Osteoarthritis and type 2 diabetes mellitus: What are the links?

Exploration of the association between estimated glucose disposal rate and osteoarthritis in middle-aged and older adults: An analysis of NHANES data from 2011 to 2018

Background

It is unclear how the estimated glucose disposal rate (eGDR) index relates to osteoarthritis (OA). The goal of this research is to explore the possible link between the eGDR index and the likelihood of OA development.

Methods

The study encompassed 9,051 individuals from the National Health and Nutrition Examination Survey (2011-2018). Participants were divided into quartiles according to their eGDR, calculated with the equation: eGDR (mg/kg/min) = 21.158 - (0.09 × waist circumference) - (3.407 × hypertension) - (0.551 × glycosylated hemoglobin). We assessed the independent correlation between the eGDR metric and the incidence of OA through weighted multivariate regression, stratified analysis, and threshold effect evaluation.

Results

The study encompassed 9,051 participants, who had an average eGDR of 7.09. Participants with OA had lower eGDR levels compared to those without OA (6.27 ± 0.09 vs 7.31 ± 0.06, P < 0.001). The odds ratios (ORs) for OA associated with the eGDR index in the logistic regression models were 0.87 (95% confidence interval [CI]: 0.84, 0.89) in the unadjusted model I and 0.87 (95% CI: 0.84, 0.91) in model II (adjusted for all covariates). Higher eGDR index was associated with a reduced risk of OA when compared to the lowest quartile (Q1). A restricted cubic spline analysis indicated a linear negative relationship between eGDR and OA risk.

Conclusion

An increased eGDR index is inversely related to the risk of OA. The eGDR may serve as a valuable biomarker for the detection of OA and offers a new perspective for the assessment and management of the condition.

A vascularized microfluidic model of the osteochondral unit for modeling inflammatory response and therapeutic screening

Osteoarthritis (OA) has long been considered a disease of the articular cartilage. Within the past decade it has become increasingly clear that OA is a disease of the entire joint space and that interactions between articular cartilage and subchondral bone likely play an important role in the disease. Driven by this knowledge, we have created a novel microphysiological model of the osteochondral unit containing synovium, cartilage, bone, and vasculature in separate compartments with molecular and direct cell-cell interaction between the cells from the different tissue types. We have characterized the model in terms of differentiation by molecule and matrix secretion and shown that it demonstrates morphology and functionality that mimic the native characteristic of the joint space. Finally, we induced inflammation and subsequently rescued the model constructs by a known compound as proof of concept for anti-inflammatory drug screening applications.

Arthritis and Public Health Monitoring: Longitudinal Changes of Triglyceride-Glucose Index Associated with Arthritis in a Cohort of Older Chinese Adults

The current decade 2021-2030 was designated by the United Nations as the decade of healthy aging, which underlines the need for public health innovation for arthritis clinical care. The triglyceride-glucose (TyG) index is a novel and emerging parameter closely associated with diabetes and cardiovascular diseases and has been suggested to indicate the risk of arthritis. This study examined the longitudinal changes of TyG levels in relation to arthritis among a nationwide cohort of older Chinese adults. We recruited 1257 participants from a national cohort of older Chinese adults, the Chinese Longitudinal Healthy Longevity Survey. On the basis of the longitudinal changes in TyG between 2012 and 2014, we performed a k-means clustering analysis to classify the participants into four TyG groups: Class 1 with moderate and stable levels of TyG; Class 2 with low but rising level of TyG; Class 3 with consistently high TyG; and Class 4 with high and TyG-level rise compared with the baseline. After a 2-year follow-up, logistic regression was used to identify the association between TyG and the onset of arthritis. Compared with individuals in Class 1, those in Class 3 and Class 4 experienced a higher risk of arthritis, with an odds ratio (OR) of 2.823 (95% confidence interval [CI]: 1.113-7.160) and 2.848 (95% CI: 1.299-6.246), respectively. To the best of our knowledge, this is the first study exploring the association between dynamic longitudinal changes in TyG and arthritis. Further studies on world populations are called for.

Identification and validation of up-regulated TNFAIP6 in osteoarthritis with type 2 diabetes mellitus

Lines of evidence have indicated that type 2 diabetes mellitus (T2DM) is an independent risk factor for osteoarthritis (OA) progression. However, the study focused on the relationship between T2DM and OA at the transcriptional level remains empty. We downloaded OA- and T2DM-related bulk RNA-sequencing and single-cell RNA sequencing data from the Gene Expression Omnibus (GEO) dataset. Differential expression analysis and weighted gene co-expression network analysis (WGCNA) were performed to screen out hub genes between OA and T2DM, and functional enrichment was done. Single-cell sequencing analysis was further used to screen key genes on OA and T2DM datasets. Rat chondrocytes and human articular cartilage were used to validate biomarkers among OA and T2DM. Sixty-eight hub genes were obtained, which were mainly enriched in the inflammatory response. We found that the hub gene TNFAIP6 is not only closely related to OA and T2DM but also a marker of prehypertrophic chondrocytes, which are closely related to the progression of OA. TNFAIP6 was found to be significantly elevated in CD14 + monocytes in T2DM patients, and this group of cells can promote inflammation. Validation on rat chondrocytes and human cartilage showed that TNFAIP6 was highly expressed in OA and further increased in the presence of T2DM or high glucose. Our study identified several characteristic modules and hub genes in the pathogenesis of T2DM-induced OA, which may facilitate further investigation of its molecular mechanisms. Up-regulated TNFAIP6 may contribute to OA in patients with T2DM by the recruitment of pro-inflammatory CD14 + monocytes in the OA synovium, which provides a potential target for the diagnosis and treatment of T2DM-associated OA.

Genetic proxies for therapy of insulin drug targets and risk of osteoarthritis: a drug-target Mendelian randomization analysis

BACKGROUND

The potential effects of insulin therapy on osteoarthritis (OA) risk are poorly understood. This study aimed to explore the causal relationship between insulin therapy and OA.

METHODS

Mendelian randomization (MR) analysis was performed to examine the association between genetically proxied inhibition of insulin targets and the risk of overall, hip (HOA) and knee OA (KOA). We then performed univariable MR using summary statistics regarding insulin target genes derived from the DrugBank database. Data related to blood glucose reduction levels were used as a proxy for insulin levels. Two phenotypes, type 2 diabetes, and glycosylated hemoglobin levels, were selected as positive controls to confirm the direction and validity of the proxies. The OA datasets were derived from the UK Biobank cohort. Multivariable MR was adjusted for body mass index, sedentary behavior, cigarette smoking, frequency of alcohol intake, age, and genetic sex.

RESULTS

Genetically proxied insulin therapy was associated with an increased risk of overall OA [odds ratio (OR):1.2595; 95% confidence interval (CI):1.0810-1.4675] and HOA (OR:1.4218; 95%CI:1.1240-1.7985), which remained consistent across multiple MR methods. After adjusting for confounders, we found evidence supporting a significant causal link with a higher risk of overall OA and HOA. A further two-step MR analysis revealed no significant mediation effects from the six mediators in the associations.

CONCLUSION

There was a causal association between genetically proxied insulin therapy and a higher risk of OA, especially HOA.

Changes in Muscle Mass and Bone Density and Their Relationship After Total Knee Arthroplasty

Purpose: To investigate the effects of total knee arthroplasty (TKA) on muscle mass and bone density in end-stage knee osteoarthritis (OA). Methods: This prospective study was conducted on 111 patients with Kellgren-Lawrence grade 4 knee OA who underwent TKA after failing to respond to conservative treatment for more than 3 months at a single institution from June 2022 to May 2023. Appendicular lean mass index (ALMI) and bone mineral density (BMD) were measured using dual-energy X-ray absorptiometry before and every 6 months after surgery. The average follow-up period was 15.5 ± 2.31 months (range, 11.6-24 months). Results: During the follow-up period after TKA, the ALMI increased relatively continuously and consistently. The BMD of the L-spine and proximal femur did not change significantly until 12 months after TKA surgery but began to increase steeply after 12 months and slowed down after 18 months. The increase in muscle mass showed a significant positive correlation with the increase in BMD. Conclusions: Muscle mass gradually increased after TKA for end-stage knee OA, whereas bone density also increased but not until 12 months after surgery. The significant positive correlation between the increase in muscle mass and bone density suggests that the increase in muscle mass after TKA may be one of the causes of the increase in bone density.

Enhanced joint pain in diabetic patients with knee osteoarthritis is associated with increased synovitis, synovial immune cell infiltration, and erythrocyte extravasation

Objective

Diabetes mellitus (DM) is an important risk factor for the development of osteoarthritis (OA), increasing OA progression and OA pain. To gain insight into the underlying mechanisms of how DM exacerbates OA processes and OA pain, this study analyzed histological differences of synovial tissues from non-DM and DM patients with OA and correlated these differences with knee pain severity.

Materials and methods

Synovial tissue was obtained from 12 non-DM and 10 DM patients with advanced knee OA who underwent total knee arthroplasty. Synovial inflammation was assessed using the Synovitis score developed by Krenn. The Knee Injury and Osteoarthritis Outcome Score (KOOS) was used to assess knee pain intensity and disability in OA patients. The number of mast cells, macrophages, nerve fibers, capillaries, larger vessels and erythrocyte extravasation were analyzed microscopically in histological and immunostained synovial sections from non-DM and DM patients. Association analyses were performed to determine associations between OA knee pain and synovial changes affected by DM.

Results

Synovial tissue from OA patients with DM had a higher synovitis score, more erythrocyte extravasation, and contained higher numbers of mast cells and macrophages compared to non-DM patients. The number of capillaries and vessels in the lining/sublining layer of the synovial tissue was reduced in DM patients. OA patients with DM had more severe knee pain compared to non-DM patients. The KOOS pain score was associated with the synovitis score, the number of tissue macrophages, and the number of mast cells in the synovial tissue (adjusted for age, sex, and BMI). In addition, the erythrocyte extravasation score was associated with the KOOS pain score and with the synovitis score.

Conclusion

The study suggests that increased OA progression and pain severity in patients with DM result from more pronounced synovitis and synovial vascular leakage and increased infiltration of macrophages and mast cells.

Exploring the Efficacy of Alpha-Lipoic Acid in Comorbid Osteoarthritis and Type 2 Diabetes Mellitus

Background/Objectives. The comorbidity of osteoarthritis and type 2 diabetes mellitus poses a complex clinical challenge, complicating patient management due to overlapping pathophysiological mechanisms. This research aims to analyze the exacerbation of clinical symptoms and biochemical markers in patients with OA and T2DM compared to those with OA alone. Methods. We employed various assessment methods to evaluate inflammation, oxidative stress, and glycemic control in both cohorts. This study includes the administration of alpha-lipoic acid (ALA) to patients with comorbid OA and T2DM, monitoring its effects on joint function, inflammatory markers, oxidative stress levels, and glycemic control. Results. The findings indicate that T2DM significantly worsens clinical symptoms and biochemical markers in OA patients. Those with both conditions exhibited elevated indicators of inflammation and oxidative stress compared to OA-only patients. Additionally, correlations among metabolic, psychological, and inflammatory factors were identified. Body mass index emerged as a potential predictor for the deterioration of evaluated parameters. The analysis revealed that ALA administration led to statistically significant improvements in WOMAC pain scores, the Lequesne Algofunctional Index, and the AIMS-P compared to the control group. Conclusions. Further research into ALA's effects on OA progression in patients with comorbidities is essential for developing personalized treatment approaches.

The role of obesity and adipose tissue dysfunction in osteoarthritis pain

Obesity has a pivotal and multifaceted role in pain associated with osteoarthritis (OA), extending beyond the mechanistic influence of BMI. It exerts its effects both directly and indirectly through various modifiable risk factors associated with OA-related pain. Adipose tissue dysfunction is highly involved in OA-related pain through local and systemic inflammation, immune dysfunction, and the production of pro-inflammatory cytokines and adipokines. Adipose tissue dysfunction is intricately connected with metabolic syndrome, which independently exerts specific effects on OA-related pain, distinct from its association with BMI. The interplay among obesity, adipose tissue dysfunction and metabolic syndrome influences OA-related pain through diverse pain mechanisms, including nociceptive pain, peripheral sensitization and central sensitization. These complex interactions contribute to the heightened pain experience observed in individuals with OA and obesity. In addition, pain management strategies are less efficient in individuals with obesity. Importantly, therapeutic interventions targeting obesity and metabolic syndrome hold promise in managing OA-related pain. A deeper understanding of the intricate relationship between obesity, metabolic syndrome and OA-related pain is crucial and could have important implications for improving pain management and developing innovative therapeutic options in OA.

Integrated bioinformatic analysis of the molecular mechanisms between type 2 diabetes mellitus and osteoarthritis

Type 2 diabetes mellitus (T2DM) is a metabolic syndrome that has been identified as an independent risk factor for osteoarthritis (OA) and may even trigger and exacerbate the progression of OA. However, the relationship between T2DM and OA is complex and has not yet been fully clarified by current research. In this study, we analyzed the potential mechanism of action between T2DM and OA by bioinformatics. Transcriptome sequencing data of T2DM (GSE25724) and OA (GSE55235) were downloaded from the gene expression omnibus. Differential expression analysis was performed for different subgroups to obtain differentially expressed genes. The protein-protein interaction network was constructed using overlapping genes and screened for hub targets. Then the enrichment analysis was performed separately for overlapping and hub targets. The GeneMANIA is used to predict functionally similar genes of hub genes. Differential expression analyses revealed that 184 genes are involved in both diseases together. The Kyoto Encyclopedia of Genes and Genomes pathway enrichment results showed that the overlapping genes were mainly involved in the advanced glycation end products-receptor of advanced glycation end products signaling pathway, the NF-kappa B signaling pathway, the mitogen-activated protein kinases signaling pathway, and the interleukin-17 signaling pathway in diabetic complications. The functions of genes similar to the hub genes are focused on cell chemotaxis, positive regulation of cell migration, positive regulation of RNA polymerase II transcription, regulation of leukocyte migration, epithelial cell proliferation, and integrated stress response signaling. The transcription factor Jun and C-X-C motif chemokine 8 may play an important role in the inflammatory response caused by advanced glycation end products. This study improves our understanding of T2DM complicating OA and helps to stimulate more effective treatments.

U-shaped association between triglyceride glucose-body mass index with all-cause and cardiovascular mortality in US adults with osteoarthritis: evidence from NHANES 1999-2020

The association between insulin resistance (IR) and the risk of all-cause mortality and cardiovascular mortality among osteoarthritis (OA) patients remains uncertain. This study aims to clarify the correlation between a novel marker of IR, the triglyceride glucose-body mass index (TyG-BMI), and the risk of all-cause mortality and cardiovascular mortality in OA patients. Data from the National Health and Nutrition Examination Survey (NHANES) spanning from 1999 to 2020 were analyzed. Multivariable Cox proportional hazards regression analysis and restricted cubic spline plots were employed to elucidate the association between the TyG-BMI index and the risk of all-cause mortality or cardiovascular mortality in OA patients. Additionally, subgroup analysis was conducted to explore potential interactions and identify populations at elevated risk of mortality. The study cohort comprised 4097 OA patients who were followed up for a period of 20 years, during which 1197 cases of all-cause mortality and 329 cases of mortality attributed to cardiovascular disease were recorded. Our findings revealed a U-shaped nonlinear relationship between the TyG-BMI index and the risk of all-cause mortality or cardiovascular mortality in OA patients, with the lowest mortality risk thresholds identified at 282 and 270, respectively. Moreover, surpassing these thresholds was associated with a 3% increase in the risk of all-cause mortality and a 5% increase in the risk of cardiovascular mortality for every 10-unit increment in TyG-BMI level. Among American OA patients, a U-shaped nonlinear relationship exists between the TyG-BMI index and the risk of all-cause mortality or cardiovascular mortality. These findings underscore the significant role of IR in the progression of OA.

Association of the visceral fat metabolic score with osteoarthritis risk: a cross-sectional study from NHANES 2009-2018

BACKGROUND

Currently, obesity has been recognized to be an independent risk factor for osteoarthritis (OA), and the Metabolic Score for Visceral Fat (METS-VF) has been suggested to be potentially more accurate than body mass index (BMI) in the assessment of obesity. Nevertheless, the correlation of METS-VF with OA has not been obviously revealed yet. Therefore, this study aimed to delve into the potential relationship between METS-VF and OA.

METHODS

By examining data from the NHANES (2009-2018), weighted multivariate logistic regression analyses were used for assessing the correlation between METS-VF and OA. Subgroup analyses were then performed to validate the findings. Moreover, the nonlinear relationship between the two was assessed by restricted cubic spline (RCS). Receiver operating characteristic (ROC) curves were plotted to examine the diagnostic accuracy of METS-VF versus previous obesity index for OA.

RESULTS

This study involved 7639 participants. According to our results, METS-VF was notably related to an elevated risk of OA, regardless of the METS-VF and the trend of positive association was more pronounced with the elevating METS-VF level (p for trend < 0.05). Subgroup analyses showed that the positive association between METS-VF and prevalence of osteoarthritis persisted in all populations with different characteristics, confirming its validity in all populations. Besides, RCS results showed a significant non-linear relationship between METS-VF and OA (p-non-linear < 0.05). As indicated by the ROC curve analysis results, METS-VF was a superior predictor of OA to BMI and HC.

CONCLUSIONS

This study finds a possible nonlinear positive correlation between METS-VF and the risk of OA. In addition, METS-VF may serve as an indicator for the more accurate diagnosis of OA and provide a new way to further evaluate the relationship between visceral fat and OA.

Unveiling the bioinformatic genes and their involved regulatory mechanisms in type 2 diabetes combined with osteoarthritis

Background

Type 2 Diabetes Mellitus (T2D) and Osteoarthritis (OA) are both prevalent diseases that significantly impact the health of patients. Increasing evidence suggests that there is a big correlation between T2D and OA, but the molecular mechanisms remain elusive. The aims of this study are to investigate the shared biomarkers and potential molecular mechanisms in T2D combined with OA.

Methods

T2D and OA-related differentially expressed genes (DEGs) were identified via bioinformatic analysis on Gene Expression Omnibus (GEO) datasets GSE26168 and GSE114007 respectively. Subsequently, extensive target prediction and network analysis were finished with Gene Ontology (GO), protein-protein interaction (PPI), and pathway enrichment with DEGs. The transcription factors (TFs) and miRNAs coupled in co-expressed DEGs involved in T2D and OA were predicted as well. The key genes expressed both in the clinical tissues of T2D and OA were detected with western blot and qRT-PCR assay. Finally, the most promising candidate compounds were predicted with the Drug-Gene Interaction Database (DGIdb) and molecular docking.

Results

In this study, 209 shared DEGs between T2D and OA were identified. Functional analysis disclosed that these DEGs are predominantly related to ossification, regulation of leukocyte migration, extracellular matrix (ECM) structural constituents, PI3K/AKT, and Wnt signaling pathways. Further analysis via Protein-Protein Interaction (PPI) analysis and validation with external datasets emphasized MMP9 and ANGPTL4 as crucial genes in both T2D and OA. Our findings were validated through qRT-PCR and Western blot analyses, which indicated high expression levels of these pivotal genes in T2D, OA, and T2D combined with OA cases. Additionally, the analysis of Transcription Factors (TFs)-miRNA interactions identified 7 TFs and one miRNA that jointly regulate these important genes. The Receiver Operating characteristic (ROC) analysis demonstrated the significant diagnostic potential of MMP9 and ANGPTL4.Moreover, we identified raloxifene, ezetimibe, and S-3304 as promising agents for patients with both T2D and OA.

Conclusion

This study uncovers the shared signaling pathways, biomarkers, potential therapeutics, and diagnostic models for individuals suffering from both T2D and OA. These findings not only present novel perspectives on the complex interplay between T2D and OA but also hold significant promise for improving the clinical management and prognosis of patients with this concurrent condition.

Dietary and serum antioxidant capacity is inversely associated with patients in osteoarthritis: a case-control study

This study aimed to examine dietary antioxidant and serum antioxidant capacity in patients with knee osteoarthritis (OA). This case-control study consisted of 47 patients with OA (case group) and 30 healthy subjects (control group). The control and case group were matched age, gender, and body mass index (p > 0.05). A food frequency questionnaire was administered to participants, and dietary total antioxidant capacity (DTAC) was estimated using the ferric reducing antioxidant power method (FRAP). Participants' serum total antioxidant capacity (TAC) and total oxidant capacity (TOC) measurements were performed, and the oxidative stress index (OSI) was calculated. DTAC of case group was found to be lower than the control group (p < 0.05). The daily consumption of red meat and butter of the individuals in the case group was higher than that of the control group, and their fish consumption, dietary vitamin A and carotene intakes were found to be lower (p < 0.05). In addition, OA patients have TAC and OSI was also found to be significantly higher than in control group (p = 0.001 and p < 0.001). Since low dietary total antioxidant capacity and high serum total oxidant capacity, individuals with OA should pay more attention to their diet to increase serum antioxidant status.

Middle Ear Ossicular Joint Changes in Type 2 Diabetes Mellitus: A Histopathological Study

OBJECTIVES

Although previous research has indicated inner ear changes in diabetes mellitus (DM) patients, no prior study has explored the middle ear, particularly the ossicles and their joints, in DM patients. This study aimed to investigate whether type 2 DM is associated with middle ear changes, specifically affecting the ossicular chain and joints.

METHODS

This study included 47 ears from 25 patients with DM (male = 13, female = 12, age: 51.0 ± 20.5) and age- and sex-matched controls (male = 10, female = 10, age: 54.8 ± 15.9) (sex; p = 1.000, Age; p = 0.991). Otopathological evaluations of the auditory ossicles and incudomalleolar joint (IMJ) were performed using light microscopy.

RESULTS

In the IMJ of DM cases, malleus hyalinized cartilage (Malleus hC) and incus hyalinized cartilage (Incus hC) were significantly increased compared with control cases (Malleus hC; DM, 34.17 ± 9.71 μm vs. control 21.96 ± 4.16 μm, p < 0.001) (Incus hC; DM 35.11 ± 10.12 μm vs. control 22.42 ± 4.368 μm, p < 0.001). In addition, bone-line distance was significantly longer than in DM cases than control cases (DM 266.72 ± 59.11 μm vs. control 239.81 ± 35.56 μm p = 0.040). On the other hand, joint discus distance was longer in the control group than in DM cases (DM 96.84 ± 36.80 μm vs. Control 113.63 ± 23.81 μm, p = 0.001).

CONCLUSIONS

This study reveals a notable increase in the hyalinized cartilage layer and bone-line distance accompanied by reducing joint discus distance within the IMJ in DM cases. These findings suggest that DM may influence microjoints, such as the IMJ, and potentially impact auditory function.

EVIDENCE LEVEL

N/A Laryngoscope, 134:2871-2878, 2024.

Effect of type 2 diabetes mellitus on the microstructural, compositional and mechanical properties of cartilages

BACKGROUND

Osteoarthritis (OA) is a chronic and complicated degenerative disorder of joints, including several phenotypes. Type 2 diabetes mellitus (T2DM) is one of the major causes of OA. However, few studies on the mechanical behavior of diabetic cartilages have been conducted.

METHODS

This study evaluated the microstructural, compositional, and mechanical properties of healthy and diabetic rat cartilages using scanning electronic microscopy, X-ray energy spectroscopy, histology staining, and microindentation tests.

RESULTS

Our results indicated that the diabetic cartilages had a significantly higher elastic modulus and similar permeability (95%CI: 3.72-8.56 MPa and 3.16×10-6-1.83×10-5 mm4/N·s) compared to the healthy cartilages (95%CI: 0.741-3.58 MPa and 3.15×10-6-1.14×10-5 mm4/N·s). Their stress relaxation behaviors were similar regardless of the loading rate except for the stretching parameter under the fast loading. Furthermore, the stress relaxation behaviors of the diabetic cartilages were significantly affected by the loading rate, especially the equilibrium force ratio and time constant. These mechanical outcomes could be attributed to the increase of fibril diameters and calcium aggregation in the cartilage.

CONCLUSIONS

This study deepens our understanding of how T2DM might facilitate OA in cartilages, which could contribute to the development of more scientific diagnosis and therapies for patients with diabetes.

Impact of diabetes mellitus on osteoarthritis: a scoping review on biomarkers

Osteoarthritis (OA) commonly affects the knee and hip joints and accounts for 19.3% of disability-adjusted life years and years lived with disability worldwide (Refs , ). Early management is important in order to avoid disability uphold quality of life (Ref. ). However, a lack of awareness of subclinical and early symptomatic stages of OA often hampers early management (Ref. ). Moreover, late diagnosis of OA among those with severe disease, at a stage when OA management becomes more complicated is common (Refs , , , ). Established risk factors for the development and progression of OA include increasing age, female, history of trauma and obesity (Ref. ). Recent studies have also drawn a link between OA and metabolic syndrome, which is characterized by insulin resistance, dyslipidaemia and hypertension (Refs , ).

The association between diabetes mellitus and musculoskeletal disorders: a systematic review and meta-analysis

Background

Despite the fact that DM patients are living longer, research on the prevalence of MSDs and other related illnesses is still lacking compared to that of other comorbidities. This study systematically reviewed and meta-analyzed cohort studies to determine the association between diabetes mellitus (DM) and musculoskeletal disorders (MSDs).

Methods

A comprehensive search of international databases, including Medline (PubMed), Web of Science, Scopus, and Embase, was conducted up to June 2023 to identify relevant studies investigating the association between MSDs and DM.

Results

The meta-analysis included ten cohort studies with a total of 308,445 participants. The pooled risk ratio (RR) estimate for the association between MSDs and DM was 1.03 (95% CI 1.00-1.06). Based on subgroup analysis, the association between longer duration (more than 7), European, below the age of 70, and female patients was higher than the others.

Conclusion

In conclusion, the results of this meta-analysis suggest that there may be an association between MSDs and diabetes in people with diabetes. These findings add to the existing knowledge on this topic and highlight the importance of recognition and management of MSDs in people with DM. There is a need for further research to investigate the underlying mechanisms and to develop targeted interventions for the prevention and management of MSDs in this population.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=381787, identifier CRD42022381787.

SIRT3 alleviates high glucose-induced chondrocyte injury through the promotion of autophagy and suppression of apoptosis in osteoarthritis progression

A growing amount of epidemiological evidence proposes diabetes mellitus (DM) to be an independent risk factor for osteoarthritis (OA). Sirtuin 3 (SIRT3), which is mainly located in mitochondria, belongs to the family of nicotinamide adenine dinucleotide (NAD+)-dependent protein deacetylases and is involved in the physiological and pathological processes of cell regulation. The aim of this study was to investigate the effects of SIRT3 on diabetic OA and underlying mechanisms in the prevention of type 2 DM (T2DM)-induced articular cartilage damage. High-fat and high-sugar diets combined with streptozotocin (STZ) injection were used for establishing an experimental T2DM rat model. The destabilization of medial meniscus (DMM) surgery was applied to induce the rat OA model. Primary rat chondrocytes were cultivated with a concentration of gradient glucose. Treatment with intra-articular injection of SIRT3 overexpression lentivirus was achieved in vivo, and intervention with SIRT3 knockdown was performed using siRNA transfection in vitro. High glucose content was found to activate inflammatory response, facilitate apoptosis, downregulate autophagy, and exacerbate mitochondrial dysfunction in a dose-dependent manner in rat chondrocytes, which can be deteriorated by SIRT3 knockdown. In addition, articular cartilage damage was found to be more severe in T2DM-OA rats than in DMM-induced OA rats, which can be mitigated by the intra-articular injection of SIRT3 overexpression lentivirus. Targeting SIRT3 is a potential therapeutic strategy for the alleviation of diabetic OA.

Associations of individual chronic diseases and multimorbidity with multidimensional frailty

OBJECTIVE

To examine the associations between individual chronic diseases and multidimensional frailty comprising physical, psychological, and social frailty.

METHODS

Dutch individuals (N = 47,768) age ≥ 65 years completed a general health questionnaire sent by the Public Health Services (response rate of 58.5 %), including data concerning self-reported chronic diseases, multidimensional frailty, and sociodemographic characteristics. Multidimensional frailty was assessed with the Tilburg Frailty Indicator (TFI). Total frailty and each frailty domain were regressed onto background characteristics and the six most prevalent chronic diseases: diabetes mellitus, cancer, hypertension, arthrosis, urinary incontinence, and severe back disorder. Multimorbidity was defined as the presence of combinations of these six diseases.

RESULTS

The six chronic diseases had medium and strong associations with total ((f2 = 0.122) and physical frailty (f2 = 0.170), respectively, and weak associations with psychological (f2 = 0.023) and social frailty (f2 = 0.008). The effects of the six diseases on the frailty variables differed strongly across diseases, with urinary incontinence and severe back disorder impairing frailty most. No synergetic effects were found; the effects of a disease on frailty did not get noteworthy stronger in the presence of another disease.

CONCLUSIONS

Chronic diseases, in particular urinary incontinence and severe back disorder, were associated with frailty. We thus recommend assigning different weights to individual chronic diseases in a measure of multimorbidity that aims to examine effects of multimorbidity on multidimensional frailty. Because there were no synergetic effects of chronic diseases, the measure does not need to include interactions between diseases.

Risk of metabolic abnormalities in osteoarthritis: a new perspective to understand its pathological mechanisms

Although aging has traditionally been viewed as the most important risk factor for osteoarthritis (OA), an increasing amount of epidemiological evidence has highlighted the association between metabolic abnormalities and OA, particularly in younger individuals. Metabolic abnormalities, such as obesity and type II diabetes, are strongly linked to OA, and they affect both weight-bearing and non-weight-bearing joints, thus suggesting that the pathogenesis of OA is more complicated than the mechanical stress induced by overweight. This review aims to explore the recent advances in research on the relationship between metabolic abnormalities and OA risk, including the impact of abnormal glucose and lipid metabolism, the potential pathogenesis and targeted therapeutic strategies.

Diabetes mellitus in rheumatic diseases: clinical characteristics and treatment considerations

New pathophysiological insights are now available on comorbidities in rheumatic diseases (RDs). Several nationwide studies point to the fact that comorbid diabetes mellitus (DM) increases the risk of adverse outcomes in patients with various RDs. Genetic factors, intensity of systemic inflammation, anti-inflammatory potential of therapeutic agents, and duration of RDs have been insufficiently explored in the context of comorbidities. Some disease-modifying antirheumatic drugs (DMARDs) have demonstrated a potential to improve the glycemic control while glucocorticoids (GCs) have worsened it, particularly in systemic lupus erythematosus (SLE) and rheumatoid arthritis (RA). Anti-TNFalpha agents in combination with hydroxychloroquine (HCQ) have been associated with a reduced risk of DM in patients with RA, ankylosing spondylitis (AS), Sjögren syndrome (SS), and SLE. Better understanding of confounding factor of currently available antirheumatic therapies in patients with DM and RDs will pave the way for a tailored approach, limiting the severity of clinical manifestations and reducing the mortality risk.

Metformin Reduces the Risk of Total Hip Arthroplasty in Elderly Patients with Hip Osteoarthritis and Type 2 Diabetes Mellitus

Purpose

To assess if metformin could reduce the risk of total hip arthroplasty (THA) in elderly patients with hip osteoarthritis and type 2 diabetes (T2DM).

Patients and Methods

It is a retrospective study among elderly patients (≥65 years) with hip osteoarthritis and T2DM. All included patients were divided into metformin group and non-metformin group, then propensity-score match (PSM) was performed to control potential confounding factors. The primary endpoint was the incidence of the first THA during the study period. Multivariate Cox regression analysis was employed to evaluate the association of metformin with the risk of THA.

Results

A matched cohort of 716 patients were finally included, with 308 metformin users and 308 metformin non-users. During a maximum follow-up of 10 years, the incidence of THA in metformin users was significantly lower than that in non-users (4.9% vs 25.0%, P<0.01). Multivariate Cox regression analysis indicated that metformin users were significantly associated with a lower risk of THA compared with non-users (HR = 0.17, 95% CI: 0.10-0.30; P<0.01). In addition, further analyses indicated that participants with long-term metformin use (HR = 0.10, 95% CI: 0.02-0.46; P<0.01) or high metformin dosage (HR = 0.15, 95% CI: 0.04-0.57; P<0.01) had a lower risk of THA.

Conclusion

Metformin use could reduce the risk of THA in patients with hip osteoarthritis and T2DM, and the effect is accumulative and dose dependent.

Fundamentals of osteoarthritis: Inflammatory mediators in osteoarthritis

OBJECTIVES

As more has become known of the pathophysiology of osteoarthritis (OA), evidence that inflammation plays a critical role in its development and progression has accumulated. Here, we aim to review current knowledge of the complex inflammatory network in the OA joint.

DESIGN

This narrative review is presented in three main sections: local inflammation, systemic inflammation, and therapeutic implications. We focused on inflammatory mediators and their link to OA structural changes in the joint.

RESULTS

OA is characterized by chronic and low-grade inflammation mediated mostly by the innate immune system, which results in cartilage degradation, bone remodeling and synovial changes. Synovitis is regarded as an OA characteristic and associated with increased severity of symptoms and joint dysfunction. However, the articular cartilage and the subchondral bone also produce several pro-inflammatory mediators thus establishing a complex interplay between the different tissues of the joint. In addition, systemic low-grade inflammation induced by aging, obesity and metabolic syndrome can contribute to OA development and progression. The main inflammatory mediators associated with OA include cytokines, chemokines, growth factors, adipokines, and neuropeptides.

CONCLUSIONS

Future research is needed to deeper understand the molecular pathways mediating the inflammation in OA to provide new therapeutics that target these pathways, or to repurpose existing drugs.

The microbiota-metabolic syndrome axis as a promoter of metabolic osteoarthritis

The relation between obesity and osteoarthritis (OA) development has been traditionally explained as consequence of the excessive joint effort derived of overweight. However, in the last two decades a metabolic OA has been suggested through diverse molecular mechanism implying metabolic syndrome, although more investigation must be conducted to elucidate it. Metabolic syndrome is responsible of the release of diverse inflammatory cytokines, specially the increased adipokine in obesity, causing a chronic low-grade inflammatory status that alters the joint homeostasis. In this scenario, the microbiota dysbiosis contribute by worsening the low-grade chronic inflammation or causing metabolic disorders mediated by endotoxemia generated by an increased lipopolysaccharides intake. This results in joint inflammation and cartilage degradation, which contributes to the development of OA. Also, the insulin resistance provoked by type 2 Diabetes contributes to the OA development. When intake patterns are considered, some coincidences can be pointed between the food patterns associated to the metabolic syndrome and the food patterns associated to OA development. Therefore, these coincidences support the idea of a molecular mechanism of the OA development caused by the molecular mechanism generated under the metabolic syndrome status. This review points the relation between metabolic syndrome and OA, showing the connected molecular mechanisms between both pathologies as well as the shared dietary patterns that promote or prevent both pathologies.

A Bidirectional Mendelian Randomization Study of Sarcopenia-Related Traits and Knee Osteoarthritis

Background

With the development of population aging worldwide, sarcopenia and knee osteoarthritis (KOA), two age-related diseases, will continue to impose increasing medical and economic burdens on the society. Previous studies have discovered an association between the two, but the causality remains controversial, and it is difficult to eliminate confounding factors. Therefore, a Mendelian randomization (MR) study was conducted to overcome these confounding factors and investigate the causal relationship between sarcopenia and KOA.

Objective

The present work focused on assessing the causality between KOA and sarcopenia, so as to provide new strategies to prevent and treat these two conditions in clinic.

Methods

We registered the title with PROSPERO (ID: CRD42023421096). The two-sample bidirectional MR analysis was conducted in two steps, with sarcopenia being the exposure whereas KOA being the outcome in the first step, and vice versa in the second step. Genome-wide association studies (GWAS) data on low hand-grip strength (n=256,523), walking pace (n=459,915), appendicular lean mass (ALM, n=450,243), and KOA (n=403,124) were obtained from the UK Biobank. Methods such as the inverse variance weighted (IVW) and weighted median were utilized for assessing the causality of KOA with sarcopenia, and sensitivity analyses were also conducted.

Results

In the main MR analysis using the IVW method, evidence suggested that low hand-grip strength, walking pace, and ALM had adverse effects on KOA (p-value 0.0001, odds ratio (OR) 1.4569, 95% confidence interval (CI) 1.2007-1.7677 for low hand-grip strength; p-value 0.0003, OR 1.1500, 95% CI 1.050-1.183 for ALM; p-value 5.29E-19, OR 0.0932, 95% CI 0.0553-0.1572 for walking pace). However, there was no causality of KOA with sarcopenia in the opposite direction.

Conclusion

Our study suggests an obvious unidirectional causality of KOA with sarcopenia, and supports the notion that patients with sarcopenia are more susceptible to the development of KOA.

Concurrent Imaging and Clinical Study of the Efficacy of Hyaluronic Acid Injection for Knee Osteoarthritis: A Synovial Membrane Investigation with Ultrasound Imaging

We investigated whether hyaluronic acid (HA) injections can ameliorate ultrasound-detected synovitis in knee osteoarthritis (OA). We recruited 103 patients with symptomatic knee OA and ultrasound-detected synovitis and performed two ultrasound-guided fluid drainage procedures, followed by the administration of a low-molecular-weight HA injection (2.5 mL) in the subpatellar bursa, at a 2-week interval. Knee ultrasound imaging evaluations were performed before injection (baseline) and at 1 and 6 months after the second injection and included the measurements of synovial vascularity by using color Doppler ultrasound, synovial fluid depth over the suprapatellar bursa (SF), and synovial hypertrophy (SH). Initial clinical assessments included a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). VAS scores decreased significantly at both 1-month and 6-month evaluations (p < 0.001). WOMAC scores also significantly decreased at 1 month (p < 0.001), but not at 6 months (p = 0.23). The ultrasound parameters did not significantly change, except color Doppler grading, which tended to decrease at the 6-month evaluation (p = 0.059). Our findings revealed that two ultrasound-guided HA injections following fluid drainage improved pain and knee function but did not considerably influence imaging-detected synovitis in patients with knee OA.

Osteoarthritis and sarcopenia-related traits: the cross-sectional study from NHANES 2011-2014 and Mendelian randomization study

BACKGROUND

Osteoarthritis (OA) and sarcopenia are common musculoskeletal disorders in the aged population, and a growing body of evidence indicated that they mutually influence one another. Nevertheless, there was still substantial controversy and uncertainty about the causal relationship between sarcopenia and OA. We explored the complex association between sarcopenia-related traits and OA using cross-sectional analysis and Mendelian randomization (MR).

METHODS

The cross-sectional study used the data from the National Health and Nutrition Examination Survey (NHANES) 2011-2014. Weighted multivariable-adjusted logistic regression and subgroup analyses were used to evaluate the correlation between sarcopenia, grip, appendicular lean mass (ALM) and the risk of OA. Then, we further performed MR analysis to examine the causal effect of sarcopenia-related traits (grip strength, ALM) on OA. Instrumental variables for grip strength and ALM were from the UK Biobank, and the summary-level data for OA was derived from the Genetics of Osteoarthritis (GO) Consortium GWAS (n = 826,690).

RESULTS

In this cross-sectional analysis, we observed that sarcopenia, grip were significantly linked with the risk of OA (OR 1.607, 95% CI 1.233-2.094, P < 0.001), (OR 0.972, 95% CI 0.964-0.979, P < 0.001). According to subgroup analyses stratified by gender, body mass index (BMI), and age, the significant positive relationship between sarcopenia and OA remained in males, females, the age (46-59 years) group, and the BMI (18.5-24.9 kg/m²) group (P < 0.05). Furthermore, MR analysis and sensitivity analyses showed causal associations between right grip, left grip and KOA (OR 0.668; 95% CI 0.509 to 0.877; P = 0.004), (OR 0.786; 95% CI 0.608 to 0.915; P = 0.042). Consistent directional effects for all analyses were observed in both the MR-Egger and weighted median methods. Subsequently, sensitivity analyses revealed no heterogeneity, directional pleiotropy or outliers for the causal effect of grip strength on KOA (P > 0.05).

CONCLUSIONS

Our research provided evidence that sarcopenia is correlated with an increased risk of OA, and there was a protective impact of genetically predicted grip strength on OA. These findings needed to be verified in further prospective cohort studies with a large sample size.

Osteoarthritis and Diabetes: Where Are We and Where Should We Go?

Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.

The Overlap of Diabetes and Osteoarthritis in American Populations

Diabetes mellitus, a condition in which the body's ability to produce insulin is impaired, and osteoarthritis (OA), a painful degeneration of joint cartilage, are both serious conditions that affect millions of people in the United States (U.S.). Osteoarthritis is a chronic degenerative condition of the joint cartilage, affecting mainly the older population. The purpose of this paper is to find a connection, if any, between diabetes and osteoarthritis and if either condition can predispose an individual to the other. Not only can this review help to explain the co-existence of these two diseases, but it can also be used to look into a cure for patients in the future. After preliminary searches were done on PubMed, results were narrowed using specific keywords and similar risk factors among the two diseases. It was found that these two conditions are actually interrelated due to oxidative stress and pro-inflammatory cytokines. Seeing the high risk of developing one of these conditions and that obesity, one of the biggest risk factors for both diabetes and osteoarthritis, is at an all-time high in this country, a possible connection between the two of these diseases is very prevalent to look into. This information can be used to help correlate not only a better-targeted treatment but also lead to future research into why obesity is one of the biggest risk factors for both conditions.

Cytokine release by human bone marrow stromal cells isolated from osteoarthritic and diabetic osteoarthritic patients in vitro

OBJECTIVES

Primary Osteoarthritis (OA) is a disease of progressive joints degeneration due to idiopathic causes. Recent evidence showed a positive relationship between OA and metabolic syndrome. This pilot study aimed to assess the baseline level of pro and anti-inflammatory cytokines in OA patients with or without Diabetic Mellitus (DM) and assess the effect of hydrogen peroxide (H₂O₂) in cytokine production.

METHODS

Patients with primary hip and knee OA were recruited, and 3 mL of bone marrow was harvested during joint replacement surgery. Bone marrow stromal cells (BMSC) was isolated and cultured in a culture flask for three passages. Later experiment was then sub-cultured in a well plate labeled as the control group and H₂O₂ (0.1 mM) treated group. ProcartaPlex^® Multiplex Immunoassay was performed to measure cytokine levels produced by the BMSC at 0 h, as well as 72 h.

RESULTS

Cytokines such as tumor necrosis factor-alpha, interleukin (IL)-6, IL-8, and IL-1β generally exhibited higher cytokine levels in subjects with DM than in nonDM subjects at 0 and 72 h. For IL-17, its expression was similar in nonDM and DM groups at 0 and 72 h. Cytokine IL-10 showed no significant difference in both the groups while DM and nonDM groups treated with H₂O₂ showed decreased IL-4 levels compared to control groups at 72 h. Bone marrow cells from DM-OA are more vulnerable to chemical insult and are associated with higher levels of proinflammatory cytokines production and lower IL-4 level production.

CONCLUSIONS

This study provides a clue that management of OA with co-morbidity like DM needs future studies.

Causal Effect of Higher Glycated Hemoglobin (HbA1c) Levels on Knee Osteoarthritis Risk: A Mendelian Randomization Study

INTRODUCTION

The association between diabetes mellitus (DM) and risk of osteoarthritis (OA) is inconsistent based on published observational studies. This study aimed to conduct a two-sample Mendelian randomization (MR) analysis to explore the causal link between glycated hemoglobin (HbA1c) level and OA risk.

METHODS

Genome-wide association studies (GWAS) summary statistics were obtained from the publicly available Integrative Epidemiology Unit (IEU) OpenGWAS database. A series of screening processes were performed to select qualified instrumental single-nucleotide polymorphisms (SNPs) strongly related to exposure. The inverse-variance-weighted method, weighted-median method, and MR-Egger method were performed to ensure robust and reliable results. The MR-Egger intercept test, Cochran's Q test, and the leave-one-out sensitivity analysis were utilized to assess the horizontal pleiotropy, heterogeneities, and stability of these genetic variants for OA. Odds ratio (OR) and 95% confidence interval (CI) were calculated.

RESULTS

MR analyses found a robust causal association of genetically determined HbA1c with knee OA (OR = 1.561; 95% CI 1.110-2.197; P = 0.011), but not with hip OA (OR = 1.073; 95% CI 0.674-1.710; P = 0.766) or overall OA (OR = 1.141; 95% CI 0.904-1.441; P = 0.804). Sensitivity analyses showed that there was a strong association between SNPs and HbA1c (F = 21.138), no evidence of heterogeneity (Q = 150.625, P = 0.402), and no potential SNPs affecting the causal link.

CONCLUSION

Our MR study supported a causal effect of genetically increased HbA1c on knee OA risk.

Chrysophanol prevents IL-1β-Induced inflammation and ECM degradation in osteoarthritis via the Sirt6/NF-κB and Nrf2/NF-κB axis

Osteoarthritis (OA) is a common joint illness that negatively impacts people's lives. The main active ingredient of cassia seed or rhubarb is chrysophanol. It has various pharmacological effects including anticancer, anti-diabetes and blood lipid regulation. Previous evidence suggests that chrysophanol has anti-inflammatory properties in various diseases, but its effect on OA has not been investigated yet. In this study, chrysophanol inhibited IL-1β -induced expression of ADAMTS-4, MMP13, COX-2 and iNOS. Meanwhile, it can inhibit aggrecan and collagen degradation in osteoarthritic chondrocytes induced by IL-1β.Further studies depicted that SIRT6 silencing eliminated the chrysophanol effect on IL-1β. The results demonstrated that chrysophanol could stimulate SIRT6 activation and, more importantly, increase SIRT6 levels. We also discovered that chrysophanol might impede the NF-κB pathway of OA mice's chondrocytes induced by IL-1β, which could be because it depends on SIRT6 activation to some extent. It had also been previously covered that chrysophanol could produce a marked effect on Nrf2/NF-κB axis [1]. Therefore, we can infer that chrysophanol may benefit chondrocytes by regulating the SIRT6/NF-κB and Nrf2/NF-κB signaling axis.We examined the anti-inflammatory mechanism and the impact of chrysophanol on mice in vitro and in vivo. In summary, we declare that chrysophanol diminishes the inflammatory reaction of OA in mice in vitro by regulating SIRT6/NF-κB and Nrf2/NF-κB signaling pathway and protects articular cartilage from degradation in vivo. We can infer that chrysophanol could be an efficient therapy for OA.

Feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions in the setting of lifestyle-related chronic disease

BACKGROUND

Lifestyle factors are associated with musculoskeletal pain and metabolic chronic diseases. To date, intensive lifestyle medicine programs have predominantly targeted metabolic rather than musculoskeletal conditions.

OBJECTIVE

To assess the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions.

DESIGN

Prospective observational feasibility study.

SETTING

Tertiary academic medical center.

PATIENTS

Adults diagnosed with musculoskeletal condition(s) and lifestyle-related chronic disease(s) who previously completed standard-of-care musculoskeletal treatments, enrolled from 2018 to 2020.

INTERVENTIONS

Patients enrolled in an intensive interprofessional lifestyle medicine program led by a physiatrist, with options to interface with an acupuncturist, dietician, massage therapist, psychologist, physical therapist, and smoking cessation specialist. The physiatrist engaged in shared decision making with patients to establish program goals related to function, overall health, and required lifestyle changes. Bimonthly interprofessional team conferences facilitated communication between treatment team and patients.

MAIN OUTCOME MEASURES

Feasibility was measured by patient participation and goal attainment. Secondary outcomes included changes from program enrollment to discharge in patient anthropometric, metabolic lab, sleep apnea risk, and Patient-Reported Outcomes Measurement Information System (PROMIS) function, pain, and behavioral health measures.

RESULTS

Twenty-six patients enrolled in the program (18 [69%] female, mean age 59 [SD 14.5] years, baseline hemoglobin A1c 6.0% [0.8%], high-sensitivity C-reactive protein 7.7 [12.1] mg/dL, 25-hydroxy vitamin D 32.0 [14.2] ng/mL). Of 21 (81%) patients who completed the program, 13/21 (62%) met their goal. On average, program completers presented for 26.2 (10.6) total visits over 191 (88) days. By discharge, program completers achieved clinically meaningful improvement in PROMIS Anxiety (mean difference -3.5 points, 95% confidence interval [-6.5 to 0.5], p = .035), whereas noncompleters did not (p > .05).

CONCLUSIONS

An intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions is feasible. With training in lifestyle intervention, physiatrists are well suited to lead interprofessional teams aimed at assisting patients in making lifestyle changes to achieve personalized function- and health-related goals.

Knee Osteoarthritis in Relation to the Risk Factors of the Metabolic Syndrome Components and Environment of Origin

Background: Knee osteoarthritis (KOA) is a chronic degenerative pathology that is associated with multiple risk factors such as age, sex, obesity, or metabolic syndrome (MetS). The present clinical trial aimed to investigate the influence of the environment of origin, body mass index (BMI), and MetS parameters on the KOA differentiated degrees. Methods: 85 patients were admitted for the clinical study. The KOA presence was investigated using X-rays analysis. The Kellgren−Lawrence classification (KL) of the KOA severity and the MetS characteristic parameters using freshly collected blood were performed for each patient. All data collected were used for ANOVA statistic interpretation. Results: The total cholesterol and glycemia were found to be statistically significant (p < 0.028, and p < 0.03, respectively), with a high level in patients with severe KOA compared to healthy ones. Patients from rural regions are 5.18 times more prone to develop severe KOA when compared to ones from urban areas. Conclusions: The results of the statistical analysis confirmed the correlation between the incidence and severity of KOA and the influence of increased values of BMI, glycemia, triglycerides, and total cholesterol. The investigations revealed a statistically significant influence of the environment of origin on the KOA degree of the patients.

Associations between metabolic factors and radiographic knee osteoarthritis in early disease - a cross-sectional study of individuals with knee pain

Objective

Metabolic factors have been shown to be associated to severe radiographic knee osteoarthritis (RKOA). However, more knowledge is needed in early clinical knee osteoarthritis (KOA). The aim was to study associations between metabolic factors and radiographic knee osteoarthritis (OA) in individuals with knee pain. A second aim was to study associations between metabolic factors and RKOA in those with normal BMI and in those overweight/obese, respectively.

Method

This cross-sectional study included 282 individuals with knee pain (without cruciate ligament injury) and aged 30–67 years, and 70% women. Waist circumference, body mass index (BMI), proportion of fat and visceral fat area (VFA) were assessed. RKOA was defined as Ahlbäck grade 1 in at least one knee. Fasting blood samples were taken and triglycerides, cholesterol (total, low density lipoprotein (LDL) and high density lipoprotein (HDL)), C-reactive protein (CRP), glucose, HbA1C were analysed. Metabolic syndrome was defined in accordance with the International Diabetes Federation (IDF). Associations were analysed by logistic regression.

Results

Individuals with RKOA were older, had higher BMI, higher VFA, larger waist circumference and had increased total cholesterol, triglycerides and LDL-cholesterol, but not fasting glucose. There was no difference between the group with RKOA vs. non-radiographic group regarding the presence of metabolic syndrome. In a subgroup analysis of individuals with normal BMI (n = 126), those with RKOA had higher VFA, more central obesity, higher levels of CRP and total cholesterol, compared with individuals without RKOA. In individuals with obesity, age was the only outcome associated to RKOA.

Conclusion

There were clear associations between metabolic factors and RKOA in individuals with knee pain, also in those with normal BMI. In individuals with obesity age was the only variable associated to RKOA.

Trial registration:

clinicalTrials.gov Identifier: NCT04928170.

Potential Protective Role of Galectin-3 in Patients with Gonarthrosis and Diabetes Mellitus: A Cross-Sectional Study

BACKGROUND

Gonarthrosis and diabetes mellitus are two diseases that are increasingly being linked. The aim of this study was to quantify serum levels of Gal-3, pro- and anti-inflammatory cytokines (including their ratios and correlations), and participant's condition (pain, stiffness, functional limitations) in gonarthrosis patients with and without diabetes mellitus.

METHODS

A between-subject, cross-sectional experimental design was adopted. Serum levels of TNF-α, IL-6, IL-12, IL-23, IFN-γ, IL-17, IL-10, Gal-3, and WOMAC score were measured.

RESULTS

Gonarthrosis patients with diabetes mellitus had significantly (p < 0.05) lower levels of TNF-α, IL-6, IL-12, IL-17, IFN-γ, and Gal-3 compared to gonarthrosis patients without diabetes mellitus. On the other hand, IL-10/TNF-α, IL-10/IL-6, IL-10/IL-12, Gal-3/TNF-α, Gal-3/IL-6, and Gal-3/IL-12 (p = 0.001) were significantly higher (p < 0.05) in gonarthrosis with diabetes mellitus. Moderate-large correlation (p < 0.05) was detected between the serum values of Gal-3 and pro- and anti-inflammatory cytokines, including IL-12 (r = 0.575), IL-10 (r = 0.535), TNF-α (r = 0.306), and IL-23 (r = 0.323). WOMAC index was significantly lower (p < 0.05) in gonarthrosis patients without diabetes mellitus compared to gonarthrosis patients with diabetes mellitus.

CONCLUSIONS

Correlation between Gal-3 and proinflammatory cytokines and its dominance over proinflammatory cytokines implicate the potential role of Gal-3 in preventing cartilage destruction.

Phenotype-Genotype analysis of caucasian patients with high risk of osteoarthritis

Background: Osteoarthritis (OA) is a common cause of disability and pain around the world. Epidemiologic studies of family history have revealed evidence of genetic influence on OA. Although many efforts have been devoted to exploring genetic biomarkers, the mechanism behind this complex disease remains unclear. The identified genetic risk variants only explain a small proportion of the disease phenotype. Traditional genome-wide association study (GWAS) focuses on radiographic evidence of OA and excludes sex chromosome information in the analysis. However, gender differences in OA are multifactorial, with a higher frequency in women, indicating that the chromosome X plays an essential role in OA pathology. Furthermore, the prevalence of comorbidities among patients with OA is high, indicating multiple diseases share a similar genetic susceptibility to OA. Methods: In this study, we performed GWAS of OA and OA-associated key comorbidities on 3366 OA patient data obtained from the Osteoarthritis Initiative (OAI). We performed Mendelian randomization to identify the possible causal relationship between OA and OA-related clinical features. Results: One significant OA-associated locus rs2305570 was identified through sex-specific genome-wide association. By calculating the LD score, we found OA is positively correlated with heart disease and stroke. A strong genetic correlation was observed between knee OA and inflammatory disease, including eczema, multiple sclerosis, and Crohn's disease. Our study also found that knee alignment is one of the major risk factors in OA development, and we surprisingly found knee pain is not a causative factor of OA, although it was the most common symptom of OA. Conclusion: We investigated several significant positive/negative genetic correlations between OA and common chronic diseases, suggesting substantial genetic overlaps between OA and these traits. The sex-specific association analysis supports the critical role of chromosome X in OA development in females.

Impacts of Glucose-Dependent Insulinotropic Polypeptide on Orthodontic Tooth Movement-Induced Bone Remodeling

Glucose-dependent insulinotropic polypeptide (GIP) exerts extra-pancreatic effects via the GIP receptor (GIPR). Herein, we investigated the effects of GIP on force-induced bone remodeling by orthodontic tooth movement using a closed-coil spring in GIPR-lacking mice (GIPRKO) and wild-type mice (WT). Orthodontic tooth movements were performed by attaching a 10-gf nickel titanium closed-coil spring between the maxillary incisors and the left first molar. Two weeks after orthodontic tooth movement, the distance of tooth movement by coil load was significantly increased in GIPRKO by 2.0-fold compared with that in the WT. The alveolar bone in the inter-root septum from the root bifurcation to the apex of M1 decreased in both the GIPRKO and WT following orthodontic tooth movement, which was significantly lower in the GIPRKO than in the WT. The GIPRKO exhibited a significantly decreased number of trabeculae and increased trabecular separation by orthodontic tooth movement compared with the corresponding changes in the WT. Histological analyses revealed a decreased number of steady-state osteoblasts in the GIPRKO. The orthodontic tooth movement induced bone remodeling, which was demonstrated by an increase in osteoblasts and osteoclasts around the forced tooth in the WT. The GIPRKO exhibited no increase in the number of osteoblasts; however, the number of osteoclasts on the coil-loaded side was significantly increased in the GIPRKO compared with in the WT. In conclusion, our results demonstrate the impacts of GIP on the dynamics of bone remodeling. We revealed that GIP exhibits the formation of osteoblasts and the suppression of osteoclasts in force-induced bone remodeling.

Migraine, Brain Glucose Metabolism and the "Neuroenergetic" Hypothesis: A Scoping Review

Increasing evidence suggests that migraine may be the result of an impaired brain glucose metabolism. Several studies have reported brain mitochondrial dysfunction, impaired brain glucose metabolism and gray matter volume reduction in specific brain areas of migraineurs. Furthermore, peripheral insulin resistance, a condition demonstrated in several studies, may extend to the brain, leading to brain insulin resistance. This condition has been proven to downregulate insulin receptors, both in astrocytes and neurons, triggering a reduction in glucose uptake and glycogen synthesis, mainly during high metabolic demand. This scoping review examines the clinical, epidemiologic and pathophysiologic data supporting the hypothesis that abnormalities in brain glucose metabolism may generate a mismatch between the brain's energy reserve and metabolic expenditure, triggering migraine attacks. Moreover, alteration in glucose homeostasis could generate a chronic brain energy deficit promoting migraine chronification. Lastly, insulin resistance may link migraine with its comorbidities, like obesity, depression, cognitive impairment and cerebrovascular diseases. PERSPECTIVE: Although additional experimental studies are needed to support this novel "neuroenergetic" hypothesis, brain insulin resistance in migraineurs may unravel the pathophysiological mechanisms of the disease, explaining the migraine chronification and connecting migraine with comorbidities. Therefore, this hypothesis could elucidate novel potential approaches for migraine treatment.

Cohort profile: the Halland osteoarthritis (HALLOA) cohort-from knee pain to osteoarthritis: a longitudinal observational study in Sweden

PURPOSE

The overall objective in this study is to investigate the early development of radiographic knee osteoarthritis (OA) and its association with hand or/and knee OA, metabolic diseases, biomarkers, chronic pain, physical function and daily physical activity types.

PARTICIPANTS

The Halland osteoarthritis (HALLOA) cohort is a longitudinal cohort study that includes individuals with knee pain in the southwest of Sweden. Enrolment took place from 2017 to 2019. The inclusion criteria were current knee pain, with no former known radiographic knee OA and no cruciate ligament rupture or rheumatological disorder. The participants were recruited: (1) when seeking care for knee pain in primary healthcare or (2) by advertisements in local newspapers. There are 306 individuals included in the study, mean age (SD) 51.7 (8.7) years and 69% are women. The baseline and follow-ups include clinical tests, radiographical examinations, blood samples, metabolic measures, pain pressure thresholds, tests of physical functions, daily physical activity types and patient-reported outcomes.

FINDINGS TO DATE

There were associations between metabolic factors and radiographic knee OA, even in those with normal body mass index at baseline. In addition, clinical hand OA was positively associated with fasting plasma glucose. We also found that modifiable factors as increased visceral fat and total body fat were associated with increased pain sensitivity among individuals with knee pain.

FUTURE PLANS

By studying possible pathophysiological mechanisms of OA over time, we aim to provide new insights on OA progression, identify usable preventive measures helping the clinicians in the management of the disease and improve health for the patients. It is also important to study the development of chronic pain in OA, to get tools to identify individuals at risk and to be able to offer them treatment.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov (NCT04928170).

Interactions between diabetes mellitus and osteoarthritis; from animal studies to clinical data

Diabetes mellitus (DM) and osteoarthritis (OA) are commonly known metabolic diseases that affect a large segment of the world population. These two conditions share several risk factors such as obesity and aging; however, there is still no consensus regarding the direct role of DM on OA development and progression. Interestingly, both animal and human studies have yielded conflicting results, with some showing a significant role for DM in promoting OA, while others found no significant interactions between these conditions. In this review, we will discuss preclinical and clinical data that assessed the interaction between DM and OA. We will also discuss possible mechanisms associated with the effect of high glucose on the articular cartilage and chondrocytes. An emerging theme dominates the breath of published work in this area: most of the studies discussed in this review do not take into consideration the role of other factors such as the type of diabetes, age, biological sex, type of animal model, body mass index, and the use of pain medications when analyzing and interpreting data. Therefore, future studies should be more rigorous when designing experiments looking at DM and its effects on OA and should carefully account for these confounding factors, so that better approaches can be developed for monitoring and treating patients at risk of OA and DM. © 2022 The Authors. JBMR Plus published by Wiley Periodicals LLC on behalf of American Society for Bone and Mineral Research.

High glucose stimulating ECM remodeling and an inflammatory phenotype in the IPFP via upregulation of MFAP5 expression

Extracellular matrix (ECM) remodeling and inflammation in the infrapatellar fat pad (IPFP) are associated with cartilage degeneration and the severity of osteoarthritis (OA). Diabetes is associated with the progression of OA. However, it is still unclear whether diabetes can promote osteoarthritis by targeting the IPFP. In this study, we established a high-fat diet/streptozotocin (HFD/STZ)-induced diabetes mouse model. We found that fibrosis and inflammation were more severe in the IPFP in diabetic mice. Transcriptomic profiling showed that MFAP5 expression was upregulated in IPFPs collected from diabetic mice compared to IPFPs collected from normal mice. We identified that Pdgfrα(+) progenitors were the primary source of MFAP5 in the IPFP under diabetic conditions. In addition, high glucose promoted the expression of MFAP5 in Pdgfrα(+) progenitors by stimulating the translocation of Yap1. Overexpression of MFAP5 in Pdgfrα(+) progenitors promoted fibrogenic differentiation and the production of IL-6. Knocking down the expression of MFAP5 efficiently prevented fibrosis and decreased the level of IL-6 in the IPFP and attenuated cartilage degeneration. Together, these results suggest that MFAP5 may be a potential novel therapeutic target for the treatment of diabetes-induced OA.

Data-independent acquisition-based proteomics analysis correlating type 2 diabetes mellitus with osteoarthritis in total knee arthroplasty patients

BACKGROUND

To explore the effects of type 2 diabetes mellitus (T2DM) on osteoarthritis (OA), 12 bone tissue samples were obtained surgically from the human total knee arthroplasty patients and analyzed by quantitative proteomics.

METHODS

Based on patient clinical histories, patient samples were assigned to diabetes mellitus osteoarthritis (DMOA) and OA groups. A data-independent acquisition method for data collection was used with proteomic data analysis to assess intergroup proteomic differences. Gene Ontology (GO) functional analysis and Kyoto Encyclopedia of Genes and Genome pathway enrichment analysis were used to further find the correlation between T2DM and OA.

RESULTS

GO functional analysis found 153 differentially expressed proteins between DMOA and OA groups, of which 92 differentially expressed proteins were significantly up-regulated and 61 were significantly down-regulated. Kyoto Encyclopedia of Genes and Genome pathway analysis found 180 pathways, including 9 pathways significantly enriched. Further data analysis revealed that 6 signaling pathways were closely associated with T2DM and OA.

CONCLUSION

OA and DMOA onset and progression were closely related to synthesis and metabolism of extracellular matrix components (e.g., fibronectin, decorin, etc.). The effects of T2DM on OA occur though 2 major ways of oxidative stress and low-grade chronic inflammation, involving in 2 inhibited signaling pathways and 4 activated signaling pathways.

A new immunometabolic perspective of intervertebral disc degeneration

Intervertebral disc (IVD) degeneration is a common finding on spine imaging that increases in prevalence with age. IVD degeneration is a frequent cause of low back pain, which is a leading cause of disability. The process of IVD degeneration consists of gradual structural change accompanied by severe alterations in metabolic homeostasis. IVD degeneration, like osteoarthritis, is a common comorbidity in patients with obesity and type 2 diabetes mellitus, two metabolic syndrome pathological conditions in which adipokines are important promoters of low-grade inflammation, extracellular matrix degradation and fibrosis. Impairment in white adipose tissue function, due to the abnormal fat accumulation in obesity, is characterized by increased production of specific pro-inflammatory proteins such as adipokines by white adipose tissue and of cytokines such as TNF by immune cells of the stromal compartment. Investigations into the immunometabolic alterations in obesity and type 2 diabetes mellitus and their interconnections with IVD degeneration provide insights into how adipokines might affect the pathogenesis of IVD degeneration and impair IVD function and repair. Toll-like receptor-mediated signalling has also been implicated as a promoter of the inflammatory response in the metabolic alterations associated with IVD and is thus thought to have a role in IVD degeneration. Pathological starvation, obesity and adipokine dysregulation can result in immunometabolic alterations, which could be targeted for the development of new therapeutics.

Do Patients With Diabetes Have Poorer Improvements in Patient-Reported Outcomes After Total Knee Arthroplasty?

BACKGROUND

Diabetes is one of the most common comorbidities in patients undergoing total knee arthroplasty (TKA) for osteoarthritis. However, the evidence remains unclear on how it affects patient-reported outcome measures after TKA.

METHODS

We reviewed prospectively collected data of 2840 patients who underwent primary unilateral TKA between 2008 and 2018, of which 716 (25.2%) had diabetes. All patients had their HbA1c measured within 1 month before surgery, and only well-controlled diabetics (HbA1c <8.0%) were allowed to proceed with surgery. Patient demographics and comorbidities were recorded, and multiple regression was performed to evaluate the impact of diabetes on improvements in patient-reported outcome measures (Short Form 36 (SF-36), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), Knee Society Score (KSS)) and knee range of motion (ROM).

RESULTS

Compared with nondiabetics, patients with diabetes were more likely to possess a higher body mass index (P-value <.001), more comorbidities (P-value <.001), and poorer preoperative SF-36 Physical Component Summary (PCS) (P-value <.001), WOMAC (P-value = .002), KSS-function (P-value <.001), and knee ROM (P-value <.001). Multiple regression showed that diabetic patients experienced marginally poorer improvements in KSS-knee (-1.22 points, P-value = .025) and knee ROM (-1.67°, P-value = .013) than nondiabetics. However, there were no significant differences in improvements for SF-36 PCS (P-value = .163), Mental Component Summary (P-value = .954), WOMAC (P-value = .815), and KSS-function (P-value = .866).

CONCLUSION

Patients with well-controlled diabetes (HbA1c <8.0%) can expect similar improvements in general health and osteoarthritis outcomes (SF-36 PCS and Mental Component Summary, WOMAC, and KSS-function) compared with nondiabetics after TKA. Despite having marginally poorer improvements in knee-specific outcomes (KSS-knee and knee ROM), these differences are unlikely to be clinically significant.

The impact of diabetes and osteoarthritis on the occurrence of stroke, acute myocardial infarction, and heart failure among older adults with non-valvular atrial fibrillation in Hawaii: a retrospective observational cohort study

Background

To date, little is known about cardiovascular disease risks among older adults with non-valvular atrial fibrillation by their association with diabetes and osteoarthritis status, based on longitudinal data with substantial amounts of non-white individuals. The objective of this study was to examine the risks for three cardiovascular diseases: stroke, acute myocardial infarction (AMI), and heart failure (HF), by diabetes and osteoarthritis status among older adults with non-valvular atrial fibrillation in Hawaii.

Methods

We conducted a retrospective observational cohort study for older adults (65 years and older) with non-valvular atrial fibrillation using the Hawaii Medicare data 2009–2017. Their risks for the three cardiovascular diseases by diabetes and osteoarthritis status (diabetes, osteoarthritis, diabetes and osteoarthritis, and without diabetes and osteoarthritis) were examined by multivariable Cox proportional hazard regression models.

Results

The analysis included 19,588 beneficiaries followed up for a maximum of 3288 days (diabetes: n = 4659, osteoarthritis: n = 1978, diabetes and osteoarthritis: n = 1230, without diabetes and osteoarthritis: n = 11,721).  Among them, those diagnosed with the cardiovascular diseases were identified (stroke: diabetes n = 837, osteoarthritis n = 315, diabetes and osteoarthritis n = 184, without diabetes and osteoarthritis n = 1630)(AMI: diabetes n = 438, osteoarthritis n = 128, diabetes and osteoarthritis n = 118, without diabetes and osteoarthritis n = 603)(HF: diabetes n = 2254, osteoarthritis n = 764, diabetes and osteoarthritis n = 581, without diabetes and osteoarthritis n = 4272). After adjusting for age, sex, race/ethnicity, and other potential confounders, those with diabetes and osteoarthritis had higher risks for HF (hazard ratio: 1.21 95% confidence interval: 1.10–1.33) than those without diabetes and osteoarthritis. They also had higher risks than those with osteoarthritis for HF. Those with diabetes had higher risks for all three cardiovascular diseases than the other three groups.

Conclusions

Variation in cardiovascular disease risks for older adults with non-valvular atrial fibrillation in Hawaii exists with diabetes and osteoarthritis status.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12889-021-11247-0.

Effects of Incretin-Related Diabetes Drugs on Bone Formation and Bone Resorption

Patients with type 2 diabetes have an increased risk of fracture compared to the general population. Glucose absorption is accelerated by incretin hormones, which induce insulin secretion from the pancreas. The level of the incretin hormone, glucagon-like peptide-1 (GLP-1), shows an immediate postprandial increase, and the circulating level of intact GLP-1 is reduced rapidly by dipeptidyl peptidase-4 (DPP-4)-mediated inactivation. Therefore, GLP-1 receptor agonists and DPP-4 inhibitors are effective in the treatment of type 2 diabetes. However, these incretin-related diabetic agents have been reported to affect bone metabolism, including bone formation and resorption. These agents enhance the expression of bone markers, and have been applied to improve bone quality and bone density. In addition, they have been reported to suppress chronic inflammation and reduce the levels of inflammatory cytokine expression. Previously, we reported that these incretin-related agents inhibited both the expression of inflammatory cytokines and inflammation-induced bone resorption. This review presents an overview of current knowledge regarding the effects of incretin-related diabetes drugs on osteoblast differentiation and bone formation as well as osteoclast differentiation and bone resorption. The mechanisms by which incretin-related diabetes drugs regulate bone formation and bone resorption are also discussed.

[Prevalence and risk factors of osteoarthritis in patients with type 2 diabetes in Beijing, China from 2015 to 2017]

OBJECTIVE

To explore the prevalence and related factors of osteoarthritis in patients with type 2 diabetes mellitus, and provided a scientific basis for the prevention of the comorbidity.

METHODS

The data were obtained from the database of all designated medical institutions in Beijing from 2015 to 2017. Data of the adult patients with type 2 diabetes mellitus were collected for descriptive analysis, and a Logistic regression model was used to explore the related factors of osteoarthritis in the patients with type 2 diabetes mellitus.

RESULTS

A total of 1 046 264 diagnosed type 2 diabetes mellitus adult patients were included in our study, with an average age of 63.07 years, and 50.78% were males. Among the patients with type 2 diabetes mellitus, there were 341 561 cases with osteoarthritis, and the prevalence of osteoarthritis was 32.65%. The prevalence of females (38.05%) was higher than that of males (27.41%), and the difference was statistically significant (P < 0.05). Osteoarthritis occurred in all age groups among the patients with type 2 diabetes mellitus, with the highest prevalence of osteoarthritis in the age group of 65-69 years (36.76%), and the lowest prevalence in the age group ≤44 years (14.3%). Before the age of 70, the prevalence increased with age. Further analysis of related factors for osteoarthritis in the patients with type 2 diabetes mellitus showed that female (OR=1.62, 95%CI: 1.61-1.63), age (OR=1.01, 95%CI: 1.01-1.01), had other comorbidities (OR=1.19, 95%CI: 1.18-1.21), used hypoglycemic drugs (OR=0.79, 95%CI: 0.78-0.80), having the cardiovascular disease (OR=1.13, 95%CI: 1.11-1.15), having cerebrovascular disease (OR=1.25, 95%CI: 1.23-1.28), and having nephropathy (OR=1.61, 95%CI: 1.51-1.71) were associated with the osteoarthritis in the type 2 diabetic mellitus patients.

CONCLUSION

Our study revealed that the prevalence of osteoarthritis in patients with type 2 diabetes mellitus is high in Beijing area. Health education and disease monitoring should be strengthened in middle-aged and elderly patients. Screening for comorbidities should be carried out as soon as possible, with the focus on menopausal women.