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Uchio Y, Ishijima M, Ikeuchi M, Ikegawa S, Ishibashi Y, Omori G, Shiba N, Takeuchi R, Tanaka S, Tsumura H, Deie M, Tohyama H, Yoshimura N, Nakashima Y. Japanese Orthopaedic Association (JOA) clinical practice guidelines on the management of Osteoarthritis of the knee - Secondary publication. J Orthop Sci 2025; 30:185-257. [PMID: 39127581 DOI: 10.1016/j.jos.2024.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 06/28/2024] [Indexed: 08/12/2024]
Affiliation(s)
- Yuji Uchio
- Department of Orthopaedic Surgery, Shimane University, Izumo, Japan.
| | | | - Masahiko Ikeuchi
- Department of Orthopaedic Surgery, Kochi University, Nankoku, Japan
| | - Shiro Ikegawa
- Laboratory for Bone and Joint Diseases, Center for Integrated Medical Science (IMS), RIKEN, Tokyo, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Japan
| | - Go Omori
- Department of Health and Sports, Niigata University of Health and Welfare, Niigata, Japan
| | - Naoto Shiba
- Department of Orthopaedics, Kurume University School of Medicine, Fukuoka, Japan
| | - Ryohei Takeuchi
- Department of Joint Surgery Center, Yokohama Sekishinkai Hospital, Yokohama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, University of Tokyo, Tokyo, Japan
| | - Hiroshi Tsumura
- Department of Orthopaedic Surgery, Oita University, Oita, Japan
| | - Masataka Deie
- Department of Orthopaedic Surgery, Aichi Medical University, Nagakute, Japan
| | | | - Noriko Yoshimura
- Department of Preventive Medicine for Locomotive Organ Disorders, 22nd Century Medical and Research Center, University of Tokyo, Tokyo, Japan
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Kao PE, Ker A. Risk of all-cause mortality in patients with knee osteoarthritis: A systematic review and meta-analysis of cohort studies. OSTEOARTHRITIS AND CARTILAGE OPEN 2025; 7:100541. [PMID: 39640421 PMCID: PMC11616512 DOI: 10.1016/j.ocarto.2024.100541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2024] [Accepted: 10/31/2024] [Indexed: 12/07/2024] Open
Abstract
Objective This systematic review and meta-analysis aimed to evaluate the risk of all-cause mortality in patients with knee osteoarthritis (OA). Design Comprehensive searches were conducted in PubMed, Embase, and the Cochrane Library on September 01, 2024. The review included cohort studies reporting risk estimates of all-cause mortality in knee OA patients compared to those without knee OA. Using a random-effects model, the pooled hazard ratios (HRs) were calculated. Subgroup analyses were performed according to the classification of knee OA, including radiographic knee OA only, symptomatic knee OA only, and radiographic and symptomatic knee OA. Results A total of 15 cohort studies involving 1,023,799 participants were included in the systematic review, with 14 studies remaining for the meta-analysis. The meta-analysis revealed that knee OA patients had an increased risk of all-cause mortality compared to those without knee OA (pooled HR: 1.21; 95% confidence interval [CI]: 1.02, 1.45). Subgroup analyses indicated the mixed results, including radiographic knee OA only (pooled HR: 1.11; 95% CI: 0.97, 1.26), symptomatic knee OA only (pooled HR: 1.07; 95% CI: 0.80, 1.43), and radiographic and symptomatic knee OA (pooled HR: 1.58; 95% CI: 1.20, 2.07). Conclusions This meta-analysis supports an association between knee OA and an increased risk of all-cause mortality, with a particularly pronounced risk observed in radiographic and symptomatic knee OA patients. Further research is needed to determine if OA at other sites also correlates with a higher risk of all-cause mortality.
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Affiliation(s)
- Pei-En Kao
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Amy Ker
- Department of Medical Education, Kaohsiung Chang Gung Memorial Hospital, Kaohsiung 833401, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
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Hansen L, Rogoschin J, Komnik I, Potthast W. Muscle Synergies in Patients with Medial Knee Osteoarthritis During Level-, Ramp- and Stair Locomotion. J Mot Behav 2024; 57:142-152. [PMID: 39626885 DOI: 10.1080/00222895.2024.2435829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2024] [Revised: 11/05/2024] [Accepted: 11/25/2024] [Indexed: 02/25/2025]
Abstract
Knee osteoarthritis (KOA) is a prevalent and severe condition with versatile effects on human locomotion, including alterations in neuromuscular control. Muscle synergies are understood as functional low-dimensional building blocks within the neuromuscular organization. To examine alterations in muscle synergy patterns during locomotion tasks in the presence of KOA, 40 participants, including 20 with medial KOA (KL-Score ≥ 2), performed level walking, as well as ramp and stair ascent and descent trials at self-selected speeds. Sixteen-Channel bilateral surface electromyography (sEMG) and marker-based motion capture data were collected. Non-negative matrix factorization (NNMF) was applied to the sEMG data for muscle synergy extraction. During level walking and descending conditions, structural changes in muscle synergy composition were observed in the KOA affected limb when compared to the unaffected side and control group. Alterations included fewer, merged synergies with prolonged activation coefficients and a higher percentage of unclassifiable synergies. No major alterations were observed during ascending conditions. No significant differences in gait speed and stride length were observed. These results indicate that muscle synergy composition can be altered in the presence of KOA regardless of age and gait speed, but not during all forms of locomotion.
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Affiliation(s)
- Lasse Hansen
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Jana Rogoschin
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Igor Komnik
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
| | - Wolfgang Potthast
- Institute of Biomechanics and Orthopaedics, German Sport University Cologne, Cologne, Germany
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Kim W, Park YC, Goo B, Kim JH, Nam D, Kim E, Lee HJ, Pyun DH, Suh HS, Lee Y, Kim MS, Seo BK, Baek YH. Efficacy, Safety, and Economic Feasibility of Dokhwalgisaeng-Tang for Degenerative Knee Osteoarthritis: Protocol for a Multicenter, Randomized, Assessor Blinded, Controlled Trial. J Pain Res 2024; 17:3501-3510. [PMID: 39493931 PMCID: PMC11529369 DOI: 10.2147/jpr.s487089] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2024] [Accepted: 10/21/2024] [Indexed: 11/05/2024] Open
Abstract
Purpose Knee osteoarthritis (KOA) is one of the most prevalent degenerative joint diseases worldwide. The herbal decoction, Dokhwalgisaeng-tang (DHGST), has been commonly used in East Asia to treat osteoarthritis. However, there is insufficient evidence to draw clear conclusions concerning its effectiveness and safety for patients with KOA. We aim to determine the efficacy, safety, and economic feasibility of DHGST compared with Celecoxib, an oral COX-2 inhibitor, for patients with degenerative KOA. Trial Design and Methods This multicenter, randomized, noninferiority trial, involving 160 participants who will be randomized using block randomization with 1:1 allocation, will compare DHGST and Celecoxib. The total trial period is 24 weeks after random allocation, comprising 12 weeks of treatment and 12 weeks of follow-up. Participants with KOA will be administered 200 mg of DHGST (treatment group) or Celecoxib capsules (control group) for 12 weeks. Efficacy and safety evaluations will be conducted at weeks 0, 4, 8, and 12, and 24. The primary outcome measurement is the Korean Western Ontario McMaster score at week 12. Changes in pain intensity using a 100 mm visual analog scale, changes in quality of life using a EuroQol 5-dimension 5-level self-report survey, and patient satisfaction will also be measured to evaluate effectiveness between the two groups. A trial-based economic feasibility evaluation will be conducted to analyze treatment cost-effectiveness from societal and healthcare system perspectives. Drug safety will be assessed through adverse reactions and laboratory test findings. Discussion This trial protocol has the following limitations. Applying a double-dummy design is not possible, as the tablet and granule forms can easily be distinguished visually, and achieving participant blinding is challenging. The trial findings are intended to inform participants, physicians, and other stakeholders in determining whether DHGST could be used as an alternative therapeutic option for KOA. Trial Registration Number KCT0008424 (Clinical Research Information Service of the Republic of Korea), registered on 12 May 2023.
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Affiliation(s)
- Wonnam Kim
- Division of Pharmacology, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
| | - Yeon-Cheol Park
- Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Bonhyuk Goo
- Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Jung-Hyun Kim
- Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
| | - Dongwoo Nam
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
- Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Medical Center, Seoul, Republic of Korea
| | - Eunseok Kim
- Division of Clinical Medicine, School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea
- Department of Acupuncture and Moxibustion Medicine, Pusan National University Korean Medicine Hospital, Yangsan, Republic of Korea
| | - Hyun-Jong Lee
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Daegu Haany University, Daegu, Republic of Korea
| | - Dong-Hyun Pyun
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation Through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
| | - Hae Sun Suh
- Department of Regulatory Science, Graduate School, Kyung Hee University, Seoul, Republic of Korea
- Institute of Regulatory Innovation Through Science (IRIS), Kyung Hee University, Seoul, Republic of Korea
- College of Pharmacy, Kyung Hee University, Seoul, Republic of Korea
| | - Yoonsung Lee
- Clinical Research Institute, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Man S Kim
- Clinical Research Institute, Kyung Hee University Hospital at Gangdong, School of Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Byung-Kwan Seo
- Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
| | - Yong-Hyeon Baek
- Department of Acupuncture & Moxibustion, Kyung Hee University College of Korean Medicine, Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea
- Department of Acupuncture & Moxibustion, College of Korean Medicine, Kyung Hee University, Seoul, Republic of Korea
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Mahendrakar P, Kumar D, Patil U. Comprehensive Study on Scoring and Grading Systems for Predicting the Severity of Knee Osteoarthritis. Curr Rheumatol Rev 2024; 20:133-156. [PMID: 37828677 DOI: 10.2174/0115733971253574231002074759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 10/14/2023]
Abstract
Knee Osteoarthritis (KOA) is a degenerative joint ailment characterized by cartilage loss, which can be seen using imaging modalities and converted into imaging features. The older population is the most affected by knee OA, which affects 16% of people worldwide who are 15 years of age and older. Due to cartilage tissue degradation, primary knee OA develops in older people. In contrast, joint overuse or trauma in younger people can cause secondary knee OA. Early identification of knee OA, according to research, may be a successful management tactic for the condition. Scoring scales and grading systems are important tools for the management of knee osteoarthritis as they allow clinicians to measure the progression of the disease's severity and provide suggestions on suitable treatment at identified stages. The comprehensive study reviews various subjective and objective knee evaluation scoring systems that effectively score and grade the KOA based on where defects or changes in articular cartilage occur. Recent studies reveal that AI-based approaches, such as that of DenseNet, integrating the concept of deep learning for scoring and grading the KOA, outperform various state-of-the-art methods in order to predict the KOA at an early stage.
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Affiliation(s)
- Pavan Mahendrakar
- Department of Computer Science and Engineering, B.L.D.E.A's V.P.Dr.P.G. Halakatti College of Engineering and Technology, Vijayapur, Karnataka, India
| | - Dileep Kumar
- Department of Computer Science and Engineering, Scientific Collaborations for Developing Markets United Imaging Healthcare, Shanghai, China
| | - Uttam Patil
- Jain College of Engineering, T.S Nagar, Hunchanhatti Road, Machhe, Belagavi, Karnataka, India
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Abstract
PURPOSE OF REVIEW Imaging plays a pivotal role for diagnosis, follow-up and stratification of osteoarthritis patients in clinical trials and research. We aim to present an overview of currently available and emerging imaging techniques for osteoarthritis assessment and provide insight into relevant benefits and pitfalls of the different modalities. RECENT FINDINGS Although radiography is considered sufficient for a structural diagnosis of osteoarthritis and is commonly used to define eligibility of patients for participation in clinical trials, it has inherent limitations based on the projectional nature of the technique and inherent challenges regarding reproducibility in longitudinal assessment. MRI has changed our understanding of the disease from 'wear and tear' of cartilage to a whole organ disorder. MRI assessment of structural changes of osteoarthritis includes semi-quantitative, quantitative and compositional evaluation. Ultrasound is helpful in evaluating the degree of synovitis and has value in the assessment particularly of the patella-femoral joint. Recent development of computed tomography technology including weight-bearing systems has led to broader application of this technology in a research context. SUMMARY Advances in MRI technology have resulted in a significant improvement in understanding osteoarthritis as a multitissue disease.
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Affiliation(s)
- Majid Chalian
- Department of Radiology, University of Washington, Seattle, Washington, USA
| | - Frank W Roemer
- Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg and Universitätsklinikum Erlangen, Erlangen, Germany
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine
- Department of Radiology, VA Boston Healthcare System, Boston, Massachusetts, USA
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Arnold JB, Bowen CJ, Chapman LS, Gates LS, Golightly YM, Halstead J, Hannan MT, Menz HB, Munteanu SE, Paterson KL, Roddy E, Siddle HJ, Thomas MJ. International Foot and Ankle Osteoarthritis Consortium review and research agenda for diagnosis, epidemiology, burden, outcome assessment and treatment. Osteoarthritis Cartilage 2022; 30:945-955. [PMID: 35176480 PMCID: PMC10464637 DOI: 10.1016/j.joca.2022.02.603] [Citation(s) in RCA: 27] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To summarise the available evidence relating to the diagnosis, epidemiology, burden, outcome assessment and treatment of foot and ankle osteoarthritis (OA) and to develop an agenda to guide future research. METHOD Members of the International Foot and Ankle Osteoarthritis Consortium compiled a narrative summary of the literature which formed the basis of an interactive discussion at the Osteoarthritis Research Society International World Congress in 2021, during which a list of 24 research agenda items were generated. Following the meeting, delegates were asked to rank the research agenda items on a 0 to 100 visual analogue rating scale (0 = not at all important to 100 = extremely important). Items scoring a mean of 70 or above were selected for inclusion. RESULTS Of the 45 delegates who attended the meeting, 31 contributed to the agenda item scoring. Nineteen research agenda items met the required threshold: three related to diagnosis, four to epidemiology, four to burden, three to outcome assessment and five to treatment. CONCLUSIONS Key knowledge gaps related to foot and ankle OA were identified, and a comprehensive agenda to guide future research planning was developed. Implementation of this agenda will assist in improving the understanding and clinical management of this common and disabling, yet relatively overlooked condition.
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Affiliation(s)
- J B Arnold
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, South Australia, 5000, Australia
| | - C J Bowen
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - L S Chapman
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - L S Gates
- School of Health Sciences, University of Southampton, Building 67, University Road, Southampton, SO17 1BJ, UK; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Southampton, Southampton, SO17 1BJ, UK
| | - Y M Golightly
- Department of Epidemiology, Gillings School of Global Public Health, Thurston Arthritis Research Center, University of North Carolina at Chapel Hill, 3330 Thurston Building, CB 7280, Chapel Hill, NC 27599, USA
| | - J Halstead
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK; Podiatry Services, Leeds Community Healthcare NHS Trust, Leeds, LS6 1PF, UK
| | - M T Hannan
- Hinda and Arthur Marcus Institute for Aging Research, Hebrew SeniorLife, Beth Israel Deaconess Medical Center, And Harvard Medical School, Boston, MA, 02108, USA
| | - H B Menz
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia; Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK.
| | - S E Munteanu
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, 3086, Australia
| | - K L Paterson
- Centre for Health, Exercise and Sports Medicine, School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Melbourne, Victoria, 3010, Australia
| | - E Roddy
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
| | - H J Siddle
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, LS2 9JT, UK
| | - M J Thomas
- Primary Care Centre Versus Arthritis, School of Medicine, Keele University, Keele, Staffordshire, ST5 5BG, UK; Haywood Academic Rheumatology Centre, Midlands Partnership NHS Foundation Trust, Haywood Hospital, Burslem, Staffordshire, ST6 7AG, UK
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Roemer FW, Guermazi A, Demehri S, Wirth W, Kijowski R. Imaging in Osteoarthritis. Osteoarthritis Cartilage 2022; 30:913-934. [PMID: 34560261 DOI: 10.1016/j.joca.2021.04.018] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 04/22/2021] [Accepted: 04/28/2021] [Indexed: 02/02/2023]
Abstract
Osteoarthritis (OA) is the most frequent form of arthritis with major implications on both individual and public health care levels. The field of joint imaging, and particularly magnetic resonance imaging (MRI), has evolved rapidly due to the application of technical advances to the field of clinical research. This narrative review will provide an introduction to the different aspects of OA imaging aimed at an audience of scientists, clinicians, students, industry employees, and others who are interested in OA but who do not necessarily focus on OA. The current role of radiography and recent advances in measuring joint space width will be discussed. The status of cartilage morphology assessment and evaluation of cartilage biochemical composition will be presented. Advances in quantitative three-dimensional morphologic cartilage assessment and semi-quantitative whole-organ assessment of OA will be reviewed. Although MRI has evolved as the most important imaging method used in OA research, other modalities such as ultrasound, computed tomography, and metabolic imaging play a complementary role and will also be discussed.
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Affiliation(s)
- F W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, Friedrich-Alexander University Erlangen-Nürnberg (FAU) and Universitätsklinikum Erlangen, Maximiliansplatz 3, Erlangen, 91054, Germany.
| | - A Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, FGH Building, 3rd Floor, 820 Harrison Ave, Boston, MA, 02118, USA; Department of Radiology, VA Boston Healthcare System, 1400 VFW Pkwy, Suite 1B105, West Roxbury, MA, 02132, USA
| | - S Demehri
- Russell H. Morgan Department of Radiology and Radiological Science, Johns Hopkins University School of Medicine, 600 N. Wolf Street, Park 311, Baltimore, MD, 21287, USA
| | - W Wirth
- Institute of Anatomy, Paracelsus Medical University Salzburg, Salzburg, Austria, Nüremberg, Germany; Ludwig Boltzmann Institute for Arthritis and Rehabilitation, Paracelsus Medical University Salzburg, Strubergasse 21, 5020, Salzburg, Austria; Chondrometrics, GmbH, Freilassing, Germany
| | - R Kijowski
- Department of Radiology, New York University Grossmann School of Medicine, 550 1st Avenue, 3nd Floor, New York, NY, 10016, USA
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Khalil NFW, El-sherif S, El Hamid MMA, Elnemr R, Taleb RSZ. Role of global femoral cartilage in assessing severity of primary knee osteoarthritis. EGYPTIAN RHEUMATOLOGY AND REHABILITATION 2022. [DOI: 10.1186/s43166-022-00115-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background/objective
Osteoarthritis is a degenerative joint disease marked by structural changes in the joint. Radiological evaluation can be used to assess structural changes. Pain, inflammation, and stiffness are common clinical symptoms, leading to limitations in daily activities. Ultrasound, unlike traditional radiography, allows for a direct examination of changes in soft tissues. In addition, it is sensitive in detecting osteophytes as well as identifying early OA changes in femoral cartilage associated with clinical manifestations and function.
Results
A cross- sectional study of 40 patients with primary KOA diagnosed according to the American College of Rheumatology (ACR) criteria. After radiographic evaluation using Kellgren-Lawrence (K-L) scale and US examination assessing global femoral hyaline cartilage (GFC), osteophytes, meniscal extrusion, effusion, and Baker’s cyst of the most symptomatic knee, there was significant correlation between (K-L) grading and (GFC) ultrasonographic grading (p = < 0.001). After assessment of pain and functional disability using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale, there was significant correlation between KL and GFC grading with age (p = < 0.001 for both), disease duration (p = < 0.001 for both) as well as WOMAC total scores (p = < 0.001 for both). GFC grading was the only independent predictor relative to other ultrasonographic variables for WOMAC total score (p = < 0.001).
Conclusions
US is a valid tool to evaluate knee joint space and is well correlated with radiographic images. KOA severity assessed by KL grading and GFC ultrasonographic grading showed good correlation with age, duration of the disease, pain intensity, and functional disability.
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Association of Weight Change and Physical Activity with Knee Pain and Health-Related Quality of Life in East Asian Women Aged 50 Years and Older with Knee Osteoarthritis: A Population-Based Study. KOSIN MEDICAL JOURNAL 2021. [DOI: 10.7180/kmj.2021.36.2.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
bjectives: This study aimed to investigate the association of self-reported weight change and physical activity with the level of knee pain and health-related quality of life in East Asian women with knee osteoarthritis using population-based data.Methods: A total of 564 women (mean age, 68.2 years, standard deviation, 8.9 years) aged 50 years or older with knee osteoarthritis (Kellgren-Lawrence (K-L) grade ≥ 2) were included in the data analyses from the fifth Korea National Health and Nutrition Examination Survey. Data regarding the radiographic grade, self-reported weight change during the past year, physical activity, level of knee pain, and health-related quality of life (EuroQOL five- dimension (EQ-5D) index) were collected. Multiple regression analysis was performed to identify factors significantly associated with the level of knee pain and health-related quality of life in subgroups according to the body mass index (BMI) range (≤ 22.5, between 22.6 and 27.5, and > 27.5 kg/m <sup>2</sup> ).Results: In the whole group, the level of knee pain was significantly associated with K-L grade (P < 0.001), and EQ-5D was negatively associated with age (P < 0.001), the level of knee pain (P < 0.001), and weekly hours of vigorous-intensity activity (P = 0.026). In the subgroup analysis, weight gain showed significant association with the level of knee pain only in women with 22.5 kg/m<sup>2</sup> < BMI ≤ 27.5 kg/m<sup>2</sup> (P = 0.006). Weight gain showed significant association with EQ-5D in women with BMI ≤ 22.5 kg/m<sup>2</sup>(P = 0.047) whereas weekly hours of moderate-intensity activity was negatively associated with EQ-5D in women with BMI > 27.5 kg/m<sup>2</sup> .Conclusions: The association of weight change and physical activity with knee pain and health-related quality of life might be different according to BMI ranges. Well-designed interventions to improve both knee pain and health-related quality of life need to be investigated in future studies that would strictly control physical activity, diet, and weight changes.
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Perera RS, Chen L, Hart DJ, Spector TD, Arden NK, Ferreira ML, Radojčić MR. Effects of body weight and fat mass on back pain - direct mechanical or indirect through inflammatory and metabolic parameters? Semin Arthritis Rheum 2021; 52:151935. [PMID: 35027244 DOI: 10.1016/j.semarthrit.2021.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 11/05/2021] [Accepted: 11/17/2021] [Indexed: 12/29/2022]
Abstract
BACKGROUND While reports indicate the association between obesity and back pain, its mechanism is still unclear. Thus, we aimed to investigate the effects of weight and its components on back pain in middle-aged women while considering direct mechanical and indirect effects via inflammatory and metabolic parameters. METHODS We used data from the Chingford 1000 Women Study, two follow-ups seven years apart. We assessed effects of weight, body mass index (BMI), total fat mass (TFM), total lean mass (TLM) and total bone mineral density (TBMD), measured by dual-energy X-ray absorptiometry, on back pain episode. We used inflammatory (C-reactive protein, interleukin-6, and tumour necrosis factor-alpha) and metabolic parameters (systolic and diastolic blood pressure, triglyceride, high-density lipoprotein cholesterol, and fasting blood glucose) as mediators of indirect effects. We investigated associations of interest cross-sectionally and longitudinally using binary logistic regression and parallel mediation model. RESULTS We included 826 Chingford middle-aged women (mean age=60.7, SD=5.9) from the first used follow-up in cross-sectional and mediation analyses and 645 women that attended the follow-up seven years later, in longitudinal analyses. We found that increased weight was directly associated with increased odds of having back pain episode (OR=1.02; 95% CI 1.01-1.03), similarly as BMI (OR=1.05; 95% CI 1.02-1.08) and TFM (OR=1.03; 95% CI 1.01-1.04) consistently across the cross-sectional and longitudinal models, but not TLM or TBMD. However, we did not find consistent indirect effects of weight or its components through measured inflammatory or metabolic parameters on back pain. CONCLUSIONS Our results show that in middle-aged women, weight, BMI and TFM are directly related to back pain, indicating prominence of mechanical loading effect.
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Affiliation(s)
- Romain S Perera
- Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom
| | - Lingxiao Chen
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Deborah J Hart
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Nigel K Arden
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom; MRC Environmental Epidemiology Unit, University of Southampton, Southampton, United Kingdom
| | - Manuela L Ferreira
- Institute of Bone and Joint Research, The Kolling Institute, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Maja R Radojčić
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Oxford OX3 7LD, United Kingdom; Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Oxford, Oxford, United Kingdom.
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12
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YOON SAMWON, CHA YOUNGJOO, YOON HYUNSIK, KIM KYOUNGTAE, PARK ILBONG, PARK CHANHEE. RADIOLOGICAL ASSESSMENT OF KNEE JOINT WIDTH DIFFERENCES IN OLDER ADULTS WITH SYMPTOMATIC MEDIAL KNEE OSTEOARTHRITIS. J MECH MED BIOL 2021. [DOI: 10.1142/s0219519421400534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Knee osteoarthritis (OA) is a degenerative articular disease. The knee joint space width (JSW) is used for grading the severity of knee OA. However, there is a lack of research on differences in the widths of knee joints between both lower limbs in unilateral OA. The purpose of this research was to examine the radiological difference in the affected knee joint and contralateral knee joint by analyzing unilateral older adults with medial knee OA using both knees’ JSW differences. Twenty-five subjects with unilateral medial knee OA participated. X-ray radiographs were used to assess knee JSW, and the paired [Formula: see text]-test was performed to assess the knee joint gap width between the affected side and the unaffected side in the respective medial and lateral sides. The independent [Formula: see text]-test compared the differences between the lateral and medial knee JSWs on the affected side and unaffected side. The paired [Formula: see text]-test did not show a significant difference in the medial and lateral knee JSW on the affected side compared to the unaffected side ([Formula: see text]; 0.11). Meanwhile, the independent [Formula: see text]-test revealed a significant difference between the affected and unaffected sides ([Formula: see text]). This study showed no significant changes in affected knee JSWs compared to unaffected sides, but the difference between the lateral and medial JSWs was significant between the knees affected and unaffected by OA in the older adults with medial knee OA.
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Affiliation(s)
- SAMWON YOON
- Department of Physical Therapy, Catholic University of Pusan, Busan 46265, Republic of Korea
| | - YOUNGJOO CHA
- Department of Physical Therapy, Cheju Halla University, Jeju 63092, Republic of Korea
| | - HYUNSIK YOON
- Department of Physical Therapy, Chungnam National University Hospital, Daejeon 35015, Republic of Korea
| | - KYOUNGTAE KIM
- Department of Physical Therapy, Cheju Halla University, Jeju 63092, Republic of Korea
| | - ILBONG PARK
- Department of Sports Rehabilitation, Busan University of Foreign Studies, Busan 46234, Republic of Korea
| | - CHANHEE PARK
- Department of Physical Therapy, Yonsei University, Wonju, Gangwon-do 26493, Republic of Korea
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13
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Radojčić MR, Perera RS, Chen L, Spector TD, Hart DJ, Ferreira ML, Arden NK. Specific body mass index trajectories were related to musculoskeletal pain and mortality: 19-year follow-up cohort. J Clin Epidemiol 2021; 141:54-63. [PMID: 34537387 PMCID: PMC8982643 DOI: 10.1016/j.jclinepi.2021.09.020] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2021] [Revised: 09/06/2021] [Accepted: 09/14/2021] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We aimed to study 19-year body mass index (BMI) patterns and their (1) bidirectional relationship with musculoskeletal pain and (2) mortality risk. STUDY DESIGN AND SETTING We used data from the Chingford study and group-based trajectory modelling to define 19-year BMI patterns. We investigated whether baseline back, hand, hip, and knee pain (as single- and multi-site) predicted 19-year BMI trajectory, and whether 19-year BMI patterns predicted pain in year 20. We explored BMI trajectories and mortality risk over 25 years (life expectancy). RESULTS We included 938 women (mean age: year-1=54, year-20=72) and found seven distinct 19-year BMI trajectories: two normal-weighted (reference), slightly overweight, lower and upper overweight-to-obese, lower and upper obese. BMI patterns capturing the increase overweight-to-obese (BMI 27-34 overtime) were bidirectionally related to knee and multi-site pain. The lower obese pattern (BMI 33-38) was unidirectionally associated with lower limb pain. Women with BMI above 40 had an increased all-cause and cardiovascular mortality risk. CONCLUSION For most postmenopausal women, the overweight WHO category was a transition. Two patterns capturing increase overweight-to-obese were mutually related to musculoskeletal pain, i.e., knee and multi-site pain contributed to becoming obese, and trajectories of becoming obese increased the odds of experiencing pain later.
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Affiliation(s)
- Maja R Radojčić
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Centre for Sport, Exercise and Osteoarthritis Research vs. Arthritis, University of Oxford, Oxford, United Kingdom.
| | - Romain S Perera
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Department of Allied Health Sciences, Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
| | - Lingxiao Chen
- Faculty of Medicine and Health, Institute of Bone and Joint Research, The Kolling Institute, University of Sydney, Sydney, Australia
| | - Tim D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Deborah J Hart
- Department of Twin Research and Genetic Epidemiology, King's College London, London, United Kingdom
| | - Manuela L Ferreira
- Faculty of Medicine and Health, Institute of Bone and Joint Research, The Kolling Institute, University of Sydney, Sydney, Australia
| | - Nigel K Arden
- Nuffield Department of Orthopedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom; Centre for Sport, Exercise and Osteoarthritis Research vs. Arthritis, University of Oxford, Oxford, United Kingdom
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14
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Fan T, Ruan G, Antony B, Cao P, Li J, Han W, Li Y, Yung SN, Wluka AE, Winzenberg T, Cicuttini F, Ding C, Zhu Z. The interactions between MRI-detected osteophytes and bone marrow lesions or effusion-synovitis on knee symptom progression: an exploratory study. Osteoarthritis Cartilage 2021; 29:1296-1305. [PMID: 34216729 DOI: 10.1016/j.joca.2021.06.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 06/17/2021] [Accepted: 06/22/2021] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To investigate the longitudinal association between MRI-detected osteophyte scores and progression of knee symptoms, and whether the association was modified in the presence of bone marrow lesions (BMLs) or effusion-synovitis. METHODS Data from Vitamin D Effects on Osteoarthritis (VIDEO) study, a randomized, double-blinded and placebo-controlled clinical trial in symptomatic knee osteoarthritis (OA) patients, were analyzed as an exploratory study. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess knee symptoms. Osteophytes, BMLs and effusion-synovitis were measured using MRI. RESULTS 334 participants with MRI information and WOMAC score (baseline and follow-up) were included in the analyses, with 24.3% of them having knee pain increased 2 years later. Statistically significant interactions were found between MRI-detected osteophytes and BMLs or effusion-synovitis on increased knee symptoms. In participants with BMLs, higher baseline scores of MRI-detected osteophytes in most compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and effusion-synovitis. In participants with effusion-synovitis, higher baseline scores of MRI-detected osteophytes in almost all the compartments were significantly associated with increased total knee pain, weight-bearing pain, stiffness, and physical dysfunction, after adjustment for age, sex, body mass index, intervention and BMLs. In contrast, MRI-detected osteophyte scores were generally not associated with knee symptom progression in participants without baseline BMLs or effusion-synovitis. CONCLUSIONS MRI-detected OPs are associated with increased total knee pain, weight-bearing knee pain, stiffness and physical dysfunction in participants presenting BMLs or effusion-synovitis, but not in participants lacking BMLs or effusion-synovitis. This suggests they could interact with bone or synovial abnormalities to induce symptoms in knee OA.
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Affiliation(s)
- T Fan
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - G Ruan
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - P Cao
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - J Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - W Han
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - Y Li
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - S N Yung
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
| | - A E Wluka
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - T Winzenberg
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia.
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - C Ding
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
| | - Z Zhu
- Clinical Research Centre, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China; Department of Orthopaedics, Zhujiang Hospital, Southern Medical University, Guangzhou, Guangdong, China.
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15
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Gessl I, Popescu M, Schimpl V, Supp G, Deimel T, Durechova M, Hucke M, Loiskandl M, Studenic P, Zauner M, Smolen JS, Aletaha D, Mandl P. Role of joint damage, malalignment and inflammation in articular tenderness in rheumatoid arthritis, psoriatic arthritis and osteoarthritis. Ann Rheum Dis 2021; 80:884-890. [PMID: 33436384 DOI: 10.1136/annrheumdis-2020-218744] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/21/2020] [Accepted: 12/29/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVES To determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness. METHODS Patients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,<2 years was regarded as early and >5 years as long-standing arthritis. RESULTS In total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (p<0.01), PsA (p<0.01) and OA (p=0.04). CONCLUSION Tenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.
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Affiliation(s)
- Irina Gessl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Mihaela Popescu
- Department of Rheumatology, Hôpital Maisonneuve-Rosemont, Montreal, Quebec, Canada
| | - Victoria Schimpl
- Department of Pediatric and Adolescent Medicine, Klinik Donaustadt, Vienna, Austria
| | - Gabriela Supp
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Thomas Deimel
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Martina Durechova
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Miriam Hucke
- Department of Internal Medicine and Gastroenterology, Hepatology, Endocrinology, Rheumatology and Nephrology, Klinikum Klagenfurt am Wörthersee, Klagenfurt, Kärnten, Austria
| | - Michaela Loiskandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Paul Studenic
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Michael Zauner
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Josef S Smolen
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Daniel Aletaha
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
| | - Peter Mandl
- Department of Rheumatology, Medical University of Vienna, Vienna, Austria
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16
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Bestwick-Stevenson T, Ifesemen OS, Pearson RG, Edwards KL. Association of Sports Participation With Osteoarthritis: A Systematic Review and Meta-Analysis. Orthop J Sports Med 2021; 9:23259671211004554. [PMID: 34179201 PMCID: PMC8207281 DOI: 10.1177/23259671211004554] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 12/21/2020] [Indexed: 12/02/2022] Open
Abstract
Background: The association between participating in sport and osteoarthritis is not fully understood. Purpose: To investigate the association between osteoarthritis and participating in sports not listed in previous reviews: American football, archery, baseball, bobsleigh, curling, handball, ice hockey, shooting, skeleton, speed skating, and wrestling. Study Design: Systematic review; Level of evidence, 3. Methods: We searched 4 electronic databases and hand searched recent/in-press editions of relevant journals. The criteria for study selection were case-control studies, cohort studies, nested case-control studies, and randomized trials with a control group that included adults to examine the effect of exposure to any of the included sports on the development of osteoarthritis. Results: The search returned 6197 articles after deduplication. Nine studies were included in the final review, covering hip, knee, and ankle osteoarthritis. There were no studies covering archery, baseball, skeleton, speed skating, or curling. The 6 sports included in the review were analyzed as a collective; the results of the meta-analysis indicated that participation in the sports analyzed was associated with an increased risk of developing osteoarthritis of the hip (relative risk [RR] = 1.67 [95% confidence interval (CI), 1.15-2.41]; P = .04), knee (RR = 1.60 [95% CI, 1.23-2.08]; P < .001), and ankle (RR = 7.08 [95% CI, 1.24-40.51]; P = .03) as compared with controls. Meta-analysis suggested a significantly increased likelihood of developing hip osteoarthritis through participating in wrestling (RR = 1.78 [95% CI, 1.20-2.64]; P = .004) and ice hockey (RR = 1.70 [95% CI, 1.27-2.29]; P < .001), while there was no significant difference through participating in handball (RR = 2.50 [95% CI, 0.85-7.36]; P = .10). Likelihood of developing knee osteoarthritis was significantly increased in wrestling (RR = 2.22 [95% CI, 1.59-3.11]) and ice hockey (RR = 1.52 [95% CI, 1.18-1.96]; both P < .002). According to the meta-analysis, shooting did not have a significant effect on the RR of knee osteoarthritis as compared with other sports (RR = 0.43 [95% CI, 0.06-2.99]; P = .39). Conclusion: The likelihood of developing hip and knee osteoarthritis was increased for ice hockey and wrestling athletes, and the risk of developing hip osteoarthritis was increased for handball athletes. The study also found that participation in the sports examined, as a collective, resulted in an increased risk of developing hip, knee, and ankle osteoarthritis.
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Affiliation(s)
- Thomas Bestwick-Stevenson
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Onosi S Ifesemen
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK
| | - Richard G Pearson
- Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
| | - Kimberley L Edwards
- Centre for Sport, Exercise and Osteoarthritis Research Versus Arthritis, University of Nottingham, Nottingham, UK.,Academic Orthopaedics, Trauma and Sports Medicine, School of Medicine, University of Nottingham, Nottingham, UK
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Macri EM, Runhaar J, Damen J, Oei EH, Bierma-Zeinstra SM. Kellgren & Lawrence grading in cohort studies: methodological update and implications illustrated using data from the CHECK cohort. Arthritis Care Res (Hoboken) 2021; 74:1179-1187. [PMID: 33450140 PMCID: PMC9541941 DOI: 10.1002/acr.24563] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2020] [Revised: 11/26/2020] [Accepted: 01/12/2021] [Indexed: 11/13/2022]
Abstract
Objective The Cohort Hip and Cohort Knee (CHECK) is a cohort of middle‐aged individuals with hip or knee pain. Radiographs were assigned Kellgren/Lawrence (K/L) scores under different conditions at each follow‐up visit for 10 years. We aimed to describe and consolidate each scoring approach, then illustrate implications of their use by comparing baseline K/L scores assigned using 2 of these approaches, and evaluating their respective associations with joint replacement and incident radiographic osteoarthritis (ROA). Methods We compared baseline K/L scores assigned to hips and knees using 2 scoring approaches: 1) assigned by senior researchers to baseline images alone and 2) assigned by trained readers, with images read paired and in known sequence with up to 10 years of follow‐up radiographs (Poisson regression). We evaluated the associations of baseline ROA (any: K/L grade ≥1; established: K/L ≥2) with joint replacement, and of K/L 1 joints with incident established ROA (survival analysis). Results Of 1,002 participants (79% women, mean ± SD age 55.9 ± 5.2 years, body mass index 26.2 ± 4.0 kg/m2), the second scoring approach had 2.4 times (95% confidence interval [95% CI] 1.8–3.1 for knees) and 2.9 times (95% CI 2.3–3.7 for hips) higher prevalence of established ROA than the first approach. Established hip ROA had a higher risk of joint replacement using the first approach (hazard ratio [HR] 24.2 [95% CI 15.0–39.8] versus second approach HR 7.7 [95% CI 4.9–12.1]), as did knees (HR 19.3 [95% CI 10.3–36.1] versus second approach HR 4.8 [95% CI 2.4–9.6]). The risk of incident ROA did not differ by approach. Conclusion This study demonstrates that evaluating ROA prevalence and predicting outcomes depends on the scoring approach.
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Affiliation(s)
- Erin M Macri
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Netherlands
| | - Jos Runhaar
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands
| | - Jurgen Damen
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands
| | - Edwin Hg Oei
- Department of Radiology and Nuclear Medicine, Erasmus University Medical Center Rotterdam, Netherlands
| | - Sita Ma Bierma-Zeinstra
- Department of General Practice, Erasmus University Medical Center Rotterdam, Netherlands.,Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center Rotterdam, Netherlands
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18
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Arthritis and the role of endogenous glucocorticoids. Bone Res 2020; 8:33. [PMID: 32963891 PMCID: PMC7478967 DOI: 10.1038/s41413-020-00112-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Revised: 07/09/2020] [Accepted: 07/27/2020] [Indexed: 12/17/2022] Open
Abstract
Rheumatoid arthritis and osteoarthritis, the most common forms of arthritis, are chronic, painful, and disabling conditions. Although both diseases differ in etiology, they manifest in progressive joint destruction characterized by pathological changes in the articular cartilage, bone, and synovium. While the potent anti-inflammatory properties of therapeutic (i.e., exogenous) glucocorticoids have been heavily researched and are widely used in clinical practice, the role of endogenous glucocorticoids in arthritis susceptibility and disease progression remains poorly understood. Current evidence from mouse models suggests that local endogenous glucocorticoid signaling is upregulated by the pro-inflammatory microenvironment in rheumatoid arthritis and by aging-related mechanisms in osteoarthritis. Furthermore, these models indicate that endogenous glucocorticoid signaling in macrophages, mast cells, and chondrocytes has anti-inflammatory effects, while signaling in fibroblast-like synoviocytes, myocytes, osteoblasts, and osteocytes has pro-inflammatory actions in rheumatoid arthritis. Conversely, in osteoarthritis, endogenous glucocorticoid signaling in both osteoblasts and chondrocytes has destructive actions. Together these studies provide insights into the role of endogenous glucocorticoids in the pathogenesis of both inflammatory and degenerative joint disease.
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19
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Garriga C, Sánchez-Santos MT, Judge A, Hart D, Spector T, Cooper C, Arden NK. Predicting Incident Radiographic Knee Osteoarthritis in Middle-Aged Women Within Four Years: The Importance of Knee-Level Prognostic Factors. Arthritis Care Res (Hoboken) 2020; 72:88-97. [PMID: 31127870 DOI: 10.1002/acr.23932] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/21/2019] [Indexed: 12/20/2022]
Abstract
OBJECTIVE To develop and internally validate risk models and a clinical risk score tool to predict incident radiographic knee osteoarthritis (RKOA) in middle-aged women. METHODS We analyzed 649 women in the Chingford 1,000 Women study. The outcome was incident RKOA, defined as Kellgren/Lawrence grade 0-1 at baseline and ≥2 at year 5. We estimated predictors' effects on the outcome using logistic regression models. Two models were generated. The clinical model considered patient characteristics, medication, biomarkers, and knee symptoms. The radiographic model considered the same factors, plus radiographic factors (e.g., angle between the acetabular roof and the ilium's vertical cortex [hip α-angle]). The models were internally validated. Model performance was assessed using calibration and discrimination (area under the receiver characteristic curve [AUC]). RESULTS The clinical model contained age, quadriceps circumference, and a cartilage degradation marker (C-terminal telopeptide of type II collagen) as predictors (AUC = 0.692). The radiographic model contained older age, greater quadriceps circumference, knee pain, knee baseline Kellgren/Lawrence grade 1 (versus 0), greater hip α-angle, greater spinal bone mineral density, and contralateral RKOA at baseline as predictors (AUC = 0.797). Calibration tests showed good agreement between the observed and predicted incident RKOA. A clinical risk score tool was developed from the clinical model. CONCLUSION Two models predicting incident RKOA within 4 years were developed, including radiographic variables that improved model performance. First-time predictor hip α-angle and contralateral RKOA suggest OA origins beyond the knee. The clinical tool has the potential to help physicians identify patients at risk of RKOA in routine practice, but the tool should be externally validated.
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Affiliation(s)
| | | | - Andrew Judge
- University of Oxford, Oxford, University of Southampton and Southampton General Hospital, Southampton, and Bristol Medical School, University of Bristol, and Southmead Hospital, Bristol, UK
| | | | | | - Cyrus Cooper
- University of Oxford, Oxford, and University of Southampton and Southampton General Hospital, Southampton, UK
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20
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Hong JW, Noh JH, Kim DJ. The prevalence of and demographic factors associated with radiographic knee osteoarthritis in Korean adults aged ≥ 50 years: The 2010-2013 Korea National Health and Nutrition Examination Survey. PLoS One 2020; 15:e0230613. [PMID: 32196540 PMCID: PMC7083301 DOI: 10.1371/journal.pone.0230613] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2019] [Accepted: 03/05/2020] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND To reduce the social burden of knee osteoarthritis (OA) by addressing it in the early stages in the population at greatest risk, the epidemiology of knee OA needs to be understood and associated demographic factors need to be identified. OBJECTIVES We evaluated the weighted prevalence of and demographic factors associated with radiographic knee OA in Korean adults. METHODS We analyzed data from 12,287 individuals aged ≥ 50 years who had radiographs of the knee taken in the 2010-2013 Korea National Health and Nutrition Examination Survey (KNHANES). Radiographic knee OA was defined based on the Kellgren-Lawrence grade, as follows: 0: No abnormal finding 1: Mild degenerative changes, minute osteophytes 2: Mild knee OA, definite osteophytes 3: Moderate knee OA, moderate joint-space narrowing and definite osteophytes 4: Severe knee OA, severe joint-space narrowing with subchondral sclerosis. RESULTS We found that the prevalence of radiographic knee OA in the Korean adult population was 35.1%. Logistic regression analyses were performed to identify factors associated independently with radiographic knee OA, with age, sex, area of residence, education level, household income, and obesity serving as covariates. Women were at greater risk than men of having knee OA (OR 2.12, 95% CI 1.90-2.37, p < 0.001). Compared with subjects aged 50-59 years, adults aged ≥ 80 years were at 8.87-fold (95% CI 7.12-11.06, p < 0.001) greater risk of having knee OA. Residence in a rural area was associated with a greater risk of having radiographic knee OA than was residence in an urban area (OR 1.26, 95% CI 1.08-1.48, p = 0.004), regardless of knee OA severity (Kellgren-Lawrence grades ≥2, ≥3, and 4). Elementary school graduates had 1.71-fold (p < 0.001) greater risks of having knee OA than did college graduates. Household incomes ≤24th percentile were associated with a greater risk of having knee OA compared with those ≥75th percentile (OR 1.28, 95% CI 1.08-1.52, p = 0.004). Obesity was associated with an approximately two-fold greater risk of knee OA, regardless of knee OA severity (Kellgren-Lawrence grades ≥2, ≥3, and 4). CONCLUSIONS Using data from the 2010-2013 KNHANES and defining knee OA as Kellgren-Lawrence grade ≥ 2, we found that the prevalence of radiographic knee OA was 35.1% (24.4% in men, 44.3% in women) in a representative sample of Korean adults aged ≥ 50 years, with the highest prevalence (78.7%) observed in women aged ≥ 80 years. Low socioeconomic status and traditional factors, including age, female sex, and obesity, were associated with the risk of knee OA.
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Affiliation(s)
- Jae Won Hong
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
| | - Jung Hyun Noh
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
| | - Dong-Jun Kim
- Department of Internal Medicine, Ilsan-Paik Hospital, College of Medicine, Inje University, Koyang, Gyeonggi-do, Republic of Korea
- * E-mail:
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Kiio TM, Park S. Nano-scientific Application of Atomic Force Microscopy in Pathology: from Molecules to Tissues. Int J Med Sci 2020; 17:844-858. [PMID: 32308537 PMCID: PMC7163363 DOI: 10.7150/ijms.41805] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/05/2019] [Accepted: 02/26/2020] [Indexed: 12/28/2022] Open
Abstract
The advantages of atomic force microscopy (AFM) in biological research are its high imaging resolution, sensitivity, and ability to operate in physiological conditions. Over the past decades, rigorous studies have been performed to determine the potential applications of AFM techniques in disease diagnosis and prognosis. Many pathological conditions are accompanied by alterations in the morphology, adhesion properties, mechanical compliances, and molecular composition of cells and tissues. The accurate determination of such alterations can be utilized as a diagnostic and prognostic marker. Alteration in cell morphology represents changes in cell structure and membrane proteins induced by pathologic progression of diseases. Mechanical compliances are also modulated by the active rearrangements of cytoskeleton or extracellular matrix triggered by disease pathogenesis. In addition, adhesion is a critical step in the progression of many diseases including infectious and neurodegenerative diseases. Recent advances in AFM techniques have demonstrated their ability to obtain molecular composition as well as topographic information. The quantitative characterization of molecular alteration in biological specimens in terms of disease progression provides a new avenue to understand the underlying mechanisms of disease onset and progression. In this review, we have highlighted the application of diverse AFM techniques in pathological investigations.
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Affiliation(s)
| | - Soyeun Park
- College of Pharmacy, Keimyung University, 1095 Dalgubeoldaero, Daegu 42601, Republic of Korea
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22
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The incidence and characteristics of accelerated knee osteoarthritis among women: the Chingford cohort. BMC Musculoskelet Disord 2020; 21:60. [PMID: 32005116 PMCID: PMC6995080 DOI: 10.1186/s12891-020-3073-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/16/2020] [Indexed: 01/26/2023] Open
Abstract
Background Prior research on accelerated knee osteoarthritis (AKOA) was primarily confined to the Osteoarthritis Initiative, which was enriched with people with risk factors for knee osteoarthritis (KOA). It is unclear how often AKOA develops in a community-based cohort and whether we can replicate prior findings from the Osteoarthritis Initiative in another cohort. Hence, we determined the incidence and characteristics of AKOA among women in the Chingford Study, which is a prospective community-based cohort. Methods The Chingford Study had 1003 women with quinquennial knee radiographs over 15 years. We divided the 15-year observation period into three consecutive 5-year phases. Within each 5-year phase, we selected 3 groups of participants among women who started a phase without KOA (Kellgren-Lawrence [KL] < 2): 1) incident AKOA developed KL grade ≥ 3, 2) typical KOA increased radiographic scoring (excluding AKOA), and 3) no KOA had the same KL grade over time. Study staff recorded each participant’s age, body mass index (BMI), and blood pressure at baseline, 5-year, and 10-year study visits. We used multinomial logistic regression models to test the association between groups (outcome) and age, BMI, and blood pressure at the start of each phase. The cumulative incidences and odds ratios (OR) from each phase were pooled using a fixed-effect meta-analysis model. Results The person-based cumulative incidence of AKOA was 3.9% over 5 years (pooled estimate across the three 5-year phases). Among incident cases of KOA, AKOA represented ~ 15% of women with incident KOA. Women with AKOA were older than those with typical (OR = 1.56, 95%CI = 1.16–2.11) or no KOA (OR = 1.84, 95%CI = 1.40–2.43). Women with AKOA had a greater BMI than those without KOA (OR = 1.52, 95%CI = 1.17–1.97). We observed no association between group and blood pressure. Conclusions In a community-based cohort, > 1 in 7 women with incident KOA had AKOA. Like the Osteoarthritis Initiative, people with AKOA were more likely to have greater age and BMI.
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Mahapatra A, Kar S. Osteoarthritis in women reporting to tertiary care hospital in Eastern India: Associated factors determining management. J Family Med Prim Care 2019; 8:3544-3548. [PMID: 31803649 PMCID: PMC6881952 DOI: 10.4103/jfmpc.jfmpc_704_19] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Revised: 09/17/2019] [Accepted: 09/30/2019] [Indexed: 11/04/2022] Open
Abstract
Introduction: Osteoarthritis (OA) is a painful joint condition that is left heavily underdiagnosed, as it is also related to advancing age. Hence, those affected, tend to live with it, until the condition becomes excruciating or disabling. The women in our society are a section, who have very poor health seeking behavior. However, in today's era, tertiary care hospitals offer definitive management for OA in the form of Joint Replacement Surgery (JRS). This again is taken up often as a last resort and is heavily dependent on the socioeconomic condition of the family. The surgery offers proven better quality of life. Objectives: This study discusses a public health hypothesis regarding the disease presentations of OA in women visiting a tertiary care hospital and endeavors to develop a model based on some predictors that increase the predilection of recommendation of surgery among these women, These studies have been done for general populations, but here we chose to study women, as the society in eastern part of the country is male dominated and the decision to go for a surgery in case of the women is dependent on several issues. This model perhaps will bring to light the need of surgery in the women with OA and help take some policy decisions to offer some subsidized care to this section of the society. The results were derived from 350 women coming to an orthopedic tertiary care center during a 6-month study period with joint pain in any of the big joints and then finally given a definitive diagnosis of OA based on radiological KL score and clinical presentations. Results: Women above age 40 years were taken up; mean age in study being 55.94 SD 6.648 (maximum 83, minimum 43). A semi structured questionnaire was used to compare the sociodemographic parameters like type of residence, type of family, attained menopause, occupation, duration of OA, etc., In the sample, which gave multiple responses, right and left knee were maximally inflicted by OA i.e. 59.1% and 57.1% of cases, followed by hip (28.9%) and lower back (26.1%). 75% were offered conservative treatment, only 24.6% were on physiotherapy. Conclusion: Menopause, increased age, comorbidities, and preobese were seen to be significantly associated with recommendations of JRS. This can help develop a screening method for women and encourage them to undergo assessment for OA as a targeted intervention and address this growing burden of disease at the earliest.
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Affiliation(s)
- Arup Mahapatra
- Department of Community Medicine, KIMS, Campus-5, KIIT University, Patia, Bhubaneswar, Odisha, India
| | - Sonali Kar
- Department of Community Medicine, KIMS, Campus-5, KIIT University, Patia, Bhubaneswar, Odisha, India
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Seifeldein GS, Haseib A, Hassan HA, Ahmed G. Correlation of knee ultrasonography and Western Ontario and McMaster University (WOMAC) osteoarthritis index in primary knee osteoarthritis. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2019. [DOI: 10.1186/s43055-019-0029-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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25
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Sanchez-Santos MT, Judge A, Gulati M, Spector TD, Hart DJ, Newton JL, Arden NK, Kluzek S. Association of metabolic syndrome with knee and hand osteoarthritis: A community-based study of women. Semin Arthritis Rheum 2019; 48:791-798. [DOI: 10.1016/j.semarthrit.2018.07.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 06/28/2018] [Accepted: 07/23/2018] [Indexed: 01/03/2023]
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26
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Clinical Assessment and Management of Foot and Ankle Osteoarthritis: A Review of Current Evidence and Focus on Pharmacological Treatment. Drugs Aging 2019; 36:203-211. [PMID: 30680680 DOI: 10.1007/s40266-019-00639-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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27
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MRI-detected osteophytes of the knee: natural history and structural correlates of change. Arthritis Res Ther 2018; 20:237. [PMID: 30352619 PMCID: PMC6235223 DOI: 10.1186/s13075-018-1734-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2018] [Accepted: 09/25/2018] [Indexed: 01/08/2023] Open
Abstract
Backgroud The natural history of semi-quantitative magnetic resonance imaging (MRI)-detected osteophytes (MRI-detected OPs) has not been described and it is unknown whether knee structural abnormalities can predict MRI-detected OP change over time. Thus, the aim of current study is to describe the natural history of knee MRI-detected OP, and to determine if knee structural abnormalities are associated with change of MRI-detected OP in a longitudinal study of older adults. Methods Randomly selected older adults (n = 837, mean age 63 years) had MRI at baseline and 413 of them had MRI 2.6 years later to measure MRI-detected OP, cartilage defects, cartilage volume, bone marrow lesions (BMLs), meniscal extrusion, infrapatellar fat pad (IPFP) quality score/maximum area and effusion-synovitis. Results Over 2.6 years, average MRI-detected OP score increased significantly in all compartments. The total MRI-detected OP score remained stable in 53% of participants, worsened (≥ 1-point increase) in 46% and decreased in 1%. Baseline cartilage defects (RR, 1.25–1.35), BMLs (RR, 1.16–1.17), meniscal extrusion (RR, 1.22–1.33) and IPFP quality score (RR, 1.08–1.20) site-specifically and independently predicted an increase in MRI-detected OP (p values all ≤ 0.05), after adjustment for covariates. Presence of IPFP abnormality was significantly associated with increased MRI-detected OPs but became non-significant after adjustment for other structural abnormalities. Total (RR, 1.27) and suprapatellar pouch effusion-synovitis (RR, 1.22) were both associated with increased MRI-detected OPs in the lateral compartment only (both p < 0.04). Conclusion Knee MRI-detected OPs are common in older adults and are likely to progress. The association between baseline structural abnormalities and worsening MRI-detected OPs suggest MRI-detected OP could be a consequence of multiple knee structural abnormalities.
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Alves-Cardoso F, Assis S. Can osteophytes be used as age at death estimators? Testing correlations in skeletonized human remains with known age-at-death. Forensic Sci Int 2018; 288:59-66. [PMID: 29729497 DOI: 10.1016/j.forsciint.2018.04.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2017] [Revised: 04/07/2018] [Accepted: 04/16/2018] [Indexed: 12/19/2022]
Abstract
Age-at-death estimation is one of the major challenges when establishing an adult skeleton biological profile. The presence of degenerative joint changes - e.g. osteophytes - has been regarded as a good postmaturity age indicator. This study assessed if a clear relationship between age and osteophytes exists. To accomplish this goal, a total of 16 joint surfaces, from the shoulder, elbow, wrist, hip, knee, and ankle, were examined in 604 adult individuals, of both sexes from two Portuguese Identified collections. Individuals had between 20 and 98 year old at death. Statistically significant results were found between age-at-death and degrees of severity of osteophytes throughout all the articular surfaces analyzed (p>0.001). However, the strength of the correlation varies from moderate to low in the majority of the joints, for both sexes. The only strong correlation effects (r=0.567 in females and r=0.552 in males) were found associated with the left and right glenoid cavity in females and males respectively. More noticeable changes were consistently found in association with older individuals (>62 years old). Results indicate that significant relationships exist between age and the presence of osteophytes in the joint margins. However, correlation effects were low to moderate in most cases, therefore the use of osteophytes to predict age-at-death is not without significant error of interpretation.
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Affiliation(s)
- Francisca Alves-Cardoso
- LABOH - Laboratório de Antropologia Biológica e Osteologia Humana, CRIA/FCSH, Universidade NOVA de Lisboa, Portugal; CRIA - Centro em Rede de Investigação em Antropologia, Faculdade de Ciencias Sociais e Humanas, Universidade NOVA de Lisboa, 1069-061 Lisboa, Portugal.
| | - Sandra Assis
- LABOH - Laboratório de Antropologia Biológica e Osteologia Humana, CRIA/FCSH, Universidade NOVA de Lisboa, Portugal; CRIA - Centro em Rede de Investigação em Antropologia, Faculdade de Ciencias Sociais e Humanas, Universidade NOVA de Lisboa, 1069-061 Lisboa, Portugal
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Lee KM, Kang SB, Chung CY, Park MS, Kang DW, Chang CB. Factors associated with knee pain in 5148 women aged 50 years and older: A population-based study. PLoS One 2018. [PMID: 29518078 PMCID: PMC5843201 DOI: 10.1371/journal.pone.0192478] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Objective This study was performed to investigate the factors associated with the level of knee pain in a nationally representative sample of noninstitutionalized women aged 50 years or older. Methods Women aged 50 years or older were selected and included in the data analyses from the Korean National Health and Nutrition Examination Surveys (2010–2013). Those having malignant diseases or using osteoarthritis medication were excluded. Significant factors associated with the level of knee pain were analyzed using multivariate regression analysis. Results A total of 5148 women (average age, 62.9 years; standard deviation, 9.3 years) were included. For women without knee osteoarthritis, level of hip pain (p<0.001), presence of back pain (p<0.001), age (p<0.001), and body mass index (BMI) (p<0.001) were found to be significant factors associated with the level of knee pain. For women with knee osteoarthritis, the radiographic grade of knee osteoarthritis (p<0.001), presence of back pain (p<0.001), level of hip pain (p<0.001), presence of depressive symptoms (p<0.001), and BMI (p = 0.026) were the factors significantly associated with the level of knee pain. Conclusions Women without knee osteoarthritis tended to report increasing knee pain with increasing age. BMI is considered a significant controllable factor in knee pain in women regardless of the presence of radiographic knee osteoarthritis. The presence of depressive symptoms may aggravate knee pain in women with knee osteoarthritis. Attention needs to be focused on concomitant musculoskeletal problems such as lumbar spinal and hip diseases in women with knee pain.
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Affiliation(s)
- Kyoung Min Lee
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Seung-Baik Kang
- Department of Orthopaedic Surgery, SMG‑SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
| | - Chin Youb Chung
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Moon Seok Park
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Dong-wan Kang
- Department of Orthopaedic Surgery, Seoul National University Bundang Hospital, Gyeonggi, South Korea
| | - Chong bum Chang
- Department of Orthopaedic Surgery, SMG‑SNU Boramae Medical Center, Seoul National University College of Medicine, Seoul, South Korea
- * E-mail:
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30
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McQueen P, Gates L, Marshall M, Doherty M, Arden N, Bowen C. The effect of variation in interpretation of the La Trobe radiographic foot atlas on the prevalence of foot osteoarthritis in older women: the Chingford general population cohort. J Foot Ankle Res 2017; 10:54. [PMID: 29234466 PMCID: PMC5723087 DOI: 10.1186/s13047-017-0239-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 11/27/2017] [Indexed: 11/26/2022] Open
Abstract
Background The prevalence of foot osteoarthritis (OA) is much less understood than hip, knee and hand OA. The foot is anatomically complex and different researchers have investigated different joints with lack of methodological standardisation across studies. The La Trobe Foot Atlas (LFA) is the first to address these issues in providing quantitative assessment of radiographic foot OA, but has not been tested externally. The aim of this study was to evaluate three different interpretive approaches to using the LFA for grading OA when scoring is difficult due to indistinct views of interosseous space and joint contour. Methods Foot radiographs of all remaining participants (n = 218) assessed in the Chingford Women Study 23 year visit (mean (SD) for age: 75.5 years (5.1)) were scored using the LFA defined protocol (Technique 1). Two revised scoring strategies were applied to the radiographs in addition to the standard LFA analyses. Technique 2 categorised joints that were difficult to grade as ‘missing’. Technique 3 included joints that were difficult to grade as an over estimated score. Radiographic OA prevalence was defined for the foot both collectively and separately for individual joints. Results When radiographs were scored using the LFA (Technique 1), radiographic foot OA was present in 89.9%. For Technique 2 the presence of radiographic foot OA was 83.5% and for Technique 3 it was 97.2%. At the individual joint level, using Technique 1, the presence of radiographic foot OA was higher with a wider range (18.3–74.3%) than Technique 2 (17.9–46.3%) and lower with a wider range (18.3–74.3%) than Technique 3 (39.9–79.4%). Conclusion The three different ways of interpreting the LFA scoring system when grading of individual joints is technically difficult and result in very different estimates of foot OA prevalence at both the individual joint and global foot level. Agreement on the best strategy is required to improve comparability between studies.
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Affiliation(s)
- Peter McQueen
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, Southampton, SO17 1BJ UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK
| | - Lucy Gates
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, Southampton, SO17 1BJ UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
| | - Michelle Marshall
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care & Health Sciences, Keele University, Keele, UK
| | - Michael Doherty
- Arthritis Research UK Pain Centre and Academic Rheumatology, School of Medicine, University of Nottingham, Nottingham, UK
| | - Nigel Arden
- Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK.,Medical Research Council Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - Catherine Bowen
- Faculty of Health Sciences, University of Southampton, Highfield Campus Building 45, Southampton, SO17 1BJ UK.,Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Southampton, Southampton, UK
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Zhu Z, Laslett LL, Han W, Antony B, Pan F, Cicuttini F, Jones G, Ding C. Associations between MRI-detected early osteophytes and knee structure in older adults: a population-based cohort study. Osteoarthritis Cartilage 2017; 25:2055-2062. [PMID: 28935436 DOI: 10.1016/j.joca.2017.09.005] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2017] [Revised: 09/01/2017] [Accepted: 09/11/2017] [Indexed: 02/06/2023]
Abstract
OBJECTIVES To describe prevalence of osteophytes (OPs) detected only by magnetic resonance imaging (MRI) but not by standard X-ray in older adults and to evaluate longitudinal associations with knee structural changes. METHODS 837 participants were randomly selected from the local community and had MRI scans to assess knee OPs and other structures. OPs detected only by MRI but not by standard X-ray were defined as MRI-detected early OPs (MRI-OPs for short). OPs detected by both MRI and X-ray were defined as established-OPs. RESULTS The prevalence of MRI-OPs was 50% while the prevalence of established-OPs was 10% and no-OPs was 40% at total tibiofemoral (TF) compartment at baseline. Compared with no-OPs, participants with MRI-OPs had greater risks of increased cartilage defects in all TF compartments (RR 1.37, 95%CI 1.07-1.74) and bone marrow lesions (BMLs) only in medial TF compartment (RR 1.49, 95%CI 1.06-2.11), after adjustment for age, sex, BMI, cartilage defects, BMLs and/or joint space narrowing; participants with established-OPs had greater cartilage volume loss at total (β -2.02, 95%CI -3.86, -0.17) and lateral tibial sites (β -5.63, 95%CI -9.93, -1.32), greater risks of increased cartilage defects in total (RR 1.66, 95%CI 1.15-2.40) and medial TF compartments (RR 1.49, 95%CI 1.20-1.69) and BMLs in all TF compartments (RR 1.88, 95%CI 1.22-2.89), after adjustment for covariates. CONCLUSION MRI-OPs were associated with changes in knee structures, and the associations were similar but not as prominent as those for established-OPs. These suggest MRI-OPs may have a role to play in knee early-stage osteoarthritic progression.
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Affiliation(s)
- Z Zhu
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - L L Laslett
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - W Han
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, China
| | - B Antony
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Pan
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - F Cicuttini
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - G Jones
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia
| | - C Ding
- Menzies Institute for Medical Research, University of Tasmania, Hobart, Tasmania, Australia; Translational Research Centre, Academy of Orthopaedics, Guangdong Province, China; School of Basic Medical Sciences, Southern Medical University, Guangzhou, Guangdong, China; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
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Dong B, Kong Y, Zhang L, Qiang Y. Severity and distribution of cartilage damage and bone marrow edema in the patellofemoral and tibiofemoral joints in knee osteoarthritis determined by MRI. Exp Ther Med 2017; 13:2079-2084. [PMID: 28565811 DOI: 10.3892/etm.2017.4190] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2015] [Accepted: 12/23/2016] [Indexed: 12/25/2022] Open
Abstract
The aim of the present study was to analyze the distribution and severity of cartilage damage (CD) and bone marrow edema (BME) of the patellofemoral and tibiofemoral joints (PFJ and TFJ, respectively) in patients with knee osteoarthritis (OA), and to determine whether a correlation exists between BME and CD in knee OA, using magnetic resonance imaging (MRI). Forty-five patients diagnosed with knee OA (KOA group) and 20 healthy individuals (control group) underwent sagittal multi-echo recalled gradient echo sequence scans, in addition to four conventional MR sequence scans. Knee joints were divided into 15 subregions by the whole-organ MRI scoring method. MRIs of each subregion were analyzed for the presence of CD, CD score and BME score. The knee joint activity functional score was determined using the Western Ontario and McMaster Universities Arthritis Index (WOMAC) in the KOA group. Statistical analyses were used to compare the CD incidence; CD score and BME score between the PFJ and TFJ. Whether a correlation existed among body mass index, BME score, WOMAC pain score and CD score was also examined. Among the 675 subregions analyzed in the KOA group, 131 exhibited CD (CD score, 1-6). These 131 subregions were primarily in the PFJ (80/131, 61.07%), with the remainder in the TFJ (51/131, 38.93%). Thirty-three subregions had a CD score of 1, including 24 PFJ subregions (72.73%) and 9 TFJ subregions (27.27%). Among the 103 subregions with BME, the PFJ accounted for 60 (58.25%) and the TFJ for 43 (41.75%). A significant positive correlation was found between the BME and CD scores. In conclusion, CD and BME occurred earlier and more often in the PFJ compared to the TFJ in knee OA, and BME is an indirect sign of CD.
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Affiliation(s)
- Baoming Dong
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University Medical College, Xi'an, Shaanxi 710061, P.R. China
| | - Yanliang Kong
- Department of Radiology, Tongchuan People's Hospital, Tongchuan, Shaanxi 727000, P.R. China
| | - Lei Zhang
- Department of Radiology, The Second Affiliated Hospital of Xi'an Jiaotong University Medical College, Xi'an, Shaanxi 710054, P.R. China
| | - Yongqian Qiang
- Department of Radiology, The First Affiliated Hospital of Xi'an Jiaotong University Medical College, Xi'an, Shaanxi 710061, P.R. China
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Abstract
Ultrasound has become popular among rheumatologists as the first-choice imaging investigation for the evaluation and monitoring of osteoarthritis (OA). Because of recent improvement in technology, ultrasound has the ability to demonstrate and assess the minimal structural abnormalities, which involve the pathophysiology and progression of OA, such as articular cartilage, synovial tissue, bony cortex, and other soft tissue. Nowadays, ultrasonography is a promising technique for assessing soft tissue abnormalities such as joint effusion, synovial hypertrophy, Baker cyst, and other structural changes including the decrease in cartilage thickness, meniscus bulging, and formation of osteophyte. Ultrasonography not only possesses diagnostic potential in knee OA but also reveals long-term predictability for disease progress as imaging biomarker. Ultrasonography has also been proven as a useful tool in guiding therapeutic interventions and monitoring treatment effectiveness. This review addresses the utility, reliability, and potential utilization of ultrasonography as an imaging technique in knee OA.
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Meyer MA, Leroux TS, Levy DM, Tilton AK, Lewis PB, Yanke AB, Cole BJ. Flexion Posteroanterior Radiographs Affect Both Enrollment for and Outcomes After Injection Therapy for Knee Osteoarthritis. Orthop J Sports Med 2017; 5:2325967117706692. [PMID: 28589160 PMCID: PMC5444580 DOI: 10.1177/2325967117706692] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
BACKGROUND Knee injection therapy is less effective for severe osteoarthritis (OA), specifically Kellgren-Lawrence (KL) grade 4. Patient selection for knee injection trials has historically been based on extension anteroposterior (AP) radiographic evaluation; however, emerging evidence suggests that KL grading using a flexion posteroanterior (PA) radiograph more accurately and reproducibly predicts disease severity. The impact of radiographic view on patient selection and outcome after knee injection therapy remains unknown. HYPOTHESIS A 45° flexion PA radiograph will reveal more advanced knee OA in certain patients. These patients will report worse pre- and postinjection outcomes. STUDY DESIGN Cohort study; Level of evidence, 3. METHODS Four raters independently graded extension AP and flexion PA radiographs from 91 patients previously enrolled in a knee injection trial. Patients determined to have KL grade 4 OA by any rater on extension AP radiographs were excluded. Among included patients, those upgraded to KL grade 4 on flexion PA radiographs by at least 2 raters constituted group 2, while all remaining patients constituted group 1. Demographic data and patient-reported outcome scores before injection and at 6 weeks, 3 months, 6 months, and 12 months postinjection were compared between groups. RESULTS Overall, 64 patients met the inclusion criteria, of which 19 patients (30%) constituted group 2. Compared with group 1, patients in group 2 were older (58.7 vs 52.3 years, P = .02), had worse visual analog scale pain scores before (6.6 vs 5.3, P = .03) and 6 months after injection (5.3 vs 3.5, P = .01), had less improvement in both Lysholm (8.5 vs 20.5, P = .02) and Short Form-12 physical component (-2.2 vs 1.7, P = .03) scores from preinjection to 6 months postinjection, and had less improvement in both Lysholm (1.6 vs 13.1, P = .03) and Knee injury and Osteoarthritis Outcome Score sport subscale (-2.1 vs 16, P = .01) scores from preinjection to 12 months postinjection. CONCLUSION One in 3 patients considered to have mild to moderate knee OA on extension AP radiography is upgraded to severe knee OA (KL grade 4) on flexion PA radiography. These patients report worse preinjection outcomes, worse pain scores at short-term follow-up, and decreased improvement in knee function scores between 6 months and 1 year postinjection.
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Affiliation(s)
- Maximilian A. Meyer
- Department of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Timothy S. Leroux
- Department of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - David M. Levy
- Department of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Annemarie K. Tilton
- Department of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Paul B. Lewis
- Mercyhealth Rockton Avenue Hospital, Rockford, Illinois, USA
| | - Adam B. Yanke
- Department of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
| | - Brian J. Cole
- Department of Sports Medicine, Rush University Medical Center, Chicago, Illinois, USA
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Hirvasniemi J, Thevenot J, Guermazi A, Podlipská J, Roemer FW, Nieminen MT, Saarakkala S. Differences in tibial subchondral bone structure evaluated using plain radiographs between knees with and without cartilage damage or bone marrow lesions - the Oulu Knee Osteoarthritis study. Eur Radiol 2017; 27:4874-4882. [PMID: 28439649 PMCID: PMC5635082 DOI: 10.1007/s00330-017-4826-8] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Revised: 03/13/2017] [Accepted: 03/20/2017] [Indexed: 11/28/2022]
Abstract
Objectives To investigate whether subchondral bone structure from plain radiographs is different between subjects with and without articular cartilage damage or bone marrow lesions (BMLs). Methods Radiography-based bone structure was assessed from 80 subjects with different stages of knee osteoarthritis using entropy of Laplacian-based image (ELap) and local binary patterns (ELBP), homogeneity index of local angles (HIAngles,mean), and horizontal (FDHor) and vertical fractal dimensions (FDVer). Medial tibial articular cartilage damage and BMLs were scored using the magnetic resonance imaging osteoarthritis knee score. Level of statistical significance was set to p < 0.05. Results Subjects with medial tibial cartilage damage had significantly higher FDVer and ELBP as well as lower ELap and HIAngles,mean in the medial tibial subchondral bone region than subjects without damage. FDHor, FDVer, and ELBP were significantly higher, whereas ELap and HIAngles,mean were lower in the medial trabecular bone region. Subjects with medial tibial BMLs had significantly higher FDVer and ELBP as well as lower ELap and HIAngles,mean in medial tibial subchondral bone. FDHor, FDVer, and ELBP were higher, whereas ELap and HIAngles,mean were lower in medial trabecular bone. Conclusions Our results support the use of bone structural analysis from radiographs when examining subjects with osteoarthritis or at risk of having it. Key points • Knee osteoarthritis causes changes in articular cartilage and subchondral bone • Magnetic resonance imaging is a comprehensive imaging modality for knee osteoarthritis • Radiography-based bone structure analysis can provide additional information of osteoarthritic subjects
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Affiliation(s)
- Jukka Hirvasniemi
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland. .,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.
| | - Jérôme Thevenot
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland
| | - Ali Guermazi
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Jana Podlipská
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland
| | - Frank W Roemer
- Quantitative Imaging Center, Department of Radiology, Boston University School of Medicine, Boston, MA, USA.,Department of Radiology, University of Erlangen-Nuremberg, Erlangen, Germany
| | - Miika T Nieminen
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, FI-90014, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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Ekim AA, İnal EE, Kaya DS, Yılmazer Ş, Kuzgun S, Mumcu G, Yurdasiper A, Musmul A. Relationship between atherosclerosis and knee osteoarthritis as graded by radiography and ultrasonography in females. J Phys Ther Sci 2016; 28:2991-2998. [PMID: 27942107 PMCID: PMC5140787 DOI: 10.1589/jpts.28.2991] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Accepted: 04/07/2016] [Indexed: 12/14/2022] Open
Abstract
[Purpose] The aim of this study was to assess the relationship between atherosclerosis and knee osteoarthritis grade in women as assessed by both ultrasonography and radiography. [Subjects and Methods] Seventy women diagnosed with knee osteoarthritis were classified into two groups according to cartilage grading/radiographic grading. Patients with Kellgren-Lawrence grades 1 and 2 were included in group 1, while those with Kellgren-Lawrence grades 3 and 4 were included in group 2. Patients with cartilage grades 1-3 were included in group 1, while those with cartilage grades 4-6 were included in group 2. Patients were clinically assessed using a visual analog scale and the Western Ontario and McMaster Universities Arthritis Index. Radiographic osteoarthritis grade was scored using the Kellgren and Lawrence grading system. Using ultrasonography, symptomatic knees were graded and evaluated for distal femoral cartilage thickness. Carotid intima-media thickness and serum lipid levels were measured to assess atherosclerosis. [Results] Carotid intima-media thickness measurements were higher in group 2 than in group 1 as determined by the Kellgren-Lawrence and cartilage grading systems. Carotid intima-media thickness measurements were positively correlated with both the ultrasonographic cartilage grade and Kellgren-Lawrence. [Conclusion] The results of this study suggest that osteoarthritis as assessed by ultrasonography was successful and comparable to assessment with radiography. We showed a correlation between atherosclerosis and ultrasonographic knee osteoarthritis grade.
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Affiliation(s)
- Ayşe Aydemir Ekim
- Department of Physical Medicine and Rehabilitation, Zübeyde
Hanım Campus, Eskişehir State Hospital, Turkey
| | - Esra Erkol İnal
- Department of Physical Medicine and Rehabilitation, Faculty
of Medicine, Süleyman Demirel University, Turkey
| | - Dilek Serin Kaya
- Department of Physical Medicine and Rehabilitation, Zübeyde
Hanım Campus, Eskişehir State Hospital, Turkey
| | - Şebnem Yılmazer
- Department of Physical Medicine and Rehabilitation, Zübeyde
Hanım Campus, Eskişehir State Hospital, Turkey
| | - Selen Kuzgun
- Department of Physical Medicine and Rehabilitation, Zübeyde
Hanım Campus, Eskişehir State Hospital, Turkey
| | - Gamze Mumcu
- Department of Physical Medicine and Rehabilitation, Zübeyde
Hanım Campus, Eskişehir State Hospital, Turkey
| | | | - Ahmet Musmul
- Department of Biostatistics and Medical Informatics,
Faculty of Medicine, Osmangazi University, Turkey
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Kluzek S, Sanchez-Santos MT, Leyland KM, Judge A, Spector TD, Hart D, Cooper C, Newton J, Arden NK. Painful knee but not hand osteoarthritis is an independent predictor of mortality over 23 years follow-up of a population-based cohort of middle-aged women. Ann Rheum Dis 2016; 75:1749-56. [PMID: 26543059 DOI: 10.1136/annrheumdis-2015-208056] [Citation(s) in RCA: 77] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Accepted: 10/15/2015] [Indexed: 12/27/2022]
Abstract
UNLABELLED To assess whether joint pain or radiographic osteoarthritis (ROA) of the knee and hand is associated with all-cause and disease-specific mortality in middle-aged women. METHODS Four subgroups from the prospective community-based Chingford Cohort Study were identified based on presence/absence of pain and ROA at baseline: (Pain-/ROA-; Pain+/ROA-; Pain-/ROA+; Pain+/ROA+). Pain was defined as side-specific pain in the preceding month, while side-specific ROA was defined as Kellgren-Lawrence grade ≥2. All-cause, cardiovascular disease (CVD) and cancer-related mortality over the 23-year follow-up was based on information collected by the Office for National Statistics. Associations between subgroups and all-cause/cause-specific mortality were assessed using Cox regression, adjusting for age, body mass index, typical cardiovascular risk factors, occupation, past physical activity, existing CVD disease, glucose levels and medication use. RESULTS 821 and 808 women were included for knee and hand analyses, respectively. Compared with the knee Pain-/ROA- group, the Pain+/ROA- group had an increased risk of CVD-specific mortality (HR 2.93 (95% CI 1.47 to 5.85)), while the knee Pain+/ROA+ group had an increased HR of 1.97 (95% CI 1.23 to 3.17) for all-cause and 3.57 (95% CI 1.53 to 8.34) for CVD-specific mortality. We found no association between hand OA and mortality. CONCLUSION We found a significantly increased risk of all-cause and CVD-specific mortality in women experiencing knee pain with or without ROA but not ROA alone. No relationship was found between hand OA and mortality risk. This suggests that knee pain, more than structural changes of OA is the main driver of excess mortality in patients with OA.
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Affiliation(s)
- S Kluzek
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
| | - M T Sanchez-Santos
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
| | - K M Leyland
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
| | - A Judge
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - T D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - D Hart
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - C Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
| | - J Newton
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK
| | - N K Arden
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK Arthritis Research UK Centre for Sport, Exercise and Osteoarthritis, University of Oxford, Oxford, UK MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital, Southampton, UK
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Sharma L, Nevitt M, Hochberg M, Guermazi A, Roemer FW, Crema M, Eaton C, Jackson R, Kwoh K, Cauley J, Almagor O, Chmiel JS. Clinical significance of worsening versus stable preradiographic MRI lesions in a cohort study of persons at higher risk for knee osteoarthritis. Ann Rheum Dis 2016; 75:1630-6. [PMID: 26467570 PMCID: PMC4833701 DOI: 10.1136/annrheumdis-2015-208129] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Accepted: 09/20/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND Whether preradiographic lesions in knees at risk for osteoarthritis are incidental versus disease is unclear. We hypothesised, in persons without but at higher risk for knee osteoarthritis, that: 12-48 month MRI lesion status worsening is associated with 12-48 month incident radiographic osteoarthritis (objective component of clinical definition of knee osteoarthritis) and 48-84 month persistent symptoms. METHODS In 849 Osteoarthritis Initiative participants Kellgren/Lawrence (KL) 0 in both knees, we assessed cartilage damage, bone marrow lesions (BMLs), and menisci on 12 month (baseline) and 48 month MRIs. Multivariable logistic regression was used to evaluate associations between 12-48 month worsening versus stable status and outcome (12-48 month incident KL ≥1 and KL ≥2, and 48-84 month persistent symptoms defined as frequent symptoms or medication use most days of ≥1 month in past 12 month, at consecutive visits 48-84 months), adjusting for age, gender, body mass index (BMI), injury and surgery. RESULTS Mean age was 59.6 (8.8), BMI 26.7 (4.2) and 55.9% were women. 12-48 month status worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs was associated with 12-48 month incident radiographic outcomes, and worsening of cartilage damage and BMLs with 48-84 month persistent symptoms. There was a dose-response association for magnitude of worsening of cartilage damage, meniscal tear, meniscal extrusion, and BMLs and radiographic outcomes, and cartilage damage and BMLs and persistent symptoms. CONCLUSIONS In persons at higher risk, worsening MRI lesion status was associated with concurrent incident radiographic osteoarthritis and subsequent persistent symptoms. These findings suggest that such lesions represent early osteoarthritis, and add support for a paradigm shift towards investigation of intervention effectiveness at this stage.
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Affiliation(s)
- Leena Sharma
- Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Michael Nevitt
- Epidemiology and Biostatistics, University of California at San Francisco, San Francisco, California, USA
| | - Marc Hochberg
- School of Medicine, University of Maryland, Baltimore, Maryland, USA
| | - Ali Guermazi
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | - Frank W Roemer
- Department of Radiology, Boston University, Boston, Massachusetts, USA
- University of Erlangen-Nuremberg, Erlangen, Germany
| | - Michel Crema
- Department of Radiology, Boston University, Boston, Massachusetts, USA
| | | | | | - Kent Kwoh
- Division of Rheumatology, University of Arizona Arthritis Center, University of Arizona, Tucson, Arizona, USA
| | - Jane Cauley
- Department of Epidemiology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Orit Almagor
- Internal Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Joan S Chmiel
- Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Kim JL, Moon CW, Son YS, Kim SJ. Combined Effect of Bilateral Ovariectomy and Anterior Cruciate Ligament Transection With Medial Meniscectomy on the Development of Osteoarthritis Model. Ann Rehabil Med 2016; 40:583-91. [PMID: 27606264 PMCID: PMC5012969 DOI: 10.5535/arm.2016.40.4.583] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2015] [Accepted: 10/28/2015] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVE To investigate the combined effect of bilateral ovariectomy (OVX) and anterior cruciate ligament transection (ACLT) with medial meniscectomy (MM) on the development of osteoarthritis (OA). METHODS Twenty female 15-week-old Sprague-Dawley rats were used. Five rats in each group underwent bilateral OVX (OVX group), bilateral ACLT with MM (ACLT with MM group), bilateral OVX plus ACLT with MM (OVX plus ACLT with MM group), and sham surgery (SHAM group). All the rats were subjected to treadmill running for 4 weeks. The behavioral evaluation for induction of OA used the number of rears method, and this was conducted at 1, 2, and 4 weeks post-surgery. Bone mineral density (BMD) was calculated with micro-computerized tomography images and the modified Mankin's scoring was used for the histological changes. RESULTS The number of rears in the OVX plus ACLT with MM group decreased gradually and more rapidly in the ACLT with MM group. Histologically, the OVX plus ACLT with MM group had a significantly higher modified Mankin's score than the OVX group (p=0.008) and the SHAM group (p=0.008). BMDs of the OVX plus ACLT with MM group were significantly lower than the SHAM group (p=0.002), and the ACLT with MM group (p=0.003). CONCLUSION We found that bilateral OVX plus ACLT with MM induced definite OA change in terms of histology and BMD compared to bilateral OVX and ACLT with MM alone. Therefore, OVX and ACLT with MM was an appropriate degenerative OA rat model.
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Affiliation(s)
- Jae Lim Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Chang Won Moon
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Young Suk Son
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Sang Jun Kim
- Department of Physical and Rehabilitation Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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40
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Driban JB, Stout AC, Lo GH, Eaton CB, Price LL, Lu B, Barbe MF, McAlindon TE. Best performing definition of accelerated knee osteoarthritis: data from the Osteoarthritis Initiative. Ther Adv Musculoskelet Dis 2016; 8:165-171. [PMID: 27721902 DOI: 10.1177/1759720x16658032] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We evaluated agreement among several definitions of accelerated knee osteoarthritis (AKOA) and construct validity by comparing their individual associations with injury, age, obesity, and knee pain. METHODS We selected knees from the Osteoarthritis Initiative that had no radiographic knee osteoarthritis [Kellgren-Lawrence (KL) 0 or 1] at baseline and had high-quality quantitative medial joint space width (JSW) measures on two or more consecutive visits (n = 1655 knees, 1143 participants). Quantitative medial JSW was based on a semi-automated method and was location specific (x = 0.25). We compared six definitions of AKOA: stringent JSW (averaged): average JSW loss greater than 1.05 mm/year over 4 years; stringent JSW (consistent): JSW loss greater than 1.05 mm/year for at least 2 years; lenient JSW (averaged): average JSW loss greater than 0.25 mm/year over 4 years; lenient JSW (consistent): JSW loss greater than 0.25 mm/year for at least 2 years; comprehensive KL based: progression from no radiographic osteoarthritis to advance-stage osteoarthritis (KL 3 or 4; development of definite osteophyte and joint space narrowing) within 4 years; and lenient KL based: an increase of at least two KL grades within 4 years. RESULTS Over 4 years the incidence rate of AKOA was 0.4%, 0.8%, 15.5%, 22.1%, 12.4%, and 7.2% based on the stringent JSW (averaged and consistent), lenient JSW (averaged and consistent), lenient KL-based definition, and comprehensive KL-based definition. All but one knee that met the stringent JSW definition also met the comprehensive KL-based definition. There was fair substantial agreement between the lenient JSW (averaged), lenient KL-based, and comprehensive KL-based definitions. A comprehensive KL-based definition led to larger effect sizes for injury, age, body mass index, and average pain over 4 years. CONCLUSIONS A comprehensive KL-based definition of AKOA may be ideal because it represents a broader definition of joint deterioration compared with those focused on just joint space or osteophytes alone.
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Affiliation(s)
- Jeffrey B Driban
- Division of Rheumatology, Tufts Medical Center, 800 Washington Street, Box 406, Boston, MA 02111, USA
| | - Alina C Stout
- Division of Rheumatology, Tufts Medical Center, Boston, MA, USA
| | - Grace H Lo
- Medical Care Line and Research Care Line, Houston Health Services Research and Development (HSR&D) Center of Excellence Michael E. DeBakey VAMC, Houston, TX, USA
| | - Charles B Eaton
- Center for Primary Care and Prevention, Alpert Medical School of Brown University, Pawtucket, RI, USA
| | - Lori Lyn Price
- The Institute for Clinical Research and Health Policy Studies, Tufts Medical Center, Boston, MA, USA
| | - Bing Lu
- Brigham & Women's Hospital and Harvard Medical School, Boston, MA, USA
| | - Mary F Barbe
- Department of Anatomy and Cell Biology, Temple University School of Medicine, Philadelphia, PA, USA
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Klara K, Collins JE, Gurary E, Elman SA, Stenquist DS, Losina E, Katz JN. Reliability and Accuracy of Cross-sectional Radiographic Assessment of Severe Knee Osteoarthritis: Role of Training and Experience. J Rheumatol 2016; 43:1421-6. [PMID: 27084912 DOI: 10.3899/jrheum.151300] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/09/2016] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To dêtermine the reliability of radiographic assessment of knee osteoarthritis (OA) by nonclinician readers compared to an experienced radiologist. METHODS The radiologist trained 3 nonclinicians to evaluate radiographic characteristics of knee OA. The radiologist and nonclinicians read preoperative films of 36 patients prior to total knee replacement. Intrareader and interreader reliability were measured using the weighted κ statistic and intraclass correlation coefficient (ICC). Scores κ < 0.20 indicated slight agreement, 0.21-0.40 fair, 0.41-0.60 moderate, 0.61-0.80 substantial, and 0.81-1.0 almost perfect agreement. RESULTS Intrareader reliability among nonclinicians (κ) ranged from 0.40 to 1.0 for individual radiographic features and 0.72 to 1.0 for Kellgren-Lawrence (KL) grade. ICC ranged from 0.89 to 0.98 for the Osteoarthritis Research Society International (OARSI) summary score. Interreader agreement among nonclinicians ranged from κ of 0.45 to 0.94 for individual features, and 0.66 to 0.97 for KL grade. ICC ranged from 0.87 to 0.96 for the OARSI Summary Score. Interreader reliability between nonclinicians and the radiologist ranged from κ of 0.56 to 0.85 for KL grade. ICC ranged from 0.79 to 0.88 for the OARSI Summary Score. CONCLUSION Intrareader and interreader agreement was variable for individual radiograph features but substantial for summary KL grade and OARSI Summary Score. Investigators face tradeoffs between cost and reader experience. These data suggest that in settings where costs are constrained, trained nonclinicians may be suitable readers of radiographic knee OA, particularly if a summary score (KL grade or OARSI Score) is used to determine radiographic severity.
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Affiliation(s)
- Kristina Klara
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School
| | - Jamie E Collins
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School
| | - Ellen Gurary
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School
| | - Scott A Elman
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School
| | - Derek S Stenquist
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School
| | - Elena Losina
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School
| | - Jeffrey N Katz
- From the Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and the Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital; the Department of Biostatistics, Boston University School of Public Health; and Harvard Medical School; Boston, Massachusetts, USA.K. Klara, BS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital; J.E. Collins, PhD, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Gurary, MS, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health; S.A. Elman, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; D.S. Stenquist, BA, Orthopedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, and Harvard Medical School; E. Losina, PhD, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, and Department of Biostatistics, Boston University School of Public Health, and Harvard Medical School; J.N. Katz, MD, MS, Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, and Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, and Harvard Medical School.
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Goulston L, Sanchez-Santos M, D'Angelo S, Leyland K, Hart D, Spector T, Cooper C, Dennison E, Hunter D, Arden N. A comparison of radiographic anatomic axis knee alignment measurements and cross-sectional associations with knee osteoarthritis. Osteoarthritis Cartilage 2016; 24:612-22. [PMID: 26700504 PMCID: PMC4819520 DOI: 10.1016/j.joca.2015.11.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2015] [Revised: 11/02/2015] [Accepted: 11/17/2015] [Indexed: 02/02/2023]
Abstract
OBJECTIVE Malalignment is associated with knee osteoarthritis (KOA), however, the optimal anatomic axis (AA) knee alignment measurement on a standard limb radiograph (SLR) is unknown. This study compares one-point (1P) and two-point (2P) AA methods using three knee joint centre locations and examines cross-sectional associations with symptomatic radiographic knee osteoarthritis (SRKOA), radiographic knee osteoarthritis (RKOA) and knee pain. METHODS AA alignment was measured six different ways using the KneeMorf software on 1058 SLRs from 584 women in the Chingford Study. Cross-sectional associations with principal outcome SRKOA combined with greatest reproducibility determined the optimal 1P and 2P AA method. Appropriate varus/neutral/valgus alignment categories were established using logistic regression with generalised estimating equation models fitted with restricted cubic spline function. RESULTS The tibial plateau centre displayed greatest reproducibility and associations with SRKOA. As mean 1P and 2P values differed by >2°, new alignment categories were generated for 1P: varus <178°, neutral 178-182°, valgus >182° and for 2P methods: varus <180°, neutral 180-185°, valgus >185°. Varus vs neutral alignment was associated with a near 2-fold increase in SRKOA and RKOA, and valgus vs neutral for RKOA using 2P method. Nonsignificant associations were seen for 1P method for SRKOA, RKOA and knee pain. CONCLUSIONS AA alignment was associated with SRKOA and the tibial plateau centre had the strongest association. Differences in AA alignment when 1P vs 2P methods were compared indicated bespoke alignment categories were necessary. Further replication and validation with mechanical axis alignment comparison is required.
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Affiliation(s)
- L.M. Goulston
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - M.T. Sanchez-Santos
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Arthritis Research UK Sports Exercise and Osteoarthritis Centre of Excellence, University of Oxford, UK
| | - S. D'Angelo
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - K.M. Leyland
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Arthritis Research UK Sports Exercise and Osteoarthritis Centre of Excellence, University of Oxford, UK
| | - D.J. Hart
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - T.D. Spector
- Department of Twin Research & Genetic Epidemiology, King's College London, London, UK
| | - C. Cooper
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - E.M. Dennison
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK
| | - D. Hunter
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Chromatic Innovation Limited, Leamington Spa, UK
| | - N.K. Arden
- MRC Lifecourse Epidemiology Unit, Faculty of Medicine, University of Southampton, Southampton, UK,Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK,Arthritis Research UK Sports Exercise and Osteoarthritis Centre of Excellence, University of Oxford, UK,Address correspondence and reprint requests to: N.K. Arden, Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK. Tel: 44-(0)1865-737859; Fax: 44-(0)1865-227966.
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43
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Kluzek S, Bay-Jensen AC, Judge A, Karsdal MA, Shorthose M, Spector T, Hart D, Newton JL, Arden NK. Serum cartilage oligomeric matrix protein and development of radiographic and painful knee osteoarthritis. A community-based cohort of middle-aged women. Biomarkers 2016; 20:557-64. [PMID: 26848781 PMCID: PMC4819573 DOI: 10.3109/1354750x.2015.1105498] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Revised: 07/07/2015] [Accepted: 07/07/2015] [Indexed: 12/15/2022]
Abstract
CONTEXT AND OBJECTIVE We evaluated the predictive value of serum cartilage oligomeric matrix protein (sCOMP) levels over 20 years on the development of radiographic (RKOA) and painful knee osteoarthritis (KOA) in a longitudinal cohort of middle-aged women. MATERIALS AND METHODS Five hundred and ninety-three women with no baseline KOA underwent 5-year knee radiographs over 20-years and were asked about knee pain a month before each assessment. A repeated measures logistic regression model was used where the outcomes were recorded at 5, 10, 15 and 20-years follow-up. RESULTS The highest quartile of sCOMP was associated with increased risk of RKOA with overall OR of 1.97 (95% CI: 1.33-2.91) over 20 years when compared with the lowest sCOMP quartile. The association with painful KOA was similar and also independent, but only when the fourth and third sCOMP quartiles were compared. DISCUSSION AND CONCLUSION This study demonstrates that sCOMP levels are predictive of subsequent structural changes and incidence of painful KOA, independently of age and BMI.
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Affiliation(s)
- Stefan Kluzek
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford,
Oxford,
UK
- Arthritis Research UK Sports, Exercise and Osteoarthritis Centre of Excellence, University of Oxford,
Oxford,
UK
| | | | - Andrew Judge
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford,
Oxford,
UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital,
Southampton,
UK
| | | | | | - Tim Spector
- Department of Twin Research and Genetic Epidemiology, King’s College London,
London,
UK
| | - Deborah Hart
- Department of Twin Research and Genetic Epidemiology, King’s College London,
London,
UK
| | - Julia L. Newton
- Arthritis Research UK Sports, Exercise and Osteoarthritis Centre of Excellence, University of Oxford,
Oxford,
UK
| | - Nigel K. Arden
- Oxford NIHR Musculoskeletal Biomedical Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford,
Oxford,
UK
- Arthritis Research UK Sports, Exercise and Osteoarthritis Centre of Excellence, University of Oxford,
Oxford,
UK
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton General Hospital,
Southampton,
UK
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44
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Trencart P, Alexander K, De Lasalle J, Laverty S. Radiographic evaluation of the width of the femorotibial joint space in horses. Am J Vet Res 2016; 77:127-36. [DOI: 10.2460/ajvr.77.2.127] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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45
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Defining the presence of radiographic knee osteoarthritis: a comparison between the Kellgren and Lawrence system and OARSI atlas criteria. Knee Surg Sports Traumatol Arthrosc 2015; 23:3532-9. [PMID: 25079135 DOI: 10.1007/s00167-014-3205-0] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2013] [Accepted: 07/21/2014] [Indexed: 12/31/2022]
Abstract
PURPOSE The Kellgren and Lawrence (K/L) system and Osteoarthritis Research Society International (OARSI) atlas are frequently used to define radiographic knee osteoarthritis (OA). The purpose of the current study was to determine the extent to which tibiofemoral OA rates differ between the K/L system and OARSI atlas criteria and to compare qualitative (K/L and OARSI) and quantitative (millimetres) measures of joint space narrowing (JSN). METHODS Posteroanterior radiographs of 1,178 knees, from 621 individuals with varying severity of OA, were graded by a trained physician with the K/L system (grade 0-4) and the OARSI atlas (osteophytes/JSN graded 0-3). Using the K/L system, the presence of OA was defined with the traditional cut-off of ≥grade 2 (definite osteophyte and possible JSN) and an alternative cut-off of at least a definite osteophyte alone (≥grade 2/osteophyte). For the OARSI atlas, OA was considered present if the sum of osteophytes or JSN ≥grade 2, or grade 1 JSN occurred in combination with grade 1 osteophyte. Minimum joint space width (mJSW) was measured manually in millimetres. RESULTS According to the K/L system (≥grade 2), 167 knees (14.2 %) had tibiofemoral OA and 203 (17.3 %) had ≥grade 2/osteophyte. In contrast, 309 knees (26.2 %) had tibiofemoral OA according to OARSI atlas criteria. K/L and OARSI JSN descriptions were significantly associated with mJSW (p < 0.022). CONCLUSIONS Radiographic tibiofemoral OA was almost twice as common using OARSI atlas criteria compared with the K/L system. This discrepancy is likely to contribute to the large variability of OA prevalence observed in the literature and is important for clinicians to consider when diagnosing radiographic OA. The cut-off for defining radiographic knee OA using the two systems should not be considered comparable. LEVEL OF EVIDENCE III.
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46
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Hirvasniemi J, Thevenot J, Kokkonen HT, Finnilä MA, Venäläinen MS, Jämsä T, Korhonen RK, Töyräs J, Saarakkala S. Correlation of Subchondral Bone Density and Structure from Plain Radiographs with Micro Computed Tomography Ex Vivo. Ann Biomed Eng 2015; 44:1698-709. [PMID: 26369637 PMCID: PMC4696139 DOI: 10.1007/s10439-015-1452-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/04/2015] [Indexed: 12/01/2022]
Abstract
Osteoarthritis causes changes in the subchondral bone structure and composition. Plain radiography is a cheap, fast, and widely available imaging method. Bone tissue can be well seen from plain radiograph, which however is only a 2D projection of the actual 3D structure. Therefore, the aim was to investigate the relationship between bone density- and structure-related parameters from 2D plain radiograph and 3D bone parameters assessed from micro computed tomography (µCT) ex vivo. Right tibiae from eleven cadavers without any diagnosed joint disease were imaged using radiography and with µCT. Bone density- and structure-related parameters were calculated from four different locations from the radiographs of proximal tibia and compared with the volumetric bone microarchitecture from the corresponding regions. Bone density from the plain radiograph was significantly related with the bone volume fraction (r = 0.86; n = 44; p < 0.01). Mean homogeneity index for orientation of local binary patterns (HIangle,mean) and fractal dimension of vertical structures (FDVer) were related (p < 0.01) with connectivity density (HIangle,mean: r = −0.73, FDVer: r = 0.69) and trabecular separation (HIangle,mean: r = 0.73, FDVer: r = −0.70) when all ROIs were pooled together (n = 44). Bone density and structure in tibia from standard clinically available 2D radiographs are significantly correlated with true 3D microstructure of bone.
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Affiliation(s)
- Jukka Hirvasniemi
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland. .,Infotech Oulu, University of Oulu, Oulu, Finland.
| | - Jérôme Thevenot
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland
| | - Harri T Kokkonen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland
| | - Mikko A Finnilä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
| | - Mikko S Venäläinen
- Department of Applied Physics, University of Eastern Finland, Kuopio, Finland.,Cancer Center, Kuopio University Hospital, Kuopio, Finland
| | - Timo Jämsä
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
| | - Rami K Korhonen
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Juha Töyräs
- Diagnostic Imaging Center, Kuopio University Hospital, Kuopio, Finland.,Department of Applied Physics, University of Eastern Finland, Kuopio, Finland
| | - Simo Saarakkala
- Research Unit of Medical Imaging, Physics and Technology, Faculty of Medicine, University of Oulu, POB 5000, 90014, Oulu, Finland.,Infotech Oulu, University of Oulu, Oulu, Finland.,Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland.,Department of Diagnostic Radiology, Oulu University Hospital, Oulu, Finland
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47
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Sheehy L, Cooke TDV. Radiographic assessment of leg alignment and grading of knee osteoarthritis: A critical review. World J Rheumatol 2015; 5:69-81. [DOI: 10.5499/wjr.v5.i2.69] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/18/2014] [Revised: 02/25/2015] [Accepted: 05/06/2015] [Indexed: 02/06/2023] Open
Abstract
Knee osteoarthritis (OA) is a progressive joint disease hallmarked by cartilage and bone breakdown and associated with changes to all of the tissues in the joint, ultimately causing pain, stiffness, deformity and disability in many people. Radiographs are commonly used for the clinical assessment of knee OA incidence and progression, and to assess for risk factors. One risk factor for the incidence and progression of knee OA is malalignment of the lower extremities (LE). The hip-knee-ankle (HKA) angle, assessed from a full-length LE radiograph, is ideally used to assess LE alignment. Careful attention to LE positioning is necessary to obtain the most accurate measurement of the HKA angle. Since full-length LE radiographs are not always available, the femoral shaft - tibial shaft (FS-TS) angle may be calculated from a knee radiograph instead. However, the FS-TS angle is more variable than the HKA angle and it should be used with caution. Knee radiographs are used to assess the severity of knee OA and its progression. There are three types of ordinal grading scales for knee OA: global, composite and individual feature scales. Each grade on a global scale describes one or more features of knee OA. The entire description must be met for a specific grade to be assigned. The Kellgren-Lawrence scale is the most commonly-used global scale. Composite scales grade several features of knee OA individually and sum the grades to create a total score. One example is the compartmental grading scale for knee OA. Composite scales can respond to change in a variety of presentations of knee OA. Individual feature scales assess one or more OA features individually and do not calculate a total score. They are most often used to monitor change in one OA feature, commonly joint space narrowing. The most commonly-used individual feature scale is the OA Research Society International atlas. Each type of scale has its advantages; however, composite scales may offer greater content validity. Responsiveness to change is unknown for most scales and deserves further evaluation.
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48
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Liao CD, Huang YC, Lin LF, Huang SW, Liou TH. Body Mass Index and Functional Mobility Outcome Following Early Rehabilitation After a Total Knee Replacement: A Retrospective Study in Taiwan. Arthritis Care Res (Hoboken) 2015; 67:799-808. [DOI: 10.1002/acr.22474] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2014] [Revised: 08/13/2014] [Accepted: 09/02/2014] [Indexed: 12/13/2022]
Affiliation(s)
- Chun-de Liao
- Shuang Ho Hospital, Taipei Medical University; Taipei Taiwan
| | - Yi-Ching Huang
- National Taipei University of Nursing and Health Sciences; Taipei Taiwan
| | - Li-Fong Lin
- Shuang Ho Hospital, Taipei Medical University; Taipei Taiwan
| | - Shih-Wei Huang
- Shuang Ho Hospital, Taipei Medical University; Taipei Taiwan
| | - Tsan-Hon Liou
- Shuang Ho Hospital and Graduate Institute of Injury Prevention and Control, Taipei Medical University; Taipei Taiwan
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49
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Hardcastle SA, Dieppe P, Gregson CL, Arden NK, Spector TD, Hart DJ, Edwards MH, Dennison EM, Cooper C, Sayers A, Williams M, Davey Smith G, Tobias JH. Individuals with high bone mass have an increased prevalence of radiographic knee osteoarthritis. Bone 2015; 71:171-9. [PMID: 25445455 PMCID: PMC4289915 DOI: 10.1016/j.bone.2014.10.015] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/13/2014] [Accepted: 10/23/2014] [Indexed: 02/02/2023]
Abstract
We previously reported an association between high bone mass (HBM) and a bone-forming phenotype of radiographic hip osteoarthritis (OA). As knee and hip OA have distinct risk factors, in this study we aimed to determine (i) whether HBM is also associated with knee OA, and (ii) whether the HBM knee OA phenotype demonstrates a similar pattern of radiographic features to that observed at the hip. HBM cases (defined by DXA BMD Z-scores) from the UK-based HBM study were compared with unaffected family controls and general population controls from the Chingford and Hertfordshire cohort studies. A single blinded observer graded AP weight-bearing knee radiographs for features of OA (Kellgren-Lawrence score, osteophytes, joint space narrowing (JSN), sclerosis) using an atlas. Analyses used logistic regression, adjusting a priori for age and gender, and additionally for BMI as a potential mediator of the HBM-OA association, using Stata v12. 609 HBM knees in 311 cases (mean age 60.8years, 74% female) and 1937 control knees in 991 controls (63.4years, 81% female) were analysed. The prevalence of radiographic knee OA, defined as Kellgren-Lawrence grade≥2, was increased in cases (31.5% vs. 20.9%), with age and gender adjusted OR [95% CI] 2.38 [1.81, 3.14], p<0.001. The association between HBM and osteophytosis was stronger than that for JSN, both before and after adjustment for BMI which attenuated the ORs for knee OA and osteophytes in cases vs. controls by approximately 50%. Our findings support a positive association between HBM and knee OA. This association was strongest for osteophytes, suggesting HBM confers a general predisposition to a subtype of OA characterised by increased bone formation.
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Affiliation(s)
- S A Hardcastle
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK; MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, UK.
| | - P Dieppe
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK; University of Exeter Medical School, Exeter, UK
| | - C L Gregson
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - N K Arden
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; Arthritis Research UK (ARUK) Centre for Sports, Exercise and Osteoarthritis, University of Oxford, Nuffield Orthopaedic Centre, Oxford, UK
| | - T D Spector
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - D J Hart
- Department of Twin Research and Genetic Epidemiology, King's College London, London, UK
| | - M H Edwards
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - E M Dennison
- MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK
| | - C Cooper
- Oxford NIHR Musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK; MRC Lifecourse Epidemiology Unit, University of Southampton, Southampton, UK; NIHR Nutrition Biomedical Research Centre, University of Southampton, Southampton, UK
| | - A Sayers
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
| | - M Williams
- Department of Radiology, North Bristol NHS Trust, Bristol, UK
| | - G Davey Smith
- MRC Integrative Epidemiology Unit, School of Social and Community Medicine, University of Bristol, UK
| | - J H Tobias
- Musculoskeletal Research Unit, School of Clinical Sciences, University of Bristol, UK
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50
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Kerkhof HJM, Bierma-Zeinstra SMA, Arden NK, Metrustry S, Castano-Betancourt M, Hart DJ, Hofman A, Rivadeneira F, Oei EHG, Spector TD, Uitterlinden AG, Janssens ACJW, Valdes AM, van Meurs JBJ. Prediction model for knee osteoarthritis incidence, including clinical, genetic and biochemical risk factors. Ann Rheum Dis 2014; 73:2116-21. [PMID: 23962456 DOI: 10.1136/annrheumdis-2013-203620] [Citation(s) in RCA: 102] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To develop and validate a prognostic model for incident knee osteoarthritis (KOA) in a general population and determine the value of different risk factor groups to prediction. METHODS The prognostic model was developed in 2628 individuals from the Rotterdam Study-I (RS-I). Univariate and multivariate analyses were performed for questionnaire/easily obtainable variables, imaging variables, genetic and biochemical markers. The extended multivariate model was tested on discrimination (receiver operating characteristic curve and area under the curve (AUC)) in two other population-based cohorts: Rotterdam Study-II and Chingford Study. RESULTS In RS-I, there was moderate predictive value for incident KOA based on the genetic score alone in subjects aged <65 years (AUC 0.65), while it was only 0.55 for subjects aged ≥65 years. The AUC for gender, age and body mass index (BMI) in prediction for KOA was 0.66. Addition of the questionnaire variables, genetic score or biochemical marker urinary C-terminal cross-linked telopeptide of type II collagen to the model did not change the AUC. However, when adding the knee baseline KL score to the model the AUC increased to 0.79. Applying external validation, similar results were observed in the Rotterdam Study-II and the Chingford Study. CONCLUSIONS Easy obtainable 'Questionnaire' variables, genetic markers, OA at other joint sites and biochemical markers add only modestly to the prediction of KOA incidence using age, gender and BMI in an elderly population. Doubtful minor radiographic degenerative features in the knee, however, are a very strong predictor of future KOA. This is an important finding, as many radiologists do not report minor degenerative changes in the knee.
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Affiliation(s)
- H J M Kerkhof
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, Rotterdam, The Netherlands
| | - S M A Bierma-Zeinstra
- Department of General Practice, Erasmus MC, Rotterdam, The Netherlands Department of Orthopaedics, Erasmus MC, Rotterdam, The Netherlands
| | - N K Arden
- NIHR musculoskeletal Biomedical Research Unit, University of Oxford, Oxford, UK
| | - S Metrustry
- Department of Twin Research, King's College London, London, UK
| | - M Castano-Betancourt
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, Rotterdam, The Netherlands
| | - D J Hart
- Department of Twin Research, King's College London, London, UK
| | - A Hofman
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - F Rivadeneira
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - E H G Oei
- Department of Radiology, Erasmus MC, Rotterdam, The Netherlands
| | - Tim D Spector
- Department of Twin Research, King's College London, London, UK
| | - A G Uitterlinden
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, Rotterdam, The Netherlands Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - A C J W Janssens
- Department of Epidemiology, Erasmus MC, Rotterdam, The Netherlands
| | - A M Valdes
- Department of Twin Research, King's College London, London, UK Department of Academic Rheumatology, University of Nottingham, UK
| | - J B J van Meurs
- Department of Internal Medicine, Erasmus MC, Rotterdam, The Netherlands The Netherlands Genomics Initiative-sponsored Netherlands Consortium for Healthy Aging, Rotterdam, The Netherlands
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