An anti-inflammatory diet intervention for knee osteoarthritis: a feasibility study

Background Knee osteoarthritis has an inflammatory component that is linked to pain and joint pathology, yet common non-surgical and non-pharmacological interventions (e.g., exercise, calorie restricting diets) do not typically target inflammation. We aimed to evaluate the feasibility of a telehealth delivered anti-inflammatory diet intervention for knee osteoarthritis. Methods This 9-week single-arm feasibility study recruited participants aged 40–85 years with symptomatic knee osteoarthritis (inclusion criteria: average pain ≥4/10 or maximal pain ≥5/10 during past week). All participants received a telehealth-delivered anti-inflammatory dietary education intervention involving 1:1 consultations at baseline, 3- and 6-week follow-up. The diet emphasised nutrient-dense wholefoods and minimally processed anti-inflammatory foods and discouraged processed foods considered to be pro-inflammatory. The primary outcome of feasibility was assessed via: i) eligibility, recruitment and retention rates; ii) self-reported dietary adherence; iii) adverse events; and iv) treatment satisfaction. Post-intervention interviews evaluated the acceptability of the dietary intervention delivered via telehealth. Secondary outcomes included changes in self-reported body mass, Knee injury and Osteoarthritis Outcome Score (KOOS), health-related quality of life (EuroQoL-5D), analgesic use and global rating of change. Worthwhile effects were determined by the minimal detectable change (MDC) for all five KOOS-subscales (pain, symptoms, activities of daily living, sport/recreation, quality of life) being contained within the 95% confidence interval. Results Forty-eight of seventy-three (66%) individuals screened were eligible and 28 enrolled over 2 months (82% female, mean age 66 ± 8 years, body mass index 30.7 ± 4.8 kg.m−2). Six participants withdrew prior to final follow-up (21% drop-out). Of those with final follow-up data, attendance at scheduled telehealth consultations was 99%. Self-reported adherence to diet during the 9-week intervention period: everyday = 27%, most of time = 68% and some of time = 5%. Two minor adverse events were reported. Change scores contained the MDC within the 95% confidence interval for all five KOOS subscales. Suggestions to improve study design and limit drop-out included an initial face-to-face consultation and more comprehensive habitual dietary intake data collection. Conclusion This study supports the feasibility of a full-scale randomised controlled trial to determine the efficacy of a primarily telehealth-delivered anti-inflammatory dietary education intervention in adults with symptomatic knee osteoarthritis. Trial registration ACTRN12620000229976 prospectively on 25/2/2020.

Lower Limb Muscle Strength and Muscle Mass Are Associated With Incident Symptomatic Knee Osteoarthritis: A Longitudinal Cohort Study

Recent literature suggests that sarcopenia, often represented by low lower limbs muscle mass and strength, can be considered a potential risk factor for knee osteoarthritis (OA), but the available literature is still limited. We therefore aimed to investigate whether sarcopenia is associated with a higher risk of radiographic (ROA) and symptomatic knee OA (SxOA) in a large cohort of North American people in the context of the OA initiative. Sarcopenia at baseline was diagnosed in case of low skeletal muscle mass (i.e., lower skeletal mass index) and poor performance in the chair stands test. The outcomes of interest for this study included ROA (radiographical osteoarthritis) if a knee developed a Kellgren and Lawrence (KL) grade ≥2 at follow-up, and SxOA (symptomatic osteoarthritis) defined as new onset of a combination of painful knee OA. Altogether, 2,492 older participants (mean age: 68.4 years, 61.4% females) were included. At baseline, sarcopenia was present in 6.1% of the population. No significant difference in ROA prevalence was observed between those with and without sarcopenia (p=0.76), whilst people with sarcopenia reported a significant higher prevalence of SxOA (p<0.0001). Using a logistic regression analysis, adjusting for potential confounders at baseline and the diagnosis of sarcopenia during follow-up, sarcopenia was associated with a higher incidence of knee SxOA (odds ratio, OR=2.29; 95%CI [confidence interval]: 1.42-3.71; p=0.001), but not knee ROA (OR=1.48; 95%CI: 0.53-4.10; p=0.45). In conclusion, sarcopenia could be associated with a higher risk of negative knee OA outcomes, in particular symptomatic forms.

Role of ultrasound guided injection of platelet rich plasma (PRP) in knee osteoarthritis patients

Background Multiple promising researches were done regarding using platelet rich plasma (PRP) injection aiming at establishing new minimally invasive treatment option for knee OA and avoiding surgical procedures hazards which could be an option in advanced cases. Thus, our study will be directed towards ultrasound guided injecting of PRP trying to confirm the efficacy of the procedure as a therapeutic option. Objective The study aims to assess of the role of ultrasound guided PRP injection in cases of knee osteoarthritis and follow up of the symptoms outcome. Methods and material Twenty patients with different knee osteoarthritis grades were injected with PRP under ultrasound guidance and the symptoms outcome were followed up by using visual analogue scale (VAS), WOMAC osteoarthritis index, OXFORD knee score, LYSHOLM knee scoring scale at periods of , and weeks post procedure. Results A total of patients were included with the age ranging from - years old, the mean was . years old (SD ± . ). Among them patients ( ) were females and patients ( ) were males. There was statistically significant difference between the different knee pain scoring scales , and weeks after the procedure compared to before injection, where according to VAS score the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with mean reduction ratio of . % after months. The extent of the difference over the periods through WOMAC in knee osteoarthritis patients was . . ,. . and . . after , and weeks respectively, compared to . . before the procedure with a mean reduction ratio of . % after months. While according to OXFORD knee score, the patient’s scores were . . before the procedure Vs . . , . . and . . at , and weeks after injection with symptoms mean reduction ratio of . %. According to LYSHOLM knee scoring scale, the mean score was . . pre procedure and became . . , . . and . . after , and weeks respectively with months mean reduction ratio of . %. Conclusion PRP injection in symptomatic knee osteoarthritis patients cause statistically significant improvement of the symptoms.

POS0284 CLINICAL AND MRI COMPARISON OF ECCENTRIC VERSUS CONCENTRIC REHABILITATION IN SYMPTOMATIC KNEE OSTEOARTHRITIS: A PROSPECTIVE RANDOMIZED STUDY

Background:Rehabilitation is at the center of the non-medical management of knee osteoarthritis. Concentric muscle strengthening is often preferred, while eccentric contractions play an important role in controlling knee flexion and knee stability and allow the development of a high level of strength with a low energy cost. But few studies have focused on these two techniqueObjectives:To explore the effect of a 6-week-exercise program on function, pain and performance level in symptomatic knee osteoarthritis patientsMethods:An analysis was performed of the data from 60 individuals with symptomatic knee osteoarthritis who were included in the EXART study. The EXART study was a prospective, randomized controlled trial which included patients aged 40 to 85 with KL 2 or 3 responding to the American College of Rheumatology criteria. The first group benefitted from a 6 week eccentric rehabilitation program and the second group from a standard 6 week concentric rehabilitation program. The endpoints were the changes from baseline to week 6 in Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), pain, and performance measured with quadriceps power (PMax) and contraction strength (MMax). MRI muscle analysis was performed before and after physical activity.Results:Among 80 patients screened, 60 were included in the study and randomized. 25/30 subjects finished the program in the concentric group and 28/30 in the eccentric group. The mean population age was 74 (+/-8), mean IMC 27.2 (+/-4). The baseline total WOMAC mean was 49.2 (+/-19), VAS pain 5.3 (+/-2). At 6 weeks, both groups showed a significant improvement compared to baseline for the WOMAC without any difference between the two groups (mean difference evolution concentric = 7.5 ± 11.9 (p= p<0.0001); mean difference evolution eccentric = 4.5 ± 1.9 (p<0.0001); intergroup analysis p=0.7). Similar significant results were found in the WOMAC function subscale. No difference between the groups appeared in VAS pain evolution (p= 0.7). The eccentric group showed a significant improvement in PMax and high speed MMax evolution (p=0.001 and p=0.002). This improvement was not found for the concentric group (p= 0.52 and p=0.27). MRI showed a vastus medialis hypertrophy only in the eccentric group (p=0.002). We did not observe any change in the fatty infiltration of the quadriceps on MRI.Conclusion:Rehabilitation, whether eccentric or concentric, has a beneficial action on function and pain in symptomatic knee osteoarthritis whatever the methods. A gain in muscle performance and vastus medialis volume was found only with the eccentric rehabilitation. This study confirms the importance of any type of rehabilitation in knee osteoarthritis and raises the question of the relation between muscle gain/performance and function or painAcknowledgements:We would like to thank all the patients who took part in the study as well as all the members of the Fragile Platform of the Nice University Hospital.Disclosure of Interests:None declared

Efficacy and safety of a single intra-articular injection of 6 ml Hylan G-F 20 compared to placebo in Chinese patients with symptomatic knee osteoarthritis

Background Single 6 ml Hylan G-F 20 injection, is indicated for knee osteoarthritis patients who have failed to respond to non-pharmacologic therapy and/or simple analgesics. To obtain more thorough understanding of the clinical efficacy and safety, a randomized clinical trial was conducted comparing intra-articular (IA) administration of single 6 ml Hylan G-F 20 injection versus placebo in knee OA patients of Chinese ethnicity. Methods This was a randomized, multi-center, double-blind, placebo-controlled clinical trial conducted in 21 centers across China. Four hundred forty adults with knee OA received a single 6 ml Hylan G-F 20 or placebo injection and were evaluated for clinical efficacy and safety outcomes over 26 weeks. Western Ontario and McMaster Universities OA (WOMAC) A1 index, treatment-emergent adverse events (TEAEs) and standard safety parameters were measured at pre-injection, and at weeks 1, 4, 8, 12, 16, 20 and 26 post-injection. Results Four hundred forty patients (male: 98 [22.3%]; female: 342 [77.7%]) were randomized. The mean age [standard deviation (SD)] was 61.5 (7.9) years. All patients were of East Asian ethnicity. Mean WOMAC A1 score at baseline was 5.3 (1.2) and 5.2 (1.3) in single 6 ml Hylan G-F 20 injection and placebo groups, respectively. Significant reductions of WOMAC A1 score were observed in both treatment groups when compared to baseline at 26 weeks post-injection, with the mean reduction of [standard error (SE)/percentage] -2.146 (0.108)/− 40.5% and − 2.271 (0.110) /− 43.7% in the single 6 ml Hylan G-F 20 injection and the placebo groups, respectively. Additionally, clinically important reductions in pain at 26 weeks was reported in 67.0 and 68.2% in single 6 ml Hylan G-F 20 injection and placebo groups (p = 0.36). Regarding safety, TEAEs were similar between the two treatment groups (hylan G-F 20 single: 61.5%; placebo: 64.5%). Conclusions While the magnitude of the effect of a single 6 ml Hylan G-F 20 injection in this study is consistent with previously published literature with respect to the efficacy and safety of the drug, the current study shows a strong IA placebo effect and did not established superiority of single 6 ml Hylan G-F 20 injection over IA placebo in Chinese knee OA patients. Trial registration Prospectively registered Jun 16, 2017 at www.clinicaltrials.gov (NCT03190369).