scholarly journals Future Directions in Painful Knee Osteoarthritis: Harnessing Complexity in a Heterogeneous Population

2014 ◽  
Vol 94 (3) ◽  
pp. 422-432 ◽  
Author(s):  
Andrew J. Kittelson ◽  
Steven Z. George ◽  
Katrina S. Maluf ◽  
Jennifer E. Stevens-Lapsley
Keyword(s):  
Knee Osteoarthritis ◽  
Disease Process ◽  
Research Society ◽  
Future Directions ◽  
Pain Experience ◽  
Knee Oa ◽  
Research Priority ◽  
Osteoarthritis Research Society ◽  
Knee Pathology

This perspective article proposes a conceptual model for the pain experience for individuals diagnosed with knee osteoarthritis (OA). Pain in knee OA is likely a heterogeneous, multifactorial phenomenon that involves not only the OA disease process but also elements specific to patient psychology and pain neurophysiology. The relevant contributions to the pain experience for any individual patient remain difficult, if not impossible, to definitively determine, and the rationale for many clinical treatment decisions arises primarily from a mechanistic understanding of OA pathophysiology. The Osteoarthritis Research Society International (OARSI) recently identified “phenotyping” of OA pain as a research priority to “better target pain therapies to individual patients.” This perspective article proposes that contributions from 3 domains—knee pathology, psychological distress, and pain neurophysiology—should be considered equally important in future efforts to understand pain phenotypes in knee OA. Ultimately, characterization of pain phenotypes may aid in the understanding of the pain experience and the development of interventions specific to pain for individual patients.

Experimental Observation of the Sequence of Tibial Plateau Chondrocyte and Matrix Degeneration in Spontaneous Osteoarthritis in Guinea Pigs

2020 ◽  
Author(s):  
XIAOJIAN WANG ◽  
XIAOJIAN Wang ◽  
Lei Wei ◽  
Yan Xue ◽  
Rong-shan Li
Keyword(s):  
Knee Osteoarthritis ◽  
Guinea Pigs ◽  
Tibial Plateau ◽  
Caspase 3 ◽  
Physiological State ◽  
Research Society ◽  
Cartilage Tissue ◽  
Knee Oa ◽  
The Matrix ◽  
Osteoarthritis Research Society

Abstract Background To observe the sequence of chondrocyte degeneration and matrix degradation in the superficial surface cartilage of the tibial plateau in guinea pigs with spontaneous knee osteoarthritis (OA).Methods Forty guinea pigs were euthanized at the ages of 10 months (n=20) and 12 months (n=20). The degree of degeneration of the tibial plateau cartilage was evaluated by Osteoarthritis Research Society International (OARSI) score.The levels of MMP-13 and Caspase-3 in the chondrocytes were detected by immunohistochemistry (IHC). The serum concentration of CTX-II was measured and compared.Western blot analysis was used to detect the levels of MMP-13 and Caspase-3 in the cartilage tissue.Results The OARSI score in the 10-month-old group(6.4±1.7) was lower than that in the 12-month-old group(12.7±3.2)(P＜0.05). Immunohistochemical staining confirmed the levels of MMP-13(10-month-old,6.1±2.0;12-month-old,5.8±1.6) and Caspase-3(10-month-old,2.6±0.6;12-month-old,2.8±0.9) in two groups appeared to be nonsignificant (all P＜0.05).The serum CTX-II in the 10-month-old group(8.6±1.2) was lower than that in the 12-month-old group(13.7±2.3) (P＜0.05). The western blot results confirmed the levels of MMP-13(10-month-old,0.82±0.21;12-month-old,0.86±0.27) and Caspase-3(10-month-old,0.22±0.07;12-month-old,0.20±0.08) in two groups appeared to be nonsignificant (all P＜0.05).Conclusion The superficial chondrocytes of the tibial plateau first appeared to be hypertrophic and then apoptotic, and the matrix was further degraded when spontaneous knee osteoarthritis occurred in guinea pigs.Changes in the physiological state of chondrocytes are the initiating factors in the pathogenesis of knee OA.

scholarly journals Automatic Grading of Individual Knee Osteoarthritis Features in Plain Radiographs Using Deep Convolutional Neural Networks

Diagnostics ◽  
2020 ◽  
Vol 10 (11) ◽  
pp. 932
Author(s):  
Aleksei Tiulpin ◽  
Simo Saarakkala
Keyword(s):  
Knee Osteoarthritis ◽  
Joint Space Narrowing ◽  
Joint Space ◽  
Research Society ◽  
Fine Tuning ◽  
Deep Convolutional Neural Networks ◽  
Fine Grained ◽  
Knee Oa ◽  
Osteoarthritis Initiative ◽  
Osteoarthritis Research Society

Knee osteoarthritis (OA) is the most common musculoskeletal disease in the world. In primary healthcare, knee OA is diagnosed using clinical examination and radiographic assessment. Osteoarthritis Research Society International (OARSI) atlas of OA radiographic features allows performing independent assessment of knee osteophytes, joint space narrowing and other knee features. This provides a fine-grained OA severity assessment of the knee, compared to the gold standard and most commonly used Kellgren–Lawrence (KL) composite score. In this study, we developed an automatic method to predict KL and OARSI grades from knee radiographs. Our method is based on Deep Learning and leverages an ensemble of residual networks with 50 layers. We used transfer learning from ImageNet with a fine-tuning on the Osteoarthritis Initiative (OAI) dataset. An independent testing of our model was performed on the Multicenter Osteoarthritis Study (MOST) dataset. Our method yielded Cohen’s kappa coefficients of 0.82 for KL-grade and 0.79, 0.84, 0.94, 0.83, 0.84 and 0.90 for femoral osteophytes, tibial osteophytes and joint space narrowing for lateral and medial compartments, respectively. Furthermore, our method yielded area under the ROC curve of 0.98 and average precision of 0.98 for detecting the presence of radiographic OA, which is better than the current state-of-the-art.

scholarly journals Uptake of the OMERACT-OARSI Hip and Knee Osteoarthritis Core Outcome Set: Review of Randomized Controlled Trials from 1997 to 2017

2019 ◽  
Vol 46 (8) ◽  
pp. 976-980 ◽  
Author(s):  
Toby O. Smith ◽  
Michael Mansfield ◽  
Gillian A. Hawker ◽  
David J. Hunter ◽  
Lyn M. March ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Global Assessment ◽  
Core Outcome Set ◽  
Research Society ◽  
Controlled Trials ◽  
Core Outcome ◽  
Knee Oa ◽  
Randomized Controlled ◽  
Outcome Set ◽  
Osteoarthritis Research Society

Objective.To assess the uptake of the OMERACT-OARSI (Outcome Measures in Rheumatology- Osteoarthritis Research Society International) core outcome set (COS) domains in hip and/or knee osteoarthritis (OA) trials.Methods.There were 382 trials of hip and/or knee OA identified from the ClinicalTrial.gov registry from 1997 to 2017. Frequency of COS adoption was assessed by year and per 5-yearly phases.Results.COS adoption decreased from 61% between 1997 and 2001 to 38% between 2012 and 2016. Pain (95%) and physical function (86%) were most consistently adopted. Patient’s global assessment (48%) was the principal missing domain.Conclusion.Limited adoption of the COS domains indicates that further consideration to improve uptake is required.

Overview of neuroimaging

2019 ◽  
pp. 31-44
Author(s):  
Tomasz Matys ◽  
Daniel. J. Scoffings ◽  
Tilak Das
Keyword(s):  
Essential Role ◽  
Imaging Techniques ◽  
Disease Process ◽  
Future Directions ◽  
Anatomical Imaging ◽  
Radiological Methods ◽  
Physical Principles ◽  
Insight Into ◽  
Individual Disease

Imaging plays an essential role in the diagnosis and treatment of neurosurgical conditions. This chapter discusses the basic physical principles, applications, and limitations of the main imaging techniques used in neurosurgical practice, and highlights potential future directions of functional and molecular neuroimaging. Current conventional radiological methods allow demonstration of anatomical and macroscopic pathological features of disease with excellent sensitivity and resolution. Functional imaging methods that have enabled insight into a variety of physiological and pathological phenomena are also described, and are an important first step beyond anatomical imaging towards more precise characterization of the disease process. These methods however remain generally non-specific, demonstrating changes that are common endpoints of many possible pathological pathways. This chapter also covers current neuroradiology imaging modalities that are useful in neurosurgical practice, and focuses on the general usefulness and limitations of neuroradiological methods rather than the imaging manifestations of individual disease processes, which are discussed elsewhere in this book.

Comparative Clinical Outcomes After Intra-articular Injection With Adipose-Derived Cultured Stem Cells or Noncultured Stromal Vascular Fraction for the Treatment of Knee Osteoarthritis

2019 ◽  
Vol 47 (11) ◽  
pp. 2577-2583 ◽  
Author(s):  
Naomasa Yokota ◽  
Mari Hattori ◽  
Tadahiko Ohtsuru ◽  
Masaki Otsuji ◽  
Stephen Lyman ◽  
...  
Keyword(s):  
Stem Cells ◽  
Clinical Outcomes ◽  
Repeated Measures ◽  
Stromal Vascular Fraction ◽  
Research Society ◽  
Level Of Evidence ◽  
Treatment Groups ◽  
Knee Oa ◽  
Standard Medical Therapy ◽  
Osteoarthritis Research Society

Background: Intra-articular injection of adipose-derived stem cells (ASCs) has shown promise for improving symptoms and cartilage quality in the treatment of osteoarthritis (OA). However, while most preclinical studies have been performed with plastic-adherent ASCs, most clinical trials are being conducted with the stromal vascular fraction (SVF), prepared from adipose tissue without prior culture. Purpose: To directly compare clinical outcomes of intra-articular injection with ASCs or SVF in patients with knee OA. Study Design: Cohort study; Level of evidence, 3. Methods: The authors retrospectively compared 6-month outcomes in 42 patients (59 knees) receiving intra-articular injection with 12.75 million ASCs and 38 patients (69 knees) receiving a 5-mL preparation of SVF. All patients had Kellgren-Lawrence grade 2, 3, or 4 knee OA and had failed standard medical therapy. The visual analog scale (VAS) pain score and Knee injury and Osteoarthritis Outcome Score (KOOS) at baseline and 1, 3, and 6 months after injection were considered as outcomes. Outcome Measures in Rheumatology–Osteoarthritis Research Society International (OMERACT-OARSI) criteria were also used to assess positive response. A repeated measures analysis of variance was used for comparison between the treatment groups. Results: No major complications occurred in either group. The SVF group had a higher frequency of knee effusion (SVF 8%, ASC 2%) and minor complications related to the fat harvest site (SVF 34%, ASC 5%). Both groups reported improvements in pain VAS and KOOS domains. Specifically, in the ASC group, symptoms improved earlier (by 3 months; P < .05) and pain VAS decreased to a greater degree (55%; P < .05) compared with the SVF group (44%). The proportion of OMERACT-OARSI responders in the ASC group was slightly higher (ASCs, 61%; SVF, 55%; P = .25). Conclusion: It was observed that both ASCs and SVF resulted in clinical improvement in patients with knee OA, but that ASCs outperform SVF in the early reduction of symptoms and pain with less comorbidity.

scholarly journals The OMERACT-OARSI Core Domain Set for Measurement in Clinical Trials of Hip and/or Knee Osteoarthritis

2019 ◽  
Vol 46 (8) ◽  
pp. 981-989 ◽  
Author(s):  
Toby O. Smith ◽  
Gillian A. Hawker ◽  
David J. Hunter ◽  
Lyn M. March ◽  
Maarten Boers ◽  
...  
Keyword(s):  
Clinical Trials ◽  
Knee Osteoarthritis ◽  
Health Professionals ◽  
Outcome Measurement ◽  
Measurement Instrument ◽  
Research Society ◽  
Delphi Survey ◽  
Core Domain ◽  
Knee Oa ◽  
Core Domain Set

Objective.To update the 1997 OMERACT-OARSI (Outcome Measures in Rheumatology-Osteoarthritis Research Society International) core domain set for clinical trials in hip and/or knee osteoarthritis (OA).Methods.An initial review of the COMET database of core outcome sets (COS) was undertaken to identify all domains reported in previous COS including individuals with hip and/or knee OA. These were presented during 5 patient and health professionals/researcher meetings in 3 continents (Europe, Australasia, North America). A 3-round international Delphi survey was then undertaken among patients, healthcare professionals, researchers, and industry representatives to gain consensus on key domains to be included in a core domain set for hip and/or knee OA. Findings were presented and discussed in small groups at OMERACT 2018, where consensus was obtained in the final plenary.Results.Four previous COS were identified. Using these, and the patient and health professionals/researcher meetings, 50 potential domains formed the Delphi survey. There were 426 individuals from 25 different countries who contributed to the Delphi exercise. OMERACT 2018 delegates (n = 129) voted on candidate domains. Six domains gained agreement as mandatory to be measured and reported in all hip and/or knee OA clinical trials: pain, physical function, quality of life, and patient’s global assessment of the target joint, in addition to the mandated core domain of adverse events including mortality. Joint structure was agreed as mandatory in specific circumstances, i.e., depending on the intervention.Conclusion.The updated core domain set for hip and/or knee OA has been agreed upon. Work will commence to determine which outcome measurement instrument should be recommended to cover each core domain.

scholarly journals Questionnaire to Identify Knee Symptoms: Development of a Tool to Identify Early Experiences Consistent With Knee Osteoarthritis

2014 ◽  
Vol 94 (1) ◽  
pp. 111-120 ◽  
Author(s):  
Jessica M. Clark ◽  
Bert M. Chesworth ◽  
Mark Speechley ◽  
Robert J. Petrella ◽  
Monica R. Maly
Keyword(s):  
Knee Osteoarthritis ◽  
Disease Process ◽  
Diagnostic Procedures ◽  
Sampling Bias ◽  
Self Report ◽  
Early Symptoms ◽  
Knee Oa ◽  
Early Experiences ◽  
Future Work ◽  
Self Administered Questionnaire

Background Current diagnostic procedures for knee osteoarthritis (OA) identify individuals late in the disease process. A questionnaire may be a useful and inexpensive method to screen for early symptoms of knee OA. Objective The purpose of this study was to develop a brief, self-administered questionnaire for clinical and research settings to identify emerging knee problems in people who could benefit from conservative interventions. Design This prospective study utilized a mixed-methods approach. Methods and Results Questionnaire items were generated from interview data from individuals with emerging chronic knee problems. These items were reviewed by 16 rheumatology experts, resulting in a 35-item draft questionnaire. To reduce the number of items, questionnaires were mailed to 228 adults, aged 40 to 65 years, with evidence of ongoing knee problems. One hundred thirteen completed questionnaires were returned (63.1% response rate), with 105 usable questionnaires. Using principal components analysis, the number of items was reduced to a final 13-item version, the Questionnaire to Identify Knee Symptoms (QuIKS). The QuIKS has 4 subscales: medications, monitoring, interpreting, and modifying. The QuIKS demonstrated strong internal consistency. Limitations A sampling bias among respondents who provided data for item reduction likely means that the QuIKS reflects those who self-report knee problems to a health care provider, which may not be generalizable to the population. Conclusions The QuIKS is a short, self-administered questionnaire used to promote activity by identifying the experiences associated with early symptoms consistent with knee OA, such as monitoring intermittent symptoms, interpreting the meaning of these symptoms, modifying behaviors, and including the use of medications. If future work validates the QuIKS, its use in developing samples could expand our understanding of early disease and improve interventions.

scholarly journals A Double-Blind Randomized Placebo-Controlled Feasibility Study Evaluating Individualized Homeopathy in Managing Pain of Knee Osteoarthritis

2015 ◽  
Vol 20 (3) ◽  
pp. 186-191 ◽  
Author(s):  
Munmun Koley ◽  
Subhranil Saha ◽  
Shubhamoy Ghosh
Keyword(s):  
Knee Osteoarthritis ◽  
Research Society ◽  
Group Differences ◽  
Loss Of Function ◽  
Double Blind ◽  
Rigorous Evaluation ◽  
Medical College ◽  
Visual Analog Scales ◽  
Osteoarthritis Research Society ◽  
Clinical Trials Registry

Few homeopathic complexes seemed to produce significant effects in osteoarthritis; still, individualized homeopathy remained untested. We evaluated the feasibility of conducting an efficacy trial of individualized homeopathy in osteoarthritis. A prospective, parallel-arm, double-blind, randomized, placebo-controlled pilot study was conducted from January to October 2014 involving 60 patients (homeopathy, n = 30; placebo, n = 30) who were suffering from acute painful episodes of knee osteoarthritis and visiting the outpatient clinic of Mahesh Bhattacharyya Homeopathic Medical College and Hospital, West Bengal, India. Statistically significant reduction was achieved in 3 visual analog scales (measuring pain, stiffness, and loss of function) and Osteoarthritis Research Society International scores in both groups over 2 weeks ( P < .05); however, group differences were not significant ( P > .05). Overall, homeopathy did not appear to be superior to placebo; still, further rigorous evaluation in this design involving a larger sample size seems feasible in future. Trial registration: Clinical Trials Registry, India (CTRI/2014/05/004589).

scholarly journals The Inverse OARSI-OMERACT Criteria Is a Valid Indicator of the Clinical Worsening of Knee Osteoarthritis: Data from the Osteoarthritis Initiative

2020 ◽  
pp. jrheum.200145
Author(s):  
Jeffrey B. Driban ◽  
Matthew S. Harkey ◽  
Lori Lyn Price ◽  
Grace H. Lo ◽  
Timothy E. McAlindon
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Knee Replacement ◽  
Walking Speed ◽  
Cox Model ◽  
Research Society ◽  
Osteoarthritis Initiative ◽  
Osteoarthritis Research Society ◽  
And Function ◽  
Relationship Of

Objective We assessed if the inverse Osteoarthritis Research Society International (OARSI) and Outcome Measures in Rheumatology (OMERACT) criteria relate to concurrent radiographic knee osteoarthritis (KOA) progression and decline in walking speed, as well as future knee replacement. Methods We conducted knee-based analyses of data from the Osteoarthritis Initiative. All knees had symptomatic OA: at least doubtful radiographic KOA (Kellgren-Lawrence grade ≥ 1) and knee pain ≥ 10/100 (Western Ontario and McMaster Universities Osteoarthritis Index pain) at the 12-month visit. The inverse of the OARSI-OMERACT responder criteria depended on knee pain and function, and global assessment of knee impact. We used generalized linear mixed models to assess the relationship of the inverse OARSI‑OMERACT criteria over 2 years (i.e., 12-month and 36-month visits) with worsening radiographic severity (any increase in Kellgren-Lawrence grade from 12 months to 36 months) and decline in self-selected 20-m walking speed of ≥ 0.1m/s (from 12 months to 36 months). We used a Cox model to assess time to knee replacement during the 6 years after the 36-month visit as an outcome. Results Among the 1746 analyzed, 19% met the inverse OARSI-OMERACT criteria. Meeting the inverse OARSI-OMERACT criteria was associated with almost double the odds of experiencing concurrent worsening in radiographic KOA severity (OR 1.89, 95% CI 1.32–2.70) or decline in walking speed (OR 1.82, 95% CI 1.37–2.40). A knee meeting the inverse OARSI-OMERACT criteria was more likely to receive a knee replacement after the 36-month visit (23%) compared with a nonresponder (10%; HR 2.54, 95% CI 1.89–3.41). Conclusion The inverse OARSI-OMERACT criteria for worsening among people with KOA had good construct validity in relation to clinically relevant outcomes.

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