Clinical Signs Of Osteoarthritis Research Articles

Results of a clinical study of Traumeel® S and Zeel® T in patients with knee osteoarthritis and concomitant cardiovascular disease

Objective: to evaluate the efficacy and safety of simultaneous intramuscular administration of Traumeel® S and Zeel® T followed by therapy with the tablet medication Zeel® T in patients with knee osteoarthritis (OA) and concomitant cardiovascular diseases. Material and methods. The analysis included 119 patients aged 45–79 years (78.2 % women and 21.8 % men) with confirmed diagnosis of knee OA according to Altman criteria, stage II–III according to Kellgren–Lawrence and confirmed cardiovascular disease. The main indicator of efficacy was the change in pain intensity in the target knee joint according to the “Pain” subscale of the WOMAC questionnaire (A) at the final examination compared to the baseline. Other criteria were the dynamics of each symptom of knee OA according to the WOMAC questionnaire (pain, stiffness, and functional impairment, total score) on each visit, pain intensity in the target joint on a visual analogue scale (VAS), time it takes to travel 15 m, and the patient's overall disease assessment on the VAS. In addition, duration of use and dose of paracetamol (if used) were assessed, as well as quality of life by EuroQol and adverse events (AEs). Treatment safety was also analyzed in patients who had received at least one dose of the study drug. Results and discussion. WOMAC pain intensity decreased by on average of 3.8 points: from 7.6 to 3.8 points (95 % confidence interval, CI from -4.3 to -3.3). Data on changes in knee OA symptoms (pain, stiffness, and functional impairment) for each WOMAC subscale and the total score showed significant improvement at each follow-up visit (p < 0.0001). The VAS pain level decreased by 52%. An improvement in joint function was noted: the time it takes to travel 15 m fell from 19.5 to 16.4 s (p < 0.0001). The EuroQol quality of life score also improved from 57.1 ± 16.2 points at baseline to 71.1 ± 14.8 points on the 84<sup>th</sup> day of therapy. Thirty (25.2 %) patients had AEs, mainly neurological: headache (7.6 %) and hypoesthesia (1.7 %). No serious AEs were recorded. An association between AEs and study drug use was noted in 4 patients (headache, hypoesthesia, muscle cramps, and injection site pain). Conclusion. The results of the study confirm the efficacy and safety of the use of Traumeel® S and Zeel® T in patients with knee OA who have concomitant cardiovascular disease. During therapy, a significant decrease in pain and other clinical signs of OA (stiffness, limitation of physical activity) was observed, which allows us to recommend this treatment regimen for patients with comorbid pathology, as well as with the risk of developing of AEs during non-steroidal anti-inflammatory drugs therapy.

A Life Dedicated to Climbing and Its Sequelae in the Fingers—A Review of the Literature

Fingers of sport climbers are exposed to high mechanical loads. This work focuses on the fingers of a 52-year-old active elite climber who was the first in mankind to master 8B (V13), 8B+ (V14) and 8C (V15) graded boulders, bringing lifelong high-intensity loads to his hands. It is therefore hypothesized that he belongs to a small group of people with the highest accumulative loads to their fingers in the climbing scene. Fingers were analyzed by means of ultrasonography, X-rays and physical examination. Soft tissue and bone adaptations, as well as the onset of osteoarthritis and finger stiffness, were found, especially in digit III, the longest and therefore most loaded digit. Finally, this article aims to provide an overview of the current literature in this field. In conclusion, elite sport climbing results in soft tissue and bone adaptations in the fingers, and the literature provides evidence that these adaptations increase over one's career. However, at later stages, radiographic and clinical signs of osteoarthritis, especially in the middle finger, seem to occur, although they may not be symptomatic.

Relationships among owner consideration of euthanasia, caregiver burden, and treatment satisfaction in canine osteoarthritis

Although diagnosis of osteoarthritis (OA) has been recently linked to euthanasia in dogs, no prior work has examined the roles of caregiver burden or treatment satisfaction in this relationship. We expected that there would be an indirect effect of caregiver burden on the association between consideration of euthanasia and clinical signs of OA, but that this effect would be influenced by owner satisfaction. Cross-sectional online evaluations were completed by 277 owners of dogs with OA recruited through social media. Canine OA-related pain and functional impairment, owner consideration of euthanasia, caregiver burden, and satisfaction were examined. Relationships among OA-related pain and functional impairment, owner consideration of euthanasia, caregiver burden, and satisfaction were statistically significant (P 0.01 for all). Cross-sectional mediation analysis demonstrated a statistically significant indirect effect of caregiver burden on the relationship between consideration of euthanasia and OA-related clinical signs (bias-corrected 95% confidence interval [BC 95% CI], 0.001–0.009), which was significantly moderated by owner satisfaction (BC 95% CI, −0.003 to −0.0002). Findings align with prior work connecting canine OA to euthanasia. The current study extends past research to demonstrate that caregiver burden in the owner may be partially responsible for this relationship. The moderating role of owner satisfaction suggests that optimizing owner impressions of treatment and the veterinary team could attenuate these relationships, potentially decreasing the likelihood of premature euthanasia for dogs with OA.

Вплив метаболічних порушень на клінічні прояви остеоартрозу та спосіб прогнозування його перебігу

Мета дослідження: вивчення впливу показників метаболічного синдрому на клінічні прояви остеоартрозу та розробка способу прогнозування тяжкості перебігу остеоартрозу залежно від компонентів метаболічного синдрому. Матеріали та методи. Були обстежені 84 хворі з остеоартрозом (20 чоловіків та 64 жінки), середній вік 57,03 ± 0,70 року. Результати. Встановлений зв’язок показників вуглеводного, ліпідного обміну, індексу маси тіла та абдомінального ожиріння з клінічними проявами остео-артрозу. Побудована модель дерева регресії для прогнозування сумарного бала за шкалою WOMAC залежно від характеристик метаболічного синдрому. Висновки. Отримані дані дозволяють зробити висновки про вплив інсулінорезистентності, дисліпідемії, артеріальної гіпертензії та абдомінального ожиріння на вираженість больового синдрому, обмеження рухливості та прояви фізичної активності у хворих на остеоартроз.

Factors associated with longitudinal change of meniscal extrusion in overweight women without clinical signs of osteoarthritis.

To identify variables associated with longitudinal change in meniscal extrusion, which might be used as possible targets for knee osteoarthritis (KOA) prevention. In a high-risk population of middle-aged overweight women, meniscal extrusion was assessed with magnetic resonance imaging (1.5 T, coronal proton density, in-plane resolution 0.5mm2, Sante DICOM Editor) at baseline and after 30 months. Outcomes were the absolute change in medial and lateral extrusion (mm) and relative change in extrusion (%). Based upon literature, 11 factors were hypothesized to be associated with longitudinal change. Generalized estimating equations were used to model the effect on meniscal change (P<0.05). In total, 677 knees of 343 women were available for analysis, with a mean age of 55.7 years (+/-3.2) and a mean BMI of 32.3 kg/m2 (+/-4.2). The greatest change in meniscal extrusion appeared medially with incident meniscal tear (4.4%; absolute 0.9 mm (95% CI: 0.3, 1.5; P=0.004); relative 14.5% (4.4, 24.7; 0.005)). Varus malalignment was associated with an increase of medial extrusion of 0.6 mm (37.6%; 0.1, 1.0; 0.009). A 5 kg/m2 higher baseline BMI was associated with absolute and relative increase of medial extrusion of 0.2 mm and 2.96% (0.1, 0.3; <0.001 and 1.3, 4.8; 0.002). Less explicit but significant changes in extrusion appeared with longitudinal change in BMI. Meniscal tears, varus malalignment and BMI were significantly associated with change in meniscal extrusion in middle-aged overweight women, providing viable therapeutic targets to prevent or reduce extrusion and thereby decelerate KOA development.

Age-related morphometric changes of the tidemark in the ovine stifle.

Though the ovine stifle is commonly used to study osteoarthritis, there is limited information about the age-related morphometric changes of the tidemark. The objective of this study was to document the number of tidemarks in the stifle of research sheep without clinical signs of osteoarthritis and of various ages (n=80). Articular cartilage of the medial and lateral tibial condyles and of the medial and lateral femoral condyles was assessed by histology: (a) to count the number of tidemark; and (b) to assess the OARSI (Osteoarthritis Research Society International) score for structural changes of cartilage. The number of tidemarks varied between anatomical regions, respectively, from 4.2 in the medial femoral condyle to 5.0 in the lateral tibial condyle. The axial part showed a significant higher number of tidemarks than the abaxial part, for all regions except the medial tibial condyle. Whilst the tidemark count strongly correlated with age (Spearman's correlation coefficient=0.70; 95% confidence interval (95% CI): 0.67-0.73; p<0.0001), the OARSI score was weakly correlated with age in our cohort of sheep (Spearman's correlation coefficient=0.25; 95% CI: 0.19-0.30; p<0.0001). Interestingly, no tidemark was seen in the three animals aged 6months. Our data indicate that the number of tidemarks increases with age and vary with anatomical region. The regional variation also revealed a higher number of tidemarks in the tibia than in the femur. This could be attributed to the local variation in cartilage response to strain and to the difference in chondrocyte biology and density.

Knee osteoarthritis patients with more subchondral cysts have altered tibial subchondral bone mineral density

BackgroundSubchondral bone cysts are a widely observed, but poorly understood, feature in patients with knee osteoarthritis (OA). Clinical quantitative computed tomography (QCT) has the potential to characterize cysts in vivo but it is unclear which specific cyst parameters (e.g., number, size) are associated with clinical signs of OA, such as disease severity or pain. The objective of this study was to use QCT-based image-processing techniques to characterize subchondral tibial cysts in patients with knee OA and to explore relationships between proximal tibial subchondral cyst parameters and subchondral bone density as well as clinical characteristics of OA (alignment, joint space narrowing (JSN), OA severity, pain) in patients with knee OA.MethodsThe preoperative knee of 42 knee arthroplasty patients was scanned using QCT. Patient characteristics were obtained, including OA severity, knee pain, JSN, and alignment. We used 3D image processing techniques to obtain cyst parameters including: cyst number, cyst number per proximal tibial volume, cyst volume per proximal tibial volume, as well as maximum and average cyst volume across the proximal tibia, as well as regional bone mineral density (BMD) excluding cysts. We used Spearman’s correlation coefficients to explore associations between patient characteristics and cyst parameters.ResultsAt both the medial and lateral compartments of the proximal tibia, greater cyst number and volume were associated with higher BMD. At the lateral region, cyst number and volume were also associated with lateral OA severity, lateral JSN, alignment and sex. Pain was not associated with any cyst parameters at any region.ConclusionCyst number and volume were associated with BMD at both the medial and lateral compartments. Lateral cyst number and volume were also associated with joint alignment, OA severity, JSN and sex. This is the first study to use clinical QCT to explore subchondral tibial cysts in patients with knee OA and provides further evidence of the relationships between subchondral cysts and clinical OA characteristics.

The Influence of Metabolic Disorders on Clinical Signs of Osteoarthritis &amp; Prediction Method for its Course

Purpose: The study was designed to investigate the influence of indicators of metabolic syndrome on clinical signs of osteoarthritis (OA) and to develop the method of prediction of OA severity, depending on the components of metabolic syndrome. Methods: The study involved 84 patients (20 males), aged 57.03±0.69 with OA in Regional Hospital of Kharkov. Control group included 20 patients. The survey plan included anthropometric data (WC), global knee pain [visual analog scale (VAS)], the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), indices of carbohydrate exchange (insulin, glucose, HbAlc, HOMA-IR), lipid metabolism [the levels of total cholesterol (TC), low-density lipoprotein cholesterol (LDL), very LDL (VLDL), triglycerides (TG), high-density lipoprotein cholesterol (HDL)]. The level of HbA1C was <7.5% in all patients. The X-ray of knees was performed for all patients. Model prediction of total score for the WOMAC scale was build using the characteristics of metabolic syndrome. The best (most accurate) model was obtained using the technique of building a regression tree using the method of CART (Classification And Regression Trees) with a choice of rule for stopping by FACT method with the percentage of unclassified observations less than 1%. Results: While assessing the anthropometric data of patients with OA we have noted that the value of BMI in patients with OA averaged 30.07±0.76 kg/m2 and exceeded the similar index in the control group (M–W Z=−5.16351, p<0.05). Abdominal obesity was found in 65.5% of patients (65% men and 64% women). The analysis of carbohydrate metabolism has revealed type 2 diabetes mellitus in 75% of patients. We have found significant correlation between fasting glucose level and BMI (r=0.77 р<0.05), waist circumference (r=0.64; р<0.05), waist-to-hip ratio (r=0.60; р<0.05), systolic blood pressure (SBP) (r=0.57; р<0.05), diastolic blood pressure (DBP) (r=0.53; р<0.05). Level of HbA1c correlated with BMI (r=0.72 p <0.05), waist circumference (r=0.63; p<0.05), waist-to-hip ratio (r=0.64; p<0.05). The analysis of lipid profile has found that dyslipidemia occurs in 85% of patients. Statistically significant relations were determined between TC and the waist-to-hip ratio (r=0.52; p<0.05), SBP (r=0.73; p<0.05), DBP (r=0.59, p<0.05). We found significant correlation between lipid metabolism and BMI, viz. TC (r=0.66; р<0.05), TG (r=0.50; р<0.05), LDL (r=0.49; р<0.05). A direct correlation was observed between waist circumference and increase of TC levels (r=0.56; р<0.05), LDL (r=0.37; р<0.05) аnd TG (r=0.58; р<0.05). The presence of relationship between lipid and carbohydrate metabolism was observed, viz between TC and fasting glucose (r=0.52; р<0.05), НbA1c (r=0.42; р<0.05), insulin (r=0.45; р<0.05), HOMA-IR index (r=0.52; р<0.05). While analyzing the impact of metabolic syndrome indicators on WOMAC index, significant influence of these indicators on the clinical course of OA was found, viz a significant correlation was determined between WOMAC index and waist circumference (r=0.48; р<0.05), SBP (r=0.56; р<0.05), LDL (r=0.35; р<0.05), TG (r=0.24; р<0.05), HbA1c (r=0.54; р<0.05), duration of OA (r=0.24; р<0.05). Tree regression model for predicting the total score for the WOMAC scale was constructed based on the characteristics of the metabolic syndrome: waist circumference, HbA1c, LDL, TG, and blood pressure values. Age of patients and duration of OA were used as additional predictors of OA severity. Decisive rules for prediction of total score according to WOMAC scale based on the constructed model are shown in Fig. 1. This method allows to predict the severity of pain and lack of joint function with 86.1% probability, i.e. to determine the number of points that patient would get by using of WOMAC scale, without questioning, only by assessing the parameters of metabolic syndrome. Conclusions: The presence of significant correlation between WOMAC index and waist circumference, SBP, LDL, TG, HbA1c has proved that metabolic changes can be an important factor for the development of immune, metabolic disorders as well as for the progression of OA. A regression tree model for the prediction of total score by WOMAC scale was created depending on the characteristics of metabolic syndrome.

Efficacy of an oral nutraceutical for the treatment of canine osteoarthritis. A double-blind, randomized, placebo-controlled prospective clinical trial.

To assess the safety and efficacy of an orally administered nutraceutical (Glu/CS+; + for additional ingredient) for the treatment of clinical osteoarthritis (OA) in dogs. In this double-blind, randomized, placebo-controlled clinical trial, client-owned dogs with clinical signs of OA in one or more joints were assigned to a Glu/CS+ (n = 30) or placebo (n = 30) group. Dogs were administered Glu/CS+ or placebo orally and wore an activity monitor (AM) continuously throughout a 97 day study period. Prior to the initiation of the treatment, seven days of baseline activity was collected. On days -7, 30, 60 and 90 of the study, owners completed a patient assessment form (Canine Brief Pain Inventory). Data between groups were compared. No serious adverse events were reported. No difference was found between groups when evaluating daily activity counts during the seven-day pre-treatment period and the 90-day treatment period. Owner assessment (pain interference and pain severity scores) improved over the 90-day treatment period for both groups, however no difference was found between treatment groups. Treatment with oral Glu/CS+ for a 90 day treatment period when compared to placebo treatment did not result in a significant increase in activity counts in dogs with clinical OA. However, owner assessment scores similarly improved throughout the study period for dogs in both groups, suggesting a caregiver placebo effect in this outcome measure.

English

Osteoarthritis (OA) is characterized by low grade inflammation leading to progressive degenerative changes in articular cartilage (Morenko et al., 2004). Joint mobility is reduced owing to pain and swelling of affected area. Severity of OA depends on type of inducer that may be chemical, enzymatic or surgical. Cartilage metabolic disturbances lead to destabilization and degeneration. Clinical manifestations of OA include softening, fibrillation, ulceration, sclerosis, bone eburnation, osteophytes and sub-chondral cysts formation (Fernihough et al., 2004). Pain leading to joint immobilization is prominent manifestation of this chronic malady (Khan et al., 2012). Initially, soft swelling can be observed on affected joints which later on subside with the progression of diseases. Crackling sounds from affected joints during walking and standing (Brandt et al., 2009). Mostly, treatment of OA is done focusing the symptom of pain and joint dysfunction (Flood, 2010). Non-steroidal anti-inflammatory drugs (NSAIDS), opiates, corticosteroids and nutraceuticals are conventional therapeutics for OA (Sofat et al., 2011). Glycosaminoglycans (GAGs) are long un-branched polysaccharides of repeating disaccharide units abundantly present in connective tissues, vitreous humor, synovial fluid, mast cells and predominately in cartilages. The major constituents are chondroitin sulphate, dermatan sulphate, heparin/heparansulphate, glucosamine and hyaluronic acid. Among these, glucosamine sulphate (GS) and chondroitin sulphate (CS) are more effective and safe therapeutic agents for OA (Miller and Clegg, 2010). CS and GS stimulate chondrocyte synthesis of collagen (Adams et al., 2013). Concurrent use of CS and GS increase synthesis of cartilage matrix and decrease progression of OA which ultimately reduces signs and symptoms of disease. In present study, efficacy of glycosaminoglycans on clinical signs of osteoarthritis and C-terminal telopeptides of type II collagen (CTX-II) was evaluated in papain induced OA albino rat model.

Study of the role of miRNA in mesenchymal stem cells isolated from osteoarthritis patients

ObjectivemiRNAs act as gene silencers that are involved in the regulation of essential cell functions. miR-335 is involved in regulating cell differentiation processes in progenitor cells. Mesenchymal stem cells (MSCs) are progenitor cells of chondrocytes and osteoblasts responsible for homeostatic maintenance of cartilage and bone. The aim of this study was to determine a possible relationship between the expression of miR-335 and osteoarthritis. MethodsMSCs obtained from the bone marrow of 3 osteoarthritic patients and 3 controls with no clinical signs of osteoarthritis or osteoporosis were cultured and phenotypically and functionally characterized in a 3-step culture. Expression levels of miR-335 and the mesoderm-specific transcript gene – MEST – that controls its expression were determined by quantitative PCR. ResultsDifferences in the expression levels of miR-335 and MEST (median [interquartile range]: 1.69 [0.85–1.74], and 3.85 [3.20–5.67] were detected between MSCs isolated from patients with osteoarthritis and controls. Although the differences detected did not reach statistical significance (P=.1), a clear trend toward lower expression of miR-335 in osteoarthritis MSCs was observed. ConclusionsGiven that miR-335 has the different genes involved in the Wnt signaling pathway as potential targets, the observed trend may help to ascertain, at least partially, some of the alterations which determine the onset or progression of osteoarthritis, and can therefore serve for the design of future therapeutic targets for the treatment of this disease.

Estudio del papel de los miARN en células madre mesenquimales aisladas de pacientes artrósicos

ObjectiveMiRNAs act as gene silencers that are involved in the regulation of essential cell functions. miR-335 is involved in regulating cell differentiation processes in progenitor cells. Mesenchymal stem cells (MSCs) are progenitor cells of chondrocytes and osteoblasts responsible for homeostatic maintenance of cartilage and bone. The aim of this study was to determine a possible relationship between the expression of miR-335 and osteoarthritis. MethodsMSCs obtained from the bone marrow of 3 osteoarthritic patients and 3 controls with no clinical signs of osteoarthritis or osteoporosis were cultured and phenotypically and functionally characterised in a 3-step culture. Expression levels of miR-335 and the mesoderm-specific transcript gene –MEST– that controls its expression were determined by quantitative PCR. ResultsDifferences in the expression levels of miR-335 and MEST (median [interquartile range]: 1.69 [0.85-1.74], and 3.85 [3.20-5.67] were detected between MSCs isolated from patients with osteoarthritis and controls. Although the differences detected did not reach statistical significance (P=.1), a clear trend towards lower expression of miR-335 in osteoarthritis MSCs was observed. ConclusionsGiven that miR-335 has the different genes involved in the Wnt signalling pathway as potential targets, the observed trend may help to ascertain, at least partially, some of the alterations which determine the onset or progression of osteoarthritis, and can therefore serve for the design of future therapeutic targets for the treatment of this disease.

Prevalence of naturally occurring cartilage defects in the ovine knee

To determine the prevalence, anatomical location and severity of cartilage defects in the stifle (knee) within a population of adult ewes (N=65). Articular cartilage (AC) of the distal femur, proximal tibia and patella was assessed using Osteoarthritis Research Society International (OARSI) recommendations for macroscopic and microscopic scoring of ovine cartilage. Synovial fluid analysis and histology of the synovial membrane were performed. All limbs were examined by computed tomography. Twenty-eight sheep (n=28; 43%) presented at least one score 2 or score 3 lesion. Twenty-two (n=22; 34%) sheep were macroscopically normal. Most frequent localizations of lesions were: axial aspect of the central third of the medial tibial condyle (32.7% of the lesions), middle third of the medial femoral condyle (29.4%), middle third of the articular surface of the patella (9.8%), and axial aspect of the central third of the lateral tibial condyle (9.8%). Grade of macroscopic lesions was significantly (H (3)=29.31, P 0.000) affected by age. Macroscopic score correlated well with histological changes that can be found in osteoarthritis (OA) (r 0.83; P 0.000). Neither clinical signs of OA, nor cytological and histological signs of inflammation were identified, while imaging abnormalities were very rare. Our data seem to indicate that naturally occurring OA exists in ageing sheep, at least subclinically. It might be useful to take into account prevalent cartilage defects at baseline in studies using ovine models.

Randomized, Controlled Clinical Trial Evaluating the Efficacy of Pulsed Signal Therapy in Dogs with Osteoarthritis

To evaluate the efficacy of pulsed signal therapy (PST) in reducing pain and increasing function in dogs with osteoarthritis (OA) using a randomized, blinded, controlled clinical trial. Randomized, controlled, blinded clinical trial. Adult dogs (n = 60) with moderate-to-severe clinical signs of OA. Dogs were randomized by age into 2 groups: dogs ≥ 9 years and dogs < 9-years old. The control group received 1 hour of rest in hospital for 9 consecutive days and dogs in the treatment group received PST for 1 hour on 9 consecutive days. Goniometry and gait analysis were performed, and the Canine Brief Pain Inventory (CBPI) questionnaire was given to the owners to fill out without supervision. Outcome measures were repeated at the end of treatment (Day 11) and 6 weeks after beginning treatment (Day 42). The PST group performed significantly better than the control group as measured by the CBPI Severity and Interference scores (P < .01). Extension (P = .04) and peak vertical force (PVF) (P = .03) were not statistically significant after adjusting for multiple comparisons. The group receiving PST performed better than the treatment group according to owner assessment.

303 COMPARISON OF TWO HYALURONIC ACID FORMULATIONS ON FUNCTIONAL OUTCOMES IN PATIENTS WITH KNEE OSTEOARTHRITIS

eight skeletal sites and knee structure in asymptomatic young to middleaged females without any clinical signs of osteoarthritis. Methods: One hundred and sixty healthy, females (29–50yr) without symptoms of osteoarthritis underwent magnetic resonance imaging of the knee. BMD was measured at the spine, hip, total body and forearm by dual energy x-ray absorptiometry, and SoS, BUA and SI were measured at the calcaneus by quantitative ultrasound (QUS). BMD and QUS measures were tested for an association with cartilage volume, defects, and bone marrow lesions (BMLs). Results: medial cartilage volume was positively associated with bmd at the total body, femoral neck, and ward’s triangle (all p < 0.05). Non-significant associations in the same direction existed at the spine (p =0.07), and trochanter (p = 0.10). Findings in the lateral compartment were similar. The presence of medial cartilage defects showed a nonsignificant association with bmd at the spine (p = 0.05). Bmd was not associated with lateral cartilage defects or bmls. No associations were observed with qus measures at the calcaneus. Conclusions: Whilst site-specific BMD is associated with cartilage volume at the knee in asymptomatic females aged 29–50yr, peripheral BMD measures, and QUS measures of the calcaneus, showed no associations with knee structure. These data suggest that the association between cartilage volume and axial/ lower limb BMD may relate to common local, possibly biomechanical, factors.

Surgical model of osteoarthritis secondary to medial patellar luxation in dogs

This study was performed to make a surgical model of osteoarthritis (OA) in the dog. Experimental medial patellar luxation (MPL) was surgically produced in the left stifle (index) of 24 skeletally mature mixed small breed dogs (age two to six years and weight 2.8 to 9 kg). The animals were randomly allocated in 2 groups; sham group (n = 12), where the right stifle was sham operated and control group (n = 12) with intact right stifle. Physical and radiographic examinations of both stifles were performed at 1.5 months intervals over a one-year experimental period. One dog was euthanatized every three months, and both stifles were explored, gross examination was performed and tissue samples from the articular cartilage, cranial cruciate ligament (CCL) and synovium were collected for histomorphology. The clinical signs of OA were obvious in the experimental dogs by 12 weeks of surgical induction of MPL, which was also evidenced in the histopathology of the joint tissues and electron microscopy of the articular cartilage. The radiographic changes of OA were not obvious until remarkable degenerative changes became abvious six months postoperatively. Surgically induced MPL can be a successful tool for experimental induction of OA in dogs.

Effect of Dietary Polydextrose on Feces Consistency and Macronutrient Digestibility in Healthy Dogs

Problem statement: There is evidence that the addition of 3% STA-LITE® polydextrose to a dry food reduces clinical signs of osteoarthritis in dogs. For the application of polydextrose as functional ingredient of dog foods, information as to its impact on the acceptance of food, feces consistency, fecal odor and digestibility of macronutrients and minerals is required. Approach: A feeding experiment with 4×4 Latin square design was carried out with 12 adult, healthy Golden Retrievers. The experimental diets consisted of a commercial dry food to which either 0, 2, 4 or 8% polydextrose was added. During the last 5 days of each two-week feeding period, feces of individual dogs were collected quantitatively. Feces consistency and fecal odor were scored. Fecal pH, fecal Lactobacilli and the apparent digestibility of macronutrients and minerals were determined. Results: The various inclusion levels of polydextrose did not affect food acceptance and intake and did not induce changes in body weight. Polydextrose intake did not influence fecal odor and the amount of feces production. Feces consistency was significantly affected by polydextrose; feces became softer with increasing dose. The apparent digestibilities of dietary dry matter, crude protein, crude fat and ash were not significantly affected by polydextrose intake. The apparent digestibilities of crude fiber and nitrogen-free extract were increased by the addition of polydextrose to the diet. Apparent digestibility of polydextrose was calculated to be 92% of intake. The high apparent digestibility of polydextrose points at fermentation of this functional ingredient in the hindgut of dogs, but it was not associated with a further lowering of fecal pH and increase in fecal Lactobacilli. Apparent calcium and phosphorus absorption were not significantly affected by polydextrose intake. Conclusion: In the clinical trial on canine osteoarthritis, a polydextrose dose of 3% in a dry dog food is used. The outcome of this study with healthy dogs indicates that 3% polydextrose may not have negative effects on the variables that are measured.

Fifteen-Year Outcome of Endoscopic Anterior Cruciate Ligament Reconstruction With Patellar Tendon Autograft for “Isolated” Anterior Cruciate Ligament Tear

Background: Few studies report the long-term results of anterior cruciate ligament rupture and single-incision endoscopic reconstructive surgery. Outcomes are often clouded by concomitant meniscal, chondral, or ligament injuries. Purpose: To determine the 15-year outcomes of anterior cruciate ligament ruptures treated with endoscopic anterior cruciate ligament reconstruction using middle-third patellar tendon autograft. Study Design: Case series; Level of evidence, 4. Methods: Between January 1993 and April 1994, 333 consecutive patients underwent anterior cruciate ligament reconstruction. Patients with associated ligamentous injury requiring surgery, previous meniscectomy, or meniscal injury requiring more than one-third meniscectomy; chondral injury diagnosed at arthroscopy; and an abnormal contralateral knee were excluded. Ninety patients met the inclusion criteria. Outcomes included range of motion, Lachman and pivot-shift tests, instrumented ligament testing, single-legged hop test, Lysholm Knee Score, the International Knee Documentation Committee evaluation, and radiographic assessment. Results: Thirty percent of patients had further anterior cruciate ligament injury. Twenty-four percent of patients (n = 22) sustained contralateral anterior cruciate ligament ruptures, and 8% (n = 7) ruptured the graft (P = .009). Graft rupture was associated with a graft inclination angle <17° (P = .02). Contralateral anterior cruciate ligament rupture was associated with age <18 years at time of primary injury (P = .001). All patients had normal or nearly normal (International Knee Documentation Committee evaluation) Lachman and instrumented testing, and 91% had a negative pivot-shift result. Seventy percent of patients had kneeling pain. Median subjective International Knee Documentation Committee evaluation was 91 of 100. Fifty-one percent of patients had radiographic evidence of osteoarthritis (41% grade B; 10% grade C). Conclusion: Good results are maintained at 15 years after surgery with respect to ligamentous stability, subjective outcomes, and range of motion. Kneeling pain remains a significant problem. Concern remains regarding the incidence of further anterior cruciate ligament injury and the increasing number of patients with radiographic and clinical signs of osteoarthritis despite surgical stabilization.

Dose-Titration Effects of Fish Oil in Osteoarthritic Dogs

Food supplemented with fish oil improves clinical signs and weight bearing in dogs with osteoarthritis (OA). Determine whether increasing the amount of fish oil in food provides additional symptomatic improvements in OA. One hundred and seventy-seven client-owned dogs with stable chronic OA of the hip or stifle. Prospective, randomized clinical trial using pet dogs. Dogs were randomly assigned to receive the baseline therapeutic food (0.8% eicosopentanoic acid [EPA] + docosahexaenoic acid [DHA]) or experimental foods containing approximately 2- and 3-fold higher EPA+DHA concentrations. Both veterinarians and owners were blinded as to which food the dog received. On days 0, 21, 45, and 90, serum fatty acid concentrations were measured and veterinarians assessed the severity of 5 clinical signs of OA. At the end of the study (day 90), veterinarians scored overall arthritic condition and progression of arthritis based on their clinical signs and an owner interview. Serum concentrations of EPA and DHA rose in parallel with food concentrations. For 2 of 5 clinical signs (lameness and weight bearing) and for overall arthritic condition and progression of arthritis, there was a significant improvement between the baseline and 3X EPA+DHA foods (P=.04, .03, .001, .0008, respectively) but not between the baseline and the 2X EPA+DHA foods. Increasing the amount of fish oil beyond that in the baseline food results in dose-dependent increases in serum EPA and DHA concentrations and modest improvements in the clinical signs of OA in pet dogs.

Is Cartilage Matrix Breakdown an Appropriate Therapeutic Target in Osteoarthritis – Insights from Studies of Aggrecan and Collagen Proteolysis?

Progressive cartilage degradation is considered a hallmark of osteoarthritis (OA), and as such methods to inhibit this process have been extensively investigated as potential disease-modifying therapies. However, all tissues of the joint are affected by disease in OA, and it is likely that the pain and disability which are the major clinical symptoms of OA, arise predominantly from pathology in these extra-cartilaginous structures. It is unclear therefore, whether specifically targeting inhibition of cartilage matrix breakdown will ameliorate global joint pathology and thereby affect the clinically-relevant OA-related disability. We have investigated this question by reviewing the literature and data available from studies of genetically-modified (GM) mice. A total of 79 different GM strains were identified in which OA-like cartilage erosion was analysed, 53 with increased, 18 with no change, and 8 with decreased cartilage damage. Inhibition of OA cartilage damage was afforded by mutations that either reduced chondrocyte hypertrophy or abrogated proteolysis of aggrecan and collagen II in cartilage. There was an association between increased cartilage breakdown and changes in subchondral bone, osteophytosis and synovial hyperplasia in GM mice. However, the effect of significantly inhibiting cartilage damage on pathology in other joints tissues has been less well examined. There appeared to be no diminution of osteophyte development in chondroprotected GM mice strains, but a possible reduction in subchondral bone plate changes. To date, there is no conclusive data on the effect of inhibiting cartilage breakdown on clinical signs of OA in GM mice. These studies have highlighted the tremendous advances studies of GM mice have afforded us in understanding the pathophysiology of cartilage degradation in OA. Furthermore they demonstrate the feasibility of targeting cartilage matrix destruction. However, it is evident that an important direction for ongoing research will be to determine the effect of successful protection of cartilage structural integrity on pathology in other tissues in the OA joint, and the clinical signs of the disease.