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Franks SJ, Gowler PRW, Dunster JL, Turnbull J, Gohir SA, Kelly A, Valdes AM, King JR, Barrett DA, Chapman V, Preston S. Modelling the role of enzymatic pathways in the metabolism of docosahexaenoic acid by monocytes and its association with osteoarthritic pain. Math Biosci 2024; 374:109228. [PMID: 38851528 DOI: 10.1016/j.mbs.2024.109228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2024] [Revised: 06/03/2024] [Accepted: 06/03/2024] [Indexed: 06/10/2024]
Abstract
Chronic pain is a major cause of disability and suffering in osteoarthritis (OA) patients. Endogenous specialised pro-resolving molecules (SPMs) curtail pro-inflammatory responses. One of the SPM intermediate oxylipins, 17-hydroxydocasahexaenoic acid (17-HDHA, a metabolite of docosahexaenoic acid (DHA)), is significantly associated with OA pain. The aim of this multidisciplinary work is to develop a mathematical model to describe the contributions of enzymatic pathways (and the genes that encode them) to the metabolism of DHA by monocytes and to the levels of the down-stream metabolites, 17-HDHA and 14-hydroxydocasahexaenoic acid (14-HDHA), motivated by novel clinical data from a study involving 30 participants with OA. The data include measurements of oxylipin levels, mRNA levels, measures of OA severity and self-reported pain scores. We propose a system of ordinary differential equations to characterise associations between the different datasets, in order to determine the homeostatic concentrations of DHA, 17-HDHA and 14-HDHA, dependent upon the gene expression of the associated metabolic enzymes. Using parameter-fitting methods, local sensitivity and uncertainty analysis, the model is shown to fit well qualitatively to experimental data. The model suggests that up-regulation of some ALOX genes may lead to the down-regulation of 17-HDHA and that dosing with 17-HDHA increases the production of resolvins, which helps to down-regulate the inflammatory response. More generally, we explore the challenges and limitations of modelling real data, in particular individual variability, and also discuss the value of gathering additional experimental data motivated by the modelling insights.
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Affiliation(s)
- S J Franks
- School of Mathematical Sciences, University of Nottingham, Nottingham, NG7 2RD, UK.
| | - P R W Gowler
- Pain Centre Versus Arthritis, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK; School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK
| | - J L Dunster
- Institute for Cardiovascular and Metabolic Research, University of Reading, UK
| | - J Turnbull
- School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK; Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - S A Gohir
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - A Kelly
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - A M Valdes
- Pain Centre Versus Arthritis, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - J R King
- School of Mathematical Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
| | - D A Barrett
- NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK; Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - V Chapman
- Pain Centre Versus Arthritis, University of Nottingham Medical School, Queen's Medical Centre, Nottingham, UK; School of Life Sciences, Faculty of Medicine and Health Sciences, University of Nottingham, Nottingham, UK; NIHR Nottingham Biomedical Research Centre, University of Nottingham, Nottingham, UK
| | - S Preston
- School of Mathematical Sciences, University of Nottingham, Nottingham, NG7 2RD, UK
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2
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Chen L, Zhou H, Gong Y, Tang Y, Su H, Jin Z, Chen G, Tong P. How Do Muscle Function and Quality Affect the Progression of KOA? A Narrative Review. Orthop Surg 2024; 16:802-810. [PMID: 38438160 PMCID: PMC10984828 DOI: 10.1111/os.14022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2023] [Revised: 01/26/2024] [Accepted: 02/03/2024] [Indexed: 03/06/2024] Open
Abstract
Knee osteoarthritis (KOA) is widely recognized as a chronic joint disease characterized by degeneration of knee cartilage and subsequent bone hyperplasia. However, it is important to acknowledge the significant role of muscles in the development and progression of KOA. Muscle function (MF) and muscle quality (MQ) are key factors in understanding the involvement of muscles in KOA. Quantitative indices such as muscle mass, muscle strength, muscle cross-sectional area, muscle thickness, and muscle fatigue are crucial in assessing MF and MQ. Despite the growing interest in KOA, there is a scarcity of studies investigating the relationship between muscles and this condition. This review aims to examine the commonly used indices and measurement methods for assessing MF and MQ in clinical settings, while also exploring the association between muscles and KOA. Furthermore, this article highlights the importance of restoring MF and MQ to enhance symptom management and improve the quality of life for patients with KOA.
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Affiliation(s)
- Lei Chen
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Haojing Zhou
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Yichen Gong
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Yi Tang
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Hai Su
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Zhaokai Jin
- The First Affiliated Hospital of Zhejiang Chinese Medical University (Zhejiang Provincial Hospital of Chinese Medicine)The First Clinical College of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Guoqian Chen
- Department of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
| | - Peijian Tong
- Department of Orthopaedics and TraumatologyThe First Affiliated Hospital of Zhejiang Chinese Medical UniversityHangzhouChina
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Mehta O, Vijay A, Gohir SA, Kelly T, Zhang W, Doherty M, Walsh DA, Aithal G, Valdes AM. Serum Metabolome Analysis Identified Amino-Acid Metabolism Associated With Pain in People With Symptomatic Knee Osteoarthritis - A Cross-Sectional Study. THE JOURNAL OF PAIN 2023; 24:1251-1261. [PMID: 36863678 DOI: 10.1016/j.jpain.2023.02.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/04/2023]
Abstract
Osteoarthritis (OA) is the most common arthritis affecting synovial joints such as knees and hips of millions of people globally. Usage-related joint pain and reduced function are the most common symptoms experienced by people with OA. To improve pain management, there is a need to identify validated biomarkers predicting therapeutic responses in targeted clinical trials. Our study aimed to identify the metabolic biomarkers for pain and pressure pain detection thresholds (PPTs) in participants with knee pain and symptomatic OA using metabolic phenotyping. Metabolite and cytokine measurements were done on serum samples using LC-MS/MS (liquid gas chromatography integrated magnetic resonance mass spectrometry) and Human Proinflammatory panel 1 kit respectively. Regression analysis was done in a test (n = 75) and replication study (n = 79) to investigate the metabolites associated with current knee pain scores and pressure pain detection thresholds (PPTs). Meta-analysis and correlation were done estimating precision of associated metabolites and identifying relationship between significant metabolites and cytokines respectively. Acyl ornithine, carnosine, cortisol, cortisone, cystine, DOPA, glycolithocholic acid sulphate (GLCAS), phenylethylamine (PEA) and succinic acid were found to be significantly (FDR <.1) associated with pain scores in meta-analysis of both studies. IL-10, IL-13, IL-1β, IL2, IL8 and TNF-α were also found to be associated with the significant metabolites. Significant associations of these metabolites and inflammatory markers with knee pain suggests that targeting relevant pathways of amino acid and cholesterol metabolism may modulate cytokines and these could be targeted as novel therapeutics development to improve knee pain and OA management. PERSPECTIVE: Foreseeing the global burden of knee pain in Osteoarthritis (OA) and adverse effects of current pharmacological therapies, this study is envisaged to investigate serum metabolites and molecular pathways involved in knee pain. The replicated metabolites in this study suggests targeting amino-acid pathways for better management of OA knee pain.
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Affiliation(s)
- Ojasvi Mehta
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK.
| | - Amrita Vijay
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Sameer A Gohir
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
| | - Tony Kelly
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK
| | - Weiya Zhang
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - David A Walsh
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Guruprasad Aithal
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK; School of Medicine, University of Nottingham, Nottingham UK
| | - Ana M Valdes
- Injury, Inflammation and Recovery Sciences, School of Medicine, University of Nottingham, Nottingham UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust and University of Nottingham, Nottingham, UK
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Gowler PRW, Turnbull J, Shahtaheri M, Gohir S, Kelly T, McReynolds C, Yang J, Jha RR, Fernandes GS, Zhang W, Doherty M, Walsh DA, Hammock BD, Valdes AM, Barrett DA, Chapman V. Clinical and Preclinical Evidence for Roles of Soluble Epoxide Hydrolase in Osteoarthritis Knee Pain. Arthritis Rheumatol 2022; 74:623-633. [PMID: 34672113 PMCID: PMC8957539 DOI: 10.1002/art.42000] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 09/14/2021] [Accepted: 10/07/2021] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Chronic pain due to osteoarthritis (OA) is a major clinical problem, and existing analgesics often have limited beneficial effects and/or adverse effects, necessitating the development of novel therapies. Epoxyeicosatrienoic acids (EETs) are endogenous antiinflammatory mediators, rapidly metabolized by soluble epoxide hydrolase (EH) to dihydroxyeicosatrienoic acids (DHETs). We undertook this study to assess whether soluble EH-driven metabolism of EETs to DHETs plays a critical role in chronic joint pain associated with OA and provides a new target for treatment. METHODS Potential associations of chronic knee pain with single-nucleotide polymorphisms (SNPs) in the gene-encoding soluble EH and with circulating levels of EETs and DHETs were investigated in human subjects. A surgically induced murine model of OA was used to determine the effects of both acute and chronic selective inhibition of soluble EH by N-[1-(1-oxopropy)-4-piperidinyl]-N'-(trifluoromethoxy)phenyl]-urea (TPPU) on weight-bearing asymmetry, hind paw withdrawal thresholds, joint histology, and circulating concentrations of EETs and DHETs. RESULTS In human subjects with chronic knee pain, 3 pain measures were associated with SNPs of the soluble EH gene EPHX2, and in 2 separate cohorts of subjects, circulating levels of EETs and DHETs were also associated with 3 pain measures. In the murine OA model, systemic administration of TPPU both acutely and chronically reversed established pain behaviors and decreased circulating levels of 8,9-DHET and 14,15-DHET. EET levels were unchanged by TPPU administration. CONCLUSION Our novel findings support a role of soluble EH in OA pain and suggest that inhibition of soluble EH and protection of endogenous EETs from catabolism represents a potential new therapeutic target for OA pain.
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Affiliation(s)
- Peter R. W. Gowler
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
| | - James Turnbull
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy. University of Nottingham, UK
| | - Mohsen Shahtaheri
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Sameer Gohir
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Tony Kelly
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Cindy McReynolds
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Centre, University of California, Davis, USA
| | - Jun Yang
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Centre, University of California, Davis, USA
| | - Rakesh R. Jha
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy. University of Nottingham, UK
| | - Gwen S. Fernandes
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Weiya Zhang
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Michael Doherty
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - David A. Walsh
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - Bruce D. Hammock
- Department of Entomology and Nematology, UC Davis Comprehensive Cancer Centre, University of California, Davis, USA
| | - Ana. M. Valdes
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Medicine. University of Nottingham, UK
| | - David A. Barrett
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy. University of Nottingham, UK
| | - Victoria Chapman
- Pain Centre Versus Arthritis and NIHR Nottingham Biomedical Research Centre, School of Life Sciences. University of Nottingham, UK
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5
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Turnbull J, Jha R, Ortori CA, Lunt E, Tighe PJ, Irving WL, Gohir SA, Kim DH, Valdes AM, Tarr AW, Barrett DA, Chapman V. Serum levels of pro-inflammatory lipid mediators and specialised pro-resolving molecules are increased in SARS-CoV-2 patients and correlate with markers of the adaptive immune response. J Infect Dis 2022; 225:2142-2154. [PMID: 34979019 PMCID: PMC8755389 DOI: 10.1093/infdis/jiab632] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Accepted: 01/02/2022] [Indexed: 12/15/2022] Open
Abstract
Background Specialized proresolution molecules (SPMs) halt the transition to chronic pathogenic inflammation. We aimed to quantify serum levels of pro- and anti-inflammatory bioactive lipids in severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) patients, and to identify potential relationships with innate responses and clinical outcome. Methods Serum from 50 hospital admitted inpatients (22 female, 28 male) with confirmed symptomatic SARS-CoV-2 infection and 94 age- and sex-matched controls collected prior to the pandemic (SARS-CoV-2 negative), were processed for quantification of bioactive lipids and anti-nucleocapsid and anti-spike quantitative binding assays. Results SARS-CoV-2 serum had significantly higher concentrations of omega-6–derived proinflammatory lipids and omega-6– and omega-3–derived SPMs, compared to the age- and sex-matched SARS-CoV-2–negative group, which were not markedly altered by age or sex. There were significant positive correlations between SPMs, proinflammatory bioactive lipids, and anti-spike antibody binding. Levels of some SPMs were significantly higher in patients with an anti-spike antibody value >0.5. Levels of linoleic acid and 5,6-dihydroxy-8Z,11Z,14Z-eicosatrienoic acid were significantly lower in SARS-CoV-2 patients who died. Conclusions SARS-CoV-2 infection was associated with increased levels of SPMs and other pro- and anti-inflammatory bioactive lipids, supporting the future investigation of the underlying enzymatic pathways, which may inform the development of novel treatments.
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Affiliation(s)
- James Turnbull
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK.,School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK
| | - Rakesh Jha
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Catherine A Ortori
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Eleanor Lunt
- Department of Health Care for Older People (HCOP), Queen's Medical Centre, Nottingham University Hospitals NHS Trust, Nottingham, Nottinghamshire, UK
| | - Patrick J Tighe
- School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK
| | - William L Irving
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK
| | - Sameer A Gohir
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Dong-Hyun Kim
- Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Ana M Valdes
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.,Academic Rheumatology, University of Nottingham, Nottingham, UK
| | - Alexander W Tarr
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK
| | - David A Barrett
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,Centre for Analytical Bioscience, Advanced Materials and Healthcare Technologies Division, School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Victoria Chapman
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK.,School of Life Sciences, Faculty of Medicine and Health Sciences, The University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
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Peng L, Yan Y, Hou X, Niu D, Wei J, Wang J. Evaluation of the effect of a three-color ladder management model for knee osteoarthritis in the community. Am J Transl Res 2021; 13:3074-3083. [PMID: 34017475 PMCID: PMC8129419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Accepted: 02/06/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore the application effect of a three-color ladder management system for knee osteoarthritis in the community. METHODS Eighty-six patients with knee osteoarthritis in our community were obtained for study and randomly grouped. The control group received routine management, while the research group received three-color ladder management for 12 months. The knee joint function (WOMAC score), pain degree (VAS score), joint flexibility, health-related behavior score, self-care ability scale (exercise of self-care agency scale (ESCA) score), quality of life (knee osteoarthritis quality of life scale (AIMS2-SF) score) and knee replacement rate were compared between the two groups before and after management, and the changes of patients' visits and treatment costs before and after management were observed. RESULTS After 12 months, the scores of WOMAC and VAS in the research group were significantly lower than those of the control group (P<0.05), while the scores of joint flexibility and extension, cognition, behavior and condition of Omaha System health-related behaviors, ESCA and AIMS2-SF were significantly higher than those of the control group (P<0.05). After 12 months, the monthly visits and expenses of green cards, yellow cards and red cards in the research group were significantly lower than those before entering the group (P<0.05). After 12 months, the knee replacement rate was 20.93% (9/43) in the research group, while it was 27.91% (12/43) in the control group, with no significant difference between the two groups (P>0.05). CONCLUSION The three-color ladder management system for knee osteoarthritis patients in the community can reduce the number of doctor visits and overall expenses, improve knee joint function, reduce pain, improve self-management ability and quality of life, and it has high community popularization.
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Affiliation(s)
- Lei Peng
- Department of Outpatient, Xujiahui Community Health Service CenterShanghai City, China
| | - Yan Yan
- Medical Department, Xujiahui Community Health Service CenterShanghai City, China
| | - Xiaoqi Hou
- Department of Outpatient, Xujiahui Community Health Service CenterShanghai City, China
| | - Deng Niu
- Xujiahui Community Health Service CenterShanghai City, China
| | - Jing Wei
- Xujiahui Community Health Service CenterShanghai City, China
| | - Jianbo Wang
- Xujiahui Community Health Service CenterShanghai City, China
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Gohir SA, Eek F, Kelly A, Abhishek A, Valdes AM. Effectiveness of Internet-Based Exercises Aimed at Treating Knee Osteoarthritis: The iBEAT-OA Randomized Clinical Trial. JAMA Netw Open 2021; 4:e210012. [PMID: 33620447 PMCID: PMC7903254 DOI: 10.1001/jamanetworkopen.2021.0012] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
IMPORTANCE Osteoarthritis is a prevalent, debilitating, and costly chronic disease for which recommended first-line treatment is underused. OBJECTIVE To compare the effect of an internet-based treatment for knee osteoarthritis vs routine self-management (ie, usual care). DESIGN, SETTING, AND PARTICIPANTS This randomized clinical trial was conducted from October 2018 to March 2020. Participants included individuals aged 45 years or older with a diagnosis of knee osteoarthritis recruited from an existing primary care database or from social media advertisements were invited. Data were analyzed April to July 2020. INTERVENTIONS The intervention and control group conformed to first-line knee osteoarthritis treatment. For the intervention group, treatment was delivered via a smartphone application. The control group received routine self-management care. MAIN OUTCOMES AND MEASURES The primary outcome was change from baseline to 6 weeks in self-reported pain during the last 7 days, reported on a numerical rating scale (NRS; range, 0-10, with 0 indicating no pain and 10, worst pain imaginable), compared between groups. Secondary outcomes included 2 physical functioning scores, hamstring and quadriceps muscle strength, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and quantitative sensory testing. RESULTS Among a total of 551 participants screened for eligibility, 146 were randomized and 105 were analyzed (mean [SD] age, 66.7 [9.2] years, 71 [67.1%] women), including 48 participants in the intervention group and 57 participants in the control group. There were no significant differences in baseline characteristics between the groups. At the 6-week follow-up, the intervention group showed a greater NRS pain score reduction than the control group (between-group difference, -1.5 [95% CI, -2.2 to -0.8]; P < .001). Similarly, the intervention group had better improvements in the 30-second sit-to-stand test (between-group difference, 3.4 [95% CI, 2.2 to 4.5]; P < .001) and Timed Up-and-Go test (between-group difference, -1.8 [95% CI, -3.0 to -0.5] seconds; P = .007), as well as the WOMAC subscales for pain (between-group difference, -1.1 [95% CI, -2.0 to -0.2]; P = .02), stiffness (between-group difference, -1.0 [95% CI, -1.5 to -0.5]; P < .001), and physical function (between-group difference, -3.4 [95% CI, -6.2 to -0.7]; P = .02). The magnitude of within-group changes in pain (d = 0.83) and function outcomes (30 second sit-to-stand test d = 1.24; Timed Up-and-Go test d = 0.76) in the intervention group corresponded to medium to very strong effects. No adverse events were reported. CONCLUSIONS AND RELEVANCE These findings suggest that this internet-delivered, evidence-based, first-line osteoarthritis treatment was superior to routine self-managed usual care and could be provided without harm to people with osteoarthritis. Effect sizes observed in the intervention group corresponded to clinically important improvements. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03545048.
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Affiliation(s)
- Sameer Akram Gohir
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Frida Eek
- Department of Health Sciences, Lund University, Lund University, Sweden
| | - Anthony Kelly
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Abhishek Abhishek
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Ana M. Valdes
- National Institute for Health Research, Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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Tauben DJ, Langford DJ, Sturgeon JA, Rundell SD, Towle C, Bockman C, Nicholas M. Optimizing telehealth pain care after COVID-19. Pain 2020; 161:2437-2445. [PMID: 32826752 PMCID: PMC7566302 DOI: 10.1097/j.pain.0000000000002048] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 08/03/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022]
Affiliation(s)
- David J. Tauben
- Departments of Anesthesiology & Pain Medicine
- Medicine, University of Washington, Seattle, WA, United States
| | | | | | - Sean D. Rundell
- Departments of Rehabilitation Medicine
- Health Services, University of Washington, Seattle, WA, United States
| | - Cara Towle
- Department of Psychiatry & Behavioral Sciences, University of Washington, Seattle, WA, United States
| | - Christina Bockman
- Department of Pharmacy, University of Washington, Harborview Medical Center, Seattle, WA, United States
| | - Michael Nicholas
- Pain Management Research Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
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