Potential role of age, sex, body mass index and pain to identify patients with knee osteoarthritis

Association between synovial tissue damage and pain in late-stage knee osteoarthritis: A cross-sectional study

OBJECTIVE

To identify the presence and distribution of histopathological features of synovial inflammation and tissue damage, and to test their associations with ultrasound (US) imaging measures of synovitis and patient-reported measures of pain in knee osteoarthritis (OA).

DESIGN

In the cross-sectional study of 122 patients undergoing surgery for painful late-stage (Kellgren-Lawrence Grade 3 or 4) knee OA, we compared US measures of synovitis (n = 118) and pain (Knee Injury and Osteoarthritis Outcome Score) to histopathological measures of inflammation vs. synovial tissue damage in synovial tissue biopsies. Associations of histopathological features with US measures of inflammation or pain were assessed using linear or logistic regression while controlling for covariates.

RESULTS

Histopathological features of inflammation were associated with higher odds of moderate/severe US synovitis (odds ratio [OR] = 1.34 [95%CI 1.04, 1.74), whereas features of synovial tissue damage were associated with lower odds of moderate/severe US synovitis (OR = 0.77 [95%CI 0.57, 1.03]). Worse histopathological scores for synovial tissue damage were associated with more pain (-1.47 [95%CI -2.88, -0.05]), even while adjusting for synovial inflammation (-1.61 [95%CI -3.12, -0.10]).

CONCLUSIONS

Synovial tissue damage is associated with pain in late-stage knee OA, independent from inflammation and radiographic damage. These novel findings suggest that preventing synovial tissue damage may be an important goal of disease-modifying OA therapy.

Knee Diameter and Cross-Sectional Area as Biomarkers for Cartilage Knee Degeneration on Magnetic Resonance Images

Background and Objectives: Osteoarthritis (OA) of the knee is a degenerative disorder characterized by damage to the joint cartilage, pain, swelling, and walking disability. The purpose of this study was to assess whether demographic and radiologic parameters (knee diameters and knee cross-sectional area from magnetic resonance (MR) images) could be used as surrogate biomarkers for the prediction of OA. Materials and Methods: The knee diameters and cross-sectional areas of 481 patients were measured on knee MR images, and the corresponding demographic parameters were extracted from the patients' clinical records. The images were graded based on the modified Outerbridge arthroscopic classification that was used as ground truth. Receiver-operating characteristic (ROC) analysis was performed on the collected data. Results: ROC analysis established that age was the most accurate predictor of severe knee cartilage degeneration (corresponding to Outerbridge grades 3 and 4) with an area under the curve (AUC) of the specificity-sensitivity plot of 0.865 ± 0.02. An age over 41 years was associated with a sensitivity and specificity for severe degeneration of 82.8% (CI: 77.5-87.3%), and 76.4% (CI: 70.4-81.6%), respectively. The second-best degeneration predictor was the normalized knee cross-sectional area, with an AUC of 0.767 ± 0.04), followed by BMI (AUC = 0.739 ± 0.02), and normalized knee maximal diameter (AUC = 0.724 ± 0.05), meaning that knee degeneration increases with increasing knee diameter. Conclusions: Age is the best predictor of knee damage progression in OA and can be used as surrogate marker for knee degeneration. Knee diameters and cross-sectional area also correlate with the extent of cartilage lesions. Though less-accurate predictors of damage progression than age, they have predictive value and are therefore easily available surrogate markers of OA that can be used also by general practitioners and orthopedic surgeons.

The Impact of Chronic Pain, Stiffness and Difficulties in Performing Daily Activities on the Quality of Life of Older Patients with Knee Osteoarthritis

Osteoarthritis causes a number of physical ailments, which result in the deterioration of a persons' general health and reduction of their ability to move freely. This cross-sectional study was designed to assess the impact of physical ailments in the course of knee osteoarthritis (KOA) on the quality of life (QoL) of patients in early old age. An anonymous survey was conducted by the use of the recognized research tools: Western Ontario scale and McMaster Osteoarthritis Index (WOMAC), The Index of Severity for Knee Disease (ISK) and World Health Organization Quality of Life-BEFF (WHOQOL-BREF). The study involved 300 people aged between 60 and 75 years old, including 150 patients diagnosed with gonarthrosis and 150 people without lower limb complaints. The significant intensification of the symptoms of knee osteoarthritis was associated with a worse assessment of health (p < 0.001), overall quality of life (p < 0.001) and in the following domains: physical (p < 0.001), mental (p < 0.001) and environmental (p < 0.001) in a group of patients with KOA. These findings suggest that taking measures to reduce knee pain and improve function may have an impact on improving the overall quality of the life of people in their early old age.

Relationship between Outerbridge Scale and Chondropathy Femorotibial Joint in Relation to Gender and Age-The Use of 1.5T and 3.0T MRI Scanners

Background and Objective: Magnetic resonance imaging (MRI) enables the effective evaluation of chondromalacia of the knee joint. Cartilage disease is affected by many factors, including gender, age, and body mass index (BMI). The aim of this study was to check the relationship between the severity of chondromalacia of the femoro-tibial joint and age, gender, and BMI assessed with 1.5T and 3.0T MRI scanners. Materials and Methods: The cross-observational study included 324 patients—159 (49%) females and 165 (51%) males aged 8−87 (45.1 ± 20.9). The BMI of study group was between 14.3 and 47.3 (27.7 ± 5.02). 1.5T and 3.0T MRI scanners were used in the study. The articular cartilage of the knee joint was assessed using the Outerbridge scale. Results: The age of the patients showed a significant correlation with Outerbrige for each compartment of the femorotibial joint (Spearman’s rank correlation rho: 0.69−0.74, p < 0.0001). A higher correlation between BMI and Outerbridge was noted in the femur medial (rho = 0.45, p < 0.001) and the tibia medial (rho = 0.43, p < 0.001) than in the femur lateral (rho = 0.29, p < 0.001) and the tibia lateral compartment (rho = 0.34, p < 0.001). Conclusions: The severity of chondromalacia significantly depends on age and BMI level, regardless of gender.

An up to date on clinical prospects and management of osteoarthritis

The rising prevalence of osteoarthritis (OA) in the general population has necessitated the development of novel treatment options. It is critical to recognize the joint as a separate entity participating in degenerative processes, as well as the multifaceted nature of OA. OA is incurable because there is currently no medication that can stop or reverse cartilage or bone loss. As this point of view has attracted attention, more research is being directed toward determining how the various joint components are impacted and how they contribute to OA pathogenesis. Over the next few years, several prospective therapies focusing on inflammation, cartilage metabolism, subchondral bone remodelling, cellular senescence, and the peripheral nociceptive pathway are predicted to transform the OA therapy landscape. Stem cell therapies and the use of various biomaterials to target articular cartilage (AC) and osteochondral tissues are now being investigated in considerable detail. Currently, laboratory-made cartilage tissues are on the verge of being used in clinical settings. This review focuses on the update of clinical prospects and management of osteoarthritis, as well as future possibilities for the treatment of OA.

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Osteoarthritis (OA) is a general term that incorporates several different joint diseases.

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The exact pathophysiology of OA remains unclear.

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OA is incurable because there is currently no medication that can stop or reverse cartilage or bone loss.

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Nonsteroidal anti-inflammatory drugs are the most frequently prescribed medications to alleviate arthritic discomfort.

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Stem cell therapies to target articular cartilage and osteochondral tissues are now under investigation.

Synovitis is associated with constant pain in knee osteoarthritis: a cross-sectional study of OMERACT knee ultrasound scores

OBJECTIVE

To examine the association between ultrasound (US)-detected knee inflammation and intermittent and constant pain experiences in patients with knee osteoarthritis (OA).

METHODS

Participants with radiographically early- (KL ≤ 2) and late-stage (KL ≥ 3) disease and frequent symptoms underwent musculoskeletal US measures of inflammation using the OMERACT knee US scoring system. Pain experiences were captured using the Intermittent and Constant OA Pain (ICOAP) tool. We assessed the association between US-synovitis and ICOAP pain experiences using a series of linear, logistic, or multinomial logistic regression models (as appropriate for each variable), while adjusting for age, sex, body mass index (BMI), and radiographic stage. Secondary analyses were performed similarly by radiographic stage.

RESULTS

Pain and synovitis measures from 248 patients (453 knees) were included. Worse synovitis was associated with higher ICOAP constant pain scores (β 8.05 [95%CI 0.67, 15.43]), but not intermittent pain scores. Moderate-to-severe synovitis was associated with a 4.73-fold increased relative risk [95%CI 1.06, 8.80] of a constant pain pattern. In secondary analyses, moderate-to-severe synovitis in early radiographic OA was associated with 2.70-higher odds [95%CI 1.04, 7.02] of any constant pain, 3.28-higher odds [95%CI 1.43, 7.52] of any intermittent pain, and with higher intermittent (β 10.47 [95%CI 1.03, 19.91]) and constant (β 12.62 [95%CI 3.02, 22.23]) pain scores. No associations identified for synovitis in those with late radiographic OA.

CONCLUSION

In patients with knee OA, moderate-to-severe synovitis is most strongly associated with constant pain. Inflammation may play context-specific roles across pain experiences, especially in earlier radiographic stages of knee OA.

PREDICTION OF SYMPTOMS PROGRESSION FOR THE PATIENTS WITH KNEE OSTEOARTHRITIS BASED ON THE QUANTITATIVE STRUCTURAL FEATURES: DATA FROM THE FNIH OA BIOMARKERS CONSORTIUM

Cartilage repair can greatly alleviate the symptoms of the patients with knee osteoarthritis (KOA). However, some imaging results suggest that the patients with obvious cartilage repair may receive insignificant or even no improvement in their symptoms. This study aims to explore the possible reasons based on the structural feature of the knee joint and construct the models used to predict the progression of knee joint symptoms. 551 subjects from Osteoarthritis Biomarkers Consortium FNIH Project in the Osteoarthritis Initiative (OAI) were included and divided into training and test sets. A total of 153 structural features from five quantitative structural feature sets were included to access the structural characteristics of the knee joints. The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index was used to evaluate the symptoms of the knee joints. A three-step feature selection method were used to screen the structural features. Finally, Naive Bayes (NB), logistic regression (LR), [Formula: see text]-nearest neighbor (KNN), support vector machine (SVM) and random forest (RF) models were constructed based on the selected features, and then compared using the receiver operating characteristic (ROC) curve. The distribution in the demographics and WOMAC symptoms scores of the participants was consistent in the training and test sets. Two demographic features and several structural features were selected using the three-step feature selection method. Among the constructed models, the models used for the progression prediction of pain, stiffness and total scores were better than that of physical function. The performance of RF model was the best while SVM model was the second best, and the performance of the remaining three models in predicting the progression of knee symptoms is indistinguishable. Structural feature-based models for the prediction of knee joint symptoms’ progression were constructed and compared. The constructed model showed good feasibility and accuracy, and may assist clinicians to predict the occurrence or progression of the knee joints symptoms in the evaluation and prognosis of cartilage repair.

Cumulative Disadvantage and Disparities in Depression and Pain Among Veterans With Osteoarthritis: The Role of Perceived Discrimination

OBJECTIVE

Perceived discrimination is associated with chronic pain and depression and contributes to racial health disparities. In a cohort of older adult veterans with osteoarthritis (OA), our objective was to examine how membership in multiple socially disadvantaged groups (cumulative disadvantage) was associated with perceived discrimination, pain, and depression. We also tested whether perceived discrimination mediated the association of cumulative disadvantage with depression and pain.

METHODS

We analyzed baseline data from 270 African American veterans and 247 White veterans enrolled in a randomized controlled trial testing a psychological intervention for chronic pain at 2 Department of Veterans Affairs medical centers. Participants were age ≥50 years and self-reported symptomatic knee OA. Measures included the Everyday Discrimination Scale, the Patient Health Questionnaire Depression Scale, the Western Ontario and McMaster Universities Osteoarthritis Index pain subscale, and demographic variables. Cumulative disadvantage was defined as the number of socially disadvantaged groups to which each participant belonged (i.e., self-reported female sex, African American race, annual income of <$20,000, and/or unemployed due to disability). We used linear regression models and Sobel's test of mediation to examine hypotheses.

RESULTS

The mean ± SD number of social disadvantages was 1.3 ± 1.0. Cumulative disadvantage was significantly associated with higher perceived discrimination, pain, and depression (P < 0.001 for all). Perceived discrimination significantly mediated the association between cumulative disadvantage and depression symptoms (Z = 3.75, P < 0.001) as well as pain severity (Z = 2.24, P = 0.025).

CONCLUSION

Perceived discrimination is an important psychosocial stressor that contributes to worsening OA-related mental and physical health outcomes, with greater effects among those from multiple socially disadvantaged groups.

Constitutional Characteristics of Physical Development in the Kyrgyz Population

Personalized medicine is one of the priorities of the development of modern medical science. The aim of this study was to identify somatotypological features of physical development in men and women of the Kyrgyz population. The physical status of 1083 men and women in the Kyrgyz population (Osh, Kyrgyzstan) was studied by the method of complex anthropometry and somatotyping. The whole complex of the conducted anatomical and anthropometric examinations corresponded to generally accepted ethical standards, with the registration of informed consent from all the examined persons. The statistical analysis included the calculation of the arithmetic mean of the indicators of their mistakes. The differences were evaluated using the Student’s method at p<0.05. The results show that among women of youth and mature age, representatives of hypersthenic and normosthenic body types predominate; women of asthenic type are a minority (classification of M. V. Chernorutsky). Women of indeterminate somatotype (scheme of I. B. Galant et al.) belong either to the normal or hypersthenic type and never to the asthenic type. In men, the abdominal somatotype corresponds to a hypersthenic, thoracic-asthenic physique; men of the muscular type-mainly normosthenics; men of indeterminate type are both hypersthenics and normosthenics. The obtained data, undoubtedly, have not only theoretical, but also significant practical significance.

Dysregulation of both miR-140-3p and miR-140-5p in synovial fluid correlate with osteoarthritis severity

Objectives

This study looked to analyse the expression levels of microRNA-140-3p and microRNA-140-5p in synovial fluid, and their correlations to the severity of disease regarding knee osteoarthritis (OA).

Methods

Knee joint synovial fluid samples were collected from 45 patients with OA of the knee (15 mild, 15 moderate and 15 severe), ten healthy volunteers, ten patients with gouty arthritis, and ten with rheumatoid arthritis. The Kellgren–Lawrence grading (KLG) was used to assess the radiological severity of knee OA, and the patients were stratified into mild (KLG < 2), moderate (KLG = 2), and severe (KLG > 2). The expression of miR-140-3p and miR-140-5p of individual samples was measured by SYBR Green quantitative polymerase chain reaction (PCR) analysis. The expression of miR-140-3p and miR-140-5p was normalised to U6 internal control using the 2^-△△CT method. All data were processed using SPSS software.

Results

Expression of both miR-140-3p and miR-140-5p was downregulated in OA synovial fluid, showing a statistical difference between the OA and non-OA group, and increased OA severity was associated with a decreased expression of miR-140-3p or miR-140-5p. The Spearman rank correlation analysis suggested that the expression of miR-140-3p or miR-140-5p was negatively correlated with OA severity. In addition, the expression of miR-140-5p was 7.4 times higher than that of miR-140-3p across all groups.

Conclusion

The dysregulation of miR-140-3p and miR-140-5p in synovial fluid and their correlations with the disease severity of OA may provide an important experimental basis for OA classification, and the miR-140-3p/miR-140-5p are of great potential as biomarkers in the diagnosis and clinical management of patients with OA.

Cite this article: C-M. Yin, W-C-W. Suen, S. Lin, X-M. Wu, G. Li, X-H. Pan. Dysregulation of both miR-140-3p and miR-140-5p in synovial fluid correlate with osteoarthritis severity. Bone Joint Res 2017;6:612–618. DOI: 10.1302/2046-3758.611.BJR-2017-0090.R1.

TIMP-2 SNPs rs7342880 and rs4789936 are linked to risk of knee osteoarthritis in the Chinese Han Population

This study aimed to investigate whether functional polymorphisms in the tissue inhibitors of metalloproteinase-2 (TIMP-2) gene are associated with susceptibility to knee osteoarthritis (OA) in the Chinese Han population. Six TIMP-2 single nucleotide polymorphisms (SNPs) were assayed using MassARRAY in 300 patients clinically and radiographically diagnosed with knee OA and in 428 controls. Allelic and genotypic frequencies were compared between groups. Logistic regression adjusting for age and gender was used to estimate risk associations between specific genotypes and knee OA by computing odds ratios (ORs) and 95% confidence intervals (95% CIs). We found that allele "A" in rs7342880 was significantly associated with increased risk of knee OA (OR = 1.44, 95%CI = 1.09-1.91, p = 0.035). In addition, in the over-dominant model, rs4789936 correlated with reduced risk of knee OA, adjusting for age and gender (OR = 0.69, 95%CI = 0.49-0.98, p = 0.036). Finally, rs7342880 correlated with increased risk of knee OA in females. This study provides evidence that TIMP-2 is a knee OA susceptibility gene in the Chinese population and a potential diagnostic and preventive marker for the disease.

Posterior cruciate-substituting total knee replacement recovers the flexion arc faster in the early postoperative period in knees with high varus deformity: a prospective randomized study

INTRODUCTION

Posterior cruciate retention (CR) and substitution (PS) has been controversial in knee replacement surgery. Satisfactory medium and long-term results have been reported in knees with and without deformity but there are limited studies about early functional comparison in terms of recovery of flexion arc, stair activity, walking ability and straight leg raising, especially, in early postoperative period in knees with deformity. Therefore, we aimed to compare the flexion arc in CR and PS knees in postoperative first year including early postoperative days prospectively.

METHODS

Consecutive patients with a deformity of >10° were included and allocated to CR and PS groups randomly. KSS and Feller-patella scores were recorded both preoperatively and postoperatively (1st, 2nd, 3rd and 12th months). Flexion and extension were measured both preoperatively and postoperatively (1st, 2nd, 3rd day and discharge day as well as 1st, 2nd, 3rd and 12th months). Visual analog scale (VAS) was recorded postoperatively at the 1st, 2nd, 3rd and discharge day and at 1st, 2nd, 3rd and 12th months. The walking ability, stair activity and straight leg raising were recorded. Patients were also examined at the last visit with minimum 7-year follow-up with KSS, Feller-patella and VAS scores. Their mean flexion arcs were measured and recorded.

RESULTS

There were 61 TKR evaluated. KSS knee and function scores at the 3rd month and KSS Knee Score at 1st year were superior in PS knees (p = 0.029, p = 0.046, p = 0.026). Flexion arc was found larger on day 1, 2, 3 and discharge day, and at 1st, 2nd, 3rd and 12th month in PS group (p = 0.048, p = 0.002, p = 0.027, p = 0.043, p = 0.014, p = 0.003, p = 0.002, p = 0.018). Walking and stair activity showed no difference but straight leg raising was better in CR knees (p = 0.02). Mean flexion arc was larger in PS knees at the last visit after 7 years (119.0° ± 7.5° in PS and 113.8° ± 8.7° in CR, p = 0.02). There was no revision required in that time interval. The other parameters were similar between groups.

CONCLUSIONS

PS knees gained active flexion arc faster and larger. But straight leg raising activity recovered early in CR knees. Both types of prosthesis produced satisfactory outcome. PS and CR TKRs can be performed with the same performance in osteoarthritic knees even with high varus deformity.

LEVEL OF EVIDENCE

Prospective Randomized Controlled Trial, Level II.