Japanese Knee Osteoarthritis Measure Research Articles

Bone marrow lesion is associated with disability for activities of daily living in patients with early stage knee osteoarthritis.

Osteoarthritis of the knee (knee OA) induces pain, loss of mobility and diminished activities of daily living (ADL). Although an understanding of the pathophysiology of early stage knee OA has been developed, the structural changes associated with disability for ADL in early stage knee OA are still unclear. The aim of the present study was to examine magnetic resonance imaging (MRI)-detected changes associated with disability for ADL in patients with early stage knee OA. One hundred and thirty-two patients with early stage medial knee OA (Kellgren-Lawrence grade ≤ 2) who first visited the outpatient clinic at our university hospital were included. They were also examined by 3.0-Tesla knee MRI. The OA-associated structural changes were scored using the Whole-Organ Magnetic Resonance Imaging Score (WORMS), and clinical manifestations were evaluated by the Japanese Knee Osteoarthritis Measure (JKOM). Median quartile regression was used for the analysis. Cartilage lesion, subchondral bone attrition and osteophytes were observed in all patients. Bone marrow lesions (BMLs) and synovitis were observed in 60% and 55% of the patients, respectively. Subchondral cysts and ligament changes were observed in 6% and 17% of the patients, respectively. Pain severity of the patients was associated with medial cartilage lesions (coefficient 2.50, 95% confidence interval 0.61-4.40, p < 0.01). Disability for ADL of the patients was associated with BMLs in the medial side of the knee joint (0.82, 0.21-1.02, p = 0.04). BMLs in the medial side of the knee joint were associated with disability for ADL of patients with early stage medial knee OA.

Symptoms and physical findings of early knee osteoarthritis

Background: There is an increasing need on identifying symptoms and physical findings of the early knee osteoarthritis (KOA). The purpose of this study was to clarify clinical manifestation of early KOA detected by ultrasonography (US) and standard radiographs, and to characterize them for early detection of KOA. Methods: A total of 1,090 participants (2,180 knees) recruited at residential health examinations were evaluated by visual analogue scale of pain, the Japanese Knee Osteoarthritis Measure (JKOM) score as a health-related score, knee extension muscle strength, and images (US and radiographs). Among them, 663 knees with Kellgren-Lawrence Grade (KLG) 0 and 1 were divided into four groups; Group A (with no pain and echo-negative OA findings, n=192), Group B (with no pain and echo-positive OA findings, n=284), Group C (with pain and echo-negative OA findings, n=84), and Group D (with pain and echo-positive OA findings, n=103). Results: Group C and D indicated a significant higher JKOM score than Group A and B, especially in terms of disturbance of activities of daily living (ADLs) such as ascending upstairs or descending downstairs, standing up, and squatting. Group B showed significant higher subscales in disturbance of these ADLs than Group A, although Group B has no pain. Maximum knee extension muscle strength in Group C and D were weaker than Group A and B. Group D indicated the weakest knee extension muscle strength among the groups. In women, weak knee extension muscle strength was significantly correlated with pain and echo-positive OA findings. The risk factors of early KOA were woman, high BMI, and weak extension muscle strength. Conclusions: This study showed that symptoms of early KOA might be not only pain but also the disturbance of ADLs such as ascending upstairs or descending downstairs, standing up, and squatting with weak knee extension muscle strength. Pain-free knees with positive US findings, when disturbing these ADLs, might be the pre-stage of early KOA, namely super-early KOA. For not only treatment of the established KOA, but also prevention of proceeding to early KOA, strengthening of the knee extension muscle to maintain these ADLs might be recommended.

Home exercise therapy to improve muscle strength and joint flexibility effectively treats pre-radiographic knee OA in community-dwelling elderly: a randomized controlled trial

To compare the efficacy and adherence rates of two parallel home exercise therapy programs—multiple exercise (training and stretching the knee and hip muscles) and control (training the quadriceps muscles)—on knee pain, physical function, and knee extension strength in community-dwelling elderly individuals with pre-radiographic knee osteoarthritis (OA). One hundred patients with medial knee pain were randomly allocated to one of two 4-week home exercise programs. Individuals with a Kellgren/Lawrence (K/L) grade 0 or 1 OA (pre-radiographic knee OA) in the medial compartment were enrolled. Primary outcomes were knee pain (visual analog scale), self-reported physical function (Japanese Knee Osteoarthritis Measure [JKOM]), and isometric maximum muscle strength of the knee extensor measured using a hand-held dynamometer. A total of 52 patients (28 [53.8%] in the multiple exercise group, 24 [46.2%] in the control group) completed the trial. The JKOM activities of daily living and general health conditions outcomes improved significantly in the multiple exercise group compared to the control group (JKOM activities of daily living, beta = − 0.76; 95% confidence interval [CI], − 1.39 to − 0.13; p = 0.01; JKOM general health conditions, beta = − 0.25; 95% CI, − 0.48 to − 0.01; p = 0.03). The home exercise compliance rates of the multiple exercise and control groups were 96.6 and 100%, respectively. When targeting pre-radiographic knee OA in community-dwelling elderly, it is important to implement home exercise programs that aim to improve muscle strength and joint flexibility rather than knee extension muscle power only.

Interaction between low back pain and knee pain contributes to disability level in individuals with knee osteoarthritis: a cross-sectional study

To test the hypothesis that the interaction between low back pain (LBP) and knee pain intensity contributes to the disability level of individuals with knee osteoarthritis (OA). Community-dwelling participants with knee OA (Kellgren/Lawrence [K/L] grade ≥1) were enrolled. LBP and its severity were identified using questionnaires. Knee pain severity and disability level were evaluated using the Japanese Knee Osteoarthritis Measure (JKOM) subscale. Multiple linear regression analyses were performed to examine the effect of the LBP-knee pain interaction, an independent variable, on disability, a dependent variable. A total of 260 participants (age, 48-88 years; 77.7% women) were included. Of them, 151 (58.1%) had LBP. The LBP-knee pain interaction was significantly associated with disability after the adjustment for covariates. A post-hoc subgroup analysis revealed that the relationship between knee pain intensity and disability level was higher in individuals with LBP (beta: 0.621 points; 95% confidence interval [CI]: 0.511 to 0.731 points) than in those without LBP (beta: 0.402 points; 95% CI: 0.316 to 0.487 points). LBP interacts with knee pain intensity and contributes to disability level in individuals with knee OA. Coexisting LBP and knee pain had a stronger impact on disability level than LBP or knee pain alone. These findings highlight the potential deteriorative effects of the LBP-knee interaction on disability. Maximal treatment effects for disability might be achieved when LBP and knee pain are targeted simultaneously, rather than separately.

Daily Oral Chondroitin Sulfate Oligosaccharides for Knee Joint Pain in Healthy Subjects: A Randomized, Blinded, Placebo-Controlled Study

Background: The increased rate of population aging in Japan has led to an increase in the incidence of osteoarthritis (OA). Chondroitin sulfate has been reported to reduce the pain and swelling associated with OA and to improve knee function. Objective: We evaluated the safety and effects of oral chondroitin sulfate oligosaccharides on knee function in a randomized, double-blinded, placebo-controlled parallel group comparison study of healthy Japanese subjects with knee joint pain. Methods: Subjects were randomly divided into test and placebo groups and given either active-test capsules containing 100 mg of chondroitin sulfate oligosaccharides or placebo capsules daily for 8 weeks. The Japanese Knee Osteoarthritis Measure (JKOM), Visual Analog Scale (VAS), blood and physical examinations, and medical interviews were performed at weeks 0, 4, and 8, and the locomotive syndrome risk test was performed at weeks 0 and 8 during the test intake period. Results: The JKOM scores did not significantly differ between the test groups. However, among subjects with worse VAS scores, those in the active test group had significantly lower JKOM scores at 8 weeks, compared to those in the placebo group. Moreover, chondroitin sulfate oligosaccharide treatment tended to improve the subjects' scores on the stand-up test, which evaluates the risk of locomotive syndrome. Furthermore, no abnormal changes or severe adverse events were observed during physical or blood examinations or medical interviews. Conclusion: Our results suggest that chondroitin sulfate oligosaccharides improve knee pain and are safe for 8-week intake.

Psychological health is associated with knee pain and physical function in patients with knee osteoarthritis: an exploratory cross-sectional study

BackgroundDepressive symptoms are a major comorbidity in older adults with knee osteoarthritis (OA). However, the type of activity-induced knee pain associated with depression has not been examined. Furthermore, there is conflicting evidence regarding the association between depression and performance-based physical function. This study aimed to examine (i) the association between depressive symptoms and knee pain intensity, particularly task-specific knee pain during daily living, and (ii) the association between depressive symptoms and performance-based physical function, while considering other potential risk factors, including bilateral knee pain and ambulatory physical activity.MethodsPatients in orthopaedic clinics (n = 95; age, 61–91 years; 67.4% female) who were diagnosed with radiographic knee OA (Kellgren/Lawrence [K/L] grade ≥ 1) underwent evaluation of psychological health using the Geriatric Depression Scale (GDS). Knee pain and physical function were assessed using the Japanese Knee Osteoarthritis Measure (JKOM), 10-m walk, timed up and go (TUG), and five-repetition chair stand tests.ResultsOrdinal logistic regression analysis showed that depression, defined as a GDS score ≥ 5 points, was significantly associated with a worse score on the JKOM pain-subcategory and a higher level of task-specific knee pain intensity during daily living, after being adjusted for age, sex, body mass index (BMI), K/L grade, and ambulatory physical activity. Furthermore, depression was significantly associated with a slower gait velocity and a longer TUG time, after adjusting for age, sex, BMI, K/L grade, presence of bilateral knee pain, and ambulatory physical activity.ConclusionsThese findings indicate that depression may be associated with increased knee pain intensity during daily living in a non-task-specific manner and is associated with functional limitation in patients with knee OA, even after controlling for covariates, including bilateral knee pain and ambulatory physical activity.

Effects of glucosamine in patients with osteoarthritis of the knee: a systematic review and meta-analysis

Osteoarthritis (OA) of the knee is one of the main causes of mobility decline in the elderly. Non-surgical treatments such as administration of supplements to strengthen the joint cartilage matrix have become popular not only for pain relief but also for joint preservation. Glucosamine has been used in many countries based on the increasing evidence of its effectiveness for OA. Although there are many previous studies and systematic reviews, the findings vary and different conclusions have been drawn. We aimed to review recent randomized controlled trials on glucosamine for knee OA to reveal up-to-date findings about this supplement. We also performed a meta-analysis of some of the outcomes to overcome the unsolved bias in each study. Eighteen articles written between 2003 and 2016 were analyzed. Many used visual analogue scale (VAS) pain scores and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), which were assessed in our meta-analysis. We found a marginally favorable effect of glucosamine on VAS pain scores. The effect on knee function, as measured by the WOMAC, was small and not significant. A newly established knee OA scale, the Japanese Knee Osteoarthritis Measure (JKOM), is commonly used in Japan. Although the number of subjects was small, the JKOM meta-analysis indicated that glucosamine is superior to a placebo in alleviating knee OA symptoms. Given this, we concluded that glucosamine has the potential to alleviate knee OA pain. Further studies are needed to evaluate the effect of glucosamine on knee function and joint preservation, as well as to evaluate the combined effect with other components, such as chondroitin.

Effects of Psidium guajava Linn. leaf extract in Japanese subjects with knee pain: a randomized, double-blind, placebo-controlled, parallel pilot study.

The extract of Psidium guajava Linn. (guava) leaf was recently revealed to suppress the advance of osteoarthritis (OA) in rat anterior cruciate ligament-transection models. To investigate the efficacy of guava leaf extract in improving knee pain, which is a common symptom of OA, we conducted a double-blind parallel pilot clinical study in Japanese subjects with knee pain. The subjects, who had no medical history of knee treatment, were randomly assigned to two groups with similar total Japanese Knee Osteoarthritis Measure (JKOM) scores. During the 12-week intake period, the subjects in each group ingested 1g of guava leaf extract (the guava group) or placebo (the placebo group) daily. At week 12, pain and stiffness in knees (one subcategory of JKOM score) in the guava group was significantly lower than that in the placebo group. Using the visual analogue scale (VAS) for knee pain, a significant association between treatment effect and test period was shown, and the guava group had a lower VAS score at week 12 than the placebo group. In conclusion, continuous intake of guava leaf extract might relieve knee pain, suggesting a potential preventive effect against OA symptoms.

Pain reduction after high tibial osteotomy was associated with reduction of histological synovitis in patients with knee osteoarthritis – a longitudinal study

Purpose: Pain is the most prominent and disabling symptom of knee osteoarthritis (OA). The pain in knee OA is considered to be involved in a type of nociceptive pain. It has been speculated that detrimental mechanical loading across the joint and inflammation, especially synovitis, may be the main factors associated with the severity of pain in knee OA. In our previous study we reported that the synovitis, which was evaluated by both histological analysis and enhanced-MRI, was correlated with both the pain severity and the disability for activity of daily living (ADL) in patients with end-stage knee OA (Clinical Rheum 2011). We also reported that the subchondral bone changes detected by MRI were correlated with histological synovitis in patients with end-stage knee OA (Osteoarthritis Cartilage 2015). However, it is still remains unclear whether pain reduction due to any treatment is associated with reduction of synovitis in patients with knee OA. The aim of this longitudinal study was to examine whether pain reduction due to high tibial osteotomy (HTO) was associated with reduction of synovitis in patients with knee OA. Methods: Fourteen patients who fulfilled the American College of Rheumatology criteria for knee OA and underwent HTO due to advanced- to end-stage knee OA with Kellgren and Lawrence grade of 3 or 4 were enrolled in this study. The operation was performed by the single surgeon (MI) with same material and procedure. The radiological assessment was conducted before HTO and implant removal using whole-leg standing radiographs. On the radiographs, the femoro-tibial angle (FTA) and the mechanical axis percent [MA%; defined as the percentage in which the mechanical axis (Mikulicz line: the weight-bearing line from the center of femoral head to the center of ankle) bisects the total width of the tibial plateau] were measured preoperatively. The synovial samples were obtained during the operation from five regions of interest (ROIs). The 5-μm paraffin sections of the samples were cut and stained with hematoxylin and eosin for microscopic analysis. Six inflammatory parameters described below were studied under ×200 of magnification. Six histological parameters were: (1) the thickness of synovial lining layer, (2) sub-synovial infiltration by lymphocytes and plasma cells, (3) surface fibrin deposition, (4) blood vessel vasodilation and blood vessel proliferation, (5) fibrosis, and (6) perivascular edema. The parameters were graded as follows: 0 = none; 1 = mild; 2 = moderate; 3 = severe. Grade 0 corresponded to normal synovial tissue and grade 3 to the most severe pattern observed in OA samples. The average of the six histological parameters was calculated to give a mean total composite score for the patient. The clinical manifestations were evaluated by the visual analog scale (VAS; 0-100) for pain and the Japanese Knee Osteoarthritis Measure (JKOM) score. The significance of the differences in reduction due to HTO was evaluated using the paired t test. A P value <0.05 was considered to be statistically significant. Results: The average age of the patients at the time of HTO was 62.4±8.2 years of age. The implant removal was performed at 17.5±5.0 months after HTO. In radiographic evaluation, eleven of fourteen patients showed K/L grade of 4 of knee OA and the remaining three patients showed K/L grade of 3. As FTA of the patients was changed from 184.2±4.9° at the time of HTO to 173.5±3.6° at the time of implant removal, it was significantly changed by HTO (P<0.01). Similarly, %MA of the patients was changed from 8.2±21.5 % at the time of HTO to 54.8±18.8 % at the time of implant removal, it was also significantly changed by HTO (P<0.01). As pain VAS of the patients was changed from 44.8 at the time of operation to 19.3 at the time of implant removal, it was significantly reduced by HTO (P<0.05). In histological analysis, the sub-synovial infiltration of the synovium of the patients at the time of implant removal (0.17±0.08) was significantly decreased than that at the time of HTO (0.27±0.10, P<0.05). Similarly, the edema of the synovium of the patients at the time of implant removal (0.28±0.12) was significantly decreased than that at the time of HTO (0.37±0.12, P<0.05). The mean total composite score of the synovium of the patients at the time of implant removal (0.23±0.07) was significantly decreased than that at the time of HTO (0.28±0.07, P<0.05). However, no significant differences of the other histological parameters of the synovium of the patients at the time of implant removal were observed in comparison to those at the time of HTO. Conclusions: Pain reduction due to HTO was associated with the reduction of synovitis in patients with knee OA.

Serum hyaluronan levels are associated with disability for activity of daily living in patients with knee osteoarthritis regardless of the radiographic severity of the disease

Purpose: Osteoarthritis (OA) is an age-related progressive joint disease, which is primarily characterized by cartilage degradation. OA of the knee is one of the major causes of morbidity and disability for activity of daily living (ADL) especially for elderly. Although plain radiographs are commonly used to detect OA in the clinical practice, it is hard to detect the essentials of the disease using plain radiographs. Biomarkers have characteristics which can be objectively measured and evaluated as indicators of normal biological processes, pathogenic processes, or pharmacologic responses to therapeutic interventions. Biomarkers have been developed to aid for diagnosing early-stage knee OA, predicting OA progression, and assessing therapeutic response. The availability of biomarkers, in addition to imaging technologies, e.g. magnetic resonance imaging (MRI), could dramatically improve diagnosis and treatment of OA. Hyaluronic acid and interleukin-6 in serum (sHA and sIL-6, respectively) are the potential candidates for biomarkers in knee OA. sHA was shown to be associated with pain of the patients with knee OA. sHA and sIL-6 were also shown to be predictors for the radiographic progression of knee OA. We also reported that sHA levels were associated with the severity of knee OA (BMC Musculoskelet Disord 2013) and sIL-6 levels were associated with pain (Osteoarthritis Cartilage 2013) and depressive state (Clin Rheum 2017) of the patients with knee OA. However, it has not been examined that whether sHA and sIL-6 were associated with disability for ADL in patients with knee OA. In this study, we examined the associations between sHA as well as sIL-6 levels and disability for ADL in patients with knee OA. Methods: One-hundred and fifteen postmenopausal women who attended our clinic with a main complaint of knee pain, showed radiographic knee OA (Kellgren-Lawrence [K/L] grade ≥2) and provided informed consent to participate in this study were enrolled. Patients with a history of hepatic diseases were excluded. The subjects were divided into two groups according to the radiographic severity of the disease: early stage group (K/L grade 2) and advanced stage group (K/L grades 3/4). Correlations between the subcategory of ADL of the Japanese Knee Osteoarthritis Measure (JKOM) or pain visual analog scale (VAS) and sHA or sIL-6 were calculated using Pearson's correlation coefficient. Results: When all the patients (early- and advanced-groups) were included, ADL was correlated with pain VAS of the patients (r = 0.58, P < 0.01). sHA was correlated with sIL-6 of all the patients (r = 0.26, P = 0.01). Disability of ADL was correlated with both sHA (r = 0.31, P < 0.01) and sIL-6 (r = 0.33, P < 0.01) of all the patients. Pain VAS was also correlated with both sHA (r = 0.26, P < 0.01) and sIL-6 (r = 0.25, P = 0.01) of all the patients. In the early stage knee OA group, ADL was also correlated with pain VAS of the patients (r = 0.53, P < 0.01). However, sHA was not correlated with sIL-6 of the early stage knee OA patients (r = 0.08, P = 0.56). Disability of ADL was correlated with both sHA (r = 0.50, P < 0.01) and sIL-6 (r = 0.30, P = 0.03) of the early stage knee OA patients. Pain VAS was correlated with sIL-6 (r = 0.31, P = 0.02) of the early stage knee OA patients, while it was not correlated with sHA (r = 0.27, P = 0.06). In the advanced stage knee OA group, ADL was also correlated with pain VAS of the patients (r = 0.64, P < 0.01). sHA was correlated with sIL-6 of the advanced knee OA patients (r = 0.31, P = 0.01). Disability of ADL was correlated with sHA of the advanced knee OA patients (r = 0.32, P = 0.01), while it was not correlated with sIL-6 (r = 0.20, P = 0.12). Pain VAS was also correlated with sHA (r = 0.31, P = 0.01), but not with sIL-6 (r = 0.19, P = 0.14), of the advanced knee OA patients. Conclusions: sHA is considered to be associated with synovitis in patients with knee OA. In our previous study, synovitis detected by the non-enhanced MRI was associated with both disability of ADL and subchondral bone pathologies detected by MRI of the patients with end stage knee OA (Osteoarthritis Cartilage 2015). Although further study is needed, the association between sHA, synovitis and subchondral bone pathologies detected by MRI is suggested in patients with knee OA.In conclusion, sHA was correlated with disability of ADL in patients with knee OA regardless of the radiographic severity of the disease.

Radiographic assessment and clinical outcomes after total knee arthroplasty using an accelerometer-based portable navigation device.

It has been reported that an accelerometer-based portable navigation device can achieve accurate bone cuts, but there have been few studies of clinical outcomes after total knee arthroplasty (TKA) using such a device. The aim of this study was to evaluate lower limb alignment and clinical outcomes after TKA using an accelerometer-based portable navigation device. Thirty-five patients (40 knees) underwent primary TKAs using an accelerometer-based portable navigation device. Postoperative radiographic assessments included the hip-knee-ankle angle, femoral component angle (FCA), and tibial component angle (TCA) in the coronal plane and the sagittal FCA and sagittal TCA in the sagittal plane. Clinical outcomes were evaluated by the Japanese Orthopedic Association score for osteoarthritic knees, Japanese Knee Osteoarthritis Measure, and the New Knee Society Score. The frequency of outliers (>3 degrees) was 10% for the hip-knee-ankle angle, 8% for FCA, 0% for TCA, 19% for sagittal FCA, and 9% for sagittal TCA. The Japanese Orthopedic Association score and Japanese Knee Osteoarthritis Measure were significantly improved postoperatively. The postoperative New Knee Society Score was 67.2% for symptoms, 50.3% for satisfaction, 58.6% for expectation, and 44.1% for function. TKA using an accelerometer-based portable navigation device achieved good results for both lower limb alignment and clinical outcomes.

Clinical results following intra-articular injection of adipose-derived stromal vascular fraction cells in patients with osteoarthritis of the knee.

BackgroundThe purpose of this study was to evaluate the clinical results following intra-articular knee injection of Stromal Vascular Fraction (SVF cell therapy).MethodsThis study involved 13 consecutive patients who had received SVF cell therapy at our clinic before November 2015 and completed the 6-month post-treatment follow-up period. For each treatment, approximately 200 mL or more of subcutaneous adipose tissue was harvested using tumescent liposuction technique and manual aspiration of tissue from the lower abdomen using a suction cannula under local anesthesia in the operating room. The adipose tissue harvested was processed using the Celution Centrifuge IV in the cell processing room of our clinic. These cells were injected into the articular cavity of both knees directly. Outcome was assessed on the basis of patient questionnaires using VAS for pain, the Japanese Knee Osteoarthritis Measure (JKOM), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC).ResultsThe 13 patients (26 knee joints), consisting of 2 men and 11 women, had a mean age of 74.5 ± 5.4 years. Eleven patients (9 women, 2 men) presented Grade IV knee OA according to the KL classification. The remaining two patients, both women, had Grade III. Pre-operative scores of JKOM, WOMAC, VAS, and BS-POP (for patients) were 55.9 ± 21.0, 49.6 ± 20.4, 72.7 ± 18.2, and 18.5 ± 2.0. No serious adverse events were reported. One month after injection of SVF, all the scores of JKOM, WOMAC, and VAS were significantly improved over baseline (P < 0.01). Ultimately, the scores were improved by an average of 35% over baseline for JKOM, 32% improvement in WOMAC, and 40% for pain (VAS).ConclusionsOur approach is unique in that it occurred within the context of the recently enacted Japanese Regenerative Medicine Safety Act which is the first in the world.

Efficacy and safety of a compound supplement containing glucosamine, chondroitin, and five bioactive ingredients in volunteers with knee joint pain

Abstract Purpose This study was designed to evaluate the efficacy and safety of a compound supplement containing glucosamine (GS), chondroitin sulfate (CS), and five bioactive ingredients for improvement of knee osteoarthritis (OA). Methods Sixteen volunteers aged ≥40 years with knee pain and without ambulant treatment participated in a 6-week randomized, double-blind, placebo-controlled study. They were assigned to the dietary supplement or placebo groups (n = 8, respectively) and ingested six capsules twice daily. The OA symptoms of each subject were determined in pre- and post-treatment periods using a visual analog scale for pain (VAS pain) and four Japanese Knee Osteoarthritis Measure (JKOM) subscales (joint stiffness, daily living, social activities, and general health condition). For safety and biomarker assessments, blood and urine samples were tested. Results In the treatment group, the subjective symptoms of VAS pain and three JKOM subscale scores except for social activities were significantly improved compared to pre-treatment. Among them, the pattern of change in joint stiffness and total JKOM scores showed a significant difference between groups (p = 0.008 and 0.041, respectively). The serum level of interleukin-6, a systemic inflammation biomarker, was significantly decreased in the treatment group after 6 weeks (p = 0.019), whereas the level remained stable in the placebo group (p = 0.690). Diagnostic urine and hematological parameters revealed no serious adverse differences following dietary supplementation over the 6-week study. Conclusion These findings suggest that the compound supplementation of functional food ingredients has potential as an adjunctive and safe therapy for knee OA.

Association of bilateral flat feet with knee pain and disability in patients with knee osteoarthritis: A cross-sectional study.

This cross-sectional study examined the relationship of flat feet with knee pain, disability, and physical performance in patients with knee osteoarthritis (OA). Orthopedic clinic participants (n = 95; age 61-91 years; 68.4% women) with Kellgren-Lawrence (K/L) grade ≥1 in the medial compartment underwent evaluation of navicular height and foot length for flat feet. Knee pain intensity, disability, and physical performance were evaluated using the Japanese Knee Osteoarthritis Measure, 10-m walk, timed up and go, and five-repetition chair stand tests. Of the 95 enrolled patients, 24 (25.3%) had bilateral flat feet, and significantly higher knee pain compared to patients with no flat feet (11.3 ± 8.23 points vs. 6.58 ± 6.37 points; p = 0.043). A ordinal logistic regression analysis showed that bilateral flat feet were significantly associated with increased knee pain (proportional odds ratio: 5.48, 95% confidence interval: 1.96, 15.3; p = 0.001) compared with no flat feet, adjusted for age, sex, body mass index, and tibiofemoral joint K/L grade, which is consistent across various different cutoffs of the definition of flat feet. Physical performance was similar between patients with and without bilateral flat feet. The presence of unilateral flat feet was not significantly associated with any outcome measures. These findings indicate that bilateral, but not unilateral, flat feet are associated with worse knee pain. A prospective study investigating a causal relationship between bilateral flat feet posture and knee pain as well as disability would be of particular interest to verify the potential adverse effect of altered foot posture. © 2017 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 35:2490-2498, 2017.

Changes in clinical symptoms and functional disability in patients with coexisting patellofemoral and tibiofemoral osteoarthritis: a 1-year prospective cohort study

BackgroundThis 1-year prospective cohort study aimed to compare the changes in clinical symptoms and functional disability between patients with coexisting patellofemoral (PF) and tibiofemoral (TF) osteoarthritis (OA) and those with isolated TFOA.MethodsSeventy-two patients with medial knee OA were enrolled. Knee pain and functional disability were assessed at baseline and at 1-year follow-up using the Japanese Knee Osteoarthritis Measure (JKOM) and a visual analog scale (VAS). We performed two-way analysis of covariance for the clinical outcome variables to examine, time (baseline and follow-up), group (coexisting PFOA and isolated TFOA), and time-group interaction effects. Furthermore, we conducted post-hoc exploratory analysis to address the possibility that dividing patients according to location of PFOA (i.e., isolated lateral, isolated medial, and mixed [bilateral]) may identify a distinct subgroup with different changes in clinical outcomes at 1-year follow-up.ResultsWe detected group effects only in scores of the JKOM pain subscale (P = 0.012) and VAS (P = 0.033), adjusted for age, sex, and body mass index. Patients with coexisting PFOA have stable moderate level knee pain and functional disability throughout the year which is significantly worse than that in those with isolated TFOA. Post-hoc subgroup analysis demonstrated that change of knee pain likely varied with location of PFOA. Patients with isolated lateral PFOA had mild/moderate level knee pain, and their VAS scores were likely to improve, whereas those with mixed PFOA exhibited stable to worsening moderate/severe knee pain.ConclusionsAlthough we did not detect differences in changes in clinical symptoms and functional disability between patients with coexisting PFOA and those with isolated TFOA, our findings indicate that patients with coexisting PFOA had worse clinical symptoms and functional disability than those with isolated TFOA. The results of the exploratory analysis suggested that patients with coexisting PFOA might have heterogeneous clinical outcomes, and presence of mixed PFOA might be an indicator of severe clinical knee OA.

Clinical Validation of Pain Management Manipulative Therapy for Knee Osteoarthritis With the Squeeze-Hold Technique: A Case Series

ObjectiveThe purpose of this case series was to describe the short-term and long-term clinical effects of a manual technique for treating osteoarthritis (OA) knee pain. MethodsThis study measured of the immediate effect and long-term effect by using a case series of different groups of subjects. Knee OA and activity restriction in patients were evaluated by using the Kellgren-Lawrence (K/L) Grading Scale and the Japanese Knee Osteoarthritis Measure (JKOM) index. In the intervention, lower limb muscles were squeezed by hand for 20 seconds. Each squeeze was performed for both lower limbs. Passive range-of-motion (ROM) exercise was performed on the knee joint. In one set of cases, immediate effects were measured after a one-time treatment with pretreatment and posttreatment outcome measures. Eleven people with knee OA participated in the study. On a visual analogue scale (VAS) for pain, muscle stiffness, and muscular hemodynamics for estimation of muscle blood flow were recorded before and after the squeeze-hold treatment. In another set of cases, the treatment was given to all patients once a week for 6 months, and long-term effects were measured. Data on 5 subjects with knee OA were collected for 6 months after initial treatment. The VAS for pain and JKOM were recorded every month for 6 months. ResultsFor immediate effects, the VAS was 69 ± 21 mm before treatment and 26 ± 22 mm after treatment. Muscle stiffness was 8.8 ± 3.6 (absolute number) before treatment and 3.5 ± 2.1 after treatment. Tissue (muscle) oxygen saturation was 60.1 ± 5.7% before treatment and 65.3 ± 4.8% after treatment. Total hemoglobin was 24.3 ± 3.3 (absolute number) before treatment and 25 ± 2.3 after treatment. A tendency for reduction in OA knee pain and muscle stiffness was observed, and a tendency for increase was observed in the blood flow in the muscle. For long-term effects in all 5 participants (any K/L grade, any JKOM score), OA knee pain and JKOM score improved gradually through 6 months. ConclusionsThe participants in this case series showed improvement in pain and function. These findings indicate the feasibility of a larger study on the squeeze-hold intervention for OA knee pain.

Relationship Between Pedometer-Based Physical Activity and Physical Function in Patients With Osteoarthritis of the Knee: A Cross-Sectional Study

ObjectiveTo examine the association between pedometer-based ambulatory physical activity (PA) and physical function in patients with knee osteoarthritis (OA). DesignCross-sectional observational study. SettingInstitutional practice. ParticipantsParticipants in orthopedic clinics (N=207; age, 56–90y; 71.5% women) with diagnosed radiographic knee OA (Kellgren/Lawrence [K/L] grade ≥1). InterventionsNot applicable. Main Outcome MeasuresAmbulatory PA was objectively measured as steps per day. Physical function was assessed using the Japanese Knee Osteoarthritis Measure (JKOM) functional subcategory, 10-m walk, Timed Up and Go (TUG), and 5-repetition chair stand (5CS) tests. ResultsPatients walking <2500 steps/d had a low level of physical function with a slower gait speed, longer TUG time, and worse JKOM functional score compared with those who walk 2500 to 4999, 5000 to 7499, and ≥7500 steps/d adjusted for age, sex, body mass index [BMI], and K/L grade. Ordinal logistic regression analysis revealed that steps per day (continuous) was associated with better physical function adjusted for age, sex, BMI, and K/L grade. These relationships were still robust in sensitivity analyses that included patients with K/L grades ≥2 (n=140). ConclusionsAlthough increased ambulatory PA had a positive relationship with better physical function, walking <2500 steps/d may be a simple indicator for a decrease in physical function in patients with knee OA among standard PA categories. Our findings might be a basis for counseling patients with knee OA about their ambulatory PA and for developing better strategies for improving physical function in sedentary patients with knee OA.

Relationship between biological factors and catastrophizing and clinical outcomes for female patients with knee osteoarthritis.

AIMTo investigate the correlations between clinical outcomes and biopsychological variables in female patients with knee osteoarthritis (OA).METHODSSeventy-seven patients with symptomatic knee OA were enrolled in this study. We investigated the age, body mass index (BMI), pain catastrophizing scale (PCS) and radiographic severity of bilateral knees using a Kellgren-Lawrence (K-L) grading system of the subjects. Subsequently, a multiple linear regression was conducted to determine which variables best correlated with main outcomes of knee OA, which were pain severity, moving capacity by measuring timed-up-and-go test and Japanese Knee Osteoarthritis Measure (JKOM).RESULTSWe found that the significant contributor to pain severity was PCS (β = 0.555) and BMI (β = 0.239), to moving capacity was K-L grade (β = 0.520) and to PCS (β = 0.313), and to a JKOM score was PCS (β = 0.485) and K-L grade (β = 0.421), respectively.CONCLUSIONThe results suggest that pain catastrophizing as well as biological factors were associated with clinical outcomes in female patients with knee OA, irrespective of radiographic severity.

Maslinic acid improves quality of life by alleviating joint knee pain in the elderly: results from a community-based pilot study.

Chronic knee joint pain is common in the elderly and associated with poor quality of life. This study, an open-label clinical trial, aimed to examine how the intake on a daily basis of maslinic acid-containing product (30 mg maslinic acid) on 29 elderly residents (mean 70.7 ± 10.1 years) of Nakajima Island, Ehime, Japan. Study participants consumed 10 g jelly containing maslinic acid daily for 16 weeks and at 0 (baseline), 4, 8, 12 and 16 weeks, assessed for health-related quality of life (Short Form-8) and knee pain score (Japanese Knee Osteoarthritis Measure). After 16 weeks, the physical quality of life, more specifically, the level of Bodily Pain and Physical Component Summary, but not mental quality of life, was significantly improved by maslinic acid intake. Furthermore, maslinic acid intake significantly decreased the Japanese Knee Osteoarthritis Measure at week 8 and tended to decrease Visual Analogue Scale score at weeks 4 and 16. These results suggest that consumption of maslinic acid has a protective effect against chronic knee pain in elderly residents in a community where knee pain causes high quality of life burden.

The effects of licorice flavonoid oil with respect to increasing muscle mass: a randomized, double‐blind, placebo‐controlled trial

The present study evaluated the effects of licorice flavonoid oil (LFO) with respect to increasing the muscle mass of elderly populations using a randomized, double-blind, placebo-controlled study. Fifty participants aged 54-90 years (seven men, 43 women), who underwent rehabilitation treatment for osteoarthritis of the knee, were examined and assigned to either the LFO group (n = 26) or the placebo group (n = 24). The LFO group consumed 300 mg LFO day-1 , whereas the placebo group consumed one placebo capsule every day for 16 weeks. We measured muscle mass, body fat percentage and the Japanese Knee Osteoarthritis Measure score at baseline and every 4 weeks thereafter. In the LFO group, muscle mass in the body trunk increased significantly after 16 weeks of LFO intake (+0.38 kg, P = 0.02). The trunk muscle mass weight of the LFO group increased significantly compared to that of the placebo group (P < 0.01). Furthermore, the body fat percentage and body trunk fat percentage of the LFO group were significantly suppressed compared to that of the placebo group (P = 0.03 and P < 0.01, respectively). The results of the present trial indicate that LFO supplementation has effects with respect to increasing muscle mass and suppressing the body fat percentage of elderly populations, especially in the body trunk. © 2016 Society of Chemical Industry.