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Jiang T, Weng Q, Zhang Y, Zhang W, Doherty M, Sarmanova A, Yang Z, Yang T, Li J, Liu K, Wang Y, Obotiba AD, Zeng C, Lei G, Wei J. Association Between Hyperuricemia and Ultrasound-Detected Hand Synovitis. Arthritis Care Res (Hoboken) 2024; 76:1187-1194. [PMID: 38570913 DOI: 10.1002/acr.25342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2023] [Revised: 02/15/2024] [Accepted: 04/02/2024] [Indexed: 04/05/2024]
Abstract
OBJECTIVE Although hand synovitis is prevalent in the older population, the etiology remains unclear. Hyperuricemia, a modifiable metabolic disorder, may serve as an underlying mechanism of hand synovitis, but little is known about their relationship. We assessed the association between hyperuricemia and hand synovitis in a large population-based sample. METHODS We performed a cross-sectional study in Longshan County, Hunan Province, China. Hyperuricemia was defined as a serum urate level >420 μmol/L in men and >360 μmol/L in women. Ultrasound examinations were performed on both hands of 4,080 participants, and both gray-scale synovitis and the Power Doppler signal (PDS) were assessed using semiquantitative scores (grades 0-3). We evaluated the association of hyperuricemia with hand gray-scale synovitis (grade ≥2) and PDS (grade ≥1), respectively, adjusting for age, sex, and body mass index. RESULTS All required assessments for analysis were available for 3,286 participants. The prevalence of hand gray-scale synovitis was higher among participants with hyperuricemia (30.0%) than those with normouricemia (23.3%), with an adjusted odds ratio (aOR) of 1.28 (95% confidence interval [CI] 1.00-1.62). Participants with hyperuricemia also had a higher prevalence of PDS (aOR 2.36; 95% CI 1.15-4.81). Furthermore, hyperuricemia positively associated, both at the hand and joint levels, with the presence of gray-scale synovitis (aOR 1.27; 95% CI 1.00-1.60 and adjusted prevalence ratio [aPR] 1.26; 95% CI 1.10-1.44, respectively) and PDS (aOR 2.35; 95% CI 1.15-4.79 and aPR 2.34; 95% CI 1.28-4.30, respectively). CONCLUSION This population-based study provides more evidence for a positive association between hyperuricemia and prevalent hand synovitis.
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Affiliation(s)
- Ting Jiang
- Xiangya Hospital, Central South University, Changsha, China, the University of Nottingham, and Pain Centre Versus Arthritis UK, Nottingtham, United Kingdom
| | - Qianlin Weng
- Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Zhang
- Massachusetts General Hospital, Harvard Medical School, Boston
| | - Weiya Zhang
- University of Nottingham and Pain Centre Versus Arthritis UK, Nottingham, United Kingdom
| | - Michael Doherty
- University of Nottingham and Pain Centre Versus Arthritis UK, Nottingham, United Kingdom
| | | | - Zidan Yang
- Xiangya Hospital, Central South University, Changsha, China
| | - Tuo Yang
- Xiangya Hospital, Central South University, Changsha, China, the University of Nottingham, and Pain Centre Versus Arthritis UK, Nottingtham, United Kingdom
| | - Jiatian Li
- Xiangya Hospital, Central South University, Changsha, China
| | - Ke Liu
- Xiangya Hospital, Central South University, Changsha, China
| | - Yuqing Wang
- Xiangya Hospital, Central South University, Changsha, China
| | | | - Chao Zeng
- Xiangya Hospital, Central South University, Changsha, China
| | - Guanghua Lei
- Xiangya Hospital, Central South University, Changsha, China
| | - Jie Wei
- Xiangya Hospital, Central South University, and Xiangya School of Public Health, Central South University, Changsha, China
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Liu B, Xian Y, Chen X, Shi Y, Dong J, Yang L, An X, Shen T, Wu W, Ma Y, He Y, Gong W, Peng R, Lin J, Liu N, Guo B, Jiang Q. Inflammatory Fibroblast-Like Synoviocyte-Derived Exosomes Aggravate Osteoarthritis via Enhancing Macrophage Glycolysis. ADVANCED SCIENCE (WEINHEIM, BADEN-WURTTEMBERG, GERMANY) 2024; 11:e2307338. [PMID: 38342630 PMCID: PMC11005727 DOI: 10.1002/advs.202307338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/03/2023] [Revised: 01/23/2024] [Indexed: 02/13/2024]
Abstract
The severity of osteoarthritis (OA) and cartilage degeneration is highly associated with synovial inflammation. Although recent investigations have revealed a dysregulated crosstalk between fibroblast-like synoviocytes (FLSs) and macrophages in the pathogenesis of synovitis, limited knowledge is available regarding the involvement of exosomes. Here, increased exosome secretion is observed in FLSs from OA patients. Notably, internalization of inflammatory FLS-derived exosomes (inf-exo) can enhance the M1 polarization of macrophages, which further induces an OA-like phenotype in co-cultured chondrocytes. Intra-articular injection of inf-exo induces synovitis and exacerbates OA progression in murine models. In addition, it is demonstrated that inf-exo stimulation triggers the activation of glycolysis. Inhibition of glycolysis using 2-DG successfully attenuates excessive M1 polarization triggered by inf-exo. Mechanistically, HIF1A is identified as the determinant transcription factor, inhibition of which, both pharmacologically or genetically, relieves macrophage inflammation triggered by inf-exo-induced hyperglycolysis. Furthermore, in vivo administration of an HIF1A inhibitor alleviates experimental OA. The results provide novel insights into the involvement of FLS-derived exosomes in OA pathogenesis, suggesting that inf-exo-induced macrophage dysfunction represents an attractive target for OA therapy.
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Liu ZF, Zhang Y, Liu J, Wang YY, Chen M, Liu EY, Guo JM, Wang YH, Weng ZW, Liu CX, Yu CH, Wang XY. Effect of Traditional Chinese Non-Pharmacological Therapies on Knee Osteoarthritis: A Narrative Review of Clinical Application and Mechanism. Orthop Res Rev 2024; 16:21-33. [PMID: 38292459 PMCID: PMC10826518 DOI: 10.2147/orr.s442025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 01/16/2024] [Indexed: 02/01/2024] Open
Abstract
Knee osteoarthritis (KOA) stands as a degenerative ailment with a substantial and escalating prevalence. The practice of traditional Chinese non-pharmacological therapy has become a prevalent complementary and adjunctive approach. A mounting body of evidence suggests its efficacy in addressing KOA. Recent investigations have delved into its underlying mechanism, yielding some headway. Consequently, this comprehensive analysis seeks to encapsulate the clinical application and molecular mechanism of traditional Chinese non-pharmacological therapy in KOA treatment. The review reveals that various therapies, such as acupuncture, electroacupuncture, warm needle acupuncture, tuina, and acupotomy, primarily target localized knee components like cartilage, subchondral bone, and synovium. Moreover, their impact extends to the central nervous system and intestinal flora. More perfect experimental design and more comprehensive research remain a promising avenue in the future.
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Affiliation(s)
- Zhi-Feng Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yang Zhang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Jing Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yu-Yan Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Mo Chen
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Er-Yang Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Jun-Ming Guo
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Yan-Hua Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Zhi-Wen Weng
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Chang-Xin Liu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Chang-He Yu
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
| | - Xi-You Wang
- Tuina and Pain Management Department, Beijing University of Chinese Medicine Affilliated Dongzhimen Hospital, Beijing, People’s Republic of China
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Nevalainen MT, Uusimaa AP, Saarakkala S. The ultrasound assessment of osteoarthritis: the current status. Skeletal Radiol 2023; 52:2271-2282. [PMID: 37060461 PMCID: PMC10509065 DOI: 10.1007/s00256-023-04342-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 03/17/2023] [Accepted: 04/10/2023] [Indexed: 04/16/2023]
Abstract
Traditionally, osteoarthritis (OA) is diagnosed with the clinical examination supplemented by the conventional radiography (CR). In the research literature, the role of ultrasound (US) imaging in the diagnostics of OA has risen steadily during the last two decades. US imaging is cheap and globally widely available often already in primary healthcare. Here, we reviewed the most essential US literature focusing on OA diagnostics and progression prediction using the various search engines. Starting from the year 2000, our search provided 1 445 journal articles. After reviewing the abstracts, 89 articles were finally included. Most of the reviewed articles focused on the imaging of knee and hand OA, whereas only a minority dealt with the imaging of hip, ankle, midfoot, acromioclavicular, and temporomandibular joints. Overall, during the last 20 years, the use of US imaging for OA assessment has increased in the scientific literature. In knee and hand joints, US imaging has been reported to be a promising tool to evaluate OA changes. Furthermore, the reproducibility of US as well as its association to MRI findings are excellent. Importantly, US seems to even outperform CR in certain aspects, such as detection of osteophytes, joint inflammation, meniscus protrusion, and localized cartilage damage (especially at the medial femoral condyle and sulcus area). Based on the reviewed literature, US can be truly considered as a complementary tool to CR in the clinical setup for OA diagnostics. New technical developments may even enhance the diagnostic value of the US in the future.
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Affiliation(s)
- Mika T Nevalainen
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.
- Department of Diagnostic Radiology, Oulu University Hospital, P.O. Box 50, 90029, Oulu, Finland.
| | - Antti-Pekka Uusimaa
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Health Sciences and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland
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McWilliams DF, Yue B, Smith SL, Stocks J, Doherty M, Valdes AM, Zhang W, Sarmanova A, Fernandes GS, Akin-Akinyosoye K, Hall M, Walsh DA. Associations of Muscle Strength with Central Aspects of Pain: Data from the Knee Pain and Related Health in the Community (KPIC) Cohort. J Pers Med 2023; 13:1450. [PMID: 37888061 PMCID: PMC10608698 DOI: 10.3390/jpm13101450] [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: 08/16/2023] [Revised: 09/26/2023] [Accepted: 09/27/2023] [Indexed: 10/28/2023] Open
Abstract
Knee pain is associated with lower muscle strength, and both contribute to disability. Peripheral and central neurological mechanisms contribute to OA pain. Understanding the relative contributions of pain mechanisms to muscle strength might help future treatments. The Knee Pain and related health In the Community (KPIC) cohort provided baseline and year 1 data from people with early knee pain (n = 219) for longitudinal analyses. A cross-sectional analysis was performed with baseline data from people with established knee pain (n = 103) and comparative data from people without knee pain (n = 98). Quadriceps and handgrip strength indicated local and general muscle weakness, respectively. The indices of peripheral nociceptive drive were knee radiographic and ultrasound scores. The indices associated with central pain mechanisms were Pressure Pain detection Threshold (PPT) distal to the knee, and a validated self-report Central Aspects of Pain Factor (CAPF). The associations were explored using correlation and multivariable regression. Weaker quadriceps strength was associated with both high CAPF and low PPT at baseline. Year 1 quadriceps weakness was predicted by higher baseline CAPF (β = -0.28 (95% CI: -0.55, -0.01), p = 0.040). Weaker baseline and year 1 handgrip strength was also associated with higher baseline CAPF. Weaker baseline quadriceps strength was associated with radiographic scores in bivariate but not adjusted analyses. Quadriceps strength was not significantly associated with total ultrasound scores. Central pain mechanisms might contribute to muscle weakness, both locally and remote from the knee.
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Affiliation(s)
- Daniel F. McWilliams
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Bin Yue
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen 518033, China
| | - Stephanie L. Smith
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Joanne Stocks
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- Centre for Sports, Exercise, and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham NG7 2UH, UK
| | - Michael Doherty
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Ana M. Valdes
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Weiya Zhang
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Aliya Sarmanova
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | | | - Kehinde Akin-Akinyosoye
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
| | - Michelle Hall
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Division of Physiotherapy Education, School of Medicine, University of Nottingham, Nottingham NG7 2UH, UK
| | - David A. Walsh
- Pain Centre Versus Arthritis, University of Nottingham, Nottingham NG7 2RD, UK (S.L.S.); (J.S.); (M.D.); (A.M.V.); (W.Z.); (A.S.); (M.H.); (D.A.W.)
- NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals NHS Trust, Nottingham NG7 2UH, UK
- Academic Rheumatology, Division of Injury, Recovery and Inflammation Sciences, School of Medicine, University of Nottingham, Nottingham NG5 1PB, UK
- Sherwood Forest Hospitals NHS Foundation Trust, Mansfield NG17 4JL, UK
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Wang CC, Hu TM, Chen CL, Hong CC, Chang YH, Kao CL. Concurrent Imaging and Clinical Study of the Efficacy of Hyaluronic Acid Injection for Knee Osteoarthritis: A Synovial Membrane Investigation with Ultrasound Imaging. Pharmaceuticals (Basel) 2023; 16:1186. [PMID: 37631101 PMCID: PMC10459875 DOI: 10.3390/ph16081186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 08/12/2023] [Accepted: 08/17/2023] [Indexed: 08/27/2023] Open
Abstract
We investigated whether hyaluronic acid (HA) injections can ameliorate ultrasound-detected synovitis in knee osteoarthritis (OA). We recruited 103 patients with symptomatic knee OA and ultrasound-detected synovitis and performed two ultrasound-guided fluid drainage procedures, followed by the administration of a low-molecular-weight HA injection (2.5 mL) in the subpatellar bursa, at a 2-week interval. Knee ultrasound imaging evaluations were performed before injection (baseline) and at 1 and 6 months after the second injection and included the measurements of synovial vascularity by using color Doppler ultrasound, synovial fluid depth over the suprapatellar bursa (SF), and synovial hypertrophy (SH). Initial clinical assessments included a visual analog scale (VAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). VAS scores decreased significantly at both 1-month and 6-month evaluations (p < 0.001). WOMAC scores also significantly decreased at 1 month (p < 0.001), but not at 6 months (p = 0.23). The ultrasound parameters did not significantly change, except color Doppler grading, which tended to decrease at the 6-month evaluation (p = 0.059). Our findings revealed that two ultrasound-guided HA injections following fluid drainage improved pain and knee function but did not considerably influence imaging-detected synovitis in patients with knee OA.
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien 981002, Taiwan;
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Tsung-Ming Hu
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien 981002, Taiwan;
- Department of Future Studies and LOHAS Industry, Fo Guang University, Yilan 262307, Taiwan
| | - Chien-Lung Chen
- Taipei Hospital, Ministry of Health and Welfare, New Taipei City 24213, Taiwan;
- Institute of Hospital and Health Care Administration, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
| | - Chung-Chih Hong
- Tri-Service General Hospital Songshan Branch, Taipei 10508, Taiwan;
| | - Yu-Hui Chang
- Department of Nursing, Taipei Veterans General Hospital, Taipei 11220, Taiwan;
| | - Chung-Lan Kao
- Department of Physical Medicine and Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei 11221, Taiwan
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital, Section 2, Shi-Pai Road, Taipei 11220, Taiwan
- Center for Intelligent Drug Systems and Smart Bio-Devices (IDS2B), National Chiao Tung University, Hsinchu 30010, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
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Chrabański O, Kluczewska E, Gołąb T, Gorczewska I. Assessment of the Effectiveness of Knee Joints Treatment With the Use of 90 Y : Prospective Ultrasound and Clinical Analysis. Clin Nucl Med 2023; 48:404-408. [PMID: 36947794 PMCID: PMC10082054 DOI: 10.1097/rlu.0000000000004618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 01/13/2023] [Indexed: 03/24/2023]
Abstract
PURPOSE The purpose of this prospective study was to assess the effectiveness of knee joints treatment by radiosynoviorthesis with the use of 90 Y based on ultrasound and clinical analysis. MATERIALS AND METHODS Ninety-seven patients were qualified for treatment from October 2016 to June 2017, and observation period lasted until December 2017. Bioethics Committee of the Medical University of Silesia approved this study. The effectiveness of knee joints treatment with the use of 90 Y was based on 927 ultrasound measurements of fluid and 927 synovial thickness in 3 sites of the suprapatellar recess, 309 assessments of patient's disability documented in Lequesne questionnaire, 309 assessments of pain on visual analog scale, as well as 103 overall self-assessment. Statistical methods were used to process the results. RESULTS A reduction in fluid was found in 62.14% of the knees; synovial thickness reduction was observed in 97.09% of all knees. The greatest benefit from the therapy was experienced by patients complaining of morning stiffness lasting more than 15 minutes (in 85.71% of joints). There was reduction in pain at rest in 94.52% of knee joints and in 80.39% of joints with pain while walking. At the second follow-up visit after treatment, the percentage of improvement in self-assessment was 74.76%. CONCLUSIONS Statistically significant decreases in the amount of fluid and thickness of the synovial membrane as well as the level of disability and the intensity of pain after radiosynoviorthesis 90 Y treatment were demonstrated.
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Affiliation(s)
- Olgierd Chrabański
- From the Department of Radiodiagnostics, Interventional Radiology and Nuclear Medicine, Faculty of Medical Sciences in Katowice, Medical University of Silesia, Katowice, Poland
| | - Ewa Kluczewska
- Department of Radiology and Radiodiagnostics, Faculty of Medical Sciences in Zabrze, Medical University of Silesia, Katowice, Poland
| | - Tomasz Gołąb
- Department of Nuclear Medicine, Clinica Medica, Tychy
| | - Izabela Gorczewska
- Department of Nuclear Medicine and Endocrine Oncology, Maria Skodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
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8
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Zhuang H, Ren X, Zhang Y, Jiang F, Zhou P. Trimethylamine-N-oxide sensitizes chondrocytes to mechanical loading through the upregulation of Piezo1. Food Chem Toxicol 2023; 175:113726. [PMID: 36925039 DOI: 10.1016/j.fct.2023.113726] [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: 12/12/2022] [Revised: 02/23/2023] [Accepted: 03/13/2023] [Indexed: 03/17/2023]
Abstract
BACKGROUND Mechanical strain plays a crucial role in chondrocyte apoptosis and osteoarthritis (OA) disease progression through Piezo1. Trimethylamine-N-oxide (TMAO) is a diet-derived metabolite that correlates positively with multiple chronic diseases. Herein, we explored the potential role of TMAO in sensitizing chondrocytes to Piezo1-mediated mechanotransduction. METHODS The cytotoxicity of TMAO on chondrocytes was assayed. Piezo1 expression was measured after TMAO intervention. Pathological mechanical loading or Yoda1 (a specific Piezo1 channel activator) was administered in chondrocytes. The calcium levels and cytoskeleton in chondrocytes were observed by fluorescence microscopy. Flow cytometry, western blotting, and mitochondrial membrane potential assays were utilized to evaluate apoptosis. A rat OA model was constructed by anterior cruciate ligament transection. Hematoxylin-eosin staining, Safranin-O/Fast Green staining, immunochemistry, and TUNEL were applied to estimate OA severity. RESULTS TMAO intervention alone did not affect chondrocyte viability up to 600 μM. TMAO significantly increased Piezo1 expression and up-regulated intracellular calcium levels, further leading to cytoskeletal damage. Mechanical strain or Yoda1 treatment significantly induced chondrocyte apoptosis. Notably, TMAO intervention further aggravated chondrocyte apoptosis and cartilage destruction under pathological mechanical loading. CONCLUSION TMAO significantly up-regulated Piezo1 expression and sensitized chondrocytes to mechanical loading, which may be closely related to the pathogenesis of OA.
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Affiliation(s)
- Huangming Zhuang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Xunshan Ren
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Yuelong Zhang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Fuze Jiang
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China
| | - Panghu Zhou
- Department of Orthopedics, Renmin Hospital of Wuhan University, Wuhan, China.
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9
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Naredo E, Rodriguez-Garcia SC, Terslev L, Martinoli C, Klauser A, Hartung W, Hammer HB, Cantisani V, Zaottini F, Vlad V, Uson J, Todorov P, Tesch C, Sudoł-Szopińska I, Simoni P, Serban O, Sconfienza LM, Sala-Blanch X, Plagou A, Picasso R, Özçakar L, Najm A, Möller I, Micu M, Mendoza-Cembranos D, Mandl P, Malattia C, Lenghel M, Kessler J, Iohom G, de la Fuente J, DʼAgostino MA, Collado P, Bueno A, Bong D, Alfageme F, Bilous D, Gutiu R, Marian A, Pelea M, Fodor D. The EFSUMB Guidelines and Recommendations for Musculoskeletal Ultrasound - Part II: Joint Pathologies, Pediatric Applications, and Guided Procedures. ULTRASCHALL IN DER MEDIZIN (STUTTGART, GERMANY : 1980) 2022; 43:252-273. [PMID: 34734404 DOI: 10.1055/a-1640-9183] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/13/2023]
Abstract
The second part of the Guidelines and Recommendations for Musculoskeletal Ultrasound (MSUS), produced under the auspices of EFSUMB, following the same methodology as for Part 1, provides information and recommendations on the use of this imaging modality for joint pathology, pediatric applications, and musculoskeletal ultrasound-guided procedures. Clinical application, practical points, limitations, and artifacts are described and discussed for every joint or procedure. The document is intended to guide clinical users in their daily practice.
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Affiliation(s)
- Esperanza Naredo
- Department of Rheumatology, Bone and Joint Research Unit. Hospital Universitario Fundación Jiménez Díaz, IIS Fundación Jiménez Díaz, and Universidad Autónoma de Madrid, Madrid, Spain
| | | | - Lene Terslev
- Copenhagen Center for Arthritis Research, Center for Rheumatology and Spine Diseases, Rigshospitalet, Glostrup, Denmark; Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Carlo Martinoli
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Andrea Klauser
- Department of Radiology, Medical University Innsbruck, Section Head Rheumatology and Sports Imaging, Innsbruck, Austria
| | - Wolfgang Hartung
- Clinic for Rheumatology and Clinical Immunology, Asklepios Clinic, Bad Abbach, Germany
| | - Hilde B Hammer
- Department of Rheumatology, Diakonhjemmet Hospital and Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Vito Cantisani
- Department of Radiological, Oncological and Anatomo-pathological Sciences, "Sapienza" University, Rome, Italy
| | - Federico Zaottini
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Violeta Vlad
- Sf. Maria Hospital, Rheumatology Department, Bucharest, Romania
| | - Jacqueline Uson
- Department of Rheumatology Hospital Universitario Móstoles, Universidad Rey Juan Carlos, Madrid, Spain
| | - Plamen Todorov
- Department of Internal Disease Propaedeutic and Clinical Rheumatology, Medical University of Plovdiv, Plovdiv, Bulgaria
| | | | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation, Warsaw, Poland
| | - Paolo Simoni
- Paediatric Imaging Department, "Reine Fabiola" Children's University Hospital, Université Libre de Bruxelles, Brussels, Belgium
| | - Oana Serban
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Luca Maria Sconfienza
- IRCCS Istituto Ortopedico Galeazzi, Milano Italy
- Department of Biomedical Sciences for Health, University of Milano, Milano, Italy
| | - Xavier Sala-Blanch
- Department of Anaesthesiology, Hospital Clinic, Department of Human Anatomy, Faculty of Medicine, University of Barcelona, Spain
| | - Athena Plagou
- Ultrasound Unit, Private Radiological Institution, Athens, Greece
| | - Riccardo Picasso
- Department of Health Science - DISSAL, University of Genova, Italy
- UO Radiologia, IRCCS Policlinico San Martino, Genova, Italy
| | - Levent Özçakar
- Department of Physical and Rehabilitation Medicine, Hacettepe University Medical School, Ankara, Turkey
| | - Aurelie Najm
- Institute of Infection, Immunity and Inflammation, College of Medical Veterinary and Life Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Ingrid Möller
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Mihaela Micu
- Rheumatology Division, 2nd Rehabilitation Department, Rehabilitation Clinical Hospital Cluj-Napoca, Romania
| | | | - Peter Mandl
- Division of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Clara Malattia
- UOC Clinica Pediatrica e Reumatologia, IRCCS Istituto Giannina Gaslini, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI) University of Genoa, Genoa, Italy
| | - Manuela Lenghel
- Radiology Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Jens Kessler
- Department of Anaesthesiology, Division of Pain Medicine, University Hospital Heidelberg, Heidelberg, Germany
| | - Gabriella Iohom
- Department of Anaesthesiology and Intensive Care Medicine, Cork University Hospital and University College Cork, Cork, Ireland
| | | | - Maria Antonietta DʼAgostino
- Istituto di Reumatologia Università Cattolica del Sacro Cuore, UOC Reumatologia, Fondazione Policlinico Universitario Agostino Gemelli, IRCCS, Rome, Italy
| | - Paz Collado
- Rheumatology Department, Transitional Care Clinic, Hospital Universitario Severo Ochoa, Madrid, Spain
| | - Angel Bueno
- Department of Musculoskeletal Radiology, Hospital Universitario Fundación Alcorcón, Madrid, Spain
| | - David Bong
- Instituto Poal de Reumatologia Barcelona, EULAR Working Group Anatomy for the Image, University of Barcelona, International University of Catalunya, Spain
| | - Fernando Alfageme
- Dermatology Department, Hospital Universitario Puerta de Hierro Majadahonda, Madrid, Spain
| | - Diana Bilous
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Roxana Gutiu
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Anamaria Marian
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Michael Pelea
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Daniela Fodor
- 2nd Internal Medicine Department, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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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: 274] [Impact Index Per Article: 137.0] [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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Philpott HT, Birmingham TB, Dima R, Pinto R, Bryant D, Appleton CT. Test-Retest Reliability and Sensitivity to Change of Ultrasound-Based Methods of Measuring Synovial Inflammation in Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:902-910. [PMID: 35294110 DOI: 10.1002/acr.24882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess test-retest reliability of musculoskeletal ultrasound (US) measures of inflammation in patients with knee osteoarthritis (OA) and to assess the sensitivity to change of US measures of inflammation in patients with knee OA. METHODS To mimic a common clinical scenario, 36 patients (n = 70 knees) with symptomatic knee OA who were in stable condition underwent 2 assessments within 14 days by different operators and different US machines, graded by a single rater. Test-retest reliability was measured using Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and absolute agreement parameters. A total of 51 patients (n = 72 knees) were tested immediately before and 21-28 days after intraarticular glucocorticoid injection to investigate sensitivity to change and longitudinal construct validity. Paired t-tests and standardized response mean (SRM) were used to assess sensitivity to change. Multivariate linear regression was used to investigate longitudinal construct validity of US with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, while adjusting for covariates. RESULTS US measures of inflammation demonstrated moderate (κ = 0.41, 0.60) to substantial (κ = 0.61, 0.80) agreement. Quantitative measures of synovitis and effusion demonstrated good test-retest reliability (ICC2,1 0.71, 0.92). US measures of synovitis and effusion demonstrated low-to-moderate sensitivity to change (SRM -0.29, -0.50). The associations between changes in US measures and KOOS pain scores over time were low, and 95% confidence intervals included zero. CONCLUSION In a clinical setting, US measures of inflammatory features of knee OA have substantial reliability and low-to-moderate sensitivity to change, whereas measures of structural OA features are less reliable. Longitudinal construct validity of US measures of synovitis and effusion to KOOS pain scores is not strongly supported.
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Affiliation(s)
- Holly T Philpott
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Trevor B Birmingham
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Robert Dima
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Ryan Pinto
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Dianne Bryant
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - C Thomas Appleton
- Bone and Joint Institute, Schulich School of Medicine and Dentistry, and London Health Sciences Centre-University Hospital, University of Western Ontario, London, Ontario, Canada
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12
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Effect of Ultrasonic Penetration with Volatile Oil of Olibanum and Chuanxiong Rhizoma on Acute Knee Synovitis Induced by Sports Training: An Open-Label Randomized Controlled Study. Pain Res Manag 2022; 2022:6806565. [PMID: 35265234 PMCID: PMC8901337 DOI: 10.1155/2022/6806565] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 12/16/2021] [Accepted: 01/28/2022] [Indexed: 01/15/2023]
Abstract
Background Knee synovitis is a common sports injury. We proposed the use of UTVOR, which is a combination of the use of volatile oil of Olibanum (VOO) and volatile oil of Chuanxiong Rhizoma (VOCR) and conventional ultrasound (US) therapy, to treat knee synovitis. Design, Setting, Participants, and Interventions. Participants were randomly assigned into a control group (conventional US therapy group) and a test group (UTVOR group). The control group received conventional US therapy with a coupling agent as the medium. The test group received a revised US therapy with VOO and VOCR as media. Both groups were treated once per day for three consecutive days. Main Outcome Measures. The subjects' Visual Analogue Scale (VAS) pain score, Lysholm knee score, knee swelling degree, circumference, and range of motion of the knee joint were evaluated before the first treatment and 24 h after the third treatment. The VAS pain score was considered the primary outcome, while the three other measurements were regarded as the secondary outcomes. An adverse event was reported subjectively and recorded. Results A total of 116 participants were included in the analysis (test group: n = 64; control group: n = 52). The evaluation results showed that the VAS pain scores of the male and female participants in both groups decreased after treatment (P < 0.001), but only the difference among the male sub-group had significant between-group difference (P < 0.001). After treatment, the Lysholm scores in both groups increased significantly (all P < 0.001), the range of motion and the circumference of the injured knee decreased significantly (P < 0.001), while no between-group difference was observed in general or in the gender sub-groups (all P > 0.025). No side effect or complication was reported during the treatment. Conclusion UTVOR had a superior analgesic effect to conventional US therapy in the male population, but its effects on alleviating joint function, swelling, and range of motion were comparable to that of conventional US therapy. Our study found that UTVOR can be an effective method to reduce pain and treat knee synovitis, and it is subjectively safe. Trial registration. This study was registered under the Chinese Clinical Trial Registry (Trial Registration Number: ChiCTR2000035671).
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Philpott HT, Birmingham TB, Pinto R, Primeau CA, Arsenault D, Lanting B, Zhu Y, Appleton CT. Synovitis is associated with constant pain in knee osteoarthritis: a cross-sectional study of OMERACT knee ultrasound scores. J Rheumatol 2021; 49:89-97. [PMID: 34393106 DOI: 10.3899/jrheum.210285] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/03/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To examine the association between ultrasound (US)-detected knee inflammation and intermittent and constant pain experiences in patients with knee osteoarthritis (OA). METHODS Participants with radiographically early- (KL ≤ 2) and late-stage (KL ≥ 3) disease and frequent symptoms underwent musculoskeletal US measures of inflammation using the OMERACT knee US scoring system. Pain experiences were captured using the Intermittent and Constant OA Pain (ICOAP) tool. We assessed the association between US-synovitis and ICOAP pain experiences using a series of linear, logistic, or multinomial logistic regression models (as appropriate for each variable), while adjusting for age, sex, body mass index (BMI), and radiographic stage. Secondary analyses were performed similarly by radiographic stage. RESULTS Pain and synovitis measures from 248 patients (453 knees) were included. Worse synovitis was associated with higher ICOAP constant pain scores (β 8.05 [95%CI 0.67, 15.43]), but not intermittent pain scores. Moderate-to-severe synovitis was associated with a 4.73-fold increased relative risk [95%CI 1.06, 8.80] of a constant pain pattern. In secondary analyses, moderate-to-severe synovitis in early radiographic OA was associated with 2.70-higher odds [95%CI 1.04, 7.02] of any constant pain, 3.28-higher odds [95%CI 1.43, 7.52] of any intermittent pain, and with higher intermittent (β 10.47 [95%CI 1.03, 19.91]) and constant (β 12.62 [95%CI 3.02, 22.23]) pain scores. No associations identified for synovitis in those with late radiographic OA. CONCLUSION In patients with knee OA, moderate-to-severe synovitis is most strongly associated with constant pain. Inflammation may play context-specific roles across pain experiences, especially in earlier radiographic stages of knee OA.
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Affiliation(s)
- Holly T Philpott
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Trevor B Birmingham
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Ryan Pinto
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Codie A Primeau
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Dominique Arsenault
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Brent Lanting
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - Yayuan Zhu
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
| | - C Thomas Appleton
- This work was financially supported by the Academic Medical Organization of Southwestern Ontario (AMOSO) and Western University's Bone and Joint Institute. HP is supported by a Frederick Banting and Charles Best Doctoral Award from the Canadian Institutes of Health Research (CIHR). H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, Faculty of Health Sciences, University of Western Ontario, London, ON, Canada; H.T. Philpott, MSc, T.B. Birmingham, PT, PhD, R. Pinto, MSc, C.A. Primeau, MSc, B. Lanting, MD, MSc, C.T. Appleton, MD, PhD, Bone and Joint Institute, University of Western Ontario, London, ON, Canada; D. Arsenault, MSc, B. Lanting, MD, MSc, London Health Sciences Centre, University Hospital, London, ON, Canada; B. Lanting, MD, MSc, Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; Y. Zhu, PhD, Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada; C.T. Appleton, MD, PhD, Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada, on behalf of the WOREO Knee Study group. Conflict of Interest: CTA is a consultant for Abbvie, Amgen, Bristol Myers Squibb, Celgene, Fresenius Kabi, Gilead, Janssen, Merck, Novartis, Pfizer, Hoffman LaRoche, Sandoz, Sanofi- Genzyme, and UCB. BL is a consultant and receives institutional support from Stryker, DePuy, Smith & Nephew, and Zimmer. BL is a principal investigator with research grants from Stryker, DePuy, and Smith & Nephew. Statement of ethics and consent: Participants provided written informed consent and the registry was approved by Western University's Research Ethics Board for Health Sciences Research Involving Human Subjects (HSREB #109255). Corresponding author: Tom Appleton MD PhD FRCPC, SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, Canada, N6A 4V2.
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Obotiba AD, Swain S, Kaur J, Yaseen K, Doherty M, Zhang W, Abhishek A. Synovitis and bone marrow lesions associate with symptoms and radiographic progression in hand osteoarthritis: a systematic review and meta-analysis of observational studies. Osteoarthritis Cartilage 2021; 29:946-955. [PMID: 33895290 DOI: 10.1016/j.joca.2021.03.018] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 03/12/2021] [Accepted: 03/16/2021] [Indexed: 02/02/2023]
Abstract
AIMS To systematically review observational studies for the association between features detected on ultrasound (US) and magnetic resonance imaging (MRI) and, symptoms, signs and radiographic progression of hand osteoarthritis (OA). METHODS Medline, Web of Science, EMBASE, CINAHL and AMED were searched from inception to 14th January 2020 to identify relevant studies. Quality of studies was assessed using the Newcastle-Ottawa scales and data were extracted. Odds ratios (OR) and linear regression coefficients and 95% confidence intervals (CI) were pooled using the random-effects model (METAN package, Stata v16.1). Heterogeneity and publication bias were assessed. RESULTS Thirty-two studies using US and MRI comprising 1,350 and 638 participants respectively were included. While only grey-scale synovitis (GSS) associated with AUSCAN-pain (pooled Regression coefficient (95% CI): 0.46 (0.13-0.79); 0-20 scale for AUSCAN-pain), US-detected osteophytes, GSS and power Doppler (PD) [pooled ORs (95% CI): 2.68(2.16-3.33), 2.38(1.74-3.26) and 2.04 (1.45-2.88)] as well as MRI-detected bone marrow lesions (BMLs), synovitis, osteophytes, and central bone erosions (CBEs) associated with joint tenderness [pooled ORs (95% CI): 2.59(2.12-3.18), 2.17(1.85-2.54), 2.15(1.55-2.99), and 2.41 (1.45-4.02)] respectively. US-detected GSS and PD associated with radiographic progression of CBEs [pooled ORs 5.37, 5.08], osteophytes [pooled ORs 5.17, 6.45], and joint space narrowing (pooled ORs 4.28, 4.36) whilst MRI-detected synovitis and BMLs associated with increasing KL grades with pooled ORs 2.92, 2.54 respectively. CONCLUSIONS US and MRI-detected structural and inflammatory changes associate with tenderness, whilst articular inflammation and subchondral bone damage associate with radiographic hand OA progression. There was inconsistent relationship between these changes and pain.
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Affiliation(s)
- A D Obotiba
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom; Department of Medical Imaging, College of Medicine and Health, University of Exeter, United Kingdom.
| | - S Swain
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - J Kaur
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - K Yaseen
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom; School of Health Sciences, University of Nottingham, United Kingdom.
| | - M Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - W Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom.
| | - A Abhishek
- Academic Rheumatology, School of Medicine, University of Nottingham, United Kingdom; Nottingham NIHR-BRC, Nottingham, United Kingdom.
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15
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Jiang T, Yang T, Zhang W, Doherty M, Zhang Y, Wei J, Sarmanova A, Hall M, Yang Z, Li J, Fernandes GS, Obotiba AD, Gohir SA, Courtney P, Zeng C, Lei G. Prevalence of ultrasound-detected knee synovial abnormalities in a middle-aged and older general population-the Xiangya Osteoarthritis Study. Arthritis Res Ther 2021; 23:156. [PMID: 34078472 PMCID: PMC8170794 DOI: 10.1186/s13075-021-02539-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/19/2021] [Indexed: 12/03/2022] Open
Abstract
Background There is paucity of data on the prevalence of ultrasound-detected synovial abnormalities in the general population, and the relationship between synovial changes and knee pain remains unclear. We examined the prevalence of synovial abnormalities on ultrasound and the relationship of these features with knee pain and radiographic osteoarthritis (ROA) in a community sample. Methods Participants aged 50 years or over were from the Xiangya Osteoarthritis Study, a community-based cohort study. Participants were questioned about chronic knee pain and underwent (1) ultrasonography of both knees to determine presence of synovial hypertrophy (≥ 4 mm), effusion (≥ 4 mm), and Power Doppler signal [PDS; yes/no]; and (2) standard radiographs of both knees (tibiofemoral and patellofemoral views) to determine ROA. Results There were 3755 participants (mean age 64.4 years; women 57.4%). The prevalence of synovial hypertrophy, effusion, and PDS were 18.1% (men 20.2%; women 16.5%), 46.6% (men 49.9%; women 44.2%), and 4.9% (men 4.9%; women 5.0%), respectively, and increased with age (P for trend < 0.05). Synovial abnormalities were associated with knee pain, with adjusted odds ratios (aORs) of 2.39 (95% confidence interval [CI] 2.00–2.86) for synovial hypertrophy, 1.58 (95%CI 1.39–1.80) for effusion, and 4.36 (95%CI 3.09–6.17) for PDS. Similar associations with ROA were observed, the corresponding aORs being 4.03 (95%CI 3.38–4.82), 2.01 (95%CI 1.76–2.29), and 6.49 (95%CI 4.51–9.35), respectively. The associations between synovial hypertrophy and effusion with knee pain were more pronounced among knees with ROA than those without ROA, and the corresponding P for interaction were 0.004 and 0.067, respectively. Conclusions Knee synovial hypertrophy and effusion are more common and increase with age, affecting men more than women. All three ultrasound-detected synovial abnormalities associate both with knee pain and ROA, and knee synovial hypertrophy or effusion and ROA may interact to increase the risk of knee pain. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-021-02539-2.
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Affiliation(s)
- Ting Jiang
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China.,Department of Ultrasonography, Xiangya Hospital, Central South University, Changsha, China.,Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Tuo Yang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis UK, Nottingham, UK.,Health Management Center, Xiangya Hospital, Central South University, Changsha, China
| | - Weiya Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Michael Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, USA.,The Mongan Institute, Massachusetts General Hospital, Harvard Medical School, Boston, USA
| | - Jie Wei
- Health Management Center, Xiangya Hospital, Central South University, Changsha, China.,Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Aliya Sarmanova
- Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, Bristol, UK
| | - Michelle Hall
- Pain Centre Versus Arthritis UK, Nottingham, UK.,School of Health Sciences, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Zidan Yang
- Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China
| | - Jiatian Li
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China
| | - Gwen S Fernandes
- Population Health Sciences, Bristol Medical School, University of Bristol, Bristol, UK
| | - Abasiama D Obotiba
- Division of Rheumatology, Orthopaedics and Dermatology, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis UK, Nottingham, UK
| | - Sameer A Gohir
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, UK
| | - Philip Courtney
- Department of Rheumatology, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Chao Zeng
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
| | - Guanghua Lei
- Department of Orthopaedics, Xiangya Hospital, Central South University, 87 Xiangya Road, Changsha, 410008, Hunan, China. .,Hunan Key Laboratory of Joint Degeneration and Injury, Xiangya Hospital, Central South University, Changsha, China. .,National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China.
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16
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Xu Z, He Z, Shu L, Li X, Ma M, Ye C. Intra-Articular Platelet-Rich Plasma Combined With Hyaluronic Acid Injection for Knee Osteoarthritis Is Superior to Platelet-Rich Plasma or Hyaluronic Acid Alone in Inhibiting Inflammation and Improving Pain and Function. Arthroscopy 2021; 37:903-915. [PMID: 33091549 DOI: 10.1016/j.arthro.2020.10.013] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/04/2020] [Revised: 09/30/2020] [Accepted: 10/11/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the effectiveness and explore the therapeutic mechanisms of platelet-rich plasma (PRP) combined with hyaluronic acid (HA) as a treatment for knee osteoarthritis (KOA). METHODS In total, 122 knees were randomly divided into HA (34 knees), PRP (40 knees), and PRP+HA (48 knees) groups. Platelet densities in whole blood and PRP were examined using Wright-Giemsa staining. Visual analogue scale, Lequesne, Western Ontario and McMaster Universities Osteoarthritis Index, Lysholm scores, and postoperative complications were evaluated. High-frequency color Doppler imaging was used to observe the synovium and cartilage. Enzyme-linked immunosorbent assays were used to quantify interleukin-1β, tumor necrosis factor-α, matrix metalloproteinase-3, and tissue inhibitor of metalloproteinase-1 levels in synovial fluid. RESULTS The platelet density in PRP was 5.13-times that in whole blood (P = .002). At 24 months, pain and function scores in the PRP+HA group were better than those in the HA-alone and PRP-alone groups (Ppain = .000; Pfunction = .000). At 6 and 12 months, synovial hyperplasia in the PRP and PRP+HA groups was improved (P < .05). After 6 and 12 months, the synovial peak systolic velocity, synovial end-diastolic velocity, systolic/diastolic ratio, and resistance index were improved in the PRP+HA group (P < .05). Complications were greatest in the PRP group (P = .008). After 6 and 12 months, interleukin-1β, tumor necrosis factor-α, matrix metalloproteinase-3, and tissue inhibitor of metalloproteinase-1 in the PRP and PRP+HA groups decreased (P < .05), with more apparent inhibition in the PRP+HA group (P < .05). CONCLUSIONS PRP combined with HA is more effective than PRP or HA alone at inhibiting synovial inflammation and can effectively improve pain and function and reduce adverse reactions. Its mechanism involves changes in the synovium and cytokine content. LEVEL OF EVIDENCE Level II, Prospective cohort study.
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Affiliation(s)
- Zhe Xu
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China; Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang, China
| | - Zhixu He
- Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang, China
| | - Liping Shu
- Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang, China
| | - Xuanze Li
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang, China
| | - Minxian Ma
- Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang, China
| | - Chuan Ye
- Department of Orthopaedics, The Affiliated Hospital of Guizhou Medical University, Guiyang, China; Key Laboratory of Adult Stem Cell Transformation Research, Chinese Academy of Medical Sciences, Guiyang, China; National-Local Joint Engineering Laboratory of Cell Engineering and Biomedicine, Guiyang, China; Center for Tissue Engineering and Stem Cell Research, Guizhou Medical University, Guiyang, China; China Orthopaedic Regenerative Medicine Group (CORMed), Hangzhou, China.
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17
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Wang CC, Wang CT, Tsai KL, Chou CL, Chao JK, Huang HY, Kao CL. Effect of ultrasound-detected synovitis on therapeutic efficacy of hyaluronic acid injection for symptomatic knee osteoarthritis. Rheumatology (Oxford) 2021; 60:4486-4494. [PMID: 33493323 PMCID: PMC8487310 DOI: 10.1093/rheumatology/keab020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 01/04/2021] [Indexed: 02/06/2023] Open
Abstract
Objective To determine whether ultrasound (US)-detected synovitis affects the therapeutic efficacy of hyaluronic acid (HA) injection for treating knee OA. Methods Patients with symptomatic knee OA were recruited. All the patients received HA injection two times at 2-week intervals. Clinical assessments were performed using a visual analogue scale (VAS) and the Western Ontario and McMaster Universities OA Index (WOMAC) at baseline and 1 and 6 months after treatment. Imaging evaluation was based on complete knee US examination and the Kellgren–Lawrence grading. Suprapatellar synovial fluid (SF) depth, synovial hypertrophy (SH) and vascularity were measured through US. Results In total, 137 patients who fulfilled the inclusion criteria were included in the analysis. All patients demonstrated improvement in VAS and WOMAC scores at 1 and 6 months after treatment (P < 0.001). Moreover, regression model-based analysis revealed significant associations of SF depth with the VAS and WOMAC scores in all patients. Each centimetre increase in the effusion diameter was associated with a decrease in the 1-month post-treatment VAS improvement percentage (15.26; 95% CI: 0.05, 29.5; P = 0.042) and 6-month post-treatment WOMAC improvement (37.43; 95% CI: 37.68, 50.69; P < 0.01). However, SH and vascularity were not significantly associated with VAS or WOMAC scores. Conclusion Ultrasound detected suprapatellar effusion predicts reduced efficacy of HA injection in knee OA
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Affiliation(s)
- Chien-Chih Wang
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital Yuli Branch, Hualien.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Chin-Tien Wang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Kun-Ling Tsai
- Department of Physical Therapy.,Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan
| | - Chen-Liang Chou
- Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital.,Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei
| | - Jian-Kang Chao
- Department of Psychiatry, Taipei Veterans General Hospital Yuli Branch, Hualien.,Department of Social Work, National Pingtung University of Science & Technology, Pingtung
| | - Hsin-Yi Huang
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei.,Taipei Veterans General Hospital Biostatistics Task Force, Taipei
| | - Chung-Lan Kao
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei.,Department of Physical Medicine and Rehabilitation, Taipei Veterans General Hospital.,Department of Physical Medicine & Rehabilitation, School of Medicine, National Yang Ming Chiao Tung University, Taipei.,Center For Intelligent Drug Systems and Smart Bio-devices (IDS2B), National Chiao Tung University, Hsinchu, Taiwan
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18
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Persson MSM, Stocks J, Varadi G, Hashempur MH, van Middelkoop M, Bierma-Zeinstra S, Walsh DA, Doherty M, Zhang W. Predicting response to topical non-steroidal anti-inflammatory drugs in osteoarthritis: an individual patient data meta-analysis of randomized controlled trials. Rheumatology (Oxford) 2021; 59:2207-2216. [PMID: 32276272 PMCID: PMC7449808 DOI: 10.1093/rheumatology/keaa113] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 01/31/2020] [Indexed: 11/24/2022] Open
Abstract
Objectives To identify predictors of the specific (difference between treatment and placebo) and overall (change from baseline in treatment arm) treatment effects of topical NSAIDs in OA. Methods Randomized controlled trials (RCTs) of topical NSAIDs in OA were identified through systematic literature searching and inquiry to pharmaceutical companies. The raw, de-identified data were analysed in one-stage individual patient data meta-analysis (IPD-MA). Negative values for treatment effects (0–100 scale) indicate pain reduction. Results Of 63 eligible RCTs, 15 provided IPD (n = 1951 on topical NSAID), including 11 placebo-controlled RCTs (n = 1587 on topical NSAIDs, 1553 on placebo). Seven potential predictors of response were examined. Topical NSAIDs were superior to placebo [−6 (95% CI −9, −4)], with a small, but statistically significant greater effect in women than men [difference −4 (95% CI −8, −1)]. The overall treatment effect was 4-fold larger than the specific effect [−25 (95% CI −31, −19)] and increased with greater baseline pain severity (P < 0.001). No differences in efficacy were observed for age, BMI, features of inflammation, duration of complaints or radiographic OA severity. Conclusion Topical NSAIDs are effective for OA pain relief. Greater overall pain relief in individuals with more baseline pain might be due to contextual and non-specific effects, including regression to the mean. Additional factors that have been linked either mechanistically or through empirical evidence to outcomes should be selected for inclusion across future RCTs in order to facilitate the identification of response predictors through IPD-MA.
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Affiliation(s)
- Monica S M Persson
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Joanne Stocks
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | | | | | - Marienke van Middelkoop
- Department of General Practice, University Medical Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Sita Bierma-Zeinstra
- Department of General Practice, University Medical Center, Erasmus Medical Center, Rotterdam, The Netherlands
| | - David A Walsh
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Weiya Zhang
- Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
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Abstract
PURPOSE OF REVIEW This narrative review summarizes the last 5 years of published, peer-reviewed research on the use of musculoskeletal ultrasound (US) in osteoarthritis (OA). RECENT FINDINGS Multiple features relevant to OA can be visualized on US, including synovitis, erosion, enthesitis, osteophytes, cartilage damage, meniscal extrusion, and popliteal cysts. US can be used to confirm a diagnosis of OA or make an alternate diagnosis in the clinical setting. When a standardized protocol is used, US is a reliable modality for assessment of the features of OA. Findings on US can predict progression and response to therapy in OA of the hand and knee and can allow characterization of risk factors in a cost-effective, non-invasive, repeatable manner. US is becoming more widely used in OA imaging and has clear value in addition to radiography and clinical assessment. US will likely prove useful in defining phenotypes and providing treatment guidance in OA.
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Affiliation(s)
- Amanda E Nelson
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3300 Doc J. Thurston Building, Campus Box #7280, Chapel Hill, NC, 27599-7280, USA.
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20
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Oo WM, Linklater JM, Bennell KL, Pryke D, Yu S, Fu K, Wang X, Duong V, Hunter DJ. Are OMERACT Knee Osteoarthritis Ultrasound Scores Associated With Pain Severity, Other Symptoms, and Radiographic and Magnetic Resonance Imaging Findings? J Rheumatol 2020; 48:270-278. [PMID: 32414954 DOI: 10.3899/jrheum.191291] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/28/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE To investigate the associations of Outcome Measures in Rheumatology (OMERACT) ultrasound scores for knee osteoarthritis (OA) with pain severity, other symptoms, and OA severity on radiographs and magnetic resonance imaging (MRI). METHODS Participants with symptomatic and mild to moderate radiographic knee OA underwent baseline dynamic ultrasound (US) assessment according to standardized OMERACT scanning protocol. Using the published US image atlas, a physician operator obtained semiquantitative or binary scores for US pathologies. Clinical severity was measured on numerical rating scale (NRS) and Knee Injury and Osteoarthritis Outcome Score (KOOS) symptoms and pain subscores. OA severity was assessed using the Kellgren-Lawrence (KL) grade on radiographs and MRI Osteoarthritis Knee Score (MOAKS) on noncontrast-enhanced MRI. Separate linear regression models were used to determine associations of US OA pathologies with pain and KOOS subscores, and Spearman correlations were used for US scores with KL grade and MOAKS. RESULTS Eighty-nine participants were included. Greater synovial hypertrophy, power Doppler (PD), and meniscal extrusion scores were associated with worse NRS pain [β 0.92 (95% CI 0.25-1.58), β 0.73 (95% CI 0.11-1.35), and β 1.01 (95% CI 0.22-1.80), respectively]. All greater US scores, except for cartilage grade, demonstrated significant associations with worse KOOS symptoms, whereas only PD and meniscal extrusion were associated with worse KOOS pain. All US scores, except for PD, were significantly correlated with KL grade. US pathologies, except for cartilage, revealed moderate to good correlation with their MOAKS counterparts, with US synovitis having the greatest correlation (0.69, 95% CI 0.60-0.78). CONCLUSION OMERACT US scores revealed significant associations with pain severity, KL grade, and MOAKS.
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Affiliation(s)
- Win Min Oo
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney;
| | - James M Linklater
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Kim L Bennell
- K.L. Bennell, PhD, Centre for Health, Exercise and Sports Medicine, Department of Physiotherapy, School of Health Sciences, Faculty of Medicine Dentistry & Health Sciences, The University of Melbourne, Melbourne, Australia
| | - Danielle Pryke
- J.M. Linklater, FRANZCR, D. Pryke, Grad Dip Medical Sonography, Department of Musculoskeletal Imaging, Castlereagh Sports Imaging Center, St. Leonards, Sydney
| | - Shirley Yu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Kai Fu
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Xia Wang
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - Vicky Duong
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
| | - David J Hunter
- W.M. Oo, PhD, S. Yu, FRACP, K. Fu, PhD, X. Wang, PhD, V. Duong, DPT, D.J. Hunter, PhD, Rheumatology Department, Royal North Shore Hospital and Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney
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Millar B, McWilliams DF, Abhishek A, Akin-Akinyosoye K, Auer DP, Chapman V, Doherty M, Ferguson E, Gladman JRF, Greenhaff P, Stocks J, Valdes AM, Walsh DA. Investigating musculoskeletal health and wellbeing; a cohort study protocol. BMC Musculoskelet Disord 2020; 21:182. [PMID: 32199451 PMCID: PMC7085148 DOI: 10.1186/s12891-020-03195-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 03/09/2020] [Indexed: 12/17/2022] Open
Abstract
Background In an ageing population, pain, frailty and disability frequently coexist across a wide range of musculoskeletal diagnoses, but their associations remain incompletely understood. The Investigating Musculoskeletal Health and Wellbeing (IMH&W) study aims to measure and characterise the development and progression of pain, frailty and disability, and to identify discrete subgroups and their associations. The survey will form a longitudinal context for nested research, permitting targeted recruitment of participants for qualitative, observational and interventional studies; helping to understand recruitment bias in clinical studies; and providing a source cohort for cohort randomised controlled trials. Methods IMH&W will comprise a prospective cohort of 10,000 adults recruited through primary and secondary care, and through non-clinical settings. Data collection will be at baseline, and then through annual follow-ups for 4 years. Questionnaires will address demographic characteristics, pain severity (0–10 Numerical Rating Scale), pain distribution (reported on a body Manikin), pain quality (McGill Pain Questionnaire), central aspects of pain (CAP-Knee), frailty and disability (based on Fried criteria and the FRAIL questionnaire), and fracture risk. Baseline characteristics, progression and associations of frailty, pain and disability will be determined. Discrete subgroups and trajectories will be sought by latent class analysis. Recruitment bias will be explored by comparing participants in nested studies with the eligible IMH&W population. Discussion IMH&W will elucidate associations and progression of pain, frailty and disability. It will enable identification of people at risk of poor musculoskeletal health and wellbeing outcomes who might be suitable for specific interventions, and facilitate generalisation and comparison of research outcomes between target populations. The study will benefit from a large sample size and will recruit from diverse regions across the UK. Purposive recruitment will enrich the cohort with people with MSK problems with high representation of elderly and unwell people. Trial registration Clinicaltrials.gov NCT03696134. Date of Registration: 04 October 2018.
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Affiliation(s)
- Bonnie Millar
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Daniel F McWilliams
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Abhishek Abhishek
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Kehinde Akin-Akinyosoye
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Dorothee P Auer
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.,Division of Clinical Neuroscience, School of Medicine, University of Nottingham, Nottingham, UK
| | - Victoria Chapman
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.,School of Life Sciences, University of Nottingham, Nottingham, UK
| | - Michael Doherty
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Eamonn Ferguson
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK.,School of Psychology, University of Nottingham, Nottingham, UK
| | - John R F Gladman
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Rehabilitation, Ageing and Wellbeing, School of Medicine, University of Nottingham, Nottingham, UK
| | - Paul Greenhaff
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of Physiology, Pharmacology and Neuroscience, University of Nottingham, Nottingham, UK
| | - Joanne Stocks
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Ana M Valdes
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK.,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK.,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK
| | - David A Walsh
- NIHR Biomedical Research Centre, Academic Rheumatology, University of Nottingham Clinical Sciences Building, City Hospital, Nottingham, NG5 1PB, UK. .,Division of ROD, School of Medicine, University of Nottingham, Nottingham, UK. .,Pain Centre Versus Arthritis, University of Nottingham, Nottingham, UK. .,Sherwood Forest Hospitals NHS Foundation Trust, Sutton in Ashfield, Nottinghamshire, UK.
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22
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Kauppinen K, Pylväläinen J, Pamilo K, Helminen O, Haapea M, Saarakkala SS, Nevalainen MT. Association between grayscale sonographic and clinical findings in severe knee osteoarthritis. JOURNAL OF CLINICAL ULTRASOUND : JCU 2020; 48:75-81. [PMID: 31580500 DOI: 10.1002/jcu.22779] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2019] [Revised: 08/31/2019] [Accepted: 09/06/2019] [Indexed: 06/10/2023]
Abstract
PURPOSE To assess whether ultrasonographic (US) findings associate with clinical findings in severe knee osteoarthritis (OA). Association of US findings with side-of-knee pain and inter-reader agreement of knee US were also evaluated. METHODS One-hundred-two patients (in total 123 knees) with severe knee OA were recruited for this cross-sectional study. US was performed by a single observer, and on 53 knees by two independent observers to assess inter-reader reliability. Preoperative clinical data was available for 69 knees. Cutoff values were applied to dichotomize US and clinical findings. The Chi-square test, Mann-Whitney test, and prevalence- and bias-adjusted kappa (PABAK) were applied for statistical analyses. RESULTS Seven of 99 associations tested were statistically significant. Associations were observed between range of flexion and lateral femoral (P = .009) and tibial (P = .001) osteophytes, mediolateral instability and damage to the lateral femoral cartilage (P = .014) and damage to the lateral meniscus (P = .031), and alignment and damage to the lateral femoral cartilage (P < .001), lateral tibial osteophytes (P = .037), and damage to the lateral meniscus (P < .001). A strong association was observed between medial-sided pain and same-sided cartilage damage and osteophytes (P < .001). That inter-reader agreement was excellent on the medial side of the knee joint (PABAK = 0.811-0.887). CONCLUSIONS US findings show a rather poor association with clinical OA findings. Inter-reader agreement of knee US is excellent on the medial side.
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Affiliation(s)
- Kyösti Kauppinen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Juho Pylväläinen
- Department of Radiology, Helsinki University Hospital, Helsinki, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
| | - Konsta Pamilo
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Olli Helminen
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Surgery, Central Finland Central Hospital, Jyväskylä, Finland
| | - Marianne Haapea
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Simo S Saarakkala
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Mika T Nevalainen
- Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Department of Radiology, Central Finland Central Hospital, Jyväskylä, Finland
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, Oulu, Finland
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23
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Akin-Akinyosoye K, Sarmanova A, Fernandes GS, Frowd N, Swaithes L, Stocks J, Valdes A, McWilliams DF, Zhang W, Doherty M, Ferguson E, Walsh DA. Baseline self-report 'central mechanisms' trait predicts persistent knee pain in the Knee Pain in the Community (KPIC) cohort. Osteoarthritis Cartilage 2020; 28:173-181. [PMID: 31830591 DOI: 10.1016/j.joca.2019.11.004] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 10/13/2019] [Accepted: 11/18/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES We investigated whether baseline scores for a self-report trait linked to central mechanisms predict 1 year pain outcomes in the Knee Pain in the Community cohort. METHOD 1471 participants reported knee pain at baseline and responded to a 1-year follow-up questionnaire, of whom 204 underwent pressure pain detection thresholds (PPTs) and radiographic assessment at baseline. Logistic and linear regression models estimated the relative risks (RRs) and associations (β) between self-report traits, PPTs and pain outcomes. Discriminative performance for each predictor was compared using receiver-operator characteristics (ROC) curves. RESULTS Baseline Central Mechanisms trait scores predicted pain persistence (Relative Risk, RR = 2.10, P = 0.001) and persistent pain severity (β = 0.47, P < 0.001), even after adjustment for age, sex, BMI, radiographic scores and symptom duration. Baseline joint-line PPTs also associated with pain persistence (RR range = 0.65 to 0.68, P < 0.02), but only in univariate models. Lower baseline medial joint-line PPT was associated with persistent pain severity (β = -0.29, P = 0.013) in a fully adjusted model. The Central Mechanisms trait model showed good discrimination of pain persistence cases from resolved pain cases (Area Under the Curve, AUC = 0.70). The discrimination power of other predictors (PPTs (AUC range = 0.51 to 0.59), radiographic OA (AUC = 0.62), age, sex and BMI (AUC range = 0.51 to 0.64), improved significantly (P < 0.05) when the central mechanisms trait was included in each logistic regression model (AUC range = 0.69 to 0.74). CONCLUSION A simple summary self-report Central Mechanisms trait score may indicate a contribution of central mechanisms to poor knee pain prognosis.
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Affiliation(s)
- K Akin-Akinyosoye
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - A Sarmanova
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - G S Fernandes
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK; Centre for Sports, Exercise, and Osteoarthritis Versus Arthritis, UK.
| | - N Frowd
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - L Swaithes
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - J Stocks
- Pain Centre Versus Arthritis, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - A Valdes
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - D F McWilliams
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - W Zhang
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - M Doherty
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
| | - E Ferguson
- Pain Centre Versus Arthritis, UK; School of Psychology, University of Nottingham, UK.
| | - D A Walsh
- Pain Centre Versus Arthritis, UK; NIHR Nottingham Biomedical Research Centre, Nottingham University Hospitals, NHS Trust, UK; Division of Rheumatology, Orthopaedics, and Dermatology, School of Medicine, University of Nottingham, UK.
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24
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Gohir SA, Greenhaff P, Abhishek A, Valdes AM. Evaluating the efficacy of Internet-Based Exercise programme Aimed at Treating knee Osteoarthritis (iBEAT-OA) in the community: a study protocol for a randomised controlled trial. BMJ Open 2019; 9:e030564. [PMID: 31662373 PMCID: PMC6830654 DOI: 10.1136/bmjopen-2019-030564] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 07/22/2019] [Accepted: 09/17/2019] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is the most common joint disease worldwide. As of today, there are no disease-modifying drugs, but there is evidence that muscle strengthening exercises can substantially reduce pain and improve function in this disorder, and one very well tested physiotherapy protocol is the 'Better Management of Patients with Osteoarthritis' developed in Sweden. Given the high prevalence of knee OA, a potentially cost-effective, digitally delivered approach to treat knee OA should be trialled. This study aims to explore the benefits of iBEAT-OA (Internet-Based Exercise programme Aimed at Treating knee Osteoarthritis) in modulating pain, function and other health-related outcomes in individuals with knee OA. METHODS AND ANALYSIS A randomised controlled trial was designed to evaluate the efficacy of a web-based exercise programme in a population with knee OA compared with standard community care provided by general practitioners (GPs) in the UK. We anticipate recruiting participants into equal groups. The intervention group (n=67) will exercise for 20-30 min daily for six consecutive weeks, whereas the control group (n=67) will follow GP-recommended routine care. The participants will be assessed using a Numerical Rating Scale, the Western Ontario and McMaster Universities Osteoarthritis Index, the Arthritis Research UK Musculoskeletal Health Questionnaire, the Pittsburgh Sleep Quality Index, 30 s sit to stand test, timed up and go test, quantitative sensory testing, musculoskeletal ultrasound scan, muscle thickness assessment of the vastus lateralis, and quadriceps muscles force generation during an isokinetic maximum voluntary contraction (MVC). Samples of urine, blood, faeces and synovial fluid will be collected to establish biomarkers associated with changes in pain and sleep patterns in individuals affected with knee OA. Standard parametric regression methods will be used for statistical analysis. ETHICS AND DISSEMINATION Ethical approval was obtained from the Research Ethics Committee (ref: 18/EM/0154) and the Health Research Authority (protocol no: 18021). The study was registered in June 2018. The results of the trial will be submitted for publication in a peer-reviewed journal. TRIAL REGISTRATION NUMBER NCT03545048.
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Affiliation(s)
- Sameer Akram Gohir
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
| | - Paul Greenhaff
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
- Division of Physiology, Pharmacology and Neuroscience, University of Nottingham School of Medical and Surgical Sciences, Nottingham, Nottingham, UK
- MRC Arthritis Research UK Centre, MSK Ageing Research, Nottingham, United Kingdom
- School of Life Sciences, University of Nottingham, Nottingham, United Kingdom
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Abhishek Abhishek
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
- Academic Rheumatology, University of Nottingham, Nottingham, United Kingdom
| | - Ana M Valdes
- NIHR Nottingham Biomedical Research Centre, School of Medicine, University of Nottingham, Nottingham, East Midland, UK
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25
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Ni Z, Kuang L, Chen H, Xie Y, Zhang B, Ouyang J, Wu J, Zhou S, Chen L, Su N, Tan Q, Luo X, Chen B, Chen S, Yin L, Huang H, Du X, Chen L. The exosome-like vesicles from osteoarthritic chondrocyte enhanced mature IL-1β production of macrophages and aggravated synovitis in osteoarthritis. Cell Death Dis 2019; 10:522. [PMID: 31285423 PMCID: PMC6614358 DOI: 10.1038/s41419-019-1739-2] [Citation(s) in RCA: 106] [Impact Index Per Article: 21.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2019] [Revised: 05/28/2019] [Accepted: 05/31/2019] [Indexed: 02/07/2023]
Abstract
Synovitis, a common clinical symptom for osteoarthritis (OA) patients, is highly related to OA pathological progression and pain manifestation. The activated synovial macrophages have been demonstrated to play an important role in synovitis, but the mechanisms about macrophage activation are still not clear. In this study, we found that the exosome-like vesicles from osteoarthritic chondrocytes could be a new biological factor to stimulate inflammasome activation and increase mature IL-1β production in macrophages. The degraded cartilage explants produced more exosome-like vesicles than the nondegraded ones, while the exosome-like vesicles from chondrocytes could enter into joint synovium tissue and macrophages. Moreover, the exosome-like vesicles from osteoarthritic chondrocytes enhanced the production of mature IL-1β in macrophages. These vesicles could inhibit ATG4B expression via miR-449a-5p, leading to inhibition of autophagy in LPS-primed macrophages. The decreased autophagy promoted the production of mitoROS, which further enhanced the inflammasome activation and subsequent IL-1β processing. Ultimately, the increase of mature IL-1β may aggravate synovial inflammation and promote the progression of OA disease. Our study provides a new perspective to understand the activation of synovial macrophages and synovitis in OA patients, which may be beneficial for therapeutic intervention in synovitis-related OA patients.
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Affiliation(s)
- Zhenhong Ni
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Liang Kuang
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Hangang Chen
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Yangli Xie
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Bin Zhang
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Junjie Ouyang
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Jiangyi Wu
- Center for Joint Surgery, Southwest Hospital, Army Medical University (Third Military Medical University), 400038, Chongqing, China
| | - Siru Zhou
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Liang Chen
- Department of Spine Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Nan Su
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - QiaoYan Tan
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Xiaoqing Luo
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Bo Chen
- Department of Spine Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Shuai Chen
- Department of Spine Surgery, Institute of Surgery Research, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Liangjun Yin
- Department of Orthopedic Surgery, The Second Affiliated Hospital, Chongqing Medical University, 400010, Chongqing, China
| | - Haiyang Huang
- Department of Orthopedic Surgery, Qianjiang Nationality Hospital, 409000, Chongqing, China
| | - Xiaolan Du
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China
| | - Lin Chen
- Laboratory for the Rehabilitation of Traumatic Injuries, Laboratory of Trauma, Center of Bone Metabolism and Repair, State Key Laboratory of Trauma, Burns and Combined Injury, Research Institute of Surgery, Laboratory for Prevention and Rehabilitation of Military Training Related Injuries, Daping Hospital, Army Medical University (Third Military Medical University), 400042, Chongqing, China.
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Aso K, Shahtaheri SM, Hill R, Wilson D, McWilliams DF, Walsh DA. Associations of Symptomatic Knee Osteoarthritis With Histopathologic Features in Subchondral Bone. Arthritis Rheumatol 2019; 71:916-924. [DOI: 10.1002/art.40820] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2018] [Accepted: 12/18/2018] [Indexed: 12/19/2022]
Affiliation(s)
- Koji Aso
- Arthritis Research UK Pain Centre, NIHR Nottingham Biomedical Research CentreUniversity of Nottingham, Nottingham, UK, and Kochi Medical School, Kochi University Nankoku Japan
| | - S. Mohsen Shahtaheri
- Arthritis Research UK Pain Centre, NIHR Nottingham Biomedical Research CentreUniversity of Nottingham Nottingham UK
| | - Roger Hill
- Arthritis Research UK Pain Centre, NIHR Nottingham Biomedical Research CentreUniversity of Nottingham, Nottingham, UK, and Sherwood Forest Hospitals NHS Foundation Trust Sutton‐in‐Ashfield UK
| | - Deborah Wilson
- Arthritis Research UK Pain Centre, NIHR Nottingham Biomedical Research CentreUniversity of Nottingham, Nottingham, UK, and Sherwood Forest Hospitals NHS Foundation Trust Sutton‐in‐Ashfield UK
| | - Daniel F. McWilliams
- Arthritis Research UK Pain Centre, NIHR Nottingham Biomedical Research CentreUniversity of Nottingham Nottingham UK
| | - David A. Walsh
- Arthritis Research UK Pain Centre, NIHR Nottingham Biomedical Research CentreUniversity of Nottingham, Nottingham, UK, and Sherwood Forest Hospitals NHS Foundation Trust Sutton‐in‐Ashfield UK
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27
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Contribution of Infrapatellar Fat Pad and Synovial Membrane to Knee Osteoarthritis Pain. BIOMED RESEARCH INTERNATIONAL 2019; 2019:6390182. [PMID: 31049352 PMCID: PMC6462341 DOI: 10.1155/2019/6390182] [Citation(s) in RCA: 111] [Impact Index Per Article: 22.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Revised: 02/26/2019] [Accepted: 03/14/2019] [Indexed: 02/07/2023]
Abstract
Osteoarthritis (OA) is the most common form of joint disease and a major cause of pain and disability in the adult population. Interestingly, there are patients with symptomatic OA displaying pain, while patients with asymptomatic OA that do not experience pain but show radiographic signs of joint damage. Pain is a complex experience integrating sensory, affective, and cognitive processes related to several peripheral and central nociceptive factors besides inflammation. During the last years, the role of infrapatellar fat pad (IFP), other than the synovial membrane, has been investigated as a potential source of pain in OA. Interestingly, new findings suggest that IFP and synovial membrane might act as a functional unit in OA pathogenesis and pain. The present review discuss the role of IFP and synovial membrane in the development of OA, with a particular focus on pain onset and the possible involved mediators that may play a role in OA pathology and pain mechanisms. Inflammation of IFP and synovial membrane may drive peripheral and central sensitization in KOA. Since sensitization is associated with pain severity in knee OA and may potentially contribute to the transition from acute to chronic, persistent pain in knee OA, preventing sensitization would be a potentially effective and novel means of preventing worsening of pain in knee OA.
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28
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Ashraf S, Radhi M, Gowler P, Burston JJ, Gandhi RD, Thorn GJ, Piccinini AM, Walsh DA, Chapman V, de Moor CH. The polyadenylation inhibitor cordycepin reduces pain, inflammation and joint pathology in rodent models of osteoarthritis. Sci Rep 2019; 9:4696. [PMID: 30886197 PMCID: PMC6423048 DOI: 10.1038/s41598-019-41140-1] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Accepted: 02/15/2019] [Indexed: 01/23/2023] Open
Abstract
Clinically, osteoarthritis (OA) pain is significantly associated with synovial inflammation. Identification of the mechanisms driving inflammation could reveal new targets to relieve this prevalent pain state. Herein, a role of polyadenylation in OA synovial samples was investigated, and the potential of the polyadenylation inhibitor cordycepin (3’ deoxyadenosine) to inhibit inflammation as well as to reduce pain and structural OA progression were studied. Joint tissues from people with OA with high or low grade inflammation and non-arthritic post-mortem controls were analysed for the polyadenylation factor CPSF4 and inflammatory markers. Effects of cordycepin on pain behavior and joint pathology were studied in models of OA (intra-articular injection of monosodium iodoacetate in rats and surgical destabilisation of the medial meniscus in mice). Human monocyte-derived macrophages and a mouse macrophage cell line were used to determine effects of cordycepin on nuclear localisation of the inflammatory transcription factor NFĸB and polyadenylation factors (WDR33 and CPSF4). CPSF4 and NFκB expression were increased in synovia from OA patients with high grade inflammation. Cordycepin reduced pain behaviour, synovial inflammation and joint pathology in both OA models. Stimulation of macrophages induced nuclear localisation of NFĸB and polyadenylation factors, effects inhibited by cordycepin. Knockdown of polyadenylation factors also prevented nuclear localisation of NFĸB. The increased expression of polyadenylation factors in OA synovia indicates a new target for analgesia treatments. This is supported by the finding that polyadenylation factors are required for inflammation in macrophages and by the fact that the polyadenylation inhibitor cordycepin attenuates pain and pathology in models of OA.
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Affiliation(s)
- Sadaf Ashraf
- School of Pharmacy, University of Nottingham, Nottingham, UK.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Masar Radhi
- School of Pharmacy, University of Nottingham, Nottingham, UK.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Peter Gowler
- School of Life Sciences, University of Nottingham, Nottingham, UK.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - James J Burston
- School of Life Sciences, University of Nottingham, Nottingham, UK.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK
| | - Raj D Gandhi
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | - Graeme J Thorn
- School of Pharmacy, University of Nottingham, Nottingham, UK
| | | | - David A Walsh
- School of Medicine, University of Nottingham, Nottingham, UK.,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK.,NIHR Nottingham Biomedical Research Centre, Nottingham, UK
| | - Victoria Chapman
- School of Life Sciences, University of Nottingham, Nottingham, UK. .,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK. .,NIHR Nottingham Biomedical Research Centre, Nottingham, UK.
| | - Cornelia H de Moor
- School of Pharmacy, University of Nottingham, Nottingham, UK. .,Arthritis Research UK Pain Centre, University of Nottingham, Nottingham, UK.
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29
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Sarmanova A, Hall M, Fernandes GS, Valdes AM, Walsh DA, Doherty M, Zhang W. Thresholds of ultrasound synovial abnormalities for knee osteoarthritis - a cross sectional study in the general population. Osteoarthritis Cartilage 2019; 27:435-443. [PMID: 30448531 PMCID: PMC6414397 DOI: 10.1016/j.joca.2018.09.018] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 09/05/2018] [Accepted: 09/18/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To establish "normal" ranges for synovial thickness and effusion detected by ultrasound (US) and to determine cut-offs associated with knee pain (KP) and radiographic knee osteoarthritis (RKOA) in the community. METHODS 147 women and 152 men ≥40 years old were randomly selected from the Nottingham KP and Related Health in the Community (KPIC) cohort (n = 9506). The "normal" range was established using the percentile method in 163 participants who had no KP and no RKOA. Optimal (maximum sensitivity and specificity) and high specificity (90%) cut-offs were established using receiver operating characteristic (ROC) curve analysis in a comparison between people with both KP and RKOA and normal controls. RESULTS Effusion and synovial hypertrophy differed by gender but not by age or laterality, therefore gender-specific reference limits were estimated. However, the "normal" ranges between men and women were similar for effusion (0-10.3 mm vs 0-9.8 mm), but different for synovial hypertrophy (0-6.8 mm vs 0-5.4 mm). Power Doppler Signal (PDS) in the healthy controls was uncommon (1.2% in men and 0.0% in women). The optimal cut-off was 7.4 mm for men and 5.3 mm for women for effusion, and 3.7 and 1.6 for hypertrophy respectively. The high specificity cut-off was 8.9 for men and 7.8 for women for effusion, and 5.8 and 4.2 for hypertrophy respectively. CONCLUSIONS US effusion and synovial hypertrophy but not PDS are common, but differ by gender, in community-derived people without painful knee OA. Currently used cut-offs for abnormality need reappraisal.
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Affiliation(s)
- A Sarmanova
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK.
| | - M Hall
- Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK; School of Health Sciences, University of Nottingham, UK.
| | - G S Fernandes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK.
| | - A M Valdes
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK.
| | - D A Walsh
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK.
| | - M Doherty
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK.
| | - W Zhang
- Division of Rheumatology, Orthopaedics and Dermatology, School of Medicine, University of Nottingham, UK; Arthritis Research UK Pain Centre, and NIHR Nottingham BRC, Nottingham, UK; Arthritis Research UK Centre for Sports, Exercise and Osteoarthritis, Nottingham, UK.
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30
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Osteoarthritis year in review 2018: imaging. Osteoarthritis Cartilage 2019; 27:401-411. [PMID: 30590194 DOI: 10.1016/j.joca.2018.12.009] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Revised: 12/10/2018] [Accepted: 12/17/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE To provide a narrative review of the most relevant original research published in 2017/2018 on osteoarthritis imaging. METHODS The PubMed database was used to recover all relevant articles pertaining to osteoarthritis and medical imaging published between 1 April 2017 and 31 March 2018. Review articles, case studies and in vitro or animal studies were excluded. The original publications were subjectively sorted based on relevance, novelty and impact. RESULTS AND CONCLUSIONS The publication search yielded 1,155 references. In the assessed publications, the most common imaging modalities were radiography (N = 708) and magnetic resonance imaging (MRI) (355), followed by computed tomography (CT) (220), ultrasound (85) and nuclear medicine (17). An overview of the most important publications to the osteoarthritis (OA) research community is presented in this narrative review. Imaging studies play an increasingly important role in OA research, and have helped us to understand better the pathophysiology of OA. Radiography and MRI continue to be the most applied imaging modalities, while quantitative MRI methods and texture analysis are becoming more popular. The value of ultrasound in OA research has been demonstrated. Several multi-modality predictive models have been developed. Deep learning has potential for more automatic and standardized analyses in future OA imaging research.
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31
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Ashraf S, Mapp PI, Shahtaheri SM, Walsh DA. Effects of carrageenan induced synovitis on joint damage and pain in a rat model of knee osteoarthritis. Osteoarthritis Cartilage 2018; 26:1369-1378. [PMID: 30031926 DOI: 10.1016/j.joca.2018.07.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2018] [Revised: 06/29/2018] [Accepted: 07/03/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is associated with ongoing pain and joint damage that can be punctuated by acute flares of pain and inflammation. Synovitis in normal knees might resolve without long-term detriment to joint function. We hypothesised that osteoarthritis is associated with impaired resilience to inflammatory flares. DESIGN We induced synovitis by injecting carrageenan into rat knees with or without meniscal transection (MNX)-induced OA, and measured synovitis, weightbearing asymmetry (pain behaviour), and joint damage up to 35 days after OA induction (23 days after carrageenan-injection). RESULTS Carrageenan injection induced weightbearing asymmetry for 1 week, transient increase in knee diameter for 2 days, and a sustained increase in synovial macrophages, endothelial cell proliferation and vascular density compared with naive vehicle-injected controls. MNX surgery induced weightbearing asymmetry and histological evidence of OA. Carrageenan-injection in MNX-operated knees was followed for 2 days by increased weightbearing asymmetry compared either to MNX+vehicle or to sham+carrageenan groups. OA structural damage and synovitis at day 35 were greater in MNX+carrageenan compared to MNX+vehicle and sham+carrageenan groups. Carrageenan injection did not induce OA in Sham-operated knees. CONCLUSION Intra-articular injection of the pro-inflammatory compound carrageenan in OA and sham-operated control knees induced a short term increase in joint pain. Even though pain flares resolved in both groups and damage was not induced in sham-operated knees, carrageen injection exacerbated long-term joint damage in OA knees. OA knees display less resilience to inflammatory episodes. Preventing inflammatory flares may be particularly important in preventing symptoms and long term joint damage in OA.
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Affiliation(s)
- S Ashraf
- School of Pharmacy, University of Nottingham, Nottingham, UK; Arthritis Research UK Pain Centre and NIHR Nottingham BRC, University of Nottingham, Nottingham, UK.
| | - P I Mapp
- Arthritis Research UK Pain Centre and NIHR Nottingham BRC, University of Nottingham, Nottingham, UK.
| | - S M Shahtaheri
- Arthritis Research UK Pain Centre and NIHR Nottingham BRC, University of Nottingham, Nottingham, UK.
| | - D A Walsh
- Arthritis Research UK Pain Centre and NIHR Nottingham BRC, University of Nottingham, Nottingham, UK.
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