“I wish it had a place to go”: a nominal group study of barriers to the effectiveness of non-surgical treatments for knee osteoarthritis inclusive of minority populations

Abstract Objective To examine patient experience, views, and opinions regarding the ineffectiveness of the current knee osteoarthritis (OA) treatments. Methods Nominal groups were conducted with consecutive clinic patients with knee OA, oversampling African Americans. Patients discussed and rank-ordered their concerns. Results Fourteen nominal groups with 48 knee OA patients were conducted with a mean age of 60.6 years (standard deviation, 9.8) and a knee OA duration of 7.8 years (sd, 5.4); 25% were men, and 54% were African American. The most frequently cited highly ranked concerns for the ineffectiveness of current knee OA treatments were as follows: (1) medication-related—(A) side effects (3 groups; 4% vote), (B) limited efficacy (5 groups; 11% vote), (C) medication not targeting underlying disease (7 groups; 16% vote), (D) lack of personalized medication use (3 groups; 4% vote), (E) temporary benefit (3 groups; 6% vote), and (F) fear of addiction/natural treatment preference (2 groups; 3% vote); (2) exercise/physical therapy-related—(G) exacerbation of joint pain (1 group; 3% vote), (H) difficulty in doing exercises (2 groups; 2% vote), (I) lack of motivation (8 groups; 12% vote), (J) technical challenges/lack of personalized exercise regimens (1 group; 1% vote), and (K) cost (2 groups; 3% vote); and (3) weight loss-related—(L) difficulty in achieving weight loss (4 groups; 6% vote) and (M) motivation (1 group; 1% vote). Conclusions A representative sample of participants with knee OA identified several barriers to the effectiveness of current knee OA treatments. This new knowledge provides insights for making the current treatment options potentially more usable and/or more effective.

Download Full-text

Effect of liraglutide on body weight and pain in patients with overweight and knee osteoarthritis: protocol for a randomised, double-blind, placebo-controlled, parallel-group, single-centre trial

BMJ Open ◽

10.1136/bmjopen-2018-024065 ◽

2019 ◽

Vol 9 (5) ◽

pp. e024065 ◽

Cited By ~ 1

Author(s):

Henrik Gudbergsen ◽

Marius Henriksen ◽

Eva Ejlersen Wæhrens ◽

Anders Overgaard ◽

Henning Bliddal ◽

...

Keyword(s):

Weight Loss ◽

Body Weight ◽

Knee Osteoarthritis ◽

Controlled Trial ◽

Single Centre ◽

Double Blind ◽

Double Blind Placebo ◽

Knee Oa ◽

Parallel Group ◽

Pain Subscale

IntroductionWith an increasing prevalence of citizens of older age and with overweight, the health issues related to knee osteoarthritis (OA) will intensify. Weight loss is considered a primary management strategy in patients with concomitant overweight and knee OA. However, there are no widely available and feasible methods to sustain weight loss in patients with overweight and knee OA. The present protocol describes a randomised controlled trial evaluating the efficacy and safety of the glucagon-like peptide-1 receptor agonist liraglutide in a 3 mg/day dosing in patients with overweight and knee OA.Methods and analysis150 volunteer adult patients with overweight or obesity and knee OA will participate in a randomised, double-blind, placebo-controlled, parallel-group and single-centre trial. The participants will partake in a run-in diet intervention phase (week −8 to 0) including a low calorie diet and dietetic counselling. At week 0, patients will be randomised to either liraglutide 3 mg/day or liraglutide placebo 3 mg/day for 52 weeks as an add-on to dietetic guidance on re-introducing regular foods and a focus on continued motivation to engage in a healthy lifestyle. The co-primary outcomes are changes in body weight and the Knee Injury and Osteoarthritis Outcome Score pain subscale from week 0 to week 52.Ethics and disseminationThe trial has been approved by the regional ethics committee in the Capital Region of Denmark, the Danish Medicines Agency and the Danish Data Protection Agency. An external monitoring committee (The Good Clinical Practice Unit at Copenhagen University Hospitals) will oversee the trial. The results will be presented at international scientific meetings and through publications in peer-reviewed journals.Trial registration numbers2015-005163-16,NCT02905864, U1111-1171-4970Based on protocol versionV.6; 30 January 2017, 15:30 hours

Download Full-text

Knee Osteoarthritis: A Review of Pathogenesis and State-Of-The-Art Non-Operative Therapeutic Considerations

Genes ◽

10.3390/genes11080854 ◽

2020 ◽

Vol 11 (8) ◽

pp. 854

Author(s):

Dragan Primorac ◽

Vilim Molnar ◽

Eduard Rod ◽

Željko Jeleč ◽

Fabijan Čukelj ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Platelet Rich Plasma ◽

Treatment Options ◽

Stromal Vascular Fraction ◽

Disease Stage ◽

Knee Oa ◽

Marrow Mesenchymal Stem Cells ◽

The Moment ◽

And Function ◽

Orthopedic Patients

Being the most common musculoskeletal progressive condition, osteoarthritis is an interesting target for research. It is estimated that the prevalence of knee osteoarthritis (OA) among adults 60 years of age or older is approximately 10% in men and 13% in women, making knee OA one of the leading causes of disability in elderly population. Today, we know that osteoarthritis is not a disease characterized by loss of cartilage due to mechanical loading only, but a condition that affects all of the tissues in the joint, causing detectable changes in tissue architecture, its metabolism and function. All of these changes are mediated by a complex and not yet fully researched interplay of proinflammatory and anti-inflammatory cytokines, chemokines, growth factors and adipokines, all of which can be measured in the serum, synovium and histological samples, potentially serving as biomarkers of disease stage and progression. Another key aspect of disease progression is the epigenome that regulates all the genetic expression through DNA methylation, histone modifications, and mRNA interference. A lot of work has been put into developing non-surgical treatment options to slow down the natural course of osteoarthritis to postpone, or maybe even replace extensive surgeries such as total knee arthroplasty. At the moment, biological treatments such as platelet-rich plasma, bone marrow mesenchymal stem cells and autologous microfragmented adipose tissue containing stromal vascular fraction are ordinarily used. Furthermore, the latter two mentioned cell-based treatment options seem to be the only methods so far that increase the quality of cartilage in osteoarthritis patients. Yet, in the future, gene therapy could potentially become an option for orthopedic patients. In the following review, we summarized all of the latest and most important research in basic sciences, pathogenesis, and non-operative treatment.

Download Full-text

Phenylalanine Is a Novel Marker for Radiographic Knee Osteoarthritis Progression: The MOST Study

The Journal of Rheumatology ◽

10.3899/jrheum.200054 ◽

2020 ◽

Vol 48 (1) ◽

pp. 123-128

Author(s):

Guangju Zhai ◽

Xianbang Sun ◽

Edward W. Randell ◽

Ming Liu ◽

Na Wang ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Radiographic Progression ◽

Phenylalanine Level ◽

Combined Analysis ◽

Knee Oa ◽

Increased Risk ◽

Group 2 ◽

Site Significance ◽

Radiographic Knee Osteoarthritis ◽

Group 1

Objective.To identify plasma markers associated with an increased risk of radiographic knee osteoarthritis(OA) progression using a metabolomics approach.Methods.Study participants were from the Multicenter Osteoarthritis Study (MOST) and were categorized into 2 groups based on the presence of baseline radiographic OA. Subjects in group 1 had unilateral knee OA and subjects in group 2 had bilateral knee OA. Progression was defined as a half-grade or greater worsening in joint space width at 30-month follow-up. For group 1, a participant progressed when their OA knee showed radiographic progression and the contralateral knee developed OA; for group 2, a participant progressed when both knees with OA showed radiographic progression. Metabolomic profiling was performed on plasma samples collected at baseline and logistic regression was performed to test the association between each metabolite and knee OA progression after adjustment for age, sex, BMI, and clinic site. Significance was defined as P ≤ 0.0003 in the combined analysis.Results.There were 234 progressors (57 in group 1 and 177 in group 2) and 322 nonprogressors (206 in group 1 and 116 in group 2) included in the analyses. Among 157 metabolites studied, we found that odds of progression were 1.46 times higher per SD increase of phenylalanine level (95% CI 1.20–1.77, P = 0.0001) in the combined analysis. Sex-specific analysis showed that an association was seen in women (P = 0.0002) but not in men.Conclusion.Our data suggest that phenylalanine might be a novel plasma marker for higher risk of bilateral radiographic knee OA progression in women.

Download Full-text

Does the Conservative Non-pharmacological Management of Knee Osteoarthritis in Switzerland Reflect the Clinical Guidelines? A Survey Among General Practitioners, Rheumatologists, and Orthopaedic Surgeons

Frontiers in Rehabilitation Sciences ◽

10.3389/fresc.2021.658831 ◽

2021 ◽

Vol 2 ◽

Author(s):

Lea Ettlin ◽

Irina Nast ◽

Erika O. Huber ◽

Karin Niedermann

Keyword(s):

Knee Osteoarthritis ◽

General Practitioners ◽

Treatment Options ◽

Barriers And Facilitators ◽

First Line ◽

Pharmacological Management ◽

Physically Active ◽

Knee Oa ◽

Diagnostic Measures ◽

Active Patient

Introduction: The International Guidelines recommend exercise, education and weight management (if appropriate) as the first-line conservative treatment for patients with knee osteoarthritis (OA) to enhance their self-management. The aim of this study was to investigate the current state of conservative non-pharmacological management of patients with knee OA in Switzerland and to explore the perceived barriers and facilitators to the application of the guideline recommendations.Materials and methods: Eleven semi-structured interviews with selected general practitioners (GPs), rheumatologists and orthopaedic surgeons were performed. Based on these results, an online survey was developed and sent to the members of three scientific medical societies. Questions addressed the frequency of diagnostic measures, treatment options, reasons for referral to exercise and also barriers and facilitators.Results: A total of 234 members responded. They indicated that patients normally present due to pain (n = 222, 98.2%) and functional limitations of the knee (n = 151, 66.8%). In addition to clinical assessment, X-ray (n = 214, 95.5%) and MRI (n = 70, 31.3%) were the most frequently used diagnostic measures. Treatment options usually involved patient education for diagnosis (n = 223, 98.6%) and suitable activities (n = 217, 96%), pharmacological treatment (n = 203, 89.8%) and referral to physiotherapy (n = 188, 83.2%). The participants estimated that they had referred 54% of their patients with knee OA for a specific exercise. The referral to exercise was driven by “patient expectation/high level of suffering” (n = 73, 37.1%) and their “own clinical experience” (n = 49, 24.9%). The specialists rated the most important barriers to referral to exercise as “disinterest of patient” (n = 88, 46.3%) and “physically active patient” (n = 59, 31.1%). As the most important facilitators, they rated “importance to mention exercise despite the short time of consultation” (n = 170, 89.4%) and “insufficiently physically active patient” (n = 165, 86.9%).Discussion: A substantial evidence–performance gap in the management of patients with knee OA appears to exist in Switzerland. For the systematic referral to exercise as the first-line intervention, it might be useful for medical doctors to suggest a structured exercise programme to patients with knee OA, rather than just advising general exercise.

Download Full-text

Noninterventional Therapies for the Management of Knee Osteoarthritis

The Journal of Knee Surgery ◽

10.1055/s-0038-1676107 ◽

2018 ◽

Vol 32 (01) ◽

pp. 046-054 ◽

Cited By ~ 5

Author(s):

Joseph Dadabo ◽

Julia Fram ◽

Prakash Jayabalan

Keyword(s):

Weight Loss ◽

Knee Osteoarthritis ◽

Treatment Plan ◽

Treatment Strategies ◽

Therapeutic Modalities ◽

Knee Oa ◽

Oral Analgesic ◽

Individualized Approach ◽

Oral Supplements

AbstractThe goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.

Download Full-text

Developments in Smart Multi-Function Gait Assistive Devices for the Prevention and Treatment of Knee Osteoarthritis—A Literature Review

Applied Sciences ◽

10.3390/app112210947 ◽

2021 ◽

Vol 11 (22) ◽

pp. 10947

Author(s):

Hanatsu Nagano ◽

William Sparrow ◽

Rezaul Begg

Keyword(s):

Articular Cartilage ◽

Knee Joint ◽

Knee Osteoarthritis ◽

Treatment Options ◽

Smart Systems ◽

Messenger Ribonucleic Acid ◽

Knee Oa ◽

Senior Population ◽

Electro Magnetic ◽

Joint Motions

Knee osteoarthritis (OA) is a degenerative condition that critically affects locomotor ability and quality of life and, the condition is particularly prevalent in the senior population. The current review presents a gait biomechanics conceptual framework for designing active knee orthoses to prevent and remediate knee OA. Constant excessive loading diminishes knee joint articular cartilage and, therefore, measures to reduce kinetic stresses due to the fact of adduction moments and joint compression are an essential target for OA prevention. A powered orthosis enables torque generation to support knee joint motions and machine-learning-driven “smart systems” can optimise the magnitude and timing of joint actuator forces. Although further research is required, recent findings raise the possibility of exoskeleton-supported, non-surgical OA interventions, increasing the treatment options for this prevalent, painful and seriously debilitating disease. Combined with advances in regenerative medicine, such as stem cell implantation and manipulation of messenger ribonucleic acid (m-RNA) transcription, active knee orthoses can be designed to incorporate electro-magnetic stimulators to promote articular cartilage resynthesis.

Download Full-text

Absence of pain in subjects with advanced radiographic knee osteoarthritis

BMC Musculoskeletal Disorders ◽

10.1186/s12891-020-03647-x ◽

2020 ◽

Vol 21 (1) ◽

Author(s):

Kyeong Min Son ◽

Jeong Im Hong ◽

Dong-Hyun Kim ◽

Dae-Gyu Jang ◽

Michel D. Crema ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Structural Damage ◽

Treatment Options ◽

Multivariable Analysis ◽

Female Gender ◽

Womac Score ◽

Multivariable Logistic Regression Analysis ◽

Knee Oa ◽

Aging Study ◽

Radiographic Knee Osteoarthritis

Abstract Background To investigate the frequency of pain among subjects with advanced radiographic knee osteoarthritis (OA) defined as Kellgren–Lawrence (KL) grade 4 and clinical features associated with pain. Methods Subjects from the Hallym Aging Study (HAS), the Korean National Health and Nutrition Examination Survey (KNHANES), and the Osteoarthritis Initiative (OAI) were included. Participants were asked knee-specific questions regarding the presence of knee pain. Clinical characteristics associated with the presence of pain were evaluated with multivariable logistic regression analysis. Results The study population consisted of 504, 10,152 and 4796 subjects from HAS, KNHANES, and OAI, respectively. KL grade 4 OA was identified in 9.3, 7.6, and 11.5% of subjects, while pain was absent in 23.5, 31.2, and 5.9% of subjects in KL grade 4 knee OA, respectively. After multivariable analysis, female gender showed a significant association with pain in the KNHANES group, while in the OAI group, younger age did. Advanced knee OA patients without pain did not differ from non-OA subjects in most items of SF-12 in both Korean and OAI subjects. Total WOMAC score was not significantly different between non-OA and advanced knee OA subjects without pain in the OAI. Conclusions Our study showed that a considerable number of subjects with KL grade 4 OA did not report pain. In patients whose pain arises from causes other than structural damage of the joint, therapeutic decision based on knee X-ray would lead to suboptimal result. In addition, treatment options focusing solely on cartilage engineering, should be viewed with caution.

Download Full-text

Weight loss as treatment for knee osteoarthritis symptoms in obese patients: 1-year results from a randomised controlled trial

Annals of the Rheumatic Diseases ◽

10.1136/ard.2010.142018 ◽

2011 ◽

Vol 70 (10) ◽

pp. 1798-1803 ◽

Cited By ~ 64

Author(s):

Henning Bliddal ◽

Anthony R Leeds ◽

Lise Stigsgaard ◽

Arne Astrup ◽

Robin Christensen

Keyword(s):

Weight Loss ◽

Knee Osteoarthritis ◽

Controlled Trial ◽

Symptomatic Improvement ◽

Control Group ◽

Womac Pain ◽

Obese Patients ◽

Knee Oa ◽

Womac Index ◽

Point Total

ObjectiveTo evaluate 1-year symptomatic improvement in obese patients with knee osteoarthritis (OA) on an intensive low-energy diet (LED) maintained by frequent consultations with a dietician compared to minimal attention.MethodsThe LED programme consisted of group therapy with dietary consultations and two periods of a low-calorie diet of 810 kcal/day during weeks 0–8 and weeks 32–36. The control group only received dietary instruction and attention for 2 h at baseline, and at weeks 8, 32, 36 and 52. The primary end point (total Western Ontario and McMaster Universities (WOMAC) index) was assessed as the mean group difference during and after 1 year.ResultsThe study population consisted of 89 patients, 89% women, average age 63 years. After 1 year, mean weight loss in the LED group was −10.9 kg (11%) versus −3.6 kg (4%) in the control group (p<0.0001). There was no difference between the groups in total WOMAC index (p=0.11), although both groups improved. However, the LED intervention resulted in less WOMAC pain (7.7 mm), with a group mean difference of 7.2 mm (95% CI 1.0 to 13.4, p=0.022). After one year 14 (32.8%) responded to LED versus 7 (15.6%) to control, with an absolute benefit of 16.3% (−1.1& to 33.6%, p=0.066).ConclusionContinuous reinforcement of a weight loss programme can be successful over a year in obese knee OA patients. Weight loss was statistically reflected only by a reduction in pain. However, the overall clinical benefits of the intervention on health should lead to a strong recommendation of weight loss in this group of patients.

Download Full-text

One-year efficacy and safety of single or one to three weekly injections of hylan G-F 20 for knee osteoarthritis: a systematic literature review and meta-analysis

Clinical Rheumatology ◽

10.1007/s10067-020-05477-7 ◽

2020 ◽

Author(s):

Orazio De Lucia ◽

Joerg Jerosch ◽

Sophie Yoon ◽

Tobias Sayre ◽

Wilson Ngai ◽

...

Keyword(s):

Knee Osteoarthritis ◽

Physical Function ◽

Treatment Options ◽

Womac Pain ◽

Efficacy And Safety ◽

Knee Oa ◽

Randomized Studies ◽

Sf 36 ◽

Meta Analyses

Abstract The aim of this study was to evaluate the long-term efficacy and safety of single or 1–3 weekly injections of hylan G-F 20 at 1 year following the first injection for knee osteoarthritis (OA). Searches were conducted in PubMed/MEDLINE, Embase, and CENTRAL and included relevant conference proceedings (January 1, 1995–August 17, 2020). Randomized controlled trials (RCTs), non-randomized trials, and observational studies investigating 1-year efficacy and safety of 1–3 weekly injections or single hylan G-F 20 injection for knee OA were included. Primary outcomes were WOMAC pain, physical function, and stiffness. Meta-analyses of RCTs and non-randomized studies were conducted separately. Our search identified 24 eligible studies. Hylan G-F 20, in the meta-analyses of RCTs, showed statistically significant improvement in WOMAC pain (SMCC − 0.98, 95% CI − 1.50, − 0.46), physical function (SMCC − 1.05, 95% CI − 1.28, − 0.83), and stiffness (SMCC − 1.07, 95% CI −1.28, −0.86). Improvement was also seen for VAS pain, SF-36 MCS (mental component summary), and SF-36 PCS (physical component summary). Analyses of non-randomized studies showed similar efficacy estimates. There were no significant differences in efficacy based on injection schedule, nor between RCT and non-randomized studies. Rates of adverse events (AEs) were low for most types of AEs. Hylan G-F 20 (either as single or 1–3 weekly injections) showed improvement in 1-year efficacy outcomes in comparison to baseline and was generally well tolerated. While further research will inform the medical field regarding viscosupplementation treatment options for knee OA, these findings show that hylan G-F 20 at both frequencies/dosages are efficacious and generally well tolerated for long-term use.

Download Full-text

A study on correlation between deficiency of vitamin D and knee osteoathritis among patients attending a tertiary care hospital in Andhra Pradesh

International Journal of Research in Orthopaedics ◽

10.18203/issn.2455-4510.intjresorthop20203961 ◽

2020 ◽

Vol 6 (6) ◽

pp. 1161

Author(s):

Komala Rao ◽

V. Ramesh

Keyword(s):

Vitamin D ◽

Knee Osteoarthritis ◽

Vitamin D Deficiency ◽

Serum Vitamin ◽

Care Hospital ◽

Serum Vitamin D ◽

Knee Oa ◽

Group 2 ◽

25 Oh Vitamin D ◽

Group 1

Background: The prevalence of vitamin D deficiency is the burning topic worldwide. Vitamin D deficiency is a under diagnosed medical condition since a significant proportion of the population in many countries and regions around the world have low serum 25-hydroxy (OH) vitamin D levels. The aim of this study was to investigate the association between serum vitamin D deficiency and knee osteoarthritis (OA).Methods: The study population consists of 200 patients divided into two groups, group 1 and group 2. Group 1 with 100 subjects with no clinical features of knee osteoarthritis served as controls and group 2 consists of 100 patients of patients diagnosed with knee osteoarthritis. Serum 25-OH vitamin D was measured in all the participants by the enzyme-linked fluorescence assay (ELFA) method and concentrations <20 ng/ml was considered as deficient.Results: In group 1, 47% were male and 53% were female whereas in group 2, 41% were male and 59% were female. In group 1, only 8% are vitamin D deficiency whereas in group 2, 61% have vitamin D deficiency. There was a significant association between serum vitamin D and staging of knee OA.Conclusions: The present study findings showed a significant association between serum 25-OH vitamin D deficiency and in patients with knee OA.

Download Full-text