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Dell'Isola A, Recenti F, Englund M, Kiadaliri A. Twenty-year trajectories of morbidity in individuals with and without osteoarthritis. RMD Open 2024; 10:e004164. [PMID: 38955511 DOI: 10.1136/rmdopen-2024-004164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 05/21/2024] [Indexed: 07/04/2024] Open
Abstract
OBJECTIVES To identify multimorbidity trajectories over 20 years among incident osteoarthritis (OA) individuals and OA-free matched references. METHODS Cohort study using prospectively collected healthcare data from the Skåne region, Sweden (~1.4 million residents). We extracted diagnoses for OA and 67 common chronic conditions. We included individuals aged 40+ years on 31 December 2007, with incident OA between 2008 and 2009. We selected references without OA, matched on birth year, sex, and year of death or moving outside the region. We employed group-based trajectory modelling to capture morbidity count trajectories from 1998 to 2019. Individuals without any comorbidity were included as a reference group but were not included in the model. RESULTS We identified 9846 OA cases (mean age: 65.9 (SD 11.7), female: 58%) and 9846 matched references. Among both cases and references, 1296 individuals did not develop chronic conditions (no-chronic-condition class). We identified four classes. At the study outset, all classes exhibited a low average number of chronic conditions (≤1). Class 1 had the slowest progression towards multimorbidity, which increased progressively in each class. Class 1 had the lowest count of chronic conditions at the end of the follow-up (mean: 2.9 (SD 1.7)), while class 4 had the highest (9.6 (2.6)). The presence of OA was associated with a 1.29 (1.12, 1.48) adjusted relative risk of belonging to class 1 up to 2.45 (2.12, 2.83) for class 4. CONCLUSIONS Our findings suggest that individuals with OA face an almost threefold higher risk of developing severe multimorbidity.
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Affiliation(s)
- Andrea Dell'Isola
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Filippo Recenti
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genoa, Savona, Italy
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Ali Kiadaliri
- Clinical Epidemiology Unit, Orthopedics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden
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Chandrashekar S, Jeyaraman M, Mounissamy P, Jeyaraman N, Khanna M, Gupta A. Safety and Efficacy of Bone-Marrow Aspirate Concentrate in Hip Osteoarthritis: A Systematic Review of Current Clinical Evidence. Indian J Orthop 2024; 58:835-844. [PMID: 38948376 PMCID: PMC11208346 DOI: 10.1007/s43465-024-01183-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2024] [Accepted: 05/04/2024] [Indexed: 07/02/2024]
Abstract
Introduction Hip osteoarthritis (OA) is one of the leading causes of disability and morbidity worldwide. It is estimated to affect 9.2% individuals globally with age over 45 years. Conventional treatment modalities have limitations and side-effects. To overcome these limitations, over the last decade, there has been an increased interest in the use of orthobiologics derived from autologous sources including platelet-rich plasma (PRP), bone-marrow aspirate concentrate (BMAC) and adipose tissue derived formulations. This review qualitatively presents the in-vitro, pre-clinical, clinical and on-going clinical studies exploring the safety and efficacy of BMAC for management of hip OA. Materials and methods The electronic database search was done through PubMed, Embase, Web of Science, Scopus, ProQuest and Google Scholar till February 2024. The search terms used were "osteoarthritis" OR "hip osteoarthritis" OR "orthobiologics" OR "efficacy or use of orthobiologic treatment" OR "bone-marrow concentrate" OR "bone-marrow aspirate concentrate", AND "BMAC". The inclusion criteria were clinical studies of any level of evidence written in the English language, published till February 2024, evaluating the safety and efficacy of intra-articular administration of BMAC for the management of hip OA. Results A total of 5 studies were included in this review for qualitative data synthesis. The total number of patients who participated in the study was 182, ranging from 4 to 112 in a single study. No adverse events were reported throughout the duration of the study. In addition, intra-articular administration of BMAC led to reduced pain, and improved function and overall quality of life (QoL). Conclusion The results from this review demonstrated that administration of BMAC is safe and potentially efficacious in terms of reducing pain, improving function and overall QoL of patients with hip OA in short- and mid-term average follow-up based on the included studies. Nonetheless, more adequately powered, multi-center, prospective, double-blind, non-randomized and randomized controlled trials with long-term follow-up are warranted to establish long-term safety and efficacy of BMAC for management of hip OA and justify its routine clinical use.
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Affiliation(s)
- Sushma Chandrashekar
- Fellow in Orthopaedic Rheumatology, Dr RML National Law University, Lucknow, 226010 Uttar Pradesh India
| | - Madhan Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077 Tamil Nadu India
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA
| | - Prabu Mounissamy
- Department of Orthopaedics, Jawaharlal Institute of Postgraduate Medical Education and Research, Puducherry, 605006 India
| | - Naveen Jeyaraman
- Department of Orthopaedics, ACS Medical College and Hospital, Dr MGR Educational and Research Institute, Chennai, 600077 Tamil Nadu India
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
| | - Manish Khanna
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
- Department of Orthopaedics, Dr KNS Mayo Institute of Medical Sciences, Lucknow, 225001 Uttar Pradesh India
| | - Ashim Gupta
- Indian Stem Cell Study Group (ISCSG) Association, Lucknow, 226010 Uttar Pradesh India
- Department of Orthopaedics, South Texas Orthopaedic Research Institute (STORI Inc.), Laredo, TX 78045 USA
- Regenerative Orthopaedics, Noida, 201301 Uttar Pradesh India
- Future Biologics, Lawrenceville, GA 30043 USA
- BioIntegrate, Lawrenceville, GA 30043 USA
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Luo S, Liu Z, Zhang J, Chen Y, Lei Y, Gao X, Liu C, Chen Y, Liu C, Yan P, Chen Y, Li H, Zhao C, Wang H, Wang K, Wang C, Tian R, Yang P. Three-gene signature revealing the dynamics of lymphocyte infiltration in subchondral bone during osteoarthritis progression. Int Immunopharmacol 2024; 137:112431. [PMID: 38897125 DOI: 10.1016/j.intimp.2024.112431] [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: 02/21/2024] [Revised: 06/04/2024] [Accepted: 06/05/2024] [Indexed: 06/21/2024]
Abstract
Osteoarthritis (OA), a degenerative joint disorder, has an unclear immune infiltration mechanism in subchondral bone (SCB). Thus, this study aims to discern immune infiltration variations in SCB between early- and late-stages of OA and identify pertinent biomarkers. Utilizing the GSE515188 bulk-seq profile from the Gene Expression Omnibus database, we performed single-sample gene-set enrichment analysis alongside weighted gene co-expression network analysis to identify key cells and immune-related genes (IRGs) involved in SCB at both stages. At the meanwhile, differentially expressed genes (DEGs) were identified in the same dataset and intersected with IRGs to find IR-DEGs. Protein-protein interaction network and enrichment analyses and further gene filtering using LASSO regression led to the discovery of potential biomarkers, which were then validated by ROC curve analysis, single-cell RNA sequencing, qRT-PCR, western blot and immunofluorescence. ScRNA-seq analysis using GSE196678, qRT-PCR, western blot and immunofluorescence results confirmed the upregulation of their expression levels in early-stage OA SCB samples. Our comprehensive analysis revealed lymphocytes infiltration as a major feature in early OA SCB. A total of 13 IR-DEGs were identified, showing significant enrichment in T- or B-cell activation pathways. Three of them (CD247, POU2AF1, and TNFRSF13B) were selected via the LASSO regression analysis, and results from the ROC curve analyses indicated the diagnostic efficacy of these 3 genes as biomarkers. These findings may aid in investigating the mechanisms of SCB immune infiltration in OA, stratifying OA progression, and identifying relevant therapeutic targets.
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Affiliation(s)
- Sen Luo
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Zeyu Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Jiewen Zhang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yuanyuan Chen
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yutian Lei
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Xu Gao
- Department of Orthopedics, Honghui Hospital, Xi'an, Shaanxi, China
| | - ChengYan Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yutao Chen
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Chenkun Liu
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Peng Yan
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Yang Chen
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Heng Li
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Chuanchuan Zhao
- Department of Operating Room, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Haifan Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Kunzheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Chunsheng Wang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China
| | - Run Tian
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China.
| | - Pei Yang
- Department of Bone and Joint Surgery, The Second Affiliated Hospital of Xian Jiaotong University, Xi'an, Shaanxi, China.
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Kuang S, Liu Z, Liu L, Fu X, Sheng W, Hu Z, Lin C, He Q, Chen J, Gao S. Polygonatum sibiricum polysaccharides protect against knee osteoarthritis by inhibiting the TLR2/NF-κB signaling pathway in vivo and in vitro. Int J Biol Macromol 2024; 274:133137. [PMID: 38901508 DOI: 10.1016/j.ijbiomac.2024.133137] [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: 03/21/2024] [Revised: 06/10/2024] [Accepted: 06/11/2024] [Indexed: 06/22/2024]
Abstract
Polygonatum sibiricum polysaccharides (PSP), the primary constituent of Polygonatum sibiricum, have been shown to exhibit a wide range of pharmacological effects, but their impact on osteoarthritis (OA) remains unclear. The objective of this study was to investigate the protective effects of PSP against OA and to elucidate its underlying molecular mechanism. In our in vitro experiments, PSP not only inhibited the IL-1β-induced inflammatory responses and the nuclear factor kappa-B (NF-κB) signaling pathway in chondrocytes but also regulated the cartilage matrix metabolism. In addition, we detected 394 significantly differentially expressed genes through RNA-seq analysis on PSP-intervened chondrocytes, and the toll-like receptor 2 (TLR2) was identified as the most important feature by functional network analysis and qRT-PCR. It was also revealed that PSP treatment significantly reversed the IL-1-induced up-regulation of TLR2 expression in chondrocytes, while TLR2 overexpression partially inhibited the regulatory effects of PSP on inflammation, NF-κB signaling pathway and matrix metabolism. In our in vivo experiments, PSP treatment alleviated the development of destabilization of medial meniscus (DMM)-induced OA in mouse knee joints, inhibited the DMM-induced activation of the TLR2/NF-κB signaling pathway in mouse knee joint cartilage, and reduced the serum levels of inflammatory cytokines. In conclusion, PSP exerts its anti-inflammatory, matrix synthesis-promoting and matrix catabolism-suppressing effects in knee OA by inhibiting the TLR2/NF-κB signaling pathway, suggesting that PSP may be potentially targeted as a novel all-natural, low-toxicity drug for OA prevention and treatment.
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Affiliation(s)
- Shida Kuang
- College of Traditional Chinese Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Andrology Laboratory, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
| | - Zhewen Liu
- The First Affiliated Hospital, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
| | - Lumei Liu
- College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
| | - Xinying Fu
- College of Integrated Traditional Chinese and Western Medicine, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Andrology Laboratory, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China
| | - Wen Sheng
- Andrology Laboratory, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Hunan University of Medicine, Huaihua, Hunan 418000, China
| | - Zongren Hu
- Andrology Laboratory, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Hunan University of Medicine, Huaihua, Hunan 418000, China
| | - Chengxiong Lin
- Hunan University of Medicine, Huaihua, Hunan 418000, China
| | - Qinghu He
- Andrology Laboratory, Hunan University of Chinese Medicine, Changsha, Hunan 410208, China; Hunan University of Medicine, Huaihua, Hunan 418000, China.
| | - Jisong Chen
- Hunan University of Medicine, Huaihua, Hunan 418000, China.
| | - Shuguang Gao
- Department of Orthopaedics, Xiangya Hospital Central South University, Changsha, Hunan, 410008, China.
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He R, Wei Y, Peng Z, Yang J, Zhou Z, Li A, Wu Y, Wang M, Li X, Zhao D, Liu Z, Dong H, Leng X. α-Ketoglutarate alleviates osteoarthritis by inhibiting ferroptosis via the ETV4/SLC7A11/GPX4 signaling pathway. Cell Mol Biol Lett 2024; 29:88. [PMID: 38877424 PMCID: PMC11177415 DOI: 10.1186/s11658-024-00605-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Accepted: 06/04/2024] [Indexed: 06/16/2024] Open
Abstract
Osteoarthritis (OA) is the most common degenerative joint disorder that causes disability in aged individuals, caused by functional and structural alterations of the knee joint. To investigate whether metabolic drivers might be harnessed to promote cartilage repair, a liquid chromatography-mass spectrometry (LC-MS) untargeted metabolomics approach was carried out to screen serum biomarkers in osteoarthritic rats. Based on the correlation analyses, α-ketoglutarate (α-KG) has been demonstrated to have antioxidant and anti-inflammatory properties in various diseases. These properties make α-KG a prime candidate for further investigation of OA. Experimental results indicate that α-KG significantly inhibited H2O2-induced cartilage cell matrix degradation and apoptosis, reduced levels of reactive oxygen species (ROS) and malondialdehyde (MDA), increased superoxide dismutase (SOD) and glutathione (GSH)/glutathione disulfide (GSSG) levels, and upregulated the expression of ETV4, SLC7A11 and GPX4. Further mechanistic studies observed that α-KG, like Ferrostatin-1 (Fer-1), effectively alleviated Erastin-induced apoptosis and ECM degradation. α-KG and Fer-1 upregulated ETV4, SLC7A11, and GPX4 at the mRNA and protein levels, decreased ferrous ion (Fe2+) accumulation, and preserved mitochondrial membrane potential (MMP) in ATDC5 cells. In vivo, α-KG treatment inhibited ferroptosis in OA rats by activating the ETV4/SLC7A11/GPX4 pathway. Thus, these findings indicate that α-KG inhibits ferroptosis via the ETV4/SLC7A11/GPX4 signaling pathway, thereby alleviating OA. These observations suggest that α-KG exhibits potential therapeutic properties for the treatment and prevention of OA, thereby having potential clinical applications in the future.
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Affiliation(s)
- Rong He
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Yuchi Wei
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Zeyu Peng
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Jie Yang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Zhenwei Zhou
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Ailin Li
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Yongji Wu
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Mingyue Wang
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Xiangyan Li
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Daqing Zhao
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China
| | - Zhonghua Liu
- Department of orthopaedics, The Third Affiliated Hospital of Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China.
| | - Haisi Dong
- Northeast Asia Research Institute of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China.
| | - Xiangyang Leng
- College of Traditional Chinese Medicine, Changchun University of Chinese Medicine, Changchun, 130117, Jilin Province, China.
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Runhaar J, Özbulut Ö, Kloppenburg M, Boers M, Bijlsma JWJ, Bierma-Zeinstra S. Two-year clinical follow-up enhances the diagnosis of early-stage hip osteoarthritis: data from check cohort. RMD Open 2024; 10:e004208. [PMID: 38862243 PMCID: PMC11168179 DOI: 10.1136/rmdopen-2024-004208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2024] [Accepted: 05/16/2024] [Indexed: 06/13/2024] Open
Abstract
OBJECTIVE To provide a set of diagnostic criteria for early-stage hip osteoarthritis (OA) in primary care, using signs and symptoms monitored over 2 years in individuals with hip pain and/or stiffness. Additionally, the study aimed to see whether these factors were additive to factors based on baseline signs and symptoms only. METHODS Data of the 543 persons with 735 symptomatic hips were collected from the prospective Cohort Hip and Cohort Knee cohort study. Using data from 5 to 10 years of follow-up, 24 experts (13 general practitioners, 11 secondary care physicians (6 rheumatologists and 5 orthopaedic surgeons)) inspected individuals' medical data on the presence of clinically relevant hip OA. Their diagnoses are used as reference standards. Backward selection method was used to provide models using the factors from baseline to 2 years of follow-up. Additionally, new models were combined with previously published models, using same selection method. Area under the curve (AUC) was calculated after each removal of factors in the final combined models. RESULTS Radiographic factors and high-sensitive C reactive protein did not end up in any model with change factors only. AUC value (SD) of the final obtained model of change factors was 0.70 (0.01). Adding newly defined factors to previously published models significantly (p<0.0001) increased the AUC value to 0.75 (0.01). CONCLUSION Final diagnostic criteria, consisting only of the factors obtained through history taking and physical examination, were able to detect early-stage hip OA associated with clinically relevant hip OA 5-10 years later, with 'moderate' precision.
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Affiliation(s)
- Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | - Ömer Özbulut
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
| | | | - Maarten Boers
- Department of Epidemiology & Data Science, Amsterdam UMC Locatie VUmc, Amsterdam, Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Sita Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
- Department of Orthopaedics & Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, Netherlands
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Lindéus M, Peat G, Englund M, Kiadaliri A. Changes in educational inequalities in knee and hip osteoarthritis surgery and non-surgery specialist care visits over time in Sweden. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100470. [PMID: 38680730 PMCID: PMC11053214 DOI: 10.1016/j.ocarto.2024.100470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2023] [Accepted: 04/07/2024] [Indexed: 05/01/2024] Open
Abstract
Objective To examine changes in prevalence and socioeconomic inequalities in knee and hip OA outcomes, in more specific surgery and non-surgery specialist care visits, from 2001 to 2011 in Sweden and to what extent sociodemographic factors can explain the changes. Design We included all individuals aged ≥35 years resident in Sweden from 2001 to 2011. Individual-level data was retrieved from the Swedish Interdisciplinary Panel. Highest educational attainment was used as socioeconomic measure and the concentration index was used to assess relative and absolute educational inequalities. We used decomposition method to examine changes in prevalence and relative educational inequalities. Results A total of 4,794,693 and 5,359,186 people were included for the years 2001 and 2011, respectively. The crude prevalence of surgery and specialist visits for knee and hip OA was 36-83% higher in 2011 than in 2001. The increase in hip OA outcomes was largely explained by changes in the sociodemographic composition of the population, whereas for knee OA outcomes, changes in the strength of the associations with sociodemographic factors appeared more important. All outcomes were concentrated among people with lower education in all study years. The relative inequalities declined over the study period, while the absolute inequalities increased for knee OA outcomes and remained stable for hip OA. Conclusion Our findings show an increasing burden of all studied OA outcomes. Moreover, our findings suggest persistent educational inequalities with more surgeries and specialist visits among lower-educated individuals. Future research should incorporate additional variables to better understand and address these inequalities.
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Affiliation(s)
- Maria Lindéus
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Lund University, Centre for Economic Demography, Lund, Sweden
| | - George Peat
- Centre for Applied Health & Social Care Research (CARe), Sheffield Hallam University, Sheffield, South Yorkshire, UK
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Ali Kiadaliri
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
- Lund University, Centre for Economic Demography, Lund, Sweden
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Mark J, Shema-Shiratzky S, Sommer J, Nolan T, Segal G. Reduction in Healthcare Resource Utilization Following Treatment With a Home-Based Footworn Device in Patients With Knee Osteoarthritis: A Retrospective Claims Analysis. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2024; 11:134-140. [PMID: 38765914 PMCID: PMC11102045 DOI: 10.36469/001c.117155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/18/2024] [Accepted: 04/29/2024] [Indexed: 05/22/2024]
Abstract
Background: One in 7 US adults has knee osteoarthritis (OA) and almost two-thirds of them suffer from low back pain. OA is the third most rapidly rising condition associated with disability and leads to a significant burden on the healthcare system and society. Objective: This study looked at the healthcare resource utilization (HCRU) in patients with knee OA and low back pain before and after the utilization of a new, home-based, noninvasive, biomechanical intervention. Methods: This was a retrospective claims analysis of 585 patients treated with a personalized, noninvasive, home-based, biomechanical treatment that aims to alleviate knee pain and improve function (AposHealth®). The date of the first AposHealth claim was the index date. Data prior to the index date and post-index date were used to monitor changes in HCRU while in treatment. Descriptive statistics, including frequencies, means and standard deviations, were used to present patient characteristics. To standardize the results, an average monthly claims data rate was calculated and an expected annual rate was extrapolated. Annual HCRU rate per 1000 members was calculated. Results: HCRU decreased after utilizing the new intervention including a decrease of 79% in diagnostic claims, a 70% decrease in outpatient services, a 22% decrease in non-operative treatments, a 61% decrease in pain medications including an 85% drop in opioids use, and a 44% decrease in intra-articular injections. The pre-index estimated rate for total knee replacement (TKR), which is based on existing literature, was 15.1%, whereas the post-index rate of TKR was 0.9%. Conclusions: Patients with knee OA treated with a home-based, noninvasive, biomechanical intervention incurred fewer healthcare resources, leading to an overall reduction in the cost of care.
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Affiliation(s)
- Josh Mark
- AMA Research Group, Tel-Aviv, Israel
| | | | | | - Tim Nolan
- AMA Research Group, Tel-Aviv, Israel
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9
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Moseng T, Vliet Vlieland TPM, Battista S, Beckwée D, Boyadzhieva V, Conaghan PG, Costa D, Doherty M, Finney AG, Georgiev T, Gobbo M, Kennedy N, Kjeken I, Kroon FPB, Lohmander LS, Lund H, Mallen CD, Pavelka K, Pitsillidou IA, Rayman MP, Tveter AT, Vriezekolk JE, Wiek D, Zanoli G, Østerås N. EULAR recommendations for the non-pharmacological core management of hip and knee osteoarthritis: 2023 update. Ann Rheum Dis 2024; 83:730-740. [PMID: 38212040 PMCID: PMC11103326 DOI: 10.1136/ard-2023-225041] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 12/01/2023] [Indexed: 01/13/2024]
Abstract
INTRODUCTION Hip and knee osteoarthritis (OA) are increasingly common with a significant impact on individuals and society. Non-pharmacological treatments are considered essential to reduce pain and improve function and quality of life. EULAR recommendations for the non-pharmacological core management of hip and knee OA were published in 2013. Given the large number of subsequent studies, an update is needed. METHODS The Standardised Operating Procedures for EULAR recommendations were followed. A multidisciplinary Task Force with 25 members representing 14 European countries was established. The Task Force agreed on an updated search strategy of 11 research questions. The systematic literature review encompassed dates from 1 January 2012 to 27 May 2022. Retrieved evidence was discussed, updated recommendations were formulated, and research and educational agendas were developed. RESULTS The revised recommendations include two overarching principles and eight evidence-based recommendations including (1) an individualised, multicomponent management plan; (2) information, education and self-management; (3) exercise with adequate tailoring of dosage and progression; (4) mode of exercise delivery; (5) maintenance of healthy weight and weight loss; (6) footwear, walking aids and assistive devices; (7) work-related advice and (8) behaviour change techniques to improve lifestyle. The mean level of agreement on the recommendations ranged between 9.2 and 9.8 (0-10 scale, 10=total agreement). The research agenda highlighted areas related to these interventions including adherence, uptake and impact on work. CONCLUSIONS The 2023 updated recommendations were formulated based on research evidence and expert opinion to guide the optimal management of hip and knee OA.
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Affiliation(s)
- Tuva Moseng
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Theodora P M Vliet Vlieland
- Department of Orthopaedics, Rehabilitation and Physical Therapy, Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Simone Battista
- University of Genoa Department of Neuroscience Ophthalmological Rehabilitation Genetics and Mother and Child Health, Genova, Italy
| | - David Beckwée
- Rehabilitation Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Vladimira Boyadzhieva
- UMHAT "St. Iv. Rilski" Clinic of Rheumatology, Medical University Sofia, Sofia, Bulgaria
| | - Philip G Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds and NIHR Leeds Biomechanical Reserch Centre, Leeds, UK
| | - Daniela Costa
- Comprehensive Health Research Center (CHRC), Universidade Nova de Lisboa, Lisboa, Portugal
| | - Michael Doherty
- Department of Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Andrew G Finney
- Research Institute for Primary Care and Health Sciences, Keele University School of Medicine, Keele, UK
- School of Nursing and Midwifery, Keele University, Keele, UK
| | - Tsvetoslav Georgiev
- Clinic of Rheumatology, University Hospital St. Marina, First Department of Internal Medicine, Medical University Varna, Varna, Bulgaria
| | - Milena Gobbo
- Positivamente Centro de Psicología, Madrid, Spain
| | - Norelee Kennedy
- School of Allied Health, Faculty of Education and Health Sciences and Health Research Institute, University of Limerick, Limerick, Ireland
| | - Ingvild Kjeken
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | - Féline P B Kroon
- Department of Rheumatology, Leiden University Medical Center (LUMC), Leiden, The Netherlands
- Department of Rheumatology, Zuyderland Medical Centre Heerlen, Heerlen, The Netherlands
| | - L Stefan Lohmander
- Department of Clinical Sciences Lund, Orthopaedics, Lund University, Lund, Sweden
| | - Hans Lund
- Centre for Evidence-Based Practice, Western Norway University of Applied Sciences, Bergen, Norway
| | | | - Karel Pavelka
- Institute of Rheumatology, Department of Rheumatology, Charles University First Faculty of Medicine, Praha, Czech Republic
| | - Irene A Pitsillidou
- EULAR Patient Research Partner, Cyprus League Against Rheumatism, Nicosia, Cyprus
| | - Margaret P Rayman
- Department of Nutritional Sciences, University of Surrey Faculty of Health and Medical Sciences, Guildford, UK
| | - Anne Therese Tveter
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
| | | | - Dieter Wiek
- EULAR Patient Research Partner, Deutsche Rheuma-Liga, Bonn, Germany
| | - Gustavo Zanoli
- Orthopaedic Ward, Casa di Cura Santa Maria Maddalena, Novara, Italy
| | - Nina Østerås
- Center for treatment of Rheumatic and Musculoskeletal Diseases (REMEDY), Diakonhjemmet Hospital, Oslo, Norway
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10
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Zhao H, Liu Y, Yang C, Han CH. Efficacy and Safety of Acupoint Catgut Embedding for Knee Osteoarthritis: a Protocol for Systematic review and Meta-Analysis. J Acupunct Meridian Stud 2024; 17:76-80. [PMID: 38686431 DOI: 10.51507/j.jams.2024.17.2.76] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2023] [Revised: 06/10/2024] [Accepted: 04/03/2024] [Indexed: 05/02/2024] Open
Abstract
Background Knee osteoarthritis causes physical dysfunction, and its prevalence increases with age. Although clinical studies examined acupoint catgut embedding in patients with knee osteoarthritis, no systematic reviews or meta-analyses have been conducted to date. We aim to comprehensively review the effects of acupoint catgut embedding on knee osteoarthritis. Methods Eleven databases will be searched from inception to August 1, 2023, without language limitations. Additionally, two registration platforms-ClinicalTrials.gov and the World Health Organization International Clinical Trials Registry-will be searched for ongoing trials. The primary outcomes will be assessed using the Visual Analog Scale and the Western Ontario and McMaster Universities Osteoarthritis Index. Secondary outcomes include the total effective rate, Lysholm Score, and adverse effects. Two reviewers will independently select the studies, extract data, and evaluate the risk of bias and the quality of evidence. Discussion This systematic review will provide evidence regarding the safety and efficacy of acupoint catgut embedding in patients with knee osteoarthritis.
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Affiliation(s)
- HuiYan Zhao
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
- Korean Convergence Medical Science, University of Science & Technology, School of Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Yan Liu
- Department of Acupuncture, Beijing GuangRen Combination of Traditional Chinese and Western Medicine Hospital, Beijing, China
| | - Changsop Yang
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
| | - Chang-Hyun Han
- KM Science Research Division, Korea Institute of Oriental Medicine, Daejeon, Korea
- Korean Convergence Medical Science, University of Science & Technology, School of Korea Institute of Oriental Medicine, Daejeon, Korea
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11
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Huang G, Hong W, Wang K, Xu M, Chen B, Qian D, Pei B. Causal analysis of body composition measurements in osteoarthritis knee: a two-sample mendelian randomization study. BMC Musculoskelet Disord 2024; 25:341. [PMID: 38684987 PMCID: PMC11057087 DOI: 10.1186/s12891-024-07465-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 04/22/2024] [Indexed: 05/02/2024] Open
Abstract
BACKGROUND To analyse the causal associations of different physical measures with osteoarthritis knee (KOA). METHODS Exposure factors (weight, body mass index (BMI), body fat percentage, waist circumference, hip circumference, waist-hip ratio (WHR), and basal metabolic rate (BMR)), and outcome factor KOA were analyzed by inverse-variance weighted (IVW) method, along with heterogeneity test, sensitivity and pleiotropy analyses. Meta-analysis was used to combine the effect values of IVW methods in different data sources. RESULTS Weight, BMI, body fat percentage, waist circumference, hip circumference and BMR analyses showed causal association with increased KOA risk, while WHR analysis indicated a reduction of the incidence of KOA. P-value for all the results was less than 0.05 and F-value large than 20. All results were negative for heterogeneity tests and sensitivity analyses, and there was pleiotropy in weight and BMR. Meta-analysis results showed that the results of Odds Ratios (95% Confidence Intervals) for Weight (1.43(1.35-1.51)), BMI (1.40(1.10-1.78)), body fat percentage (1.56(1.44-1.68)), waist circumference (1.40(1.10-1.78)), hip circumference (1.37(1.30-1.44)), WHR (0.86(0.71-1.04)) and BMR (1.36(1.27-1.46) were consistent with the ones by Mendelian randomization analyses. CONCLUSIONS Body fat percentage may be a better indicator of KOA than BMI. In addition, weight and BMR may have a causal effect in KOA, but WHR does not have a causal relationship. BMI, body fat percentage, waist circumference, and hip circumference has a causal effect on KOA.
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Affiliation(s)
- Guoxin Huang
- Department of Evidence-Based Medicine Center, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China
- School of Public Health and Management, Hubei University of Medicine, Shiyan, Hubei, China
| | - Weimin Hong
- General Surgery, Cancer Center, Department of Breast Surgery, Zhejiang Provincial People's Hospital (Affiliated People's Hospital), Hangzhou Medical College, Hangzhou, Zhejiang, 310000, China
| | - Ke Wang
- Department of Burn and Plastic Surgery-Hand Surgery, Changshu Hospital Affiliated to Soochow University, Changshu No.1 People's Hospital, Changshu, 215500, China
| | - Ming Xu
- Department of Burn and Plastic Surgery-Hand Surgery, Changshu Hospital Affiliated to Soochow University, Changshu No.1 People's Hospital, Changshu, 215500, China
| | - BingQian Chen
- Department of Orthopedics, Changshu Hospital Affiliated to Soochow University, Changshu No.1 People's Hospital, Changshu, 215500, China.
| | - Da Qian
- Department of Burn and Plastic Surgery-Hand Surgery, Changshu Hospital Affiliated to Soochow University, Changshu No.1 People's Hospital, Changshu, 215500, China.
| | - Bin Pei
- Department of Evidence-Based Medicine Center, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, 441000, China.
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12
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Korthagen NM, Houtman E, Boone I, Coutinho de Almeida R, Sivasubramaniyan K, Mahdad R, Nelissen RGHH, Ramos YFM, Tessari MA, Meulenbelt I. Thyroid hormone induces ossification and terminal maturation in a preserved OA cartilage biomimetic model. Arthritis Res Ther 2024; 26:91. [PMID: 38664820 PMCID: PMC11044551 DOI: 10.1186/s13075-024-03326-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2023] [Accepted: 04/21/2024] [Indexed: 04/29/2024] Open
Abstract
OBJECTIVE To characterize aspects of triiodothyronine (T3) induced chondrocyte terminal maturation within the molecular osteoarthritis pathophysiology using the previously established T3 human ex vivo osteochondral explant model. DESIGNS RNA-sequencing was performed on explant cartilage obtained from OA patients (n = 8), that was cultured ex vivo with or without T3 (10 ng/ml), and main findings were validated using RT-qPCR in an independent sample set (n = 22). Enrichment analysis was used for functional clustering and comparisons with available OA patient RNA-sequencing and GWAS datasets were used to establish relevance for OA pathophysiology by linking to OA patient genomic profiles. RESULTS Besides the upregulation of known hypertrophic genes EPAS1 and ANKH, T3 treatment resulted in differential expression of 247 genes with main pathways linked to extracellular matrix and ossification. CCDC80, CDON, ANKH and ATOH8 were among the genes found to consistently mark early, ongoing and terminal maturational OA processes in patients. Furthermore, among the 37 OA risk genes that were significantly affected in cartilage by T3 were COL12A1, TNC, SPARC and PAPPA. CONCLUSIONS RNA-sequencing results show that metabolic activation and recuperation of growth plate morphology are induced by T3 in OA chondrocytes, indicating terminal maturation is accelerated. The molecular mechanisms involved in hypertrophy were linked to all stages of OA pathophysiology and will be used to validate disease models for drug testing.
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Affiliation(s)
- N M Korthagen
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - E Houtman
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - I Boone
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - R Coutinho de Almeida
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - K Sivasubramaniyan
- Galapagos BV, Willem Einthovenstraat 13, Oegstgeest, 2342 BH, The Netherlands
| | - R Mahdad
- Alrijne hospital, Simon Smitweg 1, Leiderdorp, 2353 GA, The Netherlands
| | - R G H H Nelissen
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - Y F M Ramos
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands
| | - M A Tessari
- Galapagos BV, Willem Einthovenstraat 13, Oegstgeest, 2342 BH, The Netherlands
| | - I Meulenbelt
- Department Biomedical Data Sciences, Section of Molecular Epidemiology, LUMC, Einthovenweg 20, Postzone S05-P, 2333 ZC, Leiden, The Netherlands.
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13
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Lee DY. Prevalence and Risk Factors of Osteoarthritis in Korea: A Cross-Sectional Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:665. [PMID: 38674311 PMCID: PMC11052057 DOI: 10.3390/medicina60040665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/26/2024] [Revised: 04/04/2024] [Accepted: 04/18/2024] [Indexed: 04/28/2024]
Abstract
Background and Objectives: The goal of this study is to determine the prevalence of knee osteoarthritis (OA) and risk factors for the disease in Korean adults over the age of 50, as well as to provide basic data for OA prevention through management. Materials and Methods: Based on 2010-2013 data from the Korean National Health and Nutrition Survey, 7962 adults over the age of 50 who participated in radiological tests and health surveys for the diagnosis of osteoarthritis were chosen as participants. Results: The risk factors for OA occurrence were investigated using complex sample multiple logistic regression analysis. According to the findings, the prevalence of knee OA in Korea was 33.3% in this study, with the risk of OA being higher in women, the elderly, people with a lower education level, and people with obesity. Conclusions: To reduce the incidence of OA, interventions and lifestyle changes are needed to prevent the onset of disease in participants with risk factors for OA, such as older women, low education levels, and obesity.
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Affiliation(s)
- Do-Youn Lee
- College of General Education, Kookmin University, Seoul 02707, Republic of Korea
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14
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Cheng S, Zeng F, Zhou J, Dong X, Yang W, Yin T, Huang K, Liang F, Li Z. Altered static and dynamic functional brain network in knee osteoarthritis: A resting-state functional magnetic resonance imaging study: Static and dynamic FNC in KOA. Neuroimage 2024; 292:120599. [PMID: 38608799 DOI: 10.1016/j.neuroimage.2024.120599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2023] [Revised: 03/26/2024] [Accepted: 03/30/2024] [Indexed: 04/14/2024] Open
Abstract
This study aimed to investigate altered static and dynamic functional network connectivity (FNC) and its correlation with clinical symptoms in patients with knee osteoarthritis (KOA). One hundred and fifty-nine patients with KOA and 73 age- and gender-matched healthy subjects (HS) underwent resting-state functional magnetic resonance imaging (rs-fMRI) and clinical evaluations. Group independent component analysis (GICA) was applied, and seven resting-state networks were identified. Patients with KOA had decreased static FNC within the default mode network (DM), visual network (VS), and cerebellar network (CB) and increased static FNC between the subcortical network (SC) and VS (p < 0.05, FDR corrected). Four reoccurring FNC states were identified using k-means clustering analysis. Although abnormalities in dynamic FNCs of KOA patients have been found using the common window size (22 TR, 44 s), but the results of the clustering analysis were inconsistent when using different window sizes, suggesting dynamic FNCs might be an unstable method to compare brain function between KOA patients and HS. These recent findings illustrate that patients with KOA have a wide range of abnormalities in the static and dynamic FNCs, which provided a reference for the identification of potential central nervous therapeutic targets for KOA treatment and might shed light on the other musculoskeletal pain neuroimaging studies.
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Affiliation(s)
- Shirui Cheng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China
| | - Fang Zeng
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China
| | - Jun Zhou
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Xiaohui Dong
- School of Nursing, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China
| | - Weihua Yang
- Dali Bai Autonomous Prefecture Chinese Medicine Hospital, Dali 671000, China
| | - Tao Yin
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China
| | - Kama Huang
- College of Electronics and Information Engineering, Sichuan University, Chengdu 610064, China
| | - Fanrong Liang
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China.
| | - Zhengjie Li
- Acupuncture and Tuina School, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Acupuncture and Brain Research Center, Chengdu University of Traditional Chinese Medicine, Chengdu 611137, China; Key Laboratory of Acupuncture for Senile Disease (Chengdu University of TCM), Ministry of Education, Chengdu 611137, China.
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15
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Qi B, Wang Z, Cao Y, Zhao H. Study on the treatment of osteoarthritis by acupuncture combined with traditional Chinese medicine based on pathophysiological mechanism: A review. Medicine (Baltimore) 2024; 103:e37483. [PMID: 38579081 PMCID: PMC10994424 DOI: 10.1097/md.0000000000037483] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2024] [Accepted: 02/13/2024] [Indexed: 04/07/2024] Open
Abstract
Osteoarthritis (OA) is a major contributor to disability and social costs in the elderly. As the population ages and becomes increasingly obese, the incidence of the disease is higher than in previous decades. In recent years, important progress has been made in the causes and pathogenesis of OA pain. Modern medical treatment modalities mainly include the specific situation of the patient and focus on the core treatment, including self-management and education, exercise, and related weight loss. As an important part of complementary and alternative medicine, TCM has remarkable curative effect, clinical safety, and diversity of treatment methods in the treatment of OA. Traditional Chinese Medicine treatment of OA has attracted worldwide attention. Therefore, this article will study the pathophysiological mechanism of OA based on modern medicine, and explore the treatment of OA by acupuncture combined with Chinese Medicine.
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Affiliation(s)
- Biao Qi
- Shenzhen Baoan District Shiyan People’s Hospital, Shenzhen, China
| | - Zeyu Wang
- Shenzhen Pingshan District Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Ying Cao
- Shenzhen Pingshan District Hospital of Traditional Chinese Medicine, Shenzhen, China
| | - Haishen Zhao
- Community Health Service Center of Nanhui New Town, Shanghai, China
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16
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Qiu F, Li J, Gan L, Legerlotz K. Arthritis prevalence is associated with metabolic syndrome risk factors but not with physical activity in middle-aged and older patients - a cross-sectional study. BMC Geriatr 2024; 24:242. [PMID: 38459429 PMCID: PMC10924363 DOI: 10.1186/s12877-024-04859-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 03/01/2024] [Indexed: 03/10/2024] Open
Abstract
BACKGROUND In light of the aging population, increasingly suffering from the metabolic syndrome (MS), strategies need to be developed to address global public health challenges known to be associated with MS such as arthritis. As physical activity (PA) may play a crucial role in tackling those challenges, this study aimed to determine the association between the number of MS risk factors, PA and arthritis in people ≥ 50 years old. METHODS Data from the Survey of Health, Ageing, and Retirement in Europe (SHARE) were used to estimate the prevalence of arthritis and MS risk factors in the European population ≥ 50 years and to evaluate the associations between MS risk factors, PA and arthritis. Binary logistic regression was performed to calculate the odds ratio of different factors. RESULTS 73,125 participants were included in the analysis. 55.75% of patients stated at least one of the three MS risk factors. The prevalence of rheumatoid arthritis (RA) and osteoarthritis (OA)/other rheumatism among ≥ 50 years population was 10.19% and 19.32% respectively. Females showed a higher prevalence of arthritis than males. Prevalence did not differ between groups with different levels of PA. Arthritis prevalence was positively correlated with the number of MS risk factors (P < 0.01) but not with PA (P > 0.05). CONCLUSION Middle-aged and older Europeans with multiple comorbidities suffered from RA, OA or other rheumatism more frequently than participants with fewer comorbidities, while the level of physical activity was not associated with the number of metabolic risk factors in patients with RA and OA/other rheumatism.
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Affiliation(s)
- Fanji Qiu
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany.
| | - Jinfeng Li
- Department of Kinesiology, Iowa State University, 50011, Ames, USA, IA
| | - Liaoyan Gan
- Alberta International School of Recreation, Sport and Tourism of Beijing Sport University, Beijing Sport University, 572423, Lingshui, China
- Faculty of Kinesiology, Sport, and Recreation, University of Alberta, T6G2R3, Edmonton, Canada
| | - Kirsten Legerlotz
- Movement Biomechanics, Institute of Sport Sciences, Humboldt-Universität zu Berlin, Unter den Linden 6, 10099, Berlin, Germany
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17
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Han X, Bai F, Li P, Bai X, Zhang Y, Wang W. Identification of novel potential drugs for the treatment and prevention of osteoarthritis. Biochem Biophys Rep 2024; 37:101647. [PMID: 38304574 PMCID: PMC10830515 DOI: 10.1016/j.bbrep.2024.101647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2023] [Revised: 12/27/2023] [Accepted: 01/15/2024] [Indexed: 02/03/2024] Open
Abstract
Objectives Osteoarthritis (OA) is characterized by a high prevalence, poor prognosis, and a propensity to lead to disability. Despite the availability of standard therapies, they are associated with potential side effects and don't provide a complete cure for patients. Consequently, there is an urgent demand for the development of novel drugs. Method The gene expression profiles (GSE64394, GSE178557 and GSE215039) of normal and OA chondrocytes samples were downloaded from the Gene Expression Omnibus (GEO) database. Differentially expressed genes (DEGs) were identified by the "LIMMA" R package. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment were conducted using the R package clusterProfiler. A protein-protein (PPI) interaction network was performed to identify hub genes by using the Search Tool for the Retrieval of Interacting Genes (STRING) and Cytoscape. Small molecule compounds linked to OA were predicted through the NetworkAnalyst platform. Finally, molecular docking was conducted using AutoDock and Pymol software. Results We identified 98 DEGs primarily implicated in endochondral ossification, extracellular matrix degradation, and Wnt signaling pathways. 23 DEGs were closely associated with OA, and 10 hub genes were found to be potential drug targets for OA. Two new targeted compounds, tetrachlorodibenzodioxin (TCDD) and valproic acid (VPA), were screened. And they both exhibited strong binding affinity to their respective targets. Conclusions Reducing exposure to TCDD could be a crucial strategy in preventing OA, and VPA has gained recognition as a novel drug candidate for OA treatment.
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Affiliation(s)
- Xiaosong Han
- Department of Osteology, the First People's Hospital of Zunyi, Zunyi, Guizhou, 563099, China
| | - Fan Bai
- Department of Osteology, the First People's Hospital of Zunyi, Zunyi, Guizhou, 563099, China
| | - Peng Li
- Department of Osteology, the First People's Hospital of Zunyi, Zunyi, Guizhou, 563099, China
| | - Xiaojin Bai
- Department of Osteology, the First People's Hospital of Zunyi, Zunyi, Guizhou, 563099, China
| | - Yanli Zhang
- Biological Medicine Research and Development Center, Yangtze Delta of Zhejiang, Hangzhou, Zhejiang, 314006, China
| | - Wenmin Wang
- Biological Medicine Research and Development Center, Yangtze Delta of Zhejiang, Hangzhou, Zhejiang, 314006, China
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18
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Eymard F, Aron-Wisnewsky J. Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution. Joint Bone Spine 2024; 91:105639. [PMID: 37734439 DOI: 10.1016/j.jbspin.2023.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.
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Affiliation(s)
- Florent Eymard
- Department of Rheumatology, Henri-Mondor University Hospital, Assistance publique-Hôpitaux de Paris, AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France.
| | - Judith Aron-Wisnewsky
- Department of Nutrition, Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, AP-HP, 75013 Paris, France; Sorbonne université, Inserm, Nutrition and Obesity: Systemic Approaches, NutriOmics, 75013 Paris, France
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19
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Segarra-Queralt M, Crump K, Pascuet-Fontanet A, Gantenbein B, Noailly J. The interplay between biochemical mediators and mechanotransduction in chondrocytes: Unravelling the differential responses in primary knee osteoarthritis. Phys Life Rev 2024; 48:205-221. [PMID: 38377727 DOI: 10.1016/j.plrev.2024.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Accepted: 02/06/2024] [Indexed: 02/22/2024]
Abstract
In primary or idiopathic osteoarthritis (OA), it is unclear which factors trigger the shift of articular chondrocyte activity from pro-anabolic to pro-catabolic. In fact, there is a controversy about the aetiology of primary OA, either mechanical or inflammatory. Chondrocytes are mechanosensitive cells, that integrate mechanical stimuli into cellular responses in a process known as mechanotransduction. Mechanotransduction occurs thanks to the activation of mechanosensors, a set of specialized proteins that convert physical cues into intracellular signalling cascades. Moderate levels of mechanical loads maintain normal tissue function and have anti-inflammatory effects. In contrast, mechanical over- or under-loading might lead to cartilage destruction and increased expression of pro-inflammatory cytokines. Simultaneously, mechanotransduction processes can regulate and be regulated by pro- and anti-inflammatory soluble mediators, both local (cells of the same joint, i.e., the chondrocytes themselves, infiltrating macrophages, fibroblasts or osteoclasts) and systemic (from other tissues, e.g., adipokines). Thus, the complex process of mechanotransduction might be altered in OA, so that cartilage-preserving chondrocytes adopt a different sensitivity to mechanical signals, and mechanic stimuli positively transduced in the healthy cartilage may become deleterious under OA conditions. This review aims to provide an overview of how the biochemical exposome of chondrocytes can alter important mechanotransduction processes in these cells. Four principal mechanosensors, i.e., integrins, Ca2+ channels, primary cilium and Wnt signalling (canonical and non-canonical) were targeted. For each of these mechanosensors, a brief summary of the response to mechanical loads under healthy or OA conditions is followed by a concise overview of published works that focus on the further regulation of the mechanotransduction pathways by biochemical factors. In conclusion, this paper discusses and explores how biological mediators influence the differential behaviour of chondrocytes under mechanical loads in healthy and primary OA.
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Affiliation(s)
- Maria Segarra-Queralt
- BCN MedTech, Universitat Pompeu Fabra, C/ de la Mercè, 12, Barcelona, 08002, Catalonia, Spain
| | - Katherine Crump
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, Murtenstrasse 35, Bern, 3008, Bern, Switzerland; Graduate School for Cellular and Biomedical Sciences (GCB), University of Bern, Mittelstrasse 43, Bern, 3012, Bern, Switzerland
| | - Andreu Pascuet-Fontanet
- BCN MedTech, Universitat Pompeu Fabra, C/ de la Mercè, 12, Barcelona, 08002, Catalonia, Spain
| | - Benjamin Gantenbein
- Tissue Engineering for Orthopaedics & Mechanobiology, Bone & Joint Program, Department for BioMedical Research (DBMR), Medical Faculty, University of Bern, Murtenstrasse 35, Bern, 3008, Bern, Switzerland; Department of Orthopedic Surgery & Traumatology, Inselspital, University of Bern, Freiburgstrasse 18, Bern, 3010, Bern, Switzerland
| | - Jérôme Noailly
- BCN MedTech, Universitat Pompeu Fabra, C/ de la Mercè, 12, Barcelona, 08002, Catalonia, Spain.
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Heidari N, Olgiati S, Meloni D, Parkin J, Fish B, Slevin M, Azamfirei L. A Gender-Bias-Mitigated, Data-Driven Precision Medicine System to Assist in the Selection of Biological Treatments of Grade 3 and 4 Knee Osteoarthritis: Development and Preliminary Validation of precisionKNEE. Cureus 2024; 16:e55832. [PMID: 38590455 PMCID: PMC11000206 DOI: 10.7759/cureus.55832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2024] [Indexed: 04/10/2024] Open
Abstract
Objective To identify key variables predictive of patient responses to microfragmented adipose tissue (MFAT) treatment in knee osteoarthritis (KOA) and evaluate its potential to delay or mitigate the need for total knee replacement (TKR). Methods We utilised a dataset comprising 329 patients treated with MFAT for KOA, incorporating variables such as gender, age, BMI, arthritic aetiology, radiological grade, and Oxford Knee Scores (OKS) pre- and post-treatment. We employed random forest regressors for model training and testing, with gender bias mitigation and outlier detection to enhance prediction accuracy. Model performance was assessed through root mean squared error (RMSE) and mean absolute error (MAE), with further validation in a TKR-suitable patient subset. Results The model achieved a test RMSE of 6.72 and an MAE of 5.38, reflecting moderate predictive accuracy across the patient cohort. Stratification by gender revealed no statistically significant differences between actual and predicted OKS improvements (p-values: males = 0.93, females = 0.92). For the subset of patients suitable for TKR, the model presented an increased RMSE of 9.77 and MAE of 7.81, indicating reduced accuracy in this group. The decision tree analysis identified pre-operative OKS, radiological grade, and gender as significant predictors of post-treatment outcomes, with pre-operative OKS being the most critical determinant. Patients with lower pre-operative OKS showed varying responses based on radiological severity and gender, suggesting a nuanced interaction between these factors in determining treatment efficacy. Conclusion This study highlights the potential of MFAT as a non-surgical alternative for KOA treatment, emphasising the importance of personalised patient assessments. While promising, the predictive model warrants further refinement and validation with a larger, more diverse dataset to improve its utility in clinical decision-making for KOA management.
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Affiliation(s)
- Nima Heidari
- Discovery Driven Precision Medicine, European Quantum Medical, London, GBR
| | - Stefano Olgiati
- Medical Supercomputation and Biostatistics, European Quantum Medical, Milan, ITA
| | - Davide Meloni
- Supercomputation and Artificial Intelligence, European Quantum Medical, Turin, ITA
| | - James Parkin
- Radiology, Norfolk and Norwich University Hospitals National Health Service (NHS) Foundation Trust, London, GBR
| | - Brady Fish
- Board Member, European Quantum, Philadelphia, USA
| | - Mark Slevin
- Medicine, Pharmacy, Science and Technology, George Emil Palade University, Targu Mures, ROU
| | - Leonard Azamfirei
- Medicine, Pharmacy, Science and Technology, George Emil Palade University, Targu Mures, ROU
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Hernigou P, Hosny GA, Scarlat M. Evolution of orthopaedic diseases through four thousand three hundred years: from ancient Egypt with virtual examinations of mummies to the twenty-first century. INTERNATIONAL ORTHOPAEDICS 2024; 48:865-884. [PMID: 37867166 DOI: 10.1007/s00264-023-06012-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2023] [Accepted: 10/11/2023] [Indexed: 10/24/2023]
Abstract
PURPOSE This study conducts a comprehensive comparative analysis of bone pathologies between ancient Egypt and today. We aim to elucidate the prevalence, types, and potential aetiological factors influencing skeletal disorders in these two distinct temporal and cultural contexts. METHODS The research employs a multidisciplinary approach, integrating osteological, paleopathological, and historical data to understand bone pathologies in mummies and the actual world. Applying radiographs and CT scans as noninvasive techniques has shed new light on past diseases such as fractures, dysplasia, osteoarthritis, surgery, and tuberculosis. Virtual inspection has almost replaced classical autopsy and is essential, especially when dealing with museum specimens. RESULTS Findings indicate no significant disparities in the prevalence and types of bone pathologies through 4300 years of evolution. Moreover, this study sheds light on the impact of sociocultural factors on bone health. Examination of ancient Egypt's burial practices and associated cultural beliefs provides insights into potential behavioral and ritualistic influences on bone pathologies and the prevalence of specific pathologies in the past and present. CONCLUSION This comparative analysis illuminates the dynamic of bone pathologies, highlighting the interplay of biological, cultural, and environmental factors. By synthesizing archeological and clinical data, this research contributes to a more nuanced understanding of skeletal health's complexities in ancient and modern societies, offering valuable insights for anthropological and clinical disciplines.
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Affiliation(s)
| | | | - Marius Scarlat
- Clinique Chirurgicale St Michel, Groupe ELSAN, Toulon, France
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22
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Lammi MJ, Qu C. Regulation of Oxygen Tension as a Strategy to Control Chondrocytic Phenotype for Cartilage Tissue Engineering and Regeneration. Bioengineering (Basel) 2024; 11:211. [PMID: 38534484 DOI: 10.3390/bioengineering11030211] [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: 02/12/2024] [Revised: 02/18/2024] [Accepted: 02/21/2024] [Indexed: 03/28/2024] Open
Abstract
Cartilage defects and osteoarthritis are health problems which are major burdens on health care systems globally, especially in aging populations. Cartilage is a vulnerable tissue, which generally faces a progressive degenerative process when injured. This makes it the 11th most common cause of global disability. Conservative methods are used to treat the initial phases of the illness, while orthopedic management is the method used for more progressed phases. These include, for instance, arthroscopic shaving, microfracturing and mosaicplasty, and joint replacement as the final treatment. Cell-based implantation methods have also been developed. Despite reports of successful treatments, they often suffer from the non-optimal nature of chondrocyte phenotype in the repair tissue. Thus, improved strategies to control the phenotype of the regenerating cells are needed. Avascular tissue cartilage relies on diffusion for nutrients acquisition and the removal of metabolic waste products. A low oxygen content is also present in cartilage, and the chondrocytes are, in fact, well adapted to it. Therefore, this raises an idea that the regulation of oxygen tension could be a strategy to control the chondrocyte phenotype expression, important in cartilage tissue for regenerative purposes. This narrative review discusses the aspects related to oxygen tension in the metabolism and regulation of articular and growth plate chondrocytes and progenitor cell phenotypes, and the role of some microenvironmental factors as regulators of chondrocytes.
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Affiliation(s)
- Mikko J Lammi
- Department of Medical and Translational Biology, Umeå University, SE-90187 Umeå, Sweden
| | - Chengjuan Qu
- Department of Odontology, Umeå University, SE-90187 Umeå, Sweden
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Wang J, Sun Z, Yu C, Zhao H, Yan M, Sun S, Han X, Wang T, Yu T, Zhang Y. Single-cell RNA sequencing reveals the impact of mechanical loading on knee tibial cartilage in osteoarthritis. Int Immunopharmacol 2024; 128:111496. [PMID: 38224628 DOI: 10.1016/j.intimp.2024.111496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 12/25/2023] [Accepted: 01/03/2024] [Indexed: 01/17/2024]
Abstract
Articular cartilage degeneration is one of the major pathogenic alterations observed in knee osteoarthritis (KOA). Mechanical stress has been verified to contribute to KOA development. To gain insight into the pathogenic mechanism of KOA development, we investigated chondrocyte subsets under different mechanical loading conditions via single-cell RNA sequencing (scRNA-seq). Articular cartilage tissues from both high mechanical loading (named the OATL group) and low mechanical loading (named the OATN group) surfaces were obtained from the proximal tibia of KOA patients, and scRNA-seq was conducted. Chondrocyte subtypes, including a new subset, HTC-C (hypertrophic chondrocytes-C), and their functions, development and interactions among cell subsets were identified. Immunohistochemical staining was also conducted to verify the existence and location of each chondrocyte subset. Furthermore, differentially expressed genes (DEGs) and their functions between regions with high and low mechanical loading were identified. Based on Gene Ontology terms for the DEGs in each cell type, the characteristic of cartilage degeneration in the OATL region was clarified. Mitochondrial dysfunction may be involved in the KOA process in the OATN region.
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Affiliation(s)
- Junjie Wang
- Qingdao Medical College, Qingdao University, Qingdao, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Zewen Sun
- Qingdao Medical College, Qingdao University, Qingdao, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Chenghao Yu
- Qingdao Medical College, Qingdao University, Qingdao, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Haibo Zhao
- Qingdao Medical College, Qingdao University, Qingdao, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Mingyue Yan
- Qingdao Medical College, Qingdao University, Qingdao, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Shenjie Sun
- Department of Emergency, Qingdao Municipal Hospital, Qingdao, China
| | - Xu Han
- Qingdao Medical College, Qingdao University, Qingdao, China; Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tianrui Wang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China
| | - Tengbo Yu
- Department of Orthopaedic Surgery, Qingdao Municipal Hospital, Qingdao, China.
| | - Yingze Zhang
- Department of Orthopaedic Surgery, The Affiliated Hospital of Qingdao University, Qingdao, China.
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Jonidi Shariatzadeh F, Solouk A, Mirzadeh H, Bonakdar S, Sadeghi D, Khoulenjani SB. Cellulose nanocrystals-reinforced dual crosslinked double network GelMA/hyaluronic acid injectable nanocomposite cryogels with improved mechanical properties for cartilage tissue regeneration. J Biomed Mater Res B Appl Biomater 2024; 112:e35346. [PMID: 38359175 DOI: 10.1002/jbm.b.35346] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 09/04/2023] [Accepted: 10/14/2023] [Indexed: 02/17/2024]
Abstract
Improvement of mechanical properties of injectable tissue engineering scaffolds is a current challenge. The objective of the current study is to produce a highly porous injectable scaffold with improved mechanical properties. For this aim, cellulose nanocrystals-reinforced dual crosslinked porous nanocomposite cryogels were prepared using chemically crosslinked methacrylated gelatin (GelMA) and ionically crosslinked hyaluronic acid (HA) through the cryogelation process. The resulting nanocomposites showed highly porous structures with interconnected porosity (>90%) and mean pore size in the range of 130-296 μm. The prepared nanocomposite containing 3%w/v of GelMA, 20 w/w% of HA, and 1%w/v of CNC showed the highest Young's modulus (10 kPa) and excellent reversibility after 90% compression and could regain its initial shape after injection by a 16-gauge needle in the aqueous media. The in vitro results demonstrated acceptable viability (>90%) and migration of the human chondrocyte cell line (C28/I2), and chondrogenic differentiation of human adipose stem cells. A two-month in vivo assay on a rabbit's ear model confirmed that the regeneration potential of the prepared cryogel is comparable to the natural autologous cartilage graft, suggesting it is a promising alternative for autografts in the treatment of cartilage defects.
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Affiliation(s)
| | - Atefeh Solouk
- Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Hamid Mirzadeh
- Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
- Polymer and Color Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Shahin Bonakdar
- National Cell Bank Department, Pasteur Institute of Iran, Tehran, Iran
| | - Davoud Sadeghi
- Biomedical Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
| | - Shadab Bagheri Khoulenjani
- Polymer and Color Engineering Department, Amirkabir University of Technology (Tehran Polytechnic), Tehran, Iran
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Magnusson K, Turkiewicz A, Rydén M, Englund M. Genetic Influence on Osteoarthritis Versus Other Rheumatic Diseases. Arthritis Rheumatol 2024; 76:206-215. [PMID: 37691153 DOI: 10.1002/art.42696] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/21/2023] [Accepted: 09/01/2023] [Indexed: 09/12/2023]
Abstract
OBJECTIVE We aimed to compare the genetic contribution to osteoarthritis (OA) versus other rheumatic/musculoskeletal diseases (RMDs) in the same population and to explore the role for any shared genetics between OA and other RMDs. METHODS In 59,970 Swedish twins aged 35 years or older, we estimated the heritability (the variance explained by genetic factors) of OA in peripheral joints, back and neck pain, shoulder pain (adhesive capsulitis, impingement syndrome, etc), rheumatoid arthritis, spondyloarthritis (SpA) and psoriatic arthritis, myalgia, and osteoporosis diagnosed in specialist and inpatient care. We also studied how much covariance between OA and each of the RMDs could be explained by genetics by studying phenotypic correlations in bivariate classical twin models. RESULTS Any-site OA and hip OA (50% and 64%) were among the most heritable RMDs (as compared with 23% for fibromyalgia [lowest] and 63% for SpA [highest]). The highest phenotypic correlations were between OA (any joint site) and shoulder pain in the same individual (r = 0.33, 95% confidence interval 0.31-0.35), of which 70% (95% confidence interval 52-88) could be explained by shared genetics. The phenotypic correlation between OA and back/neck pain was r = 0.25, with 25% to 75% explained by genetics. Phenotypic correlations between OA and each of the other RMDs were lower (r ~ 0.1 to r ~ 0.2), with inconclusive sources of variation. CONCLUSION OA has relatively large heritability as compared with other RMDs. The coexistence of OA and shoulder pain, as well as back pain, was common and could often be explained by genetic factors. Findings imply similar etiologies of OA and several pain conditions.
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Affiliation(s)
- Karin Magnusson
- Lund University, Lund, Sweden and Norwegian Institute of Public Health, Oslo, Norway
| | - Aleksandra Turkiewicz
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Martin Rydén
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
| | - Martin Englund
- Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Orthopaedics, Clinical Epidemiology Unit, Lund, Sweden
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26
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Wang L, Ye Y. Trends and projections of the burden of osteoarthritis disease in China and globally: A comparative study of the 2019 global burden of disease database. Prev Med Rep 2024; 37:102562. [PMID: 38205169 PMCID: PMC10776652 DOI: 10.1016/j.pmedr.2023.102562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 12/12/2023] [Accepted: 12/13/2023] [Indexed: 01/12/2024] Open
Abstract
This study aims to characterize the burden of osteoarthritis in China and globally from 1990 to 2019 and predict the burden for the next decade. The Global Burden of Disease (GBD) database is designed to assess the burden of various diseases and injuries on a global scale. Age-standardized rate data for the incidence, prevalence, and Years Lived with Disability (YLDs) of osteoarthritis in both China and the global context were extracted. Furthermore, the Estimated Annual Percentage Change (EAPC) to illustrate the long-term trends in the burden of osteoarthritis disease was calculated. Autoregressive integrated moving average (ARIMA) models were applied to forecast the trends in age-standardized incidence rate (ASIR), age-standardized prevalence rate (ASPR), and age-standardized YLDs rate (ASYR) for osteoarthritis in China and globally for the next 11 years. Knee osteoarthritis showed a changing trend of ASIR, ASPR, and ASYR from 1990 to 2019 in China, initially decreasing and then increasing. In contrast, global osteoarthritis exhibited a relatively stable overall trend over three decades. Knee osteoarthritis exhibited the highest incidence, prevalence, and YLDs across various age groups and genders. The ARIMA forecast indicated a slight upward trend in osteoarthritis burden in China and globally over the next 11 years. Osteoarthritis poses a significant health issue, emphasizing the need to enhance awareness and management of osteoarthritis among the population and policymakers, particularly focusing on the elderly and female populations.
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Affiliation(s)
- Liping Wang
- Department of Orthopedics, Jinhua Guangfu Tumor Hospital, Jinhua 321000, China
| | - Yitong Ye
- Department of Orthopedics, Jinhua Guangfu Tumor Hospital, Jinhua 321000, China
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Hu K, Shu Y, Feng Z, Zou M, Luo J, Wei Z, Peng J, Hao L. Role of lipid metabolism gene KLF4 in osteoarthritis. Clin Rheumatol 2024; 43:453-464. [PMID: 37608136 DOI: 10.1007/s10067-023-06742-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Revised: 08/04/2023] [Accepted: 08/14/2023] [Indexed: 08/24/2023]
Abstract
INTRODUCTION Osteoarthritis (OA) is a common degenerative disease of joints, which can appear in almost any joint of the body. Therefore, the widespread occurrence of this disease has a huge impact on the lives of patients around the world. As an important part of metabolism, lipid metabolism is closely related to the occurrence and development of osteoarthritis. METHOD We screened UGCG and KLF4 based on weighted co-expression network analysis (WGCNA) and SVM-REF analysis. The data from Gene Expression Omnibus (GEO) and single-cell data verified the expression of these two genes. We analyzed KLF4-related genes and established a diagnosis model of OA related to lipid metabolism through the least absolute shrinkage and selection operator (LASSO) analysis. RT-PCR was used to verify the expression of KLF4 in osteoarthritis. RESULTS Ten important lipid metabolism related genes (LMRGs) in OA were obtained. Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis showed that they are involve in the formation of immune microenvironment in osteoarthritis. CIBERSORT analysis revealed that there were significant differences in the immune microenvironment between osteoarthritis patients and normal controls. RT-PCR results showed that the expression of KLF4 in OA samples was lower than that in normal samples. The diagnostic model can be used to diagnose OA patients well. CONCLUSIONS Overall, we demonstrated the potential relationship between the abnormal lipid metabolism and the pathological process of OA. Finally, we identified KLF4 as our significant LMRG and constructed a KLF4-related scoring model to accurately diagnose OA. In conclusion, therapy strategies targeting on regulating lipid metabolism may become a key factor in treating OA. Key Points (a) We identified the significant LMRG KLF4 and constructed a novel KLF4-related scoring model for the accuracy diagnosis of OA. (b) The potential relationship between lipid metabolism and the immune microenvironment in OA was demonstrated in our research. (c) The relationship of lipid metabolism and OA has been further improved in our research and provided novel insight for the diagnosis and therapy for OA patients.
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Affiliation(s)
- Kaibo Hu
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Yuan Shu
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Zuxi Feng
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Mi Zou
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Jiazhe Luo
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Ziyue Wei
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China
| | - Jie Peng
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
- The Second Clinical Medical College of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
- Department of Sports Medicine, Huashan Hospital, Fudan University, 200040, Shanghai, China.
| | - Liang Hao
- Departments of Orthopedics, Second Affiliated Hospital of Nanchang University, Nanchang, 330006, Jiangxi Province, China.
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An F, Zhang J, Gao P, Xiao Z, Chang W, Song J, Wang Y, Ma H, Zhang R, Chen Z, Yan C. New insight of the pathogenesis in osteoarthritis: the intricate interplay of ferroptosis and autophagy mediated by mitophagy/chaperone-mediated autophagy. Front Cell Dev Biol 2023; 11:1297024. [PMID: 38143922 PMCID: PMC10748422 DOI: 10.3389/fcell.2023.1297024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Accepted: 11/27/2023] [Indexed: 12/26/2023] Open
Abstract
Ferroptosis, characterized by iron accumulation and lipid peroxidation, is a form of iron-driven cell death. Mitophagy is a type of selective autophagy, where degradation of damaged mitochondria is the key mechanism for maintaining mitochondrial homeostasis. Additionally, Chaperone-mediated autophagy (CMA) is a biological process that transports individual cytoplasmic proteins to lysosomes for degradation through companion molecules such as heat shock proteins. Research has demonstrated the involvement of ferroptosis, mitophagy, and CMA in the pathological progression of Osteoarthritis (OA). Furthermore, research has indicated a significant correlation between alterations in the expression of reactive oxygen species (ROS), adenosine monophosphate (AMP)-activated protein kinase (AMPK), and hypoxia-inducible factors (HIFs) and the occurrence of OA, particularly in relation to ferroptosis and mitophagy. In light of these findings, our study aims to assess the regulatory functions of ferroptosis and mitophagy/CMA in the pathogenesis of OA. Additionally, we propose a mechanism of crosstalk between ferroptosis and mitophagy, while also examining potential pharmacological interventions for targeted therapy in OA. Ultimately, our research endeavors to offer novel insights and directions for the prevention and treatment of OA.
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Affiliation(s)
- Fangyu An
- Teaching Experiment Training Center, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jie Zhang
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Peng Gao
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Zhipan Xiao
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Weirong Chang
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Jiayi Song
- School of Basic Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Yujie Wang
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Haizhen Ma
- Teaching Department of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Rui Zhang
- Teaching Department of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Zhendong Chen
- Teaching Department of Medicine, Gansu University of Chinese Medicine, Lanzhou, China
| | - Chunlu Yan
- School of Traditional Chinese and Western Medicine, Gansu University of Chinese Medicine, Lanzhou, China
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Bagheri K, Krez A, Anastasio AT, Adams SB. The use of platelet-rich plasma in pathologies of the foot and ankle: A comprehensive review of the recent literature. Foot Ankle Surg 2023; 29:551-559. [PMID: 37516651 DOI: 10.1016/j.fas.2023.07.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 06/27/2023] [Accepted: 07/23/2023] [Indexed: 07/31/2023]
Abstract
Platelet-rich plasma (PRP) is an autologous serum containing higher concentrations of platelets and growth factors above normal blood. The process of obtaining PRP involves the extraction of blood from the patient which is then centrifuged to obtain a concentrated suspension of platelets. PRP continues to evolve as a potential treatment modality with many applications in orthopaedic surgery. The therapeutic components of PRP possess numerous theoretical regenerative properties. The present manuscript outlines how PRP is prepared, noting the tremendous variability between preparation protocols. Given the growing body of evidence examining the use of PRP in pathologies of the foot and ankle, we assess its efficacy as it relates to our field. Specifically, we evaluate the literature in the past five years regarding the role of PRP in treating plantar fasciitis, Achilles tendinopathy, insertional Achilles tendinitis, Achilles tendon ruptures, osteochondral lesions of the talus, hallux rigidus, and ankle osteoarthritis.
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Affiliation(s)
- Kian Bagheri
- Campbell University School of Osteopathic Medicine, Lillington, NC, USA.
| | | | - Albert T Anastasio
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
| | - Samuel B Adams
- Department of Orthopedic Surgery, Duke University Hospital, Durham, NC, USA
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Zhang J, Santos C, Park C, Mazurowski MA, Colglazier R. Improving Image Classification of Knee Radiographs: An Automated Image Labeling Approach. J Digit Imaging 2023; 36:2402-2410. [PMID: 37620710 PMCID: PMC10584746 DOI: 10.1007/s10278-023-00894-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/26/2023] Open
Abstract
Large numbers of radiographic images are available in musculoskeletal radiology practices which could be used for training of deep learning models for diagnosis of knee abnormalities. However, those images do not typically contain readily available labels due to limitations of human annotations. The purpose of our study was to develop an automated labeling approach that improves the image classification model to distinguish normal knee images from those with abnormalities or prior arthroplasty. The automated labeler was trained on a small set of labeled data to automatically label a much larger set of unlabeled data, further improving the image classification performance for knee radiographic diagnosis. We used BioBERT and EfficientNet as the feature extraction backbone of the labeler and imaging model, respectively. We developed our approach using 7382 patients and validated it on a separate set of 637 patients. The final image classification model, trained using both manually labeled and pseudo-labeled data, had the higher weighted average AUC (WA-AUC 0.903) value and higher AUC values among all classes (normal AUC 0.894; abnormal AUC 0.896, arthroplasty AUC 0.990) compared to the baseline model (WA-AUC = 0.857; normal AUC 0.842; abnormal AUC 0.848, arthroplasty AUC 0.987), trained using only manually labeled data. Statistical tests show that the improvement is significant on normal (p value < 0.002), abnormal (p value < 0.001), and WA-AUC (p value = 0.001). Our findings demonstrated that the proposed automated labeling approach significantly improves the performance of image classification for radiographic knee diagnosis, allowing for facilitating patient care and curation of large knee datasets.
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Affiliation(s)
- Jikai Zhang
- Department of Electrical and Computer Engineering, Duke University, Room 10070, 2424 Erwin Road, Durham, NC, 27705, USA.
| | - Carlos Santos
- Wake Forest University, Winston-Salem, NC, 27109, USA
| | - Christine Park
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
| | - Maciej A Mazurowski
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
- Department of Electrical and Computer Engineering, Department of Biostatistics and Bioinformatics, Department of Computer Science, Duke University, Durham, NC, USA
| | - Roy Colglazier
- Department of Radiology, Duke University Medical Center, Durham, NC, USA
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Fatema K, Rony MAH, Azam S, Mukta MSH, Karim A, Hasan MZ, Jonkman M. Development of an automated optimal distance feature-based decision system for diagnosing knee osteoarthritis using segmented X-ray images. Heliyon 2023; 9:e21703. [PMID: 38027947 PMCID: PMC10665756 DOI: 10.1016/j.heliyon.2023.e21703] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 10/25/2023] [Accepted: 10/26/2023] [Indexed: 12/01/2023] Open
Abstract
Knee Osteoarthritis (KOA) is a leading cause of disability and physical inactivity. It is a degenerative joint disease that affects the cartilage, cushions the bones, and protects them from rubbing against each other during motion. If not treated early, it may lead to knee replacement. In this regard, early diagnosis of KOA is necessary for better treatment. Nevertheless, manual KOA detection is time-consuming and error-prone for large data hubs. In contrast, an automated detection system aids the specialist in diagnosing KOA grades accurately and quickly. So, the main objective of this study is to create an automated decision system that can analyze KOA and classify the severity grades, utilizing the extracted features from segmented X-ray images. In this study, two different datasets were collected from the Mendeley and Kaggle database and combined to generate a large data hub containing five classes: Grade 0 (Healthy), Grade 1 (Doubtful), Grade 2 (Minimal), Grade 3 (Moderate), and Grade 4 (Severe). Several image processing techniques were employed to segment the region of interest (ROI). These included Gradient-weighted Class Activation Mapping (Grad-Cam) to detect the ROI, cropping the ROI portion, applying histogram equalization (HE) to improve contrast, brightness, and image quality, and noise reduction (using Otsu thresholding, inverting the image, and morphological closing). Besides, the focus filtering method was utilized to eliminate unwanted images. Then, six feature sets (morphological, GLCM, statistical, texture, LBP, and proposed features) were generated from segmented ROIs. After evaluating the statistical significance of the features and selection methods, the optimal feature set (prominent six distance features) was selected, and five machine learning (ML) models were employed. Additionally, a decision-making strategy based on the six optimal features is proposed. The XGB model outperformed other models with a 99.46 % accuracy, using six distance features, and the proposed decision-making strategy was validated by testing 30 images.
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Affiliation(s)
- Kaniz Fatema
- Health Informatics Research Lab, Department of Computer Science and Engineering, Daffodil International University, Dhaka, 1341, Bangladesh
| | - Md Awlad Hossen Rony
- Health Informatics Research Lab, Department of Computer Science and Engineering, Daffodil International University, Dhaka, 1341, Bangladesh
| | - Sami Azam
- Faculty of Science and Technology, Charles Darwin University, Darwin, NT, 0909, Australia
| | - Md Saddam Hossain Mukta
- Department of Computer Science and Engineering, United International University, Dhaka, 1212, Bangladesh
| | - Asif Karim
- Faculty of Science and Technology, Charles Darwin University, Darwin, NT, 0909, Australia
| | - Md Zahid Hasan
- Health Informatics Research Lab, Department of Computer Science and Engineering, Daffodil International University, Dhaka, 1341, Bangladesh
| | - Mirjam Jonkman
- Faculty of Science and Technology, Charles Darwin University, Darwin, NT, 0909, Australia
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Walrabenstein W, Wagenaar CA, van de Put M, van der Leeden M, Gerritsen M, Twisk JWR, van der Esch M, van Middendorp H, Weijs PJM, Roorda LD, van Schaardenburg D. A multidisciplinary lifestyle program for metabolic syndrome-associated osteoarthritis: the "Plants for Joints" randomized controlled trial. Osteoarthritis Cartilage 2023; 31:1491-1500. [PMID: 37328047 DOI: 10.1016/j.joca.2023.05.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2022] [Revised: 05/04/2023] [Accepted: 05/04/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To determine the effectiveness of the "Plants for Joints" multidisciplinary lifestyle program in patients with metabolic syndrome-associated osteoarthritis (MSOA). DESIGN Patients with hip or knee MSOA were randomized to the intervention or control group. The intervention group followed a 16-week program in addition to usual care based on a whole food plant-based diet, physical activity, and stress management. The control group received usual care. The patient-reported Western Ontario and McMasters Universities Osteoarthritis Index (WOMAC) total score (range 0-96) was the primary outcome. Secondary outcomes included other patient-reported, anthropometric, and metabolic measures. An intention-to-treat analysis with a linear-mixed model adjusted for baseline values was used to analyze between-group differences. RESULTS Of the 66 people randomized, 64 completed the study. Participants (84% female) had a mean (SD) age of 63 (6) years and body mass index of 33 (5) kg/m2. After 16 weeks, the intervention group (n = 32) had a mean 11-point larger improvement in WOMAC-score (95% CI 6-16; p = 0.0001) compared to the control group. The intervention group also lost more weight (-5 kg), fat mass (-4 kg), and waist circumference (-6 cm) compared to the control group. Patient-Reported Outcomes Measurement Information System (PROMIS) fatigue, pain interference, C-reactive protein, hemoglobin A1c, fasting glucose, and low-density lipoproteins improved in the intervention versus the control group, while other PROMIS measures, blood pressure, high-density lipoproteins, and triglycerides did not differ significantly between the groups. CONCLUSION The "Plants for Joints" lifestyle program reduced stiffness, relieved pain, and improved physical function in people with hip or knee MSOA compared to usual care.
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Affiliation(s)
- Wendy Walrabenstein
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Department of Nutrition and Dietetics, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands.
| | - Carlijn A Wagenaar
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Marieke van de Put
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Marike van der Leeden
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Rehabilitation Medicine, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Martijn Gerritsen
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Martin van der Esch
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Faculty of Health, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical, & Neuropsychology Unit, Leiden University, Leiden, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Peter J M Weijs
- Department of Nutrition and Dietetics, Center of Expertise Urban Vitality, Amsterdam University of Applied Sciences, Amsterdam, the Netherlands; Amsterdam Movement Sciences Research Institute, Amsterdam, the Netherlands; Department of Nutrition & Dietetics, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Leo D Roorda
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
| | - Dirkjan van Schaardenburg
- Reade Center for Rheumatology and Rehabilitation, Amsterdam, the Netherlands; Department of Clinical Immunology and Rheumatology, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands; Amsterdam Rheumatology & immunology Center, Amsterdam, the Netherlands; Amsterdam Rehabilitation Research Center Reade, Amsterdam, the Netherlands
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Jin X, Liang W, Zhang L, Cao S, Yang L, Xie F. Economic and Humanistic Burden of Osteoarthritis: An Updated Systematic Review of Large Sample Studies. PHARMACOECONOMICS 2023; 41:1453-1467. [PMID: 37462839 DOI: 10.1007/s40273-023-01296-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/12/2023] [Indexed: 10/13/2023]
Abstract
OBJECTIVE A previous systematic literature review demonstrated a significant economic and humanistic burden on patients with osteoarthritis (OA). The aim of this study was to systematically review and update the burden of OA reported by large sample studies since 2016. METHODS We searched Medline (via Ovid) and Embase using the updated search strategy based on the previous review. Those studies with a sample size ≥ 1000 and measuring the cost (direct or indirect) or health-related quality of life (HRQL) of OA were included. Pairs of reviewers worked independently and in duplicate. An arbitrator was consulted to resolve discrepancies between reviewers. The Kappa value was calculated to examine the agreement between reviewers. All costs were converted to 2021 US dollars according to inflation rates and exchange rates. RESULTS A total of 1230 studies were screened by title and abstract and 159 by full text, and 54 studies were included in the review. The Kappa value for the full-text screening was 0.71. Total annual OA-related direct costs ranged from US$326 in Japan to US$19,530 in the US. Total annual all-cause direct costs varied from US$173 in Italy to US$41,433 in the US. The annual indirect costs ranged from US$736 in the US to US$18,884 in the Netherlands. Thirty-four studies reported HRQL, with EQ-5D (13, 38%) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) (6, 18%) being the most frequently used instruments. The EQ-VAS and utility scores ranged from 41.5 to 81.7 and 0.3 to 0.9, respectively. The ranges of WOMAC pain (range 0-20, higher score for worse health), stiffness (range 0-8), and physical functioning (range 0-68) were 2.0-3.0, 1.0-5.0, and 5.8-42.8, respectively. CONCLUSION Since 2016, the ranges of direct costs of OA became wider, while the HRQL of patients remained poor. More countries outside the US have published OA-related disease burden using registry databases.
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Affiliation(s)
- Xuejing Jin
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Wanxian Liang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Lining Zhang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Shihuan Cao
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Lujia Yang
- Centre for Evidence-Based Chinese Medicine, Beijing University of Chinese Medicine, No. 11, Bei San Huan Dong Lu, Chaoyang District, Beijing, China
| | - Feng Xie
- Department of Health Research Methods, Evidence, and Impact (formerly Clinical Epidemiology and Biostatistics), Faculty of Health Sciences, McMaster University, Hamilton, ON, Canada.
- Centre for Health Economics and Policy Analysis, Faculty of Health Sciences, McMaster University, 1280 Main Street West, Hamilton, ON, Canada.
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Kuş G, Yasacı Z, Boz C, Türkmen E. Association of Osteoarthritis Prevalence With Age and Obesity Factors in Organization for Economic Cooperation and Development Countries: Panel Regression Model. Am J Phys Med Rehabil 2023; 102:901-906. [PMID: 37026825 DOI: 10.1097/phm.0000000000002244] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/08/2023]
Abstract
INTRODUCTION According to cross-sectional analysis studies supported by microdata, incidence of Osteoarthritis increases in parallel with ageing and obesity, which are common predictors of the disease. The aim of this study is to reveal whether ageing and obesity have an effect on the increase in osteoarthritis prevalence by analyzing cross-country data from Organization for Economic Cooperation and Development countries. METHODS We used static panel data regression analysis for 36 countries for the period between 2000 and 2017. Along with osteoarthritis prevalence, we used a group of people with a body mass index ≤ 30 within the population as obesity indicator and those older than 65 yrs within the population as ageing indicator. We calculated the effect of ageing and obesity on osteoarthritis prevalence using STATA 13 software. RESULTS Both variable coefficients, age, and obesity, respectively, were found to be positive and statistically significant at the 1% level. This study shows that both ageing and obesity contribute to an increase in the osteoarthritis prevalence based on macro data from 36 Organization for Economic Cooperation and Development countries. CONCLUSIONS These findings have significant implications that can be used by both the public and policymakers for preventing the osteoarthritis. Adopting the preventive measures could contribute to decrease in health expenditures.
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Affiliation(s)
- Gamze Kuş
- From the Hatay Mustafa Kemal University-Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Hatay, Turkey (GK); Harran University-Faculty of Health Sciences, Division of Physiotherapy and Rehabilitation, Şanlıurfa, Turkey (ZY); Istanbul University-Cerrahpaşa, Faculty of Health Sciences, Health Economics, Istanbul, Turkey (CB); and Istanbul University-Cerrahpaşa, Institute of Graduate Studies, Department of Physiotherapy and Rehabilitation, Istanbul, Turkey (ET)
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Opava CH, Kindblom K, Rao K, Thorstensson CA, Swärdh E. Challenges of transforming evidence-based management of osteoarthritis into clinical practice in rural central Western India. Perceptions of an educational program. PHYSIOTHERAPY RESEARCH INTERNATIONAL 2023; 28:e2014. [PMID: 37170720 DOI: 10.1002/pri.2014] [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: 02/22/2023] [Accepted: 04/27/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE Osteoarthritis (OA) is a major threat to public health worldwide and is predicted to increase. Existing interventions to implement clinical practice guidelines (CPGs) seem to be used mainly in the Western world. We conducted a structured educational program on the evidence-based management of OA (BOA) for Indian physical therapists (PT). Our study aimed to describe Indian PTs' knowledge, attitudes and confidence on evidence-based management of OA, and their perceptions of a course on this subject. METHODS The 2-day course included didactic parts and practical skills training. Thirty-five PTs participated and answered a questionnaire. Fourteen of them participated in focus group interviews. Questionnaire data are presented as medians and full ranges. Manifest content analysis was used to analyze interview data that are presented as catagories illustrated by interview quotes. The formal ethics permission was granted. RESULTS 74% of PTs agreed that radiography determines the type of treatment required, and 69% agreed that a prescription for exercise is enough to ensure adherence. PTs agreed (mean 5 on 6-point scale) that exercises increasing pain should be advised against. Confidence in guiding the physical activity was generally high (≥5 on 6-point scales). Five categories reflected participants' perceptions of the course content: Shift in management focus, Need for cultural adaptation, Importance of social support, Development of organization and collaboration, and Feelings of hesitation. DISCUSSION Our results indicate that in order to facilitate the implementation of CPGs, PT curricula may consider the inclusion of knowledge on CPGs, focus more on students' own reflections on transforming theory into practice, and incorporate training of basic skills required for implementation of self-management, body awareness, and neuromuscular fitness. If given access and mandates, PTs may play a major role in the early diagnosis and treatment of OA and thus contribute to the prevention of an epidemic of OA in India.
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Affiliation(s)
- Christina H Opava
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Loni, Maharashtra, India
| | - Kristina Kindblom
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Loni, Maharashtra, India
| | - Keerthi Rao
- Dr. APJ Abdul Kalam College of Physiotherapy, Pravara Institute of Medical Sciences - DU, Loni, Maharashtra, India
| | - Carina A Thorstensson
- Institute of Neuroscience and Physiology, Gothenburg University, Goteborg, Sweden
- Department of Research and Development, Halland County Council, Varberg, Sweden
| | - Emma Swärdh
- Division of Physiotherapy, Department of Neurobiology, Health Care Sciences and Society, Karolinska Institutet, Huddinge, Sweden
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Novin S, Alvarez C, Renner JB, Golightly YM, Nelson AE. Features of Knee and Multijoint Osteoarthritis by Sex and Race and Ethnicity: A Preliminary Analysis in the Johnston County Health Study. J Rheumatol 2023; 51:jrheum.2023-0479. [PMID: 37714542 PMCID: PMC10940227 DOI: 10.3899/jrheum.2023-0479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/17/2023]
Abstract
OBJECTIVE To evaluate knee osteoarthritis (KOA) and multijoint osteoarthritis (MJOA), and to compare features by sex and race and ethnicity in a population-based cohort. METHODS Participants (n = 544) enrolled in the Johnston County Health Study (JoCoHS) as of January 2023 were categorized by radiographic and symptomatic KOA and MJOA phenotypes, and frequencies were compared by sex and race and ethnicity. Symptoms were assessed according to the Knee Injury and Osteoarthritis Outcome Score (KOOS) and pain, aching, and stiffness (PAS) scores at various joints. Models produced estimates (odds ratio [OR] or mean ratios [MR] and 95% CI) adjusted for age, BMI (kg/m2), and education. RESULTS Men had twice the odds of having MJOA-6 (≥ 3 lower extremity joints affected); there were no significant differences in MJOA phenotypes by race and ethnicity. Women had 50% higher odds of having KOA or having various features of KOA. Women reported significantly worse KOOS Symptoms scores (MR 1.25). Black participants had higher odds of more severe KOA (OR 1.47), subchondral sclerosis (OR 2.06), and medial tibial osteophytes (OR 1.50). Black participants reported worse KOOS Symptoms than White participants (MR 1.18). Although not statistically significant, Hispanic participants (vs non-Hispanic participants) appeared to have lower odds of radiographic changes but reported worse symptoms. CONCLUSION Preliminary findings in the diverse JoCoHS cohort suggest more lower extremity- predominant MJOA in men compared to women. Women and Black participants had more KOA features and more severe symptoms. Hispanic participants appear to have higher pain and symptoms scores despite having fewer structural changes. Studies in diverse populations are needed to understand the burden of OA.
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Affiliation(s)
- Sherwin Novin
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Carolina Alvarez
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jordan B. Renner
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Radiology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Yvonne M. Golightly
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, USA
| | - Amanda E. Nelson
- Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
- Department of Medicine, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Steinmetz JD, Culbreth GT, Haile LM, Rafferty Q, Lo J, Fukutaki KG, Cruz JA, Smith AE, Vollset SE, Brooks PM, Cross M, Woolf AD, Hagins H, Abbasi-Kangevari M, Abedi A, Ackerman IN, Amu H, Antony B, Arabloo J, Aravkin AY, Argaw AM, Artamonov AA, Ashraf T, Barrow A, Bearne LM, Bensenor IM, Berhie AY, Bhardwaj N, Bhardwaj P, Bhojaraja VS, Bijani A, Briant PS, Briggs AM, Butt NS, Charan J, Chattu VK, Cicuttini FM, Coberly K, Dadras O, Dai X, Dandona L, Dandona R, de Luca K, Denova-Gutiérrez E, Dharmaratne SD, Dhimal M, Dianatinasab M, Dreinhoefer KE, Elhadi M, Farooque U, Farpour HR, Filip I, Fischer F, Freitas M, Ganesan B, Gemeda BNB, Getachew T, Ghamari SH, Ghashghaee A, Gill TK, Golechha M, Golinelli D, Gupta B, Gupta VB, Gupta VK, Haddadi R, Hafezi-Nejad N, Halwani R, Hamidi S, Hanif A, Harlianto NI, Haro JM, Hartvigsen J, Hay SI, Hebert JJ, Heidari G, Hosseini MS, Hosseinzadeh M, Hsiao AK, Ilic IM, Ilic MD, Jacob L, Jayawardena R, Jha RP, Jonas JB, Joseph N, Kandel H, Karaye IM, Khan MJ, Kim YJ, Kolahi AA, Korzh O, Koteeswaran R, Krishnamoorthy V, Kumar GA, Kumar N, Lee SW, Lim SS, Lobo SW, Lucchetti G, Malekpour MR, Malik AA, Mandarano-Filho LGG, Martini S, Mentis AFA, Mesregah MK, Mestrovic T, Mirrakhimov EM, Misganaw A, Mohammadpourhodki R, Mokdad AH, Momtazmanesh S, Morrison SD, Murray CJL, Nassereldine H, Netsere HB, Neupane Kandel S, Owolabi MO, Panda-Jonas S, Pandey A, Pawar S, Pedersini P, Pereira J, Radfar A, Rashidi MM, Rawaf DL, Rawaf S, Rawassizadeh R, Rayegani SM, Ribeiro D, Roever L, Saddik B, Sahebkar A, Salehi S, Sanchez Riera L, Sanmarchi F, Santric-Milicevic MM, Shahabi S, Shaikh MA, Shaker E, Shannawaz M, Sharma R, Sharma S, Shetty JK, Shiri R, Shobeiri P, Silva DAS, Singh A, Singh JA, Singh S, Skou ST, Slater H, Soltani-Zangbar MS, Starodubova AV, Tehrani-Banihashemi A, Valadan Tahbaz S, Valdez PR, Vo B, Vu LG, Wang YP, Yahyazadeh Jabbari SH, Yonemoto N, Yunusa I, March LM, Ong KL, Vos T, Kopec JA. Global, regional, and national burden of osteoarthritis, 1990-2020 and projections to 2050: a systematic analysis for the Global Burden of Disease Study 2021. THE LANCET. RHEUMATOLOGY 2023; 5:e508-e522. [PMID: 37675071 PMCID: PMC10477960 DOI: 10.1016/s2665-9913(23)00163-7] [Citation(s) in RCA: 79] [Impact Index Per Article: 79.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/08/2023]
Abstract
Background Osteoarthritis is the most common form of arthritis in adults, characterised by chronic pain and loss of mobility. Osteoarthritis most frequently occurs after age 40 years and prevalence increases steeply with age. WHO has designated 2021-30 the decade of healthy ageing, which highlights the need to address diseases such as osteoarthritis, which strongly affect functional ability and quality of life. Osteoarthritis can coexist with, and negatively effect, other chronic conditions. Here we estimate the burden of hand, hip, knee, and other sites of osteoarthritis across geographies, age, sex, and time, with forecasts of prevalence to 2050. Methods In this systematic analysis for the Global Burden of Disease Study, osteoarthritis prevalence in 204 countries and territories from 1990 to 2020 was estimated using data from population-based surveys from 26 countries for knee osteoarthritis, 23 countries for hip osteoarthritis, 42 countries for hand osteoarthritis, and US insurance claims for all of the osteoarthritis sites, including the other types of osteoarthritis category. The reference case definition was symptomatic, radiographically confirmed osteoarthritis. Studies using alternative definitions from the reference case definition (for example self-reported osteoarthritis) were adjusted to reference using regression models. Osteoarthritis severity distribution was obtained from a pooled meta-analysis of sources using the Western Ontario and McMaster Universities Arthritis Index. Final prevalence estimates were multiplied by disability weights to calculate years lived with disability (YLDs). Prevalence was forecast to 2050 using a mixed-effects model. Findings Globally, 595 million (95% uncertainty interval 535-656) people had osteoarthritis in 2020, equal to 7·6% (95% UI 6·8-8·4) of the global population, and an increase of 132·2% (130·3-134·1) in total cases since 1990. Compared with 2020, cases of osteoarthritis are projected to increase 74·9% (59·4-89·9) for knee, 48·6% (35·9-67·1) for hand, 78·6% (57·7-105·3) for hip, and 95·1% (68·1-135·0) for other types of osteoarthritis by 2050. The global age-standardised rate of YLDs for total osteoarthritis was 255·0 YLDs (119·7-557·2) per 100 000 in 2020, a 9·5% (8·6-10·1) increase from 1990 (233·0 YLDs per 100 000, 109·3-510·8). For adults aged 70 years and older, osteoarthritis was the seventh ranked cause of YLDs. Age-standardised prevalence in 2020 was more than 5·5% in all world regions, ranging from 5677·4 (5029·8-6318·1) per 100 000 in southeast Asia to 8632·7 (7852·0-9469·1) per 100 000 in high-income Asia Pacific. Knee was the most common site for osteoarthritis. High BMI contributed to 20·4% (95% UI -1·7 to 36·6) of osteoarthritis. Potentially modifiable risk factors for osteoarthritis such as recreational injury prevention and occupational hazards have not yet been explored in GBD modelling. Interpretation Age-standardised YLDs attributable to osteoarthritis are continuing to rise and will lead to substantial increases in case numbers because of population growth and ageing, and because there is no effective cure for osteoarthritis. The demand on health systems for care of patients with osteoarthritis, including joint replacements, which are highly effective for late stage osteoarthritis in hips and knees, will rise in all regions, but might be out of reach and lead to further health inequity for individuals and countries unable to afford them. Much more can and should be done to prevent people getting to that late stage. Funding Bill & Melinda Gates Foundation, Institute of Bone and Joint Research, and Global Alliance for Musculoskeletal Health.
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Carvalho C, Helena Gonçalves G, Fernando Approbato Selistre L, Petrella M, De Oliveira Sato T, Da Silva Serrão PRM, Márcia Mattiello S. Association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis. Arch Rheumatol 2023; 38:387-396. [PMID: 38046241 PMCID: PMC10689021 DOI: 10.46497/archrheumatol.2023.9386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2021] [Accepted: 12/09/2022] [Indexed: 12/05/2023] Open
Abstract
Objectives This study aimed to investigate the association between ankle torque and performance-based tests, self-reported pain, and physical function in patients with knee osteoarthritis (OA). Patients and methods The cross-sectional study was conducted with 39 individuals (24 females, 15 males; mean age: 57.3±6.2 years; range, 40 to 65 years) with knee OA between January 2014 and July 2015. Ankle torque was determined using an isokinetic dynamometer. The 40-m fast-paced walk test and a stair climb test were used to assess functional performance. Self-reported pain and physical function were assessed using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Pearson's correlation coefficients were calculated to test correlations between the dependent variables (40-m fast-paced walk test, stair climb test, WOMAC pain and physical function domains, sex, age, body mass index, and radiologic evidence of OA) and the independent variables (mean plantar flexor torque and dorsiflexor peak torque). A multiple linear regression analysis was applied to quantify the association between the dependent and independent variables. Results Dorsiflexor and plantar flexor peak torques in the concentric and eccentric modes were negatively correlated with the 40-m fast-paced walk and stair climb tests (r=-0.33 to -0.51, p≤0.05). A negative correlation was found between concentric plantar flexor torque and the WOMAC physical function score (r=-0.35, p=0.03). No correlation was found between ankle torques and the WOMAC pain score (p>0.05). The multiple linear regression analysis showed that the eccentric plantar flexor and dorsiflexor torques were significantly associated with the stair climb test (β=-0.001, 95% confidence interval [CI]: -0.001 to 0.000, p=0.03, and β=-0.002, 95% CI: -0.004 to 0.000, p=0.05, respectively). No significant associations were found between concentric plantar flexor and dorsiflexor torques and the stair climb test (p>0.05). No significant associations were found between the ankle torques and the 40-m fast-paced walk test and WOMAC physical function (p>0.05). Conclusion Ankle torque plays an important role in functional performance. Thus, ankle torque deficit, especially eccentric plantar flexor and dorsiflexor torques, may exert a negative influence on stair climbing performance in patients with knee osteoarthritis.
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Affiliation(s)
- Cristiano Carvalho
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
| | | | | | - Marina Petrella
- Department of Physical Therapy, Federal University of São Carlos, São Carlos, Brazil
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Nemati D, Quintero D, Best TM, Kaushal N. Investigating the association between knee osteoarthritis symptoms with pain catastrophizing domains between Hispanics and non-Hispanic Whites. Rheumatol Int 2023:10.1007/s00296-023-05396-1. [PMID: 37597058 DOI: 10.1007/s00296-023-05396-1] [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: 06/06/2023] [Accepted: 07/14/2023] [Indexed: 08/21/2023]
Abstract
Knee osteoarthritis (KOA) is a chronic disease accompanied by debilitating symptoms including pain, stiffness, and limited physical functionality, which have been shown to be associated with pain catastrophizing. Previous studies have revealed racial discrepancies in pain catastrophizing, notably between Hispanics and non-Hispanics while pointing to potential health disparities. Using a conceptual model, this study aimed to investigate racial differences in associations between KOA symptoms with specific pain catastrophizing domains (rumination, magnification, and helplessness). Patients with KOA (n = 253; 147 Hispanics, 106 non-Hispanic Whites) completed a survey that included measures of knee symptoms, pain catastrophizing, and demographic variables. Structural equation modeling revealed that among Hispanics, each pain catastrophizing domain (rumination, magnification, and helplessness) was associated with at least two symptomatic experiences, including pain severity and difficulty in physical function. Specifically, pain severity was associated with (a) rumination: β = 0.48, p < 0.001, (b) magnification: β = 0.31, p = 0.003; and (c) helplessness: β = 0.39, p < 0.001). Additionally, a lower score in physical function was associated with higher magnification (β = 0.26, p = 0.01), and helplessness (β = 0.25, p = 0.01). Among non-Hispanic White patients, pain severity was further associated with two domains of pain catastrophizing, including rumination (β = 0.39, p < 0.001) and helplessness (β = 0.35, p = 0.01). In addition, association pathways for demographic variables revealed that older Hispanics experienced greater challenges with higher pain severity (β = 0.26, p = 0.01) and greater difficulty with physical function (β = 0.31, p < 0.001) while Hispanics females experienced higher pain (β = 0.19, p = 0.03). These findings highlight the importance of designing tailored interventions that consider key demographic factors such as age, and gender, to improve physical function that might alleviate pain catastrophizing among Hispanics with KOA.
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Affiliation(s)
- Donya Nemati
- Center for Healthy Aging, Self-Management, & Complex Care, College of Nursing, The Ohio State University, 1585 Neil Avenue, Columbus, OH, 43210, USA.
| | - Daniel Quintero
- Department of Orthopedics, Miller School of Medicine, U Health Sports Medicine Institute, U of Miami, Coral Gables, FL, USA
| | - Thomas M Best
- Department of Orthopedics, Miller School of Medicine, U Health Sports Medicine Institute, U of Miami, Coral Gables, FL, USA
| | - Navin Kaushal
- Department of Health Sciences, Indiana University School of Health and Human Sciences, Indianapolis, IN, USA
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Wang Q, Runhaar J, Kloppenburg M, Boers M, Bijlsma JWJ, Bacardit J, Bierma-Zeinstra SMA. A machine learning approach reveals features related to clinicians' diagnosis of clinically relevant knee osteoarthritis. Rheumatology (Oxford) 2023; 62:2732-2739. [PMID: 36534939 DOI: 10.1093/rheumatology/keac707] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 12/09/2022] [Indexed: 08/03/2023] Open
Abstract
OBJECTIVES To identify highly ranked features related to clinicians' diagnosis of clinically relevant knee OA. METHODS General practitioners (GPs) and secondary care physicians (SPs) were recruited to evaluate 5-10 years follow-up clinical and radiographic data of knees from the CHECK cohort for the presence of clinically relevant OA. GPs and SPs were gathered in pairs; each pair consisted of one GP and one SP, and the paired clinicians independently evaluated the same subset of knees. A diagnosis was made for each knee by the GP and SP before and after viewing radiographic data. Nested 5-fold cross-validation enhanced random forest models were built to identify the top 10 features related to the diagnosis. RESULTS Seventeen clinician pairs evaluated 1106 knees with 139 clinical and 36 radiographic features. GPs diagnosed clinically relevant OA in 42% and 43% knees, before and after viewing radiographic data, respectively. SPs diagnosed in 43% and 51% knees, respectively. Models containing top 10 features had good performance for explaining clinicians' diagnosis with area under the curve ranging from 0.76-0.83. Before viewing radiographic data, quantitative symptomatic features (i.e. WOMAC scores) were the most important ones related to the diagnosis of both GPs and SPs; after viewing radiographic data, radiographic features appeared in the top lists for both, but seemed to be more important for SPs than GPs. CONCLUSIONS Random forest models presented good performance in explaining clinicians' diagnosis, which helped to reveal typical features of patients recognized as clinically relevant knee OA by clinicians from two different care settings.
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Affiliation(s)
- Qiuke Wang
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Maarten Boers
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Amsterdam, The Netherlands
| | - Johannes W J Bijlsma
- Department of Rheumatology and Clinical Immunology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Jaume Bacardit
- School of Computing, Newcastle University, Newcastle, UK
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
- Department of Orthopaedics and Sport Medicine, Erasmus MC University Center Rotterdam, Rotterdam, The Netherlands
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Vincent HK, Sharififar S, McLaren C, May J, Vincent KR. Acute and chronic cardiovascular responses to concentric and eccentric exercise in older adults with knee osteoarthritis. BMC Sports Sci Med Rehabil 2023; 15:95. [PMID: 37528468 PMCID: PMC10394881 DOI: 10.1186/s13102-023-00708-1] [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: 03/06/2023] [Accepted: 07/25/2023] [Indexed: 08/03/2023]
Abstract
PURPOSE Muscle contraction type in resistance exercise training may confer benefits besides strength in individuals with osteoarthritis and cardiovascular disease (CVD) risks. The purpose of the study was to explore whether Eccentric-resistance training (RT) improved hemodynamic responses to acute walking exercise stress compared to Concentric-RT among individuals with knee OA over four months. METHODS This was a secondary analysis from a randomized, controlled, single-blinded study. Participants (N = 88; 68.3 ± 6.4 yrs; 67.4% female) were randomized to one of two work-matched resistance training (RT) programs against a non-RT control group. Pre-training and month four, participants completed a self-paced Six-Minute Walk Test (6MWT) and progressive treadmill exercise test. Heart rates, blood pressures and mean arterial pressures (MAP) were captured during each test. Antihypertensive medications use was documented at each time point. RESULTS Leg strength improved in both training groups by month four (p < .05). Changes in 6MWT distance and progressive treadmill test time were not different across groups over four months. Neither Concentric or Eccentric RT produced different hemodyamic responses during the 6MWT compared to the control group post-training. However, Concentric RT was associated with 6.0%-7.4% reductions in systolic blood pressure during the graded treadmill walking test at 50%, 75% and 100% of the test time compared to Eccentric RT and the controls (p = .045). MAP values were lower at 75% and 100% of the treadmill test after Concentric RT (5.7%-6.0% reductions) compared to Eccentric RT (1.0%-2.4% reductions) and controls (1.5% and 4.0% elevations) post-training (p = .024). Antihypertensive medication use did not change in any group. CONCLUSIONS The repeated, progressive exposures of Concentric RT-induced blunted the hypertensive responses to acute exercise compared to Eccentric-RT. Among people with knee OA, Concentric-RT may confer strength benefits to manage OA and possibly reduce cardiovascular stress during exercise.
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Affiliation(s)
- Heather K Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, UF Orthopaedics and Sports Medicine Institute, PO Box 112730, Gainesville, FL, 32611, USA.
| | - Sharareh Sharififar
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, UF Orthopaedics and Sports Medicine Institute, PO Box 112730, Gainesville, FL, 32611, USA
| | - Christian McLaren
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, UF Orthopaedics and Sports Medicine Institute, PO Box 112730, Gainesville, FL, 32611, USA
| | - James May
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, UF Orthopaedics and Sports Medicine Institute, PO Box 112730, Gainesville, FL, 32611, USA
| | - Kevin R Vincent
- Department of Physical Medicine and Rehabilitation, College of Medicine, University of Florida, UF Orthopaedics and Sports Medicine Institute, PO Box 112730, Gainesville, FL, 32611, USA
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Rosada M, Speciali D, Dias de Oliveira FB, Campedelli RR, Rodrigues H, Antonioli E, Ferretti M. Eight weeks of a lower limb resistance training protocol and gait performance in patients with symptomatic mild to moderate knee osteoarthritis. J Orthop Sci 2023:S0949-2658(23)00196-3. [PMID: 37532651 DOI: 10.1016/j.jos.2023.07.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 04/13/2023] [Accepted: 07/14/2023] [Indexed: 08/04/2023]
Abstract
BACKGROUND The role of strengthening the lower limbs to optimize the biomechanics of the hip, knee and ankle during walking in patients with knee osteoarthritis, is still unclear. This study aimed to analyse the walking biomechanics of individuals with symptomatic mild to moderate knee osteoarthritis before and after a simplified lower limb resistance training protocol, focused on knee joint exercises with individualized load. METHODS Forty-one patients with symptomatic and radiographic mild to moderate knee osteoarthritis underwent 3D gait analysis pre-post 8 weeks lower limb resistance training protocol performed 3 times a week. Parameters investigated were spatiotemporal, sagittal range of motion, flexion and extension minimum and maximum values, power and moment of hip, knee and ankle, as well as self-reported pain and physical function by the Western Ontario MacMaster University Osteoarthritis Index. Paired t test, Wilcoxon, Spearman's correlation and a logistic model were used for statistical analysis, with p < 0.05. Pain improvement more than 2 points was considered clinically relevant. The effect size (ES) was calculated using Cohen's d. RESULTS Post protocol walking speed increased 6.7% (ES: 0.711), cadence 3.7% (ES: 0.655), stride length 2.6% (ES: 0.542), and double support time reduced 6.9% (ES:0.459). It was also observed a significant increase in one maximum repetition test for legpress 46%, knee extension 23% and knee flexion chair 27% (p < 0.001). Patients reported a 62.5% reduction in pain (ES:1.518) and 64.9% improvement in physical function (ES:1.376). 82% of the patients presented more than 2 points improvement in pain. No evidence of strong correlations between pain, strength gains and gait parameters were found. CONCLUSIONS There was a significant and clinical improvement of spatiotemporal gait parameters, pain, physical function, and strength after 8-week lower limb resistance training protocol. Patients who had a clinically relevant pain improvement presented better gait performance.
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Affiliation(s)
- Mariana Rosada
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
| | | | | | | | | | | | - Mario Ferretti
- Hospital Israelita Albert Einstein, São Paulo, SP, Brazil.
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Thirumaran AJ, Deveza LA, Atukorala I, Hunter DJ. Assessment of Pain in Osteoarthritis of the Knee. J Pers Med 2023; 13:1139. [PMID: 37511752 PMCID: PMC10381750 DOI: 10.3390/jpm13071139] [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: 06/15/2023] [Revised: 07/10/2023] [Accepted: 07/12/2023] [Indexed: 07/30/2023] Open
Abstract
Knee osteoarthritis (KOA) pain is a subjective and personal experience, making it challenging to characterise patients' experiences and assess their pain. In addition, there is no global standard for the assessment of pain in KOA. Therefore, this article examines the possible methods of assessing and characterising pain in patients with KOA using clinical symptoms, pain assessment tools, and imaging. We examine the current methods of assessment of pain in KOA and their application in clinical practice and clinical trials. Furthermore, we explore the possibility of creating individualised pain management plans to focus on different pain characteristics. With better evaluation and standardisation of pain assessment in these patients, it is hoped that patients would benefit from improved quality of life. At the same time, improvement in pain assessment would enable better data collection regarding symptom response in clinical trials for the treatment of osteoarthritis.
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Affiliation(s)
- Aricia Jieqi Thirumaran
- Nepean Hospital, Kingswood, NSW 2747, Australia
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
| | - Leticia Alle Deveza
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
| | - Inoshi Atukorala
- Senior Lecturer in Clinical Medicine & Consultant Rheumatologist, University Medical Unit, National Hospital Sri Lanka, Colombo 00700, Sri Lanka
- Faculty of Medicine, University of Colombo, Colombo 00800, Sri Lanka
| | - David J Hunter
- Sydney Musculoskeletal Health, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, St Leonards, NSW 2065, Australia
- Rheumatology Department, Royal North Shore Hospital, St Leonards, NSW 2065, Australia
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Altamirano S, Jansen MP, Oberski DL, Eijkemans MJC, Mastbergen SC, Lafeber FPJG, van Spil WE, Welsing PMJ. Identifying multivariate disease trajectories and potential phenotypes of early knee osteoarthritis in the CHECK cohort. PLoS One 2023; 18:e0283717. [PMID: 37450467 PMCID: PMC10348540 DOI: 10.1371/journal.pone.0283717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 03/15/2023] [Indexed: 07/18/2023] Open
Abstract
OBJECTIVE To gain better understanding of osteoarthritis (OA) heterogeneity and its predictors for distinguishing OA phenotypes. This could provide the opportunity to tailor prevention and treatment strategies and thus improve care. DESIGN Ten year follow-up data from CHECK (1002 early-OA subjects with first general practitioner visit for complaints ≤6 months before inclusion) was used. Data were collected on WOMAC (pain, function, stiffness), quantitative radiographic tibiofemoral (TF) OA characteristics, and semi-quantitative radiographic patellofemoral (PF) OA characteristics. Using functional data analysis, distinctive sets of trajectories were identified for WOMAC, TF and PF characteristics, based on model fit and clinical interpretation. The probabilities of knee membership to each trajectory were used in hierarchical cluster analyses to derive knee OA phenotypes. The number and composition of potential phenotypes was selected again based on model fit (silhouette score) and clinical interpretation. RESULTS Five trajectories representing different constant levels or changing WOMAC scores were identified. For TF and PF OA, eight and six trajectories respectively were identified based on (changes in) joint space narrowing, osteophytes and sclerosis. Combining the probabilities of knees belonging to these different trajectories resulted in six clusters ('phenotypes') of knees with different degrees of functional (WOMAC) and radiographic (PF) parameters; TF parameters were found not to significantly contribute to clustering. Including baseline characteristics as well resulted in eight clusters of knees, dominated by sex, menopausal status and WOMAC scores, with only limited contribution of PF features. CONCLUSIONS Several stable and progressive trajectories of OA symptoms and radiographic features were identified, resulting in phenotypes with relatively independent symptomatic and radiographic features. Sex and menopausal status may be especially important when phenotyping knee OA patients, while radiographic features contributed less. Possible phenotypes were identified that, after validation, could aid personalized treatments and patients selection.
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Affiliation(s)
- Sara Altamirano
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Mylène P Jansen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Daniel L Oberski
- Department of Methodology and Statistics, Faculty of Social and Behavioral Sciences, Utrecht University, Utrecht, the Netherlands
- Department of Data Science and Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Marinus J C Eijkemans
- Department of Data Science and Biostatistics, Julius Center, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Simon C Mastbergen
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Floris P J G Lafeber
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Willem E van Spil
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Rheumatology, Dijklander Hospital, Hoorn, The Netherlands
| | - Paco M J Welsing
- Department of Rheumatology & Clinical Immunology, University Medical Center Utrecht, Utrecht, The Netherlands
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Li S, Si H, Zhang S, Xu J, Liu Y, Shen B. Does diabetes mellitus impair the clinical results of total knee arthroplasty under enhanced recovery after surgery? J Orthop Surg Res 2023; 18:490. [PMID: 37430329 DOI: 10.1186/s13018-023-03982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and osteoarthritis (OA) are common diseases that are predicted to increase in prevalence, and DM is a risk factor for OA progression and has a negative impact on the outcome. However, the evidence remains unclear on how it affects patients' clinical results of total knee arthroplasty (TKA) under enhanced recovery after surgery (ERAS). METHODS A retrospective single-center study was conducted comparing diabetic and non-diabetic patients who underwent TKA in West China Hospital of Sichuan University between September 2016 to December 2017 under ERAS. Consecutive propensity score matching (PSM) was conducted by 1:1 (DM: non-DM) matching analysis with all baselines as covariates. The primary clinical results were the improvement of knee joint function, the incidence of postoperative complications, and the FJS-12 sensory results 5 years after the operation between DM and Non-DM groups. The secondary clinical results were the postoperative length of stay (LOS), postoperative blood test and total blood loss (TBL). RESULT After PSM, the final analysis included 84 diabetic patients and 84 non-diabetic patients. Diabetic patients were more likely to experience early postoperative complications (21.4% vs. 4.8%, P = 0.003), of which wound complications are the most significant (10.7% vs. 1.2%, P = 0.022). Diabetic patients experienced longer postoperative LOS with a significant increase in patients with LOS exceeding 3 days (66.7% vs. 50%, P = 0.028) and showed less postoperative range of motion (ROM) (106.43 ± 7.88 vs. 109.50 ± 6.33 degrees, P = 0. 011). Diabetic patients also reported lower Forgotten joint score (FJS-12) than non-diabetic patients (68.16 + 12.16 vs. 71.57 + 10.75, P = 0.020) in the 5-year follow-up and were less likely to achieve a forgotten knee joint (10.7% vs. 1.2%, P = 0.022). In additional, Compared with non-diabetics, diabetic patients showed lower hemoglobin (Hb) (P < 0.001) and hematocrit (HCT) (P < 0.001) and were more likely to suffer from hypertension before TKA (P < 0.001). CONCLUSION Diabetic patients show increased risk for postoperative complications, and have lower lower postoperative ROM and lower FJS-12 compared with non-diabetic patients after TKA under ERAS. More perioperative protocols are still needed to be investigated and optimized for diabetic patients.
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Affiliation(s)
- Shuai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Haibo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jiawen Xu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yuan Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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Farrag A, Elsayed W, Saleh DA, Hefny A, Shaheen A. Arabic version of the intermittent and constant osteoarthritis pain questionnaire (ICOAP-Ar): translation, cross-cultural adaptation, and measurement properties. BMC Musculoskelet Disord 2023; 24:481. [PMID: 37312050 DOI: 10.1186/s12891-023-06492-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 05/04/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Pain is the most incapacitating symptom of knee osteoarthritis (OA), with intermittent and/or continuous nature as described by the patients. Accuracy of pain assessment tools across different cultures is important. This study aimed to translate and culturally adapt the Intermittent and Constant OsteoArthritis Pain (ICOAP) measure into Arabic (ICOAP-Ar) and evaluate its psychometric properties in patients with knee OA. METHODS The ICOAP was cross-culturally adapted following the recommended guidelines from English. Knee OA patients from outpatient clinics were recruited to assess the structural (confirmatory factor analysis) and construct validity (Spearman's correlation coefficient - rho) to assess the relationship between the ICOAP-Ar and the pain and symptoms subscales of the Knee Injury and Osteoarthritis Outcome Score (KOOS), in addition to internal consistency (Cronbach's alpha and the corrected item-total correlation). A week later, test-retest reliability (intraclass correlation coefficient (ICC)) was evaluated. Following four weeks of physical therapy treatment, the ICOAP-Ar responsiveness was evaluated using the receiver operating characteristic curve. RESULTS Ninety-seven participants were recruited (age = 52.97 ± 9.9). A model with single pain construct showed acceptable fit (Comparative fit index = 0.92). The ICOAP-Ar total and subscales had a strong to moderate negative correlation with the KOOS pain and symptoms domains, respectively. The ICOAP-Ar total and subscales demonstrated satisfactory internal consistency (α = 0.86-0.93). The ICCs were excellent (ICCs = 0.89-0.92) with acceptable corrected item total correlations (rho = 0.53-0.87) for the ICOAP-Ar items. The ICOAP-Ar responsiveness was good with moderate effect size (ES = 0.51-0.65) and large standardized response mean (SRM = 0.86-0.99). A cut-off point of 51.1/100 was determined with moderate accuracy (Area under the curve = 0.81, sensitivity = 85%, specificity = 71%). No floor or ceiling effects were found. CONCLUSIONS The ICOAP-Ar exhibited good validity, reliability, and responsiveness after physical therapy treatment for knee OA, which renders it reliable for evaluating knee OA pain in clinical and research settings.
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Affiliation(s)
- Ahmed Farrag
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt.
| | - Walaa Elsayed
- Department of Physical Therapy, College of Applied Medical Sciences, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
| | - Doaa Al Saleh
- Department of Physical Therapy, King Fahd Military Medical Complex, Dhahran, Saudi Arabia
| | | | - Afaf Shaheen
- Basic Science Department, Faculty of Physical Therapy, Cairo University, Cairo, Egypt
- Department of Health Rehabilitation Sciences, College of Applied Medical Sciences, King Saud University, Riyadh, Saudi Arabia
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Roux CH, Rousseau AS, Iannelli A, Gautier N, Ferrero S, Hinault C, Chinetti G, Ngueyon-Sime W, Guillemin F, Amri EZ. The Association between Oxytocin and Lower Limb Osteoarthritis: A Prospective Cohort Study. Int J Mol Sci 2023; 24:ijms24119750. [PMID: 37298701 DOI: 10.3390/ijms24119750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Revised: 05/29/2023] [Accepted: 05/31/2023] [Indexed: 06/12/2023] Open
Abstract
Oxytocin (OT), a neuropeptide best known for its role in emotional and social behaviors, has been linked to osteoarthritis (OA). This study aimed to investigate the serum OT level in hip and/or knee OA patients and to study its association with disease progression. Patients from the KHOALA cohort with symptomatic hip and/or knee OA (Kellgren and Lawrence (KL) scores of 2 and 3) and follow-up at 5 years were included in this analysis. The primary endpoint was structural radiological progression, which was defined as an increase of at least one KL point at 5 years. Logistic regression models were used to estimate the associations between OT levels and KL progression while controlling for gender, age, BMI, diabetes and leptin levels. Data from 174 hip OA patients and 332 knee OA patients were analyzed independently. No differences in OT levels were found between the 'progressors' and 'non-progressors' groups among the hip OA patients and knee OA patients, respectively. No statistically significant associations were found between the OT levels at baseline and KL progression at 5 years, the KL score at baseline or the clinical outcomes. Higher structural damage at baseline and severe structural progression of hip and knee osteoarthritis did not appear to be associated with a low serum OT level at baseline.
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Affiliation(s)
- Christian Hubert Roux
- CHU, Inserm, Université Côte d'Azur, 06000 Nice, France
- CNRS, Inserm, iBV, Université Côte d'Azur, 06000 Nice, France
| | | | - Antonio Iannelli
- Centre Hospitalier Universitaire de Nice-Digestive Surgery and Liver Transplantation Unit, Archet 2 Hospital, 151 Route Saint Antoine de Ginestière, BP 3079, CEDEX 3, 06200 Nice, France
| | - Nadine Gautier
- CNRS, Inserm, iBV, Université Côte d'Azur, 06000 Nice, France
| | | | | | - Giulia Chinetti
- CHU, Inserm, C3M, Université Côte d'Azur, 06000 Nice, France
| | - Willy Ngueyon-Sime
- CHRU de Nancy, Inserm, Université de Lorraine, CIC Clinical Epidemiology, 54500 Nancy, France
| | - Francis Guillemin
- CHRU de Nancy, Inserm, Université de Lorraine, CIC Clinical Epidemiology, 54500 Nancy, France
| | - Ez Zoubir Amri
- CNRS, Inserm, iBV, Université Côte d'Azur, 06000 Nice, France
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Pester BD, Wilson JM, Yoon J, Lazaridou A, Schreiber KL, Cornelius M, Campbell CM, Smith MT, Haythornthwaite JA, Edwards RR, Meints SM. Brief Mindfulness-Based Cognitive Behavioral Therapy is Associated with Faster Recovery in Patients Undergoing Total Knee Arthroplasty: A Pilot Clinical Trial. PAIN MEDICINE (MALDEN, MASS.) 2023; 24:576-585. [PMID: 36394250 PMCID: PMC10501468 DOI: 10.1093/pm/pnac183] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 10/04/2022] [Accepted: 11/10/2022] [Indexed: 09/16/2023]
Abstract
OBJECTIVE To assess whether brief mindfulness-based cognitive behavioral therapy (MBCBT) could enhance the benefits of total knee arthroplasty (TKA) in improving pain and pain-related disability. Specifically, to determine 1) whether patients who received MBCBT differed from matched controls who received treatment-as-usual with regard to postsurgical pain outcomes and 2) whether changes in pain catastrophizing, depression, or anxiety explained the potential effects of MBCBT on pain outcomes. DESIGN Pilot clinical trial. SETTING An academic teaching hospital serving a large urban and suburban catchment area surrounding the Boston, Massachusetts metropolitan region. SUBJECTS Sample of 44 patients undergoing TKA. Patients who completed a brief MBCBT intervention (n = 22) were compared with age-, race-, and sex-matched controls who received treatment-as-usual (n = 22). METHODS The MBCBT intervention included four 60-minute sessions delivered by a pain psychologist in person and via telephone during the perioperative period. Participants were assessed at baseline and at 6 weeks, 3 months, and 6 months after surgery. RESULTS Compared with matched controls, patients who received MBCBT had lower pain severity and pain interference at 6 weeks after surgery. Group differences in outcomes were mediated by changes in pain catastrophizing but not by changes in depression or anxiety. The MBCBT group had similar reductions in pain severity and interference as the control group did at 3 and 6 months after surgery. CONCLUSIONS This work offers evidence for a safe and flexibly delivered nonpharmacological treatment (MBCBT) to promote faster recovery from TKA and identifies change in pain catastrophizing as a mechanism by which this intervention could lead to enhanced pain-related outcomes.
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Affiliation(s)
- Bethany D Pester
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jenna M Wilson
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jihee Yoon
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Asimina Lazaridou
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Kristin L Schreiber
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Marise Cornelius
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Claudia M Campbell
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Michael T Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Jennifer A Haythornthwaite
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Robert R Edwards
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Samantha M Meints
- Department of Anesthesiology and Pain Medicine, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts, USA
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Chang J, Yuan Y, Fu M, Wang D. Health-related quality of life among patients with knee osteoarthritis in Guangzhou, China: a multicenter cross-sectional study. Health Qual Life Outcomes 2023; 21:50. [PMID: 37244981 DOI: 10.1186/s12955-023-02133-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 05/18/2023] [Indexed: 05/29/2023] Open
Abstract
PURPOSES To investigate health-related quality of life (HRQoL) of patients with knee osteoarthritis (KOA) in Guangzhou, China, and examine its association with selected sociodemographic characteristics as well as knee function. METHODS This multicenter cross-sectional study included 519 patients with KOA in Guangzhou from April 1 to December 30, 2019. Data on sociodemographic characteristics were obtained using the General Information Questionnaire. The disability was measured using the KOOS-PS, resting pain using the Pain-VAS, and HRQoL using the EQ-5D-5L. The association of selected sociodemographic factors, KOOS-PS and Pain-VAS scores with HRQoL (EQ-5D-5L utility and EQ-VAS scores) were analyzed using linear regression analyses. RESULTS The median (interquartile range [IQR]) of EQ-5D-5L utility and EQ-VAS scores were 0.744 (0.571-0.841) and 70 (60-80) respectively, lower than the average HRQoL in the general population. Only 3.661% of KOA patients reported no problems in all EQ-5D-5L dimensions, with Pain/Discomfort being the most frequently affected dimension (78.805%). The correlation analysis showed that the KOOS-PS score, Pain-VAS score and HRQoL were moderately or strongly correlated. Patients with cardiovascular disease, no daily exercise, and high KOOS-PS or Pain-VAS scores had lower EQ-5D-5L utility scores; and patients with body mass index (BMI) > 28 ,high KOOS-PS or Pain-VAS scores had lower EQ-VAS scores. CONCLUSIONS Patients with KOA had relatively low HRQoL. Various sociodemographic characteristics as well as knee function were associated with HRQoL in regression analyses. Providing social support and improving their knee function through methods such as total knee arthroplasty might be crucial to improve their HRQoL.
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Affiliation(s)
- Jinghui Chang
- School of Health Management, Southern Medical University, Guangzhou, 510515, China
| | - Yuxin Yuan
- Department of Biostatistics, State Key Laboratory of Organ Failure Research, Ministry of Education, and Guangdong Provincial Key Laboratory of Tropical Disease Research, School of Public Health, Southern Medical University, Guangzhou, 510515, China
| | - Manru Fu
- The Third Affiliated Hospital, Southern Medical University, Guangzhou, 510282, China
| | - Dong Wang
- School of Health Management, Southern Medical University, Guangzhou, 510515, China.
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50
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Bahns C, Kopkow C. Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice. BMC Musculoskelet Disord 2023; 24:424. [PMID: 37312080 PMCID: PMC10262543 DOI: 10.1186/s12891-023-06464-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/26/2023] [Indexed: 06/15/2023] Open
Abstract
BACKGROUND Osteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists' adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use. METHODS A cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists' management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen. RESULTS In total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline. CONCLUSIONS In accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice. TRIAL REGISTRATION German Clinical Trials Register (DRKS00026702). Registered 14 October 2021.
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Affiliation(s)
- Carolin Bahns
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Universitätsplatz 1, 01968, Senftenberg, Germany.
| | - Christian Kopkow
- Department of Therapy Science I, Brandenburg University of Technology Cottbus-Senftenberg, Universitätsplatz 1, 01968, Senftenberg, Germany
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