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Jones CE, Cibere J, Qian H, Zhang H, Guo Y, Russell D, Forster BB, Wong H, Esdaile JM, Wilson DR. T1Gd is reduced in bone marrow lesions overlying cartilage in the hip. Osteoarthritis Cartilage 2023; 31:1405-1414. [PMID: 37385537 DOI: 10.1016/j.joca.2023.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Revised: 05/26/2023] [Accepted: 06/12/2023] [Indexed: 07/01/2023]
Abstract
OBJECTIVE Bone Marrow Lesions (BMLs) are areas in bone with high fluid signal on MRI associated with painful and progressive OA. While cartilage near BMLs in the knee has been shown to be degenerated, this relationship has not been investigated in the hip. RESEARCH QUESTION is T1Gd lower in areas of cartilage overlying BMLs in the hip? DESIGN 128 participants were recruited from a population-based study of hip pain in 20-49-year-olds. Proton-density weighted fat-suppressed and delayed Gadolinium Enhanced MR Imaging of Cartilage (dGEMRIC) images were acquired to locate BMLs and quantify hip cartilage health. BML and cartilage images were registered and cartilage was separated into BML overlying and surrounding regions. Mean T1Gd was measured in 32 participants with BMLs in both cartilage regions and in matched regions in 32 age- and sex-matched controls. Mean T1Gd in the overlying cartilage was compared using linear mixed-effects models between BML and control groups for acetabular and femoral BMLs, and between cystic and non-cystic BML groups. RESULTS Mean T1Gd of overlying cartilage was lower in the BML group compared to the control group (acetabular: -105 ms; 95% CI: -175, -35; femoral: -8 ms; 95% CI: -141, 124). Mean T1Gd in overlying cartilage was lower in cystic compared to non-cystic BML subjects, but the confidence interval is too large to provide certainty in this difference (-3 [95% CI: -126, 121]). CONCLUSIONS T1Gd is reduced in overlying cartilage in hips from a population-based sample of adults aged 20-49, which suggests BMLs are associated with local cartilage degeneration in hips.
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Affiliation(s)
| | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, BC, Canada; Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
| | | | - Yimeng Guo
- Arthritis Research Canada, Vancouver, BC, Canada
| | - David Russell
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Bruce B Forster
- Department of Radiology, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada
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Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Kopec JA, Singer J, Wong H, Thorne A, Cibere J. Magnetic resonance imaging predictors (cartilage, osteophytes and meniscus) of prevalent and 3-year incident medial and lateral tibiofemoral knee joint tenderness and patellofemoral grind. BMC Musculoskelet Disord 2022; 23:1048. [DOI: 10.1186/s12891-022-06033-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2022] [Accepted: 11/25/2022] [Indexed: 12/03/2022] Open
Abstract
Abstract
Objective
To identify magnetic resonance imaging (MRI) predictors (cartilage [C], osteophytes [O] and meniscus [M] scores) of prevalent and 3-year incident medial tibiofemoral (MTF) and lateral tibiofemoral (LTF) knee joint tenderness and patellofemoral (PF) grind.
Methods
Population-based knee pain cohort aged 40–79 was assessed at baseline (N = 255), 3- and 7-year follow-up (N = 108 × 2 = 216). COM scores were measured at 6/8/6 subregions respectively. Age-sex-BMI adjusted logistic models predicted prevalence versus relevant COM predictors (medial, lateral or patellar / trochlear groove scores). Fully adjusted models also included all relevant COM predictors. Binary generalized estimating equations models predicting 3-year incidence were also adjusted for individual follow-up time between cycles.
Results
Significant predictors of prevalent MTF tenderness: medial femoral cartilage (fully adjusted odds ratio [aOR] 1.84; 95% confidence interval [CI] 1.11, 3.05), female (aOR = 3.05; 1.67, 5.58), BMI (aOR = 1.53 per 5 units BMI; 1.10, 2.11). Predictors of prevalent LTF tenderness: female (aOR = 2.18; 1.22, 3.90). There were no predictors of prevalent PF grind in the fully adjusted model. However, medial patellar osteophytes was predictive in the age-sex-BMI adjusted model. There were no predictors of 3-year incident MTF tenderness. Predictors of 3-year incident LTF tenderness: female (aOR = 3.83; 1.25, 11.77). Predictors of 3-year incident PF grind: lateral patellar osteophytes (aOR = 4.82; 1.69, 13.77). In the age-sex-BMI adjusted model, patellar cartilage was also a predictor.
Conclusion
We explored potential MRI predictors of prevalent and 3-year incident MTF/LTF knee joint tenderness and PF grind. These findings could guide preemptive strategies aimed at reducing these symptoms in the present and future (3-year incidence).
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Jones CE, Cibere J, Qian H, Zhang H, Guo Y, Russell D, Forster BB, Wong H, Esdaile JM, Wilson DR. Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage Values in Hips With Bone Marrow Lesions. Arthritis Care Res (Hoboken) 2022; 74:1997-2004. [PMID: 34137188 DOI: 10.1002/acr.24733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 04/28/2021] [Accepted: 06/15/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVE Bone marrow lesions (BMLs) are associated with painful and progressive osteoarthritis (OA). Quantitative magnetic resonance imaging (MRI) has been used to study early cartilage degeneration in knees with BML, but similar work has not been done in hips. The purpose of this study was to compare mean delayed gadolinium-enhanced MRI of cartilage (dGEMRIC) relaxation values (T1Gd) in hips with BML to hips without BML in a population-based study. Reduced T1Gd suggests depleted glycosaminoglycan. Our hypothesis was that mean T1Gd is lower in hips with BML compared to hips without BML. METHODS Study participants (n = 128) were recruited from a cross-sectional population-based study of people ages 20-49 years with and without hip pain. dGEMRIC and proton density (PD)-weighted MRI scans of 1 hip from each participant were used for this analysis. BMLs were identified from PD-weighted fat-suppressed images. We applied a sampling-weighted linear regression model to determine the association of the presence of BMLs with mean cartilage T1Gd (significance: P < 0.05). The model was adjusted for age, sex, body mass index (BMI), hip pain, cam/pincer deformity, and physical activity. RESULTS Thirty-two (25%) of the 128 participants had at least 1 BML. Subjects with at least 1 BML, compared to those without, had similar weighted characteristics of age, BMI, physical activity levels, and frequency of hip pain. Mean T1Gd was 75.25 msec lower (95% confidence interval -149.69, -0.81; P = 0.048) (9%) in the BML compared to the no-BML group. CONCLUSION Our results suggest that hips with BMLs are associated with hip cartilage degeneration early in the OA disease process.
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Affiliation(s)
- Carly E Jones
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, British Columbia, Canada, and University of British Columbia, Vancouver, British Columbia, Canada
| | - Hong Qian
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - Honglin Zhang
- Centre for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Yimeng Guo
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - David Russell
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Bruce B Forster
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hubert Wong
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - David R Wilson
- Centre for Hip Health and Mobility, Department of Orthopedics, University of British Columbia, Vancouver, British Columbia, Canada
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Gill J, Sayre EC, Guermazi A, Nicolaou S, Cibere J. Association between statins and progression of osteoarthritis features on magnetic resonance imaging in a predominantly pre-radiographic cohort: the Vancouver Longitudinal Study of Early Knee Osteoarthritis (VALSEKO): a cohort study. BMC Musculoskelet Disord 2022; 23:937. [PMID: 36307782 PMCID: PMC9615180 DOI: 10.1186/s12891-022-05900-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 10/19/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
To evaluate the effect of statin use on osteoarthritis (OA) incidence/progression using magnetic resonance imaging (MRI) in a population-based cohort with predominantly pre-radiographic knee OA.
Methods
A cohort aged 40–79 years with knee pain was recruited using random population sampling and followed for 7 years. Baseline exclusions were inflammatory arthritis, recent knee surgery/injury, and inability to undergo MRI. At baseline, current statin use was ascertained. Baseline and follow-up MRIs were read semi-quantitatively for cartilage damage (grade 0–4, 0/1 collapsed, 6 regions), osteophytes (grade 0–3, 8 regions), bone marrow lesions (BML) (grade 0–3, 6 regions) and effusion (grade 0–3). The primary outcome was cartilage damage incidence/progression, while secondary outcomes were incidence/progression of osteophytes, BML, and effusion, each defined as an increase by ≥1 grade at any region. To ensure population representative samples, sample weights were used. Logistic regression was used to assess the association of statin use at baseline with incidence/progression of MRI outcomes. Analyses were adjusted for sex, age, BMI, and multiple comorbidities requiring statin therapy.
Results
Of 255 participants evaluated at baseline, 122 completed the 7-year follow-up. Statin use was not significantly associated with progression of cartilage damage (OR 0.82; 95% CI 0.17, 4.06), osteophytes (OR 3.48; 95% CI 0.40, 30.31), BML (OR 0.61; 95% CI 0.12, 3.02), or effusion (OR 2.38; 95% CI 0.42, 13.63), after adjusting for confounders.
Conclusion
In this population-based cohort of predominantly pre-radiographic knee OA, statins did not affect MRI incidence/progression of cartilage damage, BML, osteophytes or effusion. Therefore, statin use does not appear to affect people with pre-radiographic stages of knee OA.
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Kopec JA, Sayre EC, Cibere J, Li LC, Wong H, Okhmatovskaia A, Esdaile JM. Reducing the burden of low back pain: results from a new microsimulation model. BMC Musculoskelet Disord 2022; 23:804. [PMID: 35996103 PMCID: PMC9396830 DOI: 10.1186/s12891-022-05747-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 08/08/2022] [Indexed: 11/25/2022] Open
Abstract
Background Low back pain (LBP) causes the highest morbidity burden globally. The purpose of the present study was to project and compare the impact of three strategies for reducing the population health burden of LBP: weight loss, ergonomic interventions, and an exercise program. Methods We have developed a microsimulation model of LBP in Canada using a new modeling platform called SimYouLate. The initial population was derived from Cycle 1 (2001) of the Canadian Community Health Survey (CCHS). We modeled an open population 20 years of age and older. Key variables included age, sex, education, body mass index (BMI), type of work, having back problems, pain level in persons with back problems, and exercise participation. The effects of interventions on the risk of LBP were obtained from the CCHS for the effect of BMI, the Global Burden of Disease Study for occupational risks, and a published meta-analysis for the effect of exercise. All interventions lasted from 2021 to 2040. The population health impact of the interventions was calculated as a difference in years lived with disability (YLDs) between the base-case scenario and each intervention scenario, and expressed as YLDs averted per intervention unit or a proportion (%) of total LBP-related YLDs. Results In the base-case scenario, LBP in 2020 was responsible for 424,900 YLDs in Canada and the amount increased to 460,312 YLDs in 2040. The effects of the interventions were as follows: 27,993 (95% CI 23,373, 32,614) YLDs averted over 20 years per 0.1 unit change in log-transformed BMI (9.5% change in BMI) among individuals who were overweight and those with obesity, 19,416 (16,275, 22,557) YLDs per 1% reduction in the proportion of workers exposed to occupational risks, and 26,058 (22,455, 29,661) YLDs averted per 1% increase in the proportion of eligible patients with back problems participating in an exercise program. Conclusions The study provides new data on the relationship between three types of interventions and the resultant reductions in LBP burden in Canada. According to our model, each of the interventions studied could potentially result in a substantial reduction in LBP-related disability. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05747-2.
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Affiliation(s)
- Jacek A Kopec
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada. .,Arthritis Research Canada, Vancouver, BC, Canada.
| | - Eric C Sayre
- Arthritis Research Canada, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, BC, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population and Public Health, University of British Columbia, 2206 E Mall, Vancouver, BC V6T 1Z3, Canada
| | - Anya Okhmatovskaia
- McGill Clinical and Health Informatics, McGill University, Montreal, QC, Canada
| | - John M Esdaile
- Arthritis Research Canada, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
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Kopec J, Sayre EC, Cibere J, Li L, Wong H, Okhmatovskaia A, Esdaile J. OP0054 REDUCING THE BURDEN OF LOW BACK PAIN: RESULTS FROM A NEW MICROSIMULATION MODEL. Ann Rheum Dis 2022. [DOI: 10.1136/annrheumdis-2022-eular.870] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BackgroundLow back pain (LBP) has been the leading cause of disability worldwide for the past 30 years. In 2019, LBP was responsible for 64 million years lived with disability (YLDs) [1].ObjectivesThe purpose of the present study was to project and compare the impact of three strategies for reducing the population health burden of LBP: weight loss, ergonomic interventions, and an exercise program.MethodsWe have developed a microsimulation model of LBP in Canada using a novel simulation platform, SimYouLate. The initial population was derived from Cycle 1 (2001) of the Canadian Community Health Survey (CCHS). We modeled an open population 20 years of age and older. Key variables included age, sex, education, body mass index (BMI), type of work, having a back problem, pain level in persons with back problems, and exercise. The effects of interventions on the risk of LBP were obtained from the CCHS for the effect of BMI, the Global Burden of Disease Study for occupational risks, and a published meta-analysis for the effect of exercise. All interventions lasted from 2021 to 2040. Strength of the interventions varied over a wide range. YLDs were defined as LBP prevalence multiplied by disability weight. The population health impact of the interventions was calculated as a difference in YLDs between the base-case scenario and each intervention scenario and expressed as YLDs averted per intervention unit and as % of total LBP-related YLDs.ResultsIn the base-case scenario, LBP in 2020 was responsible for 424,900 YLDs in Canada and the amount increased to 460,312 YLDs in 2040. The effects of the interventions on YLDs were as follows: 27,993 (95% CI 23,373, 32,614) YLDs averted over 20 years per 0.1 unit change in log-transformed BMI (10.5% change in BMI) among overweight and obese individuals, 19,416 (16,275, 22,557) YLDs averted per 1% reduction in the proportion of workers exposed to occupational risks, and 26,058 (22,455, 29,661) YLDs averted per 1% increase in the proportion of eligible patients with back problems participating in the exercise program. Table 1 shows the intervention impact as % of total LBP-related YLDs and Figure 1 shows YLD-equivalence between the interventions. A one unit reduction in BMI per year among the overweight and obese individuals would be approximately equivalent in terms of disability reduction to an effective ergonomic intervention in 35% of at-risk workers and an exercise intervention in 27% of eligible patients with back problems over the same period (Figure 1).Table 1.YLDs averted between 2021 and 2040 as % of total LBP-related YLDs, according to intervention type and level, in persons aged 20+ in CanadaInterventionEffect (%)95% LCL95% UCLReduction in BMI per year0.11.4-1.44.10.34.82.27.30.56.33.98.81.08.56.011.03.011.99.414.45.013.510.916.0Reduction in occupational exposure20%5.21.98.540%9.56.412.760%13.810.616.980%18.114.821.4100%22.418.825.9Increase in exercise participation20%6.62.810.440%12.48.716.060%18.114.521.780%23.920.127.6100%29.625.533.7LCL: lower confidence limit. UCL: upper confidence limit.Figure 1.Equivalence between BMI, ergonomic and exercise interventions in terms of their impact on YLDs. Each point represents a specific number of YLDs averted. Values on the y-axis show reduction in % of workers at risk and increase in % exercising that are required to achieve the same reduction in YLDs as the corresponding reduction in BMI shown on the x-axis.ConclusionThis is the first population-based microsimulation study to compare currently available preventive strategies in LBP in terms of YLDs averted and to provide measures of equivalence between these strategies.References[1]Hartvigsen J, Hancock MJ, Kongsted A, et al. What low back pain is and why we need to pay attention. Lancet 2018;391(10137):2356-2367.AcknowledgementsThe study was supported by a grant from the Canadian Institutes for Health Research (FRN 142440).Disclosure of InterestsNone declared.
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Li L, Marozoff S, Lu N, Xie H, Kopec JA, Cibere J, Esdaile JM, Avina-Zubieta JA. Correction: Association of tramadol with all-cause mortality, cardiovascular diseases, venous thromboembolism, and hip fractures among patients with osteoarthritis: a population-based study. Arthritis Res Ther 2022; 24:114. [PMID: 35585560 PMCID: PMC9116000 DOI: 10.1186/s13075-022-02805-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Affiliation(s)
- Lingyi Li
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shelby Marozoff
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Na Lu
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Hui Xie
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - J Antonio Avina-Zubieta
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada. .,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
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Li L, Marozoff S, Lu N, Xie H, Kopec JA, Cibere J, Esdaile JM, Aviña-Zubieta JA. Association of tramadol with all-cause mortality, cardiovascular diseases, venous thromboembolism, and hip fractures among patients with osteoarthritis: a population-based study. Arthritis Res Ther 2022; 24:85. [PMID: 35410440 PMCID: PMC8996663 DOI: 10.1186/s13075-022-02764-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Accepted: 03/15/2022] [Indexed: 11/10/2022] Open
Abstract
Background The use of tramadol among osteoarthritis (OA) patients has been increasing rapidly around the world, but population-based studies on its safety profile among OA patients are scarce. We sought to determine if tramadol use in OA patients is associated with increased risks of all-cause mortality, cardiovascular diseases (CVD), venous thromboembolism (VTE), and hip fractures compared with commonly prescribed nonsteroidal anti-inflammatory drugs (NSAIDs) or codeine. Methods Using administrative health datasets from British Columbia, Canada, we conducted a sequential propensity score-matched cohort study among all OA patients between 2005 and 2013. The tramadol cohort (i.e., tramadol initiation) was matched with four comparator cohorts (i.e., initiation of naproxen, diclofenac, cyclooxygenase-2 [Cox-2] inhibitors, or codeine). Outcomes are all-cause mortality, first-ever CVD, VTE, and hip fractures within the year after the treatment initiation. Patients were followed until they either experienced an event, left the province, or the 1-year follow-up period ended, whichever occurred first. Cox proportional hazard models were used to estimate hazard ratios after adjusting for competing risk of death. Results Overall, 100,358 OA patients were included (mean age: 68 years, 63% females). All-cause mortality was higher for tramadol compared to NSAIDs with rate differences (RDs/1000 person-years, 95% CI) ranging from 3.3 (0.0–6.7) to 8.1 (4.9–11.4) and hazard ratios (HRs, 95% CI) ranging from 1.2 (1.0–1.4) to 1.5 (1.3–1.8). For CVD, no differences were observed between tramadol and NSAIDs. Tramadol had a higher risk of VTE compared to diclofenac, with RD/1000 person-years (95% CI) of 2.2 (0.7–3.7) and HR (95% CI) of 1.7 (1.3–2.2). Tramadol also had a higher risk of hip fractures compared to diclofenac and Cox-2 inhibitors with RDs/1000 person-years (95% CI) of 1.9 (0.4–3.4) and 1.7 (0.2–3.3), respectively, and HRs (95% CI) of 1.6 (1.2–2.0) and 1.4 (1.1–1.9), respectively. No differences were observed between tramadol and NSAIDs for all events. Conclusions OA patients initiating tramadol have an increased risk of mortality, VTE, and hip fractures within 1 year compared with commonly prescribed NSAIDs, but not with codeine. Supplementary Information The online version contains supplementary material available at 10.1186/s13075-022-02764-3.
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Affiliation(s)
- Lingyi Li
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Experimental Medicine Program, Faculty of Medicine, University of British Columbia, Vancouver, Canada
| | - Shelby Marozoff
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Na Lu
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada
| | - Hui Xie
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - John M Esdaile
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada.,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada
| | - J Antonio Aviña-Zubieta
- Arthritis Research Canada, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada. .,Division of Rheumatology, Department of Medicine, University of British Columbia, Vancouver, Canada.
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Kopec JA, Sayre EC, Okhmatovskaia A, Cibere J, Li LC, Bansback N, Wong H, Ghanbarian S, Esdaile JM. A comparison of three strategies to reduce the burden of osteoarthritis: A population-based microsimulation study. PLoS One 2021; 16:e0261017. [PMID: 34879102 PMCID: PMC8654220 DOI: 10.1371/journal.pone.0261017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Accepted: 11/22/2021] [Indexed: 12/12/2022] Open
Abstract
Objectives The purpose of this study was to compare three strategies for reducing population health burden of osteoarthritis (OA): improved pharmacological treatment of OA-related pain, improved access to joint replacement surgery, and prevention of OA by reducing obesity and overweight. Methods We applied a validated computer microsimulation model of OA in Canada. The model simulated a Canadian-representative open population aged 20 years and older. Variables in the model included demographics, body mass index, OA diagnosis, OA treatment, mortality, and health-related quality of life. Model parameters were derived from analyses of national surveys, population-based administrative data, a hospital-based cohort study, and the literature. We compared 8 what-if intervention scenarios in terms of disability-adjusted life years (DALYs) relative to base-case, over a wide range of time horizons. Results Reductions in DALYs depended on the type of intervention, magnitude of the intervention, and the time horizon. Medical interventions (a targeted increase in the use of painkillers) tended to produce effects quickly and were, therefore, most effective over a short time horizon (a decade). Surgical interventions (increased access to joint replacement) were most effective over a medium time horizon (two decades or longer). Preventive interventions required a substantial change in BMI to generate a significant impact, but produced more reduction in DALYs than treatment strategies over a very long time horizon (several decades). Conclusions In this population-based modeling study we assessed the potential impact of three different burden reduction strategies in OA. Data generated by our model may help inform the implementation of strategies to reduce the burden of OA in Canada and elsewhere.
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Affiliation(s)
- Jacek A. Kopec
- University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
| | - Eric C. Sayre
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | - Jolanda Cibere
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C. Li
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Nick Bansback
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Hubert Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Shahzad Ghanbarian
- Centre of Clinical Epidemiology and Evaluation, Vancouver, British Columbia, Canada
| | - John M. Esdaile
- University of British Columbia, Vancouver, British Columbia, Canada
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Mohtajeb M, Cibere J, Mony M, Zhang H, Sullivan E, Hunt MA, Wilson DR. Open MRI assessment of anterior femoroacetabular clearance in active and passive impingement-provoking postures. Bone Jt Open 2021; 2:988-996. [PMID: 34825828 PMCID: PMC8636292 DOI: 10.1302/2633-1462.211.bjo-2021-0143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims Cam and pincer morphologies are potential precursors to hip osteoarthritis and important contributors to non-arthritic hip pain. However, only some hips with these pathomorphologies develop symptoms and joint degeneration, and it is not clear why. Anterior impingement between the femoral head-neck contour and acetabular rim in positions of hip flexion combined with rotation is a proposed pathomechanism in these hips, but this has not been studied in active postures. Our aim was to assess the anterior impingement pathomechanism in both active and passive postures with high hip flexion that are thought to provoke impingement. Methods We recruited nine participants with cam and/or pincer morphologies and with pain, 13 participants with cam and/or pincer morphologies and without pain, and 11 controls from a population-based cohort. We scanned hips in active squatting and passive sitting flexion, adduction, and internal rotation using open MRI and quantified anterior femoroacetabular clearance using the β angle. Results In squatting, we found significantly decreased anterior femoroacetabular clearance in painful hips with cam and/or pincer morphologies (mean -11.3° (SD 19.2°)) compared to pain-free hips with cam and/or pincer morphologies (mean 8.5° (SD 14.6°); p = 0.022) and controls (mean 18.6° (SD 8.5°); p < 0.001). In sitting flexion, adduction, and internal rotation, we found significantly decreased anterior clearance in both painful (mean -15.2° (SD 15.3°); p = 0.002) and painfree hips (mean -4.7° (SD 13°); p = 0.010) with cam and/pincer morphologies compared to the controls (mean 7.1° (SD 5.9°)). Conclusion Our results support the anterior femoroacetabular impingement pathomechanism in hips with cam and/or pincer morphologies and highlight the effect of posture on this pathomechanism. Cite this article: Bone Jt Open 2021;2(11):988–996.
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Affiliation(s)
- Maryam Mohtajeb
- School of Biomedical Engineering, University of British Columbia, Vancouver, British Columbia, Canada.,Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.,Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michelle Mony
- Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
| | - Honglin Zhang
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Emily Sullivan
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | - David R Wilson
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, British Columbia, Canada.,Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
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11
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Mohtajeb M, Cibere J, Graffos A, Mony M, Zhang H, Hunt MA, Wilson DR. Open MRI validation of a hip model driven with subject-specific motion capture data in predicting anterior femoroacetabular clearance. BMC Musculoskelet Disord 2021; 22:972. [PMID: 34814875 PMCID: PMC8609822 DOI: 10.1186/s12891-021-04820-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 10/26/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Cam and/or pincer morphologies (CPM) are potential precursors to hip osteoarthritis (OA) and important contributors to non-arthritic hip pain. However, only some CPM hips develop OA and/or pain, and it is not clear why. Anterior impingement between the femoral head/neck contour and acetabular rim during motion is a proposed pathomechanism. Understanding how activity and deformity combine to produce impingement may shed light on the causes of hip degeneration/pain. The objective of this study was to determine the accuracy of a subject-specific hip model driven by subject-specific motion data in predicting anterior impingement. METHODS We recruited 22 participants with CPM (both with and without pain) and 11 controls. We collected subject-specific 3D kinematics during squatting and sitting flexion, adduction, and internal rotation (FADIR) (an active and a passive maneuver, respectively, proposed to provoke impingement). We then developed 3D subject-specific hip models from supine 3T hip MRI scans that predicted the beta angle (a measure of anterior femoroacetabular clearance) for each frame of acquired kinematics. To assess the accuracy of these predictions, we measured the beta angle directly in the final position of squatting and sitting FADIR using open MRI scans. We selected the frame of motion data matching the static imaged posture using the least-squares error in hip angles. Model accuracy for each subject was calculated as the absolute error between the open MRI measure of beta and the model prediction of beta at the matched time frame. To make the final model accuracy independent of goodness of match between open MRI position and motion data, a threshold was set for least-squares error in hip angles, and only participants that were below this threshold were considered in the final model accuracy calculation, yielding results from 10 participants for squatting and 7 participants for sitting FADIR. RESULTS For squatting and sitting FADIR, we found an accuracy of 1.1°(0.8°) and 1.3°(mean (SD), and root mean squared error, respectively) and 0.5°(0.3°) and 0.6°, respectively. CONCLUSION This subject-specific hip model predicts anterior femoroacetabular clearance with an accuracy of about 1°, making it useful to predict anterior impingement during activities measured with motion analysis.
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Affiliation(s)
- Maryam Mohtajeb
- School of Biomedical Engineering, University of British Columbia, Vancouver, BC, Canada
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Angelo Graffos
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
| | - Michelle Mony
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Honglin Zhang
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada
| | - Michael A Hunt
- Motion Analysis and Biofeedback Laboratory, University of British Columbia, Vancouver, BC, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - David R Wilson
- Center for Hip Health and Mobility, University of British Columbia, Vancouver, BC, Canada.
- Department of Orthopaedics, University of British Columbia, 7/F, 2635 Laurel Street, Vancouver, BC, V5Z1M9, Canada.
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12
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Kopec JA, Heath AJ, Sayre EC, Cibere J, Li LC, Marra CA, Liu RR, Esdaile JM. Prevalence of joint-specific osteoarthritis and joint pain in British Columbia, Canada. Rheumatol Int 2021; 42:1623-1628. [PMID: 34716488 DOI: 10.1007/s00296-021-05031-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Accepted: 10/12/2021] [Indexed: 10/20/2022]
Abstract
The objective is to determine the prevalence of self-reported physician-diagnosed osteoarthritis (OA) and musculoskeletal symptoms (pain, stiffness or discomfort) in specific joints among adults in British Columbia (BC), Canada. We carried out a cross-sectional mixed-mode survey in a random population sample of persons 18 years of age and older. Estimates were weighted to reflect the age and sex distribution of the population of BC. We obtained responses from 2,233 individuals. Overall, 18.4% (95% CI 16.8-20.1) of the adult population reported OA. Of those, more than 40% had OA in multiple sites. Prevalence ranged from 8.8% (95% CI 7.6-10.1) in the knee to 2.7% (2.1-3.5) in the foot. One-year prevalence of symptoms ranged from 49.1% (47.0-51.2) in the lower back to 23.3% (21.5-25.1) in the hip. Females reported more symptoms and OA than males in all joints. The most common site of self-reported physician-diagnosed OA in BC is the knee, but OA in the hands, hips, and feet is also common. Having OA in one joint is a strong predictor of OA in other joints.
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Affiliation(s)
- Jacek A Kopec
- School of Population and Public Health, University of British Columbia, 230-2238 Yukon Street, Vancouver, BC, V5Y 3P2, Canada. .,Arthritis Research Canada, Vancouver, Canada.
| | | | | | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Linda C Li
- Arthritis Research Canada, Vancouver, Canada.,Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada
| | - Carlo A Marra
- School of Pharmacy, University of Otago, Dunedin, New Zealand
| | - Ran R Liu
- Department of Medicine, Queens University, Kingston, Canada
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13
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Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Kopec JA, Singer J, Wong H, Thorne A, Cibere J. A whole-joint, unidimensional, irreversible, and fine-grained MRI knee osteoarthritis severity score, based on cartilage, osteophytes and meniscus (OA-COM). PLoS One 2021; 16:e0258451. [PMID: 34648543 PMCID: PMC8516189 DOI: 10.1371/journal.pone.0258451] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Accepted: 09/26/2021] [Indexed: 11/18/2022] Open
Abstract
Objective To develop a whole-joint, unidimensional, irreversible, and fine-grained MRI knee osteoarthritis (OA) severity score, based on cartilage, osteophytes and meniscus (OA-COM), and to predict progression across different severity states using OA-COM as outcome and clinical variables as predictors. Methods Population-based knee pain cohort aged 40–79 was assessed at baseline and 7-year follow-up. OA-COM score was defined as the sum of MRI scores for cartilage, osteophytes and menisci, measured at 6, 8 and 6 sites, total score 0–54. To anchor severity levels, we fit cross-sectional logistic models using OA-COM to predict Kellgren-Lawrence (KL) grades in subsets at or one point below each grade. OA-COM threshold scores were selected on sensitivity, specificity, positive and negative predictive value. We developed longitudinal logistic models for OA-COM progression over each threshold over 7 years. Potential predictors included age, sex, BMI, malalignment, physical exam effusion, quadriceps weakness, and crepitus, selected on area under the receiver operating characteristic curve (AUC) and Akaike’s Information Criterion (AIC). Results Optimal OA-COM thresholds were 12, 18, 24 and 30, for KL grades 1 to 4. Significant predictors of progression (depending on threshold) included physical exam effusion, malalignment and female sex, with other selected predictors age, BMI and crepitus. Conclusion OA-COM (0–54 range) is a whole-joint, unidimensional, irreversible, and fine-grained MRI OA severity score reflecting cartilage, osteophytes and menisci. OA-COM scores 12, 18, 24 and 30 are equivalent to KL grades 1 to 4, while offering fine-grained differentiation of states between KL grades, and within pre-radiographic disease (KL = 0) or late-stage disease (KL = 4). In modeling, several clinical variables predicted progression across different states over 7 years.
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Affiliation(s)
- Eric C. Sayre
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- * E-mail:
| | - Ali Guermazi
- Radiology, Boston University School of Medicine, Boston, Massachusetts, United States of America
| | - Savvas Nicolaou
- Radiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - John M. Esdaile
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
- Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jacek A. Kopec
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Hubert Wong
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Anona Thorne
- School of Population & Public Health, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Medicine, University of British Columbia, Vancouver, British Columbia, Canada
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14
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Sayre EC, Esdaile JM, Kopec JA, Singer J, Wong H, Thorne A, Guermazi A, Nicolaou S, Cibere J. Specific manifestations of knee osteoarthritis predict depression and anxiety years in the future: Vancouver Longitudinal Study of Early Knee Osteoarthritis. BMC Musculoskelet Disord 2020; 21:467. [PMID: 32677938 PMCID: PMC7367326 DOI: 10.1186/s12891-020-03496-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 07/09/2020] [Indexed: 12/21/2022] Open
Abstract
Background To evaluate whether knee osteoarthritis (OA) manifestations predict depression and anxiety using cross-sectional and longitudinal prediction models. Methods A population-based cohort (n = 122) with knee pain, aged 40–79, was evaluated at baseline, 3 and 7 years. Baseline predictors were: age decade; sex; BMI ≥ 25; physical exam knee effusion; crepitus; malalignment; quadriceps atrophy; flexion; flexion contracture; Kellgren-Lawrence (KL) x-ray grade (0/1/2/3+); WOMAC pain ≥25; WOMAC stiffness ≥25; self-reported knee swelling; and knee OA diagnosis (no/probable/definite). Depression and anxiety, cutoffs 5+ and 7+ respectively, were measured via the Hospital Anxiety and Depression Scale. We fit logistic models at each cycle using multivariable models selected via lowest Akaike’s information criterion. Results Baseline depression model: sex (female OR = 0.27; 0.10, 0.76) and KL grade (KL 1 OR = 4.21; 1.31, 13.48). Three-year depression model: KL grade (KL 1 OR = 18.92; 1.73, 206.25). Seven-year depression model: WOMAC stiffness ≥25 (OR = 3.49; 1.02, 11.94) and flexion contracture ≥1 degree (OR = 0.23; 0.07, 0.81). Baseline anxiety model: knee swelling (OR = 4.11; 1.51, 11.13) and age (50–59 vs. 40–49 OR = 0.31 [0.11, 0.85]; 60–69 OR = 0.07 [0.01, 0.42]). Three-year anxiety model: WOMAC stiffness ≥25 (OR = 5.80; 1.23, 27.29) and KL grade (KL 1 OR = 6.25; 1.04, 37.65). Seven-year anxiety model: sex (female OR = 2.71; 0.87, 8.46). Conclusion Specific knee OA-related manifestations predict depression and anxiety cross-sectionally, 3 years in the future, and for depression, 7 years in the future. This information may prove useful to clinicians in helping to identify patients most at risk of present or future depression and anxiety, thus facilitating preemptive discussions that may help counter that risk.
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Affiliation(s)
- Eric C Sayre
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.
| | - John M Esdaile
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,Medicine, University of British Columbia, Vancouver, BC, Canada.,Medicine, University of Calgary, Calgary, AB, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joel Singer
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Hubert Wong
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anona Thorne
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Ali Guermazi
- Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Savvas Nicolaou
- Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, 5591 No. 3 Road, Richmond, BC, V6X 2C7, Canada.,Medicine, University of British Columbia, Vancouver, BC, Canada
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15
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LI L, Lu N, Xie H, Cibere J, Kopec J, Esdaile J, Aviña-Zubieta JA. OP0191 ASSOCIATION OF TRAMADOL WITH ALL-CAUSE MORTALITY, CARDIOVASCULAR DISEASE, VENOUS THROMBOEMBOLISM AND HIP FRACTURES AMONG PATIENTS WITH OSTEOARTHRITIS. A POPULATION-BASED STUDY. Ann Rheum Dis 2020. [DOI: 10.1136/annrheumdis-2020-eular.1889] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background:Both tramadol (narcotic-like drug) and nonsteroidal anti-inflammatory drugs (NSAIDs) are prescribed for pain relief among osteoarthritis (OA) patients. Evidence comparing risks of adverse events between tramadol and NSAIDs users is inconclusive.Objectives:To examine the association of tramadol with all-cause mortality, cardiovascular disease (CVD), venous thromboembolism (VTE) and hip fractures (HFx) compared with NSAIDs and codeine in OA.Methods:Design: Sequential propensity score-matched cohort study. Sample: All patients with OA who received medical care from 2005 to 2014 in the entire province of British Columbia, Canada. Tramadol cohort: Initial prescription of tramadol (n=56325). Four comparator cohorts: the initiation of one of the following: naproxen (n=13798), diclofenac (n=17675), cyclooxygenase-2 [Cox-2] inhibitor (n= 17039), or codeine (a weak opioid) (n=7813). Patients required to be prescribed neither tramadol nor its comparators during the year before the initial prescription date (i.e., index date). Outcomes: 1) all-cause mortality;first ever2) CVD, 3) VTE, 4) HFx within the 1styear after the initiation of tramadol or its comparators. Follow-up: from index date until the event occurred, disenrollment, or the end of a 1-year follow-up period. Statistical analysis: We created baseline covariates (demographics, comorbidities, medications and health resource utilization) from the year prior to the index date. Calendar years from 2005 to 2014 were divided into 10 blocks; propensity scores were calculated using logistic regression within each block. We used 1:1 greedy matching method. We estimated hazard ratios (HRs) using Cox proportional hazard models.Results:After propensity score matching, 112650 patients with OA were included (mean age of 68 years, 62.8% were females). During the 1-year follow-up, 296 deaths (21.5/1000 person-years) occurred in the tramadol cohort and 246 (17.8/1000 person-years) in the naproxen cohort (Table 1). All-cause mortality was higher for tramadol compared with all NSAIDs cohorts, but not with the codeine cohort (Table 1, Figure 1). Tramadol initiators have also a higher risk of CVD and VTE compared with the diclofenac and Cox-2 inhibitor initiators with HRs ranging from 1.2 to 1.7. Furthermore, tramadol was also associated with a higher risk of HFx compared with all NSAIDs cohorts (HRs ranging from 1.4 to 1.5). No significant difference was found between tramadol and codeine (Table 1).Table 1Group1Group2Group3Group4All-cause MortalityTramadolNaproxenTramadolDiclofenacTramadolCox-2 inhibitorTramadolCodeineOA (n)13798137981767517675170391703978137813Death (n)296246439345402267168199Rate (/1000 PY)21.517.824.819.523.615.721.525.5HR (95% CI)1.2 (1.0-1.4)1.01.3 (1.1-1.5)1.01.5 (1.3-1.8)1.00.8 (0.7-1.0)1.0CVDOA (n)11708117081492414924147791477968096809CVD (n)309319410349404353156164Rate (/1000 PY)26.427.327.523.427.323.922.924.1HR (95% CI)1.0 (0.9-1.1)1.01.2 (1.1-1.3)1.01.2 (1.0-1.3)1.00.9 (0.8-1.1)1.0VTEOA (n)13472134721723017230166991669976607660VTE (n)4137604070402830Rate (/1000 PY)3.02.83.52.34.22.43.73.9HR (95% CI)1.2 (0.9-1.6)1.01.5 (1.1-1.9)1.01.7 (1.3-2.3)1.01.0 (0.7-1.4)1.0HFxOA (n)13378133781721617216166701667075937593HFx (n)6649885991603540Rate (/1000 PY)5.03.75.13.45.53.64.65.3HR (95% CI)1.4 (1.0-1.8)1.01.5 (1.2-1.9)1.01.5 (1.2-1.9)1.00.9 (0.7-1.2)1.0Conclusion:OA patients initiating tramadol have an increased risk of mortality, CVD, VTE, and HFx within 1 year compared with NSAIDs, but no statistically significant difference in the risk was observed between tramadol and codeine.Disclosure of Interests:None declared
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16
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Kopec JA, Hong Q, Wong H, Zhang CJ, Ratzlaff C, Cibere J, Li LC, Prlic H, Wilson DR, Forster BB, Esdaile JM. Prevalence of Femoroacetabular Impingement Syndrome among Young and Middle-aged White Adults. J Rheumatol 2019; 47:1440-1445. [DOI: 10.3899/jrheum.190345] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/18/2019] [Indexed: 11/22/2022]
Abstract
Objective.The purpose of the study was to determine the prevalence of femoroacetabular impingement syndrome (FAIS) in white adults 20 to 49 years of age.Methods.Participants were white men and women aged 20–49 years, recruited through random digit dialing from the population of Metro Vancouver, British Columbia, Canada. Participants filled out a self-administered questionnaire and underwent a physical examination and radiographs of both hips. FAIS was defined as a combination of hip symptoms, physical signs of impingement, and radiological findings of cam or pincer morphology as recommended by the Warwick Agreement. All analyses were weighted to reflect the population from which the sample was drawn.Results.Data were obtained for 500 participants. In the study population, 48.9% were males and the age distribution was 32.2%, 31.4%, and 36.4% in the groups 20–29, 30–39, and 40–49 years, respectively. The physical signs of impingement correlated significantly with symptoms, but there was no significant association between either symptoms or physical examination with radiographic findings. FAIS on either side was found in 3.0% (95% CI 1.5–4.5) of the population.Conclusion.In this study, FAIS was present in 3% of whites aged 20–49 years. Further research is needed to develop consistent criteria for assessing hip symptoms, physical signs, and hip joint morphology, and to better understand the relationships between them.
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Cibere J, Guermazi A, Nicolaou S, Esdaile JM, Thorne A, Singer J, Wong H, Kopec JA, Sayre EC. Association of Knee Effusion Detected by Physical Examination With Bone Marrow Lesions: Cross-Sectional and Longitudinal Analyses of a Population-Based Cohort. Arthritis Care Res (Hoboken) 2019; 71:39-45. [PMID: 29648685 DOI: 10.1002/acr.23575] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2017] [Accepted: 04/03/2018] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the association of effusion detected by physical examination with the prevalence of bone marrow lesions (BMLs) on magnetic resonance imaging (MRI), and the incidence/progression of BMLs over 3 years in subjects with knee osteoarthritis. METHODS A population-based cohort with knee pain (n = 255) was assessed for effusion on physical examination. On MRI, BMLs were graded 0-3 (none, mild, moderate, severe), and incidence/progression was defined as a worsening of the sum of BML scores over 6 surfaces by ≥1 grade. We analyzed the full cohort and a mild disease subsample with a Kellgren/Lawrence (K/L) grade <3. Cross-sectional logistic and longitudinal exponential regression analyses were performed, adjusted for age, sex, body mass index (BMI) and pain. We calculated sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) for effusion detected by physical examination versus BMLs (prevalence and incidence/progression). RESULTS The weighted mean age was 56.7 years, the mean BMI was 26.5, 56.3% were women, 20.1% had effusion on physical examination, and 80.7% had a K/L grade <3. Effusion on physical examination was significantly associated with prevalent BMLs in the full cohort (odds ratio [OR] 6.10 [95% confidence interval (95% CI) 2.77-13.44]) and in the K/L grade <3 cohort (OR 6.88 [95% CI 2.76-17.15]). In the full cohort, sensitivity, specificity, PPV, and NPV were 34.6, 92.5, 79.9, and 62.1%, respectively, and in the K/L <3 cohort 31.7, 94.0, 75.5, and 70.1%, respectively. Longitudinally, effusion on physical examination was not significantly associated with BML incidence/progression in the full cohort (hazard ratio [HR] 1.83 [95% CI 0.95-3.52]) or in the K/L grade <3 cohort (HR 1.73 [95% CI 0.69-4.33]). In the two cohorts, sensitivity, specificity, PPV, and NPV were 32.0, 82.2, 42.2, and 74.9%, respectively, and 21.2, 85.6, 30.1, and 78.8% respectively. CONCLUSION BMLs on MRI can be predicted from physical examination effusion cross-sectionally, with a high PPV of 79.9%. Assessment for knee effusion on physical examination is useful for determining potential candidates with BMLs before costly MRI screening for recruitment into clinical trials.
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Affiliation(s)
- Jolanda Cibere
- Arthritis Research Canada, Richmond, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Ali Guermazi
- Boston University School of Medicine, Boston, Massachusetts
| | - Savvas Nicolaou
- the University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Esdaile
- Arthritis Research Canada, Richmond, and the University of British Columbia, Vancouver, British Columbia, and the University of Calgary, Calgary, Alberta, Canada
| | - Anona Thorne
- the University of British Columbia, Vancouver, British Columbia, Canada
| | - Joel Singer
- the University of British Columbia, Vancouver, British Columbia, Canada
| | - Hubert Wong
- the University of British Columbia, Vancouver, British Columbia, Canada
| | - Jacek A Kopec
- Arthritis Research Canada, Richmond, and the University of British Columbia, Vancouver, British Columbia, Canada
| | - Eric C Sayre
- Arthritis Research Canada, Richmond, British Columbia, Canada
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18
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Barber T, Sharif B, Teare S, Miller J, Shewchuk B, Green LA, Marlett N, Cibere J, Mrklas K, Wasylak T, Li LC, Campbell-Scherer D, Marshall DA. Qualitative study to elicit patients' and primary care physicians' perspectives on the use of a self-management mobile health application for knee osteoarthritis. BMJ Open 2019; 9:e024016. [PMID: 30782723 PMCID: PMC6361338 DOI: 10.1136/bmjopen-2018-024016] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
OBJECTIVE To elicit perspectives of family physicians and patients with knee osteoarthritis (KOA) on KOA, its treatment/management and the use of a mobile health application (app) to help patients self-manage their KOA. DESIGN A qualitative study using Cognitive Task Analysis for physician interviews and peer-to-peer semistructured interviews for patients according to the Patient and Community Engagement Research (PaCER) method. SETTING Primary care practices and patient researchers at an academic centre in Southern Alberta. PARTICIPANTS Intentional sampling of family physicians (n=4; 75% women) and patients with KOA who had taken part in previous PaCER studies and had experienced knee pain on most days of the month at any time in the past (n=5; 60% women). RESULTS Physician and patient views about KOA were starkly contrasting. Patient participants expressed that KOA seriously impacted their lives and lifestyles, and they wanted their knee pain to be considered as important as other health problems. In contrast, physicians uniformly conceptualised KOA as a relatively minor health problem, although they still recognised it as a painful condition that often limits patients' activities. Consequently, physicians did not regard KOA as a condition to be proactively and aggressively managed. The gap between physicians' and patients' conceptualisation of KOA and its treatment extended to the use of an app for self-management. While patients were supportive of the app, physicians were sceptical of its use and focused more on accountability and patient resources. CONCLUSIONS The clear discord between physicians' mental models and patients' lived experience and perceived needs around KOA emphasised a gap in understanding and communication about treatment and management of KOA. As such, this preliminary and formative research will inform a codesign approach to develop an app that will act as a communications tool between patients and physicians, enabling patient-physician discussions regarding modifiable self-management options based on a patient's perspectives and needs.
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Affiliation(s)
- Tanya Barber
- Enhancing Alberta Primary Care Research Networks (EnACt), Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Behnam Sharif
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Sylvia Teare
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Jean Miller
- O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Brittany Shewchuk
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lee A Green
- Enhancing Alberta Primary Care Research Networks (EnACt), Department of Family Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Family Medicine, Univeristy of Alberta, Edmonton, Alberta, Canada
| | - Nancy Marlett
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jolanda Cibere
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly Mrklas
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Strategic Clinical Networks, Research and Innovation Analytics, Alberta Health Services, Calgary, Alberta, Canada
| | - Tracy Wasylak
- Strategic Clinical Networks, Alberta Health Services, Edmonton, Alberta, Canada
| | - Linda C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
| | | | - Deborah A Marshall
- Department of Community Health Sciences, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada
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Kopec JA, Qian H, Cibere J, Wong H, Li LC, Barber M, Prlic HM, Zhang C, Ratzlaff C, Forster BB, Esdaile JM. Relationship Between Hip Morphology and Hip-Related Patient-Reported Outcomes in Young and Middle-Aged Individuals: A Population-Based Study. Arthritis Care Res (Hoboken) 2018; 71:1202-1208. [PMID: 30295424 PMCID: PMC6772056 DOI: 10.1002/acr.23774] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2018] [Accepted: 10/02/2018] [Indexed: 11/06/2022]
Abstract
Objective Radiographic measurements of the alpha angle and the lateral center edge (LCE) angle in the hip joint are important for the diagnosis of femoroacetabular syndrome, a potential risk factor for hip osteoarthritis. Our objective was to determine whether these measurements are associated with hip‐related patient‐reported outcomes in young and middle‐aged individuals. Methods A stratified random sample of white men and women ages 20–49 years, with and without hip pain, was selected using random digit dialing from the population of metro Vancouver, Canada. The alpha and LCE angles were measured bilaterally on radiographs using Dunn and anteroposterior views, respectively. Patient‐reported outcomes were measured by the Copenhagen Hip And Groin Outcome Score (HAGOS), which has scales for symptoms, pain, daily activities, sports, physical activity, and quality of life (QoL). We performed descriptive analyses and a regression analysis with restricted cubic splines, adjusted for age and sex and weighted for the sampling design. Results Data were obtained for 500 subjects. The alpha angle distribution was strongly skewed, with a mean of 54°. The LCE angle distribution was symmetric, with a mean of 34°. In the restricted cubic splines analysis, the relationship between the alpha angle and HAGOS scores was nonlinear, with higher alpha angles generally associated with worse HAGOS scores for alpha >60°. The associations were statistically significant for symptoms, sports, and QoL. No association was found between the LCE angle and HAGOS scales. Conclusion In a general population sample ages 20–49 years, we have found an association between the alpha angle and hip‐related patient‐reported outcomes.
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Affiliation(s)
- Jacek A Kopec
- University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Hong Qian
- St. Paul's Hospital, Vancouver, British Columbia, Canada
| | - Jolanda Cibere
- University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Hubert Wong
- University of British Columbia, Vancouver, British Columbia, Canada
| | - Linda C Li
- University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Morgan Barber
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Helen M Prlic
- Arthritis Research Canada, Richmond, British Columbia, Canada
| | | | | | - Bruce B Forster
- University of British Columbia, Vancouver, British Columbia, Canada
| | - John M Esdaile
- University of British Columbia, Vancouver, and Arthritis Research Canada, Richmond, British Columbia, Canada
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Chin C, Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Kopec J, Thorne A, Singer J, Wong H, Cibere J. Quadriceps Weakness and Risk of Knee Cartilage Loss Seen on Magnetic Resonance Imaging in a Population-based Cohort with Knee Pain. J Rheumatol 2018; 46:198-203. [PMID: 30275263 DOI: 10.3899/jrheum.170875] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/18/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE To determine whether baseline quadriceps weakness predicts cartilage loss assessed on magnetic resonance imaging (MRI). METHODS Subjects aged 40-79 with knee pain (n = 163) were recruited from a random population sample and examined for quadriceps weakness with manual isometric strength testing, using a 3-point scoring system (0 = poor resistance, 1 = moderate resistance, 2 = full resistance), which was dichotomized as normal (grade 2) versus weak (grade 0/1). MRI of the more symptomatic knee was obtained at baseline and at mean of 3.3 years. Cartilage was graded 0-4 on MRI. Exponential regression analysis was used to evaluate whether quadriceps weakness was associated with whole knee cartilage loss, and in secondary analyses with compartment-specific cartilage loss, adjusted for age, sex, body mass index, Western Ontario and McMaster Universities Osteoarthritis Arthritis Index pain score, and baseline MRI cartilage score. RESULTS Of 163 subjects, 54% were female, with a mean age of 57.7 years. Quadriceps weakness was seen in 11.9% of the subjects. Weakness was a predictor of whole knee cartilage loss (HR 3.48, 95% CI 1.30-9.35). Quadriceps weakness was associated with cartilage loss in the medial tibiofemoral (TF) compartment (HR 4.60, 95% CI 1.25-17.02), while no significant association was found with lateral TF (HR 1.53, 95% CI 0.24-9.78) or patellofemoral compartment (HR 2.76, 95% CI 0.46-16.44). CONCLUSION In this symptomatic, population-based cohort, quadriceps weakness predicted whole knee and medial TF cartilage loss after 3 years. To our knowledge, this is the first study to show that a simple clinical examination of quadriceps strength can predict the risk of knee cartilage loss.
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Affiliation(s)
- Carson Chin
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA. .,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada.
| | - Eric C Sayre
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Ali Guermazi
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Savvas Nicolaou
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - John M Esdaile
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Jacek Kopec
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Anona Thorne
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Joel Singer
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Hubert Wong
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
| | - Jolanda Cibere
- From the Department of Medicine, the Division of Rheumatology, the Department of Radiology and the School of Population and Public Health, University of British Columbia, Vancouver; Arthritis Research Canada, Vancouver; Canadian Institutes of Health Research HIV Trials Network, Vancouver; Centre for Health Evaluation and Outcomes Sciences, Vancouver, British Columbia, Canada; Department of Radiology, Boston University Medical Center, Boston, Massachusetts, USA.,C. Chin, MD, FRCPC, Division of Rheumatology, University of British Columbia; E.C. Sayre, PhD, Research Associate, Arthritis Research Canada; A. Guermazi, MD, Professor, Department of Radiology, Boston University Medical Center; S. Nicolaou, MD, Assistant Professor, Department of Radiology, University of British Columbia (UBC), Director of Emergency/Trauma Imaging, Vancouver General Hospital; H. Wong, PhD, Associate Professor, School of Population and Public Health, UBC, and Associate Head, Data and Methodology, CIHR Canadian HIV Trials Network; A. Thorne, MSc, Senior Biostatistician, CIHR Canadian HIV Trials Network, School of Population and Public Health, UBC; J. Singer, PhD, Professor, School of Population and Public Health, UBC, and Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, MSc, PhD, Associate Professor, School of Population and Public Health, UBC, and Research Scientist, Arthritis Research Canada; J.M. Esdaile, MD, MPH, Professor, Department of Medicine, UBC, and Scientific Director, Arthritis Research Canada; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, UBC, and Senior Research Scientist, Arthritis Research Canada
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Guo Y, Zhang H, Qian H, Wilson DR, Wong H, Barber M, Forster BB, Esdaile J, Cibere J. Association of Femoroacetabular Impingement and Delayed Gadolinium-Enhanced Magnetic Resonance Imaging of Cartilage: A Population-Based Study. Arthritis Care Res (Hoboken) 2018; 70:1160-1168. [DOI: 10.1002/acr.23463] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2017] [Accepted: 10/31/2017] [Indexed: 11/08/2022]
Affiliation(s)
- Yimeng Guo
- Arthritis Research Canada; Richmond British Columbia Canada
| | - Honglin Zhang
- University of British Columbia and Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Hong Qian
- St. Paul's Hospital; Vancouver British Columbia Canada
| | - David R. Wilson
- University of British Columbia and Vancouver Coastal Health Research Institute; Vancouver British Columbia Canada
| | - Hubert Wong
- University of British Columbia, St. Paul's Hospital, and Canadian HIV Trials Network; Vancouver British Columbia Canada
| | - Morgan Barber
- Arthritis Research Canada; Richmond British Columbia Canada
| | - Bruce B. Forster
- University of British Columbia, Vancouver Coastal Health Research Institute, and Providence Health Care; Vancouver British Columbia Canada
| | - John Esdaile
- Arthritis Research Canada, Richmond; and University of British Columbia, Vancouver, British Columbia; and University of Calgary; Calgary Alberta Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Richmond; and University of British Columbia; Vancouver British Columbia Canada
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Keng A, Sayre EC, Guermazi A, Nicolaou S, Esdaile JM, Thorne A, Singer J, Kopec JA, Cibere J. Association of body mass index with knee cartilage damage in an asymptomatic population-based study. BMC Musculoskelet Disord 2017; 18:517. [PMID: 29221481 PMCID: PMC5723095 DOI: 10.1186/s12891-017-1884-7] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 11/29/2017] [Indexed: 01/09/2023] Open
Abstract
Background Cartilage changes are an important early finding of osteoarthritis (OA), which can exist even before symptoms. Our objective was to determine the prevalence of knee cartilage damage on magnetic resonance imaging (MRI) in an asymptomatic population-based cross-sectional study and to evaluate the association of body mass index (BMI) with cartilage damage. Methods Subjects, aged 40-79 years, without knee pain (n = 73) were recruited as a random population sample and assessed for BMI (kg/m2), including current BMI (measured), past BMI at age 25 (self-reported) and change in BMI. Knee cartilage was scored semi-quantitatively (grades 0-4) on MRI. In primary analysis, cartilage damage was defined as ≥2 (at least moderate) and in a secondary analysis as ≥3 (severe). We also conducted a sensitivity analysis by dichotomizing current BMI as <25 vs. ≥25. Logistic regression was used to evaluate the association of each BMI variable with prevalent MRI-detected cartilage damage, adjusted for age and sex. Results Of 73 subjects, knee cartilage damage ≥2 and ≥3 was present in 65.4% and 28.7%, respectively. The median current BMI was 26.1, median past BMI 21.6, and median change in BMI was a gain of 2.8. For cartilage damage ≥2, current BMI had a non-statistically significant OR of 1.65 per 5 units (95% CI 0.93-2.92). For cartilage damage ≥3, current BMI showed a trend towards statistical significance with an OR of 1.70 per 5 units (95% CI 0.99-2.92). Past BMI and change in BMI were not significantly associated with cartilage damage. Current BMI ≥ 25 was statistically significantly associated with cartilage damage ≥2 (OR 3.04 (95% CI 1.10-8.42)), but not for ≥3 (OR 2.63 (95% CI 0.86-8.03)). Conclusions MRI-detected knee cartilage damage was highly prevalent in this asymptomatic population-based cohort. We report a trend towards significance of BMI with cartilage damage severity. Subjects with abnormal current BMI (≥25) had a 3-fold increased odds of cartilage damage ≥2, compared to those with normal BMI. This study lends support towards the role of obesity in the pathogenesis of knee cartilage damage at an asymptomatic stage of disease.
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Affiliation(s)
- Alvin Keng
- University of Toronto, Toronto, ON, Canada
| | - Eric C Sayre
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - Ali Guermazi
- Section of Musculoskeletal Imaging, Boston University Medical Center, Boston, MA, USA.,Boston University School of Medicine, Boston, MA, USA
| | - Savvakis Nicolaou
- Vancouver General Hospital, Vancouver, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - John M Esdaile
- Arthritis Research Centre of Canada, Richmond, BC, Canada.,Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Anona Thorne
- Canadian HIV Trials Network, Vancouver, BC, Canada
| | - Joel Singer
- Canadian HIV Trials Network, Vancouver, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jacek A Kopec
- Arthritis Research Centre of Canada, Richmond, BC, Canada.,School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Centre of Canada, Richmond, BC, Canada. .,Department of Medicine, University of British Columbia, Vancouver, BC, Canada. .,Arthritis Research Canada Milan Ilich Arthritis Research Centre, 5591 No. 3 Road, Richmond, BC, V6X2C7, Canada.
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Kopec JA, Cibere J, Li LC, Zhang C, Barber M, Qian H, Wong H, Steininger G, Prlic H, Simatovic J, Ratzlaff C, Sayre EC, Ye J, Forster BB, Esdaile JM. Relationship between physical activity and hip pain in persons with and without cam or pincer morphology: a population-based case-control study. Osteoarthritis Cartilage 2017; 25:1055-1061. [PMID: 28219714 DOI: 10.1016/j.joca.2017.02.795] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2016] [Revised: 02/08/2017] [Accepted: 02/14/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVES The purpose of the study was to determine if physical activity (PA) is a risk factor for persistent or recurrent hip pain in young and middle-aged persons with and without radiographic findings of cam or pincer morphology (CPM). METHODS A population sample of persons aged 20-49 with (cases) and without (controls) hip pain in Metro Vancouver, Canada, was selected through random digit dialing (RDD). Self-reported PA was expressed as average energy expenditure (MET-hours) per year, over lifetime. CPM was defined as alpha angle >55°, lateral centre edge angle (LCE) >40°, or positive cross-over sign. RESULTS Data were obtained for 500 subjects, 269 cases and 231 controls. Prevalence of radiographic CPM was 49% in the cases and 44% in the controls. In a logistic regression model adjusted for age, gender and CPM, total lifetime PA, including occupational, domestic and recreational activities, was significantly associated with hip pain (Odds ratio (OR) 1.30 per 1000 MET-hours, 95% CI 1.15-1.38). The effect of total PA was observed in those with CPM (1.44, 1.17-1.78) and without CPM (1.23, 1.04-1.45). For domestic activities, the association was seen only in those with CPM (significant interaction). When PA was categorized into quartiles, higher levels of PA were associated with a greater risk of pain. CONCLUSIONS PA, as measured by average energy expenditure over lifetime is a risk factor for hip pain in young and middle-aged persons. For some activities, the risk is likely increased in persons with radiographic evidence of CPM.
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Affiliation(s)
- J A Kopec
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada.
| | - J Cibere
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada
| | - L C Li
- Department of Physical Therapy, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada
| | - C Zhang
- Department of Family Medicine, University of Calgary, Calgary, AB, Canada
| | - M Barber
- Arthritis Research Canada, Richmond, BC, Canada
| | - H Qian
- Centre for Health Evaluation and Outcome Sciences, St. Paul's Hospital, Vancouver, BC, Canada
| | - H Wong
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | | | - H Prlic
- Arthritis Research Canada, Richmond, BC, Canada
| | | | - C Ratzlaff
- Arthritis Centre and College of Medicine, University of Arizona, Tucson, AZ, USA
| | - E C Sayre
- Arthritis Research Canada, Richmond, BC, Canada
| | - J Ye
- Arthritis Research Canada, Richmond, BC, Canada
| | - B B Forster
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
| | - J M Esdaile
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Canada, Richmond, BC, Canada
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Sayre EC, Guermazi A, Esdaile JM, Kopec JA, Singer J, Thorne A, Nicolaou S, Cibere J. Associations between MRI features versus knee pain severity and progression: Data from the Vancouver Longitudinal Study of Early Knee Osteoarthritis. PLoS One 2017; 12:e0176833. [PMID: 28472071 PMCID: PMC5417516 DOI: 10.1371/journal.pone.0176833] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2016] [Accepted: 04/18/2017] [Indexed: 01/22/2023] Open
Abstract
Objective To determine associations between features of osteoarthritis (OA) on MRI and knee pain severity and knee pain progression. Design Baseline, 3.3- and 7.5-year assessments were performed for 122 subjects with baseline knee pain (age 40–79), sample-weighted for population (with knee pain) representativeness. MRIs were scored for: osteophytes (0:absent to 3:large); cartilage (0:normal to 4:full thickness defect; 0/1 collapsed); subchondral sclerosis (0:none to 3:>50% of site), subchondral cyst (0:absent to 3:severe), bone marrow lesions (0:none to 3:≥50% of site); and meniscus (0:normal to 3:maceration/resection), in 6–8 regions each. Per feature, scores were averaged across regions. Effusion/synovitis (0:absent to 3:severe) was analyzed as ≥2 vs. <2. Linear models predicted WOMAC knee pain severity (0–100), and binary models predicted 10+ (minimum perceptible clinical improvement [MPCI]) and 20+ (minimum clinically important difference [MCID]) increases. Models were adjusted for age, sex, BMI (and follow-up time for longitudinal models). Results Pain severity was associated with osteophytes (7.17 per unit average; 95% CI = 3.19, 11.15) and subchondral sclerosis (11.03; 0.68, 21.39). MPCI-based pain increase was associated with osteophytes (odds ratio per unit average 3.20; 1.36, 7.55), subchondral sclerosis (5.69; 1.06, 30.44), meniscal damage (1.68; 1.08, 2.61) and effusion/synovitis ≥2 (2.25; 1.07, 4.71). MCID-based pain increase was associated with osteophytes (3.79; 1.41, 10.20) and cartilage defects (2.42; 1.24, 4.74). Conclusions Of the features investigated, only osteophytes were consistently associated with pain cross-sectionally and longitudinally in all models. This suggests an important role of bone in early knee osteoarthritis.
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Affiliation(s)
- Eric C. Sayre
- Arthritis Research Canada, Richmond, BC, Canada
- * E-mail:
| | - Ali Guermazi
- Radiology, Boston University School of Medicine, Boston, MA, United States of America
| | - John M. Esdaile
- Arthritis Research Canada, Richmond, BC, Canada
- Medicine, University of British Columbia, Vancouver, BC, Canada
- Medicine, University of Calgary, Calgary, AB, Canada
- School of Medicine, University of Queensland, Brisbane St. Lucia, QLD, Australia
| | - Jacek A. Kopec
- Arthritis Research Canada, Richmond, BC, Canada
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Joel Singer
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Anona Thorne
- School of Population & Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Savvas Nicolaou
- Radiology, University of British Columbia, Vancouver, BC, Canada
| | - Jolanda Cibere
- Arthritis Research Canada, Richmond, BC, Canada
- Medicine, University of British Columbia, Vancouver, BC, Canada
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Poole AR, Ha N, Bourdon S, Sayre EC, Guermazi A, Cibere J. Ability of a Urine Assay of Type II Collagen Cleavage by Collagenases to Detect Early Onset and Progression of Articular Cartilage Degeneration: Results from a Population-based Cohort Study. J Rheumatol 2016; 43:1864-1870. [PMID: 27481905 DOI: 10.3899/jrheum.150917] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2016] [Indexed: 11/22/2022]
Abstract
OBJECTIVE To evaluate the association of a sandwich assay for cartilage collagenase-mediated degradation, the C2C human urine sandwich assay (IB-C2C-HUSA), with early and late knee cartilage pathology and with progression of cartilage damage. METHODS A population-based cohort with knee pain, age 40-79 years, was evaluated at baseline (n = 253) and after mean 3.3 years (n = 161). We evaluated the IB-C2C-HUSA and a related competitive inhibition assay (C2C). The C2C assay was applied to serum (sC2C) and urine (uC2C). Based on knee radiographs and magnetic resonance imaging (MRI), 3 subgroups [no cartilage pathology, preradiographic cartilage pathology, and radiographic osteoarthritis (ROA)] were evaluated cross-sectionally for association with biomarker levels. Longitudinally, we evaluated whether baseline assays predict subsequent progression of cartilage degeneration, defined by MRI cartilage loss. RESULTS Cross-sectionally, statistically significant differences were seen in the 3 subgroups for IB-C2C-HUSA (p < 0.001), with the highest levels seen in ROA, and for sC2C (p = 0.023), while no differences were seen for uC2C (p = 0.501). Baseline IB-C2C-HUSA levels were higher in progressors vs nonprogressors (p = 0.003). In logistic regression analysis, only baseline IB-C2C-HUSA was associated with an increased risk of progression of cartilage damage (OR 1.78, 95% CI 1.03-3.09). CONCLUSION The IB-C2C-HUSA degradation assay detects the generation of a pathology-related cartilage collagen peptide(s) that increase(s) with onset of degeneration of knee articular cartilage. The baseline values are associated with progression of cartilage degeneration over 3 subsequent years. This assay may have value in clinical OA trials. Further, it points to collagenase activity as a therapeutic target for controlling degeneration of articular cartilage.
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Affiliation(s)
- A Robin Poole
- From the Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec; R&D Diagnostics, IBEX Pharmaceuticals, Montreal, Quebec; Arthritis Research Canada, Richmond, British Columbia, Canada; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.A.R. Poole, PhD, DSc, Professor Emeritus, Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University; N. Ha, PhD, Manager, R&D Diagnostics, IBEX Pharmaceuticals, currently affiliated with Beckman Coulter, Miami, Florida, USA; S. Bourdon, BSc, Manager, Assay Production, IBEX Pharmaceuticals; E.C. Sayre, PhD, Statistical Analyst, Arthritis Research Canada; A. Guermazi, MD, PhD, Professor, Department of Radiology, Boston University School of Medicine; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada
| | - Nhuan Ha
- From the Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec; R&D Diagnostics, IBEX Pharmaceuticals, Montreal, Quebec; Arthritis Research Canada, Richmond, British Columbia, Canada; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.A.R. Poole, PhD, DSc, Professor Emeritus, Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University; N. Ha, PhD, Manager, R&D Diagnostics, IBEX Pharmaceuticals, currently affiliated with Beckman Coulter, Miami, Florida, USA; S. Bourdon, BSc, Manager, Assay Production, IBEX Pharmaceuticals; E.C. Sayre, PhD, Statistical Analyst, Arthritis Research Canada; A. Guermazi, MD, PhD, Professor, Department of Radiology, Boston University School of Medicine; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada
| | - Suzanne Bourdon
- From the Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec; R&D Diagnostics, IBEX Pharmaceuticals, Montreal, Quebec; Arthritis Research Canada, Richmond, British Columbia, Canada; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.A.R. Poole, PhD, DSc, Professor Emeritus, Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University; N. Ha, PhD, Manager, R&D Diagnostics, IBEX Pharmaceuticals, currently affiliated with Beckman Coulter, Miami, Florida, USA; S. Bourdon, BSc, Manager, Assay Production, IBEX Pharmaceuticals; E.C. Sayre, PhD, Statistical Analyst, Arthritis Research Canada; A. Guermazi, MD, PhD, Professor, Department of Radiology, Boston University School of Medicine; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada
| | - Eric C Sayre
- From the Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec; R&D Diagnostics, IBEX Pharmaceuticals, Montreal, Quebec; Arthritis Research Canada, Richmond, British Columbia, Canada; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.A.R. Poole, PhD, DSc, Professor Emeritus, Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University; N. Ha, PhD, Manager, R&D Diagnostics, IBEX Pharmaceuticals, currently affiliated with Beckman Coulter, Miami, Florida, USA; S. Bourdon, BSc, Manager, Assay Production, IBEX Pharmaceuticals; E.C. Sayre, PhD, Statistical Analyst, Arthritis Research Canada; A. Guermazi, MD, PhD, Professor, Department of Radiology, Boston University School of Medicine; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada
| | - Ali Guermazi
- From the Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec; R&D Diagnostics, IBEX Pharmaceuticals, Montreal, Quebec; Arthritis Research Canada, Richmond, British Columbia, Canada; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.A.R. Poole, PhD, DSc, Professor Emeritus, Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University; N. Ha, PhD, Manager, R&D Diagnostics, IBEX Pharmaceuticals, currently affiliated with Beckman Coulter, Miami, Florida, USA; S. Bourdon, BSc, Manager, Assay Production, IBEX Pharmaceuticals; E.C. Sayre, PhD, Statistical Analyst, Arthritis Research Canada; A. Guermazi, MD, PhD, Professor, Department of Radiology, Boston University School of Medicine; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada
| | - Jolanda Cibere
- From the Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University, Montreal, Quebec; R&D Diagnostics, IBEX Pharmaceuticals, Montreal, Quebec; Arthritis Research Canada, Richmond, British Columbia, Canada; Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.A.R. Poole, PhD, DSc, Professor Emeritus, Division of Orthopedics, Department of Surgery, Faculty of Medicine, McGill University; N. Ha, PhD, Manager, R&D Diagnostics, IBEX Pharmaceuticals, currently affiliated with Beckman Coulter, Miami, Florida, USA; S. Bourdon, BSc, Manager, Assay Production, IBEX Pharmaceuticals; E.C. Sayre, PhD, Statistical Analyst, Arthritis Research Canada; A. Guermazi, MD, PhD, Professor, Department of Radiology, Boston University School of Medicine; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia, and Senior Scientist, Arthritis Research Canada.
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Kopec J, Sayre E, Cibere J, Li L, Bansback N, Wong H, Rahman M, Esdaile J. SAT0424 Trends in Osteoarthritis Incidence in British Columbia, Canada, 2001-2012: Table 1. Ann Rheum Dis 2016. [DOI: 10.1136/annrheumdis-2016-eular.3304] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Abstract
OBJECTIVES To study the effects of several survey features on response rates in a general population health survey. METHODS In 2012 and 2013, 8000 households in British Columbia, Canada, were randomly allocated to 1 of 7 survey variants, each containing a different combination of survey features. Features compared included administration modes (paper vs online), prepaid incentive ($2 coin vs none), lottery incentive (instant vs end-of-study), questionnaire length (10 minutes vs 30 minutes), and sampling frame (InfoCanada vs Canada Post). RESULTS The overall response rate across the 7 groups was 27.9% (range = 17.1-43.4). All survey features except the sampling frame were associated with statistically significant differences in response rates. The survey mode elicited the largest effect on the odds of response (odds ratio [OR] = 2.04; 95% confidence interval [CI] = 1.61, 2.59), whereas the sampling frame showed the least effect (OR = 1.14; 95% CI = 0.98, 1.34). The highest response was achieved by mailing a short paper survey with a prepaid incentive. CONCLUSIONS In a mailed general population health survey in Canada, a 40% to 50% response rate can be expected. Questionnaire administration mode, survey length, and type of incentive affect response rates.
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Affiliation(s)
- Yimeng Guo
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Jacek A Kopec
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Jolanda Cibere
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Linda C Li
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
| | - Charles H Goldsmith
- At the time of the study, Yimeng (Jimmy) Guo was with the University of British Columbia and Arthritis Research Canada, Vancouver, BC. Jacek A. Kopec is with the Arthritis Research Canada and the Division of Epidemiology, Biostatistics, and Public Health Practice, School of Population and Public Health at the University of British Columbia, Vancouver. Jolanda Cibere is with Arthritis Research Canada and the Department of Medicine at the University of British Columbia. Linda C. Li is with Arthritis Research Canada and the Department of Physical Therapy at the University of British Columbia. Charles H. Goldsmith is with the Faculty of Health Science at Simon Fraser University, Vancouver
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Hung A, Sayre EC, Guermazi A, Esdaile JM, Kopec JA, Thorne A, Singer J, Wong H, Nicolaou S, Cibere J. Association of Body Mass Index With Incidence and Progression of Knee Effusion on Magnetic Resonance Imaging and on Knee Examination. Arthritis Care Res (Hoboken) 2016; 68:511-6. [DOI: 10.1002/acr.22714] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 07/22/2015] [Accepted: 08/18/2015] [Indexed: 01/15/2023]
Affiliation(s)
- Amy Hung
- University of British Columbia; Vancouver British Columbia Canada
| | - Eric C. Sayre
- Arthritis Research Canada; Vancouver British Columbia Canada
| | | | - John M. Esdaile
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Jacek A. Kopec
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
| | - Anona Thorne
- University of British Columbia and CIHR Canadian HIV Trials Network; Vancouver British Columbia Canada
| | - Joel Singer
- University of British Columbia and Centre for Health Evaluation and Outcome Sciences; Vancouver British Columbia Canada
| | - Hubert Wong
- University of British Columbia and CIHR Canadian HIV Trials Network; Vancouver British Columbia Canada
| | - Savvas Nicolaou
- University of British Columbia and Vancouver General Hospital
| | - Jolanda Cibere
- University of British Columbia and Arthritis Research Canada; Vancouver British Columbia Canada
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Zhang C, Li L, Forster BB, Kopec JA, Ratzlaff C, Halai L, Cibere J, Esdaile JM. Femoroacetabular impingement and osteoarthritis of the hip. Can Fam Physician 2015; 61:1055-1060. [PMID: 26668284 PMCID: PMC4677941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE To outline the clinical presentation, physical examination findings, diagnostic criteria, and management options of femoroacetabular impingement (FAI). SOURCES OF INFORMATION PubMed was searched for relevant articles regarding the pathogenesis, diagnosis, treatment, and prognosis of FAI. MAIN MESSAGE In recent years, FAI has been increasingly recognized as a potential precursor and an important contributor to hip pain in the adult population and idiopathic hip osteoarthritis later in life. Femoroacetabular impingement is a collection of bony morphologic abnormalities of the hip joint that result in abnormal contact during motion. Cam-type FAI relates to a non-spherical osseous prominence of the proximal femoral neck or head-neck junction. Pincer-type FAI relates to excessive acetabular coverage over the femoral head, which can occur owing to several morphologic variants. Patients with FAI present with chronic, deep, or aching anterior groin pain most commonly in the sitting position, or during or after activity. Patients might also experience occasional sharp pains during activity. A thorough history should be taken that includes incidence of trauma and exercise frequency. A physical examination should be performed that includes a full hip, low back, and abdominal examination to assess for alternate causes of anterior groin pain. Diagnosis of FAI should be confirmed with radiography. Femoroacetabular impingement can be managed conservatively with rest, modification of activities, medications, and physiotherapy, or it can be treated surgically. CONCLUSION Femoroacetabular impingement is an important cause of anterior groin pain. Early recognition and intervention by the primary care provider might be critical to alleviating morbidity and preventing FAI progression.
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Cibere J. THU0475 Factors Associated with Care Seeking in a Population-Based Cohort with Knee Pain. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.5360] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Kopec J, Li L, Zhang C, Barber M, Qian H, Wong H, Prlic H, Ratzlaff C, Cibere J, Sayre E, Ye J, Forster B, Esdaile J. OP0051 Relationship Between Physical Activity and Hip Pain in Persons with and Without Femoroacetabular Impingement: A Population-Based Case-Control Study. Ann Rheum Dis 2015. [DOI: 10.1136/annrheumdis-2015-eular.2053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Marra CA, Grubisic M, Cibere J, Grindrod KA, Woolcott JC, Gastonguay L, Esdaile JM. Cost-utility analysis of a multidisciplinary strategy to manage osteoarthritis of the knee: economic evaluation of a cluster randomized controlled trial study. Arthritis Care Res (Hoboken) 2014; 66:810-6. [PMID: 24249680 DOI: 10.1002/acr.22232] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2013] [Accepted: 11/05/2013] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To determine if a pharmacist-initiated multidisciplinary strategy provides value for money compared to usual care in participants with previously undiagnosed knee osteoarthritis. METHODS Pharmacies were randomly allocated to provide either 1) usual care and a pamphlet or 2) intervention care, which consisted of education, pain medication management by a pharmacist, physiotherapy-guided exercise, and communication with the primary care physician. Costs and quality-adjusted life-years (QALYs) were determined for patients assigned to each treatment and incremental cost-effectiveness ratios (ICERs) were determined. RESULTS From the Ministry of Health perspective, the average patient in the intervention group generated slightly higher costs compared with usual care. Similar findings were obtained when using the societal perspective. The intervention resulted in ICERs of $232 (95% confidence interval [95% CI] -1,530, 2,154) per QALY gained from the Ministry of Health perspective and $14,395 (95% CI 7,826, 23,132) per QALY gained from the societal perspective, compared with usual care. CONCLUSION A pharmacist-initiated, multidisciplinary program was good value for money from both the societal and Ministry of Health perspectives.
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Affiliation(s)
- Carlo A Marra
- University of British Columbia and Providence Health Care Institute, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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Kopec J, Heath A, Sayre E, Cibere J, Li L, Marra C, Liu R, Esdaile J. THU0219 Prevalence of Joint Pain and Self-Reported Osteoarthritis in British Columbia, Canada. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.2300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Cibere J, Kopec J, Wong H, Singer J, Esdaile J, Nicolaou S, Guermazi A. THU0224 Knee Effusion is A Risk Factor for Prevalence and Progression of Bone Marrow Lesions: A Population-Based Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.4840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Li L, Kopec J, Wong H, Qian H, Cibere J, Sayre E, Zhang C, Barber M, Ye J, Prlic H, Esdaile J. FRI0207 Prevalence of Femoroacetabular Impingement in Caucasians Compared to Chinese in Vancouver, Canada: A Population-Based Study. Ann Rheum Dis 2014. [DOI: 10.1136/annrheumdis-2014-eular.3947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
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Rahman MM, Cibere J, Goldsmith CH, Anis AH, Kopec JA. Osteoarthritis incidence and trends in administrative health records from British Columbia, Canada. J Rheumatol 2014; 41:1147-54. [PMID: 24737915 DOI: 10.3899/jrheum.131011] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To calculate the incidence rates of osteoarthritis (OA) and to describe the changes in incidence using 18 years of administrative health records. METHODS We analyzed visits to health professionals and hospital admission records in a random sample (n = 640,000) from British Columbia, Canada, from 1991/1992 through 2008/2009. OA was defined in 2 ways: (1) at least 1 physician diagnosis or 1 hospital admission; and (2) at least 2 physician diagnoses in 2 years or 1 hospital admission. Crude and age-standardized rates were calculated, and the annual relative changes were estimated from the Poisson regression models. RESULTS In 2008/2009, the overall crude incidence rate (95% CI) of OA using definition 1 was 14.6 (14.0-14.8); [12.5 (12.0-13.0) among men and 16.3 (15.8-16.8) among women] per 1000 person-years. The rates were lower by about 44% under definition 2. For the period 2000/2001-2008/2009, crude incidence rates based on definition 1 varied from 11.8 to 14.2 per 1000 person-years for men, and from 15.7 to 18.5 for women. Annually, on average, crude rates rose by about 2.5-3.3% for both men and women. The age-adjusted rates increased by 0.6-0.8% among men and showed no trend among women. CONCLUSION Our study generated updated incidence rates of administrative OA for the Province of British Columbia. Physician-diagnosed overall incidence rates of OA varied with the case definitions used; however, trends were similar in both case definitions. Age-adjusted rates among men increased slightly during the period 2000/2001-2008/2009. These findings have implications for projecting future prevalence and costs of OA.
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Affiliation(s)
- M Mushfiqur Rahman
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia.
| | - Jolanda Cibere
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
| | - Charlie H Goldsmith
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
| | - Aslam H Anis
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
| | - Jacek A Kopec
- From the School of Population and Public Health, and the Department of Medicine, University of British Columbia, Vancouver; Department of Health Sciences, Simon Fraser University, Burnaby; Arthritis Research Centre of Canada, Richmond; Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada.M.M. Rahman, MSc, PhD candidate, School of Population and Public Health, University of British Columbia; J. Cibere, MD, PhD, Associate Professor, Department of Medicine, University of British Columbia; C.H. Goldsmith, PhD, Professor, Health Sciences, Simon Fraser University; A.H. Anis, PhD, Professor, School of Population and Public Health, University of British Columbia, and Director, Centre for Health Evaluation and Outcome Sciences; J.A. Kopec, MD, PhD, Professor, School of Population and Public Health, University of British Columbia
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Crema MD, Cibere J, Sayre EC, Roemer FW, Wong H, Thorne A, Singer J, Esdaile JM, Marra MD, Kopec JA, Nicolaou S, Guermazi A. The relationship between subchondral sclerosis detected with MRI and cartilage loss in a cohort of subjects with knee pain: the knee osteoarthritis progression (KOAP) study. Osteoarthritis Cartilage 2014; 22:540-6. [PMID: 24508776 DOI: 10.1016/j.joca.2014.01.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2013] [Revised: 12/27/2013] [Accepted: 01/25/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the association between subchondral sclerosis detected at baseline with MRI and cartilage loss over time in the same region of the knee in a cohort of subjects with knee pain. METHODS 163 subjects with knee pain participated in a longitudinal study to assess knee osteoarthritis progression (KOAP). Subjects received baseline knee radiographs as well as baseline and 3-year follow-up MRI examinations. Baseline subchondral sclerosis and bone marrow lesions (BMLs) were scored semiquantitatively on MRI in each region from 0 to 3. Cartilage morphology at baseline and follow-up was scored semiquantitatively from 0 to 4. The association between baseline subchondral sclerosis and cartilage loss in the same region of the knee was evaluated using logistic regression, adjusting the results for age, gender, body mass index, and the presence of concomitant BMLs. RESULTS The prevalence of subchondral sclerosis detected by MRI in the regions of the knee varied between 1.6% (trochlea) and 17% (medial tibia). The occurrence of cartilage loss over time in regions varied between 6% (lateral tibia) and 13.1% (medial femur). The prevalence of radiographically-detected subchondral sclerosis in compartments varied from 2.9% (patellofemoral) to 14.2% (medial tibiofemoral). In logistic regression models, there were no significant associations between baseline subchondral sclerosis detected by MRI and cartilage loss in the same region of the knee. CONCLUSION Baseline subchondral sclerosis as detected by MRI did not increase the risk of cartilage loss over time.
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Affiliation(s)
- M D Crema
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, Hospital do Coração (HCor) and Teleimagem, Sao Paulo, Brazil.
| | - J Cibere
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada; Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - E C Sayre
- Arthritis Research Centre of Canada, Richmond, BC, Canada
| | - F W Roemer
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA; Department of Radiology, University of Erlangen, Erlangen, Germany
| | - H Wong
- Arthritis Research Centre of Canada, Richmond, BC, Canada; School of Population of Public Health, University of British Columbia, Vancouver, BC, Canada
| | - A Thorne
- School of Population of Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J Singer
- School of Population of Public Health, University of British Columbia, Vancouver, BC, Canada
| | - J M Esdaile
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - M D Marra
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
| | - J A Kopec
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - S Nicolaou
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - A Guermazi
- Department of Radiology, Quantitative Imaging Center, Boston University School of Medicine, Boston, MA, USA
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Rahman MM, Kopec JA, Anis AH, Cibere J, Goldsmith CH. Risk of cardiovascular disease in patients with osteoarthritis: a prospective longitudinal study. Arthritis Care Res (Hoboken) 2014; 65:1951-8. [PMID: 23925995 DOI: 10.1002/acr.22092] [Citation(s) in RCA: 76] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 07/17/2013] [Indexed: 01/15/2023]
Abstract
OBJECTIVE To determine the risk of cardiovascular disease (CVD) among osteoarthritis (OA) patients using population-based administrative data from British Columbia, Canada. METHODS The medical history of a random sample of 600,000 individuals from 1991-2009 was analyzed. A total of 12,745 OA cases and up to 3 non-OA individuals matched by age, sex, and year of diagnosis were followed for CVD events. Cox proportional hazards and Poisson regression models were used to estimate the relative risks (RRs) of CVD, myocardial infarction, ischemic heart disease (IHD), congestive heart failure (CHF), and stroke after adjusting for available sociodemographic and medical factors. RESULTS OA was an independent predictor of CVD. The adjusted RRs were 1.15 (95% confidence interval [95% CI] 1.04-1.27), 1.26 (95% CI 1.13-1.42), and 1.17 (95% CI 1.07-1.26) among older men, younger women, and older women, respectively. Analyses were stratified by age and sex due to statistically significant interactions between OA and age and sex. RRs among older men, younger women, and older women were 1.33 (95% CI 1.11-1.62), 1.66 (95% CI 1.37-2.01), and 1.45 (95% CI 1.22-1.72) for IHD, respectively, and 1.25 (95% CI 1.02-1.54), 1.29 (95% CI 1.00-1.68), and 1.20 (95% CI 1.03-1.39) for CHF, respectively. Compared to non-OA individuals, OA cases who underwent total joint replacements had a 26% increased risk of CVD. CONCLUSION This prospective longitudinal study suggests that OA is associated with an increased risk of CVD. Older men and adult women with OA had a higher risk of CVD, particularly IHD and CHF. Further studies are needed to confirm these results and to elucidate the potential biologic mechanisms.
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Affiliation(s)
- M Mushfiqur Rahman
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada
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Ezzat AM, Cibere J, Koehoorn M, Li LC. Association between cumulative joint loading from occupational activities and knee osteoarthritis. Arthritis Care Res (Hoboken) 2013; 65:1634-42. [PMID: 23609965 DOI: 10.1002/acr.22033] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 04/11/2013] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To determine the associations between cumulative occupational physical load (COPL) and 3 definitions of knee osteoarthritis (OA). METHODS Cross-sectional analyses were performed from 2 population-based cohorts (n = 327). Eligible symptomatic participants were those with pain, aching, or discomfort in or around the knee on most days of a month at any time in the past and any pain in the past 12 months. Asymptomatic participants responded "no" to both knee pain questions. Self-reported COPL was calculated over each participant's lifetime and then categorized into quarters (QCOPL). Radiographic OA (ROA) and symptomatic OA (SOA) were defined by Kellgren/Lawrence grade ≥2, with SOA also including pain. Magnetic resonance imaging (MRI) OA was defined using criteria by Hunter et al. Logistic regression, adjusted with population weights, examined the associations between QCOPL and each of ROA, SOA, and MRI-OA after controlling for covariates and two-way interactions. RESULTS Participants had a mean ± SD age of 58.5 ± 11.0 years and a mean ± SD body mass index of 26.3 ± 4.7 kg/m(2) . Of those, 109 (33.3%) had ROA, 102 (31.2%) had SOA, and 131 (40.1%) had MRI-OA. Compared with QCOPL-1, increased odds of ROA were found for QCOPL-4 (odds ratio [OR] 3.15, 95% confidence interval [95% CI] 1.02-9.70) and QCOPL-3 (OR 4.19, 95% CI 1.55-11.34). Statistically significant relationships were found in SOA (QCOPL-4: OR 8.16, 95% CI 1.89-35.27; QCOPL-3: OR 5.73, 95% CI 1.36-24.12) and MRI-OA (QCOPL-4: OR 9.54, 95% CI 2.65-34.27; QCOPL-3: OR 9.04, 95% CI 2.65-30.88; QCOPL-2: OR 7.18, 95% CI 2.17-23.70). CONCLUSION Occupational activity is associated with knee OA, with dose-response relationships observed in SOA and MRI-OA.
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Affiliation(s)
- Allison M Ezzat
- School of Population and Public Health, University of British Columbia, Vancouver, British Columbia, Canada
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Maksymowych WP, Cibere J, Loeuille D, Weber U, Zubler V, Roemer FW, Jaremko JL, Sayre EC, Lambert RG. Preliminary Validation of 2 Magnetic Resonance Image Scoring Systems for Osteoarthritis of the Hip According to the OMERACT Filter. J Rheumatol 2013; 41:370-8. [DOI: 10.3899/jrheum.131083] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Objective.Development of a validated magnetic resonance image (MRI) scoring system is essential in hip OA because radiographs are insensitive to change. We assessed the feasibility and reliability of 2 previously developed scoring methods: (1) the Hip Inflammation MRI Scoring System (HIMRISS) and (2) the Hip Osteoarthritis MRI Scoring System (HOAMS).Methods.Six readers (3 radiologists, 3 rheumatologists) participated in 2 reading exercises. In Reading Exercise 1, MRI of the hip of 20 subjects were read at a single time point followed by further standardization of methodology. In Reading Exercise 2, MRI of the hip of 18 subjects from a randomized controlled trial, assessed at 2 timepoints, and 27 subjects from a cross-sectional study were read for HIMRISS and HOAMS bone marrow lesions (BML) and synovitis. Reliability was assessed using intraclass correlation coefficient (ICC) and kappa statistics.Results.Both methods were considered feasible. For Reading 1, HIMRISS ICC were 0.52, 0.61, 0.70, and 0.58 for femoral BML, acetabular BML, effusion, and total scores, respectively; and for HOAMS, summed BML and synovitis ICC were 0.52 and 0.46, respectively. For Reading 2, HIMRISS and HOAMS ICC for BML and synovitis-effusion improved substantially. Interobserver reliability for change scores was 0.81 and 0.71 for HIMRISS femoral and HOAMS summed BML, respectively. Responsiveness and discrimination was moderate to high for synovitis-effusion. Significant associations were noted between BML or synovitis scores and Western Ontario and McMaster Universities Osteoarthritis Index pain scores for baseline values (p ≤ 0.001).Conclusion.The BML and synovitis-effusion components of both HIMRISS and HOAMS scoring systems are feasible and reliable, and should be validated further.
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Jaremko JL, Lambert RGW, Zubler V, Weber U, Loeuille D, Roemer FW, Cibere J, Pianta M, Gracey D, Conaghan P, Ostergaard M, Maksymowych WP. Methodologies for semiquantitative evaluation of hip osteoarthritis by magnetic resonance imaging: approaches based on the whole organ and focused on active lesions. J Rheumatol 2013; 41:359-69. [PMID: 24241486 DOI: 10.3899/jrheum.131082] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE As a wider variety of therapeutic options for osteoarthritis (OA) becomes available, there is an increasing need to objectively evaluate disease severity on magnetic resonance imaging (MRI). This is more technically challenging at the hip than at the knee, and as a result, few systematic scoring systems exist. The OMERACT (Outcome Measures in Rheumatology) filter of truth, discrimination, and feasibility can be used to validate image-based scoring systems. Our objective was (1) to review the imaging features relevant to the assessment of severity and progression of hip OA; and (2) to review currently used methods to grade these features in existing hip OA scoring systems. METHODS A systematic literature review was conducted. MEDLINE keyword search was performed for features of arthropathy (such as hip + bone marrow edema or lesion, synovitis, cyst, effusion, cartilage, etc.) and scoring system (hip + OA + MRI + score or grade), with a secondary manual search for additional references in the retrieved publications. RESULTS Findings relevant to the severity of hip OA include imaging markers associated with inflammation (bone marrow lesion, synovitis, effusion), structural damage (cartilage loss, osteophytes, subchondral cysts, labral tears), and predisposing geometric factors (hip dysplasia, femoral-acetabular impingement). Two approaches to the semiquantitative assessment of hip OA are represented by Hip OA MRI Scoring System (HOAMS), a comprehensive whole organ assessment of nearly all findings, and the Hip Inflammation MRI Scoring System (HIMRISS), which selectively scores only active lesions (bone marrow lesion, synovitis/effusion). Validation is presently confined to limited assessment of reliability. CONCLUSION Two methods for semiquantitative assessment of hip OA on MRI have been described and validation according to the OMERACT Filter is limited to evaluation of reliability.
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Affiliation(s)
- Jacob L Jaremko
- From the Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, Alberta, Canada; Department of Radiology and Department of Rheumatology, Balgrist University Hospital, Zurich, Switzerland; Department of Medicine, CHU de NANCY-Brabois, Vandoeuvre, France; Department of Radiology, Klinikum Augsburg, Augsburg, Germany; Quantitative Imaging Center (QIC), Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA; Department of Medicine, University of British Columbia and Research Scientist, Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada; St. Vincent's Hospital, Victoria, Australia; Radiology Department, Craigavon Area Hospital, Southern Health and Social Care Trust, Portadown, Northern Ireland; National Institute for Health Research (NIHR) Leeds Musculoskeletal Biomedical Research Unit, Chapel Allerton Hospital, Leeds, UK; Department of Rheumatology, Copenhagen University Hospital at Glostrup, Copenhagen, Denmark; Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
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Davis EM, Lynd LD, Grubisic M, Kopec JA, Sayre EC, Cibere J, Esdaile J, Marra CA. Responsiveness of health state utility values in knee osteoarthritis. J Rheumatol 2013; 40:2075-82. [PMID: 24187098 DOI: 10.3899/jrheum.130176] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVE Adaptive tests are increasingly being used to assess health-related quality of life in patients with a variety of medical conditions, including osteoarthritis (OA) of the knee. This approach has recently been used to assess health state utility valuations (HSUV) for use in quality-adjusted life-year calculations. To accurately assess incremental value for money, these tools must be responsive. Therefore, we examined the responsiveness of the Health Utilities Index mark 3 (HUI3) and Paper Adaptive Test-5D (PAT-5DQOL) in a group of patients with knee OA. METHODS We used patient-level data from a randomized controlled trial evaluating a pharmacist-initiated multidisciplinary intervention in newly diagnosed patients with knee OA. The mean change for utility scores from baseline to 6 months was calculated, as well as effect size (ES) and standardized response mean (SRM) for the HUI3 and PAT-5DQOL, and generalized additive model plots, using the Western Ontario and McMaster Osteoarthritis index as a reference standard. RESULTS When patients were assessed based on whether their condition had improved, remained unchanged, or worsened over time, the PAT-5DQOL showed greater responsiveness in patients whose condition had either improved or worsened. ES and SRM were generally small for both instruments. CONCLUSION The PAT-5DQOL is more responsive to change over time than the HUI3 in patients with knee OA.
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Affiliation(s)
- Erin M Davis
- From the School of Pharmacy, Memorial University, St. John's, Newfoundland and Labrador; Collaboration for Outcomes Research and Evaluation (CORE), and School of Population and Public Health, University of British Columbia, Arthritis Research Centre, and Centre for Health Evaluation and Outcome Sciences, Providence Health Care Research Institute, Vancouver, British Columbia, Canada
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Sayre EC, Singer J, Thorne A, Wong H, Kopec JA, Esdaile JM, Guermazi A, Nicolaou S, Cibere J. Does moderate or severe nonspecific knee injury affect radiographic osteoarthritis incidence and progression? BMC Musculoskelet Disord 2013; 14:309. [PMID: 24164716 PMCID: PMC4231427 DOI: 10.1186/1471-2474-14-309] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Accepted: 10/22/2013] [Indexed: 11/16/2022] Open
Abstract
Background Knee injuries can lead to radiographic osteoarthritis (ROA). Injuries may be “specific” (SI) including ligament or meniscal tears or patellar trauma, or “nonspecific” (NSI). Our objective is to understand the effect of knee NSI on ROA incidence and progression. Methods 163 people (sample-weighted for population representativeness) aged 40+ with history of knee pain had radiographs assessed on Kellgren Lawrence (KL) grade (0/1 collapsed) at baseline and follow-up (median 3.2 years apart). Progression was an increase in KL score. SIs and NSIs were labeled “severe” (walking aid for ≥1 week) or “moderate”. One model treated SI and NSI as dichotomous (yes/no), and another as trichotomous (none/moderate/severe). Models were adjusted for age, sex, BMI, KL grade and follow-up time. Results SI/NSI history was none, moderate (7.8/24.4%) or severe (11.0/10.8%). Duration at baseline since SI/NSI ranged from <1 year to several decades (SI/NSI mean 4.6/6.5 years). SI was significantly associated with ROA incidence and progression (odds ratio (OR) = 2.90; 95% CI = 1.04, 8.09), but NSI showed no significant effect (OR = 1.36; 95% CI = 0.61, 3.02). In the trichotomous model, severe SI was significant (OR = 4.35, 95% CI = 1.26, 15.02), while moderate SI was not (OR = 1.51, 95% CI = 0.33, 6.84). NSI showed no effect: moderate OR = 1.51, 95% CI = 0.61, 3.74; severe OR = 0.90, 95% CI = 0.24, 3.40. This study had 80% power to detect an NSI OR of 2.9. Conclusion We find no evidence that history of NSI affects knee ROA incidence and progression in a population with knee pain, adjusting for SI, age, sex, BMI, KL grade and follow-up time.
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Affiliation(s)
- Eric C Sayre
- Arthritis Research Centre of Canada, 5591 No, 3 Rd, Richmond, BC, V6X 2C7, Canada.
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Kopec JA, Sayre EC, Schwartz TA, Renner JB, Helmick CG, Badley EM, Cibere J, Callahan LF, Jordan JM. Occurrence of radiographic osteoarthritis of the knee and hip among African Americans and whites: a population-based prospective cohort study. Arthritis Care Res (Hoboken) 2013; 65:928-35. [PMID: 23281251 DOI: 10.1002/acr.21924] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2012] [Accepted: 11/27/2012] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the incidence and progression of radiographic osteoarthritis (OA) in the knee and hip among African Americans and whites. METHODS Using the joint as the unit of analysis, we analyzed data from the Johnston County Osteoarthritis Project, a population-based prospective cohort study in rural North Carolina. Baseline and followup assessments were 3-13 years apart. Assessments included standard knee and hip radiographs read for Kellgren/Lawrence (K/L) radiographic grade. Weighted analyses controlled for age, sex, body mass index, level of education, and baseline K/L grade; bootstrap methods adjusted for lack of independence between left and right joints. Time-to-event analysis was used to analyze the data. RESULTS For radiographic knee OA, being African American had no association with incidence (adjusted hazard ratio [HRadj ] 0.80, 95% confidence interval [95% CI] 0.53-1.22), but had a positive association with progression (HRadj 1.67, 95% CI 1.05-2.67). For radiographic hip OA, African Americans had a significantly lower incidence (HRadj 0.44, 95% CI 0.27-0.71), whereas the association with progression was positive but nonsignificant (HRadj 1.46, 95% CI 0.53-4.01). In sensitivity analyses, the association with hip OA incidence was robust to a wide range of assumptions. CONCLUSION African Americans are protected against incident hip OA, but may be more susceptible to progressive knee OA.
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Affiliation(s)
- Jacek A Kopec
- University of British Columbia, Vancouver, and Arthritis Research Centre of Canada, Richmond, British Columbia, Canada.
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Hemmati I, Sayre EC, Guermazi A, Nicolaou S, Kopec JA, Thorne A, Singer J, Cibere J. SAT0331 Comparison of Anatomic Knee Alignment on Physical Examination and Radiographs. Ann Rheum Dis 2013. [DOI: 10.1136/annrheumdis-2013-eular.2056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Rahman MM, Kopec JA, Cibere J, Goldsmith CH, Anis AH. The relationship between osteoarthritis and cardiovascular disease in a population health survey: a cross-sectional study. BMJ Open 2013; 3:bmjopen-2013-002624. [PMID: 23674445 PMCID: PMC3657665 DOI: 10.1136/bmjopen-2013-002624] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
OBJECTIVES Our objective was to determine the relationship between osteoarthritis (OA) and heart diseases (myocardial infarction (MI), angina, congestive heart failure (CHF)) and stroke using population-based survey data. DESIGN Cross-sectional study. SETTING Canadian Community Health Survey (CCHS). PARTICIPANTS Adult participants in the CCHS cycles 1.1, 2.1 and 3.1 were included. CCHS provides nationally representative data on health determinants, health status and health system utilisation. We have identified 40 817 self-reported OA subjects and selected 1:1 matched non-OA respondents by age, sex and CCHS cycles. MAIN OUTCOME MEASURES Self-reported heart disease was the primary outcome and MI, angina, CHF and stroke were considered as secondary outcomes. Multivariable logistic regression models were used to estimate the ORs after adjusting for sociodemographic status, obesity, physical activity, smoking status, fruit and vegetable consumption, medication use, diabetes, hypertension and chronic obstructive pulmonary disease. RESULTS The mean age of OA cases was 66 years and 71.6% were women. OA exhibited increased odds of prevalent heart disease, and adjusted overall OR (95% CI) was 1.45 (1.36 to 1.54), 1.35 (1.21 to 1.50) among men and 1.51 (1.39 to 1.64) among women with OA. OA showed increased ORs for angina and CHF in both men and women, and for MI in women. ORs (95% CI) for men and women, respectively, were 1.08 (0.91 to 1.28) and 1.49 (1.28 to 1.75) for MI, 1.76 (1.43 to 2.17) and 1.84 (1.59 to 2.14) for angina, 1.50 (1.13 to 1.97) and 1.81 (1.49 to 2.21) for CHF, and 1.08 (0.83 to 1.40) and 1.13 (0.93 to 1.37) for stroke. CONCLUSIONS Prevalent OA was associated with self-reported heart disease, particularly angina, and CHF in both men and women, after controlling for established risk factors for these conditions. This study provides a rationale for further investigation of the association between OA and heart disease in longitudinal studies for investigating possible biological and behavioural mechanisms.
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Affiliation(s)
- M Mushfiqur Rahman
- School of Population and Public Health, University of British Columbia Vancouver, British Columbia, Canada
- Arthritis Research Centre of Canada, Richmond, British Columbia, Vancouver, Canada
| | - Jacek A Kopec
- School of Population and Public Health, University of British Columbia Vancouver, British Columbia, Canada
- Arthritis Research Centre of Canada, Richmond, British Columbia, Vancouver, Canada
| | - Jolanda Cibere
- Arthritis Research Centre of Canada, Richmond, British Columbia, Vancouver, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - Charlie H Goldsmith
- Arthritis Research Centre of Canada, Richmond, British Columbia, Vancouver, Canada
- Department of Health Sciences, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Aslam H Anis
- School of Population and Public Health, University of British Columbia Vancouver, British Columbia, Canada
- Centre for Health Evaluation and Outcome Sciences, Vancouver, British Columbia, Canada
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Li LC, Lineker S, Cibere J, Crooks VA, Jones CA, Kopec JA, Lear SA, Pencharz J, Rhodes RE, Esdaile JM. Capitalizing on the teachable moment: osteoarthritis physical activity and exercise net for improving physical activity in early knee osteoarthritis. JMIR Res Protoc 2013; 2:e17. [PMID: 23659903 PMCID: PMC3650932 DOI: 10.2196/resprot.2553] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/27/2013] [Accepted: 04/11/2013] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Practice guidelines emphasize the use of exercise and weight reduction as the first line of management for knee osteoarthritis (OA). However, less than half of the people with mild OA participate in moderate intensity physical activity. Given that physical activities have been shown to reduce pain, improve quality of life, and have the potential to reduce the progression of joint damage, many people with OA are missing the benefits of this inexpensive intervention. OBJECTIVE The objectives of this study are (1) to develop a behavioral theory-informed Internet intervention called Osteoarthritis Physical Activity & Exercise Net (OPEN) for people with previously undiagnosed knee OA, and (2) to assess the efficacy of the OPEN website for improving physical activity participation through a proof-of-concept study. METHODS OPEN was developed based on the theory of planned behavior. Efficacy of this online intervention is being assessed by an ongoing proof-of-concept, single-blind randomized controlled trial in British Columbia, Canada. We are currently recruiting participants and plan to recruit a total of 252 sedentary people with previously undiagnosed knee OA using a set of validated criteria. Half of the participants will be randomized to use OPEN and receive an OA education pamphlet. The other half only will receive the pamphlet. Participants will complete an online questionnaire at baseline, 3 months, and 6 months about their participation in physical activities, health-related quality of life, and motivational outcomes. In addition, we will perform an aerobic fitness test in a sub-sample of participants (n=20 per study arm). In the primary analysis, we will use logistic regression to compare the proportion of participants reporting being physically active at or above the recommended level in the 2 groups, adjusting for baseline measurement, age, and sex. RESULTS This study evaluates a theory-informed behavioral intervention at a time when people affected with OA tend to be more motivated to adopt an active lifestyle (ie, at the early stage of OA). Our approach, which consisted of the identification of early knee OA followed immediately by an online intervention that directly targets physical inactivity, can be easily implemented across communities. CONCLUSIONS Our online intervention directly targets physical inactivity at a time when the joint damage tends to be mild. If OPEN is found to be effective in changing long-term physical activity behaviors, it opens further opportunities to promote early diagnosis and to implement lifestyle interventions. TRIAL REGISTRATION Clinicaltrial.gov: NCT01608282; http://clinicaltrials.gov/ct2/show/NCT01608282 (Archived by WebCite at http://www.webcitation.org/6G7sBBayI).
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Affiliation(s)
- Linda C Li
- Arthritis Research Centre of Canada, Richmond, BC, Canada.
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Ratzlaff C, Simatovic J, Wong H, Li L, Ezzat A, Langford D, Esdaile JM, Kennedy C, Embley P, Caves D, Hopkins T, Cibere J. Reliability of hip examination tests for femoroacetabular impingement. Arthritis Care Res (Hoboken) 2013; 65:1690-6. [PMID: 23609994 DOI: 10.1002/acr.22036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Accepted: 04/12/2013] [Indexed: 11/10/2022]
Abstract
OBJECTIVE To assess the interrater reliability of hip examination tests used to assess femoroacetabular impingement (FAI) among clinicians from different disciplines. METHODS Twelve subjects were examined by 9 clinicians using 12 hip tests drawn from a review of the literature and consultation with experts in hip pain and FAI. Examiners assessed both hips of each subject and were blinded to subject history. The order in which subjects were seen, the order of tests, and order of examination of the 2 hips within each subject were all randomized. Interrater reliability (IRR) for the 10 categorical tests was summarized using overall raw agreement (ORA), positive agreement (agreement on abnormal findings), and negative agreement (agreement on normal findings). An ORA of >0.75 was considered to indicate adequate reliability. For the 2 range of motion (ROM) outcomes, IRR was summarized using the median of the absolute difference (MAD) in measurements obtained by any 2 examiners on any patient. MAD reflects the "typical" difference (in degrees) between 2 raters. RESULTS Adequate reliability (ORA >0.75) was achieved for 6 of the 10 hip examination tests with categorical outcomes. Positive agreement ranged from 0.35 to 0.84, while negative agreement ranged from 0.62 to 0.99. For the ROM outcomes, examiners were, on average, within 5° of each other for flexion and 7° for internal rotation. CONCLUSION The results provide evidence that the most common hip examination tests would likely be sufficiently reliable to allow agreement between examiners when discriminating between painful FAI and normal hips in a clinical setting.
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Affiliation(s)
- Charles Ratzlaff
- Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts; Arthritis Research Centre of Canada, Vancouver, British Columbia, Canada
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Hunt MA, Pollock CL, Kraus VB, Saxne T, Peters S, Huebner JL, Sayre EC, Cibere J. Relationships amongst osteoarthritis biomarkers, dynamic knee joint load, and exercise: results from a randomized controlled pilot study. BMC Musculoskelet Disord 2013; 14:115. [PMID: 23530976 PMCID: PMC3623736 DOI: 10.1186/1471-2474-14-115] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2012] [Accepted: 03/14/2013] [Indexed: 12/03/2022] Open
Abstract
Background Little is known about the relationships of circulating levels of biomarkers of cartilage degradation with biomechanical outcomes relevant to knee osteoarthritis (OA) or biomarker changes following non-pharmacological interventions. The objectives of this exploratory, pilot study were to: 1) examine relationships between biomarkers of articular cartilage degradation and synthesis with measures of knee joint load during walking, and 2) examine changes in these biomarkers following 10 weeks of strengthening exercises. Methods Seventeen (8 male, 9 female; 66.1 +/- 11.3 years of age) individuals with radiographically-confirmed medial tibiofemoral OA participated. All participants underwent a baseline testing session where serum and urine samples were collected, followed by a three-dimensional motion analysis. Motion analysis was used to calculate the external knee adduction moment (KAM) peak value and impulse. Following baseline testing, participants were randomized to either 10 weeks of: 1) physiotherapist-supervised lower limb muscle strengthening exercises, or 2) no exercises (control). Identical follow-up testing was conducted 11 weeks after baseline. Biomarkers included: urinary C-telopeptide of type II collagen (uCTX-II) and type II collagen cleavage neoepitope (uC2C), serum cartilage oligomeric matrix protein (sCOMP), serum hyaluronic acid (sHA) and serum C-propeptide of type II procollagen (sCPII). Linear regression analysis was used to examine relationships between measures of the KAM and biomarker concentrations as baseline, as well as between-group differences following the intervention. Results KAM impulse predicted significant variation in uCTX-II levels at baseline (p = 0.04), though not when controlling for disease severity and walking speed (p = 0.33). KAM impulse explained significant variation in the ratio uCTX-II;sCPII even when controlling for additional variables (p = 0.04). Following the intervention, changes in sCOMP were significantly greater in the exercise group compared to controls (p = 0.04). On average those in the control group experienced a slight increase in sCOMP and uCTX-II, while those in the exercise group experienced a reduction. No other significant findings were observed. Conclusions This research provides initial evidence of a potential relationship between uCTX-II and knee joint load measures in patients with medial tibiofemoral knee OA. However, this relationship became non-significant after controlling for disease severity and walking speed, suggesting further research is necessary. It also appears that sCOMP is amenable to change following a strengthening intervention, suggesting a potential beneficial role of exercise on cartilage structure. Trial registration Clinicaltrials.gov NCT01241812
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Affiliation(s)
- Michael A Hunt
- Department of Physical Therapy, University of British Columbia, BC, Vancouver, Canada.
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50
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Marra CA, Cibere J, Grubisic M, Grindrod KA, Gastonguay L, Thomas JM, Embley P, Colley L, Tsuyuki RT, Khan KM, Esdaile JM. Pharmacist-initiated intervention trial in osteoarthritis: a multidisciplinary intervention for knee osteoarthritis. Arthritis Care Res (Hoboken) 2013; 64:1837-45. [PMID: 22930542 DOI: 10.1002/acr.21763] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2011] [Accepted: 06/07/2012] [Indexed: 01/23/2023]
Abstract
OBJECTIVE Knee osteoarthritis (OA) is a commonly undiagnosed condition and care is often not provided. Pharmacists are uniquely placed for launching a multidisciplinary intervention for knee OA. METHODS We performed a cluster randomized controlled trial with pharmacies providing either intervention care or usual care (14 and 18 pharmacies, respectively). The intervention included a validated knee OA screening questionnaire, education, pain medication management, physiotherapy-guided exercise, and communication with the primary care physician. Usual care consisted of an educational pamphlet. The primary outcome was the pass rate on the Arthritis Foundation's quality indicators for OA. Secondary outcomes included the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), the Lower Extremity Function Scale (LEFS), the Paper Adaptive Test-5D (PAT-5D), and the Health Utilities Index Mark 3 (HUI3). RESULTS One hundred thirty-nine patients were assigned to the control (n = 66) and intervention (n = 73) groups. There were no differences between the groups in baseline measures. The overall quality indicator pass rate was significantly higher in the intervention arm compared to the control arm (difference of 45.2%; 95% confidence interval 34.5, 55.9). Significant improvements were observed for the intervention care group as compared to the usual care group in the WOMAC global, pain, and function scores at 3 and 6 months (all P < 0.01); the PAT-5D daily activity scores at 3 and 6 months (both P < 0.05); the PAT-5D pain scores at 6 months (P = 0.05); the HUI3 single-attribute pain scores at 3 and 6 months (all P < 0.05); and the LEFS scores at 6 months (P < 0.05). CONCLUSION Pharmacists can launch a multidisciplinary intervention to identify knee OA cases, improve the utilization of treatments, and improve function, pain, and quality of life.
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Affiliation(s)
- Carlo A Marra
- University of British Columbia and Providence Health Care Research Institute, Vancouver, British Columbia, Canada.
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