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Ivanochko NK, Gatti AA, Stratford PW, Maly MR. Interactions of cumulative load with biomarkers of cartilage turnover predict knee cartilage change over 2 years: data from the osteoarthritis initiative. Clin Rheumatol 2024; 43:2317-2327. [PMID: 38787477 DOI: 10.1007/s10067-024-07014-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 05/01/2024] [Accepted: 05/16/2024] [Indexed: 05/25/2024]
Abstract
The purpose was to investigate relationships of cumulative load and cartilage turnover biomarkers with 2-year changes in cartilage in knee osteoarthritis. From participants with Kellgren-Lawrence (KL) grades of 1 to 3, cartilage thickness and transverse relaxation time (T2) were computed from 24-month (baseline) and 48-month magnetic resonance images. Cumulative load was the interaction term of the Physical Activity Scale for the Elderly (PASE) and body mass index (BMI). Serum cartilage oligomeric matrix protein (COMP) and the nitrated form of type II collagen (Coll2-1 NO2) were collected at baseline. Multiple regressions (adjusted for baseline age, KL grade, cartilage measures, pain, comorbidity) evaluated the relationships of cumulative load and biomarkers with 2-year changes. In 406 participants (63.7 (8.7) years), interactions of biomarkers with cumulative load weakly predicted 2-year cartilage changes: (i) COMP × cumulative load explained medial tibia thickness change (R2 increased 0.062 to 0.087, p < 0.001); (ii) Coll2-1 NO2 × cumulative load explained central medial femoral T2 change (R2 increased 0.177 to 0.210, p < 0.001); and (iii) Coll2-1 NO2 × cumulative load explained lateral tibia T2 change (R2 increased 0.166 to 0.188, p < 0.001). Moderate COMP or Coll2-1 NO2 at baseline appeared protective. High COMP or Coll2-1 NO2, particularly with high BMI and low PASE, associated with worsening cartilage. Moderate serum concentrations of cartilage turnover biomarkers, at high and low physical activity, associated with maintained cartilage outcomes over 2 years. In conclusion, high concentrations of cartilage turnover biomarkers, particularly with high BMI and low physical activity, associated with knee cartilage thinning and increasing T2 over 2 years. Key Points • Higher quality cartilage may be better able to tolerate a larger cumulative load than poor quality cartilage. • Among participants enrolled in the Osteoarthritis Initiative Biomarkers Consortium Project, a representation of cumulative load exposure and its interaction with cartilage turnover biomarkers were weakly related with 2-year change in knee cartilage. • These findings suggest that cartilage turnover is a factor that modifies the relationship between loading exposure and cartilage loss in knee OA.
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Affiliation(s)
- Natasha K Ivanochko
- Department of Kinesiology and Health Sciences, University of Waterloo, Room 1036 Burt Matthews Hall, 200 University Avenue, Waterloo, ON, N2L 3G1, Canada
| | - Anthony A Gatti
- Department of Radiology, Stanford University, Stanford, USA
- NeuralSeg Ltd., Hamilton, Canada
| | - Paul W Stratford
- School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - Monica R Maly
- Department of Kinesiology and Health Sciences, University of Waterloo, Room 1036 Burt Matthews Hall, 200 University Avenue, Waterloo, ON, N2L 3G1, Canada.
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Wadhwa S, Skelton M, Fernandez E, Paek T, Levit M, Yin MT. Significance of radiographic temporomandibular degenerative joint disease findings. Semin Orthod 2024; 30:277-282. [PMID: 38983798 PMCID: PMC11230652 DOI: 10.1053/j.sodo.2023.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/11/2024]
Abstract
The field of orthodontics has seen a recent increase in the number of patients over the age of 50 seeking treatment and also an increase in the use of cone beam technology. Similar to other joints in the body, the temporomandibular joint (TMJ) is associated with age-related degeneration. However, unlike other joints, degeneration of the TMJ is rarely symptomatic and when there is pain, it is usually self-limiting. In this article, we will review: a) the incidence and prevalence of TMJ degenerative diseases, b) similarities and differences of TMJ vs knee degenerative diseases, and c) current treatment recommendations for TMJ degenerative diseases. In the vast majority of people, radiographic evidence of TMJ degeneration is an incidental finding. Future longitudinal research is needed to follow the natural course of TMJ degenerative patients.
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Affiliation(s)
- Sunil Wadhwa
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Michelle Skelton
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Emily Fernandez
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Taylor Paek
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Michael Levit
- Columbia University College of Dental Medicine, Division of Orthodontics, NYC, NY, USA 10032
| | - Michael T Yin
- Columbia University College of Physicians and Surgeons, Division of Infectious Diseases, NYC, NY, USA 10032
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Lozano-Meca JA, Gacto-Sánchez M, Montilla-Herrador J. Movement-evoked pain is not associated with pain at rest or physical function in knee osteoarthritis. Eur J Pain 2024; 28:987-996. [PMID: 38186263 DOI: 10.1002/ejp.2236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Revised: 12/01/2023] [Accepted: 12/20/2023] [Indexed: 01/09/2024]
Abstract
INTRODUCTION Knee Osteoarthritis (KOA) is mainly characterized by pain. The assessment of KOA-related pain frequently focuses on different constructs subject to sources of bias or drawbacks, as the classical Pain at Rest (PAR). Movement-evoked pain (MEP), recently defined as 'pain during walking', emerges as a differential concept, since PAR and MEP are driven by different underlying mechanisms. Given the novelty of the MEP approach, its association with PAR or with different performance-based tests has not been studied in KOA yet. MATERIALS AND METHODS A cross sectional study was conducted. PAR was measured, alongside the performance of four mobility tests and their corresponding MEP: Timed Up and Go Test, 10-metre Walk Test, 2-Minute Walk Test, and 6-Minute Walk Test. Association and agreement were explored for MEP versus PAR, while the correlation of the tests versus each corresponding MEP-measure was assessed. RESULTS Neither association nor agreement were found in the duality MEP versus PAR. Also, the lack of association between the performance of a mobility test and the perceived level of pain during the development of the test was stated. CONCLUSION Movement-evoked pain is neither related to pain at rest nor to functional performance in subjects affected by knee osteoarthritis. The results from our study suggest that MEP and pain at rest measure and refer to different constructs in knee osteoarthritis. The implementation of MEP as an outcome in exercise-therapy could enhance the tracking of results, as well as the development of tailored interventions under different conditions. SIGNIFICANCE This research elucidates the relevance of MEP, recently defined as 'pain during walking', through the analysis of its association with PAR and with functional performance (measured through four mobility tests) in knee osteoarthritis. The results from our study highlight the absence of either association or agreement between MEP and PAR, fact that supports and endorses the idea that both concepts measure and refer to different constructs in knee osteoarthritis.
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Sethi V, Anand C, Della Pasqua O. Clinical Assessment of Osteoarthritis Pain: Contemporary Scenario, Challenges, and Future Perspectives. Pain Ther 2024; 13:391-408. [PMID: 38662319 PMCID: PMC11111648 DOI: 10.1007/s40122-024-00592-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Accepted: 03/06/2024] [Indexed: 04/26/2024] Open
Abstract
The multifaceted nature of osteoarthritis (OA) pain presents a challenge in understanding and managing the condition. The diverse pain experiences, progression rates, individual responses to treatments, and complex disease mechanisms contribute to heterogeneity in the clinical studies outcomes. The lack of a standardized methodology for assessing and classifying OA pain challenges healthcare practitioners. This complicates the establishment of universally applicable protocols or standardized guidelines for treatment. This article explores the heterogeneity observed in clinical studies evaluating OA pain treatments, highlighting the necessity for refined methodologies, personalized patient categorization, and consistent outcome measures. It discusses the role of the multidimensional nature of OA pain, underlying pain mechanisms, and other contributing factors to the heterogeneity in outcome measures. Addressing these variations is crucial to establishing a more consistent framework for evidence-based treatments and advancing care of the patient with OA pain.
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Affiliation(s)
- Vidhu Sethi
- Haleon (Formerly GSK Consumer Healthcare), GSK Asia House, Rochester Park, Singapore, 139234, Singapore.
| | - Chetan Anand
- Advanced Pain Management Centre, Hackettstown, NJ, USA
| | - Oscar Della Pasqua
- Clinical Pharmacology Modelling and Simulation, GlaxoSmithKline, Brentford, UK
- Clinical Pharmacology and Therapeutics Group, University College London, BMA House, Tavistock Square, London, UK
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Hernandez SG, Mannix R, Kerr ZY, Lempke LB, Chandran A, Walton SR, DeFreese JD, Echemendia RJ, Guskiewicz KM, McCrea MA, Meehan Iii WP, Brett BL. Longitudinal Characterization of Pain Interference and Influential Factors in Former National Football League (NFL) Players Over a 19-Year Period: An NFL-LONG Study. THE JOURNAL OF PAIN 2024:104577. [PMID: 38796128 DOI: 10.1016/j.jpain.2024.104577] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 04/23/2024] [Accepted: 05/18/2024] [Indexed: 05/28/2024]
Abstract
Previous studies on pain experiences in retired contract sport athletes have been cross-sectional, leaving gaps in our understanding of the evolution of pain interference (PI) and factors that influence trajectories decades after sport discontinuation. This study investigated the longitudinal course of PI in former male National Football League (NFL) players over a 19-year period following sport discontinuation and examined factors influencing overall levels and trajectories of PI. Former NFL players completed health surveys in 2001, 2010, and 2019, with PI ratings measured using the 36-Item Short Form Health Survey (2001 and 2010) and the Patient-Reported Outcomes Measurement Information System (2019). Unconditional latent growth curve models analyzed overall PI severity and trajectories. Conditional latent growth curve models explored the influence of musculoskeletal injuries, osteoarthritis (OA), and depression diagnosis on PI. Over 19 years (N = 338; mean age = 48.96 ± 9.35), PI significantly increased (slope = .179, P < .001; mean Patient-Reported Outcomes Measurement Information System PI t-scores 2001 = 54.19, 2010 = 54.64, 2019 = 57.38). Cumulative musculoskeletal injuries (B = .092, P < .001) and baseline depression diagnosis (B = 4.463, P < .001) were associated with overall PI levels but not change over time. OA was significantly associated with overall PI levels (B = 6.536, P < .001) and trajectory (B = -.253, P < .001); those endorsing OA in 2001 had lower PI increases over 19 years. The body region of injury and level of play during injuries mirrored overall injury effects. PI mildly increased over 19 years, with multiple factors independently influencing overall PI levels. Enhancing former contact sport athletes' daily functionality may be achieved through holistic biopsychosocial interventions addressing musculoskeletal injuries, OA, and depression. Future research should identify factors influencing elevated trajectories of long-term PI post-sport discontinuation. PERSPECTIVE: This study assessed PI in former NFL athletes over 2 decades, revealing notable interindividual variability in trajectories over time. Musculoskeletal injuries, depression, and OA correlated with overall PI. Prevention and intervention in these 3 areas present the potential to improve disruptions in daily living due to pain in former athletes.
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Affiliation(s)
- Sean G Hernandez
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Rebekah Mannix
- Division of Emergency Medicine, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics and Emergency Medicine, Harvard Medical School, Boston, Massachusetts
| | - Zachary Yukio Kerr
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Landon B Lempke
- Michigan Concussion Center, University of Michigan, Ann Arbor, Michigan
| | - Avinash Chandran
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Datalys Center for Sports Injury Research and Prevention, Indianapolis, Indiana
| | - Samuel R Walton
- Department of Physical Medicine and Rehabilitation, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - J D DeFreese
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Ruben J Echemendia
- Psychological and Neurobehavioral Associates, Inc, State College, Pennsylvania; Department of Psychology, University of Missouri-Kansas City, Kansas City, Missouri
| | - Kevin M Guskiewicz
- Department of Exercise and Sport Science, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Michael A McCrea
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - William P Meehan Iii
- Sports Medicine Division, Boston Children's Hospital, Boston, Massachusetts; Department of Pediatrics and Orthopedics, Harvard Medical School, Boston, Massachusetts
| | - Benjamin L Brett
- Department of Neurosurgery, Medical College of Wisconsin, Milwaukee, Wisconsin.
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Tamargo JA, Johnson AJ, Cruz-Almeida Y, Sibille KT. Measurement of Pain Frequency Associated with Knee Osteoarthritis: Future Directions. THE JOURNAL OF PAIN 2024:104545. [PMID: 38697495 DOI: 10.1016/j.jpain.2024.104545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 04/08/2024] [Accepted: 04/10/2024] [Indexed: 05/05/2024]
Affiliation(s)
- Javier A Tamargo
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Alisa J Johnson
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Yenisel Cruz-Almeida
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
| | - Kimberly T Sibille
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA
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Little CL, Druce KL, Dixon WG, Schultz DM, House T, McBeth J. What do people living with chronic pain want from a pain forecast? A research prioritization study. PLoS One 2023; 18:e0292968. [PMID: 37824568 PMCID: PMC10569639 DOI: 10.1371/journal.pone.0292968] [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: 05/09/2023] [Accepted: 10/03/2023] [Indexed: 10/14/2023] Open
Abstract
Because people with chronic pain feel uncertain about their future pain, a pain-forecasting model could support individuals to manage their daily pain and improve their quality of life. We conducted two patient and public involvement activities to design the content of a pain-forecasting model by learning participants' priorities in the features provided by a pain forecast and understanding the perceived benefits that such forecasts would provide. The first was a focus group of 12 people living with chronic pain to inform the second activity, a survey of 148 people living with chronic pain. Respondents prioritized forecasting of pain flares (100, or 68%) and fluctuations in pain severity (94, or 64%), particularly the timing of the onset and the severity. Of those surveyed, 75% (or 111) would use a future pain forecast and 80% (or 118) perceived making plans (e.g., shopping, social) as a benefit. For people with chronic pain, the timing of the onset of pain flares, the severity of pain flares and fluctuations in pain severity were prioritized as being key features of a pain forecast, and making plans was prioritized as being a key benefit.
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Affiliation(s)
- Claire L. Little
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - Katie L. Druce
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
| | - William G. Dixon
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
| | - David M. Schultz
- Centre for Atmospheric Science, Department of Earth and Environmental Sciences, University of Manchester, Manchester, United Kingdom
- Centre for Crisis Studies and Mitigation, University of Manchester, Manchester, United Kingdom
| | - Thomas House
- Department of Mathematics, University of Manchester, Manchester, United Kingdom
| | - John McBeth
- Centre for Epidemiology Versus Arthritis, University of Manchester, Manchester, United Kingdom
- NIHR Manchester Musculoskeletal Biomedical Research Unit, Central Manchester University Hospitals NHS Foundation Trust, Manchester, United Kingdom
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Bruyere O, Honvo G, Vidovic E, Cortet B. Is the Rate of Responders to Hyaluronic Acid Injection for Patients with Knee Osteoarthritis Stable Over Time? Post hoc Analyses of a 6-Month Follow-Up Study. Rheumatol Ther 2023; 10:1297-1303. [PMID: 37479957 PMCID: PMC10469129 DOI: 10.1007/s40744-023-00573-x] [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: 03/27/2023] [Accepted: 06/14/2023] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Recently, a study showing the non-inferiority of a single injection of sodium hyaluronate plus sorbitol (Synolis VA®) compared to hylan G-F20 (Synvisc-One®) over a 24-week period in patients with knee osteoarthritis was published. The objective of the present study is to assess if a short-term response to a single injection of sodium hyaluronate plus sorbitol can be maintained over a 6 month-period and if the maintenance of the response to treatment is dependent on the functional status at baseline. METHODS Responders to treatment at days 28, 84, and 168 were evaluated according to the responder criteria proposed by the OMERACT-OARSI. The Western Ontario and McMaster Universities Arthritis Index (WOMAC) was used to assess functional status at baseline. All analyses were adjusted for age, gender, BMI, and baseline WOMAC total score using data from the intention-to-treat (ITT) population. RESULTS Out of the 96 patients included in the study who were receiving Synolis VA®, 59.38% were responders at day 28 according to the OMERACT/OARSI responder criteria, 59.78% at day 84, and 64.52% at day 168. Among the responders at D28, the probability of being responder at D84 and D168 was significantly higher than among non-responders, with corresponding odds ratio (95% CI) of 2.85 (1.07-7.59) and 7.28 (2.53-20.93), respectively. Patients with a poorer physical function at baseline were more likely to respond to the treatment at all time points, compared to those with a better physical function (OR 3.74 [1.37-10.21]). CONCLUSIONS An early response of a single injection of sodium hyaluronate plus sorbitol is predictive of long-term response, up to 24 weeks. Patients with a poorer physical function may best benefit from the treatment.
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Affiliation(s)
- Olivier Bruyere
- WHO Collaborating Centre for Epidemiology of Musculo-Skeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium.
| | - Germain Honvo
- WHO Collaborating Centre for Epidemiology of Musculo-Skeletal Health and Ageing, Research Unit in Public Health, Epidemiology and Health Economics, University of Liège, Liège, Belgium
| | - Eduard Vidovic
- Aptissen SA Medical Department, Plan-les-Ouates, Switzerland
| | - Bernard Cortet
- Department of Rheumatology and UR 4490, University Hospital of Lille, Lille, France
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van der Meulen C, van de Stadt LA, Rosendaal FR, Runhaar J, Kloppenburg M. Determination and characterization of patient subgroups based on pain trajectories in hand osteoarthritis. Rheumatology (Oxford) 2023; 62:3035-3042. [PMID: 36648311 PMCID: PMC10473188 DOI: 10.1093/rheumatology/kead017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2022] [Revised: 12/06/2022] [Accepted: 12/24/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES To investigate pain, pain trajectories and their determinants in hand osteoarthritis (OA). METHODS Data from the HOSTAS (Hand OSTeoArthritis in Secondary care) consisting of consecutive hand OA patients were used. Australian Canadian Osteoarthritis Hand Index (AUSCAN) pain was measured yearly for four years. Patients with complete AUSCAN at ≥2 time points were eligible for longitudinal analysis. Associations between variables of interest and baseline AUSCAN pain were investigated with linear regression. Development of pain over time was modelled using latent class growth analysis (LCGA). Associations of LCGA classes with variables of interest were analysed using multinomial logistic regression adjusted for baseline pain. RESULTS A total of 484/538 patients [mean (s.d.) age 60.8 (8.5) years, 86% women, mean (s.d.) AUSCAN pain 9.3 (4.3)] were eligible for longitudinal analysis. Sex, marital and working status, education, disease duration and severity, anxiety and depression scores, lower health-related quality of life (HR-QoL), specific illness perceptions and coping styles were associated with baseline pain. LCGA yielded three classes, characterized by average pain levels at baseline; average pain remained stable over time within classes. Classes with more pain were positively associated with BMI, tender joint count, symptom duration, hand function scores and depression scores, negatively with physical HR-QoL, and education level. CONCLUSION Baseline pain was associated with patient and disease characteristics, and psychosocial factors. LCGA showed three pain trajectories in hand OA patients, with different baseline pain levels and stable pain over time. Classes were distinguished by BMI, education level, disease severity, depression and HR-QoL.
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Affiliation(s)
- Coen van der Meulen
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Lotte A van de Stadt
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
| | - Frits R Rosendaal
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Margreet Kloppenburg
- Department of Rheumatology, Leiden University Medical Center, Leiden, The Netherlands
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Chang WY, Choi S, Yoo SJ, Lee J, Lim C. Factors Associated with Osteoarthritis and Their Influence on Health-Related Quality of Life in Older Adults with Osteoarthritis: A Study Based on the 2020 Korea National Health and Nutrition Examination Survey. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6073. [PMID: 37372660 DOI: 10.3390/ijerph20126073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Revised: 05/30/2023] [Accepted: 06/01/2023] [Indexed: 06/29/2023]
Abstract
Numerous studies have investigated factors associated with osteoarthritis (OA), but few have investigated their effects on psychological problems and health-related quality of life in older adults with OA. We aimed to investigate factors associated with OA and their influence on health-related quality of life in older adults with OA. Among 1394 participants aged ≥65 years, 952 and 442 were categorized into the OA and non-OA groups, respectively. Comprehensive data on demographic characteristics, medical conditions, health-related quality of life, blood test results, and nutritional intake were obtained. Univariate and multivariate logistic regression analyses were used to evaluate the odds ratio for factors associated with OA, including age (odds ratio (OR), 1.038; p = 0.020), female sex (OR, 5.692; p < 0.001), body mass index (OR, 1.108; p < 0.001), hypertension (OR, 1.451; p < 0.050), hyperlipidemia (OR, 1.725; p = 0.001), osteoporosis (OR, 2.451; p < 0.001), and depression (OR, 2.358; p = 0.041). The OA group showed a significantly lower subjective health status (p < 0.001) and higher difficulty in mobility (p < 0.001) and pain/discomfort (p = 0.010) than the non-OA group. The sleeping hours were significantly shorter in the OA group than those in the non-OA group (p = 0.013). OA was a significant contributing factor for unfavorable health-related quality of life in older adults. Controlling the factors associated with OA should be prioritized, and health-related quality of life should be monitored in older adults with OA.
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Affiliation(s)
- Weon-Young Chang
- Department of Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea
| | - Sungwook Choi
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea
| | - Seung Jin Yoo
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea
| | - Jaeryun Lee
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea
| | - Chaemoon Lim
- Department of Orthopedic Surgery, Jeju National University Hospital, Jeju 63241, Republic of Korea
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11
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Collins JE, Yang YH, Opare-Addo MB, Losina E. Quantifying sustained pain worsening in knee osteoarthritis. Osteoarthritis Cartilage 2023; 31:802-808. [PMID: 37024069 PMCID: PMC10200767 DOI: 10.1016/j.joca.2023.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 02/10/2023] [Accepted: 03/04/2023] [Indexed: 04/08/2023]
Abstract
OBJECTIVE Recent work suggests that many persons with knee osteoarthritis (OA) experience stable symptoms over time. Whether patients experience periods of symptom exacerbation or flare which interrupt this stable course, and how long such periods last, has received little study. Our objective is to describe the frequency and duration of episodes of pain worsening in persons with knee OA. METHODS We selected participants from the Osteoarthritis Initiative with radiographic, symptomatic knee OA. We defined a clinically relevant increase in knee pain as an increase in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain of ≥9 points. We defined sustained worsening as maintaining at least 80% of the initial increase. We used Poisson regression to estimate the incidence rate (IR) of episodes of pain worsening. RESULTS 1093 participants were included in the analysis. Eighty-eight percent had ≥1 increase in WOMAC pain ≥9 points (IR: 26.3 per 100 person years (95% CI: 25.2, 27.4)). Forty-eight percent had ≥1 episode of sustained worsening (IR: 9.7 per 100 person-years (95% CI: 8.9, 10.5)). Elevated pain was maintained an average of 2.4 years after the initial increase. CONCLUSION Most participants with knee OA reported at least one clinically relevant increase in WOMAC pain, but fewer than half experienced an episode of sustained pain worsening. These individual-level data portray a more nuanced and fluctuating course of OA pain than suggested by trajectory studies. These data could be useful in shared decision-making regarding prognosis and treatment choices in persons affected by symptomatic knee OA.
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Affiliation(s)
- J E Collins
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America.
| | - Y H Yang
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - M B Opare-Addo
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America
| | - E Losina
- Orthopaedic and Arthritis Center for Outcomes Research (OrACORe) and Policy and Innovation EValuation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, United States of America; Harvard Medical School, Boston, MA, United States of America; Department of Biostatistics, Boston University School of Public Health, Boston, MA, United States of America
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12
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Thomas MJ. Expanding and explaining symptoms in knee osteoarthritis trajectories: fluctuations, flares, and future directions. Osteoarthritis Cartilage 2023; 31:725-726. [PMID: 37024070 DOI: 10.1016/j.joca.2023.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 03/30/2023] [Indexed: 04/08/2023]
Affiliation(s)
- Martin J Thomas
- Centre for Musculoskeletal Health Research, School of Medicine, Keele University, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Staffordshire ST6 7AG, UK.
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13
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Infrared Thermography in Symptomatic Knee Osteoarthritis: Joint Temperature Differs Based on Patient and Pain Characteristics. J Clin Med 2023; 12:jcm12062319. [PMID: 36983319 PMCID: PMC10055129 DOI: 10.3390/jcm12062319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Revised: 03/03/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
The aim of this study was to evaluate osteoarthritis (OA) patients with infrared thermography to investigate imaging patterns as well as demographic and clinical characteristics that influence knee inflammation. Forty patients with one-sided symptomatic knee OA were included and evaluated through knee-specific PROMs and the PainDETECT Questionnaire for neuropathic pain evaluation. Thermograms were captured using a thermographic camera FLIR-T1020 and temperatures were extracted using the software ResearchIR for the overall knee and the five ROIs: medial, lateral, medial patella, lateral patella, and suprapatellar. The mean temperature of the total knee was 31.9 ± 1.6 °C. It negatively correlated with age (rho = −0.380, p = 0.016) and positively correlated with BMI (rho = 0.421, p = 0.007) and the IKDC objective score (tau = 0.294, p = 0.016). Men had higher temperatures in the knee medial, lateral, and suprapatellar areas (p = 0.017, p = 0.019, p = 0.025, respectively). Patients with neuropathic pain had a lower temperature of the medial knee area (31.5 ± 1.0 vs. 32.3 ± 1.1, p = 0.042), with the total knee negatively correlating with PainDETECT (p = 0.045). This study demonstrated that the skin temperature of OA symptomatic knees is influenced by demographic and clinical characteristics of patients, with higher joint temperatures in younger male patients with higher BMI and worst objective knee scores and lower temperatures in patients affected by neuropathic pain.
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14
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Pain Trajectory after Short-Stay Anorectal Surgery: A Prospective Observational Study. J Pers Med 2023; 13:jpm13030528. [PMID: 36983710 PMCID: PMC10052694 DOI: 10.3390/jpm13030528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/05/2023] [Accepted: 03/09/2023] [Indexed: 03/17/2023] Open
Abstract
The evolution of pain after anorectal surgery has not been well characterized. The main objective of this study is to evaluate patterns in acute postoperative pain in patients undergoing short-stay anorectal surgery. A total of 217 patients were included in the study, which used group-based trajectory modeling to estimate postoperative pain and then examined the relationships between sociodemographic or surgical factors and pain trajectories. Three distinct postoperative pain trajectories were determined: hemorrhoidectomy (OR, 0.15), higher anxiety (OR, 3.26), and a higher preoperative pain behavior score (OR, 3.15). In multivariate analysis, they were associated with an increased likelihood of being on the high pain trajectory. The pain trajectory group was related to postoperative analgesic use (p < 0.001), with the high-low group needing more nonsteroidal analgesics. The study showed that there were three obvious pain trajectories after anorectal surgery, including an unreported low-moderate-low type. More than 60% of patients maintained moderate to severe pain within 7 days after the operation. These postoperative pain trajectories were predominantly defined by surgery factors and patient factors.
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15
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Franceschini M, Boffa A, Pignotti E, Andriolo L, Zaffagnini S, Filardo G. The Minimal Clinically Important Difference Changes Greatly Based on the Different Calculation Methods. Am J Sports Med 2023; 51:1067-1073. [PMID: 36811558 PMCID: PMC10026158 DOI: 10.1177/03635465231152484] [Citation(s) in RCA: 23] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Accepted: 12/19/2022] [Indexed: 02/24/2023]
Abstract
BACKGROUND The minimal clinically important difference (MCID) for patient-reported outcome measures (PROMs) expresses both the extent of the improvement and the value that patients place on it. MCID use is becoming increasingly widespread to understand the clinical efficacy of a given treatment, define guidelines for clinical practice, and properly interpret trial results. However, there is still large heterogeneity in the different calculation methods. PURPOSE To calculate and compare the MCID threshold values of a PROM by applying various methods and analyzing their effect on the study results interpretation. STUDY DESIGN Cohort study (Diagnosis); Level of evidence, 3. METHODS The data set used to investigate the different MCID calculation approaches was based on a database of 312 patients affected by knee osteoarthritis and treated with intra-articular platelet-rich plasma. MCID values were calculated on the International Knee Documentation Committee (IKDC) subjective score at 6 months using 2 approaches: 9 methodologies referred to an anchor-based approach and 8 methodologies to a distribution-based approach. The obtained threshold values were applied to the same series of patients to understand the effect of using different MCID methods in evaluating patient response to treatment. RESULTS The different methods employed led to MCID values ranging from 1.8 to 25.9 points. The anchor-based methods ranged from 6.3 to 25.9, while the distribution-based ones were from 1.8 to 13.8 points, showing a 4.1× variation of the MCID values within the anchor-based methods and a 7.6× variation within the distribution-based methods. The percentage of patients who reached the MCID for the IKDC subjective score changed based on the specific calculation method used. Among the anchor-based methods, this value varied from 24.0% to 66.0%, while among the distribution-based methods, the percentage of patients reaching the MCID varied from 44.6% to 75.9%. CONCLUSION This study proved that different MCID calculation methods lead to highly heterogeneous values, which significantly affect the percentage of patients achieving the MCID in a given population. The wide-ranging thresholds obtained with the different methodologies make it difficult to evaluate the real effectiveness of a given treatment questioning the usefulness of MCID, as currently available, in the clinical research.
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Affiliation(s)
- Marco Franceschini
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Angelo Boffa
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Elettra Pignotti
- Applied and Translational Research
(ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research
(ATR) Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
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16
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Wirth W, Maschek S, Marijnissen ACA, Lalande A, Blanco FJ, Berenbaum F, van de Stadt LA, Kloppenburg M, Haugen IK, Ladel CH, Bacardit J, Wisser A, Eckstein F, Roemer FW, Lafeber FPJG, Weinans HH, Jansen M. Test-retest precision and longitudinal cartilage thickness loss in the IMI-APPROACH cohort. Osteoarthritis Cartilage 2023; 31:238-248. [PMID: 36336198 DOI: 10.1016/j.joca.2022.10.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Revised: 09/22/2022] [Accepted: 10/30/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To investigate the test-retest precision and to report the longitudinal change in cartilage thickness, the percentage of knees with progression and the predictive value of the machine-learning-estimated structural progression score (s-score) for cartilage thickness loss in the IMI-APPROACH cohort - an exploratory, 5-center, 2-year prospective follow-up cohort. DESIGN Quantitative cartilage morphology at baseline and at least one follow-up visit was available for 270 of the 297 IMI-APPROACH participants (78% females, age: 66.4 ± 7.1 years, body mass index (BMI): 28.1 ± 5.3 kg/m2, 55% with radiographic knee osteoarthritis (OA)) from 1.5T or 3T MRI. Test-retest precision (root mean square coefficient of variation) was assessed from 34 participants. To define progressor knees, smallest detectable change (SDC) thresholds were computed from 11 participants with longitudinal test-retest scans. Binary logistic regression was used to evaluate the odds of progression in femorotibial cartilage thickness (threshold: -211 μm) for the quartile with the highest vs the quartile with the lowest s-scores. RESULTS The test-retest precision was 69 μm for the entire femorotibial joint. Over 24 months, mean cartilage thickness loss in the entire femorotibial joint reached -174 μm (95% CI: [-207, -141] μm, 32.7% with progression). The s-score was not associated with 24-month progression rates by MRI (OR: 1.30, 95% CI: [0.52, 3.28]). CONCLUSION IMI-APPROACH successfully enrolled participants with substantial cartilage thickness loss, although the machine-learning-estimated s-score was not observed to be predictive of cartilage thickness loss. IMI-APPROACH data will be used in subsequent analyses to evaluate the impact of clinical, imaging, biomechanical and biochemical biomarkers on cartilage thickness loss and to refine the machine-learning-based s-score. CLINICALTRIALS GOV IDENTIFICATION NCT03883568.
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Affiliation(s)
- W Wirth
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - S Maschek
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - A C A Marijnissen
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - A Lalande
- Institut de Recherches Internationales Servier, Suresnes, France.
| | - F J Blanco
- Grupo de Investigación de Reumatología (GIR), INIBIC - Complejo Hospitalario Universitario de A Coruña, SERGAS. Centro de Investigación CICA, Departamento de Fisioterapia y Medicina, Universidad de A Coruña, A Coruña, Spain.
| | - F Berenbaum
- Department of Rheumatology, AP-HP Saint-Antoine Hospital, Paris, France; INSERM, Sorbonne University, Paris, France.
| | - L A van de Stadt
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands.
| | - M Kloppenburg
- Rheumatology, Leiden University Medical Center, Leiden, the Netherlands; Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands.
| | - I K Haugen
- Division of Rheumatology and Research, Diakonhjemmet Hospital, Oslo, Norway.
| | - C H Ladel
- CHL4special consultancy, Darmstadt, Germany.
| | - J Bacardit
- School of Computing, Newcastle University, Newcastle, United Kingdom.
| | - A Wisser
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - F Eckstein
- Department of Imaging & Functional Musculoskeletal Research, Institute of Anatomy & Cell Biology, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Ludwig Boltzmann Inst. for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg & Nuremberg, Salzburg, Austria; Chondrometrics GmbH, Freilassing, Germany.
| | - F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Universitätsklinikum Erlangen and Friedrich-Alexander-University Erlangen-Nürnberg (FAU), Erlangen, Germany.
| | - F P J G Lafeber
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - H H Weinans
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
| | - M Jansen
- University Medical Center Utrecht and Utrecht University, Utrecht, the Netherlands.
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17
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Previtali D, Boffa A, Di Martino A, Deabate L, Delcogliano M, Filardo G. Recall Bias Affects Pain Assessment in Knee Osteoarthritis: A Pilot Study. Cartilage 2022; 13:50-58. [PMID: 36345999 PMCID: PMC9924980 DOI: 10.1177/19476035221118417] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE The objective of this study was to evaluate the recall bias of symptoms evaluation in knee osteoarthritis (OA). DESIGN In this multicentric pilot study, 50 patients with knee OA used a mobile App (Ecological Momentary Assessment [EMA]) to collect pain and function on two 0 to 10 numerical rating scales (NRS) 2 times a day for 2 months. At the 1-month and at the 2-month follow-up visits, patients retrospectively evaluated the mean level of pain/function of the last month. Recall bias was computed as the difference between the mean level of pain/function reported using the App and the level reported with the retrospective assessment. The correlation between the recall bias and patients' characteristics, as well as pain/function trajectories, was analyzed. RESULTS A statistically significant recall bias was documented with higher pain reported at 1-month with the retrospective assessment (P < 0.001). These results were confirmed also at the 2-month follow-up (P = 0.002). For function, no significant recall bias was documented. During the first and second months, 47 and 31 patients showed pain peaks, respectively. The number of pain peaks during the first month was correlated with the magnitude of the recall bias (P = 0.02). CONCLUSIONS The recall bias influences the retrospective self-assessment of pain at the follow-up visits and the presence of pain peaks, a common event in the patients with OA, increases the magnitude of recall bias. The EMA performed with a mobile App is a useful tool to limit the influence of recall bias in the clinical and research setting evaluation of knee OA.
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Affiliation(s)
- Davide Previtali
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Angelo Boffa
- Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2,
IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Alessandro Di Martino, Clinica Ortopedica e
Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Via di Barbiano 1/10, 40136
Bologna, Italy.
| | - Luca Deabate
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland
| | - Marco Delcogliano
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland,Faculty of Biomedical Sciences,
Università della Svizzera Italiana, Lugano, Switzerland
| | - Giuseppe Filardo
- Service of Orthopaedics and
Traumatology, Department of Surgery, EOC, Lugano, Switzerland,Applied and Translational Research
Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy,Faculty of Biomedical Sciences,
Università della Svizzera Italiana, Lugano, Switzerland
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18
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Ackerman I. Waiting for orthopedic surgery - are we underestimating the impacts on people with advanced osteoarthritis? Osteoarthritis Cartilage 2022; 30:1545-1546. [PMID: 36063989 PMCID: PMC9458548 DOI: 10.1016/j.joca.2022.08.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Revised: 08/22/2022] [Accepted: 08/24/2022] [Indexed: 02/02/2023]
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19
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López F. Safety and efficacy of intra-articular infiltration of purified autologous adipose tissue for osteoarthritis treatment: a pre-post study. J Exp Orthop 2022; 9:97. [PMID: 36163597 PMCID: PMC9512941 DOI: 10.1186/s40634-022-00534-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/06/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Félix López
- Maestranza Medical Center, Madrid, Spain. .,Bluehealthcare, Madrid, Spain.
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20
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Nowinka Z, Alagha MA, Mahmoud K, Jones GG. Predicting Depression in Patients With Knee Osteoarthritis Using Machine Learning: Model Development and Validation Study. JMIR Form Res 2022; 6:e36130. [PMID: 36099008 PMCID: PMC9518113 DOI: 10.2196/36130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Revised: 07/31/2022] [Accepted: 08/09/2022] [Indexed: 11/23/2022] Open
Abstract
Background Knee osteoarthritis (OA) is the most common form of OA and a leading cause of disability worldwide. Chronic pain and functional loss secondary to knee OA put patients at risk of developing depression, which can also impair their treatment response. However, no tools exist to assist clinicians in identifying patients at risk. Machine learning (ML) predictive models may offer a solution. We investigated whether ML models could predict the development of depression in patients with knee OA and examined which features are the most predictive. Objective The primary aim of this study was to develop and test an ML model to predict depression in patients with knee OA at 2 years and to validate the models using an external data set. The secondary aim was to identify the most important predictive features used by the ML algorithms. Methods Osteoarthritis Initiative Study (OAI) data were used for model development and external validation was performed using Multicenter Osteoarthritis Study (MOST) data. Forty-two features were selected, which denoted routinely collected demographic and clinical data such as patient demographics, past medical history, knee OA history, baseline examination findings, and patient-reported outcome measures. Six different ML classification models were trained (logistic regression, least absolute shrinkage and selection operator [LASSO], ridge regression, decision tree, random forest, and gradient boosting machine). The primary outcome was to predict depression at 2 years following study enrollment. The presence of depression was defined using the Center for Epidemiological Studies Depression Scale. Model performance was evaluated using the area under the receiver operating characteristic curve (AUC) and F1 score. The most important features were extracted from the best-performing model on external validation. Results A total of 5947 patients were included in this study, with 2969 in the training set, 742 in the test set, and 2236 in the external validation set. For the test set, the AUC ranged from 0.673 (95% CI 0.604-0.742) to 0.869 (95% CI 0.824-0.913), with an F1 score of 0.435 to 0.490. On external validation, the AUC varied from 0.720 (95% CI 0.685-0.755) to 0.876 (95% CI 0.853-0.899), with an F1 score of 0.456 to 0.563. LASSO modeling offered the highest predictive performance. Blood pressure, baseline depression score, knee pain and stiffness, and quality of life were the most predictive features. Conclusions To our knowledge, this is the first study to apply ML classification models to predict depression in patients with knee OA. Our study showed that ML models can deliver a clinically acceptable level of performance (AUC>0.7) in predicting the development of depression using routinely available demographic and clinical data. Further work is required to address the class imbalance in the training data and to evaluate the clinical utility of the models in facilitating early intervention and improved outcomes.
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Affiliation(s)
- Zuzanna Nowinka
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - M Abdulhadi Alagha
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
- Data Science Institute, London School of Economics and Political Science, London, United Kingdom
| | - Khadija Mahmoud
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
| | - Gareth G Jones
- MSk Lab, Department of Surgery and Cancer, Faculty of Medicine, Imperial College London, London, United Kingdom
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21
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Does Bone Marrow Edema Influence the Clinical Results of Intra-Articular Platelet-Rich Plasma Injections for Knee Osteoarthritis? J Clin Med 2022; 11:jcm11154414. [PMID: 35956034 PMCID: PMC9369660 DOI: 10.3390/jcm11154414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/25/2022] [Accepted: 07/26/2022] [Indexed: 02/05/2023] Open
Abstract
Platelet-rich plasma (PRP) is increasingly used for the intra-articular treatment of knee osteoarthritis (OA). However, clinical studies on PRP injections reported controversial results. Bone marrow edema (BME) can cause symptoms by affecting the subchondral bone and it is not targeted by intra-articular treatments. The aim of this study was to investigate if the presence of BME can influence the outcome of intra-articular PRP injections in knee OA patients. A total of 201 patients were included in the study, 80 with and 121 without BME at the baseline MRI. BME area and site were evaluated, and BME was graded using the Whole-Organ Magnetic Resonance Imaging Score (WORMS). Patients were assessed with International Knee Documentation Committee (IKDC) score Knee injury and Osteoarthritis Outcome Score (KOOS) subscales, the EuroQol-Visual Analogue Scale (EQ-VAS), and the Tegner score at baseline, 2, 6, and 12 months. Overall, the presence of BME did not influence the clinical results of intra-articular PRP injections in these patients treated for knee OA. Patients with BME presented a similar failure rate and clinical improvement after PRP treatment compared to patients without BME. The area and site of BME did not affect clinical outcomes. However, patients with a higher BME grade had a higher failure rate.
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22
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Zhao AT, Caballero CJ, Nguyen LT, Vienne HC, Lee C, Kaye AD. A Comprehensive Update of Prolotherapy in the Management of Osteoarthritis of the Knee. Orthop Rev (Pavia) 2022; 14:33921. [PMID: 35769650 PMCID: PMC9235417 DOI: 10.52965/001c.33921] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Accepted: 01/12/2022] [Indexed: 12/07/2023] Open
Abstract
This is a comprehensive review of the literature focusing on the use of prolotherapy in the treatment of osteoarthritis of the knee. It covers the background, efficacy, and advantages of prolotherapy in the management of osteoarthritis symptoms and then covers the existing evidence of the use of prolotherapy for this purpose. Current treatments for osteoarthritis of the knee are numerous, yet patients continue to endorse chronic pain and poor quality of life. Prolotherapy is a treatment that has been inadequately studied with poor sample sizes and lack of standardization between trials. However, in recent years the literature on prolotherapy in the treatment of knee osteoarthritis has grown. Although there is still a lack of homogeneity, trials have shown that dextrose prolotherapy, autologous conditioned serum, hyaluronic injections, and normal saline administered either intra- or peri-articularly are comparable in reducing pain scores to other primary treatment options. The mechanism of action for prolotherapy is still unclear, but researchers have found that prolotherapy plays some role in cartilage growth or chondrogenesis and has been shown to have improved radiographic outcomes. Prolotherapy appears to be a safe treatment alternative that has been shown to improve stiffness, pain, function, and quality of life in osteoarthritis of the knee. Knee osteoarthritis is remarkably prevalent in the United States and is one of the most common causes of disability in the elderly population. Although there are many treatment options, patients continue to live with chronic pain which can incur high costs for patients. A safe, long-term, and effective solution has not yet been identified. Prolotherapy has been shown to be a safe option for improving pain, function, and quality of life as effectively as other treatment options.
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Affiliation(s)
- Alex Tang Zhao
- Georgetown University School of Medicine, Washington, DC
| | | | - Linh T Nguyen
- Louisiana State University School of Medicine Shreveport, Shreveport, LA
| | - Hunter C Vienne
- Louisiana State University School of Medicine Shreveport, Shreveport, LA
| | - Christopher Lee
- Department of Internal Medicine, Creighton University School of Medicine-Phoenix Regional Campus, Phoenix, AZ
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center, Shreveport, LA
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23
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Sedaghati-Khayat B, Boer CG, Runhaar J, Bierma-Zeinstra SMA, Broer L, Ikram MA, Zeggini E, Uitterlinden AG, van Rooij JGJ, van Meurs JBJ. Risk assessment for hip and knee osteoarthritis using polygenic risk scores. Arthritis Rheumatol 2022; 74:1488-1496. [PMID: 35644035 PMCID: PMC9541521 DOI: 10.1002/art.42246] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 04/24/2022] [Accepted: 05/24/2022] [Indexed: 11/25/2022]
Abstract
Objective Polygenic risk scores (PRS) allow risk stratification using common single‐nucleotide polymorphisms (SNPs), and clinical applications are currently explored for several diseases. This study was undertaken to assess the risk of hip and knee osteoarthritis (OA) using PRS. Methods We analyzed 12,732 individuals from a population‐based cohort from the Rotterdam Study (n = 11,496), a clinical cohort (Cohort Hip and Cohort Knee [CHECK] study; n = 908), and a high‐risk cohort of overweight women (Prevention of Knee OA in Overweight Females [PROOF] study; n = 328), for the association of the PRS with prevalence/incidence of radiographic OA, of clinical OA, and of total hip replacement (THR) or total knee replacement (TKR). The hip PRS and knee PRS contained 44 and 24 independent SNPs, respectively, and were derived from a recent genome‐wide association study meta‐analysis. Standardized PRS (with Z transformation) were used in all analyses. Results We found a stronger association of the PRS for clinically defined OA compared to radiographic OA phenotypes, and we observed the highest PRS risk stratification for TKR/THR. The odds ratio (OR) per SD was 1.3 for incident THR (95% confidence interval [95% CI] 1.1–1.5) and 1.6 (95% CI 1.3–1.9) for incident TKR in the Rotterdam Study. The knee PRS was associated with incident clinical knee OA in the CHECK study (OR 1.3 [95% CI 1.1–1.5]), but not for the PROOF study (OR 1.2 [95% CI 0.8–1.7]). The OR for OA increased gradually across the PRS distribution, up to 2.1 (95% CI 1.4–3.2) for individuals with the 10% highest PRS compared to the middle 50% of the PRS distribution. Conclusion Our findings validated the association of PRS across OA definitions. Since OA is becoming frequent and primary prevention is not commonly applicable, PRS‐based risk assessment could play a role in OA prevention. However, the utility of PRS is dependent on the setting. Further studies are needed to test the integration of genetic risk assessment in diverse health care settings.
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Affiliation(s)
- Bahar Sedaghati-Khayat
- Department of Internal medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Cindy G Boer
- Department of Internal medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Sita M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Orthopaedics & Sports Medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Linda Broer
- Department of Internal medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - M Arfan Ikram
- Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Eleftheria Zeggini
- Institute of Translational Genomics, Helmholtz Zentrum München, German Research Center for Environmental Health, Neuherberg, Germany.,Technical University of Munich (TUM) and Klinikum Rechts der Isar, TUM School of Medicine, Munich, Germany
| | - André G Uitterlinden
- Department of Internal medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeroen G J van Rooij
- Department of Internal medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Joyce B J van Meurs
- Department of Internal medicine, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Epidemiology, Erasmus MC University Medical Center Rotterdam, Rotterdam, The Netherlands
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Atukorala I, Downie A, Pathmeswaran A, Deveza LMA, Chang T, Zhang Y, Hunter DJ. Short-term pain trajectories in patients with knee osteoarthritis. Int J Rheum Dis 2022; 25:281-294. [PMID: 35080125 DOI: 10.1111/1756-185x.14267] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2021] [Revised: 11/06/2021] [Accepted: 11/20/2021] [Indexed: 11/29/2022]
Abstract
AIM It is unknown if pain in knee osteoarthritis (KOA) follows distinct patterns over the short term. Therefore, the aim of this study was to identify whether persons with a previous history of KOA pain fluctuations have distinct trajectories of pain over 90 days and to examine associations between baseline characteristics and pain trajectories. METHOD People with a previous history of KOA were selected from a web-based longitudinal study. Baseline variables were sex, age, being obese/overweight, years of KOA, knee injury, knee buckling, satisfactory Lubben Social Support Score, pain and stress scales, Intermittent Constant Osteoarthritis Pain Score (ICOAP), medication use, and physical activity. Participants completed a Knee Injury and Osteoarthritis Outcomes Score (KOOS) pain subscale (KOOS-p, rated 0 = extreme to 100 = no knee problems) at 10-day intervals for 90 days. Short-term KOOS-p trajectories were identified using latent growth mixture modeling and the baseline risk factors for these pain trajectories were examined. RESULTS Participants (n = 313) had a mean age of 62.2 (SD ± 8.1) years and and a body mass index of 29.8 (SD ± 6.6) kg/m2 . The three-class latent growth mixture modeling quadratic model with best fit indices was chosen (based on lowest sample-size-adjusted Bayesian Information Criterion, high probability of belonging, interpretability). Three distinct pain trajectory clusters (over 90 days) were identified: low-moderate pain at baseline with large improvement (n = 11), minimal change in pain over 90 days (n = 248), and moderate-high pain with worsening (n = 46). Higher ICOAP (intermittent scale), perceived stress, negative affect score, and knee buckling at baseline were associated with a worse knee pain trajectory (P < 0.05). CONCLUSIONS Persons with KOA showed unique short-term pain trajectories over 90 days, with distinct characteristics at baseline associated with each trajectory.
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Affiliation(s)
- Inoshi Atukorala
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Aron Downie
- Faculty of Medicine and Health, Sydney School of Public Health, Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia.,Department of Chiropractic, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
| | | | - Leticia Miranda Alle Deveza
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Thashi Chang
- Department of Clinical Medicine, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Yuqing Zhang
- Division of Rheumatology, Allergy, and Immunology, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - David John Hunter
- Institute of Bone and Joint Research, Kolling Institute, University of Sydney, Sydney, New South Wales, Australia.,Rheumatology Department, Royal North Shore Hospital, Sydney, New South Wales, Australia
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25
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Wang ST, Ni GX. Depression in Osteoarthritis: Current Understanding. Neuropsychiatr Dis Treat 2022; 18:375-389. [PMID: 35237034 PMCID: PMC8883119 DOI: 10.2147/ndt.s346183] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Accepted: 02/06/2022] [Indexed: 02/05/2023] Open
Abstract
Depression, one of the most common comorbidities with osteoarthritis (OA), affects patient prognosis and quality of life. It also increases the overall burden of disease. This subgroup of patients has not been effectively managed in clinical settings. The study aimed to direct physicians' attention to the co-occurrence of depression and OA. Therefore, this review summarizes the relevant literature published over the past 10 years. The focus is on the prevalence of and risk factors for depression in OA, the effects of depression on OA development and treatment response, comorbidity mechanisms, screening, and non-pharmacological treatment. The research on the etiology of depression has been driven largely by epidemiological studies. Recent studies have shown that high levels of pain, poor levels of function, high numbers of OA sites, and slow gait might be associated with depression. However, the pathophysiology of OA and depression comorbidities remains unclear. In addition to immune inflammation and structural changes in the brain, which have been documented in brain imaging studies, psychosocial factors may also play a role. The evidence indicates that depression can be treated with early intervention; however, adjustments may need to be made for individuals with comorbid depression in OA. It is recommended that health care providers pay more attention to depressive symptoms in patients with OA. Clinicians should develop and implement an individualized and comprehensive treatment plan for patients based on a mental health assessment and in teams with other professionals to optimize treatment outcomes.
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Affiliation(s)
- Shen-Tao Wang
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, People’s Republic of China
| | - Guo-Xin Ni
- School of Sport Medicine and Rehabilitation, Beijing Sport University, Beijing, People’s Republic of China
- Correspondence: Guo-Xin Ni, Tel +86-10-62989780, Fax +86-10-62989670, Email
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26
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Boffa A, Andriolo L, Franceschini M, Martino AD, Asunis E, Grassi A, Zaffagnini S, Filardo G. Minimal Clinically Important Difference and Patient Acceptable Symptom State in Patients With Knee Osteoarthritis Treated With PRP Injection. Orthop J Sports Med 2021; 9:23259671211026242. [PMID: 34631901 PMCID: PMC8495529 DOI: 10.1177/23259671211026242] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/04/2021] [Indexed: 01/12/2023] Open
Abstract
Background: Although several injection-based treatments have been proposed to address knee osteoarthritis (OA), it is often difficult to understand the clinical relevance of the obtained results. The psychometric measures of minimal clinically important difference (MCID) and Patient Acceptable Symptom State (PASS) were developed to better interpret study findings. Purpose: To establish the MCID and the PASS for the International Knee Documentation Committee (IKDC) Subjective score and the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients treated with intra-articular platelet-rich plasma (PRP) injections for knee OA. Study Design: Case series; Level of evidence, 4. Methods: This study included 215 patients with knee OA (68% men, 32% women; age, 53.2 ± 11.3 years; body mass index, 26.8 ± 4.3 kg/m2) who underwent intra-articular PRP injections. Patients were assessed through the IKDC Subjective score and KOOS subscales, and the MCID and the PASS for both measures were independently calculated at 6 and 12 months post-injection. The MCID was calculated using the value equal to half of the standard deviation of the overall cohort improvement. The PASS was assessed using a 2-point scale (satisfied or not satisfied), with threshold values being detected through a receiver operating characteristic curve analysis and the Youden index to maximize the sensitivity and the specificity of the threshold values. Results: All scores improved significantly from baseline to 6 months and baseline to 12 months (P < .001 for all scores). All scores were stable from 6 to 12 months except for the KOOS Quality of Life subscale, which improved further (P = .033). For the IKDC, the MCID values were 8.6 and 8.5 points and the PASS scores were 59.7 and 62.1 at 6 and 12 months, respectively. Overall, the MCID and the PASS for all KOOS subscales remained constant at the 2 follow-up points. The percentage of patients who achieved the MCID and the PASS was higher than 85% at both 6 and 12 months post-injection. Conclusion: This study provided the MCID and PASS thresholds for the IKDC and KOOS scores in patients with knee OA treated with PRP injections. These psychometric measures may allow a better interpretation of the clinical relevance of injection-based treatment outcomes for knee OA.
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Affiliation(s)
- Angelo Boffa
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Luca Andriolo
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Marco Franceschini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alessandro Di Martino
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Emanuela Asunis
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Alberto Grassi
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Stefano Zaffagnini
- Clinica Ortopedica e Traumatologica 2, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Giuseppe Filardo
- Applied and Translational Research Center, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy.,Orthopaedic and Traumatology Unit, Ospedale Regionale di Lugano, EOC, Lugano, Switzerland.,USI-Università della Svizzera Italiana, Facoltà di Scienze Biomediche, Lugano, Switzerland
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27
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Intra-Articular Administration of Autologous Purified Adipose Tissue Associated with Arthroscopy Ameliorates Knee Osteoarthritis Symptoms. J Clin Med 2021; 10:jcm10102053. [PMID: 34064752 PMCID: PMC8150587 DOI: 10.3390/jcm10102053] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 04/20/2021] [Accepted: 05/10/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of this study was to evaluate the safety and efficacy of the intra-articular administration of autologous purified adipose tissue to treat knee osteoarthritis (OA) following arthroscopy. Thirty patients with radiological evidence of knee OA were recruited. A small liposuction and arthroscopic lavage and debridement were performed in the same surgical time. The harvested fat was processed intraoperatively with Lipocell (Tiss’You, RSM) to purify the adipose tissue injected into the knee. Clinical evaluations were performed with VAS, Womac, and Lequesne questionnaires before treatment and after 1, 3, 6, and 12 months of follow-up. Pain, measured with VAS, significantly decreased, showing a reduction of 53% after 1 month and 83% after a year. Functional recovery, measured with Womac, showed an improvement of 47% after 1 month post-treatment and 84% after 1 year. No adverse effects have been observed. The intra-articular administration of purified adipose tissue associated with arthroscopic lavage and debridement is a safe and significantly effective strategy in improving the symptoms of knee osteoarthritis in up to 1 year of follow-up.
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Johnson AJ, Vasilopoulos T, Booker SQ, Cardoso J, Terry EL, Powell-Roach K, Staud R, Kusko DA, Addison AS, Redden DT, Goodin BR, Fillingim RB, Sibille KT. Knee pain trajectories over 18 months in non-Hispanic Black and non-Hispanic White adults with or at risk for knee osteoarthritis. BMC Musculoskelet Disord 2021; 22:415. [PMID: 33952243 PMCID: PMC8101224 DOI: 10.1186/s12891-021-04284-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 04/14/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Pain is the hallmark symptom of knee osteoarthritis (OA), and varies widely across individuals. Previous research has demonstrated both fluctuating and stable pain trajectories in knee OA using various time periods. Changes in pain assessed quarterly (i.e. 3-month intervals) in knee OA are relatively unknown. The current study aimed to investigate temporal variations in pain over a one and a half year period (18 months) based on quarterly characteristic pain assessments, and to examine differences in pain patterns by sociodemographic and baseline pain characteristics. METHODS The sample included a prospective cohort of 188 participants (mean age 58 years; 63% female; 52% non-Hispanic Black) with or at risk for knee OA from an ongoing multisite investigation of ethnic/race group differences. Knee pain intensity was self-reported at baseline and quarterly over an18-month period. Baseline pain assessment also included frequency, duration, and total number of pain sites. Group-based trajectory modeling was used to identify distinct pain trajectories. Multinomial logistic regression was used to examine associations between sociodemographic characteristics, risk factors, and pain trajectory groups. RESULTS Pain trajectories were relatively stable among a sample of adults with knee pain. Four distinct pain trajectories emerged in the overall sample, with the largest proportion of participants (35.1%) classified in the moderate-high pain group. There were significant relationships between age, education, income, ethnicity/race and trajectory group; with younger, less educated, lower income, and non-Hispanic Black participants had a greater representation in the highest pain trajectory group. CONCLUSIONS Pain remained stable across a one and a half-year period in adults with or at risk for knee osteoarthritis, based on quarterly assessments. Certain sociodemographic variables (e.g. ethnicity/race, education, income, age) may contribute to an increased risk of experiencing greater pain.
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Affiliation(s)
- Alisa J. Johnson
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Terrie Vasilopoulos
- Department of Anesthesiology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Staja Q. Booker
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Josue Cardoso
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
| | - Ellen L. Terry
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Keesha Powell-Roach
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Biobehavioral Nursing Science, College of Nursing, University of Florida, Gainesville, FL USA
| | - Roland Staud
- Department of Rheumatology, College of Medicine, University of Florida, Gainesville, FL USA
| | - Daniel A. Kusko
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Adriana S. Addison
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - David T. Redden
- Department of Biostatistics, School of Public Health, University of Alabama at Birmingham, Birmingham, AL USA
| | - Burel R. Goodin
- Department of Psychology, College of Arts and Sciences, University of Alabama at Birmingham, Birmingham, AL USA
| | - Roger B. Fillingim
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Community Dentistry & Behavioral Science, College of Dentistry, University of Florida, PO Box 100242, Gainesville, FL 32610 USA
| | - Kimberly T. Sibille
- Pain Research and Intervention Center of Excellence (PRICE), University of Florida, Gainesville, FL USA
- Department of Aging & Geriatric Research, Institute on Aging, University of Florida, Gainesville, FL USA
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