567 research outputs found
Pain in osteoarthritis
No full textedited by David T. Felson, Hans-Georg Schaible.xii, 308 p. : ill. ; 25 cm
Bone marrow lesions in osteoarthritis: What lies beneath
No full textOsteoarthritis (OA) is the most common joint disease in the United States, affecting more than 30 million people, and is characterized by cartilage degeneration in articulating joints. OA can be viewed as a group of overlapping disorders, which result in functional joint failure. However the precise cellular and molecular events within which lead to these clinically observable changes are neither well understood nor easily measurable. It is now clear that multiple factors, in multiple joint tissues, contribute to degeneration. Changes in subchondral bone are recognized as a hallmark of OA, but are normally associated with late-stage disease when degeneration is well established. However, early changes such as Bone Marrow Lesions (BMLs) in OA are a relatively recent discovery. BMLs are patterns from magnetic resonance images (MRI) that have been linked with pain and cartilage degeneration. Their potential utility in predicting progression, or as a target for therapy, is not yet fully understood. Here we will review the current state-of-the-art in this field under three broad headings: (1) BMLs in symptomatic OA: malalignment, joint pain and disease progression (2) biological considerations for bone-cartilage crosstalk in joint disease and (3) mechanical factors that may underlie BMLs and drive their communication with other joint tissues. Thus this review will provide insights on this topic from a clinical, biological and mechanical perspective. This article is protected by copyright. All rights reserved.Tamara Alliston, Christopher J. Hernandez, David M. Findlay, David T. Felson,
Oran D. Kenned
Magnetic resonance imaging–assessed subchondral cysts and incident knee pain and knee osteoarthritis: data from the Multicenter Osteoarthritis Study
No full textObjective
To examine whether knee subchondral cysts, measured on magnetic resonance imaging (MRI), are associated with incident knee osteoarthritis (OA) outcomes.
Methods
We used longitudinal data from the Multicenter Osteoarthritis Study, a community-based cohort of subjects with risk factors for knee OA. Participants without a history of knee surgery and/or inflammatory arthritis (i.e., rheumatoid arthritis and gout) were followed up for 84 months for the following incident outcomes: 1) radiographic knee OA (Kellgren/Lawrence grade ≥2), 2) symptomatic radiographic knee OA (radiographic knee OA and frequent knee pain), and 3) frequent knee pain (with or without radiographic knee OA). In a subset of participants, subchondral cysts were scored on baseline MRIs of 1 knee. Multiple logistic regression, with adjustment for participant characteristics and other baseline knee MRI findings, was used to assess whether subchondral cysts were predictive of incident outcomes.
Results
Among the participants with knees eligible for analyses of outcomes over 84 months, incident radiographic knee OA occurred in 22.8% of knees with no baseline radiographic knee OA, symptomatic radiographic knee OA occurred in 17.0% of knees with no baseline symptomatic radiographic knee OA, and frequent knee pain (with or without radiographic knee OA) occurred in 28.8% of knees with no baseline radiographic knee OA and 43.7% of knees with baseline radiographic knee OA. With adjustment for age, sex, and body mass index, the presence of subchondral cysts was not associated with incident radiographic knee OA but was associated with increased odds of incident symptomatic radiographic knee OA (odds ratio 1.92 [95% confidence interval 1.16–3.19]) and increased odds of incident frequent knee pain in those who had radiographic knee OA at baseline (odds ratio 2.11 [95% confidence interval 0.87–5.12]). Stronger and significant associations were observed for outcomes based on consistent reports of frequent knee pain within ~1 month of the study visit.
Conclusions
Subchondral cysts are likely to be a secondary phenomenon, rather than a primary trigger, of radiographic knee OA, and may predict symptoms in knees with existing disease
Knee joint kinematics before and after body weight change
No full textObesity is a well-defined mechanical factor for osteoarthritis (OA). More than one-third of adults in the United States are obese, and one in three obese adults has arthritis. In obese individuals, knee pain is highly prevalent and is often thought to be the first symptom of knee OA. In the pathomechanics of knee OA, altered kinematics and contact location in the knee joint are potent contributors to OA initiation and progression. However, such kinematics and cartilage contact location in obese individuals, and how the knee joint responses to excess load due to obesity are not clear and understudied, mainly limited by the instrumentations. Therefore, we conducted a series of dissertation studies to investigate the effect of weight on the knee joint kinematics in six degrees of freedom (6DOF) and cartilage contact location using a fluoroscopic imaging system with magnetic resonance-based morphological models. In Study 1, the 6DOF kinematic analysis showed that obese individuals with knee pain walked with a reduced range of flexion-extension motion and a reduced medial-lateral translation compared with non-obese controls. In Study 2, the cartilage contact analysis showed that obese individuals experienced different contact location on both the tibial and femoral cartilage surfaces during walking when compared with a healthy group, while pain had a minimal effect on the cartilage contact location. In Study 3, we followed up with the obese individuals in Study 1 and the kinematic analysis showed that the change in range of the flexion-extension and adduction-abduction motion during gait were associated with the change in body weight; however, knee pain was not associated with the kinematic change. In conclusion, this series of dissertation studies suggests that the kinematics of the knee in obese individuals with knee pain was modifiable through weight loss. Weight management should be addressed more than controlling for pain in obese individuals with pain, as pain management might not able to restore the contact locations.2020-07-06T00:00:00
Correlates and consequences of varus knee thrust in osteoarthritis
No full textVarus knee thrust is an abnormal frontal-plane movement (i.e., an out-bowing) of the knee that occurs during the weight-acceptance phase of gait. Varus thrust is of clinical interest, as it is a potentially-modifiable biomechanical risk factor for knee osteoarthritis (OA) progression and has been associated with knee pain. The overall aim of this dissertation is to identify the structural and symptomatic consequences of varus thrust at the knee and along the lower limb, and the possible anatomical and sensorimotor causes of varus thrust in older adults with or at risk for OA. Varus thrust was assessed in Multicenter Osteoarthritis (MOST) Study participants using high-speed videos of self-paced walking. Varus thrust was observed in 31.3% of 3730 knees. We investigated the longitudinal relation of varus thrust to MRI lesions and found that thrust was associated with increased odds of incident and worsening bone marrow lesions and worsening cartilage loss. We then investigated the longitudinal association of varus thrust with WOMAC knee pain and found that thrust was associated with increased odds of incident and worsening total WOMAC knee pain and worsening pain during weight-bearing and non-weight bearing activities. In an ancillary quantitative gait analysis of a single subject with unilateral varus thrust, we found altered joint moments at the hip, knee, and ankle in the thrust limb compared to the non-thrust limb. We bolstered this pilot data with an investigation of low back and lower extremity pain in the presence of thrust in MOST participants: limbs with thrust had increased odds of incident frequent pain proximal (hip or low back) and distal (ankle and foot) to the knee compared to limbs without thrust. Finally, we investigated the cross-sectional relation of anatomical and sensorimotor impairments at the knee and lower extremity to the prevalence of varus thrust. Thrust was most prevalent in limbs with static varus malalignment and supinated feet during gait, while increasing static knee laxity had a protective effect against thrust. These results fill substantial gaps in the narrative regarding the role of varus thrust in OA development
Osteoarthritis: Virtual joint replacement as an outcome measure in OA
No full textEffective osteoarthritis (OA) therapies would delay the need for total joint replacement (TJR). Recently, a committee of researchers attempted to develop a threshold for virtual TJR to be used as a standardized outcome for OA trials; their failure highlights challenges that complicate the measurement of OA and provision of TJR. © 2012 Macmillan Publishers Limited. All rights reserved
American College of Rheumatology hybrid measure for assessing efficacy of treatment in patients with refractory rheumatoid arthritis: Comment on the article by Genovese et al
No full text
- …
