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Ferrero S, Roux CH. Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial. Semin Arthritis Rheum 2024; 67:152459. [PMID: 38692054 DOI: 10.1016/j.semarthrit.2024.152459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/24/2024] [Indexed: 05/03/2024]
Affiliation(s)
- Stephanie Ferrero
- Rheumatology Department, Hospital Pasteur 2 CHU, 06000 Nice, France.
| | - Christian Hubert Roux
- Rheumatology Department, Hospital Pasteur 2 CHU, 06000 Nice, France; Inserm, CNRS, iBV, Université Côte d'Azur, 06000 Nice, France
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Chen Y, Xiao H, Wang Y, Geng B, Xia Y. Letter to the editor regarding "Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial". Semin Arthritis Rheum 2024; 67:152458. [PMID: 38703486 DOI: 10.1016/j.semarthrit.2024.152458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Accepted: 04/24/2024] [Indexed: 05/06/2024]
Affiliation(s)
- Yi Chen
- The Second Hospital of Lanzhou University, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, No.82 Cuiyingmen, Chengguan District, Lanzhou City 730030, Gansu, China
| | - Hefang Xiao
- The Second Hospital of Lanzhou University, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, No.82 Cuiyingmen, Chengguan District, Lanzhou City 730030, Gansu, China
| | - Yaobin Wang
- The Second Hospital of Lanzhou University, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, No.82 Cuiyingmen, Chengguan District, Lanzhou City 730030, Gansu, China
| | - Bin Geng
- The Second Hospital of Lanzhou University, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, No.82 Cuiyingmen, Chengguan District, Lanzhou City 730030, Gansu, China
| | - Yayi Xia
- The Second Hospital of Lanzhou University, Orthopaedic Clinical Research Center of Gansu Province, Intelligent Orthopaedic Industry Technology Center of Gansu Province, No.82 Cuiyingmen, Chengguan District, Lanzhou City 730030, Gansu, China.
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3
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Zhu R, Fang H, Wang J, Ge L, Zhang X, Aitken D, Cai G. Inflammation as a therapeutic target for osteoarthritis: A literature review of clinical trials. Clin Rheumatol 2024:10.1007/s10067-024-07042-y. [PMID: 38961031 DOI: 10.1007/s10067-024-07042-y] [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: 03/14/2024] [Revised: 06/12/2024] [Accepted: 06/24/2024] [Indexed: 07/05/2024]
Abstract
The burden of osteoarthritis (OA) is rapidly increasing with population aging, but there are still no approved disease-modifying drugs available. Accumulating evidence has shown that OA is a heterogeneous disease with multiple phenotypes, and it is unlikely to respond to one-size-fits-all treatments. Inflammation is recognized as an important phenotype of OA and is associated with worse pain and joint deterioration. Therefore, it is believed that anti-inflammatory treatments may be more effective for OA with an inflammatory phenotype. In this review, we summarized clinical trials that evaluated anti-inflammatory treatments for OA and discussed whether these treatments are more effective in inflammatory OA phenotypes compared to general OA patients.
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Affiliation(s)
- Rui Zhu
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Haonan Fang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Junjie Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Liru Ge
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Xiaoyue Zhang
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China
| | - Dawn Aitken
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public Health, Anhui Medical University, Hefei, 230032, Anhui, China.
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia.
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4
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Ooghe A, Liu X, Robbins S, Eyles JP, Deveza LA, Branders S, Clermont F, Pereira A, Hunter DJ. Report of similar placebo response in one internet versus onsite randomised controlled trials from the literature. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100474. [PMID: 38737983 PMCID: PMC11088186 DOI: 10.1016/j.ocarto.2024.100474] [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: 05/03/2023] [Accepted: 04/23/2024] [Indexed: 05/14/2024] Open
Abstract
Objective The aim of this study was to compare the magnitude and the predictors of the placebo response in an internet versus onsite randomised controlled trials (RCTs) in people with hand osteoarthritis (HOA). Method This study is a post-hoc analysis based on one internet RCT (RADIANT) and previously published onsite RCTs for HOA identified through a rigorous searching and selection strategy. The magnitude of the placebo response in the two different types of RCTs were compared using heterogeneity statistics and forest plots visualisation. Classic placebo predictors as well as a combined model, defined with data from onsite RCTs, were tested to predict the placebo response. Results We analysed the dataset from RADIANT and fourteen previously published onsite RCTs. None of the analyses showed a significant difference between the placebo response for the internet versus onsite RCTs. The "classic" placebo predictors combined in a multivariate predictive model correlated significantly with the placebo response measured in RADIANT study. Conclusion Despite the absence of face-to-face interactions with the study personnel, there is no evidence that either the magnitude or the predictors of the placebo response of this internet RCT differ from those of onsite RCTs. This analysis is considered as a first step towards evaluating the difference between these designs and strengthens the argument that internet RCTs remain an acceptable alternative way to assess the efficacy of an active treatment in comparison to a placebo.
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Affiliation(s)
- Arthur Ooghe
- Cognivia, 11 rue Granbonpré, Bte 9 - 1435 Mont-Saint-Guibert, Belgium
| | - Xiaoqian Liu
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Australia
| | - Sarah Robbins
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Australia
| | - Jillian P. Eyles
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Australia
| | - Leticia A. Deveza
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Australia
| | - Samuel Branders
- Cognivia, 11 rue Granbonpré, Bte 9 - 1435 Mont-Saint-Guibert, Belgium
| | - Frédéric Clermont
- Cognivia, 11 rue Granbonpré, Bte 9 - 1435 Mont-Saint-Guibert, Belgium
| | - Alvaro Pereira
- Cognivia, 11 rue Granbonpré, Bte 9 - 1435 Mont-Saint-Guibert, Belgium
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital, Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Australia
- Sydney Musculoskeletal Health, Kolling Institute, The University of Sydney, Australia
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5
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Kuswanto W, Baker MC. Repurposing drugs for the treatment of osteoarthritis. Osteoarthritis Cartilage 2024:S1063-4584(24)01207-X. [PMID: 38821468 DOI: 10.1016/j.joca.2024.05.008] [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: 10/12/2023] [Revised: 04/12/2024] [Accepted: 05/10/2024] [Indexed: 06/02/2024]
Abstract
OBJECTIVE Currently, no disease-modifying therapies for osteoarthritis (OA) exist, and attempts to identify novel cellular targets have been challenging. Risk factors for OA include advanced age, obesity, and metabolic syndrome. This creates an attractive opportunity to repurpose existing drugs that are used to treat comorbidities commonly encountered in patients with OA, if those drugs possess OA disease modifying properties. METHODS This narrative review incorporates findings from knee or hand OA randomized clinical trials, post-hoc clinical trial analyses, prospective cohort studies, and observational data. RESULTS Drugs used for the treatment of rheumatoid arthritis (methotrexate; TNFa, IL-1, and IL-6 pathway inhibitors; hydroxychloroquine), atopic/allergic disease (anti-histamines), osteoporosis (bisphosphonates and vitamin D), type 2 diabetes (metformin and GLP-1 agonists), and cardiovascular disease (atorvastatin, fish oil, and beta blockers) were reviewed for their potential benefit in OA. This review outlines the successful attributes of repurposed drugs, the challenges in repurposing drugs, and strategies for future clinical trials to support OA drug repurposing. Potential drug candidates for OA may be identified through the use of existing datasets and via collaborations with researchers in other fields to include OA endpoints in future clinical trials. CONCLUSION Given the association of OA with several commonly treated comorbidities, drug repurposing is an appealing approach that could provide a favorable benefit-to-risk ratio for chronic OA treatment.
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Affiliation(s)
- Wilson Kuswanto
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA; Gilead Sciences Inc, Foster City, CA, USA
| | - Matthew C Baker
- Division of Immunology and Rheumatology, Department of Medicine, Stanford University, Stanford, CA, USA.
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Wu R, Peng Q, Wang W, Zheng J, Zhou Y, Yang Q, Zhang X, Li H, Meng L. Systematic review and network meta-analysis on the efficacy and safety of parmacotherapy for hand osteoarthritis. PLoS One 2024; 19:e0298774. [PMID: 38722915 PMCID: PMC11081354 DOI: 10.1371/journal.pone.0298774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2023] [Accepted: 01/31/2024] [Indexed: 05/13/2024] Open
Abstract
OBJECTIVE Hand osteoarthritis poses a significant health challenge globally due to its increasing prevalence and the substantial burden on individuals and the society. In current clinical practice, treatment options for hand osteoarthritis encompass a range of approaches, including biological agents, antimetabolic drugs, neuromuscular blockers, anti-inflammatory drugs, hormone medications, pain relievers, new synergistic drugs, and other medications. Despite the diverse array of treatments, determining the optimal regimen remains elusive. This study seeks to conduct a network meta-analysis to assess the effectiveness and safety of various drug intervention measures in the treatment of hand osteoarthritis. The findings aim to provide evidence-based support for the clinical management of hand osteoarthritis. METHODS We performed a comprehensive search across PubMed, Embase, Web of Science, and Cochrane Central Register of Controlled Trials was conducted until September 15th, 2022, to identify relevant randomized controlled trials. After meticulous screening and data extraction, the Cochrane Handbook's risk of bias assessment tool was applied to evaluate study quality. Data synthesis was carried out using Stata 15.1 software. RESULTS 21 studies with data for 3965 patients were meta-analyzed, involving 20 distinct Western medicine agents. GCSB-5, a specific herbal complex that mainly regulate pain in hand osteoarthritis, showed the greatest reduction in pain [WMD = -13.00, 95% CI (-26.69, 0.69)]. CRx-102, s specific medication characterized by its significant effect for relieving joint stiffness symptoms, remarkably mitigated stiffness [WMD = -7.50, 95% CI (-8.90, -6.10)]. Chondroitin sulfate displayed the highest incidence of adverse events [RR = 0.26, 95% CI (0.06, 1.22)]. No substantial variation in functional index for hand osteoarthritis score improvement was identified between distinct agents and placebo. CONCLUSIONS In summary, GCSB-5 and CRx-102 exhibit efficacy in alleviating pain and stiffness in HOA, respectively. However, cautious interpretation of the results is advised. Tailored treatment decisions based on individual contexts are imperative.
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Affiliation(s)
- Ruiqi Wu
- Guangxi University of Chinese Medicine, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Qinglin Peng
- Guangxi University of Chinese Medicine, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Weiwei Wang
- Guangxi University of Chinese Medicine, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Jixian Zheng
- Hainan Medical University, Haikou, 570100, Hainan, China
| | - Yi Zhou
- Guangxi University of Chinese Medicine, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Qipei Yang
- Guangxi University of Chinese Medicine, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Xuan Zhang
- Guangxi University of Chinese Medicine, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Hongyu Li
- Guangxi Orthopedic Hospital, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
| | - Lin Meng
- Guangxi Orthopedic Hospital, Nanning, 530000, Guangxi Zhuang Autonomous Region, China
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Jalali K, Mandl LA. Rheumatology: What You May Have Missed in 2023. Ann Intern Med 2024; 177:S82-S90. [PMID: 38621248 DOI: 10.7326/m24-0678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/17/2024] Open
Abstract
Many patients with rheumatologic conditions receive care from physicians other than rheumatologists. Here we note key findings from 6 studies in rheumatology published in 2023 that offer valuable insights for internal medicine specialists and subspecialists outside of rheumatology. The first study investigated the effect of low-dose glucocorticoids on patients with rheumatoid arthritis (RA) over 2 years and challenged existing perceptions about the risks of glucocorticoids in this setting. The second study focused on the updated guideline for preventing and treating glucocorticoid-induced osteoporosis. With the chronic and widespread use of glucocorticoids, the American College of Rheumatology emphasized the importance of assessing fracture risk and initiating pharmacologic therapy when appropriate. The third study explored the potential use of methotrexate in treating inflammatory hand osteoarthritis, suggesting a novel approach to managing this challenging and common condition. The results of the fourth article we highlight suggest that sarilumab has promise as an adjunct treatment of polymyalgia rheumatica relapse during glucocorticoid dosage tapering. The fifth study evaluated sublingual cyclobenzaprine for fibromyalgia treatment, noting both potential benefits and risks. Finally, the sixth article is a systematic review and meta-analysis that assessed the therapeutic equivalence of biosimilars and reference biologics in the treatment of patients with RA. Knowledge of this recent literature will be useful to clinicians regardless of specialty who care for patients with these commonly encountered conditions.
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Affiliation(s)
- Kafaf Jalali
- Division of Rheumatology, McMaster University, Hamilton, Ontario, Canada (K.J.)
| | - Lisa A Mandl
- Division of Rheumatology, Hospital for Special Surgery and Weill Cornell Medicine, New York, New York (L.A.M.)
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Bean MB, Favero M, Ramonda R, Scanzello CR. Erosive Hand Osteoarthritis: Recent Advances and Future Treatments. Curr Rheumatol Rep 2024; 26:103-111. [PMID: 38214806 PMCID: PMC10965372 DOI: 10.1007/s11926-023-01130-9] [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] [Accepted: 12/28/2023] [Indexed: 01/13/2024]
Abstract
PURPOSE OF THE REVIEW Erosive hand osteoarthritis (EHOA) is an aggressive form of hand osteoarthritis that leads to significant disability, and recent data suggests that it is increasing in prevalence. This review provides an update of our current understanding of epidemiology, genetic associations, biomarkers, pathogenesis, and treatment of EHOA, with particular focus on studies published within the last 5 years. RECENT FINDINGS New studies of EHOA have identified new genetic loci associated with disease, including variants in genes involved in inflammation and bone remodeling. Preclinical studies implicate pathways of innate immunity, including some that may be causal in the condition. Recent novel studies showed that inflammatory features identified by ultrasound and MRI are associated with development of erosive lesions over time on conventional radiography. In the future, these imaging modalities may be useful in identifying patients at risk of adverse outcomes. Promising new findings in genetics, biomarkers, and treatment targets will hopefully allow for future therapeutic options for this debilitating condition.
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Affiliation(s)
- Marta B Bean
- Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA.
| | - Marta Favero
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
- Medicine Unit 1, Ca' Foncello Hospital, Treviso, Italy
| | - Roberta Ramonda
- Rheumatology Unit, Department of Medicine-DIMED, Padova University Hospital, Padova, Italy
| | - Carla R Scanzello
- Division of Rheumatology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, 19104, USA
- Department of Medicine & Translational Musculoskeletal Research Center, Corp. Crescenz VA Medical Center, Philadelphia, PA, 19104, USA
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9
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McHugh J. Methotrexate improves pain in hand OA. Nat Rev Rheumatol 2024; 20:3. [PMID: 37949970 DOI: 10.1038/s41584-023-01056-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2023]
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10
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Kloppenburg M. Inflammation is a relevant treatment target in osteoarthritis. Lancet 2023; 402:1725-1726. [PMID: 37839421 DOI: 10.1016/s0140-6736(23)01726-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/14/2023] [Indexed: 10/17/2023]
Affiliation(s)
- Margreet Kloppenburg
- Departments of Rheumatology and Clinical Epidemiology, Leiden University Medical Center, 2300RC Leiden, the Netherlands.
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Wang Y, Jones G, Keen HI, Hill CL, Wluka AE, Kasza J, Teichtahl AJ, Antony B, O'Sullivan R, Cicuttini FM. Methotrexate to treat hand osteoarthritis with synovitis (METHODS): an Australian, multisite, parallel-group, double-blind, randomised, placebo-controlled trial. Lancet 2023; 402:1764-1772. [PMID: 37839420 DOI: 10.1016/s0140-6736(23)01572-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Revised: 07/20/2023] [Accepted: 07/26/2023] [Indexed: 10/17/2023]
Abstract
BACKGROUND Hand osteoarthritis is a disabling condition with few effective therapies. Hand osteoarthritis with synovitis is a common inflammatory phenotype associated with pain. We aimed to examine the efficacy and safety of methotrexate at 6 months in participants with hand osteoarthritis and synovitis. METHODS In this multisite, parallel-group, double-blind, randomised, placebo-controlled trial, participants (aged 40-75 years) with hand osteoarthritis (Kellgren and Lawrence grade ≥2 in at least one joint) and MRI-detected synovitis of grade 1 or more were recruited from the community in Melbourne, Hobart, Adelaide, and Perth, Australia. Participants were randomly assigned (1:1) using block randomisation, stratified by study site and self-reported sex, to receive methotrexate 20 mg or identical placebo orally once weekly for 6 months. The primary outcome was pain reduction (measured with a 100 mm visual analogue scale; VAS) in the study hand at 6 months assessed in the intention-to-treat population. Safety outcomes were assessed in all randomly assigned participants. This trial was registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000877381). FINDINGS Between Nov 22, 2017, and Nov 8, 2021, of 202 participants who were assessed for eligibility, 97 (48%) were randomly assigned to receive methotrexate (n=50) or placebo (n=47). 68 (70%) of 97 participants were female and 29 (30%) were male. 42 (84%) of 50 participants in the methotrexate group and 40 (85%) of 47 in the placebo group provided primary outcome data. The mean change in VAS pain at 6 months was -15·2 mm (SD 24·0) in the methotrexate group and -7·7 mm (25·3) in the placebo group, with a mean between-group difference of -9·9 (95% CI -19·3 to -0·6; p=0·037) and an effect size (standardised mean difference) of 0·45 (0·03 to 0·87). Adverse events occurred in 31 (62%) of 50 participants in the methotrexate group and 28 (60%) of 47 participants in the placebo group. INTERPRETATION Treatment of hand osteoarthritis and synovitis with 20 mg methotrexate for 6 months had a moderate but potentially clinically meaningful effect on reducing pain, providing proof of concept that methotrexate might have a role in the management of hand osteoarthritis with an inflammatory phenotype. FUNDING National Health and Medical Research Council of Australia.
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Affiliation(s)
- Yuanyuan Wang
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Helen I Keen
- Rheumatology Group, School of Medicine, University of Western Australia, Perth, WA, Australia; Department of Rheumatology, Fiona Stanley Hospital, Murdoch, WA, Australia
| | - Catherine L Hill
- The Queen Elizabeth Hospital and Department of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Anita E Wluka
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Alfred Hospital, Melbourne, VIC, Australia
| | - Jessica Kasza
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | | | - Benny Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
| | - Richard O'Sullivan
- Lumus Imaging, Richmond, VIC, Australia; Department of Medicine, Central Clinical School, Monash University, Prahran, VIC, Australia
| | - Flavia M Cicuttini
- School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia; Alfred Hospital, Melbourne, VIC, Australia.
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Mathieu S, Lambert C, Fayet F, Couderc M, Beauger M, Malochet S, Pickering ME, Tournadre A, Soubrier M. Comparison of the cardiovascular risk profile of rheumatoid arthritis versus hand osteoarthritis patients. Rheumatol Int 2023; 43:2065-2072. [PMID: 37566254 DOI: 10.1007/s00296-023-05405-3] [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: 06/07/2023] [Accepted: 07/23/2023] [Indexed: 08/12/2023]
Abstract
It is clear that there is an increased cardiovascular (CV) risk in rheumatoid arthritis (RA) as a result of systemic inflammation. Hand osteoarthritis (HOA) patients, also have an increased CV risk, but the causes are still debated. Our objective was to compare CV risk factors and risk scores between HOA and RA patients. Thirty-five HOA patients were matched by age (< 3 years) and sex to 35 RA patients in a case-control study. We compared their CV risk profiles and their risk of occurrence of CV events at 10 years using the risk equations SCORE1, SCORE2, and QRISK3. There was a significant increase in SCORE1, SCORE2, but not in QRISK3 in the RA group compared to the HOA group, provided that the multiplication coefficient for RA was applied. This increase was found to no longer be significant for SCORE1 when RA patients have low disease activity (DAS28 ≤ 3.2; n = 8). There was no difference between groups in the frequency of metabolic syndrome, blood pressure, abdominal circumference, body mass index, uricemia, triglyceridemia, HDL cholesterolemia, or pain intensity. Conversely, HOA patients had higher LDL cholesterol and fasting blood glucose levels, in the main analysis and in the subgroup of moderate/high RA activity patients (DAS28 > 3.2; n = 26). We found a higher CV risk in RA compared to HOA patients with moderate/high disease activity. The increased CV risk reported in OA remains to be confirmed in HOA, but these patients appear to have a pro-atherogenic lipid and glycemic profile.
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Affiliation(s)
- Sylvain Mathieu
- Université Clermont Auvergne, CHU Clermont-Ferrand, INSERM, Neuro-Dol, 63000, Clermont-Ferrand, France.
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France.
| | - C Lambert
- Unité de Biostatistiques, DRCI, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Françoise Fayet
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Marion Couderc
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Marine Beauger
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Sandrine Malochet
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Marie-Eva Pickering
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Anne Tournadre
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
| | - Martin Soubrier
- Service de Rhumatologie, CHU Clermont-Ferrand, 63000, Clermont-Ferrand, France
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13
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Richette P, Latourte A. Hand osteoarthritis: A fresh look. Joint Bone Spine 2023; 91:105652. [PMID: 37797830 DOI: 10.1016/j.jbspin.2023.105652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/16/2022] [Indexed: 10/07/2023]
Abstract
Hand osteoarthritis (OA) has been the subject of numerous publications in recent years, particularly in the fields of imaging and therapeutics. The imaging studies revealed a good correlation between the presence of synovitis and/or subchondral edema and arthritic joint pain. Several randomized controlled trials (RCTs) have assessed the efficacy of biologics and conventional DMARDs in patients with symptomatic hand OA. No less than six RCTs have evaluated the symptomatic and, in some cases, structural efficacy of anti-IL-1, anti-TNF or anti-IL-6 drugs. Overall, the results of these trials were disappointing - none of them demonstrated superiority over placebo. There were also two negative trials with hydroxychloroquine. In the end, the only trial that was positive evaluated 10mg oral prednisone versus placebo for 6 weeks in patients with flares of hand OA and synovitis visible on ultrasound. While that trial confirms the role of inflammation in hand OA, it should obviously not encourage the long-term use of corticosteroids as a symptomatic treatment.
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Affiliation(s)
- Pascal Richette
- Service de rhumatologie, hôpital Lariboisière, Paris, France.
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14
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Gezer HH, Ostor A. What is new in pharmacological treatment for osteoarthritis? Best Pract Res Clin Rheumatol 2023; 37:101841. [PMID: 37302928 DOI: 10.1016/j.berh.2023.101841] [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: 05/03/2023] [Accepted: 05/10/2023] [Indexed: 06/13/2023]
Abstract
Osteoarthritis (OA) is a degenerative joint disease in which structural changes of hyaline articular cartilage, subchondral bone, ligaments, capsule, synovium, muscles, and periarticular changes are involved. The knee is the most commonly affected joint, followed by the hand, hip, spine, and feet. Different pathological mechanisms are at play in each of these various involvement sites. Although systemic inflammation is more prominent in hand OA, knee and hip OA have been associated with excessive joint load and injury. As OA has varied phenotypes and the primarily affected tissues differ, treatment options must be tailored accordingly. In recent years, ongoing efforts have been made to develop disease-modifying options that halt or slow disease progression. Many are still in clinical trials, and as insights into the pathogenesis of OA evolve, novel therapeutic strategies will be developed. In this chapter, we provide an overview of the novel and emerging strategies in the management of OA.
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Affiliation(s)
- Halise Hande Gezer
- Marmara University School of Medicine, PMR Department Rheumatology Division, Istanbul, Turkiye
| | - Andrew Ostor
- Cabrini Medical Centre, Monash University, Melbourne & ANU, Canberra, Australia.
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15
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Foster NE, L E, L D, M H. Osteoarthritis year in review 2022: epidemiology & therapy. Osteoarthritis Cartilage 2023:S1063-4584(23)00730-6. [PMID: 36963607 DOI: 10.1016/j.joca.2023.03.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 03/09/2023] [Accepted: 03/15/2023] [Indexed: 03/26/2023]
Abstract
This 'Year in Review' provides a synopsis of key research themes and individual studies from the clinical osteoarthritis (OA) field, focused on epidemiology and therapy. The electronic database search for the review was adapted from the 2021 year in review search, to increase search specificity for relevant study designs, and was conducted in Medline, Embase and medRxiv (31st March 2021 to 4th March 2022). Following screening for eligibility, studies were grouped according to their key research design, including reviews, cohorts and randomised trials. 11 key themes emerged, including the importance of several comorbidities in predicting OA incidence and prevalence, surgical approaches that can reduce the risk of post-traumatic OA, the heterogenous but nevertheless relatively stable nature of OA subgroup trajectories, the paucity of robust studies particularly of surgery for OA and the very modest benefit of many therapies under evaluation in trials. A particular interest of the authors was to consider whether new studies are helping determine how to better ensure the right patient with OA is matched to the right treatment at the right time. There are several new studies developing improved predictive models through big data analytics and machine learning which show promise, need validation, and may support new approaches to stratified care.
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Affiliation(s)
- Nadine E Foster
- STARS Education and Research Alliance, Surgical Treatment and Rehabilitation Service (STARS), The University of Queensland and Metro North Health, Queensland, Australia.
| | - Eriksson L
- Lars Eriksson, The University of Queensland, UQ Library, Herston Qld 4006, Queensland, Australia.
| | - Deveza L
- Institute of Bone and Joint Research, Kolling Institute of Medical Research, The University of Sydney, Sydney, New South Wales, Australia; Department of Rheumatology, Northern Clinical School, Royal North Shore Hospital, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
| | - Hall M
- Centre for Health, Exercise and Sports Medicine, University of Melbourne, Victoria, Australia.
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Gao R, Pu J, Wu Z, Tang J, Wang X. Osteoarthritis or arthritis? Toward understanding of primary Sjögren's syndrome patients with arthralgia. J Orthop Surg Res 2023; 18:41. [PMID: 36647153 PMCID: PMC9841668 DOI: 10.1186/s13018-023-03513-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/09/2022] [Accepted: 01/07/2023] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVE To identify primary Sjögren's syndrome (pSS) patients with arthralgia at risk for osteoarthritis (OA) or arthritis. METHODS This study included 368 pSS patients admitted to a mono-centric from March 2010 to December 2020. Patients were divided into groups according to whether complicated with OA or arthritis. Data were analyzed to determine the differences in demographical characteristics, symptoms, and laboratory examination. RESULTS The involvement of the OA joints was predominately knee and spine sites (including cervical and lumbar spine degeneration). When diagnosing arthritis, it was mainly peripheral symmetric polyarthritis, the most affected sites were the interphalangeal and metacarpophalangeal joints. There were significant differences in age, disease duration, uric acid (UA), and total cholesterol (TC) between pSS-OA and pSS-nOA patients (P < 0.050). Logistic regression analysis showed that age (OR = 1.965; P = 0.009) and joint pain (OR = 3.382; P < 0.001) were dangerous factors associated with OA. Interestingly, although the level of UA, TC, and triglycerides (TG) was shown to be positive with OA, there was no statistical significance after the OR was computed in the four-cell table. In pSS-arthritis, EULAR Sjögren's syndrome disease activity index (ESSDAI) (P = 0.011), the frequency of joint pain (P < 0.001), and muscular involvement (P = 0.037) were higher than non-arthritis group. In pSS patients only presenting with joint pain, arthritis patients had higher ESSDAI and system involvements, but lower UA and TG levels compared with OA group (P < 0.050). CONCLUSION In pSS patients with arthralgia, OA accounted for the majority. pSS patients with advanced age and more pronounced metabolic characteristics, such as elevated blood lipids and uric acid, was a key factor in groups at risk for OA. However, arthritis patients had higher rates of dry mouth and eye, higher disease activity, antibodies positive, and more organs damage. In the future, it may be necessary to be more cautious in the diagnosis of joint manifestations in pSS patients in order to make the appropriate treatments.
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Affiliation(s)
- Ronglin Gao
- grid.24516.340000000123704535Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065 China
| | - Jincheng Pu
- grid.24516.340000000123704535Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065 China
| | - Zhenzhen Wu
- grid.24516.340000000123704535Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065 China
| | - Jianping Tang
- grid.24516.340000000123704535Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065 China
| | - Xuan Wang
- grid.24516.340000000123704535Department of Rheumatology and Immunology, Tongji Hospital, School of Medicine, Tongji University, No. 389 Xincun Road, Shanghai, 200065 China
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Tenti S, Bruyère O, Cheleschi S, Reginster JY, Veronese N, Fioravanti A. An update on the use of conventional and biological disease-modifying anti-rheumatic drugs in hand osteoarthritis. Ther Adv Musculoskelet Dis 2023; 15:1759720X231158618. [PMID: 36937821 PMCID: PMC10017945 DOI: 10.1177/1759720x231158618] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Accepted: 02/02/2023] [Indexed: 03/15/2023] Open
Abstract
Osteoarthritis (OA) is a highly prevalent condition worldwide associated with pain, progressive disability, reduced participation in social activities, and impaired quality of life. Despite its growing burden, the therapeutic options are still limited and almost exclusively addressed to symptoms' management, while no disease-modifying OA drugs able to prevent or retard disease progression are actually available. For these reasons, in the last decades, relevant efforts to find new potential therapeutic targets in OA have been made and a number of existing conventional and biological disease-modifying anti-rheumatic drugs (DMARDs), including hydroxychloroquine (HCQ), methotrexate (MTX), tumor necrosis factor (TNF)-α, interleukin (IL)-1, and IL-6 inhibitors, commonly used to treat inflammatory rheumatic diseases, have been repurposed for the treatment of OA and explored also in hand osteoarthritis (HOA). The current narrative review was aimed to provide a comprehensive and updated understanding of the possibilities and the criticisms related to the treatment of HOA with conventional and biological DMARDs. Unfortunately, therapy with conventional and biologic drugs in HOA has not achieved the expected success, despite a rationale for their use exists. Thus, our findings outline the urgent need to enhance the exploration of HOA basic molecular mechanisms to find new potential therapeutic targets, personalized for each patient, and appropriate for the different subsets of HOA and for the different phases of disease.
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Affiliation(s)
- Sara Tenti
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, University of Siena, Viale Bracci 1, 53100 Siena, Italy
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health, Aspects of Musculoskeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Sara Cheleschi
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda ospedaliero-universitaria Senese, Siena, Italy
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Centre for Public Health, Aspects of Musculoskeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
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Alekseeva LI, Sharapova EP, Lila AM. Osteoarthritis of hand joints: prevalence, risk factors, phenotypes, diagnosis, treatment. MODERN RHEUMATOLOGY JOURNAL 2022. [DOI: 10.14412/1996-7012-2022-6-98-105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Osteoarthritis is the most common rheumatic disease, accompanied by constant pain and dysfunction of the joints, the progression of which leads to a deterioration in the quality of life and often to disability of patients. The article presents the prevalence, predictors of development and progression of osteoarthritis of the hand joints (OHJ). Clinical classification of OHJ, clinical picture depending on the localization of the process, topical features of involvement of the hand joints in different types of OHJ are given. Clinical, laboratory and instrumental methods for diagnosing of the disease, classification and diagnostic criteria are described, much attention is paid to modern principles of OHJ therapy in accordance with Russian clinical guidelines, as well as EULAR and ACR recommendations.
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Affiliation(s)
- L. I Alekseeva
- V.A. Nasonova Research Institute of Rheumatology, Moscow; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
| | | | - A. M. Lila
- V.A. Nasonova Research Institute of Rheumatology, Moscow; Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
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Mathieu S, Tournadre A, Soubrier M, Sellam J. Effect of disease-modifying anti-rheumatic drugs in osteoarthritis: A meta-analysis. Joint Bone Spine 2022; 89:105444. [PMID: 35908643 DOI: 10.1016/j.jbspin.2022.105444] [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: 05/17/2022] [Revised: 06/28/2022] [Accepted: 07/11/2022] [Indexed: 10/31/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) displays features of systemic and local inflammation, suggesting that DMARDs used in rheumatoid arthritis could potentially also be effective in OA. However, studies of the effects of DMARDs in OA have yielded conflicting data, and have been insufficiently large to draw conclusions. In this meta-analysis, we aimed to estimate the effect of DMARDs - such as methotrexate, hydroxychloroquine, TNF, and IL-1 inhibitors - on OA. METHODS We searched for relevant articles of randomized controlled trials published up to March 2022, using Pubmed, EMBASE, and the Cochrane Library. Studies were reviewed in accordance with PRISMA 2020 guidelines. The effects of DMARDs on OA outcomes (symptoms, quality of life, ESR) were expressed as the standardized mean difference. RESULTS We retrieved 29 references. Among these, 23 randomized controlled trials compared the effects of DMARDs versus placebo or other treatments on disease activity, including 1143 DMARD-treated OA patients and 1155 OA patients in the control group. We found statistically significant improvement of pain and stiffness with methotrexate, especially in knee OA. TNF inhibitors improved the swollen joint count in hand OA, and inflammation parameters, without change in pain, stiffness, or function. Hydroxychloroquine and IL-1 inhibitors were not effective. CONCLUSION Overall, the presently available data regarding the effects of DMARDs on OA symptoms intensity are disappointing. Only methotrexate might have an analgesic effect, especially in knee OA, which warrants further investigation.
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Affiliation(s)
- Sylvain Mathieu
- Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France.
| | - Anne Tournadre
- Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Martin Soubrier
- Service de Rhumatologie, CHU Gabriel Montpied, Clermont-Ferrand, France
| | - Jérémie Sellam
- Sorbonne Université, Service de rhumatologie, Hôpital Saint-Antoine, Assistance Publique-Hôpitaux de Paris (AP-HP) Inserm UMRS_938, Centre de Recherche Saint-Antoine, 75012 Paris, France
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20
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Williams JAE, Chester-Jones M, Minns Lowe C, Goff MV, Francis A, Brewer G, Marian I, Morris SL, Warwick D, Eldridge L, Julier P, Gulati M, Barker KL, Barber VS, Black J, Woollacott S, Mackworth-Young C, Glover V, Lamb SE, Vincent TL, Vincent K, Dutton SJ, Watt FE. Hormone replacement therapy (conjugated oestrogens plus bazedoxifene) for post-menopausal women with symptomatic hand osteoarthritis: primary report from the HOPE-e randomised, placebo-controlled, feasibility study. THE LANCET. RHEUMATOLOGY 2022; 4:e725-e737. [PMID: 36341025 PMCID: PMC9620575 DOI: 10.1016/s2665-9913(22)00218-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Background Symptomatic hand osteoarthritis is more common in women than in men, and its incidence increases around the age of menopause, implicating oestrogen deficiency. No randomised controlled trials of hormone replacement therapy (HRT) have been done in people with hand osteoarthritis. We aimed to determine the feasibility and acceptability of a form of HRT (conjugated oestrogens plus bazedoxifene) in post-menopausal women with painful hand osteoarthritis. Methods The HOPE-e feasibility study was a randomised, double-blind, placebo-controlled trial, for which we recruited women aged 40-65 years, for whom 1-10 years had passed after their final menstrual period, with definite hand osteoarthritis and at least two painful hand joints. Participants were recruited across three primary or secondary care sites and from the community and were randomly assigned (1:1) to receive conjugated oestrogens plus bazedoxifene or placebo, orally once every day for 24 weeks, before weaning for 4 weeks until the end of the study. The primary feasibility outcomes were rates of identification, recruitment, randomisation, retention, and compliance of eligible participants, and the likelihood of unmasking. The secondary objective was to generate proof-of-concept quantitative and qualitative data on the acceptability of proposed clinical outcomes for a full trial and adverse events. We used an intention-to-treat analysis, and criteria for progression to a full trial were pre-defined as recruitment of at least 30 participants across all sites in 18 months; a dropout rate of less than or equal to 30% of randomised individuals; and acceptability to the majority of participants, including acceptable rates of adverse events. Due to the COVID-19 pandemic, the recruitment window was reduced to 12-15 months. A proportionately reduced minimum sample size of 22 was judged to be sufficient to test feasibility. This trial was registered at ISRCTN, ISRCTN12196200. Findings From May 9, 2019 to Dec 31, 2020, 434 enquiries or referrals were received. We did 96 telephone pre-screens; of the 35 eligible participants, seven were excluded as ineligible at the telephone or face-to-face screening and 28 (80% [95% CI 63-92]) were randomly assigned. Of the 406 who were not randomly assigned, 250 (62%) were ineligible (with contraindicated medications accounting for 50 [20%] of these), 101 (25%) did not respond to further enquiries, and 55 (14%) chose not to proceed (with the most common reason being not wanting to take a hormone-based drug). All 28 randomised participants completed all follow-up assessments with high compliance and outcome measure completeness. All three adverse event-related treatment withdrawals were in the placebo group. No serious adverse events were reported. Participants and investigators were successfully masked (participant Bang's blinding index placebo group 0·50 [95% CI 0·25-0·75]). The trial met the prespecified criteria for progression to a full trial. Interpretation This first-ever feasibility study of a randomised controlled trial of HRT for post-menopausal women with painful hand osteoarthritis met its progression criteria, although it was not powered to detect a clinical effect. This outcome indicates that a full trial of an HRT in this population is feasible and acceptable and identifies potential refinements with regard to the design of such a trial. Funding Research for Patient Benefit programme, National Institute for Health Research.
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Affiliation(s)
- Jennifer A E Williams
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Mae Chester-Jones
- OCTRU, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Catherine Minns Lowe
- Physiotherapy Research Unit, Physiotherapy Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Megan V Goff
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
- Cancer Prevention Trials Unit, King's College London Guy's Campus, London, UK
| | - Anne Francis
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Gretchen Brewer
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Ioana Marian
- OCTRU, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Susan L Morris
- National Institute for Health and Care Research Clinical research Network (Thames Valley and South Midlands), Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | | | - Lucy Eldridge
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Patrick Julier
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Malvika Gulati
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Karen L Barker
- Physiotherapy Research Unit, Physiotherapy Department, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
| | - Vicki S Barber
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Joanna Black
- Oxford Clinical Trials Research Unit (OCTRU), Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford, UK
| | - Sue Woollacott
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
| | - Charles Mackworth-Young
- Rheumatology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | | | - Sarah E Lamb
- Centre for Rehabilitation Research, NDORMS, Oxford, University of Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Tonia L Vincent
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
- Rheumatology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
| | - Katy Vincent
- Nuffield Department of Women's and Reproductive Health, University of Oxford, Oxford, UK
| | - Susan J Dutton
- OCTRU, Centre for Statistics in Medicine, NDORMS, University of Oxford, Oxford, UK
| | - Fiona E Watt
- Centre for Osteoarthritis Pathogenesis Versus Arthritis, Kennedy Institute of Rheumatology, NDORMS, University of Oxford, Oxford, UK
- Rheumatology Department, Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
- Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London, UK
- Correspondence to: Dr Fiona E Watt, Centre for Inflammatory Disease, Department of Immunology and Inflammation, Imperial College London, London W12 0NN, UK
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Fuggle N, Bere N, Bruyère O, Rosa MM, Prieto Yerro MC, Dennison E, Dincer F, Gabay C, Haugen IK, Herrero-Beaumont G, Hiligsmann M, Hochberg MC, Laslop A, Matijevic R, Maheu E, Migliore A, Pelletier JP, Radermecker RP, Rannou F, Uebelhart B, Uebelhart D, Veronese N, Vlaskovska M, Rizzoli R, Mobasheri A, Cooper C, Reginster JY. Management of hand osteoarthritis: from an US evidence-based medicine guideline to a European patient-centric approach. Aging Clin Exp Res 2022; 34:1985-1995. [PMID: 35864304 PMCID: PMC9464159 DOI: 10.1007/s40520-022-02176-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Accepted: 06/08/2022] [Indexed: 12/02/2022]
Abstract
Hand osteoarthritis is the most common joint condition and is associated with significant morbidity. It is of paramount importance that patients are thoroughly assessed and examined when complaining of hand stiffness, pain, deformity or disability and that the patient's concerns and expectations are addressed by the healthcare professional. In 2019 the American College of Rheumatology and Arthritis Foundation (ACR/AF) produced guidelines which included recommendations for the treatment of hand osteoarthritis. An ESCEO expert working group (including patients) was convened and composed this paper with the aim to assess whether these guidelines were appropriate for the treatment of hand osteoarthritis therapy in Europe and whether they met with the ESCEO patient-centered approach. Indeed, patients are the key stakeholders in healthcare and eliciting the patient's preference is vital in the context of an individual consultation but also for informing research and policy-making. The patients involved in this working group emphasised the often-neglected area of aesthetic changes in hand osteoarthritis, importance of developing pharmacological therapies which can alleviate pain and disability and the need of the freedom to choose which approach (out of pharmacological, surgical or non-pharmacological) they wished to pursue. Following robust appraisal, it was recommended that the ACR/AF guidelines were suitable for a European context (as described within the body of the manuscript) and it was emphasised that patient preferences are key to the success of individual consultations, future research and future policy-making.
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Affiliation(s)
- Nicholas Fuggle
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Nathalie Bere
- European Medicines Agency, Amsterdam, The Netherlands
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
| | | | | | - Elaine Dennison
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK
| | - Fitnat Dincer
- Department of Physical and Rehabilitation Medicine, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Cem Gabay
- Division of Rheumatology, University Hospital of Geneva, and Department of Pathology and Immunology, University of Geneva of Medicine, Geneva, Switzerland
| | - Ida K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Gabriel Herrero-Beaumont
- Head of Rheumatology Department, Bone and Joint Research Unit, IIS-Fundación Jiménez Díaz UAM, 28040, Madrid, Spain
| | - Mickaël Hiligsmann
- Department of Health Services Research, CAPHRI Care and Public Health Research Institute, Maastricht University, 6200 MD, Maastricht, The Netherlands
| | - Marc C Hochberg
- Departments of Medicine and Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Andrea Laslop
- Scientific Office, Federal Office for Safety in Health Care, Vienna, Austria
| | - Radmila Matijevic
- Faculty of Medicine, University of Novi Sad, Novi Sad, Serbia
- Clinical Center of Vojvodina, Clinic for Orthopedic Surgery, Novi Sad, Serbia
| | - Emmanuel Maheu
- Rheumatology Department, Hospital Saint-Antoine, AP-HP, and Private Office, Paris, France
| | - Alberto Migliore
- Rheumatology Unit - San Pietro Fatebenefratelli Hospital, Rome, Italy
| | - Jean-Pierre Pelletier
- Osteoarthritis Research Unit, University of Montreal Hospital Research Centre (CRCHUM) and Arthritis Division, University of Montreal Hospital Centre (CHUM), Montreal, Canada
| | - Régis Pierre Radermecker
- Department of Diabetes, Nutrition and Metabolic Disorders, Clinical Pharmacology, University of Liège, CHU de Liège, Liège, Belgium
| | - François Rannou
- Service de Rééducation et de Réadaptation de l'Appareil Locomoteur et des Pathologies du Rachis, Hôpitaux Universitaires-Paris Centre, Groupe Hospitalier Cochin, Assistance Publique-Hôpitaux de Paris, Université de Paris, INSERM U1124, Paris, France
| | - Brigitte Uebelhart
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Leukerbad Clinic -Private Rehabilitation Clinic, 3954, Leukerbad, Switzerland
| | - Nicola Veronese
- Department of Internal Medicine, Geriatrics Section, University of Palermo, Palermo, Italy
| | - Mila Vlaskovska
- Medical Faculty, Department of Pharmacology and Toxicology, Medical University Sofia, Sofia, Bulgaria
| | - René Rizzoli
- Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, University of Geneva, Geneva, Switzerland
| | - Ali Mobasheri
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, 90014, Oulu, Finland
- Department of Regenerative Medicine, State Research Institute Centre for Innovative Medicine, 08406, Vilnius, Lithuania
- Departments of Orthopedics, Rheumatology and Clinical Immunology, University Medical Center Utrecht, 3584 CX, Utrecht, The Netherlands
- Department of Joint Surgery, The First Affiliated Hospital of Sun Yat-Sen University, Guangzhou, 510080, China
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Centre, University of Southampton, Tremona Road, Southampton, SO16 6YD, UK.
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health Economics, WHO Collaborating Center for Public Health Aspects of Musculo-Skeletal Health and Ageing, University of Liège, Avenue Hippocrate 13, CHU B23, 4000, Liege, Belgium
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Omega-3 Fatty Acids for the Management of Osteoarthritis: A Narrative Review. Nutrients 2022; 14:nu14163362. [PMID: 36014868 PMCID: PMC9413343 DOI: 10.3390/nu14163362] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2022] [Revised: 08/11/2022] [Accepted: 08/13/2022] [Indexed: 12/02/2022] Open
Abstract
Osteoarthritis (OA) is a disease which results in degeneration of cartilage within joints and affects approximately 13.6% of adults over 20 years of age in Canada and the United States of America. OA is characterized by a state of low-grade inflammation which leads to a greater state of cellular catabolism disrupting the homeostasis of cartilage synthesis and degradation. Omega-3 polyunsaturated fatty acids (PUFAs) have been postulated as a potential therapeutic treatment option for individuals with OA. Omega-3 PUFAs are recognized for their anti-inflammatory properties, which could be beneficial in the context of OA to moderate pro-inflammatory markers and cartilage loss. The purpose of this narrative review is to outline recent pre-clinical and clinical evidence for the use of omega-3 in the management of OA.
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Jones G. Is topical therapy a way forward in osteoarthritis? Int J Rheum Dis 2022; 25:723-724. [PMID: 35898159 DOI: 10.1111/1756-185x.14355] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 05/15/2022] [Indexed: 11/28/2022]
Affiliation(s)
- Graeme Jones
- Menzies Institute for Medical Research Hobart, Hobart, Tasmania, Australia
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Tenti S, Veronese N, Cheleschi S, Seccafico I, Bruyère O, Reginster JY, Fioravanti A. Prescription-grade crystalline glucosamine sulfate as an add-on therapy to conventional treatments in erosive osteoarthritis of the hand: results from a 6-month observational retrospective study. Aging Clin Exp Res 2022; 34:1613-1625. [PMID: 35637324 PMCID: PMC9246990 DOI: 10.1007/s40520-022-02151-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 05/02/2022] [Indexed: 11/26/2022]
Abstract
Objective To evaluate the efficacy of prescription-grade Crystalline Glucosamine Sulfate (pCGS) as an add-on treatment to conventional therapy, compared to usual therapy alone, in patients with erosive osteoarthritis of the hand (EHOA). Methods This 6-month retrospective case–control study included patients with concomitant knee osteoarthritis and symptomatic EHOA. Participants were stratified into two groups based on whether or not pCGS (1500 mg/day) was added to the conventional therapy (education and training in ergonomic principles, exercise and use on-demand of symptomatic drugs) for hand osteoarthritis. Patients were evaluated at baseline, after 3 and 6 months. Primary outcomes were the change from baseline to month 6 in Visual Analogue Scale (VAS) hand pain and in Functional Index for Hand Osteoarthritis (FIHOA) score. A set of secondary parameters was also evaluated. Results 123 patients were included as follows: 67 treated with pCGS in addition to conventional therapy (pCGS Group) and 56 with conventional therapy alone (Control Group). After 6 months a significant difference in VAS and in FIHOA score (p < 0.01 and p < 0.001, respectively) was observed in favor of pCGS Group. Similar results were found for morning stiffness duration (p < 0.05), health assessment questionnaire (p < 0.01) and physical and mental component score of 36-item short form (p < 0.05 and p < 0.001, respectively). A significant reduction of symptomatic drug consumption at 3 and 6 months was reported in the pCGS Group (p < 0.001). No serious adverse event was recorded in both groups. Conclusions Despite all the limitations inherent to an observational study, our results suggest the potential effectiveness of pCGS, when used in combination with conventional therapy in EHOA. Further randomized placebo-controlled trials are needed to confirm these positive findings. Trial Registration ClinicalTrials.gov, http://www.clinicaltrials.gov, date of registration: February
2, 2022, NCT05237596. The present trial was retrospectively registered. Supplementary Information The online version contains supplementary material available at 10.1007/s40520-022-02151-7.
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Affiliation(s)
- Sara Tenti
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Nicola Veronese
- Geriatric Unit, Department of Internal Medicine and Geriatrics, University of Palermo, Palermo, Italy
| | - Sara Cheleschi
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Iole Seccafico
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy
| | - Olivier Bruyère
- Division of Public Health, Epidemiology and Health, Economics, WHO Collaborating Centre for Public Health, Aspects of Musculo-Skeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Jean-Yves Reginster
- Division of Public Health, Epidemiology and Health, Economics, WHO Collaborating Centre for Public Health, Aspects of Musculo-Skeletal Health and Ageing, University of Liege, Liege, Belgium
| | - Antonella Fioravanti
- Clinic for the Diagnosis and Management of Hand Osteoarthritis, Rheumatology Unit, Department of Medicine, Surgery and Neuroscience, Azienda Ospedaliera Universitaria Senese, Policlinico Le Scotte, Viale Bracci 1, 53100, Siena, Italy.
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Oo WM, Hunter DJ. Repurposed and investigational disease-modifying drugs in osteoarthritis (DMOADs). Ther Adv Musculoskelet Dis 2022; 14:1759720X221090297. [PMID: 35619876 PMCID: PMC9128067 DOI: 10.1177/1759720x221090297] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/10/2022] [Indexed: 12/12/2022] Open
Abstract
In spite of a major public health burden with increasing prevalence, current osteoarthritis (OA) management is largely palliative with an unmet need for effective treatment. Both industry and academic researchers have invested a vast amount of time and financial expense to discover the first diseasing-modifying osteoarthritis drugs (DMOADs), with no regulatory success so far. In this narrative review, we discuss repurposed drugs as well as investigational agents which have progressed into phase II and III clinical trials based on three principal endotypes: bone-driven, synovitis-driven and cartilage-driven. Then, we will briefly describe the recent failures and lessons learned, promising findings from predefined post hoc analyses and insights gained, novel methodologies to enhance future success and steps underway to overcome regulatory hurdles.
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Affiliation(s)
- Win Min Oo
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
- Department of Physical Medicine and Rehabilitation, Mandalay General Hospital, University of Medicine, Mandalay, Mandalay, Myanmar
| | - David J. Hunter
- Rheumatology Department, Royal North Shore Hospital, and Institute of Bone and Joint Research, Kolling Institute, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW 2065, Australia
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Abstract
Osteoarthritis (OA) most commonly affects knee joints, and the next most commonly affected sites are the hands and hips. Three distinct hand OA phenotypes have been described: erosive hand OA (EHOA), nodal hand OA - also known as non-erosive hand OA (non-EHOA) - and first carpometacarpal joint OA. EHOA predominantly affects women and is the most aggressive form of hand OA, characterized by a severe clinical onset and progression, leading to joint damage, disability and reduction of quality of life. Clinical signs of inflammation associated with EHOA include the acute onset of pain, swelling and redness. Moreover, EHOA is characterized by radiographic features such as central erosion, saw-tooth and gull-wing lesions and, rarely, ankylosis. The aim of this Review is to report the latest findings on epidemiology, clinical features, pathology and aetiopathogenesis, biomarkers, imaging modalities and treatments for EHOA. The ongoing development of new hand OA classification criteria should facilitate standardization between studies.
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Wang Y, Teichtahl AJ, Jones G, Keen HI, Hill CL, Wluka AE, Kasza J, Cicuttini FM. METHODS - A randomised controlled trial of METhotrexate to treat Hand Osteoarthritis with Synovitis: study protocol for a randomised controlled trial. BMC Musculoskelet Disord 2021; 22:953. [PMID: 34781952 PMCID: PMC8591971 DOI: 10.1186/s12891-021-04842-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/04/2021] [Indexed: 11/23/2022] Open
Abstract
Background Hand osteoarthritis is a common and disabling problem without effective therapies. Accumulating evidence suggests the role of local inflammation in causing pain and structural progression in hand osteoarthritis, and hand osteoarthritis with synovitis is a commonly encountered clinical phenotype. Methotrexate is a well-established, low-cost, and effective treatment for inflammatory arthritis with a well-described safety profile. The aim of this multicentre, randomised, double-blind, placebo-controlled trial is to determine whether methotrexate reduces pain over 6 months in patients with hand osteoarthritis and synovitis. Methods Ninety-six participants with hand osteoarthritis and synovitis will be recruited through the Osteoarthritis Clinical Trial Network (Melbourne, Hobart, Adelaide, and Perth), and randomly allocated in a 1:1 ratio to receive either methotrexate 20 mg or identical placebo once weekly for 6 months. The primary outcome is pain reduction (assessed by 100 mm visual analogue scale) at 6 months. The secondary outcomes include changes in physical function and quality of life assessed using Functional Index for Hand Osteoarthritis, Australian Canadian Osteoarthritis Hand Index, Health Assessment Questionnaire, Michigan Hand Outcomes Questionnaire, Short-Form-36, tender and swollen joint count, and grip strength, and structural progression assessed using progression of synovitis and bone marrow lesions from magnetic resonance imaging and radiographic progression at 6 months. Adverse events will be recorded. The primary analysis will be by intention to treat, including all participants in their randomised groups. Discussion This study will provide high-quality evidence to address whether methotrexate has an effect on reducing pain over 6 months in patients with hand osteoarthritis and synovitis, with major clinical and public health importance. While a positive trial will inform international clinical practice guidelines for the management of hand osteoarthritis, a negative trial would be highly topical and change current trends in clinical practice. Trial registration Australian New Zealand Clinical Trials Registry (ANZCTR), ACTRN12617000877381. Registered 15 June 2017, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=373124
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Affiliation(s)
- Yuanyuan Wang
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Andrew J Teichtahl
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Graeme Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, 7000, Australia
| | - Helen I Keen
- Rheumatology Group, School of Medicine, University of Western Australia, Perth, WA, 6009, Australia.,Department of Rheumatology, Fiona Stanley Hospital, Murdoch, WA, 6150, Australia
| | - Catherine L Hill
- The Queen Elizabeth Hospital, University of Adelaide, Woodville, SA, 5011, Australia.,Department of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Anita E Wluka
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Jessica Kasza
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia
| | - Flavia M Cicuttini
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, VIC, 3004, Australia.
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28
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Correspondence on "Methotrexate treatment in hand osteoarthritis refractory to usual treatments: A randomised, double-blind, placebo-controlled trial" by Ferrero et al. Semin Arthritis Rheum 2021; 52:151904. [PMID: 34462129 DOI: 10.1016/j.semarthrit.2021.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Accepted: 08/24/2021] [Indexed: 11/20/2022]
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