Management Of OA Research Articles

Full spectrum medical cannabis (Vijaya) oil as a veterinary treatment for osteoarthritis, hip dysplasia and musculoskeletal disorders: A case series

In veterinary medicine, Osteoarthritis, Hip Dysplasia and pain disorders are commonly diagnosed conditions, and it presents significant difficulties for the well-being of canines. The aim of this case series is to report the use of full spectrum medical cannabis (vijaya) for treating symptoms such as pain, inflammation, impaired mobility. Four Labrador breed patients between 6 years to 8 years, suffering from acute mobility issues were diagnosed with OA and HD. All patients were administered 4 drops of the full spectrum oil, orally, twice daily. After one month of the treatment, there was significant change in the pain markers with improved mobility. The recommended dose is 0.16 mg/kg/body wt for management of OA and HD related pain and inflammation. A boost in appetite and quality of life was also observed. In the future it is important to incorporate new treatment options in the medical practice and further research needs to be conducted on its use for other illnesses and animal species.

Physiotherapy for patients with hip and knee osteoarthritis in Germany: a survey of current practice

BackgroundOsteoarthritis (OA) of the hip and the knee is common and leads to pain, stiffness and disability. Clinical practice guidelines (CPG) provide recommendations to assist healthcare professionals in clinical decision-making. Although evidence-based physiotherapy has been shown to be effective in the management OA, a gap between clinical practice and guideline recommendations exists. Little is known about OA management provided by physiotherapists in Germany and whether treatment aligns with CPGs. The objectives of this study were (1) to investigate the current physiotherapy practice in patients with hip and/or knee OA in Germany, (2) to evaluate physiotherapists’ adherence to guideline recommendations and (3) to explore barriers and facilitators to guideline use.MethodsA cross-sectional online survey was conducted among physiotherapists. The questionnaire collected information on demographic characteristics, physiotherapists’ management of hip and knee OA and the use of CPGs in clinical practice. Guideline adherence was evaluated by comparing the survey findings with guideline recommendations. Full adherence was assumed if all recommended treatment options were chosen.ResultsIn total, 447 (74.9%) of 597 eligible physiotherapists completed the survey. Data from 442 participants (mean age 41.2 ± 12.8 years; 288 female (65.1%)) were included in the analysis. The most common treatment choices for both hip and knee OA were exercise therapy (hip OA: 424/442, 95.9%; knee OA: 426/442, 96.4%), self-management advice (hip OA: 413/442, 93.2%; knee OA: 395/442, 89.4%) and education (hip OA: 325/442, 73.5%; knee OA: 331/442, 74.9%), followed by manual therapy (hip OA: 311/442, 70.4%; knee OA: 311/442, 70.4%) and joint traction (hip OA: 208/442, 47.1%; knee OA: 199/442, 45.0%). Full guideline adherence was found in 17.2% (76/442) of physiotherapists for hip OA management and in 8.6% (38/442) for knee OA. Less than half of the respondents (212/430, 49.3%) were aware of an OA guideline.ConclusionsIn accordance with current guideline recommendations, most physiotherapists provide exercise therapy and education for patients with hip and/or knee OA. Interventions with low or conflicting evidence were also frequently provided. The limited awareness of existing OA guidelines and the low guideline adherence indicate an insufficient implementation of CPGs in German physiotherapy practice.Trial registrationGerman Clinical Trials Register (DRKS00026702). Registered 14 October 2021.

Effects of a Massive Open Online Course on osteoarthritis knowledge and pain self-efficacy in people with hip and/or knee osteoarthritis: protocol for the MOOC-OA randomised controlled trial

BackgroundOsteoarthritis (OA) is a prevalent, chronic joint condition that commonly affects the knee and hip causing pain, impaired function, and reduced quality of life. As there is no cure, the main goal of treatment is to alleviate symptoms via ongoing self-management predominantly consisting of exercise and weight loss (if indicated). However, many people with OA do not feel adequately informed about their condition and management options to self-manage effectively. Patient education is recommended by all OA Clinical Practice Guidelines to support appropriate self-management, but little is known about the optimal delivery method and content. Massive Open Online Courses (MOOCs) are free, interactive, e-learning courses. They have been used to deliver patient education in other chronic health conditions but have not been used in OA.MethodsA two-arm parallel-design, assessor- and participant-blinded superiority randomised controlled trial. People with persistent knee/hip pain consistent with a clinical diagnosis of knee/hip OA (n = 120) are being recruited from the Australia-wide community. Participants are randomly allocated into one of two groups i) electronic information pamphlet (control group) or ii) MOOC (experimental group). Those allocated to the control group receive access to an electronic pamphlet about OA and its recommended management, currently available from a reputable consumer organisation. Those allocated to the MOOC receive access to a 4-week 4-module interactive consumer-facing e-Learning course about OA and its recommended management. Course design was informed by behaviour theory and learning science, and consumer preferences. The two primary outcomes are OA knowledge and pain self-efficacy with a primary endpoint of 5 weeks and a secondary endpoint of 13 weeks. Secondary outcomes include measures of fear of movement, exercise self-efficacy, illness perceptions, OA management and health professional care seeking intentions, physical activity levels, and actual use of physical activity/exercise and weight loss, pain medication, and health professional care seeking to manage joint symptoms. Clinical outcomes and process measures are also collected.DiscussionFindings will determine whether a comprehensive consumer-facing MOOC improves OA knowledge and confidence to self-manage joint pain compared to a currently available electronic OA information pamphlet.Trial registrationProspectively registered (Australian New Zealand Clinical Trials Registry ID: ACTRN12622001490763).

P074 Intra-articular platelet-rich plasma injections versus intra-articular corticosteroid injections for the symptomatic management of knee osteoarthritis: a systematic review and meta-analysis

Abstract Background/Aims Osteoarthritis (OA) is the commonest reason for orthopaedic referral in the UK, with the burden of knee OA affecting 10-25% of patients over 60 and 6% of those over 30. Intra-articular (IA) corticosteroid (CS) injections are the mainstay of treatment for symptomatic management in knee OA, particularly in the UK. IA platelet-rich-plasma (PRP) injections are a promising alternative, but no systematic reviews to date have compared them to the current standard of care, IA CS injections. We aim to investigate the effect of IA PRP injections versus IA corticosteroid injections for the symptomatic management of knee OA. Methods All published trials comparing IA PRP and CS injections for knee OA were included. MEDLINE, EMBASE, Scopus and Web of Science were searched through June 2020. Risk of bias was assessed using the Cochrane Risk of Bias tool and overall was deemed low. A random effects model was used to calculate standardized mean difference with 95% confidence interval in WOMAC, VAS and KOOS scores (or subscores), comparing IA PRP to CS injections across studies at different time points of follow-up. Where studies used different outcome measures, these were combined using the standardised mean difference (SMD). Results 8 studies and 648 patients were included. 443 (68%) were female, mean age 59 years, with a mean BMI of 28.4. OA was diagnosed radiologically using the Kellgren-Lawrence scale. Compared with CS injections, PRP was significantly better in reducing OA symptoms (pain, stiffness, functionality) at 3-, 6- and 9-months post-intervention (P < 0.01). The greatest effect was observed at 6 and 9 months (-0.78 (-1.34 to -0.23) SD and -1.63 (-2.14 to -1.12) SD respectively). At 6 months, this equates to an additional reduction of 9.51 in WOMAC or 0.97 on the VAS pain scales. On WOMAC pain and stiffness subscales, there were significant additional reductions in the PRP group for pain and stiffness (-2.66 (-4.73 to -0.60), P < 0.01 and 1.95 (-2.30 to -1.59), P < 0.01 respectively), but not functionality at 6 months. At 6 months PRP allowed greater return to sporting activities than CS injections, as measured by the KOOS subscale for sporting activity, of magnitude 9.7 (-0.45 to 19.85) (P = 0.06). Triple injections of PRP, generally separated by a week, were superior to single injections over 12 months of follow-up (P < 0.001). Considerable heterogeneity in the preparation of PRP was observed. Conclusion IA-PRP injections produce superior outcomes when compared with CS injections for symptomatic management of knee OA, including improved pain management, less joint stiffness and better participation in exercise/sporting activity at 12 months follow-up. Giving three IA-PRP, with injections separated by a week, appears more effective than one IA-PRP injection. IA corticosteroid injections should no longer be routinely used for symptomatic management of knee OA. Disclosure M.E.D. McLarnon: None. N. Heron: None.

P043 Income-Related Health Inequality and Osteoarthritis Intervention Outcomes: a Cohort Study

Abstract Background/Aims Osteoarthritis (OA) management programmes have been lately developed to tackle the osteoarthritis burden. Though beneficial, OA management programmes can be less effective on people in lower socioeconomic positions and widen the possible pre-existing inequalities gap (‘intervention-generated inequalities’). In Sweden, an OA management programme was implemented in the national healthcare system, including exercise and education. Its results are recorded in the ‘Better Management of People with Osteoarthritis’ (BOA) register, one of the most extensive OA datasets worldwide. Hence, this study investigated the influence of this Swedish osteoarthritis management programme on income-related inequality. Methods A register-based study with data from the BOA register. We calculated Erreygers’ and Wagstaff’s concentration indices and how they changed throughout time. We considered the variables ‘Pain intensity’, ‘Self-efficacy‘, ‘Use of NSAIDs’ and ‘Desire for surgery’ at three-time points (baseline, after three and twelve months from the beginning of the programme). Concentration indices’ values range from -1 to + 1. Zero indicates no income inequality. A positive (or negative) sign indicates an unequal concentration of the variables of interest among those with higher (or lower) income. We used bootstrapping (1000 replications) to compute 95% confidence intervals for changes in the concentration indices from baseline. Results A total of 115,403 people with knee and hip OA were identified. ‘Pain intensity’ and ‘Desire for surgery’ were disproportionately concentrated among those with lower income at the baseline, while the opposite happened for ‘Use of NSAIDs’ and ‘Self-efficacy’ (Table 1). Income inequalities for ‘Pain intensity’, ‘Self-efficacy’ and ‘Desire for surgery’ widened following the programme, though their magnitude was small. Conversely, income-related inequality in the ‘Use of NSAIDs’ narrowed after attending the programme. Conclusion Considering the concentration indices’ values, people with lower income were already experiencing higher levels of pain and desire for surgery and lower levels of self-efficacy than their higher counterparts. This trend got even worse after attending the abovementioned programme. Instead, people with higher income were keener on using NSAIDs but attending this programme narrowed this gap. These results highlighted ‘intervention-generated inequalities’ in the BOA data. OA management programmes should be structured to reduce inequalities among people with different incomes. Disclosure S. Battista: None. A. Kiadaliri: None. M. Englund: None. T. Jönsson: None. K. Gustafsson: None. M. Testa: None. A. Dell'Isola: None.

Cost-utility analysis and net monetary benefit of Platelet Rich Plasma (PRP), intra-articular injections in compared to Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone in knee osteoarthritis in Iran

PurposeTo evaluate the cost-effectiveness of Platelet Rich Plasma (PRP), Plasma Rich in Growth Factors (PRGF), Hyaluronic Acid (HA) and ozone as effective treatment approaches in knee osteoarthritis management from Iran Health care perspective.MethodsA decision tree model was conducted to assess the cost-effectiveness of four common intra-articular treatment approaches in patients with mild and moderate knee osteoarthritis. The data on clinical effectiveness was obtained from a randomized controlled trial (RCT) conducted in Iran and used to estimate utility values. The direct medical costs were estimated according to tariffs for public medical centers and hospitals, approved by the Iran Ministry of Health and Medical Education in 2021. The incremental cost-effectiveness ratio (ICER) and the net monetary benefit (NMB) were used to evaluate the cost-utility analysis. Deterministic and probabilistic sensitivity analyses are performed to investigate the robustness of the results and account for the different sources of uncertainty.ResultsIn this study, HA intra-articular injection-related costs ($581.67/patient) were defined as the highest cost, followed by PRGF ($328.10/patient), PRP (318.58/patient), and Ozone (103.20/patient). According to the utility value, PRP and PRGF (0.68) have the same and the most utility among Intra-articular injections in knee osteoarthritis management. However, the PRP injection method was identified as the most cost-effective intervention due to its high NMB and ICER estimates. Based on the Monte Carlo Simulation, PR intervention, compared to other ones, was introduced as the dominant strategy regarding knee OA management, with a WTP of $10,000 for 100% of cases.ConclusionThe study result demonstrated that intra-articular injection of PRP, compare to other injections, is a cost-effective treatment option for patients with mild and moderate knee osteoarthritis. In addition, intra-articular injection of PRP was identified as the best injection, with the highest level of net monetary benefit, for knee OA management.

Upregulation of leucine-rich alpha-2 glycoprotein: A key regulator of inflammation and joint fibrosis in patients with severe knee osteoarthritis.

Osteoarthritis (OA) is a degenerative disease of the joints mainly affecting older individuals. Since the etiology behind the progression of OA is not well understood, several associated consequences, such as synovial joint stiffness and its progression due to joint fibrosis, are still poorly understood. Although a lot of developments have been achieved in the diagnosis and management of OA, synovial fibrosis remains one of the major challenging consequences. The present study was therefore focused on understanding the mechanism of synovial fibrosis, which may further contribute to improving symptomatic treatments, leading to overall improvements in the treatment outcomes of patients with OA. We used advanced proteomic techniques including isobaric tag for relative and absolute quantitation and sequential window acquisition of all theoretical mass spectra for the identification of differentially expressed proteins in the plasma samples of patients with OA. An in silico study was carried out to evaluate the association of the identified proteins with their biological processes related to fibrosis and remodeling of the extracellular matrix (ECM). The most significantly upregulated protein was then validated by Western blot and enzyme-linked immunosorbent assay. The target protein was then further investigated for its role in inflammation and joint fibrosis using an in vitro study model. Leucine-rich alpha-2 glycoprotein (LRG1) was found to be the most highly differentially expressed upregulated (9.4-fold) protein in the plasma samples of patients with OA compared to healthy controls. The knockdown of LRG1 followed by in vitro studies revealed that this protein promotes the secretion of the ECM in synovial cells and actively plays a role in wound healing and cell migration. The knockdown of LRG1 further confirmed the reduction of the inflammatory- and fibrosis-related markers in primary cells. LRG1 was identified as a highly significant upregulated protein in the plasma samples of patients with OA. It was found to be associated with increased fibrosis and cell migration, leading to enhanced inflammation and joint stiffness in OA pathogenesis.

Patients with an Open Abdomen in Asian, American and European Continents: A Comparative Analysis from the International Register of Open Abdomen (IROA)

BackgroundInternational register of open abdomen (IROA) enrolls patients from several centers in American, European, and Asiatic continent. The aim of our study is to compare the characteristics, management and clinical outcome of adult patients treated with OA in the three continents.Material and methodsA prospective analysis of adult patients enrolled in the international register of open abdomen (IROA). Trial registration: NCT02382770.Results1183 patients were enrolled from American, European and Asiatic Continent. Median age was 63 years (IQR 49–74) and was higher in the European continent (65 years, p < 0.001); 57% were male. The main indication for OA was peritonitis (50.6%) followed by trauma (15.4%) and vascular emergency (13.5%) with differences among the continents (p < 0.001). Commercial NPWT was preferred in America and Europe (77.4% and 52.3% of cases) while Barker vacuum pack (48.2%) was the preferred temporary abdominal closure technique in Asia (p < 0.001). Definitive abdominal closure was achieved in 82.3% of cases in America (fascial closure in 90.2% of cases) and in 56.4% of cases in Asia (p < 0.001). Prosthesis were mostly used in Europe (17.3%, p < 0.001). The overall entero-atmospheric fistula rate 2.5%. Median open abdomen duration was 4 days (IQR 2–7). The overall intensive care unit and hospital length-of-stay were, respectively, 8 and 11 days (no differences between continents). The overall morbidity and mortality rates for America, Europe, and Asia were, respectively, 75.8%, 75.3%, 91.8% (p = 0.001) and 31.9%, 51.6%, 56.9% (p < 0.001).ConclusionThere is no uniformity in OA management in the different continents. Heterogeneous adherence to international guidelines application is evident. Different temporary abdominal closure techniques in relation to indications led to different outcomes across the continents. Adherence to guidelines, combined with more consistent data, will ultimately allow to improving knowledge and outcome.

A Strong Correlation Between the Severity of Flatfoot and Symptoms of Knee Osteoarthritis in 95 Patients.

ObjectiveThe purpose of this study is to assess the association between the presence and severity of flatfoot and symptoms of knee OA.Methods95 participants with knee OA were recruited from a patient cohort at a regional hospital. Symptoms of knee OA, including knee degeneration, femorotibial alignment, pain, stiffness and dysfunction were assessed using the Kellgren-Lawrence (K-L) grading system, femoral-tibial angle (FTA), and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Participants were divided into groups with flatfoot (mild, moderate and severe) and without flatfoot based on the Clarke's angle. Linear regression and ordinal logistic regression were used for statistical analysis, as appropriate.ResultsHaving flatfoot was associated with a significantly increased risk of having a higher K-L grade (OR: 20.03; 95% CI, 5.88, 68.27; p < 0.001), smaller FTA (Beta: −2.96; 95% CI, −4.41, −1.50; p < 0.001), higher pain score (Beta: 0.47; 95% CI, 0.24, 0.69; p < 0.001) and greater loss of function (Beta: 0.25; 95% CI, 0.02, 0.48; p = 0.03). Severe grades of flat feet were associated with a higher K-L grade (OR: 0.19; 95% CI, 0.08, 0.44; p < 0.001), smaller FTA (Beta: 1.51; 95% CI, 0.66, 2.35; p = 0.001), higher pain score (Beta: −0.25; 95% CI, −0.39, −0.11; p = 0.001), greater stiffness (Beta: −0.24; 95% CI, −0.38, −0.09; p = 0.002) and greater loss of function (Beta: −0.27; 95% CI, −0.41, −0.14; p < 0.001).ConclusionThe results indicated that the severity of flattening is significantly associated with symptoms of knee OA. For the conservative management of knee OA, both flatfoot and its severity should be carefully considered.

Chronic knee osteoarthritis: Relationships of body mass index and selected psychosocial factors among Nigerians.

Knee Osteoarthritis is the most commonly affected joint among Africans. There is a shred of preliminary evidence that a high body mass index (BMI) is associated with high kinesiophobia. Little is known about the relationships of psychosocial factors such as Kinesiophobia, Pain Catastrophizing (PC), Self-Efficacy (SE), and BMI among Nigerians with knee OA. This study aims to determine the relationships between BMI and selected psychosocial factors (kinesiophobia, pain catastrophizing, and self-efficacy) among individuals with knee OA in Nigeria. Seventy-seven consecutively sampled patients diagnosed with knee OA from three selected public hospitals in Enugu, South-East Nigeria, participated in this cross-sectional survey. Brief Fear of Movement Scale for Osteoarthritis (BFMSO), Pain Catastrophizing Scale (PCS), and Arthritis Self-Efficacy Scale-8 item (ASES-8 item) were used to assess Kinesiophobia, PC, and SE, respectively. Also, a stadiometer and weighing scale were used to determine height and weight respectively. Data were analyzed using Pearson's correlation coefficient at and multiple linear regression. Participants were aged years. Female participants had a higher BMI () than the males (). The mean scores for BMI of the right knee, left knee, and bilateral knees were , , and , respectively. Significant positive correlations were found between BMI and PC () whereas significant negative correlations existed between BMI and SE (). Significant predictive markers of BMI were PC () and SE (). Body mass index, PC, and SE correlate significantly in individuals with knee OA. The results call for the routine integration of psychologically-informed physiotherapy practice in the management of knee OA.

Gait biomechanics phenotypes among total knee arthroplasty candidates by machine learning cluster analysis.

Knee osteoarthritis patient phenotyping is relevant to developing targeted treatments and assessing the treatment efficacy of total knee arthroplasty (TKA). This study aimed to identify clusters among TKA candidates based on demographic and knee mechanic features during gait, and compare gait changes between clusters postoperatively. TKA patients underwent 3D gait analysis 1-week pre (n = 134) and 1-year post-TKA (n = 105). Principal component analysis was applied to frontal and sagittal knee angle and moment waveforms, extracting major patterns of variability. Age, sex, body mass index, gait speed, and frontal and sagittal pre-TKA angle and moment PC scores previously identified as relevant to TKA outcomes were standardized (mean = 0, SD = 1, [134 × 15]). Multidimensional scaling and machine learning-based hierarchical clustering were applied. Final clusters were validated by examining intercluster differences pre-TKA and gait feature changes (PostPCscore - PrePCscore ) by k-way Χ2 and ANOVA tests. Four TKA candidate phenotypes yielded optimum clustering metrics, interpreted as higher and lower functioning clusters that were predominantly male and female. Higher functioning clusters pre-TKA (clusters 1 and 4) had more dynamic sagittal flexion moment (p < 0.001) and frontal plane adduction moment (p < 0.001) loading/un-loading patterns during stance. Post-TKA, higher functioning clusters demonstrated less knee mechanic improvements during gait (flexion angle p < 0.001; flexion moment p < 0.001).TKA candidates can be characterized by four clusters, predominately separated by sex and knee joint biomechanics. Post-TKA knee kinematics and kinetics improvements were cluster-specific; lower functioning clusters experienced more improvement. Cluster-based patient profiling may aid in triaging and developing OA management and surgical strategies meeting group-level function needs.

FREQUENT USE OF PRESCRIPTION NSAIDS AND OPIOIDS AMONG PEOPLE WITH KNEE OR HIP OSTEOARTHRITIS DESPITE CONTRAINDICATIONS TO OR PRECAUTIONS WITH NSAIDS

Purpose: Oral NSAIDs are recommended for OA management. However, many patients with OA have contraindications to NSAIDs or have comorbidities that warrant precaution. Because few other oral therapies are available, such patients may still receive NSAIDs or may instead receive opioids, which are not recommended and have numerous concerning adverse effects. They may also receive physical therapy (PT), an effective option, as a safe alternative. We evaluated differences in the patterns of NSAID, opioid, and PT use among persons with newly diagnosed knee or hip OA with and without NSAID contraindications or precautions using population-based Swedish register data.

Effect of foot orthoses vs sham insoles on first metatarsophalangeal joint osteoarthritis symptoms: a randomized controlled trial

To compare contoured foot orthoses to sham flat insoles for first MTP joint OA walking pain. This was a participant- and assessor-blinded, sham-controlled, multi-centre randomized clinical trial set in community-based private practices. Eighty-eight adults aged ≥45 years with symptomatic radiographic first MTP joint OA were randomized to receive contoured foot orthoses (n=47) or sham flat insoles (n=41), worn at all times when wearing shoes for 12 weeks. Primary outcome was change in first MTP joint walking pain (11-point numerical rating scale (NRS), 0-10) over 12 weeks. Secondary outcomes included additional first MTP joint and foot pain measures, physical function, quality of life and physical activity. Separate linear regression models for primary and secondary outcomes on treatment group were fit, adjusting for the outcome at baseline and podiatrist. Other measures included adverse events. 88 participants were randomized and 87 (99%) completed the 12-week primary outcome. There was no evidence foot orthoses were superior to sham insoles for reducing pain (mean difference-0.3 NRS units (95% CI -1.2 to 0.6), p=0.53). Similarly, foot orthoses were not superior to sham on any secondary outcomes. Sensitivity analyses yielded similar results. Adverse events were generally minor and transient. Contoured foot orthoses are no more effective than flat sham insoles for the clinical management of first MTP joint OA. Given the dearth of evidence on treatments for first MTP joint OA, further research is needed to identify effective management approaches for this common and debilitating condition.

Engineered adipose-derived stem cells with IGF-1-modified mRNA ameliorates osteoarthritis development

BackgroundOsteoarthritis (OA), a prevalent degenerative disease characterized by degradation of extracellular matrix (ECM), still lacks effective disease-modifying therapy. Mesenchymal stem cells (MSCs) transplantation has been regarded as the most promising approach for OA treatment while engrafting cells alone might not be adequate for effective regeneration. Genetic modification has been used to optimize MSC-based therapy; however, there are still significant limitations that prevent the clinical translation of this therapy including low efficacy and safety concerns. Recently, chemically modified mRNA (modRNA) represents a promising alternative for the gene-enhanced MSC therapy. In this regard, we hypothesized that adipose derived stem cells (ADSCs) engineered with modRNA encoding insulin-like growth factor 1 (IGF-1) were superior to native ADSCs on ameliorating OA development.MethodsMouse ADSCs were acquired from adipose tissue and transfected with modRNAs. First, the kinetics and efficacy of modRNA-mediated gene transfer in mouse ADSCs were analyzed in vitro. Next, we applied an indirect co-culture system to analyze the pro-anabolic potential of IGF-1 modRNA engineered ADSCs (named as IGF-1-ADSCs) on chondrocytes. Finally, we evaluated the cell retention and chondroprotective effect of IGF-1-ADSCs in vivo using fluorescent labeling, histology and immunohistochemistry.ResultsmodRNA transfected mouse ADSCs with high efficiency (85 ± 5%) and the IGF-1 modRNA-transfected ADSCs facilitated burst-like production of bio-functional IGF-1 protein. In vitro, IGF-1-ADSCs induced increased anabolic markers expression of chondrocytes in inflammation environment compared to untreated ADSCs. In a murine OA model, histological and immunohistochemical analysis of knee joints harvested at 4 weeks and 8 weeks after OA induction suggested IGF-1-ADSCs had superior therapeutic effect over native ADSCs demonstrated by lower histological OARSI score and decreased loss of cartilage ECM.ConclusionsThese findings collectively supported the therapeutic potential of IGF-1-ADSCs for clinical OA management and cartilage repair.

Applicability of Exercise and Education Programmes for Knee Osteoarthritis Management to Switzerland.

Objectives: The aim of this study was to assess the applicability of six OARSI (Osteoarthritis Research Society International) approved exercise and education programmes for the conservative management of knee osteoarthritis to the Swiss health care system. Methods: The RE-AIM framework was used in this cross-sectional survey study to analyse the characteristics of the six exercise and education programmes. A survey was developed based on the RE-AIM dimensions, "Reach, Effectiveness, Adoption, Implementation, and Maintenance," for rating the applicability of the programmes (on a scale of 1 = "least applicable" to 10 = "most applicable"). Programme scores of ≥7 indicated applicability to the Swiss health care system. Nine selected physiotherapy experts for knee OA management in Switzerland were invited for the rating. Results: The six programmes were rated by six of the nine invited research experts with mean scores of between 5.9 and 9.45. Four programmes scored 7 or more. These four programmes all included supervised exercise sessions and education with the goal that the participants understand the diagnosis and the management of OA. The two lower rated programmes focused on exercise counselling or weight reduction. Conclusion: The programme with the highest scores consists of exercise and education and scored higher than 7 in all RE-AIM dimensions. Therefore, this programme is most applicable to the Swiss health care system as only a few adaptations would be needed for its successful implementation.

Intra-Articular Injections of Platelet-Rich Plasma versus Hyaluronic Acid in Treatment of Knee Osteoarthritis (Systematic Review and Meta-analysis)

Abstract Background Although PRP is one of the options in the management of knee OA, its effectiveness and wide application is still controversial. Therefore, we conducted the present systematic review and meta-analysis to compare the safety and effectiveness of PRP versus HA injection for knee OA. Objective The purpose of this study is to compare between the efficacy of intra-articular injections of Platelet-Rich Plasma versus Hyaluronic Acid in treatment of knee osteoarthritis. Methods We performed this systematic review and meta-analysis in accordance to the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement and Meta-analysis Of Observational Studies in Epidemiology (MOOSE) statement. PRISMA and MOOSE are reporting checklists for Authors, Editors, and Reviewers of Meta-analyses of interventional and observational studies. According to International committee of medical journal association (ICJME), reviewers must report their findings according to each of the items listed in those checklists. Results The overall effect favoured PRP over HA for WOMAC function score, WOMAC pain score, WOMAC stiffness score, and WOMAC total score; mostly 6 and 12 months after treatment. According VAS score, we found that the overall effect favoured PRP over HA at 12 months only. In contrary, the overall effect did not favour PRP over HA for VAS score at 3 and 6 months. PRP is superior to HA for IKDC scores at 6 and 12 months with similar results at 3 months. Conclusion Intra-articular PRP injection is more effective in terms of pain relief and function improvement at short-term follow-up in the treatment of knee OA than HA, and there is no significant difference in the risk of adverse events between PRP and HA. A randomized controlled trial with larger group sizes is necessary to find the predictors of the response to PRP and HA intra-articular injection.

In vivo effect of the Chinese Tenghuang Jiangu Formula on cartilage destruction and subchondral bone sclerosis

BackgroundOsteoarthritis (OA) is a prevalent degenerative joint disease worldwide, and currently no optimal treatment is available. Tenghuang Jiangu Formula (THJGF), a traditional Chinese medicine composed by several herb components, has been shown in several clinical trials a promising result in the management of OA. However, the mechanism of this medicine remains largely unknown. PurposeThis study aims to investigate the effect of THJGF on preventing cartilage degeneration in a mouse model of OA. MethodsExperimental OA was induced by surgical destabilization of the medial meniscus (DMM) in mice. Starting at 4 weeks post-surgery, THJGF at concentrations of high-dose (4 g/kg), middle-dose (2 g/kg) and low-dose (0.4 g/kg) were administered, respectively, through oral gavage for 4 weeks. The therapeutic effect of THJGF was evaluated by histological, radiographical, and immunohistochemical analyses. ResultsAt concentration of middle-dose (2 g/kg) administration of THJGF resulted amelioration of OA, as evidenced by the decreased OARSI scores. Meanwhile, synovitis in OA joint was improved. Immunohistochemical analyses revealed that the expression of the OA-phenotype markers, MMP13 and iNOS, decreased significantly in THJGF-treated mice. In THJGF treated joint, subchondral bone sclerosis was significantly reduced as detected by micro-CT evaluation. ConclusionsOur results demonstrate oral administration of THJGF prevent OA progression through inhibiting expression of catabolic factors as well as subchondral bone sclerosis.

Foot and ankle pain and risk of incident knee osteoarthritis and knee pain: Data from the Multicentre Osteoarthritis Study

ObjectivesTo examine whether foot and/or ankle pain increases the risk of knee OA. DesignWe utilised longitudinal data from the Multicentre Osteoarthritis Study (MOST); a community-based cohort of risk factors for knee OA. Participants without frequent knee pain (clinic visit only) and radiographic knee OA (RKOA) at baseline and, with no evidence of inflammatory musculoskeletal disease and a history of knee-related surgery were followed for up to 84-months for incident outcomes; i) RKOA (Kellgren-Lawrence (KL) ≥2), ii) symptomatic RKOA (RKOA and frequent pain in the same knee) and iii) frequent knee pain only. At baseline, ankle and foot symptoms were assessed, with knee radiographs and symptoms also assessed at 30, 60 and 84-months. Our exposures included baseline ankle, foot, and ankle and foot pain (participant-level). Associations between foot and/or ankle pain and incident outcomes were assessed using multiple logistic regression, with adjustment for participant characteristics and ankle/foot pain. ResultsNo statistically significant associations were observed between ankle, foot and, ankle and foot pain and incident RKOA, respectively. Ankle pain with (2.30, 95% CI 1.13 to 4.66) and without foot pain (OR: 2.53, 95% CI 1.34 to 4.80) were associated with increased odds of incident symptomatic RKOA and frequent knee pain. No statistically significant associations were observed between foot pain and these outcomes. ConclusionsAnkle pain should be a focus point, more so than foot pain, in the management of knee OA. Future studies should include additional ankle joint-specific symptom questions to better elucidate the knee OA biomechanical pathway.

How Do Physiotherapists Treat People with Knee Osteoarthritis and their evidence awareness: A cross-sectional survey among Indian Physiotherapists

Background: Evidence-based practice in the field of physiotherapy is of utmost importance and is the way ahead. Physiotherapists' knowledge of evidence in terms of assessment and management of knee OA may influence the implementation of evidence-based practice. However, physiotherapist’s practice patterns are usually based on their professional experience or expert opinions. The present study aimed to explore the evidence awareness among Indian physiotherapists and identify their practice patterns in patients with knee OA. Methods: An online cross-sectional survey was conducted among Indian physiotherapists. The survey was designed using current clinical practice guidelines and previously published similar studies. The survey consisted of three sections: (1) demographic details, (2) questions related to evidence awareness, (3) questions related to the practice patterns of Indian physiotherapists. The evidence awareness and practice patterns of physiotherapists were explored. Results: A total of 165 responses were received and analyzed. Most participants perceived footwear modifications (21.2%) and resistance exercises (44.2%) as having very strong evidence. Range of motion assessment and functional assessment was regarded as a must during the patient's initial visit. In terms of management strategies majority of the participants considered patient education (n=122), strengthening exercises (n=81), and therapeutic ultrasound (n=79) as their treatment of choice. Conclusion: Most physiotherapist assessment strategies were aimed at identifying impairments in patients. In line with the clinical practice guidelines, most physiotherapists use patient education and strengthening exercises to treat patients with knee OA. However, treatment modalities like ultrasound, TENS, and dry needling, which lack scientific support, are still being used by the physiotherapist. There is a lack of coherence between physiotherapists' evidence awareness and their choice of management strategies. KEY WORDS: Knee, Osteoarthritis, Survey, Resistance exercises.

Treatment Recommendations for the Management of Osteoarthritis

OA is the most common form of arthritis. It results from the degradation of the joint through overuse or injury. It is estimated that 30.8 million adults in the United States suffer from OA. Treatment options of OA come in both non-pharmacologic and pharmacologic forms, with varying levels of efficacy for each option depending on the joint it is intended to be used for. In 2019, the American College of Rheumatology (ACR) updated the guidelines for the management of osteoarthritis of the knee, hip, and hand. The guidelines have been updated to state that acetaminophen is no longer the first line option for OA. In addition supplements like glucosamine and chondroitin are also no longer favored for use in the management of OA. This clinical capsule aims to describe the guidelines for OA as outlined by the ACR so that pharmacists in any type of setting, but especially in the community, can recommend appropriate therapy and counsel patients accordingly.