was 1.51 (95% confidence interval [CI] = 1.16 to 1.98) for definite ROA and 1.47 (95% CI = 1.24 to 1.75) for early-stage ROA.

CONCLUSION

Hip pain was associated with definite and early-stage hip ROA, yet the overall ROA prevalence was modest and the prevalence among pain-free hips was substantial. Therefore, radiographs provided little assistance with help to identify patients with hip OA among patients who recently presented with hip or knee complaints.

The Surgical Treatment of Osteoarthritis

Osteoarthritis is a degenerative condition affecting the whole joint with the underlying bone, representing a major source of pain, disability, and socioeconomic cost worldwide. Age is considered the strongest risk factor, albeit abnormal biomechanics, morphology, congenital abnormality, deformity, malalignment, limb-length discrepancy, lifestyle, and injury may further increase the risk of the development and progression of osteoarthritis as well. Pain and loss of function are the main clinical features that lead to treatment. Although early manifestations of osteoarthritis are amenable to lifestyle modification, adequate pain management, and physical therapy, disease advancement frequently requires surgical treatment. The symptomatic progression of osteoarthritis with radiographical confirmation can be addressed either with arthroscopic interventions, (joint) preservation techniques, or bone fusion procedures, whereas (joint) replacement is preferentially reserved for severe and end-stage disease. The surgical treatment aims at alleviating pain and disability while restoring native biomechanics. Miscellaneous surgical techniques for addressing osteoarthritis exist. Advanced computer-integrated surgical concepts allow for patient personalization and optimization of surgical treatment. The scope of this article is to present an overview of the fundamentals of conventional surgical treatment options for osteoarthritis of the human skeleton, with emphasis on arthroscopy, preservation, arthrodesis, and replacement. Contemporary computer-assisted orthopaedic surgery concepts are further elucidated.

Innate Immunity at the Core of Sex Differences in Osteoarthritic Pain?

Osteoarthritis (OA) is a progressive whole-joint disease; no disease-modifying drugs are currently available to stop or slow its process. Symptoms alleviation is the only treatment option. OA is the major cause of chronic pain in adults, with pain being the main symptom driving patients to seek medical help. OA pathophysiology is closely associated with the innate immune system, which is also closely linked to pain mediators leading to joint pain. Pain research has shown sex differences in the biology of pain, including sexually dimorphic responses from key cell types in the innate immune system. Not only is OA more prevalent in women than in men, but women patients also show worse OA outcomes, partially due to experiencing more pain symptoms despite having similar levels of structural damage. The cause of sex differences in OA and OA pain is poorly understood. This review provides an overview of the involvement of innate immunity in OA pain in joints and in the dorsal root ganglion. We summarize the emerging evidence of sex differences regarding innate immunity in OA pain. Our main goal with this review was to provide a scientific foundation for future research leading to alternative pain relief therapies targeting innate immunity that consider sex differences. This will ultimately lead to a more effective treatment of pain in both women and men.

Quality of Evidence Supporting the Role of Curcuma Longa Extract/Curcumin for the Treatment of Osteoarthritis: An Overview of Systematic Reviews

Background

Well known for its good anti-inflammatory effect, curcuma longa extract (CLE)/curcumin (C) has a potential effect on osteoarthritis (OA), and a large number of researchers have completed several systematic reviews/meta-analyses (SRs/MAs) in this research area. However, the methodological and evidentiary quality of these SRs/MAs need to be further evaluated, and whether these findings provide reliable evidence for clinicians remains controversial.

Methods

Two researchers collected data from seven databases for SRs/MAs that are about randomized controlled trials (RCTs) on CLE/C for OA. Assessment was made for the SRs/MAs included in this article by means of the Assessment System for Evaluating Methodological Quality 2 (AMSTAR-2), the Risk of Bias in Systematic (ROBIS) scale, the list of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA), and the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) system.

Results

Nine published SRs/MAs were included in our study. According to the results of the AMSTAR-2 assessment, only one SR/MA was assessed as high quality. According to the ROBIS evaluation results, only 2 SRs/MAs have a low risk of bias. According to the results of the PRISMA checklist assessment, only 2 SRs/MAs studies fully reported the checklist, while other studies had reporting flaws. According to GRADE, a total of 59 effect sizes extracted from the included SRs/MAs were evaluated, among which no effect size was rated as high.

Conclusions

CLE/C may be an effective and safe complementary treatment for OA. However, further standard SRs/MAs and RCTs are needed to provide an evidence-based medical rationale for this.

Efficacy of Intra-Articular Injection of Biofermentation-Derived High-Molecular Hyaluronic Acid in Knee Osteoarthritis: An Ultrasonographic Study

OBJECTIVE

The aim of this study is to evaluate the efficacy of intra-articular injection with HYAJOINT Plus, a biofermentation-derived, high-molecular hyaluronic acid (HA), on the progression of structural changes of cartilage in patients with knee osteoarthritis (OA) by using objectively promised ultrasonography (US) evaluation.

DESIGN

In this prospective clinical trial, 56 OA patients completed the study. One single dose of injection of HYAJOINT Plus into the knee cavity was performed. The primary efficacy outcome measure for structural change of knee joint was evaluated by US using a semiquantitative grading system. Secondary efficacy outcome measures included Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) total and subscale scores. All efficacy outcomes were measured at baseline and at first, third, and sixth month following treatment.

RESULTS

There were significant US grade-improvement changes of cartilage between baseline and follow-up visits over medial femoral condyle and transverse overall evaluation at 3- and 6-month follow-ups, and over lateral femoral condyle, intercondylar notch, and medial longitudinal area at 6-month follow-up. The improved score change of WOMAC from baseline was significant at 1- and 3-month follow-ups in pain subscale, whereas score change from baseline was significant at 6-month follow-up in total score and all 3 subscale scores.

CONCLUSIONS

It was determined that significant improvement was found on cartilage by US after intra-articular injection with high-molecular weight, biological fermentation-derived HYAJOINT Plus. The semiquantitative grading system by US is a promising tool to identify the efficacy on cartilage band after interventions.

Physiotherapists' experiences of osteoarthritis guidelines in primary health care - an interview study

BACKGROUND

Osteoarthritis is a common joint disease, globally. Guidelines recommend information, exercise and, if needed, weight reduction as core treatment. There is a gap between evidence-based recommended care for osteoarthritis and clinical practice. To increase compliance to guidelines, implementation was conducted. The aim of the study was to explore physiotherapists' experiences of osteoarthritis guidelines and their experiences of implementation of the guidelines in primary health care in a region in southern Sweden.

METHODS

Eighteen individual, semi-structured interviews with physiotherapists in primary health care were analysed with inductive qualitative content analysis.

RESULTS

The analysis resulted in two categories and four subcategories. The physiotherapists were confident in their role as primary assessors for patients with osteoarthritis and the guidelines were aligned with their professional beliefs. The Supported Osteoarthritis Self-Management Programme, that is part of the guidelines, was found to be efficient for the patients. Even though the physiotherapists followed the guidelines they saw room for improvement since all patients with hip and/or knee osteoarthritis did not receive treatment according to the guidelines. Furthermore, the physiotherapists emphasised the need for management's support and that guidelines should be easy to follow.

CONCLUSION

The physiotherapists believed in the guidelines and were confident in providing first line treatment to patients with osteoarthritis. However, information about the guidelines probably needs to be repeated to all health care providers and management. Data from a national quality register on osteoarthritis could be used to a greater extent in daily clinical work in primary health care to improve quality of care for patients with osteoarthritis.

Jintiange Capsule May Have a Positive Effect on Pain Relief and Functional Activity in Patients with Knee Osteoarthritis: A Meta-Analysis of Randomized Trials

Background

Knee osteoarthritis (KOA) occurs frequently in the elderly and causes pain, especially when they walk. Traditional Chinese medicine treatment is effective in releasing knee osteoarthritis. Jintiange (JTG) capsule is widely used in treating knee osteoarthritis, but its clinical effects such as pain relief are still unclear. This meta-analysis aims to evaluate the clinical results systematically and negative effects of JTG capsule in patients with knee osteoarthritis.

Methods

A meta-analysis of clinical randomized controlled trials (RCTs) on JTG capsule treatment was carried out in KOA patients. The search time was from the establishment of the database to May 2021. The database included PubMed, Cochrane Library, EMBASE, Web of Science database, Chinese Biomedical database (CBM), Chinese VIP information, China National Knowledge Infrastructure (CNKI), and WanFang database. The outcome indicators were extracted from the included literature and analyzed, and the risk of bias was assessed through Cochrane Handbook 5.0.1.

Results

Twenty-two articles analyzed in this study involved 1887 patients. JTG capsule used alone or used with other interventions affects total effective rate significantly (RR: 1.19; 95% Cl: 1.11, 1.29; P=0.045), VAS score (SMD: −0.74; 95% Cl: −0.90, −0.59; P ≤ 0.001), WOMAC score (SMD: −0.77; 95% Cl: −0.96, −0.59; P ≤ 0.001), and Lequesne score (SMD: −0.82; 95% Cl: −1.02, −0.61; P=0.010).

Conclusion

Our current evidence indicated that JTG capsule may release the pain of KOA patients and improve their functional activity. However, considering the unsatisfactory quality of the included trials, more high-quality trials are needed to prove this issue.

An Updated Systematic Review and Meta-analysis of Duloxetine for Knee Osteoarthritis Pain

OBJECTIVE

We conducted the updated systematic review and meta-analysis of the best available quantitative and qualitative evidence to evaluate the effects and safety of duloxetine for the treatment of knee osteoarthritis (OA) pain.

METHODS

A comprehensive literature search used 3 English and 4 Chinese biomedical databases from inception through July 10, 2020. We included randomized controlled trials of duloxetine with intervention duration of 2 weeks or longer for knee OA. The primary outcome was pain intensity measured by Brief Pain Inventory and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. Secondary outcome measurements included 36-Item Short Form Health Survey, Patient's Global Impression of Improvement, Clinical Global Impressions of Severity, and adverse events (AEs). The quality of all included studies was evaluated using the Cochrane risk-of-bias criteria. The review was registered in the PROSPERO (CRD 42020194072).

RESULTS

Six studies totaling 2059 patients met the eligibility criteria. Duloxetine had significant reductions in Brief Pain Inventory 24 hours average pain (mean difference [MD]=-0.74; 95% confidence interval [CI], -0.92 to -0.57; P<0.00001; I2=13%; 5 trials; 1695 patients); patient general activity (MD=-0.76; 95% CI, -0.96 to -0.56; P<0.00001; I2=0%; 5 trials; 1694 patients) WOMAC physical function subscale (MD=-4.22; 95% CI, -5.14 to -3.30; P<0.00001; I2=26%; 5 trials; 1986 patients); Patient's Global Impression of Improvement (MD=-0.48; 95% CI, -0.58 to -0.37; P<0.00001; I2=29%; 5 trials; 1741 patients); and Clinical Global Impressions of Severity (MD=-0.34; 95% CI, -0.44 to -0.24; P<0.00001; I2=0%; 4 trials; 1178 patients) compared with placebo control. However, no difference on WOMAC pain subscale (standard mean difference=-1.68; 95% CI, -3.45 to 0.08; P=0.06; I2=100%; 3 trials; 1104 patients) and in serious AEs (risk ratio=0.92; 95% CI, 0.40-2.11; P=0.84; I2=0%; 5 trials; 1762 patients) between duloxetine and placebo. Furthermore, duloxetine failed to show superior effects for improving the life quality and demonstrated more treatment-emergent AEs.

CONCLUSION

Duloxetine may be an effective treatment option for knee OA patients but further rigorously designed and well-controlled randomized trials are warranted.

Exploring the Mechanism of Resveratrol in Reducing the Soft Tissue Damage of Osteoarthritis Based on Network Pharmacology and Experimental Pharmacology

AIM

To explore the mechanism of resveratrol in reducing the soft tissue damage of osteoarthritis (OA) based on network pharmacology.

METHODS

Pharmmapper was used to predict the target of resveratrol, OMIM and Genecards were used to collect OA-related disease genes, and David ver 6.8 was used for enrichment analysis. Then, animal experiments were carried out for verification. The rat OA model was established and the rats were randomly divided into 4 groups: model group, resveratrol low-dose group, resveratrol high-dose group, and blank control group for follow-up experiments. Hematoxylin-eosin (HE) staining was used to detect the degree of pathological damage of rat bones and joints. Enzyme-linked immunosorbent assay (ELISA) was used for the content of inflammatory factors. Western blot was used to detect the expression of Toll-like receptor 4 (TLR4), Myeloid differentiation factor 88 (MyD88), nuclear factor kappa B protein (NF-κB), cysteine protease-9 (CASP-9), Bcl-2 protein, and Bax protein.

RESULTS

Through network pharmacological analysis, this study found that resveratrol may regulate the TLR4 signaling pathway, PI3K-Akt signaling pathway, FoxO signaling pathway, Osteoclast differentiation, Rheumatoid arthritis, etc. Animal experiments showed that compared with the model group, the pathological damage of bone and joint in the resveratrol low-dose and high-dose groups was significantly improved. Compared with the model group, the serum levels of IL-1beta, IL-6, IL-17, TNF-α, and MCP-1 in the resveratrol low-dose and high-dose groups were significantly reduced (P < 0.05); protein levels of TLR-4, MyD88, and NF-κB p65 were significantly reduced (P < 0.05); caspase-9 and Bax protein levels were significantly reduced (P < 0.05), and Bcl-2 was significantly increased (P < 0.05).

CONCLUSION

Resveratrol may inhibit the activation of the TLR4-mediated NF-κB signaling pathway and has a repairing effect on soft tissue damage in OA.

Effects of total knee arthroplasty for primary knee osteoarthritis on postural balance: A systematic review

BACKGROUND

Knee osteoarthritis is often related to physical function impairment. Although total knee arthroplasty is considered effective for advanced cases of knee osteoarthritis, its effects on postural balance is a topic of debate.

RESEARCH QUESTION

What are the effects of total knee arthroplasty for primary knee osteoarthritis on postural balance compared to preoperative status and/or to healthy controls?.

METHODS

Longitudinal studies (with more than 1-month follow-up) assessing postural balance measures (either clinical-based such as balance scales or laboratory-based such as postural sway) were considered eligible and selected in a 2-phase process. Six main electronic databases were searched, complemented by 3 grey literature sources. The risk of bias was evaluated using the Joanna Briggs Institute Critical Appraisal Tools.

RESULTS

A total of 19 studies were included for qualitative synthesis, of which 14 had low and 5 had a moderate risk of bias. The follow-up period ranged from 1-24 months. Most studies (n = 11) presented comparisons to preoperative status only. From these, 7 studies reported relevant improvements in postural balance, 2 reported partial improvements, and 2 no improvements. The remaining studies (n = 8) presented comparisons to healthy controls and, although improvements following total knee arthroplasty were consistently observed, only one study reported postural balance measures comparable to that of controls.

CONCLUSIONS

The majority of studies reported relevant improvements (especially in clinical-based measures) compared to preoperative evaluations, although inconsistencies were found possibly due to variability in studies' populations, assessment tools, and follow-up times. Despite this, persistent deficits in postural balance were commonly observed when compared to healthy controls.

SIGNIFICANCE

This evidence synthesis could better inform clinicians and researchers about the therapeutic effects and limitations of total knee arthroplasty concerning postural balance. Standardization of assessment tools is recommended to strengthen the certainty of cumulative evidence.

Effects of a medical second opinion programme on patients' decision for or against knee arthroplasty and their satisfaction with the programme

BACKGROUND

German social legislation gives patients the right to obtain a second opinion before elective surgery and defines quality criteria for reimbursement by statutory health insurances. However, the effects of second opinions before elective surgery are largely unknown. The aim of this study was to evaluate the effects of a second opinion programme in patients recommended for knee arthroplasty.

METHODS

The largest statutory health insurance funds in Bavaria offered patients who had been recommended to have knee arthroplasty the opportunity to partake in a second opinion programme which consisted of an in person presentation to an experienced knee surgeon. In this cohort study, consecutive patients from this second opinion programme who signed informed consent were included from 07/10/2016 to 14/02/2020. Data were collected before and after the second opinion visit.

RESULTS

A total of 141 (66%) of 215 patients who presented for a second opinion participated in the evaluation study. The second opinion physician recommended knee arthroplasty to 40% of the patients, later knee arthroplasty if the conditions worsened to 40%, and no knee arthroplasty to 20%. After receiving the second opinion 28 of 56 (41%) undecided patients preferred knee arthroplasty, 14 no knee arthroplasty, 14 remained undecided. Four of 46 patients with a preference for "arthroplasty" changed their decision to "no arthroplasty", five of 35 patients from "no arthroplasty" to "arthroplasty". The patients were more confident in their decision according to the decision confidence scale (before: 5.4 ± 3.0; after: 7.8 ± 2.5; p < 0.001). They rated their satisfaction with the second opinion programme with a mean grade of 1.35 (± 0.60) (best:1; worst:6). Logistic regression analyses showed that the recommendation of the second opinion physician for joint arthroplasty was associated with the guideline criteria radiological severity of osteoarthritis (p = 0.001) and knee-joint-specific quality of life (p = 0.041).

CONCLUSION

The second opinion of an experienced knee surgeon frequently deviates from the initial recommendation for knee arthroplasty. The association of guideline criteria to the second recommendation suggests a high quality of the second opinion. From the patient perspective, the second opinion reduces uncertainties in their treatment decision.

Effectiveness of Mobilization with Movement on the Management of Knee Osteoarthritis: A Systematic Review of Randomized Controlled Trials

Background

Osteoarthritis is becoming a global major cause of pain and functional disability worldwide, especially in the elderly population. Nowadays, evidence shows that mobilization with movement (MWM) has a beneficial effect on knee osteoarthritis subjects. However, its adequacy remains unclear.

Objective

To review the best available evidence for the effectiveness of MWMs on pain reduction and functional improvement in patients with knee osteoarthritis.

Methods

A comprehensive search of literature was conducted using the following electronic databases: Google Scholar, PubMed, Physiotherapy Evidence Database (PEDro), Science Direct, Cochrane Library, and Scopus. Only randomized controlled trials (RCTs) were included, and the methodological quality of the studies was appraised using the PEDro scale. It was reported according to the guideline of the PRISMA statement.

Results

A total of 15 RCTs having 704 participants were included. The present systematic review suggests that there were significant differences between MWM groups and control groups in terms of visual analogue scale (VAS), Western Ontario and MacMaster Universities Osteoarthritis Index (WOMAC) scale, and flexion range of motion.

Conclusions

This systematic review demonstrated that MWM was effective to improve pain, range of motion, and functional activities in subjects with knee osteoarthritis.

PLCγ1 inhibition combined with inhibition of apoptosis and necroptosis increases cartilage matrix synthesis in IL-1β-treated rat chondrocytes

Osteoarthritis (OA) is an age-related, chronic degenerative disease. With the increasing median age of the population, this disease has become an important public health problem. New, disease-modifying therapies are needed. A potential novel molecular target is phospholipase Cγ1 (PLCγ1), a critical enzyme with important functions including calcium signaling regulation and cell proliferation. In rat chondrocytes treated with IL-1β (20 ng·mL-1 for 36 h), inhibition of PLCγ1 with U73122 (2 μm for 12 h) increased levels and expression of the cartilage matrix components Collagen2 and Aggrecan. This beneficial effect of PLCγ1 inhibition was counteracted by increased chondrocyte apoptosis and necroptosis, increased cell death, and increase levels of ROS, all potentially negative for OA. Combined treatment of IL-1β + U73122-treated chondrocytes with inhibitors of apoptosis (Z-VAD, 10 μm) and necroptosis (Nec-1, 30 μm) enhanced the increases in levels and expression of Collagen2 and Aggrecan, and prevented the increases in cell death and ROS levels. These results suggest that PLCγ1 inhibition may be a viable approach for an OA therapy, if combined with targeted inhibition of chondrocyte apoptosis and necroptosis.

Effects of platelet-rich plasma injection for pain control and cartilage repair in knee osteoarthritis: A protocol for the systematic review and meta-analysis of randomized controlled trials in animal models

BACKGROUND

Knee osteoarthritis (KOA) is a common disabling condition and a heavy financial burden to the society. Platelet-rich plasma (PRP) is considered to be an effective method in the repair and regeneration of cartilage and alleviate pain in KOA. But the utilising of PRP to treat KOA in clinical has shown variable results from many studies. The objective of this protocol is to determine the efficacy of PRP in pain control and cartilage repair in KOA animal models.

METHOD

We will search the following three electronic databases: MEDLINE, EMBASE and Web of Science. The primary outcome will include the histological score of cartilage and pain score. The secondary outcomes will be the behavioural assessments and cartilage thickness. SYRCLE's risk of bias tool will be used to assessment the risk of bias of including studies. The standardized mean difference and 95% confidence interval will be used to calculate the effect of PRP treatment. The I2 inconsistency values will be used to calculated the heterogeneity between studies.

RESULTS

The results of this paper will be submitted to a peer-reviewed journal for publication.

CONCLUSION

This research will determine the efficacy of PRP of the treatment of knee osteoarthritis model.

PROSPERO REGISTRATION NUMBER

CRD42020181589.

Hip Muscle Strengthening for Knee Osteoarthritis: A Systematic Review of Literature

BACKGROUND AND PURPOSE

Osteoarthritis (OA) of the knee joint results in chronic pain and functional decline among older adults. Hip muscle weakness has been observed in persons with knee OA and is claimed to increase the medial compartment loading on the knee joint. Although individual studies are available, no review has yet integrated the literature on the benefits of hip muscle strengthening for persons with knee OA. This review aims to systematically summarize the current evidence on the effectiveness of hip muscle strengthening on knee pain, lower extremity function, and biomechanical measures of the knee in persons with knee OA.

METHODS

An extensive electronic literature search was conducted in the databases PubMed, Scopus, Cumulative Index to Nursing and Allied Health (CINAHL), Cochrane Central Register of Controlled Trials (CENTRAL), and Physiotherapy Evidence Database (PEDro) to identify the published trials in the English language from January 1990 to August 2017. Randomized controlled trials that studied the effectiveness of hip muscle strengthening in persons with knee OA on knee pain, physical function, and biomechanical measures of the knee were considered for inclusion. The key word combinations were knee osteoarthritis, degenerative arthritis, arthralgia, muscle strengthening, and resistance training using the Boolean operators AND, OR. Two reviewers independently performed the study selection, and a third reviewer intervened when the consensus was not attained. Quality assessment of the included studies was carried out using the PEDro scale.

RESULTS AND DISCUSSION

The search produced 774 results, from which 81 full-text articles were studied. Five randomized controlled trials of good methodological quality, including 331 participants, were included in the review. The effectiveness of hip muscle strengthening was assessed in isolation, combination, and comparison with other lower extremity exercise. Overall, the studies reported clear benefits of hip muscle strengthening on knee pain, physical function, and hip muscle strength. However, hip muscle strengthening was ineffective in improving the biomechanical measures such as dynamic alignment and knee adduction (also known as valgus) moment.

CONCLUSION

The current review identified strong, high-quality evidence to recommend hip muscle strengthening in the conservative management of persons with knee OA. Further research is needed to establish the underlying mechanisms for the clinical benefits.

Efficacy of high intensity laser therapy in knee osteoarthritis: a double-blind controlled randomized study

OBJECTIVE

The aim of this study is to investigate the effectiveness of high intensity laser therapy on pain, functionality, flexion range of motion (FROM), and ultrasonographic cartilage measurement in patients with knee osteoarthritis.

METHODS

This study was designed as a double-blind randomized placebo-controlled study. Forty patients diagnosed with knee osteoarthritis according to the American College of Rheumatology criteria were included in the study. After obtaining written informed consent, patients were randomized into high intensity laser therapy (HILT) + exercise therapy (ET), and placebo laser (PL) + ET groups. Each patient was treated five sessions per week for 2 weeks. The outcomes measured were pain level and functional disability using the visual analog scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), respectively. The femoral cartilage thickness measurement was made ultrasonographically, and FROM was measured with goniometry.

RESULTS

Statistically significant improvements were detected in VAS, WOMAC scores, femoral cartilage thickness, and FROM at the end of the treatment (in week 2) compared to the pre-treatment period in both groups (p < 0.05). There were significant decreases in the VAS and WOMAC scores of both groups in the 6th week compared to the pre-treatment period, and the results of the FROM and femur cartilage thickness measurements were increased at statistically significant levels (p < 0.05). The VAS and WOMAC scores were significantly lower in the 6th week in HILT + ET group compared to the PL + ET group (p < 0.05). Similarly, statistically significant increases were detected in the FROM and femur cartilage thickness measurements in HILT + ET group (p < 0.05).

CONCLUSION

HILT + ET combination was more effective in KOA than the PL + ET combination. Key Points • HILT is an effective modality on pain, functional status and FROM in patients with KOA. • HILT is a modality that increases femoral cartilage thickness in patients with KOA.

Characteristics of Non-Spine Musculoskeletal Ambulatory Care Visits in the United States, 2009-2016

BACKGROUND

Despite the enormous economic and societal impact of musculoskeletal disorders, detailed data on the patient demographics and visit characteristics of nonspine musculoskeletal ambulatory care are sparse. Such data are essential to inform policymakers on population health needs and to justify health care resource allocation.

OBJECTIVE

To determine the demographic, patient, and visit characteristics of adult musculoskeletal ambulatory clinic visits, with the exception of spine visits, in the United States.

DESIGN

Survey/registry.

SETTING

National Ambulatory Medical Care Survey (NAMCS), Centers for Disease Control and Prevention (CDC) 2009 to 2016.

PATIENTS

The NAMCS was designed to capture information regarding the provision and use of ambulatory medical care services in the United States. Nonfederally employed office-based physicians reported data for this survey from 2009 to 2016.

INTERVENTIONS

None.

MAIN OUTCOME MEASURE(S)

Average annual estimated number (in 100 000s), Average annual estimated rate of ambulatory care musculoskeletal visits per 100 U.S. adults.

RESULTS

During 2009 to 2016, the leading cause of musculoskeletal visits was knee symptoms (15.3 million annually from 2009 to 2010, 14.0 million annually from 2011 to 2012, 12.5 million annually from 2013 to 2014, and 12.4 million annually from 2015 to 2016). Musculoskeletal visits were most frequent in patients that were 45 to 64 years of age (40.4% to 43.6% of visits were for patients 45 to 64 years of age depending on body region). Orthopedic surgeons conducted more musculoskeletal visits than any other physician specialty for all body regions. Among body regions, magnetic resonance imaging (MRI) studies were ordered most commonly for patients with shoulder (total visits in 100 000 ± standard error [SE] 47.00 ± 0.21; 12.5% of total visits for shoulders) and knee symptoms (61.85 ± 0.15; 11.4% of total visits for knees). Opioid and opioid analgesic combinations (9.2% to 14.8% of visits) were most commonly prescribed in visits related to hip complaints.

CONCLUSIONS

Visits were most frequent for knee symptoms and in patients of working age groups, which likely affects work productivity. Orthopedic surgeons were the most common provider specialty. Opioid medications were prescribed most commonly for patients with hip symptoms, which may highlight an area for potential intervention given the ongoing opioid crisis.

Multiple occurrence of premature polyarticular osteoarthritis in an early medieval Bohemian cemetery (Prague, Czech Republic)

OBJECTIVES

To highlight conditions that may cause early-onset degenerative joint disease, and to assess the possible impact of such diseases upon everyday life.

MATERIAL

Four adults aged under 50 years from a medieval skeletal collection of Prague (Czechia).

METHODS

Visual, osteometric, X-ray, and histological examinations, stable isotope analysis of bone collagen.

RESULTS

All four individuals showed multiple symmetrical degenerative changes, affecting the majority of joints of the postcranial skeleton. Associated dysplastic deformities were observed in all individuals, including bilateral hip dysplasia (n = 1), flattening of the femoral condyles (n = 3), and substantial deformation of the elbows (n = 3). The diet of the affected individuals differed from the contemporary population sample.

CONCLUSIONS

We propose the diagnosis of a mild form of skeletal dysplasia in these four individuals, with multiple epiphyseal dysplasia or type-II collagenopathy linked to premature osteoarthritis as the most probable causes.

SIGNIFICANCE

Combining the skeletal findings with information from the medical literature, this paper defines several characteristic traits which may assist with the diagnosis of skeletal dysplasia in the archaeological record.

LIMITATIONS

As no genetic analysis was performed to confirm the possible kinship of the individuals, it is not possible to definitively assess whether the individuals suffered from the same hereditary condition or from different forms of skeletal dysplasia.

SUGGESTIONS FOR FURTHER RESEARCH

Further studies on premature osteoarthritis in archaeological skeletal series are needed to correct the underrepresentation of these mild forms of dysplasia in past populations.

Spa therapy and rehabilitation of musculoskeletal pathologies: a proposal for best practice in Italy

Spa therapy is a heterogeneous collection of treatments and methods based on natural resources. It is often considered as an option in the common therapeutic approach to many musculoskeletal disorders, as well as respiratory, vascular, and dermatological disorders. The objective of this paper is to highlight possible interactions between rehabilitation and spa medicine in the field of musculoskeletal disorders, through an analysis of the scientific literature, in order to give the practitioner the ability to integrate good clinical practice in the field of rehabilitation through practical application involving spa therapies. The literature search was conducted using Medline, PEDro, Cochrane Database, and Google Scholar. Only studies published in English and works concerning the implementation of spa thermal treatment in neuro-musculoskeletal diseases were included. Specifically, the publications analyzed dealt with the treatment of diseases such as arthritis, rheumatic arthritis, ankylosing spondylitis, and low back pain through the use of thermal spa therapies. In conjunction with its widespread use in clinical practice, many studies in the literature suggest the effectiveness of crenobalneotherapy for a number of musculoskeletal disorders, generally those which are chronic and debilitating, finding significant clinical improvement both in terms of pain and functional limitations. Some of the guidelines formulated by national and international bodies on the treatment of specific diseases, such as the Italian Rheumatology Society (SIR) and the Osteoarthritis Research Society International (OARSI) guidelines, recognize the value of thermal medicine as a complement, but not a replacement, for conventional therapy (pharmacological or not).

Systematic Review of Modular Bicompartmental Knee Arthroplasty for Medio-Patellofemoral Osteoarthritis

BACKGROUND

We aimed to locate, appraise, and synthesize the available literature to assess the functional outcome of modular bicompartmental knee arthroplasty (BKA) compared to total knee arthroplasty (TKA) for medio-patellofemoral osteoarthritis.

METHODS

After an extensive literature search based on electronic databases such as MEDLINE, EMBASE, CINAHL, and PubMed, and grey literature, 9 articles satisfied our selection criteria which included 1 randomized controlled trial, 1 prospective cohort, 3 retrospective cohort, and 4 case series. Narrative synthesis was performed due to clinical, methodological, and statistical heterogeneity among the included studies.

RESULTS

There were 331 participants (341 knees) in this systematic review. BKA group included 229 patients (239 knees) and TKA group included 102 patients (102 knees). The quality of included studies ranged from moderate to very low as per GRADE (grading of recommendations, assessment, development, and evaluation working group) score with low to high risk of bias. Most of the studies showed comparable functional outcome in BKA compared to TKA such as Knee Society Score, Knee Osteoarthritis and Outcome Score, Short Form-36 score, and revision surgery in short-term to midterm follow-up. BKA patients achieved better range of movement and forgotten knee status than TKA patients. It resulted in longer operative time, but less intraoperative blood loss. Long-term series showed 95.1% survivorship of BKA at 5 years and 58% at 17 years.

CONCLUSION

Current evidence suggests that modular BKA provides comparable functional outcome to TKA at short-term to midterm follow-up, however, with poor long-term survivorship.

The Protective Effect of New Carnosine-Hyaluronic Acid Conjugate on the Inflammation and Cartilage Degradation in the Experimental Model of Osteoarthritis

Osteoarthritis (OA) is a disease that currently has no cure. There are numerous studies showing that carnosine and hyaluronic acid (HA) have a positive pharmacological action during joint inflammation. For this reason, the goal of this research was to discover the protective effect of a new carnosine conjugate with hyaluronic acid (FidHycarn) on the inflammatory response and on the cartilage degradation in an in vivo experimental model of OA. This model was induced by a single intra-articular (i.ar.) injection of 25 µL of normal saline with 1 mg of monosodium iodoacetate solution (MIA) in the knee joint of rats. MIA injection caused histological alterations and degradation of the cartilage, as well as behavioral changes. Oral treatment with FidHycarn ameliorated the macroscopic signs, improved thermal hyperalgesia and the weight distribution of the hind paw, and decreased histological and radiographic alterations. The oxidative damage was analyzed by evaluating the levels of nitrotyrosine and inducible nitric oxide synthase (iNOS) that were significantly reduced in FidHycarn rats. Moreover, the levels of pro-inflammatory cytokines and chemokines were also significantly reduced by FidHycarn. Therefore, for the first time, the effectiveness of oral administration of FidHycarn has been demonstrated in an osteoarthritis model. In conclusion, the new FidHycarn could represent an interesting therapeutic strategy to combat osteoarthritis.

Increased Urinary Concentration of C-Terminal Telopeptide of Type II Collagen and Pain by Radiographic Grade in Women with Knee Osteoarthritis in Northeastern Mexico: A Cross-Sectional Study

Osteoarthritis (OA) of the knee causes disability, pain, and progressive destruction of cartilage in adult women. The objective of the study was to evaluate the concentrations of the urinary biomarker C-terminal telopeptide of type II collagen (CTX-II) and pain by radiographic grade in women with knee OA in northeastern Mexico: Cross-sectional study of 155 women with knee OA. Concentrations of biochemical parameters were evaluated and urine samples were collected to measure biomarker levels (uCTX-II) ng/mmol by competitive enzyme-linked immunoabsorbent assay (ELISA) technique and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale was used for pain classification; median age of 49 years and 29.1 kg/m2 of body mass index (BMI). uCTX-II biomarker levels were grade 2 (210.7 ng/mmol), grade 3 (314.8 ng/mmol), and grade 4 (478.8 ng/mmol) relative to Kellgren and Lawrence, uCTX-II levels were compared with WOMAC scale and presented significant statistical difference (p = 0.0001). An association of the biomarker CTX-II and an increase in BMI was found in female patients with knee OA (odds ratio = 1.01; 95% confidence interval 1.001-1.005; p = 0.047).This study demonstrates an increase in the levels of the biomarker uCTX-II, the degree of pain, and radiographic grade in women with knee OA in northeastern Mexico.

Renal insufficiency plays a crucial association factor in severe knee osteoarthritis-induced pain in patients with total knee replacement: A retrospective study

Pain, the main symptom of osteoarthritis (OA), can lead to functional disability in patients with knee OA. Understanding the association factors related to knee pain is important since preventing OA-induced disabilities can be achieved by modifying these pain-associated issues. Therefore, this study was aimed to investigate the association factors for OA-induced knee pain in Taiwanese patients who received total knee replacements (TKR).In this retrospective study, 357 subjects who had undergone TKR at the Taipei Municipal Wan-Fang Hospital were recruited. The distribution of pain severity among patients with knee OA was evaluated. Demographic data and clinical parameters were analyzed to determine relationships between these variables and the severity of knee OA pain.Of the 357 patients studied, 54% and 33% had moderate and severe knee pain, respectively. Furthermore, a multivariate logistic regression analysis revealed that serum creatinine (>1.5 mg/dL) and an estimated glomerular filtration rate (eGFR) (<60 mL/min/1.73 m) were significantly associated with severe knee pain in OA patients. A significant correlation between severe knee pain and serum creatinine or eGFR was demonstrated by Pearson correlations.Taken together, the renal insufficiency defined by an elevated serum creatinine or a low eGFR in OA patients who required TKR was associated with severe knee pain. These variables must be considered while treating knee OA pain, especially in those patients with severe pain.

Efficacy of Intra-Articular Polynucleotides Associated With Hyaluronic Acid Versus Hyaluronic Acid Alone in the Treatment of Knee Osteoarthritis: A Randomized, Double-Blind, Controlled Clinical Trial

OBJECTIVE

Pain and range of motion loss are the main clinical features of osteoarthritis (OA). Hyaluronic acid (HA) is one of the infiltrative therapies for OA treatment; however, its effectiveness is a matter of an ongoing debate in clinical practice. Polynucleotides (PNs), a DNA-derived macromolecule with natural origin and trophic activity, were found to favor cell growth and collagen production, in preclinical and clinical studies regarding cartilage regeneration. This study aimed at evaluating whether injection of PNs, in combination with HA [PNs associated with HA (PNHA)], can ameliorate pain and function of knees affected by OA, more than HA alone.

DESIGN

A randomized, double-blind, controlled clinical trial.

PATIENTS

The study enrolled 100 patients, then randomized to receive PNHA or HA alone (3 weekly knee I.A. injections).

INTERVENTIONS AND MAIN OUTCOME MEASURES

Pain reduction, decrease of proinflammatory synovial fluid (SF) factors, and improvement in knee function were evaluated by Knee Society Score and WOMAC scores, after 2, 6, and 12 months and by biochemical and immunoenzymatic analyses of SF at the end of the treatment.

RESULTS

Knee Society Score total score and pain item significantly ameliorated in both groups, showing better results in PNHA- than in the HA-treated group. A significant reduction in the WOMAC score was observed over time for both groups. No significant adverse events were reported in either group.

CONCLUSIONS

These findings suggest that I.A. injection of PNs, in combination with HA, is more effective in improving knee function and pain, in a joint affected by OA, compared with HA alone.

What does digitalization hold for the creation of real-world evidence?

Health-related information is increasingly being collected and stored digitally. These data, either structured or unstructured, are becoming the ubiquitous assets that might enable us to comprehensively map out a patient's health journey from an asymptomatic state of wellness to disease onset and its trajectory. These new data could provide rich real-world evidence for better clinical care and research, if they can be accessed, linked and analyzed-all of which are possible. In this review, these opportunities will be explored through a case vignette of a patient with OA, followed by discussion on how this digitalized real-world evidence could best be utilized, as well as the challenges of data access, quality and maintaining public trust.

Intra-articular platelet-rich plasma injection for knee osteoarthritis: a summary of meta-analyses

OBJECTIVE

The purpose of this study was (1) to perform a summary of meta-analyses comparing platelet-rich plasma (PRP) injection with hyaluronic acid (HA) and placebo injection for KOA patients, (2) to determine which meta-analysis provides the best available evidence to making proposals for the use of PRP in the treatment of KOA patients, and (3) to highlight gaps in the literature that require future investigation.

MATERIAL AND METHODS

PubMed, EMBASE, and Cochrane databases search were performed for meta-analyses which compared PRP injection with HA or placebo. Clinical outcomes and adverse events were extracted from these meta-analyses. Meta-analysis quality was assessed using the Quality of Reporting of Meta-analyses (QUOROM) systems and the Oxman-Guyatt quality appraisal tool. The Jadad decision algorithm was also used to determine which meta-analysis provided the best available evidence.

RESULTS

Four meta-analyses were included in our study, and all of these articles were Level I evidence. The QUOROM score of each included meta-analysis range from 14 to 17 points (mean score 15, maximum score 18), and the Oxman-Guyatt score range from 4 to 6 points (mean score 5, maximum score 7). Three meta-analyses indicated PRP showed more benefit in pain relief and functional improvement than the control group, and the other one suggested no difference between these groups. All included meta-analyses found no statistical difference in adverse events between these groups. In addition, a meta-analysis conducted by Shen et al. got the highest methodological quality score and suggested that PRP provided better pain relief and function improvement in the treatment of KOA.

CONCLUSIONS

For short-term follow-up (≤1 year), intra-articular PRP injection is more effective in terms of pain relief and function improvement in the treatment of KOA patients than HA and placebo, and there is no difference in the risk of an adverse event between PRP and HA or placebo.

LEVEL OF EVIDENCE

Level I evidence, a summary of meta-analyses TRIAL REGISTRATION: PROSPERO ID CRD42018116168.

Inhibition of cyclooxygenase-2 activity in subchondral bone modifies a subtype of osteoarthritis

Osteoarthritis (OA) causes the destruction of joints. Its pathogenesis is still under investigation, and there is no effective disease-modifying therapy. Here, we report that elevated cyclooxygenase-2 (COX-2) expression in the osteocytes of subchondral bone causes both spontaneous OA and rheumatoid arthritis (RA). The knockout of COX-2 in osteocytes or treatment with a COX-2 inhibitor effectively rescues the structure of subchondral bone and attenuates cartilage degeneration in spontaneous OA (STR/Ort) mice and tumor necrosis factor-α transgenic RA mice. Thus, elevated COX-2 expression in subchondral bone induces both OA-associated and RA-associated joint cartilage degeneration. The inhibition of COX-2 expression can potentially modify joint destruction in patients with arthritis.

Gait analysis in patients after bilateral versus unilateral total hip arthroplasty

BACKGROUND

Gait abnormalities were reported in patients after total hip arthroplasty (THA). One-stage bilateral THA was introduced for bilateral hip pathologies, showing similar clinical and surgical outcome to unilateral procedure. However, no studies analyze the gait features after bilateral THA surgery compared to unilateral THA.

RESEARCH QUESTION

Are there differences in gait characteristics between bilateral and unilateral THA patients and are there differences between these cases and asymptomatic age-matched healthy subjects?

METHODS

In this prospective observational study, thirty-five patients with bilateral (n = 18) or unilateral THA (n = 17) and twenty asymptomatic age-matched volunteers were studied. Participants underwent three-dimensional gait analysisin order to detect gait spatial-temporal and kinematic (Gait Variable Score - GVS) parameters. Mobility (Timed Up and Go - TUG), fear of movement (Tampa Scale of Kinesiophobia - TSK) and pain during walking (Numeric Rating Scale - NRS) were also assessed. Patients were evaluated the day before surgery and at seven days, whereas healthy subjects underwent a single evaluation. ANOVA was used to assess differences between the three groups at each time-point and within-group differences in bilateral and unilateral groups.

RESULTS

At baseline, no differences between the two groups of patients were found. As expected, their gait spatial-temporal and kinematic parameters and functional variables were impaired with respect to healthy subjects, both before and after surgery. After surgery, GVS Pelvic-TILT closer to normative values, longer stance and shorter swing phases were found in bilateral cases compared to unilateral patients. Moreover, a higher NRS score was found in bilateral patients, whereas TUG and TSK revealed no differences between the two groups of patients.

SIGNIFICANCE

The current findings, focusing on short-term effectiveness of bilateral THA, could assist physiotherapists in selecting the best ambulation training and an appropriate rehabilitation approach immediately after surgery.

Increased subchondral bone thickness in hips with cam-type femoroacetabular impingement

OBJECTIVES

Increased thickness of subchondral acetabular bone with associated articular cartilage thinning in hips with femoroacetabular (FAI) cam impingement has been observed on magnetic resonance imaging (MRI). Dynamic attrition by the cam deformity moving into the acetabulum may potentiate trans-articular shear stresses thus causing these subchondral bone changes. We aimed to quantify the hypertrophic changes of subchondral acetabular bone in patients with cam-type FAI.

METHODS

MRI studies were performed on an asymptomatic population of young Swiss army recruits. Subjects underwent clinical examination and completed questionnaires before undergoing an MRI of the hip. Cam deformities were graded and the dimensions of the acetabular subchondral bone quantified. Univariate linear regression was used to determine the association between the presence of cam deformities and the degree of subchondral acetabular sclerosis.

RESULTS

There was a strong association between cam deformities and the thickness, area and shape of subchondral sclerosis. The main increase in hypertrophy was observed in the antero-superior acetabulum where impingement typically occurs. The subchondral sclerosis was 0.66 mm thicker in cam-type deformities than in hips without cam-type deformities (95% CI, 0.38-0.93, p value < 0.001).

CONCLUSIONS

Mechanical stress in the antero-superior acetabular area is elevated in hips with a cam-type deformity. The study supports the concept that cam-type deformity induced stress leads to hypertrophy of subchondral acetabular bone in the area of impingement. This is collocated with the clinically observed cartilage damage caused by the cam mechanism.

The Oxidative Stress in Knee Osteoarthritis Patients. An Attempt of Evaluation of Possible Compensatory Effects Occurring in the Disease Development

Background and Objective: Osteoarthritis (OA) is a disorder of the musculoskeletal system resulting in worsening of life condition. The research revealed the involvement of oxidative stress into both OA pathogenesis and the effects of therapeutic agents applied in OA cases. The activities of the most important antioxidant enzymes, namely superoxide dismutase (SOD), glutathione peroxidase (GPx), catalase (CAT) and total antioxidant status (TAS), in blood of the knee OA patients were studied, with the aim of clarifying which enzymatic antioxidants are involved into osteoarthritis (OA)-related oxidative stress and whether any compensatory effects occur. The results were additionally analyzed with regard to gender. Methods: Whole blood SOD (U/mL), plasma GPx (U/L) and CAT (U/mL) activities as well as plasma TAS (mmol/L)) in knee OA patients were investigated. Sixty-seven patients (49 females and 18 males) with primary knee OA were enrolled. The control comprised 21 subjects (10 females and 11 males) free of osteoarthritis or inflammation. Results: TAS was decreased in OA subjects (4.39 ± 0.53 vs. 4.70 ± 0.60), with this effect being more significant in OA females (4.31 ± 0.51 vs. 5.02 ± 0.54). GPx was depressed in all OA patients (518 ± 176 vs. 675 ± 149). In both genders, GPx was decreased, significantly in males (482 ± 185 vs. 715 ± 105). SOD was decreased in all OA patients (109 ± 32 vs. 127 ± 42). CAT showed no difference in all OA subjects vs. control, while in OA females it was depleted (20.2 (11.6–31.6) vs. 38.5 (27.9–46.6)) and in OA men it increased (26.9 (23.3–46.5) vs. 14.0 (7.0–18.6)). Conclusions: The obtained results suggest that in men some compensatory mechanisms towards OA-related oxidative stress occurred. Based on the obtained data, the introduction of antioxidant supplements into OA therapy could be suggested with further research concerning the choice of agents.

Pain and affective distress in arthritis: relationship to immunity and inflammation

INTRODUCTION

Most arthritides are associated with pain and psychological distress (clinically significant depression and anxiety). Pain and depression are mutually exacerbating; both may continue even when joint involvement appears well controlled. Area covered: There is strong evidence that arthritis-related stress impacts the central nervous system and, together with peripheral inflammatory changes, can cause central sensitization that can lead to chronic pain and worsening of affective distress. Cytokines and chemokines participate both in joint inflammation and in central sensitization. We review evidence of these relationships in five arthritides, namely rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, gout, and in osteoarthritis of the hips and knees. Central sensitization in these conditions results in long-lasting pain and psychological distress. Expert commentary: Chronic pain and depression are important but often neglected in the clinical assessment and treatment of arthritis. The potential role of biologic cytokines and Janus kinase inhibitors in dealing with these symptoms needs further study.

Blood loss of total knee arthroplasty in osteoarthritis: an analysis of influential factors

BACKGROUND

Total knee arthroplasty is regarded as the most effective treatment for severe knee osteoarthritis. The influential factors of blood loss in total knee arthroplasty remain controversial. The study aims to explore the influential factors of blood loss in total knee arthroplasty comprehensively.

MATERIAL AND METHODS

Three hundred and four osteoarthritis patients undergoing unilateral primary total knee arthroplasty were enrolled. Demographic characteristics, laboratory results, surgical protocol, and hemostatic and anticoagulation drugs were collected. Estimation of blood loss was calculated using the Gross equation. Multivariable stepwise linear regression analysis was performed to find out the influential factors.

RESULTS

Total blood loss reached the biggest volume (1346 ± 671 mL) in the post-operative third day. Hidden blood loss reached 465 ± 358 mL. Gender, tranexamic acid, prosthesis type, and drainage were proven to be positively correlated with the total blood loss (all P < 0.05). Male appeared to suffer more surgical blood loss than female. Posterior cruciate stabilizing prosthesis might lead to more surgical blood loss than posterior cruciate retaining prosthesis. Tranexamic acid could effectively reduce total blood loss while drainage might increase bleeding. Gender and anticoagulation drugs were correlated with hidden blood loss (both P < 0.05). Low molecular weight heparin resulted in less hidden blood loss than rivaroxaban.

CONCLUSIONS

Posterior cruciate retaining prosthesis and topical use of tranexamic acid were preferred to reduce total blood loss. Drainage was not recommended due to the risk of increasing bleeding. Low molecular weight heparin was recommended to prevent venous thrombosis.

Emerging Interventions for Elderly Patients-The Promise of Regenerative Medicine

The impressive increase in lifespan that occurred in the 20th century has driven a boom in age-associated degeneration resulting from senescence. Geriatric syndromes, such as sarcopenia and frailty, do not fall neatly into classical medical definitions of disease because they result from subtle declines in physiological function that occur over many years instead of specific organ-related pathology. These conditions have become more clinically prominent with the aging population and are the focus of research in regenerative medicine. Two major approaches are being pursued: the first targets specific organs that are adversely affected by senescence, and the second targets senescence pathways themselves, with the goal of favorably altering the affected physiology. This review will highlight a few examples of recent applications of both of these approaches to illustrate the potential of the application of a regenerative medicine approach to improve the quality of life and independence in older adults.

Strengthening the quadriceps femoris muscle versus other knee training programs for the treatment of knee osteoarthritis

People with knee osteoarthritis have atrophy of the muscles surrounding the knee joint. Therefore, exercise programs primarily have been focused on the strengthening of quadriceps femoris muscle (QFM). Primary aim of this systematic review was to determine which exercise increases strength of the QFM and describe the details of the training programs. Secondary aim was to determine effectiveness of strengthening of the QFM alone on pain and dysfunction in patient with knee osteoarthritis. PubMed, PEDro, and Cochrane were searched. PEDro for methodological quality of randomized controlled trials and Cochrane Collaborations' tool for risk of bias were used. A total of 1128 articles were identified from the database searches. Ten studies which were moderate-to-high level of evidence were included. In the comparison of different strengthening exercises of the QFM, significant difference was not found between training groups. However, strengthening of the QFM exercise training was superior to proprioceptive training. Additional hot packs plus shortwave diathermy or ultrasound or transcutaneous electrical nerve stimulation had superiority to isokinetic strengthening of the QFM alone. Only additional Russian electrical stimulation showed the significant difference compared with strengthening of the QFM exercise. Most of the included studies showed that strengthening of the QFM exercises has an effect on pain reduction and improvement of function. This review indicated that the strengthening of QFM training compared with other knee exercises provided muscle strengthening, pain reduction, and improved function while combination with other electrotherapy modalities or combination with Russian electrical stimulation had superiority to alone strengthening QFM training.