Synovitis is believed to play a role in producing symptoms in persons with hand osteoarthritis, but data on slow-acting anti-inflammatory treatments are sparse.
To determine the effectiveness of ...hydroxychloroquine versus placebo as an analgesic treatment of hand osteoarthritis.
Randomized, double-blind, placebo-controlled clinical trial with 12-month follow-up. (ISRCTN registry number: ISRCTN91859104).
13 primary and secondary care centers in England.
Of 316 patients screened, 248 participants (82% women; mean age, 62.7 years) with symptomatic (pain ≥4 on a 0- to 10-point visual analogue scale) and radiographic hand osteoarthritis were randomly assigned and 210 (84.7%) completed the 6-month primary end point.
Hydroxychloroquine (200 to 400 mg) or placebo (1:1) for 12 months with ongoing usual care.
The primary end point was average hand pain during the previous 2 weeks (on a 0- to 10-point numerical rating scale NRS) at 6 months. Secondary end points included self-reported pain and function, grip strength, quality of life, radiographic structural change, and adverse events. Baseline ultrasonography was done.
At 6 months, mean hand pain was 5.49 points in the placebo group and 5.66 points in the hydroxychloroquine group, with a treatment difference of -0.16 point (95% CI, -0.73 to 0.40 point) (P = 0.57). Results were robust to adjustments for adherence, missing data, and use of rescue medication. No significant treatment differences existed at 3, 6, or 12 months for any secondary outcomes. The percentage of participants with at least 1 joint with synovitis was 94% (134 of 143) on grayscale ultrasonography and 59% on power Doppler. Baseline structural damage or synovitis did not affect treatment response. Fifteen serious adverse events were reported (7 in the hydroxychloroquine group 3 defined as possibly related and 8 in the placebo group).
Hydroxychloroquine dosage restrictions may have reduced efficacy.
Hydroxychloroquine was no more effective than placebo for pain relief in patients with moderate to severe hand pain and radiographic osteoarthritis.
Arthritis Research UK.
Objective
It is unclear what impact obesity has on the progression of knee osteoarthritis (OA) from diagnosis to knee replacement surgery. This study was undertaken to examine the relative risk of ...knee replacement surgery in overweight and obese patients who were newly diagnosed as having knee OA in a community setting.
Methods
Subjects were selected from the Information System for Development of Primary Care Research database, which compiles comprehensive clinical information collected by health care professionals for >5.5 million people in Catalonia, Spain (80% of the population). Patients newly diagnosed as having knee OA in primary care between 2006 and 2011 were included. Knee replacement was ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification codes from linked hospital admissions data. Multivariable Cox regression models were fitted for knee replacement according to body mass index (BMI), and were adjusted for relevant confounders. Population proportional attributable risk was calculated.
Results
A total of 105,189 participants were followed up for a median of 2.6 years (interquartile range 1.3–4.2). Of these patients, 7,512 (7.1%) underwent knee replacement. Adjusted hazard ratios and 95% confidence intervals (95% CIs) for knee replacement for the World Health Organization BMI categories were 1.41 (95% CI 1.27–1.57) for overweight, 1.97 (95% CI 1.78–2.18) for obese I, 2.39 (95% CI 2.15–2.67) for obese II, and 2.67 (95% CI 2.34–3.04) for obese III compared to normal weight. The effect of BMI on risk of knee replacement was stronger among younger participants. The population attributable risk of obesity for knee OA–related knee replacement was 31.0%.
Conclusion
Overweight and obese patients are at >40% and 100% increased risk of knee replacement surgery, respectively, compared to patients with normal weight. This association is even stronger in younger patients. Weight reduction strategies could potentially reduce the need for knee replacement surgery by 31% among patients with knee OA.
To investigate the relationship between baseball pitching biomechanics and pain, injury, or surgery, in pitchers of all ages and competition levels.
Systematic review.
This study was registered on ...Prospero (CRD42019137462). Four online databases (MEDLINE, SPORTDiscus, CINAHL, and Embase) from inception to June 13, 2019 were systematically searched. Risk of bias was assessed through the modified Downs and Black.
967 titles/abstracts were screened with 11 studies (1376 pitchers) included. Four studies used 3D biomechanical analyses, five studies video analysis, and two studies evaluated EMG activity. Level 1b evidence suggests that injured pitchers had greater elbow valgus torque at late arm cocking (injured: 91.6Nm, non-injured: 74.7Nm, p=0.013) and early trunk rotation was predictive of increased upper extremity surgical risk (Hazard Ratio: 1.69 (95% CI 1.02–2.80)). Level 3b evidence observed pitchers with upper extremity surgical history had greater lateral trunk tilt at release (surgery: 29.3°, controls: 23.4°, p=0.035), and flexor carpi ulnaris EMG activity was decreased (injured: 68% MMT, controls: 103% MMT) in pitchers with elbow injury.
Increased elbow valgus torque and early trunk rotation were injury risk factors, and elbow injured pitchers displayed diminished forearm muscle activity. Due to the low power of many of these studies, and the lack of prospective 3D biomechanical studies, other pitching biomechanical variables cannot be ascertained as injury risk factors. Future studies are needed to prospectively assess pitching injury risk through 3D biomechanical methods.
Background
Osteoarthritis (OA) is a chronic joint disease, with increasing global burden of disability and healthcare utilisation. Recent meta-analyses have shown a range of effects of OA on ...mortality, reflecting different OA definitions and study methods. We seek to overcome limitations introduced when using aggregate results by gathering individual participant-level data (IPD) from international observational studies and standardising methods to determine the association of knee OA with mortality in the general population.
Methods
Seven community-based cohorts were identified containing knee OA-related pain, radiographs, and time-to-mortality, six of which were available for analysis. A two-stage IPD meta-analysis framework was applied: (1) Cox proportional hazard models assessed time-to-mortality of participants with radiographic OA (ROA), OA-related pain (POA), and a combination of pain and ROA (PROA) against pain and ROA-free participants; (2) hazard ratios (HR) were then pooled using the Hartung–Knapp modification for random-effects meta-analysis.
Findings
10,723 participants in six cohorts from four countries were included in the analyses. Multivariable models (adjusting for age, sex, race, BMI, smoking, alcohol consumption, cardiovascular disease, and diabetes) showed a pooled HR, compared to pain and ROA-free participants, of 1.03 (0.83, 1.28) for ROA, 1.35 (1.12, 1.63) for POA, and 1.37 (1.22, 1.54) for PROA.
Discussion
Participants with POA or PROA had a 35–37% increased association with reduced time-to-mortality, independent of confounders. ROA showed no association with mortality, suggesting that OA-related knee pain may be driving the association with time-to-mortality.
Funding
Versus Arthritis Centre for Sport, Exercise and Osteoarthritis and Osteoarthritis Research Society International.
To assess the uptake of the OMERACT-OARSI (Outcome Measures in Rheumatology- Osteoarthritis Research Society International) core outcome set (COS) domains in hip and/or knee osteoarthritis (OA) ...trials.
There were 382 trials of hip and/or knee OA identified from the ClinicalTrial.gov registry from 1997 to 2017. Frequency of COS adoption was assessed by year and per 5-yearly phases.
COS adoption decreased from 61% between 1997 and 2001 to 38% between 2012 and 2016. Pain (95%) and physical function (86%) were most consistently adopted. Patient's global assessment (48%) was the principal missing domain.
Limited adoption of the COS domains indicates that further consideration to improve uptake is required.
Abstract
Objective
To estimate the lifetime risk of knee and hip replacement following a diagnosis of RA.
Methods
The analysis was undertaken using routinely collected data from the English NHS. ...Diagnosis of RA was identified using primary care records, with knee and hip replacement observed in linked hospital records. Parametric survival models were fitted for up to 15 years of follow-up, with age, sex, Charlson comorbidity score, socioeconomic status, BMI and smoking status included as explanatory variables. A decision model was used to combine and extrapolate survival models to estimate lifetime risk.
Results
The number of individuals with a diagnosis of RA and included in the study was 13 961. Lifetime risk of knee replacement and hip replacement was estimated to be 22% (95% CI: 16, 29%) and 17% (95% CI: 11, 26%) following a diagnosis of RA for the average patient profile (non-smoking women aged 64 with no other comorbidities, BMI of 27 and in the top socioeconomic quintile). Risks were higher for younger patients.
Conclusion
The lifetime risk of knee and hip replacement for individuals with a diagnosis of RA is approximately double that of the general population. These findings allow for a better understanding of long-term prognosis and healthcare resource use, and highlight the importance of timely diagnosis and effective treatment.
Study Design Clinical measurement, cross-sectional. Background Individuals who have undergone anterior cruciate ligament (ACL) reconstruction commonly experience long-term impairments in quality of ...life (QoL), which may be related to persistent knee symptoms or radiographic osteoarthritis (ROA). Understanding the impact of knee symptoms and ROA on QoL after ACL reconstruction may assist in the development of appropriate management strategies. Objectives To (1) compare QoL between groups of individuals after ACL reconstruction (including those who are symptomatic with ROA, symptomatic without ROA, and asymptomatic unknown ROA status), and (2) identify specific aspects of QoL impairment in symptomatic individuals with and without ROA post ACL reconstruction. Methods One hundred thirteen participants completed QoL measures (Knee injury and Osteoarthritis Outcome Score QoL subscale KOOS-QoL, Anterior Cruciate Ligament Quality of Life ACL-QoL, Assessment of Quality of Life-8 Dimensions AQoL-8D) 5 to 20 years after ACL reconstruction. Eighty-one symptomatic individuals underwent radiographs, and 32 asymptomatic individuals formed a comparison group. Radiographic osteoarthritis was defined as a Kellgren-Lawrence grade of 2 or greater for the tibiofemoral and/or patellofemoral joints. Mann-Whitney U tests compared outcomes between groups. Individual ACL-QoL items were used to explore specific aspects of QoL. Results In symptomatic individuals after ACL reconstruction, ROA was related to worse knee-related outcomes on the KOOS-QoL (median, 50; interquartile range IQR, 38-69 versus median, 69; IQR, 56-81; P<.001) and the ACL-QoL (median, 51; IQR, 38-71 versus median, 66; IQR, 50-82; P = .04). The AQoL-8D scores showed that health-related QoL was impaired in both symptomatic groups compared to the asymptomatic group. The ACL-QoL item scores revealed greater limitations and concern surrounding sport and exercise and social/emotional difficulties in the symptomatic group with ROA. Conclusion Osteoarthritis is associated with worse knee-related QoL in symptomatic individuals after ACL reconstruction. Diagnosing ROA in symptomatic individuals after ACL reconstruction may be valuable, because these individuals may require unique management. Targeted strategies to facilitate participation in satisfying activities have potential to improve QoL in symptomatic people with ROA after ACL reconstruction. J Orthop Sports Phys Ther 2018;48(5):398-408. doi:10.2519/jospt.2018.7830.
There is a pressing need to develop reliable molecular biomarkers in osteoarthritis. The aim of the study was to identify novel serum biomarkers for osteoarthritis using a metabolomics approach.
A ...two-stage study design was utilised. 123 knee osteoarthritis cases and 299 controls were selected from the TwinsUK cohort as a discovery sample. 76 knee osteoarthritis cases and 100 controls from the Chingford Study were used as replication. Knee osteoarthritis was defined as either radiographic, medically diagnosed or total knee joint replacement due to primary osteoarthritis. All the subjects were unrelated white women. Their serum samples were assessed for targeted metabolite profiling by electrospray ionisation tandem mass spectrometry using the AbsoluteIDQ kit. 163 serum metabolites were assessed and their concentrations obtained. The ratios of metabolite concentrations as proxies for enzymatic reaction rates were calculated and tested for the association with knee osteoarthritis. Significance was assessed after adjustment for multiple testing (Bonferroni method) and potential confounders.
In the discovery stage, the authors identified 14 ratios significantly associated with knee osteoarthritis with p < or = 1.9 x 10(-6). Two of these 14 ratios were successfully confirmed in the replication stage-the ratios of valine to histidine and xleucine to histidine, with p=0.002. The significance remained after adjustment for age and body mass index.
This is the first serum-based metabolomic study of osteoarthritis in humans. The branched-chain amino acids to histidine ratio has potential clinical use as an osteoarthritis biomarker and shows the clinical potential of metabolomics.
ObjectivesTo investigate the rates of return to work and workability among working-age people following total hip arthroplasty (THA).MethodsParticipants from the Geneva Arthroplasty Registry and the ...Clinical Outcomes for Arthroplasty Study aged 18–64 years when they had primary THA and with at least 5 years’ follow-up were mailed a questionnaire 2017–2019. Information was collected about preoperative and post-THA employment along with exposure to physically demanding activities at work or in leisure. Patterns of change of job were explored. Survival analyses using Cox proportional hazard models were created to explore risk factors for having to stop work because of difficulties with the replaced hip.ResultsIn total, 825 returned a questionnaire (response 58%), 392 (48%) men, mean age 58 years, median follow-up 7.5 years post-THA. The majority (93%) of those who worked preoperatively returned to work, mostly in the same sector but higher rates of non-return (36%–41%) were seen among process, plant and machine operatives and workers in elementary occupations. 7% reported subsequently leaving work because of their replaced hip and the risk of this was strongly associated with: standing >4 hours/day (HR 3.81, 95% CI 1.62 to 8.96); kneeling/squatting (HR 3.32, 95% CI 1.46 to 7.55) and/or carrying/lifting ≥10 kg (HR 5.43, 95% CI 2.29 to 12.88).ConclusionsIt may be more difficult to return to some (particularly physically demanding) jobs post-THA than others. Rehabilitation may need to be targeted to these types of workers or it may be that redeployment or job change counselling are required.
•Different latent subgroups of 19-year body mass index (BMI) patterns exist in UK postmenopausal women.•BMI of 27-34 over 19-years was bidirectionally related to knee and multi-site pain.•BMI of ...33-38 over time was unidirectionally associated with hip and knee pain.•Women with BMI>40 had increased all-cause and cardiovascular mortality risk.•Women with BMI 25-27 had no different pain or mortality risk than women with BMI<25.
We aimed to study 19-year body mass index (BMI) patterns and their (1) bidirectional relationship with musculoskeletal pain and (2) mortality risk.
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).
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.
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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