Summary Objective Epidemiological data suggest low serum 25-hydroxyvitamin D3 (25-OH-D3 ) levels are associated with radiological progression of knee osteoarthritis (OA). This study aimed to assess ...whether vitamin D supplementation can slow the rate of progression. Method A 3 year, double-blind, randomised, placebo-controlled trial of 474 patients aged over 50 with radiographically evident knee OA comparing 800 IU cholecalciferol daily with placebo. Primary outcome was difference in rate of medial joint space narrowing (JSN). Secondary outcomes included lateral JSN, Kellgren and Lawrence grade, WOMAC pain, function, stiffness and the Get up and Go test. Results Vitamin D supplementation increased 25-OH-D3 from an average of 20·7 (SD 8·9) μg/L to 30·4 (SD 7·7) μg/L, compared to 20·7 (SD 8·1) μg/L and 20·3 (SD 8·1) μg/L in the placebo group. There was no significant difference in the rate of JSN over three years in the medial compartment of the index knee between the treatment group (average -0.01 mm/year) and placebo group (-0.08 mm/year), average difference 0.08 mm/year, (95% CI -0·14 to 0·29, p=0.49). No significant interaction was found between baseline vitamin D levels and treatment effect. There were no significant differences for any of the secondary outcome measures. Conclusion Vitamin D supplementation did not slow the rate of JSN or lead to reduced pain, stiffness or functional loss over a three year period. On the basis of these findings we consider that vitamin D supplementation has no role in the management of knee OA.
Circulating microRNAs (c-miRs) show promise as biomarkers. This systematic review explores their potential association with age-related fracture/osteoporosis (OP), osteoarthritis (OA) and sarcopenia ...(SP), as well as cross-disease association. Most overlap occurred between OA and OP, suggesting potentially shared microRNA activity. There was little agreement in results across studies. Few reported receiver operating characteristic analysis (ROC) and many identified significant dysregulation in disease, but direction of effect was commonly conflicting. c-miRs with most evidence for consistency in dysregulation included miR-146a, miR-155 and miR-98 for OA (upregulated). Area under the curve (AUC) for miR-146a biomarker performance was AUC 0.92, p = 0.028. miR-125b (AUC 0.76–0.89), miR-100, miR-148a and miR-24 were consistently upregulated in OP. Insufficient evidence exists for c-miRs in SP. Study quality was typically rated intermediate/high risk of bias. Wide study heterogeneity meant meta-analysis was not possible. We provide detailed critique and recommendations for future approaches in c-miR analyses based on this review.
•Circulating microRNAs across 3 musculoskeletal ageing diseases offer new insights•These studies are increasingly common but heterogenous in design.•Studies generally lack rigour and scale, with intermediate-high risk of bias.•Validation rarely done, agreement lacking on direction of change•ROC analyses show good discrimination for some microRNAs but need replication.
Compelling arguments support scaling of group consultations across the National Health Service (NHS) and globally. We need to recognise self‐care is the most important type of care for people with ...long‐term health problems. Healthcare systems like the NHS are essential for diagnosis, acute care and initiating optimal therapy but people are on their own over 99.95% of waking hours. We must accept and encourage the contribution that other people with the same long‐term health problems can make and enable both types of care through face‐to‐face and virtual group consultations. Patients and communities need agency and choice to implement and access these patient‐centred and codesigned care models. This can bring system benefits, mapped to healthcare's quintuple aim, to those electing to use group consultations and even those who do not. The process of both training and delivering group consultation models can create and sustain compassionate communities and this ‘Fourth Healthcare Revolution’ may be exactly what is needed to save primary care.
There is an ongoing concern about the risk of injury to the spine in professional rugby players. The objective of this study was to investigate the prevalence of vertebral fracture using vertebral ...fracture assessment (VFA) dual energy X-ray absorptiometry (DXA) imaging in professional male rugby players. Ninety five professional rugby league (n = 52) and union (n = 43) players (n = 95; age 25.9 (SD 4.3) years; BMI: 29.5 (SD 2.9) kg.m2) participated in the research. Each participant received one VFA, and one total body and lumbar spine DXA scan (GE Lunar iDXA). One hundred and twenty vertebral fractures were identified in over half of the sample by VFA. Seventy four were graded mild (grade 1), 40 moderate (grade 2) and 6 severe (grade 3). Multiple vertebral fractures (≥2) were found in 37 players (39%). There were no differences in prevalence between codes, or between forwards and backs (both 1.2 v 1.4; p>0.05). The most common sites of fracture were T8 (n = 23), T9 (n = 18) and T10 (n = 21). The mean (SD) lumbar spine bone mineral density Z-score was 2.7 (1.3) indicating high player bone mass in comparison with age- and sex-matched norms. We observed a high number of vertebral fractures using DXA VFA in professional rugby players of both codes. The incidence, aetiology and consequences of vertebral fractures in professional rugby players are unclear, and warrant timely, prospective investigation.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Radiographs are the main outcome measure in epidemiological studies of osteoarthritis (OA). Ultrasound imaging has unique advantages in that it involves no ionising radiation, is easy to use and ...visualises soft tissue structures. Our objective was to measure the inter-rater reliability and validity of ultrasound imaging in the detection of features of knee OA.
Eighteen participants from a community cohort, had both knees scanned by two trained musculoskeletal sonographers, up to six weeks apart. Inter-rater reliability for osteophytes, effusion size and cartilage thickness was calculated by estimating Kappa (κ) and Intraclass correlation coefficients (ICC), as appropriate. A measure of construct validity was determined by estimating κ between the two imaging modalities in the detection of osteophytes.
Reliability: κ for osteophyte presence was 0.77(right femur), 0.65(left femur) and 0.88 for both tibia. ICCs for effusion size were 0.70(right) and 0.85(left). Moderate to substantial agreement was found in cartilage thickness measurements.
For osteophytes, κ was moderate to excellent at 0.52(right) and 0.75(left).
Substantial to excellent agreement was found between ultrasound observers for the presence of osteophytes and measurement of effusion size; it was moderate to substantial for femoral cartilage thickness. Moderate to substantial agreement was observed between ultrasound and radiographs for osteophyte presence.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
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