Knee Osteoarthritis Pain Research Articles

Transient receptor potential ankyrin 1 in the knee is involved in osteoarthritis pain

Transient receptor potential families play important roles in the pathology of osteoarthritis (OA) of the knee. While transient receptor potential ankyrin 1 (TRPA1) is also an essential component of the pathogenesis of various arthritic conditions, its association with pain is controversial. Thus, we researched whether TRPA1 is involved in knee OA pain by in vivo patch–clamp recordings and evaluated the behavioral responses using CatWalk gait analysis and pressure application measurement (PAM). Injection of the Trpa1 agonist, allyl isothiocyanate (AITC), into the knee joint significantly increased spontaneous excitatory synaptic current (sEPSC) frequency in the substantia gelatinosa of rats with knee OA, while injection of the Trpa1 antagonist, HC-030031, significantly decreased the sEPSC. Meanwhile, AITC did not affect the sEPSC in sham rats. In the CatWalk and PAM behavioral tests, AITC significantly decreased pain thresholds, but no difference between HC-030031 and saline injections was observed. Our results indicate that Trpa1 mediates knee OA-induced pain. We demonstrated that Trpa1 is activated in the knee joints of rats with OA, and Trpa1 activity enhanced the pain caused by knee OA.

Correlation between Abdominal Obesity and Pain in Knee Osteoarthritis.

Obesity is an independent risk factor for the occurrence of knee osteoarthritis. The influence of abdominal obesity is not well studied. We proposed to determine the relationship between total abdominal obesity, pain, and functional impairment with the severity of radiographic changes in knee osteoarthritis. A cross-sectional study including 92 patients with knee pain was performed. The evaluation of degree of pain in the knee was assessed by the visual analogue scale and the functional impairment by WOMAC and Lequesne indices. Radiographic severity was assessed by Kellgren and Lawrence score (KL score). Mean age of patients was 55.2 years (19-86), with a predominance of women (80.4% of patients). Mean body mass index (BMI) was 30.66 kg/m2 (18.5-49.97). Obesity was found in 53 patients (57.6%). The average waist circumference (WC) was 102.82 (± 15.51) centimeters. Abdominal obesity was found in 80 patients (87%). Patients had a mean visual analogue scale (VAS) of 18 ± 23.24 mm. The average algofunctionnal Lequesne score was 8.95 (0-23), and the WOMAC score was 26.82 (0-69). Fifty percent of patients had stage 3 of OA according to KL score. We found no association between BMI and intensity of knee pain (p = 0.278), but WC was significantly associated with the elevation of VAS (p = 0.008). Physical function was positively correlated with BMI and WC (p = 0.001). Finally, BMI and WC were significantly associated with radiographic severity (grade 1-2 of KL vs. grade 3-4 of KL) (respectively, p = 0.001; p = 0.017). Both obesity and abdominal obesity are independently associated with pain, disability, and radiographic severity of knee osteoarthritis.

Intra-articular mm-ii, a novel suspension of large empty multilamellar liposomes, in painful knee osteoarthritis: a 26 week phase 2b placebo-controlled double blind randomized trial

Intra-articular mm-ii, a novel suspension of large empty multilamellar liposomes, in painful knee osteoarthritis: a 26 week phase 2b placebo-controlled double blind randomized trial

Researchers in rheumatology should avoid categorization of continuous predictor variables

BackgroundRheumatology researchers often categorize continuous predictor variables. We aimed to show how this practice may alter results from observational studies in rheumatology.MethodsWe conducted and compared the results of two analyses of the association between our predictor variable (percentage change in body mass index [BMI] from baseline to four years) and two outcome variable domains of structure and pain in knee and hip osteoarthritis. These two outcome variable domains covered 26 different outcomes for knee and hip combined. In the first analysis (categorical analysis), percentage change in BMI was categorized as ≥ 5% decrease in BMI, < 5% change in BMI, and ≥ 5% increase in BMI, while in the second analysis (continuous analysis), it was left as a continuous variable. In both analyses (categorical and continuous), we used generalized estimating equations with a logistic link function to investigate the association between the percentage change in BMI and the outcomes.ResultsFor eight of the 26 investigated outcomes (31%), the results from the categorical analyses were different from the results from the continuous analyses. These differences were of three types: 1) for six of these eight outcomes, while the continuous analyses revealed associations in both directions (i.e., a decrease in BMI had one effect, while an increase in BMI had the opposite effect), the categorical analyses showed associations only in one direction of BMI change, not both; 2) for another one of these eight outcomes, the categorical analyses suggested an association with change in BMI, while this association was not shown in the continuous analyses (this is potentially a false positive association); 3) for the last of the eight outcomes, the continuous analyses suggested an association of change in BMI, while this association was not shown in the categorical analyses (this is potentially a false negative association).ConclusionsCategorization of continuous predictor variables alters the results of analyses and could lead to different conclusions; therefore, researchers in rheumatology should avoid it.

Impact of Elderly Women's Knee Osteoarthritis Pain on Daily Living Activity at Northern Upper Egypt

Background: The most common cause of discomfort in old age is osteoarthritis. The age range between 55 and 64 years old has the largest annual incidence of knee osteoarthritis. 65 and younger make up more than half of those with symptomatic knee OA. Women make up 62% of those with osteoarthritis. Aim: The current study’s objective is to determine the effect of osteoarthritis pain in the knees of older women on their ability to carry out everyday activities in Northern Upper Egypt. Setting: The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital. Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique. Tools: Katz scale, interview questionnaire, and Visual Analog Scale (VAS). Results: showed that more than one-third (40%) of the elderly women in the study had knee joint problems from less than five years ago and 70% of them experienced severe pain. Additionally, 30% of the women in the study required supervision, guidance, personal assistance, or complete care when getting dressed, and 90% reported fatigue, 71.3% anxiety, and 70% limited social participation. Conclusion: The pain of osteoarthritis in older women has an impact on their social, psychological, and physical health. Recommendations: Through targeted programs to people in the community, raise public awareness of osteoarthritis pain and complications.

Clinical results of autologous protein solution injection for knee osteoarthritis with severe disease grade is inferior to mild or moderate grade

Autologous protein solution (APS) is made from platelet-rich plasma that extracts high-concentration growth factors and cytokines. Intra-articular APS injection was reported to improve knee osteoarthritis (KOA) pain and function. However, efficacy differences regarding osteoarthritis severity remained unknown. This retrospective study clinically assessed 220 knees with KOA in the Kellgren–Lawrence (KL) grades 2–4 that underwent APS injection using the Knee Injury and Osteoarthritis Outcome Score (KOOS). A telephone survey was performed for patients who dropped out to check symptom changes. The recalculated estimated responder rate included the telephone survey results. The 12-month follow-up was completed with 148 knees (67%), whereas 72 knees dropped out. The follow-up rate was significantly lower in KL4 than KL2 and 3. The KOOS significantly improved in 148 knees, whereas the KOOS was lower in KL4 than in KL2. The responder rate was 55% total, 58% in KL2, 57% in KL3, and 47% in KL4; however, the estimated responder rate, including the telephone survey, was 49% total, 55% in KL2, 54% in KL3, and 36% in KL4. This study showed improved clinical symptoms 1-year after APS injections for KOA, with a lower responder rate in KL4 than in KL2 or KL3.

Cooled radiofrequency ablation versus cryoneurolysis of the genicular nerves for the symptomatic pain management in knee osteoarthritis: a study protocol of a prospective, randomized, single-blinded clinical trial

BackgroundCooled radiofrequency ablation (CRFA) and cryoneurolysis (CRYO) are two novel methods of genicular neurolysis to relief pain in symptomatic knee osteoarthritis (KOA). In this study, the two methods will be compared, giving us the opportunity to investigate their efficacy, safety and complications.MethodsIn this prospective randomized trial 70 patients with KOA will be recruited using a diagnostic block of four genicular nerves. Two groups will be created through software randomization: a CRFA group (35 patients) and a CRYO group (35 patients). The target of the interventions will be four genicular nerves; the superior medial, superior lateral, inferior medial, as well as the medial (retinacular) genicular branch from vastus intermedius. The primary outcome of this clinical trial will be the efficacy of CRFA or CRYO at 2-, 4-, 12-and 24-weeks post-intervention using the Numerical Rating Pain Scale (NRPS). The secondary outcomes are the safety of the two techniques, as well as the clinical evaluation using the Knee Injury and Osteoarthritis Outcome Score (KOOS), the Oxford Knee Score (OKS), and the 7-point scale of Patient Global Impression of Change (PGIC).DiscussionThese two novel techniques can block pain transmission through genicular nerves in different ways. In contrast to cryoneurolysis, the CRFA method has been well documented in the past. This is the first clinical trial to compare CRFA vs CRYO and draw conclusions about their safety and efficacy.Trial registrationISRCTN87455770 [https://doi.org/10.1186/ISRCTN87455770]. Registered 29/3/2022, first patient recruited 31/8/2022.

Response to intra-articular cortisone injections in knee osteoarthritis patients with and without effusion on ultrasound: A pilot study

ObjectiveInflammation, manifesting as effusion and synovitis, is thought to contribute to pain in knee osteoarthritis (OA). We conducted a pilot study to investigate recruitment feasibility and assess whether effusion on ultrasound of the knee was associated with greater reduction in knee pain after corticosteroid injection. MethodsA pilot study was conducted from 2020 to 2021 including patients ≥40 years with knee OA undergoing clinically indicated corticosteroid injections. At baseline, participants completed the Knee Injury and Osteoarthritis Outcome Score (KOOS) Pain subscale and had an ultrasound of the injected knee(s) to assess for effusion, defined as anechoic material in the suprapatellar recess. KOOS Pain was re-assessed two weeks following injection. We used mixed linear models to evaluate the change in KOOS Pain scores for knees with and without effusion to determine estimates of the magnitude of association. ResultsWe recruited 10 participants who contributed 16 knees from 4 clinical sessions. The mean age was 68 years (standard deviation [SD] 13) and 90% were female. Six knees had effusion. At baseline, knees without effusion had greater pain (mean KOOS Pain 44, SD 19) compared to those with effusion (mean KOOS Pain 51, SD 15). Knees without effusion had a 6 point (95% CI −16, 28) greater improvement in KOOS Pain 2-weeks post injection compared to those with effusion. ConclusionThis pilot study demonstrated clinic-based recruitment was feasible. We did not observe clinically important or statistically significant differences in pain relief post corticosteroid injection between knee OA patients with or without effusion.

Coping Strategies among Elderly Women with Knee Osteoarthritis Pain at Beni-Suef City: Impact of Socio-demographic Characteristics

Background: Given that optimization of management of the subscapularis is essential to ensuring an optimal outcome after shoulder arthroplasty, this review will focus on the ideal method of Lesser Tuberosity Osteotomy (LTO) repair and the methods by which this is assessed. Specifically, we will review the existing literature to determine how suture configuration, number of sutures, type of sutures, and osteotomy size all influence the biomechanics of an LTO repair. Methods: A systematic review was performed in which one reviewer searched PubMed to find studies analyzing biomechanical strength of lesser tuberosity osteotomy repairs after a total shoulder arthroplasty. The following keywords were used to retrieve articles: (biomechanical) and (Lesser Tuberosity Osteotomy) or (LTO) or (subscapularis repair) and (total shoulder). Results: Nine studies met inclusion criteria. LTO was the strongest, most durable repair in most biomechanical studies. However, the biomechanical testing protocols and repair techniques widely varied throughout the literature. Dual row repair with sutures wrapped around the stem as well thin LTO fragments showed superior biomechanical outcomes. There has been minimal literature focusing on how the number, size and type of suture utilized in a repair affect biomechanical outcomes. Discussion: While the LTO repair technique has been demonstrated in multiple studies to be a biomechanically superior method of subscapularis repair in the setting of TSA, there has not been a single study which has analyzed the effects of repair technique, osteotomy size, as well as suture number/type/size using a standardized biomechanical testing protocol.

Systematic Review of Lesser Tuberosity Osteotomy Techniques, Outcomes and Biomechanical Testing Parameters: A Critical Appraisal

Background: The leading cause of pain and incapacity in elderly women is Osteoarthritis (OA). It affects females more frequently than males. The quantity and quality of coping resources that a person may have at their disposal affect the coping style they ultimately choose. The purpose of this study was to examine how the socio-demographic features of older women in Beni-Suef city who were experiencing knee Osteoarthritis (OA) pain affected their coping mechanisms. Design: The current study used a descriptive cross-sectional research design. The investigation was conducted in the orthopaedics outpatient clinic and the physiotherapy unit at Beni-Suef University Hospital. Subjects: In the current study, 300 studied women were recruited using a non-probability consecutive sampling technique. Tools: Pain Coping Inventory (PCI), Visual Analog Scale (VAS) and Interview Questionnaire Results: Based on the visual analogue scale for measuring pain intensity. It demonstrates that 50% of the older women in the study had low coping skills, 49.3% experienced moderate pain, 50.3% had moderate and 50.3% had severe pain. Younger (65-70 years old), women with intermediate education (38.5% and 32.7%), women who were retired and unemployed (48.1% and 32.7%), married (92.3%), women who lived in rural areas (53.8%) and elderly adult women with an adequate family income (92.3%) were more likely to use high levels of coping strategies. There was a positive association between pain level and activities of daily life (r= 0.109 and p= 0.05) and a severe negative link between the overall pain coping inventory and degree of pain (r= -0.280 and p= 0.000). Conclusion: Age, educational attainment, employment position and marital status all significantly influenced how well older women coped with pain. Even Nevertheless, there was a statistically significant correlation between the ability of older women to cope with pain and their monthly income and area of residence. The overall pain coping inventory and the visual analogue scale were shown to have a substantial negative connection. While the Katz scale for ADL and the pain coping inventory showed a positive association.

Patient appropriateness for total knee arthroplasty and predicted probability of a good outcome

ObjectivesOne-fifth of total knee arthroplasty (TKA) recipients experience a suboptimal outcome. Incorporation of patients’ preferences in TKA assessment may improve outcomes. We determined the discriminant ability of preoperative measures of...

The role of peripheral nerve stimulation in refractory non-operative chronic knee osteoarthritis.

Aim: This case series aimed to analyze the efficacy of a temporary peripheral nerve stimulation (PNS) device implanted for 60days at 60days post-explant for patients with non-surgical osteoarthritic knee pain. Patients & methods: 19patients were selected for treatment with temporary PNS at an outpatient pain management clinic. Results: Patients demonstrated improvement in their knee pain from baseline post-temporary PNS explant (p=0.973). Conclusion: Temporary PNS serves as a promising therapy for patients with limited options for therapy, necessitating further high-quality studies.

Clinical Effectiveness of Ultrasound-Guided Biolaser Versus Ozone Therapy in Reducing Chronic Pain in Knee Osteoarthritis: A Three-Month Follow-Up Study

Background: Biolaser is an emerging technology, which has attracted the attention of many surgeons and specialists in different medical fields. Objectives: This study aimed to evaluate the clinical effectiveness of ultrasound-guided biolaser radiation versus ozone therapy in reducing chronic pain in patients with knee osteoarthritis during a three-month follow-up. Patients and Methods: Sixty patients referring to pain clinic of Shohadaye-Tajrish and Akhtar hospitals in 2017, were included in this randomized single-blind clinical trial study. According to a randomized table of numbers, in Biolaser group (n = 30): 10 mL of normal saline + 5 mL of lidocaine 1% + BioLaser + Physical Therapy and in the Ozone group (n = 30), received 10 mL Ozone (30 mic/mL) plus 5 mL lidocaine 1% + BioLaser placebo + Physical Therapy received. The patients were evaluated for pain using visual analog scale (VAS) and knee function with Knee injury and Osteoarthritis Outcome Score (KOOS) questioner. The patients were followed up 4 &amp; 12 weeks and reviewed at weeks 12 after the injection by an observer who was unaware of the groups (IRCT20111121008146N15). Results: Comparison of the mean age (56.8 ± 8.5 years in the biolaser group vs. 51.5 ± 5.4 years in the ozone therapy group; P = 0.721) and body mass index (31.1 ± 3.4 kg/m2 in the biolaser group vs. 30.5 ± 2.6 kg/m2 in the ozone therapy group; P = 0.214) did not indicate any significant differences between the two groups. The pain severity decreased significantly at different times in the biolaser and ozone therapy groups (P = 0.018). The knee pressure sensitivity score was 1.3 ± 0.5 in the biolaser group and 1.6 ± 0.4 in the ozone therapy group at 12 weeks post-treatment (P = 0.037). The knee circumference was also 35.6 ± 3.0 cm in the biolaser group and 39.7 ± 3.9 cm in the ozone therapy group at 12 weeks post-treatment (P = 0.032). The KOOS performance score was 46.9 ± 9.4 in the biolaser group and 49.3 ± 7.9 in the ozone therapy group (P = 0.187). Besides, the KOOS quality of life score was 10 ± 1.3 in the biolaser group and 10.4 ± 1.5 in the ozone therapy group (P = 0.586). Conclusion: Biolaser therapy under ultrasound guidance was found to be a safe, non-invasive, and effective method, which could improve chronic pain in knee osteoarthritis during a three-month follow-up.

TANGO: Development of Consumer Information Leaflets to Support TAperiNG of Opioids in Older Adults with Low Back Pain and Hip and Knee Osteoarthritis.

Globally, the rate of opioid prescription is high for chronic musculoskeletal conditions despite guidelines recommending against their use as their adverse effects outweigh their modest benefit. Deprescribing opioids is a complex process that can be hindered by multiple prescriber- and patient-related barriers. These include fear of the process of, or outcomes from, weaning medications, or a lack of ongoing support. Thus, involving patients, their carers, and healthcare professionals (HCPs) in the development of consumer materials that can educate and provide support for patients and HCPs over the deprescribing process is critical to ensure that the resources have high readability, usability, and acceptability to the population of interest. This study aimed to (1) develop two educational consumer leaflets to support opioid tapering in older people with low back pain (LBP) and hip or knee osteoarthritis (HoKOA), and (2) evaluate the perceived usability, acceptability, and credibility of the consumer leaflets from the perspective of consumers and HCPs. This was an observational survey involving a consumer review panel and an HCP review panel. 30 consumers (and/or their carers) and 20 HCPs were included in the study. Consumers were people older than 65 years of age who were currently experiencing LBP or HoKOA, and with no HCP background. Carers were people who provided unpaid care, support, or assistance to an individual meeting the inclusion criteria for consumers. HCPs included physiotherapists (n=9), pharmacists (n=7), an orthopaedic surgeon (n=1), a rheumatologist (n=1), nurse practitioner (n=1) and a general practitioner (n=1), all with at least threeyears of clinical experience and who reported working closely with this target patient population within the last 12 months. Prototypes of two educational consumer leaflets (a brochure and a personal plan) were developed by a team of LBP, OA, and geriatric pharmacotherapy researchers and clinicians. The leaflet prototypes were evaluated by two separate chronological review panels involving (1) consumers and/or their carers, and (2) HCPs. Data collection for both panels occurred via an online survey. Outcomes were the perceived usability, acceptability, and credibility of the consumer leaflets. Feedback received from the consumer panel was used to refine the leaflets, before circulating the leaflets for further review by the HCP panel. Additional feedback from the HCP review panel was then used to refine the final versions of the consumer leaflets. Both consumers and HCPs perceived the leaflets and personal plan to be usable, acceptable, and credible. Consumers rated the brochure against several categories, which scored between 53 and 97% positive responses. Similarly, the overall feedback provided by HCPs was 85-100% positive. The modified System Usability Scale scores obtained from HCPs was 55-95% positive, indicating excellent usability. Feedback for the personal plan from both HCPs and consumers was largely positive, with consumers providing the highest positive ratings (80-93%). While feedback for HCPs was also high, we did identify that prescribers were hesitant to provide the plan to patients frequently (no positive responses). This study led to the development of a leaflet and personal plan to support the reduction of opioid use in older people with LBP or HoKOA. The development of the consumer leaflets incorporated feedback provided by HCPs and consumers to maximise clinical effectiveness and future intervention implementation.

Effect of Nadi Sweda on symptoms of Pain, Swelling and Stiffness in Knee Osteoarthritis - An Open Labeled Single Arm Clinical Study

Introduction: More than 100 million populations globally suffer from Osteoarthritis (OA) which is considered the leading cause of disability. The prevalence of OA knee in India is about 6% of total osteoarthritis. Therefore, there is a need for alternative and well-tolerable supplementary treatment which has no drug interaction with conventional drugs for OA. Aim and objectives: To evaluate the effect of traditional sudation therapy (Nadi Swedana) on pain, swelling and stiffness of patients with knee osteoarthritis. Method: The study was conducted after getting approval from Institutional Ethical Committee and was registered to the Clinical Trials Registry of India (CTRI/2018/03/012636 19/03/2018). A total of 20 patients with knee joint osteoarthritis were treated for 6 weeks. Pre-test and the post-test outcome measure was recorded on subjective parameters and statistically analyzed. Results: The applied score for pain, swelling and stiffness decreased significantly lower after the intervention (p&lt;0.05). Conclusions: Traditional sudation therapy by Nadi Swedana was beneficial for patients with knee osteoarthritis.

Comparative Efficacy of Intra-Articular Injection, Physical Therapy, and Combined Treatments on Pain, Function, and Sarcopenia Indices in Knee Osteoarthritis: A Network Meta-Analysis of Randomized Controlled Trials.

Knee osteoarthritis (KOA) is associated with a high risk of sarcopenia. Both intra-articular injections (IAIs) and physical therapy (PT) exert benefits in KOA. This network meta-analysis (NMA) study aimed to identify comparative efficacy among the combined treatments (IAI+PT) in patients with KOA. Seven electronic databases were systematically searched from inception until January 2023 for randomized controlled trials (RCTs) reporting the effects of IAI+PT vs. IAI or PT alone in patients with KOA. All RCTs which had treatment arms of IAI agents (autologous conditioned serum, botulinum neurotoxin type A, corticosteroids, dextrose prolotherapy (DxTP), hyaluronic acid, mesenchymal stem cells (MSC), ozone, platelet-rich plasma, plasma rich in growth factor, and stromal vascular fraction of adipose tissue) in combination with PT (exercise therapy, physical agent modalities (electrotherapy, shockwave therapy, thermal therapy), and physical activity training) were included in this NMA. A control arm receiving placebo IAI or usual care, without any other IAI or PT, was used as the reference group. The selected RCTs were analyzed through a frequentist method of NMA. The main outcomes included pain, global function (GF), and walking capability (WC). Meta-regression analyses were performed to explore potential moderators of the treatment efficacy. We included 80 RCTs (6934 patients) for analyses. Among the ten identified IAI+PT regimens, DxTP plus PT was the most optimal treatment for pain reduction (standard mean difference (SMD) = -2.54) and global function restoration (SMD = 2.28), whereas MSC plus PT was the most effective for enhancing WC recovery (SMD = 2.54). More severe KOA was associated with greater changes in pain (β = -2.52) and WC (β = 2.16) scores. Combined IAI+PT treatments afford more benefits than do their corresponding monotherapies in patients with KOA; however, treatment efficacy is moderated by disease severity.

Discordance Between Self-Reported and Performance-Based Physical Function in Patients Who Have Knee Osteoarthritis: Associations With Pain Intensity and Negative Affect

BackgroundAlthough self-reported measures of physical disability are strong indication criterion for total knee arthroplasty (TKA) in painful knee osteoarthritis (OA), some patients may report greater-than-observed disability. Contributing factors to this discordance are relatively unexplored. We aimed to examine whether pain and negative affect, including anxiety and depression, were associated with the discordance of self-reported measures with performance-based measures (PPM) of physical function. MethodsWe used cross-sectional data (n = 212) from two randomized rehabilitation trials in knee OA. All patients were assessed for knee pain intensity and symptoms of anxiety and depression. Self-reported function was assessed by the Western Ontario and McMaster Universities Arthritis Index (WOMAC) physical-function subscale. Objective performance-based measures (PPMs) of physical function were assessed by timed gait and stair tests. Continuous discordance scores were quantified by the difference in percentiles between WOMAC and PPMs (WOMAC-PPM), where a positive discordance, WOMAC-PPM >0, implied greater perceived than observed disability. ResultsAround 1 in 4 patients had >20 percentile units in WOMAC-PPM discordance. In Bayesian regression analyses, knee pain intensity had >99% posterior probability of positive associations with WOMAC-PPM discordance. Among patients awaiting TKA, anxiety intensity had approximately 99% probability of positive associations with discordance, and these associations had >65% probability of exceeding 10 percentile units. In contrast, depression had low (79% to 88%) probability of any association with discordance. ConclusionIn patients who have knee OA, a sizable proportion reported substantially greater physical disability than actually observed. Pain and anxiety intensity, but not depression, were meaningful predictors of this discordance. If validated, our findings may help in refining patient selection criteria for TKA.

Cross-sectional reliability and concurrent validity of a quantitative 2-dimensional ultrasound image analysis of effusion and synovial hypertrophy in knee osteoarthritis

ObjectiveEffusion-synovitis is related to pain and progression in knee osteoarthritis (OA), but current gold standard ultrasound (US) measures are limited to semi-quantitative grading of joint distension or 1-dimensional thickness measures. A novel quantitative 2-dimensional image analysis methodology is applied to US images of effusion-synovitis; reliability and concurrent validity was assessed in patients with knee OA. MethodsCross sectional analysis of US images collected from 51 patients with symptomatic knee OA were processed in ImageJ and segmented in 3DSlicer to produce a binary mask of the supra-patellar synovitis region of interest (ROI). Area measures (mm2) of total synovitis, effusion and hypertrophy components were exported. Intra-rater reliability and test-retest reliability (1–14 days washout) were estimated with intra-class correlation coefficients (ICCs). Concurrent validity was measured by Spearman correlations between quantitative measures and gold standard OMERACT and caliper measurements of synovitis. ResultsIntra-rater reliability for hypertrophy area was estimated at 0.98, 0.99 for effusion area, and 0.99 for total synovitis area. The test-retest reliability for total synovitis area was 0.63 (SEM 87.8 ​mm2), 0.59 for hypertrophy area (SEM 21.0 ​mm2), and 0.64 for effusion area (SEM 73.8 ​mm2). Correlation between total synovitis area and OMERACT grade was 0.84, 0.81 between total synovitis area and effusion-synovitis calipers, and 0.81 between total effusion area and effusion calipers. ConclusionThis new research tool for image analysis demonstrated excellent intra-rater reliability, good concurrent validity, and moderate test-retest reliability. Quantitative 2D US measures of effusion-synovitis and its individual components may enhance the study and management of knee OA.

Effect of Online Simulation-Based Education on Nurses' Knowledge and Skills Toward Electrocardiogram Interpretation

Background: Osteoarthritis (OA); a whole joint disorder is a most common and progressive disease that worsens with age. Synovitis and synovial effusion can play important role in early OA diagnosis and progression. Limited pharmacological interventions affecting synovial effusion are studied clinically in Indian population. Aim: This was a pilot, observational, single arm, open label study in real world set-up designed to evaluate the efficacy and safety of Mobileye® capsules containing sodium hyaluronate along with collagen and polysaccharides derived from rooster comb extract in subjects suffering from synovial effusion and knee pain of osteoarthritis. Materials and Method: The study was conducted on total 30 subjects at Outpatient Department (OPD) at three different sites under the supervision of medical doctor. All subjects consumed Mobileye® capsule orally twice daily for 3 months. Synovial effusion, VAS score, WOMAC score and safety parameters were assessed as scheduled. Results: Treatment with Mobileye® capsule showed significant and progressive improvement in all study related parameters. Baseline score vs. day 90 score (mean + SD) for synovial effusion, WOMAC pain score, WOMAC stiffness score, WOMAC physical function score, WOMAC total score and VAS score were 8.52+2.960 mm vs. 2.58+0.903 mm (p&lt;0.0001), 15.13+3.10 vs. 4.13+2.4 (p&lt;0.0001), 6.63+1.098 vs. 1.60+1.192 (p&lt;0.0001), 54.33+8.39 vs. 14.23+8.67 (p&lt;0.0001), 76.13+ 11 vs. 20.33+ 10.86 and 8.13 + 1.28 vs. 1.93+1.17 (p&lt;0.0001) respectively. No significant adverse events were reported. Conclusion: Oral intake of Mobileye® capsule is safe and effective intervention in reducing synovial effusion, pain, stiffness and in improving joint mobility. Keywords: Electrocardiogram interpretation, nurses' knowledge and skills, online simulation education.

Modulation effects of different treatments on periaqueductal gray resting state functional connectivity in knee osteoarthritis knee pain patients.

The analgesic effect of acupuncture is widely recognized, but the mechanical characteristics of acupuncture for pain relief, compared to non-steroidal anti-inflammatory (NSAIDs) and placebo medication, remain unknown. To compare the modulation effects of acupuncture treatment with NSAIDs and placebo medication on descending pain modulation system (DPMS) in knee osteoarthritis (KOA) patients. This study recruited 180 KOA patients with knee pain and 41 healthy controls (HCs). Individuals with KOA knee pain were divided randomly into groups of verum acupuncture (VA), sham acupuncture (SA), celecoxib (SC), placebo (PB), and waiting list (WT), with 36 patients in each group. VA and SA groups included ten sessions of puncturing acupoints or puncturing non-acupoints acupuncture treatment for two successive weeks. Celecoxib capsules were continuously given orally to patients in the SC group at a dosage of 200 mg daily for 2 weeks. In the PB group, patients received a placebo capsule once a day for 2 weeks at the same dosage as celecoxib capsules. In the WL group, patients did not receive any treatment. Patients underwent a resting-state BOLD-fMRI scan pre- and post-receiving the therapy, whereas HCs only underwent a baseline scan. Seed (ventrolateral periaqueductal gray, vlPAG, a key node in DPMS) based resting-state functional connectivity (rs-FC) was applied in the data analysis. All groups demonstrated improved knee pain scores relative to the initial state. There was no statistical difference between the VA and SA groups in all clinical outcomes, and vlPAG rs-FC alterations. KOA knee pain individuals reported higher vlPAG rs-FC in the bilateral thalamus than HCs. KOA knee pain patients in the acupuncture group (verum + sham, AG) exhibited increased vlPAG rs-FC with the right dorsolateral prefrontal cortex (DLPFC) and the right angular, which is associated with knee pain improvement. In contrast with the SC and PB group, the AG exhibited significantly increased vlPAG rs-FC with the right DLPFC and angular. Contrary to the WT group, the AG showed greater vlPAG rs-FC with the right DLPFC and precuneus. Acupuncture treatment, celecoxib, and placebo medication have different modulation effects on vlPAG DPMS in KOA knee pain patients. Acupuncture could modulate vlPAG rs-FC with brain regions associated with cognitive control, attention, and reappraisal for knee pain relief in KOA patients, compared with celecoxib and placebo medication.