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1.
Can we have an overall osteoarthritis severity score for the patellofemoral joint using magnetic resonance imaging? Reliability and validity.
Kobayashi, S, Peduto, A, Simic, M, Fransen, M, Refshauge, K, Mah, J, Pappas, E
Clinical rheumatology. 2018;(4):1091-1098
Abstract
This work aimed to assess inter-rater reliability and agreement of a magnetic resonance imaging (MRI)-based Kellgren and Lawrence (K&L) grading for patellofemoral joint osteoarthritis (OA) and to validate it against the MRI Osteoarthritis Knee Score (MOAKS). MRI scans from people aged 45 to 75 years with chronic knee pain participating in a randomised clinical trial evaluating dietary supplements were utilised. Fifty participants were randomly selected and scored using the MRI-based K&L grading using axial and sagittal MRI scans. Raters conducted inter-rater reliability, blinded to clinical information, radiology reports and other rater results. Intra- and inter-rater reliability and agreement were evaluated using the intra-class correlation coefficient (ICC) and Cohen's weighted kappa. There was a 2-week interval between the first and second readings for intra-rater reliability. Validity was assessed using the MOAKS and evaluated using Spearman's correlation coefficient. Intra-rater reliability of the K&L system was excellent: ICC 0.91 (95% CI 0.82-0.95); weighted kappa (ĸ = 0.69). Inter-rater reliability was high (ICC 0.88; 95% CI 0.79-0.93), while agreement between raters was moderate (ĸ = 0.49-0.57). Validity analysis demonstrated a strong correlation between the total MOAKS features score and the K&L grading system (ρ = 0.62-0.67) but weak correlations when compared with individual MOAKS features (ρ = 0.19-0.61). The high reliability and good agreement show consistency in grading the severity of patellofemoral OA with the MRI-based K&L score. Our validity results suggest that the scale may be useful, particularly in the clinical environment. Future research should validate this method against clinical findings.
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2.
Sedentary Behavior in Patients With Knee Osteoarthritis Before and After Total Knee Arthroplasty: A Systematic Review.
Frimpong, E, McVeigh, JA, Meiring, RM
Journal of aging and physical activity. 2018;(4):671-681
Abstract
OBJECTIVE The objective of this systematic review is to integrate the available evidence on changes in sedentary behavior (SB) in patients with knee osteoarthritis after total knee arthroplasty (TKA). METHODS A systematic literature search from January 2002 to October 31, 2017, was performed for studies assessing objectively and/or subjectively measured SB following TKA. The Scottish Intercollegiate Guidelines Network Methodology appraisal tool was used to critically appraise the methodological quality of the included studies. RESULTS Ten studies reporting on SB with a total of 1,028 participants were included in the review. Three studies reported changes in SB with two showing a reduction in SB and one (with high risk of bias) an increase in SB after TKA. Seven studies showed no change in SB following TKA. CONCLUSION Currently, there is insufficient evidence which suggests that SB time improves following TKA. Detailed assessments of SB after TKA are needed.
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3.
Vitamin D supplementation and inflammatory and metabolic biomarkers in patients with knee osteoarthritis: post hoc analysis of a randomised controlled trial.
Zheng, S, Wang, B, Han, W, Zhu, Z, Wang, X, Jin, X, Antony, B, Cicuttini, F, Wluka, A, Winzenberg, T, et al
The British journal of nutrition. 2018;(1):41-48
Abstract
The aim of this study was to determine whether vitamin D supplementation and maintaining vitamin D sufficiency are associated with changes in inflammatory and metabolic biomarkers in patients with knee osteoarthritis (OA) and vitamin D deficiency. A total of 413 participants with symptomatic knee OA and vitamin D deficiency were enrolled in a randomised, placebo-controlled trial and received 1·25 mg vitamin D3 or placebo monthly for 24 months across two sites. In this post hoc analysis, 200 participants from one site (ninety-four from the placebo group and 106 from the vitamin D group; mean age 63·1 (sd 7·3) years, 53·3 % women) were randomly selected for measurement of serum levels of inflammatory and metabolic biomarkers at baseline and 24 months using immunoassays. In addition, participants were classified into two groups according to serum 25-hydroxyvitamin D (25(OH)D) levels at months 3 and 24: (1) not consistently sufficient (25(OH)D≤50 nmol/l at either month 3 or 24, n 61), and (2) consistently sufficient (25(OH)D>50 nmol/l at both months 3 and 24, n 139). Compared with placebo, vitamin D supplementation had no significant effect on change in serum high-sensitive C-reactive protein, IL-6, IL-8, IL-10, leptin, adiponectin, resistin, adipsin and apelin. Being consistently vitamin D sufficient over 2 years was also not associated with changes in these biomarkers compared with not being consistently sufficient. Vitamin D supplementation and maintaining vitamin D sufficiency did not alter serum levels of inflammatory and metabolic biomarkers over 2 years in knee OA patients who were vitamin D insufficient, suggesting that they may not affect systemic inflammation in knee OA patients.
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4.
Intraarticular Injection of a Cross-Linked Sodium Hyaluronate Combined with Triamcinolone Hexacetonide (Cingal) to Provide Symptomatic Relief of Osteoarthritis of the Knee: A Randomized, Double-Blind, Placebo-Controlled Multicenter Clinical Trial.
Hangody, L, Szody, R, Lukasik, P, Zgadzaj, W, Lénárt, E, Dokoupilova, E, Bichovsk, D, Berta, A, Vasarhelyi, G, Ficzere, A, et al
Cartilage. 2018;(3):276-283
Abstract
OBJECTIVE To evaluate the efficacy and safety of an intraarticular injection of Cingal (Anika Therapeutics, Inc., Bedford, MA) compared with Monovisc (Anika Therapeutics, Inc., Bedford, MA) or saline for the treatment of knee osteoarthritis. DESIGN This multicenter, double-blind, saline-controlled clinical trial randomized subjects with knee osteoarthritis (Kellgren-Lawrence grades I-III) to a single injection of Cingal (4 mL, 88 mg hyaluronic acid [HA] plus 18 mg triamcinolone hexacetonide [TH]), Monovisc (4 mL, 88 mg HA), or saline (4 mL, 0.9%). The primary efficacy outcome was change in WOMAC (Western Ontario and McMaster Universities Arthritis Index) Pain Score through 12 weeks with Cingal versus saline. Secondary outcomes included Patient and Evaluator Global Assessments, OMERACT-OARSI Responder index, and WOMAC Total, Stiffness, and Physical Function scores through 26 weeks. RESULTS A total of 368 patients were treated (Cingal, n = 149; Monovisc, n = 150; saline, n = 69). Cingal improvement from baseline was significantly greater than saline through 12 weeks ( P = 0.0099) and 26 weeks ( P = 0.0072). WOMAC Pain was reduced by 70% at 12 weeks and by 72% at 26 weeks with Cingal. Significant improvements were found in most secondary endpoints for pain and function at most time points through 26 weeks. At 1 and 3 weeks, Cingal was significantly better than Monovisc for most endpoints; Cingal and Monovisc were similar from 6 weeks through 26 weeks. A low incidence of related adverse events was reported. CONCLUSIONS Cingal provides immediate and long-term relief of osteoarthritis-related pain, stiffness, and function, significant through 26 weeks compared to saline. Cingal had similar immediate advantages compared with HA alone, while showing benefit comparable to HA at 6 weeks and beyond.
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5.
The effects of two different water exercise trainings on pain, functional status and balance in patients with knee osteoarthritis.
Kunduracilar, Z, Guvenir Sahin, H, Sonmezer, E, Sozay, S
Complementary therapies in clinical practice. 2018;:374-378
Abstract
METHODS Eighty-nine female patients who had been diagnosed with knee osteoarthritis were divided into three groups as two experimental and a control group. All groups have received the standard therapy (hotpack, ultrasound, TENS). Both experimental groups underwent water exercise program. While Group 1 performed lower extremity exercise training, Group 2 performed upper extremity exercises as well as trunk exercises in addition to the lower extremity exercises used in the Group 1. The third group was control group who did not receive water exercise treatment. The pain severity was measured with the Visual Analog Scale (VAS). Functional status was assessed by using the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Balance was evaluated by using the single leg stance test. RESULTS The change in VAS scores from pre-to post-treatment was highest in Group 1 (p < 0.001). On the other hand, the change in WOMAC pain, stiffness and physical function values from pre-to post-treatment was highest in Group 2 (p < 0.001). DISCUSSION Water exercise training was found to be beneficial in the treatment of knee osteoarthritis in both groups. Moreover, adding upper extremity and trunk exercises to the lower extremity exercises was found to be more effective for improving the function.
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6.
A Randomized, Double Blind, Placebo Controlled, Parallel-Group Study to Evaluate the Safety and Efficacy of Curene® versus Placebo in Reducing Symptoms of Knee OA.
Panda, SK, Nirvanashetty, S, Parachur, VA, Mohanty, N, Swain, T
BioMed research international. 2018;:5291945
Abstract
BACKGROUND Curene® is a bioavailable formulation of turmeric Curcucma longa extract comprising naturally derived curcuminoids formulated with proprietary Aquasome® technology. Curcuminoids were found to have anti-inflammatory properties by inhibiting Cyclooxygenase-2 (COX-2) and 5-lipoxygenase (5-LOX) enzyme and hence have potential application in the treatment of Osteoarthritis (OA). To evaluate the safety and efficacy of Curene® a randomized, double blind, placebo controlled, parallel-group study was conducted in subjects with knee OA. Significant improvements in clinical endpoints were observed during the trial along with excellent safety profile. METHODS Fifty (50) subjects aged between 40 and 75 years who were suffering from unilateral or bilateral OA of the knee for greater than 3 months according to American College of Rheumatology (ACR) criteria were enrolled. They were randomized into two treatment groups; one group received Curene® 500 mg once daily and the other group received placebo. Efficacy was evaluated using change from baseline in Visual Analogue Scale (VAS) and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) score. Biochemical and hematological parameters including urine analysis were performed to evaluate the safety of Curene® in OA patients. RESULT Forty-six (46) subjects completed the study. The reduction from baseline in total WOMAC score (also subscale scores) and VAS score resulted in statistically significant difference when compared to placebo. It was also found to be safe and well tolerated as there was no incidence of treatment related AEs. CONCLUSION Curene® results in statistically significant and clinically meaningful reduction in pain, stiffness, and improvement in physical functioning in subjects suffering from knee OA. Curene® also demonstrates excellent safety profile during the study. TRIAL REGISTRATION This trial is registered with Clinical Trial Registry, India, CTRI/2017/07/009044, registered on 14th July 2017, http://ctri.nic.in/Clinicaltrials/showallp.php?mid1=19264&EncHid=&userName=ocius%20life%20sciences.
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7.
Efficacy of Argane Oil on Metabolic Syndrome in a Moroccan Knee Osteoarthritis Population.
Essouiri, J, Abourazzak, FE, Lazrak, F, Najdi, A, Benaicha, N, Harzy, T, Errasfa, M
Current rheumatology reviews. 2018;(1):84-88
Abstract
Five medical conditions which characterize metabolic syndrome are abdominal obesity, elevated blood pressure, elevated fasting plasma glucose, high serum triglycerides, and low highdensity lipoproteins cholesterol. When a patient has any three of the five above conditions, he is known to have metabolic syndrome, and these conditions represent a key element in cardiovascular diseases. On the other hand, knee osteoarthritis is a degenerative disease which was shown to be affected by some of the parameters of metabolic syndrome. Edible Argane oil is used in Moroccan folk medicine against several health conditions, such as knee osteoarthritis, though, evidence-based medical data about the above health benefit from Argane oil treatment are lacking. In the present clinical controlled study, we have found that consumption of Argane oil by 38 patients who have knee osteoarthritis and metabolic syndrome can improve several of their metabolic syndrome parameters and decrease their blood lipid atherogenic ratios. The present clinical study, to the best of our knowledge, is the first one to show that Argane oil consumption could be a therapeutic preventive tool against key cardiovascular risk factors of metabolic syndrome in knee osteoarthritis patients.
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8.
The effects of Momordica charantia (bitter melon) supplementation in patients with primary knee osteoarthritis: A single-blinded, randomized controlled trial.
Soo May, L, Sanip, Z, Ahmed Shokri, A, Abdul Kadir, A, Md Lazin, MR
Complementary therapies in clinical practice. 2018;:181-186
Abstract
BACKGROUND Osteoarthritis is a common problem affecting the joints in the elderly, caused disability and consequently decrease the quality of life. The conservative treatment includes the usage of analgesia, but the use of herbal medicine is growing. Momordica charantia or bitter melon has been widely described to have anti-diabetic and anti-inflammatory effects. However, its effect on reducing pain in primary knee osteoarthritis is not well studied. We aim to determine the effects of Momordica charantia in reducing pain among primary knee osteoarthritis patients. MATERIALS AND METHODS Thirty-eight and thirty-seven primary knee osteoarthritis patients underwent 3 months of Momordica charantia and placebo supplementation respectively. Three 500 mg per capsule of Momordica charantia were taken thrice daily. Rescue analgesia was allowed as needed. Pain and symptoms throughout the Momordica charantia supplementation period were assessed using Knee Injury and Osteoarthritis Outcome Score and EQ-5D-3L Health questionnaire, while rescue analgesia intake throughout the period of supplementation was measured using analgesic score. RESULTS After 3 months supplementation period, body weight, body mass index, and fasting blood glucose reduced significantly in the Momordica charantia group. There were also significant improvements in Knee Injury and Osteoarthritis Outcome Score subscales and EQ-5D-3L dimension score, and reduction in analgesic score. The placebo group had also shown significant improvements in certain Knee Injury and Osteoarthritis Outcome Score subscales and EQ-5D-3L dimension score, but with increased of the analgesic score. CONCLUSION Momordica charantia supplementation offers a safe alternative to reducing pain and improving symptoms among the primary knee osteoarthritis patients while reducing the need for analgesia consumption. These beneficial effects can be seen as early as 3 months of supplementation.
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9.
Economic evaluation of telephone-based weight loss support for patients with knee osteoarthritis: a randomised controlled trial.
O'Brien, KM, van Dongen, JM, Williams, A, Kamper, SJ, Wiggers, J, Hodder, RK, Campbell, E, Robson, EK, Haskins, R, Rissel, C, et al
BMC public health. 2018;(1):1408
Abstract
BACKGROUND The prevalence of knee osteoarthritis is increasing worldwide. Obesity is an important modifiable risk factor for both the incidence and progression of knee osteoarthritis. Consequently, international guidelines recommend all patients with knee osteoarthritis who are overweight receive support to lose weight. However, few overweight patients with this condition receive care to support weight loss. Telephone-based interventions are one potential solution to provide scalable care to the many patients with knee osteoarthritis. The objective of this study is to evaluate, from a societal perspective, the cost-utility and cost-effectiveness of a telephone-based weight management and healthy lifestyle service for patients with knee osteoarthritis, who are overweight or obese. METHODS An economic evaluation was undertaken alongside a pragmatic randomised controlled trial. Between May 19 and June 30, 2015, 120 patients with knee osteoarthritis were randomly assigned to an intervention or usual care control group in a 1:1 ratio. Participants in the intervention group received a referral to an existing non-disease specific 6-month telephone-based weight management and healthy lifestyle service. Quality-adjusted life years (QALYs) was the utility measure and knee pain intensity, disability, weight, and body mass index (BMI) were the clinical measures of effect. Costs included intervention costs, healthcare utilisation costs (healthcare services and medication use) and absenteeism costs due to knee pain. Data was collected at baseline, 6 weeks and 26 weeks. The primary cost-effectiveness analysis was performed from the societal perspective. RESULTS Mean cost differences between groups (intervention minus control) were $493 (95%CI: -3513 to 5363) for healthcare costs, $-32 (95%CI: -73 to 13) for medication costs, and $125 (95%CI: -151 to 486) for absenteeism costs. The total mean difference in societal costs was $1197 (95%CI: -2887 to 6106). For QALYs and all clinical measures of effect, the probability of the intervention being cost-effective compared with usual care was less than 0.36 at all willingness-to-pay values. CONCLUSIONS From a societal perspective, telephone-based weight loss support, provided using an existing non-disease specific 6-month weight management and healthy lifestyle service was not cost-effective in comparison with usual care for overweight and obese patients with knee osteoarthritis. TRIAL REGISTRATION NUMBER ACTRN12615000490572 , registered 18th May 2015.
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10.
Clinical therapeutic effect and safety of celecoxib in treating knee osteoarthritis.
Yu, Z, Zhao, L, Yu, C, Bi, J, Yu, X
Pakistan journal of pharmaceutical sciences. 2018;(4(Special)):1629-1632
Abstract
The clinical therapeutic effect and safety of celecoxib in treating knee osteoarthritis were observed. 180 patients who have been confirmed with knee osteoarthritis in our hospital were selected as research objects. They were randomly divided into research group and control group, each containing 90 patients. The control group was given with diclofenac sodium therapy, while the research group was subjected to celecoxib therapy. The total therapeutic response rates between the two groups were observed and compared. The total therapeutic response rate of research groups was relatively higher, P<0.05. There was no significant difference in pain score, erythrocyte sedimentation rate (ESR), quality of life score (QLS) between two groups before treatment, P>0.05. However, these indexes of research group were superior then the control group after treatment,P<0.05. In addition, the rate of adverse reaction of research group was also lower than that of control group, P<0.05. Using celecoxib to treat knee osteoarthritis can significantly improve the total therapeutic rate and reduce the rate of adverse effect.