Histopathological subgroups in knee osteoarthritis.

OBJECTIVE: Osteoarthritis (OA) is a heterogeneous, multi-tissue disease. We hypothesised that different histopathological features characterise different stages during knee OA progression, and that discrete subgroups can be defined based on validated measures of OA histopathological features. DESIGN: Medial tibial plateaux and synovium were from 343 post-mortem (PM) and 143 OA arthroplasty donations. A 'chondropathy/osteophyte' group (n = 217) was classified as PM cases with osteophytes or macroscopic medial tibiofemoral chondropathy lesions ≥grade 3 to represent pre-surgical (early) OA. 'Non-arthritic' controls (n = 48) were identified from the remaining PM cases. Mankin histopathological scores were subjected to Rasch analysis and supplemented with histopathological scores for subchondral bone marrow replacement and synovitis. Item weightings were derived by principle components analysis (PCA). Histopathological subgroups were sought using latent class analysis (LCA). RESULTS: Chondropathy, synovitis and osteochondral pathology were each associated with OA at arthroplasty, but each was also identified in some 'non-arthritic' controls. Tidemark breaching in the chondropathy/osteophyte group was greater than in non-arthritic controls. Three histopathological subgroups were identified, characterised as 'mild OA', or 'severe OA' with mild or moderate/severe synovitis. CONCLUSIONS: Presence and severity of synovitis helps define distinct histopathological OA subgroups. The absence of a discrete 'normal' subgroup indicates a pathological continuum between normality and OA status. Identifying specific pathological processes and their clinical correlates in OA subgroups has potential to accelerate the development of more effective therapies.

Trace metal geochemistry in mangrove sediments and their transfer to mangrove plants (New Caledonia).

Because of their physico-chemical inherent properties, mangrove sediments may act as a sink for pollutants coming from catchments. The main objective of this study was to assess the distribution of some trace metals in the tissues of various mangrove plants developing downstream highly weathered ferralsols, taking into account metals partitioning in the sediment. In New Caledonia, mangroves act as a buffer between open-cast mines and the world's largest lagoon. As a result of the erosion of lateritic soils, Ni and Fe concentrations in the sediment were substantially higher than the world average. Whatever the mangrove stand and despite low bioaccumulation and translocations factors, Fe and Ni were also the most abundant metals in the different plant tissues. This low bioaccumulation may be explained by: i) the low availability of metals, which were mainly present in the form of oxides or sulfur minerals, and ii) the root systems acting as barriers towards the transfer of metals to the plant. Conversely, Cu and Zn metals had a greater mobility in the plant, and were characterized by high bioconcentration and translocation factors compared to the other metals. Cu and Zn were also more mobile in the sediment as a result of their association with organic matter. Whatever the metal, a strong decrease of trace metal stock was observed from the landside to the seaside of the mangrove, probably as a result of the increased reactivity of the sediment due to OM enrichment. This reactivity lead to higher dissolution of bearing phases, and thus to the export of dissolved trace metals trough the tidal action. Cu and Zn were the less concerned by the phenomenon probably as a result of higher plant uptake and their restitution to the sediment with litter fall in stands where tidal flushing is limited.

Quantitative sensory testing in painful osteoarthritis: a systematic review and meta-analysis.

OBJECTIVE: To systematically review the use of quantitative sensory testing (QST) in pain characterisation (phenotyping) in osteoarthritis (OA). METHODS: Six bibliographic databases (Medline, Embase, Amed, Cinahl, PubMed, Web of Science) were searched to identify studies published before May 2011. Data were extracted based on the primary site of OA, QST modalities, outcome measures and test sites. Standardised mean difference (SMD) and 95% confidence intervals (CIs) were calculated if possible. Publication bias was determined using funnel plot and Egger's test. Heterogeneity was examined using Cochran Q test and I2 statistic. Random effects model was used to pool the results. RESULTS: Of 41 studies (2281 participants) included, 23 were case control studies, 15 case only studies, two randomised controlled trials, and one uncontrolled trial. The majority of studies examined pressure pain with smaller numbers using electrical and/or thermal stimuli. QST was more often applied to the affected joint than distal and remote sites. Of 20 studies comparing people with OA and healthy controls, seven provided sufficient information for meta-analysis. Compared with controls, people with OA had lower pressure pain thresholds (PPTs) both at the affected joint (SMD = -1.24, 95% CI -1.54, -0.93) and at remote sites (SMD = -0.88, 95% CI -1.11, -0.65). CONCLUSION: QST of PPTs demonstrated good ability to differentiate between people with OA and healthy controls. Lower PPTs in people with OA in affected sites may suggest peripheral, and in remote sites central, sensitisation. PPT measurement merits further evaluation as a tool for phenotyping OA pain.

Rasch analysis of the intermittent and constant osteoarthritis pain (ICOAP) scale.

OBJECTIVES: The intermittent and constant osteoarthritis pain (ICOAP) questionnaire was developed to assess two forms of pain reported by people with osteoarthritis: intermittent and constant pain. Studies examining its measurement qualities have provided some support for its use as separate and total scales. However, it has not been previously evaluated using Rasch analysis. The current study examined the fit between data obtained from the ICOAP questionnaire and the Rasch model to determine whether it meets the requirements of interval-level measurement. DESIGN: ICOAP responses from 175 participants with knee osteoarthritis were collected in a cross-sectional questionnaire study. Participants were recruited from hospital clinics and a group who had taken part in previous research. The questionnaires were completed at home and returned by pre-paid envelope and the data were analysed using RUMM2020. RESULTS: Fit to the Rasch model was achieved for both the constant and intermittent subscales following removal of a small number of items. The Total scale initially resulted in substantial misfit to the model, but fit was improved by removing four items that misfit the model. However, several participants presented with high fit residuals, which is consistent with misfit. CONCLUSIONS: The results support the use of Constant and Intermittent subscales as unidimensional measures of pain. The Total scale can be adapted to improve fit to the Rasch model, but there are concerns over participant misfit.