A clinician's perspective on the role of imaging in knee osteoarthritis in clinical practice.

Knee osteoarthritis (OA) is a highly prevalent and disabling disease. Most persons age 45 and over with chronic knee pain have OA and with characteristic history and physical findings, diagnostic imaging is usually not necessary. Further, treatment of chronic knee pain with or without evidence of OA is similar, so imaging does not usually alter therapy. The exception is atypical presentations, such as sudden onset of pain perhaps after trauma or evidence of arthritis in atypical locations elsewhere in the body. Imaging is also unnecessary to follow patients. Given the absence of treatments that slow progression, there is little rationale for acquiring repeated imaging. However, ultrasound or other knee imaging may be helpful in locating the joint when carrying out intraarticular corticosteroid injections. There is controversy as to whether imaging should be acquired before these injections, but recent studies suggest no increased risk of disease progression for most persons receiving these injections. While guidelines currently discourage imaging in the diagnosis or management of most persons with OA, this may change for individuals with identifiable correctible lesions, when effective treatments that alter progression emerge or when imaging is used to identify subtypes of disease that may respond to specific treatments.

Ligament mechanics of ageing and osteoarthritic human knees.

Knee joint ligaments provide stability to the joint by preventing excessive movement. There has been no systematic effort to study the effect of OA and ageing on the mechanical properties of the four major human knee ligaments. This study aims to collate data on the material properties of the anterior (ACL) and posterior (PCL) cruciate ligaments, medial (MCL) and lateral (LCL) collateral ligaments. Bone-ligament-bone specimens from twelve cadaveric human knee joints were extracted for this study. The cadaveric knee joints were previously collected to study ageing and OA on bone and cartilage material properties; therefore, combining our previous bone and cartilage data with the new ligament data from this study will facilitate subject-specific whole-joint modelling studies. The bone-ligament-bone specimens were tested under tensile loading to failure, determining material parameters including yield and ultimate (failure) stress and strain, secant modulus, tangent modulus, and stiffness. There were significant negative correlations between age and ACL yield stress (p = 0.03), ACL failure stress (p = 0.02), PCL secant (p = 0.02) and tangent (p = 0.02) modulus, and LCL stiffness (p = 0.046). Significant negative correlations were also found between OA grades and ACL yield stress (p = 0.02) and strain (p = 0.03), and LCL failure stress (p = 0.048). However, changes in age or OA grade did not show a statistically significant correlation with the MCL tensile parameters. Due to the small sample size, the combined effect of age and the presence of OA could not be statistically derived. This research is the first to report tensile properties of the four major human knee ligaments from a diverse demographic. When combined with our previous findings on bone and cartilage for the same twelve knee cadavers, the current ligament study supports the conceptualisation of OA as a whole-joint disease that impairs the integrity of many peri-articular tissues within the knee. The subject-specific data pool consisting of the material properties of the four major knee ligaments, subchondral and trabecular bones and articular cartilage will advance knee joint finite element models.

The role of sirtuin 1 and its activator, resveratrol in osteoarthritis.

Osteoarthitis (OA) is the most common aging-related joint pathology; the aging process results in changes to joint tissues that ultimately contribute to the development of OA. Articular chondrocytes exhibit an aging-related decline in their proliferative and synthetic capacity. Sirtuin 1 (SIRT 1), a longevity gene related to many diseases associated with aging, is a nicotinamide adenine dinucleotide (NAD+)-dependent protein deacetylase and master metabolic regulator. Along with its natural activator resveratrol, SIRT 1 actively participates in the OA pathological progress. SIRT 1 expression in osteoarthritic cartilage decreases in the disease progression of OA; it appears to play a predominantly regulatory role in OA. SIRT 1 can regulate the expression of extracellular matrix (ECM)-related proteins; promote mesenchymal stem cell differentiation; play anti-catabolic, anti-inflammatory, anti-oxidative stress, and anti-apoptosis roles; participate in the autophagic process; and regulate bone homeostasis in OA. Resveratrol can activate SIRT 1 in order to inhibit OA disease progression. In the future, activating SIRT 1 via resveratrol with improved bioavailability may be an appropriate therapeutic approach for OA.

The effect of continuous nursing based on transtheoretical model on elderly patients with knee osteoarthritis / 中国实用护理杂志

Objective To investigate the effect of continuous nursing based on transtheoretical model (TTM) on elderly patients with knee osteoarthitis (KOA). Methods A total of 120 elderly patients with KOA from January 2015 to December 2016 were selected and divided into observation group and control group by the random digits table method , with 60 cases in each. The observation group was given continuous nursing based on TTM, while the control group was given continuous nursing. The functions and symptoms of knee joint of the 2 groups were evaluated by Lysholm Knee Scale Scores (LKSS) and Lequesne's Indexes (LI) after 6 months of implementation and compared. The compliance of rehabilitation training, the distribution of different behavior stages and the quality of life were compared after 6 months of implementation. Results The score of LKSS of the observation group was (78.04±8.55) points, and that of the control group was (69.22 ± 7.90) points, and there was significant difference between the 2 groups (t=6.780, P<0.05). The LI of the observation group was (5.37±1.05) points, and the control group was (6.09 ± 1.60) points, and there was significant difference between the 2 groups (t =3.356, P<0.05). There were significant differences in the distributions of the compliance of rehabilitation training and different behavior stages between the 2 groups (Z=5.814, 6.910, P<0.05). The rate of completely compliance, the percentage of action and maintenance stages of the observation group was 85.00%(51/60), 53.33% (32/60), and the control group was 55.00% (33/60), 28.33% (17/60) , and there was a significant difference between the 2 groups (χ2=12.857, 7.761, P<0.05). The physical condition, symptom and other 5 life quality scores and the total score of the observation group was (26.37±3.08), (11.80±2.15), (18.66± 2.27), (14.98±2.52), (6.93±0.94), (78.69±10.36) points, and the control group was (24.22±3.32), (9.44± 1.29), (17.24±3.07), (14.06±2.07), (6.56±1.05), (71.62±12.15) points, and there was significant difference between the 2 groups (t =2.034-7.291, all P<0.05). Conclusions The application of continuous nursing based on TTM on elderly patients with KOA can significantly change the stages of healthy behavior, improve the patients' compliance of rehabilitation training and quality of life, improve the function and symptom of knee joint.

A study of the prevalence of osteoporosis and hypovitaminosis D in patients with primary knee osteoarthritis.

INTRODUCTION: Osteoarthritis and Osteoporosis are highly prevalent disease, so is hypovitaminosis D. We tried to find out prevalence of osteoporosis and hypovitaminosis D in patients suffering from primary knee Osteoarthritis. We also compared the prevalence of oseotoporosis between general population and patients of primary osteoarthritis. METHODS: Patients suffering from primary knee OA were taken from Rheumatology OPD of Medical College Hospital and SSKM Hospital Kolkata, India. For each patient age and sex matched friend or relative of same locality was taken in the study as controls. Hospital staffs that come from different part of state was taken in the study as controls. The control population was the representative of general population. RESULTS: Total number of participants in this study was 206. Out of which there were 98 cases and 108 controls. BMD status correlates significantly with Primary OA. Serum Vitamin D3 status correlates significantly with Osteoarthritis. Age of the patients correlated significantly with both BMD Status and Knee OA but not with the vVitamin D level. There were significant correlation between the Serum Vitamin D3 status and BMD of the subjects. CONCLUSION: Osteoporosis is prevalent both in general population and patients suffering from Knee Osteoarthritis and may increase the disability. The matter is complicated by the fact hypovitaminosis D is also prevalent in the population and positively correlated with both Osteoporosis and osteoarthrosis, though we cannot comment on further pathogenesis because of cross sectional design of the study.

Nerve growth factor: an update on the science and therapy.

OBJECTIVE: Nerve growth factor (NGF) is a key regulator of nociceptive pain and thus appears to be an interesting target molecule for an innovative class of analgesic medication. We set out to review the principles of neurogenic inflammation and results of anti-NGF regimens in animal studies as well as clinical trials with patients with back pain and osteoarthritis (OA). DESIGN: We searched using Google Scholar Search and Pubmed as well as through conference reports for articles and abstracts related to NGF and clinical trials using anti-NGF regimens. We report on efficacy findings and adverse events (AEs) related to these agents in this review. RESULTS: We identified five full articles and eight abstract reports relating to anti-NGF agents studied for use in back pain and in OA. CONCLUSIONS: Anti-NGF agents either alone or in combination with non-steroidal anti-inflammatory agents (NSAIDs) were more efficacious for the treatment of pain in a number of trials of knee and hip pain compared to NSAIDs alone. However, adverse effects that included rapidly progressive OA and joint replacement were more common in patients treated with anti-NGF and NSAIDs than either treatment alone. Anti-NGF treatment related neurologic symptoms including paresthesias, and potentially other types of adverse effects were usually transient but warrant additional investigation.

Clinical Research of Invigorating the Kidney and Activating Blood Therapy on Treating Osteoarthritis Patients in the Pattern of Kidney Deficiency / 中国中医药信息杂志

Objective To explore the clinical effiicacy and effect on cytokines of invigorating the kidney and activating blood fomula on treating osteoarthritis patients in the pattern of kidney deficiency. Methods 113 patients with knee osteoarthritis were randomly divided into two groups including 56 cases of treatment group and 57 cases of control group, which were treated by invigorating the kidney and activating blood fomula and combinaton of Celecoxib and Glucosamine respectively. The clinical effiicacy of two groups were investigated by Womac osteoarthritis index and the average severity of OA index. The changes of serum inflammatory cytokines TNF-? and IL-6 were detected by ELISA. Results The total efficiency of the treatment group was 89.3% and better than the control group (P 0.05) compared with control group. The serum TNF-?, IL-6 levels of treatment group significantly decreased after treatment in treatment group (P

Effect of T-614 on proliferation characteristics of fibroblast like synovial cells in osteoarthritis / 中华风湿病学杂志

Objective To investigate the proliferation characteristics of fibroblast like synovial cells (FLS)in osteoarthritis in vitro and the mechanism of the immnnosuppressive effect of T-614 [N-(3-formy- lamino-4-oxo-6-phenoxy-4H-chromen-7-yl)methanesulfonamide ] on them.Methods FLS of OA and non- inflamed synovium(NS)were cultured and identified in vitro in the presence or absence of T-614.After incu- bation,the survival fraction(SF)of FLS was evaluated by MTT,cell cycle was observed using fluorescence - activated cell sorting(FCS)method and the expression of c-fos and COX-2 mRNA was examined by RT- PCR in FLS of OA patients.Results No statistically significant difference was noted between the OA and NS FLS in proliferation ability and cell cycle.High dose T-614 suppressed FLS SF obviously in OA and NS sta- tistically(P＜0.05),whereas the inhibition degree was not different between the two kinds of FLS.The agent induced cell apoptosis and reduced the accumulation of c-fos mRNA in OA-FLS at dose 1000 ml/L,prolonged G_1 term and shortened S term at dose 200 ml/L.The expression of COX-2 mRNA in OA FLS was suppressed obviously by T-614 at dose 1000 ml/L.Conclusion OA FLS do not display a distinct activated unlimited viability compared with NS cells,without stimulated by proinflammatory cytokine in vitro.High dose T-614 moderately inhibits the proliferation and differentiation of FLS,directly affects gene of the c-fos and COX-2 expression in OA,which may contribute to its immunosuppressive effect on OA'synovitis.