In knee OA, intraarticular triamcinolone increased cartilage loss and did not differ from saline for knee pain

Abstract Objective To describe the association between change in subchondral bone marrow lesions (BMLs) and change in tibiofemoral cartilage volume and knee symptoms in patients with symptomatic knee OA. Methods In total, 251 participants (mean 61.7 years, 51% female) were included. Tibiofemoral cartilage volume was measured at baseline and 24 months, and BML size at baseline, 6 and 24 months. Knee pain and function scores were evaluated at baseline, 6 and 24 months. Change in total and compartment-specific BML size was categorized according to the Least Significance Criterion. Linear mixed-effects models were used to evaluate the associations of change in BMLs over 6 and 24 months with change in cartilage volume over 24 months and knee symptoms over 6 and 24 months. Results Total BML size enlarged in 26% of participants, regressed in 31% and remained stable in 43% over 24 months. Compared with stable BMLs in the same compartment, enlarging BMLs over 24 months were associated with greater cartilage loss (difference: −53.0mm3, 95% CI: −100.0, −6.0), and regressing BMLs were not significantly associated with reduced cartilage loss (difference: 32.4mm3, 95% CI: −8.6, 73.3) over 24 months. Neither enlargement nor regression of total BML size over 6 and 24 months was associated with change in knee pain and function over the same time intervals. Conclusions In subjects with symptomatic knee osteoarthritis and BMLs, enlarging BMLs may lead to greater cartilage loss but regressing lesions are not associated with reduced cartilage loss while neither is associated with change in knee symptoms.

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One year change of knee cartilage morphology in the first release of participants from the Osteoarthritis Initiative progression subcohort: association with sex, body mass index, symptoms and radiographic osteoarthritis status

Annals of the Rheumatic Diseases ◽

10.1136/ard.2008.089904 ◽

2008 ◽

Vol 68 (5) ◽

pp. 674-679 ◽

Cited By ~ 95

Author(s):

F Eckstein ◽

S Maschek ◽

W Wirth ◽

M Hudelmaier ◽

W Hitzl ◽

...

Keyword(s):

Risk Factors ◽

Body Mass Index ◽

Body Mass ◽

Statistical Significance ◽

Weight Bearing ◽

Rate Of Change ◽

Cartilage Loss ◽

Knee Oa ◽

Symptomatic Knee ◽

Osteoarthritis Initiative

Objective:The Osteoarthritis Initiative (OAI) is a multicentre study targeted at identifying biomarkers for evaluating the progression and risk factors of symptomatic knee OA. Here cartilage loss using 3 Tesla (3 T) MRI is analysed over 1 year in a subset of the OAI, together with its association with various risk factors.Methods:An age- and gender-stratified subsample of the OAI progression subcohort (79 women and 77 men, mean (SD) age 60.9 (9.9) years, body mass index (BMI) 30.3 (4.7)) with both frequent symptoms and radiographic OA in at least one knee was studied. Coronal FLASHwe (fast low angle shot with water excitation) MRIs of the right knee were acquired at 3 T. Seven readers segmented tibial and femoral cartilages blinded to order of acquisition. Segmentations were quality controlled by one expert.Results:The reduction in mean cartilage thickness (ThC) was greater (p = 0.004) in the medial than in the lateral compartment, greater (p = 0.001) in the medial femur (−1.9%) than in the medial tibia (−0.5%) and greater (p = 0.011) in the lateral tibia (−0.7%) than in the lateral femur (0.1%). Multifactorial analysis of variance did not reveal significant differences in the rate of change in ThC by sex, BMI, symptoms and radiographic knee OA status. Knees with Kellgren–Lawrence grade 2 or 3 and with a BMI >30 tended to display greater changes.Conclusions:In this sample of the OAI progression subcohort, the greatest, but overall very modest, rate of cartilage loss was observed in the weight-bearing medial femoral condyle. Knees with radiographic OA in obese participants showed trends towards higher rates of change than those of other participants, but these trends did not reach statistical significance.

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Prevalence and overlap of doctor-diagnosed knee OA, frequent knee pain and radiographic knee OA in Sweden

Osteoarthritis and Cartilage ◽

10.1016/j.joca.2014.02.396 ◽

2014 ◽

Vol 22 ◽

pp. S206-S207

Author(s):

A. Turkiewicz ◽

M. Gerhardsson de Verdier ◽

G. Engström ◽

L.S. Lohmander ◽

M. Englund

Keyword(s):

Knee Pain ◽

Knee Oa

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

Annals of the Rheumatic Diseases ◽

10.1136/annrheumdis-2021-eular.3287 ◽

2021 ◽

Vol 80 (Suppl 1) ◽

pp. 409.2-409

Author(s):

E. Strebkova ◽

E. Tchetina ◽

L. Alekseeva

Keyword(s):

Body Weight ◽

Knee Pain ◽

Mammalian Target Of Rapamycin ◽

Clinical Manifestations ◽

Normal Weight ◽

Womac Pain ◽

Obese Patients ◽

Normal Body ◽

Knee Oa ◽

Normal Body Weight

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

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

Journal of Back and Musculoskeletal Rehabilitation ◽

10.3233/bmr-210043 ◽

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.

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Exercise and Osteoarthritis: Are We Stopping Too Early? Findings from the Clearwater Exercise Study

Journal of Aging and Physical Activity ◽

10.1123/japa.14.2.169 ◽

2006 ◽

Vol 14 (2) ◽

pp. 169-180 ◽

Cited By ~ 1

Author(s):

Frances V. Wilder ◽

John P. Barrett ◽

Edward J. Farina

Keyword(s):

Clinical Trials ◽

Knee Pain ◽

Exercise Intervention ◽

Pain Reduction ◽

Optimal Length ◽

Knee Oa ◽

Pain Scores ◽

Time Periods

The value of exercise for people with knee osteoarthritis (OA) receives continuing consideration. The optimal length of study follow-up time remains unclear. A group of individuals with knee OA participating in an exercise intervention was followed for 2 years. The authors quantified the change in knee-pain scores during Months 1–12 and during Months 13–24. Eleven individuals with radiographic knee OA and knee-pain scores of 2+ were evaluated. Pain scores were collected weekly from participants who exercised three times a week. Participants demonstrated pain reduction during both time periods. Pain reduction during Months 13–24, –10.7%, was slightly higher than pain reduction during Months 1–12, –7.8%. Among people with knee OA who exercise, these findings suggest that knee-pain amelioration continues beyond 12 months. Clinicians should consider encouraging long-term exercise programs for knee-OA patients. To best characterize the effect of exercise on knee pain, researchers designing clinical trials might want to lengthen the studies’ duration.

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Assessment of bone marrow Oedema-like lesions using MRI in patellofemoral knee osteoarthritis: Comparison of different MRI pulse sequences

British Journal of Radiology ◽

10.1259/bjr.20201367 ◽

2021 ◽

pp. 20201367

Author(s):

Henry Noorveriandi ◽

Matthew J Parkes ◽

Michael J Callaghan ◽

David T Felson ◽

Terence W O'Neill ◽

...

Keyword(s):

Bone Marrow ◽

Knee Pain ◽

Intraclass Correlation ◽

Pulse Sequences ◽

Correlation Coefficients ◽

Bone Marrow Oedema ◽

Volume Distribution ◽

Data Set ◽

Knee Oa ◽

Contrast Enhanced

Objective: To compare bone marrow oedema-like lesion (BML) volume in subjects with symptomatic patellofemoral (PF) knee OA using four different MRI sequences and to determine reliability of BML volume assessment using these sequences and their correlation with pain. Methods: Seventy-six males and females (mean age 55.8 years) with symptomatic patellofemoral knee OA had 1.5 T MRI scans. PD fat suppressed (FS), STIR, contrast-enhanced (CE) T1-w FS, and 3D T1-w FFE sequences were obtained. All sequences were assessed by one reader, including repeat assessment of 15 knees using manual segmentation and the measurements were compared. We used random-effects panel linear regression to look for differences in the log-transformed BML volume (due to positive skew in the BML volume distribution) between sequences and to determine associations between BML volumes and knee pain. Results: Fifty-eight subjects had PF BMLs present on at least one sequence. Median BML volume measured using T1-w FFE sequence was significantly smaller (224.7 mm3, interquartile range [IQR] 82.50–607.95) than the other three sequences. BML volume was greatest on the CE sequence (1129.8 mm3, IQR 467.28–3166.02). Compared to CE sequence, BML volumes were slightly lower when assessed using PDFS (proportional difference = 0.79; 95% confidence interval [CI] 0.62, 1.01) and STIR sequences (proportional difference = 0.85; 95% CI 0.67, 1.08). There were strong correlations between BML volume on PDFS, STIR, and CE T1-w FS sequences (ρs = 0.98). Correlations were lower between these three sequences and T1-w FFE (ρs = 0.80–0.81). Intraclass correlation coefficients were excellent for PDFS, STIR, and CE T1-w FS sequences (0.991 to 0.995), while the ICC for T1-w FFE was good at 0.88. We found no significant association between BML volumes assessed using any of the sequences and knee pain. Conclusion: T1-w FFE sequences were less reliable and measured considerably smaller BML volume compared to other sequences. BML volume was larger when assessed using the contrast enhanced T1-w FS although not statistically significantly different from BMLs when assessed using PDFS and STIR sequences. Advances in knowledge: This is the first study to assess BMLs by four different MRI pulse sequences on the same data set, including different fluid sensitive sequences and gradient echo type sequence.

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The Effect of a Lower Body Positive Pressure Supported Treadmill Exercise Regime on Systemic Biomarkers of Inflammation and Cartilage Degradation in Individuals with Knee Osteoarthritis: A Pilot Study

International Journal of Kinesiology and Sports Science ◽

10.7575/aiac.ijkss.v.9n.3p18 ◽

2021 ◽

Vol 9 (3) ◽

pp. 18

Author(s):

Stephen Cornish ◽

Jason Peeler

Keyword(s):

Articular Cartilage ◽

Knee Pain ◽

Weight Bearing ◽

Cartilage Degradation ◽

Treadmill Walking ◽

Positive Pressure ◽

Control Group ◽

Knee Oa ◽

And Cartilage

Background: Knee osteoarthritis (OA) has been linked to a chronic low-grade inflammatory response and altered metabolic activity of articular cartilage. Objective: The purpose of this investigation was to evaluate the effectiveness of a 12-week (3 times/week) lower body positive pressure (LBPP) treadmill walking regime on knee pain and systemic biomarkers of inflammation and cartilage degradation. Methods: Sixteen overweight (BMI > 25 kg/m2) knee OA patients were randomized to a LBPP treadmill walking exercise group (N = 7) or non-exercise control group (N = 9). Baseline and 12-week follow-up assessments evaluated the following dependent variables: acute knee pain during full weight bearing treadmill walking; inflammatory biomarkers (C-reactive protein, interleukin-1β, interleukin-6, s100A8/A9, and tumor necrosis factor-α), and catabolic metabolism of articular cartilage (sCOMP). Results: Knee pain at baseline and follow-up remained unchanged for the non-exercise control group (P > 0.05). However, knee pain for the LBPP exercise group was significantly decreased at follow-up (P ≤ 0.05). No differences in the biomarkers of inflammation and cartilage degradation were observed for between and within group comparisons (all P > 0.05). Conclusions: Data suggested that the LBPP supported walking regime could be effectively used to promote regular weight bearing exercise without exacerbation of knee joint pain and did not increase levels of systemic inflammation or catabolic activity of articular cartilage in overweight knee OA patients. This pilot investigation offers important insight regarding the potential role that the LBPP technology could play in facilitating investigations examining the disease modifying effect of exercise on knee OA pathogenesis.

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Synovial Cytokines Significantly Correlate with Osteoarthritis-Related Knee Pain and Disability: Inflammatory Mediators of Potential Clinical Relevance

Journal of Clinical Medicine ◽

10.3390/jcm8091343 ◽

2019 ◽

Vol 8 (9) ◽

pp. 1343 ◽

Cited By ~ 16

Author(s):

Timo A. Nees ◽

Nils Rosshirt ◽

Jiji A. Zhang ◽

Tobias Reiner ◽

Reza Sorbi ◽

...

Keyword(s):

Growth Factors ◽

Growth Factor ◽

Knee Pain ◽

Inflammatory Mediators ◽

Clinical Relevance ◽

Knee Oa ◽

Broad Variety ◽

Ifn Γ ◽

And Function ◽

Endothelial Growth Factor

The aim of this study was to identify inflammatory mediators of potential clinical relevance in synovial fluid (SF) samples of patients with knee osteoarthritis (OA). Therefore, radiographic OA severity, knee pain and function of 34 OA patients undergoing unicompartmental (UC) and bicompartmental (BC) knee arthroplasty were assessed prior to surgery and SF samples were analyzed for a broad variety of inflammatory mediators, including interleukins (ILs), interferons (IFNs), C-X-C motif ligand chemokines (CXCLs), and growth factors (nerve growth factor; NGF, vascular endothelial growth factor; VEGF, and stem cell growth factor β; SCGF-β) using multiplex assay. Significant differences were observed between the SF levels of different inflammatory markers. When compared to UC OA, significantly higher concentrations of IL-7, IL-8, IL-10, IL-12, IL-13, IFN-γ, VEGF and CXCL1 were detected in BC OA. Correlation analyses revealed significant associations between OA severity and IL-6, IL-8, IFN-γ, SCGF-β, VEGF, CXCL1. Interestingly, increases in both anti- (IL-10, IL-13) and pro-inflammatory (IL-7, IL-12, IFN-γ) cytokines, as well as growth factors (SCGF-β, VEGF), correlated significantly with the level of knee pain. Poorer knee function was associated with higher IL-6, IL-10, IL-12, IL-13, IL-18, βNGF, SCGF-β, VEGF and CXCL9 levels. In conclusion, this study provides an extensive profile of synovial inflammatory mediators in knee OA and identifies cytokines of potential clinical relevance. In fact, five of the mediators examined (IL-10, IL-12, IL-13, SCGF-β, VEGF) significantly correlate with both knee pain and function.

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Knee Pain Patterns and Associations with Pain and Function in Persons with or at Risk for Symptomatic Radiographic Osteoarthritis: A Cross-sectional Analysis

The Journal of Rheumatology ◽

10.3899/jrheum.150545 ◽

2015 ◽

Vol 42 (12) ◽

pp. 2398-2403 ◽

Cited By ~ 6

Author(s):

Daniel L. Riddle ◽

Mateusz Makowski

Keyword(s):

Knee Pain ◽

Cross Sectional ◽

Knee Oa ◽

Womac Function ◽

Radiographic Osteoarthritis ◽

Pain Location ◽

Pain Scores ◽

Patient Reported ◽

And Function ◽

Sectional Analysis

Objective.Knee pain location is routinely assessed in clinical practice. We determined the patterns of patient-reported pain locations for persons with knee osteoarthritis (OA). We also examined associations between knee pain patterns and severity of self-reported pain with activity and self-reported functional status.Methods.The Osteoarthritis Initiative data were used to examine reports of pain location (localized, regional, or global) and type and extent of knee OA. Multivariable ANCOVA models were used to determine associations between the Knee Injury and Osteoarthritis Outcome Survey (KOOS) Pain and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Function scales and pain location after adjusting for potential confounding. We also used radar graphs to illustrate pain patterns for various locations and severity of knee OA.Results.Radar graphs of 2696 knees indicated that pain pattern and location and extent of knee OA demonstrate substantial overlap. An interaction between race and pain location was found for WOMAC Function, but not for KOOS Pain scores. Global knee pain was associated (p < 0.001) with substantially worse function (by 6.5 points in African Americans) compared with pain that was localized. Knee pain reported as global was independently associated (p < 0.001) with clinically important lower (worse by 3.9 points) KOOS Pain scores compared with pain that was localized.Conclusion.Pain patterns are not useful for inferring potential location or severity of knee OA in individual patients, but knee pain patterns that are global are independently associated with worse pain and function compared with localized pain, and associations differ for function based on race.

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