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Cocea AC, Stoica CI. Interactions and Trends of Interleukins, PAI-1, CRP, and TNF-α in Inflammatory Responses during the Perioperative Period of Joint Arthroplasty: Implications for Pain Management-A Narrative Review. J Pers Med 2024; 14:537. [PMID: 38793119 PMCID: PMC11122505 DOI: 10.3390/jpm14050537] [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: 04/16/2024] [Revised: 05/14/2024] [Accepted: 05/15/2024] [Indexed: 05/26/2024] Open
Abstract
Inflammation during the perioperative period of joint arthroplasty is a critical aspect of patient outcomes, influencing both the pathophysiology of pain and the healing process. This narrative review comprehensively evaluates the roles of specific cytokines and inflammatory biomarkers in this context and their implications for pain management. Inflammatory responses are initiated and propagated by cytokines, which are pivotal in the development of both acute and chronic postoperative pain. Pro-inflammatory cytokines play essential roles in up-regulating the inflammatory response, which, if not adequately controlled, leads to sustained pain and impaired tissue healing. Anti-inflammatory cytokines work to dampen inflammatory responses and promote resolution. Our discussion extends to the genetic and molecular influences on cytokine production, which influence pain perception and recovery rates post-surgery. Furthermore, the role of PAI-1 in modulating inflammation through its impact on the fibrinolytic system highlights its potential as a therapeutic target. The perioperative modulation of these cytokines through various analgesic and anesthetic techniques, including the fascia iliac compartment block, demonstrates a significant reduction in pain and inflammatory markers, thus underscoring the importance of targeted therapeutic strategies. Our analysis suggests that a nuanced understanding of the interplay between pro-inflammatory and anti-inflammatory cytokines is required. Future research should focus on individualized pain management strategies.
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Affiliation(s)
- Arabela-Codruta Cocea
- Faculty of Medicine, Doctoral School, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Cristian Ioan Stoica
- Orthopedics, Anaesthesia Intensive Care Unit, Faculty of Medicine, “Carol Davila” University of Medicine and Pharmacy, 050474 Bucharest, Romania;
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Jin Q, Chen M, Kong J, Chen D, Wu X, Shi X, Jie L, Yu L, Li S, Dai Z. Clinical and Animal Studies of Waist and Knee Scraping Therapy for Knee Osteoarthritis. Comb Chem High Throughput Screen 2024; 27:2278-2294. [PMID: 38284729 DOI: 10.2174/0113862073264397231228054318] [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: 08/02/2023] [Revised: 11/24/2023] [Accepted: 11/29/2023] [Indexed: 01/30/2024]
Abstract
BACKGROUND Knee osteoarthritis (KOA) is a degenerative condition with knee pain as the main clinical manifestation. Scraping is one of the commonly used traditional Chinese medicine treatment methods, which activates blood circulation, removes blood stasis, reduces inflammation, and so on. Although scholars have proposed that the synergistic treatment of the waist and knee for KOA is superior to simple knee treatment, there is no relevant reference literature on the application of scraping therapy. Therefore, this study aims to explore the effectiveness and potential mechanisms of waist and knee scraping therapy for treating KOA through clinical and animal studies in order to promote its clinical application. OBJECTIVE To explore the clinical efficacy of waist and knee scraping therapy in the treatment of KOA from clinical study and increase animal study on this basis to preliminarily explore its mechanism, providing an objective basis for better treatment of KOA. METHODS The clinical study recruited 90 KOA patients and divided them into a control group, a knee scraping group, and a waist and knee scraping group using a random number table method. All patients were evaluated for clinical efficacy, the Western Ontario McMaster Universities Osteoarthritis Index (WOMAC), and Traditional Chinese Medicine Syndrome Score. The KOA rat model was established using the Hulth method. The rats were randomly divided into a control group, KOA group, waist scraping group, knee scraping group, and waist and knee scraping group. During the intervention process of rats, the pain sensitivity threshold was measured, and HE staining was performed on the synovium and cartilage. The protein and mRNA expression levels of TNF-α, IL- 1β, IL-6, PGP9.5, SP and TRPA1, TRPV4, SP, and NGF were measured by Western blot and real-time PCR. RESULTS In the clinical study, the clinical efficacy of the 2 scraping groups was significantly higher than that of the control group. The clinical efficacy of the waist and knee scraping group on the 60th day of treatment was significantly higher than that of the knee scraping group. In terms of improving WOMAC scores, all 3 groups had significance; The function and total score of the waist and knee scraping group on the 28th day of treatment, as well as the pain, function, and total score on the 60th day, were lower than those of the knee scraping group. In terms of improving pain while standing, pain when walking on flat ground, and total score, the scraping group had significant differences. The score of heavy limbs in the waist and knee scraping group was lower than that in the knee scraping group. In an animal study, during the 4th week after modeling, there were differences in the pain sensitivity threshold between the KOA group and the waist scraping group compared to the control group, while there were differences in the pain sensitivity threshold between the knee scraping group and the waist and knee scraping group compared to the KOA group. The expression levels of various proteins and genes in the KOA group and waist scraping group increased compared to the control group; The knee scraping group and the waist and knee scraping group were lower than those in the KOA group. CONCLUSION Scraping therapy can significantly alleviate knee joint pain and stiffness, improve joint function, and improve clinical efficacy, and the short-term and long-term effects of waist and knee scraping therapy are more significant. The scraping therapy has a definite therapeutic effect on KOA rats, which can improve the threshold of cold hyperalgesia and mechanical hyperalgesia, and the waist and knee scraping therapy is more obvious. This may be related to reducing inflammatory reactions in synovial and ganglion tissues.
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Affiliation(s)
- Qianhong Jin
- Nursing College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | | | - Jing Kong
- Nursing College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Dandan Chen
- Nursing College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Xuan Wu
- Nursing College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Xiaoqing Shi
- The First Clinical Medical College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Lishi Jie
- The First Clinical Medical College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Likai Yu
- The First Clinical Medical College of Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Sha Li
- Infection Management Office, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
| | - Zhengxiang Dai
- Infection Management Office, Jiangsu Provincial Hospital of Traditional Chinese Medicine Affiliated to Nanjing University of Traditional Chinese Medicine, Jiangsu, China
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3
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De Roover A, Escribano-Núñez A, Monteagudo S, Lories R. Fundamentals of osteoarthritis: Inflammatory mediators in osteoarthritis. Osteoarthritis Cartilage 2023; 31:1303-1311. [PMID: 37353140 DOI: 10.1016/j.joca.2023.06.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 06/15/2023] [Accepted: 06/16/2023] [Indexed: 06/25/2023]
Abstract
OBJECTIVES As more has become known of the pathophysiology of osteoarthritis (OA), evidence that inflammation plays a critical role in its development and progression has accumulated. Here, we aim to review current knowledge of the complex inflammatory network in the OA joint. DESIGN This narrative review is presented in three main sections: local inflammation, systemic inflammation, and therapeutic implications. We focused on inflammatory mediators and their link to OA structural changes in the joint. RESULTS OA is characterized by chronic and low-grade inflammation mediated mostly by the innate immune system, which results in cartilage degradation, bone remodeling and synovial changes. Synovitis is regarded as an OA characteristic and associated with increased severity of symptoms and joint dysfunction. However, the articular cartilage and the subchondral bone also produce several pro-inflammatory mediators thus establishing a complex interplay between the different tissues of the joint. In addition, systemic low-grade inflammation induced by aging, obesity and metabolic syndrome can contribute to OA development and progression. The main inflammatory mediators associated with OA include cytokines, chemokines, growth factors, adipokines, and neuropeptides. CONCLUSIONS Future research is needed to deeper understand the molecular pathways mediating the inflammation in OA to provide new therapeutics that target these pathways, or to repurpose existing drugs.
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Affiliation(s)
- Astrid De Roover
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Ana Escribano-Núñez
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Silvia Monteagudo
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium
| | - Rik Lories
- Laboratory of Tissue Homeostasis and Disease, Skeletal Biology and Engineering Research Center, Department of Development and Regeneration, KU Leuven, 3000 Leuven, Belgium; Division of Rheumatology, University Hospitals Leuven, 3000 Leuven, Belgium.
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4
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Walsh DA, Sofat N, Guermazi A, Hunter DJ. Osteoarthritis Bone Marrow Lesions. Osteoarthritis Cartilage 2023; 31:11-17. [PMID: 36191832 DOI: 10.1016/j.joca.2022.09.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/17/2022] [Revised: 09/19/2022] [Accepted: 09/24/2022] [Indexed: 02/02/2023]
Abstract
Assessment and treatment of Bone Marrow Lesions (BMLs) could ultimately make step changes to the lives of people with osteoarthritis (OA). We here review the imaging and pathological characteristics of OA-BMLs, their differential diagnosis and measurement, and cross-sectional and longitudinal associations with pain and OA structural progression. We discuss how biomechanical and cellular factors may contribute to BML pathogenesis, and how pharmacological and non-pharmacological interventions that target BMLs might reduce pain and OA structural progression. We critically appraise semiquantitative and quantitative methods for assessing BMLs, and their potential utilities for identifying people at risk of symptomatic and structural OA progression, and evaluating treatment responses. New interventions that target OA-BMLs should both confirm their importance, and reduce the unacceptable burden of OA.
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Affiliation(s)
- D A Walsh
- Professor of Rheumatology, Pain Centre Versus Arthritis, NIHR Nottingham Biomedical Research Centre, Academic Rheumatology, Division of Injury, Inflammation and Recovery, School of Medicine, University of Nottingham Clinical Sciences Building, City Hospital, Hucknall Road, Nottingham, NG5 1PB, United Kingdom; Consultant Rheumatologist, Sherwood Forest Hospitals NHS Foundation Trust, Mansfield Road, Sutton in Ashfield, NG17 4JL, United Kingdom.
| | - N Sofat
- Professor of Rheumatology, Institute for Infection and Immunity, St George's University of London, Cranmer Terrace, London, SW17 ORE, United Kingdom; Consultant Rheumatologist, St George's University Hospitals NHS Trust, London, SW17 OPQ, United Kingdom.
| | - A Guermazi
- Professor of Radiology, Department of Radiology, VA Boston Healthcare System, Boston University School of Medicine, Boston, MA, United States.
| | - D J Hunter
- Professor of Medicine, Sydney Musculoskeletal Health, Kolling Institute, University of Sydney and Rheumatology Department, Royal North Shore Hospital, Sydney, Australia.
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Salis Z, Gallego B, Nguyen TV, Sainsbury A. Association of Decrease in Body Mass Index With Reduced Incidence and Progression of the Structural Defects of Knee Osteoarthritis: A Prospective Multi-Cohort Study. Arthritis Rheumatol 2022; 75:533-543. [PMID: 35974435 DOI: 10.1002/art.42307] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 06/10/2022] [Accepted: 07/13/2022] [Indexed: 01/31/2023]
Abstract
OBJECTIVE To define the association between change in body mass index (BMI) and the incidence and progression of the structural defects of knee osteoarthritis as assessed by radiography. METHODS Radiographic analyses of knees at baseline and at 4-5 years of follow-up were obtained from the following 3 independent cohort studies: the Osteoarthritis Initiative (OAI) study, the Multicenter Osteoarthritis Study (MOST), and the Cohort Hip and Cohort Knee (CHECK) study. Logistic regression analyses using generalized estimating equations, with clustering of both knees within individuals, were used to investigate the association between change in BMI from baseline to 4-5 years of follow-up and the incidence and progression of knee osteoarthritis. RESULTS A total of 9,683 knees (from 5,774 participants) in an "incidence cohort" and 6,075 knees (from 3,988 participants) in a "progression cohort" were investigated. Change in BMI was positively associated with both the incidence and progression of the structural defects of knee osteoarthritis. The adjusted odds ratio (OR) for osteoarthritis incidence was 1.05 (95% confidence interval [95% CI] 1.02-1.09), and the adjusted OR for osteoarthritis progression was 1.05 (95% CI 1.01-1.09). Change in BMI was also positively associated with degeneration (i.e., narrowing) of the joint space and with degeneration of the femoral and tibial surfaces (as indicated by osteophytes) on the medial but not on the lateral side of the knee. CONCLUSION A decrease in BMI was independently associated with lower odds of incidence and progression of the structural defects of knee osteoarthritis and could be a component in preventing the onset or worsening of knee osteoarthritis.
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Affiliation(s)
- Zubeyir Salis
- Centre for Big Data Research in Health, The University of New South Wales, Kensington, Australia
| | - Blanca Gallego
- Centre for Big Data Research in Health, The University of New South Wales, Kensington, Australia
| | - Tuan V Nguyen
- Centre for Health Technologies, University of Technology Sydney, Ultimo, New South Wales, Australia, and School of Population Health, UNSW Medicine & Health, The University of New South Wales, Kensington, New South Wales, Australia
| | - Amanda Sainsbury
- School of Human Sciences, The University of Western Australia, Perth, Western Australia, Australia
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6
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Sanchez-Lopez E, Coras R, Torres A, Lane NE, Guma M. Synovial inflammation in osteoarthritis progression. Nat Rev Rheumatol 2022; 18:258-275. [PMID: 35165404 PMCID: PMC9050956 DOI: 10.1038/s41584-022-00749-9] [Citation(s) in RCA: 287] [Impact Index Per Article: 143.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/14/2022] [Indexed: 02/06/2023]
Abstract
Osteoarthritis (OA) is a progressive degenerative disease resulting in joint deterioration. Synovial inflammation is present in the OA joint and has been associated with radiographic and pain progression. Several OA risk factors, including ageing, obesity, trauma and mechanical loading, play a role in OA pathogenesis, likely by modifying synovial biology. In addition, other factors, such as mitochondrial dysfunction, damage-associated molecular patterns, cytokines, metabolites and crystals in the synovium, activate synovial cells and mediate synovial inflammation. An understanding of the activated pathways that are involved in OA-related synovial inflammation could form the basis for the stratification of patients and the development of novel therapeutics. This Review focuses on the biology of the OA synovium, how the cells residing in or recruited to the synovium interact with each other, how they become activated, how they contribute to OA progression and their interplay with other joint structures.
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Affiliation(s)
- Elsa Sanchez-Lopez
- Department of Orthopaedic Surgery, University of California San Diego, San Diego, CA, USA
| | - Roxana Coras
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain
| | - Alyssa Torres
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA
| | - Nancy E Lane
- Division of Rheumatology, Department of Medicine, University of California Davis, Davis, CA, USA
| | - Monica Guma
- Division of Rheumatology, Allergy and Immunology, Department of Medicine, University of California San Diego, San Diego, CA, USA.
- Department of Medicine, Autonomous University of Barcelona, Barcelona, Spain.
- San Diego VA Healthcare Service, San Diego, CA, USA.
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7
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Gwinnutt JM, Wieczorek M, Cavalli G, Balanescu A, Bischoff-Ferrari HA, Boonen A, de Souza S, de Thurah A, Dorner TE, Moe RH, Putrik P, Rodríguez-Carrio J, Silva-Fernández L, Stamm T, Walker-Bone K, Welling J, Zlatković-Švenda MI, Guillemin F, Verstappen SMM. Effects of physical exercise and body weight on disease-specific outcomes of people with rheumatic and musculoskeletal diseases (RMDs): systematic reviews and meta-analyses informing the 2021 EULAR recommendations for lifestyle improvements in people with RMDs. RMD Open 2022; 8:rmdopen-2021-002168. [PMID: 35361692 PMCID: PMC8971792 DOI: 10.1136/rmdopen-2021-002168] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 02/23/2022] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND A European League Against Rheumatism (EULAR) taskforce was convened to develop recommendations for lifestyle behaviours in rheumatic and musculoskeletal diseases (RMDs). This paper reviews the literature on the effects of physical exercise and body weight on disease-specific outcomes of people with RMDs. METHODS Three systematic reviews were conducted to summarise evidence related to exercise and weight in seven RMDs: osteoarthritis, rheumatoid arthritis, systemic lupus erythematosus, axial spondyloarthritis (axSpA), psoriatic arthritis, systemic sclerosis and gout. Systematic reviews and original studies were included if they assessed exercise or weight in one of the above RMDs, and reported results regarding disease-specific outcomes (eg, pain, function, joint damage). Systematic reviews were only included if published between 2013-2018. Search strategies were implemented in the Medline, Embase, Cochrane Library of systematic reviews and CENTRAL databases. RESULTS 236 articles on exercise and 181 articles on weight were included. Exercise interventions resulted in improvements in outcomes such as pain and function across all the RMDs, although the size of the effect varied by RMD and intervention. Disease activity was not influenced by exercise, other than in axSpA. Increased body weight was associated with worse outcomes for the majority of RMDs and outcomes assessed. In general, study quality was moderate for the literature on exercise and body weight in RMDs, although there was large heterogeneity between studies. CONCLUSION The current literature supports recommending exercise and the maintenance of a healthy body weight for people with RMDs.
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Affiliation(s)
- James M Gwinnutt
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Maud Wieczorek
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Center on Aging and Mobility, University of Zurich, Zurich, Switzerland
| | - Giulio Cavalli
- Unit of Immunology, Rheumatology, Allergy and Rare Diseases, IRCCS San Raffaele Hospital and Vita-Salute San Raffaele University, Milan, Italy
| | - Andra Balanescu
- Department of Internal Medicine and Rheumatology, “Sf. Maria” Hospital, “Carol Davila” University of Medicine and Pharmacy, Bucharest, Romania
| | - Heike A Bischoff-Ferrari
- Center on Aging and Mobility, University of Zurich, Zurich, Switzerland,Department of Aging Medicine and Aging Research, University Hospital Zurich and University of Zurich, Zurich, Switzerland,University Clinic for Aging Medicine, City Hospital Zurich - Waid, Zurich, Switzerland
| | - Annelies Boonen
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Savia de Souza
- Centre for Rheumatic Diseases, King's College London, London, UK
| | - Annette de Thurah
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark,Department of Rheumatology, Aarhus University Hospital, Aarhus, Denmark
| | - Thomas E Dorner
- Centre for Public Health, Department of Social and Preventive Medicine, Medical University of Vienna, Vienna, Austria,Social Insurance Fund for Public Service, Railway and Mining Industries, Sitzenberg-Reidling, Austria,Karl-Landsteiner Institute for Health Promotion Research, Sitzenberg-Reidling, Austria
| | - Rikke Helene Moe
- National Advisory Unit for Rehabilitation in Rheumatology, Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway
| | - Polina Putrik
- Department of Internal Medicine, Division of Rheumatology, Maastricht University Medical Center, Maastricht, The Netherlands,Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands
| | - Javier Rodríguez-Carrio
- Area of Immunology, Department of Functional Biology, Universidad de Oviedo, Oviedo, Spain,Department of Metabolism, Instituto de Investigación Sanitaria del Principado de Asturias (ISPA), Oviedo, Spain
| | - Lucía Silva-Fernández
- Rheumatology Department, Hospital Universitari Son Espases, Palma de Mallorca, Spain
| | - Tanja Stamm
- Section for Outcomes Research, Center for Medical Statistics, Informatics, and Intelligent Systems, Medical University of Vienna, Vienna, Austria,Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Vienna, Austria
| | - Karen Walker-Bone
- MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK
| | - Joep Welling
- NVLE Dutch Patient Organization for Systemic Autoimmune Diseases, Utrecht, The Netherlands
| | - Mirjana I Zlatković-Švenda
- Institute of Rheumatology, University of Belgrade School of Medicine, Belgrade, Serbia,Department of Internal Medicine, University of East Sarajevo Faculty of Medicine Foča, Republika Srpska, Bosnia and Herzegovina
| | - Francis Guillemin
- EA 4360 Apemac, Université de Lorraine, Nancy, France,Inserm, CHRU Nancy, CIC-1433 Epidémiologie Clinique, Université de Lorraine, Nancy, France
| | - Suzanne M M Verstappen
- Centre for Epidemiology Versus Arthritis, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK .,MRC Versus Arthritis Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK.,NIHR Manchester Biomedical Research Centre, Manchester University NHS Foundation Trust, Manchester Academic Health Science Centre, Manchester, UK
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8
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Jafarzadeh SR, Neogi T, Stefanik JJ, Li JS, Guermazi A, Apovian CM, Felson DT. Mediating Role of Bone Marrow Lesions, Synovitis, Pain Sensitization, and Depressive Symptoms on Knee Pain Improvement Following Substantial Weight Loss. Arthritis Rheumatol 2020; 72:420-427. [PMID: 31562683 DOI: 10.1002/art.41125] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2019] [Accepted: 09/24/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE Massive weight loss leads to marked knee pain reduction in individuals with knee pain, but the reason for the reduction in pain is unknown. This study was undertaken to quantify the contribution of magnetic resonance imaging (MRI)-evidenced changes in pain-sensitive structures, bone marrow lesions (BMLs), and synovitis, and changes in pain sensitization or depressive symptoms, to knee pain improvement after substantial weight loss. METHODS Morbidly obese patients with knee pain on most days were evaluated before bariatric surgery or medical weight management and at 1-year follow-up for BMLs and synovitis seen on MRI, the pressure pain threshold (PPT) at the patella and the right wrist, depressive symptoms (using the Center for Epidemiologic Studies Depression scale [CES-D]), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain survey. Natural-effects models were used to quantify the extent that achieving a minimum clinically important difference (MCID) of ≥18% on the WOMAC pain scale could be mediated by weight loss-induced changes in BMLs, synovitis, PPT, and depressive symptoms. RESULTS Of 75 participants, 53.3% lost ≥20% of weight by 1 year. Of these, 75% attained the MCID for pain improvement, compared with 34.3% in those who had <20% weight loss. Mediation analyses suggested that, in those with at least 20% weight loss, the odds of pain improvement increased by 62%, 15%, and 22% through changes in patella PPT, wrist PPT, and CES-D, respectively, but pain improvement was not mediated by MRI changes in BMLs or synovitis. CONCLUSION Weight loss-induced knee pain improvement is partially mediated by changes in pain sensitization and depressive symptoms but is independent of MRI changes in BMLs and synovitis.
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Affiliation(s)
| | - Tuhina Neogi
- Boston University School of Medicine, Boston, Massachusetts
| | - Joshua J Stefanik
- Boston University School of Medicine and Northeastern University, Boston, Massachusetts
| | - Jing-Sheng Li
- The Boston University College of Health and Rehabilitation Sciences: Sargent College, Boston, Massachusetts
| | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | | | - David T Felson
- Boston University School of Medicine, Boston, Massachusetts, and University of Manchester, NIHR Manchester Biomedical Research Centre, and Manchester University NHS Foundation Trust, Manchester, UK
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9
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The relationship of weight loss to structure modification in knee OA. Osteoarthritis Cartilage 2019; 27:845-847. [PMID: 30825610 DOI: 10.1016/j.joca.2019.02.794] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2019] [Accepted: 02/20/2019] [Indexed: 02/02/2023]
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10
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Jafarzadeh SR, Clancy M, Li JS, Apovian CM, Guermazi A, Eckstein F, Felson DT. Changes in the structural features of osteoarthritis in a year of weight loss. Osteoarthritis Cartilage 2018; 26:775-782. [PMID: 29567521 PMCID: PMC5962405 DOI: 10.1016/j.joca.2018.03.003] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2017] [Revised: 02/26/2018] [Accepted: 03/12/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE In patients undergoing bariatric surgery or medical management for obesity, we assessed whether those experiencing substantial weight loss had changes in innervated knee structures or in cartilage. METHODS Severely obese patients (body mass index (BMI) ≥35) with knee pain on most days were seen before bariatric surgery or medical weight management and at 1-year follow-up. Examinations included 3T MRI acquired at both time points for semi-quantitative scoring of bone marrow lesions (BML), synovitis, cartilage damage, and for quantitative measurement of cartilage thickness. Association of ≥20% vs <20% weight loss with change in semi-quantitative scores was evaluated using linear mixed-effects models, and that with cartilage thickness change used non-parametric and parametric methods. Sensitivity analyses tested different thresholds for weight loss, weight loss as a continuous measure, examined those with and without bariatric surgery, and with worse osteoarthritis (OA). RESULTS 75 subjects (median age 49 years, 92% women) were included. At baseline, 61 subjects (81%) had Kellgren and Lawrence (KL) grade >0, and 16 (21%) had KL grade ≥3; 69 (92%) had cartilage damage. For BML, synovitis, and cartilage damage, the majority of knees had change in semi-quantitative scores of 0, and there was no difference between those with and without ≥20% weight loss. Similarly, in terms of cartilage thickness loss, in 14 of 16 sub-regions thickness loss was not associated with weight loss. Sensitivity analyses showed similar findings. CONCLUSION In middle-aged persons with mostly mild radiographic OA, structural features changed little over a year and weight loss was not associated with effects on structural changes.
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Affiliation(s)
- S. Reza Jafarzadeh
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine,Address correspondence and reprint requests to: S. Reza Jafarzadeh, DVM, MPVM, PhD: Clinical Epidemiology Research and Training Unit, Boston University School of Medicine, 650 Albany Street, Suite X200, Boston, MA 02118. Tel: 617-638-5884. Fax: 617-638-5239. address:
| | - Margaret Clancy
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine
| | - Jing-Sheng Li
- College of Health and Rehabilitation Sciences: Sargent College, Boston University
| | | | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
| | - Felix Eckstein
- Institute of Anatomy, Paracelsus Medical University Salzburg & Nuremberg, Austria
| | - David T. Felson
- Clinical Epidemiology Research and Training Unit, Boston University School of Medicine,University of Manchester and NIHR Biomedical Research Centre, Central Manchester NHS Foundation Trust, Manchester, UK
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11
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Hangaard S, Gudbergsen H, Skougaard M, Bliddal H, Nybing JD, Tiderius CJ, Boesen M. Point of no return for improvement of cartilage quality indicated by dGEMRIC before and after weight loss in patients with knee osteoarthritis: a cohort study. Acta Radiol 2018; 59:336-340. [PMID: 28696168 DOI: 10.1177/0284185117720857] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background It has been demonstrated that weight loss improves symptoms in obese subjects with knee osteoarthritis (KOA). A parallel change in cartilage morphology remains to be demonstrated. Purpose To demonstrate a parallel change in cartilage morphology. Material and Methods Obese patients with KOA were examined before and after weight loss over 16 weeks. Target knee joints were radiographically assessed by the Kellgren/Lawrence grading (KLG) system. Patients with KLG-1 and 2 changes in the lateral compartment were included. Delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) was performed using intra-articular contrast. Results Nine patients with lateral KLG-1 and ten patients with lateral KLG-2 were studied. There were no group differences regarding the lateral compartment baseline dGEMRIC T1 values: median = 497 ms (KLG-1) and 533 ms (KLG-2) ( P = 0.12), or regarding reduction in body mass index (BMI) after 16 weeks: 12.8% versus 11.4% ( P = 0.74). In the KLG-1 group, several cases of increased dGEMRIC T1 values were seen and median value decreased significantly less than in KLG-2 group (15 ms versus 41 ms, P = 0.03) after weight loss. Conclusion Improvement of cartilage quality, assessed with dGEMRIC, after weight loss might be possible in early stage KOA (KLG-1), but not in later stage KOA (KLG-2). The results may suggest a point of no return for improvement of cartilage quality that should be tested in larger trials.
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Affiliation(s)
- Stine Hangaard
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Henrik Gudbergsen
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Marie Skougaard
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Henning Bliddal
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Janus D Nybing
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
| | - Carl Johan Tiderius
- Department of Orthopaedics, Lund University, Skåne University Hospital, Lund, Sweden
| | - Mikael Boesen
- Department of Radiology, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
- The Parker Institute, Copenhagen University Hospital, Bispebjerg and Frederiksberg Hospital, Denmark
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12
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Maricar N, Callaghan MJ, Parkes MJ, Felson DT, O'Neill TW. Interobserver and Intraobserver Reliability of Clinical Assessments in Knee Osteoarthritis. J Rheumatol 2016; 43:2171-2178. [PMID: 27909143 DOI: 10.3899/jrheum.150835] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2016] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Clinical examination of the knee is subject to measurement error. The aim of this analysis was to determine interobserver and intraobserver reliability of commonly used clinical tests in patients with knee osteoarthritis (OA). METHODS We studied subjects with symptomatic knee OA who were participants in an open-label clinical trial of intraarticular steroid therapy. Following standardization of the clinical test procedures, 2 clinicians assessed 25 subjects independently at the same visit, and the same clinician assessed 88 subjects over an interval period of 2-10 weeks; in both cases prior to the steroid intervention. Clinical examination included assessment of bony enlargement, crepitus, quadriceps wasting, knee effusion, joint-line and anserine tenderness, and knee range of movement (ROM). Intraclass correlation coefficients (ICC), estimated kappa (κ), weighted kappa (κω), and Bland-Altman plots were used to determine interobserver and intraobserver levels of agreement. RESULTS Using Landis and Koch criteria, interobserver κ scores were moderate for patellofemoral joint (κ = 0.53) and anserine tenderness (κ = 0.48); good for bony enlargement (κ = 0.66), quadriceps wasting (κ = 0.78), crepitus (κ = 0.78), medial tibiofemoral joint tenderness (κ = 0.76), and effusion assessed by ballottement (κ = 0.73) and bulge sign (κω = 0.78); and excellent for lateral tibiofemoral joint tenderness (κ = 1.00), flexion (ICC = 0.97), and extension (ICC = 0.87) ROM. Intraobserver κ scores were moderate for lateral tibiofemoral joint tenderness (κ = 0.60); good for crepitus (κ = 0.78), effusion assessed by ballottement test (κ = 0.77), patellofemoral joint (κ = 0.66), medial tibiofemoral joint (κ = 0.64), and anserine tenderness (κ = 0.73); and excellent for effusion assessed by bulge sign (κω = 0.83), bony enlargement (κ = 0.98), quadriceps wasting (κ = 0.83), flexion (ICC = 0.99), and extension (ICC = 0.96) ROM. CONCLUSION Among individuals with symptomatic knee OA, the reliability of clinical examination of the knee was at least good for the majority of clinical signs of knee OA.
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Affiliation(s)
- Nasimah Maricar
- From the Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service (NHS) Foundation Trust, MAHSC, Manchester; Department of Physiotherapy, and Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA. .,N. Maricar, BSc (Hons), MSc, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Callaghan, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; M.J. Parkes, BSc (Hons), Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; D.T. Felson, MD, MPH, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MB, BCh, BAO, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Rheumatology, Salford Royal NHS Foundation Trust.
| | - Michael J Callaghan
- From the Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service (NHS) Foundation Trust, MAHSC, Manchester; Department of Physiotherapy, and Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,N. Maricar, BSc (Hons), MSc, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Callaghan, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; M.J. Parkes, BSc (Hons), Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; D.T. Felson, MD, MPH, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MB, BCh, BAO, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Matthew J Parkes
- From the Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service (NHS) Foundation Trust, MAHSC, Manchester; Department of Physiotherapy, and Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,N. Maricar, BSc (Hons), MSc, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Callaghan, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; M.J. Parkes, BSc (Hons), Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; D.T. Felson, MD, MPH, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MB, BCh, BAO, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - David T Felson
- From the Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service (NHS) Foundation Trust, MAHSC, Manchester; Department of Physiotherapy, and Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,N. Maricar, BSc (Hons), MSc, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Callaghan, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; M.J. Parkes, BSc (Hons), Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; D.T. Felson, MD, MPH, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MB, BCh, BAO, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Rheumatology, Salford Royal NHS Foundation Trust
| | - Terence W O'Neill
- From the Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Academic Health Science Centre (MAHSC), University of Manchester; UK National Institute for Health Research (NIHR) Manchester Musculoskeletal Biomedical Research Unit, Central Manchester National Health Service (NHS) Foundation Trust, MAHSC, Manchester; Department of Physiotherapy, and Department of Rheumatology, Salford Royal NHS Foundation Trust, Salford, UK; Clinical Epidemiology Unit, Boston University School of Medicine, Boston, Massachusetts, USA.,N. Maricar, BSc (Hons), MSc, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Physiotherapy, Salford Royal NHS Foundation Trust; M.J. Callaghan, PhD, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; M.J. Parkes, BSc (Hons), Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC; D.T. Felson, MD, MPH, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Clinical Epidemiology Unit, Boston University School of Medicine; T.W. O'Neill, MB, BCh, BAO, Arthritis Research UK Centre for Epidemiology, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, MAHSC, University of Manchester, and NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester NHS Foundation Trust, MAHSC, and Department of Rheumatology, Salford Royal NHS Foundation Trust
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13
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Solis-Hernández JL, Rojano-Mejía D, Marmolejo-Mendoza M. [Knee dysfunction in the general population and associated factors]. CIR CIR 2015; 84:208-12. [PMID: 26688474 DOI: 10.1016/j.circir.2015.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 08/20/2015] [Indexed: 10/22/2022]
Abstract
BACKGROUND Knee joint dysfunction is present in 80% of people over 50 years of age, and in women there is a 1.5 times higher risk compared to men. Another important risk factor is obesity, which leads to a 3 times increase in the risk of suffering functional limitations in the joint. The aim of this study was to determine knee joint dysfunction and the associated factors. MATERIAL AND METHODS An analytical and descriptive study was conducted on 218 individuals older than 50 years of age in a primary care centre. A physical examination was performed on each patient, and the Western Ontario and McMaster Universities Osteoarthritis Index questionnaire was applied to them all. Logistic regression analysis was used to determine the association between age, gender, body mass index, and knee function. ANOVA was used to compare the means of the Western Ontario and McMaster Universities Osteoarthritis Index scores and body mass index measurements. A p<0.05 was considered statistically significant. RESULTS The mean age was 64.27 years (SD 10.43). An OR of 4.50 was obtained for having a disability in people over 65 years of age, 2.90 in obese people, and 2.02 in women. The mean scores in the 3 domains of Western Ontario and McMaster Universities Osteoarthritis Index were higher as the body mass index increased. CONCLUSIONS Women have greater disability than men, becoming more evident in older ages, and other risk of joint dysfunction increases up 3 times in obese patients.
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Affiliation(s)
- José Luis Solis-Hernández
- Servicio de Laboratorio de Análisis Clínicos, Unidad de Medicina Familiar N.(o) 20, Instituto Mexicano del Seguro Social, México, D.F., México
| | - David Rojano-Mejía
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Física y Rehabilitación Centro, Unidad Médica de Alta Especialidad, Hospital de Traumatología y Ortopedia Lomas Verdes, Instituto Mexicano del Seguro Social, México, D.F., México.
| | - Marlene Marmolejo-Mendoza
- Coordinación Clínica de Educación e Investigación en Salud, Unidad de Medicina Familiar N.(o) 2, Instituto Mexicano del Seguro Social, México, D.F., México
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14
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Beckwée D, Vaes P, Shahabpour M, Muyldermans R, Rommers N, Bautmans I. The Influence of Joint Loading on Bone Marrow Lesions in the Knee: A Systematic Review With Meta-analysis. Am J Sports Med 2015; 43:3093-107. [PMID: 25634907 DOI: 10.1177/0363546514565092] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Bone marrow lesions (BMLs) are considered as predictors of pain, disability, and structural progression of knee osteoarthritis. The relationship between knee loading and BMLs is not yet completely understood. PURPOSE To summarize the available evidence regarding the relationship between joint loading and the prevalence and progression of BMLs in the tibiofemoral joint. STUDY DESIGN Meta-analysis. METHODS Three databases (PubMed, Web of Science, and The Cochrane Library) were systematically screened for studies encompassing BMLs and changes in knee loading. A methodological quality assessment was conducted, and a meta-analysis computing overall odds ratios (ORs) was performed where possible. RESULTS A total of 29 studies involving 7641 participants were included. Mechanical loading was categorized as body weight and composition, compartmental load, structural lesion, and physical activity. High compartmental loads and structural lesions increased the risk for BMLs (overall ORs ranging from 1.56 [95% CI, 1.13-2.15] to 8.2 [95% CI, 4.4-15.1]; P = .006). Body weight increased the risk for BMLs to a lesser extent (overall OR, 1.03; 95% CI, 1.01-1.05; P = .007). Contradictory results for the effect of physical activity on BMLs were found. CONCLUSION Augmented compartmental loads and structural lesions increased the risk of the presence or progression of BMLs. Body weight increased the risk for BMLs to a lesser extent. Contradictory results for the effect of physical activity on BMLs may be explained by a dose-response relationship, knee alignment, and structural lesions. CLINICAL RELEVANCE It has been shown that unloading the knee temporarily may induce beneficial effects on osteoarthritis-related structural changes. Therefore, an early recognition of BMLs in the aging athlete's knee may provide information to counter the onset and aggravation of symptomatic knee osteoarthritis by reducing the knee load.
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Affiliation(s)
- David Beckwée
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Peter Vaes
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Maryam Shahabpour
- Department of Radiology, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Ronald Muyldermans
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Nikki Rommers
- Department of Rehabilitation Sciences Research, Vrije Universiteit Brussel, Brussels, Belgium
| | - Ivan Bautmans
- Department of Frailty in Ageing Research, Vrije Universiteit Brussel, Brussels, Belgium
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15
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Haugen IK, Slatkowsky Christensen B, Bøyesen P, Sesseng S, van der Heijde D, Kvien TK. Increasing synovitis and bone marrow lesions are associated with incident joint tenderness in hand osteoarthritis. Ann Rheum Dis 2015; 75:702-8. [DOI: 10.1136/annrheumdis-2014-206829] [Citation(s) in RCA: 36] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2014] [Accepted: 02/19/2015] [Indexed: 11/04/2022]
Abstract
ObjectivesTo explore whether changes of MRI-defined synovitis and bone marrow lesions (BMLs) are related to changes in joint tenderness in a 5-year longitudinal study of the Oslo hand osteoarthritis (OA) cohort.MethodsWe included 70 patients (63 women, mean (SD) age 67.9 (5.5) years). BMLs and contrast-enhanced synovitis in the distal and proximal interphalangeal joints were evaluated on 0–3 scales in n=69 and n=48 patients, respectively. Among joints without tenderness at baseline, we explored whether increasing/incident synovitis and BMLs were associated with incident joint tenderness using generalised estimating equations. Among joints with tenderness at baseline, we explored whether decreasing or resolution of synovitis and BMLs were associated with loss of joint tenderness. We adjusted for age, sex, body mass index, follow-up time and changes in radiographic OA.ResultsAmong joints without tenderness at baseline, increasing/incident synovitis and BMLs were seen in 45 of 220 (20.5%) and 47 of 312 (15.1%) joints, respectively. Statistically significant associations to incident joint tenderness were found for increasing/incident synovitis (OR=2.66, 95% CI 1.38 to 5.11) and BMLs (OR=2.85, 95% CI 1.23 to 6.58) independent of structural progression. We found a trend that resolution of synovitis (OR=1.72, 95% CI 0.80 to 3.68) and moderate/large decreases of BMLs (OR=1.90, 95% CI 0.57 to 6.33) were associated with loss of joint tenderness, but these associations were non-significant.ConclusionsThe Oslo hand OA cohort is the first study with longitudinal hand MRIs. Increasing synovitis and BMLs were significantly associated with incident joint tenderness, whereas no significant associations were found for decreasing or loss of synovitis and BMLs.
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16
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Bartels EM, Christensen R, Christensen P, Henriksen M, Bennett A, Gudbergsen H, Boesen M, Bliddal H. Effect of a 16 weeks weight loss program on osteoarthritis biomarkers in obese patients with knee osteoarthritis: a prospective cohort study. Osteoarthritis Cartilage 2014; 22:1817-25. [PMID: 25106676 DOI: 10.1016/j.joca.2014.07.027] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 06/26/2014] [Accepted: 07/29/2014] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Changes in biomarkers for bone and cartilage in knee osteoarthritis (KOA) may reflect changes in tissue turnover induced by interventions. The aim of this study was to assess the effect on osteoarthritis biomarkers of an intensive weight loss intervention in obese KOA patients. METHODS 192 obese KOA patients followed a 16 weeks weight loss intervention (ClinicalTrials.gov: NCT00655941). Serum Cartilage Oligomeric Matrix Protein (sCOMP), Urine C-terminal telopeptide of collagen type II (uCTX-II) and type I (uCTX-I) were determined by enzyme-linked immunoassay (ELISA) at baseline and after 16 weeks. Patient-reported symptoms were assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS) Questionnaire without the sports and recreation score (KOOS-4). Change from baseline was analyzed using Analysis of CoVariance (ANCOVA) adjusting for sex, age, and body mass index (BMI). Bivariate associations were analyzed using Spearman's test of rank correlation. RESULTS 175 patients completed the treatment and lost mean 13.4 (95% CI: 12.5-14.4) kg. sCOMP concentration decreased on average 1.1 (95% CI: -1.5 to -0.8) U/L with a correlation to weight loss (r = -0.17, P = 0.028), but not to change in KOOS-4 (r = -0.13, P = 0.091). uCTX-II increased significantly, mean 69 (95% CI: 31-106) ng/mmol creatinine, with no relation to weight loss (P = 0.14). Change in uCTX-II was reversely related to change in KOOS-4 (r = -0.28, P = 0.0003). uCTX-I increased, mean 67 (95% CI: 47-87) μg/mmol creatinine, and correlated to weight loss (r = 0.22, P = 0.0007), while not to KOOS-4 (P = 0.93). CONCLUSION A rapid substantial weight loss in obese KOA patients was weakly, while significantly associated with a reduction in sCOMP, and increases in both uCTX-II and uCTX-I.
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Affiliation(s)
- E M Bartels
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.
| | - P Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Nutrition, Exercise and Sports, University of Copenhagen, Denmark.
| | - M Henriksen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - A Bennett
- Immunodiagnostic Systems Limited (IDS), UK.
| | - H Gudbergsen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Knowledgecentre for Telemedicine, The Capital Region of Denmark, Denmark; Department of Rheumatology, Copenhagen University Hospitals, Glostrup, Frederiksberg and Bispebjerg, Denmark.
| | - M Boesen
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Department of Radiology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark.
| | - H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University Hospital Bispebjerg and Frederiksberg, Denmark; Faculty of Health Science, University of Copenhagen, Denmark; SMI, Aalborg University, Denmark.
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17
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Bliddal H, Leeds AR, Christensen R. Osteoarthritis, obesity and weight loss: evidence, hypotheses and horizons - a scoping review. Obes Rev 2014; 15:578-86. [PMID: 24751192 PMCID: PMC4238740 DOI: 10.1111/obr.12173] [Citation(s) in RCA: 201] [Impact Index Per Article: 20.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Revised: 01/10/2014] [Accepted: 01/14/2014] [Indexed: 01/06/2023]
Abstract
Obesity is widely acknowledged as a risk factor for both the incidence and progression of osteoarthritis, and has a negative influence on outcomes. Loss of at least 10% of body weight, coupled with exercise, is recognized as a cornerstone in the management of obese patients with osteoarthritis, and can lead to significant improvement in symptoms, pain relief, physical function and health-related quality of life. However, questions still remain surrounding optimal management. Given the significant health, social and economic burden of osteoarthritis, especially in obese patients, it is imperative to advance our knowledge of osteoarthritis and obesity, and apply this to improving care and outcomes. This paper overviews what is already known about osteoarthritis and obesity, discusses current key challenges and ongoing hypotheses arising from research in these areas, and finally, postulates what the future may hold in terms of new horizons for obese patients with osteoarthritis.
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Affiliation(s)
- H Bliddal
- The Parker Institute, Department of Rheumatology, Copenhagen University HospitalBispebjerg and Frederiksberg, Denmark
| | - A R Leeds
- Cambridge Weight PlanCorby, Northamptonshire, UK
- School of Biosciences and Medicine, University of SurreyGuildford, Surrey, UK
- Faculty of Science, University of CopenhagenCopenhagen, Denmark
| | - R Christensen
- The Parker Institute, Department of Rheumatology, Copenhagen University HospitalBispebjerg and Frederiksberg, Denmark
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Abstract
Objective: We performed comprehensive proteomic analyses of articular cartilage by using the isobaric tags for relative and absolute quantitation (iTRAQ) method, and searched for candidate biomarkers for osteoarthritis (OA). Methods: Articular cartilage was collected from patients with OA or femoral neck fracture for the control group. Molecular variations were detected by the iTRAQ method, and quantitative analyses were performed by western blot. Results: Using the iTRAQ method, we identified 76 proteins with different expression levels in OA patients and the control group. Among these proteins, we selected LECT2 (leukocyte cell-derived chemotaxin-2), BAALC (brain and acute leukemia, cytoplasmic), and PRDX6 (peroxiredoxin-6), which had not been reported as biomarkers for OA. Conclusions: Use of these proteins in combination with conventional OA biomarkers may better reflect the grade and prognosis of OA.
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Affiliation(s)
- Daiki Ikeda
- Department of Orthopaedic Surgery, Fujita Health University Hospital , Toyoake, Aichi , Japan and
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