Osteoarthritis Disability Research Articles

COMPARING EXERCISE AGAINST A PLACEBO FOR PAIN AND DISABILITY OUTCOMES IN MUSCULOSKELETAL CONDITIONS: A SYSTEMATIC REVIEW & META-ANALYSIS

BACKGROUND Musculoskeletal conditions are the leading cause of years lived with disability globally, with pain and disability being two of the most important patient-reported outcomes. Exercise is a commonly recommended treatment for musculoskeletal conditions, though it is unclear whether exercise outperforms sham for improving pain and disability. AIM: To determine if exercise improves pain and disability more than sham for people with musculoskeletal conditions. METHODS We searched 5 databases and 3 clinical trial registers for randomised controlled trials comparing exercise against sham in people with a musculoskeletal condition. The co-primary outcomes were pain and disability. Data were analysed using random effects meta-analysis or narrative synthesis if < 5 studies were available to be pooled. The certainty of findings was assessed using the Grading of Recommendations, Assessment, Development and Evaluations tool. Data are presented as mean difference [95% CI], with a difference of >10/100 for pain and >14.5/68 for disability (WOMAC physical function sub-scale) considered clinically meaningful. RESULTS Within the 15 included studies, all reported pain intensity and 13 reported disability. There was low certainty evidence that exercise was more efficacious than sham for lowering low back pain (-5.94 [-7.74, -4.15], n=1091), osteoarthritis pain (-6.19 [-14.36, 1.97], n=447) and osteoarthritis disability (-7.95 [-11.45, -4.46], n=211). Narrative synthesis showed varied effects of exercise versus sham on pain and disability in neck pain, as well as on disability in low back pain and other measures of disability in osteoarthritis. No studies were located for rheumatoid arthritis. CONCLUSION Based on low certainty evidence from a limited number of studies, exercise may not cause clinically significant differences for pain and disability compared to sham in adults with osteoarthritis and back pain. Further research is needed to confirm this for low back pain and osteoarthritis and to extend the findings other musculoskeletal conditions.

Osteoarthritis and social disadvantage interactions: retrospective overview and emergent findings and health implications

Osteoarthritis, a widespread arthritic disease commonly resulting in considerable pain and functional disability is often found to vary among those deemed affected. While age, gender, and genetics commonly explain this, what does the research show specifically in terms of extrinsic factors such as social disadvantage? This report aimed to update what is known about the social context and its role as a possible remediable osteoarthritis disability determinant if suboptimal. Using the PUBMED data base and others, osteoarthritis studies published between January 1, 2000 and March 20, 2024 concerning possible social disadvantage linkages were sought and carefully examined. As well, data drawn from the researcher’s repository were reviewed. The search results revealed a growing interest in this topic where osteoarthritis can be observed to be negatively influenced in the face of one or more forms of social deprivation. Yet, very few clinical trials prevail to either test the validity of this idea or apply these understandings to preventing suffering. In light of the increasing osteoarthritis burden, despite years of research, it appears that to maximize wellbeing for all, and to limit or obviate unwanted osteoarthritis associated health and disability costs, more resounding research along with a focus on advancing social equity and mitigating all forms of social deprivation is strongly indicated.

The interplay of body composition, pain intensity, and psychological status in Egyptian patients with knee osteoarthritis

BackgroundThere is a clear relationship between poor mental health, obesity, and osteoarthritis (OA). Individuals who experience symptoms of anxiety and depression are more likely to report higher levels of pain and disability in OA. In addition, higher body mass index (BMI) levels can contribute to additional pain and disability in individuals with OA. We aimed to explore the interplay of Body composition, pain intensity, and psychological status in Egyptian patients with knee OA.ResultsThis cross-sectional study included 60 patients with Knee OA diagnosed clinically according to the American College of Rheumatology (ACR) criteria. Body composition measurement was performed with an InBody analyzer. Pain was assessed by the pain visual analog scale (VAS), disability was measured with Western Ontario and McMaster Universities Osteoarthritis (WOMAC) scores, and depressed mood and/or anxiety was measured by the Hospital Anxiety and Depression Scale (HADS). Body mass index (BMI), total body fat (TBF) %, fat mass (FM), and fat mass index (FMI) were positively correlated with pain and disability in patients with knee OA. TBF% was positively correlated with depression and anxiety.ConclusionsThis study has shed light on the association between mental disorders, body composition measurements, knee pain, and disability. Interventions to treat osteoarthritis in elderly patients should focus on treating mood changes such as anxiety and depression, psychological support, and controlling body mass with proper diet and exercise programs.

Comparison of clinical outcomes between total hip replacement and total knee replacement.

Total hip replacements (THR) and total knee replacements (TKR) are effective treatments for severe osteoarthritis (OA). Some studies suggest clinical outcomes following THR are superior to TKR, the reason for which remains unknown. This study compares clinical outcomes between THR and TKR. To compare the clinic outcomes of THR anad TKR using a comprehensive range of patient reported outcome measures (PROMs). A prospective longitudinal observational study of patients with OA undergoing THR and TKR were evaluated using a comprehensive range of generic and joint specific PROMs pre- and post-operatively. A total of 131 patients were included in the study which comprised the THR group (68 patients) and the TKR group (63 patients). Both groups demonstrated significant post-operative improvements in all PROM scores (P < 0.001). There were no significant differences in post-operative PROM scores between the two groups: Hip and Knee Osteoarthritis Outcome scores (P = 0.140), Western Ontario and McMaster Universities Osteoarthritis Index pain (P = 0.297) stiffness (P = 0.309) and function (P = 0.945), Oxford Hip and Knee Score (P = 0.076), EuroQol-5D index (P = 0.386) and Short-Form 12-item survey physical component score (P = 0.106). Subgroup analyses showed no significant difference (P > 0.05) between cruciate retaining and posterior stabilised prostheses in the TKR group and no significant difference (P > 0.05) between cemented and uncemented fixation in the THR group. Obese patients had poorer outcomes following TKR but did not significantly influence the outcome following THR. Contrary to some literature, THR and TKR are equally efficacious in alleviating the pain and disability of OA when assessed using a comprehensive range of PROMs. The varying knee prosthesis types and hip fixation techniques did not significantly influence clinical outcome. Obesity had a greater influence on the outcome following TKR than that of THR.

Accelerometer-derived physical activity analysis of elderly osteoarthritis patients

BackgroundBecause disability in Osteoarthritis (OA) may change physical activity (PA), which might affect the disease progression, it is important to measure a patient's daily PA to study the relationship between a patient's PA and disease progression. ObjectiveThe objective of the present study was to investigate the relationship between PA and patients with OA and people without OA using data from the Korea National Health and Nutrition Examination Survey (KNHANES). MethodsDemographic study was conducted to obtain data of comorbidities of participants. PA was compared between the group with OA (OA group) and the group without OA (non-OA group). In addition, PAs of OA patients with comorbidities and those without comorbidities were compared. The cut-off of moderate to vigorous physical activity (MVPA) was obtained through a receiver operating characteristic (ROC) curve. ResultsIn the demographic study, there were significantly more educated participants in the OA group (p < .001). Actigraph data showed a significant decrease in MVPA (p < .001) but a significant increase in light activity (p = .002) in the OA group. In addition, the OA group showed significantly lower light PA but significantly higher MVPA in ≥10 min bout length. OA patients with comorbidities showed higher MVPA than OA patients without comorbidities (p = .044). The cut-off point of MVPA was 7.071 min/day when ROC curve was conducted. ConclusionsThe present study suggests that patients with OA and low activity need a certain level of physical activity and a cut-off point for MVPA is presented which accounts for comorbidities in OA patients.

Association of high kinesiophobia and pain catastrophizing with quality of life in severe hip osteoarthritis: a cross-sectional study

BackgroundWhile fear of movement is an important predictor of pain and disability in osteoarthritis (OA), its impact on patients with hip OA remains uncertain. This study aimed to determine whether fear of movement, evaluated by the Tampa Scale for Kinesiophobia (TSK)-11, and pain catastrophizing, evaluated by the Pain Catastrophizing Scale (PCS), were associated with quality of life (QOL) in patients with hip OA.MethodsThis cross-sectional study was conducted between November 2017 and December 2018. Ninety-one consecutively enrolled patients with severe hip OA were scheduled for primary unilateral total hip arthroplasty. The EuroQOL-5 Dimensions questionnaire was used to measure general QOL. The Japanese Orthopedic Association Hip Disease Evaluation Questionnaire was used to assess disease-specific QOL. The covariates included age, sex, body mass index (BMI), pain intensity, high pain catastrophizing (PCS ≥ 30), and high kinesiophobia (TSK-11 ≥ 25). Variables were subjected to multivariate analysis using each QOL scale.ResultsIn multiple regression analysis, pain intensity, high pain catastrophizing, and BMI were independently correlated with the disease-specific QOL scale. High pain catastrophizing, pain intensity, and high kinesiophobia were independently correlated with the general QOL scale.ConclusionsHigh pain catastrophizing (PCS ≥ 30) was independently associated with disease and general QOL scales. High kinesiophobia (TSK-11 ≥ 25) was independently associated with the general QOL scale in preoperative patients with severe hip OA.

Can Vitamin D Positively Impact Sarcopenia Severity Among Older Adults with Hand Osteoarthritis: A Review of the Evidence

Aim This review examines the research base concerning hand osteoarthritis and changes in muscle mass and quality known as sarcopenia and the possible use of vitamin-D supplementation for reducing this potentially adverse functionally disabling state. Methods Publications detailing a possible link between hand osteoarthritis manifestations and sarcopenia, plus those discussing vitamin D as a possible intervention strategy for minimizing sarcopenia in the older adult were systematically sought and reviewed. Results Collectively, data reveal hand osteoarthritis in the older population is common, and is possibly affected by age as well as disease associated muscle mass declines. Vitamin D, a powerful steroid required by the body to foster many life affirming physiological functions may help reduce the degree of any prevailing sarcopenia and thereby some degree of hand osteoarthritis disability. Conclusions Older individuals with hand osteoarthritis, as well as healthy older adults at risk for sarcopenia are likely to benefit physically from efforts to clarify the extent of this association and if indicated, to examine and intervene thoughtfully to maximize muscle composition as well as safe vitamin D levels where subnormal. Researchers can make highly notable impacts in multiple spheres in this regard and are encouraged to do so.

Osteoarthritis and Frailty: Associations, Relevance, and Counter Solutions

Background Many older adults, including those who have acquired painful disabling osteoarthritis of one or more joints may be frail rather than obese as is often reported. Those older adults who are frail may acquire osteoarthritis in turn if they encounter excess joint stresses and injury. Aims This report sought to examine what has been published to date on both of these debilitating health states, namely osteoarthritis and frailty. Methods Reviewed were relevant articles published in ACADEMIC SEARCH COMPLETE, PUBMED, WEB OF SCIENCE, SCOPUS and GOOGLE SCHOLAR regardless of time period but that focused on osteoarthritis and frailty related topics. The focus was on ascertaining how these two conditions might interact among community-dwelling older adults and whether more should be done specifically to mitigate any potentially preventable ‘frailty’ induced negative health impact among this group. Results Older adults with osteoarthritis living in the community may suffer from both osteoarthritis and frailty. Those that do are at high risk for disability and injury and should be targeted more effectively. Conclusion Timely and concerted efforts are needed to offset frailty correlates as well as excess osteoarthritis disability among community dwelling older adults.

Short-term results of a novel management of supracondylar fracture with coexisting osteoarthritis with bifold fixation and total knee arthroplasty

PurposePresence of supracondylar and periarticular femoral fracture with associated arthritis of knee poses a challenging situation to the orthopaedic surgeon. The results of fixation of fracture in osteoporosis are not very satisfactory and have complications. With fixation alone, they still cannot bear weight on affected leg due to severe disability of osteoarthritis. To make patient walk, conventionally three surgeries in the form of fracture fixation, removal of implant and total knee arthroplasty (TKA) needs to be done in staged manner. We propose a novel management in form of bifold fixation and simultaneous TKA.MethodsEight cases (6 females, 2 males) of supracondylar femoral fractures with severe osteoarthritis of the knee and osteoporosis were primarily fixed with bifold fixation using SIGN nail (www.signfracturecare.org) and locking plate together with simultaneous total knee arthroplasty. There were five cases (2 males and 3 females) of grade 4 (Kellgren-Lawrence grading) osteoarthritis (OA) and three cases (all females) of severe rheumatoid arthritis (RA).ResultsThe mean age was 68 years and average time for full weight bearing was 6 days. Radiographic evidence of fracture union was achieved in 16.25 weeks. The mean Knee Society Score (KSS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score at 26 months was 83.13 and 22.13 respectively.ConclusionsSingle stage combined bifold osteosynthesis with interlocking nail and locking plate together with total knee arthroplasty helps in one time management of these difficult injuries. It is a cost-effective and economically sound option and gives excellent results with good patient satisfaction.

Understanding the Association Between Osteoarthritis and Social Participation: The Canadian Longitudinal Study on Aging.

The focus on disability in osteoarthritis (OA) has largely been on the ability to perform specific activities, which neglects the greater implications for social participation. We investigated the association between OA and social participation, considering activity limitations and instrumental supports as intervening variables in the association. Data were from 21,214 respondents, ages 45-85 years, from cycle 1 of the Canadian Longitudinal Study on Aging. The questionnaire elicited information regarding self-reported doctor-diagnosed OA, difficulty with 14 activities, perceived availability and receipt of instrumental supports, and 17 social participation activities. Structural equation modeling was used. The primary outcome was social participation, and the primary predictor was OA. The intervening variables included activity limitations, received instrumental supports, and perceived instrumental supports. Latent variables were developed for intervening and social participation variables. The covariates included age, sex, body mass index, income, education, smoking, and comorbidity count. The mean age of the respondents was 63 years, 51% were female, and 26.5% reported having OA. Two distinct social participation indicators were identified, including social participation-diversity and social participation-intensity. When intervening variables were not considered, minimal/no association was found between OA and social participation. When intervening variables were considered, unique pathways linking OA and social participation were found. The overall negative association between activity limitations and social participation was partially direct and partially buffered by both receipt of and perceived availability of instrumental supports. In the absence of activity limitations, OA was associated with greater social participation. Enhanced social participation in people with OA who do not have activity limitations may reflect proactive steps taken by those with mild OA to maintain activity and social engagement. For those with activity limitations, findings highlight the need for interventions to mitigate limitations and draw particular attention to the importance of both provision and awareness of available instrumental supports in maintaining social participation.

Modular Dual Mobility Constructs Used for Recurrent Hip Instability.

BackgroundRecurrent hip dislocation despite prior attempts at surgical stabilization is a dreadful and technically challenging complication. A modular dual mobility (MDM) articulation has shown promise in addressing this problem, which might seem intractable. Our purpose was to examine the outcomes of revision total hip arthroplasty (THA) with an MDM placed through a direct anterior (DA) approach when all other conservative and surgical treatments have failed.MethodsFifteen patients revised with an MDM for recurrent instability (RI) between 2012 and 2018 by a single surgeon at a single institution were reviewed retrospectively, with a minimum of two years' follow-up. All patients underwent full acetabular revision with an MDM articulation through a DA approach with intraoperative fluoroscopy. No stems were revised. Dislocations, complications, and clinical outcomes are reported.Results All patients had recurrent posterior instability with a mean number of 4 ± 2 (range: 2 to 8) dislocations prior to MDM revision THA (MDM rTHA). Eight patients had already failed surgical intervention for instability, and seven had failed repeated closed reductions and conservative care. After MDM rTHA, there were no dislocations at a mean follow-up of 4 ± 1 years (range: 2 to 8). Similarly, there were no further revisions or reoperations. Postoperatively, the mean cup inclination improved to 45 ± 2 degrees (range: 41 to 48), and the mean anteversion improved to 20 ± 2 degrees (range: 17 to 23). All cups were well-positioned utilizing fluoroscopic guidance. The mean effective head size increased from 32 mm to 44 mm. The mean hip disability and osteoarthritis disability score (HOOS, Jr) was 73 ± 25% (range: 40 to 100).ConclusionRefractory hip instability in THA may be effectively managed with an MDM articulation, even when prior attempts at surgical stabilization have failed. Intraoperative imaging and a direct anterior approach may aid the challenges of implant positioning and achieving hip stability in a revision setting.

Dynamic stabilization home exercise program for treatment of thumb carpometacarpal osteoarthritis: A prospective randomized control trial

Study DesignRandomized control trial. IntroductionThumb carpometacarpal (CMC) osteoarthritis (OA) is a common cause of hand pain and disability. Standard conservative therapy (SCT) for thumb CMC OA includes an orthosis and instruction in joint protection, adaptive equipment, and pain relieving modalities. The dynamic stability home exercise (HE) program is complementary conservative therapy designed to strengthen the stabilizing muscles of the thumb CMC. Purpose of the StudyTo investigate whether the addition of HE to SCT (SCT+HE) was more effective at reducing pain and disability in thumb CMC OA compared to SCT alone. MethodsThe study compared 2 groups: SCT and SCT+HE. The SCT group received SCT with in-home pain management instructions, joint protection strategies with adaptive equipment, and a hand-based thumb-spica orthosis. The SCT+HE group received HE program instructions for adductor stretching and opponens and first dorsal interosseous strengthening in addition to SCT. Our primary outcome measure was the numerical rating scale (NRS) with secondary outcome measures of QuickDASH (shortened Disabilities of the Arm, Shoulder and Hand questionnaire), range of motion, grip strength, and pinch strength. Outcome measurements were assessed at first visit, 6 weeks, and 6 months. ResultsThere was no statistical difference between the 2 groups for NRS and QuickDASH at 6 weeks (P = .28 and P = .36, respectively) or 6 months (P = .52 and P = .97, respectively). However, there was a statistically significant decrease in NRS and QuickDASH scores at 6 weeks and 6 months within both groups. ConclusionsBoth SCT and SCT+HE are effective at reducing pain and disability in OA of the thumb CMC joint. Neither therapy program was superior to the other at improving NRS or QuickDASH scores at 6-week or 6-month follow-up.

Vitamin D and Osteoarthritis: An Updated Clinical Summary and Review

BACKGROUND: Osteoarthritis remains the most widespread disabling musculoskeletal condition affecting the wellbeing of many older adults. AIM: This work aimed to update and document findings published in the English language concerning what is known about vitamin D and osteoarthritis disease manifestations and progression, an area of research that has produced confusing results. QUESTIONS: Specifically examined were: (1) Whether the presence of inadequate serum vitamin D levels predisposes an older adult to more profound osteoarthritis disability than adequate levels; and (2) Whether applying vitamin D as a supplement to older adults with osteoarthritis and coexisting vitamin D deficiencies is likely to ameliorate osteoarthritis disability in some way. METHODS: To achieve the current aims, all relevant English language research reports published in the last 40 years, with an emphasis on data from January 1, 2018 up until January 16 2021, and located in the major data bases of PUBMED, Scopus, and Web of Science, were sought. A narrative depiction and synthesis of the key points that emerged from this diverse body of literature was then undertaken. RESULTS: Findings showed that regardless of study type, a vitamin D deficit that may prevail in a fair proportion of older osteoarthritis cases may produce less than favorable results if the deficiency is not compensated for. However, very few studies are sufficiently well-designed and a number show no uniform consensus in this regard. CONCLUSION: More well-designed research may help to more firmly establish the possible protective, reparative or aversive role of vitamin D in mediating osteoarthritis and whether supplementation is desirable in vitamin D deficient cases.

Osteoarthritis, COVID-19 Social Isolation-Impacts, and Counter Solutions

Background to the Issue Many older adults, including those already suffering from chronically painful disabling osteoarthritis of one or more joints remain more susceptible than healthy age and gender matched adults to the COVID-19 corona virus. Aims This report sought to examine what has been published in 2020 on this health condition from the perspective of the variable of widely imposed social isolation strategies designed to mitigate the spread of this highly infectious disease, and to especially keep older community dwelling adults ‘safe’ from infection. Methods Reviewed were all articles published in 2020 in PUBMED from January 1-December 24, 2020 on osteoarthritis and COVID-19 isolation impacts, plus relevant past osteoarthritis and isolation literature among older adults. The focus was on ascertaining how social isolation and distancing strategies might impact current community-dwelling adults diagnosed with osteoarthritis and whether more should be done specifically to mitigate any potentially preventable ‘socially’ induced negative health impact among this group, in spite of the laudable goals of this public health strategy. Results Older adults with osteoarthritis living in the community who are asked to self-isolate, may incur more osteoarthritis pain and disability than would otherwise be encountered if actions taken to counter this possibility are not forthcoming. Advocated over and above basic care approaches are several psychosocial strategies including the role of mobilizing various forms of social support. Conclusion Data indicate a need for concerted thoughtful and immediate attention to offset isolation, fear, and anxiety and depression effects as part of a carefully devised integrated plan of management to reduce excess osteoarthritis disability, as well as excess COVID-19 risk among otherwise free living older adults already compromised by osteoarthritis.

Nutraceutical supplements in management of pain and disability in osteoarthritis: a systematic review and meta-analysis of randomized clinical trials

This study designed to evaluate the effect of nutraceutical supplementation on pain intensity and physical function in patients with knee/hip OA. The MEDLINE, Web of Science, Cochrane Library, Scopus, EMBASE, Google Scholar, Science direct, and ProQuest in addition to SID, Magiran, and Iranmedex were searched up to March 2020. Records (n = 465) were screened via the PICOS criteria: participants were patients with hip or knee OA; intervention was different nutritional supplements; comparator was any comparator; the outcome was pain intensity (Visual analogue scale [VAS]) and physical function (Western Ontario and McMaster Universities Arthritis [WOMAC] index); study type was randomized controlled trials. The random effects model was used to pool the calculated effect sizes. The standardized mean difference (SMD) of the outcome changes was considered as the effect size. The random effects model was used to combine the effect sizes. Heterogeneity between studies was assessed by Cochran's (Q) and I2 statistics. A total of 42 RCTs were involved in the meta-analysis. Nutritional supplementation were found to improve total WOMAC index (SMD = − 0.23, 95% CI − 0.37 to − 0.08), WOMAC pain (SMD = − 0.36, 95% CI − 0.62 to − 0.10) and WOMAC stiffness (SMD = − 0.47, 95% CI − 0.71 to − 0.23) subscales and VAS (SMD = − 0.79, 95% CI − 1.05 to − 0.05). Results of subgroup analysis according to the supplementation duration showed that the pooled effect size in studies with < 10 months, 10–20 months and > 20 months supplementation duration were 0.05, 0.27, and 0.36, respectively for WOMAC total score, 0.14, 0.55 and 0.05, respectively for WOAMC pain subscale, 0.59, 0.47 and 0.41, respectively for WOMAC stiffness subscale, 0.05, 0.57 and 0.53, respectively for WOMAC physical function subscale and 0.65, 0.99 and 0.12, respectively for VAS pain. The result suggested that nutraceutical supplementation of patients with knee/hip OA may lead to an improvement in pain intensity and physical function.

COVID-19 and Osteoarthritis Disability: Possible Impact on Premature Mortality, and Excess Morbidity and Preventive Strategies

Older adults who already have chronically painful disabling osteoarthritis of one or more joints, which is the most common musculoskeletal disease affecting the older people. may also be more susceptible than healthy age and gender matched adults to infections such as COVID-19 as a result of their debilitated state and oftentimes comorbid health conditions such as diabetes, heart disease and asthma. This piece discusses this topic and offers some directives focused on disability and fatality prevention among osteoarthritis sufferers and other older adults and younger at risk adults.

Anxiety and Osteoarthritis Disability: Updated Overview and Commentary

Introduction:Osteoarthritis, a widespread highly painful often incapacitating joint disease continues to impose immense personal and societal challenges among adults of all ages, especially among older adults. In the absence of any effective cure or treatment, it has become essential to explore all correlates of this chronic disabling disease, especially those that might be preventable or modifiable. Anxiety, a potentially remediable state of mental distress - found linked to chronically disabling forms of arthritis, in various imperceptible ways, and which may have an immense bearing on the outcomes of osteoarthritis, has not received as much attention in the related literature as other topics, such as surgery.Objective:In line with previous promising work, this narrative review elected to explore the extent to which current researchers in the field are pursuing this topic, and if so, the degree to which prevailing peer-reviewed data sources support an important role for continued research in this realm, and in what regard.Methods:Primarily explored were the key databases housing relevant publications that emerged over Aug 1, 2018-Feb 26, 2020 using the keywordsOsteoarthritisandAnxiety.Using a descriptive approach, the relative progress made over the past five previous years in this regard was assessed, in addition to what joints have been studied and with what frequency, and how the degree of interest compares to other currently researched osteoarthritis themes. The potential for intervening in the osteoarthritis pain cycle by addressing anxiety was also examined.Results:Findings show a high level of current interest in this topic, and that despite the paucity of prospective studies, studies on joints other than the knee and hip joints, some equivocal conclusions, small numbers of anxiety-related studies compared to other topics, and substantive design limitations, it appears that future research in this realm is strongly indicated.Conclusion:This topic if examined further is likely to produce highly advantageous results at all stages of the osteoarthritic disease process and in the context of primary, secondary, as well as tertiary measures to ameliorate osteoarthritis pain and disability.

Identification of knee osteoarthritis disability phenotypes regarding activity limitation: a cluster analysis

BackgroundStudies have reported the subtypes of individuals with knee osteoarthritis (OA) attempting to cluster this heterogonous condition. Activity limitations are commonly used to set goals in knee OA management and better identify subgroups based on level of disability in this patient population. Therefore, the objective of this study was to identify those activity limitations which could classify the disability phenotypes of knee OA. The phenotypes were also validated by comparing impairments and participation restrictions.MethodsParticipants comprised individuals with symptomatic knee OA. They were interviewed and undertook physical examination according to a standard evaluation forms based on the International Classification of Functioning, Disability and Health (ICF) model. Cluster analysis was used to determine those activity limitations which could best classify the phenotypes of knee OA. To validate the clustered variables, comparisons and regression analysis were performed for the impairments consisting of pain intensity, passive range of motion and muscle strength, and the participation restrictions included the difficulty level of acquiring goods and services and community life.ResultsIn all, 250 participants with symptomatic knee OA were enrolled in the study. Three activity limitations identified from data distribution and literature were used as the cluster variables, included the difficulty level of maintaining a standing position, timed stair climbing and 40-m self-paced walk test. The analysis showed four phenotypes of individuals with knee OA according to the levels of disability from no to severe level of disability. All parameters of impairment and participation restrictions significantly differed among phenotypes. Subgroups with greater disability experienced worse pain intensity, limited range of motion (ROM), muscle power and participation restriction levels. The variance accounted for of the subgroups were also greater than overall participants.ConclusionThe results of this study emphasized the heterogeneous natures of knee OA. Three activity limitations identified could classify the individuals with symptomatic knee OA to homogeneous subgroups from no to severe level of disability. The management plan, based on these homogeneous subgroups of knee OA, could be designated by considering the levels of impairments and participation restrictions.

Genome-wide association study of widespread pain links LRRC3B as possible novel pain associated gene

Purpose: The hallmark clinical symptom of clinical osteoarthritis (OA) is pain, which is one of the leading causes of disability in OA. Pain not only has a physical effect on the individual, but can also impact the individual mentally and socially. Despite this high burden, there is not a lot known on the role of genetics in musculoskeletal pain. In this study, we aimed to investigate the genetic determinants of muscoskeletal pain and the way we perceive it. In order to examine this, we have performed a genome-wide association study (GWAS) using the number of self-reported pain sites, as a proxy for musculoskeletal pain. Methods: We have included 8,930 individuals (57.3% women) from the Rotterdam Study (RS) cohorts, RSI, RSII and RSII, with self-reported pain sites and genetic information available. Participants could indicate on 15 body sites if they were experiencing pain on these sites. Resulting in a score from 0-no pain at any site to 15-pain at every site. This score was used as outcome in the GWAS analysis. Genotype reference was imputed to HRC v1.1, GWAS analysis were adjusted for age and sex, in addition a sex stratified analysis was also performed. As the number of pain sites score did not have a normal distribution, top signals from the GWAS were additionally re-analyzed using a Poisson regression model. Top signals were followed up using gene expression information from GTEx database. Results: The meta-analysis GWAS results of the Rotterdam study cohorts, did not show any genome-wide significant or suggestive associations (p<1E-07) with number of pain sites. However the mean number of pain sites in women is 1.58 (SD=2.34), which is significantly higher than in men (0.84 SD=1.56, p<1E-04). Thus we performed sex stratified analysis. In the female stratified GWAS one genome-wide significant signal was associated with number of pain sites, also after Poisson regression analysis (Beta= 0.50, ppoisson=4.3*10-08) and was not associated with number of pain sites in men (beta=0.093, p=0.60). The lead variant rs1488240, with risk allele A has a MAF of 9% and is a novel pain associated variant. This variant is located near the Leucine-Rich Repeat Containing 3B (LRRC3B) gene and has a variant in high linkage disequilibrium which is a coding variant in LRRC3B ((rs35497952, r2 = 0.83, synonymous). GTEx expression data shows high expression of LRRC3B in multiple nervous system tissues. The strongest gene expression was reported in basal ganglia(n=194) and the cerebellum (n=209). No significant or suggestive signals were found in the male stratified analysis. In the female stratified analysis next to our one novel pain associated signal, we were also able to replicate 42 known pain associated variants(p<0.05). Conclusions: We have identified one novel pain associated variant, a synonymous variant in the LRRC3B gene, and nominally replicate 42 known pain associated variants. LRRC3B is highly expressed in the cerebellum and basal ganglia of the brain, which are both known to be involved in pain processing and modulation. In addition, LRRC3B has protein interactions and co-expression with IGDCC3 which is linked to functions in axon guidance, and is highly expressed in mouse nervous systems and limb development. Suggesting LRRC3B might play a role in chronic musculoskeletal pain.

Tramadol for osteoarthritis.

Tramadol for osteoarthritis.