Osteoarthritis year in review 2019: imaging Kijowski, R.; Demehri, S.; Roemer, F. ...
Osteoarthritis and cartilage,
March 2020, 2020-03-00, 20200301, Letnik:
28, Številka:
3
Journal Article
Recenzirano
Odprti dostop
To provide a narrative review of original articles on osteoarthritis (OA) imaging published between April 1, 2018 and March 30, 2019.
All original research articles on OA imaging published in English ...between April 1, 2018 and March 30, 2019 were identified using a PubMed database search. The search terms of “Osteoarthritis” or “OA” were combined with the search terms “Radiography”, “X-Rays”, “Magnetic Resonance Imaging”, “MRI”, “Ultrasound”, “US”, “Computed Tomography”, “Dual Energy X-Ray Absorptiometry”, “DXA”, “DEXA”, “CT”, “Nuclear Medicine”, “Scintigraphy”, “Single-Photon Emission Computed Tomography”, “SPECT”, “Positron Emission Tomography”, “PET”, “PET-CT”, or “PET-MRI”. Articles were reviewed to determine relevance based upon the following criteria: 1) study involved human subjects with OA or risk factors for OA and 2) study involved imaging to evaluate OA disease status or OA treatment response. Relevant articles were ranked according to scientific merit, with the best publications selected for inclusion in the narrative report.
The PubMed search revealed a total of 1257 articles, of which 256 (20.4%) were considered relevant to OA imaging. Two-hundred twenty-six (87.1%) articles involved the knee joint, while 195 (76.2%) articles involved the use of magnetic resonance imaging (MRI). The proportion of published studies involving the use of MRI was higher than previous years. An increasing number of articles were also published on imaging of subjects with joint injury and on deep learning application in OA imaging.
MRI and other imaging modalities continue to play an important role in research studies designed to better understand the pathogenesis, progression, and treatment of OA.
Summary Objective Test the hypothesis that greater baseline peak external knee adduction moment (KAM), KAM impulse, and peak external knee flexion moment (KFM) during the stance phase of gait are ...associated with baseline-to-2-year medial tibiofemoral cartilage damage and bone marrow lesion progression, and cartilage thickness loss. Methods Participants all had knee OA in at least one knee. Baseline peak KAM, KAM impulse, and peak KFM (normalized to body weight and height) were captured and computed using a motion analysis system and six force plates. Participants underwent MRI of both knees at baseline and 2 years later. To assess the association between baseline moments and baseline-to-2-year semiquantitative cartilage damage and bone marrow lesion progression and quantitative cartilage thickness loss, we used logistic and linear regressions with generalized estimating equations (GEE), adjusting for gait speed, age, gender, disease severity, knee pain severity, and medication use. Results The sample consisted of 391 knees (204 persons): mean age 64.2 years (SD 10.0); BMI 28.4 kg/m2 (5.7); 156 (76.5%) women. Greater baseline peak KAM and KAM impulse were each associated with worsening of medial bone marrow lesions, but not cartilage damage. Higher baseline KAM impulse was associated with 2-year medial cartilage thickness loss assessed both as % loss and as a threshold of loss, whereas peak KAM was related only to % loss. There was no relationship between baseline peak KFM and any medial disease progression outcome measures. Conclusion Findings support targeting KAM parameters in an effort to delay medial OA disease progression.
Summary Objective To identify the independent relation of synovitis with incident radiographic knee osteoarthritis (OA) after adjusting for other structural factors known to cause synovitis. Design ...We examined MRIs from knees that developed incident radiographic OA from the Multicenter Osteoarthritis Study (MOST) and compared these case knees with controls that did not develop OA. We examined baseline MRIs for knees developing OA at any time up to 84 months follow-up. We scored lesions in cartilage, meniscus, bone marrow and synovitis. Synovitis scores were summed (0–9) across three regions, suprapatellar, infrapatellar and intercondylar region, each of which was scored 0–3. After bivariate analyses examining each factor's association with incidence, we carried out multivariable regression analyses adjusting for age, sex, BMI, alignment and cartilage and meniscal damage. Results We studied 239 case and 731 control knees. In bivariate analyses, cartilage lesions, meniscal damage, synovitis and bone marrow lesions were all risk factors for OA. After multivariable analyses, synovitis was associated with incident OA. A higher synovitis score increased the risk of incident OA (adjusted OR per unit increase 1.1; (95% CI 1.0, 1.2, P = .02)), but increased risk was associated only with synovitis scores of ≥3 (adjusted OR 1.6; 95% CI 1.2, 2.1, P = .003). Conclusions Synovitis, especially when there is a substantial volume within the knee, is an independent cause of OA.
Summary Objective In an effort to evolve semi-quantitative scoring methods based upon limitations identified in existing tools, integrating expert readers’ experience with all available scoring tools ...and the published data comparing the different scoring systems, we iteratively developed the magnetic resonance imaging (MRI) Osteoarthritis Knee Score (MOAKS). The purpose of this report is to describe the instrument and its reliability. Methods The MOAKS instrument refines the scoring of bone marrow lesions (BMLs) (providing regional delineation and scoring across regions), cartilage (sub-regional assessment), and refines the elements of meniscal morphology (adding meniscal hypertrophy, partial maceration and progressive partial maceration) scoring. After a training and calibration session two expert readers read MRIs of 20 knees separately. In addition, one reader re-read the same 20 MRIs 4 weeks later presented in random order to assess intra-rater reliability. The analyses presented here are for both intra- and inter-rater reliability (calculated using the linear weighted kappa and overall percent agreement). Results With the exception of inter-rater reliability for tibial cartilage area (kappa = 0.36) and tibial osteophytes (kappa = 0.49); and intra-rater reliability for tibial BML number of lesions (kappa = 0.54), Hoffa-synovitis (kappa = 0.42) all measures of reliability using kappa statistics were very good (0.61–0.8) or reached near-perfect agreement (0.81–1.0). Only intra-rater reliability for Hoffa-synovitis, and inter-rater reliability for tibial and patellar osteophytes showed overall percent agreement <75%. Conclusion MOAKS scoring shows very good to excellent reliability for the large majority of features assessed. Further iterative development and research will include assessment of its validation and responsiveness.
It is unknown whether joint inflammation precedes other articular tissue damage in osteoarthritis. Therefore, this study aims to determine if synovitis precedes the development of radiographic knee ...osteoarthritis (ROA).
The participants in this nested case-control study were selected from persons in the Osteoarthritis Initiative with knees that had a Kellgren Lawrence grading (KLG)=0 at baseline (BL). These knees were evaluated annually with radiography and non-contrast-enhanced MRI over 4 years. MRIs were assessed for effusion-synovitis and Hoffa-synovitis. Case knees were defined by ROA (KLG≥2) on the postero-anterior knee radiographs at any assessment after BL. Radiographs were assessed at P0 (time of onset of ROA), 1 year prior to P0 (P-1) and at BL. Controls were participants who did not develop incident ROA (iROA) from BL to 48 months).
133 knees of 120 persons with ROA (83 women) were matched to 133 control knees (83 women). ORs for occurrence of iROA associated with the presence of effusion-synovitis at BL, P-1 and P0 were 1.56 (95% CI 0.86 to 2.81), 3.23 (1.72 to 6.06) and 4.7 (1.10 to 2.95), respectively. The ORs for the occurrence of iROA associated with the presence of Hoffa-synovitis at BL, P-1 and P0 were 1.80 (1.1 to 2.95), 2.47 (1.45 to 4.23) and 2.40 (1.43 to 4.04), respectively.
Effusion-synovitis and Hoffa-synovitis strongly predicted the development of iROA.
Introduction
Covid-19 pandemic put parents under great pressure, and the most vulnerable parents may have become too overwhelmed to find appropriate ways to be supportive caregivers and to address ...children’s fears and insecurities.
Objectives
Assess the level of parental stress experienced by mothers during the COVID-19 pandemic and compare it with that experienced by fathers.
Methods
This was a descriptive and comparative analytical study, shared on social networks during the period from 8 to 20 April 2021, targeting mothers of children aged 2 to 18 years. The mother answered the questionnaire for herself and her child. The level of stress experienced by the mother in the parent-child relationship during the COVID-19 pandemic was assessed by the brief version of the Parental Stress Index (PSI-SF).
Results
The total number of participants was 65 mothers. Parental stress level in mothers was high in 58.5%, the average PSI score was 94.25; the mean score of the parental distress subscale was 34.06; the mean score of the dysfunctional child-parent interaction subscale was 27.86; and the average score of the child difficulty subscale was 32.32. The mean scores of the parental distress subscale, the child difficulty subscale, as well as the mean PSI total score were significantly higher in mothers than in fathers, with p= 0.010; p= 0.022 and p=0.017 respectively.
Conclusions
Our results highlight a higher level of stress in mothers than in fathers. This can be explained the parental, marital and professional responsibilities imposed on women, underlining the urgent need to provide mothers with adequate support.
Disclosure
No significant relationships.
Introduction
Acute measles encephalitis is a pathology of the central nervous system. It is most frequent in children but can also be described in adults. Given the rarity of this pathology, we ...present the case of this patient.
Objectives
present a rare neuropsychiatric complication of measles
Methods
Présentation d’un cas clinique d’encéphalite rougeoleuse et revue de la littérature
Results
Mrs. HJ, 45 years old, without any somatic history, was followed for an antisocial personality with a substance use disorder. She consulted the emergency for psychomotor agitation, a fever of 39, and a rash on the face, thorax, and limbs. At the psychiatric interview, she was disoriented and very unstable. She seemed to be hallucinating.
The brain imaging and the lumbar puncture (CT scan and brain MRI) were without abnormality. The rapid test (HIV) was negative and the biological check-up showed a hyperleukocytosis at 12660 and a crp at 138. The patient was put on double antibiotic therapy.
The evolution was marked by the non-improvement of the symptomatology with the persistence of agitation. Her speech was almost absent with a refusal to answer and to execute orders. She maintained certain postures. The patient was put on 400 mg of amisulpride.
After recovery of the viral serology, the diagnosis of a measles encephalopathy was confirmed (IgM positive) and the patient improved after a few days of hospitalization and was addressed to the psychiatric outpatient clinic.
Conclusions
Measles encephalitis is a rare but serious complication that requires multidisciplinary management
Disclosure
No significant relationships.
Introduction
The Covid-19 outbreak and the subsequent lockdown have profoundly impacted families’ daily life. Children may be among the most exposed to the psychosocial consequences of the pandemic.
...Objectives
To assess the psychological well-being of children during the COVID-19 pandemic.
Methods
This was a descriptive study shared on social media during the period from 8 to 20 April 2021, targeting mothers of children aged 2 to 18 years. The first part included socio-demographic data of mothers and children. Then, to assess the behavior and coping skills of children and adolescents, we administered the Strengths and Difficulties Questionnaire (SDQ).
Results
Our study included 65 middle-aged moms = 35.28 years. Among mothers, 1.5% reported having at least one child with a psychiatric, medical or genetic illness. The average age of the children was 8.54 years, the sex ratio was 1.03 and they were in primary school in 52.3%. Moms had talked to their child about COVID in 93.8%, using scientific data in 69.4% of cases. The total average SDQ score was 10.82; and overall mental health was at risk in 15.4% of the children. They had risky emotional symptoms in 9.2%, risky aggressive behaviors in 12.3%, risky hyperactivity-inattention symptoms in 16.9%, relationship behaviors with at-risk pairs in 24.6%, and risky prosocial behavior in 9.2% of cases.
Conclusions
Researchers and government officials should be more concerned about the mental health of children who are often neglected as a result of the pandemic due to their comparatively lower mortality than older adults.
Disclosure
No significant relationships.
Summary Objective To test the hypothesis that quantitative measures of meniscus extrusion predict incident radiographic knee osteoarthritis (KOA), prior to the advent of radiographic disease. Methods ...206 knees with incident radiographic KOA (Kellgren Lawrence Grade (KLG) 0 or 1 at baseline, developing KLG 2 or greater with a definite osteophyte and joint space narrowing (JSN) grade ≥1 by year 4) were matched to 232 control knees not developing incident KOA. Manual segmentation of the central five slices of the medial and lateral meniscus was performed on coronal 3T DESS MRI and quantitative meniscus position was determined. Cases and controls were compared using conditional logistic regression adjusting for age, sex, BMI, race and clinical site. Sensitivity analyses of early (year Y 1/2) and late (Y3/4) incidence was performed. Results Mean medial extrusion distance was significantly greater for incident compared to non-incident knees (1.56 mean ± 1.12 mm SD vs 1.29 ± 0.99 mm; +21%, P < 0.01), so was the percent extrusion area of the medial meniscus (25.8 ± 15.8% vs 22.0 ± 13.5%; +17%, P < 0.05). This finding was consistent for knees restricted to medial incidence. No significant differences were observed for the lateral meniscus in incident medial KOA, or for the tibial plateau coverage between incident and non-incident knees. Restricting the analysis to medial incident KOA at Y1/2 differences were attenuated, but reached significance for extrusion distance, whereas no significant differences were observed at incident KOA in Y3/4. Conclusion Greater medial meniscus extrusion predicts incident radiographic KOA. Early onset KOA showed greater differences for meniscus position between incident and non-incident knees than late onset KOA.
Cell therapies are being investigated as potential disease modifying treatment options for osteoarthritis (OA). Progenza (PRG) comprises in vitro expanded mesenchymal stem cells derived from human ...donor adipose tissue combined with cell culture supernatant. The primary objective of this first-in-human study was to evaluate the safety and tolerability of PRG.
We conducted a single centre, randomized, double-blind, placebo-controlled, single ascending dose study. Twenty patients aged 40-65 years with symptomatic Kellgren-Lawrence grade 1-3 knee OA were treated in two cohorts and randomized 4:1 to PRG or placebo. Cohort 1: 3.9 million cells (PRG 3.9M, n = 8) or placebo (n = 2) and cohort 2: 6.7 million cells (PRG 6.7M, n = 8) or placebo (n = 2). Each patient received a single intra-articular injection and was followed-up for 12 months.
The study population comprised 20 patients (placebo, n = 4; PRG 3.9M, n = 8; PRG 6.7M, n = 8). All patients reported at least one treatment-emergent adverse event (TEAE). The majority of events 143/169 (84.6%) were mild with 34 (20.1%) being considered by the investigator to be treatment related. There were no serious AEs or withdrawals due to AEs during the study. There was a statistically significant within group improvement in VAS pain scores from baseline at all timepoints for the PRG combined group, with highly significant improvements seen at months 3, 6, 9 and 12 (p ≤ 0.005) while VAS pain scores in the placebo group showed marginal improvement. A statistically significant improvement was also seen in WOMAC pain subscale scores from baseline at all timepoints for the PRG combined group while a marginal improvement in the placebo group was not statistically significant. Between screening and month 12, there was no decrease in average lateral tibial cartilage volume in the PRG 3.9M group while the placebo group showed a statistically significant cartilage loss. This difference between the placebo and PRG 3.9M group was statistically significant (LSM difference 106.47 mm
, 95% CI 13.56 mm
, 199.37 mm
, p = 0.028).
When administered as a single intra-articular injection to patients with symptomatic knee OA, PRG was safe and well tolerated. Furthermore, measurable improvements in symptoms and knee structure outcomes warrant further studies on PRG's potential for disease modification in OA. Trial registration ANZCTR, ACTRN12615000439549. Date registered: 7th May 2015, https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=368355.
PDF
