1
|
Beckwée D, Nijs J, Bierma-Zeinstra SMA, Leemans L, Leysen L, Puts S, Rice D, Schiphof D, Bautmans I. Exercise therapy for knee osteoarthritis pain: how does it work? A study protocol for a randomised controlled trial. BMJ Open 2024; 14:e074258. [PMID: 38199628 PMCID: PMC10806725 DOI: 10.1136/bmjopen-2023-074258] [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: 04/21/2023] [Accepted: 11/28/2023] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION Muscle strengthening training (MST) and behavioural graded activity (BGA) show comparable effects on knee osteoarthritic (KOA) pain, but the mechanisms of action remain unclear. Both exercise-induced anti-inflammation and central sensitisation are promising pathways for pain relief in response to exercise therapy in patients with KOA: MST has the potential to decrease inflammation and BGA has the potential to decrease central sensitisation. Hence, this study aims to examine inflammation and central sensitisation as mediators for the effect of MST and/or BGA on pain in patients with KOA. METHODS AND ANALYSIS The Knee OsteoArthritis PAIN trial started on 10 January 2020 (anticipated end: April 2024). The three-arm clinical trial aims to recruit 90 KOA patients who will be randomly allocated to 12 weeks of (1) MST, (2) BGA or (3) care as usual. Assessments will be performed at baseline, 13 and 52 weeks after finishing the intervention. Outcomes, including pain (Knee injury and Osteoarthritis Outcome Score), were chosen in line with the OARSI recommendations for clinical trials of rehabilitation interventions for OA and the IMMPACT/OMERACT recommendations for the assessment of physical function in chronic pain clinical trials. Inflammation as well as features of central sensitisation (including conditioned pain modulation, offset analgesia, temporal summation of pain and event-related potentials following electrical stimulation), will be considered as treatment mediators. A multiple mediators model will be estimated with a path-analysis using structural equation models. In July 2023, all 90 KOA patients have been included and 42 participants already finished the study. ETHICS AND DISSEMINATION This study obtained ethics approval (B.U.N. 143201941843). Unravelling the mechanisms of action of exercise therapy in KOA will not only be extremely valuable for researchers, but also for exercise immunology and pain scientists and clinicians. TRIAL REGISTRATION NUMBER NCT04362618.
Collapse
Affiliation(s)
- David Beckwée
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Movement Antwerp (MOVANT) research group, Universiteit Antwerpen, Antwerpen, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| | - Jo Nijs
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Department of Health and Rehabilitation, Unit of Physiotherapy, Institute of Neuroscience and Physiology, University of Gothenburg, Goteborg, Sweden
- University Hospital Brussels, Brussels, Belgium
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
- Department of Orthopedics and Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lynn Leemans
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Laurence Leysen
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - Sofie Puts
- Rehabilitation Research Group, Vrije Universiteit Brussel, Brussel, Belgium
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
- Pain in Motion International Research Group, Vrije Universiteit Brussel, Brussel, Belgium
| | - David Rice
- Health and Rehabilitation Research Institute, School of Clinical Sciences, Auckland University of Technology, Auckland, New Zealand
- Department of Anaesthesiology and Perioperative Medicine, Waitematā Pain Service, Te Whatu Ora Waitematā, Auckland, New Zealand
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus University Medical Centre, Rotterdam, Netherlands
| | - Ivan Bautmans
- Gerontology and Frailty in Ageing (FRIA) Research Department, Vrije Universiteit Brussel, Brussel, Belgium
| |
Collapse
|
2
|
Szilagyi IA, Waarsing JH, van Meurs JBJ, Bierma-Zeinstra SMA, Schiphof D. A systematic review of the sex differences in risk factors for knee osteoarthritis. Rheumatology (Oxford) 2023; 62:2037-2047. [PMID: 36495186 PMCID: PMC10234207 DOI: 10.1093/rheumatology/keac688] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 12/01/2022] [Indexed: 07/30/2023] Open
Abstract
OBJECTIVES Previous systematic reviews focused on the evidence of common risk factors for knee OA (KOA); however, the effect and strength of association between risk factors and KOA might be different between the two sexes. The aim of the present systematic review was to determine the current evidence on sex differences in the association between risk factors and KOA and their prevalence. METHODS We searched the following electronic bibliographic databases: MEDLINE (PubMed), EMBASE and Web of Science. A methodological quality assessment was conducted independently by two researchers according to an adapted version of the standardized set of criteria known as the Newcastle-Ottawa Quality Assessment Scale (NOS). The NOS, a star system, was converted to three categories of quality. RESULTS In total, 27 studies reported sex-specific risk estimates on several risk factors for KOA. Out of the 22 longitudinal cohort studies (except one nested case-control), 12 were of good quality and 10 were of fair quality. The five cross-sectional studies consisted of one of good, three of fair and one of poor quality. There was an indication of sex differences in risk factors leading to higher risk of KOA: high BMI, alcohol consumption, atherosclerosis and high vitamin E levels in women, and high physical activity, soft drink consumption and abdominal obesity in men. Knee injury, high blood pressure and low step rate seem to affect both women and men. CONCLUSION More good quality studies are needed to assess sex differences in risk factors for KOA, especially for symptomatic/clinical OA.
Collapse
Affiliation(s)
- Ingrid A Szilagyi
- Correspondence to: Ingrid A. Szilagyi, Department of General Practice, Erasmus MC, University Medical Center Rotterdam, PO Box 2400, Rotterdam 3000 CA, The Netherlands. E-mail:
| | - Jan H Waarsing
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dieuwke Schiphof
- Department of General Practice, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| |
Collapse
|
3
|
Gouldin AG, Patel NK, Golladay GJ, Puetzer JL. Advanced glycation end-product accumulation differs by location and sex in aged osteoarthritic human menisci. Osteoarthritis Cartilage 2023; 31:363-373. [PMID: 36494052 PMCID: PMC10088070 DOI: 10.1016/j.joca.2022.11.012] [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: 08/25/2022] [Revised: 11/15/2022] [Accepted: 11/28/2022] [Indexed: 12/12/2022]
Abstract
OBJECTIVE There is a clear link between increasing age and meniscus degeneration, leading to increased injury, osteoarthritis (OA) progression, and often total knee replacement. Advanced glycation end-products (AGEs) are non-enzymatic crosslinks and adducts that accumulate in collagen with age, altering tissue mechanics and cell function, ultimately leading to increased injury and inflammation. AGEs, both fluorescent and non-fluorescent, play a central role in age-related degradation of tissues throughout the body; however, little is known about their role in meniscus degeneration. The objective of this study was to characterize changes in aged OA menisci, specifically evaluating zonal AGE accumulation, to gain a better understanding of changes that may lead to age-related meniscal degeneration. METHOD Deidentified human menisci (N = 48, 52-84 years old) were obtained from subjects undergoing total knee replacement. Changes in extracellular matrix (ECM) were assessed by gross morphology, confocal analysis, and biochemical assays. Deoxyribonucleic acid (DNA), glycosaminoglycan (GAG), collagen, and AGE accumulation were compared with patient age, zonal region, and patient sex. RESULTS There were minimal changes in DNA, GAG, and collagen concentration with age or zone. However, collagen fraying and AGEs increased with age, with more AGEs accumulating in the meniscal horns compared to the central body and in male menisci compared to females. CONCLUSIONS Overall, this work provides greater insights into regional changes that occur in human menisci with age and OA. These results suggest AGEs may play a role in the degeneration of the meniscus, with AGEs being a possible target to reduce age-related tears, degeneration, and OA progression.
Collapse
Affiliation(s)
- A G Gouldin
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States.
| | - N K Patel
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| | - G J Golladay
- Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| | - J L Puetzer
- Department of Biomedical Engineering, Virginia Commonwealth University, Richmond, VA, United States; Department of Orthopaedic Surgery, Virginia Commonwealth University, Richmond, VA, United States.
| |
Collapse
|
4
|
Waqas K, Szilagyi IA, Schiphof D, Boer CG, Bierma-Zeinstra S, van Meurs JBJ, Zillikens MC. Skin autofluorescence, a non-invasive biomarker of advanced glycation end products, and its relation to radiographic and MRI based osteoarthritis. Osteoarthritis Cartilage 2022; 30:1631-1639. [PMID: 36087928 DOI: 10.1016/j.joca.2022.08.014] [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: 02/21/2022] [Revised: 08/11/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVES Accumulation of advanced glycation end products (AGEs) in articular cartilage during aging has been proposed as a mechanism involved in the development of osteoarthritis (OA). Therefore, we investigated a cross-sectional relationship between skin AGEs, a biomarker for systemic AGEs accumulation, and OA. METHODS Skin AGEs were estimated with the AGE Reader™ as skin autofluorescence (SAF). Knee and hip X-rays were scored according to Kellgren and Lawrence (KL) system. KL-sum score of all four joints was calculated per participant to assess severity of overall radiographic OA (ROA) including or excluding those with prosthesis. Knee MRI of tibiofemoral joint (TFMRI) was assessed for cartilage loss. Sex-stratified regression models were performed after testing interaction with SAF. RESULTS 2,153 participants were included for this cross-sectional analysis. In women (n = 1,206) for one unit increase in SAF, the KL-sum score increased by 1.15 (95% confidence interval = 1.00-1.33) but excluding women with prosthesis, there was no KL-sum score increase [0.96 (0.83-1.11)]. SAF was associated with higher prevalence of prosthesis [Odds ratio, OR = 1.67 (1.10-2.54)] but not with ROA [OR = 0.83 (0.61-1.14)] when compared to women with no ROA. In men (n = 947), there was inconclusive association between SAF and KL sum score or prosthesis. For TFMRI (n = 103 women), SAF was associated with higher prevalence of cartilage loss, full-thickness [OR = 5.44 (1.27-23.38)] and partial-thickness [OR = 1.45 (0.38-5.54)], when compared to participants with no cartilage loss. CONCLUSION Higher SAF in women was associated with higher prosthesis prevalence and a trend towards higher cartilage loss on MRI. Our data presents inconclusive results between SAF and ROA in both sexes.
Collapse
Affiliation(s)
- K Waqas
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - I A Szilagyi
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - D Schiphof
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands.
| | - C G Boer
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - S Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics & Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands; Department of Epidemiology, Erasmus MC, University Medical Center, Rotterdam, the Netherlands; Department of Orthopaedics & Sports Medicine, Erasmus MC, University Medical Center, Rotterdam, the Netherlands.
| | - M C Zillikens
- Department of Internal Medicine, Erasmus University Medical Center, Rotterdam, the Netherlands.
| |
Collapse
|
5
|
Iijima H, Gilmer G, Wang K, Sivakumar S, Evans C, Matsui Y, Ambrosio F. Meta-analysis Integrated With Multi-omics Data Analysis to Elucidate Pathogenic Mechanisms of Age-Related Knee Osteoarthritis in Mice. J Gerontol A Biol Sci Med Sci 2022; 77:1321-1334. [PMID: 34979545 PMCID: PMC9255692 DOI: 10.1093/gerona/glab386] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Indexed: 01/05/2023] Open
Abstract
Increased mechanistic insight into the pathogenesis of knee osteoarthritis (KOA) is needed to develop efficacious disease-modifying treatments. Though age-related pathogenic mechanisms are most relevant to the majority of clinically presenting KOA, the bulk of our mechanistic understanding of KOA has been derived using surgically induced posttraumatic OA (PTOA) models. Here, we took an integrated approach of meta-analysis and multi-omics data analysis to elucidate pathogenic mechanisms of age-related KOA in mice. Protein-level data were integrated with transcriptomic profiling to reveal inflammation, autophagy, and cellular senescence as primary hallmarks of age-related KOA. Importantly, the molecular profiles of cartilage aging were unique from those observed following PTOA, with less than 3% overlap between the 2 models. At the nexus of the 3 aging hallmarks, advanced glycation end product (AGE)/receptor for AGE (RAGE) emerged as the most statistically robust pathway associated with age-related KOA. This pathway was further supported by analysis of mass spectrometry data. Notably, the change in AGE-RAGE signaling over time was exclusively observed in male mice, suggesting sexual dimorphism in the pathogenesis of age-induced KOA in murine models. Collectively, these findings implicate dysregulation of AGE-RAGE signaling as a sex-dependent driver of age-related KOA.
Collapse
Affiliation(s)
- Hirotaka Iijima
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Japan Society for the Promotion of Science, Tokyo, Japan
| | - Gabrielle Gilmer
- Medical Scientist Training Program, School of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Kai Wang
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Sruthi Sivakumar
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christopher Evans
- Rehabilitation Medicine Research Center, Mayo Clinic, Rochester, Minnesota, USA
| | - Yusuke Matsui
- Biomedical and Health Informatics Unit, Graduate School of Medicine, Nagoya University, Nagoya, Japan
| | - Fabrisia Ambrosio
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- McGowan Institute for Regenerative Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
- Department of Environmental and Occupational Health, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| |
Collapse
|
6
|
Corica D, Pepe G, Currò M, Aversa T, Tropeano A, Ientile R, Wasniewska M. Methods to investigate advanced glycation end-product and their application in clinical practice. Methods 2021; 203:90-102. [DOI: 10.1016/j.ymeth.2021.12.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 12/01/2021] [Accepted: 12/16/2021] [Indexed: 12/15/2022] Open
|
7
|
Alenazi AM, Obaidat SM, Alshehri MM, Alothman S, Gray C, Rucker J, Waitman LR, Kluding PM. Type 2 Diabetes Affects Joint Pain Severity in People with Localized Osteoarthritis: A Retrospective Study. PAIN MEDICINE 2021; 21:1025-1031. [PMID: 31710675 DOI: 10.1093/pm/pnz299] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVE To examine the association between type 2 diabetes (T2D) and pain severity in people with localized osteoarthritis (OA) and to explore the association between glycemic control, measured by hemoglobin A1c (HbA1c) level, and pain severity in people with localized OA and T2D. DESIGN Retrospective study. SETTING A tertiary medical center. SUBJECTS Data from 819 patients (mean age = 65.08±9.77 years, 54.3% women) were used. METHODS Patients were grouped to localized OA only (N = 671) and localized OA+T2D (N = 148) based on diagnosis codes. An index date was set as the first diagnosis date of localized OA and linked to pain severity, measured by numeric rating scale from 0 to 10. HbA1c values were obtained for patients with T2D within six months of the index date. Multiple linear regression was used. RESULTS After controlling for age, gender, body mass index (BMI); diagnoses of depression, hypertension, dyslipidemia; OA locations; and medication list (+/- 90 days of the index date), T2D was significantly associated with increased pain severity (B = 1.07, 95% confidence interval [CI] = 0.25 to 1.88, P = 0.014). For patients with T2D and localized OA with available data for HbA1c (N = 87), the results showed that an increased HbA1c value was significantly associated with higher pain severity (B = 0.36, 95% CI = 0.036 to 0.67, P = 0.029) after controlling for age, gender, BMI, medications, and OA locations. CONCLUSION T2D was associated with higher pain severity in people with localized OA, and poor glycemic control was associated with higher pain severity in people with localized OA+T2D. Clinicians should emphasize that better HbA1c control might help with pain management in people with T2D and OA.
Collapse
Affiliation(s)
- Aqeel M Alenazi
- Department of Rehabilitation Sciences and Physical Therapy, Prince Sattam Bin Abdulaziz University, Alkharj, Saudi Arabia.,Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA
| | - Sakher M Obaidat
- Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA.,Department of Rehabilitation Sciences, Hashemite University, Zarqa, Jordan
| | - Mohammed M Alshehri
- Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA.,Department of Rehabilitation Science, Jazan University, Jazan, Saudi Arabia
| | - Shaima Alothman
- Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA
| | - Corey Gray
- Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA
| | - Jason Rucker
- Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA
| | - Lemuel R Waitman
- Department of Internal Medicine, University of Kansas, Medical Center, Kansas City, Kansas, USA
| | - Patricia M Kluding
- Department of Physical Therapy and Rehabilitation Science, University of Kansas, Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
8
|
Abd Elazeem MI, Ahmed ABS, Mohamed RA, Abdelaleem EA. Serum level of Adrenomedullin in patients with primary knee osteoarthritis; relation to disease severity. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2021. [DOI: 10.1186/s43166-021-00070-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Adrenomedullin (AM) is a peptide which was suggested to be involved in the pathogenesis of osteoarthritis through its anti-inflammatory and anti-apoptotic effect. AM was found to be elevated in some inflammatory rheumatic diseases as rheumatoid arthritis and ankylosing spondylitis.
The current study was performed to measure serum Adrenomodullin (AM) concentrations in patients with primary knee osteoarthritis (KOA) and to assess association with severity of the disease. The study was performed on 50 patients with primary KOA diagnosed according to American College of Rheumatology (ACR) Revised Criteria for Early Diagnosis of Knee Osteoarthritis and 20 age- and sex-matched controls with no clinical features of KOA. The Kellgren and Lawrence (KL) classification was used to evaluate the disease severity of knee OA. Disease activity was assessed by The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Blood samples had been collected from patients with OA and controls for assessing Adrenomodullin in patients’ sera by ELISA.
Results
There were a significant increase in serum Adrenomedullin concentrations in KOA patients compared to controls (10.64 ±19.2 ng/ml vs. 1.39 ±1.6 ng/ml in cases and controls respectively) (p value = 0.036). There was positive significant correlation of serum Adrenomedullin levels with KL grades (r=0.608, p value <0.001). OA patients with VAS score >6 have significantly higher serum Adrenomedullin levels than OA patients with VAS Score <6. No detected significant correlation between any of (patients’ age, BMI, disease duration, tenderness score, and WOMAC score) with serum Adrenomedullin levels among studied OA cases (p values >0.05).
Conclusion
This study concluded that serum Adrenomedullin (AM) level is elevated in patients with KOA and is positively correlated with the severity of disease.
Collapse
|
9
|
Alenazi AM, Alshehri MM, Alothman S, Alqahtani BA, Rucker J, Sharma NK, Bindawas SM, Kluding PM. The Association of Diabetes With Knee Pain Locations, Pain While Walking, and Walking Speed: Data From the Osteoarthritis Initiative. Phys Ther 2020; 100:1977-1986. [PMID: 32750122 PMCID: PMC7596886 DOI: 10.1093/ptj/pzaa144] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/02/2020] [Indexed: 01/14/2023]
Abstract
OBJECTIVE Osteoarthritis (OA) and diabetes mellitus (DM) often coexist and can result in negative outcomes. DM can affect pain and walking speed in people with knee OA; however, the impact of DM on OA is understudied. The purpose of this study was to investigate the association between diabetes and knee pain locations, pain severity while walking, and walking speed in people with knee OA. METHODS A cross-sectional analysis was used. Data from 1790 individuals from the Osteoarthritis Initiative (mean [SD] age = 69 [8.7] years) with knee pain were included and grouped into knee OA and diabetes (n = 236) or knee OA only (n = 1554). Knee pain locations were categorized as no pain, localized pain, regional pain, or diffuse pain. Knee pain during a 20-m walk test was categorized as no pain, mild, moderate, or severe knee pain. Walking speed was measured using the 20-m walk test. Multinomial and linear regression analyses were performed. RESULTS Diabetes was associated with regional knee pain (odds ratio [OR] = 1.77; 95% CI = 1.01-3.11). Diabetes was associated only with moderate (OR = 1.78; 95% CI = 1.02-3.10) or severe (OR = 2.52; 95% CI = 1.01-6.28) pain while walking. Diabetes was associated with decreased walking speed (B = -0.064; 95% CI = -0.09 to -0.03). CONCLUSIONS Diabetes was associated with regional knee pain but not with localized or diffuse knee pain and was associated with moderate to severe knee pain while walking and slower walking speed in people with knee OA. IMPACT Clinicians can use a knee pain map for examining knee pain locations for people with diabetes and knee OA. Knee pain during walking and walking speed should be screened for people with knee OA and diabetes because of the influence of diabetes on these parameters in this population. LAY SUMMARY Diabetes might be associated with specific knee pain locations, pain during activities such as walking, and reduced walking speed in people with knee OA.
Collapse
Affiliation(s)
| | | | - Shaima Alothman
- Lifestyle and Health Research Center, Princess Nourah bint Abdulrahman University, Riyadh, Saudi Arabia
| | | | | | | | | | | |
Collapse
|
10
|
Sun Y, Wang C, Gong C. Repairing effects of glucosamine sulfate in combination with etoricoxib on articular cartilages of patients with knee osteoarthritis. J Orthop Surg Res 2020; 15:150. [PMID: 32299482 PMCID: PMC7164152 DOI: 10.1186/s13018-020-01648-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 03/25/2020] [Indexed: 12/20/2022] Open
Abstract
Purpose To evaluate the repairing effects of glucosamine sulfate combined with etoricoxib on articular cartilages of patients with knee osteoarthritis (KOA). Methods A total of 106 KOA patients were randomly divided into control (n = 40) and experimental groups (n = 66) and treated with etoricoxib alone and glucosamine sulfate plus etoricoxib, respectively. Changes in WOMAC score and clinical efficacy were observed. The synovial fluid was extracted. Bone metabolism indices, growth factors, inflammatory factors, matrix metalloproteinases (MMPs), and NO-induced apoptosis-related factors were measured by ELISA. JNK and Wnt5a mRNA levels were determined using RT-PCR. Results After treatment, the total WOMAC scores of both groups significantly declined (P < 0.05), being lower in experimental group. The total effective rate of experimental group was higher (P < 0.05). BGP and OPG levels rose, especially in experimental group (P < 0.05). CTX-II, COMP, and RANKL levels decreased, particularly in experimental group (P < 0.05). TGF-β, IGF-1, and FGF-2 levels increased, especially in experimental group (P < 0.05). Both groups, particularly experimental group, had decreased levels of IL-1β, IL-17, IL-18, TNF-α, MMP-3, MMP-9, and MMP-13 (P < 0.05). JNK and Wnt5a mRNA levels of both groups dropped, which were lower in experimental group (P < 0.05). NO and LPO levels reduced, being lower in experimental group. SOD level rose, especially in experimental group (P < 0.05). Conclusion Glucosamine sulfate plus etoricoxib can repair the articular cartilages of KOA patients. Probably, JNK and Wnt5a are downregulated to inhibit the secretion of MMPs through lowering the levels of inflammatory factors, thereby delaying cartilage matrix degradation. NO-induced chondrocyte apoptosis may be suppressed via the SOD pathway.
Collapse
Affiliation(s)
- Yong Sun
- Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), 40 Jintang Street, Luohu District, Shenzhen, 518010, Guangdong Province, People's Republic of China.
| | - Changde Wang
- Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), 40 Jintang Street, Luohu District, Shenzhen, 518010, Guangdong Province, People's Republic of China
| | - Chunzhu Gong
- Shenzhen Pingle Orthopedic Hospital (Shenzhen Pingshan Traditional Chinese Medicine Hospital), 40 Jintang Street, Luohu District, Shenzhen, 518010, Guangdong Province, People's Republic of China
| |
Collapse
|
11
|
Linagliptin protects human chondrogenic ATDC5 cells against advanced glycation end products (AGEs)-induced apoptosis via a mitochondria-dependent pathway. Chem Biol Interact 2019; 315:108901. [PMID: 31733186 DOI: 10.1016/j.cbi.2019.108901] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 10/18/2019] [Accepted: 11/12/2019] [Indexed: 01/07/2023]
Abstract
Chondrocytes in joints are responsible for the formation and remodeling of articular cartilage. The accumulation of advanced glycation end products (AGEs) in cartilage is detrimental to the survival of chondrocytes. Linagliptin is one of the most commonly used anti-diabetes agents, and recent work indicates that it exerts an anti-inflammatory effect in different cell types. In this study, we showed that Linagliptin had a protective role in AGEs-induced chondrocyte injury. The presence of Linagliptin ameliorated AGEs-induced reactive oxygen species (ROS) induction and reduced cellular protein carboxyl content. Linagliptin mitigated AGEs-induced mitochondrial membrane potential (ΔΨm) reduction and NAPDH oxidase subunit NOX-4 induction, indicating that Linagliptin is a potent anti-ROS agent in chondrocytes. Additionally, Linagliptin inhibited AGEs-induced production of high mobility group box chromosomal protein 1 (HMGB-1), and the expression of matrix metalloproteases (MMPs)-2 and -9. Flow cytometry experimentation showed that Linagliptin inhibited AGEs-induced apoptotic subpopulation. Moreover, Linagliptin inhibited the AGEs-induced increased ratio of Bax to Bcl-2, translocation of cytochrome C from mitochondria to the cytoplasm, and release of cleaved caspase-3. Collectively, our data indicate that the anti-diabetes drug Linagliptin has a new role in rescuing chondrocyte from insult by AGEs, and may, therefore, have the potential to treat joint disorders.
Collapse
|
12
|
Veronese N, Cooper C, Reginster JY, Hochberg M, Branco J, Bruyère O, Chapurlat R, Al-Daghri N, Dennison E, Herrero-Beaumont G, Kaux JF, Maheu E, Rizzoli R, Roth R, Rovati LC, Uebelhart D, Vlaskovska M, Scheen A. Type 2 diabetes mellitus and osteoarthritis. Semin Arthritis Rheum 2019; 49:9-19. [PMID: 30712918 PMCID: PMC6642878 DOI: 10.1016/j.semarthrit.2019.01.005] [Citation(s) in RCA: 93] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 12/13/2018] [Accepted: 01/08/2019] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Type 2 diabetes mellitus (T2DM) and osteoarthritis (OA) are common diseases that frequently co-exist, along with overweight/obesity. While the mechanical impact of excess body weight on joints may explain lower limb OA, we sought to explore whether T2DM is linked to OA outside of excess weight and whether T2DM may play a role in OA pathophysiology. The consequence of T2DM on OA outcomes is a question of research interest. METHODS We conducted a critical review of the literature to explore the association between T2DM and OA, whether any association is site-specific for OA, and whether the presence of T2DM impacts on OA outcomes. We also reviewed the literature to assess the safety of anti-OA treatments in patients with T2DM. RESULTS T2DM has a pathogenic effect on OA through 2 major pathways involving oxidative stress and low-grade chronic inflammation resulting from chronic hyperglycemia and insulin resistance. T2DM is a risk factor for OA progression and has a negative impact on arthroplasty outcomes. Evidence is mounting for safety concerns with some of the most frequently prescribed anti-OA medications, including paracetamol, non-steroidal anti-inflammatory drugs, and corticosteroid injections, while other anti-OA medications may be safely prescribed in OA patients with T2DM, such as glucosamine and intra-articular hyaluronic acid. CONCLUSIONS Future research is needed to better understand whether diabetes control and prevention can modulate OA occurrence and progression. The selection of therapy to treat OA symptoms in patients with T2DM may require careful consideration of the evidence based to avoid untoward safety issues.
Collapse
Affiliation(s)
- Nicola Veronese
- National Research Council, Neuroscience Institute, Aging Branch, Padova, Italy.
| | - Cyrus Cooper
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK; NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium
| | - Jean-Yves Reginster
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium; Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000 Liège, Belgium; Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Marc Hochberg
- Division of Rheumatology & Clinical Immunology, Department of Medicine, University of Maryland School of Medicine, Baltimore, MD, USA; Geriatric Research, Education and Clinical Center, Baltimore, MD, USA; Medical Care Clinical Center, VA Maryland Health Care System, Baltimore, MD, USA
| | - Jaime Branco
- CEDOC, NOVA Medical School, Universidade Nova de Lisboa, Department of Rheumatology, CHLO, Hospital Egas Moniz, Lisbon, Portugal
| | - Olivier Bruyère
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium; Department of Public Health, Epidemiology and Health Economics, University of Liège, CHU Sart Tilman B23, 4000 Liège, Belgium
| | - Roland Chapurlat
- INSERM UMR 1033, Université de Lyon, Hôpital E Herriot, 69437 Lyon cedex 03, France
| | - Nasser Al-Daghri
- Chair for Biomarkers of Chronic Diseases, Biochemistry Department, College of Science, King Saud University, Riyadh, Kingdom of Saudi Arabia
| | - Elaine Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Gabriel Herrero-Beaumont
- Department of Rheumatology, Bone and Joint Research Unit, Fundación Jiménez Diaz, Universidad Autonoma, Madrid, Spain
| | - Jean-François Kaux
- Department of Physical & Rehabilitation Medicine and Sports Traumatology, SportS(2), FIFA Medical Centre of Excellence, University and University Hospital of Liège, 4000 Liège, Belgium
| | - Emmanuel Maheu
- Rheumatology Department, AP-HP, Saint-Antoine Hospital, 4 Blvd. Beaumarchais, 75011 Paris, France
| | - René Rizzoli
- WHO Collaborating Centre for Public Health Aspects of Musculoskeletal Health and Aging, Liège, Belgium; Division of Bone Diseases, Geneva University Hospitals and Faculty of Medicine, Geneva, Switzerland
| | - Roland Roth
- Max-Reger-Strasse 17-19, 45128 Essen-Suedviertel, Germany
| | - Lucio C Rovati
- School of Medicine and Surgery, University of Milano - Bicocca, Milan, Italy; Department of Clinical Research, Rottapharm Biotech, Monza, Italy
| | - Daniel Uebelhart
- Division of Musculoskeletal, Internal Medicine and Oncological Rehabilitation, Department of Orthopaedics and Traumatology, Hôpital du Valais (HVS), Centre Hospitalier du Valais Romand (CHVR), CVP, Crans-Montana, Switzerland
| | - Mila Vlaskovska
- Medical University Sofia, Medical Faculty, Department of Pharmacology, 2, Zdrave str., 1431 Sofia, Bulgaria
| | - André Scheen
- Division of Diabetes, Nutrition and Metabolic Disorders and Clinical Pharmacology Unit, Department of Medicine, University of Liège, CHU Liège, Sart Tilman B35, B-4000 Liège, Belgium
| |
Collapse
|
13
|
Andia I, Maffulli N. Some patients (and some of us) respond better to some biological therapies: the as yet unsolved conundrum. J Orthop Traumatol 2018; 19:1. [PMID: 30128775 PMCID: PMC6102158 DOI: 10.1186/s10195-018-0505-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 03/24/2018] [Indexed: 11/24/2022] Open
Abstract
Very often, treatment for many common musculoskeletal conditions is only palliative, or involves surgery with major shortcomings. Biological interventions—in particular, platelet-rich plasma (PRP) therapies—may well provide more effective treatments, but their actual efficacy is under scrutiny. PRP is biologically unique to each individual depending on endogenous and exogenous factors, including, but not limited to, demographic factors (i.e. age), immune status (i.e. microbiota), metabolic diseases and concomitant medications. All these potential modifiers of the ultimate effects of PRP have been poorly explored, and their relationship with efficacy has not been established.
Collapse
Affiliation(s)
- Isabel Andia
- Regenerative Medicine Laboratory, BioCruces Health Research Institute, Cruces University Hospital, 48903, Barakaldo, Spain
| | - Nicola Maffulli
- Department of Musculoskeletal Disorders, University of Salerno School of Medicine and Dentistry, Salerno, Italy. .,Queen Mary University of London, Barts and the London School of Medicine and Dentistry, London, UK.
| |
Collapse
|