Knee Osteoarthritis Patients Research Articles

Comparative Effects of Pulsed Electromagnetic Field Therapy Versus Pulsed Ultrasound Therapy on the Range of Motion in Knee Osteoarthritis

This randomized controlled study compared the effectiveness of pulsed electromagnetic field (PEMF) therapy and pulsed ultrasound therapy on the range of motion in 40 knee osteoarthritis patients. Divided into two groups of 20, Group A received PEMF therapy, while Group B underwent pulsed ultrasound therapy over an 8-week period. Data analysis using SPSS version 23.0 revealed significant improvements in both groups. The ultrasound group showed an increase in the range of motion from 110.1±1.651 to 113.75±0.786 degrees (p=0.001), and the PEMF group showed an increase from 109.65±1.725 to 113.75±0.786 degrees (p=0.000). Both therapies were effective in improving the range of motion in patients with knee osteoarthritis. The pre and post-operatively range of motion of the US group was 109.65±1.725 degrees and 113.75±0.786 degrees respectively with a p-value of 0.000 which is significant. When assessing range of motion, both ultrasound and pulsed electromagnetic field therapy are used.

Investigating the efficacy of Commiphora mukul drops in patients with knee osteoarthritis: a randomized, double-blind, placebo-controlled clinical trial

IntroductionKnee osteoarthritis is the common joint disease and one of the major causes of pain and disability in the world. Regarding the people tendency to traditional medicine the present study was designed to survey the activity of Commiphora mukul (C. mukul) drops on knee osteoarthritis for the first time. MethodsThe present study was performed as a randomized, double-blind placebo-controlled trial with 70 patients with moderate knee osteoarthritis, which divided into two groups, drug recipients and placebo. Twenty drops were administered to the placebo group and the control group was administered 20 drops of drug twice a day for 2 months. The pain, function and clinical health scores of both groups were measured at the beginning and end of the study with Visual Analogue Scale and knee injury and osteoarthritis outcome score evaluation scales. ResultsThe intervention and control groups were similar in terms of age, gender, pain score and knee function before the intervention. Pain intensity in right and left legs was decreased and exhibited statistically significant differences before and after the intervention in both the intervention group (P<0.001) and the control group (P<0.01). Five indices of discomfort and dryness, pain, activity and daily activities, exercise and recreation and quality of life in the intervention group, improved (P<0.001) though in control group the difference between indices were not significant except exercise and recreation. Discussion/ConclusionsThe consumption of C. mukul extract for 2 months was effective in relieving the symptoms of the knee osteoarthritis in patients and improve the quality of life.

Identifying significant structural factors associated with knee pain severity in patients with osteoarthritis using machine learning

Our main objective was to use machine learning methods to identify significant structural factors associated with pain severity in knee osteoarthritis patients. Additionally, we assessed the potential of various classes of imaging data using machine learning techniques to gauge knee pain severity. The data of semi-quantitative assessments of knee radiographs, semi-quantitative assessments of knee magnetic resonance imaging (MRI), and MRI images from 567 individuals in the Osteoarthritis Initiative (OAI) were utilized to train a series of machine learning models. Models were constructed using five machine learning methods: random forests (RF), support vector machines (SVM), logistic regression (LR), decision tree (DT), and Bayesian (Bayes). Employing tenfold cross-validation, we selected the best-performing models based on the area under the curve (AUC). The study results indicate no significant difference in performance among models using different imaging data. Subsequently, we employed a convolutional neural network (CNN) to extract features from magnetic resonance imaging (MRI), and class activation mapping (CAM) was utilized to generate saliency maps, highlighting regions associated with knee pain severity. A radiologist reviewed the images, identifying specific lesions colocalized with the CAM. The review of 421 knees revealed that effusion/synovitis (30.9%) and cartilage loss (30.6%) were the most frequent abnormalities associated with pain severity. Our study suggests cartilage loss and synovitis/effusion lesions as significant structural factors affecting pain severity in patients with knee osteoarthritis. Furthermore, our study highlights the potential of machine learning for assessing knee pain severity using radiographs.

Efficacy of home-based exercise in the treatment of pain and disability at the hip and knee in patients with osteoarthritis: a systematic review and meta-analysis

BackgroundAn increasing body of evidence suggests that home-based exercise (HBE) therapy has significant therapeutic effects on knee osteoarthritis (KOA) and hip osteoarthritis (HipOA), and it has advantages such as cost savings, strong operability, and good compliance compared with hospitalization and exercise courses.ObjectiveTo evaluate the efficacy of HBE in the treatment of KOA and HipOA.MethodsA systematic search was conducted in PubMed, Cochrane, Web of Science, and Embase to collect randomized controlled trials. The retrieval time was from database establishment until March 6, 2024. Stata 15.1 software was used for data analysis.ResultsA total of 16 randomized controlled trials involving 3,015participants were included, with 1,519 participants in the intervention group and 1,496 in the control group. The meta-analysis showed that, compared to the control group, HBE can significantly improve pain [SMD=-0.38, 95% CI (-0.58, -0.18); P = 0.001], joint function [SMD=-0.60, 95% CI (-1.01, -0.19); P = 0.004], balance ability [SMD=-0.67, 95% CI (-1.00, -0.34); P = 0.001], mobility (ADL) [SMD = 0.51, 95% CI (0.19, 0.82); P = 0.002] in patients with KOA and HipOA. There is no statistical difference in the improvement of joint stiffness [WMD = -0.80, 95% CI (-1.61, 0.01); P = 0.052]. In addition, subgroup analysis showed that HBE significantly improved pain, joint function, and balance ability in KOA patients compared with the control group. HipOA patients showed significant improvement in pain and joint function; However, HBE only improved activity ability in patients with comorbidities of KOA and HipOA.ConclusionHBE can effectively alleviate pain, improve joint function, and enhance physical function in patients with KOA and HipOA. However, more high-quality randomized controlled trials (RCTs) with large sample sizes and long-term interventions are needed to validate the efficacy of HBE due to limitations in the methodology and consistency of indicator outcomes in the included RCTs.Registration numberWe’ve registered with PROSPERO, and the number is CRD42023443085.

Cross-species transcriptomics identifies obesity associated genes between human and mouse studies

BackgroundFundamentally defined by an imbalance in energy consumption and energy expenditure, obesity is a significant risk factor of several musculoskeletal conditions including osteoarthritis (OA). High-fat diets and sedentary lifestyle leads to increased adiposity resulting in systemic inflammation due to the endocrine properties of adipose tissue producing inflammatory cytokines and adipokines. We previously showed serum levels of specific adipokines are associated with biomarkers of bone remodelling and cartilage volume loss in knee OA patients. Whilst more recently we find the metabolic consequence of obesity drives the enrichment of pro-inflammatory fibroblast subsets within joint synovial tissues in obese individuals compared to those of BMI defined ‘health weight’. As such this present study identifies obesity-associated genes in OA joint tissues which are conserved across species and conditions.MethodsThe study utilised 6 publicly available bulk and single-cell transcriptomic datasets from human and mice studies downloaded from Gene Expression Omnibus (GEO). Machine learning models were employed to model and statistically test datasets for conserved gene expression profiles. Identified genes were validated in OA tissues from obese and healthy weight individuals using quantitative PCR method (N = 38). Obese and healthy-weight patients were categorised by BMI > 30 and BMI between 18 and 24.9 respectively. Informed consent was obtained from all study participants who were scheduled to undergo elective arthroplasty.ResultsPrincipal component analysis (PCA) was used to investigate the variations between classes of mouse and human data which confirmed variation between obese and healthy populations. Differential gene expression analysis filtered on adjusted p-values of p < 0.05, identified differentially expressed genes (DEGs) in mouse and human datasets. DEGs were analysed further using area under curve (AUC) which identified 12 genes. Pathway enrichment analysis suggests these genes were involved in the biosynthesis and elongation of fatty acids and the transport, oxidation, and catabolic processing of lipids. qPCR validation found the majority of genes showed a tendency to be upregulated in joint tissues from obese participants. Three validated genes, IGFBP2 (p = 0.0363), DOK6 (0.0451) and CASP1 (0.0412) were found to be significantly different in obese joint tissues compared to lean-weight joint tissues.ConclusionsThe present study has employed machine learning models across several published obesity datasets to identify obesity-associated genes which are validated in joint tissues from OA. These results suggest obesity-associated genes are conserved across conditions and may be fundamental in accelerating disease in obese individuals. Whilst further validations and additional conditions remain to be tested in this model, identifying obesity-associated genes in this way may serve as a global aid for patient stratification giving rise to the potential of targeted therapeutic interventions in such patient subpopulations.

Effect of local mud application in patients with knee osteoarthritis - A systematic review and meta-analysis.

Mud therapy is a safe, cost-effective approach for Knee Osteoarthritis (OA), promoting healing through warmth and minerals, providing pain relief, and improving function. The main objective of the current review is to assess the effectiveness of local mud application for pain management in patients with Knee OA. The published papers were obtained from PubMed, Embase, Scopus, Cochrane Library, ClinicalTrails.gov, Web of Science, and references from relevant systematic reviews from 1990 January to February 2023. Trials meeting the predefined criteria were included in this meta-analysis. The main focus of this study was to assess pain as a primary outcome measure. R software version 4.3.1 and Cochrane Risk of Bias Tool 1 were used to derive meta-analysis and risk of bias in the included studies. A meta-analysis was performed using the fixed-effects model to obtain a summary of treatment effects, which calculated the effect size (standardized mean difference; SMD) along with a 95% Confidence Interval (CI).In the current meta-analysis, a total of ten studies with 560 Knee OA patients were included. Findings demonstrated significant effects of local mud application on pain (SMD: -0.36, 95% CI: -0.56, -0.16), and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scale (SMD: -0.49, 95% CI: -0.68, -0.29) for individuals suffering from Knee OA. The current study identified compelling evidence to support the recommendation of mud application as an effective intervention for individuals with Knee OA. While local mud application may serve as a supplementary therapy alongside conventional medical approaches for improved Knee OA management, additional high-quality randomized controlled trials are required to validate these findings.

Prevalence of mental health disorders in knee osteoarthritis patients: a systematic review and meta-analysis.

Knee osteoarthritis (OA) is a prevalent degenerative disease affecting synovial joints, predominantly the knee, leading to various complications, including mental health conditions like depression and anxiety. This systematic review aimed to determine the prevalence of depression and anxiety in knee OA patients. A comprehensive literature search was conducted in various databases till September 15, 2023. Studies focusing on the prevalence of mental health issues in patients with knee OA were included, excluding narrative reviews, protocols, unpublished reports, editorials, case reports, abstracts, and commentaries. All statistical analyses were performed in R version 4.2.3. This review included a total of 14 studies involving middle-aged to elderly adult patients with knee OA, with ages ranging from 45 to 75 years. Among these, 13 studies involving 3390 adult patients with an average age of 59.75 years reported a pooled prevalence of depression of 30% (95% confidence interval: 18-43), demonstrating a substantial heterogeneity (I 2=98%). Additionally, anxiety was identified with a combined prevalence of 27% (95% confidence interval: 24-30) based on three studies that included 1407 older adult patients with an average age of 62.1 years. These studies displayed minimal heterogeneity (I 2=7%). The findings show a significant prevalence of depression among adult patients with knee OA and anxiety among older adults with knee OA, emphasizing the need for integrated healthcare approaches that address both orthopedic and mental health conditions. More comprehensive research is essential to deepen our understanding of the connection between mental illnesses and knee OA and to develop effective preventive and treatment strategies.

Unravelling relationships between obesity, diabetes, and factors related to somatosensory functioning in knee osteoarthritis patients.

This study explores the association between obesity, diabetes, and somatosensory functioning in patients with knee osteoarthritis (OA), aiming to understand how metabolic conditions are related to pain mechanisms in this patient population. We hypothesized that higher body mass index (BMI), fat mass, and glycated hemoglobin levels (HbA1c) are associated with signs of altered somatosensory functioning. A cross-sectional analysis was conducted as part of a larger multicentre prospective cohort study. Data were collected from patients awaiting total knee arthroplasty in Belgium and the Netherlands. Associations between BMI, fat mass, HbA1c, and various pain-related variables were examined employing Pearson and Spearman correlation analyses which were further analyzed with linear regression techniques. The study included 223 participants. Analysis revealed a significant although weak negative correlation between fat mass and pressure pain thresholds (PPT) at multiple locations, suggesting a link between higher fat mass and increased mechanical hyperalgesia. There were no significant correlations between BMI and pain-related outcomes. HbA1c levels showed very weak positive correlations with pain measures but did not withstand correction for multiple testing. The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA. However, no significant correlations were found between BMI or HbA1c levels and pain-related outcomes. Future research should focus on longitudinal studies to elucidate the causal relationships and further explore the impact of metabolic factors on pain mechanisms in this patient population. Key Points • The findings indicate that fat mass may be closely associated with altered somatosensory functioning in patients with knee OA.

Correlation Between Radiological Grading and Clinical Scoring in Knee Osteoarthritis Patients.

Osteoarthritis is characterized by mechanical joint abnormalities, primarily involving articular cartilage and subchondral bone degradation. Diagnosis of knee osteoarthritis relies on American College of Rheumatology criteria, and severity assessment utilizes the Western Ontario and McMaster Universities Osteoarthritis Index score and Kellgren and Lawrence grading. Despite reported associations, discrepancies persist in the correlation between Western Ontario and McMaster Universities Osteoarthritis Index and Kellgren and Lawrence grade. Descriptive cross-sectional study was conducted at the National Trauma Centre, over six months with consecutive convenience sampling. Demographic and clinico-radiological data were collected. Mean, SD and correlation coefficient was calculated. Consecutive convenient sampling yielded 80 participants meeting American College of Rheumatology criteria, aged 52-81 years, predominantly female (67.50%). Significant positive correlations were identified between age, Western Ontario and McMaster Universities Osteoarthritis Index score, and KL grade. Results showed most cases with Kellgren and Lawrence grade III and strong correlations (r=0.73, p=0.00) between total Western Ontario and McMaster Universities Osteoarthritis Index scores and Kellgren and Lawrence grading. Notably, pain, stiffness and physical functions individually exhibited a significant possitive correlation with Kellgren and Lawrence grading. The study affirms age-related influences on osteoarthritis, emphasizes female predilection, and underscores the importance of assessing both clinical and radiological parameters. In conclusion, this study supports Western Ontario and McMaster Universities Osteoarthritis Index efficacy in dynamic disease assessment and management, especially in settings where radiological examinations may be impractical, thus establishing Western Ontario and McMaster Universities Osteoarthritis Index as a versatile tool for systematic monitoring and intervention in knee osteoarthritis.

Inter-rater reliability and test-retest reliability of the foot posture index (FPI-6) for assessing static foot posture in elderly female patients with knee osteoarthritis and its association with quadriceps muscle tone and stiffness.

1. To assess the Inter-rater reliability and test-retest reliability of FPI-6 total score and individual scores in static foot posture evaluation among elderly female patients with knee osteoarthritis (KOA), aiming to establish the reliability of the FPI-6 scale. 2. To investigate the disparity between dominant and non-dominant quadriceps characteristics in elderly female KOA patients, as well as explore the correlation between quadriceps characteristics and abnormal foot posture, thereby offering novel insights for the prevention and treatment of KOA. The study enrolled a total of 80 lower legs of 40 participants (all female) with unilateral or bilateral KOA, who were assessed by two raters at three different time points. The inter-rater and test-retest reliability of the FPI-6 was evaluated using the intra-class correlation coefficient (ICC), while the absolute reliability of FPI-6 was examined using the standard error of measurement (SEM), minimum detectable change (MDC), and Bland-Altman analysis. The internal consistency of FPI-6 was assessed using Spearman's correlation coefficient. Additionally, MyotonPRO was employed to assess quadriceps muscle tone and stiffness in all participants, and the association between quadriceps muscle tone/stiffness and the total score of FPI-6 was analyzed. Our study found excellent inter-rater and test-retest reliability (ICC values of 0.923 and 0.931, respectively) for the FPI-6 total score, as well as good to excellent reliability (ICC values ranging from 0.680 to 0.863 and 0.739-0.883) for individual items. The SEM and MDC values for the total score of FPI-6 among our study inter-rater were 0.78 and 2.15, respectively. and the SEM and MDC values for the test-retest total score of FPI-6 were found to be 0.76 and 2.11, respectively. Furthermore, the SEM and MDC values between inter-rater and test-retest across six individual items ranged from 0.30 to 0.56 and from 0.84 to 1.56. The Bland-Altman plots and respective 95% LOA showed no evidence of systematic bias. In terms of the mechanical properties of the quadriceps on both sides, the muscle tone and stiffness of rectus femoris (RF), vastus medialis (VM), and vastus lateralis (VL) were significantly higher in the non-dominant leg compared to the dominant leg. Additionally, in the non-dominant leg, there was a significant positive correlation between the muscle tone and stiffness of VM, VL, RF and the total score of FPI-6. However, in the dominant leg, only VM's muscle tone and stiffness showed a significant positive correlation with the total score of FPI-6. The reliability of the FPI-6 total score and its six individual items was good to excellent. Our findings offer a straightforward and dependable approach for researchers to assess foot posture in elderly female patients with KOA. Furthermore, we observed significantly greater quadriceps tension and stiffness in the non-dominant leg compared to the dominant leg. The FPI-6 total score exhibited a significant correlation with changes in quadriceps muscle performance among KOA patients. These observations regarding the relationship between changes in quadriceps muscle performance and foot posture in elderly female KOA patients may provide novel insights for disease prevention, treatment, and rehabilitation.

Effect of Proper Use of Cane and Physical Therapy Management to Reverse Hamstrings Tightness and Abductors Weakness Due to Improper Use in Knee and Hip OA Patients

Effect of Proper Use of Cane and Physical Therapy Management to Reverse Hamstrings Tightness and Abductors Weakness Due to Improper Use in Knee and Hip OA Patients

Microfragmented abdominal adipose tissue-derived stem cells from knee osteoarthritis patients aged 29-65 years demonstrate in vitro stemness and low levels of cellular senescence.

To investigate the level of cellular senescence in stem cells derived from microfragmented abdominal adipose tissue harvested from patients with knee osteoarthritis (OA). Stem cells harvested from microfragmented abdominal adipose tissue from 20 patients with knee OA, aged 29-65 years (mean = 49.8, SD = 9.58), were analysed as a function of patient age and compared with control cells exhibiting signs of cellular senescence. Steady-state mRNA levels of a panel of genes associated with senescence were measured by qPCR. Intracellular senescence-associated proteins p16 and p21, and senescence-associated β-galactosidase activity were measured by flow cytometry. Cellular proliferation was assessed using a 5-ethynyl-2'-deoxyuridine proliferation assay. Stemness was assessed by stem cell surface markers using flow cytometry and the capacity to undergo adipogenic and osteogenic differentiation in vitro. No correlation was found between cellular senescence levels of the microfragmented adipose tissue-derived stem cells and patient age for any of the standard assays used to quantify senescence. The level of cellular senescence was generally low across all senescence-associated assays compared to the positive senescence control. Stemness was verified for all samples. An increased capacity to undergo adipogenic differentiation was shown with increasing patient age (p = 0.02). No effect of patient age was found for osteogenic differentiation. Autologous microfragmented adipose tissue-derived stem cells may be used in clinical trials of knee OA of patients aged 29-65 years, at least until passage 4, as they show stemness potential and negligible senescence in vitro. Not applicable.

Research Progress in Traditional Chinese Medicine Treatment of Knee Osteoarthritis

Knee osteoarthritis (KOA) is a degenerative disease characterized by pathological changes in the cartilage and subchondral bone of the knee joint. Initially, knee joint pain is the main symptom, and in the later stages, deformities and mobility disorders may occur. Modern medicine lacks effective treatment methods for early and mid stage KOA, and has drawbacks such as significant side effects and high costs. A large number of studies have confirmed that traditional Chinese medicine has unique advantages in treating KOA, and has obvious advantages such as small trauma, low cost, and definite therapeutic effect, which are gradually being accepted by a large number of KOA patients. The commonly used methods for preventing and treating KOA with traditional Chinese medicine in clinical practice include: oral administration of traditional Chinese medicine, external application of traditional Chinese medicine, fumigation, acupuncture therapy, massage therapy for regulating tendons, and targeted penetration therapy of traditional Chinese medicine. According to relevant literature, traditional Chinese medicine can significantly alleviate knee joint symptoms and improve knee joint function in patients with knee osteoarthritis, which is of great significance for the prevention and treatment of knee osteoarthritis. This article provides a review of the research progress in the prevention and treatment of KOA using traditional Chinese medicine in recent years.

Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis.

This systematic review and meta-analysis aims to investigate the effects of virtual reality (VR) exercise compared to traditional rehabilitation on pain, function, and muscle strength in patients with knee osteoarthritis (KOA). Additionally, the study explores the mechanisms by which VR exercise contributes to the rehabilitation of KOA patients. We systematically searched PubMed, the Cochrane Library, Embase, Web of Science, Scopus, and PEDro according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search spanned from the library construction to 24 May 2024, focusing on randomized controlled trials Primary outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and muscle strength. Meta-analysis was conducted using RevMan (version 5.4) and Stata (version 14.0). The bias risk of included studies was assessed using the Cochrane RoB 2.0 tool, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. This meta-analysis and systematic review included nine studies involving 456 KOA patients. The results indicated that VR exercise significantly improved pain scores (SMD, -1.53; 95% CI: -2.50 to -0.55; p = 0.002), WOMAC total score (MD, -14.79; 95% CI: -28.26 to -1.33; p = 0.03), WOMAC pain score (MD, -0.93; 95% CI: -1.52 to -0.34; p = 0.002), knee extensor strength (SMD, 0.51; 95% CI: 0.14 to 0.87; p = 0.006), and knee flexor strength (SMD, 0.65; 95% CI: 0.28 to 1.01; p = 0.0005), but not significantly for WOMAC stiffness (MD, -0.01; 95% CI: -1.21 to 1.19; p = 0.99) and physical function (MD, -0.35; 95% CI: -0.79 to -0.09; p = 0.12). VR exercise significantly alleviates pain, enhances muscle strength and WOMAC total score in KOA patients, but improvements in joint stiffness and physical function are not significant. However, the current number of studies is limited, necessitating further research to expand on the present findings. https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024540061, identifier CRD42024540061.

The predictors to self-reported and performance-based physical function in knee osteoarthritis patients: a cross-sectional study.

Osteoarthritis (OA) knee patients have limited ability in physical function, or difficulties with physical tasks and activities may develop disability. This study aimed to observe the predictors of self-reported and performance-based physical function in patients with knee OA by analyzing the impacts of demographic, pathological, and muscle impairment factors. 135 knee OA patients participated in this study to complete self-reported questionnaires using Knee Injury and Osteoarthritis Outcome Score (KOOS). When measuring performance-based physical function, a 6-meter gait speed (6MGS) test was measured to evaluate their mobility, and a 5-time Sit-to-Stand test (5STS) was assessed to evaluate their balance. Pain intensity, knee extensor and flexor muscle strength, age, body mass index (BMI), durations of symptoms, and radiographic severity were also collected. Spearman correlation and stepwise multiple linear regression were used to explore the association and predictors in self-reported and performance-based physical function. BMI and durations of symptoms did not indicate any significant correlation with either self-reported or performance-based physical function. Age is significantly negatively associated with 6MGS (r 2 = -0.383, p < 0.01), while knee extensor muscle strength has a moderate correlation with 5STS (r 2 = -0.528, p < 0.01). In the stepwise multiple linear regression models, pain intensity (β = 0.712, p < 0.001), knee flexor muscle strength (β = 0.112, p = 0.042) were significantly associated with self-reported physical function in daily activities and contributed to 55.0% of the variance in KOOS-PF score. Knee muscle strength, including knee extensor (5STS: β = -0.428, p < 0.001) and flexor muscle strength (6MGS: β = 0.367, p < 0.001), were the main predictors with performance-based physical function. Pain intensity was the leading risk factor of self-reported physical function, and knee flexor muscle strength contributed as well. The severity of knee OA, durations of symptoms and BMI did not contribute to physical function. However, knee extensor and flexor muscle strength were the main predictors of performance-based performance. Our results show that strengthening of weak knee muscles in both quadriceps and hamstring muscle strength should be considered a priory consideration in knee OA no matter if people are in the early or end-stage of knee OA.

Metformin as adjuvant therapy in obese knee osteoarthritis patients

AimsThis study aimed at investigating the efficacy of metformin as adjuvant therapy for obese knee osteoarthritis (OA) patients, considering its anti-inflammatory and cartilage-protective effects.Patients and methodsIn this randomized, double-blind, placebo-controlled study, 50 obese knee OA patients were assigned randomly to two groups, the metformin group (n = 25) which was treated with metformin 500 mg orally BID plus celecoxib 200 mg orally once daily, and the placebo group (n = 25) which was treated with placebo tablets BID plus celecoxib 200 mg orally once daily for 12 weeks. Cartilage Oligomeric Matrix Protein (COMP), C-terminal cross-linked telopeptide of type I collagen (CTX-1), and Interleukin 1-beta (IL-1β) serum levels were measured, while Western Ontario and McMaster Universities Arthritis Index (WOMAC) score assessed knee pain, stiffness, and physical function at baseline and after 12 weeks.ResultsFollowing a 12-week treatment, the metformin group exhibited significantly reduced levels of COMP, CTX-1, and IL-1β in the serum compared to the placebo group (p = 0.0081, p = 0.0106, and p = 0.0223, respectively). Furthermore, metformin group produced significant improvements in WOMAC total scale (p < 0.0001), specifically in knee pain, stiffness, and physical function compared to placebo group (p < 0.0001, p < 0.0001, and p < 0.0001, respectively).ConclusionMetformin as an adjuvant therapy in obese knee OA patients may have beneficial effects on cartilage degradation and inflammation, as evidenced by the significant decreases in serum COMP, CTX-1, and IL-1β levels. Additionally, metformin may improve clinical outcomes, as shown by the significant improvements in WOMAC scores.Clinicaltrials.gov IDNCT05638893/Registered December 6, 2022 — Retrospectively.

Exploring the Superior Efficacy of Hyaluronic Acid and Platelet-Rich Plasma Co-Administration Over Hyaluronic Acid Alone in Pain Reduction and Functional Status Improvement of Knee Osteoarthritis Patients

Objective: This study aimed to determine whether concurrent injection of hyaluronic acid (HA) with platelet-rich plasma (PRP) would enhance therapeutic effectiveness compared to HA alone in the management of knee osteoarthritis (OA) over a 12-month follow-up. Methodology: A prospective, comparative study was conducted in department of orthopedic Nawaz Sharif Medical College / Aziz Bhatti Shahed Hospital Gujrat from Jan 2023 To Dec 2023 on 100 patients with knee OA (Kellgren-Lawrence grades I-III). The patients were divided into two groups: Group 1, consisting of 50 patients, received intra-articular HA injections, while Group 2, comprising the remaining 50 patients, received a combination of HA and PRP. Pain and functional outcomes were assessed using the Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores at baseline, and at 2, 6, and 12-months post-injection. Results: Assessments at baseline, 2 months, 6 months, and 12 months post-injection revealed significant improvement in both groups compared to baseline. However, patients in Group 2 (HA+PRP) showed significantly greater improvement than those in Group 1 (HA alone), with WOMAC scores at 2-, 6-, and 12-months yielding p-values of 0.001*, 0.001*, and 0.000*, respectively. Conclusions: The study concluded that the combination of PRP and HA is more effective than HA alone in reducing pain and improving joint function in patients with knee OA. The findings suggest that PRP+HA offers superior benefits for managing knee osteoarthritis compared to HA alone.

Association between progression of knee osteoarthritis pathology and gait changes over two years: Data from the IMI-APPROACH cohort

ObjectiveGait alterations in knee osteoarthritis (OA) patients are potentially related to structural progression of joint tissues, of which some are modifiable. The current objective was to determine whether progression in individual OA pathologies is related to gait kinematic parameters in knee OA patients, and whether these changes are influenced by pain. DesignRange of motion (ROM) during gait, joint tissue pathologies and morphology from index knee radiographs and MRI, and WOMAC pain were collected at baseline and at two-years in the IMI-APPROACH clinical knee OA cohort. Principal component (PC) analysis was performed on two-year change in gait parameters; the resulting (first) PC was compared between progressors and non-progressors for each structural parameter. When the PC indicated differences between groups (p < 0.1), individual gait parameters were compared for that structural outcome. Statistically significant differences in individual gait parameters were corrected for pain change. Results191 patients (age 66.5 ± 6.7; BMI 27.5 ± 4.8; 76 % female; 51 % Kellgren-Lawrence grade ≥2) were analyzed. The gait change PC differed between progressors and non-progressors for meniscal extrusion, bone marrow lesions (BMLs), and patellofemoral cartilage lesions. Further, meniscal extrusion progressors showed significantly more knee ROM and calf ROM decrease, BML progressors worsened more in thigh ROM, and patellofemoral cartilage lesion progressors improved in knee ROM. BML results were no longer significant after pain change adjustment (p = 0.054). ConclusionsMeniscal extrusion and BML progression are associated with gait worsening, though for BMLs the effect might be influenced by pain.

Thigh muscle composition changes in knee osteoarthritis patients during weight loss: Sex-specific analysis using data from osteoarthritis initiative

ObjectivesSex of patients with knee osteoarthritis (KOA) may impact changes in thigh muscle composition during weight loss, the most well-known disease-modifying intervention. We investigated longitudinal sex-based changes in thigh muscle quality during weight loss in participants with KOA. MethodsUsing Osteoarthritis Initiative (OAI) cohort data, we included females and males with baseline radiographic KOA who experienced >5% reduction in BMI over four years. Using a previously validated deep-learning algorithm, we measured MRI-derived biomarkers of thigh muscles at baseline and year-4. Outcomes were the intra- and inter-muscular adipose tissue (Intra-MAT and Inter-MAT) and contractile percentage of thigh muscles between females and males. The analysis adjusted for potential confounders, such as demographics, risk factors, BMI change, physical activity, diet, and KOA status. ResultsA retrospective selection of available thigh MRIs from KOA participants who also had a 4-year weight loss (>5% of BMI) yielded a sample comprising 313 thighs (192 females and 121 males). Female and male participants exhibited a comparable degree of weight loss (females: -9.72±4.38, males: -8.83±3.64, P-value=0.060). However, the changes in thigh muscle quality were less beneficial for females compared to males, as shown by a less degree of longitudinal decrease in Intra-MAT (change difference,95%CI: 783.44 mm2/4-year, 505.70 to 1061.19, P-value<0.001) and longitudinal increase in contractile percentage (change difference,95%CI: -3.9%/4-year, -6.5 to -1.4, P-value=0.019). ConclusionsIn participants with KOA and 4-year weight loss, the longitudinal changes in thigh muscle quality were overall beneficial but to a less degree in females compared to males. Further research is warranted to investigate the underlying mechanisms and develop sex-specific interventions to optimize muscle quality during weight loss.

Is detection of disease-modifying osteoarthritis drug treatment more effective when performing cartilage morphometry without blinding to MR image acquisition order?

ObjectiveWe here explore whether observed treatment effects of a putative disease modifying osteoarthritis drug (DMOAD) are greater when cartilage morphometry is performed with rather than without knowledge of MRI acquisition order (unblinded/blinded to time point). MethodsIn the FORWARD randomized controlled trial, 549 knee osteoarthritis patients were randomized 1:1:1:1:1 to three once-weekly intra-articular injections of placebo, 30µg sprifermin every 6 or 12 months(M), or 100µg every 6/12M. After year 2, cartilage segmentation of baseline through 24M MRIs was performed, with blinding to acquisition order. After year 5, 24 and 60M MRIs were analyzed together, with unknown relative order, but with segmented BL images as reference (24M unblinded vs. BL), by the same operators. Total femorotibial joint cartilage thickness (TFTJ_ThC) change was obtained for 352 participants analyzed under both conditions. Results24M data read unblinded to order revealed a -35±44 µm lower TFTJ_ThC than blinded analysis (all groups: lower/upper bounds -120/+51µm; correlation r2=97%). With unblinded analysis, the placebo group lost -46±57µm TFTJ_ThC over 24M, whereas 100µg/every 6M lost -2.2±73µm (difference=44µm [95%CI: 22,66]). With blinded analysis, placebo lost -11±53µm, whereas 100µg/every 6M gained 30±62µm (difference=40µm [95%CI: 21,60]). 100µg sprifermin injected every 6M showed statistically significant (p<0.001) treatment effects in TFTJ_ThC, with Cohen D=-0.66 for unblinded and D=-0.69 for blinded analysis. ConclusionsThese results do not reveal that detection of proposed DMOAD treatment is enhanced with MRIs read unblinded to order; rather, the sensitivity is similar to blinded analysis. Choices on blinded vs. unblinded analysis may thus be based on other criteria.