scholarly journals The Effect of Widespread Pain on Knee Pain Worsening, Incident Knee Osteoarthritis (OA), and Incident Knee Pain: The Multicenter OA (MOST) Study

2017 ◽  
Vol 44 (4) ◽  
pp. 493-498 ◽  
Author(s):  
Lisa C. Carlesso ◽  
Jingbo Niu ◽  
Neil A. Segal ◽  
Laura A. Frey-Law ◽  
Cora E. Lewis ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
The Body ◽  
National Institutes Of Health ◽  
Widespread Pain ◽  
Multinomial Regression ◽  
Pain Mechanisms ◽  
Knee Oa ◽  
Point Increase ◽  
Pain Subscale

Objective.Whether widespread pain (WSP) affects the risk of developing knee pain or knee osteoarthritis (OA) is unknown and could enhance understanding of pain mechanisms in OA.Methods.Subjects from the Multicenter OA (MOST) study, a US National Institutes of Health–funded prospective cohort of older adults with or at risk of knee OA, were characterized regarding WSP, defined as pain above and below the waist on both sides of the body and axially using a standard homunculus, excluding knee pain at 60 months (baseline). Followup occurred 2 years later. We assessed the relation of WSP to odds of knee pain worsening (≥ 2-point increase in the Western Ontario and McMaster Universities Arthritis Index pain subscale) using logistic regression, and to odds of incident radiographic knee OA (ROA; Kellgren-Lawrence arthritis scale ≥ grade 2 of either knee among those free of ROA at baseline) and incident consistent frequent knee pain (CFKP; knee pain on most days during the past month among participants free of knee pain at baseline) in 1 or both knees using multinomial regression adjusting for potential confounders.Results.There were 1752 participants available for analysis [mean age (SD) 67.0 yrs (7.7), body mass index 30.5 kg/m2(5.9), 59% women]. Baseline presence of WSP was not associated with worsened knee pain (adjusted OR 1.15, 95% CI 0.89–1.48, p = 0.30), ROA (adjusted OR 0.86, 95% CI 0.46–1.63, p = 0.65), or incident CFKP (adjusted OR 1.69, 95% CI 0.96–2.96, p = 0.07).Conclusion.WSP was not significantly associated with worsening knee pain, incident ROA, or CFKP. Development of knee pain and ROA does not appear to be influenced by underlying WSP.

The efficacy of transcatheter arterial embolization for knee pain on patients with knee osteoarthritis: A case series

2021 ◽  
pp. 1-6
Author(s):  
Kun Yung Kim ◽  
Gi-Wook Kim
Keyword(s):  
Conservative Treatment ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Transcatheter Arterial Embolization ◽  
Rating Scale ◽  
Case Series ◽  
Arterial Embolization ◽  
Numeric Rating Scale ◽  
Knee Oa ◽  
Before And After

BACKGROUND: Knee osteoarthritis (OA) is accompanied by inflammation and angiogenesis. Modifying angiogenesis through transcatheter arterial embolization (TAE) can be a potential treatment for knee OA. OBJECTIVE: We subjected five OA knees in three patients to TAE and report the results of our post-treatment observations. CASE DESCRIPTION: Three patients that had experienced knee pain for a minimum of one year prior to the study, and whose pain had persisted despite conservative treatment, were included in this study. Patients more often chose conservative treatment over surgical treatment. Pain and functional scales were evaluated before, immediately, and 1 month after TAE using the Numeric Rating Scale (NRS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). TAE was performed by an experienced interventional radiologist. The average values of NRS evaluated before and after 5 TAEs were 5.2 before TAE, 3 immediately after TAE, and 3.6 after 1 month of TAE, and the average values of WOMAC were 52, 38.4, and 36.4, respectively. There were no major adverse effects. CONCLUSION: The examined cases support the conclusion that TAE is an effective treatment for patients with knee OA. Substantial pain relief and WOMAC improvement were observed both immediately and one month after TAE.

scholarly journals 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 ◽  
2019 ◽  
Vol 9 (5) ◽  
pp. e024065 ◽  
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

scholarly journals P129 Adolescent knee pain and risk of knee osteoarthritis 50 years later

Rheumatology ◽  
2020 ◽  
Vol 59 (Supplement_2) ◽  
Author(s):  
Michael A Clynes ◽  
Faidra Laskou ◽  
Mark H Edwards ◽  
Cyrus Cooper ◽  
Angela Taylor ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Meniscal Tear ◽  
Later Life ◽  
Self Report ◽  
P Value ◽  
Knee Oa ◽  
American College Of Rheumatology ◽  
Increased Risk ◽  
The Mean

Abstract Background Adolescent knee pain is a common complaint which may be due to patellar dislocation, meniscal tear, Osgood-Schlatter’s disease or patellofemoral maltracking. We studied the association of such pain with knee osteoarthritis (OA) 50 years later using a retrospective cohort design. Methods This study was based in the Hertfordshire Cohort Study, a cohort of men and women born in 1931 - 9. Participants completed a questionnaire detailing recall of adolescent knee pain, self-reported OA, demographics, lifestyle and The Western Ontario and McMaster Universities Arthritis Index (WOMAC). Clinical OA was defined based on the American College of Rheumatology (ACR) criteria and assessed at a clinical visit where knee radiographs were also taken and graded according to the methods of Kellgren and Lawrence. Results Completed data were available for 135 men and 139 women. The mean age was 78.8 (SD 2.6) years and the mean (SD) BMI was 26.3 (4.0). Two percent of men (n = 3) and 5% of women (n = 7) reported adolescent knee pain, of which 2 men and 3 women sought medical advice for their knee pain. 1 man and 2 women reported that their pain had been constant since teenage years while 2 men and 4 women reported that it was intermittent in nature. A report of adolescent knee pain was associated with an increased risk of clinical (odds ratio (OR) 5.45, p-value 0.015, 95% confidence interval (CI) 1.39 - 21.36); radiological (OR 2.33, p-value 0.228, 95% CI 0.60 - 9.24) and self-report (OR 2.71, p-value 0.134, 95% CI 0.74 - 10.0) of knee OA in later life. After adjustments for age, sex and BMI, adolescent knee pain was associated with an increased risk of clinical (OR 4.80, p-value 0.047, 95% CI 1.02 - 22.53); radiological (OR 1.85, p-value 0.404, 95% CI 0.44 - 7.78); self-report (OR 3.23, p-value 0.10, 95% CI 0.80 - 12.94) although relationships were only significant for clinical knee OA. Conclusion Recalled adolescent knee pain was associated with a clinical diagnosis of knee OA in later life. The lack of association with self-report of OA suggests that this is not simply a consequence of recall bias and exploration in other data sets is now indicated. Disclosures M.A. Clynes: None. F. Laskou: None. M.H. Edwards: None. C. Cooper: None. A. Taylor: None. M. Stokes: None. E.M. Dennison: None.

scholarly journals Evolution of pain at 3 months by oral resveratrol in knee osteoarthritis (ARTHROL): protocol for a multicentre randomised double-blind placebo-controlled trial

BMJ Open ◽  
2017 ◽  
Vol 7 (9) ◽  
pp. e017652 ◽  
Author(s):  
Christelle Nguyen ◽  
Isabelle Boutron ◽  
Gabriel Baron ◽  
Emmanuel Coudeyre ◽  
Francis Berenbaum ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Controlled Trial ◽  
Tertiary Care ◽  
Double Blind ◽  
Double Blind Placebo ◽  
Knee Oa ◽  
The Mean ◽  
Anti Inflammatory

IntroductionOsteoarthritis (OA) pathophysiology is driven in part by joint inflammation. Resveratrol has in vitro anti-inflammatory properties. We aim to assess the efficacy of oral resveratrol for knee pain at 3 months in people with knee OA.Methods and analysisWe will conduct a randomised double-blind placebo-controlled trial. Overall, 164 individuals with knee OA fulfilling 1986 American College of Rheumatology criteria will be recruited in three tertiary care centres in France and randomised to receive oral resveratrol, 40 mg (two caplets) two times per day for 1 week, then 20 mg (one caplet) two times per day or a matching placebo for a total of 6 months. Randomisation will be centralised and stratified by centre. The allocation ratio of assignments will be 1:1. The primary outcome will be the mean change from baseline in knee pain on a self-administered 11-point pain Numeric Rating Scale at 3 months. Secondary outcomes will be the mean change in knee pain at 6 months, the function subscore of the Western Ontario and McMaster Universities Arthritis Index score, patient global assessment, proportion of responders according to the Osteoarthritis Research Society International–Outcome Measures in Rheumatology criteria at 3 and 6 months, and self-reported number of intra-articular injections of corticosteroids or hyaluronic acid and consumption of analgesics and non-steroidal anti-inflammatory drugs since the last contact. Other interventions will be allowed and self-reported. Adherence will be monitored by capsule counts and a booklet and adverse events recorded at 3 and 6 months. Statisticians, treating physicians and participants will be blinded to the allocated treatment.Ethics and disseminationThe oral resveratrol in knee osteoarthritis (ARTHROL) trial has been authorised by theAgenceNationale de Sécurité du Médicament et des Produits de Santéand ethics were approved by theComité deProtection des Personnes Île-de-FranceIII. The findings of the study will be published in a peer-reviewed journal and disseminated at conferences. The design of ARTHROL will warrant the translation of its findings into clinical practice.Trial registration numberClinicalTrials.gov identifier:NCT02905799. Pre-results. First received: 14 September 2016. Last updated: 16 September 2016. Status: not yet recruiting.

scholarly journals Hypertonic dextrose injections (prolotherapy) in the treatment of symptomatic knee osteoarthritis: A systematic review and meta-analysis

2016 ◽  
Vol 6 (1) ◽  
Author(s):  
Regina WS Sit ◽  
Vincent CH Chung ◽  
Kenneth D. Reeves ◽  
David Rabago ◽  
Keith KW Chan ◽  
...  
Keyword(s):  
Systematic Review ◽  
Knee Osteoarthritis ◽  
Primary Outcome ◽  
Meta Analysis ◽  
Knee Oa ◽  
Composite Scale ◽  
Symptomatic Knee Osteoarthritis ◽  
Symptomatic Knee ◽  
Pain Subscale ◽  
Hypertonic Dextrose

Abstract Hypertonic dextrose injections (prolotherapy) is an emerging treatment for symptomatic knee osteoarthritis (OA) but its efficacy is uncertain. We conducted a systematic review with meta-analysis to synthesize clinical evidence on the effect of prolotherapy for knee OA. Fifteen electronic databases were searched from their inception to September 2015. The primary outcome of interest was score change on the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Three randomized controlled trials (RCTs) of moderate risk of bias and one quasi–randomized trial were included, with data from a total of 258 patients. In the meta-analysis of two eligible studies, prolotherapy is superior to exercise alone by a standardized mean difference (SMD) of 0.81 (95% CI: 0.18 to 1.45, p = 0.012), 0.78 (95% CI: 0.25 to 1.30, p = 0.001) and 0.62 (95% CI: 0.04 to 1.20, p = 0.035) on the WOMAC composite scale; and WOMAC function and pain subscale scores respectively. Moderate heterogeneity exists in all cases. Overall, prolotherapy conferred a positive and significant beneficial effect in the treatment of knee OA. Adequately powered, longer-term trials with uniform end points are needed to better elucidate the efficacy of prolotherapy.

scholarly journals GAMBARAN KEJADIAN NYERI LUTUT DENGAN KECURIGAAN OSTEOARTRITIS LUTUT PADA PERAWAT DI POLIKLINIK RAWAT JALAN BLU RSUP PROF. DR. R. D. KANDOU MANADO

e-CliniC ◽  
2014 ◽  
Vol 2 (1) ◽  
Author(s):  
Rita Purnama Deu
Keyword(s):  
Body Mass Index ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Visual Analog Scale ◽  
Outpatient Treatment ◽  
Analog Scale ◽  
High Heel ◽  
Knee Oa ◽  
Lequesne Index ◽  
Female Nurses

Abstract: Osteoarthritis (OA) is a degenerative joint disease associated with destruction of joint cartilages. OA can occur in all joints of the cervical, thoracal, and lumbar vertebrae, pelvis, knees, ankles, hands, and fingers. However, it is most commonly found in the knee joints because these joints bear heavier burden than the other joints. OA patients usually complain pain at the time of doing activities or if there is some load on the affected joint. On a more serious degree, there is continuous pain which disturbs the patient’s mobility. This study aimed to find the incidence knee osteoarthritis among nurses at outpatient treatment of Prof. Dr. R.D. Kandou Hospital. This was a descriptive quantitative study. Sample consisted of 25 nurses. Data were obtained through interviews and questionnaires and then were analyzed by using SPSS. The results showed that the highest numbers of nurses (14 nurses, 56.0%) with suspected knee OA were in the age group of 51-60 years. There were as many as 23 female nurses (92.0%) with suspected knee OA. Based on BMI (Body Mass Index) most of the nurses (13 nurses, 52.0%) were obese I, meanwhile based on the degrees of knee pain most of the nurses (19 nurses, 76.0%) experienced mild pain. Based on the Lequesne index functions most samples (13 nurses, 52.0%) showed mild functional. Based on the usage of high heel shoes most of the female nurses (19 nurses, 76.0%) used high heel shoes. Conclusion: Most of the nurses at outpatient treatment of Prof. Dr. R.D.Kandou Hospital that were suspected of knee osteoarthritis were obese I, had associated mild pain, and showed mild functional tested with Lequesne index funtion. Moreover, most of the female nurses wore high heel shoes.Keywords: knee osteoarthritis , knee pain, Lequesne index parameters, BMT (Body Mass Index), VAS (Visual Analog Scale)Abstrak: Osteoartritis (OA) merupakan penyakit degenerative sendi yang berkaitan dengan kerusakan kartilago sendi. OA dapat mengenai semua persendian dari servikal, thorakal, dan lumbal, panggul, lutut, pergelangan kaki, tangan sampai ke jari-jari, tetapi paling sering ditemukan pada sendi lutut karena pada sendi ini terdapat pembebanan yang lebih besar. Pasien OA biasanya mengeluh nyeri pada waktu melakukan aktivitas atau jika ada pembebanan pada sendi yang terkena. Pada derajat yang lebih berat, nyeri dapat dirasakan terus menerus sehingga sangat mengganggu mobilitas pasien. Penelitian ini bertujuan untuk mengetahui angka kejadian nyeri lutut dengan kecurigaan OA lutut pada perawat di Poliklinik Rawat Jalan BLU RSUP Prof. Dr. R. D Kandou Manado. Penelitian ini menggunakanpendekatan deskriptif kuantitatif. Sampel berjumlah 25 perawat. Data diperoleh melalui kuesioner dan wawancara yang kemudian dianalisis menggunakan SPSS. Hasil penelitian memperlihatkan bahwa perawat yang dicurigai OA lutut terbanyak pada kelompok umur 51-60 tahun sebanyak 14 perawat (56,0 %). Berdasarkan jenis kelamin perawat yang di curigai OA lutut terbanyak pada perempuan yaitu sebanyak 23 perawat (92,0 %). Berdasarkan IMT (Indeks Massa Tubuh) sebagian besar perawat ialah obes I yaitu 13 perawat (52,0 %). Berdasarkan derajat nyeri lutut sebagian besar mengalami nyeri ringan yaitu sebanyak 19 perawat (76,0 %). Berdasarkan indeks Lequesne sebagian besar fungsi fungsional ringan yaitu 13 perawat (52,0 %). Berdasarkan pemakaian sepatu tumit tinggi sebagian besar perawat perempuan menggunakan sepatu tumit tinggi yaitu sebanyak 19 perawat (76,0 %). Simpulan: Sebagian besar perawat di Poliklinik Rawat Jalan BLU RSUP Prof. Dr. R.D. Kandou Manado yang dicurigai osteoartritis lutut termasuk obes I, disertai nyeri ringan, dan indeks Lequesne fungsional ringan. Sebagian besar perawat perempuan menggunakan sepatu tumit tinggi.Kata kunci : osteoartritis lutut, nyeri lutut, parameter indeks Lequesne, VAS (Visual Analog Scale)

scholarly journals Medium- and long-term results of high tibial osteotomy in patients with primary and secondary knee osteoarthritis with varus deformity

2019 ◽  
Vol 13 (2) ◽  
pp. 38-46
Author(s):  
V. E. Byalik ◽  
S. A. Makarov ◽  
L. I. Alekseeva ◽  
E. I. Byalik
Keyword(s):  
Knee Osteoarthritis ◽  
High Tibial Osteotomy ◽  
The Body ◽  
Long Term Results ◽  
Tibial Osteotomy ◽  
Female Ratio ◽  
Knee Oa ◽  
Functional Scores ◽  
The Mean

The most common operation for knee osteoarthritis (OA) is total knee arthroplasty (TKA); however, the latter is associated with the development of severe complications. This was the reason for the revival of the interest of orthopedic traumatologists in high tibial osteotomy (HTO), the essence of which is to transfer the load away from the affected medial part of the knee joint (KJ) to the intact lateral one.Objective: to evaluate the medium- and long-term results of open-wedge (OW) HTO in primary and secondary I–III stage knee OA.Patients and methods. The Laboratory of Orthopedic Rheumatology and Rehabilitation, V.A. Nasonova Research Institute of Rheumatology, performed 10 OW HTOs in 9 patients in 2005 to 2009 and 21 more OW HTOs in 19 patients in 2014 to 2018 (a total of 31 operations). The male/female ratio was 2.5:1. The mean age of the patients was 57.6±12.5 years; the body mass index (BMI) was 28.5±3.6 kg/m2 ; the correction angle was 11.7±2.5°. Preoperative planning was performed using the Miniaci method; the X-ray stage of knee OA was evaluated according to the Kellgren–Lawrence classification. OW HTO was carried out. For assessment of its results, the investigators determined the degree of pain using a visual analogue scale (VAS) and the KJ status by the Knee Society Score (KSS) scale. The results were assessed at one (n=31), 3.5±0.6 (n=28), and 8.5±1.3 (n=10) years.Results and discussion. There was a tendency to worsen surgical results over time. The mean VAS values for pain at 1, 3.5, and 8.5 years were as follows: 9.8±10.3; 21.2±16.2 and 38±15.5 mm, respectively. In the same periods, the KSS functional scores were 83.6±14.8, 85.2±12.6, and 80.5±14.2; the objective scores were 80.7±8.5, 75.2±12.7, and 67.8±16.3. There was a strong correlation between the severity of pain and the functional and objective KSS scores (-0.78, -0.81 years, and -0.91 at 1, 3.5, and 8.5 years, respectively; p<0.05). At 3.5±0.6 years, the survival rate after OW HTO was 96.6%. None of the patients examined at 8.5±1.3 years after OW HTO needed TKA. The surgical result was studied in 2 patients at 14 years; one patient underwent TKA, the other refused surgical intervention, the result was satisfactory.Conclusion. OW HTO has limited indications for use. However, in patients who are allowed to undergo this operation, pain syndrome can be relieved, by maintaining and/or improving KJ function; in most cases, TKA can be delayed for more than 10 years. 

scholarly journals The effectiveness of Kinesio Taping® for pain management in knee osteoarthritis: a randomized, double-blind, controlled clinical trial

2019 ◽  
Vol 11 ◽  
pp. 1759720X1986913 ◽  
Author(s):  
Venta Donec ◽  
Raimondas Kubilius
Keyword(s):  
Pain Management ◽  
Knee Osteoarthritis ◽  
Knee Pain ◽  
Rating Scale ◽  
Pain Tolerance ◽  
Control Group ◽  
Double Blind ◽  
Kinesio Taping ◽  
Pain Subscale

Background: Kinesio Taping® method is a nonpharmacological alternative for pain management in musculoskeletal disorders. However, the existing evidence is insufficient to assess its full effectiveness for pain management in knee osteoarthritis (KO). Our aim was to evaluate the effectiveness of the Kinesio Taping method in reducing knee pain for KO patients. Methods: In this randomized, double blind, controlled trial, we recruited 187 patients with grade I-III KO who were allocated to either the Kinesio Taping or control group. The study was carried out in outpatient facility. Either Kinesio Taping or nonspecific taping was applied on the affected knee area for 4 weeks. Pain evaluation was performed at baseline, after 1 month of taping and after 1 further month without taping. The data on usage of painkillers were collected; Numeric Pain Rating Scale; an algometer, and Knee injury and Osteoarthritis Outcome Scores (KOOS) pain subscale were used to assess pain. Tolerance and subjective opinions toward the effectiveness of taping were evaluated. The chosen level of significance was p < 0.05, ß ⩽ 0.2. Results: The majority (>70%) of both groups’ patients indicated that tapes reduced the knee pain. The reported use of painkillers decreased, in addition to self-reported increase in the KOOS subscale, thereby indicating pain alleviation. All self-reported improvement remained at the 1-month follow up ( p < 0.05). Significantly higher and clinically meaningful reduction of pain intensity was found in the Kinesio Taping group after the treatment month, in comparison with the control group ( p < 0.05). More pain reduction was reported in the daytime for participants in the Kinesio Taping group at the follow up ( p = 0.022). No changes in algometry results were observed. Conclusions: Elastic taping can safely relieve knee pain and reduce the need for pharmacological management in KO. A specific Kinesio Taping technique is clinically more beneficial for knee-pain alleviation in comparison with nonspecific taping. [ ClinicalTrials.gov identifier: NCT03076177.]

scholarly journals KARAOKE: Krill oil versus placebo in the treatment of knee osteoarthritis: protocol for a randomised controlled trial

2019 ◽  
Author(s):  
Laura L Laslett ◽  
Benny Antony ◽  
Anita Wluka ◽  
Catherine Hill ◽  
Lyn March ◽  
...  
Keyword(s):  
Knee Osteoarthritis ◽  
Disease Progression ◽  
Knee Pain ◽  
Controlled Trial ◽  
Safety Data ◽  
Treatment Compliance ◽  
Krill Oil ◽  
Knee Oa ◽  
Knee Effusion ◽  
Secondary Outcomes

Abstract Background: Knee osteoarthritis (OA) is a common and important cause of pain and disability, but interventions aimed at structural modification have been disappointing. While OA affects the whole joint, synovitis and effusion have been recognised as having a role in the pathogenesis of OA. Krill oil reduces knee pain and systemic inflammation and could be used for targeting inflammatory mechanisms of OA. Methods: 260 patients with clinical knee OA, significant knee pain and effusion-synovitis present on MRI will be recruited in 5 Australian cities (Hobart, Melbourne, Sydney, Adelaide and Perth). They will be randomly allocated to the two arms of the study, receiving 2g/day krill oil or inert placebo daily for 6 months. MRI of the study knee will be performed at screening, and after 6 months. Knee symptoms, function and MRI structural abnormalities will be assessed using validated methods. Safety data will be recorded. Primary outcomes are absolute change in knee pain (assessed by visual analog score) and change in size of knee effusion-synovitis over 24 weeks. Secondary outcomes include improvement in knee pain over 4, 8, 12, 16 and 20 weeks. The primary analyses will be intention-to-treat analyses of primary and secondary outcomes. Per protocol analyses adjusting for missing data and for treatment compliance will be performed as the secondary analyses. Discussion: This study will provide high-quality evidence to assess whether krill oil 2g/day reduces pain and effusion-synovitis size in older adults with clinical knee OA and knee effusion-synovitis. If krill oil is effective and confirmed to be safe, we will provide compelling evidence that krill oil improves pain and function, changes disease trajectory and slows disease progression in OA. Given the lack of approved therapies for slowing disease progression in OA, and moderate cost of krill oil, these findings will be readily translated into clinical practice.

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