Visual narratives in medicine - Bridging the gap in graphic medicine with an illustrated narrative of osteoarthritis.

Objective: Visual narratives have been used in medicine to share information in the form of stories with the potential to improve understanding of conditions and change behaviours. One genre of visual narratives is "graphic medicine", which integrates comics into medical education and the delivery of healthcare. Graphic medicine can maximise the impact of research findings by presenting them in a more accessible format, which may be particularly useful in certain populations, such as those with low levels of health literacy. Those with lower health literacy levels and osteoarthritis (OA) are less likely to manage their condition with guideline recommended management strategies, experience a higher burden of disease, and have lower access to care. Our objectives were to review the current visual narratives in the field of and create a graphic medicine visual narrative based on existing research. Design: This paper summarises the current visual narratives in OA and presents a graphic medicine visual narrative to illustrate the experience of living with OA. Considerations for the dissemination of visual narratives to target audiences are also discussed. Results: The most common visual narratives in are infographics, videos, and graphic medicine. A graphic medicine visual narrative, based on previous qualitative work and informed by a framework, was created to illustrate two distinct narratives - impairment and participatory. Conclusion: Visual narratives remain an emerging field in OA but may serve as a useful resource for patients or clinicians to discuss various aspects of OA management. Future research should evaluate and validate the use of visual narratives in OA.

Efficacy and Safety of Two Chondroprotective Supplements in Patients With Knee Osteoarthritis: A Randomized, Single-Blind, Pilot Study.

Background: Hyaluronic acid (HA), glucosamine (Glc), and chondroitin sulfate (CS) are key ingredients commonly incorporated into dietary chondroprotective supplements for the management of osteoarthritis (OA). Despite their widespread use, there is a paucity of published data regarding their efficacy and safety, necessitating rigorous investigation in clinical settings. To address this knowledge gap, we conducted a randomized, single-blind pilot study to evaluate the effects of two commercially available multi-ingredient supplements on patients with mild-to-moderate knee OA. Methods: A total of 51 patients diagnosed with mild-to-moderate knee OA were enrolled in a four-week randomized study and allocated equally (1:1:1 ratio) into three groups: a control group (n = 17) that received no treatment, an HA group (n = 17) given Syalox® 300 Plus (1 tablet/day) containing HA (300 mg) and Boswellia serrata extract (100 mg), and a Glc + CS group (n = 17) given Cartijoint® Forte (1 tablet/day) containing Glc (415 mg), CS (400 mg), and curcuminoids from rhizomes of Curcuma longa L (50 mg).Physicians conducting evaluations were blinded to group assignments, whereas patients were not. All participants underwent assessments of pain relief, functional capacity improvement, and serum adropin levels, an emerging biomarker of knee OA, at baseline and after the four-week intervention period. Results: Both the HA and the Glc + CS groups exhibited improvements at the end of the study relative to baseline, with statistically significant differences (p < 0.05) observed in pain at rest, pain during movement, range of motion, and the overall Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, including its pain, stiffness, and physical function subscales. Notably, the HA group outperformed the Glc + CS group in the alleviation of pain at rest, pain during movement, and on the WOMAC pain subscale, with all differences being statistically significant (p < 0.05). Additionally, both groups showed a significant elevation in serum adropin levels from baseline (p < 0.05), with the HA group experiencing a more substantial increase when compared to the Glc + CS group (p < 0.05). Both supplements showed a limited number of treatment-emergent adverse events. Conclusion: Oral supplementation with either HA or Glc + CS demonstrated potential benefits for managing symptoms of mild-to-moderate knee OA. Notably, HA supplementation was associated with greater improvements in pain relief and higher elevations in serum adropin levels compared to Glc + CS supplementation. However, larger-scale and longer-term studies are necessary to further evaluate the safety and efficacy of these dietary supplements within the clinical management arsenal for knee OA.

Prognostic Factors in Intra-articular Platelet-Rich Plasma Treatment for Knee Osteoarthritis: A Comparative Analysis of Responders and Nonresponders.

BACKGROUND: Knee osteoarthritis (KOA) is a chronic joint disease affecting activities of daily living (ADL) and quality of life due to pain and limited range of motion, afflicting a large number of patients worldwide. However, it is difficult to prevent the progression of the disease. Therapeutic strategies for KOA aim to maintain ADL and QOL by alleviating pain or managing locomotive function. Recently, intra-articular injection of platelet-rich plasma (PRP) has been gaining attention. In this study, the clinical results of PRP treatment in our institution were reported and compared between responders and non-responders using patient characteristics and imaging data assessed from plain X-rays and magnetic resonance imaging (MRI). METHODS: Participants in the study were KOA patients with varus deformity assessed as grade 2 or higher in the Kellgren-Lawrence classification who received PRP treatment from January 2022 to November 2023 and were followed up for at least three months. PRP was prepared with 27 mL of blood collected from the patient, and 2.7 mL of PRP was prepared using the PEAK©ï¸ŽPRP System from DePuy Synthes (Raynham, MA). Intra-articular injections of PRP were performed under echo-guided procedures, and responders or non-responders were determined using the Osteoarthritis Research Society International Standing Committee for Clinical Trials Response Criteria Initiative (OMERACT-OARSI) criteria evaluated by the Japanese Knee Injury and Osteoarthritis Outcome Score (J-KOOS) at three months after PRP injection. The clinical efficacy of PRP treatment for KOA was assessed in this study, and a dichotomous analysis was performed comparing the responder group and the non-responder group using patient characteristics and assessed data from plain X-ray images and MRI to determine prognostic factors for PRP treatment. RESULTS: The study population included 36 knees with a mean age of 70.6. ± 9.2 years, comprising six knees in men and 30 knees in women. The responder group consisted of 16 knees (44.4%), and the non-responder group consisted of 20 knees (55.6%). J-KOOS subscores at pre-treatment elicited that each subscale in the R group was significantly lower than that in the NR group at pretreatment. A dichotomous analysis for the two groups revealed the distribution of sex and past medical history of hyperlipidemia to be significantly different between the two groups. Multivariable logistic regression analysis showed that the coexistence of hyperlipidemia was the main prognostic factor for the efficacy of PRP therapy. DISCUSSION: In this study, comparisons were conducted between responders and non-responders to estimate prognostic factors for the efficacy of PRP therapy. Surprisingly, responders to the treatment tended to show lower J-KOOS scores and to have hyperlipidemia. A literature review revealed conflicting reports on prognostic factors for PRP therapy in KOA, highlighting the need for further research.

Uncovering the shared neuro-immune-related regulatory mechanisms between spinal cord injury and osteoarthritis.

Adults with spinal cord injury (SCI), a destructive neurological injury, have a significantly higher incidence of osteoarthritis (OA), a highly prevalent chronic joint disorder. This study aimed to dissect the neuroimmune-related regulatory mechanisms of SCI and OA using bioinformatics analysis. Using microarray data from the Gene Expression Omnibus database, differentially expressed genes (DEGs) were screened between SCI and sham samples and between OA and control samples. Common DEGs were used to construct a protein-protein interaction (PPI) network. Weighted gene co-expression network analysis (WGCNA) was used to mine SCI- and OA-related modules. Shared miRNAs were identified, and target genes were predicted using the Human MicroRNA Disease Database (HMDD) database. A miRNA-gene-pathway regulatory network was constructed with overlapping genes, miRNAs, and significantly enriched pathways. Finally, the expression of the identified genes and miRNAs was verified using RT-qPCR. In both the SCI and OA groups, 185 common DEGs were identified, and three hub clusters were obtained from the PPI network. WGCNA revealed three SCI-related modules and two OA-related modules. There were 43 overlapping genes between the PPI network clusters and the WGCNA network modules. Seventeen miRNAs shared between patients with SCI and OA were identified. A regulatory network consisting of five genes, six miRNAs, and six signaling pathways was constructed. Upregulation of CD44, TGFBR1, CCR5, and IGF1, while lower levels of miR-125b-5p, miR-130a-3p, miR-16-5p, miR-204-5p, and miR-204-3p in both SCI and OA were successfully verified using RT-qPCR. Our study suggests that a miRNA-gene-pathway network is implicated in the neuroimmune-related regulatory mechanisms of SCI and OA. CD44, TGFBR1, CCR5, and IGF1, and their related miRNAs (miR-125b-5p, miR-130a-3p, miR-16-5p, miR-204-5p, and miR-204-3p) may serve as promising biomarkers and candidate therapeutic targets for SCI and OA.

Mechanical and histological properties of native medial menisci compared to allograph medial menisci in the osteoarthritic knee.

This study was designed to provide information on how the menisci change over the course of osteoarthritis, particularly with regard to their mechanical properties. The aim was to determine the difference between healthy menisci (fresh frozen meniscal transplants) and menisci harvested during total knee arthroplasty. The latter allows the grading of age-related and osteoarthritic changes in the menisci on macroscopic and microscopic levels. A total of 10 menisci from arthritic knee joints (medial) harvested during total knee arthroplasty were used and compared with 10 medial fresh frozen meniscal transplants. The mechanical measurements were carried out on a Mach-1 testing machine using indentation testing to determine the instantaneous modulus and the thickness of the menisci. The specimens were then embedded in paraffin, sectioned on a microtome, and stained with hematoxylin-eosin and safranin-O. All measurements were divided into the anterior horn, pars intermedia, and posterior horn. There was no significant difference in the instantaneous modulus for the posterior horn in the fresh frozen menisci with 0.27 ± 0.1 MPa compared to the arthritic menisci with 0.18 ± 0.03 MPa. No significant difference could be determined for the meniscus thicknesses. There was a significant difference in the safranin-O staining. There were also significant differences in the Pauli score: the arthrosis menisci showed a sum score that was, on average, four times higher than the sum score of the fresh frozen menisci. In the present study, it could be shown very well that there are significant differences in the mechanical properties as well as in the macroscopic and histopathological scores, such as the Pauli score, between the fresh frozen meniscus allografts considered healthy and osteoarthritic menisci resulting from total knee arthroplasty. With a degradation score of 3 (Pauli), the instantaneous modulus was reduced by more than 50% compared to healthy controls. More importantly, however, the fresh frozen menisci only show a grade 2 when converting the sum values into grades, where a grade 2 indicates slight degeneration. This is interesting because fresh frozen meniscus transplants were always considered healthy in previous publications and should, therefore, actually have a grade 1.

Translation, Cross-Cultural Adaptation, and Validation of the Persian Version of the Harris Hip Score.

Background: The Harris hip score (HHS), a self-administered questionnaire, is widely used to evaluate hip pathology affecting health-related quality of life and physical function. This study's purpose was HHS translation to Persian (HHS-Pr) and validation in patients with different hip pathologies. Methods: Translation and cultural adaptation followed existing guidelines. Hip pathology patients (n = 151) completed the HHS, 12-Item Health Survey, and the Western Ontario and McMaster Universities Arthritis Index (WOMAC). Criterion validity was determined from comparisons between the HHS measures and the different corresponding WOMAC domains. Internal consistency used Cronbach's alpha (α), content validity the "content validity index," and floor/ceiling effect the end-range 15%. Test-retest reliability used the intraclass correlation coefficient (subsample n = 30) at 3-7 days that compared baseline with a repeated measure. Measurement precision and change sensitivity used longitudinal assessment (subgroup n = 30) from the standard error of the measurement and minimal detectable change. Results: Cross-cultural adaptation required minor wording changes. The mean HHS-Pr was 57.77 ± 19.69. Criterion validity was significant with the WOMAC (r = -0.76) and 12-Item Health Survey Physical Component Summary (r = 0.47). Internal consistency was high before (α = 0.75) and after standardization (α = 0.86). Content validity was satisfactory (content validity index = 0.88). No floor/ceiling effects were found. Test-retest reliability (intraclass correlation coefficient = 0.85) was excellent, as was standard error of the measurement (raw score = 5.8) and minimal detectable change (raw score = 11.4). Conclusions: The HHS-Pr demonstrated adequate validity, reliability, and sensitivity to change. These psychometric properties sufficiently measure functional status in patients with hip pathologies in a Persian-speaking population.

Beginning of the era of Organ-on-Chip models in osteoarthritis research.

Osteoarthritis (OA) is a prevalent degenerative joint disease characterized by the progressive breakdown of joint cartilage and underlying bone, affecting millions globally. Traditional research models, including in-vitro cell cultures and in-vivo animal studies, have provided valuable insights but exhibit limitations in replicating the complex human joint environment. This review article focuses on the transformative role of Organ-on-Chip (OoC) and Joint-on-Chip (JoC) technologies in OA research. OoC and JoC models, rooted in microfluidics, integrate cellular biology with engineered environments to create dynamic, physiologically relevant models that closely resemble human tissues and organs. These models enable an accurate depiction of pathogenesis, offering deeper insights into molecular and cellular mechanisms driving the disease. This review explores the evolution of OoC technology in OA research, highlighting its contributions to disease modeling, therapeutic discovery, and personalized medicine. It delves into the design concepts, fabrication techniques, and integration strategies of joint components in JoC models, emphasizing their role in accurately mimicking joint tissues and facilitating the study of intricate cellular interactions. The article also discusses the significant advancements made in OA research through published JoC models and projects the future scope of these technologies, including their potential in personalized medicine and high-throughput drug screening. The evolution of JoC models signifies a paradigm shift in OA research, offering a promising path toward more effective and targeted therapeutic strategies.

Effect of strength training on knee proprioception in patients with knee osteoarthritis: A systematic review and meta-analysis.

Proprioception is significantly impaired in knee osteoarthritis (KOA), contributing to reduced functionality. Strength training (ST) is essential in KOA by improving muscle strength, although it may also be effective in improving proprioception. The purpose was to determine the effect of ST on knee proprioception in KOA patients. Pubmed, CINAHL, Scopus, WOS, and PEDro were searched for randomized controlled trials (RCTs) (inception to March 2023). Comparisons for ST were physical exercise different from ST, non-exercise-based interventions, and no intervention. Methodological quality was assessed using the PEDro scale, and risk of bias (RoB) using the Cochrane tool. Meta-analyses were performed by comparison groups using the standardized mean difference (SMD) (Hedge's g) with random effects models, also considering subgroups by proprioception tests. Finally, six RCTs were included. The mean PEDro score was 6.3, and the highest proportion of biases corresponds to performance, selection, and detection. The meta-analysis indicated that only when compared with non-intervention, ST significantly improved knee proprioception for the joint position sense (JPS) (active + passive), JPS (passive), and threshold to detect passive motion (TTDPM) subgroups (g â€‹= â€‹-1.33 [-2.33, -0.32], g = â€‹-2.29 [-2.82, -1.75] and g â€‹= â€‹-2.40 [-4.23, -0.58], respectively). However, in the knee JPS (active) subgroup, ST was not significant (g â€‹= â€‹-0.72 [-1.84, 0.40]). In conclusion, ST improves knee proprioception compared to non-intervention. However, due to the paucity of studies and diversity of interventions, more evidence is needed to support the effectiveness of ST. Future RCTs may address the limitations of this review to advance knowledge about proprioceptive responses to ST and contribute to clinical practice.

Obesity-related knee osteoarthritis: a role for the rheumatology advanced nurse practitioner in Ireland.

Arthritis is the leading cause of disability in Ireland with knee osteoarthritis the most common presentation. One in five women and one in 10 men over the age of 60 in Ireland are diagnosed with osteoarthritis. The causative factors are multifactorial, but the increasing incidence of obesity is contributing greatly to the occurrence of osteoarthritis of the weight-bearing joints. The rheumatology advanced nurse practitioner is an autonomous clinical practitioner and potential solution to the growing numbers of people needing interventions for osteoarthritis, due to their ability to assess, diagnose, treat, and discharge these patients who ordinarily would be assessed from a medical waiting list. As obesity is becoming increasingly prevalent, it is important to address this with the patient cohort to try to reduce the burden of disease and treat not only the symptomatic knee osteoarthritis but the causative factors and provide patient-centred care.

Study on the value of second-generation sequencing technology in the clinical diagnosis of osteoarticular brucellosis.

To assess the value of next-generation sequencing (NGS) technology in the diagnosis of osteoarticular brucellosis pathogenesis. Fifty eight patients admitted to the Department of Orthopaedics, Hebei Provincial Chest Hospital from January 2021 to January 2023 were retrospectively analyzed, and the patients were classified into 48 cases in the osteoarticular brucellosis group and 10 cases in the nonosteoarticular brucellosis group according to the final clinical diagnosis. All patients underwent serum agglutination test (SAT), CT-guided puncture or surgical sampling of lesions for bacteriological culture and NGS after admission. The diagnostic efficacy of these three methods for osteoarticular brucellosis was compared using the final clinical diagnosis as the reference standard. Among the 58 patients with suspected osteoarticular brucellosis, 40 cases (68.97%) were positive by NGS, 33 cases (56.89%) by SAT and 10 cases (17.24%) by culture, and the differences were statistically significant (p < 0.05). Using the final clinical diagnosis as a criterion, the sensitivity of NGS, SAT, and culture for the detection of osteoarticular brucellosis was 83.33%, 62.50%, and 20.83%, respectively, the specificity was 100.00%, 70.00%, and 100.00%, the diagnostic accuracy was 86.20%, 63.79%, and 34.49%, and the κ values were 0.799, 0.590, and 0.504, respectively. NGS has a high pathogen detection rate and sensitivity in the pathogenetic diagnosis of patients with osteoarticular brucellosis and can provide clinical guidance for the diagnosis and management of patients with osteoarticular brucellosis.

Impact of context specificity on response to the shortened WOMAC function scale in patients undergoing total knee arthroplasty.

OBJECTIVE: To determine, in patients undergoing total knee arthroplasty (TKA), whether increasing context specificity of selected items of the shortened version of the Western Ontario and McMaster Universities Osteoarthritis Index function (WOMAC-F) scale (ShortMAC-F) (i) enhanced the convergent validity of the ShortMAC-F with performance-based mobility measures and (ii) impacted on mean scale score, structural validity, reliability, and interpretability. DESIGN: Secondary analysis of randomized clinical trial data. SETTING AND PARTICIPANTS: Patients undergoing TKA (n=114). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The ShortMAC-F was modified by specifying the "ascending stairs" and "rising from sitting" items to enquire about difficulty in performing the tasks without reliance on compensatory strategies, while the modified "level walking" item enquired about difficulty in walking 400 meters. Before and 12 weeks after TKA, patients completed the WOMAC-F, modified ShortMAC-F, knee pain scale, sit-to-stand test, fast gait speed test, and stair-climb test. Interpretability was evaluated by calculating anchor-based substantial clinical benefit (SCB) estimates. RESULTS: The modified ShortMAC-F correlated significantly more strongly than ShortMAC-F or WOMAC-F with pooled performance measures (differences in correlation values, 0.12-0.14). Increasing item context specificity of the ShortMAC-F did not influence its psychometric properties of unidimensionality (comparative fit and Tucker-Lewis indices >0.95; root mean square error of approximation, 0.05-0.08), reliability (Cronbach alpha, 0.75-0.83), correlation with pain intensity (correlation values, 0.48-0.52), and SCB estimates (16 percentage points); however, it resulted in lower mean score (4.5-4.8 points lower). CONCLUSIONS: The modified ShortMAC-F showed sufficient measurement properties for clinical application, and it seemed more adept than WOMAC-F at correlating with performance-based measures in TKA.

Long-Term Outcomes of Wrist Arthroplasty Using the ReMotion™ Implant in Non-inflammatory Wrist Pathology.

Background: Wrist arthroplasty is increasingly offered to patients with symptomatic wrist arthritis as an alternative to wrist arthrodesis. The purpose of this study was to present our outcomes with the ReMotion™ wrist arthroplasty in a consecutive series of patients with wrist arthritis from non-inflammatory conditions. Methods: Thirteen (eight women, nine dominant wrists) patients, 68 (44-85) years of age with advanced radiocarpal arthritis due to SLAC/SNAC (11) and Kienbock disease (2) had a ReMotion™ (Stryker, Michigan, USA) wrist arthroplasty implanted, and were prospectively followed for 7 (4-9) years. The outcome measures included patient-rated wrist and hand evaluation (PRWHE) score, disabilities of the arm, shoulder and hand questionnaire (QuickDASH) score, visual analogue pain score (0-10) on the radial and ulnar aspect of the wrist at rest (VASrR/VASuR) and activity (VASrA/VASuA), active wrist range of motion (AROM) including flexion, extension, ulnar and radial deviation, pronation and supination and grip and key-pinch strength measured preoperatively and at yearly follow-ups by independent hand therapists. Results: Six patients had ten re-operations during the follow-up including four revisions to a new arthroplasty. Four were considered loose at follow-up. A significant reduction in PRWHE (63 to 12), radial pain at activity (6 to 1) and increased pronation (85° v 90°) was observed. Conclusions: We found a high complication and reoperation rate, two out of 13 had no complications or reoperations. The ReMotion™ arthroplasty should be used with caution in non-inflammatory wrist patients and the patients followed closely. A high reoperation and revision rate can be expected, and surgeons familiar with revision arthroplasty procedures should perform the surgery. Level of Evidence: Level II (Therapeutic).

Association Between Statin Use and the Incidence of Clinically Diagnosed Osteoarthritis: A Nationwide Retrospective Cohort Study in Taiwan.

OBJECTIVE: To investigate the effect of higher cumulative defined daily dose per year (cDDD/y) compared with lower cDDD/y of statin use in the incidence of any joint osteoarthritis (OA). DESIGN: In this population-based retrospective cohort study, patients who were aged ≥40 years were newly initiated on statin therapy between 2002 and 2011, and had a statin prescription for ≥90 days in the first year of treatment were identified from the 2000 Longitudinal Generation Tracking Database. All patients were separated into groups with higher cDDD/y (>120 cDDD/y) and lower cDDD/y (≤120 cDDD/y; as an active comparator) values. Propensity score matching was performed to balance potential confounders. All recruited patients were followed up for 8 years. Marginal Cox proportional hazard models were used to estimate time-to-event outcomes of OA. RESULTS: Compared with lower cDDD/y use, higher cDDD/y use did not reduce the risk of any joint OA (adjusted hazard ratio, 1.07; 95% confidence interval, 0.99-1.14). Dose-related analysis did not reveal any dose-dependent association. A series of sensitivity analyses showed similar results. Joint-specific analyses revealed that statin did not reduce the incidence of knee, hand, hip, and weight-bearing (knee or hip) OA. CONCLUSIONS: Higher cDDD/y statin use did not reduce the risk of OA in this Taiwanese nationwide cohort study. The complexity of OA pathogenesis might contribute to the ineffectiveness of statin. Repurposing statin with its anti-inflammation properties might be ineffective for OA development, and balancing the catabolism and anabolism of cartilage might be a major strategy for OA prevention.

Polyphyllin I Mitigated IL-1ß-Induced Chondrocytes Damage through Downregulating TWIST1 Expression.

BACKGROUND: Osteoarthritis (OA) is a chronic joint disease characterized by the degradation of articular cartilage. Polyphyllin I (PPI) has anti-inflammatory effects in many diseases. However, the mechanism of PPI in OA remains unclear.

The impact of sericin on inflammation, oxidative stress, and lipid metabolism in female rats with experimental knee osteoarthritis.

OBJECTIVE: This study investigated the effects of sericin on inflammation, oxidative stress, and lipid metabolism in female rats with experimental knee osteoarthritis (KOA), focusing on evaluating its effectiveness via the sterol regulatory protein (SREBP)-1C and SREBP-2 pathways. METHODS: The rats were randomly assigned to three experimental groups: the C group (control), the KOA group (KOA control), and the sericin group (KOA + sericin). The KOA model was created by injecting monosodium iodoacetate (MIA) into the knee joint. Sericin was administered intra-articularly to rats on days 1, 7, 14, and 21 (0.8 g/kg/mL, 50 µL). After 21 days, the rats were sacrificed, and serum samples were analyzed using an ELISA to measure tumor necrosis factor-alpha (TNF-α), interleukin-1 beta (IL-1ß), IL-10, SREBP-1c, SREBP-2, acetyl-CoA carboxylase (ACC), fatty acid synthase (FAS), cholesterol, triglyceride, and total oxidant-antioxidant status (TOS-TAS) levels. RESULTS: The KOA group exhibited higher serum TNF-α, IL-1ß, TOS, SREBP-1C, ACC, FAS, triglyceride, SREBP-2, and cholesterol levels than the C group (P < 0.05). However, the levels of these cytokines, except cholesterol, were significantly lower in the sericin group than in the KOA group. The KOA group exhibited significantly lower serum TAS and IL-10 levels than the C group (P < 0.05). In the sericin group, there was a statistically significant increase (P < 0.05). CONCLUSION: Sericin shows promising potential for reducing inflammation, oxidative stress, and lipid metabolism in experimental models of KOA in rats. However, further clinical research is necessary to validate the potential of sericin as a therapeutic agent for treating KOA. Key Points • Sericin can reduce knee osteoarthritis (KOA) symptoms in an experimental rat model. • In particular, in the serum of an experimental KOA rat model, sericin specifically reduces the levels of proinflammatory cytokines, such as tumor necrosis factor-alpha (TNF-α) and interleukin-1beta (IL-1ß), and increases the levels of anti-inflammatory cytokines, such as IL-10. • Sericin reduced lipid metabolism via the sterol regulatory protein (SREBP)-1C and SREBP-2 pathways and oxidative stress in the serum of the experimental KOA rat model. • The intra-articular administration of sericin has been shown to significantly reduce lipid metabolism, oxidative stress, and inflammation, as supported by biochemical analysis. These findings suggest its promising potential as an alternative treatment option for KOA.

MRI use leading up to total knee arthroplasty: a retrospective cohort study.

BACKGROUND: Demand for total knee arthroplasty (TKA) is increasing as it remains the gold-standard treatment for end-stage osteoarthritis (OA) of the knee. Magnetic resonance imaging (MRI) scans of the knee are not indicated for diagnosing knee OA and represent a possible delay to orthopaedic surgeon referral and unnecessary expenditure. The purpose of this study was to determine the proportion of patients who underwent an MRI in the two years prior to their primary TKA for OA and determine patient and physician associations with increased MRI usage. METHODS: This is a population-based cohort study using administrative data from Ontario, Canada. All patients over 40 years old who underwent their first primary TKA between April 1, 2008, and March 31, 2019, were included. Statistical analyses were performed using SAS and included the Cochran-Armitage test for trend of MRI prior to surgery. A predictive multivariable regression model was used to determine features correlated to receiving an MRI. RESULTS: There were 194,989 eligible first-time TKA recipients, of which 38,244 (19.6%) received an MRI in the two years prior to their surgery. The majority of these (69.6%) were ordered by primary care physicians. Patients who received an MRI were younger, had fewer comorbidities and were more affluent than patients who did not (p < 0.001). MRI use prior to TKA increased from 2008 to 2018 (p < 0.001). CONCLUSION: Despite MRIs rarely being indicated for the work-up of end-stage OA, nearly one in five patients have an MRI in the two years prior to their TKA. This may be increasing healthcare expenditure and surgical wait-times.

Suppressive Activity of Boiogito, a Japanese Traditional Kampo Medicine, on Periostin Secretion in Human Fibroblast-Like Synoviocytes In Vitro.

Background Knee osteoarthritis (KOA) is a prevalent degenerative disease that affects the knee joints, particularly among individuals aged over 40 years. It leads to pain, stiffness, and reduced quality of life; affects approximately 300 million individuals worldwide; and is increasing, particularly in developed nations. Although treatments for KOA range from conservative measures to surgical interventions, such as total knee arthroplasty (TKA), the financial burden of TKA in many countries underscores the urgent need for effective conservative therapies. The pathophysiology of KOA involves articular cartilage degeneration, increased subchondral bone turnover, synovitis, and periarticular soft tissue contracture. Abnormal bone turnover, intensified by factors, such as weight gain and knee injury, precedes cartilage degeneration. Synovitis, characterized by inflammation in the synovial tissue, plays a crucial role in perpetuating the disease by triggering a cascade of catabolic and proinflammatory mediators, including cytokines, such as interleukin (IL)-1 beta, tumor necrosis factor-alpha, and IL-13. Periostin, an extracellular matrix protein, is implicated in KOA progression, with its levels increasing with disease severity. Materials & methods In this study, the preventive effect of boiogito (BOT), a traditional herbal medicine, on periostin secretion in human fibroblast-like synoviocytes (hFLS) stimulated by IL-13 was investigated. Synoviocyte Growth Medium and recombinant human IL-13 were used for cell culture and stimulation. BOT was dissolved in phosphate-buffered saline and applied to cell cultures. Periostin secretion and mRNA expression were measured using enzyme-linked immunosorbent assay and quantitative reverse transcription polymerase chain reaction, respectively. Cell viability was assessed using an MTT assay, and signal transducer and activator of transcription factor 6 (STAT6) phosphorylation was examined using Western blotting. Results IL-13 stimulation of hFLS significantly increased periostin secretion, with levels rising above 20 ng/mL after 72 h of stimulation. Pretreatment with BOT dose-dependently suppressed periostin secretion, with doses of 1,000 µg/mL significantly reducing periostin levels. Furthermore, BOT inhibited periostin mRNA expression and STAT6 phosphorylation in IL-13-stimulated hFLS, suggesting its potential in modulating IL-13-mediated inflammatory pathways in KOA. Conclusion This study demonstrated the preventive effect of BOT on periostin secretion in IL-13-stimulated hFLS, highlighting its potential as a therapeutic agent for KOA. By inhibiting periostin production and downstream signaling pathways, BOT may offer a promising conservative treatment option for KOA, addressing the inflammatory cascade implicated in disease progression. Further research is warranted to elucidate the specific herbal components responsible for the therapeutic effects of BOT and to validate its efficacy in clinical settings.

Longitudinal in vivo cationic contrast-enhanced computed tomography classifies equine articular cartilage injury and repair.

Cationic contrast-enhanced computed tomography (CECT) capitalizes on increased contrast agent affinity to the charged proteoglycans in articular cartilage matrix to provide quantitative assessment of proteoglycan content with enhanced images. While high resolution microCT has demonstrated success, we investigate cationic CECT use in longitudinal in vivo imaging at clinical resolution. We hypothesize that repeated administration of CA4+ will have no adverse side effects or complications, and that sequential in vivo imaging assessments will distinguish articular cartilage repair tissue from early degenerative and healthy cartilage in critically sized chondral defects. In an established equine translational preclinical model, lameness and synovial effusion scores are similar to controls after repeated injections of CA4+ (eight injections over 16 weeks) compared to controls. Synovial fluid total protein, leukocyte concentration, and sGAG and PGE2 concentrations and articular cartilage and synovial membrane scores are also equivalent to controls. Longitudinal in vivo cationic CECT attenuation in repair tissue is significantly lower than peripheral to (adjacent) and distantly from defects (remote sites) by 4 weeks (p < 0.001), and this difference persists until 16 weeks. At the 6- and 8-week time points, the adjacent locations exhibit significantly lower cationic CECT attenuation compared with the remote sites, reflecting peri-defect degeneration (p < 0.01). Cationic CECT attenuation at clinical resolution significantly correlates with cationic CECT (microCT) (r = 0.69, p < 0.0001), sGAG (r = 0.48, p < 0.0001), and ICRS II histology score (r = 0.63, p < 0.0001). In vivo cationic CECT imaging at clinical resolution distinguishes fibrous repair tissue from degenerative and healthy hyaline cartilage and correlates with molecular tissue properties of articular cartilage.

Safety and Efficacy of Early Rehabilitation With Assistance From a Single-Joint Hybrid Assistive Limb in Patients With Total Knee Arthroplasty: A Randomized Controlled Clinical Pilot Study.

Background This study aimed to evaluate the safety and effectiveness of knee exercise within four hours after total knee arthroplasty (TKA) using a single-joint hybrid assistive limb (HAL-SJ). Materials and methods This pilot single-blind randomized controlled trial included participants who underwent TKA for osteoarthritis and were randomly allocated to the early rehabilitation (n = 14) or control rehabilitation (n = 16) group. Knee rehabilitation exercises using the HAL-SJ began within four hours postoperatively in the early group and seven days after surgery in the control group. Knee circumference, range of motion (ROM), pain, muscle strength, and extension lag were assessed before and one and two weeks after surgery. Results Circumferences at 1 and 10 cm from the upper edge of the patella did not differ between the groups before surgery or one week postoperatively. The extension lag and knee flexion ROM after one week were significantly better in the early intervention group than in the control group. However, the quadriceps and hamstring isometric knee strength and pain scores did not differ between the groups at one and two weeks postoperatively. HAL-SJ-related complications were not reported. Conclusion Rehabilitation knee exercises using the HAL-SJ within four hours after TKA improved extension lag and knee flexion ROM without exacerbating knee swelling and pain.

FUNCTIONAL CAPACITY IN PATIENTS WITH KNEE OSTEOARTHRITIS: CROSS-SECTIONAL STUDY.

Knee osteoarthritis (KOA) is a disabling inflammatory disease that makes walking and activities of daily living difficult. This condition can reduce functional capacity and increase the risk for surgery. OBJECTIVE: To know the functional capacity of patients with KOA evaluated by the six-minute walk test (6MWT). METHOD: This cross-sectional study evaluated age, gender, weight, BMI, pain (VAS 90-100), physical disability (WOMAC 0-96), degree of joint damage by radiographic imaging, and 6MWT. RESULTS: A total of 176 patients referred by Orthopedics were evaluated, with the inclusion of 164 participants. The mean age was 61.89 ± 10.62 years, 81% women, 67% with cardiovascular disease, hypertension and/or diabetes, 81% obese, with moderate pain (VAS 47.74 ± 29.27) and according to WOMAC, most had severe or very severe disability. The distance covered in the 6MWT was 354.03 ± 102.03m, 67% of the predicted distance. The maximum heart rate achieved was 107.27 ± 17.71 bpm, which characterizes 68% of the predicted by age. Only 12% of the sample showed a marked drop in oxygenation in the 6MWT and 40% had a recovery heart rate in the 1st minute below 15 bpm. CONCLUSION: Patients with KOA, who were evaluated by the 6MWT, have low functional capacity and physical deconditioning. Level of Clinical Evidence III, Case Control Study.

A osteoartrite de joelho (OAJ) é uma doença inflamatória incapacitante que dificulta as atividades de vida diária do indivíduo. Esta condição pode reduzir a capacidade funcional e aumentar o risco de cirurgia, caso necessária. Objetivo: Conhecer a capacidade funcional de pacientes com OAJ, avaliada pelo teste de caminhada de seis minutos (TC6M). Métodos: Neste estudo transversal, avaliamos idade, sexo, peso, índice de massa corporal (IMC), dor (escala visual analógica ­ EVA 90-100), incapacidade física (Western Ontario and McMaster Universities Osteoarthritis Index ­ WOMAC 0-96), grau de lesão articular por imagem radiográfica e TC6M. Resultados: Foram avaliados 176 pacientes encaminhados pela Ortopedia, com a inclusão de 164 participantes. Na amostra, verificou-se: média de idade de 61,89 ± 10,62 anos; 81% de mulheres; 67% com doença cardiovascular, hipertensão e/ou diabetes; 81% de obesos; com dor moderada (EVA 47,74 ± 29,27); e, segundo WOMAC, maioria com incapacidade intensa ou muito intensa. A distância percorrida no TC6M foi 354,03 ± 102,03 m, sendo esse valor 67% da distância prevista. A frequência cardíaca máxima alcançada foi de 107,27 ± 17,71 bpm, que caracteriza 68% da prevista pela idade. Somente 12% apresentaram acentuada queda de oxigenação no TC6M e 40% apresentaram frequência cardíaca de recuperação no primeiro minuto inferior a 15 bpm. Conclusão: Os pacientes com OAJ, que foram avaliados pelo TC6M, apresentaram baixa capacidade funcional e descondicionamento físico. Nível de Evidência III, Estudo de Caso Controle.