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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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Kawai T, Shimizu T, Goto K, Kuroda Y, Okuzu Y, Fujibayashi S, Matsuda S. Number of Levels of Spinal Fusion Associated with the Rate of Joint-Space Narrowing in the Hip. J Bone Joint Surg Am 2021; 103:953-960. [PMID: 33770019 DOI: 10.2106/jbjs.20.01578] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Fusion of a joint reportedly increases force in the adjacent joints and leads to progression of arthritis. Whether lumbar spinal fusion increases force in the hip joint and promotes wear of the joint space is unclear. The purpose of this study was to evaluate the rate of joint-space narrowing in the hip following spinal fusion and to examine the effects of the number of levels fused on the joint-narrowing rate. METHODS We retrospectively reviewed data for patients who underwent lumbar spinal fusion from 2011 to 2018 at our institute. Patients with a previous hip surgery, Kellgren-Lawrence grade ≥II hip osteoarthritis, hip dysplasia, and rheumatoid arthritis were excluded. The rate of joint-space narrowing in the hip was measured in 205 eligible patients (410 hips) following spinal fusion, and the effects of sex, age, body mass index, indication for spinal fusion, laterality, sacral fixation, and number of levels fused on the narrowing rate were examined. RESULTS The rate of joint-space narrowing for all patients was 0.114 ± 0.168 mm/year. The narrowing rate for single-level fusion was 0.062 ± 0.087 mm/year, whereas that for fusion of ≥7 levels was 0.307 ± 0.254 mm/year. In the multivariate regression analysis, only the length of fusion (standardized coefficient [SC] = 0.374, p < 0.0001) was associated with an increased narrowing rate. When the narrowing rate was normalized by height, female sex was another risk factor for increased narrowing (SC = 0.109, p = 0.023). Secondary regression modeling performed with patients who underwent spinal fusion for degenerative disc disease showed that the length of fusion (SC = 0.454, p < 0.0001) and female sex (SC = 0.138, p = 0.033) were associated with increased joint-space narrowing. CONCLUSIONS Longer spinal fusion was associated with the progression of hip joint narrowing following spinal fusion. Surgeons should be aware of the possible increased risk of hip degeneration following spinal fusion and should inform patients of this risk. LEVEL OF EVIDENCE Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Toshiyuki Kawai
- Department of Orthopedic Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
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Taniguchi M, Ikezoe T, Kamitani T, Tsuboyama T, Ito H, Matsuda S, Tabara Y, Matsuda F, Ichihashi N. Extracellular-to-intracellular water ratios are associated with functional disability levels in patients with knee osteoarthritis: results from the Nagahama Study. Clin Rheumatol 2021; 40:2889-2896. [PMID: 33486595 DOI: 10.1007/s10067-021-05591-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 01/09/2021] [Accepted: 01/12/2021] [Indexed: 12/23/2022]
Abstract
INTRODUCTION/OBJECTIVES To test the hypothesis that greater extracellular-to-intracellular water (ECW/ICW) ratios in lower-limb muscles are associated with worsened functional abilities in patients with knee osteoarthritis (OA). METHODS We analyzed data from 787 participants (82.2% female; mean age, 69.6 ± 5.3 years) from the Nagahama Prospective Cohort who were ≥60 years old and had radiographically confirmed bilateral knee OA. The Knee Scoring System (KSS) was used to assess functional abilities. Lower-limb ECW/ICW ratios and skeletal mass index values were determined with multi-frequency bioelectrical impedance analysis (BIA). Multiple linear regression analysis was used to test for associations between ECW/ICW ratios and functional abilities. Subgroup analyses based on OA severities and symptomaticity were also conducted. RESULTS Increased ECW/ICW ratios were associated with a 4.38-point decrease in the KSS function scores (95% confidence interval [CI], 3.15-5.62 points) after adjusting for covariates. This association varied according to the degree of knee symptoms, especially in individuals with radiologically mild OA. ECW/ICW ratios in individuals with asymptomatic mild OA were associated with a 2.14-point decrease in the KSS function score (95% CI, 0.32-3.96 points), whereas those in individuals with severe symptomatic mild OA were associated with a 6.16-point decrease (95% CI, 2.13-10.19 points). CONCLUSIONS Our findings indicate that higher ECW/ICW ratios are associated with greater functional disability in patients with knee OA. Therefore, ECW/ICW ratio measurements with multi-frequency BIA can serve as valuable indicators for functional disability in patients with knee OA. Key Points • Higher extracellular-to-intracellular water (ECW/ICW) ratios are associated with greater functional disability levels in patients with knee osteoarthritis (OA). • ECW/ICW ratios are useful clinical signs as a biomarker for poor functional abilities in patients with knee OA.
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Affiliation(s)
- Masashi Taniguchi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Tome Ikezoe
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
| | - Tsukasa Kamitani
- Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Tadao Tsuboyama
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan.,Department of Physical Therapy, School of Health Sciences, Bukkyo University, Kyoto, Japan
| | - Hiromu Ito
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shuichi Matsuda
- Department of Orthopaedic Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yasuharu Tabara
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Fumihiko Matsuda
- Center for Genomic Medicine, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Noriaki Ichihashi
- Department of Physical Therapy, Human Health Sciences, Graduate School of Medicine, Kyoto University, 53-Kawahara-cho, Shogoin, Sakyo-ku, Kyoto, 606-8507, Japan
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Attur M, Krasnokutsky S, Zhou H, Samuels J, Chang G, Bencardino J, Rosenthal P, Rybak L, Huebner JL, Kraus VB, Abramson SB. The combination of an inflammatory peripheral blood gene expression and imaging biomarkers enhance prediction of radiographic progression in knee osteoarthritis. Arthritis Res Ther 2020; 22:208. [PMID: 32912331 PMCID: PMC7488029 DOI: 10.1186/s13075-020-02298-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2020] [Accepted: 08/24/2020] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE Predictive biomarkers of progression in knee osteoarthritis are sought to enable clinical trials of structure-modifying drugs. A peripheral blood leukocyte (PBL) inflammatory gene signature, MRI-based bone marrow lesions (BML) and meniscus extrusion scores, meniscal lesions, and osteophytes on X-ray each have been shown separately to predict radiographic joint space narrowing (JSN) in subjects with symptomatic knee osteoarthritis (SKOA). In these studies, we determined whether the combination of the PBL inflammatory gene expression and these imaging findings at baseline enhanced the prognostic value of either alone. METHODS PBL inflammatory gene expression (increased mRNA for IL-1β, TNFα, and COX-2), routine radiographs, and 3T knee MRI were assessed in two independent populations with SKOA: an NYU cohort and the Osteoarthritis Initiative (OAI). At baseline and 24 months, subjects underwent standardized fixed-flexion knee radiographs and knee MRI. Medial JSN (mJSN) was determined as the change in medial JSW. Progressors were defined by an mJSN cut-point (≥ 0.5 mm/24 months). Models were evaluated by odds ratios (OR) and area under the receiver operating characteristic curve (AUC). RESULTS We validated our prior finding in these two independent (NYU and OAI) cohorts, individually and combined, that an inflammatory PBL inflammatory gene expression predicted radiographic progression of SKOA after adjustment for age, sex, and BMI. Similarly, the presence of baseline BML and meniscal lesions by MRI or semiquantitative osteophyte score on X-ray each predicted radiographic medial JSN at 24 months. The combination of the PBL inflammatory gene expression and medial BML increased the AUC from 0.66 (p = 0.004) to 0.75 (p < 0.0001) and the odds ratio from 6.31 to 19.10 (p < 0.0001) in the combined cohort of 473 subjects. The addition of osteophyte score to BML and PBL inflammatory gene expression further increased the predictive value of any single biomarker. A causal analysis demonstrated that the PBL inflammatory gene expression and BML independently influenced mJSN. CONCLUSION The use of the PBL inflammatory gene expression together with imaging biomarkers as combinatorial predictive biomarkers, markedly enhances the identification of radiographic progressors. The identification of the SKOA population at risk for progression will help in the future design of disease-modifying OA drug trials and personalized medicine strategies.
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Affiliation(s)
- Mukundan Attur
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA. .,Division of Rheumatology, Rheumatology Research laboratory, NYU Langone Orthopedic Hospital, 301 East 17th Street, Suite 1612, New York, NY, 10003, USA.
| | | | - Hua Zhou
- Applied Bioinformatics Laboratories, NYU Grossman School of Medicine, New York, NY, USA
| | - Jonathan Samuels
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Gregory Chang
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jenny Bencardino
- Department of Radiology, NYU Grossman School of Medicine, New York, NY, USA.,Division of Musculoskeletal Imaging, Department of Radiology, Hospital of the University of Pennsylvania, Philadelphia, PA, 19104, USA
| | - Pamela Rosenthal
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
| | - Leon Rybak
- Applied Bioinformatics Laboratories, NYU Grossman School of Medicine, New York, NY, USA
| | | | | | - Steven B Abramson
- Department of Medicine, NYU Grossman School of Medicine, New York, NY, USA
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Janvier T, Jennane R, Toumi H, Lespessailles E. Subchondral tibial bone texture predicts the incidence of radiographic knee osteoarthritis: data from the Osteoarthritis Initiative. Osteoarthritis Cartilage 2017; 25:2047-2054. [PMID: 28935435 DOI: 10.1016/j.joca.2017.09.004] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2017] [Revised: 09/01/2017] [Accepted: 09/08/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate whether trabecular bone texture (TBT) parameters measured on computed radiographs (CR) could predict the onset of radiographic knee osteoarthritis (OA). MATERIALS AND METHODS Subjects from the Osteoarthritis Initiative (OAI) with no sign of radiographic OA at baseline were included. Cases that developed either a global radiographic OA defined by the Kellgren-Lawrence (KL) scale, a joint space narrowing (JSN) or tibial osteophytes (TOS) were compared with the controls with no changes after 48 months of follow-up. Baseline bilateral fixed flexion CR were analyzed using a fractal method to characterize the local variations. The prediction was explored using logistic regression models evaluated by the area under the receiver operating characteristic curves (AUC). RESULTS From the 344 knees, 79 (23%) developed radiographic OA after 48 months, 44 (13%) developed progressive JSN and 59 (17%) developed osteophytes. Neither age, gender and BMI, nor their combination predicted poorer KL (AUC 0.57), JSN or TOS (AUC 0.59) scores. The inclusion of the TBT parameters in the models improved the global prediction results for KL (AUC 0.69), JSN (AUC 0.73) and TOS (AUC 0.71) scores. CONCLUSIONS Several differences were found between the models predictive of three different outcomes (KL, JSN and TOS), indicating different underlying mechanisms. These results suggest that TBT parameters assessed when radiographic signs are not yet apparent on radiographs may be useful in predicting the onset of radiological tibiofemoral OA as well as identifying at-risk patients for future clinical trials.
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Affiliation(s)
- T Janvier
- Univ. Orléans, I3MTO Laboratory, EA 4708, 45067 Orléans, France
| | - R Jennane
- Univ. Orléans, I3MTO Laboratory, EA 4708, 45067 Orléans, France
| | - H Toumi
- Univ. Orléans, I3MTO Laboratory, EA 4708, 45067 Orléans, France; CHR Orléans, Rheumatology Department, 45032 Orléans, France
| | - E Lespessailles
- Univ. Orléans, I3MTO Laboratory, EA 4708, 45067 Orléans, France; CHR Orléans, Rheumatology Department, 45032 Orléans, France.
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Low Skeletal Muscle Mass in the Lower Limbs Is Independently Associated to Knee Osteoarthritis. PLoS One 2016; 11:e0166385. [PMID: 27832208 PMCID: PMC5104343 DOI: 10.1371/journal.pone.0166385] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 10/27/2016] [Indexed: 12/22/2022] Open
Abstract
Objectives It has been reported that low skeletal muscle mass correlates with knee osteoarthritis in obese individuals. This study aimed to investigate whether lower limb skeletal muscle mass is independently associated with knee osteoarthritis in the general population. Materials and Methods This cross-sectional study used public data from the Fourth and Fifth Korean National Health and Nutrition Examination Survey. Subjects included 4924 community-dwelling adults aged ≥50 years (821 subjects with knee osteoarthritis and 4,103 controls). Skeletal muscle mass index (SMI) was calculated from the appendicular skeletal muscle mass measured by dual energy X-ray absorptiometry. Independent effects of total and lower limb SMI values on knee osteoarthritis were determined using odds ratios (OR) adjusted for age, sex, obesity, total femur bone mineral density, serum vitamin D level, diabetes mellitus status, and physical activity on multivariate logistic regression analysis. Results The adjusted logistic regression model revealed that older age, female sex, and obesity were significantly associated with knee osteoarthritis. A higher serum vitamin D level was also positively correlated with knee osteoarthritis (OR, 1.015; 95% CI, 1.003–1.027; P = 0.010). Although total SMI was not significantly associated with knee osteoarthritis (OR, 0.976; 95% CI, 0.946–1.007; P = 0.127), a low lower limb SMI had an independent effect on knee osteoarthritis (OR, 0.941; 95% CI, 0.900–0.983; P = 0.006). Conclusions Low skeletal muscle mass in the lower limbs but not in the whole body was independently associated with knee osteoarthritis.
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Miyatake K, Muneta T, Ojima M, Yamada J, Matsukura Y, Abula K, Sekiya I, Tsuji K. Coordinate and synergistic effects of extensive treadmill exercise and ovariectomy on articular cartilage degeneration. BMC Musculoskelet Disord 2016; 17:238. [PMID: 27245323 PMCID: PMC4888618 DOI: 10.1186/s12891-016-1094-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2016] [Accepted: 05/24/2016] [Indexed: 01/15/2023] Open
Abstract
Background Although osteoarthritis (OA) is a multifactorial disease, little has been reported regarding the cooperative interaction among these factors on cartilage metabolism. Here we examined the synergistic effect of ovariectomy (OVX) and excessive mechanical stress (forced running) on articular cartilage homeostasis in a mouse model resembling a human postmenopausal condition. Methods Mice were randomly divided into four groups, I: Sham, II: OVX, III: Sham and forced running (60 km in 6 weeks), and IV: OVX and forced running. Histological and immunohistochemical analyses were performed to evaluate the degeneration of articular cartilage and synovitis in the knee joint. Morphological changes of subchondral bone were analyzed by micro-CT. Results Micro-CT analyses showed significant loss of metaphyseal trabecular bone volume/tissue volume (BV/TV) after OVX as described previously. Forced running increased the trabecular BV/TV in all mice. In the epiphyseal region, no visible alteration in bone morphology or osteophyte formation was observed in any of the four groups. Histological analysis revealed that OVX or forced running respectively had subtle effects on cartilage degeneration. However, the combination of OVX and forced running synergistically enhanced synovitis and articular cartilage degeneration. Although morphological changes in chondrocytes were observed during OA initiation, no signs of bone marrow edema were observed in any of the four experimental groups. Conclusion We report the coordinate and synergistic effects of extensive treadmill exercise and ovariectomy on articular cartilage degeneration. Since no surgical procedure was performed on the knee joint directly in this model, this model is useful in addressing the molecular pathogenesis of naturally occurring OA.
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Affiliation(s)
- Kazumasa Miyatake
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Takeshi Muneta
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Miyoko Ojima
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Jun Yamada
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Yu Matsukura
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Kahaer Abula
- Department of Joint Surgery and Sports Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Ichiro Sekiya
- Center for Stem Cell and Regenerative Medicine, Tokyo Medical and Dental University, Tokyo, 113-8519, Japan
| | - Kunikazu Tsuji
- Department of Cartilage Regeneration, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8519, Japan.
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Attur M, Krasnokutsky S, Statnikov A, Samuels J, Li Z, Friese O, Hellio Le Graverand-Gastineau MP, Rybak L, Kraus VB, Jordan JM, Aliferis CF, Abramson SB. Low-grade inflammation in symptomatic knee osteoarthritis: prognostic value of inflammatory plasma lipids and peripheral blood leukocyte biomarkers. Arthritis Rheumatol 2016. [PMID: 26195278 DOI: 10.1002/art.39279] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVE Inflammatory mediators, such as prostaglandin E2 (PGE2 ) and interleukin-1β (IL-1β), are produced by osteoarthritic (OA) joint tissue, where they may contribute to disease pathogenesis. We undertook the present study to examine whether inflammation, evidenced in plasma and peripheral blood leukocytes (PBLs), reflects the presence, progression, or specific symptoms of symptomatic knee OA. METHODS Patients with symptomatic knee OA were enrolled in a 24-month prospective study of radiographic progression. Standardized knee radiographs were obtained at baseline and 24 months. At baseline, levels of the plasma lipids PGE2 and 15-hydroxyeicosatetraenoic acid (15-HETE) were measured, and transcriptome analysis of PBLs was performed by microarray and quantitative polymerase chain reaction. RESULTS Baseline PGE2 synthase (PGES) levels determined by PBL microarray gene expression and plasma PGE2 levels distinguished patients with symptomatic knee OA from non-OA controls (area under the receiver operating characteristic curve [AUC] 0.87 and 0.89, respectively, P < 0.0001). Baseline plasma 15-HETE levels were significantly elevated in patients with symptomatic knee OA versus non-OA controls (P < 0.0195). In the 146 patients who completed the 24-month study, elevated baseline expression of IL-1β, tumor necrosis factor α, and cyclooxygenase 2 (COX-2) messenger RNA in PBLs predicted higher risk of radiographic progression as evidenced by joint space narrowing (JSN). In a multivariate model, AUC point estimates of models containing COX-2 in combination with demographic traits overlapped the confidence interval of the base model in 2 of the 3 JSN outcome measures (JSN >0.0 mm, JSN >0.2 mm, and JSN >0.5 mm; AUC 0.62-0.67). CONCLUSION The inflammatory plasma lipid biomarkers PGE2 and 15-HETE identify patients with symptomatic knee OA, and the PBL inflammatory transcriptome identifies a subset of patients with symptomatic knee OA who are at increased risk of radiographic progression. These findings may reflect low-grade inflammation in OA and may be useful as diagnostic and prognostic biomarkers in clinical development of disease-modifying OA drugs.
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Affiliation(s)
- Mukundan Attur
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | - Svetlana Krasnokutsky
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | - Alexander Statnikov
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | - Jonathan Samuels
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | - Zhiguo Li
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | - Olga Friese
- Pfizer Worldwide Research and Development, St. Louis, Missouri
| | | | - Leon Rybak
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | | | | | - Constantin F Aliferis
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
| | - Steven B Abramson
- New York University School of Medicine and New York University Langone Medical Center, New York, New York
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Bastick AN, Belo JN, Runhaar J, Bierma-Zeinstra SMA. What Are the Prognostic Factors for Radiographic Progression of Knee Osteoarthritis? A Meta-analysis. Clin Orthop Relat Res 2015; 473:2969-89. [PMID: 25995176 PMCID: PMC4523522 DOI: 10.1007/s11999-015-4349-z] [Citation(s) in RCA: 111] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 05/05/2015] [Indexed: 01/31/2023]
Abstract
BACKGROUND A previous systematic review on prognostic factors for knee osteoarthritis (OA) progression showed associations for generalized OA and hyaluronic acid levels. Knee pain, radiographic severity, sex, quadriceps strength, knee injury, and regular sport activities were not associated. It has been a decade since the literature search of that review and many studies have been performed since then investigating prognostic factors for radiographic knee OA progression. QUESTIONS/PURPOSES The purpose of this study is to provide an updated systematic review of available evidence regarding prognostic factors for radiographic knee OA progression. METHODS We searched for observational studies in MEDLINE and EMBASE. Key words were: knee, osteoarthritis (or arthritis, or arthrosis, or degenerative joint disease), progression (or prognosis, or precipitate, or predictive), and case-control (or cohort, or longitudinal, or follow-up). Studies fulfilling the inclusion criteria were assessed for methodologic quality according to established criteria for reviews on prognostic factors in musculoskeletal disorders. Data were extracted and results were pooled if possible or summarized according to a best-evidence synthesis. A total of 1912 additional articles were identified; 43 met our inclusion criteria. The previous review contained 36 articles, thus providing a new total of 79 articles. Seventy-two of the included articles were scored high quality, the remaining seven were low quality. RESULTS The pooled odds ratio (OR) of two determinants showed associations with knee OA progression: baseline knee pain (OR, 2.38 [95% CI, 1.74-3.27) and Heberden nodes (OR, 2.66 [95% CI, 1.46-8.84]). Our best-evidence synthesis showed strong evidence that varus alignment, serum hyaluronic acid, and tumor necrosis factor-α are associated with knee OA progression. There is strong evidence that sex, former knee injury, quadriceps strength, smoking, running, and regular performance of sports are not associated with knee OA progression. Evidence for the majority of determined associations, however, was limited, conflicting, or inconclusive. CONCLUSIONS Baseline knee pain, presence of Heberden nodes, varus alignment, and high levels of serum markers hyaluronic acid and tumor necrosis factor-α predict knee OA progression. Sex, knee injury, and quadriceps strength, among others, did not predict knee OA progression. Large variation remains in definitions of knee OA and knee OA progression. Clinical studies should use more consistent definitions of these factors to facilitate data pooling by future meta-analyses.
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Affiliation(s)
- Alex N. Bastick
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Room NA-1923, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Janneke N. Belo
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Room NA-1923, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Sita M. A. Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Room NA-1923, PO Box 2040, 3000 CA Rotterdam, The Netherlands
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Eymard F, Parsons C, Edwards MH, Petit-Dop F, Reginster JY, Bruyère O, Richette P, Cooper C, Chevalier X. Diabetes is a risk factor for knee osteoarthritis progression. Osteoarthritis Cartilage 2015; 23:851-9. [PMID: 25655678 DOI: 10.1016/j.joca.2015.01.013] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2014] [Revised: 01/19/2015] [Accepted: 01/23/2015] [Indexed: 02/02/2023]
Abstract
PURPOSE Recent studies have suggested that metabolic factors (obesity, diabetes, hypertension and dyslipidemia) and their clustering in metabolic syndrome (MetS) might be involved in the pathophysiology of knee osteoarthritis (OA). We investigated their impact on radiographic progression by an annualised measure of the joint space narrowing (JSN) of the medial tibiofemoral compartment. METHODS 559 patients older than 50 years with symptomatic knee OA were recruited for the placebo arm of the SEKOIA trial. The presence of diabetes, hypertension and dyslipidemia was determined at baseline interview. Body mass index (BMI) was calculated, obesity was considered >30 kg/m(2). MetS was defined by the sum of metabolic factors ≥ 3. Minimal medial tibiofemoral joint space on plain radiographs was measured by an automated method at baseline and then annually for up to 3 years. RESULTS The mean age of patients was 62.8 [62.2-63.4] years; 392 were women. A total of 43.8% was obese, 6.6% had type 2 diabetes, 45.1% hypertension, 27.6% dyslipidemia and 13.6% MetS. Mean annualised JSN was greater for patients with type 2 diabetes than without diabetes (0.26 [-0.35 to -0.17] vs 0.14 [-0.16 to -0.12] mm; P = 0.001). This association remained significant after adjustment for sex, age, BMI, hypertension and dyslipidemia (P = 0.018). In subgroup analysis, type 2 diabetes was a significant predictor of JSN in males but not females. The other metabolic factors and MetS were not associated with annualised JSN. CONCLUSION Type 2 diabetes was a predictor of joint space reduction in men with established knee OA. No relationships were found between MetS or other metabolic factors and radiographic progression.
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Affiliation(s)
- F Eymard
- Department of Rheumatology, AP-HP Henri Mondor Hospital, F-94010 Créteil Cedex, France
| | - C Parsons
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, SO16 6YD Southampton, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, SO16 6YD Southampton, UK
| | - F Petit-Dop
- Clinical Department, Servier Laboratory, 92150 Suresnes, France
| | - J-Y Reginster
- Department of Public Health and Health Economics, University of Liege, 4020 Liege, Belgium
| | - O Bruyère
- Department of Public Health and Health Economics, University of Liege, 4020 Liege, Belgium
| | - P Richette
- Department of Rheumatology, AP-HP Lariboisière Hospital, F-75475 Paris Cedex 10, France
| | - C Cooper
- MRC Lifecourse Epidemiology Unit, Southampton General Hospital, SO16 6YD Southampton, UK
| | - X Chevalier
- Department of Rheumatology, AP-HP Henri Mondor Hospital, F-94010 Créteil Cedex, France.
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11
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Bennell K, Hinman RS, Wrigley TV, Creaby MW, Hodges P. Exercise and osteoarthritis: cause and effects. Compr Physiol 2013; 1:1943-2008. [PMID: 23733694 DOI: 10.1002/cphy.c100057] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Osteoarthritis (OA) is a common chronic joint condition predominantly affecting the knee, hip, and hand joints. Exercise plays a role in the development and treatment of OA but most of the literature in this area relates to knee OA. While studies indicate that exercise and physical activity have a generally positive effect on healthy cartilage metrics, depending upon the type of the activity and its intensity, the risk of OA development does appear to be moderately increased with sporting participation. In particular, joint injury associated with sports participation may be largely responsible for this increased risk of OA with sport. Various repetitive occupational tasks are also linked to greater likelihood of OA development. There are a number of physical impairments associated with OA including pain, muscle weakness and altered muscle function, reduced proprioception and postural control, joint instability, restricted range of motion, and lower aerobic fitness. These can result directly from the OA pathological process and/or indirectly as a result of factors such as pain, effusion, and reduced activity levels. These impairments and their underlying physiology are often targeted by exercise interventions and evidence generally shows that many of these can be modified by specific exercise. There is currently little clinical trial evidence to show that exercise can alter mechanical load and structural disease progression in those with established OA, although a number of impairments, that are amenable to change with exercise, appears to be associated with increased mechanical load and/or disease progression in longitudinal studies.
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Affiliation(s)
- Kim Bennell
- Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, University of Melbourne, Australia.
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12
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Lee S, Kim TN, Kim SH. Sarcopenic obesity is more closely associated with knee osteoarthritis than is nonsarcopenic obesity: A cross-sectional study. ACTA ACUST UNITED AC 2012. [DOI: 10.1002/art.37696] [Citation(s) in RCA: 118] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
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13
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Mazzuca SA, Brandt KD, Lane KA, Chakr R. Malalignment and subchondral bone turnover in contralateral knees of overweight/obese women with unilateral osteoarthritis: implications for bilateral disease. Arthritis Care Res (Hoboken) 2011; 63:1528-34. [PMID: 22034115 DOI: 10.1002/acr.20574] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To explore whether the risk of incident tibiofemoral (TF) osteoarthritis (OA) in the radiographically normal contralateral knee of overweight/obese women with unilateral knee OA is mediated by malalignment and/or preceded by increased turnover of subchondral bone. METHODS We used data of post hoc analyses from a randomized controlled trial. Cross-sectional analyses evaluated the baseline association between frontal plane alignment and bone turnover in the medial TF compartment in 78 radiographically normal contralateral knees. Longitudinal analyses ascertained whether incident radiographic OA (TF osteophyte formation within 30 months) was associated with malalignment and/or increased bone turnover at baseline. Alignment subcategories (varus/neutral/valgus) were based on the anatomic axis angle. (99m)Tc-methylene diphosphonate uptake in a late-phase bone scan was quantified in regions of interest in the medial tibia (MT) and medial femur (MF) and adjusted for uptake in a reference segment of the ipsilateral tibial shaft (TS). RESULTS MF and MT uptake in varus contralateral knees was 50-55% greater than in the TS. Adjusted MT uptake in varus contralateral knees was significantly greater than that in neutral and valgus contralateral knees (mean 1.55 versus 1.38 and 1.43, respectively; P < 0.05). Among 69 contralateral knees followed longitudinally, 22 (32%) developed TF OA. Varus angulation was associated with a marginally significant increase in the odds of incident OA (adjusted odds ratio 3.98, P = 0.067). CONCLUSION While the small sample size limited our ability to detect statistically significant risk factors, these data suggest that the risk of developing bilateral TF OA in overweight/obese women may be mediated by varus malalignment.
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Chapple CM, Nicholson H, Baxter GD, Abbott JH. Patient characteristics that predict progression of knee osteoarthritis: a systematic review of prognostic studies. Arthritis Care Res (Hoboken) 2011; 63:1115-25. [PMID: 21560257 DOI: 10.1002/acr.20492] [Citation(s) in RCA: 103] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To identify, by systematic review, patient characteristics that can be used by health care practitioners to predict the likelihood of knee osteoarthritis (OA) progression. METHODS A search was conducted of the electronic databases Medline, EMBase, CINAHL, AMED, and Web of Science in November 2010. Two reviewers screened articles using inclusion/exclusion criteria. Study participants were adults with established knee OA. Outcome measures for disease progression were change in pain or function or deterioration in radiographic features. Included studies identified clinically relevant prognostic factors at baseline and reported a statistical association with outcome. Minimum followup was 1 year. Articles were assessed for bias, and strength of evidence was summarized for potential predictors of progression. RESULTS Thirty studies were included, of which 26 were of high quality. Age, varus knee alignment, presence of OA in multiple joints, and radiographic features had strong evidence as predictors of knee OA progression. Body mass index was a strong predictor for long-term progression (>3 years). Moderate participation in physical activity was not associated with progression. Numerous variables had limited or conflicting evidence. CONCLUSION Relatively few predictive variables have strong supporting evidence; numerous variables have limited or conflicting evidence. All variables with strong evidence can be easily evaluated and utilized in clinical practice. Existing knowledge should be developed in future research, particularly in cases where study numbers are low or findings are limited or conflicting. Standardized measurement of potential predictors and outcome measures is recommended.
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Affiliation(s)
- Cathy M Chapple
- School of Physiotherapy, University of Otago, Dunedin, New Zealand.
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15
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Down C, Xu Y, Osagie LE, Bostrom MPG. The lack of correlation between radiographic findings and cartilage integrity. J Arthroplasty 2011; 26:949-54. [PMID: 21144698 DOI: 10.1016/j.arth.2010.09.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2010] [Accepted: 09/17/2010] [Indexed: 02/01/2023] Open
Abstract
Total knee arthroplasty is a common treatment of osteoarthritis, although unicompartmental knee arthroplasties are frequently used to retain unaffected compartments. Joint space width (JSW) is a major factor in determining treatment. We examined the relationship between JSW and cartilage quality in 60 patients undergoing total knee arthroplasty to assess its accuracy in representing cartilage degradation. Radiographic JSW was recorded, whereas the unaffected compartment of each tibial plateau was examined postoperatively using Collins, Mankin, and Kellgren and Lawrence scores. No correlation was seen between visual or histologic grading and JSW. Histology more accurately represented cartilage quality, yet it is impractical to obtain preoperatively; thus, JSW is the main mode of assessment. However, using JSW solely to indicate unicompartmental knee arthroplasty may overlook disease in apparently unaffected compartments.
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Affiliation(s)
- Carrie Down
- Laboratory for Mineralized Tissue Research, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA
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Abstract
Arthritis Research UK published a report in 2009 entitled "Osteoarthritis and obesity" in which they highlight the severe consequences of obesity for musculoskeletal health. Throughout the report, however, the mechanical effect of excess body weight is assumed to be the direct cause of osteoarthritis (OA). Although this assumption is common, is it supported by the evidence? A survey of the studies associating OA with obesity is inconclusive on whether body weight is the causative factor. The increase in direct-loading on joints due to weight-gain is not as great as is often believed, and compensatory gait patterns ameliorate much of the kinematic effects. One manifestation of obesity, however, is increased adipose tissue--a rich source of proinflammatory endocrine factors. I propose that body weight might not be the main problem in OA pathogenesis, but that increased adipose tissue itself might be both an indicator and a driver of widespread disease.
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Affiliation(s)
- Richard M Aspden
- Bone and Musculoskeletal Research Program, Division of Applied Medicine, University of Aberdeen, Institute of Medical Sciences, Foresterhill, Aberdeen AB25 2ZD, UK.
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