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Meert L, Vervullens S, Heusdens CHW, Smeets RJEM, Meeus M, Mertens MGCAM. Unravelling relationships between obesity, diabetes, and factors related to somatosensory functioning in knee osteoarthritis patients. Clin Rheumatol 2024:10.1007/s10067-024-07022-2. [PMID: 38913223 DOI: 10.1007/s10067-024-07022-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/24/2024] [Accepted: 05/28/2024] [Indexed: 06/25/2024]
Abstract
OBJECTIVE This study explores the association between obesity, diabetes, and somatosensory functioning in patients with knee osteoarthritis (OA), aiming to understand how metabolic conditions are related to pain mechanisms in this patient population. We hypothesized that higher body mass index (BMI), fat mass, and glycated hemoglobin levels (HbA1c) are associated with signs of altered somatosensory functioning. METHODS A cross-sectional analysis was conducted as part of a larger multicentre prospective cohort study. Data were collected from patients awaiting total knee arthroplasty in Belgium and the Netherlands. Associations between BMI, fat mass, HbA1c, and various pain-related variables were examined employing Pearson and Spearman correlation analyses which were further analyzed with linear regression techniques. RESULTS The study included 223 participants. Analysis revealed a significant although weak negative correlation between fat mass and pressure pain thresholds (PPT) at multiple locations, suggesting a link between higher fat mass and increased mechanical hyperalgesia. There were no significant correlations between BMI and pain-related outcomes. HbA1c levels showed very weak positive correlations with pain measures but did not withstand correction for multiple testing. CONCLUSION The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA. However, no significant correlations were found between BMI or HbA1c levels and pain-related outcomes. Future research should focus on longitudinal studies to elucidate the causal relationships and further explore the impact of metabolic factors on pain mechanisms in this patient population. Key Points • The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA.
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Affiliation(s)
- Lotte Meert
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium.
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands.
- Pain in Motion International Research Group (PiM), Brussels, Belgium.
| | - Sophie Vervullens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Brussels, Belgium
| | - Christiaan H W Heusdens
- Department of Orthopedics and Traumatology, University Hospital of Antwerp, Edegem, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rob J E M Smeets
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Brussels, Belgium
- CIR Clinics in Revalidatie, Eindhoven, The Netherlands
| | - Mira Meeus
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Pain in Motion International Research Group (PiM), Brussels, Belgium
| | - Michel G C A M Mertens
- Research Group MOVANT, Department of Rehabilitation Sciences and Physiotherapy (REVAKI), University of Antwerp, Wilrijk, Belgium
- Research School CAPHRI, Department of Rehabilitation Medicine, Maastricht University, Universiteitssingel 40, 6229 ER, Maastricht, The Netherlands
- Pain in Motion International Research Group (PiM), Brussels, Belgium
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Van den Langenbergh J, Bastiaansen-Jenniskens Y, van Osch G, Runhaar J, Bierma-Zeinstra S, Soballe K, Laursen J, Liljensoe A, Kops N, Mechlenburg I, Clockaerts S. PLOD2 gene expression in infrapatellar fat pad is correlated with fat mass in obese patients with end-stage knee osteoarthritis. OSTEOARTHRITIS AND CARTILAGE OPEN 2024; 6:100469. [PMID: 38694906 PMCID: PMC11061337 DOI: 10.1016/j.ocarto.2024.100469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 04/06/2024] [Indexed: 05/04/2024] Open
Abstract
Objective To investigate associations between obesity-linked systemic factors and gene expression indicative for the inflammatory and fibrotic processes in the infrapatellar fat pad (IFP), in a population of obese patients with end-stage knee osteoarthritis (KOA). Methods We collected human IFPs from 48 patients with a mean body mass index (BMI) of 35.44 kg/m2 during total knee replacement procedures. These patients were part of a randomized controlled trial and met the criteria of having OA and a BMI of ≥30 kg/m2. Blood samples were collected to assess serum levels of glucose, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, and leptin. Total body composition was measured using dual-energy X-ray absorptiometry. Gene expressions of IL6, TNFA, COL1A1, IL1B, ASMA, PLOD2 in the IFP were analyzed. Results Univariate analysis resulted in a positive correlation between BMI and procollagen-lysine,2-oxoglutarate 5-dioxygenase 2 (PLOD2) expression (r2 = 0.13). In univariate analyses of obesity-linked systemic factors and PLOD2, significant correlations were found for lean mass (r2 = 0.20), fat mass (r2 = 0.20), serum cholesterol (r2 = 0.17), serum triglycerides (r2 = 0.19) and serum leptin (r2 = 0.10). A multiple linear regression model indicated fat mass to be a strong predictor of PLOD2 production in the IFP (r2 = 0.22, P = 0.003). Conclusion Our study demonstrates the positive association between fat mass and PLOD2 expression in the IFP of obese end-stage knee OA patients. This may indicate that within this patient population the fibrotic process in the IFP is influenced by systemic adipose tissue, next to local inflammatory processes.
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Affiliation(s)
- J. Van den Langenbergh
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
| | - Y.M. Bastiaansen-Jenniskens
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, Rotterdam, Netherlands
| | - G.J.V.M. van Osch
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of Otorhinolaryngology, Rotterdam, Netherlands
| | - J. Runhaar
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands
| | - S.M.A. Bierma-Zeinstra
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, Rotterdam, Netherlands
- Erasmus MC, University Medical Center Rotterdam, Department of General Practice, Rotterdam, Netherlands
| | - K. Soballe
- Aarhus University Hospital, Orthopaedic Research Unit, Aarhus, Denmark
| | - J. Laursen
- Aarhus University Hospital, Orthopaedic Research Unit, Aarhus, Denmark
| | - A. Liljensoe
- Aarhus University Hospital, Orthopaedic Research Unit, Aarhus, Denmark
| | - N. Kops
- Erasmus MC, University Medical Center Rotterdam, Department of Orthopaedics and Sports Medicine, Rotterdam, Netherlands
| | - I. Mechlenburg
- Aarhus University Hospital, Orthopaedic Research Unit, Aarhus, Denmark
| | - S. Clockaerts
- KU Leuven, Department of Development and Regeneration, Skeletal Biology and Engineering Research Center, Leuven, Belgium
- H.H. Z. Lier, Orthopedic Surgery and Traumatology, Lier, Belgium
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Alenazi AM, Alqahtani BA. Diabetes is associated with longitudinal declined physical performance measures in persons with or at risk of knee osteoarthritis: data from the Osteoarthritis Initiative. Eur J Phys Rehabil Med 2024; 60:496-504. [PMID: 38647532 DOI: 10.23736/s1973-9087.24.08034-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
BACKGROUND The primary aim of this study was to longitudinally examine the impact of diabetes mellitus (DM) on physical performance measures including Gait Speed and Chair Stand tests over 8 years of follow-up in people with or at risk of knee osteoarthritis (OA). DESIGN A prospective longitudinal study. SETTING Multisite community based. POPULATION This study included participants with or at risk of knee OA aged from 45 to 79 years from the Osteoarthritis Initiative from baseline to 96 months follow-up. METHODS The participants performed physical performance measures using a 20 m Walk Test for Gait Speed and 5 Times Sit To Stand for repeated chair stand test time at baseline and during follow-up visits. Participants were asked about the presence of diabetes mellitus (DM) at baseline and categorized into with or without DM. Generalized estimating equations were utilized with 2 models, one for DM and Gait Speed and the other for DM and Repeated Chair Stand Test after controlling for covariates including age, sex, education, Body Mass Index (BMI), depressive symptoms, physical activity level, baseline number of comorbidities, and baseline Kellgren and Lawrence grades for OA grading for each knee. RESULTS A total of 4796 participants were included and categorized into those with DM (N.=362) and without DM (N.=4311) at baseline. Participants with DM at baseline showed significantly declined gait speed (B=-0.048, 95% Confidence Interval [95% CI]: [-0.07, -0.02], P<0.001) and significantly an increased time for repeated chair stand test (B=0.49, 95% CI: [0.08, 0.89], P=0.018) over time when compared to those without DM at baseline, after controlling for covariates. CONCLUSIONS DM was associated with negative impact on Gait Speed and Repeated Chair Stand Test time in individuals with or at risk of knee OA. Individuals with knee OA and diabetes who exhibit declining physical performance measures are at risk of functional dependence, reduced quality of life, and complex rehabilitation requirements.
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Affiliation(s)
- Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia -
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia
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Spitzer AI, Rodbard HW, Iqbal SU, Nakazawa M, DiGiorgi M, Winston R. Extended-Release Versus Immediate-Release Triamcinolone Acetonide in Patients Who Have Knee Osteoarthritis and Type 2 Diabetes Mellitus. J Arthroplasty 2024:S0883-5403(24)00527-8. [PMID: 38815874 DOI: 10.1016/j.arth.2024.05.055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2023] [Revised: 05/17/2024] [Accepted: 05/20/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Intra-articular (IA) corticosteroid injections may cause hyperglycemia (glucose level > 180 mg/dL). In a phase 2 study of 33 patients who had osteoarthritis of the knee (OAK) and type 2 diabetes mellitus (T2D), triamcinolone acetonide extended-release (TA-ER) was associated with minimal glycemic control disruption compared with triamcinolone acetonide immediate-release (TA-IR). This post hoc analysis characterizes the clinical relevance of these results. METHODS Patients who had symptomatic OAK for ≥ 6 months, T2D for ≥ 1 year, and hemoglobin A1c ≥ 6.5 and ≤ 9.0% were randomized to receive an IA injection of either TA-ER or TA-IR. Changes in continuous glucose monitor daily glucose level, percentage of time in or above the target glucose range (> 70 to 180 mg/dL), time to glucose level 250 mg/dL and maximum glucose level > 250 mg/dL, and glycemic variability were evaluated. RESULTS Across postinjection days 1 to 3, the TA-ER group (n = 18) had a lower median change from baseline in maximum glucose level (92.3 versus 169.1 mg/dL), a reduced percentage of time with a glucose level > 250 mg/dL (12 versus 26%), a smaller proportion of patients who had a maximum glucose level > 250 mg/dL (50 versus 93%), and a greater percentage of time in the target glucose range (62 versus 48%) versus the TA-IR group (n = 15). There was less glycemic variability and lower glucose spikes in the TA-ER versus TA-IR group. Median times to glucose level 250 mg/dL (44 versus 6 hours) and maximum glucose level (34 versus 13 hours) were significantly longer in the TA-ER versus TA-IR group. CONCLUSIONS Use of TA-ER was associated with a clinically meaningful reduction in hyperglycemia versus TA-IR.
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Neitzke CC, LaValva SM, Chandi SK, Chiu YF, McLawhorn AS, Gausden EB. Should We Wait for Bone-on-Bone Arthritis? Equivalent Clinical Outcomes in Patients Requiring Advanced Imaging Prior to Primary Total Hip Arthroplasty. J Arthroplasty 2024:S0883-5403(24)00515-1. [PMID: 38776991 DOI: 10.1016/j.arth.2024.05.043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 05/12/2024] [Accepted: 05/13/2024] [Indexed: 05/25/2024] Open
Abstract
INTRODUCTION Plain radiographs remain the standard for diagnosing osteoarthritis (OA). Total hip arthroplasty (THA) is generally offered only for advanced OA by plain radiographs. Advanced imaging is used as an adjunct to assess OA severity in cases of progressive symptoms with less advanced OA by plain radiographs. The objective of this study was to compare outcomes following THA in patients who have advanced OA visualized by plain radiographs to patients who have less severe OA visualized by plain radiographs. METHODS From February 2016 to February 2020, 93 patients who had Kellgren-Lawrence (KL) grade 0 to 2 OA and underwent THA were identified. The median age was 65 years, and 55% were women. They were matched 1:3 to patients who underwent THA for KL 4 OA based on age, sex, BMI, and Charlson Comorbidity Index. The primary outcome was achievement of the Hip Injury and Osteoarthritis Outcome Score, Joint Replacement (HOOS JR) minimum clinically important difference (MCID), substantial clinical benefit (SCB), and patient acceptable symptom state (PASS) at 1 year postoperatively. RESULTS There was no difference between the KL 0 to 2 and KL 4 cohorts in the achievement of HOOS JR MCID (86 versus 85.6%, P = 0.922), SCB (81.7 versus 80.2%, P = 0.751), or PASS (89.2 versus 85.6%, P = 0.374). The KL 0 to 2 cohort had a similar improvement in their 2-year HOOS JR (42.5 versus 38.6, P = 0.019). CONCLUSION In this series, there was no difference in outcomes following primary THA between patients who have severe OA on plain radiographs (KL 4) compared to those who have less severe OA (KL 0 to 2). In the setting of severe symptoms and the absence of advanced OA on radiographs, advanced imaging can be used to guide treatment and select patients who could benefit from THA.
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Affiliation(s)
- Colin C Neitzke
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Scott M LaValva
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sonia K Chandi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Yu-Fen Chiu
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | | | - Elizabeth B Gausden
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
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Power JD, Perruccio AV, Canizares M, Davey JR, Gandhi R, Mahomed NN, Syed K, Veillette C, Rampersaud YR. The impact of diabetes status on pain and physical function following total joint arthroplasty for hip and knee osteoarthritis: variation by sex and body mass index. Sci Rep 2024; 14:11152. [PMID: 38750058 PMCID: PMC11096302 DOI: 10.1038/s41598-024-61847-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Accepted: 05/10/2024] [Indexed: 05/18/2024] Open
Abstract
Few studies have examined diabetes impact on total joint arthroplasty (TJA) outcomes, with variable findings. We investigated the association between diabetes and post-TJA physical function and pain, examining whether diabetes impact differs by sex and BMI. Patient sample completed questionnaires within 3 months prior to hip or knee TJA for osteoarthritis (OA) and 1-year post-surgery. Surgical 'non-response' was defined as < 30% improvement in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function at 1-year. Two adjusted logistic regression models were estimated: (1) excluding, (2) including an interaction between diabetes, sex and BMI. The sample (626 hip, 754 knee) was 54.9% female, had mean BMI of 30.1, 13.0% reported diabetes. In adjusted models excluding an interaction, diabetes was not associated with non-response. However, a significant 3-way interaction (physical function: p = 0.003; pain: p = 0.006) between diabetes, sex, and BMI was found and was associated with non-response: non-response probability increased with increasing BMI in men with diabetes, but decreased with increasing BMI in women in diabetes. Findings suggest uncertainty in diabetes impact may be due to differential impacts by sex and BMI. A simple consideration of diabetes as present vs. absent may not be sufficient, with implications for the large TJA population.
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Affiliation(s)
- J Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada.
- Arthritis Community Research & Epidemiology Unit, Toronto, ON, Canada.
| | - Anthony V Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Arthritis Community Research & Epidemiology Unit, Toronto, ON, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Arthritis Community Research & Epidemiology Unit, Toronto, ON, Canada
| | - J Roderick Davey
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Nizar N Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- ICES, Toronto, ON, Canada
| | - Khalid Syed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Christian Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
| | - Y Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, 399 Bathurst Street MP10-326, Toronto, ON, M5T 2S8, Canada
- Orthopaedics, Department of Surgery, University of Toronto, Toronto, ON, Canada
- Neurosurgery, Department of Surgery, University of Toronto, Toronto, ON, Canada
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Courties A. Osteoarthritis and diabetes: Is there a true link? Joint Bone Spine 2024; 91:105684. [PMID: 38181900 DOI: 10.1016/j.jbspin.2023.105684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Revised: 12/13/2023] [Accepted: 12/19/2023] [Indexed: 01/07/2024]
Affiliation(s)
- Alice Courties
- Inserm UMRS_938, Department of Rheumatology, Centre de Recherche Saint-Antoine, Saint-Antoine Hospital, Sorbonne Université, Assistance publique-Hôpitaux de Paris (AP-HP), 75012 Paris, France.
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Power JD, Trifoi F, Canizares M, Perruccio AV, Shanmugaraj A, Gandhi R, Davey JR, Syed K, Mahomed NN, Veillette C, Rampersaud YR. The impact of diabetes on physical and mental health status and patient satisfaction after total hip and knee arthroplasty. PLoS One 2024; 19:e0302315. [PMID: 38656990 PMCID: PMC11042719 DOI: 10.1371/journal.pone.0302315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 04/01/2024] [Indexed: 04/26/2024] Open
Abstract
OBJECTIVE To assess the impact of diabetes on physical and mental health status, as well as patient satisfaction, one-year following knee and hip total joint arthroplasty (TJA) for osteoarthritis (OA). METHODS Participants were 626 hip and 754 knee TJA patients. Pre-surgery data were collected on socio-demographics and health status. The 12-item Short Form Health Survey (SF-12) was collected pre- and one year post-surgery, and physical (PCS) and mental component (MCS) summary scores computed. One-year patient satisfaction was also recorded. Four regression models tested the effect of diabetes on: 1) PCS change score; 2) MCS change score; 3) achieving minimal clinically important improvement (MCII) on PCS; and 4) patient satisfaction ('Somewhat or Very Satisfied' vs. 'Somewhat or Very Dissatisfied'). An interaction between surgical joint and diabetes was tested in each model. RESULTS Self-reported diabetes prevalence was 13.0% (95% CI: 11.2%-14.7%) and was more common in knee 16.1% (95% CI: 13.4%-18.7%) than hip 9.3% (95% CI: 7.0%-11.5%) patients. In adjusted analyses, change scores were 2.3 units less on the PCS for those with diabetes compared to those without (p = 0.005). Patients with diabetes were about half as likely to achieve MCII as patients without diabetes (p = 0.004). Diabetes was not significantly associated with satisfaction or changes in MCS scores. Diabetes effects did not differ by surgical joint. CONCLUSIONS Findings support that diabetes has a negative impact on improvements in physical health after TJA. Considering the growing prevalence of OA and diabetes in the population, our findings support the importance of perioperative screening and management of diabetes in patients undergoing TJA.
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Affiliation(s)
- J. Denise Power
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Krembil Research Institute, Toronto, Ontario, Canada
| | - Flaviu Trifoi
- Schulich School of Medicine & Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Mayilee Canizares
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Krembil Research Institute, Toronto, Ontario, Canada
| | - Anthony V. Perruccio
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Arthritis Community Research and Epidemiology Unit (ACREU), Krembil Research Institute, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Ajaykumar Shanmugaraj
- Faculty of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Rajiv Gandhi
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - J. Roderick Davey
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Khalid Syed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Nizar N. Mahomed
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Christian Veillette
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
| | - Y. Raja Rampersaud
- Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
- Department of Surgery, Orthopaedics, University of Toronto, Toronto, Ontario, Canada
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Shukla R, Singh S, Kamath S, Shah U, Patel S, Kherajani K, Gupta A, Shaw P, Unnithan V, Kaithathara S, Gharde P. Interplay Between Diabetes Mellitus and the Occurrence of Osteoarthritis and Associated Conditions in Women of Menopausal Age. Cureus 2024; 16:e58502. [PMID: 38765429 PMCID: PMC11101597 DOI: 10.7759/cureus.58502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 04/17/2024] [Indexed: 05/22/2024] Open
Abstract
Osteoarthritis (OA) and diabetes mellitus (DM) have long-term deleterious chronic effects and are among the most prevalent chronic disorders. DM and its associated factors, such as hyperglycemia, have a significant contribution to the pathophysiology of OA, particularly in post-menopausal women. Women who have uncontrolled diabetes (DM) are more prone to develop osteoarthritis (OA), which may be exacerbated by poor glycemic control. Furthermore, this category of female patients with DM has an increased risk of developing fractures, even in those with initially normal bone density scores, further illustrating the correlation between DM and bone health. Additionally, multiple risk factors, including obesity, metabolic syndrome, hypertension, estrogen-based hormone therapy, and hyperuricemia, in menopausal women can lead to the development and exacerbation of OA. It is discovered that these variables have a direct or indirect impact, frequently causing inflammation and hormonal changes, which contribute to the intricate interaction between DM and OA. The management of OA and DM in women thus calls for a multi-faceted management plan including glycemic control, weight control, exercise, and specialized pain management methods catering to the specific requirements of the patients. Regularly screening for OA should be implemented for menopausal women with DM and utmost care should be provided by healthcare professionals. Regular monitoring of joint health and early management, encouraging interdisciplinary cooperation, putting preventative measures into place, and creating individualized treatment programs are essential. A thorough understanding of the link between DM and OA will ultimately lead to improved health outcomes and a better future for these individuals.
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Affiliation(s)
- Rushikesh Shukla
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shailja Singh
- Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Shruthi Kamath
- Medicine, Kasturba Medical College, Mangalore, Mangalore, IND
| | - Urmil Shah
- Medicine, Rajiv Gandhi Medical College, Thane, IND
| | - Siddhi Patel
- Medicine, Dr. D. Y. Patil Medical College, Hospital and Research Centre, Pune, IND
| | | | - Ananya Gupta
- Medicine, Kasturba Medical College, Mangalore, Mangalore, IND
| | - Priya Shaw
- Medicine, Burdwan Medical College and Hospital, Bardhaman, IND
| | - Vishnu Unnithan
- Nuclear Medicine, King Edward Memorial Hospital and Seth Gordhandas Sunderdas Medical College, Mumbai, IND
| | | | - Pankaj Gharde
- General Surgery, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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Vanderbleek JJ, Owensby JK, McAnnally A, England BR, Chen L, Curtis JR, Yun H. Classifying Multimorbidity Using Drug Concepts via the Rx-Risk Comorbidity Index: Methods and Comparative Cross-Sectional Study. Arthritis Care Res (Hoboken) 2024; 76:559-569. [PMID: 37986017 DOI: 10.1002/acr.25273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 06/26/2023] [Accepted: 11/14/2023] [Indexed: 11/22/2023]
Abstract
OBJECTIVE The study objective was to update a method to identify comorbid conditions using only medication information in circumstances in which diagnosis codes may be undercaptured, such as in single-specialty electronic health records (EHRs), and to compare the distribution of comorbidities across Rx-Risk versus other traditional comorbidity indices. METHODS Using First Databank, RxNorm, and its web-based clients, RxNav and RxClass, we mapped Drug Concept Unique Identifiers (RxCUIs), National Drug Codes (NDCs), and Anatomical Therapeutic Chemical (ATC) codes to Rx-Risk, a medication-focused comorbidity index. In established rheumatoid arthritis (RA) and osteoarthritis (OA) cohorts within the Rheumatology Informatics System for Effectiveness registry, we then compared Rx-Risk with other comorbidity indices, including the Charlson Comorbidity Index, Rheumatic Disease Comorbidity Index (RDCI), and Elixhauser. RESULTS We identified 965 unique ingredient RxCUIs representing the 46 Rx-Risk comorbidity categories. After excluding dosage form and ingredient related RxCUIs, 80,911 unique associated RxCUIs were mapped to the index. Additionally, 187,024 unique NDCs and 354 ATC codes were obtained and mapped to the index categories. When compared to traditional comorbidity indices in the RA cohort, the median score for Rx-Risk (median 6.00 [25th percentile 2, 75th percentile 9]) was much greater than for Charlson (median 0 [25th percentile 0, 75th percentile 0]), RDCI (median 0 [25th percentile 0, 75th percentile 0]), and Elixhauser (median 1 [25th percentile 1, 75th percentile 1]). Analyses of the OA cohort yielded similar results. For patients with a Charlson score of 0 (85% of total), both the RDCI and Elixhauser were close to 1, but the Rx-Risk score ranged from 0 to 16 or more. CONCLUSION The misclassification and under-ascertainment of comorbidities in single-specialty EHRs can largely be overcome by using a medication-focused comorbidity index.
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Affiliation(s)
- Jared J Vanderbleek
- University of Alabama at Birmingham and University of Alabama at Birmingham Hospital
| | | | | | - Bryant R England
- University of Nebraska Medical Center and VA Nebraska-Western Iowa Health Care System, Omaha
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11
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Uematsu T, Nojiri S, Ishijima M, Nishizaki Y. Association between osteoarthritis and cardiovascular disease in elderly in Japan: an administrative claims database analysis. BMJ Open 2024; 14:e080387. [PMID: 38531574 DOI: 10.1136/bmjopen-2023-080387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/28/2024] Open
Abstract
OBJECTIVE To investigate whether osteoarthritis (OA) is a risk factor for cardiovascular disease (CVD); whether there are differences concerning ischaemic heart disease (IHD), congestive heart failure (CHF) and stroke; and whether there are differences between OA sites (hips, knees and hand) in predicting CVD onset. DESIGN Population-based matched case-control study. SETTING Health insurance claims data among Japanese patients. PARTICIPANTS Japanese patients aged ≥65 years with newly diagnosed CVD and hospitalised between January 2015 and December 2020 (cases) and age-matched and sex-matched 1:1 individuals (controls). MAIN OUTCOME MEASURES A conditional logistic regression model was used to estimate the adjusted ORs and their 95% CIs for CVD, IHD, CHF and stroke risk, adjusting for covariates. RESULTS A total of 79 296 patients were included, with respect to CVD (39 648 patients with newly diagnosed CVD and 39 648 controls). After adjustment for covariates, the exposure odds of knee OA (KOA), hip OA (HipOA) and hand OA (HandOA) for CVD were 1.192 (95% CI 1.115 to 1.274), 1.057 (95% CI 0.919 to 1.215) and 1.035 (95% CI 0.684 to 1.566), respectively, showing an association only for KOA. The exposure odds of KOA, HipOA and HandOA for IHD were 1.187 (95% CI 1.086 to 1.297), 1.078 (95% CI 0.891 to 1.306) and 1.099 (95% CI 0.677 to 1.784), respectively. The exposure odds of KOA, HipOA and HandOA for stroke were 1.221 (95% CI 1.099 to 1.356), 0.918 (95% CI 0.723 to 1.165) and 1.169 (95% CI 0.635 to 2.151), respectively. Similar to CVD, only KOA was associated with both. For CHF, neither KOA nor HipOA and HandOA were associated with CHF development. CONCLUSION This study confirms the association of KOA with CVD, particularly IHD and stroke, in the Japanese population. The finding that patients with KOA have a higher CVD risk can potentially assist in guiding future treatment strategies.
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Affiliation(s)
- Takuya Uematsu
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
- Department of Hospital Pharmacy, Juntendo University Hospital, Tokyo, Japan
| | - Shuko Nojiri
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
- Medical Technology Innovation Center, Juntendo University, Tokyo, Japan
| | - Muneaki Ishijima
- Department of Medicine for Orthopedics and Motor Organ, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
| | - Yuji Nishizaki
- Clinical Translational Science, Juntendo University School of Medicine Graduate School of Medicine, Tokyo, Japan
- Division of Medical Education, Juntendo University School of Medicine, Tokyo, Japan
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12
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Eymard F, Aron-Wisnewsky J. Osteoarthritis in patients with obesity: The bariatric surgery impacts on its evolution. Joint Bone Spine 2024; 91:105639. [PMID: 37734439 DOI: 10.1016/j.jbspin.2023.105639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2023] [Revised: 08/28/2023] [Accepted: 09/03/2023] [Indexed: 09/23/2023]
Abstract
Obesity is one of the main modifiable risk factors for osteoarthritis (OA). Moreover, obesity is associated with greater pain intensity and functional limitation, but also with a significantly lower responder rate to intra-articular treatments. Consequently, an arthroplasty is indicated earlier and more frequently in patients with obesity. However, pain and functional symptoms improve slightly less after arthroplasty in patients with obesity, who display higher incidence of early and late complications following prosthetic surgery. Bariatric surgery (BS) has increased worldwide and is efficient to induce major and sustainable weight-loss. Importantly, BS significantly reduces pain and functional limitation in patients with symptomatic knee OA. Biomarkers analysis also revealed a decrease in catabolic factors and an increase in anabolic one after BS suggesting a structural protective effect in knee OA. Nevertheless, the impact of BS prior to arthroplasty remains unclear. BS seems to decrease short- and mid-term complications such as infections or thrombosis. However, BS does not appear to modify long-term complications rate, and may even increase it, especially revisions and infections. Although few studies have compared the symptomatic and functional outcomes of joint replacement with or without BS, these are not significantly improved by prior BS. Despite these heterogeneous results, medico-economic studies found that BS prior to arthroplasty was cost-effective. To conclude, BS could significantly reduce the symptoms of OA and potentially slow its progression, but appears more disappointing in preventing long-term complications of arthroplasties and improving their functional results.
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Affiliation(s)
- Florent Eymard
- Department of Rheumatology, Henri-Mondor University Hospital, Assistance publique-Hôpitaux de Paris, AP-HP, 1, rue Gustave-Eiffel, 94000 Créteil, France.
| | - Judith Aron-Wisnewsky
- Department of Nutrition, Pitié-Salpêtrière, Assistance publique-Hôpitaux de Paris, AP-HP, 75013 Paris, France; Sorbonne université, Inserm, Nutrition and Obesity: Systemic Approaches, NutriOmics, 75013 Paris, France
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13
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Hussein N, Meade J, Pandit H, Jones E, El-Gendy R. Characterisation and Expression of Osteogenic and Periodontal Markers of Bone Marrow Mesenchymal Stem Cells (BM-MSCs) from Diabetic Knee Joints. Int J Mol Sci 2024; 25:2851. [PMID: 38474098 DOI: 10.3390/ijms25052851] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2024] [Revised: 02/14/2024] [Accepted: 02/16/2024] [Indexed: 03/14/2024] Open
Abstract
Type 2 diabetes mellitus (T2DM) represents a significant health problem globally and is linked to a number of complications such as cardiovascular disease, bone fragility and periodontitis. Autologous bone marrow mesenchymal stem cells (BM-MSCs) are a promising therapeutic approach for bone and periodontal regeneration; however, the effect of T2DM on the expression of osteogenic and periodontal markers in BM-MSCs is not fully established. Furthermore, the effect of the presence of comorbidities such as diabetes and osteoarthritis on BM-MSCs is also yet to be investigated. In the present study, BM-MSCs were isolated from osteoarthritic knee joints of diabetic and nondiabetic donors. Both cell groups were compared for their clonogenicity, proliferation rates, MSC enumeration and expression of surface markers. Formation of calcified deposits and expression of osteogenic and periodontal markers were assessed after 1, 2 and 3 weeks of basal and osteogenic culture. Diabetic and nondiabetic BM-MSCs showed similar clonogenic and growth potentials along with comparable numbers of MSCs. However, diabetic BM-MSCs displayed lower expression of periostin (POSTN) and cementum protein 1 (CEMP-1) at Wk3 osteogenic and Wk1 basal cultures, respectively. BM-MSCs from T2DM patients might be suitable candidates for stem cell-based therapeutics. However, further investigations into these cells' behaviours in vitro and in vivo under inflammatory environments and hyperglycaemic conditions are still required.
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Affiliation(s)
- Nancy Hussein
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds LS9 7TF, UK
- Department of Oral Medicine and Periodontology, Faculty of Dentistry, Mansoura University, Mansoura 35516, Egypt
| | - Josephine Meade
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds LS9 7TF, UK
| | - Hemant Pandit
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds LS9 7TF, UK
| | - Elena Jones
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, School of Medicine, University of Leeds, Leeds LS9 7TF, UK
| | - Reem El-Gendy
- Division of Oral Biology, School of Dentistry, University of Leeds, Leeds LS9 7TF, UK
- Department of Oral Pathology, Faculty of Dentistry, Suez Canal University, Ismailia 41522, Egypt
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14
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Yang J, Li S, Li Z, Yao L, Liu M, Tong K, Xu Q, Yu B, Peng R, Gui T, Tang W, Xu Y, Chen J, He J, Zhao K, Wang X, Wang X, Zha Z, Zhang H. Targeting YAP1-regulated Glycolysis in Fibroblast-Like Synoviocytes Impairs Macrophage Infiltration to Ameliorate Diabetic Osteoarthritis Progression. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2304617. [PMID: 38044289 PMCID: PMC10837355 DOI: 10.1002/advs.202304617] [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: 07/08/2023] [Revised: 11/03/2023] [Indexed: 12/05/2023]
Abstract
The interplay between immune cells/macrophages and fibroblast-like synoviocytes (FLSs) plays a pivotal role in initiating synovitis; however, their involvement in metabolic disorders, including diabetic osteoarthritis (DOA), is largely unknown. In this study, single-cell RNA sequencing (scRNA-seq) is employed to investigate the synovial cell composition of DOA. A significant enrichment of activated macrophages within eight distinct synovial cell clusters is found in DOA synovium. Moreover, it is demonstrated that increased glycolysis in FLSs is a key driver for DOA patients' synovial macrophage infiltration and polarization. In addition, the yes-associated protein 1 (YAP1)/thioredoxin-interacting protein (TXNIP) signaling axis is demonstrated to play a crucial role in regulating glucose transporter 1 (GLUT1)-dependent glycolysis in FLSs, thereby controlling the expression of a series of adhesion molecules such as intercellular adhesion molecule-1 (ICAM-1) which may subsequently fine-tune the infiltration of M1-polarized synovial macrophages in DOA patients and db/db diabetic OA mice. For treatment, M1 macrophage membrane-camouflaged Verteporfin (Vt)-loaded PLGA nanoparticles (MVPs) are developed to ameliorate DOA progression by regulating the YAP1/TXNIP signaling axis, thus suppressing the synovial glycolysis and the infiltration of M1-polarized macrophages. The results provide several novel insights into the pathogenesis of DOA and offer a promising treatment approach for DOA.
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Affiliation(s)
- Jie Yang
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Shanshan Li
- State Key Laboratory of Pulp and Paper EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Zhenyan Li
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Lutian Yao
- Department of OrthopedicsThe First Hospital of China Medical UniversityShenyang110001China
| | - Meijing Liu
- Key Laboratory of Big Data‐Based Precision MedicineSchool of Engineering MedicineBeihang UniversityBeijing100191China
- Clinical Research Platform for Interdisciplinary of Stomatologythe First Affiliated Hospital of Jinan University and Department of StomatologyJinan UniversityGuangzhou510632China
| | - Kui‐Leung Tong
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Qiutong Xu
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Bo Yu
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Rui Peng
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Tao Gui
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Wang Tang
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Yidi Xu
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Jiaxu Chen
- Guangzhou Key Laboratory of Formula‐Pattern Research CenterSchool of Traditional Chinese MedicineJinan UniversityGuangzhou510640China
| | - Jun He
- Institute of Laboratory Animal ScienceJinan UniversityGuangzhou510632China
| | - Kewei Zhao
- Guangzhou Key Laboratory of Chinese Medicine Research on Prevention and Treatment of Osteoporosisthe Third Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou510375China
| | - Xiaogang Wang
- Key Laboratory of Big Data‐Based Precision MedicineSchool of Engineering MedicineBeihang UniversityBeijing100191China
- Clinical Research Platform for Interdisciplinary of Stomatologythe First Affiliated Hospital of Jinan University and Department of StomatologyJinan UniversityGuangzhou510632China
| | - Xiaoying Wang
- State Key Laboratory of Pulp and Paper EngineeringSouth China University of TechnologyGuangzhou510640China
| | - Zhengang Zha
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
| | - Huan‐Tian Zhang
- Department of Bone and Joint Surgerythe First Affiliated Hospital of Jinan UniversityKey Laboratory of Regenerative Medicine of Ministry of EducationJinan UniversityGuangzhouGuangdong510630China
- Guangzhou Key Laboratory of Chinese Medicine Research on Prevention and Treatment of Osteoporosisthe Third Affiliated Hospital of Guangzhou University of Chinese MedicineGuangzhou510375China
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15
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Hassan HI, Kaka B, Sharaye KO, Abdulaziz U, Sada A, Fatoye F, Ibrahim AA. Musculoskeletal disorders and their associated factors among individuals with diabetes mellitus in northwest Nigeria. Reumatologia 2024; 61:439-447. [PMID: 38322105 PMCID: PMC10839917 DOI: 10.5114/reum/178237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Accepted: 12/12/2023] [Indexed: 02/08/2024] Open
Abstract
Introduction Diabetes mellitus (DM) is a growing public health problem causing a significant amount of disability and mortality in Nigeria. Musculoskeletal disorders (MSDs) are common complications associated with DM. However, studies on the prevalence of MSDs and their associated factors are limited in Nigeria, particularly in the northwest region. The purpose of this study was to determine the prevalence of MSDs and their associated factors among individuals with DM in northwest, Nigeria. Material and methods A retrospective cross-sectional survey of medical case records of all consecutive patients with DM attending a diabetic clinic in Ahmadu Bello University Teaching Hospital, Zaria was conducted between February 2015 and September 2021. Data on sociodemographic and clinical variables was collected using a researcher-designed questionnaire and analysed using descriptive statistics and logistic regression models. Results Four hundred eighty-nine cases (170 men [34.8%], 319 females [65.2%]; mean age: 51.4 ±12.3 years) were analysed. The majority of the participants had type 2 DM (96.7%), with a mean DM duration of 7.02 ±5.05 years. The overall prevalence of MSDs was 32.7%, with the highest prevalence found for lumbosacral spondylosis (11%) followed by knee osteoarthritis (8.4%). Among the different potential predictors examined, only duration of DM was significantly associated with overall MSDs (AOR: 1.76, 95% CI: 1.04-2.98; p = 0.035) whereas both duration of DM (AOR: 2.64, 95% CI: 1.19-5.89; p = 0.018) and body mass index (AOR: 7.461, 95% CI: 1.33-43.8; p = 0.023) were significantly associated with lumbosacral spondylosis. Conclusions Approximately one-third of the study participants had MSDs, with lumbosacral spondylosis being the most frequently occurring disorder. Being obese and having a longer duration of DM were associated with MSDs. Clinicians in Nigeria need to pay attention to MSDs and related factors in DM patients by conducting routine assessments and implementing early treatment.
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Affiliation(s)
- Halima Ibrahim Hassan
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | - Bashir Kaka
- Department of Physiotherapy, Faculty of Allied Health Sciences, College of Health Sciences, Bayero University, Kano, Nigeria
| | | | - Umar Abdulaziz
- Rheumatology Unit, Department of Internal Medicine, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Aisha Sada
- Department of Physiotherapy, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria
| | - Francis Fatoye
- Department of Health Professions, Faculty of Health, Psychology and Care, Manchester Metropolitan University, Manchester, United Kingdom
| | - Aminu Alhassan Ibrahim
- Department of Physiotherapy, School of Basic Medical Sciences, Skyline University Nigeria, Kano, Nigeria
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16
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Kandasamy G, Almaghaslah D, Almanasef M, Almeleebia T, Vasudevan R, Siddiqua A, Shorog E, M. Alshahrani A, Prabahar K, Veeramani VP, Amirthalingam P, F. Alqifari S, Mani V, Viswanath Reddy LK. An evaluation of knee osteoarthritis pain in the general community-Asir region, Saudi Arabia. PLoS One 2024; 19:e0296313. [PMID: 38206937 PMCID: PMC10783780 DOI: 10.1371/journal.pone.0296313] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 12/09/2023] [Indexed: 01/13/2024] Open
Abstract
BACKGROUND Knee osteoarthritis (KOA) is one of the most common conditions resulting in disability, particularly in the elderly population. Osteoarthritis (OA) is the most common articular disease and the leading cause of chronic disability in the developed world. OBJECTIVE This study was carried out to evaluate knee pain in the Asir region of Saudi Arabia. An analytical cross-sectional survey design was adopted in the Asir region from April 2023 to August 2023 to assess the knee pain of the adult population using an anonymous online questionnaire. RESULTS Of 1234, 332 were men (26.90) and 902 were women (73.09). WOMAC index score category 55.34% (n = 683) of the subjects had a low risk (score <60), 28.68% (n = 354) had a moderate risk (score 60-80), and 15.96% (n = 197) had a high risk (score ≥81) for KOA. According to clinical criteria, 79.33% (n = 979) of the study subjects had OA. Age group, gender 2.17 (1. 67-2.82) [OR 2.17; 95% CI 1.67-2.82), family history of OA [OR 0.47; 95% CI 0.37-0.62], diabetes [OR 2.78; 95% CI 2.17-3.56], hypertension [OR 0.35; 95% CI 0.26-0.45] were significantly associated with the percentage of the WOMAC index score using the Chi-square test analysis (P<0.05). Therefore, the WOMAC index showed higher diagnostic precision with a statistically significant association [OR 9.31 CI 6.90-12.81] with a P< 0.0001. CONCLUSION KOA is more common in older, obese people who have reached the age of 50 in the Asir region, and it is more prevalent in women. Alarms the need for appropriate awareness programs for better disease prevention and health outcomes for the benefit of the community through general public health programs.
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Affiliation(s)
- Geetha Kandasamy
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Dalia Almaghaslah
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Mona Almanasef
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Tahani Almeleebia
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Rajalakshimi Vasudevan
- Department of Pharmacology, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Ayesha Siddiqua
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Eman Shorog
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Asma M. Alshahrani
- Department of Clinical Pharmacy, College of Pharmacy, King Khalid University, Abha, Saudi Arabia
| | - Kousalya Prabahar
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Vinoth Prabhu Veeramani
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | | | - Saleh F. Alqifari
- Department of Pharmacy Practice, Faculty of Pharmacy, University of Tabuk, Tabuk, Saudi Arabia
| | - Vasudevan Mani
- Department of Pharmacology and Toxicology, College of Pharmacy, Qassim University, Buraydah, Saudi Arabia
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Wang Y, Sun M, Yao N, Qu S, Guo R, Wang X, Li J, Xie Z, Liu Y, Wu Z, Wang F, Li B. Ideal cardiovascular health metrics have better identification of arthritis. BMC Public Health 2024; 24:114. [PMID: 38191356 PMCID: PMC10775435 DOI: 10.1186/s12889-023-17602-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 12/27/2023] [Indexed: 01/10/2024] Open
Abstract
BACKGROUND This study aimed to explore the association between ideal cardiovascular health metrics (ICVHM) and arthritis (AR), as well as the interactions of various indicators in ICVHM on AR in US adults. METHODS We involved 17,041 participants who were interviewed by NHANES from 2011 to 2018. AR included osteoarthritis or degenerative arthritis (OA), rheumatoid arthritis (RA), and psoriatic arthritis and other arthritis (Other AR). Logistic regression was applied to analyze the association between AR and ICVHM. Mixed graphical model (MGM) was used to explore the interaction between variables in ICVHM. RESULTS Higher ICVHM scores had a protective effect on AR. Compared to "≤1" score, the ORs of AR in participants with 2, 3, 4, and ≥5 were 0.586, 0.472, 0.259, and 0.130, respectively. Similar results were also found in different types of AR. ICVHM has a maximum area under the curve value of 0.765 and the interaction between blood pressure and total cholesterol was 0.43. CONCLUSIONS ICVHM correlates significantly with AR and is better at identifying AR than individual indicators. ICVHM can be better improved by controlling the indicators with stronger interactions. Our findings provide guidance for promoting health factors, which have important implications for identification and prevention of AR.
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Affiliation(s)
- Yuxiang Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Mengzi Sun
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Nan Yao
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Shifang Qu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Ruirui Guo
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Xuhan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Jing Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Zechun Xie
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Yan Liu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Zibo Wu
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Fengdan Wang
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China
| | - Bo Li
- Department of Epidemiology and Biostatistics, School of Public Health, Jilin University, 1163 Xinmin Avenue, 130021, Changchun, P. R. China.
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18
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Lekhwani S, Nath B, Gupta SD, Kumari R, Vaswani ND, Pawar N. Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand. Indian J Community Med 2024; 49:76-81. [PMID: 38425961 PMCID: PMC10900440 DOI: 10.4103/ijcm.ijcm_832_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2022] [Accepted: 11/09/2023] [Indexed: 03/02/2024] Open
Abstract
Introduction Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition. Material and Methods A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD). Results Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities. Conclusion Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.
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Affiliation(s)
- Seema Lekhwani
- Department of Biochemistry, Pt BD Sharma, PGIMS, Rohtak, Haryana, India
| | - Bhola Nath
- Department of Community and Family Medicine, AIIMS Raebareli, Uttar Pradesh, India
| | | | - Ranjeeta Kumari
- Department of Community and Family Medicine, AIIMS Rishikesh, Uttarakhand, India
| | | | - Neeraj Pawar
- Department of Community and Family Medicine, AIIMS Raebareli, Uttar Pradesh, India
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19
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Li F. Metformin Reduces the Risk of Total Hip Arthroplasty in Elderly Patients with Hip Osteoarthritis and Type 2 Diabetes Mellitus. Diabetes Metab Syndr Obes 2023; 16:3481-3487. [PMID: 37937237 PMCID: PMC10627062 DOI: 10.2147/dmso.s419830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 09/07/2023] [Indexed: 11/09/2023] Open
Abstract
Purpose To assess if metformin could reduce the risk of total hip arthroplasty (THA) in elderly patients with hip osteoarthritis and type 2 diabetes (T2DM). Patients and Methods It is a retrospective study among elderly patients (≥65 years) with hip osteoarthritis and T2DM. All included patients were divided into metformin group and non-metformin group, then propensity-score match (PSM) was performed to control potential confounding factors. The primary endpoint was the incidence of the first THA during the study period. Multivariate Cox regression analysis was employed to evaluate the association of metformin with the risk of THA. Results A matched cohort of 716 patients were finally included, with 308 metformin users and 308 metformin non-users. During a maximum follow-up of 10 years, the incidence of THA in metformin users was significantly lower than that in non-users (4.9% vs 25.0%, P<0.01). Multivariate Cox regression analysis indicated that metformin users were significantly associated with a lower risk of THA compared with non-users (HR = 0.17, 95% CI: 0.10-0.30; P<0.01). In addition, further analyses indicated that participants with long-term metformin use (HR = 0.10, 95% CI: 0.02-0.46; P<0.01) or high metformin dosage (HR = 0.15, 95% CI: 0.04-0.57; P<0.01) had a lower risk of THA. Conclusion Metformin use could reduce the risk of THA in patients with hip osteoarthritis and T2DM, and the effect is accumulative and dose dependent.
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Affiliation(s)
- Fuchun Li
- Fourth Department of Orthopedics, The First Affiliated Hospital of Harbin Medical University, Harbin, 150001, People’s Republic of China
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20
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Xing X, Wang Y, Pan F, Cai G. Osteoarthritis and risk of type 2 diabetes: A two-sample Mendelian randomization analysis. J Diabetes 2023; 15:987-993. [PMID: 37525375 PMCID: PMC10667649 DOI: 10.1111/1753-0407.13451] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 05/29/2023] [Accepted: 07/14/2023] [Indexed: 08/02/2023] Open
Abstract
BACKGROUND Physical inactivity is an independent risk factor for type 2 diabetes (T2D). Osteoarthritis (OA) is a common joint disease that limits patients' physical activity, which may increase risk of other chronic diseases including T2D. However, studies evaluating the effect of OA on T2D are scarce. This study aimed to investigate the causal effect of knee and hip OA on risk of T2D from a genetic perspective. METHODS We performed two-sample Mendelian randomization (MR) analyses to obtain nonconfounding estimates of the effect of OA on T2D risk. Single nucleotide polymorphisms (SNPs) from genome-wide association studies were selected as genetic instruments for radiographic knee and hip OA (ie, Kellgren-Lawrence grade ≥2). The associations of these SNPs with T2D were evaluated in participants from the UK Biobank. Sensitivity analyses were conducted to test the robustness of the MR results. RESULTS Genetic predisposition of knee but not hip OA was significantly associated with an increased risk of T2D (knee OA: odds ratio [OR] 1.18, 95% confidence interval (CI) 1.09-1.27, p <.001; hip OA: OR 1.04, 95% CI 0.94-1.16, p = .425). Sensitivity analyses showed that the main findings are robust. CONCLUSION The current study provides genetic evidence supporting that knee OA is a potential risk factor for T2D.
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Affiliation(s)
- Xing Xing
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiChina
| | - Yining Wang
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiChina
| | - Faming Pan
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiChina
- The Inflammation and Immune Mediated Diseases Laboratory of Anhui ProvinceAnhui Medical UniversityHefeiChina
| | - Guoqi Cai
- Department of Epidemiology and Biostatistics, School of Public HealthAnhui Medical UniversityHefeiChina
- Menzies Institute for Medical Research, University of TasmaniaHobartAustralia
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21
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Liaghat B, Folkestad L, Skou ST, Koes B, Stammerjohan AF, Hartvigsen J. Prevalence and consequences of spinal pain among people with type 1 and type 2 diabetes mellitus in Denmark. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:3744-3752. [PMID: 37659046 DOI: 10.1007/s00586-023-07911-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 07/30/2023] [Accepted: 08/19/2023] [Indexed: 09/05/2023]
Abstract
PURPOSE To describe 1-week and 1-year prevalence of spinal pain and its consequences in relation to leisure activity, work-life, and care-seeking in people with type 1 and 2 diabetes mellitus (DM). METHODS A cross-sectional survey including adults diagnosed with DM from two Danish secondary care centres. Using the Standardised Nordic Questionnaire, spinal pain prevalence (cervical, thoracic, lumbar) and its consequences were evaluated (proportions, 95% confidence intervals) and compared to the general population. RESULTS Among 3767 people, 1-week and 1-year spinal pain prevalence were 11.6-32.4 and 18.5-49.6%, respectively, highest for lumbar pain (24.6-49.6%). The prevalence was similar between DM types for cervical and thoracic pain, but higher in type 2 for lumbar spine. Women had higher pain prevalence across spinal regions and DM types, while cervical and thoracic pain estimates were higher for age < 60 vs. ≥ 60. Within the past year, > 50% reported pain > 30 days, high proportions had reduced their activities (leisure time, 43.7-63.9%; work, 20.7-33.3%), 13.3-28.1% reported sick-leave > 30 days, and 44.3-48.5% had sought care due to spinal pain. CONCLUSION Spinal pain is common in people with type 1 and 2 DM, resulting in considerable consequences for work/leisure activities, sick-leave, and healthcare utilisation as compared to the general population.
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Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark.
- Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of Southern Denmark, Odense, Denmark
- Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- The Research and Implementation Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands
| | - Amalie Frost Stammerjohan
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, 5230, Odense, Denmark
- Chiropractic Knowledge Hub, Odense, Denmark
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22
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Larder CE, Iskandar MM, Kubow S. Collagen Hydrolysates: A Source of Bioactive Peptides Derived from Food Sources for the Treatment of Osteoarthritis. MEDICINES (BASEL, SWITZERLAND) 2023; 10:50. [PMID: 37755240 PMCID: PMC10538231 DOI: 10.3390/medicines10090050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Revised: 08/03/2023] [Accepted: 08/11/2023] [Indexed: 09/28/2023]
Abstract
Osteoarthritis (OA) is the most common joint disorder, with a social and financial burden that is expected to increase in the coming years. Currently, there are no effective medications to treat it. Due to limited treatment options, patients often resort to supplements, such as collagen hydrolysates (CHs). CHs are products with low molecular weight (MW) peptides, often between 3 and 6 kDa, and are a result of industrialized processed collagen. Collagen extraction is often a by-product of the meat industry, with the main source for collagen-based products being bovine, although it can also be obtained from porcine and piscine sources. CHs have demonstrated positive results in clinical trials related to joint health, such as decreased joint pain, increased mobility, and structural joint improvements. The bioactivity of CHs is primarily attributed to their bioactive peptide (BAP) content. However, there are significant knowledge gaps regarding the digestion, bioavailability, and bioactivity of CH-derived BAPs, and how different CH products compare in that regard. The present review discusses CHs and their BAP content as potential treatments for OA.
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Affiliation(s)
- Christina E. Larder
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (C.E.L.); (M.M.I.)
- Corporation Genacol Canada Inc., Blainville, QC J7C 6B4, Canada
| | - Michèle M. Iskandar
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (C.E.L.); (M.M.I.)
| | - Stan Kubow
- School of Human Nutrition, McGill University, Ste-Anne-de-Bellevue, QC H9X 3V9, Canada; (C.E.L.); (M.M.I.)
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23
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Sampath SJP, Venkatesan V, Ghosh S, Kotikalapudi N. Obesity, Metabolic Syndrome, and Osteoarthritis-An Updated Review. Curr Obes Rep 2023; 12:308-331. [PMID: 37578613 DOI: 10.1007/s13679-023-00520-5] [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] [Accepted: 07/07/2023] [Indexed: 08/15/2023]
Abstract
PURPOSE OF REVIEW Metabolic syndrome (MetS), also called the 'deadly quartet' comprising obesity, diabetes, dyslipidemia, and hypertension, has been ascertained to have a causal role in the pathogenesis of osteoarthritis (OA). This review is aimed at discussing the current knowledge on the contribution of metabolic syndrome and its various components to OA pathogenesis and progression. RECENT FINDINGS Lately, an increased association identified between the various components of metabolic syndrome (obesity, diabetes, dyslipidemia, and hypertension) with OA has led to the identification of the 'metabolic phenotype' of OA. These metabolic perturbations alongside low-grade systemic inflammation have been identified to inflict detrimental effects upon multiple tissues of the joint including cartilage, bone, and synovium leading to complete joint failure in OA. Recent epidemiological and clinical findings affirm that adipokines significantly contribute to inflammation, tissue degradation, and OA pathogenesis mediated through multiple signaling pathways. OA is no longer perceived as just a 'wear and tear' disease and the involvement of the metabolic components in OA pathogenesis adds up to the complexity of the disease. Given the global surge in obesity and its allied metabolic perturbations, this review aims to throw light on the current knowledge on the pathophysiology of MetS-associated OA and the need to address MetS in the context of metabolic OA management. Better regulation of the constituent factors of MetS could be profitable in preventing MetS-associated OA. The identification of key roles for several metabolic regulators in OA pathogenesis has also opened up newer avenues in the recognition and development of novel therapeutic agents.
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Affiliation(s)
- Samuel Joshua Pragasam Sampath
- Department of Biotechnology, Faculty of Science & Humanities, SRM Institute of Science and Technology, Kattankulathur, Chengalpattu District, Tamil Nadu, 603203, India.
- Molecular Biology Division, Indian Council of Medical Research - National Institute of Nutrition, Hyderabad, Telangana, 500007, India.
| | | | - Sudip Ghosh
- Molecular Biology Division, Indian Council of Medical Research - National Institute of Nutrition, Hyderabad, Telangana, 500007, India
| | - Nagasuryaprasad Kotikalapudi
- Division of Endocrinology, Diabetes, and Metabolism, Beth Israel Deaconess Medical Center, Harvard Medical School Teaching Hospital, Boston, MA, 02115, USA
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24
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Arruda AL, Hartley A, Katsoula G, Smith GD, Morris AP, Zeggini E. Genetic underpinning of the comorbidity between type 2 diabetes and osteoarthritis. Am J Hum Genet 2023; 110:1304-1318. [PMID: 37433298 PMCID: PMC10432145 DOI: 10.1016/j.ajhg.2023.06.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2023] [Revised: 06/16/2023] [Accepted: 06/20/2023] [Indexed: 07/13/2023] Open
Abstract
Multimorbidity is a rising public health challenge with important implications for health management and policy. The most common multimorbidity pattern is the combination of cardiometabolic and osteoarticular diseases. Here, we study the genetic underpinning of the comorbidity between type 2 diabetes and osteoarthritis. We find genome-wide genetic correlation between the two diseases and robust evidence for association-signal colocalization at 18 genomic regions. We integrate multi-omics and functional information to resolve the colocalizing signals and identify high-confidence effector genes, including FTO and IRX3, which provide proof-of-concept insights into the epidemiologic link between obesity and both diseases. We find enrichment for lipid metabolism and skeletal formation pathways for signals underpinning the knee and hip osteoarthritis comorbidities with type 2 diabetes, respectively. Causal inference analysis identifies complex effects of tissue-specific gene expression on comorbidity outcomes. Our findings provide insights into the biological basis for the type 2 diabetes-osteoarthritis disease co-occurrence.
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Affiliation(s)
- Ana Luiza Arruda
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Munich School of Data Science, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Technical University of Munich (TUM), School of Medicine, Graduate School of Experimental Medicine, 81675 Munich, Germany
| | - April Hartley
- MRC Integrative Epidemiology Unit, University of Bristol, BS8 2BN Bristol, UK
| | - Georgia Katsoula
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Technical University of Munich (TUM), School of Medicine, Graduate School of Experimental Medicine, 81675 Munich, Germany
| | - George Davey Smith
- MRC Integrative Epidemiology Unit, University of Bristol, BS8 2BN Bristol, UK
| | - Andrew P Morris
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; Centre for Genetics and Genomics Versus Arthritis, Centre for Musculoskeletal Research, The University of Manchester, M13 9PT Manchester, UK
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München - German Research Center for Environmental Health, 85764 Neuherberg, Germany; TUM School of Medicine, Technical University Munich and Klinikum Rechts der Isar, 81675 Munich, Germany.
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25
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Yu D, Huang X, Mamas MA, Wilkie R. Persistent high prevalence of modifiable cardiovascular risk factors among patients with osteoarthritis in the UK in 1992-2017. RMD Open 2023; 9:e003298. [PMID: 37648396 PMCID: PMC10471862 DOI: 10.1136/rmdopen-2023-003298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Accepted: 07/31/2023] [Indexed: 09/01/2023] Open
Abstract
OBJECTIVES To compare the annual and period prevalence of modifiable cardiovascular risk factors (MCVRFs) between populations with and without osteoarthritis (OA) in the UK over 25 years. METHODS 215 190 patients aged 35 years and over from the UK Clinical Practice Research Datalink GOLD database who were newly diagnosed OA between 1992 and 2017, as well as 1:1 age-matched, sex-matched, practice-matched and index year-matched non-OA individuals, were incorporated. MCVRFs including smoking, hypertension, type 2 diabetes, obesity and dyslipidaemia were defined by Read codes and clinical measurements. The annual and period prevalence and prevalence rate ratios (PRRs) of individual and clustering (≥1, ≥2 and ≥3) MCVRFs were estimated by Poisson regression with multiple imputations for missing values. RESULTS The annual prevalence of MCVRFs increased in the population with OA between 1992 and 2017 and was consistently higher in the population with OA compared with the population without OA between 2004 and 2017. Trends towards increased or stable annual PRRs for individuals and clustering of MCVRFs were observed. A 26-year period prevalence of single and clustering MCVRFs was significantly higher in individuals with OA compared with non-OA individuals. Period PRRs were higher in Southern England, women and increased with age for most MCVRFs except for obesity, which has the higher PRR in the youngest age group. CONCLUSIONS A consistently higher long-term prevalence of MCVRFs was observed in individuals with OA compared to those without OA. The higher prevalence of obesity in the youngest age group with OA highlights the need for public health strategies. Further research to understand MCVRF management in OA populations is necessary.
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Affiliation(s)
- Dahai Yu
- Department of Nephrology, First Affiliated Hospital, Zhengzhou University, Zhengzhou, China
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Xiaoyang Huang
- Shenzhen Ellen-Sven Precision Medicine Institute, Shenzhen, Guangdong, China
| | - Mamas A Mamas
- School of Medicine, Keele University, Keele, Staffordshire, UK
| | - Ross Wilkie
- School of Medicine, Keele University, Keele, Staffordshire, UK
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26
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Li S, Si H, Zhang S, Xu J, Liu Y, Shen B. Does diabetes mellitus impair the clinical results of total knee arthroplasty under enhanced recovery after surgery? J Orthop Surg Res 2023; 18:490. [PMID: 37430329 DOI: 10.1186/s13018-023-03982-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2023] [Accepted: 07/05/2023] [Indexed: 07/12/2023] Open
Abstract
BACKGROUND Diabetes mellitus (DM) and osteoarthritis (OA) are common diseases that are predicted to increase in prevalence, and DM is a risk factor for OA progression and has a negative impact on the outcome. However, the evidence remains unclear on how it affects patients' clinical results of total knee arthroplasty (TKA) under enhanced recovery after surgery (ERAS). METHODS A retrospective single-center study was conducted comparing diabetic and non-diabetic patients who underwent TKA in West China Hospital of Sichuan University between September 2016 to December 2017 under ERAS. Consecutive propensity score matching (PSM) was conducted by 1:1 (DM: non-DM) matching analysis with all baselines as covariates. The primary clinical results were the improvement of knee joint function, the incidence of postoperative complications, and the FJS-12 sensory results 5 years after the operation between DM and Non-DM groups. The secondary clinical results were the postoperative length of stay (LOS), postoperative blood test and total blood loss (TBL). RESULT After PSM, the final analysis included 84 diabetic patients and 84 non-diabetic patients. Diabetic patients were more likely to experience early postoperative complications (21.4% vs. 4.8%, P = 0.003), of which wound complications are the most significant (10.7% vs. 1.2%, P = 0.022). Diabetic patients experienced longer postoperative LOS with a significant increase in patients with LOS exceeding 3 days (66.7% vs. 50%, P = 0.028) and showed less postoperative range of motion (ROM) (106.43 ± 7.88 vs. 109.50 ± 6.33 degrees, P = 0. 011). Diabetic patients also reported lower Forgotten joint score (FJS-12) than non-diabetic patients (68.16 + 12.16 vs. 71.57 + 10.75, P = 0.020) in the 5-year follow-up and were less likely to achieve a forgotten knee joint (10.7% vs. 1.2%, P = 0.022). In additional, Compared with non-diabetics, diabetic patients showed lower hemoglobin (Hb) (P < 0.001) and hematocrit (HCT) (P < 0.001) and were more likely to suffer from hypertension before TKA (P < 0.001). CONCLUSION Diabetic patients show increased risk for postoperative complications, and have lower lower postoperative ROM and lower FJS-12 compared with non-diabetic patients after TKA under ERAS. More perioperative protocols are still needed to be investigated and optimized for diabetic patients.
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Affiliation(s)
- Shuai Li
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Haibo Si
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Shaoyun Zhang
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Jiawen Xu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yuan Liu
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Bin Shen
- Department of Orthopedic Surgery and Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China.
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27
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Kamps A, Runhaar J, de Ridder MAJ, de Wilde M, van der Lei J, Zhang W, Prieto-Alhambra D, Englund M, de Schepper EIT, Bierma-Zeinstra SMA. Comorbidity in incident osteoarthritis cases and matched controls using electronic health record data. Arthritis Res Ther 2023; 25:114. [PMID: 37403135 PMCID: PMC10318652 DOI: 10.1186/s13075-023-03086-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 06/04/2023] [Indexed: 07/06/2023] Open
Abstract
BACKGROUND Comorbidities are common in patients with osteoarthritis (OA). This study aimed to determine the association of a wide range of previously diagnosed comorbidities in adults with newly diagnosed OA compared with matched controls without OA. METHODS A case-control study was conducted. The data were derived from an electronic health record database that contains the medical records of patients from general practices throughout the Netherlands. Incident OA cases were defined as patients with one or more diagnostic codes recorded in their medical records that correspond to knee, hip, or other/peripheral OA. Additionally, the first OA code had to be recorded between January 1, 2006, and December 31, 2019. The date of cases' first OA diagnosis was defined as the index date. Cases were matched (by age, sex, and general practice) to up to 4 controls without a recorded OA diagnosis. Odds ratios were derived for each 58 comorbidities separately by dividing the comorbidity prevalence of cases by that of their matched controls at the index date. RESULTS 80,099 incident OA patients were identified of whom 79,937 (99.8%) were successfully matched with 318,206 controls. OA cases had higher odds for 42 of the 58 studied comorbidities compared with matched controls. Musculoskeletal diseases and obesity showed large associations with incident OA. CONCLUSIONS Most of the comorbidities under study had higher odds in patients with incident OA at the index date. While previously known associations were confirmed in this study, some associations were not described earlier.
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Affiliation(s)
- Anne Kamps
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands.
| | - Jos Runhaar
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Maria A J de Ridder
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Marcel de Wilde
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Johan van der Lei
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Weiya Zhang
- School of Medicine, Faculty of Medicine & Health Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, NG7 2HA, UK
| | - Daniel Prieto-Alhambra
- Department of Medical Informatics, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Windmill Road, Headington, OX3 7HE, Oxford, UK
| | - Martin Englund
- Clinical Epidemiology Unit, Orthopaedics, Department of Clinical Sciences, Lund University, Wigerthuset, Remissgatan 4, 22185, Lund, Sweden
| | - Evelien I T de Schepper
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
- Department of Orthopaedics and Sports Medicine, Erasmus MC, Dr. Molewaterplein 40, 3015 GD, Rotterdam, Netherlands
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Kwolek K, Grzelecki D, Kwolek K, Marczak D, Kowalczewski J, Tyrakowski M. Automated patellar height assessment on high-resolution radiographs with a novel deep learning-based approach. World J Orthop 2023; 14:387-398. [PMID: 37377994 PMCID: PMC10292056 DOI: 10.5312/wjo.v14.i6.387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 04/06/2023] [Accepted: 05/06/2023] [Indexed: 06/19/2023] Open
Abstract
BACKGROUND Artificial intelligence and deep learning have shown promising results in medical imaging and interpreting radiographs. Moreover, medical community shows a gaining interest in automating routine diagnostics issues and orthopedic measurements.
AIM To verify the accuracy of automated patellar height assessment using deep learning-based bone segmentation and detection approach on high resolution radiographs.
METHODS 218 Lateral knee radiographs were included in the analysis. 82 radiographs were utilized for training and 10 other radiographs for validation of a U-Net neural network to achieve required Dice score. 92 other radiographs were used for automatic (U-Net) and manual measurements of the patellar height, quantified by Caton-Deschamps (CD) and Blackburne-Peel (BP) indexes. The detection of required bones regions on high-resolution images was done using a You Only Look Once (YOLO) neural network. The agreement between manual and automatic measurements was calculated using the interclass correlation coefficient (ICC) and the standard error for single measurement (SEM). To check U-Net's generalization the segmentation accuracy on the test set was also calculated.
RESULTS Proximal tibia and patella was segmented with accuracy 95.9% (Dice score) by U-Net neural network on lateral knee subimages automatically detected by the YOLO network (mean Average Precision mAP greater than 0.96). The mean values of CD and BP indexes calculated by orthopedic surgeons (R#1 and R#2) was 0.93 (± 0.19) and 0.89 (± 0.19) for CD and 0.80 (± 0.17) and 0.78 (± 0.17) for BP. Automatic measurements performed by our algorithm for CD and BP indexes were 0.92 (± 0.21) and 0.75 (± 0.19), respectively. Excellent agreement between the orthopedic surgeons’ measurements and results of the algorithm has been achieved (ICC > 0.75, SEM < 0.014).
CONCLUSION Automatic patellar height assessment can be achieved on high-resolution radiographs with the required accuracy. Determining patellar end-points and the joint line-fitting to the proximal tibia joint surface allows for accurate CD and BP index calculations. The obtained results indicate that this approach can be valuable tool in a medical practice.
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Affiliation(s)
- Kamil Kwolek
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Dariusz Grzelecki
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Konrad Kwolek
- Department of Orthopaedics and Traumatology, University Hospital, Krakow 30-663, Poland
| | - Dariusz Marczak
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Jacek Kowalczewski
- Department of Orthopaedics and Rheumoorthopedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
| | - Marcin Tyrakowski
- Department of Spine Disorders and Orthopaedics, Centre of Postgraduate Medical Education, Gruca Orthopaedic and Trauma Teaching Hospital, Otwock 05-400, Poland
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Liaghat B, Folkestad L, Skou ST, Koes B, Hartvigsen J. Prevalence and consequences of musculoskeletal pain in the upper and lower extremities: A cross-sectional analysis of patients with type 1 and type 2 diabetes in Denmark. Prim Care Diabetes 2023; 17:267-272. [PMID: 36890059 DOI: 10.1016/j.pcd.2023.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Revised: 01/18/2023] [Accepted: 02/22/2023] [Indexed: 03/08/2023]
Abstract
AIMS To describe the one-week and 12-month prevalence of musculoskeletal pain in the upper and lower extremities and consequences in relation to care seeking, leisure time activity, and work life in patients with type 1 and 2 diabetes. METHODS A cross-sectional survey including adults diagnosed with type 1 and 2 diabetes from two Danish secondary care databases. Questions covered pain prevalence (shoulder, elbow, hand, hip, knee, ankle) and its consequences based on the Standardised Nordic Questionnaire. Data was presented using proportions (95 % confidence intervals). RESULTS The analysis included 3767 patients. The one-week prevalence was 9.3-30.8 % and 12-month prevalence 13.9-41.8 %, highest for shoulder pain (30.8-41.8 %). The prevalence was similar between type 1 and 2 diabetes for the upper extremity, but higher in type 2 for the lower extremity. Women had a higher pain prevalence for any joint for both diabetes types, while estimates did not vary between age groups (<60 or ≥60 years). More than half of the patients had reduced their activities at work or leisure time, and more than one-third had sought care during the past year because of pain. CONCLUSIONS Musculoskeletal pain in the upper and lower extremities is common in patients with type 1 and 2 diabetes from Denmark, with considerable consequences for work and leisure activities.
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Affiliation(s)
- Behnam Liaghat
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Centre for Evidence-Based Orthopaedics, Department of Orthopaedic Surgery, Zealand University Hospital, Køge, Denmark.
| | - Lars Folkestad
- Department of Endocrinology, Odense University Hospital, Odense, Denmark; Department of Clinical Research, University of Southern Denmark, Odense, Denmark; Open Patient Exploratory Network, University of Southern Denmark, Odense, Denmark
| | - Søren T Skou
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Slagelse, Denmark
| | - Bart Koes
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Department of General Practice, Erasmus MC, Rotterdam, the Netherlands
| | - Jan Hartvigsen
- Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark; Chiropractic Knowledge Hub, Odense, Denmark
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Scheuing WJ, Reginato AM, Deeb M, Acer Kasman S. The burden of osteoarthritis: Is it a rising problem? Best Pract Res Clin Rheumatol 2023; 37:101836. [PMID: 37633827 DOI: 10.1016/j.berh.2023.101836] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 04/27/2023] [Indexed: 08/28/2023]
Abstract
The objective of this review is to provide an overview of the current status of osteoarthritis (OA) as one of the most common joint disorders worldwide. Despite being the 11th cause of disability globally, there has been an increase in the prevalence, annual incidence, and years lived with disability of OA, particularly in developed and developing countries. Erosive hand OA, which affects approximately 10% of the general population, has been associated with a higher clinical burden compared to non-erosive hand OA. Patients with knee and hip OA, but not hand OA, are also at an increased risk of cardiovascular disease and all-cause mortality. Furthermore, OA has a significant contribution to healthcare costs in most countries. The recent COVID-19 pandemic has further exacerbated the disease burden of OA patients due to limited access to medical and surgical treatment. With increasing life expectancy and the aging of the global population, the burden of OA is expected to worsen. Therefore, this review highlights the importance of improving population and policymaker awareness of risk factors, such as obesity and injury, as well as early intervention and management of OA to control the future burden of the disease.
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Affiliation(s)
| | | | - Mery Deeb
- Department of Internal Medicine, Kent Hospital/Brown University, Warwick, RI, USA.
| | - Sevtap Acer Kasman
- Marmara University School of Medicine, PMR Department, Rheumatology Division, Istanbul, Türkiye.
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Roxburgh BH, Campbell HA, Cotter JD, Reymann U, Williams MJA, Gwynne-Jones D, Thomas KN. Acute and adaptive cardiovascular and metabolic effects of passive heat therapy or high-intensity interval training in patients with severe lower-limb osteoarthritis. Physiol Rep 2023; 11:e15699. [PMID: 37300374 DOI: 10.14814/phy2.15699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Accepted: 04/27/2023] [Indexed: 06/12/2023] Open
Abstract
Exercise is painful and difficult to perform for patients with severe lower-limb osteoarthritis; consequently, reduced physical activity contributes to increased cardiometabolic disease risk. The aim of this study was to characterize the acute and adaptive cardiovascular and metabolic effects of two low or no impact therapies in patients with severe lower-limb osteoarthritis: passive heat therapy (Heat) and high-intensity interval training (HIIT) utilizing primarily the unaffected limbs, compared to a control intervention of home-based exercise (Home). Participants completed up to 12 weeks of either Heat (20-30 min immersed in 40°C water followed by ~15-min light resistance exercise), HIIT (6-8 × 60-s intervals on a cross-trainer or arm ergometer at ~90-100% peak V ̇ $$ \dot{V} $$ O2 ) or Home (~15-min light resistance exercise); all 3 sessions/week. Reductions in systolic (12 & 10 mm Hg), diastolic (7 & 4 mm Hg), and mean arterial (8 & 6 mm Hg) blood pressure (BP) were observed following one bout of Heat or HIIT exposure, lasting for the duration of the 20-min monitoring period. Across the interventions (i.e., 12 weeks), resting systolic BP and diastolic BP decreased with Heat (-9 & -4 mm Hg; p < 0.001) and HIIT (-7 & -3 mm Hg; p ≤ 0.011), but not Home (0 & 0 mm Hg; p ≥ 0.785). The systolic and diastolic BP responses to an acute exposure of Heat or HIIT in the first intervention session were moderately correlated with adaptive responses across the intervention (r ≥ 0.54, p ≤ 0.005). Neither intervention improved indices of glycemic control (p = 0.310). In summary, both Heat and HIIT induced potent immediate and adaptive hypotensive effects, and the acute response was moderately predictive of the long-term response.
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Affiliation(s)
- Brendon H Roxburgh
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- HeartOtago, University of Otago, Dunedin, New Zealand
| | - Holly A Campbell
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- HeartOtago, University of Otago, Dunedin, New Zealand
| | - James D Cotter
- School of Physical Education, Sport and Exercise Sciences, University of Otago, Dunedin, New Zealand
- HeartOtago, University of Otago, Dunedin, New Zealand
| | - Ulla Reymann
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - Michael J A Williams
- HeartOtago, University of Otago, Dunedin, New Zealand
- Department of Medicine, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
| | - David Gwynne-Jones
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- Department of Orthopaedic Surgery, Dunedin Hospital, Southern District Health Board, Dunedin, New Zealand
| | - Kate N Thomas
- Department of Surgical Sciences, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
- HeartOtago, University of Otago, Dunedin, New Zealand
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Fujita R, Ota S, Yamamoto Y, Kataoka A, Warashina H, Inoue T, Ozeki S, Sugiura H. Effect of diabetes mellitus on physical activity in patients with knee osteoarthritis: A cross-sectional study. J Orthop Surg (Hong Kong) 2023; 31:10225536231197726. [PMID: 37621081 DOI: 10.1177/10225536231197726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
Abstract
PURPOSE Knee osteoarthritis (OA) may be comorbid with diabetes mellitus (DM), and physical activity is a recommended lifestyle strategy for both diseases. The present study investigated the physical activity differences by intensity between knee OA patients with or without DM, and evaluated if physical activity was associated with the presence of DM in knee OA patients. METHODS A total of 183 patients (mean age 74.9 ± 6.4 years) with moderate-to-severe knee OA underwent evaluation of knee function (i.e., knee flexion/extension range-of-motion, knee-extension muscle strength, and knee pain), the timed up-and-go (TUG) test, and physical activity measurement using an accelerometer. Physical activity by intensity was compared between knee OA patients with and without DM. The association between physical activity, including knee function and the TUG test time, and DM was assessed. RESULTS The 2 groups (with or without DM) did not differ significantly in knee OA severity or age. Compared to knee OA patients without DM, knee OA patients with DM had a significantly lower average daily step count (p < 0.001), and significantly shorter times spent performing light-intensity physical activity (LPA; p < 0.001) and moderate-to-vigorous-intensity physical activity (MVPA; p = 0.006). After adjusting for age, sex, and body mass index, we found that a lower average daily step count and shorter LPA time significantly correlated with DM (β = -0.200, p = 0.006; β = -0.216, p = 0.004, respectively) and a longer TUG test time (β = -0.196, p = 0.014; β = -0.208, p = 0.011, respectively). A shorter MVPA time significantly correlated with lower contralateral knee-extension muscle strength (β = 0.187, p = 0.032). CONCLUSION Knee OA patients with DM had significantly lower physical activity levels than those without DM. Furthermore, the presence of DM correlated with a lower step count and a shorter LPA time in knee OA patients.
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Affiliation(s)
- Remi Fujita
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
- Department of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Susumu Ota
- Department of Rehabilitation and Care, Seijoh University, Tokai, Japan
| | - Yuri Yamamoto
- Department of Rehabilitation, Nagoya Orthopaedic and Joint Replacement Clinic, Kitanagoya, Japan
| | - Akito Kataoka
- Department of Rehabilitation, Nagoya Orthopaedic and Joint Replacement Clinic, Kitanagoya, Japan
| | - Hideki Warashina
- Department of Orthopedics, Nagoya Orthopaedic and Joint Replacement Clinic, Kitanagoya, Japan
| | - Tomoe Inoue
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
| | - Shinya Ozeki
- Department of Rehabilitation, Mariana Home-Nursing Station, Nagoya, Japan
| | - Hideshi Sugiura
- Department of Integrated Health Sciences, Nagoya University Graduate School of Medicine, Nagoya, Japan
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Alenazi AM, Alhowimel AS, Alshehri MM, Alqahtani BA, Alhwoaimel NA, Segal NA, Kluding PM. Osteoarthritis and Diabetes: Where Are We and Where Should We Go? Diagnostics (Basel) 2023; 13:diagnostics13081386. [PMID: 37189487 DOI: 10.3390/diagnostics13081386] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 03/23/2023] [Accepted: 03/27/2023] [Indexed: 05/17/2023] Open
Abstract
Diabetes mellitus (DM) and osteoarthritis (OA) are chronic noncommunicable diseases that affect millions of people worldwide. OA and DM are prevalent worldwide and associated with chronic pain and disability. Evidence suggests that DM and OA coexist within the same population. The coexistence of DM in patients with OA has been linked to the development and progression of the disease. Furthermore, DM is associated with a greater degree of osteoarthritic pain. Numerous risk factors are common to both DM and OA. Age, sex, race, and metabolic diseases (e.g., obesity, hypertension, and dyslipidemia) have been identified as risk factors. These risk factors (demographics and metabolic disorder) are associated with DM or OA. Other possible factors may include sleep disorders and depression. Medications for metabolic syndromes might be related to the incidence and progression of OA, with conflicting results. Given the growing body of evidence indicating a relationship between DM and OA, it is vital to analyze, interpret, and integrate these findings. Therefore, the purpose of this review was to evaluate the evidence on the prevalence, relationship, pain, and risk factors of both DM and OA. The research was limited to knee, hip, and hand OA.
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Affiliation(s)
- Aqeel M Alenazi
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Ahmed S Alhowimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Mohammed M Alshehri
- Departement of Physical Therapy, Jazan University, Jazan 45142, Saudi Arabia
| | - Bader A Alqahtani
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Norah A Alhwoaimel
- Department of Health and Rehabilitation Sciences, Prince Sattam Bin Abdulaziz University, Alkharj 11942, Saudi Arabia
| | - Neil A Segal
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, MI 66160, USA
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas Medical Center, Kansas City, MI 66160, USA
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Nadella H, Bloom AW, Demory Beckler M, Kesselman MM. The Overlap of Diabetes and Osteoarthritis in American Populations. Cureus 2023; 15:e38287. [PMID: 37255905 PMCID: PMC10226284 DOI: 10.7759/cureus.38287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 04/28/2023] [Indexed: 06/01/2023] Open
Abstract
Diabetes mellitus, a condition in which the body's ability to produce insulin is impaired, and osteoarthritis (OA), a painful degeneration of joint cartilage, are both serious conditions that affect millions of people in the United States (U.S.). Osteoarthritis is a chronic degenerative condition of the joint cartilage, affecting mainly the older population. The purpose of this paper is to find a connection, if any, between diabetes and osteoarthritis and if either condition can predispose an individual to the other. Not only can this review help to explain the co-existence of these two diseases, but it can also be used to look into a cure for patients in the future. After preliminary searches were done on PubMed, results were narrowed using specific keywords and similar risk factors among the two diseases. It was found that these two conditions are actually interrelated due to oxidative stress and pro-inflammatory cytokines. Seeing the high risk of developing one of these conditions and that obesity, one of the biggest risk factors for both diabetes and osteoarthritis, is at an all-time high in this country, a possible connection between the two of these diseases is very prevalent to look into. This information can be used to help correlate not only a better-targeted treatment but also lead to future research into why obesity is one of the biggest risk factors for both conditions.
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Affiliation(s)
- Harshita Nadella
- Rheumatology and Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Allan W Bloom
- Internal Medicine, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Davie, USA
| | - Michelle Demory Beckler
- Microbiology and Immunology, Nova Southeastern University Dr. Kiran C. Patel College of Allopathic Medicine, Fort Lauderdale, USA
| | - Marc M Kesselman
- Rheumatology, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Nova Southeastern University, Davie, USA
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Hui Mingalone CK, Nehme CR, Chen Y, Liu J, Longo BN, Garvey KD, Covello SM, Nielsen HC, James T, Messner WC, Zeng L. A novel whole "Joint-in-Motion" device reveals a permissive effect of high glucose levels and mechanical stress on joint destruction. Osteoarthritis Cartilage 2023; 31:493-506. [PMID: 36379392 PMCID: PMC10033281 DOI: 10.1016/j.joca.2022.10.018] [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: 02/09/2022] [Revised: 09/12/2022] [Accepted: 10/13/2022] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Osteoarthritis (OA) has recently been suggested to be associated with diabetes. However, this association often disappears when accounting for body mass index (BMI), suggesting that mechanical stress may be a confounding factor. We investigated the combined influence of glucose level and loading stress on OA progression using a novel whole joint-in-motion (JM) culture system. DESIGN Whole mouse knee joints were placed in an enclosed chamber with culture media and actuated to recapitulate leg movement, with a dynamic stress regimen of 0.5 Hz, 8 h/day for 7 days. These joints were treated with varying levels of glucose and controlled for osmolarity and diffusion. Joint movement and joint space were examined by X-ray fluoroscopy and microCT. Cartilage matrix levels were quantified by blinded Mankin scoring and immunohistochemistry. RESULTS Culturing in the JM device facilitated proper leg extension and flexion movements, and adequate mass transport for analyzing the effect of glucose on cartilage. Treatment with higher levels of glucose either via media supplementation or intra-articular injection caused a significant decrease in levels of glycosaminoglycan (GAG) and an increase in aggrecan neoepitope in articular cartilage, but only under dynamic stress. Additionally, collagen II level was slightly reduced by high glucose levels. CONCLUSIONS High levels of glucose and dynamic stress have permissive effects on articular cartilage GAG loss and aggrecan degradation, implicating that mechanical stress confounds the association of diabetes with OA. The JM device supports novel investigation of mechanical stress on the integrity of an intact living mouse joint to provide insights into OA pathogenesis.
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Affiliation(s)
- C K Hui Mingalone
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - C R Nehme
- Department of Mechanical Engineering, Tufts University, Medford, MA 02155, USA
| | - Y Chen
- Program in Pharmacology and Drug Development, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - J Liu
- Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA
| | - B N Longo
- Department of Mechanical Engineering, Tufts University, Medford, MA 02155, USA
| | - K D Garvey
- Program in Pharmacology and Drug Development, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - S M Covello
- Program in Pharmacology and Drug Development, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA
| | - H C Nielsen
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA; Department of Pediatrics, Tufts Medical Center, Boston, MA 02111, USA
| | - T James
- Department of Mechanical Engineering, Tufts University, Medford, MA 02155, USA
| | - W C Messner
- Department of Mechanical Engineering, Tufts University, Medford, MA 02155, USA.
| | - L Zeng
- Program in Cell, Molecular, and Developmental Biology, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA; Program in Pharmacology and Drug Development, Graduate School of Biomedical Sciences, Tufts University, Boston, MA 02111, USA; Department of Immunology, Tufts University School of Medicine, Boston, MA 02111, USA.
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Warmink K, Vinod P, Korthagen NM, Weinans H, Rios JL. Macrophage-Driven Inflammation in Metabolic Osteoarthritis: Implications for Biomarker and Therapy Development. Int J Mol Sci 2023; 24:ijms24076112. [PMID: 37047082 PMCID: PMC10094694 DOI: 10.3390/ijms24076112] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 03/19/2023] [Accepted: 03/21/2023] [Indexed: 04/14/2023] Open
Abstract
Osteoarthritis (OA) is a common and debilitating joint disorder that leads to progressive joint breakdown and loss of articular cartilage. Accompanied by a state of low-grade inflammation, its etiology extends beyond that of a wear-and-tear disease, and the immune system might have a role in its initiation and progression. Obesity, which is directly associated with an increased incidence of OA, alters adipokine release, increases pro-inflammatory macrophage activity, and affects joint immune regulation. Studying inflammatory macrophage expression and strategies to inhibit inflammatory macrophage phenotype polarization might provide insights into disease pathogenesis and therapeutic applications. In pre-clinical studies, the detection of OA in its initial stages was shown to be possible using imaging techniques such as SPECT-CT, and advances are made to detect OA through blood-based biomarker analysis. In this review, obesity-induced osteoarthritis and its mechanisms in inducing joint degeneration are summarized, along with an analysis of the current developments in patient imaging and biomarker use for diagnostic and therapeutic strategies.
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Affiliation(s)
- Kelly Warmink
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Prateeksha Vinod
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
| | - Nicoline M Korthagen
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, 3584 CL Utrecht, The Netherlands
| | - Harrie Weinans
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
- Department of Biomechanical Engineering, TU Delft, 2628 CD Delft, The Netherlands
| | - Jaqueline L Rios
- Department of Orthopedics, University Medical Center Utrecht, 3584 CX Utrecht, The Netherlands
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Ruan G, Ying Y, Lu S, Zhu Z, Chen S, Zeng M, Lu M, Xue S, Zhu J, Cao P, Chen T, Wang X, Li S, Li J, Liu Y, Liu Y, Zhang Y, Ding C. The effect of systemic iron status on osteoarthritis: A mendelian randomization study. Front Genet 2023; 14:1122955. [PMID: 37007954 PMCID: PMC10060517 DOI: 10.3389/fgene.2023.1122955] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Accepted: 03/07/2023] [Indexed: 03/18/2023] Open
Abstract
Objective: To assess the causal effect of systemic iron status by using four biomarkers (serum iron; transferrin saturation; ferritin; total iron-binding capacity) on knee osteoarthritis (OA), hip OA, total knee replacement, and total hip replacement using 2-sample Mendelian randomization (MR) design.Methods: Three instrument sets were used to construct the genetic instruments for the iron status: Liberal instruments (variants associated with one of the iron biomarkers), sensitivity instruments (liberal instruments exclude variants associated with potential confounders), and conservative instruments (variants associated with all four iron biomarkers). Summary-level data for four OA phenotypes, including knee OA, hip OA, total knee replacement, and total hip replacement were obtained from the largest genome-wide meta-analysis with 826,690 individuals. Inverse-variance weighted based on the random-effect model as the main approach was conducted. Weighted median, MR-Egger, and Mendelian randomization pleiotropy residual sum and outlier methods were used as sensitivity MR approaches.Results: Based on liberal instruments, genetically predicted serum iron and transferrin saturation were significantly associated with hip OA and total hip replacement, but not with knee OA and total knee replacement. Statistical evidence of heterogeneity across the MR estimates indicated that mutation rs1800562 was the SNP significantly associated with hip OA in serum iron (odds ratio, OR = 1.48), transferrin saturation (OR = 1.57), ferritin (OR = 2.24), and total-iron binding capacity (OR = 0.79), and hip replacement in serum iron (OR = 1.45), transferrin saturation (OR = 1.25), ferritin (OR = 1.37), and total-iron binding capacity (OR = 0.80).Conclusion: Our study suggests that high iron status might be a causal factor of hip OA and total hip replacement where rs1800562 is the main contributor.
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Affiliation(s)
- Guangfeng Ruan
- Clinical Research Centre, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Yi Ying
- Department of Hematopathology, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Shilong Lu
- Department of Imaging Diagnosis, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Zhaohua Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shibo Chen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Muhui Zeng
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Ming Lu
- Department of Immunology, School of Basic Medical Sciences, Anhui Medical University, Hefei, China
| | - Song Xue
- Department of Rheumatology and Immunology, Arthritis Research Institute, The First Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Jianwei Zhu
- Department of Orthopedics, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
| | - Peihua Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Tianyu Chen
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Xiaoshuai Wang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Shengfa Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Jia Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yu Liu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yanqi Liu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
| | - Yan Zhang
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- *Correspondence: Yan Zhang, ; Changhai Ding,
| | - Changhai Ding
- Clinical Research Centre, Guangzhou First People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, China
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Menzies Institute for Medical Research, University of Tasmania, Hobart, TAS, Australia
- *Correspondence: Yan Zhang, ; Changhai Ding,
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Zheng J, Huang X, Huang J, Meng B, Li F, Liu H, Chen L, Zhou R, Zou M, Wu X. Association of Diabetes Mellitus Status and Hyperglycemia With Symptomatic Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2023; 75:509-518. [PMID: 35225437 DOI: 10.1002/acr.24872] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Revised: 02/12/2022] [Accepted: 02/22/2022] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Emerging evidence indicates that hyperglycemia has an adverse impact on the knee joint which, in turn, may increase the risk of knee osteoarthritis (OA), but evidence from the real-life settings of large-scale cohort studies remains unclear. We sought to evaluate the association of glycemic control and the risk of symptomatic knee OA in a community-based cohort of older adults. METHODS We conducted a prospective analysis of 10,730 participants without knee OA. Comprehensive blood biomarker data were obtained. Diabetes mellitus (DM) was defined mainly using a glycosylated hemoglobin (HbA1c ) level of ≥6.5%; poor glycemic control in individuals with DM was defined as an HbA1c level of ≥7%. We fit Cox regression models, stratified according to DM status. We evaluated the hazards associated with HbA1c and fasting blood glucose levels using a spline model. RESULTS During a median follow-up of 5 years, knee OA developed in 1,089 participants (108 with DM and 971 without). Knee OA was related to DM (hazard ratio [HR] 1.29 [95% confidence interval (95% CI) 1.02-1.78]), bad glycemic regulation in DM patients (HR 1.41 [95% CI 1.05-2.09]), and long-term DM (≥5 versus <5 years; HR 1.49 [95% CI 1.02-2.17]). High levels of HbA1c (>7.7% and 61 mmoles/mole) and fasting blood glucose (>186 mg/dl) were significantly associated with higher risk of incident knee OA. CONCLUSION DM, bad glycemic management, and long-term DM are potential risk factors of symptomatic knee OA independent of age and body mass index. Targeting blood glucose, in addition to bodyweight, may be an important avenue for prevention of knee OA.
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Affiliation(s)
- Jiazhen Zheng
- The Hong Kong University of Science and Technology (Guangzhou), Guangzhou, China, and the Hong Kong University of Science and Technology, Clear Water Bay, Hong Kong, China
| | - Xihao Huang
- West China Hospital, Sichuan University, Chengdu, China
| | | | | | - Furong Li
- Southern University of Science and Technology, Shenzhen, China
| | - Huamin Liu
- Southern Medical University, Guangzhou, China
| | | | - Rui Zhou
- Southern Medical University, Guangzhou, China
| | - Mengchen Zou
- Nanfang Hospital, Southern Medical University, Guangzhou, China
| | - Xianbo Wu
- Southern Medical University, Guangzhou, China
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King LK, Ivers NM, Waugh EJ, MacKay C, Stanaitis I, Krystia O, Stretton J, Wong S, Weisman A, Bardai Z, Ross S, Brady S, Shloush M, Stier T, Gakhal N, Agarwal P, Parsons J, Lipscombe L, Hawker GA. Improving diagnosis and treatment of knee osteoarthritis in persons with type 2 diabetes: development of a complex intervention. Implement Sci Commun 2023; 4:20. [PMID: 36855209 PMCID: PMC9972628 DOI: 10.1186/s43058-023-00398-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Accepted: 02/09/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Symptomatic knee osteoarthritis (OA) commonly co-occurs in people with type 2 diabetes (T2DM) and increases the risk for diabetes complications, yet uptake of evidence-based treatment is low. We combined theory, stakeholder involvement and existing evidence to develop a multifaceted intervention to improve OA care in persons with T2DM. This was done in partnership with Arthritis Society Canada to leverage the existing infrastructure and provincial funding for community arthritis care. METHODS Each step was informed by a User Advisory Panel of stakeholder representatives, including persons with lived experience. First, we identified the target groups and behaviours through consulting stakeholders and current literature. Second, we interviewed persons living with T2DM and knee OA (n = 18), health professionals (HPs) who treat people with T2DM (n = 18) and arthritis therapists (ATs, n = 18) to identify the determinants of seeking and engaging in OA care (patients), assessing and treating OA (HPs) and considering T2DM in OA treatment (ATs), using the Theoretical Domains Framework (TDF). We mapped the content to behavioural change techniques (BCTs) to identify the potential intervention components. Third, we conducted stakeholder meetings to ascertain the acceptability and feasibility of intervention components, including content and modes of delivery. Fourth, we selected intervention components informed by prior steps and constructed a programme theory to inform the implementation of the intervention and its evaluation. RESULTS We identified the barriers and enablers to target behaviours across a number of TDF domains. All stakeholders identified insufficient access to resources to support OA care in people with T2DM. Core intervention components, incorporating a range of BCTs at the patient, HP and AT level, sought to identify persons with knee OA within T2DM care and refer to Arthritis Society Canada for delivery of evidence-based longitudinal OA management. Diverse stakeholder input throughout development allowed the co-creation of an intervention that appears feasible and acceptable to target users. CONCLUSIONS We integrated theory, evidence and stakeholder involvement to develop a multifaceted intervention to increase the identification of knee OA in persons with T2DM within diabetes care and improve the uptake and engagement in evidence-based OA management. Our partnership with Arthritis Society Canada supports future spread, scalability and sustainability. We will formally assess the intervention feasibility in a randomized pilot trial.
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Affiliation(s)
- Lauren K. King
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Noah M. Ivers
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Esther J. Waugh
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Crystal MacKay
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada
| | - Ian Stanaitis
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Owen Krystia
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada
| | | | - Sim Wong
- Patient Research Partner, Toronto, ON Canada
| | - Alanna Weisman
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.250674.20000 0004 0626 6184Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON Canada
| | - Zahra Bardai
- grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Susan Ross
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Shawn Brady
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Marlee Shloush
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Tara Stier
- grid.469795.0Arthritis Rehabilitation and Education Program, Arthritis Society Canada, Toronto, ON Canada
| | - Natasha Gakhal
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Payal Agarwal
- grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Community and Family Medicine, University of Toronto, Toronto, ON Canada
| | - Janet Parsons
- grid.17063.330000 0001 2157 2938Department of Physical Therapy, University of Toronto, Toronto, ON Canada ,grid.415502.7Applied Health Research Centre, Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Toronto, ON Canada
| | - Lorraine Lipscombe
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
| | - Gillian A. Hawker
- grid.17063.330000 0001 2157 2938Department of Medicine, University of Toronto, Toronto, ON Canada ,grid.417199.30000 0004 0474 0188Women’s College Research Institute, Women’s College Hospital, Toronto, ON Canada
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Association between knee osteoarthritis and the risk of cardiovascular disease and the synergistic adverse effects of lack of exercise. Sci Rep 2023; 13:2777. [PMID: 36797339 PMCID: PMC9935498 DOI: 10.1038/s41598-023-29581-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2022] [Accepted: 02/07/2023] [Indexed: 02/18/2023] Open
Abstract
We aimed to determine whether knee OA is associated with CVD risk and all-cause death and to evaluate whether the association differs by exercise behavior. We used Korea National Health Insurance Service (KNHIS) database and included 201,466 participants (7572 subjects diagnosed with knee OA) who underwent health screening between 2009 and 2015. Those who had been diagnosed with knee OA or CVD before the index year were excluded. Cox proportional hazard models were used after adjusting for sociodemographic and CVD risk factors to evaluate the association between knee OA and CVD risk and all-cause death. Stratification analysis was further performed to determine the effect of exercise behavior on this relationship. During a median follow-up of 7.06 ± 2.24 years, 8743 CVD (2510 MI and 6553 stroke) cases developed. Individuals with knee OA had increased risks of CVD [hazard ratio (HR) 1.26, 95% confidence interval (CI) 1.15-1.38], myocardial infarction (MI) (HR 1.20, 95% CI 1.00-1.44), and stroke (HR 1.29, 95% CI 1.16-1.43) compared with those without knee OA. Those with knee OA who did not exercise had an increased risk of CVD (HR 1.25, 95% CI 1.11-1.40), whereas no significant increased CVD risk was observed in those with knee OA who exercised at least once a week (HR 1.11, 95% CI 0.96-1.28). There was no association between knee osteoarthritis and all-cause death. Knee OA was independently associated with an increased risk of CVD. Lack of exercise might have a synergistic adverse effect on the association between knee OA and CVD.
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Yoo HJ, Jeong HW, Park SB, Shim SJ, Nam HS, Lee YS. Do Individualized Patient-Specific Situations Predict the Progression Rate and Fate of Knee Osteoarthritis? Prediction of Knee Osteoarthritis. J Clin Med 2023; 12:jcm12031204. [PMID: 36769856 PMCID: PMC9918059 DOI: 10.3390/jcm12031204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2022] [Revised: 01/16/2023] [Accepted: 01/31/2023] [Indexed: 02/05/2023] Open
Abstract
Factors affecting the progression rate and fate of osteoarthritis need to be analyzed when considering patient-specific situation. This study aimed to identify the rate of remarkable progression and fate of primary knee osteoarthritis based on patient-specific situations. Between May 2003 and May 2019, 83,280 patients with knee pain were recruited for this study from the clinical data warehouse. Finally, 2492 knees with pain that were followed up for more than one year were analyzed. For analyzing affecting factors, patient-specific information was categorized and classified as demographic, radiologic, social, comorbidity disorders, and surgical intervention data. The degree of contribution of factors to the progression rate and the fate of osteoarthritis was analyzed. Bone mineral density (BMD), Kellgren-Lawrence (K-L) grade, and physical occupational demands were major contributors to the progression rate of osteoarthritis. Hypertension, initial K-L grade, and physical occupational demands were major contributors to the outcome of osteoarthritis. The progression rate and fate of osteoarthritis were mostly affected by the initial K-L grade and physical occupational demands. Patients who underwent surgical intervention for less than five years had the highest proportion of initial K-L grade 2 (49.0%) and occupations with high physical demand (41.3%). In identifying several contributing factors, the initial K-L grade and physical occupational demands were the most important factors. BMD and hypertension were also major contributors to the progression and fate of osteoarthritis, and the degree of contribution was lower compared to the two major factors.
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Affiliation(s)
- Hyun Jin Yoo
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea
- Department of Orthopedic Surgery, Konyang University College of Medicine, Daejeon 35365, Republic of Korea
| | - Ho Won Jeong
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea
| | - Sung Bae Park
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea
| | - Seung Jae Shim
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea
| | - Hee Seung Nam
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea
| | - Yong Seuk Lee
- Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seoul 13620, Republic of Korea
- Correspondence: or ; Tel.: +82-31-787-7199; Fax: +82-31-787-4056
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Associations between obesity, diabetes mellitus, and cardiovascular disease with progression states of knee osteoarthritis (KOA). Aging Clin Exp Res 2023; 35:333-340. [PMID: 36525243 DOI: 10.1007/s40520-022-02312-8] [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: 09/01/2022] [Accepted: 11/27/2022] [Indexed: 12/23/2022]
Abstract
BACKGROUND Data on common comorbidities targeting at different progression states of knee osteoarthritis (KOA) in continuous time are limited. AIMS To examine the associations between obesity, diabetes mellitus (DM), and cardiovascular disease (CVD) with the progression of KOA. METHODS Data were obtained from the Osteoarthritis Initiative for up to 48 months. Progression states of KOA were defined as (1) normal; (2) asymptomatic radiographic KOA (RKOA, Kellgren-Lawrence grade ≥ 2 in at least one knee); (3) only knee symptoms; (4) symptomatic KOA (SxKOA, a combination of RKOA and knee symptoms in the same knee). A multi-state Markov model was used to investigate the associations while accounting for potential confounders. RESULTS Participants with obesity had an increased risk of developing RKOA [normal to asymptomatic RKOA, adjusted hazard ratio (aHR) 1.55, 95% confidence interval (95% CI) (1.07, 2.24); only knee symptoms to SxKOA, aHR 2.25, 95% CI (1.60, 3.18)], and an increased risk of developing knee symptoms [normal to only knee symptoms, aHR 1.45, 95% CI (1.15, 1.83); asymptomatic RKOA to SxKOA, aHR 1.33, 95% CI (1.16, 1.52)]. DM was also significantly associated with development of RKOA or knee symptoms [normal to asymptomatic RKOA, aHR 1.92, 95% CI (1.12, 3.30); normal to only knee symptoms, aHR 1.78, 95% CI (1.12, 2.84)]. Knee symptoms were less likely to be relieved among participants with CVD, compared with those without [only knee symptoms to normal, aHR 0.60, 95% CI (0.38, 0.94)]. CONCLUSIONS Obesity, DM and CVD are associated with an increased risk for SxKOA progression. Common comorbidities should be considered to prevent KOA development.
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Sarvilina IV, Danilov AB, Tkacheva ON, Gromova OA, Solovieva EY, Dudinskaya EN, Rozanov AV, Kartashova EA. [Influence of chronic pain in osteoarthritis on the risk of cardiovascular diseases and modern methods of drug prevention]. Zh Nevrol Psikhiatr Im S S Korsakova 2023; 123:20-30. [PMID: 37315238 DOI: 10.17116/jnevro202312305120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/16/2023]
Abstract
The purpose of the review of scientific medical literature was to evaluate the data of the epidemiology of osteoarthritis (OA) and cardiovascular diseases (CVD) with the analysis of risk factors, pathophysiological and pathobiochemical mechanisms of the relationship between OA and the risk of developing CVD in the presence of chronic pain, modern strategies for screening and management of this cohort of patients, the mechanism of action and pharmacological effects of chondroitin sulfate (CS). Conclusions were drawn about the need for additional clinical and observational studies of the efficacy and safety of the parenteral form of CS (Chondroguard) in patients with chronic pain in OA and CVD, improvement of clinical recommendations for the treatment of chronic pain in patients with OA and cardiovascular risk, with special attention to interventions that eliminate mobility restrictions in patients and the inclusion of basic and adjuvant therapy with DMOADs to achieve the goals of multipurpose monotherapy in patients with contraindications to standard therapy drugs.
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Affiliation(s)
- I V Sarvilina
- Medical Center «Novomedicina» LLC, Rostov-on-Don, Russia
| | - Al B Danilov
- Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - O N Tkacheva
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - O A Gromova
- Federal Research Center «Computer Science and Control», Moscow, Russia
| | - E Yu Solovieva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E N Dudinskaya
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
| | - A V Rozanov
- Russian Clinical and Research Center of Gerontology - Pirogov Russian National Research Medical University, Moscow, Russia
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Mohajer B, Moradi K, Guermazi A, Dolatshahi M, Zikria B, Najafzadeh N, Kalyani RR, Roemer FW, Berenbaum F, Demehri S. Diabetes-associated thigh muscle degeneration mediates knee osteoarthritis-related outcomes: results from a longitudinal cohort study. Eur Radiol 2023; 33:595-605. [PMID: 35951046 PMCID: PMC10448875 DOI: 10.1007/s00330-022-09035-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 07/01/2022] [Accepted: 07/24/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES We examined the association between diabetes mellitus (DM) and longitudinal MRI biomarkers for thigh muscle degeneration in patients with knee osteoarthritis (KOA) and their mediatory role in worsening KOA-related symptoms. METHODS The Osteoarthritis Initiative (OAI) participants with radiographic KOA (Kellgren-Lawrence grade ≥ 2) were included. Thighs and corresponding knees of KOA patients with versus without self-reported DM were matched for potential confounders using propensity score (PS) matching. We developed and used a validated deep learning method for longitudinal thigh segmentation. We assessed the association of DM with 4-year longitudinal muscle degeneration in biomarkers of muscle cross-sectional area (CSA) and contractile percentage (non-fat CSA/total CSA). We further investigated whether DM is associated with 9-year risk of KOA radiographic progression, knee replacement (KR), and symptoms worsening. Finally, we evaluated whether the DM-KOA worsening association is mediated through preceding muscle degeneration. RESULTS After PS matching, 698 thighs/knees were included (185:513 with:without DM; average ± SD age:64 ± 8-years; female/male:1.4). Baseline DM was associated with a decreased contractile percent of total thigh muscles and quadriceps (mean difference, 95%CI -0.16%/year, -0.25 to -0.07, and -0.21%/year, -0.33 to -0.08). DM was also associated with an increased risk of worsening KOA-related symptoms (hazard ratio, 95%CI 1.70, 1.18-2.46) but not radiographic progression or KR. The decrease in quadriceps contractile percent partially mediated the increased risk of symptoms worsening in patients with DM. CONCLUSIONS Baseline DM is associated with thigh muscle degeneration and KOA-related symptoms worsening. As a potentially modifiable risk factor, DM-associated longitudinal thigh muscle degeneration may partially mediate the symptoms worsening in patients with DM and coexisting KOA. KEY POINTS • Diabetes mellitus (DM) is associated with worsening knee osteoarthritis (KOA)-related symptoms. • As a potentially modifiable factor, DM-associated thigh muscle (quadriceps) degeneration partially mediates the worsening of KOA-related symptoms.
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Affiliation(s)
- Bahram Mohajer
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD, 21287, USA
| | - Kamyar Moradi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Mahsa Dolatshahi
- School of Medicine, Tehran University of Medical Sciences, Tehran, Iran
| | - Bashir Zikria
- Department of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | | | - Rita R Kalyani
- Division of Endocrinology, Diabetes, and Metabolism, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Frank W Roemer
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Universitätsklinikum Erlangen & Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen, Germany
| | - Francis Berenbaum
- Department of Rheumatology, Sorbonne University, INSERM CRSA, AP-HP Hospital Saint Antoine, Paris, France
| | - Shadpour Demehri
- Musculoskeletal Radiology, The Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 601 N Caroline St, JHOC 5165, Baltimore, MD, 21287, USA.
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Zhu Z, Huang JY, Ruan G, Cao P, Chen S, Zhang Y, Han W, Chen T, Cai X, Liu J, Tang Y, Yu N, Wang Q, Hunter DJ, Wei JCC, Ding C. Metformin use and associated risk of total joint replacement in patients with type 2 diabetes: a population-based matched cohort study. CMAJ 2022; 194:E1672-E1684. [PMID: 36535678 PMCID: PMC9829054 DOI: 10.1503/cmaj.220952] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/28/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND It is uncertain whether metformin use is associated with reduced risk of joint replacement in patients with type 2 diabetes mellitus. We aimed to establish whether metformin use was associated with a reduced risk of total knee replacement (TKR) or total hip replacement (THR) among these patients. METHODS We selected patients with type 2 diabetes mellitus that was diagnosed between 2000 and 2012 from the Taiwan National Health Insurance Research Database. We used prescription time-distribution matching and propensity-score matching to balance potential confounders between metformin users and nonusers. We assessed the risks of TKR or THR using Cox proportional hazards regression. RESULTS We included 20 347 participants who were not treated with metformin and 20 347 who were treated with metformin, for a total of 40 694 participants (mean age 63 yr, standard deviation 11 yr; 49.8% were women) after prescription time-distribution matching. Compared with participants who did not use metformin, those who used metformin had lower risks of TKR or THR (adjusted hazard ratio [HR] 0.70, 95% confidence interval [CI] 0.60-0.81 for TKR or THR; adjusted HR 0.71, 95% CI 0.61-0.84 for TKR; adjusted HR 0.61, 95% CI 0.41-0.92 for THR) after adjustment for covariates. Propensity-score matching analyses (10 163 participants not treated with metformin v. 10 163 treated with metformin) and sensitivity analyses using inverse probability of treatment weighting and competing risk regression showed similar results. INTERPRETATION Metformin use in patients with type 2 diabetes mellitus was associated with a significantly reduced risk of total joint replacement. Randomized controlled clinical trials in patients with osteoarthritis are warranted to determine whether metformin is effective in decreasing the need for joint replacement.
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Affiliation(s)
- Zhaohua Zhu
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Jing-Yang Huang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Guangfeng Ruan
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Peihua Cao
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Shibo Chen
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Yan Zhang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Weiyu Han
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Tianyu Chen
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Xiaoyan Cai
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Jia Liu
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Yujin Tang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Na Yu
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Qian Wang
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - David J Hunter
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - James Cheng-Chung Wei
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
| | - Changhai Ding
- Clinical Research and Orthopedic Centres (Zhu, Cao, S. Chen, Zhang, Han, T. Chen, Wang, Hunter, Ding), Zhujiang Hospital, Southern Medical University, Guangzhou, China; Department of Medical Research (Huang), Chung Shan Medical University Hospital; Institute of Medicine (Huang, Wei), Chung Shan Medical University, Taichung, Taiwan; Clinical Research Centre (Ruan), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Rheumatology (Cai, Ding), Guangzhou First People's Hospital, School of Medicine, South China University of Technology, Guangzhou, China; Department of Orthopedics (Liu, Tang, Ding), Affiliated Hospital of Youjiang Medical University for Nationalities, Baise, China; Guangzhou Eighth People's Hospital (Yu), Guangzhou Medical University, Guangzhou, Guangdong, China; Department of Rheumatology (Hunter), Royal North Shore Hospital and Sydney Musculoskeletal Health, Kolling Institute, University of Sydney, Sydney, Australia; Department of Medicine (Wei), Chung Shan Medical University Hospital; Graduate Institute of Integrated Medicine (Wei), China Medical University; Department of Medical Research (Wei), Taichung Veterans General Hospital, Taichung, Taiwan; Menzies Institute for Medical Research (Ding), University of Tasmania, Hobart, Australia
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Hu X, Meng L, Wei Z, Xu H, Li J, Li Y, Jia N, Li H, Qi X, Zeng X, Zhang Q, Li J, Liu D. Prevalence and potential risk factors of self-reported diabetes among elderly people in China: A national cross-sectional study of 224,142 adults. Front Public Health 2022; 10:1051445. [PMID: 36620236 PMCID: PMC9811661 DOI: 10.3389/fpubh.2022.1051445] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 11/28/2022] [Indexed: 12/23/2022] Open
Abstract
Aim To evaluated the prevalence and potential risk factors of self-reported diabetes among the elderly in China, by demographic data, socioeconomic factors, and psychological factors. Methods Descriptive analysis and Chi-square analysis were used to assess the prevalence and variation between self-reported diabetes and non-diabetes by demographic data, living habits, socioeconomic factors and comorbidities. Univariate and multivariate logistic regression were used to describe the odds ratios (OR) of diabetes prevalence in different groups, while stratification analysis was performed to describe prevalence based on gender, age, and urban/rural areas. Results 215,041 elderly adults (102,692 males and 112,349 females) were eventually included in the analysis. The prevalence of self-reported diabetes among the elderly in China is about 8.7%, with the highest prevalence in Beijing (20.8%) and the lowest prevalence in Xizang (0.9%). Logistic regression analysis showed that urban area (P < 0.001), older age (65-84 years old, P < 0.001), female (P < 0.001), higher income(P < 0.001), poor sleep quality (P = 0.01) and some other factors were potential risk factors for diabetes. Conclusions This study illustrates the prevalence and potential risk factors of diabetes among the elderly in China Meanwhile, these results provide information to assist the government in controlling non-communicable diseases in the elderly.
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Affiliation(s)
- Xing Hu
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China.,Graduate School of Peking University Health Science Center, Beijing, China
| | - Lingbing Meng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Zhimin Wei
- Health Service Department of the Guard Bureau of the Joint Staff Department, Beijing, China
| | - Hongxuan Xu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Jianyi Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Yingying Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Na Jia
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Hui Li
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xin Qi
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | - Xuezhai Zeng
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
| | | | - Juan Li
- Institute of Psychology, Chinese Academy of Sciences, Beijing, China
| | - Deping Liu
- Department of Cardiology, Beijing Hospital, National Center of Gerontology, Institute of Geriatric Medicine, Chinese Academy of Medical Sciences, Beijing, China
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King LK, Krystia O, Waugh EJ, MacKay C, Stanaitis I, Stretton J, Weisman A, Ivers NM, Parsons JA, Lipscombe L, Hawker GA. Understanding the behavioural determinants of seeking and engaging in care for knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the theoretical domains framework. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100305. [PMID: 36474800 PMCID: PMC9718122 DOI: 10.1016/j.ocarto.2022.100305] [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: 03/22/2022] [Revised: 07/27/2022] [Accepted: 07/28/2022] [Indexed: 11/22/2022] Open
Abstract
Objectives Symptomatic knee osteoarthritis (OA) frequently co-occurs in individuals with type 2 diabetes mellitus (T2DM). In the context of T2DM, OA is often underdiagnosed and undertreated. To elucidate strategies to improve OA care in persons with T2DM, we assessed their perceptions of the barriers and enablers to seeking and engaging in OA care. Design We conducted semi-structured interviews with 18 individuals with T2DM and symptomatic knee OA in Ontario, Canada. Transcripts were deductively coded using the Theoretical Domains Framework (TDF), an implementation science framework that incorporates theoretical domains of behaviour determinants, which can be linked to behaviour change techniques. Within each of the relevant domains, data were thematically analyzed to generate belief statements. Results Seven of the TDF domains prominently influenced the behaviour to seek and engage in OA care. Participants described insufficient receipt of OA knowledge to fully engage in care (knowledge), feeling incapable of participating in physical activity due to joint pain (beliefs about capabilities), uncertainty about effectiveness of therapies (optimism) and lack of guidance from health care providers and insufficient access to community programs/supports (environmental context and resources). Key enablers were strong social support (social influences), sources of accountability (behavioural regulation) and experiencing benefit from treatment (reinforcement). Participants did not see concomitant T2DM as limiting the desire to seek OA care. Conclusions Among individuals with symptomatic knee OA and T2DM, we identified behavioural determinants of seeking and engaging in OA care. These will be mapped to behavioural change techniques to inform development of a complex intervention.
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Affiliation(s)
- Lauren K. King
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Owen Krystia
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Esther J. Waugh
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Noah M. Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet A. Parsons
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital – Unity Health Toronto, Toronto, ON, Canada
| | - Lorraine Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Gillian A. Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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King LK, Krystia O, Waugh EJ, MacKay C, Stanaitis I, Stretton J, Weisman A, Ivers NM, Parsons JA, Lipscombe L, Hawker GA. Barriers and enablers to health care providers assessment and treatment of knee osteoarthritis in persons with type 2 diabetes mellitus: A qualitative study using the Theoretical Domains Framework. OSTEOARTHRITIS AND CARTILAGE OPEN 2022; 4:100299. [PMID: 36474789 PMCID: PMC9718241 DOI: 10.1016/j.ocarto.2022.100299] [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: 03/22/2022] [Revised: 07/05/2022] [Accepted: 07/26/2022] [Indexed: 11/19/2022] Open
Abstract
Objectives Symptomatic knee osteoarthritis (OA) commonly co-exists in persons with Type 2 diabetes (T2DM) and may impede diabetes self-management. Yet, OA is often underdiagnosed and undertreated due to competing health care demands. We sought to determine healthcare providers' (HCPs') perceptions of the barriers and enablers to assessing and treating knee OA in persons with T2DM. Design We conducted 18 semi-structured telephone interviews with HCPs who manage persons with T2DM (family physicians, endocrinologists, diabetes educators). Interviews were analyzed deductively using Theoretical Domains Framework (TDF), a framework developed to comprehensively identify behavioural determinants. Within relevant domains, data were thematically analyzed to generate belief statements, and these were compared across the different HCP disciplines. Results Six TDF domains influenced HCPs behaviour to assess and treat knee OA in persons with T2DM. For all HCPs, important barriers included not seeing assessment/treatment of joint pain as a priority for their patients (intention), and insufficient access to required resources such as physiotherapy to treat OA (environmental context and resources). Endocrinologists and diabetes educators perceived having insufficient knowledge and skills to identify and manage OA (knowledge, skills), did not consider it within their professional role to do so (professional role and identity), and perceived other physicians would not want to receive a referral for OA care (social influences). Conclusions We identified barriers and enablers encountered by diabetes HCPs to assessing and treating knee OA in persons with T2DM involving multiple domains of the TDF. These will help inform development of a complex intervention to improve health outcomes.
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Affiliation(s)
- Lauren K. King
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Owen Krystia
- Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Esther J. Waugh
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | | | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Lunenfeld-Tanenbaum Research Institute, Mount Sinai Hospital, Toronto, ON, Canada
| | - Noah M. Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
- Department of Community and Family Medicine, University of Toronto, Toronto, ON, Canada
| | - Janet A. Parsons
- Department of Physical Therapy, University of Toronto, Toronto, ON, Canada
- Applied Health Research Centre and Li Ka Shing Knowledge Institute, St. Michael's Hospital – Unity Health Toronto, Toronto, ON, Canada
| | - Lorraine Lipscombe
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
| | - Gillian A. Hawker
- Department of Medicine, University of Toronto, Toronto, ON, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada
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King LK, Waugh E, MacKay C, Stanaitis I, Stretton J, Weisman A, Ivers NM, Lipscombe LL, Hawker G, Parsons JA. 'It's a Dance Between Managing Both': a qualitative study exploring perspectives of persons with knee osteoarthritis and type 2 diabetes mellitus on the impact of osteoarthritis on diabetes management and daily life. BMJ Open 2022; 12:e061472. [PMID: 36332958 PMCID: PMC9639074 DOI: 10.1136/bmjopen-2022-061472] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVES Type 2 diabetes (T2DM) and knee osteoarthritis (OA) commonly co-occur and epidemiologic studies suggest concomitant symptomatic knee OA increases the risk of T2DM complications. We sought to explore the experiences and perspectives of individuals' living with both symptomatic knee OA and T2DM, with a focus on the impact of OA on T2DM management and daily life. DESIGN We conducted qualitative semistructured telephone interviews with persons living with T2DM and knee OA. We inductively coded and analysed interview transcripts, informed by interpretative description. SETTING We recruited participants from a community arthritis self-management programme and an academic hospital's family medicine clinic in Ontario, Canada. PARTICIPANTS We included 18 participants who had a physician diagnosis of both T2DM and knee OA, with variation age, gender, and duration of T2DM and knee OA. RESULTS Participants with T2DM described how concomitant painful and disabling knee OA made it difficult to engage in physical activity, negatively impacting blood glucose control. Joint pain itself, associated sleep disturbance and emotional distress were also seen to affect blood glucose control. Beyond diabetes management, the impact of OA-related pain and functional limitations on nearly all aspects of daily life led participants to view their OA as important. Despite this, many participants described that their health professionals paid little attention to their OA, which left them to self-manage. Balancing both conditions also required navigating a medical system that provided piecemeal care. CONCLUSIONS Individuals with T2DM view symptomatic knee OA as an important barrier to both T2DM management and overall well-being, yet are frequently met with insufficient support from health professionals. Greater recognition and management of knee OA in persons with T2DM could help improve patient-centred care and potentially disease outcomes.
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Affiliation(s)
- Lauren K King
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Esther Waugh
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Crystal MacKay
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
| | - Ian Stanaitis
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Jane Stretton
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Alanna Weisman
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Leadership Sinai Centre for Diabetes, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - Noah M Ivers
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Lorraine L Lipscombe
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Gillian Hawker
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
- Women's College Research Institute, Women's College Hospital, Toronto, Ontario, Canada
| | - Janet A Parsons
- Department of Physical Therapy, University of Toronto, Toronto, Ontario, Canada
- Applied Health Research Centre, St. Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada
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Auroux M, Merle B, Fontanges E, Duvert F, Lespessailles E, Chapurlat R. The disability associated with hand osteoarthritis is substantial in a cohort of post-menopausal women: the QUALYOR study. Osteoarthritis Cartilage 2022; 30:1526-1535. [PMID: 35995128 DOI: 10.1016/j.joca.2022.07.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 06/10/2022] [Accepted: 07/14/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Our primary aims were to assess current prevalence of HOA and the disability associated with this condition, in the group usually most affected, i.e., women older than 55. METHODS We performed hand radiographs, clinical examination, grip strength measurement, AUSCAN and COCHIN questionnaires in a cohort of postmenopausal women aged at least 55. Radiographic hand OA (RHOA) was defined as at least 2 affected joints among 30, grading 2 or more using the Kellgren Lawrence score but without any HOA symptom. Symptomatic HOA (OA ACR) was defined according to ACR criteria for hand OA. Moderate to severe symptomatic HOA was defined as having OA ACR and AUSCAN total score of >43/100. RESULTS We enrolled 1,189 participants. The mean age was 71.7 years. Inter-reader reliability of radiographs reading was good (ICC = 0.86) and intra-reader reliability was excellent (ICC = 0.97). Among the 1,189 women, 333 (28.0%) had RHOA, 482 (40.5%) patients fulfilled the ACR criteria for symptomatic HOA and 82 of these (17% of OA ACR population) had moderate to severe symptomatic HOA. The prevalence of symptomatic erosive osteoarthritis was 11.8%. Mean AUSCAN and Cochin scores were higher and grip strength lower in patients with symptomatic HOA compared to patient without HOA. Differences were more noticeable in patients with moderate to severe HOA. CONCLUSIONS We have assessed disability associated with HOA in greater detail than previously and found that a third of postmenopausal women had RHOA, two fifths had symptomatic HOA and one sixth of symptomatic patients had moderate to severe HOA related disability and a tenth had symptomatic erosive osteoarthritis, representing a substantial burden of disease in our population-based cohort.
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Affiliation(s)
- M Auroux
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France.
| | - B Merle
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 Lyon Cedex 03, France
| | - E Fontanges
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France
| | - F Duvert
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France
| | - E Lespessailles
- Centre Hospitalier Régional d'Orléans, Université d'Orléans, Orléans, France
| | - R Chapurlat
- Hôpital E Herriot, Hospices Civils de Lyon, 69437 Lyon Cedex 03 Lyon, France; INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 Lyon Cedex 03, France
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