scholarly journals Does cartilage loss cause pain in osteoarthritis and if so, how much?

2020 ◽  
Vol 79 (8) ◽  
pp. 1105-1110 ◽  
Author(s):  
Kathryn Bacon ◽  
Michael P LaValley ◽  
S Reza Jafarzadeh ◽  
David Felson
Keyword(s):  
Knee Pain ◽  
Linear Models ◽  
Structural Features ◽  
Pain Scale ◽  
Small Degree ◽  
Cartilage Thickness ◽  
Cartilage Loss ◽  
Womac Pain ◽  
Womac Pain Score ◽  
Thickness Loss

ObjectivesAlthough treatment development in osteoarthritis (OA) focuses on chondroprotection, it is unclear how much preventing cartilage loss reduces joint pain. It is also unclear how nociceptive tissues may be involved.MethodsUsing data from the Osteoarthritis Initiative, we quantified the relation between cartilage loss and worsening knee pain after adjusting for bone marrow lesions (BMLs) and synovitis, and examined how much these factors mediated this association. 600 knee MRIs were scored at baseline, 12 months and 24 months for quantitative and semiquantitative measures of OA structural features. We focused on change in medial cartilage thickness using an amount similar to that seen in recent trials. Linear models calculated mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain score with cartilage loss, adjusted for baseline BMLs, synovitis and covariates. Mediation analysis tested whether change in synovitis or BMLs mediated the cartilage loss–pain association. We carried out a subanalysis for knees with non-zero baseline WOMAC pain scores and another for non-valgus knees.ResultsCartilage thickness loss was significantly associated with a small degree of worsening in pain over 24 months. For example, a loss of 0.1 mm of cartilage thickness over 2 years was associated with a 0.32 increase in WOMAC pain (scale 0–20). The association of cartilage thickness loss with pain was mediated by synovitis change but not by BML change. Subanalysis results were similar.ConclusionsCartilage thickness loss is associated with only a small amount of worsening knee pain, an association mediated in part by worsening synovitis. Demonstrating that chondroprotection reduces knee pain will be extremely challenging and is perhaps unachievable.

scholarly journals The WOMAC Pain Scale and Crosstalk From Co-occurring Pain Sites in People With Knee Pain: A Causal Modeling Study

2020 ◽  
Vol 100 (10) ◽  
pp. 1872-1881
Author(s):  
Daniel L Riddle ◽  
Robert A Perera
Keyword(s):  
Knee Pain ◽  
Pain Scale ◽  
Causal Modeling ◽  
The Body ◽  
Test Theory ◽  
Coefficient Of Determination ◽  
Womac Pain ◽  
Cross Sectional ◽  
Pain Scores ◽  
Body Regions

Abstract Objective The Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain scale quantifies knee pain severity with activities of daily living, but the potential impact of pain in other body regions on WOMAC pain scores has not been explored using a causal modeling approach. The purpose of this study was to determine if pain in other areas of the body impact WOMAC pain scores, a phenomenon referred to as “crosstalk.” Methods Cross-sectional datasets were built from public use data available from the Osteoarthritis Initiative (OAI) and the Multicenter Osteoarthritis Study (MOST). The WOMAC Pain Scale and generic hip, knee, ankle, foot and back pain measures were included. Three nested regression models grounded in causally based classical test theory determined the extent of crosstalk. Improvements in the coefficient of determination across the 3 models were used to determine the presence of crosstalk. Results Causal modeling provided evidence of crosstalk in both OAI and MOST datasets. For example, in OAI, multiple statistical models demonstrated significant increases in coefficient of determination values (P < .0001) as additional pain areas were added to the models. Conclusions Crosstalk appears to be a clinically important source of error in the WOMAC Pain Scale, particularly for patients with a larger number of painful body regions and when contralateral knee joint pain is more severe. Impact Statement This study has important implications for arthritis research. It also should raise clinician awareness of the threat to score interpretation and the need to consider the extent of pain in other body regions when interpreting WOMAC pain scores.

scholarly journals Knee Pain During Daily Tasks, Knee Osteoarthritis Severity, and Widespread Pain

2014 ◽  
Vol 94 (4) ◽  
pp. 490-498 ◽  
Author(s):  
Daniel L. Riddle ◽  
Paul W. Stratford
Keyword(s):  
Knee Pain ◽  
Pain Scale ◽  
Womac Pain ◽  
Widespread Pain ◽  
Cross Sectional ◽  
Knee Oa ◽  
Bilateral Knee ◽  
Scale Scores ◽  
Cross Sectional Design ◽  
High Level

Background The presence of widespread pain is easily determined and is known to increase the risk for persistent symptoms. Objective The study hypothesis was that people with no or minimal knee osteoarthritis (OA) and high Western Ontario and McMaster Universities (WOMAC) Pain Scale scores would be more likely than other subgroups to report widespread pain. Design A cross-sectional design was used. Methods Data were obtained from the Multicenter Osteoarthritis Study, which includes people with or at high risk for knee OA. The inclusion criteria were met by 755 people with unilateral knee pain and 851 people with bilateral knee pain. Widespread pain was assessed with body diagrams, and radiographic Kellgren-Lawrence grades were recorded for each knee. Knee pain during daily tasks was quantified with WOMAC Pain Scale scores. Results Compared with people who had high levels of pain and knee OA, people with a low level of pain and a high level of knee OA, and people with low levels of pain and knee OA, a higher proportion of people with a high level of knee pain and a low level of knee OA had widespread pain. This result was particularly true for people with bilateral knee pain, for whom relative risk estimates ranged from 1.7 (95% confidence interval=1.2–2.4) to 2.3 (95% confidence interval=1.6–3.3). Limitations The cross-sectional design was a limitation. Conclusions People with either no or minimal knee OA and a high level of knee pain during daily tasks are particularly likely to report widespread pain. This subgroup is likely to be at risk for not responding to knee OA treatment that focuses only on physical impairments. Assessment of widespread pain along with knee pain intensity and OA status may assist physical therapists in identifying people who may require additional treatment.

A Randomized, Double-blind, Phase III Trial in Moderate Osteoarthritis Knee Pain Comparing Topical Ketoprofen Gel with Ketoprofen-free Gel

2013 ◽  
Vol 40 (10) ◽  
pp. 1742-1748 ◽  
Author(s):  
Matthias Rother ◽  
Philip G. Conaghan
Keyword(s):  
Knee Pain ◽  
Subcutaneous Tissue ◽  
Subscale Score ◽  
Phase Iii ◽  
Womac Pain ◽  
Double Blind ◽  
Womac Pain Score ◽  
American College Of Rheumatology ◽  
Pain Scores ◽  
Pain Subscale

Objective.This randomized, double-blind, phase III study evaluated the efficacy and safety of ketoprofen in an ultradeformable vesicle gel compared with ketoprofen-free gel in osteoarthritis (OA) knee pain.Methods.Patients with American College of Rheumatology-defined OA of the knee and moderate pain were randomized to receive 100 mg ketoprofen in 4.4 g transfersome gel (IDEA-033) or 4.4 g ketoprofen-free vehicle (TDT 064) topically, twice daily, for 12 weeks. The primary endpoint was mean change in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale score from baseline to Week 12.Results.Patients (n = 555) were randomized and treated. Mean baseline WOMAC pain scores were 5.2 (SD 1.0) for IDEA-033 and 5.3 (SD 1.0) for TDT 064. Mean change in WOMAC pain scores from baseline to Week 12 was 38.6% for IDEA-033 and 44.6% for TDT 064 (Mann-Whitney estimator 0.4505; p = 0.022). Both groups reported progressive decreases in pain and improvements in function and stiffness. Mean baseline WOMAC function scores decreased from 5.4 to 3.4 with IDEA-033 and 3.1 with TDT 064 at Week 12. The proportion of patients achieving ≥ 50% decrease in WOMAC pain score from baseline at Week 12 was 41.2% (95% CI 0.35–0.47) with IDEA-033 and 50.5% (95% CI 0.45–0.57) with TDT 064. Mild skin and subcutaneous tissue disorders were the most frequently reported treatment-related adverse events (AE).Conclusions.IDEA-033 was inferior to drug-free gel (TDT 064) in relieving moderate OA knee pain and improving joint function (Clinical TrialsNCT00722852).

scholarly journals POS0358 EVALUATION OF THE EFFECT OF mTOR EXPRESSION ON THE CLINICAL MANIFESTATIONS OF KNEE OSTEOARTHRITIS IN OBESE AND NORMAL WEIGHT PATIENTS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 409.2-409
Author(s):  
E. Strebkova ◽  
E. Tchetina ◽  
L. Alekseeva
Keyword(s):  
Body Weight ◽  
Knee Pain ◽  
Mammalian Target Of Rapamycin ◽  
Clinical Manifestations ◽  
Normal Weight ◽  
Womac Pain ◽  
Obese Patients ◽  
Normal Body ◽  
Knee Oa ◽  
Normal Body Weight

Background:Currently, a large number of molecular biological and genetic markers are known to be involved in the development of osteoarthritis (OA). The mammalian target of rapamycin (mTOR) signaling pathway is responsible for chondrocyte proliferation, cartilage matrix production, and cell growth. OA is characterized by increased mTOR synthesis, which is accompanied by an increase in proliferative activity and destruction of chondrocytes. Obesity is an important factor in the progression of knee OA. The study of mTOR expression in patients with OA and obesity is an urgent task in the development of personalized OA therapy.Objectives:To determine the expression of mTOR in patients with knee OA in combination with obesity and normal body weight. To evaluate the effect of mTOR on the clinical manifestations of OA in patients with different body mass index (BMI).Methods:The study included 73 female patients aged 45-65 y.o. with Kellgren-Lawrence stage II-III knee OA. The patients were divided into 2 groups: group 1 (n=50) with obesity (BMI > 30 kg / cm2) and group 2 (n=23) with normal or increased body weight (BMI < 30 kg/cm2). The average age of patients with obesity is 56.5 ± 5.87 years, without obesity - 58.7 ± 5.43 years. Clinical manifestations were evaluated by a WOMAС. RNA was isolated from the patients ‘ blood samples, which was used to determine the expression of mTOR.Results:Patients with knee OA with and without obesity did not differ in age. OA develops at an earlier age in obese patients, than in non-obese patients (p < 0.001). Patients from 1 group had a high BMI > 30 kg/m2 at the onset of OA. Obese patients had more severe knee OA is significantly more often detected: Kellgren-Lawrence stage III was determined in 10% of obese patients and in 4.35% - without obesity (p < 0.001). Significantly higher values of the WOMAC index pain, stiffness, joint functional failure, and total WOMAC were observed in obese patients (p = 0.006, p = 0.039, p = 0.037, and p = 0.014, respectively). Obese patients had higher VAS pain scores (p < 0.05) compared to patients with a lower BMI. Obese patients had a higher mTOR expression (p < 0.05) of 8.02±8.62, compared to non-obese patients. High mTOR expression was associated with VAS knee pain (r=0.78; p < 0.05) and WOMAC pain (r=0.89; p<0.05) in obese patients (Table 1).Table 1.Correlation of m-TORParametersmTOR (1 group, n=50)mTOR (2 group, n=23)Body weightр > 0,05р > 0,05Pain (VAS)r=0,78; р<0,05p = 0,07; r = 0,45Pain (WOMAC)r=0,89; р<0,05р > 0,05Total WOMACр > 0,05р > 0,05Conclusion:Our study showed that patients with obesity and knee OA have higher rates of mTOR expression, compared to patients with normal body weight. High mTOR expression correlates with the severity of knee pain in obese patients. Thus, the evaluation of mTOR expression in obese patients and knee OA plays an important role in predicting the severity of clinical manifestations of OA, and may influence the choice of personalized therapy tactics for such patients.Disclosure of Interests:None declared

Higher Function Scores and Satisfaction in Patients with Anteromedial Osteoarthritis Compared with Other Wear Patterns of the Knee: 2 Years after Both Total and Unicondylar Knee Arthroplasties

2019 ◽  
Vol 33 (07) ◽  
pp. 629-635
Author(s):  
Suzanne Witjes ◽  
Alexander Hoorntje ◽  
Koen L. M. Koenraadt ◽  
Gino M. M. J. Kerkhoffs ◽  
Rutger C. I. van Geenen
Keyword(s):  
Knee Pain ◽  
Knee Arthroplasty ◽  
Anterior Knee Pain ◽  
Cross Sectional Study ◽  
Pain Scale ◽  
Specific Function ◽  
Cross Sectional ◽  
Wear Pattern ◽  
Unicondylar Arthroplasty ◽  
Anterior Knee

AbstractAnteromedial osteoarthritis (AMOA) is a common wear pattern in primary osteoarthritic knees. In patients with bone-on-bone disease, the most appropriate surgical intervention is still a matter of debate. Knee arthroplasty is a well-accepted treatment to relieve symptoms and regain function. Unfortunately, satisfaction is limited, especially related to activities. A cross-sectional study was performed among patients treated with total knee arthroplasty (TKA) and unicondylar arthroplasty (UKA) to determine if the osteoarthritis wear pattern or type of prosthesis affects knee-specific function scores and satisfaction related to activities. All UKA patients (N = 100) were treated for AMOA. Based on radiological assessment of the wear pattern, TKA patients were divided into two groups: TKA for AMOA (N = 68) and true TKA (N = 99). The Knee injury and Osteoarthritis Outcomes Score (KOOS), new Knee Society score (KSS), anterior knee pain scale, visual analog scales (VASs) for satisfaction about activities, and net promoter score were collected. After 2 years' follow-up, the anterior knee pain scale and VAS satisfaction showed significantly better scores for patients treated with TKA for AMOA compared with the true TKA group. Also in the KOOS subscales, some differences were seen in favor of the TKA for AMOA group. The new KSS was not in favor of a specific wear pattern, but patients with AMOA treated with UKA performed better on the symptoms subscale compared with patients treated with TKA. In conclusion, patients treated with TKA for AMOA showed better knee-specific function scores and satisfaction scores compared with patients treated with TKA for other wear patterns, and only slight differences were found between both the AMOA groups (TKA for AMOA and UKA). Thus, the radiologic assessment of wear patterns might be useful to take into account the shared decision-making process, when discussing expectations, timing, and outcomes with knee osteoarthritis patients considering knee arthroplasty. When AMOA is present, it might be beneficial to choose UKA over TKA.

Loss of patellofemoral cartilage thickness over 5 years following ACL injury depends on the initial treatment strategy: results from the KANON trial

2019 ◽  
Vol 53 (18) ◽  
pp. 1168-1173 ◽  
Author(s):  
Adam G Culvenor ◽  
Felix Eckstein ◽  
Wolfgang Wirth ◽  
L Stefan Lohmander ◽  
Richard Frobell
Keyword(s):  
Treatment Strategy ◽  
Controlled Trial ◽  
Cruciate Ligament ◽  
Acl Injury ◽  
Cartilage Thickness ◽  
Acl Rupture ◽  
Thickness Loss ◽  
Patellar Cartilage ◽  
Randomised Controlled ◽  
The Impact

ObjectivesTo evaluate changes in patellofemoral cartilage thickness over 5 years after anterior cruciate ligament (ACL) injury and to determine the impact of treatment strategy.Methods121 adults (ages 18–35 years, 26% women) had an ACL injury and participated in the KANON randomised controlled trial. Of those, 117 had available MRIs at baseline (<4 weeks post-ACL rupture) and at least one follow-up measurement (2, 5 years). Patellofemoral cartilage thickness was analysed by manual segmentation (blinded to acquisition order). Patellar, trochlear and total patellofemoral cartilage thickness changes were compared between as-randomised (rehabilitation+early ACL reconstruction (ACLR) (n=59) vs rehabilitation+optional delayed ACLR (n=58)) and as-treated groups (rehabilitation+early ACLR (n=59) vs rehabilitation +delayed ACLR (n=29) vs rehabilitation alone (n=29)).ResultsPatellofemoral cartilage thickness decreased −58 µm (95% CI −104 to –11 µm) over 5 years post-ACL rupture, with the greatest loss observed in trochlea during the first 2 years. Participants randomised to rehabilitation+early ACLR had significantly greater loss of patellar cartilage thickness compared with participants randomised to rehabilitation+optional delayed ACLR over the first 2 years (−25 µm (−52, 1 µm) vs +14 µm (−6 to 34 µm), p=0.02) as well as over 5 years (−36 µm (−78 to 5 µm) vs +18 µm (−7, 42 µm), p=0.02). There were no statistically significant differences in patellofemoral cartilage thickness changes between as-treated groups.ConclusionPatellofemoral (particularly trochlear) cartilage thickness loss was observed in young adults following acute ACL rupture. Early ACLR was associated with greater patellofemoral (particularly patellar) cartilage thickness loss over 5 years compared with optional delayed ACLR, indicating that early surgical intervention may be associated with greater short-term structural patellofemoral cartilage deterioration compared with optional delayed surgery.Trial registration numberISRCTN84752559; Post-results.

Rasch analysis of the anterior knee pain scale in adolescents with patellofemoral pain

2020 ◽  
Vol 34 (12) ◽  
pp. 1512-1519
Author(s):  
Mitchell Selhorst ◽  
Alicia Fernandez-Fernandez ◽  
M Samuel Cheng
Keyword(s):  
Knee Pain ◽  
Anterior Knee Pain ◽  
Rasch Analysis ◽  
Principal Component ◽  
Pain Scale ◽  
Patellofemoral Pain ◽  
Level Measurement ◽  
Level Data ◽  
Item Responses ◽  
Anterior Knee

Objective: The aim of this study was to evaluate the Anterior Knee Pain Scale in a cohort of adolescents being treated conservatively for patellofemoral pain using Rasch analysis. Design: This is a psychometric study. Setting: Physical therapy clinics of a large pediatric hospital in Columbus, Ohio (United States) Subjects: A total of 646 adolescent patients with patellofemoral pain (76% female, 14.6 ± 1.6 years old). Intervention: Not applicable. Main Measure: The Anterior Knee Pain Scale. Results: The median Anterior Knee Pain Scale score was 73 (interquartile range 64–81), with scores ranging from 7 to 100 on the 100-point scale. The Rasch person reliability for the Anterior Knee Pain Scale was 0.74 and the Cronbach’s alpha was 0.75, representing an acceptable person reliability. Principal component analysis revealed a ratio of 5.2:1 demonstrating acceptable unidimensionality of the Anterior Knee Pain Scale. A significant misfit was observed in the item “Abnormal Painful Kneecap Movements” (Outfit Means Square 2.74, Infit Means Square 1.41). Ordering of item responses was unsatisfactory as only five of the 13 items demonstrated appropriate distinction between each of the responses. There was no differential item functioning for sex or age for all items of the Anterior Knee Pain Scale, based upon the criterion of ⩾ 0.5 logit difference. Conclusion: The Anterior Knee Pain Scale does not meet interval-level measurement criteria and should be considered ordinal level data.

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