Osteoarthritis Status Research Articles

Serum cartilage oligomeric matrix protein reflects the presence of clinically diagnosed synovitis in patients with knee osteoarthritis

Objective Cartilage oligomeric matrix protein (COMP) is a component of articular cartilage whose serum levels show a strong correlation with radiographic osteoarthritis (OA) status. It has recently been found, however, that COMP is also produced in synovium. To assess the hypothesis that synovitis affects serum COMP levels in patients with knee OA, we collected sera for COMP simultaneous with a clinical examination for synovitis.Design Sera were collected from OA patients who fulfilled the American College of Rheumatology criteria for knee OA. Radiographs were classified according to the grading system of Kellgren and Lawrence. Synovitis was diagnosed clinically by joint tenderness plus swelling and/or increased warmth over the joint. COMP levels in sera were measured by inhibition ELISA with monoclonal antibody (mAb) 17-C10.Results Serum COMP levels were significantly correlated with age, synovitis and an interaction of synovitis and OA severity. Synovitis showed the strongest effect on COMP levels (R=0.1587, P< 0.01), in contrast to C-reactive protein, duration of OA and OA severity score which showed no significant effect on COMP levels. Individual signs of synovitis, namely, joint tenderness and warmth had a significant effect on serum COMP levels while swelling alone did not.ConclusionSynovitis exerts a significant effect on serum COMP levels measured with mAb 17-C10 in OA patients. These findings underscore the importance of the clinical joint examination to assess for synovitis, when attempting to apply objective measures, such as COMP, to the clinical setting.

The effects of personal relevance of topic and information type on older adults' accurate recall of written medical passages about osteoarthritis.

This study investigated the influence of information type (based on whether the text affirmed the reader's veridical beliefs or disconfirmed the reader's erroneous beliefs) and self-reported osteoarthritis status on older adults' accurate recall of written medical passages about osteoarthritis. One week after reading the passages, adults aged 65 through 80 without osteoarthritis (n = 46) and with osteoarthritis (n = 31) completed a cued recall task that focused on accurate memory of what the passage said. Disconfirming information was less accurately recalled than affirming information. Whereas self-reported osteoarthritis status was not significantly (p >.05) related to accurate recall of affirming information, it was significantly (p <.05) related to accurate recall of disconfirming information. Older adults with osteoarthritis were more likely than older adults without osteoarthritis to misrepresent the content of the passages as supporting their misconceptions.

Session 3: Imaging. Radiological assessment of hand OA

The different radiographic procedures and methods for reading films and assessing the status and progression of hand osteoarthritis (OA) were reviewed. The methods that relate to each of the above procedures were assigned to categories upon which there was or was not general agreement. It was agreed that the radiographic method should use published standardized radiographic protocols; that X-ray features should be graded separately for determining the extent of the disease and that changes in osteophyte size was the most sensitive indicator of progression. For epidemiological studies films should be read blind and randomly, but for assessing progression films should be read in pairs and in sequence. No agreement was obtained on the value of the lateral radiographic view of the hand nor on which radiographic atlas would be best for long-term longitudinal studies. Further work was required to evaluate the role of MRI and scintigraphy in hand OA; radiographic atlases could be improved by incorporating diagrams to illustrate the change in grade for each feature; validation was required for methods of assessment in long-term trials.

Self-reported functional status in osteoarthritis of the knee in a rural southern community: the role of sociodemographic factors, obesity, and knee pain.

This study examined the roles of sociodemographic factors (age, race, gender, education, marital status), obesity, and severity of radiographic knee osteoarthritis (OA) and knee pain on self-reported functional status. The sample included 1,272 African-American and Caucasian individuals, aged 45 years or older, from the Johnston County Osteoarthritis Project. Analysis of variance was used to assess variation in mean Health Assessment Questionnaire (HAQ) scores by the above variables. Mean HAQ scores differed by severity of radiographic knee OA and knee pain, obesity, and all demographic factors (P < 0.0001), except race. Only age, female sex, obesity, and knee pain severity were independent effects (P < 0.0009). Disability associated with knee pain varied by both radiographic knee OA severity and obesity. Knee pain severity was more important than radiographic knee OA severity in determining disability. Obesity was independently associated with disability and compounded disability from knee pain. Studies of disability in knee OA should include assessment of obesity, severity of radiographic knee OA, and severity of knee pain, as well as their interactions.

Obesity as a Risk Factor for Osteoarthritis of the Hand and Wrist: A Prospective Study

The Tecumseh Community Health Study provides an opportunity to investigate the role of obesity in the etiology of osteoarthritis. This longitudinal study, conducted in Tecumseh, Michigan, began in 1962 with baseline examinations of clinical, biochemical, and radiologic characteristics. A 1985 reexamination of the cohort characterized osteoarthritis status in 1,276 participants, 588 males and 688 females, who were aged 50-74 years at this follow-up. Baseline obesity, as measured by an index of relative weight, was found to be significantly associated with the 23-year incidence of osteoarthritis of the hands among subjects disease free at baseline. Greater baseline relative weight was also associated with greater subsequent severity of osteoarthritis of the hands. The difference between baseline and follow-up weight values was not significantly associated with the incidence of osteoarthritis of the hands. Furthermore, there was no evidence that development of osteoarthritis subsequently led to increased incidence of obesity.

Indices of severity and disease activity for osteoarthritis

Several indices have recently been constructed by rheumatologists for the assessment of clinical status in osteoarthritis of the extremities. These include the algofunctional indices for the hip and knee (Lequesne), the Western Ontario and McMasters Universities (WOMAC) index (Bellamy), patients and investigator's overall opinion (results of drug trials), global evaluation of change in handicap (self-assessment), and articular index of physical examination in nature (Doyle et al). Each of the above indices have been validated by their respective authors. Presently, we propose to further validate the disease-activity indices.

Cervical cancer screening and registration--are they working?

The aim of the study was to investigate the accuracy of one year's cervical cancer registrations and to review these women's medical records. The study was a survey of medical records of women registered as having a malignancy of cervix or uterus in 1985. Cases were drawn solely from the county of Leicestershire, having been registered by the Trent Cancer Registration Bureau. The study group comprised all 82 women registered as having a malignancy of cervix or uterus (part unspecified) during the study period. In one case the medical records could not be obtained, so 81 were reviewed. Medical records were reviewed; demographic, clinical and tumour characteristics, and screening experience were noted. Errors of registration of invasive cancer resulted in a 22% overestimate: only 54 of 66 cases registered actually had this cancer. Cases over 40 years of age (n = 37) were compared to those under 40 (n = 17). Thirty two women (59%), predominantly in the older age group, had never had a cervical smear. Forty four women (81%) presented with symptoms rather than as a result of screening. There was no difference in the stage of the disease at presentation between the two age groups but eight of nine women under 35 years had poorly differentiated tumours. At 2 year follow up, 12 (71%) of the younger women were alive and asymptomatic, one had a recurrence and four were dead. The corresponding figures for the older women were 18 (50%), 5 (14%) and 13 (36%). Eight screened women had only had normal smears reported in the 5 years preceding the cancer diagnosis. Seven of these were under 45 years old and four had late stage disease. It will be impossible to assess the impact of newly implemented computerised call and recall systems for cervical cytology screening unless a more reliable data base can be created.

Applicability of a health status model to osteoarthritis

A five-component model of health status has been operationalized by the Arthritis Impact Measurement Scales (AIMS) to serve as a core for the health status assessment of individuals with rheumatoid arthritis (RA). These five components of health status are Lower Extremity Function, Upper Extremity Function, Affect, Symptom, and Social Interaction. To test the utility of this model, this study examines the stability and the applicability of the five-component model in a different rheumatic disease, osteoarthritis (OA). The model displays similar characteristics between OA and RA for Upper Extremity Function, Affect, and Social Interaction. Pain, however, appears to be more strongly associated with Physical Activity in the OA sample, suggesting that pain as a measured symptom of OA is closely related to ambulation, while pain as a symptom of RA may be more a manifestation of joint involvement and less dependent upon walking and climbing. This study presents the AIMS as a means of assessing five components of health status in either OA or RA.

Use of self-report activities of daily living questionnaires in osteoarthritis

Self-report activities of daily living (ADL) questionnaires and traditional observer-reported physical measures were used to assess clinical status in a clinical trial involving patients with osteoarthritis (OA) of the knee. The observer-reported measures included pain on active motion, pain on passive motion, joint tenderness, joint swelling, joint crepitus, walking time, and observer global assessment. Self-report ADL questionnaires included scales to assess difficulty, dissatisfaction, and pain in eight activities of daily living, as well as a visual analog pain scale and patient global assessment. Significant correlations were seen between the observerreported physical measures and self-report questionnaire measures, indicating that both types of measures detect similar information. In comparisons made four weeks apart, changes in observer-reported physical measures and self-report questionnaire measures were also significantly correlated. Among the eight individual activities within the ADL scales, poorest status was reported for walking, and minimal problems were reported for the two activities involving use of the upper extremities, indicating criterion validity. Self-report ADL questionnaire measures appeared as sensitive as traditional observer-reported measures in detecting changes in clinical status over a four-week period. Self-reported ADL questionnaires appear valid, sensitive, and useful in assessment of clinical status in OA.

Tibial Tubercle Advancement for Anterior Knee Pain

In a prospective study of 29 consecutive cases of tibial tubercle advancement, the patients were assessed on the Larson knee chart preoperatively, three years postoperatively, and again after a minimum of six years (range, six to eight years; mean, 7.2 years). Only one patient was lost to follow-up evaluation. The overall results show that at three years, 65.5% of the knees were excellent or good, 13.8% were fair, and 20.7% were poor. By six years a significant change occurred in five knees. Four knees deteriorated, while one improved. The remainder maintained their three-year postoperative grade. The patients provide clinical evidence to support the biomechanical and morphological observations that form the basis of the Maquet principle. Two considerations influence the final result: surgical complications (three out of four cases with complications had a poor result) and the preoperative status (in patellofemoral osteoarthritis a preoperative Larson score of over 60 is necessary for a satisfactory outcome).