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Mobasheri A, Im GI, Katz JN, Loughlin J, Kraus VB, Sandell LJ, Berenbaum F, Abramson S, Lotz M, Hochberg M, Pelletier JP, Madry H, Block JA, Lohmander LS, Altman RD. Osteoarthritis Research Society International (OARSI): Past, present and future. OSTEOARTHRITIS AND CARTILAGE OPEN 2021; 3:100146. [PMID: 36474983 PMCID: PMC9718339 DOI: 10.1016/j.ocarto.2021.100146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 02/15/2021] [Accepted: 02/18/2021] [Indexed: 11/23/2022] Open
Abstract
We provide a detailed account of the origin and establishment of the Osteoarthritis Research Society International (OARSI) and celebrate its history from inception to the current day. We discuss the mission, vision and strategic objectives of OARSI and how these have developed and evolved over the last 3 decades. We celebrate the achievements of the society as we approach its 30th birthday, honor the entire presidential line and respectfully pay tribute to the past presidents who are no longer with us. We reflect on the strong foundations of our society, OARSI's efforts to disseminate understanding of the health, disability and economic burdens of osteoarthritis (OA) to policymakers, and the exciting initiatives to make the society inclusive and international. We thank our corporate and industrial sponsors, who have supported us over many years, without whom our annual congresses would not have been possible. We celebrate our longstanding strategic partnership with our publisher, Elsevier, and the successful launch of our new journal Osteoarthritis and Cartilage Open, the most significant new development in our dissemination toolbox. For the first time in the history of the organization, our annual congress was cancelled in April 2020 and the 2021 meeting will be virtual. Despite the numerous challenges posed by the ongoing COVID-19 pandemic and the need to adapt quickly to a rapidly changing landscape, we must remain optimistic about the future. We will take advantage of new exciting opportunities to advance our mission and vision to enhance the quality of life of persons with OA.
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Affiliation(s)
- Ali Mobasheri
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, Vilnius, Lithuania
- Departments of Orthopaedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, the Netherlands
- Department of Joint Surgery, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, Guangdong, China
| | - Gun-il Im
- Dongguk University, Goyang, South Korea
| | - Jeffrey N. Katz
- Brigham and Women’s Hospital, Harvard Medical School and Harvard Chan School of Public Health, Boston, MA, United States
| | - John Loughlin
- Newcastle University, Biosciences Institute, Newcastle Upon Tyne, United Kingdom
| | | | | | - Francis Berenbaum
- Department of Rheumatology, Sorbonne Université, INSERM CRSA, AP-HP Hopital Saint Antoine, Paris, France
| | - Steve Abramson
- New York University Langone Orthopedic Center, New York, NY, USA
| | - Martin Lotz
- The Scripps Research Institute, La Jolla, CA, USA
| | - Marc Hochberg
- Department of Medicine, Division of Rheumatology and Clinical Immunology, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM), Montreal, Quebec, Canada
| | - Henning Madry
- Department of Orthopaedic Surgery and Center of Experimental Orthopaedics, Saarland University Medical Center, Homburg, Germany
| | - Joel A. Block
- Department of Internal Medicine, Division of Rheumatology, Rush Medical College, Chicago, IL, USA
| | - L. Stefan Lohmander
- Department of Clinical Sciences, Orthopaedics, Faculty of Medicine, Lund University, Lund, Sweden
| | - Roy D. Altman
- Ronald Reagan UCLA Medical Center, Los Angeles, CA, USA
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Onodera CMK, Coelho-Júnior HJ, Sampaio RAC, Santos Duarte Lana JF, Teixeira LFM, Uchida MC, Bizzacchi JMA. The importance of objectively measuring functional tests in complement to self-report assessments in patients with knee osteoarthritis. Gait Posture 2020; 82:33-37. [PMID: 32871410 DOI: 10.1016/j.gaitpost.2020.08.121] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2019] [Revised: 08/16/2020] [Accepted: 08/18/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Osteoarthritis (OA) is a chronic degenerative disease which can result in chronic pain, loss of joint function and consequently decline in quality of life. RESEARCH QUESTION A variety of instruments that measure the different dimensions of health status in patients with OA are available. However, despite the fact that WOMAC and other questionnaires and scales may provide additional understanding regarding the patient's condition, some studies have reported discrepancies between patients' perceptions and their actual ability to perform the task. The aim of the present study was investigate the physical capabilities with the function domain of WOMAC. METHODS This study has a cross-sectional design including patients diagnosed with moderate to severe knee OA (i.e., grades II, III and IV) according to the Kellgren-Lawrence. These patients were submitted to the battery of functional tests recommended by the OARSI group (30-second chair stand test, 40 m fast paced walking test, Stair climb test, timed "Up and Go", and Six-minute walking test) and filled the WOMAC. Pearson's correlation and multiple linear regression was applied. RESULTS A total of 153 patients were included. A significant and weak correlation was observed between WOMAC and the 40-meter walking test, TUG, stair-climbing test, and the 6MWT. In addition, 30-second chair stand test demonstrated a significant and moderate correlation (r=-0.503). The multiple regression analysis results indicated that only 30-second chair stand test was a significant (p = 0.001) predictor of WOMAC. This result remains significant even after adjusting for age, BMI, total muscle mass, and number of knees affected SIGNIFICANCE: The 30-second chair stand test is associated with the WOMAC function domain. There is no correlation of this domain with any other functional tests, emphasizing the importance of including other tests for a global evaluation.
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Affiliation(s)
| | - Hélio José Coelho-Júnior
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas SP, Brazil; Department of Geriatrics of Università Cattolica del Sacro Cuore, Rome, Italy
| | - Ricardo Aurélio Carvalho Sampaio
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas SP, Brazil; Department of Health Education, Federal University of Sergipe, Lagarto SE, Brazil
| | - José Fabio Santos Duarte Lana
- Research Institute of Sports Medicine, Orthopedics and Regeneration - iMOR, Uberaba, MG, Brazil; Institute of Orthopedics and Traumatology of University of Campinas, Campinas SP, Brazil
| | - Luis Felipe Milano Teixeira
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas SP, Brazil; Department of Physical Education of Sorocaba's University, Sorocaba SP, Brazil
| | - Marco Carlos Uchida
- Department of Adapted Physical Activity, School of Physical Education, University of Campinas, Campinas SP, Brazil.
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Swain S, Sarmanova A, Coupland C, Doherty M, Zhang W. Comorbidities in Osteoarthritis: A Systematic Review and Meta-Analysis of Observational Studies. Arthritis Care Res (Hoboken) 2020; 72:991-1000. [PMID: 31207113 DOI: 10.1002/acr.24008] [Citation(s) in RCA: 112] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 06/11/2019] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) is a common chronic condition in older individuals, but its association with other chronic conditions is largely unknown. This study aimed to systematically review the literature on comorbidities in individuals with OA compared to those without. METHODS We searched 4 databases for observational studies on comorbidities in individuals with OA. Studies of OA only or in comparison with non-OA controls were included. The risk of bias and study quality were assessed using the Newcastle-Ottawa Scale. The prevalence of comorbidities in the OA group and the prevalence ratio (PR) and 95% confidence interval (95% CI) between OA and non-OA groups were calculated. RESULTS In all, 42 studies from 16 countries (27 case-only and 15 comparative studies) met the inclusion criteria. The mean age of participants varied from 51 to 76 years. The pooled prevalence of any comorbidity was 67% (95% CI 57-74) in individuals with OA versus 56% (95% CI 44-68) in individuals without OA. The pooled PR for any comorbidity was 1.21 (95% CI 1.02-1.45). The PR increased from 0.73 (95% CI 0.43-1.25) for 1 comorbidity to 1.58 (95% CI 1.03-2.42) for 2, and to 1.94 (95% CI 1.45-2.59) for ≥3 comorbidities. The key comorbidities associated with OA were stroke (PR 2.61 [95% CI 2.13-3.21]), peptic ulcer (PR 2.36 [95% CI 1.71-3.27]), and metabolic syndrome (PR 1.94 [95% CI 1.21-3.12]). CONCLUSION Individuals with OA are more likely to have other chronic conditions. The association is dose-dependent in terms of the number of comorbidities, suggesting multimorbidities. Further studies on the causality of this association and clinical implications are needed.
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Affiliation(s)
| | | | - Carol Coupland
- School of Medicine, University of Nottingham, Nottingham, UK
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Menetski JP, Hoffmann SC, Cush SS, Kamphaus TN, Austin CP, Herrling PL, Wagner JA. The Foundation for the National Institutes of Health Biomarkers Consortium: Past Accomplishments and New Strategic Direction. Clin Pharmacol Ther 2019; 105:829-843. [PMID: 30648736 PMCID: PMC6593617 DOI: 10.1002/cpt.1362] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2018] [Accepted: 12/18/2018] [Indexed: 11/16/2022]
Abstract
The Foundation for the National Institutes of Health (FNIH) Biomarkers Consortium (BC) is a public-private partnership that aims to facilitate drug development with biomarkers across a range of therapeutic areas. The BC is organized to address specific precompetitive biomarker projects, giving participating stakeholders a role in the design and conduct of projects and making the results freely public. Ultimately, the goals of the BC are to accelerate the development of new medicines, inform regulatory decision making, and improve patient care. Here, we describe how the BC works and briefly highlight its accomplishments. The BC has had many notable successful biomarker projects in the past 12 years, including I-SPY2, which has improved clinical trials and biomarker use for breast cancer, and an evidentiary framework for biomarker qualification. Recently, the BC has undergone a strategic expansion of its scope to include related drug development tools along the lines of the Biomarkers, Endpoints, and other Tools (BEST) resource.
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Affiliation(s)
- Joseph P. Menetski
- Foundation for the National Institutes of HealthNorth BethesdaMarylandUSA
| | - Steven C. Hoffmann
- Foundation for the National Institutes of HealthNorth BethesdaMarylandUSA
| | - Stephanie S. Cush
- Foundation for the National Institutes of HealthNorth BethesdaMarylandUSA
| | | | - Christopher P. Austin
- National Center for Advancing Translational SciencesNational Institutes of HealthBethesdaMarylandUSA
| | - Paul L. Herrling
- Foundation for the National Institutes of HealthBethesdaMarylandUSA
| | - John A. Wagner
- Takeda Pharmaceuticals International Co.CambridgeMassachusettsUSA
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5
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Problems persist in reporting of methods and results for the WOMAC measure in hip and knee osteoarthritis trials. Qual Life Res 2018; 28:335-343. [PMID: 30229533 PMCID: PMC6373321 DOI: 10.1007/s11136-018-1978-1] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2018] [Indexed: 01/25/2023]
Abstract
Purpose The Western Ontario and McMaster Universities Arthritis Index (WOMAC) is a commonly used outcome measure for osteoarthritis. There are different versions of the WOMAC (Likert, visual analogue or numeric scales). A previous review of trials published before 2010 found poor reporting and inconsistency in how the WOMAC was used. This review explores whether these problems persist. Methods This systematic review included randomised trials of hip and/or knee osteoarthritis published in 2016 that used the WOMAC. Data were extracted on the version used, score range, analysis and results of the WOMAC, and whether these details were clearly reported. Results This review included 62 trials and 41 reported the WOMAC total score. The version used and item range for the WOMAC total score were unclear in 44% (n = 18/41) and 24% (n = 10/41) of trials, respectively. The smallest total score range was 0–10 (calculated by averaging 24 items scored 0–10); the largest was 0–2400 (calculated by summing 24 items scored 0–100). All trials reported the statistical analysis methods but only 29% reported the between-group mean difference and 95% confidence interval. Conclusion Details on the use and scoring of the WOMAC were often not reported. We recommend that trials report the version of the WOMAC and the score range used. The between-group treatment effect and corresponding confidence interval should be reported. If all the items of the WOMAC are collected, the total score and individual subscale scores should be presented. Better reporting would facilitate the interpretation, comparison and synthesis of the WOMAC score in trials. Electronic supplementary material The online version of this article (10.1007/s11136-018-1978-1) contains supplementary material, which is available to authorized users.
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Delgado-Enciso I, Paz-Garcia J, Rodriguez-Hernandez A, Madrigal-Perez VM, Cabrera-Licona A, Garcia-Rivera A, Soriano-Hernandez AD, Cortes-Bazan JL, Galvan-Salazar HR, Valtierra-Alvarez J, Guzman-Esquivel J, Rodriguez-Sanchez IP, Martinez-Fierro ML, Paz-Michel B. A promising novel formulation for articular cartilage regeneration: Preclinical evaluation of a treatment that produces SOX9 overexpression in human synovial fluid cells. Mol Med Rep 2017; 17:3503-3510. [PMID: 29286152 PMCID: PMC5802147 DOI: 10.3892/mmr.2017.8336] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2017] [Accepted: 09/07/2017] [Indexed: 12/13/2022] Open
Abstract
Osteoarthritis (OA) is a chronic disorder of synovial joints, in which there is progressive softening and disintegration of the articular cartilage. OA is the most common form of arthritis, and is the primary cause of disability and impaired quality of life in the elderly. Despite considerable medical necessity, no treatment has yet been proven to act as a disease‑modifying agent that may halt or reverse the structural progression of OA. The replacement of the joint with a prosthesis appears to be the best option in the advanced stages of the disease. A formulation (BIOF2) for cartilage regeneration has been recently developed. The present study evaluated the effects of BIOF2 on gene expression in human cell cultures, followed by efficacy trials in three OA animal models. Human synovial fluid cells that were exposed to the formulation exhibited increased transcription factor SOX‑9 (SOX9; chondrogenic factor) expression, and decreased mimecan (mineralization inducer) and macrophage‑stimulating protein receptor (osteoclastogenic factor) expression. The intra‑articular application of BIOF2 in the animal models significantly increased cartilage thickness from 12 to 31% at 28 days, compared with articular cartilage treated with saline solution. The articular area and number of chondrocytes additionally increased significantly, maintaining an unaltered chondrocyte/mm2 proportion. Evaluation of the histological architecture additionally displayed a decrease in the grade of articular damage in the groups treated with BIOF2. In conclusion, BIOF2 has proven to be effective for treating OA in animal models, most likely due to SOX9 overexpression in articular cells.
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Affiliation(s)
- Ivan Delgado-Enciso
- Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
| | - Juan Paz-Garcia
- Centro Hospitalario Union, Villa de Álvarez, Colima 28950, Mexico
| | | | | | | | | | | | - Jose L Cortes-Bazan
- Cancerology State Institute, Colima State Health Services, Colima 28000, Mexico
| | | | | | | | - Iram P Rodriguez-Sanchez
- Department of Genetics, School of Medicine, Nuevo Leon Autonomous University, Monterrey, Nuevo León 64460, Mexico
| | - Margarita L Martinez-Fierro
- Molecular Medicine Laboratory, Academic Unit of Human Medicine and Health Sciences, Universidad Autónoma de Zacatecas, Zacatecas 98160, México
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Ruiz Iban M, Tejedor A, Gil Garay E, Revenga C, Hermosa J, Montfort J, Peña M, López Millán J, Montero Matamala A, Capa Grasa A, Navarro M, Gobbo M, Loza E. GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017. [DOI: 10.1016/j.recote.2017.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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8
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Ruiz Iban MA, Tejedor A, Gil Garay E, Revenga C, Hermosa JC, Montfort J, Peña MJ, López Millán JM, Montero Matamala A, Capa Grasa A, Navarro MJ, Gobbo M, Loza E. GEDOS-SECOT consensus on the care process of patients with knee osteoarthritis and arthoplasty. Rev Esp Cir Ortop Traumatol (Engl Ed) 2017; 61:296-312. [PMID: 28689784 DOI: 10.1016/j.recot.2017.03.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 03/21/2017] [Accepted: 03/27/2017] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVE To develop recommendations on the evaluation and management procedure in patients undergoing total knee replacement based on best evidence and the experience of a panel of experts. METHODS A multidisciplinary group of 12 experts was selected that defined the scope, users and the document parts. Three systematic reviews were performed in patients undergoing knee replacement: (i)efficacy and safety of fast-tracks; (ii)efficacy and safety of cognitive interventions in patients with catastrophic pain, and (iii) efficacy and safety of acute post-surgical pain management on post-surgical outcomes. A narrative review was conducted on the evaluation and management of pain sensitization, and about the efficacy and safety of pre-surgical physiotherapy. The experts generated the recommendations and explicative text. The level of agreement was evaluated in a multidisciplinary group of 85 experts with the Delphi technique. The level of evidence was established as well for each recommendation. RESULTS A total of 20 recommendations were produced. An agreement higher than 80% was reached in all of them. We found the highest agreement on the need for a full discharge report, on providing proper information about the process and on following available guidelines. CONCLUSIONS There is consensus among professionals involved in the management of patients undergoing total knee replacement, in that it is important to protocolize the replacement process, performing a proper, integrated and coordinated patient evaluation and follow-up, paying special attention to the surgical procedure and postoperative period.
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Affiliation(s)
- M A Ruiz Iban
- Servicio Traumatología y Cirugía Ortopédica, Hospital Universitario Ramón y Cajal, Madrid, España
| | - A Tejedor
- Especialista en Medicina Familiar y Comunitaria, CS Las Ciudades, Getafe, Madrid, España
| | - E Gil Garay
- Servicio de Traumatología y Cirugía Ortopédica, Hospital Universitario La Paz, Madrid, España
| | - C Revenga
- Servicio de Traumatología y Cirugía Ortopédica, Hospital San Juan Grande, Jerez de la Frontera, Cádiz, España
| | - J C Hermosa
- Especialista en Medicina Familiar y Comunitaria, CS Las Ciudades, Getafe, Madrid, España
| | - J Montfort
- Servicio de Reumatología, Hospital del Mar, Barcelona, España
| | - M J Peña
- Responsable de Enfermería de Atención Primaria del sector II, Zaragoza, España
| | - J M López Millán
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitario Virgen Macarena, Sevilla, España
| | - A Montero Matamala
- Servicio de Anestesiología, Reanimación y Terapéutica del Dolor, Hospital Universitari Arnau de Vilanova, Lleida, España
| | - A Capa Grasa
- Servicio de Medicina Física y Rehabilitación Médica, Hospital Universitario La Paz, Madrid, España
| | - M J Navarro
- Servicio de Medicina Física y Rehabilitación Médica, Hospital Universitario Doctor Peset, Valencia, España
| | - M Gobbo
- Positivamente Centro de Psicología, Madrid, España
| | - E Loza
- Instituto de Salud Musculoesquelética, Madrid, España.
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Abstract
Few studies have assessed postoperative trends in opioid cessation and predictors of persistent opioid use after total knee arthroplasty (TKA) and total hip arthroplasty (THA). Preoperatively, 574 TKA and THA patients completed validated, self-report measures of pain, functioning, and mood and were longitudinally assessed for 6 months after surgery. Among patients who were opioid naive the day of surgery, 8.2% of TKA and 4.3% of THA patients were using opioids at 6 months. In comparison, 53.3% of TKA and 34.7% of THA patients who reported opioid use the day of surgery continued to use opioids at 6 months. Patients taking >60 mg oral morphine equivalents preoperatively had an 80% likelihood of persistent use postoperatively. Day of surgery predictors for 6-month opioid use by opioid-naive patients included greater overall body pain (P = 0.002), greater affected joint pain (knee/hip) (P = 0.034), and greater catastrophizing (P = 0.010). For both opioid-naive and opioid users on the day of surgery, decreases in overall body pain from baseline to 6 months were associated with decreased odds of being on opioids at 6 months (adjusted odds ratio [aOR] = 0.72, P = 0.050; aOR = 0.62, P = 0.001); however, change in affected joint pain (knee/hip) was not predictive of opioid use (aOR = 0.99, P = 0.939; aOR = 1.00, P = 0.963). In conclusion, many patients taking opioids before surgery continue to use opioids after arthroplasty and some opioid-naive patients remained on opioids; however, persistent opioid use was not associated with change in joint pain. Given the growing concerns about chronic opioid use, the reasons for persistent opioid use and perioperative prescribing of opioids deserve further study.
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Wang P, Yang L, Liu C, Wei X, Yang X, Zhou Y, Jiang H, Lei Z, Reinhardt JD, He C. Effects of Whole Body Vibration Exercise associated with Quadriceps Resistance Exercise on functioning and quality of life in patients with knee osteoarthritis: a randomized controlled trial. Clin Rehabil 2016; 30:1074-1087. [PMID: 26427960 DOI: 10.1177/0269215515607970] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To determine effects of Whole Body Vibration Exercise (WBVE) associated with quadriceps resistance exercises (QRE) versus QRE only on pain, physical function, biomarkers in serum and urine, activities of daily living (ADL), and quality of life in patients with knee osteoarthitis (OA). DESIGN Randomized-controlled trial . SETTING Rehabilitation medicine outpatient department of West China Hospital, Chengdu, Sichuan, People's Republic of China. SUBJECTS Forty-nine patients were assigned to WBVE+QRE and 50 to QRE . MAIN OUTCOME MEASURES Primary outcomes included pain assessed with visual analogue scale (VAS), Timed up & go test (TUG), 6-min walk distance test (6MWD), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Secondary outcomes comprised range of motion, muscular strength, serum COMP and urinary CTX-II, Lequesne Index (LI), and SF-36. All outcomes were analyzed with mixed effects regression. RESULTS Compared with QRE, WBVE+QRE showed significantly greater improvement in VAS at 4weeks ( p=0.03), in VAS ( p<0.01), 6MWD ( p=0.01), WOMAC pain ( p=0.01), and WOMAC physical function ( p=0.02) at 16 weeks, and in all primary outcomes at 24 weeks (all p<0.01). CONCLUSION Over a six months period, WBVE in combination with QRE was superior to QRE in most outcomes.
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Affiliation(s)
- Pu Wang
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
| | - Lin Yang
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
| | - Chuan Liu
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
| | - Xiaofei Wei
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
| | - Xiaotian Yang
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
| | - Yujing Zhou
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
| | - Hua Jiang
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Zhongjie Lei
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China
| | - Jan D Reinhardt
- 3 Institute for Disaster Management and Reconstruction of Sichuan University and Hong Kong Polytechnic University, Chengdu, Sichuan, People's Republic of China.,5 Department of Health Sciences and Health Policy, University of Lucerne, Lucerne, Switzerland
| | - Chengqi He
- 1 Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, Sichuan, People's Republic of China.,2 Key Laboratory of Rehabilitation Medicine in Sichuan, Chengdu, Sichuan, People's Republic of China
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Stok KS, Besler BA, Steiner TH, Villarreal Escudero AV, Zulliger MA, Wilke M, Atal K, Quintin A, Koller B, Müller R, Nesic D. Three-Dimensional Quantitative Morphometric Analysis (QMA) for In Situ Joint and Tissue Assessment of Osteoarthritis in a Preclinical Rabbit Disease Model. PLoS One 2016; 11:e0147564. [PMID: 26808542 PMCID: PMC4726512 DOI: 10.1371/journal.pone.0147564] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2015] [Accepted: 01/05/2016] [Indexed: 11/23/2022] Open
Abstract
This work utilises advances in multi-tissue imaging, and incorporates new metrics which define in situ joint changes and individual tissue changes in osteoarthritis (OA). The aims are to (1) demonstrate a protocol for processing intact animal joints for microCT to visualise relevant joint, bone and cartilage structures for understanding OA in a preclinical rabbit model, and (2) introduce a comprehensive three-dimensional (3D) quantitative morphometric analysis (QMA), including an assessment of reproducibility. Sixteen rabbit joints with and without transection of the anterior cruciate ligament were scanned with microCT and contrast agents, and processed for histology. Semi-quantitative evaluation was performed on matching two-dimensional (2D) histology and microCT images. Subsequently, 3D QMA was performed; including measures of cartilage, subchondral cortical and epiphyseal bone, and novel tibio-femoral joint metrics. Reproducibility of the QMA was tested on seven additional joints. A significant correlation was observed in cartilage thickness from matching histology-microCT pairs. The lateral compartment of operated joints had larger joint space width, thicker femoral cartilage and reduced bone volume, while osteophytes could be detected quantitatively. Measures between the in situ tibia and femur indicated an altered loading scenario. High measurement reproducibility was observed for all new parameters; with ICC ranging from 0.754 to 0.998. In conclusion, this study provides a novel 3D QMA to quantify macro and micro tissue measures in the joint of a rabbit OA model. New metrics were established consisting of: an angle to quantitatively measure osteophytes (σ), an angle to indicate erosion between the lateral and medial femoral condyles (ρ), a vector defining altered angulation (λ, α, β, γ) and a twist angle (τ) measuring instability and tissue degeneration between the femur and tibia, a length measure of joint space width (JSW), and a slope and intercept (m, Χ) of joint contact to demonstrate altered loading with disease progression, as well as traditional bone and cartilage and histo-morphometry measures. We demonstrate correlation of microCT and histology, sensitive discrimination of OA change and robust reproducibility.
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Affiliation(s)
- Kathryn S. Stok
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- SCANCO Medical AG, Bruttisellen, Switzerland
- * E-mail:
| | | | | | | | | | - Markus Wilke
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | - Kailash Atal
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Aurelie Quintin
- Department of Clinical Research, University of Bern, Bern, Switzerland
| | | | - Ralph Müller
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
| | - Dobrila Nesic
- Department of Clinical Research, University of Bern, Bern, Switzerland
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Brummett CM, Urquhart AG, Hassett AL, Tsodikov A, Hallstrom BR, Wood NI, Williams DA, Clauw DJ. Characteristics of fibromyalgia independently predict poorer long-term analgesic outcomes following total knee and hip arthroplasty. Arthritis Rheumatol 2015; 67:1386-94. [PMID: 25772388 PMCID: PMC4414825 DOI: 10.1002/art.39051] [Citation(s) in RCA: 134] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Accepted: 01/22/2015] [Indexed: 12/27/2022]
Abstract
Objective While psychosocial factors have been associated with poorer outcomes after knee and hip arthroplasty, we hypothesized that augmented pain perception, as occurs in conditions such as fibromyalgia, may account for decreased responsiveness to primary knee and hip arthroplasty. Methods A prospective, observational cohort study was conducted. Preoperative phenotyping was conducted using validated questionnaires to assess pain, function, depression, anxiety, and catastrophizing. Participants also completed the 2011 fibromyalgia survey questionnaire, which addresses the widespread body pain and comorbid symptoms associated with characteristics of fibromyalgia. Results Of the 665 participants, 464 were retained 6 months after surgery. Since individuals who met criteria for being classified as having fibromyalgia were expected to respond less favorably, all primary analyses excluded these individuals (6% of the cohort). In the multivariate linear regression model predicting change in knee/hip pain (primary outcome), a higher fibromyalgia survey score was independently predictive of less improvement in pain (estimate −0.25, SE 0.044; P < 0.00001). Lower baseline joint pain scores and knee (versus hip) arthroplasty were also predictive of less improvement (R2 = 0.58). The same covariates were predictive in the multivariate logistic regression model for change in knee/hip pain, with a 17.8% increase in the odds of failure to meet the threshold of 50% improvement for every 1‐point increase in fibromyalgia survey score (P = 0.00032). The fibromyalgia survey score was also independently predictive of change in overall pain and patient global impression of change. Conclusion Our findings indicate that the fibromyalgia survey score is a robust predictor of poorer arthroplasty outcomes, even among individuals whose score falls well below the threshold for the categorical diagnosis of fibromyalgia.
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Zhen G, Cao X. Targeting TGFβ signaling in subchondral bone and articular cartilage homeostasis. Trends Pharmacol Sci 2014; 35:227-36. [PMID: 24745631 DOI: 10.1016/j.tips.2014.03.005] [Citation(s) in RCA: 154] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2013] [Revised: 02/27/2014] [Accepted: 03/13/2014] [Indexed: 01/02/2023]
Abstract
Osteoarthritis (OA) is the most common degenerative joint disease and no disease-modifying therapy for OA is currently available. Targeting articular cartilage alone may not be sufficient to halt this disease progression. Articular cartilage and subchondral bone act as a functional unit. Increasing evidence indicates that transforming growth factor β (TGFβ) plays a crucial role in maintaining homeostasis of both articular cartilage and subchondral bone. Activation of extracellular matrix (ECM) latent TGFβ at the appropriate time and location is a prerequisite for its function. Aberrant activation of TGFβ in the subchondral bone in response to an abnormal mechanical loading environment induces formation of osteroid islets at the onset of OA. As a result, alteration of subchondral bone structure changes the stress distribution on the articular cartilage and leads to its degeneration. Thus, inhibition of TGFβ activity in the subchondral bone may provide a new avenue of treatment for OA. In this review we will discuss the role of TGFβ in the homeostasis of articular cartilage and subchondral bone as a novel target for OA therapy.
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Affiliation(s)
- Gehua Zhen
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Ross Building, Room 229, 720 Rutland Ave, Baltimore, MD 21205, USA
| | - Xu Cao
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Ross Building, Room 229, 720 Rutland Ave, Baltimore, MD 21205, USA.
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Survey criteria for fibromyalgia independently predict increased postoperative opioid consumption after lower-extremity joint arthroplasty: a prospective, observational cohort study. Anesthesiology 2014; 119:1434-43. [PMID: 24343289 DOI: 10.1097/aln.0b013e3182a8eb1f] [Citation(s) in RCA: 167] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Variance in pain after total knee and hip arthroplasty may be due to a number of procedural and peripheral factors but also, in some individuals, to aberrant central pain processing as is described in conditions like fibromyalgia. To test this hypothesis, the authors conducted a prospective, observational cohort study of patients undergoing lower-extremity joint arthroplasty. METHODS Five hundred nineteen patients were preoperatively phenotyped using validated self-reported pain questionnaires, psychological measures, and health information. In addition to being assessed for factors previously found to be associated with poor outcomes in arthroplasty, participants also completed the American College of Rheumatology survey criteria for fibromyalgia. Previous studies have suggested that rather than being "present" or "absent," features of fibromyalgia as measured by this instrument, occur over a wide continuum. Postoperative pain control was assessed by total postoperative opioid consumption. RESULTS Preoperatively, patients with higher fibromyalgia survey scores were younger, more likely to be female, taking more opioids, reported higher pain severity, and had a more negative psychological profile. In the multivariate analysis, the fibromyalgia survey score, younger age, preoperative opioid use, knee (vs. hip), pain severity at baseline, and the anesthetic technique were all predictive of increased postoperative opioid consumption. CONCLUSIONS The use of the survey criteria for fibromyalgia led to the finding of distinct phenotypic differences, and the measure was independently predictive of opioid consumption. This self-report measure may provide an additional simple means of predicting postoperative pain outcomes and analgesic requirements. Future studies are needed to determine whether tailored therapies can improve postoperative pain control in this population.
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