AB0880 NEUROPATHIC PAIN IN PATIENTS WITH KNEE OSTEOARTHRITIS: PREVALENCE AND RELATED FACTORS

Background:Discordance between radiographic and pain severity in osteoarthritis (OA) has led researchers to investigate other pain mechanisms, including neuropathic pain (NP). Recent meta-analysis concluded that NP prevalence in people with knee or hip OA was 23% [1].Objectives:The primary objective of this study was to determine the prevalence of NP in patients with painful knee OA. Secondarily, we evaluated the relationship between NP and pain intensity, function and radiographic severity of knee OA.Methods:This cross-sectional study enrolled patients with knee OA (ACR criteria) from a rheumatology outpatient Hospital over a four-month period. Exclusion criteria were: knee surgery, chronic conditions of the nervous system, cognitive or psychiatric disorders. The patient’s characteristics and pain severity using the Visual Analogue Scale (VAS) were evaluated. The NP was assessed according to the Douleur Neuropathique 4 questionnaire (DN4) (arabic valid version). Functional impairment was estimated using the short form of the Knee injury and Osteoarthritis Outcome Score (KOOS-PS) (KOOS-PS scores to 0 representing no difficulty and 100 representing extreme difficulty). Radiographs were rated using the Kellgren Lawrence (KL) grade classification (I-IV). Statistical analysis was performed to find the factors closely related with NP.Results:Ninety three patients with knee OA were included in the study. The mean age was 65.03±18.5 years with a sex ratio of 0.08. Mean duration of symptoms was 3.5 years [3months-20 years]. Concerning the marital status: 53.8% were married, 34.4% were widow and 10.8% were divorced. The majority of patients were illiterate (65.6%) and only 2.2% went to university. Patients were from low socio-economic class in 37.6% of cases. At least one comorbidity was revealed for 90.3% of patients and their mean BMI was 31.6±6.3 [19.9-52.3]. Concerning the clinical features of the KOA, mean VAS pain was 6.6±1.6 and KOOS-PS was 45.6±18.5. Of the subjects, 22.6% have radiographic at grade II, 57% at grade III and 20.4% at grade IV based on KL grading.The mean (SD) score by the study participants on the DN4 was 4.9± 2.4. The prevalence of NP (DN4≥4) was 71%.A DN4 score≥4 was significantly associated with the VAS pain (p=0.00) and the KOOS-PS (p=0.00) and the presence of comorbidity (p=0.04). However, there was no significant relation between DN4 score and, age, sex, marital status, socio economic class, level of education, BMI and KL grade (p=0.7, p=0.08, p=0.7,p=0.3, p=0.7, p=0.7, p=0.6).Conclusion:Our results highlight the high frequency of NP in patients with knee OA according to the DN4. Knee OA patients with NP encounter clinically relevant functional limitation. Thus, it is important to be aware of this neuropathic component to ensure appropriate management in the treatment of knee OA pain.References:[1]French HP, Smart KM, Doyle F. Prevalence of neuropathic pain in knee or hip osteoarthritis: A systematic review and meta-analysis. Semin Arthritis Rheum. 2017;47(1):1-8.Acknowledgments:noneDisclosure of Interests:None declared

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The Prevalence and Severity of Chronic Pain in Patients With Chronic Kidney Disease: A Systematic Review and Meta-Analysis

Canadian Journal of Kidney Health and Disease ◽

10.1177/2054358121993995 ◽

2021 ◽

Vol 8 ◽

pp. 205435812199399

Author(s):

Sara N. Davison ◽

Sarah Rathwell ◽

Sunita Ghosh ◽

Chelsy George ◽

Ted Pfister ◽

...

Keyword(s):

Systematic Review ◽

Chronic Kidney Disease ◽

Chronic Pain ◽

Pain Management ◽

Meta Analysis ◽

Pain Severity ◽

Chronic Pain Management ◽

Dialysis Patients ◽

Severity Scores ◽

The Mean

Background: Chronic pain is a common and distressing symptom reported by patients with chronic kidney disease (CKD). Clinical practice and research in this area do not appear to be advancing sufficiently to address the issue of chronic pain management in patients with CKD. Objectives: To determine the prevalence and severity of chronic pain in patients with CKD. Design: Systematic review and meta-analysis. Setting: Interventional and observational studies presenting data from 2000 or later. Exclusion criteria included acute kidney injury or studies that limited the study population to a specific cause, symptom, and/or comorbidity. Patients: Adults with glomerular filtration rate (GFR) category 3 to 5 CKD including dialysis patients and those managed conservatively without dialysis. Measurements: Data extracted included title, first author, design, country, year of data collection, publication year, mean age, stage of CKD, prevalence of pain, and severity of pain. Methods: Databases searched included MEDLINE, CINAHL, EMBASE, and Cochrane Library, last searched on February 3, 2020. Two reviewers independently screened all titles and abstracts, assessed potentially relevant articles, and extracted data. We estimated pooled prevalence of overall chronic pain, musculoskeletal pain, bone/joint pain, muscle pain/soreness, and neuropathic pain and the I2 statistic was computed to measure heterogeneity. Random effects models were used to account for variations in study design and sample populations and a double arcsine transformation was used in the model calculations to account for potential overweighting of studies reporting either very high or very low prevalence measurements. Pain severity scores were calibrated to a score out of 10, to compare across studies. Weighted mean severity scores and 95% confidence intervals were reported. Results: Sixty-eight studies representing 16 558 patients from 26 countries were included. The mean prevalence of chronic pain in hemodialysis patients was 60.5%, and the mean prevalence of moderate or severe pain was 43.6%. Although limited, pain prevalence data for peritoneal dialysis patients (35.9%), those managed conservatively without dialysis (59.8%), those following withdrawal of dialysis (39.2%), and patients with earlier GFR category of CKD (61.2%) suggest similarly high prevalence rates. Limitations: Studies lacked a consistent approach to defining the chronicity and nature of pain. There was also variability in the measures used to determine pain severity, limiting the ability to compare findings across populations. Furthermore, most studies reported mean severity scores for the entire cohort, rather than reporting the prevalence (numerator and denominator) for each of the pain severity categories (mild, moderate, and severe). Mean severity scores for a population do not allow for “responder analyses” nor allow for an understanding of clinically relevant pain. Conclusions: Chronic pain is common and often severe across diverse CKD populations providing a strong imperative to establish chronic pain management as a clinical and research priority. Future research needs to move toward a better understanding of the determinants of chronic pain and to evaluating the effectiveness of pain management strategies with particular attention to the patient outcomes such as overall symptom burden, physical function, and quality of life. The current variability in the outcome measures used to assess pain limits the ability to pool data or make comparisons among studies, which will hinder future evaluations of the efficacy and effectiveness of treatments. Recommendations for measuring and reporting pain in future CKD studies are provided. Trial registration: PROSPERO Registration number CRD42020166965

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Investigating high-concentration 8% capsaicin patch in chronic cancer-treatment related peripheral neuropathic pain.

Journal of Clinical Oncology ◽

10.1200/jco.2016.34.26_suppl.208 ◽

2016 ◽

Vol 34 (26_suppl) ◽

pp. 208-208 ◽

Cited By ~ 1

Author(s):

Sabrina Ramnarine ◽

Barry Laird ◽

Linda J Williams ◽

Marie T Fallon

Keyword(s):

Neuropathic Pain ◽

Cancer Treatment ◽

Short Form ◽

Depression Score ◽

Post Treatment ◽

Pain Severity ◽

High Concentration ◽

Peripheral Neuropathic Pain ◽

Clinically Significant

208 Background: Cancer-treatment related peripheral neuropathic pain is a challenging clinical problem as current interventions have limited efficacy and significant toxicities. This study aims to examine the analgesic effect of high-concentration 8% capsaicin patch in this cohort of patients. Methods: A single arm study was conducted. Patients with long-term peripheral neuropathic pain received a single application of 8% transdermal capsaicin patch to the affected area (chest wall, hands or feet). Assessments at baseline, 4 weeks and 12 weeks post-treatment included: Brief Pain Inventory (BPI) short form (pain severity and interference with function); Hospital Anxiety and Depression Scale (HADS). The primary efficacy measure was a clinically significant improvement in pain (≥ 30% reduction in total BPI score (responders) from baseline to 4 weeks and 12 weeks). Secondary efficacy measures assessed worst pain, function and associated changes in mood. Results: 19 patients, median age 61.5 all had peripheral neuropathic pain for a median of 2 years (IQR 1-3) following treatment for various types of cancer: gynecological (n = 2), breast (n = 6), colorectal (n = 8), multiple myeloma (n = 2) or other (n = 1). At 4 weeks, 37% (7/19) patients showed a clinically significant improvement in pain (≥ 30%). Of the 7 responders, 5 had > 50% reduction in pain. 16% (3/19) suggested a partial improvement (mean 17%). Of the patients reassessed at 12 weeks, 50% (7/14) were responders with all patients exhibiting a reduction in: worst pain score, -1.3 (95% CI: -2.5, -0.06; p = 0.04), interference with function, -10.9 (95% CI: -21.5, -0.4; p = 0.04) and HADS depression score, -1.7 (95% CI: -3.4, 0.02; p = 0.05). Total HADS score correlated with total BPI at 4 weeks (r = 0.68) and 12 weeks (r = 0.70). HADS depression score also correlated with BPI at 12 weeks (r = 0.73). All correlations were significant (p < 0.01). Conclusions: In patients with chronic, resistant, cancer-treatment related peripheral neuropathic pain, high-concentration 8% capsaicin patch may provide some benefit in pain severity, function and mood with the effect continuing at 12 weeks post-treatment. This may warrant further long-term follow up in a larger cohort.

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Hemodialysis and peritoneal dialysis—health-related quality of life: systematic review plus meta-analysis

BMJ Supportive & Palliative Care ◽

10.1136/bmjspcare-2021-003182 ◽

2021 ◽

pp. bmjspcare-2021-003182

Author(s):

Samira Raoofi ◽

Fatemeh Pashazadeh Kan ◽

Sima Rafiei ◽

Zahra Hoseinipalangi ◽

Sepide Rezaei ◽

...

Keyword(s):

Quality Of Life ◽

Short Form ◽

Meta Analysis ◽

Health Condition ◽

Factors Affecting ◽

Sf 36 ◽

Wide Range ◽

Health Related ◽

The Mean

BackgroundPatients with end-stage renal disease undergoing haemodialysis experience a variety of stressors leading to decreased level of quality of life (QoL). Thus, in this study, we aimed to review the current literature and identify factors affecting the health-related QoL (HRQoL) in these patients.MethodsA total of 147 studies were extracted from databases of Web of Science, PubMed, Scopus, Google Scholar, and Embase published between January 2000 and December 2020. Data were analysed using R software and results were reported with reference to Preferred Reporting Items for Systematic Reviews and Meta-Analyses standards.ResultsA total of 623 728 patients undergoing dialysis participated in 147 studies in which QoL was assessed by means of two valid questionnaires, including Short-Form 36 (SF-36) and Kidney Disease Quality of Life (KDQOL)-short form V.1.3. Total HRQoL score for patients undergoing dialysis measured by KDQOL was 64.25 (95% CI 55.67 to 72.82). Based on SF-36, the mean score of mental health items was higher than the mean score of physical health condition. Furthermore, meta-regression based on the geographical place of residence revealed that the highest QoL in patients was observed in Japan, 66.96 (95% CI 63.65 to 70.28) and Brazil, 58.03 (95% CI 53.45 to 62.6).ConclusionStudies conducted on HRQoL among patients undergoing dialysis recommend useful strategies to clinicians, letting them assess patients’ QoL in terms of a wide range of physical, mental and environmental aspects.

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Surgical versus Conservative Management of Weber B Fibular Fractures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00142 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0014

Author(s):

Abduljabbar Alhammoud ◽

Osama Aldahamsheh

Keyword(s):

Clinical Outcomes ◽

Surgical Management ◽

Short Form ◽

Meta Analysis ◽

Random Effect Model ◽

Functional Score ◽

Type B ◽

Significant Difference ◽

Functional Scores ◽

The Mean

Category: Trauma Introduction/Purpose: Fibular fractures are one of the most common traumatic injuries treated by orthopaedic surgeons. These fractures range from stable to unstable, and accordingly may be treated conservatively with immobilization or operatively with open reduction and internal fixation. Unstable Weber classification type B fibula fractures are at the level of the syndesmosis. When stressed, they show an increased medial clear space widening. Recent studies have suggested these fractures may be treated non-operatively. The purpose of this study was to systematically review the literature to determine whether operative and non-operative management of Weber B fractures exhibit any difference in functional outcomes. Methods: For this study, the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRIMSA) guidelines were followed. A systematic review of the literature was performed on the Medline (PubMed), Ovid, and Embase databases in May 2017. Only studies analyzing surgical and non-surgical management of Weber B fibular fractures were included. A meta-analysis was performed to pool difference of the mean for functional outcome scores (Olerud Molander Ankle [OMA] score, American Orthopaedic Foot and Ankle Score [AOFAS], Visual Analogue Scale [VAS], and Short-form 36 [SF36] questionnaire) of the ankles of patients who underwent surgical and non-surgical management. Descriptive, quantitative, and qualitative data were extracted and analyzed using Comprehensive meta-analysis software and SPSS 21. Random effect model used to pool the difference of the mean of the outcomes and I2 to assess the heterogeneity. Results: Of the 823 articles identified, four studies met inclusion criteria for the meta-analysis. A total of 383 unstable Weber type B fibular fractures were identified, with 198 treated operatively and 161 treated non-operatively. There were 158 (41.2%) male and 225 (58.8%) female patients, who averaged 45.6 years of age (Table). Mean follow up was 27.3 months. The pooled mean difference (SMD) for OMA functional score did not show any statistically significant difference between surgical and non-surgical management (SMD = 12.364 [95% CI: -4.684, 29.413]; I2 = 91.93%), although each single paper highlighted the superiority of non-surgical management. Other functional scores could not be pooled because they were not consistently reported within the included studies. Conclusion: The early literature suggests that there is no difference in the clinical outcomes of unstable Weber B fractures, whether they are treated operatively or non-operatively. Longer-term studies are warranted to examine the clinical outcomes of patients managed non-operatively.

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Pain, Depression, and Quality of Life in Neuromyelitis Optica Spectrum Disorder

Neurology Neuroimmunology & Neuroinflammation ◽

10.1212/nxi.0000000000000985 ◽

2021 ◽

Vol 8 (3) ◽

pp. e985

Author(s):

Ilya Ayzenberg ◽

Daniel Richter ◽

Eugenia Henke ◽

Susanna Asseyer ◽

Friedemann Paul ◽

...

Keyword(s):

Quality Of Life ◽

Neuropathic Pain ◽

Neuromyelitis Optica ◽

Clinical Characteristics ◽

Short Form ◽

Spectrum Disorder ◽

Pain Severity ◽

Neuromyelitis Optica Spectrum Disorder ◽

Upper Thoracic

ObjectivesTo evaluate prevalence, clinical characteristics, and predictors of pain, depression, and their impact on the quality of life (QoL) in a large neuromyelitis optica spectrum disorder (NMOSD) cohort.MethodsWe included 166 patients with aquaporin-4–seropositive NMOSD from 13 tertiary referral centers. Patients received questionnaires on demographic and clinical characteristics, PainDetect, short form of Brief Pain Inventory, Beck Depression Inventory–II, and Short Form 36 Health Survey.ResultsOne hundred twenty-five (75.3%) patients suffered from chronic NMOSD-associated pain. Of these, 65.9% had neuropathic pain, 68.8% reported spasticity-associated pain and 26.4% painful tonic spasms. Number of previous myelitis attacks (OR = 1.27, p = 0.018) and involved upper thoracic segments (OR = 1.31, p = 0.018) were the only predictive factors for chronic pain. The latter was specifically associated with spasticity-associated pain (OR = 1.36, p = 0.002). More than a third (39.8%) suffered from depression, which was moderate to severe in 51.5%. Pain severity (OR = 1.81, p < 0.001) and especially neuropathic character (OR = 3.44, p < 0.001) were associated with depression. Pain severity and walking impairment explained 53.9% of the physical QoL variability, while depression and walking impairment 39.7% of the mental QoL variability. No specific medication was given to 70.6% of patients with moderate or severe depression and 42.5% of those with neuropathic pain. Two-thirds (64.2%) of patients with symptomatic treatment still reported moderate to severe pain.ConclusionsMyelitis episodes involving upper thoracic segments are main drivers of pain in NMOSD. Although pain intensity was lower than in previous studies, pain and depression remain undertreated and strongly affect QoL. Interventional studies on targeted treatment strategies for pain are urgently needed in NMOSD.

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Pain burden, sensory profile and inflammatory cytokines of dogs with naturally-occurring neuropathic pain treated with gabapentin alone or with meloxicam

PLoS ONE ◽

10.1371/journal.pone.0237121 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0237121

Author(s):

Hélène L. M. Ruel ◽

Ryota Watanabe ◽

Marina C. Evangelista ◽

Guy Beauchamp ◽

Jean-Philippe Auger ◽

...

Keyword(s):

Neuropathic Pain ◽

Inflammatory Cytokines ◽

Short Form ◽

Conditioning Stimulus ◽

Brief Pain Inventory ◽

Pain Scale ◽

Sensory Profile ◽

Pain Mechanisms ◽

Pain Scores ◽

Naturally Occurring

Canine neuropathic pain (NeuP) has been poorly investigated. This study aimed to evaluate the pain burden, sensory profile and inflammatory cytokines in dogs with naturally-occurring NeuP. Twenty-nine client-owned dogs with NeuP were included in a prospective, partially masked, randomized crossover clinical trial, and treated with gabapentin/placebo/gabapentin-meloxicam or gabapentin-meloxicam/placebo/gabapentin (each treatment block of 7 days; total 21 days). Pain scores, mechanical (MNT) and electrical (ENT) nociceptive thresholds and descending noxious inhibitory controls (DNIC) were assessed at baseline, days 7, 14, and 21. DNIC was evaluated using ΔMNT (after-before conditioning stimulus). Positive or negative ΔMNT corresponded to inhibitory or facilitatory pain profiles, respectively. Pain scores were recorded using the Client Specific Outcome Measures (CSOM), Canine Brief Pain Inventory (CBPI), and short-form Glasgow Composite Measure Pain Scale (CMPS-SF). Data from baseline were compared to those of sixteen healthy controls. ΔMNT, but not MNT and ENT, was significantly larger in controls (2.3 ± 0.9 N) than in NeuP (-0.2 ± 0.7 N). The percentage of dogs with facilitatory sensory profile was similar at baseline and after placebo (61.5–63%), and between controls and after gabapentin (33.3–34.6%). The CBPI scores were significantly different between gabapentin (CBPI pain and CBPI overall impression) and/or gabapentin-meloxicam (CBPI pain and interference) when compared with baseline, but not placebo. The CBPI scores were not significantly different between placebo and baseline. The concentration of cytokines was not different between groups or treatments. Dogs with NeuP have deficient inhibitory pain mechanisms. Pain burden was reduced after gabapentin and/or gabapentin-meloxicam when compared with baseline using CBPI and CMPS-SF scores. However, these scores were not superior than placebo, nor placebo was superior to baseline evaluations. A caregiver placebo effect may have biased the results.

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Differences in Psychological Characteristics Between People With Knee Osteoarthritis From Japan and Australia

10.21203/rs.3.rs-63571/v1 ◽

2020 ◽

Author(s):

Daisuke Uritani ◽

Penny K. Campbell ◽

Ben Metcalf ◽

Thorlene Egerton

Keyword(s):

Depressive Symptoms ◽

Knee Osteoarthritis ◽

Pain Catastrophizing ◽

Short Form ◽

Controlled Trial ◽

Psychological Characteristics ◽

Knee Oa ◽

Fear Of Movement ◽

The Mean ◽

Equivalence Margin

Abstract BackgroundThe aim of this study was to investigate differences in psychological characteristics between people with knee osteoarthritis (OA) from Japan and Australia.Methods A total of 62 adults from Japan and 168 adults from Australia aged over 50 years with knee pain were included. Japanese data were collected from patients with knee OA diagnosed by medical doctors. Australian data were baseline data from a randomized controlled trial. Psychological characteristics evaluated were depressive symptoms (depression subscale of the 21-item short-form of Depression Anxiety Stress Scale), fear of movement (Brief Fear of Movement Scale for Osteoarthritis), and pain catastrophizing (Pain Catastrophizing Scale). Psychological characteristics were compared between the Japanese and Australian cohorts by calculating 95% confidence intervals (CIs) for difference of the mean. To test for equivalence of the average values of characteristics, the equivalence margin was set at 0.5 standard deviations (SD) of the mean, where these SDs were based on the Australian data. When the 95%CI for the difference of the mean value lay entirely within the range of equivalence margin (i.e. between -0.5 and 0.5 times the Australian SD), the outcome was considered equivalent.ResultsThere were no significant differences between the groups from Japan and Australia for depressive symptoms (mean ± SD; Japan 4.9±5.4, Australia 4.2±4.7) and fear of movement (11.7±3.8, 12.5±3.2, respectively). Mean (95%CI) between group differences were 0.75 (-0.79 to 2.28) for depressive symptoms and -0.77 (-1.77 to 0.22) for fear of movement. Based on the equivalence test, 95%CIs of mean difference between groups for depressive symptoms was within the range of equivalence margin (±2.35). However, the lower limit of the 95% CI of difference in mean for fear of movement (-1.77) was just outside the lower equivalence margin (-1.60). People from Japan with knee OA showed significantly higher pain catastrophizing (20.7±11.0) than those from Australia (14.8±9.6).ConclusionsPeople from Japan with knee OA showed higher pain catastrophizing than people from Australia. The level of depressive symptoms and fear of movement appeared to be equivalent between people from the two countries.

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Sexual satisfaction and subjective well-being after heart transplantation

European Journal of Cardiovascular Nursing ◽

10.1093/eurjcn/zvab060.121 ◽

2021 ◽

Vol 20 (Supplement_1) ◽

Author(s):

I Matic ◽

M Grubisic ◽

N Matic ◽

A Ljubas ◽

A Miljas

Keyword(s):

Heart Transplantation ◽

Marital Status ◽

Multiple Regression ◽

Sexual Satisfaction ◽

Short Form ◽

Female Gender ◽

Well Being ◽

Subjective Well Being ◽

Satisfaction Scale ◽

The Mean

Abstract Introduction Heart transplantation is still the most dominant method used to achieve successful results in treating end-stage heart failure patients. Besides using new medicines, technologies and monitoring of patients" physical condition, overall care should also include monitoring patients’ well–being, which is not often done. The purpose of this study was to undertake a sexual satisfaction and subjective well-being after heart transplantation. Methods The study was conducted on a random sample of 30 patients who had heart transplantation. The data were collected prospectively during a visit to the clinic. Sexual satisfaction was measured by short form of the New Scale of Sexual Satisfaction. The questionnaire consists of twelve items in which patients evaluate their satisfaction with sexual domains. Subjective well-being was measured by the Personal Wellbeing Index. The questionnaire consists of seven items in which patients evaluate their satisfaction with some domains of life. All reported values have been converted onto a standard 0-100 range. The values were given as mean (M) and standard deviation (SD). The differences were tested by the t-test. The result of the questionnaire was determined by correlation analysis and multiple regression. Results The mean age of participants was 59.5 ± 7.3, most of them were male (80%) and married (76%). The mean score on the sexual satisfaction scale was 30.7 ± 9.9. Compared to the results of the general population 46,9 ± 8,5 result are significantly unfavorable (p<.001). The overall subjective well-being was 75.0 ± 13.2 within the normative range. Compared to women, men were significantly more satisfied with sex life, 33.40 ±8.33 vs 20.20 ±9.41 (p=.005), significantly higher well-being 77.3 ± 13.8; vs 65.7 ± 2.4 (p=.002). Patients who were married had significantly greater satisfaction with sex lives 33,1 ± 9,1 than singles 23,1 ± 9,2 (p=.029), whereas this difference was not observed with respect to well-being 75,4 ± 12,4 vs 73,5 ± 16,67 (p=.764). Positive and significant correlations were found between sexual satisfaction and subjective well-being (.60; p=.002) as well as negative, between sexual satisfaction and female gender (-.54; p=.005). Results of multiple regression of the model that included the predictors: subjective well-being, gender and marital status has shown predictive success of the model explains about 56% of sexual satisfaction variance. Sexual satisfaction was a significant predictor in explaining 33% of variance in subjective well-being. Conclusion(s) Subjective well-being is satisfactory after successful heart transplantation, but sexual satisfaction is poorly. It takes a certain time for some patients to adapt to new life situations but gender and marital status play an important role. Further studies which will include more patients, especially women and young, should be made to evaluate variables associated with sexual satisfaction of patients after heart transplantation.

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Subgroup analyses of the effectiveness of oral glucosamine for knee and hip osteoarthritis: a systematic review and individual patient data meta-analysis from the OA trial bank

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2017-211149 ◽

2017 ◽

Vol 76 (11) ◽

pp. 1862-1869 ◽

Cited By ~ 40

Author(s):

Jos Runhaar ◽

Rianne M Rozendaal ◽

Marienke van Middelkoop ◽

Hans J W Bijlsma ◽

Michael Doherty ◽

...

Keyword(s):

Individual Patient Data ◽

Meta Analysis ◽

Hip Osteoarthritis ◽

Patient Data ◽

Good Evidence ◽

Trial Data ◽

Pain Severity ◽

Knee Oa ◽

Structural Abnormalities ◽

Better Than

ObjectiveTo evaluate the effectiveness of oral glucosamine in subgroups of people with hip or knee osteoarthritis (OA) based on baseline pain severity, body mass index (BMI), sex, structural abnormalities and presence of inflammation using individual patient data.MethodsAfter a systematic search of the literature and clinical trial registries, all randomised controlled trials (RCTs) evaluating the effect of any oral glucosamine substance in patients with clinically or radiographically defined hip or knee OA were contacted. As a minimum, pain, age, sex and BMI at baseline and pain as an outcome measure needed to be assessed.ResultsOf 21 eligible studies, six (n=1663) shared their trial data with the OA Trial Bank. Five trials (all independent of industry, n=1625) compared glucosamine with placebo, representing 55% of the total number of participants in all published placebo-controlled RCTs. Glucosamine was no better than placebo for pain or function at short (3 months) and long-term (24 months) follow-up. Glucosamine was also no better than placebo among the predefined subgroups. Stratification for knee OA and type of glucosamine did not alter these results.ConclusionsAlthough proposed and debated for several years, open trial data are not widely made available for studies of glucosamine for OA, especially those sponsored by industry. Currently, there is no good evidence to support the use of glucosamine for hip or knee OA and an absence of evidence to support specific consideration of glucosamine for any clinically relevant OA subgroup according to baseline pain severity, BMI, sex, structural abnormalities or presence of inflammation.

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Neuropathic pain in the IMI-APPROACH knee osteoarthritis cohort: prevalence and phenotyping

RMD Open ◽

10.1136/rmdopen-2021-002025 ◽

2021 ◽

Vol 7 (3) ◽

pp. e002025

Author(s):

Eefje Martine van Helvoort ◽

Paco M J Welsing ◽

Mylène P Jansen ◽

Willem Paul Gielis ◽

Marieke Loef ◽

...

Keyword(s):

Neuropathic Pain ◽

Physical Function ◽

Functional Disability ◽

Short Form ◽

Joint Damage ◽

The Body ◽

Knee Oa ◽

Paindetect Questionnaire ◽

Registration Number ◽

Private Research

ObjectivesOsteoarthritis (OA) patients with a neuropathic pain (NP) component may represent a specific phenotype. This study compares joint damage, pain and functional disability between knee OA patients with a likely NP component, and those without a likely NP component.MethodsBaseline data from the Innovative Medicines Initiative Applied Public-Private Research enabling OsteoArthritis Clinical Headway knee OA cohort study were used. Patients with a painDETECT score ≥19 (with likely NP component, n=24) were matched on a 1:2 ratio to patients with a painDETECT score ≤12 (without likely NP component), and similar knee and general pain (Knee Injury and Osteoarthritis Outcome Score pain and Short Form 36 pain). Pain, physical function and radiographic joint damage of multiple joints were determined and compared between OA patients with and without a likely NP component.ResultsOA patients with painDETECT scores ≥19 had statistically significant less radiographic joint damage (p≤0.04 for Knee Images Digital Analysis parameters and Kellgren and Lawrence grade), but an impaired physical function (p<0.003 for all tests) compared with patients with a painDETECT score ≤12. In addition, more severe pain was found in joints other than the index knee (p≤0.001 for hips and hands), while joint damage throughout the body was not different.ConclusionsOA patients with a likely NP component, as determined with the painDETECT questionnaire, may represent a specific OA phenotype, where local and overall joint damage is not the main cause of pain and disability. Patients with this NP component will likely not benefit from general pain medication and/or disease-modifying OA drug (DMOAD) therapy. Reserved inclusion of these patients in DMOAD trials is advised in the quest for successful OA treatments.Trial registration numberThe study is registered under clinicaltrials.gov nr: NCT03883568.

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