Osteoarthritis of the knees in the COPCORD world

Improvement in Gait Speed Affects Short-term Improvement in Activities of Daily Living in Patients with Moderate and Severe Knee Osteoarthritis

Objectives

It is unclear whether improvements in knee pain or physical function lead to improvements in activities of daily living (ADL) and quality of life (QOL) in patients with moderate to severe knee osteoarthritis (KOA). This study aimed to investigate whether improvements in knee pain and physical function, achieved through exercise therapy, lead to improvements in ADL and QOL in patients with moderate to severe KOA.

Methods

This case-control study included 18 patients with KOA. We evaluated knee range of motion, knee extension muscle strength (KEM), gait speed, knee pain, Knee Injury and Osteoarthritis Outcome Score (KOOS)-ADL, and KOOS-QOL at the first visit and after 3 months of exercise therapy. Patients were classified into the ADL and QOL improvement or no-improvement groups. Statistical analysis used split factorial analysis of variance with time and group as the main effects. When interactions were observed, post-hoc analysis was performed with two-sample t-tests.

Results

For ADL improvement, the improvements in KEM of the affected side and gait speed were statistically significant. At 3 months, the gait speed of the improvement group was significantly higher than that of the no-improvement group. For QOL improvement, there was no significant interaction for any of the factors evaluated.

Conclusions

No factor showed significant contribution to improved QOL in patients with moderate to severe KOA. However, increased gait speed may improve ADL and contribute to the development of efficient rehabilitation programs for patients with moderate to severe KOA.

The association of vitamin D status with oxidative stress biomarkers and matrix metalloproteinases in patients with knee osteoarthritis

Objective

The association of vitamin D status with osteoarthritis (OA) has been demonstrated previously. The current study was performed to examine the association of vitamin D status with oxidative stress markers and matrix metalloproteinases (MMPs) in patients with knee OA.

Methods

This case-control study was conducted on 124 subjects with mild to moderate knee OA and 65 healthy controls. Demographic data was collected from all participants at baseline. Serum levels of vitamin D as well as markers of oxidative stress including malondialdehyde (MDA), total oxidant status (TOS), superoxide dismutase (SOD), oxidative stress index (OSI), paraoxonase-1 (PON-1), glutathione peroxidase (GPX), catalase (CAT), and total antioxidant capacity (TAC) were evaluated for each participant. Furthermore, serum concentrations of MMP-1, MMP-3, MMP-13, and cartilage oligomeric matrix protein (COMP) were measured.

Results

The results of the present study indicated that individuals with vitamin D insufficiency had higher levels of MDA, TOS, SOD, and OSI as well as lower levels of PON-1 and TAC. Based on the linear regression analysis, serum vitamin D levels were inversely correlated with MDA, TOS, SOD, OSI, MMP-1, and MMP-13 and positively associated with TAC levels (p < 0.0001). Patients with sufficient vitamin D levels had lower MMP-1 and MMP-13 levels compared to patients with vitamin D insufficiency (p < 0.001 and p < 0.001, respectively).

Conclusion

Findings from this study showed a strong association between vitamin D deficiency and increased oxidative stress and MMPs activity in patients with knee OA.

A randomized, double-blind placebo-controlled phase I clinical study on safety and efficacy of the G-Rup® syrup (a mixture of ginger extract and honey) in symptomatic treatment of knee osteoarthritis

WHAT IS KNOWN AND OBJECTIVES

Present study evaluated the safety profile and efficacy of G-Rup® syrup (100 mg/ml ginger extract plus 150 mg/ml honey) in symptomatic treatment of knee osteoarthritis (OA).

METHODS

Patients diagnosed with knee OA were randomly assigned (1:1) to receive either of a 30 ml twice daily regimen of G-Rup® syrup or placebo over a 12-week period. Primary endpoints of the study comprised of an improvement in the joint's stiffness, physical functioning and pain score, assessed by WOMAC questionnaire and the visual analog scale (VAS). Secondary objectives comprised of safety and tolerability of the syrup by patients.

RESULTS AND DISCUSSION

The 30 ml twice-daily regimen of G-Rup® syrup was safe and well tolerated by patients. Moreover, in whole studied time points, treatment with G-Rup® syrup could significantly Power the VAS score (p < 0.001) whereas improving WOMAC total score (p < 0.001) and pain (p < 0.001), physical functioning (p < 0.001), and stiffness sub-scores (p = 0.006) compared to the placebo receiving group.

WHAT IS NEW AND CONCLUSION

Based on obtained results, the G-Rup® syrup, composed of a combination of honey and ginger, may be a proper supplementary choice, along with routine therapeutic regimens, for improvement of symptomatic treatment of OA.

Characterization of microRNA Levels in Synovial Fluid from Knee Osteoarthritis and Anterior Cruciate Ligament Tears

This study investigated modifications of microRNA expression profiles in knee synovial fluid of patients with osteoarthritis (OA) and rupture of the anterior cruciate ligament (ACL). Twelve microRNAs (26a-5p, 27a-3p, let7a-5p, 140-5p, 146-5p, 155-5p, 16-5p,186-5p, 199a-3p, 210-3p, 205-5p, and 30b-5p) were measured by real-time quantitative polymerase chain reaction (RT-qPCR) in synovial fluids obtained from 30 patients with ACL tear and 18 patients with knee OA. These 12 miRNAs were chosen on the basis of their involvement in pathological processes of bone and cartilage. Our results show that miR-26a-5p, miR-186-5p, and miR-30b-5p were expressed in the majority of OA and ACL tear samples, whereas miR-199a-3p, miR-210-3p, and miR-205-5p were detectable only in a few samples. Interestingly, miR-140-5p was expressed in only one sample of thirty in the ACL tear group. miR-140-5p has been proposed to modulate two genes (BGN and COL5A1100) that are involved in ligamentous homeostasis; their altered expression could be linked with ACL rupture susceptibility. The expression of miR-30b-5p was higher in OA and chronic ACL groups compared to acute ACL samples. We provide evidence that specific miRNAs could be detected not only in synovial fluid of patients with OA, but also in post-traumatic ACL tears.

Study on the Influencing Factors of Osteoarthritis in Southern China

Background

Osteoarthritis (OA) is a common chronic disease with numerous and interacting influencing factors, and current inadequate patient perceptions and behaviors in access to care contribute to the difficulties in the diagnosis, treatment, and management of osteoarthritis.

Objective

The purpose of this study was to investigate the influencing factors of osteoarthritis (OA) in a southern Chinese population and to provide a scientific basis for the prevention and treatment of OA.

Methods

A 1 : 2 matched case-control study was used to select 160 patients with OA from three hospitals in southern China as a case group. Three hundred and twenty cases of the same sex and similar age (within ± 2 years) were selected as the control group, and relevant data were collected for univariate and multivariate conditional logistic regression analysis.

Results

There were no significant differences between the two groups of participants in terms of age, sex, and education (P > 0.05). Logistic regression statistical analysis showed that genetic factors (OR = 4.52, 95% CI = 1.56-7.83), body mass index (OR = 2.57, 95% CI = 1.16-5.84), alcohol consumption (OR = 3.81, 95% CI = 1.53-5.87), and a history of external joint limb injury (OR = 3.37, 95% CI = 1.67-5.24) would increase the risk of OA. In contrast, eating more fresh vegetables (OR = 0.08, 95% CI = 0.03-0.31), more fresh fruits (OR = 0.34, 95% CI = 0.12-0.96), more soy products (OR = 0.11, 95% CI = 0.04-0.45), and exposure to sunlight (OR = 0.31, 95% CI = 0.14-0.71) would reduce the OA risk of OA.

Conclusion

Obesity, alcohol consumption, and a history of joint trauma all increase the risk of OA in a southern Chinese population, whereas a diet rich in fresh vegetables, fresh fruit, soy products, and sun exposure would reduce the risk of OA. In the future, we should focus on improving patients' awareness of medical care and developing their self-management skills, improving GPs' treatment skills, improving negative attitudes of both doctors and patients, and promoting positive patient care.

Correlation between goniometric measurements of range of motion and radiographic scores in osteoarthritis knee: An observational study among females

Osteoarthritis (OA) is a chronic degenerative joint disease. Different radiological changes are found according to grades. Range of motions (ROMs) of knee decreases with severity of OA. Women are more sufferer than men in OA knee. Objective was to correlate goniometric ROM with Kellgren-Lawrence (KL) radiographic score of female osteoarthritic knee. The study was a cross-sectional study conducted in Department of Physical Medicine and Rehabilitation, BSMMU, Dhaka, from February 2020 to March 2021. According to ACR (American College of Rheumatology) criteria, total 66 patients with primary OA knee were selected and examined in this study. Maximal flexion, extension, and rotation movements were measured by a universal goniometer. X-ray of standing both (A/P and lateral) view and skyline view of knee joint were taken and assessed with KL radiographic scores for medial, lateral, and patellofemoral compartments. Correlations between ROMs and KL scores were analyzed by Pearson correlation test. Among the 66 patients, mean age was 53.59 ± 7.19 years and mean body mass index was 26.62 ± 3.35. Majority (84.8%) of the patients were housewives. Mean maximum flexion was 126.71 ± 4.88°, maximum extension was -3.98 ± 1.74°, and internal and external rotations were 6.38 ± 1.29 and 8.48 ± 1.55°, respectively. More than half of patients had medial compartment KL score 3 or more while KL score 2 was found in 47% and 62.1% patients, respectively, in lateral and patellofemoral compartments. Statistically significant negative correlations were found between range of motion and radiographic scores. Strong correlation was present between maximal flexion and medial compartment score (r = -0.821, P < .001), whereas moderate correlation with other compartments. Extension values were moderately correlated with patellofemoral scores (r = -0.560, P < .001) and weakly correlated with rest of radiographic scores. Internal and external rotation were more related with medial compartment (r= -0.469, P < .001) and lateral compartment scores (r = -0.481, P < .001), respectively, than other compartment scores. There were significant negative correlations between goniometric measurements of knee ROM and radiographic scores in osteoarthritis knee in female patients.

Burden of osteoarthritis in India and its states, 1990-2019: findings from the Global Burden of disease study 2019

OBJECTIVE

To describe the burden of osteoarthritis (OA) in India from 1990 to 2019.

DESIGN

Data from Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 were used. The burden of OA -knee OA, hip OA, hand OA, and other OA- was estimated for India and its states from 1990 to 2019 through a systematic analysis of prevalence, incidence, years lived with disability (YLD), and disability-adjusted life years (DALY) using methods reported in GBD 2019 study.

RESULT

Around 23.46 million individuals in India had OA in 1990; this increased to 62.35 million in 2019. The age-standardised prevalence of OA increased from 4,895 (95% uncertainty interval (UI):4,420-5,447) in 1990-5313 (95%UI:4,799-5,898) in 2019, per 100,000 persons. Similarly, DALYs due to OA increased from 0.79 million (95%UI:0.40-1.55) to 2.12 million (95%UI:1.07-4.23); while age-standardised DALYs increased from 164 (95%UI:83-325) to 180 (95%UI:91-361) per 100,000 persons from 1990 to 2019. OA was the 20^th most common cause of YLDs in India in 2019, accounting for 1.48% (95%UI:0.88-2.78) of all YLDs; increasing from 23rd most common cause in 1990 (1.25%(95%UI:0.74-2.34)). Knee OA was the most common form of OA, followed by hand OA. The prevalence, incidence, and DALYs for OA and knee OA were consistently higher in females than males.

CONCLUSION

The burden and impact of OA in India are substantial and is increasing. Adopting suitable control and preventive community measures to reduce modifiable risk factors (obesity, injuries, occupational stress) are needed to reduce the current and future burden of OA in India.

Higher dietary phytochemical index is associated with lower odds of knee osteoarthritis

Previous studies have shown that adherence to dietary patterns rich in plant-based foods may reduce the odds of osteoarthritis; however, limited data are available on the association of consumption of diets rich in phytochemicals and odds of knee osteoarthritis (KOA). In this case–control study conducted in Iran, we aimed to investigate whether a higher dietary phytochemical index (DPI) is associated with decreased odds of having KOA. A total of 124 cases aged 20–60 years diagnosed with bilateral primary KOA according to the American College of Rheumatology criteria and 124 controls frequency-matched on age, sex, and body mass index (BMI) were included in the study. A validated food frequency questionnaire (FFQ) was used to collect information on dietary intakes. To calculate DPI scores, the dietary energy derived from foods rich in phytochemicals (kcal) was divided by the participant’s total daily energy intake (kcal). Patients with KOA had lower intakes of dietary fiber (P = 0.004), vitamin A (P = 0.007), vitamin C (P = 0.001), and folate (P = 0.021) compared to controls. In the crude model, individuals in the third tertile of DPI had 65% lower odds of having KOA compared to those in the first tertile (OR 0.35, 95% CI 0.19 to 0.67, P-trend = 0.001). After adjustment for potential confounders, including age, sex, physical activity, smoking, and supplement use, this inverse association remained significant (OR 0.37, 95% CI 0.19 to 0.73, P-trend = 0.004). After further adjustment for BMI, this inverse association between DPI and odds of KOA also remained significant (OR 0.35, 95% CI 0.18 to 0.69, P-trend = 0.003). These findings suggest that adherence to a phytochemical-rich diet, as indicated by the increasing DPI score, is associated with lower odds of KOA.

Risk factors of knee osteoarthritis in Bangladeshi adults: a national survey

BACKGROUND

Knee osteoarthritis was reported as the second most prevalent condition in the national musculoskeletal survey. The purpose of this extended study was to identify risk factors for knee osteoarthritis in Bangladeshi adults.

METHODS

This cross-sectional study was conducted in rural and urban areas of Bangladesh using stratified multistage cluster sample of 2000 adults aged 18 years or older recruited at their households. The Modified Community Oriented Program for Control of Rheumatic Disorders (COPCORD) questionnaire was used to collect data. The diagnosis of knee osteoarthritis was made using the decision tree clinical categorization criteria of the American College of Rheumatology. Univariate and multivariate logistic regression analyses were done to identify the risk factors for knee osteoarthritis.

RESULTS

A total of 1843 individuals (892 men and 951 women) participated, and 134 had knee osteoarthritis yielding a prevalence of 7.3% (95% confidence interval (CI) 4.9 to 9.6%). The mean (standard deviation) age of the knee osteoarthritis patients was 51.7 (11.2) years. Multivariate logistic regression analysis found a significant association with increasing age (≥38 years OR 8.9, 95% CI 4.8-16.5; ≥58 years OR 13.9, 95% CI 6.9-28.0), low educational level (OR 1.7, 95% CI 1.0-2.7) and overweight (OR 1.9, 95% CI 1.2-2.9) with knee osteoarthritis. Knee osteoarthritis patients had a high likelihood of having work loss preceding 12 months (age and sex-adjusted OR 2.3; 95% CI 1.4-3.8; P < 0.01).

CONCLUSIONS

Knee osteoarthritis is a commonly prevalent musculoskeletal problem among Bangladeshi adults having link to work loss. Increasing age, low education and overweight are significant risk factors of knee osteoarthritis.

Effects of Swedish massage on gait spatiotemporal parameters in adult women with medial knee osteoarthritis: A randomized controlled trial

BACKGROUND

Patients with knee osteoarthritis (OA) are always faced with functional limitations in daily activities due to knee pain. They are also at risk of falling because of compensatory kinetics and kinematics changes in walking, which is why they are seeking complementary therapies to deal with their problems.

OBJECTIVE

The present research aimed to evaluate whether Swedish massage is effective in relieving the symptoms of knee OA and improving the gait spatiotemporal parameters of patients with knee OA.

METHODS

Thirty adult women with knee OA participated in this study voluntarily. The intervention group (n = 15) received Swedish massage on their quadriceps for 20-30 min per session (12 sessions). During this period, the control group (n = 15) received their regular treatment. Osteoarthritis symptoms were evaluated by the Western Ontario and McMaster Universities Osteoarthritis Index. The spatiotemporal parameters of gait were also captured by the motion analysis system during barefoot walking.

RESULTS

The intervention group demonstrated significantly more pain relief and improved function compared to the control group. A significant increase was observed in the gait speed, total support time, and single support time (P < 0.05). Moreover, there was a significant decrease in the step width and initial double support time of the patients after receiving Swedish massage (P < 0.05).

CONCLUSION

It can be concluded that Swedish massage may positively affect pain relief and function improvement in patients with knee OA. Also, Swedish massage was found to improve the spatiotemporal parameters in the patients. This may have important clinical implications regarding the rehabilitation of patients with knee OA.

Prevalence and Incidence of Osteoarthritis: A Population-Based Retrospective Cohort Study

While trends data of osteoarthritis (OA) are accumulating, primarily from Western Europe and the US, a gap persists in the knowledge of OA epidemiology in Middle Eastern populations. This study aimed to explore the prevalence, incidence, correlations, and temporal trends of OA in Israel during 2013-2018, using a nationally representative primary care database. On 31 December 2018, a total of 180,126 OA patients were identified, representing a point prevalence of 115.3 per 1000 persons (95% CI, 114.8-115.8 per 1000 persons). Geographically, OA prevalence was not uniformly distributed, with the Southern and Northern peripheral districts having a higher prevalence than the rest of the Israeli regions. OA incidence increased over time from 7.36 per 1000 persons (95% CI 6.21-7.50 per 1000 persons) in 2013 to 8.23 per 1000 persons (95% CI 8.09-8.38 per 1000 persons) in 2017 (p-value for trend = 0.02). The incidence was lowest in patients under 60 years (in both sexes) and peaked at 60-70 years. In older ages, the incidence leveled off in men and declined in women. The growing risk of OA warrants a greater attention to timely preventive and therapeutic interventions. Further population-based studies in the Middle East are needed to identify modifiable risk factors for timely preventive and therapeutic interventions.

Effectiveness of Pistacia atlantica on older adult knee osteoarthritis, a randomized triple blind clinical trial

Osteoarthritis is the most common cause of disability and aging is the major risk factor. One of the low-risk herbal medicines for reducing pain and inflammation in persian medicine is Pistacia atlantica gum. A triple-blind placebo-controlled clinical trial was performed in order to evaluate the efficacy of P. atlantica gum ointment on knee osteoarthritis in elderly people. A total of 60 patients were randomly allocated to two groups. The intervention group used 4% P. atlantica ointment and the control group used placebo, topically applied three times a day, for 8 weeks. The patients were evaluated before and after the intervention using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale. There were significant differences (p < .001) between two the groups in terms of joint stiffness and pain as well as function. Within groups, regarding the effect size (EF) in joint stiffness was 2.82 and 0.74 in the Pistacia and placebo groups, respectively. Regarding pain, the effect size of the intervention and placebo groups were 3.90 and 0.99, respectively. In addition, regarding function, the effect size of the intervention and the placebo groups were 4.33 and 1.17, respectively. Therefore, it seems that topical P. atlantica is significantly better than the placebo in the old patients with knee osteoarthritis.

Physician induced demand for knee replacement surgery in Iran

BACKGROUND

The structure of the Iranian health system has raised this hypothesis that a part of the Knee Replacement Surgery (KRS) services are provided due to Physician-Induced Demand (PID).

METHODS

This paper used an unbalanced individual panel data covering the steady-state 15,729 KRSs performed by 995 surgeons provided by the Armed Forces Insurance Organization at the provincial level over the 60 months (2014-2018). We use a generalized method of moment's system (GMM-SYS) to obtain consistent and asymptotically efficient estimates, which provide a vital instrument for our dynamic panel data.

RESULTS

The outcomes show that with unequal increasing orthopedic surgeons to population ratio, both the number and size of KRS services were increased significantly at a 1 % level. Given that the positive elasticity obtained for the service size was significantly larger than the number of services, the findings give strong support for the existence of PID in the Iran system for KRS care. Also, the raw and population-adjusted number of KRS, cost, and the surgery per active physician increased significantly at the monthly province level.

CONCLUSIONS

This is the first time that the existence of PID in the Iranian health system is investigated using approved econometric models. The findings indicate that the health system structure has been provided the conditions for aggressive, costly, and high-risk services such as KRS to be exposed to PID.

Approaches to osteoarthritis - A qualitative study among patients in a rural setting in Central Western India

BACKGROUND

Osteoarthritis (OA) represents a major cause of disability in India. For implementation of best practice management, it is important to consider the views of people in India since they might deviate from those expressed in previous studies by people with OA in the Western world.

OBJECTIVE

The purpose of this study was to explore and describe approaches toward OA and its management among patients in a rural setting in Central Western India.

DESIGN AND METHOD

Conventional content analysis was used to analyze semi-structured interviews with 24 patients diagnosed with OA from the target area of Pravara University Hospital and ten adjacent primary health care centers in Maharashtra, India.

RESULTS

Four categories; lack of power, active ambivalence, taking control and a constant struggle were identified as patients' approaches to OA. The categories were further elaborated on in seven subcategories.

CONCLUSION

Daily challenges and efforts, of which some may be unique to patients in a rural setting in India, underlie passive and active approaches to OA and its management. Understanding these may enhance Indian physiotherapists' implementation of evidence-based self-management programs adapted to Indian conditions and reduce the distress of their patients.

Activation of NOTCH1 by Shear Force Elicits Immediate Cytokine Expression in Human Chondrocytes

Osteoarthritis is caused by overloading of joints and is characterized by inflammation-induced disruption of cartilage structure. Current treatment strategy aims to relieve inflammation and prevent further deterioration of joint function. However, how mechanical force leads to inflammation and deterioration of chondrocyte function still remains incompletely understood. To explore the force-regulated molecular mechanism, an in vitro hydraulic shear force experiment to simulate the condition of force loading was required. The result demonstrated that multiple cytokines and immune regulators, including interleukin 8, interferon β, TRAF1 and TNFAIP3, were significantly increased by shear force within two hours of treatment. Moreover, JAG1 and HES1 were drastically upregulated as well, suggesting that NOTCH1 signaling is activated by shear force. Short-term expression of NOTCH1 intracellular domain activated a similar set of cytokines, indicating that NOTCH1 responds to shear force and activates downstream genes. When incubated under the medium conditioned by NOTCH1-activated chondrocyte, osteoblasts expressed higher levels of interferon β and interferon λ. Together, our results indicated that NOTCH1 functions as a force sensor and promotes expression of cytokines and immune regulators from shear-force bearing chondrocytes.

Long non-coding RNA SNHG15 is a competing endogenous RNA of miR-141-3p that prevents osteoarthritis progression by upregulating BCL2L13 expression

Increasing evidence has demonstrated that the dysregulated expression of long noncoding RNAs (lncRNAs) has important roles in the progression of osteoarthritis (OA), but the function of the lncRNA SNHG15 remains unclear. In the present study, we observed that SNHG15 was downregulated in OA cartilage tissues and IL-1β-induced chondrocytes. The lower expression of SNHG15 was negatively associated with the observed modified Mankin scale scores, extracellular matrix (ECM) degradation and chondrocyte apoptosis. Downregulated expression of SNHG15 increased chondrocyte viability and decreased chondrocyte apoptosis and ECM degradation in vitro and reduced damage to articular cartilage in vivo. Mechanistically, we demonstrated that SNHG15 overexpression promotes the expression of BCL2L13 by sponging miR-141-3p. The higher expression of miR-141-3p was negatively correlated with SNHG15 and BCL2L13 levels in OA cartilage tissues, and a positive correlation was also shown between SNHG15 and BCL2L13 levels. Furthermore, ectopic expression of miR-141-3p or knockdown of BCL2L13 expression could both reduce the effects of SNHG15 on chondrocyte proliferation, apoptosis and ECM degradation. Collectively, these findings reveal that SNHG15 inhibits OA progression by acting as an miR-141-3p sponge to promote BCL2L13 expression, suggesting that knockdown of SNHG15 expression in chondrocytes can be a potential therapeutic strategy to ameliorate OA progression.

Unicompartmental knee arthroplasties in Hong Kong: 15 years of experience in a teaching hospital

INTRODUCTION

Osteoarthritis (OA) of the knee is a growing problem in an aging population. Unicompartmental knee arthroplasties (UKA) have been used for management of isolated OA of the medial tibiofemoral joint. This is the first study on the usage of UKA in Hong Kong.

METHODS

Retrospective analysis of all patients undergoing medial compartment UKA in a tertiary referral center since 2003. Preoperative and postoperative International Knee Society Knee Scores (KSKS) and Knee Societal Functional Assessment (KSFA) scores, range of motion, flexion deformity, and lower limb mechanical alignment were measured. Statistical analysis using paired sample t-tests was performed. Revision operations, rate of revisions, and causes of failure were analyzed. Univariate and multivariate logistic regression analyses of risk factors for revision operation were performed against patient demographics, type of prosthesis, postoperative alignment, and degree of correction.

RESULTS

There were 94 UKA performed with an average follow-up of 4.3 years (range: 0.5-15.2 years). The KSKS and KSFA scores improved from 54.5 and 54.0 to 85.6 and 64.5 ( p < 0.01), respectively. There was no significant improvement in the range of motion ( p = 0.87) and fixed flexion deformity ( p = 0.14). Mechanical alignment improved from 172.1° to 174.9° varus postoperatively ( p < 0.01). Six cases required revision operation with a revision rate of 1.50 per 100 observed component years. Causes of revision included two cases of tibial tray loosening and one case each of progressive OA, mechanical failure, persistent pain, and infection. Logistic regression analysis for risk factors showed no statistical significance.

CONCLUSIONS

UKA offers good functional improvement but further long-term studies are required to evaluate survivorship.

Magnetic resonance evaluation of knee osteoarthritis among the Saudi Population

Background and Objectives

Osteoarthritis (OA) is the most prevalent worldwide joint degenerative disorder with high morbidities and disabilities. The current study aimed to investigate the prevalence of knee osteoarthritis (KOA) in Arar by using magnetic resonance imaging (MRI).

Methods

The prevalence of KOA was studied in Arar through MRI evaluation of randomly chosen sample from patients and their relatives attending the Prince Abdul Aziz Bin Mussad Hospital from October 2015 to November 2016.

Results

A total of 410 participants were enrolled in the study [328 (80%) male and 82 (20%) females]. After MRI, 163 participants [39.75% (95% CI) = 35.14 - 44.57%)] were diagnosed with KOA. The prevalence of OA was about 25.6% (95% CI = 20.8 - 31.1%) below the age of 40 years, which was found to increase by age in the enrolled volunteers. KOA prevalence was higher in females than males (75.6% and 27.7% respectively). There was a significant association between the age and genders of the participants and the prevalence of OA (p-value < 0.0001 for both variables). There was also a significant association between the age and gender of the participants and the MRI-estimated grading (p-value < 0.0001 and 0.0044 respectively).

Conclusion

KOA is a common disease among Arar young population, especially females. Its prevalence increases by age with higher grades of severity affecting the elderly.

Platelet-rich Plasma-induced Inhibition of Chondrocyte Apoptosis Directly Affects Cartilage Thickness in Osteoarthritis

Abstract

The search for minimally invasive treatment of osteoarthritis has led to the development of biological options such as platelet-rich plasma (PRP), mesenchymal stem cells (MSCs), and bone marrow aspirate concentrates. This research was conducted to study the outcomes of PRP administration in the chemical-induced model of osteoarthritis in rat knee.

Methods and results

Two milligrams of monoiodoacetate (MIA) was used for the induction of arthritis in the right knee of 16 rats. Autologous PRP was prepared by double centrifugation, which was then administered in the arthritic knee of eight rats. This group was labeled as the treated group (A) while the rest were counted as the non-treated group (B). Chondrocyte count and uncalcified cartilage thickness were morphometrically assessed on hematoxylin and eosin (H&E) stained slides, and it was noted that treated group A had a higher chondrocyte count and more cartilage height as compared to non-treated group B. Intergroup comparison was done between the treated group (A) and non-treated group (B) using the independent t-test. P-values were found to be statistically significant for these parameters.

Conclusion

This study thus concluded that PRP had induced an inhibitory effect on the apoptosis of chondrocytes, which, in turn, prevented the loss of cartilage height by inhibiting matrix loss.

Perceived barriers to and facilitators of physical activity in people with knee osteoarthritis: Development of the Evaluation of the Perception of Physical Activity questionnaire

BACKGROUND

The physical activity (PA) level of individuals with knee osteoarthritis is lower than in the general population. International recommendations recommend a non-pharmacological intervention including a self-management education program, weight loss and an adapted exercise program. However, we have no scale assessing the perceived barriers to and facilitators of PA in this population.

OBJECTIVE

We constructed and validated a self-administered questionnaire assessing perceived barriers to and facilitators of regular practice of PA in people with knee osteoarthritis.

METHODS

Semi-structured interviews identified 24 barriers and facilitators. We developed a 24-item questionnaire, Evaluation of the Perception of Physical Activity (EPPA) that was completed by 548 individuals with knee osteoarthritis, to assess acceptability, construct validity, internal consistency and convergent validity. Participants also completed the Knee Osteoarthritis Fears and Beliefs Questionnaire (KOFBeQ), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) and International Physical Activity Questionnaire (IPAQ). Reliability and sensitivity to change were evaluated in a second group of 168 people with knee osteoarthritis at a 3-week spa therapy resort.

RESULTS

Factorial analysis identified 17 items grouped into 4 subscales (Barriers, Facilitators, Motivation and Beliefs). The internal consistency was good for Barriers, Facilitators and Motivation subscales (Cronbach α>0.70) and intermediate for the Beliefs subscale (Cronbach α=0.64). The EPPA subscale scores were significantly correlated with KOFBeQ and WOMAC scores but not associated with IPAQ physical activity level. Reliability was good for all subscales, with intraclass correlation coefficients>0.60. A sensitivity to change was found for only the Beliefs subscale, with a moderate effect size.

CONCLUSIONS

The EPPA questionnaire has good psychometric properties and can help guide the management of knee osteoarthritis. It can be used in research for evaluating the perception of physical activity.

Translation, validation and cross-cultural adaptation of the Nepali version of WOMAC® LK 3.1

BACKGROUND

Among many self-reported outcome measures, Western Ontario and McMaster Universities Arthritis Index (WOMAC) is one of the commonly used indexes for osteoarthritis patients. Despite high prevalence of musculoskeletal problems in Nepal, there is no validated tool available in the local language. Thus, this study aimed to translate the English WOMAC® into Nepali, and validate it for use in the future.

METHODS

Guidelines by Beaton et al were followed for translation and cross-cultural adaptation of the original WOMAC into Nepali language. Diagnosed cases of knee osteoarthritis (OA) attending the rheumatology outpatient department of National Center for Rheumatic Diseases, Kathmandu were enrolled in the study. These patients were interviewed with the Nepali version. Internal consistency was measured by Cronbach's alpha and test-retest reliability by intra-class correlation coefficient (ICC). Correlation between domains of WOMAC was tested with visual analog scale (VAS) and numerical rating scale (NRS) of pain and stiffness.

RESULTS

The test-retest reliability was good with ICC of >0.75 for all domains and items. Internal consistency was acceptable with Cronbach's alpha scores of 0.852, 0.704 and 0.955 for pain, stiffness and physical function domains, respectively. Strong correlation was observed between WOMAC stiffness domain and VAS for stiffness and NRS for stiffness with rho (ρ) values of 0.750 and 0.759, respectively. Moderate correlation was seen between WOMAC pain and VAS for pain and NRS for pain with ρ of 0.658 and 0.584, respectively.

CONCLUSIONS

Nepali WOMAC is a reliable and valid instrument for assessment of disease severity and its impact in Nepali-speaking patients with OA.

Improved chondrogenic response of mesenchymal stem cells to a polyethersulfone/polyaniline blended nanofibrous scaffold

Owing to the fact that the cartilage tissue is not able to repair itself, the treatment of the joint damages is very difficult by current methods. Induction of tissue repair requires suitable cell and extracellular matrix. Providing these two parts can only be done using tissue engineering. In the present study, polyethersulfone (PES) and polyaniline (PANI) blend was electrospined for nanofibrous scaffold fabrication. Mesenchymal stem cells were isolated from human adipose tissue (AT-MSCs), and after characterization cultured on the PES-PANI scaffold and culture plate. Electron microscopic and 3-(4,5-dimethylthiazol-2-yl)-2,5-diphenyltetrazolium bromide (MTT) colorimetric assays were used for biocompatibility evaluation of the scaffold and the chondrogenic differentiation potential of AT-MSCs were investigated by staining of proteoglycans and gene and protein expression evaluation. Alcian blue staining, real-time reverse-transcriptase polymerase chain reaction and Western blot results showed that chondrogenic differentiation potential of AT-MSCs was significantly increased when grown on PES-PANI nanofibers and was compared to the one grown on a culture plate. According to the results, PES-PANI has a promising potential to be used as a biomedical implant in patients with joints lesion, such as arthritis and osteoarthritis.

Association between the aspartic acid D-repeat polymorphisms and osteoarthritis susceptibility: An updated systematic review and meta-analyses

OBJECTIVES

Association between the D-repeat of asporin (ASPN) gene and osteoarthritis (OA) was still inconsistent. We performed this meta-analysis to systematically assess the D-repeat polymorphisms in OA susceptibility.

METHODS

Relevant studies were enrolled by searching databases. Odd ratios (ORs) with 95% confidence intervals (95% CIs) were used for evaluating the association between ASPN gene and OA. Heterogeneity was calculated using the Q statistic, and three different subgroup analyses were performed on ethnicity, gender, and OA positions respectively. False discovery rate (FDR) was applied to regulate the multiple comparisons.

RESULTS

Twelve qualified articles involving 5190 OA patients and 5167 healthy controls were included. With D13 polymorphism, Caucasian male patients have low OA susceptibility (P = .008, PFDR = .024, OR [95% CI] = 0.83 [0.73-0.95]). As to D14 polymorphism, all male patients (P = .0004, PFDR = .001, OR [95% CI] = 1.38 [1.15-1.64]), Asian male patients (P = .01, PFDR = .01, OR [95% CI] = 1.72 [1.11-2.66]), and Caucasian male patients (P = .005, PFDR = .001, OR [95% CI] = 1.32 [1.09-1.60]) have high OA susceptibility. In the pooled-population of KOA with D14 polymorphism, overall male patients (P = .03, PFDR = .045, OR [95% CI] = 1.35 [1.02-1.78]) and Asian male patients (P = .01, PFDR = .03, OR [95% CI] = 1.72 [1.11-2.66]) have high OA risk. With D16 polymorphism, Latin America patients may have high OA risk (P = .04, PFDR = .15, OR [95% CI] = 1.43 [1.02-2.01]).

CONCLUSION

Our results suggest that D-repeat of ASPN gene is mainly associated with male patients. The D13 polymorphism plays a protective role for OA in Caucasians male individuals while D14 plays a risk factor for KOA in male patients.

Prevalence of osteoarthritis and association between smoking patterns and osteoarthritis in China: a cross-sectional study

Objective

The aims of this study were to estimate the prevalence of radiographic osteoarthritis (OA) and to assess the association between smoking patterns and OA prevalence in adults aged 50 years or older belonging to the Shanxi province of China.

Methods

A cross-sectional study in the rural regions of the Shanxi province was conducted among 2638 Chinese adults (aged ≥50 years). Demographic characteristics and behavioral information were collected through epidemiological surveys. All participants with joint pain underwent plain radiographic examination and were diagnosed by a professional orthopedist. Associations between smoking patterns and the prevalence of OA were assessed using binary logistic regression modeling.

Results

Among 2638 individuals (men, 50.3% and women, 49.7%; mean age, 61.5 years) included in the analysis, 49.8% had radiographic OA and 27.5% had knee OA. The prevalence of radiographic OA was higher in women than in men (P<0.001). After adjusting for potential confounding factors, there was a nonsignificant correlation between smoking and OA prevalence in the multivariate model. Odds ratios (ORs) for all types of OA and knee OA were higher in active and passive smokers than in nonsmoking individuals after adjustments (OR 1.374; 95% confidence interval [CI] 1.049–1.802; OR 1.440; 95% CI 1.059–1.958, respectively).

Conclusions

This study showed that smoking may not be an independent risk factor for OA; however, there was a positive correlation between active and passive smoking and OA.

Vitamin D receptor gene polymorphisms and susceptibility for primary osteoarthritis of the knee in a Latin American population

BACKGROUND

Primary Osteoarthritis (OA) of the knee is a multifactorial disease that has an important genetic component, and several genes have been associated with its development. The vitamin D receptor has a role in skeletal metabolism that suggests a relationship with OA. The aim of this study was to analyze the association of Vitamin D receptor gene (VDR) polymorphisms in Mexican Mestizo patients.

METHODS

A case-control study was conducted in which 107 cases with primary OA of the knee and 114 controls were included. Cases were patients > 40 years of age with a Body mass index (BMI) of ≤27 and a radiological score for OA of the knee of ≥2. Controls were subjects > 40 years of age with a radiological score of < 2. VDR polymorphisms rs1544410, rs7975232, and rs731236 were analyzed by means of restriction endonucleases, and logistic regression was developed to evaluate risk magnitude.

RESULTS

A significantly increased risk was found of nearly two-fold for the allele T and TT genotypes of rs731236, independently of other well recognized risk factors.

CONCLUSIONS

The rs731236 polymorphism is associated with the risk of primary OA of the knee in Mexican Mestizo population.

Genetic polymorphism in the asporin gene is not a key risk factor for osteoarthritis: Evidence based on an updated cumulative meta-analysis

To provide an evidence-based medical basis for the treatment of osteoarthritis, a meta-analysis was performed to assess the association between asporin (ASPN) gene polymorphism and susceptibility to osteoarthritis (OA). The current study searched the literature from January 1st, 1915 through February 1st, 2017 using the Cochrane Library, PubMed, the Excerpta Medica database (EMBASE) and three main Chinese databases (VIP, CNKI and Wan Fang). Cohort and case-control studies that explored the association between different types of ASPN alleles and OA susceptibility were evaluated. The K/L grading system, clinical and radiological diagnoses were used for OA diagnosis. A random-effects model was used in a pooled analysis to adjust for heterogeneity of the included studies, and the differences between treatment groups were reported as odds ratio (OR), 95% confidence intervals (CIs) and P-values. Begg's funnel plots and Egger's tests were used to assess publication bias in the present meta-analysis. Following document retrieval and screening, a total of 10 studies were deemed eligible, including 4,842 patients and 3,661 healthy subjects. Results of the multivariate meta-regression analysis revealed that the study sample size was a source of heterogeneity between studies. The D17 allele was a risk factor for the development of OA (OR=1.33, 95% CI: 1.02–1.73, P<0.05). The other alleles were not considered as risk factors for development of OA (P>0.05). The results of the meta-analysis verified that ASPN polymorphisms were not significantly relevant to an increased OA risk. However, the mechanisms contributing to the association between ASPN polymorphisms and OA risk still require further study.

Emerging Concepts in Treating Cartilage, Osteochondral Defects, and Osteoarthritis of the Knee and Ankle

The management and treatment of cartilage lesions, osteochondral defects, and osteoarthritis remain a challenge in orthopedics. Moreover, these entities have different behaviors in different joints, such as the knee and the ankle, which have inherent differences in function, biology, and biomechanics. There has been a huge development on the conservative treatment (new technologies including orthobiologics) as well as on the surgical approach. Some surgical development upraises from technical improvements including advanced arthroscopic techniques but also from increased knowledge arriving from basic science research and tissue engineering and regenerative medicine approaches. This work addresses the state of the art concerning basic science comparing the knee and ankle as well as current options for treatment. Furthermore, the most promising research developments promising new options for the future are discussed.

Effect of Yoga Based Lifestyle Intervention on Patients With Knee Osteoarthritis: A Randomized Controlled Trial

Objective: To investigate the effect of integrated approach of yoga therapy (IAYT) intervention in individual with knee Osteoarthritis. Design: Randomized controlled clincial trail. Participants: Sixty-six individual prediagnosed with knee osteoarthritis aged between 30 and 75 years were randomized into two groups, i.e., Yoga (n = 31) and Control (n = 35). Yoga group received IAYT intervention for 1 week at yoga center of S-VYASA whereas Control group maintained their normal lifestyle. Outcome measures: The Falls Efficacy Scale (FES), Handgrip Strength test (left hand LHGS and right hand RHGS), Timed Up and Go Test (TUG), Sit-to-Stand (STS), and right & left extension and flexion were measured on day 1 and day 7. Results: There were a significant reduction in TUG (p < 0.001), Right (p < 0.001), and Left Flexion (p < 0.001) whereas significant improvements in LHGS (p < 0.01), and right extension (p < 0.05) & left extension (p < 0.001) from baseline in Yoga group. Conclusion: IAYT practice showed an improvement in TUG, STS, HGS, and Goniometer test, which suggest improved muscular strength, flexibility, and functional mobility. CTRI Registration Number: http://ctri.nic.in/Clinicaltrials, identifier CTRI/2017/10/010141.

EVALUATION OF FUNCTIONAL CHARACTERISTICS IN PATIENTS WITH KNEE OSTEOARTHRITIS

OBJECTIVE

This study evaluated the physical and functional characteristics of Turkish patients with knee osteoarthritis and how this disease affects their physical and functional status.

METHODS

This study included 320 patients, who were evaluated to assess body mass index (BMI) and Hospital for Special Surgery (HSS) score in terms of age, sex and functional characteristics.

RESULTS

Mean patient age was 66.92±8.89 years and mean BMI was 31.02±5.20 kg/m². Mean patient HSS score was 58.70±11.08. According to their sit-to-stand test results, 33% of the patients (n=104) were found to be independent. There was a significant relationship between BMI and functional activity score (p<0.05).

CONCLUSIONS

The majority of the patients in our study were female and obese, and had low functionality levels. Function in patients with OA is restricted as a result of excess weight, so preventive measures can help Turkish patients with OA maintain their ideal weight. Furthermore, patient education can be help this population acquire the habit of regular exercise in order to reduce pain and improve their physical activity and quality of life. Level of Evidence IV, Case Series.

An updated meta-analysis of the asporin gene D-repeat in knee osteoarthritis: effects of gender and ethnicity

Background

Knee osteoarthritis (KOA) is the most prevalent form of knee joint disease and characterized by the progressive degeneration of articular cartilage. Although pathology of KOA remains unknown, genetic factors are considered to be the major cause. Asporin is a group of biologically active components of extracellular matrix (ECM) in articular cartilage, and asporin gene (ASPN) D-repeat polymorphism was reported to be associated with KOA. Thus, our meta-analysis is aimed at investigation of the association between asporin D-repeat polymorphism and susceptibility of KOA.

Methods

We gathered data from MEDLINE, Embase, OVID, and ScienceDirect to search relevant published epidemiological studies through April 2017. Compared with previous studies, our meta-analysis is the first study to investigate the association of ASPN D15, D16, and D17 alleles and KOA susceptibility by ethnic- and sex-stratified subgroup analysis.

Results

We found no significant association between D15 allele and susceptibility to KOA (OR = 1.05, 95% CI 0.95–1.17) in overall population. The same results were observed in the analysis of D16 (OR = 1.01, 95% CI 0.80–1.28) and D17 alleles (OR = 1.28, 95% CI 0.91–1.80). The ethnic- and sex-subgroup analyses did not alter the ORs. However, significant association was detected in the sensitivity analysis of D17 in overall population (OR = 1.05, 95% CI 0.95–1.17) and Asian population (OR = 1.78, 95% CI 1.02–3.11, P < 0.05).

Conclusion

Our results indicated that D-repeat polymorphism of ASPN may not play a major role in susceptibility of KOA in ethnic- and sex-specific analysis. Because of the limitations of the present meta-analysis, firm conclusions could not be drawn based on the current evidence, and further studies are required to detect genuine role of ASPN.

Use of strong opioids for chronic pain in osteoarthritis: an insight into the Latin American reality

INTRODUCTION

Osteoarthritis is the most common cause of arthritis and one of the main causes of chronic pain. Although opioids are frequently employed for chronic pain treatment, their usage for osteoarthritis pain remains controversial due to the associated adverse effects. Most guidelines reserve their use for refractory pain in patients with hip and knee osteoarthritis. The situation is even more complex in Latin America, where the prevalence of insufficient pain treatment is high because of the limited availability and use of strong opioids. Areas covered: In this article we review the epidemiology of osteoarthritis, its socioeconomic burden, its impact as a chronic pain cause and the pharmacological treatment options, giving emphasis to the role of strong opioids, their safety and efficacy, especially in Latin American countries, where restrictions regulate their usage. Expert commentary: Usage of strong opioids is safe and effective in the short-term management of osteoarthritis with moderate to severe pain, when other pharmacological treatments are inadequate and surgery is contraindicated, provided their use adheres to existing guidelines. Educational programs for patients and physicians and further research on treating chronic pain with opioids should be implemented to reduce adverse effects and improve care quality.

India-Based Knee Osteoarthritis Evaluation (iKare): A Multi-Centre Cross-Sectional Study on the Management of Knee Pain and Early Osteoarthritis in India

Background

Access to early knee osteoarthritis treatment in low and middle income nations is often believed to be limited. We conducted a cross-sectional study in India to assess prior access to treatment among patients presenting with knee pain to specialist orthopaedic clinics.

Methods

The multi-centre, cross-sectional study included patients presenting with knee pain at 3 hospitals in India. Patients who met the inclusion criteria and provided informed consent completed a questionnaire designed to assess patient demographics, socioeconomic status, knee pain, treatment method, and patient's knowledge on osteoarthritis (OA). Their orthopaedic surgeons also completed a questionnaire on the severity of patient's OA and their recommended treatments. The impact of demographic characteristics on the prescription of treatment options was analyzed using logistic regression.

Results

A total of 714 patients met the eligibility criteria and participated in this study. The majority of patients had been experiencing pain for less than 1 year (64.8%) and had previously been prescribed medications (91.6%), supplements (68.6%), and nonpharmacological (81.9%) treatments to manage their knee OA. Current treatment recommendations included oral medications (83.3%), intra-articular injections (29.8%), and surgical intervention (12.7%). Prescription of oral medications was related to younger age, lack of deformities, and lower Kellgren-Lawrence grades (p < 0.01). Patients treated in private hospital settings were more likely to have been previously treated with medications (range, 84.3% to 92.6%; p < 0.01) and physical treatments (range, 61.8% to 84.8%; p < 0.01) than patients treated at government hospitals.

Conclusions

Contrary to the perception, our findings suggest a similar proportion of early knee OA treatment between India and North America.

Effect of an orally formulated processed black cumin, from Iranian traditional medicine pharmacopoeia, in relieving symptoms of knee osteoarthritis: A prospective, randomized, double-blind and placebo-controlled clinical trial

AIM

Osteoarthritis is a global health problem, especially for the elderly. A good replacement for non-surgical treatments is the use of traditional medicines. We selected a revere plant (Nigella sativa L.), a widely utilized medicinal herb for the treatment of inflammatory conditions, from the Iranian traditional medicine (ITM) pharmacopoeia with proven anti-inflammatory and analgesic actions.

METHODS

We performed a prospective, randomized, double-blind, and placebo-controlled clinical trial, in order to investigate whether the herb is useful in alleviating the symptoms of knee osteoarthritis. American College of Rheumatology clinical criteria were the basis of diagnosis, while the Knee injury and Osteoarthritis Outcome Score (KOOS) questionnaire was considered as the main outcome measure. One hundred and ten eligible patients were assigned to receive a placebo or an active intervention (2 g/day of processed N. sativa seed powder in divided doses). Acetaminophen tablets were the rescue medicine. Finally, 40 patients in the placebo group and 37 patients in the active group completed the trial and were included in the statistical analysis.

RESULTS

Both cohorts demonstrated statistically significant within-group differences (P < 0.05) in some subscales that were more prominent in the active group without any considerable adverse effects. Nevertheless, KOOS score results and the mean number of acetaminophen tablets used by patients showed no statistically significant between-group differences.

CONCLUSIONS

It can be concluded that future programmed studies with larger sample sizes, longer follow-up periods, and other forms of N. sativa seeds as an active intervention is necessary to evaluate its efficacy in relieving the symptoms of knee osteoarthritis.

The effect of pomegranate juice on clinical signs, matrix metalloproteinases and antioxidant status in patients with knee osteoarthritis

BACKGROUND

Osteoarthritis (OA) is one of the commonest forms of musculoskeletal disorders that leads to joint degeneration and has a major impact on patients' quality of life. Experimental and in vitro studies have suggested the protective roles of pomegranate juice (PJ) as a rich antioxidant source for mitigating cartilage inflammation. In this interventional study, 38 patients with knee OA were randomly divided into two groups: PJ or control for 6 weeks to evaluate the effect of this intervention on clinical signs, inflammation and antioxidant status.

RESULTS

Significant decreases in Western Ontario and McMaster Universities Osteoarthritis index (WOMAC) total score (P = 0.01), stiffness score (P = 0.00) and physical function score (P = 0.01) were observed in PJ group after the intervention. The means of serum levels of matrix metalloproteinase (MMP)-13 was significantly decreased (P = 0.02) and glutathione peroxidase was increased in the intervention group compared with the control group after the study period (P = 0.02).

CONCLUSIONS

According to the findings of this clinical trial, PJ consumption can improve physical function and stiffness, decrease breakdown cartilage enzymes and increase antioxidant status in patients with knee OA. © 2016 Society of Chemical Industry.

Increased 18F-FDG uptake suggests synovial inflammatory reaction with osteoarthritis: preliminary in-vivo results in humans

OBJECTIVE

The aim of this prospective study was to compare the metabolic activity of the knee joints of a group of patients with painful knees clinically (such as recurrent joint pain, joint instability, and functional limitations) consistent with osteoarthritis and those of another group of patients without such complaints, using [F]-2-fluoro-2-deoxy-D-glucose (F-FDG)-PET imaging.

METHODS

A total of 97 patients who participated in either painful joint prosthesis or diabetic foot research studies involving F-FDG-PET scans were asked to complete a knee pain questionnaire. The patients were asked whether they experienced pain in any joint, and if so, which joints were affected.

RESULTS

A total of 18 knee joints without prosthesis were reported to be painful. The maximum standardized uptake values (SUVmax) of the middle joint space and lateral synovial tissue of these 18 knees were measured and compared with those of a set of patients with control asymptomatic knees. The average SUVmax of the middle part of the joint space in the painful knees was 1.35±0.59 compared with an average SUVmax value of 0.86±0.14 in the control group (P=0.0176). The average SUVmax of the synovium in the lateral part of the painful joints was 1.17±0.49 compared with 0.73±0.31 in the control group (P=0.0161).

CONCLUSION

These data indicate that increased F-FDG uptake is associated with knee pain in osteoarthritis patients and that there is a positive relationship between the two parameters.

The Prevalence and the Determinants of Musculoskeletal Diseases in Emiratis Attending Primary Health Care Clinics in Dubai

OBJECTIVES

To estimate the prevalence of rheumatic diseases in the Emiratis attending primary health care (PHC) clinics in Dubai. The secondary objective was to study the relationship between age, gender, and body mass index (BMI) and rheumatic diseases in the general population. .

METHODS

The Prevalence of Rheumatic Diseases and Osteoporosis (PRO) in Dubai study was a cross-sectional study, which randomly enrolled Emiratis' aged between 18-85 years old who attended one of 13 PHC clinics between 2 January 2009 and 31 December 2009. Demographic and health data for all participants was obtained via a questionnaire. Participants that indicated positive answers had their responses validated by a rheumatologist and underwent a thorough locomotor examination. .

RESULTS

The study included 3,985 participants with a mean age of 42.1±15.8 years. The majority (77.4%) were female. Lower back pain was the most prevalent problem in our study population (32.9%). Knee osteoarthritis (OA) was the most common form of arthritis seen in our cohort (25.8%). Overall, the prevalence of inflammatory arthritis was 3.1%. Age and BMI were associated with increased risk of knee OA and lower back pain. .

CONCLUSIONS

Rheumatic diseases are quite common in Emirati patients attending PHC clinics. Lower back pain and knee OA were the most common musculoskeletal diseases seen in our cohort. There is a need for more population-based studies in the Middle East to have a better understanding of the epidemiology of rheumatic diseases in this region.

D14 repeat polymorphism of the asporin gene is associated with primary osteoarthritis of the knee in a Mexican Mestizo population

BACKGROUND

Asporin is a novel extracellular matrix protein (ECM) with an important role in the development of osteoarthritis (OA), because it has been reported that functional polymorphisms in the aspartic acid repeat (D) of the asporin gene (ASPN) are associated with susceptibility to OA.

AIM

This study was planned to investigate the association of the ASPN polymorphism with primary OA of the knee in a Mexican population, including several countryside regions.

METHODS

We conducted a case-control study in which 93 cases with primary OA of the knee and 118 controls were included. Cases included patients > 40 years of age, with a body mass index (BMI) ≤ 27 and a radiologic score for OA of the knee of ≥ 2. Controls were subjects > 40 years of age with a radiologic score of < 2. The D repeat polymorphism was genotyped and logistic regression was developed to evaluate risk magnitude.

RESULTS

The D14 allele was more common in our cases and was associated with an increased risk for developing OA, while the frequencies of the remaining alleles did not exhibit differences.

CONCLUSION

Our data suggest that the D14 allele of the ASPN polymorphism could exert an influence on primary OA of the knee etiology in a Mexican Mestizo population.

Osteoarthritis and frailty in elderly individuals across six European countries: results from the European Project on OSteoArthritis (EPOSA)

BACKGROUND

Osteoarthritis (OA) is the most common cause of disability in the elderly. Clinical frailty is associated with high mortality, but few studies have explored the relationship between OA and frailty. The objective of this study was to consider the association between OA and frailty/pre-frailty in an elderly population comprised of six European cohorts participating in the EPOSA project.

METHODS

Longitudinal study using baseline data and first follow-up waves, from EPOSA; 2,455 individuals aged 65-85 years were recruited from pre-existing population-based cohorts in Germany, Italy, the Netherlands, Spain, Sweden and the United Kingdom. Data were collected on clinical OA at any site (hand, knee or hip), based on the clinical classification criteria developed by the American College of Rheumatology (ACR). Frailty was defined according to Fried's criteria. The covariates considered were age, gender, educational level, obesity and country. We used multinomial logistic regression to analyse the associations between OA, frailty/pre-frailty and other covariates.

RESULTS

The overall prevalence of clinical OA at any site was 30.4 % (95 % CI:28.6-32.2); frailty was present in 10.2 % (95 % CI:9.0-11.4) and pre-frailty in 51.0 % (95 % CI:49.0-53.0). The odds of frailty was 2.96 (95 % CI:2.11-4.16) and pre-frailty 1.54 (95 % CI:1.24-1.91) as high among OA individuals than those without OA. The association remained when Knee OA, hip OA or hand OA were considered separately, and was stronger in those with increasing number of joints.

CONCLUSIONS

Clinical OA is associated with frailty and pre-frailty in older adults in European countries. This association might be considered when designing appropriate intervention strategies for OA management.