Predicting Knee Pain and Knee Osteoarthritis Among Overweight Women.

BACKGROUND: There is a need for prediction of knee osteoarthritis (KOA) in general practice to motivate subjects for preventive therapies and optimize preventive trials. AIM: To develop a prediction model, with questionnaire and physical examination variables, for incident frequent knee pain (FKP) and symptomatic KOA after 2.5 and/or 6.5 years among overweight and obese middle-aged women. DESIGN AND SETTING: Models were developed in the Prevention of Knee Osteoarthritis in Overweight Females study (age 50 to 60 years, body mass index [BMI] ≥ 27 kg/m2) (ISRCTN 42823086). FKP was defined as knee pain during most days in the past month. Symptomatic KOA was defined according to the combined (clinical and radiographic) American College of Rheumatology criteria. METHOD: Multivariable analysis by backward stepwise deletion was performed for questionnaire and physical examination variables. The prediction model was externally validated in Rotterdam Study (RS)-III. Area under the curves (AUCs) of receiver operating characteristic were calculated. RESULTS: 32% of 237 women (mean age 55.7 ± 3.2 years; mean BMI, 31.9 ± 3.8 kg/m2) developed FKP and 30% developed symptomatic KOA. AUC of age and BMI was 0.63 (0.55 to 0.71) for incident FKP. The final model included age, BMI, mild knee symptoms, knee problems climbing stairs, morning stiffness, postmenopausal status, and heavy work. AUC was 0.71 (0.63 to 0.78). Results were similar for incident KOA. Applying external validation, similar results were observed in the RS-III. CONCLUSION: In this study, easy-obtainable variables modestly improved the prediction of FKP and symptomatic KOA above age and BMI. To improve the identification of high-risk individuals, development of valid tests for other known risk factors, like meniscal damage, that are applicable in primary care, are urgently needed.

Long-term effects of a lifestyle intervention and oral glucosamine sulphate in primary care on incident knee OA in overweight women.

Objectives: The present study was designed to evaluate the effect of a lifestyle intervention aimed to reduce body weight and of oral glucosamine sulphate on the incidence of knee osteoarthritis (OA) after 6-7 years in a population of middle-aged, overweight women, without knee OA at baseline. Methods: The Prevention of knee Osteoarthritis in Overweight Females study, ISRCTN42823086, was a randomized controlled trial with a 2 × 2 factorial design. Four hundred and seven women aged 50-60 years with a BMI of ⩾27 kg/m 2 and free of knee OA were randomized. Results: Four hundred and seventy-seven knees from 245 participants were available after a mean follow-up time of 6.6 years. Nineteen per cent of all knees showed incident knee OA. Both interventions showed no significant preventive effect on incident knee OA. Despite the fact that per protocol analyses showed greater differences between both groups for the lifestyle intervention, significance was not reached. A significant effect of losing ⩾5 kg or ⩾ 5% of baseline weight in the first 12 months on the incidence of knee OA according to the primary outcome was found (odds ratio = 0.10; 95% CI: 0.02, 0.41). Conclusion: No significant preventive effect on incident knee OA of either the lifestyle intervention or the glucosamine intervention was found. As a proof of concept, the preventive effect of moderate weight loss in 1 year on the incidence of clinical knee OA is demonstrated. This trial provides important insights for future studies on the prevention of knee OA, which are currently lacking. Trial registration: ISRTCN registry, http://www.isrctn.com , ISRCTN42823086.

Central nervous system depression of neonates breastfed by mothers receiving oxycodone for postpartum analgesia.

OBJECTIVE: To quantify the incidence of central nervous system (CNS) depression in neonates breastfed by mothers medicated with oxycodone as compared with neonates whose breastfeeding mothers used codeine or acetaminophen only. STUDY DESIGN: We retrospectively compared 3 cohorts in 533 breastfeeding mother-infant pairs exposed to oxycodone (n = 139), codeine (n = 210), or acetaminophen only (n = 184). Standardized questionnaires were administered to mothers during the postpartum period to identify maternal and neonatal health outcomes temporally related to analgesia exposure. RESULTS: Maternal exposure to oxycodone during breastfeeding was associated with a 20.1% rate of infant CNS depression (28/139) compared with 0.5% in the acetaminophen group (1/184; P < .0001; OR, 46.16; 95% CI, 6.2-344.2) and 16.7% in the codeine group (35/210; P > .05; OR, 0.79; 95% CI, 0.46-1.38). Mothers of neonates with symptoms in the oxycodone and codeine cohorts took significantly higher doses of medication compared with mothers of infants with no symptoms in the same cohorts (P = .0005 oxycodone; median, 0.4 mg/kg/day; range, 0.03-4.06 mg/kg/day versus median, 0.15 mg/kg/day; range, 0.02-2.25 mg/kg/day; codeine P < .001; median, 1.4 mg/kg/day; range, 0.7-10.5 mg/kg/day versus 0.9 mg/kg/day; range, 0.18-5.8 mg/kg/day). Mothers were significantly more likely to experience sedative adverse effects from oxycodone as compared with codeine (P < .0001; OR, 17.62; 95% CI, 9.95-31.21). CONCLUSION: Oxycodone is not a safer alternative to codeine in breastfed infants.

Codeine-acetaminophen versus nonsteroidal anti-inflammatory drugs in the treatment of post-abdominal surgery pain: a systematic review of randomized trials.

BACKGROUND: Cesarean section, episiotomy, and third and perineal tears are associated with significant tissue damage, causing pain in the immediate postpartum period. The current standard in North America is to prescribe oral acetaminophen/codeine (A + C) for postpartum pain. Codeine has opioid-related adverse effects and may not be safe during breastfeeding in the postpartum period for all neonates. Nonsteroidal anti-inflammatory drugs (NSAIDs) are devoid of opioid-related adverse effects and could be a possible alternative for analgesia in postpartum pain. The objective of this systematic review was to compare the analgesic effect and safety profile of acetaminophen/codeine (A + C) with NSAIDs in the management of pain after laparotomy. METHODS: A systematic search was performed by using MEDLINE, EMBASE, CINAHL, and Cochrane Library databases to identify randomized controlled trials comparing A + C to NSAIDs for postlaparotomy pain. Selected articles were critically appraised by using the CONSORT method and Jadad score. RESULTS: Nine relevant articles were identified. All 9 studies used a visual analog scale for pain intensity and reported the incidence of adverse effects as an outcome. None of the studies showed lower pain intensity scores after treatment with A + C compared with different NSAIDs. In 3 studies, the number of patients with adverse effects was significantly lower in the NSAID group compared with the A + C-group. In 1 other study, the rate of constipation was significantly lower in the NSAID group when compared with the A + C-group. The other 5 studies did not report any significant differences in the rates of adverse effects between the 2 groups. CONCLUSIONS: None of the studies found A + C to be superior to NSAIDs in controlling postlaparotomy pain. NSAIDs appear to be an equipotent alternative in the treatment of postlaparotomy pain. Four of the 9 studies reported less adverse effects in the NSAID group. There appears to be an overall better risk/benefit ratio for the use of NSAIDs for postpartum pain.